Foam rolling and ITB friction/Runners knee

I could wax lyrical about the foam roller. It is the best method we have for stretching out the difficult bit of tissue called the Iliotibial band that frustrates so many SW18/SW19 runners!

But here’s a blog from Tom Goom who has an excellent website about running injuries – https://www.running-physio.com/

Like many runners, I enjoy a love-hate relationship with my foam roller. My fiancé really likes it, but mainly uses it to prop the window open! Lots has been said about them by fellow runners though few have had such a unique view as @4races4cities. One of my favourite descriptions comes from @Jens_Itchy_Feet,

“A lot of strange humping and squealing in pain on the living room floor…my muscles felt like they’d been worked over by one of those moustachioed-man-woman masseurs you may expect to find in a Moroccan Haman”

But there’s much more to using a foam roller than swearing and pain – recent research has started to show great benefits in improving flexibility. The work of McDonald et al (2012) is so recent in fact that it’s yet to be published in full although it has been accepted for the Journal of Strength and Conditioning Research. An abstract is available here. They found that performing Self Myofascial Release with a foam roller on the quadriceps muscles improved range of movement without impairing muscular performance. We’ll look at their research and that of others in this area to try and answer some of the common questions about using a foam roller.

What does using a foam roller actually do?

Muscles are surrounded by a soft tissue known as fascia. It is thought that this tissue can influence flexibility and joint range of movement. Research suggests that using a foam roller is a form of “Self Myofascial Release” and that it makes the fascia more flexible and breaks down scar tissue and adhesions.

Which Foam Roller should I buy?

McDonald et al used a roller with a hollow but solid PVC core surrounded by a layer of neoprene foam and had very positive results. Miller and Rockey (2006) used the more traditional roller composed entirely of foam and found rolling made no significant difference to hamstring flexibility. Curran, Fiore and Crisco (2008) compared these 2 types, the Multilevel Rigid Roller and Bio-Foam Roller and found “significantly higher pressure and isolated contact area” with the Multilevel Rigid Roller.

In short, it appears the hollow but solid core design is more effective than the traditional foam roller as it appears to place higher pressure on the fascia. This is the design favoured by The Grid, which is the foam roller I currently use. I find it effective but at close to £40 it may be out of many people’s budgets and there may be cheaper alternatives available.

How long should I use it?

McDonald et al got good results from using the roller for just 2 minutes in the form of 2 x 1-minute sessions separated by a rest period of 30 seconds. Other research suggests between 1 and 5 minutes on each muscle group or working until a sensation of release is felt.

How often?

The guidance from the research on this is far less clear. In fact, as with many things, there is a lack of in-depth research in this area. Most studies seem to focus on the acute effects of using a foam roller rather than long-term usage. Miller and Rockey (2006) used the foam roller 3 times per week over 8 weeks but offered no justification in the research as to why. This can hardly be used as guidance considering they also didn’t report any beneficial effects!

I think how often you use a foam roller depends on your goals and your body. If you are a flexible runner who seldom suffers from muscular tightness there may be very little benefit in doing regular sessions with the foam roller. If like many runners, you struggle with persistent tight areas or are trying to stretch as part of rehab (e.g. ITB) you may want to use it every other day for a short period, until symptoms/ tightness improves. There is a balance here, as with most things. If you are too aggressive with the roller and use it too often you may cause a build-up of micro-trauma in the muscles and cause pain. I would suggest a frequency of 2-3 times per week is usually adequate in most cases but you can increase this to as much as 3 times per day providing it isn’t increasing your pain levels and you make this change gradually. In some ways using a foam roller is comparable to stretching and many stretching protocols recommend as much as 3 times per day so it should be feasible with a roller too. You have to ask though why is this area so tight, and why is it needing this level of input to release it? Sometimes persistent muscle tightness continues due to weakness elsewhere or because you keep aggravating by continuing to train too much or too intensively.

What’s the technique?

McDonald et al describe the technique nicely in their article. There are a host of videos on YouTube to look at if you want specific ideas for certain muscles but this is the technique used in McDonald et al’s research;

  1. Place as much of your body mass as possible on the foam roller (within pain limits).
  2. Begin at the proximal part of the muscle (the part closest to the body) and roll down the length of the muscle using short kneading-like motions.
  3. Once you’ve covered the length of the muscle quickly return to the start position moving the roller in one fluid motion.
  4. Roll the length of the muscle 3-4 times within each 1-minute session.
  5. Swearing is optional.

(I may have made that last one up)

Other studies used similar techniques with fairly similar time frames, however, what’s more important is what works for you. If you have a technique you find effective for your needs then stick with it. There is also the technique of finding a sore area and holding the pressure on this area for 30-60 seconds or until you feel it release. This can be beneficial but is often very sore!

Using the roller when injured

I haven’t found any convincing research on the use of the foam roller to manage specific injuries. Several studies mention it but these tend to be expert opinion pieces rather than randomised controlled trials (which is really what we want). Our rationale comes from clinical reasoning rather than high-quality research. For example, where we know that tissue flexibility plays an important part we can reason that using a foam roller can be useful as the research suggests it improves flexibility. Following that reasoning we can make a few broad recommendations on which areas to work on with the foam roller;

You’ll see a few areas come up regularly so a programme of rolling calf, quads, ITB and hamstrings will cover most things and could be used for injury prevention as well as treatment.

Does using the roller impair muscle performance?

One of the key findings of McDonald et al was that the roller increased flexibility without reducing muscle performance. Other studies have reported similar findings. As a result, some have recommended it as a part of a warm to improve flexibility. However, none of these studies has demonstrated improved running performance or reduced injury rate as a direct result of using a foam roller.

How does it compare to static stretching?

Static stretching used to be a huge part of an athlete’s regime but in recent years research has suggested it may be detrimental to performance and it’s now not recommended prior to sport. It still has a role in improving and maintaining flexibility and I continue to recommend it as part of a cool down after sport or within a rehab programme.

To some degree tight, fairly inflexible tissues can be very effective – they help to transmit the impact of running into forward momentum more efficiently than loose flexible tissues. There tends to be a connection between strength and tissue tightness – tight tissues are often strong. The downside is when this tightness starts to cause pain, affects movement patterns or places structures under a greater tension (e.g. Calf tightness increases tension on the plantar fascia, ITB tightness affects movement of the knee cap, TFL tightness affects the ITB etc).

So like many things, it’s a balance – enough tightness to be effective with enough flexibility to move freely.

D’Amico and Morin compared stretching the hamstrings and using the foam roller in a pilot study, that, as far as I’m aware is yet to be published in a Journal. They concluded that using the roller increased range of movement as much as static stretching but that the foam roller improved isometric strength and jumping ability compared to static stretching (and the control group). They went on to conclude that Self Myofascial Release using a foam roller could be used to aid strength or power performance.

In theory, then the foam roller could be used as part of a warm-up as it appears to improve flexibility without impairing performance.

Limitations in the research

It’s worth noting that the research on foam rollers isn’t extensive. What is there is fairly limited and has a number of limitations. McDonald et al’s research only involved 11 subjects and all were male. D’Amico and Morin only had 13 subjects and neither study examined directly the effect of using a foam roller on running performance. There have also been some conflicting studies, such as Miller and Rockey (2006) who found no change in hamstring flexibility after 8 weeks of foam rolling, 3 times per week and there is very little evidence on use of rolling for specific injuries. Clearly, further research is needed, until then we can take some guidance from what evidence is available while being aware of its limitations.

Closing thoughts: Foam rolling is a form of Self Myofascial Release which is thought to improve flexibility without reducing muscle performance. As little as 2 minutes can create changes in range of movement and it has potential to help a number of injuries… And finally….credit to @seesteverun for the title, the man’s a genius!

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