Comparison of Passive Stretching Versus Massage on Preventing the Symptoms of Delayed Onset Muscle Soreness in Normal Adults.

IDL - International Digital Library Of
Medical and Research
Volume 1, Issue 5, May 2017 Available at: www.dbpublications.org
International e-Journal For Medical And Research-2017
IDL - International Digital Library 1 | P a g e Copyright@IDL-2017
Comparison of Passive Stretching Versus
Massage on Preventing the Symptoms of
Delayed Onset Muscle Soreness in Normal
Adults.
Mr. Ruth Magedelin. R
Mr. Saravana Hariganesh. M
OBJECTIVE: To compare the effectiveness of passive stretching versus massage on
preventing
the symptoms of delayed onset muscle soreness in normal adults.
STUDY DESIGN: Quasi- Experimental study design.
SUBJECTS: 50subjects, with the age group of 18-21 years of both the genders were
selected. INTERVENTION: Subjects were randomly divided into 2 groups (Group A&
Group B), 25 subjects in Group A received passive stretching and 25 subjects in Group
B received Massage after 3 hours of inducing DOMS.
OUTCOME MEASURE: Pain, Elbow Range of Motion and swelling were assessed by
Visual analogue scale, goniometer, Inch tape.
RESULTS: Statistical analysis was done by using independent ‘t’ test and paired ‘t’
test which showed there is no statistical significant difference between Group A(Passive
stretching) and Group B(Massage).
CONCLUSION: The result of this study concludes that massage decreased the pain
immediately after intervention and regained the Elbow Range of Motion at immediately
at 24 hours, at 48 hours and 72 hours than passive stretching. But massage and passive
stretching has equal effect on pain reduction at 24hours, 48 hours and 72 hours after
intervention. Similarly they both have equal effect on Arm Circumference.
KEY WORDS: Delayed onset muscle soreness, Eccentric exercise, Elbow flexors,
Muscle strength, Elbow Range of motion, Passive stretching, Massage.

Delayed onset of muscle soreness (DOMS), is defined as the sensation of
discomfort or pain in the skeletal muscle following physical activity, usually eccentric,
to which an individual is not accustomed or any individual engaging in a new physical
activity, or those that have suddenly increase exercise volume and in intensity, has likely
experience Delayed onset of muscle soreness 1
.
Delayed onset muscle soreness(DOMS) is a predictable painful condition which often
occurs after unaccustomed eccentric exercise. It is begins to develop approximately 12
to 24 hours after the cessation of exercise. Although the time course varies, the signs and
symptoms, which can last up to 10 to 14 days, gradually dissipate2
.Almost every
individual unaccustomed to exercise who begins a resistance training program,
particularly a program that includes eccentric exercise experience, muscle soreness.
Delayed onset muscle soreness is caused by inflammation of the damaged muscle or
connective tissue and efflux of substances from the damaged tissue to the extra cellular
space that sensitize the free nerve endings. Delayed onset muscle soreness is thought to
be the result of activation of group IV receptor, which are responsible for the
transmission of dull aching pain signals. These receptors can respond to pressure and
shear stress and chemical substance, such as bradykinin, serotonin, and histamine, that
accumulate in the interstitium. The responses of group IV receptors to any one stimulus
may be sensitized and potentiated if the chemical environment of the interstitium is
altered. This is a possible mechanism for development of Delayed onset of muscle
soreness after eccentric exercise.4
Exercise-induced muscle soreness falls into two categories: Acute and delayed
onset.Acute muscle soreness develops during or after strenuous exercise performed to
the point of muscle exhaustion. This response occurs as a muscle becomes fatigue
during acute exercise because of the lack of adequate blood flow and oxygen (ischemic)
and a temporary buildup of metabolites, such as lactic acid and potassium, in the
exercise muscle. The sensation is characterized as a feeling of burning or aching in the
muscle2
.

The incidence of Delayed onset of muscle soreness is difficult to calculate, because most
people who experience it do not seek medical attention, instead accepting Delayed onset
of muscle soreness as temporary discomfort. Every healthy adult most likely has
developed Delayed onset of muscle soreness on countless occasions, with the condition
occurring regardless of the person’s general fitness level. However, although it is
experienced widely, there are still controversies regarding the prevention and treatment
of Delayed onset of muscle soreness is also questionable2
.
It is commonly held a opinion in clinical and fitness settings that the initial onset of
Delayed onset of muscle soreness can be prevented or at least kept to a minimum by
progressing intensity and volume of exercise gradually, by performing low- intensity
warm-up and cool-down activities, or by gentle stretching the exercised muscle before
and after strenuous exercise2
.Although these techniques are regularly advocated and
employed, little to no evidence in the literature supports their efficacy in the prevention
of Delayed onset of muscle soreness.E Ernst state that ‟ An effective treatment has been
sought out for many years . Among the treatments triedare Tens, ultrasound, stretching
etc,. To date, none of these approaches has been fully convincing”3
.Massage is widely
used as a therapeutic modality for recovery from musclefatigue and injury and is the
probably one of the most popular treatment after unaccustomed activity.
A number of authors have examined the effects of massage on Delayed onset of muscle
soreness and indirect markers of muscle damage such as impairment of muscle function,
swelling, and changes in muscle protein in the blood4
.
This study is to compare the effectiveness of passive stretching and manual massage on
preventing the symptoms of delayed onset of muscle soreness.
Aim of the Study
 To find the effectiveness of passive stretching in reducing the symptoms of delayed
onset muscle soreness in normal adults.
 To find the effectiveness of massage in reducing the symptoms of delayed onset
muscle soreness in normal adults.
 To compare the effectiveness of passive stretching versus massage in reducing the
symptoms of delayed onset muscle soreness in normal adults.

Delayed onset muscle soreness is a frequent problem after unaccustomed exercise. No
universally accepted treatment exists. Passive Stretching and massage therapy is often
recommended for this condition but uncertainly exists about their effectiveness.
Generally passive stretching is considered to be effective but reviews are not supporting
this. This study is intended to find whether passive stretching or massage reduces the
symptoms of delayed onset of muscle soreness in normal adults after their unaccustomed
activities like sports meet in college. Therefore the need of the study is to find which
technique (passive stretching or massage) have quick recovery, reduces the symptom of
soreness, decrease days of impairment& decrease the rehabilitation time.
METHODOLOGY
Study Design: Experimental design. Study Type: Comparative study. Sample Size: 50
students. Sampling Method: Random sampling. Study Duration: 3 Days (72hrs) per
subject. Study Setting: SRM College of Physiotherapy SRM University, Kattankulathur.
Inclusion Criteria: Both male and female, 18-21 years of age & who are willing to
participate in the study Exclusion Criteria: Subjects with recent fracture of upper
extremity, Subjects with musculoskeletal problem in shoulder or elbow joint or wrist
joint, subjects with any congenital deformity or contracture in upper extremity, regular
Sports persons, subject who are regular to gym& subjects under any resisted exercise
program
PROCEDURE
From subjects written informed consent is obtained and those who satisfied the inclusion
and exclusion criteria were selected randomly and divided into two groups (Group A&
Group B) with 25 participants in each groups. The individuals in both the Groups(A&B)
were made to do eccentric contraction of biceps brachi muscle of non dominant hand to
induce soreness using dumbbells. After 3hours of eccentric contraction of biceps brachii
both the interventions Passive Stretching and Massage was applied on subjects of
respective groups on non dominant arm to prevent the symptoms of delayed onset
muscle soreness. Before the intervention, immediately after the intervention, in 24

hours, in 48 hours and in 72 hours readings were taken for pain, Range of motion,
swelling were assessed by Visual analogue scale, inch tape by measuring Arm
circumference and Range of motion by goniometer. And these readings were noted and
used for statistical purpose.
To induce delayed onset muscle soreness in biceps brachii subjects are instructed to do
10 sets of 6 maximal voluntary eccentric contractions of elbow flexors on the non
dominant side in standing position with the help of the dumbbells Subjects tried with
different dumbbells and10 RM decided, this considered as the weight of the dumbbells
GGRROOUUPP AA IINNTTEERRVVEENNTTIIOONN
After 3hrs4
of inducing delayed onset muscle soreness Group A subjects received
passive
stretching of non dominant biceps brachii muscle. Passive Stretching were held for 30
sec of 5 sets.
GGRROOUUPP BB IINNTTEERRVVEENNTTIIOONN
After 3hrs4
of inducing delayed onset muscle soreness group B subjects received
massage to non dominant biceps brachii muscle. Subjects were instructed to wear
minimal clothing for the appropriate arm in supine lying position. Pillow was placed
along the side of trunk so that they can rest on it in a degree of slight abduction and
flexion of shoulder. Powder used as a lubricant the10-minute massage given massage
techniques consisted of stroking, effleurage, petrissage(kneading), friction, hacking,
picking up and repeated effleurage of elbow to shoulder.4
ASSESSMENT PROCEDURE
Symptoms of delayed onset muscle soreness assessed by Visual Analogue Scale (Vas)
Goniometeric Measurements& Upper Arm Circumference Outcome measures were
assessed before the intervention, immediately after the intervention, 24 hrs after the
intervention, 48 hrs after the intervention, 72 hrs after the intervention from both the
groups.
Table: 1 Comparison of VAS score pre and post test in Group A and Group B
GROUP A GROUP B
Mean SD Paired t
test
P
Value
Mean SD Paired t
test
P
Value

PRE TEST 4.80 1.354 5.283 0.000
***
4.36 1.287 4.599 0.000
***POST TEST 1 3.44 1.325 2.40 1.871
PRE TEST 4.80 1.354 18.504 0.000
***
4.36 1.287 16.937 0.000
***POST TSET 2 0.08 0.400 0.00 0.000
PRE TEST 4.80 1.354 17.725 0.000
***
4.36 1.287 16.937 0.000
***POST TEST 3 0.00 0.000 .00 00.000
PRE TEST 4.80 1.354 17.725 0.000
***
4.36 1.287 16.937 0.000
***POST TEST 4 0.00 0.000 0.00 0.000
 PRE TEST = Before the intervention, POST TEST1= Immediately after the intervention, POST TEST 2= 24 hrs after the
intervention, POST TEST 3=48 hrs after the intervention, POST TEST 4= 72 hrs after the intervention.
Table 2: Comparison of Arm circumference pre and post test in Group-A & Group B
GROUP A GROUP B
Mean SD Pair t
Test
P
value
Mean SD Pair t
Test
P
value
PRE
TEST-
POST
TEST 1
0.16400 0.18000 4.556 0.000
***
0.180 0.076 11.784 0.000
***
PRE
TEST–
POST
TEST 2
0.30000 0.18708 8.018 0.000
***
0.380 0.132 14.363 0.000
***
PRE
TEST-
POST
TEST 3
0.30000 0.18708 8.018 0.000
***
0.404 0.203 9.948 0.000
***
PRE
TEST–
POST
TEST 4
0.30000 0.18708 8.018 0.000
***
0.404 0.203 9.948 0.000
***
 *** - There is a statistical significance difference between Pre and Post test in the Arm Circumference for
Group A & Group B at 95% [P < 0.05] PRE TEST = Before the intervention, POST TEST1= Immediately

after the intervention, POST TEST 2= 24 hrs after the intervention, POST TEST 3=48 hrs after the
intervention, POST TEST 4= 72 hrs after the intervention.
Table 3: Comparison of Elbow Range of Motion pre and post test in Group A & Group
B
GROUP A GROUP B
Mean SD Pair t
Test
P
value
Mean SD Pair t
Test
P
value
PRETEST-
POSTTEST1
2.120 0.526 20.152 0.000
***
1.44000 1.15758 6.220 0.000
***
PRETEST–
POSTTEST2
4.440 1.003 22.126 0.000
***
3.24000 2.60256 6.225 0.000
***
PRE TEST-
POSTTEST3
4.440 1.003 22.126 0.000
***
3.24000 2.60256 6.225 0.000
***
PRE TEST–
POSTTEST4
4.440 1.003 22.126 0.000
***
3.24000 2.60256 6.225 0.000
***
*** - There is a statistical significance difference between Pre and Post test in the Range of motion for Group A &
Group B at 95% [P < 0.05] PRE TEST = Before the intervention, POST TEST1= Immediately after the intervention,
POST TEST 2= 24 hrs after the intervention, POST TEST 3=48 hrs after the intervention, POST TEST 4= 72 hrs after
the intervention.

Table 4: Comparison of VAS score between Group A and Group B.
Groups Mean SD Independent t Test P Value
POST TEST1 Group A 3.44 1.325 2.268 0.028
***Group B 2.40 1.871
POST TEST2 Group A 0.08 0.400 1.000 0.322
NSGroup B 0.00 0.000
POST TEST3 Group A 0.00 0.000 0.343 0.733
POST TEST4 Group A 0.00 0.000 0.343 0.733
*** - There is statistical significance difference between Group A and Group B at 95%[P˂0.05]NS - Not
statistical significance difference between Group A and Group B at 95%[P˂0.05]
PRE TEST = Before the intervention, POST TEST1= Immediately after the intervention, POST TEST 2=
24 hrs after the intervention, POST TEST 3=48 hrs after the intervention, POST TEST 4= 72 hrs after the
intervention.
Table 5: Comparison of Arm circumference between Group A and Group B.
GROUPS Mean SD Independent
t Test
P value
POST TEST 1 Group A 25.8000 2.45085 0.325 0.746
NS
Group B 26.0120 2.14599 0.325 0.746
NS
POST TEST 2 Group A 25.6640 2.45015 0.225 0.823
NS
Group B 25.8120 2.18390 0.225 0.823
NS
POST TEST 3 Group A 25.6640 2.45015 0.188 0.852
NS
Group B 25.7880 2.20857 0.188 0.852
NS
POST TEST 4 Group A 25.6640 2.45015 0.188 0.852
NS
Group B 25.7880 2.20857 0.188 0.852
NS
NS - Not Statistical significant between Group A and Group B at 95%[P˃0.05]
PRE TEST = Before the intervention, POST TEST1= Immediately after the intervention, POST TEST 2= 24 hrs after
the intervention, POST TEST 3=48 hrs after the intervention, POST TEST 4= 72 hrs after the intervention.

Table 6: Comparison of Range of motion between Group A and Group B
GROUPS Mean SD Independent
t Test
P value
POST TEST 1 Group A 136.3200 5.91411 2.076 0.043
***
Group B 132.9600 5.52630 2.076 0.043
***
POST TEST 2 Group A 138.6400 6.01997 2.289 0.027
***
Group B 134.7600 5.96713 2.289 0.027
***
POST TEST 3 Group A 138.6400 6.01997 2.289 0.027
***
Group B 134.7600 5.96713 2.289 0.027
***
POST TEST 4 Group A 138.6400 6.01997 2.289 0.027
***
Group B 134.7600 5.96713 2.289 0.027
***
*** - There is statistical significant between Group A and Group B at 95%[P˂0.05]
PRE TEST = Before the intervention, POST TEST1= Immediately after the intervention, POST TEST 2= 24 hrs after
the intervention, POST TEST 3=48 hrs after the intervention, POST TEST 4= 72 hrs after the intervention.
RESULTS
Comparison of VAS score pre and post test in Group A (passive stretching) &Group B
(massage) shows there is a significant difference between pre and post test at
immediately after the intervention, 24,48 and 72 hours at 95%[p˂0.05].
Comparing the pre and post test of arm circumference in Group A(passive stretching)&
Group B (massage) there is a significant difference between pre and post test at
immediately after the intervention, 24,48 and 72 hours at 95%[p˂0.05].
Comparing the pre and post test of elbow range of motion in Group A (passive
stretching) & Group B (massage) shows there is a significant difference between pre and
post test at immediately after the intervention, 24,48 and 72 hours at 95%[p˂0.05].
Comparison of VAS score between Group A and Group B shows there is statistical
significant difference exist in post test1 of Visual analogue scale score between Group

A(passive stretching) and Group B(massage) at 95%[P˂0.05]. There no statistical
significant difference exist in post test2, post test3, post test4 at 95% [p˃0.05].
Comparison of Arm circumference between Group A and Group B shows there is no
statistical significant difference exist in post test of Arm circumference between Group
A(passive stretching) and Group B(massage) at 95% [P˃0.05].
Comparison of Elbow Range of Motion between Group A and Group B shows there is
statistical significant difference exist in post test of Elbow Range of motion between
Group A(passive stretching) and Group B(massage) at 95%[P˂0.05].
DISCUSSION
Delayed onset muscle soreness is a symptom of eccentric exercise induced muscle
damage and occurs 8-12 hours post exercise, when the affected muscle contracts or
stretches; it peak at 2 to 3days and slowly dissipate by 8-10 days.
On comparing pre and post test of VAS score in passive stretching group P value of
post test is P˂0.05 hence there is a statistical significant difference between pre and post
test, this implies that passive stretching group has effect on reducing the pain. Similarly
pre and post test of VAS score of massage group shows reduction of pain.
On comparing pre and post test of Arm Circumference measurement in passive
stretching group P value of post test is P˂0.05 hence there is a statistical significant
difference between pre and post test, proves passive stretching group has effect in
reducing the swelling . Same way on Group B too shows statistical difference between
pre and post values of arm circumference which implies massage has an effect on
reducing swelling due to induced DOMS.
On comparing pre and post test of Elbow range of motion in both the groups each
group shows statistically significance difference between pre and post test, implies both
the interventions has effect on increasing in Range of Motion.
On comparing the VAS score between passive stretching group and massage group P
value is ˃ 0.05 hence there is no statistical significance difference in 24hours(post test
2), 48hours(post test 3), 72hours(post test 4), but P value of post test 1 is ˂0.05 hence
there is a significant difference immediately after the intervention. This proves massage

is effective than passive stretching on preventing the symptoms of delayed onset muscle
soreness.
On comparing the Arm Circumference measures between passive stretching group and
massage group P value of post test is P˃0.05 hence there is no statistical significance
immediately after the intervention(post test 1), 24hours(post test 2), 48 hours(post test
3), 72hours (post test 4). This means the effects are same on comparing passive
stretching group and massage group.
On comparing the Elbow Range of Motion measures between passive stretching group
and massage group P value of post test are ˂0.05 hence there is a statistical significant
difference between passive stretching group and massage group.
All the reviews except Weber et al reported that massage had positive effects on
Delayed onset of muscle soreness, this study also found that massage intervention
reduces pain and improve in Range of Motion when compared to the passive stretching
group and indicate passive stretching could not prevent Delayed onset of muscle
soreness as it is suggested in reviews.26
It is difficult to explain how massage reduces Delayed onset of muscle soreness, because
no authors yet described the effects of massage on cellular events or patho physiologic
changes in the muscle or connective tissue after eccentric exercise. Increasing blood
flow appears to be a major consequence of massage.17
Increasing in blood and lymph
flow may enhance removal of pain substrates that starts to accumulate in the injured
area, reducing swelling. In this study it has been found that there is reduction of pain
and increase in Range of Motion in massage group when compared with passive
stretching Group as it is discussed in above paragraphs.
CONCLUSION
The result of this study Conclude that Massage decreased the pain and increased the
Range of Motion but did not reduce swelling , thereby massage is effective than passive
stretching on preventing symptoms of delayed onset of muscle soreness.

Limitations of the study are only young age group has taken & less number of subjects
involved. In future studies isokinetic dynamometer can be used for inducing Delayed
onset of muscle soreness& Cryotherapy can be included in the study to compare the
effects.
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Comparison of Passive Stretching Versus Massage on Preventing the Symptoms of Delayed Onset Muscle Soreness in Normal Adults.

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