One popular belief about massage for exercise recovery is that it can help increase blood circulation to deliver oxygen faster and remove metabolic wastes. However, a majority of existing studies found that massage therapy does not do so.
First, blood lactate — sometimes referred to as “lactic acid” — is a byproduct of anaerobic metabolism as a result of insufficient oxygen delivered to muscles and other tissues. (4) Lactate is part of the Cori cycle, which is a process where glucose and lactate are constantly recycled during exercise to produce energy. (5) It is not a “toxin.”
However, a study by Cambron et al. found that different types of massage may elicit different blood pressure responses, which may influence blood circulation. The authors found that Swedish massage decreases blood pressure among the subjects while trigger point therapy and sports massage increases blood pressure. But the increase may likely have been caused by pain the subjects experienced due to “potentially painful massage techniques.” (7)
Since most massage are quite relaxing, it makes sense that the clients' and patients' heart rate would decrease, which would decrease circulation. In fact, the therapist is more likely to have an increased circulation due to the work.
Current evidence shows that there are little long-term or short-term benefits of massage on muscle soreness. Dr. Jason Brummit, DPT, from George Fox University in Newberg, Oregon, reviewed several studies that examined the effects of massage on muscle soreness. (2) Subjects who received massage after exercise in various studies did not feel any difference in soreness compared to those who did not receive a massage.
“Additional studies evaluating the effects of massage on athletes experiencing DOMS have also failed to demonstrate positive effects,” Brummitt wrote. “Active recovery techniques have been shown to be consistently superior to massage for lactate clearance. In addition, massage interventions have failed to effect post-exercise limb girth. Subjects who received massage generally experienced no improvement in pain or soreness perception as compared with controls. Hilbert et al. suggested massage can positively affect subjects' perceived intensity of DOMS related soreness, but not until 48 hours post exercise.”
A more recent study published in the Journal of Strength and Conditioning Research found that elastic resistance exercise is just as good as massage to acutely provide muscle soreness relief. “Coaches, therapists, and athletes can use either active warm-up or massage to reduce DOMS acutely, for example, to prepare for competition or strenuous work, but should be aware that the effect is temporary, that is, the greatest effects occurs during the first 20 minutes after treatment and diminishes within an hour,” the authors concluded. (7)
These are the most common type of white blood cell in mammals that are the front line combatants against infection, and there is a dearth of research that examines massage therapy's effect on them. (8) An early study from East Carolina University in Greenville, North Carolina, found that neutrophil levels in the massage group is significantly higher than the control group. The small study also suggested that muscle soreness may be reduced if massage is applied after two hours post-exercise.
Most of the existing studies have very small sample population sizes that may or may not reflect on the majority of the population. Furthermore, some studies have inconsistent samples, such as using a broad age group, single gender, or specific population group like elite or recreational athletes.
Small sample population size is likely to fall in the small sample fallacy where extremes of outcome are more likely to appear than larger sample sizes. Philosophy professor Kevin DeLaplante explains this phenomenon:
While there may not be much physiological benefits of massage therapy after exercise, there are some evidence that supports psychological benefits. Tiidus et al. found no physiological benefits among marathon runners in his (tiny) sample population, but seven out of 12 runners reported positive benefits after their massage. (10)
“These comments included statements such as, ‘More relaxed in massaged leg’, ‘Less stiff in massaged leg’, ‘Massage leg felt better while weight lifting’, ‘Feels different between legs when walking downstairs - massage feels better’, ‘Massage leg feels less pain’, ‘Massage leg feels looser when running’. These statements are indicative of the subjective impressions of improvements that massage can make,” the authors reported. (10)
“Why is it that the athlete feels refreshed or better after a massage? It may have something to do with biochemical markers for pain that have not been measured,” Dr. Brummitt told Massage & Fitness Magazine. He referred a recent study that indicated subjects who received neck and upper back adjustments had higher levels of oxytocin – a hormone that gives us a “euphoric feeling” – and neurotensin, which is a type of protein that act as a painkiller. (11)
“Could it be that this effect – the manipulation – be similar to that of the manual treatment via massage? It is possible,” Brummitt speculated.
Some psychological benefits from massage have been analyzed and measured. Dr. Christopher Moyer and his colleagues found that massage has a significant effect on reducing anxiety and depression in a 2004 meta-analysis. (12)
“Quantitative research reviews show that a series of [massage therapy (MT)] treatments consistently produces sizable reductions of depression in adult recipients. The effects of MT on anxiety are even better understood. Single sessions of MT significantly reduce state anxiety, the momentary emotional experiences of apprehension, tension, and worry in both adults and in children, and multiple sessions of MT, performed over a period of days or weeks, significantly reduce trait anxiety, the normally stable individual tendency to experience anxiety states, to an impressive degree in adults,” Moyer at al. stated. (13)
Given what we know so far, there is no need to denounce science or defend your beliefs as if the evidence is attacking you: it is not. In fact, research is just one part of your decision-making process for your clients or patients. It is part of a guide that helps you make the best choices at the time.
Science writer Paul Ingraham of PainScience.com described:
“When confronted with evidence that’s a bummer, at odds with your experience, remember that your experience is a fully legit third of that EBM equation. But! You must be very cautious not to lean too hard on your experience, because “you are the easiest person to fool” (Feynman). It’s only a third of the equation. Not two thirds. Not half. Just a third, roughly, give or take (probably always less than a third for younger professionals). And it’s never a very reliable third. Just like science, experience is difficult to interpret and often wrong.”
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2. Brummit, Jason. The Role of Massage in Sports Performance and Rehabilitation: Current Evidence and Future Direction. North American Journal of Sports Physical Therapy. 2008 Feb; 3(1): 7–21.
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4. The Free Dictionary. Blood Lactate. http://medical-dictionary.thefreedictionary.com/blood+lactate
5. The Cori Cycle. Interactive Concepts of Biochemistry. http://www.wiley.com/college/boyer/0470003790/animations/cori_cycle/cori_cycle.htm
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8. Neutrophils. Pubmed Health. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022058/
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14. Ingraham, P. EBM vs. clinical experience. PainScience.com.
15. Hilbert JE, Sforzo GA, Swensen T. The effects of massage on delayed onset muscle soreness. British Journal of Sports Medicine. 2003 Feb;37(1):72-5.