Expert Consensus on the Contraindications and Cautions of Foam Rolling—An International Delphi Study

Background: Foam rolling is a type of self-massage using tools such as foam or roller sticks. However, to date, there is no consensus on contraindications and cautions of foam rolling. A methodological approach to narrow that research gap is to obtain reliable opinions of expert groups. The aim of the study was to develop experts’ consensus on contraindications and cautions of foam rolling by means of a Delphi process. Methods: An international three-round Delphi study was conducted. Academic experts, defined as having (co-) authored at least one PubMed-listed paper on foam rolling, were invited to participate. Rounds 1 and 2 involved generation and rating of a list of possible contraindications and cautions of foam rolling. In round 3, participants indicated their agreement on contraindications and cautions for a final set of conditions. Consensus was evaluated using a priori defined criteria. Consensus on contraindications and cautions was considered as reached if more than 70% of participating experts labeled the respective item as contraindication and contraindication or caution, respectively, in round 3. Results: In the final Delphi process round, responses were received from 37 participants. Panel participants were predominantly sports scientists (n = 21), physiotherapists (n = 6), and medical professionals (n = 5). Consensus on contraindications was reached for open wounds (73% agreement) and bone fractures (84%). Consensus on cautions was achieved for local tissue inflammation (97%), deep vein thrombosis (97%), osteomyelitis (94%), and myositis ossificans (92%). The highest impact/severity of an adverse event caused by contraindication/cautions was estimated for bone fractures, deep vein thrombosis, and osteomyelitis. Discussion: The mechanical forces applied through foam rolling can be considered as potential threats leading to adverse events in the context of the identified contraindications and cautions. Further evaluations by medical professionals as well as the collection of clinical data are needed to assess the risks of foam rolling and to generate guidance for different applications and professional backgrounds.

Acute Effects of Vibration Foam Rolling with Light and Moderate Pressure on Blood Pressure and Senior Fitness Test in Older Women

Vibration foam rolling (VR) can improve flexibility and sports performance. However, blood pressure (BP), heart rate (HR) and senior fitness test (SFT) responses induced by an acute VR session in older women are currently unknown. Fifteen healthy women (72.90 ± 4.32 years) completed three separated randomly sequenced experimental visits. During each visit, they started with a warm-up protocol (general warm up (GW): walking + static stretching (SS), SS + VR with light pressure (VRL), or SS + VR with moderate pressure (VRM)), and completed BP, HR, SFT measurements. The systolic BP increased significantly after all three warm up protocols (p < 0.05). Both VRL and VRM protocols induced statistically significant improvements (effect size range: 0.3–1.04, p < 0.05) in the senior fitness test (back scratch, 30 s chair stand, 30 s arm curl, and 8 foot up and go), as compared to the GW. In addition, the VRM showed greater improvement for the 2 min step test when comparing with the VRL. Therefore, including VR in a warm-up protocol can result in superior SFT performance enhancement than the GW does in healthy older women.

Acute Effects of Foam Rolling on Hamstrings After Half-Marathon: A Muscle Functional Magnetic Resonance Imaging Study

Purpose: Foam rolling (FR) is widely used for post-exercise muscle recovery; yet, the effects of FR on skeletal muscle inflammation and microvascular perfusion following prolonged exercise are poorly understood. We aim to address the gap in knowledge by using magnetic resonance imaging (MRI) T2 mapping and intravoxel incoherent motion (IVIM) sequences to study the acute effects of FR on hamstrings following half-marathon running in recreational runners.Methods: Sixteen healthy recreational marathon runners were recruited. After half-marathon running, FR was performed on the hamstrings on the dominant side, while the other limb served as a control. MRI T2 and IVIM scans were performed bilaterally at baseline (pre-run), 2–3 h after running (post-run), immediately after FR (post-FR0), 30 min after FR (post-FR30) and 60 min after FR (post-FR60). T2, a marker for inflammatory edema, as well as IVIM microvascular perfusion fraction index f for biceps femoris long head (BFL), semitendinosus (ST) and semimembranosus (SM) were determined. Total Quality Recovery (TQR) scale score was also collected.Results: Both T2 and f were higher at post-run compared to pre-run in all hamstrings on both sides (all p &lt; 0.05; all d &gt; 1.0). For the FR side, T2 decreased, and f increased significantly at post-FR0 and post-FR30 compared to post-run in all muscles (p &lt; 0.05; all d &gt; 0.4) except for f at BFL and SM at post-FR30 (both p &gt; 0.05), though f at BFL was still marginally elevated at post-FR30 (p = 0.074, d = 0.91). Both parameters for all muscles returned to post-run level at post-FR60 (all p &gt; 0.05; all d &lt; 0.4) except for T2 at SM (p = 0.037). In contrast, most MRI parameters were not changed at post-FR0, post-FR30 and post-FR60 compared to post-run for the control side (p &lt; 0.05; d &lt; 0.2). TQR scores were elevated at post-FR0 and post-FR30 compared to post-run (both p &lt; 0.05; both d &gt; 1.0), and returned to the post-run level at post-FR60 (p &gt; 0.99; d = 0.09). Changes in TQR scores compared to post-run at any time points after FR were correlated to T2 for ST at post-FR30 (r = 0.50, p = 0.047) but not T2 for other muscles and any changes in f values.Conclusions: Hamstrings inflammatory edema and microvascular perfusion were elevated following half-marathon running, which were detectable with MRI T2 mapping and IVIM sequences. FR resulted in acute alleviation in inflammation and greater microvascular perfusion; however, the effects seemed to last only for a short period of time (30–60 min). FR can provide short-term benefits to skeletal muscle after prolonged running.

A Comparison of the Effects of Foam Rolling and Stretching on Physical Performance. A Systematic Review and Meta-Analysis

Foam rolling and stretching with its various techniques are frequently used as a warm-up routine to increase the range of motion of a joint. While the magnitude of the changes in range of motion between foam rolling and stretching (static and dynamic techniques) is similar, it is not clear if this also holds true for performance parameters (e.g., strength, jump height). The purpose of this meta-analysis was to compare the effects of an acute bout of foam rolling (with and without vibration) with an acute bout of stretching (with all techniques included) on performance parameters in healthy participants. We assessed the results from 13 studies and 35 effect sizes by applying a random-effect meta-analysis. Moreover, by applying a mixed-effect model, we performed subgroup analyses with the stretching technique, type of foam rolling, tested muscle, treatment duration, and type of task. We found no significant overall effect, and the analysis revealed only a trend of the performance parameters in favor of foam rolling when compared to stretching (when considering all techniques). Significantly favorable effects of foam rolling on performance were detected with subgroup analyses when compared to static stretching, when applied to some muscles (e.g., quadriceps) or some tasks (e.g., strength), when applied for longer than 60 s, or when the foam rolling included vibration. When foam rolling was compared to dynamic stretching or applied in the non-vibration mode, the same magnitude of effect was observed. While the present meta-analysis revealed no significantly different effect between foam rolling and stretching (including all techniques) prior to exercise, differences could be observed under specific conditions.

Acute Effects of Vibration Foam Rolling Warm-Up on Jump and Flexibility Asymmetry, Agility and Frequency Speed of Kick Test Performance in Taekwondo Athletes

The effect of asymmetry on flexibility and jump in taekwondo athletes and the influence of vibration foam rolling on asymmetry and frequency speed of kick test has not been examined. This study examined the effects of three warm-up protocols on subsequent sports performance in elite male taekwondo athletes. Fifteen elite male taekwondo athletes (20.63 ± 1.18 years) completed three warm-up protocols in a randomized order: general warm-up [GW], GW with vibration foam rolling [GW + VR], and GW with double VR for the weaker leg [GW + double VR]), was delivered before the subsequent tests: flexibility, single-leg countermovement jump (CMJ), 505 agility, hexagon test, and multiple frequency speed of kick tests (FSKTs). Relative to GW, the GW + VR significantly improved the hexagon test (GW + VR = 11.60 ± 1.01 s; GW = 12.80 ± 1.58 s). In addition, the GW + VR and GW + double VR yielded greater kick numbers in FSKT 5 (GW + VR = 21.13 ± 1.96 reps; GW + double VR = 20.93 ± 1.67 reps; GW = 19.27 ± 1.62 reps) and a higher kick decrement index (GW + VR = 5.45 ± 2.57%; GW + double VR = 5.88 ± 3.22%; GW = 9.54 ± 5.00%). However, the GW + VR and GW + double VR did not significantly improve the flexibility and CMJ asymmetry performance. The GW + VR is more beneficial for warming up than the GW is among male collegiate taekwondo athletes.

Is “Delayed Onset Muscle Soreness” a False Friend? The Potential Implication of the Fascial Connective Tissue in Post-Exercise Discomfort

Strenuous and unaccustomed exercise frequently lead to what has been coined “delayed onset muscle soreness” (DOMS). As implied by this term, it has been proposed that the associated pain and stiffness stem from micro-lesions, inflammation, or metabolite accumulation within the skeletal muscle. However, recent research points towards a strong involvement of the connective tissue. First, according to anatomical studies, the deep fascia displays an intimate structural relationship with the underlying skeletal muscle and may therefore be damaged during excessive loading. Second, histological and experimental studies suggest a rich supply of algogenic nociceptors whose stimulation evokes stronger pain responses than muscle irritation. Taken together, the findings support the hypothesis that DOMS originates in the muscle-associated connective tissue rather than in the muscle itself. Sports and fitness professionals designing exercise programs should hence consider fascia-oriented methods and techniques (e.g., foam rolling, collagen supplementation) when aiming to treat or prevent DOMS.

Effects of Foam Rolling Duration on Tissue Stiffness and Perfusion: A Randomized Cross-Over Trial

Despite its beneficial effects on flexibility and muscle soreness, there is still conflicting evidence regarding dose-response relationships and underlying mechanisms of foam rolling (FR). This study aimed to investigate the impact of different FR protocols on tissue perfusion and tissue stiffness. In a randomized crossover trial, two FR protocols (2x1 min, 2x3 min) were applied to the right anterior thigh of twenty healthy volunteers (11 females, 25 ± 4 years). Tissue perfusion (near infrared spectroscopy, NIRS) and stiffness (Tensiomyography, TMG and Myotonometry, MMT) were assessed before and after FR application. Variance analyses revealed a significant interaction of FR duration and tissue perfusion (F[1,19] = 7.098, p = 0.015). Local blood flow increased significantly from pre to post test (F[1,19] = 7.589, p = 0.013), being higher (Δ +9.7%) in the long-FR condition than in the short-FR condition (Δ +2.8%). Tissue stiffness (MMT) showed significant main effects for time (F[1,19] = 12.074, p = 0.003) and condition (F[1,19] = 7.165, p = 0.015) with decreases after short-FR (Δ -1.6%) and long-FR condition (Δ -1.9%). However, there was no time*dose-interaction (F[1,19] = 0.018, p = 0.895). No differences were found for TMG (p > 0.05). FR-induced changes failed to exceed the minimal detectable change threshold (MDC). Our data suggest that increased blood flow and altered tissue stiffness may mediate the effects of FR although statistical MDC thresholds were not achieved. Longer FR durations seem to be more beneficial for perfusion which is of interest for exercise professionals designing warm-up and cool-down regimes. Further research is needed to understand probable effects on parasympathetic outcomes representing systemic physiological responses to locally applied FR stimulations.