effects of massage on alpha motoneuron excitability

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massage. The H-reflex amplitude was

found to be markedly reduced during

the period of massage in comparisonwith that obtained before or following

massage. This finding was interpreted

as indicating a reduction in (inhibi-

tion of) motoneuron activity.

muscle being massaged. A secondary

aspect of the study was to confirm

our previous finding6 that both femaleand male subjects responded in a

similar manner to the massage, which

was applied by a male therapist.

Massage may be compared with othertherapeutic techniques such as tendon

pressure8~9 nd muscle tapping, o

which have recently been investigated

as to their effects on alpha motoneu-

ron excitability. These two techniques,

like massage, result in a reduction in

H-reflex amplitude, indicating re-

duced motoneuron excitability. The

studies of Kukulka and c0lleagues8~9have documented changes specific

only to the muscle group under

investigation.

Bdanger and colleagues10 also re-

ported a reduction in H-reflex ampli-tude recorded from the triceps surae

muscle, resulting from the application

of muscle tapping to other sites onthe ipsilateral limb, in neurologically

nonimpaired subjects. This generality

of response led to the speculation

that massage may also result in a gen-

eralized neurophysiological response,

the effects of which may extend be-yond the muscle being massaged.

Such a finding would provide both

practical clinical information and fur-

ther insights into the neurophysiologi-cal mechanisms subserving the previ-

ously reported inhibitory effects of

massage.

The purpose of this investigation wasto document the effects of massage,

applied to two ipsilateral and two

contralateral sites of the lower limbs,on motoneuron excitability of the

right triceps surae muscle in neuro-logically nonimpaired subjects. We

expected that the inhibitory effects

(a decreased H-reflex amplitude) of

massage would extend beyond the

Subjects

Sixteen subjects (8 men, 8 women),recruited from a population of under-

graduate students and university staff,

volunteered to participate in the study.

The subjects, who ranged in age from

20 to 37 years @=22.3, SD=3.8), had

no known neurologic or orthopedicimpairments. Each subject signed an

institutionally approved informed con-

sent form before participating in the

study. Subjects were asked to refrain

from ingesting substances containing

caffeine or alcohol on the day of thedata collection. These substances have

been demonstrated to alter theH-reflex amplitude.11

H-reflex Acquisition

Details of the H-reflex recording pro-

cedures have been reported in detail

elsewhere12 and are summarized asfollows. Following preparation of the

recording site, two miniature (4-mm

diameter) Beckman surface recording

electrodes* were positioned (parallelto the direction of the muscle fibers)

along the midline of the posterior

surface of the triceps surae muscle,

1116th of the distance between the

flare of the medial malleolus and the

distal crease of the popliteal fossa of

the right leg. The reference electrodewas positioned over the external mal-

leolus of the same leg. The electrical

activity of the stimulated muscle (H-

reflex and M-response) was recordedby a DISA differential amplifiert (com-

mon mode rejection ratio= >90 dB,

input resistance=250 Ma) and band--'Beckman Instruments Inc. 110 Technology Park, Norcross, GA 30071.

+Dantech, 100 Dynamic Dr, #103, Scarborough, Ontario, Canada N1V 5C4.

*~nternational usiness Machines Corp, PO Box 13283, Boca Raton, FL 33432.

'Grass Instrument Co, 101 Old Colony Ave, Quincy, MA 02169.

pass filtered (3 dB down at 20 and

2,000 Hz) and sampled by an IBMPC -A P compute6 at 5,000Hz.

Following the location of the idealstimulating site (ie, one that resulted

in an H-reflex devoid of artifacts) by a

hand-held probe, the cathode (10-mm

diameter) was positioned over the

posterior tibial nerve in the region

of the popliteal fossa. The anode

(20 cm2) was placed across the thighat the superior border of the patella.

Individual square-wave pulses

(1-millisecond duration) were deliv-

ered from a Grass S88 stimulators

and related stimulus isolation (Grass

~ 1 ~ 5 ' )nd constant current (GrassCCUI~ ) nits at 10-second intervals.

The stimulator was controlled by a

software management package specif-

ically designed for H-reflex data ac-

quisition and processing.13 In this

investigation, the peak-to-peak ampli-tudes (in millivolts) of the H-reflex

and M-response were recorded and

analyzed. The peak-to-peak amplitudeis easily quantifiable and a widely

used characteristic6.8J4 in describing

the H-reflex.

Massage Technique

The form of massage used in this

study and in previous investigations596

consisted of a one-handed, rhythmic-

pressure grasping and releasing of themuscle tissue in the region of the mus-

cle belly. This deep-massage tech-

nique, also referred to as petrissage,l

was administered by the same person

(q,ho is experienced in the ap-plication of this technique in both clin-

ical and research situations. The pres-

sure applied during the massage was

not experimentally controlled, but we

believe it corresponded to that used in

clinical practice and in previous stud-ies. The rate of application was stan-

dardized at 0.5Hz,

based on therhythm developed during the previousstudies and verified during this experi-

ment. Talcum powder was applied to

the massage site before beginning the

massage. The procedure used closely

followed the standard procedure for aclinical massage. The massage was ap-

plied to the triceps surae and ham-

string muscles of each leg.

Physical TherapyNolume 71, Number 8/August 1991



citability of the ITS of 16neurologi-

cally nonirnpaired individuals. A sig-

nificant decr ease was observed in the

amplitude of the H -reflex, reco rded

during massage of the ITS. This de-

crease was interpreted as represent-

ing a reduction in the excitability of

the triceps surae muscle motoneu ronpool. This finding confirms the speci-

ficity of the n eurom uscular re spon se

and suggests that the stimulus an d

receptors activated during massageare specific to the muscle being

massaged.

Acknowledgments

This research was conducted while DrWilliams was the recipient of a Cana-

dian Visiting Commonwealth Fellow-

ship at Concordia U niversity. The sup-

port of this agency is acknowledged,

as is the support of the Dean of the

Faculty of Arts and Science, ConcordiaUniversity. We also exp ress o u r ap-

preciation to Francois Kemp, P eng ,

and Michel Goyette, P eng , of th e

Centre de Recherche, Institut de

Readaptation d e M ontreal, for their

development of the data-acquisition

and data-analysis software an d their

support.

References

1 Beard G, Wood EC. Massage: Principles andTechniques. Philadelphia, Pa: WB Saunders Co;1964.

2 Tappan FM. Healing Massage Techniques:AStudy of Eastern a n d W estern Methods Reston,Va: Reston Publishing Company Inc; 1978.

3 Hollis M. Massage for Therapists Oxford,England: Blackwell Scientific Publications Ltd;1987.

4 Tappan FM. Healing Massage Techniques:Holktic , Classic and E m q i n g Methods. 2nded. East Norwalk, Conn: Appleton & Lange;1988.

5 Morelli M, Seabome DE, Sullivan SJ.Changes in H-reflex amplitude during massageof triceps surae in healthy subjects.Journal ofOrthopaedic and Sports Physical Therapy.1990;14:5559.

6 Morelli M, Seaborne DE, Sullivan SJ.H-reflex modulation during manual musclemassage of human triceps surae. Arch PhysMed Rehabil. In press.

7 Schieppati M. The Ho h a nn reflex: a meansof assessing spinal reflex excitability and itsdescending control in man. Pmg Neumbiol.1987;28:345-376.

8 Kukulka CG, Beckman SM, Holte JB, Hop-penwonh PK. Effects of intermittent tendonpressure on alpha motoneuron excitability.Phys Ther. 1986;66:1091-1094.

9 Leone JA, Kukulka CG. Effects of tendonpressure on alpha motoneuron excitability inpatients with stroke. Phys Ther. 1988;68:475480.

10 Bklanger AY, Morin S, Pkpin P, et al. Man-ual muscle tapping decreases soleus H-reflexamplitude in control subjects. PhysiotherapyCanada . 1989;41:192-196.

11 Eke-Okoro ST. The H-reflex studied in thepresence of alcohol, caffeine, force and fatigue.Electmmyogr Clin Neumphysiol. 1982;22:579-

589.

12 Morelli M, Sullivan SJ, Seaborne DE. Com-parison of human triceps surae H-reflexes ob-tained from mid and distal recording sites.Electmmyogr Clin Neumphysiol. 1990;30:181-186.

13 Mathieu PA, Kemp F, Goyette M, et al. Utili-sation d'un micro-ordinateur pour la mesuredu reflexe-H. In: Proceedings of the CanadianMedical an d Biological Engineering Congress.1988:75-76.

14 Wolf SL, MinkwitzJA Topical anaesthetics:effects on the Achilles tendon and H-reflexes,I: able-bodied subjects. Arch Phys Med Rehabil.

1989;70:531-536.15 Hayes KC, Sullivan SJ. Tonic neck reflexinfluence on tendon and Hoffmann reflexes inman. Electromyogr Clin Neumphysiol.1976;16:251-261.

Abstracts for research, theory, and special interest platformand poster presentations.rProposals for 90-minute program sessions.

Deadline: All materials must be received at the APTA office

by Monday, November 4,1991.

For complete directions and required forms, consult theSeptember and October issues of Physical Therapy.

16 / 560 Physical Therapyll70lume 71, Number 8/August 1991

effects of massage on alpha motoneuron excitability

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