Content uploaded by Andreas Konrad
Author content
All content in this area was uploaded by Andreas Konrad on Oct 05, 2020
Content may be subject to copyright.
©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
`
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.
References
Behm, D. G. (2018) The Science and Physiology of Flexibility and
Stretching: Implications and Applications in Sport Performance
and Health. London, UK: Routledge Publishers.
Behm, D. G. and Wilke, J. (2019) Do Self-Myofascial Release Devices
Release Myofascia? Rolling Mechanisms: A Narrative Review.
Sports Medicine. 49, 1173–1181.
Cheatham, S. W., Stull, K. R. and Kolber, M. J. (2019) Comparison of a
vibration roller and a nonvibration roller intervention on knee
range of motion and pressure pain threshold: A randomized
controlled trial. Journal of Sport Rehabilitation 28(1), 39–45.
Cohen, J. (1988) Statistical Power Analysis for the Behavioral Sciences
Second Edition. Hillsdale: Erlbaum.
Davis, H. L., Alabed, S. and Chico, T. J. A. (2020) Effect of sports
massage on performance and recovery: a systematic review and
meta-analysis. BMJ Open Sport & Exercise Medicine 6(1),
e000614.
Eriksson Crommert, M., Lacourpaille, L., Heales, L. J., Tucker, K. and
Hug, F. (2015). Massage induces an immediate, albeit short-
term, reduction in muscle stiffness. Scandinavian Journal of
Medicine and Science in Sports 25(5), e490–e496.
Fallon, J. B. and Macefield, V. G. (2007) Vibration sensitivity of human
muscle spindles and golgi tendon organs. Muscle and Nerve
36(1), 21–29.
Faul, F., Erdfelder, E., Buchner, A. and Lang, A.-G. (2009) Statistical
power analyses using G*Power 3.1: tests for correlation and
regression analyses. Behavior Research Methods 41(4), 1149–
1160.
Germann, D., El Bouse, A., Shnier, J., Abdelkader, N. and Kazemi, M.
(2018) Effects of local vibration therapy on various performance
parameters: A narrative literature review. Journal of the
Canadian Chiropractic Association 62(3), 170–181.
Konrad, A., Reiner, M. M., Thaller, S. and Tilp, M. (2019) The time
course of muscle-tendon properties and function responses of a
five-minute static stretching exercise. European Journal of Sport
Science 19, 1195-1202.
Kujala, R., Davis, C. and Young, L. (2019) The effect of handheld
percussion treatment on vertical jump height. International
Journal of Exercise Science: Conference Proceedings 8(7). 75.
Lee, C. L., Chu, I. H., Lyu, B. J., Chang, W. D. and Chang, N. J. (2018)
Comparison of vibration rolling, nonvibration rolling, and static
stretching as a warm-up exercise on flexibility, joint
proprioception, muscle strength, and balance in young adults.
Journal of Sports Sciences 36(22), 2575–2582.
Veqar, Z. and Imtiyaz, S. (2014) Vibration Therapy in Management of
Delayed Onset Muscle Soreness (DOMS). Journal Of Clinical
and Diagnostic Research 8(6), LE01-LE4.
Weerapong, P., Hume, P. A. and Kolt, G. S. (2005). The mechanisms of
massage and effects on performance, muscle recovery and injury
prevention. Sports Medicine 35, 235–256.
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