Practical Science on Movement and Pain

How Does Foam Rolling Work?

images-23Foam rolling is very popular. Athletic trainers use it as a part of the warm-up. Physical therapists use it as part of their treatment strategy, often to improve extensibility of “short” tissues.

There is very limited evidence about what benefit, if any, foam rolling confers. But there are at least a few studies showing that it leads to short term increases in range of motion that are not accompanied by strength loss. (This is interesting because stretching interventions tend to show increased range of motion that are associated with a loss of strength and power.)

The purpose of this article is not to question whether foam rolling is effective for anything. I’m willing to assume that it is effective in some way for some people. It is hard for me to believe that so many intelligent trainers such as Mike Boyle would be singing its praises unless it was good for something. So I’ll give it the benefit of the doubt for purposes of this article.

The question that I want to answer in this post is the following: if foam rolling does work to reduce pain or improve mobility, what is the mechanism? I do not find the common explanations very convincing. But there is one (less commonly heard) explanation which I really like. Here’s my critical analysis of the different theories for why foam rolling works, including my favorite one.

1. Does foam rolling “improve tissue quality”? 

This is one you will hear quite frequently, usually without any specifics as to which “qualities” are at issue. I think some people imagine that foam rolling can somehow smooth out bumps or incongruities in their tissues like a rolling pin over pizza dough. Of course, this explanation is usually intended for lay people and not scientists, so perhaps we can cut some slack about the lack of specifics. Perhaps the qualities to be improved involve the presence of fascial adhesions or trigger points. I’ll address those claims specifically below.

2. Does foam rolling lengthen or “melt” fascia? 

For some reason people just tend to assume that foam rolling works by changing the fascia. I honestly have no idea why. A foam roller puts pressure on all the other tissues in the body, and they all communicate with the CNS, which controls how we move and feel. Isn’t the CNS the most obvious place to look for changes after foam rolling?

No, it always has to be the fascia!

But fascia is tough stuff. Sure it has some interesting adaptive properties, but at the end of the day its purpose is to form a solid structure for the body. Is it really plausible that we can significantly change our structure just by leaning on a foam roller a little bit? We must be made of stronger stuff than that. If fascia started to break down, or elongate, or “melt” every time it felt a little sustained pressure, we would be pretty fragile creatures. Every time we sat on a rock our posterior chain would lengthen. So for me the idea that foam rolling lengthens or melts some important structural stuff in our body does not pass the common sense test.

And, more importantly, the research does not support this idea either. There are a few research studies (here and here) which try to determine the degree of pressure necessary to cause permanent deformation in mature human connective tissue. The upshot is that if you want permanent change, you better be prepared (as Paul Ingraham notes) to “get medieval.” Steam roller maybe, foam roller, no. It’s not going to happen in any of the places where the roller is most commonly applied, which are usually the strongest parts of the body – the ITB band, lumbar fascia, plantar fascia, etc.

 3. Does foam rolling break up fascial adhesions?  

Maybe a foam roller can’t lengthen the IT band, which is stronger than steel, but could it break up some little fascial adhesions that prevent sliding between different muscle groups? One of the studies I referenced above show that manual pressure might be enough to deform nasal fascia. Now I don’t see many people foam rolling their nose, but maybe there are tiny little adhesions between large muscles groups that are as weak and deformable as nasal fascia.

Again this seems highly speculative to me. How do we know where these adhesions are, or what angle will help break them? A foam roller is a blunt non specific instrument that delivers force in a diffuse manner into the tissue. Smash! Part of the job of fascia is to diffuse force, so it would be hard to target a specific point here. Also, the angle of pressure is always straight in. The foam roller would have limited ability to provide the kind of precise oblique force that might be able to slide one layer of tissue with respect to the other.

Another problem I have with the idea that foam rolling breaks up fascial adhesions is that the effects are often temporary. People do some foam rolling, they feel better for a while, and then tomorrow or even later that same day, they feel the need to roll the same area again. If the mechanism of effect is breaking fascial adhesions, then why do we need to repeat the process? Did the fascia knit itself back together again? The temporary nature of the results strongly suggests a nervous system mediated mechanism for efficacy, not a structural one.

3.  Does foam rolling get rid of trigger points?

Many foam rolling proponents explain that proper procedure involves finding a “trigger point” and staying on that point for a while. Is foam rolling a way to treat trigger points?

It should be noted that the term trigger point means different things to different people. For some it just means a sore spot, but for others it refers to a specific pathology. The technical definition involves several elements such as a hyperirritable nodule within a palpably taut band that elicits a twitching response to snapping palpation. Trigger points are thought to be caused by some sort of metabolic crisis in the muscle cells which causes chemical irritation in the local area and for some unknown reason refer pain to other areas when pressed.

Trigger points are controversial to say the least. There is substantial debate as to whether they even exist. Whether they can be reliably identified is another debate. And whether they can be effectively treated is another. There are many recommended treatments – stretching, post-isometric relaxation, sticking needles into them, pressing on them, etc. I definitely don’t have the time or anything approaching the knowledge to address all these debates.

But given all these uncertainties, I’m disinclined to believe that foam rolling works by getting rid of a trigger point. There are just too many unanswered questions here. The experts in trigger point therapy will tell you that not every sore spot is a trigger point, that not all trigger points are clinically relevant, and that their identification and treatment takes practice and expertise. So I don’t think shotgun fascia smashing with a foam roller is a plausible trigger point treatment (assuming they exist and can be treated with pressure.)

4. Does foam rolling work by proprioceptive stimulation?

I often hear claims that foam rolling works by proprioceptive enhancement – stimulating mechanoreceptors in the muscles and/or fascia, such as golgi tendon organs, or muscle spindle fibers, or ruffinis, or pacinis, or Pacinos or DeNiros. This could have some beneficial effect of encouraging relaxation of muscular or fascial tone, or causing the brain to reorganize its sensory or movement maps in the local area.

I think this is a very plausible explanation and definitely on the right track. But I doubt it is the main mechanism which explains why people like to foam roll. If stimulating these mechanoreceptors explains the claimed benefits of foam rolling, then why wouldn’t you just stretch and move around, and get probably even more stimulation to these organs, but within the context of functional movements? Can the foam roller, which doesn’t really provide that much movement or stretch to the target muscle or fascia, provide more proprioceptive stimulation then functional movements like the squat, lunge or reach? I think not.

Perhaps what foam rolling has to offer over movement is novel proprioceptive stimulation. I think novelty is great and of huge potential benefit. It helps get the brain’s attention, which is what you need to do if you want the brain to change. But here’s something else that you need to do. You need to provide the brain with information that is relevant to something that the brain cares about. The brain cares about how to move your body through functional patterns such as squats, lunges and hip hinges. How is the information derived from foam rolling relevant to these tasks? The brain is not interested in information just because it’s novel. The information must also help it solve movement problems. Why would the nervous system be interested in how it feels to have a lacrosse ball jammed into your butt?

5. Does foam rolling work by diffuse noxious inhibitory control?

This is my favorite explanation. And this is probably the mechanism with which readers will have the least familiarity. Here’s a description of what it is, how it works, and why I think it’s the major reason for the potential efficacy of foam rolling (and many other forms of manual therapy).

Diffuse noxious inhibitory control (DNIC) is one of several varieties of “descending modulation”, by which the brain adjusts the “volume” on nociception (danger signals which originate in the body). DNIC means that the brain inhibits nociceptive signals from traveling up the spinal cord to the brain.

DNIC is reliably triggered by a sustained nociceptive input, such as immersing your hand in cold water. The inhibition is diffuse – it suppresses nociception not just from the local area, but distant areas as well. In other words, if your leg hurts, and you stick your hand in icewater for a while, the resulting DNIC will cause both the hand and the leg to hurt less. This dynamic of fighting pain in one area by creating it in another likely explains the success of many therapies, and is sometimes called counterirritation. The effect is temporary of course.

How powerful is the effect of DNIC? Very powerful. When a soldier loses a limb in battle, he will often feel no pain so long as the emergency persists, and DNIC is a major reason. David Butler refers to DNIC as the “drug cabinet in the brain.” Here’s a video where he explains this idea in a little more detail, including the fact that some of the drugs in the brain are stronger than morphine.

Pain expert Lorimer Moseley views descending modulation and DNIC as a way for the brain to “second-guess” the periphery about the threat posed by a particular stimulus. For example, if the periphery is communicating information suggesting there is a large amount of mechanical threat in a particular area, the brain, which has access to a wealth of additional information about what is actually going on in the periphery, may decide that the problem is not so serious, and therefore inhibit the transmission of nociceptive signals to the brain.

There is significant research showing that many chronic pain conditions such as fibromyalgia, irritable bowel syndrome, and TMJ are characterized by relative failure of the DNIC mechanism.

The effectiveness of DNIC in suppressing pain is highly dependent on the expectation that the counterirritant will have an analgesic affect. In this interesting study, researchers immersed the hands of participants in cold water, shocked them with an electric blast to the sural nerve, and then measured the level of nociceptive activity in the spine, as well as the self-reported pain level. Importantly, the participants were divided into two groups. The first group, called the “analgesia group”, was told that the cold water immersion would reduce the amount of pain they felt from the shock. The other group, called the “hyperalgesia group” was told the opposite – that the cold water immersion would make the pain in the leg worse.

The analgesia group experienced 77% less pain, and less spinal cord nociceptive activity than the hyperalgesia group, who experienced almost no reductions in pain or spinal cord nociceptive activity. In other words, expectation of relief was a huge factor in determining whether whether DNIC worked.

Now let’s put this all together. DNIC is a powerful but temporary way to reduce pain in one area by creating pain in another. It depends on a decision by the brain to ignore danger signals from the body. Expectation of benefit from the irritating stimulus plays a strong role.

There are several aspects of foam rolling that are very consistent with the hypothesis that its main benefit is achieved by creating DNIC. Rule number one in foam rolling is to find a sore spot and stay on it for some time. You need to create some pain. Of course, the pain is often a “good pain”, which is exactly the type of feeling that would correlate with the brain’s conclusion that the irritation is somehow beneficial – which is what gets DNIC going.

Foam rolling often creates pain relief, not just in the area of pressure, but in other areas as well. People also tend to feel more freedom of motion, which could easily be explained by suppression of nociceptive activity, which tends to create muscle guarding, stiffness, and compensatory patterns of movement.

Further, the results of foam rolling are often temporary and need to be repeated (and often repeated harder the next time- are people becoming addicted to the drug cabinet in the brain?) This suggests a CNS mediated mechanism.

So here is the story I tell about foam rolling. You put a foam roller into your butt and create some significant nociceptive signalling. The brain receives it and says something like: “OK, the butt is telling me that there is some danger down there right now. But I happen to know that this is a therapeutic situation because my trainer said so. So, let’s send some drugs down the spinal cord to block all this talk about danger. And, we’ll make this feel like a “good” pain, not an injury.” The drugs reduce pain and thereby improve movement temporarily.

Make sense?

Practical implications 

Now some people will read this and say “well who cares about how it works, all I care about is that it works.” And in some sense that is fine, but this lack of curiosity ignores the potential improvements one might make to a therapeutic regime by understanding the real mechanism of effect.

If foam rolling really works by nothing other than DNIC, then perhaps it would be easier to get the same effect by just pinching yourself or putting your hand in ice water. Or maybe this would mess with expectations, which we know are important to get the effect.

Here’s another interesting question that arises from the consideration that foam rolling may work purely on the basis of DNIC. If the results are only temporary, can there be any progressive benefit? I think the answer is: it depends. Pain relief and improved movement open a window of opportunity that one might climb through. If you are feeling better only for an hour, this provides enough time to train movements that would not normally be accessible, learn new skills, develop new capacities, and reduce the perceived threat associated with certain movements. This could have permanent benefit. But of course if you just sit on the couch, the benefits would probably be temporary.

Here’s another question I have in regard to foam rolling. If the major reason it works is release of the drug cabinet in the brain, then can one become addicted? I have no real evidence of this, but I swear I’ve seen a disturbing pattern. Someone gets relief from a foam roller, and then graduates to the lacrosse ball, and then to the wooden ball, until they are bruising themselves with steel in an effort to get that fix! Avoiding this type of situation is one reason it’s a good idea to know why something works.

Conclusion

Well there’s a lot more to be said here, but I am out of time, and if you have already read this far you are a champion!

I’m sure some of my readers will point out that I missed one or two great explanations for why foam rolling works. If I did, then please post in the comments and I’ll try to address it in a further post.

One way or the other, let me know what you think in the comments. And pass this around!

 

If you enjoyed this post and would like to subscribe to this blog and receive notification of posts by e-mail, sign up below:

Enjoy the post?
Sign up for blog post updates and get an e-report on improving mobility.

62 Responses to How Does Foam Rolling Work?

  1. Ryan Nagy says:

    Great article. I am not quite buying the DNIC argument. Though to be fair, I think that is because I do not quite understand it. Will come back to the ideas in a few days.

    I do not know what you use foam rolls for. I use them for support and feedback. And door #4 proprioceptive stimulation works fine for me as an explanation.

    You wrote:

    “You need to provide the brain with information that is relevant to something that the brain cares about. The brain cares about how to move your body through functional patterns such as squats, lunges and hip hinges. How is the information derived from foam rolling relevant to these tasks?”

    I agree with the first part 1000%. The brain wants relevant information. When I use foam rollers under my spine and neck or a clients spine and neck, it is providing relevant information: Direct knowledge of where in space the spine is as given by the feedback from the roller. All of which is, I believe relevant information.

    Just my two cents. It is a subjective topic, regardless of how scientific we become.

    And you may be talking about foam rollers in a way that I do no use them

    cheers! Good food for thought and action.

    Ryan

    • Todd Hargrove says:

      Ryan,

      I totally agree with what you are saying here. But you are using rollers differently than the kind of use I am talking about here, which is for fascia smashing and myofascial release.

      • Ryan Nagy says:

        Thanks for the clarification Todd.

        By the way – Would you consider adding some type of “subscribe to comment” plugin so that people can get notified of replies? I have to navigate back here to read comments and sometimes I forget.

        Also, I would like to subscribe to your blog and get updates via email, but I do not see the option.

        cheers!

        Ryan

        • Todd Hargrove says:

          Hi Ryan,

          Hmm, I will look into that, thanks for the suggestion. You can subscribe by e-mail by clicking on my Get Free Report On Joint Mobility thing.

    • Daniel Pope says:

      Ryan, check out David Butler’s book, “The Sensitive Nervous System.” Lorimer Moseley and David Butler have really changed the way I treat as a therapist. I feel that this is extremely important stuff to understand. Definitely worth looking into.

  2. Dale Favier says:

    Great essay. In my early years as a massage therapist I was very gung ho on trigger point work. And I still use a version of it, on occasion. But I had certain clients that really worried me. They LOVED the trigger point work, and it gave them real relief. Well, that’s great! Except next time I saw them they wanted more, deeper, harder. And more again, and more again, with the pain addressed moving around and around the body, and getting worse and worse. It became clear to me that far from making an effective intervention in the pain cycle, I had just been incorporated into it. I didn’t have a vocabulary for talking about it, then, but I think it was what you’re calling DNIC addiction.

    • Todd Hargrove says:

      Hi Dale,

      As a rolfer, I preferentially attract DNIC junkies. They think: if anyone can really give me the pressure I need, its a rolfer!

  3. James Wilson says:

    This is great! as I have just began to see clients for corrective exercise within the yoga communities, I have only been experimenting with foam rollers for about 6 months. I have found that the pressure alone does not access relief, but focusing the client on actively releasing the area under “sensation” brings them more results. This fits perfectly with the intention required to promote the release of DNIC.
    I especially appreciate your point referring to the window DNIC opens up to develop better motor patterning! Thanks Todd

  4. Greg Lehman says:

    Well done Todd, i could not agree more.

    The adhesions between sliding tissues is the last hope for manual therapists to blame passive tissue properties (e.g. Scar tissue or its softer cousin, “adhesions”) for muscle dysfunction and pain.

    I dont know how to debate the idea as there is no research on the topic. Are you aware of any?

    Best,

    Greg

    • Todd Hargrove says:

      Thanks Greg!

      No I don’t know of any research on the sliding layers. I recall the logic of it being discussed by Spina (see the link) as well as on SS a few times. Personally I am persuaded by the temporariness argument. If the effect is temporary how could it be adhesions? Maybe the adhered bits remain sticky even after breaking?

  5. Mel Smith says:

    Like nearly all addictions it depends on the person. I use the roller, tennis ball or whatever and DNIC does its thing. I know when it’s enough and I am not going to go back for more if I don’t need.

  6. mauricio herrador says:

    I will recommend that we get rid of all the lacrosse balls at our clinic! : )

    • Daniel Pope says:

      I don’t know if getting rid of the lacrosse balls is necessarily what you need. If a patient buys into a therapy because it alleviates pain then that is a win in my book. I think half the battle of getting people better is having them believe in the therapy and getting some results, regardless of whether or not we’re actually making structural changes. I think the arguement that practitioners like Butler is saying is that if we can modulate pain coming from the brain, then we are effectively treating people.

  7. Wonderful, wonderful essay. I’m right with you.

  8. Very well done! I haven’t seen a better explanation for the practical application of the Placebo effect in a very long time. I have had patients that are absolutely convinced that the foam roller is the answer to all sport injuries and I have always had runners and cyclists that are functionally addicted to “IT BAND” treatments. Those treatments have, classically, always been about intense “happy pain” as they like to call it. I am going to re-post (with credit of course) so that this essay can be useful across the community.

    Andrew

  9. stacy says:

    Thanks Todd for this wonderful insight to foam rolling. I am glad that Ryan commented about other uses of foam rollers which seems to go unnoticed for feedback (proprioceptive acuity)and support. In this case, we are very interested in a whole body (CNS included) understanding of how foam rollers may be a tool of choice for movement educators. Keep your posts coming; maybe your next post can offer how Feldenkrais teachers use them for support to affect the fascial system by reducing superfluous muscular activity. This way our clients may be more able to sense what they are doing and learn off this new information.

    • Todd Hargrove says:

      Thanks Stacy,

      Yes the post should have been more clear that I am talking about foam rolling for smashing not as a prop in a movement exercise a la Feldenkrais. I think I will throw in a caveat to make that clear.

  10. Margy Verba says:

    Great article…I will pass along to all of my staff! I recently attended a Robert Schliep Fascial Fitness workshop where he addressed another possibility of how foam rollers might be beneficial; in fact, rolling on a foam roller is included in his Fascial Fitness program. He refers to a mechanism analogous to squeezing water out of a sponge, and rehydration. Rather than paraphrase: http://www.bodyworkmovementtherapies.com/article/S1360-8592%2812%2900168-4/fulltext#sec3.5. Thanks again…thoroughly enjoy your articles. I have subscribed to many blogs, and often rapidly unsubscribe. Yours is one I truly look forward to. p.s. I cannot recommend highly enough the Fascial Fitness workshop…Robert Schliep is an awesome presenter!

    • Todd Hargrove says:

      Thanks Margy,

      I was waiting for someone to mention that! I actually saw this paper right before posting but didn’t have time to get to it. When I have time I will review this and make edits or do another post. My first impression is that MAYBE this could be a mechanism of effect, but two big questions that arise are: (1) does this lead to any lasting benefit; and (2) can the same effect be achieved with stretching or movement? Schleip has great stuff and I appreciate his critical thinking skills but he is very eager to attribute the benefits of massage to something, anything having to do with fascia, while ignoring other mechanisms that have far more evidentiary support and don’t require huge leaps of faith to believe. Like DNIC.

      • Margy Verba says:

        I find over and over: “when all you have is a hammer, everything looks like a nail.” The folks in the fascia world attribute everything (pain and healing) to fascia; the folks in the neuromuscular world, motor control; the pain research folks (a la Lorimer Moseley camp), the brain; the orthopedists, turn to surgery; etc. Anyway, love your newsletter…thanks so much for putting in the time!

      • Jeff Sims says:

        Have you reconsidered your thinking after reading Schleip’s?

  11. Guerin Green says:

    foam rolling (the typical IT band area) changes the way my patella moves in my surgically repaired knee. It also increases its range of motion. This seems to be a posteriori evidence that something physical is occurring. doubt that this is a N=1 experience…

    • Todd Hargrove says:

      Hi Guerin,

      Thanks for the anecdote. Your experience does suggest a physical change, but it could be mediated by CNS changes. Perhaps reduced nociception from DNIC reduces protective muscle contractions which relocate the patella. Can I ask – how long does the patella relocate after foam rolling?

      • Guerin Green says:

        are you asking about time to effect, or persistence? Time to effect is immediate, assuming the rolling is thorough; persistence depends on activity level– usually a day or so; but throw in squats or deadlifts or mixed sports, than less. It affects pain level, “crunchiness” and both flexion and extension ranges, too.

        • Todd Hargrove says:

          Thanks Geurin, very interesting. (I meant persistence.)

          • Guerin Green says:

            curious why you didn’t address the possibility of reducing inflammation (perhaps you have previously). if compression can work (and perhaps it doesn’t) by inducing compensatory bloodflow after a restriction is released, could not the same mechanism be in place here?

          • Todd Hargrove says:

            Hi Guerin,

            I know that IASTM is thought to work through creating inflammation but I have not heard that claim with regard to foam rolling. To be fair, there are probably many claims out there as to why it works that I didn’t address because I don’t know about them.

  12. Ben says:

    Nice post, Todd. It’s curious how individuals will say, “who cares why it works, as long as it works?!” in one breath, yet at the same time promote foam rolling for the purpose of “self-myofascial release”. Which one is it? Either you don’t care, or you believe in an explanatory model. But you can’t have it both ways. And if it was common knowledge that self-myofascial release and trigger point models have very little support, then I wonder how many people would have started foam rolling in the first place.

    How much of any positive effect is simply the result of changing perception? If you think you’re in pain already, applying a foam roller might show you how much pain you could REALLY have. Of course it will feel good when you remove the roller, and you’ve effectively improved your perception of your situation.

    In relation to DNIC addiction, if more and more of a stimulus is required to produce the same effect, basically a tolerance, then isn’t the brain being trained to produce pain, and to possibly associate movement with pain? Regardless of any perceived desirable effect, I can’t see that as a good thing.

    • Todd Hargrove says:

      Hi Ben,

      Thanks for the comment. Yeah a lot of the “I don’t care about the mechanism” claims are often not in good faith, but to protect their own preferred theory. But I do believe that some people really don’t care and that’s fine.

      Yes I think it is about changing perception – that’s what activates the DNIC. And I do worry about the longer term consequences of overreliance on DNIC as a way to feel better. I think if it gets you out of a jam that is great, but when you start to depend on it on a regular basis, that seems like a problem. I recall a girl in my rolfing class who basically rolled herself ALL day long. No kidding.

  13. Chris Hayden says:

    Very interesting stuff. I’ve had some clients who do seem rather self-abusive with those things, so I’m always trying to advocate for a mellow approach. Jon Martine, a Rolfing instructor, mentioned that rolling the IT band could squash the offshoots of the lateral femoral cutaneous nerve, temporarily deadening the sensation.
    That being said, is it possible that the deep pressure provided by this approach gives the brain qualitatively different proprioceptive information? I’ve read about deep vs. superficial pressure receptors, but not remembering offhand the specific names.

    • Todd Hargrove says:

      Hi Chris,

      That’s a good idea, I have thought that myself. In my mind its definitely a possibility. But I’m slightly skeptical for the reasons stated in #4 of the post.

  14. stacy says:

    I would like to point to a book that I found fascinating by Dr. Ginger Campbell, the author of brainscience podcasts, one of my favorites! The ebook is called Are you Sure? A great book that looks into the certainty of knowing, and how we register aha moments from sensory experience. Also, why it is so hard to give up preconceived ideas….and how we become so reliant on old patterns of thinking….

  15. stacy says:

    sorry, forgot the link:mhttp://www.amazon.com/Unconscious-Origins-Certainty-Brain-ebook/dp/B008AK8W1Q to the book.

  16. Ev says:

    I am sorry to be cynical, but if you were writing this blog in the 1950’s, when smoking was actually thought to bring mild benefits to ones health, you would be writing this post against the anti-smoking crowd at the time. A few people did voice their concerns back then about the potential negative effects, but you what they got back? “Do you have EVIDENCE smoking is harmful? No!”. That is an analogy to this post, in my opinion, summarized.

    • Todd Hargrove says:

      I’m not sure I would use that exact analogy.

      • Ev says:

        Fair enough, and rereading what I wrote it comes across as more negative than I intended. I think the issue is you have guys like Kelly Starret, and so many others, who are not only extremely well trained professionally in this stuff but also in the trenches everyday, helping amateur office workers to gold medal winning athletes, and they are nearly all converging–after trial and error not theorising–that foam rolling is making a difference and helping people. I’m all for being sceptical, and I am very interested in the mechanisms as you are, but from my POV you’re taking something that seems quite objectively and unambiguously to be working for people but complaining because there is no evidence you can find and thus perhaps we should not do it.

        • Todd Hargrove says:

          Hi Ev,

          Thanks for clarifying.

          I stated right off the bat in this post that it is not about whether foam rolling works, but how it works. That being said, here are a few thoughts on whether it works.

          As stated in the post, if many trainers like Mike Boyle think it works then I consider that some form of evidence. I pointed out that there is very little research showing what it does. I don’t see this as “complaining” but just accurately setting forth the state of the research.

          I agree that convergence is a good sign, but are all these trainers really independently converging or just following the trends? Trends come and go, and maybe foam rolling is one of them. Or not.

          You stated that foam rolling “seems quite objectively and unambiguously to be working.” Exactly. “Seems.” You can’t use “seems” in the same sentence as “objectively and unambiguously.” Reminds me of the joke in Anchorman: “60% of the time, it works every time.” If you look at enough studies about “what works” with regard to pain and movement, you will see that things are very often not what they seem.

  17. Todd, I written a very complimentary post about what you’ve done here and would like to publish it along with a link, of course.

    May I?

    Barrett

  18. Great article Todd. I appreciate you tackling this confusing topic. My opinion is a combination of your theories are responsible for what is taking place. For full disclosure- I created a self-myofascial tool, and I am a proponent of soft tissue mobilization. I think rolling is helpful, but it is not the answer to everything. I think you are spot on with the CNS. We tell our clients the “circuit system” is overloaded and needs to be reset. It is imperative, that once reset, appropriate exercises need to be included for maintaining correct movement. Case in point; after ACL surgery we will mobilize the hamstrings to decrease activity which then improves quad contraction. One of the problems with foam rolling is it one dimensional and just compresses muscles. Soft tissue, especially muscles, are dynamic and need to be mobilized three-dimensionally. We explain to our clients that muscles are like a ball of putty and you need to stretch, pull, push etc… to get to full length. To maintain the change it must be done regularly along with appropriate exercises. Hopefully we can get some research on this subject!

  19. Tyler says:

    Could it possibly work through desensitization? If you apply a stimulus enough eventually you will react less to it? Although if the stimulus were too great (lacrosse ball too early) maybe it would lead to sensitization instead if the opposite effect. I notice that after a week of foam rolling it hurts to do it less, and also that after a week off from it it hurts more to do. Whether I am moving better I don’t know.

  20. Brian Hartley says:

    Todd,

    Great article. If DNIC is the primary mechanism my main take home message from this article is that foam rolling before, and not after your workout is optimal.

    Thanks,

    Brian

  21. Great article Todd. Not surprised that this is receiving so much attention on social media. One quick point…stretching in a neurally loaded position (ie touching your toes while flexing the neck) results in a strength loss with no shift in the length tension curve though stretching in a position that does not load the neural structures causes a rightward shift in the length tension curve such that one simply has greater strength at longer muscle lengths. We just published an article on this exact topic entitled, “The Role of Neural Tensioj in Stretch Induced Strength Loss” in this months JSCR. We specifically loaded at the slump position. Always look forward to your work…keep em coming. See you in Seattle soon! Will share this with my online community!

    • “specifically looked at the slump position”

    • Todd Hargrove says:

      Hi Chris,

      That is VERY cool information, thanks for sharing. And congrats on the study that was a great idea to investigate. It occurs to me that the more “functional” stretches that I prefer don’t load the neural structures as much as the ones I consider less functional. I am thinking of a deep lunge or hip hinge or overhead reach or rotation. My recollection from my yoga experience was that my least favorite postures involved lots of neural tension (i.e. forward bends.) Great distinction.

  22. Christi says:

    Did you mean Athletic Trainers or Personal (fitness) Trainers in the intro paragraph? Just being nit-picky….

  23. Fraser Dods says:

    The whole topic of Trigger Points, (myo)fascial tightness and associated pain mechanisms is explained incely by Dr. Chan Gunn (www.istop.org). Whereas IMS uses acupuncture needles to release neuropathically mediated tight myofascial structures, foam rolling does so on a more superficial level/basis – but both treatment techniques bring about a (positive) change in the muscle spindle activation which controls and mediates our extrafusal muscle tension. While DNIC may have a role, the more direct influence is on the local neuromuscular components. The analogy I use with patients is that of an elastic band (“the muscle”) with a knot tied in it. Like a normal muscle, that elastic band can stretch and contract. When you tie a knot in the elastic, it (like a muscle) will still stretch and contract to a degree, but where the knot is, the elastic doesn’t function and overall elasticity and contractility of that elastic is lost. Rest or stretching does nothing to remove the knot from the elastic band. Only releasing the knot returns that elastic to its full elasto-contractile properties. The neuromuscular stimulation of direct sustained pressure (foam roller, dry needle, finger acupressure) to a myofascial element triggers a release of the muscle spindle activation to its host muscle. This deactivation of the spindle lowers the muscle’s resting tone which directly and almost immediately translates into a muscle that is more relaxed and thus capable of greater elasticity (longer/stretchable) and greater contractility (stronger) muscle. Most patients are never even aware of the degree of tightness/hypertension that, for example, is chronically present in their glut medius (GMd). They will however feel a strong stretch there when it is placed under tension, and it will be surprisingly (to the patient) weak and unable to produce force when manual muscle tested. A single 90 second direct pressure to GMd trigger point can produce immediate subjective and objective improvements in ROM and immediate 30-40% strength increases in GMd (though there was NO conscious awareness of previous pain in that muscle). The increase in ROM and strength is not regional, it is specific only to the muscle triggered – suggestive (does not prove) that there is a local, rather than centrally mediated mechanism acting.

    • Todd Hargrove says:

      Hi Fraser,

      Thanks for the comment.

      It sounds like you are basically saying (minus all the jargon) that the foam roller changes proprioceptive signaling which encourages the muscle to relax. How does the foam roller stretch the muscle more than, say … a stretch?

      • Fraser Dods says:

        It is difficult to provide an accurate explanation of a neuroanatomically mediated system without using correct anatomical and physiological “jargon”.

        A “stretch” just tensions the extrafusal muscle fibers. A foam roller (or any form of stimulus correctly applied) deforms (not necessarily stretches) the neuromyofascial tissue, providing (in the foam roller’s case via pressure, input to the trigger point which then results in a change in “proprioceptive” (intrafusal) status which produces a relaxation of the extrafusal muscle fibers. Another analogy – pulling on a tight rope attached to a winch will not lessen the tension in the winch/rope unit. If you “turn on” the winch and it unwinds – then the tension in the rope is diminished via the slack that occurs when the winch unwinds. Please read C.Gunn for a deeper explanation, which is beyond the scope of this exchange of communiques.

  24. Bruce Wilk says:

    Sensory stimulation blocks the perception of pain. It does not fix impairments. YOU CANNOT RUB YOUR PROBLEMS AWAY!

  25. Rikard Dahl says:

    Hey Todd!

    I just stumbled in here through a google search but have read around a bit and especially your posts about foam rolling. I don’t have a strong opinion myself on the matter but I have some questions; I’m new to the practice of Feldenkraid and Rolfing but a wiki search said that they are types of alternative medicine that is not neccesarily evidence-based. You seem to be sceptical about foam rolling but you do believe in soft tissue therapy, have I understood it correctly? I’m really just looking to navigate in the jungle of movement therapies and philosophies so bo criticism is implied but please explain how and for what your type of soft tissue therapy can be effective.

    Greetings from Norway

    //Rikard Dahl

    • Todd Hargrove says:

      Hi Rikard,

      Those are good questions. There is a great deal of pseudoscience promulgated in the Rolfing community, and in general I disagree with the explanations they offer for the any beneficial effects. However I do think Rolfing can be beneficial. It is basically a form of massage, and massage is not alternative medicine – it is mainstream medicine with proven efficacy.

      The Feldenkrais community tends to be far more science-based in my experience, and their explanations make quite a bit of sense in light of recent neuroscience. Further, although the “Feldenkrais Method” itself might be considered an “alternative” therapy, motor control-based therapies are not alternative – there is good evidence that they are an effective way to treat chronic pain and improve movement.

      In other words, the way I practice Rolfing and the Feldenkrais method and the way I understand their mechanisms of effect might not look that much different from what a science-based, evidence-based physical therapist would use to help a client start moving better and feeling better.

  26. Amelia says:

    Hi Todd,

    I really do agree with your theory about DNIC. What an interesting idea to test out. Get different groups of people who have never heard of foam rolling, and tell each group opposing things and see which group benefits most from it.

    I read a book recently about neuroplasticity (The Brain That Changes Itself – Norman Doige) and there is definitely some validity to your theory.

    It all kind of relates back to the idea of Positive Thinking too – BELIEVING that it is working, and interpreting the sensation not as Pain, but as Improvement. And as we ‘wait’ to see if the pain in the trigger point subsides…. perhaps the pain is not actually subsiding but we are merely deciding that it is not a danger, not a stress, we can let go, and let the natural ‘pain killers’ of the brain flow into the area to block and render irrelevant the perceived pain.

    Kinda like the Foam Roller is one big placebo effect.

    I think also practices like Yoga also are a ‘placebo effect’. Your brain is distracted with breath, and focusing on positions and movement, that eventually after time you believe that okay… NOW… i can reach further into this pose … “its my 10th class, so i must be more flexible now” and that constant retraining of the brain with new movements, behaviors and sensations.

    YES – ultimately we become, more flexible or have a greater range of motion than we did before… but perhaps all along it has been our MIND, and the conditions we place upon ourselves holding us back, and the potential of this full range of movement has always been there, but we trained our muscles into stiffness. And with negative thoughts such as…. “Oh I’m too old” “I’m too fat” “I’m too unfit” “My legs are too short”

    My brother is a professional athlete (footballer/soccer) but had always suffered from what he thought was groin pain from the age of 15-21, and 9 months ago he found out it was something to do with his hips, and adductors (sorry im not a medical person) and he had hernias, so he had a full hip reconstruction, had muscles cut, and some bone shaved off and all this stuff…..

    Now he does foam rolling, the IT Bands, the osteopath (apparently some huge guy that digs his elbow into his muscles with all his might to ‘release the muscle”) After reading your post on foam rolling I wonder if this is really a helping him at all if my brother may be a DNIC addict, (and possibly even myself as I always want harder and harder massages – even the massage therapists comment on how usually hard they work on m)I have started foam rolling (inspired by my brother) and already feel like i need it to be HARDER and have been using the specialized balls too.

    What I find most interesting about all these treatments my brother is undergoing, is that throughout it all he has maintained a positive mindset, and believed that each therapy would work the way it is supposed to. He had been making a slow recovery though and still had a lot of pain.

    The week where we saw the MOST improvement was when he was suffering ALOT of pain in his right hip – he had been thinking it was like a Bone rubbing on Bone… and he was very worried and it was very painful. After MRI scans they found everything was fine… it was just a glute strain, and the right hip area was over tensing to protect the glute.

    As SOON as he realized that the pain was not a DANGER…. his improvement began to shoot up rapidly.

    And I personally believe that its thanks to the mind, the brain has decided, this isn’t serious, RELAX we don’t need to protect this area.

    I know that a long winded, kind of off-topic response to your article, but it would seem silly that something like DNIC is only relevant to foam rolling (not that that is what your article insinuates) but I think that theory would relate to all perceptions of pain and effectiveness of treatments.

    Its like people who swear they were healed by having Reiki…
    If you believe someones hands hovering over you sending healing energy inside you WILL WORK… then you will feel relief.

    anyway – your article was great, I am currently researching Myofascial therapy for a university assignment and this was one of best articles I have come across so far.

  27. Oliver says:

    Thank you for your time. I hear more serious weight lifters mention rollers regularly. The main point of what you’re saying seems to be they help you feel better and that they don’t actually help healing. Replacing one pain with another can’t be disputed as a form of pain relief, but is that all that’s happening? Perhaps the fix is temporary because the athlete does what continues to do what causes the pain, not the roller effects are superficial. This notion of good pain and feeling better sounds like some massages, but I think these are more than temporary and clients probably become addicted to them also.There’s probably more research proving massage as a benefit -real, not a feel better fix that’s not a fix at all- than with rollers. If massages are effective in real healing, then why? I think it is to do with manipulation and circulation. I also think acting on some injured areas correctly can aid healing by encouraging the bodily process.If so this could surely be applied to rollers. Like a bit of poison can stimulate cleansing, perhaps rollers stimulate healing.Your argument is a convincing one as I prod painful areas in my shoulder to alleviate the discomfort, but I see rollers as having overlap with massage and I believe/trust massage is proven to some greater extent. Unless you could state massage didn’t aid healing and was akin to ice water I would stubbornly side with rollers. Speaking of ice, I note the usefulness of ice-hot showers. Maybe you could say these stimulated temperature receptors and that this was also a temporary fix, but I think like massages, these have been proven to benefit to some extent, and the mechanism seems to follow helping the body to heal itself by encouraging circulation.

  28. Ben Cornwell says:

    An excellent and rigorous article. I foudn it linked to from a forum, and I thought I’d chip in since my experience was so different to that outlined in the article.

    Coming from a cycling and emphatically not distance running background, I started to run and would get very sharp pain in the outside of my knee on every single run as I reached about 4km. It didn’t sound like anything ITB related after reading endlessly, but I eventually gave in and got a roller. After one session the pain was gone, and didn’t return. I only had to do it again about 18 months later after a break from running and restarting. And then only once.

    So whatever happened there, it doesn’t sound like your option 5 in this case.

  29. Christopher Rupert says:

    I think, about Fascia, as per Runner’s World http://www.runnersworld.com/tag/plantar-fasciitis, there are many useful tips that could help you heal the syndrome instead of Foam Rolling. I also believe that Plantar Fasciitis Foam Rolling wouldn’t make much a difference. Anyone would like to throw a light on this shade?

Leave a reply