Running head: SMR EFFECTS OF DURATION AND APPLICATION

Effects of Duration and Application Area of Self-Myofascial Release
on Flexibility in Physically Active Adults

A DISSERTATION
Submitted to the Faculty of the School of Graduate Studies and Research of California
University of Pennsylvania in partial fulfillment of the requirements for the degree of
Doctor of Health Science (DHSc) in Health Science and Exercise Leadership

By
Brian Zelanko

Research Advisor, Thomas F. West
California, Pennsylvania
2019

EFFECTS OF DURATION AND APPLICATION

CALIFORNIA UNIVERSITY of PENNSYLVANIA
CALIFORNIA, PA
DISSERTATION APPROVAL

Health Science and Exercise Leadership

We hereby approve the Dissertation of

Brian Zelanko
Candidate for the degree of Health Science (DHSc)

Date

Faculty
Digitally signed by Thomas West

11/13/19
11/13/19
11/13/19
11/13/19

2019.12.13 07:06:43
Thomas West Date:
-05'00'

signed by Marc Federico
Marc Federico Digitally
Date: 2019.12.16 14:49:28 -05'00'

EFFECTS OF DURATION AND APPLICATION

Acknowledgements
I would like to sincerely thank my family; especially my father Gary, my mother
Deb, and my sister Amy for their guidance, love, and support. I would like to thank my
fiancé Heather for her love, patience, and support.
I would like to especially thank my dissertation chair: Dr. Thomas F. West, and
also my dissertation committee: Dr. Barry McGlumphy, Dr. Marc Federico, and
professor Tony Ambler-Wright for their encouragement, commitment, patience, and
time.
I would like to thank my coworkers and friends who encouraged me and
volunteered their time to ensure my success. A special word of gratitude to Ashley
Mullan for her support and time.

EFFECTS OF DURATION AND APPLICATION

Table of Contents
List of Figures ...................................................................................................................... i
List of Tables ...................................................................................................................... ii
Abstract .............................................................................................................................. iii
Introduction ......................................................................................................................... 1
Methods............................................................................................................................... 6
Research Design.............................................................................................................. 6
Subjects ........................................................................................................................... 7
Instruments ...................................................................................................................... 9
Testing......................................................................................................................... 9
Intervention ............................................................................................................... 10
Online Questionnaire ................................................................................................ 11
Procedures ..................................................................................................................... 12
Baseline Testing ........................................................................................................ 14
Flexibility Testing ..................................................................................................... 15
Intervention ............................................................................................................... 16
Online Questionnaire ................................................................................................ 18
Data Analysis ................................................................................................................ 19
Quantitative data ....................................................................................................... 19
Qualitative data ......................................................................................................... 20
Results ............................................................................................................................... 22
Demographic Information and Tabling of Descriptive Statistics ................................. 22
Hypotheses Testing ....................................................................................................... 23
Quantitative Data ...................................................................................................... 24
Qualitative Data ........................................................................................................ 26
Feels Beneficial ...................................................................................................... 27
Duration Matters .................................................................................................... 28
Hit the Trigger Point .............................................................................................. 29
Immediate Effects .................................................................................................. 30
Incorporate ............................................................................................................. 31
Additional Findings ...................................................................................................... 32
Discussion ......................................................................................................................... 35

EFFECTS OF DURATION AND APPLICATION
Quantitative Data .......................................................................................................... 35
Qualitative Data ............................................................................................................ 40
Conclusion ........................................................................................................................ 46
Future Directions for Research ......................................................................................... 48
References ......................................................................................................................... 50
Appendix A: Review of the Literature.............................................................................. 57
Self-Myofascial Release ............................................................................................... 59
Tools for Self-Myofascial Release............................................................................ 61
Application of Self-Myofascial Release ................................................................... 69
Location of Application ......................................................................................... 70
Duration, Frequency and Repetitions .................................................................... 71
Scientific Rationale for Self-Myofascial Release ......................................................... 77
Mechanisms of Self-Myofascial Release .................................................................. 77
Models of Fascial Dysfunction .............................................................................. 77
Fascial Adhesion Model ..................................................................................... 77
Fluid Model ......................................................................................................... 78
Fascial Inflammation Model ............................................................................... 78
Autonomic Nervous System Stimulation Models.................................................. 79
Effects of Tissue Pressure ......................................................................................... 80
Releasing Trigger Points ........................................................................................... 84
Influence on the Autonomic Nervous System .......................................................... 85
Application to Sport and Physical Activity .................................................................. 88
Conclusion .................................................................................................................... 96
References ................................................................................................................... 100
Appendix B: Problem Statement .................................................................................... 109
Appendix C: Additional Methods ................................................................................... 112
Appendix C1: Limitations........................................................................................... 113
Appendix C2: Recruitment Flyer ................................................................................ 116
Appendix C3: Recruitment E-mail ............................................................................. 118
Appendix C4: Informed Consent ................................................................................ 121
Appendix C5: Health-Check Questionnaire ............................................................... 128
Appendix C6: Letter of Approval ............................................................................... 130
Appendix C7: Detecto Weight Beam Scale with the Height Rod .............................. 132
Appendix C8: Omron Body Composition Monitor and Scale .................................... 134

EFFECTS OF DURATION AND APPLICATION
Appendix C9: Figure Finder Flex-Tester®, Novel Products, Inc., USA .................... 136
Appendix C10: SPRI 36" High-Density Foam Roller ................................................ 140
Appendix C11: Pre- and Post- Questionnaire ............................................................. 142
Appendix C12: Follow-up Questionnaire ................................................................... 144
Appendix C13: E-mail List ......................................................................................... 146
Appendix C14: Script for Subjects ............................................................................. 148
Appendix C15: Data Collection Sheet ........................................................................ 151
Appendix C16: IRB Approval .................................................................................... 153
Appendix C17: Online Metronome (YouTube.com) .................................................. 157
References ....................................................................................................................... 159
Supporting Material ........................................................................................................ 170
Resume........................................................................................................................ 170
Personal Training Certification ................................................................................... 171
Corrective Exercise Specialist Certification ............................................................... 172
CPR, First Aid & AED Certification .......................................................................... 173

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List of Figures
Figure 1: Distribution of Change in Hamstring Flexibility (cm) ...................................... 26
Figure 2: Analysis of Covariance for Height (cm) ........................................................... 33
Figure 3: Analysis of Covariance for Weight (kg) ........................................................... 34

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List of Tables
Table 1: Descriptive Statistics of the Subjects .................................................................. 23
Table 2: The Mean Changes in Hamstring Flexibility (cm) for Each Intervention .......... 25
Table 3: The Main Themes Derived from Categories and their Representative Subject
Quotes ................................................................................................................... 27

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Abstract
Foam rolling can acutely improve range of motion (ROM) and it’s possible that
longer durations of foam rolling can provide more favorable results. The purpose of this
research was to explore the effects of different durations and the application area of foam
rolling on changes in hamstring flexibility, ease of movement, and muscle tightness in
physically active adults. It was hypothesized that both a 60 seconds (s) and 180 s of
application of self-myofascial release (SMR) would increase hamstring flexibility when
compared to a control group, with longer treatment times resulting in greater increases in
ROM. Additionally, it was hypothesized that both rolling through the trigger point (TP)
and holding the roller on the TP would increase hamstring flexibility when compared to a
control group, with holding on the TP resulting in greater increases in ROM. Forty
subjects (20 female and 20 male) were randomly assigned to one of five groups: (1) foam
rolling (60 s) holding on the TP, (2) foam rolling (180 s) holding on the TP, (3) foam
rolling (60 s) rolling through the TP, (4) foam rolling (180 s) rolling through the TP and
(5) control group focusing on rhythmic breathing but not foam rolling. A sit-and-reach
test measuring hamstring flexibility was completed before and after each session, and
questionnaires were completed pre-, post- and 24-hours after. A 3 (time of application) x
3 (location of application) between-subjects factorial analysis of variance (ANOVA) was
conducted to compare the effects of the application area and the location of the foam
roller. The main effect for foam rolling (p = 0.308), time of application (p = 0.310) and
location of application (p = 0.541) were not significant. The interaction between time and
location of application was not significant (p = 0.488). An inductive content analysis was
performed, codes were used for data reduction, and similar information was placed

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together. Categories were formed so the five main themes would emerge: (1) ‘Feels
beneficial’; (2) ‘Duration matters’; (3) ‘Hit the TP’; (4) ‘Immediate effects’; and (5)
‘Incorporate.’ Foam rolling functionally improved hamstring flexibility, but the
differences did not differ significantly between any of the five groups. The 60 s holding
on the TP group displayed the greatest improvement in overall mean score on the sit-andreach test, and subjects reported improved movement and less tightness following
treatment.
Keywords: foam rolling, hamstrings, trigger point, flexibility, qualitative,
questionnaire, self-myofascial release

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Introduction
Self-myofascial release (SMR) techniques, such as foam rolling, have become
popular in the field of health and wellness to improve flexibility, function, and
performance; reduce injuries and soreness; and address overactive musculature
(Cheatham, Kolber, Cain & Lee, 2015; Grieve et al., 2015). Self-myofascial release is
performed under the same principles as myofascial release (MFR), but individuals apply
the release themselves rather than receiving the treatment by a health or fitness
professional (Kalichman & Ben David, 2016). It is used as a treatment to release tension
in the fascia due to trauma, poor posture, and/or inflammation. Self-myofascial release is
suggested for two primary reasons: (1) to alleviate pain associated with trigger points
(TP) or adhesions in the soft tissue and (2) to influence the autonomic nervous system
(ANS) to inhibit overactive myofascial tissue (Hou, Tsai, Cheng, Chung & Hong, 2002;
Schleip, 2003).
To complete SMR, a person uses their own body weight to roll on a cylindrical
piece of foam to massage muscle restrictions, reduce adhesions and improve soft-tissue
extensibility by applying external pressure to the muscle and surrounding fascia
(Beardsley & Škarabot, 2015; Cheatham et al., 2015; Kelly & Beardsley, 2016;
Macdonald et al., 2013). Self-myofascial release can be completed using a wide variety
of tools that may differ in size, shape, and construction, but the foam roller and handheld
roller massagers are the most commonly used tools (Clark, Lucett & Sutton, 2014, p. 207;
Beardsley & Škarabot, 2015; Kalichman & Ben David 2016). Commercial foam rollers
are typically available in two sizes, a 6 inch (in.) x 36 in., which is considered standard

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and a 6 in. x 18 in., both of which can be comprised of bio-foam or multi-rigid layers
(Cheatham et al., 2015; Kalichman & Ben David 2016).
The exact mechanism or the combination of multiple factors by which SMR
exerts its effects is unclear, and research findings on SMR mechanisms are limited.
Connective tissue, or fascia, is comprised of many layers of collagen fiber bundles
surrounding the muscles and organs of the body, is highly adaptable, but can cause pain
when inflamed (Beardsley & Škarabot, 2015; Hironobu et al., 2013). External pressure
can lead to changes at the cellular level allowing for tension to be released resulting in an
ease of movement for fuller range of motion (ROM), decreased pain and tenderness and
increased pain threshold (Aboodarda, Spence & Button, 2015; Beardsley & Škarabot,
2015; Kumar, Sarkar, Saha & Equebal, 2017). The external pressure from SMR induces a
state of tissue relaxation due to the stimulation of the type III and type IV receptors, the
interstitial receptors and Ruffini endings, all of which influence the ANS (Clark et al.,
2014, p. 207; Kalichman & Ben David 2016; Kelly & Beardsley, 2016). Influencing the
ANS by applying external pressure can increase blood flow to the area allowing the tissue
to receive more oxygen and nutrients, remove waste byproducts, change the viscosity of
the tissue for better muscle contraction and joint motion, and decrease sympathetic tone
to reduce faulty muscle contraction (Edgerton, Wolf, Levendowski & Roy, 1996;
Schleip, 2003).
The current recommendations for application suggest that SMR techniques should
target TPs by starting at the proximal portion of the muscle and rolling towards the distal
portion, or vice versa and/or positioning the foam roller over an area of intense pain (the
TP) for release. Recommendations include holding on the TP for 30 (maximal pain

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tolerance) to 90 seconds (s) (lower pain tolerance) depending on the intensity or pressure
of application (Clark et al., 2014, p. 215; Kalichman & Ben David, 2016; Macdonald et
al., 2013). Subjects have reported that it is easier to move through their ROM following
SMR treatment as they have decreased pain and increased pain threshold (Aboodarda et
al., 2015; Hironobu et al., 2013; Vaughan & McLaughlin, 2014). Research has shown
that SMR using a foam roller can acutely improve ROM (Kelly & Beardsley, 2015;
Macdonald et al., 2013; Murray, Jones, Horobeanu, Turner & Sproule, 2016; Škarabot et
al., 2015) and that longer durations of SMR may provide more favorable results when
compared to current recommendations of 30 to 90 s (Pearcey et al., 2015; Rios Monteiro
et al., 2017a; Roylance et al., 2013; Sullivan, Silvey, Button & Behm, 2013). However,
limitations occur when interpreting the results due to varied methodologies.
The current literature utilizes methodology of varying rolling procedures,
protocols, and measurements, and vary in the number of sets, frequency, duration,
placement of the roller, holding versus rolling through the TP, and the types of foam
rollers used, posing a problem for forming cohesive recommendations. Current research
studies failed to implement true experimental designs using randomized controlled preand post-tests and utilized small sample sizes. More high-quality empirical research
should be completed focusing on the effects of duration and area of application of SMR
on ROM including adequate study design and sample sizes (Behara & Jacobson, 2017;
Morton, Oikawa, Phillips, Devries & Mitchell, 2016; Roylance et al., 2013; Sheffield &
Cooper, 2013; Sullivan et al., 2013).
Current research studies have reported varying procedures making it difficult to
form cohesive recommendations related to the optimal duration for foam rolling. Murray

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et al. (2016) focused on rolling for 30 full rolls with 15 rolls in each direction. Takanobu,
Mitsuhiko, and Komeianother (2014) had subjects complete 20 repetitions of rolling on
each muscle group at one-minute (min) intervals. Sheffield and Cooper (2013) had
subjects roll distally three times and proximally three times. Additionally, Kelly and
Beardsley (2015), and Škarabot, Beardsley, and Štirn (2015) had subjects complete 30 s
of rolling where Macdonald et al. (2013) had subjects complete two bouts of 60 s of foam
rolling, all of which complicate general conclusions. The duration of application ranged
from 5 s (Sullivan et al., 2013) to 20 min (45 s followed by 15 s rest repeated 20 times)
(Pearcey et al., 2015) with additional durations from other studies falling in between
(Kelly & Beardsley, 2015; Rios Monteiro et al., 2017a; Škarabot et al., 2015; Roylance et
al., 2013).
Current research studies have reported varying procedures related to the area of
application of the roller such as rolling continuously or holding where discomfort was
felt, but lack detail describing specifically how the roller was applied to the treatment
area. Several research studies used procedures that focused on rolling through the TP
(Kelly & Beardsley, 2015; Murray et al., 2016; Peacock, Krein, Silver, Sanders & Von
Carlowitz, 2014; Rios Monteiro et al., 2017a) while another study had subjects hold
where discomfort was felt (Sheffield & Cooper, 2013). These studies all resulted in
increased flexibility, but there was no described protocol that directed subjects to roll
until they were able to identify a TP and hold specifically on that targeted area.
Additionally, many of the research studies used commercially available foam
rollers that varied in size, length, density and rigidity (Murray et al. 2016; Kelly &
Beardsley, 2015; Rios Monteiro & Corrêa Neto, 2016; Rios Monteiro et al., 2017a;

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Škarabot et al., 2015). Others used custom-made rollers that are difficult to replicate and
can affect research results as they can access deeper layers of the muscle tissue
(Macdonald et al., 2013; Pearcey et al., 2015; Sheffield & Cooper, 2013).
A generalized consensus from the research studies support the benefits of SMR
on acutely increasing ROM when completing longer durations (Rios Monteiro et al.,
2017a; Sullivan et al., 2013), but the issue with interpretation of the overall results
continues to be the varied methodologies. While increases in ROM have been reported
after only five s of application up to treatment lasting 20 min, there is not enough highquality evidence to draw firm and definitive conclusions on the optimal duration or area
of application when completing SMR with a foam roller.
The purpose of this research is to explore the effects of different durations and the
application area of the foam roller on changes in hamstring flexibility, ease of movement
and muscle tightness in physically active adults using a box sit-and-reach test and online
questionnaires. This research will determine if the duration of application and location of
the foam roller leads to increases in hamstring flexibility when compared to a control
group with no foam rolling. Further analysis considering the perception of ease of
movement and muscle tightness will be qualitatively reviewed through questionnaires
completed online. It was hypothesized that both a 60 s and 180 s of application of SMR
would increase hamstring flexibility when compared to a control group with no foam
rolling, with 180 s resulting in greater increases in ROM measured by the sit-and-reach.
It was hypothesized that both rolling through the TP and holding the roller on the TP
during SMR would increase hamstring flexibility when compared to a control group and
that holding on the TP will result in greater increases in ROM.

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Methods
This research explored the effectiveness of different durations of SMR and the
application area of the foam roller on changes in hamstring flexibility, ease of movement,
and muscle tightness in physically active adults. This section will explain the research
design, study population, sampling including the description of the study area and the
procedures for selection, data collection including the description of tools and methods
that will be used to collect the information, and data analysis.
Research Design
A mixed-methods design incorporating two types of research, quantitative and
qualitative, was implemented with a greater focus on the quantitative aspect of the
design. An experimental random controlled trial measuring pre- and post-test data was
used to examine the quantitative data related to the different durations and area of
application of SMR using a foam roller on hamstring flexibility. Questionnaires were
incorporated to explore the qualitative data related to the different durations and area of
application of SMR using a foam roller that focused on sense of movement and muscle
tightness in physically active adults (Carter, Bryant-Lukosius, DiCenso, Blythe &
Neville, 2014).
One dependent variable, sit-and-reach distance measuring hamstring flexibility,
was evaluated pre- and post-intervention as quantitative data using a box sit-and-reach
test. The hamstring complex was studied as it is often shortened, overactive, and tight
leading to muscular imbalances specifically when the pelvis is pulled downward, which
can cause flattening of the back and lead to a higher prevalence of pain and injury

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(Nainpurwala & Honkalas, 2016). Two independent variables, time and location, were
examined to test the effects of the foam roller on changes in hamstring flexibility. Test
procedures varied the duration of the foam rolling and the location of the application as a
between-subjects factor, utilizing test (pre/post) as a within-subjects factor. Subjects were
randomly assigned to one of five procedure groups prior to the initial baseline testing
consisting of an experimental or control group including: (1) foam rolling (60 s) holding
on the TP, (2) longer duration of foam rolling (180 s) holding on the TP, (3) foam rolling
(60 s) rolling through the TP, (4) longer duration of foam rolling (180 s) rolling through
the TP, or (5) control group who laid on their back with their legs propped up and the
foam roller positioned under their hamstrings, but not completing foam rolling. Online
questionnaires were conducted immediately pre- and post-intervention and again 24
hours post-intervention. There were potential limitations (Appendix C1) to the research
design and protocol.
Subjects
Members of the Gaithersburg Fitness Center were recruited using a recruitment
flyer (Appendix C2) and a recruitment email (Appendix C3) advertising the research
study, and participation was voluntary. Subjects were required to complete the informed
consent form (Appendix C4) prior to participating in the research. This research included
physically active adult females and males from 18 to 50 years of age. Subjects were
required to be proficient in English and regularly participate at the fitness center and/or
exercise at least three days per week. Subjects were excluded from the research if they
were pregnant, believed that they may be pregnant, or became pregnant during the time
of this study. Subjects were excluded if they were under the age of 18 or over the age of

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50, had any communicable diseases, or had any illness or disease that could affect their
participation or be aggravated by their participation, including disease of the
cardiovascular, respiratory, urinary, nervous or endocrine systems. Subjects were
excluded from the research if they had a serious injury or surgery within the last six
months or any orthopedic problem such as arthritis, bursitis, fibromyalgia, osteoporosis,
or scoliosis, and that would affect their ability to participate. Subjects were free from any
condition, injury or illness that would affect their participation in this research study or
that would be worsened by their participation. The health-check questionnaire (Appendix
C5) was used to determine if the volunteers met exclusion/inclusion criteria.
A total of 40 subjects volunteered and were selected to participate in this research
study. A priori power analysis was conducted to measure statistical power and to evaluate
the risk of a Type II error. The results of the power analysis utilizing an alpha of 0.05,
power of 0.80, and an effect size of 0.545 resulted in a recommended group size of 9.04.
Individuals that were willing to volunteer replied to the researcher via email or spoke to
the researcher in-person to confirm their willingness to participate. The subjects were
recruited free of coercion or influence by the researcher, and any subject was free to
discontinue their participation at any time and for any reason without the threat of
retaliation. Once the informed consent form (Appendix C4) and the health-check
questionnaire (Appendix C5) was completed, the subjects were randomly assigned to an
experimental or the control group prior to the initial baseline testing. Subjects were
expected to meet with the researcher in order to: 1) receive an introduction of the
research project, 2) review and sign the informed consent form (Appendix C4) and

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complete the health- check questionnaire (Appendix C5) and 3) complete the testing
session.
The research took place at the Gaithersburg Fitness Center located in
Gaithersburg, MD, at the AstraZeneca site. A separate room that is located at the fitness
center (the assessment room) was used for meeting with the subjects individually and to
conduct the testing for the experimental part of the design. The subjects used this room to
complete the online questionnaires as part of the qualitative design, which allowed for
privacy and reduced the likelihood of interruptions. Permission to complete this research
at the Gaithersburg Fitness Center was granted and approved by the program manager at
the site (Appendix C6).
Instruments
Several instruments were utilized for the research and the data collection process.
Anthropometric data was collected prior to baseline testing, including: age, sex, height
using a Detecto Weight Beam Scale with the Height Rod (Appendix C7), and weight and
body mass index (BMI) using an Omron Body Composition Monitor and Scale (HBF516B) (Appendix C8). Age was reported in years, sex as female or male, height in
centimeters (cm) to the nearest tenth, weight in kilograms (kg) to the nearest tenth, and
BMI to the nearest tenth.
Testing. The subjects’ hamstring flexibility was tested using a box, and a sit-andreach test was completed (Figure Finder Flex-Tester®, Novel Products, Inc., USA)
(Appendix C9). A box sit-and-reach test (Appendix C9) is a widely-used, valid
measurement for hamstring flexibility used in the physical education curriculum as well

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as the fitness industry (Grieve et al., 2015). Recent research conducted using a metaanalysis reported that sit-and-reach tests have a moderate mean correlation coefficient of
criterion-related validity with an r range = 0.46-0.67 for estimating hamstring
extensibility (Mayorga-Vega, Merino-Marban & Viciana, 2014). Reliability is very high
with a correlation coefficient of 0.98 to 0.99 (Hartman & Looney, 2003). Scores for the
box sit-and-reach test were recorded in cm (to the nearest half cm) for both pre- and postintervention. Increasing reach distance corresponds with improved hamstring flexibility.
Intervention. Subjects in each experimental group completed a single bout of
foam rolling, except for subjects in the control group who did not foam roll. Subjects in
each of the four experimental groups either held the foam roller (SPRI 36" High-Density
Foam Roller) (Appendix C10) on a TP or rolled over the TP for either 60 or 180 s,
depending on group assignment. A commercially available foam roller (Appendix C10)
was used for the study and was applied to the hamstring complex. Self-myofascial release
using a foam roller is a viable option for the research to address pain, soreness, and
discomfort because it is low cost, widely available, easily portable, and convenient to use
(Kalichman & Ben David, 2016). Foam rolling is a technique that is widely practiced to
release muscle tension, relax contracted muscles and decrease over-activity of skeletal
muscles (Beardsley & Škarabot, 2015; Clark et al., 2014, p. 207; Kalichman & Ben
David 2016). No recent research on the validity or reliability of foam rolling techniques
has been reported. Subjects in the control group did not foam roll but laid on their back
(supine) with their legs propped up and the foam roller positioned under their hamstrings.
The subjects remained in that position for the same duration as the longer duration foam
rolling session (180 s) while completing rhythmic breathing.

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Online Questionnaire. All subjects were asked to participate in a pre- and postonline questionnaire (Appendix C111), and follow-up questionnaire (Appendix C12) for
the collection of qualitative data related to foam rolling. An online survey tool called
SurveyMonkey® was utilized to collect the data. An account was created, and
questionnaires were created and made available for the subjects to complete online.
Open-ended questions were incorporated, which allowed subjects to respond with more
descriptive and developed responses to each of the questions. The pre- and postquestionnaires (Appendix C11) were completed immediately prior to the baseline testing
and immediately following the experimental testing, respectively, using an available
laptop. The follow-up questionnaire (Appendix C12) was sent 24 hours following the
experimental testing and could be completed at the subjects leisure. The questionnaires
were submitted anonymously and individually.
Online questionnaires are acceptable for gathering qualitative data with good
validity and reliability, with reliability coefficients ranging from 0.6- 0.7 (Wladis &
Samuels, 2016) and an r range of 0.72 to 0.76 (Goossens et al., 2011), but those results
were related to student higher education enrollment and food allergy quality of life
respectively, not foam rolling specifically. The questions on the pre-, post- (Appendix
C11) and follow-up questionnaires (Appendix C12) focused on foam rolling, and the
subject’s perceived ease of movement and muscle tightness. If the subject was not able to
respond to any of the questions, then they were able to respond with “N/A” (not
applicable) in the response box. Each subject submitted their response by highlighting
and clicking the “submit” button at the bottom of the page which completed their
questionnaire and recorded their responses.

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The follow-up questionnaire (Appendix C12) was sent to each subject 24 hours
following their assigned intervention and was completed online using SurveyMonkey®.
Each subject received an e-mail notification from SurveyMonkey®, sent by the
researcher, that allowed them to click on a link taking them directly to the online
questionnaire. Completing the follow-up questionnaire (Appendix C12) 24 hours
following the intervention allowed each subject time to reflect upon their experience and
discuss any changes in their feelings or opinions of foam rolling, ease of movement, and
muscle tightness. Each e-mail was sent individually to ensure privacy and anonymity.
The email addresses for each of the subjects were collected and recorded on the email list (Appendix C13) when the subjects responded to the recruitment e-mail
(Appendix C3) or spoke with the researcher in-person at the fitness center. A script
(Appendix C14) was used during the instructional demonstration, communicating the
foam rolling technique to each subject so all subjects received the exact same set of
directions. A data collection spreadsheet (Appendix C15) using Microsoft Excel was used
for recording all necessary individual data throughout the entirety of the research.
Procedures
A review request form for approval to conduct research was submitted to the
Institutional Review Board (IRB) of California University of Pennsylvania, and the
process of obtaining subjects for the research did not begin until approval was granted
(Appendix C16). The researcher also obtained the necessary certificate of IRB training
(CITI) prior to meeting with any of the subjects to conduct research.

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Members of the Gaithersburg Fitness Center were recruited for the study at the
fitness center using purposive sampling. Fitness center members received the same initial
recruitment email (Appendix C3), ensuring equity of subject sampling. The initial
recruitment email (Appendix C3) provided information and details about the research
topic as a tactic for recruitment. Subjects were recruited free of coercion and without
influence from the researcher. Subjects responded directly to the researcher by replying
to the initial recruitment email (Appendix C3) or spoke with the researcher in-person at
the fitness center to indicate that they were interested in volunteering for the research
study. Email addresses for the subjects were collected and recorded on the e-mail list
(Appendix C13) and used for future correspondence to set meeting times for reviewing
the informed consent form (Appendix C4) and completing the baseline and experimental
testing along with the questionnaires. The recruitment of subjects lasted one month, and
following the recruitment period, all individuals volunteering for the research were
contacted via e-mail to set a meeting time with the researcher. While meeting with the
researcher individually, the informed consent form (Appendix C4) and the health-check
questionnaire (Appendix C5) were reviewed and completed. All subjects signed the
informed consent form (Appendix C4), and any subject not signing the informed consent
form (Appendix C4) would have been excluded from the research. Exclusion criteria
were included in the recruitment flyer (Appendix C2) and recruitment email (Appendix
C3), so it was clear to those who would be eligible to participate in the research study.
Results of a power analysis utilizing an alpha of 0.05, power of 0.80, and an effect
size of 0.545 resulted in a recommended group size of 9.04. Estimation of effect size was
derived from Morton et al. (2016) and Mohr, Long and Goad (2014). For this research,

EFFECTS OF DURATION AND APPLICATION

14

the target was to obtain 11 subjects per group in case subjects dropped out or were
excluded for any reason during the intervention, but 40 subjects volunteered for the
research study, and groups consisted of eight subjects. Subjects were randomly assigned
to one of five procedural groups after signing the informed consent form (Appendix C4)
and prior to the initial baseline testing. The procedural groups consisted of four
experimental groups and one control group including: (1) foam rolling (60 s) holding on
the TP, (2) longer duration of foam rolling (180 s) holding on the TP, (3) foam rolling (60
s) rolling through the TP, (4) longer duration of foam rolling (180 s) rolling through the
TP, or (5) a control group that did not foam roll but laid on their back with their legs
propped up and the foam roller positioned under their hamstrings. The control group
completed rhythmic breathing for 180 s and took a breath every three s.
A data collection spreadsheet (Appendix C15) created using Microsoft Excel was
utilized for subject randomization and assignment for groups along with data collection.
The subjects were provided a number for testing purposes of retaining anonymity. Data
that was collected related to anthropometric data, baseline testing, post- intervention
testing, and recording notes such as if the subject was unable to keep pace with the roll or
maintain proper positioning throughout the duration of the intervention were saved on the
data collection spreadsheet (Appendix C15).
Baseline Testing. All baseline testing was completed by the researcher, and the
subjects met with the researcher individually to complete the informed consent form
(Appendix C4) and health-check questionnaire (Appendix C5). Subjects provided their
age in years and sex as male or female. Their height was determined using the Detecto
Weight Beam Scale with the height rod (Appendix C7). Subjects removed their shoes and

EFFECTS OF DURATION AND APPLICATION

15

stood on the scale with their feet flat on the top of the platform, looking straight ahead,
and the height beam was adjusted to the top of their head. Their height was recorded in
cm to the nearest tenth. Body weight for each subject was recorded in kg to the nearest
tenth, and BMI was obtained using the Omron Body Composition Monitor and Scale
(HBF-516B) (Appendix C8). Subjects stepped onto the scale without their shoes on; their
height was entered so that BMI could be calculated, and their weight and BMI were
digitally displayed on the Omron screen. The results were recorded by the researcher and
entered into the data collection spreadsheet (Appendix C15) using Microsoft Excel.
Flexibility Testing. The hamstring flexibility of each subject was tested using a
box, and a sit-and-reach test was completed (Appendix C9). Subjects were instructed to
remove their shoes and to sit on the floor with their feet flat against the side of the box
(Appendix C9) and their legs straight and knees fully extended. The subject then reached
forward as far as possible with their arms fully extended and finger-tips on the metal
slider located on the top of the box (Appendix C9). The subject pushed the metal tab
forward until they could not reach any further forward without bending their knees. Their
feet remained flat on the side of the box. Two attempts were completed by each subject,
and the measurements were recorded to the nearest half-cm for both pre- and postintervention of foam rolling. The best score for the two attempts, pre- and postintervention, was used for data analysis (Sullivan et al., 2013). Minimal rest time, less
than 10 s, was given between attempts. The baseline measurements took approximately
10 min to complete. Following the pre-intervention baseline testing, the subject was then
notified of their random group assignment and provided a number that was used for the
testing.

EFFECTS OF DURATION AND APPLICATION

16

Intervention. Following the baseline testing, subjects completed their assigned
intervention protocol. The researcher provided a brief demonstration following a script
(Appendix C14) so that each subject received the exact same directions. Each subject was
permitted to practice the technique of foam rolling for 2 or 3 full rolls of the hamstring
complex (back of thigh), from the proximal to the distal portion or vice versa (Takanobu
et al., 2014). The researcher verbally instructed each subject, as needed, while the subject
applied the foam roller to their hamstring complex for their intervention protocol. Every
subject received the same verbal instructions. The researcher fielded and responded with
an answer to any question related to the application and proper technique of foam rolling
during the intervention.
The foam rolling was initiated at the distal end of the hamstrings at the popliteal
fold and rolling to the proximal end of the gluteal fold, or vice versa, then reversed. The
subjects were instructed to apply as much pressure as possible onto the foam roller, at a
pace of three s per roll distally then proximally. An online metronome on YouTube.com
(Appendix C17) was used to regulate the pace, which was set at 20 beats per min (bpm)
(Kelly & Beardsley, 2016; Pearcey et al., 2015). The two groups rolling through the TP
(60 or 180 s) continued the roll for the assigned duration at the pace set by the
metronome, switching the direction of the roll at each “beep” sound. Subjects allocated to
the two groups that held the foam roller on the TP (60 or 180 s) rolled to identify the TP
by finding a highly sensitive or painful area located in the muscle belly and held the foam
roller on that spot for the assigned duration. The subjects were instructed that they could
briefly readjust the roller if necessary. The control group did not complete any foam
rolling, but laid supine with the foam roller positioned under the hamstrings for the same

EFFECTS OF DURATION AND APPLICATION

17

amount of time as the longer duration of SMR totaling 180 s and focusing on rhythmic
breathing. Following the intervention or control, each subject completed the post-test in
the same manner that the pre-test was completed, by completing the box sit-and-reach
test (Appendix C9) along with the post-intervention questionnaire (Appendix C11).
Verbal instructions for foam rolling were provided for each subject, and the
instructions were the same for each subject following the script (Appendix C14). Subjects
were instructed to sit on the floor with their legs fully extended, placing their hands flat
on a mat for cushion and comfort, with the foam roller under their legs so that the roll
could be initiated at the distal end of the hamstrings at the popliteal fold and rolling to the
proximal end of the gluteal fold, or vice versa, then reversed. Subjects were instructed to
place their hands behind them and push upwards so that they are able to lift and be
supported by their hands while they foam rolled. They were instructed to keep their arms
and legs straight and to roll forward and back so that the foam roller rolled over their
entire hamstring. Subjects were instructed to keep their glute off the floor and to keep
their heels lifted to reduce friction while foam rolling. The subjects were instructed to
apply as much pressure onto the roller as possible and to switch their direction when
hearing a “beep” produced by the online metronome.
Subjects that were in the two groups that rolled through the TP (60 or 180 s) were
instructed to continue the roll for the assigned duration. Subjects that were in the two
groups that held the foam roller (Appendix C10) on the TP (60 or 180 s) were instructed
to roll 2 to 3 full rolls to identify the TP. A pace of 20 bpm was used to control for the
pace of the roll. When the subject was able to identify the highly sensitive or painful area
normally located in the muscle belly, they were instructed to hold the foam roller

EFFECTS OF DURATION AND APPLICATION

18

(Appendix C10) on that spot for the assigned duration, and the metronome was turned
off. Subjects were instructed that they may readjust the roller if necessary. Subjects in the
control group were instructed to lay supine with the foam roller (Appendix C10)
positioned under their hamstrings for the same amount of time that it took to complete the
longer duration of SMR totaling 180 s. Subjects in the control group were also instructed
to focus on their breathing and to take deep breaths at each “beep” of the metronome
(Appendix C 17) or every three s. All subjects were instructed that they would be
excluded from the research if they could not maintain the pace of the roll for the duration
of the intervention, could not maintain appropriate positioning on the foam roller
(Appendix C10) for the duration of the intervention, could not complete their assigned
intervention due to extreme pain or discomfort, or if they were not able to complete their
assigned intervention due to any other reason.
Online Questionnaire. All subjects completed a pre- and post- questionnaire
(Appendix C11) for the collection of qualitative data related to foam rolling. The online
survey tool called SurveyMonkey® was utilized to collect the data. The researcher created
an account and three questionnaires. Subjects completed the pre- and post- questionnaire
(Appendix C11) on an available laptop computer at the fitness center. Open-ended
questions were incorporated, allowing each subject to respond with a more descriptive
and developed response to each of the questions. The pre- and post-questionnaire
(Appendix C11) was completed immediately prior to the baseline testing and
immediately following the experimental testing. The questionnaires were completed in
the assessment room at the fitness center for privacy and were submitted anonymously
and individually.

EFFECTS OF DURATION AND APPLICATION

19

A follow-up questionnaire (Appendix C12) was sent to each subject to be
completed 24 hours following the testing, which could be completed at their leisure. Each
subject received an e-mail notification from SurveyMonkey®, sent by the researcher, that
allowed them to click on a link to send them directly to the online questionnaire.
Completing the questionnaire 24 hours following the intervention allowed each subject
time to reflect upon their experience and discuss any changes in their feelings or opinions
of foam rolling, ease of movement, and muscle tightness, adding validity to the research.
Each e-mail was sent individually to ensure privacy and anonymity.
The questionnaires reduced the risk of coercion or intimidation because they were
submitted anonymously. The responses were reviewed multiple times as part of the
inductive content analysis to understand the perception of ease of movement and muscle
tightness.
Data Analysis
This mixed-method concurrent design systematically combined the collection and
analysis of both quantitative and qualitative data, combining both numeric and narrative
data in the analysis, allowing for high validity due to the combination of data collection
and the strength of each approach (Ingham-Broomfield, 2016).
Quantitative data. The aim of the quantitative research was to determine if the
duration of application and location of the foam roller would lead to increased hamstring
flexibility when compared to a control group not completing foam rolling. The following
hypotheses were tested:

EFFECTS OF DURATION AND APPLICATION

20

H1: Both a 60 s and 180 s application of SMR will result in greater hamstring
flexibility as measured by the sit-and-reach when compared to a control group
completing no foam rolling.
H2: The 180 s application of SMR will result in greater hamstring flexibility as
measured by the sit-and-reach when compared to the 60 s procedure group.
H3: Rolling through the TP and holding the roller on the TP during SMR will
result in greater hamstring flexibility as measured by the sit-and-reach when compared to
a control group completing no foam rolling.
H4: Holding on the TP will result in greater hamstring flexibility as measured by
the sit-and-reach when compared to rolling through the TP.
A 3 (time of application) x 3 (location of application) between-subjects factorial
analysis of variance (ANOVA) was conducted to compare the effects of the application
area and location of the foam roller on hamstring flexibility. Two independent variables,
time and location, were examined to test the effects of the foam roller on changes in
hamstring flexibility. The data analysis was conducted using hypothesis testing, and a
probability (P) value of < 0.05 was considered statistically significant. A least squares
differences method would be used for post-hoc analysis to further isolate group
differences. The main effects of the location of the roller, duration, and interaction effects
were tested. The statistical analysis was performed using statistical package software
(SAS University Edition) with descriptive summary statistics.
Qualitative data. The aim of the qualitative research was to explore the
perception of SMR using a foam roller on ease of movement and muscle tightness, which

EFFECTS OF DURATION AND APPLICATION

21

included pre- and post-intervention questionnaires and a follow-up questionnaire at 24
hours post-intervention. For the questionnaires, a qualitative inductive content analysis
was implemented, and a thematic analysis was performed. Codes were used for data
reduction to separate findings; similar information was placed together to form larger
groups based on word and phrase repetition and categories were created. The categories
were labeled so the themes emerged, the themes were defined for the main findings, and
the main findings were discussed (Ingham-Broomfield, 2016).
An overall conclusion, explanation, and understanding of the research will be
developed through the integration of the quantitative and qualitative data, forming a
meta-inference. Broader generalizations and theories will form to provide theoretical
statements regarding the observations of the findings (Venkatesh, Brown & Bala, 2013).

EFFECTS OF DURATION AND APPLICATION

22

Results
The purpose of this research was to examine the effect of different durations and
application areas of the foam roller on changes in hamstring flexibility, ease of
movement, and muscle tightness in physically active adults using a box sit-and-reach test
and online questionnaires. Two independent variables, time and location, were examined
to test the effects of the foam roller on changes in hamstring flexibility. Test procedures
varied the duration of the foam rolling and the location of the foam roller as a betweensubjects factor, utilizing test (pre/post) as a within-subjects factor. The independent
variables each had three levels for a total of five experimental groups. Forty subjects, 20
males and 20 females, volunteered to participate in this research study. Each informed
subject was randomly assigned to one of five procedure groups consisting of an
experimental or control group prior to the initial baseline testing. To gain a better
understanding of the perception of ease of movement and muscle tightness, each subject
completed a pre-intervention questionnaire before the initial baseline testing followed by
a post- intervention questionnaire after the completion of the assigned intervention. A
follow-up questionnaire was sent to each subject 24 hours post-intervention. This section
will include the demographic and tabling of descriptive statistics, hypotheses testing and
additional findings.
Demographic Information and Tabling of Descriptive Statistics
Subjects used in this research (N=40) were volunteers from the Gaithersburg
Fitness Center at the AstraZeneca site. All subjects completed a health-check
questionnaire to ensure that they met exclusion/inclusion criteria, and one subject was

EFFECTS OF DURATION AND APPLICATION

23

excluded from the research. All subjects were proficient in English, regularly participated
at the fitness center at least three days per week, or exercised at least three days per week,
and were free from any condition, injury or illness that could affect their participation in
the research, or that could be worsened by participating.
Table 1
Descriptive Statistics of the Subjects
Sex

Unit of

(m/f)

n

Variable

Measure

Mean

SD

Minimum

Maximum

F

20

Age

yrs

36.0

8.24

22.0

49.0

Height

cm

166.1

8.31

153.0

190.5

Weight

kgs

70.0

13.7

46.1

103.0

25.2

3.46

18.0

31.1

BMI
M

20

Age

yrs

36.1

6.79

24.0

48.0

Height

cm

178.8

7.25

167.5

192.0

Weight

kgs

86.3

14.62

62.2

115.7

26.8

4.03

17.2

33.3

BMI
Total

40

Age

yrs

36.0

7.45

22.0

49.0

Height

cm

172.4

10.02

153.0

192.0

Weight

kgs

78.1

16.23

46.1

115.7

26.0

3.79

17.2

33.3

BMI

Hypotheses Testing
The following hypotheses were tested in this research study. A probability (P)
value of ≤ 0.05 was considered statistically significant.

EFFECTS OF DURATION AND APPLICATION

24

H1: Both a 60 s and 180 s application of SMR will result in greater hamstring
flexibility as measured by the sit-and-reach test when compared to a control group
completing rhythmic breathing.
H2: The 180 s application of SMR will result in greater hamstring flexibility as
measured by the sit-and-reach test when compared to the 60 s procedure group.
H3: Rolling through the TP and holding the roller on the TP during SMR will
result in greater hamstring flexibility as measured by the sit-and-reach when compared to
a control group completing rhythmic breathing.
H4: Holding on the TP will result in greater hamstring flexibility as measured by
the sit-and-reach when compared to rolling through the TP.
Quantitative data. To test the hypotheses, each subject’s greatest pre- and postflexibility score was recorded for each condition including: foam rolling (60 s) holding
on the TP, longer duration of foam rolling (180 s) holding on the TP, foam rolling (60 s)
rolling through the TP, longer duration of foam rolling (180 s) rolling through the TP,
and a control group where subject’s were lying on their back with their legs propped up
and the foam roller positioned under their hamstrings while completing rhythmic
breathing, but no foam rolling. A 3 (time of application) x 3 (location of application)
between-subjects factorial ANOVA was conducted to compare the effects of the
application area and location of the foam roller on hamstring flexibility. The main effect
for foam rolling was not significant (F (4,35) = 1.25, p = .308). The main effect for time
of application was not significant (F (1,35) = 1.06, p = .310). The main effect for location
of application was not significant (F (1,35) = 0.38, p = .541). The interaction between
time and location of application was not significant (F (1,35) = 0.49 p = .488).

EFFECTS OF DURATION AND APPLICATION

25

Table 2
The Mean Changes in Hamstring Flexibility (cm) for Each Intervention
Intervention n

Mean

SD

180 s H

8

1.81

180 s TP

8

60 s H

Min

Max

Range

95% CI

1.850 -1.00

5.00

6.00

0.26

3.36

1.88

2.295 -2.00

5.50

7.50

-0.04

3.79

8

3.13

2.20

0.00

6.50

6.50

1.28

4.96

60 s TP

8

2.13

1.727 0.00

4.00

4.00

0.68

3.56

C

8

0.75

2.550 -2.00

6.00

8.00

-1.38

2.88

Note: The mean changes in hamstring flexibility (cm) for each intervention. This table includes the average
mean, standard deviation, minimum and maximum, range, and the lower and upper 95% confidence
interval.

Neither the time of application or the location of application of the foam roller
appeared to have any significant effect on hamstring flexibility. Post-hoc analysis was not
completed.

EFFECTS OF DURATION AND APPLICATION

26

Figure 1
Distribution of Change in Hamstring Flexibility (cm)

F 1.25
Pr >F 0.308

Maximum

Upper Quartile
Mean
Median
Lower Quartile

Minimum

Note. Distribution of change in hamstring flexibility (cm). The box plot includes the minimum, maximum,
lower and upper quartile, mean and median for the subjects’ change in hamstring flexibility in cm for each
assigned procedural group including: 180 s H, 180 s TP, 60 s H, 60 s TP and C.

Qualitative data. To gain a better understanding of the subject’s perception of
their ease of movement and muscle tightness, a qualitative inductive content analysis was
performed, and the responses that were collected from SurveyMonkey® were reviewed
several times. A thematic analysis was performed, codes were used for data reduction to
separate findings, similar information was placed together to form larger groups based on
word and phrase repetition, and categories were created. The categories were labeled so
the themes emerge; the themes were defined for the main findings. From the
questionnaires, five main themes emerged: (1) ‘Feels beneficial’; (2) ‘Duration matters’;
(3) ‘Hit the TP’; (4) ‘Immediate effects’; and (5) ‘Incorporate.’

EFFECTS OF DURATION AND APPLICATION

27

Table 3
The Main Themes Derived from Categories and their Representative Subject Quotes

Main Themes

Categories

Representative Subject Quotes

Feels beneficial

Release tension and

“It feels better, and it helps with flexibility

relax the muscle

and [ROM]…foam rolling can help loosen
it up and reduce pain”
“There’s a certain amount of time before the

Duration Matters

Tightness and

foam roller allows that muscle to release

tension as a guide

depending on soreness, tightness, etc.”
“Yes, that’s how you work that tension and

Rolling and holding relieve the pressure.”
Hit the TP

or combining

“I feel more natural and free. I feel less

After foam rolling

pressure and great.”

Immediate effects
Incorporate

“Definitely, I feel like I will do more, and
Continuing to foam

now I have more knowledge and believe in

roll

the benefits. It makes sense to [me] now to
help me and recover from running and
exercise.”

Note. The main themes derived from categories and their representative subject quotes. This table includes
the five main themes that emerged from the inductive content analysis. Similar information from the
responses were placed together to form groups based on word and phrase repetition, and categories were
created. From the categories, five main themes emerged. Representative subject quotes provide examples
from the responses.

Feels beneficial. Most of the subjects reported that they had better movement, less
tightness, or both. Subjects also reported that they felt more relaxed after foam rolling.
“It feels better, and it helps with flexibility, and [ROM]…foam rolling can help
loosen it up and reduce pain.”

EFFECTS OF DURATION AND APPLICATION

28

“Feel much more relaxed with less muscle tightness and better mobility or
movement.”
Also, most of the subjects had prior experience with foam rolling and reported that they
foam roll their muscles to address or reduce soreness and tightness.
“…it helps increase flexibility for my muscles and helps me work out longer, so
my muscles don’t get stiff.”
“…helps me release the muscles (TPs) release soreness and increase flexibility
and relieve pain.”
Duration matters. The majority of the subjects felt that the amount of time they
spent foam rolling was important and mattered. Tightness and soreness were a guide, and
subjects felt that if they didn’t foam roll long enough that they didn’t feel foam rolling
was as beneficial.
“There’s a certain amount of time before the foam roller allows that muscle to
release depending on soreness, tightness, etc.”
“…shorter duration I don’t feel the effect.”
A few of the subjects in the 60 s groups reported that they didn’t think 60 s was long
enough.
“…if I would have done more than 60 s it would have been better.”
“When I did the foam rolling now it felt better so I felt like I wanted to do longer.
60 s wasn’t enough time to break down my tightness.”

EFFECTS OF DURATION AND APPLICATION

29

“The amount of time is important, but I don’t think 60 s is enough.”
One subject in the 60 s group that had not foam rolled prior to the research responded that
at least 60 s or more is better.
“For the first time 60 s [foam rolling] was good for me but I feel that I can do
more and I think that 60 s or more is better.”
Hit the trigger point. The subjects in the foam rolling groups noticed sore, tight,
or painful areas in their hamstrings and indicated that foam rolling those areas were
important for reducing tension and relaxing the muscle.
“Yes, that’s how you work that tension and relieve the pressure.”
“…I feel like you have to work it out so it’s important to stretch and massage that
area.”
Many subjects reported that during their own foam rolling sessions that they combine
rolling and holding.
“…continuous [foam rolling] unless a trigger spot then I will work the area.”
“Continuous rolling but stopping at certain spots that are tight and sore.”
“Typically, I go back and forth and find area that need more and trying to find the
TP then focus on the area [that] needs it the best and hold.”
One subject in the continuous rolling group mentioned that they would have spent time
holding the foam roller on specific areas.

EFFECTS OF DURATION AND APPLICATION

30

“…I felt like I was hitting TPs and by myself I would have held and would have
relaxed the muscle more like a massage and given a different sensation.”
Two subjects mentioned incorporating the areas directly above and below the TP while
foam rolling.
“…I think the effect of foam rolling is helpful for the areas that need it the most.
Areas above and below the TP need it the most.”
“Yes, with small adjustments can help to make small dynamic movements and
provide localized muscle relief.”
Immediate effects. Nearly all of the subjects described having better movement,
less tightness or both, or that they were feeling more relaxed after foam rolling.
“I feel more natural and free. I feel less pressure and great.”
“I have better movement and less tightness. I feel like I can move better.”
“Feel much more relaxed with less muscle tightness and better movement.”
“More relaxed with less muscle tightness and better movement.”
On the follow-up questionnaire, some of the subjects responded that they felt less tight or
both less tightness and better movement even 24 hours after foam rolling.
“Both, I feel looser and less sore compared to yesterday prior to foam rolling.”
“I feel less sore after my workout yesterday than I usually do.”

EFFECTS OF DURATION AND APPLICATION

31

Other subjects reported feeling neither less tightness nor better movement, fine, or no
different on the follow-up questionnaire.
“Now I feel the same as before foam rolling yesterday, so neither.”
“Don’t notice a difference the day after foam rolling.”
“Not different from before foam rolling.”
Incorporate. An overwhelming number of responses by the subjects indicated that
they would foam roll on their own following the research study or continue to utilize a
foam roller as they did prior to the research.
“Definitely, I feel like I will do more and now I have more knowledge and believe
in the benefits. It makes sense to [me] now to help me and recover from running
and exercise.”
“Yes, slowly over the muscles until I find the tightest spot and hold it there for a
min until the tightness goes away.”
“…it’s a cost effective means to massage your legs. We don’t have the time or
means to go get a massage.”
Subjects wanted to foam roll because they felt that foam rolling would not only reduce
tension and improve flexibility, but also improve their exercise performance and reduce
the likelihood of suffering from an injury.
“…I usually don’t work out without foam rolling. It helps with running and I feel
like I need to foam roll after running.”

EFFECTS OF DURATION AND APPLICATION

32

“…this is something that [I] will combine with what I am doing in the gym.”
“I see the benefits in removing tension and preventing injury.”
“Probably to help with performance unless I get seriously injur(ed).”
Additional Findings
The covarient of height and of weight were examined to test the effects on
changes in hamstring flexibility using an Analysis of Covariance (ANCOVA). The main
effect for height was significant (F (9,30) = 2.57, p = .025). The main effect for weight
was significant (F (9,30) = 2.36, p = .037).

EFFECTS OF DURATION AND APPLICATION

33

Figure 2
Analysis of Covariance for Height (cm)
7
6
5

180s H
180s TP

Change (cm)

4

60s H
60s TP

3

C
Linear (180s H)

2

Linear (180s TP)

1
0

Linear (60s H)
Linear (60s TP)
150

160

170

180

190

Linear (C)

-1
-2

Height (cm)

Note. Analysis of covariance for height (cm). The scattered plot includes the change in hamstring flexibility
in cm from pre- to post-intervention for each subject and their group assignment: 180 s H, 180 s TP, 60 s H,
60 s TP and C with height as a covariant.

EFFECTS OF DURATION AND APPLICATION

34

Figure 3
Analysis of Covariance for Weight (kg)
7
6
5
180s H

Change (cm)

4

180s TP
60s H

3

60s TP
C
Linear (180s H)

2

Linear (180s TP)
Linear (60s H)

1

Linear (60s TP)
0

Linear (C)
40

60

80

100

120

-1
-2

Weight (kg)

Note. Analysis of covariance for weight (kg). The scattered plot includes the change in hamstring flexibility
in cm from pre- to post-intervention for each subject and their group assignment: 180 s H, 180 s TP, 60 s H,
60 s TP and C with weight as a covariant.

EFFECTS OF DURATION AND APPLICATION

35

Discussion
The primary purpose of this research was to examine the effects of different
durations and application areas of foam rolling on changes in hamstring flexibility using
a box sit-and-reach test. Additionally, this study qualitatively explored ease of movement
and muscle tightness using online questionnaires. The two quantitative variables studied
were treatment time consisting of 60 s or 180 s and location of the foam roller, including
either continuous rolling or holding on a TP located in the hamstring muscle. The control
group completed a sham treatment but did not foam roll. Each subject completed the
initial baseline testing followed by the pre-questionnaire before completing their assigned
group intervention. Subjects were randomly assigned to an experimental group or the
control group consisting of: (1) foam rolling (60 s) holding on the TP, (2) longer duration
of foam rolling (180 s) holding on the TP, (3) foam rolling (60 s) rolling through the TP,
(4) longer duration of foam rolling (180 s) rolling through the TP and (5) control group
where the subject lay supine with the foam roller placed under their hamstrings and
focusing on rhythmic breathing but did not foam roll. Each subject completed the box sitand-reach test immediately after their assigned intervention then completed the postquestionnaire. A follow-up questionnaire was sent to each subject via e-mail using
SurveyMonkey® 24-hours after the intervention was completed.
Quantitative Data
It was hypothesized that:
H1: Both a 60 s and 180 s application of SMR will result in greater hamstring
flexibility as measured by the sit-and-reach test when compared to a control group
completing rhythmic breathing.

EFFECTS OF DURATION AND APPLICATION

36

H2: The 180 s application of SMR will result in greater hamstring flexibility as
measured by the sit-and-reach test when compared to the 60 s procedure group.
H3: Rolling through the TP and holding the roller on the TP during SMR will
result in greater hamstring flexibility as measured by the sit-and-reach when compared to
a control group completing rhythmic breathing.
H4: Holding on the TP will result in greater hamstring flexibility as measured by
the sit-and-reach when compared to rolling through the TP.
When examining the effects of duration and application area of foam rolling, both
a 60 s and 180 s application of SMR using a foam roller improved hamstring flexibility as
measured by the box sit-and-reach test when compared to a control group, but the
differences were not statistically significant. The 180 s application of SMR did not result
in greater hamstring flexibility when compared to the 60 s group. Rolling through the TP
and holding the foam roller on the TP during SMR resulted in improved hamstring
flexibility as measured by the box sit-and-reach, but the differences were not statistically
significant. Holding on the TP for 180 s did not result in greater hamstring flexibility
when compared to the 60 s group. There were functional improvements following the
foam rolling application for each treatment group with the greatest mean increase in
flexibility observed in the 60 s holding on the TP group, but none of the four
experimental groups had results that significantly differed from the control group as
determined by statistical analysis. Post hoc analysis was not completed because the
groups were not significantly different using an alpha value of ≤ 0.05 as statistically
significant.

EFFECTS OF DURATION AND APPLICATION

37

Recently, it was suggested that a longer duration of rolling may lead to increased
benefits. Research by Sullivan et al. (2013) had similarities in procedure where the
rolling application targeted the hamstrings, and a sit-and-reach test was administered to
examine changes in ROM and muscle length performance for either 5 s or 10 s of rolling.
The rolling application resulted in a significant main effect for time with an increase in
ROM from pre- to post-rolling with an observed trend toward a group main effect with
10 s increasing ROM more compared to 5 s. Peacock et al. (2014) had subjects foam roll
for 30 s, but there were no differences in hamstring flexibility when compared to an
experimental group measured by a box sit-and-reach test. Morton et al. (2016) had
subjects with bilateral hamstring tightness roll for 60 s, and there were no differences
between the intervention groups. It is important to note that the studies completed by
Peacock et al. (2014) and Morton et al. (2016) both lacked a control group, and the
research design of each study implemented a protocol comparing two experimental
groups, one including and one excluding SMR.
Bradbury-Squires et al. (2015) had subjects roll for either 20 or 60 s and ROM
was 10% greater in the 20 s and 16% greater in the 60 s group when compared to the
control group. The increase in ROM in the present study is similar to Bradbury-Squires et
al. (2015) as there was a trend for the 60 s application to increase ROM. The research
completed by Bradbury-Squires et al. (2015) and Sullivan et al. (2013) supports that
incorporating longer durations of rolling can increase flexibility and that 60 s is more
beneficial when compared to a shorter duration. Rios Monteiro and Corrêa Neto (2016)
incorporated groups that foam rolled for longer than 60 s, but the procedure involved
testing foam rolling during an inter-set rest period on muscular fatigue. Fatigue index was

EFFECTS OF DURATION AND APPLICATION

38

(statistically) significantly greater, greater fatigue resistance, for the control group
compared to the groups completing 90 or 120 s of foam rolling, and higher fatigue
resistance was observed for the group completing 60 s of foam rolling compared to 120 s
suggesting that foam rolling more than 60 s may not be as beneficial as initially
hypothesized. It is possible that 60 s is the ideal amount of time to foam roll to produce
maximum results. Rios Monteiro and Corrêa Neto (2016) suggested that foam rolling for
volumes greater than 90 s are detrimental to the ability to continually produce force;
however, a research study completed by Rios Monteiro et al. (2017a) at least 90 s of
SMR was needed to improve overhead deep squat scores. In this research, the 180 s of
foam rolling and 180 s of holding on the TP groups had slight improvements in hamstring
flexibility when compared to the control group, but the improvements were less than that
of the 60 s holding on the TP group. Results of the 60 s rolling through the TP group
were similar to those observed in the 180 s of foam rolling and of holding on the TP
groups.
The current research on holding the foam roller on a TP and examining the effects
of flexibility is limited. Sheffield & Cooper (2013) had subjects hold the roller for 30 s on
the area where discomfort was felt, and there was an immediate improvement in
hamstring flexibility. An active knee extension (AKE) test was administered, and a
goniometer was used to measure hamstring flexibility. Wilke, Vogt & Banzer (2018)
examined the effectiveness of SMR on reducing latent TP sensitivity and found that a
static application using a foam roller for 90 s increased pain pressure threshold, but
flexibility was not tested. Similar results were observed in the present study where 60 s of
holding the foam roller on a TP was more effective than rolling through the TP for 60 s,

EFFECTS OF DURATION AND APPLICATION

39

but foam rolling for a longer duration of 180 s did not enhance the effects. It is possible
that longer durations of foam rolling is not beneficial for improving hamstring flexibility.
Based on the results from this study, increases in hamstring flexibility began to diminish
from foam rolling somewhere between 60 and 180 s.
Of the research that has been examined, SMR using a foam roller can be effective
at increasing ROM, and longer durations of foam rolling can improve results up to a
point. It is possible that foam rolling for too long can diminish results. In this study,
increases in flexibility were observed in each group when compared to the control, with
the greatest increases observed in the 60 s holding on the TP group. The increases in
flexibility for each group were a functional improvement, but none of the four
experimental groups statistically differed from the control group; however, there is
evidence supporting that foam rolling for up to 60 s can elicit significant results. There is
additional evidence indicating that holding on a TP for at least 30 s is effective at
increasing flexibility. Based on the present research, there is a trend that 60 s of holding
can improve flexibility, but results will diminish at 180 s. It is possible that the benefits of
foam rolling can be the most effective when applying up to 90 s, but based on this
research and the current available research, 60 s may be optimal for the best results. More
research should be completed examining the effects of foam rolling and holding on the
TP for 60 up to 90 s.
The exact mechanisms by which foam rolling works is not fully understood, but
there are theories that have been proposed and investigated. SMR is performed under the
same principles as MFR or massage, except a person uses their own body weight to roll
to reduce muscle restrictions and adhesions. Soft tissue is affected by foam rolling

EFFECTS OF DURATION AND APPLICATION

40

leading to an increase in extensibility from applying external pressure to the muscle and
the surrounding fascia. It is possible that the external pressure can lead to changes at the
cellular level allowing for tension to be released due to the stimulation of type III and
type IV receptors, the interstitial receptors, and Ruffini endings that influence the ANS
(Kalichman & Ben David 2016; Kelly & Beardsley, 2016). It is possible that the external
pressure can increase blood flow to the application area allowing the tissue to receive
more oxygen and nutrients, remove waste byproducts, change the viscosity of the tissue
for better muscle contraction and joint motion, and decrease sympathetic tone to reduce
faulty muscle contraction (Edgerton et al., 1996; Schleip, 2003). Interstitial muscle
receptors (type III and IV) and Ruffini endings (type II) respond to slow, deep, sustained
pressure and stimulate the nervous system by decreasing gamma loop activity, in return,
relaxing the muscle (Schleip, 2003).
Qualitative Data
The purpose of gathering qualitative data was to explore the perception of ease of
movement and muscle tightness in physically active adults. To interpret the data, a
thematic analysis was performed, and codes were used for data reduction to separate
findings. Responses that contained similar information were placed together to form
larger groups based on word and phrase repetition, and categories were created. The
categories were labeled so that five main themes emerged: (1) ‘Feels beneficial’; (2)
‘Duration matters’; (3) ‘Hit the TP’; (4) ‘Immediate effects’; and (5) ‘Incorporate.’
On the pre-questionnaire, 31 of the 40 subjects reported foam rolling prior to the
research and nearly half of the subjects reported foam rolling for less than or up to one

EFFECTS OF DURATION AND APPLICATION

41

min per muscle group on their own. Eight subjects reported foam rolling for more than
one min per muscle group and two subjects reported counting the number of repetitions
of rolls. Fourteen of the subjects reported that they combined rolling and holding on tight
spots or TPs while completing their foam rolling session. Nineteen subjects reported that
they thought that the duration of foam rolling mattered, while eight reported “no”, seven
said “probably”, two “did not know”, and two responded with “N/A”. One subject stated
that they didn’t think the duration mattered as much as the intensity of the roll and
another subject stated that it probably “depends on how sore you are.”
Thirty-two subjects reported that they thought it was important to hold the roller
on an area that was sore or painful, three reported “no” and three subjects responded with
“N/A”. One subject stated that it “depends where it’s at. If it’s pain in the leg or another
part that you could use the foam roller on,” indicating that some areas of the body may
not be affected by the foam roller. One subject responded that they thought “rolling is
better than holding on it. It hurts when you stay on it.”
Eighteen of the subjects reported that they felt less muscle tightness and better
movement following their foam rolling session, three had less muscle tightness, three felt
a little “looser” and one reported that they typically felt better the next day. Thirty-two of
the subjects said that they would continue to foam roll on their own after the study; two
said “no” and six responded with either “N/A” or that they weren’t sure.
The same questions were asked and similar responses were observed on the postquestionnaire, but 28 of the subjects reported that they thought the duration of the foam
rolling application mattered compared to 18 on the pre-questionnaire. Four subjects in the

EFFECTS OF DURATION AND APPLICATION

42

60 s foam rolling group responded that they didn’t think that was enough time to spend
foam rolling. One subject in the 60 s group that had not completed foam rolling before
stated that, “for the first time 60 s was good for me, but I feel that I can do more and I
think that 60 s or more is better,” and another subjected replied that “if [they] would have
done more than 60 s it would have been better.” Two subjects had similar responses
stating that “…60 s wasn’t enough time to break down [their] tightness.” One subject was
unsure but speculated, “maybe if I [had] foam rolled longer, maybe I could have reached
farther.” A subject in the 180 s foam rolling group stated, “I think that less than a min and
a half wouldn’t be beneficial. I felt like after two min it loosened up” and someone
replied that they, “…felt a lot looser now after foam rolling [three] min. I feel less tense.”
A subject in the longer duration group confirmed that “Yes, there’s a certain amount of
time before the foam roller allows that muscle to release depending on soreness,
tightness, etc.” One subject thought their time would be better spent weight lifting unless
“it’s time investing in tightness of trigger pointing” with a harder object, and another
subject stated that they “…get the same results with less time.”
Thirty-three subjects reported that they thought holding on a sore or painful area
was important for the muscle to help release soreness and tension. One subject in the
holding on the TP group stated that holding the foam roller “…helped a lot because I feel
like that one specific spot was limiting me.” One subject that was in the rolling group still
thought that holding would have been beneficial, stating, “…I felt like I was hitting TPs
and by myself I would have held and would have relaxed the muscle more like a
massage…” and another subject thought that combining rolling and holding would have
worked even better to help relax their muscle and work through the area that was giving

EFFECTS OF DURATION AND APPLICATION

43

them trouble. Eight subjects on the post-questionnaire compared to the three on the prequestionnaire reported that they had better movement following their assigned foam
rolling intervention. Eight subjects on the post-questionnaire compared to the three on the
pre-questionnaire also reported that they had less tightness and felt looser following their
assigned foam rolling intervention.
A similar response for the post- compared to the pre-questionnaire was observed,
and eighteen subjects reported feeling both less tight and having better movement after
foam rolling. Three subjects reported that they felt more relaxed, five responses indicated
“N/A” or “no” and one subject stated that they “…needed a harder surface to roll on.” It
is possible that the five responses of “N/A” are indicative of subjects allocated to the
control group. Thirty-six subjects responded that they would continue foam rolling on
their own; one responded that they would not, and three were unsure.
The follow-up questionnaire allowed the subjects time to reflect on their foam
rolling experience and respond to different questions asking them of their views on foam
rolling and describing their experience from the day before. Twenty-three of the 40
subjects completed the follow up questionnaire. Most of the subjects confirmed in their
response that they had better movement, less tightness, or both immediately after foam
rolling. Eight of the subjects responded that they felt that they had better movement and
less tightness 24-hours following their foam rolling experience. Seven subjects felt the
same as they did before foam rolling, three stated that they felt less tight or looser, two
responded that it was difficult to tell because of the workouts they completed the day
before, and one “N/A”.

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44

When asked their views on foam rolling after completing their assigned
intervention the day before, 18 of the 23 subjects elaborated on their improvements like
relaxing the muscle to reduce tightness and having better movement, but one subject was
unsure of the effectiveness of foam rolling and wrote that “i(t) might be helpful if my legs
are sore.” Two of the subjects thought that focusing on TP release was more important
than foam rolling. The next question asking subjects to elaborate on their views that
changed or were different related to foam rolling resulted in a variety of responses. Most
of the subjects explained how foam rolling a different way (other than what they were
used to) was beneficial, like rolling for longer, holding on a spot, and continuous rolling.
Responses indicated that they felt the rolling relieved stress and increased their ROM.
When asked again if they would continue to foam roll on their own, 19 subjects
responded with “yes” for reasons like: enhance recovery, improve flexibility, targeting
TPs, pain relief and reducing tension, and improving their performance during workouts.
One subject stated that they would only foam roll if it’s convenient or if they suffer an
injury, another subject stated that they would TP with harder objects but not foam roll,
one subject was unsure, and one responded “N/A”.
The open-ended questions enabled the subjects to respond with more descriptive
and developed responses to the questions. The elaborate responses were grouped using a
coding method to form categories: “release tension and relax the muscle,” “tightness and
tension as a guide,” “rolling and holding or combining,” “after foam rolling,” and
“continuing to foam roll.” From the five categories and their representative subject quotes
emerged, the five main themes of this qualitative research. Qualitative research related to
foam rolling is limited, and no recent research was found to compare responses from the

EFFECTS OF DURATION AND APPLICATION

45

questionnaires; however, research by Rey, Padròn-Cabo, Costa and Barcala-Furelos
(2019) incorporated perceptual measures including a Total Quality Recovery (TQR) scale
to evaluate the general perception of recovery and a visual analog scale (VAS) of muscle
pain to rate muscle soreness levels for professional soccer players. The scales were
administered before a training session intervention and 24 hours after. The subjects foam
rolled a total of 20 min focusing on the quadriceps, hamstrings, adductors, gluteals, and
gastrocnemius muscles, completing two 45 s bouts. Flexibility was measured using a box
sit-and-reach test. No significant changes in flexibility were reported; however, foam
rolling had a large effect on recovery evident of the TQR and VAS results. While those
scores do not provide elaborate and descriptive insight into specifically how each subject
felt before and after foam rolling, it does relate to the responses gathered in this research
suggesting that subjects can feel the benefits of foam rolling and help them feel more
recovered. This research also supports that it is possible for effects to be felt up to 24hours following application.

EFFECTS OF DURATION AND APPLICATION

46

Conclusion
From the present findings, there is evidence to support that foam rolling
continuously, rolling through the TP, or holding on a TP can functionally improve
hamstring flexibility; however, the differences did not differ significantly between any of
the five conditions. There were no significant differences between the groups that
continuously foam rolled through the TP or held on a TP. All four of the foam rolling
conditions had increases on the box sit-and-reach scores compared to the control group
completing a sham treatment, with the 60 s holding on the TP group displaying the
greatest improvement in overall mean score, but neither the time of application nor the
location of application of the foam roller appeared to have any statistically significant
effect on hamstring flexibility.
Five main themes emerged from the qualitative data: (1) ‘Feels beneficial’; (2)
‘Duration matters’; (3) ‘Hit the TP’; (4) ‘Immediate effects’; and (5) ‘Incorporate.’
Subjects felt like foam rolling helped them have better movement, less tightness, or both,
and they felt more relaxed after foam rolling. Tightness and tension were a guide for the
subjects, and many felt that foam rolling, either continuous rolling or holding on a TP for
at least 60 s or longer, helped them feel better. Subjects noticed TPs in their hamstrings
and thought foam rolling those areas were important for reducing tension and relaxing the
muscle with the effects occurring immediately after foam rolling. Effects lasting up to 24hours were reported on the follow-up questionnaire.
Overall, foam rolling treatments for all four groups showed a trend towards
increasing hamstring flexibility, with the greatest increase observed in the 60 s holding on
the TP group, but the experimental groups did not differ significantly from the control

EFFECTS OF DURATION AND APPLICATION

47

group. The current literature supports that SMR using a foam roller can be effective at
increasing ROM, and longer durations of foam rolling can improve results up to a point,
with the possibility of diminishing results depending on the application time. Both rolling
and holding on the TP can be effective for increasing flexibility, but more research
should be completed. Subjects reported that they had better movement and less tightness
following treatment.
The practical applications of this research are beneficial for physical therapists,
athletic trainers, health and fitness professionals, fitness enthusiasts, and athletes. Foam
rolling is beneficial for functionally improving flexibility, and applying the foam roller
for at least 60 s or longer can reduce muscle tightness. Foam rolling can be applied
continuously or holding on the TP to improve flexibility and should be applied for up to
60 s to maximize results. There are additional benefits associated with foam rolling as it
can enhance ease of movement, reduce muscular tension, and provide a sense of
relaxation, which is important for movement, mobility, agility, and speed. Foam rolling
reduces fatigue and soreness (Healey, Hatfield, Blanpied, Dorfman & Riebe, 2014;
Pearcey et al. 2015; Škarabot et al., 2015), and reduces premotor time (Hironobu et al.,
2013).

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48

Future Directions for Research
The results of this study differed from the results of other studies looking at foam
rolling. The foam rolling treatments for all four groups showed a trend towards increasing
hamstring flexibility, with the greatest increase observed in the 60 s holding on the TP
group, but the experimental groups did not differ significantly from the control group.
The subjects of this research were members of the Gaithersburg Fitness Center and
between the ages of 18 and 50. There were 40 subjects, enough for statistical power, but
future research should incorporate a different population, a larger sample size, and
explore other age ranges. Future research should include individuals with no previous
foam rolling experience to reduce confirmation bias.
The present study utilized a commercial foam roller, but previous research that
incorporated the use of other types of rollers like a handheld roller massager had
significant increases in ROM when compared to a control group. Future studies should
examine the effects of other types of rollers that are hard and dense like polyvinyl
chloride pipe (PVC), deep tissue, ribbed, or grid foam rollers that can access deeper
layers of muscle fascia or vibrating foam rollers for targeting the TP. Perussion
massagers like vibrating massage guns have been increasing in popularity and should be
examinined in the future. The present study design incorporated a single bout of foam
rolling, but it is possible that additional sets of foam rolling can elicit a greater response
and lead to better increases in ROM. Future research should incorporate multiple sets of
foam rolling.
The foam rolling application in the present study was applied only once, and a
short follow up period was implemented. Further research should investigate the

EFFECTS OF DURATION AND APPLICATION

49

cumulative effect of foam rolling and long term improvements in flexibility. This
research focused on the hamstring muscle group; future research should examine the
effects of foam rolling on other muscle groups, areas of musculoskeletal pain or
functionally tight muscles.
The present study examined the effects of a longer duration of application with an
application time of 180 s, and slight increases in flexibility were observed compared to
the control. Since the 60 s holding on the TP group had better increases in flexibility
compared to the 180 s groups, it is possible that benefits associated with foam rolling
may begin to diminish after a certain period of time. Previous research that had subjects
roll for 90 s reported a reduction in pain pressure threshold. Future research should
explore the effects of 60 up to 90 s of application to establish the optimal amount of time
to foam roll and should also focus on targeting the TP.
Future research should incorporate a likert scale to boost the quantitative
component for examining the effectiveness of SMR. Qualitative research related to foam
rolling is limited, and future research should incorporate qualitative methods to explore
additional aspects of foam rolling. To increase the quality and quantity of qualitative
literature, researchers can incorporate one-on-one interviews, a case study, focus groups,
or document observations of foam rolling events.

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50

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EFFECTS OF DURATION AND APPLICATION
Appendix A
Review of the Literature

57

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Numerous techniques have been created and identified for the treatment of
myofascial pain and to increase flexibility and ROM. A relatively new technique of soft
tissue mobilization that has become popular in the last decade SMR (Kalichman & Ben
David, 2016; Macdonald et al., 2013). Tools for SMR are portable and techniques can be
applied for self-therapy at home or the workplace and can be added to any fitness or
rehabilitation program (Kalichman & Ben David, 2016).
Currently, there is a lack of high quality, empirical research related to the
utilization and effectiveness of SMR techniques, specifically related to application and
duration of SMR, resulting in critics and skeptics that question the usefulness of the
techniques. There is also a gap in the current literature and research base specifically
related to the duration of SMR application and its effects on flexibility (Cheatham et al.,
2015). While there are general guidelines and recommendations for the application of
SMR techniques including duration, due to the lack of substantiating research, current
recommendations may not lead to the most optimal results because of issues concerning
validity and reliability. Further research should be completed to test the current
recommendations and to explore longer durations of SMR. The purpose of this review of
the literature is to evaluate the existing research on the effectiveness of SMR related to
measures of function and various application variables including duration, area of
application location, and holding on the TP versus rolling through the TP. This review
will define SMR, the tools, mechanisms, and applications, rationale for SMR, the release
of TPs, influence on the ANS, and the effects of tissue pressure. Applications of SMR,
including frequency, repetition, and duration, and the application to sport and physical
activity with clinical relevance will also be reviewed.

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Self-Myofascial Release
Robert C. Ward first introduced MFR in the early 1980s, a passive manual
therapy technique, which applies the principles of biomechanical loading of the soft
tissue and neural reflex to stimulate the mechanoreceptors in the fascia (Remvig, Ellis &
Patijn, 2008). In general, MFR is a hands-on technique were pressure is applied by
another person or licensed professional in a gentle or firm manner to induce the stretch
response on a restricted area, or areas, of the muscle fascia which is a band or sheet of
connective tissue that separates muscles from the internal organs. Furthermore, MFR can
include deep tissue massage focusing on aligning deeper layers of muscles and
connective tissue, classic massage using a slower movement, and neuromuscular therapy
and myotherapy using static pressure called ischemic compression (Kalichman & Ben
David, 2016). Self-myofascial release is performed under the same principles as MFR, as
a treatment to release tension in the fascia due to trauma, posture, or inflammation where
the individual treats themselves rather than having the treatment provided by another
person (Kalichman & Ben David, 2016).
The prevalence of myofascial pain has been reported by approximately 21% of
patients in a general orthopedic clinic, 30% of patients seen in general medical clinic and
85-93% of patients in specialty pain management centers placing the prevalence of
myofascial pain in the same realm of other orthopedic conditions (Kalichman & Ben
David, 2016). For example, in the United States, low-back pain affects nearly 80% of all
adults, 80,000 to 100,000 anterior cruciate ligament (ACL) knee injuries occur each year,
shoulder pain has been reported in up to 21% of the general population, and ankle sprains
have been the most commonly reported sports-related injury (Clark et al., 2014, p. 3).

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Continued pain originating from myofascial TPs and fascial restrictions could also lead to
a common chronic condition called myofascial pain syndrome (Kalichman & Ben David,
2016). Researchers and practitioners have developed a systematic process to identify
neuromusculoskeletal dysfunctions and strategies including soft tissue therapy, such as
SMR can be implemented to reduce the onset of pain, soreness, discomfort, and injury by
reducing neuromusculoskeletal immobility and pain (Kumar et al., 2017; Macdonald et
al., 2013).
Self-myofascial release techniques are not just used to treat injury and pain, they
have become popular in the health and wellness environment including fitness centers
and gyms to improve flexibility, function, performance, reduce soreness, and address
overactive musculature in clients and athletes alike (Cheatham et al., 2015; Grieve et al.,
2015). Self-myofascial release first became popular with world-class athletes who used
SMR to aid in athletic performance by increasing ROM, flexibility, and allowing for
quicker recovery after events (Ahrens, 2016). Self-myofascial release can also improve
and enhance arterial function and vascular endothelial function producing favorable
results while replacing expensive and invasive hands-on sessions or painful deep tissue
massage (Beardsley & Škarabot, 2015; Cheatham et al., 2015; Hironobu et al., 2013;
Kalichman & Ben David, 2016). Using a foam roller has been and continues to be an
appealing option to address pain, soreness and discomfort because it is a tool that is
inexpensive, widely available, portable, and convenient to use (Kalichman & Ben David,
2016). Additionally, other techniques to treat myofascial pain can be more invasive and
expensive, or less convenient, like surgical intervention, bracing, medication, injection

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therapy, MTrP therapy, dry needling, or electromedicine like ultrasound, laser therapy, or
transcutaneous electrical nerve stimulation (Kalichman & Ben David, 2016).
Self-myofascial release is suggested for use for two primary reasons: (1) to
alleviate pain associated with TPs or adhesions in the soft tissue and (2) to influence the
ANS. This treatment is recognized as the first phase of the National Academy of Sports
Medicine (NASM) Corrective Exercise Continuum (Clark et al., 2014, p. 4; Kalichman &
Ben David, 2016). Self-myofascial release can be completed prior to exercising during
warm up to prepare soft tissues for movement, following exercise to allow the body to
cool down after physical activity or independently administered for self-care (Ahrens,
2016). Self-myofascial release has also been shown to be more effective than no
treatment application for musculoskeletal and painful conditions like acute low back pain,
fibromyalgia, lateral epicondylitis, plantar fasciitis, headache, fatigue, pelvic rotation, and
hamstring tightness (Ajimsha, Al-Mudahka & Al-Madzhar, 2015).
Tools for Self-Myofascial Release
Self-myofascial release can be completed using a wide variety of tools that may
differ in size, shape, and construction, but the foam roller and handheld roller massagers
are the most common tools that are currently used (Beardsley & Škarabot, 2015;
Kalichman & Ben David, 2016). Foam rollers are inexpensive, costing around $20, are
light weight making them easily portable because they can be carried to and from various
locations and are typically available at local sports and online stores across the nation and
even in fitness centers or rehabilitation clinics (Kalichman & Ben David, 2016).
Commercial foam rollers are often available in two sizes, a 6 in. x 36 in., which is

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considered standard, and a half size that is 6 in. x 18 in., both made of either bio-foam or
multi-rigid layers (Cheatham et al., 2015; Kalichman & Ben David 2016).
An individual using a foam roller can complete exercises at home, at the office or
while traveling because the exercises require minimal professional supervision
(Kalichman & Ben David, 2016). There are a variety of foam rollers on the market which
may be soft or hard and other tools like handheld massagers might be more firm and
dense. Other tools that can be used for SMR include balls, handheld or customized
instruments and vibration devices that range from $2 to $65 (Ahrens, 2016; Cheatham et
al., 2015; Kalichman & Ben David 2016). Balls like medicine balls, tennis balls,
baseballs, lacrosse balls or golf balls are relatively inexpensive, easy to apply, and can be
used as a progression from the roller massager (Clark et al., 2014, p. 211). Tennis, golf,
and lacrosse balls may be more versatile than the foam roller and can concentrate on
focal spots where tension and soreness is felt with varying levels of density to affect the
applied and perceived pressure, but it may be more difficult to control the depth of
penetration into the soft tissue compared to other SMR tools (Clark et al., 2014, p. 211;
Kalichman & Ben David 2016). Handheld or customized instruments that can be made of
plastic, wood, PVC pipe, ceramic, metal, or steel, may be useful for addressing hard to
reach areas where the foam roller is not as effective such as the neck region (Clark et al.,
2014, p. 211; Kalichman & Ben David 2016). Instruments can be very precise depending
on their shape and size and may be able to penetrate deeper into the soft tissue and some
rollers may be more travel-friendly because of size or weight, or better suited for
different muscles of the body like handheld devices for the upper shoulder and neck
muscles (Cheatham et al., 2015).

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Tools that are hard and firm may have more of an effect on the soft tissue and
fascia because they can access deeper layers during use and when high pressure is applied
(Cheatham et al. 2015; Kalichman & Ben David 2016). A recent review by Cheatham et
al. (2015) exploring SMR with a foam roll or roller massager reported that higher density
tools have a stronger effect than softer density tools. Five of the reported studies used a
foam roller to measure its effects on ROM, three of those studies reported using a 6 in. x
36 in. polyethylene foam roller and two studies reported using a 6 in. x 36 in. high
density foam roller constructed out of a hollow PVC pipe and outer ethylene acetate
foam. Five studies used some type of a roller massager, two studies used a mechanical
device involving a roller bar that applied a standard force and cadence, two studies used a
commercial roller that was self-administered, and one study reported using a tennis ball
as a self-administered roller massager. Foam rolling 30 s to one min (2 to 5 sessions) and
the roller massage applied for five s to two min (2 to 5 sessions) offered acute benefits for
increasing sit-and-reach scores and joint ROM at the hip, knee and ankle without
affecting muscle performance (Bushell, Dawson & Webster, 2015; Macdonald et al.,
2015; Mohr et al., 2014; Peacock et al., 2015; Škarabot et al., 2015). A study included in
the review by Curran, Fiore and Crisco (2008) found that the higher density foam rollers
resulted in higher pressure to the target tissues during rolling than the typical commercial
foam rollers suggesting a potential benefit. The purpose of the study was to determine if
the pressure and contact area on the lateral thigh differed between a Multilevel Rigid
roller (MRR) and a Bio-Foam roller (BFR) for subjects performing SMR. Ten healthy
men and women performed SMR on the lateral thigh using both myofascial rollers and
thin-film pressure sensor recorded pressure and contact area during each SMR trial. The

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sensor pressure exerted on the soft tissue of the lateral thigh by the MRR was
significantly greater than the conventional BFR and the contact area of the MRR was
significantly less than the BFR. The results indicated that there might be a potential
benefit of increased flexibility when completing SMR with the MRR due to the
significantly higher pressure and isolated contact area associated with using the tool for
addressing adhesions deep within the soft tissue.
The varied methods, rollers used and outcome measures used in the review by
Cheatham et al. (2015) makes it difficult for a direct comparison and consensus of the
optimal tool for SMR; however, it may be beneficial for individuals to use a progression
that begins with a soft material, then progressing to a more rigid and firm tool to access
deeper layers of muscle and tissue for optimal results. Additionally, during the
application of SMR techniques, users can adjust the level of pressure that is applied while
completing the exercises as the pressure that is exerted by the tool can be manipulated
and adjusted by the individual’s technique, force, angle of application, and body mass.
A recent review by DeBruyne, Dewhurst, Fischer, Wojtanowski & Durall (2017)
was conducted to determine if a foam roller or a roller massager was more effective for
increasing hamstring flexibility in physically active adults. Four randomized controlled
trials (RTCs) that were high level of evidence were included in the research, two of the
studies focused on the research of foam rolling while the other two studies focused on
roller massagers. All four of the studies resulted in improvements to muscle–tendon
flexibility in physically active adults, but utilization of a roller massager resulted in
greater improvement in flexibility when compared to a foam roller. Studies conducted by
Macdonald et al. (2014) and Mohr et al. (2014) both utilized a foam roller and measured

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hip-joint ROM, but neither reported statistically significant increases in hamstring
flexibility, while two studies using a roller massager conducted by Jay et al. (2014) and
by Sullivan et al. (2013), each testing sit-and-reach scores, reported significant increases
in hamstring flexibility after treatment. Based on the results, clients and athletes may
observe greater improvements in flexibility with the use a roller massager.
The duration of application of SMR may be positively correlated with increased
hamstring flexibility since the strongest statistical result also had the longest treatment
duration equaling 10 min with the use of a roller massager (Jay et al., 2014). This was
compared to 10 to 20 s of rolling in the other roller-massager study, and also compared to
the two foam rolling studies with one that completed two repetitions of 60 s using a
custom-made foam roller consisting of PVC (Macdonald et al., 2014), and the other
completing three 60 s rolling sessions using a 15-cm-diameter Cando EVA foam roller
(Mohr et al., 2014). Both foam rollers and roller massagers use compression, but the
difference in application and implementation may have caused the disparities stemming
from the amount of tissue pressure and compression, and the duration used for each
protocol. The two studies using foam rollers involved each subject applying their own
body weight to the foam rollers, while the treatment was either performed by a trained
investigator or a mechanized roller apparatus. In the two roller massager studies, it is
likely that more force was used and the force was applied in a more uniform manner,
which may have influenced the results. The research by DeBruyne et al. (2017) was
limited research because only four studies were analyzed and each of the studies had
small sample sizes.

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Markovic (2015) compared the effects of foam rolling to a new form of
instrumented soft tissue mobilization, Fascial Abrasion Technique (FAT), on hip and
knee ROM in soccer players using a tool that griped the surface tissue to allow for deeper
and more effective tissue mobility using less direct pressure. Twenty male subjects were
randomly assigned to one of two groups: foam rolling (FR) or FAT. Passive knee flexion
was measured and straight leg tests where the examiner lifted the subjects’ dominant leg
with the knee fully extended to the end ROM until resistance was felt and additional
flexion of the hip caused knee flexion, posterior pelvic tilt, or lumbar flexion were
completed before, immediately after, and 24 hours post intervention for both groups.
Passive knee flexion was measured by the examiner while the subject was supine with
both knees extended, and the examiner held the subject’s ankle in one hand and the
anterior thigh with the other, then moved the thigh to 90 degrees of hip flexion and
moved the knee into maximum flexion until resistance was felt and additional hip flexion
occurred. The subject was also supine for the straight leg test with both knees extended.
The intervention included two min of foam rolling the quadriceps and hamstrings for the
FR group and two min of FAT to the quadriceps and hamstrings muscles for the FAT
group. Both groups had significant increases in the lower extremity ROM, but ROM
increased two-fold when using the FAT tool for the same duration. Markovic (2015)
suggested that while foam rolling was effective, other tools may be more effective for
increasing ROM like the FAT. A small sample size was used for this research, which
may have affected the results, so a larger sample pool should be utilized. There are other
potential challenges with FAT like the need of another person to apply the technique,
especially if focusing on the posterior chain musculature. Also, the person may need to be

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a health care profession trained in applying the technique. Additionally, the efficacy of
FAT may be dependent upon the expertise of the professional that diagnoses and treats
the affected musculature because a trained professional understands optimal treatment in
terms of the duration, the amount of pressure and line of application.
Vibration instruments have emerged as popular tools for SMR. A research study
by Sands, McNeal, Stone, Haff & Kinser (2008) investigating the use of a vibration
device, a Power-Plate Pro 5 Airdaptive (Power-Plate North America, Northbrook, IL),
and stretching on acute ROM and pain pressure threshold recruited ten young male
gymnasts to participate and assessed their split ROM. One side of the split was randomly
assigned as the experimental condition and the other side of the split was assigned to the
control. Both groups completed splits while on the vibration device, the device was
turned on for experimental group and turned off for the control group. Pain pressure
threshold was assessed using an algometer (Force One, FDIX 50, Wagner Instruments,
Greenwich, CT). All split positions were held for 45 s. Significant differences from preto post-intervention were observed for the vibration group, but not for the control group.
Pain pressure threshold differences for each group were not statistically different from
pre- to post- intervention. The results of the study indicate that incorporating vibration
can improve split ROM when compared to stretching alone.
In a more recent study using a vibration device by Rodrigues et al. (2017),
exploring the acute effects of a single bout of stretching and mechanical vibration on the
hamstring, twelve healthy men completed four conditions: (1) control (CONT) of no
intervention; (2) stretching (ST) completing four sets of 30 s of static stretching of the
hamstrings muscle; (3) vibration (VIB) completing four sets of 30 s bouts of vibration

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applied to the hamstring muscle; and (4) stretching with vibration (ST+VIB) including a
combination of the stretching and vibration protocols. A Flexmachine was utilized prior
to, and following the experimental conditions where subjects pressed the start button, and
the mechanical arm went up, subjects pressed the button to register first sensation of
stretching then the arm continued to maximal ROM, and the subjects pressed the button
for the arm to go back down. The mechanical arm ascended and descended at a rate of 5°
per s. Maximal ROM (ROMm), maximal torque (Torquem), first sensation of stretching
in the ROM (ROMf), and the first sensation of stretching in the torque (Torquef) were
evaluated. The right lower limb of each subject received the mechanical vibration with a
frequency of 30 Hz and amplitude of 3 mm, and the vibration was directly applied to the
muscle belly of the hamstring using a chair constructed specifically for the study. The
results showed no significant difference between the conditions for ROMm, Torquem,
ROMf and Torquef. A digital goniometer was used to measure ROM (Bosch, DWM 40
L). The results indicated that the vibration did not enhance flexibility because no
statistical differences were found between baseline and following the intervention.
Overall, more research should be completed before drawing firm conclusions on the
effectiveness of vibration devices. Both research articles focusing on vibration used
different tools, methods, protocols, participants, areas of application, and duration.
Further research could focus on establishing and utilizing the same tools, methods,
protocols, and duration so that the variables and parameters of the research are more
constant. Further research could also examine the use of handheld vibration devices and
target the TPs found in the muscle belly.

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Current research shows that SMR can lead to an increase in flexibility and ROM.
Using a commercial foam roller can be effective, but some research has suggested that
other tools like the roller massager, FAT, and MRR may be more effective; however, the
research that has been conducted used different instrumentation and procedures, as well
as subject type, which affected the results. There currently is not a standard for
comparison because each protocol has differences based on the warm-up, the duration of
treatment, the time elapsed between treatment and assessment, and the method of
measuring flexibility or ROM, and the type of tool being tested. A standardized protocol
for foam-roller and roller-massager treatment, or any other type of treatment tool, should
be established to conduct a better basis for comparison, and the warm-up, duration of
treatment, treatment and assessment time, and method of measurement of flexibility or
ROM should all be identical between comparative studies.
Application of Self-Myofascial Release
Self-myofascial release is a type of MFR that can be completed with a foam roller
or roller massager, which is performed by the individual themselves rather than by a
clinician. A person can use their own body weight to roll on a cylindrical piece of foam,
which allows them to massage muscle restrictions, reduce adhesions, and improve softtissue extensibility by applying pressure to the muscle and surrounding fascia (Beardsley
& Škarabot, 2015; Cheatham et al., 2015; Kelly & Beardsley, 2016; Macdonald et al.,
2013). Foam rollers may be best suited to address large muscle groups, but can also be
used to address certain muscles that are overactive, tight, stiff, and/or sore (Kalichman &
Ben David 2016). As a noninvasive technique, current recommendations suggest that
SMR techniques should address TPs in the muscle by starting at the proximal portion of

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the muscle and working towards the distal portion of the muscle or vice versa (Kalichman
& Ben David, 2016; Macdonald et al., 2013). The foam roller or roller massager can be
positioned over the area of condensed pain for release (Kalichman & Ben David, 2016;
Macdonald et al., 2013). Patients have reported that it is easier to move through their
ROM following SMR treatment (Hironobu et al., 2013). Additionally, anyone completing
SMR should also focus on maintaining proper postural alignment, sustaining the
drawing-in maneuver (pulling the navel in toward the spine), slowly rolling over the
target area, relaxing and not tightening up, and pausing or holding on the area of
condensed pain or knot until a sense of release is felt (Clark et al., 2014, p.214).
Location of application. Where SMR is applied may affect the results of
flexibility, for example when SMR is applied to the rear of the body there are greater
changes in sit-and-reach flexibility because it is targeting the hamstrings directly, a major
muscle utilized during the sit-and-reach (Beardsley & Škarabot, 2015; Grieve et al.,
2015; Sullivan et al., 2013).
Kelly & Beardsley (2016) determined a cross-over effect, which indicates that
where ROM was restricted on one side of the body whether due to injury, post-operation
immobilization, or neurological conditions that the SMR treatment of the healthy limb
benefited the injured limb through the cross-over effect. The purpose of the research was
to explore the potential cross-over effect of SMR by investigating a FR treatment on the
ipsilateral leg of three bouts of 30 s on changes of the ipsilateral and contralateral ankle
DF ROM. Kelly & Beardsley (2016) completed a within- and between-subject design
with 26 subjects that were assigned to either the FR or control group. Ankle DF ROM
was recorded at baseline and again post-, 5, 10, 15, and 20 min following the

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intervention. There were no significant between-group effects, but a significant withingroup effect was observed in the FR group between baseline and all post-intervention
times. A significant within-group effect was also observed in the ipsilateral leg at
baseline and at all post-intervention times, and in the contralateral leg until 10 min postintervention, indicating a cross-over effect. The authors concluded that FR improved
ankle DF ROM for up to 20 min in the ipsilateral leg and up until 10 min in the
contralateral leg, indicating a cross-over effect.
Duration, Frequency and Repetitions
Current NASM recommendations for SMR include daily application completing
one set of the roll through, and holding on the tender spots of the muscle for 30 (maximal
pain tolerance) to 90 (lower pain tolerance) s depending on the intensity, or pressure of
application (Clark et al., 2014, p. 215). General research guidelines for most SMR
durations use a hold for 30 to 60 s (Kalichman & Ben David 2016) with varying
frequency, repetition and duration reported in the current literature using a variety of
measurements and protocols.
A systematic review by Cheatham et al. (2015) critically appraised the current
evidence on SMR as it is related to the following three questions: (1) Does SMR with a
foam roll or roller massager improve joint ROM without effecting muscle performance,
(2) after an intense bout of exercise, does SMR with a foam roller or roller massager
enhance post exercise muscle recovery and reduce delayed onset muscle soreness
(DOMS), and (3) does SMR release with a foam roller or roller massager prior to activity
affect muscle performance? Studies that were included met the following criteria: (1)
peer-reviewed and written in English, (2) measured the effects of SMR using a foam

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roller or roller massager on joint ROM, acute muscle soreness, DOMS, and muscle
performance, (3) compared an intervention program using a foam roller or roller
massager to a control group, (4) compared two intervention groups using a foam roller or
roller massager. A total of 14 studies met the inclusion criteria and were further
evaluated by the researchers. When taking a closer look at the duration of rolling for the
studies utilizing a foam roller and evaluating its effect on joint ROM, Bushell et al.
(2015) had subjects foam roll for three, one-min bouts, with 30 s rest and no reported
cadence guidelines, and Mohr et al. (2014) had a similar procedure with subjects foam
rolling for three, one-min bouts with a one s cadence and no reported rest period.
Additionally, Macdonald et al. (2013) had subjects foam roll for two one-min bouts with
no rest period or cadence reported, Peacock et al. (2015) had subjects foam roll for one
30 s bout with no rest period or cadence reported, and Pearcy et al. (2015) had subjects
foam roll for 45 s with 15 s rest for each muscle group for a 20-min session with a
cadence of 50 bpm. The major finding of the research suggested implementation of SMR
techniques ranging from 30 s to one min for two to five sets using a foam roller, or five s
to two min of two to five sessions using a roller massager. Self-myofascial release
techniques were beneficial for enhancing joint ROM and flexibility as a pre-exercise
warmup or cool down, and foam rolling or using a roller massager reduced the amount of
perceived pain after high-intensity exercise. Additionally, short bouts of foam rolling, one
session for 30 s, or using a roller massager for one 2-min session, did not enhance or
negatively affect muscular performance.
Kalichman & Ben David (2016) reviewed the current methods of SMR, the
mechanisms, and the efficacy of treating myofascial pain, improving muscle flexibility

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and strength. The search included articles from PubMed, Google Scholar and PEDro
databases without search limitations. The inclusion criteria of the review included: any
type of research dealing with methods of SMR, and applications with full references
available. Forty-two publications were included in the review. In general, most of the
rolling protocols included 30 to 60 s of rolling on the specified muscle, based on the
findings, there was a consensus for providing sustained pressure for at least 30 s using a
foam roller over the painful area and holding over the tender and painful areas.
Macdonald et al. (2013) examined the effect of SMR via foam roller application
on knee extensor force and activation and knee joint ROM. Subjects completed a
duration of two, one-min bouts of SMR during the research trial. Eleven healthy males
participated in the within-subject design and the quadriceps maximum voluntary
contraction force, evoked force and activation, and knee joint ROM were measured
before, two min, and 10 min after two conditions: (1) two, one min trials of SMR and (2)
no SMR. There were no significant differences between conditions for any of the
measurements, but after the foam rolling protocol, significant increase in ROM at two
and 10 min following the application of SMR was reported. The study showed that an
acute bout of SMR, two one-min bouts, applied to the quadriceps could enhance knee
joint ROM without deficits in muscular performance.
Pearcey et al. (2015) examined the effects of foam rolling as a recovery tool after
an intense bout of exercise by assessing the pressure-pain threshold, sprint time, changeof-direction speed, power, and dynamic strength-endurance. Eight healthy and physically
active males participated and performed two conditions separated by four weeks in the
repeated-measures design. The participants completed 10 sets of 10 repetitions of squats

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at 60 percent of the one-repetition max (1RM), followed by no foam rolling, or 20 min of
foam rolling immediately, 24, and 40 hours post-exercise. The main measurements
included a 30-meter (m) sprint to measure sprint speed, broad-jump to measure power, Ttest to measure change-of-direction speed, and dynamic strength-endurance. The foam
rolling protocol had subjects roll for 45 s followed by a 15 s rest for a total time of 20 min
using a custom-made roller constructed from hollow PVC pipe on the quadriceps, hip
adductors, hamstrings, IT band, and gluteals. It was determined that completing bouts of
20 min of foam rolling can significantly improve muscle tenderness and lead to improved
sprint times, power, and dynamic performance.
Sullivan et al. (2013) completed a pre/post-test design that measured the effects of
a roller massager application to the hamstrings on sit-and-reach ROM and muscle length
performance and implemented a protocol including either five or 10 s of foam rolling.
Seventeen total participants were included in four trials of roller massager rolling at a
constant pressure (13 kgs) and rate (120 bpm) for one set of five s, one set of 10 s, two
sets of five s, and two sets of 10 s. Additionally, nine participants were included in a
control group that completed no foam rolling. The sit-and-reach, maximal voluntary
contraction force and muscle activation of the hamstrings were measured before and after
each session of rolling. The use of a roller massager increased ROM by 4.3% and 10 s of
rolling increased ROM more than five s of rolling. There was a significant main effect for
time with an increase in ROM from pre- to post-rolling of 4.3%, and there was also a
trend toward a group main effect with 10 s of roller-massager rolling exceeding 5 s of
rolling by 2.3%. There were no changes in maximal voluntary contraction force and
muscle activation of the hamstrings. Results indicated that while rolling with a massage

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roller could significantly increase ROM, 10 s of SMR increased ROM more, which
suggested that a longer duration of SMR should be completed to maximize ROM.
Twenty-five recreationally active females participated in the study to analyze the
effect of different foam rolling volumes on fatigue of the knee extensors (Rios Monteiro
& Corrêa Neto, 2016). The researchers completed a randomized cross-over, withinsubject design including four groups: (1) foam rolling for 60 s, (2) foam rolling for 90 s,
(3) foam rolling for 120 s, and (4) the control group that did not complete foam rolling.
The testing procedure included three sets of knee extensions of 10 repetitions at a predetermined maximum load with foam rolling completed during the inter-set rest period.
The results showed that fatigue index was statistically significantly greater (greater
fatigue resistance) for the control group compared to the groups completing 90 or 120 s
of foam rolling, and higher fatigue resistance was observed for the group completing 60 s
of foam rolling compared to 120 s, but there were no significant differences between
other conditions. Results indicated that foam rolling should not be applied for volumes
greater than 90 s due to detrimental effects on continual force production of the muscle
and that foam rolling should not be applied to the agonist muscle group between sets of
knee extensions.
Bradbury-Squires et al. (2015) completed a randomized controlled clinical trial to
determine the effects of applying a roller massager for 20 and 60 s on knee-joint ROM
and dynamic muscular performance. The same participants performed three conditions
using a roller massager to measure knee-joint ROM and neuromuscular efficiency during
a lunge including: (1) five repetitions of SMR for 20 s, (2) five repetitions of SMR for 60
s, and (3) a control group where patients sat quietly. Ten recreationally active men

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participated in the research study and participants performed the experimental conditions
on the quadriceps muscles separated by 24 to 48 hours. The results indicated that kneejoint ROM was 10% and 16% greater in the 20 and 60 s roller massager groups
respectively when compared to the control, which indicated that using a roller massager
could increase ROM and that longer durations could lead to increased benefits.
Rios Monteiro et al. (2017a) examined how different doses of SMR affected the
outcome scores related to the overhead deep squat assessing bilateral symmetry,
functional mobility of the hips, knees, and ankles, mobility of the shoulders and thoracic
spine, and stability and motor control of the core musculature by having subjects perform
30, 60, 90, and 120 s of SMR using a foam roller. Twenty recreationally active females
completed tests on four occasions: session one and two consisted of baseline testing,
session three consisted of SMR applied to the lateral thigh, and session four consisted of
SMR applied to the lateral torso and plantar fascia. SMR was completed using the Grid
Foam Roller (Trigger Point Technologies, 5321 Industrial Oaks Blvd., Austin, Texas
78735, USA) and a tennis ball (Head Master, Belo Horizonte, Minas Gerais, Brazil). The
results showed that all the conditions improved performance, but higher volumes of SMR
at 90 s or more were statistically significant in improving the performance of the
overhead deep squat. Rios Monteiro et al. (2017a) concluded that SMR was effective for
improving the deep squat, but at least 90 s of SMR was required for a change in the deep
squat score from baseline.
While the varied testing procedures, application of SMR, and tools used to date in
the research make it difficult to determine the optimal duration and frequency of SMR.
The following research begins to build a consensus of the effects on ROM and

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performance. There is a need for more high quality randomized controlled trials because
the research designs are medium level evidence of within-subject and quasi-experimental
designs. Not only do differences in methods and protocols make it difficult to determine
optimal duration and frequency based on the reported results related to SMR, but the
studies also use small sample sizes, which limit external validity and affect the
interpretation of the results.
Scientific Rationale for Self-Myofascial Release
There is a consensus starting to build suggesting that SMR can enhance ROM and
that multiple tools including foam rollers, roller massagers and other handheld devices
can be effective. The following section will discuss the current ideas and literature that
describes how SMR effects the body.
Mechanisms of Self-Myofascial Release
The exact mechanism and the potential for many factors in combination, by which
SMR exerts its effects is unclear and research reports on SMR mechanisms are limited.
The following theoretical frameworks can be used to understand the mechanisms of
SMR, which includes many possible explanations (Kalichman & Ben David 2016; Kelly
& Beardsley, 2016).
Models of Fascial Dysfunction. There have been several suggested models to
describe the mechanisms that SMR may affect when applied to the fascia including
fascial adhesion model, fluid model, and fascial inflammation model.
Fascial adhesion model. The fascial adhesion model suggests that different layers
of fascia alter and they can stick together, so if fascia loses its pliability and becomes
restricted, the rest of the body or the surrounding areas become tense (Beardsley &

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Škarabot, 2015). The fascial alignment can become haphazard and multidirectional,
fibers can lose their elasticity causing them to flatten out and stick to one another rather
than gliding across one another and the fibers eventually become matted together
(Bremer, 2014). An example would include the hamstring area losing its pliability and
the range of knee flexion becoming affected leading to decreased ROM at the knee joint
(Hironobu et al., 2013). The model suggests that external pressure could lead to changes
at the cellular level allowing for tension to be released, which will also result in better
ROM (Beardsley & Škarabot, 2015).
Fluid model. The fluid model suggests that the water content of fascia affects its
pliability. The fascia can extrude water when pressure is applied and becomes
compressed (Beardsley & Škarabot, 2015). Fascia is made up of nearly 70% to 80%
water and dehydration of the fascia can cause chronic pain, fatigue, bloating, and muscle
aches as well as psychological disorders (Bremer, 2014). SMR techniques can increase
the pliability of fascial tissues due to changes in fluid resulting from receptors that have
autonomic functions that can cause changes to heart rate, blood pressure and influence
the hypothalamus that can lead to changes in global muscle tonus and local fluid
dynamics. The external pressure from SMR techniques stimulate the type III and type IV
receptors (the interstitial receptors), and the Ruffini endings (type II), affecting fluid
properties and ultimately leading to changes in the viscosity of the tissue. Changing the
viscosity of the muscle allows for better tissue dynamics allowing for better overall
muscle contraction and joint motion (Schleip, 2003; Beardsley & Škarabot, 2015).
Fascial inflammation model. Another model, based on fascial inflammation,
suggests that fascia can become tightened because of inflammation and that SMR can

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increase blood flow and nitric oxide production to reduce inflammation (Beardsley &
Škarabot, 2015). Any trauma to the tissue can create inflammation and in turn activate the
body’s pain receptors initiating muscle tension and causing a muscle spasm. Adhesions
begin to form where knots or TPs develop and lead to weak and inelastic soft tissue
(Schleip, 2003). This can initiate the cumulative injury cycle where soft tissue remodels
along the line of stress in a random order, not allowing the muscle fibers to move
properly, creating a roadblock for normal functional movement patters. This causes
muscle imbalance and increases the likelihood of injury. Self-myofascial release breaks
up the traumatized tissue and improve the tissue’s ability to lengthen (Clark et al., 2014,
p. 208).
Autonomic Nervous System Stimulation Models. There are two main
neurophysiological mechanisms involved during SMR when pressure is applied to the
muscle, one that involves the Golgi reflex arc and another that involves feedback of
various muscle and mechanoreceptors (Jami, 1992). The Golgi tendon organs (GTO),
which are found in all muscle tendons where the muscle attaches to the bone, respond to
pressure and tension, and continued static tension activates the GTO (Jami, 1992).
Through afferent sensory signal input to the central nervous system (CNS) via
stimulation of the Golgi reflex arc and other muscle receptors, the GTO produces
autogenic inhibition where the muscle is inhibited to contract by its own receptors
(Beardsley & Škarabot, 2015; Jami, 1992; Kelly & Beardsley, 2016). When a muscle is
stretched and pressure is exerted on any part of the muscle or tendon during MFR or

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SMR, the GTO is stimulated causing a reduction in motor unit firing and ultimately
resulting in decreased muscle tension (Beardsley & Škarabot, 2015).
Other mechanoreceptors that are found in the fascia are the Ruffini endings (type
II), Pacinian corpuscles and interstitial muscle receptors (type III and IV) that, when
stimulated by pressure, also reduce muscular tension (Schleip, 2003). Interstitial muscle
receptors (type III and IV) and Ruffini endings (type II) respond to slow, deep, sustained
pressure and stimulate the nervous system by decreasing gamma loop activity, in return,
relaxing the muscle (Schleip, 2003). That process decreases gamma loop activity within
the muscle where nerve cells and fibers of the small anterior horn can create a contraction
sending afferent impulses through the posterior root of the horn cells, inducing a reflex
contraction for the entire muscle (Hou et al., 2002).
Through the proposed mechanisms, SMR using a foam roller or roller massager
can provide benefits like those of MFR, stretching, or massage (Takanobu et al., 2014),
and can provide increased stretch tolerance of a muscle, which can lead to pain-relieving
effects as well as increased ROM by increasing muscle extensibility (Clark et al., 2014, p.
208; Kelly & Beardsley, 2016). Self-myofascial release can affect the ANS and the CNS
causing a decrease in muscle tightness by stimulating the receptors and inducing a
relaxation phase within the muscle.
Effects of Tissue Pressure
The most common theory used to explain increases in ROM when applying
myofascial techniques is the thixotropic property of the fascia (Schleip, 2003). According
to the theory, pressure to connective tissue can change its aggregate form from a dense
state to a more fluid state allowing it to become more pliable (Twomey and Taylor,

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1982). Connective tissue, known as fascia, surrounds the muscles and organs of the body,
which is formed of many layers of collagen fiber bundles running parallel with one
another, and with additional adjacent layers with different orientations that are separated
by thin layers of adipose tissue (Beardsley & Škarabot, 2015; Hironobu et al., 2013).
Connective tissue has three cell types: fibroblasts, adipocytes and mast cells that are
embedded in an extracellular matrix, and can be classified as either dense or loose
(Bremer, 2014). Fascia is loose connective tissue with three types of fibers: collagen,
elastin and reticular (Bremer, 2014). Fascia is highly adaptable, responds to strain and
dominant loading patterns and is very strong. It is used during force transmission of the
musculoskeletal system and can become inflamed due to mechanical trauma resulting in
pain stemming from affected mechanoreceptors and nerve endings (Beardsley &
Škarabot, 2015; Bremer, 2014).
Pressure to the muscle from SMR can induce tissue deformations in most tissues
and reduce the restrictive barriers or fibrous adhesions between the layers of tissue
(Beardsley & Škarabot, 2015; Kalichman & Ben David, 2016). Sustained slow tissue
pressure stimulates the mechanoreceptors such as Pacinian corpuscles and triggers the
ANS and CNS response leading to a decrease in the tonus of striated muscle fibers
causing the phenomenon contributing to the release that is felt during or following SMR.
Specifically, the mechanoreceptors cause the CNS to change the tonus of the skeletal
motor units resulting in a change in the tissue response by preventing the pain-spasm
cycle, releasing the muscle spasm and decreasing adhesions and restoring the connective
tissue to its normal homeostasis (Kalichman & Ben David, 2016). The autonomic
response creates changes in the global muscle tonus, local fluid dynamics, and

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intrafascial smooth muscle cells, creating a change in tissue pressure (Clark et al., 2014,
p. 209).
Research suggests that the pressure generated from a foam roller generates
friction, stretches the tissue and causes a warming of the fascia that leads to the breakup
of adhesions and restores soft-tissue extensibility (Kalichman & Ben David, 2016;
Macdonald et al., 2013). Murray et al. (2016) did not see similar results when testing
adolescent athletes and concluded that muscle temperature did not increase when foam
rolling was completed for a single 60 s bout that was applied to the quadriceps. Murray et
al. (2016) investigated if a single bout of foam rolling affects flexibility, skeletal muscle
contractility and reflected temperature using 12 male squash players. The participants
were evaluated on two occasions, one occasion to complete the treatment and the other to
complete the control, which was separated by 7 to 12 days. Flexibility of the hip flexors
and quadriceps, muscle contractility measured by a tensiomyography and temperature of
the quadriceps using a thermography was completed before 60 s of SMR on one leg and
at the completion, 5, 10, 15, and 30 min following, but no SMR was completed for the
control visit. Sixty s of SMR (30 full rolls, 15 in each direction) lead to slight significant
increases in the flexibility, but muscle contractility and temperature remained unchanged
indicating that muscle temperature was not increased by SMR.
The pressure that is applied by the foam roller can be painful because that
pressure may be applied to adhesions in the muscle, but that pain tends to dissipate
following SMR. A recent study investigated the change in pain levels by measuring the
pressure pain threshold (PPT) following the application of a foam roller for three min to
the right iliotibial band (ITB) (Vaughan & McLaughlin, 2014). The researchers marked

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three points on the ITB and measured the PPT using a pressure algometer pre-, post-, and
five min post-intervention. The results showed that there was a statistically significant
increase in the PPT immediately following the treatment, which indicated that foam
rolling the ITB increases pain tolerance leading to the perception of decreased pain in an
affected area following application.
A randomized, single-blinded, control trial study was completed to determine the
effects of rolling massage on PPT for individuals with tender spots in their plantar flexor
muscles (Aboodarda et al., 2015). The study included 150 participants that were
randomly assigned into one of five intervention groups: (1) heavy rolling massage on the
calf that exhibited higher tenderness, (2) heavy rolling massage on the contralateral calf,
(3) light stroking of the skin with the roller massager on the calf that exhibited the higher
tenderness, (4) manual massage on the calf that exhibited higher tenderness, and (5) no
intervention as the control group. PPT was measured at 30 s and up to 15 min postintervention with a pressure algometer. The results suggested that heavy rolling and
manual massage over tender areas increased the PPT compared to light rolling using a
massage roller and control conditions of no rolling or massage. The results show that
after rolling there is an acute increase in pain threshold and may mediate the perception
of pain following brief bouts.
Research also suggests that when pressure is applied to the muscle using both a
foam roller and a handheld roller massagers short-term benefits occur that include
increased flexibility in tests like the sit-and-reach. Many articles suggest that SMR may
have increased positive effects related to increased flexibility when it is combined with
static stretching (Cheatham et al., 2015; Grieve et al., 2015; Sullivan et al., 2013). The

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recent review by Beardsley and Škarabot (2015) confirmed acute increases in flexibility
when pressure is applied to the muscle for most of the investigations that were reviewed,
which related to the use of SMR techniques indicating that pressure to the muscle can
lead to increased joint ROM.
A randomized controlled trial by Kumar et al. (2017) determined that after 10
sessions of MFR, when combined with static stretching (SS), pain and tenderness of the
treated area significantly decreased and improved pressure tolerance and functionality
when compared to static stretching alone. The purpose of the study was to evaluate the
effectiveness of MFR in the treatment of chronic plantar fasciitis. Thirty subjects were
randomly assigned to two different groups: (1) receiving 10 sessions of MFR along with
stretching exercises, and (2) 10 sessions of stretching exercises only. Pain intensity was
measured by VAS, tenderness was assessed by PPT, and functional status was recorded
by a Foot Function Index (FFI) scale, which were measured at baseline, 10 days postintervention and one week following the completion of the intervention. Significant
improvements were recorded in both groups, but Group 1 (MFR with stretching) showed
statistically significant results in comparison to Group 2 (stretching only) indicating that
MFR is when combined with SS is even more effective than SS alone.
Releasing Trigger Points
Trigger points are small, highly sensitive areas located in muscle fibers that can
often be detected in areas where there is muscle weakness and reduced or limited ROM,
cause pain, and lead to dysfunction (Kalichman & Ben David, 2016). Trigger points form
due to trauma and inflammation that activate the body’s pain receptors, which increase
muscle tension resulting in a spasm. The muscle spasm forms what is perceived as a

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“knot” or an adhesion the results in altered length-tension relationships and inelasticity
(Beach, Parkinson, Stothart & Callaghan, 2005). Trigger points can develop in any
muscle, primarily located in the muscle belly, and are easier to target with a foam roller
for large muscle groups like the quadriceps, hamstrings and latissimus dorsi. Other
smaller tools can be utilized to address adhesions in more specific, smaller muscles.
Another way to identify a TPs is to apply pressure to an area where stiffness and
tightness is felt and use a visual analogue scale (VAS) to identify and quantify the pain
based on perceived pain and perception (Aboodarda et al., 2015). Often, if the localized
pain is greater than a five out of 10 using the VAS, zero indicating no pain at all and 10
indicating intolerable pain, then it is an area where a TP exists. If using the VAS method,
it is important to implement the same scale each time to ensure consistency (Aboodarda
et al., 2015).
Influence on the Autonomic Nervous System
It has been reported that SMR using a foam roller or other applications can
influence the ANS by stimulating the interstitial type III and IV receptors and the Ruffini
endings and increasing gamma motor neuron activity that can lead to changes in heart
rate, blood pressure and respiration (Kalichman & Ben David, 2016; Schleip, 2003). Selfmyofascial release can reduce sympathetic tone, which reduces muscle tonus
(hypertonicity), increase vasodilatation, and local fluid dynamics, changing the viscosity
of the muscle tissue (Schleip, 2003). Current research indicates that changes in ROM
may be due to the altered viscoelastic and thixotropic property (become thin and less
viscous) of fascia that increases intramuscular temperate and blood flow, altering musclespindle length and stretch perception (Cheatham et al., 2015; Kalichman & Ben David,

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2016). Increased vasodilation will, in return, promote increased oxygen and nutrient
uptake as well as removal of waste byproducts (Edgerton et al., 1996). Self-myofascial
release with a foam roller can improve arterial function and vascular endothelial function
as well as modulate ANS activity (Beardsley & Škarabot, 2015). Changes to the viscosity
of the muscle tissue can allow for better muscular contractions and joint motion.
Recent research by Takanobu et al. (2014), using a randomized controlled
crossover design, investigated the acute effects of SMR using a foam roller on arterial
stiffness and vascular endothelial function by measuring brachial-ankle pulse wave
velocity (baPWV) and plasma nitric oxide (NO) concentration before, and 30 min
following exercise. Ten healthy adults performed SMR of the adductor, hamstrings,
quadriceps, IT band, and trapezius, and a control, where SMR was not performed, on
separate days. Takanobu et al. (2014) determined that baPWV significantly decreased
and plasma NO concentration significantly increased following SMR using a foam roller,
and no significant differences were noted for the control group. The results indicated that
SMR with a foam roller reduces arterial stiffness and improves vascular endothelial
function, implying that SMR produces favorable effects on the arterial function and
supports the notion of the mechanisms contributing to the changes in arterial stiffness of
the skeletal muscle.
Hotfiel et al. (2017) completed a study to determine the effect of foam rolling on
arterial blood flow of the lateral thigh. Twenty-one healthy participants completed three
trials, first under resting conditions and two trials immediately after and 30 min after
foam rolling. The foam rolling protocol consisted of three sets of 45 s of foam rolling the
lateral thigh with 20 s of rest between sets. The foam rolling exercises were performed

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using a custom-made foam roller (Blackroll AG, Bottighofen, Switzerland) composed of
polypropylene with an outer diameter of 15 cm, a length of 30 cm and at a thickness of 6
cm. The participants were instructed to roll from the lateral tibia condyle upward to a
position superior to the greater trochanter and back to the starting position and to place as
much body mass as tolerable on the foam roller. The arterial tissue perfusion was
determined by spectral Doppler and power Doppler ultrasound, determined by peak flow
(Vmax), time average velocity maximum (TAMx), time average velocity mean (TAMn),
and resistive index (RI). The results showed that arterial blood flow of the lateral thigh
increased significantly after foam rolling exercises compared with baseline scores, and an
increase in Vmax of 73.6% immediately and 52.7% 30 min post- intervention, in TAMx
of 53.2% and 38.3%, and in TAMn of 84.4% and 68.2% respectively. Based on the
results, blood flow of the lateral thigh increased significantly after foam rolling and
enhanced blood flow was detected until 30 min post-intervention.
Theoretical framework offers proposed models like the fascial adhesion model,
fluid model, and fascial inflammation model to describe the mechanisms behind SMR.
Pressure applied to a muscle from SMR can break up adhesions between the layers of
tissue caused by stimulating the GTO, which reduces motor unit firing and ultimately
decreases muscle tension. The Ruffini endings (type II), Pacinian corpuscles and
interstitial muscle receptors (type III and IV) also reduce muscular tension when
stimulated by pressure.

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Application to Sport and Physical Activity
While SMR has a wide range of effects, it is most known for increasing flexibility
before and following exercise (Beardsley & Škarabot, 2015; Cheatham et al., 2015;
Kalichman & Ben David, 2016; Macdonald et al., 2013). Flexibility is an important
physical quality because reduced ROM can lead to weakness and pain (Kalichman & Ben
David, 2016; Kelly & Beardsley, 2016). Many factors contribute to flexibility such as
joint structure, muscle length, age, and activity level (Kelly & Beardsley, 2016).
Flexibility is measurable and is determined by ROM at a given joint, specifically where
ROM describes the degree of angular motion at that join (Kelly & Beardsley, 2016). A
lack of flexibility at the ankle could lead to injury, which is often seen following ankle
sprains, fractures, and Achilles tendon injuries decreasing functional ability (Kelly &
Beardsley, 2016; Sheffield & Cooper, 2013).
Recent research by Sheffield and Cooper (2013) investigated the immediate
effects of an SMR technique on amateur female football players on flexibility and fascia
tightness on injury predisposition and performance. Fifteen participants between the ages
of 16 and 20, who trained four times a week and played 90 min of matches twice a week
participated in the study, but any subject that had a lower limb injury within the last 6
months was excluded. The protocol included a foam roller of 89cm in length and 15cm in
diameter for SMR that was held three times for 30 s on the areas where discomfort was
felt. An active knee extension (AKE) test was conducted before and after the foam rolling
protocol to measure hamstring flexibility. A significant difference between the AKE
scores before and after SMR for both the left leg and for the right leg measurements was

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found and the results from the study showed that there was an immediate improvement in
hamstring flexibility from completing a single bout of SMR using a foam roller.
Healey, Hatfield, Blanpied, Dorfman & Riebe (2013) completed a study to
determine if the use of myofascial rollers before athletic tests could improve
performance. Twenty-six healthy college-aged individuals (13 men and 13 women)
participated in the randomized crossover design and performed a series of planking
exercises or foam rolling exercises followed by a series of athletic performance tests
including: vertical jump height and power, isometric force, and agility. The subjects
performed the foam rolling for 30 s on each of the following muscles: quadriceps,
hamstrings, calves, latissimus dorsi, and rhomboids. Fatigue, soreness, and exertion were
measured and an ANOVA with repeated measures and appropriate post hoc were utilized
to analyze the results. The results showed that there were no significant differences
between foam rolling and planking for any of the athletic tests, but there was a significant
difference between genders on all the of the tests. There were significant decreases from
pre- to post- intervention on fatigue, soreness and exertion for both groups. Post-exercise
fatigue after foam rolling was significantly less than after the subjects performed
planking. Healey et al. (2014) concluded that SMR had no effect on performance, but
induced a feeling of relaxation and reduced feelings of fatigue that may allow participants
to extend acute workout time and increase volume.
Roylance et al. (2013) completed a randomized crossover design to compare acute
changes in joint ROM using SMR, postural alignment exercises and static stretching.
Twenty-seven participants (14 males and 13 females) who had below average joint ROM
were randomly assigned to complete two 30–40- min sessions consisting of three sit-and-

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reach measurements with two treatments including foam rolling combined with either
postural alignment exercises or static stretching on two separate days. Significant gains
were reported with both postural alignment exercises and static stretching when
combined with foam-rolling. The results indicated that an acute treatment of foam rolling
significantly increased ROM when combined with either static stretching or postural
alignment exercises due to increased sit-and-reach scores.
Behara & Jacobson (2015) compared the acute effects of a single-bout of lower
extremity SMR using a custom deep-tissue roller (DTR) and a dynamic stretch protocol.
The study included 14 subjects that consisted of NCAA Division 1 offensive linemen at a
Midwestern university that participated in the randomized crossover design to assess
vertical jump (VJ) power and velocity, knee isometric torque and hip ROM before and
after: (1) no treatment, (2) deep tissue foam rolling, and (3) dynamic stretching. The
results indicated that there were no significant differences for VJ peak power, VJ average
power, VJ peak velocity, VJ average velocity, peak knee extension torque, average knee
extension torque, peak knee flexion torque, or average knee flexion torque. There was a
statistically significant difference in hip flexibility after both dynamic stretching and
foam rolling, so although there were no changes in strength or power, there was an
increase in flexibility after DTR. Behara & Jacobson (2015) concluded that although
SMR did not increase or reduce maximal isometric strength or velocity, DTR appeared to
enhance ROM and may be an appropriate substitute for SS due to the potential negative
impact SS may have on strength and power output.
A research study by Hironobu et al. (2013) determined that MFR not only
significantly improved active and passive ROM, but also significantly reduced premotor

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time following the application of MFR techniques leading to reduced reaction time (RT).
The purpose of the study was to compare the effects of MFR and stretching on ROM,
muscle stiffness, and RT. Forty healthy adults were randomly assigned to four groups: (1)
MFR of the quadriceps, (2) MFR of the hamstrings, (3) stretching the quadriceps, and (4)
control. The results showed that both active and passive ROM was significantly increased
in the two MFR groups and the stretch group, but no significant differences were in
muscle stiffness were observed between groups. Premotor time was significantly reduced
by MFR, and significant differences were noted between the MFR groups and control,
and RT was significantly lower after MFR. The research shows that not only does MFR
improve ROM, but can also improve RT and increase ease of movement corresponding
with improved performance.
The research by Macdonald et al. (2013) showed that there were no deficits in
force production or muscle activation following an acute bout of SMR, which was
confirmed by the research from Sullivan et al. (2013) that reported that there were no
significant changes in maximal voluntary contraction (MVC) force or muscle activation
(EMG) when applying SMR techniques.
Rios Monteiro et al. (2017b) investigated the effects of different volumes of foam
rolling, 60 and 120 s, of the hamstrings during the inter-set rest period on repetition
performance on knee extensions using a randomized within-subject design. Twenty-five
active adult females completed a 10-repetition maximum test, and completed three sets of
knee extensions at a predetermined load to concentric failure, then completed passive rest
or foam rolling for either 60 or 120 s. The results showed that with more time spent foam
rolling that fewer repetitions were completed. Rios Monteiro et al. (2017b) concluded

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that inter-set foam rolling decreased maximum repetition (MR) performance when
applied to the antagonist muscle compared to a control condition on knee extension
fatigue when completing 60 to 120 s of foam rolling between sets. Additionally, Rios
Monteiro & Corrêa Neto (2016) reported that inter-set rolling should not be applied to the
agonist muscle when completing strength training due to the decreased MR performance.
Research has shown that application of SMR induces short-term benefits for sitand-reach sores and joint ROM at the hip, knee, and ankle without affecting muscle
performance, and ROM increases could be observed immediately and up to 10 min after
application (Beardsley & Škarabot, 2015; Cheatham et al., 2015; Kalichman & Ben
David 2016). Kalichman and Ben David (2016) concluded that there was no evidence to
support the application of SMR prior to strength training because no increases in strength
performance were observed. It was suggested that SMR techniques not be utilized as
warm-up prior to activities that required strength or enhanced performance, which is
consistent with the current recommendations surrounding static stretching related to
power activities. Beardsley & Škarabot (2015) and Cheatham et al. (2015) determined
that SMR did not appear to impede nor improve athletic performance, but may have
changed the perception of fatigue. SMR reduced stress but did not lead to greater
increases of stress reduction compared to just resting by laying down, which was
measured by levels of serum cortisol levels following exercise (Kalichman & Ben David,
2016).
Pearcey et al. (2015) determined that a single 20 min bout of foam rolling
immediately following exercise and 24 hours following exercise reduced muscle
tenderness and enhanced recovery after DOMS. Measures also determined that foam

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93

rolling when DOMS was induced led to improvement sprint times, power output and
endurance-strength based activities compared to not completing foam rolling. Another
research article determined that SMR reduced DOMS ranging from 10 to 20 min postexercise and reported that the evidence suggested that continued foam rolling over the
course of three days for up to 10 min each application may reduce pain for up to 30 min
(Beardsley & Škarabot, 2015; Cheatham et al., 2015).
A randomized, controlled trial concluded that similar results were observed when
comparing groups of static stretch (SS) and SS with the addition of SMR, and therefore
no additional the addition of SMR to the SS protocol did not lead to increased benefits
(Morton et al., 2016). The authors compared the effects of SS combined with SMR to SS
alone on knee-extension ROM and hamstring stiffness during a four-week intervention.
Nineteen men with bilateral hamstring tightness and reduced ROM were randomly
assigned to either the SMR and SS group or the SS-only group. The intervention
consisted of four repetitions of SMR for 60 s twice daily for four weeks. Passive ROM,
hamstring stiffness, rate of torque development (RTD), and MVC were assessed pre- and
post- intervention. Passive ROM, RTD, and MVC all increased after the intervention, and
hamstring stiffness at the end-ROM was reduced post-intervention. There were no
differences between the intervention groups, and Morton et al. (2016) concluded that the
addition of SMR to SS did not enhance the efficacy of SS alone.
Škarabot et al. (2015) completed a randomized within-subject design to determine
the effects of SS, FR and a combination of FR and SS on passive ankle DF ROM. Eleven
resistance-trained adolescents were assessed pre-, immediately post-, and 10, 15, and 20
min following the intervention. The FR intervention consisted of three sets of 30 s of

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application followed by 10 s of rest, and the FR and SS protocol was comprised of the FR
protocol and followed by a SS condition consisting of three sets of 30 s of stretch
followed by 15 s of rest. ROM increased for all conditions, and between baseline and
post-intervention by 6.2% for SS and 9.1% for FR and SS, but not for FR alone. There
were no significant differences between groups for any other point for any condition. FR
and SS combined was superior to FR for increasing ROM. Škarabot et al. (2015)
concluded that all three conditions improved acute flexibility, but that FR and SS
combined led to the most significant increases in DF ROM.
Peacock et al. (2014) completed a study to determine if an acute bout of foam
rolling combined with a dynamic warm-up improved exercise performance. Eleven
athletically trained male subjects participated in a two condition, counterbalanced,
crossover within-subjects study that compared two warm-up routines: a total body
dynamic warm-up (DYN) and a total-body DYN with SMR that included a total-body
foam rolling session. Following each warm-up condition, subjects performed flexibility,
power, agility, strength, and speed tests, and T-tests were utilized to determine if there
were any significant differences in test results between conditions. The participants
completed a five min general warm-up followed by the same five min dynamic warm-up,
and the SMR group completed the bout of total body foam rolling. For the five min
general warm-up, the subjects jogged for 1000 m, completed a variety of mobility and
full ROM dynamic warm-up techniques that included arm circles, body weight squats,
body weight squat jumps, sprinting high knees, sprinting butt kickers, alternating lunge
jumps, alternating log jumps, scapular push-ups, thoracic rotations, and clapping pushups. The performance tests included flexibility and power measures (sit-and reach,

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vertical jump, and standing long jump), an agility measure (18.3 m pro agility test), a
maximum strength measure (1-RM bench press), and a sprint measure (37 m sprint). The
SMR techniques were completed for five strokes of 30 s using a conventional foam roller
(Black Molded Foam Roller - 6” x 12” Round, Perform Better, Cranston, RI) to target the
thoracic/lumbar region, gluteals, hamstrings, calves, quadriceps, and pectorals. The
results indicated that SMR was effective at improving power, agility, strength, and speed
compared to DYN. Based on the results, Peacock et al. (2014) concluded that an acute
warm-up bout of SMR with DNY improved overall athletic performance.
The consensus, based on the research results, indicates that SMR can assist in
improving flexibility (Roylance et al., 2013; Sheffield & Cooper, 2013), reducing fatigue
and soreness (Beardsley & Škarabot, 2015; Cheatham et al., 2015; Healey et al., 2014;
Pearcey et al. 2015; Škarabot et al., 2015) and improving ease of movement by reducing
premotor time (Hironobu et al., 2013). There are conflicting reports on the effects of
SMR on athletic or testing performance. Two recent research studies have indicated that
inter-set foam rolling of the agonist and antagonist muscle groups resulted in decreased
performance (Rios Monteiro & Corrêa Neto, 2016; Rios Monteiro et al., 2017b), while
other research studies demonstrated that SMR did not affect athletic or testing
performance (Healey et al., 2014; Kalichman & Ben David, 2016; Macdonald et al.,
2013; Sullivan et al., 2013). Additionally, Peacock et al. (2014) reported that an acute
warm-up combining SMR with DNY improved overall athletic performance. More
research should be completed related to the effects of SMR on athletic performance that
incorporates that same methodology and procedures to aid in forming more cohesive
recommendations.

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Conclusion
Overuse, inactivity and nonfunctional movements are a common occurrence
(Harkness, Macfarlane, Silman & McBeth, 2005). Self-myofascial release techniques
using a foam roller have become popular for improved flexibility, function, performance,
reduced injuries and soreness, and in addressing overactive musculature (Cheatham et al.,
2015; Grieve et al., 2015). As a manual therapy technique where pressure is applied to
the muscle and fascia that is performed by the individual themselves without the need of
a clinician or therapist (Beardsley & Škarabot, 2015; Cheatham et al., 2015; Hironobu et
al., 2013; Kalichman & Ben David, 2016), SMR is used to alleviate pain associated with
TPs and adhesions in the soft tissue that can be caused by sticking, fluid, inflammation,
or trauma (Kalichman & Ben David, 2016; Schleip, 2003). While the tools to administer
SMR differ in size, shape, and construction, the foam roller and handheld roller
massagers are the most commonly used (Beardsley & Škarabot, 2015; Kalichman & Ben
David 2016). Self-myofascial release can affect the ANS by stimulating the
mechanoreceptors causing a change in the tonus of the skeletal muscle, local fluid
dynamics and intrafascial smooth muscle cells, thus altering the tissue pressure (Schleip,
2003). The mechanisms involved in SMR were unclear based on the research, but
theoretical framework was explored to understand the current theories that included the
fascial adhesion model, fluid model, and fascial inflammation model (Kelly & Beardsely,
2016).
Conclusive research supports SMR for increased flexibility and increased ROM,
making it an attractive technique for clients and athletes (Beardsley & Škarabot, 2015).
Based on the research, while SMR using a foam roller is beneficial for increasing

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flexibility and ROM, there may be other tools that can provide even better results such as
the roller massager (DeBruyne et al., 2017; Markovic, 2015). It has been reported that
SMR does not impede athletic performance and leads to the reduction of DOMS to help
enhance recovery from training and competition, but results were inconsistent due to
varied methods, procedures and small sample sizes. There were conflicting results on
whether SMR should be used as a warm-up, but more research confirmed that SMR
could increase flexibility and ROM without negatively affecting athletic performance.
There was a consensus on treatment time, pressure and cadence for using SMR tools and
the application of SMR techniques, but different methods were used for the research
studies. Improvements in ROM were seen in as little as 10 s of application up to 20 min
of foam rolling (Cheatham et al., 2015). The current NASM recommendations for SMR
include daily application of 30 to 90 s depending on the intensity (Clark et al., 2014, p.
215), but many protocols suggested completing 30 to 60 s of SMR. Overall, there was not
enough high-quality evidence to draw firm and definitive conclusions on the required
duration of application when completing SMR.
There were many limitations to note in the available research. The main
limitations included small sample sizes, varied methods and different outcome measures
making it difficult for direct comparisons and developing a consensus for optimal
programming (Cheatham et al., 2015). There were different types of tools that were used
which could have affected the outcomes due to the degree of variability related to the
application of pressure tissue (Beardsley & Škarabot, 2015; Cheatham et al., 2015). There
were many differences regarding the instructions that were provided during the protocols
for the application of SMR techniques, which could have affected the outcomes related to

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98

flexibility due to the degree of pressure that was used by the participants (Beardsley &
Škarabot, 2015; Cheatham et al., 2015). For example, one protocol advised participants to
use a moderate amount of pressure while another protocol advised participants to use as
much pressure as possible and another protocol based pressure using on a pain VAS
(Beardsley & Škarabot, 2015). Other studies incorporated and used a device that
artificially applied a specific amount of force to determine the pressure that was applied
during the study (Beardsley & Škarabot, 2015). Kelly & Beardsley (2016) reported that
their research was limited in several aspects including: sample size, non-use of a blinded
research, research protocol, methodology, and clinical relevance. The time course for the
application of SMR techniques was unclear because of differences in protocols,
instructions, and methodology which led to varying volumes of SMR, differences in the
muscle groups that were treated, the SMR tool that was used, and the level of pressure
that was applied (Beardsley & Škarabot, 2015).
It is well documented in the review of the literature that SMR has acute effects,
but there is a lack of research that is dedicated to the chronic effects of SMR. The current
literature and research regarding the exact mechanism or mechanisms of SMR leading to
the effects is very limited and although the current theories offer insight and rational
regarding the suggested mechanisms, they have not been reviewed in detail and are not
supported by current research (Beardsley & Škarabot, 2015; Cheatham et al., 2015;
Kalichman & Ben David, 2016). There is a need for more high-quality research using
randomized controlled trials focusing on SMR as an intervention to increase ROM and
specifically for longer durations (Feldbauer, Smith & Van Lunen, 2015). There is a need
for high-quality clinical trials evaluating the efficacy and effectiveness of SMR on

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treatment of myofascial pain, chronic pain and disorders (Kalichman & Ben David,
2016). The phenomenon of myofascial TPs has been questioned due to concerns over
reliability and validity of the clinical trials (Beardsley & Škarabot, 2015).
Many studies have used the same, or similar types of commercially available
roller massagers, but there were numerous research studies that used foam rollers of
varying kinds or used custom rollers that are difficult to replicate (Beardsley & Škarabot,
2015; Cheatham et al., 2015). Future research should investigate the physiological effects
of SMR on muscle tissue (Feldbauer et al., 2015). Future research should focus on
replicating the methods and utilizing larger sample sizes (Cheatham et al., 2015). It was
reported that continued application of SMR could reduce DOMS for up to 3 days, but
more research is needed to examine the influence of SMR on damaged connective
tissues, the removal of lactic acid, edema reduction, and oxygen delivery to the muscle
(Cheatham et al., 2015).

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Takanobu, O., Mitsuhiko, M., & Komei, I. (2014). Acute effects of self-myofascial
release using a foam roller on arterial function. Journal of Strength &
Conditioning Research, 28(1), 69-73.
https://doi.org/10.1519/jsc.0b013e31829480f5

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Twomey, L., & Taylor, J. (1982). Flexion creep deformation and hysteresis in the lumbar
vertebral column. Spine, 7(2), 116–122. https://doi.org/10.1097/00007632198203000-00005
Vaughan, B., & McLaughlin, P. (2014). Immediate changes in pressure pain threshold in
the iliotibial band using a myofascial (foam) roller. International Journal of
Therapy & Rehabilitation, 21(12), 569-574.
https://doi.org/10.12968/ijtr.2014.21.12.569

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Appendix B
Problem Statement

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Problem Statement
Self-myofascial release techniques, such as foam rolling, have become popular in
the field of health and wellness and can be used to improve flexibility, function,
performance, reduce injuries and soreness, and address overactive musculature; however,
there is a lack of high-quality empirical research focusing on the effects of duration and
area of application on ROM (Cheatham et al., 2015; Grieve et al., 2015). The current
recommendations suggest that SMR techniques should target TPs by starting at the
proximal portion of the muscle and rolling towards the distal portion, or vice versa, and
positioning the foam roller over any area of discomfort or intense pain (the TP) for
release and holding on the TP for 30 (maximal pain tolerance) to 90 s (lower pain
tolerance) depending on the pressure of application (Clark et al., 2014, p. 215; Kalichman
& Ben David, 2016; Macdonald et al., 2013).
The current literature utilizes methodology of varying rolling procedures,
protocols, and measurements which vary in number of sets, frequency, duration,
placement of the roller, holding versus rolling through the TP, and the types of foam
rollers used, posing a problem for forming cohesive recommendations (Behara &
Jacobson, 2017; Cheatham et al., 2015; Morton et al., 2016; Roylance et al., 2013;
Sheffield & Cooper, 2013; Sullivan et al., 2013). Foam rolling procedures included
rolling through the TP (Murray et al., 2016; Takanobu et al., 2014) or positioning the
roller over the TP (Kelly & Beardsley, 2015; Sheffield & Cooper, 2013) with varying
repetitions (Takanobu et al., 2014) or durations (Kelly & Beardsley, 2015; Pearcey et al.,
2015; Rios Monteiro et al., 2017a; Roylance et al., 2013; Sheffield & Cooper, 2013;
Škarabot et al., 2015; Sullivan et al., 2013), which also complicate general conclusions. A

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consensus is building that supports the benefits of SMR on acutely increasing ROM when
completing longer durations (Rios Monteiro et al., 2017a; Roylance et al., 2013; Pearcey
et al., 2015), but varied methodology, reported research procedures and the use of small
sample sizes prevents any common interpretation of the overall results.
The purpose of this research is to explore the effectiveness of different durations
of SMR and the location of the foam roller on changes in hamstring flexibility, and the
ease of movement and muscle tightness in physically active adults.

EFFECTS OF DURATION AND APPLICATION
Appendix C
Additional Methods

112

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Appendix C1
Limitations

113

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114

The design of the research was a strength but also a limitation. A randomized
controlled trial was utilized, which is the “gold-standard” of research and has good
internal validity, but only eight subjects were included in each group. If a within-subject
design was implemented, all subjects would have completed each condition so more data
points would have been collected and errors associated with individual differences would
have been reduced; however, with each subject completing each condition there is a
possibility of one condition impacting the performance of another or all other conditions.
The subjects were members of the Gaithersburg Fitness center and ages 18-50 were
included, which may not be a true representation of the population that typically foam
rolls, and although a prior power analysis was conducted to measure statistical power
evaluating the risk of a Type II error, the sample size was small. Most of the subjects had
foam rolled prior to the research and could have indicated confirmation bias.
A commercial foam roller (SPRI 36" High-Density Foam Roller) (Appendix C10)
was used for this research and may not have been as effective at penetrating the muscle to
access deeper layers of muscle fascia, and even though the pace of the roll was constant,
this could be considered a limitation because it did not allow subjects the freedom to
choose the pace of the roll and lacked true representation of actual application. The
pressure from the foam rolling application was not constant, which could have led to
individual differences and it could be possible that subjects with a higher body weight
applied more pressure to the foam roller affecting their results or that there was decreased
pressure on the trigger point due to roller size and density. Also, fatigue in the upper
extremity or core fatigue during the protocol could cause the subject to relax and reduce
the amount of pressure that was exerted on the foam roller.

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The verbal instructions from the script (Appendix C14) described how subjects
should identify a TP using the foam roller, but subjects may have had difficulty finding
the most sensitive or most painful area of the hamstrings to hold the foam roller on and
addressed an area or spot on their hamstrings that was less restricted minimizing their
results. The sham treatment implemented in the control group may have been effective at
relaxing the subjects, their hamstrings and effective at reducing tension from their lower
back leading to increases in their flexibility and different results may have been observed
if they had sat quietly during the time that they did not foam roll. The box sit-and-reach
test (Figure Finder Flex-Tester®, Novel Products, Inc., USA) (Appendix C9) is a valid
and reliable measure of flexibility but may also incorporate low back extensibility and
shoulder joint ROM, not isolating hamstring flexibility, affecting reach distance results.
Tension in the gastrocnemius, lumbar extensors, and sciatic nerve may also inhibit
flexibility.
Questionnaires are a valid and reliable source for gathering qualitative data;
however, it is possible that the questions may have been worded in a way that made the
subjects feel pressured to answer a certain way affecting the results. There was only
slightly more than 50% participation on the follow-up questionnaire (Appendix C12),
limiting the responses. The responses that were collected on the follow-up questionnaire
(Appendix C12) and reviewed for the inductive-content analysis may not be a true
representation of the whole sample.

EFFECTS OF DURATION AND APPLICATION
Appendix C2
Recruitment Flyer

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117

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Appendix C3
Recruitment Email

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119

Recruitment Email for Research Study:

Dear Fitness Center Members,

I am a doctoral candidate at California University of Pennsylvania, and I will be
conducting a research study about the effects of duration and application area of selfmyofascial release (SMR) on flexibility in physically active adults. The purpose of the
research is to explore the effectiveness of different durations of SMR and the location of
the foam roller on changes in hamstring flexibility, and ease of movement and muscle
tightness in physically active adults. I am emailing at ask if you would like to participate
in the research study? Participation is completely voluntary, and your results will be
anonymous. Participation will include:
•

Completing a health questionnaire

•

Providing informed consent

•

Meeting with the principle investigator to complete the testing

•

Completing online questionnaires related to the research topic

If you are interested in participating, please contact me via email at
zelankob@medimmune.com or by phone at 301-398-6986.
If you have any questions, please do not hesitate to contact me.

EFFECTS OF DURATION AND APPLICATION
Thank you,
Brian Zelanko
Lead Personal Trainer, Principle Investigator
HealthFitness
Phone: 301.398.6986
Email: zelankob@medimmune.com
www.healthfitness.com

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Appendix C4
Informed Consent Form

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122

Informed Consent Form
Effects of Duration and Application Area of Self-Myofascial Release on Flexibility in
Physically Active Adults
Please read this entire form and sign the last page if you agree to volunteer to participate
in this research project. You may ask the researcher for clarification of any aspect of your
participation.
Introduction and Purpose
You are invited to participate in a research study that will
examine the effects of self-myofascial release (SMR) using
a foam roller on hamstring muscle flexibility. SMR/foam

Retrieved from
http://www.movementmasterminds.com/wp
-content/uploads/2015/10/Hamstring.jpg

rolling is common treatment completed by rolling back and forth on a cylindrical piece of
foam over the targeted muscle, increasing flexibility. The purpose of this research is to
test different time periods of SMR/foam rolling and the location of the foam roller
treatment on the changes in hamstring flexibility, ease of movement and muscle tightness
in physically active adults.
Procedures
Agreeing to participate in the research will involve 3 days of participation totaling
approximately 2 hours. Meeting with the researcher on the first day will not last longer
than 45 minutes and meeting with the researcher on the second day of participation will
not last longer than one hour. The third day will be completing an online questionnaire
that will take less than 15 minutes. Your participation will potentially require you to:
1) Attend a meeting at the fitness center to explain the study and self-myofascial release
using a foam roller. This form will be reviewed and signed if you agree to participate.

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2) Attend a second session to complete the hamstring flexibility testing and SMR/foam
rolling treatment. You will have hamstring flexibility measured, prior to the
SMR/foam rolling treatment and after the treatment.
This will be completed using the sit-and-reach test.
This test requires you to sit with legs straight while
reaching as far as possible along a measuring device.
3) You will complete a pre-treatment questionnaire that

Retrieved from
https://performbetter.co.uk/product/sitand-reach-box/

will contain eight open-ended questions related to foam rolling.
4) A brief demonstration of proper SMF/foam rolling of the hamstrings will be provided
along with an opportunity to practice.
5) Complete a SMR/foam rolling treatment for your hamstrings for 60 seconds to 180
seconds and either holding the foam roller on the trigger point or rolling through the
trigger point. Treatment could also include lying on your back with the foam roller
positioned under your legs while completing rhythmic breathing by inhaling and
exhaling at a rate for 20 beats per minute for 180 seconds.
6) Immediately after the treatment you will have your hamstring flexibility measured
and complete a post-treatment questionnaire that will include eight open- ended
questions related to foam rolling.
7) A follow-up questionnaire will be sent to you 24 hours post-treatment containing 6
questions. Since this questionnaire can be completed remotely, your email address
will be collected at the beginning of the research when replying to the recruitment

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124

email or when calling the fitness center because as it is necessary to complete the
follow-up survey.
Risks and Benefits
SMR/foam rolling is a commonly completed activity in fitness, and the known risks are
low. There is a risk of muscle pain or soreness due to foam rolling, and there is always a
potential for more severe or unforeseeable risks that are associated with any type of
research and physical activity. Treatments to assist with recovery from soreness include:
low intensity exercise, rest, ice, compression, and elevation. To minimize these risks, the
researcher will be present to administer the testing and treatments, monitoring all exercise
techniques to ensure that proper form is being used. In the event of an injury or physical,
emotional, or psychological harm, notify the researcher and the Fitness Facility’s
emergency action plan will be followed. Treatment, including first aid or referral to
emergency services, will be provided. Additionally, you can call your primary care
physician to address injuries. You are responsible for the costs associated with treatment.
You will not forfeit any of your legal rights by signing this informed consent form. There
are no alternative procedures or treatments available for this study.
The individual benefits of this study could include reduced pain and soreness, improved
range of motion and ease of movement, and a sense of relaxation. This research project
will improve the current literature base, improve our knowledge, and reinforce the
effectiveness of foam rolling.
Payment and Costs
No compensation is provided for your participation. There are no costs to you for
participating.

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Confidentiality
A subject number will used to identify you while you complete the research study. All
data will be associated with this subject number and not with your name. Only necessary
information will be collected and will not include any information that could be used to
identify you as a participant. All data will be stored electronically on the University
Microsoft Office Cloud storage, and all paper forms will be kept locked and secured and
destroyed upon the conclusion of the study. Only the primary researcher (Brian Zelanko)
and dissertation chairperson (Thomas F. West) will handle individual data.
Participation
Participation will be on a voluntary basis, and participation will not affect the relationship
with the investigator or your relationship with the Gaithersburg Fitness Center. You can
withdraw at any time, for any reason, without penalty, retaliation, or loss of any benefit
and your data will be deleted. Your data will be excluded from the research if you cannot
complete the foam rolling within the specified parameters.
Participant Considerations
You are being asked to participate in this research because:
•

you are proficient in English;

•

you regularly participate at the fitness center;

•

you are not pregnant, do not believe that you may be pregnant, or will not become
pregnant during the time of this study;

•

you are over the age of 18 and under the age of 50;

•

you do not have any communicable disease;

EFFECTS OF DURATION AND APPLICATION
•

126

you do not have any illness or disease that could affect your participation or be
aggravated by your participation including disease of the cardiovascular, respiratory,
urinary, nervous or endocrine systems;

•

you have not had a serious injury or surgery within the last 6 months or any
orthopedic problems such as arthritis, bursitis, fibromyalgia, osteoporosis, or
scoliosis;

•

you also must be free from any condition, injury or illness that could affect your
participation in this study or be worsened by your participation. If you fail to meet
any of the above conditions, please notify the researcher.

If you fail to meet any of the above, please notify the researcher as you do not meet the
qualifications to participate.
The primary investigator will inform you if any new developments or findings related to
the research may affect your willingness to continue your participation.
Research Investigator Contacts
This research is being conducted by Brian Zelanko. Any questions can for forwarded or
directed to:
Brian Zelanko MS, CES, CPT

Thomas F. West, PhD, ATC

Lead Personal Trainer &

Research Advisor, Dept of Exercise

DHSc Candidate/Primary Researcher

Science and Sport Studies

Department of Exercise Science & Sport Studies

California University of
Pennsylvania

Zel2969@calu.edu or zelankob@medimmune.com Thomas.west@calu.edu
(717) 634-1028

(724) 938-4356

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127

This study has been approved by the California University of Pennsylvania Institutional
Review Board. This approval is effective 04/01/2019 and expires 03/31/2020. You will
be provided a copy of this form for your records.
Statement of Consent
I have read the above information, have asked any questions and received answers, and I
consent to participate in this research study.

Signature of Participant

Date

Name of Participant (Print)

Name of Person Obtaining Informed Consent
(Authorized Personnel)

Date

EFFECTS OF DURATION AND APPLICATION
Appendix C5
Health-Check Questionnaire

128

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129

Health-check Questionnaire
First Name

Last Name

Date

Please check all the following which currently apply:

Are you Proficient in English? ............................................................... □ Yes □ No
Do you regularly participate at the fitness center and/or exercise at least three
days per week ......................................................................................... □ Yes □ No
Women: Are you pregnant or believe that you may be pregnant, or could you
become pregnant during the time of this study? ......................................□ Yes □ No
Are you currently over the age of 18 and under the age of 50? ...............□ Yes □ No
Do you currently have a communicable disease? ....................................□ Yes □ No
Do you currently have any illness or disease that could affect your participation
or be aggravated by your participation including disease of the cardiovascular,
respiratory, urinary, nervous or endocrine systems .................................□ Yes □ No
Have you had a serious injury (within last 6 months)? ............................□ Yes □ No
Have you had surgery (within last 6 months)? ........................................□ Yes □ No
Do you have an orthopedic problem such as rheumatoid arthritis, bursitis,
fibromyalgia, Osteoporosis, and/or scoliosis ..........................................□ Yes □ No
Do you have any other condition, injury or illness that could affect your participation
in this research study or that could be worsened by your participation ...□ Yes □ No
Have you ever been diagnosed with blood/bleeding disorder .................□ Yes □ No
Do you currently have a contagious skin disorder ...................................□ Yes □ No

Signature:

Date:

EFFECTS OF DURATION AND APPLICATION
Appendix C6
Letter of Approval

130

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131

August 5, 2018
Sarah Lane, Program Manager
Gaithersburg Fitness Center
101 Orchard Ridge Rd.
Gaithersburg, MD 20878
Dear IRB Committee:
It is my understanding that Brian Zelanko will be conducting a research
study at the Gaithersburg Fitness Center on the “Effects of Duration and
Application Area of Self-Myofascial Release on Flexibility in Physically
Active Adults.” Mr. Zelanko has informed me of the design of the study as
well as the targeted population.
Mr. Zelanko has provided me with a detailed summary (copy enclosed) that
we have reviewed, and I understand that members of the Fitness Center will
be recruited for the study on a voluntary basis and complete an informed
consent prior to participating in the research. I understand that participants
of the research will be placed into groups and different durations of selfmyofascial release using a foam roller on hamstring flexibility will be tested.
It was also clear that interviews will be conducted to gather data for the
research, and that the results will be pooled for the dissertation project but
individual participant results of the study will remain confidential and
anonymous. Additionally, if the study is published, only pooled results will
be documented.
I support this effort and will provide any assistance necessary for the
successful implementation of this study. If you have any questions, please
reach me at (301) 398-4507.
Sincerely,
Sarah B. Lane

EFFECTS OF DURATION AND APPLICATION
Appendix C7
Detecto Weight Beam Scale with the Height Rod

132

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133

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Appendix C8
Omron Body Composition Monitor and Scale (HBF-516B)

134

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135

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Appendix C9
Figure Finder Flex-Tester®, Novel Products, Inc., USA

136

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137

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138

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139

EFFECTS OF DURATION AND APPLICATION
Appendix C10
SPRI 36" High-Density Foam Roller

140

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141

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Appendix C11
Pre- and Post- Questionnaire

142

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143

EFFECTS OF DURATION AND APPLICATION
Appendix C12
Follow-up Questionnaire

144

EFFECTS OF DURATION AND APPLICATION

145

EFFECTS OF DURATION AND APPLICATION
Appendix C13
Email List

146

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147

Subject Email List
Full Name

E-mail

EFFECTS OF DURATION AND APPLICATION
Appendix C14
Script for Subjects

148

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149

To all subjects during the practicing of the technique:
“Sit on the floor with your legs fully extended and place the foam roller under
your legs. Place your hands behind you and push upwards so that you can lift and support
your own body weight, and you can have your hands flat on the mat for cushion and
comfort. The foam roller should be positioned under your upper legs so that the roll can
be initiated slightly above the back of the knee joint and rolling to just below the glute, or
vice versa, and then reversed. Keep your arms and legs straight and roll forward and back
so that the foam roller rolls over the entire hamstring. Keep your glute off the floor and
keep your heels lifted to reduce friction while rolling. Apply as much pressure onto the
roller as possible and switch your direction when hearing the beep produced by the online
metronome. The pace of your roll should be three s each direction, which is equivalent to
a pace of 20 bpm. If necessary, you may readjust the roller or yours hands for comfort or
due to fatigue. You will be excluded from the research if you cannot maintain the pace of
the roll for the duration of the intervention, cannot maintain your positioning on the foam
roller for the duration of the intervention, cannot complete the assigned intervention due
to extreme pain or discomfort, or if you are not able to complete their assigned
intervention due to any other reason.”
To the subjects that are in the two groups rolling through the TP (60 or 180 s):
“You will follow the instructions that were provided during the practice and
continue the roll for the assigned duration (either 60 or 180 s).”
To the subjects that are in the two groups that are holding the foam roller on the
TP (60 or 180 s):

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“Roll at the designated pace until you are able to identify the TP, which is the area
of the muscle that is highly sensitive and tight or painful. A TP is often found in the
muscle belly. Once you have identified the TP, hold the foam roller on that spot for the
assigned duration (60 or 180 s), and the metronome will be turned off.”
To the subjects in the control group:
“Lie face-up with the foam roller positioned under your hamstrings. Relax the
head and shoulders and begin to focus on your breathing by inhaling deeply and exhaling.
Continue with the deep breathing and begin to take a deep breath at each beep of the
metronome. You will continue the rhythmic breathing for 180 s.”

EFFECTS OF DURATION AND APPLICATION
Appendix C15
Data Collection Spreadsheet

151

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152

To randomize groups and assign numbers, a Microsoft Excel spreadsheet was
used. The list will be made with names going down the left column. Those cells were
highlighted and the function =rand () was used to generate random numbers. The
numbers were assigned to the respective subject. To randomize groups, Sort & Filter
were used and the randomized numbers were arranged from smallest to largest. Groups
were divided evenly amongst subjects.
Microsoft Excel was used for data collection, and column headings were
incorporated including: subject number, age, sex, height, weight, BMI, group assignment,
sit-and reach-scores (pre), sit-and-reach scores (post), and additional information/notes.

EFFECTS OF DURATION AND APPLICATION
Appendix C16
IRB Approval

153

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154

Institutional Review Board
California University of Pennsylvania
Morgan Hall, Room 310
250 University Avenue
California, PA 15419
instreviewboard@calu.edu
Melissa Sovak, Ph.D.

Dear Brian,
Please consider this email as official notification that your proposal titled "Effects of
Duration and Application Area of Self-Myofascial Release on Flexibility in
Physically Active Adults” (Proposal #18-057) has been approved by the
California University of Pennsylvania Institutional Review Board as amended with
the following stipulation:
I approve with minor revisions to the procedure section of the informed consent.
The researcher needs to articulate in the informed consent that an email address
will be collected in order to complete the follow-up survey.
•

The informed consent was revised and now includes a statement indicating that an
email address will be collected for the completion of the follow-up survey.

Further, when or how the researcher is going to collect email addresses is not clear.
•

Email addresses will be collected when volunteers reply to the recruitment email
or call the fitness center and recorded on the Email List (appendix C12).

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155

For the procedure section of the informed consent, how many questions included in
each survey needs to be provided.
•

The informed consent now indicates that the pre- and post-treatment questionnaire
will contain eight questions and the follow-up questionnaire will contain six
questions.

The researcher provides an overall time estimation which is beneficial, but an
estimation of the time requirement across the two days would benefit the participant
when considering if he/she wants to participate.
•

The informed consent now indicates that the first day will not last longer than 45
min and the second day will not last longer than one hour.

Also, it is not clear if the participants would be meeting with the researcher both
days.
•

The informed consent now indicates that the subject will be meeting with the
researcher on both days.

The procedure description could be improved by listing the steps of the research in
the order they will occur. Currently, the researcher groups all of the questionnaires
together, which does not provide the potential participant with the opportunity to
grasp all of the elements involved in this research process
•

The procedure for the testing was listed out in the order that each step will occur.

Once you have completed the above request you may immediately begin data
collection. You do not need to wait for further IRB approval. At your earliest
convenience, you must forward a copy of the changes for the Board’s records.

EFFECTS OF DURATION AND APPLICATION

156

The effective date of the approval is 4/1/19 and the expiration date is 3/31/20. These
dates must appear on the consent form.
•

The dates have been added.

Please note that Federal Policy requires that you notify the IRB promptly regarding
any of the following:

(1) Any additions or changes in procedures you might wish for your study (additions or
changes must be approved by the IRB before they are implemented)
(2) Any events that affect the safety or well-being of subjects
(3) Any modifications of your study or other responses that are necessitated by any
events reported in (2).

(4) To continue your research beyond the approval expiration date of 3/31/20 you must
file additional information to be considered for continuing review. Please
contact instreviewboard@cup.edu. Please notify the Board when data collection is
complete.

Regards,
Melissa Sovak, Ph.D.
Chair, Institutional Review Board

EFFECTS OF DURATION AND APPLICATION
Appendix C17
Online Metronome (YouTube.com)

157

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158

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159

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Supporting Material
Resume

BRIAN
ZELANKO
Lead Personal Trainer, HealthFitness
PROFILE

EDUCATION

Highly competent Lead Personal
Trainer with experience in scheduling,
supervising, and managing a Fitness
Center. Excels at planning,
coordinating and programming. A
hardworking and confident leader
with years of experience.

California University of Pennsylvania
01/2016 – present
Candidate for the degree of Doctor of Health Science (DHSc) in Health
Science and Exercise Leadership
Expected to graduate in December 2019

Currently manages the personal
training program at the Gaithersburg,
MD site, which includes the hiring of
Personal Trainers, monitoring their
performance, implementing center
policies and ensuring customer
service. Averages over 14 personal
training sessions per week, instructs
two group exercise classes per week,
designs exercise programs, conducts
fitness testing and educates members
on how to safely and correctly utilize
exercise equipment.

CONTACT
PHONE:
717-634-1028
EMAIL:
bzelanko@gmail.com

HOBBIES
Weight training
Running
Walking my dog
Spending time with family & friends

California University of Pennsylvania
07/2014 – 07/2015
M.S. in Exercise Science & Health Promotion, Concentration in
Rehabilitation Science
Graduated with 4.0 GPA
Shippensburg University of Pennsylvania
08/2009 – 08/2011
B.S. in Exercise Science
Graduated with over 3.0 GPA

WORK EXPERIENCE
HealthFitness, Lead Personal Trainer
08/2017–Present
Started as a Health Fitness Specialist in 2016 and was promoted within
one year to the Lead Personal Trainer.
Hoffman Homes for Youth, MHW Supervisor
02/2015–11/2016
Started as a Mental Health Worker in 2012, was promoted to a Shift
Leader position in 2013 and then to MHW Supervisor.
Personal Trainer, Frederick Sport&Health
06/2011–02/2012
First professional position after graduating from Shippensburg University.
Assisted clients and members with exercise program design and
instruction.

SKILLS
NSCA Certified Personal Trainer
NASM Corrective Exercise Specialist
NASE Speed, Strength, Agility and Endurance Specialist
American Red Cross Adult First Aid/CPR/AED Certified

EFFECTS OF DURATION AND APPLICATION
Personal Training Certification
rtifications

171

EFFECTS OF DURATION AND APPLICATION
Corrective Exercise Specialist Certification

172

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CPR, First Aid & AED Certification

173