David Kesselman, DC, has been practicing chiropractic for the past 25 years, with extensive knowledge of the spine and associated nerve structures.

If you're one of the estimated 85% of adults who have experienced low back pain, you know how challenging it can be to get relief. Depending on the nature of the discomfort, foam rolling may be worth trying.

This approach relies on a technique called self-myofascial release (SMR) to work on fascia, the connective tissue that encases muscles, muscle fibers, and the entire musculoskeletal system. Fascia can become stiff, restricting your range of motion and causing muscle soreness.

There is little research to confirm foam rolling for back pain is effective, and it has its pros and cons. But when done with care, integrating SMR into your self-care routine may bring relief from discomfort, make it easier to effectively perform stretches that help reduce back pain, and allow you to move more freely during exercise and everyday physical activities.

A foam roller is a lightweight cylinder that varies in length and thickness: Most are 6 inches in diameter and have become ubiquitous in gyms, health clubs, and physical therapy practices.

The goal of foam rolling is to target trigger points—adhesions in the fascia that can develop when you’ve worked muscles hard. In its healthy state, fascia is very flexible and has a gel-like consistency that allows muscles to move freely. Adhesions eventually heal, but when they do, tough non-elastic scar tissue forms, and muscles can’t move as easily. These adhesions contribute to the painful "knots" you can feel in your muscles.

In practice, foam rolling involves finding trigger points and applying prolonged pressure to them—similar to the way a massage therapist might work out a knot to loosen a muscle. Studies have shown that foam rolling can be effective as part of a pre-workout warmup to get muscles ready for exercise or a post-workout recovery to prevent muscle tightening.

It’s believed that using a foam roller to put pressure on fascia warms and increases blood flow to the connective tissue while also breaking down scar tissue, restoring the fascia’s natural, supple state. This has several potential benefits:

Using a foam roller in the treatment of back pain is not a straightforward endeavor.

For one thing, because nerves run through the fascia, the pain felt in a specific area may not be in the same spot as the adhesion causing it—what's known as referred pain. For instance, the piriformis, a small muscle under the buttock, can cause lower backache. This makes it important to figure out the source of the pain in order to target it correctly.

What's more, using a foam roller incorrectly could increase discomfort or cause a new injury. If your back pain is due to nerve compression or if you experience pain, weakness, numbness, and/or electrical sensations that go down one leg (known as sciatica), applying pressure to the injured nerves could make your problems worse.

Foam rolling is also not recommended if you have spinal instability, spondylolisthesis, and/or connective tissue disorders. Talking with your healthcare provider prior to starting foam rolling may help you choose the self-care program that is right for you.

Foam rolling is not recommended for pregnant women whose joints are naturally loose due to a hormone called relaxin. People who have rheumatoid arthritis flare-ups, deep-vein thrombosis, advanced osteoporosis, or neuropathy also should not foam roll. Never apply pressure to open wounds or fractures.

The greatest risk of injury to the back with foam rolling is using it directly on the vertebrae of the neck or on the mid-to-lower vertebrae of the back. Doing so requires using intense muscle control to keep the proper form and hold the roller in place at a trigger point. Using the lower back muscles in this way may cause excess muscle tension, which can do more harm than good.

Using a foam roller directly on the lower back may cause harmful pressure on the kidneys and liver. Muscles provide some padding, but unlike the heart and lungs, which are safely housed in the rib cage, the kidneys and liver don’t have bones protecting them. Putting pressure on certain areas of the back could injure these organs.

To correctly use a foam roller to relieve back soreness, you first need to identify the tender trigger points around your hips, buttock, hamstrings, or upper back—these are all places where tightness can cause referred pain in the back.

Position the roller on one of these points. Using your core muscles, lean into the spot to add pressure and slowly roll back and forth over the knot in 1-inch increments for 30 to 60 seconds. Don’t be frustrated if you can only hold the roll for 10 seconds in your first session. It will be uncomfortable. However, you shouldn’t feel shooting pain or numbness. If you do, stop the rolling. Drink water after a rolling session, and incorporate muscle stretching to get the most benefit.

Here are three areas where you may find trigger points to target with a foam roller to reduce back pain.

Iliotibial band: The iliotibial band is a thick band of fascia that runs along the outside of the thigh from the pelvis to just below the knee. Working on trigger points in this area can improve your range of motion along several muscle groups. 

Mid-upper back: Releasing tension in the area around and just below the shoulders can help the relax muscles along the length of the back.

3. Hamstrings: The hamstring muscle runs along the back of the upper leg. When tight and inflexible, this muscle can pull on the muscles in the lower back and cause pain.

Finding the technique and the tool that works may take some time, along with professional guidance. With back pain, progress takes patience. And, often, the back needs some rest too. Listen to your body and be careful not to overexert your muscles or fascia, which will only delay healing.

Manusov E. Evaluation and diagnosis of low back pain. Prim Care. 2012;39(3):471-9. doi:10.1016/j.pop.2012.06.003

Junker D, Stöggl T. The training effects of foam rolling on core strength endurance, balance, muscle performance and range of motion: A randomized controlled trial. J Sports Sci Med; 18(2):229-238.

Cheatham S, Kolber M, Cain M, Lee M. The effect of self-myofascial release using a foam roll or roller massager on joint range of motion muscle recovery and performance: A systematic review. Int J Sports Phys Ther; 10(6):827-38.

McCall, P. American Council on Exercise. How and when to use foam rollers and myofascial release in an exercise program.

Harvard Health Publishing Harvard Medical School. Should you add foam rolling to your workout routine?.

McGrath, C. American Council on Exercise. Why you should be foam rolling.

Chaudhry, H. Three-dimensional mathematical model for deformation of human fasciae in manual therapy. J Am Osteopath Assoc.

Penney, S. Foam Rolling - Applying the Technique of Self-myofascial Release. NASM.

Sanjana F. Effect of MELT method on thoracolumbar connective tissue: The full study. J Bodyw Mov Ther.

By Anne Asher, CPT Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.

Thank you, {{form.email}}, for signing up.

There was an error. Please try again.