Professional Documents
Culture Documents
discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/305691504
CITATIONS READS
0 1,076
4 authors, including:
SEE PROFILE
Some of the authors of this publication are also working on these related projects:
All content following this page was uploaded by Christian Baumgart on 09 September 2016.
Klassifikationen und Schwierigkeiten, According to the function, fascial sensomotoric system adapts to
mittels Foam-Rolling fasziales Bindege- connective tissue is present in these altered information [15,17,
webe zu beeinflussen. Die in Sport und different forms with respect to the 23,4143,51,57,58].
Therapie beschriebenen sechs Myo- density and alignment within fibers In consideration of the lower leg,
fascial lines sind nicht evidenzbasiert. [11,60,61,63]. Staubesand and Li [67] showed that
Fasziales Bindegewebe verbindet un-
terschiedliche Korperregionen und -ge-
the lamina superficialis of fascia cru-
Lymph, nerves, interoception, ris possesses slotted to funnel-
webe und dient der Kraftubertragung and blood vessels
und Kompression. Daruber hinaus shaped passage openings for the
trennt fasziales Bindegewebe verschie- Lymph, nerves, and blood vessels Vv. perforantes, connecting the
dene Kompartimente und -gewebe. Aus passing through the fascial connec- superficial and deep venous system.
biomechanischer Sicht ist fasziales Bin- tive tissue are mostly found Usually, such points of passages are
degewebe in der Lage zu kontrahieren, combined in orthogonal direction accompanied by a respective small
wenn auch nur mit kaum messbarer (Fig. 1). artery and/or vein, mostly vegeta-
Kraftentwicklung. In Sport und Thera- Fascial connective tissue also has an tive nerve, and thin-walled lym-
pie wird durch Foam-Rolling hoher extensive innervation and is supplied phatic vessel. Further, openings
Druck auf das darunter liegende Ge- for larger skin nerves and vessels
by different mechano- and chemo-
webe ausgeubt, was zu Schadigungen
von Nervengewebe, Rezeptoren, Gefa- receptors [20,31,38]. Importantly, can be found [67].
en und Knochen fuhren kann insbe- the number of receptors is up to The local myelinated axons con-
sondere bei Vorschadigungen und Er- ten-fold higher in fascial connective duct afferents from the skin for
krankungen wie Diabetes mellitus, tissue than in muscle [72]. Further, touch and pressure (Ab- fibers of
Krampfadern oder Osteoporose. the periosteum is considered as fas- an average diameter of 8 mm) as
cial connective tissue and is densely well as temperature and surface
sselwo
Schlu rter supplied by receptors [40]. pain (Ad- fibers of an average
Biomechanik Myofascial release Training
Faszien Physiotherapie
By interoceptive, proprioceptive, diameter of <3 mm). Also, there
and nociceptive capabilities, mech- are many unmyelinated fibers con-
anical and chemical information are ducting afferents from the skin and
collected and transmitted to the proceed deep pain through C-fibers
CNS. Through changes in afferents, [20,67].
the perception of the own body In conclusion, this particular
image is affected and the anatomy of fascia connective tissue
is potentially not suited for high
mechanical compression forces
induced by Foam-rolling exercises.
Superficial, deep, and visceral
layers
The superficial layer of fascial con-
nective tissue consists of loose con-
nective and fat tissue and is
subcutaneously located. Mostly, it
is connected to the reticular layer
of the dermis and is multiply
attached to tendons and bones. In
comparison to the deeper layer,
Figure 1
Passage of a triad through superficial
superficial fascial connective tissue
fascial connective tissue. Left nerve, tolerates higher stretching tensions
middle vein; right artery. Most of [2429,32,73].
these perforation points are topographi- The deeper layer of fascial connec-
cally identical with traditional Chinese tive tissue is organized as apo-
acupuncture points. Usually, the perfor-
ating nerves innervate Pacinian and
neuroses or fascia latae, plantar
Meissner corpuscles under the skin fascia, ligaments, tendons, joint
[56,67]. capsules, and muscle septa. It is
J. Freiwald et al.
Foam-rolling in sport and therapy 259
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 258266 (2016)
Table 1. Fascial categories: functions, terms and histological features linking (modified after [34]).
fibrous and encloses muscles, Evidence of myofascial lines Strong evidence was only found
bones, nerves, and blood vessels for three of the six assumed myo-
as well as has a lower blood flow For many years, therapeutic inter- fascial lines, namely, the super-
than the superficial fascial connec- ventions have focused on fascial ficial back, back functional, and
tive tissue due to its different func- connective tissue. However, its front functional line.
tion [36,75]. anatomy, physiology, and biome- Moderate to strong evidence was
The visceral layer of fascial connec- chanical functions are not suffi- found for the spiral and lateral line.
tive tissue consists of a serous ciently investigated (among others No evidence was found for the
double membrane layer and serves, [73]). Therefore, the existing con- superficial frontline.
among other purposes, as a suspen- cepts for therapy and training should
sion and protection for the inner be critically reviewed [46,52,64]. For To conclude, and in consideration of
organs [6,36]. example, Wilke, Krause [73] ques- that poor evidence, it is surprisingly
Overall, due to the particular tioned in their comprehensive review that patients in medicine and sport
anatomy, the dissimilar fascial con- the presence of assumed myofascial are still treaded under the assump-
nective tissue layers possess differ- lines and provided the following tion of six myofascial lines [48,
ent functions. conclusions (Table 4): 49,73].
Table 2. Fascial categories: functions, terms, and histological features fascicular, compression, and separating (modified after [34]).
Fascicular Provides myofascial force Intramuscular & extramuscular Loose connective Collagen types:
transmission & proprioceptive fasciae. Neuromuscular sheaths tissue I, III, IV, V, XII, XIV
feedback for movement Endomysium Dense regular Golgi tendon organs
control Perimysium multidirectional
Maintains protection for Epimysium parallel ordered
nerves and vessels Endotendon connective tissue
Allows vascular sheaths to be Peritendon Dense irregular
in continuity with adventitia Paratendon connective tissue
Perichondrium
Endosteum
Periosteum
Endoneurium
Perineurium
Epineurium
Compression Provides stocking, Fasciae of limbs/membrorum Dense regular woven Collagen type:
compression and tension Brachial fascia connective tissue I
compartmental effects Antebrachial fascia Multidirectional
Influences venous return Dorsal fascia of hand parallel ordered Elastin
Enhances proprioception, Fascia lata connective tissue Ruffinis corpuscles
muscular efficiency and Crural fascia
coordination Dorsal fascia of foot
Separating Compartmentalizes organs and Parietal Fasciae Loose connective Collagen Types:
body regions to maintain Parietal pleura tissue III, V, VII
structural functions Fibrous pericardium Dense irregular
Promotes sliding and reduces Endothoracic fascia fusocellular Extracellular matrix:
friction during motion Parietal peritoneum connective tissue reticular and elastic
Responds to stretch and Endoabdominal fascia fibers
distension Endopelvic fascia Reticular fibers
Provides physical support and Visceral fascia provide a cellular
shock absorption Meninges framework
Limits the spread of infection Visceral pleura Elastin
Serous pericardium Pacinian and Ruffinis
Visceral abdominal fascia corpuscles
Visceral pelvic fascia
Extraserosal fascia
Sternopericardial ligaments
Bronchopericardial membrane
Pulmonary ligaments
Extraperitoneal fascia
Investing fascia
Subcutaneous tissue of abdomen
Membranous layer of perineum
Biomechanics of fascial bones, and inner organs [5,25,32, is mechanically stressed (e.g., joint
connective tissue and FOAM- 54,73,74]. capsules, tendons, ligaments, nerves,
rolling arteries, arterioles, veins, venules,
Mechanical impact on the capillaries, lymphatics) [13,42,
Fascial connective tissue links underling tissue 45,66]. The mechanical effects of
muscles with the surrounding tissue During Foam-rolling exercises, all Foam-rolling exercises on these tis-
and transmits and distributes forces the underlying tissue innervated sues have not been examined yet. For
to muscles, adjacent muscles, by mechano- and chemoreceptors example, whether and to which
J. Freiwald et al.
Foam-rolling in sport and therapy 261
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 258266 (2016)
Dense connective tissue Connective tissue containing closely packed, irregularly arranged (that is, aligned in many directions)
collagen fibers
Non-dense (areolar) Connective tissue containing sparse, irregularly arranged collagen fibers
connective tissue
Superficial fascia Enveloping layer directly beneath the skin containing dense and areolar connective tissue and fat
Deep fascia Continuous sheet of mostly dense, irregularly arranged connective tissue that limits the changes in shape
of underlying tissues. Deep fascia may be continuous with epimysium and intermuscular septa and may
also contain layers of areolar connective tissue
Intermuscular septa A thin layer of closely packed bundles of collagen fibers, possibly with several preferential directions
predominating, arranged in various layers. The septa separate different, usually antagonistic, muscle
groups (for example, flexors and extensors), but may not limit force transmission
Interosseal membrane Two bones in a limb segment can be connected by a thin collagen membrane with a structure similar to
the intermuscular septa.
Periost Surrounding each bone and attached to it is a bi-layered collagen membrane similar in structure to the
epimysium
Neurovascular tract The extramuscular collagen fiber reinforcement of blood and lymph vessels and nerves. This complex
structure can be quite stiff. The diameter and, presumably, the stiffness of neurovascular tracts decrease
along limbs from proximal to distal parts. Their stiffness is related to the angle or angles of the joints
that they cross
Epimysium A multi-layered, irregularly arranged collagen fiber sheet that envelopes muscles and that may contain
layers of both dense and areolar connective tissue
Intra- and extramuscular A multilayered structure with densely laid down bundles of collagen with major preferential directions.
aponeurosis The epimysium also covers the aponeuroses, but is not attached to them. Muscle fibers are attached to
intramuscular aponeuroses by their myotendinous junctions
Perimysium A dense, multi-layered, irregularly arranged collagen fiber sheet that envelopes muscle fascicles.
Adjacent fascicles share a wall of the tube (like the cells of a honeycomb)
Endomysium Fine network of irregularly arranged collagen fibers that form a tube enveloping and connecting each
muscle fiber. Adjacent muscle fibers share a wall of the tube (like the cells of a honeycomb)
extent nerve tissue is influenced in pressures to the spine and spinous affected by the density and acti-
its ability to synthesize and express processes are applied. vation potential of myofibroblasts
neurotransmitter is unknown To summarize, during Foam-rolling [69].
[20,16,37]. exercises, a high mechanical load to One possible function for the con-
Noteworthy, during Foam-rolling the entire underlying tissue is tractile abilities of fascial connec-
exercises, the commonly induced induced, potentially leading to tive tissue may be to adjust the
mechanical pressure on the under- harmful effects in connective tis- preload of the (fascial) collagen
lying tissue is clearly higher than sue, nerves, vessels, and bones that scaffold to the respective resting
the upper permissible value of need further research. and action phases of the corre-
maximal compression in vein sponding muscle [67]. However,
therapy [3]. Contractile abilities of fascial Staubesand and Li [67] noted that
Lastly, when performing Foam-roll- connective tissue the discovery of contractile abilities
ing exercises in the supine position, The previously prevailing idea that regarding fascial connective tissue
users have reported creaky noises fascial connective tissue has purely should not be overestimated,
at the vertebral bodies similar to passive functions needs revision. In because they are well known during
chiropractic treatments. Given the fact, stray smooth muscle cells wound healing and scar formation
fact that the education of chiroprac- (myofibroblasts) were found in the [7,67,69].
tic take many years, especially due superficial sheet and deeper layers Also worth mentioning, the fascial
to the potential risks of the applied of the fascia cruris, which can there- connective tissue is just mm to mm
treatments, it is not wise that fore actively contract [67]. thick, and thus, contributes only
uneducated staff offer Foam-rolling Consequently, the stiffness of the minor to the contractile forces,
courses in gyms during which high fascial connective tissue is also ranging from few Dyn up to
Table 4. Myofascial lines and corresponding soft tissue components (modified after
fascial myofibroblasts could led to
[73]). changes in myofascial tissue stiff-
ness (tone) [43]. The term tone
Myofascial Line Soft tissue component is defined as a mechanical tension
Superficial back line Plantar fascia state, including both the viscoelas-
Achilles tendon/M. gastrocnemius tic tone and contractile activity
Hamstrings (M. biceps femoris, M. semitendinosus, [18,43]. Beside this peripheral fac-
M. semimembranosus) tors, there are also central nervous
Sacrotuberous ligament and medical induced aspects that
Lumbar fascia/erector spinae
have an impact on the myofascial
Superficial front line Toe extensors, M. tibialis anterior, anterior crural
tissue stiffness, for instance, drugs
department
Subpatellar tendon effecting the CNS [47] and infiltra-
M. rectus femoris/quadriceps tion of C3 transferase and botulinum
M. rectus abdominis toxin, respectively [65]. Moreover,
M. sternalis/sternochondral fascia thixotropic aspects should also be
M. sternocleidomastoideus taken into account [2,14,43].
Back functional line M. vastus lateralis To summarize, fascial connective
M. gluteus maximus
tissue has contractile abilities.
Lumbar fascia
M. latissimus dorsi However, both the function and
Front functional line M. adductor longus underlying physiology is not com-
M. rectus abdominis pletely understood. The observed
M. pectoralis major contraction forces of the fascia con-
Spiral line Lumbar/erector spinae nective tissue are small and the
Sacrotuberous ligament influential factors requires more
M. biceps femoris
research.
M. peroneus longus
M. tibialis anterior
M. tensor fasciae latae, iliotibial tract Conclusions and future
M. obliquus abdominis internus requirements
M. obliquus abdominis externus
M. serratus anterior To date, Foam-rolling is frequently
M. rhomboideus major and minor applied as a treatment in medicine
M. splenius capitis and cervicis and sport. However, the nomencla-
Lateral line M. peroneus longus and brevis, lateral crural compartment
Iliotibial tract/gluteus medius
ture, definitions, and anatomy of
M. tensor fasciae latae fascia connective tissue are not
M. gluteus maximus entirely clear. Furthermore, it is sur-
M. obliquus abdominis externus and internus prisingly that patients in medicine
M. intercostalis externus and internus and sport are treaded under the
M. splenius capitis/M. sternocleidomastoid assumption of six myofascial lines,
whereas the scientific evidence is
only poor.
For an appropriate application of
4.1 mN/cell [69]. The generated The influencing factors of the fascial Foam-rolling exercises in therapy
forces show oscillative character- contractile abilities include mental and training, universally accepted
istics, lasting from seconds to factors, age, trigger points, illness, nomenclatures and definitions of
minutes. Nevertheless, long-term and water content [1,8,12,21, fascial connective tissue regarding
fascial connective tissue contrac- 22,33,43,50] as well as impair- its anatomy and physiology are
tions are also known that can led ment-, disease-, and stress-induced necessary. In consideration to
to contractures [62]. Finally, in changes in the chemical environ- potential harmful effects, more evi-
vivo, it is difficult to differentiate ment (e.g., through cytokines, pH) dence based knowledge is strongly
between the changes of stiffness in [53]. Therefore, it is conceivable required.
muscles or/and fascial connective that changes in the biomechanical Due to the particular anatomy, the
tissue [43]. or chemical environment of the dissimilar fascia connective tissue
J. Freiwald et al.
Foam-rolling in sport and therapy 263
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 258266 (2016)
experimental results, Scand. J. Med. Dordrecht/London/New York, 2010, Sci. Sports Exerc. 41 (1) (2009) 184
Sci. Sports 15 (6) (2005) 349380. pp. 105175. 190.
[29] P.A. Huijing, Epimuscular myofascial [42] S. Mense, R.D. Gerwin (Eds.), Muscle [55] S. Schiaffino, T. Partridge, Skelteal
force transmission: a historical review Pain: Understanding the Mechanisms, muscle repair und regeneration, in:
and implications for new research. Springer-Verlag, Berlin/Heidelberg, G.J.M. Stienen (Ed.), Advances in
International Society of Biomechanics 2010. Muscle Research, vol. 3, Springer,
Muybridge Award Lecture, Taipei, 2007, [43] S. Mense, A.T. Masi, Increased muscle Dordrecht, 2008, pp. 1194.
J. Biomech. 42 (1) (2009) 921. tonus as a cause of muscle pain, in: S. [56] R. Schleip, Fascial plasticity a
[30] P.A. Huijing, et al., Fascia Research II Mense, R.D. Gerwin (Eds.), Muscle new neurobiological explanation:
Basic Science and Implications for Pain: Understanding the Mechanisms, Part 2, J. Bodyw. Mov. Ther. (2003)
Conventional and Complementary Springer, Heidelberg/Dordrecht/ 105116.
Health Care, Urban & Fischer, London/New York, 2010, pp. 207249. [57] R. Schleip, Fascia as an organ of com-
Munchen, 2009. [44] T. Meyer, et al., Regenerations- munication, in: Fascia: The Tensional
[31] L. Jozsa, P. Kannus, Human Tendons, managment im Spitzensport. Network of the Human Body, Elsevier,
Human Kinetics, Champaign, 1997, p. REGman-Ergebnisse und Handlungs- Edingburgh, 2012, pp. 7779.
574. empfehlungen, Strau, Koln, 2016. [58] R. Schleip, H. Jager, Interoception, in:
[32] F. Krause, et al., Intermuscular force [45] S.L. Michlovitz, J.W. Bellew, T.P. Nolan Fascia: The Tensional Network of the
transmission along myofascial chains: (Eds.), Modalities for Therapeutic Human Body, Elsevier, Edingburgh,
a systematic review, J. Anat. (2016). Intervention, 5th ed., F.A. Davis 2012, pp. 8994.
[33] M. Kreulen, M.J.C. Smeulders, P.A. Company, 2012. [59] R. Schleip, D.G. Muller, Training
Huijing, Spastic paresis, in: Fascia: The [46] D.G. Muller, R. Schleip, Fascial fitness, principles for fascial connective tis-
Tensional Network of the Human in: Fascia: The Tensional Network of sues: scientific foundation and
Body, Elsevier, Edingburgh, 2012, pp. the Human Body, Elsevier, Edingburgh, suggested practical applications, J.
205213. 2012465475. Bodyw. Mov. Ther. 17 (1) (2013)
[34] M. Kumka, J. Bonar, Fascia: a morpho- [47] E. Mutschler, et al. Mutschler 103115.
logical description and classification Arzneimittelwirkungen: Pharmakologie, [60] R. Schleip, et al. (Eds.), Fascia: The
system based on a literature review, Klinische Pharmakologie, Toxikologe, Tensional Network of the Human
J. Can. Chiropr. Assoc. 56 (3) (2012) vol. 10, Wissenschaftliche Verlags- Body, Elsevier, Edingburgh, 2012, p.
179191. gesellschaft Stuttgart, Stuttgart, 2013. 535.
[35] H.M. Langevin, P.A. Huijing, [48] T. Myers, Anatomy trains and force [61] R. Schleip, H. Jager, W. Klingler, What
Communicating about fascia: history, transmission, in: Fascia: The Tensional is fascia? A Review of Different
pitfalls, and recommendations, Int. J. Network of the Human Body, Elsevier, Nomenclatures, J. Bodyw. Mov. Ther.
Ther. Massage Bodyw. 2 (4) (2009) 38. Edingburgh, 2012, pp. 131136. 16 (4) (2012) 496502.
[36] H. Leonhardt (Ed.), 3rd ed., Anatomie [49] T.W. Myers, Anatomy Trains [62] R. Schleip, H. Jager, W. Klingler, Fascia
des Menschen, vol. 1, Thieme, Myofascial Meridians for Manual and is alive, in: R. Schleip, et al. (Eds.),
Stuttgart, 2003. Movement Therapists, 3rd ed., Fascia: The Tensional Network of the
[37] S.M. Lephart, F.H. Fu (Eds.), Churchill Livingstone, Edingburg, Human Body, Elsevier, Edingburgh,
Proprioception and Neuromuscular 2014. 2012, pp. 157164.
Control in Joint Stability, Human [50] I.L. Naylor, Dupuytrens disease and [63] R. Schleip, et al. (Eds.), Lehrbuch
Kinetics, Champaign, 2000, p. 439. other fibrocontractive disorders, in: Faszien Grundlagen, Forschung,
[38] B.R. MacIntosh, P.F. Gardiner, A.J. Fascia: The Tensional Network of the Behandlung, Urban & Fischer,
McComas, Sceletal Muscle. Form and Human Body, Elsevier, Edingburgh, Munchen, 2014.
Function, 2nd ed., Human Kinetics, 2012, pp. 191197. [64] G. Slomka, The Fascial Network. Train
Champaign, 2006. [51] J.L. Oschmann, Fascia as a body-wide and Improve Your Posture, Strength
[39] K. McKenney, et al., Myofascial release communication system, in: Fascia: The and Flexibility, Meyer & Meyer
as a treatment for orthopaedic con- Tensional Network of the Human Body, Sport, Aachen, 2015.
ditions: a systematic review, J. Athl. Elsevier, Edingburgh, 2012, pp. 103 [65] B.J. Snow, et al., Treatment of spas-
Train. 48 (4) (2013) 522527. 110. ticity with botulinum toxin: a double-
[40] S. Mense, Functional anatomy of [52] S. Paoletti, Faszien Anatomie, blind study, Ann. Neurol. 28 (4)
muscle: muscle, nociceptors and affer- Strukturen, Techniken, Spezielle (1990) 512515.
ent fibers, in: S. Mense, R.D. Gerwin Osteopathie, 2nd ed., Urban & [66] J. Sobotta, Atlas der Anatomie des
(Eds.), Muscle Pain: Understanding the Fischer, Munchen, 2011. Menschen. Rumpf, Eingeweide, untere
Mechanisms, Springer, Heidelberg/ [53] M. Parizi, E.W. Howard, J.J. Tomasek, Extremitat, in: R Putz, R. Pabst (Eds.),
Dordrecht/London/New York, 2010, Regulation of LPA-promoted myofibro- 21. Auflage ed., Atlas der Anatomie
pp. 1748. blast contraction: role of Rho, myosin des Menschen, Vol. 2, Urban &
[41] S. Mense, Central nervous mechanisms of light chain kinase, and myosin light Fischer, Munchen, 2000, p. 429.
muscle pain: ascending pathways, cen- chain phosphatase, Exp. Cell Res. 254 [67] J. Staubesand, Y. Li, Zum Feinbau der
tral sensitization, and pain-modulating (2) (2000) 210220. Fascia cruris mit besonderer
systems, in: S. Mense, R.D. Gerwin [54] T.G. Sandercock, H. Maas, Force Berucksichtigung epi-und intrafas-
(Eds.), Muscle Pain: Understanding the summation between muscles: are zialer Nerven, Manuelle Medizin 34
Mechanisms, Springer, Heidelberg/ muscles independent actuators? Med. (34) (1996) 196200.
J. Freiwald et al.
Foam-rolling in sport and therapy 265
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 258266 (2016)
[68] P.M. Tiidus, Skeletal Muscle Damage the Human Body, Elsevier, Edingburgh, Exerc. Sport Sci. Rev. 38 (3) (2010)
and Repair, Human Kinetics, 2012, pp. 165170. 128134.
Champaign, 2008. [72] J.C. van der Wal, Proprioception, in: [75] K. Zilles, B.N. Tillmann, Anatomie,
[69] J.J. Tomasek, et al., Myofibroblasts Fascia: The Tensional Network of the Springer-Verlag, Berlin, 2010.
and mechano-regulation of connective Human Body, Elsevier, Edingburgh,
tissue remodelling, Nat. Rev. Mol. Cell 2012, pp. 8187.
Biol. 3 (5) (2002) 349363. [73] J. Wilke, et al., What is evidence-based Corresponding author:
[70] F. Van den Berg, The physiology of fas- about myofascial chains: a systematic Univ. Prof. Dr. Jurgen Freiwald M.A.,
cia, in: Fascia: The Tensional Network of review, Arch. Phys. Med. Rehabil. 97 Department of Movement
the Human Body, Elsevier, Edingburgh, (3) (2016) 454461. and Training Science, University of
2012, pp. 149155. [74] C.A. Yucesoy, Epimuscular myofascial Wuppertal, Wuppertal, Germany.
[71] F. Van den Berg, Extracellular matrix, force transmission implies novel Fax: +49 0202 439 2956.
in: Fascia: The Tensional Network of principles for muscular mechanics, E-Mail: freiwald@uni-wuppertal.de
ScienceDirect
J. Freiwald et al.
Foam-rolling in sport and therapy 267
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267275 (2016)
J. Freiwald et al.
Foam-rolling in sport and therapy 269
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267275 (2016)
as anaerobic capacity, explosive up procedures prior to training or While many studies have examined
strength, and anaerobic power competition can be given at this the short-term effects of Foam-roll-
related parameters (Overviews in time. ing exercises on flexibility (ROM),
[10,18,51,59,83]). only few studies have investigated
Mikesky et al. [59] and Healey et al. Improving anaerobic performance middle- or long-term effects [10,11,
[38] investigated the effects of prior Janot et al. [42] compared the 16,18,36,44,60,77].
Foam-rolling exercises on vertical effects of static stretching and Roylance et al. [72] investigated the
jump height, hamstring flexibility, Foam-rolling exercises on anaerobic short-term effects of either postural
flying-start 20-yard dash, and iso- power parameters (i.e., 30-sec alignment or static stretching on
kinetic knee extension at 908/s. The Wingate test performance). The lumbar spinal, hip, knee, and ankle
results showed no effects of Foam- effects of Foam-rolling exercises flexibility (ROM), when Foam-rolling
rolling exercises. These findings are on anaerobic power are inconclu- exercises were additionally per-
supported by those of Kuhnemann sive. Consequently, to improve formed. The results demonstrate
[48], who demonstrated that an anaerobic capacity, no recommen- that additionally performed Foam-
ergometer based warming-up dation to perform Foam-rolling exer- rolling exercises increased flexibility
increased the vertical jump height cises can be given. (ROM).
in contrast to Foam-rolling exercises Similarly, Markovic [53] evaluated
(Fig. 4). Improving flexibility (ROM) the short-term effects of Foam-roll-
To summarize, most studies show no Foam-rolling exercises can tempor- ing exercises on hip and knee flexi-
effects of Foam-rolling exercises on arily increase the ROM of hip, knee, bility (ROM) in soccer players. In
performance parameters in athletes, and ankle-joint without impairing this study, passive knee flexion
when Foam-rolling exercises were the neuromuscular activity or maxi- and straight leg raise tests were
included in warming-up procedures mum isometric force [18,51,60]. measured before, immediately after,
[21,38,59,64]. Consequently, to However, in one study, there were and 24 h after the Foam-rolling
improve athletic performance, no no differences in ROM, when a con- treatment. The findings show that
general recommendation to perform ventional stretch training was com- the knee and hip flexibility (ROM)
Foam-rolling exercises as warming- pared to Foam-rolling exercises [44]. only improved immediately after the
treatment, whereas no effects were
evident after 24 h.
Further, Skarabot et al. [80] com-
pared the short-term effects of
Foam-rolling, static-stretching, and
a combination of both exercises on
ankle flexibility (ROM). The results
show that all interventions increased
flexibility (ROM); noteworthy, a
combination of Foam-rolling and
static stretching exercises has
superior effects compared to an iso-
lated treatment. Moreover, accord-
ing to the interventions, the
effects on flexibility (ROM) lasted
less than 10 min.
Lastly, Mohr et al. [60] compared
the middle-term effects of Foam-
rolling, static stretching, and a
combination of both exercises on
hip flexibility (ROM) over six ses-
Figure 4
sions. Again, the outcomes revealed
Effects of commonly performed Foam-rolling (i.e., at both thighs and calves) and
traditional ergometer cycling warming-up (i.e., for 10 min at RPE 12-14) exercises that all interventions increased
on the counter movement jump height in male recreational athletes (n = 20). Note: flexibility (ROM) and that a combi-
* Statistical significant differences (p < 0.001) between pre and post and within post. nation of Foam-rolling and static
stretching exercises showed the and coordination has not been pro- unclear. However, it is possible that
largest effects. ven yet. It is important to consider Foam-rolling exercises induce struc-
Taken overall, the underlying that Foam-rolling exercises may not tural damage or metabolic and
reasons for the improved flexibility only impact the sensory function, neuronal alterations that lead to
(ROM) remain unclear. From a struc- but also the local metabolism. changes in DOMS [10,12,25,31,43,
tural point of view, the observed Therefore, changes in the local 68,89,92].
effects can be explained by a metabolism may influence the sen- Consequently, at this time, there is
reduction in bonds between fascial somotoric function [56]. In contrast only minor scientific evidence in
connective and muscle tissue [8,12, to Foam-rolling exercises, after regards to Foam-rolling exercises
6770,78] or a plastic deformation traditional warming-up procedures, as a treatment to reduce DOMS.
of the connective tissue (e.g., fas- the improvement in joint position
cia, tendon, capsule). From an func- perception and position sense at Reduction of muscle and
tional point of view, a temporally the knee joint are well proven connective tissue tone
reduction in the perception of pain [5,50,73]. One Foam-rolling exercises associ-
may also lead to a short-term Consequently, to improve sensomo- ated expectation is to reduce the
enhanced flexibility (ROM) [10,12, toric function and coordination, a muscular and connective tissue tone
23,43,68,91,90]. recommendation to perform Foam- (Myofascial Release). Noteworthy,
Consequently, to improve flexibility rolling exercises cannot be given at most research failed to conduct
(ROM), a recommendation to per- this time. In athletes, a sport- valid measurements. For example,
form Foam-rolling exercises can be specific and individual warming-up previous studies failed to differen-
given, when aiming to increase the seems to be more beneficial than tiate between the mechanical tone
flexibility beyond the maximal Foam-rolling exercises. and neuro-muscular activation,
accessible effects induced through which is widely independent from
traditional stretching procedures. Improving reduction of stress- ROM [23,25,32,56].
relaxation Due to the lack of valid measure-
Improving sensomotoric function Practitioners recommend Foam-roll- ments, future studies should apply
and coordination ing exercises to reduce stress. valid procedures to measure the
The fascia connective tissue, especi- However, in this context, there is muscle and connective tissue tone
ally the deep layers, has a compre- only one study. Kim et al. [45] (e.g., through myotonometrie and
hensive innervation and is supplied examined the influence of Foam-roll- electromyography).
by various receptors [39,55,82,84]. ing exercises on the level of serum Therefore, we cannot give a recom-
The number of receptors located in cortisol as an established stress mendation to perform Foam-rolling
the fascial connective tissue is parameter after treadmill running exercises to reduce the muscle
about 10-fold higher than in the and showed that Foam-rolling exer- and fascial connective tissue tone
muscle tissue [88]. The periosteum cises had no beneficial effects [45]. yet.
is considered as fascia connective Consequently, at this time, we can-
tissue as well and is also densely not give a recommendation to per- Foam rolling potential risks
supplied with receptors [85,88]. form Foam-rolling exercises to
Among others, pain, motion, pres- reduce stress associated cortisol Surprisingly, and in consideration of
sure, vibration, chemical, and ther- levels. many assumed positive effects of
mal conditions can be detected by Foam-rolling exercises, our litera-
receptors within the fascial connec- Reduction of delayed muscle ture review has revealed no refer-
tive tissue. The afferent information soreness (DOMS) ence concerning any harmful
are integrated by the peripheral and It has been shown that Foam-rolling effects. This is remarkable, since
central nervous system, potentially exercises can reduce the subjective Foam-rolling exercises exert a high
affecting sensomotoric function and perceived delayed onset of muscle mechanical pressure not only on the
coordination [24,2629,50]. soreness (DOMS) measured by pres- targeting fascial connective tissue,
Schleip and Muller [75] proposed sure pain thresholds and a visual but also on muscles, bones, nerves,
Foam-rolling exercises to improve analog scale [52]. receptors, and vessels. In addition
proprioceptive refinement, but The underlying mechanisms of a to the pressure load, the shear and
whether Foam-rolling exercises decrease in DOMS according to tensile forces caused by Foam-roll-
affect the sensomotoric function Foam-rolling exercises remain ing exercises in and between the
J. Freiwald et al.
Foam-rolling in sport and therapy 271
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267275 (2016)
different tissues cannot be neg- Doppler ultrasound showed a The accumulation of fluid in tissues
lected [15,61]. temporary complete interruption of occurs during inflammation, which
the blood flow and in some cases is detectible by the use of T2 con-
Mechanical strain of the even a complete compression of trast in MRI [87]. Due to our exten-
underneath tissue the examined vessels, particularly sive experience in top-level sports,
Curran et al. [20] showed that of veins. we have repeatedly seen athletes
the mechanical pressure differs Also, the effects of Foam-rolling showing signs of edema after
according to the applied type of exercises on the lymphatic system Foam-rolling exercises that were
Foam-roller and also among the are still unclear. However, the visible in MRI (T2 weighted).
subjects [20]. In their study, the applied mechanical pressure loads However, if the edema are induced
authors measured the maximum and direction of Foam-rolling by shear forces and irritations or
mean pressure load at the lateral against the physiological venous damages of the vascular endo-
tight that was reported to be and lymphatic flow are contrary to thelium during Foam-rolling exer-
68.8 kPa (i.e., 516 mm/Hg). Thus, the commonly accepted scientific cises remains unclear [8,62].
these measured pressure values are doctrine in medicine and physio-
about 10-fold higher than the therapy [22,35,46,58]. Conclusions and future
highest medical compression Additionally, attention should be requirements
category 4 (i.e., extra strong com- paid to bony prominences such as
pression, at least 6.5 kPa or the spinous processes or the fibula This second part of the review dis-
49 mm/Hg) and exceeded twice head. cussed Foam-rolling exercises in
the pressure loads that are used sport and therapy. It was shown that
in occlusion studies [1,9,22]. Inflammation and pain it is not possible to treat isolated
Own studies achieved comparable During, immediately, and on the the fascial connective tissue by
results. During common Foam-roll- next day, Foam-rolling exercises Foam-rolling exercises and that
ing exercises, the vertical pressure may induce pain [48]. The type of there are no established and proven
load was 33 1% of the body pain and its time course may training methods overall [3]. There
weight measured at the calf and indicate inflammatory processes is no scientific evidence that Foam-
the front thigh. Considering relative [30,66,79,92]. Due to the fact that rolling exercises can improve warm-
and absolute contraindications such pain is a physiological warning sign ing-up procedures, athletic perform-
as peripheral neuropathy, diabetes [92], the question arises whether ance, reduce muscle and fascial
mellitus, and the risk of venous this warning must be considered in connective tissue tone, and improve
thrombosis or osteoporosis, which the training advises. stress-relaxation. In contrast, Foam-
may be evident in patients, older Inflammatory processes can be rolling exercises can enhance flexi-
people, or also in athletes, the use detected by blood tests. Okamoto, bility (ROM) and reduce delayed
of Foam-rolling exercises can lead to Masuhara [62] measured increased onset of muscular soreness
harmful effects. neutrophil concentrations after (DOMS). In the scientific literature,
Foam-rolling exercises. Furthermore, it is important to consider that
Nerve, vessels, and bones in healthy volunteers, a study showed potential harmful effects of Foam-
From the perspective of phlebology that the arterial pulse wave velocity rolling exercises are completely
and lymphology, the mechanical decreased, while the nitric oxide con- ignored.
pressure exerted by Foam-rolling centration increased after Foam-roll- Future investigations to define fields
exercises has to be critically ques- ing exercises. These findings were of applications concerning Foam-
tioned. Indeed, not only the fascial concluded by the authors as rolling exercises in therapy, medi-
connective tissue is mechanically beneficial and potential preventive cine, and sport are required.
stressed, but also the vessels, in effects on arterial function and car- Therefore, in- and exclusion criteria
particular venous valves, and diovascular disease, respectively. as well as implementation of indi-
nerves, which run near the surface However, it is also possible to inter- vidualized Foam-rolling exercises
e.g. of the hamstrings in the pop- pret, in particular, the increase in are needed. In a further step, train-
litea fossa (i.e., among others the N. nitric oxide concentration after ing principles and methods of Foam-
ischiadicus, V. poplitea). During Foam-rolling exercises as a damage rolling exercise including the use of
Foam-rolling exercises at the lower of the intima (i.e., the endothelium) different types of Foam-rollers
leg, own measurements using [2,86]. according to different sports should
J. Freiwald et al.
Foam-rolling in sport and therapy 273
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267275 (2016)
decreases in force parameters, Int. J. [50] S.M. Lephart, F.H. Fu (Eds.), [63] S. Paoletti, Faszien: Anatomie,
Sports Phys. Ther. 9 (1) (2014) 92 Proprioception and Neuromuscular Strukturen, Techniken, Spezielle
102. Control in Joint Stability, Human Osteopathie, vol. 2, Elsevier Urban
[37] S. Hasberry, M.J. Pearcy, Temperature Kinetics, Champaign, 2000, p. 439. & Fischer, Munchen, 2011.
dependence of the tensile properties [51] G.Z. MacDonald, et al., An acute bout [64] C.A. Peacock, et al., An acute bout of
of interspinous ligaments of sheep, J. of self-myofascial release increases self-myofascial release in the form of
Biomed. Eng. 8 (1) (1986) 6266. range of motion without a subsequent foam rolling improves performance
[38] K.C. Healey, et al., The effects of myo- decrease in muscle activation or force, testing, Int. J. Exerc. Sci. 7 (3)
fascial release with foam rolling on J. Strength Condit. Res. 27 (3) (2013) (2014) 202211.
performance, J. Strength Condit. Res. 812821. [65] C.A. Peacock, et al., Comparing acute
28 (1) (2014) 6168. [52] G.Z. Macdonald, et al., Foam rolling as bouts of sagittal plane progression
[39] U. Hoheisel, T. Taguchi, S. Mense, a recovery tool after an intense bout of foam rolling vs. frontal plane pro-
Nociception: the thoracolumbar fascia physical activity, Med. Sci. Sports gression foam rolling, J. Strength
as a sensory organ, in: R. Schleip, et al. Exerc. 46 (1) (2014) 131142. Condit. Res. 29 (8) (2015) 23102315.
(Eds.), Fascia: The Tensional Network [53] G. Markovic, Acute effects of instru- [66] J.S. Petrofsky, Heat will reduce pain,
of the Human Body, Churchill ment assisted soft tissue mobilization inflammation, and stiffness in the
Livingstone, Kidlington, 2012, pp. vs. foam rolling on knee and hip range lower back if used between therapy
95101. of motion in soccer players, J. Bodyw. for 2 weeks, 2014.
[40] C.Y. Huang, et al., Temperature- Mov. Ther. 19 (4) (2015) 690696. [67] A. Pilat, Myofascial induction
dependent viscoelastic properties of [54] K. McKenney, et al., Myofascial release approaches, in: Fascia: The Tensional
the human supraspinatus tendon, J. as a treatment for orthopaedic con- Network of the Human Body, Elsevier,
Biomech. 42 (4) (2009) 546549. ditions: a systematic review, J. Athl. Edingburgh, 2012, pp. 311317.
[41] R. Igel, Das Fasziendistorsionsmodell Train. 48 (4) (2013) 522527. [68] J.P.J. Pinel, Biopsychologie, 2. neu
(nach Typaldos): Die 6 Storungen und [55] S. Mense, Functional anatomy of bearbeitete deutsche Auflage ed.,
deren Behandlung, Deutsche Zeitschrift muscle: muscle, nociceptors and affer- Spektrum Akademischer Verlag,
fur Osteopathie 4 (2014) 2125. ent fibers, in: S. Mense, R.D. Gerwin Heidelberg, 2001p. 596.
[42] J. Janot, et al., Effects of self myofas- (Eds.), Muscle Pain: Understanding the [69] S. Preck, Faszienbehandlung, in: B.C.
cial release and static stretching on Mechanisms, Springer, Heidelberg/ Kolster, et al. (Eds.), Massage.
anaerobic power output, J. Fitness Dordrecht/London/New York, 2010, Klassische Massage, Querfriktion,
Res. 2 (2013) 4154. pp. 1748. Funktionsmassage,
[43] K. Jay, et al., Specific and cross [56] S. Mense, A.T. Masi, Increased muscle Faszienbehandlung, Springer, Berlin-
over effects of massage for muscle tonus as a cause of muscle pain, in: S. Heidelberg, 2015, pp. 460494.
soreness: randomized controlled trial, Mense, R.D. Gerwin (Eds.), Muscle [70] P.P. Purslow, J.-P. Delage, General
Int. J. Sports Phys. Ther. 9 (1) (2014) Pain: Understanding the Mechanisms, anatomy of the muscle fasciae, in:
8291. Springer, Heidelberg/Dordrecht/ Fascia: The Tensional Network of the
[44] D. Junker, T. Stoggl, The foam roll as a London/New York, 2010, pp. 207249. Human Body, Elsevier, Edingburgh,
tool to improve hamstring flexibility, [57] T. Meyer, et al., Regenerationsmanagment 2012, pp. 511.
J. Strength Condit. Res. (2015). im Spitzensport. REGman-Ergebnisse und [71] L. Remvig, R.M. Ellis, J. Patijn, Myofascial
[45] K. Kim, et al., Effect of self-myofascial Handlungsempfehlungen, Strau, Koln, release: an evidence-based treatment
release on reduction of physical stress: 2016. approach? Int. Musculoskelet. Med. 30
a pilot study, J. Phys. Ther. Sci. 26 [58] S.L. Michlovitz, J.W. Bellew, T.P. Nolan (1) (2008) 2935.
(11) (2014) 17791781. (Eds.), Modalities for Therapeutic [72] D.S. Roylance, et al., Evaluating acute
[46] B.C. Kolster, Massage, Springer, Intervention, 5th ed., F.A. Davis changes in joint range-of-motion
Berlin-Heidelberg, 2016. Company, 2012. using self-myofascial release, postural
[47] M. Kuhn, Messung der Gewebespannung [59] A.E. Mikesky, et al., Acute effects of alignment exercises, and static
mittels Myotonometrie mit und ohne the stick on strength, power, and flexi- stretches, Int. J. Exerc. Sci. 6 (4)
lokale Warmeapplikation und deren bility, J. Strength Condit. Res. 16 (3) (2013) 310319.
Veranderungen, Bergische Universitat (2002) 446450. [73] E. Salgado, F. Ribeiro, J. Oliveira,
Wuppertal, Wuppertal, 2015. [60] A.R. Mohr, B.C. Long, C.L. Goad, Effect Joint-position sense is altered by foot-
[48] M. Kuhnemann, Untersuchung akuter of foam rolling and static stretching ball pre-participation warm-up exer-
Effekte einer myofaszialen on passive hip-flexion range of cise and match induced fatigue,
Eigenbehandlung mittels Massagerolle motion, J. Sport Rehabil. 23 (4) Knee 22 (3) (2015) 243248.
auf die Vertikalsprungleistung und aus- (2014) 296299. [74] P.C. Sawyer, et al., Effects of moist
gewahlte Gewebeeigenschaften, in: [61] B.M. Nigg, B.R. MacIntosh, J. Mester heat on hamstring flexibility and
Research Center for Performance (Eds.), Biomechanics and Biology of muscle temperature, J. Strength
Diagnostics and Training Advice Movement, Human Kinetics, Champaign, Condit. Res. 17 (2) (2003) 285290.
(FLT), Bergische University 2000. [75] R. Schleip, D.G. Muller, Training
Wuppertal, Wuppertal, 2016. [62] T. Okamoto, M. Masuhara, K. Ikuta, principles for fascial connective tis-
[49] J.F. Lehmann, et al., Effect of thera- Acute effects of self-myofascial release sues: scientific foundation and
peutic temperatures on tendon exten- using a foam roller on arterial suggested practical applications, J.
sibility, Arch. Phys. Med. Rehabil. 51 function, J. Strength Condit. Res. Bodyw. Mov. Ther. 17 (1) (2013)
(8) (1970) 481487. (2014). 103115.
[76] R. Schleip, et al. (Eds.), Lehrbuch Berucksichtigung epi-und intrafas- [89] B. Vaughan, P. McLaughlin, Immediate
Faszien - Grundlagen, Forschung, zialer Nerven, Manuelle Medizin 34 changes in pressure pain threshold in
Behandlung, Urban & Fischer, (34) (1996) 196200. the iliotibial band using a myofascial
Munchen, 2014. [83] K.M. Sullivan, et al., Roller-Massager (foam) roller, Int. J. Ther. Rehabil. 21
[77] A.N. Schroeder, T.M. Best, Is self myo- application to the hamstrings (12) (2014) 569574.
fascial release an effective preexercise increases sit-and-reach range of [90] K. Wiemann, Beeinflussung muskularer
and recovery strategy? A literature motion within five to ten seconds Parameter durch ein zehnwochiges
review, Curr. Sports Med. Rep. 14 (3) without performance impairments, Dehnungstraining, Sportwissenschaft
(2015) 200208. Int. J. Sports Phys. Ther. 8 (3) 21 (1991) 295305.
[78] S. Shah, A. Bhalara, Myofascial release, (2013) 228236. [91] K. Wiemann, T. Fischer, Ruhespannung
Int. J. Health Sci. Res. 2 (3) (2012) [84] J. Tesarz, et al., Sensory innervation of und Muskelkater, Sportwissenschaft
6977. the thoracolumbar fascia in rats and (1997) 428436.
[79] J.P. Shah, et al., Biochemicals associ- humans, Neuroscience 194 (2011) [92] M. Zenz, I. Jurna (Eds.), Lehrbuch der
ated with pain and inflammation are 302308. Schmerztherapie, 2. neubearbeitete
elevated in sites near to and remote [85] B. Tillmann, Binde- und Stutzgewebe Auflage ed., Wissenschaftliche
from active myofascial trigger points, des Bewegungsapparates, in: H. Verlagsgesellschaft, Stuttgart, 2001,
Arch. Phys. Med. Rehabil. 89 (1) Leonhardt, et al. (Eds.), Anatomie p. 970.
(2008) 1623. des Menschen, Thieme, Stuttgart,
[80] J. Skarabot, C. Beardsley, I. Stirn, 2003, pp. 1349.
Comparing the effects of self-myofas- [86] D. Tousoulis, et al., The role of nitric Corresponding author:
cial release with static stretching on oxide on endothelial function, Univ. Prof. Dr. Jurgen Freiwald M.A.,
ankle range-of-motion in adolescent Curr. Vasc. Pharmacol. 10 (1) (2012) Department of Movement
athletes, Int. J. Sports Phys. Ther. 418. and Training Science, University of
10 (2) (2015) 203212. [87] M. Vahlensieck, M. Reiser (Eds.), MRT Wuppertal, Wuppertal, Germany.
[81] G. Slomka, The Fascial Network. Train des Bewegungsapparats, 4th ed., Fax: +49 0202 439 2956
and Improve Your Posture, Strength Thieme Verlag, Stuttgart, 2015. E-Mail: freiwald@uni-wuppertal.de
and Flexibility, Meyer & Meyer [88] J.C. van der Wal, Proprioception, in:
Sport, Aachen, 2015. Fascia: The Tensional Network of the
[82] J. Staubesand, Y. Li, Zum Feinbau der Human Body, Elsevier, Edingburgh,
Fascia cruris mit besonderer 2012, pp. 8187.
ScienceDirect
J. Freiwald et al.
Foam-rolling in sport and therapy 275
View publication stats