So…does massage work?
Well to be honest that is far too wide a question. Does what type of massage work? Does it work for what? For such a question to be answered it needs to be asked in the following format:
Does [type of massage] work for [specific issue]?
For example: Does thai massage work for detoxification?
Answer: No. No massage works for detoxification, as detoxification isn’t a thing.
To tie into the focus of this article we can fill one of the spaces straight away:
Does sports massage work for [specific issue]?
The other space could have several insertions, each of which will need to be explored. Firstly though we’ll explore the common incorrect views of the benefits of massage.
The many, many myths of the benefits of massage
You may be surprised with the number of benefits you expect massage to give that are in the realm of hocus pocus. I know I was.
Yet many massage therapists will doggedly defend their benefit claims.
The reasoning has several facets.
1. Backbone of the industry
2. Lack of education
3. Huge number of quacks in the industry teaching
4. Lack of scientific and medical understanding
A number of these issues are not the fault of the therapists.
If you haven’t had scientific or medical education then it isn’t surprising that your understanding of such practises is limited. Therefore the ‘quacks’ of the industry will find it easier to convince you with pseudoscience. For instance that massage will remove toxins.
This problem can of course be remedied by receiving proper education. That is education on analytical and anatomical versions of massage, such as sports massage, and education on how to not only read but critically analyse scientific data. Unfortunately nearly all therapists do not have an understanding of the second principle, and many do not possess the first.
This does bring me on to my pet peeve. This industry is ridiculously unregulated. I cannot even count the number of therapists who have ‘sports massage’ listed as a service, but only hold certification in holistic or Swedish massage.
Unless you are going for a relaxation massage ALWAYS ask to see certification. If it can’t be provided then walk away. Poor anatomical knowledge and little to no understanding of the mechanics of anatomy and injury can very quickly lead to further problems with high pressure massage.
Benefit Myth 1: Massage removes toxins
The claim that massage causes detoxification is a prevailing one. But it simply isn’t true. ‘Toxins’, as they are described by many therapists, possibly exist in a minute amount but probably don’t exist at all. Also your body is incredibly efficient at maintaining homeostasis (clearing what it doesn’t need and maintaining what it does). It wouldn’t have evolved to need massage to maintain its chemical balance.
Either way massage does not possess the ability to remove toxins. It is often claimed that it does it by increasing or improving blood flow, but as can be seen below this too is not the case.
It is possible that massage actually creates a mildly toxic state by producing a condition known as rhabdomyolysis. However this is then balanced out by the bodies homeostatic ability.
Benefit Myth 2: Massage flushes lactic acid
Massage does not remove lactic acid or the associated hydrogen ions (Hemmings et al, 2001; Robertson et al, 2004). In fact it is possible that it impedes its removal when applied directly after exercise (Wiltshire et al, 2010).
This unfortunately is the opposite of what is claimed by many massage therapists. Lactic acid is often also touted as one of the ‘toxins’ that massage removes.
This may be seen as bad news by many individuals who are dedicated to their training and use massage post workout as part of their recovery routine. But it doesn’t need to be. Lactic acid is only a cause of pain during the immediate few seconds after a set or interval. Frankly even then the temporary raise in acidity is caused by hydrogen ions and not lactic acid, which is in fact essential to the energy creating metabolic pathways (McArdle et al, 2010).
Lactic acid is not the cause of delayed onset muscle soreness (DOMS), aka the pain in your muscle in the days following a good workout. You can see more about massages effects on DOMS below.
Benefit Myth 3: Massage therapists can identify problem areas through tightness
Therapists’ ability to identify the most painful areas via looking for areas of tightness has proven to be ineffective. ‘Tight’ muscular areas just do not correspond to the problem and painful areas all that often.
In one study (Maigne, 2005) therapists were asked to identify which side of a patient was more painful using touch only. Their final result was not a great deal over just getting it right by chance, or flipping a coin.
If you focus this more, and ask therapists to identify specific areas of pain, rather than the side where they have a 50% chance of guessing correctly, then the accuracy drops a lot more.
Experience and solid anatomical knowledge will help therapists hone in on the real issues, but without consistent feedback from the client their chance of getting the exact areas all of the time are limited.
Benefit Myth 4: Massage improves circulation
This is debated in the literature. There will be some warming of the skin and an increased blood flow at the skin (Hinds et al, 2004), but it is just superficial and tests demonstrate that it does not appear to translate deeper into the muscles.
This has been confirmed by several studies who demonstrate that there is no change in blood flow at an artery during or following massage (Hinds et al, 2004).
Further to these studies a review of the available literature produces the conclusion that blood flow is unaffected by massage (Tiidus, 1999)
However, even ignoring the science, the claim you need a massage to improve circulation does not make much sense. You can get a far larger increase in circulation, and to a much wider area, by being just slightly more active. For instance going for a walk. It’s better for your health, you’ll get a wider distribution of increased circulation and it won’t have cost you anything.
The above are 4 of the biggest myths surrounding massage, but there are more. These include reduced muscle fatigue, fascia release, inflammation reduction and cortisol reduction. A great resource for the myths surrounding massage is the following article on PainScience.com.
Sooo..Is massage good for anything?
Yes. Defiantly. Just not in the ways that many think.
Before we get into the more proven benefits of massage though we will talk about one of the hotly contested beneficial claims of massage. Further down I will look into what the strongest benefits of massage is consistently shown to be, and it isn’t what most people would expect. But first….
Massage helps with DOMS recovery
This has always struck me as a funny claim. Sports massage causes muscle soreness in the day, or days, post treatment. So it seemed unlikely to me that it could reduce post exercise muscle soreness. However the science may or may not back this (Hemmings, 2001; Jonhagen et al, 2004; Moraska, 2005).
I identified five studies (Farr et al, 2002; Hilbert et al, 2003; Rodenberg et al, 1994; Smith et al, 1994; Tiidus and Shoemaker, 1995) that show massage benefits DOMS and three disputing this claim (Hasson et al, 1992; Jonhagen et al, 2004; Wenos et al, 1990).
Unfortunately though the type of exercise performed, the type of massage used and the time from training end that the massage was applied vary wildly. So conformation of the best way to use massage to reduce DOMS is unknown. If it does have an effect though then within 2 hours of the end of training at an absolute max seems to be the smart choice, and preferably within 10 minutes (Moraska, 2005).
Another thing to consider with the above mentioned studies is the fact that they all, for and against massage, have methodological criticisms and study limitations, such as low masseuse experience and small sample sizes.
This further fuels the fire that a final conclusion cannot be taken as this time. The cause of DOMS is not even currently understood (Moraska, 2005), and combined with the studies limitations, you should take any results with a pinch of salt.
It is also very possible that the reduced DOMS reported in the treated area is a placebo effect. See the discussion of massages effect on perceived recovery within the psychological benefits section below.
Lower back pain
Lower back pain is the most prevalent issue that sports massage therapists deal with. Literally millions are spent every year on treatment. And thankfully it does appear that this is not in vain.
When randomised studies using control groups are used it has been shown that the massage groups experienced a greater reduction in pain compared to an exercise control group and a sham treatment control group (Preyde, 2000). This benefit was not only noticed immediately after treatment but also at follow up. Improvements in function as well as pain were also noted.
A notable conclusion of the study was that experienced therapists provided the largest effect for improvement. These therapists were not only experienced but also had strong education in physiology. It was also noted that the providing of exercises and postural education also produced a greater improvement in lower back conditions. The benefit of massage when combined with efficient warm up prior to exercise has also been noted and the combination of massage with a focus on improved flexibility seems to be a recurring feature in the literature when it comes to the beneficial potential of massage (Best et al, 2008; Rodenburg et al, 1994).
Injury prevention is more often than not associated with a reduction in the range of motion of a joint. This produces poor biomechanical movement patterns that strain certain body tissues, causing them to become damaged.
Massages effect on mobility and range of motion is again debated, and unfortunately not deeply studied. One study reports that massage of the associated muscles produced a marked improvement of range of motion at the hip (Crosman et al, 1984). A counter study found that stretching techniques, but not massage, improved hip mobility (Wiktorsson-Moller et al, 1983).
It should be noted however that Wiktorsson-Moller does have clear methodological and reporting issues, including a far smaller sample size and little indication of the massage procedure used.
That being said it is important, and complimentary to Wiktorsson-Moller findings, that any client looking for an increase in range of motion is provided with flexibility exercises.
So few studies have been produced on massage as a treatment for soft tissue (muscular) injuries that it is not possible to provide a definitive answer. Of the studies that have been done though the evidence appears promising (Moraska, 2005).
Improvement of Sleep
Evidence does suggest that individuals who have been lacking in quality deep sleep experience an increased in perceived pain as well as a reduced emotional state (Moyer et al, 2004; Sunshine et al, 1996). It has been concluded that massage promotes deeper sleep and so benefits the clients psychological wellbeing as well as their perceived pain levels (Sunshine et al, 1996).
Blood Pressure and Heart Rate Reductions
It’s been identified that massage therapy often leads to a reduction in heart rate (Cottingham et al, 1988; Moyer et al, 2004; Okvat et al, 2002), although it should be noted that the opposite effect is possible if the treatment is a new experience for the client (Reed and Held, 1988).
Linking in to this it has been noted that massage also reduces systolic (during heart beat) and diastolic (during heart rest) blood pressure (Moyer et al, 2004).
Reductions in both heart rate and blood pressure are shown to be at or above 60% when compared to control groups (Moyer et al, 2004).
Psychological Benefits of Sports Massage
This is where massage really does appear to consistently receive praise within the scientific literature. A number of studies have been produced that argue the benefits of sports massage are not physiological, but rather psychological, in nature (Cafarelli and Flint, 1992).
It is not the benefit most people hope for, or imagine they would get from sports massage. But its effects on the body and its workings cannot be ignored. It is suspected that many of the physiological benefits people experience from getting a massage are in fact caused by improvement in the psychological.
Noted psychological benefits of sports massage included the following:
Depression, Anxiety and Stress Reduction
Depression, anxiety and stress are closely linked psychological conditions that not only have a large psychological effect, but also a potent effect on the physiological. Strong evidence exists that massage has a potent effect in the reduction of depression, anxiety and stress (Leivadi et al, 1999; Moraska, 2005; Moyer et al, 2004; Weinberg, 1988).
The reduction in depression has been shown to be as high as 64% greater when compared to those receiving a comparison treatment (Moyer et al, 2004).
Perception of Recovery
Interestingly, in a number of studies (Hemmings et al, 2000; Moraska, 2005), it has been noted that participants believed that they had recovered more than they actually had from an exercise session after recieving sports massage. This was demonstrated by verbal conformation that they felt better, even though actual exercise performance had not reached pre workout levels.
It has been claimed that this perception of increased recovery does produce an improvement in effort expended in future training sessions (Hemmings et al, 2000).
Increased Sense Of Wellbeing and Worth and Improved Mood and Emotional Coping
It has been proposed that an increased sense of wellbeing and worth is produced through sports massage due to decreased arousal levels, leading to improvements in mood and an increased ability for emotional control (Hemmings, 2001; Hemmings et al, 2000; Moraska, 2005).
Studying this can prove to be difficult as it can be hard to quantify, or put a number on, these improvements. However a few studies have tried, and have produced promising results. The reasoning behind these benefits is however still debated (Longworth, 1982)
Sports massage research would barely be a toddler if it was human. There is so much that needs to be analysed that most claims of the benefits or limitations of massage are impossible. However, as with all science, the wise money should ride on probability. All I can do is as I have. Outline the direction most research falls on many of the claims regarding the benefits of sports massage. From there you can draw your own conclusions.
One thing is clear from my studying though. You can discount anybody who claims for definite that they know what the benefits of massage are. Hundreds of scientists and many many thousands in research hours and grants have proved inconclusive on nearly every claim so far. Nobody, at this stage, can know for certain.
It may well not always be like this. This area of research is growing. However at this moment in time most of the claims lean one way or the other, that is towards being confirmed or rejected, but give no conclusive answer.
It does appear that anatomical education and experience are what should be sought out over anything else when finding a massage therapist. In addition to this advice about stretching, mobility, strengthening and posture should also be provided as part of the service.
As always I will keep my ear to the ground for any new research that is produced and as the scientific communities’ thoughts shift I’ll continue to report them in the simplest terms that I can. To be first in line, or to see my next research article you can follow me on Twitter, Facebook, Google+, Youtube, Instagram and Pintrest or add me on my personal Facebook page.
There is a ton of other stuff there to, such as My Body Evolution diary.
As always if you have any questions regarding anything mentioned here, or in terms of your own body evolution journey, feel free to give me a shout.
Until next time. Stay curious.
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Cottingham, J.T., Porges, S.W. and Richmond, K., 1988. Shifts in pelvic inclination angle and parasympathetic tone produced by Rolfing soft tissue manipulation. Physical therapy, 68(9), pp.1364-1370.
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Hey. I’m Simon. A Leicester and Leicestershire based exercise scientist, personal fitness trainer, nutritionist, sports therapist, sports and deep tissue masseuse. My core beliefs are scientifically backed principles and providing clients with quick results.
I have been providing personal fitness training, nutrition, sport therapy and sports and deep tissue massage to the residents of Leicester and Leicestershire since 2005.
You can find out more about me and my story on my about me. To read my latest diary entries and articles visit my Blog. To see what BDC is up to follow us on Twitter, Facebook, Google+, Youtube, Instagram and Pintrest. To see what I personally am up to you can add my personal Facebook page. Best wishes. Si.