How Does Foam Rolling Work?

 

Posted on May 2, 2013 by Todd Hargrove
“Thank You Todd Hargrove for your great article, I wanted to share it with as many people as possible”.

 

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This part only by ,  Suzanne Newman, ” ALWAYS BUY THE BLACK FOAM ROLLERS.  THE WHITE ONES DO NOT HOLD UP UNDER WEIGHT FOR LONG! MY FAVORITE ARE, TRIGGERPOINT ROLLERS, IN MY VIEW ARE BY FAR THE BEST”! 

 

Foam 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. Like Frosty the Snowman in the hothouse. Every time we went camping without a thermarest we would wake up in the morning with one side longer than the other. 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. Smash! 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 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?

The winner! 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 its 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.

 

 

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.

New research shows that the effectiveness of DNIC in suppressing pain is highly dependent on theexpectation 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 is a huge factor in determining whether you will get some DNIC from a painful stimulus.

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.

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 Dr. Oz said so. So I’ll 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!

 

 

  • This was the outcome for me, but it was a hell of a lot more than four sessions in a hell of a lot of money. I have been a massage therapist/body worker for 18 years. I would say close to half of my clients came to me after having no results from physical therapists, and I was there last resort and for a good percentage of the time, I know I helped them more than these PT’s did. Believe me, I know how frustrating that is. It is time consuming, it costs a lot of money, it also wastes insurance money.
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  • I am more impressed each time I go not only by the technique but, the incredible staff with their kindness, and most importantly, their ability to communicate effectively, and the knowledge. Thank you Neurac Institute for the first time since 2007 I feel like I might be able to soon be an athlete again!
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    Neurac is an abbreviation of Neuromuscular Activation and consists of therapeutic exercises in Redcord slings. The aim of the Neurac Method is to restore pain free movement patterns and improve function. Neurac Treatment challenges the interplay between muscles and is focusing on what is causing the problem – not only the symptoms.Science shows that pain and/or inactivity can disturb signals sent to the muscles from the brain. This disturbance can lead to impaired muscle interaction causing some muscles to be overloaded and painful. The method includes testing procedures, called Neurac Testing, to identify dysfunctions and muscular imbalances. Neurac Testing is systematically examining the body to identify weaknesses in the muscle chains. If a weakness is identified it is called a Weak Link. Neurac Treatment focuses on correcting the Weak Links thereby reducing the strain on the overloaded muscles. Often immediate pain relief and/or improved function can be achieved.
  • Neurac is performed with the Redcord Workstation Professional, ant the treatment consists of especially tailored exercises and techniques. To enhance treatment outcomes vibration can be applied with the patentedRedcord Stimula. Many patients experience additional pain relief when the vibration stimulus is applied. Read more about Neurac treatment – Step by step.Neurac Treatment aims to be pain free and without negative side effects. The treatment requires motivation and concentration from you as a patient. The exercises can be both hard and challenging but should always be performed controlled and with good movement quality. To obtain long term treatment effects individual exercise for maintenance is recommended. Read more about follow-up here.

 

  • Neurac treatment is indicated for musculoskeletal ailments such as:Low back pain and pelvic girdle pain
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  • Please contact us if you want more information of how Redcord can help you achieve better function and less pain!
  • Tyler Joyce, PT
    Owner/CSO Redcord USA
    Owner Neurac Institute for Physical Therapy
    Neurac 1&2 Instructor
    800 Bunn Drive
    Princeton, NJ 08540
    Cell: 609-516-2663
    Work: 609-683-1010
    Redcord: 609-683-1110
    Email: tyler@redcord.us
    Email: tylerdjoyce@gmail.com
    Website: NeuracPT.com
    Website: Redcord.us

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Redcord is offering a unique treatment method for musculoskeletal ailments called Neurac® (Neuromuscular Activation).  NEURomuscular Activation (NEURAC)

It is thought by many cultures that the process of breathing is the essence of being. A rhythmic process of expansion and contraction, breathing is one example of the consistent polarity we see in nature such as night and day, wake and sleep, seasonal growth and decay and ultimately life and death. In yoga, the breath is known as prana or a universal energy that can be used to find a balance between the body-mind, the conscious – unconscious, and the sympathetic-parasympathetic nervous system. Unlike other bodily functions, the breath is easily used to communicate between these systems, which give us an excellent tool to help facilitate positive change. It is the only bodily function that we do both voluntarily and involuntarily. We can consciously use breathing to influence the involuntary (sympathetic nervous system) that regulates blood pressure, heart rate, circulation, digestion and many other bodily functions. Pranayama is a yoga practice that literally means the control of life or energy. It uses breathing techniques to change subtle energies within the body for health and well-being. Breathing exercises can act as a bridge into those functions of the body of which we generally do not have conscious control.

An example of how life affects physiology:

  During times of emotional stress our sympathetic nervous system is stimulated and affects a number of physical responses. Our heart rate rises, we perspire, our muscles tense and our breathing become rapid and shallow. If this process happens over a long period of time, the sympatric nervous system becomes over stimulated leading to an imbalance that can affect our physical health resulting in inflammation, high blood pressure and muscle pain to name a few. Consciously slowing our heart rate, decreasing perspiration and relaxing muscles are more difficult than simply slowing and deepening breathing. The breath can be used to directly influence these stressful changes causing a direct stimulation of the parasympathetic nervous system resulting in relaxation and a reversal of the changes seen with the stimulation of the sympathetic nervous system. We can see how our bodies know to do this naturally when we take a deep breath or sigh when a stress is relieved.

 

The breathing process can be trained:

  Breathing can be trained for both positive and negative influences on health. Chronic stress can lead to a restriction of the connective and muscular tissue in the chest resulting in a decrease range of motion of the chest wall. Due to rapid more shallow breathing, the chest does not expand as much as it would with slower deeper breaths and much of the air exchange occurs at the top of the lung tissue towards the head. This results in “chest” breathing. You can see if you are a chest breather by placing your right hand on your chest and your left hand on your abdomen. As you breathe, see which hand raises more. If your right hand raises more, you are a chest breather. If your left hand raises more, you are an abdomen breather.

Chest breathing is inefficient because the greatest amount of blood flow occurs in the lower lobes of the lungs, areas that have limited air expansion in chest breathers. This kind of chest breathing which is rapid, shallow, results in less oxygen transfer to the blood and subsequent poor delivery of nutrients to the tissues. The good news is that similar to learning to play an instrument or riding a bike, you can train the body to improve its breathing technique. With regular practice you will breathe from the abdomen most of the time, even while asleep.

Note: Using and learning proper breathing techniques is one of the most beneficial things that can be done for both short and long term physical and emotional health.

 

The benefits of abdominal breathing:

  Abdominal breathing is also known as diaphragmatic breathing. The diaphragm is a large muscle located between the chest and the abdomen. When it contracts it is forced downward causing the abdomen to expand. This causes a negative pressure within the chest forcing air into the lungs. The negative pressure also pulls blood into the chest improving the venous return to the heart. This leads to improved stamina in both disease and athletic activity. Like blood, the flow of lymph, which is rich in immune cells, is also improved. By expanding the lung’s air pockets and improving the flow of blood and lymph, abdominal breathing also helps prevent infection of the lung and other tissues. But most of all it is an excellent tool to stimulate the relaxation response that results in less tension and an overall sense of well-being.

 

Abdominal Breathing Technique:

  Breathing exercises such as this one should be done twice a day or whenever you find your mind dwelling on upsetting thoughts or when you are experiencing pain.

* Place one hand on your chest and the other on your abdomen. When you take a deep breath in, the hand on the abdomen should rise higher than the one on the chest. This insures that the diaphragm is pulling air into the bases of the lungs.

* After exhaling through the mouth, take a slow deep breath in through your nose imagining that you are sucking in all the air in the room and hold it for a count of 7 (or as long as you are able, not exceeding 7)

* Slowly exhale through your mouth for a count of 8. As all the air is released with relaxation, gently contract your abdominal muscles to completely evacuate the remaining air from the lungs. It is important to remember that we deepen respirations not by inhaling more air but through completely exhaling it.

* Repeat the cycle four more times for a total of 5 deep breaths and try to breathe at a rate of one breath every 10 seconds (or 6 breaths per minute). At this rate our heart rate variability increases which has a positive effect on cardiac health.

 

Once you feel comfortable with the above technique, you may want to incorporate words that can enhance the exercise. Examples would be to say to yourself the word, relaxation (with inhalation) and stress or anger (with exhalation). The idea being to bring in the feeling/emotion you want with inhalation and release those you don’t want with exhalation.

In general, exhalation should be twice as long as inhalation. The use of the hands on the chest and abdomen are only needed to help you train your breathing. Once you feel comfortable with your ability to breathe into the abdomen, they are no longer needed.

Abdominal breathing is just one of many breathing exercises. But it is the most important one to learn before exploring other techniques. The more it is practiced, the more natural it will become improving the body’s internal rhythm.

 

Using breathing exercises to increase energy:

  If practiced over time, the abdominal breathing exercise can result in improved energy throughout the day, but sometimes we are in need of a quick “pick-up.” The Bellows breathing exercise (also called, the stimulating breath) can be used during times of fatigue that may result from driving over distances or when you need to be revitalized at work. It should not be used in place of abdominal breathing but in addition as a tool to increase energy when needed. This breathing exercise is opposite that of abdominal breathing. Short, fast rhythmic breaths are used to increase energy, which are similar to the “chest” breathing we do when under stress. The bellows breath recreates the adrenal stimulation that occurs with stress and results in the release of energizing chemicals such as epinephrine. Like most bodily functions this serves an active purpose, but overuse results in adverse effects as discussed above.

 

The Bellows Breathing Technique (The Stimulating Breath):

This yogic technique can be used to help stimulate energy when needed. It is a good thing to use before reaching for a cup of coffee.

* Sit in a comfortable up-right position with your spine straight.

* With your mouth gently closed breathe in and out of your nose as fast as possible. To give an idea of how this is done, think of someone using a bicycle pump (a bellows) to quickly pump up a tire. The upstroke is inspiration and the down stroke is exhalation and both are equal in length.

* The rate of breathing is rapid with as many as 2-3 cycles of inspiration/expiration per second.

* While doing the exercise, you should feel effort at the base of the neck, chest and abdomen. The muscles in these areas will increase in strength the more this technique is practiced. This is truly an exercise.

* Do this for no longer than 15 seconds when first starting. With practice, slowly increase the length of the exercise by 5 seconds each time. Do it as long as you are comfortably able, not exceeding one full minute.

* There is a risk for hyperventilation that can result in loss of consciousness if this exercise is done too much in the beginning. For this reason, it should be practiced in a safe place such as a bed or chair.

This exercise can be used each morning upon awakening or when needed for an energy boost.