Practical Science on Movement and Pain

The Foam Rolling Debate

There has been some heated debate on the internets recently concerning the use of foam rollers to improve movement and reduce pain.

For example Greg Lehman recently wrote a nice blog post questioning the use of foam rollers in the management of ITB pain, which provoked a response from Mike Boyle, a well known strength and conditioning coach and strong advocate of foam rollers.

What does the research say? Until now there have been few studies addressing the effectiveness of foam rolling in doing anything at all. But wait!

Brett Contreras has just posted on a new study which suggests that foam rolling can do something other than allow us to waste ten minutes of time writhing in pain. The study found that foam rolling the quadriceps increased range of motion. Even more interesting is that it did not lead to any decrease in strength that is typically seen with other techniques that increase ROM, such as massage or stretching.

While I was in the middle of writing this post, Bret posted again with a detailed critique of the study by Greg Lehman. It’s a great analysis, and its accompanied by some excellent comments from Bret about the importance of questioning everything, especially your own biases.

So Bret’s post unfortunately made most of mine redundant or useless, so I scrapped most of it. But I will retain a few brief thoughts related to the issue of whether foam rolling can improve “tissue quality” by deforming fascia or breaking up adhesions.

For me, the idea that we can alter mature connective tissue through the pressures provided by an elbow or foam roller has always seemed implausible on its face.

Fascia is the stuff that gives our body stability and holds it together. Could the body have really been designed in such as way that its basic structural stuff starts to break down every time it sustains a little pressure? Hopefully my body is made of stronger stuff than that. And if it isn’t, I’m not getting anywhere near a foam roller.

Of course, the research on the strength of connective tissue suggests that it has nothing to fear from a foam roller. As Paul Ingraham notes, if you want to change the structure of your connective tissue, you better be prepared to get medieval. For example, in this study, researchers concluded that deformation of dense fascia such as the fascia lata or the plantar fascia would require forces far outside the range possible in manual therapy. But the thin nasal fascia is apparently deformable. Perhaps “adhesions” are more in the nature of nasal fascia than plantar fascia, and are likely to be broken even if the stronger structures remain intact.

There is a lot more to discuss and debate here, and many questions, but I guess the one thing I want to make clear is that this study is not evidence that foam rollers cause any form of structural change to fascia.

Thanks for reading this far and let me know what you think in the comments.

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52 Responses to The Foam Rolling Debate

  1. Daniel Rold says:

    I really don’t understand the conflict. Ever hear of a trigger point? Well its binded fascia right? Maybe some caused by actin and myosin filaments that may not have fully released. I’ve had a few. When I did some foam roll they went away. Nice. I’ve had clients with lateral pelvis deviations, with pelvic tilts, etc. Those problems led to knee and hip problems. Fix the overly taught IT band and the problems go away. There is a balance between laboratory and clinic. Its important to learn from lab but sorry clinical results are far more important to me. Foam Rolling works. End of story with me.

    • Todd Hargrove says:

      Hi Daniel,

      I understand that some foam rolling advocates claim that it works by getting rid of trigger points. I am skeptical of the whole idea of trigger points but its a complicated issue and a whole can of worms I didn’t want to get into in this post.

      • Joanna says:

        I agree with Daniel. Why are tying ourselves in cerebral knots? Thousands of people can testify to the presence and efficacy of treating trigger points. Only a handful of ‘experts’ are shedding doubt. My money is on the weight of evidence.

        • Todd Hargrove says:

          Joanna,

          Thousands of people will also testify to the efficacy of homeopathy, reflexology, stretching for injury prevention and many other methods that don’t square very well with better forms of evidence, such as controlled trials and basic science. As Anoop said below, people believed in leeches and bloodletting for years. Following the crowd is a poor way to find the truth. I prefer analyzing the evidence. That’s not “tying myself in a cerebral knots” – its how progress is made.

          • Joanna says:

            Oncd upon a time, people were convinced the earth was flat.

          • Todd Hargrove says:

            Exactly. And we learned better by science, and not just going with what seems to work.

          • Joanna says:

            Todd, sorry about the terse reply. What I meant was that science can’t always provide answers at a particular moment in time. Remember Copernicus and Gailieo? They were riidiculed by contemporary scientists for their theoretical evidence of a round earth. Also, scientific trials or their results are often skewed to favour a particular outcome.

            I think the most important point is that trigger point therapy works, bringing pain relief to thousands of long-term sufferers for whom mainstream medicine hasn’t been able to offer any alternative solutions. If the name trigger point therapy offends, we can call it whatever else we like.

            BTW homeopathy has been validated in some trials, reflexology, like acupuncture (recognised by science) works on meridian pathways and leeches are actually still used in some UK hospitals.

          • Todd Hargrove says:

            Hi Joanna,

            No problem on the terse reply.

            Science doesn’t always provide answers but that doesn’t mean we stop asking questions or doing science, which is what I am doing here. Of course there is nothing wrong with placing your bets wherever you want until the answers come in. If foam rolling feels good then by all means do it. But don’t presume it works better than placebo. Or that it works by curing trigger points, which are still a questionable idea.

            I don’t have time for the debates on homeopathy, reflexology or acupuncture, but suffice it to say that I completely disagree that these theories have been validated by science. Quite the opposite. If you would like an idea of my views on these subjects, you can go to the Science Based Medicine blog and do a search for any of these terms. You will find a mountain of evidence and analysis suggesting that the theory of each approach is implausible on its face, is completely inconsistent with what we know about the laws of physics, chemistry and biology, and that the treatments are no more efficacious than placebo.

    • Josh Hewett says:

      Binded Fascia? WTF? No. There is no “binded fascia”. This is psuedo science.

  2. Sharon says:

    I understand your feelings about foam rollers being unlikely to alter the structure of fasia. But there are many muscles that have connections to the ITB including TFL as well as the lateral quad and glut max. It is likely that when rolling over the ITB you are compressing onto the lateral quadricep muscle bulk. Decrease the tension in the muscle inserting onto the ITB and then you may feel a feeling of release/relief over the area. Perhaps this is why many feel relief with a foam roller.

  3. Robyn Delgado says:

    how does it happen? I refer back to your blog titled “why massage is like chicken sexing” Thanks, this is an interesting conversation.

  4. Phil says:

    I have been following this debate with some interest. A very simple demonstration as to whether fascia can be “relieved” in any way is to get your hands on a piece of meat. For anyone that has worked with whole sections of carcass, for the butchers among us, they will know just how strong fascial tissue is. To strip silverskin (fascia) off a section of muscle requires a knife. I struggle to accept the notion that fascia can be altered with a foam roller.

  5. julie edwards says:

    i guess you really have to know your own body to feel the benefits
    and discomforts of too much rolling. i love the roller. ~_*

  6. Johnny Vuong says:

    That’s interesting that this topic has brought up. I’ve always have had this question in mind but has no opportunities to share with anyone yet.

    First of all, all the research done has been amazing and the courses I’ve took in FST has been helping lots of my clients.

    Personally from my experience, I have a background in martial arts, Trigger Point Therapy as well as Fascial Stretch Therapy.

    When I used Trigger Point Therapy Method in the past, I’ve got a lot of good results; however, I’ve always found that something is missing because pain is the first thing that people commented on when they have to see me. I knew there’s a way out there that requires much les pain to get better. So here I found FST. I now finished level 2.

    The much better approach I found that works is I combine both methods depending on where the problem lies as well as how my clients response to the treatment. I can use Trigger Point Therapy first on site specific and then use FST last or the other way around.

    I assumed that you all understand how Trigger Point Therapy works and how FST works..

    So, if anyone has a different view or approach, email me back. I appreciate your input and I look forward to hear more from all.

    Thanks

    Johnny Vuong

  7. Rod says:

    Sitting here chuckling to myself. Of the 100 of thousands of foam rollers sold over the years, how many are in closets and under beds, relegated to the universe of shit that people dont use.Is there a message in this?

  8. Rick Merriam says:

    I agree with most of this Todd. We hear a lot about static stretching (and other forms of stretching!) neurologically inhibiting muscles which of course, decreases performance. Unfortunately, the consumer/client/athlete very rarely hears about “Deep Tissue” Massage having the same effect on the neuromuscular (fascial) system.

    Most licensed massage therapists don’t know the muscles that are lying beneath their elbow, and they are just doing whatever they were taught in school, which was not right to begin with.

    The truth is, the tight muscle(s) is the symptom.

    The muscle (and brain)is going to sense an elbow as a stressor every time, guaranteed. A foam roller is less stressful to the neuormuscular (fascial) system because to some extent, it is controlled by the user. And based on its structure alone, it is impossible to get between the rectus femoris/vastus intermedius etc.

    A foam roller will increase range of motion of the quadriceps in the sagittal plane, but the majority of the quadriceps wrap around the femur, and can’t be addressed by the foam roller. So, I have to question the impact that the foam roller had on the overall strength of the quadriceps. I also have to question the value of the strength assessment, since it was only emphasizing the sagittal plane.

    So, the assessment for flexibility/strength is extremely limited because it only emphasized the sagittal plane.

    I also wonder how long the increased range of motion held?

    Answer: Not very long because the brain will always find stability at the joint(s). So, within a very short amount of time, the quadriceps tightened up again in order to find stability at the joint(s).

    Improving range of motion is one thing, having stability throughout the new range of motion is the key to improving performance, and decreasing the injuries.

    I enjoyed this post Todd. Thanks for shipping it.

  9. Paul says:

    A beautiful theory on fascia, explore this resources a find the truth. . .
    http://www.fasciacongress.org/
    http://theiasi.org/index.php
    http://www.anatomytrains.com/

  10. In my work, being based on the Feldenkrais Method, rollers are used to amplify the awareness of a particular movement. You do it very little and with great precision. Too much, not so good. Feldenkrais, himself, had a rack of hand made wooden rollers, each with a precise circumference. He’d pull one for a particular message he was trying to relay to the client’s movement system, used it quickly with great focus and put it away.

  11. Glad you posted this Todd, so much of this crazy Fascia Frenzy getting into the Yoga world now too.

    Also, when you have an awesome steamroller picture it doesn’t matter what anyone else has posted, you have to post :).

    Keep up the awesome writing!

    • Todd Hargrove says:

      Haha, thnaks Byron. Yes a pic is worth a thousand words, in this case its better than the post.

  12. Kelly Ward says:

    Love, love, love my foam roller. Knee pain disappears and I feel like a new woman after some hammie and glute rolling. My squats are deeper and my pulls are proper.
    Wish there was a way for those with weaker upper body strength to enjoy the benefits of IT rolling not to mention experience the pleasure of pain.
    Thanks for conversation!

  13. John says:

    Whether true or not, I’ve read and heard that it takes at least 6 months and up to 2 years of regular work to change the fascia’s structure. If there is going to be any real change in structure, it must first be precedded by consistent change in function.

    In a link (http://www.massage-stlouis.com/pushing-muscle-are-we-really-doing-what-we-think-we-are-doing) you posted Todd from Massage St. Louis, the author supposes that the real effects of massage come from the stimulation of the nerve receptors in and just below the skin. My suspicion is this is what the rollers at doing. Rollling over the foam must produce a novel sensation that probably has a stimulating affect on the nervous system. Plus, the body map might get a wee bit fuller. But this too is merely speculation on my part and I seriously doubt that “science” will be able to prove or disprove such questions because the nervous system is much too complex.

    • Todd Hargrove says:

      John,

      Like you, my guess is that any changes caused by a foam roller are more to the neural representations of the stuff being rolled, rather than changes to the stuff itself.

  14. pieter d says:

    Does it work (effect)?
    How good does it work (efficiency)?
    How does it work (mechanism)?

    First two questions should be settled rather easy with RCT’s. But since good RCT’s are rare, people rely on anecdote and personal experience, and that get’s them in troubles.

    The last question is a lot more difficult, and I find people arguing about this a lot, without even having answered the first questions. No need to do that, too hypothetical if you ask me.

    Does foam rolling work? Probably maybe sometimes…
    And does it stretch fascia? Or does it relax the fascia? Or are the underlying triggerpoints the reason? Or the mini nervous entrapments? Or the central representation of the tissue? Or…

  15. Erik says:

    I guess brilliant people like Thomas Myers who have actually helped people by working with the fascia, muscles, proprioceptors, etc. didn’t actually help anyone, eh? I like foam rollers for input and feedback for those who live in the sedentary world of today. After that I find that 3D work in the gym with bodyweight and various implements the best way to relieve “tight” areas.

    • Todd Hargrove says:

      Erik,

      There is nothing in my post that says that Tom Meyers never helped anyone. I’m sure he has helped many people. But I doubt he has ever deformed anyone’s fascia into a different shape or changed their structure, which is part of his explanation for why his therapeutic approach is effective. You mentioned working with proprioceptors and giving input and feedback. That is a very plausible mechanism for why rolfing or a foam roller would cause changes. Deforming the fascia is not IMO.

  16. Erik says:

    Deformed fascia or re-directing fascia as a rolfer would probably say? Can anyone explain the before and after pictures of 10 sessions or so of basic rolfing?

    • Todd Hargrove says:

      Erik,

      I’m a rolfer and I haven’t heard the term redirection much. Much more common is lengthen, soften, release, melt, etc. Although none of these terms have precise definitions, I believe one commonly intended meaning is that the fascia actually deforms into a different shape through thixotrophy. As I said above I believe this cannot occur except with very thin fascia and a lot of pressure. Another potential meaning of these terms is that the central nervous system reduces contractile tone in the muscle or fascia, which can alter the way the body feels and moves. I believe this does occur and is the reason that rolling or rolfing can have an effect. In other words, the effects are functional not structural, software not hardware.

  17. Rod says:

    You can foam roll,use balls,do yoga,pilates,climb mountains, abuse substances, and save the world,blah blah blah, and learn something from all of them. They lead to the same place, if you are paying attention, which is that technique isnt important but rather a underlying structure of how we interact with the world. Explore that and tell the techniques to fuck off.If you can find it on facebook it’s not new, unique or important.Facebook and blogs are a good way to be shown whats in play and this blog is way above average for that.There is a reason why a neuro based approach is focused on here.

  18. Kari Suomalainen says:

    Having done a number of dissections on human cadavers and on several occasions especially focused on fascias on those dissections I would like to clarify some terms people tend to get mixed up with. First fascia or plane of connective tissue that in the body is holding stuff together and separating structures into compartments is stiff tough and essentially unyielding tissue made of tightly arranged collagen fibers. That sheet of collagen is certainly not deformable by hand even at high levels of force. In fact one of connective tissues good positive qualities that it is stiff. That´s exactly how it should be, because that´s the only way it is going to hold anything together. So, if someone tells me that her iliotibial band is tight, I will tell her that it is a good thing and she is doing fine. I would be worried if someone said that her iliotibial band or thoracolumbar fascia is suddenly become slack. However, there is other type of connective tissue that is quite different and that is loose or areolar connective tissue that is most certainly deformable by hand and would in theory be deformed by forces produced by foam rolling as well. The loose connective tissue is richly innervated also. I´m not saying that loose or any connective tissue is only or even the primary way that various manipulations and stretches of the bodywork work, but it is much more plausible that the local tissue response is most likely happening in the loose connective tissue. Moreover the layer of loose connective tissue is the space where the adhesions and restrictions do build up in cases of injury or inflammation. I also do think that there are many situations when any kind of braking of connective tissue is a bad idea and should not be attempted by any means. Oh, and good articles you write here Todd!

    • Todd Hargrove says:

      Kari,

      Thank you very much for your comment. What you are saying makes sense. I was wondering whether there are at least some adhesions that can be broken at low levels of force. (I meant to include that question in my post but forgot.) Are you saying that may be possible?

  19. Kari Suomalainen says:

    Yes, I´m saying it may be possible to brake some adhesions, particularly in between the fascial layers. I´m not sure is the foam rolling the most efficient way of doing that. I´m not sure weather that braking happens in form of cellular/tissue damage, or is it more of a rapid remodeling of the tissue matrix that takes place in manual deformation of loose connective tissue. On a cadaver of course the tissue is just being remodeled and stays that way for good. In a living body the remodeling/ braking of adhesions might produce some cellular, immunological and neural responses. Weather those responses are helpful or not is an interesting question.

  20. stacy says:

    Thank you Todd for another great post on foam rollers and “to roll or not to roll” with regard to the IT band. A lot of us wereintroduced to our first foam rollers in a Feldenkrais® training, long before they were in the rehab/fitness community. Maybe some of your readers would like to know that Feldenkrais was the first to use foam rollers and based his method on sound principles of brain science, physics, and motor learning to obtain optimal movement organization. Using the background of the Feldenkrais Method, we can use three dimensional tools with mini puzzles and guided attention to create changes in the nervous system promote motor learning. So, I would have to agree with Greg Lehman, who you reference, that facilitating pain should be discouraged in this context since it often interferes with learning and sensory perception.

    I am also a fan of Dr. Robert Schleip who Greg who points to studies that show that there is a diminution in proprioception following induced pain to the fascial tissues. However, when I purchased his fascial fitness DVD, he included the lateral soft tissue massage with a firm foam roller.
    I also found Gretchen Reynold’s new book, The First 20 Minutes fascinating with the many references she draws to the poor research to support stretching, massage, cryotherapy and more when it comes to injury prevention, recovery and heightening movement performance. What she also shows is how strong we like to hold onto our beliefs. Your blog has been a great facilitator to stir up a good discussion and debate. So I also have to agree and applaud your weigh in on this discussion.

    Clearly we all have a lot to learn in movement science, and particularly from the latest in neuroscience. If anyone is in the Bay area, and finds neuroscience an exciting way to progress one’s learning about movement, please check out the upcoming Feldenkrais Conference: Embodying Neuroscience (www.feldenkrais.com).

  21. Todd Hargrove says:

    Stacy,

    Thanks for the great information. If I was doing more detailed post I would have contacted you beforehand, but I wrote this up fairly quickly and without too much thought. Thanks for filling in some of the gaps!

  22. Anoop says:

    Thanks Todd.

    If you like the blood letting part you would love this article: http://workout911.com/?p=3709

  23. Dan says:

    The problem with studies done relating to the human body is that even using proper research and testing techniques there are usually holes. Unfortunately advocates of the foam roller still are only left with “it works – I can tell you why but it works”. As long as I”m not doing damage to my body, I know it works and that’s really what is important.

    • Todd Hargrove says:

      Hi Dan,

      Thanks for your comment. There are certainly holes in scientific studies. But they are usually even more holes in someone’s opinion that something “works.” Especially if they are selling the product that they claim works! :) In all seriousness, there are many people who will claim that acupuncture works, homeopathy works, reiki works, astrology works, and various other modalities work, which have all been proven NOT to work by RCTs. It wasn’t long ago that the finest medical minds thought that bloodletting was an effective treatment for a wide variety of diseases. There are many problems with scientific studies and we need to be aware of their limitations, but they are not to be lightly dismissed in favor of what seems to work.

      That being said, I do agree with your last sentiment that if you don’t seem to be doing any damage to your body, go ahead and do foam rolling if you like!

      • Dan says:

        That’s valid, at one point smoking was supposed to be good for your lungs ;). The range of motion theory seems to be very very questionable but the idea that it improves blood flow which in turn improves a lot of other things seems fairly valid. I don’t know, I find it to be relaxing and when I’m done I certainly feel better. Although, there might be a placebo effect going on there

  24. Erick Sullivan says:

    I realize I’m a little late to the party here, but just had to throw a couple of things in. My personal experience is that trigger points,adhesions,knots, whatever you want to call them, do exist. I don’t know what the correct science involved in the process is.

    However, I do have a lot of personal experience with learning to relieve pain and tension through self massage using a tennis ball, my hand, or a thera-cane. Sometimes it helps a lot and last a long time, other times it provides only short term relief.

    One of the most extreme positive results I achieved involved a very sharp knife like pain in my heel on the outer/lower side (like if you drew a straight line from the center of the end of the fibula to the floor). This pain got to the point of being debilitating. I tried everything: ice, heat, massage, chiropractic, physical therapy, everything they could throw at it with only very short term relief. Ended up getting an MRI, nothing was found. The ortho said surgery was out because there were only 2 things he could potentially do that “might” provide relief and that he wouldn’t touch it without knowing exactly what the source of pain was, which I really appreciated him saying.
    Enter the trigger point therapy workbook by Clair Davies. I scoured the book looking at all the trigger point info on the lower leg. After zeroing in on a couple of spots, I got to work. One I worked with my hand, the other involved a tennis ball. That night, I got more relief than I had received from all the other therapies and strategies combined. The next day I started experiencing some pain, though not as bad as I had before. Twice that day I worked the same 2 trigger points, almost 100% relief. It took a month for any hint of pain to return, again I spent 10 minutes while watching TV working trigger points, this time a full 100% relief. That was about 4 years ago now and I haven’t had a single problem with it since.

    This isn’t to make the case that trigger points are the holy grail of pain relief. I have used that same book working on other pain issues that got nothing more than mild temporary relief with 100% return of pain.

    Overall I find it to be a method worthy of trying for a couple of reasons, especially self massage. First, if it works and you encounter the issue again when seeing a specialist would be inconvenient (like a vacation to Italy), you are your own specialist. If it doesn’t, you have spent whatever the cost of a book, tennis ball, and theracane cost. For me that was less than the cost of 2 co-pays to specialists who were unable to help me at all, and when I left their office I didn’t have a book, tennis ball, and tool to use. Second, in the case of muscle pains that come and go, it usually seems to at least provide temporary relief, which IMO is better than no relief, so long as the pain doesn’t return worse than it was before working on trigger points.

    Foam rollers, I’ll continue to use, but sparingly. The days of thinking an hour on the floor in front of the TV was a GREAT way to spend my time are over.

    Issues not really discussed enough, IMO, include daily stress and tension, along with lifestyle, diet, and nutrition. Each of those discussions are important, and as all other topics, there are many viewpoints to be considered. Personally, I find deep stress relief as the absolute best form of pain relief and muscle therapy. My method? Camping in southeast Oklahoma for a weekend and spending at least a couple of hours each day sitting in my lawn chair by the rushing clear creek waters with no distractions, no phone, no computer, and most importantly, no agenda other than total chilling. Getting a break from the daily grind is undervalued in our high paced world.

  25. That’s great to hear. I too hope that foam rollers does not cause any ill-effects and it’s just similar to a deep tissue massage. And it gives a great relaxation to your hard muscles and release the tightness of the muscle!

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