Foam rollers or massage therapist?

There’s been a lot of interest in massage lately since the release of the new study from the research group I’m working with (1). Seems the study is resonating well within the physiotherapy and massage communities, and to a lesser extent on the strength-oriented side of the blogosphere. I’ve summarized the results previously, and also theorized on whether a similar effect would happen following a strength training session. Another question that has been brought up in some emails I’ve received is whether or not we’d expect to find similar results if someone used a foam roller or other device such as ‘The Stick’ instead of receiving a massage from a therapist.

Theory versus Practice

I suspect that it would be possible to obtain somewhat similar results using self-massage tools, but this is where the differentiation between theory and practice rears its ugly head. The practice of massage is more involved than most people realize, with a collection of different techniques most have never heard of, and to which I’m no expert. Given that, I’ll keep my thoughts to two specific points relevant to the study, the duration and intensity of the stimulus and how these relate to the self-massage protocols most use around the gym.

Duration of Treatment

After the study was released, many were ‘astounded’ that we achieved such results with as little as 10 minutes of massage. This seems like a short massage, but it was focused on only one muscle of one leg (quadriceps). It’s rare that people devote this amount of time to a single muscle during a massage. So while the actual length of the massage seems short, this is actually quite a bit of mechanical stimulation to one specific muscle at a time.

What does this mean for foam rolling? Well, when was the last time you foam rolled a single muscle for ten minutes? I’d wager that most people’s whole-body foam rolling sessions don’t last that long, let alone for one muscle. That’s why I think that in theory, yes you’ll get a similar response to self-administered massage with the foam roller, but in practice, you may come up short.

We didn’t test a dose-response relationship (time of massage treatment for benefit) in this study (1), it was ten minutes of massage for every participant. Had we done this, we might know that we could achieve a similar effect with five minutes, or maybe even two, who knows? All we can say is that we saw the effect at ten minutes and that doesn’t rule out the possibility that shorter (or longer) treatments could have similar effects. If they do, then the duration would be less of an issue, and I suspect that many could achieve similar effects with more moderate duration foam-rolling protocols.

Intensity of Treatment

The next parameter is the intensity of the stimulus, or does a massage therapist apply more or less pressure when massaging than what you would achieve with a foam roller? This one is a little more complicated; while we have estimates as to the pressure applied by massage therapists during treatment (2), the foam roller will be influenced by a few variables:

  1. Type of roller: This area has exploded recently. We have different density foam rolls, tennis or lacrosse balls, PVC pipes and a gamut of commercially designed self massage products. The variations in the hardness of the material are important as it alters the pressure applied to the muscle. The softer the rolling device, the less intense the stimulus on the soft-tissue as it provides an absorptive surface to dissipate the forces. Unfortunately we don’t have any research to tell us what type of roller is optimal.
  2. Weight of the individual: Heavier individuals will exert more pressure for a similar contact area compared to lighter individuals with the roller. The more weight applied over a similar surface area will produce more pressure (see #4).
  3. Body Fat: This would also be a factor for therapist administered massages, any sub-cutaneous fat could lessen the ability of either treatment modality to effectively reach the muscle beneath. With a bunch of spongy tissue in the way, I suspect the ability to effectively massage the muscle is compromised, whether self-applied or by a therapist.
  4. Contact Area: This would go hand in hand with the size of the individual, but based on variation in muscle and limb size it’s safe to say contact area will generally increase with body size, such that there may not be huge fluctuations in the pressure applied. Since pressure is the force divided by the contact area, by influencing the area in contact with the roller you’ll change the pressure applied to the muscle. From a technique perspective, rolling bilaterally or just a single limb at a time can effectively double the pressure applied to the muscle, assuming you keep all other points of contact constant.
  5. Points of contact with the ground: The more of you in contact with the ground and not the roller, the less your weight will be applied to the point of contact with the roller. This means a less intense massage, but as I mentioned above, we don’t have precise estimates on how much pressure is needed to produce the effects we found in the study.

With the number of variables between the different types of massage and those listed above for foam rolling, while it may seem like a simple comparison, it actually becomes pretty complicated to compare DIY and professional massages. In my experience, I’ve definitely seen many clients react like someone is torturing them when they hit the foam roller, and it’s probably a safe assumption that most massages don’t go that way.

Don’t take my word for it

As I said above, I’m no expert when it comes to massage, so I took to the internet to find one. Patrick Ward is a massage therapist and strength coach operating Optimum Sports Performance out of Tempe, Arizona. I sent him my article to get his thoughts and here’s what he had to say:

You raise some great points, Dan. While the intent of self-massage may be similar to that of treatment by a skilled therapist there are some significant differences. I think a lot of it may come down to the question of what are you trying to accomplish? In a massage treatment there is (or should be) a specific goal or objective that the therapist is attempting to achieve. With foam rolling people often lie down and roll around without accomplishing much and, as you noted, act like they are being tortured, which probably comes down to poor education on how to use the implement. Aside from the differences you have already keyed in on, a few other things I would consider are timing, interpersonal connection, and precision.

Timing of treatment

I agree with regard to the duration of time spent on one structure and the elicitation of mechanotransduction, most roll too little to get the response found in the study; however, most are rolling pre-workout in which case eliciting a greater relaxation response (perhaps a shift towards a more parasympathetic state) would not be something we are actively seeking. Rather, the rolling is just used to treat tissue that may need some quick compression and then move on and start to warm up the area.

From a practical standpoint, this is where I often talk about the two divisions of massage therapy I see. There is the general approach, which is used for recovery purposes (as it was in the study or as it would be to help push someone towards a parasmypathetic state following competition) and then there is a specfic approach which would be more focused on the treatment of a specific structure, or group of structures, with the emphasis on using the therapy as a catalyst to get the person off the table and moving (similar to how most use foam rolling pre-workout).

Physical Connection

One point that isn’t mentioned in the study or the blog posts and the most important difference between DIY massage and hands on massage in my opinion is the human element! Having someone place their hands on you and make contact with your skin is a very powerful thing and I think it would be difficult to not investigate the interpersonal relationship that develops between therapist and client. The aspect of touch is something that is powerful in all aspects of human life, not just in sports and athletics or for recovery purposes. They show this with premature babies, orphans, people in hospice, cancer sufferers, etc. Even our primate ancestors perform daily grooming which shows the importance of touch therapy in animals other than humans.

Precision

Then of course there is the precision of the therapist, who can be very precise in where they place their contact which may lead to a greater response from the body rather than the broad, non-specific contact of many of the self myofascial release tools out there.

There are numerous differences between self-massage and receiving treatment from a skilled massage therapist. While treatment from a therapist may deliver very specific results it should be noted that proper education on how to perform self-massage with the various implements available today can make self-massage a beneficial part of your recovery strategy in between treatments with a massage therapist. Depending on cost and availability, treatments may occur anywhere from one time per week or month.

Cost/Benefit Ratio

To close this one out (it’s Dan again), from a cost/benefit ratio, the self-massage methods definitely seem advantageous although as Patrick has shown us, I’m sure nothing beats the trained (precise) hands of a registered massage therapist. While an optimal strategy would involve both methods, if it’s between self-massage and nothing, I’ll take ‘The Stick’, foam roller, or whatever homemade solution you’ve come up with any day of the week. The cost of these methods is so low, the time investment minimal and they’re definitely convenient so it’s worth a shot.

Get Rolling

If after reading this you’re fired up to start mixing weight-training (or endurance exercise) with post-exercise massage (foam rolling), head over to Jonathon Goodman’s free resource section at the Personal Trainer Development Centre. There you’ll find Mike Robertson’s free guide to self-massage techniques that will get you up and rolling in no time.

As always, I want to hear your opinion. Let me know what you think in the comments below or find me (or Patrick) on twitter!

Comments

    David Felix says:

    Great article. As I am always trying to learn and improve. What are your thoughts on pre-workout foam rolling. At this point I have my boot campers foam roll 30 seconds lower body…hip flexors, quads, IT band, and glutes. My question is this….Should I change this to post workout and should I begin implementing upper body as well. Times is an issue…just trying to figure what is the most beneficial way for me to approach this with my clients. Thanks for your time and I look forward to your response. – David

    Dan Ogborn says:

    Thanks David. The ultimate question here is what do you hope to achieve with your rolling. If it's to address a few tight spots and get your clients moving, then you've got a good setup. In my mind, the massage study suggests that there could be benefit to adding regular post-exercise massage as well, and if you have a budget in mind, then foam-rolling would be the way to go.

    Patrick was nice enough to do a small interview on my Tumblr page as well, and I asked him about goals of pre vs post exercise massage which would probably be of interest to you.

    http://danogborn.tumblr.com/post/19027604915/patrick-ward-cscs-lmt-on-strength-training-and-massage

    My suggestion would be to run an experiment and try both. If you do, be sure to ask your clients whether they feel it was beneficial or a waste of time and let us know the result.

    As for upper body rolling, I approach this on an individual basis. I find smaller clients with less muscle mass often have some pretty intense discomfort when rolling the upper body with foam rollers. In this case I often use other equipment (lacrosse and floor hockey ball) positioned between the client and the wall. This allows them to have a higher level of control over the rolling force, and the smaller implement size is more appropriate for the size and anatomical orientation of the upper body musculature.

    Jim Schueller, CSCS says:

    I definitely utilize pre-workout Foam Rolling myself and with my clientsl, favoring that vs. post-workout rolling if time constraints exist. I like to make sure that any muscle "adhesions" or tight spots are addressed before we go into a workout, as I feel that will better prepare the athlete for proper movements.

    Definitely I wish all of my clients could go to a massage therapist or ART practitioner more often, but the self myo-fascial release techniques are still invaluable.

    Dan Ogborn says:

    Thanks for sharing your opinion Jim, much appreciated. I'm definitely a pre-exercise roller myself, although based on these findings I'm going to experiment with post-exercise rolling as well. It's going to be long duration sessions focused on the primary musculature used in the session, we'll see how it works out.

    As for more clients using therapists, I think it's only a matter of time. As more data is collected on whether or not there are recovery/performance effects, I think we may see a cost/benefit ratio emerge that could convince more clients to take the plunge. We'll see…

    Nat says:

    Hi

    I really liked this article.

    There is a definate shift towards the foam roller/self massage in gyms with people seeming to be advised to foam roll before and after. But like others i wonder how effective the pre-workout would be…I can understand the need to address tight area's before a workout starts but time is usually in short supply here, so maybe a dynamic warm-up would be best.

    Also with physical massage a muscle is usually warmed before deeper techniques applied, whereas with a foam roller most people seem to launch straight into full bodyweight on the roller, which always seems counter productive as surely if there is a very tight/sore spot in a muscle the muscle will just reflex and protect itself and not actually relax the tight area…if that makes sense?! Not sure I explained that how I meant it!

    so perhaps a dynamic warm up is the way forward with foam roller and stretch kept for after a workout when the muscles are much more warm and pliable and probably more in tune with self massage achieving more?

    I think self massage can make a big difference to people if time is adequatly dedicated to it & stretching, but i guess it's how good coaches/gym instructors/PTs are on teaching people to use self massage tools instead of just saying here's a foam roller get on with it (not saying all instructors do that) and how open the person is to spending time on this. Massage therapy is still the better option, but self massage is still much better than nothing at all.

    Dan Ogborn says:

    Hi Nat, thanks for commenting. Definitely agree that if foam rolling is used pre-exercise that it should probably be used as a component of a bigger plan, and not simply be the ONLY tool used for a warmup. I actually did a small, unpublished pilot study with some physiotherapy students looking at foam rolling as a warmup. Let's just say we didn't find much of an effect (vertical jump, isometric knee extension strength, Thomas Test ROM).

    I think, as you said, many do use the foam roller in a general sense, and I've actually been guilty of this myself!!! We spend so much time designing the actual training programs, carefully picking each exercise and considering how they all interact with each other, it's funny how this often doesn't translate to other components of the program like foam rolling.

    Anoop says:

    Hi Dan

    Nice blog!

    I am not sure f you read the recent foam rolling sudy. I wrote a review about it and you may be interested in it: http://home3/danogbor/public_html.exercisebiology.com/index.php/site/articles/does_foam_rolling_work/

    Dan Ogborn says:

    Hi Anoop,
    Thanks Anoop, I've recently checked out your site as well, nice work.

    I'm familiar with that study and worked with one of the authors during my masters. I posted a comment in response to Greg's review, but I think it was on bretcontreras.com and not Greg Lehman's site.

    I've actually performed a small pilot study where we looked at foam rolling (0,15,30) rolls on isometric knee extension peak torque, vertical jump and ROM (thomas test) and found no difference. We were unable to use a blinded design, but did use a randomized repeated measures, so all participants performed each 'dose' of rolling, each separated by a week. We didn't pursue it further given the lack of effect.

    There is much work do be done to figure out whether these mechanical treatments are actually doing anything, and we have definitely gotten ahead of ourselves in assuming any effects found are the result of 'improving' fascia independent from the muscle itself.

    Anoop says:

    Thanks Dan!

    Why did not publish it? And could the small sample size couple have made it non -significant?

    I know atleast 2 more studies which is not published yet which showed negative results for foam rolling.

    I was wondering if you could use a very soft foam as the control or placebo group. this probably won't do much but will raise the expectation and get them doing the same movement as the treatment group. just a thought.

    Dan Ogborn says:

    Publishing negative results is easier said than done. We weren't underpowered (sufficient sample size) for the isometric torque or vertical jump, however the project was planned for second year physiotherapy students so we used the thomas test (subjective) and was variable. Our design had three raters, evenly distributed across participants and conditions, so it was well balanced, but I would like a more rigorous ROM measurement in future work.

    It is always difficult to determine what would be an optimal placebo or control condition in physical experiments like this, one of the reasons we went with a titration of rolling from 0-30 within subject. I think this is probably a fair trade-off, although I would have liked to do an even longer rolling condition, but on average the 30 roll condition came in around 1 min, similar to the recent rolling study.

    Richard says:

    Interesting post, I purchased a foam roller weeks back and have found that it does "work" in releasing muscle tension. I just take it easy and do some basic moves.

    cheers

    Paige Westbrook says:

    I love to roll out with my golf ball muscle roller, best roller i have ever used!!http://zzathletics.com/Golf-Ball-Muscle-Roller-Massager-GBMR1.htm

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