Compression of Myofascial Trigger Points With a Foam Roller or Ball for Exercise-induced Anterior Knee Pain: A Randomized Controlled Trial

Li L, Huang F, Huang Q, et. al. Altern Ther Health Med. 2020. 26(3). 16-23.

Take-Home Message

Combining compression of myofascial trigger points and static stretching may be more beneficial at combating anterior knee pain than stretching or compression alone.


Anterior knee pain is a common symptom that can impede training and be challenging to treat. Knee pain can sometimes be attributable to myofascial trigger points; however, there is little evidence to decide if compressing myofascial trigger points with a foam roller or ball helps alleviate anterior knee pain. Therefore, Li and colleagues completed a randomized controlled trial to investigate the effects of compression of myofascial trigger points with or without static stretching on anterior knee pain among runners. The authors randomized 80 participants into 4 groups: 1) combined compression and stretching, 2) stretching only, 3) compression only, and 4) control. The compression intervention was administered for 30 minutes once every 5 days. A clinician identified active trigger points by evaluating 10 muscles in the thigh and posterior leg. The combined group received static stretching for 8 muscles or muscle groups (e.g., quadriceps, hamstrings, gastrocnemius) immediately after compression. Participants performing static stretching performed each stretch for 20 seconds with a therapist once every 5 days. They also repeated their stretches 3 times/day at home. The control group attended a 30-minute class about exercise and nutrition once per month. All treatments lasted 8 weeks. Assessments occurred at baseline, 4 weeks of intervention, immediately postintervention, and 8 weeks post-intervention. At each time point, researchers assessed knee pain using a visual analog scale and measured knee range of motion. At baseline, the pain score did not differ between groups. Starting at 4 weeks of intervention, the combined treatment group reported greater improvement in knee pain than the other 3 groups. Starting immediately after the intervention, the combined group also had better knee range of motion than the other 3 groups.


The authors demonstrated that combining compression and static stretching may be better at combating anterior knee pain than stretching or compression alone. This is helpful as it adds to the existing literature of the best practices for treating anterior knee pain. If these strategies together are more effective at treating anterior knee pain, clinicians may want to incorporate this into their treatments. This strategy may be especially helpful in patients with anterior knee pain without a significant injury (e.g., overtraining, improper footwear) as it should decrease the amount of training time missed for treatment. To truly understand how significant this impact is, future research should continue to perform similar studies across different populations. It would also be beneficial for future research to look at longer follow-up times to see if these effects persist over the long-term. Regardless, this study provides further evidence that combining the compression of myofascial trigger points and static stretching may be worth adding to a treatment plan for someone with anterior knee pain.

Questions for Discussion

What is your treatment strategy for anterior knee pain? Do you see the data from this study impacting that treatment plan? What other treatment strategies might future research look to incorporate based on your experience?

Written by: Kyle Harris
Reviewed by:  Jeffrey Driban

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