Issue 36 Blue Crab Edition

This week we’re taking aim at one of the biggest trends in personal rehab. Massage guns. Are they a complete waste of money? I can’t tell you that. What I can tell you is how effective they are at increasing plantar flexors’ range of motion. Read on for that. After that, we’re breaking down a meta-analysis of motor control exercises compared to strengthening exercises for extremity MSK disorders. I slogged through a lot of data for you this week, so I hope you appreciate it.

If you do, please share with one person this week. Keep PT Crab going by keeping PT Crab growing.

With that, let’s dive in!

Massage Guns Are Like Stretching

The Gist - Researchers are piling in to assess the effectiveness of Theraguns, Hypervolts, and their ilk. We don’t have enough studies for a meta-analysis or anything yet, but we do have one controlled study to give us some information. They put two groups through two protocols (as you may expect). They all had their plantar flexion ROM checked, then one was 5 minutes of plantar flexor Hypervolt massage and the other was 5 minutes of just sittin’ there. Afterward, they compared the difference in plantar flexor ROM changes between the just sittin’ there folks and the get punched in the calf folks. Here’s what they found.

Maximum dorsiflexion range increased by 5.4° in the Hypervolt group and 1.6° in the just sittin’ theres. Yay! Without a reduction in plantar flexor strength. Yay! But hold on a second. These same researchers did a similar test of stretching vs. nothing back in 2017 and found that it increased dorsiflexion range by 4.9°. And it’s free. So there.

Tell Me More - Let’s talk about how the massage gun was applied. The researchers locked the legs of their participants into 0° knee flexion and 20° ankle plantar flexion, then put the gun to work on the medial calf, working their way down it, then restarting the process on the lateral side. This was done for 5 minutes with pressure that was as identical as possible by hand throughout. The control group sat in the same position and did nothin’.

Why do massagers like this work? Kinda the same reasons behind any fascial treatment. Fascia is thixotropic, it becomes more susceptible to shear forces when it’s vibrated. That’s most likely what’s going on here. This was shown a few years ago by a study looking into gastroc shear wave elastography after a massage. Do we know exactly what these guns are doing? Not yet, no. But they’re about as good as stretching in young, healthy men at least, and look a lot cooler.

Paper me captain. Here ya’ll go.

Use MCE Unless They Have OA

The Gist - This paper is a doozy. It’s a systematic review and meta-analysis comparing motor control exercises to strengthening exercises for extremity MSK disorders. Just the title is basically a paragraph. But this is the gist, so let’s gist it.

All their analysis basically boils down to this: In groups that contain people with OA, motor control exercises are a bit better than strengthening exercises, but not to a clinically important level. In groups that don’t contain people with OA, motor control exercises are better than strengthening exercises in terms of increasing function and reducing disability. They pulled 21 RCTs to get to this result and found that MCE reduced pain by 0.74 points more than standard strengthening exercises as well as reducing disability a bit more.

Tell Me More - Like I said, this is an incredibly dense paper, the type that is usually harder for me to pull specific things out of. Other than the topline results, the majority of the paper is a breakdown of the approach and statistical methods. Even though the MCEs weren’t far ahead of the standard strengthening exercises, the authors argue that they’re worth doing since costs, risks, and inconvenience are comparable.

Lastly, what are MCEs? They’re specifically designed exercises created to focus on specific muscle activation sequences to improve neuromuscular control, joint stability, and movement quality. Check them out in Medbridge when you get a chance.

Where’s that link? It’s chillin’ right here.

I hope you enjoyed this week’s edition. Please share with friends, colleagues, coworkers, and enemies. Cheers!