Comparison of Passive Stretching Versus Massage on Preventing the Symptoms of Delayed Onset Muscle S

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Comparison of Passive Stretching Versus Massage on Preventing the Symptoms of Delayed Onset Muscle Soreness in Normal Adults.

Mr. Ruth Magedelin. R Mr. Saravana Hariganesh. M

OBJECTIVE: To compare the effectiveness of passive stretching versus massage on preventing the symptoms of delayed onset muscle soreness in normal adults.

STUDY DESIGN: Quasi- Experimental study design.

SUBJECTS: 50subjects, with the age group of 18-21 years of both the genders were selected. INTERVENTION: Subjects were randomly divided into 2 groups (Group A& Group B), 25 subjects in Group A received passive stretching and 25 subjects in Group B received Massage after 3 hours of inducing DOMS. OUTCOME MEASURE: Pain, Elbow Range of Motion and swelling were assessed by Visual analogue scale, goniometer, Inch tape.

RESULTS: Statistical analysis was done by using independent ‘t’ test and paired ‘t’ test which showed there is no statistical significant difference between Group A(Passive stretching) and Group B(Massage).

CONCLUSION: The result of this study concludes that massage decreased the pain immediately after intervention and regained the Elbow Range of Motion at immediately at 24 hours, at 48 hours and 72 hours than passive stretching. But massage and passive stretching has equal effect on pain reduction at 24hours, 48 hours and 72 hours after intervention. Similarly they both have equal effect on Arm Circumference.

KEY WORDS: Delayed onset muscle soreness, Eccentric exercise, Elbow flexors, Muscle strength, Elbow Range of motion, Passive stretching, Massage.

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Delayed onset of muscle soreness (DOMS), is defined as the sensation of discomfort or pain in the skeletal muscle following physical activity, usually eccentric, to which an individual is not accustomed or any individual engaging in a new physical activity, or those that have suddenly increase exercise volume and in intensity, has likely experience Delayed onset of muscle soreness 1.

Delayed onset muscle soreness(DOMS) is a predictable painful condition which often occurs after unaccustomed eccentric exercise. It is begins to develop approximately 12 to 24 hours after the cessation of exercise. Although the time course varies, the signs and symptoms, which can last up to 10 to 14 days, gradually dissipate 2.Almost every individual unaccustomed to exercise who begins a resistance training program, particularly a program that includes eccentric exercise experience, muscle soreness.

Delayed onset muscle soreness is caused by inflammation of the damaged muscle or connective tissue and efflux of substances from the damaged tissue to the extra cellular space that sensitize the free nerve endings. Delayed onset muscle soreness is thought to be the result of activation of group IV receptor, which are responsible for the transmission of dull aching pain signals. These receptors can respond to pressure and shear stress and chemical substance, such as bradykinin, serotonin, and histamine, that accumulate in the interstitium. The responses of group IV receptors to any one stimulus may be sensitized and potentiated if the chemical environment of the interstitium is altered. This is a possible mechanism for development of Delayed onset of muscle soreness after eccentric exercise.4 Exercise-induced muscle soreness falls into two categories: Acute and delayed onset.Acute muscle soreness develops during or after strenuous exercise performed to the point of muscle exhaustion. This response occurs as a muscle becomes fatigue during acute exercise because of the lack of adequate blood flow and oxygen (ischemic) and a temporary buildup of metabolites, such as lactic acid and potassium, in the exercise muscle. The sensation is characterized as a feeling of burning or aching in the muscle2.

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International e-Journal For Medical And Research-2017 The incidence of Delayed onset of muscle soreness is difficult to calculate, because most people who experience it do not seek medical attention, instead accepting Delayed onset of muscle soreness as temporary discomfort. Every healthy adult most likely has developed Delayed onset of muscle soreness on countless occasions, with the condition occurring regardless of the person’s general fitness level. However, although it is experienced widely, there are still controversies regarding the prevention and treatment of Delayed onset of muscle soreness is also questionable2.

It is commonly held a opinion in clinical and fitness settings that the initial onset of Delayed onset of muscle soreness can be prevented or at least kept to a minimum by progressing intensity and volume of exercise gradually, by performing low- intensity warm-up and cool-down activities, or by gentle stretching the exercised muscle before and after strenuous exercise2.Although these techniques are regularly advocated and employed, little to no evidence in the literature supports their efficacy in the prevention of Delayed onset of muscle soreness.E Ernst state that ‟ An effective treatment has been sought out for many years . Among the treatments triedare Tens, ultrasound, stretching etc,. To date, none of these approaches has been fully convincing”3.Massage is widely used as a therapeutic modality for recovery from musclefatigue and injury and is the probably one of the most popular treatment after unaccustomed activity.

A number of authors have examined the effects of massage on Delayed onset of muscle soreness and indirect markers of muscle damage such as impairment of muscle function, swelling, and changes in muscle protein in the blood4.

This study is to compare the effectiveness of passive stretching and manual massage on preventing the symptoms of delayed onset of muscle soreness.

Aim of the Study  To find the effectiveness of passive stretching in reducing the symptoms of delayed onset muscle soreness in normal adults.  To find the effectiveness of massage in reducing the symptoms of delayed onset muscle soreness in normal adults.  To compare the effectiveness of passive stretching versus massage in reducing the symptoms of delayed onset muscle soreness in normal adults.

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International e-Journal For Medical And Research-2017 Delayed onset muscle soreness is a frequent problem after unaccustomed exercise. No universally accepted treatment exists. Passive Stretching and massage therapy is often recommended for this condition but uncertainly exists about their effectiveness.

Generally passive stretching is considered to be effective but reviews are not supporting this. This study is intended to find whether passive stretching or massage reduces the symptoms of delayed onset of muscle soreness in normal adults after their unaccustomed activities like sports meet in college. Therefore the need of the study is to find which technique (passive stretching or massage) have quick recovery, reduces the symptom of soreness, decrease days of impairment& decrease the rehabilitation time.

METHODOLOGY Study Design: Experimental design. Study Type: Comparative study. Sample Size: 50 students. Sampling Method: Random sampling. Study Duration: 3 Days (72hrs) per subject. Study Setting: SRM College of Physiotherapy SRM University, Kattankulathur.

Inclusion Criteria: Both male and female, 18-21 years of age & who are willing to participate in the study Exclusion Criteria: Subjects with recent fracture of upper extremity, Subjects with musculoskeletal problem in shoulder or elbow joint or wrist joint, subjects with any congenital deformity or contracture in upper extremity, regular Sports persons, subject who are regular to gym& subjects under any resisted exercise program PROCEDURE From subjects written informed consent is obtained and those who satisfied the inclusion and exclusion criteria were selected randomly and divided into two groups (Group A& Group B) with 25 participants in each groups. The individuals in both the Groups(A&B) were made to do eccentric contraction of biceps brachi muscle of non dominant hand to induce soreness using dumbbells. After 3hours of eccentric contraction of biceps brachii both the interventions Passive Stretching and Massage was applied on subjects of respective groups on non dominant arm to prevent the symptoms of delayed onset muscle soreness. Before the intervention, immediately after the intervention, in 24

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International e-Journal For Medical And Research-2017 hours, in 48 hours and in 72 hours readings were taken for pain, Range of motion, swelling

were assessed by Visual analogue scale, inch tape by measuring Arm

circumference and Range of motion by goniometer. And these readings were noted and used for statistical purpose.

To induce delayed onset muscle soreness in biceps brachii subjects are instructed to do 10 sets of 6 maximal voluntary eccentric contractions of elbow flexors on the non dominant side in standing position with the help of the dumbbells Subjects tried with different dumbbells and10 RM decided, this considered as the weight of the dumbbells GROUP A INTERVENTION After 3hrs4 of inducing delayed onset muscle soreness Group A subjects received passive stretching of non dominant biceps brachii muscle. Passive Stretching were held for 30 sec of 5 sets.

GROUP B INTERVENTION After 3hrs4 of inducing delayed onset muscle soreness group B subjects received massage to non dominant biceps brachii muscle. Subjects were instructed to wear minimal clothing for the appropriate arm in supine lying position. Pillow was placed along the side of trunk so that they can rest on it in a degree of slight abduction and flexion of shoulder. Powder used as a lubricant the10-minute massage given massage techniques consisted of stroking, effleurage, petrissage(kneading), friction, hacking, picking up and repeated effleurage of elbow to shoulder.4 ASSESSMENT PROCEDURE Symptoms of delayed onset muscle soreness assessed by Visual Analogue Scale (Vas) Goniometeric Measurements& Upper Arm Circumference Outcome measures were assessed before the intervention, immediately after the intervention, 24 hrs after the intervention, 48 hrs after the intervention, 72 hrs after the intervention from both the groups.

Table: 1 Comparison of VAS score pre and post test in Group A and Group B

Mean

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GROUP A Paired t SD test

P Value

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Mean

GROUP B Paired t SD test

P Value

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International e-Journal For Medical And Research-2017 PRE TEST

4.80

1.354

POST TEST 1

3.44

1.325

PRE TEST

4.80

1.354

POST TSET 2

0.08

0.400

PRE TEST

4.80

1.354

POST TEST 3

0.00

0.000

PRE TEST

4.80

1.354

POST TEST 4

0.00

0.000



5.283

0.000

4.36

1.287

***

2.40

1.871

0.000

4.36

1.287

***

0.00

0.000

0.000

4.36

1.287

.00

00.000

4.36

1.287

0.00

0.000

18.504

17.725

4.599

*** 16.937

0.000 ***

0.000 ***

16.937

*** 17.725

0.000

0.000 ***

16.937

0.000 ***

PRE TEST = Before the intervention, POST TEST1= Immediately after the intervention, POST TEST 2= 24 hrs after the intervention, POST TEST 3=48 hrs after the intervention, POST TEST 4= 72 hrs after the intervention.

Table 2: Comparison of Arm circumference pre and post test in Group-A & Group B GROUP A

Mean

SD

Pair t Test

PRE

0.16400

0.18000

GROUP B

4.556

P

Mean

SD

value

Pair t Test

0.000

0.180

0.076

11.784

TEST-

P value 0.000 ***

POST

***

TEST 1 PRE

0.30000

0.18708

8.018

0.000

0.380

0.132

14.363

TEST–

0.000 ***

POST

***

TEST 2 PRE

0.30000

0.18708

8.018

0.000

0.404

0.203

9.948

TEST-

0.000 ***

POST

***

TEST 3 PRE

0.30000

0.18708

8.018

0.000

TEST–

0.404

0.203

9.948

0.000 ***

POST

***

TEST 4 

*** - There is a statistical significance difference between Pre and Post test in the Arm Circumference for Group A & Group B at 95% [P < 0.05] PRE TEST = Before the intervention, POST TEST1= Immediately

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International e-Journal For Medical And Research-2017 after the intervention, POST TEST 2= 24 hrs after the intervention, POST TEST 3=48 hrs after the intervention, POST TEST 4= 72 hrs after the intervention.

Table 3: Comparison of Elbow Range of Motion pre and post test in Group A & Group B GROUP A

Mean

SD

Pair t Test

PRETEST-

2.120

0.526

GROUP B

20.152

P

Mean

SD

value 0.000

Pair t Test

1.44000

1.15758

6.220

POSTTEST1

P value 0.000 ***

*** PRETEST–

4.440

1.003

22.126

0.000

3.24000

2.60256

6.225

POSTTEST2

0.000 ***

*** PRE TEST-

4.440

1.003

22.126

0.000

3.24000

2.60256

6.225

POSTTEST3

0.000 ***

*** PRE TEST–

4.440

1.003

22.126

0.000

POSTTEST4

3.24000

2.60256

6.225

0.000 ***

*** *** - There is a statistical significance difference between Pre and Post test in the Range of motion for Group A & Group B at 95% [P < 0.05] PRE TEST = Before the intervention, POST TEST1= Immediately after the intervention, POST TEST 2= 24 hrs after the intervention, POST TEST 3=48 hrs after the intervention, POST TEST 4= 72 hrs after the intervention.

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International e-Journal For Medical And Research-2017 Table 4: Comparison of VAS score between Group A and Group B. POST TEST1 POST TEST2 POST TEST3 POST TEST4

Groups

Mean

SD

Independent t Test

P Value

Group A

3.44

1.325

2.268

0.028

Group B

2.40

1.871

Group A

0.08

0.400

Group B

0.00

0.000

Group A

0.00

0.000

Group B

0.00

0.000

Group A

0.00

0.000

Group B

0.00

0.000

*** 1.000

0.322 NS

0.343

0.733 NS

0.343

0.733 NS

*** - There is statistical significance difference between Group A and Group B at 95%[P˂0.05]NS - Not statistical significance difference between Group A and Group B at 95%[P˂0.05] PRE TEST = Before the intervention, POST TEST1= Immediately after the intervention, POST TEST 2= 24 hrs after the intervention, POST TEST 3=48 hrs after the intervention, POST TEST 4= 72 hrs after the intervention.

Table 5: Comparison of Arm circumference between Group A and Group B. GROUPS

Mean

SD

Independent

P value

t Test POST TEST 1

Group A

25.8000

2.45085

0.325

0.746 NS

Group B

26.0120

2.14599

0.325

0.746 NS

POST TEST 2

Group A

25.6640

2.45015

0.225

0.823 NS

Group B

25.8120

2.18390

0.225

0.823 NS

POST TEST 3

Group A

25.6640

2.45015

0.188

0.852 NS

Group B

25.7880

2.20857

0.188

0.852 NS

POST TEST 4

Group A

25.6640

2.45015

0.188

0.852 NS

Group B

25.7880

2.20857

0.188

0.852 NS

NS - Not Statistical significant between Group A and Group B at 95%[P˃0.05] PRE TEST = Before the intervention, POST TEST1= Immediately after the intervention, POST TEST 2= 24 hrs after the intervention, POST TEST 3=48 hrs after the intervention, POST TEST 4= 72 hrs after the intervention.

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International e-Journal For Medical And Research-2017 Table 6: Comparison of Range of motion between Group A and Group B GROUPS

Mean

SD

Independent

P value

t Test POST TEST 1

Group A

136.3200

5.91411

2.076

0.043 ***

Group B

132.9600

5.52630

2.076

0.043 ***

POST TEST 2

Group A

138.6400

6.01997

2.289

0.027 ***

Group B

134.7600

5.96713

2.289

0.027 ***

POST TEST 3

Group A

138.6400

6.01997

2.289

0.027 ***

Group B

134.7600

5.96713

2.289

0.027 ***

POST TEST 4

Group A

138.6400

6.01997

2.289

0.027 ***

Group B

134.7600

5.96713

2.289

0.027 ***

*** - There is statistical significant between Group A and Group B at 95%[P˂0.05] PRE TEST = Before the intervention, POST TEST1= Immediately after the intervention, POST TEST 2= 24 hrs after the intervention, POST TEST 3=48 hrs after the intervention, POST TEST 4= 72 hrs after the intervention.

RESULTS Comparison of VAS score pre and post test in Group A (passive stretching) &Group B (massage) shows there is a significant difference between pre and post test at immediately after the intervention, 24,48 and 72 hours at 95%[p˂0.05].

Comparing the pre and post test of arm circumference in Group A(passive stretching)& Group B (massage) there is a significant difference between pre and post test at immediately after the intervention, 24,48 and 72 hours at 95%[p˂0.05].

Comparing the pre and post test of elbow range of motion in Group A (passive stretching) & Group B (massage) shows there is a significant difference between pre and post test at immediately after the intervention, 24,48 and 72 hours at 95%[p˂0.05].

Comparison of VAS score between Group A and Group B shows there is statistical significant difference exist in post test1 of Visual analogue scale score between Group

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International e-Journal For Medical And Research-2017 A(passive stretching) and Group B(massage) at 95%[P˂0.05]. There no statistical significant difference exist in post test2, post test3, post test4 at 95% [p˃0.05].

Comparison of Arm circumference between Group A and Group B shows there is no statistical significant difference exist in post test of Arm circumference between Group A(passive stretching) and Group B(massage) at 95% [P˃0.05].

Comparison of Elbow Range of Motion between Group A and Group B shows there is statistical significant difference exist in post test of Elbow Range of motion between Group A(passive stretching) and Group B(massage) at 95%[P˂0.05].

DISCUSSION Delayed onset muscle soreness is a symptom of eccentric exercise induced muscle damage and occurs 8-12 hours post exercise, when the affected muscle contracts or stretches; it peak at 2 to 3days and slowly dissipate by 8-10 days.

On comparing pre and post test of VAS score in passive stretching group P value of post test is P˂0.05 hence there is a statistical significant difference between pre and post test, this implies that passive stretching group has effect on reducing the pain. Similarly pre and post test of VAS score of massage group shows reduction of pain.

On comparing pre and post test of Arm Circumference measurement in passive stretching group P value of post test is P˂0.05 hence there is a statistical significant difference between pre and post test, proves passive stretching group has effect in reducing the swelling . Same way on Group B too shows statistical difference between pre and post values of arm circumference which implies massage has an effect on reducing swelling due to induced DOMS. On comparing pre and post test of Elbow range of motion in both the groups each group shows statistically significance difference between pre and post test, implies both the interventions has effect on increasing in Range of Motion.

On comparing the VAS score between passive stretching group and massage group P value is ˃ 0.05 hence there is no statistical significance difference in 24hours(post test 2), 48hours(post test 3), 72hours(post test 4), but P value of post test 1 is ˂0.05 hence there is a significant difference immediately after the intervention. This proves massage IDL - International Digital Library

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International e-Journal For Medical And Research-2017 is effective than passive stretching on preventing the symptoms of delayed onset muscle soreness.

On comparing the Arm Circumference measures between passive stretching group and massage group P value of post test is PË&#x192;0.05 hence there is no statistical significance immediately after the intervention(post test 1), 24hours(post test 2), 48 hours(post test 3), 72hours (post test 4). This means the effects are same on comparing passive stretching group and massage group.

On comparing the Elbow Range of Motion measures between passive stretching group and massage group P value of post test are Ë&#x201A;0.05 hence there is a statistical significant difference between passive stretching group and massage group.

All the reviews except Weber et al reported that massage had positive effects on Delayed onset of muscle soreness, this study also found that massage intervention reduces pain and improve in Range of Motion when compared to the passive stretching group and indicate passive stretching could not prevent soreness as it is suggested in reviews.

Delayed onset of muscle

26

It is difficult to explain how massage reduces Delayed onset of muscle soreness, because no authors yet described the effects of massage on cellular events or patho physiologic changes in the muscle or connective tissue after eccentric exercise. Increasing blood flow appears to be a major consequence of massage. 17 Increasing in blood and lymph flow may enhance removal of pain substrates that starts to accumulate in the injured area, reducing swelling. In this study it has been found that there is reduction of pain and increase in Range of Motion in massage group when compared with passive stretching Group as it is discussed in above paragraphs.

CONCLUSION The result of this study Conclude that Massage decreased the pain and increased the Range of Motion but did not reduce swelling , thereby massage is effective than passive stretching on preventing symptoms of delayed onset of muscle soreness.

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International e-Journal For Medical And Research-2017 Limitations of the study are only young age group has taken & less number of subjects involved. In future studies isokinetic dynamometer can be used for inducing Delayed onset of muscle soreness& Cryotherapy can be included in the study to compare the effects.

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