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Tuesday, June 6, 2023

Self myofasical release followed by static stretching is superior to either technique alone

Brent Brookbush

Brent Brookbush


Research Review: Self myofasical release followed by static stretching is superior to either technique alone

By Stefanie DiCarrado DPT, PT, NASM CPT & CES

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

Original Citation: Skarabot, J., Beardsley, B., Stim, I. (2015). Comparing the effects of self-myofascial release with static stretching on ankle range of motion in adolescent athletes. International Journal of Sports Phyiscal Therapy. 10(2): 203-212 - ARTICLE

A subject foam rolls his plantarflexors according to the study protocol.

Why is this relevant?: Flexibility is an important aspect of most rehabilitation, fitness and performance enhancement programs. The addition of self-administered release techniques (e.g. foam rolling) is relatively new, and until recently little research was published on their affects. Of particular interest, is the affect that self-administered release techniques have on a flexibility program when preceding static stretching. This study compares release followed by static stretching to release techniques alone.

Study Summary

Study Design Randomized Within-subject Design
Level of Evidence Level III: Evidence from a controlled study, non randomized
Subject Demographics
  • Age: 15.3 + 1.0 years
  • Gender: 6 males, 5 females
  • Characteristics: Adolescents, performing a minimum of 6 months of the following per week: 16 hours of swim training, 3 hours of resistance training, and a minimum 30 minutes of foam rolling
    • Height: 172.3 + 8.6 cm
    • Weight: 64.5 + 10.3 kg

  • Inclusion Criteria: Minimum of 6 months of resistance training experience (ACSM classified as "Intermediate resistance-trained")
  • Exclusion Criteria: Previous lower extremity injury
Outcome Measures
  • Passive ankle dorsiflexion range of motion (DF ROM) immediately, 10, 15, and 20 minutes post intervention
  • Within conditions (SS, FR, FR+SS)
    • Significant time effect for all conditions
      • Effects lasted less than 10 mins for all conditions

    • Significant increase in DF ROM in SS and SS+FR, but not in FR

  • Between conditions
    • Significantly greater DF ROM following FR+SS than in FR or SS

ConclusionsIt is more beneficial to combine FR and SS in an individual with decreased DF ROM as a result of muscle shortness or tightness than to perform FR alone.  The affects on ROM may only last 10 minutes; however, this is conflicted within the literature.
Conclusions of the ResearchersA combination of FR and SS provides greater ROM benefits than FR alone in an adolescent athletic population.  The effects of which lasted less than 10 minutes regardless of intervention.

Static stretching of the plantarflexors

Review & Commentary: This study is unique in its comparison of foam rolling and static stretching as separate modalities to a combined intervention of both foam rolling and static stretching in adolescent athletic swimmers. At the date of publication, no other research study looked at the combination of both modalities and none looked at foam rolling within an adolescent athletic population.

Authors strengthened their methodology with standardized practices. Subjects used only their dominant leg and performed interventions and testing barefoot - the process of determining leg dominance was described adequately. Testing took place on 3 separate days with a minimum of 24 hours between each trial and was held at the same time of day to minimize any diurnal effect. Researchers randomized the selection of interventions by having subjects pick a folded piece of paper with the order of intervention written inside. Researchers recorded a baseline ankle dorsiflexion range of motion (DF ROM) prior to intervention and recorded it again immediately after the intervention as well as 10, 15, and 20 minutes later; noting how long flexibility was maintained. Both static stretching and foam rolling interventions involved the same variables of 3 sets of 30 seconds with a 15 second rest in between. The equipment and procedures were standardized across all subjects. When combined, the FR intervention preceded the SS intervention.

The authors noted the following study limitations:

  • A lack of familiarity with the specific foam roller used - although the group was familiar with foam rolling in general, so it is unlikely this had a significant affect.
  • DF ROM was measured using a lunge technique, and repetitions were not limited; it is possible the subjects may have activated or mobilized soft tissue affecting outcomes.
  • The lunge test was performed with the knee bent where as the stretching intervention was performed with the knee straight.
  • The raters were not blinded as to which intervention was implemented for the particular subject.
  • The subjects' activity prior to test day was not monitored nor standardized.

The authors of this study did not mention a significant limitation (nor did the authors of Muscle release technique improved dorsiflexion ROM without loss of force production ): The study did not include limited DF ROM as part of the inclusion criteria; furthermore, they did not attempt to assess the source of the restriction (e.g. muscular or articular). How do we assess the effectiveness of a flexibility protocol on individuals who may not have needed it?

The weight-bearing lunge test has a high inter- and intra-rater reliability, but as noted in a previous review, it may be worth investigation to determine if an individual may compensate at both the hip and ankle reducing the validity of this method of DF measurement. Finally, subjects were not provided a numerical pain/intensity scale in which to judge their foam rolling or static stretching level of discomfort which may account for some discrepancies between the two studies - for example, a non-significant increase in DF ROM following FR and a shorter time effect on ROM found within this study.

Why is this study important?

This study provides evidence supporting the combined use of foam rolling (FR) and static stretching (SS) to improve ankle DF ROM, over foam-rolling or static stretching alone.

How does it affect practice?

Clinicians looking to improve dorsiflexion range of motion (DF ROM) should consider including release and lengthening techniques for structures that may be restricting motion.

How does it relate to Brookbush Institute Content?

The Brookbush Institute promotes the use of release, joint mobilization and stretching techniques to address mobility restrictions with self-administered programs. This study provides evidence for the combined use of 2 of those 3 steps. Future research should consider the addition of joint mobility combined with self-administered release and stretching techniques, in those individuals exhibiting restriction.

The Brookbush Institute's predictive model of Lower Leg Dysfunction (LLD)  includes the common occurrence of ankle dorsiflexion restriction and lists the compensatory changes in muscle length and activity, as well as changes in arthrokinematic motion. The following videos demonstrate release, mobilization and stretching techniques that may enhance dorsiflexion range of motion.

Calf and Fibularis Static Release:

Calf and Fibularis (Peroneal) Active Release:

Calf and Fibularis (Peroneal) Static Stretching:

Calf and Fibularis Static Stretching (with slant board):

Calf and Fibularis Active Stretching:

Calf and Fibularis Dynamic Stretching:

Ankle Mobilization (Self Administered):

Manual Calf Stretch:

© 2015 Brent Brookbush

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