By Iris Saar, M. Sc. Applied Exercise Science candidate, ACSM CPT, RRCA
Is one "better" or more effective than the other? find out here-
Self-myofascial release (SMR) is a flexibility technique intended to inhibit over active muscles and connective tissues (Clark & Lucett, 2010). The muscles’ sensory organs, known as the Golgi tendon and muscle spindle, react to low-grade, constant pressure applied on specific trigger points and respond by inhibiting the muscle’s length; some evidence supports the claim that following SMR, the muscle becomes more pliable and its range of motion (ROM) increases (Roylance et al., 2013). This has been attributed to an effect of blood resurgence which follows the ischemic pressure applied through SMR and the ultimate increase in an active ROM (Gulick et al., 2011). In the corrective exercise continuum, SMR is an initial tool found in its first step of inhibition. Acute variables to SMR allow the daily application of the method with 30-90 seconds timed pressure. Among the contraindications to SMR are blood cloths, aneurysm, osteoporosis and advanced diabetes (Clark & Lucett, 2010).
Static stretch (SS) is a subsequent flexibility method, positioned at the second phase of the corrective exercise continuum. Its main goal is the lengthening and relaxation of myofascial tissues; similar to SMR, SS can establish an inhibitory reaction through muscular autogenic inhibition (Clark & Lucett, 2010). SS has been found to increase ROM through decreases in muscle stiffness, however this outcome may indeed be detrimental to performance if applied pre-exercise and to certain sports, such as running; additionally, changes in ROM may imply enhanced tolerance to stretch and not necessarily an enlarged ROM (Kay & Blazevich, 2012). Acute variables to SS also allows daily utilization with 1-4 repetitions of 20-30 holds at point of tensions and 60 seconds holds for people over 65 years of age. Among the contraindications to SS are injuries or muscle strains and acute rheumatoid arthritis, with precautions measure of hypertensive patients (Clark & Lucett, 2010).
It is important to note that SMR can, and perhaps should, be used in conjunction with SS. The literature supports this combination; according to Mauntel et al., (2014), SMR may be applied in conjunction with static stretching, positional release therapy (PRT), active release therapy (ART) and trigger point pressure release. While examining ankle ROM, researched compared the flexibility effects of SS alone with SS combined with SMR. While both interventions acutely increased ROM, the combination of SS with SMR, applied through foam rolling, was significantly more effective in post-hoc increases in ankle ROM (Škarabot et al., 2015). It is possible that the physiological rationale for the combination of the two lies in their different effects on the neuromuscular system; SS is known to decrease motor units excitability, discharging rates as well as muscle-tendon unit stiffness (Killen et al., 2019). SMR influence the neuromuscular system through the mechanoreceptors, or interstitial receptors and leads to decreases in sympathetic tone, increased vasodilation and the viscoelasticity of the tissues (Clark & Lucett, 2010). A synergetic and times combination of SS and SMR can therefore amplify those positive effects and minimize detrimental effects on performance related to reduced muscle-tendon stiffness.
One viable issue that might contradict this notion is the implied risk for inner organs when using SMR. SS uses force at a certain end point of tension without direct pressure. SMR, on the contrary, is applied via direct, albeit low-grade, pressure on the muscle’s taut bands or trigger points. While potentially effective in increased ROM, SMR might pose a risk for inner organs which are either sensitive to such pressure or simply may benefit more from in in-direct method such as SS. High mechanical forces applied directly on the myofascial lines do stress the component of the fascia as well as it related lymph nodes, deeper muscles and organs and even venous blood vessels; observation of SMR through Doppler ultrasound found blood flow interruption (Freiwald et al., 2016). This raises the question if the myofascial tissues are suitable for high mechanical forces, particularly in an age where more research in needed to explore the complex role of the fascia. The skill level required to appropriately palpate inner organs is not quite common within the genral population and therefore manual therapy practitioners are better educated and pose another consideration to favor SS over SMR for such musculatures.
Another consideration is timing and population. According to the American College of Sports Medicine (ACSM), SS is recommended to the general population, with the stretches being held for 15-30seconds after a dynamic warm up (Page, 2012). This guideline follows for rehabilitation protocols. However, athletic populations which engage in competitive sports might need to favor SMR to minimize strength losses that are associated with SS. This differentiation between SS and SMR is relevant more when ROM issues are addressed pre-exercise, as SS application post-exercise does not carry the risk of performance being harmed.
Although the above mentioned distinctions between SMR and SS are valuable, the human body works synergistically with all its three movement systems: the skeletal, nervous and muscular. Such harmonized activity requires an appropriate application of a combined approach to mobility. Performing movement assessment may be a tool to allow for identification of over and under active muscles, which in turn can suggest the proper method to each category based on the tonic / phasic states of the muscle tissue, or in terms of corrective exercise, inhibition or lengthening respectively. For example, while performing a one-legged squat a person was demonstrating an inward trunk rotation (Clark & Lucett, 2010). Such movement compensation suggests alterations in optimal joint motion and can lead to injuries, often seen in baseball pitching such as ulnar collateral ligament damage (Plummer et al., 2018). The following chart lists the over and under active muscles associated with the trunk lean compensation, and classifies the appropriate SMR or SS based on their tonic state, location and level of practical accessibility to SMR or SS, or both (table 1):
To summarize, both SMR and SS has been shown to be an effective tool in restoring ROM. As the human movement systems are intertwined, absolute isolation or preferencing one technique over the other does not seem to either be rationale through the literature nor practical. Muscles may be identified as overactive when in fact their tonic state is underactive, and simple drawing of either technique based on visual movement assessment may not be sufficient and lead to undesired results. A long-term observation and study of an individual’s response to SMR and SS can establish a better understating as to which technique can receive more weight in terms of application, yet both are likely to be combined in the overall perspective for performance and rehabilitation purposes.
Clark, M., & Lucett, S. (Eds.). (2010). NASM essentials of corrective exercise training (1st Ed.). Lippincott Williams & Wilkins.
Freiwald, J., Baumgart, C., Kühnemann, M., & Hoppe, M. W. (2016). Foam-rolling in sport and therapy–potential benefits and risks: part 1–definitions, anatomy, physiology, and biomechanics. Sports Orthopaedics and Traumatology, 32(3), 258-266.
Gulick, D. T., Palombaro, K., & Lattanzi, J. B. (2011). Effect of ischemic pressure using a
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Kay, A. D., & Blazevich, A. J. (2012). Effect of acute static stretch on maximal muscle performance: a systematic review. Medicine & Science in Sports & Exercise®, 44(1), 154-164.
Killen, B. S., Zelizney, K. L., & Ye, X. (2019). Crossover effects of unilateral static stretching and foam rolling on contralateral hamstring flexibility and strength. Journal of Sport Rehabilitation, 28(6), 533-539.
Mauntel, T. C., Clark, M. A., & Padua, D. A. (2014). Effectiveness of myofascial release therapies on physical performance measurements: A systematic review. Athletic Training and Sports Health Care, 6(4), 189-196.
Page, P. (2012). Current concepts in muscle stretching for exercise and rehabilitation. International Journal of Sports Physical Therapy, 7(1), 109.
Penney, S., NASM-CPT, C. E. S., & PES, F. (2013). Foam Rolling-Applying the Technique of Self-myofascial Release. [Web log post]. (n.d.). Retrieved from: https://blog.nasm.org/foam-rolling-and-self-myofascial-release
Plummer, H. A., Oliver, G. D., Powers, C. M., & Michener, L. A. (2018). Trunk lean during a single-leg squat is associated with trunk lean during pitching. International Journal of Sports Physical Therapy, 13(1), 58.
Roylance, D. S., George, J. D., Hammer, A. M., Rencher, N., Fellingham, G. W., Hager, R. L., &
Myrer, W. J. (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.
Škarabot, J., Beardsley, C., & Štirn, I. (2015). Comparing the effects of self‐myofascial release with static stretching on ankle range‐of‐motion in adolescent athletes. International Journal of Sports Physical Therapy, 10(2), 203.
Vijay, K., & Pamela, V. D. S. (2017). Effectiveness of Myofascial Release with Foam Roller Versus Static Stretching in Healthy Individuals with Hip Adductor Tightness: A Randomized Clinical Trial. International Journal of Medical Research & Health Sciences, 6(12), 35-41.