An acute bout of foam rolling of the biceps brachii does not affect upper extremity sensorimotor function: a randomized trial

Abstract

Purpose

To investigate the effects of single session foam rolling of the biceps brachii on upper extremity sensorimotor function including elbow proprioception, strength, and functional motor performance in healthy individuals.

Methods

Sixty healthy participants (mean age = 21.53 ± 2.80 years) were randomly assigned into the foam rolling group (FRG, n = 30) (mean age = 22.10 ± 2.98 years) (a single session of foam rolling to the biceps brachii muscle) or control group (CG, n = 30) (mean age = 20.97 ± 2.52 years) (no application). Proprioception [joint position sense (JPS) with an inclinometer, force sense (force reproduction) with a hand-held dynamometer], muscle strength (biceps brachii muscle strength with a hand-held dynamometer), and functional motor performance [modified pull-up (MPU) test, closed kinetic chain upper extremity stability (CKCUES) test, and push-up test] were evaluated. Evaluations were done before and immediately after the single session application in a pretest-posttest design. We used the Student t-test to investigate between-group differences and we used the χ2 test for dichotomous data for analyses. We determined the significance level as p < 0.05.

Results

JPS (p_45°=0.70, p_60°=0.80, p_75°=0.09), force sense (p = 0.63), and muscle strength (p = 0.11) did not change after the single session of foam rolling (p > 0.05). Foam rolling did not affect the functional motor performance test (p_{CKCUES−average}=0.78; p_{CKCUES−score}=0.66; p_{CKCUES−power}=0.89; p_MPU=0.10; p_push−up=0.97) results (p > 0.05).

Conclusions

Single session foam rolling of the biceps brachii has no effect on upper extremity sensorimotor function including elbow proprioception, strength, and upper extremity functional motor performance.

Trial registration

Clinical Trials- NCT03516149 (Date: 24/04/2018)

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-025-09173-y.

Background

Foam rolling is a self-induced myofascial release (SMR) technique that potentially reduces fascial restrictions between the layers of fascia [1]. Warming of the fascia by generating friction between the soft tissue and the foam roller because of applied pressure to the related soft tissue using body weight contributes to the thixotropic property of the fascia and breaking up of fibrous adhesions, thereby improving normal muscle mechanics [2]. Recently, interest in foam rolling has grown, and studies have focused on investigating its effects [3].

It appears that lower extremity foam rolling can improve flexibility, joint and fascia mobility [4] without neuromuscular deterioration [5], and side effects [6]. It can also correct muscular imbalance, reduce muscle spasm, pain, and joint stress, and thus improve optimal skeletal function and neuromuscular efficiency [5, 7].

The sensorimotor system, which is a part of the body’s motor control system, contains sensory, motor, and central components that are involved in maintaining functional joint stability during body movements [8]. The term sensorimotor function includes proprioception, dynamic neuromuscular control, strength, and functional performance [9]. Proprioception and neuromuscular control of the elbow joint are of great importance in performing fine manipulative tasks during ADL such as lifting objects, and sporting activities such as shooting and throwing [10, 11]. In this context, it is important to develop effective strategies to increase proprioception and neuromuscular control at the elbow [12].

Foam rolling may affect proprioception due to the stimulation of receptors via the properties of the foam roller and applied pressure on the involved structure (13). Rearrangement of the afferent pathways and facilitation of the co-activation of the involved force couples may contribute to strength and functional stability. On the other hand, optimum relaxation in muscle and fascia and improved flexibility may also have a positive effect on the muscle length-tension relationship [3, 13]. Neuromuscular efficiency, muscle balance, which is the harmonious action of the muscles that surround a joint to keep the bones centered, and optimal skeletal function can be achieved [5]. Overall, functional performance can be improved [14]. However, it is unknown whether foam rolling is directly beneficial to athletic performance markers including muscle strength [15]. Furthermore, foam rolling may even worsen strength because of possible relaxation effect [6, 16, 17]. This proposition raises the question of whether this technique, which is frequently used as a single session application in warm-up especially before performance events such as exercise or sports competition, can negatively affect sensorimotor function. Therefore, it is extremely important to know what happens after a single foam rolling application, and whether it has a negative effect on sensorimotor function, that is, whether the application is safe [18]. Nevertheless, findings regarding the effects of foam rolling on sensorimotor function are conflicting [6]. The literature generally indicates no substantial effects of acute bouts of foam rolling on strength or performance [19], whereas one study reported positive effects [20]. Previous authors reported improvement [16, 21] or no change [16] in proprioception after foam rolling. Furthermore, those studies were conducted on the lower extremities. To date, in only one study on the upper extremity, the short-term effects of foam rolling of the biceps brachii were investigated [22]. Ozden and Yesilyaprak concluded that foam rolling of the biceps brachii for 4 weeks improves elbow flexion muscle strength, JPS, and some parameters of upper extremity functional motor performance [22]. However, since no researchers have examined the immediate effects of foam rolling of the biceps brachii to date, it is unknown whether a single session of foam rolling of the biceps brachii is a safe method for upper extremity sensorimotor function.

Therefore, we aimed to investigate the effects of a single session of foam rolling of the biceps brachii on elbow proprioception, strength, and upper extremity functional motor performance. Based on the results of previous research, we hypothesized that there would be no detrimental effects or some improvement in sensorimotor function.

Methods

Experimental approach to the problem

Research design

This prospectively registered, two-arm, randomized controlled study was conducted at Dokuz Eylül University, Physical Therapy and Rehabilitation Department. The Ethics Committee of Dokuz Eylül University (Number: 3470-GOA) approved this study. All participants provided informed written and verbal consent. Informed Consent Form was obtained from all participants in the study. This study was carried out in accordance with the policies and procedures of the Declaration of Helsinki and its later amendments, and it was approved by the Dokuz Eylul University Ethics Committee, all participants gave written informed consent to participate voluntarily, and patient anonymity is preserved. The author, who was not involved with the applications, assigned participants to the Foam Rolling (FRG) or Control Group (CG) (Fig. 1) using a computerized random number generator (Random.org; Randomness and Integrity Services Ltd, Dublin, Ireland; https://www.random.org). The allocation of the participants was concealed by using sequentially numbered, sealed, opaque envelopes. We compared the intervention and no-treatment control groups with a 1:1 ratio. ‘Permission for publication’ has been obtained from the persons whose figures are used. Written permission for publication was obtained from the patient shown in (Fig 2).

Fig. 1.

CONSORT (Consolidated Standards of Reporting Trials) flow diagram of the study

Fig. 2.

a,b Foam-rolling application

Subjects

Between August 2018-October 2018, 60 healthy individuals participated in the study. Eligibility criteria are presented in Box 1.

Procedures

Intervention

FRG

Participants in the FRG performed single session foam rolling under the supervision of the physical therapist. The participants knelt on the floor with the side of their trunks close to a rectangular stair step. The participants placed the dominant side biceps brachii muscle belly using body weight on a standard 15.3 cm foam roller that was put on a portable stair step. The shoulder was approximately in 90º abduction, and the elbow was in full extension (Fig. 2. a and b). We selected the biceps brachii muscle due to its distinct anatomy and ease of differentiation from adjacent muscles. The participants performed 2 sets of 60 s of foam rolling including 10 back-and-forth movements in each 60 s, with a 30-second interval between sets. Application speed was controlled with a metronome. The recommended duration for foam rolling application typically ranges from 5 to 10 rolls over a period of 60–90 s to 5 min. However, there is no clear consensus in the existing literature on the optimal duration. To minimize the potential relaxation effects associated with prolonged application, we opted for a standardized set duration of 60 s [18]. In order to ensure sufficient pressure during the application, we gave the participants verbal encouragement to place as much of their body weight as possible on the foam roller. Prior to the application, we ran a trial session for teaching purposes [20]

CG

Participants in the CG did not perform foam rolling. After all the study assessments were finished, we gave them an information brochure about sensorimotor function and demonstrated foam rolling.

Outcome measures

Evaluations were made in random order before and immediately after application in the FRG, and before and after a passive waiting period equal to the duration of the foam rolling in the CG. Two minutes of rest were provided between the tests. By performing a familiarization session for all tests, any learning effect was excluded. Prior to the main evaluations, a test-retest procedure was conducted on a sample of 10 participants to assess the reliability of the measurements. Intra-rater reliability was determined by calculating the Intraclass Correlation Coefficient (ICC) model 3,3 along with the corresponding 95% confidence intervals. The level of reliability was categorized as excellent (ICC > 0.75), moderate (ICC = 0.40–0.75), or poor (ICC < 0.40) [23]. The results of our test-retest reliability analyses for all evaluation methods demonstrated good to excellent reliability, with ICC values ranging from 0.78 to 0.97.

Proprioception

Joint position sense (JPS)

We measured JPS with a digital inclinometer (Baseline, NY, USA). Participants sat on a chair with their hips flexed at 90°, their forearm on the arm of the chair, covered with a foam pad, in a semi-prone position with the elbow fully extended at the starting position. We asked participants to bend their elbows to the target angle (JPS 45°, JPS 60°, JPS 75°) in a random order, to maintain the position for 5 s to learn the relevant angle, and finally to return to the starting position and rest for 5 s. Three repetitions were performed with first eyes open and then eyes closed in teaching the target angle, and with eyes closed in the actual tests [10].

Force sense

Force sense was assessed during elbow flexion using unilateral force reproduction test with a hand-held dynamometer (HHD) (MicroFET^®3; Hoggan Inc, UT, USA). Since altering the position of the body and relevant joints influences the outcomes of the maximal voluntary isometric contraction (MVIC) measurements [24, 25], we assessed the MVIC in the same position as the force sense assessment position [26]. The participants sat on a chair with 90° elbow and 90° shoulder flexion, the forearm supinated, and the elbow resting on the treatment table. First, we measured the MVIC of the elbow flexors three times using the HHD and averaged the results. A 1-minute rest was provided between trials to avoid fatigue. The reference force was determined as 30% of the MVIC. Second, after a 5-minute rest period, we taught the participant the amount of target contraction three times on the dominant extremity, with a 45-second rest period between each contraction, initially with their eyes open and then with their eyes closed. Following a 45-second rest, the participant was asked to reproduce the force on the same side with their eyes closed. A 1-minute rest was provided between trials [22, 26–28].

We conducted all proprioception tests on the dominant side and calculated the deviations from the target (absolute error) and averaged the 3 test results in proprioception evaluations.

Muscle strength

We used the HHD to evaluate dominant side biceps brachii muscle strength. The participants lay on their backs with neutral shoulder, elbow flexed at 90°, forearm in supination, and upper arm next to the trunk. Localization of the HHD was just proximal to the styloid process of the radius. We instructed the participants to gradually increase their muscle force to a maximum effort in 2 s and then sustain it for 5 s. The participants provided muscle contraction until their efforts matched the examiner’s (make test) [25, 29]. We chose to perform the make test because it is more reliable and safer than the break test for HHD-acquired data. We averaged the 3 consecutive test results with one-minute rest periods between tests [30].

Functional motor performance

We had the participants warm up from submaximal to maximal levels before the performance tests. Throughout the tests, we verbally encouraged the participants to provide a high-intensity effort. We averaged the 3 consecutive test results with one-minute intervals between tests.

Closed kinetic chain upper extremity stabilization test (CKCUEST)

Using two parallel strips of athletic tape (3.8 cm wide), 90 cm apart, we marked two lines on a floor. The starting position for the test was one hand on each piece of tape while the body was in a push-up position. The participant moved both hands back and forth from each line as many times as possible in 15 s, men in the push-up position, and women in the modified push-up position (kneeling). We allowed a 45-second rest period between 3 trials. We averaged the scores. In addition to the average number of lines touched, the score and power were calculated using the following equation: score = average of the number of lines touched/height, power=[(68% weight*the average number of lines touched)/15] [31].

Modified Pull-up test (MPUT)

We positioned the participants on their back and adjusted the metal frame above their heads to be just above the shoulder level. Men performed the test with the support from their heels. Women were supported with a step just below their knees. The participants started the test by holding the metal frame with the arms in full extension, pulling it parallel to the floor, and finally lowering their bodies with their elbows fully extended. During the test, we instructed the participants to limit the movement of the head and trunk, and to maintain smoothness as much as possible. The participants performed the test with as many pulls as possible within 15 s during the 3 trials, allowing a 45-second rest between repetitions. We averaged the scores [32].

Push-up test

The participants performed push-ups in the prone position with the trunk straight and hands open at shoulder width. Males performed the test on the hands and feet in the standard position, and females on the hands and knees (modified position). Participants began the test with the elbows fully extended. As the body descended to the floor, the participants bent their elbows until the humerus was parallel to the surface. During the test, we instructed the subjects to keep the head and trunk position straight. They performed a submaximal warm-up before 3 maximal tests. They performed the maximal tests after a 15-second trial and a 45-second rest period. The number of push-ups completed by the participants in the 15-second bout was recorded [32].

Statistical analysis

Because there were no relevant studies, we decided to include 30 individuals per group to ensure parametric conditions and did not perform an a priori power analysis.

We used the “Statistical Package for Social Sciences” (SPSS v22.0) for data analyses. We determined the normal distribution of continuous data with the Shapiro-Wilk test. We used the Student t-test to investigate between-group differences for patient characteristics that are continuous data and for outcome measurements and we used the χ2 test for dichotomous data. We determined the significance level as p < 0.05.

Results

Study groups had similar clinical, demographic, and anthropometric characteristics (Table 1), and outcome measurements at baseline (the first column of Table 2-3-4- 5)All participants attended the single session foam rolling. Foam rolling was well tolerated and there were no adverse effects. The reasons for the exclusion and flow of participants through the trial are presented in Fig. 1. All participants in the experimental group received the intervention as randomly allocated. All participants completed all outcome measurements. There was no loss to follow-up/discontinued intervention.

Table 1.

Box 1. Eligibility criteria

Inclusion Criteria	Exclusion Criteria
18 years of age or older	Open wound, acne, or similar skin problems
No elbow pain up until 6 months before recruitment	Experience of foam rolling or myofascial relaxation exercises
No regular participation in upper extremity sports in the previous 6 months	A history of previous or current upper extremity injuries, upper extremity fracture, or surgery
	Systemic diseases, i.e., musculoskeletal disease, cardiovascular disease, osteoporosis, or diabetes mellitus
	Peripheral neuropathy
	Pregnancy
	Vertigo

Table 2.

Participants characteristics

	CG (n = 30)	FRG (n = 30)	p value
Age (y) a	20.97 ± 2.52	22.10 ± 2.98	0.144 §
Height (cm) a	170.17 ± 8.59	169.43 ± 7.81	0.695 §
Mass (kg) a	65.70 ± 15.95	66.33 ± 14.94	0.750 §
Body Mass Index (kg/m²) a	22.42 ± 3.91	22.95 ± 4.06	0.544 §
Sex (Male/Female)	12/18	13/17	0.50 ‡
Dominant Extremity (Right/Left)	28/2	29/1	0.50 ‡

^a Values are presented as mean ± standard deviation

‡: χ² test. §: Student T Test, CG: Control Group, FRG: Foam Roller Group

Table 3.

Proprioception results in study groups

Outcome Measure		Group	1st	2nd	∆ 2nd − 1st	p †
JPS (°)	45°	FRG	4.32 ± 2.20	3.58 ± 1.93	−0.73 ± 3.07	0.70
		CG	4.76 ± 2.99	4.37 ± 2.78	−0.38 ± 3.77
	60°	FRG	4.61 ± 2.44	5.12 ± 2.80	0.51 ± 3.68	0.80
		CG	4.63 ± 3.44	4.17 ± 1.86	−0.45 ± 3.96
	75°	FRG	3.27 ± 1.85	3.26 ± 1.83	−0.01 ± 2.33	0.09
		CG	4.62 ± 3.30	3.61 ± 1.97	−1.01 ± 3.38
Force sense (kg)		FRG	0.47 ± 0.26	0.40 ± 0.23	−0.07 ± 0.31	0.63
		CG	0.39 ± 0.23	0.29 ± 0.13	−0.10 ± 0.26

Values are presented as mean ± standard deviation unless otherwise indicated

FRG Foam Rolling Group, CG Control Group, JPS Joint Position Sense

1st: Baseline, 2nd: After one session. Δ: Change between two measurements

†: Independent Sample T Test

Table 4.

Muscle strength results in study groups

Outcome Measure	Group	1st	2nd	∆ 2nd − 1st	p †
Biceps Brachii Muscle Strength (kg)	FRG	20.68 ± 5.54	19.63 ± 5.94	−1.04 ± 2.08	0.11
	CG	18.18 ± 4.10	18.06 ± 5.21	−0.11 ± 2.34

1 st : Baseline, 2nd : After one session. Δ: Change between two measurements.

Values are presented as mean ± standard deviation unless otherwise indicated

FRG Foam Rolling Group, CG Control Group, CKCUEST Closed Kinetic Chain Upper Extremity Stability Test, MPUT Modified pull-up test.

^a MPUT outcome: the number of pull-ups, ^bPush up test outcome: the number of push-ups, ^cCKCUEST outcome: average number of lines touched, score (inch^-1) and power (kg). †: Independent Sample T Test

Table 5.

Functional motor performance results in study groups

Outcome Measure			Group	1st	2nd	∆ 2nd − 1st	p †
Functional motor performance	MPUTa		FRG	9.63 ± 2.96	10.06 ± 3.02	0.43 ± 1.74	0.10
			CG	8.77 ± 2.33	8.86 ± 2.30	0.08 ± 2.16
	Push upb		FRG	11.46 ± 3.90	12.24 ± 4.78	0.77 ± 2.40	0.97
			CG	9.53 ± 2.46	9.69 ± 2.91	0.16 ± 1.80
	CKCUESTc	Average	FRG	19.64 ± 4.32	20.67 ± 4.52	1.03 ± 2.34	0.78 (Average) 0.66 (Score) 0.89 (Power)
		Score		0.29 ± 0.06	0.30 ± 0.06	0.01 ± 0.03
		Power		58.86 ± 16.73	62.30 ± 19.05	3.43 ± 7.81
		Average	CG	18.54 ± 3.09	19.08 ± 3.78	0.54 ± 2.40
		Score		0.27 ± 0.05	0.28 ± 0.06	0.008 ± 0.03
		Power		54.65 ± 13.63	55.71 ± 12.87	1.05 ± 8.51

1 st : Baseline, 2nd : After one session. Δ: Change between two measurements

Values are presented as mean ± standard deviation unless otherwise indicated. FRG: Foam Rolling Group, CG: Control Group

CKCUEST Closed Kinetic Chain Upper Extremity Stability Test, MPUT Modified pull-up test

^a MPUT outcome: the number of pull-ups, ^bPush up test outcome: the number of push-ups, ^cCKCUEST outcome: average number of lines touched, score (inch⁻¹) and power (kg)

†: Independent Sample T Test

There was no statistically significant difference between the two groups in JPS, force sense, biceps brachii strength, CKCUEST, MPUT, and push-up test results. These results are presented in Table 2, Table 3, and Table 4.

Discussion

This was the first trial investigating the effects of single session foam rolling of the biceps brachii on sensorimotor function. According to the results of our study, a single session of foam rolling has no detrimental effect on sensorimotor function including elbow JPS, force sense, elbow strength, and upper extremity functional motor performance.

A limited number of studies examining the effects of foam rolling on proprioception were performed on the lower extremities [16, 21, 33, 34], and the results of these studies differ. Cho and Kim found improvement in hip position matching error [21], whereas David et al. did not find a significant change in this parameter after foam rolling of the hamstrings [16]. The reason for these contradictory findings may be the already normal or close to normal baseline JPS values in the study​​ by David et al. [16]. Differences in application duration, speed, set, and foam roller type may also have caused different findings. Researchers who found improvement in JPS after foam rolling [16, 21, 35, 36] suggested that foam rolling may have improved JPS by stimulating muscle spindles by creating pressure on the involved tissue, as in massage and stretching [21]. The single session of foam rolling may not have been sufficient to reveal similar neurological effects in the elbow joint. Although there is no study describing normal values ​​for elbow JPS, a joint position error of up to 5° is generally considered normal in the upper extremity [37]. In addition, Juul-Kristensen et al., who used the same JPS measurement method with us, reported an error value of approximately 6° in elbow JPS [10]. The mean JPS error we found was lower in both groups (between 3.27–4.76°). Therefore, relatively normal baseline JPS values ​​could also explain the lack of improvement in our JPS results.

There was no change in force sense after foam rolling. Previous researchers also found no improvement in force sense either immediately after foam rolling [16] or at the end of the 4-week application [22]. Although force sense arises from the sense of tension peripherally (afferent feedback from the muscle) and the sense of effort centrally, the main factor in the prediction of the target force seems to be the sense of effort [38]. Ozden and Yesilyaprak suggested that foam rolling may not have a significant central effect even after 4-week practice [22]. While the current study did not directly assess central mechanisms, the lack of change in force sense following foam rolling may be considered consistent with the suggestion that foam rolling does not have a significant central effect, as proposed by Ozden and Yesilyaprak [22]. Since there is no clear information about the normal values ​​of force sense in the literature, we do not know whether baseline values in groups ​​are normal. Perhaps, as in JPS, the force sense, which was already normal before the application, may not have further changed immediately after the application. In addition, David et al. suggested that during foam rolling, less time is spent for the tendons, and therefore, the Golgi tendon organ (GTO) is less stimulated, whereas the force sense testing acts on the GTO [16]. The test result may not have changed because the activity of the GTO, which influences the test result, has not improved much.

In the literature, since foam rolling has been shown to consistently increase joint range of motion (ROM) and flexibility [6], it is recommended for athletes seeking an acute increase in muscle flexibility or joint ROM as part of a warm-up or pre-exercise activity [6]. In our study, consistent with the findings of David et al., there was no improvement or worsening in JPS and force sense after foam rolling. However, fatigue worsens proprioception [39]. In this context, foam rolling as part of a warm-up before a muscular performance event such as exercise or sports competition does not create fatigue and related negative changes, does not adversely affect proprioception, and so it does not increase the risk of injury [40]. Therefore, it can be used safely. There is no study in the literature examining the effects of an acute bout of foam rolling on upper extremity proprioception. Thus, a direct comparison is not possible.

In the literature, studies on the effects of foam rolling on muscle strength are generally conducted in the lower extremities. There is inconsistency in current results; some researchers reported no significant deficits in subsequent muscle strength [18, 41], while some reported improved strength [18]. Possible mechanisms that might explain the improvement of muscle strength by SMR [20] are as follows: With ischemic compression, (a) elongation of shortened sarcomeres and a better contribution to the contraction of the related muscle [42], (b) reactive hyperemia due to pressure, leading to better blood supply and oxygen uptake, decrease in the production of nociceptive and inflammatory substances, reduction of possible muscle fiber damage and, as a result, better power production [3, 13]. With the applied pressure, activation of the autonomic nervous system by stimulating interstitial type III and IV receptors that respond to light touch and Ruffini endings that respond to deep continuous pressure in the fascia, decrease in sympathetic tonus, increase in gamma motor neuron activity, relaxation of intra-fascial smooth muscle cells and decrease in fascial viscosity. It has been hypothesized that these combined effects improve muscle function [1]. When we compare our study with studies reporting that foam rolling has a positive effect on muscle strength (4-week application and 4 application sessions, etc.), there is a difference in terms of the number of sessions [22]. Ozden and Yesilyaprak reported improvements in strength after 4 weeks of foam rolling of the biceps brachii [22]. In contrast, no significant changes in strength were found in this study following a single session of foam rolling on the biceps brachii. The effects of long-term applications could be different; however, further longitudinal studies are needed to confirm this [43].

Researchers suggested that the SMR has a relaxation effect. Therefore, foam rolling may not affect or worsen strength. While almost every researcher found that foam rolling had no immediate effect on strength [18, 41], one reported improvement after foam rolling [36]. It has been reported that a long-duration application is required to create a relaxation effect. Philip et al. found that 5 min of foam rolling caused a reduction in power output [2]. To avoid a decrease in muscle strength, the possible relaxation effect should be excluded with an application for less than 5 min [44]. Considering our study results, we can say that 2 min of foam rolling application does not negatively affect muscle strength.

Fascia is a key component of connective tissue, and deterioration in quality of fascia can negatively influence sporting performance [3]. Foam rolling can decrease fascia tightness, improve joint mobility and flexibility [2, 3], correct muscular imbalance, reduce overstress, and thus improve performance [5]. Although it is argued that foam rolling can have a positive effect on performance by creating a warm-up effect [2, 20, 22], there are limited studies on the effect of application on performance [41]. Warming with foam rolling may occur with circulatory changes such as changes in tissue perfusion, increase in plasma nitric oxide (NO) level, decrease in arterial stiffness, and improvement in vascular endothelial function [45]. In addition, it has been suggested that the SMR technique applied before an activity such as exercise can increase neuromuscular efficiency and mobility due to fascial relaxation, and accordingly, increase performance [17, 46]. However, there seems to be no certain beneficial acute effect of the technique on performance [43]. Nevertheless, it also seems not to be harmful to performance for individuals to perform the technique immediately before a physical activity. In our study, there was no increase or deterioration in performance parameters, which supports this information. It has been suggested that foam rolling does not directly affect performance, but that the decrease in the perception of fatigue provides a psychological environment that helps to increase performance [41], and that the pressure applied as in massage stimulates parasympathetic activity by reducing cortisol levels [47]. However, there is a lack of good quality experimental data on these suggestions.

Foam rolling of the biceps brachii for 4 weeks was found to be beneficial for improving upper extremity functional performance (measured with CKCTUES and push-up test, which are performed in a weight-bearing position, and therefore require more joint stability) [22]. Like our results, these researchers found that foam rolling did not affect the MPUT results [22]. The researchers pointed out that [22] with the increased dynamic neuromuscular stabilization via intense mechanoreceptor stimulation by foam rolling [12], weight-bearing tests may have better reflected the effects of the application rather than MPUT. As performance mainly depends on strength and neuromuscular control [14], in the present study, the lack of improvement in muscle strength and proprioception may explain the lack of improvement in the results of weight-bearing performance tests.

There are inconsistencies in the foam rolling protocols of the studies in the literature [48]. Protocols range from a single 30-second application per muscle to four sets of 60 s [18, 20, 49]. Findings suggest that multiple sets of applications may be required to elicit a positive effect, as no beneficial responses were consistently reported with a single set of application. This indicates that a dose-response relationship may exist. It has been stated that a short duration of SMR (< 30 s) has no effect on performance, and application duration between 60 s and 5 min may have a positive effect [18, 49]. According to our foam rolling protocol, participants performed 2 sets of foam rolling of the biceps brachii for 60 s in each set, for 2 min in total, and we did not detect any improvement or worsening in performance. However, given the paucity of experimental evidence to support foam rolling as a performance-enhancing technique, the duration, intensity, and the number of sessions required to achieve optimal recovery should be investigated [41].

In studies that found no positive effect of foam rolling on performance, several factors that could lead to this result were discussed. Cornell et al. found that single session SMR for the vastus lateralis (VL) muscle resulted in a small, but significant increase in knee extension force peak among males, but no significant change among females [50]. The authors suggested that the effect of foam rolling on performance might be influenced by the gender factor [50]. Since gender was homogeneously distributed in the groups in our study, we can exclude the effect of gender on our performance results. On the other hand, the variability in the effectiveness of foam rolling on field-based performance tests was attributed to the complexity of the test used [51]. Foam rolling appears to cause less change in multidirectional tests, which are associated with greater degrees of motor control and coordination, while it causes greater changes in unidirectional tests [6, 15]. As suggested recently [32], we performed multiple measurements including less or more complex tests, to encompass the big picture about the functional performance of the upper extremity. However, our results were similar for all tests. Rahimi et al. attributed the lack of a significant change in performance indices after foam rolling for lower extremity to the athletic population’s high physical fitness levels. Physical fitness levels of the participants in our study were not high, and the application was performed on the biceps brachii muscle, but our performance results were similar to the findings of Rahimi et al. [52]. A single session of foam rolling before a muscular performance event does not seem to increase upper extremity functional motor performance.

The major limitation of the study is the variability of pressure because of the lack of standardization of the pressure via objective measurement when performing foam rolling. However, we gave verbal encouragement for the participants to provide and maintain adequate pressure onto the foam roller. Another limitation is that, given the nature of the intervention, blinding of the physiotherapist was not possible; however, she was not involved in the analysis process.

Single session foam rolling of the biceps brachii does not deteriorate sensorimotor function including elbow proprioception, strength, and upper extremity functional motor performance. The likelihood of injury or decreased performance due to diminished proprioception or strength is unlikely. Foam rolling can be an option to achieve an acute increase in muscle flexibility without compromising upper extremity sensorimotor function as part of a safe warm-up before a muscular performance event such as training or sports competition. If the aim is to increase the upper extremity sensorimotor function with a single session application, we do not recommend the use of foam rolling. In future studies, the effects of our technique in the athletic population and elbow pathologies should be investigated.

Conclusions

The likelihood of injury or decreased performance after single session foam rolling of the biceps brachii due to diminished proprioception or strength is unlikely. Foam rolling can be an option to achieve an acute increase in muscle flexibility without compromising upper extremity sensorimotor function as part of a safe warm up before a muscular performance event such as training or sports competition. Foam rolling is not a suitable technique for increasing upper extremity sensorimotor function in a single session.

Abbreviations

FRG

Foam rolling group

CG

Control group

JPS

Joint position sense

MPU

Modified pull-up

CKCUES

Closed kinetic chain upper extremity stability

SMR

Self-induced myofascial release

ADL

Activities of dailiy living

HDD

Hand-held dynamometer

MVIC

Maximal voluntary isometric contraction

MPUT

Modified pull-up test

SPSS

Statistical package for social sciences

GTO

Golgi Tendon Organ

ROM

Range of motion

VL

Vastus lateralis

Authors’ contributions

1)Substantial contributions to conception and design, analysis, and interpretation of data; S.S.Y., substantial contributions to design, acquisition of data and interpretation of data; F.Ö.2)Drafting the article and revising it critically for important intellectual content; S.S.Y. and F.Ö.3)Final approval of the version to be published; S.S.Y. and F.Ö.4)Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; S.S.Y. and F.Ö.

Funding

None declared.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The Ethics Committee of Dokuz Eylül University (Number: 3470-GOA) approved this study.

 This study was carried out in accordance with the policies and procedures of the Declaration of Helsinki and its later amendments.

Informed consent to participate was obtained from all the participants in the study.

Our study complies with CONSORT guidelines.

There are no participants under the age of 18 in the study.

Consent for publication

Written informed consent for publication of her clinical images was obtained from the participant.

Competing interests

The authors declare no competing interests.