Foam Rolling and Orthopaedic Manual Physical Therapy in Athletes
Condition: Athletic Injuries
MeSH terms: Athletic Injuries
Study type: Interventional

Summary: 
      The main objective of the present study was to evaluate whether FR massage is effective in
      improving dynamic balance, flexibility and dynamic strength after intense exercise recovery
      compared to OMPT protocol or a control group. The present study was a randomized controlled
      trial. Amateur athletes will be recruited from two athletic clubs. Participants will be
      randomizing and allocating into three non-balanced groups through a computer software by an
      external assistant who will be blinding to the study objectives: FR group (n = 18), OMPT
      group (n = 15) and control group (CG) (n = 14). The intervention period will be lasting one
      day (1 session). Participant assessment will be perform twice: prior to the study
      (pre-intervention) and immediately after finishing the intervention (post-intervention).

      Interventions: FR group. FR auto-massage will place the foam roller between their ischial
      tuberosity and a hard surface (i.e., the floor) with their legs held in an extended position,
      keeping their ankles relaxed and oriented upward. For FR in the lumbar region, participants
      use their weight to slide the FR through the erector of the lumbar and thoracic spine. The
      total approximate duration will be about 10-15 minutes; OMPT group. Based on the protocol
      used by Espí-López et al.: a) Unspecific and bilateral lumbar thrust (L5-S1), one of each
      side were performed; The total duration will be approximately 10-15 minutes.; CG. The CG did
      not receive any intervention.

      Outcomes will be Lumbar flexibility, Hip flexion, Dynamic balance, Standing Jump and
      Impression of Change.
    

Detailed description: 
      Introduction Foam rolling (FR) is a form of self-massage in which the targeted musculature is
      rolled and compressed using a FR. In the field of physical therapy that has been shown to
      produce a reduced feeling of fatigue in healthy athletes12 as well as hypoalgesic effects in
      subjects with delayed-onset muscle soreness.

      Currently, self-massage through FR is commonly used in the sports field. The reason for this
      is that it has been suggested that it could have the positive effects traditionally
      associated with orthopedic manual physical therapy (OMPT), That is why despite the widespread
      use of FR massage in the field of muscle recovery in athletes, there is a lack of scientific
      literature about its effectiveness compared to OMPT that can justify its use. Therefore, the
      main objective of the present study was to evaluate whether FR massage is effective in
      improving dynamic balance, flexibility and dynamic strength after intense exercise recovery
      compared to OMPT protocol or a control group.

      Methods The present study was a randomized controlled trial. Participants Amateur athletes
      will be recruited from two athletic clubs. The inclusion criteria will be as follows: (a)
      male and female amateur athletes aged 18 to 30 years. The exclusion criteria: (a) previous
      surgery of the locomotor system in lower limbs; (b) musculoskeletal injuries in any part of
      the body that prevent practicing sports; (c) understanding or communication difficulties; and
      (d) insufficient fluency in the Spanish language to follow measurement instructions.

      Informed written consent will be obtaining from all the participants prior to inclusion. All
      the participants will be explaining the study procedures, which will be design according to
      the ethical standards of the Helsinki Declaration.

      Procedure Participants will be randomizing and allocating into three non-balanced groups
      through a computer software by an external assistant who will be blinding to the study
      objectives: FR group (n = 18), OMPT group (n = 15) and control group (CG) (n = 14). The
      intervention period will be lasting one day (1 session).

      Participant assessment will be perform twice: prior to the study (pre-intervention) and
      immediately after finishing the intervention (post-intervention).

      Interventions FR group. FR auto-massage will place the foam roller between their ischial
      tuberosity and a hard surface (i.e., the floor) with their legs held in an extended position,
      keeping their ankles relaxed and oriented upward. For FR in the lumbar region, participants
      use their weight to slide the FR through the erector of the lumbar and thoracic spine. The
      total approximate duration will be about 10-15 minutes.

      OMPT group. Based on the protocol used by Espí-López et al.: a) Unspecific and bilateral
      lumbar thrust (L5-S1), one of each side were performed; b) Hip joint decompression,
      performing 25 repetitions c) Hip rotator stretch with hip and knee flexion, 15 repetitions;
      d) Femorotibial decompression, 25 reps. e) Quadriceps femoral muscle compression and
      traction, 25 repetitions; f) Opening of the internal and external femorotibial interline, 15
      repetition; g) Ankle decompression, 3 repetitions; h) Posteroanterior and anteroposterior
      mobilization of head and base of fibula, 25 repetitions. The total duration will be
      approximately 10-15 minutes.

      CG. The CG did not receive any intervention.

      Primary outcomes: Physical functional variables Lumbar flexibility. Modified Schober test
      (MMST). The MMST was designed to assess the mobility of the entire lower back, so the MMST
      was used to measure lumbar flexion before and after FR and TM interventions. The examiner
      will place his thumbs on the lower margin of the posterior-upper iliac spine (lower reference
      point) and a pen mark was made. While the examiner held the tape against the subject's skin,
      another signal was marked 15 cm above the first (upper reference point). Each subject was
      then asked to perform an active flexion of the entire trunk and the distance between the two
      points will be measuring and then the subject return to his initial position. The difference
      between the initial distance and the new bending measurements will be take.

      Hip flexion. by the passive straight leg raise (SLR). Passive SLR will be conducting using a
      procedure previously described by Hopper et al. A Richards splint and an ankle foot orthosis
      were applied to the left leg to maintain the knee in full extension and the ankle at a
      neutral plantar angle. An inclinometer will be attaching to a belt, which will place around
      the pelvis at the level of the anterior superior iliac spine (Baseline Bubble Inclinometer.
      Fabrication Enterprises, PO Box, 1500 White Plains, NY 10602, USA). A second inclinometer
      will be then attaching to the Richards splint at the level of the knee joint line. The mean
      of 3 measures will be using for analysis. During the test, the participants are positioned
      with their hands on the abdomen, cervical spine in a neutral position and eyes closed.

      Dynamic balance using the Star Excursion Balance Test (SEBT). The SEBT is a dynamic test that
      requires strength, flexibility, and proprioception. The goal of the SEBT is to maintain
      single-leg stance while reaching as far as possible with the contralateral leg. Subjects are
      instructed to stand with both feet positioned inside the boundaries of the starting box. The
      test initiates when the subject begins to reach in one of the four diagonal directions.

      Standing Jump. Subjects are placed their feet shoulder-width apart and toes placed in a line
      on the floor. The subjects then made a horizontal leap forward, where they were allowed the
      arms to swing, and it will be done along the length of a tape measure that was fixed to the
      ground. The subjects had to stick to the ground in the landing phase, preventing any
      additional movement of the feet when landing.

      The jumped distance will be calculating as the distance from the jump initiation line to the
      heel of the back foot. The best of three attempts was recorded, with a recovery of 60 seconds
      between attempts. All distances will be measuring with an accuracy of 0.01 meters.

      Secondary outcome:

      Impression of Change (CGI). Patient Global Impression of Change Scale (PGIOCS) that evaluates
      the change perceived by the subject after a treatment. This scale has 7 affirmations to
      choose from (I have improved a lot, quite, a little, I am the same, I have worsened a little,
      a lot or a lot) and a pain analogue scale of 10 cm.
    

Intervention name(s): Foam Rolling (FR); Control Group (CG); Orthopaedic Manual Physical Therapy Group (OMPT)
Intervention type(s): Other; Other; Other
Intervention description(s): FR auto-massage will place the foam roller between their ischial tuberosity and a hard surface (i.e., the floor) with their legs held in an extended position, keeping their ankles relaxed and oriented upward. For FR in the lumbar region, participants use their weight to slide the FR through the erector of the lumbar and thoracic spine. The total approximate duration will be about 10-15 minutes.; The CG did not receive any intervention.; Based on the protocol used by Espí-López et al.: a) Unspecific and bilateral lumbar thrust (L5-S1), one of each side were performed; b) Hip joint decompression, performing 25 repetitions c) Hip rotator stretch with hip and knee flexion, 15 repetitions; d) Femorotibial decompression, 25 reps. e) Quadriceps femoral muscle compression and traction, 25 repetitions; f) Opening of the internal and external femorotibial interline, 15 repetition; g) Ankle decompression, 3 repetitions; h) Posteroanterior and anteroposterior mobilization of head and base of fibula, 25 repetitions. The total duration will be approximately 10-15 minutes.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment