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Zainal Zainuddin, MS, contributed to conception and design; acquisition and analysis and interpretation of the data; and
drafting, critical revision, and final approval of the article. Mike Newton, MS, contributed to conception and design and critical
revision and final approval of the article. Paul Sacco, PhD, contributed to conception and design; analysis and interpretation of
the data; and critical revision and final approval of the article. Kazunori Nosaka, PhD, contributed to conception and design;
acquisition and analysis and interpretation of the data; and drafting, critical revision, and final approval of the article.
Address correspondence to Kazunori Nosaka, PhD, School of Exercise, Biomedical and Health Sciences, Faculty of
Computing, Health and Science, Edith Cowan University, 100 Joondalup Drive, Joondalup, Western Australia 6027, Australia.
Address e-mail to k.nosaka@ecu.edu.au.
Context: Delayed-onset muscle soreness (DOMS) describes Intervention(s): Subjects performed 10 sets of 6 maximal
muscle pain and tenderness that typically develop several isokinetic (908·s21) eccentric actions of the elbow flexors with
hours postexercise and consist of predominantly eccentric mus- each arm on a dynamometer, separated by 2 weeks. One arm
cle actions, especially if the exercise is unfamiliar. Although received 10 minutes of massage 3 hours after eccentric exer-
DOMS is likely a symptom of eccentric-exercise–induced mus- cise; the contralateral arm received no treatment.
cle damage, it does not necessarily reflect muscle damage. Main Outcome Measure(s): Maximal voluntary isometric
Some prophylactic or therapeutic modalities may be effective and isokinetic elbow flexor strength, range of motion, upper arm
only for alleviating DOMS, whereas others may enhance re- circumference, plasma creatine kinase activity, and muscle
covery of muscle function without affecting DOMS. soreness.
Objective: To test the hypothesis that massage applied after Results: Delayed-onset muscle soreness was significantly
eccentric exercise would effectively alleviate DOMS without af- less for the massage condition for peak soreness in extending
fecting muscle function. the elbow joint and palpating the brachioradialis muscle (P ,
Design: We used an arm-to-arm comparison model with 2 .05). Soreness while flexing the elbow joint (P 5 .07) and pal-
independent variables (control and massage) and 6 dependent pating the brachialis muscle (P 5 .06) was also less with mas-
variables (maximal isometric and isokinetic voluntary strength, sage. Massage treatment had significant effects on plasma cre-
range of motion, upper arm circumference, plasma creatine ki- atine kinase activity, with a significantly lower peak value at 4
nase activity, and muscle soreness). A 2-way repeated-mea- days postexercise (P , .05), and upper arm circumference,
sures analysis of variance and paired t tests were used to ex- with a significantly smaller increase than the control at 3 and 4
amine differences in changes of the dependent variable over days postexercise (P , .05). However, no significant effects of
time (before, immediately and 30 minutes after exercise, and massage on recovery of muscle strength and ROM were evi-
1, 2, 3, 4, 7, 10, and 14 days postexercise) between control dent.
and massage conditions. Conclusions: Massage was effective in alleviating DOMS by
Setting: University laboratory. approximately 30% and reducing swelling, but it had no effects
Patients or Other Participants: Ten healthy subjects (5 men on muscle function.
and 5 women) with no history of upper arm injury and no ex- Key Words: elbow flexors, muscle strength, range of motion,
perience in resistance training. creatine kinase
E
xercise consisting of predominantly eccentric muscle in other indicators of muscle damage.5,6 In this context, it is
actions has the potential to cause greater injury to mus- necessary to separate DOMS from other symptoms of eccen-
cles than that involving largely isometric or concentric tric-exercise–induced muscle damage, especially when inves-
actions, especially if the exercise is unfamiliar.1–3 Muscle pain tigating prophylactic or therapeutic modalities. It may be that
and tenderness generally develop 24 hours after such exercise some interventions are effective only for alleviating DOMS,
and are usually described as delayed-onset muscle soreness but others enhance recovery of muscle function without af-
(DOMS).2,4,5 Undoubtedly, DOMS is one of the symptoms of fecting DOMS. Thus, when a treatment is found to alleviate
eccentric-exercise–induced muscle damage; however, DOMS DOMS without any effects on recovery of muscle function,
does not necessarily indicate muscle damage.5 The level of the treatment is still effective if DOMS is the main concern.
DOMS does not reflect the extent of muscle damage, and the A number of prophylactic or therapeutic measures have
course of DOMS does not correspond to the course of changes been examined for their efficacy in preventing or reducing
Table 1. Changes in Peak Isokinetic Torque Before, Immediately After, and 1 to 14 Days After Exercise for the Control and Massage
Conditions (N 5 10)
Mean (SEM) Peak Isokinetic Torque, Nm
Days After Exercise
Torque and
Condition Pre-exercise Postexercise 1 2 3 4 7 10 14
21
308·s
Control 25.8 (4.8) 17.3 (3.2) 14.8 (2.8) 16.0 (2.5) 19.0 (3.9) 20.2 (4.2) 21.6 (4.1) 22.2 (4.1) 23.3 (4.5)
Massage 25.6 (4.4) 17.7 (2.9) 18.9 (4.4) 19.5 (3.9) 21.0 (4.5) 23.0 (4.3) 23.1 (3.9) 25.7 (4.2) 25.4 (4.7)
3008·s21
Control 19.8 (4.2) 14.8 (3.8) 14.5 (2.9) 15.0 (3.4) 14.2 (3.2) 14.8 (3.3) 16.2 (3.6) 19.2 (3.5) 18.1 (3.7)
Massage 19.3 (4.2) 13.2 (3.2) 13.9 (3.9) 15.2 (3.7) 17.2 (3.7) 16.7 (3.9) 17.0 (4.1) 19.4 (4.1) 18.3 (3.6)
DISCUSSION
We investigated the effects of a 10-minute massage per-
formed 3 hours after an eccentric exercise on DOMS and other
Figure 2. Changes in plasma creatine kinase (CK) activity before
(pre) and 1 to 14 days postexercise for the massage and control
indicators of eccentric-exercise–induced muscle damage. We
arms. * Indicates a significant difference between arms; #, a sig- used a self-report visual analog scale to quantify the magnitude
nificant difference from baseline. of muscle soreness for palpation, extension, and flexion of the
elbow flexors; this scale has been reported to be the most
satisfactory means of assessing pain sensation.19 Because the
Plasma CK Activity perception of pain is highly subjective and varies widely
No significant difference in plasma CK activity between among individuals, the use of soreness as a quantifier of mus-
arms was evident before exercise (P 5 .90). Plasma CK ac- cle injury is problematic.5 Yet it is the most widely experi-
tivity increased significantly postexercise for both conditions enced negative consequence of eccentric exercise, making it
(P 5 .01); however, significantly smaller CK increases oc- an important variable to consider. To minimize the confound-
curred for the massaged arm than for the control (P 5 .02) ing effects associated with difference in individual responses,
(Figure 2). The CK peak value for the massage condition (982 we used the arm-to-arm comparison model to compare mas-
6 356 IU·L21) was 36% lower than that for the control con- sage and control conditions.
dition (2704 6 637 IU·L21). The arm-to-arm comparison model is advantageous when
comparing 2 conditions in a relatively small number of sub-
jects; however, it may produce a carryover effect, especially
Muscle Soreness for the blood markers of muscle damage, if the time between
Muscle soreness developed after both exercise bouts. The the bouts is short. We avoided this potential problem by pro-
course of development of soreness differed, depending on the viding an adequate interval between the bouts based on pre-
type of measurement. Peak soreness for palpation of the bra- vious studies, which was more than 2 weeks.2,18 Yet a possible
chioradialis and brachialis and elbow joint flexion was report- placebo effect should also be considered, because it is difficult
ed 1 to 3 days postexercise, whereas peak soreness on elbow to eliminate a possible placebo effect in the arm-to-arm com-
joint extension occurred 4 days postexercise. All reports of parison model. Practically, people expect to have some effects
soreness resolved by 7 days postexercise. As shown in Table of massage when they receive it, and psychological effects
3, the highest peak soreness score was observed for extension, may always exist to some degree. We did not include a placebo
followed by palpation of the brachioradialis. Significant dif- treatment such as touching, because subjects might have no-
ferences between the massage and the control conditions were ticed a difference if they had received a placebo treatment for
found for peak soreness with palpation of the brachioradialis one arm and actual treatment for the other arm. However, sub-
and extending the elbow joint (P 5 .01 to .02), with peak jects were randomly grouped by test order (control-treatment
values for the other 2 soreness variables showing borderline or treatment-control), and dominant and nondominant arms
significance (P 5 .06 to .07). The massage resulted in a 20% were equally balanced over the 2 conditions. Moreover, the
to 40% decrease in the severity of soreness compared with no changes in muscle strength (see Table 1 and Figure 1), ROM,
treatment in the same individuals. and upper arm circumference (see Table 2) immediately post-