Introduction to Delayed Onset Muscle Soreness

Recently in clinic I noticed I am treating more clients who are starting to increase the distance they are running ahead of a half or full marathon.  What [...]

I said in a previous post that scientists are interested in finding out how massage works.  So if we accept that massage reduces muscle pain, that leaves the question, "How does massage reduce muscle pain?". In 1965, Ronald Melzack and Patrick Wall outlined a scientific theory about psychological influence on pain perception; the ‘gate control theory’.  According to the gate control theory, pain signals are not free to reach the brain as soon as they are generated at the injured tissues or sites. They need to encounter certain ‘neurological gates’ at the spinal cord level and these gates determine whether the pain signals should reach the brain or not. In other words, pain is perceived when the gate gives way to the pain signals and it is less intense or not at all perceived when the gate closes for the signals to pass through. Cutaneous mechano-receptors are stimulated by touch (massage) and transmit information within large never fibres to the spinal cord.  These impulses block the passage of painful stimuli entering the same spinal segment along small, slowly conducting neurons. This theory gives the explanation for why someone finds relief by rubbing or massaging an injured or a painful area. For example, the pain gate theory explains "how"  a child feels better after mum or dad intuitively rub their knee when they have fallen over. In summary massage produces short term pain relief by being a particularly effective trigger for the pain gate process. References Melzack R, & Wall PD (1965). Pain mechanisms: a new theory. Science (New York, N.Y.), 150 (3699), 971-9  Moayedi M, & Davis KD (2013). Theories of pain: from specificity to gate control. Journal of neurophysiology, 109 (1), 5-12 Jacobs M. (1960) Massage for the relief of pain: anatomical and physiological considerations.  Physical Therapy Review, 40: 93-8 Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965 Nov 19;150(3699):971–979. Wells PE, Frampton V, Bowsher D. (1988) Pain: Management and Control in Physiotherapy.  Heinemann Medical.  Chapter 13. Watson J. (1982) Pain mechanisms: a review.  1. Characteristics of the peripheral receptors.  Australian Journal of Physiotherapy.  27:135-43

Many clients come to our clinics a few days after vigorous work outs or competing in sporting competition because their legs feel tried or heavy.  These clients often book a sports massage, but is their any scientific evidence to explain what is happening in the body during the treatment? Massage dilates superficial blood vessels and increases the rate of blood flow.  In addition if a deeper pressure is used like in sports or deep tissue massage on a healthy adult it improves the venous return.  Both of these changes to the blood flow represent a potent means to accelerate healing.  For example, it suggests that massage should improve the performance of fatigued muscles.  In addition, Goats asserts that massaged muscle fibres display less spasm, an increased force of contraction and enhanced endurance compared with muscles simply rested.  Which suggests that massage will assist in the improvement of sporting performance where it has been compromised. References Scull CD (1945) Massage - Physiologic Basis.  Archive of Physical Medicine 26: 159-67 Wilkins RW, Halperin MH, Litter J. (1950)  The effects of various physical procedures on circulation in human limbs.  Ann Intern Med 33: 1232-45 Goats GC (1994) Massage - the scientific basis of an ancient art: part 2.  Physiological and therapeutic effects Br J Sp Med 28(3)