Research: the effect of massage on muscle pain

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Studies show that massage after exercise reduces muscle soreness. However, the design of almost all these studies leaves something to be desired, thus certainty about these effects remains elusive.

Increased Muscle Strength After Massage

The reason for this article is a new study that I came across. Soon, a study will be published in the Journal of Strength and Conditioning Research showing that massaging the calf muscles, after a training that has led to muscle damage, results in increased muscle strength and better athletic performance [1].

These findings suggest that massage of the gastrocnemius after EIMD can improve muscle strength and proprioception* by influencing the superficial layer of the gastrocnemius.

-Mal-Soon Shin, Kyungnam University

Researchers from South Korea wanted to know the effect of massage on the muscle damage caused by training, also known as Exercise-Induced Muscle Damage (EIMD). This muscle damage is usually caused intentionally, expecting that the recovery from the damage will make the muscle stronger [2,3,4]. During this recovery, performances are usually worse because muscle strength is reduced and we deal with an inflammatory response and muscle pain (Delayed Onset Muscle Soreness, DOMS) [5,6].

To cause muscle soreness in the large, upper calf muscle (gastrocnemius), researchers had participants go up and down the stairs of a five-story building twenty times. Afterwards, the participants were divided into two groups, where one group received a massage for the calves and the other group did not. Before and after the stair climbing (and possibly the massage), they looked at differences in muscle activation, whether more or less muscle pain could be expected (by measuring lactic acid), and what the influence on so-called “proprioception” was.

Proprioception

Muscle pain, among other things, causes a reduction in so-called proprioception. Proprioception is the ability to perceive the position of one’s own body and its various parts (relative to each other). “Hand-eye coordination” is an example of this, but in reality, it involves any spatial assessment of where the different parts of your body are and in which direction and with what speed they move. Not being able to touch your nose with your finger while intoxicated is an example of when this proprioception does not work. You can probably imagine how important this insight is during everyday movements, but also during sports.

Muscle pain reduces this proprioception because the affected muscles can no longer be “felt” optimally. The Korean researchers found that massage after strength training that led to muscle damage (which then led to muscle pain) ensures that this proprioception is less reduced.

For this, participants had to estimate at what angle their foot was from their lower leg and at what angle their lower leg was relative to their thigh. The smaller the difference between the estimated angle and the actual angle, the better the proprioception. This difference was thus smaller after massage.

Based on this, the researchers suggest that performances are improved. I have my doubts about this because this assumption is only based on the estimation of the angle of the ankle or the knee. Whether this actually affects performances and to what extent is of course the question. Especially when talking about strength sports instead of, for example, ball sports.

Spatial estimation and the exact angle of the wrist, for example, is much more important in tennis to let the ball fly precisely over the net and land on the baseline than it is for bench pressing.

Muscle Activation

In addition, the researchers looked at muscle activation, the relative degree to which a muscle is engaged compared to maximum effort. They measured this using EMG in both the inside and the outside of the gastrocnemius.

The researchers conclude that activation is higher when massaged. However, the graph on the right (above) shows that this was dependent on the location measured (“experimental” is the group that was massaged). I don’t find this result so unequivocal.

Muscle Soreness and Lactic Acid

However, for this article, I am mainly interested in any influence on muscle soreness.

The researchers tried to objectively measure muscle soreness by looking at the amount of lactic acid in the blood, an indicator of muscle damage and possibly expected muscle soreness.

The graph on the right shows that both with or without massage, the amount of lactic acid increased to the same extent after the stair climbing. The researchers therefore conclude that the massage has no effect on the (expected) muscle soreness.

However, muscle soreness can have more indicators than lactic acid (for example, the amount of creatine kinase).

Effect of Massage on Muscle Soreness (7 Studies)

Moreover, one study is not everything when it comes to the effect of massage on muscle soreness. Reason enough to take another look at the rest of the literature.

Although it is often a sign of a heavy training and therefore often appreciated as a sign of your effort, there can be reasons not to want to feel muscle soreness. For example, you can simply be a wimp and not be able to handle pain. As a “real” sportsman, however, you might also find muscle soreness undesirable when you have to play a match at that moment and only then realize that the training from the day before yesterday was apparently too intensive. You might also simply want to train again and feel hindered by the muscle soreness (while this is actually a sign that your recovery is not yet complete).

Therefore, various studies have been conducted to determine whether massage can do something against this. These studies show, among other things, that massage [7,8,9,10]:

• Improves local blood circulation
• Ensures better lymph fluid flow
• Results in lower production of edema (accumulation of lymph fluid)
• Lowers resting muscle tension

If we want to know what this actually does to muscle soreness, we can look at seven studies that have been collected by a researcher for comparison [11].

Study 1: “Less pain, but not significant. Better removal of creatine kinase”

A study from Germany showed improved removal of the waste substance creatine kinase [12]. The requested pain score was lower after massage, but the difference was too small for statistical significance (difference could thus have been caused by chance). The chance of coincidence was moreover even greater due to the small number of people participating in the study and the fact that participants were not “randomly” assigned to the control group or experimental group.

Study 2: “No difference in muscle soreness massaged leg compared to non-massaged leg”

In another study, participants had to do knee-extensions (or “leg extensions”) [13]. They were untrained people with sedentary jobs who would therefore quickly experience muscle soreness. After the training, one leg was massaged. Muscle soreness was measured after 24, 48, and 72 hours. There was no significant difference in muscle soreness between the massaged leg and the non-massaged leg.

Study 3: “Massage after running reduces muscle soreness and lactic acid”

The third study did see an effect of massage on muscle soreness [14]. After running, athletes were divided into three groups: 1- do nothing after training 2- get massaged after training 3- do a cool-down after training. The group that was massaged had the least muscle soreness, moreover, lactic acid decreased the fastest. However, you can hardly speak of a “group” when it comes to only three people. The entire study consisted of only nine people who also had to be divided into three groups. The chance that individual differences play a role is too large to take the conclusion very seriously.

Study 4: “Single massage has no effect on muscle strength and soreness”

There were somewhat more participants in the fourth study, but still not enough, namely 16 men [15]. These were also divided into three groups, this time after doing leg-extensions: 1- do nothing after training 2- massage 3- placebo massage after training (massage without pressure).

The massage had no effect on muscle soreness and strength in this study.

Study 5: “Less muscle soreness through massage, warm-up, and cool-down”

I have already come across this study when I wanted to determine for an article whether a warm-up reduces the chances of muscle soreness [16,17]. Then I had exactly the same problem. The study showed that doing a warm-up, massage, and stretching reduces muscle soreness after training the forearms. Because all these methods were done by one group, you can in no way deduce which action was responsible for the reduced muscle soreness and to what extent.

Of course, 50 participants were used for this. If the study does not fail on one point, it fails on another.

Study 6: “Less muscle soreness after half-hour massage”

Because here, too, it went wrong again, few participants, namely 19 untrained men [18]. They were massaged for half an hour or rested after an upper arm training. The group that was massaged had less muscle soreness and less of the waste substance creatine kinase in their blood.

Study 7: “Less muscle soreness in massaged leg 48 hours after leg training”

In the last study, finally, only nine participants were used. They trained both legs, where one leg was massaged and the other was not. After 48 hours, the massaged leg resulted in less muscle soreness, after 96 hours there was no difference anymore. Besides the fact that only nine people participated, this setup assumes that the effects of a massage occur locally. This is not established at all. If the effects had to do with the nervous system, for example, then the non-massaged leg would also benefit from the massage.

Conclusion: Massaging Probably Reduces Muscle Soreness

Some studies show no effect of massage on muscle soreness, but the general trend of the studies suggests this. Given the limited design of almost all these studies, this still needs to be investigated better for confirmation. More research also needs to be done to show how massage brings about this effect.

In conclusion, even though massage has some potential in reducing the symptoms of DOMS, its effectiveness has not been convincingly demonstrated. A definitive study seems to be warranted.

-E. Ernst, University of Exeter

References

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