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Clinical Scenario: Dynamic stretching and foam rolling are commonly used by athletes to reduce injury and enhance recovery, thereby improving athletic performance. In contrast to dynamic stretching, little research has been conducted on the acute effects of foam rolling as part of the preexercise warm-up routine. Previously, when researchers implemented foam rolling with static stretching as a warm-up, some found that foam rolling slightly improved flexibility and performance outcomes. More recent research has shown that dynamic stretching is favorable to static stretching when used as a warm-up strategy. Therefore, adding foam rolling to dynamic stretching is hypothesized to create more significant improvements in flexibility and performance compared with adding foam rolling to static stretching. Focused Clinical Question: In active individuals, does foam rolling in addition to dynamic stretching lead to enhanced performance compared with dynamic stretching alone? Summary of Key Findings: Four randomized controlled trials were included. Two studies concluded that the addition of foam rolling to dynamic stretching increased vertical jump height more than dynamic stretching alone, while 2 studies found no difference between these treatment groups. Two studies concluded that the addition of foam rolling increased agility performance compared with dynamic stretching alone, while one study found no difference between treatment groups and one study did not measure agility. All 4 studies reviewed concluded that foam rolling did not improve flexibility more than dynamic stretching alone. Clinical Bottom Line: Foam rolling in conjunction with dynamic stretching may further improve an athlete’s agility and power output; however, little improvement has been observed with foam rolling in regard to athlete flexibility when compared with completing dynamic stretching programs alone. Strength of Recommendation: Inconsistent findings from 4 randomized controlled trials suggest there is Grade C evidence to support the inclusion of foam rolling in a dynamic warm-up.

Pain catastrophizing is a maladaptive cognitive strategy that is associated with increased emotional responses and poor pain outcomes. Total knee replacement procedures are on the rise and 20% of those who have the procedure go on to have ongoing pain. Pain catastrophizing complicates this pain and management of this is important for recovery from surgery and prevention of chronic pain. This study examines the effect of interventions on PC for patients undergoing total knee replacement (TKR).Multiple search engines were searched from inception up to March 2021 for relevant studies measuring PC in adults who have undergone TKR. Studies were screened using the Downs and Black Checklist. We included 10 studies (n = 574) which recruited peri surgical TKR participants. Effect sizes were calculated and compared on effect of intervention on PC.Five studies examined the effect of cognitive behavioral therapy-based intervention on PC with low to moderate effects. Two studies examined the effect of a pain neuroscience education on PC with small effects short term. One study examined the effect of hypnotic therapy on PC with small, short-term effect (1 month) but large effect at 6 months. One study compared the effect of an isometric quadricep exercise with auditory and visual feedback on PC to treatment as usual with small, short-term effects. One study compared the effects of an activity and goal setting diary on PC with a moderate effect at 4 weeks.PC is a modifiable characteristic. Several interventions show modest benefit, however more research is needed to aid in clinical decision-making for this population. Interventions are most likely to produce benefits when they are targeted to people with high levels of PC.