The Influence of Local Muscle Vibration During Foam Rolling on Range of Motion and Pain

Research Review: The Influence of Local Muscle Vibration During Foam Rolling on Range of Motion and Pain

By Arran McManus MSc, BSc (Hons), ASCC, PGCAP & FHEA

Edited by Brent Brookbush DPT, PT, COMT, MS, PES, CES, CSCS, ACSM H/FS

Announcement and Review of Findings Prior to Journal Publication - Enrique, D; Mauntel, T; Pietrosimone, B; Clark, M; Padua, D. The Influence of Local Muscle Vibration During Foam Rolling on Range of Motion and Pain. Submitted for publication to the Journal Strength and Conditioning Research in 2017 - Link to Manuscript

Why the Study is Relevant: A reduction in dorsiflexion range of motion (ROM) has been correlated with several lower extremity impairments (1-13). Research has demonstrated that release of the gastrocnemius /soleus with a foam roll may result in an increase in dorsiflexion without a decrease in force production, when combined with stretching will increase ROM more than either release or stretching alone, may decrease post onset muscle soreness and recovery time, and may enhance rehabilitation from plantar heel pain (13 - 18). Research has also demonstrated that vibration training may increase flexibility and performance (19-21). To our knowledge, this soon to be published 2017 study is the first to investigate the effect of foam rolling with vibration on ankle dorsiflexion ROM. The findings suggest that the addition of vibration enhances the benefits of foam rolling, resulting in greater change in ROM and reduction in pain pressure threshhold. The technology used in the study was the VYPER™ by Hyperice .

Caption: Photograph of an athlete using the viper foam roll on calf

HyperIce.com Viper Vibrating Foam Roll

Study Summary

Design	Cross-over study
Level of Evidence	IB evidence from at least one randomized controlled trial
Participant Characteristics	Demographics Age (± standard deviation, in years): 21.1 ± 2.0 Gender: 14 female, 6 male Height: 167.3 ±7.7 cm Body Mass: 64.5 ± 11.5 kg Inclusion Criteria: Age 18-26 Physically active (a minimum of 30 minutes of exercise 3x per week for the last 6 months) Ankle dorsiflexion range of motion less than 40 degrees, as measured by the weight bearing lunge test At least 1 myofascial trigger point in the gastrocnemius or soleus of the dominant leg Exclusion criteria: Lower extremity surgical procedure Lower extremity injury, defined as an injury that restricted activity for more than 2 days, within the last 6 months Neurological disorder
Methodology	All participants completed a screening session consisting of: Weight bearing lunge dorsiflexion test Examination for myofascial trigger points (identified in prone position, knees extended) Four criterion were used to identify myofascial trigger points (22-23): Palpable band taught within the skeletal muscle Hypersensitive tender spot/nodule within a taught band Recognition of current pain complaint by pressure on the tender nodule Painful limit to full stretch range of motion At least 2 of the criteria above had to be satisfied to identify a myofascial trigger point (11) Study Outline: 5-minute stationary bike warm-up at moderate intensity (3/10 on rate of perceived exertion (RPE) scale Range of motion measurements and pain pressure threshold assessment Random assignment to foam rolling or foam rolling with vibration group Foam rolling intervention Range of motion assessments repeated Stretching intervention Final range of motion measurements and pain pressure threshold assessment Intervention groups (randomly assigned crossover): Participants were randomly assigned to one of two groups (compression and vibration/compression only) The self-administered myofascial and trigger point intervention consisted of: Using the VYPER™ (Hyperice, Irvine, CA), a high-density foam cylinder 18” long and 6” wide with a vibrating motor embedded within it, to produce local muscle vibration The vibration feature was set to 2 (32Hz), selected for its tolerability and intensity. During compression-only treatment the VYPER™ (Hyperice, Irvine, CA) was used without the vibration feature. Participants in both groups were instructed to: Place the foam roller under the calf of one leg and put the non-rolling leg on top, keeping hips off the ground If this was too painful, participants placed the foot of the non-rolling leg on the ground. Slowly move the roller between the ankle and knee for 5 seconds, then return to the ankle, for a total of 30 seconds. Hold pressure for 45 seconds over the three most painful pre-identified trigger points. Stretching Protocol (performed after self-myofascial and trigger point release): Both groups performed the same stretching protocol immediately after completing a second round of range of motion measurements. Static stretch for the gastrocnemius/soleus was performed standing, using a slant board with knee straight followed by knee bent for three sets of 30 seconds each. Range of motion measurements: Weight bearing lunge test: A digital inclinometer was used to measure the angle of the tibia from vertical. Participants stood barefoot on the dominant leg (defined as the kicking foot), supported themselves against a wall and rested the non-dominant foot in a comfortable position. The participant bent the dominant knee, lunging as far forward as possible, keeping it in line with the long-axis of the leg and the heel on the ground. The foot was then moved posteriorly until maximum range of dorsiflexion was reached, defined as when the heel lifted off the ground. Inclinometer measurements were recorded at maximum dorsiflexion. Ankle Dorsiflexion Recorded with a 12-inch goniometer (standard ROM technique for gastrocnemius and soleus). Measurements were taken at the first point of tissue restriction with the knee straight as well as bent to 90 degrees. Three measurements were taken and averaged. Pain Pressure Threshold and Numerical Rating Scale measurements: The measurements were taken on the participant’s least sensitive myofascial trigger point. A handheld dynamometer with focal tip attachment was used to apply a slowly increasing force over the center of the marked myofascial trigger-point. Pressure was stopped and the measurement taken when participants informed the researcher the pain was ‘just noticeable.’ Participants were asked to quantify pain on a numerical rating scale (0 = no pain, 10 = unbearable pain) after they were shown an illustration of the scale and pain values were verbally stated to them. Outcome measures: Ankle dorsiflexion ROM Pain pressure threshold of the gastrocnemius/soleus complex
Data Collection and Statistical Analysis	Data was calculated using a 2x2 repeated measures ANOVA, with time defined as pre- to post-stretching vs pre- to post-foam rolling, and intervention defined as traditional or vibrational foam rolling. Examination of 95% confidence intervals was performed to determine if the change scores were significant with traditional and vibrational foam rolling pre- to post-foam rolling and pre- to post-stretching.
Results	No significant differences between baseline measures of ROM or pain pressure threshold (no carryover effect between day 1 and day 2 of data collection) Changes in ankle dorsiflexion ROM were similar following foam rolling and static stretching (P>0.05) Changes in ankle dorsiflexion ROM were greater following foam rolling with vibration (Δ 3.4 ±4° knee straight, 3.2 ±2.6° knee bent) compared to foam rolling without vibration (Δ 1.8 ±2.7° knee straight, 1.6 ±1.3° knee bent)(P<0.05) Ankle dorsiflexion ROM improved post foam rolling (Δ 1.8 ±7° knee straight, Δ 1.6 ±1.3° knee bent) and was further improved with stretching (Δ 3.2 ±2.6° knee straight, Δ 3.6 ±2.8° knee bent) Participants demonstrated an increase in the pain pressure threshold after both interventions, with no significant differences observed between the two interventions.
Our Conclusions	The findings suggest that combining vibration with foam rolling results in greater improvements in ankle dorsiflexion than foam rolling alone. Human movement professionals may consider recommending self-myofascial release techniques using the VYPER™ to optimize mobility programs.
Researchers' Conclusions	Greater increases in all ankle dorsiflexion range of motion measures were recorded following foam rolling with vibration than following traditional foam rolling.

Review & Commentary: This 2017 study investigates a new tool, that is gaining popularity. Specifically, the study investigated combining vibration with self-administered release techniques on the gastrocnemius /soleus complex and the effect on ankle dorsiflexion. The findings suggest that immediate benefits in ankle dorsiflexion range of motion may be achieved by adding vibration training to release techniques.

This study had many methodological strengths, including:

Participant randomization increases the strength of the study and confidence in findings.
The use of well-described, commonly used self-myofascial release techniques (with the exception of the vibration tool) make the study easily applicable and reproducible.
Individuals were assessed for ankle dorsiflexion ROM prior to intervention, ensuring that the intervention was used on individuals who may benefit.
Multi-faceted data collection included pain pressure threshold. No difference was found between vibration and standard foam rolling which may have implications for the mechanism by which vibration training increases range of motion.

Weaknesses that should be noted prior to clinical integration of the findings:

The pain pressure threshold is a subjective measure that may be affected by tolerance and expectation.
The vibration component was measured only at setting 2 (32Hz). The significance, if any, of varied intensities of vibration was not measured.
This study was limited to the gastrocnemius /soleus complex and the effect on ankle dorsiflexion, release techniques with vibration should be researched on additional body segments.
Electromyography and movement assessment may have provided additional information on the impact of release techniques with vibration.

Why This Study is Important:

This study investigates the effectiveness of a new device designed to combine the benefits of self-myofascial release and vibration training. More research should be done comparing techniques, modalities and equipment with the intent of optimizing intervention selection. This study demonstrated that local vibration may be beneficial for reducing myofascial trigger-points and increasing range of motion. Additional research is needed to determine whether the same benefits can be realized for other muscles and joints of the body.

How the Findings Apply to Practice:

Human movement professionals should consider incorporating local vibration therapy and self-myofascial release techniques using devices like the VYPER™ by Hyperice . This study demonstrated that the addition of vibration training to self-myofascial release of the gastrocnemius /soleus resulted in a larger increase in dorsiflexion ROM when compared to self-myofascial release using a standard foam roll. This may have important implications for movement preperation, prehabilitation and rehabilitation programs, as a lack of ankle dorsiflexion has been correlated with various lower extremity impairments (1-12).

How does it relate to Brookbush Institute Content?

The findings support the addition of a new modality/technique to the Brookbush Institute’s (BI) integrated approach to addressing movement impairment. Similar to the protocols used in this study, BI recommends addressing ankle dorsiflexion restriction with release , mobilization and lengthening techniques in individuals exhibiting signs of Lower Extremity Dysfunction (LED) . Further, the BI introduced the VYPER ™ and Hypersphere ™ into programs when these products were introduced to the market and noted impressive results. This study adds objective 3rd party evidence to those findings.

These videos illustrate self-myofascial release techniques recommended for assessing and improving ankle dorsiflexion ROM, and a more recent video that includes the use of the Hypersphere ™

Dorsiflexion Goniometry:

Gastrocnemius and Soleus Muscle Self Administered Static Release

Tensor Fasciae Latae Release:

Rhomboid Release with Hypersphere:

Bibliography:

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- Self-myofascial Release of Ankle
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- Whole Body Vibration Training
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- Trigger Points
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Questions, comments, and criticisms are welcomed and encouraged -

The Influence of Local Muscle Vibration During Foam Rolling on Range of Motion and Pain

Research Review: The Influence of Local Muscle Vibration During Foam Rolling on Range of Motion and Pain

Bibliography:

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Foam Rolling May Aid in the Prevention of Delayed Onset Muscle Soreness

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Longer Duration Self Myofascial Release Produced Greater ROM Results Without Altering Performance

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