THE EFFECT OF EFFLEURAGE MASSAGE IN RECOVERY

FROM FATIGUE IN THE ADDUCTOR MUSCLES OF

THE THUMB

Ryan Young, M.Ost,a Boris Gutnik, PhD,b Robert W. Moran, MHSc(Ost),c and Rex W. Thomson, PhDd

ABSTRACT

696

a School of Healb School of Healc School of Heald School of SpoSources of supp

research.Submit requests

Health and Comm92025, Auckland,Paper submitted

0161-4754/$30.Copyright D 20doi:10.1016/j.jm

Objective: The aim of this study was to investigate the effect of local effleurage massage on the recovery from fatigue in

the small hand muscles.

Methods: This study was a within-subject repeated measure design. Twelve healthy, right-handed volunteer male

subjects with a mean age of 25 F 2.8 years were recruited into the study from a university population. Subjects were

randomly allocated to a rest or massage protocol. Subjects undertook the alternate protocol at a subsequent session. All

subjects underwent baseline dynamometry testing of isometric thumb adduction (nondominant hand) before undertaking a

fatigue-inducing task of the thumb adductors. Subjects then underwent either 5 minutes of massage applied to the first

dorsal interspace or 5 minutes of rest. Subjects were then retested.

Results: The maximal force recorded after the massage protocol was not significantly different from the maximal force

recorded after the rest protocol, with a mean difference of only 0.63 N (95% confidence interval, ÿ12.55 to 13.80 N;

P = .92). The maximal gradient of force development after the massage protocol was not significantly different from the

maximal gradient recorded after the rest protocol, with a mean decrease in gradient of 19.48 N/s (95% confidence interval,

ÿ117.33 to 156.30 N; P = .77).

Conclusions: Effleurage massage was not an effective intervention for enhancing the restoration of postfatigue Fmax

and Gmax in the small muscles of the hand. The wide variation in response to this massage protocol may support the notion

that there is no universal effect of effleurage massage in enhancing recovery from fatigue. (J Manipulative Physiol Ther

2005;28:696Q701)

Key Indexing Terms: Massage; Muscle Fatigue; Physiology; Hand; Muscles; Skeletal

Several variants of massage are widely used in sports

and musculoskeletal medicine with the aim of

enhancing performance and muscle recovery and

reducing soreness after intense physical activity.1 Several

studies have investigated the apparent contradictory effects

of massage on athletic performance using different massage

techniques and durations of massage.2-9

The few well-controlled studies that have investigated

massage have beenmainly focused on its potential to promote

recovery from fatigue and enhance athletic performance.

th and Community Studies, Unitec, New Zealand.th and Community Studies, Unitec, New Zealand.th and Community Studies, Unitec, New Zealand.rt, Unitec, New Zealand.ort: No external funds were received for this

for reprints to: Boris Gutnik, PhD, School ofunity Studies, Unitec New Zealand, Private BagNew Zealand (e-mail: bgutnik@unitec.ac.nz).August 23, 2004.

0005 by National University of Health Sciences.pt.2005.09.015

However, these studies have also produced contradictory

results.1,4,10-12 There appears to be little in the literature

regarding the effects of massage when used as a method of

enhancing recovery from fatigue after isometric contractions

of the small distal hand muscles. Investigating fatigue in the

intrinsic muscles of the hand has application in studying

common occupational and recreational tasks involving grip

and manipulation of objects between thumb and fingers.

The aim of this research was to investigate the effect of

local effleurage massage on the recovery from fatigue of the

hand muscles—specifically, the adductors of the thumb.

METHODS

Twelve healthy, right-handed volunteer male subjects

with a mean age of 25 F 2.8 years were recruited into the

study from the university population. None of the subjects

had any history of musculoskeletal injury, trauma, or disease

of the upper limb or hand. The study was approved by the

Human Research Ethics Committee, Unitec New Zealand,

Auckland, New Zealand, and all subjects gave informed

consent before testing began.

Fig 1. Custom-built electronic dynamometer and demonstration ofhand position as used during the experiment.

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697

The data collection was undertaken over 2 separate

testing sessions. Subjects were randomly allocated to

receive either rest (the first dependant variable) or massage

(the second dependant variable) at the first session. The 2

testing sessions were separated by at least 1 week to

minimize any training effects.

Two parameters, the maximal force of the isometric

adduction of the thumb (Fmax, expressed in newtons) and

the maximal gradient of force development as the steepest

slope of the force-time curve (Gmax, expressed in newtons

per second), were measured using a specially constructed

electronic dynamometer (Fig 1) with a known accuracy of

0.1%.13 The study used a maximal isometric contraction

where participants were asked to adduct the thumb as

forcefully and as fast as possible and to relax as quickly as

possible. In this case, the Fmax produced is smaller than the

maximal voluntary isometric contraction force developed

by the adductors of thumb (2-5 seconds of contraction) that

is measured in other studies.14 -19 Subjects were comfort-

ably seated in front of the dynamometer using a height adjust-

able chair that allowed consistency in subject positioning.

To minimize the possible influence of previous training

effects arising from dominant use, only the nondominant

hand was investigated. The left arm and trunk was strapped

to the chair to minimize flexion of the arm and body

movement. The chair height was adjusted so that subjects

could comfortably rest their pronated left arm on the

dynamometer with the elbow at approximately 908 of

flexion and the forearm in a horizontal position.

The thumb of the left hand was initially abducted to 908

and the interphalangeal joint placed against the center of the

button. The index finger rested alongside the lateral edge of

the boxlike elevation, and the plantar surface of the hand lay

flat on the surface of the dynamometer (Fig 1). The subject

was asked to sit in a relaxed upright posture, with the head

facing straight ahead and eyes fixed on a designated point.

Subjects were provided with headphones to receive audio

stimuli generated via the dynamometer software.

In response to audio stimulation (bbeepsQ), the subject

adducted the thumb against the button on the dynamometer.

Subjects were encouraged to undertake the movement as

fast as possible and with maximal force, and to subsequently

release as fast as possible. This type of contraction is

ostensibly isometric in nature, where the muscle develops

tension without changing length.20

Protocol 1: RestThe subject was positioned in front of the dynamometer

as outlined previously. In response to a succession of audio

stimuli (20 beeps), each separated by a resting interval

(randomly computer generated) of between 4 and 8 seconds,

the subject pushed with maximal effort against the button

(thumb adduction) and released as fast as possible. The

number (20) of stimuli delivered was large because of the

high variability in Fmax and Gmax between muscle con-

tractions. The minimum 4-second interval between stimuli

was considered to be sufficient to allow full recovery.21 The

Fmax and Gmax were calculated automatically by the

dynamometer software. The averages of these force and

gradient values were used to indicate the participant’s

prefatigue FVmax av and GVmax av.

These initial contractions were immediately followed by

a fatigue-inducing exercise consisting of a 1-minute

sustained maximal isometric contraction against the button.

This fatigue protocol was similar to that outlined by Milner-

Brown et al.18 Participants were then unbuckled from the

chair and underwent 5 minutes of rest in the horizontal

position on a treatment table.

Immediately after either the massage or rest, the subject

was again positioned in the front of the dynamometer and,

in response to a succession of 20 audio stimuli, pushed

maximally against the button as fast and as hard as possible.

Again, the average force and gradient values of the

contraction were calculated to provide the postfatigue

results of FUmax av and GUmax av.

Protocol 2: MassageThe same protocol was used, but instead of the

condition of rest, subjects underwent 5 minutes of

effleurage massage (Fig 2). This massage consisted of

slow, rhythmic, deep stroking applied with the operator’s

reinforced thumb along the long axis of the dorsal aspect

of the adductor muscles of the thumb from the radial

border of the second metacarpophalangeal joint to the base

of the radial border of the second metacarpal. Water-

soluble massage oil was used to decrease skin friction. An

experienced osteopath (RM) performed the massage

intervention on all subjects. The massage was not formally

standardized for contact pressure or rate of application but

Fig 2. Diagram to illustrate experimental design. Subjects were randomly allocated to start with the rest or massage protocols. Thealternate protocol was undertaken at the subsequent testing session.

Fig 3. Bar chart demonstrating the mean maximum force ( Fmax av)for rest and massage protocols. Bars represent mean values F SD.Mean values calculated from 20 trials.

Fig 4. Bar chart demonstrating the mean maximal gradient( Gmax av) for the rest and massage protocols. Bars representmean values F SD. Mean values calculated from 20 trials.

698 Journal of Manipulative and Physiological TherapeuticsYoung et alNovember/December 2005Effleurage Massage Muscle Fatigue

was delivered within the pressure comfort tolerance of the

subject. Subjectively, the operator reported that all massage

was of a similar magnitude of pressure.

Statistical AnalysisTwo-tailed Student t tests were used to compare groups,

and 95% confidence intervals (CIs) were calculated for the

mean differences between groups. a was set at .05. A further

descriptive analysis of data was undertaken to record the

effect of massage on each individual subject after fatigue.

Two variables (Fmax av and Gmax av) were calculated for

each individual. The changes in these variables after

massage compared to rest were used to indicate the direction

of effect of massage in the recovery from fatigue.

In the individual analysis, the subjects who showed the

most beneficial effect from the massage were considered to

be those who increased the Fmax av and Gmax av greater

than +5% in comparison to the rest protocol. Those who

showed a detrimental effect from the massage (ÿ) were

Table 2. Overall effect of massage on maximal force and maximal gradient

Subject 1 2 3 4 5 6 7 8 9 10 11 12

%Fmax av ÿ ÿ 0 0 ÿ + ÿ 0 ÿ + + 0

%Gmax av ÿ + 0 ÿ 0 0 0 0 0 ÿ + +

Overall effect ÿ ? 0 ÿ ÿ + ÿ 0 ÿ ? + +

%Fmax av represent percentage mean maximal force change with massage over rest; %Gmax, percentage mean maximal gradient of force change with

massage over rest; +, beneficial effect (increase in Fmax av and Gmax av greater than +5% in comparison to the rest protocol); 0, no effect (less than 5%

change in comparison to rest protocol); ÿ, detrimental effect (decrease in Fmax av and Gmax av greater than +5% in comparison to the rest protocol); ?,

equivocal effect (increase/decrease in one parameter occurs with opposite effect in other parameter).

Table 1. Mean values for maximum force and maximal gradient pre- and postfatiguing exercise for rest and massage protocols

Rest protocol Massage protocol

Mean

differencea95% CI for

mean difference

P value

for mean

difference

Effect

statistic

95% CI for

effect statisticPrefatigue Postfatigue Prefatigue Postfatigue

Fmax (N) 56.77

(13.95)

54.71

(15.01)

58.53

(16.04)

55.34

(16.01)

0.63 ÿ12.55 to

13.8

.92 0.04 ÿ0.8 to 0.9

Gmax (N/s) 419.42

(142.22)

400.11

(170.66)

428.73

(126.36)

419.59

(151.04)

19.48 ÿ117.33 to

156.30

.77 ÿ0.12 ÿ0.8 to 1.0

All values are mean F SD.a Mean difference for Fmax is calculated between rest protocol postfatigue Fmax and massage protocol postfatigue Fmax. Mean difference for Gmax is

calculated between rest protocol postfatigue Gmax and massage protocol postfatigue Gmax.

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699

considered to be those who decreased the Fmax av and

Gmax av less than 5% (in comparison to the rest protocol).

No effect (0) was indicated if the difference in these

indexes between the rest and massage protocols was greater

than ÿ5% but less than +5%.

RESULTS

There was no significant difference in maximal force

between the subjects before participating in either the rest or

massage (95% CI, ÿ14.5 to 11.0 N; t22 = 2.07; P = .78).

The maximal force recorded after the massage protocol

was not significantly different from the maximal force

recorded after the rest protocol (Fig 3), with a mean

difference of only 0.63 N (95% CI, ÿ12.55 to 13.80 N;

t22 = 2.07; P = .92). The maximal gradient of force

development after the massage protocol was not signifi-

cantly different from the maximal gradient recorded after the

rest protocol (Fig 4), with a mean decrease in gradient

of 19.48 N/s (95% CI, ÿ117.33 to 156.30 N; t22 = 2.07;

P = .77). A summary of the results including effect sizes is

presented in Table 1.

Individual analysis of the 2 fatigue variables is presented

in Table 2. Three participants received some beneficial

effect from the massage, and 5 subjects showed a de-

trimental effect.

DISCUSSION

This investigation was carried out to evaluate the

possible effect of effleurage massage in the recovery from

fatigue of the thumb adductors, ostensibly the first dorsal

interosseous and adductor pollicis muscles.22 Previous

studies have investigated fatigue of the first dorsal inteross-

eous muscle and were based on different models of

movement—the abduction or the flexion force generated

by the index finger.14,17,18,23 The isometric adduction of the

thumb is most likely due to the contraction of the first dorsal

interossei and the adductor pollicis muscles.

Muscular fatigue is evidenced by reduction in maximal

force, shortening velocity, gradient of force development,

and prolongation of relaxation.24,25 The results of this study

support those studies that have reported no effect of

massage during long-term recovery6 and those that suggest

that massage has no significant effect on performance.5

Although it is important to note that these latter 2 studies

investigated large muscle group performance in the sporting

setting, the current study investigated fatigue recovery in

small muscles of the hand with differing composition of

muscle fiber types than large muscles.

The adductor pollicis muscle, which is actively involved

in thumb adduction, is composed of more type I fibers (slow

twitch fibers—80%) than the first dorsal interossei (50%),

and these fibers show differences with regard to resistance

to fatigue.26

The classic view is that there is a positive correlation

between fatigability of a muscle and the intrinsic proportion

of fast twitch fibers.27 It is possible that the 1-minute

maximum voluntary sustained contractions recommended

by Milner-Brown et al18 and used in the present study were

not sufficient to fatigue the adductor pollicis muscle because

it is composed of a large number of slow twitch fibers and

700 Journal of Manipulative and Physiological TherapeuticsYoung et alNovember/December 2005Effleurage Massage Muscle Fatigue

is, therefore, resistant to fatigue. Mills and Thompson17

used 1.5 minutes of sustained contraction, and this elicited

significant fatigue, but in that particular study, only the first

dorsal interossei was used.

The results of our study show a wide variation of

response to the fatiguing exercise. Some subjects showed a

decrease in force and gradient, others exhibited no change,

and the remainder showed an increase in values. A wide

variation in fiber type proportions in the intrinsic hand

muscles has been shown in the autopsy studies.21,26 The

variation of the proportion of different types of muscle

fibers between subjects may help to explain the variability

in response because of a greater number (increased

resistance to fatigue) or lesser number (smaller resistance

to fatigue) of slow twitch fibers.

Previous studies that have investigated the effect of

fatigue on force development of the first dorsal interossei

muscles have measured the reduction of the maximal

voluntary contraction force.14-19 In this present study, the

pre- and postfatigue values of Fmax were analyzed. The

subjects were all requested to adduct their thumbs as

forcefully and as quickly as possible. This is different to

the maximal voluntary contraction force (2-5 seconds of

contraction) because there is no time for the individual

tetany to fuse. Therefore, the force produced would be

markedly smaller than in a longer contraction where a state

of tetany could develop. There are no reports on the

relationship between the maximal voluntary contraction

force and the Fmax, but the mechanisms of recruitment and

the muscle contraction are the same. It is assumed that

because fatigue results in a reduction in the maximal force

development, the Fmax will also be reduced with fatigue.

Many studies have reported psychological regeneration

as a beneficial effect of massage.1,5,28-30 Samples30 reported

that the effect of massage may be largely subjective. There

was no significant physical benefit of massage in Fmax or

Gmax in the present study. If it is assumed that there is little

or no physiological benefit of massage in expediating

recovery from fatigue,1,4 there still remains the possibility

of a positive psychological effect. Although, not inves-

tigated in the present study, the psychological effects of

massage on motor tasks may be a worthwhile avenue for

further investigation.

CONCLUSIONS

Effleurage massage was not an effective intervention for

enhancing the restoration of postfatigue Fmax and Gmax in

the small muscles of the hand. The wide variation in

response to this massage protocol may support the notion

that there is no universal effect of effleurage massage.

Further research is needed about fatigue recovery and

performance-based effects of massage with respect to the

small muscles of the hand.

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