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The practice of massage has long been considered an integral part
of sport preparation, conditioning and recovery (Cafarelli and Flint,
1993;
Caldwell, 2001;
Drust, et al., 2003;
Harmer, 1991;
Hemmings, 2001;
Tiidus and Shoemaker, 1995).
Since the time of ancient Greece, massage and sport have co-existed.
However, it was not until the 1972 Munich Olympics where Lasse Viren
attributed his two gold medals to a daily massage (Caldwell, 2001),
that massage became synonymous with sporting achievement. In addition,
more recently Callaghan, 1993
and Clews, 1999
reported extensive use of massage on their national Olympic teams.
Although massage is practised widely throughout sporting circles,
the effects and mechanism associated with massage are unclear or
anecdotal (Boone et al., 1991,
Wiktorsson-Möller, et al., 1983;
Cafarelli and Flint, 1993;
Harmer, 1991;
Hemmings, 2001;
Tiidus and Shoemaker, 1995).
Athletes use massage in an attempt to aid recovery as well as warm-up
for training or competition (Boone et al., 1991;
Cafarelli and Flint, 1993;
Caldwell, 2001;
Cash, 1996;
Drust et al., 2003;
Harmer, 1991;
Hemmings, 2001;
Tiidus and Shoemaker, 1995;
Wiktorsson-Möller et al., 1983).
Current recommendations from Sports Medicine Australia (2005)
for warming-up prior to activity involve 2-3 minutes of jogging
to raise a light sweat prior to stretching. This activity is to
increase the heat throughout the body and reduce the risk of musculoskeletal
injury by increasing tissue suppleness. Stretching follows to further
reduce the risk of injury, reduce muscle tension and increase freedom
of movement. However, there are numerous articles indicating that
pre-event static stretching can impair force (Behm and Kibele, 2007;
Behm et al., 2001;
2006),
balance, reaction and movement time (Behm et al., 2004b)
and jump landing contact time (Power et al., 2004).
Although Nelson et al., 2001
found that the deleterious effect of prior stretching was limited
to slower isokinetic velocities (60°/s and 120°/s), other studies
have found prior static stretching to inhibit dynamic jump performance
(Behm et al., 2006,
Behm and Kibele, 2007;
Young and Behm, 2002,).
Whereas increased ROM is coupled with performance impairments when
static stretching is implemented, pre-event massage might improve
ROM without the associated impairments. It would be important to
discover if there are any massage-related impairments and if they
could affect dynamic jump performance. While Hunter et al. (2006)
reported that post-massage effects on isokinetic force were only
significant at 60°/s; they also opined that the deleterious effect
might only occur with the first contraction after massage. With
the incertitude in the literature it would be opportune to further
investigate the effect of massage on jump measures.
Massage involves methodical pressure, friction and rubbing (Hemmings,
2001).
Various strokes such as, effleurage, petrissage, tapotement and
frictions have been developed from Swiss massage. Petrissage ("to
knead") is a vigorous stroke, which compresses and releases
soft tissue via picking up and squeezing the muscle and overlying
tissues. It is aimed at stretching muscle fibres, increasing mobility
between the tissue interfaces, aiding venous and lymph return, relaxing
muscles, and in helping with the removal of wastes (Goats, 1994a;
Paine, 2000).
Tapotement is a percussive massage stroke, such as hacking, pecking
or cupping; aimed at stimulating the cutaneous tissue and superficial
muscle, aiding the preparation for competition (Goats, 1994b;
Paine, 2000).
Unfortunately, the factions that prescribe pre-event massage, do
not agree on the type, style, application, duration, intensity,
number of strokes, or the time prior to competition required to
benefit from massage (Caldwell, 2001;
King, 1993;
Paine, 2000).
In addition, limited empirical data was found to substantiate each
stroke's claimed benefit or if they had any effect at all. Therefore,
both practitioner and recipient may have a poor understanding of
the true nature of massage.
Currently, the majority of studies, on sports massage, focus on
post-event conditions specifically aiding recovery from intense
exercise and the relieving of delayed onset of muscular soreness
symptoms (Weber et al., 1994).
Very little research has been conducted on the pre-exercise or pre-event
condition (Hemmings, 2001).
Although various authors have speculated on the positive effects
of massage (Cafarelli and Flint, 1993;
Caldwell, 2001;
Hemmings et al., 2000;
Hemmings, 2001;
King, 1993;
Paine, 2000),
there is little scientific or empirical data to support these claims
(Boone et al., 1991;
Hemmings et al., 2000;
Shoemaker et al., 1997).
Furthermore, these studies have methodological problems. Duration
of the treatment and the type and number of strokes conducted during
the treatment are inconsistent, with these decisions often left
up to the discretion of the therapist applying the treatment (Wiktorsson-Möller
et al., 1983).
Consequently, scientific knowledge in the area of the pre-event
massage is lacking. There is insufficient evidence to suggest that
pre-event massage is of any physiological benefit, whether it has
a positive or negative affect on performance and ROM. Hence, the
purpose of the study was to establish whether particular massage
strokes (petrissage or tapotement) had any effect on power performance
of the plantar flexors and ankle joint flexibility immediately post-treatment.
| METHOD |
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Subjects
Nineteen students, who volunteered (8 female and 11 male)
from the University of Ballarat, (mean; age = 21 ± 2.25 years,
height = 1.78 ± 0.09 m, weight 76.59 ± 9.87 kg) participated
in and completed the study. Following approval from the University
Human Research and Ethics committee, all subjects read and
signed an informed consent form prior to beginning the study.
Subjects were required to be injury free in the ankles, lower
legs and feet as well as have a moderate level of proficiency
in jumping sports to decrease likelihood of injury from the
test. Typically, this meant the subjects were participating
in team sports such as Australian Rules football and netball
at a recreational level.
Design
Subjects were required to attend four sessions throughout
the study. All tests for each individual were conducted at
approximately the same time of day to eliminate diurnal variations.
The first session was a familiarisation / information session
where the procedure and tests were described, demonstrated
and practised. The remaining sessions were the test sessions,
where the experiment was implemented. The order in which the
test sessions were completed was randomly assigned (dice throw)
prior to commencement of the first test session. Each test
session involved four components:
1.
Pre- intervention calf flexibility test where both ankles
were tested for ROM.
2. Treatment / intervention which was either the control,
massage treatment 1 (petrissage) or massage treatment 2 (tapotement),
applied in a randomly assigned order.
3. Post intervention calf flexibility, where the subject completed
the same ROM test, commencing on the same leg as in the pre-test.
4. Completion of two power jump tests conducted in random
order.
The
above sequence was completed on three separate occasions,
to allow the three different testing conditions to be conducted.
All massage was completed in a laboratory free of other people
or sounds to prevent external stimuli from influencing the
result. The massage was performed on an Athlagen Access-lift
electric table that was set at a height comfortable for the
therapist to complete the massage. No adjustments of table
height where permitted once a testing session commenced due
to the noise associated with the motor. Testing bouts were
conducted no closer than 48 hours and no further than 96 hours
from each other. The control condition was conducted to account
for possible influences of the resting prone position, oil
or the contact of the hands on the skin. The same therapist
was used for all subjects.
Familiarisation
/ information session
This session was conducted approximately one week prior to
the commencement of testing. The purpose of this session was
to inform the participant of the requirements of the study,
familiarise each subject with the testing procedures, and
demonstrate the massage styles to be performed.
Ankle
joint flexibility measures
Ankle joint flexibility was assessed prior to and following
the intervention. Subjects assumed a supine position with
their hands above their heads on a wall to brace their body
position for the measure to be performed. The hands were in
this position to avoid sliding along the floor whilst the
testers wound in the device. The machine was braced by one
of the testers to avoid the machine from moving whilst the
other tester wound the device. The testers also stabilised
the subject's ankle firmly in the device to avoid any slippage
of the foot in the machine (Figure
1).
The assignment of which leg would be tested first was determined
randomly with an eight-sided die. The same order for the legs
was used for pre- and post-testing. Once this order was determined,
the subject was tested and received the treatment on this
leg first for the duration of the study. Following this procedure,
the plantar surface of the first foot was placed on the wooden
plate of the ankle joint flexibility device. The plate was
then wound slowly to increase ankle dorsiflexion. The subjects
were to inform the testers when they reached a position that
induced a sensation just prior to the onset of pain. The subject
was instructed to look directly up at the ceiling to avoid
influence of visual stimulus in regards to ankle position.
A reading was taken of the acute angle between the horizontal
and movable plate on the degrees scale on the side of the
device, with the measurement resolution 0.5 degrees. This
angle was considered as the measure of passive flexibility
of the plantar flexors. This procedure was then immediately
repeated for the following leg. Only a single flexibility
trial was conducted due to the time taken to perform the test.
This test has been reliably used in previously published research
(Young et al., 2006).
Repeating this procedure could influence the subject's perception
of the end point just before pain and consequently affect
the overall result.
Treatment
interventions
The order in which each participant completed the interventions
was predetermined randomly. The position for all three interventions
was the same; lying prone on an Athlagen Access Lift electric
table, with the feet hanging off the end of the table in a
relaxed position. 'Cold-pressed' vegetable based oil was applied
to each of the subjects over the plantar flexors. The amount
of oil applied to each subject was sufficient to provide comfort
during the vigorous application of petrissage without irritation
of the skin or hair on the leg. No conversing between the
therapist and subject was allowed, no noise, talking in the
laboratory, music or anything else that could alter the mood
state was permitted during the intervention.
Control
condition
The control condition consisted of resting in a prone position
as described above and the oil was applied. The massage therapist
rested the hands on each leg over the triceps surae group
for a period of three minutes on each leg. No movement of
the therapist's hands was permitted throughout the duration
of the application. Direct contact was used in the control
to account for any influence of physical contact. This control
was necessary due to the potential psychological effect of
massage as demonstrated by Tyurin, 1985.
Massage
treatment 1 - Petrissage
The subject adopted a position as described above. The oil
was applied to both legs as with the control. The therapist
then proceeded to massage the subject's plantar flexors with
a vigorous kneading 'duck-billing' motion - petrissage (Figure 2). This was applied to one leg for a period of three
minutes and then the other leg.
Massage
treatment 2 - Tapotement
The subject adopted the starting position as described above.
Oil was applied as with the other two interventions, although
not normally required for tapotement technique. This was done
to be consistent with the preceding two interventions. A percussive
hacking style (Figure 3)
was applied to the plantar flexors for duration of three minutes
each leg as per the other two interventions. The strike rate
of this technique was vigorous at 4Hz. This was consistent
throughout the total six minute time period. Consistency was
ensured with the therapist wearing a "Walkman" with
earphones and a compact disc playing a beeping noise every
0.5 s. The therapist was instructed to strike his right hand
twice for each beat.
To
ensure consistency for all conditions, the same qualified
massage therapist was used. The therapist had been practising
massage professionally for over three years and was qualified
with a Diploma of Health Science (Remedial Massage).
Jump procedures
All subjects on completing all other tests performed two tests
of muscle power. The order, in which these tests were conducted,
was randomly assigned. Once determined, the subject completed
these tests in this order for the remainder of their test
sessions. These two tests were selected as they are seen to
be two differing neurophysiological methods of force generation
(Young et al., 2006).
The drop-jump involves a stretch-shortening cycle (SCC), whereas
the concentric calf raise is a pure concentric contraction.
Drop
jump
The drop jump was performed from a 30cm high box onto a contact
mat system (Swift Performance Equipment) (Power et al., 2004;
Young and Behm, 2002,
Young and Elliott, 2001;
Young et al., 2006).
Subjects were instructed to keep their hands on their hips
throughout the test, and to step off the box with a straight
leg to ensure the fall began as close to 30cm as possible.
The objective was to jump for maximum height and minimum contact
time. As previous studies have indicated, these instructions
produced short contact times (<200msec) and change the
jumping task compared with jumping only for height (Power
et al., 2004;
Young and Behm, 2002;
Young et al., 2006).
The testers, to ensure correct technique and give feedback
as required, repeated the cues of maximum height and minimum
contact time. Each subject performed a maximum of two jumps
with approximately 30 seconds rest between trials. The best
score was retained for the final result.
The test yields two results, height achieved and contact time.
The power measure is the height divided by contact time. As
the flight time determines the height achieved, it is only
valid if the subject lands in the exact position of the take-off.
Consequently, the subjects' instructions were to land from
their jumps with the hips and knees extended and the feet
fully plantar flexed before flexing these joints to distribute
the impact of landing. "Although this test does not totally
isolate the plantar flexors, such a jumping technique has
been shown to reduce the activation of the quadriceps and
increase the activation of the gastrocnemius compared to a
drop jump for height only," (Young et al., 2006).
Concentric
calf raise
This test was performed in a modified Smith Machine (Olympic
bar is attached and guided along vertical rails) with a 10kg
bar on the shoulders to enhance stability whilst performing
the movement (Young et al., 2006).
The subject was placed in the Smith Machine and instructed
to remain still, on flat feet. Their weight was then measured
and recorded. When instructed to 'go' the subject performed
a maximal explosive concentric calf raise as 'hard and fast
as possible'. Their knees had to remain locked throughout
the test and their toes were to remain in contact with the
ground. This test isolated the plantar flexors as hip and
knee extension was eliminated. To decrease the subject utilising
other muscles, their technique was assessed during the movement.
The power measures were captured with a Kistler force platform
(Z4852/C) operating at 1000Hz. The software ascertained the
absolute maximum force and reported this as peak force. The
maximum rate of force development (RFD) was calculated as
the greatest force increase over 5 msec on the ascending aspect
of the curve. The subjects performed two trials, with the
best score taken as the result. These parameters have been
used previously (Young and Elliot, 2001).
Statistical
analysis
To compare the measures of muscle power from the concentric
calf raise and drop jump across these conditions, a one-way
Analysis of Variance (ANOVA) with repeated measures was employed.
For the flexibility measures, a two-way ANOVA, (3 conditions
x 2 times {pre- and post-intervention}) with repeated measures,
was also used; however, the focus was on the condition time
interaction since the flexibility results had a pre- and post-
treatment score. The ANOVAs were conducted separately for
right and left limbs. Significance was set at p < 0.05
for all tests. Effect sizes (ES = mean change / standard deviation
of the sample scores) were also calculated and reported (Cohen,
1988).
Cohen applied qualitative descriptors for the effect sizes
(ES) with ratios of less than 0.41, 0.41-0.70 and greater
than 0.7 indicating small, moderate and large changes respectively.
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| RESULTS |
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Ankle joint flexibility
There was a significant (p < 0.01) main effect for time
(pre- vs. post-intervention) for both legs. For the right
leg there was a significant group time interaction (p <
0.05) (Figure 4). To
determine which condition was different, simple contrasts
were performed revealing the gains in flexibility from pre-
to post-massage were greater for the petrissage (3.7% ES =
0.64) and tapotement (3.2% ES = 0.62) compared to the control
(1.3% ES = 0.18). There was no significant difference between
either massage treatments for either leg.
For the left leg there was no statistical significance in
ankle joint flexibility (Figure
5). Although not significant (p = 0.34), numerically,
the two massage treatments had larger gains in flexibility
compared with the control group (petrissage = 2.7% ES = 0.48:
moderate, tapotement = 2.4% ES = 0.34: small, control = 1.1%
ES = 0.1).
Power
performance
There was no significant difference observed between the three
conditions in any of the variables related to power (Table
1). The concentric calf raise also failed to yield any
significant results.
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| DISCUSSION |
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The
purpose of this study was to determine if petrissage and tapotement
forms of massage would influence the flexibility of the plantar
flexors and muscle power.
Ankle
joint flexibility
Unlike previous studies (Mikesky et al., 2002),
this study was able to demonstrate a significant effect of
massage on ROM. Interestingly, the ROM results showed significance
only on the right and a corresponding numerical indication
on the left reached a significance value of p=0.34. Effect
size magnitudes (Cohen, 1988)
indicated that both types of massage for the right ankle and
petrissage for the left ankle caused moderate changes in ROM
while tapotement had a small effect for the left ankle. However,
when comparing the two massage techniques, the results were
very similar. This was surprising, as it has been claimed
that petrissage and tapotement have different effects on soft
tissues and subsequently a greater difference between the
two strokes may have been expected (Goats, 1994b).
As discussed earlier, the proposed purpose of petrissage is
to increase lymphatic and venous drainage, squeeze out metabolic
waste products, promote deeper relaxation of tissues and stretch
muscle fibres, making the tissue interface more mobile (Paine,
2000;
Prentice, 2003).
These claims would account for the increase in flexibility
associated with petrissage via reducing stiffness at a fibre
level and increasing muscle compliance. However, tapotement
is claimed to increase muscle tone, vibrate tissues and stimulate
cutaneous reflexes (Goats, 1994a).
Its percussive nature works superficially stimulating muscles
and cutaneous neural structures. Both techniques involved
direct contact on the skin for a duration of three minutes.
Throughout that time, a vigorous application of massage to
the skin from either technique would stimulate the cutaneous
receptors (Goats, 1994a).
This application of rubbing or striking the skin for the prolonged
period would overload the cutaneous receptors and possibly
make recognising the end point of the stretch more difficult.
This hypothesis is in agreement with Magnusson et al., 1996
who attributed increases in ROM more to increases in stretch
tolerance than to changes in tissue compliance or stiffness.
As there was no significant difference between the two massage
styles, the style of massage may not be significant in regards
to improving the flexibility. Perhaps the act of vigorous
skin contact, regardless of the action performed, would have
the same effect.
Power
performance
When comparing the effects of massage on the power of the
plantar flexors no significant change was noted for either
the drop-jump or the concentric calf raise. Similarly, Mikesky
et al. (2002)
used a jump test when assessing massage and vertical jump
power. Again, their study failed to yield any significant
results with the counter movement jump. The lack of impairment
in jump performance following the massage techniques is in
contrast to studies examining the effect of static stretching.
A number of studies have illustrated that prior to activity;
static stretching can impair force (Behm and Kibele, 2007,
Behm et al., 2001;
2006),
jump performance (Cornwell et al., 2002;
Young and Elliot, 2001;
Young and Behm, 2002),
balance, reaction and movement time (Behm et al., 2004b)
and jump landing contact time (Power et al., 2004).
Young et al., 2006
showed that increasing the stretch duration increased the
decrement in the drop jump performance. Consequently, if massage
can increase muscle length without affecting performance in
power events it could be hypothesised that vigorous, short
duration massage may be a better method of preparing the body
just prior to a power event compared with static stretching.
However, to further emphasize the point, massage in this study
did not positively affect power performance, it just did not
impair performance.
Ankle
joint flexibility and power
Stretch-induced decrements in force and power have been attributed
to an increase in compliance (Fowles et al., 2000;
Taylor et al., 1990)
and an inhibition of muscle activation (Avela et al., 1999;
Behm et al., 2001;
Fowles et al., 2000).
The increased ankle joint flexibility of this study might
also be attributed to an increased muscle compliance, which
in turn would potentially adversely affect the plantar flexors'
force length relationship. However, there were no significant
changes in power with the massage conditions.
An increase in ankle joint flexibility may occur due to an
increase in muscle temperature altering tissue viscosity and
tissue compliance. Drust et al., 2003
demonstrated significant increases in muscle temperature,
up to a depth of 2.5cm with massage application. However this
is not as encompassing as an active warm-up that involves
muscular contractions. Numerous static stretching studies
use an active warm-up followed by a stretch to the 'point
of discomfort' (Behm and Kibele, 2007,
Behm et al., 2001;
2004a;
2006;
Power et al., 2004,
Young and Behm, 2002).
As a consequence, a decrease in muscle viscosity and increase
in compliance should result. However according to the previously
cited studies, an increase in muscle compliance should result
in a decrease in power. Perhaps the hypothetical positive
effects of massage on the neural system counterbalance or
eliminate the negative effect of increased compliance.
Furthermore, massage is performed within a subject's tolerance
levels. The verbal cue of 'point of discomfort', as described
in static stretching studies, may not be achieved keeping
the muscle below the elastic limit. Alter, 1996
defined the elastic limit as the smallest value of stress
required to produce a permanent strain on the body. He states
that increasing the stress beyond this point would result
in a stressed connective tissue and muscle and as a result
these tissues would not return to their original length. Consequently,
static stretching to the 'point of discomfort' may exceed
the elastic limit altering the ability to generate power,
whereas massage might not reach this level and not affect
the tissue in this manner.
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