Static Stretching & Foam Rolling: Ankle Dorsiflexion ROM

Effects of Static Stretching and Foam Rolling on
Ankle Dorsiflexion Range of Motion
JASON CHADWICK SMITH1, BRANDI R. WASHELL1, MARY FRANCES AINI1, SYDNEY BROWN1,
and MACGREGOR C. HALL2
Neuromechanics Laboratory, Department of Kinesiology, Coastal Carolina University, Conway, SC; and 2Beleura Health
Solutions, Mornington, Victoria, AUSTRALIA
1
ABSTRACT
SMITH, J. C., B. R. WASHELL, M. F. AINI, S. BROWN, and M. C. HALL. Effects of Static Stretching and Foam Rolling on Ankle
Dorsiflexion Range of Motion. Med. Sci. Sports Exerc., Vol. 51, No. 8, pp. 1752–1758, 2019. Static stretching (SS) has been used for inducing
acute and long-term increases in range of motion (ROM). Foam rolling (FR) has recently gained popularity for acutely increasing ROM. However, the long-term effects of FR on ROM have not been thoroughly evaluated. Therefore, the purpose of this study was to investigate the acute
and long-term changes in dorsiflexion ROM as a result of 6 wk of FR, SS, and FR followed by SS (FR + SS). Methods: Participants (n = 44)
were randomly assigned to FR, SS, and FR + SS groups. The FR group foam rolled the triceps surae. The SS group performed a wall stretch for
both legs. The FR + SS group performed FR immediately followed by SS. All groups completed 12 training sessions in 6 wk. Dorsiflexion
ROM was assessed before and after the first training session, before the second session of week 3, before and after the last session in week 6,
and at week 7. Results: There was a 4.0% acute increase in ROM at week 6 (P = 0.004) for all three groups. ROM increased 8.4% from week 3
to week 7 for all three groups (P < 0.001). When comparing week 1 baseline to week 7, ROM increased 18.3% for all three groups (P = 0.003).
Conclusion: SS and FR seem to be comparable in terms of increasing dorsiflexion ROM acutely as well as after 6 wk of training for
healthy, university-age participants. FR combined with SS does not seem to provide a synergistic effect on improving dorsiflexion ROM.
Key Words: SELF-MYOFASCIAL RELEASE, FLEXIBILITY
APPLIED SCIENCES
I
and dynamic stretching were all equally effective at acutely
increasing ROM. Konrad et al. (12) reported a 4.3% increase
in dorsiflexion ROM after police cadets completed four sets
of 30 s of SS. Morse et al. (19) reported a 16.4% acute increase
in dorsiflexion ROM after recreationally active men completed
five sets of 60 s of SS, with the maximum dorsiflexion angle
being reassessed after each set. Taniguchi et al. (20) reported a
30.7% increase in dorsiflexion ROM after five sets of 60 s
of SS. Therefore, the acute change in dorsiflexion ROM could
be affected by stretching intensity and stretching duration.
SS is an effective method for inducing long-term changes
in ROM. Konrad and Tilp (21) reported 17.5% increase in
dorsiflexion ROM after 6 wk of SS, which included five sessions per week with four sets of 30 s of stretching per session,
in healthy police cadets. Hayes et al. (22) reported a 42.25%
increase in dorsiflexion ROM after healthy volunteers completed 6 wk of SS, which included five sessions per week with
each session containing three stretches performed for five sets
of 30 s. It seems that total duration of stretching per session
and total number of sessions influence the magnitude of the
chronic change in ROM. Despite this variability in SS prescription, Medeiros and Martini (7) concluded that long-term
SS results in approximately a 5° increase in dorsiflexion ROM
in a recent meta-analysis.
Another method for increasing ROM that has been used in
clinical settings and has recently gained popularity with the
general population is the use of foam rolling (FR). This method
requires the participant to use the bodyweight to create pressure
mproving one’s range of motion (ROM) has primarily
been attempted through various stretching methods as part
of physical fitness and rehabilitation programs with the intention of improving performance and reducing risk of injury
(1–5). A variety of stretching methods including static stretching
(SS), ballistic stretching, dynamic stretching, and proprioceptive
neuromuscular facilitation can be used to increase ROM (6–8).
In addition, an active warm-up can increase ROM (1,9–11).
Because of its applicability to a wide range of clinical and
nonclinical populations as well as its ease of use and safety,
SS is probably the most common form of flexibility training
used to improve ROM (12–17). The magnitude of the impact
of stretching has on ROM is likely influenced by the muscle
group(s) used during the flexibility training.
Several studies have evaluated the acute change in ROM
due to SS. In a recent systematic review, Behm et al. (18)
concluded that SS, proprioceptive neuromuscular facilitation,
Address for correspondence: Jason Chadwick Smith, Ph.D., 105 Independence
Drive, Williams-Brice Building, Room 111, Department of Kinesiology,
Coastal Carolina University, Conway, SC 29526; E-mail: [email protected].
Submitted for publication October 2018.
Accepted for publication February 2019.
0195-9131/19/5108-1752/0
MEDICINE & SCIENCE IN SPORTS & EXERCISE®
Copyright © 2019 by the American College of Sports Medicine
DOI: 10.1249/MSS.0000000000001964
1752
Copyright © 2019 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
FOAM ROLLING AND STATIC STRETCHING
dorsiflexion ROM before and after 6 wk of training with the
acute response after training to be different than pretraining
for all three groups. We also hypothesized that ROM would
be improved for SS and FR followed by SS after 6 wk. We
did not anticipate any long-term change in ROM for FR alone.
METHODS
Forty-four healthy, university-age participants (n = 18 female
(mean ± SD): age, 21.3 ± 2.0 yr; height, 162.7 ± 5.6 cm; mass,
70.4 ± 20.6 kg); n = 26 male (mean ± SD): age, 21.7 ± 1.7 yr;
height, 176.0 ± 5.9 cm; body mass, 82.7 ± 11.9 kg)) were
assigned to one of three groups (SS (n = 17), FR (n = 16), or
the combination of FR and SS (FR + SS; n = 11)) using an online algorithm (www.randomization.com). At the beginning
of the study, all participants completed the written informed
consent form and health history questionnaire before having
their dorsiflexion ROM assessed. All participants reported that
they had not performed any lower extremity stretching, therapeutic massage, or FR within the month before participation.
They were also instructed to refrain from stretching, FR, and
therapeutic massage outside the study during their participation. The participants stretched and/or foam rolled both lower
legs; however, only the dorsiflexion ROM from each subject’s
dominant leg (kicking leg) was assessed to standardize the
procedure. Each participant had their ROM assessed at the
same approximate time of day throughout the study. Participants came to the laboratory twice per week for 6 wk to undergo the appropriate experimental treatment. We chose two
sessions per week to minimize scheduling conflicts and ensure
appropriate supervision of each session in the laboratory rather
than allowing sessions to be completed outside the laboratory.
Sessions were separated by at least 48 h. If they missed a session, they were required to come to the laboratory for three
sessions during the following week, with the first session of
that week counting as the second session of the previous week.
Thus, 12 experimental sessions were completed in 6 wk for all
participants. During week 7, dorsiflexion ROM was assessed
a final time without any intervention. To ensure compliance
and proper technique, all sessions were supervised by a member of the research team. All procedures were approved by the
university’s institutional review board (Protocol No. 2017.15).
Ankle dorsiflexion ROM assessment. Each participant performed a wall stretch to assess dorsiflexion ROM in
their dominant leg. Foot position was standardized for all measurements and stretches. With their dominant foot perpendicular to the wall, the subjects placed their weight on the outside
edge of the sole of their foot to keep the talus in a neutral
position, which should maintain the arch (37). Then, they
pressed their first toe to the ground and held this position as
they lunged forward with their nondominant foot while the
knee of the dominant leg was in full extension, placing their
hands on the wall for balance. The end point of their ROM
was defined as the maximum point of discomfort without
reaching their pain threshold. Once maximum dorsiflexion was
achieved, a digital torpedo level (Model 320.48295; Craftsman)
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1753
APPLIED SCIENCES
between the foam roller and the muscle group(s) being foam
rolled. Using a back and forth motion, the foam roller is rolled
over the length of the muscle in an effort to improve ROM.
Several studies have documented acute increases in ROM
(23–26). The magnitude of this acute response varies based
on the muscle group and surrounding tissues being foam
rolled (27). García-Gutiérrez et al. (28) demonstrated a 6%
increase in dorsiflexion ROM after three sets of 20 s of FR
were completed. Similarly, Halperin et al. (29) demonstrated
~4% increase in dorsiflexion ROM after three sets of 30 s of
roller massage. Conversely, de Souza et al. (27) reported ~11%
increase in dorsiflexion ROM when participants completed two
sets of 10 repetitions and 20 repetitions of FR. Therefore, the
acute increase in dorsiflexion ROM also seems to be dependent on the FR stimulus.
There is conflicting and limited research on the long-term
effects of FR on ROM. Junker and Stöggl (30) reported a
3-cm increase in the stand-and-reach test after 4 wk of FR
the hamstrings. Participants performed three sets of 10 rolls
during each session with three sessions performed each week.
Hodgson et al. (31) reported no long-term change in hamstring
or quadriceps ROM after 4 wk of roller massage training three
times per week or six times per week. Hamstring flexibility
was assessed by performing active and passive hip flexion
while in the supine position with the knee in full extension.
Quadriceps ROM was assessed using a kneeling lunge position.
For each session, participants performed four sets of 30 s of
roller massage. Aune et al. (32) reported no long-term change
in dorsiflexion ROM in soccer players that performed three
sets of 60 s of FR daily for 4 wk. The differing results in these
studies may be attributed to differences in ROM assessment,
pressure exerted by the modality used (foam roller or roller
massage), and/or muscle groups rolled.
The research evaluating the synergistic effect of FR and SS
on ROM is sparse and conflicting. Škarabot et al. (33) demonstrated a 9.1% acute increase in dorsiflexion ROM when adolescent trained swimmers with FR experience performed FR
followed immediately by SS. This acute increase was significantly
greater than the 6.2% increase due to SS alone. Interestingly, FR
alone had no acute increase in ROM. However, Hodgson et al.
(34) reported no acute synergistic effect for hip flexion and knee
flexion ROM when recreationally trained subjects performed
30 s of SS followed by 30 s of roller massage. The longterm effects of FR alone or combined with SS have not been
thoroughly evaluated. Mohr et al. (35) reported a 23.55° increase in hip flexion ROM compared with baseline after six
sessions of FR and SS in hamstring flexibility in patients with
limited flexibility. However, this change in ROM was determined by comparing the baseline assessment to the postintervention assessment at the end of the six sessions. Therefore, it
is difficult to separate an acute response from a long-term response to FR and SS (36). Therefore, the purpose of the current
study was to investigate the acute and long-term effects of 6 wk
of SS and FR, separately and combined, on dorsiflexion ROM.
We hypothesized that there would be differences in the acute
response to SS, FR, and FR followed by SS in terms of
APPLIED SCIENCES
FIGURE 1—Timeline for ROM assessments and experimental treatments (SS, FR, and FR + SS). *ROM assessments used for statistical analysis.
with an accuracy of ±0.1° was placed on the anterior shaft of
the tibia with the most superior edge of the level immediately
inferior to the tibial tuberosity. Two of the authors measured
ROM for all participants. To avoid variability across raters,
the same author tested the same participants throughout the
study. These authors were blinded as to which group participants belonged. Three trials were performed during each assessment, with the trial producing the greatest dorsiflexion
ROM being recorded for statistical analysis. Figure 1 shows
the timeline for ROM assessments as well as when experimental treatments were conducted. Although we measured
ROM during one session each week, only ROM data from
the first session of week 1, the second session of week 3,
the last session in week 6, and week 7 were used for statistical analysis.
SS group. Participants in the SS group performed the wall
stretch as previously described for both legs. Each stretch was
held for 30 s. One set was performed on the nondominant leg
followed by one set performed on the dominant leg. A total of
three sets of 30 s were completed for each leg based on
Škarabot et al. (33).
FR group. Participants in the FR group used a foam roller
on the posterior aspect of their lower legs using a high-density
ethylene vinyl acetate foam roller (36 inches long, 6 inches in
diameter; yogaaccessories.com). A member of the research
team demonstrated the appropriate technique. With the nondominant lower leg laying on the foam roller, the participants
used both hands and the dominant foot on the floor to support
their weight (Fig. 2). A metronome set to 60 bpm was used to
control the speed of FR. Participants used their arms and non–
foam-rolled leg to propel themselves forward and backward to
roll muscle belly of the triceps surae over the foam roller.
They instructed not to foam roll down the Achilles tendon.
With each beep of the metronome, participants either foam
rolled up the lower leg or down the lower leg. Participants
were instructed to foam roll over the muscle belly and avoid
the popliteal fossa and gastrocnemius’ tendon origins. After
30 s of FR, the participant switched leg positions and foam
rolled the dominant lower leg. A total of three sets of 30 s of
FR was performed on both legs.
FR + SS group. Participants in the FR + SS group performed
FR in the same manner as the FR group followed immediately
by SS performed in the same manner as the SS group.
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Official Journal of the American College of Sports Medicine
Statistical analysis. Based on previous work (30), a
power analysis determined that at least nine subjects were
needed per group based on an α of 0.05 and a power of 0.80.
Specific comparisons were planned a priori. A one-way ANOVA
was used to assess differences in ROM across groups in the initial
baseline pretest measure. To assess differences in the acute response to training, ROM scores from the first day of training
(pretest and posttest) were compared with ROM scores on
the last day of training from week 6 (pretest and posttest)
across groups using a 3 4 (group–time) repeated-measures
ANOVA. Long-term changes in ROM were statistically analyzed using a 3 3 (group–time) repeated-measures ANOVA
on the pretest ROM score from week 1 and ROM scores from
weeks 3 and 7. When statistical significance was determined,
post hoc tests using pairwise comparisons with a Bonferroni
correction were used. The α level was set to 0.05. Results
are reported as means ± SD.
RESULTS
Acute response. There were no differences in pretest
ROM scores from week 1 across groups (P = 0.308). Because
FIGURE 2—FR technique for participants in the FR and FR + SS groups.
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of a significant Mauchly test for sphericity (P < 0.001),
Greenhouse–Geisser correction was used when comparing
the acute ROM response from week 1 to the acute ROM response
from week 6. The results of the 3 4 repeated-measures
ANOVA test for the acute response to training reported no significant interaction across groups. However, there was a significant
main effect for time (F = 8.992, P = 0.001, η2p = 0.180, 1 −
β = 0.934). Results of the pairwise comparisons showed that there
was no difference before and immediately after the first day of
training for any of the groups. During week 6, all three groups
demonstrated an acute increase in ROM (P = 0.004). With all
three groups combined, ROM increased by 4.0% during the
last day of training in week 6. Although not significantly different from each other, the percent change in ROM during
the last session in week 6 was 4.7%, 3.2%, and 4.3% for the
SS, FR, and FR + SS groups, respectively.
Long-term response. Because of a significant Mauchly
test for sphericity (P < 0.001), Greenhouse–Geisser correction
was used when comparing the dorsiflexion ROM across week
1 pretest, week 3, and week 7. The 3 3 repeated-measures
ANOVA that assessed longitudinal changes in ROM across
groups demonstrated no significant interaction (P = 0.314).
However, there was a main effect for time (F = 8.661,
P = 0.002, η2p = 0.174, 1 − β = 0.887). For all three groups,
ROM was not significantly different from week 1 to week 3
(P = 0.287), but increased from week 3 to week 7 by 8.4%
(P < 0.001). Although not significantly different from each other,
ROM increased from week 3 to week 7 by 10.6%, 5.6%, and
9.0% for SS, FR, and FR + SS, respectively. From week 1
to week 7, ROM for all three groups increased by 18.3%
(P = 0.003). Although not significantly different from each
other, ROM increased from week 1 to week 7 by 15.0%,
25.1%, and 13.5% for SS, FR, and FR + SS, respectively. Table 1
shows the dorsiflexion ROM for each group across time.
DISCUSSION
TABLE 1. Dorsiflexion ROM for all SS, FR, and FR followed by the SS (FR + SS) groups across time.
Group
Week 1 Pretest
Week 1 Posttest
Week 3
Week 6 Pretest
Week 6 Posttest*
Week 7**,***
SS
FR
FR + SS
38.0 (2.5)
32.5 (2.6)
33.9 (2.9)
39.7 (2.5)
34.4 (2.5)
34.9 (2.9)
38.6 (2.4)
38.4 (2.5)
34.5 (2.8)
41.6 (2.4)
39.0 (2.5)
36.5 (2.8)
42.9 (2.4)
40.4 (2.5)
38.1 (2.8)
42.8 (2.2)
40.2 (2.3)
37.0 (2.6)
Means (SD) are in degrees.
*Significantly different from week 6 pretest for all groups (P = 0.001).
**Significantly different from week 1 pretest (P < 0.001).
***Significantly different from week 3 (P < 0.001).
FOAM ROLLING AND STATIC STRETCHING
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1755
APPLIED SCIENCES
The purpose of this investigation was to compare the acute
and long-term changes in dorsiflexion ROM for SS, FR, and
FR + SS. Participants developed an acute increase in ROM
over time for all three groups. In addition, ROM improved
for all three groups over the duration of the entire study. Statistically significant changes in ROM occurred during the latter
half of the study. The combination of FR and SS did not provide a synergist effect on increasing ROM acutely or over
6 wk of training. To our knowledge, this is the first study evaluating the effect of several weeks of FR + SS on ROM.
SS. The SS results of our study are in partial agreement
with previous studies. Although we did not have an initial
acute response to SS during the first day of training, we did
see a 4.7% acute increase in dorsiflexion ROM during the last
day of training. Konrad et al. (12) also reported an acute increase of 4.3% in dorsiflexion ROM after police cadets completed four sets of 30 s of SS. Kay et al. (37) reported an
acute increase of 5.2% in dorsiflexion ROM after three sets
of 20 s of SS for recreationally active individuals, although this
acute response was not different from the change in ROM
when performing isometric contractions. Škarabot et al. (33)
reported an acute increase of 6.2% in dorsiflexion ROM after
three sets of 30 s of SS in resistance-trained, adolescent swimmers. In the previously mentioned studies, no attempt was
made to standardize the position of the talus during stretching
or during ROM assessment. In the current investigation, we
attempted to place the talus in a neutral position by having
the participants maintain the arch while stretching and while
having their ROM assessed. Previous research has shown that
subtalar joint position can influence dorsiflexion ROM (38).
Unfamiliarity with this novel foot position in the current study
may have increased antagonistic activity, thereby restricting
the participants’ dorsiflexion ROM during week 1. Future studies
may want to investigate different methods for standardizing foot
placement that are less novel or attempt to implement a familiarization session that does not affect ROM.
In regard to long-term SS regimes, Medeiros and Martini (7)
concluded in a recent systematic review and meta-analysis that
dorsiflexion ROM can be improved by 5.17° using SS, regardless
of dosage. Our long-term SS changes in ROM (4.8° increase)
were in agreement with their conclusions. Blazevich et al. (39)
demonstrated a 19.9% increase in dorsiflexion ROM after four
sets of 30 s of SS, which was performed twice daily over 3 wk.
Konrad and Tilp (21) reported a 17.5% increase in dorsiflexion
ROM after four sets of 30 s of SS performed for five sessions
per week for 6 wk. Hayes et al. (22) reported a 42.25% increase
in dorsiflexion ROM after 6 wk of SS, which was performed five
sessions per week with each session containing five sets of 30 s of
stretching. In the current study, the 4.8° increase in ROM due to
SS resulted in a 12.6% increase in ROM after three sets of 30 s of
SS, which was performed twice per week for 6 wk. Differences in
the magnitude of percent change between the current study and
previous studies may be attributed to differences in SS dosage
and number of stretching sessions completed.
Acute increases in ROM due to SS have been attributed to
an increased stretch tolerance (6,40) and/or an increased compliance of the musculotendinous unit (6,19). Whatman et al.
APPLIED SCIENCES
(41) documented acute changes in passive stiffness after four
sets of 20 s of hamstring stretching. Although musculotendinous
unit compliance remained increased for at least 20 min after treatment, they reported that the only clinically meaningful posttest
assessment of passive stiffness was immediately after treatment.
Interestingly, Konrad and Tilp (21) reported no changes in
muscle stiffness, tendon stiffness, fascicle length, or pennation
angle after 6 wk of plantar flexor SS. They concluded that
these long-term changes in ROM due to SS were attributed
to an increased stretch tolerance possibly due to adaptations
to nociceptive endings (21). Previous research has suggested
that the increased ROM in healthy individuals due to SS training protocols lasting no more than 8 wk seems to be caused by
an increased stretch tolerance (42,43). Therefore, the longitudinal changes in ROM due to SS in the current investigation
may be due to an increased stretch tolerance.
FR. In the current investigation, there was no acute change
in dorsiflexion ROM due to FR on the first day of training.
Škarabot et al. (33) also evaluated the acute effect of SS, FR,
and FR + SS using the same dosage of FR (three sets of
30 s) as the current investigation. Although they did not control the speed of FR, their FR alone results were similar to ours
in that there was a nonsignificant 2.8% acute increase in
dorsiflexion ROM. However, the acute response during the
last training session for the current study demonstrated a 3.2%
increase in dorsiflexion ROM for the FR group. Our results
are also similar to Halperin et al. (29), who documented a
3.6% increase in dorsiflexion ROM 1 min after subjects completed three sets of 30 s of roller massage at a rate of one roll in
1 s, which is the same as our FR protocol. Although no study
to date has compared them directly, this suggests that FR and
roller massage produce similar results. Aune et al. (32) demonstrated a 9% increase in dorsiflexion ROM 30 min after participants completed three sets of 60 s of FR. This suggests that a
dose–response relationship exists between FR and the magnitude of the acute increase in ROM.
In the current study, we reported a 25.1% increase in
dorsiflexion ROM using FR after 6 wk of training. Although
this percent increase is not statistically different from the improvements in ROM induced by SS alone or FR + SS, this
study is one of the very first investigations into long-term
changes in ROM induced by FR. Aune et al. (32) reported a
7% improvement in dorsiflexion ROM when participants performed three sets of 30 s of FR daily for 4 wk, which was not
different from the increase in ROM induced by eccentric training. However, the FR speed was not standardized among participants. Hodgson et al. (31) also reported no improvement in
hamstring ROM after 4 wk of FR using four sets of 30 s of
roller massage performed either three times per week or six
times per week with the same cadence as the current investigation. However, they had seven to eight subjects in each group.
Junker and Stöggl (30) reported 3- or 4-cm increases in hamstring flexibility as measured by the stand-and-reach test after
participants completed 4 wk of FR or proprioceptive neuromuscular facilitation training, respectively. Their FR protocol
consisted of three sets of 10 rolls back and forth over the
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Official Journal of the American College of Sports Medicine
hamstrings. The differing results between these previous studies and our current study may be attributed to differences in FR
speed and duration as well as sample size. Furthermore, hamstring flexibility may be due to limitations in neural tension
rather than any myofascial component (44).
Research studies evaluating FR on the contralateral limb
have documented acute increases in ROM (28,45), suggesting
some neural involvement as a potential mechanism. In addition,
changes in pain pressure threshold have been documented immediately after FR (46–48) or roller massage for the rolled muscle groups (47–49) as well as the contralateral muscle groups.
This suggests that FR’s mechanism for an acute increase in
ROM is likely due to an increased stretch tolerance with some
neural involvement. Another possible mechanism is an increased blood flow to the area, thereby producing a warm-up
effect. Okamoto et al. (50) documented significant increases
in nitric oxide concentration after participants performed 20
repetitions of FR over the adductors, hamstrings, quadriceps,
iliotibial band, and trapezius. Hotfiel et al. (51) demonstrated
an increased blood flow to the lateral thigh after three sets of
45 s of FR. In theory, this could increase local temperature
in the surrounding tissues to improve ROM and warrants future study. Long-term changes in ROM due to FR may also
be attributed to an increased stretch tolerance and/or increased blood flow. Future studies may wish to evaluate these
potential mechanisms.
FR + SS. To date, there are only two studies evaluating the
synergistic effect of FR + SS, excluding the current investigation, and one study evaluated the synergistic effect of SS
combined with roller massage. One study demonstrated a 9.1%
acute increase in ankle ROM when adolescent swimmers who
have been using FR performed FR + SS when using the Grid
Foam Roller, which seemed to apply more pressure than traditional foam rollers (33). Participants placed the contralateral leg
on the foam-rolled leg to increase the pressure exerted by the
foam roller. This led to an increase in ROM that was statistically different from the 6.2% acute increase due to SS alone.
Methodological differences between this study and the current
investigation include differences in previous FR experience,
pressure exerted by foam roller, differences in assessing ROM,
and differences in potential experimenter bias. Škarabot et al.
(33) used subjects who were currently FR for the previous
6 months. We only recruited participants who had not participated in FR for the previous month. This could lead to differences in the amount of pressure each participant is able to
exert on the foam roller without inducing pain. Although previous studies have documented no difference in the increase in
ROM when varying the pressure exerted by a foam roller (52)
or roller massage (53) alone, we cannot rule out the possibility
of a synergistic effect on ROM for different pressures exerted
combined with SS. The differences in pressure used in these
studies and the present investigation combined with SS may
explain the differing results. Future studies may wish to explore
the optimal combination of pressure exerted by the foam roller
or roller massage and SS dosage to enhance ROM. Škarabot
et al. (33) assessed ROM by using a weight-bearing lunge test
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with the knee flexed. In the present study, a wall stretch was
used where the knee was placed in full extension. This difference in knee joint position could shift the restriction of ROM
from the gastrocnemius during the wall stretch to the soleus
during the lunge test. Because of the lack of research in this
area, it is unclear if differences in FR + SS in terms of ROM
were due to differences in knee position. Škarabot et al. (33)
were not blinded as to which treatment the subjects were receiving when assessing ROM. In the current investigation,
the two judges that were determining ROM were blinded as
to which group each participant was receiving.
Hodgson et al. (34) also documented an acute synergistic
effect for improving hip and knee ROM when performing a
single 30-s bout of SS followed by a single 30-s bout of roller
massage. This suggests that the hamstrings and quadriceps
may be respond more robustly to FR or roller massage combined with SS than the triceps surae. Mohr et al. (35) also
showed a synergistic effect of FR + SS in subjects with limited
hamstring flexibility after six training sessions. However, because of the nature of the experimental design, it is impossible
to separate the acute response from any long-term changes that
may have taken place (36). The current study was designed to
apply our results to the general population, separating acute and
long-term responses to FR + SS. Our findings showed that there
was no synergistic effect of FR + SS on dorsiflexion ROM for
the general population after 6 wk (12 sessions) of training.
Longer training studies, studies using a greater training dosage
and/or frequency, and studies evaluating muscles/joints that
have a larger ROM may show a different response to FR + SS.
In the present study, there was no synergistic effect of
FR + SS on dorsiflexion ROM for the young, healthy adult
population. FR and SS were equally effective at acutely increasing ROM after training and equally effective at increasing ROM
after 6 wk (12 sessions) of training. Different dosages of FR,
SS, and FR + SS may produce different results. Furthermore,
clinical populations may experience different results.
The authors of this study have no conflicts of interest to declare. The results of the present study do not constitute endorsement by the American
College of Sports Medicine. The results of the present study are presented
clearly, honestly, and without fabrication, falsification, or inappropriate
data manipulation. No funding was received for this investigation.
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