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Mechanical Percussion Devices: A Survey of Practice Patterns Among Healthcare Professionals

June 2021
International Journal of Sports Physical Therapy 16(3):766-777

DOI:10.26603/001c.23530

License
CC BY-NC-ND 4.0

Authors:

Scott W. Cheatham

California State University, Dominguez Hills

Russell T. Baker

University of Idaho

David Behm

Memorial University of Newfoundland

Kyle Stull

Concordia University- Chicago

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# Background Mechanical percussion devices have become popular among sports medicine professionals. These devices provide a similar effect as manual percussion or tapotement used in therapeutic massage. To date, there are few published studies or evidence-based guidelines for these devices. There is a need to understand what professionals believe about this technology and how they use these devices in clinical practice. # Purpose To survey and document the knowledge, clinical application methods, and use of mechanical percussion devices among healthcare professionals in the United States. # Design Cross-sectional survey study. # Methods A 25 question online survey was emailed to members of the National Athletic Trainers Association, Academy of Orthopedic Physical Therapy, and American Academy of Sports Physical Therapy. # Results Four hundred twenty-five professionals completed the survey. Most professionals (92%, n=391) used devices from two manufacturers: Hyperice® and Theragun®. Seventy-seven percent directed clients to manufacturer and generic websites (n=329) to purchase devices. Most respondents used a medium and low device speed setting for pre- and post-exercise (62%, n=185), pain modulation (59%, n=253), and myofascial mobility (52%, n=222). A large proportion of respondents preferred a total treatment time between 30 seconds and three minutes (36-48%, n=153-204) or three to five minutes (18-22%, n=76-93). Most respondents (54-69%, n=229-293) believed that mechanical percussion increases local blood flow, modulates pain, enhances myofascial mobility, and reduces myofascial restrictions. Most respondents (72%, n=305) were influenced by other colleagues to use these devices. Sixty-six percent used patient reported outcomes (n=280) to document treatment efficacy. Live instruction was the most common mode of education (79%, n=334). # Conclusion These results are a starting point for future research and provide insight into how professionals use mechanical percussion devices. This survey also highlights the existing gap between research and practice. Future research should examine the efficacy of this technology and determine consensus-based guidelines. # Level of Evidence 3

The Hyperice Hypervolt (Hyperice, Inc, Irvine, CA) mechanical percussion device.

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Various application tips for mechanical percussion.

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Figures - uploaded by Scott W. Cheatham

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Content uploaded by Scott W. Cheatham

Content may be subject to copyright.

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Mechanical Percussion Devices: A Survey of Practice Patterns

Among Healthcare Professionals

Scott W Cheatham, Ph.D., DPT, PT, OCS, ATC, CSCS

1 a , Russell T Baker, PhD, DAT, AT, CMP, PRT-c®

, David G Behm,

PhD

, Kyle Stull, DHSc, MS, LMT, CSCS, NASM-CES

, Morey J Kolber, PT, PhD, OCS

1 California State University Dominguez Hills, 2 University of Idaho, 3 Memorial University of Newfoundland, 4 National Academy of Sports Medicine, 5

Nova Southeastern University

Keywords: massage, muscle soreness, perceived pain, recovery, tapotement

https://doi.org/10.26603/001c.23530

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Cheatham SW, Baker RT, Behm DG, Stull K, Kolber MJ. Mechanical Percussion Devices:

A Survey of Practice Patterns Among Healthcare Professionals. IJSPT.

2021;16(3):766-777.

Level of Evidence

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Figure 1: The Hyperice Hypervolt (Hyperice, Inc,

Irvine, CA) mechanical percussion device.

Figure 2: Various application tips for mechanical

percussion.

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H7KEI7D77>;?;@3F76,:;EE75F;A@6;E5GEE7EF:7?3<AD;FKA8

D7EBA@67@F3@EI7DE8AD735:CG7EF;A@I;F:;@F:7F:D776;E

F;@5FEGDH7K3D73EGE;@9DAG@676H3>G7E8AD73E7A8;@F7DBD7

F3F;A@?AD7 67F3;>76 67E5D;BF;A@A8D7EBA@67@F3@EI7DE

53@478AG@6;@,34>7E

*+)('',&( *)!"+'&!'"%

)*-++"('."+

;8FK@;@7 B7D57@F @ A8 D7EBA@67@FE I7D7 ?7@ 3@6

 @ I7D7 IA?7@ ;8FKFIA B7D57@F @ D7

BADF7647;@9357DF;S763F:>7F;5FD3;@7D@3B:KE

;53>F:7D3B;EF35:;DABD35FAD3B7DEA@3>FD3;@7D3@6

 D7BADF76 :3H;@9 3 ?76;53> 679D77 AD AF:7D 5D767@F;3>

EG5:3E?3EE397 F:7D3B;EF  EG4EF3@F;3> BDABADF;A@A8D7

EBA@67@FED7BADF76IAD=;@9;@3@AGFB3F;7@F835;>;FK

@ADG@;H7DE;FKE7FF;@9@,:7D7BADF763H

7D397 K73DE ;@ BD35F;57 I3E 3BBDAJ;?3F7>K K73DE ,34>7



&75:3@;53>)7D5GEE;A@7H;57E+GDH7KA8)D35F;57)3FF7D@E?A@9!73>F:53D7)DA87EE;A@3>E

International Journal of Sports Physical Therapy

Table 1: Demographics and devices (N=425)

   #&







  & !!

















  & "!""













 ! "

KH40AB

&  !$!#! "











   #!!" "!













% "!  ""# !$!









/

*7EBA@67@FE5:AE73>>ABF;A@EF:3F3BB>;76FAF:7?&&76;53>A5FAD(A5FADA8(EF7AB3F:K)&A5FADA8)A6;3FD;5&76;5;@7

"0;4

4<0;4

%A454A=>CC>0=BF4A

%7HB820;)74A0?8BC

78A>?A02C>A

4AC8N43C7;4C82)A08=4A

$22D?0C8>=0;)74A0?8BC

"0BB064)74A0?8BC

4AC8N43%4AB>=0;)A08=4A

"%"$

$C74A

$DC?0C84=C5028;8CH

>B?8C0;10B435028;8CH

*=8E4AB8CHB?>ACB<43828=4>A0C7;4C82CA08=8=65028;8CH

867B27>>;0C7;4C82CA08=8=65028;8CH

8C=4BB>AF4;;=4BB5028;8CH

$C74A

E4A064H40AB8=?A>54BB8>=0;?A02C824

H?4A824JH?4AE>;C

)74A06D=J>A868=0;(%A>

)8<)0<%>F4A"0BB064AM

A05CD=

$C74A2><<4A280;34E824B

!0A64A>D=310;;

(<0;;A>D=310;;

;0CC8?

D;;4C>A2>=4C8??>8=CH

>A:

$C74AC8?B

"0=D502CDA4AF41B8C4

4=4A82F41B8C446<0I>=

(C>A41A82:0=3<>AC0A

(4;;8=<H5028;8CH

3>=LCA42><<4=3

&AEFD7EBA@67@FED7BADF76GE;@9?75:3@;53>B7D5GEE;A@

67H;57E 8DA? F:7 ?3@G835FGD7DE !KB7D;57M  @

3@6,:7D39G@M@,:7?AEFBABG>3D3BB>;53FAD

F;BEGE76I7D7F:7E?3>>DAG@643>> @ 3@6>3D97

DAG@6 43>>  @ F;BE *7EBA@67@FE ?AEF A8F7@ 6;

D75F76 5>;7@FE FA ?3@G835FGD7DE I74E;F7E  @ AD

97@7D;5I74E;F7E@FABGD5:3E767H;57E8ADE7>8

53D7,34>7

&75:3@;53>)7D5GEE;A@7H;57E+GDH7KA8)D35F;57)3FF7D@E?A@9!73>F:53D7)DA87EE;A@3>E

International Journal of Sports Physical Therapy

Table 2: Clinical application: pre and post-exercise intervention (N=425)

 #!!!$!   pre-exercise!#!' !  #&











 #!!"!   pre-exercise













%!"!"$$ pre-exercise













 #!!!$!   post-exercise!#!' !











 #!!"!   post-exercise













%!"!"$$ post-exercise













*7EBA@67@FE5:AE73>>ABF;A@EF:3F3BB>;76FAF:7?

867B?443;4E4;A0=64I

"438D<B?443;4E4;A0=64I

!>FB?443;4E4;A0=64I

3>=LCDB40B?428N2B?443

3>=LCDB4?4A2DBB8>=5>A0?A48=C4AE4=C8>=CA40C<4=C

C>B42>=3B

B42>=3BC><8=DC4B

C><8=DC4B

<8=DC4B>A6A40C4A

3>=LCDB40B?428N2CA40C<4=CC8<4

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C>B42>=3B0;>=6C741>3HA468>=D?0=33>F=

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International Journal of Sports Physical Therapy

Table 3: Clinical application: pain modulation and myofascial mobility (N=425)

 #!!!$!   pain modulation!#!' !  #&

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%!"!"$$ pain modulation







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

 #!!!$!   myofascial mobility!#!' !



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

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%!"$$ myofascial mobility





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EBA@67@FE BD787DD76 3 FAF3> FD73F?7@F D3@97 47FI77@ 

E75A@6E 3@6 F:D77 ?;@GF7E  8A>>AI76 4KF:D77 FA

SH7?;@GF7E 8AD 3>> 8AGD 5A@6;F;A@E>3D97BAD

F;A@A8D7EBA@67@FE?AH76F:767H;573F3D3F7D3@9

;@947FI77@FIAFAE75A@6E8AD3>>8AGD5A@6;F;A@E"@F7D

7EF;@9>KFI7@FK FA FI7@FKFIAB7D57@F A8 D7EBA@67@FE 6;6

@AFGE73 EB75;S5 67H;57 EB776E7FF;@9FD73F?7@FF;?7AD

?AH;@9 EB776 8AD 3>> 8AGD 5A@6;F;A@E ,:7 D7EG>FE EG997EF

&75:3@;53>)7D5GEE;A@7H;57E+GDH7KA8)D35F;57)3FF7D@E?A@9!73>F:53D7)DA87EE;A@3>E

International Journal of Sports Physical Therapy

Table 4: Beliefs, clinical measures, and education (N=425)

!! ! #!!$! " "!  #&













 #""! !"!$# %" #!!



















 !""(#!& #! #!!" ""$!















!# !#!"!!!!""! #!!" ""















!#""!#" #!!









*7EBA@67@FE5:AE73>>ABF;A@EF:3F3BB>;76FAF:7?

')*+'G?7D;53>B3;@D3F;@9E53>7.+.;EG3>3@3>A9E53>7&+,&G@5F;A@3>&AH7?7@F+5D77@,&+&+7>75F;H7G@5F;A@3>&AH7?7@FEE7EE?7@F

=9DAH?A4E4=C8>=

%4A5>A<0=244=70=24<4=C

)74A0?4DC82CA40C<4=C46?08=<>3D;0C8>=

%A44G4A28B4F0A<D?

%>BC4G4A28B4CA40C<4=C

$C74A?;40B4B?4285H

=70=243<H>50B280;

%08=<>3D;0C8>=

=2A40B439>8=CA0=64>5<>C8>=

=70=243?>BC4G4A28B4A42>E4AH

=70=243?A44G4A28B4=4DA><H>50B280;4G28C0C8>=

=2A40B48=;>20;1;>>3O>F

A40:8=6D?B20A0374B8>=B

A40:8=6D?<H>50B280;CA8664A?>8=CB

$C74A

%44AA4E84F43A4B40A270AC82;4B

>=C8=D8=643D20C8>=2>DAB4B0=32>=54A4=24

"0=D502CDA4A8=BCAD2C8>=B

(>280;<4380;?>BCB>AE834>B46->D)D14

>;;01>A0C8>=F8C7>C74A?A>54BB8>=0;B

"H?A8>A4<?8A820;4G?4A84=24

$C74A?;40B4B?4285H

>8=CA0=64>5<>C8>=

%A4BBDA4?08=C7A4B7>;3460;6><4C4A

%0C84=CA4?>AC43>DC2><4B46#%'(+(?08=B20;4B

">E4<4=C10B43C4BC8=646"(("

"DB2;4?4A5>A<0=24BCA4=6C7C4BC8=6

#>3>=>C4E0;D0C4

$C74A

!8E48=BCAD2C8>=

+834>8=BCAD2C8>=

(4;56D8343?A>6A0<462;84=C27>>B4B?0A0<4C4AB

3D20C8>=<0C4A80;B4670=3>DCBF8C74G4A28B4B

F:3F5>;@;5;3@E?3K47@A@EB75;S5AD;@5A@E;EF7@FI;F:F:7

GF;>;L76 FD73F?7@F B3D3?7F7DE I:7@ BDAH;6;@9 >A53> ?7

5:3@;53>B7D5GEE;A@F:7D3BK

"@5A@E;EF7@F FD73F?7@F B3D3?7F7DE :3H7 3>EA 477@ D7

BADF7635DAEE F:7>;F7D3FGD77J3?;@;@9F:778875F;H7@7EEA8

>A53> ?GE5>7 H;4D3F;A@ F:7D3BK I;F: H;4D3F;A@ 8D7CG7@5;7E

D3@9;@98DA?!L3@6FD73F?7@F6GD3F;A@D3@9;@98DA?

E;JE75A@6EFA?;@GF7E*7E73D5:7DE7J3?;@;@9EFD7@9F:

FD3;@;@9BDAFA5A>E3@6>A53>H;4D3F;A@F:7D3BK:3H7D7BADF76

F:3F>AI7D8D7CG7@5;7E;7!LI7D7@AF3E78875F;H7

3E:;9:7D8D7CG7@5;7E79 !L!L8AD;?BDAH

;@9?GE5>7B7D8AD?3@57(F:7DD7E73D5:7DE:3H73>EA

D7BADF76F:3F>AI8D7CG7@5;7E;7!L53@4778875F;H7

8AD;?BDAH;@9 ?GE5G>3D B7D8AD?3@57I;F:E:ADFFD73F?7@F

6GD3F;A@E;7?;@GF7E,:;E:3E>76EA?7D7E73D5:7DE

FAEG997EFF:3F3D7>3F;A@E:;B47FI77@8D7CG7@5K3@6FD73F

?7@F6GD3F;A@;7:;9:8D7CG7@5K3@6>A@9FD73F?7@F6G

D3F;A@AD>AI8D7CG7@5K3@6E:ADFFD73F?7@F6GD3F;A@?3K

7J;EFI:;5:5AG>69G;675>;@;5;3@E;@E7FF;@9FD73F?7@FB3D3

?7F7DE;@3@3FF7?BFFA?3J;?;L7FD73F?7@F78875F;H7@7EE

78AD7GE;@9F:7>;F7D3FGD7FA9G;675>;@;53>BD35F;575>;@

;5;3@E3@6D7E73D5:7DEE:AG>65A@E;67DF:D77 CG7EF;A@E 

D7FD3;@;@9BDAFA5A>EGF;>;L76;@EFG6;7E 7J3?;@;@9H;4D3

F;A@3>F:7D3BK?3F5:;@9 E;?;>3D BD35F;57E8AG@6;@5>;@;53>

D7:34;>;F3F;A@ADSF@7EEE7FF;@9ED7FD73F?7@F6GD3F;A@

3@6H;4D3F;A@3>8D7CG7@5K7CG3>>KI7;9:F76H3D;34>7E;@67

F7D?;@;@9 FD73F?7@F 78875F 3@6  A D7BADF76 AD 53>5G

>3F76 78875F E;L7E EGBBADF AD D78GF7 F:7 BAF7@F;3> D7BADF76

D7EG>FEF:AG9:FFA5A@FD3EF735:AF:7D;@F:7>;F7D3FGD7G

FGD7D7E73D5: E:AG>6 GF;>;L7 EB75;S5 FD73F?7@F B3D3?7F7DE

FA:7>B67F7D?;@7FD73F?7@F78875F;H7@7EE3@6K;7>69D73F7D

G@67DEF3@6;@9A@ BAF7@F;3>F;EEG7 363BF3F;A@E3@6?75:3

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*7E73D5: E:AG>6 3>EA 47 5A@6G5F76 FA 3EE7EE F:7 78875FA8

?75:3@;53> B7D5GEE;A@ FD73F?7@F A@ H3D;AGE 5>;@;53> AGF

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?75:3@;53> B7D5GEE;A@ ;@5D73E7E >A53> 4>AA6 TAI ?A6G

&75:3@;53>)7D5GEE;A@7H;57E+GDH7KA8)D35F;57)3FF7D@E?A@9!73>F:53D7)DA87EE;A@3>E

International Journal of Sports Physical Therapy

>3F7EB3;@7@:3@57E ?KA83E5;3>?A4;>;FK3@6D76G57E?K

A83E5;3>D7EFD;5F;A@E?3>>7DBADF;A@47>;7H76F:7E767H;57E

5AG>6 7@:3@57 BD77J7D5;E7 @7GDA?KA83E5;3> 7J5;F3F;A@

3@6 ;@5D73E7 <A;@F D3@97 A8 ?AF;A@  ,:7A@>K

BG4>;E:76 ?75:3@;53> B7D5GEE;A@ EFG6K D7BADF76 35GF7

BAEFFD73F?7@F;@5D73E7E;@*(&4GF@A5:3@97E;@B>3@F3D

T7JAD &. ,:;E EFG6K BDAH;67E EA?7 ;@;F;3> 63F3 EGB

BADF;@9 F:7 78875FE A8 ?75:3@;53> B7D5GEE;A@ 67H;57E A@

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International Journal of Sports Physical Therapy

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International Journal of Sports Physical Therapy

The effect of percussion and manual activation massage on explosive strength and balance in young adult males: A crossover pilot study

Article

Full-text available

Oct 2024

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.

Comparison of the effects of cold water immersion and percussive massage on the recovery after exhausting eccentric exercise: A three-armed randomized controlled trial

Article

Full-text available

Sep 2024

Introduction Athletic training requires both challenging stimuli for adaptation and sufficient recovery for improved performance. While cold water immersion (CWI) is already a popular recovery method, handheld percussive massage (PM) devices have also gained popularity in recent years. This study aims to assess the effects of CWI and PM on performance recovery after strenuous eccentric exercises compared to a passive rest (PR) control condition. Methods Thirty-four healthy physically active participants (9 females, 25 males) were randomly divided into three groups: CWI (n = 11), PM (n = 11), and passive rest (PR) (n = 12). They underwent an exhausting eccentric exercise protocol and different measurements at six time points (baseline, POST1, POST2, POST24, POST48, and POST72) over the time course of 72 h. These included subjective assessments of muscle soreness and perceived stiffness as well as measures of skin temperature, leg volume, creatine kinase activity, and three different jump tests. The eccentric exercise protocol consisted of 15 min downhill running (slope: 12%, speed: 10 km/h) and 3 sets of successive depth jumps (dropping height: 0.5 m) until individual exhaustion. After POST1 measurements, participants received 12 min of either CWI (11 ± 0.5°C), PM (40 Hz) or PR (supine posture). Results No significant group effects were found for the number of depth jumps performed during the exhaustion protocol. All jump tests displayed a significant group × time interaction effect. Post-hoc analysis indicated significant lower jump heights in ΔPOST2 between CWI and both PM and PR. No other significant group effects were observed at any time point. No significant group × time interaction effects were noted for CK, leg volume, and soreness. The perceived stiffness showed a significant group × time interaction effect. Post-hoc analysis revealed a significant decrease in stiffness for PM compared to PR at ΔPOST2. Conclusion Neither CWI nor PM showed any significant improvement in performance recovery over the 72-h period following strenuous eccentric exercise compared to PR. CWI showed an immediate performance decline which may be attributed to a cold-related reduction in motor nerve conduction velocity.

Efficacy of Percussion Massage Therapy Applied to the Lower Extremity on Pain, Edema, and Quality of Life in Pregnant Women: Randomized Controlled Trial

Article

Full-text available

Sep 2024
CLIN EXP OBSTET GYN

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).

The effectiveness of massage gun treatment combined with passive stretching in reducing non-specific lower back pain

Article

Full-text available

Oct 2024

Non-specific lower back pain is a common condition characterized by strain, muscle spasms, or weakness of the paraspinal muscles, particularly the multifidus muscle, which affects adjacent musculature such as the gluteus, hamstrings, and quadriceps. This study aimed to investigate whether massage gun treatment combined with passive stretching could reduce non-specific low back pain in patients experiencing subacute and chronic phases of this condition. This pseudo-experimental research employed a one-group pretest-posttest design with three treatments. Participants were selected using purposive sampling based on inclusion criteria: suffering from non-specific low back pain, willingness to participate, and age between 20 and 65 years. Exclusion criteria included anatomical abnormalities of the spine, fractures, open wounds, and specific spinal disorders. The visual analog scale (VAS) was used to measure pain intensity before and after each treatment session. Initial VAS scores averaged 65.6 units. Following the first treatment, scores decreased significantly to 52.1 units; subsequent reductions occurred at 42.1 units post-second treatment and 33.5 units post-third treatment. Statistical analysis revealed a significant difference across all three treatment sessions (p = 0.000 0.05), indicating a progressive improvement in pain control over time. Massage gun therapy coupled with passive stretching demonstrated efficacy in reducing non-specific lower back pain among participants. These findings suggest that repeated application of these interventions can lead to sustained improvements in pain management for individuals suffering from subacute and chronic non-specific low back pain conditions

Investigating the Effects of Percussion Therapy on Ultrasonography-Diagnosed Thoracolumbar Fascia on Trigger Points and Hyperlordosis in Low Back Pain: A Placebo-Controlled Trial

Article

Aug 2024
Alternative Ther Health Med

A comparison of dynamic warm-up and “warm-up” using self-massage tools on subsequent sit-and-reach displacement

Article

Full-text available

Aug 2024
PLOS ONE

Objectives A dynamic warm-up (DWU) comprising exercise involving rhythmic muscle actions results in an acute increase in range of motion; however, recent findings suggest that a passive one using self-massage techniques might elicit a similar effect. This study’s purpose was to compare the acute effect of leg cycling DWU on sit-and-reach score to the effect of a preparatory regimen of foam rolling (FR) or percussive massage (PM). Design Single-blind, randomized, repeated-measures crossover study. Methods Thirty-two asymptomatic, physically-active participants (male; n = 17) aged 20.9 ± 1.5 years performed sit-and-reach tests before, immediately following and 10-, 20- and 30-minutes following eight minutes of each of the “warm-ups.” Analyses of variance at each time point across conditions and for the percent change elicited by each intervention were conducted to determine significant differences (p < 0.05). Results Repeated-measures ANOVA revealed a significant difference between mean percent difference of sit-and-reach score for FR (8.8 ± 0.5%) compared to DWU and PM (p = 0.046 and 0.048, respectively) while DWU (6.3 ± 0.8%) and PM (6.8 ± 0.5%) did not differ (p = 0.717). There were no differences between scores across interventions at any of the four time points. Conclusions A bout of FR or PM resulted in an acute increase in a sit-and-reach score during a test performed immediately post and at 10-, 20- and 30-minutes post that was similar in magnitude to that which was present following leg cycling. These passive “warm-ups” are appropriate alternate strategies that can be employed to improve performance on a sit-and-reach test.

Portable Percussive Massage Device-Related Rectus Sheath Hematoma and Obstructive Uropathy: A Case Report

Article

Full-text available

May 2024

Lawrence Kwon

Introduction Rectus sheath hematomas (RSHs) can occur from the rupture of the epigastric arteries, leading to blood accumulation within the rectus abdominis sheath. Herein, we report the unique case of an RSH resulting in acute ureteral obstruction, which was associated with the use of a handheld deep-tissue percussive massage device in attempts to relieve abdominal pain. Case Report A morbidly obese man in his late 50s was admitted with complications of COVID-19, including acute respiratory syndrome, bilateral peroneal deep vein thromboses, and acute kidney injury. He was treated with anticoagulants (subcutaneous enoxaparin and apixaban), dexamethasone, and remdesivir. He developed severe abdominal pain, and a large (14 × 17 cm) right rectus sheath and an extraperitoneal pelvic hematoma were identified by computed tomography. The hematoma extended across the midline into the left pelvis and the retroperitoneum with associated mild right hydronephrosis. A handheld percussive massage device (Theragun®) was applied repeatedly at the site of enoxaparin injection into the abdominal wall in attempts to alleviate the pain. On day 12, bilateral nephrostomy tubes were inserted. A nephrostogram revealed mild hydroureteronephrosis to the ureterovesicular junction bilaterally and extrinsic compression of the bladder. On day 17, the patient suffered a cardiac arrest and died. Conclusion This case report offers insights into the pathophysiology of obstructive uropathy and is a reminder of the importance of considering uncommon causes of obstructive uropathy in the diagnosis and management of AKI, particularly in hospitalized patients receiving anticoagulation. We know of no previous reference of obstructive uropathy caused by retroperitoneal hematoma associated with the use of a portable massage device applied to the abdominal wall.

The impact of protocol designs for using massage guns on lower body flexibility: A randomised cross-over design study

Article

Nov 2024

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.

Assessment of Range of Motion Before and After Hamstring Percussion Therapy Using Thermography and CNN

Chapter

Nov 2024

Alternative Formen des Beweglichkeitstrainings: wissenschaftliche Erkenntnisse und Mythen im Fokus

Article

Sep 2024

Noch immer verlassen sich viele Sportlerinnen und Sportler auf das Dehnen, wenn es darum geht, die Beweglichkeit zu verbessern – trotz widersprüchlicher Erkenntnisse hinsichtlich der Wirksamkeit verschiedener Dehnmethoden. Es gibt aber auch Alternativen: Krafttraining, Foam Rolling und die perkussive Massage zählen zu aktuellen Trends, die sich zunehmender Beliebtheit erfreuen. Unsere Autoren betrachten diese alternativen Formen des Beweglichkeitstrainings aus wissenschaftlicher Perspektive und leiten daraus praktische Handlungsempfehlungen ab.

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

Article

Full-text available

Dec 2020
J SPORT SCI MED

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.

The effects of vibration foam roller applied to hamstring on the quadriceps electromyography activity and hamstring flexibility

Article

Full-text available

Aug 2019

This study investigates the effect of vibration foam roller (VFR) applied to the hamstring, on the quadriceps electromyography (EMG) activity and hamstring flexibility. A total of 16 subjects were randomly assigned to either the VFR group (n=8) or the nonvibration foam roller group (NVFR, n=8). The two groups applied the foam roller or the VFR to the dominant hamstring, at a rate of 40 times per min, for a total of 200 times in 5 min. The primary outcome was to measure hamstring extensibility using the sit and reach test. The EMG activity of the dominant rectus femoris (RF), vastus lateralis (VL), and vastus medialis (VM) was measured as the secondary outcome. Results indicate a significant increase in the sit and reach distance after the intervention in both groups, as compared to preintervention. The sit and reach difference between VFR and NVFR show no significant difference after the intervention. Significant increases were observed after intervention in the %maximum voluntary isometric contraction (%MVIC) of VL, VM, and RF in the VFR group, and RF in the NVFR group, as compared to the preintervention values. Furthermore, %MVIC values of VL and RF, but not the VM muscle, were significantly different between the two groups. These findings suggest that regardless of vibration, the application of foam roller to hamstring may exert a positive effect on hamstring flexibility. Furthermore, these results indicate that the application of foam roller with vibrations causes more EMG activation in the antagonists.

Do Self-Myofascial Release Devices Release Myofascia? Rolling Mechanisms: A Narrative Review

Article

Full-text available

Aug 2019
SPORTS MED

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.

Effects of local vibration therapy on various performance parameters: A narrative literature review

Article

Full-text available

Dec 2018
J Can Chiropract Assoc

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.

The immediate effects of foam roller with vibration on hamstring flexibility and jump performance in healthy adults

Article

Full-text available

Feb 2019

This study aimed to determine whether foam roller with vibration (FRV) can improve hamstring flexibility and jump performance in young adults. Twenty subjects were randomly allocated into either the FRV or the foam-roller with no vibration (FRNV) groups. The vibration of the vibration foam-roller was 32 Hz. All participants completed one 10-min session on the hamstring. Active straight leg raising (ASLR) test in supine position and active knee extension (AKE) test in sitting position were performed to measure hamstring flexibility, before and immediately after the session. ASLR, AKE, and vertical jump performance test were performed before the session and immediately after the session. Analysis of covariance was used to determine statistical significance. ASLR and AKE tests were significantly different between FRV and FRNV, except the right hamstring. There was significant improvement with respect to ASLR and AKE tests after the session in FRV group. The vertical jump performance test of both groups was not significantly different after the session. FRV is more effective than FRNV for improving hamstring flexibility.

ROLLER MASSAGE: SURVEY OF PHYSICAL THERAPY PROFESSIONALS AND A COMMENTARY ON CLINICAL STANDARDS- PART II

Article

Full-text available

Aug 2018
Int J Sports Phys Ther

Background: Roller massage (RM) has become a popular intervention prescribed by physical therapy (PT) professionals. While this popularity has stimulated an increase in research and product development, the trends in the use of RM among PT professionals remain undocumented. It is unknown how professionals are using RM and integrating the research into their clinical practice. Purpose: To survey and document responses in the knowledge, clinical application methods, and use of RM devices among PT professionals in the United States. Design: Cross-sectional survey study. Methods: A 20-question online survey related to personal and professional demographics, beliefs about RM, preferred RM devices, RM exercise prescription, and client education was emailed to PT members of the Orthopedic and Sports Physical Therapy Sections. Results: A total of 685 sports and orthopedic PT professionals completed the survey. Most professionals surveyed believe that RM decreases pain (80%), increases mobility (68%), and increases range of motion (ROM) (40%). Fifty-one percent believed moderate density rollers have the greatest effect. Eighty percent of professionals use a foam roller in their practice and 51% recommend to clients. A high proportion of professionals prescribe RM for injury treatment (82%) and for pre and post-exercise interventions (55%). Most professionals recommend rolling daily for 30 seconds to two minutes (55%), per muscle group (64%), at a self-paced cadence (47%). A high proportion of professionals use patient reported outcomes (80%), followed by joint ROM (59%), and movement-based testing (42%) to measure effects of RM. Eighty-seven percent of professionals use live instruction to educate clients and 91% believe there is a gap in the research. Conclusion: The results of this survey should be considered descriptive and a starting point for future research to establish a consensus on optimal RM programming, devices, and application parameters for different musculoskeletal conditions. The observed responses provide some insight into how PT professionals are using RM in their practice and highlight the existing gap between the research and professional practice. Further research is needed to explore the responses documented in this study. Level of evidence: 3.

ROLLER MASSAGE: A COMMENTARY ON CLINICAL STANDARDS AND SURVEY OF PHYSICAL THERAPY PROFESSIONALS- PART 1

Article

Full-text available

Aug 2018
Int J Sports Phys Ther

Roller massage (RM) has become a popular intervention used by rehabilitation professionals and active individuals. The emerging popularity has resulted in the production of various types of rollers and a growing body of research on the therapeutic effects and science behind RM. Despite the growing popularity and research, there is no consensus on clinical standards such as a describing the intervention, indications, precautions, contraindications, and assessment. There have been no specific peer reviewed publications that have discussed such standards. This leaves a gap in the knowledge regarding how clinicians are integrating the RM research into their clinical practice. The purpose of this clinical commentary is to discuss proposed clinical standards for RM. Part I will discuss the proposed clinical standards and Part II will report the results of a 20-question survey sent to physical therapy (PT) professional members of the Orthopedic and Sports Physical Therapy Sections of the American Physical Therapy Association.

Exploring the Preparation, Perceptions, and Clinical Profile of Athletic Trainers Who Use Instrument-Assisted Soft Tissue Mobilization

Article

Full-text available

Jul 2018

Purpose: To explore preparation methods, perceptions, and the clinical profile of athletic trainers utilizing Instrument Assisted Soft Tissue Mobilization (IASTM), and to compare group differences regarding the use of one’s hands versus instruments to apply soft tissue mobilization (STM). Methods: Athletic trainers completed an electronic survey. Descriptive statistics were calculated for participant demographics, clinical profile items, and items assessing IASTM application. Exploratory factor analysis was conducted to determine underlying factors. Results: Athletic trainers complete formal (59.7%) and informal (95%) IASTM training. Those who complete professional IASTM courses rate instruments as more effective than those who do not. Conclusions: Instruments are perceived to be as, or more effective, than one’s hands when applying STM to treat chronic musculoskeletal pathologies. Further research is needed to determine if type of preparation impacts the application strategies or clinical efficacy of IASTM.

Roller Massage: A Descriptive Survey of Allied Health Professionals

Article

Mar 2018
J SPORT REHABIL

Scott W. Cheatham

Background: In sports medicine, the interprofessional care of athletes has become a frequent practice. This type of care often involves different interventions used among professionals. One common intervention prescribed is roller massage (RM) or self-myofascial release. The trends in the use of RM among allied health professionals is non-existent. The surveillance of such responses has not been documented. Purpose: To survey and document responses in the knowledge, clinical application, and use of RM devices among allied health professionals in the United States. Design: Cross-sectional descriptive survey study. Methods: A 20 question survey was sent to allied health professionals including physical therapists, athletic trainers, and fitness professionals. The survey covered topics such as demographics, beliefs about RM, preferred devices, exercise prescription, and client education. Results One thousand forty-two professionals (N=1042) completed the survey. Most respondents believed that RM decreases pain (82%) and increases mobility (76%). A high percentage use a foam roller in their practice (81%), recommend a full-size foam roller (49%), and believe the medium density (48%) is the most effective. A high proportion of respondents prescribe RM for injury treatment (69%) and for pre-and post-exercise (61%). They also recommend rolling daily for 30 seconds to 2 minutes per muscle group (33%) at a self-paced cadence (46%). A high percentage of respondents use patient reported outcomes (74%), joint ROM (49%), and movement-based testing (48%) to measure effects of RM. Eighty-seven percent use live instruction to educate clients and 88% believe there is a gap in the research. Conclusion: The results of this survey document responses in the use of RM among allied health professionals. The reported responses provide insight into how professionals are using RM as an intervention and the potential gaps between the research and professional practice. Future studies are needed to further validate these findings.

Knowledge of self-myofascial release among allied health students: A descriptive survey

Article

Feb 2018

Background University and collegiate education of the human myofascial system is commonly taught in basic science courses such as anatomy. Allied health programs may expand upon these concepts by teaching interventions such as myofascial release in clinical education courses. Self-myofascial release (SMR) with a device such as a foam roller is an emerging intervention that has become popular among clinicians and active individuals. Currently, it's unknown if allied health programs provide SMR education. Purpose The purpose of this study was to survey and document responses in the knowledge of SMR among allied health students. Methods 12 undergraduate and graduate allied health programs in the United States were sent a 12-question electronic survey that represented three areas: 1) respondent demographics and beliefs, 2) experience with SMR, 3) future practice and education. Descriptive data including response frequency and percentage was calculated and reported for the 12 questions. Results A total of 502 students from the different allied health programs completed the survey which represented a 33.00% response rate (502/1521). Approximately, half of respondents (49.6%, N = 249) reported learning about SMR in their degree program and the other half (50.40%, N = 253) report receiving no education. Most respondents (>50%) currently use or have used an SMR device and believe that SMR produces therapeutic benefits. Furthermore, most respondents (≥50%) had an idea of how they would integrate SMR into their future practice and where to purchase an SMR device. Conclusion A more global consensus on education for emerging therapeutic intervention such as SMR is needed in order to standardize and develop best teaching practices in allied health. This study highlighted the difference among allied health programs in the United States. This research should be a starting point for future survey research on this topic.

Mechanical Percussion Devices: A Survey of Practice Patterns Among Healthcare Professionals

Abstract and Figures

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