myHealthSciences Weekly

What to Make of Foam Rollers and Massage Guns?

November 30, 2021 Brandon Zerbe Episode 46
myHealthSciences Weekly
What to Make of Foam Rollers and Massage Guns?
Show Notes Transcript

How do these self-massage tools work? What benefits do they actually provide? If they are beneficial, when should you use them? And is the only thing stopping me from being on the pro tour, a little chest massage after a bad sand wedge shot? Well, let’s get into it!

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Sean Gallagher was the first physical therapist listed as using a foam roller as a self-message tool back in 1987 [1]. A couple decades later, foam rollers became all the rage. Not only do you still see foam rollers in every gym, but they’ve evolved with various patterns and grids to target deeper muscles and tissues. Additionally, vibration foam rollers (VFRs) that combine the vibration technology with foam rollers have been created [2]. And recently, you see massage guns widely marketed which combine many of these aspects of self-message, deep tissue manipulation, and vibration or percussive technology. A commercial of pro golfer Colin Morikawa was released showing him using his massage gun as a warm-up, cool-down, and mid-round tool [3]. But how do these self-massage tools work? What benefits do they actually provide? If they are beneficial, when should you use them? And is the only thing stopping me from being on the pro tour, a little chest massage after a bad sand wedge shot? Well, let’s get into it!

What Are the Advertised Benefits?

Massage guns are relatively new to market being released around 2016. And most scientific studies are a few years behind the latest innovation. This means there isn’t a lot of research to review on massage guns, but I did find a couple studies you’ll be interested to hear! I’ll get to them in a few minutes. But, as mentioned earlier, they’re an evolution of various other self-message tools like foam rollers and vibration technology. And when you review the proclaimed benefits of massage guns, they’re like these other tools proclaiming melting away tension, reducing muscle soreness, activating the body pre-workout, relieving stress after workouts, preventing injuries, and a host of other recovery claims [4, 5]. But these other self-massage tools have been around for decades and there’s plenty of research to review on them. So first, how exactly do these self-massage tools work?

How Do They Work?

Originally, these tools were considered SMR tools. SMR (meaning “self-myofascial release”) is ubiquitous in the rehabilitation and training literature and purports that the use of foam rollers and other similar devices release myofascial constrictions accumulated from scar tissue, muscle spasms and other pathologies. This is accomplished by treating myofascial trigger points, but the identification of trigger points is reported to not be highly reliable. On top of this, a recent narrative review on the subject submits that there is insufficient evidence to support that the primary mechanisms underlying rolling and other similar devices are the release of myofascial restrictions and thus the term “self-myofascial release” is misleading [6]. So, it appears these self-message tools aren’t breaking up scar tissue as previously thought. They lied to us! Maybe… according to this review of the literature.

Despite this mechanism not appearing to be true, few studies have examined the other underlying mechanisms of foam rolling or similar tools. Nevertheless, the potential effects have been attributed to mechanical, neurological, physiological, and psychophysiological parameters. A mechanical parameter could be altered tissue stiffness leading to increased flexibility. A neurological parameter could be mediating pain-systems or decreasing your sensitivity to pain. A physiological mechanism could be increased blood flow leading to quicker healing. And a psychophysiological response may include improved perceptions of well-being and/or the placebo effect [7]. Now, it could be a combination of these factors, or it could be none of them. We just don’t know yet. But whatever the mechanism, what does the science show in regard to benefits? Should you be using self-message before, during, and/or after workouts to optimize performance and/or recovery?

What Does the Science Show?

Let’s start with a review of the foam roller evidence as it’s the most robust. Then I’ll get into vibrating foam rollers and finally massage guns to tie it all together. Using the one loop method because bunny ears are for kids.

Foam Rolling as a Warmup

There was a good meta-analysis performed in 2019 that looked at the effects of foam rolling on performance and recovery by evaluating 21 related studies. When looking at foam rolling as a warm-up, before a performance, they found that jump performance (like a vertical leap) and strength performance (like a weighted leg extension) were not improved or impaired. Foam rolling had essentially no effect. Surprisingly though, it did improve sprint performance in 3 out of 4 studies. However, the average percentage improvement in sprint performance was only 0.7%. This shows that although the effect size was rather small from a purely statistical point of view, the average improvement in sprint performance could be relevant for elite athletes but barely noticeable for recreational athletes. Furthermore, the small average overall effect size for sprint performance is based on only four studies showing effect sizes of 0.66 and 0.70. Therefore, it can be speculated that sprint performance does not, per se, benefit more from foam rolling and could be due to outliers in the data or placebo effects [7].

But where foam rolling does appear to show clearer positive effects is with flexibility and pain perception. In these studies, it was estimated that 62% of the population will experience short-term improvements in flexibility when using foam rolling as a pre-exercise warm-up. This extra flexibility may help you perform certain exercises with better form, by allowing you to get into adequate positions. But it’s possible this added flexibility could just be due to decreased pain perception. For example, constant and vigorous pressure exerted on the soft tissues from foam rolling may overload the skin receptors, thus minimizing pain sensation and increasing stretch tolerance. So, to summarize foam rolling as a warm-up, it does appear to help a little with increased flexibility and decreased pain perception, but it doesn’t appear to improve performance in any meaningful ways for most [7].

Foam Rolling as a Cooldown

Could foam rolling have better effects when performed as a cooldown? Again, let’s look at sprint, strength, and jump performance. Usually, when you perform a workout, you become fatigued and your ability to sprint, lift, or jump is decreased immediately after the workout and even days later as your muscles recover. But it’s possible that foam rolling may reduce the decrease one typically sees after working out. For sprinting, it appears to have a positive effect both immediately, 24 hours later, and even 4 days later. And for strength training, it appears to have a positive effect up to 24 hours later. And these results for post-rolling are stronger than the results we saw for pre-rolling so there may be a better argument to foam roll after a workout. But the results for jump performance were again negligible. And the study concluded by saying that the effects of post-rolling on performance should again be interpreted with caution, as the overall effects were not significant, and the number of available studies was limited.

The largest average effects of foam rolling in general and post-rolling in particular were found for the alleviation of perceived muscle pain. This means you’re less likely to feel sore the following hours and days after working out. Which is a good thing! So, to summarize foam rolling as a cooldown, it could help with performance recovery, but the strongest results are for reduction in muscle soreness.

Foam Roller Types

But would the results have been any better if these studies utilized some of the newer foam rollers with various patterns and grids or varying firmness to target tissues on a deeper level? Well, a recent study compared soft, medium, and firm density foam rollers to find out. And their conclusion was that all three roller densities produced similar post-intervention effects on range of motion and pressure pain thresholds. So, if they these new foam roller variations are better, the benefits are negligible [8].

What about vibrating foam rollers? An earlier meta-analysis reported that there was no difference between the use of vibrating foam rollers and typical foam rollers. But these results differ from a newer published study, and they theorized that there was no significant difference in the previous meta-analysis due to the smaller number of included studies (three studies and four results). This newer published study included more studies than previous studies and did find that vibrating foam rollers are more effective in improving the range of motion than typical foam rollers [9]. So, vibrating foam rollers may produce better results but not by much and still concentrated in the flexibility and pain perception spectrums.

Massage Guns

Now could we see better results with the latest and greatest massage guns? Like I mentioned earlier, these are new tools and there just aren’t a lot of studies on them yet. I could only find one that looked at jump performance and they concluded that it didn’t affect one’s vertical jump height [10]. I did find another that looked at whether a massage gun would increase one’s range of motion in the ankle though. And surprisingly, a massage gun did increase maximum dorsiflexion by a large magnitude following the massage treatment by 5.4°. This again, is likely due to factors similar to foam rolling such as a decrease in muscle stiffness, as well as by changes in perception of pain. Interestingly, a static 5-min stretching exercise conducted by the same research team with the same setup seems to have a similar effect on ROM gain (+4.9°) to the 5-min massage in the current study (+5.4°) [11].

And finally, I did find a study comparing foam rolling, massage, and percussive therapy or massage guns. This study concluded that percussive therapy may have potential for muscle recovery as it did outperform foam rolling and massage in this one study. Nonetheless, more studies are needed to determine which of these techniques is the most effective both in the short and long term [12]. So, to summarize this up, it does appear that the innovation in the self-massage space is working… a little bit. Massage guns appear to perform slightly better than vibrating foam rollers which perform slightly better than traditional foam rollers. But let me get into my final thoughts to wrap this whole debacle up.

Final Thoughts

I think self-massage tools could be a useful tool to improve your flexibility before certain exercises. I think it could also be useful to decrease muscle soreness after exercise. But the effects of any of these modalities are questionable for a few reasons. One, light exercise, or active recovery as some call it, of the affected muscles is probably more effective than massage in improving muscle blood flow (thereby possibly enhancing healing) and temporarily reducing delayed onset muscle soreness [13]. Two, most of the improved flexibility you get from foam rolling is gone 30 minutes later [14]. And three, blinding the participants in these studies isn’t possible. This means participants know when they’re foam rolling in the studies and consequently, the risk of a placebo bias is comparatively high [7].

Therefore, I would only recommend foam rolling if you’ve completed more evidence-based, higher value activities first. For example, have walked at least 12,000 steps today? Have you completed your cardio and strength workout? Have you incorporated a dynamic warm-up and stretching into your routine? If you’ve done all of these higher value activities and still want to do everything possible to reach peak physical performance, then I think foam rolling and massage gunning are worthwhile activities. I personally have foam rolled in the past and would likely use a massage gun if I had one. But, as of now, I’m not dying to go out and buy one as the effects aren’t as great as advertised. But hey, Christmas is around the corner so if you want to get me one then I can give you my anecdotal evidence!