BRINGING SCIENCE TO TREATMENT

Don’t jump the gun on percussive massage

Percussion massage guns are gaining popularity among professional and recreational athletes and creeping into rehab clinics. Marketers claim that they improve performance, aid in recovery, promote relaxation, break up scar tissue, speed up healing, and more. However, a literature search reveals only two articles concerning the efficacy or use of these devices.

The first is an Austrian study that hypothesized that applying percussive massage to the gastrocnemius would improve dorsiflexion range of motion without affecting plantar flexion strength(1). The investigators enrolled sixteen healthy recreationally active males. Each subject was randomly assigned to undergo the experimental or the control trial. Two days later, they completed the opposite trial.

The experimental trial consisted of a five-minute application of percussive massage to the entire gastrocnemius muscle. During the control trial, subjects only sat in the experimental position for six minutes. Before and after each trial, while positioned on an isokinetic dynamometer with their knee straight, the participants self-selected a dorsiflexion position defined by maximum discomfort as their end range of motion. The researchers measured the maximum voluntary plantarflexion contraction using the same positioning in the isokinetic dynamometer.

The analysis found a significant increase in the dorsiflexion range of motion after applying the percussion treatment. However, this study has many limitations. The sample size was extremely small, and while subjects were blind to the study’s objective, they were not blind to the application of the variable of treatment or no treatment. When looking at the mean end range results after both the intervention and the control period, the difference was only 2.17º, a range that falls well within the 7.38º (percussion) and 9.73º (control) standard deviation. Despite the fact that the change in the range of motion mean reached significance after the percussive treatment, the small sample size and difference between the means, self-selected outcomes, and overall study design make it difficult to draw definitive conclusions.

Of greater concern is the case report of a 25-year-old Chinese woman who presented to the hospital with severe pain in her quads and dark urine(2). The woman cycled at her local gym at an intensity of six to seven miles per hour for 30 minutes two and three days before coming to the hospital. After each cycling session, her coach administered percussive massage treatment to her thigh muscles for 10 minutes each. Other than mild iron deficiency anemia, the woman was previously in good health.

The hospital workup revealed “undetectably high” serum creatinine kinase levels and hemoglobinuria. The woman was diagnosed with severe rhabdomyolysis and underwent treatment in the hospital for two weeks. Fortunately, she was released after that time and recovered without incident.

Rhabdomyolysis can be caused by trauma to the muscle, especially after exercise. In this case, the woman’s exercise intensity alone, also a trigger for rhabdomyolysis, was not significant enough to cause the muscle breakdown. The investigators concluded that the trauma caused by the percussion gun broke down the muscle fibers and resulted in the potentially life-threatening sequelae.

Practical implications

The fitness industry consists of businesses trying to earn money by selling gadgets to make people better athletes. One percussion gun sales copy claims that their gun is just like having a personal physical therapist. These gizmos appeal to the desire to make performance and recovery a passive endeavor. Beware the temptation to incorporate them into your treatment plan. Even if  the reasoning sounds plausible, it’s no better than snake oil if it lacks the science to support it.

Also, ask your athletes if they are using one at home. The directions for use aren’t scientifically proven guidelines. Without guidance, these devices may inflict more harm than good, especially if used after an intense therapy session. Lastly, the anemia in the Chinese woman might not be a factor in the development of rhabdomyolysis. However, the authors of the case study caution the use of percussive massage in anyone with this syndrome.

References

  1. J Sports Sci Med. 2020;19:690-94
  2. Phys Ther. 2021 Jan;101(1):pzaa199
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