Muscle tightness and restricted lower extremity range of motion (ROM) are common in active individuals and athletics. A number of studies have shown that reduced hip and knee range of motion increases the risk of thigh muscle injuries in sports involving sprinting. At COR, Santa Clara Physical Therapy, we’ve seen poor hip and knee range of motion correlate with low back, ankle, and even shoulder pain/dysfunction. I’ve provided massage at the hip and have seen massive improvements in low back movement quality and pain! Reduced joint ROM in lower extremities decreases movement efficiency and quality, making exercise harder! Maintaining and regaining normal ROM is vital for injury prevention, health, exercise enjoyment, and performance gains, two common exercise goals.
A common modality that has been used for improving joint ROM in sports and exercise settings is stretching, static stretching in particular. It is well known that both acute and chronic stretching exercise improve lower extremity ROM. There is compelling evidence that pre-exercise static stretching could also impair neuromuscular performance (Behm 2011, checkout this interview I had with Dr. Behm).
Self-myofascial release (self massage) with foam roller (FR) or stick roller (SR), and manual massage from a physical therapist have been recently used in clinical and sports practice for joint ROM enhancement. Regarding self-myofascial release, the results consistently show that the use of both FR and SR acutely improve lower extremity ROM in healthy young adults, without compromising performance. This research supports our frequent use of these tools (including baseballs, tennis balls, etc.) in our Santa Clara Boot Camp classes, physical therapy, and personal training.
A recent study (Markovic 2015) analyzed the effects of a physical therapist provided massage technique compared to form rolls. The main findings in this study was that both massage techniques statistically improved range of motion after application and 24-hours after treatment in the manual massage group! The participants were active male soccer players and simply had 2 minutes of work done on their quadriceps and saw:
Manual massage improved range of motion by 13–15°, twice as large compared with those observed following foam roll
Moreover, while the acute effects of FR on knee and hip ROM diminished after 24 h, while most of the gains in ROM (9–10°) by the manual massage remained preserved 24 hours after treatment.
7 Ways Massages May Improve Range of Motion
- Arterial dilation and vascular plasticity: Many isolate mobility as a muscle discrepancy. As I’ve discussed previously, muscles are not the only tissues limiting range of motion. Arteries and veins can also inhibit mobility and research suggests soft tissue massage improves this mobility
- Positive result on plasma nitric oxide concentration: Nitric oxide can facilitate recovery and possibly improve muscular capacity. Massages provide a positive result on plasma nitric oxide concentrations.
- Reduction of sense of fatigue: Massage has also been suggested to reduce sense of fatigue. When you feel fatigued, limited range of motion typically occurs. Massage can reduce this sense of fatigue and improve range of motion.
- Connective tissue recovery following exercise-induced muscle soreness: Macdonald et al. and Pearcey et al. studied the effect of foam rolling on recovery from exercise-induced delayed onset of muscle soreness (DOMS) and found that foam rolling reduced pain perception throughout the period of DOMs.
- Increased neuromuscular efficiency: There are specific muscle firing patterns. These patterns become disorganized due to overuse, injury, soreness, etc. Massage can improve these areas.
- Decreases in pain press threshold: Vaughan and McLaughlin demonstrated that 3-min of foam rolling over the iliotibial band resulted in significant increase in pressure pain threshold (PPT) immediately post-treatment. These investigators speculated that foam rolling might reduce pain perception via restoration of soft tissue extensibility and/or activation of a central pain-modulatory system.
- Thixotropic property of fascia: Markovic (2015) describes the following theory:”[t]he most common theory used to explain the increased ROM with the application of myofascial manipulation techniques is the thixotropic property of the fascia. According to this theory, application of energy (heat or mechanical pressure) to connective tissue changes its aggregate form from a more dense ‘gel’ state to a more fluid ‘sol’ state. If mechanical stress, heat, massage or pressure is applied to the fascia, it can become more pliable, allowing for a greater ROM.”
Massages and Foam Rolls Review
Overall, self-myofascial releases improve range of motion, but not as much as massages. If looking for long-term gains, massages provide the largest benefits. However, research must assess intensity levels and if SMR of the same intensity provides the same result as massage at the same intensity. Personally, the specificity of a human providing manual massage is superior to a foam roll, baseball, or any other SMR device. However, more precise and comparable research is needed! Until then, do your SMR, but if you can get a massage from a physical therapist!
- Markovic G. Acute effects of instrument assisted soft tissue mobilization vs. foam rolling on knee andhip range of motion in soccer players. J Bodyw Mov Ther. 2015 Oct;19(4):690-6. doi: 10.1016/j.jbmt.2015.04.010. Epub 2015 May 5
- Aboodarda SJ, Spence AJ, Button DC. Pain pressure threshold of a muscle tender spot increases following local and non-localrolling massage. BMC Musculoskelet Disord. 2015 Sep 28;16(1):265.
Written by Dr. John Mullen, DPT