The Efficacy of Lymphatic Massage on Lower Extremity Edema and Performance After Treadmill Exercise in Sprinter Compare to Static Stretching and Cold Water Immersion
Condition: Post-exercise Lower Extremity Edema
MeSH terms: Edema
Study type: Interventional

Summary: 
      Background: Lower extremity edema is often seen after exercise in healthy individuals,
      especially sprinters, in sports physical therapy practice. Edema is defined as the excessive
      fluid accumulation in the interstitial space. Recent studies showed that there could be an
      increase in fluid up to 31.2 ml after a 15-minute running bout in healthy individuals. Fluid
      accumulation may be resulted from (1) high intensity training, (2) compression of blood and
      lymph vessels due to increased soft tissue tension and (3) the effect of gravity. Lower
      extremity edema not only causes great impact on athlete's recovery and performance, it could
      also lead to fibrosis, dysfunction and contracture. The pilot study showed that lower
      extremity edema not only existed post-exercise, and decreased ankle circumference was found
      after a 5-minute massage session, not only when compared to the status after exercise, but
      also when compared to the baseline (resting). The result also showed lower extremity edema
      may exist both during resting and after exercise. However, no studies to date investigated
      the solutions to decrease lower extremity edema during resting and after exercise in
      sprinters. Massage has been proven beneficial to athletes by increasing range of motion,
      promote recovery and increase skin blood flow, however, no study investigated the effect of
      massage on lower extremity edema and compared that to different common recovery modalities
      such as cold water immersion and static-stretching.

      Purposes: To explore the effects of massage on sprinter's gastrocnemius after running on
      edema and strength with immediate and short-term follow ups.

      Methods: This study will recruit both male and female sprinters age between 20-30 years old
      who participate in the event of 100, 200 and 400 meter sprints. After individuals'
      enrollments and baseline data collections, all subjects will receive all three different
      treatments (massage, cold water immersion and static stretching) in randomized orders a week
      apart, respectively. Outcome measures are: visual analogue scale (VAS) score, lower leg
      volume, pressure pain threshold and horizontal jump distance. All measurements will be
      recorded at baseline, immediately after exercise, immediately after treatment, and 10 minutes
      after treatment as the follow up. Descriptive statistics will be used for participants'
      characteristics. Three-way ANOVA (3 treatments x 4 times x 2 legs) with repeated measures
      design will be used to detect differences, and post-hoc analysis will be used when
      interactions are identified. p value of < .05 will be used in this study.
    


Intervention name(s): Lymphatic massage; Static stretching; Cold water immersion
Intervention type(s): Other; Other; Other
Intervention description(s): One certified physical therapist will perform the massage regimens and techniques adapting from Swedish massage such as effleurage and petrissage that will be used in the massage group. Participants will first lay down in prone position, and the massage leg will be supported on the therapist's leg or on pillows with legs being positioned at approximately 30 degrees of knee flexion. This can promote venous return of the lower legs and also keep the ankle plantar flexors in a relative low muscle tension position. After positioning, long strokes will be applied from the distal to proximal part of gastrocnemius with approximately 20 repetitions and then 20 repetitions of circular strokes would be applied at the popliteal fossa. Finally, therapist will knead around participant's Achilles tendon for 10 repetitions.6 The combination of the techniques mentioned above will repeat 3 times in each subject, and the total duration of massage will be approximately 5 minutes.; For the static stretching group, participants will perform the standing gastrocnemius stretches. First, participant stands facing a wall and put the stretched leg behind the body. Physical therapist will ask the participant to slightly flex the front leg, and keep back leg extended with heel on the ground. Both toes will be positioned pointing forward. Participant will then be asked to lunge forward slowly until the calf muscles on the back leg feeling stretched. Participant will hold in this position for 60 seconds and repeat 3 times.; In the cold-water immersion group, participant's lower leg will be put in a bucket filled with cold water for 10 minute. The temperature of the water will be kept in 11-15 degrees Celsius.52 The water level should reach participant's fibular head to ensure complete immersion of the lower leg.
Intervention model: Single Group Assignment
Intervention model description: There will be a total of 4 different time points where outcome measures will be assessed including: baseline, immediately after pre-conditioning, immediately after treatment and 10 minutes after treatment. Once the participant completed the assessment of one treatment, another assessment session from one of the two remaining treatments will be scheduled in the following week, and the data collections for all three treatments will be finished in three consecutive weeks. This could ensure that all participants receive similar training schedules with similar training intensity within a fixed time period.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: lymphatic massage; static stretching; cold water immersion