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Introduction and Hypothesis: Perineal massage during labor reduces the need for episiotomy and shortens the length of the episiotomy. Pregnant women should be offered instrumented (EPI-NO) or manual perineal massage in labor. This study was conducted to determine the effect of perineal massage applied with (EPI-NO) and without an instrument during the active phase of labor on episiotomy rate and episiotomy length in women who gave birth vaginally., Methods: The study included 101 pregnant women aged 18-35 years, with gestational ages between 38 and 42 weeks and indications for vaginal delivery. Participants were randomly assigned to one of three groups: EPI-NO massage, manual massage, and control. The perineal massage was administered during the active labor phase (4- to 8-cm dilation) for 20 min in the intervention groups. Postpartum episiotomy rates and lengths were recorded using standardized forms. The research data were collected using the Introductory Information Form and Birth Assessment Form., Results: The episiotomy rate was found to be 33.3% in group I, 75.0% in group II, and 74.4% in the Control group, and a statistically significant difference was found between the groups (p = 0.001; p < 0.01). The mean episiotomy length of the women was 1.5 cm (mean ± SD: 1.50 ± 1.20) for group I, 3 cm (mean ± SD 2.70 ± 1.50) for group II, and 3.5 cm (mean ± SD 3.10 ± 2.00) for the control group (p < 0.000)., Conclusion: Perineal massage with EPI-NO was the most effective method at decreasing the episiotomy rate and shortening the episiotomy length compared with other groups., (© 2024. The International Urogynecological Association.)

Traffic police riders are exposed to prolonged static postures causing significant angular deviation of the musculoskeletal, including the lumbar angle (L1-L5). This postural alteration contributes to awkward posture, musculoskeletal disorders and spinal injury, especially in the lower back area, as it is one of the most severe modern diseases nowadays. Thus, the study aimed to evaluate the effect of lumbar support with a built-in massager system on spinal angle profiles among traffic police riders. A randomised controlled trial (pre-testpost-test control design) was used to assess spinal angle pattern while riding the high-powered motorcycle for 20 minutes. Twenty-four traffic police riders were randomly selected to participate and 12 riders were assigned to the control group and 12 riders to the experimental group. The pre-test and post-test were conducted at a one-week interval. Each participant was required to wear a TruPosture Smart Shirt (to monitor spinal posture). The TruPosture Apps recorded the spinal angle pattern. The data indicated that the police riders using motorcycle seat with lumbar support and built-in massager system showed a huge improvement in maintaining posture which only involves slight spinal angle deviation changes from the spinal reference angle throughout the 20 minutes ride. The data collected then were analysed using the Mann-Whitney test and Wilcoxon signed-ranked test to verify a statistically significant difference between and within the control and experimental groups. There were significant differences in all sensors between the control group and experimental groups (p<0.05) and within the experimental group. According to the findings, it can be said that the ergonomic intervention prototype (lumbar support with built-in massager system) successfully helps to maintain and improve the natural curve of the spinal posture. This indirectly would reduce the risk of developing musculoskeletal disorders and spinal injury among traffic police riders., Competing Interests: The authors have declared that no competing interests exist.

Background and Aim: Manual abdominal massage has been shown to effectively treat slow-transit constipation, but it is labor-intensive. To offer an alternative treatment option for constipation, the Bamk-001 automatic abdominal massage device was developed. The aim of this study was to assess the effect of the Bamk-001 device on symptom profiles and colon transit time (CTT) in patients with chronic constipation., Methods: Thirty-seven patients with chronic functional constipation diagnosed using the Rome IV criteria were enrolled prospectively from December 2018 to February 2019. All patients received device-assisted automatic abdominal massage for 15 min twice daily, once in the morning before breakfast and once at night, for 14 days. CTT was measured before and at the end of the study period. Slow-transit constipation and very-slow-transit constipation were defined as CTT ≥ 48 h and ≥ 72 h, respectively. Patients' symptom profiles regarding overall defecation satisfaction and device-related adverse events were analyzed., Results: Among the 37 patients, the mean age was 40.1 ± 11.8, and 5.4% (n = 2) were men. The Bamk-001 device significantly improved CTT from 54.0 (33.6-75.6) to 28.8 (18.0-52.8) h (p = 0.001) in patients with chronic constipation. In subgroup analysis, CTT improved significantly from 54.0 (33.6-75.6) to 28.8 (18.0-52.8) h (p = 0.003) and from 88.2 (74.4-124.8) to 45.6 (27.3-74.1) h (p = 0.005) in the slow-transit and very-slow-transit constipation groups, respectively (p = 0.001). Moreover, all patient symptoms were alleviated after treatment. No serious adverse events were reported., Conclusion: The Bamk-001 automatic abdominal massage device showed significant care efficacy, including the improvement in CTT and symptom profiles in patients with slow-transit constipation. The use of an automatic abdominal massage device as an adjunct in the management of constipation is a potentially beneficial intervention for patients with slow-transit constipation., (© 2020. Springer Science+Business Media, LLC, part of Springer Nature.)

This was a randomized, placebo-controlled study. The sample consisted of 3 groups of patients: an experimental group, massage application with lavender oil (n = 15); a placebo group, massage application with ultrasound gel (n = 15); and a control group (n = 15). Massage application was performed 3 hours after analgesic application. Pain levels of the patients in the experiment and placebo groups were evaluated with a Verbal Rating Scale (VRS) at the 30th minute and the 3rd hour after the application. Similarly, the pain level of patients in the control group was also evaluated with the VRS at 3 hours after the initial analgesic administration and following the 30th minute and the 3rd hour. Generally, the VRS scores of the 3 groups did not show a significant difference in terms of group and time interaction (P = .221). However, there was a significant difference in VRS scores between the experimental and control groups at the 30th minute after the massage (P = .036). This difference was caused by the lower pain level of the group, which had massage with lavender (2.66 ± .89) compared with the control group (3.80 ± 1.01). According to the study results, while only hand massage application after gynecologic surgery was effective for a short period in decreasing postoperative pain, it was determined that massage application with lavender had a longer effect in decreasing postoperative pain. The results of this study showed that this inexpensive and easy-to-apply method can be safely performed by nurses on postoperative patients and can support pain management of patients in the first hours after gynecologic surgery., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

"Foam Rolling" has been used in sports settings to increase range of motion and decrease muscle stiffness without decreasing muscle strength and athletic performance. However, there has been no study investigating the acute and prolonged effect of different durations of foam rolling intervention on muscle stiffness, and the minimum foam rolling intervention duration required to decrease muscle stiffness is unclear. Therefore, the purpose of this study was to investigate the acute and prolonged effect of different durations of foam rolling intervention on ROM, muscle stiffness, and muscle strength. The 45 participants were randomly allocated to 1 of 3 groups (30 s × 1 times group vs 30 s × 3 times group vs 30 s× 10 times group). The outcome measures were dorsiflexion range of motion, shear elastic modulus of medial gastrocnemius, and muscle strength before, 2 min and 30 min after foam rolling intervention. There were no significant differences before and 2 min after foam rolling intervention in 30 s×1 time group, whereas dorsiflexion range of motion was increased in both 30 s×3 times group (p = 0.042, d = 0.26) and 30 s× 10 times group (p < 0.01, d = 0.33). However, the increase in dorsiflexion range of motion was returned to baseline value after 30 minutes in both 30 s × 3 times group and 30 s × 10 times group. In addition, there were no significant changes in shear elastic modulus and muscle strength in all groups. This study suggested that foam rolling for more than 90 s or more of foam rolling was effective in order to increase the range of motion immediately without changing muscle stiffness and muscle strength., (© Journal of Sports Science and Medicine.)

Objective: Percussion massage guns are commonly used by professional athletes and nonathletes worldwide for warm-up and physical recovery; however, there are no published clinical or evidence-based reports on percussion guns regarding their benefits, indications, contraindications, and even side effects. The purpose of this case report is to describe the first case of rhabdomyolysis as a severe and potentially life-threatening illness following use of a percussion gun., Methods: A young Chinese woman with untreated iron deficiency anemia presented with fatigue and pain in her thigh muscles for 3 days and tea-colored urine for 1 day, after cycling and subsequently receiving percussion gun treatment by her coach for the purpose of massage and relaxing tired muscles. Muscle tenderness and multiple hematomas were found on her thighs, and her urinalysis indicated hemoglobinuria. Her serum creatine kinase was reported as "undetectably high," a hallmark of serious muscle damage leading to a diagnosis of severe rhabdomyolysis. Aggressive intravenous fluid resuscitation, urine alkalinization via intravenous alkaline solution, assessment of urine output, and maintenance of electrolyte balance were administered during hospitalization., Results: The patient's clinical presentation gradually improved with the decline of creatine kinase, and she recovered well during follow-up., Conclusion: A case of severe rhabdomyolysis after percussion massage should alert caregivers, sports professionals, and the public to suspect and recognize the potentially serious adverse effects of percussion guns and to ensure that percussion massage guns be used appropriately and safely in rehabilitation therapy, especially in individuals with an underlying disease or condition. Research is needed to examine the benefits, indications, contraindications, and adverse reactions of percussion guns., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Physical Therapy Association.)

The human hair follicle (HF) represents a promising drug delivery target as an anatomical entity by itself, but also as a gateway enabling dermal or systemic bioavailability of active cosmetic and pharmaceutical ingredients. Due to its morphological characteristics, the HF provides a mechanically driven transport process of nanoparticles (NPs) when external forces are applied. This mechanism was presented as the so-called ratchet effect within the framework of an in silico study published recently. To investigate the influence of massage frequency on the penetration depth of NPs, and, by this, to validate the results obtained in silico, we implemented a corresponding application protocol on an ex vivo porcine skin model. In this connection, we compared three different skin massage frequencies (4.2 Hz, 50 Hz, 100 Hz) for the topical application of cyanine 5-labeled silica NPs (Cy5-SNPs). To elucidate the interplay of frequency and particle size, we furthermore applied Cy5-SNPs of three different diameters (300 nm, 676 nm, 1000 nm). Confocal laser scanning microscopy was utilized to investigate the follicular penetration depth of Cy5-SNPs on cryohistological slices. By this, we could demonstrate that the massage frequency and the follicular penetration depth exhibit an inverse relation pattern. Thus, the highest follicular penetration depth was observed within the 4.2 Hz group, while the lowest follicular penetration depth was found within the 100 Hz group for each Cy5-SNP size category. Additionally, we found that 676 nm Cy5-SNPs penetrated significantly deeper into HFs than 300 nm Cy5-SNPs and 1000 nm Cy5-SNPs, respectively. Summarizing, our results show that a low massage frequency including a dominant radial direction component leads to deeper follicular penetration depths of NPs than automated 3D-oscillation massage at 50 Hz or 100 Hz. Thus, our findings are in line with recent in silico results. Regarding translational purposes, our results are of high interest, since a massage executed at 250BPM (4.2 Hz) is within a realizable range for manual application, e.g. for the implementation into clinical routines or the domestic use of drugs or cosmetics. Furthermore, the application of different massage frequencies offers the opportunity of patho-specific targeting as different anatomical parts of the HF can be reached., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Current recommendations by cardiac implantable electronic devices (CIEDs) manufacturers on electromagnetic interference (EMI) are based on extrapolations of studies exposing CIEDs to electromagnetic fields produced by Helmholtz coils and industrial equipment. There are currently little data whether commercially available electronic massagers can cause EMI in CIEDs in vivo. This is of interest as the use of electronic massagers is common in Asia., Methods: The study evaluated CIED patients before, during and after a 10-minute exposure to a commercially available electronic backrest upper body massager. Post-exposure sensing, pacing threshold, and lead impedance were compared to baseline values. The presence of artefacts, EMI, and adverse clinical events during exposure was recorded., Results: Eighty-six patients (59 pacemakers and 27 implantable cardioverter-defibrillators) with a total of 151 leads (60 atrial, 86 right ventricular, and 5 left ventricular) were evaluated. There was no incidence of EMI causing inappropriate inhibition of pacing or inappropriate defibrillation. There was no significant difference in the pacing threshold, sensing, and lead impedance post-exposure compared to baseline values., Conclusion: Our study, though limited by small numbers and exposure to only 1 type of electronic massager, shows that it is potentially safe for patients with CIEDs to use commercially available electronic massagers with similar characteristics as the one tested in this study., (© 2020 Wiley Periodicals LLC.)

Introduction: Chronic constipation is associated with various comorbidities and reduced quality of life. Current solutions, either pharmacological or invasive, show limited efficacy. Manual colon-specific massage is a well-established intervention to treat chronic constipation, but it should be applied daily. MOWOOT automatically provides intermittent colonic exo-peristalsis (ICE) treatment like that in manual massage., Methods: This study assessed the safety and effectiveness of the ICE device to treat chronic constipation due to neurogenic bowel dysfunction or idiopathic causes with high component of pelvic floor disorders. The ICE device was used daily for 20 minutes over 4 weeks. Each participant was followed for 9 consecutive weeks. The same outcome measures (primary: complete bowel movements per week; secondary: Knowles Eccersley Scott Symptom Score and Patient Assessment of Constipation Quality of Life among others) were assessed at baseline (V1), last intervention weeks (V2), and post-treatment (V3). Responders were defined for selected outcomes as better results at V2 respect to V1., Results: N = 92 adult patients constituted the intention-to-treat population, with N = 65 as the per protocol population. Adherence (quantity of treatment received) was ≥95% in the intention-to-treat population. Adverse events related with the treatment were low (8.7%). Using the device significantly increased the number of complete bowel movements per week (V2 - V1 = 1.8 [2.7], P < 0.0001), reduced the symptoms of chronic constipation (Knowles Eccersley Scott Symptom Score V2 - V1 = -3.9 [5.0], P < 0.0001), improved quality of life (Patient Assessment of Constipation Quality of Life V2 - V1 = -0.7 [0.8], P < 0.0001), and facilitated a reduction in laxatives. Colon transit and fecal consistency were not modified. There was a high number of responders (>70%)., Discussion: Considering safety, adherence, and efficacy being demonstrated, the results favor the use of MOWOOT to treat chronic constipation (Visual abstract, Supplementary Digital Content 1, http://links.lww.com/CTG/A440).(Equation is included in full-text article.).

Handheld percussive massage treatment has gained popularity in recent years, for both therapeutic use and in sports practice. It is used with the goals of increasing flexibility and performance, but also to accelerate recovery. However, until now, there has been no scientific evidence, which proves such effects. Therefore, the purpose of this study was to investigate the effects of a 5-min percussion treatment of the calf muscles on range of motion (ROM) and maximum voluntary contraction (MVC) torque of the plantar flexor muscles. Sixteen healthy male volunteers (mean ± SD; 27.2 ± 4.2 years, 1.79 ± 0.05 m, 79.4 ± 9.1 kg) were tested on two separate days with either a 5-min massage treatment of the calf muscles with a Hypervolt device or the control condition (sitting only). Before and after the treatments, dorsiflexion ROM and MVC torque of the plantar flexor muscles were measured with a dynamometer. Maximum dorsiflexion ROM increased with a large magnitude following the massage treatment by 5.4° (+18.4%; p = 0.002, d = 1.36), while there was no change in the control group. Moreover, MVC torque did not change following both the massage treatment and the control treatment. Similar to a conventional massage by a therapist, ROM can be increased by a handheld percussive massage treatment without having an effect on muscle strength., (© Journal of Sports Science and Medicine.)

Context: Several studies have reported that self-massage using a foam roller (FR) increased joint range of motion (ROM) immediately. However, the mechanism of increasing ROM by the FR intervention has not been elucidated., Objective: To clarify the mechanism by investigating properties and morphological changes of muscles targeted by the FR intervention., Design: An interventional study., Setting: An athletic training laboratory., Participants: Ten male college volunteers with no injuries in their lower limbs (mean [SD]: age 23.8 [3.2] y, height 173.2 [4.9] cm, weight 69.5 [8.6] kg)., Intervention: The FR intervention on the right plantar flexors for 3 minutes., Main Outcome Measures: Maximum ankle ROM, muscle hardness, and fascicle length of the gastrocnemius muscle at the neutral (0°), maximum dorsiflexion, and maximum plantar flexion positions. All measurements were conducted before (PRE) and after (POST) the FR intervention., Results: Dorsiflexion ROM increased significantly at POST (PRE: 13.6° [8.0°], POST: 16.6° [8.4°]; P < .001), although plantar flexion ROM did not change significantly between PRE and POST (PRE: 40.0° [6.1°], POST: 41.1° [4.9°]). There was no significant difference in muscle hardness and fascicle length between PRE and POST in any of the angles., Conclusions: Dorsiflexion ROM increased significantly by the FR intervention in the present study; however, muscle hardness and fascicle length did not change. FR may affect not only the muscle but also the fascia, tendon, and muscle-tendon unit. The FR protocol of the present study can be applied in clinical situations, because it was found to be effective to increase ROM.

Behm, DG, Alizadeh, S, Hadjizadeh Anvar, S, Mahmoud, MMI, Ramsay, E, Hanlon, C, and Cheatham, S. Foam rolling prescription: a clinical commentary. J Strength Cond Res 34(11): 3301-3308, 2020-Although the foam rolling and roller massage literature generally reports acute increases in range of motion (ROM) with either trivial or small performance improvements, there is little information regarding appropriate rolling prescription. The objective of this literature review was to appraise the evidence and provide the best prescriptive recommendations for rolling to improve ROM and performance. The recommendations represent studies with the greatest magnitude effect size increases in ROM and performance. A systematic search of the rolling-related literature found in PubMed, ScienceDirect, Web of Science, and Google Scholar was conducted using related terms such as foam rolling, roller massage, ROM, flexibility, performance, and others. From the measures within articles that monitored ROM (25), strength (41), jump (41), fatigue (67), and sprint (62) variables; regression correlations and predictive quadratic equations were formulated for number of rolling sets, repetition frequency, set duration, and rolling intensity. The analysis revealed the following conclusions. To achieve the greatest ROM, the regression equations predicted rolling prescriptions involving 1-3 sets of 2-4-second repetition duration (time for a single roll in one direction over the length of a body part) with a total rolling duration of 30-120-second per set. Based on the fewer performance measures, there were generally trivial to small magnitude decreases in strength and jump measures. In addition, there was insufficient evidence to generalize on the effects of rolling on fatigue and sprint measures. In summary, relatively small volumes of rolling can improve ROM with generally trivial to small effects on strength and jump performance.

Study Design: A randomized, single-blinded (the outcome assessor was unaware of participants' allocation group) controlled clinical trial., Objective: To investigate the effects of myofascial release therapy (MRT) over the suboccipital muscles, compared with self-MRT using a novel device, the INYBI tool, on pain-related outcomes, active cervical mobility, and vertical mouth opening, in adults with chronic non-specific neck pain (NSNP)., Summary of Background Data: MRT is used to manage chronic musculoskeletal pain conditions, with purported positive effects. The efficacy of self-MRT, compared with MRT, has been scarcely evaluated., Methods: Fifty-eight participants (mean age of 34.6 ± 4.7 yrs; range 21-40 yrs; 77.6% females, 22.4% males) with persistent NSNP agreed to participate, and were equally distributed into an INYBI (n = 29) or a control group (n = 29). Both groups underwent a single 5-minutes intervention session. For participants in the control group, MRT of the suboccipital muscles was performed using the suboccipital muscle inhibition technique, while those in the INYBI group underwent a self-MRT intervention using the INYBI device. Primary measurements were taken of pain intensity (visual analogue scale), local pressure pain sensitivity, as assessed with an algometer, and active cervical range-of-movement. Secondary outcomes included pain-free vertical mouth opening. Outcomes were collected at baseline, immediately after intervention and 45 minutes later., Results: The analysis of variance (ANOVAs) demonstrated no significant between-groups effect for any variable (all, P > 0.05). In the within-groups comparison, all participants significantly improved pain-related outcomes, and showed similar positive changes for mouth opening. Cervical range-of-movement- mainly increased after intervention for participants in the control group., Conclusion: Both, MRT and self-MRT using the INYBI, are equally effective to enhance self-reported pain intensity, and local pressure pain sensitivity in chronic NSNP patients. For cervical mobility, MRT appears to be slighlty superior, compared with the INYBI, to achieve improvements in this population., Level of Evidence: 2.

Background: Studies that examine the growth effects of massage at ages beyond infancy are rare. A recently developed massage chair (BEG-100) targets teenagers who want to increase their growth. The chair can stretch areas around the knee after fixating the knee and ankle areas., Methods: This is a clinical study that included 38 children aged 11 years whose heights ranged from 145.0 to 155.0 cm. We aim to observe the potential of a 24-week massage for growth promotion. We will also evaluate the changes in height percentile, height, height standard deviation score, bone age, height standard deviation score for bone age, growth rate, predicted height estimated from bone age, seated height-to-standing height ratio, weight, and body mass index. To confirm safety, the associated adverse events will be investigated., Objective: The aim of this study was to investigate the growth-promoting effect of BEG-100 in children with average height., Trial Registration: KCT0004673 (Clinical Research Information Service).

Introduction: Low back pain is a chronic recurrent symptom, which can lower the patient's quality of life. With technological development of automated home massage systems, now offers a promising alternative to physiotherapy. However, thus far, the effectiveness of such methods has not been evaluated. We aimed to compare the efficacy and cost-effectiveness of a massage chair with those of conventional physiotherapy for the treatment., Methods: This was a randomized controlled trial with a two-group parallel design. Following randomization and allocation, 56 participants were enrolled to receive either physiotherapy (n = 25) or mechanical massage using the massage chair (n = 31). Pain severity was measured using a visual analog scale (VAS) and satisfaction assessed with the McGill Pain Questionnaire (MPQ). Quality of life modification was analyzed using the Functional Rating Index (FRI). Cost-effectiveness was analyzed by comparing the sum of physiotherapy fees and monthly rental fees for chair massage., Results: Physiotherapy and massage chair were both effective for pain control as assessed with the VAS (P < .001), satisfaction as assessed by MPQ (P < .001) and life quality improvement as assessed by FRI (P < .001) in both groups. Both VAS and FRI scores were significantly higher for physiotherapy than for massage chair (P = .03 and P = .03, respectively). There was no significant difference in MPQ between the two groups. Massage chair therapy was more cost-effective than physiotherapy, at only 60.17% of the physiotherapy cost (P < .001)., Conclusions: The home massage chair system was cost-effective, but pain control and disability improved more with physiotherapy. However, our results showed that the massage chair is a promising treatment for pain control and quality of life modification, but efficacy is still superior in physiotherapy and the chair is not a replacement for physiotherapy., Trial Registration: Clinical Research Information Service, KCT0003157. Retrospectively registered August 2, 2018.

Purpose: Fascial adhesions can reduce range of motion (ROM). Different techniques of varying costs have been studied to release these adhesions and restore normal ROM, but none have compared instrument-assisted soft tissue mobilization (IASTM) with a roller massage stick. The objective was to compare the acute and residual effects of IASTM and a roller massage stick on active and passive hamstring ROM after a single treatment., Design: Prospective cohort study in a university laboratory., Methods: Sixteen (8M, 8F) recreationally active individuals (age 23.38±2.45 yrs). IASTM using Graston instruments and a roller massage stick were randomly applied to the hamstrings of the dominant or non-dominant leg for 3.5 minutes. Active and passive ROM were measured pre-intervention, immediately post-intervention, and 48-hrs post-intervention., Results: There was a main effect for time showing a significant increase in active and passive ROM from pre-intervention to immediate post-intervention (p<0.05) and from pre-intervention to 48-hr post-intervention (p<0.05). However, no interaction effect between treatment and time was found in either active or passive ROM (p>0.05)., Conclusions: IASTM and the roller massage stick were equally effective immediately and over time, but the roller massage stick is more affordable.

Context: Limited ankle dorsiflexion (DF) range of motion has been correlated with decreased flexibility of the gastrocnemius/soleus complex. Decreased ankle DF range of motion can lead to an increase in lower-extremity injuries, for example, acute ankle sprains, Achilles tendinopathy., Objective: The purpose of this study was to determine whether a single application of the intervention to the gastrocnemius/soleus complex via multidirectional self-myofascial release using a foam roller, multiplanar dynamic stretch performed in downward dog, or a combination of both techniques acutely improved ankle DF., Design: Subjects were assigned to groups via random card selection. Investigators provided verbal cues as needed to yield correct performance of interventions. Both interventions were performed twice for 1 minute using a dynamic walking rest of 30.48 m at a self-selected pace between interventions. Statistical analyses were completed using a 1-way analysis of variance, at α level ≤ .05., Setting: A convenience sample study., Participants: A total of 42 asymptomatic physical therapy students (18 females and 24 males) with mean age of 26.12 (4.03) years volunteered to participate., Interventions: Multidirectional self-myofascial release using a foam roller, multiplanar dynamic stretch performed in downward dog, or a combination of both techniques., Main Outcome Measures: Weight-bearing right ankle DF measurements were recorded in centimeters using a forward lunge technique (intraclass correlation coefficient = .98, .97, and .96)., Results: Data analysis revealed no significant difference between the 3 groups in all pre-post measurements (P = .82). Mean (SD) measurements from pretest to posttest for myofascial release, dynamic stretching, and combination interventions were 0.479 (0.7) cm, 0.700 (0.7) cm, and 0.907 (1.4) cm, respectively., Conclusion: Until further studies are conducted, the selection of technique to increase ankle DF range of motion should be based on each individual patient's ability, preference, and response to treatment.

Background: Linforoll is a device composed of handpiece with roller and pressure sensor connected wireless to the computer displaying the pressure curve of the applied force. In a previous study, we proved it to regulate the applied force according to the hydromechanic conditions of the massaged tissues. Standardization of massage based on applied force was repeatable in the same patient; it decreased limb volume and provided evident increase in tissue elasticity. Methods and Results: In this study, we measured additional parameters useful for the understanding of tissue and fluid events and approval of the device for general practice. These were skin stiffness, subcutaneous tissue stiffness independent of skin, skin water concentration, changes in skin temperature, skin capillary blood flow, subcutaneous tissue fluid pressure, volume of the moved edema fluid, and visualization of movement on indocyanine green (ICG) lymphography. Measurements were done before and during the massage. The data were obtained from a group of 20 patients with obstructive lymphedema of lower limbs during the Linforoll massage. There was a lack of significant changes in skin stiffness, skin water concentration, skin surface temperature, and capillary blood flow, but evident increase in the subcutaneous tissue elasticity (tonometry) and lymphography-shown flow of the edema fluid. Conclusions: The skin tissue hydromechanic parameters remained normal proving lack of destructive changes under high massaging pressures. The obtained data evidently show that not the skin but the subcutis accumulated edema fluid that can successfully be moved proximally under pressures of 80-120 mmHg.

Context: Roller massage (RM) is a popular myofascial intervention. To date, no research has investigated the effects of RM on experienced and nonexperienced individuals and if there are differences between a prescribed RM program and a self-preferred program., Objective: The main objective was to measure the effects of a prescribed RM program with a foam roller on knee passive range of motion (ROM) and pressure pain threshold (PPT) among experienced and nonexperienced individuals. A secondary objective was to determine if there are differences between a prescribed RM program and a self-preferred program in experienced individuals., Design: Pretest and posttest observational study., Setting: University kinesiology laboratory., Participants: A total of 60 healthy adults (age = 26 [5.3] y) were allocated into 3 groups of 20 subjects: experienced, nonexperienced, and control. The experienced and nonexperienced groups followed a prescribed 2-minute RM intervention. The control group did their own 2-minute self-preferred program., Main Outcome Measures: Knee passive ROM and PPT., Results: For the experienced and nonexperienced, the between-group analysis revealed a statistically significant difference for ROM and PPT (P < .001). Within-group analysis revealed a posttest knee passive ROM increase of 8° for experienced and 7° for the nonexperienced. For PPT, there was a posttest increase of 180 kPa for the experienced and 169 kPa for the nonexperienced. For the prescribed versus self-preferred program, the between-group analysis (experienced vs control) revealed a statistically significant difference (P < .001). The within-group analysis revealed a posttest knee passive ROM increase of 8° for the prescribed and 5° for the self-preferred program. For PPT, there was a posttest increase of 180 kPa for the prescribed program and 137 kPa for the self-preferred program., Conclusion: These findings suggest that experienced and nonexperienced individuals have similar responses to a prescribed RM program. A prescribed RM program may produce better outcomes than a self-preferred program.

Stroiney, DA, Mokris, RL, Hanna, GR, and Ranney, JD. Examination of self-myofascial release vs. instrument-assisted soft-tissue mobilization techniques on vertical and horizontal power in recreational athletes. J Strength Cond Res 34(1): 79-88, 2020-This study examined whether pre-exercise self-myofascial release (SMR) and instrument-assisted soft-tissue mobilization (IASTM) would improve performance on measures of vertical jump height and 40-yd sprint time. Differences in perceived pain levels were also examined. Forty-nine college students volunteered for the study and were randomly assigned to receive either IASTM via Tècnica Gavilàn PTB or SMR via The Stick before performance assessments. After the massage intervention, subjects rated their level of perceived pain using a visual analog scale. An independent t test was used to analyze differences in perceived pain levels between the 2 massage interventions. A 2 × 2 analyses of covariance analyzed differences between sex and the 2 massage interventions. There was no interaction (p > 0.05) between the massage intervention and sex for both the vertical jump and 40-yd sprint tests. There was a significant main effect for vertical jump and SMR (p = 0.04). Sex also had a significant main effect for both the vertical jump (p = 0.04) and the 40-yd sprint (p = 0.02). There were no significant differences between massage interventions for the 40-yd sprint times (p = 0.73). There were no significant differences in perceived pain (t(49) = -1.60, p > 0.05). The use of SMR before exercise may improve vertical jump height in recreational athletes. Pain should not be a factor when choosing massage interventions for athletes because IASTM was not perceived to be more painful than SMR. Self-myofascial release and IASTM did not enhance sprinting performance in this study.

Purpose: To compare the single application and two week treatment effects of device-applied (Eyepeace) and manually-applied eyelid massage techniques, as an adjunct to warm compress therapy, on ocular surface and tear film parameters., Methods: Twenty participants (11 females, 9 males; mean age, 27 ± 11 years) with dry eye symptoms were recruited in a two week, investigator-masked, randomised, contralateral-eye trial. Following 10 min of warm compress therapy application (MGDRx EyeBag ® ) on both eyes, eyelid massage therapy was applied to one eye (randomised) by device, and to the fellow eye by manual eyelid massage, once daily for 14 days. Ocular surface and tear film measurements were conducted at baseline, and 15 min post-application by a clinician, then again after 14 days of self-administered daily treatment at home., Results: Baseline clinical measurements did not differ between the treatment groups (all p > 0.05). Following two weeks of treatment, tear film lipid layer grade improved significantly with device massage (p = 0.008), and was marginally greater than manual massage by less than 1 grade (p = 0.03). Although immediate post-treatment improvements in tear film stability were observed in both groups (both p < 0.05), no significant long-term cumulative effects or inter-treatment differences in stability measures were detected (all p > 0.05). Visual acuity, tear meniscus height, conjunctival hyperaemia, ocular surface staining, and meibomian gland dropout did not change during the treatment period (all p > 0.05)., Conclusions: Two weeks of treatment with the eyelid massage device, as an adjunct to warm compress therapy, effected marginally greater improvements in tear film lipid layer thickness than the conventional manual technique, which were statistically but not clinically significant. Future parallel group trials with longer treatment periods and a greater range of disease severity are required., (Copyright © 2019 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Context: Foam rolling (FR) has been developed into a popular intervention and has been established in various sports disciplines. However, its effects on target tissue, including changes in stiffness properties, are still poorly understood., Objective: To investigate muscle-specific and connective tissue-specific responses after FR in recreational athletes with different FR experience., Design: Case series., Setting: Laboratory environment., Participants: The study was conducted with 40 participants, consisting of 20 experienced (EA) and 20 nonexperienced athletes (NEA)., Intervention: The FR intervention included 5 trials per 45 seconds of FR of the lateral thigh in the sagittal plane with 20 seconds of rest between each trial., Main Outcome Measures: Acoustic radiation force impulse elastosonography values, represented as shear wave velocity, were obtained under resting conditions (t0) and several times after FR exercise (0 min [t1], 30 min [t2], 6 h [t3], and 24 h [t4]). Data were assessed in superficial and deep muscle (vastus lateralis muscle; vastus intermedius muscle) and in connective tissue (iliotibial band)., Results: In EA, tissue stiffness of the iliotibial band revealed a significant decrease of 13.2% at t1 (P ≤ .01) and 12.1% at t3 (P = .02). In NEA, a 6.2% increase of stiffness was found at t1, which was not significantly different to baseline (P = .16). For both groups, no significant iliotibial band stiffness changes were found at further time points. Also, regarding muscle stiffness, no significant changes were detected at any time for EA and NEA (P > .05)., Conclusions: This study demonstrates a significant short-term decrease of connective tissue stiffness in EA, which may have an impact on the biomechanical output of the connective tissue. Thus, FR effects on tissue stiffness depend on the athletes' experience in FR, and existing studies have to be interpreted cautiously in the context of the enrolled participants.

Context: Decreased hamstring flexibility can lead to a plethora of musculoskeletal injuries, including low back pain, hamstring strains, and patellofemoral pain. Lack of flexibility may be the result of myofascial adhesions. The fascia connected to the hamstrings is part of the superficial back line that runs from the cranium to the plantar aspect of the foot. Any disruption along this chain may limit the flexibility of the hamstring., Objective: To investigate if self-myofascial release (SMR) of the plantar surface of the foot in addition to the hamstring group was more effective at improving the flexibility of the hamstrings when compared with either intervention alone., Design: Cross-over study., Setting: Athletic training facility., Participants: Fifteen college students (5 males and 10 females; age: 20.9 [1.4] y, height: 173.1 [10.3] cm, mass: 80.0 [24.9] kg) who were not older than 30, with no history of low back pain or injury within the past 6 months, no history of leg pain or injury within the past 6 months, no current signs or symptoms of cervical or lumbar radicular pain, no current complaint of numbness or tingling in the lower-extremity, and no history of surgery in the lower-extremity or legs., Interventions: Each participant received each intervention separated by at least 96 hours in a randomized order: hamstring foam rolling, lacrosse ball on the plantar surface of the foot, and a combination of both., Main Outcome Measures: The sit-and-reach test evaluated hamstring flexibility of each participant before and immediately after each intervention., Results: There were no significant differences found among the SMR techniques on sit-and-reach distance (F2,41 = 2.7, P = .08, ηp2=.12). However, at least 20% of participants in each intervention improved sit-and-reach distance by 2.5 cm., Conclusions: SMR may improve sit-and-reach distance, but one technique of SMR does not seem to be superior to another.

Objectives: Secondary lymphedema is a serious and debilitating condition, which may cause a range of cutaneous, infectious and joint complications with major psychological and social consequences. There is no curative treatment available. Initial symptomatic treatment includes Intensive Decongestive Treatment (IDT), which involves the use of multi-layered compression bandages, along with manual lymph drainage, physical exercise and skin care. IDT leads to an average decrease in limb volume of 20-40%, when compared to the contralateral limb. A better reduction may be obtained through the use of new adjuvant techniques, of which endermology is an example. The aim of this phase II study is to validate an IDT protocol combining endermology with standard of care in breast cancer related lymphedema., Study Design: A standardised care protocol was proposed by the University Hospital of Toulouse's Lymphology team for the treatment of upper limb lymphedema after breast cancer surgery using Cellu M6 (LPG) Endermologie over 30 min. Every patient benefitted from IDT over 5 consecutive days, within the multidisciplinary Lymphology unit. Patients were randomised into three arms as follows: Arm 1: IDT for 5 days with bandages + manual lymphatic drainage. Arm 2: IDT with bandages + manual lymphatic drainage + Cellu M6 for 5 days. Arm 3: bandages + Cellu M6 for 5 days. During the study, patients will be followed-up for a period of 6 months. Use of LPG's Cellu M6 in combination with IDT may improve upper limb volume reduction compared with standard of care. By improving breast cancer related lymphedema, we expect to minimise further fluid build-up and to improve skin care, thus reducing the number of consultations and hospital admissions caused by this condition. The results of the present research protocol are expected to promote evidence supporting the use of endermology in the field of lymphology., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Heroin addiction remains a significant public health problem worldwide, and relapse to heroin use following cessation of agonist maintenance treatment is common. The problems associated with use of opioid agonists mean that non-opioid therapies need to be developed to ameliorate acute and protracted opioid withdrawal syndromes., Methods: Fifteen men with opioid use disorder on methadone maintenance treatment have been enrolled from an addiction treatment center as an experimental group in this case-controlled study. This group is receiving laser meridian massage on the back, including the Bladder meridian and Governor Vessel, 3 times weekly for 4 weeks. An age-matched control group that does not receive laser meridian massage has also been enrolled. Urinary morphine levels are being checked before and after 2 and 4 weeks of treatment. Subjects are requested to self-report their number of episodes or days of heroin use and 0 to 10-point visual analogue scale scores for heroin craving/refusal to use heroin during the previous week before and after 2 and 4 weeks of treatment. Quality of life will be reported using the Short Form-12v2 before and after 4 weeks of treatment. Pulse diagnosis will be recorded and heart rate variability calculated after one single treatment session. The baseline patient characteristics will be compared between the experimental and control groups using the independent t test and Chi-square test. Data are compared between the 2 groups using repeated-measures analysis of variance, generalized estimating equations, and the paired t test., Objective: To investigate the effect of adjuvant laser meridian massage in men with opioid use disorder on methadone maintenance treatment., Trial Registration: ClinicalTrials.gov NCT04003077.

D'Amico, AP and Gillis, J. Influence of foam rolling on recovery from exercise-induced muscle damage. J Strength Cond Res 33(9): 2443-2452, 2019-The purpose of this study was to examine the impact of foam rolling (FR) on recovery from exercise-induced muscle damage (EIMD). Thirty-seven male individuals performed 40 × 15-m sprints, inducing muscle damage. Immediately after sprinting and in the 4 days following, perceived muscle soreness, hip abduction range of motion (ROM), hamstring muscle length, vertical jump (VJ), and agility measures were recorded. Eighteen subjects (mean ± SD; age 22.4 ± 2.0 years; BMI [body mass index] 26.9 ± 4.2 kg·m) foam rolled before testing each day, whereas 19 (mean ± SD; age 23.2 ± 3.2 years; BMI 26.3 ± 4.0 kg·m) served as a non-FR control (CON). Measurements recorded during the 5 days of recovery from the repeated sprint protocol were compared with week 1 baseline measurements. The area under the curve (AUC) was calculated by summing all 5 scores as they changed from baseline measurement, and these data were compared by condition using a 2-tailed Mann-Whitney U-test (alpha level = 0.05). Perceived soreness, hip abduction ROM, hamstring muscle length, and VJ were not significantly different between groups (p ≥ 0.25). Agility was less impaired in the FR condition (p = 0.0049) as AUC was higher in CON (2.88 ± 2.45 seconds) than in FR (0.33 ± 2.16 seconds). Based on these data, FR appears to expedite recovery of agility after EIMD instigated by a repeated sprint protocol. Foam rolling may be useful for athletes requiring adequate agility who need to recover quickly from demanding bouts of exercise.

Background: In sports medicine, the interprofessional care of athletes has become a frequent practice. This type of care often involves different interventions used among professionals. One common intervention prescribed is roller massage (RM) or self-myofascial release. The trends in the use of RM among allied health professionals are nonexistent. The surveillance of such responses has not been documented., Purpose: To survey and document responses in the knowledge, clinical application, and use of RM devices among allied health professionals in the United States., Design: Cross-sectional descriptive survey study., Methods: A 20-question survey was sent to allied health professionals including physical therapists, athletic trainers, and fitness professionals. The survey covered topics such as demographics, beliefs about RM, preferred devices, exercise prescription, and client education., Results: One thousand and forty-two professionals (N = 1042) completed the survey. Most respondents believed that RM decreases pain (82%) and increases mobility (76%). A high percentage use a foam roller in their practice (81%), recommend a full-size foam roller (49%), and believe the medium density (48%) is the most effective. A high proportion of respondents prescribe RM for injury treatment (69%) and for preexercise and postexercise (61%). They also recommend rolling daily for 30 seconds to 2 minutes per muscle group (33%) at a self-paced cadence (46%). A high percentage of respondents use patient-reported outcomes (74%), joint range of motion (49%), and movement-based testing (48%) to measure effects of RM. Eighty-seven percent use live instruction to educate clients, and 88% believe there is a gap in the research., Conclusion: The results of this survey document responses in the use of RM among allied health professionals. The reported responses provide insight into how professionals are using RM as an intervention and the potential gaps between the research and professional practice. Future studies are needed to further validate these findings.

The term "self-myofascial release" is ubiquitous in the rehabilitation and training literature and purports that the use of foam rollers and other similar devices release myofascial constrictions accumulated from scar tissue, ischaemia-induced muscle spasms and other pathologies. Myofascial tone can be modulated with rollers by changes in thixotropic properties, blood flow, and fascial hydration affecting tissue stiffness. While rollers are commonly used as a treatment for myofascial trigger points, the identification of trigger points is reported to not be highly reliable. Rolling mechanisms underlying their effect on pain suppression are not well elucidated. Other rolling-induced mechanisms to increase range of motion or reduce pain include the activation of cutaneous and fascial mechanoreceptors and interstitial type III and IV afferents that modulate sympathetic/parasympathetic activation as well as the activation of global pain modulatory systems and reflex-induced reductions in muscle and myofascial tone. This review submits that there is insufficient evidence to support that the primary mechanisms underlying rolling and other similar devices are the release of myofascial restrictions and thus the term "self-myofascial release" devices is misleading.

We examined the influence of stretching alone (SS) or combined with self-massage (SM) on maximal ankle dorsiflexion angle, maximal voluntary contraction (MVC) torque and calf muscle activity, and subcutaneous tissue thickness in 15 young (25 ± 3 years) and 15 middle-aged (45 ± 5 years) adults. Participants performed two sessions of calf muscle stretches (3x 30-s stretches, 30-s rest): stretch after a 60-s control condition (SS) and stretch after 60 s of self-massage with therapy balls (SM). Evaluations were performed before and 5 min after the intervention. Linear mixed effects model revealed no main effect for age on ROM or MVC and significant main effects for treatment and time. Change in ankle angle was greater after SM: SS = 3.1 ± 2°, SM = 6.2 ± 3.3° (Hedges' g = 0.98,  p  < 0.001). Similar results were observed for MVC torque: SS = -4 ± 16%, SM = 12 ± 16% (Hedges' g = 0.97,  p  = 0.0001). Changes in MVC torque and absolute EMG amplitude were correlated, but subcutaneous tissue thickness was not altered by treatment. The gains in ROM were more pronounced in less flexible middle-aged adults, underscoring the need to include flexibility exercises in their training.

Introduction: Roller massage with a foam roller has become a common intervention. To date, no studies have examined the therapeutic effects of different surface type rollers. The purpose of this study was to measure the therapeutic effects of three different surface type pattern foam rollers with the same density on passive knee joint range of motion (ROM) and pressure pain threshold (PPT) of the quadriceps., Methods: This pre-test, post-test randomized controlled trial was conducted in a university laboratory. Thirty-six participants (M = 22, F = 14; mean age = 25.20 ± 4.44 years) were randomly assigned to three groups: (1) smooth surface, (2) multilevel surface, and (3) GRID surface. The intervention was a 2-min rolling session. Outcomes included knee ROM and PPT., Results: Between group comparisons revealed a statistically significant post-intervention difference between the three rollers for knee ROM (p = 0.04) and PPT (p < 0.001). Within group comparison for ROM revealed a 3-degree (p = 0.015) increase for the smooth, a 5-degree (p < 0.001) increase for the multilevel, and a 6-degree (p < 0.001) increase for the GRID surface roller. For PPT, there was an increase of 14 kPa (p = 0.562) for the smooth, 179 kPa (p < 0.001) for the multilevel, and 182 kPa (p < 0.001) for the GRID., Conclusion: The GRID and multilevel surface rollers produced greater immediate post-intervention effects than the smooth roller. The therapeutic effects of the GRID and multilevel rollers may be due to the surface architecture. These rollers may provide a greater deformation of the tissues which creates a local mechanical and global neurophysiological effect., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

This case report describes a case of an elderly woman diagnosed with acute osteoporotic vertebral compression fracture (OVCF) at thoracic spine after using an electrical automated massage chair (EAMC). Care should be taken when using an EAMC, especially by those with or at risk of developing osteoporosis. Osteoporotic vertebral compression fracture (OVCF) is a common problem among elderly population and presents a high burden to society. Osteoporotic fractures may occur after a minimal trauma of the vertebrae. Electrical automated massage chair (EAMC) is a device that uses a programmed algorithm to perform automated massage. The massage chair, a popular device among elderly with back pain, relies on friction and rhythmic tapping created by a motorized roller. However, research regarding the safety of this device is lacking, especially in the perspective of OVCF. We present a case of an elderly woman diagnosed with acute OVCF of the thoracic spine after using an EAMC. The patient had no risk factor for fragility fracture and experienced an abrupt onset of severe upper back pain while using EAMC. Imaging studies revealed an isolated acute compression fracture at T8 vertebra (AO classification type A1) while dual-energy X-Ray absorptiometry scan confirmed osteoporosis. The patient was treated with a plastic orthosis and oral medications for osteoporosis. After 6-months follow-up, the patient showed union of the fractured T8 vertebra and no remaining symptoms. This case highlights that OVCF can be induced by EAMC. Therefore, patients with or at risk for osteoporosis should be cautious while opting for deep tissue massage using EAMC.

Self myofascial therapy via foam roller is a common technique used by many athletes and patients to aid recovery, improve range of motion (ROM) and prevent injury. Further, it is suggested that foam rolling improves core stability. However, research about the training effects of foam rolling on measures of core "strength endurance", muscle performance, balance and flexibility is limited. Forty recreationally active females and males (age: 18-48 yrs) were randomly assigned to a foam roll (FOAM, n = 14), a core stabilization (CORE; n = 12) and a control group (CG, n = 12). FOAM massaged their lower leg muscles (5 exercises) with the foam roll 2 times per week for 8 weeks while CORE was assigned to core stability training including 5 exercises. CG underwent no intervention. Applied tests for outcome measurements were the Bourban trunk muscle strength test (TMS), standing long jump (SLJ), single leg triple hop for distance (SLTH) test, Y-Balance test and stand and reach test. There was an interaction effect (time x treatment) for the dorsal TMS (p = 0.043), demonstrating greater improvements in CORE compared with FOAM and CG with no difference between FOAM and CG. For the stand and reach test a main effect for time (p < 0.001) and time x treatment interaction (p = 0.005) were found, indicating an increase in ROM in FOAM compared with CORE and CG with no difference between the latter. No significant effects were found for balance and muscle performance. An 8-week training with the foam roll is effective in increasing ROM in the stand and reach test without concomitant decreases in core "strength endurance", muscle performance and balance parameters. The core stabilization training was sufficient to improve performance in dorsal TMS test.

Introduction: An isolated injury to the tibial division is rare among compressive sciatic neuropathy. To date, isolated injury to the tibial division of the sciatic nerve after self-massage of the gluteal muscle has not been reported. Here, we report a case of compressive sciatic neuropathy diagnosed after self-massage of the gluteal muscle using magnetic resonance image (MRI) and ultrasound images and its associated therapeutic process., Patient Concerns: A 50-year-old woman presented right lower extremity pain for the past 7 days., Diagnosis: Electrophysiological findings were consistent with right tibial neuropathy proximal to the branch to hamstring muscles. However, T2-weighted MRI showed high signal intensity and swelling in the right sciatic nerves from the superior gemellus level to the quadratus femoris level. After considering both radiologic and electrophysiological findings, the patient was diagnosed with an isolated injury to the tibial division of the right sciatic nerve., Interventions: The patient agreed to an ultrasound-guided perineural steroid injection upon receiving detailed explanation of the procedure., Outcomes: After the injection, there was significant improvement in pain., Conclusion: Therefore, in making a diagnosis of sciatic neuropathy, it may be important to find the lesion via MRI than relying solely on the patient's history or electrophysiologic study.

Monteiro, ER, Costa, PB, Corrêa Neto, VG, Hoogenboom, BJ, Steele, J, and da Silva Novaes, J. Posterior thigh foam rolling increases knee extension fatigue and passive shoulder range-of-motion. J Strength Cond Res 33(4): 987-994, 2019-The purpose of this study was to analyze the acute effects of different foam rolling (FR) volumes on knee extensors fatigue and shoulder passive range-of-motion (PROM). Twelve recreationally active women were recruited for participation in 2 experiments separated by 3 weeks, and the same subjects performed all procedures in each experiment. In experiment 1, subjects performed 3 sets of knee extensions using a predetermined 10 repetition maximum load to momentary concentric failure: control condition (CG) with passive rest and 2 FR conditions for the hamstrings using 2 volumes (60 and 120 seconds; FR60 and FR120, respectively). Experiment 2 consisted of 2 shoulder flexion and extension baseline PROM tests. Following baseline measures, subjects performed a single 60-second bout of FR on the hamstrings. Outcome PROM measures were measured through manual goniometry immediately (post-0), 10 minutes (post-10), 20 minutes (post-20), 30 minutes (post-30), 24 hours (post-24), and 48 hours (post-48) after the intervention to assess the effects on PROM over an extended period. Fatigue index indicated significantly greater fatigue resistance for CG when compared with FR60 (p = 0.035; [INCREMENT]% = 6.49) and FR120 (p = 0.002; [INCREMENT]% = 9.27), and there were no significant differences between FR60 and FR120 (p = 0.513; [INCREMENT]% = 2.78). Shoulder flexion PROM increased in post-0 as compared to baseline 1 (p = 0.002; d = 1.58), baseline 2 (p < 0.001; d = 1.92), and baseline higher measurement (p < 0.001; d = 1.59) and remained increased for post-10 as compared to baseline 2 (p = 0.017; d = 1.55). Shoulder extension PROM increased in post-0 as compared to baseline 1 (p < 0.001; d = 2.61), baseline 2 (p < 0.001; d = 2.83), and baseline higher measurement (p < 0.001; d = 2.59) and remained increased for post-10 as compared to baseline 1 (p < 0.001; d = 1.93), baseline 2 (p < 0.001; d = 2.16), and baseline higher measurement (p < 0.001; d = 1.91) and post-20 as compared to baseline 1 (p = 0.008; d = 1.58), baseline 2 (p = 0.001; d = 1.85), and baseline higher measurement (p = 0.011; d = 1.55). Foam rolling volumes equal to or greater than 60 seconds are detrimental to the ability to continually produce force in the lower extremity and should not be applied to the hamstrings muscle group between sets of knee extensions. PROM results indicate that FR applied to the hamstrings demonstrates an increase in both shoulder flexion and extension PROM. This work may have important clinical (rehabilitation) implications, as it demonstrates global effects of FR on functional outcomes.

Both foam rolling and joint distraction training with elastic bands are very popular interventions designed to improve muscular function, motor performance, and joint range of motion, as well as to reduce feeling of fatigue and delayed onset of muscle soreness. The heterogeneity of methods used among studies however prevents from drawing firm conclusions about the optimal content of pre/post interventions. The present study aims at answering the following questions: i) Do foam rolling and joint distraction with elastic band training improve joint range of motion in national rugby players? ii) Do short and long rolling durations have similar effects on range of motion? In a first experiment, we compared ankle, knee, and hip flexibility scores in 30 national rugby players after a 7-week foam rolling training program involving either a short (20s) or long (40s) rolling duration. Data revealed that foam rolling substantially improved all range of motion scores, regardless the rolling duration (performance gains ranged from 9 to 18° in the foam rolling groups, i.e. 8 to 20% increase, but remained under 2° in the control group). In a second experiment, we investigated the effect of a 5-week joint distraction with elastic band training program on hamstring and adductor range of motion in 23 national rugby players. Data showed that elastic band training significantly improved sit-and-reach (29.16% increase, p = 0.01) as well as side split (2.31% increase, p < 0.001) stretching performances. Taken together, present findings confirm that both foam rolling and joint distraction exercises with elastic bands are likely to enhance joint range of motion and specific mobility patterns during sport performance, and further serve prophylaxis. Such effects therefore constitute a promising avenue for clinical, home therapy, and personal flexibility training.

Massage rollers are commonly used for beauty care, but their effects on skin blood flow (SkBF) and vascular reactivity remain unclear. We hypothesized that the short-term usage of a massage roller increases the SkBF, while a long-term massage intervention improves vascular dilatation. We measured the facial SkBF change to 5 min massage roller to the right cheek in 12 subjects. We also assessed the effect of 5-week daily use of facial massage roller on the SkBF in the right cheek and the reactivity to local heat in 14 subjects. The short-term massage significantly increased facial SkBF solely in the right cheek for at least 10 min after the massage. The 5-week intervention significantly increased the vasodilatation response to the heat stimulation solely in the right cheek. These findings suggested that performing short-term facial massage with a roller increases SkBF, and long-term use improves the vascular dilatation response., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Purpose: To investigate the effect of the meibomian gland squeezer for treatment of meibomian gland dysfunction (MGD)., Methods: Seventy patients (140 eyes) with MGD were randomly divided into 2 groups: 36 patients who were treated by the meibomian gland squeezer as the treatment group and 34 patients were selected as the control group. Patients were evaluated at baseline, and 2-week and 1-month visits for subjective symptoms, objective signs and pain assessments, including ocular symptom scores, Ocular Surface Disease Index, tear breakup time, corneal fluorescein staining, Schirmer scores with no anesthetic (Schirmer I test), meibum quality, meibum expressibility, and Numeric Rating Scale-11., Results: Sixty-five patients were followed in the study, and mean (±SD) age was 57.0 (±12.6) years. Compared with baseline, the 2 groups had varying degrees of improvement in ocular symptom scores and Ocular Surface Disease Index at the 2-week and 1-month visits; there was a statistically significant difference between groups (P < 0.001). At the 1-month visit, the treatment group showed a greater improvement in the breakup time (3.8 ± 1.6 vs. 1.8 ± 1.0 seconds, P < 0.001), corneal fluorescein staining (-2.1 ± 2.13 vs. -0.9 ± 1.3, P = 0.03), Schirmer I test (5.3 ± 2.9 vs. 2.3 ± 2.8 mm, P < 0.001), meibum quality (-7.5 ± 2.9 vs. -5.3 ± 2.4, P = 0.004), and meibum expressibility (-1.2 ± 0.8 vs. -0.7 ± 0.4, P = 0.007). In the treatment group, the mean (±SD) of total pain scores was 2.4 ± 1.0, which indicated that mild pain was still predominant under topical anesthesia., Conclusions: The meibomian gland squeezer may be safe, effective, and helpful for treatment of MGD and may offer an attractive treatment option for some patients with MGD, although it can cause mild pain or discomfort.

Objective: To verify whether the mechanical massage using massage chairs and binaural beats (brain massage) affect the mental fatigue recovery and cognitive enhancements., Methods: 25 healthy adults used massage chairs that could provide mechanical massage and binaural beats (brain massage) for 20 min. Mental fatigue and cognitive function were assessed before and after receiving brain massage using electroencephalogram (EEG) and 5 prolonged cognitive tests., Results: When a person received a brain massage on the massage chair, the decrease in mental fatigue was statistically significant compared to taking a rest or receiving a mechanical massage only on the massage chair. In addition, sustained attention, verbal short-term and long-term memory and non-verbal long-term memory were statistically significantly increased after using brain massage., Conclusion: Brain massage (mechanical massage and binaural beats) are effective in reducing mental fatigue and improving the cognitive function., (Copyright © 2018. Published by Elsevier Ltd.)

Objective: Depressomassage is a non-invasive massage technique using a mechanical suction device that is used in the treatment of traumatic or burn scars. Since color and transepidermal water loss (TEWL) are respectively the most important physical and physiological characteristic of hypertrophic scar formation, we wanted to investigate the effects of depressomassage on the recovery of color and TEWL in burn scars compared to the traditional physiotherapy., Methods: In this pilot comparative controlled study a total 43 burn patients were included and allocated into 2 groups. All patients received standard physical therapy, and the test group received additional depressomassage during 6 months. Color was assessed using the POSAS questionnaire (for color, vascularity and pigmentation) and the Minolta Chromameter. TEWL was measured using DermaLab., Results: Patients of both groups were evaluated at baseline, after 1, 3 and 6 months and after 1year. The evidence for a difference in evolution of color and TEWL between both groups in our study was minimal., Conclusions: In practice, precise indications to begin depressomassage have to be kept in mind. Perhaps other scar abnormalities such as decreased elasticity, increased thickness, excessive pain or itching could be sufficient reasons to begin depressomassage and should be assessed., (Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.)

Roller massage (RM) interventions have shown acute increases in range of motion (ROM) and pain pressure threshold (PPT). It is unclear whether the RM-induced increases can be attributed to changes in neural or muscle responses. The purpose of this study was to evaluate the effect of altered afferent input via application of RM on spinal excitability, as measured with the Hoffmann (H-) reflex. A randomized within-subjects design was used. Three 30-s bouts of RM were implemented on a rested, nonexercised, injury-free muscle with 30 s of rest between bouts. The researcher applied RM to the plantar flexors at three intensities of pain: high, moderate, and sham. Measures included normalized M-wave and H-reflex peak-to-peak amplitudes before, during, and up to 3 min postintervention. M-wave and H-reflex measures were highly reliable. RM resulted in significant decreases in soleus H-reflex amplitudes. High-intensity, moderate-intensity, and sham conditions decreased soleus H-reflex amplitudes by 58%, 43%, and 19%, respectively. H-reflexes induced with high-intensity rolling discomfort or pain were significantly lower than moderate and sham conditions. The effects were transient in nature, with an immediate return to baseline following RM. This is the first evidence of RM-induced modulation of spinal excitability. The intensity-dependent response observed indicates that rolling pressure or pain perception may play a role in modulation of the inhibition. Roller massage-induced neural modulation of spinal excitability may explain previously reported increases in ROM and PPT. NEW & NOTEWORTHY Recent evidence indicates that the benefits of foam rolling and roller massage are primarily accrued through neural mechanisms. The present study attempts to determine the neuromuscular response to roller massage interventions. We provide strong evidence of roller massage-induced neural modulation of spinal excitability to the soleus. It is plausible that reflex inhibition may explain subsequent increases in pain pressure threshold.

Background: The therapeutic intermittent pneumatic compression (IPC) pressures are usually set arbitrarily at levels between 40 and 60 mmHg. However, it is not known how much force has been transferred to edema fluid. There is a need to know how high edema fluid pressures should be generated to evacuate the stagnant fluid. The externally applied compression force dissipates in hard tissues and only a portion of it is conveyed to tissue fluid. Simultaneous measuring of compression force using deep tissue tonometry and recording edema fluid pressures under a tonometer would give hints of how high should therapist or patient set IPC pressures to mobilize fluid., Aim: (1) To simultaneously measure the applied tonometer force and the generated edema fluid pressures under the tonometer, (2) to plot tonometer force against fluid pressure data to create a correlation curve for setting pressure of IPC at levels initiating fluid flow, (3) to work out a formula for setting pressures in the pneumatic device for individual patient, based on tonometry, (4) to prove the value of formula on a cohort of patients treated with IPC., Methods: Deep tissue tonometry force and tissue fluid pressures under the tonometer indentor were measured in lower limbs in a group of 20 patients with lymphedema stages I-III., Results: (1) Deep tissue tonometry penetrating to a depth of 10 mm provided data on pressure generated in tissue fluid under the tonometer indentor. (2) Plotting the applied tonometer force against the tonometer-generated tissue fluid pressures revealed that force to reach the threshold of 30 mmHg fluid pressure necessary for initiation of flow should be >1000 g/sq. cm. (3) A formula, based on tonometry values, for setting ICP pressures at levels generating pressures for initiating edema fluid flow was worked out. (4) Usefulness of the formula for setting IPC at effective levels was proved on a cohort of patients., Conclusions: Deep tissue tonometry of limbs is useful for setting IPC devices at compression pressures for mobilizing edema fluid.

Two experiments (n = 10) were conducted to determine the effects of roller massager (RM) on ankle plantar flexor muscle recovery after exercise-induced muscle damage (EIMD). Experiment 1 examined both functional [i.e., ankle plantar flexion maximal isometric contraction and submaximal (30%) sustained force; ankle dorsiflexion maximal range of motion and resistance to stretch; and medial gastrocnemius pain pressure threshold] and morphological [cross-sectional area, thickness, fascicle length, and fascicle angle] variables, before and immediately, 1, 24, 48, and 72 h after an EIMD stimulus. Experiment 2 examined medial gastrocnemius deoxyhaemoglobin concentration kinetics before and 48 h after EIMD. Participants performed both experiments twice: with (RM) and without (no-roller massager; NRM) the application of a RM (6 × 45 s; 20-s rest between sets). RM intervention did not alter the functional impairment after EIMD, as well as the medial gastrocnemius morphology and oxygenation kinetics (P > 0.05). Although, an acute increase of ipsilateral (RM = + 19%, NRM = -5%, P = 0.032) and a strong tendency for contralateral (P = 0.095) medial gastrocnemius pain pressure threshold were observed. The present results suggest that a RM has no effect on plantar flexors performance, morphology, and oxygenation recovery after EIMD, except for muscle pain pressure threshold (i.e., a soreness).

Objective: A portable back massage robot which can complete the massage operations such as tapping, kneading and rolling was designed to improve the level of intelligence and massage effect. An efficient full covered path planning algorithm was put forward for a portable back massage robot to improve the coverage., Background: Currently, massage robots has become one of important research focuses with the increasing requirements for healthcare. The massage robot is difficult to be widely accepted as there are problems of massage robot in control, structure, and coverage path planning., Method: The 3D electromagnetic simulation model was established to optimize electromagnetic force. By analyzing the Traditional Chinese Medicine massage operation and the demands, the path planning algorithm models were established. The experimental platform of the massage robot was built., Results: The simulation results show presented path planning algorithm is suitable for back massage, which ensures that the massage robot traverse the entire back area with improved massage coverage. The tested results show that the massage effect is best when the duty cycle is in the range of 1/8 to 1/2, and the massage force increases with the increase of the input voltage., Conclusions: The massage robot eventually achieved the desired massage effect, and the proposed efficient algorithm can effectively improve the coverage and promote the massage effect.

Background: Massage robot is considered as an effective physiological treatment to relieve fatigue, improve blood circulation, relax muscle tone, etc. The simple massage equipment quickly spread into market due to low cost, but they are not widely accepted due to restricted massage function. Complicated structure and high cost caused difficulties for developing multi-function massage equipment., Objective: This paper presents a novel massage robot which can achieve tapping, rolling, kneading and other massage operations, and proposes an improved reciprocating path planning algorithm to improve massage effect., Methods: The number of coil turns, the coil current and the distance between massage head and yoke were chosen to investigate the influence on massage force by finite element method. The control system model of the wheeled massage robot was established, including control subsystem of the motor, path algorithm control subsystem, parameter module of the massage robot and virtual reality interface module. The improved reciprocating path planning algorithm was proposed to improve regional coverage rate and massage effect., Results: The influence caused by coil current, the number of coil turns and the distance between massage head and yoke were simulated in Maxwell. It indicated that coil current has more important influence compared to the other two factors. The path planning simulation of the massage robot was completed in Matlab, and the results show that the improved reciprocating path planning algorithm achieved higher coverage rate than the traditional algorithm., Conclusions: With the analysis of simulation results, it can be concluded that the number of coil turns and the distance between the moving iron core and the yoke could be determined prior to coil current, and the force can be controllable by optimizing structure parameters of massage head and adjusting coil current. Meanwhile, it demonstrates that the proposed algorithm could effectively improve path coverage rate during massage operations, therefore the massage effect can be improved.

Background: Self-myofascial release (SMR) aims to mimic the effects of manual therapy and tackle dysfunctions of the skeletal muscle and connective tissue. It has been shown to induce improvements in flexibility, but the underlying mechanisms are still poorly understood. In addition to neuronal mechanisms, improved flexibility may be driven by acute morphological adaptations, such as a reduction in passive tissue stiffness or improved movement between fascial layers. The aim of the intended study is to evaluate the acute effects of SMR on the passive tissue stiffness of the anterior thigh muscles and the sliding properties of the associated fasciae., Methods: In a crossover study design, 16 participants will receive all of the following interventions in a permutated random order: (1) one session of 2 × 60 s of SMR at the anterior thigh, (2) one session of 2 × 60 s of passive static stretching of the anterior thigh and (3) no intervention. Passive tissue stiffness, connective tissue sliding, angle of first stretch sensation, as well as maximal active and passive knee flexion angle, will be evaluated before and directly after each intervention., Discussion: The results of the intended study will allow a better understanding of, and provide further evidence on, the local effects of SMR techniques and the underlying mechanisms for flexibility improvements., Trial Registration: ClinicalTrials.gov, identifier: NCT02919527 . Registered on 27 September 2016.

Mechanical and geometrical cues influence cell behaviour. At the tissue level, almost all organs exhibit immediate mechanical responsiveness, in particular by increasing their stiffness in direct proportion to an applied mechanical stress. It was recently shown in cultured-cell models, in particular with fibroblasts, that the frequency of the applied stress is a fundamental stimulating parameter. However, the influence of the stimulus frequency at the tissue level has remained elusive. Using a device to deliver an oscillating torque that generates cyclic strain at different frequencies, we studied the effect(s) of mild skin massage in an ex vivo model and in vivo. Skin explants were maintained ex vivo for 10 days and massaged twice daily for one minute at various frequencies within the range of 65-85 Hz. Biopsies were analysed at D0, D5 and D10 and processed for immuno-histological staining specific to various dermal proteins. As compared to untreated skin explants, the massaging procedure clearly led to higher rates of expression, in particular for decorin, fibrillin, tropoelastin, and procollagen-1. The mechanical stimulus thus evoked an anti-aging response. Strikingly, the expression was found to depend on the stimulus frequency with maximum expression at 75Hz. We then tested whether this mechanical stimulus had an anti-aging effect in vivo. Twenty Caucasian women (aged 65-75y) applied a commercial anti-aging cream to the face and neck, followed by daily treatments using the anti-aging massage device for 8 weeks. A control group of twenty-two women, with similar ages to the first group, applied the cream alone. At W0, W4 and W8, a blinded evaluator assessed the global facial wrinkles, skin texture, lip area, cheek wrinkles, neck sagging and neck texture using a clinical grading scale. We found that combining the massaging device with a skin anti-aging formulation amplified the beneficial effects of the cream.

Clinical Scenario: Increasing the length of the muscle-tendon unit may prevent musculotendinous injury. Various methods have been proposed to increase muscle-tendon flexibility, including self-mobilization using foam rollers or roller massagers, although the effectiveness of these devices is uncertain. This review was conducted to determine if the use of foam rollers or roller massagers to improve hamstrings flexibility is supported by moderate- to high-quality evidence., Clinical Question: Are foam rollers or roller massagers effective for increasing hamstrings flexibility in asymptomatic physically active adults? Summary of Key Findings: The literature was searched for studies on the effects of using foam rollers or roller massagers to increase hamstrings flexibility in asymptomatic physically active adults. Four randomized controlled trials were included; 2 studies provided level 2 or 3 evidence regarding foam rollers and 2 studies provided level 2 or 3 evidence regarding roller massagers. Both roller-massager studies reported increases in hamstrings flexibility after treatment. Data from the foam-roller studies did not demonstrate a statistically significant increase in hamstrings flexibility, but 1 study did demonstrate a strong effect size. Clinical Bottom Line: The reviewed moderate-quality studies support the use of roller massagers but provide limited evidence on the effectiveness of foam rolling to increase hamstrings flexibility in asymptomatic physically active adults. Flexibility gains may be improved by a longer duration of treatment and administration by a trained therapist. Gains appear to decline rapidly postrolling. Neither device has been shown to confer a therapeutic benefit superior to static stretching, and the effectiveness of these devices for preventing injury is unknown. Strength of Recommendation: Grade B evidence supports the use of roller massagers to increase hamstrings flexibility in asymptomatic physically active adults.

Objectives: Edema fluid in lymphedematous limbs should be evacuated to sites where it can be absorbed. It should be moved either to the hypogastrium or arm/scapular regions along tissue channels or implanted silicon channels or through lymphovenous anastomoses. For that purpose, the manual lymphatic drainage of limb is an effective method. Standardization of manual massage applied force and timing becomes necessary., Aim: A device with known pressing area and continuously showing the applied force while moving it toward the root of the limb is needed. Moreover, force could be adjusted to the stiffness of the massaged tissues that varies at different levels of the limb. Results from such a device would be repeatable and reproducible by others., Methods: In this study we present data on tissue fluid hydromechanics obtained from 20 patients with obstructive limb lymphedema during massage with a massaging roller called Linforoll. Linforoll is composed of a hand piece with roller and pressure sensor connected wireless to the computer displaying the pressure curve of the applied force. Electron microscopy studies for checking eventual tissue changes were done., Results and Conclusions: Linforoll provides the possibilities of: 1) regulating the applied force according to the hydromechanic conditions of the massaged tissues; 2) standardization of massage repeatable in the same patient; 3) decrease of limb volume; 4) evident increase in tissue elasticity; 5) application as a driving force for fluid flow along the surgically implanted tubing and vessels running to the lymphovenous shunts.

Objectives/hypothesis: Throughout the latter portion of the 19th and early 20th centuries, pneumomassage devices were widely used by otologists to treat a variety of ear diseases. The so-called eardrum massagers produced a regular, repetitive, oscillatory movement through modifying the air pressure in the ear canal. The goal of this study was to trace the invention, clinical use, technological diversification, abandonment, and ultimate resurrection of tympanic pneumomassage., Method: Review of the 19th- and early 20th-century medical journals, texts, and trade catalogs concerning the tympanic pneumomassage., Results: In 1884, the Belgian otologist Charles Delstanche introduced what he called a rarefacteur, and 5 years later he introduced the masseur du tympan. This lead to a frenzied development of imaginative mechanical and electrical pneumassagers with a goal to exercise the tympanic membrane and ossicles to overcome contraction and rigidity. Tympanic pneumomassage rose to prominence in mainstream otology as a treatment for otitis media, chronic deafness, and tinnitus. After gradually fading out of the otological practice by the 1930s, pneumomassage was reintroduced in the 1980s after a half century of obscurity, this time as a novel invention notably for the treatment of Menière's disease., Conclusion: The golden era of pneumomassage illustrates the ingenuity of otologists and medical instrument makers in creating a proliferation of clever devices, as well as how highly touted treatment methods may become widely adopted by practitioners despite the lack of efficacy. It also noteworthy that historic therapeutic methods are sometimes reintroduced for purposes not envisioned by their original makers., Level of Evidence: N/A. Laryngoscope, 126:1180-1186, 2016., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)