press & release: myofascial strategies



The effectiveness of self-myofascial release: a literature review

By Iris Saar, Ms. C. Exercise Science candidate, Concordia university of Chicago



Self-myofascial release (SMR) is a flexibility technique which constitutes the first phase in the corrective exercise continuum, the inhibition phase (Behm & Wilke, 2019). SMR is a relatively simple protocol and is readily available to employ. The scientific rationale for SMR stems from the notion that an altered length-tension relationships lead to reduced ability of a muscle to produce force. SMR is often followed, or suggested in conjunction, with static stretching as a mean for lengthening previously inhibited musculatures. The relatively low injury risk and potential positive effects may be used by a wide range of populations, including youth and elderly athletes.

SMR consists of few techniques which may be used with or without an apparatus such as a foam roller, different diameter balls and handheld percussion devices (Konrad et al., 2020). Weather SMR is an efficient strategy in rehabilitation and recovery regimen is a topic still being evaluated in the literature. The following studies and narrative reviews portray some of the consideration evident in the literature regarding the effectiveness of SMR techniques, instrument selection, physiological changes, and performance measures.


SMR- techniques


A paramount technique to SMR is the rolling of myofascial trigger points (MTP). MTP are locally-sensitive regions, located within taut bands in the myofascial. MTP can be active, causing pain, or passive, which refers to it being latent within the myofascial (Wilke et al., 2018). The dynamic pressure applied via foam roller along the tissues creates friction and leads to changes in the muscle spindle and Golgi tendon due to the resultant stretch reflex (Clark & Lucett, 2010). Those physiological responses will be discussed later. In a meta-analysis by Wiewelhove et al., (2019) foam rolling has been analyzed as a technique both pre- and post-exercise to determine its efficiency. Five inclusion criteria yield a total of 21 studies, concluding that foam roller is superior to other apparatus (such as roller massage) when implemented post-exercise as a recovery tool, rather than pre-exercise as a warm up routine. Foam rolling has been reported to elicit positive changes in certain aspects such as sprint velocity; however these were minimal and can be applied mostly to elite athletes whom margin in performance is more significant (Wiewelhove et al., 2019). SMR, as its name suggests, can be used without any apparatus; applying ischemic pressure using one’s own limbs (hands) is an available, mostly simple to implement SMR technique. Muscle function and range of motion (ROM) have been reported in several studies to be improved following apparatus-free SMR, although the acute variables of applying such self-massage techniques are not entirely agreed upon, with pressure times ranging between 30-120 seconds (Behm & Wilke, 2019; Monteiro et al., 2017).

Another SMR technique involves the use of medicine balls in various levels of stiffness and diameters. Using a ball can elicit different levels of tissue pressure and be selected based upon the size of the myofascial to be released; according to Kim et al., (2019), using a softer ball was found to be more beneficial for tissue pressure, when applied towards the sternocleidomastoid and lower trapezius muscles, with the first tending towards over-activity.


SMR- instrument selection


The various instruments suggested in the literature to perform SMR often include a foam roller, medicine and massage balls, roller massage and hand held percussion devices (Behm, & Wilke, 2019). While they tend to serve the same purpose of applied ischemic pressure on the myofascial tissues, differences between the instruments exist to the point of various effects on the tissues. In the case of a foam roller, its use can exceed the locally targeted tissue and impact other parts of the kinetic chain due to changes in the parasympathetic nervous system (Behm, & Wilke, 2019). Various sizes and textures of medicine balls are another common tool used in SMR; balls can provide firm-to-low degree pressure on the tissue and may be beneficial for the posterior chain musculatures, where lying supine can provide a simple palpation approach to the myofascia (Kim et al., 2019). Hand held percussion devices have been increasingly used in recent years as an instrument for SMR. Current devises can reach a maximal vibration frequency of 53MHZ and a set of different tips to trigger different levels of tissue thickness (Konrad et al., 2020). It is possible that the perceived efficacy of the device contributed to its rise in popularity; however the literature does not fully support this. Minor acute improvements in ROM were found when percussion device was used following a manual massage, however those changes were related to psychological responses such as reduced perception of pain, rather than to a biomechanical adaptations (Konrad et al., 2020). Nevertheless, percussion devices are a widely used instrument which may enhance some positive effects of manual therapy methods.


SMR- physiological changes


The altered length-tension relationships that form due to muscular adhesions hinder the optimal ability to produce force. SMR can potentially alleviate the referred pain and restore, to a certain extent, some levels of ROM around the joints. This is achieved by the lengthening effects of SMR as well as its ischemic pressure which modifies the signal to the muscle spindles and Golgi tendons. The literature points out a few notable physiological changes which are related to SMR, with measurable outcomes such as sprinting performance, muscle strength, power and flexibility. According to Stroiney et al., (2016), SMR can increase performance through improvements in the body’s ability to deliver oxygen to the muscle under stress (referred to in the study as Vo2Max). This is due to increases in blood circulation and increased nutrients to the exercising muscles. However, when tested through 40-minutes run, SMR did not improve Vo2Max and overall running economy. SMR can assist in breaking “barriers trigger points” (Wiewelhove et al., 2019); when released, these trigger point can be slightly reduced in their adhesions and lead to better performance, according to this meta-analysis. Another contributor to fascial restriction, which can be changed through SMR, is the level of hydration to the fascia. Once fascial tissues are dehydrated, their elasticity is reduced. Since SMR can increase both blood circulation and perfusion, the fascia can by further hydrated and in turn, increase the skeletal muscle’s ROM (Behm & Wilke, 2019). Muscle force has also been studied in the literature as a cursor for SMRs physiological effect. In a study by Konrad et al., (2020), muscle receptors activity level was stimulated by SMR applied through a percussion device. This can increase the muscle’s ability to voluntarily contract and produce force.


SMR- performance measures


The evidence provided above for the effectiveness of SMR, together with its documented physiological changes, sets a base for potential improvements in performance. As in the case of endurance sports (namely, running), the body’s ability to consume adequate amounts of oxygen and deliver it to the exerting muscles may be improved following a pre-exercise bout of SMR (Konrad et al., 2020). Despite this finding and supporting evidence for increased ROM following SMR, the literature lacks extensive base of evidence regarding the effects of SMR on athletic performance. Phillips et al., (2018) researched performance improvements related to different lengths of SMR application; a cohort study confirmed previous studies’ finding regarding increases in ROM. Other performance criteria, such as vertical jump and power, were negatively affected by a prolonged bout of SMR pre-exercise. In terms of anaerobic performance, sprinting abilities were improved slightly in a study by Wiewelhove et al., (2019), however due to methodological variance it is possible that SMR has a negligent effect on performance, under acute conditions.

This state of the science poses the need in future research regarding the long-term or physiological retention of SMR and its impact on performance: currently, the science is focuses on acute effects rather on a macro cycle which spans over a year of training and includes an off-season training periodization. Researching an athlete’s performance under a consistent application of SMR, both pre and post exercise and during in and off season, might reveal a more stable understanding and can potentially change coaching’s approaches towards performance and recovery.


References


Behm, D. G., & Wilke, J. (2019). Do self-myofascial release devices release myofascia? Rolling mechanisms: A narrative review. Sports Medicine, 49(8), 1173-1181.


Kim, Y., Hong, Y., & Park, H. S. (2019). A soft massage tool is advantageous for compressing deep soft tissue with low muscle tension: Therapeutic evidence for self-myofascial release. Complementary Therapies in Medicine, 43, 312-318.


Konrad, A., Glashüttner, C., Reiner, M. M., Bernsteiner, D., & Tilp, M. (2020). The Acute Effects of a Percussive Massage Treatment with a Hypervolt Device on Plantar Flexor Muscles’ Range of Motion and Performance. Journal of Sports Science & Medicine, 19(4), 690.


Monteiro, E. R., Škarabot, J., Vigotsky, A. D., Brown, A. F., Gomes, T. M., & da Silva Novaes, J. (2017). Acute effects of different self‐massage volumes on the FMS™ overhead deep squat performance. International Journal of Sports Physical Therapy, 12(1), 94.


Phillips, J., Diggin, D., King, D. L., & Sforzo, G. A. (2018). Effect of Varying Self-myofascial Release Duration on Subsequent Athletic Performance. Journal of Strength And Conditioning Research.


Stroiney, D., Herrrick, S., Vitti, S., Bossi, J., Paolone, V., & Matthews, T. (2016). The Effects Of An Acute Bout Of Self-myofascial Release On The Physiological Parameters Of Running: 3473 Board# 234 May 30, 800 AM-930 AM. Medicine & Science in Sports & Exercise, 47(5S), 942.


Wiewelhove, T., Döweling, A., Schneider, C., Hottenrott, L., Meyer, T., Kellmann, M., Pfeiffer, M. & Ferrauti, A. (2019). A meta-analysis of the effects of foam rolling on performance and recovery. Frontiers in Physiology, 10, 376.


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, 35(4), 349.