JOURNAL WATCH Journal Watch

MASSAGE REDUCES PAIN PERCEPTION AND HYPERALGESIA IN EXPERIMENTAL MUSCLE PAIN: A RANDOMIZED, CONTROLLED TRIAL. Frey Law LA, Evans S, Knudtson J, Nus S, et al. Journal of Pain 2008;9:714–21

The purpose of this study was to perform a double-blinded, randomised controlled trial of the

effects of massage on hyperalgesia (mechanical pressure pain thresholds, PPT) and perceived pain using delayed-onset muscle soreness (DOMS) as an endogenous model of myalgia. (Myalgia is defined as pain in a muscle or pain in multiple muscles.) Participants were randomly assigned to a no-treatment control, a superficial touch group or a deep-tissue massage group. Eccentric wrist extension exercises were performed at visit one to induce DOMS 48 hours later at visit two. Pain (assessed using visual analogue scales) and PPTs were measured at baseline, after exercise, before

treatment and after treatment. Results: Deep massage decreased pain (48.4% DOMS reversal) during muscle stretch. PPT was reduced (27.5% reversal) in both the deep massage and the superficial touch groups relative to control. Resting pain did not vary between treatment groups.

sportEX comment All soft tissue practitioners know the

value of massage, but proving its efficacy by good clinical evidence is difficult. We should take any positives we can – and this study shows positive results. The study also highlights the difficulties facing researchers. The correlation between myalgia and DOMS is questionable.

PHYSIOLOGICAL ADJUSTMENTS TO STRESS MEASURES FOLLOWING MASSAGE THERAPY: A REVIEW OF THE LITERATURE. Moraska A, Pollini RA, Boulanger K, Brooks MZ, Teitlebaum L. Evidence-based Complementary and Alternative Medicine. eCAM Advance Access published online on May 7, 2008

Online databases were searched for articles relevant to both massage therapy and stress. Articles were included in this review if (i) the massage therapy account consisted of manipulation of soft tissues and was conducted by a trained therapist, and (ii) a dependent measure to evaluate physiological stress was reported. Hormonal and physical parameters are reviewed. A total of 25 studies met all inclusion criteria. A majority of studies employed a 20- to 30-minute massage administered twice a week over five weeks with evaluations conducted before and after an individual session (single treatment) or following a series of sessions (multiple treatments). Results: Single treatment reductions in salivary cortisol and heart rate were consistently noted. A sustained reduction for these measures was not supported in the literature, although the single-treatment effect was repeatable within a study. To date, there are insufficient research data to make definitive statements regarding the multiple treatment effect of massage therapy on urinary cortisol or catecholamines, but some evidence for a positive effect on diastolic blood pressure has been documented. Although significant improvement has been demonstrated following massage therapy, the general research body on this topic lacks the necessary scientific rigour necessary to provide a definitive understanding of the effect of massage therapy on many physiological variables associated with stress.

sportEX comment Moraska has a good track record, having previously produced an excellent review of sports massage literature. Like many reviews of the effects of manual therapy, this one criticises the standard of research methodology; the important thing to note here, however, is that the search criteria stipulated the use of trained therapists who should know what they are doing (some studies use nurses or students, who have received minimal training) and that, given the reported positive outcomes, bit by bit we are building up evidence that massage does have physiological effects.

www.sportEX.net 5

Are DOMS signs and symptoms similar to those of myalgia? Previous studies tend to suggest that massage makes no difference to DOMS. The type of massage is rarely defined in these studies; in this study, however, the massage is described as “deep tissue massage”, which, although a bit more specific than in some studies, still leaves room for interpretation. The authors note the difficulties in choosing an assessment method. In many previous studies involving massage and DOMS, the result is quantified by performance factors rather than clinical findings such as pain on stretch, flexibility or power output; therefore, it becomes difficult to compare studies.