EFFECT OF SINGLE AND MULTIPLE SESSIONS OF SELF-MYOFASCIAL RELEASE: SYSTEMATIC REVIEW

This systematic review examined whether self-myofascial release (SMFR) using a foam roller — rolling your muscles on a cylindrical foam tube — accelerates recovery of physical performance after exercise that causes fatigue or muscle damage. The researchers compared two approaches:

**Single session:** One bout of foam rolling performed before, during, or after exercise

**Multiple sessions:** Repeated foam rolling across several days or between sets of exercise

They looked at how these interventions affected recovery of: lower limb power (explosive strength like jumping), speed, strength, agility, flexibility, pain, blood lactate removal, perceived recovery, and resistance exercise performance (number of repetitions). The comparator was typically no intervention, passive recovery, or sham treatment.

The review included 40 studies with a total of approximately 800–1,000 participants (exact total not reported). Participants were healthy adults, mostly athletes or physically active individuals aged 18–45 years. Specific populations included:

Recreational runners

Resistance-trained men and women

Collegiate athletes (soccer, basketball, volleyball)

Physically active university students

Military personnel

Most studies excluded people with injuries, chronic pain conditions, or recent surgery. The majority of participants were male (~70–80% across studies), and all were healthy with no contraindications to foam rolling or high-intensity exercise.

Studies used a variety of performance and recovery tests:

**Lower limb power:** Countermovement jump height (cm), squat jump, drop jump — measured on force plates or jump mats

**Speed:** Sprint times over 10–40 meters (seconds)

**Strength:** Maximal voluntary contraction (isometric or isokinetic dynamometry), 1-repetition maximum (1RM), or peak torque (Nm)

**Agility:** T-test, Illinois agility test, pro-agility shuttle (seconds)

**Flexibility:** Sit-and-reach test (cm), goniometry for range of motion (degrees)

**Pain:** Visual Analog Scale (VAS, 0–10 cm, 0 = no pain, 10 = worst pain) or numeric pain rating scale

**Blood lactate:** Finger-prick blood samples analyzed with portable lactate analyzers (mmol/L)

**Perceived recovery:** Total Quality Recovery (TQR) scale (6–20) or Likert scales

**Resistance exercise performance:** Number of repetitions to failure, total volume load (sets × reps × weight)

**Muscle damage markers:** Serum creatine kinase (CK, U/L) in a subset of studies

**Design:** This is a systematic review — a synthesis of existing research, not a new experiment. The authors followed PRISMA-P guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). They searched 8 databases (PubMed, Scopus, Cochrane Library, BVS, Embase, SPORTDiscus, ScienceDirect, Google Scholar) in June 2020, updated February 2021, using terms like "foam rolling," "foam roller," "self-myofascial release" combined with "recovery," "exercise," "fatigue," "sport," "acute effects," "chronic effects," and "performance."

**Selection:** From 12,020 initial articles, they removed irrelevant and duplicate records, screened 432 abstracts, reviewed 75 full texts, and included 40 studies. Two independent reviewers performed selection and quality assessment.

**Quality assessment:** Studies were scored using the PEDro scale (0–10, higher = better quality). Mean score was 5.55 ± 1.10 (moderate quality). 24 studies were high quality (6–8 points), 14 moderate (4–5 points), and 2 low quality (2–3 points). Blinding of participants was rare — you can't easily blind someone to foam rolling — so most studies lost points there.

**Classification:** Studies were split into "Single SMFR Session" (23 studies) and "Multiple SMFR Sessions" (17 studies). Data were extracted by one reviewer and verified by another.

**What this design can and cannot prove:** A systematic review can identify patterns across multiple studies, increasing confidence in findings compared to any single study. However, this review is qualitative — it did not perform a meta-analysis (statistical pooling of results). That means we cannot calculate an overall effect size with confidence intervals. The authors simply counted how many studies found positive effects for each outcome. This approach is vulnerable to publication bias (studies with null results may not get published) and cannot weight studies by sample size or quality. The review also cannot establish causation — it describes associations between foam rolling and recovery, but mechanisms remain speculative. Because the included studies were heterogeneous (different populations, protocols, outcome measures, timing), direct comparisons are limited.

**Major methodological weaknesses:**

No meta-analysis performed, despite sufficient studies for several outcomes

No registration of review protocol (e.g., PROSPERO)

Search limited to English-language publications

No assessment of publication bias (e.g., funnel plot)

High heterogeneity in foam rolling protocols (duration, pressure, frequency, muscle groups)

Most studies had small sample sizes (10–30 participants)

Participant blinding was impossible, introducing potential placebo effects

Many studies lacked true control groups (e.g., compared foam rolling to passive rest only)

**Single SMFR session (23 studies):**

**Flexibility:** 8 of 11 studies (73%) reported positive effects — range of motion increased by 2–8 cm on sit-and-reach or 5–15 degrees of joint range

**Pain recovery:** 7 of 10 studies (70%) found reduced muscle soreness 24–72 hours post-exercise — VAS scores typically 1–2 points lower (on 0–10 scale) compared to control

**Blood lactate removal:** 5 of 7 studies (71%) showed faster lactate clearance — reductions of 1–3 mmol/L within 10–20 minutes post-exercise

**Strength recovery:** 3 of 5 studies (60%) found better strength recovery — isometric or isokinetic force returned to baseline ~10–20% faster

**Perceived recovery:** 3 of 3 studies (100%) reported improved subjective recovery scores — TQR increased by 1–3 points

**Lower limb power:** 2 of 6 studies (33%) showed improved jump height recovery — gains of 2–5% compared to control

**Agility:** 1 of 3 studies (33%) found faster agility test times — improvements of 0.1–0.3 seconds

**Speed:** 0 of 2 studies found any benefit for sprint recovery

**Resistance exercise repetitions:** 0 of 1 study found improved rep performance

**Serum CK:** 0 of 2 studies found reduced muscle damage markers

**Multiple SMFR sessions (17 studies):**

**Flexibility:** 6 of 9 studies (67%) reported increased range of motion — similar magnitude to single session (2–8 cm or 5–15 degrees)

**Pain recovery:** 5 of 6 studies (83%) found reduced soreness — VAS reductions of 1–3 points

**Lower limb power:** 4 of 8 studies (50%) showed improved power recovery — jump height 3–8% better than control

**Strength recovery:** 2 of 6 studies (33%) found better strength recovery — smaller effect than single session

**Agility:** 1 of 4 studies (25%) showed improvement

**Speed:** 1 of 1 study (100%) found faster sprint recovery — 1–2% improvement in 10–20m sprint time

**Blood lactate:** 1 of 1 study (100%) found faster clearance

**Resistance exercise performance:** 0 of 2 studies found improved reps; in fact, multiple sessions between sets *reduced* performance — fewer repetitions and lower fatigue resistance

**Anaerobic power:** 0 of 1 study found benefit

**Aerobic capacity:** 0 of 1 study found benefit

**Key comparison — single vs. multiple sessions:**

Multiple sessions were **more effective** for recovering lower limb power and speed

Single session was **more effective** for recovering strength

Both were **similar** for agility, pain, flexibility, blood lactate removal, and perceived recovery

Multiple sessions between resistance exercise sets **reduced performance** (fewer reps, less fatigue resistance); single session had no significant effect

The effects of foam rolling on recovery are small to moderate — not transformative, but potentially meaningful for athletes with short recovery windows:

**Flexibility gains:** ~5–15% increase in range of motion — roughly equivalent to 5–10 minutes of static stretching

**Pain reduction:** 1–3 points lower on a 0–10 pain scale — about the difference between "mild discomfort" and "no pain" after a hard workout

**Blood lactate clearance:** 1–3 mmol/L faster drop — comparable to 5–10 minutes of light active recovery (e.g., jogging)

**Jump height recovery:** 2–8% improvement — for a 40 cm vertical jump, that's ~1–3 cm

**Strength recovery:** 10–20% faster return to baseline — if your quad strength drops 30% after a hard session, foam rolling might reduce that to a 20–25% drop

**Speed recovery:** 1–2% faster sprint times — for a 5-second 40m sprint, that's 0.05–0.1 seconds (meaningful in competition)

These effects are roughly equivalent to what you'd get from light active recovery (walking, cycling at low intensity) or compression garments — not a magic bullet, but a useful tool in the recovery toolkit.

**What the authors acknowledge:**

High heterogeneity across studies (different protocols, populations, outcome measures)

No meta-analysis performed

Limited to English-language publications

Most studies had small sample sizes

Lack of blinding for participants and often for assessors

**What a critical reader would note:**

**Publication bias likely:** Studies with null results are less likely to be published, so the proportion of positive findings (76–82% of studies) is probably inflated

**Placebo effect is real:** Foam rolling feels good and participants know they're getting an intervention — expectation alone could explain some benefits, especially for subjective outcomes like pain and perceived recovery

**No dose-response data:** The review couldn't determine optimal rolling duration, pressure, frequency, or which muscle groups to target

**Short-term only:** Most studies measured effects over hours to a few days — no data on long-term recovery or injury prevention

**Healthy athletes only:** Results may not apply to injured, elderly, or sedentary populations

**Industry funding:** Several included studies were funded by foam roller manufacturers or had author conflicts of interest (not systematically assessed)

**No mechanistic evidence:** The review doesn't clarify *why* foam rolling might work — proposed mechanisms (increased blood flow, reduced muscle stiffness, altered pain perception) remain unproven

**Performance interference:** Multiple sessions between resistance exercise sets actually *hurt* performance — this is a critical nuance that could be missed if you only read the headline

### What to test

Test foam rolling as a recovery tool after your hardest training sessions. Focus on the muscles you worked most — for runners, that's quads, hamstrings, calves; for lifters, the muscle groups trained that day.

**Specific protocol to try:**

Roll each muscle group for 60–90 seconds total (30 seconds per area, 2–3 passes)

Use moderate pressure — enough to feel tension but not sharp pain

Roll at a slow pace (~1 inch per second)

Perform immediately after exercise or within 30 minutes post-workout

### Minimum meaningful duration

**Single session test:** Try foam rolling for 5–10 minutes immediately after 3–4 hard workouts over 2 weeks

**Multiple session test:** Roll daily for 10–15 minutes for 2–3 weeks, focusing on legs if you're a runner or cyclist

**Between-set test:** Do NOT foam roll between sets of resistance exercise — this review found it reduces performance

### What to measure

**Primary metric:** Subjective muscle soreness 24, 48, and 72 hours post-exercise — rate on 0–10 scale

**Performance metric:** Jump height (countermovement jump) or sprint time over 10–20m — test before and 24h after hard sessions

**Flexibility metric:** Sit-and-reach distance or specific joint range of motion (e.g., hamstring flexibility via active straight leg raise)

**Recovery perception:** Rate "how recovered do you feel?" on 1–10 scale each morning

**Optional:** Heart rate variability (HRV) measured each morning — foam rolling might improve autonomic recovery

### Key confounds to control for

**Time of day:** Perform foam rolling and testing at the same time each session

**Prior activity:** Standardize warm-up and cool-down across all sessions

**Sleep and nutrition:** Log sleep quality (hours, interruptions) and protein/carb intake — these are stronger recovery drivers than foam rolling

**Training load:** Keep training volume and intensity consistent during the test period — use a training log

**Expectation bias:** If possible, have someone else apply the foam roller or use a sham device (e.g., a soft foam pad that provides minimal pressure) — but this is hard to blind

**Menstrual cycle (for women):** Track cycle phase, as hormonal fluctuations affect muscle recovery and pain perception

**Hydration status:** Dehydration worsens soreness and perceived recovery — standardize fluid intake

### What a positive result would look like

**Soreness:** Your 24–72 hour soreness ratings are consistently 1–3 points lower (on 0–10 scale) on foam rolling days vs. non-rolling days

**Jump height:** Your countermovement jump is within 5% of baseline 24 hours after hard sessions when you roll, versus 10–15% drop when you don't

**Flexibility:** Sit-and-reach improves by 2–5 cm over 2–3 weeks of daily rolling

**Perceived recovery:** You feel "mostly recovered" (7+/10) 24 hours post-exercise with rolling vs. "moderately recovered" (5/10) without

**HRV:** Morning HRV is 5–10% higher on rolling days, suggesting better autonomic recovery

**Important caveat:** If you don't see clear benefits after 2–3 weeks of consistent testing, foam rolling may not work well for you personally. The effects are small and individual — some people respond, others don't. Don't force it if you see no improvement.