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  • Essay / Self-myofascial release as a therapeutic approach to improve joint range of motion

    Fascia is a sheet of connective tissue surrounding and binding together structures including nerves, blood vessels, and muscle fibers throughout the body . In a normal, healthy state, fascia can stretch and move without restriction and, in doing so, helps maintain good posture, range of motion (ROM), flexibility, and strength (Schleip and Klingler 2012 ). Several factors can damage fascia and affect its compliance, including inflammation, inactivity, repetitive movements or disease (Sullivan et al 2013). When fascia is damaged, it becomes tense and loses its elasticity. It binds around the affected area, causing fibrous adhesions to form between tissue layers. Fibrous adhesions are known to be painful and can restrict joint ROM and decrease soft tissue strength, endurance, and elasticity. (MacDonald et al. 2013). Therefore, targeting these adhesions may contribute to joint mobilization. Myofascial release therapy (MFR) is a collective term for a range of manual therapy techniques that use applied pressure to manipulate fascia in a way that allows restricted connective tissue fibers to reorganize and become more flexible. Say no to plagiarism. Get a tailor-made essay on “Why Violent Video Games Should Not Be Banned”? Get an original essay This technique can relieve pain, increase joint ROM, and increase flexibility (Shah and Bhalara 2012). Self-myofascial release (SMR) works on the same principles as myofascial release, but allows the individual themselves to apply pressure to the affected soft tissue area, in place of the clinician (Beardsley and Šcarabot 2015). Pressure can be applied using different devices, including the most commonly used dense foam roller and roller massager (Sullivan et al 2013). A foam roller (FR) is a dense foam cylinder that a person rolls their body weight onto to increase ROM for a specific region of the body. The exact mechanism of action behind this is unknown. The undulating pressure applied during rolling is thought to cause the rupture of fibrous adhesions in the restricted tissues, thereby stretching the fascia and restoring extensibility to the soft tissues. The more portable roller massager is similar to the foam roller in its mechanism of action, however, the roller massager relies on an individual's upper body strength to apply pressure to the muscles, rather than its body weight (Sullivan et al 2013). SMR via foam rolling (FR) or roller massage (RM) is becoming a popular therapeutic approach to increase myofascial flexibility and, therefore, joint ROM (Cheatham et al 2015). Several studies have investigated the effect of FR or RM on joint ROM. across a large population of people. The main areas tested for ROM were the knee, ankle, hip, and lower extremities. Studies have found both beneficial and ineffective effects of SMR therapy. MacDonald et al (2013) examined the effects of FR on knee flexion ROM in 11 male subjects. Subjects served as their own controls and were tested before FR, two and ten minutes after FR, and after no FR over four sessions with one to two days of rest between each session. A 10° increase in knee flexion ROM was seen two minutes after the test and an 8° increase in knee flexion ROM was seen ten minutes after the test compared to theresults from the control group, suggesting that RF can increase knee ROM. Bradbury-Squires et al (2015) compared the effects of 5 sets of 20 and 60 seconds of MR and no MR on knee joint ROM in ten recreationally active men. Increases of 10% and 16% in knee ROM were observed after 20 and 60 seconds of MR, respectively. Regarding ankle ROM, studies have compared the effects of FR and RM to those of static stretching. The results implied that FR was only effective in combination with static stretching, but RM was found to be an effective measure on its own. Škarabot et al (2015) studied the effects of three 30-second sessions of FR in 11 resistance-trained adolescents. Ankle ROM was measured before testing, immediately after testing, and ten, fifteen, and twenty minutes after testing. While a 9.1% increase in ankle ROM was seen in the treatment group performing static stretching and FR, no increase in ankle ROM was seen for the group performing only a FR. On the other hand, Halperin et al (2014) studied the effects of RM in 14 recreationally trained subjects and found that RM alone increased ankle dorsiflexion ROM immediately and 10 minutes after testing by 4%. . Bushell et al (2015) studied the effects of FR on hip extension ROM in 31 subjects from various backgrounds. The treatment group underwent three 1-minute FR sessions with 30 seconds of rest between each session. A significant increase in hip extension ROM was noted during the second session in the treatment group. Mohr et al (2014) measured the effects of FR combined with static stretching on hip flexion ROM in 40 male subjects with passive hip ROM less than 90°. Results demonstrated that FR alone produced small increases in ROM, but ROM was increased when FR was combined with static stretching. These results further support Škarabot's suggestion that joint ROM is best improved using a combination of FR and static stretching. Monteiro et al (2014) studied the effects of 120-second sessions of FR and RM in 18 resistance-trained men. Both FR and RM interventions produced a significant increase in hip ROM compared to control. Contrary to the findings of Bushell, Škarabot, and Monteiro, Mikesky et al (2002) found no acute improvement after two minutes of MR on hip ROM in 30 subjects. Need to develop this. Interpretation of the literature indicates that self-myofascial release via foam rolling or roller massage can improve joint ROM over a short-term period. However, due to the heterogeneity of studies, it is difficult to draw definitive conclusions. Based on PEDro scores, the average quality of studies conducted on the effects of SMR on joint ROM is moderate. No studies were able to meet the criteria for subject or therapist blinding and very few studies reported meeting the criteria for allocation concealment or assessor blinding. There are several other limitations that should be considered when interpreting the results of these studies. For example, sample sizes were small in all studies, and although subjects varied in activity levels, they were all in a similar age range. In addition, half of the studies conducted their research on exclusively male populations. This must be taken into account when examining their results, because the effects of SMR..