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The Acute Effects of a Percussive Massage Treatment with a Hypervolt Device on Plantar Flexor Muscles' Range of Motion and Performance

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Handheld percussive massage treatment has gained popularity in recent years, for both therapeutic use and in sports practice. It is used with the goals of increasing flexibility and performance, but also to accelerate recovery. However, until now, there has been no scientific evidence, which proves such effects. Therefore, the purpose of this study was to investigate the effects of a 5-min percussion treatment of the calf muscles on range of motion (ROM) and maximum voluntary contraction (MVC) torque of the plantar flexor muscles. Sixteen healthy male volunteers (mean ± SD; 27.2 ± 4.2 years, 1.79 ± 0.05 m, 79.4 ± 9.1 kg) were tested on two separate days with either a 5-min massage treatment of the calf muscles with a Hypervolt device or the control condition (sitting only). Before and after the treatments, dorsiflexion ROM and MVC torque of the plantar flexor muscles were measured with a dynamometer. Maximum dorsiflexion ROM increased with a large magnitude following the massage treatment by 5.4° (+18.4%; p = 0.002, d= 1.36), while there was no change in the control group. Moreover, MVC torque did not change following both the massage treatment and the control treatment. Similar to a conventional massage by a therapist, ROM can be increased by a handheld percussive massage treatment without having an effect on muscle strength.
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©Journal of Sports Science and Medicine (2020) 19, 690-694
http://www.jssm.org
Received: 31 August 2020 / Accepted: 19 September 2020 / Published (online): 01 December 2020
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The Acute Effects of a Percussive Massage Treatment with a Hypervolt Device on
Plantar Flexor Muscles’ Range of Motion and Performance
Andreas Konrad , Christoph Glashüttner, Marina Maren Reiner, Daniel Bernsteiner and Markus
Tilp
Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14, A-8010 Graz, Austria
Abstract
Handheld percussive massage treatment has gained popularity in
recent years, for both therapeutic use and in sports practice. It is
used with the goals of increasing flexibility and performance, but
also to accelerate recovery. However, until now, there has been
no scientific evidence, which proves such effects. Therefore, the
purpose of this study was to investigate the effects of a 5-min per-
cussion treatment of the calf muscles on range of motion (ROM)
and maximum voluntary contraction (MVC) torque of the plantar
flexor muscles. Sixteen healthy male volunteers (mean ± SD; 27.2
± 4.2 years, 1.79 ± 0.05 m, 79.4 ± 9.1 kg) were tested on two sep-
arate days with either a 5-min massage treatment of the calf mus-
cles with a Hypervolt device or the control condition (sitting
only). Before and after the treatments, dorsiflexion ROM and
MVC torque of the plantar flexor muscles were measured with a
dynamometer. Maximum dorsiflexion ROM increased with a
large magnitude following the massage treatment by 5.4°
(+18.4%; p = 0.002, d= 1.36), while there was no change in the
control group. Moreover, MVC torque did not change following
both the massage treatment and the control treatment. Similar to
a conventional massage by a therapist, ROM can be increased by
a handheld percussive massage treatment without having an ef-
fect on muscle strength.
Key words: Theragun, percussion, vibration massage, massage
therapy, massage gun.
Introduction
Handheld percussive massage treatment has gained popu-
larity in the therapeutic and athletic communities in the last
few years. Different manufacturers (e.g. Theragun, Hype-
rice) provide percussion devices for both self-massage and
massage by a therapist. Such devices are able to vibrate in
different frequencies up to 53 Hz. Depending on the tissue
(i.e. soft tissue vs. bony tissue), several attachment heads
can be fixed to the devices (see Figure 1), so that local
points can receive a massage (Hypervolt, Hyperice, Cali-
fornia, US). A recent review (Davis et al., 2020) showed
that conventional massage can improve delayed onset mus-
cle soreness (DOMS) and can acutely increase range of
motion (ROM). However, no improvements could be ob-
served in strength, jump, sprint, endurance, and fatigue pa-
rameters. Similar to a conventional massage, vibration
therapy of the whole body (by standing on a plate; (Veqar
and Imtiyaz, 2014)), and also vibration of specific muscles
with, for example, a vibrating foam roller (Cheatham et al.,
2019), can increase ROM. Compared to a conventional
massage, vibration therapy can also enhance strength pa-
rameters (Lee et al., 2018; Veqar and Imtiyaz, 2014).
Percussive massage treatment likely combines the
elements of a conventional massage and vibration therapy.
However, there is a lack of scientific evidence as to how
and if percussive massage treatment affects ROM and mus-
cle strength. To date, only one conference paper has inves-
tigated the effects of a handheld percussive massage treat-
ment device (Kujala et al., 2019). However, the authors did
not find changes in vertical jump height following a 5-min
massage with a percussion device on several lower body
muscle groups.
To the best of our knowledge, to date, no study has
investigated the acute effects of a handheld percussive
massage treatment on both flexibility and muscle perfor-
mance. Since percussive massage treatment has increased
in popularity with strength and conditioning coaches, and
athletes, this is a huge gap in the literature.
Therefore, the purpose of this study was to investi-
gate the effects of a 5-min percussive massage treatment of
the calf muscles on dorsiflexion ROM as well as maximum
voluntary contraction (MVC) torque of the plantar flexors.
According to the literature on conventional massage and
vibration therapy techniques, we hypothesized that the per-
cussive massage treatment would increase dorsiflexion
ROM while having no negative effect on MVC torque.
Figure 1. The handheld massage device (Hypervolt) with the
different attachment heads which can be used. For this study,
the soft attachment head was used (1). Further attachments
which are provided with most percussive massage treatment
devices are hard plain (2), spinal (3), hard ball (4), and trigger
point (5) heads.
Methods
Experimental design
Participants visited the laboratory for two sessions, with a
two-day break in between, at the same time of day. The
percussive massage treatment and the control trial were
Research article
Konrad et al.
691
performed in random order. Before and after both treat-
ments (massage and control), dorsiflexion ROM and MVC
torque of the plantar flexor muscles were determined.
Subjects
Sixteen healthy recreational male athletes (mean ± SD;
27.2 ± 4.2 years, 1.79 ± 0.05 m, 79.4 ± 9.1 kg) volunteers
participated in this study. Subjects with a history of lower
leg injuries, any type of neuromuscular disorder, and elite
athletes were excluded from the study. Subjects were in-
formed about the testing procedure, but were not informed
about the study´s aim and hypotheses. The study was ap-
proved by the local research ethics board, and written in-
formed consent was obtained from all volunteers before the
onset of the experimental procedures.
Measures
Measurements were performed after a standardized warm-
up (10-min warm-up on a stationary bike at 60 rev/min
with 90 Watts) in the following order: 1. ROM; 2. MVC;
3. massage treatment for 5 min or control condition (just
sitting for 6 min); 4. ROM; 5. MVC.
Range of Motion (ROM) measurement
ROM was determined with an isokinetic dynamometer
(CON-TREX MJ, CMV AG, Duebendorf, Switzerland)
with the standard setup for ankle joint movement individu-
ally adjusted. Subjects were seated with a hip joint angle of
110°, with the foot resting on the dynamometer foot plate
and the knee fully extended. Two oblique straps on the up-
per body and one strap around the thigh were used to secure
the participant to the dynamometer and exclude any eva-
sive movement. The foot was fixed barefooted with a strap
to the dynamo meter footp la te, and the estima te d ankle joint
center was carefully aligned with the axis of the dynamom-
eter to avoid any heel displacement. Participants were first
moved to the neutral ankle joint position in the dynamom-
eter (90°) and were subsequently asked to regulate the mo-
tor of the dynamometer with a remote control to get into a
dorsiflexion (stretching) position until the point of maxi-
mum discomfort was reached. The difference between the
maximum dorsiflexion and the neutral position was de-
fined as the dorsiflexion RoM.
Maximum Voluntary Contraction (MVC) torque meas-
urement
MVC measurement was performed with the dynamometer
at a neutral ankle position (90°). Participants were in-
structed to perform three isometric MVCs of the plantar
flexors for 5 s, with rest periods of at least 1 min between
the measurements to avoid any fatigue. The attempt with
the highest MVC torque value was taken for further analy-
sis.
Percussive massage treatment
During the percussive massage treatment, subjects were
seated on the dynamometer, with the same setup as in the
previous measurements (ROM and MVC), but the ankle
joint was rotated to 20° plantar flexion to ensure that the
calf muscles were relaxed (see Figure 2). The percussive
massage treatment was applied by the same investigator
using a Hypervolt device (Hyperice, California, US). This
device provides percussions at 53 Hz, with the soft attach-
ment head (see Figure 1) being used for the massage. The
percussive massage treatment was applied to the right calf
muscles for 5 min in total. The focus for the first 2.5 min
of the massage treatment was the medial gastrocnemius
muscle, while the focus in the second 2.5 min was on the
lateral gastrocnemius muscle. The investigator started the
massage treatment at the very medial side of the treated
muscle and moved the massage device longitudinally in a
straight line from distal to proximal and back to distal
within 20 s. Back at the distal end of the muscle the inves-
tigator moved the percussive massage device laterally and
again moved it longitudinally from distal to proximal and
back to distal. Thus, for each muscle, the massage started
from the medial side and finished at the lateral side. The
investigator always tried to apply the same pressure to the
skin. The control group participants were seated in the
same position; however, no massage was applied.
Figure 2. During the percussive massage treatment, the sub-
ject was seated on the dynamometer (similar to the ROM and
MVC assessments) and the investigator applied the massage
with the Hypervolt massage device.
Statistical analyses
SPSS (version 20.0, SPSS Inc., Chicago, Illinois) was used
for all the statistical analyses. A Shapiro-Wilk test was
used to verify the normal distribution of all the variables.
Subsequently, if the data were normally distributed, we
performed a two-way repeated ANOVA (factors: time [pre
vs. post] and treatment modality [massage vs. control]).
Otherwise, we performed a Friedman test to test the effect
of the treatment (massage vs. control). If the ANOVA test
with repeated measures or the Friedman test were signifi-
cant, we performed a t-test or a Wilcoxon test (both Bon-
ferroni-corrected), respectively. To confirm the homogene-
ity between groups, we performed a t-test between the two
groups and their pre-variables (massage vs. control). The
effect sizes d (for t-test) and r (for Wilcoxon) were inter-
preted following the suggestions by Cohen (1988). Thus,
the effect size d defines 0.2, 0.5, and 0.8 as small, medium,
and large effect, respectively. Moreover, the effect size r
defines <0.3, 0.3 - 0.5, and >0.5 as small, medium, and
Acute effects of a percussive massage treatment
692
large effect, respectively. The statistical power and power
analysis were calculated with the open source software
G*Power (Faul et al., 2009). An alpha level of p = 0.05 was
defined for the statistical significance of all the tests.
Results
Range of Motion (ROM)
The ANOVA test for ROM revealed a significant interac-
tion effect (p = 0.003; F = 12,1; df = 15; η² = 0.44) and time
effect (p < 0.0001; F = 23,9; df = 15; η² = 0.62), but no
group effect (p = 0.83; F = 0.05; df = 15; η² = 0.003). The
pairwise comparison showed a significant increase in
ROM in the massage treatment group (+5.4°; +18.4%; p =
0.002) with a large magnitude (d = 1.36), but no significant
change in the control group (+1.6°; +5,3%; p = 0.18) with
a medium magnitude (d = 0.51) (see Table 1). Statistical
power for the pairwise comparisons was 0.91 for the mas-
sage treatment group and 0.74 for the control group. The
pre-test comparison of both groups showed no significant
difference (p = 0.81).
Maximum Voluntary Contraction (MVC)
The Friedman test for MVC showed no significant differ-
ence (P = 0.35; χ2 = 3.3). The changes between pre and post
treatment for the massage group and control group were
+0.53 Nm (+0.003%; p = 0.99) and +1.69 Nm (+1.0%; p =
0.65), respectively (see Table 1). The effect sizes for the
changes were small for the massage group (r = 0.17) and
medium for the control group (r = 0.31). Statistical power
for the pairwise comparisons was 0.99 for the massage
treatment group and 0.82 for the control group. The pre-
test comparison of both groups showed no significant dif-
ference (p = 0.67).
Table 1. Results of the maximum dorsiflexion range of motion (ROM) and maximum voluntary
contraction (MVC) measurements. Data are means ±SD.
Percussive massage treatment Control
PRE POST PRE POST
ROM (°) 29.30 ± 6.53 34.70 ± 7.38 * 30.9 ± 8.9 32.53 ± 9.73
MVC (Nm) 179.24 ± 20.45 179.76 ± 20.17 176.8 ± 21.8 178.53 ± 20.69
* = significant difference between pre- and post-session data.
Discussion
The purpose of this study was to investigate the effects of
a 5-min percussive massage treatment of the calf muscles
on dorsiflexion ROM and plantar flexors MVC torque. In
accordance with our hypothesis, we found an increase in
ROM without a negative effect on MVC torque.
As with a conventional massage (Davis et al.,
2020), and also vibration therapy [whole body: (Veqar and
Imtiyaz, 2014); localized: (Cheatham et al., 2019;
Germann et al., 2018)], the dorsiflexion ROM was signifi-
cantly increased (+5.4°) following a single percussive mas-
sage treatment with the Hypervolt device. According to the
review by Weerapong et al. (2005), a possible mechanism
for the increase in ROM following a conventional massage
is biomechanical changes (i.e. reduction in muscle compli-
ance), but also physiological (i.e. increased blood flow),
neurological (i.e. reduction in perception of pain), and psy-
chological changes (i.e. increased relaxation). More specif-
ically, Eriksson Crommert et al. (2015) showed a reduction
in muscle stiffness of the gastrocnemius medialis with
shear wave elastography immediately after a massage.
Moreover, thixotropic effects, assumed in foam rolling
(Behm and Wilke, 2019) or stretching (Behm, 2018, p.48),
can be a further explanation for the increase in ROM fol-
lowing the percussive massage treatment. Similar to foam
rolling, the percussive massage treatment induces pressure
and friction on the treated muscle, skin, and fascia. This
could have an impact on fluid viscosity and, hence, lead to
less resistance to a movement (Behm, 2018, p.48; Behm
and Wilke, 2019). With regard to vibration therapy, the in-
crease in ROM can be mainly explained by a decrease in
perception of pain (Cheatham et al., 2019; Veqar and
Imtiyaz, 2014). Thus, it can be assumed that the changes in
ROM following the percussive massage treatment can be
explained by a decrease in muscle stiffness, as well as by
changes in perception of pain. Interestingly, a static 5-min
stretching exercise conducted in our laboratory (Konrad et
al., 2019) with the same setup seems to have a similar ef-
fect on ROM gain (+4.9°) to the 5-min massage in the cur-
rent study (+5.4°). The increase in ROM following the
static stretching exercise in this study (Konrad et al., 2019)
was explained by a decrease in muscle stiffness. Thus,
again, it can be assumed that the ROM increase following
the percussive massage treatment is likely due a decrease
in muscle stiffness.
With regard to the muscle performance, the percus-
sive massage treatment did not result in changes in MVC.
This is in accordance with the findings of Kujala et al.
(2019), who did not find any changes in vertical jump per-
formance following a 5-min percussive massage treatment
of the lower leg muscles. Although the duration of the mas-
sage was similar in the study by Kujala et al. (2019) and
the current study, the subjects of Kujala et al. (2019) re-
ceived a massage of the gluteal, quadriceps, calves, and
hamstring muscles of both legs, while in the present study
the focus of the massage was on the right calf muscles only.
Nevertheless, although subjects of the present study re-
ceived a more pronounced stimulus, the effect (i.e. no
change in muscle performance) was the same. The findings
of the present study on muscle performance are similar to
the results of a conventional massage (Davis et al., 2020),
but differ from the findings on vibration therapy
(Cheatham et al., 2019; Germann et al., 2018), where an
increase in strength has been found. A possible mechanism
for these findings might be that vibration therapy can stim-
ulate more muscle receptors in all three types, which leads
to increased motor fiber recruitment (Fallon and
Macefield, 2007; Germann et al., 2018). Although, more
muscle receptors in all three types are stimulated following
vibration therapy, the response from Ia and II afferent
are stronger compared to Ib afferent fibers (Fallon and
Konrad et al.
693
Macefield, 2007).
A possible explanation for the contradictory find-
ings between the various whole-body and local vibration
therapies and the current findings might be found in the
different massage durations and frequencies, and the dif-
ferent muscles examined. Thus, future studies should con-
sider these parameters. Moreover, while the present study
focused on muscle performance, future studies should ad-
ditionally investigate the effects of percussive massage
treatment on DOMS, pain, and trigger points. Since the
handheld percussive massage device used in this study has
different attachment heads (see Figure 1), it would be in-
teresting to investigate possible differences between them.
In addition, we recommend performing appropriate exper-
iments to determine possible mechanisms (i.e. mechanical
or neurological) which might explain changes in muscle
performance parameters and flexibility.
Conclusion
Handheld percussive massage treatment is a novel ap-
proach for therapists and athletes. This study was the first
to examine the effect of a 5-min massage of the calf mus-
cles on the ROM and muscle performance (MVC) of the
plantar flexor muscles. We observed an increase in ROM,
but no change in MVC torque output. Therefore, we sug-
gest including a percussive massage treatment in a warm-
up regimen to optimize the flexibility level of an athlete,
without losing muscle performance.
Acknowledgements
This study was supported by a grant (Project P 32078-B) from the Aus-
trian Science Fund FWF. The authors have no conflicts of interests to de-
clare. The experiments comply with the current laws of the country in
which they were performed.
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Key points
This study was the first to examine the effect of a 5-
min handheld percussive massage treatment of the
calf muscles on the ROM and muscle performance
(MVC) of the plantar flexor muscles.
Dorsiflexion ROM increased following the percus-
sive massage treatment
Since we found no changes in MVC, we suggest in-
cluding a percussive massage treatment in a warm-up
regimen to optimize the flexibility level of an athlete,
without losing muscle performance
AUTHOR BIOGRAPHY
Andreas KONRAD
Employment
Institute of Human Movement Science,
Sport and Health, University of Graz
Degree
PhD, MSc
Research interests
Biomechanics, muscle performance,
training science, muscle-tendon-unit,
soccer science
E-mail: andreas.konrad@uni-graz.at
Christoph GLASHÜTTNER
Employment
Institute of Human Movement Science,
Sport and Health, University of Graz
Degree
BSc
Research interests
Training science, biomechanics
E-mail:
christoph.glashuettner@edu.uni-graz.at
Marina Maren REINER
Employment
Institute of Human Movement Science,
Sport and Health, University of Graz
Degree
MSc, BSc
Research interests
Training science, biomechanics, muscle-
tendon-unit
E-mail: marina.reiner@uni-graz.at
Acute effects of a percussive massage treatment
694
Daniel BERNSTEINER
Employment
Institute of Human Movement Science,
Sport and Health, University of Graz
Degree
BSc student
Research interests
Training science, biomechanics
E-mail: daniel.bernsteiner@edu.uni-
graz.at
Markus TILP
Employment
Prof., Institute of Human Movement
Science, Sport and Health, University of
Graz
Degree
PhD
Research interests
Biomechanics, training science, muscle-
tendon-unit, sports game analysis
E-mail: markus.tilp@uni-graz.at
Mag. Dr. Andreas Konrad
Institute of Human Movement Science, Sport and Health, Univer-
sity of Graz, Mozartgasse 14, A-8010 Graz, Austria
... The evidence on Myofascial Gun or Thera Gun in the field of Physical therapy is sparse as it is a new technology. Researches on effects of Thera Gun have shown significant improvement in pain and ROM in cervical, back and planter flexors (18,19). ...
... A study was done by Konrad A et al to analyze the effects of massage gun on Planter flexor muscles and its range of motion after the session. The ROM was improved from 29.30 ± 6.53 to 34.70 ± 7.38 (19). Guzman et al assessed hamstring length ROM after only one 5 min session with Myofascial Gun. ...
... Forward head posture, as indicated by the Tragus-to-Wall Distance Test, decreased significantly from 15.57 ± 2.18 cm to 13.79 ± 2.06 cm (p<0.001). The NDI scores for functional status also showed significant improvement, decreasing from 70.41 ± 10.69 to19.53 ± 8.00 (p<0.001). ...
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... To the best of our knowledge, the effects of massage guns on soft tissue properties were not compared to those of other therapies. However, its use in modifying tissue stiffness, and muscle tone, reducing fatigue, improving performance, and aiding recovery is growing, especially among athletes [9]. ...
... Musculoskeletal disorders are often treated with extracorporeal shock wave therapy (ESWT). Some studies have reported the effectiveness of ESWT in improving MPS symptoms and reducing pain by producing mechanical energy through air pressure, which spreads in tissue and causes secondary biological effects, promoting tissue repair and regeneration [9]. ESWT significantly benefits conditions like non-union fractures, calcifi-cation, plantar fasciitis, tenosynovitis, and trigger points [10]. ...
... The participants had posterior leg muscle pain (visual analog scale [VAS]: 3-7) for at least two weeks, reduced ROM with pain and tension in dorsiflexion, and at least one referred pain symptom of the trigger point or muscle bundle of the gastrocnemius muscle. Meanwhile, the exclusion criteria included unwillingness to continue, use of drugs or physical intervention, and new neurological or musculoskeletal symptoms during the treatment [9,[13][14][15][16][17]. ...
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Introduction: Myofascial pain syndrome is a common musculoskeletal injury, especially among athletes, typically treated with symptomatic invasive and non-invasive methods. This study compares the effects of massage guns and radial extracorporeal shock wave therapies on myofascial pain syndrome symptoms in amateur athletes. Materials and Methods: In this clinical trial, 45 amateur athletes (18-30 years old) were recruited, who were randomly assigned to 15-member groups of shock wave, massage gun, and control (routine treatment included electrotherapy and stretching, which was applied on three groups). After initial evaluations of the pain intensity, pain pressure threshold (PPT), isometric muscle strength, and range of motion (ROM), the patients received single-session treatment and were immediately reassessed. Results: The results showed pain relief and improved PPT following shock wave plus routine treatment (P=0.03). The control group had less pain, while pain intensity and PPT did not change. The variables were not significantly different between the groups (P=0.12). Shock wave along with routine treatment increased plantar flexion ROM (P=0.00), unlike the massage gun. Additionally, dorsiflexion ROM (P=0.63) and maximal isometric gastrocnemius muscle strength (P=0.95) remained unchanged in all groups. Conclusion: One session of massage gun therapy immediately reduced gastrocnemius muscle pain, while it failed to change PPT, maximal isometric gastrocnemius muscle strength, or dorsiflexion and plantar flexion ROM. However, shock wave therapy immediately increased plantar flexion ROM and PPT, and reduced pain intensity. These modalities led to limited changes, suggesting the need for repeated sessions and supplementary treatments.
... Recent literature reviews (Ferreira et al., 2023;Martin, 2021;Sams et al., 2023) reported massage guns can improve short-term flexibility of calves and hamstrings. Significant acute increases in dorsiflexion have been reported after applying PT to the calves for 5-min at a speed of 3180 rpm (Konrad et al., 2020) and after five 30s applications, with each application followed by a 30 s break, at a speed of 1800 rpm (Rao et al., 2023). Significant increases in hip flexion have also been reported after applying PT to the hamstrings for 5-min at a speed of 3180 rpm (Ateş et al., 2023), and after shorter durations of 90 s at 1800 rpm (Peloquin et al., 2022), two 60s treatments with 30s rest in-between at 1750 rpm (Skinner et al., 2023) and 90 s at 1800 rpm (Hernandez, 2020). ...
... Results from this study showed increases in dominant and/or nondominant dorsiflexion after most protocols, except for those including the fastest speed of 2400 rpm and two applications at 1750 rpm and 2100 rpm across the week. Although this current study did not report significant findings after one application at 2400 rpm, Konrad et al. (2020) measured dorsiflexion with using the isokinetic dynamometer test and reported a significant increase of 5.4 • (18.4%; p < .002) after Table 4 Results of paired samples t-tests comparing pre-and post-data for each of the dependent variables following the eight protocols A to H. Level of significance p < .05*, ...
... one application for 5-min to the gastrocnemius at 3100 rpm and a depth of 12 mm (Konrad et al., 2020). In contrast, Leabeater et al. (2023) reported no change in dominant or non-dominant dorsiflexion following 5-min of PT directly on the gastrocnemius at a similar speed of 3200 rpm at a depth of 12 mm using the weight-bearing lunge test (Leabeater et al., 2023). ...
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Introduction Current protocols for delivering percussive therapy (PT) using massage guns are heterogeneous creating a need to establish the impact of study design on physiological measures. This cross-over design study aimed to determine the most effective protocol, among the eight protocols examined, on lower body flexibility, and to support the provision of protocol validation for future research. Method Recreationally active healthy adults (n=35) undertook two main protocols; three sessions per week at 2100 rpm or increasing the speed from session-to-session: 1750 to 2100 to 2400 rpm. PT was applied for 60 s to each of the quadriceps, gluteals, hamstrings and calves of both legs. Paired-samples t-tests assessed pre- and post-intervention data for hip flexion and ankle dorsi-flexion range of motion (ROM). These were collected in all sessions using a digital goniometer allowing changes for eight different protocols to be examined. Results Results showed the most effective protocol, among the eight protocols examined, for achieving significant gains in lower body flexibility is applying massage gun PT three times a week with increased speeds across sessions (1750 to 2100 to 2400 rpm), with average increases for the combined dominant and non-dominant legs of 5.8% for hip flexion and 5.6% ankle dorsiflexion. Conclusions Practitioners and the public using this protocol could target specific improvements in hip flexion and ankle dorsi-flexion ROM and researchers may wish to adopt this protocol to allow homogenous analysis across study populations in future research.
... Despite their growing popularity among athletes and therapists, the evidence supporting the purported benefits of percussion massage devices remains limited. These devices, which combine traditional massage with vibration, are thought to enhance flexibility, performance, and recovery, but further research is needed to establish their definitive effects [9]. Percussion massage devices, typically powered by electricity or batteries, deliver rapid, compressive forces to myofascial tissue using a variety of attachments. 1 Popular brands like Theragun and Hypervolt offer devices for both self-massage and professional use. ...
... Limited research, a lack of clinical practice guidelines, and scarce information on how health professionals utilize these devices contribute to this gap. To date, most studies have focused on the effects of percussion massage therapy on joint range of motion and muscle stiffness [9,[11][12][13]. This study investigated the effects of adding percussion massage therapy to a conventional exercise program for the management of NSLBP. ...
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Aim: This study aimed to investigate the effects of percussion massage therapy applied to the paravertebral muscles on pain, functionality, flexibility, kinesiophobia, and quality of life in individuals with mechanical low back pain. Materials and Methods: The study included 40 individuals diagnosed with non specific low back pain. Participants were randomly assigned to percussion massage therapy (PMT) and conventional therapy (CT). Both groups underwent a 6-week treatment program. Pain levels were assessed using the Visual Analog Scale (VAS), functionality was evaluated using the Oswestry Disability Index (ODI), flexibility was measured using the Sit-and-Reach Test, kinesiophobia was assessed using the Tampa Scale for Kinesiophobia (TSK), and quality of life was measured using the Short Form-36 (SF-36). Assessments were conducted before and after treatment. The CT group received exercises focused on strengthening, stabilization, and stretching the lumbar region, while the PMT group received percussion massage therapy to the paravertebral muscles in addition to conventional physiotherapy. Results: Post-treatment, both groups significantly improved all assessment parameters (p<0.05). However, the PMT group demonstrated greater effectiveness compared to the CT group in terms of ODI, TSK, VAS, Sit-and-Reach Test, and the physical role limitation, emotional function, social function, pain, and general health subscales of the SF-36 (p<0.05). Conclusion: This study concluded that incorporating percussion massage therapy, a novel approach in the literature, into the rehabilitation program for individuals with mechanical low back pain may be an effective addition to treatment.
... Flossing the lower leg increased ankle dorsiflexion ROM. MR techniques using foam rollers and massage guns are thought to exert a thixotropic effect, which reduces fascia viscosity by applying pressure (Bohlen et al., 2014;Konrad et al., 2020). As flossing also applies pressure over a wide area, it might have reduced fascia viscosity in the lower leg, leading to an increase in ankle dorsiflexion ROM. ...
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Flossing has been hypothesized to improve joint range of motion (flexibility), potentially through enhanced fascial gliding, although this mechanism remains speculative. This study aimed to clarify the effect of flossing, a new type of myofascial release, on joint range of motion by focusing on tissue gliding properties. This study involved 14 healthy participants (aged 18-25 years) who performed two types of active exercises with floss bands wrapped around their lower legs. As a control, the participants performed the same active exercises on different days without floss bands. Measurements taken before and after the intervention included ankle dorsiflexion range of motion, ankle plantar flexion maximum voluntary contraction, medial head of the gastrocnemius muscle thickness using ultrasound, and fascial hardness at five locations according to depth. Lower leg flossing significantly increased ankle dorsiflexion range of motion by 28.3 ± 19.9% (control: 14.6 ± 12.4%, P = 0.04, d = 0.83). No significant changes were observed in maximum voluntary plantar flexion contraction or overall muscle and fascial hardness. However, the rate of change in hardness showed a trend toward reduction in the superficial fascia and the upper and middle gastrocnemius muscles, with the upper gastrocnemius muscle exhibiting a statistically significant decrease in hardness (P = 0.05). Flossing showed trends toward reducing superficial muscle and fascial hardness, particularly in the superficial fascia and the upper gastrocnemius muscle, although not all changes were statistically significant. This suggests that potential improvements in intertissue gliding around the fascia could contribute to an increased range of motion.
... A study on the treatment of non-specific neck pain demonstrated that when PT combined with head exercises, was more effective in alleviating pain than exercise alone [26]. This effect may be attributed to PT's ability to enhance joint mobility [27], and reduce tissue stiffness [28] thereby relieving musculoskeletal pain. Notably, recent research has highlighted the significant positive impact of PT on fascial tissue [28][29][30]. ...
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Background Chronic non-specific low back pain (CNSLBP) is prevalent among firefighters and may negatively affect their job performance. Alterations in the thoracolumbar fascia (TLF) structure are associated with CNSLBP. Percussive massage therapy (PT) has demonstrated potential in modifying fascial properties and alleviating pain. However, its effects on TLF structure in CNSLBP patients have not been thoroughly investigated. This study evaluates the effects of 6 weeks of PT on TLF echo intensity, thickness, pain, and disability in firefighters with CNSLBP, utilizing ultrasound imaging as a primary assessment tool. Methods This six-week randomized controlled trial involved 38 firefighters with CNSLBP. Participants were randomly assigned 1:1 to either the PT group (receiving PT and core stability exercise) or the control group (receiving only core stability exercise). TLF echo intensity and thickness were measured using ultrasound imaging, and disability was assessed using the Roland-Morris Disability Questionnaire (RMQ) at baseline and post-intervention. Pain was measured using the Visual Analog Scale (VAS) at baseline, immediately after the first intervention, three weeks post-intervention, and post-intervention. Paired t-tests were conducted to analyze within-group changes in RMQ and ultrasound data, while ANCOVA was used to assess between-group differences, and repeated measures ANOVA for VAS scores. Results Participants in the PT and control groups were aged 26.6±4.1 and 23.6±1.7 years, respectively, with BMI of 23.1±1.8 and 21.8±1.2 kg/m². The PT group showed significant reductions in bilateral TLF echo intensity post-intervention (left side: mean difference -6.4, 95% CI -9.7 to -3.1, p < 0.001, effect size 0.67; right side: mean difference -7.6, 95% CI -11.8 to -3.3, p < 0.01, effect size 0.60). Changes in TLF thickness were not statistically significant (p > 0.05). The PT group demonstrated significantly lower VAS scores than the control group (mean difference - 0.626, 95% CI -1.087 to -0.165, p = 0.009, effect size 0.63). RMQ scores decreased by -1.3 (95% CI -2.1 to -0.4, p < 0.01, effect size 0.5). Conclusion Six weeks of percussive massage therapy significantly reduced thoracolumbar fascia echo intensity, alleviated pain, and improved functional disability in firefighters with chronic non-specific low back pain, but was not effective in altering fascia thickness. Percussive massage therapy emerges as an effective and safe strategy for managing chronic non-specific low back pain in firefighters. Trial registration Retrospectively registered in Thai Clinical Trials Registry (TCTR20221223001) on December 22, 2022.
... Using the G*power sample size (3.1.9.2) tool, the necessary sample size for the study was calculated to be 52 with 80% power (α = 0.05) and effect size (d = 0.80) [25]. The statistical analysis was conducted using SPSS version 22.0 (IBM Corp., Chicago, IL, USA). ...
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Background Pain and edema in the legs are the most common problems in pregnancy. This study examined the effect of percussion massage therapy applied to the lower extremities on pain, edema, and quality of life in pregnant women. Methods Sixty pregnant women between 24 and 36 weeks of pregnancy were included in the study. Pregnant women were randomly divided into two groups: the percussion massage treatment (PMT) group (n = 30) and the control group (n = 30). Twelve sessions of percussive massage therapy were administered to the bilateral medial gastrocnemius, lateral gastrocnemius, peroneus longus, and tibialis anterior muscles of pregnant women included in the PMT group, three times a week for four weeks. The lower extremities of the pregnant women in the control group did not get any massage therapy. A Visual Analog Scale (VAS) was used to assess pain. A tape measure was used to measure the ankle, knee, and thigh circumference. The Fatigue Severity Scale (FSS) was used to evaluate fatigue, and the Short Form-36 (SF-36) was used to assess quality of life. Results When comparing pre-treatment and post-treatment results within each group, statistically significant differences were found in both groups in terms of right/left ankle, knee, and thigh circumference measurements, and SF-36 physical function (PF) measurements (p < 0.05). When the difference measurements between the groups were compared, a statistically significant improvement in the PMT group was detected in VAS (p = 0.000), right/left ankle (p = 0.002/p = 0.006) and right/left hip circumference measurements (p = 0.006/p = 0.008), FSS (p = 0.009), and SF-36-role emotional (RE) (p = 0.000), mental health (MH) (p = 0.005), social function (SF) (p = 0.005), and body pain (BP) (p = 0.003) measurements. Conclusions PMT was more effective than the control group in parameters such as pain, ankle and thigh circumference measurements, fatigue, and some sub-parameters of quality of life. PMT could be preferred to enhance the quality of life of pregnant women by improving parameters like pain, edema, and fatigue. Clinical Trial Registration The study protocol was registered at ClinicalTrials.gov https://clinicaltrials.gov/ (NCT06338254).
Article
Therapeutic devices are increasingly used by therapists and horse owners. Percussive therapy (PCT) has been shown to effect blood flow, tissue oxygenation, increase range of motion (ROM) and improve recovery in humans. The aims of this study were to investigate the immediate effects of PCT on horses. Using a within-subjects randomised blinded cross-over design, twelve polo horses in training received two 12-min PCT sessions to the major superficial muscle groups, with the device on or off, 24-h apart. Pre- and post-intervention or sham sessions epaxial muscle mechanical nociceptive thresholds (MNT) and thoracic (T) profile dimensions were measured. Each horse performed four in-hand trot passes where spinal kinematics and gait symmetry were measured with inertial measurement units, plus stride length was analysed via 2D video recordings. There were no significant differences between MNT measures. Within the sham group, thoracic profile was significantly different pre and post at T18 (mean change -0.48 cm ± 1.03; ) and in the intervention group, there was a significant difference between the pre and post at T13 (mean change = −0.76 cm ± 1.35). There was no significant difference in stride length or gait symmetry at the poll, withers, and pelvis but differences in T6, T13, L3 and sacrum ROM in the sham group and T6 and T18 in the intervention group were seen. Overall, the application of PCT did not result in MNT or stride length changes in the intervention group when compared to the sham scenario although there were minor changes to thoracolumbar profile and spinal ROM. Further research assessing walk kinematics, ridden horse performance are recommended, along with assessing different PCT applications and other variables such as blood flow and neurophysiological responses that affect behaviour.
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Objective Massage is ubiquitous in elite sport and increasingly common at amateur level but the evidence base for this intervention has not been reviewed systematically. We therefore performed a systematic review and meta-analysis examining the effect of massage on measures of sporting performance and recovery. Design and eligibility We searched PubMed, MEDLINE and Cochrane to identify randomised studies that tested the effect of manual massage on measures of sporting performance and/or recovery. We performed separate meta-analyses on the endpoints of; strength, jump, sprint, endurance, flexibility, fatigue and delayed onset muscle soreness (DOMS). Results We identified 29 eligible studies recruiting 1012 participants, representing the largest examination of the effects of massage. We found no evidence that massage improves measures of strength, jump, sprint, endurance or fatigue, but massage was associated with small but statistically significant improvements in flexibility and DOMS. Conclusion Although our study finds no evidence that sports massage improves performance directly, it may somewhat improve flexibility and DOMS. Our findings help guide the coach and athlete about the benefits of massage and inform decisions about incorporating this into training and competition.
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The term “self-myofascial release” is ubiquitous in the rehabilitation and training literature and purports that the use of foam rollers and other similar devices release myofascial constrictions accumulated from scar tissue, ischaemia-induced muscle spasms and other pathologies. Myofascial tone can be modulated with rollers by changes in thixotropic properties, blood flow, and fascial hydration affecting tissue stiffness. While rollers are commonly used as a treatment for myofascial trigger points, the identification of trigger points is reported to not be highly reliable. Rolling mechanisms underlying their effect on pain suppression are not well elucidated. Other rolling-induced mechanisms to increase range of motion or reduce pain include the activation of cutaneous and fascial mechanoreceptors and interstitial type III and IV afferents that modulate sympathetic/parasympathetic activation as well as the activation of global pain modulatory systems and reflex-induced reductions in muscle and myofascial tone. This review submits that there is insufficient evidence to support that the primary mechanisms underlying rolling and other similar devices are the release of myofascial restrictions and thus the term “self-myofascial release” devices is misleading.
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Introduction: The therapeutic effects of local muscle vibration (LMV) remain controversial due to a lack of specific protocols. This review was conducted to better understand the effects of various LMV application protocols. Methods: A comprehensive literature search was performed based on title and abstract and a set of predetermined inclusion criteria. Study quality was then evaluated via the PEDro scale. Results: 23 articles were returned initially, and 21 studies were evaluated. The average PEDro score was 5.97/10. Reported outcome measures included muscle activation, strength, power, and range of motion / flexibility. The frequency and amplitude of LMV ranged from 5 - 300 Hz and 0.12-12 mm respectively, and duration from 6 seconds - 30 minutes. Conclusion: Most studies found that LMV elicits beneficial changes in the mentioned outcome measures. However, the methodological procedures used are quite heterogeneous. Further research is needed to understand the optimal application of LMV.
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The purpose of this study was to investigate the time course of the changes of muscle-tendon mechanical properties and the function responses of the plantar flexor muscles following 5 × 60 s of static stretching. Fourteen healthy volunteers were tested on four separate days in a random order with three different rest times (0, 5, 10 min) after 5 × 60 s of stretching or following a control period without stretching. During each test, the dorsiflexion range of motion (RoM), passive resistive torque (PRT), and maximum voluntary contraction (MVC) were measured with a dynamometer. Ultrasonography of the gastrocnemius medialis (GM) muscle-tendon junction displacement and motion capture allowed us to determine the length changes in the tendon and muscle, respectively, and hence to calculate their stiffness. We observed an increase in RoM and decrease in MVC at 0, 5, and 10 min post-stretching. This could be attributed to an increase in muscle elongation which lasted at least 10 min. A decrease in muscle-tendon stiffness was observed immediately, but not 5 or 10 min after the stretching. A decrease in PRT and muscle stiffness was observed up to 5 min after the stretching. No changes were detected in tendon stiffness or in any variable in the control group. The effects of a 5 × 60 s static stretching exercise changes the muscle-tendon functions (RoM, MVC), which are related to mechanical changes of the muscle but not the tendon structure, respectively. Although the functional changes last for at least 10 min, changes in muscle stiffness were only observed up to 5 min after the stretching exercise.
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Both athletic and nonathletic population when subjected to any unaccustomed or unfamiliar exercise will experience pain 24-72 hours postexercise. This exercise especially eccentric in nature caused primarily by muscle damage is known as delayed-onset muscle soreness (DOMS). This damage is characterized by muscular pain, decreased muscle force production, reduce range of motion and discomfort experienced. DOMS is due to microscopic muscle fiber tears. The presence of DOMS increases risk of injury. A reduced range of motion may lead to the incapability to efficiently absorb the shock that affect physical activity. Alterations to mechanical motion may increase strain placed on soft tissue structures. Reduced force output may signal compensatory recruitment of muscles, thus leading to unaccustomed stress on musculature. Differences in strength ratios may also cause excessive strain on unaccustomed musculature. A range of interventions aimed at decreasing symptoms of DOMS have been proposed. Although voluminous research has been done in this regard, there is little consensus among the practitioners regarding the most effective way of treating DOMS. Mechanical oscillatory motion provided by vibration therapy. Vibration could represent an effective exercise intervention for enhancing neuromuscular performance in athletes. Vibration has shown effectiveness in flexibility and explosive power. Vibration can apply either local area or whole body vibration. Vibration therapy improves muscular strength, power development, kinesthetic awareness, decreased muscle sore, increased range of motion, and increased blood flow under the skin. VT was effective for reduction of DOMS and regaining full ROM. Application of whole body vibration therapy in postexercise demonstrates less pressure pain threshold, muscle soreness along with less reduction maximal isometric and isokinetic voluntary strength and lower creatine kinase levels in the blood.
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Warm-up is an essential component for optimizing performance before an exercise session. This study investigated that the immediate effects of vibration rolling (VR), nonvibration rolling (NVR), and static stretching as a part of a warm-up regimen on the flexibility, knee joint proprioception, muscle strength, and dynamic balance of the lower extremity in young adults. Compared with the preintervention, VR induced the range of motion of knee flexion and extension significantly increased by 2.5% and 6%, respectively, and isokinetic peak torque and dynamic balance for muscle strength and dynamic balance increased by 33%–35% and 1.5%, respectively. In the three conditions, most outcomes between VR and NVR were comparable; however, the participants had a significantly higher knee joint reposition error after NVR than after VR, indicating that NVR would have a hampering knee joint proprioception effect. In particular, compared with static stretching, VR significantly increased the quadriceps muscle strength by 2-fold and dynamic balance by 1.8-fold. These findings suggest that athletic professionals may take VR into account for designing more efficient and effective preperformance routine to improve exercise performances. VR has high potential to translate into an on-field practical application.
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Background: The use of foam rollers to provide soft-tissue massage has become a common intervention among health and fitness professionals. Recently, manufacturers have merged the science of vibration therapy and foam rolling with the development of vibrating foam rollers. To date, no peer reviewed investigations have been published on this technology. Purpose: The purpose of this study was to compare the effects of a vibrating roller and non-vibrating roller intervention on prone knee flexion passive range of motion (ROM) and pressure pain thresholds (PPT) of the quadriceps musculature. Methods: Forty-five recreationally active adults were randomly allocated to one of three groups: vibrating roller, non-vibrating roller, and control. Each roll intervention lasted a total of 2 minutes. The control group did not roll. Dependent variables included prone knee flexion ROM and PPT measures. Statistical analysis included parametric and non-parametric tests to measure changes among groups. Results: The vibrating roller demonstrated the greatest increase in PPT (180kPa, p< 0.001), followed by the non-vibrating roller (112kPa, p< 0.001), and control (61kPa, p<0.001). For knee ROM, the vibrating roller demonstrated the greatest increase in ROM (7 degrees, p< 0.001), followed by the non-vibrating roller (5 degrees, p< 0.001), and control (2 degrees, p<0.001). Between groups, there was significant difference in PPT between the vibrating and non-vibrating roller (p=.03) and vibrating roller and control (p<.001). There was also a significant difference between the non-vibrating roller and control (p<.001). For knee ROM, there was no significant difference between the vibrating and non-vibrating roller (p=.31). A significant difference was found between the vibrating roller and control group (p<.001) and non-vibrating roller and control (p<.001). Conclusion: The results suggest that a vibrating roller may increase an individual's tolerance to pain greater than a non-vibrating roller. This investigation should be considered exploratory and a starting point for future research on this technology.
Article
Using ultrasound shear wave elastography, the aims of this study were: (a) to evaluate the effect of massage on stiffness of the medial gastrocnemius (MG) muscle and (b) to determine whether this effect (if any) persists over a short period of rest. A 7-min massage protocol was performed unilaterally on MG in 18 healthy volunteers. Measurements of muscle shear elastic modulus (stiffness) were performed bilaterally (control and massaged leg) in a moderately stretched position at three time points: before massage (baseline), directly after massage (follow-up 1), and following 3 min of rest (follow-up 2). Directly after massage, participants rated pain experienced during the massage. MG shear elastic modulus of the massaged leg decreased significantly at follow-up 1 (-5.2 ± 8.8%, P = 0.019, d = -0.66). There was no difference between follow-up 2 and baseline for the massaged leg (P = 0.83) indicating that muscle stiffness returned to baseline values. Shear elastic modulus was not different between time points in the control leg. There was no association between perceived pain during the massage and stiffness reduction (r = 0.035; P = 0.89). This is the first study to provide evidence that massage reduces muscle stiffness. However, this effect is short lived and returns to baseline values quickly after cessation of the massage. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.