Soft tissue therapy or Foam rolling?

One question that I’m asked a lot in the clinic is, “whether or not we can expect to find similar results for myofascial release using a foam roller or other device such as ‘the stick’ instead of receiving soft tissue therapy / sports massage?”.

What is myofascial release?

Myofascial release has been described as an umbrella term for a wide variety of manual therapy techniques in which pressure is applied to muscle and fascia (McKenney et al 2013).

What is fascia?

According to Stecco and Schleip (2016) Fascia or fascial system, “A network of interacting, interrelated, interdependent tissues forming a complex whole, all collaborating to perform movement”

In their study Kuma and Bonar (2012) state that, the literature supports defining fascia as, “an innervated, continuous, functional organ of stability and motion that is formed by 3-dimensional collagen matrices”.

“The fascial system includes adipose tissue, adventitia, neurovascular sheaths, aponeuroses, deep and superficial fascia, dermis, epineurium, joint capsules, ligaments, membranes, meninges, myofascial expansions, periosteum, retinacula, septa, tendons (including endo-/peri-/epi-/paratendon), visceral fascia and all the intra- and intermuscular connective tissues, including endo-/peri-/epimysium” (Adstrum et al., 2017).

This tissue is an amazing creation of nature that fulfils many structural and chemical functions of mammals and is largely responsible for the huge freedom of movement possessed by human beings. Collagen is the primary structural component of fascia. This protein has many functions as it travels uninterrupted through the body. Collagen is designed to primarily resist tensile stress and is the makeup of skin, tendons, and ligaments, as well as the coverings of muscle tissues and their different constituent parts.

This dense tissue is said to be arranged in a way that allows maximum distribution of load with minimal framework. As light as it is, collagen is proportionally stronger than steel cable.

In a healthy musculoskeletal system, loose and dense fibrous connective tissue permeates the body and enables all body systems to operate in an integrated manner, fascia supports free movement of our muscles and bones through the variety of movements we utilise in sport, performance art, and life.

Injuries to the fascial system cause a significant loss of performance in recreational exercise as well as high-performance sports leading to the development and perpetuation of musculoskeletal disorders.

Exercise and manual therapy have shown to reduce inflammatory process associated with fascial injury and fibrosis.

Soft tissue therapy and treatments where pressure is applied to the musculature such as myofascial release, have been identified as having several different central and peripheral neurophysiological effects. Several potentially pain-relieving (analgesic) effects have been observed. These pain-relieving effects could lead to an increase in stretch tolerance immediately following the application of the therapy, which could account for the immediate changes found in flexibility that are frequently observed.

Grieve et al. (2015), observed an increase in sit-and-reach distance following the application of a self-myofascial release to the sole of the foot, Kelly & Beardsley (2016), observed increases in contralateral (opposite) ankle dorsiflexion after ipsilateral (one side) leg foam rolling. It has been shown that stretching of the lower limb increases range of motion of the cervical spine (Neck) (Wilke et al., 2016).

In neurophysiological models, myofascial release is thought to stimulate intra-fascial mechanoreceptors, which cause alterations in the afferent input to the central nervous system thus leading to a reduction in the activation of specific groups of motor units. Therefore, myofascial release does not affect the physical properties of the muscle or fascia but rather sends signals to the brain through afferent nerves, which then signals to the muscle to relax its contracted state. However, this model assumes that muscle tissue is responsible for the tightness and that it is muscle tissue that is being changed by the treatment.

Foam rolling (tool-assisted massage of myofascial tissues) appears to improve short-term flexibility and recovery from muscle soreness (Beardsley and Škarabot, 2015; Schroeder and Best, 2015).

While placebo and dynamic self-myofascial release did not change myofascial trigger point (MTrP) sensitivity, static compression of MTrP increased pain pressure threshold (PPT) (Wilk and Vogt 2018).

Soft tissue therapy / manual therapy, experience of the therapist is paramount for a successful outcome, while the intent of self-massage may be like that of a treatment by a therapist, there are significant differences. In a soft tissue treatment there should be a specific goal or objective that the therapist is attempting to achieve. With foam rolling most people often lie down and roll around without accomplishing much and act like they are being tortured, which probably comes down to poor education on how to use the equipment. Aside from these two differences other areas to consider are education, timing, interpersonal connection, and precision of the treatment. The palpation skills of an experienced therapist are the single most important aspect of soft tissue therapy (if you can’t feel what is happening to the tissue how can you treat it effectively?).

Dealing with myofascial dysfunction can be a long-term issue and requires diligence to correct. It is important whenever we are deciding to use self-myofascial release tools that we always maintain context and ask the question, why did this tissue become this way?

Your body is a system of systems and there is no one cure-all answer to any problem. So, we can best support any mobility work we do by optimising correct movement patterns and preventing problems from occurring in the first place.

So call us today on 0203 893 5100 or book your initial assessment session online.

References:

Adstrum, S. Hedley, G. Schleip, R. et al. (2017). Defining the fascial system, Journal of Bodywork Movement Therapy, 21(1), pp. 173-464.

Grieve, R. Gooodwin, F. Alfaki, M. Bourton, A. Jeffries, C. & Scott, H. (2014). The immediate effect of bilateral self-myofascial release on the plantar surface of the feet on hamstring and lumbar spine flexibility: A pilot randomised controlled trial. Journal of Bodywork and Movement Therapies.

Kelly, S. Beardsley, C. (2016). Specific and cross-over effects of foam rolling on ankle dorsiflexion range of motion. International Journal of Sports Physical Therapy, 11(4), pp. 544.

Beardsley, C. Škarabot, J. (2015). Is self-myofascial release an effective preexercise and recovery strategy? A literature review. Journal of bodywork and movement therapies, 19(4), pp. 747-58.

Kuma, M. Bonar, J. (2012). Fascia: a morphological description and classification system based on a literature review, The Journal of Canadian Chiropractic Association 56(3), pp. 179–191.

McKenney, K. Elder, A. Elder, C. Hutchins, A.(2013). Myofascial release as a treatment for orthopaedic conditions: a systematic review, Journal of Athletic Training, 48: pp. 522-527.

Schroeder, A. Best, T. (2015). Is self-myofascial release an effective preexercise and recovery strategy? A literature review. Current Sports Medicine Reports, 14(3), pp. 200-8.

Stecco, C. Schleip, R. (2016). A fascia and the fascial system, Journal of Bodywork and Movement Therapies, 20(1), pp. 139–140.

Wilke, J. Niederer, D. Vogt, L, Winfried Banzer. (2016) Remote effects of lower limb stretching: preliminary evidence for myofascial connectivity? Journal of sports sciences, 34(22), pp. 2145-48.

Wilke, J. Vogt, L. Banzer, W. (2018). Immediate effects of self-myofascial release on latent trigger point sensitivity: a randomized-placebo-controlled trial. Biology of Sport. https://www.researchgate.net/publication/324226684_Immediate_effects_of_self-myofascial_release_on_latent_trigger_point_sensitivity_a_randomized_placebo-controlled_trial [accessed Sep 19, 2018].

Zügel,M. Maganaris,C. Wilke,J. Jurkat-Rott,K. Klingler,W. Wearing,S. Findley,T. Barbe,M. Steinacker,J. Vleeming,A. Bloch,W. Schleip,R. Hodges, P. (2018). Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics, british Journal of sports Medicine,

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