The Effects of Myofascial Release with Foam Rolling on Performance

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In the last decade self myofascial release (SMR) has become an increasingly common modality to supplement traditional methods of massage, so a masseuse is not necessary. However, there is limited clinical data demonstrating the efficacy or mechanism of this treatment on athletic performance .The purpose of this study was to determine whether the use of myofascial rollers before athletic tests can enhance performance.

Twenty-six (13 men and 13 women) healthy college aged individuals (21.56±2.04 years, 23.97±3.98 body mass index (BMI), 20.57±12.21 percent body fat) were recruited. The study design was a randomized, crossover design in which subject performed a series of planking exercises or foam rolling exercises then performed a series of athletic performance tests (vertical jump height and power, isometric force, and agility.) Fatigue, soreness, and exertion were also measured.

A 2 x 2 (Trial x Gender) ANOVA with repeated measures and appropriate post-hoc was used to analyze the data. There were no significant differences between foam rolling and planking for all four of the athletic tests. However, there was a significant difference between genders on all of the athletic tests (p ≤ 0.001).

As expected there were significant increases from pre to post during both trials for fatigue, soreness, and exertion (p ≤ 0.01). Post-exercise fatigue after foam rolling was significantly less than after the subjects performed planking (p ≤ 0.05). The reduced feeling of fatigue may allow participants to extend acute workout time and volume, which can lead to chronic performance enhancements. However, foam rolling had no affect on performance.

J Strength Cond Res. 2013 Apr 12. [Epub ahead of print]
The Effects of Myofascial Release with Foam Rolling on Performance.
Healey KC, Hatfield DL, Blanpied P, Dorfman LR, Riebe D.
Source
1Human Performance Laboratory, Department of Kinesiology, University of Rhode Island, South Kingston, RI 02881, USA 2Department of Physical Therapy, University of Rhode Island, South Kingston, RI 02881, USA.
Abstract

Exercise is as effective as massage for sore muscles

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It’s a common belief that massage is the best for treating post-workout pain. However a new research published in the Journal of Strength and Conditioning Research has found that massage and exercise had the same benefits.
Lars Andersen, the lead author of the study and a professor at the National Research Center for the Working Environment in Copenhagen, and his colleagues asked 20 women to do a shoulder exercise while hooked up to a resistance machine. The women shrugged their shoulders while the machine applied resistance, which engaged the trapezius muscle between the neck and shoulders. Two days later, the women came back to the lab with aching trapezius muscles. On average they rated their achiness as a five on a 10 point scale, up from 0.8 before they had done the shoulder work out.

Then the women received a 10-minute massage on one shoulder and did a 10-minute exercise on the other shoulder. Some women got the massage first, while others did the exercise first.
The exercise again involved shoulder shrugs; this time the women gripped an elastic tube held down by their foot to give some resistance. (Hygenic Corporation, which makes the tubing used in the study, supported the study.)
Andersen’s group found that, compared to the shoulder that wasn’t getting any attention, massage and exercise each helped diminish muscle soreness. The effect peaked 10 minutes after each treatment, with women reporting a reduction in their pain of 0.8 points after the warm up exercise and 0.7 points after the massage.
“It’s a moderate change,” said Andersen. He said he expects that athletes would notice a difference in having their soreness reduced by this amount.
“I think that for athletes…by reducing soreness then they’re able to perform better, but we didn’t measure this. But if you are sore your movements are very stiff and it’s difficult to perform,” he said.
Andersen said he’d like to see future studies track whether warming up the muscles to relieve soreness does indeed impact how well athletes perform.
The study suggests that “maybe (massage or exercise) has some benefit for individuals prior to an activity, even though the benefit may be short-lasting,” said Jason Brumitt, of the School of Physical Therapy at Pacific University, who was not involved in the research.
It’s not clear how massage or exercise would relieve soreness, but Brumitt said that it’s thought that they help to clear out metabolic byproducts associated with tissue damage.
Andersen recommends that people try light exercise to ease their pain. The effect is moderate, and only offers temporary relief, but the benefit of using exercise, Andersen said, is that it doesn’t require a trained therapist or travel time.
“If people go out and exercise and get sore they can find some relief in just warming up the muscles,” he said.

Reference:
J Strength Cond Res. 2013 Mar 21.
Acute effects of massage or active exercise in relieving muscle soreness: Randomized controlled trial.

http://www.ncbi.nlm.nih.gov/pubmed/23524365

Can myofascial techniques modify immunological parameters?

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OBJECTIVES:
The objective was to determine the effect of myofascial techniques on the modulation of immunological variables.
DESIGN:
Thirty-nine healthy male volunteers were randomly assigned to an experimental or control group.
INTERVENTIONS:
The experimental group underwent three manual therapy modalities: suboccipital muscle release, so-called fourth intracranial ventricle compression, and deep cervical fascia release. The control group remained in a resting position for the same time period under the same environmental conditions.
OUTCOME MEASURES:
Changes in counts of CD3, CD4, CD8, CD19, and natural killer (NK) cells (as immunological markers) between baseline and 20 minutes post-intervention.
RESULTS:
Repeated-measures ANOVA revealed a significant time × groups interaction (F(1,35)=9.33; p=0.004) for CD19. There were no significant time × group interaction effects on CD3, CD4, CD8, or NK cell counts. Intrasubject analyses showed a higher CD19 count in the experimental group post-intervention versus baseline (t=-4.02; p=0.001), with no changes in the control group (t=0.526; p=0.608).
CONCLUSION:
A major immunological modulation, with an increased B lymphocyte count, was observed at 20 minutes after the application of craniocervical myofascial induction techniques.

J Altern Complement Med. 2013 Jan;19(1):24-8. doi: 10.1089/acm.2011.0589. Epub 2012 Nov 23.
Can myofascial techniques modify immunological parameters?
Fernández-Pérez AM, Peralta-Ramírez MI, Pilat A, Moreno-Lorenzo C, Villaverde-Gutiérrez C, Arroyo-Morales M.

Myofascial force transmission between the latissimus dorsi and gluteus maximus muscles

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There are extensive connections between the latissimus dorsi (LD) and gluteus maximus (GMax) muscles and the thoracolumbar fascia (TLF), which suggests a possible pathway for myofascial force transmission.
The present study was designed to provide empirical evidence of myofascial force transmission from LD to contralateral GMax through TFL in vivo. To accomplish this goal, we evaluated whether active or passive tensioning of the LD results in increased passive tension of the contralateral GMax, indexed by changes in the hip resting position (RP) or passive stiffness. The hip RP was defined as the angular position in which the passive joint torque equals zero, and passive hip stiffness was calculated as the change in passive torque per change in joint angle. Thirty-seven subjects underwent an assessment of their passive hip torque against medial rotation by means of an isokinetic dynamometer.
These measures were carried out under three test conditions: (1) control, (2) passive LD tensioning and (3) active LD tensioning.
Electromyography was used to monitor the activity of the hip muscles and the LD under all conditions.

Repeated measures analyses of variance demonstrated that passive LD tensioning shifted the hip RP towards lateral rotation (p=0.009) but did not change the passive hip stiffness (p>0.05). Active LD tensioning shifted the hip RP towards lateral rotation (p<0.001) and increased the passive hip stiffness (p≤0.004).

The results demonstrated that manipulation of the LD tension modified the passive hip variables, providing evidence of myofascial force transmission in vivo.

J Biomech. 2013 Mar 15;46(5):1003-7. doi: 10.1016/j.jbiomech.2012.11.044. Epub 2013 Feb 8.
Myofascial force transmission between the latissimus dorsi and gluteus maximus muscles: An in vivo experiment.
Carvalhais VO, Ocarino Jde M, Araújo VL, Souza TR, Silva PL, Fonseca ST.

Massage therapy for neck and shoulder pain

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Objective. To evaluate the effectiveness of massage therapy (MT) for neck and shoulder pain. Methods. Seven English and Chinese databases were searched until December 2011 for randomized controlled trials (RCTs) of MT for neck and shoulder pain. The methodological quality of RCTs was assessed based on PEDro scale.
The meta-analyses of MT for neck and shoulder pain were performed. Results. Twelve high-quality studies were included.

In immediate effects, the meta-analyses showed significant effects of MT for neck pain (standardised mean difference, SMD, 1.79; 95% confidence intervals, CI, 1.01 to 2.57; P < 0.00001) and shoulder pain (SMD, 1.50; 95% CI, 0.55 to 2.45; P = 0.002) versus inactive therapies. And MT showed short-term effects for shoulder pain (SMD, 1.51; 95% CI, 0.53 to 2.49; P = 0.003). But MT did not show better effects for neck pain (SMD, 0.13; 95% CI, -0.38 to 0.63; P = 0.63) or shoulder pain (SMD, 0.88; 95% CI, -0.74 to 2.51; P = 0.29) than active therapies.

In addition, functional status of the shoulder was not significantly affected by MT.

Conclusion. MT may provide immediate effects for neck and shoulder pain. However, MT does not show better effects on pain than other active therapies. No evidence suggests that MT is effective in functional status.

Massage therapy for neck and shoulder pain: a systematic review and meta-analysis.
Kong LJ, Zhan HS, Cheng YW, Yuan WA, Chen B, Fang M.
Evid Based Complement Alternat Med. 2013;2013:613279. doi: 10.1155/2013/613279. Epub 2013 Feb 28.

Effect of massage on the efficacy of the mental and incisive nerve block

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The purpose of this trial was to assess the effect of soft tissue massage on the efficacy of the mental and incisive nerve block (MINB).

Thirty-eight volunteers received MINB of 2.2 mL of 2% lidocaine with 1 : 80,000 epinephrine on 2 occasions. At one visit the soft tissue overlying the injection site was massaged for 60 seconds (active treatment). At the other visit the crowns of the mandibular premolar teeth were massaged (control treatment). Order of treatments was randomized. An electronic pulp tester was used to measure pulpal anesthesia in the ipsilateral mandibular first molar, a premolar, and lateral incisor teeth up to 45 minutes following the injection.
The efficacy of pulp anesthesia was determined by 2 methods: (a) by quantifying the number of episodes with no response to maximal electronic pulp stimulation after each treatment, and (b) by quantifying the number of volunteers with no response to maximal pulp stimulation (80 reading) on 2 or more consecutive tests, termed anesthetic success. Data were analyzed by McNemar, Mann-Whitney, and paired-samples t tests.

Anesthetic success was 52.6% for active and 42.1% for control treatment for lateral incisors, 89.5 and 86.8% respectively for premolars, and 50.0 and 42.1% respectively for first molars (P = .344, 1.0, and .508 respectively). There were no significant differences in the number of episodes of negative response to maximum pulp tester stimulation between active and control massage. A total of 131 episodes were recorded after both active and control massage in lateral incisors (McNemar test, P = 1.0), 329 (active) versus 316 (control) episodes in the premolars (McNemar test, P = .344), and 119 (active) versus 109 (control) episodes respectively for first molars (McNemar test, P = .444). Speed of anesthetic onset and discomfort did not differ between treatments.

We concluded that soft tissue massage after MINB does not influence anesthetic efficacy.

Effect of massage on the efficacy of the mental and incisive nerve block.
Jaber A, Whitworth JM, Corbett IP, Al-Baqshi B, Jauhar S, Meechan JG.
Anesth Prog. 2013 Spring;60(1):15-20. doi: 10.2344/12-00024.1.

Acute effects of massage or active exercise in relieving muscle soreness

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Massage is commonly believed to be the best modality for relieving muscle soreness. However, actively warming up the muscles with exercise may be an effective alternative. The purpose of this study was to compare the acute effect of massage with active exercise for relieving muscle soreness.

Twenty healthy female volunteers (mean age 32 years) participated in this examiner-blind randomized controlled trial (ClinicalTrials.gov NCT01478451). Participants performed eccentric contractions for the upper trapezius muscle on a Biodex dynamometer.
Delayed onset muscle soreness (DOMS) presented 48 hours (h) later, at which participants
1) received ten minutes (min) of massage of the trapezius muscle or
2) performed ten min of active exercise (shoulder shrugs 10 x 10 reps) with increasing elastic resistance (Thera-Band).
First, one treatment was randomly applied to one shoulder while the contralateral shoulder served as passive control. Two hours later the contralateral resting shoulder received the other treatment. Participants rated intensity of soreness (scale 0-10) and a blinded examiner took measures of pressure pain threshold (PPT) of the upper trapezius immediately before treatment and 0, 10, 20 and 60 min after treatment 48 h post eccentric exercise.
Immediately prior to treatment intensity of soreness was 5.0 (SD 2.2) and PPT was 138 (SD 78) kPa.
In response to treatment, a significant treatment by time interaction was found for intensity of soreness (P<0.001) and PPT (P<0.05).
Compared with control, both active exercise and massage significantly reduced intensity of soreness and increased PPT (i.e. reduced pain sensitivity). For both types of treatment the greatest effect on perceived soreness occurred immediately after treatment, while the effect on PPT peaked 20 min after treatment.

In conclusion, active exercise using elastic resistance provides similar acute relief of muscle soreness as compared with massage. Coaches, therapists and athletes can use either active warm-up or massage to reduce DOMS acutely, e.g. before competition or strenuous work, but should be aware that the effect is temporary, i.e. the greatest effects occurs during the first 20 min after treatment and diminishes within an hour.

Acute effects of massage or active exercise in relieving muscle soreness: Randomized controlled trial.
Andersen LL, Jay K, Andersen CH, Jakobsen MD, Sundstrup E, Topp R, Behm DG.
J Strength Cond Res. 2013 Mar 21. [Epub ahead of print]

Strengthening Your Hip Muscles

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Some Exercises May Be Better Than Others
J Orthop Sports Phys Ther 2013;43(2):65. doi:10.2519/jospt.2013.0501

Weak hip muscles lead to poor hip motion, and poor hip motion can cause knee, hip, and back pain. By exercising to strengthen the hip muscles that control how your hip moves, you can reduce your pain in these parts of your body. The 2 key muscles to include in your exercise program are the gluteus maximus (the chief muscle on the back of your hip—your buttocks) and the gluteus medius (the main muscle on the side of your hip). However, it is often difficult to strengthen these muscles without also strengthening a muscle called the tensor fascia lata, which is located toward the front of the hip. Too much activation of that muscle may create unwanted hip motion that may worsen knee, hip, or back pain. A study published in the February 2013 issue of JOSPT provides information intended to help physical therapists and their patients select exercises that target the buttock muscles without causing other unwanted muscle actions.

In this study, the researchers had 20 healthy people perform 11 different hip exercises commonly used for both fitness and rehabilitation. While the participants performed the exercises, fine wires were used to record the amount of electrical activity within the 3 muscles. This indicated how much each muscle was working. The researchers’ goal was to discover which exercises used the gluteus maximus and gluteus medius muscles the most, while minimizing the action of the tensor fascia lata. They found that 5 specific exercises worked best: the clam, the single-leg bridge, hip extension while on both hands and knees (with the knee bent or straight), and the sidestep.

Patients with certain types of knee, hip, or back pain may benefit from focusing on the 5 exercises recommended by these researchers. Your physical therapist can help determine which of these exercises are best for you and customize a treatment program based on your diagnosis, your level of pain, and your current and desired hip function. Even if you do not have any pathology or pain, you may want to incorporate these 5 exercises in your general fitness or strength program.

This news is based on an article by Selkowitz et al, titled “Which Exercises Target the Gluteal Muscles While Minimizing Activation of the Tensor Fascia Lata? Electromyographic Assessment Using Fine-Wire Electrodes,” J Orthop Sports Phys Ther 2013;43(2):54-64. doi:10.2519/jospt.2013.4116.

Get the article PDF including patient handout http://www.jospt.org/members/getfile.asp?id=5943

Motor control exercises reduces pain and disability in chronic and recurrent low back pain

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Motor control exercises reduces pain and disability in chronic and recurrent low back pain: a meta-analysis.
Byström MG, Rasmussen-Barr E, Grooten WJ.

Abstract
STUDY DESIGN.: Meta-analysis of randomized, controlled trials.
OBJECTIVE.: To determine the short-term, intermediate, and long-term effectiveness of MCE, with regard to pain and disability, in patients with chronic and recurrent low-back pain.
SUMMARY OF BACKGROUND DATA.: Previous meta-analyses have shown no difference between the effects of MCE and general exercise in the treatment of low back pain. Several high quality studies on this topic have been published lately, warranting a new meta-analysis. METHODS.: We searched electronic databases up to October 2011 for randomized controlled trials clearly distinguishing MCE from other treatments. We extracted pain and disability outcomes and converted them to a 0 to 100 scale. We used the RevMan5 (Nordic Cochrane Centre, Copenhagen, Denmark) software to perform pooled analyses to determine the weighted mean differences (WMDs) between MCE and 5 different control interventions.
RESULTS.: Sixteen studies were included. The pooled results favored MCE compared with general exercise with regard to disability during all time periods (improvement in WMDs ranged from -4.65 to -4.86), and with regard to pain in the short and intermediate term (WMDs were -7.80 and -6.06, respectively). Compared with spinal manual therapy, MCE was superior with regard to disability during all time periods (the WMDs ranged between -5.27 and -6.12), but not with regard to pain. Furthermore, MCE was superior to minimal intervention during all time periods with regard to both pain (the WMDs ranged between -10.18 and -13.32) and disability (the WMDs ranged between -5.62 and -9.00).
CONCLUSION.: In patients with chronic and recurrent low back pain, MCE seem to be superior to several other treatments. More studies are, however, needed to investigate what subgroups of patients experiencing LBP respond best to MCE.

Quick Switch to ‘Barefoot’ Shoes Can Be Bad to the Bone

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The growing number of runners who are considering trying “barefoot” five-finger running shoes, researchers at BYU have a message for you: Take it slow!

A new study from a team of exercise science professors found that runners who transition too quickly to minimalist shoes suffer an increased risk of injury to bones in the foot, including possible stress fractures.
With minimalist shoes now making up 15 percent of the $6.5 billion running shoe market, the findings are nothing to run from.
“Transitioning to minimalist shoes is definitely stressful to the bones,” said Sarah Ridge, study lead author and assistant professor of exercise science at BYU. “You have to be careful in how you transition and most people don’t think about that; they just want to put the shoes on and go.”
The research, appearing online ahead of print in the journal Medicine & Science in Sports & Exercise, studied 36 experienced runners over a 10-week period.
Each runner first underwent MRIs on their feet prior to the study period. Half of the runners were then asked to gradually transition into five-finger minimalist shoes while the other half continued to run in traditional running shoes.
Subjects in the experimental group followed an industry suggested protocol. They did one short (1-2 mile) run in the minimalist shoes the first week, and added an additional short run each week so that they ran at least 3 miles in the new shoes by week three. They were then told to add mileage in the minimal shoes as they felt comfortable, with the goal of replacing one short run per week in traditional shoes with the new shoes.
At the end of the 10-week period, MRIs were again conducted. The MRIs revealed that those who had transitioned to the minimalist shoes suffered greater increases in bone marrow edema (inflammation causing excessive fluid in the bone) and more stress injuries than those in traditional shoes.
“Whenever a bone is impacted by running (or some other repetitive action), it goes through a normal remodeling process to get stronger,” Ridge said. “Injury occurs when the impact is coming too quickly or too powerfully, and the bone doesn’t have a chance to properly remodel before impact reoccurs.”
Interestingly, the study found the majority of those who suffered stress injuries were women.
Ridge and her coauthors, which include BYU exercise science faculty Wayne Johnson, Ulrike Mitchell and Iain Hunter, said the study does not mean minimalist shoes are bad.
Rather, to minimize the risk of injuries, runners should transition over a longer duration than 10 weeks and at a lower intensity (miles per week).
“People need to remember they’ve grown up their whole life wearing a certain type of running shoes and they need to give their muscles and bones time to make the change,” Johnson said. “If you want to wear minimalist shoes, make sure you transition slowly.”
This is the first of many studies looking at minimalist running shoes, the authors said. Over the next several months they plan to publish enough research to begin to establish clear recommendations for anyone considering making the switch.

Journal Reference:
Sarah T. Ridge, A.Wayne Johnson, Ulrike H. Mitchell, Iain Hunter, Eric Robinson, Brent S. E. Rich, Stephen Douglas Brown. Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes. Medicine & Science in Sports & Exercise, 2013; : 1 DOI: 10.1249/MSS.0b013e3182874769