Topic > Self-Myofascial Release as a Therapeutic Approach to Improve Joint Range of Motion

Fascia is a sheet of connective tissue that surrounds and binds together structures including nerves, blood vessels, and muscle fibers throughout the body. In the normal, healthy state, fascia can stretch and move without restriction and, in doing so, helps maintain good posture, range of motion (ROM), flexibility, and strength (Schleip and Klingler 2012). Several factors can damage the fascia and affect its compliance, including inflammation, inactivity, repetitive movements, or disease (Sullivan et al 2013). When fascia is damaged, it becomes tight and loses its elasticity. It binds around the affected area, causing fibrous adhesions to form between the layers of tissue. Fibrous adhesions are known to be painful and can limit joint ROM and decrease soft tissue strength, endurance, and elasticity. (MacDonald et al 2013). Therefore, targeting these adhesions can aid in joint mobilization. Myofascial release (MFR) therapy is a collective term given to a series of manual therapy techniques that use applied pressure to manipulate the fascia in a way that allows tight connective tissue fibers to reorganize and become more flexible. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay This technique can relieve pain, increase joint ROM, and increase flexibility (Shah and Bhalara 2012). Self-myofascial release (SMR) works on the same principles as myofascial release but allows the individual to apply pressure to the affected soft tissue area themselves, rather than the clinician (Beardsley and Šcarabot 2015). Pressure can be applied using several devices, including the most commonly used dense foam roller and roller massager (Sullivan et al 2013). A foam roller (FR) is a cylinder of dense foam that a person rolls their body weight on to increase ROM for a specific body region. The exact mechanism of action behind this is unknown. The wave pressure applied during rolling is believed to cause the breakdown of fibrous adhesions in the constricted tissue, thereby stretching the fascia and restoring soft tissue extensibility. The more portable roller massager is similar to the foam roller in its mechanism of action, however, the roller massager relies on an individual's upper body strength to apply pressure to the muscles, rather than weight bodily (Sullivan et al 2013). SMR via Foam Rolling (FR) or Roller Massage (RM) is becoming a popular therapeutic approach to increase myofascial flexibility and, consequently, joint ROM (Cheatham et al 2015). Several studies have investigated the effect of FR or MR on joint ROM across a large population of people. The main areas tested for ROM were the knee, ankle, hip, and lower extremity. Studies have found both beneficial and ineffective effects of SMR therapy. MacDonald et al (2013) examined the effects of FR on knee flexion ROM in 11 male subjects. Subjects served as controls and were tested before FR, two and ten minutes after FR, and after no FR in four sessions with one to two days of rest between each session. A 10° increase in knee flexion ROM was found two minutes after testing and an 8° increase in knee flexion ROM was found ten minutes after testing compared to the results of the control group, suggesting that FR can increase knee ROM. Bradbury-Squires et al (2015) compared the effects of 5 sets of 20 and 60 seconds ofMRI and no MRI on knee joint ROM in ten recreationally active men. Increases of 10% and 16% in knee ROM were found after 20 and 60 seconds of MRI, respectively. In relation to ankle ROM, studies have compared the effects of FR and MR with static stretching. The results implied that FR was only effective in combination with static stretching, but MR was found to be an effective measure on its own. Škarabot et al (2015) studied the effects of three 30-second sessions of FR in 11 resistance-trained adolescents. Ankle ROM was measured before the test, immediately after the test, and ten, fifteen, and twenty minutes after the test. While a 9.1% increase in ankle ROM was found in the treatment group that performed static stretching and FR, no increase in ankle ROM was found in the group that performed FR only. On the other hand, Halperin et al (2014) studied the effects of MRI in 14 recreationally trained subjects and found that MRI alone increased ankle dorsiflexion ROM immediately and 10 minutes after testing by 4%. Bushell et al (2015) studied the effects of FR on hip extension ROM in 31 subjects with different training backgrounds. The treatment group underwent three one-minute FR sessions with 30 seconds of rest between each session. A significant increase in hip extension ROM was found during the second session in the treatment group. Mohr et al (2014) measured the effects of FR combined with static stretching on hip flexion ROM in 40 male subjects with passive hip ROM less than 90°. The results demonstrated that FR alone produced low increases in ROM, but ROM increased when FR was combined with static stretching. These findings further support Škarabot's suggestion that joint ROM may be best improved using a combination of FR and static stretching. Monteiro et al (2014) studied the effects of 120-second sessions of both FR and RM in 18 resistance-trained men. Both FR and MR interventions produced a significant increase in hip ROM compared to control. Contrary to the findings of Bushell, Škarabot and Monteiro, Mikesky et al (2002) found no acute improvements after two minutes of MRI on hip ROM in 30 subjects. Need to delve deeper into this topic. Interpretation of the literature indicates that self-myofascial release via foam rolling or roller massage can improve joint ROM in a short-term period. However, due to the heterogeneity of the studies, it is difficult to reach definitive conclusions. Based on PEDro scores, the average quality of studies conducted on the effects of SMR on joint ROM is moderate. No studies were able to meet the subject or therapist blinding criteria, and very few studies reported meeting the allocation concealment or rater blinding criteria. There are several other limitations that should be taken into consideration when interpreting the results of these studies. For example, sample sizes were small in all studies, and although subjects varied in activity levels, they all fell within the same age range. Furthermore, half of the studies conducted their research on exclusively male populations. This must be taken into account when examining the results as the effects of SMR may be different in women. Many of the investigations evaluating the effects of SMR on joint ROM have used different types of roller massagers and foam rollers, varying from custom-made devices or.