THE EFFECT OF EFFLEURAGE MASSAGE IN RECOVERY

FROM FATIGUE IN THE ADDUCTOR MUSCLES OF

THE THUMB
Ryan Young, M.Ost,a Boris Gutnik, PhD,b Robert W. Moran, MHSc(Ost),c and Rex W. Thomson, PhDd

ABSTRACT

Objective: The aim of this study was to investigate the effect of local effleurage massage on the recovery from fatigue in
the small hand muscles.
Methods: This study was a within-subject repeated measure design. Twelve healthy, right-handed volunteer male
subjects with a mean age of 25 F 2.8 years were recruited into the study from a university population. Subjects were
randomly allocated to a rest or massage protocol. Subjects undertook the alternate protocol at a subsequent session. All
subjects underwent baseline dynamometry testing of isometric thumb adduction (nondominant hand) before undertaking a
fatigue-inducing task of the thumb adductors. Subjects then underwent either 5 minutes of massage applied to the first
dorsal interspace or 5 minutes of rest. Subjects were then retested.
Results: The maximal force recorded after the massage protocol was not significantly different from the maximal force
recorded after the rest protocol, with a mean difference of only 0.63 N (95% confidence interval, ÿ12.55 to 13.80 N;
P = .92). The maximal gradient of force development after the massage protocol was not significantly different from the
maximal gradient recorded after the rest protocol, with a mean decrease in gradient of 19.48 N/s (95% confidence interval,
ÿ117.33 to 156.30 N; P = .77).
Conclusions: Effleurage massage was not an effective intervention for enhancing the restoration of postfatigue F max
and G max in the small muscles of the hand. The wide variation in response to this massage protocol may support the notion
that there is no universal effect of effleurage massage in enhancing recovery from fatigue. (J Manipulative Physiol Ther
2005;28:696Q701)
Key Indexing Terms: Massage; Muscle Fatigue; Physiology; Hand; Muscles; Skeletal

S
everal variants of massage are widely used in sports
and musculoskeletal medicine with the aim of
enhancing performance and muscle recovery and
reducing soreness after intense physical activity.1 Several
studies have investigated the apparent contradictory effects
of massage on athletic performance using different massage
techniques and durations of massage.2-9
The few well-controlled studies that have investigated
massage have been mainly focused on its potential to promote
recovery from fatigue and enhance athletic performance.
a
School of Health and Community Studies, Unitec, New Zealand.
b
School of Health and Community Studies, Unitec, New Zealand.
c
d
School of Health and Community Studies, Unitec, New Zealand.
School of Sport, Unitec, New Zealand.
Sources of support: No external funds were received for this
research.
Submit requests for reprints to: Boris Gutnik, PhD, School of
Health and Community Studies, Unitec New Zealand, Private Bag
92025, Auckland, New Zealand (e-mail: bgutnik@unitec.ac.nz).
Paper submitted August 23, 2004.
0161- 4754/$30.00
Copyright D 2005 by National University of Health Sciences.
doi:10.1016/j.jmpt.2005.09.015
However, these studies have also produced contradictory
results.1,4,10-12 There appears to be little in the literature
regarding the effects of massage when used as a method of
enhancing recovery from fatigue after isometric contractions
of the small distal hand muscles. Investigating fatigue in the
intrinsic muscles of the hand has application in studying
common occupational and recreational tasks involving grip
and manipulation of objects between thumb and fingers.
The aim of this research was to investigate the effect of
local effleurage massage on the recovery from fatigue of the
hand muscles —specifically, the adductors of the thumb.
METHODS
Twelve healthy, right-handed volunteer male subjects
with a mean age of 25 F 2.8 years were recruited into the
study from the university population. None of the subjects
had any history of musculoskeletal injury, trauma, or disease
of the upper limb or hand. The study was approved by the
Human Research Ethics Committee, Unitec New Zealand,
Auckland, New Zealand, and all subjects gave informed
consent before testing began.

696
Journal of Manipulative and Physiological Therapeutics
Volume 28, Number 9
The data collection was undertaken over 2 separate
testing sessions. Subjects were randomly allocated to
receive either rest (the first dependant variable) or massage
(the second dependant variable) at the first session. The 2
testing sessions were separated by at least 1 week to
minimize any training effects.
Two parameters, the maximal force of the isometric
adduction of the thumb ( F max, expressed in newtons) and
the maximal gradient of force development as the steepest
slope of the force-time curve ( G max, expressed in newtons
per second), were measured using a specially constructed
electronic dynamometer (Fig 1) with a known accuracy of
0.1%.13 The study used a maximal isometric contraction
where participants were asked to adduct the thumb as
forcefully and as fast as possible and to relax as quickly as
possible. In this case, the F max produced is smaller than the
maximal voluntary isometric contraction force developed
by the adductors of thumb (2- 5 seconds of contraction) that
is measured in other studies.14 -19 Subjects were comfort-
ably seated in front of the dynamometer using a height adjust-
able chair that allowed consistency in subject positioning.
To minimize the possible influence of previous training
effects arising from dominant use, only the nondominant
hand was investigated. The left arm and trunk was strapped
to the chair to minimize flexion of the arm and body
movement. The chair height was adjusted so that subjects
could comfortably rest their pronated left arm on the
dynamometer with the elbow at approximately 908 of
flexion and the forearm in a horizontal position.
The thumb of the left hand was initially abducted to 908
and the interphalangeal joint placed against the center of the
button. The index finger rested alongside the lateral edge of
the boxlike elevation, and the plantar surface of the hand lay
flat on the surface of the dynamometer (Fig 1). The subject
was asked to sit in a relaxed upright posture, with the head
facing straight ahead and eyes fixed on a designated point.
Subjects were provided with headphones to receive audio
stimuli generated via the dynamometer software.
In response to audio stimulation (bbeepsQ), the subject
adducted the thumb against the button on the dynamometer.
Subjects were encouraged to undertake the movement as
fast as possible and with maximal force, and to subsequently
release as fast as possible. This type of contraction is
ostensibly isometric in nature, where the muscle develops
tension without changing length.20
Protocol 1: Rest
The subject was positioned in front of the dynamometer
as outlined previously. In response to a succession of audio
stimuli (20 beeps), each separated by a resting interval
(randomly computer generated) of between 4 and 8 seconds,
the subject pushed with maximal effort against the button
(thumb adduction) and released as fast as possible. The
number (20) of stimuli delivered was large because of the
Young et al 697
Effleurage Massage Muscle Fatigue
Fig 1. Custom-built electronic dynamometer and demonstration of
hand position as used during the experiment.
high variability in F max and G max between muscle con-
tractions. The minimum 4-second interval between stimuli
was considered to be sufficient to allow full recovery.21 The
F max and G max were calculated automatically by the
dynamometer software. The averages of these force and
gradient values were used to indicate the participant’s
prefatigue FVmax av and GVmax av.
These initial contractions were immediately followed by
a fatigue-inducing exercise consisting of a 1-minute
sustained maximal isometric contraction against the button.
This fatigue protocol was similar to that outlined by Milner-
Brown et al.18 Participants were then unbuckled from the
chair and underwent 5 minutes of rest in the horizontal
position on a treatment table.
Immediately after either the massage or rest, the subject
was again positioned in the front of the dynamometer and,
in response to a succession of 20 audio stimuli, pushed
maximally against the button as fast and as hard as possible.
Again, the average force and gradient values of the
contraction were calculated to provide the postfatigue
results of FUmax av and GUmax av.
Protocol 2: Massage
The same protocol was used, but instead of the
condition of rest, subjects underwent 5 minutes of
effleurage massage (Fig 2). This massage consisted of
slow, rhythmic, deep stroking applied with the operator’s
reinforced thumb along the long axis of the dorsal aspect
of the adductor muscles of the thumb from the radial
border of the second metacarpophalangeal joint to the base
of the radial border of the second metacarpal. Water-
soluble massage oil was used to decrease skin friction. An
experienced osteopath (RM) performed the massage
intervention on all subjects. The massage was not formally
standardized for contact pressure or rate of application but
698 Young et al
Effleurage Massage Muscle Fatigue
Fig 2. Diagram to illustrate experimental design. Subjects were randomly allocated to start with the rest or massage protocols. The
alternate protocol was undertaken at the subsequent testing session.
Fig 3. Bar chart demonstrating the mean maximum force ( F max av)
for rest and massage protocols. Bars represent mean values F SD.
Mean values calculated from 20 trials.
was delivered within the pressure comfort tolerance of the
subject. Subjectively, the operator reported that all massage
was of a similar magnitude of pressure.
Statistical Analysis
Two-tailed Student t tests were used to compare groups,
and 95% confidence intervals (CIs) were calculated for the
mean differences between groups. a was set at .05. A further
descriptive analysis of data was undertaken to record the
Journal of Manipulative and Physiological Therapeutics
November/December 2005
Fig 4. Bar chart demonstrating the mean maximal gradient
( G max av) for the rest and massage protocols. Bars represent
mean values F SD. Mean values calculated from 20 trials.
effect of massage on each individual subject after fatigue.
Two variables ( F max av and G max av) were calculated for
each individual. The changes in these variables after
massage compared to rest were used to indicate the direction
of effect of massage in the recovery from fatigue.
In the individual analysis, the subjects who showed the
most beneficial effect from the massage were considered to
be those who increased the F max av and G max av greater
than +5% in comparison to the rest protocol. Those who
showed a detrimental effect from the massage (ÿ) were
Journal of Manipulative and Physiological Therapeutics Young et al 699
Volume 28, Number 9 Effleurage Massage Muscle Fatigue

Table 1. Mean values for maximum force and maximal gradient pre- and postfatiguing exercise for rest and massage protocols

Rest protocol Massage protocol P value

Mean 95% CI for for mean Effect 95% CI for
Prefatigue Postfatigue Prefatigue Postfatigue differencea mean difference difference statistic effect statistic

F max (N) 56.77 54.71 58.53 55.34 0.63 ÿ12.55 to .92 0.04 ÿ0.8 to 0.9
(13.95) (15.01) (16.04) (16.01) 13.8
G max (N/s) 419.42 400.11 428.73 419.59 19.48 ÿ117.33 to .77 ÿ0.12 ÿ0.8 to 1.0
(142.22) (170.66) (126.36) (151.04) 156.30

All values are mean F SD.

a
Mean difference for F max is calculated between rest protocol postfatigue F max and massage protocol postfatigue F max. Mean difference for G max is
calculated between rest protocol postfatigue G max and massage protocol postfatigue G max.

Table 2. Overall effect of massage on maximal force and maximal gradient

Subject 1 2 3 4 5 6 7 8 9 10 11 12

%F max av ÿ ÿ 0 0 ÿ + ÿ 0 ÿ + + 0
%G max av ÿ + 0 ÿ 0 0 0 0 0 ÿ + +
Overall effect ÿ ? 0 ÿ ÿ + ÿ 0 ÿ ? + +

% F max av represent percentage mean maximal force change with massage over rest; %G max, percentage mean maximal gradient of force change with
massage over rest; +, beneficial effect (increase in F max av and G max av greater than +5% in comparison to the rest protocol); 0, no effect (less than 5%
change in comparison to rest protocol); ÿ, detrimental effect (decrease in F max av and G max av greater than +5% in comparison to the rest protocol); ?,
equivocal effect (increase/decrease in one parameter occurs with opposite effect in other parameter).

considered to be those who decreased the F max av and
G max av less than 5% (in comparison to the rest protocol).
No effect (0) was indicated if the difference in these
indexes between the rest and massage protocols was greater
than ÿ5% but less than +5%.
RESULTS
There was no significant difference in maximal force
between the subjects before participating in either the rest or
massage (95% CI, ÿ14.5 to 11.0 N; t 22 = 2.07; P = .78).
The maximal force recorded after the massage protocol
was not significantly different from the maximal force
recorded after the rest protocol (Fig 3), with a mean
difference of only 0.63 N (95% CI, ÿ12.55 to 13.80 N;
t 22 = 2.07; P = .92). The maximal gradient of force
development after the massage protocol was not signifi-
cantly different from the maximal gradient recorded after the
rest protocol (Fig 4), with a mean decrease in gradient
of 19.48 N/s (95% CI, ÿ117.33 to 156.30 N; t 22 = 2.07;
P = .77). A summary of the results including effect sizes is
presented in Table 1.
Individual analysis of the 2 fatigue variables is presented
in Table 2. Three participants received some beneficial
effect from the massage, and 5 subjects showed a de-
trimental effect.
DISCUSSION
This investigation was carried out to evaluate the
possible effect of effleurage massage in the recovery from
fatigue of the thumb adductors, ostensibly the first dorsal
interosseous and adductor pollicis muscles.22 Previous
studies have investigated fatigue of the first dorsal inteross-
eous muscle and were based on different models of
movement — the abduction or the flexion force generated
by the index finger.14,17,18,23 The isometric adduction of the
thumb is most likely due to the contraction of the first dorsal
interossei and the adductor pollicis muscles.
Muscular fatigue is evidenced by reduction in maximal
force, shortening velocity, gradient of force development,
and prolongation of relaxation.24,25 The results of this study
support those studies that have reported no effect of
massage during long-term recovery 6 and those that suggest
that massage has no significant effect on performance.5
Although it is important to note that these latter 2 studies
investigated large muscle group performance in the sporting
setting, the current study investigated fatigue recovery in
small muscles of the hand with differing composition of
muscle fiber types than large muscles.
The adductor pollicis muscle, which is actively involved
in thumb adduction, is composed of more type I fibers (slow
twitch fibers — 80%) than the first dorsal interossei (50%),
and these fibers show differences with regard to resistance
to fatigue.26
The classic view is that there is a positive correlation
between fatigability of a muscle and the intrinsic proportion
of fast twitch fibers.27 It is possible that the 1-minute
maximum voluntary sustained contractions recommended
by Milner-Brown et al18 and used in the present study were
not sufficient to fatigue the adductor pollicis muscle because
it is composed of a large number of slow twitch fibers and
700 Young et al
Effleurage Massage Muscle Fatigue
is, therefore, resistant to fatigue. Mills and Thompson17
used 1.5 minutes of sustained contraction, and this elicited
significant fatigue, but in that particular study, only the first
dorsal interossei was used.
The results of our study show a wide variation of
response to the fatiguing exercise. Some subjects showed a
decrease in force and gradient, others exhibited no change,
and the remainder showed an increase in values. A wide
variation in fiber type proportions in the intrinsic hand
muscles has been shown in the autopsy studies.21,26 The
variation of the proportion of different types of muscle
fibers between subjects may help to explain the variability
in response because of a greater number (increased
resistance to fatigue) or lesser number (smaller resistance
to fatigue) of slow twitch fibers.
Previous studies that have investigated the effect of
fatigue on force development of the first dorsal interossei
muscles have measured the reduction of the maximal
voluntary contraction force.14-19 In this present study, the
pre- and postfatigue values of F max were analyzed. The
subjects were all requested to adduct their thumbs as
forcefully and as quickly as possible. This is different to
the maximal voluntary contraction force (2-5 seconds of
contraction) because there is no time for the individual
tetany to fuse. Therefore, the force produced would be
markedly smaller than in a longer contraction where a state
of tetany could develop. There are no reports on the
relationship between the maximal voluntary contraction
force and the F max, but the mechanisms of recruitment and
the muscle contraction are the same. It is assumed that
because fatigue results in a reduction in the maximal force
development, the F max will also be reduced with fatigue.
Many studies have reported psychological regeneration
as a beneficial effect of massage.1,5,28-30 Samples30 reported
that the effect of massage may be largely subjective. There
was no significant physical benefit of massage in F max or
G max in the present study. If it is assumed that there is little
or no physiological benefit of massage in expediating
recovery from fatigue,1,4 there still remains the possibility
of a positive psychological effect. Although, not inves-
tigated in the present study, the psychological effects of
massage on motor tasks may be a worthwhile avenue for
further investigation.
CONCLUSIONS
Effleurage massage was not an effective intervention for
enhancing the restoration of postfatigue F max and G max in
the small muscles of the hand. The wide variation in
response to this massage protocol may support the notion
that there is no universal effect of effleurage massage.
Further research is needed about fatigue recovery and
performance-based effects of massage with respect to the
small muscles of the hand.
Journal of Manipulative and Physiological Therapeutics
November/December 2005
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