What's the best way to recover from a run?
A. Rest day or some variation of plain old time to recovery
C. Foam rolling
D. Good nutrition/re-fueling
E. A combination of rest, sleep, and good nutrition
Ok, ok I kinda gave away the answer there. In my opinion, the answer is "E."
What combination of the above answers do you ACTUALLY do on a daily/weekly basis to assist your own recovery?
Foam rolling is the easy answer, isn't it? Because you can roll around on that pillar of styrofoam or rub weird mobility contraptions on your legs for 10 mins and say "ok! I'm all recovered!"
Well, I've done that before.
All of this isn't to say foam rolling is "bad" or "useless". It's not a waste of time, especially if YOUR body responds well to it. Mine responds so-so; it doesn't always do a whole lot for me.
I still prescribe in the clinic, but I better see immediate results in my runner-patient to justify it. Because I don't want to waste your precious time telling you to roll around on this thing and for you not get any benefit out of it.
With me so far?
So the next question is WHY? Why foam roll at all, what is it supposed to do, and how does this things work?
My goal with this blog post is to de-mystify foam rolling by breaking down a different blog post I LOVE! This one is written by a fellow PT, Dr. Todd Hargrove, for other physical therapists. It's filled with our technical and medical language, but please, still feel free to check it out.
My hope with my blog post is to make our professional jargon understandable for the everyday runner, because how are you supposed to learn if we don't explain it in a way you understand it?
Let's start with what you might have been told it's supposed to do. What do we think foam rolling does?
I know I've heard other PT's tell patients and runners tell other runners that foam rolling improves recovery by breaking up adhesions, aka muscle knots, or muscle/membrane tissues sticking together that shouldn't be stuck together. When those are broken up, your mobility improves by increasing muscle length. It also helps to reduce pain and delayed onset muscles soreness (DOMS).
Eh…here's why I struggle with this answer. How is all that supposed to happen by mashing soft tissues into submission with a styrofoam pillar?
The underlying problem with this theory and the corresponding thought that the more foam rolling you do, the better you'll feel, is that fascia, the connective tissue that the IT band (ITB) is made of, is tough stuff.
Let me explain.
In this study , scientists found it takes over 2,000 lbs of pressure to create a 1% change in your ITB.
A 1% change from +2,000lbs of pressure!
(For practical reference, that’s close to the tensile strength of steel.)
I don't think you can sit on a foam roller hard enough to generate +2,000lbs of pressure!
(I don't think you'd really want to either.)
So then WHY do changes happen after foam rolling? Why do we feel loser or more flexible? If you're not actively changing the fascia of your ITB, then what the heck is going on when you foam roll?" How does it work?
Let's start here: have you ever foam rolled your glute or quad or calf, felt great, but then an hour or a day later, it feels just as tight?
I know this happens to me.
So what went wrong? Did I foam roll "incorrectly"? Am I broken since the foam rolling "didn't work?" Or maybe it did..?
And around and around we go…
The truth is: if foam rolling truly did break down these fascial adhesions, then why would we need to foam roll again and again? Did these adhesions magically return?
I'm a huge fan of Dr. Hargrove's explanation:
"The temporary nature of the results strongly suggests a nervous system mediated mechanism for efficacy, not a structural one…A foam roller puts pressure on all the other tissues in the body, and they all communicate with the CNS [the central nervous system aka your brain], which controls how we move and feel. Isn’t the CNS the most obvious place to look for changes after foam rolling?"
What he's saying here is that we know, scientifically and objectively, that by foam rolling we are not creating a structural difference in the tissue of the ITB or its surrounding muscles.
What we are doing, is creating an input (the pressure of foam rolling) and our brain is gathering that information and providing an output, the changes we experience afterwards. Dr. Hargrove is suggesting our nervous system is the star player here and our muscles and all the fancy receptors within our muscles are the sidekicks.
Here's where Dr. Hargrove challenged ME as a physical therapist.
I heard (and agreed more with) the explanation that foam rolling works through "proprioceptive enhancement – stimulating mechanoreceptors in the muscles and/or fascia, such as golgi tendon organs, or muscle spindle fibers, or ruffinis, or pacini's [the fancy muscle and joint receptors I mentioned above that all take information from your environment and relay it to your brain]."
Here's where things get good. Dr. Hargrove's point is:
"If stimulating these mechanoreceptors explains the claimed benefits of foam rolling, then why wouldn’t you just stretch and move around… but within the context of functional movements? Can the foam roller, which doesn’t really provide that much movement or stretch to the target muscle or fascia, provide more proprioceptive stimulation then functional movements like the squat, lunge or reach? I think not."
That made me take a good hard long look.
Because again, how does mashing your muscle into a foam roller provide better, more valuable than a squat to bend down and pick up your kid?
Or a lunge to pick up clothes off the floor?
The key here is that our brains crave relevant information.
We naturally, automatically filter out any information that just doesn't matter to our survival.
You know how you first walk into grandma's house and smell the aroma chocolate chip cookies wafting from the kitchen? But after a couple minutes, you don't smell it anymore. Why? Because your brain has deemed that smell "pleasant" but not crucial. The chocolate chip cookies aren't threatening your survival (hopefully) so it decides to just not pay attention.
Something similar applies to foam rolling. Dr. Hargrove's point is this: "You need to provide the brain with information that is relevant to something that the brain cares about. The brain cares about how to move your body through functional patterns such as squats, lunges and hip hinges. How is the information derived from foam rolling relevant to these tasks? The brain is not interested in information just because it’s novel. The information must also help it solve movement problems."
So what's the answer then?
Fancy words: Diffuse Noxious Inhibitory Control (DNIC).
Diffuse Noxious Inhibibitty bobbitty what??
I know. I get it. Let's break this down.
To start, pain is in our brain.
It's still very real-like a papercut with lemon juice on it. But the intensity, or the "volume" of pain can be turned up (intensified) or turned down (decreased) by our brain based on the information it's receiving (from arms or legs or sensors in our tendons and ligaments, the list goes on!) Diffuse Noxious Inhibitory Control "means that the brain inhibits nociceptive signals from traveling up the spinal cord to the brain."
In other words…
This pain-modulating method of DNIC means that the brain stops, inhibits, outside pain source signals from traveling up the nerve highway that is your spinal cord to the brain, the end destination.
Think of it like holding up a stop sign to pain signals, essentially saying "nope. Road closed. You can't make your way up to the brain and tell us we're in pain."
(First, WOW! Is our brain powerful or what??) Second, so what the heck does this have to do with foam rolling?
This whammy of a sentence:
"The effectiveness of DNIC (the pain volume controlling method) in suppressing pain is highly dependent on the expectation that the counterirritant will have an analgesic affect. " (analgesic meaning ability to take away or decrease pain)
That IS what you expect when you foam roll, right?
So putting the puzzle pieces together:
"DNIC is a powerful but temporary way to reduce pain in one area by creating pain in another. It depends on a decision by the brain to ignore danger [pain] signals from the body. Expectation of benefit from the irritating [think 'painful'] stimulus plays a strong role. "
Ummm….excuse me. Is your brain blown as much as mine right now?
Essentially, when you foam roll, you mentally expect there to be some amount of "good pain" which will be beneficial in the long run. It becomes a "it's good for you, so eat your vegetables" sort of situation. Therefore, you may indeed experience a decrease in perceived pain levels afterwards because you told your brain to do so. You provided an additional stimulus, the "good pain" of foam rolling and told your brain "get over it".
You come off of the foam roller with decreased pain and way less stiffness than before (aka improved mobility).
Because the sensation of pain tells your brain and muscles to guard, get stiff, to NOT allow motion because it's deemed "unsafe". You just over-rode that function in the system. You told your brain, "hey get distracted by this other sensation of foam rolling and chill out on my hip flexors." Your brain obliged and your hip flexors relaxed, restoring healthy, appropriate mobility.
Science is cool.
And our brains are powerful.
And absolutely unique to each and every individual, which helps explain why the results of foam rolling are so dependent and different for every runner and why it works wonders for some and does nothing for others.
And that's ok.
You're not broken if it doesn't work for you and you can keep doing it if it truly helps with your recovery. But don’t feel you "have" to do just because everyone else is.
Learn the science. Inform yourself. And personalize your training routine.
Run strong. And Dare to Train Differently!
Until next time,
Dr. Marie Whitt // @ dr.whitt.fit