Immediate Effects of Graston Massage on Muscle Properties and Performance in Elite Female Handball Players

Primary outcomes

1. IGT (isolated gastrocnemius tightness) Assessment

   Time frame: Baseline

   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)

2. Assessment of Muscle Mechanical Properties

   Time frame: Baseline

   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)

3. Measuring Strength

   Time frame: Baseline

   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)

4. Measuring Agility

   Time frame: Baseline

   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)

5. Vertical Jump Test

   Time frame: Baseline

   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)