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

Research Review: Longer duration self myofascial release produced greater ROM results without altering performance

By Stefanie DiCarrado DPT, PT, NASM CPT & CES

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

Original Citation: Sullivan, K.M., Silvey, D.B.J., Button, D.C., Behm, D.G. (2013). Roller-massager application to the hamstrings increases sit-and-reach range of motion within five to ten seconds without performance impairments. International Journal of Sports Physical Therapy 8(3) 228-236.- ARTICLE

Roller massage myofascial release of the hamstrings, applied by a external source.

Why is this relevant?: The use of self-myofasical release to improve range of motion (ROM) is not new, but its use within a corrective exercise program has not been extensively researched. This study is the first to examine the relationship between duration and volume of self -myofasical techniques and improvements in ROM. Additionally, research on static stretching techniques have shown a reduction in maximal force production of the affected musculature immediately following a static stretch, but this study, along with others, provides evidence that myofascial release can produce ROM gains without the decrease in muscle force output (1,2).

Study Summary

Self myofasical release of the hamstrings with roller massager

Review & Commentary: This study is unique in its examination and evaluation not only of the effects of myofasical release on muscle length and force production but also of the effects of various durations of myofasical release on those parameters. Previous research supports these findings of increased range of motion (ROM) without decreased force production but no research exists on appropriate duration or volume of myofascial release and its effects on ROM (1,2).

The strength of a study lies within the strength of its methodology. The designers of this study created a very strong methodology with high standardization of intervention implementation and documentation. The study involved both an experimental and control group with randomization of the interventions; the control group consisted of members from the experimental group that returned for an extra day of testing. That extra day of testing included the standard warm up exercises and all pre- and post tests but without the roller massage intervention. Although not directly compared in this study, the use of subjects from the experimental group as controls allows for direct comparison of intervention on the same body; basically the subjects act as their own controls. The authors may choose to publish that data in a future research paper.

Subjects were excluded if they had any roller massager experience, limiting any possibility of an adaptive carry over effect. All subjects performed the same warm up exercises, which were clearly described, and participated in 2 intervention session 24 hours apart. Subjects performed a total of four interventions distributed randomly throughout the 2 sessions: myofascial release via roller massage for 1 set of 10s, 2 set of 10s, 1 set of 5s, and 2 sets of 5s. Each intervention session consisted of 2 interventions with 1 intervention applied to each leg, separated by a 30 minute rest -- this allows for intra-subject comparison of these interventions in the future. The researchers briefed each subject of the protocol and usage of the roller massage prior to use to eliminate any reactive muscle guarding that would affect results.

The authors clearly described all equipment, setup, and settings of all devices to allow for replication and further validation of this study in the future. This included the use of a custom device to ensure consistent pressure and rolling velocity of the roller massage across subjects. The subjects did not apply the roller massager interventions themselves, eliminating any technique variations. The researchers used a metronome to monitor the rolling velocity at 120bpm. At this frequency, the roller massager would roll from the distal hamstring attachment to proximal attachment and back within 1 second. Subjects performed post tests 3 minutes after completing the intervention. To ensure standardized placement of electrodes between sessions, the researchers traced the electrodes with indelible ink.

In addition to strong standardization across subject selection and intervention sessions, the authors clearly described their outcome measures and the validity of their measurements. The sit and reach test as a measure of hamstring flexibility is a proven technique used within research settings. The use of surface electrodes on a superficial muscle such as the biceps femoris is an acceptable and proven method for measuring muscle activation and timing. The researchers described and provided reliability data on the specific device used to measure maximal isometric voluntary contraction (MVC) force output. Subjects maintained the isometric contraction on one leg for 4 seconds and were given verbal encouragement, they then performed an MVC on the other leg after a 60s rest. The researchers looked at evoked twitch force and electromechanical delay (EMD) to monitor the effects on the excitability of the muscle and the compliance of the muscle tendon. They did this by providing a twitch stimulation via electrode 1s before and after the MVC -- the higher the twitch force, the greater the excitability.

The authors noted the following study limitations:

• Use of a specially designed device to deliver intervention - clinically individuals use a self administered myofascial release techniques or a professional uses a manual myofasical release techniques, but for research, it is important to provide standardization to study the effects of the intervention.
• Sit and reach test involves hamstring and low back flexibility - the authors noted it is possible the low percentage of improvements in the test may be do to decreased flexibility in the low back. Since the article is looking at the affects of myofascial release on hamstring length, it may have been better to perhaps use a goniometric assessment of hamstring flexibility like the hamstring 90/90 test . However, the sit and reach test will change if the hamstrings are lengthened. This does lead to questioning how much of the subjects had a low sit and reach score due to decreased flexibility in the low back and actually did not have hamstring length restrictions. Regardless, there were statistically significant improvements among subjects.

As noted in earlier paragraphs, it would be interesting to compare the results of right leg vs leg left of an individual as well as a direct comparison of the individual in the experimental group and the same individual within the control group. Future research should explore longer durations of myofasical release and the effects it has on ROM and muscle force output.

Why is this study important?

This study provides evidence supporting the use of longer duration myofascial release to address range of motion (ROM) limitation without compromising muscle force output. This study examines the use of a more portable self myofascial release tool, the roller massager, rather than a more typically used foam roller.

How does it affect practice?

Clinicians looking to improve an individual's ROM without a decrease in muscle performance should consider myofasical release as a pre-activity exercise. More specifically, the clinician should consider myofasical release of long duration to maximize the flexibility benefits.

How does it relate to Brookbush Institute Content?

The Brookbush Institute promotes self myofascial release, stretching, and joint mobilization as important steps in a corrective exercise program to improve ROM and at times inhibit an overactive muscle. In cases where the individual requires ROM changes without a decrease in neural activity (muscle inhibition), one would release but not necessarily stretch that muscle. For example, the biceps femoris is listed as both short and overactive within the predictive models of Lumbo-Pelvic Hip Complex Dysfunction (LPHCD) and Lower Leg Dysfunction (LLD) . As the hamstrings are important during running activities to decelerate knee extension (anterior motion of the tibia), the hamstrings must be of appropriate length without decrease force output. Therefore, in cases such as these, the Brookbush Institute recommends releasing the hamstrings without stretching them. The following videos describe two self myofasical release techniques, active and static, of the biceps femoris .

Biceps Femoris SA Static Release:

Biceps Femoris SA Active Release:

Sources

1. Review: Halperin, I., Aboodarda, S.J., Button, D.C., Andersen, L.L., Behm, D.G. (2014). Roller massager improves range of motion of plantar flexor muscles without subsequent decreases in force parameters. The International Journal of Sports Physical Therapy. 9(1): 92 -102

2. Review: Mohr, A. R., Long, B. C., & Goad, C. L. (forthcoming 2014). Foam Rolling and Static Stretching on Passive Hip Flexion Range of Motion. Journal of sport rehabilitation. Currently in press.

© 2015 Brent Brookbush

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