Soft Tissue Association Oct 2024

RESEARCH INTO PRACTICE

Research Review Physical Therapy

In partnership with The Association for Soft Tissue Therapists

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INCIDENCE OF INJURY AND ILLNESS AT THE BEIJING 2022 PARALYMPIC WINTER GAMES HELD IN A CLOSED-LOOP ENVIRONMENT: A PROSPECTIVE COHORT STUDY OF 7332 ATHLETE DAYS. Derman W, Runciman P, Eken M et al. British Journal of Sports Medicine 2024 doi:10.1136/bjsports-2023-107525

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PHYSICAL ACTIVITY DOSE FOR GENERALIZED ANXIETY DISORDER & WORRY: RESULTS FROM THE IRISH LONGITUDINAL STUDY ON AGEING. Herring MP, Rasmussen CL, McDowell CP et al. Psychiatry Research 2024;332:115723 There is a consensus that physical activity is beneficial for mental health.

OPEN The big question is how much exercise is required? This study quantified associations of weekly accumulated moderate-to-vigorous physical activity (MVPA) doses with generalised anxiety disorder (GAD) and worry across 10 years using data from The Irish Longitudinal Study on Ageing (TILDA).

The authors worked out the exercise intensity using metabolic equivalent of task (MET) minutes per week; eg. moderate-intensity brisk walking = 4METs. Worry symptoms and GAD status were measured using the Penn State worry questionnaire-abbreviated and the composite international diagnostic interview.

There were 7,650 participants in the study and the results showed that, compared to no activity, engaging in even minimal physical activity [equivalent of 10min/day for 5 days/week of moderate-intensity activity (eg. brisk walking)], may lower the risk of GAD over time among older adults.

Co-Kinetic comment Who needs a gym membership? A short brisk walk everyday will do you a power of good.

Injuries and illnesses from all teams were recorded on a daily basis by team medical staff on a web-based form and by local organising committee medical (polyclinic) facilities and venue medical support. Duplicates recorded on both systems were removed. Incidence of injuries and illnesses are reported per 1,000 athlete days.

The results showed that 564 athletes (426 male and 138 female) representing 46 countries were monitored for the 13-day period of the games (7,332 athlete days). The overall incidences were 13.0 injuries (10.6–15.8) and 6.1 illnesses (4.5–8.4) per 1,000 athlete days. The incidence of injury in alpine skiing (19.9; 15.2–26.1) was significantly higher compared with Nordic skiing, ice hockey and wheelchair curling, whereas the incidence of respiratory illness was significantly higher in Nordic skiing (1.6; 0.9– 2.9) compared with alpine skiing, ice hockey and snowboarding.

Co-Kinetic comment Stats like these are collected at all the big sporting events with the objective of improving injury risk mitigation strategies to safeguard the wellbeing of the athlete. These were the lowest figures for injury and illness reported at any Paralympic Winter Games, so the plan is working.

THE ROLE OF PHYSICAL EXERCISE IN CHRONIC MUSCULOSKELETAL PAIN: BEST MEDICINE—A NARRATIVE REVIEW. De la Corte-Rodriguez H, Roman-Belmonte JM, Resino-Luis C et al. Healthcare 2024;12(2):242

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The aim of this paper is to provide a narrative review of the effects of physical exercise in the treatment of chronic musculoskeletal pain. The search terms “exercise musculoskeletal chronic pain” were used in the PubMed, Cochrane, Embase, CINAHL, and PEDro databases and 134 publications were ultimately included in this review.

The conclusion drawn from these studies was that in addition to its analgesic capacity, physical exercise has an effect on other pain-related areas, such as sleep quality, activities of daily living, quality of life, physical function, and emotion. In general, even during periods of acute pain, maintaining Co-Kinetic.com

a minimum level of physical activity can be beneficial. Programmes that combine several of the various exercise modalities (aerobic, strengthening, flexibility, and balance), known as multicomponent exercise, can be more effective and better adapted to clinical conditions. For chronic pain, the greatest benefits typically occur with programmes performed at light-to-moderate intensity and at a frequency of two to three times per week for at least 4 weeks. Exercise programmes should be tailored to the specific needs of each patient based on clinical guidelines and World Health Organization recommendations. Given

that adherence to physical exercise is a major problem, it is important to empower patients and facilitate lifestyle change. There is strong evidence of the analgesic effect of physical exercise in multiple pathologies, such as in osteoarthritis, chronic low back pain, rheumatoid arthritis, and fibromyalgia.

Co-Kinetic comment Do any of our readers really need evidence to show that exercise is beneficial in a host of aspects of life? If you do, here it is. The bottom line is that for the management of musculoskeletal pain, physical exercise is an effective, cheap and safe therapeutic option and it does not have the adverse effects of pharmacological treatments or invasive techniques. Go and spread the word.

Following breast cancer, mastectomy often leads to shoulder dysfunction, which limits the patients’ ability to perform daily activities and results in physical and psychological difficulties.

This study was carried out to evaluate the impact of Maitland mobilisations (mobs) on shoulder dysfunction postmastectomy.

Forty-two female patients, aged between 40 and 60 years, who were experiencing postmastectomy shoulder dysfunction were randomly assigned to two comparable groups: the study group were given a mixture of anterior-posterior, posterior-anterior and longitudinal glide mobs to the glenohumeral joint as well

MAITLAND MOBILISATIONS ON SHOULDER DYSFUNCTION POSTMASTECTOMY. Hammad AJM, Wakedi IS, Eldin Abd El Ghani S et al. International Journal of Chemical and Biochemical Sciences 2023;24(9):156–164 their conventional physical therapy protocol. The control group were given just the conventional physical therapy protocol. Treatments were given three times a week for 1 month.

Shoulder ROM was measured by goniometer and function by a disabilities of the arm, shoulder and hand (DASH) questionnaire pre- and 1-month post-intervention. The Maitland group demonstrated a substantial statistical difference in all measures.

CATASTROPHIC INJURIES AND EXERTIONAL MEDICAL EVENTS IN LACROSSE AMONG YOUTH, HIGH SCHOOL AND COLLEGIATE ATHLETES: LONGITUDINAL SURVEILLANCE OVER FOUR DECADES (1982–2020). Moseley GA, Lincoln AE, Drezner JA et al. Annals of Medicine OPEN 2024;56(1):2311223 Catastrophic injuries and exertional medical events in lacrosse in the US among youth or amateur, high school and college athletes were analysed from the National Center for Catastrophic Sport Injury Research (NCCSIR) database from 1982/83 to 2019/20.

Sixty-nine catastrophic events (16 youth or amateur, 36 high school and 17 college; 84% male) occurred in US lacrosse during the period. Thirty-six percent of all incidents were fatal. The overall injury rate was 0.5 per 100,000 athlete seasons. There were 15 cases of non-traumatic sudden cardiac arrests (SCAs) and 15 incidents of commotio cordis.

Fatality rates from SCA and commotio cordis decreased 95% from 1982/83–2006/07 to 2007/08–2019/20. Incidence rates were higher for collegiate versus high school and collegiate versus youth 2005/06–2019/20. Contact with a stick or ball (41%) and contact with another player (20%) were the primary mechanisms of injury.

Co-Kinetic comment The fact that you are reading the Co-Kinetic journal indicates that there is a very good chance you are a supporter of the glories of sport and its many health benefits. A study like this one brings you down to earth. Sometimes sport has very bad days.

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Co-Kinetic comment According to the charity Breast Cancer Now, around 55,000 women and 400 men are diagnosed with breast cancer every year in the UK. Around 10,000 women are under 50 and of these around 7,600 are in their 40s and 2,400 under 39. According to the Sport England Active people survey, that age range covers 60% of the women who participate in sport or fitness activities at least once a week. If you treat this population then this paper is a must-read. The protocols for both the mobs and the conventional therapy are well described. Excellent work by the authors.

MENTAL HEALTH PROBLEMS, SLEEP QUALITY AND OVERUSE INJURIES IN ADVANCED SWEDISH ROCK-CLIMBERS – THE CLIMB STUDY. Identeg F, Nigicser I, Edlund K et al. BMC Sports Science, Medicine and Rehabilitation 2024;16:46

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A self-selected sample of advanced and elite Swedish rock-climbing athletes was recruited through the Swedish Rock-climbing Federation, local rock-climbing gyms and through social media. A total of 183 participants were included in the rock-climbing group, whose mean age (SD) was 28.2 (8.3) years among women and 30.5 (9.6) years in men. In addition there were 180 participants in a non-climbing control group. Participants in the control group answered an online survey of validated questionnaires, examining symptoms of stress, anxiety, depression, and sleep quality. The climbing participants answered the same survey as the non-climbing controls but with additional questions regarding musculoskeletal problems and disabilities related to these. Outcome measures used were the depression anxiety stress scale, Pittsburgh sleep quality index and the Oslo Sports Trauma Research Center overuse injury questionnaire.

A total of 30.6% of the rock-climbing group (26.7% of men, 35.9% of women) reported at least moderate levels of symptoms of depression compared to 28.2% (28.2% of men and 28.4% of women) in the control group.

A total of 23.1% of the rock-climbing group (17.2% of men, 30.8% of women) reported moderate or more severe symptoms of anxiety compared to 26.6% (21.2% of men, 30.3% of women) in the control group.

A total of 48.4% of the rock-climbing group (39.1% men, 61.6% women) reported moderate or more severe levels of symptoms of stress, compared to 45.3% (39.5% of men and 48.6% of women) of the control group.

Regarding sleep quality, 54.6% of the climbers (61.0% men, 46.2% women,) were categorised as good sleepers, compared to 65.0% (70.4% men, 61.5% women) in the control group. No differences were observed in reported symptoms of depression, anxiety, stress or sleep quality between the groups. Similarly, there were no differences between elite and advanced rock-climbers, as far as reported symptoms of depression, anxiety, stress or sleep quality.

The climbers reported injuries related to the finger and hand (49.5%), shoulder (35.2%), knee (29.1%), lumbar back (26.4%), arm (25.3%), thoracic back and neck (17.0%), and foot and lower leg (12.1%).

Co-Kinetic comment In summary there is no significant difference between the climbers and the non-climbers but both groups show high levels of symptoms of mental health problems and poor sleep quality. Is this just in Sweden or does the rest of Europe suffer as well? There’s a research project there for someone. Bet the European Union will fund it if you ask nicely.

Quarterly Research Review Oct-Dec 2024

RESEARCH INTO PRACTICE

EFFECTS OF PHYSICAL ACTIVITY AND MASSAGE THERAPY ON SLEEP DISORDERS AMONG CHILDREN WITH AUTISM SPECTRUM DISORDER: A SYSTEMATIC REVIEW. Ekradi S, Shahrbanian S, Todd T, Hassani F. Review Journal of Autism and Developmental Disorders 2024 doi:10.1007/s40489-024-00433-6 The “usual suspect” medical databases were searched for examples of physical activity (PA) and massage therapy (MT) on sleep-related variables in children with a reported autism spectrum disorder (ASD) diagnosis. Outcomes included sleep efficiency, sleep-onset latency, sleep duration, sleep behaviour, and sleep quality. PEDro and McMaster scales were used to assess the quality of included studies. The search yielded a total of 20 studies that met all inclusion criteria. Fifteen studies related to the effects of PA and five studies related to the effects of MT. The total number of participants was 511.

Overall, the quality of the studies ranged from 5 to 9 on the PEDro scale, which corresponded to fair quality.

Of the PA studies, five were based on PA levels, four on aquatic exercise and others were sport specific such as, yoga, basketball, and aerobic exercise. The duration of the PA interventions ranged from 21 days to 90 days. Weekly frequency was two and three times per week in five studies, and the duration of therapy sessions ranged from a minimum of 30min to a maximum of 75min.

In the five MT studies, types of massage included traditional Thai aromatherapy massage and qigong. Weekly

frequency was two and three times per week in three studies. The duration of experimental programmes ranged from 14 days, and the duration of individual sessions ranged from a minimum of 15min to a maximum of 60min.

The overall conclusion was that both PA and MT have beneficial effects on sleep efficiency, sleep-onset latency, wake after sleep onset, and sleep quality. In addition, aquatic exercise and swimming were found to be particularly effective in improving sleep in children with ASD.

Co-Kinetic comment ASD affects just over 1% of the world’s population. That makes around 700,000 adults and children in the UK. In the USA, the latest percentage population figure is higher, at around 1 in 36 children being diagnosed, which is higher than the 1 in 110 that it was in 2006. That is a very large population if you are thinking of specialising in the treatment of those affected. The causes are not well understood but the current thinking is that it is a mix of genetic and environmental factors including prenatal exposure to air pollution or certain pesticides. What does not cause it is the MMR vaccination and there are many studies that say so. The reasons for the increase are thought to be that clinicians have got better at diagnosing it.

RESEARCH PROGRESS IN THE EFFECT OF EXERCISE INTERVENTION ON SLEEP DISORDERS AND THE MECHANISMS INVOLVED. Gong M, Tang Q, Tan S, Hu X. Sichuan da xue xue bao. Yi xue ban [Journal of Sichuan OPEN University. Medical Science Edition] 2024;55(1):236–242 (in Chinese) This is a summary of the current state of play in sleep disorder research.

Reported findings suggest that both acute exercise intervention and longterm regular exercise intervention can improve the disrupted sleep structure and normalise the duration and proportion of the different phases of sleep. Exercise intervention has a positive effect on the endocrine functions, the metabolic functions, the immune response, the autonomic nervous system, and cardiac functions during sleep. It is a non-medicative therapeutic strategy for improving sleep disorders. The specific type of exercise intervention (aerobic exercise, resistance exercise, or meditative movement) adopted is one of the moderating variables of exercise intervention

programmes. Different types of exercise improve sleep disorders by way of different mechanisms. Exercise volume and intensity are another moderating variable of exercise intervention programmes. The optimal amount and intensity of exercise for different individuals to improve sleep disorders may vary. Exercise interventions implemented at different times throughout the day can also have varying degrees of impact on sleep disorders and there is no consensus on the optimal exercise time for improving sleep quality at present. A summary of the mechanisms of how exercise intervention works includes epigenetics, hyperarousal, human circadian rhythm, and body temperature regulation.

Co-Kinetic comment This is good companion piece to the one on sleep disorders in autism. It throws up a lot of ideas but the bottom line is that exercise will help; however, what type, how much and what time of day you do it is trial and error.

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EFFICACY OF POSTERIOR GLIDE JOINT OPEN MOBILIZATION OVER ANTERIOR GLIDE JOINT MOBILIZATION FOR IMPROVING EXTERNAL RANGE OF MOTION WITH FROZEN SHOULDER. Bathri B, Siddiqui S, Pawar N, Sahu S. Iconic Research and Engineering Journals 2023;7(6):273–278 The object of this study was to measure the efficacy of the effects of posterior glide joint mobilisation (mobs) over anterior glide joint mobs for improving external rotation of patients with idiopathic adhesive capsulitis of the shoulder with a specific ROM deficit.

Twenty patients (four men and 16 women), between the ages of 37 and 66 years were randomly divided into two groups. One received posterior glide mobs the other anterior glide mobs two to three times a week for a total of six sessions.

All of the patients were allowed to complete any pain-free activities of daily living but were advised not to do resisted arm activities with a resistance of greater than 3kg, such as closing a car door, opening stiff doors, gardening, vacuuming, sawing, pushing, pulling or lifting.The results showed that the posterior glides increased the ROM more that the anterior ones.

Co-Kinetic comment Another paper that is a plus for manual therapy but a massive minus for the standard of the work. This does not give the grades of mobilisation nor the number of repetitions.

Poor.

SURGICAL TREATMENT OF DISTAL HAMSTRING TENDON INJURIES YIELD A HIGHER RETURNTO-SPORTS RATE: A SYSTEMATIC REVIEW. MARÍN FERMÍN T, AMINAKE G, VASILIADIS AV et al. Knee Surgery, Sports Traumatology, Arthroscopy 2024 doi:10.1002/ksa

The purpose of this study is to compare the patient-reported outcomes and return-to-sport of the conservative and surgical treatment of distal hamstring tendon injuries. The PubMed, Scopus and Virtual Health Library databases up to January 2023 were searched for clinical studies evaluating conservative or surgical management outcomes of distal hamstring tendon injuries. Eighteen studies were included for 67 patients and 68 distal hamstring tendon injuries.

Initially, 39 patients (58.2%) underwent surgical treatment, whereas 28 (41.8%) were treated conservatively. Among the conservative treatment patients, 15 failed and had to be operated on (53.6%), all with distal semitendinosus tendon injuries. Anchor fixation was the technique of choice in 20 lesions (36.4%), tenodesis in 16 (29.1%), tenectomy in 14 (25.5%) and sutures were preferred in five (9%). Thirteen out of 28 patients (46.4%) undergoing initial conservative treatment returned to sport at a mean of 3.6 months (range 1 week to 12 months), in contrast to surgical treatment, in which 36 out of 39 patients (92.3%) returned at a mean of 4.2 months (range 6 weeks to 12 months). Additionally, 14 of the 15 patients (93.3%) converted to surgical treatment after failed conservative treatment returned to sport at a mean of 7.6 months after injury.

Co-Kinetic comment Usually with injury management there is a strong bias towards conservative management because of all the extra risks that go with surgery; however, given that 15 out of 28 patients initially treated conservatively had to be operated on and the fact that surgical treatment of distal hamstring tears has a very high return-to-play rate it is worth considering surgery as the first choice.

PubMed, MEDLINE, Cochrane library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase were searched from January 1, 2012 to September 1, 2023 using terms related to physical post-concussion symptoms.

Eligible articles were critically appraised using the Scottish Intercollegiate Guidelines Network (SIGN) and the quality assessment tool. The grading of recommendations assessment, development, and evaluation system was applied to rate the quality of evidence. This search resulted in 32 articles which were included in the study.

A review of these suggests that transcranial magnetic stimulation improves symptoms in adults, specifically headaches. Young adults reported a significant decrease in physical symptoms following subsymptom aerobic training as well as cervical spine manual therapy.

Tentatively, adults demonstrated improvements in headache symptoms

EFFECTIVENESS OF NON-PHARMACOLOGICAL THERAPY ON PHYSICAL SYMPTOMS IN PATIENTS WITH PERSISTENT CONCUSSION SYMPTOMS: A SYSTEMATIC REVIEW. Moser N, Gargoum S, Popovic MR, Kalsi-Ryan S. Journal of Neurotrauma 2023 doi:10.1089/neu.2023.0474 following neurofeedback sessions, and progressive muscle relaxation resulted in a decrease in monthly headaches.

Multimodal therapy in adults produced significant change in physical symptoms when compared with usual care.

However, no further reduction in physical symptoms was observed when adult patients received a programme of care that afforded cervicovestibular rehabilitation with symptom-limited exercise compared with a symptomlimited exercise programme alone.

Cognitive behavioural therapy demonstrated inconsistent findings for its effects on physical symptoms, specifically headaches.

Veterans had a significant change in post-concussive symptoms, specifically headaches, following the 3-month use of an interactive smartphone

application as compared with standard care. Finally, in a paediatric population, the use of melatonin did not produce any changes in physical persistent concussion symptoms as compared with placebo. Preliminary evidence suggests that various forms of rehabilitative therapies can improve persistent physical concussive symptoms. However, given the methodological limitations in the majority of trials, the results need to be interpreted with caution.

Co-Kinetic comment “Concussion” is a word that is sending shock waves through the governing bodies of every contact sport so anything that assists return-to-play should be welcomed. However, as the last line of this report says, it should be interpreted with caution. The bottom line is that in most cases recovery takes time and there is no magic potion to speed up the process.

Co-Kinetic journalReview 2016;73(July):XX-XX Quarterly Research Oct-Dec 2024

RESEARCH INTO PRACTICE

Research Review Manual Therapy

Fourteen professional cyclists of both genders, aged 15–40 years, were the subjects. They were divided equally into two groups, one treated with a foam roller and the other with cross fictional massage, thrice a week for a 6-week programme. Outcome measurements of a numeric pain score, knee outcome survey sports activities scale and pressure algometer were taken at 1, 2, 4 and 6 weeks.

In the foam roller group the cyclists applied the roller over the iliotibial band (ITB) till they found a trigger point then held the pressure over it for 120s before looking for other trigger points to treat. In the cross friction

Fifteen recreationally active young women, aged 22.9±1.2 years, chosen as a convenience sample, underwent a randomised cross-over study with three conditions. The sequence of these conditions and muscle order [erector spinae (ES) and upper trapezius (UT)] was randomised during the first visit using a blind draw. They received either a 5min classical or sports massage, or passive rest as a control on distinct days. They were asked to refrain from intensive resistance training for at least 48h before each measurement. All measurements were taken at the same time of day to mitigate the potential influence of circadian rhythms. They relaxed in a prone position for 5min before measurement. Shear-wave elastography was used to measure the stiffness of both muscle groups. Further data was obtained immediately after the intervention and at 5min and 10min post-intervention.

For the control condition, participants remained relaxed in the same prone position for 5min. The massage intervention was performed by a graduate kinesiologist with several years of experience with various massage applications. Both massage techniques were performed on both muscles for 5min using five techniques, each of which was performed for 1min.

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COMPARATIVE EFFECTS OF FOAM ROLLER AND CROSS FRICTIONAL MASSAGE ON ILIOTIBIAL BAND SYNDROME IN CYCLISTS. Ilyas M, Munir M, Irfan AB, Izhar N. Journal Riphah College of Rehabilitation Sciences 2023;11(4):225–230

group, a therapist found a trigger point and applied “moderate pressure”, perpendicular to it.

The results showed that both interventions were effective for treatment, but neither was statistically superior to other.

Co-Kinetic comment Top marks for using the word “thrice”.

Middling marks for proving that both

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interventions have a positive effect on trigger points. Zero marks for having the wrong title. This study is about dealing with trigger points identified in the ITB which may or not contribute to the patients’ knee pain. How about this for the daftest statistic of the year? The gender split of the 14 subjects was described as “42.8% were females and 57.1% male”. What were the other 0.1% then?

DIFFERENTIAL EFFECTS OF CLASSICAL VS. SPORTS MASSAGE ON ERECTOR SPINAE AND UPPER TRAPEZIUS MUSCLE STIFFNESS: A SHEAR-WAVE ELASTOGRAPHY STUDY IN YOUNG WOMEN. Jelen A, Javornik E, Zupančič M, Kozinc Ž. Sports 2024;12(1):26 The massage pressure was defined on a five-point scale, from light lotioning (grade 1), heavy lotioning (grade 2), medium pressure (grade 3), strong pressure (grade 4), and deep pressure (grade 5). The massage tempo was described as an extremely slow pace (grade 1), a slow pace (grade 2), a moderate pace (grade 3), a fast pace (grade 4), and a rapid pace (grade 5).

A classic massage of the ES consisted of surface effleurage (pressure 1 and pace 4) with the whole palm perpendicular to the spine from the opposite side, deep effleurage (2 and 3) with the root of the palm and the fingers in the direction of the feet to the head, rubbing (3 and 3) with the fingers in the direction of the head to the feet, petrissage (3 and 2) with the root of the palm at an angle of 45° to the spine in the direction of the feet to the head, and deep effleurage (2 and 3) with the whole palm in the direction of the head to the feet. A classic massage of the UT fibres consisted of kneading (1 and 4) the muscle perpendicular to its course with the fingers, surface effleurage (2 and 3) with the whole palms from the direction of

the acromion towards the C7 vertebra, deep effleurage (3 and 3) with the whole palms from the direction of the acromion towards the C7 vertebra, kneading (3 and 2) with the fingers in the direction of the acromion towards the C7 vertebra, and rubbing (2 and 3) with the palms in the direction of the C7 vertebra towards the acromion.

The sports massage was basically the same only deeper.

There was a change in the muscle stiffness over the time periods for all three interventions but no great difference between the three.

Co-Kinetic comment This seems like a lot of work to come to the conclusion that there is really no difference between two types of massage and a rest but there is something to build on. The sample size was small and the treatments very short. If you have access to the measuring machine there is scope for further research. A great dissertation subject for someone.

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ACUTE EFFECTS OF SHORT-TERM MASSAGE PROCEDURES ON NEUROMECHANICAL CONTRACTILE PROPERTIES OF RECTUS FEMORIS MUSCLE. Dakić M, Ilić V, Toskić L et al. Medicina 2024;60(1):125 Fourteen healthy and active male students (age 25.1±3.9 years) were included in this study.

Tensiomyography was used to evaluate muscle responses after four different types of short-term recovery methods (passive rest, percussive-mechanical, vibromechanical, and manual massage) on the rectus femoris muscle on four occasions: baseline, post-fatigue, post-recovery and prolonged recovery.

The results showed that muscle fatigue decreased maximal vertical muscle displacement (Dm) and muscle contraction time (Tc) in postfatigue compared to the baseline

measurement. The most important finding shows that only the vibromechanical massage resulted in an increase in Tc in the prolonged recovery compared to the postfatigue measurement, whereas only manual massage showed no differences in Dm from the baseline in post-recovery. Moreover, both manual and vibro-mechanical massages increased Dm and Tc in prolonged recovery, indicating no differences from the baseline thus showing signs of muscle recovery.

Percussive-mechanical massage and passive rest did not show indices of muscle recovery.

Co-Kinetic comment In simple terms, what all that means is that both manual and mechanical massage is good for you. Tensiomyography has been validated in other research as a way of measuring muscle stiffness. It is based on the response of the muscles to an appropriate electrical stimulus, enabling the detection of neuromechanical changes during external muscle electrostimulation using a sensor that records the radial displacement of the muscle belly. So now you know.

EFFECT OF THE SPORTS MASSAGE GIVEN TO BADMINTON PLAYERS BEFORE MATCHES UPON THEIR STATE ANXIETY. Arslan Y, Suveren C. Journal of Southwest Jiaotong University 2023;58(2):858–867

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Forty-seven players from teams in badminton leagues in Ankara and Tokat provinces participated in the study. At the beginning of the research, important matches were determined through discussions with the coaches.

Forty minutes before these matches, Spielberger’s inventory of state anxiety was completed. Then, the experimental group (n=27) were given a massage lasting 2–3min on their lower limbs. The control group (n=20) were not. Thirty minutes before the matches they again completed the anxiety questionnaire.

The results showed that at the initial questionnaire, there were no significant differences between the two groups,

EFFECTIVENESS OF MANIPULATIVE THERAPY AND HEAT THERAPY ON PAIN REDUCTION, INCREASED RANGE OF MOTION AND MOTION FUNCTION IN CASES OF LOW BACK PAIN. Wijaya F, Kushartanti W, Ambardini RL et al.

International Journal of Physical Education, Sports and Health 2023;10(3):76–79 OPEN Twenty patients with chronic low back pain received manipulative therapy in the form of massage and stretching for 20min, followed by hot compresses for 20–30min. The results showed that there was reduced pain (measured on a VAS scale), plus an increase in ROM (measured with a modified Schober test) and function (measured with a modified oswentry [sic] disability index).

Co-Kinetic comment On the face of it this is yet another positive result for manual therapy, but on the contrary it is really an example of poor research or, to give the researchers the benefit of the doubt, an example of poor reporting of research.

There are no descriptive details of the subjects or the therapists who are administrating the intervention. There is no description of the therapy applied other than to say that it is massage and stretching. They can’t even spell “Oswestry” which presumably is the test they actually used. It’s poor. Come on journal editors stop wasting our time reading rubbish like this please.

but the massage group registered a noteworthy decrease in state anxiety after the intervention. When the results were broken down by age of the subjects, it was found that premassage state-anxiety score averages increase with increasing age and that the greatest improvement in the postmassage scores occurred in the players aged 18 and younger.

Co-Kinetic comment Oh to be young. The older you get the more you have to worry about. What this does show is that although the physiological benefits of massage before competition can be argued about, a bit of TLC just before a match works wonders.

Quarterly Research Review Oct-Dec 2024

RESEARCH INTO PRACTICE

ROBOTICS IN MASSAGE: A SYSTEMATIC REVIEW. Yang J, Lim KH, Mohabbat AB et al. Health Services Research and Managerial Epidemiology 2024;11 doi:10.1177/23333928241230948 The Ovid and Scopus databases were searched from OPEN their inception up to March 2023. Given the substantial methodological diversity among the included studies, a qualitative analysis was conducted. Robotic massage is defined as being performed by machines or devices with minimal human interaction.

Seventeen studies met the inclusion criteria, comprising 15 preliminary trials, 1 quasi-experimental study, and 1 randomised controlled trial. Approximately 29% of the studies focused on the application of robotic massage for patients, 24% targeted both healthy volunteers and patients, and the remaining 47% were preclinical trials assessing the effectiveness of robotic massage solely on healthy volunteers. Primary interventions included robotic massage for oral rehabilitation, scalp massage, low back massage, shoulder massage, and full-body massage. All studies provided evidence that robotic massage interventions can enhance health and wellbeing.

Co-Kinetic comment According to this paper, traditional hands-on massage by a trained therapist is repetitive, labour intensive, and time consuming. The challenges to traditional massage include the availability of trained therapists, the occurrence of overuse syndromes among therapists, inconsistencies in technique, and the need for personalised treatments. Way back at the start of the Industrial Revolution (1811), in Nottingham, England, a group of workers protested about (among other things) being replaced by machines doing their jobs. It is about time the Luddites were resurrected or we will soon all be out of a job.

MECHANICAL STIMULATION OF THE LOWER EXTREMITIES WITH A TEXTILE-BASED PNEUMATIC MASSAGER INCREASES PARASYMPATHETIC ACTIVITY INDEX AND LOWERS BLOOD GLUCOSE LEVELS. Hatakeyama N, Sakurai T, Ohto-Fujita E et al. Journal of Fiber Science and Technology 2024;80(2) doi:10.2115/ fiberst.2024-0004 A home-use pneumatic massager with a polyester cuff (EXM-12000, Medo Sangyo Co. Ltd), was applied to the lower extremities of 20 healthy adult males aged 31.5±7 years while seated. The treatment lasted 10min at an intensity level the subject had previously reported a comfortable.

Heart rate (HR) and heart rate variability (HRV), which is considered an index of parasympathetic nerve activity, were measured while using the device or just wearing it without massage pressure. HR dropped and HRV increased (which is good).

In a second experiment, the subjects performed on a treadmill

Co-Kinetic comment You get bang for your buck with this. Three experiments in one paper all showing benefits of the pneumatic massager. If you want to buy one they range in price from less than £100 to £600. Bet you never thought you would be reading about rehabilitation techniques in a journal dedicated to chemistry, nanoscience and engineering. In the same edition there are articles about colourisation of wool fibres and the tensile properties of weft knitted fabric.

Every day’s a school day.

IMPACT OF WARM-UP METHODS ON STRENGTH-SPEED FOR SPRINTERS IN ATHLETICS: A MINI REVIEW. Herrera E, OsorioFuentealba C. Frontiers in Sports and Active Living 2024;6:1360414 This is a literature review and (at the time of writing) we only have the OPEN abstract so we are bit short on the detail of the search strategy and the actual studies being reviewed. However, the main findings indicate that foam rolling, isometric exercises and pre-competitive massages have no significant effects on sprint performance. Static stretching and prolonged pre-competitive massages have negative impacts on strength and power. A vibration platform enhances step length, step rate and running velocity, jump height and total number of jumps performed in a 30s period in non-experienced sprinters. Eccentric exercise increases vertical force, post-activation potentiation demonstrates a reduction in 100-metre time and short-term improvement in vertical and horizontal jumps. Blood flow restriction significantly improves jump height and flight time.

Co-Kinetic comment This illustrates the point we made about the study of anxiety in badminton players. The evidence may suggest, as it does it here, that the physiological effects of massage are at best of no use to athletes pre-performance or at worst

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with increasing load until ventilatory threshold was exceeded and then spent 20min in the massager cuff or again just wearing it as a control. No significant difference was found in HR but HRV increased.

In a third experiment, 7 subjects aged 39.6±11 years rested for 30min during which time they ingested a glucose solution. They sat at a desk working at a computer for 2h while either using or just wearing the device. Blood glucose levels were measured every 30min for 2h. Blood glucose levels in the massage group were significantly less than in the control group.

This study aims to use a qualitative analysis of consumer perceptions to understand the perceived therapeutic potential of percussive massage therapy as a home-based intervention for musculoskeletal concerns of everyday users and elite athletes. The TOLOCO® massage gun (TOLOCO®) was identified as the best-selling percussive massage therapy device on Amazon.

The data for the study came from inductive thematic qualitative analysis on the top 100 positive comments and the top 100 critical comments of the device between June 2020 and April 2023. The TOLOCO® massage gun had a 4.5-star rating with 35,985 total ratings and 7,516 verified purchase consumer reviews. Of those 7,516 reviews, there were 5,936 positive reviews and 1,580 critical reviews.

Analysis identified four themes which were pain management, versatility, accessibility, and safety and user education. Consumer reviews indicated use for this percussive therapy device in adolescents, adults, and older people across a spectrum

THE EFFECT OF MASSAGE ON PAIN REDUCTION IN OSTEOARTHRITIS KNEE: LITERATURE REVIEW. OPEN Afrida HK, Dheirani D, Adi IC et al. Insight 2024;1(2):19–28 PubMed, Google Scholar and Scimago were searched using the key words “knee osteoarthritis” and “massage therapy”. This resulted in five studies which cumulatively suggested that 20min of massage (effleurage, petrissage and frictions) applied two times a week for 8 weeks was the optimal dose for reducing pain.

o-Kinetic C comment As you can probably guess from the short report on this paper, it is lacking in detail. However, the headline is that massage is good for arthritic pain. If you want more detail of techniques and dosage you will have to go to the five quoted studies.

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CONSUMER PERCEPTIONS OF HOME-BASED PERCUSSIVE MASSAGE THERAPY FOR MUSCULOSKELETAL CONCERNS: INDUCTIVE THEMATIC QUALITATIVE ANALYSIS. Butala S, Galido PV, Woo BKP. JMIR Rehabilitation and Assistive Technologies 2024;11:e52328 of activity levels. Consumers reported the therapeutic potential of percussive massage therapy in managing wideranging musculoskeletal concerns such as acute pain, chronic pain, non-surgical injury rehabilitation, post-surgical injury rehabilitation, and injury prevention.

Consumers highlighted the versatility of the device to address person-specific needs as a key feature in supporting its perceived therapeutic benefits.

Additionally, consumers frequently commented on the affordability and availability of this device to increase accessibility to home-based care. Some critical reviews emphasised a concern

for the quality of the device itself.

However, this concern did not translate to the overall modality of percussive massage therapy. Of note, despite strong approval for its therapeutic potential, consumer reviews lacked evidence-based insights on appropriate usage.

Co-Kinetic comment This is basically an opinion poll and an example of what the modern Luddites are up against, because a key driver to the use of massage guns is that they are cheap and easily available.

The limited scientific research on percussive massage therapy and the fact that some of that research suggests that if not used properly they can be dangerous carries little weight.

EFFECTS OF SWEDISH MASSAGE AT DIFFERENT TIMES OF THE DAY ON DYNAMIC AND STATIC BALANCE IN TAEKWONDO ATHLETES. Bayrakdaroğlu S, Eken Ö, Bayer R et al. Healthcare 2024;12(2):165 Twelve taekwondo athletes who had been practising on a regular basis for more than 5 years completed static and dynamic balance tests either after a no-massage protocol (NMP), a 5min massage protocol (5MMP), a 10min massage protocol (10MMP), or a 15min massage protocol (15MMP) two times a day in the morning (08:00–12:00) and in the evening (16:00–20:00), on nonconsecutive days.

The interventions were provided by three expert masseurs, and to avoid affecting measurement outcomes the masseurs administered massages to the same participants in each session. The protocol included effleurage, friction, petrissage and pressure techniques, with the massage strokes directed towards the heart and muscle fibres

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using approximately 15mL of classic baby oil each time.

The balance tests were completed immediately after the massage. The participants’ static balance values were obtained using an electronic assessment platform connected to a computer via portable and specialised software (Desmotec E.Board 1.2.0.1 version, Biella, Italy). The participants’ dynamic balance values were obtained using a portable dynamic balance and training system (Challenge Disc 2.0, TCD006, Togu®, Bayern, Germany).

Those who received a 10MMP or 15MMP displayed significantly improved dynamic balance compared to those in the NMP. These improvements were independent of the time of day when the massages were administered.

Co-Kinetic comment Massage has an effect, and we will always applaud that. However, what is surprising, in a study so detailed it states how much massage lotion was used, is that they make no reference to the depth of the massage strokes that made that difference. Next time, eh!

Quarterly Research Review Oct-Dec 2024