INTRODUCTION
Delayed- onset muscle soreness (DOMS) is described as common clinical condition experienced by majority of sportsperson following major eccentric activities approximately after 24-72 hours [1,2]. DOMS negatively affects the athlete’s performance via affecting the muscular strength, shock absorption and ability to perform the coordinated movements [3,4]. The management of DOMS is still considered controversial due to the fact that the path physiology behind it is unknown. DOMS can occur as a result of alteration of normal lineage my filaments; thickening or complete disruption of Z lines of sarcomeres; increase in the muscle cell enzyme creatine kinase (CK) level. Etiological factors of DOMS include accumulation of lactic acid; muscular spasm; homeostasis and NGF (nerve growth factor). Common treatment methods utilized for its management includes thermotherapy, compression, cryotherapy and manual therapy [5,6,7]. Manual therapy is most preferred treatment intervention for DOMS, as easy to perform [8,9,10,11]. Massage is defined as a soft tissue manipulation performed in a skillful and purposeful manner via utilizing the hands, forearm, elbow, knees , feet and digital pressure which may or may not accompany the use of cryotherapy or thermotherapy in order to achieve therapeutic gain [12].It is used commonly for a variety of therapeutic effects in the cases of pain , swelling, decreased range of motion, muscular sprain, tension and anxiety affecting musculoskeletal, neurological and cardiorespiratory symptoms. It is widely used by majority of sportsperson in aiding enhanced recovery from strenuous exercises [13]. Manual therapy techniques utilized for managing the symptoms of DOMS includes superficial effleurage, deep effleurage, petrissage and tapotement. “Superficial effleurage” is the sliding of both hands in the direction of muscle fibers from distal to proximal direction with a gentle pressure on the associated body tissues. “Deep effleurage” is the sliding of both hands in the direction of muscle fibers from distal to proximal direction with more pressure on the associated body tissues. “Petrissage” is the use of surface of the palm of the hand to compress and lift the tissue sequentially. “Tapotement” is the agitation of tissues with the cupped hands. There seems to be controversy in the management of DOMS , due to variety of treatment options. The present literature was conducted to evaluate the influence of manual therapy in the management of DOMS symptoms.
METHODOLOGY
Search Strategy: Literature search was performed with keywords like “manual therapy”, “delayed onset muscle soreness” amongst the different databases like Google Scholar, PubMed and Research Gate. The articles were searched between year 2018 to 2022. Boolean operators like AND, OR was used.
Inclusion criteria: The studies were included if they were
(i) published in English language
(ii) available as full- text
(iii) included sportsperson as participants
(iv) utilized manual therapy as intervention measure
Exclusion criteria: The studies were excluded if they were
(i) unpublished work
(ii) conference proceedings
(iii) reviews
Data Extraction: Articles were included in this study after screening of eligibility , abstract and full text. The included studies were then qualitatively analyzed.
Participants Characteristics: The present study included a total of 233 sportspersons out of which 78 were runners [17]; 55 were ski mountaineering racers [14]; 40 were athletes [15] and remaining 60 were team sports athletes (soccer, handball and volleyball) [16].
Study Design: All the included studies were RCT’s (Randomized Controlled Trials). The studies were conducted in different countries : Australia [17]; Italy [14]; Pakistan [15] and Greece [16].
Outcome Measures: NPRS (Numeric Pain Rating Scale) was utilized as an outcome measure in 03 studies[14,15,17 ]; followed by Vertical jump performance which was used in 02 studies [15,17]. Other outcome measures used were Mc Gill Pain Questionnaire, isometric strength, flexibility, mood [17]; PGIC (Patient Global Impression of Change Scale) [14]; sprint speed [15]; borg rate of perceived exertion, VAS (Visual Analogue Scale), ROM (Range of Motion), CPK (Creatinine Phosphokinase) in serum [16].
RESULTS
Table 1 Describes the characteristics of the studies included in this literature review.
Table 2 Describes the population, intervention, comparison and outcome measures of the included studies. This literature review included a total of 04 studies [14,15,16,17].
Table 1: Characteristics of the included studies
|
Author Name; |
Objective |
Research Design/ |
Procedure |
Outcome measure |
Conclusion |
|
Bender |
To study the effect of massage therapy on pain after habitual running. |
RCT; 78 runners. age: 18-60 years |
Two groups were made; experimental group (quadriceps massage for 10 mins); control group (sham hip and knee mobilisation for 10 mins) |
NPRS, McGill Pain Questionnaire, vertical jump performance, isometric strength, flexibility, |
Massage therapy was effective in reducing pain. |
|
Visconti |
To compare the effect of manual massage, long wave diathermy, and sham long wave diathermy for the management of DOMS. |
RCT;55 ski mountaineering racers, all males; Age:23-60 years |
Three groups were made, first group received sham LWD (10 mins switched- off after 10 sec switched-on) (n=19); second group received manual massage (10 mins. Pain-free effleurage in both limbs) (n=19); third group received real LWD (10 mins switched-on) (n=19) |
NPRS, PGI C |
No significant changes in NPRS scores. |
|
Rehman |
To compare massage therapy and passive stretching for reducing DOMS of tibialis anterior. |
RCT;40 male athletes |
Two groups were made Group A (massage therapy for 10 mins x 3 days); group B (static stretching for 20 secs 4 reps x 3days); Prior to intervention DOMS were induced by performing 3 sets of test side ankle eccentric plantar flexion with 20 secs rest in between |
NPRS, |
Massage therapy and static stretching both were found to be effective for reducing the muscle soreness in tibialis anterior muscle as well as for improving athlete’s performance. |
|
Angelopoulos et al. [16]; 2022; |
To compare cold water immersion and sports massage in athletes with DOMS. |
RCT;60 male athletes of team sports (soccer, handball, volleyball); Mean age :21 years |
60 participants were divided into four groups: CWI group (n=15), massage group (n=15), combined massage and CWI group (n=15), control group(n=15) |
BOGR, VAS, ROM, CPK in serum |
CWI and sports massage help in decreasing pain. |
Abbreviations:
NPRS: Numeric Pain Rating Scale
PGIC: Patient Global Impression of Change Scale
VAS: Visual Analogue Scale
ROM : Range of Motion
CPK: Creatinine Phosphokinase
CWI: Cold Water Immersion
LWD: Long Wave Diathermy
DOMS : Delayed Onset Muscle Soreness; RCT: Randomized Controlled Trial
Table 2 : PICO parameters of the included studies
|
Author Name; |
Population |
Intervention |
Comparison |
Outcome Variable |
|
Bender et al.[17]; |
Runners |
Massage : 10 minutes - Superficial effleurage : - Deep effleurage : 03 minutes, - Petrissage: 03 minutes - Tapotement: 1 minute - Superficial effleurage : |
- Sham hip joint mobilizations -Sham knee joint |
- Pain and perceived fatigue - Pain behaviour - Mood profile - Flexibility - Vertical jump performance - Isometric strength |
|
Visconti et al.[14]; |
Ski-mountaineering racers |
Pain – free effleurage : 10 minutes in bilateral lower limbs - Prone position (posterior compartment muscles: hamstring and triceps surae) - Supine position (anterior compartment muscles: quadriceps and foot dorsiflexors) |
- Real long wave diathermy - Sham long wave diathermy |
- Pain - Perceived recovery |
|
Rehman et al.[15]; |
Athletes |
Sports massage : 10 minutes for 03 days on tibialis anterior muscle - Effleurage (stroking) : - Petrissage (kneading) : - Tapotement (percussion) : - Deep tissue massage: - Effleurage: 02 minutes |
Static stretching |
- Pain - Speed - Vertical jump performance |
|
Angelopou los et al.[16]; 2022; |
Amateur athletes |
Sports massage : 20 minutes (10 minutes for each quadriceps muscle) - Effleurage: 02 minutes - Petrissage: 02 minutes - Compressions : - Stripping massage - Tapotements : 02 minutes |
Cold water immersion |
- Fatigue - Pain - Range of motion - Level of creatine |
Effect of manual therapies in the management of DOMS symptoms:
A randomized trial study was conducted to study the effect of massage therapy on pain after habitual sporting activity. The study concluded that massage therapy was effective in reducing the intensity of pain . As there is limited researches evaluating the effect of massage therapy after habitual sporting activity , the primary research question of this study was to find out the effect of massage therapy in improving the mood and performance of runners after habitual sporting activity (10 - km run) , thereby reducing pain and perceived fatigue in the quadriceps muscle . 78 participants were enrolled in this study, out of which two groups were made each comprising of 39 participants. The experimental group received quadriceps massage for 10minutes and control group received sham hip and knee mobilizations for 10 minutes. Pain, perceived fatigue, flexibility, mood, strength and vertical jump were the main outcome measures. This study founded that there was significant difference between the control group and experimental group on numeric pain rating scale. This study has also founded that massage therapy have no effect on the jumping performance, flexibility, strength and perceived fatigue . Although , it was effective in reducing pain intensity after being applied to the quadriceps muscle [17].
A randomized controlled trial to compare the effectiveness of manual massage, long- wave diathermy, and sham long- wave diathermy for the management of delayed- onset muscle soreness was conducted . Long wave diathermy (LWD) is also referred as capacitive and resistive electric transfer therapy transmits heat and aids in microcirculation and cell metabolism. The evidence of its effect is limited besides knowing the fact that heat resolves the symptoms of DOMS. So, their study was aimed to study the effects of manual massage, real LWD and sham LWD on pain and its post- treatment effects in a group of athletes with lower limb DOMS. In this study , a total of 55 individuals were incorporated in the study which were divided into three groups. There were 19 participants in the manual massage group ; 17 participants in the real LWD group and remaining 19 participants were from sham LWD group. The participant’s age was between 23 to 60 years. NPRS (Numeric Pain Rating Scale) questionnaire and PGIC (Patient Global Impression of Change Scale) were the two main outcome measures utilized in the study. They documented no significant difference was founded regarding the NPRS (numeric pain rating scale) between the real LWD, sham LWD and manual muscle groups. In their study any strong conclusion cannot be drawn [14].
Another randomized controlled study was conducted to compare the effect of massage therapy and static stretching in reducing DOMS of tibialis anterior. This study finds the literature gap in the fact that there is limited evidence of comparison of these two techniques on DOMS of tibialis anterior muscle. The objective of this study was to find the effect of these two techniques on the performance of the athlete. In this study 40 individuals were incorporated in the study Age group of athletes were 18 to 30 years. Two groups were made each carrying equal number of participants (20). First group was group -A (massage therapy) and second group was group -B (static stretching). DOMS was induced in both the groups before applying intervention. NPRS (Numeric Pain Rating Scale), vertical jump height test and sprint speed test were the outcome measures. They reported no significant difference was observed by the researchers between massage therapy and static stretching among the athletes with tibialis anterior DOMS. The study concluded that static stretching positively influences the performance of the athletes [15].
An randomized controlled trial to study the effect of cold – water immersion and sports massage in athletes with delayed onset muscle soreness (DOMS) was conducted . This research was conducted in order to find out the combined effect of these two techniques in the management of DOMS. Sixty male athletes were incorporated in the study which were randomized into four groups of 15 participants each (a cold water immersion group, a massage group, a combined massage and cold water immersion group and a control group).BORG scale, VAS scale, ROM of the knee joint , knee isometrics strength and CPK( Creatinine Phosphokinase) levels in the blood serum were the outcome measures. They stated that there is no significant changes between the two groups. This study concluded that these two techniques were not affecting the adaptations caused by the DOMS but causes significant reduction in the pain. Thus, these techniques can be considered as a measure of intervention for recovery followed by DOMS [16].
DISCUSSION
The primary objective of this literature review was to find out the effectiveness of manual therapy in the management of DOMS. In this literature review 04 randomized controlled trial studies were included. The included studies utilized different types of manual therapy techniques like superficial effleurage, deep effleurage, tapotement, petrissage. All the included studies were conducted on athletic population. Due to limited access to the databases few studies were gathered. The duration of manual therapy techniques application varies between 10 minutes to 20 minutes. The main outcome measures studied were pain, range of motion, vertical jump performance, fatigue as well as perceived recovery. The location of DOMS was lower limb usually sustained after encountering strenuous activities. This study provides the evidences regarding the beneficial effects of using massage in the treatment of DOMS.
LIMITATIONS OF THE STUDY
The present literature review has few limitations. This study included very few studies due to limited access to the databases. Secondly, meta- analysis is not performed in this study.
FUTURE SCOPE OF THE STUDY
Future studies can focus on meta- analysis of the randomized controlled trials to find out the effectiveness of manual therapy techniques in the management of symptoms of DOMS.
CONCLUSION
This study concludes that manual therapy is effective in reducing delayed onset muscle soreness in combination with other techniques like stretching and cold water immersion. However, more studies are needed to confirm the existing findings.
CONFLICT OF INTEREST
The author declares no conflict of interest.
REFERENCES
- Lewis PB, Ruby D, Bush-Joseph CA. Muscle soreness and delayed-onset muscle soreness. Clin Sports Med. 2012;31:255–62 https://doi.org/10.1016/j.csm.2011.09.009.
- Vickers AJ. Time course of muscle soreness following different types of exercise. BMC Musculoskelet Disord. 2001;2:5 https://doi.org/10.1186/1471-2474-2-5.
- Proske U, Allen TJ. Damage to skeletal muscle from eccentric exercise. Exerc Sport Sci Rev. 2005;33:98–104 https://doi.org/10.1186/1471-2474-2-5.
- Vila-Chã C, Hassanlouei H, Farina D, Falla D. Eccentric exercise and delayed onset muscle soreness of the quadriceps induce adjustments in agonist antagonist activity, which are dependent on the motor task. Exp Brain Res. 2012;216:385–95 https://doi.org/10.1007/s00221-011-2942-2.
- Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness: treatment strategies and performance factors. Sports Med. 2003;33:145–64 https://doi.org/10.2165/00007256-200333020-00005.
- Costello JT, Baker PR, Minett GM, Bieuzen F, Stewart IB, Bleakley C. Wholebody cryotherapy (extreme cold air exposure) for preventing and treating muscle soreness after exercise in adults. Cochrane Database Syst Rev. 2015; 9:CD010789 https://doi.org/10.1002/14651858.cd010789.pub2.
- Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 2015;127(1):57–65 https://doi.org/10.1080/00325481.2015.992719.
- Bakowski P, Musielak B, Sip P, Biegański G. Effects of massage on delayed onset muscle soreness. Chir Narzadow Ruchu Ortop Pol. 2008;73:261e265.
- Guo J, Li L, Gong Y, Zhu R, Xu J, Zou J, et al. Massage alleviates delayed onset muscle soreness after strenuous exercise: a systematic review and meta-analysis. Front Physiol. 2017;8:747 https://doi.org/10.3389%2Ffphys.2017.00747.
- Han JH, Kim MJ, Yang HJ, Lee YJ, Sung YH. Effects of therapeutic massage on gait and pain after delayed onset muscle soreness. J Exerc Rehabil. 2014; 10:136–40 https://doi.org/10.12965%2Fjer.140106.
- Visconti L, Capra G, Carta G, Forni C, Janin D. Effect of massage on DOMS in ultramarathon runners: a pilot study. J Bodyw Mov Ther. 2015;19:458–63 https://doi.org/10.1016/j.jbmt.2014.11.008.
- Kennedy, A.B., Jerrilyn, A.C., Patricia, A.S., Ravensara, S.T., Ruth, P.S., 2016. Int. J.Therapeut.Massage Bodyw. 9 (3), 15e26 https://doi.org/10.3822/ijtmb.v9i3.312.
- Sinha, A.G., 2010. Principles and Practice of Therapeutic Massage. Jaypee Brothers Medical Publishers Pvt. Limited, New Delhi.
- Lorenzo Visconti , Corrado Forni, Rudi Coser, Marco Trucco, Elisa Magnano and Gianpiero Capra. Comparison of the effectiveness of manual massage, long-wave diathermy, and sham long-wave diathermy for the management of delayed-onset muscle soreness: a randomized controlled trial. Archives of Physiotherapy (2020) 10:1 https://doi.org/10.1186/s40945-019-0073-4.
- Ateeb Ur Rehman, Noman Sadiq, Dr. Asghar Khan. STRETCHING FOR REDUCING DOMS OF TIBIALIS ANTERIOR. European Journal of Health Sciences ISSN 2520- 4645 (online) Vol.6, Issue 2, pp 18-29 2021.
- Pavlos Angelopoulos , Anastasios Diakoronas , Dimitrios Panagiotopoulos , Maria Tsekoura , Panagiota Xaplanteri , Dimitra Koumoundourou , Farzaneh Saki , Evdokia Billis , Elias Tsepis and Konstantinos Fousekis , Cold-Water Immersion and Sports Massage Can Improve Pain Sensation but Not Functionality in Athletes with Delayed Onset Muscle Soreness. Healthcare 2022, 10, 2449 https://doi.org/10.3390/healthcare10122449.
- Paula Urio Bender a, Clarissa Medeiros da Luz a, Jonatan M Feldkircher a, Guilherme S Nunes. Massage therapy slightly decreased pain intensity after habitual running, but had no effect on fatigue, mood or physical performance: a randomized trial. Journal of Physiotherapy 65 (2019) 75–80 https://doi.org/10.1016/j.jphys.2019.02.006