Foam rolling and stretching do not provide superior acute flexibility and stiffness

Key points

1. 01A pooled analysis of 38 studies found no significant difference in range of motion between stretching or foam rolling and other warm-up interventions.
2. 02Stiffness and passive peak torque also did not differ significantly between stretching/foam rolling and the alternatives.
3. 03The benefit is likely explained by increased muscle and core temperature, which many warm-up activities can produce.
4. 04Stretching and foam rolling did not add extra flexibility benefit when combined with other warm-up activities.
5. 05Study quality was only fair, with moderate certainty for range of motion and very low certainty for stiffness and torque.

How it was conducted

Design

Systematic review with meta-analysis (PROSPERO CRD42023439426), following PRISMA, using robust variance estimation

Sources

PubMed, Web of Science, and SPORTDiscus

Studies

38 studies, 140 effect sizes, in healthy participants

Comparison

Stretching or foam rolling versus other interventions (walking, vibration, cycling, calisthenics, strength training, electrical stimulation, heat, cryotherapy)

Outcomes

Range of motion, muscle/tendon stiffness, and passive peak torque

Quality assessment

PEDro scale for risk of bias and GRADE for certainty of evidence

What they found

• No significant difference in range of motion between stretching/foam rolling and alternatives: ES = 0.05, 95%CI -0.10 to 0.20, p = 0.51, 34 studies, 80 clusters.
• No significant difference in stiffness: ES = 0.09, 95%CI -0.21 to 0.40, p = 0.49, 7 studies, 33 clusters.
• No significant difference in passive peak torque: ES = -0.13, 95%CI -0.28 to 0.02, p = 0.07, 3 studies, 12 clusters.
• Stretching versus alternatives for range of motion: ES 0.065, 95%CI -0.060 to 0.200, p = 0.31.
• Foam rolling versus alternatives for range of motion: ES -0.27, 95%CI -0.93 to 0.40, p = 0.39.
• Study quality was fair with a mean PEDro score of 4.62 plus or minus 1.26 (range 3-8); funnel plots showed no publication bias.

Limitations

• The compared interventions were highly heterogeneous, making pooled comparisons difficult.
• The definition of dynamic stretching varied across studies.
• Some studies applied warm-ups before the compared interventions, which may have blurred differences.
• Certainty of evidence was very low for stiffness and passive peak torque outcomes, with only 3-4 studies each.

Why it matters

For patients

If you want to loosen up before activity, you can pick whatever warm-up you enjoy, such as light cycling or jogging, rather than feeling you must stretch or foam roll.

For clinicians

Stretching and foam rolling can be used interchangeably with other temperature-raising warm-up activities for acute flexibility, with no clear added benefit from combining them.

For readers

This review reframes acute flexibility gains as a general warm-up effect driven by muscle temperature rather than a unique property of stretching or foam rolling.