TENS Versus Foam Rolling for Recovery After Eccentric Exercise-Induced Muscle Damage in Elite Female Volleyball Players: A Comparative Study
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 30
- Locations
- 1
- Primary Endpoint
- Change in Serum Creatine Kinase (CK) Concentration
Study Overview
Brief Summary
Purpose:
This study compared two recovery methods-transcutaneous electrical nerve stimulation (TENS) and foam rolling (FR)-for muscle recovery after intense exercise in elite female volleyball players.
Background:
Delayed-onset muscle soreness (DOMS) is common after intense training and can reduce athletic performance. TENS uses mild electrical currents applied through the skin to reduce pain and improve blood flow. Foam rolling uses a cylindrical device to apply pressure to muscles. Both methods are widely used by athletes, but no previous study has directly compared them in elite female volleyball players.
Participants:
Thirty elite female volleyball players from Iran's Premier League, aged 18-28 years, with at least five years of competitive experience.
Procedures:
Participants completed a demanding lower-body exercise protocol designed to induce muscle soreness. They were then randomly assigned to one of three groups:
TENS group: received electrical stimulation to thigh muscles for 20 minutes Foam rolling group: performed self-massage with a foam roller for 20 minutes Control group: rested quietly for 20 minutes Interventions were applied 30 minutes after exercise and repeated 24 hours later.
Outcomes Measured:
Blood marker of muscle damage (creatine kinase [CK]) Vertical jump height Anaerobic sprint power Muscle soreness Measurements were taken before exercise and at 1, 24, and 48 hours afterward.
Hypothesis:
Both active recovery methods would reduce muscle damage markers and preserve jumping ability better than passive rest, with TENS potentially providing faster benefits.
Detailed Description
STUDY RATIONALE:
Delayed-onset muscle soreness (DOMS) develops 12-72 hours (h) after unaccustomed eccentric exercise and manifests as localized pain, swelling, and functional impairment. This is particularly significant for elite volleyball players, whose performance depends on explosive vertical jumping and sustained lower-body power. A single volleyball match may involve more than 100 maximal vertical jumps combined with rapid lateral movements, making the quadriceps, hamstrings, and gastrocnemius muscles susceptible to repeated eccentric loading during landing phases.
Transcutaneous electrical nerve stimulation (TENS) enhances local blood flow and activates large-diameter sensory fibers, which may accelerate metabolite clearance and modulate pain perception. Foam rolling (FR) applies bodyweight-driven compressive forces using a cylindrical device, with reported benefits including improved tissue compliance and reduced fascial restrictions. Despite growing interest in these modalities, direct head-to-head comparisons in elite female volleyball players are lacking.
STUDY DESIGN:
This was a prospective, randomized, controlled, parallel-group trial conducted at the Zahedan Olympic Village, Iran, between September and December 2020. The study employed a three-arm design comparing TENS, FR, and passive rest (control).
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Single (Outcomes Assessor)
Masking Description
A single trained assessor, blinded to group allocation, conducted all functional performance measurements (vertical jump test and Running-based Anaerobic Sprint Test [RAST]) and processed blood samples for creatine kinase (CK) analysis. Participants could not be blinded due to the nature of the interventions.
Eligibility Criteria
- Ages
- 18 Years to 28 Years (Adult)
- Sex
- Female
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Age 18-28 years
- •At least five years of competitive volleyball experience
- •Current participation in Iran's national Premier League
- •Training frequency of at least five sessions per week
- •Absence of musculoskeletal injury during the preceding six months
Exclusion Criteria
- •Use of anti-inflammatory medications or supplements
- •Contraindications to transcutaneous electrical nerve stimulation (TENS), including cardiac pacemaker, epilepsy, or pregnancy
- •Exposure to the study interventions (TENS or foam rolling [FR]) within the preceding four weeks
- •Lower-body strength training within 72 hours (h) prior to testing
Arms & Interventions
Transcutaneous Electrical Nerve Stimulation (TENS)
Participants received transcutaneous electrical nerve stimulation (TENS) applied to the quadriceps and hamstrings of the dominant leg using a clinical-grade stimulator. Four self-adhesive electrodes (5 × 9 centimeters [cm]) were positioned over the rectus femoris and biceps femoris. Stimulation parameters: biphasic symmetric waveform; frequency 120-150 hertz (Hz); pulse width 100 microseconds (μs); intensity 10-30 milliamperes (mA) adjusted to produce strong, comfortable paresthesia without visible muscle contraction; duration 20 minutes per session. Interventions were applied 30 minutes after the eccentric exercise protocol and repeated 24 hours (h) later, resulting in two sessions.
Intervention: Transcutaneous Electrical Nerve Stimulation (TENS) (Device)
Foam Rolling (FR)
Participants performed foam rolling (FR) using a medium-density, smooth-surface foam roller (15 centimeters [cm] diameter × 45 cm length). A standardized bilateral sequence targeted the quadriceps, hamstrings, iliotibial band, gastrocnemius-soleus complex, and gluteal muscles. Each muscle group was rolled for 45 seconds per side at a cadence of approximately 3 cm per second. Three complete cycles were performed, totaling approximately 20 minutes per session. Interventions were applied 30 minutes after the eccentric exercise protocol and repeated 24 hours (h) later, resulting in two sessions.
Intervention: Foam Rolling (FR) (Other)
Control (CON)
Participants in the control (CON) group rested quietly in a supine position for 20 minutes without receiving any therapeutic intervention. Rest periods were applied 30 minutes after the eccentric exercise protocol and repeated 24 hours (h) later, matching the timing of active intervention sessions.
Outcomes
Primary Outcomes
Change in Serum Creatine Kinase (CK) Concentration
Time Frame: Baseline (pre-exercise), 1 hour, 24 hours, and 48 hours postexercise
Serum creatine kinase (CK) activity was measured as a biomarker of exercise-induced muscle membrane disruption. Venous blood samples (5 milliliters \[mL\]) were collected from the antecubital vein into serum separation tubes. Samples were centrifuged at 1500 × g for 10 minutes, and serum was stored at -80 degrees Celsius (°C) until analysis. CK activity was measured using an enzymatic colorimetric assay (CK-NAC, International Federation of Clinical Chemistry \[IFCC\] kinetic method) on an automated analyzer. Results are expressed in units per liter (U/L).
Change in Vertical Jump Height
Time Frame: Baseline (pre-exercise), 1 hour, 24 hours, and 48 hours postexercise
Explosive lower-extremity power was assessed using the Sargent jump test. Participants stood adjacent to a wall-mounted measuring board graduated in 0.5-centimeter (cm) increments and marked their standing reach height with the dominant hand. They then performed a countermovement jump with an arm swing and touched the board at peak height. The best of three trials, separated by 30 seconds of rest, was recorded. Jump height was calculated as the difference between standing reach and peak jump height, expressed in centimeters (cm).
Change in Anaerobic Peak Power
Time Frame: Baseline (pre-exercise), 1 hour, 24 hours, and 48 hours postexercise
Anaerobic peak power was derived from the Running-based Anaerobic Sprint Test (RAST). Participants completed six maximal 35-meter (m) sprints with 10-second passive recovery intervals. Sprint times were recorded using dual-beam infrared timing gates (accuracy ±0.001 seconds). Power output was calculated using the formula: body mass × distance² ÷ time³. Results are expressed in watts per kilogram (W/kg).
Secondary Outcomes
- Change in Muscle Soreness(Baseline (pre-exercise), 1 hour, 24 hours, and 48 hours postexercise)
Investigators
Mohammadreza Rezaeipour
Assoc.Prof.Dr.
University of Sistan and Baluchestan