Sports Massage To Improve The Hormon Beta Endorphin (BE)
	
Bambang Priyonoadi1, Panggung Sutapa1, Ali Satia Graha1 	
¹Sport Science Major, Sport Science Department, Yogyakarta State University
Author: bambang_pa@uny.ac.id
	
Keywords:	Sports massage, high intensity, weight training, beta-endorphin 
Abstract:	
Background: Massage may decrease muscle tension, accelerate blood circulation, increase nerve conductivity, and hormonal changes, and increase immunity. Sports massage may also increase the level of beta endorphin (BE) hormone to accelerate the recovery of athletes. Objective: The aim of this study was to evaluate evidence of the effect of exercise massage on changes in BE hormone levels. Method: This research is an experimental research with the pre-test – post-test design. Research subjects were taken by inclusion: 1). 3rd year student of Sport Science Department, Yogyakarta State University, Indonesia, 2). Male students, 3). Healthy, 4). Willing to be the subject of research. There were 18 students divided into 2 groups namely: treatment group I (K1), which was given sports massage, and group II (K2) as a control group, treated with placebo massage. The blood samples were taken through in vena cubiti of both control and experiment groups before (7cc) and after treatment (7cc), and examined for the level of beta endorphin (BE) hormone, by using instrument.  The treatment for all the groups were physical activity exercises in the form of circuit weight training with 12 sessions and 10 repetitions/sets of 3 sets at high intensity for 60 minutes. After completion of circuit weight training, all samples are rested for 60 minutes. After the breaks, then all of the samples in each group were given 45 minutes massage treatment in the form of sports massage and placebo massage treatment for the group I and group II, respectively; following by resting for 60 minutes. Results: The exercise may significantly increase the beta-endorphin hormone levels by 1.65 ng/ml (F> 0.05). Conclusion: Sports massage to athletes performed heavy work and or exercise at high intensity may increase BE hormone.

1. INTRODUCTION
The massage is often undertaken to reduce the movement errors due to daily or exercise activities. The massage, including sports massage, is a massage that is specifically used or given to healthy people, especially sportsmen. The objects of sports massage are certain body parts of a healthy person. Manipulation is a method of gripping, which is a way of using the hands to adjust to certain areas of the body and also to give certain influences (Findley and Susan, 2010: 54; Priyonoadi, 2011: 8-18). The manipulation techniques that are often used in massage according to Paine (2015: 101) are effleurage (rubbing), petrissage (squeezing and pressing), shaking, friction (grinding), tapotemen (beating, hacking, clapping), walken (variations of rubbing), vibration, stroking, skin-rolling (folding the skin), chiropractice (tapping). Those manipulation techniques are often used in sports activities. There are 9 types of manipulation taught in FIK UNY (Priyonoadi, 2011: 8-18), namely effleurage, petrissage, shaking, friction, tapotemen (beating, hacking, clapping), walken, and vibration. In this study, the manipulation technique used only 9 kinds of manipulation, namely effleurage, petrissage, shaking, friction, tapotemen (beating, hacking, clapping), walken, and vibration. 
Sports massage is known as a manual and manipulative therapy. This is a physical treatment mainly used in the neuromusculoskeletal system to treat pain and disability. The type and method of massage are preferred to make muscles relaxed and to improve the blood circulation (Findley and Susan, 2010: 5; Priyonoadi, 2011: 2), for recovery between training or high intensity competition sessions, reducing the possibility of tissue damage (Arroyo, et al., 2009: 638-644), decreasing heart rate, improving the blood circulation and pressure, reducing muscle tension, increasing joint motion, and reducing pain (Callaghan, 1993: 28), as well as multidirectional changing in the metabolism of important biological compounds, improving the functional state of neuromuscular devices and activating energy production (Bykov et al., 2011: 49-51). Therefore the massage can help the athlete achieves the effectiveness and the rate of the recovery (Arroyo, et al, 2009: 638-644). Massage affecting BE hormonal changes is seen in Fraser's and Cooper (2009: 15) and Rokade (2011: 436) massage studies. BE hormone interferes the pain transmission by increasing the circulation of naturally-produced neurotransmitters in neural synapses in central nervous system pathways. Endorphins bind to the pre-synaptic membrane, inhibiting the release of substance P which may inhibit the transmission of pain, resulting in less pain. It is possible that hormone levels BE levels can be used as a parameter to predict the health level of the body after experiencing high-intensity exercise, such as a circuit weight training. Therefore, the research about the benefit of sports massage to beta endorphin (BE) hormone levels need to be conducted.

2. RESEARCH METHODS
Participants
This experimental research was conducted using a pretest-posttest design (Sugiyono, 2013: 68; Sugiyono, 2014: 116-117). Research subjects were taken by inclusion: 1). 3rd year student of Sport Science Department, Yogyakarta State University, Indonesia, 2). Male students, 3). Healthy, 4). Willing to be the subject of research. The research subjects were 23 males and during the research process there were 5 subjects who could not continue the research, so that the entire subject was 18 males and healthy sport science students of Yogyakarta State University, Indonesia. Prior to the research the subjects signed consent letters stating the willing to be the subject of research. During the reserach the subjects divided into into 2 groups, namely treatment (K1) and control (K2) groups. The K1 and K2 groups were treated with sport and the placebo massages, respectively. 
Procedure.
All the groups (K1 and K2) took a preliminary test (pretest) 7cc  of blood sampling of the subjects were taken from the cubital vein.  The beta endorphin (BE) hormone levels of the blood were examined in the laboratorium using instruments. Furthermore, the subjects participated in the activity, namely physical activity training which is a circuit weight training of 12 sessions and repetition 10 times / set as many as 3 sets at high intensity for 60 minutes, workout load of each muscle is 30% from 1 RM, each session takes 30 seconds, the breaking interval between training sessions to another session was 60 seconds, the breaking interval between sets was 3-5 minutes. The breaking interval was used as a substitute for exhausting activities before being treated using massage. Resting for 60 minutes, 45 minutes sports massage for the group K1 and the placebo for group K2, and another 60 minutes rest. The blood tests (posttest) were again undertaken 7cc after the subject finished 60 minutes rest. Measurements 1 and 2 were performed with the sample in the position of sitting. In the research process, there were 2 people who resigned because they were unable to continue the research and 4 participants with the extreme data results so that the total sample that could be analysed was 18. Data takers were experts of Prodia Laboratory located at Jl. Bintaran Kulon No. 28 Yogyakarta, and expert therapists (masseurs) were professional therapists from the FIK UNY Therapy Clinic.
Instruments
The BE hormone level was examined by  ELISA (Enzyme-Linked Immunosorbent Assay) method carried out by the indirect sandwich using Peptide Enzyme Immunoassay (IEA), Kite (EIA Protocol, 2014: 1-24).
. Data were interpreted using Elisa Reader with 95% sensitivity. 
Statistical Analysis
Normality (Shapiro-Wilks), homogeneity (Levene test), and T-test of data were undertaken by using SPSS V.19.0 suit of program. 

3.RESULTS
Description of Research Data
Table 1.	The Increase in BE Levels (ng/ml) in the Experimental and Control Groups 
VAR	EXPERIMENTAL GROUP	CONTROL GROUP	
Ind. Var	BE HORMONE	
GS (Post-Pre)
	BE HORMONE	
GS (Post-Pre)
	
	POST	PRE		POST	PRE		
SPORTS MASSAGE

	9.52	8.53	0.99	14.83	14.98	-0.15	
	11.15	9.37	1.78	7.97	7.41	0.56	
	10.13	8.99	1.14	14.53	15.38	-0.85	
	13.83	12.14	1.69	9.65	9.37	0.28	
	14.03	11.5	2.53	13.63	13.07	0.56	
	13.44	11.88	1.56	16.16	16.53	-0.37	
	15.72	13.07	2.65	12.61	12.56	0.05	
	11.1	9.46	1.64	13.5	13.76	-0.26	
	11.32	10.42	0.9	8.64	9.1	-0.46	
	Σ=	14,88	Σ=	-0.64	
	Mean	1.6533	Mean	-.0711	
	Std. Dev	.61838	Std. Dev	.47745	
	Min	.90	Min	-.85	
	Max	2.65	Max	.56	

Table 1 describes the results of research on the Gain Score (GS) for the experimental group of sports massage on the value of the BE hormone level with the total level (Σ) of 14.88 ng/ml and the average value () of 1.6533 ng/ml, standard deviation .61838 ng/ml, minimum value of .90 mg/dl, and maximum value of 2.65 ng/ml. Whereas the GS level of BE hormone in the control group was gained the total score (Σ) of -0.64 ng/ml and the average value () of -.0711 ng/ml, standard deviation of .47745 ng/ml with the minimum value of -.85 ng/ml, and the maximum value of .56 ng/ml. 
Presentation of Test Results Test Requirements
Normality test
The normality test of  beta endorphin (BE) hormone levels data indicates that data is normally distributed with p ˃ α 0.05.
Homogeneity Test
The homogeneity test of beta endorphin (BE) hormone levels data is analysed by using the Levene's technique. It is obtained that F> α 0.05, meaning the working hypothesis is rejected and the null hypothesis is accepted. Thus it can be concluded that the final Gain Score (GS) data of the population variants in the treatment group is homogeny.
T-test
Table 2. T-test
	t-test for Equality of Means	
	t	df	Sig.
 (2-tailed)	M. Diff	Std. Er. Diff	95% Confidence Interval of the Difference	
						Lower	Up	
Gain Score BE	Eq. var. ass	6.622	16	000	1.724	.2604	1.172	2.277	
	Eq. var. not ass	6.622	15.04	000	1.724	2604	1.169	2.279	

Based on the results of data analysis through the Simultaneous Confidence Interval presented in table 2, the confidence level was 95%. It can be argued that with a 95% confidence level there was an increase in the BE variables. The degree of changes in the increase of BE hormone was at the lowest level of 1.172 ng/ml with the coefficient of 1.724 ng/ml.
Based on the presentation of the results of T-test data analysis in Table 2. that the Gain Score (GS) data of the whole group of sports massage treatment and in the control group on the BE hormone levels have been found significance F> α 0.05, meaning the working hypothesis is rejected and the null hypothesis is accepted. So it can be concluded that the final Gain Score (GS) data:
Sports massage may have a significant effect on elevated levels of the hormone BE.
The results showed that:
Sports massage may increase hormone levels to 1.65 ng/ml and have a significant effect due to F> 0.05.
4. DISCUSSION
Agreeing with Tejero's statement (2014) the best way to describe the practice of massage to  mechanically manipulate body tissue is by applying rhythmic pressure. Furthermore, Field et al. (2010: 381-385) state that one of the mechanisms giving to massage impacts is by  stimulating mechano receptors nervous system found in the skin (eg. Meissner and Pacinian corpuscles, Merkel disc tip, Ruffini and free nerve endings). The pressure applied to the receptors activates pathways that send signals along nerve fibers and myelin to limbic regions of the brain (Sliz, et al., 2012: 77-87), or affects the release of such substances P or serotonin considered responsible for mediating 'relax' (Listing et al, 2010: 165-173). These suggest that emotion and neuronal modulation are key elements for the effectiveness of massage therapy. Major et al (2015: 9) believes catecholamines released in lymphoid organs under central nervous system control are known as regulators of the immune repertoire. The mediation of massage increases catecholamines. Banker (2013: 78) states that the effleurage massage to rats may significantly decrease fluorescence intensity in both the cortical and cortico-medullary intersections. This is in line with the opinion of Herman et al (2012: 5) and Hawk, et al., (2012: 18-22) that the large noradrenergic nerve plexus predominates in the subcapsular cortex and the corticomedullary junction, where reside thymocytes are more mature. Reinforced by Major's research (2015: 45) previous studies conducted on humans show that the effleurage massage enhances vagal activity through stimulation of pressure receptors which in turn signals the limbic system reduces norepinephrine release in the bloodstream causing regulation of overall sympathetic activity. Interestingly, Major's research (2015: 20) and other research groups have shown sympathetic nerves that lymphoid innervate tissue as one of the major pathways of the nervous and immune systems communicate to maintain body homeostasis (Diego, 2009: 630-638; Field and Diego, 2008: 361-373; Pilipovic et al, 2012: 1211-1223; Leposavic et al, 2011: 290-308; Leposavic and Perisic, 2008: 290-322).
The results of the above analyses indicate that sports massage can increase levels of hormones BE physiologically due to the impact of treatment on sports massage as much as 9 (nine) repetition that resulted in the influence on a good in nerve system, it turns out that this repetitive manipulation stimulus is responded to by larger A-beta fibers, so this stimulus reaches the brain first, thereby closing the pain gate so that pain perception does not arise. In addition, the stimulation provided to stimulate the body's natural morphine expenditure is the hormone endorphin by stimulating the sensory nerve receptors to be delivered to the central nervous system. If the impulse reaches the nucleus of the rafe Magnus resulting in secreting the enkephalin proceeding in both directions downward to the end of the dorsal nucleus root of the spinal cord (aiming at the secretion of serotonin to affect the spinal cord neurons to secrete enkephalin) in order to inhibit the carrying nerve the pain that enters through the lamina I and IV of the dorsal roots, while the upwardly transmitted signals of the midbrain of the midbrain (periaqueductus), the stimuli received by the periaqueductal are conveyed to the hypothala mus, from this hypothalamus via the descending nerve pathway of the endorphin hormone secreted to the vessels blood (Guyton, 1994: 312-314; Barett et al., 2010: 70). So it can be said that the pain and fatigue is reduced because the release of enkepha lin  (inside the endorphin beta molecule) released by centring on the brain and spinal cord as a result of the gate control theory also resulted in a sense of euphoria due to the release of the BE hormone that circulates throughout the body (Guyton, 1994: 312-314; Barett et al., 2010: 70). So sports massage is recommended to the athlete in order to increase the levels of the BE hormone that is used in an effort to reduce muscle fatigue and pain.
5. CONCLUSIONS
Sports massage may affect and significantly increase BE hormone levels.
6. ACKNOWLEDGEMENT
I am grateful to all the sport science students of Yogyakarta State University who have been pleased to be the samples, and the masseurs who generously assisted the treatments.
7. REFERENCES

Arroyo-Morales M., Olea N, Ruíz C., del CastiloJde D., Martínez M., Lorenzo C., Díaz-Rodríguez L. (2009). Massage after exercise--responses of immunologic and endocrine markers: a randomized single-blind placebo-controlled study. Journal of strength and conditioning research/National Strength & Conditioning Association 23:2 Mar  pg 638-44. 

Banker, Christine Waters. (2013). "Immunomodulatory Effects of Massage in Skeletal Muscle". Dissertations-Rehabilitation Sciences. University of Kentucky Uknowledge, Paper 18. chris.waters24@gmail.com. Error! Hyperlink reference not valid..

Bykov, A.T., Iakimenko, S.N., Khodasevich, L.S., Poliakova, A.V. (2011). The influence of various technologies of sports massage on biochemical parameters of the blood.Vopr Kurortol Fizioter Lech Fiz Kult.  Sep-Oct;(5):49-51.

Callaghan, M. J. (1993). The roleof massage inthe management of the athlete: a review. British Medical Journal 27 (1): 28.

Diego M. A., & Field T. (2009). Moderate pressure massage elicits a parasympathetic nervous system response. Int J Neurosci 119,630–638.10.1080/00207450802 3 29605  [PubMed] [Cross Ref]

EIA Protocol. (2014). Peptide enzyme immunoassay (eia). Peninsula Laboratories, LLC A Member of The Bachem Group. 305 Old Country Rd. San Carlos, CA 94070, USA. 2014:1-24.

Field T., & Diego M. (2008). Vagal activity, early growth and emotional development. Infant Behav Dev 31, 361–373. 10.1016/j.infbeh.2007.12.008      [PMC free article] [PubMed] [Cross Ref]

Field T., Diego M. dan Hernandez Reif M. (2010). Moderate pressure is essential for massage therapy effects. Int J Neurosci 120, 381–385.

Findley, Susan. (2010). Sport massage. Human Kinetics, 1st edition. Amazon Medi EU. S. arl. ISBN-13: 978-0736082600., 2-3., 23-54.

Fraser DM, Cooper AM. (2009). Myles midwives. Edisi ke15, New York: United Kingdom. Churchilll Livingstone Oxford. 
Guyton AC., (1994). Buku Ajar Fisiologi Kedokteran (Textbook of Medical Physiology). Alih Bahasa , LMA. Ken Ariata Tengadi, dkk.  Editor, Melfiawati S. Edisi 7 Bagian II. Jakarta: EGC. 
Herman PM, Poindexter BL, Witt CM, Eisenberg DM. (2012). Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations. BMJ Open.; 2(5).  

Leposavic G., Pilipovic I., & Perisic M.(2011).  Age-associated remodeling of neural and nonneural thymic catecholaminergic network affects thymopoietic productivity.  Neuroimmuno modulation 18.290–308.10.1159/000329499 [PubMed] [Cross Ref]

Leposavic G., & Perisic M. (2008). Age-associated remodeling of thymopoiesis: role for gonadal hormones and catecholamines. Neuroimmunomodulation 15, 290–322. 10.1159/000156473      [PubMed][Cross Ref]

Listing M. et al. (2010). The efficacy of classical massage on stress perception and cortisol following primary treatment of breast cancer. Arch Womens Ment Health 13, 165–173.10.1007/s00737-009-0143-9[PubMed] [Cross Ref]

Major Benjamin., Rattazzi Lorenza., Brod Samuel., Pilipović Ivan., Leposavić Gordana., and D’Acquisto Fulvio.  (2015). Massage like stroking boosts the immune system in mice. Sci Rep. 5: 10913. Published online 2015 Jun 5. doi:  10.1038/srep10913 PMCID: PMC4650642

Paine., T. (2015). The complied guide to sport massage. Bloomsburg Sport. Amazon Media EU Sarl. ISBN-10: 1472912322.
Pilipovic I., et al. (2012). Catecholaminergic signalling through thymic nerve fibres, thymocytes and stromal cells is dependent on both circulating and locally synthesized glucocorticoids. Exp Physiol 97, 1211–1223. 10.1113/expphysiol.2012. 064899 [PubMed] [Cross Ref]

Priyonoadi B. (2011). Sports masase. Cetakan kedua. Yogyakarta: FIK UNY. 

Rokade BP. (2011). Release of endomorphin hormone and its effects on our body and moods: a review. International Conference on Chemical, Biological and Environment Sciences: 436-8.  

Sliz D., Smith A., Wiebking C., Northoff G. dan Hayley S. (2012). Neural correlates of a single session massage treatment. brain imaging behav. 6, 77–87. 10.1007/s11682-011-9146-z[PMC free article] [PubMed] [Cross Ref]

Sugiyono, (2013). Statistika untuk penelitian. Cetakan ke-23, Penerbit: Alfabeta, Bandung.

Sugiyono, (2014). Metode penelitian kombinasi (mixed methods). Penerbit: Alfabeta, Bandung. 

Tejero-Fernandez V., Membrilla-Mesa M., Galiano-Castillo N. & Arroyo-Morales M. (2014). Immunological effects of massage after exercise: A systematic review. Phys Ther Sport, 10.1016/j.ptsp.2014. 07.001 [PubMed] [Cross Ref]