Author Names
Espí-López, G.V., Ruescas-Nicolau, M., Castellet-García, M., Suso-Martí, L., Cuenca-Martínez, F., Marques-Sule, E.
Reviewer Name
Gabryella Lakes, SPT
Reviewer Affiliation(s)
Duke University Doctor of Physical Therapy Division
Paper Abstract
Self-massage using foam rolling (FR) has been posited to have similar benefits as those traditionally associated with manual therapy (MT) but more economical, easy, and efficient. Despite the widespread use of this technique for the recovery of athletes, there is no evidence supporting the effectiveness of FR vs. MT. The purpose of this study was to assess the effects of FR self-massage in athletes after a high-intensity exercise session compared with a MT protocol. A randomized controlled trial was performed. Forty-seven volunteer amateur athletes (22.2 ± 2.5 years, 53.2% men) were divided into 3 groups: a FR group ( n = 18, performed FR self-massage), a MT group ( n = 15, received a MT protocol), and a control group ( n = 14, passive recovery). After an intense exercise session, dynamic balance, lumbar and hip flexibility, and leg dynamic force were assessed before and after the intervention and 1 week later. Results showed that, in the FR group, dynamic balance scores increased for both limbs at postintervention ( p = 0.001) and at follow-up ( p = 0.001). These scores were higher for the FR group vs. the MT group at postintervention (right limb, p = 0.048) and at follow-up (right limb: p = 0.049; left limb: p = 0.048), although this variable differed at baseline. In all the groups, lumbar flexion increased at postintervention ( p < 0.05), although it was only maintained in the FR group at follow-up ( p = 0.048). In conclusion, self-massage with FR may be more effective than MT for the recovery of dynamic balance in athletes after intense exercise, although this result should be interpreted with caution. Foam rolling could have a relevant role in postexercise recovery to prevent injuries in athletes.
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?
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- Yes
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- Yes
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Cannot Determine, Not Reported, or Not Applicable
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Cannot Determine, Not Reported, or Not Applicable
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- 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?
- Yes
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Yes
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
The Foam Rolling Technique (FRT) is comparable to a Manual Therapy (MT) protocol in significant overall effectiveness, with FRT showing a tendency to produce greater immediate benefits on dynamic balance.
Key Finding #2
Both the Foam Rolling Technique (FRT) and Manual Therapy (MT) significantly improved lumbar spine flexibility immediately post-intervention, but need further research regarding the effect over time.
Key Finding #3
The intervention protocol used in this study neither impaired nor improved jump performance, but perception of change was significantly greater compared to the control group, indicating a possible indirect effect on athletic performance by significantly affecting lumbar flexibility and dynamic balance, and helping to relieve muscle fatigue.
Please provide your summary of the paper
This study aimed to compare the effect of foam rolling versus manual therapy on several factors of athletic performance, following a high-intensity workout session, including dynamic balance, flexibility, and dynamic force. As foam rolling and manual therapy have been compared as having similar benefits, the results of this study presented a more economic, easy, and efficient recovery technique that still targeted combating muscle fatigue and decreasing myalgia in athletes, post-exercise. The effects of these techniques were only analyzed in short-term periods (1 week post initial session); therefore, the overall long-term effects and benefits of these techniques, as compared to one another, have not been determined at this time. Overall, it was found that both foam rolling and manual therapy improved dynamic balance after the intervention; however, there was greater immediate improvement seen in the foam rolling group. It was also found that both foam rolling and manual therapy had immediate and significant effects on improvement in lumbar flexibility, but no effect on leg dynamic force and hip flexibility. Due to these conclusions, it is suggested that foam rolling is as effective as manual therapy in treating post-activity recovery, and that it would be a viable treatment alternative for therapists and trainers to utilize in the athletic population.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This randomized control trial offers clinicians a therapeutic post-exercise intervention that is not only comparable to manual therapy, but also can be recommended to athletes to be used when manual therapy is not available. Balance impairments and muscle flexibility are specifically two factors that can contribute to post-exercise injuries, both of which this study found are significantly impacted by foam rolling. In this regard, the results suggest that foam rolling can be clinically useful as an immediate treatment option in the recovery of dynamic balance and flexibility in athletes. There is currently no long-term evidence of one method being more beneficial than the other since this study only focuses on short-term benefits of foam rolling versus manual therapy. As the target population of this study was amateur athletes, evidence for utilization and effectiveness of foam rolling as compared to manual therapy in the general population has not been determined at this time, which should be considered when using this study as potential evidence/clinical reasoning. Since this is the first study comparing foam rolling to manual therapy, there are still many factors that were not taken into consideration – i.e., muscle fatigue – resulting in the need for continued RCTs to provide additional findings.
