The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to midportion Achilles tendinopathy. J Orthop Sports Phys Ther 2018;48(5):A1–A38. doi:10.2519/jospt.2018.0302

https://www.jospt.org/doi/pdf/10.2519/jospt.2018.0302

Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018

Foam rolling is thought to improve muscular performance and flexibility as well as to alleviate muscle fatigue and soreness. For this reason, foam rolling has become a popular intervention in all kinds of sport settings used to increase the efficiency of training or competition preparation as well as to speed post-exercise recovery. The objective of this meta-analysis was to compare the effects of foam rolling applied before (pre-rolling as a warm-up activity) and after (post-rolling as a recovery strategy) exercise on sprint, jump, and strength performance as well as on flexibility and muscle pain outcomes and to identify whether self-massage with a foam roller or a roller massager is more effective. A comprehensive and structured literature search was performed using the PubMed, Google Scholar, PEDro, and Cochrane Library search engines. Twenty-one studies were located that met the inclusion criteria. Fourteen studies used pre-rolling, while seven studies used post-rolling. Pre-rolling resulted in a small improvement in sprint performance (+0.7%, g = 0.28) and flexibility (+4.0%, g = 0.34), whereas the effect on jump (-1.9%, g = 0.09) and strength performance (+1.8%, g = 0.12) was negligible. Post-rolling slightly attenuated exercise-induced decreases in sprint (+3.1%, g = 0.34) and strength performance (+3.9 %, g = 0.21). It also reduced muscle pain perception (+6.0%, g = 0.47), whereas its effect on jump performance (-0.2%, g = 0.06) was trivial. Of the twenty-one studies, fourteen used foam rollers, while the other seven used roller massage bars/sticks. A tendency was found for foam rollers to offer larger effects on the recovery of strength performance (+5.6%, g = 0.27 vs. -0.1%, g = -0.01) than roller massagers. The differences in the effects between foam rolling devices in terms of pre-rolling did not seem to be of practical relevance (overall performance: +2.7 %, g = 0.11 vs. +0.4%, g = 0.21; flexibility: +5.0%, g = 0.32 vs. +1.6%, g = 0.39). Overall, it was determined that the effects of foam rolling on performance and recovery are rather minor and partly negligible, but can be relevant in some cases (e.g., to increase sprint performance and flexibility or to reduce muscle pain sensation). Evidence seems to justify the widespread use of foam rolling as a warm-up activity rather than a recovery tool.

/pdf/a-meta-analysis-of-the-effects-of-foam-rolling-on-2uwja4ym57.pdf

A Meta-Analysis of the Effects of Foam Rolling on Performance and Recovery.

The term “self-myofascial release” is ubiquitous in the rehabilitation and training literature and purports that the use of foam rollers and other similar devices release myofascial constrictions accumulated from scar tissue, ischaemia-induced muscle spasms and other pathologies. Myofascial tone can be modulated with rollers by changes in thixotropic properties, blood flow, and fascial hydration affecting tissue stiffness. While rollers are commonly used as a treatment for myofascial trigger points, the identification of trigger points is reported to not be highly reliable. Rolling mechanisms underlying their effect on pain suppression are not well elucidated. Other rolling-induced mechanisms to increase range of motion or reduce pain include the activation of cutaneous and fascial mechanoreceptors and interstitial type III and IV afferents that modulate sympathetic/parasympathetic activation as well as the activation of global pain modulatory systems and reflex-induced reductions in muscle and myofascial tone. This review submits that there is insufficient evidence to support that the primary mechanisms underlying rolling and other similar devices are the release of myofascial restrictions and thus the term “self-myofascial release” devices is misleading.

Do Self-Myofascial Release Devices Release Myofascia? Rolling Mechanisms: A Narrative Review.

Effect of self-myofascial release on myofascial pain, muscle flexibility, and strength: A narrative review.

Background:
Instrument assisted soft tissue mobilization (IASTM) is a popular treatment for myofascial restriction. IASTM uses specially designed instruments to provide a mobilizing effect to scar tissue and myofascial adhesions. Several IASTM tools and techniques are available such as the Graston® technique. Currently, there are no systematic reviews that have specifically appraised the effects of IASTM as a treatment or to enhance joint range of motion (ROM).

The efficacy of instrument assisted soft tissue mobilization: a systematic review.

Background
Self‐myofascial release (SMR) is a popular intervention used to enhance a client's myofascial mobility. Common tools include the foam roll and roller massager. Often these tools are used as part of a comprehensive program and are often recommended to the client to purchase and use at home. Currently, there are no systematic reviews that have appraised the effects of these tools on joint range of motion, muscle recovery, and performance.

The effects of self-myofascial release using a foam roll or roller massager on joint range of motion, muscle recovery, and performance: a systematic review.

BACKGROUND The use of foam rollers to provide tissue massage is a commonly used intervention by rehabilitation professionals for their patients and clients. Currently, there is no consensus on the optimal foam rolling treatment approach. Of particular interest are the effects of different instructional methods of foam rolling, as individuals ultimately perform these interventions independently outside of formal care. Finding the optimal instructional method may help improve the individual's understanding of the technique, allowing for a safe and effective intervention. PURPOSE The purpose of this study was to compare the effects of video-guided, live instructed, and self-guided foam roll interventions on knee flexion Range of Motion (ROM) and pressure pain thresholds. METHODS Forty-five healthy adults were recruited and randomly allocated to one of three intervention groups: video-guided, live-instructed, and self-guided. Each foam roll intervention lasted a total of 2 minutes. Dependent variables included knee flexion ROM and pressure pain threshold of the left quadriceps. Statistical analysis included subject demographic calculations and appropriate parametric and non-parametric tests to measure changes within and between intervention groups. RESULTS Each intervention group showed significant gains in knee flexion ROM (p ≤ 0.003) and pressure pain thresholds (p < 0.001). An approximate 5 degree increase of knee flexion and a 150 kPa increase in pressure pain threshold was observed at the posttest measure for all groups. There was no significant difference (p=0.25) found between intervention groups. CONCLUSION All three foam roll interventions showed short-term increases in knee flexion ROM and pressure pain thresholds. The two instructional methods (video and live instruction) and the self-guided method produced similar outcomes and can be used interchangeably. Individuals can benefit from various types of instruction and in cases of limited resources video may offer an alternative or adjunct to live instruction or an existing self-guided program. LEVEL OF EVIDENCE 2c.

Comparison of video-guided, live instructed, and self-guided foam roll interventions on knee joint range of motion and pressure pain threshold: a randomized controlled trial.

RHEUMATOID ARTHRITIS (RA) IS A CHRONIC SYSTEMIC INFLAMMATORY DISEASE THAT AFFECTS THE JOINTS OF THE BODY CAUSING DEFORMITY AND FUNCTIONAL IMPAIRMENTS. RA AFFECTS APPROXIMATELY 1.3 MILLION AMERICANS WITH WOMEN BEING AFFECTED MORE THAN MEN. BECAUSE OF THE PREVALENCE OF THIS CONDITION, IT IS IM

Rheumatoid Arthritis: Exercise Programming for the Strength and Conditioning Professional

SNAPPING HIP SYNDROME (SHS) IS A MUSCULOSKELETAL CONDITION CHARACTERIZED BY A PALPABLE OR AUDIBLE “SNAPPING” THAT OCCURS AROUND THE HIP WITH MOVEMENT. SHS IS FURTHER CLASSIFIED INTO INTERNAL AND EXTERNAL VARIANTS. BECAUSE OF THE PREVALENCE OF SHS AMONG ACTIVE INDIVIDUALS, IT IS IMPORTANT FOR

Matt Cain

Papers

The effects of self-myofascial release using a foam roll or roller massager on joint range of motion, muscle recovery, and performance: a systematic review.

The efficacy of instrument assisted soft tissue mobilization: a systematic review.

Comparison of video-guided, live instructed, and self-guided foam roll interventions on knee joint range of motion and pressure pain threshold: a randomized controlled trial.

Rheumatoid Arthritis: Exercise Programming for the Strength and Conditioning Professional

Snapping Hip Syndrome: A Review for the Strength and Conditioning Professional