P.18 - The effects of calf massage in boys with Duchenne muscular dystrophy

Abstract

The hallmark of DMD is progressive weakness and functional difficulties caused by muscle fibrosis resulting in increased stiffness and shortening. A survey in 2012 investigating the use of complementary therapies in our clinic population found that massage was the most commonly used complementary therapy in boys with DMD. This finding prompted this study of the effects of massage on calf muscle length and elasticity, and gait parameters in 20 ambulant boys with DMD (mean 8.75, (SD 2.71) range 6–14 years). The study used a within-subjects randomised controlled cross-over design with a blinded assessor. A ten minute massage was administered by a trained physiotherapist according to a standardised protocol. Muscle stiffness was measured using a myotonometer and muscle length using a goniometer. Spatio-temporal gait parameters were assessed using an electronic walkway and a timed 10m walk/run. Participant perception of muscle stiffness and pain was collected using 10 point visual rating scales. Outcome measures were administered pre- and post-massage. Following a single bilateral calf massage there was a significant reduction in muscle stiffness (-8.65N/m p < 0.001, 95%CI -12.94- -4.36), and a small but statistically significant increase in calf muscle length (soleus 30 p < 0.001, 95%CI 2–4, gastrocnemius 30 p < 0.001, 95%CI 2–4). Of the 16 participants who completed the perception scales, six reported improvement in perceived pain and ten reported a reduction in perceived muscle stiffness. There were no significant changes in gait parameters or 10m walk/run time. Assessment 6–10 days later (mean 7.1(SD 0.55)), found that reduced muscle stiffness (-10.2N/m p < 0.006, 95%CI -17.15- -3.24) and soleus length were maintained (20 p < 0.005, 95%CI 1–4). Massage has positive effects on muscle length and stiffness in ambulant boys with DMD. A further study with larger numbers of participants is needed to validate these findings.