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Tuesday 10th August, 2021

Author: Dr Graeme Blennerhassett

Do foam rollers actually work: you'll be very surprised

Foam roller exercises — In this article we look at whether foam rollers work, and how you can use them safely and effectively

Foam rollers have become a popular way to have practically unlimited self massage. They are inexpensive and can easily be carried to places such as your gym. Proponents say that they may not be as effective as having a professional therapist perform the therapy, but they allow practically unlimited massage for practically no cost. This is an excellent objective, but how safe and effective is self massage performed by foam rollers?

Clinical trial results of the effectiveness of foam rollers are a bit inconsistent, but generally show that they are able to provide pain relief. However, in clinical trials the people being treated are screened to make sure the use of rollers is appropriate, then given thorough instructions and supervision. In the real world people can use the rollers on conditions where they are not appropriate, and do so without instructions or supervision. This is why our clinical experience found that in some cases their risks out weighed their benefits.

In this article we will discuss the clinical trial results and the risks associated with unsupervised usage. We will then discuss how you can minimise those risks, and an alternative you can use.

What are foam rollers
The benefits of foam rollers
Effectiveness of foam rollers compared with professional therapists
Table: summary of clinical trials of foam roller usage
Recommendations
Professionals
Referrences

What are foam rollers

Foam rollers and other similar tools such as balls are tools used to exert pressure on muscles to emulate the therapy given by a manual therapist. The advantage of using these tools is that that that the massage can be self applied.

The benefits of foam rollers

If you read articles on foam rolling you will see benefits listed such as reducing pain and relaxing muscles. You’ll also see false and misleading claims such as that foam rollers help break up adhesions, which I’ll discuss later. Lets’ look at benefits found by using foam rollers in clinical trials, then from a real world clinical point of view.

Clinical trials — In clinical trials patients are carefully chosen and well supervised

The clinical trial trial results of foam rollers

The clinical trial results from using foam rollers are a bit inconsistent. Many produced a reduction in pain and tenderness, but this was often temporary, while other trials found little or no benefit. One trial found that using foam rollers produced a lengthening (relaxing) of muscles), but commented that this was less than that achieved using conventional stretching. We’ve summarised these results in the table below.

Foam roller usage unsupervised — In the real world people are unsupervised and use foam rollers on conditions they shouldn't

Foam rollers in the real world

One needs to appreciate that the clinical trial results are likely to represent the best results under ideal circumstances. This is because patients are selected for suitability then given appropriate instructions and supervision. This usually does not happen in the real world, so one would expect poorer results and greater risks.

Suitability

In clinical trials everyone with an injury or another condition making foam roller massage techniques inappropriate or unsafe would be excluded. In the real world people use foam rollers on conditions they shouldn’t, and do harm.

Good pain vs bad pain

Professional therapists sometimes refer to the pain caused by pressure techniques as “good pain”. These professionals have the skill and knowledge to determine whether the pain is beneficial or harmful. It is so easy for users of foam rollers without this knowledge to think pain is desirable and either press to hard, or press upon something they shouldn’t. To quote one review of the clinical trials of foam roller usage.
"During Foam-rolling exercises, all the underlying tissue is mechanically stressed, potentially leading to damage, receptors, vessels, or bones. This concern especially rises in users with diseases, for example diabetes, varices or oseteoporosis" (1)

“Breaking up adhesions”

We see claims by proponents of foam massage claiming that it helps break up adhesions. I cannot overstate how bad this is. This claim is totally false, and it encourages people to apply potentially damaging pressure.

Effectiveness of foam rollers compared with professional therapists

Foam rollers are often used to reduce post exercise soreness and speed recovery. As we discuss in our article on post exercise soreness and recovery professional massage therapy is an excellent therapy for achieving achieving this. So, how effective are foam rollers compared with professional therapy? For the following reasons it’s extremely difficult for most people to come even close to emulating the effectiveness of a professional therapist with a roller.

They won’t have the skill or knowledge
It can be difficult to get into the needed positions and apply the correct pressure
Most importantly, when consulting a professional therapist you are usually lying relaxed on a table. However, when using a foam roller the muscles being massaged are often tightened just to get into the appropriate position. Massage won’t relax muscles if you are trying to tighten them at the same time.

Summary of clinical trials of foam roller usage

NOTE: You may need to scroll the table below left/right for more information

Reference	Type of study	Results and comments
1	Review of 75 studies and other scientific papers	Poor and conflicting evidence of any benefits, plus concern about the potential risks
2	Review of studies	Rolling improves flexibility, but these gains decline rapidly after rolling. Effects are not better than standard stretching
3	Tested tenderness of iliotibial band (ITB) after foam rolling	Foam rolling reduced tenderness
4	Tested foam rollers for sports recovery	Reduced post exercise soreness and increased blood flow
5	Review of 21 studies of foam rolling	Quote: Overall, it was determined that the effects of foam rolling on performance and recovery are rather minor and partly negligible, but can be relevant in some cases (e.g., to increase sprint performance and flexibility or to reduce muscle pain sensation). Evidence seems to justify the widespread use of foam rolling as a warm-up activity rather than a recovery tool.
6	Tested both foam roller and vibrating roller on calf muscle flexibility	Both showed improvement
7	Tested vibrating and non vibrating rollers for flexibility, pain and tenderness	Vibration rollers gave better results
8	Tested the effect of foam rollers on hamstring flexibility	Foam rollers produced no improvement
9.	Review of 15 studies of foam rolling	Could not conclude any optimal program
10	Tested effects of foam rollers on knee range of movement	The massage was painful, but increased range of movement
11	Review of 9 studies of foam rolling	If used before or after exercise it can reduce soreness

Recommendations

The objective of the use of foam rollers is to be able to provide convenient and practically unlimited massage therapy, especially before and after exercise. If done effectively and safely there are some benefits to be had, so please allow us to suggest some things you can do to get the most benefits while reducing the risks. We will also suggest a very effective alternative. Keep in mind that this is general information only. We ask that you get specific advice from a professional familiar with your specific needs.

The safer and more effective usage of foam rollers

Restrict the usage to healthy uninjured muscles

Using foam rollers on healthy uninjured muscles is relatively safe. Examples would be use as preparation for or recovery after a workout. Do not use on any injured muscles or if there is a pain syndrome unless specifically instructed to do so by a properly qualified professional.

Do not use painful pressure techniques

As well as using techniques where painful pressure is applied professional therapists use very effective techniques where the muscles are squeezed. We describe this to patients as like squeezing out an old sponge. If you can use foam roller techniques that emulate these squeezing techniques rather than pressure techniques you will not only be much safer, but you will likely get better results. Pain can mean damaging tissues which is of course detrimental, plus it can stimulate the muscle to tighten which is the opposite to what you are trying to achieve.

The alternative to foam rollers

In our article discussing the results of clinical trials on ways to reduce post exercise soreness and speed recovery the two very effective therapies were found to be vibration massage and manual massage by professional therapists. As we’ve seen, self applied manual massage is not as effective as when professionally applied. However, the application of vibration massage does not need any special skill. One only needs to place the head of a vibration massager on the part to be massaged. Therefore, with the appropriate advice self applied vibration massage should work similarly to professionally applied vibration massage. We also note that because vibrations penetrate rather than the pressure of a roller vibration massagers are far safer. Because of these reasons we recommend that it is easier, safer and more effective to self apply therapy with a vibration massager than a foam roller.

Warning: percussion massagers and massage guns

It has become popular to use massage guns for this purpose. As discussed in our article Percussion vs vibration massage these devices usually work on percussion rather than vibration. Also, as discussed in our article Should I get a massage gun they have handles that don’t allow effective use over a lot of your body, and the market is flooded with “cheap and nasty” products. To get the benefits of vibration massage buy a proper vibration massager.

Getting started using vibration massage

To help you get started using vibration massage please check out the following resources.
Video: How to choose a massager
Article: Percussion vs vibration massage
How to use your massager: Instructions page
Video: Our highly effective vibration massager

Professional at desk — Professionals: click image to find out more and possibly trial vibration massage

Professionals

DrGraeme massagers were originally built by Dr Graeme for use in his clinic, and to prescribe to his patients for additional self use at home. Now these are used by colleagues and other professionals for similar purposes. If you are a professional and wish to know more about this therapy, or possibly get a sample massager to trial please check out our practitioner page.

References

Freiwald J, Baumgart C, Kühnemann M, Hoppe MW. Foam-Rolling in Sport und Therapy- Potential benefits and risks. Sport Orthop Traumatol. 2016;32(3):267–75.
DeBruyne DM, Dewhurst MM, Fischer KM, Wojtanowski MS, Durall C. Self-mobilization using a foam roller versus a roller massager: Which is more effective for increasing hamstrings flexibility? J Sport Rehabil. 2017;26(1):94–100.
Vaughan B, McLaughlin P. Immediate changes in pressure pain threshold in the Iliotibial band using a myofascial (foam) roller. Int J Ther Rehabil. 2014;21(12):569–74.
Adamczyk JG, Gryko K, Boguszewski D. Does the type of foam roller influence the recovery rate, thermal response and DOMS prevention? PLoS One
Weiwlhove T. A Meta-Analysis of the effects of foam rolling on perforrmance and recovery. Front Physiol. 2019;10:376.
de Benito AM, Valldecabres R, Ceca D, Richards J, Igual JB, Pablos A. Effect of vibration vs non-vibration foam rolling techniques on flexibility, dynamic balance and perceived joint stability after fatigue. PeerJ. 2019;2019(11):1–17.
Romero-Moraleda B, González-García J, Cuéllar-Rayo Á, Balsalobre-Fernández C, Muñoz-García D, Morencos E. Effects of Vibration and Non-Vibration Foam Rolling on Recovery after Exercise with Induced Muscle Damage. J Sports Sci Med 2019;18(1):172–80.
Miller JK, Rockey AM. Foam Rollers Show No Increase in the Flexibility of the Hamstring Muscle Group. UW-LJournal Undergrad Res . 2006;1–4.
Cheatham SW, Kolber MJ, Cain M, Lee M. The Effects of Self-Myofascial Release Using a Foam Roll or Roller Massager on Joint Range of Motion, Muscle Recovery, and Performance: a Systematic Review.. Vol. 10, International journal of sports physical therapy. 2015. p. 827–38.
Bradbury-Squires DJ, Noftall JC, Sullivan KM, Behm DG, Power KE, Button DC. Roller-massager application to the quadriceps and knee-joint range of motion and neuromuscular efficiency during a lunge. J Athl Train. 2015;50(2):133–40.
Schroeder AN, Best TM. Is self myofascial release an effective preexercise and recovery strategy? A literature review. Curr Sports Med Rep. 2015;14(3):200–8.

About Dr Graeme

Several years ago Dr Graeme, a Chiropractor practicing in Victoria, Australia was looking for a serious hand held massager his patients could use at home to get the extra quality massage they needed. The ones he found in the shops and on-line for home use looked nice but were not serious, and... read more

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Do foam rollers actually work: you'll be very surprised

CONTENTS

What are foam rollers

The benefits of foam rollers