Foam rolling and myofascial pain

1. Myofascial Pain Syndrome and the
Effects of Self-Myofascial Release
Karlye Smith
Athletic Training Student
Gustavus Adolphus College

2. Objectives
• What is myofascia?
• What is myofascial pain syndrome?
• What are myofascial trigger points?
• What is myofascial release?
– Purpose
– Restrictions
• What is self-myofascial release?
• What is foam rolling and how to
• Anatomy review
• Interactive time

3. What is myofascial?
• Myo = muscle
• Fascia = connective tissue covering muscles
from head to toe providing support, stability
and cushioning
• Myofascial = dense, tough, flexible tissue that
surrounds and covers all muscles and bones

4. What do you believe pain is?
• Merriam – Webster definition of pain
– Physical suffering or discomfort caused by illness
or injury
• But, everyone’s perception and tolerance of pain is
different

5. Myofascial pain
• Refers to pain that is caused by muscular
irritation from repetitive movements
• Tightening of the fascial system is a protective
mechanism due to micro-trauma or an acute
injury

6. What is myofascial pain syndrome?
• Myofascial pain syndrome refers to pain and
inflammation in the body’s soft tissue
– This accounts for roughly 85% of pain most people
are having
• This is a chronic condition that affects the
fascia, which is a connective tissue that covers
the muscles, involving either a single muscle
or a group of muscles

7. What is myofascial pain syndrome?
• Myofascial pain syndrome may develop from a
musculoskeletal injury or from excess strain on a
muscle, ligament or tendon
• Signs & Symptoms:
– Muscle pain
– Tenderness and trigger points
– Spasm
– Muscle weakness
– Stiffness
– Problems sleeping

8. What are myofascial trigger points?
• With myofascial pain syndrome, there are hypersensitive
pressure points in muscles that can cause either pain or
referred pain
– Referred pain is pain felt at a site other than the location of the
cause
• A common example of a trigger point is felt while foam rolling your
iliotibial (IT) band as it causes pain to radiate up to the hip or all the
way down the leg to the ankle.
• Trigger point occur due to repetitive motions or by stress
related muscle tension
• Trigger points can also occur due to trauma, such as
accidents or sports injury
– Other causes include long term muscle strain from poor
ergonomics, posture and physical or emotional stress.

9. What are myofascial trigger points?
• Two types of trigger points:
– Active which is an area of extreme tenderness that is
typically found within the muscles and may cause
weakness or restriction in movement
– Latent are inactive and cause no pain during activities
but are tender when touched. These points can be
activated when the muscle is strained, fatigued or
injured
• Trigger points cause:
– Tenderness
– Tingling
– Burning
– Weakness

10. What is myofascial release?
• Myofascial release is a soft tissue therapy for
treatment of muscle immobility and pain.
– This is most commonly done by massage
therapists, physical therapists and athletic trainers
• The goal of myofascial release is to elongate
and soften the connective tissue

11. Myofascial Restrictions
• Unwanted bonding may occur with
inflammation, injury, postural stress or lack of
full active range of motion
• Creates excessive deposits of tissue resulting
in thick bandaging around joints, fibrous
masses, and in belly of muscles
• Weakens the muscle and holds the skeleton in
insufficient alignment
Shah & Bhalara, 2012

12. Purpose of myofascial release
• Release the restrictions within the deeper
layers of fascia
• Allows for restoration of length and health to
the myofascial tissues will take the pressure
off the pain sensitive areas as well as restoring
alignment and mobility to the joints (Barnes, M. F.,
1997)
• Alleviation of pain, improvement of athletic
performance, and greater flexibility and ease
of movement to posture (Shah & Bhalara, 2012)

13. What is self-myofascial release?
• This is when an individual uses a soft object to
provide myofascial release under their own
power by using gravity to induce the pressure
– Foam roller
– Theracane
– Ball
• Tennis ball, soccer ball, softball, lacrosse ball, etc.
• Allows for the adhesions that have been made on
the fascia to get broken up or “looser”

14. Foam Roller
• Are inexpensive and effective tool that help break up the
adhesions
• There are multiple types of foam rollers
1. Grid roller
• Which is firm on the inside, but has a soft foam outer layer
• Best for serious massage work on injuries
2. Molded foam roller
• Which are tiny beads compressed into a solid log shape
• Know for their durability
3. EVA foam roller
• Easy to carry, keep their shape to provide a lot of pressure and last a
long time
4. High-density foam roller
• Best suited for serious athletes
5. Low-density foam roller
• Doesn’t work out the trigger points like the others
• Range in lengths 6”-36”

15. Grid Roller
Molded Foam Roller
EVA Foam Roller
High-Density Foam Roller
Low-Density Foam Roller

16. Benefits
• Correct muscle imbalances
• Increase extensibility of musculotendinous junction
– Ability to be stretched at muscle-tendon conjunction
– Flexibility
• Increase joint range of motion
• Decrease muscle soreness and relieve joint stress
• Decrease neuromuscular hyper tonicity
– Spasms
• Increase neuromuscular efficiency
– Ability of nervous system to recruit muscles properly to produce
and reduce force
• Maintain normal functional muscular length
Shah & Bhalara, 2012

17. IMAGINE…
• A bungee cord with a knot tied into it and
then envision stretching the cord. This creates
tension, stretching the unknotted portion of
the muscle and the attachment points. The
knot, however, has remained unaltered. Foam
rolling can assist in breaking up these knots in
the muscle

18. How to..
• Place the foam roller at the proximal portion of
the muscle
• Put full weight onto foam roller
• Roller distally, down the muscle massaging the
fascia
• Upon a sharp pain, back up and hold the position
• By holding position right before pain, allows the
fascia time to relax and release before continuing
to roll

19. How do I know when a release occurs?
• NOTE: a release may feel different to every
person
• Painful/tender → relief of symptoms
• Tension release, dispersive sensation
• Could feel some “crunchies” or “popping”

20. Warnings
• You may be sore the next day
• It should feel as if your muscles have been
worked/released, however you should not
push yourself to the point of excessive
soreness

21. Focus
• Hip Flexors
• Quads
• Hamstrings
• TFL and ITB
• Piriformis
• Calf
• Low Back

22. Hip Flexor Muscles
• Quadriceps Muscles
• Iliopsoas
– Iliacus
• Origin:
– Iliac fossa and Iliac Crest
• Insertion:
– Lesser Trochanter of femur
– Psoas Major
• Origin:
– Transverse process and
bodies of T12-L5
• Insertion:
– Lesser Trochanter of Femur
• Action (all):
– Hip Flexion

23. Hip Flexor
• Place the foam roller under your hip flexors. Using your arms or
leg that if off of foam roller, slowly move your body forward and
backwards allowing the foam roller to massage the front of your
hip and pelvis.
• This exercise can be performed on your forearms or hands and
with both legs off the ground or the leg that is not being
massaged in contact with the ground.

24. Quadriceps Muscles
• Rectus Femoris
– Origin:
• Anterior Inferior Iliac
Spine
• Vastus Intermedius
– Origin:
• Anterior Surface of
Femur
• Vastas Medialis
– Origin:
• Medial Surface of Femur
• Vastas Lateralis
– Origin:
• Lateral Surface of Femur
– Insertion (all):
• Tibial Tuberosity via the
Patellar tendon
– Action (all):
• Knee extension and Hip
Flexion

25. Quads
• Position yourself face-down with
both thighs resting on top of the
foam roller. Support yourself on
your elbows and forearms, and
keep your abdominal and back
muscles lightly flexed to stabilize
your spine.
• Roll slowly back and forth on the
foam roller, from just above your
knees to just below your hips, and
pause at any spot that feels
especially tender. Your toes should
drag the floor.
• To dig down deeper into the muscle
and increase the intensity of this
exercise, tilt your body to the left or
right while rolling.

26. Tensor Fascia Latae & Iliotibial Band
• Origin:
– Anterior superior iliac
spine
• Insertion:
– Lateral condyle of tibia
via iliotibial tendon
• Action:
– Hip flexion, abduction
and internal rotation

27. ITB & TFL
• Start by lying on your side, support your body weight with your legs and arms,
and lie with a foam roller under the upper, proximal portion of your IT band.
• Use your legs and arms to roll the length of your IT band along the foam roller,
traveling down to just above your knee joint. As you get closer to your knee, you
may feel more tenderness, so be prepared to use your arms and legs to ease
pressure off of your IT band.
• Roll back towards the upper portion of your IT band, and continue back and
forth for a few passes.

28. Piriformis
• Origin:
– Anterior surface of the
sacrum
• Insertion:
– The superior boarder of
the greater trochanter
of femur
• Action:
– Laterally rotates thigh
and abducts thigh if
knee is bent

29. Piriformis
• Sit on the center of the foam roller, with one foot crossed to the
opposite knee. Place one or both hands on the floor behind you
to support your upper body.
• Roll forward and backward until a tender spot is felt.
• Stay in this position until a release occurs.

30. Hamstring Muscles
• Biceps Femoris
– Origin:
• Short head – lateral lip of
the linea aspera
• Long head – ischial
tuberosity
– Insertion: Lateral surface
for fibular head and
lateral condyle of tibia
– Action: Knee flexion and
external rotation; hip
extension
• Semimembranosus &
Semitendinosus
– Origin: Ischial tuberosity
– Insertion: Medial surface
of Tibia
– Action: Knee flexion and
internal rotation; Hip
extension

31. Hamstrings
• Sit with back of your thighs on top of the foam roller and both hands
on the floor behind you. Keep your leg muscles relaxed, and let your
heels lightly drag the floor.
• Roll your hamstrings from just above your knees to just below your
pelvis. To increase intensity, shift your weight to one leg by crossing
your legs at the ankle.

32. Calf Muscles
• Gastrocnemius
– Origin:
• Medial Head – medial
condyle of femur
• Lateral Head – lateral
condyle of femur
– Insertion: Posterior
calcaneus via calcaneal
tendon
– Action: Plantar flexes foot
and flexes knee
• Soleus
– Origin: Proximal half of
posterior surface of tibia
and proximal 1/3 of
posterior fibula
– Insertion: Posterior
calcaneus via calcaneal
tendon
– Action: Plantar flexes foot

33. Calf
• Place a foam roller under one leg, positioned under the
middle of your calf. Take the opposite leg and cross the
opposite leg over the top of the leg on the foam roller.
• Slowly roll up and down the calf muscle searching for a
tender spot. Roll from knee to ankle searching for points of
tenderness.

34. Low Back Musculature
• External/Internal Abdominal
Oblique
– Action: Assists in flexing and
rotating vertebral column
• Erector Spinae
– Action: Extends vertebral
column, bends to one side
and rotates head same
direction
• Quadratus Lumborum
– Action: Abducts vertebral
column toward side being
contracted
• Multifidus
– Action: Extend vertebral
column and rotates toward
opposite side

35. Low back
• Position yourself with your lower
back on the foam roller, both knees
bent, and feet flat on the floor. Keep
your abdominal muscles flexed to
support your upper body and
stabilize your spine. Look straight
ahead and keep your head and neck
in a neutral position. If necessary,
place one or both elbows on the
floor behind you for additional
support.
• Roll from just above your hips to
just below your lower ribs. If you
feel the roller against your spine, tilt
your body slightly to the right or left
to refocus the pressure on the
muscles.
Caution: This exercise is not recommended for individuals who are
experiencing back pain and who have not consulted with their doctor.

36. Vertical
• Lying vertically on the
foam roller with your butt
and head supported.
• Gently rest your arms to
the ground.
• Inhale and exhale evenly.
• For more of a stretch,
scoot head to end of foam
roller.
• Foam roller should be
placed at the base of the
skull.
• Let gravity pull head
downwards

37. Post foam roll
• Drink plenty of water, get enough sleep, and
eat healthy
– This will help to flush your system and fuel your
muscles more effectively
• Give yourself 24-48 hours before focusing on
the same area again
– To make sure areas are not aggravated or irritated

38. Take Home Message
• What myofascial pain syndrome is
• What causes myofascial trigger points
• What foam rolling is used for and how to do it