The Mechanisms of Massage and Effects on Performance, Muscle Recovery and Injury Prevention

AbstractMany coaches, athletes and sports medicine personnel hold the belief, based on observations and experiences, that massage can provide several benefits to the body such as increased blood flow, reduced muscle tension and neurological excitability, and an increased sense of well-being. Massage can produce mechanical pressure, which is expected to increase muscle compliance resulting in increased range of joint motion, decreased passive stiffness and decreased active stiffness (biomechanical mechanisms). Mechanical pressure might help to increase blood flow by increasing the arteriolar pressure, as well as increasing muscle temperature from rubbing. Depending on the massage technique, mechanical pressure on the muscle is expected to increase or decrease neural excitability as measured by the Hoffman reflex (neurological mechanisms). Changes in parasympathetic activity (as measured by heart rate, blood pressure and heart rate variability) and hormonal levels (as measured by cortisol levels) following massage result in a relaxation response (physiological mechanisms). A reduction in anxiety and an improvement in mood state also cause relaxation (psychological mechanisms) after massage. Therefore, these benefits of massage are expected to help athletes by enhancing performance and reducing injury risk. However, limited research has investigated the effects of pre-exercise massage on performance and injury prevention.Massage between events is widely investigated because it is believed that massage might help to enhance recovery and prepare athletes for the next event. Unfortunately, very little scientific data has supported this claim. The majority of research on psychological effects of massage has concluded that massage produces positive effects on recovery (psychological mechanisms). Post-exercise massage has been shown to reduce the severity of muscle soreness but massage has no effects on muscle functional loss. Notwithstanding the belief that massage has benefits for athletes, the effects of different types of massage (e.g. petrissage, effleurage, friction) or the appropriate timing of massage (pre-exercise vs post-exercise) on performance, recovery from injury, or as an injury prevention method are not clear. Explanations are lacking, as the mechanisms of each massage technique have not been widely investigated. Therefore, this article discusses the possible mechanisms of massage and provides a discussion of the limited evidence of massage on performance, recovery and muscle injury prevention. The limitations of previous research are described and further research is recommended.

[1]  P. Sacco,et al.  The effects of therapeutic massage on delayed onset muscle soreness and muscle function following downhill walking. , 2002, Journal of science and medicine in sport.

[2]  J. A. Starkey Treatment of ankle sprains by simultaneous use of intermittent compression and ice packs , 1976, The American journal of sports medicine.

[3]  Hazel M. Clarkson,et al.  Musculoskeletal Assessment: Joint Range of Motion and Manual Muscle Strength , 1989 .

[4]  S. Galloway,et al.  Massage provision by physiotherapists at major athletics events between 1987 and 1998 , 2004, British Journal of Sports Medicine.

[5]  M. Weber,et al.  The effects of three modalities on delayed onset muscle soreness. , 1994, The Journal of orthopaedic and sports physical therapy.

[6]  S. Magnusson,et al.  Passive properties of human skeletal muscle during stretch maneuvers , 1998, Scandinavian journal of medicine & science in sports.

[7]  D. H. Jones Massage and ultrasound as therapeutic modalities in exercise-induced muscle damage. , 1999, Canadian Journal of Applied Physiology.

[8]  L. Haugh,et al.  A Prospective Randomized Three‐Week Trial of Spinal Manipulation, Transcutaneous Muscle Stimulation, Massage and Corset in the Treatment of Subacute Low Back Pain , 1994, Spine.

[9]  B. Danneskiold-Samsøe,et al.  Regional muscle tension and pain ("fibrositis"). Effect of massage on myoglobin in plasma. , 1983, Scandinavian journal of rehabilitation medicine.

[10]  P. Clarkson,et al.  Exercise-Induced Muscle Damage and Adaptation , 1989, Sports medicine.

[11]  P. Harmer The effect of pre-performance massage on stride frequency in sprinters , 1984 .

[12]  J. Viitasalo,et al.  Warm underwater water-jet massage improves recovery from intense physical exercise , 2004, European Journal of Applied Physiology and Occupational Physiology.

[13]  T. Lundeberg,et al.  Sensory stimulation (massage) reduces blood pressure in unanaesthetized rats. , 1999, Journal of the autonomic nervous system.

[14]  P. Droppleman,et al.  Measures of salivary secretory immunoglobulin A and state anxiety after a nursing back rub. , 1994, Applied nursing research : ANR.

[15]  S. J. Sullivan,et al.  Effects of massage on alpha motoneuron excitability. , 1991, Physical therapy.

[16]  R. Eston,et al.  Electromyographic analysis of repeated bouts of eccentric exercise , 2001, Journal of sports sciences.

[17]  R G Eston,et al.  Electromyographic analysis of exercise resulting in symptoms of muscle damage , 2000, Journal of sports sciences.

[18]  Effects of ultrasound and trolamine salicylate phonophoresis on delayed-onset muscle soreness. , 1991, Physical therapy.

[19]  E. Ernst Does post-exercise massage treatment reduce delayed onset muscle soreness? A systematic review. , 1998, British journal of sports medicine.

[20]  D. Holbert,et al.  The effects of athletic massage on delayed onset muscle soreness, creatine kinase, and neutrophil count: a preliminary report. , 1994, The Journal of orthopaedic and sports physical therapy.

[21]  G. Ironson,et al.  Massage therapy is associated with enhancement of the immune system's cytotoxic capacity. , 1996, The International journal of neuroscience.

[22]  S. L. Nielsen,et al.  Effect of massage on blood flow in skeletal muscle. , 1974, Scandinavian journal of rehabilitation medicine.

[23]  L. Smith,et al.  Acute inflammation: the underlying mechanism in delayed onset muscle soreness? , 1991, Medicine and science in sports and exercise.

[24]  M. Callaghan The role of massage in the management of the athlete: a review. , 1993, British journal of sports medicine.

[25]  H. A. deVrics,et al.  Physiology of Exercise For Physical Education, Athletics and Exercise Science (5th Edition) , 1994 .

[26]  A. Goswami,et al.  Comparative Study of Lactate Removal in Short Term Massage of Extremities, Active Recovery and a Passive Recovery Period After Supramaximal Exercise Sessions , 1996, International journal of sports medicine.

[27]  P. Clarkson,et al.  Muscle function after exercise-induced muscle damage and rapid adaptation. , 1992, Medicine and science in sports and exercise.

[28]  P. McNair,et al.  Effect of passive stretching and jogging on the series elastic muscle stiffness and range of motion of the ankle joint , 1996, British journal of sports medicine.

[29]  P. Tiidus,et al.  Effleurage Massage, Muscle Blood Flow and Long-Term Post-Exercise Strength Recovery , 1995, International journal of sports medicine.

[30]  Armstrong Rb,et al.  Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. , 1984 .

[31]  David Brodie,et al.  The short-term effects of myofascial trigger point massage therapy on cardiac autonomic tone in healthy subjects. , 2002, Journal of advanced nursing.

[32]  M. Corley,et al.  Physiological and psychological effects of back rubs. , 1995, Applied nursing research : ANR.

[33]  G C Goats,et al.  Massage--the scientific basis of an ancient art: Part 1. The techniques. , 1994, British journal of sports medicine.

[34]  Patria A. Hume,et al.  Delayed Onset Muscle Soreness , 2003, Sports medicine.

[35]  S. J. Sullivan,et al.  H-reflex modulation during manual muscle massage of human triceps surae. , 1991, Archives of physical medicine and rehabilitation.

[36]  P. Tiidus Manual massage and recovery of muscle function following exercise: a literature review. , 1997, The Journal of orthopaedic and sports physical therapy.

[37]  R. Armstrong,et al.  Initial events in exercise-induced muscular injury. , 1990, Medicine and science in sports and exercise.

[38]  C. Moorehead All rights reserved , 1997 .

[39]  J A Bartlett,et al.  Immunological effects of massage therapy during academic stress. , 2000, Psychosomatic medicine.

[40]  J. T. Lightfoot,et al.  Immediate Postexercise Massage Does Not Attenuate Delayed Onset Muscle Soreness , 1997 .

[41]  Scott P. Lamp,et al.  Understanding Sports Massage , 2004 .

[42]  D. Steenbeek,et al.  Warm-up, Stretching and Massage Diminish Harmful Effects of Eccentric Exercise , 1994, International journal of sports medicine.

[43]  S. Hasson,et al.  Effect of ibuprofen use on muscle soreness, damage, and performance: a preliminary investigation. , 1993, Medicine and science in sports and exercise.

[44]  Diana S. Natalicio,et al.  The State-Trait Anxiety Inventory , 1971 .

[45]  P. Clarkson,et al.  Exercise-induced muscle damage in humans. , 2002, American journal of physical medicine & rehabilitation.

[46]  R. Weinberg,et al.  The Relationship of Massage and Exercise to Mood Enhancement , 1988 .

[47]  H. Lund,et al.  The effect of passive stretching on delayed onset muscle soreness, and other detrimental effects following eccentric exercise , 1998, Scandinavian journal of medicine & science in sports.

[48]  W. Reid,et al.  Different effects of strenuous eccentric exercise on the accumulation of neutrophils in muscle in women and men , 2000, European Journal of Applied Physiology.

[49]  T. Boone,et al.  The effect of massage on oxygen consumption at rest. , 1995, The American journal of Chinese medicine.

[50]  R. Armstrong,et al.  Mechanisms of Exercise-Induced Muscle Fibre Injury , 1991, Sports medicine.

[51]  M. McHugh,et al.  Flexibility and Its Effects on Sports Injury and Performance , 1997, Sports medicine.

[52]  A. Bell MASSAGE AND THE PHYSIOTHERAPIST. , 1964, Physiotherapy.

[53]  E. Howley,et al.  The effects of static stretching and warm-up on prevention of delayed-onset muscle soreness. , 1989, Research quarterly for exercise and sport.

[54]  L. Smith Causes of Delayed Onset Muscle Soreness and the Impact on Athletic Performance: A Review , 1992 .

[55]  P. Tiidus,et al.  Failure of manual massage to alter limb blood flow: measures by Doppler ultrasound. , 1997, Medicine and science in sports and exercise.

[56]  W. Bierman,et al.  The influence of manual massage on muscle relaxation: effect on trunk flexion. , 1962, Journal of the American Physical Therapy Association.

[57]  P. Clarkson,et al.  Etiology of exercise-induced muscle damage. , 1999, Canadian journal of applied physiology = Revue canadienne de physiologie appliquee.

[58]  Birgitta Öberg,et al.  Effects of warming up, massage, and stretching on range of motion and muscle strength in the lower extremity , 1983, The American journal of sports medicine.

[59]  B. Hemmings Psychological and immunological effects of massage after sport , 2000 .

[60]  J. Faulkner,et al.  Injury to skeletal muscle fibers during contractions: conditions of occurrence and prevention. , 1993, Physical therapy.

[61]  J. Fraser,et al.  Psychophysiological effects of back massage on elderly institutionalized patients. , 1993, Journal of advanced nursing.

[62]  J. Craig,et al.  Delayed onset muscle soreness: lack of effect of therapeutic ultrasound in humans. , 1999, Archives of physical medicine and rehabilitation.

[63]  R L Lieber,et al.  Structural and mechanical basis of exercise-induced muscle injury. , 1992, Medicine and science in sports and exercise.

[64]  F. Dolgener,et al.  The Effect of Massage on Lactate Disappearance , 1993 .

[65]  J. Longworth Psychophysiological effects of slow stroke back massage in normotensive females , 1982, ANS. Advances in nursing science.

[66]  C. Cinque Massage for Cyclists: The Winning Touch? , 1989, The Physician and sportsmedicine.

[67]  J. Duarte,et al.  Exercise, Muscle Damage and Fatigue , 1992, Sports medicine.

[68]  O. Airaksinen,et al.  The effects of massage in patients with chronic tension headache. , 1990, Acupuncture & electro-therapeutics research.

[69]  S. Labyak,et al.  The effects of effleurage backrub on the physiological components of relaxation: a meta-analysis. , 1997, Nursing research.

[70]  J. Allen,et al.  Lack of effect of acupuncture upon signs and symptoms of delayed onset muscle soreness. , 2000, Clinical physiology.

[71]  K. Francis,et al.  The effects of ice massage on delayed muscle soreness , 1984, The American journal of sports medicine.

[72]  G. Sundelin,et al.  The effects of preexercise stretching on muscular soreness, tenderness and force loss following heavy eccentric exercise , 1999, Scandinavian journal of medicine & science in sports.

[73]  T. Field,et al.  Massage and relaxation therapies' effects on depressed adolescent mothers. , 1996, Adolescence.

[74]  M. Gleeson,et al.  Cardiorespiratory, hormonal and haematological responses to submaximal cycling performed 2 days after eccentric or concentric exercise bouts. , 1995, Journal of sports sciences.

[75]  C. Harris,et al.  200 THE EFFECT OF DELAYED ONSET MUSCULAR SORENESS (DOMS) ON RUNNING KINEMATICS , 1990 .

[76]  R. Conatser,et al.  Muscle stiffness, strength loss, swelling and soreness following exercise‐induced injury in humans. , 1993, The Journal of physiology.

[77]  A. Zelikovski,et al.  The effects of the modified intermittent sequential pneumatic device (MISPD) on exercise performance following an exhaustive exercise bout. , 1993, British journal of sports medicine.

[78]  D. Braverman,et al.  Massage techniques in rehabilitation medicine. , 1999, Physical medicine and rehabilitation clinics of North America.

[79]  C. J. Sutherland,et al.  An investigation of the effects of massage on quadriceps performance after exercise fatigue. , 1995, Complementary therapies in nursing & midwifery.

[80]  K. McCully,et al.  Noninvasive assessment of vascular function in the posterior tibial artery of healthy humans , 2003, Dynamic medicine : DM.

[81]  P. Clarkson,et al.  Influence of previous concentric exercise on eccentric exercise-induced muscle damage. , 1997, Journal of sports sciences.

[82]  J. Monedero,et al.  Effect of Recovery Interventions on Lactate Removal and Subsequent Performance , 2000, International journal of sports medicine.

[83]  B. Hemmings Sports massage and psychological regeneration , 2000 .

[84]  B. Kaada,et al.  Increase of plasma β-endorphins in connective tissue massage , 1989 .

[85]  B. Jensen,et al.  Treatment of myofascial trigger-points with ultrasound combined with massage and exercise – a randomised controlled trial , 1998, Pain.

[86]  M. Tarnopolsky,et al.  Naproxen does not alter indices of muscle damage in resistance-exercise trained men. , 1999, Medicine and science in sports and exercise.

[87]  Noel D. Duncan,et al.  Influence of compression therapy on symptoms following soft tissue injury from maximal eccentric exercise. , 2001, The Journal of orthopaedic and sports physical therapy.

[88]  E. Cafarelli,et al.  The Role of Massage in Preparation For and Recovery From Exercise , 1992, Sports medicine.

[89]  R. Eston,et al.  Effects of cold water immersion on the symptoms of exercise-induced muscle damage. , 1999, Journal of sports sciences.

[90]  A. Guyton,et al.  Textbook of Medical Physiology , 1961 .

[91]  S. J. Sullivan,et al.  Changes in h-reflex amplitude during massage of triceps surae in healthy subjects. , 1990, The Journal of orthopaedic and sports physical therapy.

[92]  The effects of massage on delayed onset muscle soreness , 2003 .

[93]  Intermittent pneumatic compression effect on eccentric exercise-induced swelling, stiffness, and strength loss. , 1995, Archives of physical medicine and rehabilitation.

[94]  P. Tesch,et al.  Hyperbaric oxygen therapy does not affect recovery from delayed onset muscle soreness. , 2000, Medicine and science in sports and exercise.

[95]  M. Hernandez-Reif,et al.  Lower Back Pain is Reduced and Range of Motion Increased After Massage Therapy , 2001, The International journal of neuroscience.

[96]  P. Terry,et al.  Development and validation of a mood measure for adolescents. , 1999, Journal of sports sciences.

[97]  R. Armstrong,et al.  Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. , 1984, Medicine and science in sports and exercise.

[98]  G J Wilson,et al.  The ability of tests of muscular function to reflect training-induced changes in performance. , 1997, Journal of sports sciences.

[99]  P. Harris The metabolic effects of exercise , 1966, Proceedings of the Nutrition Society.

[100]  W. Evans,et al.  The metabolic effects of exercise-induced muscle damage. , 1991, Exercise and sport sciences reviews.

[101]  G. Atkinson,et al.  The effects of massage on intra muscular temperature in the vastus lateralis in humans. , 2003, International journal of sports medicine.

[102]  Hansen Ti,et al.  Effect of massage, shortwave diathermy and ultrasound upon 133Xe disappearance rate from muscle and subcutaneous tissue in the human calf. , 1973 .

[103]  R. Thayer,et al.  Measurement of Activation through Self-Report , 1967, Psychological reports.

[104]  P. Zehr Considerations for use of the Hoffmann reflex in exercise studies , 2002, European Journal of Applied Physiology.

[105]  P. Samples Does 'Sports Massage' Have a Role in Sports Medicine? , 1987, The Physician and sportsmedicine.

[106]  P. J. Benjamin,et al.  Tappan's Handbook of Healing Massage Techniques: Classic, Holistic and Emerging Methods , 1998 .

[107]  J. Graydon,et al.  Effects of massage on physiological restoration, perceived recovery, and repeated sports performance , 2000, British journal of sports medicine.