Authored by Michael L Fink*
Abstract
Background and purpose: Foam rolling is a commonly used technique for increasing soft tissue extensibility especially after injury, but little research exists to showcase its effectiveness to date. The purpose of this article was to assess the effect of soft tissue mobilization with roller devices compared to PNF stretching on hamstring muscle flexibility.
Methods: A literature search of Medline and Cinahl Plus was conducted to identify potential studies (published through October 2014).
Findings: 12 articles met inclusion criteria (4 related to soft tissue mobilization with roller devices, 8 related to PNF stretching). No studies provided a direct comparison of soft tissue mobilization with roller devices and PNF stretching. All 8 studies related to PNF stretching report significant improvement in hamstring flexibility following intervention. 3 of 4 studies related to soft tissue mobilization with roller devices reported hamstring flexibility improvement.
Clinical relevance: Soft tissue mobilization with roller devices and PNF stretching are both common techniques in physical therapy practice. Physical therapists should be familiar with expected outcomes and supporting evidence regarding these interventions as many patients require improved flexibility.
Keywords: Stretching; Foam roller; Range of motion; Massage; Muscle tightness
Introduction
Using rolling devices for soft tissue mobilization, often termed “muscle massage” or “myofascial release”, is prevalent in modern athletic training, personal fitness and physical therapy practice. Athletes, patients, and those interested in maintaining fitness alike are delivered claims about the potential benefits of these devices. Claims range from decreasing fatigue post-exercise to improving athletic performance to increasing range of motion (ROM) and muscle flexibility [1]. This may be of special interest to physical therapists because ROM and flexibility limitations are common patient/client impairments that often must be addressed to restore function. However, the majority of device manufacturers promote these products without sufficient, or often any, research to back up their declarations. As a result, it is important to appraise the available literature to determine the effectiveness of rolling devices in restoring muscle flexibility and ROM. It is also logical to compare these effects with proprioceptive neuromuscular facilitation (PNF) stretching, another commonly used technique aimed at improving flexibility/ROM [2].
Foam rollers (Figure 1) and rolling pin type devices such as “The Stick” [3] (Figure 2) are commonly advertised tools. Foam rollers are often referred to as self-myofascial release devices, due to use of an individual’s own body weight rolling over the foam roll to apply pressure onto muscle and fascial tissues1. Rolling pin type devices use a non-motorized solid spindles, capable of producing direct force to muscle externally, using a rotary movement pattern. Both rolling devices may be fixed onto an external apparatus to allow for a self-soft tissue mobilization effect [4], can be self-applied, or can applied by another individual externally.
PNF stretching, specifically contract-relax stretching, involves a therapist passively moving a muscle group to the point of resistance due to restriction then asking the client to provide a volitional isometric contraction of either the same muscle being stretched or the antagonist muscle(s). The volitional isometric contraction is followed by relaxation of the muscle group and passive progressive stretching to a new point of restriction5. Contract-relax PNF stretching, is based on the concept of reciprocal inhibition and autogenic inhibition. Reciprocal inhibition describes the phenomenon of activation of a muscle group causes inhibition of the antagonist muscle group. It is believed that the isometric contraction causes input to the Ia-inhibitory interneurons, which cause inhibition of the motor neurons to the antagonist muscle group [5]. When applying this concept to the hamstring muscle group, the quadriceps are isometrically contracted resulting in a reflexive relaxation of the hamstring muscle group. In contrast, autogenic inhibition applies to contraction of the muscle group being stretched which activates Golgi tendon organs, causing inhibition of motor neurons of the same muscle through IBMinhibitory interneurons [5]. When autogenic inhibition is applied to the hamstring muscle group, the hamstrings are isometrically contracted resulting in a reflexive relaxation of this muscle group.
The purpose of this study was to compare soft tissue mobilization with rolling devices to that of PNF stretching for increasing hamstring muscle flexibility in college-aged athletic population to determine the most effective intervention for clinical use.
The hamstring muscle group was chosen to evaluate the efficacy of rolling devices versus PNF for restoring muscle flexibility due to it being a site of frequent muscular tightness. Additionally, hamstring tightness can have a negative effect on performance and place the athletic population at higher risk of injury. Yasuhiro et al [6]. concluded that hamstring tightness decreased medial and lateral reach on the star excursion balance test. The test scores support decreased performance and also support increased future injury risk [6]. Hamstring muscle tightness can even contribute to low back pain by limiting rotation of the pelvis during flexion. Movements with large amounts of full body flexion, in the presence of hamstring tightness, puts greater stress on posterior chain structures supporting the spine Zhu Q [7]. further described a correlation between adolescents with hamstring tightness and MRI findings of disc herniation in the lumbar spine and lumbo-sacral junction [7]. These potential outcomes associated with hamstring inflexibility place even more importance on determining an effective means of improving or restoring hamstring muscle flexibility.
Methods
Search
A literature search of Medline and Cinahl Plus was conducted between September and October 2014 to identify articles related to hamstring muscle flexibility using soft tissue mobilization with rolling devices and PNF stretching. The search terms for soft tissue mobilization with rolling devices included: “Self-myofascial release”, or “foam roller”, or “The Stick”, “range of motion” or “flexibility”, and “muscle”. The search terms for hamstring PNF stretching included: “PNF stretch”, “PNF stretching”, “hamstring”, and “range of motion”. The following limitations were implemented: peer-reviewed, research article (Cinahl Plus); English (Medline and Cinahl); humans (Medline); publication date 2000-present.
Inclusion criteria
Peer reviewed articles, written in English, from 2000 to present, with the aforementioned search terms for each conditions were included. Additionally, research studies must discuss an intervention fitting the above operational definition of soft tissue mobilization with rolling devices or PNF, target the hamstrings, measure hamstring flexibility, and include a sample of subjects with a mean within college-aged range (18-26).
Exclusion criteria
The articles were excluded if the intervention did not fit into either the operational definition for soft tissue massage with rolling devices or PNF, if the intervention did not target the hamstring muscle group, the subjects were not college-aged (18-26), or hamstring flexibility was not assessed in some manner.
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