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Acute inflammation is a generalized response of the body to any kind of tissue injury as a result of chemical, thermal or mechanical stimuli (Hurley, 1973), and is part of the damage-repair process of healing. The physical damage to the muscle fibers stimulates an acute-phase inflammatory response, which includes infiltration into skeletal muscle by neutrophils and macrophages. Neutrophil infiltration follows a relatively rapid time course, as neutrophils begin to accumulate in skeletal musclewithin two to four hours, reaching their peak concentration within a one day period (Pizza,2002; MacIntryre et al, 2000). This time period may vary depending on the intensity of the injury (Smith, 1990). They typically return to control levels within seven days after injury induced by lengthening contractions (Koh et al 2003, Pizza et al2002). Macrophages, on the other hand, generally appear in the injured skeletal muscle after the arrival of neutrophils at approximately 24 h following injury and remain elevatedwhile the neutrophil concentrations are diminishing (Koh et al 2003, Pizza et al 2005).
Massage therapy appears to be clinically beneficial by reducing inflammation and promoting mitochondrial biogenesis (Crane et al, 2012).
Fibroblasts are key modulators in the inflammatory responses in the connective tissues. They synthesize abundant IL-1 in contact with a relaxed three-dimensional collagen network, which up regulates the production of additional inflammatory mediators.
Massage reduces the production of NFkB, the production of inflammatory prostaglandins [PGE2] and the production of inflammatory cytokines tumour necrosis factor–a (TNF-a) and interleukin-6 (IL-6) mitigating cellular stress resulting from myofiber injury.
The therapeutic effect of massage is similar to NSAIDs and can provide equivalent benefits without the side effects of NSAIDs (Crane et al, 2012).