Massages Could be an Alternative Approach to Reduce Muscle Soreness and Pain

As part of my Anatomy and Physiology class, we wrote various research papers and this one is about the impact of massages to reduce muscle soreness. This paper covers an introduction to this topic, the specific medical background to muscle function and the controversy around what kind of massage is best for improving delayed onset muscle soreness.

Abstract: 

            There are hundreds of muscles in the human body that work cohesively to maximize the body’s ability to move while also providing support and protection for different organs. Most people expend more muscular energy throughout the day when they complete rigorous exercises that contract and relax various muscles throughout the body. During exercise, muscles follow a particular pattern of steps that results in a contraction that permits the muscle to lengthen or shorten. During strenuous bouts of exercise, it is possible to overexert the body and cause fatigue and soreness that at times can be perceived as painful. The methods to help alleviate muscle soreness and fatigue range from over the counter drugs like ibuprofen to non-traditional treatments such as a massage. With increased exhaustion of the muscle during physical exercise particularly for athletes, energy depletion and reduced blood flow call for the necessity of some type of intervention, one of which is massage therapy. This review will discuss the possible muscle recovery benefits of massage therapy rather than drugs to reduce muscle soreness and how the lack of evidence-based research covering massage therapy is one of the greatest challenges when it comes to deciding whether or not this treatment helps muscle. 

Keywords: massage therapy, muscle, soreness, pain, performance, injury prevention, recovery 

Word count: 2,091

Introduction: 

Massages are manual or mechanical forces applied to the muscle and body tissues in rhythmical patterns that promote pain relief and an overall healthy well-being (1). It is commonly thought amongst the sports world that massages are a therapeutic method to help reduce muscle fatigue and promote recovery after strenuous muscle activity (2). Muscle exertion requires two main contractions, either isotonic or isometric. Isotonic contractions involve two subtypes: concentric contractions, when muscle tension increases to meet the resistance but maintains that tension as the muscle shortens and movement occurs (3). Conversely, in eccentric contractions, the muscle lengthens as the resistance becomes more substantial than the force the muscle produces (3). The eccentric muscle contractions involve the lengthening of muscle fibers by performing motions like walking down the stairs, running downhill, or sitting into a chair slowly (4). After high intensity performances that use the muscles in strenuous ways, the recovery treatment becomes crucial. Massages have become a more popular choice of treatment, with the assumption that they can reduce delayed-onset-muscle soreness (DOMS) but there is little evidence to show that massage therapy has a positive effect on the recovery of muscle function (2). This review will discuss the two perspectives in regards to the success rate of massage therapy, the gaps in scientific research for message therapy benefits, and how future studies should focus on the different massage techniques, the influence of gender, and the psychological factors that affect perceived muscle soreness. 

Does massage therapy sufficiently work to reduce muscle soreness and pain? 

            Massage therapy is widely known throughout the sport’s medical world as a productive therapeutic modality to enhance muscle recovery and help reduce soreness (5). It is very typical or many athletes to over-exert themselves, which causes burnout, and poor performance (6). Many athletes do not take the necessary time to recover so they experience further problems later on in physical conditioning (6)). Since they do not want to spend much time away from sport doing recovery, massages have become greatly emphasized even though there is limited evidence that demonstrates the effects of massage therapy (6). The intensity of eccentric exercise in particular can cause nonuniform contractions of the sarcomeres. In normal contractions, calcium binds to the regulatory protein troponin, which ignites a conformational change in the regulatory protein tropomyosin (13). This allows the thick myosin filament heads to attach to the myosin binding cites on thin filaments, allowing a cross bridge to form (13). Once the heads are attached, the thin actin filament begins to slide toward the center of the sarcomere, bringing the anchoring Z discs closer together (13). In severe eccentric contractions, there is an A band disruption that causes a misalignment of myofibrils and damage to the Z discs (5). This stressful kind of exercise can also create a homeostatic imbalance of calcium in the sarcolemma, which is the membrane of a muscle fiber (5). Since calcium helps drive the contractile motion of muscles, an imbalance creates protein and membrane degeneration. It also causes the phosphocreatine levels essential for ATP energy production, to drop (5). If there is damage to the contractile proteins, a massage may help to enhance the blood flow and oxygen delivery to the tissue to promote healing but evidence to support the benefits of increased blood flow are lacking (5). One successful method of measuring the microcirculatory damage was done using the Doppler ultrasound (5). This provided clear data during effleurage massage therapy, a light or deep stroking, because it showed that there was no positive effect of this therapy to increase blood flow. In fact, light muscle contractions like jogging, showed to be more effective in reducing muscle soreness (5). There are fewer benefits to manual massage therapies than there is to stretching and ice application, depending on the severity of the muscle soreness and intensity of exercise (5). Muscle fatigue is often associated with hydrogen ion accumulation and depletion of both ATP and creatine phosphates which disrupts muscle excitation and relaxation. By increasing the blood flow to the area of inflammation, more oxygen and nutrients could provide enhanced benefits but there is little data to support the benefits of manual massages in terms of muscle damage repair, strength and retention, and the recovery of muscles (5). 

One of the leading effects of intense physical exercise is delayed-onset-muscle-soreness, also referred to as DOMS. This is a symptom that can indicate muscle damage but does not necessarily indicate that there is always muscle damage (2). It often peaks around 2-3 days post intense exercise such as downhill running, lowering of weights and plyometrics (7). Muscle damage is believed to occur during repeated eccentric contractions where the sarcomeres are overstretched, and damage of the sarcoplasmic reticulum causes a homeostatic imbalance of calcium (7). The muscle damage does not necessarily cause the soreness because the contractions induce changes in the interstitial fluid that causes inflammation (7). DOMS is caused by the inflammation of the muscle tissue, resulting in the group IV pain receptors ability to transmit dull pain signals to the muscles (2). DOMS events can cause mechanical stress to the muscle fibers, causing sarcomeres to rupture, creating a homeostatic calcium imbalance as mentioned before (1). The sarcoplasmic reticulum damage which stores the calcium, increases the intracellular calcium and triggers the inflammation (1). Inflammation is observed if there is redness, heat, swelling and or other pain in the area of soreness (2). Various lengths of muscle therapy conducted showed that after an 8-minute massage, there was no positive effect on DOMS or muscle strength in contrast to a 30-minute massage conducted 2 hours post exercise to the elbow flexors and extensors, where there was a reduction in DOMS (2). It is suggested that massage therapy enhances the blood blow to the inflamed area, increasing the lymph fluid which removes the pain substrates and increases the flow of neutrophils to the damaged tissues but there is no evidence to support that there is an increase in the neutrophil influx (2). It is also suggested that massage can increase the circulation to provide nutrients to muscles, but it is also suggested that massage therapy increases blood flow to the skin and away from the skeletal muscles (Nelson). 

There is a significant amount of controversy around the best massage therapy to treat DOMS because in performed studies, there are different types of eccentric exercises used which then result in different levels of muscle fatigue and damage (2). This creates inconsistency within the studied group of individuals, which creates disparities in the final data (2). Some of the types of massages used are effleurage, which is a light or deep muscle stroking. (5). Another kind is petrissage, which is when the muscle is kneaded and rolled or tapotement massage when a series of percussive blows are applied to the inflamed area (5). Massages will often include a combination of all three depending on the level of pressure deemed necessary. Massage therapy accounts for half of all visits to practitioners of alternative therapies, especially for back, neck and head pain (8). In a study conducted to determine the efficacy of beliefs of massage post a 10k run, 80% of participants thought massage therapy would benefit them, especially those who had received a massage in prior situations which bumped the percentage to 91.9% (8). While this study was only conducted on long distance endurance runners, it shows the large quantity of people who believe that massage therapy is successful for them. Another common message therapy tool used now a days is foam rolling (FR), as an intervention to range of motion and other muscle recovery (9). Athletes and non-athletes use them before, during, and post workouts (9). It is associated with an increase in range of motion but not an increase in muscle performance (9). It serves as a method to reduce DOMS after intense exercise (9). In order to use any kind of massage therapy requires previous knowledge and experience about what works for an individual’s muscle recovery needs. Some people may not find significant benefits of massage therapy and therefore resort to other methods of muscle recovery treatment like cryotherapy while others may believe that it relieves the pain enough so that it becomes part of a routine. It all depends on the recommendations of the physician and trainers who all have different backgrounds as well as the patient’s previous history of massage therapy. 

More sophisticated and inclusive studies needed to support massage therapy argument

Massage therapy is a general term that encompasses many different techniques and beliefs depending on both the individual receiving treatment and the person conducting the massage. Some of the types of messages include Swedish massage, deep tissue massage, sports massage, and a chair massage. All of these can be provided by one or more kinds of therapists such as a chiropractor, a masseuse, reflexologist, and physical therapists each of whom have different backgrounds in education, unique experience levels, and a wide range of beliefs when it comes to the proper duration and intensity of the treatment for that patient (10). In many primary studies conducted about massage success for muscle pain relief, very few have compensated for the gaps between different types of massage and different pain indications amongst patients (10). Perception of pain amongst the subjects is subjective and differs greatly depending on the injury, the individual’s pain tolerance, and honesty during examination (2).

Another gap in research is the sex differences of exercise induced pain (11). It is often assumed that women have greater pain levels when it comes to rigorous exercises, but research says otherwise (11). It is reported that women have moderately lower and less frequent muscle pain than men (11). One of the attributed reasons is because estrogen can have beneficial effects in maintaining muscle cells during exercise, but those studies have only been conducted non-human species. It has been found that women do report lower soreness ratings than men when their estrogen levels are higher (11). Future studies are needed to understand the role of estrogen in women so that pain level disparities between men and women can be better understood (11). 

Future possibilities to enhance knowledge of massage therapy treatment

Future areas of massage therapy studies need to include methods of measuring different interpretations of soreness and tests that take into account the psychological factors that influence pain experience of every individual. (7). There is a lack of understanding of why certain individuals perceive more pain during strenuous exercise and why others do not during even if the same routine has been completed. Future studies would also benefit from examining the amount of depth and pressure that should be applied to different areas of the body in order to reduce some of the tension and pain, especially in those that suffer from DOMS (7). Many studies are also conducted using various types of massage treatments, so it is important for research to examine how one treatment modality is effective at a time (12). While research has been conducted during and post exercise, there is no research that examines pre-exercise massage benefits (1). Questions remain about whether or not massages could increase performance in sprinting and jumping and which type of massage would produce the most benefits (1). Very few studies have been conducted on the possible benefits of early, pre-exercise intervention and how it could affect muscle soreness (5). 

Conclusion: 

Massage therapy can produce mechanical pressures that lessen tissue adhesion which decreases the stiffness and tension of muscles by increasing blood flow to the arteriolar areas (1). The mechanical pressure also allows for a decrease in neural excitability therefore more muscle relaxation occurs. The more neural excitability, the more possibilities for muscle contractions. While some research supports the claim that massage therapy can enhance recovery of muscles and reduction of soreness, it is not proven that it helps with muscle functional loss (1). Sport massages are often recommended to promote healthy muscle strength and good range of movement (1). Unfortunately, there is no scientific evidence that shows that massage therapy can improve performance, enhance recovery, prevent muscular injury, or increase blood flow (1). Massage therapy can be a helpful resource to help reduce muscle soreness, but everyone will make different decisions about what treatment is best for themselves depending on how their pain levels are. With a growing interest in this form of treatment, more research will continue to help bring awareness to the challenges and potential benefits of using massage therapy as a mechanism to reduce muscle soreness and muscle pain in the future. 

Works Cited:

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