Foam rollers. Lacrosse balls. Battery-powered vibrating sticks, tubes and scrapers, stainless steel, acu-this, myo-that. The world of “muscle release” is rife with tools of all shapes, sizes, and materials, priced from $3.00 to $300. But what’s the real deal? What exactly are these tools doing? And are they worth the splurge? I get asked questions about this topic all of the time, and I also see the ridiculous market and so called “experts” endorsing products and making sweeping claims that make me roll my eyes pretentiously. We’ve turned to some of the scientific literature to give you the real answers and what the research says – because it’s just a little too easy to call yourself an “expert” on the interwebs these days with very little actual knowledge of muscle physiology and pathology. In the expanse of the health and wellness world, you should be critical with where you spend your money, and with who you trust.
Companies and associated influencers will frequently cite that these various muscle tools will do things like “break up scar tissue, adhesions, and trigger points”. Let’s take a deeper look at this. Muscles consist of millions of muscle fibres called sarcomeres, that link together. When we incite movement, the sarcomeres slide along each other powered by a series of small chemical reactions. It can be helpful to visualize the sarcomeres as straight, parallel lines. They are high in certain substances like collagen and elastin which give them pliability and extensibility. In healthy muscle, they slide smoothly and nicely. Around the bundles of sarcomeres is fascia, which is a very, very thick tissue that envelopes muscles. Fascia is everywhere. It’s around individual muscles, groups of muscles, and in some places divides muscles into compartments. The photo below shows a nice healthy muscle.
When we suffer from an acute or overuse injury, or even if you’ve just really been training hard, the nice, straight, parallel smooth sarcomeres are torn. They may be just a little torn, like a few guitar strings that have been twinged off the strut, or many may be torn.
Myth debunker alert: Muscle soreness after a big workout is not actually a buildup of lactic acid – it is most likely muscle fiber microtears combined with cellular inflammation.
Alas – the body is amazing, and it will heal the sarcomeres back together again. However, the caveat with this healing process is that if myofibril damage happens again too quickly and you haven’t allowed the tissues to heal properly, or if you’ve really overdone it and there’s a LOT of damage, the fibres aren’t able to heal in the nice straight parallel lines anymore and resemble more of a knotted ball of yarn. They are lower in collagen and elastin, they aren’t as stretchy, they don’t glide as smoothly, and most importantly, they are weaker. This is often what we refer colloquially to as “scar tissue” or “adhesions”. You can feel these sometimes as “knots” or a strip of muscle that feels ropey or taut. If you’ve been training a lot, these are very normal response to chronic muscle overload. Just be careful though, if you constantly have these, you might want to dive a little deeper into why – or perhaps you’re overdoing it.
Image of muscle from an electron microscope after eccentric exercise. Notice the disruption in the muscle pattern.
American Physiological Society – (http://jap.physiology.org/content/107/2/570)
There are a few ways that we can treat these taut bands of “adhesions” or trigger points.
- A surgical scalpel
- Progressive loading (exercise)
- *Deep muscle stimulation/Acupunture/Dry needling
- **Muscle release techniques (foam roller, balls, etc.)
Ok, so. Number 1 – a surgical scalpel. Let’s start here. Fascia is one of the strongest substances in the entire body. It literally holds us together and is absolutely everywhere. It’s over muscles, in between them, in the crevices between organs, and it is THICK and STRONG. Here it goes –
Foam rollers do not “break up” fascial adhesions.
Whew. I said it. But it’s literally impossible. Think of a weightlifter thrusting hundreds of pounds overhead. Fascia is part of why they have the body and muscle tension to do this without melting to the floor or breaking into skeletal pieces. Fascia and muscles are STRONG and SMART. They can’t be rolled out flat like cookie dough with a tennis ball or a $50 ball that has been heated in the microwave. Sorry. While you may have a transient (as in, like 1-2 minutes) after rolling that muscles are warmer and more flexible, these effects are very, very short-lived and unlikely to change either performance or recovery times in any statistically significant way.
NOW – Before you say “Well it DOES work for me! I always feel better!” – hang on. I’m not saying it doesn’t work – it just likely doesn’t work in the way that you think that it does. While you’re probably not ironing out muscle fibres, what you are doing is providing a stimulus via a roller, ball, knob, etc that is changing the message that the muscle is sending the central nervous system (CNS). Remember our body and muscles only ever do what our CNS tells us to do. We are merely puppets guided by our brains and nerves. If you’re tired and training a lot, or if you maybe have an underlying weakness in a muscle, there’s a message being sent to the brain from the muscle saying “I’m having trouble doing this, but I am trying.” The brain says “Ok, let me help you – tighten up! That should do the trick.” And so, when you take a ball to a calf muscle, it interrupts this message by saying “Oh – maybe you don’t need to be so tight. Sorry about that – back to business as usual!” If a patient says to me “I love foam rolling it helps me so much!” I say, “Great! Keep it up.” If you’re the person though who says, “I roll until I have bruises and nothing ever changes!” then stop. Just stop. You’re doing yourself more harm than good, and if anything you’re probably amplifying the “Ah! Tighten up!” brain-to-muscle message even more.
Other things that clinically seem to help adjust this brain-muscle messaging system are acupuncture, acupuncture with electrical stimulation, and dry needling – a personal favourite and the most masochistic of the three in my opinion. But if you’re a patient of mine who’s had it, you know the Great Power of the Dry Needle – I’ve had people who book appointments just to needle the “knot” out of their calves. We travel to Hell and then Heaven together in a mere thirty minutes and emerge back into the world with a renewed view on the greatness of life itself. Not sure what dry needling is? Check out the video – but warning, if you’re squeamish with needles proceed with caution.
Finally, the number one thing you can do to help work out these problems is identify why they’re occurring in the first place – especially if it seems that it’s something that never fully goes away. Remember that muscles often tighten or shorten up when they are overloaded. This might mean that it’s weaker. Runners in particular need a LOT of strength in their calves – and so if you’re always getting trigger points or sore spots there, the most likely culprit could just be that you’re not strong enough. Alternate hypotheses might include an imbalance to another underactive muscle group, or perhaps something right to left or hips-to-feet that’s having to compensate. There are a million different reasons for how we prefer to move – this is why it can be frustrating when people ask us a “why” question and expect a full-blown answer without us being able to get our hands on you and test things out.
Physios trained in treating runners aren’t just there to diagnose your problem (you’ve got Google for that), but are trained in seeking out the underlying movement patterns or preferences that are making you feel the way you feel. That’s where the magic comes in.
In summary, I do generally recommend some type of tissue work for everyone, as I do believe that it can be useful. Regardless of what the literature says, it does help with blood flow, and anything that improves blood flow to muscles is a win in my books. But just keep in mind that the mechanism is probably much more complex and nervous-system related than it appears. As such, my rule of thumb is to always do releases in relaxed positions – aka not in a forearm plank – to let muscles actually soften. Secondly, don’t go so hard that you’re making a face or gritting your teeth. This is just going to crank up the system ever further and perhaps do yourself a disservice. And the next time tells you someone that their $200 tool will “break up scar tissue”, save your pennies and buy the $3.00 lacrosse ball instead.
Lauren Roberts is a Registered Physiotherapist and Founder of The Running Physio in Toronto. For more information on her team, the clinic and booking, head to https://therunningphysio.janeapp.com/.
The Muscle Fibre Complex. https://www.physiology.org/
The Science of Sore – DOMS explained. Brandon Roberts, 2016. https://www.strongerbyscience.com/doms/
The Titin/Telethonin Complex. http://www.ks.uiuc.edu/Research/telethonin/
The Evidence Behind Foam Rolling: A Review. Sport and Olympic-Paralympic Studies Journal (SOPSJ), 2018. https://www.researchgate.net/profile/Gibwa_Cole/publication/328474367_The_Evidence_Behind_Foam_Rolling_A_Review/links/5bcfd18aa6fdcc204a035823/The-Evidence-Behind-Foam-Rolling-A-Review.pdf