Self-Massage Acute Effects on Pressure Pain Threshold, Muscular Electrical Activity, and Muscle Force Production: A Systematic Review and Meta-Analysis

ABSTRACT

Furlan, MR, Machado, E, Petter, GdN, Barbosa, IM, Geremia, JM, and Glänzel, MH. Self-massage acute effects on pressure pain threshold, muscular electrical activity, and muscle force production: a systematic review and meta-analysis. J Strength Cond Res 38(3): 620-635, 2024-Self-massage (SM) is often used in physiotherapy and sports training programs. However, the SM acute effects on pressure pain threshold (PPT), muscle electrical activity (MEA), and muscle force production remain unclear. A meta-analytical review was performed to verify the SM acute effects on neuromuscular responses in healthy adults or athletes. The review (CRD42021254656) was performed in the PubMed, Web of Science, and Embase databases. A synthesis of the included studies was performed, and both the risk of bias and the evidence certainty level were assessed through the PEDro scale and Grading of Recommendations Assessment, Development, and Evaluation approach, respectively. Nineteen studies were included, 5 evaluated the PPT, 7 the thigh muscles' MEA, and 15 the lower-limb strength. The SM application induces moderate increases in quadriceps' PPT (5 studies; standardized mean difference [SMD]: 0.487; 95% CI 0.251-0.723; p < 0.001; I2 = 0%). We found no SM effects on the hamstrings and plantar flexors' MEA. Also, we observed small increases in knee extensors' concentric torque (2 studies; SMD: 0.288; 95% CI 0.088-0.489; p = 0.005; I2 = 0%), without effects in isometric muscle strength, eccentric torque, and rate of force development. Grading of recommendations assessment, development, and evaluation analysis showed high and low certainty levels for the SM effects on quadriceps' PPT and muscle strength, respectively. Self-massage pressure-volume application seems to be a determining factor in inducing changes in these parameters, and it may vary among the treated muscles, where a higher pressure-volume application is required for increasing knee flexors and plantar flexors' PPT and strength. Thus, new studies with better methodological quality should be performed to strengthen this evidence.

Foam roller-based self-induced myofascial therapy in patients with hemophilic knee arthropathy: a multicenter, single-blind, randomized clinical study

BACKGROUND

Hemophilia is a congenital coagulopathy characterized by degenerative joint damage. Self-induced myofascial therapy aims to decrease pain and improve tissue mobility, functionality and proprioception.

AIM

The aim of this study was to evaluate the safety and efficacy of self-induced myofascial release in patients with hemophilic knee arthropathy.

DESIGN

This is a randomized clinical study.

SETTING

This study was carried out in different patient associations.

POPULATION

Fifty-two patients with hemophilia were included in the study.

METHODS

Patients were randomized to the experimental group (daily home protocol of foam roller-based self-induced myofascial therapy for 8 weeks) or the control group (no intervention). The variables were the frequency of hemarthrosis (self-reporting), pain intensity (visual analog scale), range of motion (goniometry) and muscle strength (dynamometry). All variables were evaluated at baseline, post-treatment and after a 10-week follow-up.

RESULTS

The patients included in the experimental group showed significant improvements in terms of a decrease in frequency of hemarthrosis (mean difference [MD]=-0.61; 95% confidence interval [CI]: -0.81; -0.41) and pain intensity (MD=-0.33; 95% CI: -0.48, -0.18), increased range of motion (MD=0.88; 95% CI: 0.39; 1.37), strength in quadriceps (MD=0.88; 95% CI: 0.39; 1.37). (MD=12.39; 95% CI: 3.44; 21.34) and hamstrings (MD=7.85; 95% CI: 0.60; 15.11). There were intergroup differences in the frequency of hemarthrosis (F=14.51; P<0.001), pain intensity (F=9.14; P<0.001) and range of motion (F=13.58; P<0.001).

CONCLUSIONS

Self-induced myofascial therapy can be an effective complementary technique in the treatment of patients with hemophilic arthropathy. Self-induced myofascial therapy can reduce the frequency of knee hemarthrosis in patients with hemophilia. This technique can improve pain intensity and range of motion in patients with hemophilic knee arthropathy.

CLINICAL REHABILITATION IMPACT

Hemophilic knee arthropathy is characterized by chronic pain, decreased range of motion, and periarticular muscle atrophy. Foam roller-based self-induced myofascial therapy can reduce the frequency of hemarthrosis and pain intensity and improve range of motion in patients with hemophilic arthropathy. Foam roller-based self-induced myofascial therapy is safe and effective in the treatment of patients with hemophilia. The inclusion of self-induced myofascial therapy exercises in the approach to degenerative joint pathologies may be an effective and safe treatment option.

Self-Massage Techniques for the Management of Pain and Mobility With Application to Resistance Training: A Brief Review

ABSTRACT

MacLennan, M, Ramirez-Campillo, R, and Byrne, PJ. Self-massage techniques for the management of pain and mobility with application to resistance training: a brief review. J Strength Cond Res 37(11): 2314-2323, 2023-Fascial restrictions that occur in response to myofascial trigger points (MTrP), exercise-induced muscle damage (EIMD), and delayed onset of muscle soreness (DOMS) cause soft tissue to lose extensibility, which contributes to abnormal muscle mechanics, reduced muscle length, and decrements in joint range of motion (ROM) and actively contributes to musculoskeletal pain. Resistance training and in particular, weightlifting movements have unique mobility requirements imperative for movement efficacy and safety with ROM restrictions resulting in ineffective volume and intensity tolerance and dampened force output and power, which may lead to a failed lift or injury. Self-massage (SM) provides an expedient method to promote movement efficiency and reduce injury risk by improving ROM, muscular function, and reducing pain and allows athletes to continue to train at their desired frequency with minimal disruption from MTrPs-associated adverse effects. Thus, the aim of this review was to determine the efficacy of various self-massage tools in managing pain and mobility and to explore the potential benefits of SM on resistance training performance. Many SM devices are available for athletes to manage ROM restrictions and pain, including differing densities of foam rollers, roller massagers, tennis balls, and vibrating devices. To attenuate adverse training effects, a 10-to-20-minute bout consisting of 2-minute bouts of SM on the affected area may be beneficial. When selecting a SM device, athletes should note that foam rollers appear to be more effective than roller massagers, with vibrating foam rollers eliciting an increased reduction to pain perception, and tennis balls and soft massage balls were shown to be efficacious in targeting smaller affected areas.

Stretching and Releasing of Iliotibial Band Complex in Patients with Iliotibial Band Syndrome: A Narrative Review

Iliotibial band syndrome (ITBS) is one of the most common overuse syndromes causing knee pain; it is especially prevalent in runners and also common in cyclists, rowers, and field athletes, with occasional cases occurring in non-athletes too. ITBS symptoms can negatively affect not only knee function, but also mental and physical aspects of health-related quality of life. Although various conservative treatment options have been investigated and discussed, there is still no consensus on a standard of care for ITBS. Moreover, the literature on the etiology and risk factors of ITBS, which could help in selecting appropriate treatment methods, is conflicting and inconclusive. The role of individual treatment modalities such as stretching and releasing techniques has not been extensively studied and remains unclear. In this article, we will critically review the available evidence for the benefits of ITB stretching and "release" methods in the treatment of ITBS. In addition to the direct evidence (clinical studies examining the effects of ITB stretching and other methods that purportedly stretch or "release" the ITB), we present several additional lines of reasoning that discuss the rationale for ITB stretching/releasing in terms of the etiology of ITBS, the mechanical properties and behavior of the ITB, and the risk factors for ITBS development. We conclude that the current literature provides some evidence for the inclusion of stretching or other "release" methods in the early rehabilitation of ITBS. Long-term interventions typically include ITB stretching; however, it remains unclear to what extent stretching within a multimodal treatment actually contributes to resolving the symptoms. At the same time, there is no direct evidence to suggest that stretching and "release" methods have any negative effects.

Effect of manual physical therapy on sleep quality and jaw mobility in patients with bruxism: A biopsychosocial randomized controlled trial

This study aimed to investigate the effects of deep-stripping and trigger-point pressure release massage on the Pittsburgh Sleep Quality Index (PSQI), jaw mobility, and pressure pain threshold (PPT) of masticatory muscles in patients with sleep bruxism. A randomized controlled trial was conducted among 45 patients diagnosed with sleep bruxism. The patients were randomly assigned to three groups. Group I was the control group and included five men and 10 women; Group II was the deep-stripping massage group, which included two men and 13 women; and Group III was the pressure release group, which involved four men and 11 women. Patients were tested two times, before and after 6 weeks. Group I received transcutaneous electrical nerve stimulation and passive stretching; Group II received a deep-stripping massage; and Group III received a trigger-point pressure release massage. Findings revealed significant improvements in PSQI (p = 0.0001), jaw opening (p = 0.0001), jaw protrusion (p = 0.0001), jaw left lateral movement (p = 0.004), jaw retraction (p = 0.0001), right temporalis PPT (p = 0.0001), left temporalis PPT (p = 0.0001), right master PPT (p = 0.001), left master PPT (p = 0.001), right lateral pterygoid PPT (p = 0.001), left lateral pterygoid PPT (p = 0.001), right digastric muscle PPT (p = 0.001), and left digastric muscle PPT (p = 0.001) in the post-test condition in Group II compared with Group I and Group III. Deep-stripping massage improved PSQI, jaw mobility, or PPT of the masticatory muscles compared with trigger-point pressure release massage and traditional treatment techniques in patients with sleep bruxism.

Effects of Myofascial Self-Release on Range of Motion, Pressure Pain Threshold, and Hamstring Strength in Asymptomatic Individuals: A Randomized, Controlled, Blind Clinical Trial

CONTEXT

Myofascial self-release is performed using a roller to exert pressure on the soft tissues and to promote effects similar to those of traditional massage. However, there is no standardization regarding its application, mainly in relation to time.

OBJECTIVE

To evaluate the effects of myofascial self-release with a rigid roller on range of motion (ROM), pressure pain threshold (PPT), and hamstring strength in asymptomatic individuals following 2 different times of intervention.

DESIGN

Randomized, controlled, blind, clinical trial comparing preintervention and immediately postintervention within 2 groups.

SETTING

Institutional physiotherapy clinic.

PARTICIPANTS

A total of 40 university students (18-30 y), who had no symptoms, participated.

INTERVENTION

Foam roller for 30 seconds and 2 minutes for group 2.

MAIN OUTCOME MEASURES

Hamstring PPT, knee-extension ROM, and peak knee-flexion torque measured before and immediately after the intervention.

RESULTS

Both groups experienced a statistically significant increase in ROM compared with baseline (30 s and 2 min for group 2 P < .024). There were no statistically significant differences comparing peak knee-flexion torque or PPT.

CONCLUSIONS

Hamstring myofascial self-release using a roller for 30 seconds or 2 minutes produced an increase in ROM in healthy individuals. PPT and peak knee-flexion isometric torque showed no effects.

Immediate effect of foam roller on pain and ankle range of motion in patients with plantar fasciitis: A randomized controlled trial

Background:

Stretching has been proven to be effective on pain and range of motion (ROM) in patients with plantar fasciitis. Despite recent gain in popularity and the proposed theories of effectiveness of foam roller, there is a lack of literature on the effect of foam rolling on plantar fasciitis.

Objective:

The objective of this study was to compare the effects of foam rolling and stretching on pain and ankle ROM in patients with plantar fasciitis.

Methods:

A total of 50 participants were included and randomly allocated to the stretching and foam roller groups. Visual analog scale (VAS), pressure pain thresholds (PPTs) for gastrocnemius, soleus and plantar fascia and weight-bearing lunge test (WBLT) measurements were recorded at baseline and immediately after treatment.

Results:

Within-group analysis has shown there is a statistically significant difference (p<0.001) in all the outcome measures in both foam roller and self-stretching groups. The between-groups analysis showed no statistical significance difference in VAS, plantar fascia PPT and WBLT parameters (with p-values of 0.171, 0.372 and 0.861, respectively); however, significant differences were found in gastrocnemius PPT (p=0.029) and soleus PPT (p=0.013).

Conclusion:

It was seen that both stretching and foam rolling techniques helped in reducing pain and increasing the ROM. However, the effectiveness of foam roller was superior to stretching in terms of increase in PPTs at gastrocnemius and soleus.

Clinical Trial Registration No:

CTRI/2018/01/011398.

Name of registry:

The Clinical Trials Registry — India (CTRI); https://ctri.nic.in.

The Effect of Foam Rolling Versus IASTM on Knee Range of Motion, Fascial Displacement, and Patient Satisfaction

CONTEXT

Soft tissue restrictions have been linked to poor flexibility and decreased range of motion (ROM). To decrease the soft tissue restrictions and ultimately increase ROM/flexibility, myofascial release techniques, such as foam rolling (FR) and instrument-assisted soft tissue mobilization (IASTM), have been used. However, the benefit regarding which technique is more beneficial remains unknown.

OBJECTIVE

To examine the effects of myofascial release techniques (FR vs the instrumented portion of IASTM) on knee joint ROM, rectus femoris (RF) and biceps femoris (BF) fascial displacement, and patient satisfaction.

DESIGN

Randomized controlled clinical trial.

SETTING

Mid-Atlantic University.

PARTICIPANTS

Twenty moderately active participants (age 21.1 [2.0] y) with variable levels of soft tissue restriction in the quadriceps and hamstrings started and completed the study. Participants were randomly assigned to 2 groups, FR or IASTM.

INTERVENTIONS

All participants completed the same warm-up prior to the intervention. The FR group followed the proper FR protocol for gluteals/iliotibial band, quadriceps, and hamstrings/adductors, and the participants were monitored while the protocol was completed. The IASTM group received treatment on the gluteals/iliotibial band followed by the quadriceps, adductors, and hamstrings. Participants in both groups attended intervention sessions twice per week for 3 weeks. Prior to the start, knee ROM measurements were taken, along with fascial displacement measured via ultrasound. Upon completion of the study, posttest measurements were completed. A patient satisfaction survey was also administered at this time.

MAIN OUTCOME MEASURES

Pretest to posttest knee ROM measurements, RF and BF fascial displacement, and patient satisfaction.

RESULTS

Both groups improved pretest to posttest for knee-extension ROM, with a slight trend toward increased knee-extension ROM for the FR group. Both groups improved pretest to posttest for BF and RF fascial displacement, in favor of the IASTM group for BF fascial displacement. Both groups were equally satisfied.

CONCLUSIONS

As both groups improved pretest to posttest, either treatment could be used.

Self-massage prior to stretching improves flexibility in young and middle-aged adults

We examined the influence of stretching alone (SS) or combined with self-massage (SM) on maximal ankle dorsiflexion angle, maximal voluntary contraction (MVC) torque and calf muscle activity, and subcutaneous tissue thickness in 15 young (25 ± 3 years) and 15 middle-aged (45 ± 5 years) adults. Participants performed two sessions of calf muscle stretches (3x 30-s stretches, 30-s rest): stretch after a 60-s control condition (SS) and stretch after 60 s of self-massage with therapy balls (SM). Evaluations were performed before and 5 min after the intervention. Linear mixed effects model revealed no main effect for age on ROM or MVC and significant main effects for treatment and time. Change in ankle angle was greater after SM: SS = 3.1 ± 2°, SM = 6.2 ± 3.3° (Hedges' g = 0.98, p < 0.001). Similar results were observed for MVC torque: SS = -4 ± 16%, SM = 12 ± 16% (Hedges' g = 0.97, p = 0.0001). Changes in MVC torque and absolute EMG amplitude were correlated, but subcutaneous tissue thickness was not altered by treatment. The gains in ROM were more pronounced in less flexible middle-aged adults, underscoring the need to include flexibility exercises in their training.

Roller massage decreases spinal excitability to the soleus

Roller massage (RM) interventions have shown acute increases in range of motion (ROM) and pain pressure threshold (PPT). It is unclear whether the RM-induced increases can be attributed to changes in neural or muscle responses. The purpose of this study was to evaluate the effect of altered afferent input via application of RM on spinal excitability, as measured with the Hoffmann (H-) reflex. A randomized within-subjects design was used. Three 30-s bouts of RM were implemented on a rested, nonexercised, injury-free muscle with 30 s of rest between bouts. The researcher applied RM to the plantar flexors at three intensities of pain: high, moderate, and sham. Measures included normalized M-wave and H-reflex peak-to-peak amplitudes before, during, and up to 3 min postintervention. M-wave and H-reflex measures were highly reliable. RM resulted in significant decreases in soleus H-reflex amplitudes. High-intensity, moderate-intensity, and sham conditions decreased soleus H-reflex amplitudes by 58%, 43%, and 19%, respectively. H-reflexes induced with high-intensity rolling discomfort or pain were significantly lower than moderate and sham conditions. The effects were transient in nature, with an immediate return to baseline following RM. This is the first evidence of RM-induced modulation of spinal excitability. The intensity-dependent response observed indicates that rolling pressure or pain perception may play a role in modulation of the inhibition. Roller massage-induced neural modulation of spinal excitability may explain previously reported increases in ROM and PPT.

NEW & NOTEWORTHY Recent evidence indicates that the benefits of foam rolling and roller massage are primarily accrued through neural mechanisms. The present study attempts to determine the neuromuscular response to roller massage interventions. We provide strong evidence of roller massage-induced neural modulation of spinal excitability to the soleus. It is plausible that reflex inhibition may explain subsequent increases in pain pressure threshold.

An acute session of roller massage prolongs voluntary torque development and diminishes evoked pain

INTRODUCTION

Roller massage (RM) has been reported to reduce pain associated with exercise-induced muscle soreness and increase range of motion without force or activation impairments. The objective was to examine RM effects on evoked pain and contractile properties.

METHODS

Twelve men received three sets of 30-s RM at a perceived discomfort level of 7/10 on a visual analogue scale on the ipsilateral (IPSI-R) stimulated plantar flexors (PF), contralateral PF (CONTRA-R), Sham (light rolling on stimulated PF), or Control. At pre-test, post-test, and 5-min post-test, they received evoked maximal twitch, tetanus, and 70% maximal tetanic stimulation, and performed a maximal voluntary isometric contraction (MVIC). Data analysis included perceived pain and contractile properties.

RESULTS

The 70% tetanus illustrated significant 9-10% increases in pain perception with Sham and Control at post- and 5-min post-test, respectively (p < 0.01). There was no pain augmentation with IPSI-R and CONTRA-R. There were no main effects or interactions for most contractile properties. However, MVIC force developed in the first 200 ms showed 9.5% (p = 0.1) and 19.1% (p = 0.03) decreases with IPSI-R at post-test and 5-min post-test.

CONCLUSION

Data suggest that RM-induced neural inhibition decreased MVIC F200 and nullified the testing-induced increase in evoked pain associated with 70% tetanic stimulation.

Myofascial Pain Syndrome in the Elderly and Self-Exercise: A Single-Blind, Randomized, Controlled Trial

OBJECTIVE

This study aimed to demonstrate the effect of self-exercise with a therapeutic inflatable ball (SEIB) in elderly patients with myofascial pain syndrome.

DESIGN

Single-blind, randomized, controlled noninferiority trial.

SETTING

University campus.

PARTICIPANTS

Forty elderly patients with myofascial pain syndrome completed the study. They were randomly allocated to SEIB (n = 22; mean age, 70.23 ± 6.11 years) or ultrasound (US) therapy (n = 18; mean age, 67.99 ± 5.64 years).

INTERVENTION

SEIB and US therapy (twice weekly for 4 consecutive weeks).

OUTCOME MEASURES

Visual analog scale (VAS), pressure pain threshold (PPT), and cervical lateral flexion (CLF) were measured at baseline and at 1, 2, 3, and 4 weeks.

RESULTS

The noninferiority test indicated that SEIB was not inferior to US for VAS, PPT, and CLF. Between-group comparisons showed no significant differences in the VAS (F = 2.579; p = 0.117), the PPT (F = 0.245; p = 0.624), and the CLF (F = 2.072; p = 0.159). In within-group comparisons, both groups presented significant differences in VAS (SEIB after 1 week and US after 1 week), PPT (SEIB after 3 weeks and US after 4 weeks), and CLF (SEIB after 4 weeks and US after 4 weeks) compared with baseline values.

CONCLUSIONS

SEIB for 4 weeks has an effect similar to that of US for desensitizing myofascial pain and increasing joint flexibility. High accessibility and low cost would make SEIB a practical self-treatment method in elderly patients with myofascial pain syndrome.

Pain pressure threshold of a muscle tender spot increases following local and non-local rolling massage

Background

The aim of the present study was to determine the acute effect of rolling massage on pressure pain threshold (PPT) in individuals with tender spots in their plantar flexor muscles.

Methods

In a randomized control trial and single blinded study, tender spots were identified in 150 participants’ plantar flexor muscles (gastrocnemius or soleus). Then participants were randomly assigned to one of five intervention groups (n = 30): 1) heavy rolling massage on the calf that exhibited the higher tenderness (Ipsi-R), 2) heavy rolling massage on the contralateral calf (Contra-R), 3) light stroking of the skin with roller massager on the calf that exhibited the higher tenderness (Sham), 4) manual massage on the calf that exhibited the higher tenderness (Ipsi-M) and 5) no intervention (Control). PPT was measured at 30 s and up to 15 min post-intervention via a pressure algometer.

Results

At 30 s post-intervention, the Ipsi-R (24 %) and Contra-R (21 %) demonstrated higher (p < 0.03) PPT values compared with Control and Sham. During 15 min post-intervention, PPT was higher (p < 0.05) following Ipsi-R (19.2 %), Contra-R (15.9 %) and Ipsi-M (10.9 %) compared with Control. There was no difference between the effects of three deep tissue massages (Ipsi-R, Ipsi-M and Contra-R) on PPT.

Discussion

Whereas the increased PPT following ipsilateral massage (Ipsi-R and Ipsi-M) might be attributed to the release of fibrous adhesions; the non-localized effect of rolling massage on the contralateral limb suggests that other mechanisms such as a central pain-modulatory system play a role in mediation of perceived pain following brief tissue massage.

Conclusion

Overall, rolling massage over a tender spot reduces pain perception.

Trial registration

ClinicalTrials.gov (NCT02528812), August 19^th, 2015.