Issues with foam rolling

Posted on May 20, 2013

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Brotastic.

Brotastic.

Foam rolling is one of those polarizing topics. To some it’s another coming of Christ; others swear it doesn’t do anything. Hell, some say it’s detrimental.

These argumenters will go into all the physiology, what happens during massage, what scar tissue is, etc. and try to make an argument from that angle.

This has confused me for quite a while.

I’m going to make much different, much more practical arguments. Perhaps you’ll share my confusion after the following.

The true purpose of foam rolling

Again, I’m not going into the physiology of massage. The purpose of foam rolling is much more simple: To help us get out of musculoskeletal pain.

Done.

And why do we get in pain?

Primarily because of how we move. Move one way = pain; move another way = less / no pain. There are plenty examples on the site making this argument. Browse around if needed.

In order for foam rolling to help alleviate pain then it has to

Change how we move.

Foam rolling can’t, by itself, change how we move. Only the brain can do that.

This is where a quote from Thomas Myers (Anatomy Trains) is poignant. It goes something like,

“You can manipulate the tissue all you want. You can loosen it, make it more relaxed, whatever, but you still have to train it.”

Leading to another quote from him,

“Now you can only train the tissue and not manually manipulate it, but it’s a hell of a lot harder.”

Meaning harder to get the tissue to do what you want.

The contention being you don’t need manual therapy to get someone out of pain, but you DO need to change how they move. However, manual therapy may help make training the tissue easier.

It’s important to make sure we’re on the same page terminology wise. From here on out we’re going to consider manual therapy = An actual massage therapist using their fingers, and foam rolling as rolling around on a giant piece of foam. With the idea foam rolling is trying to replicate a manual therapist.

Before getting into specific issues during rolling I’m going to cover some general ones.

It fucking hurts

Let’s be honest, the act of foam rolling feels awful.

The most obvious issue here is we’re trying to get people out of pain and the act of foam rolling puts them in pain. You’ll often see people masochistically rolling something like their IT band with gruesome facial expressions. “Knee hurts? Let me destroy my IT band! Eat this shit IT band! Screw the foam! Where is my PVC pipe?!?! ROAR!!!”

This is a big reason runners carry foam rollers around like it’s their favorite dildo bible. They love self-inflicted pain (hence all the running to nowhere). From a running website:

foam-roller-it-band-exercise

What a bad ass.

You even have those who have no problem bruising themselves or their patients. “But that’s because we’re breaking down tissue so new healthy tissue can form blah blah blah.”

Congratulations. While you MAY get a person’s knee to feel better (temporarily) by doing this to them,

IT band bruising manual therapy

they now have an entire thigh feeling like it was substituted for a pinata, beaten by 50 kids with various bats, all during their afternoon sugar high. Meaning the client is still in pain. And the reason their knee may feel better is probably because the bruising pain is greater than the knee pain.

When someone lifts weights, plays sports, or whatever, and they have a traumatic event and a couple days later there’s bruising in that area. Do you:

  1. Think “Ah crap, they strained / tore / injured something, hence the bleeding.”
  2. Think “Awesome. That’s just part of getting that tissue to do what we want. No pain no gain son!”

Let’s hope it’s 1. Oh, and what happens when an area is traumatized to the point it bleeds? Like a tear or bruise? The area often attains scar / fibrotic tissue! It doesn’t get rid of it. It gets MORE of it.

From Muscle injuries: Biology and treatment (bolding mine):

The healing of an injured skeletal muscle follows a fairly constant pattern irrespective of the underlying cause (contusion, strain, or laceration). Three phases have been identified in this process:

1. destruction phase, characterized by the rupture and ensuing necrosis of the myofibers, the formation of a hematoma [like a bruise] between the ruptured muscle stumps, and the inflammatory cell reaction;

2. repair phase, consisting of the phagocytosis of the necrotized tissue, the regeneration of the myofibers, and the concomitant production of a connective tissue scar, as well as the capillary ingrowth into the injured area; and

3. remodeling phase, a period during which the maturation of the regenerated myofibers, the contraction and reorganization of the scar tissue, and the recovery of the functional capacity of the muscle occur.

By trying to get rid of scar tissue through bruising people you are -quite literally- giving people scar tissue.

Stop this nonsense. You are hurting people and physically traumatizing them. It rivals the intelligence of my penile head.

Next argument the defenders are thinking: Yes, I realize people report feeling better after rolling; I’m talking about in the act, and I’m just getting started with those issues.

Foam rolling is an exercise itself

Your average personal training or physical therapy client: Maybe 40 years old, a good deal overweight, hasn’t worked out in years, history of low back and knee problems, etc.

You realize you’re basically asking this person to perform various plank variations for minutes on end, right?

should i foam roll

Planks with crappy form.

Awesome way to piss your lower back off.

Awesome way to piss your lower back off.

Or how about asking people to support a great deal of their bodyweight with just their arms?

foam roll hamstrings

I come from a very heavy athletic background. Once I got into the real world it took me about a week to realize your average client -who is not a 16 year old athlete- absolutely, positively, hates foam rolling. It’s exhausting for them. 10 minutes, or however long you have people foam roll, is not a workout’s warm-up for a new client, it is THE workout. A workout where they are in pain, constantly. And for the client -a client who likely has various painful joints, who is nervous about getting really sore because they haven’t worked out in forever- your introduction is to immediately put them in pain. Think about it.

Direction matters

I wrote about this extensively in a post called Muscles and Onion Bags. The takeaway is you can’t just manipulate a tissue in any direction. If a muscle is short, you need to manipulate (roll) it in a specific direction in order to lengthen it. Manipulate it in the wrong direction and you may actually be tightening an already tight muscle.

Are you sure you’re even tight?

There’s a difference between a muscle being short and it being stiff. Without complicating this much, if someone else moves you (passive movement) and you have trouble getting the range of motion, that area is short.

passive knee flexion

Passive knee flexion.

 

Move something with your own muscles (active movement) and have issues? You’re stiff.

active knee flexion

Active knee flexion.

(Yes, you can be both.)

Stiffness matters much more than shortness as stiffness will be evident when we move autonomously, which is what’s most important. That is, lengthening a short muscle does not guarantee better movement. Work on stiffness and you’re much more on your way.

In other words, people use foam rolling to “lengthen” things when often being “short” isn’t the issue.

“Yeah, but”

I know, the defenders are thinking, “Ok, but I can correct all that. I can not roll as hard so I lessen the pain, I can pick positions that aren’t as strenuous for people and slowly build them up, I can go in the proper direction, I can make sure I only go after truly short muscles, etc.”

Fair enough. You’re trying to turn shit into crap, but ok. However, there’s something you pretty much can’t change.

First, we need to quickly go over

Common pain problems

Let’s cover some of the most common joints people have issues at:

  • Lower back
  • Knees
  • Shoulders
  • Hips

Within that, let’s cover (briefly) what movement issues are typical at each of these joints (what causes pain).

Lower back

Too much arching and twisting. A case can easily be made the lower back just overall moves too much.

Knees

The femur turns in; the lower leg turns out. Essentially, the knee caves in too often.

Internally rotated knees versus...

And or the knees hyperextend:

knee hyperextension

Shoulders

The shoulders are downwardly rotated and or hang too low:

Jeremy Back downward rotation lines 2

And or the humerus glides too far forward:

Tight lats

Right picture is bad, left is better. From: www.manualtherapymentor.com

Jeremy side anterior glide lines

Or too far upward:

Notice the right shoulder protruding

Notice the right shoulder protruding

Jennifer front humeral superior glide arrow comparison

Hips

The femoral head glides too far forward:

Hip picture normal

Hip pain ABnormal

Check out the lower back, knee, shoulder and hip pain categories for more on these issues.

Let’s connect this to foam rolling.

Common foam rolling positions

Calves:

foamroller-calves

Quads:

should i foam roll

IT band:

it band foam roll bad

Adductors

foam-rolling-adductors

Hip flexors:

Hip Flexors foam rolling

Glutes

Foam-Roll-Glutes

Lats:

lats foam rolling massage

Specific joint issues with foam rolling

The easiest way to understand why foam rolling presents issues is this: I constantly hear people mention how important movement is. Well…Why does no one care how we move when foam rolling?

Lower back issues are caused by the lower back rotating, arching, just moving too much. Why does no one care how foam rolling does this,

Awesome way to piss your lower back off.

this,

foam-rolling-adductors with lines

this,

foam roller calves lower back bad

and this,


Foam_Rolling-IT_Band lower back twisted with lines

all to the lower back???

Since writing this piece on lateral pelvic tilts, I’ve gotten a good amount of emails regarding the topic.

lateral-tilt

One thing people will reference is foam rolling the IT band to help their lateral pelvic tilt. Uhh, look familiar?

foam roll it band lower back issues lines

The act of foam rolling causes a person to do exactly what they already do too much of. Foam rolling is literally making a person twist, arch, flex, overall move their lower back. Training wise, this is exactly what we’re trying to get them to STOP doing.

How about the knees?

Knee pain is caused by the knees turning inward / adducting / hyperextending too much, as well as the lower leg turning out too much.

Getting pushed into hyperextension:

SMR Gastroc knee hypertension with lines

Pushing into adduction / internal rotation:

IT band foam rolling with lines

Shoulder pain can be caused by the humerus gliding too far forward or upward. A very common reason for this is someone’s propensity to lean on their elbows and or wrists.

Notice the right shoulder protruding

And what are we doing during a ton of foam rolling positions?

Foam-Roll-Glutes with lines

The shoulders are getting pushed upwards, which is exactly why someone like the following has shoulder pain:

Jennifer front humeral superior glide arrow

Or notice how the elbows are constantly behind the shoulders, meaning the humerus is getting pushed into extension, causing the humeral head to travel forward, which is often a reason for pain:

Jeremy side anterior glide lines

foam roll quads bad shoulders with lines

A more subtle variant is downward rotation of the scapulae, which is the most common shoulder issue.

Jeremy Back downward rotation lines 2

A common occurrence in this issue is the scapula won’t fully upwardly rotate. As the arm approaches full range of motion, the scapula will often suddenly adduct due to the pull of the rhomboids.

Shoulder scapular motions

Watch the left shoulder / rhomboid area:

So, when foam rolling the lats you’re not helping this issue because even though the arm is up, the act of gravity on the foam roller is pushing the scapula into adduction,

Scapular adduction due to foam rolling with lines

which is the very same issue we’re trying to avoid. The foam roller essentially blocks full upward rotation from occurring, and in many shoulder issues, this is already happening without the aid of a foam roller.

Look how retracted (adducted) the left scapula is here:

Rob scapular retraction excessive

The last thing a guy like that needs is anything which pushes the scapula into retraction. Right shoulder below:

Finally, the hips. Primary cause of pain is anterior glide of the femur. The head of the femur is consistently going too far forward. One common reason for this is sitting down. The head of the femur can get pushed forward due to the opposing force of gravity in a chair,

Hip pain from sitting drawing

Which looks eerily similar to,

foam roll glutes issues anterior glide lines

The roller is actually pushing the femoral head forward, just like in sitting, and just like in those who often present hip pain.

Also, in anterior glide the anterior hip capsule -which is under the hip flexors- is too lax / loose. Foam rolling proponents state one should foam roll to help loosen up. So, when rolling the hip flexors you are potentially rolling the anterior hip capsule,

Hip Flexors foam rolling

and if you’re potentially making an already too lax capsule more lax, you’re spinning your wheels treatment wise.

Closing thoughts

The defenders

For the group who still wants to debate, the group I know is going “I don’t care what he says, foam rolling worked for me,” my last comment for you is:

So you had X condition and now X condition is gone. Presumably because you started foam rolling. Can you say it was because of the foam rolling? If you also added Y exercise, Z stretch, and Q modification, you can’t attribute anything directly to foam rolling.

You say you have a movement approach…

I recently watched an interview with Shirley Sahrmann. Throughout the years I’ve heard her state physical therapy needs to undergo a paradigm shift. One aspect of this shift needs to be changing towards a movement approach. You know, instead of the pull on some bands, ice and stim some shit, pop some ibuprofen, call it a day approach.

In the interview she was asked how well we’ve done making this transition. She laughs and responds, “Not very, not very.”

Also stating,

“Even though I see people nod accordingly [that they understand the approach], I don’t think they understand.”

I think foam rolling is a perfect example of what she’s saying. Sahrmann herself is not a big manual therapy person, for some of the reasons I outlined above. (You need to consider what else is going on besides what you’re rubbing.) However, I’ve heard multiple people who claim to be of the “movement” approach, people I’ve literally seen say “You get what you train” (a phrase coined by Sahrmann), who completely ignore the movement going on when doing something such as foam rolling. Some of these are practitioners where foam rolling constitutes maybe 10 minutes out of 60 minute session. You wouldn’t let someone put their lower back in a bad position during a single rep of a deadlift, then why are you willing to let them do it during 10 minutes worth of foam rolling?

Or you don’t want your client leaning on their elbows at their work desk, but you’re cool with them doing it during all that rolling?

Piggy backing on Sahrmann once more: Think of the pain issues I went over. Things like humeral superior glide, femoral anterior glide, rotational issues at the lower back, excessive rotation at the knee; what do all these things have in common? The site of pain is where something is moving too much. The idea of foam rolling is to get something to move more. (You don’t hear someone go “I’m foam rolling so I can stiffen up.”)

Consider what’s going on besides the single area you’re humping. Foam rolling is making joints which already move too much, move even more.

“You get what you train”

…even when you’re foam rolling.

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