Friday, September 18, 2015

Massage Therapy Speeds Recovery in Bodybuilders After Eccentric Workouts - DOMS + CK ↓ / Performance ↑

While many athletes use it and trainers all around the world are convinced that it works, the evidence on what exactly massage therapy does or doesn't do to an exhausted athlete's muscle and lymphatic system is scarce. Even the assumption that it helps reduce DOMS may be based on a placebo effect. After all, it's impossible to conduct a truly double-blinded massage study.
If they can afford it, athletes often employ their own massage therapist. It is commonly believed that sport massage after intensive exercise might improve power and perceptual recovery in sportsmen and -women. As Mehdi Kargarfard et al. (2015) point out in their latest paper, "few studies have been done in this area" to confirm what everyone appears to believe to be a scientific fact" (Kargarfard. 2015).

Accordingly, the researchers' latest study aimed to examine the effect of massage on the performance of bodybuilders - a group of athletes of which only few will be able to afford their own massage therapist, although they may in fact be among those athletes who could benefit most from massage therapy of which scientists believe that it reduces DOMS and speeds up recovery by removing accumulated extracellular fluid from the muscles, thus reducing swelling and pain via increased blood and lymph circulation - and at least the net outcome, i.e. a subjective reduction in DOMS (learn more) has been confirmed consistently (Bąkowski. 2008; Ali. 2012; Andersen. 2013; Visconti. 2014; Urakawa. 2015).
Learn more about supplements of which people say they help w/ recovery the SuppVersity

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If we assume that the mechanism has been correctly identified, massage therapy appears to work very differently from ice-baths of which a recent study has shown that it may actually impair the training-induced adaptation process by soothing the fire that's fueling the corresponding processes (learn more in "Using Ice / Cold Water Immersion After Workouts Will Impair Muscle and Strength Gains, as well as Vascular Adaptations").
Table 1: Descriptive statistics of the participants (Kargafard. 2015).
What makes the study particularly interesting is that the N=30 subjects were all healthy young men (28.77 ± 3.54 years) who were free of any supplement and steroid use, but had at least 2 years experience in bodybuilding (Table 1). The participants were randomly assigned using the permuted block randomisation method to either a massage (n = 15) or a control (n = 15) group. Participants were excluded if they had any relative or absolute contraindications to exercise or exercise testing.
  • Tests were performed 1 week prior to the commencement of the treatment protocols and conducted during an 8-week preseason training period to limit the training effect. 
  • Both groups performed five repetition sets at 75–77% of 1RM of knee extensor and flexor muscle groups. The massage group then received a 30-min massage after the exercise protocol while the control group maintained their normal passive recovery. More specifically, ...
    "... the participants were asked to perform squats to 90º knee flexion for five sets at 75% 1RM until exhaustion (but not less than 10 repetitions); then they had to perform leg press to 90º knee flexion for five sets at 75–77% 1RM until exhaustion (but not less than 10 repetitions). One-minute rest intervals were given between sets. If a participant could not complete 10 repetitions without assistance from the spotters, the initial intensity was reduced until at least 10 repetitions could be achieved. This was followed by a 5-min rest and an isometric protocol to induce DOMS in the right quadriceps muscle" (Kargarfard. 2015).
  • Participants’ diets and medications were recorded and remained constant throughout the experimental period, which excludes a distortion of the results.
Criteria under investigation included: plasma creatine kinase (CK) level, agility test, vertical jump test, isometric torque test, and perception of soreness.
So why are you confident that massage therapy is not going to backfire? Well, as I pointed out previously in this article, there is no evidence of direct anti-inflammatory effects as they have been ascribed to ice-baths or vitamin supplements that could blunt the necessary hormetic response to exercise. Rather than that, data from a recently published study by Andrzejewksi et al. suggest that repeated massage may contribute to processes of creation of new and development of already existing vascular networks in the skeletal muscle tissue during increased exercise", which is the exact opposite of the proven detrimental effects of ice-baths (Andrzejewski. 2015). It does thus appear very unlikely that the overall long-term effects of massage therapy are going to be detrimental. A long-term study with bodybuilding specific outcomes, like strength and hypertrophy is still necessary, because a low risk of negative effects does not imply that there are going to be increased gains in strength or size.
All variables were measured over 6 time periods: baseline, immediately after the DOMS inducing protocol, right after the massage, and 24, 48, and 72 h after the massage, the scientists describe as follows:
"30-min standardised supine massage was performed by a licensed massage therapist with 3 years of experience on the exercised/right thigh of participants in the massage group after 2 h following the muscle soreness inducing exercise protocol. To maintain consistency and reproducibility for the entire massage procedure, tape-recorded messages were announced to remind the therapist when to change the massage strokes being performed. Western massage techniques of effleurage, petrissage, and vibration were used.

While there are rumors that massage therapy may also help you shed bod weight, this has been shown only for different techniques: "Electro-Cut" Your Body Fat - Study Shows 5.6 cm and 4.9% Reduction in Waist & Body Fat in Young Women in 6 Weeks
Each massage began with 4 min of effleurage consisting of 2 min of light stroking with the palm around the knee, and 2 min of light stroking over the medial thigh. Effleurage was followed by petrissage, which consisted of 2 min of twohanded palm kneading of the anterior thigh muscles, 2 min of two-handed thumb kneading over the medial thigh, 2 min of circular two-handed lifting of the anterior thigh, 1 min of pressing and spreading the tissues perpendicular to the long axis of the thigh, and 1 min of rolling the fingertips over the anterior thigh muscles. Two minutes of vibration was added between the petrissage techniques of circular lifting of the anterior thigh muscles and pressing and spreading the tissues.

The massage was then concluded with 3 min of effleurage over the anterior and medial thigh. While massages were performed on the experimental group, participants of the control group were asked to remain seated and to maintain their normal passive recovery regime as well as to refrain from performing any additional exercises or stretches"
(Kargarfard. 2015).
What the scientists found when they analyzed their results was (a) the obvious, i.e. significant (P < .001) decreases in jumping, agility performance, and isometric torque, but significant (P < .001) increases in CK and muscle soreness levels in all subjects.
Will foam rolling do the same? Whether it will do the same would require future studies with direct comparisons. What I can tell you, though, is that studies by MacDonald et al (2014) and Pearcey et al. (2015) consistently showed similar results, i.e. decreased DOMS and accelerated recovery / preserved muscle function with foam rolling after intense workouts.
There was yet also (b) a significant difference between the control and the massage group who demonstrated a better recovery rate as evidenced by:
  • faster recovery of vertical jump performance and maximal muscle torque (measured when subjects were fixed w/ 90º of hip and knee flexion on an isokinetic dynamometer) from 24-72h in response to the  massage therapy,
  • reduced increases in creatine kinase (CK) levels, a relatively unspecific marker of muscle damage, after the massage therapy.
What was not observed was a meaningful difference in the agility test, where the pre-test difference was similar before and after the test and treatment.
Figure 1: Creatine kinase (CK | top, left), jump height / distance (bottom, left), agility test times (top, right) and visual analog scale rating for DOMS (bottom, right) for the two study groups (Kargarfard. 2015).
In view of the fact that the study wasn't blinded (for obvious reasons), it is also not clear how much of the subjective reduction in DOMs may just have happened in the subject's head. In conjunction with the previously mentioned faster recovery of performance markers and CK, though, it appears to be very reasonable to follow Kargarfard's conclusion that "As such, a post-exercise massage session can improve the exercise performance and recovery rate in male bodybuilders after intensive exercise" (Kargarfard. 2015).
Since the purported mechanism is very different, it's unlikely that there will be similarly negative long-term consequences as they've been observed w/ ice baths.
Bottom line: In spite of the lack of being double-blinded, the consistency of objective and subjective performance and DOMS markers can be considered sufficient evidence for the existnece of sign. short-term benefits of massage therapy on athletes' recovery.

If we assume my previously mentioned hypothesis that the accelerated manual removal of "debris" after workouts was much different from the anti-inflammatory effects of ice-baths / and cold water immersion therapy is correct, there is also no reason to believe that massage therapy would have a similarly detrimental long-term effect on the training-induced adaptation to exercise as we've recently seen them in response to ice-baths | Comment on Facebook!

  • Ali, Rasooli S., et al. "Influence of massage, active and passive recovery on swimming performance and blood lactate." The Journal of sports medicine and physical fitness 52.2 (2012): 122-127.
  • Andersen, Lars L., et al. "Acute effects of massage or active exercise in relieving muscle soreness: Randomized controlled trial." The Journal of Strength & Conditioning Research 27.12 (2013): 3352-3359.
  • Andrzejewski, Waldemar, et al. "Increased skeletal muscle expression of VEGF induced by massage and exercise." Folia Histochemica et Cytobiologica 53.2 (2015): 145-151.
  • Bąkowski, Paweł, et al. "Effects of massage on delayed-onset muscle soreness." Polish Orthopedics and Traumatology 73.4 (2008): 261-265.
  • Kargarfard, M, et al. "Efficacy of massage on muscle soreness, perceived recovery, physiological restoration and physical performance in male bodybuilders." Journal of Sports Sciences (2015): Ahead of print.
  • MacDonald, Graham Z., et al. "An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force." The Journal of Strength & Conditioning Research 27.3 (2013): 812-821.
  • MacDonald, Graham Z., et al. "Foam rolling as a recovery tool after an intense bout of physical activity." Med Sci Sports Exerc 46.1 (2014): 131-142.
  • Pearcey, Gregory EP, et al. "Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures." Journal of athletic training 50.1 (2015): 5-13.
  • Urakawa, Susumu, et al. "Manual therapy ameliorates delayed‐onset muscle soreness and alters muscle metabolites in rats." Physiological reports 3.2 (2015): e12279.
  • Visconti, Lorenzo, et al. "Effect of massage on DOMS in ultramarathon runners: A pilot study." Journal of Bodywork and Movement Therapies (2014).