Elsevier

Physical Therapy in Sport

Volume 6, Issue 3, August 2005, Pages 137-145
Physical Therapy in Sport

Original research
Evaluation of the effect of two massage techniques on hamstring muscle length in competitive female hockey players

https://doi.org/10.1016/j.ptsp.2005.04.003Get rights and content

Abstract

Background

Massage is frequently used in prevention and management of soft tissue injuries in sport. There is little scientific evidence to support its use.

Objective

The primary purpose of this study was to evaluate the effect of dynamic soft tissue mobilisation (DSTM) in comparison with classic massage on hamstring muscle length in competitive female field hockey players.

Design

A randomised, self-controlled comparative clinical trial, with a blinded measurer. Thirty-nine players were recruited and randomly allocated into two groups. One group received classic massage and the other DSTM.

Outcome measures

Passive straight leg raise (PSLR) and passive knee extension (PKE) were used to measure indirect hamstring length, before, following and 24 h post-intervention.

Result

The PKE test demonstrated a significant improvement in hamstring length immediately following massage in both groups (F=7.66, p=0.01). This increase was comparable between the two massage groups (F=0.164, p=0.69). Post-hoc linear contrast showed no maintenance over 24 h in either group, (classic F(1,18)=2.106, p=0.164, DSTM F (1,15)=0.599, p=0.451).

Conclusion

Passive KE showed that both classic massage and DSTM had an immediate, significant effect on hamstring length in competitive female field 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

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