This blog post of an exclusive excerpt from my new book, The Physiology of Yoga.

Myofascial release (MFR) has become increasingly popular and widely used since the 1990s. Below is a extract from The Physiology of Yoga where we explore some of the research that looks at whether MFR and self-MFR (think foam rolling) is actually effective.

MFR is, firstly, a treatment modality wherein the therapist applies a low-load, long-duration stretch to the soft tissues of the body, guided by feedback from the recipient’s body to determine stretch direction, force, and duration. Think of it as being gently stretched by someone, perhaps with some gentle pressure from the therapist’s hands along the tissues being stretched.

Some osteopathy textbooks claim that fascia can become restricted due to psychogenic disease, overuse, trauma, infectious agents, or inactivity, potentially resulting in pain, muscle tension, and diminished blood flow (DiGiovanna, Schiowitz, and Dowling 2005). MFR is claimed to help release those fascial restrictions.

As for its efficacy, reviews published in 2013 (McKenney et al.) and 2015 (Ajimsha, Al-Mudahka, and Al-Madzhar) found some encouraging results with MFR but determined that because of the low quality of the studies available, few conclusions could be drawn. A further review of MFR on chronic pain by Laimi and colleagues (2018) found that current evidence of MFR in chronic pain relies on only a few studies, that previous positive conclusions could not be confirmed, and that it is not known whether MFR is any more effective in treating chronic musculoskeletal pain than sham procedures.

Perhaps, however, MFR cannot be reliably measured through science. In an article titled “Why Myofascial Release Will Never Be Evidence-Based” for the journal International Musculoskeletal Medicine, Robert Kidd (2009) noted, “Myofascial release is an art form. Much depends on the innate talent and experience of the therapist” (p. 55). If an intervention relies on a therapist’s innate talent and nothing else, then it cannot be easily quantified or codified and thus cannot be easily studied.

MFR as described requires a therapist to perform the treatment on a recipient. However, self-MFR does not require a therapist. Foam rolling is probably most associated with self-MFR, but many other products and modalities—from spiky massage balls to massage sticks to percussive massage guns—also claim to release fascia. But not all of these products have been through the rigor of scientific study. There is currently no regulation around MFR claims, so anyone with any product can claim that it elicits MFR.

A recent review by Wiewelhove and colleagues (2019) looked at all the literature available on the efficacy of self-massage products applied before exercise (as a warm-up activity) and after exercise (as a recovery strategy) on sprint, jump, and strength performance as well as flexibility and muscle pain outcomes. Twenty-one studies met their criteria—14 of which used foam rollers and 7 of which used roller massage bars or sticks. They concluded the following:

Overall, it was determined that the effects of foam rolling on performance and recovery are rather minor and partly negligible, but can be relevant in some cases (e.g., to increase sprint performance and flexibility or to reduce muscle pain sensation). Evidence seems to justify the widespread use of foam rolling as a warm-up activity rather than a recovery tool. (p. 1)

Even if self-MFR has the potential for reducing pain sensations or improving performance, the reason is not at all clear. In 2019, Behm and Wilke looked at possible mechanisms behind any efficacy of MFR in their aptly named paper, Do Self-Myofascial Release Devices Release Myofascia? Examining the physiology and biomechanics of several self-massage rolling devices, they concluded that there is some evidence that rolling might affect blood flow or local hydration changes, but manual forces are not typically sufficient to change the shape of connective tissue. They also looked at research that has shown rolling to increase our tolerance to stretching and decrease pain and determined that this is likely due to counterstimulation. Counterstimulation is the process of decreasing pain signals from a site because of the introduction of a more obvious stimulation (think of rubbing your shin after bumping it or biting your lip when receiving a jab). They also suggested that increased parasympathetic activity (in other words, being more relaxed) might be an important mechanism behind rolling’s observed benefits. So, they concluded, the primary mechanism behind rolling and other similar devices is not the release of myofascial restrictions, thus suggesting that the term self-myofascial release is a misleading one.

Myofascial release, whether administered by a therapist or by oneself, might very well have some benefits—and if you personally swear by it to keep yourself pain-free and injury-free, then that might be the only evidence you need. However, the scientifically observed benefits do not (so far) seem particularly significant. The mechanism behind any of MFR’s benefits seems likely due to temporary changes to the nervous system, rather than the fascia, suggesting that the term myofascial release is a misnomer. Additionally, a product does not need any science behind it to be labeled a myofascial-releasing device, so caution is advised when reading the label of any such item.

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References:

Ajimsha, M.S., N.R. Al-Mudahka, and J.A. Al-Madzhar. 2015. “Effectiveness of Myofascial Release: Systematic Review of Randomized Controlled Trials.” Journal of Bodywork and Movement Therapies 19 (1): 102-112.

Behm, D.G., and J. Wilke. 2019. “Do Self-Myofascial Release Devices Release Myofascia? Rolling Mechanisms: A Narrative Review.” Sports Medicine 49:1173-1181.

DiGiovanna, E.L., S. Schiowitz, and D.J. Dowling, eds. 2005. An Osteopathic Approach to Diagnosis and Treatment. Lippincott Williams & Wilkins.

Kidd, R. 2009. “Why Myofascial Release Will Never Be Evidence-Based.” International Musculoskeletal Medicine 31 (2): 55-56.

Laimi, K., A. Mäkilä, E. Bärlund, N. Katajapuu, A. Oksanen, V. Seikkula, J. Karppinen, and M. Saltychev. 2018. “Effectiveness of Myofascial Release in Treatment of Chronic Musculoskeletal Pain: A Systematic Review.” Clinical Rehabilitation 32 (4): 440-450.

McKenney K., A.S., Elder, C., Elder, and A. Hutchins. 2013. “Myofascial Release as a Treatment for Orthopaedic Conditions: A Systematic Review. Journal of Athletic Training 48 (4): 522-527.

Wiewelhove, T., A. Döweling, C. Schneider, L. Hottenrott, T. Meyer, M. Kellmann, M. Pfeiffer, and A. Ferrauti. 2019. “A Meta-Analysis of the Effects of Foam Rolling on Performance and Recovery.” Frontiers in Physiology 9 (10): 376.