The Journal of Pain, Vol 9, No 8 (August), 2008: pp 714-721

Available online at www.sciencedirect.com

Massage Reduces Pain Perception and Hyperalgesia in

Experimental Muscle Pain: A Randomized, Controlled Trial
Laura A. Frey Law, Stephanie Evans, Jill Knudtson, Steven Nus, Kerri Scholl, and
Kathleen A. Sluka
Program in Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, Iowa.

Abstract: Massage is a common conservative intervention used to treat myalgia. Although subjec-
tive reports have supported the premise that massage decreases pain, few studies have systemati-
cally investigated the dose response characteristics of massage relative to a control group. The
purpose of this study was to perform a double-blinded, randomized controlled trial of the effects of
massage on mechanical hyperalgesia (pressure pain thresholds, PPT) and perceived pain using de-
layed onset muscle soreness (DOMS) as an endogenous model of myalgia. Participants were randomly
assigned to a no-treatment control, superficial touch, or deep-tissue massage group. Eccentric wrist
extension exercises were performed at visit 1 to induce DOMS 48 hours later at visit 2. Pain, assessed
using visual analog scales (VAS), and PPTs were measured at baseline, after exercise, before treat-
ment, and after treatment. Deep massage decreased pain (48.4% DOMS reversal) during muscle
stretch. Mechanical hyperalgesia was reduced (27.5% reversal) after both the deep massage and
superficial touch groups relative to control (increased hyperalgesia by 38.4%). Resting pain did not
vary between treatment groups.
Perspective: This randomized, controlled trial suggests that massage is capable of reducing myalgia
symptoms by approximately 25% to 50%, varying with assessment technique. Thus, potential anal-
gesia may depend on the pain assessment used. This information may assist clinicians in determining
conservative treatment options for patients with myalgia.
© 2008 by the American Pain Society
Key words: Myalgia, delayed onset muscle soreness, analgesia, manual therapy, treatment.

M
usculoskeletal pain is one of the most prevalent
forms of pain reported in primary care22 and for
chronic pain conditions.21 However, relatively
little is known regarding treatment outcomes for deep
tissue muscle pain. Chronic musculoskeletal pain is a pri-
mary component in several pain syndromes that include
both inflammatory and noninflammatory conditions.
Approximately 10% to 15% of the US population has
chronic widespread muscle pain; 20% to 50% of the pop-
ulation has chronic regional muscle pain.10,21 Although
Received April 6, 2007; Revised January 30, 2008; Accepted March 10,
2008.
Supported by departmental funding from the Graduate Program in Phys-
ical Therapy and Rehabilitation Science at The University of Iowa.
Address reprint requests to Dr. Laura Frey Law, Graduate Program in
Physical Therapy and Rehabilitation Science, The University of Iowa,
1-252 Medical Education Building, Iowa City, IA 52242. E-mail: laura-
freylaw@uiowa.edu
1526-5900/$34.00
© 2008 by the American Pain Society
doi:10.1016/j.jpain.2008.03.009
pharmacological treatment for musculoskeletal pain is
common, increasingly patients and clinicians are seeking
alternative therapies with minimal risk.
Temporary muscle pain frequently occurs after unac-
customed eccentric exercise (muscle lengthening con-
tractions), resulting in delayed onset muscle soreness
(DOMS) 8 to 24 hours after activity.1,7,17,27,40,42 This can
be used experimentally as an endogenous muscle pain
model to produce sensations similar to clinical muscle
pain conditions, including deep tissue muscle pain with
contraction or stretch, taut bands, occasional resting
pain, mechanical hyperalgesia, and the perception of
trigger points.10,39 DOMS provides a controlled pain
model to study therapeutic interventions, which is chal-
lenging in clinical populations due to variation in under-
lying pathology, concomitant interventions, and so
forth.
Massage has been used for rehabilitation and relax-
ation for thousands of years around the world, with few
adverse effects. A number of different massage tech-
niques are in use today; however, classic Western mas-

714
Frey Law et al
47
sage, that is, Swedish massage, is the most common.
Massage has been proposed to decrease tissue adhesion,
promote relaxation, increase regional blood circulation,
increase parasympathetic circulation, increase intramus-
cular temperature, and decrease neuromuscular excit-
ability.47 However, despite its common use, there is only
limited scientific evidence to support the use of massage
to prevent or decrease muscle pain.4,14,19,34
Many studies combine massage with other treatments
or include a range of populations, making it difficult to
interpret the isolated influence of massage. For example,
massage in conjunction with acupuncture reduced pain
in a randomized-controlled trial (RCT) of cancer patients
undergoing surgery.34 A quantified review of 9 RCTs in-
vestigating massage in pediatric populations revealed
that arthritis pain was significantly reduced after multi-
ple treatments.4 Conversely, patient satisfaction in-
creased but pain scores did not change in an RCT involv-
ing patient choice of 1 alternative therapy (massage,
chiropractic, or acupuncture) added to standard care for
low back pain.14 A Cochrane systematic review of mas-
sage for neck disorders was unable to conclude whether
massage had a significant effect due to the mix of find-
ings and lack of quality studies.16 However, a Cochrane
review of massage for low back pain concluded that it
might be beneficial but needed additional investiga-
tion.19
Treatment for DOMS has also been investigated. Mas-
sage applied 15 minutes to 3 hours after the unaccus-
tomed exercise but before the development of DOMS
results in reduced DOMS pain relative to control condi-
tions.23,35,49 However, once DOMS has developed, 24 to
48 hours after exercise, massage has been reported to
have no effect26 as well as provide some benefit.15
Unfortunately, few well-controlled trials of massage
exist either in clinical or experimentally induced pain
populations. Further, the potential confounding influ-
ence of cutaneous touch is rarely considered. Thus, the
purpose of this study was to determine the effects of
massage using an endogenous muscle pain model in oth-
erwise healthy individuals, using a blinded, randomized,
controlled trial to compare deep soft-tissue massage,
light superficial touch, and no treatment (control). We
hypothesized that a single dose of deep-tissue massage
would result in a reduction in DOMS pain ratings and
mechanical hyperalgesia versus cutaneous stroking or no
treatment.
Methods
Subjects
Written informed consent was obtained before partic-
ipation from all study participants as approved by The
University of Iowa Biomedical Institutional Review
Board. Subjects were recruited from the community and
campus using posted fliers and word of mouth. Exclusion
criteria included current complaints of pain, a history of
chronic pain, any current or past medical condition re-
stricting exercise, a history of sensory loss or numbness in
715
the arms or legs, pregnancy, and the inability to under-
stand or follow directions.
Subjects were randomly assigned to 1 of 3 treatment
groups: Control (no massage, quiet rest), cutaneous,
light stroking of the skin (superficial touch), or treatment
(deep-tissue massage of the muscles) by a random draw-
ing. Subjects were not informed ahead of time of the 3
treatment groups. Each subject attended 2 sessions. Un-
accustomed eccentric wrist extensions were performed
at session 1 to induce DOMS. The treatment session, con-
trol, cutaneous, or deep massage, occurred at the second
visit 24 to 48 hours after session 1. Strength, pain, and
sensory testing were performed before and after exer-
cise at session 1 and before and after treatment at session
2, by the same 2 investigators for all subjects. These in-
vestigators divided the tasks consistently across subjects
and assisted each other as necessary to facilitate testing.
The testers remained blinded to group assignments
throughout the study. A third investigator was responsi-
ble for scheduling and random assignment, and a fourth
investigator was responsible for the massage treatment.
The study protocol is outlined in Table 1.
Strength Testing
Maximum isometric wrist extension torque measure-
ments were obtained for each participant using the Bio-
dex Isokinetic Dynamometer System 3 (Biodex Medical
Systems, New York, NY). Participants were positioned
with their forearms secured, the wrist positioned in neu-
tral, and the wrist lateral joint line centered with the
Biodex center of rotation. Measurements were repeated
4 times: Baseline and after exercise at session 1 and be-
fore and after treatment at session 2.
Pain and Sensory Testing
Several pain and sensory measurements were evalu-
ated to assess the effect of massage on experimental
muscle pain. The pressure pain threshold (PPT) has been
Table 1. Experimental Protocol
ORDER SESSION 1 SESSION 2
1 Pain (VAS) at rest Pain (VAS) at rest
2 Pain (VAS) with stretch Pain (VAS) with stretch
3 Pressure pain threshold PPT
(PPT)
4 Maximum isometric torque Maximum isometric torque
5 Pain (VAS) with max Pain (VAS) with max
contraction contraction
6 Eccentric exercise to 6-minute treatment (deep
fatigue (3 sets) massage, superficial,
control)
7 Pain (VAS) at rest Pain (VAS) at rest
8 Pain (VAS) with stretch Pain (VAS) with stretch
9 PPT PPT
10 Maximum isometric torque Maximum isometric torque
11 Pain (VAS) with max Pain (VAS) with max
contraction contraction
Abbreviations: VAS, visual analog scale; PPT, pressure pain threshold.
716
defined as the lowest stimulus intensity at which an in-
dividual perceives mechanical pain.45 PPTs provide a
means to evaluate mechanical hyperalgesia,28,36,38
where a reduction in PPT values relative to baseline indi-
cates mechanical hyperalgesia. Four PPT values were ob-
tained over the extensor digitorum muscle belly, each
spaced approx 1 cm apart in a diamond pattern, using a
hand-held digital pressure algometer (Somedic AB,
Farsta, Sweden), using the 1 cm2 tip at a rate of 40 kPa/s.
The mean of the 4 measures was used for each time
point: Baseline and after exercise (session 1) and before
and after treatment (session 2). The mean PPT values
were normalized by baseline PPT values to determine
relative mechanical hyperalgesia values. This measure
has demonstrated good repeatability and reliability in a
number of previous investigations with intraclass corre-
lation coefficients (ICCs) between 0.95 and 0.99.12,38,46
Pain intensity was evaluated using a 10-cm visual ana-
log scale (VAS) with the far left and right ends anchored
with the phrases, “no pain” and “the worst pain imagin-
able,” respectively.37 Subjects were asked to mark the
line indicating their level of muscle pain, discomfort, or
soreness. VAS measurements were obtained at rest, dur-
ing stretch, and immediately after maximum isometric
contraction (Biodex 3.0; Biodex Medical Systems) at 4
time points: Baseline and after exercise (session 1); be-
fore and after treatment (session 2), for a total of 12 VAS
measures. The VAS provides a valid and reliable measure
of acute pain.5,8
Fatiguing Exercise
To induce DOMS, subjects were asked to perform 3 sets
of eccentric (lengthening) wrist extensor contractions to
fatigue using a 10-lb hand weight. Fatigue was defined
as the point when individuals were no longer able to
control the weight during 3 consecutive eccentric (low-
ering phase) repetitions. Assistance during the concen-
tric (shortening) phase of the motion using the opposite
hand was permitted to encourage maximum eccentric
fatigue. A short rest of approximately 1 to 2 minutes
between sets was allowed. For this study, we operation-
ally defined DOMS as increased pain with rest, stretch, or
contraction of ⱖ0.5 cm on a 10-cm VAS and/or mechan-
ical hyperalgesia of ⱖ10% change in PPTs 24 to 48 hours
after eccentric exercise.
Massage Treatment
All subjects were exposed to the same environmental
conditions (room, music, massage cream, and therapist)
for the 6-minute intervention (regardless of treatment
group). Six minutes was chosen, based on the clinical
practice experience of the investigators for a small re-
gion of interest. The experimental group received a
deep-tissue massage to the extensor mass of the fore-
arm, consisting of effleurage (superficial, light stroking
primarily of the cutaneous layers) for 1 minute, petris-
sage (deep-tissue kneading of the muscles) for 4 minutes,
and effleurage again for 1 minute. The superficial touch
group received only effleurage of the skin without ma-
Massage Reduces Pain and Hyperalgesia
nipulating the deeper tissues for 6 minutes. The control
group had a thin layer of massage cream applied but
received no further touch during the 6 minutes. This was
done to maintain consistency and ensure blinding of the
coinvestigators.
Each massage was performed by the same experi-
menter (female) and prefaced with the statement, “if at
any time the pressure is uncomfortable, just let me know
and I can change it.” Subjects were escorted to a sepa-
rate, quiet room and instructed to lay supine on a plinth.
The same 2 songs of soothing music (Yoga Energy, BMG
special products, 2002) were played in the background.
The experimenter did not speak to the subject during the
6 minutes allotted for treatment. After the treatment,
subjects were asked not to reveal details of their treat-
ment to the other investigators.
Statistical Analyses
To test for differences in peak torque, a 3-way mixed,
repeated-measures analyses of variance (ANOVA) was
used (time ⫻ sex ⫻ group), with the Huynh-Feldt correc-
tion for nonsphericity as needed.24 To test for between-
group and sex differences in treatment effectiveness
of DOMS symptoms, 2-way (treatment group ⫻ sex)
ANOVA were used. When no sex differences occurred,
the data were collapsed into 1 group (1-way ANOVA).
The effect of treatment group on pain and hyperalge-
sia was evaluated by using a percent (%) reversal (ab-
solute change after treatment normalized by pain in-
crease between sessions 1 and 2) for pain and mechanical
hyperalgesia. Post hoc testing was done using Dunnett’s
t statistic, comparing the massage groups against the
no-treatment control. Only subjects with the respective
DOMS symptom (eg, stretch pain) at the beginning of
session 2 were considered for treatment effects, opera-
tionally defined as decreased PPTs by 10% or more or
increased VAS pain scores of 0.5 or greater from baseline
(cohort determined separately for each measure). This
approach avoided evaluating if massage decreased pain
in individuals not reporting pain for a particular activity
(eg, at rest), with adjusted sample sizes for each variable.
Mean, standard error of the mean (SEM), and percent
change values are reported. Significance was set at ␣ ⫽
0.05.
Results
Subjects
Forty-four healthy individuals (22 male, 22 female) par-
ticipated in this study and were randomly placed into the
deep massage (n ⫽ 16), superficial touch (n ⫽ 17), and
control (n ⫽ 11) groups. Mean age was 23.3 ⫾ 3.5, with a
range of 19 to 41 years. All but 1 of the 44 subjects
reported development of DOMS, as operationally de-
fined. One subject (female, deep massage group) was
removed from further analyses due to lack of any DOMS
symptoms, as evidenced by either pain or mechanical
hyperalgesia, leaving a total of 43 subjects included in
the remaining analyses. Muscle pain with stretch and
Frey Law et al
Table 2. Frequency of Delayed Onset Muscle Soreness (DOMS) Symptoms Observed
DEEP (N ⫽ 16)
1 Resting pain ⱖ0.5 6 8
1 Stretch pain ⱖ0.5 14
1 Contraction pain ⱖ0.5 5 5
Mechanical hyperalgesia ⱖ10% 13
DOMS observed (any of above) 15
mechanical hyperalgesia were the most frequent mea-
sures of DOMS (Table 2). The most inconsistent indicator
of DOMS was pain during maximal contraction, with
only 25% of subjects reporting this symptom.
Analyses of All Participants With DOMS
Peak Torque
Subjects were successfully fatigued after eccentric ex-
ercise; mean maximum torque decreased by 40.4% im-
mediately after eccentric exercise relative to baseline
(Fig 1). Although absolute peak torque values were ap-
proximately double for men than women (eg, baseline ⫽
10.3 vs 5.9 Nm, F1,37 ⫽ 31.07, P ⬍ .0001), the relative
changes in strength due to fatigue were not significantly
different between men and women (F1,37 ⫽ 3.65, P ⫽
.06). Torque partially recovered at the beginning of the
second session but remained significantly lower than
baseline by 12.2% (F2,74 ⫽ 56.1, P ⬍ .0001). Treatment
did not produce any additional torque recovery.
Muscle Pain
Wrist extensor muscle pain during stretch, rest, and
maximal contraction for all 43 subjects with any form of
DOMS are shown in Fig 2A–C. No differences between
baseline DOMS pain ratings were observed between
Figure 1. Mean (SEM) maximum wrist extensor torque normal-
ized to baseline values for each treatment group. No significant
group or group ⫻ time interactions were observed. *Signifi-
cantly different than baseline (P ⱕ .05).
717
MASSAGE TREATMENT GROUP
SUPERFICIAL (N ⫽ 17) CONTROL (N ⫽ 11) TOTAL (N ⫽ 44)
5 19 (43.2%)
17 11 42 (95.5%)
1 11 (25.0%)
14 9 36 (81.8%)
17 11 43 (97.7%)
men and women (F1,37 ⫽ 0.19 –2.99, P ⫽ .09 – 0.67) or
treatment groups (F2,37 ⫽ 0.311– 0.945, P ⫽ .40 – 0.74).
DOMS significantly increased during stretch by 2.44 ⫾
0.28 cm (10 cm VAS; F1,37 ⫽ 68.7, P ⬍ .0001) and mini-
mally increased at rest (0.75 ⫾ 0.16 cm; F1,37 ⫽ 20.0, P ⬍
.0001). No significant increase in muscle pain during
maximal contraction with DOMS occurred relative to
pre-exercise ratings (0.03 ⫾ 0.24 cm; F1,37 ⫽ 0.02, P ⫽ .89).
Due to the lack of increased contraction pain with
DOMS, it was omitted from further analyses.
Mechanical Hyperalgesia
Mechanical hyperalgesia occurred with a mean de-
crease in PPTs of 25.8 ⫾ 2.78% (F1,37 ⫽ 80.65, P ⬍ .0001;
Fig 2D) for the 43 subjects. Absolute PPT values were
significantly higher for men than women at every time
point (mean baseline values: 192.3 vs 152.0 kPa/sec,
F1,37 ⫽ 7.56, P ⫽ .009). However, when normalized to
baseline, the relative change in PPT (eg, mechanical hy-
peralgesia) was not different between sexes (eg,
⫺21.9% vs ⫺29.9%, F1,37 ⫽ 2.58, P ⫽ .12). Thus, data
between men and women are reported as 1 group for
subsequent analyses.
Cohort-Specific Analyses
Stretch and Resting Pain
A significant treatment effect (F2,36 ⫽ 3.87; P ⫽ .03)
was observed in the 42 subjects exhibiting pain with mus-
cle stretch (Fig 3). No significant sex main effect (F1,36 ⫽
1.07, P ⫽ .31) or treatment ⫻ sex interaction (F2,36 ⫽ 0.31,
P ⫽ .74) occurred. Between-group post hoc tests revealed
deep massage produced a reversal in stretch pain (48.4%
reduction) compared with the no-treatment control
(17.7% increase, P ⬍ .01), with a mean between-group
difference in pain ratings of 1.1 ⫾ 0.5 cm. However, the
superficial touch group was not significantly different
from the other 2 groups (P ⫽ .3). Of the 19 subjects
reporting DOMS at rest, there was no difference in pain
reversal between sexes (F1,13 ⫽ 0.08, P ⫽ .78) or treat-
ment groups (Fig 3): deep massage (66.5 %), superficial
touch (55.2%), and no treatment (33.2%), (F2,18 ⫽ 1.14,
P ⫽ .34).
Mechanical Hyperalgesia
In the 36 subjects with mechanical hyperalgesia, treat-
ment effects (% reversal) did not vary by sex (F1,30 ⫽ 0.97,
P ⫽ .33) but did vary by group (F2,35 ⫽ 3.44, P ⫽ .04; Fig 3).
718
Figure 2. Mean (SEM) baseline and delayed onset muscle soreness (DOMS) symptoms for all 43 subjects with any one DOMS
symptom. A, pain at rest; B, pain during stretch; C, pain during maximal isometric contraction; and D, pressure pain thresholds (PPTs).
*Significantly different than baseline (P ⱕ .05).
Mechanical hyperalgesia was reduced by 27% after deep
massage and superficial touch (27.6 ⫾ 14.7% and 27.5 ⫾
20.4%, respectively), whereas no treatment resulted in
further increased hyperalgesia by 38.4 ⫾ 20.8% (P ⫽ .02).
Discussion
Deep tissue massage was able to reduce mechanical
hyperalgesia (increase thresholds) and decrease stretch
Figure 3. Mean (SEM) percent reversal of DOMS symptoms in
those subjects exhibiting resting pain (n ⫽ 19), stretch pain (n ⫽
42), and mechanical hyperalgesia (n ⫽ 36) by treatment group.
*Significantly different than the no-treatment control group
(P ⱕ .05).
Massage Reduces Pain and Hyperalgesia
pain relative to the no-treatment control group. Super-
ficial touch alone was able to reverse DOMS mechanical
hyperalgesia equally as well as that observed with deep
massage. Further, when combining the superficial touch
and deep massage groups, stretch pain reduction re-
mained significantly greater than the control group, al-
though independently superficial touch was not signifi-
cantly better than no treatment. These results would
suggest that deep-tissue massage is better than superfi-
cial touch in reducing muscle pain but that superficial
touch may contribute some benefit.
It is challenging to test massage relative to a placebo
treatment due to the sensory feedback system, but su-
perficial touch may provide a form of placebo interven-
tion. However, it is likely that the no-treatment control
provided little to no placebo effect. In the classically ref-
erenced report by Beecher,3 placebo responses occurred
in 35% of the 15 studies analyzed (range, 21%–58%) in a
total of 1082 patients. However, in low-back pain pa-
tients, as many as 65% to 70% of those studied reported
pain relief with sham or discredited treatment.44 Thus,
the reduction in mechanical hyperalgesia observed after
superficial touch may be a placebo response.
Conversely, superficial touch may involve an active
treatment effect, similar to deep-tissue massage. Animal
models would suggest that even light stroking can pro-
duce an anti-nociceptive response.31 Massage-like stim-
ulation in rats increases the endogenous release of oxy-
tocin in the plasma and the periaqueductal gray (PAG),
Frey Law et al
and the antinociceptive effects are prevented by block-
ade of oxytocin receptors.2,31,48 Oxytocin is a hormone
that has been shown to increase pain threshold, induce
physical relaxation, and lower blood pressure and cor-
tisol levels in rats. Injection of oxytocin into the PAG
produces analgesia by activation of opioid receptors in
the PAG.31 In humans, oxytocin has been shown to re-
lieve cancer pain33 and low back pain48 and increase the
pain threshold to colonic distension in people with irri-
table bowel syndrome.29 Thus, massage may decrease
hyperalgesia and pain through activation of descending
inhibitory pathways, using the PAG-opioid system and
oxytocin.
Resting pain was not altered by massage relative to
control subjects but rather decreased regardless of the
treatment group. However, the mean increase in resting
pain intensity was low, less than 1 cm on the VAS, which
may not be clinically meaningful. Indeed, DOMS is more
frequently associated with movement and muscle con-
traction.11,32,43 Alternatively, the lack of treatment ef-
fect for resting pain may be that it is mediated by dif-
ferent mechanisms than stretch pain or mechanical
hyperalgesia, such as central versus peripheral, or activa-
tion of chemoreceptors versus mechanical nociceptors.
To assess muscle pain with contraction, we asked sub-
jects to rate their contraction pain after performing a
maximal isometric effort. DOMS is typically associated
with pain with movement and muscle contraction.32 How-
ever, maximal contractions were perceived as equally
painful at baseline and with DOMS, with mean pain rat-
ings of 2.35 cm. Further, the maximum effort may have
been compromised at the second session due to the
DOMS. The peak torque was significantly reduced with
DOMS, consistent with prior studies.11,30 Using a con-
trolled submaximal contraction (eg, pain with lifting a
constant load) may be a better measure of DOMS con-
traction pain for future studies. Studies involving DOMS
may neglect to indicate the conditions under which pain
is assessed. Our results demonstrate notable differences
between pain ratings at rest, during stretch and with
maximal contraction, suggesting this information is valu-
able.
The current study demonstrates that soft-tissue mas-
sage can reduce hyperalgesia and pain using a DOMS
model. Prior studies have had varied findings regarding
the effects of massage on DOMS pain. Massage applied
shortly after bouts of eccentric exercise (immediately to 3
hours after fatigue) but before the development of
DOMS typically reduces pain associated with DOMS at 24
to 48 hours.23,35,41,49 However, Jonhagen et al26 re-
ported no improvement in DOMS pain with massage
provided both after exercise and repeated daily for an
additional 2 days. Participants rated their pain before
and after massage without discussion of the conditions
used to elicit pain (ie, palpation, contraction, or rest). If
their pain rating is analogous to what we term resting
719
pain in the current study, this may partially explain their
lack of pain reduction.
Some literature suggests that men and women may
respond differently to pain due to different pain modu-
latory mechanisms such as baroreceptor reflex arch
(blood pressure related analgesia)6; descending inhibi-
tory controls20; endogenous opioid system18; and hor-
mones, family history, and affective/cognitive factors.25
However, no sex differences were observed in this cohort
for any of the pain intensity scales, consistent with prior
studies involving DOMS.9,13 Our study found men to
have higher absolute PPTs, a common finding.45 How-
ever, when normalized to baseline, no further sex differ-
ences were noted in relative change in PPTs with DOMS
(hyperalgesia) or treatment (reversal of hyperalgesia).
Further, no treatment ⫻ sex interactions were evident,
suggesting that men and women responded similarly to
massage.
Although we observed a positive effect of deep tissue
massage relative to a no treatment control, these find-
ings may not be universally applicable. The confined
analyses to those individuals reporting increased pain
resulted in a reduced sample size. A type II error may
have occurred for the resting pain condition, adversely
influencing our conclusion that massage did not affect
resting pain. Additionally, we were not adequately able
to assess contraction pain using our current methodol-
ogy. The results from our 6-minute Swedish massage
treatment may or may not translate to different treat-
ment durations and/or massage techniques. Although
we were able to detect significant improvements in pain
with a 6-minute massage from a well-trained doctor of
physical therapy (DPT) student, therapist experience
level may have an influence on outcomes.35 Neverthe-
less, advanced massage skills probably would result in
greater treatment effects, not reduced. Last, DOMS pro-
vides a controlled model of muscle soreness but may not
mimic precisely the peripheral and central pain mecha-
nisms associated with other muscle pain conditions.
In conclusion, the current study supports the use of
massage to decrease stretch pain perception and hyper-
algesia after the induction of DOMS. We have demon-
strated that deep-tissue massage partially reverses
stretch pain, and both deep-tissue and superficial touch
treatments partially reversed mechanical hyperalgesia—
the 2 most frequent measures of DOMS in this study.
Several clinical implications can be drawn from these re-
sults. Even a relatively brief, 1-time treatment can pro-
duce measurable changes in muscle pain. Massage is ca-
pable of partially reversing muscle pain and hyperalgesia
associated with muscle stretch and mechanical pressure
but may not be able to reverse resting pain. The condi-
tions under which muscle pain is assessed may account
for some of the disparity in the literature regarding the
effect of massage on muscle pain.
720
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