Here at Hawkes Physiotherapy, we offer massage treatments as part of our Physio and Sports massage services and one of the things that we see people for is for muscle soreness after strenuous activity, which is commonly called DOMS or Delayed Onset Muscle Soreness.
Now we know that from our experience that in our Stoke-on-Trent clinics our patients definitely feel less soreness after a massage but what does the research say to the question, “Does massage help DOMS (Delayed Onset Muscle Soreness)?”
So firstly what is DOMS?
Before we can see if massage can help delayed onset muscle soreness we first need to know more about DOMS. Basically, it is pain and tension that develops in muscle tissue following intense or unaccustomed exercise and tends to be worse from eccentric type muscle contractions, which is when the muscle is lengthening under load. The soreness doesn’t occur straight away, hence ‘delayed’, it usually starts at 24-48 hours after and usually peaks at 48-72 hours then eases back down again.
What causes Delayed Onset Muscle Soreness?
Lots of ideas have been proposed over the years from microtrauma to inflammation but we have found that these are not the cause. Semark et al (1999) found no link between delayed onset muscle soreness and inflammation and Yu et al (2004) also found no evidence to support that the muscle soreness results from damage.
So what is it then?
The latest thinking is that it is more of a neurologically driven reflex, which causes an involuntary increase in muscle tone. This type of effect is supported in a study by Ayles et al (2011), where they found muscle soreness not only in the muscles trained but in other muscles that weren’t trained but were innervated by the same spinal level. So this means the nerves themselves are possibly responsible for the effect. Truth is nobody is sure even to this day but I believe that the nervous system is the key because this is the way most things are going nowadays.
Why is DOMS a problem?
Obviously, athletes need to train frequently and if you are very sore and tight for 3 days then you may struggle to train optimally for 3 days and this means training only twice per week, which is not sufficient. Kargarfard et al (et al 2016) found that having DOMS hampered muscle function and performance and De Marchi et al (2017) also found that range of movement was also negatively affected. So anything to ease DOMS is welcome as you feel better and the muscles can function better once it passes.
Now DOMS has previously been thought to relate to recovering itself, meaning that people thought once the soreness is gone that you are recovered and if you are still sore then you aren’t recovered, this has actually been shown to not be the case at all. The DOMS is more of an impedance to optimal training as muscle doesn’t function well when pain is around. Check out the video below on how Delayed Onset Muscle Soreness isn’t a good measure of recovery:
So does massage help DOMS (Delayed Onset Muscle Soreness) then?
Now the main problem with the research in this area is that there is not much in the way of high-quality reviews but from what we do have it would seem that Sports massage has the greatest effect on preventing or lessening the extent of the delayed onset muscle soreness and this is good as prevention is better than cure anyway. In a study by Hilbert et al (2001), they massaged the Hamstrings 2 hours after intense exercise of the Hamstrings and they found a reduced intensity of muscle soreness at 48 hours after exercising.
In another area of the body, they got people to eccentrically work the elbow flexors with 10 sets of 6 maximal isokinetic eccentric actions of the elbow flexors with each arm on a dynamometer and they found a significant 30% reduction of muscle soreness and creatine kinase levels were lower too when massage was done for 10 minutes 3 hours after exercise (Zainuddin et al 2005).
There is evidence that you can get positive effects from using massage to reduce DOMS when you have already got it as was reported by (Law et al 2008). They did a randomised controlled trial but this was challenging due to blinding the participants because people know what massage is, so to have a true placebo is difficult. However, they found that when massage was done 48hours after exercise when DOMS already existed, pain reduced on muscle stretch by 48.4% and sensitivity to touch reduced by 27.5% but the pain at rest was no better.
How does it compare to other methods?
The most touted paper is this meta-analysis by Dupuy et al (2018). They looked at different kinds of recovery protocols and methods and compared their effects on DOMS and a few other variables. In a nutshell, they found that massage was better than things such as stretching, active recovery, compression garments, cryotherapy and more.
Overall it would seem that most supporting evidence shows that massage can reduce delayed onset muscle soreness when it is done after the exercise. So it would be more of a prevention or minimisation tactic to enable you to get back training again and this is born out in reality as many athletes use sports massage therapists as a matter of course for this very reason.
The content in this blog article is provided for general information purposes only and is not meant to replace a physiotherapy or medical consultation.