Soft Tissue Mobilization Effects on Doms
Condition: Performance
Study type: Interventional

Summary: 
      Aim: The aim of the study was to examine and compare the time-dependent effects of IASTM and
      FR applications on delayed muscle pain and physical performance.

      Method: 50 physically active healthy male individuals between the ages of 20-35 will be
      included in the study. Participants will be divided into 3 separate groups as instrument
      assisted soft tissue mobilization(IASTM), foam roller (FR) and control group. DOMS creation
      protocol will be implemented after preliminary evaluation. IASTM and FR groups will be
      treated after the formation of doms. The control group will not be applied. participants are
      evaluated 1 day before the doms were created and at 24, 48 and 72 hours after doms created.
      Subjetcs were tested for physical activity level with IPAQ-SF, flexibility with sit and reach
      test, pain with Visual analog scale, edema with thigh circumference measurement, explosive
      power with horizontal and vertical jump test, dynamic balance with y balance test and
      isokinetic muscle strength of the quadriceps and hamstring muscles with isokinetic
      dynamometer.
    

Detailed description: 
      Muscle soreness after exercise is often referred to as delayed onset muscle soreness (DOMS).
      DOMS is common in people who do strenuous and unusual exercise and physical activity. DOMS,
      also called Grade 1 muscle strain, is characterized by localized tenderness and pain. DOMS
      typically peaks between 24-72 hours after strenuous exercise and disappears within 5-7
      days.2-4 Associated with exercises involving eccentric muscle movement DOMS also affects
      athletic performance by causing decreased range of motion and reduced peak torque.

      According to literature, many improvement strategies have been used by athletes, coaches and
      health professionals to minimize DOMS symptoms and improve performance. These strategies
      include massage, stretching exercises and the use of anti-inflammatory drugs. Studies
      conducted in different populations to date show that the results of these treatments on DOMS
      usually have minimal analgesic effects. Improvements in strength and flexibility have also
      been observed in some studies.

      Myofascial release method, developed by James Cyriax, Instrument assisted soft tissue
      mobilization (IASTM) is applied with specially designed instruments. In particular, the use
      of instruments in the technique, which has been shown to have a mobilizing effect on soft
      tissue to reduce pain, increase range of motion and function, creates a deeper effect and
      allows specific treatment. It is also known to provide a mechanical advantage for the
      clinician by reducing the pressure on the hand. Current studies show that IASTM can improve
      joint ROM change the perception of pain and increase local circulation

      Foam Roller (FR), another method used for myofascial relaxation, is a method that has been
      frequently researched in recent years, especially in the warming and recovery phases. FR
      includes a wide variety of therapy techniques, including massage and self-massage. Myofascial
      release is used to treat somatic dysfunction causing pain and limitation. Self myofascial
      release is performed using FR or stick. To demonstrate the effect of self-myofascial
      relaxation, studies focused on the effect of FR on increasing ROM, reducing muscle soreness,
      and lower extremity biomechanical performance. The first effect is associated with recovery
      and recovery, while the second effect is associated with performance. There are several
      studies reporting that FR also has a major impact on improving flexibility. In fact, there
      are studies reporting that it shows this effect even after a single FR session.

      The number of studies investigating or comparing the effects of FR and IASTM techniques on
      delayed muscle pain is very limited in the literature. Studies comparing the effects of the
      two techniques have generally compared their effectiveness in the upper extremity muscles. In
      the lower extremity, there is only one study investigating and comparing the effects of both
      treatment methods in healthy active individuals. In this study, only the effects of
      techniques on flexibility were evaluated. Therefore, the aim of our study is to examine and
      compare the time-dependent effects of IASTM and FR applications on delayed muscle pain and
      physical performance.

      Method:

      Participants who want to take part in the study will first be informed about the study in
      written and verbal form and their written consent will be obtained. Then, the
      socio-demographic characteristics and information of all participants will be recorded. On
      the same day, the assessments detailed below will be audited by all participants and they
      will be given the opportunity to practice in order to adapt to the assessment methods.
      Preliminary evaluations of all participants (all evaluations mentioned in the evaluations
      section) will be taken at least 48 hours after the practice day. After the preliminary
      evaluations, individuals will be randomly divided into 3 groups with GraphPad - version 8.4.3
      software in order to determine which group (foam roller/instrument assisted soft tissue
      mobilization or control group) the participants will be in. Treatment methods to be applied
      to the groups were divided into two as IASTM and Foam roller.

      Group 1 (Foam Roller): It will be applied to the Quadriceps, Hamstring and Gastrocnemius
      muscles of the participant's dominant lower extremity using a rigid FR. A total of 6 minutes
      will be applied to a person, 2 minutes for each muscle. Pressure intensity; According to the
      Visual Analogue Scale, which is the point where pain will not be felt but moderate to severe
      discomfort will be felt, it will be done at a severity of 7/10.

      Group 2 (IASTM): Myofascial release technique will be applied to the Quadriceps, Hamstring
      and Gastrocnemius muscles in the dominant lower extremity of the participant with the Graston
      technique®, the instrument to be used in this technique. The application will be at 45°
      angles for each muscle, 2 minutes, for a total of 6 minutes. The IASTM application will
      include sweep-fan-sweep strokes and cycles will be performed along each muscle for a
      specified time.

      Group 3 (control): Individuals in this group will be asked not to participate in any physical
      activity during the evaluations (5 days) and to do their normal daily activities

      Method: After the first evaluations, DOMS will be applied 48 hours later. Immediately after
      the DOMS is created, FR will be applied to those in Group 1, IASTM will be applied to those
      in Group 2, and no application will be made to those in Group 3. On the same day, 30 minutes
      after the applications, pain (VAS) and edema (Quadriceps circumference measurement) will be
      evaluated. At 24, 48 and 72 hours, all evaluations will be repeated to the participants.

      DOMS creation protocol: It will be created by eccentric contraction in the isokinetic device.
      The patient will be positioned with the knee at 90° flexion. Then, the knee extensors will be
      asked to perform 5 sets of 15 repetitions of maximal voluntary eccentric contraction at an
      angular speed of 60°/s. There will be 2 minutes of rest between sets.
    

Intervention name(s): Instrument assisted soft tissue mobilization; Foam Roller
Intervention type(s): Other; Other
Intervention description(s): Myofascial release technique will be applied to the Quadriceps, Hamstring and Gastrocnemius muscles of the participant's dominant lower extremity with the Graston technique®. The application will be at 450 angles for each muscle, 2 minutes, for a total of 6 minutes. The IASTM application will include sweep-fan-sweep strokes and cycle through each muscle for the specified time.; Will be applied to the Quadriceps, Hamstring and Gastrocnemius muscles of the participant's dominant lower extremity using rigid Foam Roller. A total of 6 minutes will be applied to a person, 2 minutes for each muscle. Pressure intensity; According to the Visual Analog Scale, which is the point where pain will not be felt but moderate to severe discomfort will be felt, it will be done at a severity of 7/10.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: doms; muscle strength; flexibility; recovery