IASTM and Foam Rolling: Do they work how you thought?

Disclaimer! Before you get bent out of shape and claim that I’m calling these useless interventions just know that I’m not at all. This blog post is intended to raise awareness on these increasingly popular tools. I have provided research as well as some of my personal opinion. Before throwing stones, please look objectively at the data I’m going to present and know that I am not calling these tools useless altogether- just that they may not work in the way you were taught.

  

Both Foam rolling and IASTM have exploded in popularity in the last decade. I can’t check my email or Facebook without seeing at least one ad from some company advertising their take on the soft tissue tools. Not to mention the gym/personal training world is constantly cluttered with every kind of foam roller ad, each making claims to “lengthen” this or “release” that. You can’t deny that the marketing is truly getting creative and definitely makes a good case with face validity to the average consumer. Maybe if the tool looks crazy enough, people will buy it. From sleek and smooth butter knives, jade rocks and meat tenderizer rollers, to plastic toys that look like they came straight out of an adult store.

 Holy hell this thing looks painful!!!!

 Mmmm makes me want toast

Uhhh....No comment

 

These interventions/tools are most often marketed and taught based on the notion that they lengthen/release fascia, break down adhesions, and/or tear up scar tissue….but do they really?

I don’t really want to get into an in depth review of fascia here as this is an incredibly lengthy subject, and Paul Ingraham has already done a very nice job here. I do however; believe it is quite a stretch to say that we are “releasing” and lengthening fascia with either of these techniques.  What does releasing fascia even really mean? Is it stretching? Is it breaking down? Is it a contraction that is decreasing force in force production? Chaudhry et al. came to the conclusion that “the palpable sensations of tissue release that are often reported by osteopathic physicians and other manual therapists cannot be due to deformations produced in the firm tissues of plantar fascia and fascia lata.” They came to this conclusion after using a three-dimensional model equation that revealed very large forces, outside the normal physiologic range (they calculated that supra-physiological forces of ~ 9,075N or 925kg), are required to produce even 1% compression and 1% shear in fascia lata and plantar fascia.¹ Meaning that we as manual therapists don’t have the strength with our hands, or our foam rollers, or even our butter knife tools to lengthen the fascia permanently. This tells us what fascial “release” is NOT, so what is it?

Fascia has been shown to be highly innervated and smooth muscle like contractile cells have been visualized interspersed throughout its network.^2,3 This could be explained by a theory that perceived alterations in soft tissue texture reported by clinicians and patients are due to neurophysiologic changes that result from mechanoreceptor stimulation as opposed to true mechanical changes. Schleip voiced this very theory in his 2003 paper Fascial Plasticity – A New Neurobiological Explanation by stating that “Fascia nevertheless is densely innervated by mechanoreceptors which are responsive to manual pressure. Stimulation of these sensory receptors has been shown to lead to a lowering of sympathetic tonus as well as a change in local tissue viscosity. Fascia and the autonomic nervous system appear to be intimately connected.”² This idea makes lot more sense when think about the forces we exert every day on our fascia. If mechanical deformation were the case I would have a completely flat butt and deep divots on my hamstrings based on the amount of time I spent sitting on a hard chair with my full body weight in PT school learning this B.S.

So, if it isn’t releasing fascia then clearly it has to be those darn fuzzy unicorns called adhesions right? I would love for this to be true… I really would. It would make manual therapy and my rationale for scraping cocoa butter onto a patient’s toast…I mean leg… so much easier to explain to them. The only problem is there is no research to demonstrate or visualize these mysterious little adhesion devils existing, and if they do exist we definitely haven’t ever demonstrated an accurate and reliable way to locate and diagnose them with an objective evaluation or palpatory examination. Greg Lehman really does a great job of voicing my thoughts here(read the comments between Lehman and Spina at the end for a great discussion):

“Adhesions, adhesions, scar tissue, scar tissue, restrictions, restrictions.  I have heard this for over a decade and I still don’t get it.  The use of the word “adhesion” sounds identical to the use of the word “subluxations” in chiropractic land.  Believe it or not there is more research behind subluxation than there is behind an adhesion.  I don’t know what an adhesion is.  It makes no sense.  If it is scar tissue than there is no way you are breaking it up with your hands.  Not possible.  Surgeons use knives for this.  Is it some stickiness between tissues.  Well don’t worry about it.  When you move, warm up, strength train it will go away.  Welcome to viscosity land.”

“And why do we get adhesions?  Sure, we can get scar tissue after some major trauma or surgery.  But why would be get adhesions with regular working out.  And this is what we hear.  We hear that adhesions follow because of microtrauma.  You know the same microtrauma that we create everytime we work out.  The same microtrauma that causes us to adapt, get stronger, jump higher, have a better immune system, stronger bones, denser tendons, better functioning nervous system.  But somehow this wonderful tissue stress causes the Hobgoblin “Adhesion”.  This makes no sense.  What a shitty evolutionary adaptation.  So those fit, strong, healthy people who have never had any “body work” must be riddled with adhesions.  Poor souls”⁴

-Dr. Greg Lehman

Lastly, if there were some sort of adhesions present between the skin and underlying fascia (not claiming there aren’t, they just haven’t yet been demonstrated in a study of live humans to date) how would compressing them while lying on a foam roller break these adhesions? How could compression shear away adhesions that stretching and exercise could not? This idea has never made sense to me. I have never been able to get gum off of the bottom of my shoe by stepping down even harder on the pavement compressing the gum further? Again, I’m not saying that foam rollers are useless at all. In fact, Bret Contreras, Chris Beardsley, and Andrew Vigotsky have done an excellent job of compiling all research to date on foam rolling here. I strongly recommend taking a read through as it is very nicely organized and thorough.

Hopefully, this will spark some critical thinking and discussion amongst your peers. We will never get out of the dinosaur ages of physical therapy while ideas like this are still the most prevalent in the profession. I am not claiming to know all the answers, only demonstrating that evidence should be used in critical thinking surrounding mechanisms of treatment interventions. Evidence may arise in the future that proves me completely wrong on this (I doubt it), but until there is solid supporting evidence we should not think about fascia as the easily manipulated/deformed structure that many clinicians do.

Thanks for reading,

Jarod Hall, PT, DPT, CSCS

1.  Chaudhry H, Schleip R, Ji Z, Bukiet B, Maney M, Findley T. Three-dimensional mathematical model for deformation of human fasciae in manual therapy. J Am Osteopath Assoc. 2008 Aug;108(8):379–90. PubMed #18723456 
2. Schleip R. Fascial plasticity: a new neurobiological explanation. Journal of Bodywork & Movement Therapies. 2003 Jan;7(1):11–19.
3. Schleip R, Klingler W, Lehmann-Horn F. Fascia is able to contract in a smooth muscle-like manner and thereby influence musculoskeletal mechanics. Proceedings of the 5th World Congress of Biomechanics, Munich. 2006:51–54.
4.  http://www.greglehman.ca/2012/10/26/fascia-science-stretching-the-relevance-of-the-gluteus-maximus-and-latissimus-dorsi-sling/
5. Thanks to the awesome PT for usage of hilarious photos.

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