The Mechanisms of Massage and Effects on Performance, Muscle Recovery and Injury Prevention

Comparison Between Classic and Light Touch Massage on Psychological and Physical Functional Variables in Athletes: a Randomized Pilot Trial

BACKGROUND

Despite the general belief of the benefits and the widespread use of massage in sport field, there are limited empirical data on possible effectiveness of massage on psychological and physical functional variables.

PURPOSE

The main objective of the present study was to compare the effectiveness of classical and light touch massage on psychological and physical functional variables in athletes.

SETTING

Athletic club of Valencia.

PARTICIPANTS

20 amateur athletes were recruited from two athletic clubs.

RESEARCH DESIGN

A single-blind, randomized, pilot-placebo trial.

INTERVENTION

The subjects were randomly allocated to two different groups: a) Massage group (MG) (n=10); b) Control group (CG) (n=10). The intervention period lasted one month (one session per week).

MAIN OUTCOME MEASURES

Assessment of the participants was performed at baseline and 24 hours following the completion of the intervention. Outcome measures included hip flexion, knee extension, and mood state.

RESULTS

The results suggest that MG obtained better results on physical variables (p < .05). However, for both groups, trends suggest significant improvements in the overall mood state of the participants (p < .05).

CONCLUSION

Our results suggest that classic massage could be an effective intervention to improve functional physical variables in athletes. However, trends suggest that a light touch intervention could provoke improvements in physiological measures.

Does Acupuncture Benefit Delayed-Onset Muscle Soreness After Strenuous Exercise? A Systematic Review and Meta-Analysis

Purpose: This systematic review and meta-analysis was designed to evaluate the effects of acupuncture intervention on alleviating delayed onset of muscle soreness (DOMS) after intense exercise.

Method: Randomized controlled trials (RCTs) were searched from online databases including Medline (PubMed), Cochrane Library, Web of Science, Embase, PsycINFO, China Knowledge Resource Integrated Database (CNKI), and Wanfang (Chinese) up to April 2019. Data points were extracted from the eligible RCTs at the time points of 24, 48, and 72 h post strenuous exercise-induced DOMS. The outcomes of muscle soreness rating (MSR), creatine kinase (CK), and maximal isometric force (MIF) were pooled into the meta-analysis to assess the acupuncture intervention on DOMS.

Results: Six eligible RCTs were included in the meta-analysis, and the results showed that acupuncture intervention significantly decreased MSR [standardized mean difference (SMD) −0.49, 95%CI −0.73 to −0.24, P < 0.001, I² = 34%] and the serum level of CK (SMD −0.91, 95%CI −1.27 to −0.56, P < 0.001, I² = 30%), accompanied with the improvement of the muscle strength (MIF) (SMD 0.54, 95%CI 0.16 to 0.93, P = 0.006, I² = 51%) after intense exercise. At the same time, the findings also revealed that acupuncture intervention had a long-lasting effect and tended to accumulate the effect size and that it had the most efficacy on alleviating DOMS at the time point of 72 h post exercise.

Conclusion: The current evidence indicates that acupuncture intervention after intense exercise could be effective for alleviating DOMS and improving muscle recovery. The long-lasting effect of acupuncture intervention on DOMS started from 24 h and would reach a peak on the time point of 72 h post exercise.

The effect of vibration therapy on neck myofascial trigger points: A randomized controlled pilot study

BACKGROUND

The purpose of this study was to evaluate the effect of low-frequency self-administered vibration therapy into myofascial trigger points in the upper trapezius and levator scapulae on patients with chronic non-specific neck pain.

METHODS

Twenty-eight patients with chronic non-specific neck pain were randomly assigned into a vibration group, receiving 10 self-applied sessions of vibration therapy in the upper trapezius and levator scapulae trigger points; or a control group, receiving no intervention. Self-reported neck pain and disability (Neck Disability Index) and pressure pain threshold were assessed at baseline and after the first, fifth and 10th treatment sessions.

FINDINGS

Significant differences were found in the vibration group when compared to the control group after the treatment period: the vibration group reached lower Neck Disability Index scores (F = 4.74, P = .033, η² = 0.07) and greater pressure pain threshold values (F = 7.56, P = .01, η² = 0.10) than the control group. The vibration group reported a significant reduction in Neck Disability Index scores (χ2 = 19,35, P = .00, Kendall's W = 0.28) and an increase in pressure pain threshold (χ2 = 87,10, P = .00, Kendall's W = 0.73) between the assessment times over the course of the treatment. The mean increase in pressure pain threshold in the vibration group after the 10 sessions was 8.54 N/cm2, while the mean reduction in Neck Disability Index scores was 4.53 points.

INTERPRETATION

Vibration therapy may be an effective intervention for reducing self-reported neck pain and disability and pressure pain sensitivity in patients with chronic non-specific neck pain. This tool could be recommended for people with non-specific neck pain.

Effectiveness of oral exercise on oral function among the elderly

Purpose

To evaluate the effectiveness of oral exercise on oral function among the elderly at a selected old age home in Chennai.

Research Design

The present study adopted a one-group pretest and posttest (preexperimental) design.

Methods

Participants received intervention "oral exercise" which comprised of exercises for expression muscles (orbicularis oculi, buccinator and orbicularis oris), tongue, salivary glands, and swallowing. The pre- and posttests included assessment of oral function (dry mouth symptoms, amount of salivary pH, salivary secretion, size of mouth opening, halitosis, and oral motor function) using summated xerostomia inventory, spitting into a measuring container for 10 min, pH meter, Vernier caliper, organoleptic test, and Sunnybrook facial grading system, respectively.

Results

Using nonprobability convenience sampling technique, a total of 48 older people living in an old age home who met the inclusion and dental screening criteria were recruited. There was a statistically considerable difference noted in the mean scores of the dry mouth symptoms (t = 11.88), amount of salivary secretions (t = 17.05), salivary pH (t = 8.68), size of mouth opening (t = 14.76), halitosis (t = 13.13), and oral motor function (t = 11.52) at P <.001 before and after oral exercise among the elderly.

Conclusion

Oral exercise as a self-regulating intervention can efficiently promote oral health of older people.

The Effect on Muscle Hardness of Acupuncture Stimulation Using Low-reactive Level Laser Therapy and Silver Spike Point Therapy, along with Stretching

BACKGROUND AND AIMS

Muscle hardness causes lower activity in athletic practice or sport competition. Increase in muscle hardness often cause injury and muscle fatigue. The aim of this study is to investigate the effect on muscle hardness of acupuncture stimulation using low-reactive level laser therapy (LLLT) and silver spike point (SSP) therapy, along with stimulation by stretching.

MATERIALS SUBJECTS AND METHODS

Muscle fatigue was created experimentally, and the effect of LLLT was examined with the indices of muscle hardness and the pennation angle, using ultrasound diagnostic equipment with real-time tissue elastography (RTE) functionality.

RESULTS

As a result, a combined use of stretching and SSP therapy was effective on muscle hardness, while LLLT alone had no immediate lowering of muscle hardness. In addition, only the laser stretching group demonstrated a significant decrease in the pennation angle.

CONCLUSIONS

This is because an improved local blood flow due to SSP therapy is considered to have relaxed muscle tonus, which boosted metabolism and removed algogenic substances. This became more effective through a combined use of stretching and low-power laser irradiation. Moreover, it was suggested that stimulation of the acupuncture points in the crus could have a further effect on muscle hardness and the pennation angle.

Effects of Manual Therapy on Fatigue, Pain, and Psychological Aspects in Women with Fibromyalgia

Fibromyalgia is a condition characterised by chronic widespread muscle pain and fatigue, sleep disturbances, cognitive disorders, and mood disturbance. The purpose of this study was to determine the effectiveness of a manual therapy technique performed with moderate digital pressure in women with fibromyalgia (n = 24). In this randomised, controlled trial, the participants were randomly assigned to the experimental group or placebo group. The experimental group was assisted with manual therapy sessions based on connective tissue massage, whereas the placebo group was "treated" with ultrasound sessions performed without conductive gel and with the machine turned off as the placebo. Fatigue severity scale (FSS), visual analogical scale (VAS), Pittsburgh sleep quality index (PSQI), and profile of mood states (POMS-29) were completed before and after the intervention. In the experimental group (manual therapy), significant results were obtained on a VAS scale, referring to the neck pain in patients with fibromyalgia (p < 0.001). Correlations showed a relationship between fatigue and sleep variables (R = 0.411; p = 0.046) and pain variables with the POMS anger-hostility subscale (R = 0.436; p = 0.033). Although the size of the sample could be a limitation, the study concluded that the application of manual therapy in fibromyalgia patients performed with moderate pressure for 15 min on the posterior cervical musculature decreased the perception of pain, muscle fatigue, and the state of tension-anxiety.

Does the Therapist's Sex Affect the Psychological Effects of Sports Massage?-A Quasi-Experimental Study

Objectives: The aim of this study was to determine the influence of the sex of the therapist and of the athlete on the athlete’s current emotional state after a sports massage. The assumption was that the effect of a massage on the current mood was independent of the sex of the therapists or athletes. Background: Sports massages are an integral part of the support given to athletes during training or competition and are a commonly used method for promoting athletes’ physical and mental recovery. Few studies have measured the mental characteristics or even the nonspecific effects of sports massages. Sexual attraction or dislike are among the nonspecific effects of a treatment. Materials and methods: One hundred and sixty-eight high-performance male and female amateur athletes received a sports massage from 15 male and female trained therapists. The current emotional state of the athletes was measured before and after intervention using the BSKE-EA17 adjective scale, whose items can be assigned to five categories of the current emotional state. ANOVAs (analysis of covariances) were carried out to calculate the interactions between the sexes. Cohen’s d for similar group sizes and similar group variances were determined. Results: Neither the sex of the therapist nor the sex of the athlete had any influence on the mental effect of a sports massage. The only exception was when male athletes were treated by female therapists, where an increase in “elevated mood” was observed. Sports massages resulted in an increase in the responses in the categories “elevated mood” (d = 1.1) and “level of activation” (d = 0.3) and a decrease in the responses for “low mood” (d = 0.3), “level of deactivation” (d = 0.6) and “level of excitation” after the massage compared to before the massage (d = 0.9). Conclusions: Sports massages appear to increase the positive dimensions of the athletes’ current emotional state and reduce the negative dimensions. The self-reported mood changes from before the massage to after the massage were not influenced by other prognostic variables, including wait time, age of the athlete or the duration of the run. The results suggest that the specific effects of sports massages on the mental status are supported. Disregarding the aspect of the therapists’ sex, sports officials, trainers and athletes therefore can be more independent in the personnel planning of sports therapists.

Effectiveness of breathing exercises, foot reflexology and back massage (BRM) on labour pain, anxiety, duration, satisfaction, stress hormones and newborn outcomes among primigravidae during the first stage of labour in Saudi Arabia: a study protocol for a randomised controlled trial

INTRODUCTION

Labour pain is among the severest pains primigravidae may experience during pregnancy. Failure to address labour pain and anxiety may lead to abnormal labour. Despite the many complementary non-pharmacological approaches to coping with labour pain, the quality of evidence is low and best approaches are not established. This study protocol describes a proposed investigation of the effects of a combination of breathing exercises, foot reflexology and back massage (BRM) on the labour experiences of primigravidae.

METHODS AND ANALYSIS

This randomised controlled trial will involve an intervention group receiving BRM and standard labour care, and a control group receiving only standard labour care. Primigravidae of 26-34 weeks of gestation without chronic diseases or pregnancy-related complications will be recruited from antenatal clinics. Eligible and consenting patients will be randomly allocated to the intervention or the control group stratified by intramuscular pethidine use. The BRM intervention will be delivered by a trained massage therapist. The primary outcomes of labour pain and anxiety will be measured during and after uterine contractions at baseline (cervical dilatation 6 cm) and post BRM hourly for 2 hours. The secondary outcomes include maternal stress hormone (adrenocorticotropic hormone, cortisol and oxytocin) levels, maternal vital signs (V/S), fetal heart rate, labour duration, Apgar scores and maternal satisfaction. The sample size is estimated based on the between-group difference of 0.6 in anxiety scores, 95% power and 5% α error, which yields a required sample size of 154 (77 in each group) accounting for a 20% attrition rate. The between-group and within-group outcome measures will be examined with mixed-effect regression models, time series analyses and paired t-test or equivalent non-parametric tests, respectively.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Ethical Committee for Research Involving Human Subjects of the Ministry of Health in the Saudi Arabia (H-02-K-076-0319-109) on 14 April 2019, and from the Ethics Committee for Research Involving Human Subjects (JKEUPM) Universiti Putra Malaysia on 23 October 2019, reference number: JKEUPM-2019-169. Written informed consent will be obtained from all participants. Results from this trial will be presented at regional, national and international conferences and published in indexed journals.

TRIAL REGISTRATION NUMBER

ISRCTN87414969, registered 3 May 2019.

Evaluating the Efficacy of Massage Intervention for the Treatment of Poststroke Constipation: A Meta-Analysis

Background

It is essential to determine a safe and effective method for treating constipation after stroke. Massage has been widely used in recent years. However, meta-analysis data on the efficacy of massage for the treatment of constipation experienced after stroke are almost nonexistent.

Objective

This review aimed to examine the effectiveness of using massage therapy to treat constipation in patients who suffered a stroke event.

Methods

This systematic review adhered to the reporting guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Electronic databases, including Cochrane Library, PubMed, EMBASE, Web of Science, China Biology Medicine, Wan Fang Data, VIP Database for Chinese Technical Periodicals, and National Knowledge Infrastructure, were searched for relevant studies on the efficacy of massage for the treatment of poststroke constipation. Rev-Man 5.3 software was used to analyze the study data.

Results

A total of 11 randomized controlled trials with 1045 patients were included. A statistically significant difference in the total effective rates was found between the massage and control groups (OR = 4.96; 95% confidence interval (CI): 2.81, 8.76; P < 0.001). Compared with the control groups, the massage group had markedly reduced incidences of constipation (OR = 0.34; 95% CI: 0.25, 0.47; P < 0.001) and of four symptoms of discomfort (P < 0.001). The frequency of defecation on day two and day three in the massage group was significantly higher than that in the control group (P < 0.001).

Conclusion

Our results strongly suggest that massage can effectively reduce the incidence and severity of constipation after stroke. However, large, multicenter, long-term, and high-quality randomized controlled trials need to be conducted to establish a definitive conclusion.

Does soft tissue mobilization assist static stretching to improve hamstring flexibility? A randomized controlled trial

Objectives Objective of the study is to investigate whether Soft tissue mobilization (STM) can assist with static stretching to improve hamstring flexibly. Methods The design of the study was repeated measure design. The study was conducted at the physical therapy laboratory of Jamia Hamdard University, New Delhi. Participants included 78 healthy males with hamstring tightness, randomly assigned to either the control group (static stretching) or the experimental group (STM and static stretching). The experimental group received five sets of four different STM techniques, followed by two sets of 30-s static stretches 3 days per week over the course of 12 weeks. The control group received 5 min of sham ultrasound with an inactive probe prior to static stretching. Active knee extension test (AKE) was the outcome measure. Results Both groups showed significant improvement in AKE compared with the baseline measurements. With ingroup analysis showed a significant difference in AKE across all measured time periods (weeks 4, 8, and 12) with pre-test in both groups (p<0.05). No significant difference in AKE improvement was found between groups (p>0.05). Conclusion The results of this study show that STM prior to static stretching does not significantly improve hamstring flexibility among healthy individuals. Although this study cannot be generalized, the results may be useful for evidence-based practice in the management of hamstring tightness.

Effect of physical stimulation (gingival massage) on age-related changes in gingival microcirculation

The decline in circulatory function with aging may be alleviated by a combination of gingival massage (physical stimulation) and mechanical cleaning. Several studies have reported the systemic effect of physical stimulation on various parts of the body, including its therapeutic effect on pain in the neck and shoulders that becomes evident with age, and improvement in blood circulation. In contrast, few studies have reported on the changes in gingival microcirculation induced by gingival massage, while no previous study has evaluated the effect of gingival microcirculation on age-related changes in the hemodynamics of the oral cavity. This study aimed to investigate how gingival massage affects age-related changes in gingival microcirculation. Male Wistar rats (7-week, 6-month and 1-year old) were prepared for a gingival massage group and a control group. Mechanical stimulation was applied on the maxillary molar gingiva for 5 seconds twice a week for 4 weeks. Subsequently, gingival reactive hyperemia was measured using a laser Doppler flowmeter. In addition, morphological analyses were also performed by hematoxylin and eosin and Indian ink staining and a vascular resin cast model. Base Flow, maximum response (Peak), and time required for the maximum response to halve (T1/2) were reduced in 1-year-old rats compared with the other age groups. In the mechanical stimulated group, T1/2 was increased in 7-week, 6-month, and 1-year-old rats, and total blood flow (Mass) was increased in 6-month and 1-year-old rats. In addition, clear blood vessel networks and loop-like revascularization were only observed in the mechanical stimulated group. Changes in age-related decline in gingival microcirculatory function and vascular construction were reported in this study, and the results suggested that gingival massage activates both the functional and morphological aspects of gingival microcirculation and may be effective for maintaining oral health.

Instrument-assisted soft tissue mobilisation versus stripping massage for upper trapezius myofascial trigger points

Objective

This study investigated the effects of instrument-assisted soft tissue mobilisation (IASTM) versus stripping massage (SM) on myofascial trigger points in the right upper trapezius.

Method

Forty patients (34 women and 6 men), aged 18–23 years, with active trigger points in the right upper trapezius were divided into two equal groups (A and B). Group A (n = 20) received IASTM using an M2T blade twice a week for four weeks in addition to stretching exercise. Group B (n = 20) received SM twice a week for four weeks in addition to stretching exercise. The visual analogue scale, a pressure algometer, and the Arabic version of the Neck Disability Index were used to evaluate patients' pre- and post-treatment statuses.

Results

Within-group analysis showed significant differences between pre- and post-treatment values of all outcome measures in both groups. In contrast, between-group analysis did not show any significant differences between the two groups in pre- or post-treatment values of any outcome measures.

Conclusion

IASTM and SM are effective methods for improving pain and function in patients with upper trapezius trigger points.

Immediate Effects of Self-Thai Foot Massage on Skin Blood Flow, Skin Temperature, and Range of Motion of the Foot and Ankle in Type 2 Diabetic Patients

Objectives: The purpose of this study was to investigate the immediate effects of self-Thai foot massages (STFMs) on the foot skin blood flow, the foot skin temperature, and range of motion (ROM) of the foot and ankle in type 2 diabetic patients with peripheral neuropathy. Design: A randomized crossover study. Subjects: Twenty five diabetic patients with peripheral neuropathy were recruited. Interventions: Participants were randomly assigned to either STFM or Thai foot massage (TFM) performed by a massage therapist; then, they were switched to the other group after a 1-week washout period. In both groups, the foot massage was performed in a seated position on the dominant lower leg and foot for 25 min. Outcome measures: Before and immediately after treatment, foot skin blood flow, foot skin temperature, and ROM of the foot and ankle were evaluated. Heart rate was measured throughout the treatment. Results: After a single treatment of the massage, foot skin blood flow and ROM of the foot and ankle significantly improved in both groups (p < 0.05). Foot skin temperature did not change in STFM, whereas it significantly increased in TFM. Heart rate significantly increased in STFM, whereas it tended to decrease in TFM. Conclusions: Both STFM and TFM by a massage therapist could improve foot skin blood flow and ROM of the foot and ankle in diabetic patients with peripheral neuropathy. An STFM could be a promising alternative treatment that patients can perform at home.

Effects of Dynamic Stretching Combined With Static Stretching, Foam Rolling, or Vibration Rolling as a Warm-Up Exercise on Athletic Performance in Elite Table Tennis Players

CONTEXT

Warm-up exercise is an essential preexercise routine for athletes to optimize performance. However, the benefits of combined warm-up protocols remain unclear.

OBJECTIVE

This comparative study investigated the acute effects of dynamic stretching (DS) followed by static stretching (SS), self-myofascial release using a foam rolling (FR) device, or vibration foam rolling (VFR) as a warm-up exercise to improve flexibility, power, agility, and specific skills in elite table tennis players.

DESIGN

A crossover study.

SETTING

University.

PARTICIPANTS

Twenty-three elite table tennis players.

INTERVENTIONS

Players completed 3 different interventions in a random order (DS + SS, DS + FR, and DS + VFR). The target muscle groups included the bilateral posterior calf, posterior thigh, anterior thigh, back, and shoulder.

MAIN OUTCOME MEASURES

Sit-and-reach test for flexibility, board jump test for lower-extremity power, medicine ball throw test for upper-extremity power, Edgren Side Step Test for agility, and ball speed of table tennis was assessed before and after intervention.

RESULTS

After intervention, significant increases in flexibility (15.2%, 20.4%, and 23.8%); lower-limb power (4.5%, 6.6%, and 6.3%); upper-limb power (9.6%, 8.5%, and 9.1%); and ball speed (7.4%, 7.6%, and 7.7%) were observed for DS + SS, DS + FR, and DS + VFR, respectively (all P < .001). In addition, only DS coupled with FR (5.1%) and DS in conjunction with VFR (2.7%) significantly improved agility (P < .001). However, no significant improvements in agility were observed after DS + SS. In addition, no one protocol was superior to the other in all outcomes.

CONCLUSION

The authors suggest that a combination of DS with FR or VFR as warm-up exercises significantly improved flexibility, power, ball speed, in addition to agility in elite table tennis players. Coach and athletic professionals may take this information into account for choosing more effective warm-up protocols to enhance performance.

The effect of soft tissue manipulation and rest on knee extensor muscles fatigue: Do torque parameters and induced perception following muscle fatigue have enough reliability?

Background:

Muscle fatigue affects the precision of the subjects’ performance and limits the range of physical and sports activities. There is limited scientific evidence to support the use of soft tissue manipulation for enhancing muscle performance and its recovery. The aim of this study is to compare the effects of soft tissue manipulation and rest on the knee extensor muscle fatigue after maximal isokinetic contractions.

Methods:

Fifteen healthy females 20–30 years of age were selected for this research. This study implemented a semi-experimental test–retest measurement method. The subjects then either rested or received soft tissue manipulation on the knee extensors for a duration of 15 min. After intervention (soft tissue manipulation or rest), the parameters were evaluated for the third time.

Results:

The stability of the average of peak torque (APT), average power (AP), and visual analog scale (VAS) before performing fatigue protocol was 85%, 83%, and 31.9%, respectively. The stability after fatigue was 43%, 50%, and 93%, respectively. After maximal fatigue and a decrease in torque output to below 50% maximal torque, 15 min of soft tissue manipulation could change the APT after fatigue from a mean of 58.3 (nm) to 91.5 (nm), the AP from 39.4 to 63.6 (nm/s), and the VAS, from 90.0 to 12 (mm). But 15 min of rest could change the APT from 52.5 to 68.1 (nm), the AP from 37.6 to 48 (nm/s), and the VAS from 90.0 to 27.3 (mm).

Conclusion:

The study showed that soft tissue manipulation was more effective than rest as a strategy to return muscles to a normal state and caused more relief in perceived fatigue.

Lower limb massage in humans increases local perfusion and impacts systemic hemodynamics

Massage is commonly used as a complementary therapy for many different conditions. Demonstration of its physiological impact and understanding of its therapeutic mechanisms is still insufficient and often inconclusive. This study aims to characterize the physiological effects of effleurage, one of the most popular techniques, on human in vivo microcirculation and its impact on cardiovascular function. Two differently oriented variations of the technique, referred to influence physiological outcomes, were applied to 32 young (mean 19.8 ± 1.6 yr old) healthy volunteers of both sexes in a single, randomly chosen limb after informed written consent. Each protocol included a 10-min baseline (Phase I), a 5-min massage (Phase II), and a 10-min recovery (Phase III) register. A 30-min washout period separated both protocols. Perfusion was assessed by laser Doppler flowmetry (LDF) and reflection photoplethysmography (PPG), with their sensors applied distally in both feet. Blood pressure and pulse were also obtained. LDF signals were further analyzed in their components by the (Morlet) wavelet transform to probe the mechanisms involved. Results showed that effleurage consistently evoked a significant (P < 0.001) perfusion increase in the massaged limb, also visible in the contralateral limb (not significant) independently from the orientation (variant) used. No matter the perfusion differences known between sexes, the adaptive response was equivalent in both sexes. The component analysis of the LDF curves also suggests that these procedures, although brief and superficial, do modify multiple components of cardiovascular integration, with cardiac, respiratory, and myogenic components appearing to play a major role in reestablishing distal microcirculatory homeostasis.NEW & NOTEWORTHY The impact of effleurage, a well-known massage procedure used in human rehabilitation, in the lower limb hemodynamics, is demonstrated. When applied in a sole limb, massage increases skin microcirculatory flowmotion not only locally but also beyond, affecting systemic hemodynamics. This observation is an interesting example of the efficacy of cardiovascular integration mechanisms involving distal microcirculatory homeostasis. The proposed methodology allows a mechanistic view over skin flowmotion regulation, being applicable to further explore massage and its impact on microcirculatory physiology.

Knowledge and Perception of Athletes on Sport Massage Therapy (SMT)

BACKGROUND

Interest in sport massage is steadily increasing in recent times especially in developing countries. One study showed that general practitioners had minimal or no knowledge about sport massage therapy (SMT). Coaches, athletes, and sports medicine personnel have various beliefs about the benefits and efficacy of SMT. It would be prudent, therefore, for athletes who are frequent users of SMT to possess adequate knowledge and appropriate attitudes about SMT.

PURPOSE

The purpose of this study was to determine the knowledge and perceptions of athletes about SMT.

SETTING

The study setting was located in the City of Cape Town, Western Cape Province, South Africa.

RESEARCH DESIGN

A quantitative, cross-sectional and descriptive study design was used.

PARTICIPANTS

The study sample consisted of 100 conveniently sampled athletes, males and females aged 18 years and older, from various mountain biking and trail running events in the City of Cape Town.

METHODS

A researcher-generated and self-administered demographic questionnaire was distributed amongst the participants either as a hardcopy or completed online via Google forms. The knowledge and perception questionnaire consisted of 10 knowledge and 17 perception questions, and was based on previously validated questionnaires. The data were analyzed descriptively using frequencies (percentages).

RESULTS

The results of the study indicated that the participants had a moderate-to-high knowledge of SMT and that they had positive perceptions overall about SMT.

CONCLUSION

This study indicated that athletes who made use of SMT were quite knowledgeable about SMT and that they were well-disposed towards SMT as a beneficial modality for sport performance and postexercise recovery.

Effectiveness of deep tissue massage therapy, and supervised strengthening and stretching exercises for subacute or persistent disabling neck pain. The Stockholm Neck (STONE) randomized controlled trial

OBJECTIVE

To compare the effectiveness of deep tissue massage, supervised strengthening and stretching exercises, and a combined therapy (exercise followed by massage) (index groups), with advice to stay active (control group).

METHODS

Randomized controlled trial of 619 adults with subacute or persistent neck pain allocated to massage (n = 145), exercise (n = 160), combined therapy (n = 169) or advice (n = 147). Primary outcomes were minimal clinically important improvements in neck pain intensity and pain-related disability based on adapted questions from the Chronic Pain Questionnaire. Secondary outcomes were perceived recovery and sickness absence. Outcomes were measured at seven, 12, 26 and 52 weeks.

RESULTS

We found improvement in pain intensity favouring massage and combined therapy compared to advice; at seven weeks (RR = 1.36; 95%CI:1.04-1.77) and 26 weeks (RR = 1.23; 95%CI:0.97-1.56); and seven (RR = 1.39; 95%CI:1.08-1.81) and 12 weeks (RR = 1.28; 95%CI:1.02-1.60) respectively, but not at later follow-ups. Exercise showed higher improvement of pain intensity at 26 weeks (RR = 1.31; 95%CI:1.04-1.65). Perceived recovery was higher in the index groups than in the advice group at all follow-ups. We found no consistent differences in pain related disability or sickness absence.

CONCLUSIONS

In this study, at 12-months follow-up, none of the index therapies were more effective than advice in terms of pain intensity in the long term or in terms of pain-related disability in the short or long term. However, the index therapies led to higher incidence of improvement in pain intensity in the short term, and higher incidence of favorable perceived recovery in the short and in the long term than advice.

TRIAL REGISTRATION

ISRCTN01453590. Registered 3 July 2014.

Massage Therapy Modulates Inflammatory Mediators Following Sprint Exercise in Healthy Male Athletes

Massage therapy is a common postexercise muscle recovery modality; however, its mechanisms of efficacy are uncertain. We evaluated the effects of massage on systemic inflammatory responses to exercise and postexercise muscle performance and soreness. In this crossover study, nine healthy male athletes completed a high-intensity intermittent sprint protocol, followed by massage therapy or control condition. Inflammatory markers were assessed pre-exercise; postexercise; and at 1, 2, and 24 h postexercise. Muscle performance was measured by squat and drop jump, and muscle soreness on a Likert scale. Significant time effects were observed for monocyte chemoattractant protein-1 (MCP-1), interleukin-8 (IL-8), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor alpha (TNFα), drop jump performance, squat jump performance, and soreness. No significant effects for condition were observed. However, compared with control, inflammatory marker concentrations (IL-8, TNFα, and MCP-1) returned to baseline levels earlier following the massage therapy condition (p < 0.05 for all). IL-6 returned to baseline levels earlier following the control versus massage therapy condition (p < 0.05). No differences were observed for performance or soreness variables. MCP-1 area under the curve (AUC) was negatively associated with squat and drop jump performance, while IL-10 AUC was positively associated with drop jump performance (p < 0.05 for all). In conclusion, massage therapy promotes resolution of systemic inflammatory signaling following exercise but does not appear to improve performance or soreness measurements.

The effect of brief pre-anesthetic exercise therapy of jaw and neck joints on mouth opening, neck extension, and intubation conditions during induction of general anesthesia: a randomized controlled trial

BACKGROUND

The effort to improve tracheal intubation process is clinically valuable. We hypothesized that a preoperative brief exercise therapy would increase mouth opening and neck extension, enhancing intubation conditions during general anesthesia.

METHODS

Patients undergoing general anesthesia were randomized into two groups. The exercise group performed the exercise regimen including masseter muscle massage and stretching of jaw and neck joints before anesthetic induction, while the control did not. Before (baseline) and after the intervention, we evaluated Mallampati score, mouth aperture size, and sternomental distance. After tracheal intubation, intubation difficulty scale with direct laryngoscope and oropharyngeal soft tissue injury were also evaluated.

RESULTS

A total of 138 patients completed the analysis (control = 68, exercise = 70). Baseline characteristics did not differ between groups. At anesthetic induction, there was a significant difference in Mallampati score between the two groups (P = 0.039) and the incidence of Mallampati scores of 1 was higher in the exercise group (odds ratio [95% CI]: 2.1 [1.0-4.3], P = 0.043). Mouth opening after the intervention was greater in the exercise group than in the control group (estimated difference [95% CI]: - 2.4 [- 4.8 - -0.1], P = 0.042) and sternomental distance was similar between the two groups (estimated difference [95% CI]: - 3.7 [- 9.0-1.7, P = 0.175). The exercise group showed less soft tissue injuries (odds ratio [95% CI]: 0.2 [0.1-0.8], P = 0.009), however, intubation difficulty scale did not differ between the study groups (P = 0.112).

CONCLUSIONS

The brief pre-anesthetic exercise improved intubation conditions and enabled faster tracheal intubation with less injury to oropharyngeal soft tissue.

TRIAL REGISTRATION

Clinical Research Information Service (registration number: KCT0002618), registered at December 28, 2017.

Health status, heat preparation strategies and medical events among elite cyclists who competed in the heat at the 2016 UCI Road World Cycling Championships in Qatar

Purpose

Assess the health status and heat preparation strategies of athletes competing in a World Cycling Championships held in hot ambient conditions (37°C, 25% relative humidity, wet-bulb-globe-temperature 27°C) and monitor the medical events arising during competition.

Methods

69 cyclists (~9% of the world championships participants) completed a pre-competition questionnaire. Illnesses and injuries encountered by the Athlete Medical Centre (AMC) were extracted from the race reports.

Results

22% of respondents reported illness symptoms in the 10 days preceding the Championships. 57% of respondents had previously experienced heat-related symptoms (cramping most commonly) while 17% had previously been diagnosed with exertional heat illness. 61% of the respondents had undergone some form of heat exposure prior to the Championships, with 38% acclimating for 5 to 30 days. In addition, several respondents declared to live in warm countries and all arrived in Qatar ~5 days prior to their event. 96% of the respondents used a pre-cooling strategy for the time trials and 74% did so before the road race (p<0.001), with ice vests being the most common. The AMC assessed 46 injuries and 26 illnesses in total, with three cyclists diagnosed with heat exhaustion.

Conclusions

The prevalence of previous heat illness in elite cyclists calls for team and event organisation doctors to be trained on heat illness management, including early diagnosis and rapid on-site cooling. Some cyclists had been exposed to the heat prior to the Championships, but few had a dedicated plan, calling for additional education on the importance of heat acclimation. Pre-cooling was widely adopted.

Sequential Pulse Compression's Effect on Blood Flow in the Lower-Extremity

CONTEXT

Several interventions are available to reduce the intensity and duration of the unwanted effects (eg, muscle soreness) associated with physical activity, such as massage, compression garments, and sequential pulse compression (SPC). Such interventions aim to increase blood flow to alleviate symptoms. However, there is a lack of evidence to support the use of SPC to alter total hemoglobin concentration (THb) in active individuals.

OBJECTIVE

To examine the acute effects of a single session of SPC on hemoglobin concentration compared with a control condition.

DESIGN

Single cohort, crossover design.

PARTICIPANTS

Thirty-four physically active and healthy participants (females = 12 and males = 22) completed the study.

INTERVENTIONS

The authors randomly assigned participants to first receive the experimental (SPC) or control condition. Measures were recorded precondition and postcondition. Participants returned to the laboratory to complete the second condition ≥24 hours after the first condition.

MAIN OUTCOME MEASURES

Relative changes in THb, deoxygenated hemoglobin, and oxygenated hemoglobin measures were recorded using near-infrared spectroscopy placed on the muscle belly of the medial gastrocnemius of the dominant limb.

RESULTS

SPC significantly increased THb (P < .001, d = 0.505) and oxygenated hemoglobin (P < .001, d = 0.745) change scores compared with the control condition. No statistical difference in deoxygenated hemoglobin change scores was found between the SPC and control conditions, but a medium effect size suggests potential biological significance (P = .06, d = 0.339).

CONCLUSIONS

Overall, SPC increases THb to the lower-extremity and may be a viable option in the management of muscle soreness related to physical activity.

Crossover Effects of Unilateral Static Stretching and Foam Rolling on Contralateral Hamstring Flexibility and Strength

CONTEXT

Static stretching (SS) and self-administered foam rolling (SAFR) are both effective techniques often used in rehabilitation settings to improve one's range of motion (ROM). However, their effects on nonintervened contralateral limb's performance remain equivocal.

OBJECTIVE

To examine the acute effects of unilateral hamstring's SS and SAFR on the contralateral hip-flexion passive ROM and the strength performance.

DESIGN

Randomized crossover trial.

SETTING

Controlled laboratory.

PARTICIPANTS

A total of 23 healthy young adults (13 males and 10 females) participated in this investigation.

INTERVENTIONS

Ten sets of 30-second SS or SAFR were performed on the participants' dominant hamstring muscles.

MAIN OUTCOME MEASURES

Before (pre) and after (post) the interventions, the contralateral hip-flexion passive ROM, the isometric strength of the contralateral hamstrings, and surface electromyography amplitude were measured. Separate 2-way (time × intervention) repeated measures analyses of variance were used to examine the changes in the dependent variables.

RESULTS

Both interventions significantly increased the contralateral hip-flexion passive ROM. In addition, the post-ROM value was significantly greater (P = .03) for the SS (mean ± SE = 73.5° ± 4.7°) than that for the SAFR (mean ± SE = 70.3° ± 4.5°). There were also main effects for time (P = .03) and intervention (P = .02) for the contralateral hamstring strength. However, no significant interaction or main effects were found for the normalized electromyography amplitude of the knee flexor muscles.

CONCLUSIONS

The increased contralateral hip-flexion passive ROM following both interventions was likely due to the enhanced stretch tolerance. However, the differential strength performance responses might be due to different neural mechanisms, which are proposed and discussed.

Effect of vibration vs non-vibration foam rolling techniques on flexibility, dynamic balance and perceived joint stability after fatigue

Background

Foam roller and vibration techniques are currently used to assist in recovery after fatigue. The main purpose of this study was to determine the effects of the use of a foam roller with and without vibration on dynamic balance, ankle dorsiflexion, hamstring and lumbar spine flexibility and perceived knee and ankle stability after an induced fatigue protocol.

Methods

A total of 24 healthy recreationally active participants (17 males and seven females) were recruited to a randomized cross over trial consisting of; no treatment (NT), foam roller treatment (FR) and vibration foam roller treatment (VFR). The assessments included; the Sit & Reach test, Y balance test and post-treatment perceived knee and ankle stability. Measurements were taken after a standardized warm up (baseline) and repeated following an exercise-induced muscle fatigue protocol consisting of repeated lunges until volitional fatigue. The three treatment conditions were assessed on three separate days in a randomized order. A 3 × 3 repeated measures ANOVA was used to investigate differences between the three treatments over the three time points and a one factor repeated measures ANOVA was used to determine any differences between treatments using the Global Rate of Change scale when considering perceived stability.

Results

FR and VFR conditions both showed a greater ankle dorsiflexion range of motion (ROM) (p < 0.001), greater posteromedial and posterolateral reach distances (p < 0.001) and a better knee and ankle perceived stability (p < 0.001) when compared to the NT condition. A trend toward significance was observed in the hamstring and lumbar spine flexibility (p = 0.074) in both treatment conditions when compared to the NT condition. However, no differences were seen between the FR and VFR conditions.

Conclusions

Both FR conditions seem to assist in exercise-induced muscle fatigue recovery with improvements in ROM, balance and perceived stability.

The Training and Development of Elite Sprint Performance: an Integration of Scientific and Best Practice Literature

Despite a voluminous body of research devoted to sprint training, our understanding of the training process leading to a world-class sprint performance is limited. The objective of this review is to integrate scientific and best practice literature regarding the training and development of elite sprint performance. Sprint performance is heavily dependent upon genetic traits, and the annual within-athlete performance differences are lower than the typical variation, the smallest worthwhile change, and the influence of external conditions such as wind, monitoring methodologies, etc. Still, key underlying determinants (e.g., power, technique, and sprint-specific endurance) are trainable. In this review, we describe how well-known training principles (progression, specificity, variation/periodization, and individualization) and varying training methods (e.g., sprinting/running, technical training, strength/power, plyometric training) are used in a sprint training context. Indeed, there is a considerable gap between science and best practice in how training principles and methods are applied. While the vast majority of sprint-related studies are performed on young team sport athletes and focus on brief sprints with maximal intensity and short recoveries, elite sprinters perform sprinting/running over a broad range of distances and with varying intensity and recovery periods. Within best practice, there is a stronger link between choice of training component (i.e., modality, duration, intensity, recovery, session rate) and the intended purpose of the training session compared with the “one-size-fits-all” approach in scientific literature. This review provides a point of departure for scientists and practitioners regarding the training and development of elite sprint performance and can serve as a position statement for outlining state-of-the-art sprint training recommendations and for generation of new hypotheses to be tested in future research.

Self-Myofascial Release Effect With Foam Rolling on Recovery After High-Intensity Interval Training

The goal of this experiment was to assess the impact of self-myofascial massage with the aid of a foam roller on a lower limb immediately after high-intensity interval training (HIIT), using the Tabata protocol (20 s work/10 s rest, repeated 8 times), according to selected recovery variables. The method used Tabata squats (20 s of air squats/10 s of rest, repeated 8 times), after which the subject performed three series of self-myofascial massage with a foam roller on one leg, the other leg being used as the control. Biomechanical lower limb performance was assessed through a squat jump, a countermovement jump, and a hopping on the spot test. Flexibility was assessed through the active and passive range of motion at the hip, knee, and ankle. Pain was measured by recording the delay of muscle soreness (DOMS). Measurements were recorded immediately after the workout, then 24 and 48 h later. Twenty healthy males participated in the study. The results revealed no effect on jumping performance, in terms of height, leg stiffness, power or force output. Additionally, HIIT had a significant impact on muscle damage, as revealed by the reduction in performance 48 h later (−9.7% for the countermovement height). The self-myofascial release decreased DOMS by 50% for the massaged leg compared with 20% for the control leg and increased the hip range of motion by approximately 4.2% for the massaged leg in comparison with the unmassaged leg. This experiment reveals the poor effect of self-myofascial release on regaining the initial value of performance but could be useful for reducing DOMS after high-intensity interval training.

Combined Effects of Self-Myofascial Release and Dynamic Stretching on Range of Motion, Jump, Sprint, and Agility Performance

Richman, ED, Tyo, BM, and Nicks, CR. Combined effects of self-myofascial release and dynamic stretching on range of motion, jump, sprint, and agility performance. J Strength Cond Res 33(7): 1795-1803, 2019-Massage has been used as both a pre- and post-exercise modality with purported benefits to flexibility and athletic performance. This study was designed to determine the effect of a 6-minute protocol of self massage known as self-myofascial release (SMR) using a foam rolling device in conjunction with a general warm-up and sport-specific dynamic stretching (DS) session on flexibility and explosive athletic performance in a sample of 14 female collegiate athletes. After familiarization, participants completed 2 testing sessions that began with 5 minutes of jogging at a self-selected pace, followed by either a 6-minute foam rolling session (SMR) or 6 minutes of light walking (LW) and a subsequent 6-minute period of sport-specific DS. Sit-and-reach (SR) was measured after a general warm-up, the SMR, or LW session, and following DS, after which participants performed 3 trials each of squat jump (SJ), countermovement jump (CMJ), and drop jump (DJ). Two additional tests, the agility T-Test (TT) and a 10-yd short sprint (SP), were then performed. The change in SR after SMR was significantly greater than the change seen in SR after LW, although the total changes seen in each condition were not statistically different after the addition of DS. Squat jump and CMJ improved by 1.72 ± 2.47 cm and 2.63 ± 3.74 cm (p = 0.070, p = 0.070), with no significant change to DJ, SP, and TT. Self-myofascial release in the form of foam rolling after a general warm-up and preceding a DS session seems to improve SJ and CMJ with no detriment to flexibility, DJ, sprint, and agility performance in comparison with LW and DS.

The Neglected Leg Lymphatic Vascular Changes in the Pathomechanism of Delayed Onset Muscle Soreness in Runners

Background: Delayed onset muscle soreness (DOMS) in runners is classified as a leg muscle strain injury and presents with tenderness or stiffness to palpation and movement limitation. Most attention is directed at muscles but not at the mass of other limb soft tissues, including their lymphatic vasculature, although they undergo mechanical stress and bruises, edema, nail destruction, and pains contributing to symptoms. Methods and Results: The study was done on lower limbs of long-distance runners suffering from DOMS complaints. There were 16 runners, 11 males and 5 females, age 22-28, practicing long-distance running over the last 5 years, with body mass index (BMI) 23 ± 4. Inclusion criteria: three to five marathon runs per year and daily 3-5 km slow runs. Last long distance run 3 to 7 days before the investigation. Controls were six subjects initiating running, of the same age group and BMI. Testing of blood and lymph flow was done before and after standard ergometer 300 W 30 minutes cycling. The measurement methods were leg and big toe venous plethysmography, big toe capillary Doppler, tonometry of skin and deep tissues, lymphoscintigraphy, and indocyanine green (ICG) fluorescent lymphography. (a) Strain gauge plethysmography of the calf and big toe revealed a two- to three-times higher venous capacity in runners than in controls, (b) the increased toe venous capacity was confirmed by point Doppler recordings showing two- to three-times higher blood capillary flow compared to controls, (c) lymphoscintigraphy revealed retention of tracer in feet, dilated superficial and deep lymphatics, and enlarged popliteal and inguinal lymph nodes, and (d) ICG lymphograms showed confluents of accumulated fluid in foot and calf subcutaneous tissue with fluorescence level reaching 40%-50% compared to 20% in controls. Conclusion: Our results show that, 3-5 days after run, not only muscles but also skin and subcutaneous tissue reveal major tissue fluid accumulation, an overload bringing about functional lymphatic transport insufficiency. This may be an additional factor responsible for DOMS symptoms.

Training Room Procedures and Use of Therapeutic Modalities in Athletes

Athletic trainers, physical therapists, and team physicians have differing roles when providing care, yet often need to collaborate. Athletic trainers and physical therapists use a variety of therapeutic modalities and manual therapy techniques in conjunction with rehabilitation exercises to improve outcomes. Clinicians must be knowledgeable of the scientific rationale for each modality to choose the most effective treatment for the specific condition and stage of recovery. The team physician should be familiar with the use of common procedures in an athletic training room. Here, we review the most current evidence and the basic methods encountered in athletic training room settings.

Effects of manual cranial therapy on heart rate variability in children without associated disorders: Translation to clinical practice

BACKGROUND

and purpose: Heart rate variability (HRV) represents a marker of autonomic activity, self-regulation and psychiatric illness. Few studies of manual therapy have investigated the neurophysiological effects of manual cranial therapy (MC-t). This study assessed the neurophysiological short/medium-term effects of two manual therapy interventions: massage therapy (Mss-t) and MC-t.

MATERIALS AND METHODS

A double-blind clinical trial was conducted with 50 healthy children, randomized into two groups who received a Mss-t intervention or MC-t. The variables analysed included vital signs (temperature, respiratory rate, heart rate, blood pressure) and HRV components, including the root mean square of successive differences (RMSSD), high frequency (HF), low frequency (LF) and LF/HF ratio.

RESULTS

Both interventions produced short-term parasympathetic effects, although the effects of MC-t were more persistent.

CONCLUSION

The persistence of the MC-t intervention suggested a prominent vagal control and better self-regulation. Autonomic imbalances in mental pathologies may benefit from the neurophysiological effects of MC-t.

Cold water immersion recovery strategy increases blood pressure levels after high-intensity intermittent exercise

BACKGROUND

This study aimed to investigate the effects of cold water immersion (CWI) recovery strategies on the blood pressure levels and related physiological parameters after high-intensity intermittent exercise (HIIE).

METHODS

This randomized crossover study included 20 men (21.5±1.6 years). Each participant performed a maximum-exertion exercise performance test on a bicycle, and heart rate was measured. Subsequently, six cycles of HIIE (1 minute at 120% heart rate reserve [HRR] and 4 minutes at 40% HRR) were performed in a random sequence, and the recovery period involved either CWI or static rest (SR).

RESULTS

Systolic and diastolic blood pressure levels at the 6th and 20th minute of CWI recovery were significantly higher than those during SR and significantly higher than those during a quiet state at the 6th minute. The heart rates at the 20th minute and 35th minute of CWI recovery were significantly lower than that during SR, and the ratings of perceived exertion (RPE) at the 6th and 20th minute of CWI recovery were significantly lower than that during SR. No significant difference in lactate production was evident between the two recovery strategies. Ear temperature was not significantly different when it was quiet, at the end of exercise, and at the 6th and 35th minute of recovery; however, at the 20th minute of recovery, ear temperature during CWI was significantly higher than that during SR.

CONCLUSIONS

CWI after HIIE reduced the extent to which blood pressure decreased. For the fatigue-related heart rate and RPE indicators, CWI was superior to SR.

Manual Massage Therapy for Patients with COPD: A Scoping Review

Background and objectives: Manual massage therapy is a therapeutic option for the treatment of several pathological conditions affecting the musculoskeletal system. It has been pointed out that massage might be beneficial for chronic obstructive pulmonary disease (COPD) patients thanks to therapeutic effects primarily related to hyperemia (increased skin temperature and blood flow), and activation of the lymphatic system. The present study reports current evidence on the systemic effects of manual massage in patients with COPD. Materials and Methods: A scoping review was conducted on five major databases. The search went through all databases since their inception until December 2018. Results: Seventy-eight citations were retrieved; after the selection process was completed, seven articles were considered eligible. In patients receiving manual massage, improvements were observed in Forced Expiratory Volume in 1 s, dyspnea perception, and in the 6-min walking test. Conclusions: To date, the use of manual massage in patients with COPD is not supported by substantial evidence in the literature: indeed, it is proposed as a therapeutic option in association with other interventions such as physical exercise.

A Meta-Analysis of the Effects of Foam Rolling on Performance and Recovery

Foam rolling is thought to improve muscular performance and flexibility as well as to alleviate muscle fatigue and soreness. For this reason, foam rolling has become a popular intervention in all kinds of sport settings used to increase the efficiency of training or competition preparation as well as to speed post-exercise recovery. The objective of this meta-analysis was to compare the effects of foam rolling applied before (pre-rolling as a warm-up activity) and after (post-rolling as a recovery strategy) exercise on sprint, jump, and strength performance as well as on flexibility and muscle pain outcomes and to identify whether self-massage with a foam roller or a roller massager is more effective. A comprehensive and structured literature search was performed using the PubMed, Google Scholar, PEDro, and Cochrane Library search engines. Twenty-one studies were located that met the inclusion criteria. Fourteen studies used pre-rolling, while seven studies used post-rolling. Pre-rolling resulted in a small improvement in sprint performance (+0.7%, g = 0.28) and flexibility (+4.0%, g = 0.34), whereas the effect on jump (-1.9%, g = 0.09) and strength performance (+1.8%, g = 0.12) was negligible. Post-rolling slightly attenuated exercise-induced decreases in sprint (+3.1%, g = 0.34) and strength performance (+3.9 %, g = 0.21). It also reduced muscle pain perception (+6.0%, g = 0.47), whereas its effect on jump performance (-0.2%, g = 0.06) was trivial. Of the twenty-one studies, fourteen used foam rollers, while the other seven used roller massage bars/sticks. A tendency was found for foam rollers to offer larger effects on the recovery of strength performance (+5.6%, g = 0.27 vs. -0.1%, g = -0.01) than roller massagers. The differences in the effects between foam rolling devices in terms of pre-rolling did not seem to be of practical relevance (overall performance: +2.7 %, g = 0.11 vs. +0.4%, g = 0.21; flexibility: +5.0%, g = 0.32 vs. +1.6%, g = 0.39). Overall, it was determined that the effects of foam rolling on performance and recovery are rather minor and partly negligible, but can be relevant in some cases (e.g., to increase sprint performance and flexibility or to reduce muscle pain sensation). Evidence seems to justify the widespread use of foam rolling as a warm-up activity rather than a recovery tool.

Massage therapy slightly decreased pain intensity after habitual running, but had no effect on fatigue, mood or physical performance: a randomised trial

QUESTION

Does massage therapy reduce pain and perceived fatigue in the quadriceps, and improve the mood and physical performance of runners after habitual sporting activity (10-km run)?

DESIGN

Randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded assessment.

PARTICIPANTS

Seventy-eight runners after sporting activity (10-km run).

INTERVENTION

The experimental group received 10 minutes of massage to the quadriceps aimed at recovery following sport practice, and the control group received a sham joint mobilisation.

OUTCOME MEASURES

Pain and perceived fatigue were each assessed using a 0-to-10 numerical rating scale; pain behaviour via the McGill Pain Questionnaire; mood profile via Brunel Mood Scale; quadriceps muscle flexibility using maximal knee flexion angle via inclinometer; isometric muscle strength of knee extensors via hand-held dynamometry; and vertical jump performance using jump height via My Jump 2 app. Evaluations were carried out immediately before and after the intervention, and at 24, 48 and 72 hours after the intervention. Generalised estimating equations were used to estimate a between-group difference (95% CI) using data across all time points.

RESULTS

The experimental group had significantly lower scores than the control group on the numerical rating scale for pain by 0.7 points (95% CI 0.1 to 1.3). There were no significant between-group differences for any of the other outcome measures.

CONCLUSION

Massage therapy was effective at reducing pain intensity after application to the quadriceps of runners compared to a sham technique, but the magnitude of the effect was small. There were no significant effects on perceived fatigue, flexibility, strength or jump performance.

TRIAL REGISTRATION

Brazilian Registry of Clinical Trials, RBR-393m7m.

Effects of cold water immersion and compression garment use after eccentric exercise on recovery

[Purpose]

The combined effect of different types of post-exercise treatment has not been fully explored. We investigated the effect of combined cold water immersion (CWI) and compression garment (CG) use after maximal eccentric exercise on maximal muscle strength, indirect muscle damage markers in the blood, muscle thickness, and muscle soreness score 24 h after exercise.

[Methods]

Ten men performed two trials (CWI + CG and CON) in random order. In the CWI + CG trial, the subjects performed 15 min of CWI (15°C), followed by wearing of a lower-body CG for 24 h after exercise. In the CON trial, there was no post-exercise treatment. The exercise consisted of 6 × 10 maximal isokinetic (60°·s^-1) eccentric knee extensions using one lower limb. The maximal voluntary contraction (MVC) and maximal isokinetic (60°·s^-1) strength during knee extension, as well as the indirect muscle damage markers, were evaluated before exercise and 24 h after exercise.

[Results]

The maximal muscle strength decreased in both trials (p < 0.001), with no difference between them. The exercise-induced elevation in the myoglobin concentration tended to be lower in the CWI + CG trial than in the CON trial (p = 0.060). The difference in the MVC, maximal isokinetic strength, muscle thickness, and muscle soreness score between the trials was not significant.

[Conclusion]

CWI followed by wearing of a CG after maximal eccentric exercise tended to attenuate the exercise-induced elevation of indirect muscle damage markers in the blood.

The Parameters of Foam Rolling, Self-Myofascial Release Treatment: A Review of the Literature

Self-myofascial release (SMR) is a well-known and popular therapy. Its growing popularity is based on high effectiveness and availability. However, there is a lack of agreement about which parameters should be used to optimize the effects of the therapy. The purpose of this review is to critically select and assess current literature and ascertain the values of the follow­ing parameters: (1) therapy duration, (2) volume of applied pressure, (3) speed and (4) frequency of roll, (5) type of roller, (6) the number of treatment applications during one session, (7) the duration of intervals between applications that yield the best results in terms of soft tissue.

The authors launched their research in May 2018. The search strategy included the electronic databases EBSCOhost and PubMed. The following inclusion criteria were assessed:

- English language, high quality manuscripts (evaluation in PEDro scale)

- at least one of the groups using the foam roller, tennis ball or the stick to fascial release

- basic parameters of therapy described.A total 55 articles met the inclusion criteria. Patients can usually withstand a maximum tolerable pressure for 30-120 seconds, repeated 1-3 times, separated by 30 seconds of rest. The intensity of a single rolling movement should be moderate, and the movement should last about 3 seconds. Keeping the roller on particularly sensitive areas is recommended to release tension and enhance blood perfusion.Currently, there is no consensus on an optimal FR programme. However, there is a tendency to use SMR tools with a physiol­ogy-based method to enhance therapeutic efficiency.

Optimizing recovery to support multi-evening cycling competition performance

Road criterium and track bicycle racing occur at high speeds, demand repeated high power outputs, last 10-90 min, and offer little chance for recovery after the event. Consecutive evenings of criterium and track racing are respectively known as speed-week or six-day events and take place in evening hours over the course of a week. Given the schedule and timing of these competitions, return to homeostasis can be compromised. No recommendations exist on how to optimize recovery for cyclists participating in these types of repeated evening competitions. Criterium and track cyclists spend considerable time, near and above the individual lactate threshold and therefore mostly utilize carbohydrate as their chief energy substrate. Henceforth, pre - and post-race nutrition and hydration is examined and recommendations are brought forward for carbohydrate, protein, and fluid intake. As evening high-intensity exercise perturbs sleep, strategies to optimize sleep are discussed and recommendations for an optimal sleep environment are given. Active recovery is examined, and the benefits of a short duration low intensity exercise reviewed. Passive recovery methods such as compression garments and cold water immersion are recommended, while evidence for massage, pneumatic compression devices, and neuromuscular electrical stimulation is still lacking. Optimizing recovery strategies will facilitate a return to the resting state following strenuous night competition.

Effects of Massage as a Combination Therapy with Lumbopelvic Stability Exercises as Compared to Standard Massage Therapy in Low Back Pain: a Randomized Cross-Over Study

BACKGROUND

Little is known about the effects of providing massage as a combination therapy (CT) with lumbopelvic stability training (LPST) in management of chronic nonspecific low back pain (CLBP) among elite female weight lifters. It is unclear whether massage therapy (MT) together with LPST has any additional clinical benefits for individuals with CLBP.

PURPOSE

The current study compares the therapeutic effects of CT against MT as a stand-alone intervention on pain intensity (PI), pain pressure threshold (PPT), tissue blood flow (TBF), and lumbopelvic stability (LPS) among elite weight lifters with CLBP.

SETTING

The study was conducted at the campus for National Olympic weight lifting training camp.

PARTICIPANTS

A total of 16 professional female elite weight lifting athletes who were training for Olympic weight lifting competition participated in the study.

RESEARCH DESIGN

A within-subject, repeated measures, crossover, single-blinded, randomized allocation study.

INTERVENTION

The athletes were randomized into three sessions of CT and MT with a time interval of 24 hrs within sessions and a wash out period of four weeks between the sessions.

MAIN OUTCOME MEASURES

The PI, PPT, TBF, and LPS were measured before and after each session repeatedly in both groups of intervention. The changes in the PI, PPT, TBF, and LPS were analyzed using repeated measures analysis of variance (ANOVA).

RESULTS

The results showed that the CT significantly demonstrated greater effects in reducing pain perception (45%-51%), improving pain pressure threshold (15% up to 25%), and increasing tissue blood flow (131%-152%) than MT (p < .001).

CONCLUSION

The combination therapy of massage therapy and LPST is likely to provide more clinical benefits in terms of PI, PPT, and TBF when compared to massage as a stand-alone therapy among individuals with chronic nonspecific low back pain.

EFFECT OF SHORT-TERM SLING EXERCISE WITH WHOLE BODY VIBRATION RECOVERY METHOD ON HEART RATE, BLOOD PRESSURE AND LACTIC ACID LEVEL VARIABILITY

The objective of this study was to compare heart rate, blood pressure, and lactic acid level with different recovery methods after having maximal exercise to provide reliable data regarding efficient recovery methods. Heart rate, blood pressure, and lactic acid level were continuously recorded for 30[Formula: see text]min at 5-min intervals during a recovery period after performing a maximal exercise test based on the Bruce-protocol. Study subjects were 36 healthy men in the 20[Formula: see text]s. They were randomly assigned to a passive recovery group ([Formula: see text] people), a sling exercise group ([Formula: see text] people), and a sling exercise with whole-body vibration group ([Formula: see text] people). One-way ANOVA was conducted to compare the recovery effects by using SPSS 18.0 Korea. The statistical significance was accepted at [Formula: see text]. Our results revealed that SWRG showed significantly faster heart rate recovery than SRG. Systolic and diastolic blood pressure tended to decrease more in the combined group than the PRG. Thirdly, the lactic acid level decreased to a lower level in the combined group than the PRG.

Effects of different recovery strategies following a half-marathon on fatigue markers in recreational runners

Purpose

To investigate the effects of different recovery strategies on fatigue markers following a prolonged running exercise.

Methods

46 recreational male runners completed a half-marathon, followed by active recovery (ACT), cold water immersion (CWI), massage (MAS) or passive recovery (PAS). Countermovement jump height, muscle soreness and perceived recovery and stress were measured 24h before the half-marathon (pre), immediately after the recovery intervention (post_rec) and 24h after the race (post₂₄). In addition, muscle contractile properties and blood markers of fatigue were determined at pre and post₂₄.

Results

Magnitude-based inferences revealed substantial differences in the changes between the groups. At post_rec, ACT was harmful to perceived recovery (ACT vs. PAS: effect size [ES] = −1.81) and serum concentration of creatine kinase (ACT vs. PAS: ES = 0.42), with CWI being harmful to jump performance (CWI vs. PAS: ES = −0.98). It was also beneficial for reducing muscle soreness (CWI vs. PAS: ES = −0.88) and improving perceived stress (CWI vs. PAS: ES = −0.64), with MAS being beneficial for reducing muscle soreness (MAS vs. PAS: ES = −0.52) and improving perceived recovery (MAS vs. PAS: ES = 1.00). At post₂₄, both CWI and MAS were still beneficial for reducing muscle soreness (CWI vs. PAS: ES = 1.49; MAS vs. PAS: ES = 1.12), with ACT being harmful to perceived recovery (ACT vs. PAS: ES = −0.68), serum concentration of creatine kinase (ACT vs. PAS: ES = 0.84) and free-testosterone (ACT vs. PAS: ES = −0.91).

Conclusions

In recreational runners, a half-marathon results in fatigue symptoms lasting at least 24h. To restore subjective fatigue measures, the authors recommend CWI and MAS, as these recovery strategies are more effective than PAS, with ACT being even disadvantageous. However, runners must be aware that neither the use of ACT nor CWI or MAS had any beneficial effect on objective fatigue markers.