A study to compare the effect of myofascial release and instrument assisted soft tissue mobilization® for Delayed onset of muscle soreness

Completed

• Conditions: Delayed onset of muscle soreness

• Registration Number: CTRI/2021/05/033733
• Lead Sponsor: P Mallika

Brief Summary

**Title of the Study: A comparative study on the Efficacy of myofascial release and instrument assisted soft tissue mobilization® for Delayed onset of muscle soreness.**

**BACKGROUND**

Exercise is a powerful tool and an integral part of the rehabilitation of patients suffering from various musculoskeletal conditions. In healthy adults, exercise increases the thresholds for induced pain. (1) Pain perceived during exercise is considered to result from a combination of factors including acids, ions, proteins, and hormones. Although it is commonly believed that lactic acid is responsible for this pain.  Soreness is accompanied by a prolonged strength loss, a reduced range of motion, and elevated levels of markers in the blood. These are taken as indirect indicators of muscle damage, and biopsy analysis has documented damage to the contractile elements. (2)

Physical inactivity or sedentary lifestyles are significant factors for the health concern worldwide. (3) Unaccustomed exercise with eccentric muscle contraction and exhaustive exercise cause muscle damage, inflammation, leakage of muscle proteins into the circulation and soreness, which is called as delayed onset of muscle soreness. Muscle cramps are sudden, intense, electrically active contractions elicited by motor neuron hyper excitability. Although it is commonly assumed that cramps during exercise are the result of fluid electrolyte imbalance induced by sweating. Fluid electrolyte imbalance may cause cramps if there is profuse prolonged sweating such as that found in working in a hot environment. (4)

There are three types of pain related to exercise, 1) Pain experienced during or immediately following exercise, 2) Delayed onset muscle soreness, and 3) Pain induced by muscle cramps. Each is characterized by a different time course and different aetiology. (2)

The conditions includes in exercise induced leg pain are: [1]. Bones: Stress fractures, medial tibial stress syndrome. [2]. Muscles: chronic exertional compartment syndrome, hernia, delayed onset of muscle soreness and neoplasm, [3]. Blood vessels: popliteal artery entrapment syndrome, endofibrotic disease, popliteal artery aneurism, [4]. Nerves: entrapment syndromes: radiculopathies, %. [5]. Tendons: tibialis anterior, tibialis posterior, peroneals and Achilles tendinopathies. (5)

Overstretching and over training of muscle fibre gives damage and causes shin splints and tendinopathies. Shin splints are always associated with a large number of different exercises related induced leg injuries. Conditions associated with chronic exercise include compartmental syndrome, tibialis anterior strain, tibial periostitis and tibial stress fracture. Periostitis causes because of the over stimulation or inflammation of the periosteum. Most common areas of periostitis are mid to distal, medial border of the tibia. Repetitive loading on the same bone resists the ability of the bone to overcome. As result of it profound, localized pain starts occurring during running or hopping activities. (6)

Delayed onset muscle soreness (DOMS) is a familiar experience for the elite or normal athlete. It is felt after unusual physical activities and is largely seen among sportsmen, regardless of fitness levels. DOMS occurs as a result of microscopic tears in the muscle fibres following eccentric exercises, such as plyometric, downhill running, and resistance training. During unaccustomed or vigorous exercises the muscles are overexerted at the myotendinous junction. DOMS usually develops within 12—24 hours after exercises, peaks 24—48 hours after an exercise bout and resolves within 96 hours. It reduces physical performance and is one of the major concerns.

Exercise induced muscle pain arises from accumulation of endogenous algesic substances and because of increase in the intramuscular pressure. These endogenous algesics are released from cells when there is a disturbance in homeostasis as a result of intense exercise. The exercise induced pain depends on both the intensity and duration of the exercise. The level of exercise intensity and metabolic activity regulated by the central nervous system. Both the physiological and psychological mechanisms involves, the afferent fibres increases the stimulation of the muscle nociceptors and reduces the maximal voluntary muscle contraction. (7)

The lactic acid theory says accumulation of the lactic acid continues to produce the exercise cessation. (8) The muscle spasm theory says after eccentric exercise, the resting membrane muscle activity increases. (9) The muscle damage theory, proposed by Hough, says eccentric exercise causes the disruption of the contractile component of the muscle tissue, particularly at the level of the z-line. (10) The inflammatory theory, following the repetitive eccentric muscle action, there is oedema formation and inflammatory cell infiltration. (11) The enzyme efflux theory proposed by Gulick and Kimura, based on the assumption of calcium. (12) The connective tissue damage theory says the role of the connective tissue which forms sheaths around the bundles of muscle fibres. (13) Individuals who regularly participate in high-volume, intense exercise, tend to have signiï¬cantly raised base levels of creatine kinase compared to sedentary and moderately exercising individuals.

Various treatment strategies aimed at alleviating the symptoms of exercise induced soreness. These include cryotherapy, stretching, anti-inflammatory drugs, ultrasound, electrical current techniques, massage and compression. (14)  Initial treatment for soft tissue injuries is PRICE (prevention, rice, ice, compression and elevation).  Static stretching during pre or post exercise are done as a preventative measures. Anti-inflammatory drugs are proposed to reduce muscle oedema following soft tissue injury. The management of DOMS includes several strategies to accelerate the recovery process. Various physiotherapy measures help in managing DOMS including laser therapy, massage, electrical stimulation, contrast bath and cryotherapy, which are considered the treatment of choice. Electrotherapeutic modality treatments also promoted to reduce the inflammatory response and to increase in tissue healing and blood flow. (14)

Most effective strategies for reducing the exercise induced pain are exercises. Temporarily pain reduction occurs during exercise by breaking the adhesions in the sore muscles, increases the removal of noxious waste products via an increased blood flow or increased the endorphin release during activity. (10)

**NEED FOR THE STUDY**

Delayed onset of muscle soreness is a regional pain syndrome which occurs due to exercise and described as pain between the knee and ankle. Leg pain is experienced among athletes often associated with exercise. Repetitive weight bearing exercises commonly causes painful injuries in particular region. In 1966, the American medical Association (AMA) Committee of the Medical aspect of Sports, subcommittee on classification of Sports injuries published the Standard Nomenclature of Athletic injuries as Shin splints, exercise related leg pain.

Tendinopathies are most common during strenuous exercises. The pain pattern of an athlete with tendon pain depends mainly on the chronicity of the condition. In early stage, the athlete may have tendon pain only after the exercise. As the condition progresses, the pain may become constant with all the daily activities. Interventions for tendon pain are largely based on the symptoms. Delayed onset of muscle soreness in quadriceps muscle is very common after a sudden and strenuous activity.

Myofascial release (MFR) is a form of manual therapy that involves the application of a low load, long duration stretch to the myofascial complex, intended to restore optimal length, decrease pain, and improve function. Instrument assisted soft tissue mobilisation (IASTM) has become a popular myofascial intervention utilised to treat soft tissue injuries.

Scientific researches were done to find out the effect of IASTM as most notable, mechanical and neurophysiological. The mechanical theory suggests that pressure and shearing from the instrument may release and breaks down the scar tissue, adhesions and fascial restriction and aids in fast tissue healing. Despite the emerging research and popularity of IASTM, there is no unison on the optimal treatment parameters such as: tool type, tool angle, stroke type, rate and amount of pressure being applied. A limited research study exists to determine the effect of their immediate effectiveness.

This study will explore immediate effectiveness of Myofascial release and Instrument assisted soft tissue release for delayed onset of muscle soreness. Thus, the objective of this study is to determine do these techniques will provide significant results for delayed onset of muscle soreness, as well as to compare the superiority of myofascial release and instrument assisted soft tissue mobilisation for delayed onset of muscle soreness.

**REVIEW OF LITERATURE**

**Scott W. Cheatham et.al (2019):** studied the effects of a light pressure instrument assisted soft tissue mobilization (IASTM) technique on tactile discrimination and pain perception in individuals after strenuous exercises. 23 subjects were undergone three different testing sessions: baseline measures and exercise, 24 hours post treatment and measures, and 48-ours post treatment and measures. Researcher included two point discrimination, pressure pain threshold as an outcome measures for the study. Study results suggested that a light pressure IASTM technique may produce a neuromodulation effect on local tactile discrimination and pain perception in individuals with DOMS.(15)

**Ellie Cathcart et.****al. (2019):** studied to find out the immediate biomechanical (increased elasticity, increased range of motion), systemic (local vs. distal areas of pain threshold) and bodily awareness effects of a myofascial release technique on the thoracic spine. 12 subjects were taken for the study. ROM, pain pressure thresholds and interoceptive sensitivity to assess biomechanical, systemic and interoceptive effects of MFR were used as outcome measures. The results showed significant increases in ROM, PPT post MFR intervention. The increased ROM and PPT suggests that the MFR had caused a biomechanical change in tissue elasticity creating an increase in tissue flexibility.(16)

**Justin Stanek et.****al. (2018):** compared the effect of a single session of compressive myofascial release (CMR) or IASTM using the Graston technique (GT) on closed chain ankle- DF ROM. 44 active participants were selected who has less than 30 o of DF. 3 groups were made: control, CMR and GT. Both groups received 5-minute treatment that included scanning the area and treating specific restrictions. Standing, kneeling ankle dorsiflexion was measured before and immediately after treatment. Compressive MFR increased ankle DF after single treatment. (17)

**Heinz Lohrer et.al. (2018):** reviewed to describe the current evaluation methods and treatment for exercise induced leg pain. Review results that conservative treatment must be a choice of treatment. (18)

**Ali H. Y. Astokorki, Alexis R. Mauger (2017):** studied the effect of TENS and IFC could reduce exercise-induced pain (EIP) and whether this would affect exercise performance. In two parts, 18 (Part I) and 22 (Part II) healthy male and female participants completed an isometric contraction of the dominant bicep until exhaustion (Part I) and a 16.1 km cycling time trial as quickly as they could (Part II) whilst they received TENS, IFC, and a SHAM placebo. In Part I, TENS significantly reduced perceived EIP (mean reduction of 12%) during the isometric contraction (P = 0.006) and significantly improved participants’ time to exhaustion by a mean of 38% (P = 0.02). In Part II, TENS significantly improved (P = 0.003) participants’ time trial completion time (~2% improvement) through an increased mean power output. Results stated that TENS can attenuate perceived EIP in a healthy population and that doing so significantly improves endurance performance in both submaximal isometric single limb exercise and whole-body dynamic exercise. (7)

**Blanca Romero Moraleda et.al. (2017):** compared the immediate effects of a neurodynamic mobilisation (NM) treatment or foam roller (FR) treatment after DOMS. 32 healthy subjects were randomly assigned into NM group (16) and the FR group (16). The subjects performed 100 drop jumps (5 sets of 20 repetitions, separated by 2 min rests) from a 0.5-m high box to induce muscle soreness. Participants were randomly assigned. The NPRS, isometric leg strength with dynamometry, surface electromyography at maximum voluntary isometric contraction and muscle peak activation upon landing after a test jump was measured starting and 48 hour after baseline before treatment and immediately after treatment. Results showed significant reduction in NPRS score after treatment. FR group had a significant improvement in strength compared to pre-treatment.(19)

**Jooyoung Kim et. al (2017):** reviewed the mechanism and effects of IASTM along with its application. IASTM refers to a technique that uses instruments to remove scar tissues from injured soft tissues and facilitate healing process through formation of new extracellular matrix proteins such as collagen. Recently, frequent use of this instrument has increased in the fields of sports rehabilitation and athlete training. Some experimental studies and case reports have reported that IASTM can significantly improve soft tissue function and range of motion following sports injury, while also reducing pain. Review stated that IASTM studies that have mostly focused on tendons need to broaden their scope toward other soft tissues such as muscles and ligaments. (20)

**Lucas V. Lima et.al. (2017):** studies literature and reviewed to know whether exercise increase or decrease pain. Exercise is an integral part of the rehabilitation of patients who is suffering from a variety of chronic musculoskeletal conditions. However, exercise can also increase pain and challenging the rehabilitation for the person with the pain.(1)

**Dawn T. Gulick et.al. (2017):** conducted a study to determine if a series of six IASTM treatments given over 3 weeks would influence the pressure pain threshold of a myofascial trigger points. 29 samples were taken for the study. A 5 minute intervention using three IASTM technique can effectively increase the PPT of myofascial trigger points in a 6 treatments overa 3 weeks period of time. (21)

**Benjamin R Kivlan et.al. (2015):** Studied to determine if ASTYM therapy administered to the lower extremity does result in an immediate change of maximal force output during a unilateral isometric squat test among individuals with a lower extremity injury. 45 subjects (14 males, 31 females) between ages 18-65 years were randomized into 3 groups: 1. Control group: received no treatment, 2. Placebo group: received a sham ASTYM treatment, 3. ASTYM therapy group. Maximum force output was retested after procedures. The result concluded that ASTYM therapy can immediately improve muscle performance for patients presenting with muscular weakness caused by a lower extremity musculoskeletal injury. (22)

**Markovic G. (2015):** in his study evaluated the acute effects of foam rolling and a new form of IASTM, fascial abrasion technique on hip and knee range of motion in soccer players. 20 male soccer players were randomly assigned into FR and FAT group. The results supported the use of newly developed IASTM, FAT and FR for increasing lower extremity ROM of athlets.(23)

**Kazue Kanda et. al. (2013):** studied to determine the relationship among delayed onset muscle soreness, muscle damage and inflammatory responses to eccentric exercise and investigate the underlying mechanisms. 9 healthy males performed one leg- calf rise exercise with their right leg on a force plate. They performed 10 sets of 40 repetitions of exercise at 0.5 Hz load with a rest of 3 minutes between sets. VAS, blood and urine samples were collected before and 2, 4,24,48,72, and 96 hours post exercise. Blood samples were analysed for leucocyte differential counts and neutrophil functions. Researcher also determined serum marker of muscle damage and myoglobin. Results suggested neutrophils mobilised in the circulation and also positive correlation between the exercise induced increased in neutrophil migratory activity and increases in Mb, suggests the muscle damage and inflammation. (4)

**Chesterton Linda S. et.al. (2007):** evaluated inter-rater reliability using a fixed-angle algometer. Study comprised of 2 phases. 5 newly trained observers in the assessment of pressure pain threshold were asked to use algometry. The study results showed highly reliable measures for PPT.(24)

**P. V. Tisi et.al. (1997):** studied to identify a stable biochemical marker of disease severity in patients with intermittent claudication and to assess the effect of therapeutic exercise training. 82 samples were observed. Repetitive low-grade inflammatory events in claudicants lead to elevation of serum acute-phase proteins. Exercise training is associated with symptomatic improvement and reduction in inflammatory markers.(25)

**AIM**

To determine the efficacy of Myofascial release and Instrument assisted soft tissue mobilization for delayed onset of muscle soreness.

**OBJECTIVE OF THE STUDY**

1. To find out the efficacy of Instrument assisted soft tissue mobilization for delayed onset of muscle soreness.

2. To find out the efficacy of Myofascial release for delayed onset of muscle soreness.

3. To compare the effect of myofascial release versus instrument assisted soft tissue mobilization for delayed onset of muscle soreness.

**HYPOTHESIS**

**NULL HYPOTHESIS:**

There is no significant difference in pain, disability by using myofascial release versus instrument assisted soft tissue mobilization for delayed onset of muscle soreness.

**ALTERNATE HYPOTHESIS:**

There is a significant difference in pain, disability by using myofascial release versus instrument assisted soft tissue mobilization for delayed onset of muscle soreness.

**METHODOLOGY**

**SAMPLING DESIGN:**

Samples will be collected from Garden City University (Department of Physiotherapy). Sample will be screened for delayed onset of muscle soreness. Selected samples will be referred to outpatient department for further evaluation and intervention.

**METHOD OF COLLECTION OF DATA:**

106 samples will be identified by simple random sampling method where the entire sample is allocated into three groups with 35 samples in each group. Group A is a control group. Rest and cryotherapy will be given. Group B patients will be given Instrument assisted soft tissue mobilization, like wise Group C patients will be given Myofascial release technique.

**STUDY DESIGN:**

Randomized Control Trail

**SAMPLE SIZE:**

105 Subjects

**SAMPLE TECHNIQUE:**

Simple random sampling technique

**INCLUSION CRITERIA:**

1.  Age: 18- 30 years of college students

2.  Male and female included

3.   Moderate sensitivity on pain sensitivity questionnaire (PSQ) (26)

4.   International Physical Activity Questionnaire (IPAQ) score Low level physical activity (27)

5.   Sample with exercise induced pain post

**EXCLUSION CRITERIA:**

1.  Medical history of cardiovascular and respiratory diseases

2.   Uncontrolled hypertension

3.   Present history of using blood thinners

4.  A history of musculoskeletal conditions like arthritis, chondromalacia patella, Juvenile arthritis, Lower back pain, inter vertebral disc lesions/prolapse, Radiculopathy and history of ligament injuries must be excluded

5.   Recent history of surgery

6. A history of an active infection or skin allergy.

**PROCEDURE**

105 samples will be collected and divided into two groups. Group A is a control group. Rest and cryotherapy will be given. Group B (IASTM) will undergo the application of instrument assisted soft tissue mobilization for delayed onset of muscle soreness. Group C will undergo application of myofascial release technique.

**METHODOLOGY**

Enrolment,Allocation and Data collection

Subjects have to fill forms of physical activity questionnaire and pain sensitivity questionnaire, to get subjective information on subject’s pain tolerance level and their physical fitness level. Moderate pain sensitivity and low level physical fitness subjects will be taken as samples. Those all subjects will be screened with Induced muscle soreness exercise protocol for exhaustion and pain. All the subjects will be evaluated with outcome measures.

**Screening test:** Participants has to undergo an ‘induced muscle soreness exercise protocol’ as a screening process. Investigator must monitor each subject during screening for safety.

This protocol includes:

1. Five minute treadmill warm-up

2. Followed by 100 drop jumps (5 sets of 20 repetitions)

3. From a 0.5m box. (7)

**OUTCOME MEASURES**

**1. The Numerical Pain Rating Scale** (**NPRS)** is a segmented numeric version of the visual analogue scale (VAS). It is an 11-point numeric scale (NRS 11) with 0 representing no pain and 10 representing worst possible pain. One end of the scale line is 0, which means no pain (hurt). At the other end is a 10, which means the person feels the worst pain. Higher scores indicate greater pain intensity. The NPRS is a valid and reliable scale to measure pain intensity. Strengths of this measure over the VAS are the ability to be administered both verbally and in writing, as well as its simplicity of scoring. (28)

**2. Pressure Algometer:** The Pressure Pain Threshold (PPT) is defined as the point at which a non-painful pressure stimulus turns into a painful pressure sensation. Pressure algometry (PA) is a method described to objectify this PPT. This technique is a well-known and well-validated method to induce acute experimental pain and showed high levels of reliability. Furthermore, some of the other researchers in their studies concluded that PA is a worthwhile tool in the diagnosis and treatment evaluation of different painful orthopaedic disorders. Pain pressure threshold will be evaluated on tender points (mid belly) quadriceps muscles by using algometer.(24)

**3. Biochemical Markers:** Due to sudden or exhaustive Exercises skeletal muscle gets disrupted ultra-structurally, resulting in leucocyte infiltration and release of myocellular proteins such as myoglobin into the circulation. There will be enhanced capacity of neutrophils which are documented after the endurance exercises. Cytokines are proteins which regulate immune and inflammatory responses. They are classified as pro-inflammatory cytokines, anti-inflammatory cytokines, immune cytokines, multifunctional cytokines and chemo cytokines. Pro-inflammatory cytokines will promote inflammation, anti-inflammatory cytokines will control inflammation. Some of these substances are induced remarkably in plasma and urine following exhaustive endurance exercise. Muscle damage markers in peripheral blood can be studied to understand the extent on injury and effect of intervention techniques. (29)

**MYOFASCIAL****RELEASE (MFR) TECHNIQUE**

MFR is a form of manual therapy that involves the application of a low load, long duration stretch to the myofascial complex, intended to restore optimal length, decrease pain, and improve function. Anecdotal evidence shows great promise for MFR as a treatment for various conditions. Facia is considered to be a source of nociceptive pain (myofascial pain) in several musculoskeletal disorders. The purpose of MFR is to restore tissue extensibility to connective tissue which has undergone changes to its mechanical properties such as loss of normal pliability and viscosity. The efficacy of MFR has been demonstrated in a multitude of conditions including low back pain, ankle injuries, carpal tunnel syndrome, chronic asthma, headaches, and fibromyalgia Myofascial release is a hands one soft tissue technique that facilitates a stretch in a restricted fascia. A sustained pressure is applied into the restricted tissue barrier, after 90-120 seconds the tissue will undergo histological length changes allowing the first release to be felt. Then the therapist must follow the release of anew barrier and holds. After few releases the tissue will become softer and more pliable. (30)

**INSTRUMENT ASSISTED SOFT TISSUE MOBILIZATION TECHNIQUE**

Instrument assisted soft tissue mobilization is a popular treatment for myofascial restriction. The pressure and shear forces applied with the instrument would release and breaks down the soft tissue adhesions and fascial restrictions and facilitates the tissue healing process. The pressure exerted by the instrument on tissue will stimulate the local mechanoreceptors, nociceptors and ascending pathways which may stimulates the resorption of excessive fibrosis and promotes the healing process. (31)

IASTM brands are augmented soft tissue mobilization (ASTYM), Graston technique, Gua Sha, fascial abrasion technique (FAT), sound- assisted soft tissue mobilization (SASTM). (22)

For IASTM treatment for quadriceps doms, the wedge blade tool will be administered. It is a stainless steel shaped metal instrument with different edges. Light pressure strokes will be applied for 90 seconds. Strokes must be performed in line with fiberes of the rectus femoris using a rate of 120 BPM with wedge tool at an angle of 30o. The soreness occurs after exercises, arises 24 hours after exercise and peaks in intensity by 48 hours post exercise. Day I: evaluation of soreness will be done, Day II: 90 second IASTM must be performed for this group. Day III: again 90 seconds IASTM must be administered on the same specific marked area. (15)

**DURATION**

The data collection duration of the study will be approximately four months.

**STATISTICAL TOOL**

The data will be analysed by using descriptive statistics such as normality test, mean, standard deviation and graphs, inferential statistics such as Pre and Post T test, ANOVA.

**ETHICAL CLEARANCE**

Ethical clearance was obtained from the ethical committee of Garden City University.

**REFERENCES**

1. Lucas V. Lima et.al. Does exercise increase or decrease pain? Central mechanisms underlying these phenomena, the journal of physiology 595013, 2017, pp 4141-4150.

2. Miles MP et.al, exercise-induced muscle pain, soreness and cramps, journal of sports medicine physical fitness, September 1997; 34 (3): 203-16.

3. Sluke, Kathleen A.et.al. Exercise-induced pain and analgesia? Underlying mechanisms and clinical translations, international association for the study of pain, September 2018, volume 159, issue pS91-S97.

4. Kazue Kanda et. al. Eccentric exercise- induced delayed –onset muscle soreness and changes in markers of muscle damage and inflammation.

5. Davide edoardo bonasia et.al. exercise induced leg pain, asia-pacific journal of sports medicine,march 2015

6. Beck BR. Exercise-Induced Leg Pain. Indianapolis, IN: American College of Sports Medicine; 2016

7. Ali H. Y. Astokorki et. Al. Transutaneous electrical nerve stimulation reduces exercise- induced perceived pain and improves endurance exercise performance, European journal of applied physiology, march 2017, vol. 117, issue 3, pp 483-492.

8. Armstrong RB. Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. Med Sci Sports Exerc 1984; 16 (6): 529-38

9. De Vries HA. Electromyographic observations of the effects of static stretching upon muscular distress. Res Q 1961; 32: 468-79

10. Hough T. Ergographic studies in muscular soreness. Am J Physiol 1902; 7: 76-92

11. Francis KT, Hoobler T. Effects of aspirin on delayed muscle soreness. J Sports Med Phys Fitness 1987; 27 (3): 333-7

12.Gulick DT, Kimura IF. Delayed onset muscle soreness: what is it and how do we treat it? J Sport Rehab 1996; 5: 234-43

13. Sydney-Smith M, Quigley B. Delayed onset muscle soreness: evidence of connective tissue damage, liquid peroxidation and altered renal function after exercise. Report to the Australian Sports Commission’s Applied Sport Research. Canberra: Aus tralian Sports Commission, 1992: 77

14. Karoline Cheung, Patria A et.al. Delayed onset muscle soreness: treatment strategies and performance factors, sports medicine, February 2003; 33 (2); 145-164.

15. Scott W. Cheatham, does a light pressure instrument assisted soft tissue mobilization technique modulate tactile discrimination and perceived pain in healthy individuals with DOMS?

16. Ellie Cathcart et.al. Immediate biomechanical, systemic and interoceptive effects of myofascial release on the thoracic spine: A RCT,journal of bodywork & movement therapies (2019),74-81.

17. Justin stanek et.al. Comparison of compressive myofascial release and the Graston technique for improving ankle dorsiflexion range of motion, journal of athletic training, 2018: 53 (2):160-167.

18. Heinz Lohrer et.al. exercise induced leg pain in athletes:diagnostic, assessment and management strategies, October 2018.

19. Romero-Moraledaetal.(2017), Neurodynamic mobilization and foam rolling improved delayed-onset muscle soreness in a healthy adult population: a randomized controlled clinical trial. PeerJ5:e3908;DOI10.7717/peerj.3908

20. Jooyoung kim et.al. Therapeutic effectiveness of instrument assisted soft tissue mobilisation for soft tissue injury: mechanism and practical application, journal of exercise rehabilitation,2017;13;12-22.

21. Dawn gulick, influence of instrument assisted soft tissue treatment technique on myofascial trigger points, journal of bodywork and movement therapies, march 2014.

22. Benjamin R Kivlan et.al. the effect of Astym therapy on muscle strength: a blinded, randomized, clinically controlled trial, BMC Musculoskeletal Disorders (2015) 16:325.

23. Markovic G. Acute effects of instrument assisted soft tissue mobilizationvs. foam rolling on knee and hip range of motion in soccer players. J Bodyw Mov Ther 2015; 19:690-696.

24. L.S.Chesterton, J.Sim, C.C. Wright, N.E. Foster Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters , clinical journal of Pain, 33(2007), p.p. 760-766.

25. P. V. Tisi et.al. Exercise Training for Intermittent Claudication: Does it Adversely Affect Biochemical Markers of the Exercise-induced Inflammatory Response? Eur J Vasc Endovasc Surg 14, 344-350 (1997).

26. Ruscheweyh R, Marziniak M, Stumpenhorst F, Reinholz J, Knecht S. Pain sensitivity can be assessed by self-rating: Development and validation of the Pain Sensitivity Questionnaire. Pain. 2009; 146(1-2):65–74. doi:10.1016/j.pain.2009.06.020

27. Helou K, El Helou N, Mahfouz M, Mahfouz Y, Salameh P, Harmouche-Karaki M. Validity and reliability of an adapted arabic version of the long international physical activity questionnaire [published correction appears in BMC Public Health. 2017 Sep 22;17 (1):736]. BMC Public Health. 2017;18(1):49. Published 2017 Jul 24. doi:10.1186/s12889-017-4599-7

28. Maria Alexandra Ferreira-valante et. al. validity of four pain intensity scales, vol.152,issue 10, (2011).

29. Kazue Kanda et.al. Eccentric exercise-induced delayed onset muscle soreness and changes in markers of munscle damage and inflammation, eccentric exercise and inflammation, 2013.

30. Barnes, journal of bodywork and movement therapies, July 1997.

31. Davidson CJ, Ganion LR, Gehlsen GM, et al. Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Med Sci Sports Exerc. 1997; 29(3):313-319.

Detailed Description

Not available

Study Timeline

• Study Start: 2021-05-25
• Study Completion: 2022-04-03
• Last Update Posted: 2024-05-31

Recruitment & Eligibility

• Status: Completed
• Sex: All
• Target Recruitment: 105

Inclusion Criteria

1)Age: 18- 30 years of college students, 2)Male and female included, 3)Moderate sensitivity on pain sensitivity questionnaire, 4)International Physical Activity Questionnaire (IPAQ) score Low level physical activity, 5)Sample with exercise induced pain post physical activity, 6)Pain in quadriceps muscle during and after screening test.

Exclusion Criteria

1)Medical history of cardiovascular and respiratory diseases, 2)Uncontrolled hypertension, 3)Present history of using blood thinners, 4)A history of musculoskeletal conditions like arthritis, chondromalacia patella, Juvenile arthritis, Lower back pain, Inter vertebral disc lesions/prolapse, Radiculopathy and history of ligament injuries must be excluded, 5)Recent history of surgery, 6)A history of an active infection or skin allergy.

Study & Design

• Study Type: Interventional
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Pressure Pain Threshold	Pre and post

Secondary Outcome Measures

Name	Time	Method
Biochemical marker	Pre and Post

Trial Locations

Locations (1)

Garden City University; 🇮🇳 Bangalore, KARNATAKA, India

Garden City University

🇮🇳Bangalore, KARNATAKA, India

P Mallika

Principal investigator

9535087324

physio108@gmail.com