Is a Massage Beneficial for Soreness?

Is a Massage Beneficial for Soreness?

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Massage is an ever-growing modality at elite swimming competitions. This has convinced many that massages help prevent soreness. Unfortunately, this belief is still highly debatable, as you’ll see from the below review article as we look at does massage improve soreness?

The study: Nelson N. Delayed onset muscle soreness: Is massage effective? J Bodyw Mov Ther. 2013 Oct;17(4):475-82. doi: 10.1016/j.jbmt.2013.03.002. Epub 2013 Apr 13.
Everyone has experienced soreness and no matter if you are an elite swimmer, coach, or parent you understand how soreness can debilitate function. Soreness secondary to exercise is called delayed onset muscle soreness (DOMS). DOMS is frequently associated with eccentric (muscle lengthening). The physiological mechanism behind DOMS is not well understood, but its presentation begins consistently between 12 – 24 hours after exercise and is marked with tenderness upon palpation (Cheung 2003). Often times DOMS will peak at 48 hours and symptoms have been reported as long as 10 days. DOMS doesn’t cause a major health risk but can impair strength, force steadiness, and coordination (Vila-Cha 2012). Sine believes DOMS is improved by performing similar movements, termed “the repeated bout effect” (RBE). RBE is believed to decrease soreness and reduce the number of muscle proteins in the blood (DiPasquale 2011). Unfortunately, RBE is not well understood, but some believe that improved motor unit activation where more fires recruit as the mechanism of improvement (Gabriel 2006).

Mechanisms of DOMS

Muscle Damage

Despite being discussed, lactate is not thought to be linked to DOMS. Specifically, lactate exits the muscle typically within an hour of stopping exercise. Instead, muscle damage, specifically through overstretching the sarcomeres in an eccentric contraction is thought as the culprit. During this period many muscle fibers and membranes can be affected, allowing calcium ions to move freely (Proske 2005).
Creatine kinase (CK) is another measure of muscle damage, yet great individuality exists in linking CK to DOMS, as CK is influenced by genetics, age, and gender (Baird 2012). This individuality casts doubt on its role in DOMS.
Some question if DOMS is corresponding with muscle damage. Crameri (2007) compared the effects of voluntary vs. electrical stimulation contractions in humans. He discovered less muscle damage in the voluntary muscle contraction group with varying amounts of soreness. Crameri theorized muscle damage doe not correlate with soreness, but changes in the extracellular matrix (ECM) are the cause of damage. These changes may lead to interstitial inflammation and pain.

Inflammation and edema

Connolly (2003) believed eccentric exercise causes damage to the cell membrane, which entices inflammation. This inflammation creates metabolic waste products, causing chemical stimulation to nerve afferents that cause pain. Metabolic waste products can also increase permeability and increase edema and mechanical pressure, causing pain (Dessem 2010).

Neural Adaptations

DOMS may also be centrally mediated, as seen in cross-education, the phenomena where improving strength in one body part is crossed to another limb (Starbuk 2012).

Psychosocial Mediator

Pain is a highly complex mechanism with psychosocial and physiological factors (Gatchel 2007). Biopsychosocial proponents suggest that pain isn’t only from tissue damage, but individual pain perception, genetics, history, mental status, etc. (George 2007; Gatchel 2007). Gatchel (2007) surveyed a group’s perception of pain, then had them perform shoulder external rotations to experience DOMS. The participants with a higher fear of pain had more pronounced DOMS symptoms. This was repeated by George (2008) as this study performed questionnaires as well as screening for COMT genotype (an enzyme linked to pain). In this study, those with high-pain perception and low COMT activity were more likely to have elevated pain intensity (George 2008).

Effectiveness of Massage

Theoretical Mechanisms of massage

The link between massage and improvement of DOMS is not clear. Some feel massage may decrease cytokine production, which mitigates inflammatory response. One study found a 45-minute Swedish massage decreased cytokine production (Rapaport 2010). Another study had participants perform an exhaustive stationary bike ride, followed by a 10-minute massage to one leg. Then, the researchers took muscle biopsies of the quadriceps muscles 2.5 hours after the massage and found significantly less inflammatory cytokines in the massaged leg (Crane 2012).
Some believe massage increases local circulation, helping deliver nutrients and speed recovery (Wiltshire 2010; Zainudden 2005) while opposing literature exists (Hinds 2004; Shoemaker 1997).
Massage has also been associated with positive effects of nervous system activity. Specifically, it seems massage decreases the H-reflex, a measure of motor neuron excitability (Sefton 2012).
Massage may also decrease stress hormone cortisol and increase serotonin and dopamine (Rapport 2010; Field 2005). These may decrease pain.
Massage may also improve the psychological component of pain (Krohn 2011; Beider 2007). If massage can reduce levels of anxiety and worry, it may provide some relief of DOMS symptoms.

Massage and DOMS

Although massage is a common modality, little research exists on its effectiveness for improving performance after exercise (Best 2008; Cheung 2003; Torres 2012). However, there is more research suggesting massage helps pain and soreness.
  1. Micklewright and colleagues examined 20 male subjects, new to strength training. The participants were asked to perform eccentric elbow extensions in order to induce DOMS. One group received soft tissue release (STR) while the other received no treatment. DOMS was assessed at 24 and 48 h after exercise. Researchers did not find any statistical reduction in the level of soreness between groups (Micklewright, 2009).
  2. Mancinelli and colleagues examined 22 female basketball and volleyball players, a group accustomed to exercise. Subjects were asked to perform quadricep exercises to induce DOMS. 11 subjects received a massage to the quads which included effleurage, petrissage, skin rolling and vibration, while the other 11 received no treatment. The participants that received the massage had increased vertical jump displacement, and lower perceived soreness (Mancinelli et al., 2006).
  3. A study conducted by Zainuddin suggested massage might be beneficial for DOMS. Researchers studied 10 subjects; 5 men and 5 women. Participants were asked to perform eccentric bicep curls to induce DOMS. One arm received a 10 min massage, 3 h post exercise, while the other arm received no treatment. The massaged arm was found to have reduced activity of CK, as well as decreased soreness compared to the arm that did not receive the massage (Zainuddin et al., 2005).
  4. Rodenburg and colleagues separated 50 subjects into 2 groups after inducing DOMS. Group 1 performed a dynamic warm-up and stretching before exercise, and received a 15 min massage after exercise. Group 2 did not perform the warm-up or receive a massage. Group 1 experienced less pain during the 96 h evaluation period (Rodenburg et al., 1994).
  5. Smith and colleagues had 14 participants perform elbow extension and flexion exercises to induce DOMS. Two hrs after exercise, the intervention group received a 30 min massage, which included effleurage and petrissage, while the control group received no treatment. Smith noted a reduction in soreness in the massage group from 24 to 96 h post exercise (Smith et al., 1994).
  6. Wenos and colleagues had participants perform eccentric knee extensions to induce DOMS. One leg received a massage, while the other leg received no treatment. Soreness was evaluated by a pain questionnaire 24, 48, and 72 h after exercise. The researchers found no significant difference between the massaged leg and the control leg (Wenos et al., 1990).
  7. Hilbert had 18 volunteers perform hamstring exercises to induce DOMS. The participants were then separated into two groups. The first group received a massage consisting of 5 min of effleurage, 1 min of tapotement, 12 min of petrissage, followed by 2 min of effleurage. The second group received a sham massage, which involved the therapist rubbing lotion on the participants’ legs and having them rest for the remaining 20 min. The massage was performed 2 h after exercise. Researchers found no significant differences in ROM, inflammatory markers or mood. They did discover that the group receiving the real massage reported a decrease in the intensity of soreness 48 h after exercise (Hilbert and Kimura, 2003).
  8. Farr and colleagues investigated the effects of a 30 min massage to 8 participants after walking downhill for 40 min. One leg received the treatment 2 h after exercise, while the other leg received no treatment. Muscle soreness, strength, and single leg vertical jump height were measured at multiple points in time after exercise. The intervention group had reduced soreness and tenderness;  measures of strength showed no improvement compared to the control leg (Farr et al., 2002).
  9. Jakeman and others studied the effect of combining massage and the use of compressive clothing. Subjects performed 100 plyometric drop jumps and were assigned to one of three groups; a passive recovery group, a group which received a 30 min massage (performed immediately after exercise) followed by wearing compression stockings for 11.5 h, and a compression group which wore the stockings for 12 h after exercise. The combination group showed significantly less soreness at 48 and 72 h after exercise compared to the compression group and the passive recovery group. Both treatment groups had similar positive effects on isokinetic muscle strength, squat jump performance, and countermovement performance compared to the passive group (Jackeman et al., 2010).

So Does Massage Improve Soreness

The majority of studies indicate that massage reduces levels of soreness. However, future studies must fill the gaps, as many gaps exist in the methods of the aforementioned studies. For example, the length and type of massage are different in most of these studies, lacking consistency.

Future Studies

Future studies must attempt to standardize the type and length of massage. Also, the location of massage must be analyzed.

Conclusion

Massage appears beneficial for reducing cytokine production and DOMS. If receiving a massage, 2 – 3 hours may be the most beneficial window. However, individual variation likely exists, as individuality is expected with pain perception.
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