Foam Roller Massage - An MSK Therapy perspective
Understanding human anatomy, physiology and the underpinning principles of the techniques foam rollers look to replicate is crucial for safe use. The author of this article understands these factors as a qualified Musculoskeletal professional and advanced clinical sports and remedial massage therapist. A large proportion of the active and even inactive population have no doubt either come across or used a foam roller as a form of self-massage. Results can often vary significantly between individuals and in some cases, symptoms can be made worse. In order, to get the best out of your self-treatment, it is essential to have some understanding about the principles behind the massage techniques the roller attempts to replicate. It is equally useful to know a little about anatomy, physiology, and types of injury. It is always advisable to seek professional advice before embarking on any form of treatment, self or otherwise. In addition, there are contraindications to using the massage techniques foam rollers look to replicate. For example, it may not be safe or advisable to use a roller at all or only on specific body areas. For example, some people with Chronic Pain may find the technique beneficial, while others symptoms are made worse.
Origins of Foam Rolling for Myofascial release (MFR)
An American Physical Therapist, Sean Gallagher is commonly referred to as the originator of the technique, as used for self-Myofascial release (SMR). The use of foam rollers for self-massage appears to date back to the early to mid-1980s. The SMR industry has grown hugely in the last 5-10 years, and there are all kinds of videos and books of people happily (smiling) while foam rolling various parts of their body. That said there are many health and fitness products advertised with people happily smiling while using them. For those of you that have used the products/tools, it is undoubtedly not a happy experience, and at worst a gritted teeth experience. There is also an ever-increasing number of product designs, shapes and sizes and a vast industry developed in a relatively short period.
A good massage therapist has many advantages over a person attempting self-massage. In order, to get the best out of self-massage foam rolling one needs to understand these differences and try to account for them. When performed correctly a rollers can be a valuable tool, though it does have limits and cannot replace a good massage therapist. Foam rolling works best suited to treating larger (longer) muscles in the body, such as the legs. It is hard and frequently impossible to use the products on smaller (shorter) muscles. Such muscles tend to be inaccessible to a rollers, due to the muscles location within the body and the design of the roller and way one uses it. Shorter muscles within the body can and frequently affect longer muscles, which then become the symptom and not the cause. This article touches on the kinetic chain, and some of these other aspects later, though there is no scope to cover such things in detail. This blog post also does not have the time to cover such things as postural and phasic muscles, which are relevant to the kinetic chain. That said such things are likely to be included in future articles.
The relevance of Pressure, Tissue reaction and Pain
When muscles are relaxed, one can treat them more effectively, and a good massage therapist will use differing pressure and techniques according to tissue tension. Applying, too much force or the wrong type of therapy, tends to be painful, making tissues tense up and create more pain. People in pain often adopt a rapid and shallow breathing pattern, which also leads to further tissue tension. In essence, the body's “fight or flight or (freeze)” response becomes initiated, and the sympathetic nervous fully activates. Any perceived form of "stressor" or "threat" to the body can initiate the "Stress Response", and pain is just one of many possible stressors.
Trying to then pummel the tissues into submission then tends to prove hugely unpleasant for the consumer/patient and can even lead to bruising. It may then feel great afterwards, once the pain infliction has ended and the bodies natural endorphins have been released. That said a good massage therapist should know how to work with various tissues and get excellent results without all the pain. A massage therapist has a distinct advantage, the fact that the consumer/patient is laying down and can relax. The comfortable position means that the muscles are not under the additional load of holding the consumer/patient’s body weight. A good massage or sports massage therapist can then treat the tissues with relatively little pain.
In the case of foam rolling, one frequently has to get into positions which result in the tissues one is treating becoming tense or placed under load. As mentioned, massaging muscles under pressure can be painful, even when using a SMR techniques. Ideally, one wants to try and have a minimal load on the soft-tissues under treatment. One may have to find some innovative self-massage positions, as a way to relax tissues under treatment.
A Foam Rolling and Sports Massage Therapy
Massage therapy training can vary hugely concerning the types of massage techniques learnt and the duration of training. One of the more basic sets of massage and sports massage techniques taught and used by massage therapists is Petrissage. Foam rollers are a means of trying to replicate petrissage massage techniques, such as squeezing and stripping. However, a massage therapist learns additional techniques and can use all of these methods more specifically than is possible with a foam rolling tools. That said, self-massage with such SMR tools should be able to produce some of the results that a massage therapist can with Petrissage techniques. Such benefits are believed to include, reduced muscle tension, increased venous and lymphatic return, increased tissue permeability, all of which can aid in the removal of waste products.
Relevance of Anatomy and Physiology knowledge
As the foam rolling technique works based on principles of massage, it makes sense to take some learning from massage therapy. Early on in massage training therapists are taught to massage towards the heart, especially with deep tissue techniques. In brief, blood is pumped from the heart around the body and returned via veins. Blood is in effect, shunted through the veins via a series of one-way valves or gates within the veins. As we move, this causes muscles contractions, which in turn squeezes the blood from section to section. Lymph also similarly moves around the body via muscles contractions and movement. The shunting of the blood in effect pumps the blood back to the heart for re-oxygenation. The following diagram illustrates a section of a vein and two sets of valves or gates within the structure. One can also see that the muscle tissue is relaxed in the first image and so there is minimal change to the shape of the vein wall. Provided that the valves within the vein are intact and the muscles remain relaxed, blood will stay held between the two sets of gates.
The second diagram demonstrates the squeezing, action of a muscle contraction and the impact on the vein. The muscle contraction distorts the walls of the vein and squeezes the blood from one section to the next, via the valves. The reason massage therapists are taught to massage towards the heart is due to the relatively fragile nature of these valves within the veins. Pushing blood the opposite way through these small one-way gates can lead to structural damage. Damage to or failure of the valves is commonly seen with varicose veins, as blood tends to pool in the various sections. Hence, it equally makes sense that when one is applying self-massage with a foam roller one works towards the heart, rather than backwards and forwards. As with Massage, it is easily possible to overwork soft tissues, which can lead to bruising, inflammation and longer recovery time. Again, a good massage therapist is trained and knows how not to overwork tissues.
Why NOT to Foam Roll the ITB
I have frequently seen people using foam rollers to treat tight Iliotibial Bands (ITB’s). Unfortunately, in many respects, ITB’s are a structural component, much like tendons and ligaments. Usually, one would not want to stretch structural elements as they provide stability to other parts of the body within the kinetic chain. Too much stretching can lead to laxity in the tissues, which then impacts how other tissues work. Also, a tight ITB is a symptom and so not only is stretching it a pointless exercise, but it is also a highly uncomfortable process. Although using a foam roller on the ITB may produce some tension relief, it is not going to fix the problem. The cause of the ITB tension is going to be somewhere else in the kinetic chain and is likely to be impacting multiple components in the chain. The ITB then usually becomes tight as a result of other dysfunctional tissues, which in turn create additional load on other soft-tissues and further dysfunction.
- Avoid applying too much pressure.
- Avoid massaging muscles which are under load.
- Massage towards the heart.
- Avoid massaging the symptom (tight ITB) and address the cause.
- Avoid overworking tissues.
- Avoid using a foam roller to treat inflamed tissues or tissues in spasm (see TPT article).
- Avoid using a foam roller if you meet any of the contraindications for Massage, Sports Massage or Remedial Massage.
If in doubt seek advice from a suitably qualified therapist or primary care practitioner. There is also a more recent article about treating the Quadricep muscles with self-myofascial release (SMR) using a Massage Stick Roller here.
The article was written by Terry Davis MChiro, BSc (Hons), Adv. Dip. Rem. Massag., Cert. WHS.
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About the Author
As of December 31st 2020, the author chose to leave the Chiropractic profession and pursue studies within the Physiotherapy field. He no longer works as a Chiropractor and works as a Myotherapist in Morningside, Brisbane. The author possesses an unusual background for somebody who trained as a Chiropractor (McTimoney). His education, training, and practical experience span over two decades and relate to both health's physical and mental aspects. He has also needed to push his own body and mind to the limits of physical and psychological endurance as part of his time serving in Britain's elite military forces. His education includes a bachelor of science degree in Business Management, with a specialisation in psychology and mental health in the workplace, an Integrated Masters in Chiropractic, MChiro and a multitude of soft-tissue therapy qualifications (see the about section for more details). His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. Terry also has extensive experience in security, work, health and safety and holds relevant certifications. He has also taught as a senior course coach at Advanced Diploma level (Myotherapy / Musculoskeletal Therapy) in Australia, both theoretical and practical aspects including advanced Myofascial Release Techniques and has certification in training and assessment. Terry will have taught many of the first students to train as Myotherapists in Brisbane. Terry's combination of knowledge through education, training, elite military service, and personal injury history has paid dividends for the consumers he sees and has treated over the last 15 years. He has extensive experience treating chronic pain and work and sports-related musculoskeletal injuries. Terry is still very active and enjoys distance running, kayaking, mountain biking and endurance-type activities.