Cyclic Compressive Loading Facilitates Recovery After Eccentric Exercise

Timothy A. Butterfield; Yi Zhao; Sudha Agarwal; Furqan Haq; Thomas M. Best


Med Sci Sports Exerc. 2008;40(7):1289-1296. 

In This Article

Abstract and Introduction


Purpose: To assess the biologic basis of massage therapies, we developed an experimental approach to mimic Swedish massage and evaluate this approach on recovery from eccentric exercise-induced muscle damage using a well-controlled animal model.
Methods: Tibialis anterior muscles of six New Zealand White rabbits were subjected to one bout of damaging, eccentric contractions. One muscle was immediately subjected to cyclic compressive loads, and the contralateral served as the exercised control.
Results: We found that commencing 30 min of cyclic compressive loading to the muscle, immediately after a bout of eccentric exercise, facilitated recovery of function and attenuated leukocyte infiltration. In addition, fiber necrosis and wet weight of the tissue were also reduced by compressive loading.
Conclusion: We conclude that subjecting muscle to compressive loads immediately after exercise leads to an enhanced recovery of muscle function and attenuation of the damaging effects of inflammation in the rabbit model. Although these observations suggest that skeletal muscle responds to cyclic compressive forces similar to those generated by clinical approaches, such as therapeutic massage, further research is needed to assess the translational efficacy of these findings.


Muscle is a mechanically responsive tissue capable of generating distinct intracellular signals that lead to specific downstream adaptations. For example, chronic stretch increases sarcomere number in series and therefore muscle length.[16] Conversely, functional overload (pressure) results in an increase in sarcomere number, resulting in a concomitant increase in muscle cross-sectional area.[26] Furthermore, evidence suggests that muscle cells themselves are highly sensitive to mechanical signals and can distinguish between loading patterns to produce various downstream effects.[18]

The in vitro and in vivo responses of skeletal muscle to controlled loading have illustrated that biomechanical signals can be reparative[11] or damaging[31] and that the optimal tissue adaptation depends on the magnitude, frequency, and duration of loading. This has been further supported by studies using cultured myoblasts and myocytes, wherein magnitude, frequency, and type of mechanical forces are all shown to influence the gene expression.[4] Although these investigations have primarily focused on the mechanosensitivity of muscle cells in vitro, the biologic responses of skeletal muscle tissue to tensile and compressive loads in vivo still remain unclear.

Intense exercise, particularly repetitive eccentric exercise (EEX), has shown to be associated with muscle damage, soreness, and inflammation.[13,21,23] These signs and symptoms typically peak within 48 h of exercise and can persist for up to 1 wk, depending on the duration of the exercise bout and the subject's level of conditioning.[12,21] Not surprisingly, optimal clinical strategies to treat and prevent these signs and symptoms, and therefore reduce associated loss of time from sport and physical activity, remain a topic of debate. Clinical interventions include, but are not limited to the following: therapeutic ultrasound,[30] electrical stimulation,[34] ice immersion,[28] static and ballistic stretching,[29] therapeutic massage,[15] and nonsteroidal anti-inflammatory medications.[24] Unfortunately, there remains little consensus in the literature regarding the efficacy of these treatments. However, anecdotal evidence gleaned from clinical practice does suggest that cyclic compressive loading (in the form of therapeutic massage) may improve functional recovery of skeletal muscle after a bout of intense EEX.

In support of this evidence, a recent Cochrane systematic review concluded that therapeutic massage is beneficial for improving both symptoms and level of function for individuals with both subacute and chronic low back pain.[14] Along with many studies included in the Cochrane review, massage has been shown to reduce pain and improve range of motion in a randomized controlled trial of 29 patients with shoulder pain,[35] relieve muscular pain in patients with fibromyalgia,[27] and improve performance and recovery from postexercise injury.[10,15] Of particular interest to us is Swedish (muscular) massage, which incorporates an assortment of component techniques including slow rhythmic stroking (effleurage), circular compression (kneading), forceful skin rolling (pétrissage), and penetrating pressure from fingertips with circular or transverse movement (friction).[22]

Swedish massage and similar approaches are used by athletes for a variety of musculoskeletal disorders, despite the lack of high-quality clinical or basic science studies to support or refute their efficacy. We hypothesized that (i) cyclic compressive loading during massage improves recovery of muscle function after a bout of intense EEX and (ii) cyclic compression of the exercised muscle will decrease leukocyte infiltration and myofiber damage. Therefore, to assess the biologic basis of massage therapies, the primary goals of this study were to 1) develop an experimental approach to mimic Swedish massage and 2) evaluate this approach to improve recovery from EEX-induced muscle damage using a well-controlled animal model that mimics EEX-induced muscle damage in humans. Such findings are important to form a theoretical basis for the efficacy of therapeutic massage, a popular clinical strategy in the treatment of EEX-associated muscle pain and loss of function.[33,36]


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