Original researchEvaluation of the effect of two massage techniques on hamstring muscle length in competitive female hockey players
Introduction
Massage dates back to early civilisation and has a long history of use in sports medicine (Hemmings, 2001, Stamford, 1985). Massage has been widely used in the prevention and management of injuries in sport, with recent recognition and acceptance in Olympic sport (Hemmings, 2001). A recent study found that massage accounted for a significant proportion (24–52.2%) of physiotherapists' treatment time at athletics events (Galloway & Watt, 2004), there is however, a paucity of evidence to support its efficacy and effectiveness.
Within the narrative literature there are frequent claims discussing the benefits of massage. Two of the benefits proposed are the relief of muscle tension (Stamford, 1985) and improved stretching of connective tissue (Samples, 1987). There are however, limited studies examining the physiological benefits of massage. Those available are difficult to evaluate and compare as they do not mention or define the pressure, time, speed and technique parameters for massage (Hilbert et al., 2003, Robertson et al., 2004, Tiidus and Shoemaker, 1995). A dynamic soft tissue mobilization (DSTM) model was developed with the aim of improving muscle length (Hopper, 1991). This model utilizes a combined technique of classic massage, followed by a dynamic component, where the limb is moved through its range. Determining a specific area of tightness, where the treatment is concentrated, precedes the dynamic component. In addition the DSTM model has standardized massage parameters for the most time effective clinical use. Currently there is no published evidence to support the effectiveness of this model.
Hamstring muscle injuries represent a significant proportion of lower limb injuries in athletes and are a major cause of time lost from sport (Ekstrand and Gillquist, 1983, Garrett et al., 1989, Hawkins et al., 2000). A reduction in muscle length has been proposed as a predisposing factor for developing hamstring muscle injury (Ekstrand and Gillquist, 1982, Hartig and Henderson, 1999, Kujala et al., 1997, Worrell, 1994, Worrell et al., 1991). A study of injury pattern among female field hockey players found that 38 out of 239 lower limb injuries were muscle strains (Murtaugh, 2001). Similarly Sherker and Cassell (2002) found muscle strains of the calf and hamstring accounted for 11% of all field hockey injuries. The decreased length of the hamstring muscles often seen in patients with disorders has been suggested to result from muscle and connective tissue shortening adaptation (Gajdosik, 1991). One of the roles of a physiotherapist is to address limitations in muscle length in order to minimize injury.
Objective measures assessing hamstring muscle length include the sit and reach test (Sincair & Tester, 1993), passive toe touch test (Brown et al., 1993, Orchard et al., 1997), the straight leg raise (SLR) test (Gajdosik & Lusin, 1983) and the knee extension (KE) test (Brown et al., 1993, Cameron and Bohannon, 1993, Gajdosik et al., 1993). A comparative study on the reliability of different indirect measures of hamstring length did not conclude any test to be superior to the others (Gajdosik et al., 1993). This study reported a significant relationship between passive SLR and active KE, and between passive SLR and passive KE. The passive SLR is a commonly used indirect test, which has shown good reliability (Hall, Cacho, McNee, Riches, & Walsh, 2001) and similarly has the KE test (Fredriksen et al., 1997, Gajdosik and Lusin, 1983). An advantage of the KE test is the minimal pelvic motion which occurs when compared to the SLR test (Gajdosik & Lusin, 1983).
The primary purpose of this study was to evaluate the effect of the DSTM model on hamstring muscle length in female field hockey players in comparison with a classic massage intervention. A secondary purpose was to compare the utility of the passive SLR (PSLR) and passive KE (PKE) tests for indirectly measuring hamstring length.
Section snippets
Subjects
Healthy female field hockey players were recruited from the Premier League Competition in Western Australia. Five clubs including 50 players agreed to participate in the study. All players completed a short questionnaire followed by a brief physical examination to determine suitability. Suitable players had hamstring tightness, defined as the onset of a stretching sensation on the posterior thigh at less than 70° SLR. In addition all players were able to achieve full range of knee extension and
Results
Baseline data indicates that the subjects in the two groups were comparable with respect to age, years played hockey and number of subjects with a previous hamstring injury (Table 1).
Hamstring length, assessed using both PSLR and PKE, was stable within (time p>0.36) and comparable between (group×time, p>0.38) groups during the control period.
Change in hamstring length measured using PSLR did not differ between the control and intervention periods in either group and there was no detectable
Discussion
Massage has a long tradition of use in sports medicine (Callaghan, 1993). Despite its continued popularity, the literature does not provide compelling evidence of its effectiveness in improving muscle length.
This study compared the effect of a defined classic massage technique and the DSTM model on hamstring length of competitive female athletes. The results demonstrated that both the DSTM and classic massage interventions resulted in immediate improvements in hamstring length in comparison to
References (32)
- et al.
Sports stretching: Effect of passive muscle stiffness of short hamstrings
Archives of Physical Medicine Rehabilitation
(1996) Physiological, psychological and performance effects of massage therapy in sport: A review of the literature
Physical Therapy in Sport
(2001)- et al.
Effect of massage of the hamstring group on performance of the sit and reach test
Physical Therapy in Sport
(2004) - et al.
Assessment of hamstring flexibility which test?
New Zealand Journal of Physiotherapy
(1993) The role of massage in the management of the athlete: A review
British Journal of Sports Medicine
(1993)- et al.
Relationship between active knee extension and active straight leg raise test
Journal of Sports Physical Therapy
(1993) - et al.
The frequency of muscle tightness and injuries in soccer players
American Journal of Sports Medicine
(1982) - et al.
The avoidability of soccer injuries
International Journal of Sports Medicine
(1983) - et al.
Passive knee extension test to measure hamstring muscle tightness
Scandinavian Journal of Medicine and Science in Sports
(1997) - et al.
Impact of prior exercise on hamstring flexibility: A comparison of proprioceptive neuromuscular facilitation and static stretching
Journal of Strength and Conditioning Research
(2003)
Effects of static stretching on the maximal length and resistance to passive stretch of short hamstring muscles
Journal of Orthopaedic and Sports Physical Therapy
Reliability on an active-knee-extension test
Physical Therapy
Comparison of four clinical tests for assessing hamstring muscle length
Journal of Sports Physical Therapy
Massage provision by physiotherapists at major athletics events between 1987 and 1998
British Journal of Sports Medicine
Computed tomography of hamstring muscle strains
Medicine and Science in Sports and Exercise
Effects of the Mulligan traction straight leg raise technique on range of movement
Journal of Manual and Manipulative Therapy
Cited by (35)
The effect of massage on acceleration and sprint performance in track & field athletes
2018, Complementary Therapies in Clinical PracticeCitation Excerpt :Neurological implications may also have potential benefits on athletic performance by increasing the intramuscular temperature and improving the speed of neuromuscular responses [9]. Recent studies on the effects of massage on performance have been directed towards assessing grip strength, flexibility, mood state, and delayed onset muscle soreness, which are all believed influenced by muscle tension and tissue adhesion [2,7,10–14]. To date, very few studies have directly investigated the effects of massage on acceleration and sprint performance in athletic population [8,15–17].
Massage and Soft Tissue Mobilization
2017, Orthopaedic Physical Therapy Secrets: Third EditionEffects of long-term self-massage at the musculotendinous junction on hamstring extensibility, stiffness, stretch tolerance, and structural indices: A randomized controlled trial
2016, Physical Therapy in SportCitation Excerpt :Good hamstring extensibility and optimal stiffness is needed for sport but also functional activity (Bradley & Portas, 2007; McHugh, Connolly, Eston, Kremenic, Nicholas, & Gleim, 1999; Witvrouw, Danneels, Asselman, D'Have, & Cambier, 2003; Ylinen, Kankainen, Kautiainen, Rezasoltani, Kuukkanen, & Hakkinen, 2009). In sport setting, massage is used frequently in order to increase hamstring extensibility (Bradley & Portas, 2007; Hopper, Conneely, Chromiak, Canini, Berggren, & Briffa, 2005; McHugh et al., 1999; Witvrouw et al., 2003). However, in previous studies (Akazawa et al., 2013; Barlow, Clarke, Johnson, Seabourne, Thomas, & Gal, 2004; Hopper et al., 2005; Hopper, Deacon, et al., 2005; Huang, Di Santo, Wadden, Cappa, Alkanani, & Behm, 2010; Wiktorsson-Möller, Oberg, Ekstrand, & Gillquist, 1983), the effects of massage on hamstring extensibility is controversial.
Effect of deep stripping massage alone or with eccentric resistance on hamstring length and strength
2014, Journal of Bodywork and Movement TherapiesMassage and stretching reduce spinal reflex excitability without affecting twitch contractile properties
2013, Journal of Electromyography and Kinesiology