Wednesday 24th November, 2021

Can foam rollers be harmful

Foam roller usage
Foam rollers are safe in supervised trials, but not so in everyday usage

Although clinical trials have shown the use of foam rollers to be safe, experts warn they can be dangerous. The reason is that, unlike clinical trials where patients are chosen for suitability then given thorough instructions and supervision, in the real world people use foam rollers on conditions they shouldn’t without instruction and supervision.

In this article we will describe the dangers and how foam rollers can be used relatively safely. We will also discuss some alternatives that are a lot safer and more effective.

CONTENTS

The uses and benefits claimed for foam rollers
Do foam rollers deliver these in the real world
How to use foam rollers safely and effectively
Appendix one: the clinical trial trial results of foam rollers
Appendix two: the alternative to foam rollers
Professionals
References

The uses and benefits claimed for foam rollers

Foam rollers (and similar tools such as balls) are used to exert pressure on muscles to emulate the therapy given by professional therapists. They are said to give the following benefits.

General

Foam rollers are intended to be a substitute for professional therapists, allowing practically unlimited therapy conveniently and without ongoing cost.

Specific

Based in part from clinical trials, proponents of foam rolling claim them to be safe and have the following benefits:

  • reducing pain
  • relaxing muscles
  • improving flexibility
  • breaking up adhesions (discussed later)

Do foam rollers deliver these in the real world

Safety

As mentioned, the real world usage of foam rollers is completely different to clinical trials. One researcher makes the following comment. This concurs with my experience as a chiropractor for over 27 years, where I stopped prescribing balls and rollers because there were too many injuries and too little benefit.

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 osteoporosis (1)

Substitute for professional therapists

For the following reasons rolling is extremely unlikely to be anywhere near as effective as a professional therapist

Foam roller vs professional therapist
  • Self users rarely have the skill or knowledge of a professional therapist
  • 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.

Major issues affecting foam rollers

Suitability of patients

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

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

Lack of instruction and supervision

The proper application of foam rollers requires:

  • determining the appropriate therapy,
  • determining the correct parts to massage (and what to avoid),
  • determining the appropriate amount of pressure, and
  • possibly getting into difficult positions.

In the clinical trials this is achieved with the help of professionals. In most real world situations users without the appropriate knowledge are left to work things out for themselves.

Very poor advice

"Good pain”

Professional therapists sometimes refer to the pain their pressure techniques cause 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.

Breaking up adhesions

We see claims by proponents of foam rolling 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.

Dr Graeme's comments

Graeme’s comments

These are my concerns about the dangers of foam rolling. To help you make the best decision, in the appendices below you will find a table summarising the clinical trial results showing possible benefits, and some effective alternatives. If you do foam roll the next section will help you stay safe and get the best possible results. Please keep in mind that this is for general information only. For specific advice please consult a professional familiar with your needs.

How to use foam rollers safely and effectively

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

We've see that the big danger is pressure techniques. It is much safer to use techniques where the muscles are squeezed. We describe this to patients as like squeezing out an old sponge. If you use a foam roller these techniques will be much safer, and you will likely get better results.

Appendix one: the clinical trial trial results of foam rollers

The following table summarises the clinical trial results from using foam rollers. Keep in mind that because of the issues we've discussed these results represent the ideal usage, and even then they are not that great. Real world usage probably won't even be as good.

You will notice that they are 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.

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

Appendix two: the alternative to foam rollers

Stretching exercise
Stretching exercises are tried and proven

Simple stretching

As discussed in review 2 (see table above) foam rolling can temporarily improve flexibility, but these gains deteriorated very fast and were no better than standard stretching exercises. Stretching exercises are tried and proven, and without the risk of applying pressure

Self massage allows the benefits of quality massage at home for little cost

Vibration massage

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. Unlike manual massage, the application of vibration massage does not need any special skill so it is extremely effective. One only needs to place the head of a vibration massager on the part to be massaged. We also note that because vibrations penetrate rather than the pressure of a roller vibration massagers are far safer.

Vibration massage resources

Article: How to use a massager
Article: The sports and exercise guide to vibration massage
Article: The practical, science based guide to post exercise recovery

Percussion vs vibration massage

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.

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

  1. 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.
  2. 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.
  3. 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.
  4. Adamczyk JG, Gryko K, Boguszewski D. Does the type of foam roller influence the recovery rate, thermal response and DOMS prevention? PLoS One
  5. Weiwlhove T. A Meta-Analysis of the effects of foam rolling on perforrmance and recovery. Front Physiol. 2019;10:376.
  6. 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.
  7. 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.
  8. Miller JK, Rockey AM. Foam Rollers Show No Increase in the Flexibility of the Hamstring Muscle Group. UW-LJournal Undergrad Res . 2006;1–4.
  9. 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.
  10. 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.
  11. 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.

We are continually adding more information on research and uses. Subscribe below to have us email them to you "hot off the press".

Dr Graeme

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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