When Your Foam Roller Isn't Working

A personal account of pain,

​by Ryan Humphries
 
Foam rolling is the shit. Stretching is awesome. And they both work to relieve pain and tightness….until they don’t. Although soft tissue work (foam rolling, lacrosse balls, softballs, massage therapy, etc.), has now been incorporated into of many strength training programs, it may not be addressing the real issue(s). 

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​HOWEVER, that’s not to say you shouldn’t do it! I believe everyone in the world should absolutely own at least one foam roller and a few lacrosse balls. EVERYONE. Why? Because when used correctly, they may not only relieve pain, but also prevent tightness and stiffness that may eventually cause pain. The infamous physical therapist and author, Kelly Starrett put it very eloquently with one phrase “All human beings should be able to perform basic maintenance on themselves.” When we are able to do so, our medical bills go down, we smile a lot more, and we hurt a lot less.
 
If you’ve ever had a trainer/coach/physical therapist/doctor tell you to do soft tissue work as mentioned above, then congratulations, you actually have someone looking out for your health; someone looking for the most non-invasive ways of helping the problem. And sometimes, often in fact, it works.
 
But then there are those other times… times when the foam roller may not be the answer.
 
For the past two years I’ve had pain in my left knee. After working with some of the best physical therapists, acupuncturists, massage therapists and chiropractors in the area, here are a few of the things I’ve learned:
 
I may have a tight psoas
I may have a tight rectus femoris
My gluteus medius may not be firing properly
I need to work on my core
I need to push my knees out
I need to screw my feet into the floor
I need to drive my heels into the floor
 
I do not doubt any of the above. In fact, every single one of those suggestions is probably correct. I have some things that are tighter than they should be, and some things that I need to get balanced out. But after working on ALL of those things, none of them were actually addressing my pain. It IS entirely possible, however, that because I WAS working on all of those things, I was able to keep the pain at bay for a while.
 
For two years, I’ve been doing the extra glute work before my training sessions. I used resistance bands before, during, and after work. I’ve been “activating the inactive muscles”. I’ve also been doing the couch stretch, the Bretzl, the calf smash and just about everything else that any physical therapist or online mobility program would prescribe for cranky knees.
 
In fact, for years I’ve advised clients to do the same (I’m not a doctor, so I can’t actually prescribe anything). But when someone comes to me with the “my knee feels weird or achy or hurts or insert word here” I immediately refer to the theory that most aches and pains in the body are not actually major issues, but instead minor issues related to extremely tight fascia that can be released with soft tissue work. And for many individuals, that’s true. Feeling a little pull in your knee? Roll your quads for a while and then stretch them. Do some glute bridges and try those squats again. Better? Awesome! Not better? Well, tightness in the fascia may not disappear over night, stay consistent with it and do it again. Do it until…. Until you really start wondering, how long until this is supposed to work?
 
I’ve been “doing it until” for over two years now. I’ve activated every muscle fiber on my “posterior chain”. My gluteus maximus, medius, minimus, and everything else that would bring all the girls to the yard. I’ve stretched and rolled everything on my “anterior chain”. My rectus femoris, my psosas, vastus intermedius; they’re all loosey goosey now after all the time and effort I’ve given them.
 
And you know what? My knee still fucking hurts. One day after a session with my massage therapist, he said “I think you should get an X-ray or MRI on this before we do anything else.” So I finally decided to have conventional medicine take a look. It seemed that I had exhausted every non-invasive option, and now I needed to really see what was going on in there.
 
Well, it turns out that I’m not crazy. The pain I’ve been feeling for the last two years was not in my head. It was also not in my rectus femoris or my gluteus medius. It’s in my fucking knee. Like, literally IN my knee. I have a complex tear in the medial meniscus, a big ass cyst just above the tear and degeneration of the articular cartilage. That. That’s what’s causing the pain. 
 
This post isn’t to freak you out about your own aches and pains, nor is it to have you take pity on mine. It’s simply to state that sometimes the foam roller works, and sometimes it doesn’t. Sometimes we look in the right places, and sometimes we don’t. Sometimes a cigar is just a cigar…and sometimes it's not ;)
 
A few things need be stated here for the record. In 2003, I had six screws and a plate embedded in my left ankle after a late night scuffle in a kitchen (another story for another time)… That, in and of itself may have played a part in what was going on in the knee. A lack of full mobility in the ankle may have played a part in wearing down the cartilage in the joint. Also, in 2009 I took a superhero-esque dive over my handlebars on National Bike To Work Day and I broke the patella (knee cap) on that same side. It was awesome.
 
I mention this because as Gray Cook and the entire FMS community likes to point out, the biggest risk of injury is past injury. I’ve had PLENTY of past injuries to that left side.
 
I also mention this because if you do NOT have a specific injury to the joint (falling on your knee, an ACL reconstruction, etc.) then your knee pain could most likely coming from tight fascia. This is probably about 90% of the cases out there according to a statistic that I just made up. But seriously, if you have not had an acute trauma to the specific area of pain, then it’s likely that tight fascia is to blame. 
 
Again, I’m not a doctor, I just play one on TV :) If you have pain, it’s highly suggested that you do some soft tissue work first. Roll above, roll below. Smash away! Breathe through the stiffness, the tightness and suffering. Stretch all the tight areas. After that, you’ll want to work on the inactive muscles around the area to balance everything out. I’m not saying anything revolutionary here. This is the advice of just about every therapist that you’ll come across. And it works! (Most of the time)
 
However, if you have been doing your due diligence in rolling, stretching, and activating, and it’s still not working? It may be time to get another opinion. An opinion from an advanced technological machine that can actually see inside your body and give you an idea of what’s going on. 
 
So how long should you wait? Well, I waited over two years and I’d say that’s probably about a year and a half too long. For me, the answer is now surgery. But who knows what it would be if I had gotten that MRI two years ago? Realistically if you’re rolling, stretching, strengthening, and you have been doing so for over three months and it’s not getting better, it’s time to have it checked out. 
 
Until next time, keep rolling, keep stretching, keep strengthening, but for the love of god, go get an MRI if that shit isn’t working!