Is your spiky ball or foam roller as effective as a sports massage?

The sadistic foam roller has firmly asserted a place for itself in the exercising community. Coaches, physiotherapists and athletes all recommend using foam roller massage to increase muscle length and help recovery from exercise. I frequently advise my online physio patients to use foam roller massage for self-treatment and have experienced its effects first-hand (or so I think). The puzzling thing about it is that I still get patients in my physiotherapy practice who complain of stiff/tight muscles, despite the fact that they have stretched and foam rolled the poor muscle to near extinction.

This made me wonder whether foam rolling is really as effective as I and many others claim, or whether we have succumbed to a powerful placebo effect. Why would it be effective for some and not for others?

To answer this question I decided to gather up all the available research on foam rolling and self-myofascial release involving equipment like balls etc. and weigh it up against the available evidence for regular massage.

In this article:

• Pre-event massage

• Post-event massage

• Maintenance

• Injury treatment

• Why does massage or foam rolling sometimes not work?

Pre-event foam rolling vs. massage

Pre-event sports massages can be defined as

“… a short, specific treatment given immediately before (30 minutes- 24 hours before) a sports event. The goal of the massage is to increase your circulation, flexibility and mental clarity to improve your performance.”

There is currently no evidence to support this claim. In fact, massage has even been shown to be detrimental to performance if applied a short period before the event.

I found 11 studies looking at the effect of foam rolling on various aspects that may influence performance e.g. muscle strength, jump performance, speed, agility, throwing velocity and accuracy.  While none of these studies showed a positive effect on performance, it is important to note that neither did they find that foam rolling caused any decrease in performance.

This may mean that you can safely use a foam roller shortly before you compete, but that it would likely not improve your performance.

It is further important to say that none of these studies received a high quality rating when I reviewed them (see end of article) using the Cochrane Collaboration’s guidelines and their results really need to be viewed with caution until they are confirmed through high quality research.

The quote above also claims that massage can provide you with “high mental clarity to improve your performance”.  This is usually derived from the fact that all athletes have a pre-performance routine that they use to get them focused and in the zone.  Looking at the research above, I would advocate that foam rolling is a safer option to include as part of your pre-performance routine.

Post-event foam rolling vs. massage

But what about after you've competed? Can massage or foam rolling help you recover quicker from exercise?

Most studies that investigated this question looked at the effects massage and foam rolling can have on Delayed Onset Muscle Soreness (DOMS).  DOMS develops after a bout of unaccustomed exercise that usually involves eccentric muscle contractions. The symptoms start between 12-24 hours after exercise, peak around 48 hours and can take up to 10 days to resolve. The athlete usually experiences a marked increase in muscle pain and a decreased ability to produce force.

There is strong evidence that sports massage, performed shortly after exercise, can decrease the pain that a person experiences with DOMS.

There is also some evidence that a post-race massage can lead to improved muscle strength one hour after the event, but not at 24, 48 or 72 hours after the event, when compared to no massage. Massage may thus be an important recovery tool for athletes between races, to help their muscles recover faster in the short term, but is unlikely to add any extra benefit in terms of muscle function in the days following the event.

I could only find two studies that investigated the effects of foam rolling on DOMS.  MacDonald et al. (2014) received a moderate quality rating but Pearcey et al. (2012) could not be rated as their article is still in print.  The results appear to be supportive of the use of foam rolling as a recovery tool after exercise.

Both studies reported a decrease in pain levels due to foam rolling. McDonald et al. (2014) also reported improved recovery for muscle strength and jump performance after foam rolling at 24 and 48 hours post-exercise, while Pearcey et al. (2012) did not consistently observe this across all test days. These results are encouraging but more research is required before a definitive judgement can be made.

One should also not underestimate the psychological effect a massage may have on an athlete. Moraska (2005) rightly points out that not all aspects of success in sport involves muscle function. Tactics, mind games and belief can also determine success. And there is some evidence that massage can positively influence the perception of fatigue and recovery when performed between bouts of exercise. There is currently no research available that investigate the psychological effects of foam rolling.

Maintenance foam rolling vs. massage

I did not find any research for either foam rolling or massage that indicated that you require either modality on a regular basis to stay injury free.

I cringe when I hear therapists (of any kind) tell people that they require regular maintenance to prevent their bodies from breaking down or going “out of alignment”.  Yes, you may find that regular massage relieves your neck pain, which is caused by you sitting for hours in front of a computer.

Guess what, life style changes e.g. taking regular breaks or exercise will do that too. AND lifestyle changes may actually prevent the injury from coming back, when massage only provides temporary relief.  As a physiotherapist, I always explain this to my patients and an important part of my treatment includes identifying and addressing the aggravating factors for their pain or injury.

OK, rant over. Let’s move on to the next part.

Treatment of injuries with massage or foam rolling

While lots of noise is currently being made about the fact that regular stretching does not prevent injury, it is also true that athletes do require a minimum range of motion to compete in certain sports. From clinical experience I also know that a person can sometimes develop excessive tightness/tone in certain muscles or joints when injured, which has to be addressed if they want to return to full function e.g. stiff ankle joint or calf muscle after a bad ankle sprain.

The studies that have looked at the effects of massage on muscle length have so far reported conflicting results and more research is needed on this topic.

There is some evidence that foam rolling can increase muscle length, but once again the evidence that support this should be viewed with caution due to the big risk of bias in the studies’ design.

With regards to the treatment of specific injuries: Van den Dolder et al. (2014), in their review of the literature, found low-quality evidence that soft tissue massage was effective for producing moderate improvements for people with non-specific shoulder pain, in active flexion and abduction range of motion, pain and functional scores compared with no treatment. Kumar et al. (2013) also found weak evidence that massage may be more effective than placebo for the treatment of non-specific lower back pain.

There is currently no research available that look at the effect of foam rolling on the treatment of injuries.

Why does massage or foam rolling sometimes not work?

Looking at the results above, one may think that it paints a rather gloomy picture for sports massage as well as self-myofascial release (via foam rollers, spiky balls etc.), but that’s not really true. It rather points to a lack of high quality research in these areas.

The good news is that it does suggest that using a foam roller or spiky ball for self-massage can at least be as effective, if not more effective, as a sports massage from your physiotherapist or massage therapist.

But, what about the question that sparked this blog post? Why do people sometimes find foam rolling to be ineffective?  The answer may lie in the reason why their muscles are tight/in tone.

It all comes down to having the correct diagnosis. You have to ask "Why are my muscles tight and sore?". If you don't address the cause, your muscles won't relax. Some of the common reasons for persistent muscle tightness or discomfort I see in clinic include increased neural tension (when your nerves aren't free to slide) and overtraining (you've not given your muscles enough time to recover between bouts of exercise).

It is well worth consulting a physiotherapist if you are struggling with persistent muscle tightness. This is something that can easily be done via an online physio consultation and we can provide you with a tailored treatment programme that will help you fix the cause not just the symptoms.

Do you know how to use a foam roller properly? I've recently written a blog post where I looked at exactly how often, for how long and also what methods you should use when foam rolling.

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn or ResearchGate.

References:

• Arabaci, R. (2008). "Acute effects of pre-event lower limb massage on explosive and high speed motor capacities and flexibility." Journal of sports science & medicine, 7(4): 549.

• Bradbury-Squires DJ, N. J., Sullivan KM, et al. (2014). "Roller massager application to the quadriceps increases knee joint ROM and neuromuscular efficiency during a lunge." J Athl Train.

• DAmico, A. and C. Morin "Effects of Myofascial Release on Human Performance A Review of the Literature." fiteval.com.Evans, D. F. (2014). "Self Myofascial Release: Effects on Hamstring Range of Motion and Torque." Honors College Thesis.

• Fama, B. J. a. B., David R. (2011). "The Acute Effect Of Self-Myofascial Release On Lower Extremity Plyometric Performance." Theses and Dissertations Paper 2.

• Furlan, A. D., L. Brosseau, et al. (2002). "Massage for Low-back Pain: A Systematic Review within the Framework of the Cochrane Collaboration Back Review Group." Spine 27(17): 1896-1910.

• Garcia, J. R. (2014). "The Effects Of A Single Bout Of Self-~Myofascial Release On Flexibility And Maximum Voluntary Contraction UNLV Theses/Dissertations/Professional Papers/Capstones." UNLV Theses/Dissertations/Professional Papers/Capstones Paper 2084

• Halperin, I., S. J. Aboodarda, et al. (2014). "Roller massager improves range of motion of plantar flexor muscles without subsequent decreases in force parameters." Int J Sports Phys Ther 9(1): 92-102.

• Healey, K. C., D. L. Hatfield, et al. (2014). "The Effects of Myofascial Release With Foam Rolling on Performance." The Journal of Strength & Conditioning Research 28(1): 61-68 10.1519/JSC.1510b1013e3182956569.

• Ivarsson, T. (2014). "A Comparison Between Foam Rolling and Dynamic Stretch on Throwing Velocity and Accuracy Among Male Handball Players." Masters Thesis

• Johansson, P. (2014). "Effects of self myofascial release on grip strength recovery." Thesis

• Kumar, S., K. Beaton, et al. (2013). "The effectiveness of massage therapy for the treatment of nonspecific low back pain: a systematic review of systematic reviews." International journal of general medicine 6: 733.

• Lawrence, D. J. (2011). "Effects of pre-performance massage before isokinetic exercise." Focus on Alternative and Complementary Therapies." 16(3): 246-247.

• Arroyo-Morales M, Fernandez-Lao C, Ariza-Garcia A, Toro-Velasco C, Winters M, Diaz-Rodriguez L, Cantarero-Villanueva I, Huijbregts P, Fernandez-De-Las-Penas C. Psychophysiological effects of pre-performance massage before isokinetic exercise. J Strength Cond Res 2010; 25: 481–8.

• Macdonald, G. Z., D. C. Button, et al. (2014). "Foam rolling as a recovery tool after an intense bout of physical activity." Med Sci Sports Exerc 46(1): 131-142.

• MacDonald, G. Z., M. D. Penney, et al. (2013). "An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force." J Strength Cond Res 27(3): 812-821.

• Minesky, A. E., Bahamonde, R. E. et al. (2002). "Acute Effects of The Stick on Strength, Power, and Flexibility." The Journal of Strength & Conditioning Research 16(3): 446-450.

• Miller, J. K., Rocky, A. M. (2006). "Foam Rollers Show No Increase in the Flexibility of the Hamstring Muscle Group." UW-L Journal of Undergraduate Research IX

• Mohr, A. R. (2011). "Effectiveness of foam rolling in combination with a static stretching protocol of the hamstrings." OKLAHOMA STATE UNIVERSITY Thesis .

• Moraska, A. (2005). "Sports massage. A comprehensive review." J Sports Med Phys Fitness 45(3): 370-380.

• Parkin, E. (2014). THE EFFECTS OF PRE-EVENT, LOWER LIMB MASSAGE ON AN ATHLETE’S PERFORMANCE DURING AN 800 METER DISTANCE, Cardiff Metropolitan University.

• Peacock, C. A. K., Darren D.; Silver, Tobin A.; Sanders, Gabriel J.; and von Carlowitz, Kyle-Patrick A (2014). "An Acute Bout of Self-Myofascial Release in the Form of Foam Rolling Improves Performance Testing." International Journal of Exercise Science 7(3).

• Pearcey1, G.E.P., Kawamoto1, D. J. B. S., J.E., Drinkwater, E.J., Behm, D.G. and Butto, D.C. (2012). "Foam rolling reduces the detrimental effects of delayed onset muscle soreness  on athletic performance measures."

• Price, H. (2013). "The comparison of Sports Massage and Self-Myofascial Release on hamstring flexibility of male athletes." Undergrad thesis

• Roylance, D. S., George, J. D. et al. (2013). "Evaluating Acute Changes in Joint Range-of-motion using Self-myofascial Release, Postural Alignment Exercises, and Static Stretches." International Journal of Exercise Science 6(4): 6.

• Sherer, E. (2013). "Effects of utilizing a myofascial foam roll on hamstring flexibility." Masters Theses

• Smythe, A. K. (2014). "Effect of myofascial release to the chest on glenohumeral internal rotation : a comparison of practitioner-applied vs self-applied techniques " An unpublished thesis submitted in partial fulfillment of the requirements for the degree of Master of Osteopathy, Unitec Institute of Technology

• Sullivan, K. M., Silvey, D. B. et al. (2013). "Roller massager application to the hamstrings increases sit and reach range of motion within five to ten seconds without performance impariments." International journal of sports physical therapy 8(3): 228.

• Torres, R., Ribeiro, F. et al. (2011). "Evidence of the physiotherapeutic interventions used currently after exercise-induced muscle damage: Systematic review and meta-analysis." Physical Therapy in Sport 13(2): 101-114.

• Van Den Dolder, P. A., Ferreira, P. H. et al. (2014). "Effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain: a systematic review with meta-analysis." British Journal of Sports Medicine 48(16): 1216-1226.

• Walters, D. (2012). "The Effects of Pre-event massage on sprint performance in females." University of Wales Institute Cardiff.

• Weerapong, P., Hume, P. et al. (2005). "The Mechanisms of Massage and Effects on Performance, Muscle Recovery and Injury Prevention." Sports Medicine 35(3): 235-256.