To Compare the Effect of Vibration Therapy and Massage in Prevention of Delayed Onset Muscle Soreness (DOMS)

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Journal of Clinical and Diagnostic Research. 2014 Jan, Vol-8(1): 133-136 133133
DOI: 10.7860/JCDR/2014/7294.3971 Original Article
To Compare the Effect of Vibration Therapy
and Massage in Prevention of Delayed
Onset Muscle Soreness (DOMS)
Orthopedics Section
SHAGUFTA IMTIYAZ1, ZUBIA VEQAR2, M.Y. SHAREEF3
Keywords: Vibration therapy, Massage therapy, DOMS
ABSTRACT
Objectives: To compare the effects of vibration therapy and
massage in prevention of DOMS.
Methods: Pre-test and Post-test Control-Group Design was
used, 45 healthy female non athletic Subjects were recruited
and randomly distributed to the three groups (15 subject in
each group). After the subject’s initial status was measured
experimental groups received vibration therapy (50 Hz vibration
for five minutes) or massage therapy (15 minutes) intervention and
control group received no treatment, just prior to the eccentric
exercise. Subjects were undergoing the following measurements
to evaluate the changes in the muscle condition: muscle soreness
(pain perception), Range of Motion (ROM), Maximum Isometric
Force (MIF), Repetition maximum (RM), Lactate dehydrogenase
(LDH) and Cretain Kinase (CK) level. All the parameters except
LDH, CK and 1RM were measured before, immediately post
intervention, immediately post exercise, 24 hours post exercise,
48 hours post exercise and 72 hours post exercise. LDH, CK and
1 RM were measured before and 48 hours post exercise.
Result: Muscle soreness was reported to be significantly less
for experimental (vibration and massage) group (p=0.000) as
compared to control group at 24, 48, and 72 hours of post-
exercise. Experimental and control group did not show any
significant difference in MIF immediate (p=0.2898), 24 hours
(p=0.4173), 48 hours (p=0.752) and 72 hours (p=0.5297) of post-
exercise. Range of motion demonstrated significant recovery
in experimental groups in 48 hours (p=0.0016) and 72 hours
(p=0.0463). Massage therapy showed significant recovery in 1RM
(p=0.000) compared to control group and vibration therapy shows
significantly less LDH level (p=0.000) 48 hours of post exercise
compare to control group. CK at 48 hours of post exercise in
vibration group (p=0.000) and massage group showed (p=0.002)
significant difference as compared to control group.
Conclusion: Vibration therapy and massage are equally effective
in prevention of DOMS. Massage is effective in restoration of
concentric strength (1 RM). Yet vibration therapy shows clinically
early reduction of pain and is effective in decreasing the level of
LDH in 48 hours post exercise periods.
INTRODUCTION
DOMS has post exercise onset of 8-10 hours with soreness
peaking 24-48 hours post exercise [1-3]. DOMS often develops
after resistance training especially after the intensity and volume of
training are increased, the order of exercise is changed or a new
training regime is performed [4]. Numerous interventions aimed at
alleviating DOMS has been proposed like Transcutaneous Electrical
Nerve Stimulation (TENS) [5], ultrasound [6] and the administration
of aspirin and other anti-inflammatory drugs [7], steroids [8] and
vitamin C and other antioxidants [9].
Vibration therapy improves muscular strength, power development
and kinesthetic awareness [10], improve muscle performance and
preventing sarcoma disruption. Vibration therapy effectively improve
muscle performance which may prevent DOMS through preventing
sarcoma disruption [11-13]. Massage can reduce the tension on the
muscle tendon unit that affects the visco-eleastic component of the
tissue leading to an increase in competence of the muscle and
improvement of muscular flexibility reducing muscle stiffness and
also increasing blood flow [14]. Researchers have demonstrated that
massage has preventive effects ,decrease muscle soreness and other
symptoms [15-19].
Symptoms
Considering all the facts and discussions the aim of the present
study is to compare the effect the vibration therapy and massage in
preventing DOMS and to evaluate the change in muscle soreness,
ROM, MIF, 1RM, Serum CK level and LDH level.
METHODS
The study was approved by Institutional Ethical Committee of
Jamia Millia Islamia. Pre-test and Post-test Control-Group Design
was used, 45 healthy female non athletic subjects were randomly
assigned to the three equal groups. After the subject’s initial
condition was measured experimental groups received vibration
therapy or massage therapy intervention and control group received
no treatment, just prior to the eccentric exercise.
Subjects were undergoing the following measurements to evaluate
the changes in the muscle condition (without bold in continuation
with the earlier lines).
Muscle soreness (pain perception), ROM, MIF, 1 RM, LDH and C K
level. All the parameters except LDH, CK and 1RM were measured
before, immediately post intervention, immediately post exercise,
24 hours post exercise, 48 hours post exercise and 72 hours post
exercise. LDH, CK and 1RM were measured before and 48 hours
post exercise.
Vibration Therapy
Subject was in supine position on treatment table with arm resting
by the side. The mechanical vibration of 50 Hz was used to apply
the vibrations on the belly and the tendons of biceps brachii for five
minutes, before eccentric exercise for induction of DOMS.
Massage Therapy
The subject was in supine position on treatment table with arm
resting by the side. Each therapeutic massage technique was
replicated through the watch (set timer) to control the amount of time
spent per stroke as well as to control the depth of the massage.
Total time for therapeutic massage was 15 minutes [20].
Exercise Protocol for DOMS Induction
General arm movement wewre performed for five minutes before
the exercise for induction of DOMS. After that, subjects were seated
on the stool with their back supported against the wall. All subjects

Shagufta Imtiyaz et al., Compare the Effect of Vibration Therapy and Massage in Prevention of DOMS www.jcdr.net
Journal of Clinical and Diagnostic Research. 2014 Jan, Vol-8(1): 133-136
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performed eccentric exercise of elbow flexor muscles using a
dumbbell. Weight of the dumbbell was 80% of the pre exercise MIF.
Subjects were instructed to lower the dumbbell from elbow flexed
(50 degrees) to an elbow extended position (170 degrees) in 4-5
seconds, keeping the velocity as constant as possible by following
the examiner counting ‘0’ for the beginning and ‘1, 2, 3, 4, 5’ during
movement. After each eccentric action the examiner removed
the load and them arm was returned to the starting position. The
movement was repeated after every 45 seconds for 30 repetitions.
This long interval between the repetitions minimized the effect of
fatigue. Subjects were verbally guided to lower the dumbbell for
constant velocity for the whole ROM [21].
Dependent Variables
Muscle soreness
Muscle soreness was evaluated using a visual analog scale [21].
The subjects were asked to indicate his perceived level of muscle
pain (soreness) in the non dominant elbow flexor muscle on the line
when an investigator extended the elbow joint.
Elbow joint angles and ROM
Subject was in the standing position. The goniometer was placed
on the subject arm with the center located at the elbow joint. Two
elbow angles were measured. Flexed elbow joint angle (FANG)
was determined when subjects were asked to fully flex the elbow
joint by touching their palm to shoulder without raising the elbow.
For placements of goniometer semipermanent marker was used to
identify the lateral middle point of the humerus, the lateral axis point of
elbow joint. Relaxed elbow joint angle (RANG) represented the angle
with the arm relaxed along the side of the body during standing. RANG
was determined when subjects relaxed the arm allowing it to hang
down by the side. For placements of goniometer a semipermanent
marker was used to identify the lateral middle point between radius
and ulna. FANG and RANG were measured three times for each
time point using a plastic goniometer, and the average of the three
measurement was calculated, and ROM was defined as the angle
subtracting the mean FANG from the mean RANG [21].
Maximal Isometric Force
Subject were tested while supine lying on a padded mat on the
treatment couch / treatment table. Their designated non dominant
upper extremity were positioned with the shoulder abducted about
30degree, the elbow flexed 90 degree and forearm supinated
with their feet against their wall [11]. Strength was measured with
the help of a strain gauge (mounted on a wall). Height of strain
gauge was adjusted according to the length of the subject’s
forearm. Instruction to the subjects were to take 1-2 sec to come
to maximum force generation along with pulling strain gauge and
then continue flexing the elbow as hard as possible for 5 second.
Consistently verbal encouragement and command was provided
throughout every effort. Three measurements were taken for each
subject and consequent measurement was separated by 2 minutes
rest. The mean values of three measurements were used for the
analysis [11].
One Repetition Maximum (1RM)
The 1 RM is the ability of a person to lift a certain weight once.
The EN-TreeM 24 kg (Enraf Nonius) software calculates 1RM with
the aid of the 1RM protocol. Subjects were in a sitting position
and perform Scott-curl on EN Tree pulley. Instruct the subject to
inhale during flexing the elbow and exhale during extending it. The
subjects are to perform a controlled, smooth and well coordinated
movement. The test was stopped as soon as the subject cannot
perform the movement well coordinated any longer. Strong verbal
encouragement was provided during the measurement. The mean
values of two measurements were used for the analysis.
Blood sampling, CK, and LDH
1 ml sample of venous blood was collected from the cubital fossa
region of the dominant arm. The blood was allowed to clot for 30
minutes at room temperature and centrifuged for 10 minutes to
obtain serum. After separation, all serum samples were stored at
–20°C until analysis for CK and LDH activity [21]. Serum CK activity
was determined spectrophotometrically by using a test kit CK (NAC
act.) kit (Mod. IFCC Method) CORAL, Goa, INDIA and LDH (P-L) kit
(Mod. IFCC Method) CORAL, Goa, INDIA.
STATISTICAL ANALYSIS
All the data obtained from three groups was tabulated. Statistical
analysis was performed using Stata 11 software. One way
ANOVA was done to find difference between three groups and
corresponding Post-hoc analysis (Bonferroni test) was done to find
pair wise difference.
RESULTS
Muscle Soreness
Muscle soreness developed after exercise in all three groups but
significantly less for experimental (vibration and massage) group
(p=0.000) as compared with control group at 24, 48, and 72
hours of post-exercise. Vibration shows early recovery compare to
massage at 24 hours (p=0.031) [Table/Fig-1].
Maximal Isometric Force (MIF)
No significant difference in per exercise MIF (p=0.4189) was
found between experimental and control group. Experimental and
control group did not shows any significant difference immediate
(p=0.2898), 24 hours (p=0.4173), 48 hours (p=0.752) and 72 hours
(p=0.5297) of post-exercise [Table/Fig-2].
Range of Motion (ROM)
No significant difference in pre exercise ROM (p=0.9322) was found
between experimental and control group. Both experimental and
control group did not show any significant difference immediate
(p=0.1458), 24 hours (p=0.1892) of post-exercise. In 48 hours
(p=0.0016) and 72 hours (p=0.0463) significant recovery shown by
experimental groups [Table/Fig-3].
[Table/Fig-1]: Muscle Soreness
[Table/Fig-2]: Maximal Isometric Force (MIF)
[Table/Fig-3]: Range of Motion
1RM
No significant difference in pre (p=0.314) and 48 hours (p=0.342)
post exercise in vibration and control group. Vibration group shows
significant difference in pre (p=0.001) and 48 hours (p=0.008) post
exercise compare to massage group. Massage therapy shows
significant recovery (p=0.000) compare to control group [Table/
Fig-4].
Creatin Kinase (CK)
No significant difference in pre exercise CK level (p=1.000) was
found between both experimental (vibration and massage) and

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www.jcdr.net Shagufta Imtiyaz et al., Compare the Effect of Vibration Therapy and Massage in Prevention of DOMS
control group. After 48 hours of post exercise vibration group
(p=0.000) and massage group showed (p=0.002) significan
difference compare to control group. No significant difference
found in experimental groups (vibration and massage) at 48 hours
(p=1.000) post exercise [Table/Fig-5].
Lactate Dehydrogenase (LDH)
No significant difference in pre exercise LDH (p=1.000) was found
between both experimental (vibration and massage) and control
group. Vibration therapy showed significantly lesser LDH level
(p=0.000) 48 hours of post exercise compare to control group
[Table/Fig-6].
DISCUSSION
DOMS is caused due to microscopic muscle fibre tears and is
commonly observed after unfamiliar high-force muscular work [3].
Effect of Interventions on Muscle Soreness
Vibration provides stimulation to muscle spindles and increases its
afferent activities. Vibration and TENS both reduce the perception
of pain through same mechanism of pain gait theory [22]. This
lead to increase in background tension and motor unit activity
synchronization in the vibrated muscles [23,24] that prevent
sarcoma disruption or damage to excitation–contraction coupling
[25] which occurs due to eccentric exercise. This preparatory effect
leads to less damage to the muscle resulting in less pain perception
in post exercise duration [12,13,17,26].
Massage reduces mechanical overload on sarcomeres during
lengthening actions (eccentric exercise) and prevent sarcoplasmic
reticulum ruptures which decreases intracellular calcium and trigger
calcium-sensitive degradative pathways and leads consequentially
to less ultrastructural damage [14]. In this way massage is effective
to reduce pain in DOMS. Massage minimizes negative-performance
factors such as muscle and connective tissue dysfunction, restricted
ROM, and pain and anxiety. Therefore it may enhance performance
and prevent injury resulting in less pain perception [14,27,28].
Effect of Interventions on ROM
Vibration training could increase ROM in the shoulder of male
gymnastic [29]. On application of vibration, the motor neuron may
become synchronized and result in more force production of the
muscle group [30,31]. Vibration may causes motor unit activation,
synchronization between muscle spindles, reflexive recruitment of
previously inactive motor units which leads to more force production
for the exercise [12]. Consequently, distribution of exercise load
(contractile stress) over a larger number of active fibers, this prevent
muscle damage or less reduction of ROM [17].
Massage generates mechanical pressure on the muscle tissue
in order to decrease tissue adhesion. Mobilizing and elongating
shortened or adhered connective tissue may increase muscle-
tendon compliance. Improved muscle compliance results in a less
stiff muscle-tendon unit [14,32,33]. These effects help to restore
muscle flexibility in post exercise period or restoration of ROM.
Effect of Interventions on Maximal Isometric Force
Strength decrement following eccentric exercise muscle action was
due to soreness (mechanical reflex inhibition [34] which prevents
subjects to fully activate their muscles [35]. Other researchers have
different beliefs such as calcium deficiency in the sarcoplasmic
reticulum, it could be postulated that there would be insufficient
calcium to support the continuous cross bridge cycling needed
for complete muscle fiber shortening [36]. Majority of researchers
believe that strength reduction is because of myofibrillar damage
involving Z-band and sarcomere disruption caused by performing
eccentric contractions [1-3, 37,38].
Many research scholar have shown that post exercise vibration [39,40]
and massage [7,41,42] therapy have no significant impact on MIF
restoration in case of eccentric exercise. Our result is in contrast
with the result of some researches [12,26] who show significant
difference in MVC in VT and non VT groups [12,26].
Effect of Intervention on Cretain Kinase
CK is the primary enzyme regulating anaerobic metabolism and has
been used as an indirect marker of DOMS in healthy individuals [43].
There is a strong relationship between CK and the clinical signs of
DOMS [44,45]. CK is released in case of damage to muscle tissues
and change in the myocyte membrane permeability. The myocyte
membrane permeability of muscles which undergo unfamiliar exercise
changes and hence CK is released. Thus, CK release was higher in
control group as opposed to experimental group where the effect
was mitigated by the preparatory massage and vibration therapy.
Application of 50 Hz vibration before exercise causes less damage
to muscle tissues and there may be less changes in the myocyte
membrane permeability, resulting in less releases of CK in blood
compared to control group after 48 hours of post exercise. Many
research scholar have shown that post exercise vibration [12,17]
and massage [20,15] therapy have significant impact on CK level in
post-eccentric exercise duration.
Effect of Interventions on LDH
Vibration therapy leads to increase of skin temperature and blood
flow [46] leading to decreased accumulation of lactic acid in the
blood. Therefore, Lower LDH activity level was found in vibration
group compared to control group 48 hours post exercise. However,
massage group has not shown this significant difference with the
control group pointing to the fact that massage may not be an
effective intervention to reduce LDH activity in the blood.
Effect of Intervention on 1RM
Massage provides the better preparatory and warm up effect in
the muscle this results in less reduction and early restoration of
isotonic muscle strength (1RM). Rodenburg et al., (1994) reported
increased maximal isotonic force in post–exercise massage group
compared to control [15]. In present study, vibration therapy failed to
show any significant difference in 1 RM restoration. Some studies
are reported that vibration therapy was not effective in recovery of
muscle strength [39,40].
CONCLUSION
The result of this study indicates that vibration therapy and
massage therapy both are equally effective in prevention of DOMS.
Massage is more effective in restoration of concentric strength (1
RM), yet vibration therapy shows clinically early reduction of pain
and is effective in decrease the level of LDH in 48 hours post
exercise periods. They can be used as an alternative to each other
depending on the requirement and condition. But the difference in
time taken for the execution of the treatment can play a pivotal role.
Situations where time is the essence, vibration can be used and
[Table/Fig-4]: 1RM [Table/Fig-5]: Creatin Kinase(CK) [Table/Fig-6]: Lactate Dehydrogenase (LDH)

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Journal of Clinical and Diagnostic Research. 2014 Jan, Vol-8(1): 133-136
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PARTICULARS OF CONTRIBUTORS:
1. Research Student, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi-25, India.
2. Assistant Professor, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi-25, India.
3. Chief Medical Officer, Ansari Health Centre, Jamia Millia Islamia (Central University), New Delhi-25, India.
NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR:
Dr. Zubia Veqar,
Assistant Professor, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi-25, India.
E-mail: veqar.zubia@gmail.com
FINANCIAL OR OTHER COMPETING INTERESTS: None.
Date of Submission: Aug 05, 2013
Date of Peer Review: Oct 25, 2013
Date of Acceptance: Nov 22, 2013
Date of Publishing: Jan 12, 2014
in other the concerned therapist’s skill and choice may decide the
interventions.
ACKNOWLEDGEMENT
Author shows heartfelt gratitude to Manpreet Kaur (Junior Research
Fellow, UCG, institute of Home Econimics, F-4 Hauz Khas Enclave,
New Delhi) for the statistical analysis of data and sincerely thank to
Dr Faizan Ahmad (Professor), Centre for Interdisciplinary Research in
Basic Sciences, Jamia Millia Islamia, for his kind help and providing
lab during the analysis of blood samples.
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