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Foam-rolling in sport and therapy Potential

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Orthopaedics
and
Traumatology
Summary
This review aimed to provide an over-
view concerning Foam-rolling exercises
in medicine and sport. In the first part
of the review, nomenclatures and defi-
nitions as well as anatomical and bio-
mechanical aspects of
connective tissue are discussed.
fascial
Regarding the nomenclatures and
effects of Foam-rolling exercises on
fascia connective tissue, conflicting
findings are evident. Additionally, there
is only poor evidence in terms of the
assumed six myofascial lines that pro-
vide a framework for treatments in
medicine and sport. Fascial connective
tissue links muscles with the surround-
ing tissues, transmits forces, and serves
compressions. From a biomechanical
point of view, fascial connective tissue
possess contractile abilities; however,
the generated contraction forces are
small. During Foam-rolling exercises,
all the underlying tissue is mechanically
stressed, potentially leading to dam-
age, for example, in neuronal tissues,
receptors, vessels, or bones. This con-
cern especially rises in users with dis-
eases, for example, diabetes, varices,
or osteoporosis.
Keywords
Biomechanics myofascial release training
fascia physiotherapy
J. Freiwald et al.
Foam-Rolling in Sport und
Therapie Potentieller
Nutzen und Risiken.
Teil 1 Definitionen,
anatomische, physiologische
und biomechanische
Aspekte
Zusammenfassung
Im Zentrum des Beitrages steht das
Foam-Rolling in den Anwendungsfel-
dern des Sports und der Therapie. Im
ersten Teil werden die Definitionen und
Klassifikationen, die Anatomie und
Physiologie sowie biomechanische As-
pekte des Fasziengewebes besprochen.
Deutlich wird die Uneinheitlichkeit der
258 J. Freiwald et al. 
Foam-rolling in sport and therapy
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 258266 (2016)
Elsevier GmbH
www.SOTjournal.com
http://dx.doi.org/10.1016/j.orthtr.2016.07.001
REVIEW / SPECIAL ISSUE
Foam-Rolling in sport and
therapy Potential benefits and
risks
Part 1 Definitions, anatomy, physiology, and biomechanics
Jurgen Freiwald, Christian Baumgart, Matthias Kuhnemann, Matthias W. Hoppe
Department of Movement and Training Science, University of Wuppertal,
Germany
Eingegangen/submitted: 13.06.2016; uberarbeitet/revised: 04.07.2016; akzeptiert/accepted: 05.07.2016
Online verfugbar seit/Available online: 29.07.2016
Introduction fascial connective tissue into four
functional categories (Tables 1
In recent years, fascial connective and 2).
tissue has shifted into the focus of Langevin and Huijing [35] specified
science in medicine and sport and different terms of fascial connective
Foam-rolling exercises are fre- tissue, showing that the nomencla-
quently used as a fascial targeting tures are both not entirely clear and
treatment [30,39,44,49,60,63]. accepted (Table 3).
Although there is contradictory evi- Overall, the provided different
dence concerning the anatomy, nomenclatures and definitions
function, and adaptability of fascial of the fascial connective tissue
connective tissue, Foam-rolling show that there is no widely
exercises have been used with accepted consents, potentially
different objectives in therapy providing difficulties for therapy
and sport [19,59,64]. Overall, the and training.
methods are referred as Myofascial
release, aiming to reduce thicken-
Fascial connective tissue
ing, adhesion, and tension of fascia anatomy and physiology
tissue and muscle as well as to
enhance sportive performance
Muscles, organs, glands, neural
[4,9,39]. pathways, and vessels are all
encased by fascial connective tissue
Fascial connective tissue that crosses the entire body. Fascial
nomenclature and definitions connective tissue does not only
have mechanical properties, but is
The nomenclatures and definitions also involved in the local and global
of fascial connective tissue are metabolism (e.g., healing of
widespread [61]. Based on different wounds, immune functions) and
anatomical, morphological, histo- can serve as a storage for fat, water,
logical, and biomechanical findings, and other substances [10,38,55,
Kumka and Bonar [34] classified 68,70,71].

Klassifikationen und Schwierigkeiten,
mittels Foam-Rolling fasziales Bindege-
webe zu beeinflussen. Die in Sport und
Therapie beschriebenen sechs Myo-
fascial lines sind nicht evidenzbasiert.
Fasziales Bindegewebe verbindet un-
terschiedliche Korperregionen und -ge-
webe und dient der Kraftubertragung
und Kompression. Daruber hinaus
trennt fasziales Bindegewebe verschie-
dene Kompartimente und -gewebe. Aus
biomechanischer Sicht ist fasziales Bin-
degewebe in der Lage zu kontrahieren,
wenn auch nur mit kaum messbarer
Kraftentwicklung. In Sport und Thera-
pie wird durch Foam-Rolling hoher
Druck auf das darunter liegende Ge-
webe ausgeubt, was zu Schadigungen
von Nervengewebe, Rezeptoren, Gefa-
en und Knochen fuhren kann insbe-
sondere bei Vorschadigungen und Er-
krankungen wie Diabetes mellitus,
Krampfadern oder Osteoporose.
sselwo
Schlu rter
Biomechanik Myofascial release Training
Faszien Physiotherapie
According to the function, fascial
connective tissue is present in
different forms with respect to the
density and alignment within fibers
[11,60,61,63].
Lymph, nerves, interoception,
and blood vessels
Lymph, nerves, and blood vessels
passing through the fascial connec-
tive tissue are mostly found
combined in orthogonal direction
(Fig. 1).
Fascial connective tissue also has an
extensive innervation and is supplied
by different mechano- and chemo-
receptors [20,31,38]. Importantly,
the number of receptors is up to
ten-fold higher in fascial connective
tissue than in muscle [72]. Further,
the periosteum is considered as fas-
cial connective tissue and is densely
supplied by receptors [40].
By interoceptive, proprioceptive,
and nociceptive capabilities, mech-
anical and chemical information are
collected and transmitted to the
CNS. Through changes in afferents,
the perception of the own body
image is affected and the
Figure 1
Passage of a triad through superficial
fascial connective tissue. Left nerve,
middle vein; right artery. Most of
these perforation points are topographi-
cally identical with traditional Chinese
acupuncture points. Usually, the perfor-
ating nerves innervate Pacinian and
Meissner corpuscles under the skin
[56,67].
J. Freiwald et al.
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 258266 (2016)
sensomotoric system adapts to
these altered information [15,17,
23,4143,51,57,58].
In consideration of the lower leg,
Staubesand and Li [67] showed that
the lamina superficialis of fascia cru-
ris possesses slotted to funnel-
shaped passage openings for the
Vv. perforantes, connecting the
superficial and deep venous system.
Usually, such points of passages are
accompanied by a respective small
artery and/or vein, mostly vegeta-
tive nerve, and thin-walled lym-
phatic vessel. Further, openings
for larger skin nerves and vessels
can be found [67].
The local myelinated axons con-
duct afferents from the skin for
touch and pressure (Ab- fibers of
an average diameter of 8 mm) as
well as temperature and surface
pain (Ad- fibers of an average
diameter of <3 mm). Also, there
are many unmyelinated fibers con-
ducting afferents from the skin and
proceed deep pain through C-fibers
[20,67].
In conclusion, this particular
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,
superficial fascial connective tissue
tolerates higher stretching tensions
[2429,32,73].
The deeper layer of fascial connec-
tive tissue is organized as apo-
neuroses or fascia latae, plantar
fascia, ligaments, tendons, joint
capsules, and muscle septa. It is

Foam-rolling in sport and therapy 259
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Table 1. Fascial categories: functions, terms and histological features linking (modified after [34]).

Fascial category Function (Example) Terminologia Anatomia Terminologia Histological Feature

Histologica
Linking Dynamic  Role in movement Fasciae of muscles (investing layer) & Dense regular Collagen types:
and stability fasciae of individual muscles: parallel ordered I, XII, XIV
 Critical to Pectoral fascia unidirectional Actin-myosin
myofascial force Supraspinatus fascia connective tissue filaments
transmission Deltoid fascia proper Pacinian corpuscles,
 Creates significant Fasciae of trunk: Free nerve endings
pretension in Thoracolumbar fascia
musculature Diaphragmatic fascia
Iliopsoas fascia
Fasciae of limbs/membrorum:
Iliotibial tract
Axillary fascia
Passive  Maintains Fasciae of muscles (muscle sheaths) Dense regular Collagen types:
continuity, passive Rectus sheath woven connective I, III, XII, XIV
force transmission Head & neck tissue Elastin
 Proprioceptive Cervical fascia Multidirectional Golgi tendon organs,
communication Carotid sheath parallel ordered Pacinian & Ruffini
throughout the Ligamentum nuchea connective tissue corpuscles
body Ligamentum flavum
Fasciae of limbs/membrorum
Intermuscular septae
Anterior talofibular ligament
Aponeuroses
Erector spinae aponeurosis
Bicipital aponeurosis
Plantar aponeurosis
Tendinous arches
Muscular & vascular spaces/lacunae
Iliopectineal arch
Tendinous arch of soleus

fibrous and encloses muscles,
bones, nerves, and blood vessels
as well as has a lower blood flow
than the superficial fascial connec-
tive tissue due to its different func-
tion [36,75].
The visceral layer of fascial connec-
tive tissue consists of a serous
double membrane layer and serves,
among other purposes, as a suspen-
sion and protection for the inner
organs [6,36].
Overall, due to the particular
anatomy, the dissimilar fascial con-
nective tissue layers possess differ-
ent functions.
Evidence of myofascial lines
For many years, therapeutic inter-
ventions have focused on fascial
connective tissue. However, its
anatomy, physiology, and biome-
chanical functions are not suffi-
ciently investigated (among others
[73]). Therefore, the existing con-
cepts for therapy and training should
be critically reviewed [46,52,64]. For
example, Wilke, Krause [73] ques-
tioned in their comprehensive review
the presence of assumed myofascial
lines and provided the following
conclusions (Table 4):
 Strong evidence was only found
for three of the six assumed myo-
fascial lines, namely, the super-
ficial back, back functional, and
front functional line.
 Moderate to strong evidence was
found for the spiral and lateral line.
 No evidence was found for the
superficial frontline.
To conclude, and in consideration of
that poor evidence, it is surprisingly
that patients in medicine and sport
are still treaded under the assump-
tion of six myofascial lines [48,
49,73].

260 J. Freiwald et al. 

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Table 2. Fascial categories: functions, terms, and histological features fascicular, compression, and separating (modified after [34]).

Fascial category Function (Example) Terminologia Histological feature

Terminologia Anatomia Histologica

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
connective tissue and FOAM-
rolling
Fascial connective tissue links
muscles with the surrounding tissue
and transmits and distributes forces
to muscles, adjacent muscles,
bones, and inner organs [5,25,32,
54,73,74].
Mechanical impact on the
underling tissue
During Foam-rolling exercises, all
the underlying tissue innervated
by mechano- and chemoreceptors
is mechanically stressed (e.g., joint
capsules, tendons, ligaments, nerves,
arteries, arterioles, veins, venules,
capillaries, lymphatics) [13,42,
45,66]. The mechanical effects of
Foam-rolling exercises on these tis-
sues have not been examined yet. For
example, whether and to which

J. Freiwald et al. 
Foam-rolling in sport and therapy 261
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Sports Orthop. Traumatol. 32, 258266 (2016)

Table 3. Recommended use of terms regarding fascial structures [35].

Dense connective tissue
Non-dense (areolar)
connective tissue
Superficial fascia
Deep fascia
Intermuscular septa
Interosseal membrane
Periost
Neurovascular tract
Epimysium
Intra- and extramuscular
aponeurosis
Perimysium
Endomysium
Connective tissue containing closely packed, irregularly arranged (that is, aligned in many directions)
collagen fibers
Connective tissue containing sparse, irregularly arranged collagen fibers
Enveloping layer directly beneath the skin containing dense and areolar connective tissue and fat
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
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
Two bones in a limb segment can be connected by a thin collagen membrane with a structure similar to
the intermuscular septa.
Surrounding each bone and attached to it is a bi-layered collagen membrane similar in structure to the
epimysium
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
A multi-layered, irregularly arranged collagen fiber sheet that envelopes muscles and that may contain
layers of both dense and areolar connective tissue
A multilayered structure with densely laid down bundles of collagen with major preferential directions.
The epimysium also covers the aponeuroses, but is not attached to them. Muscle fibers are attached to
intramuscular aponeuroses by their myotendinous junctions
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)
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
its ability to synthesize and express
neurotransmitter is unknown
[20,16,37].
Noteworthy, during Foam-rolling
exercises, the commonly induced
mechanical pressure on the under-
lying tissue is clearly higher than
the upper permissible value of
maximal compression in vein
therapy [3].
Lastly, when performing Foam-roll-
ing exercises in the supine position,
users have reported creaky noises
at the vertebral bodies similar to
chiropractic treatments. Given the
fact that the education of chiroprac-
tic take many years, especially due
to the potential risks of the applied
treatments, it is not wise that
uneducated staff offer Foam-rolling
courses in gyms during which high
pressures to the spine and spinous
processes are applied.
To summarize, during Foam-rolling
exercises, a high mechanical load to
the entire underlying tissue is
induced, potentially leading to
harmful effects in connective tis-
sue, nerves, vessels, and bones that
need further research.
Contractile abilities of fascial
connective tissue
The previously prevailing idea that
fascial connective tissue has purely
passive functions needs revision. In
fact, stray smooth muscle cells
(myofibroblasts) were found in the
superficial sheet and deeper layers
of the fascia cruris, which can there-
fore actively contract [67].
Consequently, the stiffness of the
fascial connective tissue is also
affected by the density and acti-
vation potential of myofibroblasts
[69].
One possible function for the con-
tractile abilities of fascial connec-
tive tissue may be to adjust the
preload of the (fascial) collagen
scaffold to the respective resting
and action phases of the corre-
sponding muscle [67]. However,
Staubesand and Li [67] noted that
the discovery of contractile abilities
regarding fascial connective tissue
should not be overestimated,
because they are well known during
wound healing and scar formation
[7,67,69].
Also worth mentioning, the fascial
connective tissue is just mm to mm
thick, and thus, contributes only
minor to the contractile forces,
ranging from few Dyn up to

262 J. Freiwald et al. 

Foam-rolling in sport and therapy
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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)
layers possess different functions.
Fascia connective tissue has contrac-
tile abilities. However, both the
function and underlying physiology
are also not completely understood.
The observed contraction forces of
the fascia connective tissue are small
and the influential factors require
more research.
Potentially, the particular anatomy
of fascia connective tissue is not
suited for high mechanical com-
pression forces induced by Foam-
rolling exercises. During Foam-roll-
ing, high mechanical loads to the
entire underlying tissue are induced,
hypothetically leading to harmful
effects in connective tissue, nerves,
vessels, and bones that also require
further research.
Especially, this question arises in
users with diseases of the metab-
olism and peripheral nerves. Of
particular relevance are the typical
syndromes of hereditary neuropathy
with liability to pressure palsies,
diabetic neuropathy, and peripheral
artery occlusive disease (PAOD),
which occur more frequently in
smokers and conjunction with arte-
riosclerosis. In these diseases, the
affected vessels and nerve tissue
must not be exposed to high pres-
sure loads as they react with sensory
and motor disorders. Furthermore,
Foam-rolling exercises in older or
people with osteoporosis may
induce damage. Generally, an
important question is, whether
Foam-rolling exercises can influence
fascial connective tissue as desired.
Therefore, future studies should
examine in detail, whether Foam-
rolling effects are positive or nega-
tive for both sportive and thera-
peutic purposes.
Conflict of interest
There is no conflict of interest.
264 J. Freiwald et al. 
Foam-rolling in sport and therapy
References
[1] T.M. Ball, Scleroderma and related con-
ditions, in: Fascia: The Tensional
Network of the Human Body, Elsevier,
Edingburgh, 2012, pp. 226232.
[2] J.V. Basmajian, C.J. De Luca, Muscle
Alive, 5th ed., Williams & Wilkins,
Baltimore, 1985, p. 561.
[3] C. Baumgart, et al., Massagerollen
Segen oder Fluch? in: K. Witte,
J. Edelmann-Nusser (Eds.), Sport-
technologie zwischen Theorie und
Praxis VI, Shaker, Aachen, 2015, pp.
5260.
[4] C. Beardsley, J. Skarabot, Effects of
self-myofascial release: a systematic
review, J. Bodyw. Mov. Ther. 19 (4)
(2015) 747758.
[5] M. Benjamin, D. McGonagle, Entheses:
tendon and ligament attachment sites,
Scand. J. Med. Sci. Sports 19 (4)
(2009) 520527.
[6] R. Breul, The deeper fasciae of the neck
and ventral torso, in: Fascia: The
Tensional Network of the Human
Body, Elsevier, Edingburgh, 2012,
pp. 4552.
[7] G. Broughton 2nd, J.E. Janis, C.E.
Attinger, The basic science of wound
healing, Plast. Reconstr. Surg. 117
(7 Suppl.) (2006) 12S34S.
[8] S.A. Bus, Diabetic foot, in: Fascia: The
Tensional Network of the Human Body,
Elsevier, Edingburgh, 2012, pp. 215
223.
[9] M. Caspari, H. Massa, Rolfing structural
integration, in: Fascia: The Tensional
Network of the Human Body, Elsevier,
Edingburgh, 2012, pp. 303309.
[10] J.J. de Morree, Dynamik des menschli-
chen Bindegewebe Funktion,
Schadigung und Wiederherstellung,
Urban & Fischer, Munchen, 2013.
[11] T.W. Findley, Editorial Second
International Fascia Research
Congress, Int. J. Ther. Massage
Bodyw. 2 (2) (2009) 16.
[12] T.W. Findley, Fascia-related disorders:
an introduction, in: Fascia: The
Tensional Network of the Human
Body, Elsevier, Edingburgh, 2012, pp.
187189.
[13] M. Foldi, S. Kubik (Eds.), Lehrbuch der
Lymphologie, 5., vollig uberarbeitete
Auflage ed., Urban & Fischer,
Munchen, 2002, p. 767.
[14] J. Freiwald, Optimales Dehnen. Sport
Pravention Rehabilitation, Spitta,
Balingen, 2013.
[15] J. Freiwald, Schmerz und Krafttraining,
in: W. Kieser (Ed.), Krafttraining in
Pravention und Therapie. Grundlagen,
Indikationen, Anwendungen, Hans
Huber, Bern, 2015, pp. 7185.
[16] J. Freiwald, et al., The nerve supply of
the knee joint, WMW 147 (2324)
(1997) 531541.
[17] J. Freiwald, M. Engelhard, I. Reuter,
Neuromuscular and motor system alter-
ations after knee trauma an knee
surgery, in: M. Lehmann, et al. (Eds.),
Overload, Performance, Incompetence,
and Regeneration in Sport, Kluwer
Academic/Plenum, New York, 1999.
[18] J. Freiwald, C. Baumgart, P. Konrad,
Einfuhrung in die Elektromyographie.
Sport Pravention Rehabilitation,
Spitta, Balingen, 2007.
[19] J. Freiwald, et al., Benefits and risks
according to foam rolling in sports,
Sport Orthop. Traumatol. 32 (3)
(2016) 264274.
[20] H. Frisch, Programmierte Untersuchung
des Bewegungsapparates, 9th ed.,
Springer, Heidelberg, 2009.
[21] R.U. Gautschi, Trigger points as a fas-
cia-related disorder, in: Fascia: The
Tensional Network of the Human
Body, Elsevier, Edingburgh, 2012, pp.
233243.
[22] R. Gautschi, U. Bohni, Das myofasziale
Schmerzsyndrom, Manuelle Medizin 52
(3) (2014) 203213.
[23] T. Graven-Nielsen, S. Mense, Referral of
Musculoskeletal Pain, in: S. Mense, R.
D. Gerwin (Eds.), Muscle Pain:
Understanding the Mechanisms,
Springer, Heidelberg/Dordrecht/
London/New York, 2010, pp. 177205.
[24] J.C. Guimberteau, The subcutaneous
and epitendinous tissue behavior of
the multimicrovacuolar sliding system,
in: Fascia: The Tensional Network of
the Human Body, Elsevier, Edingburgh,
2012, pp. 143146.
[25] P.A. Huijing, Muscular force trans-
mission necessitates a multilevel inte-
grative approach to the analysis
of function of skeletal muscle,
Exerc. Sport Sci. Rev. 31 (4) (2003)
167175.
[26] P.A. Huijing, Force transmission and
muscle mechanics, in: Fascia: The
Tensional Network of the Human
Body, Elsevier, Edingburgh, 2012, pp.
113115.
[27] P.A. Huijing, Myofascial force trans-
mission, in: Fascia: The Tensional
Network of the Human Body, Elsevier,
Edingburgh, 2012, pp. 117122.
[28] P.A. Huijing, R.T. Jaspers, Adaptation
of muscle size and myofascial force
transmission: a review and some new

experimental results, Scand. J. Med.
Sci. Sports 15 (6) (2005) 349380.
[29] P.A. Huijing, Epimuscular myofascial
force transmission: a historical review
and implications for new research.
International Society of Biomechanics
Muybridge Award Lecture, Taipei, 2007,
J. Biomech. 42 (1) (2009) 921.
[30] P.A. Huijing, et al., Fascia Research II
Basic Science and Implications for
Conventional and Complementary
Health Care, Urban & Fischer,
Munchen, 2009.
[31] L. Jozsa, P. Kannus, Human Tendons,
Human Kinetics, Champaign, 1997, p.
574.
[32] F. Krause, et al., Intermuscular force
transmission along myofascial chains:
a systematic review, J. Anat. (2016).
[33] M. Kreulen, M.J.C. Smeulders, P.A.
Huijing, Spastic paresis, in: Fascia: The
Tensional Network of the Human
Body, Elsevier, Edingburgh, 2012, pp.
205213.
[34] M. Kumka, J. Bonar, Fascia: a morpho-
logical description and classification
system based on a literature review,
J. Can. Chiropr. Assoc. 56 (3) (2012)
179191.
[35] H.M. Langevin, P.A. Huijing,
Communicating about fascia: history,
pitfalls, and recommendations, Int. J.
Ther. Massage Bodyw. 2 (4) (2009) 38.
[36] H. Leonhardt (Ed.), 3rd ed., Anatomie
des Menschen, vol. 1, Thieme,
Stuttgart, 2003.
[37] S.M. Lephart, F.H. Fu (Eds.),
Proprioception and Neuromuscular
Control in Joint Stability, Human
Kinetics, Champaign, 2000, p. 439.
[38] B.R. MacIntosh, P.F. Gardiner, A.J.
McComas, Sceletal Muscle. Form and
Function, 2nd ed., Human Kinetics,
Champaign, 2006.
[39] K. McKenney, et al., Myofascial release
as a treatment for orthopaedic con-
ditions: a systematic review, J. Athl.
Train. 48 (4) (2013) 522527.
[40] S. Mense, Functional anatomy of
muscle: muscle, nociceptors and affer-
ent fibers, in: S. Mense, R.D. Gerwin
(Eds.), Muscle Pain: Understanding the
Mechanisms, Springer, Heidelberg/
Dordrecht/London/New York, 2010,
pp. 1748.
[41] S. Mense, Central nervous mechanisms of
muscle pain: ascending pathways, cen-
tral sensitization, and pain-modulating
systems, in: S. Mense, R.D. Gerwin
(Eds.), Muscle Pain: Understanding the
Mechanisms, Springer, Heidelberg/
Dordrecht/London/New York, 2010,
pp. 105175.
[42] S. Mense, R.D. Gerwin (Eds.), Muscle
Pain: Understanding the Mechanisms,
Springer-Verlag, Berlin/Heidelberg,
2010.
[43] S. Mense, A.T. Masi, Increased muscle
tonus as a cause of muscle pain, in: S.
Mense, R.D. Gerwin (Eds.), Muscle
Pain: Understanding the Mechanisms,
Springer, Heidelberg/Dordrecht/
London/New York, 2010, pp. 207249.
[44] T. Meyer, et al., Regenerations-
managment im Spitzensport.
REGman-Ergebnisse und Handlungs-
empfehlungen, Strau, Koln, 2016.
[45] S.L. Michlovitz, J.W. Bellew, T.P. Nolan
(Eds.), Modalities for Therapeutic
Intervention, 5th ed., F.A. Davis
Company, 2012.
[46] D.G. Muller, R. Schleip, Fascial fitness,
in: Fascia: The Tensional Network of
the Human Body, Elsevier, Edingburgh,
2012465475.
[47] E. Mutschler, et al. Mutschler
Arzneimittelwirkungen: Pharmakologie,
Klinische Pharmakologie, Toxikologe,
vol. 10, Wissenschaftliche Verlags-
gesellschaft Stuttgart, Stuttgart, 2013.
[48] T. Myers, Anatomy trains and force
transmission, in: Fascia: The Tensional
Network of the Human Body, Elsevier,
Edingburgh, 2012, pp. 131136.
[49] T.W. Myers, Anatomy Trains
Myofascial Meridians for Manual and
Movement Therapists, 3rd ed.,
Churchill Livingstone, Edingburg,
2014.
[50] I.L. Naylor, Dupuytrens disease and
other fibrocontractive disorders, in:
Fascia: The Tensional Network of the
Human Body, Elsevier, Edingburgh,
2012, pp. 191197.
[51] J.L. Oschmann, Fascia as a body-wide
communication system, in: Fascia: The
Tensional Network of the Human Body,
Elsevier, Edingburgh, 2012, pp. 103
110.
[52] S. Paoletti, Faszien Anatomie,
Strukturen, Techniken, Spezielle
Osteopathie, 2nd ed., Urban &
Fischer, Munchen, 2011.
[53] M. Parizi, E.W. Howard, J.J. Tomasek,
Regulation of LPA-promoted myofibro-
blast contraction: role of Rho, myosin
light chain kinase, and myosin light
chain phosphatase, Exp. Cell Res. 254
(2) (2000) 210220.
[54] T.G. Sandercock, H. Maas, Force
summation between muscles: are
muscles independent actuators? Med.
J. Freiwald et al. 
Foam-rolling in sport and therapy
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 258266 (2016)
Sci. Sports Exerc. 41 (1) (2009) 184
190.
[55] S. Schiaffino, T. Partridge, Skelteal
muscle repair und regeneration, in:
G.J.M. Stienen (Ed.), Advances in
Muscle Research, vol. 3, Springer,
Dordrecht, 2008, pp. 1194.
[56] R. Schleip, Fascial plasticity a
new neurobiological explanation:
Part 2, J. Bodyw. Mov. Ther. (2003)
105116.
[57] R. Schleip, Fascia as an organ of com-
munication, in: Fascia: The Tensional
Network of the Human Body, Elsevier,
Edingburgh, 2012, pp. 7779.
[58] R. Schleip, H. Jager, Interoception, in:
Fascia: The Tensional Network of the
Human Body, Elsevier, Edingburgh,
2012, pp. 8994.
[59] R. Schleip, D.G. Muller, Training
principles for fascial connective tis-
sues: scientific foundation and
suggested practical applications, J.
Bodyw. Mov. Ther. 17 (1) (2013)
103115.
[60] R. Schleip, et al. (Eds.), Fascia: The
Tensional Network of the Human
Body, Elsevier, Edingburgh, 2012, p.
535.
[61] R. Schleip, H. Jager, W. Klingler, What
is fascia? A Review of Different
Nomenclatures, J. Bodyw. Mov. Ther.
16 (4) (2012) 496502.
[62] R. Schleip, H. Jager, W. Klingler, Fascia
is alive, in: R. Schleip, et al. (Eds.),
Fascia: The Tensional Network of the
Human Body, Elsevier, Edingburgh,
2012, pp. 157164.
[63] R. Schleip, et al. (Eds.), Lehrbuch
Faszien Grundlagen, Forschung,
Behandlung, Urban & Fischer,
Munchen, 2014.
[64] G. Slomka, The Fascial Network. Train
and Improve Your Posture, Strength
and Flexibility, Meyer & Meyer
Sport, Aachen, 2015.
[65] B.J. Snow, et al., Treatment of spas-
ticity with botulinum toxin: a double-
blind study, Ann. Neurol. 28 (4)
(1990) 512515.
[66] J. Sobotta, Atlas der Anatomie des
Menschen. Rumpf, Eingeweide, untere
Extremitat, in: R Putz, R. Pabst (Eds.),
21. Auflage ed., Atlas der Anatomie
des Menschen, Vol. 2, Urban &
Fischer, Munchen, 2000, p. 429.
[67] J. Staubesand, Y. Li, Zum Feinbau der
Fascia cruris mit besonderer
Berucksichtigung epi-und intrafas-
zialer Nerven, Manuelle Medizin 34
(34) (1996) 196200.
265
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 258266 (2016)
[68] P.M. Tiidus, Skeletal Muscle Damage
and Repair, Human Kinetics,
Champaign, 2008.
[69] J.J. Tomasek, et al., Myofibroblasts
and mechano-regulation of connective
tissue remodelling, Nat. Rev. Mol. Cell
Biol. 3 (5) (2002) 349363.
[70] F. Van den Berg, The physiology of fas-
cia, in: Fascia: The Tensional Network of
the Human Body, Elsevier, Edingburgh,
2012, pp. 149155.
[71] F. Van den Berg, Extracellular matrix,
in: Fascia: The Tensional Network of
266 J. Freiwald et al. 
Foam-rolling in sport and therapy
the Human Body, Elsevier, Edingburgh,
2012, pp. 165170.
[72] J.C. van der Wal, Proprioception, in:
Fascia: The Tensional Network of the
Human Body, Elsevier, Edingburgh,
2012, pp. 8187.
[73] J. Wilke, et al., What is evidence-based
about myofascial chains: a systematic
review, Arch. Phys. Med. Rehabil. 97
(3) (2016) 454461.
[74] C.A. Yucesoy, Epimuscular myofascial
force transmission implies novel
principles for muscular mechanics,
Available online at www.sciencedirect.com
ScienceDirect
Exerc. Sport Sci. Rev. 38 (3) (2010)
128134.
[75] K. Zilles, B.N. Tillmann, Anatomie,
Springer-Verlag, Berlin, 2010.
Corresponding author:
Univ. Prof. Dr. Jurgen Freiwald M.A.,
Department of Movement
and Training Science, University of
Wuppertal, Wuppertal, Germany.
Fax: +49 0202 439 2956.
E-Mail: freiwald@uni-wuppertal.de

Orthopaedics
and
Traumatology
Summary
The effects of Foam-rolling exercises in
therapy and sport are less investigated.
There is no scientific evidence that Foam-
rolling exercises can enhance warming-up
procedures, blood flow, athletic perform-
ance, sensomotoric function, and coordina-
tion or reduce muscle and fascial
connective tissue tone and stress-relaxa-
tion. In contrast, Foam-rolling exercises
can improve flexibility (ROM) and delayed
onset of muscular soreness (DOMS).
However, more research to compare
Foam-rolling exercises with traditional
stretching and recovery treatments is
required. During Foam-rolling exercises, a
high mechanical load is inducted to the
entire underlying tissue (e.g., fascia, mus-
cular, nerve, vessel, and bone tissue). That
external loads are 10-fold higher than the
highest medical compression category 4
and exceed twice the pressure loads that
are used in occlusion studies. To date, in
regards to Foam-rolling exercises, there are
no established and proven training
methods overall. Future investigations to
define fields of applications concerning
Foam-rolling exercises in therapy, medi-
cine, and sport are required. Therefore,
in- and exclusion criteria as well as imple-
mentation of individualized Foam-rolling
exercises are needed. In a further step,
training principles and methods of Foam-
rolling exercise including the use of differ-
ent types of Foam-rollers according to
different sports should be investigated
and defined. Importantly, more research
to investigate the underlying mechanical
and physiological mechanisms of Foam-
rolling exercises is strongly warranted.
Overall, in regards to the observed minor
scientific evidence with respect to athletic
performance and underlying mechanical
and physiological mechanism as well as
the negligence of potential harmful effects
in the scientific literature, Foam-rolling
exercises should be used cautiously at this
time.
Keywords
Foam-rolling myofascial release fascia
therapy sport
J. Freiwald et al.
REVIEW / SPECIAL ISSUE
Foam-Rolling in sport and
therapy Potential benefits and
risks
Part 2 Positive and adverse effects on athletic performance
Jurgen Freiwald, Christian Baumgart, Matthias Kuhnemann, Matthias W. Hoppe
Department of Movement and Training Science, University of Wuppertal, Germany
Eingegangen/submitted: 27.06.2016; uberarbeitet/revised: 08.07.2016; akzeptiert/accepted: 08.07.2016
Online verfugbar seit/Available online: 26.07.2016
Introduction
Foam-rolling exercises are a popular
treatment with respect to different
purposes in medicine and sport.
Foam-rolling is performed on an
individual basis through various
types of massage roller (Fig. 1) [77].
In MedLine, the keyword Foam-roll-
ing reveals 17 publications (01/24/
2016). The first publication is dated
back to 2013, but the existing num-
bers have continuously increased in
the following years. This indicates
both an overall poor scientific evi-
dence and increased interest in
Foam-rolling exercises.
With respect to the lack of scientific
evidence existing in sport and
therapy, Schroeder and Best [77]
showed that the effects of Foam-
rolling exercises as a pre-exercise
or recovery strategy are neither
homogeneous nor evident.
McKenney et al. [54] included in
their systematic review 10 publi-
cations and showed that the qual-
ity of the included studies was
mixed and only few conclusions
could be drawn. Moreover, the
authors pointed out that more
randomized controlled trials are
needed. In a further systematic
J. Freiwald et al.
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267275 (2016)
Elsevier GmbH
www.SOTjournal.com
http://dx.doi.org/10.1016/j.orthtr.2016.07.002
review, Beardsley and Skarabot
[10] showed contradictory results
of Foam-rolling exercises on flexi-
bility, force-production, athletic
performance, and delayed onset
of muscle soreness.
Foam-rolling devices,
exercises, and training
principles
For the self-treatment of fascial con-
nective tissue, different types of
Foam-rollers are used (e.g.,
material, size) (Fig. 1). The Foam-
rollers are intended to achieve a
massage and/or stretch effect on
the underlying tissue, especially
for the fascial connective tissue.
However, from the biomechanical
point of view, it is not possible to
solely influence the fascial connec-
tive tissue by external induced
pressures [8,18,59].
The purposes of Foam-rolling exer-
cises are manifold. Schleip and
Muller [75] mentioned the following
purposes:
 improving fascial remodeling;
 improving elastic recoil of fascial
tissues;
 improving myofascial health;

Foam-rolling in sport and therapy 267
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267275 (2016)

Foam-Rolling in Sport und

Therapie Potentieller
Nutzen und Risiken
Teil 2 Positive und
negative Effekte auf die
athletische
Leistungsf
ahigkeit
Zusammenfassung
Die Wirkungen des Foam-Rolling sind so-
wohl im therapeutischen als auch im sport-
lichen Anwendungsfeld wenig untersucht.
FOAM-Rolling zeigt keinen Einfluss auf das
Aufwarmen, den Blutfluss, die Kraft-
fahigkeiten, die Sprungleistungen, die an-
Figure 1
aerobe Leistungsfahigkeit sowie die Sen-
Different types of foam-rollers (left www.blackroll.de; center top www.
somotorik (Koordination). Nach dem bis-
sport-thieme.de; center bottom www.suprfit.de; right www.togu.de).
herigen Kenntnisstand konnen durch
Foam-Rolling weder der Muskeltonus noch
Stressfaktoren reduziert werden. Hinweise
zur Wirksamkeit des Foam-Rolling gibt es
im Bereich der Beweglichkeit, wobei die  improving fascial hydration and Furthermore, it is generally recom-
Effekte des Foam-Rolling nicht an die Wir- renewal; mended to perform special physical
kungen traditioneller Dehnmethoden her-  improving proprioceptive refinement. exercises, potentially helping to
anreichen. Fur die Bereiche der Regene-
ration nach sportlichen Belastungen sowie
maintain fascial connective tissue
zur Schmerzreduktion bei Muskelkater gibt Fascial connective tissue health that are referred as
es erste Wirksamkeitsnachweise; verglei- treatments Fascial Fitness (Figs. 2 and 3)
chende Studien mit tradierten Methoden [4,10,54,71,75,77,78,81].
zur Regeneration fehlen jedoch. Foam-Rol- For many years, myofascial connec-
ling ubt auf das darunter liegende Gewebe tive tissue complaints were treated Foam-rolling expected
(Faszien, Muskulatur, Nerven, Gefae,
Knochen) hohen Druck aus, der bis zum by methods like massage, osteop- effects and state of research
Zehnfachen der hochsten Kompressions- athy, and physiotherapy and are
klasse 4 reicht und doppelt so hoch ist supposed to reduce thickening, Foam-rolling exercises are used for
wie bei Studien mit kompletter Okklusion. adhesion, and tension of muscle the treatment of myofascial pain in
Gegenwartig existiert fur das Foam-Rolling and fascia tissue [17,54,58]. both preventive and rehabilitative
keine trainingswissenschaftlich und evi-
denzbasierte Trainingsmethodik. Zukunfti-
ge Untersuchungen mussen konkrete Ziel-
setzungen, Ein- und Ausschlusskriterien
sowie die physiologischen Grundlagen des
Foam-Rolling klaren und festlegen. Ferner
mussen Foam-Roller bezuglich ihrer Kon-
struktion an die individuellen Bedurfnisse
in Sport und Therapie angepasst werden
(z.B. Material, Durchmesser). Bevor diese
Arbeiten nicht geleistet und die offenen
Fragen nicht beantwortet sind, ist Foam-
Rolling nur mit Vorsicht und unter Be-
rucksichtigung potentieller Risiken anzu-
wenden, auf die in beiden Teilen des
Reviews hingewiesen wird.
sselwo
Schlu rter
Foam-Rolling Training Faszien Therapie
Physiotherapie
Figure 2
Foam-rolling exercise on the anterior tight.

268 J. Freiwald et al. 

Foam-Rolling in sport and therapy Potential benefits and risks

Figure 3
Foam-rolling exercise on the lower leg (calf).
settings [13,41,63,76] as well as an
isolated or additive warming-up pro-
cedure in competitive sports [64,65].
In the latter context, Foam-rolling
exercises are also intended to
enhance recovery after endurance
and strength efforts [57].
Due to the different types of applied
interventions and FOAM-rollers, the
results of the few existing studies are
not comparable [18,21,38,64,65].
Therefore, the resulting recommen-
dations to use Foam-rolling exercises
are ambiguous. While subjective
criteria like pain are mostly used
to evaluate therapy and training
treatments, less objective criteria
such as a controlled application
speed, pressure, or targeted region
have been applied.
Although current research for Foam-
rolling is deficient and contradic-
tory, many assumptions about its
effectiveness are postulated. In
sport, the following expectations
are suggested:
 improving warming-up and blood
flow;
 improving strength and jump
performance;
 improving anaerobic capacity;
 improving flexibility in terms of
range of motion (ROM);
 improving sensomotoric function
and coordination;
 improving stress-relaxation;
 reduction delayed onset of muscle
soreness (DOMS) and pain;
 reduction muscle and connective
tissue tone.
Improving warming up, blood
flow, and athletic performance
Using Foam-rolling exercises for
warming-up procedures are fre-
quently recommended. When Foam-
rolling exercises as warming up pro-
cedures are performed, the blood
flow in the treated area can increases
due to various causes. In addition to
fluid shifts, hormonal and/or inflam-
matory effects can be discussed, but
also a potential neuromuscular acti-
vation of the treated muscles, which
has not been studied yet [7,14].
Additionally, temperature shifts
J. Freiwald et al.
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267275 (2016)
can lead to changes in biomechan-
ical contraction and relaxation
parameters as well as stretch
responses of skeletal muscles and
fascial connective tissue [6,19,
37,40,49,58,74]. Furthermore, after
warming-up, a more accurate joint
position perception at the knee joint
has been reported [5].
In one investigations of our labora-
tory, after four and eight hours
of heating with a heat wrap
(ThermaCare), we have found differ-
ences in resting tone parameters
(i.e., passive mechanical muscle
tone, stiffness, elasticity, relaxation
time) at the paravertebral L3-L4 level
of the erector spinae muscle [47]. The
biomechanical parameters of muscle
tone, stiffness, and elasticity were
lower after the heat application,
but the relaxation time and creeping
have increased. Interestingly, after
the heat treatment, most subjects
reported an increased subjective feel-
ing in relaxation [47], but it is ques-
tionable, whether these results allow
a transfer to active warming-up pro-
cedures in sport.
One explanation for the mismatch
between objective and subjective
tension parameters may be that
active and passive warming-up pro-
cedures have increased the tempera-
ture of muscle and fascial connective
tissue, and thereby, influenced the
thresholds of chemo- and mechanor-
eceptors [12,33,34].
In regards to athletic performance,
the results of the existing studies
are also rare and contradictory.
One examination incorporating an
acute bout of Foam-rolling exercises
in adjunct with an active warming-
up shows an improved performance
in power, agility, strength, and
speed parameters. Therefore, the
authors recommended Foam-rolling
exercises [64]. However, most of the
studies show no performance
enhancing effects concerning maxi-
mum strength, and power as well

Foam-rolling in sport and therapy 269
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267275 (2016)
as anaerobic capacity, explosive
strength, and anaerobic power
related parameters (Overviews in
[10,18,51,59,83]).
Mikesky et al. [59] and Healey et al.
[38] investigated the effects of prior
Foam-rolling exercises on vertical
jump height, hamstring flexibility,
flying-start 20-yard dash, and iso-
kinetic knee extension at 908/s. The
results showed no effects of Foam-
rolling exercises. These findings are
supported by those of Kuhnemann
[48], who demonstrated that an
ergometer based warming-up
increased the vertical jump height
in contrast to Foam-rolling exercises
(Fig. 4).
To summarize, most studies show no
effects of Foam-rolling exercises on
performance parameters in athletes,
when Foam-rolling exercises were
included in warming-up procedures
[21,38,59,64]. Consequently, to
improve athletic performance, no
general recommendation to perform
Foam-rolling exercises as warming-
Figure 4
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
on the counter movement jump height in male recreational athletes (n = 20). Note:
* Statistical significant differences (p < 0.001) between pre and post and within post.
270 J. Freiwald et al. 
Foam-Rolling in sport and therapy Potential benefits and risks
up procedures prior to training or
competition can be given at this
time.
Improving anaerobic performance
Janot et al. [42] compared the
effects of static stretching and
Foam-rolling exercises on anaerobic
power parameters (i.e., 30-sec
Wingate test performance). The
effects of Foam-rolling exercises
on anaerobic power are inconclu-
sive. Consequently, to improve
anaerobic capacity, no recommen-
dation to perform Foam-rolling exer-
cises can be given.
Improving flexibility (ROM)
Foam-rolling exercises can tempor-
arily increase the ROM of hip, knee,
and ankle-joint without impairing
the neuromuscular activity or maxi-
mum isometric force [18,51,60].
However, in one study, there were
no differences in ROM, when a con-
ventional stretch training was com-
pared to Foam-rolling exercises [44].
While many studies have examined
the short-term effects of Foam-roll-
ing exercises on flexibility (ROM),
only few studies have investigated
middle- or long-term effects [10,11,
16,18,36,44,60,77].
Roylance et al. [72] investigated the
short-term effects of either postural
alignment or static stretching on
lumbar spinal, hip, knee, and ankle
flexibility (ROM), when Foam-rolling
exercises were additionally per-
formed. The results demonstrate
that additionally performed Foam-
rolling exercises increased flexibility
(ROM).
Similarly, Markovic [53] evaluated
the short-term effects of Foam-roll-
ing exercises on hip and knee flexi-
bility (ROM) in soccer players. In
this study, passive knee flexion
and straight leg raise tests were
measured before, immediately after,
and 24 h after the Foam-rolling
treatment. The findings show that
the knee and hip flexibility (ROM)
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-
sions. Again, the outcomes revealed
that all interventions increased
flexibility (ROM) and that a combi-
nation of Foam-rolling and static

stretching exercises showed the
largest effects.
Taken overall, the underlying
reasons for the improved flexibility
(ROM) remain unclear. From a struc-
tural point of view, the observed
effects can be explained by a
reduction in bonds between fascial
connective and muscle tissue [8,12,
6770,78] or a plastic deformation
of the connective tissue (e.g., fas-
cia, tendon, capsule). From an func-
tional point of view, a temporally
reduction in the perception of pain
may also lead to a short-term
enhanced flexibility (ROM) [10,12,
23,43,68,91,90].
Consequently, to improve flexibility
(ROM), a recommendation to per-
form Foam-rolling exercises can be
given, when aiming to increase the
flexibility beyond the maximal
accessible effects induced through
traditional stretching procedures.
Improving sensomotoric function
and coordination
The fascia connective tissue, especi-
ally the deep layers, has a compre-
hensive innervation and is supplied
by various receptors [39,55,82,84].
The number of receptors located in
the fascial connective tissue is
about 10-fold higher than in the
muscle tissue [88]. The periosteum
is considered as fascia connective
tissue as well and is also densely
supplied with receptors [85,88].
Among others, pain, motion, pres-
sure, vibration, chemical, and ther-
mal conditions can be detected by
receptors within the fascial connec-
tive tissue. The afferent information
are integrated by the peripheral and
central nervous system, potentially
affecting sensomotoric function and
coordination [24,2629,50].
Schleip and Muller [75] proposed
Foam-rolling exercises to improve
proprioceptive refinement, but
whether Foam-rolling exercises
affect the sensomotoric function
and coordination has not been pro-
ven yet. It is important to consider
that Foam-rolling exercises may not
only impact the sensory function,
but also the local metabolism.
Therefore, changes in the local
metabolism may influence the sen-
somotoric function [56]. In contrast
to Foam-rolling exercises, after
traditional warming-up procedures,
the improvement in joint position
perception and position sense at
the knee joint are well proven
[5,50,73].
Consequently, to improve sensomo-
toric function and coordination, a
recommendation to perform Foam-
rolling exercises cannot be given at
this time. In athletes, a sport-
specific and individual warming-up
seems to be more beneficial than
Foam-rolling exercises.
Improving reduction of stress-
relaxation
Practitioners recommend Foam-roll-
ing exercises to reduce stress.
However, in this context, there is
only one study. Kim et al. [45]
examined the influence of Foam-roll-
ing exercises on the level of serum
cortisol as an established stress
parameter after treadmill running
and showed that Foam-rolling exer-
cises had no beneficial effects [45].
Consequently, at this time, we can-
not give a recommendation to per-
form Foam-rolling exercises to
reduce stress associated cortisol
levels.
Reduction of delayed muscle
soreness (DOMS)
It has been shown that Foam-rolling
exercises can reduce the subjective
perceived delayed onset of muscle
soreness (DOMS) measured by pres-
sure pain thresholds and a visual
analog scale [52].
The underlying mechanisms of a
decrease in DOMS according to
Foam-rolling exercises remain
J. Freiwald et al.
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267275 (2016)
unclear. However, it is possible that
Foam-rolling exercises induce struc-
tural damage or metabolic and
neuronal alterations that lead to
changes in DOMS [10,12,25,31,43,
68,89,92].
Consequently, at this time, there is
only minor scientific evidence in
regards to Foam-rolling exercises
as a treatment to reduce DOMS.
Reduction of muscle and
connective tissue tone
One Foam-rolling exercises associ-
ated expectation is to reduce the
muscular and connective tissue tone
(Myofascial Release). Noteworthy,
most research failed to conduct
valid measurements. For example,
previous studies failed to differen-
tiate between the mechanical tone
and neuro-muscular activation,
which is widely independent from
ROM [23,25,32,56].
Due to the lack of valid measure-
ments, future studies should apply
valid procedures to measure the
muscle and connective tissue tone
(e.g., through myotonometrie and
electromyography).
Therefore, we cannot give a recom-
mendation to perform Foam-rolling
exercises to reduce the muscle
and fascial connective tissue tone
yet.
Foam rolling potential risks
Surprisingly, and in consideration of
many assumed positive effects of
Foam-rolling exercises, our litera-
ture review has revealed no refer-
ence concerning any harmful
effects. This is remarkable, since
Foam-rolling exercises exert a high
mechanical pressure not only on the
targeting fascial connective tissue,
but also on muscles, bones, nerves,
receptors, and vessels. In addition
to the pressure load, the shear and
tensile forces caused by Foam-roll-
ing exercises in and between the

Foam-rolling in sport and therapy 271
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267275 (2016)
different tissues cannot be neg-
lected [15,61].
Mechanical strain of the
underneath tissue
Curran et al. [20] showed that
the mechanical pressure differs
according to the applied type of
Foam-roller and also among the
subjects [20]. In their study, the
authors measured the maximum
mean pressure load at the lateral
tight that was reported to be
68.8 kPa (i.e., 516 mm/Hg). Thus,
these measured pressure values are
about 10-fold higher than the
highest medical compression
category 4 (i.e., extra strong com-
pression, at least 6.5 kPa or
49 mm/Hg) and exceeded twice
the pressure loads that are used
in occlusion studies [1,9,22].
Own studies achieved comparable
results. During common Foam-roll-
ing exercises, the vertical pressure
load was 33  1% of the body
weight measured at the calf and
the front thigh. Considering relative
and absolute contraindications such
as peripheral neuropathy, diabetes
mellitus, and the risk of venous
thrombosis or osteoporosis, which
may be evident in patients, older
people, or also in athletes, the use
of Foam-rolling exercises can lead to
harmful effects.
Nerve, vessels, and bones
From the perspective of phlebology
and lymphology, the mechanical
pressure exerted by Foam-rolling
exercises has to be critically ques-
tioned. Indeed, not only the fascial
connective tissue is mechanically
stressed, but also the vessels, in
particular venous valves, and
nerves, which run near the surface
e.g. of the hamstrings in the pop-
litea fossa (i.e., among others the N.
ischiadicus, V. poplitea). During
Foam-rolling exercises at the lower
leg, own measurements using
272 J. Freiwald et al. 
Foam-Rolling in sport and therapy Potential benefits and risks
Doppler ultrasound showed a
temporary complete interruption of
the blood flow and in some cases
even a complete compression of
the examined vessels, particularly
of veins.
Also, the effects of Foam-rolling
exercises on the lymphatic system
are still unclear. However, the
applied mechanical pressure loads
and direction of Foam-rolling
against the physiological venous
and lymphatic flow are contrary to
the commonly accepted scientific
doctrine in medicine and physio-
therapy [22,35,46,58].
Additionally, attention should be
paid to bony prominences such as
the spinous processes or the fibula
head.
Inflammation and pain
During, immediately, and on the
next day, Foam-rolling exercises
may induce pain [48]. The type of
pain and its time course may
indicate inflammatory processes
[30,66,79,92]. Due to the fact that
pain is a physiological warning sign
[92], the question arises whether
this warning must be considered in
the training advises.
Inflammatory processes can be
detected by blood tests. Okamoto,
Masuhara [62] measured increased
neutrophil concentrations after
Foam-rolling exercises. Furthermore,
in healthy volunteers, a study showed
that the arterial pulse wave velocity
decreased, while the nitric oxide con-
centration increased after Foam-roll-
ing exercises. These findings were
concluded by the authors as
beneficial and potential preventive
effects on arterial function and car-
diovascular disease, respectively.
However, it is also possible to inter-
pret, in particular, the increase in
nitric oxide concentration after
Foam-rolling exercises as a damage
of the intima (i.e., the endothelium)
[2,86].
The accumulation of fluid in tissues
occurs during inflammation, which
is detectible by the use of T2 con-
trast in MRI [87]. Due to our exten-
sive experience in top-level sports,
we have repeatedly seen athletes
showing signs of edema after
Foam-rolling exercises that were
visible in MRI (T2 weighted).
However, if the edema are induced
by shear forces and irritations or
damages of the vascular endo-
thelium during Foam-rolling exer-
cises remains unclear [8,62].
Conclusions and future
requirements
This second part of the review dis-
cussed Foam-rolling exercises in
sport and therapy. It was shown that
it is not possible to treat isolated
the fascial connective tissue by
Foam-rolling exercises and that
there are no established and proven
training methods overall [3]. There
is no scientific evidence that Foam-
rolling exercises can improve warm-
ing-up procedures, athletic perform-
ance, reduce muscle and fascial
connective tissue tone, and improve
stress-relaxation. In contrast, Foam-
rolling exercises can enhance flexi-
bility (ROM) and reduce delayed
onset of muscular soreness
(DOMS). In the scientific literature,
it is important to consider that
potential harmful effects of Foam-
rolling exercises are completely
ignored.
Future investigations to define fields
of applications concerning Foam-
rolling exercises in therapy, medi-
cine, and sport are required.
Therefore, in- and exclusion criteria
as well as implementation of indi-
vidualized Foam-rolling exercises
are needed. In a further step, train-
ing principles and methods of Foam-
rolling exercise including the use of
different types of Foam-rollers
according to different sports should

be investigated and defined.
Importantly, more research to inves-
tigate the underlying mechanical
and physiological mechanisms of
Foam-rolling exercises is strongly
warranted.
Overall, in regards to the observed
minor scientific evidence with
respect to athletic performance
and underlying mechanical and
physiological mechanism as well as
the negligence of potential harmful
effects, Foam-rolling exercises
should be used cautiously at this
time.
Conflict of interest
There is no conflict of interest.
References
[1] T. Abe, C.F. Kearns, Y. Sato, Muscle size
and strength are increased following
walk training with restricted venous
blood flow from the leg muscle,
Kaatsu-walk training, J. Appl.
Physiol. 100 (5) (2006) 14601466.
[2] E. Alshammari, et al., Markers of
inflammation, endothelial activation
and autoimmunity in adolescent
female gymnasts, J. Sports Sci. Med.
(9) (2010) 538546.
[3] W.E. Amonette, K.L. English, W.J.
Kraemer, Evidence-Based Practice in
Exercise Science. The Six-Step
Approach, Human Kinetics,
Champaign, 2016.
[4] M.F. Barnes, The basic science of myo-
fascial release: morphologic change in
connective tissue, J. Bodyw. Mov.
Ther. 1 (4) (1997) 231238.
[5] M.J. Bartlett, P.J. Warren, Effect of
warming up on knee proprioception
before sporting activity, Br. J. Sports
Med. 36 (2) (2002) 132134.
[6] C.R. Bass, et al., The temperature-
dependent viscoelasticity of porcine
lumbar spine ligaments, Spine (Phila
Pa 1976) 32 (16) (2007) E436E442.
[7] C. Baumgart, J. Freiwald, Dehnen -
Zwischen Anspruch und Wirklichkeit,
in: Pravention und Rehabilitation,
Sportverlag Strau, Koln, 2007, pp.
301309.
[8] C. Baumgart, et al., Massagerollen -
Segen oder Fluch? in:
Sporttechnologie zwischen Theorie
nd Praxis VI, 2015.
[9] C. Baumgart, et al., Massagerollen - Segen
oder Fluch? in: K. Witte, J. Edelmann-
Nusser (Eds.), Sporttechnologie zwischen
Theorie und Praxis VI, Shaker, Aachen,
2015, pp. 5260.
[10] C. Beardsley, J. Skarabot, Effects of
self-myofascial release: a systematic
review, J. Bodyw. Mov. Ther. 19 (4)
(2015) 747758.
[11] B. Behara, B.H. Jacobson, The acute
effects of deep tissue foam rolling and
dynamic stretching on muscular
strength, power, and flexibility in
Division I Linemen, J. Orthop.
Trauma (2015).
[12] N. Birbaumer, R.F. Schmidt, Biologische
Psychologie, 7th ed., Springer Medizin
Verlag, Heidelberg, 2010.
[13] E. Boettcher, Connected - Faszien:
Grundlagen und Therapieansatze,
Physiopraxis 4 (2015) 4849.
[14] D.J. Bradbury-Squires, et al., Roller-
massager application to the quadri-
ceps and knee-joint range of motion
and neuromuscular efficiency during a
lunge, J. Athl. Train. 50 (2) (2015)
133140.
[15] P. Brinckmann, et al. Orthopadische
Biomechanik, vol. 2, Westfalische
Wilhelms-Universitat Munster, Munster,
2012.
[16] J.E. Bushell, S.M. Dawson, M.M.
Webster, Clinical relevance of foam
rolling on hip extension angle in a
functional lunge position, J.
Strength Condit. Res. 29 (9) (2015)
23972403.
[17] M. Caspari, H. Massa, Rolfing structural
integration, in: Fascia: The Tensional
Network of the Human Body, Elsevier,
Edingburgh, 2012, pp. 303309.
[18] S.W. Cheatham, et al., The effects of
self-myofascial release using a foam roll
or roller massager on joint range of
motion, muscle recovery, and perform-
ance: a systematic review, Int. J. Sports
Phys. Ther. 10 (6) (2015) 827838.
[19] W.J. Ciccone 2nd, et al.,
Viscoelasticity and temperature vari-
ations decrease tension and stiffness
of hamstring tendon grafts following
anterior cruciate ligament reconstruc-
tion, J. Bone Joint Surg. Am. 88 (5)
(2006) 10711078.
[20] P.F. Curran, R.D. Fiore, J.J. Crisco, A
comparison of the pressure exerted on
soft tissue by 2 myofascial rollers, J.
Sport Rehabil. 17 (4) (2008) 432442.
[21] B.J. Fama, D.R. Bueti, The acute effect
of self-myofascial release on lower
J. Freiwald et al. 
Foam-rolling in sport and therapy
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267275 (2016)
extremity plyometric performance,
in: Physical Therapy and Human
Movement Science, Sacred Heart
University, 2011.
[22] M. Foldi, S. Kubik (Eds.), Lehrbuch der
Lymphologie, 5. vollig uberarbeitete
Auflage ed., Urban & Fischer,
Munchen, 2002, p. 767.
[23] J. Freiwald, Optimales Dehnen. Sport -
Pravention - Rehabilitation, Spitta,
Balingen, 2013.
[24] J. Freiwald, M. Engelhardt, Stand des
motorischen Lernens und der
Koordination in der orthopadisch-
traumatologischen Rehabilitation,
SportOrthoTrauma 18 (2002) 510.
[25] J. Freiwald, A. Greiwing, Optimales
Krafttraining. Sport - Pravention -
Rehabilitation, Spitta, Balingen, 2016.
[26] J. Freiwald, et al., The nerve supply of
the knee joint, WMW 147 (2324)
(1997) 531541.
[27] J. Freiwald, M. Engelhard, I. Reuter,
Neuromuscular and motor system alter-
ations after knee trauma an knee
surgery, in: M. Lehmann, et al. (Eds.),
Overload, Performance, Incompetence,
and Regeneration in Sport, Kluwer
Academic/Plenum, New York, 1999.
[28] J. Freiwald, T. Jollenbeck, C. Baumgart,
Obere Sprunggelenkverletzungen,
Pravention und Rehabilitation unter
der Perspektive der modernen
Motorikforschung, MOT 1 (2007) 17
25.
[29] J. Freiwald, C. Baumgart, P. Konrad,
Einfuhrung in die Elektromyographie.
Sport - Pravention - Rehabilitation,
Spitta, Balingen, 2007.
[30] H. Frisch, Programmierte Untersuchung
des Bewegungsapparates, 9th ed.,
Springer, Heidelberg, 2009.
[31] R.J. Gerrig, P.G. Zimbardo, Psychologie,
18th ed., Pearson Studium, Munchen,
2008.
[32] G.W. Gleim, M.P. McHugh, Flexibility
and its effects on sports injury and
performance, Sports Med. 24 (5)
(1997) 289299.
[33] E.B. Goldstein, Wahrnehmungspsychologie,
2. deutsche Ausgabe ed., Spektrum
Akademischer Verlag, Heidelberg,
2002, p. 811.
[34] B.G. Green, Temperature perception
and nociception, J. Neurobiol. 61 (1)
(2004) 1329.
[35] C. Gutenbrunner, G. Weimann (Eds.),
Krankengymnastische Methoden und
Konzepte, Springer, Berlin, 2004.
[36] I. Halperin, et al., Roller massager
improves range of motion of plantar
flexor muscles without subsequent
273
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267275 (2016)
decreases in force parameters, Int. J.
Sports Phys. Ther. 9 (1) (2014) 92
102.
[37] S. Hasberry, M.J. Pearcy, Temperature
dependence of the tensile properties
of interspinous ligaments of sheep, J.
Biomed. Eng. 8 (1) (1986) 6266.
[38] K.C. Healey, et al., The effects of myo-
fascial release with foam rolling on
performance, J. Strength Condit. Res.
28 (1) (2014) 6168.
[39] U. Hoheisel, T. Taguchi, S. Mense,
Nociception: the thoracolumbar fascia
as a sensory organ, in: R. Schleip, et al.
(Eds.), Fascia: The Tensional Network
of the Human Body, Churchill
Livingstone, Kidlington, 2012, pp.
95101.
[40] C.Y. Huang, et al., Temperature-
dependent viscoelastic properties of
the human supraspinatus tendon, J.
Biomech. 42 (4) (2009) 546549.
[41] R. Igel, Das Fasziendistorsionsmodell
(nach Typaldos): Die 6 Storungen und
deren Behandlung, Deutsche Zeitschrift
fur Osteopathie 4 (2014) 2125.
[42] J. Janot, et al., Effects of self myofas-
cial release and static stretching on
anaerobic power output, J. Fitness
Res. 2 (2013) 4154.
[43] K. Jay, et al., Specific and cross
over effects of massage for muscle
soreness: randomized controlled trial,
Int. J. Sports Phys. Ther. 9 (1) (2014)
8291.
[44] D. Junker, T. Stoggl, The foam roll as a
tool to improve hamstring flexibility,
J. Strength Condit. Res. (2015).
[45] K. Kim, et al., Effect of self-myofascial
release on reduction of physical stress:
a pilot study, J. Phys. Ther. Sci. 26
(11) (2014) 17791781.
[46] B.C. Kolster, Massage, Springer,
Berlin-Heidelberg, 2016.
[47] M. Kuhn, Messung der Gewebespannung
mittels Myotonometrie mit und ohne
lokale Warmeapplikation und deren
Veranderungen, Bergische Universitat
Wuppertal, Wuppertal, 2015.
[48] M. Kuhnemann, Untersuchung akuter
Effekte einer myofaszialen
Eigenbehandlung mittels Massagerolle
auf die Vertikalsprungleistung und aus-
gewahlte Gewebeeigenschaften, in:
Research Center for Performance
Diagnostics and Training Advice
(FLT), Bergische University
Wuppertal, Wuppertal, 2016.
[49] J.F. Lehmann, et al., Effect of thera-
peutic temperatures on tendon exten-
sibility, Arch. Phys. Med. Rehabil. 51
(8) (1970) 481487.
274 J. Freiwald et al. 
Foam-Rolling in sport and therapy Potential benefits and risks
[50] S.M. Lephart, F.H. Fu (Eds.),
Proprioception and Neuromuscular
Control in Joint Stability, Human
Kinetics, Champaign, 2000, p. 439.
[51] G.Z. MacDonald, et al., An acute bout
of self-myofascial release increases
range of motion without a subsequent
decrease in muscle activation or force,
J. Strength Condit. Res. 27 (3) (2013)
812821.
[52] G.Z. Macdonald, et al., Foam rolling as
a recovery tool after an intense bout of
physical activity, Med. Sci. Sports
Exerc. 46 (1) (2014) 131142.
[53] G. Markovic, Acute effects of instru-
ment assisted soft tissue mobilization
vs. foam rolling on knee and hip range
of motion in soccer players, J. Bodyw.
Mov. Ther. 19 (4) (2015) 690696.
[54] K. McKenney, et al., Myofascial release
as a treatment for orthopaedic con-
ditions: a systematic review, J. Athl.
Train. 48 (4) (2013) 522527.
[55] S. Mense, Functional anatomy of
muscle: muscle, nociceptors and affer-
ent fibers, in: S. Mense, R.D. Gerwin
(Eds.), Muscle Pain: Understanding the
Mechanisms, Springer, Heidelberg/
Dordrecht/London/New York, 2010,
pp. 1748.
[56] S. Mense, A.T. Masi, Increased muscle
tonus as a cause of muscle pain, in: S.
Mense, R.D. Gerwin (Eds.), Muscle
Pain: Understanding the Mechanisms,
Springer, Heidelberg/Dordrecht/
London/New York, 2010, pp. 207249.
[57] T. Meyer, et al., Regenerationsmanagment
im Spitzensport. REGman-Ergebnisse und
Handlungsempfehlungen, Strau, Koln,
2016.
[58] S.L. Michlovitz, J.W. Bellew, T.P. Nolan
(Eds.), Modalities for Therapeutic
Intervention, 5th ed., F.A. Davis
Company, 2012.
[59] A.E. Mikesky, et al., Acute effects of
the stick on strength, power, and flexi-
bility, J. Strength Condit. Res. 16 (3)
(2002) 446450. [73] E. Salgado, F. Ribeiro, J. Oliveira,
[60] A.R. Mohr, B.C. Long, C.L. Goad, Effect
of foam rolling and static stretching
on passive hip-flexion range of
motion, J. Sport Rehabil. 23 (4)
(2014) 296299.
[61] B.M. Nigg, B.R. MacIntosh, J. Mester
(Eds.), Biomechanics and Biology of
Movement, Human Kinetics, Champaign,
2000.
[62] T. Okamoto, M. Masuhara, K. Ikuta,
Acute effects of self-myofascial release
using a foam roller on arterial
function, J. Strength Condit. Res.
(2014).
[63] S. Paoletti, Faszien: Anatomie,
Strukturen, Techniken, Spezielle
Osteopathie, vol. 2, Elsevier Urban
& Fischer, Munchen, 2011.
[64] C.A. Peacock, et al., An acute bout of
self-myofascial release in the form of
foam rolling improves performance
testing, Int. J. Exerc. Sci. 7 (3)
(2014) 202211.
[65] C.A. Peacock, et al., Comparing acute
bouts of sagittal plane progression
foam rolling vs. frontal plane pro-
gression foam rolling, J. Strength
Condit. Res. 29 (8) (2015) 23102315.
[66] J.S. Petrofsky, Heat will reduce pain,
inflammation, and stiffness in the
lower back if used between therapy
for 2 weeks, 2014.
[67] A. Pilat, Myofascial induction
approaches, in: Fascia: The Tensional
Network of the Human Body, Elsevier,
Edingburgh, 2012, pp. 311317.
[68] J.P.J. Pinel, Biopsychologie, 2. neu
bearbeitete deutsche Auflage ed.,
Spektrum Akademischer Verlag,
Heidelberg, 2001p. 596.
[69] S. Preck, Faszienbehandlung, in: B.C.
Kolster, et al. (Eds.), Massage.
Klassische Massage, Querfriktion,
Funktionsmassage,
Faszienbehandlung, Springer, Berlin-
Heidelberg, 2015, pp. 460494.
[70] P.P. Purslow, J.-P. Delage, General
anatomy of the muscle fasciae, in:
Fascia: The Tensional Network of the
Human Body, Elsevier, Edingburgh,
2012, pp. 511.
[71] L. Remvig, R.M. Ellis, J. Patijn, Myofascial
release: an evidence-based treatment
approach? Int. Musculoskelet. Med. 30
(1) (2008) 2935.
[72] D.S. Roylance, et al., Evaluating acute
changes in joint range-of-motion
using self-myofascial release, postural
alignment exercises, and static
stretches, Int. J. Exerc. Sci. 6 (4)
(2013) 310319.
Joint-position sense is altered by foot-
ball pre-participation warm-up exer-
cise and match induced fatigue,
Knee 22 (3) (2015) 243248.
[74] P.C. Sawyer, et al., Effects of moist
heat on hamstring flexibility and
muscle temperature, J. Strength
Condit. Res. 17 (2) (2003) 285290.
[75] R. Schleip, D.G. Muller, Training
principles for fascial connective tis-
sues: scientific foundation and
suggested practical applications, J.
Bodyw. Mov. Ther. 17 (1) (2013)
103115.

[76] R. Schleip, et al. (Eds.), Lehrbuch
Faszien - Grundlagen, Forschung,
Behandlung, Urban & Fischer,
Munchen, 2014.
[77] A.N. Schroeder, T.M. Best, Is self myo-
fascial release an effective preexercise
and recovery strategy? A literature
review, Curr. Sports Med. Rep. 14 (3)
(2015) 200208.
[78] S. Shah, A. Bhalara, Myofascial release,
Int. J. Health Sci. Res. 2 (3) (2012)
6977.
[79] J.P. Shah, et al., Biochemicals associ-
ated with pain and inflammation are
elevated in sites near to and remote
from active myofascial trigger points,
Arch. Phys. Med. Rehabil. 89 (1)
(2008) 1623.
[80] J. Skarabot, C. Beardsley, I. Stirn,
Comparing the effects of self-myofas-
cial release with static stretching on
ankle range-of-motion in adolescent
athletes, Int. J. Sports Phys. Ther.
10 (2) (2015) 203212.
[81] G. Slomka, The Fascial Network. Train
and Improve Your Posture, Strength
and Flexibility, Meyer & Meyer
Sport, Aachen, 2015.
[82] J. Staubesand, Y. Li, Zum Feinbau der
Fascia cruris mit besonderer
View publication stats
Berucksichtigung epi-und intrafas-
zialer Nerven, Manuelle Medizin 34
(34) (1996) 196200.
[83] K.M. Sullivan, et al., Roller-Massager
application to the hamstrings
increases sit-and-reach range of
motion within five to ten seconds
without performance impairments,
Int. J. Sports Phys. Ther. 8 (3)
(2013) 228236.
[84] J. Tesarz, et al., Sensory innervation of
the thoracolumbar fascia in rats and
humans, Neuroscience 194 (2011)
302308.
[85] B. Tillmann, Binde- und Stutzgewebe
des Bewegungsapparates, in: H.
Leonhardt, et al. (Eds.), Anatomie
des Menschen, Thieme, Stuttgart,
2003, pp. 1349.
[86] D. Tousoulis, et al., The role of nitric
oxide on endothelial function,
Curr. Vasc. Pharmacol. 10 (1) (2012)
418.
[87] M. Vahlensieck, M. Reiser (Eds.), MRT
des Bewegungsapparats, 4th ed.,
Thieme Verlag, Stuttgart, 2015.
[88] J.C. van der Wal, Proprioception, in:
Fascia: The Tensional Network of the
Human Body, Elsevier, Edingburgh,
2012, pp. 8187.
Available online at www.sciencedirect.com
ScienceDirect
J. Freiwald et al.
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267275 (2016)
[89] B. Vaughan, P. McLaughlin, Immediate
changes in pressure pain threshold in
the iliotibial band using a myofascial
(foam) roller, Int. J. Ther. Rehabil. 21
(12) (2014) 569574.
[90] K. Wiemann, Beeinflussung muskularer
Parameter durch ein zehnwochiges
Dehnungstraining, Sportwissenschaft
21 (1991) 295305.
[91] K. Wiemann, T. Fischer, Ruhespannung
und Muskelkater, Sportwissenschaft
(1997) 428436.
[92] M. Zenz, I. Jurna (Eds.), Lehrbuch der
Schmerztherapie, 2. neubearbeitete
Auflage ed., Wissenschaftliche
Verlagsgesellschaft, Stuttgart, 2001,
p. 970.
Corresponding author:
Univ. Prof. Dr. Jurgen Freiwald M.A.,
Department of Movement
and Training Science, University of
Wuppertal, Wuppertal, Germany.
Fax: +49 0202 439 2956
E-Mail: freiwald@uni-wuppertal.de

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