Chronic and Residual Effects of a Two-Week Foam Rolling Intervention on Ankle Flexibility and Dynamic Balance

Abstract

Background
Foam rolling has been shown to acutely improve joint range of motion (ROM). However, limited knowledge exists on the chronic and residual effects. The primary purpose of this study was to examine the chronic and residual effects of a 2-week roller–massager intervention on ankle dorsiflexion ROM and dynamic balance.Methods
Forty-two participants (24.3 ± 2.5 years, 33 males, 9 females) were randomly assigned to either roller-massage (RM) or control group (= no intervention). Ankle ROM was assessed with the weight-bearing lunge test (WBLT) and dynamic balance with the Y-Balance test for both limbs. The RM group was instructed to roll their calf muscles for three sets of 60 s per leg on 6 days a week over 2 weeks. Acute effects were measured during baseline testing for dorsiflexion ROM and dynamic balance immediately after foam rolling. Chronic and residual effects were measured 1 day and 7 days after the intervention period. Multivariate ANOVA was performed for post-hoc comparisons to determine acute, chronic, and residual effects.ResultsSignificant acute and chronic foam rolling effects (p <0.05) were found for ankle dorsiflexion ROM. The chronic increase in ROM slightly decreased 7 days post-intervention but remained significantly above baseline (p < 0.05). Regarding dynamic balance, there were no acute but chronic (p < 0.05) and residual (p < 0.05) effects.Conclusion
Using a roller–massager for a 2-week period chronically increases ROM and dynamic balance. These increases are still significant 7 days post-intervention emphasizing the sustainability of foam rolling effects.

Full text

ORIGINAL RESEARCH
published: 15 February 2022
doi: 10.3389/fspor.2022.799985
Frontiers in Sports and Active Living | www.frontiersin.org 1February 2022 | Volume 4 | Article 799985
Edited by:
Olivier Girard,
University of Western
Australia, Australia
Reviewed by:
Fábio Juner Lanferdini,
Federal University of Santa
Catarina, Brazil
Carlos Ignacio De la Fuente,
Pontifica Universidad Catolica de
Chile, Chile
*Correspondence:
Astrid Zech
astrid.zech@uni-jena.de
Specialty section:
This article was submitted to
Elite Sports and Performance
Enhancement,
a section of the journal
Frontiers in Sports and Active Living
Received: 22 October 2021
Accepted: 20 January 2022
Published: 15 February 2022
Citation:
Seever TC, Mason J and Zech A
(2022) Chronic and Residual Effects of
a Two-Week Foam Rolling Intervention
on Ankle Flexibility and Dynamic
Balance.
Front. Sports Act. Living 4:799985.
doi: 10.3389/fspor.2022.799985
Chronic and Residual Effects of a
Two-Week Foam Rolling Intervention
on Ankle Flexibility and Dynamic
Balance
Thomas Christoph Seever, Joel Mason and Astrid Zech*
Department of Human Movement Science and Exercise Physiology, Institute of Sports Science, University of Jena, Jena,
Germany
Background: Foam rolling has been shown to acutely improve joint range of motion
(ROM). However, limited knowledge exists on the chronic and residual effects. The
primary purpose of this study was to examine the chronic and residual effects of a 2-week
roller–massager intervention on ankle dorsiflexion ROM and dynamic balance.
Methods: Forty-two participants (24.3 ±2.5 years, 33 males, 9 females) were randomly
assigned to either roller-massage (RM) or control group (=no intervention). Ankle ROM
was assessed with the weight-bearing lunge test (WBLT) and dynamic balance with the
Y-Balance test for both limbs. The RM group was instructed to roll their calf muscles for
three sets of 60 s per leg on 6 days a week over 2 weeks. Acute effects were measured
during baseline testing for dorsiflexion ROM and dynamic balance immediately after
foam rolling. Chronic and residual effects were measured 1 day and 7 days after the
intervention period. Multivariate ANOVA was performed for post-hoc comparisons to
determine acute, chronic, and residual effects.
Results: Significant acute and chronic foam rolling effects (p<0.05) were found
for ankle dorsiflexion ROM. The chronic increase in ROM slightly decreased 7 days
post-intervention but remained significantly above baseline (p<0.05). Regarding
dynamic balance, there were no acute but chronic (p<0.05) and residual
(p<0.05) effects.
Conclusion: Using a roller–massager for a 2-week period chronically increases ROM
and dynamic balance. These increases are still significant 7 days post-intervention
emphasizing the sustainability of foam rolling effects.
Keywords: roller-massage, foam rolling, range of motion, ankle dorsiflexion, balance
INTRODUCTION
Restricted ankle dorsiflexion range of motion (ROM) has been associated with altered lower
extremity movement patterns (Rabin et al., 2016; Lima et al., 2018), with potential to influence
sports performance and place undue strain on surrounding connective tissues which may
ultimately lead to injury (Hewett et al., 2005; Boling et al., 2009). It is thus not surprising that deficits
in dorsiflexion ROM have also been linked to decreased postural control (Hoch et al., 2011; Basnett
et al., 2013) and increased risk of chronic ankle instability (Hertel and Corbett, 2019), Achilles
tendinopathy (Rabin et al., 2014), patellofemoral pain (Piva et al., 2005), anterior cruciate ligament

Seever et al. Chronic Effects of Foam Rolling
injury (Fong et al., 2011), and hamstring injury (Gabbe et al.,
2006). Considering these detrimental effects on functional
performance and injury status, the improvement of ankle ROM
may be of high practical relevance for recreationally active and
sporting populations.
Muscle stretching is arguably the most common and effective
strategy to enhance joint ROM both acutely (Behm et al.,
2016) and chronically (Thomas et al., 2018). Despite its efficacy,
there is growing interest in foam rolling as an alternative
treatment method. This increased interest is reflected in the
recent proliferation of systematic reviews assessing the effects
of foam rolling on various functional outcomes (Hughes and
Ramer, 2019; Wiewelhove et al., 2019; Hendricks et al., 2020;
Skinner et al., 2020; Wilke et al., 2020). Besides improved
recovery (Kalén et al., 2017), physical performance (Halperin
et al., 2014; Peacock et al., 2014), and decreased pain perception
(Aboodarda et al., 2015), it has been established that foam rolling
can induce acute ROM changes comparable to those of muscle
stretching (Wilke et al., 2020). However, there are mixed and
limited findings regarding the chronic ROM changes following
foam rolling interventions.
To date, only three studies have examined the long-term
effectiveness of foam rolling on ankle dorsiflexion ROM (Aune
et al., 2019; Smith et al., 2019; Kiyono et al., 2020). Of these
studies, Kiyono et al. (2020) and Smith et al. (2019) observed
significant improvements after a 5- and 6-week period of
calf muscle foam rolling, respectively. Aune et al. (2019), by
contrast, did not observe significant training-induced changes
following a 4-week intervention of daily foam rolling. One
possible explanation for the inconsistency between these three
studies might be the difference in training variables, given that
all aforementioned studies prescribed different intervention set,
repetition, and frequencies. However, this fails to explain the
different results between Junker and Stöggl (2015) and Hodgson
et al. (2018) who both investigated the chronic effects of a 4-
week foam rolling intervention on hamstring flexibility. Despite
similar training protocols regarding training duration, frequency,
and volume, only Junker and Stöggl (2015) discovered significant
improvements in ROM.
Similarly sparse and inconclusive is the evidence relating
to the effects of foam rolling on static and dynamic balance.
Of the four studies that have explored the impact upon
balance (Halperin et al., 2014; Grabow et al., 2017; Lee et al.,
2018; Junker and Stöggl, 2019), only one reported significant
improvements in dynamic postural control immediately
after foam rolling the quadriceps and hamstrings (Lee
et al., 2018). Neither Halperin et al. (2014) nor Grabow
et al. (2017) found significant increases in static balance
performance directly after rolling the calf muscle and the
plantar sole, respectively. Finally, no training-induced changes
in dynamic balance were observed by Junker and Stöggl (2019)
following an 8-week foam rolling training intervention for the
lower body.
Given these mixed findings, research into foam rolling is
indeed still in its infancy (Hendricks et al., 2020). There
are currently no dosage recommendations to achieve optimal
long-term effects for performance or therapeutical effects.
Further work is needed especially to determine the long-
term (chronic) effectiveness of foam rolling on ROM, and to
elucidate its effects on balance, both of which are important
determinants of functional performance and injury prevention.
This information may help athletes and coaches/athletic trainers
to better implement foam rolling interventions into the training
routine. Therefore, the primary aim of this study was to examine
the chronic and residual effects of a 2-week roller–massager
intervention on ankle dorsiflexion ROM and dynamic balance,
with a secondary aim to explore the acute effects of roller-
massaging on the same outcome measures. It was hypothesized
that (1) the 2-week training program would increase ROM which,
in turn, would lead to improvements in dynamic balance, (2)
potential chronic improvements would remain above baseline
levels 7 days post-intervention, and (3) one bout of roller-
massaging would cause acute increases in ROM which would be
accompanied by improvements in balance performance.
MATERIALS AND METHODS
Participants
A total of 42 participants were recruited for this study. Inclusion
criteria were an age between 18 and 35 years and regular physical
activity (two times per week or more). Exclusion criteria were
a baseline flexibility ≥18 cm in the weight-bearing lunge test
(WBLT), recent injury to the lower body that could have affected
the performance on the WBLT and the Y-Balance test, and
regular foam rolling of the calf muscles (≥once a week) prior
to the investigation. The study was carried out in accordance
with the medical research guidelines of the Helsinki Declaration
and ethical approval was granted by the local ethics committee.
Written consent was obtained from all participants.
A power calculation for a repeated measures ANOVA (within-
between interaction) was performed a priori revealing a required
sample size of 40. This calculation was based on the following
input parameters: effect size of 0.3, alpha level of 0.05, power
level of 0.95, two groups, and two measurements. To account
for possible dropouts, 42 participants were included. Effect size
calculation was based on data of own studies using the WBLT
and Y-Balance test (John et al., 2019; Rahlf et al., 2020).
Experimental Approach
A randomized controlled between-subject design was used
to explore the acute, chronic, and residual effects of calf
muscle foam rolling on ankle dorsiflexion and dynamic balance.
Throughout the 24-day study period, data were gathered on
three separate occasions. The appointments were arranged at
12 p.m. or later but not earlier. An effort was made to assure
that all three assessments every individual was to participate
in were undertaken at approximately the same time of day in
the laboratory. The participants were instructed to refrain from
strenuous physical exercise of the lower body for at least 24 h
prior to each appointment. The timeline of the entire study
procedure is visualized in Figure 1.
Before the first assessments on Day 1, a simple randomization
procedure was used for group assignment by having the
participants draw a small piece of paper showing either 0
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Seever et al. Chronic Effects of Foam Rolling
FIGURE 1 | Timeline of measurements and intervention.
(=passive control group) or 1 (=experimental group).
Demographic data were then collected with a questionnaire, and
limb length was measured. After test familiarization, baseline
assessments for ankle dorsiflexion (WBLT) and dynamic balance
(Y-Balance test) were undertaken. Subsequently, the roller–
massager intervention was explained to the experimental group
by the researcher. The rolling technique was then practiced, and
the treatment began once the participant was familiar with the
technique. This process took 12 min on average. Participants in
the control group spend 12 min lying in supine position on a yoga
mat. Immediately after the 12 min, post I WBLT and Y-Balance
test measurements were performed for both groups to measure
acute effects.
After the first test session, the experimental group was
instructed to follow the unsupervised foam-rolling training
protocol for 2 weeks, starting on the next day. Controls were
asked not to change their exercise habits for the duration of the
measurement period. On Day 16, 1 day after the last foam rolling
intervention, both groups attended the laboratory for a second
time (=post II) in order to determine chronic effects. Upon
arriving, participants were first instructed to lie down in supine
position for 10 min to minimize any warm-up effect. Afterwards,
the WBLT and the Y-Balance test were performed.
The third week was treatment-free for both groups. The last
assessment (=post III) was on Day 24 to examine residual effects
of the foam rolling intervention. The procedure of the third
session was identical to the second one.
Roller–Massager Protocol
The tool used for the investigation was a customized roller–
massager (3.5 cm in diameter) made from beech wood with
a smooth surface structure. It consists of two handles (each
10 cm in length) and one center piece (20 cm in length) which
were attached to one another by a round metal bar (0.8 cm in
diameter). To minimize friction and thus facilitate a smooth
rolling motion, the metal bar was lubricated prior to assembly.
Two stainless steel washers were added as a spacer between the
center piece and the two handles.
The rolling was performed bilaterally by each participant
in a half-kneeling position (Figure 2). The leg undergoing the
treatment was on the floor with a cushioned support under the
knee. The contralateral leg was squatting to provide enough space
for the rolling motion. The roller–massager was then applied
to the triceps surae moving from the hollow of the knee to the
Achilles tendon and back (=one repetition). The same procedure
was then performed on the other leg.
The foam rolling protocol used for the acute effects was
adopted from Behm et al. (2020) and comprised three sets of
60 s for each leg. Individuals were required to switch leg sides
after each set with no obligatory rest in between, apply as much
pressure as possible, and roll at the speed of 60 beats per min
(one stroke per beat). One repetition consisted of four downward
and four upward strokes. The experimental group performed the
rolling with the same protocol in the subsequent 2-weeks on 6
days per week. The timing of the weekly rest day could be chosen
freely. Foam rolling was mandatory at the very first and the last
day of the intervention.
Weight-Bearing Lunge Test
The WBLT was used to assess ankle dorsiflexion ROM. The
WBLT has been used due to sensitivity to detect restrictions or
improvements in ankle ROM (Hall and Docherty, 2017). For the
test a good to excellent reliability (ICC between 0.65 and 0.99)
is reported (Powden et al., 2015). The general set-up used in
this study is in accordance with previous investigations (Halperin
et al., 2014; Škarabot et al., 2015; Kelly and Beardsley, 2016).
Participants were instructed to stand in front of a 90 cm tall,
wooden box in an upright lunge position without shoes. Their
hands were allowed to rest on top of the box. The big toe of the
leading leg had to be aligned with the 10 cm mark (=starting
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Seever et al. Chronic Effects of Foam Rolling
FIGURE 2 | Roller massage technique.
point) of the tape measure, which was attached to the floor at
an angle of 90◦to the box. If the second toe was longer than
the big toe, it was used for the alignment instead. The anterior
knee was then moved in a straight line toward the wooden wall.
If this movement was slow and controlled, and the contact to the
wall could be maintained for at least one second without any heel
lift of the assessed limb, the trial was valid. Heel elevation was
controlled with a resistance band (TheraBand R
, resistance level
yellow) that was placed underneath the heel of the assessed ankle
and held under tension by a 5 kg weight plate. Depending on the
outcome of each trial, the foot was gradually moved toward or
away from the wall by 0.5 cm until the maximum ROM of the
ankle joint was achieved. The number of trials was unlimited, and
the results were measured to the nearest 0.5 cm. Ankle ROM was
determined for both limbs.
Y-Balance Test
The Y-Balance test was used to determine dynamic postural
control. The test has been widely used in athletes and is
considered both reliable (ICC between 0.73 and 1.00) (Powden
et al., 2019) and valid (Gribble et al., 2012) in adult individuals. To
form the anterior, posteromedial, and posterolateral reach, three
tape measures were attached to the floor in the shape of a reversed
Y (Plisky et al., 2006). Participants performed six practice and
three recorded trials on both legs in each of the three excursion
directions. Regardless of reach direction, the participant had to
position their big toe of the stance leg behind a straight line at
the center of the Y (Stiffler et al., 2015). A trial was accepted if
the participant was able to maintain postural control, keep both
hands on their hips, touch the floor gently with the reach foot
without putting weight onto it, and return the reach foot to the
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Seever et al. Chronic Effects of Foam Rolling
FIGURE 3 | Study flow chart.
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Seever et al. Chronic Effects of Foam Rolling
TABLE 1 | Participant characteristics and baseline values of WBLT and Y-Balance test.
All Treatment Controls Group differences (P-value)aT
Sample size 42 21 21
Age (years) 24.3 ±2.5 24.2 ±2.6 24.4 ±2.4 0.724 −0.354
Weight (kg) 74.3 ±10.9 72.1 ±10.6 76.6 ±11.1 0.056 −1.937
Height (cm) 177.6 ±7.4 176.4 ±7.3 178.8 ±7.6 0.141 −1.487
Sex (female/male) 9/33 6/15 3/18 0.111 –
Physical activity (min) 332.4 ±139.5 358.6 ±159.7 306.2 ±113.7 0.083 1.753
Training frequency (twice/≥three times per week) 5/37 3/18 2/19 0.500 –
Baseline WBLT (cm) 13.4 ±2.6 13.0 ±2.6 13.8 ±2.5 0.122 −1.561
Baseline Y-Balance (%)
Anterior 64.7 ±5.4 63.2 ±6.1 66.3 ±4.1 0.007 −2.779
Posteromedial 105.9 ±7.9 103.5 ±6.9 108.3 ±8.2 0.005 −2.902
Posterolateral 100.9 ±8.6 97.3 ±8.3 104.5 ±7.3 <0.001 −4.275
Composite score 90.5 ±6.1 88.0 ±5.8 93.1 ±5.4 <0.001 −4.104
Data are presented as raw total or group mean ±SD.
aT-tests and Chi-squared tests were conducted to compare the means of the continuous and categorical variables between the two groups.
starting position in a slow and controlled manner. Heel elevation
was again controlled with a resistance band but only during the
anterior reach.
The data were recorded to the nearest 0.5 cm. To normalize
the reach distance, the maximum reach of each direction was
divided by the mean value of the participant’s limb length
and multiplied by 100 (Gribble et al., 2012). To calculate the
normalized composite score, maximum anterior, posteromedial,
and posterolateral reach were added up, divided by the three-
fold mean value of the participant’s limb length, and multiplied
by 100. Limb length was measured bilaterally from the inferior
part of the anterior superior iliac spine to the tip of the
medial malleolus.
Statistical Analysis
Statistics were performed with SPSS (version 27.0.0.0). For each
participant (n=42) data of both legs (n=84) were used for
statistics. Baseline data of continuous variables were presented
as mean and standard deviation. Baseline differences between
groups were tested with the t-test for two independent groups
and Pearson’s chi-squared test. Time as well as group by time
interaction effects for changes over the four time points (baseline,
post-tests I, II, and III) were tested with two-factor repeated-
measures ANOVA. Greenhouse-Geisser corrections were applied
when sphericity was not met according to Mauchly’s Test of
Sphericity. Levene’s test was used to examine homogeneity of
variance. To account for baseline differences between groups,
a multivariate ANOVA was used for post-hoc comparisons.
Accordingly, the dependent variables were changes in WBLT and
Y-Balance scores from baseline to post I (acute effects), baseline to
post II (chronic effects), and baseline to post III (residual effects).
The independent variable was group (control and treatment).
Statistical significance was set to an alpha level of <0.05.
RESULTS
A total of 44 participants were screened for eligibility. Two
of these were excluded, as they did not meet the inclusion
criteria. The remaining 42 participants were randomized and
allocated to either roller-massage (RM) (n=21) or no
RM (n=21). Twenty-four participants (treatment: n=11,
controls: n=13) reported previous injury to the lower limb
of which ankle sprains were mentioned most often. In general,
the physical activities were identical between both groups
including running (treatment group: n=17, controls: n=
15), cycling (both n=9), strength training (treatment: n=
9, controls: n =5), soccer (treatment: n=6, controls: n
=4), volleyball (treatment: n=3, controls: n=2), and
swimming (treatment: n=9, controls: n=5). Throughout
the study process no dropouts were recorded. Thus, 21
participants were included in the final analysis for each
condition. The flow chart of the study process is presented in
Figure 3.
Participant characteristics and baseline data of the WBLT
and the Y-Balance test are shown in Table 1. No significant
differences between groups were observed for the WBLT at
baseline. However, all Y-Balance pre-test scores were significantly
(p<0.05) different across groups.
The repeated measures ANOVA (Table 2) revealed significant
time and group by time interaction effects in the WBLT (p<
0.001) and the anterior (p=0.021), posterolateral (p=0.003)
reach and the composite score (p=0.002) of the Y-Balance test
(Figures 4,5). Only the posteromedial reach (p=0.078) of the
Y-Balance test showed no significant effects.
The results of the post-hoc multivariate ANOVA are displayed
in Table 3. Significant acute effects were determined for the
WBLT (p=0.009) and the posteromedial direction of the
Y-Balance test (p=0.049) but not for the anterior (p
=0.639) and posterolateral (p=0.317) direction and the
composite score (p=0.106). The chronic effects of both
WBLT (p=0.007) and all Y-Balance measures (p<0.05)
demonstrated statistical significance. The residual effects were
significant in the WBLT (p<0.001) and all Y-Balance
measures (p<0.05) excepting the posteromedial (p=
0.459) reach.
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Seever et al. Chronic Effects of Foam Rolling
TABLE 2 | Repeated measures ANOVA for time and group by time interaction effect.
Time effect Group by time effect
P-value FCohen’s d P-value FCohen’s d
WBLT <0.001 27.709 1.164 <0.001 15.814 0.880
Y-Balance
Anterior 0.030 3.446 0.408 0.021 3.792 0.430
Posteromedial 0.038 3.009 0.381 0.078 2.393 0.335
Posterolateral <0.001 25.981 1.127 0.003 5.312 0.510
Composite score <0.001 18.619 0.953 0.002 5.601 0.523
DISCUSSION
The primary aim of this investigation was to examine whether
roller-massaging the calf muscles for a 2-week period would
produce chronic and residual effects on ankle dorsiflexion ROM
and dynamic balance, with the results indicating significant
chronic improvements in both outcome measures. With the
exception of posteromedial reach, all improvements remained
significantly above baseline after 7 days of detraining. The
secondary aim of this study was to explore whether roller-
massaging the calf muscles for three sets of 60 s would lead to
acute effects on ankle flexibility and dynamic postural control.
Significant immediate improvements were observed in ROM and
the posteromedial reach of the Y-Balance test. No other Y-Balance
measures demonstrated significant changes.
Ankle Dorsiflexion ROM
Following the 2-week intervention, a significant increase in ankle
dorsiflexion ROM was observed. As the retention assessment
was scheduled 1 day after the last foam rolling session, it can
be concluded that these changes were actual training effects and
not acute effects. The observed chronic changes in the treatment
group are slightly below the reported recommendations for
minimal detectable change of the WBLT (Powden et al., 2015)
but were significantly different from the changes in controls. We
still consider the change practically relevant since a comparable
absolute difference in WBLT was reported between young adults
with and without chronic ankle instability (John et al., 2019).
Our result adds valuable evidence to the limited existing research
investigating the long-term effectiveness of foam rolling on
ROM. Whereas, Smith et al. (2019) and Kiyono et al. (2020) also
reported significant chronic improvements in ankle dorsiflexion
ROM, Aune et al. (2019) reported none. A likely explanation for
the discrepancy may be the selected sample in Aune et al. (2019)’s
study, consisting exclusively of elite athletes (top-division soccer
players). This suggests that foam rolling alone may not provide
the same effects for long-term ROM changes in highly trained
athletes compared to recreationally active individuals. However,
this remains to be thoroughly examined.
Our observations are in agreement with Smith et al. (2019)
and Kiyono et al. (2020), despite distinct differences in foam
rolling protocols between studies. The participants in Smith
et al. (2019) study completed 12 foam rolling sessions which
were evenly spread over a 6-week period and consisted of three
sets of 30 s. Similarly, Kiyono et al. (2020) instructed their
participants to foam roll three times a week for three sets of
30 s spanning a 5-week period. The intervention of the present
study, by contrast, comprised a 2-week period with six sessions
per week and three sets of 60 s. Above all, the comparison of these
protocols underlines that foam rolling can induce chronic ROM
changes within a relatively short amount of time. Whether this
was due to the higher training frequency and volume cannot be
ascertained. However, since no clear dose–response relationship
exists regarding acute ROM responses to foam rolling (de Souza
et al., 2019; Behm et al., 2020), it may be speculated that this
relationship is also absent from long-term ROM changes. Future
studies on the current topic should therefore seek to clarify the
relation between dose and response by incorporating two or more
different foam rolling protocols within one trial.
Nine days post-intervention, the chronic ROM changes were
still significant, which supports existing reports of ROM being
retained after 1 week of detraining (Smith et al., 2019). Although
it is currently unclear how long these changes in ROM following
foam rolling are preserved, hamstring flexibility improvements
return to baseline 4 weeks after a 6-week stretching protocol
(Willy et al., 2001), and improvements in ankle dorsiflexion are
no longer present 5 weeks following a 5-week stretching program
(Nakamura et al., 2021a), which may indicate similar detraining
timelines for foam rolling interventions. Future studies should
seek to clarify this.
Apart from chronic and residual effects, the present study
revealed significant acute effects on ROM following three sets
of 60 s of foam rolling. The outcome is well-aligned with earlier
studies investigating acute responses to foam rolling on ankle
dorsiflexion ROM (Halperin et al., 2014; Kelly and Beardsley,
2016; de Souza et al., 2019; Yoshimura et al., 2021). Although
between-study heterogeneity makes it difficult to compare the
results, it is noteworthy that Yoshimura et al. (2021) found a
remarkably higher ROM increase of 22% despite using the same
rolling duration (three sets of 60 s). The inconsistency between
dose and response is further emphasized by de Souza et al.
(2019) who reported an immediate 11% ROM improvement
regardless of protocol length (two sets of 30/60 s). Training
volume alone therefore may not be a major determinant of
the treatment outcome, and instead other variables such as
intra and inter individual differences may be more predictive
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Seever et al. Chronic Effects of Foam Rolling
FIGURE 4 | Change in WBLT over time in the treatment group and controls.
of ROM improvements following foam rolling interventions
and should be investigated further in order to optimize
protocol recommendations.
There is some debate regarding whether morphological or
neural adaptations are primarily responsible for the positive
treatment effects of foam rolling (Behm and Wilke, 2019). Wilke
et al. (2019) observed reduced tissue stiffness in the anterior thigh
immediately after one bout of foam rolling, and recent evidence
indicates that changes in gastrocnemius stiffness accompany
changes in ankle ROM (Chang et al., 2021). However, there
is contradictory evidence from Baumgart et al. (2019), who
reported decreased stiffness in the quadriceps but not the calves
despite identical foam rolling protocols. In addition, other works
examining the gastrocnemius muscle reported that foam rolling
caused neither acute (Nakamura et al., 2021b) nor chronic
(Kiyono et al., 2020) reductions in tissue stiffness. Based on
these inconsistent results, it may be argued that the primary
drivers of the ROM enhancement in the current study are neural.
Evidence to support this notion is provided by Aboodarda et al.
(2015) and Cheatham and Kolber (2018) who reported a reduced
pain perception of both the massaged and non-massaged limb
after foam rolling. It can be inferred from these findings that
foam roll training can affect the central nervous system and its
response to pain. Further, the increased threshold of pain might
be linked to an increased stretch tolerance, which is considered
to be one of the main influencing factors behind ROM gains
in the stretch-related literature (Magnusson et al., 1996; see
also Blazevich et al., 2014; Freitas et al., 2018). Even though
stretching and foam rolling are different in many respects, they
can both provide an uncomfortable or painful stimulus capable
of altering the neuronal and sensorimotor responses (Behm and
Wilke, 2019). Moreover, recent evidence by Kiyono et al. (2020)
and Nakamura et al. (2021b) shows that changes in dorsiflexion
ROM are significantly correlated with passive torque (i.e., stretch
tolerance) but not muscle stiffness.
Dynamic Balance
The present study provides the first evidence for chronic changes
in dynamic balance induced by foam rolling. Although Y-Balance
FIGURE 5 | Change in YBT composite score over time in the treatment group
and controls.
test scores dropped after 7 days of detraining, they remained
above baseline. Therefore, it appears that improvements in
chronic ankle ROM are accompanied by improvements in
balance performance following a foam rolling intervention.
However, although statistically significant, the reported changes
in all reaching directions were below the minimal detectable
change reported by Powden et al. (2019).
Since ankle dorsiflexion ROM is most strongly correlated
with the anterior reach performance (Hoch et al., 2011;
Basnett et al., 2013), it may be considered surprising
that the magnitudes of the chronic and residual effects
of the anterior reach were exceeded by the posterolateral
reach and nearly equaled by the posteromedial reach. To
explain this outcome, the following two points should be
considered: first, hip and knee flexion are strong predictors
of posterolateral and posteromedial reach performance
(Robinson and Gribble, 2008), and second, altered hip and
knee kinematics strongly correlate with decreased ankle
dorsiflexion ROM (Rabin et al., 2016). Therefore, it is plausible
that increased ankle flexibility led to improved hip and knee
movement patterns which, in turn, enabled greater posterior
reach distances.
Our findings are not consistent with those of Junker and
Stöggl (2019) who found no positive developments in dynamic
balance after 8 weeks of lower body foam rolling. Their training
program, conducted twice a week, targeted the calves, quadriceps,
hamstrings, IT-band, and glutes. Even though Junker and Stöggl
(2019) did not assess ankle dorsiflexion, an increase in ROM most
probably occurred, considering that the calf muscle protocol was
comparable to the ones used in Smith et al. (2019) and Kiyono
et al. (2020) study. It thus seems unlikely that the contradictory
results between the present study and Junker and Stöggl (2019)
are related to differences in foam rolling protocols. Instead,
it could be assumed that different assessment methods might
have contributed to the controverse findings, as Junker and
Stöggl (2019) reported considerably greater reach distances in the
composite score.
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Seever et al. Chronic Effects of Foam Rolling
TABLE 3 | Mean and statistics of acute, chronic, and residual effects.
Mean Mean change
after pre-test
ANOVA statistics
Treatment Controls Treatment Controls P-value F
Acute effects (post I)
WBLT (cm) 13.4 ±2.8 13.9 ±2.4 0.45 ±0.63 0.11 ±0.55 0.009 7.158
Y-Balance (%)
Anterior 63.5 ±5.8 67.0 ±5.6 0.31 ±2.94 0.67 ±3.85 0.639 0.222
Posteromedial 104.0 ±7.0 107.1 ±7.2 0.49 ±3.48 −1.25 ±4.46 0.049 4.008
Posterolateral 99.2 ±7.9 105.6 ±7.8 1.94 ±3.77 1.04 ±4.32 0.317 1.012
Composite score 88.9 ±6.0 93.1 ±5.3 0.86 ±2.18 0.00 ±2.60 0.106 2.675
Chronic effects (post II)
WBLT (cm) 14.0 ±2.7 14.0 ±2.4 1.0 ±0.76 0.14 ±0.52 <0.001 36.520
Y-Balance (%)
Anterior 64.8 ±5.6 66.6 ±4.2 1.62 ±2.32 0.25 ±2.23 0.007 7.556
Posteromedial 105.6 ±6.5 107.9 ±7.9 2.28 ±3.50 0.22 ±3.9 0.013 6.389
Posterolateral 102.4 ±7.0 106.6 ±7.8 5.10 ±4.69 2.06 ±4.09 0.003 9.375
Composite score 90.5 ±5.3 93.6 ±5.5 2.86 ±2.61 0.71 ±2.87 0.001 12.915
Residual effects (post III)
WBLT (cm) 13.7 ±2.8 14.0 ±2.4 0.75 ±0.82 0.12 ±0.57 <0.001 16.708
Y-Balance (%)
Anterior 64.4 ±5.7 66.5 ±4.5 1.23 ±2.3 0.14 ±2.50 0.042 4.248
Posteromedial 104.4 ±6.3 108.5 ±7.8 0.93 ±4.62 0.12 ±5.30 0.459 0.554
Posterolateral 101.9 ±7.2 106.3 ±8.0 4.59 ±5.72 1.75 ±3.96 0.010 7.003
Composite score 90.2 ±5.3 93.8 ±5.6 2.21 ±3.07 0.69 ±2.92 0.023 5.409
Data are presented as group mean ±SD.
Finally, of all Y-Balance measures, only the posteromedial
reach showed significant acute improvements. However, the
magnitude of the effect was small and thus of little practical
relevance. Considering the acute dorsiflexion ROM gains and
the chronic balance improvements, the result was unexpected.
This inconsistency may be attributed to one of the following
two reasons. First, depending on roller–massager position, the
quadriceps of the massaged limb was always engaged either
concentrically or eccentrically. This movement might have
provided an unusual stimulus capable of inducing muscle
fatigue in the quadriceps. Since muscle fatigue protocols
applied to the quadriceps can significantly reduce Y-Balance
test performance (Fatahi et al., 2016), the absence of immediate
balance improvements might have been due to a decrease in
maximal force production. Second, Lee et al. (2018) found that
vibration rolling and non-vibration rolling of the quadriceps and
hamstrings (three sets of 30 s) led to immediate improvements
in dynamic postural control. Bearing this in mind, it might
be more recommendable to foam roll the quadriceps and
hamstrings instead of the gastrocnemius muscle to acutely affect
dynamic balance.
Limitations
Several limitations need to be considered when interpreting
the findings of the current study. Firstly, all assessments were
performed under non-blinded circumstances, which increases
the risk of bias. Second, after familiarization with the foam rolling
technique, the correct execution was only supervised on Day 1.
The following 12 training sessions of the 2-week protocol were
home-based and therefore not monitored. Third, all participants
were instructed to apply as much pressure as possible with
the roller–massager, which invites a high degree of variability.
Fourth, the roller–massager was made from wood, which may
limit the findings to the use of wooden foam rolling devices. Fifth,
all participants agreed to maintain their normal exercise routine,
and differences in this exercise routine were not accounted for in
our analysis. Sixth, the subjects were aged between 18 and 35 and
recreationally active, and so the transfer of our findings to other
populations cannot be ascertained. Another limitation is the lack
of clear definition for acute, chronic, and residual effects in the
literature. In our study, we used the second test immediately after
the first RM for acute effects, the 14 days intervention period for
chronic effects, and the subsequent 7 days without intervention
for residual effects. Finally, the time points for the three categories
(acute, chronic, residual) in our study may differ compared to
other studies due to the lack of specific recommendations in
the literature.
CONCLUSION
This study demonstrated that a 2-week period of regular calf
muscle rolling chronically improved ankle dorsiflexion ROM
and dynamic balance, and that these positive improvements in
functional performance were retained after 7 days of detraining
Frontiers in Sports and Active Living | www.frontiersin.org 9February 2022 | Volume 4 | Article 799985

Seever et al. Chronic Effects of Foam Rolling
in all but one of the post III measurements, underlining the
sustainability of foam rolling effects. Further, foam rolling
acutely improved ROM despite mixed findings on immediate
balance performance.
PRACTICAL RELEVANCE
In practical terms, these findings support calf muscle roller-
massaging for (1) warm-up if acute increases in ankle dorsiflexion
ROM are required and (2) regular use to produce long-term
improvements in ankle dorsiflexion ROM and dynamic balance.
The findings also indicate that improvements in ROM and
balance persist for longer periods (at least 1–2 weeks) in the
absence of foam rolling.
DATA AVAILABILITY STATEMENT
The original contributions presented in the study are included
in the article, further inquiries can be directed to the
corresponding author.
ETHICS STATEMENT
The studies involving human participants were reviewed and
approved by the Ethics Committee of the Faculty of Social
and Behavioural Sciences of the Friedrich Schiller University
Jena, Germany. The participants provided their written informed
consent to participate in this study. Written informed consent
was obtained from the individual for the publication of the
potentially identifiable image included in this article.
AUTHOR CONTRIBUTIONS
TS, JM, and AZ were fully involved in the study and preparation
of the manuscript. All authors have read and concur with the
content in the final manuscript.
ACKNOWLEDGMENTS
The authors thank all participants of this study.
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Conflict of Interest: The authors declare that the research was conducted in the
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