Welcome to our Blog!

The objective of this blog is to create a locale for discussions and a repository of evidence about the use of physical therapy modalities. We have also created a YouTube channel where students have demonstrated the use of several physical therapy modalities. Please feel free to post links to current articles, reflections about modality usage, or feedback about the site. The YouTube link is: http://www.youtube.com/user/PTModalities?feature=mhee

Search This Blog

Sunday, January 29, 2012

Massage and Delayed Onset Muscle Soreness




Delayed onset muscle soreness (DOMS) refers to the muscle pain and soreness that occurs with exercise-induced damage after eccentric exercise.  It peaks about 24-48 hours after exercise and subsides over the following 5-9 days.  Massage has been proposed as a therapeutic technique to prevent DOMS, however the literature findings both advocate and refute it as an effective means of preventing or treating DOMS.
           
Hilbert, Sforzo, and Swensen found massage to be an effective technique to treat DOMS.   They evaluated both physical and psychological aspects using the Differential Descriptor Scale (DDS), Profile of Mood States (POMS), and a blood test for neutrophils.   Researchers compared 20-minute massage intervention to no massage after isokinetic eccentric contraction exercises in the right hamstrings.   Massage was given 2 hours after exercise.  The DDS, POMS, and a blood test were completed 6, 24, and 48 hours post-exercise.  They found massage intervention to lessen the intensity of soreness reported 48 post-exercise; however, it had no effect on neutrophils.  (Hilbert, Sforzo, & Swenson, 2003)
Smith LL, Keating, Holbert, Spratt, McCammon, Smith SS, and Israel found that applying a sport massage to muscles two hours after eccentric exercise does in fact reduce the effects of DOMS and the levels of serum creatine kinase (CK) in the muscles. They randomly assigned seven males each to a massage group and control group. Two hours after doing five sets of isokinetic eccentric bicep exercises working the elbow flexors and extensors, the massage group received a thirty-minute sport massage while the control group rested.  Levels of DOMS and CK were tested before the exercise, and 8, 24, 48, 72, 96, and 120 hours post-exercise. Circulating neutrophils and cortisol levels were tested before and right after the exercise, and every thirty minutes for the following eight hours. Both DOMS and CK showed reduced levels for the massage subjects.  Further, the level of neutrophils showed a prolonged elevation and cortisol showed diminished diurnal reduction.  (Smith, Keating, Holbert, Spratt, McCammon, Smith, & Israel, 1994).
Mancinelli, Davis, Aboulhosn, Brady, Eisenhofer, and Foutty found that massage effectively decreased the effects of DOMS in women collegiate athletes. Researchers evaluated perceived soreness using a 10-point visual analog scale. The experimental group received 17 minute massages immediately following practice on the fourth day of pre-season training while a control group rested for 17 minutes. Researchers used the 10-point visual analog scale to measure perceived soreness immediately following the massages and rest period. They found that the massages significantly reduced the level of perceived soreness, while no change in perceived soreness was seen in the control group. (Mancinelli et al., 2005)

Zainuddin, Newton, Sacco, and Nosaka found no significant difference in an arm-to-arm study between massage treatment and no treatment on the effects of DOMS.  They compared arms of the same subjects after an exercise routine, treating one arm to a 10-minute sports massage 3 hours after exercise and leaving the other as a control.  Soreness was rated on a 100 mm visual analog scale during flexion, extension, and palpation on days 1,2,3,4,7,10, and 14 post-exercise.  Muscle damage was induced by isokinetic eccentric maximal contractions of the biceps muscles of both left and right arms.  (Zainuddin, Newton, Sacco, & Nosaka, n.d.)
Jonhagen, Ackermann, Eriksson, Saartok, and Renstrom hypothesized sports massage would improve muscle recovery after eccentric exercise. They performed a randomized clinical trial with sixteen subjects who each did 300 maximal eccentric contractions with both right and left quadriceps. Each subject received a sport massage on only one leg once a day for three days after the exercise. Their other leg acted as a control and did not receive massage. Three tests were done on each leg, once a day for three days. They tested one-leg long jumps, maximal strength using a Kin-Com dynamometer, and evaluated pain by using a visual analog scale.  They found the sport massage did not affect the amount or duration of pain. It also did not affect the strength or function of the muscle after exercise. (Jonhagen, Ackermann, Eriksson, Saartok, & Renstrom, 2004)
Hart, Swanik, and Tierney found massage to be ineffective in decreasing the effects of delayed onset muscle soreness. Subjects were put through a series of eccentric leg exercises. Twenty-four, 48, and 72 hours after the exercise regimen, subjects returned to the lab where they received a five-minute sport massage on one leg while the other leg only rested. Pain measurements were assessed after each massage treatment with a visual analog scale with two extremes: no pain and worst possible pain. Researchers found no difference in relief from DOMS between the leg that was massaged and the leg that only rested. (Hart, Swanik & Tierney, 2005)

Based on the current literature, massage can be an effective method of treating DOMS for some, and have no significant difference in others.  The use of massage should be the decision of the clinician based on each individual client and their response to treatment.  More research needs to be conducted in order to come to a conclusion about how DOMS responds to massage.

Summaries by Brianna, Natalie, and Sarah L.


References

Hart, J. M., Swanik, C. B., & Tierney, R. T. (2005). Effects of sport massage on limb girth and discomfort associated with eccentric exercise. Journal of athletic training, 40(3), 181-5. Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1250257&tool=pmcentrez&rendertype=abstract

Hilbert, J. E., Sforzo, G. A., & Swenson, T. (2003). The effects of massage on delayed onset muscle soreness. British Journal of Sports Medicine, 37(1), 72-75. BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine. doi:10.1136/bjsm.37.1.72

Jonhagen, Sven, Paul Ackermann, Tommy Eriksson, Tonu Saartok, and Per A. F. H. Renstrom. "Sports Massage After Eccentric Exercise." The American Journal of Sports Medicine 32.6 (2004): 1499503. SAGE. Web. 22 Jan. 2012. <http://ajs.sagepub.com/content/32/6/1499.short>

Mancinelli, C. A., Davis, D. S., Aboulhosn, L., Brady, M., & Eisenhofer, J., Foutty, S. (2006). The effects of massage on delayed onset muscle soreness and physical performance in female collegiate athletes. Physical therapy in sport, 7(1), 5-13.

 Smith, L. L., M. N. Keating, D. Holbert, D. J. Spratt, M. R. McCammon, S. S. Smith, and R.             G. Israel. "The Effects of Athletic Massage on Delayed Onset Muscle Soreness, Creatine Kinase, and Neutrophil Count: A Preliminary Report." The Journal of Orthopaedic and Sports Physical Therapy 19.2 (1994): 93-9. UK Pubmed Central. Web. 22 Jan. 2012. <http://ukpmc.ac.uk/abstract/MED/8148868>

Zainuddin, Z., Newton, M., Sacco, P., & Nosaka, K. (n.d.). Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function. Journal of athletic training, 40(3), 174-80. Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1250256&tool=pmcentrez&rendertype=abstract

3 comments:

  1. I examined two studies that looked at using massage in two very different patient populations.

    The first study (1) examined the effects of massage therapy on the immune system of stable preterm infants. The researchers hypothesized that massage therapy (compared to a sham control) would enhance the immune system of the preterm infants by increasing the proportion of their natural killer cells.

    The message intervention was applied to 58 infants for 5 days a week until discharge (at a maximum of 4 weeks). The control intervention was given to 62 infants. Length of stay, infant weight, number of infections, and immunologic components (number of natural killer cells, t cells, and b cells) were all evaluated.

    The researchers found that the absolute numbers of natural killer cells were the same across both groups. However, the proportion of cytotoxic natural killer cells were higher in he massage therapy group, especially in infants who had a hospital stay of 25 or more days. Infants in the massage group were also heavier at the end of the study in comparison to the control group. Average length of stay and number of infections showed no difference between groups.

    These results show that massage therapy can be beneficial to preterm infants during their hospital stay. It may improve overall outcome of these infants. Larger studies are needed.

    The second study (2) looked at massage benefits to 42 adults with Rheumatoid Arthritis (RA) affecting an upper limb. The study compared moderate pressure massage to light pressure massage. The patients received a massage to the affected area once a week for 4 weeks. They also were taught to self-massage the affected area once daily.

    The moderate pressure massage group had less pain and greater perceived grip strength following the first session. A the end of the study, the moderate pressure massage group reported lower levels of pain, had greater range of motion, and greater grip strength than those who were in the light touch massage group.

    This study shows that massage can beneficial to relieving pain as well as increasing strength and range of motion in adults with RA.

    (1) Ang, J. Y., Lua, J. L., Mathur, A., Thomas, R., Asmar, B. I., Savasan, S., Buck, S., et al. (2012). A randomized placebo-controlled trial of massage therapy on the immune system of preterm infants. Pediatrics, 130(6), e1549–58. doi:10.1542/peds.2012-0196
    (2) Field, T., Diego, M., Delgado, J., Garcia, D., & Funk, C. G. (2013). Rheumatoid arthritis in upper limbs benefits from moderate pressure massage therapy. Complementary therapies in clinical practice, 19(2), 101–3. doi:10.1016/j.ctcp.2012.12.001


    ReplyDelete
  2. I looked at a study that was done to determine if massage therapy can beneficially treat pain and dysfunction associated with lumbar spine decompression and fusion surgery of the lumbar spine. The patient in the case study was a 47 year old female who had spinal decompression and fusion of L4/5 secondary to chronic disc herniation. The patient participated in seven 30 minute treatments over an 8 week period. Treatments included Swedish massage techniques and myofascial release techniques on several areas on the posterior side of the body including back, shoulders, hips, and legs. Outcomes were assessed using VAS pain scale, Hamstring Length Test, Oswestry Disability Index, and the Roland-Morris Disability Questionnaire.
    Results show that massage increased hamstring length, had positive effects in the reduction of disability, and had short-term reduction in pain. Further studies should be done to confirm that massage is beneficial for patients who have undergone spinal decompression and fusion, as this was a case study and cannot be applied to a wide range of patients in a clinical setting.


    Keller, Glenda. "The Effects of Massage Therapy after Decompression and Fusion Surgery of the Lumbar Spine: A Case Study." International Journal of Therapeutic Massage and Bodywork 5.4 (2012): 3-8. National Center for Biotechnology Informationn. US National Library of Medicine. Web. .

    ReplyDelete
  3. Super-Duper site! I am Loving it!! Will come back again, Im taking your feed also, Thanks. rehabhere.live

    ReplyDelete