Contributed by April Neufeld, BS, LMT, BCTMB; Natalie Lorick, LMT; Derek R. Austin, PT, DPT, MS, BCTMB, CSCS, Massage Therapy Foundation Contributors

Delayed onset muscle soreness (DOMS) is a commonly expected muscle condition that affects people who engage in sudden or intense exercise that doesn't fit with the person's normal physical activity. Although DOMS frequently passes within 24-48 hours, most people experience pain, tenderness, stiffness, edema, muscle weakness, and discomfort in gait as part of the normal inflammatory reaction of aggressive activity.

The micro-damage caused to the primary muscles used in the exercise is thought to be caused by the most intense of exercises, but it can actually be experienced by people of all fitness levels.

Researchers have documented many different interventions to mitigate the DOMS effect including massage therapy. However, little is understood on how massage therapy relates to gait patterns following DOMS. This month, the Massage Therapy Foundation's research column reviews a study originally published in the Journal of Exercise Rehabilitation¹ that investigated whether massage therapy affects gait and pain in participants with DOMS.

Participants & Methods

The researchers recruited 21 students attending Kyungnam University in Changwon, Korea, who did not usually perform lower-leg exercise and were otherwise healthy (age, height, weight, and gender were all documented). The participants were randomly selected into a control (n=10) and experimental groups (n=11). The researchers write that they had participants walk up and down a five-story building 20 times (isotonic exercise) to induce DOMS. Then, the individuals in the experimental group received 15 minutes of massage therapy.

The massage therapy techniques consisted of "light stroking, milking, friction, and skin rolling" for 15 minutes on the dominant gastrocnemius. As our readers know from reading other research studies, it is reasonable to expect a detailed description of each technique and the duration in which the technique was used. Unfortunately, a detailed description was not included, and no mention was made of the qualification of the person performing the massage.

While the experimental group received 15 minutes of massage, the control group received a sham TENS treatment for 15 minutes, where the TENS pads were attached to gastrocnemius, but not actually engaged.

Results

Following treatment, the researchers measured the sensitivity of pain and performed a gait analysis. Using an algometer, they measured pain sensitivity at the middle bell of the medial and lateral gastrocnemius, and found there was a significant difference between the massage group and the control, indicating that massage may reduce pain after DOMS.

Analysis on the gait examined both the time and spatial variables. The authors wrote, "In the temporal variables, there [were] statistical differences in ambulation, heel on/off time, and stride velocity but no differences in step time, cycle time, swing time, stance time, single support time, [or] double support time."

The results of the spatial variables showed that massage therapy may have had positive influence on the gait pattern. No significant correlations were found between pain and gait.

Discussion

The study authors referenced several other studies of massage therapy and its effectiveness on pain, including: massage therapy for pain treating patients with gout, massage therapy decreasing the intensity of muscle soreness at 48 hours following exercise, and a study of a sports massage program that showed effectiveness in treating DOMS. But they did not discuss if the massage techniques used in those studies matched the techniques used in their study.

The researchers also briefly discussed their reasons for not choosing to use a visual analogue scale (VAS) as a measure of pain, indicating that a previous study had outlined it as a poor tool. This was a limitation on their part, as VAS scales are commonly used in therapeutic settings and help medical providers compare the results of other studies and might be more applicable to a clinical setting.

Using a digital algometer, although perhaps more objective for measuring pain in a study, would not interfere with the standard VAS results, and are not commonly used in most clinics (at least in the U.S.).

The significant limitation of this study, not addressed by the authors, is the lack of detail on the massage techniques used. Later in the paper, the researchers discuss the effects of massage on blood and lymph circulation, elimination on lactate accumulation, and fatigue. And although there are studies that might show this, because the authors did not describe in detail the types of massage being performed, readers are limited when comparing this study to other studies where massage is the intervention.

The authors listed skin rolling as one of their massage techniques, but there is no research cited indicating that this specific technique, or this technique in combination with others, affects lymph, inflammation, or pain. The details of each massage technique could have vastly different outcomes on the condition being studied.

Without detailed definitions of each technique, readers are left to draw their own conclusions that stroking might mean effleurage, milking might mean petrissage, and friction could be multiple different types (linear or with the direction of the muscle; cross-fiber?). And without clearly understanding how much of each technique was used on each participant, other researchers have limited ability to duplicate this study.

Another limitation already mentioned is the absence of description of the person providing the massage therapy intervention. If an untrained student were performing the massage techniques, and the researchers did not define the techniques, how are readers to understand how the techniques are performed or if they were performing the technique the same as the researchers?

If studies are to be of benefit to multiple therapists across different countries, schools, and professions, then it is essential for researchers to provide the details of all aspects of the study, especially the details of the intervention. Otherwise, what a sports massage therapist in Portland, Ore., understands as "flush" will not be understood as "effleurage" to registered massage therapist in Canada, or "gliding" to a physical therapy student in Korea.

Are all these terms describing the same technique or are they just different words in different contexts? There could be fundamental differences in the way each technique is performed and indicated (or contraindicated), and the authors also did not mention why these four techniques and not others were chosen as the intervention.

Readers of this column who might be interested in writing and submitting a case report to the Massage Therapy Foundation's case report contest should remember the importance of detailing the type of massage therapy techniques used and being sure to provide sources for each technique definition. And if you would like to see how this study compares to other studies examining massage therapy's effect on pain, please visit the Massage Therapy Foundation's review archive section or search PubMed for "massage therapy."

This synopsis is authored by volunteers from the MTF's Writing Workgroup. To learn more visit their columnist page.

References

1. Han J, Kim M, Yang H, et al. Effects of therapeutic massage on gait and pain after delayed onset muscle soreness. J Exercise Rehab, 2014;10(2):136-140.