A number of studies over the years have evaluated the potential role massage plays in recovery following exercise or competition, looking at factors such as lactate clearance and delayed onset muscle soreness (DOMS). Commonly, the studies looking at massage and DOMS base their outcome on the subjects’ perception of how the muscle feels following the exercise protocol and then how it feels following massage at different time points (immediately following, +12hrs, +24hrs, +48hrs, etc) in comparison to a control group. A recent paper by Shin and Sung took the investigation a step further in order to try and understand how massage affects recovery with regard to muscle strength and proprioception.
Twenty one subjects, who did not regularly perform strength training exercises for the lower extremities, were randomly divided into two groups. Eleven subjects were in the massage-treatment group, while 10 subjects were in the control group.
The EIMD protocol consisted of the subjects going up and down a five-story building 20 times. Following the 20 reps, the subjects rested for 5min and then had their lactate levels measured. Lactate levels were measured pre- and post-exercise in order to confirm that the subjects sustained an adequate level of muscle fatigue.
Measurements of Proprioception & Strength
Strength was measured using surface EMG over the gastrocnemius during resting and isometric contractions (pushing against a wall without ankle movement for 5sec while in a prone position). Ultrasonography of the gastrocnemius during the same 5sec isometric contraction was also assessed. Proprioception was evaluated using a dual inclinometer, which measured knee and ankle proprioception via passive-to-active angle reproduction. The subjects completed three trials, lying prone, and proprioception was measured as the difference between the targeted angle and the reproduced angle in the ankle and knee joints.
The experimental group in this study received a 15 minute massage to the gastrocnemius, which consisted of light stroking, milking, friction, and skin rolling – all commonly used massage techniques. The control group received sham transcutaneous electrical nerve stimulation (TENS) to the gastrocnemius for 15min.
> EIMD was confirmed in both subject groups via a significant increase in pre- to post-lactate levels.
> Massage to the gastrocnemius increased activation of the medial gastrocnemius head during isometric contraction following the EIMD protocol.
> Massage appeared to have a positive effect on pennation angle of the superficial layer of the gastrocnemius.
> The massage treatment group increased proprioception at the ankle joint, following EIMD, however the changes in the knee joint were not found to be significant.
Massage and soft tissue therapy continue to be recovery modalities sought out by athletes, sports physios, and coaches. While a large part of the result an individual gets from massage following intense exercise may come in the way of psychological relaxation or perception that the treatment is doing something favorable (IE, placebo – which is not a bad thing!), this paper does appear to suggest that there may be other benefits at play. The tests used in the paper are not dynamic in nature, so it would be hard to suggest that perhaps those in the massage group could get off the table and go for another run up and down the stairs; however, it would be interesting to evaluate their ability to repeat their performance, following the protocol, 24hrs later, as this would be similar to what an athlete may be asked to do during a competitive season or during the rigors of a training camp.
As mentioned above, the psychological aspects of any form of touch therapy cannot be understated. The idea of placing your hands on an individual and them producing a response of overall relaxation and them believing in the overall effect is a massive win in terms of shifting that athlete to a more recovered state. That being said, from a more physiological perspective, this is not the first study to look at massage and potential improvements in joint range of motion following treatment. MacDonald and colleagues (J Strength Cond Res, 2013) looked at self-myofascial release massage, using a foam roller, and increases in knee joint range of motion and Forman and colleages (J Body Work Mov Thera, 2014) showed an increase in hamstring range of motion following deep stripping massage with eccentric contraction. Additionally, using trigger point pressure to the gastrocnemius and soleus, Grieve and colleagues (J Body Work Mov Thera, 2013) showed improved ankle joint dorsiflexion in recreational runners.
Finally, looking at the massage intervention in this study – 15min of treatment to the gastrocnemius is a long time to spend on one single muscle. A 2012 study by Crane and colleagues, evaluated the attenuation of inflammation following EIMD using massage therapy. They found that a 10min massage, using effleurage (gliding strokes), petrissage (kneading strokes), and slow stripping strokes to the quadriceps muscle were effective for mitigating the inflammatory response following an intense bike protocol. Perhaps the duration of time spent on one single muscle is a key aspect to attaining certain results when there is excessive soreness or exercise induced muscle damage.
In my next article I will lay out a few ideas surrounding common athlete symptoms, when it comes to high amounts of training, and different massage modalities that may be effective in order to positively influence those symptoms.