The aim of this study is to investigate the immediate effects of Graston massage on muscle mechanical properties and sports performance in elite handball players with isolated gastrocnemius tightness.
Handball is a high-paced competitive sport that requires advanced physical demands. The ability to achieve the desired performance in handball is influenced by the functionality of the lower extremities. One of the key structures responsible for the mobility of the lower extremities is the gastrocnemius muscle. The gastrocnemius is a superficial, two-headed skeletal muscle located in the posterior part of the leg, with its primary function being plantar flexion of the ankle. Due to intense usage, improper training models, or various traumas, structural abnormalities may develop in the gastrocnemius muscle among athletes. One of the most common structural disorders is isolated gastrocnemius tightness (IGT). IGT is considered critical in terms of sports injuries and performance and is also recognized as a prevalent disorder even in the general population. IGT, which arises as a result of gastrocnemius-soleus contracture, is a muscle dysfunction characterized by increased stiffness of the ankle joint in dorsiflexion. Restrictions in dorsiflexion caused by IGT can increase pressure on soft tissues during changing conditions and sudden movements in training and competitions, leading to a higher risk of injury and potential declines in sports performance. Chronic muscle tightness also affects the viscoelastic properties of the muscle. Mechanical muscle properties such as muscle tone and stiffness are considered fundamental elements for maintaining efficient muscle contractions in terms of both function and energy. A shortened and tight skeletal muscle may hinder potential force production, leading to increased muscle tone and stiffness. Increased tone and stiffness, in turn, can reduce movement efficiency and contribute to a higher risk of injuries. IGT can be alleviated through various interventions, including exercise models, surgical procedures, and myofascial release techniques. The Graston technique is recommended for restoring optimal length in the myofascial complex, enhancing function, and improving hypomobility caused by skeletal muscle tightness. Previous studies have emphasized the importance of IGT and its treatment. However, no comprehensive study has been found regarding the effects of preventive measures against IGT on sports performance and muscle properties in athletes. Identifying IGT and implementing effective compensatory mechanisms play a crucial role in maintaining athlete health and sustaining performance, highlighting the significance of this research.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
16
The participant was positioned prone on the treatment table with the knee slightly flexed. A small amount of lubricating gel was applied to the entire gastrosoleus complex and the calcaneal tendon. For one minute, sweeping strokes were performed downwards on the gastrocnemius heads using the GT-5 tool. From the second to the fourth minute, the GT-5 was used in an upward direction to ensure that both the gastrocnemius and soleus were treated. Afterward, with the GT-2 tool, one minute of downward sweeping and one minute of upward sweeping were performed on the calcaneal tendon. Following the two minutes of sweeping, GT-3 was used to apply short, perpendicular strokes to the medial and lateral sides of the calcaneal tendon, with 30 seconds for each side. The total application lasted approximately 7 minutes (Palmer et al., 2017).
Giresun University
Giresun, Centre, Turkey (Türkiye)
IGT (isolated gastrocnemius tightness) Assessment
The Silfverskiold test was used to identify gastrocnemius tightness, which is characterized by an equinus deformity at the ankle when the knee is extended but disappears when the knee is flexed. In this test, gastrocnemius equinus is determined when passive ankle dorsiflexion is ≤5 degrees with the knee fully extended, but increases to ≥15 degrees when the knee is flexed to 90 degrees. Participants were positioned supine on a treatment table, and goniometric measurements were taken according to the test protocol. Those who met the Silfverskiold criteria in at least one leg were classified as having IGT. (physiological parameter)
Time frame: Baseline
Assessment of Muscle Mechanical Properties
The Myoton PRO muscle palpation device was used for the evaluation. Myoton PRO is a portable, non-invasive device with established reliability and objectivity in assessing muscle mechanical properties. The device consists of a body and a probe. The probe applies mechanical pressure to the surface, generating a rapid deformation through a mechanical impulse. This deformation induces damped natural oscillations in the soft tissue, which are recorded by an accelerometer. During the application, the participant was positioned supine on a treatment table. To ensure the most relaxed position of the muscle, a small cushion was placed under the tibia, supporting the ankle. Following the device protocol, three impulses were applied to the reference point of the medial gastrocnemius using the probe. All measurements were performed by the same expert physiotherapist. (physiological parameter)
Time frame: Baseline
Measuring Strength
Strength measurement was performed on the calf muscle group. The Activforce Digital Dynamometer, which has been reported to have a high level of reliability, was used for this assessment. The device was fixed to the wall at foot level, and the participant, lying in a supine position, was instructed to apply maximum plantar flexion force against it. To prevent any backward movement that could affect the measurement, support was provided to the participant at the shoulder region during the test. (physiological parameter)
Time frame: Baseline
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Measuring Agility
Agility values were determined using the Illinois Agility Test, measured with a photocell electronic stopwatch system with a precision of 0.01 seconds. The test was conducted twice, and the best result was recorded. (physiological parameter)
Time frame: Baseline
Vertical Jump Test
Vertical jump values were measured using a Smart Speed electronic jump mat with the hands-free (arm swing) countermovement jump technique. The athlete positioned themselves with their feet shoulder-width apart on the jump mat. Once ready, the athlete bent down and jumped vertically to the highest point they could reach, landing back on the mat. Three trials were performed in the correct position, with a 3-second rest between each jump, and the best result was recorded in centimeters. Jumps were repeated with the knees flexed while the athlete was airborne. (physiological parameter)
Time frame: Baseline