Effects of Myofascial Release Using Finding-Oriented Manual Therapy Combined with Foam Roller on Physical Performance in University Athletes. A Randomized Controlled Study – Duke Center of Excellence in Manual and Manipulative Therapy

Author Names

Afanador-Restrepo, D, Rodríguez-López, C, Rivas-Campo, Y Baena-Marín, M, Castellote-Caballero, Y, Quesada-Ortiz, R, Osuna-Pérez, M, Carcelén-Fraile, M, and Aibar-Almazán, A.

Reviewer Name

Jamie Lynn Murff, SPT

Reviewer Affiliation(s)

Duke DPT

Paper Abstract

Sport is a science of constant reinvention that is always searching for strategies to improve performance. Objective: This study seeks to compare the effects of myofascial release with Findings- Oriented Orthopedic Manual Therapy (OMT) combined with Foam Roller (FR), versus FR by itself, on the physical performance of university athletes. A randomized controlled study was conducted with a total of twenty-nine university athletes, measuring Range of Motion (ROM), jump height and flight time, strength and dynamic flexibility using Goniometer pro, CMJ protocol in OptoGait, 1 Repetition Maximum (1RM) and Mean Propulsive Velocity (MPV) and the Sit and Reach (V) test, correspondingly. This study was registered at clinicaltrials.gov prior to the initial measurement of the participants under the code NCT05347303. Through a univariate analysis, together with an analysis of independent groups with ANOVA and an analysis of covariance, it was evidenced that OMT combined with FR generated more and better effects in all the evaluated ROM, jump height and flight time, RM and VMP tests. Finally, it was found that OMT combined with FR is better when it is desired to improve ROM, muscle power, strength and flexibility, while FR alone only improves dynamic flexibility.

NIH Risk of Bias Tool

Quality Assessment of Controlled Intervention Studies

Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT

Was the method of randomization adequate (i.e., use of randomly generated assignment)?

Was the treatment allocation concealed (so that assignments could not be predicted)?

Were study participants and providers blinded to treatment group assignment?

Were the people assessing the outcomes blinded to the participants’ group assignments?

Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?

Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?

Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?

Was there high adherence to the intervention protocols for each treatment group?

Were other interventions avoided or similar in the groups (e.g., similar background treatments)?

Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?

Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?

Cannot Determine, Not Reported, or Not Applicable

Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?

Cannot Determine, Not Reported, or Not Applicable

Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?

Key Finding #1

Myofascial release using foam rolling alone facilitated improvements in ROM, muscle power, strength, & dynamic flexibility.

Key Finding #2

Myofascial release using foam rolling combined with findings-oriented manual therapy facilitated greater improvements in ROM, muscle power, strength, and flexibility.

Please provide your summary of the paper

This article compared the effects of myofascial release with findings-oriented orthopedic manual therapy combined with foam roller versus foam roller by itself on range of motion, jump height and flight time (muscle power), strength, and dynamic flexibility. Pre-intervention and post-intervention testing were completed for range of motion, muscle power, strength, and dynamic flexibility using Goniometer pro, CMJ protocol in OptoGait, 1 Repetition Maximum, Mean Propulsive Velocity, and the Sit and Reach (V) test, respectively. The participants were university athletes split randomly into two groups. The control group received myofascial release protocol with foam rolling and the intervention group received myofascial release protocol based on findings-oriented orthopedic manual therapy and foam rolling. The foam rolling series included rolling out the triceps suralis (gastroc-soleus complex), hamstrings, tensor fasciae latae, and quadriceps muscles for 50 seconds with a 30 second break between each one. This series was performed twice on each leg. The control group received this intervention twice a week on discontinuous days for 8 weeks, 16 total sessions. The findings-oriented manual therapy intervention protocol consisted of evaluating restriction in the quadriceps, hamstrings, triceps suralis, and tensor fasciae latae in both legs. These areas were then treated with 2 manual techniques. The first manual technique was pressure on painful points until the pain disappears or 1 and a half minutes is reached. The next manual technique was longitudinal sliding down the muscle fibers performed with the therapist’s elbow. This intervention did not exceed 15 minutes total per participant. The intervention group received this intervention once a week along with the foam rolling series discussed above on discontinuous days for 8 weeks, 24 total sessions. Both interventions facilitated improvements from pre- to post-intervention test values, however, the group that received findings-oriented orthopedic manual therapy and foam rolling had a greater improvement in post intervention test values.

Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.

The results from this study showed that foam rolling facilitated improvements in range of motion, muscle power, strength, and dynamic flexibility. Foam rolling was performed individually by the participant which means, clinically, that this intervention could be included in a home exercise program for an appropriate patient. Additionally, the results showed that having a physical therapist apply manual therapy on top of the participant performing foam rolling facilitated greater improvements in range of motion, muscle power, strength, and dynamic flexibility than foam rolling alone. The physical capacities mentioned previously are all important aspects to athletes and non-athletes having the best building blocks possible to enhance physical performance and physical function, respectively. Clinically, this is relevant because it justifies the impact a physical therapist can have in providing care. It is important to remember that the target population of the study was university athletes with no lower extremity injury that could affect the results. This should be taken into consideration if trying to use the findings of this study for other populations.