Welcome to the world of sports medicine! One of the biggest problems I have seen with articles like this is their influence from the fitness industry, where ridiculous headlines unfortunately get people to read the articles. It has gotten to the point where I have even seen myself titling my posts with more eye catching, mainstream things like “Your Cardio is Killing Your Back” to entice the lay-person to actually read what I write instead of a lot of the garbage they get their eyes on. Data no longer exist to show how the body works or what happens to the body when certain things are done to/with it; data now exist to support each side of the argument like you stated in your email. That being said, I think that based on Greg’s writing style, he’s just trying to catch your eye with his title.

I have found that over the years I have changed the way I practice in accordance to who I associate myself with professionally (whose thoughts I agree with and those whose approach I feel comfortable and trained in), and what my certifications, and continuing education have allowed me to become proficient in. If I look at research, I try to look at studies from both sides of the argument and compare to what I have seen in my own practice. An example of this from my own personal experience is regarding posture. There is the belief that if you hold “perfect posture all day” your back and neck will not hurt. Evidence, strongly and consistently, says otherwise. When finding this out, and reading it I had to say to myself, I treat so many people with back and neck pain that sit all day. There has to be some influence of posture and poor posture that is affecting how these people feel. I did not say to hell with all the postural training I had. I incorporated useful aspects of this research to let people know it is okay to slouch after periods of constantly changing good postures, but expecting yourself to be able to maintain good posture all day is setting yourself up for failure, and feeling like a failure has huge psychological affects on pain.

Physical therapy’s motto is “the science of healing and the art of caring” but I’d like to expand it to be “the art of caring about what works”. We have had a lot of false ideas about what works either because the science behind them is old and poorly done, or anecdotal evidence runs rampant and becomes accepted as truths. Ice vs heat for inflammation is one of these thoughts. There could be all the science in the world supporting this argument, but when I get a patient who says ice decreases the inflammation in their ankle and always has after they have sprained it, and they know it “works” for them, and they are reluctant to do heat, do I sit there and say “you are wrong” and lose that person’s confidence, or do I care about what works for them and do heat. You sum it up perfectly with your statement,”I don’t necessarily believe or care that the IT band is not lengthening, I think that rolling is really self massage disguised as something else.” From personal experience I know that when my lateral thigh feels tight and I foam roll it, I feel better, especially when I follow it up with some quad/HS stretching, and then hip extensor/abductor strengthening. Is the foam roller lengthening my ITB, likely not, is stretching even lengthening, likely not, but do I feel better? Yes. The placebo effect is called the “effect” not the “non-effect” for a reason. You may not understand why something “works”, but we sure as hell know when it “works” if you are the patient, not if science supports it (although insurance companies really do care about science, but even they fall into these old school ways of thought). In the comments section of that post the authors says:

Hi Seth,
Congrats on the marathon, I hope you killed it. For recovery I would take it easy for a bit. Gentle massage, heat, general exercise and light jogs can all help. And maybe even foam rolling if you find it helpful. My post is more of a debate with myself than an absolute scream against doing it. I just write with a little too much hyperbole. I am even open to foam rolling helping in some way, I just question the mechanisms that us therapists typically put forth.

Glad to hear it has helped but time may have been a factor as well. I would recommend you figure out what you can do to prevent your ITBs from screaming the next marathon you do.
Good luck,
Greg

I don’t really know if Greg says that foam rolling can cause damage, but it is seen as stressful (not all stress is bad, a lot of times it is a survival mechanism). The nervous system and the brain are pretty smart characters too. If they sense stress they ask what they can do to decrease the stress/pain. Maybe they send endorphins to the area to mask the pain; end result = less pain, maybe it decreases the tonal outputs to the vastus lateralis and HS; end result = less pain/perceived tightness. As I said up above, the mechanisms are not well understood (I constantly have to remember that PT is only a 60 year-old profession which is only recently trying to play catch up in the evidence based practice arena, and not all this evidence is good/current/useful and many of the why’s cannot be answered yet).

I say keep foam rolling if it has worked for you!

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So, it’s clear that even the patients we are treating, and others within the athletic population are questioning whether we as physical therapists are just making performance art,or are we performing acts of science. Evidence based practice is only as effective if we listen to the evidence. And if the evidence doesn’t exist, then what does your experience say, and what does the patient think will help? I’m quickly working this question into my evals more and more (what do you think will make you feel better?). Let’s get better at what we do. Let’s evolve as practitioners and as patients. Let’s get better.

Always evolve,

Mike