are the effects of deep tissue sports massage on delayed ......with rhythmical pressure and stroking...

CARDIFF METROPOLITAN UNIVERSITY

Prifysgol Fetropolitan Caerdydd

CARDIFF SCHOOL OF SPORT

DEGREE OF BACHELOR OF SCIENCE (HONOURS)

SPORT CONDITIONING, REHABILITATION AND MASSAGE

2015-6

Are The Effects of Deep Tissue Sports Massage on Delayed Onset Muscle Soreness Present in

University Athletes?

(Dissertation submitted under the SCRAM area)

Jonathan Davies

ARE THE EFFECTS OF DEEP TISSUE SPORTS MASSAGE ON

DELAYED ONSET MUSCLE SORENESS PRESENT IN UNIVERISTY LEVEL ATHLETES?

Cardiff Metropolitan University

Prifysgol Fetropolitan Caerdydd

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By submitting this document, I certify that the whole of this work is the result of my individual effort, that all quotations from books and journals have been acknowledged, and that the word count given below is a true and accurate record of the words contained (omitting contents pages, acknowledgements, indices, tables, figures, plates, reference list and appendices). I further certify that the work was either deemed to not need ethical approval or was entirely within the ethical approval granted under the code entered below.

Ethical approval code: 15/5/106U

Word count: 9915

Name: Jonathan Davies

Date: 10/03/2016

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I am satisfied that this work is the result of the student’s own effort and was either deemed to not need ethical approval (as indicated by 'exempt' above) or was entirely within the ethical approval granted under the code entered above. I have received dissertation verification information from this student. Name: ______________________

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Notes: The University owns the right to reprint all or part of this document.

TABLE OF CONTENTS

List of Figures

Acknowledgements i

Abstract ii

CHAPTER ONE: INTRODUCTION

1.1 Introduction to the topic area 2

1.2 Rationale 4

1.3 Aims and Objectives of the study 4

1.4 Research Hypothesis 4

CHAPTER TWO: LITERATURE REVIEW

2.1 What is Delayed Onset Muscle Soreness? 6

2.2 Muscle Soreness/Fatigue 6

2.3 Sports Massage 7

2.3.1 Physiological and Psychological Benefits of Sports Massage on

Delayed Onset Muscle Soreness 7

2.3.2 Pre Event Massage 9

2.3.3 Inter- Event Massage 10

2.3.4 Post Event Massage 11

2.4 Intervention Strategies 11

2.5 Different Types of Intervention Strategies 12

2.5.1 Deep Water Running 12

2.5.2 Cryotherapy 13

2.5.3 Electrostimulation 13

2.5.4 Compression Garments 14

2.5.5 Ultrasound 14

2.6 Conclusion 15

CHAPTER THREE: METHODOLOGY

3.1 Participants 17

3.2 Procedure 17

3.3 Pilot Study 18

3.4 Massage 18

3.5 Data Analysis 19

CHAPTER FOUR: RESULTS

4.1 Results 21

4.2 Summary of Results 22

CHAPTER FIVE: DISCUSSION

5.1 Overview of Findings in The Literature 24

5.2 Findings from This Study 24

5.3 Post Performance Massage 25

5.4 Arguments within in The Literature 26

5.5 Limitations of The Current Study 28

5.6 Improvements for Future Research 29

5.7 Conclusion 29

CHAPTER SIX: CONCLUSION

6.1 CONCLUSION 32

REFERENCES 34

APPENDICES

Appendix A: Participation Information Sheet A-1

Appendix B: Participant Consent Form A-2

Appendix C: Exercises used for data collection A-3

Appendix D: Pictures of the exercises used for data collection A-4

Appendix E: Massage techniques used for the intervention A-13

Appendix F: Pictures of massage techniques used for the intervention A-14

Appendix G: VAS scales used for analysing pain scores A-15

Appendix H: Metronome that could have been used to measure

massage pressure and depth etc. A-17

Appendix I: Two-way ANOVA with RM outputs for the intervention and

time during the acute phase of recovery. A-18

Appendix J: One-way ANOVA outputs for the Mas condition during the

full length of the study. A-19

List of Figures

Figure 1. The mean SD VAS scale scores for both massage and non massage

conditions used throughout the study.

Figure 2. The mean SD VAS scale scores that show the interaction between both the

massage and non massage conditions during the acute phase of recovery.

i

Acknowledgements

Firstly, I would like to thank my supervisor Dr Andrew Miles for all his help and guidance

throughout the writing of this study. Secondly I would like to thank the participants that

took part in the study, who without, the study would not have been made possible.

ii

Abstract

Objective: The primary objective of this study is to determine the effectiveness of massage

as an intervention and to ascertain the optimal massage techniques to help aid in the

reduction of Delayed Onset Muscle Soreness (DOMS) pain in the university level athletes,

following intense eccentric exercise.

Participants: 12 male undergraduate participants from Cardiff Metropolitan University took

part in the study. Participants played for Cardiff Met’s 2nd team football, 1st team futsal and

1st team badminton squads. All participants had a minimum of 12 month’s experience of

avid gym going, but had no experience in focusing on eccentric training.

Methods: All participants attended two separate weeks of data collection in a crossover

design format with each week consisting of the participants completing eccentric and

plyometric exercises. Once the session was completed, 50% of the group, received a 10-

minute massage focusing on their hamstrings, quads and calf’s, and the alternative 50%

where then asked to go away and rest. Every 12 hour’s post-session, all participants were

asked to fill out a Visual Analogue Scale (VAS) on their perception of DOMS. As this was a

crossover design study, seven days after the first session was completed, the same

procedures were carried out, but instead, the participants who didn’t receive the Mas

condition in the first session received one and the participants who did, didn’t. Again, they

were then required to complete a VAS scale every 12 hours post session.

Results: Analysis of the data revealed that massage applied post eccentric activity, had a

significant effect on the perception of DOMS within the acute phase of recovery (p < 0.05),

and showed no interaction regarding the remainder of the study.

Conclusion: Massage applied post eccentric activity, significantly reduced the effect of

DOMS within the acute phase of recovery, therefore, this study verifies the effectiveness of

massage as an intervention to enhance the performers reaction to DOMS and aid in the

recovery process.

1

CHAPTER ONE

INTRODUCTION

2

1.1 Introduction To The Topic Area

The use of massage to aid both athletic performance and as a modality to facilitate

recovery, has survived from antiquity and is one of the most common interventions to be

used (Cafarelli and Flint, 1992). There is no method or technique that accurately describes

it, rather massage is a broad term used to establish various techniques and how they are

categorized in the way in which they stimulate the targeted muscles (Calvert, 2002). There

are a number of different styles of massage, these include, Swedish, esalen style,

connective tissue, medical and sports massage.

Best et al. (2008) defines massage as a mechanical manipulation of body tissues

with rhythmical pressure and stroking for the purpose of promoting health and well-being.

Sports massage however, is specifically defined as ‘’the science and art of applying

massage and related techniques to maintain health of the athlete and to enhance athletic

performance’’ (Benjamin and Lamp, 2005). Five techniques are commonly used within

typical massage, these being, effleurage (stroking), petrissage (kneading), friction,

tapotement and vibrations, with each specific technique has its own specific purpose and

aim (Cafarelli and Flint, 1992). Cafarelli and Flint (1992) also state that up to 45% of total

time in physiotherapy for sport-related injury and performance consists of massage

treatments. According to both Cafarelli and Flint (1992) and Best et al. (2007), the benefits

of therapeutic massage on muscle include, relief of muscle tension and stiffness, faster

healing of strained and sprained muscles or ligaments, reduced muscle pain and greater

range of motion (ROM). Hinds et al. (2004) also state that as well as the above, massage

increases muscle blood flow and lactate clearance whilst decreasing levels of Creatine

Kinase (CK). All of which, have an effect on the level of delayed onset muscle soreness

(DOMS) felt post exercise.

Various authors such as Chen & Nosaka (2006), Hinds et al. (2004) Sayers (2004),

have all stated that effleurage has a benefit on the body’s reaction to DOMS. DOMS is

sometimes accompanied by a variety of physiological symptoms such as muscle oedema,

narrowed relaxed joint angle and a decreased pain free, active and passive ROM (Chen &

Nosaka, 2006).

The main goal to an athlete’s career is to achieve the best performance in their

given sport which predominantly involves intense levels of training and is often associated

with negative performance factors (Holey and Cook, 2003). For the athlete to maximise

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their athletic performance, it is clear that the signs and symptoms associated with intense

exercise should be reduced before subsequent athletic performance is completed.

However, due to training sessions and competitions being scheduled close together, this is

not always possible (French et al. 2008). As a result of this, athletes and coaches

implement intervention strategies such as stretching, exercise, cryotherapy, compression

garments, ultrasound and massage to help fight the detrimental effects of DOMS (Cheung,

Hume and Maxwell, 2003). With regards to the sporting population, the use of massage is

most commonly used to help with the recovery and regeneration of the skeletal muscles

damaged from intense training and competition (Tiidus and Shoemaker, 1995).

Resistance training plays an integral part in an athletes training programme and in

particular, eccentric exercise is becoming one of the most popular modes of training (Chiu,

Weiss and Fry 2001). Athletes and coaches generally use eccentric training to elicit the

stretch reflex and promote muscle hypertrophy (Howatson and Van Someren, 2008). An

eccentric muscle action is when the muscle lengthens under tension that is caused by an

opposing force greater than the force capability of the muscle (Bubbic and Kravitz, 2010).

Both Hortobagyi et al. (2001) and LaStayo et al. (2000) agree that the use of controlled

eccentric overloading of the muscle, resulted in an improvement in strength and function,

therefore favourable for athletes to include in their training schedules. Eccentric training is

considered as a component that induces DOMS, which is a result from the intense training

and competitive athletic performance (Sayers, 2004). DOMS is referred to skeletal muscle

pain following intense, unaccustomed eccentric exercise (Hart, Swanik and Tierney, 2005).

Due to the aftereffects of DOMS being so extreme, it has shown to limit performance, alter

a performer’s gait biomechanics and negatively affect force production (Smith, 1992;

Sayers and Dannecker, 2004).

Despite massage being frequently used by both coaches and athletes on a weekly basis,

the present literature doesn’t support the positive effects that massage has on recovery.

Samples (1987) and Weeks and Horan (2009) both highlighted that there has been no

conclusive evidence that deep tissue sports massage helps to improve performance and

recovery time in a training or competitive setting. Therefore, to help improve athlete’s

performance and recovery time, they need to complete not only massage, but use other

interventions to aid in the recovery from performance. Therefore, greater research has to

be carried out on this subject.

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1.2 Rationale

Of all the treatment modalities involved with recovery, massage is causing great debate

because the rationale behind the theories to support the way in which massage helps aid

recovery, remains unclear (Weeks and Horan, 2008). Regardless, Weerapong, Hume and

Holt (2005) state that massage is considered to enhance recovery and performance by

improving psychological, neurological, biomechanical and physiological mechanisms. Due

to this, many coaches and athletes still believe that massage has a strong effect on

maximising sport performance (Robertson et al. 2004, Samples 1987, Tiidus, 1997,

Callaghan, 1993, Cafarelli and Flint, 1992).

1.3 Aims, Objectives and Expectations of the study

The aims of this study was to investigate the differences between and the effectiveness

of performers having a post exercise deep tissue sports massage and not having a

massage, and the effect it has on the onset of DOMS 12, 24, 36, 48, 60 and 72 hours post

eccentric exercise. The expectations of the study are that there will be a significant

interaction between massage and time during the acute phase of recovery. The objective

was to conclude whether a deep tissue sports massage had an effect on the perception of

DOMS pain scores in university level athletes.

1.4 Research Hypothesis

Null: There will be no difference between the two interventions

H1: Massage applied within two hours ‘post’ eccentric session will significantly reduce the

effect of DOMS, up to 72 hours post exercise.

H2: No massage given ‘post’ eccentric session will influence the reaction to DOMS, 24, 48

and 72 hours post exercise.

5

CHAPTER TWO

LITERATURE REVIEW

6

2.1 What is Delayed Onset Muscle Soreness (DOMS)?

Healthy individuals who engage in strenuous physical activity to which they are

unaccustomed to, usually encounter a physiological reaction known as DOMS. The

soreness tends to begin at around 8 or more hours after cessation of the activity and

peaks around 1-3 day’s post and then gradually subsides (Armstrong, 1984). The muscles

affected are firm and tender and the force that they are able to exert during voluntary

maximal contractions, is decreased. The soreness makes itself known if an external

pressure is placed on the affected muscles, or if these muscles are exercised (Timus and

Ianuzzo, 1983). However, the soreness will rapidly disappear if the exercise is completed

for more than a few minutes. In fact, as stated by Armstrong (1984), exercising the sore

muscles appears to provide the most effective way of reducing the soreness.

Unfortunately, the soreness returns if the exercise is stopped (Armstrong, 1984; Friden

1984).

Despite DOMS being subjected to plentiful research, its still not certain as to what

mechanisms are responsible for its production. Although, it was hypothesised by Friden

(1984) that during the exercise, structural damage occurs to muscle fibres or connective

tissue within the muscles. Therefore, the fact that eccentric contractions are most likely to

result in DOMS, makes it plausible that mechanical factors are responsible for the

ultrastructural changes.

2.2 Muscle Soreness/Fatigue

Cheung, Hume and Maxwell (2003) state that any individual engaging in a new

physical activity, or those who have suddenly increased their exercise volume or intensity,

has more than likely experienced DOMS. DOMS is associated with ballistic stretching and

eccentric exercises such as downhill running, the lowering phase of weight training, and

plyometrics. This theory is in agreement with Armstrong’s (1990) theory that eccentric

muscle action and DOMS have a strong association to each other. Although there is a lack

of consensus as to the precise mechanisms behind DOMS, its presentation is fairly

consistent. The sore muscles are described as feeling stiff, tender, and aching especially

after palpation or movement (Powers and Howley, 1996). Various researchers such as

Armstrong (1984); Powers and Howley (1996); Clarkson and Sayers, (1999), hypothesised

that muscle soreness and fatigue is related to muscle structural damage, followed by ion

imbalance, inflammation, and pain. The location of soreness is generally most prominent

at the myotendinous junction where connective tissue is most abundant. However, in

severe cases, soreness can be felt throughout the muscle belly (Friden, Sjostrom and

7

Ekblom, 1983). DOMS is a hindrance, because it interferes with daily living activities,

impedes adherence to exercise programmes, and interferes with an individual’s

willingness to perform therapeutic exercises during rehabilitation (Clarkson and Sayers,

1999).

2.3 Sports Massage 2.3.1 Physiological and psychological benefits of massage on athletic performance A number of authors have examined the physiological and psychological effects

and the indirect markers of muscle damage that’s caused by massage. All of which, relate

to the degree of which a performer can successfully compete at their desired level

(Mancinelli et al. 2006; Balke, Anthony and Wyatt, 1989; Best et al. 2008). These include;

swelling, impairment of muscle function, and changes to the muscle proteins in the blood.

This suggests that the physiological reactions to massage are edging towards the negative

reactions rather than the positive. Tiidus (1999) states that there has been a lot of doubt

over the effectiveness of therapeutic massage with regards the treatment of DOMS and

the recovery of muscle function. Although there has been a lot of research regarding the

benefits of massage, the empirical data to support these benefits are limited, with the

majority of the data pointing to the limitations, rather than the benefits (Weerapong, Hume

and Holt 2005; Weeks and Horan, 2008).

After Mancinelli et al. (2006) reviewed the effects of massage on DOMS and

physical performance in female collegiate athletes, they found that due to the mechanical

pressures of the massage, local blood flow increased which hampered the margination of

neutrophils and reduced further damage associated with the inflammatory phase of the

healing process. However, Hume et al. (2004) suggests that there is no actual evidence to

suggest that these physiological responses can be related to enhanced athletic

performance. When Tiidus (1997) compared the differences between effleurage and

petrissage, he found that here was no apparent difference in the performers venous blood

flow following the application of the techniques to the quadriceps. So although the

literature has been reviewed with regards the effect of blood flow and massage, the

outcome as to why blood flow is increased during effleurage techniques and not during

petrissage, is still yet to be determined.

Hume et al. (2004) suggest that massage helps to improve recovery rate and

performance because it increases the supply of oxygen, whilst removing the waste

8

products of muscle metabolism by lymphatic circulation. A study by Rinder and Sutherland

(1995) researched how the rate of removal of metabolites from circulation affects

performance. They found that there was an increase in performance when massage was

applied pre-event compared to inter-event. As a result of this study, they hypothesised that

massage must be acting to clear the collection of interstitial fluid via the lymphatic system

and the strong evidence suggests that massage does have a role in improving

performance and recovery (Rinder and Sutherland, 1995). Although Rinder and

Sutherland (1995) suggested an improvement in performance was due to activating the

lymphatic system, there is no research that has directly linked this to an increase in blood

flow and is therefore questionable whether it is beneficial to athletic performance. Massage

also increases neurological excitability, which helps decrease pain levels via the ‘gate-

control’ theory and increased levels of serotonin (Weerapong, Hume and Holt 2005).

The physiological mechanisms, along with the psychological factors mentioned

above, may, depending on the athlete and the sport, help to enhance the reduction of

muscle soreness felt post athletic performance (Goodwin et al. 2007). Although, the

research in this domain has been overshadowed with methodological and statistical

limitations as well as poor sample size. This is why further research is needed in this area

(Cafarelli and Flint, 1992; Weeks and Horan, 2008).

Tiidus, (1997); Callaghan (1993); Cafarelli and Flint, (1992) all agree that athletes

and coaches alike, believe that massage has a positive effect on enhancing athletic

performance. During the 1972 Munich Olympic games, Lasse Viren attributed winning his

two gold medals to receiving daily massage. Up until then, sports massage had never

been associated with improving athletic performance (Smith, Keating and Holbert, 1994).

Recent literature states that the aim of sports massage is not only to help boost athletic

performance, and help with recovery, but also to increase ROM and prevent injury.

(Dinsdale, 2010). Weerapong, Hume and Holt (2005) suggest that massage is believed to

help reduce the feeling of fatigue and reduce the recovery time in between events,

competition and training. Subsequently, massage should be considered a vital treatment

strategy for any athlete, both as a tool for recovery and performance enhancement.

Muscle massage may be an alternative therapy, one that is popular and effective

with many disciplines (Moraska, 2005). If massage is rendered during the early stages of

inflammation, the mechanical pressure’s applied, might decrease neutrophil margination,

9

thereby reducing inflammation and alleviating symptoms of DOMS (Tiidus, 1999). Smith,

Keating and Holbert (1994) found that massage rendered two hours post exercise,

decreased muscle soreness levels and increased the circulating neutrophil count, which

suggests that the treatment reduced inflammation, enabling an increase of ROM and

decrease of muscle pain two day’s post exercise.

2.3.2 Pre Event Massage

A pre event massage is applied to the athlete before they undergo training for an

event or competition (Dinsdale, 2010). Mills and Parker-Bennet (2004) state that a pre-

event massage isn’t narrowed down to just applying it before an event, but can be applied

days leading up to the event as part of the athlete’s preparatory programme. The speed

and depth of the application will depend on the time of the massage in relation to how

many days left until the start of the event. Benjamin and Lamp (2005) stated that the aims

of the pre event massage are to help prepare the athlete physically and mentally for the

event or competition, so altering the speed and depth of the techniques is key. Arabaci

(2008) found that if you conduct a 15-minute lower limb massage, post warm up and pre-

event, it can drastically reduce the performance of the athlete in their desired sports. This

is because the mechanical factors involved with the massage, effect the muscles length-

tension relationship and decreases muscle activation which alters the muscles reflex

sensitivity, so when it comes to taking part in the activity, the athletes performance

capabilities are decreased.

One of the few limitations to this study was that two different massage practitioners

were used which caused a huge debate because although they know the correct

techniques and depths etc, they would differ from one another in other aspects of the

massage such as speed and application. On the other hand, there were many positives to

this study. One of which was that they asked the participants not to consume any food or

drink in the 3 hours prior to the intervention, which increased the reliability of the results.

The reason why a period of fasting was involved for the study, was that they were able to

directly measure the massage’s affect on vertical jump, sprint, reaction time and flexibility

without taking into consideration any dietary products that may have helped enhance

performance. Also, the test protocol was another positive to the study because the testing

protocol used was very strict, so this would allow for an easy replication of the protocol, if a

similar study was to be conducted. The sample size was another positive, because they

had plentiful numbers and a wide variety in sample size [n=24].

10

All of the above, contributed towards the effectiveness of the study because it

allowed for good practice and a good standard of work to be published. For the purpose of

this study, Swedish massage was used instead of sports massage, which could in turn,

influence the outcome of the results.

Fletcher (2010) stated that a pre-event massage intervention has little benefit on

enhancing a person’s sprint performance. He suggests that instead of a pre-event

massage, the time could be better spent by completing a specific warm up to help with the

efficiency of the athlete’s performance. A positive effect showed from this study was that

as the massage intervention was applied directly to the same muscle previously stretched

in the warm up, this resulted in much more of an effective comparison. A limitation from

this study was that there wasn’t adequate rest allowed between each testing session. This

could be a major limitation as having little or not enough reset in between sets, can cause

the performers to suffer from fatigue and therefore, effect the outcome of the results.

Another benefit from this study was the studies sample size [n=20]. However, due to a

specific warm up being completed, the study was not just measuring the massage but also

measuring the warm up effect, therefore, it could be said that the results of this study may

be invalid and unreliable.

On reviewing the current literature, Arabaci (2008); Dinsdale (2010); Mills and

Parker-Bennet (2004) and Fletcher (2010) all conclude that because pre-event massage

has an impact on a person’s parasympathetic nervous system, changes effect a person’s

salivary flow rate and cortisol concentration, which may explain the effects of subsequent

decrement in performance. They also suggest that as a pre-event tool, warming up at

higher speeds is much more effective, than having a pre-event massage because it

initiates the appropriate responses to exercise, readying the performer for the activity.

2.3.3 Inter-Event Sports Massage

Fritz (2013) states that an inter-event massage must be applied to the muscles that

have previously been worked, or are going to be worked during their upcoming session or

event. An inter-event massage is typically applied between rounds or heats during a

competition or in-between training sessions. Sports such as swimming, athletics, tennis

and invasion game tournaments, typically use inter-event massage as a recovery tool for

their players (Benjamin and lamp, 2005). The massage is typically split into two sections,

11

the first focusing on recovery, and the second focusing on preparation (Benjamin and

Lamp, 2005). The recovery phase focuses on relaxing the muscles by using techniques

that are short, light and focused, and the preparation phase consists of techniques that are

quick, long and upbeat that focus on readying the soft tissue muscle spindles to help with

increased performance levels (Fritz, 2013).

However, Benjamin and Lamp (2005) suggest that Inter-event massage basically

evolves into a pre-event massage because the aim here is to increase muscle tone and

reactivity in readiness for performance. So it will all depend on how the therapist alters the

techniques in conjunction with the athlete, and see whether an inter-event massage in

necessary for recovery.

2.3.4 Post Event Massage

Hemmings et al. (2000) describes post event massage as an intervention applied to

an athlete after an event or training session to help with recovery of soft tissue. They state

that throughout the years, post event massage has been used to combat the after effects

of a bout of high intensity exercise, and the most appropriate and effective time for the

post event massage to be applied, is between two and six hours post event. Findlay

(2010) proposed that massage can still be used as a recovery tool up to 3 day’s post

event. The main focus behind not only post event massage, but sports massage in

general, is to increase the speed of circulation. Benjamin and Lamp (2005) suggested that

an increase in circulation will improve the amount of nutrients delivered to muscles and

organs, whilst helping to remove all waste products that culminate from high intensity

exercise. As predicted in the other studies, the affects of both pre and post event massage

may be psychological, rather than physiological. Therefore, a post event massage should

only be applied if the performer feels necessary and whether or not it helps with the

recovery process of that individual.

2.4 Intervention Strategies

There have been a wide range of interventions proposed to help alleviate DOMS

which include pre and post exercise stretching, light exercise, ultrasound, non-steroidal

anti-inflammatory drugs (NSAIDS), cryotherapy and pharmaceutical agents (Hilbert, Sforzo

& Swenson, 2003). None of these treatments however, completely alleviate DOMS.

Bougie, (1997) and Cheung, Hume & Maxwell, (2003) state that treatment mechanisms

are plentiful, however, only limited success has been reported in research to date.

12

Considerable amounts of literature (Hilbert, Sforzo and Swenson 2003; Kraemer et al.

2001), have focused on how massage is used as an intervention strategy to help alleviate

DOMS because it’s use is so predominant among athletes and exercise participants, who

often believe that it relieves all symptoms and helps with the recovery process (Moraska,

2005). However, the literature is inconclusive, with some studies encouraging the use of

massage to treat or prevent DOMS and others encouraging alternative recovery

mechanisms. The mechanism behind the removal of DOMS is down to the practitioner

having actual contact with the muscle, regardless if the technique is superficial or deep,

because it moves and manipulates the damaged muscle fibres which, with the help of

physical manipulation, gets rid of Creatine Kinase (CK). The CK is moved around and

enters the bloodstream, which is then transported around the body and allows for it to be

metabolised and supplied to the working muscles. Effectively, decreasing the perceived

soreness of DOMS felt post-exercise (Hilbert, Sforzo & Swenson, 2003).

2.4 Different Types of Recovery Intervention Strategies

This section will evaluate various styles of recovery strategies and the literature that

explains them. There are a wide variety of recovery strategies used by many professional

athletes and coaches. The five that this literature review will focus on will be;

Deep Water Running

Cryotherapy

Electrostimulation

Compression Garments

Ultrasound

2.5.1 Deep Water Running (DWR)

Takahashi, Ishihara and Aoki, (2006) found that aqua exercise had a positive effect

on a performers recovery from muscle stiffness and soreness compared to adequate

resting. Although, it did not have an effect in reducing muscle damage. So the rationale

behind the use of aquatic activities as a recovery intervention is still to be decided. The

allure of DWR is that as you train, the natural buoyancy of the water reduces the strain on

your joints, bones and muscles, diminishing any onset of pain (Takahashi, Ishihara and

Aoki, 2006). The advantage of DWR is that it exerts a mild massaging affect as well as

providing a cardiovascular (CV) workout as if you were running on solid ground

(Takahashi, Ishihara and Aoki, 2006). Past studies show that aqua activities such as DWR

13

have facilitated recovery from muscle soreness and in particular, DOMS.

2.5.2 Cryotherapy

Cryotherapy is an intervention that has emerged in recent years and is being used

as a recovery strategy by many nations across the world (Mourot, Cluzeau and Regnard,

2007). Cryotherapy uses cold air or refrigerated gas (usually between -30C and -80 C)

that is pulsed at a high intensity and pressure in dry conditions, directly onto the skin and

over the muscles the performer wishes to be treated (Hausswirth & Mujika, 2013). This

recovery strategy is used much more than others because it cools the tissues to a greater

extent (Mourot, Cluzeau and Regnard, 2007). Recent studies show that cryotherapy has a

positive influence on an athlete’s recovery capacity. Al Haddad et al. (2010) study found

that cryotherapy affected the reactivation of the parasympathetic system following

exercise, which in turn, had a positive influence on the performers recovery process and

reducing the onset of muscle soreness. Although we have seen cryotherapy have an

effect on the recovery process and skin temperature, its relation and influence on DOMS

remains to be seen.

2.5.3 Electrostimulation

The many benefits in physiotherapy from using electrostimulation have led to it

being used in a much wider range of sports (Hausswirth & Mujika, 2013). It’s easy to use,

and the recruitment mode is different to other strategies because there is a voluntary

contraction from the electricity which is used as an effective way to help athletes in the

recovery process. This is due to the electricity increasing blood flow, improving their

venous return and inducing hypoalgesia which is a condition where a decreased sensitivity

to painful stimuli is present (Sandberg, Sandberg & Dahl, 2007). With few studies being

completed, there is still adequate information available regarding the effects of

electrostimulation on recovery between exercise sessions (Neric et al. (2009) and Martin

et al. 2004). The studies that investigated the effectiveness of electrostimulation on DOMS

have shown that there is no relation to recovery of perceived pain, joint flexion, or

restoration of functional capacities (Martin et al. 2004). Comparisons were made on the

effects of electrostimulation on those who completed active or passive recovery following a

one-legged downhill race. No significant differences resulted from the alternate recovery

strategies for maximal voluntary force, activation level, or perceived pain up to four day’s

post. Similar results were obtained by Butterfield et al. (1997), who found that there were

no significant reductions in muscle pain felt, post exercise. So, the actual effect

14

electrostimulation has on DOMS is still yet to be found, as some studies state a positive

reaction, and some studies state a negative reaction. Thus, electrotherapy should only be

used if other strategies are insufficient in combatting DOMS.

2.5.4 Compression garments

The ability for performers to tolerate and recover from physical exertion during

activity is magnified as an integral component of adaptation and performance (Barnett,

2006). Previous literature has examined how post-exercise recovery, can improve skeletal

blood flow in order to help improve muscle recovery (Barnett, 2006; Vaile et al. 2008).

Based on these demands, various sports and leisure manufacturers have developed

compression garments for athletes to use to aid performance and increase post exercise

recovery. Thus, athletes who adopt this recovery method, expect to develop substantial

gains in performance and a better quality of recovery (Hausswirth and Mujika, 2013).

Research conducted by Duffield et al. (2008) found that the use of compression garments

did not improve or hamper stimulated team sport activity. However, there were benefits of

reduced muscle soreness when players wore compression garments during and following

exercise. Therefore, athletes should only implement this recovery strategy if they feel

necessary or advised by coaches and team doctors etc (Barnett, 2006; Vaile et al. 2008).

2.5.5 Ultrasound

Another recovery strategy that athletes and coaches use is ultrasound. Ultrasound

is the process in which probes are used as a method of imaging tendons, muscles and

other soft tissues, without exposing the person to radiation (Fox, Biddle and Edmunds,

1997). Craig et al. (1999) investigated the effects of pulsed ultrasound on the effects of

DOMS, by using both high and low doses applied to both a placebo and control group. On

completion of their study, they found that the use of pulsed ultrasound in the management

of DOMS did not produce any significant evidence to alleviate the symptoms. This was

supported by Plaskett et al. (1999) study who found that 10 minutes of ultrasound

treatment to the hamstring was insufficient in alleviating DOMS and facilitating in the

recovery process. Therefore, the use of pulsed or non pulsed ultrasound to try and

alleviate DOMS was not effective in the recovery process or altered the performers ability

to perform post exercise strength tests.

As stated above, the effects ultrasound has on DOMS is negative, as Gam and

Johansson reviewed 293 papers between 1953 and 1993 to evaluate the evidence of

15

effect of ultrasound in the treatment of musculoskeletal pain, and found that around 80%

of articles written, were found to have a null effect due to various factors not being met and

continued throughout the study. So they suggest that it’s effect on musculoskeletal pain is

null and shouldn’t be applied unless necessary.

2.6 Conclusion

If maximal bouts of intense exercise are needed, it has been widely researched that

a performer’s ability to efficiently recover between sessions is aided by massage therapy

(Reily & Ekblom, 2005). To aid in avoiding any detrimental affects on performance, the

physical demands that many athletes face, prompts the need for coaches to implement

recovery strategies during their training/competition schedule (Sayers and Dannecker,

2004).

Indications from the literature used and presented in the past, the majority of it

seems to state that massage has little or no effect on functional strength and performance

but has a major influence on the recovery process of an individual. It was noted that the

most beneficial aspect of massage to aid recovery and performance, was to administer

therapy within 2 hours of exercise completion. This is further highlighted by Best et al.

(2008), which reviewed how sports massage has an effect in recovery if skeletal muscle

pain from strenuous exercise.

The research conducted regarding sports massage, has been vastly flawed by

methodological issues such as, length, time, type and duration of the massage

intervention and executing poor experimental control (Robertson et al. 2004; Arabaci,

2008). The reason behind as to why performers continue to receive sports massage is stull

unsure, as there is a lack of scientific evidence that supports this (Jonhagen et al. 2004).

Therefore, further research is needed in this subject to confirm the benefits that sports

massage has on an athlete’s performance.

16

CHAPTER THREE

METHODOLOGY

17

3.1 Participants Ethical approval was gained from the Cardiff School of Sport Ethics Committee and

following this, 11 male undergraduate students volunteered to take part in this study, all of

whom were healthy and injury free. The participants age, height and weight were 21(1.9)

years, 179.4 cm (5.7) and 71.7 kg (5.8) respectively. Participants were all informed of

the testing protocols, procedures and the potential risks of the investigation by a

participant information sheet (See appendix A), and consent was obtained through a

signed consent form (See appendix B). Before the data collection began, performers were

all asked if they were suffering from any medical conditions that may limit their ability to

participate fully in the study, all were free of any medical conditions. All participants

involved [n=11] were representing the university at various sports and were training or

playing matches, at least twice a week. All of the participants had a minimum of 12

month’s experience in a gym/training environment, but were not familiar with focusing on

eccentric or plyometric training. The after effects of this programme will differ from

previous outcomes felt post regular gym exercise, because the style of exercise is different

as you are focusing on one part of a movement (i.e. eccentric), rather then the whole

exercise pattern (i.e. full squat).

3.2 Procedure

Participants attended two separate weeks of data collection at Cardiff Metropolitan

University, in a crossover design format. The first part of the initial visit was to establish

each subjects baseline measurements (i.e. height and weight). To assess the outcomes

for each of these measures, a weighing scales (SECA Ltd, Birmingham, England) and

stadiometer (Leicester Height Measure, Tyne and Wear, England) were used. Before

completing the exercises, all participants completed a warm-up that included four aspects

essential for improving muscle range of motion (ROM) and flexibility. These were; Raise,

Activation, Mobilisation and Potentiation (RAMP). I used a warm up that is based around

Jeffrey’s (2008) RAMP principle, in which he suggests that the four sections allow for an

enhanced movement development activity and for the effective deployment of mobility and

pre-hab training before specific training goals are achieved.

The RAMP warm up consisted of various exercises that integrated the physiological

and mechanical responses that are needed for the session. The participants then took part

in a 45-minute eccentric and plyometric session, where exercises varied from hamstring

nordics to eccentric heel drops (See appendix C & D). Once the session was completed,

18

50% of the group, received a 10-minute massage focusing on their hamstrings, quads and

calf’s, and the alternative 50% where then asked to go away and rest. Both groups were

then asked to go away and complete a VAS scale 12 hours post exercise. Prior to the

participants finishing their session, a massage bed was set up and checked thoroughly to

eliminate any risk of the bed breaking or collapsing. The massage bed was positioned in a

place which was deemed appropriate to all participants and wouldn’t obstruct or restrict the

procedures of any of the exercises.

Every 12 hour’s post-session, all participants were asked to fill out a Visual

Analogue Scale (VAS) (see appendix G) on their perception of DOMS. The primary

research method used within the study was the use of a scale (VAS). The validity and

reliability of this scale is adequate because it had previously been used in Gallagher et al.

(2002) study, which shows it to be less bias in comparison with other research methods

because it shows to perceive reliable data results and doesn’t divert the answers away

from the research question asked. The sheets were then collected and kept safe in a

folder for confidentiality purposes. As this was a crossover design study, seven days after

the first session was completed, the same procedures were carried out, but instead, the

participants who didn’t received the No massage condition in the first session received one

and the participants who did, didn’t. Again, I then asked them to complete a VAS scale

every 12 hours post session.

3.3 Pilot Study

A pilot study was conducted with the aim of familiarising the researcher and

massage practitioner with the protocol of the main study. A pilot study is used to identify

any possible faults or limitations in the procedure, such as, whether the protocol being

used, initiates a response to the research question (Blessing and Chakrabarti, 2009). A

pilot study also enabled the researcher to become familiar with the exercises and how

each should be coached. Blessing and Chakrabarti (2009) state that without a pilot study,

the researcher could put their study at risk, as a mistake in the procedure could lead to an

effect on the quality and reliability of the results. After the pilot study was completed, there

were slight changes made to the exercise prescription.

3.4 Massage

The participants who received the sports massage immediately following the

session were asked by the massage practitioner to lay supine and prone on the massage

bed. Standard massage procedure was then administered and permission to palpate and

19

touch the participants was gained at the start of the massage by the practitioner. The 10-

minute massage was applied to the hamstrings, quadriceps and calf’s using the

techniques explained in appendix E. Once completed, the same procedure was completed

on the next performer and so on. Before the session commenced, all participants were

asked if they had any contraindications for example, illness, open wounds or acute soft

tissue inflammation, if so, then the massage was not administered to them. The massage

was administered by a student massage practitioner who used baby oil as a massage

medium as it is suitable for all skin types, so that it decreases the chances of any

participants suffering from any allergic reactions. The massage practitioner used practical

sessions implemented in their teaching schedule to familiarise themselves with the

techniques and stroke frequency appropriate for the massage. During the massage, the

performer had to lay both supine and prone on the bed and received a 10-minute massage

on the quadriceps, hamstrings and calf’s using ‘V’ and Cam and Spindle effleurage

techniques (see appendix E & F). Each stroke was administered in line with the muscle

fibres and each technique was used for around 1.5 minutes.

3.5 Data analysis

The data was analysed using the SPSS Statistics 20 statistical data analysis

package. A two-way analysis of variance (ANOVA) with repeated measures test was used

to see if there was a significant difference between receiving and not receiving a sports

massage and its effect on DOMS of each individual. A one-way ANOVA was also applied

to see the significant differences in the Mas and NoMas conditions (See appendix I).

20

CHAPTER FOUR

RESULTS

21

4.1 Results

The VAS scale scores for perceived muscle soreness (Mean SD; n=11) for the Massage

(Mas) and No Massage (NoMas) conditions at the 6 different time points post-exercise are

shown in figure’s 1 and 2.

Figure 1. The mean SD VAS scale scores for both massage and non massage

conditions used throughout the study.

Figure 2. The mean SD VAS scores that show the interaction between both the

massage and non massage conditions during the acute phase of recovery.

22

4.2 Summary of Results

Results from a two-way ANOVA with repeated measures identify a significant

interaction effect (F (4.43), p = 0.061) between time and massage condition between 12

and 24 hour’s post-exercise (Figure 2). This suggest that the reduction in DOMS score

from 12hrs to 24hrs post-exercise was significantly greater in the Mas condition (5.36

1.75 to 3.27 1.95) compared to the NoMas condition (5.18 1.78 to 4.36 2.06). No

other significant interactions between time and massage condition were evident

suggesting that the rate of reduction in VAS scores from 24hrs post-exercise to 72hrs

post-exercise was the same regardless of whether the subjects had had a massage or not.

Results from a one-way ANOVA on the Mas condition identified a significant interaction

effect (F (5.62), p = 0.011) at 12hrs (5.36 1.75, F = 5.62; p = 0.011) when compared with

24hrs (3.27 1.95, F = 5.62; p = 0.011), 36hrs (2.73 1.49, F = 5.62; p=0.003), 48hrs

(1.73 1.27. F = 5.62; p= 0.001), 60hrs (0.82 0.98, F = 5.62; p=0.001), and 72hrs (0.55

0.93, F = 5.62; p = 0.001). Similar analysis of the NoMas conditions showed that the

mean DOMS score at 12hrs (5.18 1.78, F = 7.64; p = 0.030) was only significantly higher

than at 60hrs (4.36 2.06, F = 7.64; p = 0.003), and 72hrs (1.45 2.21, F = 7.64; p =

0.002).

23

CHAPTER FIVE

DISCUSSION

24

5.1 Overview of findings in the literature The use of massage in the sporting environment is common, with both athletes and

coaches strongly believing that massage can be an effective modality to enhance recovery

and facilitate the removal of DOMS. Despite this, the scientific support for this research

area remains conflicting and uncertain. Callaghan (1993) suggests that massage has an

adverse effect on the performers recovery and the perceived levels of soreness felt

throughout the study, negatively effected their muscle soreness pain levels and said that

they would rather rest than receive the massage condition. Whereas Rinder and

Sutherland (1995) suggest that massage is beneficial in combatting the onset of DOMS as

they state that after receiving the massage, they were able to continue their training

schedule and daily activities without feeling pain or discomfort from the soreness. The

literature states that the optimal time for massage to be applied would be immediately after

intense exercise, as this is the most sufficient way of helping to heal or prevent muscle

soreness. Although, this would only occur during specific types of massage as some are

used to break down the muscle fibres and others focus on stimulating and warming up the

targeted muscle fibres. Alternatively, massage applied before athletic activity has shown to

have adverse effects on athletic performance. Callaghan (1983) stated that applying a

deep tissue sports massage and self myofacial release (SMR) within 2 hours pre exercise

didn’t have any effect in the reduction of DOMS scores and showed an adverse effect on

performance. There is still little evidence to date that suggests the application of massage

in-between bouts of exercise has a positive or negative effect on the performers reaction

to DOMS. The majority of the previous designs have been unsound due to having poor

methodological issues, and there is great discrepancy with regards to the duration, timing

and type of massage intervention used. Thus, the question would need to be asked to the

both athletes and coaches as to why massage is still used as a recovery intervention,

when the scientific evidence still remains unclear. It is important to bring forward the

research in this domain, to try and secure the benefits of sports massage so that the

biggest benefit comes to the sporting population and predominantly to confirm the positive

effects massage can have on the athlete’s performance and in reducing the onset of

DOMS felt post-exercise.

5.2 Findings from this study

The results from this study indicate that there was a significant interaction (p =

0.061) between massage and time during the acute phase of recovery only and this was

not evident beyond 24hrs post exercise. The results show that the research hypothesis

25

regarding the acute phase of recovery must be accepted. This study agrees with the

literature that state that the effects of massage during the acute phase is prominent.

Whereas after the initial 24hr period, the pain follows the normal physiological pattern in

slowly alleviating the muscle soreness over time.

5.3 Post-performance massage

The results from this study indicate that massage applied ‘post’ eccentric activity

has a significant effect on the severity of DOMS within the first 24hrs of recovery. The

current study agrees with the literature by Barnett, A. (2006); Benjamin and Lamp (2005);

Best et al. (2008), however, there is still an element of uncertainty as the research has

found that there is both a positive and negative effect on DOMS following the application

of massage. It will always be either a positive or negative effect, as some studies have

shown a positive effect (Balke et al. (1989); Rinder and Sutherland (1995); Benjamin and

Lamp (2005) and some have shown a negative effect (Wenos, Brilla and Morrison (1990);

Weber, Servedio and Woodall (1994); Jonhagen et al. (2004). In agreement with the

current study, Balke et al. (1989) and Rinder and Sutherland (1995) both found that

massage had a positive effect in the reduction in DOMS when applied immediately after

intense exercise. However, these studies used various factors such as peak torque values

to measure the number of leg extensions completed throughout the study, rather than

sticking to measuring pain levels and post athletic results. The current study had an impact

on the severity of DOMS and thus would propose to facilitate the removal of the products

that cause the pain, which is different from a massage that brings about a performance

increase. These were then formulated as indicators of athletic performance. Although

these outcomes are exact measurements of muscle strength and can successfully predict

the force capacity of the muscles, they cannot be directly related to making improvements

in muscle soreness and athletic performance (Wiktorssen-Moller, 1983).

The pain perception scales used in the current study are reliable indicators of

DOMS. Jamison et al. (2002) devised a comparison test between electronic and paper

based VAS scales for sporting populations to use as assessments for pain levels felt post

exercise. They identified that a paper based VAS scale is the most reliable test to use to

assess DOMS. This highlights a strength of the current study as the results can be directly

related to the perception of DOMS, in particular healthy athletes. However, it is difficult for

the current study to relate to the studies conducted by Balke et al. (1989) and Ruther and

Sutherland (1995), as they metabolically stressed the athletes by exerting them to failure

26

whilst cycling on an ergometer. This is compared to the eccentric muscular activity the

participants received in the current study and in the studies researched by Wenos, Brilla

and Morrison (1990), Weber, Servedio and Woodall (1994) and Jonhagen et al. (2004),

thus, producing different perceptions of muscle soreness and fatigue.

Overall, there are mixed results regarding the application of massage applied ‘post’

intense exercise. The current study disagrees with the literature by Wenos, Brilla and

Morrison (1990); Weber, Servedio and Woodall (1994); and Jonhagen et al. (2004), in that

massage applied immediately after intense eccentric exercise had no effect on

performance outcome. The studies that have found positive results when massage was

applied immediately after intense exercise, did not use functional performance outcomes

and thus cannot be directly related to athletic performance and reducing the onset of

DOMS. Massage applied ‘post’ intense exercise is commonly implemented into the

training schedule by both athletes and coaches to help facilitate recovery between training

sessions and to help to reduce the detrimental effects on performance (Jonhagen et al.

2004). Massage is believed to prepare the muscles for strenuous exercise and help

facilitate the recovery process from micro-trauma which is typically encountered during

intense eccentric exercise (Reily, 2009). It is also believed to increase local blood flow and

oxygen levels, whilst removing the by products via systemic and lymphatic drainage,

however, there is still little evidence to support these concepts (Cafarelli and Flint, 1992).

5.4 Arguments within the Literature

DOMS that results from intense eccentric exercise is a problematic issue for

coaches and athletes alike, as it often results in pain, a decrease in muscle function and

strength and an overall reduction in athletic performance (Weerapong et al. 2005). It is

evident from the literature that the protocols used to induce muscle soreness, differ from

study to study, thus producing varying degrees of muscle damage and soreness.

Studies have used both concentric and eccentric muscular activity, fatiguing

exercise or a combination of muscular contractions to help induce muscle soreness. It has

been well documented that eccentric muscle actions produce greater muscle damage than

concentric muscle actions (Zainuddin et al. 2005). Fewer motor units are recruited during

eccentric muscle actions when compared with concentric muscle actions, so the force and

tension per cross sectional area of muscle mass is greater in eccentric muscle actions

when compared with concentric. As a result of this, there is greater damage sustained to

27

the skeletal muscle. This is then often associated with a decrement in athletic performance

which is caused by a reduction in range of motion, inhibited proprioception, deficit in force

production and altered gait biomechanics (Sayers and Dannecker, 2004). Sayers and

Dannecker (2004) suggest that the decrease in performance seen with massage ‘pre’ and

massage ‘post’, suggests that the eccentric protocol produced sufficient muscle damage

and soreness and that the massage had a little effect on preventing the onset of DOMS.

Whilst massage ‘pre and post’ was successful in recovering the participants from the

eccentric protocol, thus, ultimately improving recovery.

Further differences in the literature maybe down to the quantity of muscle mass

injured as many studies use different limbs to induce muscle damage, so to try and

compare studies, is in-appropriate. The current study used a much larger muscle mass

compared to other studies in the literature, such as Brooks et al. (2005) who used maximal

hand grip power to fatigue. Injury sustained to a larger muscle mass could cause a greater

inflammatory response and therefore muscle soreness, which makes it difficult to compare

the outcomes of the studies against each other (Hilbert et al. 2003).

The main concerns that arose from the previous research with regards to massage

are methodological issues, such as the duration, type, technique and timing of the

massage intervention (Robertson, Watt and Galloway, 2004; Arabaci, 2008). A variety of

techniques are used to help reduce the signs and symptoms of DOMS which are

associated with intense eccentric activity, most commonly, effleurage and petrissage are

used as ‘restorative’ techniques to avoid any detrimental effects on performance (Tiidus,

1999). Cash (1996) describes effleurage as a technique that is proposed to aid in the

removal of muscle waste, stretch the tissues, stimulate the parasympathetic nervous

system and increase venous return. Studies conducted by Rinder and Sutherland (1995);

Tiidus and Shoemaker (1995) and Hart et al. (2005) all investigated the effect of massage

(effleurage, petrissage or a combination of both) had on muscular recovery and

performance after intense eccentric exercise, all of these however, had varying results. In

contrast, a few studies have used massage protocols that include more than two massage

techniques, with a combination of effleurage, petrissage, tapotement and frictions. This

was demonstrated by Zainuddin et al. (2005) and Robertson et al. (2004) research

studies. The different massage combinations make it difficult to determine the

effectiveness of each individual technique because each technique has varied

physiological responses and effects. The current study only used effleurage to determine if

28

it was an effective technique to aid in the reduction of DOMS felt, post-exercise. Massage

‘post’ was the only massage intervention to improve muscle recovery and thus it can be

suggested that the application of one 12-minute massage, helped to enhance recovery

after eccentric exercise had been completed. This can then lead to an increase in

performance levels. It can also be suggested that the physiological mechanisms may have

aided the improvement in performance. However, the scientific evidence has yet to be

determined and proven, hence, controversy still remains in the literature.

Not only is there controversy regarding the type of massage used, but the duration

of massage interventions used also differs in various literature. Typically, massages range

from 6 minutes (Rinder and Sutherland, 1995), 10 minutes (Tiidus and Shoemaker, 1995;

Zainuddin et al. 2005), 12 minutes (Jonhagen et al. 2004), 20 minutes (Hilbert et al. 2003

and Robertson et al. 2004) and as long as 30 minutes (Farr et al. 2004), all of these

studies however, result in having conflicting results. The optimum duration still needs to be

determined; although Robertson et al. (2004) suggested that a leg massage should last

around 10 minutes for it to be effective. The massage of the current study was 10 minutes

and followed a simple massage protocol so it could be transferred and easily followed and

replicated into a sporting environment. The results indicate that this duration of massage

was effective in diminishing the onset of DOMS during the acute phase of recovery

following the intense eccentric protocol. This is an important application to the sporting

population because it’s a modality that can enhance recovery rates and ultimately help the

performer to prolong their highest performance levels for longer.

5.5 Limitations of the current study

Throughout the research study various limitations occurred. Firstly, the participants

used in this study played for the Cardiff Metropolitan Badminton, futsal and football squads

and on average were only undergoing one weight training sessions and one match a

week. The athletes were also unfamiliar with biasing eccentric training. Therefore, the

participants were not used to completing intense eccentric training and thus may have

responded differently to the testing protocol compared with well trained athletes. Well

trained athletes are accustomed to the discomfort and pain that is associated with DOMS

and still complete intense eccentric exercise and are able to produce similar performance

levels whilst fighting DOMS (French et al. 2008). Further to this, more experienced players

tend to incorporate eccentric training protocols into their training schedule and would be

less influenced by the eccentric muscle actions than an untrained individual (French et al.

29

2008). The same can be implied with regard to the individual responses to massage.

Jonhagen et al. (2004) stated that athletes who are used to receiving sports massage may

react differently to those who don’t. The participants in this study were not used to

receiving regular sports massage so the physiological and psychological responses may

have reacted differently to those who are continuously involved with receiving regular

massage.

The massage protocol in the study also had some limitations. Although the same

massage practitioner was used and administered the massages, it cannot be guaranteed

each individual experienced the same pressure and exact tempo of strokes. This is where

a metronome (see appendix H) could have been used to help control the tempo of the

massage. This limitation is a recurrent theme within the massage literature and is

impossible to ensure the exact same tempo, pressure and depth is applied to each

individual.

5.6 Improvements for Future Research

This study could be developed further to help confirm the research regarding this

domain to help verify the results of the current study. Firstly, the mentioned limitations

could be taken into consideration and different measures could be taken to assure the

same weaknesses don’t occur again. Secondly, the study could be completed with higher

profile players of one particular sport, to see if they respond differently to the testing

procedure, compared to the more novice athletes used in this study. Furthermore, the

same study could be performed with more of an intense eccentric protocol to see if the

massage interventions have the same effect on performance when greater muscle

damage is produced. The same massage tempo and pressure could be implemented;

however, the use of different techniques may identify varying outcomes to determine if a

changed technique has the same effects as the techniques used throughout this study.

5.7 Conclusion

Overall, the eccentric protocol used, followed the recurrent theme in the literature

and suggest that massage applied in this context has significant benefits of the onset of

symptoms of DOMS, immediately post-exercise. The massage that was applied ‘post’

eccentric activity, shows that there is a significant interaction with regards to time and

massage condition. These two findings establish why athletes should continue to receive

massage interventions, as there appears to be benefits in the reaction to muscle soreness

30

and therefore, helping to increase immediate athletic performance.

Massage applied ‘post’ eccentric activity has proved to be the optimal recovery

intervention to improve performance after intense eccentric activity. This is because it has

shown beneficial implications to the sporting environment, particularly the coach and

athlete. The results from the study suggest that a massage intervention can be

implemented to help aid in the recovery process after completing intense eccentric

exercise. However, further research is required to confirm if this massage intervention is

indeed beneficial in enhancing performance, ultimately, helping to significantly decrease

the onset of DOMS felt post eccentric exercise. This is important to benefit the sporting

population and more importantly confirm the beneficial aspects that sports massage can

have on recovery from intense exercise and helping towards alleviating the signs and

symptoms of DOMS.

31

CHAPTER SIX

CONCLUSION

32

6.0 Conclusion

There is still conflicting research with regards to the varying recovery strategies

used in a sporting environment, especially massage, and the effect it has on helping to

alleviate muscle soreness and fatigue. The literature reviewed has mixed reviews, with

some supporting the benefits and some supporting the negative effects of sports

massage. Despite this, it is still frequently used in the sporting environment by both

athletes and coaches alike. This is mainly down to the lack of quality research and the

need for more well-controlled studies to help confirm and extend the current research.

There is still a need for studies to identify the optimal massage intervention that needs to

be used to help athlete’s recover, and help diminish the negative performance factors that

relate to decrements in athletic performance.

Despite the lack of positive results within the literature, athletes continue to regularly

implement massage into their recovery programmes, and its ever increasing popularity

suggests that athletes actually do gain benefits from the massage treatments. Gary Lewin,

the head of physiotherapy at the Men’s English National Football Team stated that for an

athlete to reach and maintain their maximal efforts, all aspects of recovery and care need

to be put in place – and many players rely on the role of an expert sports massage

therapist to help them recover, and is sometimes regarded as a more important member of

the team than the team doctor (Clayton, 2011). Therefore, many players and athletes will

feel that they are out of place if they don’t receive regular sports massage. Nevertheless,

due to the lack of scientific research, conflicting results and varied massage protocols, it is

impossible to conclude which massage intervention is the best to aid in the recovery from

intense eccentric exercise.

The current research study disagrees with the majority of the literature, as they

state that massage has negative effects in the reaction to DOMS, whereas the current

study had a positive reaction during the acute phase of recovery only. With the research

question in mind, the results from the study conclude that sports massage has a significant

effect on the reaction to muscle soreness within the acute phase of recovery, and is

therefore, a suitable recovery intervention to use in combatting the onset of pain felt from

muscle soreness and fatigue. Thus, suggesting that this massage intervention could then

help to maintain higher athletic performance for longer. These findings can be transferred

into a sporting context but there is yet to be any research to determine what standard and

type of athletes react better to the intervention.

33

Overall, the research within the massage domain is contradictory in the literature,

due to various studies suggesting both the positive and negative reactions to DOMS and

athletic performance. Although this current study will help to point massage in the right

direction, there is still a need for further research to confirm the findings of the current

research study and overall, verify the effectiveness of massage as an intervention to

enhance the performers reaction to DOMS and aid in the recovery process.

34

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35

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APPENDICES

B

Appendix A – PARTICIPANT INFORMATION SHEET.

Reference Number: 15/5/106U Title of Project: The effects of Deep Tissue Massage on Delayed Onset Muscle Soreness in University Athletes

Participant Information sheet

Background This study is an attempt to understand the effectiveness of sports massage against the effects of Delayed Onset Muscle Soreness (DOMS). This study has been approved by Cardiff Metropolitan Research Ethics Committee, and is being undertaken by myself. In brief, this study is interested in how a specific massage intervention strategy may have an effect on some of the physiological responses to exercise. The area that the project will examine is:

(i) Whether or not a 10-minute massage has any physiological effect on DOMS up

to 3 days post exercise completion.

What will happen? This study will require you to complete two weeks of data collection that will consist of you all undergoing 2 eccentric lower body sessions with one group receiving a post exercise massage and the other’s not receiving the intervention in the first week. The following week, each of the two groups will receive the alternate intervention. Both groups will then complete a VAS scale 24,48 and 72 hours post exercise. The VAS scale is just a simple number scale on which you will rate the degree of pain that you feel that day. The scale will rate from 0-10 and you just circle the appropriate answer. You should also note that following these sessions, you are likely to feel a pain in your muscles that may affect your body’s range of motion (ROM) up to three day’s post exercise, this is just a reaction to the intensity and type of exercises that you will be completing. All I expect from you is too make sure that you are able to attend both weeks sessions and complete VAS scales, up to 3 day’s post exercise. Do I have to? No, you don’t. You are able to withdraw from the study at any point without giving a reason as to why. Confidentiality In terms of confidentially, all the information that you give me (Name, ages etc) will all be confidential to myself and I will input you into my data collection as participant’s 1,2 etc. So no-one will know that you undertook this study. Have you got any questions? If you have any questions, then feel free to contact me via email, or text on the information provided below; Jonathan Davies. Student at Cardiff Metropolitan University 07790920872 @outlook.cardiffmet.ac.uk

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mailto:[email protected]

C

Appendix B – PARTICIPANT CONSENT FORM

Participant Consent Form Reference Number: 15/5/106U

Title of Study: The effects of Deep Tissue Sports Massage on Delayed Onset

Muscle Soreness in University Athletes

Student Name: Jonathan Davies

Student I.D:

To be filled in by the participant – Please tick all boxes

1) I confirm that I have read and understand the information sheet for the above

study. I have had the opportunity to consider the information and think about

what is required for this study, ask questions and have had these answered

satisfactorily.

2) I understand that my participation is voluntary and that I am free to withdraw

at any time, without giving a valid reason

3) I agree to take part in the study and agree to the use of my anonymised

quotes during the publishing of this study

Name of Participant Date ________________________________________ ____/____/____ Signature of Participant Date ________________________________________ ____/____/____ Name of person taking consent Date ________________________________________ ____/____/____ Signature of person taking consent Date ________________________________________ ____/____/____

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D

Appendix C – EXERCISES USED FOR THE DATA COLLECTION.

Muscle Targeted Exercise Sets Reps Weight (if any) Rest (Secs)

Hamstrings Knee tuck Jumps 2 10 BW 60

Hamstrings Hamstring Nordics 2 10 BW 60

Quadriceps Mountain Climbers 2 10 BW 45

Quadriceps Squats with medicine ball 2 10 Relative to BW 45

Glutes Monster walks 2 10 Red Bands 60

Glutes Glute kickbacks 2 10 BW 60

Calfs Eccentric band work 2 10 BW 45

Calfs Eccentric heel drops 2 10 BW 45

Lower Body Broad jumps 2 6 BW 60

Lower Body Jump squat with slow concentric phase

2 6 BW 60

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E

Appendix D – PICTURES OF EXERCISES USED THROUGHOUT THE DATA COLLECTION.

Muscles Targeted: Hamstrings Knee Tuck Jumps

START MID-POINT FINISH Hamstring Nordics

START MID-POINT FINISH

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F

Muscles Targeted: Quadriceps Mountain climbers

START POSITION 1

POSITION 2 FINISH

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G

Squats with Medicine Ball


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H

Muscles Targeted: Glutes Monster Walks


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I

Glute Kickbacks

START

MID-POINT

FINISH

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J

Muscles Targeted: Calfs Eccentric Band Work

START

FINISH

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K

Eccentric Heel Drops

START MIDPOINT FINISH

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L

Muscles Targeted: Quadriceps, Hamstrings, Calfs and Glutes Broad Jumps

START FINISH

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M

Jump Squat with Slow Eccentric Phase

START MIDPOINT (ADD JUMP) FINISH

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N

Appendix E – MASSAGE TECHNIQUES USED.

Body Part Technique Used Duration Depth

Hamstrings

V 1.5 minutes Moderate

Cam and Spindle 1.5 minutes Deep

Quadriceps



Calfs



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O

Appendix F – PICTURES OF THE MASSAGE TECHNIQUES USED. ‘V’

‘Cam and Spindle’

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P

Appendix G – VAS SCALES USED FOR ANALYSING PAIN SCORES.

VAS Scale for induced DOMS

- Please complete one of these, every 12 hours from the time in which you received a massage.

You are now 12 hours post exercise, please circle the appropriate number in which best describes your muscle soreness.



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Q




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R

Appendix H – METRONOME THAT COULD HAVE BEEN USED TO MEASURE THE MASSAGE DEPTH, SPEED AND PRESSURE.

Accessed on the 24th February 2016; Available from;

[https://en.wikipedia.org/wiki/Metronome]

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https://en.wikipedia.org/wiki/Metronome

S

Appendix I – TWO-WAY ANOVA WITH RM OUTPUTS FOR THE INTERVENTION AND

TIME DURING THE ACUTE PHASE OF RECOVERY.

Tests of Within-Subjects Contrasts

Measure: MEASURE_1

Source Intervention Time

Type III Sum

of Squares df

Mean

Square F Sig.

Intervention Linear 2.273 1 2.273 .778 .399

Error(Interventio

n)

Linear 29.227 10 2.923

Time Linear 23.273 1 23.273 44.522 .000

Error(Time) Linear 5.227 10 .523

Intervention *

Time

Linear Linear 4.455 1 4.455 4.434 .061

Error(Interventio

n*Time)

Linear Linear 10.045 10 1.005

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T

Appendix J – ONE-WAY ANOVA OUTPUTS FOR THE MAS CONDITION DURING THE FULL LENGTH OF THE STUDY.

Pairwise Comparisons

Measure: MEASURE_1

(I) Rest

(J)

Rest

Mean

Difference

(I-J) Std. Error Sig.b

95% Confidence Interval

for Differenceb

Lower

Bound

Upper

Bound

1 2 .818 .296 .300 -.315 1.951

3 .818 .423 1.000 -.799 2.435

4 1.636 .636 .417 -.799 4.072

5 3.091* .547 .003 .997 5.184

6 3.727* .634 .002 1.302 6.153

2 1 -.818 .296 .300 -1.951 .315

3 .000 .357 1.000 -1.365 1.365

4 .818 .600 1.000 -1.479 3.116

5 2.273* .524 .022 .268 4.278

6 2.909* .639 .016 .464 5.355

3 1 -.818 .423 1.000 -2.435 .799

2 .000 .357 1.000 -1.365 1.365

4 .818 .296 .300 -.315 1.951

5 2.273* .304 .000 1.108 3.437

6 2.909* .476 .002 1.088 4.730

4 1 -1.636 .636 .417 -4.072 .799

2 -.818 .600 1.000 -3.116 1.479

3 -.818 .296 .300 -1.951 .315

5 1.455* .247 .002 .508 2.401

6 2.091* .368 .003 .682 3.500

5 1 -3.091* .547 .003 -5.184 -.997

2 -2.273* .524 .022 -4.278 -.268

3 -2.273* .304 .000 -3.437 -1.108

4 -1.455* .247 .002 -2.401 -.508

6 .636 .203 .160 -.142 1.414

6 1 -3.727* .634 .002 -6.153 -1.302

2 -2.909* .639 .016 -5.355 -.464

3 -2.909* .476 .002 -4.730 -1.088

4 -2.091* .368 .003 -3.500 -.682

5 -.636 .203 .160 -1.414 .142

Based on estimated marginal means

*. The mean difference is significant at the

b. Adjustment for multiple comparisons: Bonferroni.

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are the effects of deep tissue sports massage on delayed ......with rhythmical pressure and stroking...

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