A critical evaluation of percussion massage gun devices as a rehabilitation tool focusing on lower limb mobility: A literature review
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Abstract
Aims In recent years there has been a significant rise in the popularity of muscle gun devices. However, the current research regarding handheld muscle gun devices is unclear. Therefore, this literature review will explore the current literature regarding the effect of muscle gun device on lower limb range of motion, muscle activation, force output and the possibility of reducing delayed onset muscle soreness. Methods Four databases were used along with two academic search engines to search for studies that satisfied the inclusion criteria. To fulfil the inclusion criteria studies had to be of a pre-post design with a focus on the use of percussion massage devices on lower limbs. Studies exploring range of motion and muscle force output were of particular interest. Results Thirty-nine included studies were used in this literature review. It was found that handheld percussive massage devices are the most effective method of increasing lower limb range of motion compared to foam rolling and other self-myofascial protocols. The use of handheld percussive massage devices directly after exercise reduces delayed onset muscle soreness. However, there was no reported significant increase in muscle activation or force output following the usage of a handheld percussive massage device. Conclusion The use of muscle gun devices is recommended as part of a structured warm-up pre-exercise due to an increase in range of motion, reduction in perceived muscle soreness whilst having no negative impact on muscle activation and force output. Muscle guns may also be implemented as part of a rehabilitation programme post injury due to their ability to increase range of motion and reduce perceived pain and muscle soreness.
... Similar to foam rolling, percussion massage is a form of vibrational therapy that falls under the grouping of self-myofascial release modalities [39]. Vibrational therapy in this context refers to a hand-held piece of equipment called a percussion massage gun that massages the muscle by rapidly vibrating the muscle using different attachments meant to target different muscles or connective tissues [40].Vibrational therapy has been shown to improve range of motion and increase muscle performance (horizonal jumping, t-test, balance, peak torque) by 4-7% [41,42]. ...
... Vibrational therapy in this context refers to a hand-held piece of equipment called a percussion massage gun that massages the muscle by rapidly vibrating the muscle using different attachments meant to target different muscles or connective tissues [40].Vibrational therapy has been shown to improve range of motion and increase muscle performance (horizonal jumping, t-test, balance, peak torque) by 4-7% [41,42]. Multiple studies have found that using vibrational therapy pre-exercise leads to no change in performance testing, force output, or muscle activation [11,39,40,43,44]. Due to the mixed results of previous research, it is still unclear if percussion massage influences performance in a positive way or not at all. ...
... For percussion massage, the results of this study build upon previous research [11,39,43,44]. There were no changes in performance testing, force output, or muscle activation following percussion massage. ...
Prior to training, many athletes perform different soft-tissue preparation protocols. Many of these protocols involve stretching, foam rolling, and/or percussion massage. Many of these modalities have been studied, but not as a group to observe muscle alterations and differences in males and females. In total, 40 (20 males, 20 females) participants performed five minutes of static stretching, foam rolling, and percussion massage. Pre- and post-isometric leg strength, muscle activation and ultrasound assessments (cross-sectional area, echo intensity, pennation angle, fascicle length, and muscle thickness) were taken. The results indicate that there is no significant difference among modalities, and that they do not significantly alter any muscle characteristic or improve performance. There is a significant difference in size between males and female, with males having larger muscle and greater pennation angles than females. This allows males to generate significantly more muscle force. However, they both respond similarly to each modality. In conclusion, the muscle response to static stretching, foam rolling, and percussion massage do not differ among modalities and do not contribute to an increase or decrease in maximal isometric knee extension with similar effects between males and females.
... 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). ...
... This would set a standard for consistency in future research, allow analysis across populations and enable researchers and practitioners to develop targeted interventions to promote improvements in flexibility. This analysis of protocols should focus on the speed (rpm), depth (mm) and choice of head attachment, together with the application time of PT (min), the intervention length and the impact of multiple treatments (Martin, 2021;Sams et al., 2023). ...
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.
... PM applied on the paravertebral muscles didn't positively stimulate the lumbar range of motion but enhanced perceived stiffness and boosted temperature in the region [6]. Contrary to this finding, a relatively high number of recently published studies support the claim that PM increases flexibility and joint range of motion [1,[7][8][9][10][11][12]. Other research study reports a positive effect on muscular performance during the bench press exercise [13], which does not correspond with the finding of Konrad et al. [1]. ...
... Other research study reports a positive effect on muscular performance during the bench press exercise [13], which does not correspond with the finding of Konrad et al. [1]. The positive impact of PM on pain management is reported as well [7]. Handheld percussion devices have also become popular in warm-up routines aiming for performance improvement but without significant evidence [14]. ...
Background
Recently, the usage of percussive vibration machines in physiotherapy and sports has increased rapidly. Numerous manufacturers claim they can enhance physical performance. However, there is minimal peer-reviewed research on their efficacy. Therefore, this study aimed to investigate the effect of percussion massage (PM) on muscular performance, particularly explosive strength and balance. Moreover, this is the first study to evaluate the potential PM impact on balance.
Materials and methods
18 young male participants aged 20.89 ± 3.43 years with a BMI of 25.08 ± 3.95 completed three measurements with two interventions - PM by Theragun device (TG), activation massage (AM), and assessment without activation (WA). The targeted area was m. triceps surae, hamstrings, and m. quadriceps femoris of the dominant leg. Single-leg squat jump (SJ), countermovement jump (CMJ), and Y-balance tests (YBT) were performed. One-Way Repeated Measures ANOVA was utilized to analyze the data. The level significance threshold was set to p ≤ 0.05.
Results
No statistically significant difference was reported between TG, AM, and WA in the height of the squat jump and countermovement jump (p > 0.05). Furthermore, no significant changes were recorded in the YBT performance score (p > 0.05).
Conclusions
No improvement was reported in the monitored physical parameters when the PM by Theragun or manual AM was applied for 90 s right before the muscular performance. Therefore, we do not recommend the short-term stimulative application of PM and AM before athletic performance when lower limb explosive strength or balance improvements are the objective.
... In recent years, home massage devices have increased in popularity with the aim of relieving tightness or pain [3]. This further highlights the need to highlight the dangers of misusing such devices and encourage safe usage. ...
... There is an increased popularity of the use of home-massage equipment in recent years with the aim of relieving tightness or pain [3,5]. Moreover, there is a wide range of handheld massage devices nowadays, and every single one has its unique massaging techniques and price. ...
Vertebral artery dissection (VAD) is a common cause of stroke in middle-aged individuals. Patients with VAD usually describe a trivial minor neck trauma preceding the event. Such traumas may be associated with spinal manipulation or sudden movements of the neck. Our case is a 43-year-old lady who presented with a history of sudden-onset dizziness, dysarthria, nausea/vomiting, tinnitus, and imbalance. Two days prior to her presentation, she experienced a new-onset moderate to severe intensity headache along with neck pain. The patient mentioned a first-time use of a home massage device three weeks prior to headache onset. After investigations, the patient was diagnosed with VAD, and treatment was initiated. She was discharged in stable condition. With the recent increased popularity of home massage devices, we report this case to raise awareness about the safe use of massage devices in order to prevent the occurrence of such injuries and complications.
... 3 Percussive therapy is reported to increase blood flow, improve range of motion, aid in myofascial release, and decrease muscle soreness and inflammation. 3,18,19 Therefore, it is unsurprising that a majority of respondents noted a consideration for their use in preparation for physical activity and treatment of chronic muscle/soft tissue pain. Consideration for the use of this intervention in recovery from physical activity approached the identified threshold, suggesting it also could be a valuable tool in certain circumstances. ...
Background
Therapeutic interventions are widely used in clinical practice to prepare individuals for movement, recover from exercise, and mediate pain and inflammation associated with injury. However, there has yet to be cited consensus regarding when to use such interventions.
Purpose
Using the Delphi method, this study aimed to develop consensus among physical therapists (PTs) and athletic trainers (ATs) regarding the use of percussive, vibration, infrared, heat, and cryotherapy in a variety of treatment circumstances. These included preparation and recovery from physical activity, treatment of acute and chronic joint pain, and treatment of acute and chronic soft tissue/muscle pain.
Methods
Four rounds of surveys were delivered to individuals who were licensed or certified PTs/ATs, with more than 1,000 hours of experience working with athletic populations and experience using at least one of the interventions of interest in the prior five years. Consensus was defined as a greater than 70% agreement, and consideration for use was defined as selecting “In Some Instances’’ and”In Most Instances.”
Results
Ninety-four individuals responded to the screening survey (n 1 = 74, n 2 = 68, n 3 = 44, n 4 = 32). The individuals who participated agreed that they would consider using the following therapeutic interventions in treatment: 1) percussive therapy, local vibration, and local heat therapy in the preparation for physical activity; 2) local cryotherapy in recovery from physical activity; 3) local cryotherapy for the treatment of acute joint pain and acute soft tissue/muscle pain; 4) local heat and local cryotherapy for the treatment of chronic joint pain; and 5) percussive, local vibration, local heat, and local cryotherapy in the treatment of chronic soft tissue/muscle pain.
Conclusion
Clinical intervention often relies on patient presentation and preference. This study provides a consensus on the use of common therapeutic interventions for the management of athletic recovery, pain, and inflammation among ATs and PTs.
Level of Evidence
3
... For instance, female collegiate athletes exhibited increased vertical jump heights and reduced muscle soreness following massage treatments [12]. Notably, while one literature review indicated that percussive massage devices effectively enhanced lower limb range of motion and alleviated DOMS, they did not demonstrate a significant effect on muscle activation or force output [13]. Furthermore, sports massages have been shown to expedite muscle recovery in individuals suffering from DOMS [14]. ...
... While some recovery strategies such as stretching and active recovery require little to no equipment, in recent years there has been a proliferation of equipment-based recovery strategies. These include compression garments, massage guns and intermittent pneumatic compression (IPC) devices, which are purported to reduce perceived muscle soreness, enhance the removal of blood lactate after exercise and improve lower limb mobility ( (Lee et al., 2020) Lee et al., 2021;Overmayer & Driller, 2018;Martin, 2021). However, the empirical evidence for the effectiveness of such devices for functional recovery in endurance athletes is often limited. ...
Background
To minimise the deleterious effects of fatigue and muscle soreness and maintain availability for training and competition, triathletes may implement recovery strategies that act on various physiological, biomechanical, neurological or psychological domains. However, the use of common recovery strategies is yet to be investigated in this population.
Methods
322 triathletes (109 female, 212 male) of varying competition levels from 39 countries participated in the current study. Participants completed an anonymous online survey to determine their use and perceived effectiveness of various recovery strategies. Multiple chi-square tests were conducted to examine the association between training week type (normal vs post-competition), preferred event distance (short or long course), competition level and use of recovery strategies.
Results
The most frequently used recovery strategies during normal training weeks were active recovery (51%), stretching (47%) and additional sleep (32%), while foam rolling (35%), massage guns (20%) and compression garments (19%) were the most commonly used recovery devices. The use of active recovery, additional sleep and professional massage was significantly (p = <.002) more common in the week following a competitive event than during a normal training week. Long course triathletes were more likely to use intermittent pneumatic compression (IPC) devices (p = .008) and hydrotherapy (p = .05) than were short-course triathletes.
Conclusion
Active recovery, additional sleep and stretching are the preferred recovery choices for triathletes of all levels, though the use of foam rolling, massage guns and compression garments is common in this population. Active recovery, additional sleep and professional massage are more frequently used by triathletes in the week following a competitive event and are perceived to be the most effective recovery strategies overall.
The utilization of percussion theory with the help of (hand held massager or prominently known as hand gun) has become progressively well known as of late. In spite of the fact that their utilization is increasingly normal, both in a clinical and sports setting, there is still little data to direct the experts. This survey planned to decide the impacts of percussion therapy in as pre-and post-action or part of a treatment.
Information sources utilized were Pub Med, PEDro, Scopus, Claviate, Medline, Web of Science and Google Researcher. At first, 170 records were screened, out of which 16 could be incorporated with considerate inclusion and exclusion criteria. Fifteen had a moderate gamble of predisposition and one a high gamble of inclination.
In strength, balance, speed increase, endurance, it either didn't have upgrades or it even showed a decline in execution. In the recuperation related results, percussion gun were demonstrated to be practical instruments for firmness decrease.
# Background
There is a lack of specific research on the effect of percussive therapy (PT) delivered by massage guns on physiological adaptations. This systematic literature review investigates research conducted on the effects of PT interventions on performance in strength and conditioning settings, and on experiences of musculoskeletal pain.
# Purpose
To determine the effect of PT delivered by massage guns on physiological adaptations: muscle strength, explosive muscle strength and flexibility, and experiences of musculoskeletal pain.
# Study Design
Systematic literature review.
# Methods
Data sources (CINAHL, Cochrane Library, Psychinfo, PubMed, SportDISCUS and OpenGrey) were searched from January 2006 onwards for full text literature in any language involving adult populations receiving PT delivered by massage guns, directly to any muscle belly or tendon, with comparisons to an alternative treatment, placebo or no treatment. Literature with outcomes relating to acute or chronic physiological adaptations in muscle strength, explosive muscle strength, flexibility or experiences of musculoskeletal pain were included. Articles were assessed for quality using the Critical Appraisal Skills Programme and PEDro scores.
# Results
Thirteen studies met the inclusion criteria. All studies had limitations in methodological quality or reporting of findings but still included contextually-rich details that contributed to the overall narrative synthesis. A significant relationship was found between a single application of PT delivered by massage guns and an acute increase in muscle strength, explosive muscle strength and flexibility, with multiple treatments eliciting a reduction in experiences of musculoskeletal pain.
# Conclusion
PT delivered by massage guns can help improve acute muscle strength, explosive muscle strength and flexibility, and reduce experiences of musculoskeletal pain. These devices may provide a portable and cost-effective alternative to other forms of vibration and interventions.
Objective: The aim of our study is to investigate the effect of percussion massage applied to the quadriceps muscle with a Hypervolt device on range of motion (ROM), jumping, agility and anaerobic performance.
Material and Methods: Total of 24 (41.7% female, 58.3% male) healthy individuals with mean age of 22.04±1.19 years participated in the study. A cross-randomization method with a 72-hour washout period was used throughout the study. Percussion massage (Hyperice, California, USA) was applied to the dominant quadriceps muscle of the participants lying in the supine position for 8 minutes at a frequency of 30 Hz using the flat head of the Hypervolt device. ROM, vertical jump, T Drill Test and Wingate anaerobic performance tests (WAnT) were evaluated.
Results: Hip flexion ROM of the participants increased significantly after percussion massage with Hypervolt (p=0.02). There was no significant difference in vertical jump and T Drill Test results and ROM measurements other than hip flexion after percussion massage with Hypervolt (p˃0.05). WAnT results were found to be decreased (p<0.05).
Conclusion: While percussion massage device has positive effects on joint range of motion, they have no effect on jumping and agility performance. However, there was a decrease in anaerobic power output. Percussion devices such as Hypervolt which are utilized for warming up may reduce anaerobic performance.
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