Foam Roller Eased Knee Pain, Improved Range of Motion

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by Margarida Maia PhD |

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A foam roller to release tension in the fascia — a casing of fibrous tissue that surrounds and holds other tissues in place — is safe to be used by patients with knee joint disease caused by hemophilia, a Spanish has study found.

When the fascia tightens around muscles, it can limit mobility and cause pain. Researchers also observed that foam rolling improved the range of motion of both the knees and the muscles of the hip, while reducing the level of perceived pain.

The study, “Safety and efficacy of a self-induced myofascial release protocol using a foam roller in patients with haemophilic knee arthropathy,” was published in the journal Haemophilia.

People with hemophilia bleed excessively and bruise easily. Bleeding may occur in the muscles and joints. In about 80% of patients, joints are affected, with bleeding occurring most commonly in the knees, elbows, and ankles.

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Over time, bleeding can cause damage to the joints themselves and make their neighboring tissues, such as the fascia, tight and stiff. This can affect how far the joints are able to move and result in chronic pain, muscle wasting, and impaired proprioception (awareness of the position and movement of the body and its parts).

“This leads patients to reduce their activities and social participation, thereby decreasing their perceived quality of life,” the researchers wrote.

A way to release the tension that builds up in the fascia is using a technique called myofascial release. The technique can be applied by a physiotherapist or the patients themselves. 

“Self-induced myofascial release involves patients using their own body weight, plus materials such as a foam roller, to exert pressure on the soft tissues affected,” the researchers wrote. The pressure produces not only a local mechanical effect, but also a global neurophysiological effect that, when combined, helps relax tissues.

Now, researchers wanted to evaluate how safe and effective a self-induced myofascial release protocol is in patients with knee joint disease caused by hemophilia.

The study included 18 patients with hemophilia A and seven with hemophilia B who were recruited from the Spanish Federation of Hemophilia and the Galician Association of Hemophilia between September and December 2020. Their median age was 36 years.

The protocol comprised six different types of massage exercises that used either a foam roller (30 centimeters long and 15 centimeters wide) or a ball with a diameter of eight centimeters. Each session lasted 15 minutes and there were seven sessions per week over a period of eight weeks (about two months). Patients learned the exercises through demonstration videos available on a mobile app called He-Foam.

A physiotherapist was responsible for following up on all patients by telephone on a weekly basis to check for the absence of joint bleeding. The physiotherapist also assessed the need to adapt the protocol to suit each patient’s needs.

No bleeding episodes were reported either during or after each session.

Foam rolling resulted in an improvement of joint health, as indicated by a 1.38-point decrease in the Hemophilia Joint Health Score. Pain intensity also eased and the pressure pain threshold, which is the lowest amount of pressure that causes pain, increased.

Knee range of motion improved, as indicated by a higher degree of flexion (bending) and a loss of extension. In turn, the flexibility of muscles of the hip also improved, as indicated by a 3.54-centimeter decrease in hamstring flexibility. 

“Myofascial self-release using a foam roller is safe,” the researchers wrote, adding that it “can improve range of motion, knee joint status, and hamstring flexibility.”

“Further randomized clinical studies should confirm the findings on safety and efficacy reported by this study,” they wrote.