One of the main reasons that athletes seek out massage is to decrease the muscle stiffness they feel due to intense training and competing. A recent paper by Crommert and colleagues (Scand J Med Sci Sport, 2014) evaluated the effects of massage on muscle stiffness in the medial gastrocnemius of eighteen healthy volunteers.
Seven minutes of massage was performed on the gastrocnemius of one leg for each subject – 2min of effleurage, 2min of petrissage, 2min of deep circular friction, and 1min of effluerage – while the non-massaged lower leg served as the control. Immediately following massage, the subjects rated their level of pain experienced during the massage on a 0 to 10 scale (0 = no pain, 10 = worst imaginable pain).
Muscle stiffness was measured using shear wave elastography to quantify the shear elastic modulus (stiffness) at the midpoint of the medial gastrocnemius muscle belly at three time points: before massage (baseline), immediately following massage (follow-up 1), and after 3min of rest following follow-up 1 (follow-2), in both the massaged and non-massaged legs.
- Medial gastrocnemius stiffness was significantly lower immediately following massage (follow-up 1) compared with baseline and following rest (follow-up 2).
- There were no significant differences found between baseline and follow-up 2 in the massaged leg, indicating a return to normal muscle stiffness.
- Average level of pain rating was 1.3 +/- 1.6 and there was no correlation found between perceived pain level and a reduction in muscle stiffness in the massaged leg at follow-up 1.
Massage appears to reduce muscle stiffness; however the results are short lived with a rapid return back to baseline levels.
The authors suggested four potential mechanisms that may lead to a decrease in muscle stiffness from massage:
- A decrease in motoneuron excitability due to general relaxation.
- Manual pressure and stretching leading to a breaking apart of stable cross-bridges between actin and myosin filaments, which are spontaneously formed while the muscle is at rest.
- Increased intramuscular temperature from the massage.
- The possibility that all of these mechanisms are working together, rather than any one of them working in isolation.
These theoretical mechanisms for why manual/touch therapy works are interesting and most likely not the only mechanisms at play. I’d be inclined to think that #4 above is the most likely scenario, along with other potential influences.
The fact that massages influence on muscle stiffness was short lived is interesting. From a practical standpoint, when applying this stuff to athletes for specific purposes of addressing muscle tone and stiffness, there are a few things I think about with regard to the outcome in this study:
- The length of treatment may have been too short to produce a more longer lasting effect. Maybe seven minutes isn’t enough? One proposed mechanisms that led to a decrease in muscle stiffness was general relaxation from massage. While not measuring stiffness, Arroyo-Morales have done some studies looking at massage therapy and autonomic changes – a shift towards a more parasympathetic state – leading to greater relaxation. The two studies they performed used 40min massages following intense cycling exercise in order to achieve this result.
- Maybe the techniques used are to passive in order to produce longer lasting changes? As I discussed a few weeks ago, there might be different massage techniques for different recovery purposes. If the goal is to improve some sort of functional outcome (E.g., decrease muscle stiffness and/or improved ROM) maybe passive techniques, like the ones used in this study, need to be coupled with more active techniques which force the client to be an active participant in the treatment. This puts the client in the driver seat and might allow their brain to be more receptive to the changes taking place and cause them to be more longer lasting.
- Finally, maybe the treatment needed to be followed up with active movement in order to “make it stick”? In the past, I have written about the idea that massage might be useful to “open the window”, to help decrease threat or increase awareness for the client, and then should be followed up by movement therapies in order to teach the brain to move and be strong through the new ROM on its own. Perhaps the reduction in muscle stiffness, found in this paper, would have been longer lasting with movement therapy? Certainly a short treatment time can be beneficial in certain situations, depending on your goal. Grieve and colleagues found that a 10min treatment consisting of trigger point therapy and light stretching was adequate enough to produce a significant increase in ankle dorsiflexion in recreational runners. In a situation where the goal of treatment is some sort of functional outcome, rather than more recovery based, these short bouts of massage therapy may be enough to produce a result and then should be followed up with some sort of movement based therapy.
Massage therapy appears to impact the body on different levels via different mechanisms. This study evaluated muscle stiffness and found that seven minutes of massage was effective at decreasing muscle stiffness, however, the results were short lived. From a practical standpoint, the fact that massage decreased muscle stiffness is promising and there might be other factors that could enhance the effect of the positive change in muscle stiffness seen in this study. In an actual treatment setting we rarely (or never) rely solely on one single modality or approach and usually a variety of different approaches are stacked on top of each other, depending on the intended goal of the treatment. When used in conjunction with other modalities, the findings from this study may potentially be augmented.