Rest, Recover, Regenerate Part 5: Massage

Hopefully you have enjoyed my Rest, Recover, Regenerate” series.  So far we have covered Overtraining SyndromeDiaphragmatic BreathingContrast Therapy and Nutrition.

I wanted to finish up this 5-part series with the final insallment on massage.

Although massage has been a popular form of recovery from training and competition in athletics for a significant period of time, there is conflicting research on the potential benefits massage offers to an athlete.

Massage therapists commonly cite the following benefits of massage therapy:

  • Improved joint range of motion
  • Enhanced blood flow
  • Improved lactic acid removal
  • Decreased muscle soreness, increased relaxation and improved parasympathetic activity

Massage therapy research still has a long way to go as far as investigating what takes place under the skin and in the body during a massage, as well as validating (or refuting) many of the claims made by massage therapists around the world.  The goal of this article will be to talk about some of the purported benefits of massage listed above, and their application to athletic recovery.  Additionally, I will address some of the issues with massage therapy research (as there are many).

This article is in no way written to be an exhaustive review of the literature on massage or the benefits of massage in any other form other than recovery from exercise.  In future articles, I hope to address fascia and the brain, and how this may give us more information on what we think is taking place when an individual performs soft tissue massage therapy on you, and the potential affect this may have with regard to tissue quality.

Improved Joint Range of Motion

One of the main reasons an athlete sees a massage therapist is to enhance their joint range of motion.  This may be especially important following intense workouts or competition, when an athlete is sore or stiff.

A study conducted by McKechnie and associates looked at the effects that a 10-minute massage using two different massage techniques (vigorous petrissage and tapotment) would have on acute plantar flexor power and joint flexibility.  Both forms of massage showed significant improvements in ankle joint flexibility (dorsiflexion), and while the massage techniques did not improve power output (in a drop jump or concentric calf raise), it did not impair it.

Obviously massage is an inhibition of the nervous system, serving to increase relaxation, so I wouldn’t expect it to show improvements in power output.  Though I am still surprised that power output was not hindered by the two massage techniques.  Regardless, this paper does suggest that massage can play a beneficial role in increasing joint range of motion.   The mechanisms of how and why this works still need to be evaluated, as do further studies to determine what type of technique is the best approach to see these changes.

Enhanced Blood Flow

While one would expect massage to increase blood flow, research into this topic is rather scarce and conflicting.  Many of the studies are poorly conducted, making the results difficult to determine what the significance is.

Some evidence has been published that shows increases in and muscle temperature increase following massage, however, this local increase in temperature may not have high relevance to muscle blood flow.

Other studies show improvements in blood flow for a short period of time following various massage techniques ranging from 10-minutes up to 3-hours post massage intervention.  The length of time that muscle blood flow was improved was dependant on the length of time the massage was conducted in the study.

Hopefully future research will look more closely at muscle blood flow and massage to determine what exactly is taking place within the circulatory system when a massage is administered.

Improved lactic acid removal

Lactic acid has long been thought of as a reason that athletes get sore.  Additionally, it has been taught in massage schools that lactic acid is a “toxin” or “waste product” that we are trying “flush out” with massage techniques, in order to help athletes recover.

Unfortunately, there is no truth to either of these statements.  In fact, lactate is actually an important fuel for muscles during exercise and your body clears it out rather rapidly on its own.

Therefore, any of the studies looking at lactic acid removal as a potential benefit of massage therapy are looking at the wrong thing.  It really doesn’t matter!  Additionally, I don’t know many people that run out to get a massage following a highly anaerobic bout of exercise.  The idea that clearing lactic acid out following exercise would somehow improve performance on a subsequent exercise test is actually pretty silly.

Decreased Muscle Soreness, Increased Relaxation, and Improved Parasympathetic Activity

Improving relaxation is one of the main reasons that people seek out massage.  This alone can be a huge benefit to athletes following strenuous training or competition.  A study conducted by Arroyo-Morales and associates found that myofascial release after high intensity exercise favored the recovery of heart rate variability and diastolic blood pressure to pre-exercise levels following high-intensity exercise, assisting the recovery of the autonomic nervous system.

Decreases in muscle stiffness and perceptions of fatigue are another reason why massage has been popular amongst athletes.  Ogai and colleagues looked at the effects of petrissage on fatigue following intense cycling.  Subjects performed a rigorous interval based cycling routine, and then were asked to rest on a bed in a supine position for 35 minutes before repeating the test.  The control group just rested, while the experimental group received petrissage for 10 minutes (from the 5th to 15th minute of rest).  Ogai et al. concluded that the massage group improved pedaling performance via decreased muscle stiffness and perceived lower-limb fatigue.  These improvements were independent of blood lactate levels.

Finally, several studies have shown a decreased perception of muscle soreness.  While researchers are still trying to determine what the mechanism for this is (psychological or physiological), this is one of the greatest benefits that massage can offer an athlete looking to recover from training/competition.

Improved Immune Function

An interesting study published last year in the Journal of Strength and Conditioning Research looked at the benefits that massage has on immune function.  Following a wingate test on a cycle ergometer, the 60-subjects were given a saliva test to measure baseline levels of salivary cortisol and immunoglobulin A (IgA).  The subjects where then either placed in a placebo group (40-minutes of sham electrotherapy) or a 40-minute full-body massage group (experimental group).  Following each intervention, the subjects where then given another saliva test.

The results showed changes in salivary cortisol levels between the placebo and massage groups.  Although they were not significant, they were positive changes, with cortisol levels being lowered in the massage group.  In addition, there were significant changes in salivary immunoglobulin A (sIgA).

Salivary IgA, an immunoglobulin found in the saliva, drops during intense exercise.  If one were to over-train, this would further suppress immunoglobulin A, placing our immune system in a compromised state and potentially exposing the athlete to sickness and/or infection.

That being said, if massage can potentially help to increase salivary IgA following intense exercise or competition, massage may play a vital role in recovery and regeneration of the athlete.

Issues with massage research

There are several issues with research in massage and athletics:

  1. Time – The length of time that massage is administered in research is typically very short (usually around 5-10min) compared to what it would normally be in a real life setting.  Some of the beneficial results of a massage may not be seen with such a short intervention time.
  2. Choice of therapist – Some studies don’t discuss much about the therapist being used, their background, or their experience.  Some studies conducted on massage and anxiety or relaxation are done in nursing facilities where the therapists chosen for the study are nurses, who are typically not skilled in soft tissue therapy techniques.
  3. The Protocols Chosen – In order to maintain consistency, research uses a protocol-based approach to massage therapy (IE 5min of pettrisage, 5min of efflaurage, and 2min. of stretching on a particular muscle group).  Unfortunately, human beings are not a protocol, and rarely will they fit the mold of a protocol-based massage.  Experienced therapists have the ability to assess which muscles need more work than others, and which muscles may benefit from one technique over another.  However, this sort of improvisation does not lend itself well to the research model.

Conclusion

While there is not much research on massage therapy in athletics, it still remains to be a popular choice amongst athletes and coaches.  One of the main benefits that massage offers athletes is a decrease in perceived muscle soreness and improved relaxation.  Massage may also be beneficial to enhancing joint range of motion, which offers a significant benefit to athletes looking to improve mobility.  Additionally, there is some research to suggest that massage may offer potential benefits to immune function.

There are several issues with research conducted on massage therapy, and hopefully further research will help us gain a better understanding of the benefits of this type of therapy and how and when it would be best applied.

In future articles, I hope to go more in depth into fascia and the brain, and the potential affects that massage has on these systems, as well as some of the theories as to why it works.

References

Weerapong P, Hume PA, Kolt GS. The Mechanisms of Massage and Effects of Performance, Muscle Recovery and Injury Prevention. Sports Med. 2005;35(3):235-65.

McKechnie GJ, Young WB, Behm DG. Acute Effects of Two Massage Techniques on Ankle Joint Flexibility and Power of The Plantar Flexors. J Sports Sci Med. 2007;6:498-504.

Gladden BL. A “Lactatic” Perspective on Metabolism. Med Sci Sports Exerc. 40(3): 477-85. 2008.

Martin NA, Zoeller RF, Robertson RJ, Lephart SM. The Comparative Effects of Sports Massage, Active Recovery and Rest in Promoting Blood Lactate Clearance After Supramaximal Leg Exercise. J Athl Train. 1998;33(1):30-35.

Arroyo-Morales M, Olea N, Martinez M, Moreno-Lorenzo C, Díaz-Rodríguez L, Hidalgo-Lozano A. Effects of Myo-Fascial Release After High Intensity Exercise: A randomized Clinical Trial. J Manipulative Phisol Ther. 2008;31(3):217-23.

Ogai R, Yamane M, Matsumoto T, Kosaka M. Effects of Petrissage Massage on Fatigue and Exercise Performance Following Intensive Cycle Pedaling. Br J Sports Med. 2008 Apr.

Arroyo-Morales M, Olea N, Ruiz C, del Castilo Jde D, Martinez M, Lorenzon C, Diaz-Rodriguez L. Massage After Exercise – Responses of Immunological and Endocrine Markers: Single-Blind Placebo-Controlled Study. J Strength Cond Res. 2009 Mar;23(2):638-44.

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