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

Comparison between cold water immersion therapy (CWIT) and light emitting diode therapy (LEDT) in short-term skeletal muscle recovery after high-intensity exercise in athletes--preliminary results

In the last years, phototherapy has becoming a promising tool to improve skeletal muscle recovery after exercise, however, it was not compared with other modalities commonly used with this aim. In the present study we compared the short-term effects of cold water immersion therapy (CWIT) and light emitting diode therapy (LEDT) with placebo LEDT on biochemical markers related to skeletal muscle recovery after high-intensity exercise. A randomized double-blind placebo-controlled crossover trial was performed with six male young futsal athletes. They were treated with CWIT (5°C of temperature [SD ±1°]), active LEDT (69 LEDs with wavelengths 660/850 nm, 10/30 mW of output power, 30 s of irradiation time per point, and 41.7 J of total energy irradiated per point, total of ten points irradiated) or an identical placebo LEDT 5 min after each of three Wingate cycle tests. Pre-exercise, post-exercise, and post-treatment measurements were taken of blood lactate levels, creatine kinase (CK) activity, and C-reactive protein (CRP) levels. There were no significant differences in the work performed during the three Wingate tests (p > 0.05). All biochemical parameters increased from baseline values (p < 0.05) after the three exercise tests, but only active LEDT decreased blood lactate levels (p = 0.0065) and CK activity (p = 0.0044) significantly after treatment. There were no significant differences in CRP values after treatments. We concluded that treating the leg muscles with LEDT 5 min after the Wingate cycle test seemed to inhibit the expected post-exercise increase in blood lactate levels and CK activity. This suggests that LEDT has better potential than 5 min of CWIT for improving short-term post-exercise recovery.

The effect of soft tissue mobilisation techniques on flexibility and passive resistance in the hamstring muscle-tendon unit: a pilot investigation

The growing evidence suggests that physiological mobilisation techniques influence the passive properties of the muscle-tendon unit (MTU). Techniques that combine a transverse directed force to the physiological technique attempt greater influence on biomechanical properties. No research has investigated the biomechanical effects of a technique with addition of a transverse directed force. This pilot study aimed to explore preliminary data of effectiveness of two techniques on longitudinal load (extensibility and passive resistance) in the hamstring MTU. A counterbalanced quasi-experimental same subject design using fifteen healthy subjects compared two conditions: physiological technique and a technique with addition of a transverse directed force. Passive resistance (torque, Nm) and extensibility (knee extension range of movement) of the hamstring MTU were recorded during and following both conditions. Paired t tests explored within and across condition comparisons, with Bonferroni adjustment to account for multiple analyses. Passive resistance demonstrated a significant reduction for the technique with addition of a transverse directed force (t = 4.26, p < 0.05) that may have contributed to the significant increase in extensibility (t = 8.48, p < 0.05). The data suggest that longitudinal load through the hamstring MTU during a physiological mobilisation can be increased by the application of a transverse directed force. This merits further research.

Short-duration massage at the hamstrings musculotendinous junction induces greater range of motion

Massage for the purpose of health dates back to early civilization and more recently has been used in the management and prevention of sport injuries. Massage has also been used as part of a warm-up to help increase acute flexibility. However, the physiological benefits and mechanisms of massage are not well known. The purpose of the present study was to investigate the effectiveness of 3 massage conditions on hip flexion range of motion (ROM). This experimentation involved a novel massage technique, which focused the massage on the musculotendinous junction for a short duration. Ten recreationally active women ranging from 21 to 36 years in age participated in this study. Participants were subjected to 3 massage conditions (no massage, 10-second massage, and 30-second massage) in a random order on separate days. Hip flexion angle, passive leg tension, and electromyography (EMG) were measured thrice before and within 10 seconds after the intervention. A main effect for conditions was found with the 30-second massage providing a 7.2% increase in hip flexion ROM that was significantly greater than the control condition (p < 0.05). Significant interactions occurred with an increased ROM (p < 0.05) from pre to posttests of 5.9 and 7.2% for the 10- and 30-second massage conditions, respectively. There were no significant differences in passive tension or EMG for any conditions or time. With a significant increase in hip angle and no associated increase in passive tension or EMG, there is a suggestion that 10 and 30 seconds of musculotendinous massage induces greater ROM through a modified stretch perception, increased stretch tolerance, or increased compliance of the hamstrings. Musculotendinous massage may be used as an alternative or a complement to static stretching for increasing ROM.

Effects of recovery method after exercise on performance, immune changes, and psychological outcomes

STUDY DESIGN

Randomized controlled trial using a repeated-measures design.

OBJECTIVES

To examine the effects of commonly used recovery interventions on time trial performance, immune changes, and psychological outcomes.

BACKGROUND

The use of cryotherapy is popular among athletes, but few studies have simultaneously examined physiological and psychological responses to different recovery strategies.

METHODS

Nine active men performed 3 trials, consisting of three 50-kJ "all out" cycling bouts, with 20 minutes of recovery after each bout. In a randomized order, different recovery interventions were applied after each ride for a given visit: rest, active recovery (cycling at 50 W), or cryotherapy (cold tub with water at 10°C). Blood samples obtained during each session were analyzed for lactate, IL-6, total leukocyte, neutrophil, and lymphocyte cell counts. Self-assessments of pain, perceived exertion, and lower extremity sensations were also completed.

RESULTS

Time trial performance averaged 118 ± 10 seconds (mean ± SEM) for bout 1 and was 8% and 14% slower during bouts 2 (128 ± 11 seconds) and 3 (134 ± 11 seconds), respectively, with no difference between interventions (time effect, P≤.05). Recovery intervention did not influence lactate or IL-6, although greater mobilization of total leukocytes and neutrophils was observed with cryotherapy. Lymphopenia during recovery was greater with cryotherapy. Participants reported that their lower extremities felt better after cryotherapy (mean ± SEM, 6.0 ± 0.7 out of 10) versus active recovery (4.8 ± 0.9) or rest (2.8 ± 0.6) (trial effect, P≤.05).

CONCLUSION

Common recovery interventions did not influence performance, although cryotherapy created greater immune cell perturbation and the perception that the participants' lower extremities felt better.

Aerobic activity before and following short-duration static stretching improves range of motion and performance vs. a traditional warm-up

Many activities necessitate a high degree of static joint range of motion (ROM) for an extended duration. The objective of this study was to examine whether ROM could be improved with a short duration and volume of static stretching within a warm-up, without negatively impacting performance. Ten male recreationally active participants completed 2 separate protocols to examine changes in ROM and performance, respectively, with different warm-ups. The warm-up conditions for the ROM protocol were static stretching (SS), consisting of 6 repetitions of 6 s stretches; 10 min of running prior to the SS (AS); and 5 min of running before and after the SS (ASA). The performance protocol included a control condition of 10 min of running. Measures for the ROM protocol included hip flexion ROM, passive leg extensor tension, and hamstring electromyographic (EMG) activity at pre-warm-up, and at 1, 10, 20, and 30 min post-warm-up. Performance measures included countermovement jump (CMJ) height, reaction time (RT), movement time (MT), and balance at pre-warm-up and at 1 and 10 min post-warm-up. The ASA produced greater ROM overall than the SS and AS conditions (p < 0.0001), persisting for 30 min. There were no significant alterations in passive muscle tension or EMG. For the performance protocol, there were no main effects for condition, but there was a main effect for time, with CMJ height being greater at 1 and 10 min post-warm-up (p = 0.0004). Balance ratios and MT improved at 10 min post-warm-up (p < 0.0001). Results indicate that the ASA method can provide ROM improvements for 30 min with either facilitation or no impairment in performance. This may be especially important for athletes who substitute later into a game with minimal time for a full warm-up.

Comparative effects of acupressure at local and distal acupuncture points on pain conditions and autonomic function in females with chronic neck pain

Acupressure on local and distal acupuncture points might result in sedation and relaxation, thereby reducing chronic neck pain. The aim was to investigate the effect of acupressure at local (LP) and distal acupuncture points (DP) in females with chronic neck pain. Thirty-three females were assigned to three groups: the control group did not receive any stimuli, the LP group received acupressure at local acupuncture points, GB 21, SI 14 and SI 15, and the DP group received acupressure at distal acupuncture points, LI 4, LI 10 and LI 11. Verbal rating scale (VRS), Neck Disability Index (NDI), State-Trait Anxiety Inventory (STAI), muscle hardness (MH), salivary alpha-amylase (sAA) activity, heart rate (HR), heart rate variability (HRV) values and satisfaction due to acupressure were assessed. VRS, NDI, STAI and MH values decreased after acupressure in the LP and the DP group. HR decreased and the power of high frequency (HF) component of HRV increased after acupressure in only the LP group. Although acupressure on not only the LP but also the DP significantly improved pain conditions, acupressure on only the LP affected the autonomic nervous system while acupuncture points per se have different physical effects according to location.

Massage impairs postexercise muscle blood flow and "lactic acid" removal

PURPOSE

This study tested the hypothesis that one of the ways sports massage aids muscle recovery from exercise is by increasing muscle blood flow to improve "lactic acid" removal.

METHODS

Twelve subjects performed 2 min of strenuous isometric handgrip (IHG) exercise at 40% maximum voluntary contraction to elevate forearm muscle lactic acid. Forearm blood flow (FBF; Doppler and Echo ultrasound of the brachial artery) and deep venous forearm blood lactate and H+ concentration ([La-], [H+]) were measured every minute for 10 min post-IHG under three conditions: passive (passive rest), active (rhythmic exercise at 10% maximum voluntary contraction), and massage (effleurage and pétrissage). Arterialized [La-] and [H+] from a superficial heated hand vein was measured at baseline.

RESULTS

Data are presented as mean +/- SE. Venoarterial [La-] difference ([La-]v-a) at 30 s of post-IHG was the same across conditions (passive = 6.1 +/- 0.6 mmol x L(-1), active = 5.7 +/- 0.6 mmol x L(-1), massage = 5.5 +/- 0.6 mmol x L(-1), NS), whereas FBF was greater in passive (766 +/- 101 mL x min(-1)) versus active (614 +/- 62 mL x min(-1), P = 0.003) versus massage (540 +/- 60 mL x min(-1), P < 0.0001). Total FBF area under the curve (AUC) for 10 min after handgrip was significantly higher in passive versus massage (4203 +/- 531 vs 3178 +/- 304 mL, P = 0.024) but not versus active (3584 +/- 284 mL, P = 0.217). La(-)- efflux (FBF x [La-]v-a) AUC mirrored FBF AUC (passive = 20.5 +/- 2.8 mmol vs massage = 14.7 +/- 1.6 mmol, P = 0.03, vs active = 15.4 +/- 1.9 mmol, P = 0.064). H+ efflux (FBF x [H+]v-a) was greater in passive versus massage at 30 s (2.2 +/- 0.4e(-5) vs 1.3 +/- 0.2e(-5) mmol, P < 0.001) and 1.5 min (1.0 +/- 0.2e(-5) vs 0.6 +/- 0.09e(-5) mmol, P = 0.003) after IHG.

CONCLUSIONS

Massage impairs La(-) and H+ removal from muscle after strenuous exercise by mechanically impeding blood flow.

Cyclic compressive loading facilitates recovery after eccentric exercise

PURPOSE

To assess the biologic basis of massage therapies, we developed an experimental approach to mimic Swedish massage and evaluate this approach on recovery from eccentric exercise-induced muscle damage using a well-controlled animal model.

METHODS

Tibialis anterior muscles of six New Zealand White rabbits were subjected to one bout of damaging, eccentric contractions. One muscle was immediately subjected to cyclic compressive loads, and the contralateral served as the exercised control.

RESULTS

We found that commencing 30 min of cyclic compressive loading to the muscle, immediately after a bout of eccentric exercise, facilitated recovery of function and attenuated leukocyte infiltration. In addition, fiber necrosis and wet weight of the tissue were also reduced by compressive loading.

CONCLUSION

We conclude that subjecting muscle to compressive loads immediately after exercise leads to an enhanced recovery of muscle function and attenuation of the damaging effects of inflammation in the rabbit model. Although these observations suggest that skeletal muscle responds to cyclic compressive forces similar to those generated by clinical approaches, such as therapeutic massage, further research is needed to assess the translational efficacy of these findings.

Effect of 830 nm low-level laser therapy applied before high-intensity exercises on skeletal muscle recovery in athletes

Our aim was to investigate the immediate effects of bilateral, 830 nm, low-level laser therapy (LLLT) on high-intensity exercise and biochemical markers of skeletal muscle recovery, in a randomised, double-blind, placebo-controlled, crossover trial set in a sports physiotherapy clinic. Twenty male athletes (nine professional volleyball players and eleven adolescent soccer players) participated. Active LLLT (830 nm wavelength, 100 mW, spot size 0.0028 cm(2), 3-4 J per point) or an identical placebo LLLT was delivered to five points in the rectus femoris muscle (bilaterally). The main outcome measures were the work performed in the Wingate test: 30 s of maximum cycling with a load of 7.5% of body weight, and the measurement of blood lactate (BL) and creatine kinase (CK) levels before and after exercise. There was no significant difference in the work performed during the Wingate test (P > 0.05) between subjects given active LLLT and those given placebo LLLT. For volleyball athletes, the change in CK levels from before to after the exercise test was significantly lower (P = 0.0133) for those given active LLLT (2.52 U l(-1) +/- 7.04 U l(-1)) than for those given placebo LLLT (28.49 U l(-1) +/- 22.62 U l(-1)). For the soccer athletes, the change in blood lactate levels from before exercise to 15 min after exercise was significantly lower (P < 0.01) in the group subjected to active LLLT (8.55 mmol l(-1) +/- 2.14 mmol l(-1)) than in the group subjected to placebo LLLT (10.52 mmol l(-1) +/- 1.82 mmol l(-1)). LLLT irradiation before the Wingate test seemed to inhibit an expected post-exercise increase in CK level and to accelerate post-exercise lactate removal without affecting test performance. These findings suggest that LLLT may be of benefit in accelerating post-exercise recovery.

Massage therapy services for healthcare: a telephone focus group study of drivers for clients' continued use of services

OBJECTIVE

To explore opinions of why clients use, value and continue to seek massage therapy as a healthcare option.

DESIGN

Telephone focus group methodology was used. Current and repeat users (n = 19) of either relaxation, remedial or sports massage therapy services participated in three telephone focus groups. Audiotaped semi-structured interviews were conducted.

SETTING

Telephone focus group with massage clients from provincial and urban localities in New Zealand.

MAIN OUTCOME MEASURES

Summary of reported themes of the massage experience and suggested drivers for return to, or continuing with massage therapy. Data were transcribed, categorised (NVivo7) and thematically analysed using the general inductive approach.

RESULTS

Key drivers for return to, or continuing with, massage therapy were: positive outcomes, expectations of goals being met, a regular appointment and the massage therapy culture.

CONCLUSIONS

Massage therapy is perceived and valued as a personalised, holistic and hands-on approach to health management, which focuses on enhancing relaxation in conjunction with effective touch, within a positive client-therapist relationship and a pleasant non-rushed environment. Massage therapy as a health service is result and client driven but is reinforced by the culture of the experience.

Randomized controlled trial of a new electrical modality (InterX) and soft tissue massage, stretching, ultrasound and exercise for treating lateral epicondylitis

Background

The primary symptom reported by patients with lateral epicondylitis is pain. The InterX is a newly developed electrical device aimed at reducing pain by transmitting a varying electrical impulse into the surface of the skin via a portable, hand held applicator. This study investigates whether the InterX could provide additional acute pain relief and function for patients with acute lateral epicondylitis, to that of soft tissue massage, stretching ultrasound and exercise.

Methods

Twenty-six patients were randomized to two groups. The experimental group received InterX in conjunction with soft tissue massage, stretching, ultrasound and exercise, whereas the control group received soft tissue massage, stretching, ultrasound and exercise.

Results

In the short term, both regimes resulted in significantly reduced pain and improved functional ability ( P < 0.01). The control therapy also resulted in significantly improved grip strength.

Discussion

There was no significant difference in the improvements between groups in pain, difficulty with functional activities, although both groups' pain decreased significantly in the short (3 weeks) and medium (9 months) term. The experimental group received 30 minutes' greater treatment duration per week.

Conclusions

The provision of the InterX in addition to soft tissue massage, stretching, ultrasound and exercise did not affect patients' outcome.

Effects of Oral Health Care on Salivary Flow Rate in Patients With Type 2 Diabetes

The purpose of this study is to evaluate the effects of the authors' oral health care program on the stimulated whole salivary flow rate and buffer capacity before and after a 6-month intervention. The authors conducted the intervention study among 25 participants with diabetes. The salivary flow rate and buffer capacity were evaluated before and after this intervention. Overall, the results showed a significant increase in salivary flow rate and no significant change in buffer capacity. Also, it was likely that salivary flow rate significantly increased among patients with more than 20 remaining teeth and patients with well-controlled diabetes. The findings suggest that this program for type 2 diabetes led to an increase in the stimulated whole salivary flow rate.

Psychophysiological effects of massage-myofascial release after exercise: a randomized sham-control study

OBJECTIVE

The aim of this study was to evaluate the effect of massage on neuromuscular recruitment, mood state, and mechanical nociceptive threshold (MNT) after high-intensity exercise.

DESIGN

This was a prospective randomized clinical trial using between-groups design.

SETTING

The study was conducted at a university-based sports medicine clinic.

PARTICIPANTS

Sixty-two (62) healthy active students age 18-26 participated.

INTERVENTIONS

Participants, randomized into two groups, performed three 30-second Wingate tests and immediately received whole-body massage-myofascial induction or placebo (sham ultrasound/magnetotherapy) treatment. The duration (40 minutes), position, and therapist were the same for both treatments.

MAIN OUTCOME MEASURES

Dependent variables were surface electromyography (sEMG) of quadriceps, profile of mood states (POMS) and mechanical nociceptive threshold (MNT) of trapezius and masseter muscles. These data were assessed at baseline and after exercise and recovery periods.

RESULTS

Generalized estimating equations models were performed on dependent variables to assess differences between groups. Significant differences were found in effects of treatment on sEMG of Vastus Medialis (VM) (p = 0.02) and vigor subscale (p = 0.04). After the recovery period, there was a significant decrease in electromyographic (EMG) activity of VM (p = 0.02) in the myofascial-release group versus a nonsignificant increase in the placebo group (p = 0.32), and a decrease in vigor (p < 0.01) in the massage group versus no change in the placebo group (p = 0.86).

CONCLUSIONS

Massage reduces EMG amplitude and vigor when applied as a passive recovery technique after a high-intensity exercise protocol. Massage may induce a transient loss of muscle strength or a change in the muscle fiber tension-length relationship, influenced by alterations of muscle function and a psychological state of relaxation.

Métodos de recuperação pós-exercício: uma revisão sistemática

A recuperação pós-exercício consiste em restaurar os sistemas do corpo a sua condição basal, proporcionando equilíbrio e prevenindo a instalação de lesões e, nesse sentido, torna-se aspecto importante de todo programa de condicionamento físico, em quaisquer níveis de desempenho, mas, sobretudo nos mais elevados. O objetivo desta revisão foi reunir informações e descrever as respostas proporcionadas por métodos recuperativos pós-exercício, como crioterapia, contraste, massagem e recuperação ativa, constituindo uma fonte de atualização do referido tema. Utilizaram-se os bancos de dados MedLine, Scielo e Lilacs, como lista de periódicos, o SportsDiscus. Foram incluídos no estudo somente ensaios clínicos randomizados controlados e não-controlados, além de artigos de revisão referentes ao tema proposto. Optou-se por procurar os termos: cryotherapy, massage, active recovery, thermotherapy, immersion e exercise, individualmente e em cruzamentos. Como achado, observou-se que alguns estudos relatam que a crioterapia é prejudicial em se tratando de recuperação pós-exercício, pois reduz o desempenho imediatamente após a aplicação da técnica. Por outro lado, estudos apontam como sendo benéfica, pois reduzem o nível de creatinaquinase após alta intensidade de esforço, evitando danos musculares. Para o contraste, embora apresente significância em se tratando de remoção de lactato sanguíneo, sua efetividade necessita ser mais bem discutida. Na massagem e na recuperação ativa, os principais vieses descritos dizem respeito à pressão exercida e à intensidade do exercício, respectivamente. Entre as técnicas, as que parecem ter efeitos semelhantes são o contraste e a recuperação ativa, no que tange à remoção de lactato e diminuição da creatinaquinase. Ressalta-se que o tempo de exposição é de fundamental importância para todos os métodos. Entretanto, diversos estudos não se propõem a identificar os reais efeitos fisiológicos promovidos pelas técnicas, utilizando-as de modo inipiente. Portanto, a inconsistência dos resultados encontrados sugere que a análise das variáveis utilizadas como método de recuperação deve ser mais bem controlada.

Orthopaedic sport biomechanics - a new paradigm

This article proposes a new paradigm, "Orthopaedic sport biomechanics", for the understanding of the role of biomechanics in preventing and managing sports injury. Biomechanics has three main roles in this paradigm: (1) injury prevention, (2) immediate evaluation of treatment, and (3) long-term outcome evaluation. Related previous studies showing the approach in preventing and managing anterior cruciate ligament rupture and anterior talofibular ligament tear are highlighted. Orthopaedics and biomechanics specialists are encouraged to understand what they could contribute to the current and future practice of sports medicine.

An Engineering Approach for Quantitative Analysis of the Lengthwise Strokes in Massage Therapies

Massage therapies are widely used for improving and restoring the function of human tissues. It is generally accepted that such therapies promote human health and well-being by several possible mechanisms, including increase in blood flow and parasympathetic activity, release of relaxation hormones, and inhibition of muscle tension, neuromuscular excitability, and stress hormones. Nonetheless, most of the purported beneficial/adverse effects of massage are based on anecdotal experiences, providing little insight on its effectiveness or the mechanisms underlying its usefulness. Furthermore, most studies to date have not quantitatively demonstrated the efficacy of massage on human health. This might be due to the lack of appropriate tools necessary for the application of quantitatively controlled loading and for the evaluation of the subsequent responses. To address this issue, we developed a device that applies compression in lengthwise strokes to the soft tissues of the New Zealand white rabbit, thereby mimicking the rubbing and effleurage techniques of massage. This device permits control of the magnitude and frequency of mechanical load applied to the rabbit’s hind limb for various durations. The measurement of tissue compliance and the viscoelastic properties as a function of loading parameters was also demonstrated. Findings of this study suggest that this device offers a quantitative analysis of the applied loads on the tissue to determine an optimal range of loading conditions required for the safe and effective use of massage therapies.

Effectiveness of sports massage for recovery of skeletal muscle from strenuous exercise

OBJECTIVE

Sport massage, a manual therapy for muscle and soft tissue pain and weakness, is a popular and widely used modality for recovery after intense exercise. Our objective is to determine the effectiveness of sport massage for improving recovery after strenuous exercise.

DATA SOURCES

We searched MEDLINE, EMBASE, and CINAHL using all current and historical names for sport massage. Reference sections of included articles were scanned to identify additional relevant articles.

STUDY SELECTION

Study inclusion criteria required that subjects (1) were humans, (2) performed strenuous exercise, (3) received massage, and (4) were assessed for muscle recovery and performance. Ultimately, 27 studies met inclusion criteria.

DATA EXTRACTION

Eligible studies were reviewed, and data were extracted by the senior author (TMB). The main outcomes extracted were type and timing of massage and outcome measures studied.

DATA SYNTHESIS

Data from 17 case series revealed inconsistent results. Most studies evaluating post-exercise function suggest that massage is not effective, whereas studies that also evaluated the symptoms of DOMS did show some benefit. Data from 10 randomized controlled trials (RCTs) do, however, provide moderate evidence for the efficacy of massage therapy. The search identified no trend between type and timing of massage and any specific outcome measures investigated.

CONCLUSIONS

Case series provide little support for the use of massage to aid muscle recovery or performance after intense exercise. In contrast, RCTs provide moderate data supporting its use to facilitate recovery from repetitive muscular contractions. Further investigation using standardized protocols measuring similar outcome variables is necessary to more conclusively determine the efficacy of sport massage and the optimal strategy for its implementation to enhance recovery following intense exercise.

Massage reduces pain perception and hyperalgesia in experimental muscle pain: a randomized, controlled trial

Massage is a common conservative intervention used to treat myalgia. Although subjective reports have supported the premise that massage decreases pain, few studies have systematically investigated the dose response characteristics of massage relative to a control group. The purpose of this study was to perform a double-blinded, randomized controlled trial of the effects of massage on mechanical hyperalgesia (pressure pain thresholds, PPT) and perceived pain using delayed onset muscle soreness (DOMS) as an endogenous model of myalgia. Participants were randomly assigned to a no-treatment control, superficial touch, or deep-tissue massage group. Eccentric wrist extension exercises were performed at visit 1 to induce DOMS 48 hours later at visit 2. Pain, assessed using visual analog scales (VAS), and PPTs were measured at baseline, after exercise, before treatment, and after treatment. Deep massage decreased pain (48.4% DOMS reversal) during muscle stretch. Mechanical hyperalgesia was reduced (27.5% reversal) after both the deep massage and superficial touch groups relative to control (increased hyperalgesia by 38.4%). Resting pain did not vary between treatment groups.

PERSPECTIVE

This randomized, controlled trial suggests that massage is capable of reducing myalgia symptoms by approximately 25% to 50%, varying with assessment technique. Thus, potential analgesia may depend on the pain assessment used. This information may assist clinicians in determining conservative treatment options for patients with myalgia.

Australian chiropractic sports medicine: half way there or living on a prayer?

Sports chiropractic within Australia has a chequered historical background of unorthodox individualistic displays of egocentric treatment approaches that emphasise specific technique preference and individual prowess rather than standardised evidence based management. This situation has changed in recent years with the acceptance of many within sports chiropractic to operate under an evidence informed banner and to embrace a research culture. Despite recent developments within the sports chiropractic movement, the profession is still plagued by a minority of practitioners continuing to espouse certain marginal and outlandish technique systems that beleaguer the mainstream core of sports chiropractic as a cohesive and homogeneous group. Modern chiropractic management is frequently multimodal in nature and incorporates components of passive and active care. Such management typically incorporates spinal and peripheral manipulation, mobilisation, soft tissue techniques, rehabilitation and therapeutic exercises. Externally, sports chiropractic has faced hurdles too, with a lack of recognition and acceptance by organized and orthodox sports medical groups. Whilst some arguments against the inclusion of chiropractic may be legitimate due to its historical baggage, much of the argument appears to be anti-competitive, insecure and driven by a closed-shop mentality.sequently, chiropractic as a profession still remains a pariah to the organised sports medicine world. Add to this an uncertain continuing education system, a lack of protection for the title 'sports chiropractor', a lack of a recognized specialist status and a lack of support from traditional chiropractic, the challenges for the growth and acceptance of the sports chiropractor are considerable. This article outlines the historical and current challenges, both internal and external, faced by sports chiropractic within Australia and proposes positive changes that will assist in recognition and inclusion of sports chiropractic in both chiropractic and multi-disciplinary sports medicine alike.

Massage therapy: a comfort intervention for cardiac surgery patients

Integrative therapies have gained support in the literature as a method to control pain and anxiety. Many institutions have integrated massage therapy into their programs. Few studies have looked at the specific benefits of massage therapy for cardiac surgical patients. These patients undergo long surgical procedures and often complain of back, shoulder, and neck pain or general stress and tension. Clinical nurse specialist identify the benefits for patients and bring the evidence on massage therapy to the clinical setting. This article will provide an overview of the benefits of massage in the reduction of pain, anxiety, and tension in cardiac surgical patients. Reports of benefits seen with integration of massage in 1 cardiac surgical unit as part of evidence-based practice initiative for management of pain will be described. A clinical case example of a patient who has experienced cardiac surgery and received massage therapy will be shared.

Pressure pain sensitivity and hardness along human normal and sensitized muscle

The spatial distribution of pressure sensitivity and muscle hardness was examined on normal muscle tissue and muscle tissue after induction of delayed onset muscle soreness (DOMS). The pressure sensitivity and muscle hardness were assessed at nine sites on the tibialis muscle from the proximal to distal tendon on two separate days. In total 37 healthy volunteers participated in three experiments. In the first experiment pressure pain threshold (PPT) and pressure pain tolerance (PPTO) were assessed. Decreased PPT and PPTO were found on day 2, 7 days after day 1. Proximal and distal stimulation sites were harder compared to muscle belly sites. In a second experiment two different probe sizes were used. Variation in PPT between the nine sites was found for the large probe with muscle belly being less sensitive to pressure stimulation compared to proximal and distal sites. The most proximal stimulation site was harder compared to muscle belly sites. In a third experiment PPT and muscle hardness were assessed before and 48 h after eccentric exercise. PPT at two muscle belly sites was significantly decreased during DOMS. No specific sites were harder during DOMS, the average muscle hardness across sites was however significantly increased. Decreased PPT and increased muscle hardness did not correlate. In conclusion, within subjects the pressure sensitivity varies along the musculoskeletal unit. In DOMS, specific muscle belly sites were more sensitive to pressure stimulation. Muscle-tendon sites were harder compared to muscle belly sites.

Therapist education impacts the massage effect on postrace muscle recovery

PURPOSE

The intention of this study was to assess the effectiveness of massage on muscle recovery as a function of therapist education in participants who completed a 10-km running race.

METHODS

Race participants were offered a 12- to 15-min massage immediately post-event. Participants were randomly assigned to a student therapist with either 450, 700, or 950 h of didactic training in massage. Muscle soreness was recorded by questionnaire using a 0- to 10-point visual scale at time points immediately before and after massage, and 24 and 48 h post-event. Eight hundred ninety-five subjects were recruited, with 317 subjects returning questionnaires from all time points.

RESULTS

Race participants who received massage from student therapists with 950 h of didactic training reported significantly greater improvement in muscle soreness across time compared with those who received massage from therapists with 700 or 450 h of education in massage (P < 0.01). On study entry, there was no difference in muscle soreness (P = 0.99), with a group mean of 4.4 +/- 0.4; at the 24-h measurement, soreness was 2.4 +/- 0.6, 3.7 +/- 0.5, and 3.6 +/- 0.9 for the 950-, 700-, and 450-h groups, respectively (P < 0.01).

CONCLUSION

Level of therapist training was shown to impact effectiveness of massage as a post-race recovery tool; greater reduction in muscle soreness was achieved by therapists with 950 h of training as opposed to those with 700 or 450 h.

The effect of whole-body cryostimulation on lysosomal enzyme activity in kayakers during training

Effects of whole-body cryostimulation on lysosomal enzyme activity: acid phosphatase (AcP), arylsulphatase (ASA) and cathepsin D (CTS D), as well as on the creatine kinase (CK), and the cortisol concentration in the serum of kayakers during training were studied. Additionally, the effect of a single cryostimulation treatment in untrained men was evaluated. The kayakers were subjected to a ten-day training cycle, in which training sessions were preceded by whole-body cryostimulation at a temperature ranging from -120 to -140 degrees C, and to a control training without cryostimulation. Blood samples were taken from the kayakers before the training and after the sixth and tenth day of training and from untrained men before and after cryostimulation. The single cryostimulation caused a 30% (P < 0.05) decrease in the CK activity in untrained men. After the sixth day of training with cryostimulation, the activity of ASA was 46% (P < 0.001), AcP 32% (P < 0.05) and CK 34% lower (P < 0.05) than after the sixth day of training without cryostimulation. The results support that preceding training with whole-body cryostimulation alleviates exertion stress by a stabilisation of lysosomal membranes.

Using recovery modalities between training sessions in elite athletes: does it help?

Achieving an appropriate balance between training and competition stresses and recovery is important in maximising the performance of athletes. A wide range of recovery modalities are now used as integral parts of the training programmes of elite athletes to help attain this balance. This review examined the evidence available as to the efficacy of these recovery modalities in enhancing between-training session recovery in elite athletes. Recovery modalities have largely been investigated with regard to their ability to enhance the rate of blood lactate removal following high-intensity exercise or to reduce the severity and duration of exercise-induced muscle injury and delayed onset muscle soreness (DOMS). Neither of these reflects the circumstances of between-training session recovery in elite athletes. After high-intensity exercise, rest alone will return blood lactate to baseline levels well within the normal time period between the training sessions of athletes. The majority of studies examining exercise-induced muscle injury and DOMS have used untrained subjects undertaking large amounts of unfamiliar eccentric exercise. This model is unlikely to closely reflect the circumstances of elite athletes. Even without considering the above limitations, there is no substantial scientific evidence to support the use of the recovery modalities reviewed to enhance the between-training session recovery of elite athletes. Modalities reviewed were massage, active recovery, cryotherapy, contrast temperature water immersion therapy, hyperbaric oxygen therapy, nonsteroidal anti-inflammatory drugs, compression garments, stretching, electromyostimulation and combination modalities. Experimental models designed to reflect the circumstances of elite athletes are needed to further investigate the efficacy of various recovery modalities for elite athletes. Other potentially important factors associated with recovery, such as the rate of post-exercise glycogen synthesis and the role of inflammation in the recovery and adaptation process, also need to be considered in this future assessment.

Epicondylar injury in sport: epidemiology, type, mechanisms, assessment, management and prevention

Epicondylar injuries in sports with overhead or repetitive arm actions are frequent and often severe. Acute injury that results in inflammation should be termed epicondylitis and is usually the result of large valgus forces with medial distraction and lateral compression. Epicondylosis develops over a longer period of time from repetitive forces and results in structural changes in the tendon. Epicondylalgia refers to elbow pain at either the medial or lateral epicondyl of the elbow related to tendinopathy of the common flexor or extensor tendon origins at these points. Pain is usually associated with gripping, resisted wrist extension and certain movements such as in tennis and golf, hence the common terms 'tennis elbow' (lateral epicondylsis) and 'golf elbow' (medial epicondylossi). A variety of assessment and diagnostic tools are available to aid the clinician in their comprehensive evaluation of the patient to ensure correct diagnosis and the appropriate conservative or surgical management strategy. Corticosteroids and elbow straps are often used for treatment; however, there is only very limited prospective clinical or experimental evidence for their effectiveness. The most effective modalities of treatment are probably rest (the absence of painful activity) combined with cryotherapy in the acute stage then NSAIDs and heat in its various modalities including ultrasound. Cortisone injections may be used to create a pain-free window of opportunity to optimise the athletes' rehabilitation exercises. Medical practitioners should have a good understanding of the mechanisms of injury in order to help treat and prevent the re-occurrence of injuries. More emphasis by medical and sport science personnel working with coaches and athletes needs to be placed on prevention of elbow injury in sport through improved joint strength, biomechanically sound sport technique and use of appropriate sport equipment.