Literature Review - An investigation into the effects of Massage Therapy on

Delayed Onset Muscle Soreness (DOMS) in female collegiate Gaelic

footballers

2.0 Introduction

An investigation into the effects of Massage Therapy on Delayed Onset Muscle Soreness
(DOMS) in female collegiate Gaelic footballers will see the examination into whether
massage therapy has any positive effects on DOMS. The research displayed in this review
contains existing evidence of Massage Therapy and DOMS and whether or not massage
provides a positive effect on DOMS. Boguszewski et al. (2018) found in a study by Arroyo et
al. (2011) when performed properly, massage treatment has been shown to improve the
operation of the digestive, respiratory, and excretory systems as well as muscular and
cutaneous tissue. Massage has been promoted as a technique that speeds up physical
performance improvement and recovery after strenuous exercise; Mancinelli et al. (2006)
portrayed this through the use of studies by Cinque (1989) and Samples (1987). Zainuddin et
al. (2005) used a study by Armstrong (1984) to note that exercise that primarily involves
eccentric muscle actions has the potential to injure muscles more severely than exercises that
primarily involve isometric or concentric actions, especially if the exercise is new to you.
Zainuddin et al. (2005) also used further research from Clarkson, Nosaka and Braun (1992)
Gulick and Kimura (1996) and Nosaka, Newton and Sacco (2002) to state that after such
exercise, muscular soreness and pain typically start 24 hours later and are known as delayed-
onset muscle soreness (DOMS). In addition, many studies discuss the probable causes of
DOMS. Andersen et al (2013) stated the probable causes founded by researchers Cheung,
Hume and Maxwell (2003) and Close et al. (2005) naming lactic acid, muscle spasm,
connective tissue injury, muscle damage, inflammation, enzyme efflux, and free radicals all
as possible causes of DOMS. Massage is seen to be effective in reducing pain in DOMS and
it may prevent future injury. According to Imtiyaz, Veqar, and Shareef (2014) a study by
Weerapong and Kolt (2005) showed that massage lessens the mechanical stress placed on
sarcomeres during movements that extend them (eccentric exercise) and prevents the rupture
of the sarcoplasmic reticulum, which lowers intracellular calcium and activates calcium-
sensitive degradative pathways, resulting in less ultrastructural damage.
2.1 Does Massage Therapy have benefits?

In the study completed by Cheung, Hume and Maxwell (2012) massage is seen to have
benefits in aiding in increased blood flow to an injured area. By increasing the amount of
oxygenated blood flow to the injured area, the influx of calcium ions into the muscle fibres
and subsequent disruption of calcium homeostasis following eccentric exercise can be
restored. This research was complied from studies by Armstrong (1984 and 1990). Studies
that looked at how massage affects local blood flow, have produced a range of outcomes.
Some researchers found that massage increased blood flow via the vascular bed. On the other
hand, Tiidus (1997) claimed that there were no variations in arterial or venous blood flow
after effleurage massage of the quadriceps. Different perceptions have been examined in the
study by Cheung, Hume and Maxwell (2012) regarding soreness levels. Research taken from
studies by Lightfoot et al (1997) and Weber, Servedio and Woodall (1994) state that after
performing high intensity exercise, the use of either petrissage (kneading) or a combination of
effleurage and petrissage massage (2 minutes effleurage, 5 minutes petrissage, and 1-minute
effleurage) on the treated limb or the control limb, no differences in soreness levels or force
deficits have been observed. In contrast, Cheung, Hume and Maxwell (2012) found that
another group of researchers Rodenburg et al. (1994) observed that after a combination of
forearm eccentric exercise, warm-up, stretching, and massage (6 minutes of skin and muscle
effleurage, 30 seconds of tapotement/tapping, 5 minutes of petrissage, and 1 minute of
muscle effleurage with decreasing intensity), it was noticed that there were slight reductions
in muscle soreness. But it was impossible to separate the effects of warm-up and stretching
from the benefits of massage in this study. As research to date has only looked at the effects
of 5–30 minutes of massage treatment, with varying results, the ideal length of massage
treatment also needs to be explored. Determining whether manual manipulation of wounded
tissue promotes or inhibits recovery is also necessary. Cheung, Hume and Maxwell (2012)
stated that according to Ernst (1998) the wide range of massage techniques and massage
therapists may be to blame for the inconsistent research results. In addition, in the study of
‘Pain pressure threshold of a muscle tender spot increases following local and non-local
rolling massage’ by Aboodarda, Spence and Button (2015) it is seen that in comparison to
light rolling massage and control circumstances, the PPT increased with vigorous rolling
massage and manual massage over painful sites in the plantar flexor muscles and also in the
calf muscles. This will be discussed further in the latter part of this review.
2.2 Definition of DOMS

Research carried out by Cheung, Hume and Maxwell (2012) shows that DOMS is categorised
as a type I injury from muscle strain according to Gulick and Kimura (1996) and Safran,
Seaber and Garrett (1989). The symptoms of this injury can range from mild muscle stiffness,
which quickly goes away during normal activities, to intense, incapacitating pain that limits
movement. Cheung, Hume and Maxwell (2012) used research from Armstrong (1984) and
MacIntyre, Reid and McKenzie (1995) specifying that DOMS tenderness is primarily felt at
the muscle's distal end and gradually dissipates throughout the first 24 to 48 hours following
exercise. Cheung, Hume and Maxwell (2012) found that the high concentration of muscular
pain receptors in the connective tissue of the myotendinous area is responsible for this pain's
localization found in a study by Newham, Mills and Quigley (1982) and as a response, the
myotendinous juncture's contractile component of the muscle fibres is susceptible to
microscopic harm. Muscle soreness has been generated by researchers studying the
mechanics of DOMS using workout regimens that focus mostly on eccentric activity.

2.3 Mechanisms of Injury

Eccentric exercise damages the cell membrane, triggering an inflammatory reaction that
results in the production of prostaglandin (prostaglandin E2 [PGE2]) and leukotriene.
Leukotrienes enhance vascular permeability and draw neutrophils to the site of injury,
whereas prostaglandin E2 sensitises type III and IV pain afferents to the effects of chemical
stimuli. (Connolly, Sayers and McHugh 2003). Connolly, Sayers and McHugh (2003) also
states in their paper that according to Lieber and Fride’n (1991) and Edwards et al. (1996)
that the muscle is injured in a random manner, and the discomfort that results appears to vary
locally. Vigorous muscle contractions, particularly eccentric contractions, might aggravate a
muscle strain in the initial stages. Furthermore, Connolly, Sayers and McHugh (2003) used
the investigation by Nosaka and Clarkson (1995) to affirm that however, more eccentric
contractions on following days do not increase the already present damage in a muscle that
has already undergone an eccentric injury.
2.4 Benefits and Drawbacks of Massage on DOMS

Mancinelli et al. (2006) showed that massage improved vertical jump displacement and
reduced subjective pain in the sample of female collegiate athletes. They also discovered that
massage increased the amount of pressure that the quadriceps on one side could bear before
experiencing pain. With the exception of the shuttle run duration, which actually slowed,
none of the variables that were analysed showed a statistically significant difference for the
control group. Using pressure algometry, they tried to make soreness assessments more
objective. Ratings based on algorithm were lower than discomfort as felt. In other words, for
the massage group, the pain-pressure threshold was lower than what might be predicted based
on the subjects' reports of discomfort. The soreness scores could be impacted by the power of
suggestion since participants thought that massage would help. According to a review by
Connolly et al. (2003) that Mancinelli et al. (2006) located, no study has looked at the
therapeutic effects of massage with a sound experimental design. Weerapong et al.
(2005) stated that there is no evidence that massage can increase performance, enhance
recovery, or prevent muscular injury, which was also cited by Mancinelli et al. in their 2006
review. Therefore, their goal of their current study was to investigate if massage may help
collegiate female athletes perform better.

2.5 Deep Tissue Massage effects on Pressure Pain Threshold

In a study by Suzuki et al. (2022) it is confirmed that Pressure Pain Threshold (PPT) is found
by using a mechanical stimulus to time when the pressure-induced sensation of the stimulus
first shifts to that of pain, PPT can be calculated according to Arant, Katz, and Neogi (2022).
It has been suggested that PPT measurement using pressure algometry is an accurate, reliable,
and repeatable tool for diagnosing tender sites and evaluating therapy outcomes according to
several studies by Reeves, Jaeger and Graff-Radford (1986), Fischer (1987), Kosek, Ekholm
and Hansson (1995) Antonaci, Sand and Lucas (1998) and Chesterton et al. (2003), found by
Aboodarda, Spence and Button (2015). A massage technique used to relieve muscular and
fascial stress is deep tissue massage (DTM). The technique focuses on releasing the body's
soft tissues (such as muscles, tendons, and ligaments) and realigning the tissue layers in the
targeted areas as effectively as possible. When performing a deep tissue massage, the
therapist targets the next tissue layer only once the one above has clearly released. Another
crucial aspect of the approach is that the therapist uses either no or very little lubrication.
(Urbaniak et al., 2015) In the study of the effect of deep tissue massage therapy on delayed
onset muscle soreness of the lower extremity in karateka’s – a preliminary study by Urbaniak
et al. (2015) several deep tissue massage techniques were used, including deep friction
massage, releasing trapped muscles, and relaxing and extending muscles. In this study,
muscle pain was measured using an electronic pressure algometer by Somedic, Algometer
type II, Hörby, Sweden. To ensure reliable results, the algometer was placed on certain
locations of the subjects and the calculations were taken twice. The experimental group rated
their pain on a VAS scale of 1-10. The VAS pain scale was re-evaluated three times before
massage at 24, 48 and 72 hours and the experimental group also noted their pain once during
the massage. The muscles used to record results in this study were the rectus femoris, tibialis
anterior, biceps femoris and gastrocnemius. When compared to previous weight training, the
PPT for the rectus femoris muscle dramatically decreased (muscle pain increased). (1028.5 ±
406.5 kPa) to 24 hours following weight training (1406.2 ± 406.5 kPa) p=0.009) and up to 24
hours following weight training, following the massage (1110.8 ± 343.7 kPa) (p = 0.006).
The PPT for the gastrocnemius muscle significantly decreased (muscle soreness increased)
from the pre-weight training value (1289.5 ± 439.9 kPa) to the following values: 24 hours
post-weight training (977.9 ± 260.7 kPa) (p=0.04); 24 hours post-weight training, after the
massage session (878.9 ± 224.8 kPa) (p=0.01); 48 hours post-weight training (1074.5 ± 343.3
kPa) (p=0.04); 48 hours post-weight training, post massage session (914.3 ± 339.0 kPa)
(p=0.04). Throughout the entire experiment, neither the biceps femoris nor the tibialis
anterior muscles displayed any statistically significant PPT changes. Similarly, in the study of
‘Pain pressure threshold of a muscle tender spot increases following local and non-local
rolling massage’ by Aboodarda, Spence and Button (2015) it is seen that in comparison to
light rolling massage and control circumstances, the PPT increased with vigorous rolling
massage and manual massage over painful sites in the plantar flexor muscles and also in the
calf muscles. Since the rise in pain threshold has a temporary and diffuse effect, it is possible
that the central pain-modulatory system is primarily responsible for mediating the perception
of pain after brief rolling massages. As a result of participants' early overestimations of PPT,
their findings further imply that it is crucial to take several PPT measures when assessing
pain using algometry (Aboodarda, Spence and Button, 2015).
2.6 Conclusion

To conclude, tenderness or stiffness to palpation (especially at the musculotendinous

junction), a decrease of range of motion, flexibility, force production, and mobility are all
possible symptoms of DOMS. High intensity exercise is frequently linked to a greater sense
of muscular pain, while duration also plays a role. (Cheung, Hume and Maxwell, 2012)
Mancinelli et al. (2006) used a quote in their study from a study by Ernst (1998) that in
earlier studies, many therapeutic approaches to DOMS relief were examined. Results have
been inconsistent, and opinions on how to manage DOMS most successfully are divided. It
has been observed that massage therapy accelerates the soreness-reduction process following
supramaximal exercise. The analgesic impact of massage appears to be one of its key
benefits, and research suggests that it should be used frequently in physical therapy, sports
medicine, and rehabilitation. (Boguszewski et al., 2018) To finish, we can see in the study of
Aboodarda, Spence and Button (2015) that PPT is increased by the incorporation of deep
tissue massage. Another element which would aid in the prevention of DOMS. Even so, the
findings in the papers reviewed in this literature review, point to the need for more study,
including using larger sample sizes and more unbiased research methods.
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