The effects of foam rolling on ankle dorsiflexion range of motion in healthy adults: A systematic literature review.

BACKGROUND: Reduced ankle dorsiflexion is associated with lower limb injury and dysfunction, with static stretching mostly used to increase ankle range of motion. Foam rolling is an alternative intervention, shown to immediately increase ankle range of motion, while the long-term application has conflicting evidence. AIMS: To assess the effects of single and multiple foam rolling interventions on ankle dorsiflexion range of motion in healthy adults and appraise the methodological quality of the included studies. DESIGN: Systematic literature review. METHODS: Five electronic databases were systematically searched to identify randomised controlled trials reporting the effects of foam rolling on ankle dorsiflexion. Data was extracted from studies that met the inclusion criteria and independently appraised by each reviewer using the PEDro scale. RESULTS: Thirty-two articles were identified; six studies included foam rolling compared to other interventions on ankle dorsiflexion range of motion. Five of the six studies reported a significant increase (p < 0.05) in ankle dorsiflexion within groups compared to baseline measurements, after a single foam rolling intervention. One study found a significant within group increase in long-term effects after foam rolling on ankle dorsiflexion over seven weeks. The mean PEDro score for all studies was 6/10 indicating a high-quality level of evidence. CONCLUSION: There is strong evidence suggesting that foam rolling may be effective in increasing range of motion in a healthy adult population in the short term up to 30 min; however, definitive conclusions on long-term effects cannot be drawn due to a lack of evidence, with further research recommended.

A critical overview of the current myofascial pain literature - March 2017.

After two years of having contributed to this overview series of articles, we sadly say goodbye to Dr. Rob Grieve. We would like to thank Dr. Grieve for his insightful contributions and analyses of the myofascial pain literature. Dr. Grieve would have preferred to continue, but his many university and research responsibilities had to take priority. We are looking forward to reviewing his future research endeavors in this article. We are pleased that Dr. Li-Wei Chou, MD, PhD has agreed to replace Dr. Grieve and join our team. Dr. Chou is Assistant Professor at China Medical University in Taichung, Taiwan and he has an impressive publication record with many research studies and book chapters. In this edition of the overview article, we once again have included articles from around the world with a combination of basic research and clinical studies and case reports. The majority of papers deal with dry needling, but there are also several more basic research studies and manual therapy papers.

Physiotherapy for plantar fasciitis: a UK-wide survey of current practice.

OBJECTIVES: To identify how United Kingdom (UK) physiotherapists currently diagnose, assess and manage plantar fasciitis in routine practice. DESIGN: Online questionnaire survey. PARTICIPANTS: Practising physiotherapists across the UK who treat patients with plantar fasciitis. METHODS: Physiotherapists were approached via 'interactive Chartered Society of Physiotherapy (CSP)' online networks and an email database of clinical educators in South West England. An online questionnaire was developed by reviewing similar existing physiotherapy surveys and consultation with experienced musculoskeletal researchers/clinicians. Descriptive statistics were used to analyse the data. RESULTS: 285 physiotherapists responded, with 257 complete survey responses. Pain on palpation and early morning pain were the most common diagnostic criteria, with some physiotherapists using no formal test criteria. Advice (237/257, 92%), plantar fasciitis pathology education (207/257, 81%) and general stretching exercises (189/257, 74%) were most routinely used. Prefabricated orthotics, custom made orthotics and night splints were seldom always used. For the manual therapy approach, the most frequently used modalities were massage, myofascial release, specific soft tissue mobilisations and myofascial trigger point therapy. Commonly used outcome measures were pain assessment, functional tests and range of movement. CONCLUSIONS: Physiotherapists appeared to follow most of the established diagnostic criteria for PF, but have not followed established outcome measure guidelines. Advice as well as education with an emphasis on self-management including calf/hamstring stretching was the most commonly reported treatment approach. There was uncertainty whether this approach accurately reflected clinical practice used throughout the UK, owing to potential response bias/unknown response rate and the low number of patients with PF treated by the respondents.

A critical overview of the current myofascial pain literature - September 2016.

This edition of the overview of the current myofascial pain literature includes 24 studies, case reports and systematic and narrative reviews. Surprisingly, five of the 24 papers were difficult to read and interpret mostly because of a poor mastery of the English language. It is somewhat surprising that journal editors and reviewers would accept papers that are needlessly difficult to read and not direct the authors to language services or others who could improve the quality of the writings. Of course, it is exciting that researchers and clinicians from all over the world continue to focus on myofascial pain and attempt to shed new light on the complexity of the problem to improve the clinical decision-making process and eventually clinical approaches and outcomes. There were no new papers on manual therapies, but many focused on dry needling.

A critical overview of the current myofascial pain literature - July 2016.

The overview of the myofascial pain literature includes a wide variety of basic and clinical studies, ranging from assessing muscle activation patterns to the impact of platelet-rich plasma injections. Contributions to the literature once again came from all corners of the world, such as Australia, Belgium, Brazil, Germany, Greece, Iran, Italy, Japan, Korea, the Netherlands, Norway, Poland, Spain, Taiwan, Turkey, and the USA. A total of 30 papers are included in this overview.

A critical overview of the current myofascial pain literature - March 2016.

The worldwide interest in myofascial pain syndrome (MPS) and trigger points (TrPs) is reflected in the increasing number of publications. In this overview of the literature, we included 26 studies, case reports and review articles by authors from 18 different countries. Several research groups are exploring the characteristic of TrPs such as Chen and colleagues, who continued their work on the quantification of the taut bands. Meng and colleagues studied the relationships between TrPs and central sensitization, while Yu and colleagues examined the electrophysiological characteristics that occur as a result of active TrPs. Several researchers used objective measurements to determine clinical outcomes, such as Koppenhaver and colleagues who measured objective changes in the function and nociceptive sensitivity of lumbar multifidus muscle subjects with low back pain. Turo and colleagues quantified muscle tissue changes after dry needling in chronic myofascial pain using elastography. Multiple studies explored various treatment options for TrPs, such as dry needling, injections with lidocaine or granisetron, traditional Thai massage, self-myofascial release, kinesiotaping, and monochromatic infrared photo energy, among others.

A critical overview of the current myofascial pain literature - January 2016.

Reflecting on the past year, the number of publications on myofascial pain continues to increase in a steady rate. The current review includes 30 basic and clinical studies, case reports, reviews, and reports from fifteen different countries about trigger points (TrP), myofascial pain (MP), dry needling (DN) and other related interventions. We are pleased that during 2015 this article made the top 15 of most downloaded articles as many as three times! In general, the quality of published papers is improving as well. Nevertheless, several papers included in this overview, mention the application of "ischemic compression", which is a questionable concept in the context of TrP inactivation. As we have outlined previously, in the current thinking about myofascial pain, TrPs feature significant hypoxia and a lowered pH (Ballyns et al., 2011; Shah and Gilliams, 2008), and attempts to induce more ischemia would be counterproductive. Already in 1999, Simons, Travell and Simons changed the terminology from ischemic compression to TrP compression (Simons et al., 1999) and we recommend that contemporary researchers and clinicians adopt the new terminology and stop using the term "ischemic compression."

A critical overview of the current myofascial pain literature - October 2015.

The number of publications about myofascial pain and trigger points (TrP) seems to increase every year. In the current overview we include 27 articles published in past months. The Basic Review section includes articles about the presence and characteristics of TrPs in various neck and shoulder muscles, the correlation between referred pain from active TrPs and knee osteoarthritis, and an anatomical study exploring whether the location of TrPs may be related to the nerve innervation of muscles. Zuil-Escobar and colleagues from Spain considered the intra-rater reliability of the identification of latent TrPs in several leg muscles and the possible correlation of TrP and the presence of a lower medial longitudinal arch. In the section on manual approaches, contributing author Rob Grieve and colleagues continue their studies of TrPs in the lower extremity muscles, while Méndez-Rebolledo and colleagues studied the impact of cross taping and compression. Dry needling (DN) continues to be a topic of interest. We included twelve papers addressing a wide range of topics, such as the effectiveness and safety of DN, and the impact of DN on proprioception, spasticity, and fibromyalgia. Two papers investigated the utilization of repetitive transcranial magnetic stimulation and laser on TrPs, The final section on other clinical studies and reviews includes 8 papers. The studies originated in thirteen different countries with Spain leading the charts with 7 contributions to the literature, followed by Brazil with four. As we have mentioned in previous editions of this literature overview, many studies suffer from very small sample sizes, which makes it difficult to reach definitive conclusions. Nevertheless, myofascial pain continues to be a topic of interest to researchers and clinicians around the globe.

A critical overview of the current myofascial pain literature - July 2015.

The current overview includes thirty articles published in the recent past about myofascial pain, trigger points (TrPs) and related topics. In the Basic Research section, several interesting new studies are reviewed addressing the presence of TrPs in patients with low back pain, episodic migraine, or following a meniscectomy. An animal study of the impact of laser fluency opens the door to future studies regarding optimal dosage of low-level laser therapy in the treatment of individuals with TrPs. Six papers focus on TrP dry needling (DN), two on manual therapies, and two on injection therapy. On of the injection papers discusses the occurrence of a cardiac tamponade, which is a very rare potential complication of invasive needling therapies that can easily be avoided with proper needling techniques. Several review studies and other clinical studies conclude this overview.

The immediate effect of bilateral self myofascial release on the plantar surface of the feet on hamstring and lumbar spine flexibility: A pilot randomised controlled trial.

BACKGROUND: Self myofascial release (SMR) via a tennis ball to the plantar aspect of the foot is widely used and advocated to increase flexibility and range of movement further along the posterior muscles of a proposed "anatomy train". To date there is no evidence to support the effect of bilateral SMR on the plantar aspect of the feet to increase hamstring and lumbar spine flexibility. AIM: The primary aim was to investigate the immediate effect of a single application of SMR on the plantar aspect of the foot, on hamstring and lumbar spine flexibility. The secondary aim was to evaluate the method and propose improvements in future research. DESIGN: A pilot single blind randomised control trial. PARTICIPANTS: Twenty four healthy volunteers (8 men, 16 women; mean age 28 years ± 11.13). METHOD: Participants underwent screening to exclude hypermobility and were randomly allocated to an intervention (SMR) or control group (no therapy). Baseline and post intervention flexibility was assessed by a sit-and-reach test (SRT). A one way between groups analysis of covariance (ANCOVA) was conducted to compare between group outcome SRT measurements. Baseline pre-intervention and control SRT measurements were used as the covariate in the analysis. RESULTS: There was a significant increase (p = 0.03) in the intervention SRT outcome measurements compared to the control group, with a large effect size. CONCLUSION: An immediate clinical benefit of SMR on the flexibility of the hamstrings and lumbar spine was indicated and suggestions for methodological improvements may inform future research.

A critical overview of current myofascial pain literature - March 2015.

The second article in this review series considers multiple recent publications about myofascial pain, trigger points (TrPs) and other related topics. The article is divided into several sections, including a Basic Research section (4 articles), a section on Soft Tissue Approaches (5 articles), a Dry Needling and Acupuncture section (7 articles), an Injection section (2 articles), a section on. Modalities (1 article), Other Clinical Approaches (3 articles) and finally a Reviews section (7 articles). The thirty publications reviewed in this article originated in all corners of the world.

An evidence-informed review of the current myofascial pain literature--January 2015.

This article provides an up-to-date review of the most recent publications about myofascial pain, trigger points (TrPs) and other related topics. We have added some commentaries where indicated with supporting references. In the Basic Research section, we reviewed the work by Danish researchers about the influence of latent TrPs and a second study of the presence and distribution of both active and latent TrPs in whiplash-associated disorders. The section on Soft Tissue Approaches considered multiple studies and case reports of the efficacy of myofascial release (MFR), classic and deep muscle massage, fascial techniques, and connective tissue massage. Dry needling (DN) is becoming a common approach and we included multiple studies, reviews, and case reports, while the section on Injection Techniques features an article on TrP injections following mastectomy and several articles about the utilization of botulinum toxin. Lastly, we review several articles on modalities and other clinical approaches.

The immediate effect of triceps surae myofascial trigger point therapy on restricted active ankle joint dorsiflexion in recreational runners: a crossover randomised controlled trial.

OBJECTIVES: To investigate the immediate effect on restricted active ankle joint dorsiflexion range of motion (ROM), after a single intervention of myofascial trigger point (MTrP) therapy on latent triceps surae MTrPs in recreational runners. DESIGN: A crossover randomised controlled trial. PARTICIPANTS: Twenty-two recreational runners (11 men and 11 women; mean age 24.57; ±8.7 years) with a restricted active ankle joint dorsiflexion and presence of latent MTrPs. INTERVENTION: Participants were screened for a restriction in active ankle dorsiflexion in either knee flexion (soleus) or knee extension (gastrocnemius) and the presence of latent MTrPs. Participants were randomly allocated a week apart to both the intervention (combined pressure release and 10 s passive stretch) and the control condition. RESULTS: A clinically meaningful (large effect size) and statistically significant increase in ankle ROM in the intervention compared to the control group was achieved, for the soleus (p = 0.004) and the gastrocnemius (p = 0.026). CONCLUSION: Apart from the statistical significance (p < 0.05), these results are clinically relevant due to the immediate increase in ankle dorsiflexion. These results must be viewed in caution due to the carry-over effect in the RCT crossover design and the combined MTrP therapy approach.

The prevalence of latent myofascial trigger points and diagnostic criteria of the triceps surae and upper trapezius: a cross sectional study.

OBJECTIVES: To determine the prevalence of latent myofascial trigger points (MTrPs), specific diagnostic criteria and the association between gender and MTrP prevalence in the triceps surae and upper trapezius. DESIGN: Cross-sectional study. SETTING: University, Faculty of Health and Life Sciences. PARTICIPANTS: Two hundred and twenty healthy volunteers (132 females and 88 males; mean age 29.7 (SD 11.0). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Prevalence of latent MTrPs in the triceps surae and comparative upper trapezius; specific diagnostic criteria and pressure pain threshold (PPT). RESULTS: Latent MTrPs were prevalent in all triceps surae (range: 13 to 30%), left upper trapezius (23%) and right upper trapezius (20%). No MTrPs (0%) identified in the middle fibres of deltoid. For each specific diagnostic criterion, taut bands were most prevalent in the right gastrocnemius medial head (81%); tender spot in left gastrocnemius medial head (52%) and nodules in the right upper trapezius (35%). Local twitch response (0.5%), the least frequent diagnostic criterion was only found in the left gastocnemius medial head. A significant increase in latent MTrP prevalence for females compared to males in five of the six triceps surae MTrP sites, with no significant association for gender and latent MTrP prevalence in the left or right upper trapezius. CONCLUSIONS: This study established the prevalence of latent MTrPs, specific diagnostic criteria and baseline normative data in the triceps surae. The middle fibres of deltoid were identified as a potential MTrP control site for future clinical research in the upper limb.

Myofascial trigger point therapy for triceps surae dysfunction: a case series.

AIMS: The main aim of the case series was to inform further experimental research to determine the effectiveness of myofascial trigger point (MTrP) therapy for the treatment of triceps surae dysfunction. PARTICIPANTS: Ten participants with triceps surae dysfunction were recruited (4 females and 6 males); mean age±standard deviation=43±7.1 years. METHODS: Participants were screened for inclusion/exclusion criteria and the following outcomes measures were assessed at baseline and discharge; lower extremity functional scale (LEFS), verbal numerical rating scale (NRS), MTrP prevalence, ankle dorsiflexion range of movement (ROM) and pressure pain threshold (PPT). Intervention involved trigger point (TrP) pressure release, self MTrP release and a home stretching programme. RESULTS: There was a high prevalence of active/latent MTrPs and possible myofascial pain syndrome (MPS) for all 10 participants at baseline. Active MTrP prevalence decreased to 0%, while latent MTrPs were still present at discharge. There were positive changes in most outcome measures (LEFS, NRS, ROM and PPT) for all 10 participants. Short term to medium term treatment outcomes (6 week post discharge) showed an overall mean LEFS increase of 11 points from 61/80 at baseline to 72/80 at discharge. CONCLUSION: This case series suggests that a brief course of multimodal MTrP therapy would be helpful for some patients with sub-acute or chronic calf pain. Important preliminary data was gathered, that will inform more rigorous research in this under investigated area.

The immediate effect of soleus trigger point pressure release on restricted ankle joint dorsiflexion: A pilot randomised controlled trial.

OBJECTIVES: The primary aim of this study was to investigate the immediate effect on restricted active ankle joint dorsiflexion range of motion (ROM), after a single intervention of trigger point (TrP) pressure release on latent soleus myofascial trigger points (MTrPs). The secondary aim was to assess aspects of the methodological design quality, identify limitations and propose areas for improvement in future research. DESIGN: A pilot randomised control trial. PARTICIPANTS: Twenty healthy volunteers (5 men and 15 women; mean age 21.7±2.1 years) with a restricted active ankle joint dorsiflexion. INTERVENTION: Participants underwent a screening process to establish both a restriction in active ankle dorsiflexion and the presence of active and latent MTrPs in the soleus muscle. Participants were then randomly allocated to an intervention group (TrP pressure release) or control group (no therapy). RESULTS: The results showed a statistically significant (p=0.03) increase of ankle ROM in the intervention compared to the control group. CONCLUSION: This study identified an immediate significant improvement in ankle ROM after a single intervention of TrP pressure release on latent soleus MTrPS. These findings are clinically relevant, although the treatment effect on ankle ROM is smaller than a clinical significant ROM (5°). Suggestions for methodological improvements may inform future MTrP research and ultimately benefit clinical practice in this under investigated area.