Myofascial Release Increases Flexibility and Range of Motion as Compared with Static Stretching
by
E. LaRell Stephens, Michael Pulley, Lee Torgerson, Karyl Sands, Kevin Greene
A Research Paper for EXSC 4300
November 22, 2011
Introduction
Flexibility is considered to be one of the five ways to measure the fitness level of an individual. Some may consider flexibility to be the most important level of fitness due to the fact that flexibility allows joints in the body to move with a full range of motion. Without full range of motion in the joints, athletes would have a difficult time competing at an optimal level. Muscles and muscle tendons cross over and connect to bones near the joint and when the muscle contracts it causes the bones to move around the involved joint(s). One of the main reasons why a joint would not be allowed to move through a full range of motion is; when the muscle or muscle tendons are too tight the involved bones are not allowed to move through the joint’s available range of motion.
There have been many studies proving the effectiveness of static stretching to reduce injury and improve range of motion in a subject. Small and McNaughton (2008) cited many works which showed increased range of motion through static stretching. One study compared static stretching to eccentric stretching and while eccentric exercises did improve range of motion, static stretching had a greater affect (Nelson and Bandy, 2004). Researchers mostly agree that static stretching will increase range of motion but have questioned whether static stretching could potentially do harm to the body and ultimately have an adverse affect. Nessel (2007) explains that static stretching is stretching to the point of discomfort but staying in that point of discomfort for too long can possibly produce damage to muscle and/or
connective tissue. This opens the question, “Is there a method that can create the same or even a better results than static stretching without having to stretch the muscle and surrounding tissues which may increase the chance or risk of injury?”
Myofascial release is a fairly new technique which focuses on stretching the fascia that surrounds the muscle by using a rolling pin type device. Fascia is a thick, tough covering of connective tissue that surrounds muscle. When stretching the fascia, the fascia will loosen which will allow the muscle fibers to contract easier and glide more smoothly within the fascia. This will ultimately improve flexibility and range of motion.
Purpose Statement
The purpose of this study is to show that myofascial release is a viable option to static stretching. We believe that this study will show myofascial release will increase flexibility in the hamstrings as well or better than static stretching.
Hypothesis
It is believed that myofascial release will increase range of motion (ROM) as well as, or better than typical static stretching.
Basic Assumptions
It is assumed that the participants are physically active on a regular basis of at least three hours a week and have no known physical disabilities that will alter results. It is assumed that two laps around the track would be a good enough warm up. It is assumed that a single session of static stretching and/or myofascial release is enough to see a change in hamstring flexibility. Also, that the participants would give maximal effort during the protocols of the study.
Limitations
It is hard to know if the participants put as much effort into the static stretching protocol as they could. Also, when we were recording their pretest and post test results we are not sure if full effort was made to stretch as far as they could which could have an adverse affect on our results. Temperature may also have played a role as there was a large difference in exterior temperature between the days that the stretching protocols were administered. Stretching protocols took place inside, but it is hard to know if the warm-up was sufficient to overcome that difference as many of the subjects had to walk outside to get to the testing site. Another limitation was the recording of the flexibility itself. We used a goniometer to measure the angles of the hip joint and knee joint but human error is always a factor and may have occurred while reading the measurements. It was also difficult to maintain the hip angle while testing and recording the knee angle which is how we measured the final angles.
Delimitations
We have selected self considered active individuals (both male and female) with a three year history of a minimum of three hours of exercise activity a week. All subjects are eighteen to thirty years old. All subjects preformed both static stretching and myofascial release protocols but on different days. We compared the pre and post results between the two protocols for each subject to see if there were any changes.
Operational Definitions
Range of Motion is the amount of movement, measured in angles between the two adjoining segments around a joint. Flexibility was measured in degrees by using a goniometer to measure how far the subject could passively extend the left knee joint while having the hip joint in a flexed position.
Significance
The significance of this study is to show that myofascial release can be used as a replacement for static stretching without sacrificing range of motion.
Literature Review
In providing practical basis of stretching, the review of literature will discuss the differences found with static stretching and myofascial stretching. This will include methods, type of testing which was performed and the tools used for myofascial stretching.
Static Stretching
We tested a population of active college age subjects. In a study by O'Sullivan, Murray and Sainsbury in 2009, static stretching was studied and compared to dynamic stretching and a PKE (passive knee extension) test was done to measure the change in range of motion (ROM). They first did a warm-up, established a baseline, and then put the subjects through a variety of stretching protocols including static and dynamic depending on the group assigned randomly (O’Sullivan et al, 2009). We started by having subjects warm up, and then took baseline measurements. The next step was to use one of the two protocols for stretching, either myofascial release or static stretching. We then tested the subjects ROM using the goniometer to establish the increase/decrease angles at the knee joint. We put all subjects through the myofascial release protocol during the first session. In the second session all subjects were put through the static stretching protocol. This made it easy to see the immediate effect of the stretching protocol being performed.
Testing done by DDoi, Uracbe,Yamanake, Nomanu, and Kamiya (2010) studied the affects of static and dynamic stretching on the range of motion and strength. They tested a group of eighteen healthy Japanese women. They tested the range of motion of ankle dorsiflexion and muscle strength of ankle plantar flexion of subjects before stretching and just after stretching. We used this approach in our study when we decided to use healthy individuals and test their range or motion immediately after stretching. Bradley, Olsen, and Portas (2007) included a five minute cycle warm up before any of the test were administrated.
Protocol. The static stretching routine that was done in this study (described below) was also used in a previous study. The stretching was done in a study that compared isometric exercises to static stretching. The study had a significant increase of flexibility in the hamstring muscles over a period of time. The study showed an increase of sixteen to thirty two degrees (Makaruk, H., Makaruk, B., & Sacewicz, (2010). Our study only had one stretching session but due to the increase in flexibility in this previous study we felt like this stretching protocol would be sufficient.
Relationship to ROM. Small et al. (2008) cited many works which showed increased range of motion through static stretching. O’Sullivan et al. (2009) showed that improved range of motion with static stretching was achieved. DDoi et al. (2010) Found that the range of motion in subjects who did static stretching had increased immediately and it was maintained for ten minutes.
Instruments/Methods. O’Sullivan et al (2009) used a PKE ROM test to measure ROM and increased flexibility. There was a short warm-up performed then a baseline established. Once the baseline was established the stretching protocol was performed. In the case of O’sullivan et al. (2009) the two protocols were static and dynamic stretching. We dropped the dynamic stretching and substituted the myofascial release protocol.
Myofascial Release
A study performed by D’ Amico and Morin (2010) looked at muscle power, strength, and flexibility by the effects of myofascial release and comparing it with static. Our purpose is to determine if the technique of myofascial release can improve flexibility and range of motion and surpass that of static stretching. We used a tool called The Stick which is designed to improve sport performance and other activities by providing a deeper massage of the muscles. In a study that was performed by Mikesky et al. (2002), the acute effects of The Stick were tested. It was shown that in a 20-yard dash there were improvements among the athletes. With hamstring flexibility there was no greater than 3 degrees between any of the other types of stretching. In another study by Hickey (2000), using The Stick had a great improvement between flexibility, power, and speed among the treated group compared to the controlled group.
Protocol. For measuring flexibility, Mikesky et al (2002) used a Leighton flexometer/goniometer. Hamstring flexibility was measured with the subject supine on a training table. The flexometer was placed on a lateral aspect of the right thigh just proximal to the knee. The participants slowly flexed at the hip while keeping the ankle dorsiflexed and knee extended. Hickey (2000) had fifteen participants exposed to a test battery twice during a fourteen day period. After this time period, they received a ROM device and were instructed on how to use it. They did two treatments per day of fifty strokes on the quadriceps, hamstrings, calves, and lumbar spine. These treatments were done just after waking up in the morning and immediately after daily training session or during the evening if no training session was scheduled for that day. A control group did not participate with this device. After this fourteen day period, flexibility test were administered for final measurements.
Relationship to ROM. It is observed from the findings of McClellan, Padua, Guskiewicz, Prentice, and Hirth (2004) that there were significant increases in the flexibility of the athlete’s range of motion. Their research involved comparing three groups: no stretching (the control group), myofascial release, and static stretching. There were obvious results showing that there was a big difference in the no stretching group compared the other two stretching groups; however between the static and myofascial groups there did not yield any differences in range of motion. In another study by D’Amico et al. (2010) they also compared a static group and a myofascial group. The myofascial group didn’t illustrate any differences to the static group either.
Instruments/Methods. In our investigation, we used a passive method of the release of myofascia, which will be discussed in more detail later. In the approach of D’Amico et al. (2010), they used an active, self-application method of myofascial release. The way they did this was with a foam roller. It was placed underneath the subject perpendicular to their body as the subject was seated and their upper body was at ninety degrees. The subject started with foam roll at the knee and, while applying full body weight, they would roll up toward the buttock where the hamstrings originate. This movement was done in reverse and repeated for ninety seconds. In the study performed by Mikesky et al. (2002) and Hickey et al. (2000), they used The Stick which is a stick with plastic rollers throughout the middle to apply pressure to the muscles. The treatment can be performed by the individual and use on many muscle groups that may be harder with the foam roller.
Measurements/Tools. O’Sullivan et al. (2009) used the PKE ROM test to establish a baseline then to measure the differences in flexibility (ROM). We used a goniometer where they used a small device, with a needle that hung down as a pointer, which was attached to the proximal end of the lower leg. Mikesky et al. (2002) used a Leighton flexometer/goniometer to measure the degree of ROM for hamstring flexibility. A sit and reach test was used in the study performed by Hickey et al. (2000).
It is observed from these studies that myofascial release and static stretching both greatly improve flexibility and range of motion. However, in the limited comparisons that were illustrated in the studies that had participants doing static stretching and myofascial release (D`Amico et al, 2010; McClellan et al, 2004), there were no differences between the two.
Methods
Participants
All participants were college age (ages 18-30). Participants are active with a history of 3+ years with 3+ hours of exercise a week. Both males and females were allowed in the study with each participating in each stretching protocol to get an idea of the effects on a general population. For our study there were 3 females and 5 males participating.
Instruments and Measurements
The Stick which is a small roller was used to administer the myofascial release stretching to the group. The passive knee extension (PKE ROM) test was used to measure range of motion in all of the participants. The extension angle being recorded by a goniometer. A large rolled up mat was used in the static stretching protocol to elevate the leg while participating in some of the static stretching protocol.
Procedures
There were both males and females participating in both of the protocols. Static stretching protocol consisted of four static stretching exercises, explained below, for a period of five to seven minutes. Myofascial release protocol was performed by someone else, explained below, for a period of three minutes. The range of motion was determined by the PKE ROM test. This was measured with the participant laying flat on his/her back flexing the hip joint to preset angle (set at recording baseline). A small goniometer was used to measure the angle at the knee joint, to show the angles of movement. One of those administering the study performed all of the PKE ROM tests and recorded the results. The participants were tested (PKE ROM) before stretching session to establish a baseline. The test was administered again right after the stretching session to gather data for verification of change in ROM. The group participated in the assigned protocol then alternated between myofascial and static stretching protocols for the second trial done at a later date.
Static Stretching. The stretching exercises will focus on the hamstring muscle groups. Each stretch was held for thirty seconds with a twenty second rest period in between each stretch. The participants were taught the proper stretching protocol (listed below) at the beginning of the study.
Stretching protocol. (Participants completed four stretching exercises) First, the participants stood in front of a gymnastic box or something else that is roughly forty centimeters, placed a straight leg on it and bent their trunk forward with hips square to the stretching object. They did the same with the knee flexed at forty five degrees. Second, the participants laid on their backs and lifted a straight leg vertically with the other leg flat on the floor. While holding the leg that was vertical with their hands they slowly pulled the leg towards their torso. Third, the participants straddled their legs fully extended and bent their trunk forward to one of their leg and down the middle. Finally, the participants straddled their legs fully extended and then flexed their knee and moved their heel to the thigh of the extended leg. Then they bent their trunk forward to the extended leg.
Myofascial Release. The stretching exercises focused on the hamstring muscle groups. The protocol was administered by one of those who administered the study. With using good and even amount of force, the administrator rolled the myofascial device up and down the hamstring and upper calf of the subject. If pain occurred from too much force then the administrator would lessen the force being applied and would continue. The stretch was done for a period of three minutes focusing on the hamstrings and the upper calf.
Design and Analysis
This study is designed to measure the effectiveness of myofascial release stretching as compared with traditional static stretching. The data collected compared baseline results to those collected after the stretching protocol sessions. The results help us to determine which type of stretching increased the ROM and flexibility of the participants.
Results
Our average change was an increase in ROM of +1.25 degrees change (SD of 9.82) among subjects which participated in myofascial release. While we saw an actual decrease in ROM of -2.75 degrees (SD of 9.66) among subjects participating in static stretching. See Appendix B for collected data and Appendix D for graph of results. Alpha set at p<0.05, our T-test between change values of the two groups was 0.425. These results are not significant, but the study has merit as it showed that the myofascial release protocol was at least as effective as the static stretching.
Discussion and Conclusions
This study showed that there is promise in myofascial release as a possible replacement or substitute for static stretching. More studies should be done to better prove the effectiveness of myofascial release in other populations. They should also include variances in the length of time myofascial release is performed to determine a most affective duration.These further studies should also include greater control on the temperature, warm-up and use of different equipment to better and more accurately measure the involved angles. Additional studies can also view the differences between gender.
References
Bradley, P.S., Olsen, P.D., & Portas, M.D. (2007).The Effect of Static, Ballistic, and Proprioceptive Neuromuscular Facilitiation Stretching on Vertical Jump Performance.
D’ Amico, A., Morin, C., Bidgewater State University. (2010). Effects of Myofascial Release on Human Performance. http://www.fiteval.com/Site_1/Research_Study.html
DDoi. M., Uracbe, Y., Yamanaka, Y., Nomaru, S., & Kamiya, N. (2010). Changes in Range of Motion and Muscle Strength of the Ankle Joint after Static and Dynamic Stretching. Rigakuryoho Kagaku, 25 (5a), 785.789.
Hickey, B. (2000). The Efficacy of the ROM Device With Respect As An Ergogenic Aid With Respect to Select Measures of Power Generation, Flexibility And Speed. Florida State University College of Education. http://www.healingsearch.com/Stick/FSU_study.htm
Makaruk, H., Makaruk, B., & Sacewicz, T. (2010). The effects of static stretching and isometric strength on hamstring strength and flexibility asymmetry. Polish Journal Of Sport & Tourism, 17(3), 153-156.
McClellan EC, Padua DA, Guskiewicz KM, Prentice WE, Hirth C. Effects of Myofascial Release and Static Stretching on Active Range of Motion and Muscle Activity. Journal of Athletic Training 39, 98
Mikesky, A., Bahamonde, R., Stanton, K., Alvey, T., Fitton, T. (2002). Acute Effects of The Stick on Strength, Power, and Flexibility. Journal of Strength and Conditioning Research, 2002, 16(3), 446-450
Nelson, R. T., & Bandy, W. D. (2004). Eccentric training and static stretching improve hamstring flexibility of high school males. Journal Of Athletic Training, 39(3), 254-258.
Nessel, E. H. (2007). Does Stretching Still Fit in to a Sports Program?. American Swimming, 2007(1), 12-14.
O'Sullivan, K., Murray, E., & Sainsbury, D. (2009), The effect of warm-up, static stretching and dynamic stretching on hamstring flexibility in previously injured subjects. BMC Musculoskeletal Disorders, 10:37. doi:10.1186/1471-2474-10-37
Small, K., McNaughton, L., & Matthews, M. (2008). A Systematic Review into the Efficacy of Static Stretching as Part of a Warm-Up for the Prevention of Exercise-Related Injury. Research In Sports Medicine, 16(3), 213-231. doi: 10.1080/15438620802310784
Appendix A
Informed Consent
In the study that you will be participating in you will be tested to see if static stretching or myofascial release has a greater influence in your range of motion. We will be focusing on your hamstring muscle groups for this study. For a one week period you will be doing standard static stretching for about 8-12 minutes. These exercises will be taught to you by one of the researchers. For another one week period you will be doing a myofascial release with one of the researchers performing the exercises using a foam rolling pin. Before each trial you will be expected to run at a light pace for 5 minutes. After, the flexibility of your hamstring muscles will be tested by one of the researchers to establish a baseline. After recording your baseline you will perform the stretching protocol and we will again test your flexibility to see if a change occurs. There are very few risks involved in this study but if an injury does take place during this study, Utah Valley University or the researchers will not be held responsible or liable. We do expect that you will benefit from participating in this study. We believe that you will learn new stretching methods and you will increase your range of motion in your joints around your hamstring muscles. You are free to withdraw yourself from the study at anytime if you feel the need to do so. Your personal information and your results of the study will be kept anonymous. Please feel free to email us at pulley-3@hotmail.com if you have any questions. If you agree to meet these requirements that have been explained above, please sign and date this document below.
Name (print):
Signature: Date:
Appendix B
Data Collected
Myofascial Release Trial:
Pretest Post Test Change
Subject 1 131 135 4
Subject 2 138 135 -3
Subject 3 114 114 0
Subject 4 129 128 -1
Subject 5 125 131 6
Subject 6 134 130 -4
Subject 7 126 147 21
Subject 8 130 117 -13
Static Stretching Trial:
Pretest Post Test Change
Subject 1 124 124 0
Subject 2 124 116 -8
Subject 3 111 122 11
Subject 4 132 124 -8
Subject 5 129 136 7
Subject 6 126 114 -12
Subject 7 127 131 4
Subject 8 125 109 -16
Appendix C
Blank Data Collection Sheet
Myofascial Release Trial:
Pretest Post Test Change
Subject 1
Subject 2
Subject 3
Subject 4
Subject 5
Subject 6
Subject 7
Subject 8
Static Stretching Trial:
Pretest Post Test Change
Subject 1
Subject 2
Subject 3
Subject 4
Subject 5
Subject 6
Subject 7
Subject 8