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By Kyle Stull

Foam rolling, a form of self-myofascial release (SMR), hit the mainstream almost 15 years ago and is continuing to increase in popularity. While there are several ways to measure these popularity trends, an interesting approach is to look at the attention foam rolling is getting from the scientific community (with 30 studies having been published thus far in 2017). Research has focused on basic performance measures of flexibility, power and recovery. To attempt to answer these questions, studies have applied foam rolling to the major muscle groups, such as the hamstrings—because everyone does hamstring research—with a few studies targeting the calves, quadriceps, and the foot. An area of foam rolling research that is lacking is what shouldn’t be rolled. Additionally, this is a difficult type of study to set up. The IRB is not likely to approve the let’s see what happens when we roll the kidney study!

  • What is IRB? An Institutional Review Board serves to protect the rights and welfare of human research subjects (protecting them from harm).

What areas should be rolled? Short and tight muscles should be rolled, which vary by person. To best identify the muscles to roll, an assessment should be utilized. While there are a several effective assessments, a quick one that is presented by the National Academy of Sports Medicine (NASM) is the overhead squat. This can easily highlight the most common short or tight muscles, such as the calves, quadriceps, hip flexors, adductors, latissimus dorsi, and the pectorals. These muscles are all safe to roll because they are relatively large and aren’t laying over vital structures or organs.

What should be avoided? Foam rolling involves applying body weight pressure onto a hard, cylindrical object (not always foam). Therefore, caution should be used on some areas while other areas may need to be completely avoided.

Don’t target organs with a foam roller. Most vital organs are protected by the thorax, but other organs are accessible through the abdomen and low back, such as the kidneys under the floating ribs. While one cannot get direct pressure on them, rolling the low back can apply a significant amount of pressure to these ribs. Additionally, large hard rollers should never be used on the abdomen and small rollers should be used with caution.

Use caution around vessels and nerves. This is easier said than done because they run throughout the body. However, there are a few areas in the body that have more “accessible” spots:

  1. Femoral triangle: A region outlined by the sartorius, adductor longus, and the inguinal ligament of the upper inner thigh. Within this triangle is the femoral nerve, femoral artery, femoral vein, and deep inguinal lymph nodes.
    • Move slowly and pay attention. If you feel a pulse, shooting pains or tingling, reposition the roller. If the feelings don’t resolve try a softer roller.
  1. Sciatic nerve at the hip: The sciatic nerve is one of the largest in the body, exiting the lower spine going through the hip to innervate the leg. Although deep and not necessarily easy to get to, when excessive pressure is placed on a small, hard object for several minutes, the nerve can be irritated. The position used when rolling the piriformis applies a lot of pressure (it’s not like rolling the calf for example), so don’t spend 10-15 minutes just sitting on a ball.
    • Choose a roller that has at least some give. The size of a ball works great, but don’t choose the hardest one on the rack. When you get into position, breathe and relax to reduce tension, and then move through a program. TriggerPoint teaches to perform 4 hip flexions, followed by a few rotations to help “re-mobilize” the area.
  1. Brachial plexus at the chest: The brachial plexus is a group of nerves that exit the cervical spine, travels through the scalene over the first rib under the clavicle and under the pectoralis minor on its way to innervate the arm and hand. Spending too much time on something too hard may irritate these nerves. Rolling this area may produce sensations of numbness and tingling down the arm.
    • If you feel tingling or numbness, reposition the roller to move direct pressure off a particular nerve.
  1. Anterior triangle of the neck: A region outlined by the midline of the neck, sternocleidomastoid, and the mandible. This area has easy access to the carotid and subclavian artery. As a general rule of thumb, caution should be used anytime rolling is occurring near the head and neck. This area is incredibly complex with aches, pains, and tightness originating from all over the body. Speak with a licensed massage therapist or otherwise appropriately credentialed individual before sticking a roller in your neck.
  1. Other “endangerment sites”: Two areas that don’t get their own spots on the list because the size of most rollers don’t apply enough direct pressure, are behind the knee and the armpit. These are “soft” areas where nerves and other structures can be accessed. The back of the knee, the popliteal fossa, is a potentially dangerous site to address if trying to massage it with the thumb or other targeted pressure device, not a foam roller. However, there is little value in rolling the back of the knee, so avoid it. The same can be said for the armpit; don’t grab the closest cane and stab it into the armpit because a friend found a way to “release” the subscapularis on YouTube. Leave that to the professionals.

What about the bones and joints? Bones will always be rolled, but some are either closer to the surface or may not be as substantial as others. When rolling the quadriceps, for example, the femur takes on substantial pressure, but it’s the largest bone in the body; it can handle it. The bones of the lower back or the floating ribs are a different story. They can take some pressure, but not the entire bodyweight.

Rolling joints is not inherently dangerous (it’s even legal in many states now) and there may be some value. For example, the connective tissue around the ankle, knee, hip, shoulder, and elbow often benefit from specific techniques that can be applied with the foam roller. However, avoid using full body weight compression. These would be performed in a manner where the amount of pressure applied is very specific and easily controllable.

Image courtesy of Trigger Point

How to roll? Rolling correctly is not all that intuitive. Given that foam rollers are round, rolling back-and-forth makes sense. While this is not a bad place to start, there are four important things to keep in mind:

  1. Slow down: Rolling shouldn’t start a fire between the roller and your leg. To get the most out of the experience, move about an inch per second. This will help to identify restrictions or knots, and the muscles respond better to slow rolling; allow the body to change, don’t force it.
  2. Stop on the tender spots: Tender spots may be trigger points or knots. These are best addressed by holding pressure directly on them for 30-90 seconds or until the tenderness reduces. During this time, just hold pressure giving your body a chance to relax; don’t knead or rock back-and-forth.
  3. Move in a different direction occasionally: Rolling up-and-down the muscles is great when searching for tender spots or increasing blood flow. However, muscles move in all directions (expanding during contraction for example) and so should your foam rolling. With myofascial restrictions or adhesions, perform a few cross frictions, rotations or “pin-and-stretch” movements to help “break-up” restrictions.
  4. Stay hydrated: Water hydrates the body and makes up a large portion of the area on the outside of the cell, the extracellular matrix (ECM). This fluid helps to create separation between the sliding surfaces of tissues, which prevents many adhesions and other myofascial restrictions from developing. Twisting, stretching, or compressing the tissue will push water out of the ECM. When pressure is removed water and nutrients rush back in. The cool thing is that there appears to be a “super compensation effect” with more water rushing in than was there previously.

Foam rolling is very popular and, for the most part, it is a safe and very effective activity. However, following just a few tips and tricks can help to increase both its safety and its effectiveness. Stay away from organ and nerve rolling, slow down, stop on a few areas, and always stay hydrated and breathe. Happy rolling.