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The Role of Massage in Sports Performance and Rehabilitation: Current Evidence and Future Direction

Authors:

Abstract

Massage is a popular treatment choice of athletes, coaches, and sports physical therapists. Despite its purported benefits and frequent use, evidence demonstrating its efficacy is scarce. To identify current literature relating to sports massage and its role in effecting an athlete's psychological readiness, in enhancing sports performance, in recovery from exercise and competition, and in the treatment of sports related musculoskeletal injuries. Electronic databases were used to identify papers relevant to this review. The following keywords were searched: massage, sports injuries, athletic injuries, physical therapy, rehabilitation, delayed onset muscle soreness, sports psychology, sports performance, sports massage, sports recovery, soft tissue mobilization, deep transverse friction massage, pre-event, and post exercise. RESEARCH STUDIES PERTAINING TO THE FOLLOWING GENERAL CATEGORIES WERE IDENTIFIED AND REVIEWED: pre-event (physiological and psychological variables), sports performance, recovery, and rehabilitation. Despite the fact clinical research has been performed, a poor appreciation exists for the appropriate clinical use of sports massage. Additional studies examining the physiological and psychological effects of sports massage are necessary in order to assist the sports physical therapist in developing and implementing clinically significant evidence based programs or treatments.
Discussion. Despite the fact clinical research
has been performed, a poor appreciation exists
for the appropriate clinical use of sports
massage.
Conclusion. Additional studies examining the
physiological and psychological effects of
sports massage are necessary in order to assist
the sports physical therapist in developing and
implementing clinically significant evidence
based programs or treatments.
Key Words: sports massage, sports rehabilita-
tion, sports performance, sports recovery
CORRESPONDENCE:
Jason Brumitt
16322 SE Don Lino Ct
Damascus, OR 97089
jbrumitt72@hotmail.com
LITERATURE REVIEW
THE ROLE OF MASSAGE IN SPORTS
PERFORMANCE AND REHABILITATION:
cURRENT EVIDENCE AND FUTURE
DIRECTION
Jason Brummitt, MSPT, SCS, ATCa
7
a Pacific University School of Physical Therapy
Hillsboro, Oregon
ABSTRACT
Background. Massage is a popular treatment
choice of athletes, coaches, and sports physical
therapists. Despite its purported benefits and
frequent use, evidence demonstrating its effi-
cacy is scarce.
Purpose. To identify current literature relating
to sports massage and its role in effecting an
athlete’s psychological readiness, in enhancing
sports performance, in recovery from exercise
and competition, and in the treatment of
sports related musculoskeletal injuries.
Methods.Electronic databases were used to
identify papers relevant to this review. The fol-
lowing keywords were searched: massage,
sports injuries, athletic injuries, physical
therapy, rehabilitation, delayed onset muscle
soreness, sports psychology, sports perform-
ance, sports massage, sports recovery, soft tis-
sue mobilization, deep transverse friction mas-
sage, pre-event, and post exercise.
Results. Research studies pertaining to the
following general categories were identified
and reviewed: pre-event (physiological and
psychological variables), sports performance,
recovery, and rehabilitation.
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INTRODUCTION
Massage has been utilized in the treatment of illness and
injury for thousands of years by health care practitioners.1
Chinese writings dating back to 2500 BC describe the use
of this modality for a variety of medical purposes.1-3
Massage has been promoted as a treatment of choice for
numerous conditions such as musculoskeletal injuries,
cancer, stress, relaxation, and pregnancy.2-4
Physical therapists who specialize in sports medicine
often utilize massage techniques to aid an athlete’s recov-
ery from intense exercise or as a treatment option when
performing clinical rehabilitation.5Sports massage has
been suggested as a means to help prepare an athlete for
competition, as a tool to enhance athletic performance, as
a treatment approach to help the athlete recover after
exercise or competition, and as a manual therapy inter-
vention for sports-related musculoskeletal injuries.2,3,5
While massage is frequently performed by physical thera-
pists (and other healthcare or alternative medicine
practitioners) and is popular with athletes and coaches, its
actual efficacy is questionable.5,6
The purpose of this paper is to review and present the
current literature relating to sports massage and its roles
in effecting an athlete’s psychological readiness, in
enhancing sports performance, in recovery from exercise
and competition, and in the treatment of sports-related
musculoskeletal injuries. Recommendations are dis-
cussed highlighting the need for additional research in
sports massage.
METHODS
Selection of Papers
The following electronic databases were used to identify
papers relevant to this review: Medline (from 1950-pres-
ent), CINAHL (1982-present), PsycINFO (1985-present),
Cochrane Database of Systematic Reviews, and
SPORTDiscus (1830-present). Table 1 presents the
Medical Subject Headings (MeSHs) and textwords (tw)
utilized in the search strategy for this paper. If fewer than
300 articles were identified by a search strategy, the study
abstracts were reviewed from that category in order to
identify potentially relevant papers. The reference list of
each of the selected papers was also reviewed in order to
identify additional relevant publications.
Study Selection
Inclusion Criteria
1) The report’s study design must have been one of the
following: randomized controlled trial, quasi-experimen-
tal, single-case design, non-randomized historical cohort
comparisons, case-series, or case report.
2) The report was published in a scientific peer-reviewed
journal.
3) The sports massage protocol described in the report
must have included at least one or more of the following
techniques: effleurage, petrissage, or deep transverse fric-
tion massage (also known as cross-friction massage).
4) The purpose of the massage intervention was to impact
one or more of the following facets of athletics: pre-event
(warm-up and psychological readiness), sports perform-
ance, recovery from exercise and competition, or the
treatment of sports-related injuries.
Exclusion Criteria
1) Papers that were not published within a peer-reviewed
scientific journal.
2) Reports that detailed the use of massage for non-sports
related injuries or functions.
The rationale for these inclusion and exclusion criteria
was to identify papers that investigate the use of massage
in all facets of athletic care. The massage techniques
included for review in this paper were based upon their
prevalence within the literature and their preference
among physical therapists.7In specific situations where
there was paucity in the literature, complementary
paper(s) were presented (but not included in the overall
review). Massage protocols investigating efficacy for non-
sports related injuries or chronic conditions were consid-
ered beyond the scope of this review.
Description of Selected Massage T
echniques
Sports massage is defined as a collection of massage
techniques performed on athletes or active individuals for
the purpose of aiding recovery or treating pathology.8
Three forms of massage are frequently reported in the
sports medicine literature: effleurage, petrissage, and
deep transverse friction massage (DTFM).7
Effleurage techniques are performed along the length of
the muscle, typically in a distal to proximal sequence.1-3,8
These techniques are executed throughout a massage rou-
tine, with the strokes performed slowly utilizing light or
gentle pressure.1-3,8 The petrissage techniques include
kneading, wringing, and scooping strokes.1-3,8 These
NORTH AMERICAN JOURNAL OF SPORTS PHYSICAL THERAPY | FEBRUARY 2008 | VOLUME 3, NUMBER 1
techniques are generally performed with deeper pressure
to patient tolerance.1-3,8 Deep transverse friction massage
(also known as cross-friction massage) is performed by
using the fingers to apply a force moving transversely
across the target tissue. 1-3,8,9
Description of T
ables
The information about to be presented is summarized in
Table 3-6. Part of each of these tables includes a column
called “level of evidence.” The definition of these levels is
defined in Table 2. The reader should refer to Table 2
when referring to the information on Tables 3-6.
EFFICACY OF A PRE-EVENT MASSAGE
Athletes routinely prepare both physically and
psychologically prior to competition. Athletes typically
incorporate one or more of the following pre-competition
preparation strategies: static stretching,10,11dynamic
stretching,12,13 warm-up drills, game simulations, and men-
tal imagery.14 A pre-event massage has been suggested as
a strategy to decrease pre-competition anxiety and to pre-
pare the muscles for competition.2Currently a paucity in
the literature exists addressing the effects of a pre-event
massage in order to reduce injury risk or enhance psy-
chological readiness (Table 3).
Effect on Blood Pressure
Camborn et al15 investigated the effect of massage on a
recipient’s blood pressure (BP). Twenty five massage
therapy students provided massage treatments to 150
current massage therapy clients.15 The length of the mas-
sage and the techniques performed by the students were
not controlled, but were instead based upon the students’
perception of the clients’ needs.15 The massages ranged in
time from 30 to 90 minutes. Six different massage
techniques were used including Swedish, deep tissue,
myofascial release, sports, trigger point, and craniosacral.
The authors defined sports massage as “a more vigorous
type of massage used to prepare athletes for peak per-
formance and uses a combination of techniques including
joint mobilization, stretching and/or postisometric relax-
ation, cross-fiber friction, and pressure point massage.”15
9
T
able 1. Search Strategy
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The authors found
that clients receiv-
ing Swedish mas-
sage (effleurage
and petrissage)
experienced the
greatest reduction
in blood pressure,
whereas those
who had received
trigger point therapy and sports massage experienced an
increase in blood pressure.15 While this research provides
findings that may have clinical significance, the study
design challenges the overall strength of the findings. A
large sample size was collected (n = 150), but 25 massage
therapy students performed the non-uniform interven-
tions to clients who were already receptive to this form of
treatment. The study also lacked controls for the duration
of the massage (30 to 90 minutes) and the massage tech-
niques performed.15
Although this study15 did not directly focus on an athletic
population, a vigorous massage may be less desirable
than a “Swedish” (or relaxation) type of massage in
specific situations. Theoretically, an athlete who is expe-
riencing pre-game anxiety or stress may increase his or
her risk of sustaining an injury or of having a sub-par per-
formance.16 Future investigations should be performed
with specific athletic populations receiving massages just
prior to participating in a stressful simulation or actual
competition.15,17
Effect on Mood and Anxiety
Leivadi et al18 evaluated the effects of massage on mood
and anxiety states in female dancers (mean age = 20.1
years, SD = 1.8 years). The dancers were randomly
assigned to either a massage therapy (n = 15) group or a
relaxation therapy (n = 15) group.18 The massage
therapy group received a 30-minute treatment twice a
week for a five week period. The massages consisted of
effleurage, petrissage, and friction techniques with a treat-
ment emphasis on the upper torso.18 Those assigned to
the relaxation therapy group performed a series of mus-
cle tensing and relaxation exercises while listening to a
recorded tape.18 Both groups demonstrated significant
effects between the first and last treatment sessions for
lowered anxiety levels and improved mood scores {as
measured by the State Anxiety Inventory and the Profile
of Mood States (POMS) respectively}.18 The massage
treatment group also demonstrated significantly lower
cortisol levels
compared to the
relaxation group.
Limitations in
study design
threaten the
strength of the
findings. This
investigation
lacked a true
control group. The subjects in the relaxation therapy
group were required to independently perform the pro-
gram on their own at home. To ensure that dancers fully
complied with the relaxation program, each relaxation
session should have been performed under the supervi-
sion an examiner.
Micklewright et al19 investigated the effects of a pre-per-
formance massage on mood state. Sixteen subjects (10
male and 6 female university students) participated in the
study.19 Each subject completed the POMS questionnaire
to establish baseline mood state prior to receiving the
treatment intervention. During the first session a subject
received either 30 minutes of massage or rested 30 min-
utes on his or her back.19 The subjects served as their own
controls between the two sessions. After the treatment
intervention subjects completed a standard Wingate
anaerobic cycling test. The POMS questionnaires were
also completed after the treatment intervention and after
the cycling test.19
The investigators found that cycling performance was
better after the massage compared to the control group,
but this improvement was unrelated to changes in mood
state.19 The authors hypothesized that pre-performance
psychological factors other than one’s mood state may
enhance performance.19
Additional studies have investigated how massage effects
an athlete’s perception of recovery and regeneration.20-22
While these investigations support the beneficial psycho-
logical effects of massage; overall study design threatens
the strength of the conclusions.20-22
EFFECTS OF MASSAGE ON SPORTS PERFORMANCE
Athletes and coaches are constantly fine tuning their
training strategies in order to develop a competitive edge.
The use of therapeutic modalities, such as thermal
agents, electrical stimulation, and massage are often
performed for this purpose. Despite the frequency that
Table 2. Levels of evidence key.
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Study Study Level of Participants Professional(s) Techniques Treatment Results and Authors’ Conclusions
(Year) Design Evidence Conducting the Time
Intervention
Cambron et al15 Quasi-experimental 3150 massage 25 massage Swedish, deep tissue, One treatment 1) Nonsignificant decrease in systolic blood pressure (BP):
pre-test post-test therapy clients therapy students; myofascial release, session. average 1.8 (range: -24-34) mmHg and an average increase
design (mean age 42.5 12 in their 2nd sports, trigger point, 30 – 90 minutes in diastolic BP of 0.1 (range: -53-18).
years, range trimester and 13 craniosacral per practitioner 2) No association between BP and any of the following
19-79) in their 3rd (final) preference. variables: duration, amount of pressure, and the massage
trimester therapy intern experience.
3) Swedish massage was associated with a nonsignificant
decrease in systolic BP.
4) Systolic BP increased with trigger point and sports massage.
When the two techniques were performed in combination
both systolic and diastolic BP increases were statistically
significant.
Leivadi et al18 Randomized 230 female adult “Different trained Effluerage, petrissage Two sessions 1) Significant pre-test/post-test treatment measures for anxiety
controlled trial: dance majors massage therapists” a week for levels, less depressed moods, less neck and shoulder pain,
Pre-test/Post-test (mean age 20.1 5 weeks. less low back pain for both groups.
group design years, SD 1.8) 30-minute 2) Significant decrease in cortisol levels for the massage
sessions. intervention group.
3) Those receiving massage treatment experienced a significant
improvement in neck extension and shoulder abduction at
the end of the study.
Micklewright et al19 Within subjects 316 university and One massage Effleurage, petrissage 30-minute The massage treatment prior to Wingate Anaerobic Cycling Test
experimental design students (10 male therapist standardized significantly enhanced performance but had no effect on mood
with counterbalanced 6 female) mean massage protocol state.
design age 22 years,
SD 4.8)
Hemmings et al20 Within subjects 3Eight amateur Sports massage Effleurage, petrissage 20-minute 1) No significant difference between groups for performance.
experimental design boxers (mean age therapist standardized 2) Massage program significantly increased perceptions of
with counterbalanced 24.9 years, protocol consisting recovery.
design SD 3.8) of 8-minutes for 3) No statistical difference in blood lactate or glucose levels
the legs, 2-minutes after either intervention.
for the back, and 4) Blood lactate concentration was significantly higher after
10-minutes for the the massage program.
shoulders and
arms
Hemmings21 Within subjects 3Nine Royal Navy Sports massage Effleurage, petrissage 20-minute 1) After massage, boxers’ perceived recovery was significantly
experimental design boxing squad therapist standardized greater than resting and the touching control.
with counterbalanced members (mean 2) Massage did not affect saliva flow.
design age 22 ± 3.1
years).
Hemmings22 Within subjects 3Nine Royal Navy Sports massage Effleurage, petrissage 20-minute 1) After massage intervention, significant main effects were
experimental design boxing squad therapist standardized found in the fatigue subscale and a trend towards
with counterbalanced members (mean protocol significance in the tension subscale.
design age 22 ± 3.1 2) No main effects noted in the vigor,depression, and anger
years) subscales.
Table 3. Table Summarizing Studies Related to Pre-Event Massage
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Study Study Level of Participants Professional(s) Techniques Treatment Results and Authors’
(Year) Design Evidence Conducting the Time Conclusions
Intervention
Leivadi Randomized 2 30 female adult dance “Different trained Effluerage and 2 sessions a week 1) Significant pre-post treatment
et al18 controlled trial: majors (mean age massage therapists” petrissage techniques for 5 weeks. measures for anxiety levels, less
pre-test/post-test 20.1 years, SD 1.8) depressed moods, less neck and
group design 30-minute shoulder pain, less low back pain
sessions for both groups.
2) Significant decrease in cortisol
levels for the massage intervention
group.
3) Those receiving massage
treatment experienced a significant
improvement in neck extension
and shoulder abduction at the
end of the study.
Micklewright Within subjects 3 16 university students One massage therapist Effleurage, petrissage 30-minute The massage treatment prior to
et al19 experimental design (10 male and 6 female) standardized Wingate Anaerobic Cycling Test
with counterbalanced mean age 22 years, massage protocol significantly enhanced performance
design SD 4.8) but had no effect on mood state.
Hemmings Within subjects 3 8 amateur boxers Sports massage Effleurage, petrissage 20-minute routine 1) No significant difference between
et al20 experimental design (mean age 24.9 years therapist consisting of groups for performance.
with counterbalanced SD 3.8) 8-minutes for the legs, 2) Massage program significantly
design 2-minutes for increased perceptions of recovery
the back, and 3) No statistical difference in blood
10-minutes lactate or glucose levels after either
for the shoulders intervention.
and arms 4) Blood lactate concentration was
significantly higher after the
massage program.
Barlow Within subjects 3 11 male volunteers Massage therapist Effleurage, petrissage One 15-minute One massage to the hamstrings did
et al23 experimental design (mean age 21 massage not significantly change sit and reach
with counterbalanced years ± 3) performance.
design
Hopper Randomized controlled 2 35 competitive female Two physiotherapists 1.“Classic” massage 1. A standardized 1) Both massage types significantly
et al24 trial: pre-test/ field hockey players (consisting of 8-minute classic improved hamstring length
post-test group design (mean age 19.8 ± 3.7, effleurage, kneading, protocol for following treatment.
range 15 to 31). picking up, shaking) the classic massage 2) There was no statistical
2. Dynamic soft tissue treatment group. maintenance over a 24-hr time
Classic group: (n=19) mobilization (DSTM) 2. The DTSM group period for either group.
mean age 20.87±4.09. that consisted of received an
classic massage and 8-minute
DSTM group: (n=16) “dynamic” treatment consisting
mean age 19.13±3.15 longitudinal and of classic massage
and cross-fibre strokes and longitudinal
strokes and cross-fibre
strokes to tight tissue.
Hopper Randomized controlled 2 45 healthy male “Therapist” 1.“Classic” massage 1. Control group: The DTSM protocol significantly
et al25 trial: pre-test/post-test volunteers (consisting of lying prone for increased hamstring flexibility as
group design (mean age 23.7 years, effleurage, kneading, 5 minutes compared to either the classic
range 18-35 years). picking up, shaking) 2. Classic protocol: massage protocol or the control
2. Dynamic soft tissue 5-minutes of group.
mobilization (DSTM) effleurage,
that consisted of kneading, picking up,
classic massage and and shaking
“dynamic” 3. The DTSM group
longitudinal and received an
and cross-fiber 8-minute treatment
strokes consisting of classic
massage and
longitudinal and
cross-fiber strokes
to tight tissue.
Brooks Randomized controlled 2 52 volunteer massage- Two senior therapeutic Effleurage, friction 5 minutes Massage intervention facilitated a
et al27 trial: pre-test/post-test school clients, staff, massage students significant improvement in grip
group design faculty, and students strength recovery as compared to
(mean age 39 years, other interventions.
SD 13.63,
range 18-71).
Mancinelli Randomized controlled 2 22 NCAA Division I Two massage therapists Effleurage, petrissage, 17-minute 1) Significant slowing in shuttle run
et al28 trial: pre-test/post-test women basketball and vibration standardized protocol times for the control group.
group design volleyball players 2) Significant changes in vertical
(mean age 20 ± jump displacement, perceived
0.93 years). soreness, and algometer levels for
the massage group.
Hilbert Randomized controlled 218 volunteers (male A senior physical Classic Swedish 20 minute 1) The massage protocol did not
et al47 trial: pre-test/post-test and female), mean age therapy student techniques (effleurage, standardized protocol impact any of the following
group design 20.4 years ±1.0 percussion, petrissage) variables: range of motion, peak
torque, neutrophil count, mood, or
unpleasantness of soreness.
2) The massage protocol led to a
significant decrease in intensity of
soreness (Differential Descriptor
Scale) in the massage group as
compared to the control group.
Table 4. Table Summarizing Studies Related to the Effects of Massage on Sports Performance
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13
massage treatments are performed, only a few studies
exist in the literature that have investigated the effect of
massage on sports performance (Table 4).
Massage Effects on Flexibility
A common perception held by athletes and coaches is that
adequate flexibility will decrease the risk of injury and
enhance performance. While these claims may be debat-
able (and beyond the scope of this paper), massage has
been investigated as a strategy to increase range of
motion.
Barlow et al23 investigated the immediate effects of
massage on hamstring flexibility in physically active
young men. Eleven active men (mean age 21 ± 3 years)
were randomly assigned to attend two testing sessions
each separated by one week. The subjects either received
a 15-minute massage (performed by a massage therapist)
consisting of effleurage and petrissage strokes to the ham-
string muscles bilaterally or a 15-minute supine rest.
Three pre-test and post-test sit and reach measurements
were performed with the best one recorded. Investigators
were blinded to who had received which intervention.
The subjects were also blinded when performing the sit
and reach test to avoid subject bias threats to validity. The
authors concluded that a single bout of hamstring massage
did not have a significant effect upon sit and reach scores.
Although the authors found no significant change among
the small sample size, they did find that those who had
low pre-test reach scores (less than 15 cm) had a higher
percentage of change in reach versus those who had a 15-
cm or greater reach. This led the authors to suggest a
larger sampling should be performed with a “tighter” pop-
ulation.23 Also, future studies should investigate the effect
on flexibility when massage is applied both proximally
and distally to the target tissue.
While Barlow et al23 failed to demonstrate a statistically sig-
nificant change in flexibility, Hopper et al24 found massage
made significant short term changes in hamstring flexibil-
ity. Female field hockey players from Western Australia’s
Premier League were recruited for the study. Thirty-nine
players met the study’s inclusion criteria of experiencing
a stretching sensation on the posterior thigh at an angle
less than 70º during a straight leg raise (SLR), having full
knee extension range of motion, and having full ankle
plantarflexion.24
Athletes were randomized into one of two treatment
groups; a group receiving a “classic” massage and a group
receiving dynamic soft tissue mobilization (DSTM). The
classic massage consisted of effleurage, kneading (petris-
sage), and shaking techniques for an 8-minute treatment.
The DSTM treatment consisted of classic massage strokes
and a dynamic treatment approach. The dynamic tech-
nique was performed using a “long slow stroke” with a fist-
ed hand applied both longitudinally and across the mus-
cle fibers. This technique was applied while first passive-
ly extending the subject’s knee, then while the subject
actively extended their own knee, and finally while the
therapist passively extended the knee while the subject
performed an eccentric contraction of their hamstring
muscle.5The DSTM program was also performed for 8-
minutes.24 The passive straight leg raise (PSLR) and pas-
sive knee extension (PKE) tests were used to measure
hamstring length prior to the treatment intervention,
immediately after the massage, and 24 hours later. Both
techniques immediately created statistically significantly
changes in hamstring lengths as measured by the PKE
test. The flexibility changes though were not maintained
at 24 hours in either group.24
In a subsequent investigation by Hopper et al,25 they
reported significant increases in hamstring flexibility after
performing the DSTM program when compared to a
classic massage approach or a control group. In this
investigation, the subject sample was 45 healthy males
(mean age = 23.7 years, SD = 4.6, range = 18 to 35
years), whereas, the previous study’s population consisted
of female athletes.24 The “classic” massage protocol uti-
lized effleurage, kneading, picking up, and shaking tech-
niques performed for 5-minutes.25 The DSTM program
was similar to the one described in Hopper et al.24 The
DTSM group demonstrated significantly greater increases
in hamstring flexibility as compared to the classic
approach or the control group. While the DTSM protocol
had a greater effect on immediate hamstring flexibility
gains (post-test measurements conducted 90-seconds
after treatment), the clinical significance of these results
is difficult to extrapolate.
While it appears that some athletes may experience
improvements in hamstring flexibility after one massage,
these changes appear to be transient. If a short term goal
is to increase an athlete’s flexibility, more efficient meth-
ods may exist (especially in the absence of an adequately
staffed sports medicine team).26 Future research should
investigate which athletes are ideal candidates for mas-
sage intervention, how long each massage intervention
should be performed, and what duration is necessary to
establish permanent flexibility changes.
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Massage Effects on Strength
Brooks et al27 assessed the effects of massage on power grip
performance after maximal exercise in healthy adults. The
authors conducted a pre-test and post-test study design
with subjects randomized to one of four intervention
groups. The testing protocol consisted of a pre-test grip
strength measurement, the exercise protocol to fatigue the
muscles of the hand, the intervention, a 5-minute rest peri-
od, and the post-test strength measurement. To fatigue the
muscles of the hand and the forearm, participants isomet-
rically squeezed a hand exerciser until performance had
declined to 60% of their baseline measurement. After the
exercise period, the subjects were randomized to one of the
following treatment groups: a 5-minute standardized
massage to the dominant hand, a 5-minute standardized
massage to the non-dominant hand, 5-minutes of passive
shoulder and elbow range of motion, or 5-minutes of rest.27
The 5-minute massage protocol, consisting of effleurage
and circular friction strokes, was performed by two senior
therapeutic massage students.27 The authors found the
massage intervention to be significantly superior to the
non-massage interventions for post exercise grip perform-
ance. It was also observed that grip performance after mas-
sage was significantly greater in the non-dominant versus
the dominant arm.
The most clinically relevant outcome was that the massage
intervention demonstrated better results than the natural
recovery of the control group.27 The authors surmise that
applying massage (in this case for 5-minutes) shortly after
fatiguing exercise is beneficial.27
Mancinelli et al28 investigated the effects of massage on
female collegiate athletes when performed at the begin-
ning of the basketball and volleyball seasons. Twenty-two
NCAA division I women’s basketball or volleyball players
were recruited (11 allocated to the treatment group and 11
serving as controls). A 17-minute massage consisting of
effleurage, petrissage, and vibration techniques was per-
formed on the day of predicted peak soreness (as predict-
ed by the strength coach). The authors found that the mas-
sage intervention helped to significantly increase vertical
jump, led to a significant increase (a slowing) of shuttle run
times, and significantly decreased the athlete’s perceived
soreness. While the results suggest that performing a mas-
sage at an opportune time will have positive functional
outcomes, the results of this study are in question due to
significant design flaws. These flaws include a small sam-
ple size, the inability to control for the pre-season
conditioning levels of the athletes, and the reliance upon
the subjective prediction by the strength coach as to the
date of expected peak muscle soreness.28
EFFECTS OF SPORTS MASSAGE ON RECOVERY
FROM EXERCISE AND COMPETITION
Effects on Delayed Onset Muscle Soreness
Delayed onset muscle soreness (DOMS) is a common
physiological response experienced by athletes after initi-
ating or resuming an exercise routine, after increasing
exercise intensity, or after performing eccentric forms of
training (i.e. downhill running).29 Delayed onset muscle
soreness has been associated with minor to severe pain
occurring 24 to 72 hours after the exercise bout.29 Athletic
performance may be hampered due to DOMS, loss of
range of motion, and decreased muscle strength.30,31
While these symptoms may be temporary and part of the
natural process of strength and conditioning training, the
ramifications for sports performance during competition
may be staggering. Theoretically, it would be beneficial
to prescribe modalities that could either prevent the onset
or decrease the impact of DOMS.
Six theories have been proposed to explain the mecha-
nisms of DOMS.29 The six theories are: lactic acid, muscle
spasm, connective tissue damage, muscle damage,
inflammation, and enzyme efflux.29 Researchers have
specifically investigated the effects of massage upon
blood lactate levels and changes in blood flow (Table
5).20,32,33
Effect of Massage on Blood Flow
Massage has been proposed as a treatment modality to
increase blood flow.2,3,8,34 Proponents of massage argue
that local circulatory changes occur as evidenced by the
changes in skin temperature and superficial hyperemia.35
Initial studies measuring Xe-133 isotope clearance and
venous occlusion plethysmography indicated that mas-
sage had an effect on blood flow, whereas more recent
studies using Doppler ultrasound techniques have found
that massage had no effect on arterial or venous blood
flow.36-40
Blood Lactate Clearance
The rationale behind the lactic acid theory is that lactic
acid produced after exercise contributes to the pain and
soreness experienced by the athlete.29 Massaging a muscle
or muscle group experiencing DOMS could, theoretically,
help to facilitate the removal of lactic acid from those
areas.
NORTH AMERICAN JOURNAL OF SPORTS PHYSICAL THERAPY | FEBRUARY 2008 | VOLUME 3, NUMBER 1
15
Many amateur sports (such as track and field, boxing, and
swimming) may require athletes to participate in several
events or matches during a short period of time.
Hemmings et al20 studied the effects of massage on both
physiologic and perceived recovery in eight amateur box-
ers. The investigators designed a testing protocol to exam-
ine if massage performed between bouts of simulated box-
ing matches would help to improve physiologic variables
(blood glucose and lactate concentrations), performance,
and the athlete’s perception of recovery. The experimental
design consisted of a 10-minute active warm up period,
five 2-minute rounds of simulated boxing matches with 1-
minute rest periods between each round, an intervention
period (20-minute massage or no massage), a 35-minute
rest period (a time period representative of the period of
time between events or matches), a second 10-minute
active warm up period, and a repeat of the aforemen-
tioned boxing simulation. Four of the eight boxers served
as controls during the first round of testing. During the
second round of testing, the boxers switched groups.20
During the intervention period, the athlete either
received a massage or rested lying on a mat. The 20-
minute massage (effleurage and petrissage) protocol
consisted of 8 minutes of treatment performed on the
legs, 2 minutes on the back, and 10 minutes on the shoul-
ders and arms. Blood lactate testing was performed
Study Study Level of Participants Professional(s) Techniques Treatment Results and Authors’
(Year) Design Evidence Conducting the Time Conclusions
Intervention
Hemmings Within subjects 3 Eight amateur boxers Sports massage Effleurage, petrissage 20-minute 1) No significant difference.
et al20 experimental design (mean age 24.9 years, therapist standardized between groups for performance.
with counterbalanced SD 3.8) protocol consisting 2) Massage program significantly
design of 8-minutes for the increased perceptions of recovery
legs, 2-minutes for 3) No statistical difference in blood
the back, and 10-minutes lactate or glucose levels after
for the shoulders either intervention.
and arms 4) Blood lactate concentration was
significantly higher after the
massage program.
Robertson Within subjects 3 Nine male games players, Physiotherapist Effleurage, kneading, 20-minute 1) Massage intervention did not affect
et al32 experimental design mean age not presented stroking, picking up, standardized blood lactate concentration
with counterbalanced (range 20-22 years) wringing, rolling protocol or heart rate.
design 2) No difference in mean or
maximum power after massage.
3) Subjects scored significantly lower
on the fatigue index after massage.
Dolgener Randomized controlled 2 22 male recreational Massage therapist Effleurage, petrissage 20-minute Massage was no better than passive
et al33 trial: pre-test/post-test runners; passive recovery standardized or active recovery methods in
design group (n=7, mean age routine reducing blood lactate concentration.
24.7±5.3), bicycle
recovery (n=7, mean age
26.1±6.5), massage
recovery (n=8, mean age
24.2±6.77)
Tiidus Quasi-experimental 3 Nine volunteers (4 male Massage therapist Effleurage 10-minute 1) Massage did not significantly
et al36 pre-test/post-test and 5 female), mean age increase either arterial or venous
not reported (age range blood velocity above baseline
20 to 22 years) resting levels.
2) Massage failed to improve
isokinetic peak torque of the
quadriceps versus the contralateral
control leg.
Shoemaker Within subjects 3 10 healthy subjects Massage therapist Effleurage, petrissage, 5-minute massage Massage did not increase muscle
et al39 experimental design (7 male, 3 female); tapotement per location and blood flow (pulsed Doppler
with counter-balanced mean age 35.8± technique echo Doppler) regardless of type of
design 3.4 years) massage or the muscle group
receiving the massage.
Hinds Within subjects 313 male volunteers, Physiotherapist Effleurage and Two 6-minute bouts 1. Massage did not significantly
et al40 experimental design mean age 21±1.4 years petrissage separated by a increase femoral artery blood flow,
with counter-balanced 1-minute period blood lactate, blood pressure, or
design heart rate as compared to a control
condition.
2. Skin blood flow and skin
temperature were significantly
increased after massage as
compared to controls.
Jonhagen Randomized controlled 2 16 subjects (8 men and Sport physical therapist Effleurage, petrissage 12-minute 1. No statistical difference between
et al41 trial: pre-test/post-test 8 women), mean age standardized massage and control group for
group design 28 years (range 20-38) protocol level or duration of pain.
2. No statistical difference for
concentrations of CGRP and NPY
between massage and control groups.
3. No statistical difference for maximal
strength and functional measures
between groups.
Table 5. Table Summarizing Research Related to the Effects of Sports Massage on Recovery from Exercise and Competition
NORTH AMERICAN JOURNAL OF SPORTS PHYSICAL THERAPY | FEBRUARY 2008 | VOLUME 3, NUMBER 1
16
before and after each boxing simulation and after the inter-
vention. During the rest period, each boxer completed a
perceived recovery scale. The authors chose to measure
performance by comparing mean peak punching force per
round.20
The authors found that regardless of whether the athlete
received a massage or had rested in a supine position, the
mean punching force decreased during the second boxing
simulation. As previously indicated the authors found that
the massage intervention had a statistically significant
effect on the boxers’ perception of recovery. Massage inter-
vention also did not affect blood lactate concentrations
and, surprisingly, boxers who had received the massage
intervention presented with significantly higher lactate
concentrations during the second simulation.20 This find-
ing was unexpected, for which the authors proposed that
the perceived psychological recovery might have affected
the boxers’ later effort and energy expenditure.20
Robertson et al32 examined the effects of massage on lactate
clearance, muscular power output, and fatigue after bouts
of high intensity training. Nine male athletes (rugby, foot-
ball, or field hockey) were recruited for the study. A
testing protocol began with a standardized warm up period
consisting of 5-minutes of cycling and 3-minutes of static
stretching for the hamstrings, calf, and quadriceps mus-
cles.32 Six 30-second bouts of high intensity training were
performed on a cycle ergometer (with 30 seconds of active
recovery between sets). Upon completition of the high
intensity repetitions, the athletes performed 5-minutes of
active recovery followed by a 20-minute intervention.
Subjects were randomized into one of two interventions: a
20-minute massage or 20-minutes of “passive supine rest.”
The massage intervention was performed each time by the
same physiotherapist. The massage sequence consisted of
effleurage and petrissage techniques performed in a stan-
dardized protocol sequence of 5 minutes to the back of the
left leg, 5 minutes to the back of the right leg, 5 minutes to
the front of the right leg, and 5 minutes to the front of the
left leg. After the intervention period, the athlete per-
formed the same 8-minute warm up (5-minutes of cycling
and 3-minutes of static stretching) followed by one 30-sec-
Table 5. Table Summarizing Research Related to the Effects of Sports Massage on Recovery from Exercise and Competition (cont’d)
Lightfoot Randomized controlled 2 31 college-age subjects Massage therapist Petrissage 10-minute Massage intervention to the left calf
et al42 trial (12 men and 19 female) to the left calf demonstrated no difference for
soreness levels or leg volumes as
compared to the control group.
Weber Randomized controlled 2 40 untrained volunteer Physical therapist Effleurage, petrissage 8-minute No statistical difference between
et al43 trial: pre-test/post-test female subjects, group standardized massage, active recovery,
design mean age 23.7 years, protocol microcurrent, and controls for
SD 4.0 soreness ratings and force generation.
Hart Within subjects 3 19 college aged Certified athletic trainer Petrissage (kneading) 5-minute The sports massage protocol did not
et al44 experimental design volunteers (10 men, and effleurage standardized significantly reduce either leg girth
with counter-balanced 9 women), mean (broad stroking) “sports” massage or pain as compared to the
design age 20.6±1.2 years
control leg within 72 hours of exercise.
Monedero Within subjects 3 18 healthy trained male Certified masseur Effleurage, stroking, Massage group: 1. Combined recovery significantly
et al45
experimental design with
cyclists, mean age and taponement 15-minute massage better at removing blood lactate at
counterbalanced design 25±0.9 years
Combined recovery group:
12-mintues (as compared to all
7.5 minutes of massage interventions).
and 7.5 minutes of 2. Combined recovery was a superior
active recovery
approach to maintaining performance
over passive recovery and active or
massage interventions.
Dawson Quasi-experimental 3 12 runners (8 males, Massage therapists Effleurage, petrissage 30-minute The use of massage, when compared
et al46 pre-test/post-test 4 females), mean age standardized to the control leg, did not facilitate a
35.2±8.3 years) protocol faster return to baseline measures for
strength, soreness, or leg
circumference.
Hilbert Repeated measures 2 18 volunteers (male and A senior physical Classic Swedish 20 minute
1. The massage protocol did not impact
et al47 pre-test/post-test RCT female), mean age therapy student techniques (effleurage, standardized
any of the following
variables: range
20.4±1.0 years percussion, petrissage) protocol of motion, peak torque, neutrophil
count, mood, or unpleasantness of
soreness.
2. The massage protocol led to a
significant decrease in intensity
of soreness (Differential Descriptor
Scale) in the massage group as
compared to the control group.
Smith Randomized controlled 2 14 untrained males; Physical therapist Effleurage (stroking), 30-minute A significant trend analysis for
et al48 trial: pre-test/post-test massage group (n=7, shaking, petrissage standardized “sports” treatment by time interaction effect
design mean age 20.1±1.1) (kneading), wringing, massage performed with 1) the massage group reporting
and control group (n=7, cross-fiber massage 2 hours after exercise lower levels of muscle soreness;
mean age 18.8±0.3) 2) reduced CK levels in the massage
group; 3) massage group
demonstrating elevated neutrophil
levels.
NORTH AMERICAN JOURNAL OF SPORTS PHYSICAL THERAPY | FEBRUARY 2008 | VOLUME 3, NUMBER 1
ond high intensity bout (Wingate test). Blood samples were
collected prior to testing, after the first high intensity train-
ing, after 10- and 20-minutes of the intervention time peri-
od, and 3 minutes after the final high intensity test.32
The authors found no statistical difference between the
massage and passive rest interventions for blood lactate
concentrations and power. A significant difference did
occur between the massage intervention and the rest
group for the fatigue index. The fatigue index is the
percentage change in power output between the first 5-sec-
onds and the last 5-seconds in a 30-second period. The
authors suggested that additional investigations were nec-
essary to identify the role of massage on an athlete’s fatigue
profile.32
Jonhagen et al41 recruited 16 people (8 men and 8 women,
mean age 28 years) in order to assess if sports massage can
improve recovery after an eccentric exercise protocol.
Subjects performed 300 maximal eccentric quadriceps con-
tractions with each leg on a Kin-Com dynamometer
(Harrison, TN).41A massage program was initiated 10
minutes after exercise, with one leg from each subject ran-
domized to receive the massage treatment. The massage
program consisted of 4-minutes of effleurage and 8-min-
utes of petrissage. The massage protocol was also
performed daily each of the next two days. Testing was per-
formed before the exercise protocol, after exercise, and on
the third day. Strength testing was performed on the Kin-
Com dynamometer, a vertical long jump was performed to
measure functional changes, and a visual analog scale
(VAS) was used to measure a subject’s pain. The VAS was
performed before and after exercise and before and after
the massage treatment. Microdialysis was also performed
in the vastus lateralis muscle to analyze levels of the neu-
ropeptide Y (NPY) and calcitonin gene-related peptide
(CGRP).41Both NPY and CGRP are neuropeptides involved
in the vasodilatation of skin tissue and the modulation of
pain.41The authors found that sports massage failed to
influence any of the dependent variables. Resultant
strength loss was significant in both treatment groups,
even on the third day. Sports massage also failed to impact
functional recovery. Both groups’ demonstrated signifi-
cantly lower long jump scores, with a normalization of
scores occurring by day three. No statistical difference was
observed either in pain scores between legs or for changes
in CGRP and NPY levels.41
Additional studies evaluating the effects of massage on
athletes experiencing DOMS have also failed to demon-
strate positive effects.42,43 Active recovery techniques have
been shown to be consistently superior to massage for lac-
tate clearance.33,44,45 In addition, massage interventions have
failed to effect post-exercise limb girth.42,44,46 Subjects who
received massage generally experienced no improvement
in pain or soreness perception as compared with con-
trols.42,44,46 Hilbert et al47 suggested massage can positively
affect subjects’ perceived intensity of DOMS related sore-
ness, but not until 48 hours post exercise.
Although it is commonly thought that lactic acid
accumulation after exercise leads to the pain associated
with DOMS, this theory has been recently rejected.29 Any
increased lactic acid levels after exercise return to baseline
in approximately one hour after exercise.29 Lactic acid
likely only contributes to acute pain versus the pain expe-
rienced 24 to 48 hours after exercise.29
Massage Effects on Creatine Kinase and
Neutrophil Levels
Smith et al48 designed a study to investigate the effects of
massage on variables other than lactic acid. The authors
theorized a massage intervention performed two hours
after exercise interferes with neutrophil emigration which
may reduce the intensity of pain due to inflammation.
Initial results indicated that the 30-minute massage proto-
col applied two hours after the exercise program helped to
reduce DOMS and creatine kinase levels.48 This particular
protocol appeared to demonstrate promising results, but
the results are challenged by a small sample size (n=14).48
Although the authors called for continued studies, to date,
no further clinical studies have been published on this
aspect.48
ROLE OF SPORTS MASSAGE IN THE TREATMENT
OF SPORTS INJURIES
Both classic massage techniques and deep transverse
friction massage (DTFM) are performed in clinical rehabil-
itation settings (T
able 6). Despite the popularity of these
forms of massage by both therapists and patients, very few
studies have been conducted on this intervention, making
it a challenge to draw conclusions regarding the efficacy of
their use.
Paucity of Sports Massage Reports
Despite the prevalence of low back pain, a review of the
literature was unable to identify any randomized con-
trolled trials or quasi-experimental studies investigating
the role of massage in the treatment of sports-related back
injuries. Two “non-sports” massage papers are presented
17
NORTH AMERICAN JOURNAL OF SPORTS PHYSICAL THERAPY | FEBRUARY 2008 | VOLUME 3, NUMBER 1
here to demonstrate the challenges in interpreting the
literature.
Preyde49 researched the application of massage in the
treatment of patients with subacute low back pain. In this
study, subjects were randomized to one of four groups: a
comprehensive massage therapy group (CMT), a soft
tissue mobilization only group, a remedial exercise and
postural education only group, and a placebo group who
received a sham ultrasound. Subjects in the CMT group
experienced a statistically significant improvement in
function, reported less intense pain, and experienced a
decrease in the quality of pain as compared to the other
three groups.49
Even though the author concluded that patients with
subacute low back pain benefited from massage therapy,
the CMT group received massage (utilizing a non-
standardized treatment protocol), exercise prescription
consisting of a lower extremity stretching program, were
encouraged to walk, swim, do aerobics, and strengthening
exercises, and received education on posture and body
mechanics. While at the 1-month follow up period, a sig-
nificant number of patients in the CMT group had no pain;
it would be a leap to attribute all of this to the massage
(only 27% of subjects in the massage only group were pain
free at one month). Rather this research may demonstrate
that those who receive posture/body mechanics educa-
tion, perform exercises, and receive massage have better
outcomes versus those who only receive one treatment
modality.49
A recent Cochrane Collaboration Back Review has
concluded that the use of massage might benefit patients
with subacute and chronic nonspecific low back pain,
especially when the massage is combined with patient
education and exercise prescription.50 Despite this conclu-
sion, the panel highlights the need for additional studies to
confirm the efficacy of massage for subacute and chronic
LBP and to assess the effect of massage on returning-to-
work.50
Pettitt et al51reported the use of massage in the
management of a 19-year old female middle distance run-
ner suffering from sport-related chronic knee pain. The
patient underwent an iliotibial band release after initial
failure of conservative treatment. Despite a course of post-
operative therapy, the patient continued to experience
symptoms. The authors implemented a treatment
program consisting of joint and soft tissue (massage) mobi-
lization, therapeutic exercise, and neuromuscular electric
stimulation. The massage protocol consisted of effleurage
strokes. The authors reported that the subject was able to
return to running and complete an entire season of indoor
track and field after receiving this 10-week course of
rehabilitation. While massage was one component of the
18
Table 6. Table Summarizing Research Related to the Role of Sports Massage in the Treatment of Sports Injuries
Study Study Level of Participants Professional(s) Techniques Treatment Results and Authors’
(Year) Design Evidence Conducting the Time Conclusions
Intervention
Preyde Randomized controlled 2 Four groups: Two massage therapists Friction, trigger points, 30 to 35 minutes The comprehensive massage
et al49 trial
comprehensive massage
(each > 10 years neuromuscular each session. therapy group experienced
therapy (n=25, mean
experience) therapy significant changes in function/RDQ
age 47.9±16.2); soft-
scores, less pain, and a decrease
tissue manipulation
in PRI score.
(n=25, mean age
46.5±18.4); remedial
exercise and education
(n=22, mean age 48.4±
12.9); placebo (n=26,
mean age 41.9±16.6)
Furlan Systematic Review 1 MEDLINE, Embase, Not applicable Any type of massage Not applicable 1. Massage in combination with
et al50 Cochrane Controlled (using the hands or exercise and education may be
Trials Register, HealthSTAR,
mechanical device) beneficial for patients experiencing
CINAHL, and dissertation subacute or chronic nonspecific
abstracts low back pain.
2. Acupuncture massage may be more
effective than classic massage.
Further studies are necessary to
confirm this conclusion.
Pettitt Case report 5 19-year old female Athletic trainer Effleurage 5-minutes each Massage one of several treatments
et al51 distance runner weekday employed in the recovery of the
subject.
Blackman One group-repeated 3 Seven athletes Not provided Longitudinal gliding, 15-minute 1. Anterior compartment pressures
et al52 measures design (6 men and 1 woman). transverse gliding, standardized after the 5-week massage
Mean age not provided digital ischemic protocol. Each protocol demonstrated a
(range 21 to 29 years) pressure, myofascial patient received nonsignificant increase.
release 6 treatments over a 2. Mean values for work output in
5 week period. dorsiflexion significantly
increased after 5 weeks.
NORTH AMERICAN JOURNAL OF SPORTS PHYSICAL THERAPY | FEBRUARY 2008 | VOLUME 3, NUMBER 1
rehabilitation program, the authors acknowledge the fact
that the unique role of any one treatment can not be
known.51
Blackman et al52 investigated the effects of massage on
chronic exertional compartment syndrome (CECS). This
study again highlighted the design challenges that
researchers investigating massage effects have
experienced. Athletes suffering from CECS complain of
cramping or aching pain that develops with exercise and
resolves with cessation of activity.53,54 The authors recruit-
ed seven athletes (age range 21 to 29 years) with a
confirmed diagnosis of anterior CECS.52 Each athlete par-
ticipated in a 5-week rehabilitation program. A standard
massage intervention consisted of various techniques for
15-minutes each session. Massage was performed two
times a week during the first two weeks and one time a
week for the remaining three weeks.52 Patients were also
instructed to perform a standard stretching program for
both anterior and posterior musculature twice a day. After
the 5 week course of therapy, no significant changes were
found in compartment pressures after exercise. The
authors did find a significant change in the amount of
exercise that could be performed prior to pain onset. Study
limitations included the small sample size and the pre-
scription of multiple treatments.52
Efficacy of Deep Transverse Friction Massage
Deep transverse friction massage (DTFM) has been
suggested as a treatment option for tendon injuries such as
tennis elbow.9Paucity in the literature exists regarding the
use of DTFM in the treatment of sports-related injuries.
Despite the popularity of its use,9a review of the available
research literature fails to support the use of DTFM,55,56
whereas, eccentric exercise has demonstrated efficacy in
the conservative management of tendinopathies.57-61
DISCUSSION
Despite the fact that massage has been used as a treatment
modality for centuries, a poor appreciation for its clinical
effectiveness exists. Although several unique studies have
been designed to investigate the effects of sports massage,
further investigations are warranted.
Indirect evidence exists suggesting that massage may be
beneficial on factors related to an individual’s psychologi-
cal state. While these investigations demonstrated
improvements in blood pressure,15 mood states,18,19 and per-
ception of recovery,20-22 study design flaws limit the
strengths of the conclusions. Future research should inves-
tigate the application of massage immediately prior to
stressful sports performance situations, the effects of mas-
sage on an athlete’s perception of recovery between bouts
or events, and the effects of massage on an athlete’s mood
state throughout an entire season.
Massage has generally failed to demonstrate positive
effects upon sports performance.20,32,41One study utilizing
massage at the beginning of the season demonstrated an
increase in the experimental groups’ vertical jump, but the
study’s conclusions are threatened by several design
flaws.28 Researchers have demonstrated an association
between massage and temporary changes in hamstring
flexibility23-25 and grip performance.27 While the results from
these studies do not predict future sports performance,
these studies should provide guidance in the development
of future investigations. Additional research should be
directed at performing a massage prior to immediate ath-
letic performance (e.g. massage to the upper extremity
prior to a discus throw).
Massage has also generally failed to effect physiological
parameters related to DOMS.20,32,33,40-45 The few studies that
have reported positive effects from massage on a subject’s
pain or soreness perception have had study design flaws
and no follow-up investigations to date.47,48 To account for
the individuals who report decreased pain or a perceived
improvement after a massage, future research should
investigate local concentrations of chemo-inflammatory
factors.
Minimal studies have been performed investigating the
role of massage in sports rehabilitation.51,52 Paucity in the
literature exist related to sports massage and the manage-
ment of sports-related injuries. Evidence appears to sug-
gest that massage is efficacious for use with patients with
subacute and chronic low back pain.49,50 Clinical research
and case reports are greatly needed to help guide physical
therapy decision making when rehabilitating sports
injuries.
CONCLUSION
Research evidence has generally failed to demonstrate
massage significantly contributing to the reduction of pain
associated with delayed onset muscle soreness, or signifi-
cantly enhancing sports performance and recovery, or
playing a significant role in the rehabilitation of sports
injuries. Design flaws in research have challenged some of
the positive outcomes. Additional studies examining the
physiological and psychological effects of sports massage
are necessary in order to enhance the sports physical ther-
19
NORTH AMERICAN JOURNAL OF SPORTS PHYSICAL THERAPY | FEBRUARY 2008 | VOLUME 3, NUMBER 1
apists’ ability to develop and implement clinically signifi-
cant evidence based programs or treatments.
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NORTH AMERICAN JOURNAL OF SPORTS PHYSICAL THERAPY | FEBRUARY 2008 | VOLUME 3, NUMBER 1
... En examinant de plus près la littérature, il est possible d'observer des résultats contradictoires, ne facilitant pas les préconisations d'usage dans le domaine sportif. Cette hétérogénéité pourrait s'expliquer par le manque de reproductibilité des protocoles expérimentaux (Best et al., 2008;Brummitt, 2008). En fonction des études, les paramètres des protocoles de massage varient. ...
... Les durées effectives des massages peuvent fluctuer de 5 minutes à 30 minutes. Il en est de même pour les techniques de massage utilisées et les zones traitées (Best et al., 2008;Brummitt, 2008). ...
... MM therapy has supposedly many virtues (Calvert, 2002). Its positive effects have been extensively reported in the scientific literature Best et al., 2008;Brummitt, 2008). A sensation of psychological well-being was frequently reported (Mancinelli et al., 2006;Visconti et al., 2015). ...
Thesis
L’objectif de ce travail doctoral est d’étendre les connaissances sur les massages manuels et autogènes, et d’évaluer les effets de solutions de massage robotiques autonomes et interactives. Dans un premier temps, les travaux expérimentaux ont permis de préciser les caractéristiques du massage autogène, notamment ses effets interférents avec les performances en force lors d’une pratique intégrée aux séances d’entraînement, et l’absence de bénéfices additionnels lorsque des mouvements de pression glissée étaient intégrés aux routines. Nous avons ensuite comparé sur la base d’indicateurs psychométriques, comportementaux et neurophysiologiques massage manuel et massage autogène. Les deux méthodes de massages ont induit des états de relaxation supérieurs à la condition contrôle. Toutefois, le massage manuel semblait induire un état de relaxation plus marqué que le massage autogène, tant sur la base d’indicateurs objectifs que subjectifs. Sur le plan du contrôle moteur, le massage manuel engage le sujet dans un mode de contrôle de l’action essentiellement rétroactif. À l’inverse, le massage autogène implique la production de mouvements volontaires et engage donc le sujet dans un mode de contrôle proactif. Nous avons cherché à situer le massage robotique au sein de ce continuum. Le massage robotique, en offrant la possibilité au sujet d’interagir en temps réel avec les mouvements du robot, permet l’alternance entre modes de contrôle proactif et rétroactif. Le massage robotique représente donc une expérience sensorimotrice distincte du massage manuel et autogène. Dans une dernière étude, nous avons comparé l’efficacité du massage robotique à celle d’un massage manuel réalisé par un professionnel expérimenté. Les deux interventions ont produit des effets sur les indicateurs de bien-être et de relaxation, mais ceux-ci demeuraient plus marqués à l’issue du massage manuel. Toutefois, l’effet des deux interventions sur les sensations perçues était comparable. Les dispositifs de massages robotisés n’ont pas vocation à remplacer les praticiens. Ils représentent une solution d’assistance pour des tâches répétitives et élémentaires. Le massage robotique pourrait permettre, par exemple, de pallier la fatigue induite par la répétition des massages qui fut enregistrée au cours de l’étude. Les effets du massage robotique sur les indicateurs objectifs et subjectifs de bien-être laissent envisager des possibilités de démocratisation.
... MM therapy has supposedly many virtues (Calvert, 2002). Its positive effects have been extensively reported in the scientific literature (Weerapong et al., 2005;Best et al., 2008;Brummitt, 2008). A sensation of psychological well-being was frequently reported (Mancinelli et al., 2006;Visconti et al., 2015). ...
... However, other studies failed to detect such positive changes (Tiidus and Shoemaker, 1995;Farr et al., 2002), while others reported negative effects (Arabaci, 2008;Arazi et al., 2012). Similar inconsistent results were also reported by various meta-analytical reviews (Brummitt, 2008;Gaullier, 2015;Poppendieck et al., 2016). In another set of studies, MM was not found to promote force reduction after an exercise-induced muscle damage (Tiidus and Shoemaker, 1995;Farr et al., 2002;Hilbert et al., 2003;Zainuddin et al., 2005; Table 3). ...
... The high variability of the studies is well-illustrated by the use of effleurage and petrissage techniques, while others also used friction, picking up, and shaking techniques. Likewise, the number of areas treated and the effective time of sport MM could fluctuate from 5 to 30 min (Brummitt, 2008;Poppendieck et al., 2016). Similarly, very few studies specified the intensity, the speed and the gestural frequency exerted by the therapist during the MM. ...
Article
Full-text available
Manual massage and foam rolling are commonly used by athletes for warm-up and recovery, as well as by healthy individuals for well-being. Manual massage is an ancient practice requiring the intervention of an experienced physiotherapist, while foam rolling is a more recent self-administered technique. These two topics have been largely studied in isolation from each other. In the present review, we first provide a deep quantitative literature analysis to gather the beneficial effects of each technique through an integrative account, as well as their psychometric and neurophysiological evaluations. We then conceptually consider the motor control strategies induced by each type of massage. During manual massage, the person remains passive, lying on the massage table, and receives unanticipated manual pressure by the physiotherapist, hence resulting in a retroactive mode of action control with an ongoing central integration of proprioceptive feedback. In contrast, while performing foam rolling, the person directly exerts pressures through voluntary actions to manipulate the massaging tool, therefore through a predominant proactive mode of action control, where operations of forward and inverse modeling do not require sensory feedback. While these opposite modes of action do not seem to offer any compromise, we then discuss whether technological advances and collaborative robots might reconcile proactive and retroactive modes of action control during a massage, and offer new massage perspectives through a stochastic sensorimotor user experience. This transition faculty, from one mode of control to the other, might definitely represent an innovative conceptual approach in terms of human-machine interactions.
... It was also agreed that any soft tissue treatments should be implemented based on the needs of the athlete. Game day massages are routinely implemented in team sport environments and can be used to enhance athletic performance and improve psychological readiness (26), yet the literature supporting the use of massage in this context is inconclusive (7,11). Massage appears to be effective in increasing flexibility and reducing delayed onset muscle soreness (11). ...
Article
The aim of this study was to identify game day preparation strategies used by performance staff to improve team sport performance and to determine consensus regarding the application and importance of these strategies. Twenty-five performance staff working in high performance or professional team sports participated in this Delphi study, which implemented 3 survey rounds. The first round sought responses to open-ended questions relating to the use of game day preparation strategies. These responses were developed into statements and recirculated (round-2 survey), with subjects asked to rate their level of agreement with each statement. The third and final survey presented revised versions of statements that did not reach a consensus in the previous round, along with new statements derived from subject responses. A thematic analysis of the open-ended responses in the first survey identified 5 key themes relating to game day preparation strategies: “exercise,” “nutrition,” “psychological,” “technical and tactical,” and “other.” The round-2 survey included 38 statements across the 5 themes, with 22 reaching the consensus threshold ($75%) for agreement. The remaining 16 statements did not reach consensus. The final survey included 18 statements (16 revised and 2 new) with 12 reaching the consensus threshold for agreement. Key preparation strategies identified in this study include structured and progressive warm-ups, strength and power–based priming sessions, individualized nutrition plans, and precooling in hot conditions. Performance staff working in similar environments should consider adopting these strategies to improve athlete or team performance.
... (33,37) This supports the findings of other studies, which saw improvements in ROM following massage. (38,39) Reduced subjective stiffness following MT supports the results of other studies. (40,41) It is feasible MT reduced myofascial restrictions, hypertonicity and TrPs, thus decreasing stiffness. ...
Article
Full-text available
Background: Migraines involve moderate-to-severe neck and face pain that lasts four to 72 hours, and are followed by fatigue and stiffness. Migraines are treated using medications, massage therapy (MT), and non-pharmacological alternatives. Cervical spondylosis (CS) is characterized by degeneration of the intervertebral discs, neck pain, and involvement of soft tissues in the cervical area. CS is treated using medications and manual therapy, including MT. Objective: To determine the effects of MT on cervical range of motion and daily function in a patient with migraines and CS. Case presentation: The patient was an active 56-year-old female diagnosed with migraines and CS. Initial evaluation included cervical range of motion (ROM), goniometry, reflexes, myotomes, dermatomes, local sensation testing and orthopedic tests. Assessment was followed by five MT treatments. Swedish massage, myofascial trigger point release, and proprioceptive neuromuscular facilitation (PNF) stretching were applied to the back, neck, head, and face. The Headache Disability Index (HDI) was administered on the initial and final visits to evaluate patient function. Cervical ROM was measured pre- and posttreatment using a universal goniometer. Treatment was conducted by a second-year MT student at the MacEwan Massage Therapy Teaching Clinic in Edmonton, Alberta. Results: All cervical ranges of motion improved. The Headache Disability Index score decreased, but was not considered significant. The patient reported decreased stiffness in the upper back and shoulders, reduced migraines, and better sleeping patterns after the MT intervention. Conclusion: MT was effective in increasing cervical ROM, but had no significant effect on daily function. Further research is warranted on effects of MT on CS and migraines.
... MT may be used to promote muscle relaxation and to decrease pain which helps patients enhance their rehabilitation [9]. Classic chest physiotherapy (CPT) is one of the types of MT and recently there has been more evidence on the role of CPT on reducing pain [10]. Although some specialists in physiotherapy believe that there are some limiting factors in conducting physiotherapy for post-operative patients or even it may lead to high-risk complications in some cases [11,12]. ...
Article
Full-text available
Background: Chest physiotherapy (CPT) is a care that increases the mobilization of several structures from both muscle and subcutaneous tissue. We planned to investigate the effect of classic CPT on pain, fatigue, satisfaction, and hospital length of stay (LOS) in patients undergoing off-pump coronary artery bypass graft (CABG). Materials and methods: This study was a randomized controlled trial that conducted on 50 patients undergoing elective off-pump CABG. The patients have been randomly divided into two groups; in the group A (n=25) patients received physiotherapy at a single session of classic CPT, 4 times during 2nd to 5th days for 15 minutes in every session, in the group B (n=25) patients had not protocol of this exercise therapy (control). Results: The average age of all participants was 62.08 ±9.08 years. Of the 50 patients, 33 (66%) was male. Classic CPT significantly decreased pain (P=0.04), hospital LOS (P=0.010) and could increase in patients' satisfaction (P<0.001). However, it had no considerable effect on fatigue (P=0.725). Conclusion: According to our findings, classic CPT could improve postoperative care after off-pump CABG surgery.
... Massage is an ancient technique largely used to prepare and recover the human body from physical and sportive activities 1-3 and it could be described as a mechanical manipulation of body tissue through the use of hands (petrissage, effleurage friction, tapping) or objects (stones, rolls, tennis balls, vibrators) aiming to promote health, wellness and to enhance performance. Literature shows that massage increases mobility 4 , blood flow 5 and wellbeing 6 , reduces muscle tension 7 and neuromuscular excitability 7 as well as realigning conjunctive tissue and muscle fibers 2 . Other studies, however, demonstrated reduction 4,8 , maintenance 9 and improvement 10 on physical performance. ...
Article
Full-text available
The aim of this study was to verify the effect of massage or pseudo massage on vertical jump performance. Fifteen participants were randomly subjected to three experimental conditions: massage, pseudo massage and rest. The massage condition required three unipodal vertical jumps followed by two minutes of manual massage on plantar flexor muscles and, before performing another three jumps, the Total Quality Recover Scale (TQR) was applied. The two following conditions were structured with the same procedures, although participants were submitted either at pseudo massage (single-blinded) or two minutes of rest. Results showed no statistical differences on jump height between pre and post analysis nor between experimental conditions (massage 18.7 ± 4.1 vs 18.2 ± 4.1; pseudo massage 19.1 ± 4.0 vs 8.3 ± 3.8; rest 19.0 ± 4.0 vs 18.7 ± 3.9 cm). There were also no statistical differences in the TQR results between experimental conditions (massage 16.2 ± 4.3; pseudo massage 16.4 ± 3.9; rest 15.9 ± 2.6 ua). Both massage and pseudo massage did not affect performance on vertical jump and TQR.
... Massage therapy is one of the most commonly used therapies for athletes to enhance recovery and performance, particularly postexercise [123]. The benefits from therapeutic massage are enormous such as relieve of muscle tension and stiffness, healing of strains and sprains; reduce muscle pain, swelling and spasm; improve flexibility and motion, enhance blood flow and so on [125][126]. ...
Chapter
Full-text available
Alternative medicine has renewed its growing public interest in recent times due to inequality of patients and healthcare professionals' ratios with increased work-load for the latter, various side effects of modern medicine, lack of complete remission from chronic diseases, high cost of new drugs, and emerging new diseases. Hence, people have become more dependent on treatment systems replying on alternative medicine or herbal medicine from traditional medicinal practitioners. Alternative medicine has grown substantially over time and encompasses several millennia of therapeutic systems. The significant areas of alternative medicine include mind-body therapies, body manipulation, and the therapies based on biological systems. Natural products based biological treatment is the most popular of them as nature has endowed us with abundance of effective pharmacologically active phytochemicals. These phytochemicals possess numerous specific clinical health benefits including antioxidant, antidiabetic, anti-inflammatory, anticancer, anti-infectious and analgesic effects. In addition, alternative medicine is easily accessible, affordable, most often noninvasive, and provides favorable benefits during terminal periods of some diseases. However, due to the lack of well-designed clinical trials, the safety and effectiveness of many alternative medicines/therapies remains elusive. This chapter will critically discuss major areas, uses, safety and regulation, current challenges & future perspectives of alternative medicine.
... The Dalk is one of the earliest therapeutic tools used to relieve pain 33,34 . With its popularity for pain relief and recovery of function, it has become a widely accepted regimenal modality for musculoskeletal disorders 35,36 . ...
Article
Full-text available
Pain in joints (Waja ul Mafasil) is a major clinical problem that may or may not be associated with inflammation. Researchers and Clinicians are rigorously working to find out the best treatment modality in the management of joint pain. Unani physicians claimed the management of various joint disorders with the help of several Tadabeer. The objective of this critical review is to address the claims of Unani physicians and clinical studies conducted on the efficacy of Dalk or Hijama in the management of joint pain. Classical Unani literature, peer-reviewed journal articles and RCTs that predominantly focused on the use of regimenal modalities (Hijama and Dalk) in the joint pain were included in this review. Several published studies claiming the effect of Dalk and Hijama by Unani physicians, showing significant improvement, were included along with the literature. Various published clinical trials showed the effect of Dalk and Hijama in the management of joint pain, though, the effect showed by some clinical trials was short term. Hence, rigorous, controlled, randomized, blinded, and long duration follow up studies on large sample size are to be conducted by trained clinicians or researchers to establish the efficacy of Dalk or Hijama in the management of musculoskeletal disorders (MSDs). Keywords: Dalk; Hijama; Waja-ul-Mafasil; Joint Pain; Musculoskeletal Disorders; Unani
... Long-term recovery, which occurs within a seasonal training schedule, may include days or weeks incorporated into an annual athletic programme [2]. Different recovery procedures (e.g., massage, hyperbaric oxygenation, acceleration of venous return, electrostimulation, whole-body cryotherapy, immersion in cold water, vibration) [3][4][5][6][7][8][9] are available to athletes to speed Sex-specific response to whole-body vibration training: a randomized controlled trial a five-week WBV training programme on jumping performance (SJ and CMJ data) and cardiovascular (HR, SBP, DBP) data, taking into account sex-specific effects. The null hypothesis was that sex responds similarly to WBV training (i.e., males and females have similar SJ data). ...
Article
Full-text available
A few studies have indicated that males and females respond differently to whole-body vibration (WBV) training. However, the existing insights are still insufficient and they cannot be transferred to sex-specific practice planning. To evaluate the effect of 5-week WBV training on neuromuscular [countermovement jump (CMJ), squat jump (SJ)] and cardiovascular [heart rate and blood pressure] data, taking into account sex-specific effects. This is a comparative experimental study including 96 healthy adults, divided into two groups: a WBV group (25 females and 24 males) and a control group (27 females and 20 males). The participants attended nine to ten training sessions (twice a week for 5 weeks), each lasting approximately 30 min. Both groups performed the same exercise routine on the vibration training device. For the WBV group, the training device was vibrating during the whole training session, including the breaks. For the control group, it was turned off. Maximum jump height (H, cm) and maximum relative power (MRP, kW/kg) were noted during CMJ and SJ performed on a force plate. Resting (sitting) heart rate (bpm) and blood pressure (mmHg) were measured twice, before and after the intervention. For each parameter, ∆data (= before – after) was calculated. Interactive effects of sex (2) vs group (2) vs session (2) were noted only in males and they only concerned ∆SJMPR and ∆CMJH: compared to the control group, the WBV group had better ∆SJMPR (1.39 ± 3.05 vs -2.69 ± 4.49 kW/kg, respectively) and ∆CMJH (0.50 ± 6.14 vs -4.42 ± 5.80 cm, respectively). No sex-specific effect of WBV on neuromuscular (CMJ and SJ) or cardiovascular (heart rate and blood pressure) data was found
... Abhyanga [30] (massage) followed with Shastika shali pinda sweda (bolus fomentation of boiled rice grains tied in piece of cloth) helps in relieving muscle stiffness, heaviness and improves muscle strength [30,31]. Rhythmically applied pressure using hands in a systematic fashion helps in mechanical stimulation of the soft tissues, thus improving range of motion, relaxation of muscles and reduce pain [32]. Ayurveda classics have indicated balarishta (Table 1) specially in vata vyadhi (nervous disorders) which enhances Bala (strength of tissues) and Agni (Digestion) [33]. ...
Article
Full-text available
Background Sports injuries are the second most common type of accident after domestic (3.7%) and occupational accidents (3.1%). There is an average annual estimate of 8.6 million sports and recreational related injury incidents with an age-adjusted rate of 34.1 per 1000 populations. Common sports injuries are musculoskeletal injuries i.e. Sprains, Strains, Joint injuries, soft tissue injury (STI). The sports injury in Ayurveda can be co-related within dissimilar facets of trauma related ailments. Objective To evaluate the efficacy of a protocol-based management of common sports injuries using an integrated approach. Materials and methods Integration of Ayurveda and Physiotherapy procedures was done and phase wise treatment was framed. Total 30 patients of age between 10 and 60 years ful-filling the inclusion criteria were selected for the present study. The patients were treated with Phase wise protocol consisting of three phase’s i.e. Inflammatory (1–5 days), Stabilization and recovery (6–10 days), Muscle strengthening (11–17 days). Assessments were done through various variables like pain, tenderness, swelling, local temperature, manual muscle testing (MMT) and range of motion (ROM) at different time points. Statistical analysis Wilcoxon matched pair test was used to assess within group results for subjective parameters and paired t-test (Dependent t-test) was used to assess for objective parameters. Result The study showed that integrated treatment approach has given significant results in the parameters like pain, loss of function, tenderness, local temperature, MMT and ROM. Conclusion Phase wise management through integrated protocol is effective in the management of common sports injuries.
Article
Full-text available
A within subjects experimental design (N = 16) was used where participants performed a 30-s Wingate anaerobic cycling test (WAnT) after 30-min rest and after 30-min back massage. Mood State was measured before and after each intervention and after the WAnTs. No significant change in mood was detected following rest or massage. However, WAnT performance was better following massage compared to rest. Mood disturbance increased following the WAnT in both the rest and massage conditions. The results suggest that preperformance massage had no effect on mood state yet seemed to facilitate enhanced WAnT performance. The relationship between massage and anaerobic performance remains unclear, however is almost certainly mediated by preperformance psychological factors other than mood state.
Article
The purpose of this study was to compare an established protocol of modalities and transverse friction massage (MOD & TFM) with iontophoresis of dexamethasone and lidocaine (IONTO) in the treatment of patients with infrapatellar tendinitis. Thirty cases with infrapatellar tendinitis were randomly assigned to either the MOD & TFM or the IONTO intervention. Subjects still symptomatic after six sessions of intervention received the alternate treatment protocol. Four measures were used to assess patient status: a functional index questionnaire, a visual analog pain scale, a rating of tenderness with palpation of the involved tendon, and the number of step-ups needed to elicit pain. In response to the MOD & TFM intervention, only the number of step-ups performed to elicit pain showed significant improvement. All status measures improved significantly with the IONTO intervention. The results suggest that iontophoresis may be more effective and efficient in decreasing pain, reducing inflammation, and promoting h...
Article
Well researched and evidence-based, this book takes a unique medical approach to describing applied massage techniques for common conditions and their utilization as an adjunct to both conventional and complementary treatments. Offers guidelines on the assessment of each body region prior to massage, including symptoms and signs relating to pathology. Features photographs and line drawings that clearly illustrate correct postural techniques.
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The use of imagery processes in the regulation and enhancement of sports performance is examined in this review paper. Research studies in this area are reviewed and four general categories of research are identified: 1) mental practice, 2) precompetition imagery, 3) comparisons of successful and unsuccessful competitors, and 4) mediating variables. The conclusion is reached that mental practice research has produced equivocal results and the reasons for this are examined. The argument is made that the mental practice model for research into imagery processes in sports is nonproductive. Suggestions for future research directions are offered and guidelines for productive imagery research in sport are provided.
Article
Massage has often been highlighted as a modality for potentially enhancing psychological regeneration during intense training. Despite numerous anecdotal testimonies to its efficacy, little scientific research exists on the effects of massage on psychological states. This study aimed to investigate massage and the mood response following sports training.
Article
Massage has a long tradition of use in sport and has been used to facilitate recovery in athletes following training sessions, yet its benefits are not fully understood. Recovery from exercise is assumed to involve a host of factors. Therefore, this study aimed to investigate the effects of massage on selected psychological and immunological responses in athletes after sports training.
Article
Objective The purpose of this study was to determine if post-exercise massage has an effect on delayed-onset muscle soreness (DOMS) and physical performance in women collegiate athletes.DesignThis study used a randomized pre-test post-test control group design.ParticipantsTwenty-two NCAA Division I women basketball and volleyball players participated. On the day of predicted peak soreness, the treatment group (n=11) received a thigh massage using effleurage, petrissage and vibration while the control group (n=11) rested.Outcome measuresPaired t-tests were used to assess differences between pre and post massage measures (α=0.05) for vertical jump displacement, timed shuttle run, quadriceps length and pressure-pain threshold in the thigh.ResultsA significant increase (slowing) was found in shuttle run times for the control group (p=0.0354). There were significant changes in vertical jump displacement (p=0.0033), perceived soreness (p=0.0011) and algometer readings (p=0.0461) for the massage group.Conclusions This study supports the use of massage in women collegiate athletes for decreasing soreness and improving vertical jump.