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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 12  |  Issue : 2  |  Page : 160-165

Comparative effect of foam roller and M2T blade on hamstring flexibility in elderly population: A randomized control trial


Department of Geriatrics Physiotherapy, KAHER, KLE Institute of Physiotherapy, Belagavi, Karnataka, India

Date of Web Publication4-Jun-2019

Correspondence Address:
Dr. Tanvi Pathania
Sector 3, Plot No 32, Shivbasav Nagar, Belagavi, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_118_18

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  Abstract 


The joints become stiffer and less flexible as we tend to age. Hamstring muscle is one of the common muscles found to be tight in an individual and is the potential cause for low back issues altering the lumbopelvic rhythm in them. Various studies have compared numerous techniques to see which technique is best for increasing joint range of motion. However, there is dearth of literature on use of foam roller and M2T blade on hamstring tightness in elderly. In this study, we have compared the effect of static stretching, foam roller, and M2T blade on hamstring tightness in elderly subjects. This is a randomized control trial included 45 subjects with hamstring flexibility with age of 65–75 years both males and females. The participants were randomly allocated into three groups. Group A received static stretching, Group B received foam roller, and Group C received M2T blade for 4 weeks three times a week. Pre- and post-intervention values of passive knee extension (PKE) and sit and reach test (SRT) were observed. The results showed within-group improvements in static stretching, foam roller, and M2T blade which was statistically significant (P < 0.001). However, between-group comparison showed significant difference between foam roller and M2T blade, with P = 0.000 and 0.044 for PKE and P = 0.000 and 0.004, respectively, for SRT. Comparison between groups revealed M2T group to be more effective than foam roller.

Keywords: Elderly subjects, foam roller, hamstring tightness, M2T blade, static stretching


How to cite this article:
Pathania T, Muragod AR. Comparative effect of foam roller and M2T blade on hamstring flexibility in elderly population: A randomized control trial. Indian J Health Sci Biomed Res 2019;12:160-5

How to cite this URL:
Pathania T, Muragod AR. Comparative effect of foam roller and M2T blade on hamstring flexibility in elderly population: A randomized control trial. Indian J Health Sci Biomed Res [serial online] 2019 [cited 2019 Aug 24];12:160-5. Available from: http://www.ijournalhs.org/text.asp?2019/12/2/160/259632




  Introduction Top


Aging accompanies a considerable measure of illness and diseases. According to census 2011 reports, 103.54 million (50.91 million males and 52.62 million females) of Indian population is matured 60 years or above.[1] Muscle tightness might be a typical effect of aging caused because of cross-linkage of fibers. The joints and muscles end up stiffer and less adaptable as we tend to age.[2],[3] The ligament could start to degenerate cause friction and wear away with time. Loss of flexibility of connective tissue can cause pain, muscle weakness, impairment in gait, and loss of coordination and balance.[3]

Fascia is an important part as it encompasses a large portion of the structure and organs of the body. Due to irritation of fibrous tissue, they form an adhesion, which decreases compliance of the fascia, hampering the local blood circulation through the underlying tissue, and hinder function due to ischemia.[4] The main cause of fascial tightness in aging individuals is also due to dehydration in inactive or strained body regions, thus adding onto collagen production leading to decrease in elasticity.[5] Studies have reported that hamstring tightness increases with age when compared to the younger population and is the most frequent muscle to undergo tightness.[6],[7] Hamstring tightness increases the risk of a muscle strain during any physical activity. In addition, shortening of the hamstring muscles increases the pelvis posterior tilt, reduces the lumbar lordosis to create a flat back, and may cause back pain in the future.[8] A therapist uses various combination techniques to stretch the tight muscle or connective tissue such as static stretching, dynamic stretching, proprioceptive neuromuscular facilitator technique, and myofascial release technique for the same.[7],[9],[10]

Soft tissue mobilization is one of the treatment methods to restore flexibility by reducing muscle tension and increasing joint motion range. However, confusion persists while creating the proper selection of exercise to extend flexibility and most of the studies are targeted at the young or middle age population. Myofascial release involves release of pressure from the tight fascia by broadening and loosening the fascia and helps to inhibit sympathetic nervous action by habituated stress in the tissue.[10] The use of self-myofascial release (SMR) via a foam roller or roller massager is becoming increasingly popular to both aid recovery from exercise and prevent injury.[11] Traditional method of stretching muscles involves static stretching technique, which is a well-established method for increasing flexibility of muscles. A study was done to compare foam roller and static stretching on hamstring tightness in young population and concluded that both interventions were equally effective in increasing the flexibility.[12]

In recent years, importance is given to instrument-assisted soft tissue mobilization (IASTM).[13] These handheld instruments enable clinicians to assess, detect, and treat individuals diagnosed with scar tissue, adhesions, and soft tissue dysfunction.[14] IASTM is a procedure that is swiftly on the rise in popularity due to its effectiveness and competence while remaining noninvasive.

Various literatures have compared the effect of foam roller and static stretching for various purpose but lack literature in use of foam roller in elderly. Similarly, IASTM has been beneficial for younger population, but there is a paucity of literature in geriatric population. It is important to study the effect of M2T blade on hamstring muscle in elderly due to vast physiological changes associated with aging. Hence, the present study aims at studying and comparing the effects of foam roller and M2T blade on elderly subjects with hamstring tightness.


  Materials and Methods Top


This was a randomized controlled trial with two experimental groups and one control group. Forty-five males and females aged between 65 and 75 years were included in the study. The study was conducted in old age home Belagavi, India.

Inclusion criteria included (1) young old group aged 65–75 years; (2) 20°-50° active knee extension loss with hip in 90° of flexion; and (3) subjects who are able to comprehend command and willing to participate in the study. Exclusion criteria included (1) subjects diagnosed with neurological conditions, malignancy, peripheral vascular disease, or metabolic disorders; (2) febrile state; (3) any recent sutures or fracture in lower limb; (4) subjects receiving physiotherapy treatment at the time of baseline assessment; and (5) hypersensitive skin.

Participants with hamstring tightness were screened for eligibility criteria by the therapist as per the inclusion and exclusion criteria and were requested to participate in the study. Those willing to participate were briefed about the nature of the study and the intervention, and written consent was obtained from the participants. Demographic data were collected before the assessment. A total of 45 participants were randomly allocated into three groups of 15 each using a chit method. The three groups were static stretching (Group A), foam roller (Group B), and M2T blade (Group C). There were three dropouts from foam roller group as two complained shoulder pain and one discontinued treatment.

Static stretching

Passive stretching was given to hamstring muscle. The participant was in supine lying; therapist passively positioned the subject into hip flexion, knee in extension, and ankle in neutral without pain or discomfort until the point where resistance to movement was first noted. This position was then maintained for 60 s and repeated thrice with 10-s interval [Figure 1].
Figure 1: Static stretching

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Foam roller

Foam roller includes SMR technique that was performed with the help of high-density foam roller by exerting self-body weight to squeeze the muscle and in turn elongate the local muscle fibers. The foam roller was rolled to and fro right from the pelvis to popliteal area and if encountered with any trigger points that position was held for 10–15 s and once released again started rolling over the muscle for 5 min. This was done with breaks in between as required by the subjects and repeated 2–3 times. Treatment was repeated thrice a week for 4 weeks [Figure 2].
Figure 2: Foam rolling for hamstring muscle

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M2T blade

Participants were assessed for joint range of motion (ROM), once the assessment was taken and the patient was evaluated. M2T blade was used to find specific areas of restriction on the hamstring muscle. Treatment plane 1 and 2 were used superficially and treatment plane 3 or 8 was used for deeper tissue. Vaseline was applied on the skin of the patient to avoid friction. The area was assessed, once the areas of interest were identified. M2T blade was used in any one direction (push/pull) holding it at 45° angle until adhesions disappeared. Moderate pressure was applied over the tissue once redness occurred treatment area was changed. This was done for 30–40 s repeated three times a week for 4 weeks [Figure 3].
Figure 3: M2T blade on hamstring muscle

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All the three groups received intervention three times a week for 4 weeks. Hamstring muscle length was assessed using sit and reach test (SRT) and passive knee extension (PKE) preintervention and after 4 weeks of postintervention.

Statistical analysis

Statistical analysis for the present study was done manually as well as using Statistical Package of Social Sciences (SPSS) version 23 to verify the results obtained. Statistical measures such as mean standard deviation and other tests of significance such as paired t-test, Tukey test, and one-way ANOVA were used.


  Results Top


Subjects participating in this study had a mean age of 68.93 ± 3.41 years in Group A, 66.42 ± 1.31 years in Group B and 68.53 ± 3.05 years in Group C. The mean body mass index (kg/m2) was 26.23 ± 1.62 in Group A, 26.32 ± 1.80 in Group B, and 26.23 ± 1.62 in Group C. The demographic data for all the groups did not show any significant difference and thus demonstrated the homogeneity in the groups.

The preintervention average score for PKE in Group A was 37.60 ± 8.50, Group B was 44.41 ± 8.49, and Group C was 42.26 ± 6.04 whereas the postintervention PKE scores was increased to 39.66 ± 15.81 for Group A, 59.91 ± 8.09 for Group B, and 63.13 ± 6.77 for Group C. Changes in the PKE scores revealed high statistical significance for Group B and C but not in Group A postintervention [Table 1] and [Graph 1]. Mean reduction in PKE scores was 2.06 ± 7.99 for Group A, 15.50 ± 4.90 for Group B and 20.86 ± 1.84 for Group C with P < 0.05; the test used was paired sample t-test [Graph 2].
Table 1: Comparison of three study groups with respect to passive knee extension (degree of knee angle)

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Pairwise (between) group comparison was done using Tukey's multiple post hoc procedures which showed that the mean difference is significant in case of posttest values between Group A and Group B (P = 0.000) and also significant between Group A and Group C (P = 0.000). A significant difference was seen between Group B and Group C (P = 0.044)

The preintervention average score for SRT in Group A was 29.73 ± 4.27, Group B was 27.25 ± 3.30, and Group C was 24.13 ± 4.51 whereas the postintervention SRT scores were reduced to 14.67 ± 3.11 for Group A, 14.66 ± 3.55 for Group B, and 10.60 ± 2.44 for Group C. Changes in the SRT scores revealed high statistical significance for all three groups postintervention [Table 2] and [Graph 3]. Mean difference in SRT scores were 15.07 ± 3.088 for Group A, 12.58 ± 2.31 for Group B, and 13.53 ± 3.44 for Group C with P < 0.05; the test used was paired sample t-test [Graph 4].
Table 2: Comparison of three study groups with respect to sit and reach test

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  Discussion Top


The present study aimed to compare the effects of three different interventions, i.e., static stretching, foam roller, and M2T blade on hamstring tightness in elderly subjects between 65 and 75 years of age. Results of this study confirmed that all three interventions given in this study was effective in increasing hamstring flexibility when compared within the group and M2T was more effective when compared to other two groups.

The results from the statistical analysis of the present study depicted significant difference between static stretching, foam roller, and M2T blade in increasing PKE angle and decreasing SRT in elderly subjects. Numerous studies have proved static stretching to be the most effective treatment for increasing muscle flexibility. However, pairwise comparison was done between Group A (static stretching) and B (foam roller). Foam roller was found to be more effective in increasing the PKE and SRT in subjects with hamstring tightness. High-density foam roller was used in this study where subjects were asked to apply body weight by sitting on it and rolling the foam to and fro which is a standardized protocol for hamstring SMR.[15] There is enough literature demonstrating effect of foam roller on flexibility, performance, and strength gain done on young population[14],[16] as compared to see the effect on elderly. To our best knowledge, this is the first evidence to study the effect of foam roller on hamstring muscle on elderly.[17] Our results are differing from a study done by which compared static stretching and foam roller to improve hamstring flexibility and found no difference between the groups postintervention and both were equally effective.[14] This could be due to varying dosage given as in this study the duration of both stretching and foam rolling was less as compared to duration in our study.

This study was a 4-week intervention control trial, given thrice a week alternately. This was to see the chronic effect of foam roller on hamstring muscle as literature already exists on acute effects of SMR on hamstring muscle. As the investigation included elderly subject and tightness in them, is the consequence of age-related changes and is due to chronic effect of faulty posture and activities. We likewise accept to have a factual difference in pre-post values long-term effect was required. M2T blade is a novice instrument, which is similar to IASTM and works on the same principle as others. A pilot study was conducted to investigate the immediate effect of M2T blade on hamstring tightness in elderly subjects and was found to be beneficial to increase ROM using PKE and SLR and suggested to investigate the long-term effect of M2T blade on elderly. In our opinion, this is the first study to investigate and compare the effect of 4-week M2T blade on hamstring tightness and was effective in improving the range.[7] It works by effectively breaking down the fascia and scar tissue. The ergonomic design of these instruments provides the clinician with the ability to locate restrictions and allows the clinician to treat the affected area with the appropriate amount of pressure. Once the treatment is given post, treatment microtrauma is induced.[18],[19] This causes stimulation of local inflammatory response by reabsorption of inappropriate fibrosis or excessive scar tissue and facilitates a flow of healing activities resulting in remodeling of affected tissue structures.

The third objective of our study was to compare the effect of M2T blade and foam roller on hamstring tightness in elderly. Both groups were equally effective within the group. On comparison, M2T group was effective in terms of both the outcome measure, whereas foam roller showed significant difference in PKE but not statistically significant difference was seen in SRT values on comparison. In our study, foam roller group had three dropouts this could have resulted the change in the value as compared to the M2T blade group. An experimental study was done to examine the effect of roller massager on the hamstring muscle to increases sit and reach ROM within 5–10 s without performance impairments. Prevalent finding of the study was that the roller-massager increased the sit and reach test for lower back and hamstrings' flexibility.[20] The greater increase in ROM in this foam roller study compared to our study might be related to either greater rolling force (average body weight was 86.3 kg) or different muscles used (quadriceps vs. hamstrings). Clinically in this study, subjects in the foam roller group found it difficult to apply appropriate pressure and equal weight distribution due to fatigue of upper limb muscles. This technique is also tricky for overweight subjects or for frail individuals with some upper limb issues. In contrast, it helped individuals who were able to perform this exercise without any discomfort and gained desired benefit from the intervention in terms of increased hamstring flexibility.

Hence, with regard to the present study, static stretching, foam roller, and M2T blade all were effective in decreasing the hamstring tightness in terms of PKE and SRT. In pairwise comparison, both foam roller and M2T blade were effective as compared to static stretching but when compared to each other M2T blade was more effective in both the outcome measure for improving hamstring muscle flexibility.

Limitations

Homogeneity in gender was not considered. There was a lack of follow-up every week as this could provide information on maintenance of range and duration of effectiveness of treatment. In Foam roller group arm strength was not considered, which could be the possible cause of dropouts, and as compared to other method of intervention, fascial release with foam roller was tiring for the patient.


  Conclusion Top


The present randomized control trial demonstrated that all the three techniques (static stretching, foam roller, and M2T blade) showed improvement in increasing hamstring flexibility in terms of PKE and SRT. M2T proved to be the most effective intervention when compared to other two interventions to improve hamstring flexibility in terms of PKE and SRT.

Future scope of the study

As only healthy individuals were included in our study, future research should include testing subjects with specific condition and should be done on different muscle group to investigate similar effect. Different parameters such as strength and performance should be investigated using the same intervention on various populations.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Central Statistics Office Ministry of Statistics and Programme Implementation Government of India. Available from: http://www.mospi.nic.in/sites/default/files/publication_reports/ElderlyinIndia_2016.pdf. [Last accessed on 2018 Feb 04].  Back to cited text no. 1
    
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Gossman MR, Sahrmann SA, Rose SJ. Review of length-associated changes in muscle. Experimental evidence and clinical implications. Phys Ther 1982;62:1799-808.  Back to cited text no. 3
    
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Barnes FJ. What is Fascia? Myofascial Release. Available from: https://www.bing.com/cr. [Last accessed on 2018 Feb 04].  Back to cited text no. 4
    
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Sölch D. Ageing and restricted mobility: Frailty from the perspective of myofascial structural models. Gerontol Geriatr 2013;48:35-40.  Back to cited text no. 5
    
6.
Akinpelu AO, Bakare U, Adegok BO. Influence of age on hamstring tightness in Nigerians. J Niger Soc Physiother 2005;15:35-41.  Back to cited text no. 6
    
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Weiner DK, Haggerty CL, Kritchevsky SB, Harris T, Simonsick EM, Nevitt M, et al. How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the health ABC cohort and implications for the future. Pain Med 2003;4:311-20.  Back to cited text no. 8
    
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Gallon D, Rodacki AL, Hernandez SG, Drabovski B, Outi T, Bittencourt LR, et al. The effects of stretching on the flexibility, muscle performance and functionality of institutionalized older women. Braz J Med Biol Res 2011;44:229-35.  Back to cited text no. 10
    
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Kim DH, Kim TH, Jung DY. Effects of the Graston technique and self-myofascial release on the range of motion of a knee joint. Korean Soc Phys Med 2014;9:455-63.  Back to cited text no. 11
    
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Feland JB, Myrer JW, Schulthies SS, Fellingham GW, Measom GW. The effect of duration of stretching of the hamstring muscle group for increasing range of motion in people aged 65 years or older. Phys Ther 2001;81:1110-7.  Back to cited text no. 12
    
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Bandy WD, Irion JM, Briggler M. The effect of time and frequency of static stretching on flexibility of the hamstring muscles. Phys Ther 1997;77:1090-6.  Back to cited text no. 13
    
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Cheung Y. Effect of Foam Roller and Static Stretch on Hamstring Flexibility; 2015. Available from: http://www.repository.lib.eduhk.hk/jspui/handle/2260.2/17405. [Last accessed on 2018 Feb 05].  Back to cited text no. 14
    
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Couture G, Karlik D, Glass SC, Hatzel BM. The effect of foam rolling duration on hamstring range of motion. Open Orthop J 2015;9:450-5.  Back to cited text no. 15
    
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17.
Vigotsky AD, Lehman GJ, Contreras B, Beardsley C, Chung B, Feser EH, et al. Acute effects of anterior thigh foam rolling on hip angle, knee angle, and rectus femoris length in the modified Thomas test. PeerJ 2015;3:e1281.  Back to cited text no. 17
    
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20.
Roylance DS, George JD, Hammer AM, Rencher N, Fellingham GW, Hager RL, et al. Evaluating acute changes in joint range-of-motion using self-myofascial release, postural alignment exercises, and static stretches. Int J Exerc Sci 2013;6:310-9.  Back to cited text no. 20
    


    Figures

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    Tables

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