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EFFICACY OF LOWER LIMB COMPRESSION AND
COMBINED TREATMENT OF MANUAL MASSAGE AND
LOWER LIMB COMPRESSION ON SYMPTOMS OF
EXERCISE-INDUCED MUSCLE DAMAGE IN WOMEN
JOHN R. JAKEMAN,CHRIS BYRNE,AND ROGER G. ESTON
School of Sport and Health Science, University of Exeter, Exeter, Devon, United Kingdom
ABSTRACT
Jakeman, JR, Byrne, C, and Eston, RG. Efficacy of lower limb
compression and combined treatment of manual massage and
lower limb compression on symptoms of exercise-induced
muscle damage in women. J Strength Cond Res 24(11):
3157–3165, 2010—Strategies to manage the symptoms of
exercise-induced muscle damage (EIMD) are widespread,
though are often based on anecdotal evidence. The aim of
this study was to determine the efficacy of a combination of
manual massage and compressive clothing and compressive
clothing individually as recovery strategies after muscle
damage. Thirty-two female volunteers completed 100 plyomet-
ric drop jumps and were randomly assigned to a passive
recovery (n= 17), combined treatment (n= 7), or compression
treatment group (n= 8). Indices of muscle damage (perceived
soreness, creatine kinase activity, isokinetic muscle strength,
squat jump, and countermovement jump performance) were
assessed immediately before and after 1, 24, 48, 72, and 96
hours of plyometric exercise. The compression treatment group
wore compressive tights for 12 hours after damage and the
combined treatment group received a 30-minute massage
immediately after damaging exercise and wore compression
stockings for the following 11.5 hours. Plyometric exercise had
a significant effect on all indices of muscle damage (p,0.05).
The treatments significantly reduced decrements in isokinetic
muscle strength, squat jump performance, and countermove-
ment jump performance and reduced the level of perceived
soreness in comparison with the passive recovery group (p,
0.05). The addition of sports massage to compression after
muscle damage did not improve performance recovery, with
recovery trends being similar in both treatment groups. The
treatment combination of massage and compression signifi-
cantly moderated perceived soreness at 48 and 72 hours after
plyometric exercise (p,0.05) in comparison with the passive
recovery or compression alone treatment. The results indicate
that the use of lower limb compression and a combined
treatment of manual massage with lower limb compression
are effective recovery strategies following EIMD. Minimal
performance differences between treatments were observed,
although the combination treatment may be beneficial in
controlling perceived soreness.
KEY WORDS plyometric exercise, recovery, delayed onset
muscle soreness, performance
INTRODUCTION
After unaccustomed exertion, or activity that is
eccentrically biased, individuals often experience
symptoms of exercise-induced muscle damage
(EIMD). The nature of eccentric muscle actions,
where a muscle lengthens while generating tension, has been
shown to be a causative factor in EIMD, because over-
extension of muscle sarcomeres leads to mechanical disrup-
tion of muscle fibers, compromising contractile ability.
Symptoms of EIMD include increases in circulating my-
oproteins (26); increases in perceived soreness (16); a reduced
time to volitional exhaustion (3); and decrements in muscle
strength, power and endurance (2,29). These symptoms are
problematic for individuals engaged in regular competition,
and consequently, a number of strategies attempting to
manage the symptoms of EIMD are currently employed,
particularly in athletic populations.
Sports massage is a common feature of many athletes’
training and recovery programs, with perceived outcomes
including decreased feelings of soreness, decreased tissue
tension, increased local blood flow facilitating the removal of
cellular debris, and an influence on the inflammatory process
to expedite recovery (4,24). Scientific evidence supporting
these contentions is equivocal, though a number of review
and experimental papers have indicated potentially beneficial
effects of sports massage treatments (4,12,20,24). Recently,
the use of clothing with specific compressive properties has
Address correspondence to John R. Jakeman, j.r.jakeman@ex.ac.uk.
24(11)/3157–3165
Journal of Strength and Conditioning Research
Ó2010 National Strength and Conditioning Association
VOLUME 24 | NUMBER 11 | NOVEMBER 2010 | 3157
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become increasingly popular among competitive athletes.
The use of compressive clothing is supported by encouraging
scientific evidence, which indicates that the treatment can
facilitate limb blood flow, reduced muscle oscillation, provide
aÔdynamic castÕfacilitating muscle recovery, and influence
the inflammatory process after exercise (9,17,34).
In applied fields, strategies to manage the training and
recovery of athletes to maintain performance through
consecutive cycles of physical activity (i.e., training and
competition cycles) are common, though few scientific studies
have been completed to assess the effectiveness of these
treatments on the symptoms of EIMD. It is important to
recognize that although the symptoms of EIMD are consistent,
different forms of exercise can cause muscle damage. It is
currently unclear whether the effectiveness of a recovery
strategy on EIMD is exercise type dependent or not. The aim
of this study was to determine whether a combined treatment
involving sports massage and compression immediately
after damaging exercise was an effective strategy to manage
the symptoms of EIMD induced by strenuous plyometric
exercise. Data from a previous study (15) that indicated that
compressive clothing used independently, reduced decre-
ments in muscle strength loss and function in comparison with
a passive recovery group, were used to determine whether
sports massage had an additive effect on recoveryfrom EIMD.
Additional passive recovery data were collected to increase the
sample size of this study.
METHODS
Experimental Approach to the Problem
In this study, a randomized mixed-model experimental design
was used. Subjects were requiredtocompletestrenuous
plyometric exercise designed to induce muscle damage,
followed by either a passive recovery, compression, or com-
bined treatment intervention. Biochemical, perceptual, and
performance changes were monitored pre and postexercise.
Subjects
Thirty-two physically active (minimum 3 occasions per week)
female volunteers (Age = 21.4 61.7 years, stature = 1.66 6
0.047 m, mass = 66.7 66.8 kg) who had not engaged in
specific lower limb weight or eccentric exercise training and
had no recent history of musculoskeletal injury were
randomly allocated to a passive recovery (n= 17),
compression treatment (n= 8), or combined compression
and massage intervention group (n= 7). Participants
provided signed, informed consent to participate in the
study that received ethical approval from the School of
Sport and Health Sciences ethics committee. No significant
differences between groups were observed for age, height,
or weight (p.0.05). Volunteers were asked to maintain
normal levels of food intake and hydration, to refrain from
ingesting alcohol, nutritional supplements or nonsteroidal
anti-inflammatory drugs for the duration of the test, and to
avoid any exercise or therapeutic treatments such as massage,
which may have affected a normal recovery pattern.
Procedures
After collection of baseline data, all participants completed
a plyometric drop jump exercise protocol designed to induce
low-level muscle damage similar to that which may be
expected after training or competition in a number of sports.
The plyometric exercise protocol was used to localize muscle
damage to the quadriceps to facilitate reliable testing and to
replicate the types of muscle injury that occur to athletes in
applied settings. Volunteers in the combined treatment group
were then given a 30-minute sports massage from a qualified
masseur and a pair of commercially available compression
tights to wear for a period of 12 hours after damaging exercise.
Participants in the compression treatment group were given
an identical pair of compression tights to wear for the same
period. Participants were instructed to refrain from taking
nutritional supplements, alcohol and from engaging in
physical activity during the testing period. A priori calcu-
lations of statistical power indicated that this sample size was
appropriate to satisfy power at or above 80% (6).
Plyometric Exercise
Participants completed 10 310 plyometric drop jumps to
induce muscle damage. Volunteers were instructed to stand
on a 0.6-m box, step off with 1 foot, land with both feet
together, and attempt to achieve a 90°knee angle upon
landing, before performing a maximal vertical jump (21)
though jump height was not recorded. Jump frequency was
standardized so that participants completed 1 jump every 10
seconds and were permitted 1-minute rest between sets. The
plyometric exercise protocol was demonstrated and moni-
tored by an experienced strength and conditioning coach.
Assessment of Muscle Damage
Indices of muscle damage were collected in the same order on
each occasion: perceived soreness, creatine kinase activity,
isokinetic muscle function, countermovement jump perfor-
mance and squat jump performance. Indices of muscle
damage were assessed before and after 24, 48, 72, and 96 hours
damaging exercise. Data were also collected 1 hour after
damaging exercise to quantify the magnitude of muscle
damage immediately after exercise avoiding the influence of
acute fatigue following the plyometric exercise protocol. To
minimize the time delay between completion of the damaging
exercise and the treatment intervention, no assessment of
muscle damage was completed immediately after plyometric
exercise. Random allocation of participants to groups limits
the likelihood of differences in response to plyometric
exercise. Therefore, any between group variations in response
to damaging exercise can confidently be attributed to the
treatment intervention.
Perceived Soreness
Perceived soreness was assessed using a 10-cm visual analog
scale, with 0 indicating no pain and 10 indicating the worst
soreness experienced after exercise. Participants were in-
structed to complete an unweighted squat, holding a knee
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angle of approximately 90°for a period of 2 seconds, and mark
perceived soreness on the visual analog scale (35).
Creatine Kinase Activity
Plasma creatine kinase activity was assessed using fingertip
capillary blood sampling. The finger was cleaned using
a sterile alcohol swab, and a capillary puncture was made
using a Haemocue lancet (Haemocue, Sheffield, United
Kingdom). Thirty microliters of sampled blood was separated
by using a centrifuge and refrigerated at 4°C until analysis.
Spectrophotometry (Jenway, Dunmow, United Kingdom)
was used to analyze creatine kinase activity in accordance
with the manufacturer’s guidelines (Randox, Co. Antrim,
United Kingdom). All samples were analyzed in duplicate.
Jump Performance
Squat and countermovement jump performances were
assessed to give a further indicator of functional strength.
For assessment of squat jump performance, participants were
instructed to adopt a squat with a 90°knee angle and hands
placed on hips. This position was held for approximately
3 seconds before volunteers performed a maximal vertical
jump, maintaining a straight leg position and hand placement
on the hips during flight (2).
Tassess countermovement jump performance, participants
stood fully erect and upon verbal command performed
a maximal vertical jump (2). The average height of 3 jumps of
both squat and countermovement jump was measured using
an infrared jump system (Microgate, Bolzano, Italy) and was
taken as an indicator of jump performance. Indicators of
muscle function and performance were converted to values
relative to baseline for analysis.
Isokinetic Muscle Function
Muscle function was assessed by isokinetic dynamometry
(Biodex 3 Medical Systems, New York, NY, USA). Partic-
ipants were seated upright with the torso and experimental
leg secured to reduce extraneous movement. The axis of
rotation of the knee was aligned with that of the
dynamometer and was standardized during the testing
period. Participants completed 5 maximal voluntary exten-
sions of the dominant leg knee extensor muscles on each
occasion through 80°range of movement from full knee
extension, at 60°s
21
. The best of 5 gravity corrected knee
extensions was taken as the criterion measure of muscle
strength.
Strength and performance measures such as these are
typically reliable (intraclass correlation coefficients $0.82
[21,36]) and have been used successfully in a number of
previous investigations (2,16,23)
Experimental Treatments
After completion of the plyometric jump protocol, partic-
ipants in the combined treatment group received a 30-minute
manual massage from a professional sports masseur. Massage
was completed using an oil medium and consisted of
effleurage, petrissage, tapotment, and hacking to the whole
of both legs and was standardized for each participant
through the use of stopwatch and cue cards for the masseur
who performed all treatments. Upon completion of the
massage treatment, volunteers were given a pair of hip to
ankle compression tights (Skins, Sydney, Australia; Figure 1)
to wear for a period of 12 hours to replicate contemporary
treatment methodologies and previously investigated proto-
cols (7,9). Compression tights of this type are composed of
76% nylon tactel microfiber and 24% elastane and have been
reported to exert an average compression of 17.3 mm Hg at
the calf and 14.9 mm Hg at the thigh (33). Compression
tights were removed for approximately 10 minutes for the
1 hour assessment of muscle damage. Participants in the
compression treatment group wore identical compressive
tights for 12 hours after plyometric exercise.
Statistical Analyses
Data were analyzed using a repeated-measures analysis of
variance (ANOVA) (3 36, group 3time), with significance
set at p#0.05 a priori. The Mauchly sphericity test was used
to test assumptions of homogeneity of variance. Where this
was violated, the Greenhouse–Geisser value was used to
adjust degrees of freedom to increase the critical value of the
F-ratio. Where appropriate, modified Tukey’s post hoc tests
were applied to determine the location of between group
differences (SPSS 15.0).
Figure 1. Lower limb compression garments worn by individuals in
experimental groups.
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RESULTS
Perceived Soreness
Analysis ofcovariance was used to remove baseline variance in
perceived muscle soreness. Significant time (F= 28.3, p,
0.01), group (F=17.1,p,0.01), and group by time interaction
(F=4.8,p,0.01) effects were observed after damaging
exercise. Muscle soreness was
significantly higher in the pas-
sive recovery group 24, 48, and
72 hours after damaging exer-
cise in comparison with both
treatment groups (p,0.01).
Soreness was also elevated
1 hour after exercise in compar-
ison with the compression treat-
ment group. No significant
differences in muscle soreness
between the treatment groups
were observed 24 and 96 hours
after muscle damage. Signifi-
cantly higher soreness was
observed in the combined treat-
ment group 1 hour after muscle
damage, though this trend re-
versed 48 and 72 hours after
exercise, with the compression
group reporting higher percep-
tionsofsorenessatthesetime
points (p,0.01; Figure 2).
Countermovement Jump
Performance
No significant group differences were observed at baseline
in absolute terms for countermovement jump height (passive
recovery 0.28 60.03 m, combined 0.28 60.02 m,
compression 0.26 60.05 m, p.0.05). Significant time
(F= 15.4, p,0.01) and group 3time interaction effects were
observed (F= 4.0, p,0.01). Significant differences between
the passive recovery and treat-
ment groups were observed at
24 and 48 hours after plyomet-
ric exercise (p,0.01), with
a further significant difference
between the passive recovery
and compression group present
72 hours after exercise. No
significant differences between
treatment groups were
observed at any time (Figure 3).
Squat Jump Performance
No significant group differences
were observed at baseline in
absolute terms for squat jump
height (passive recovery 0.23 6
0.03 m, combined treatment
0.23 60.02 m, compression
0.22 60.05 m, p.0.05).
Significant time (F= 28.4, p,
0.01) group (F=18.8, p,0.01),
and group 3time interaction
effects (F= 7.5, p,0.01) were
Figure 2. Perceived soreness after plyometric exercise. *Significant difference from baseline in all groups;
+Significant difference from baseline in passive group; A) Significant difference between passive recovery and
combined treatment group; B) Significant difference between passive recovery and compression treatment group;
C) Significant difference between treatment groups.
Figure 3. Countermovement jump height after plyometric exercise. *Significant difference from baseline in all
groups; +Significant difference from baseline in passive group; †Significant difference from baseline in passive
recovery and combined treatment groups; A) Significant difference between passive recovery and combined
treatment group; B) Significant difference between passive recovery and compression treatment group.
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observed on squat jump height. Follow-up analysis indicated
significant performance differences between the control and
treatment groups 24, 48, 72, and 96 hours after damaging
exercise (p,0.01). Strength decrements were also greater in
the passive recovery group in
comparison with the compres-
sion group, 1 hour after plyo-
metric exercise. There were no
significant differences between
treatments, with the exception
of 48 hours after damaging
exercise, where jump perfor-
mance was significantly worse
in the compression group in
comparison with the combined
treatment group (p,0.01;
Figure 4).
Isokinetic Muscle Function
Absolute peak torque at baseline
was not significantly different
between groups (passive recov-
ery 158.4 625.2 Nm
21
,com-
bined treatment 168.3 633.5
Nm
21
, compression clothing
165.7 621 Nm
21
,p.0.05).
Significant time (F=26.2,p,
0.01), group (F= 8.0, p,0.01),
and group 3time interaction
effects were observed (F=5.1,
p,0.01). Significant differences in isokinetic muscle function
24, 48, 72, and 96 hours after damaging exercise (p,0.01)
between the passive recovery and treatment groups were
observed. A significant difference in relative muscle strength
was observed between treat-
ment groups at 48 hours, with
muscle strength of the com-
bined treatment group being
significantly lower than that of
the compression group (p,
0.01). Isokinetic muscle function
returned to baseline 72 hours
after muscle damage in both
treatment groups (Figure 5).
Creatine Kinase Activity
No significant difference be-
tween absolute baseline levels
of creatine kinase activity was
observed between groups
(Table 1), with baseline creatine
kinase activity within normal
resting limits (25). Creatine
kinase activity data were trans-
formed to natural log values to
satisfy assumptions of spheric-
ity associated with repeated-
measures ANOVA. A signifi-
cant main effect of time (F=
9.1, p,0.01) was observed on
Figure 4. Squat jump height after plyometric exercise. *Significant difference from baseline in all groups;
+Significant difference from baseline in passive group; †Significant difference from baseline in passive recovery
and combined treatment groups; ‡Significant difference from baseline in passive recovery and compression
groups; A) Significant difference between passive recovery and combined treatment group; B) Significant
difference between passive recovery and compression treatment group; C) Significant difference between
treatment groups.
Figure 5. Isokinetic muscle function after plyometric exercise. *Significant difference from baseline in all groups;
+Significant difference from baseline in passive group; †Significant difference from baseline in passive recovery
and combined treatment groups; A) Significant difference between passive recovery and combined treatment
group; B) Significant difference between passive recovery and compression treatment group; C) Significant
difference between treatment groups
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creatine kinase activity, but no group (F= 0.7, p.0.05), or
group 3time interaction effects (F= 1.7, p.0.05) were
present.
DISCUSSION
Data from a previous investigation (15) had indicated that the
use of lower limb compression significantly reduced decre-
ments in muscle strength loss and performance, and
moderated increases in perceived soreness following EIMD.
Data from the first investigation were used to determine
whether combining the use of lower limb compression with
a sports massage immediately after damaging exercise had an
additive beneficial effect on symptoms of EIMD. A significant
main effect for time was observed on all indices of EIMD,
indicating that the exercise protocol was successful in inducing
muscle damage. Though previous investigations (18) have
used more aggressive damage exercise protocols, plyometric
jumping of this nature has been used successfully to induce
muscle damage and was selected for its appropriateness for
athletes as this level of damage is likely to occur during the
course of a normal training and competition schedule.
Information pertaining to the performance of female athletes
following EIMD is relatively sparse, with the majority of
studies using either male or mixed gender samples. There is
currently some debate as to whether there is an effect of gender
on symptoms of EIMD in human subjects (13,33). Therefore,
this study was designed to both contribute to the limited
literature regarding female recovery responses following
EIMD and eliminate the potential for a gender effect.
Participants were individuals training and competing regularly
and were selected from competitive university sports teams
to ensure a similarity of training status. Several studies have
observed a protective effect of previous training on responses
to EIMD (see [22] for review). Therefore, individuals were
excluded if they had engaged in specific plyometric or weight
training programs in the 3 months preceding data collection.
Perceived muscle soreness significantly increased immedi-
ately after plyometric exercise in both groups. Soreness in all
groups peaked 24–48 hours after muscle damage and returned
to baseline values 96 hours after initial muscle damage,
a temporal pattern consistent with both specifically and
nonspecifically trained individuals, as in this case (38).
Perceived soreness was significantly higher in the passive
recovery group 24, 48, and 72 hours after muscle damage
and was also significantly higher in comparison with the
compression treatment group, 1 hour after exercise (p,0.01).
One hour after plyometric exercise, the perceived soreness of
individuals in the combined treatment group was significantly
higher than those in the compression treatment group. This
difference was reversed 48 and 72 hours after damaging
exercise, with greater perceived soreness reported in the
compression treatment group in comparison with the
combined treatment. Sports massage intentionally seeks to
affect deep muscle tissue, and individuals often experiencepain
during the treatment. In this case, the significantly higher
reported soreness 1 hour after damage (;30 minutes after
treatment), may be because of residual discomfort as a result
the treatment. Perceived soreness was significantly higher in
the compression treatment group 48 and 72 hours after muscle
damage, indicating that the sports massage had an additive
positive effect on soreness beyond that of lower limb
compression alone.
Muscle soreness following damaging exercise has often
been referred to as delayed onset muscle soreness, because
significant increases in perceived soreness tend to be observed
several hours after exercise. In this case, though peak soreness
followed a typical temporal pattern, occurring between 24 and
48 hours after damage, significant increases in muscle soreness
were observed 1 hour after damaging exercise and is consistent
with previous research in this area (3,35). Practically, athletes
and coaches should be aware that soreness associated with
muscle damage can be present immediately after exercise and
is not solely a delayed effect. Studies where increases in
perceived muscle soreness have not been observed immedi-
ately (#1 hour) after damaging exercise have typically used
less aggressive damaging exercise protocols (14) or have not
assessed measures of soreness #1 hour after damage (27). In
this study, and those by Twist and Eston (35) and Davies et al.
TABLE 1. Creatine kinase activity (mean 6SD) after exercise-induced muscle damage.
Pie Creatine kinase activity (UL
21
)
1 24 487296
Passive recovery 106.7 650.9 144.7 650.7* 276.5 6126.2* 155.3 660.9* 105.7 642.5 100.3 643.3
Lower limb
compression
170.1 691.7 248.8 6110.6* 245.0 6100.9* 182.5 6104.8 202.2 6222.5 227.7 6255.2
Massage and
compression
150.6 646.2 175.1 634.2* 206.4 660.1* 122.5 634.2 162.8 695.6 124.5 646.1
*Significant difference from baseline (p,0.05).
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(3), the magnitude of strain is likely to be greater than the
strain elicited by other eccentrically biased exercise protocols,
consequently increasing the magnitude of muscle damage,
as evidenced by large functional strength decrements, and
causing mechanical disruption that is likely to increase in
soreness soon after exercise.
Consistent with previous research, muscle strength was
significantly affected by the plyometric exercise protocol (2,23).
Countermovement jump height was affected to a lesser extent
than squat jump height following the damaging protocol (11.4
vs. 15.6% 1 hour after damage) as a result of the contribution of
the stretch-shortening cycle in the countermovement jump
action. Though there were some variations in response, there
were typically no significant differences in jump performance
between treatments.
Muscle function was also assessed using isokinetic dyna-
mometry at a slow speed of isokinetic muscle contraction
(60°s
21
). Previous research has indicated that strength
decrements following damaging exercise are greater at slow
contractile speeds (30). The slow contraction speed was used
to provide the greatest opportunity to observe any treatment
effect and to reduce the incidence of artifact associated with
this type of assessment. Isokinetic muscle strength decreased
18.2% after damaging exercise in the passive recovery group,
and 15.7 and 17.6% in the combined and compression
treatment groups, respectively. Strength decrements in the
passive recovery group continued to fall to 69.9% of baseline
values 48 hours after damaging exercise, before beginning to
recover 72 and 96 hours after damage. The temporal pattern
and magnitude of strength decrement observed in this study is
consistent with those of previous research investigating the
effects of EIMD (2).
It has been suggested that sports massage treatments
applied soon after muscle injury can have a positive effect
on the inflammatory process, reducing emigration of
neutrophils to the cell wall, subsequently decreasing localized
edema (1,32). Further muscle damage caused by neutrophil
and macrophage free radical production may also be
moderated by the massage process (1). Friden et al. (8) have
indicated that swelling following muscle damage may lead to
increased intracellular pressure, which in turn can result in
increased perceptions of soreness. A reduction in soreness
observed by Zainuddin et al. (39) was linked to a reduction in
swelling following damaging exercise consistent with the
suggestion of Friden et al. (8) that swelling can lead to
soreness. This is supported by Farr et al. (5) who observed
decreased soreness after a massage treatment administered
2 hours after a downhill walking exercise.
The ability for compressive clothing to significantly affect
edema after damaging exercise has also previously been
demonstrated (7). Limb constriction following damaging
exercise has been shown to decrease localized edema,
promote limb blood flow, expedite the removal of cellular
debris, and reduce perceived soreness (17). The combination
of these treatments may explain the significant differences
in perceived soreness between the passive recovery and
experimental groups in this study. Soreness has been
associated with neuromuscular inhibition following damag-
ing exercise. Westing et al. (38) indicated that soreness could
result in reduced neural drive to protect the musculoskeletal
system from further injury under high tension loading
conditions. Reductions in soreness, such as in this study, may
subsequently explain the differences in functional muscle
capability between the passive recovery and treatment
groups. However, the influence of soreness on subsequent
muscular contraction capability following muscle damage
however is unclear. Although soreness may be associated
with reduced neural drive following damaging exercise (38),
studies which have superimposed electrical stimulation on
maximum voluntary muscle contractions have indicated that
subjects are able to fully activate muscles despite the presence
of soreness (30). Soreness may or may not be a limiting factor
in the ability to produce a maximal voluntary muscle action,
but recovery methods moderating perceived soreness are
pertinent in holistic treatment strategies.
Mechanical disruption to muscle fibers after EIMD is well
documented (14,28), though the effects of massage and
compression treatments are rarely considered in these terms.
Limb constriction associated with compressive garments of
this nature have been described as creating a dynamic cast
(17), promoting normal alignment of muscle fibers after
EIMD, and the benefits in terms of perceived soreness
previously discussed. The mechanical action of massage
may also promote a return to more normal muscle fiber
alignment, while decreasing passive tension within the
muscle fibers and positively affecting perceptions of soreness
and mood state (11,12,20). It is possible that the promotion of
muscle fiber alignment, afforded by both compression and
massage treatments, may facilitate recovery of muscle
function and explain alterations in muscle function observed.
The failure of massage to subsequently affect recovery of
muscle function may indicate that there is a limit to the
potential for immediate recovery after EIMD, though this
suggestion must be examined. Compressive clothing has
previously been investigated in regard to its ability to
promote tissue repair. Trenell et al. (34) investigated the
effects of compressive clothing on the inflammatory response
and observed an increase in phosphodiester on a
31
P-MRS
spectra, suggesting that this represented an altered in-
flammatory response and accelerated muscle repair.
The timing and duration of intervention seem to play an
important part in determining the effectiveness of a treatment
when using massage and compression treatments. Butterfield
et al. (1) and Smith et al. (32) observed positive effects of
massage-type actions on recovery from EIMD where
treatment was administered within 2 hours of damaging
exercise. Butterfield et al. (1) observed that the beneficial
effects associated with their cyclic compression intervention
were lost when the treatment was applied 48 hours after
damage. The duration of intervention is similarly important.
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Moraska (24) suggested that to be effective, a massage
treatment should last at least 10 minutes per body part. This
may go some way to explaining the lack of effect observed in
other studies that used a shorter massage duration (10,11).
Lambert et al. (19) have previously indicated that compres-
sion garments of this type should be worn for a minimum of
3 hours after strenuous exercise, and this appears to be
consistent with current practice in some elite athletic fields.
After damaging exercise, increased creatine kinase activity
is often observed and is considered to indicate an increase in
cellular permeability caused by muscle damage. Although
creatine kinase activity increased significantly after damaging
exercise, there were no differences between groups across
time. This would indicate that the treatments had no
protective effect on creatine kinase activity. Although a good
indicator of the occurrence of muscle damage, creatine kinase
activity responses after EIMD typically track poorly with
other markers of muscle damage (37).
This study examined a treatment strategy using sports
massage and lower limb compression to moderate the
symptoms of, and promote recovery from EIMD in young,
nonspecifically trainedwomen. Data from a previous study (15)
were included to determine whether the combined treatment
offered any additional benefits in terms of moderating
symptoms of EIMD. The compression and combined
treatment strategies were successful in moderating functional
strength losses and increases in perceived soreness following
strenuous plyometric exercise in comparison with a passive
recovery group. Although perceptions of soreness were
moderated by the combined treatment, the practicality of
using sports massage as a treatment strategy is questionable
given the lack of effect of the combined treatment on
functional performance. Though this study observed that the
combination of lower limb compression and sports massage
was effective in ameliorating some of the deleterious
symptoms of EIMD, the additional benefits of sports massage
are unlikely to be great enough to warrant widespread use,
especially if lower limb compression is available.
PRACTICAL APPLICATIONS
The application of lower limb compression immediately after
exercise, which may be damaging in nature, reduces
perceptions of soreness and decrements in performance
in comparison with a passive recovery. Combining this
treatment with a manual massage immediately after exercise
can further benefit recovery in terms of perceived soreness but
offers no additional benefit on muscle function. However,
because no additional performance benefits were offered, the
cost and time constrictions associated with manual massage
are likely to limit its feasibility for use with groups of athletes,
especially if lower limb compression is an available treatment.
ACKNOWLEDGMENTS
The authors declare no conflict of interest and no grant
support was provided for this study.
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