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. A foam roller is just one form of the myofascial release tool. Tools are designed for a specific purpose, even if it is possible to use them in different ways (technique). Using the wrong tool for the job at hand or the wrong way can produce poor results. The author of this article understands these factors. He is a qualified Musculoskeletal professional and advanced clinical sports and remedial massage therapist with over 15 years of experience.
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 greatly between individuals, and symptoms can be made worse in some cases. Such variability in results typically relates to technique and using the wrong tool for the desired outcome. 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. Equally, some people with Chronic Pain may find the technique beneficial. In contrast, others may find symptoms are made worse, (see the article on Chronic Pain for further details on aspects of such conditions).
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. 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 the most comfortable experience, and at worst, a gritted teeth. There is also an ever-increasing number of product designs, shapes and sizes, and a vast industry developed relatively quickly.
A good soft tissue therapist (STT) has many advantages over a person attempting self-massage. To get the best out of self-massage foam rolling, one needs to understand these differences and try to account for them. Rollers can be a valuable maintenance tool when used correctly, though there are limits on what they can achieve. A foam roller cannot replace the knowledge and skill of a good therapist but is still useful. Foam rolling is 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 rollers due to the muscles location within the body. Equally, the design of the rollers and how one uses them (technique) creates further limits. Shorter muscles within the body can and frequently affect longer muscles, becoming the symptom and not the cause. This article touches on aspects of the "Kinetic Chain" and which has relevance for self-treatment. Equally, myofascial pain and Myofascial Trigger Points MTrP's, also have relevance to any type of MFR including SMR.
The relevance of Pressure, Tissue reaction and Pain
When muscles are relaxed, one can treat them more effectively, and a good soft tissue 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 creating more pain. People in pain often adopt a rapid and shallow breathing pattern, leading 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 (see the related Human Stress Response articles).
Trying to bash the tissues into submission then tends to prove hugely unpleasant for the consumer 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, soft tissue therapists should know how to work with various tissues and get excellent results without all the pain. A soft tissue therapist has distinct advantages, including knowledge, training in multiple methods, the consumer is lying down and can relax. The comfortable position means that the muscles are not under the additional load of holding the consumer's body weight. Equally, physically applying techniques creates changes in tissue tension, affecting results and levels of discomfort. Such tensional changes occur in the therapist's body while using techniques, rather than the relaxed consumer's.
In the case of foam rolling, one frequently has to get into positions that 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 SMR techniques. Ideally, one wants to try and have a minimal load on the soft tissues under treatment. One may have to find some creative self-massage positions to relax tissues under treatment.
A Foam Rolling and Sports Massage Therapy
Massage therapy education can vary hugely, not just in duration and the types of massage techniques learned. There are also varying levels of knowledge surrounding anatomy, physiology and other medical knowledge. Base level massage training and sports massage therapists learn four primary techniques. Foam rollers aim to replicate one of these techniques, petrissage, including squeezing and stripping. However, a massage therapist knows additional techniques and can use all of these methods more precisely than is possible with foam rolling tools. That said, self-massage with such SMR tools should produce some of the results that a massage therapist can with Petrissage techniques. Such benefits may include reduced muscle tension, stimulation of the parasympathetic nervous system (increasing venous and lymphatic return and tissue permeability), all of which can aid in the removal of waste products. Sadly, many massage therapists confuse stimulating the nervous system with releasing toxins from muscles. There is a distinct lack of evidence for massage releasing or removing toxins from within tissues, among other myths.
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. In massage training, therapists learn 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 moves through the veins via a series of one-way valves or gates within the veins. As we move, this causes muscle contractions, squeezing 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, 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 shape change to the vein. The muscle contraction distorts the vein's walls and squeezes the blood via the valves from one section to the next. Massage therapists learn to massage towards the heart to aid with the veinous return. Equally, the one-way valves within the veins are relatively fragile. Pushing blood the opposite way through these small one-way gates can cause 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, leading to bruising, inflammation and longer recovery time. Again, a good massage therapist is trained and knows not to overwork tissues.
Why NOT to Foam Roll the ITB
The author has frequently seen people using foam rollers to treat tight Iliotibial Band (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 body parts within the kinetic chain. Too much stretching can lead to laxity in the tissues, impacting how other tissues work. Also, a tight ITB is a symptom, so stretching is a pointless exercise and a highly uncomfortable process. Although using a foam roller on the ITB may produce some tension relief, it will not fix the problem. The cause of the ITB tension will be somewhere else in the kinetic chain and will likely impact multiple components in the chain. The ITB then usually becomes tight due to other dysfunctional tissues, which creates 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. 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.