Howard Head Sports Medicine: Demystifying Common Physical Therapy Modalities

Foam rolling, cupping, and dry needling, oh my! Which one(s) should I do? These modalities of treatment for recovery and injury prevention may seem synonymous to some, thereby, leading some of us to using them all for the same problems. However, each one has a specific purpose and effect for a specific condition. For this reason, the decision of when and why each one should be used will be discussed.

Foam rolling is commonly used as a recovery tool in the form of self-myofascial release through compression. The idea is that this compression helps break up adhesions within the muscle or between the fascia and muscle. However, some researchers are finding the positive effects of foam rolling may have less to do with myofascial release. It has been shown that foam rolling may improve range of motion not by just breaking up “knots” but through stimulating the central nervous system. The effects include improving vascular function, therefore, circulation. Also, stimulation of pressure receptors causes relaxation of the nervous system, which can reduce stress hormones, can improve pain tolerance, thereby, relaxing the muscles.

In contrast, cupping, an ancient form of alternative medicine believed to originate in China, works through decompression. Cupping can be used to break up adhesions between the muscles and fascia, therefore, increasing tissue mobility. It is purported to also draw fluid/circulation into the area, which aids in healing, and help release toxins. Although there is limited evidence of cupping’s effects or how it actually works, it still may be another tool to consider.

Lastly, dry needling has made a large presence of late. Dry needling has been supported in the literature to provide immediate and short-term pain relief for certain musculoskeletal conditions, although, showing no differences in functional outcomes when compared to other physical-therapy treatments. Meaning, it can be part of the treatment but not THE treatment for one’s rehabilitation. It is also important to find out why these trigger points are occurring so frequently (e.g. abnormal movements, poor posture).Specifically, dry needling is showing evidence of pain relief for myofascial pain, especially, if associated with myofascial trigger points, the tender “knots” we feel within the muscles.

So, the question is which one is best? It all comes down to the specifics of the condition and the outcome you are trying to achieve. Choose the right tool for the job. If you have trigger points, then dry needling and self-trigger-point release with a massage ball will be the most beneficial. If there is hypertonicity in the muscle, then foam rolling may be the best choice. In cases where the soft tissue feels “restricted” and lacks mobility, then cupping or a type of massage that “lifts” and separates may be more warranted. Consult your local physical therapist if you need guidance for which one to choose.