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EFFECT OF SINGLE AND MULTIPLE SESSIONS OF SELF-MYOFASCIAL RELEASE: SYSTEMATIC REVIEW

EFECTO DE UNA SESIÓN Y DE MÚLTIPLES SESIONES DE AUTOLIBERACIÓN MIOFASCIAL: REVISIÓN SISTEMÁTICA

ABSTRACT

Self-myofascial release with a roller has been used as a tool to accelerate recovery. The objective of this systematic review was to investigate how one session or multiple sessions of self-myofascial release with a roller affect the recovery of an athlete´s performance. The research was conducted in the PubMed, Scopus, Cochrane Library, BVS, Embase, SPORTDiscus, ScienceDirect, and Google Scholar databases using the terms: foam rolling, foam roller, and self-myofascial release combined with recovery, exercise, fatigue, and sport and acute effects, chronic effects and performance, resulting in 12,020 articles. After checking the inclusion criteria, 40 studies were selected and analyzed. It was concluded that multiple sessions of self-myofascial release with a roller are more effective in recovering lower limb power and speed performance than just one session. A single session is more effective for recovering strength performance than multiple sessions. Moreover, both single and multiple sessions showed similar results in the recovery of agility, pain, flexibility, blood lactate removal, and perception of recovery. Finally, multiple sessions between sets of resistance exercise seem to reduce performance, decreasing the number of repetitions and resistance to fatigue, while a single session did not produce a significant effect. Self-myofascial release with a roller demonstrates potential for speeding up the recovery process of athletes. Future studies should evaluate the effect of the regular use of self-myofascial release with a roller on performance recovery. Level of evidence II; Systematic review.

Keywords:
Manipulation therapy; Recovery of function; Physical performance

RESUMEN

La autoliberación miofascial con foam roller se ha utilizado como estrategia para acelerar el proceso de recuperación. Esta revisión sistemática tuvo como objetivo investigar cómo una o varias sesiones de autoliberación miofascial con foam roller afectan la recuperación del desempeño de los atletas. La investigación se llevó a cabo en las bases de datos PubMed, Scopus, Cochrane Library, BVS, Embase, SPORTDiscus, ScienceDirect y Google Scholar utilizando los términos: “foam rolling”; “foam roller”; “self-myofascial release” combinados con “recovery”, “exercise”, “fatigue”, “sport”; y “acute effects”, “chronic effects”, “performance”, que dan como resultado 12.020 artículos. Tras verificar los criterios de inclusión, se seleccionaron y analizaron 40 estudios. Se concluyó que las sesiones múltiples de autoliberación miofascial con foam roller son más efectivas para recuperar el desempeño de potencia de las extremidades inferiores y velocidad que una sola sesión. Una sesión es más efectiva para recuperar el desempeño de fuerza que múltiples sesiones. Además, una sesión y varias sesiones demostraron resultados similares en la recuperación de la agilidad, el dolor, la flexibilidad, la eliminación del lactato en sangre y la percepción de recuperación. Por último, las sesiones múltiples entre series de ejercicios de resistencia parecen reducir el desempeño, al disminuir el número de repeticiones y la resistencia a la fatiga, mientras que una sola sesión no causó un efecto significativo. La autoliberación miofascial con foam roller demuestra su potencial de acelerar el proceso de recuperación de los atletas. Estudios futuros deberán evaluar el efecto del uso crónico de la autoliberación miofascial con foam roller en la recuperación del desempeño. Nivel de evidencia II; Revisión sistemática.

Descriptores:
Terapia por manipulación; Recuperación de la función; Desempeño físico

RESUMO

A autoliberação miofascial com rolo vem sendo utilizada como estratégia para acelerar o processo de recuperação. Esta revisão sistemática teve como objetivo investigar como uma sessão ou múltiplas sessões de autoliberação miofascial com rolo afetam a recuperação do desempenho dos atletas. A pesquisa foi realizada nas bases de dados PubMed, Scopus, Cochrane Library, BVS, Embase, SPORTDiscus, ScienceDirect e Google Scholar usando os termos: “foam rolling”; “foam roller”; “self-myofascial release” combinados com “recovery”, “exercise”, “fatigue”, “sport” e “acute effects”, “chronic effects”, “performance”, resultando em 12.020 artigos. Depois da verificação dos critérios de inclusão, 40 estudos foram selecionados e analisados. Verificou-se que múltiplas sessões de autoliberação miofascial com rolo são mais efetivas para recuperar o desempenho de potência dos membros inferiores e velocidade do que apenas uma sessão. Uma sessão é mais efetiva para a recuperação do desempenho de força do que múltiplas sessões. Além disso, uma sessão e múltiplas sessões mostraram resultados similares na recuperação de agilidade, dor, flexibilidade, remoção de lactato sanguíneo e percepção de recuperação. Por fim, múltiplas sessões entre séries de exercício resistido parecem reduzir o desempenho, diminuindo o número de repetições e a resistência à fadiga, enquanto uma só sessão não provocou efeito significativo. A autoliberação miofascial com rolo demonstra potencial para acelerar o processo de recuperação de atletas. Estudos futuros devem avaliar o efeito do uso crônico da autoliberação miofascial com rolo na recuperação do desempenho. Nível de evidência II; Revisão Sistemática.

Descritores:
Liberação miofascial; Recuperação de função fisiológica; Desempenho físico

INTRODUCTION

High-intensity physical exercise causes disturbances in various physiological systems, resulting in an increased perception of fatigue, muscle damage, late-onset muscle pain, decreased muscle strength, and reduced performance.11 MacDonald GZ, Button DC, Drinkwater EJ, Behm DG. Foam rolling as a recovery tool after an intense bout of physical activity. Med Sci Sports Exerc. 2014;46(1):131-42. The relatively short period between competitive sports events makes full recovery impossible for the athletes, creating the need for recovery strategies to maintain adequate performance.22 Minett GM, Duffield R. Is recovery driven by central or peripheral factors? A role for the brain in recovery following intermittent-sprint exercise. Front. Physiol. 2014;5:24.

Self-myofascial release (SMFR) has been used as a strategy to increase pre-training performance and speed up the recovery process.33 Wiewelhove T, Döweling A, Schneider C, Hottenrott L, Meyer T, Kellmann M, et al. A meta-analysis of the effects of foam rolling on performance and recovery. Front. Physiol. 2019;10:376. SMFR seems to improve performance and power recovery of the lower limbs, speed, agility, and flexibility, as well as better muscle activation, reduced late muscle pain, and improved vascular endothelial function.11 MacDonald GZ, Button DC, Drinkwater EJ, Behm DG. Foam rolling as a recovery tool after an intense bout of physical activity. Med Sci Sports Exerc. 2014;46(1):131-42.,44 Beardsley C, Škarabot J. Effects of self-myofascial release: a systematic review. J Bodyw Mov Ther. 2015;19(4):747-58.99 Schroeder AN, Best TM. Is self myofascial release an effective preexercise and recovery strategy? A literature review. Curr Sports Med Rep. 2015;14(3):200-8.

In this context, SMFR stands out as a strategy to accelerate the process of muscle damage recovery, reduce the sensation of fatigue and muscle pain, increase flexibility, and help maintain the physical performance of athletes.44 Beardsley C, Škarabot J. Effects of self-myofascial release: a systematic review. J Bodyw Mov Ther. 2015;19(4):747-58. Although it is widely used in practice, more scientific support is needed so practitioners, athletes, coaches, physicians, and sports scientists can apply evidence-based SMFR.

Because there are different protocols for using SMFR, what effect a single session of SMFR has on the performance and recovery of athletes and whether multiple sessions could generate better results must be understood, since the most effective type of session for speeding up the recovery process is still unknown. Therefore, the objective of this systematic review was to investigate how one session or multiple sessions of SMFR affect physical performance recovery.

METHODS

Data sources and bibliographical research strategy

This study was conducted through a systematic review of the literature covering the use of SMFR, following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines.1010 Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. The search was performed against the PubMed, Scopus, Cochrane Library, BVS, Embase, SPORTDiscus, and Google Scholar databases using the following terms: (foam rolling OR foam roller OR self-myofascial release) AND (recovery OR exercise OR fatigue OR sport) AND (acute effects OR chronic effects OR performance). In the ScienceDirect database, the search strategy covered the following terms: (foam rolling OR foam roller OR self-myofascial release) AND (recovery OR exercise OR fatigue) AND (acute effects OR chronic effects OR performance). The search was conducted in June 2020 and updated in February 2021.

Study eligibility and selection criteria

The study inclusion criteria were: 1) healthy adult participants; 2) use of single or multiple sessions of SMFR before, during, or after a training protocol that induced muscle fatigue/damage; 3) participants were their own controls or were randomly divided into a control and/or intervention group; 4) results presented with evaluation of measurements of physical performance, muscle pain, or flexibility; 5) publication in English. The following types of articles were excluded from this review: conference abstracts, case reports, systematic reviews, meta-analyses, dissertations, course conclusion papers, theses, book chapters, and textbooks.

Two reviewers (RFO and GFAB) conducted the search independently, sorting the titles and abstracts by relevance and evaluating the articles found to determine which of them met the inclusion criteria. Duplicate articles were identified and excluded from the study using the Zotero program. The two reviewers had access to the full text of the articles for the eligibility assessment. Finally, the articles that met the inclusion criteria were registered and included in the qualitative analysis. More details about the process of article identification, selection, eligibility, and inclusion are shown in Figure 1.

Figure 1
Flowchart for article identification, selection, and inclusion.

Quality assessment of the studies

Included articles were evaluated by two independent reviewers (RFO and GFAB) in accordance with PRISMA-P recommendations.1010 Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. A blind review was conducted, with the names of the authors and journals masked to avoid any potential bias or conflict of interest. Subsequently, the PEDro scale was used to verify methodological quality.1111 Base de Dados em Evidências em Fisioterapia (PEDro). 2021 [acesso em 2021 fev 28]. Disponível em: https://www.pedro.org.au/wpcontent/uploads/PEDro_scale_portuguese(brasil).pdf.
https://www.pedro.org.au/wpcontent/uploa...
Studies with PEDro scores from 6 to 10 points were considered of high quality, of 4 or 5 points of moderate quality, and from 0 to 3 points of low quality. All disagreements related to PEDro-score classification were resolved by discussion and consensus between the two reviewers.

Data extraction and synthesis

The data from the included articles were extracted by one of the two reviewers (RFO) and checked by another author who was not involved in the extraction process (JES), and were adjusted as necessary. The studies were classified into two categories defined as follows: “Single SMFR Session” and “Multiple SMFR Sessions”. After classification, relevant data, including participant characteristics, measured variables, exercise/training protocols, materials, intervention moments, muscle groups treated using SMFR, and significant results, were extracted from each study and summarized. After data extraction, the findings were qualitatively synthesized according to the study objective.

RESULTS

A total of 40 studies met the inclusion criteria and were included. The articles were heterogeneous, with significant limitations in relation to the different population characteristics and different moments and duration times of the SMFR protocol.

The mean PEDro scale score for the included studies was 5.55 ± 1.10 points (ranging from 2 to 8 points), indicating moderate quality. Most of the studies (24 out of 40) had high methodological quality and low risk of bias. A reasonable number (14 out of 40) had moderate quality with moderate risk of bias and only two articles had low quality with high risk of bias.

Single SMFR session

Table 1 summarizes the 23 studies that examined the effects of just one session of SMFR on performance recovery. Nineteen of the 23 studies evaluated showed some positive effect on some performance recovery parameter (82%). Eight studies reported a positive impact on flexibility (8 out of 11), seven on recovery from pain (7 of 10), five on removal of serum lactate (5 of 7), three on strength performance recovery (3 out of 5) and the perception of recovery (3 out of 3), two on the recovery of lower limb power (2 out of 6), one on the subjective perception of strength (1 out of 4), one on the recovery of agility performance (1 out of 3), and one of skin temperature recovery (1 out of 1). No positive effects on speed recovery (0 out of 2), serum CK concentration (0 of 2), or number of resistance exercise repetitions (0 out of 1) were observed (Table 1).

Table 1
Summary of studies examining the effects of a Self-myofascial release (SMR) session on performance recovery.

Multiple SMFR sessions

Table 2 summarizes the 17 studies that examined the effects of multiple SMFR sessions on performance recovery. Thirteen of the 17 studies evaluated reported some positive effect on some performance recovery parameter (76%). Six studies observed a positive effect on flexibility (6 out of 9), five on recovery from pain (5 out of 6), four on the recovery of power in the lower limbs (4 out of 8), two on the recovery of strength performance (2 out of 6), one each on the recovery of agility performance (1 out of 4), speed (1 out of 1), removal of blood lactate (1 out of 1), and sensation of recovery (1 out of 1). However, no positive effects were observed on the recovery of anaerobic power (0 out of 1), aerobic capacity (0 out of 1), the number of repetitions (0 out of 2), or the fatigue index (0 out of 2) (Table 2).

Table 2
Synthesis of studies examining the effects of multiple SMR sessions on performance recovery.

DISCUSSION

SMFR and physical performance

Overall, multiple SMFR sessions were more effective than one session in accelerating recovery of lower limb power. This suggests that there are chronic effects or that the tissues stimulated by SMFR, especially the myofascial tissue, need more time for positive adaptation.

Four studies did not verify the effects of a single SMFR session on height, maximum power, and reaction strength index in the countermovement vertical jump or the squat jump after a training session.1919 Laffaye G, Da Silva DT, Delafontaine A. Self-Myofascial Release Effect With Foam Rolling on Recovery After High-Intensity Interval Training. Front Physiol. 2019;10:1287.,2121 Rey E, Padrón-Cabo A, Costa PB, Barcala-Furelos R. The Effects of Foam Rolling as a Recovery Tool in Professional Soccer Players. J Strength Cond Res. 2019;33(8):2194-2201.2222 Fleckenstein J, Wilke J, Vogt L, Banzer W. Preventive and Regenerative Foam Rolling are Equally Effective in Reducing Fatigue-Related Impairments of Muscle Function following Exercise. J of Sport Sci Med. 2017;16(4):474-9.,3030 Giovanelli N, Vaccari F, Floreani M, Rejc E, Copetti J, Garra M, et al. Short-term effects of rolling massage on energy cost of running and power of the lower limbs. Int J Sports Physiol Perform. 2018;13(10):1337-43. However, one study observed an increase in jump height2424 Romero-Moraleda B, Gonzalez-Garcia J, Cuellar-Rayo A, Balsalobre-Fernandez C, Munoz-Garcia D, Morencos E. Effects of Vibration and Non-Vibration Foam Rolling on Recovery after Exercise with Induced Muscle Damage. J Sports sci Med. 2019;18(1):172-80. and another reported increases in the velocity, power, and peak power of the jump.2323 Jo E, Juache GA, Saralegui DE, Weng D, Falatoonzadeh S. The Acute Effects of Foam Rolling on Fatigue-Related Impairments of Muscular Performance. Sports (Basel, Switzerland). 2018;6(4):112. In relation to multiple SMFR sessions, less of a decline in jump distance and an increase in the height of the countermovement vertical jump were confirmed in time periods from 24 to 72 hours.11 MacDonald GZ, Button DC, Drinkwater EJ, Behm DG. Foam rolling as a recovery tool after an intense bout of physical activity. Med Sci Sports Exerc. 2014;46(1):131-42.,99 Schroeder AN, Best TM. Is self myofascial release an effective preexercise and recovery strategy? A literature review. Curr Sports Med Rep. 2015;14(3):200-8.,3636 Drinkwater EJ, Latella C, Wilsmore C, Bird SP, Skein M. Foam Rolling as a Recovery Tool Following Eccentric Exercise: Potential Mechanisms Underpinning Changes in Jump Performance. Front. Physiol. 2019;10:768.,3737 Aune AA, Bishop C, Turner AN, Papadopoulos K, Budd S, Richardson M, et al. Acute and chronic effects of foam rolling vs eccentric exercise on ROM and force output of the plantar flexors. J Sports Sci. 2019;37(2):138-45.

Multiple sessions were shown to accelerate the recovery of speed performance.88 Pearcey GE, Bradbury-Squires DJ, Kawamoto J-E, Drinkwater EJ, Behm DG, Button DC. Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Athl Train. 2015;50(1):5-13. It was found that multiple sessions (immediately, 24, and 48 hours after training) generated less of an increase in sprint time in periods from 24 to 72 hours.88 Pearcey GE, Bradbury-Squires DJ, Kawamoto J-E, Drinkwater EJ, Behm DG, Button DC. Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Athl Train. 2015;50(1):5-13. On the other hand, a single session of SMFR did not produce any positive effect on post-training sprint time.1515 Pelana R, Apriantono T, Bagus B, Juniarsyah AD, Ihsani SI. Effects of foam rolling on blood lactate concentration in elite futsal players. Hum Mov. 2021;22(1):70-7.,2121 Rey E, Padrón-Cabo A, Costa PB, Barcala-Furelos R. The Effects of Foam Rolling as a Recovery Tool in Professional Soccer Players. J Strength Cond Res. 2019;33(8):2194-2201.,3232 Miller K, Costa PB, Coburn JW, Brown LE. The effects of foam rolling on maximal sprint performance and range of motion. JASC. 2019;27(01):15-26. Thus, the results indicated that multiple sessions are also more effective in accelerating speed performance recovery.88 Pearcey GE, Bradbury-Squires DJ, Kawamoto J-E, Drinkwater EJ, Behm DG, Button DC. Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Athl Train. 2015;50(1):5-13.,1515 Pelana R, Apriantono T, Bagus B, Juniarsyah AD, Ihsani SI. Effects of foam rolling on blood lactate concentration in elite futsal players. Hum Mov. 2021;22(1):70-7.,2121 Rey E, Padrón-Cabo A, Costa PB, Barcala-Furelos R. The Effects of Foam Rolling as a Recovery Tool in Professional Soccer Players. J Strength Cond Res. 2019;33(8):2194-2201.,3232 Miller K, Costa PB, Coburn JW, Brown LE. The effects of foam rolling on maximal sprint performance and range of motion. JASC. 2019;27(01):15-26.

As for agility, one study with only a single SMFR session reported effective results in the t test,2121 Rey E, Padrón-Cabo A, Costa PB, Barcala-Furelos R. The Effects of Foam Rolling as a Recovery Tool in Professional Soccer Players. J Strength Cond Res. 2019;33(8):2194-2201. while two studies showed no influence on either dynamic reaction time or in the t test.1515 Pelana R, Apriantono T, Bagus B, Juniarsyah AD, Ihsani SI. Effects of foam rolling on blood lactate concentration in elite futsal players. Hum Mov. 2021;22(1):70-7.,2323 Jo E, Juache GA, Saralegui DE, Weng D, Falatoonzadeh S. The Acute Effects of Foam Rolling on Fatigue-Related Impairments of Muscular Performance. Sports (Basel, Switzerland). 2018;6(4):112. Controversial results were observed for multiple SMFR sessions with several studies reporting negative impact on agility recovery over a prolonged period88 Pearcey GE, Bradbury-Squires DJ, Kawamoto J-E, Drinkwater EJ, Behm DG, Button DC. Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Athl Train. 2015;50(1):5-13.,4444 Stovern O, Henning C, Porcari JP, Doberstein S, Emineth K, Arney BE, et al. The Effect of Training with a Foam Roller on Ankle and Knee Range of Motion, Hamstring Flexibility, Agility, and Vertical Jump Height. Int J Res Ex Phys. 2019;15(1):39-49.,4646 Rahimi A, Amani-Shalamzari S, Clemente FM. The effects of foam roll on perceptual and performance recovery during a futsal tournament. Physiol Behav. 2020;223:112981. and one study demonstrating better recovery of the same.66 D’Amico AP, Gillis J. The influence of foam rolling on recovery from exercise-induced muscle damage. J Strength Cond Res. 2019;33(9):2443-52. It is important to highlight that the studies used different intervention protocols.66 D’Amico AP, Gillis J. The influence of foam rolling on recovery from exercise-induced muscle damage. J Strength Cond Res. 2019;33(9):2443-52.,88 Pearcey GE, Bradbury-Squires DJ, Kawamoto J-E, Drinkwater EJ, Behm DG, Button DC. Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Athl Train. 2015;50(1):5-13.,1515 Pelana R, Apriantono T, Bagus B, Juniarsyah AD, Ihsani SI. Effects of foam rolling on blood lactate concentration in elite futsal players. Hum Mov. 2021;22(1):70-7.,2121 Rey E, Padrón-Cabo A, Costa PB, Barcala-Furelos R. The Effects of Foam Rolling as a Recovery Tool in Professional Soccer Players. J Strength Cond Res. 2019;33(8):2194-2201.,2323 Jo E, Juache GA, Saralegui DE, Weng D, Falatoonzadeh S. The Acute Effects of Foam Rolling on Fatigue-Related Impairments of Muscular Performance. Sports (Basel, Switzerland). 2018;6(4):112.,4444 Stovern O, Henning C, Porcari JP, Doberstein S, Emineth K, Arney BE, et al. The Effect of Training with a Foam Roller on Ankle and Knee Range of Motion, Hamstring Flexibility, Agility, and Vertical Jump Height. Int J Res Ex Phys. 2019;15(1):39-49.,4646 Rahimi A, Amani-Shalamzari S, Clemente FM. The effects of foam roll on perceptual and performance recovery during a futsal tournament. Physiol Behav. 2020;223:112981. Overall, the results suggest similar effects on agility recovery from both a single and multiple sessions of SMFR.

Regarding strength recovery, most studies indicate that neither one session nor multiple SMFR sessions accelerate the recovery process.11 MacDonald GZ, Button DC, Drinkwater EJ, Behm DG. Foam rolling as a recovery tool after an intense bout of physical activity. Med Sci Sports Exerc. 2014;46(1):131-42.,2626 Akinci B, Zenginler Yazgan Y, Altinoluk T. The effectiveness of three different recovery methods on blood lactate, acute muscle performance, and delayed-onset muscle soreness: a randomized comparative study. J Sports Med PhysFit. 2020;60(3):345-54.,3131 Zorko N, Škarabot J, Garcia-Ramos A, Štirn I. The acute effect of self-massage on the short-term recovery of muscle contractile function. Kinesiologia Slovenica. 2016;22(3):31.,3636 Drinkwater EJ, Latella C, Wilsmore C, Bird SP, Skein M. Foam Rolling as a Recovery Tool Following Eccentric Exercise: Potential Mechanisms Underpinning Changes in Jump Performance. Front. Physiol. 2019;10:768.3737 Aune AA, Bishop C, Turner AN, Papadopoulos K, Budd S, Richardson M, et al. Acute and chronic effects of foam rolling vs eccentric exercise on ROM and force output of the plantar flexors. J Sports Sci. 2019;37(2):138-45.,4545 Junker D, Stöggl T. The training effects of foam rolling on core strength endurance, balance, muscle performance and range of motion: a randomized controlled trial. J Sport Sci Med. 2019;18(2):229-38. One SMFR session immediately following different training protocols did not cause any significant change in maximum voluntary isometric action when compared to the control group, but it decreased squat resistance when compared to active recovery and electric neuromuscular stimulation.2626 Akinci B, Zenginler Yazgan Y, Altinoluk T. The effectiveness of three different recovery methods on blood lactate, acute muscle performance, and delayed-onset muscle soreness: a randomized comparative study. J Sports Med PhysFit. 2020;60(3):345-54.,3131 Zorko N, Škarabot J, Garcia-Ramos A, Štirn I. The acute effect of self-massage on the short-term recovery of muscle contractile function. Kinesiologia Slovenica. 2016;22(3):31. On the other hand, three studies observed positive effects from one SMFR session, both immediately and 48 hours after the training protocol, demonstrating less reduction and a subsequent increase in isometric and maximum voluntary concentric contractions.1414 Nakamura M, Yasaka K, Kiyono R, Onuma R, Yahata K, Sato S, et al. The Acute Effect of Foam Rolling on Eccentrically-Induced Muscle Damage. Int J Environ Res Public Health. 2021;18(1):75.,2222 Fleckenstein J, Wilke J, Vogt L, Banzer W. Preventive and Regenerative Foam Rolling are Equally Effective in Reducing Fatigue-Related Impairments of Muscle Function following Exercise. J of Sport Sci Med. 2017;16(4):474-9.,2525 Romero-Moraleda B, La Touche R, Lerma-Lara S, Ferrer-Peña R, Paredes V, Peinado AB, et al. Neurodynamic mobilization and foam rolling improved delayed-onset muscle soreness in a healthy adult population: a randomized controlled clinical trial. PeerJ. 2017;5:e3908. In relation to the use of multiple SMFR series, only two studies had positive results, indicating that its use immediately and 24, 48, and 72 hours after different training protocols caused greater endurance and muscle strength than in the control group in the period of 24 to 48 hours.88 Pearcey GE, Bradbury-Squires DJ, Kawamoto J-E, Drinkwater EJ, Behm DG, Button DC. Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Athl Train. 2015;50(1):5-13.,3535 Naderi A, Rezvani MH, Degens H. Foam Rolling and Muscle and Joint Proprioception After Exercise-Induced Muscle Damage. J Athl Train. 2020;55(1):58-64. In this context, studies have indicated that a single session is more effective for recovering strength performance than multiple sessions.

SMFR and late-onset muscle pain

Regarding late-onset muscle pain, several studies indicated that one session of SMFR after exercise and multiple SMFR session immediately, and 24, 48, 72, and 96 hours after a sprint protocol, did not significantly reduce pain.66 D’Amico AP, Gillis J. The influence of foam rolling on recovery from exercise-induced muscle damage. J Strength Cond Res. 2019;33(9):2443-52.,1313 Yanaoka T, Yoshimura A, Iwata R, Fukuchi M, Hirose, N. The effect of foam rollers of varying densities on range of motion recovery. J Bodyw Mov Ther. 2021;26:64-71.,2222 Fleckenstein J, Wilke J, Vogt L, Banzer W. Preventive and Regenerative Foam Rolling are Equally Effective in Reducing Fatigue-Related Impairments of Muscle Function following Exercise. J of Sport Sci Med. 2017;16(4):474-9.,2626 Akinci B, Zenginler Yazgan Y, Altinoluk T. The effectiveness of three different recovery methods on blood lactate, acute muscle performance, and delayed-onset muscle soreness: a randomized comparative study. J Sports Med PhysFit. 2020;60(3):345-54. However, only these four studies had non-significant results,66 D’Amico AP, Gillis J. The influence of foam rolling on recovery from exercise-induced muscle damage. J Strength Cond Res. 2019;33(9):2443-52.,1313 Yanaoka T, Yoshimura A, Iwata R, Fukuchi M, Hirose, N. The effect of foam rollers of varying densities on range of motion recovery. J Bodyw Mov Ther. 2021;26:64-71.,2222 Fleckenstein J, Wilke J, Vogt L, Banzer W. Preventive and Regenerative Foam Rolling are Equally Effective in Reducing Fatigue-Related Impairments of Muscle Function following Exercise. J of Sport Sci Med. 2017;16(4):474-9.,2626 Akinci B, Zenginler Yazgan Y, Altinoluk T. The effectiveness of three different recovery methods on blood lactate, acute muscle performance, and delayed-onset muscle soreness: a randomized comparative study. J Sports Med PhysFit. 2020;60(3):345-54. while most of the studies reported a reduction in the perception of pain and a higher pressure pain threshold, observing maintenance of and subsequent decrease in the level of late-onset muscle pain during the period from 24 to 48 hours after the training protocol.11 MacDonald GZ, Button DC, Drinkwater EJ, Behm DG. Foam rolling as a recovery tool after an intense bout of physical activity. Med Sci Sports Exerc. 2014;46(1):131-42.,88 Pearcey GE, Bradbury-Squires DJ, Kawamoto J-E, Drinkwater EJ, Behm DG, Button DC. Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Athl Train. 2015;50(1):5-13.,1414 Nakamura M, Yasaka K, Kiyono R, Onuma R, Yahata K, Sato S, et al. The Acute Effect of Foam Rolling on Eccentrically-Induced Muscle Damage. Int J Environ Res Public Health. 2021;18(1):75.,1717 Adamczyk JG, Gryko K, Boguszewski D. Does the type of foam roller influence the recovery rate, thermal response and DOMS prevention? PloS One. 2020;15(6):e0235195.,1919 Laffaye G, Da Silva DT, Delafontaine A. Self-Myofascial Release Effect With Foam Rolling on Recovery After High-Intensity Interval Training. Front Physiol. 2019;10:1287.,2121 Rey E, Padrón-Cabo A, Costa PB, Barcala-Furelos R. The Effects of Foam Rolling as a Recovery Tool in Professional Soccer Players. J Strength Cond Res. 2019;33(8):2194-2201.,2424 Romero-Moraleda B, Gonzalez-Garcia J, Cuellar-Rayo A, Balsalobre-Fernandez C, Munoz-Garcia D, Morencos E. Effects of Vibration and Non-Vibration Foam Rolling on Recovery after Exercise with Induced Muscle Damage. J Sports sci Med. 2019;18(1):172-80.,2525 Romero-Moraleda B, La Touche R, Lerma-Lara S, Ferrer-Peña R, Paredes V, Peinado AB, et al. Neurodynamic mobilization and foam rolling improved delayed-onset muscle soreness in a healthy adult population: a randomized controlled clinical trial. PeerJ. 2017;5:e3908.,2727 Lee EJ, Van Iterson EH, Baker SE, Kasak AJ, Taylor NE, Kang C, et al. Foam rolling is an effective recovery tool in trained distance runners. Sport Sci Health. 2020;16(1):105-15.,3434 D’Amico A, Gillis J, McCarthy K, Leftin J, Molloy M, Heim H, et al. Foam rolling and indices of autonomic recovery following exercise-induced muscle damage. Int J Sports Phys Ther. 2020;15(3):429-40.3636 Drinkwater EJ, Latella C, Wilsmore C, Bird SP, Skein M. Foam Rolling as a Recovery Tool Following Eccentric Exercise: Potential Mechanisms Underpinning Changes in Jump Performance. Front. Physiol. 2019;10:768. Thus, both the use of one session and the use of multiple sessions of SMFR produced similar results and are indicated for the reduction of late-onset muscle pain.

SMFR and flexibility

Only six studies did not demonstrate increased flexibility after the use of one1919 Laffaye G, Da Silva DT, Delafontaine A. Self-Myofascial Release Effect With Foam Rolling on Recovery After High-Intensity Interval Training. Front Physiol. 2019;10:1287.,2121 Rey E, Padrón-Cabo A, Costa PB, Barcala-Furelos R. The Effects of Foam Rolling as a Recovery Tool in Professional Soccer Players. J Strength Cond Res. 2019;33(8):2194-2201.,2020 D’Amico A, Paolone V. The Effect of Foam Rolling on Recovery Between Two Eight Hundred Metre Runs. J Hum Kinet. 2017;57(1):97-105. or multiple SMFR sessions.66 D’Amico AP, Gillis J. The influence of foam rolling on recovery from exercise-induced muscle damage. J Strength Cond Res. 2019;33(9):2443-52.,3636 Drinkwater EJ, Latella C, Wilsmore C, Bird SP, Skein M. Foam Rolling as a Recovery Tool Following Eccentric Exercise: Potential Mechanisms Underpinning Changes in Jump Performance. Front. Physiol. 2019;10:768.,3737 Aune AA, Bishop C, Turner AN, Papadopoulos K, Budd S, Richardson M, et al. Acute and chronic effects of foam rolling vs eccentric exercise on ROM and force output of the plantar flexors. J Sports Sci. 2019;37(2):138-45. Most of the studies reported increased flexibility after the use of one or multiple (from 2 to 24) SMFR sessions, even when different intervention protocols were used.11 MacDonald GZ, Button DC, Drinkwater EJ, Behm DG. Foam rolling as a recovery tool after an intense bout of physical activity. Med Sci Sports Exerc. 2014;46(1):131-42.,1212 Maniatakis A, Mavraganis N, Kallistratos E, Mandalidis D, Mylonas K, Angelopoulos P, et al. The effectiveness of Ergon Instrument-Assisted Soft Tissue Mobilization, foam rolling, and athletic elastic taping in improving volleyball players’ shoulder range of motion and throwing performance: a pilot study on elite athletes. J Phys Ther Sci. 2020;32(10):611-4.1414 Nakamura M, Yasaka K, Kiyono R, Onuma R, Yahata K, Sato S, et al. The Acute Effect of Foam Rolling on Eccentrically-Induced Muscle Damage. Int J Environ Res Public Health. 2021;18(1):75.,1818 de Benito AM, Valldecabres R. Effect of vibration vs non-vibration foam rolling techniques on flexibility, dynamic balance and perceived joint stability after fatigue. PeerJ. 2019;7:e8000.,2424 Romero-Moraleda B, Gonzalez-Garcia J, Cuellar-Rayo A, Balsalobre-Fernandez C, Munoz-Garcia D, Morencos E. Effects of Vibration and Non-Vibration Foam Rolling on Recovery after Exercise with Induced Muscle Damage. J Sports sci Med. 2019;18(1):172-80.,2626 Akinci B, Zenginler Yazgan Y, Altinoluk T. The effectiveness of three different recovery methods on blood lactate, acute muscle performance, and delayed-onset muscle soreness: a randomized comparative study. J Sports Med PhysFit. 2020;60(3):345-54.,3232 Miller K, Costa PB, Coburn JW, Brown LE. The effects of foam rolling on maximal sprint performance and range of motion. JASC. 2019;27(01):15-26.,3333 Pożarowszczyk B, Kisilewicz A, Kawczyński A. Effects of training and foam rolling on muscle properties in swimmers. SWIMMING VII. 2018:92-98.,3636 Drinkwater EJ, Latella C, Wilsmore C, Bird SP, Skein M. Foam Rolling as a Recovery Tool Following Eccentric Exercise: Potential Mechanisms Underpinning Changes in Jump Performance. Front. Physiol. 2019;10:768.,4040 Alin L, Azab M. Effects of Self Myofascial Release Using a Foam Roll on Range of Motion and Performance Level of Individual Routine in Rhythmic Gymnastics. Ovidius Univ. Ann. Ser. Phys. Educ Sport. Sci. Mov. Health. 2019;19(2 supplement):256-61.,4141 Guillot A, Kerautret Y, Queyrel F, Schobb W, Di Rienzo F. Foam Rolling and Joint Distraction with Elastic Band Training Performed for 5-7 Weeks Respectively Improve Lower Limb Flexibility. J Sport Sci Med. 2019;18(1):160-71.,4444 Stovern O, Henning C, Porcari JP, Doberstein S, Emineth K, Arney BE, et al. The Effect of Training with a Foam Roller on Ankle and Knee Range of Motion, Hamstring Flexibility, Agility, and Vertical Jump Height. Int J Res Ex Phys. 2019;15(1):39-49.,4545 Junker D, Stöggl T. The training effects of foam rolling on core strength endurance, balance, muscle performance and range of motion: a randomized controlled trial. J Sport Sci Med. 2019;18(2):229-38.,4747 Junker DH, Stöggl TL. The foam roll as a tool to improve hamstring flexibility. J Strength Cond Res. 2015;29(12):3480-5. Thus, the use of a single session or multiple sessions of SMFR after a training protocol produced similar results, both being indicated for flexibility recovery.

SMFR and other results

One study found that multiple SMFR sessions increased the removal of blood lactate and the sensation of recovery.4646 Rahimi A, Amani-Shalamzari S, Clemente FM. The effects of foam roll on perceptual and performance recovery during a futsal tournament. Physiol Behav. 2020;223:112981. Five studies with one post-exercise SMFR session also observed faster lactate removal,77 Kalén A, Pérez-Ferreirós A, Barcala-Furelos R, Fernández-Méndez M, Padrón-Cabo A, Prieto JA, et al. How can lifeguards recover better? A cross-over study comparing resting, running, and foam rolling. Am J Emerg Med. 2017;35(12):1887-91.,1515 Pelana R, Apriantono T, Bagus B, Juniarsyah AD, Ihsani SI. Effects of foam rolling on blood lactate concentration in elite futsal players. Hum Mov. 2021;22(1):70-7.1717 Adamczyk JG, Gryko K, Boguszewski D. Does the type of foam roller influence the recovery rate, thermal response and DOMS prevention? PloS One. 2020;15(6):e0235195.,2929 Özsu İ, Gurol B, Kurt C. Comparison of the Effect of Passive and Active Recovery, and Self-Myofascial Release Exercises on Lactate Removal and Total Quality of Recovery. J Educ Train Stud. 2018;6(9a):33-42. but two studies did not observe this effect.2020 D’Amico A, Paolone V. The Effect of Foam Rolling on Recovery Between Two Eight Hundred Metre Runs. J Hum Kinet. 2017;57(1):97-105.,2626 Akinci B, Zenginler Yazgan Y, Altinoluk T. The effectiveness of three different recovery methods on blood lactate, acute muscle performance, and delayed-onset muscle soreness: a randomized comparative study. J Sports Med PhysFit. 2020;60(3):345-54. These results highlight that both one session and multiple sessions of SMFR have the potential to accelerate lactate removal. It was not possible to determine the effect of SMFR on aerobic power or aerobic capacity due to a lack of studies.

The use of multiple SMFR sessions between sets of exercise reduced the number of repetitions and resistance to fatigue.3838 Monteiro ER, Vigotsky A, Škarabot J, Brown AF, de Melo Fiuza AGF, Gomes TM, et al. Acute effects of different foam rolling volumes in the interset rest period on maximum repetition performance. Hong Kong Physiother J. 2017;36:57-62.,3939 Monteiro ER, Neto VGC. Effect of different foam rolling volumes on knee extension fatigue. Int J Sports Phys Ther. 2016;11(7):1076-81.,4242 Monteiro ER, Škarabot J, Vigotsky AD, Brown AF, Gomes TM, da Silva Novaes J. Maximum Repetition Performance After Different Antagonist Foam Rolling Volumes In The Inter‐Set Rest Period. Int J Sports Phys Ther. 2017;12(1):76-84.,4343 Monteiro ER, Costa PB, Neto VGC, Hoogenboom BJ, Steele J, da Silva Novaes J. Posterior thigh foam rolling increases knee extension fatigue and passive shoulder range-of-motion. J Strength Cond Res. 2019;33(4):987-94. The studies used multiple sessions of SMFR with intervention times of 60, 90, and 120 seconds between sets of knee extensions to eccentric failure.3838 Monteiro ER, Vigotsky A, Škarabot J, Brown AF, de Melo Fiuza AGF, Gomes TM, et al. Acute effects of different foam rolling volumes in the interset rest period on maximum repetition performance. Hong Kong Physiother J. 2017;36:57-62.,3939 Monteiro ER, Neto VGC. Effect of different foam rolling volumes on knee extension fatigue. Int J Sports Phys Ther. 2016;11(7):1076-81.,4242 Monteiro ER, Škarabot J, Vigotsky AD, Brown AF, Gomes TM, da Silva Novaes J. Maximum Repetition Performance After Different Antagonist Foam Rolling Volumes In The Inter‐Set Rest Period. Int J Sports Phys Ther. 2017;12(1):76-84.,4343 Monteiro ER, Costa PB, Neto VGC, Hoogenboom BJ, Steele J, da Silva Novaes J. Posterior thigh foam rolling increases knee extension fatigue and passive shoulder range-of-motion. J Strength Cond Res. 2019;33(4):987-94. The longer the duration of the SMFR session, the greater the decrease in performance. Using One SMFR session between two exercise sets had no positive effect nor did it reduce the number of repetitions.2828 da Silva PRN, Monteiro ER, Peixoto CG, de Carvalho ABM, Monteiro TMG, de Figueiredo TC. Acute Effects of Inter-Set Rest Period Foam Rolling on Repetition Performance in Strength Training. J. Exerc. Physiol. Online. 2019;22(3). The results indicate that multiple SMFR sessions between sets of resistance exercises should be avoided because they hinder performance recovery.

The use of a single SMFR session after the training protocol did not influence either serum CK concentration or the perception of exertion, but it produced a greater perception of recovery and an increase in skin temperature.77 Kalén A, Pérez-Ferreirós A, Barcala-Furelos R, Fernández-Méndez M, Padrón-Cabo A, Prieto JA, et al. How can lifeguards recover better? A cross-over study comparing resting, running, and foam rolling. Am J Emerg Med. 2017;35(12):1887-91.,1313 Yanaoka T, Yoshimura A, Iwata R, Fukuchi M, Hirose, N. The effect of foam rollers of varying densities on range of motion recovery. J Bodyw Mov Ther. 2021;26:64-71.,1616 Wattimena FY, Winata B. Effect of Hot-Water Immersion and Foam Rolling on Recovery in Amateur Sepaktakraw Players. Int J Hum Mov Sports Sci. 2020;8(6):498-504.,1717 Adamczyk JG, Gryko K, Boguszewski D. Does the type of foam roller influence the recovery rate, thermal response and DOMS prevention? PloS One. 2020;15(6):e0235195.,2121 Rey E, Padrón-Cabo A, Costa PB, Barcala-Furelos R. The Effects of Foam Rolling as a Recovery Tool in Professional Soccer Players. J Strength Cond Res. 2019;33(8):2194-2201.,2727 Lee EJ, Van Iterson EH, Baker SE, Kasak AJ, Taylor NE, Kang C, et al. Foam rolling is an effective recovery tool in trained distance runners. Sport Sci Health. 2020;16(1):105-15.,2929 Özsu İ, Gurol B, Kurt C. Comparison of the Effect of Passive and Active Recovery, and Self-Myofascial Release Exercises on Lactate Removal and Total Quality of Recovery. J Educ Train Stud. 2018;6(9a):33-42.,3030 Giovanelli N, Vaccari F, Floreani M, Rejc E, Copetti J, Garra M, et al. Short-term effects of rolling massage on energy cost of running and power of the lower limbs. Int J Sports Physiol Perform. 2018;13(10):1337-43. It was also associated with a lower perception of exertion after the Wingate test when compared to passive recovery.1818 de Benito AM, Valldecabres R. Effect of vibration vs non-vibration foam rolling techniques on flexibility, dynamic balance and perceived joint stability after fatigue. PeerJ. 2019;7:e8000. In addition, one study with multiple SMFR sessions reported similar positive sensation of recovery results after futsal matches.4646 Rahimi A, Amani-Shalamzari S, Clemente FM. The effects of foam roll on perceptual and performance recovery during a futsal tournament. Physiol Behav. 2020;223:112981. A single session and multiple sessions of SMFR both demonstrated similar positive results for the perception of recovery. One SMFR session can have a positive effect on recovery of the perception of exertion.

CONCLUSION

Although both a single session and multiple sessions have similar effects on the recovery of agility, the reduction in late-onset muscle pain, lactate removal, increased flexibility, and perceived recovery, the two strategies produced different effects on the recovery of lower limb power, speed, and strength. While a single SMFR session appears to be more effective in recovering strength performance, multiple sessions are more effective restoring the power of the lower limbs and speed. Additionally, there is evidence that multiple sessions during rest periods between sets of resistance exercises reduce performance. Effects experienced after using this SMFR strategy point to a smaller decrease in performance and may be beneficial to athletes who train and compete repeatedly. So, it is important to evaluate the individual responses within the practical context. Further studies should assess the chronic use of SMFR in performance recovery and identify potential mechanisms involved in the process.

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Publication Dates

  • Publication in this collection
    04 Apr 2022
  • Date of issue
    Jul-Aug 2022

History

  • Received
    28 Apr 2021
  • Accepted
    05 Oct 2021
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