The efficacy of manual versus local vibratory massage in promoting recovery from post-exercise muscle damage - a systematic review.
Background. It is well established that unaccustomed activity/exercise with a large eccentric component causes the development of muscle damage which results in soreness and a decline in the functional capacity of muscle. Although this usually subsides after 3-4 days of relative inactivity, it temporarily impedes the level of performance in sports by preventing training and leading to greater susceptibility to injuries. Manual massage (MM) is a therapeutic modality that has been utilised in management of this condition for centuries with most of its accepted benefits being based on anecdotal reports and its functional benefits remaining contentious. Vibration therapy (VT) has on the other hand, recently gained popularity and replaced more time consuming manual massage. Its effectiveness is however also still in question as there is not enough clear scientific evidence regarding its efficacy in overcoming the consequences of exercise-induced muscle damage (EIMD) when compared to those of MM. Aims. To conduct a systematic review examining the efficacy of MM as compared to the local vibration therapy (LVT) modalities on recovery from EIMD and to determine its efficacy in attenuating the negative effects of EIMD on measures of joint flexibility, muscle strength/power output, muscle soreness/DOMS, systemic markers of inflammation and blood lactate concentration and / or markers of fatigue. Method. Following extensive computerised literature searches carried out using PubMed/MEDLINE, ResearchGate, EBSCOhost, Google Scholar and Science Direct, and a comprehensive literature review, randomized controlled trials and counter balance trials focusing on the beneficial effects of MM and LVT, were located. Criteria required for inclusion of trials in a systematic review were determined. After screening of the 63 initial studies located, articles that did not meet the inclusion criteria were excluded. The findings in terms of the effects of MM and LVT in terms of measures of joint flexibility, muscle strength/power output, muscle soreness/DOMS, systemic markers of inflammation and blood lactate concentration and /or markers of fatigue, were presented in tabular format, differentiating between the MM and LVT. A binary outcome summary for the trials in each category in which similar methodology was used, was created. Fisher’s Exact test was conducted to establish whether the difference between MM and LVT for each outcome measure was statistically significant or not. Finally, the findings of the systematic review were compared to those of Imityaz et al. (2014). Results: No trials reported a positive effect of MM on joint flexibility, while 50% (n=2) showed a beneficial effect of LVT. Of the 11 trials located investigating the effects of MM on strength, 4 (36%) revealed an attenuation of force deficit, while 50% (n=2) of the 4 trials on the effects of LVT showed a positive effects. DOMS was attenuated following EIMD in 75% (n=9) of the trials following MM and 100% (n=4) following LVT. Blood creatine kinase concentration was reduced in 50% of trials following MM (n=2) and LVT (n=1). No reduction in blood lactate concentration or markers of fatigue was shown following MM or LVT. Fisher’s Exact test showed no significant difference in the efficacy of MM and LVT in attenuating the effects of EIMD (p>0.05). CONCLUSION: A systematic review of the literature confirmed that MM is no more effective in controlling functional declines and physiological response to EIMD than LVT. However, most studies had limitations and methodological flaws and frequently reported conflicting results. The number of randomized controlled studies qualifying for review was also small (n=28).