If there were one sport you had to pick to test what recovery techniques work, what sport would it be? Ironman Triathlon of course! Researchers from Brazil (1) recruited 74 Ironman Brazil athletes who presented to the physiotherapy clinic complaining of anterior thigh (quadriceps) soreness immediately following the event.
Thirty-seven (37) athletes were randomised to the massage group; the other 37 were the controls. The massage group received 7 minutes of Swedish style massage to the quadriceps, whilst people in the control group just rested in a sitting position for 7 minutes.
Two outcome measures were used to gauge any effectiveness of the massage therapy:
- Pain and Perceived Fatigue – athletes were asked to rate their pain and fatigue on a visual analogue scale (VAS).
- Pain Pressure Threshold – a digital pressure algometer was used to apply pressure on three sites on the anterior thigh. Participants had to tell the researchers when the increasing pressure of the algometer changed from a “pressure” to “pain” with the highest pressure reading being recorded as their pain threshold.
Measurements were taken before and after intervention (or control) and the assessors were blinded to whether the athletes had received massage or not. Only one participant was lost in the study due to nausea.
The results showed a statistically significant difference between groups for pain and perceived fatigue – put another way, the massage group felt less discomfort and fatigue after the seven-minute massage. There were no differences between the groups for pain pressure threshold.
This research raises some interesting issues. The first issue for me is that (only) a seven-minute massage resulted in a modest but notable improvement in pain and perceived fatigue (7mm and 15mm respectively on a 0-100mm VAS). Would a longer massage session result in a greater magnitude of effect/benefit? Obviously the current study can’t answer the question, but it would be nice to know at what point in time the effect/benefit tapers off or reverses – 10, 15, 20 minutes?
The second issue, and probably the most interesting is that the massage group improved with perceived pain and fatigue, but not pressure pain threshold. There’s a bunch of different theories and studies on how massage ‘works’ in the recovery process with psychological, physiological, and neurological responses being postulated.
The current study suggests that a neurological response (gate control theory – where massage stimulates the neural input back to the central nervous system supressing the original pain) can’t explain the perceived reduction in pain. If it did, pressure pain and perceived pain should both improve.
A physiological response such as endorphin release and/or removal of ‘waste’ (catabolic) molecules could be an explanation, as could be a psychological response (personal touch and attention resulting in a sense of relaxation and well being).
It’s an interesting study, however the (very) short follow up on the participants is a major limitation. Whilst for most triathletes their next Ironman is going to be months away, people who play ‘tournament’ sports like tennis, football, or basketball – optimising a quick recovery is super important. It would have been nice to see whether the massage group maintained their better pain and fatigue perception over a few days or more.
The study on the effectiveness of massage therapy on recovery following an Ironman Triathlon adds to a building body of evidence that massage in an important component of optimising athletic performance.
- Nunes, Guilherme S., et al. "Massage therapy decreases pain and perceived fatigue after long-distance Ironman triathlon: a randomised trial." Journal of physiotherapy 62.2 (2016): 83-87.
- Weerapong, Pornratshanee, Patria A. Hume, and Gregory S. Kolt. "The mechanisms of massage and effects on performance, muscle recovery and injury prevention." Sports medicine 35.3 (2005): 235-256.
- Best, Thomas M., et al. "Effectiveness of sports massage for recovery of skeletal muscle from strenuous exercise." Clinical Journal of Sport Medicine 18.5 (2008): 446-460.
- Bervoets, Diederik C., et al. "Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review." Journal of physiotherapy 61.3 (2015): 106-116.