How Massage Heals Sore Muscles
A massage after vigorous exercise unquestionably feels good, and it seems to reduce pain and help muscles recover. Many people — both athletes and health professionals – have long contended it eases inflammation, improves blood flow, and reduces muscle tightness. But until now no one has understood why massage has this apparently beneficial effect.
Now researchers have found what happens to muscles when a masseur goes to work on them.
Their experiment required having people exercise to exhaustion and undergo five incisions in their legs in order to obtain muscle tissue for analysis. Despite the hurdles, the scientists still managed to find 11 brave young male volunteers. The study was published in the Feb. 1 issue of Science Translational Medicine.
On a first visit, they biopsied one leg of each subject at rest. At a second session, they had them vigorously exercise on a stationary bicycle for more than an hour until they could go no further. Then they massaged one thigh of each subject for 10 minutes, leaving the other to recover on its own. Immediately after the massage, they biopsied the thigh muscle in each leg again. After allowing another two-and-a-half-hour of rest, they did a third biopsy to track the process of muscle injury and repair.
Vigorous exercise causes tiny tears in muscle fibers, leading to an immune reaction — inflammation — as the body gets to work repairing the injured cells. So the researchers screened the tissue from the massaged and unmassaged legs to compare their repair processes and find out what difference massage would make.
They found that massage reduced the production of compounds called cytokines, which play a critical role in inflammation. Massage also stimulated mitochondria, the tiny powerhouses inside cells that convert glucose into the energy essential for cell function and repair. “The bottom line is that there appears to be a suppression of pathways in inflammation and an increase in mitochondrial biogenesis,” helping the muscle adapt to the demands of increased exercise, said the senior author, Dr. Mark A. Tarnopolsky.
Dr. Tarnopolsky, a professor of pediatrics and medicine at McMaster University in Hamilton, Ontario, said that massage works quite differently from Nsaids and other anti-inflammatory drugs, which reduce inflammation and pain but may actually retard healing. Many people, for instance, pop an aspirin or Aleve at the first sign of muscle soreness. “There’s some theoretical concern that there is a maladaptive response in the long run if you’re constantly suppressing inflammation with drugs,” he said. “With massage, you can have your cake and eat it too—massage can suppress inflammation and actually enhance cell recovery.”
“This is important research because it is the first to show that massage can reduce pro-inflammatory cytokines which may be involved in pain,” said Tiffany Field, director of the Touch Research Institute at the University of Miami Medical School. She was not involved in the study. “We have known from many studies that pain can be reduced by massage based on self-report, but this is the first demonstration that the pain-related pro-inflammatory cytokines can be reduced,” she said.
Getting a massage from a professional masseur is obviously more expensive than taking an aspirin. But, as Dr. Field points out, massage techniques can be taught. “People within families can learn to massage each other,” she said. “If you can teach parents to massage kids, couples to massage each other. This can be cost-effective.”
Dr. Tarnopolsky suggests that, in the long run, a professional massage may even be a better bargain than a pill. “If someone says “This is free and it might make you feel better, but it may slow down your recovery, do you still want it?” he asked. “Or would you rather spend the 50 bucks for a post-exercise massage that also might enhance your recovery?”
Correction: An earlier version of this article misidentified where mitochondria are found; they are inside of cells but in the cytoplasm, not the nuclei.
PAIN
How Massage Helps Heal Muscles and Relieve Pain
A great article by Maia Szalavitz is a health writer for TIME.com.
Massage may work as well as drugs like aspirin or Advil in easing pain from intense exercise.
The word massage alone elicits deep relaxation and stress relief, and now a new study sheds light on how deep touch works to ease pain and promote healing in sore muscles.
Researchers at McMaster University in Canada found that massage affects the activity of certain genes, directly reducing inflammation in muscles — the same result you’d get by taking aspirin or ibuprofen — and boosting their ability to recover from exercise.
The study involved 11 young men who were willing to engage in what the researchers described as “exhaustive aerobic exercise” — the equivalent of an intense spinning class. The men rode stationary bikes to the point of exhaustion.
After the workout, each man received a 10-minute Swedish-style massage on only one leg; the other leg served as the control. They also had biopsies taken from their leg muscles before and after exercise, immediately after the massage, and then again two and a half hours later.
MORE: Aching Back? Try Massage for Chronic Pain
Researchers found that massage set off a series of molecular events in muscles that helped reverse discomfort related to exercise. Massage dampened the activity of proteins known as inflammatory cytokines, which cause inflammation and pain. It also increased levels of proteins that signal the muscles to produce more mitochondria, the cell structures that produce energy, and help muscles recover from activity.
Tiffany Field, a leading researcher on the effects of massage and director of the Touch Research Institute at the University of Miami Medical School, says she found the results “very believable.” She was not associated with the new research. (Field notes that her group is planning to study the effect of massage on some of the same inflammatory cytokines in HIV-positive pregnant women.)
Massage basically has the same pain-relieving effect as drugs like aspirin, ibuprofen (Advil), and naproxen (Aleve), says Field. Known as NSAIDS, for nonsteroidal anti-inflammatory drugs, these medications work by reducing levels of substances called prostaglandins that increase levels of inflammatory cytokines. “By reducing the inflammation — of the pro-inflammatory cytokines, to be specific — you would reduce pain,” says Field.
Mainstream medicine has often dismissed massage as a bona fide therapy, but “these findings will have an impact on traditional medicine, as every ‘beneath-the-skin’ finding helps,” says Field.
The study was published in Science Translational Medicine.
Massage for Pain Relief
Great Article By Chris Woolston
From an early age, we learn that the touch of a hand can ease the pain. When a toddler bangs his knee in a tricycle accident, he’ll instinctively rub the sore spot. Likewise, an office worker with stiff shoulders will probably try to knead them. And if a dancer can’t shake the throbbing pain in her back, she just might schedule an appointment with a massage therapist.
The healing power of a well-placed hand is so apparent that just about every culture in history has used massage to relieve pain. Massage faded into the background with the arrival of modern medicine, but a growing number of people are turning (or returning) to hands-on relief. According to a 2008 survey by the American Massage Therapy Association, about 21 percent of adults had a massage at least once in the last year, and almost 25 percent have used massage therapy at least once for pain relief.
It may be an “alternative treatment,” but massage already has the respect of the medical community. As reported in Rheumatology, more than 70 percent of doctors say that they have referred their patients to massage therapists.
If you’re suffering from pain — brief or chronic — you may want to give massage a try. Minor aches and pains aside, you should have a doctor evaluate you to rule out other causes of pain (especially persistent or acute pain for which there’s no apparent cause); in some cases, pain can signal a serious condition, such as cancer or scoliosis. Also, before you climb into the massage chair or lie down on the table, you’ll probably want answers to a few questions.
How does massage ease the pain?
Massage seems to ease pain in several different ways. For starters, it can increase blood flow to sore, stiff joints and muscles, which are warmed by the extra circulation. As reported by the National Center for Complementary and Alternative Medicine, animal studies have found that massage also triggers the release of natural painkillers called opioids in the brain. (The report doesn’t explain how scientists massage the animals.) Animal studies also suggest that massage speeds up the flow of oxytocin, a hormone that relaxes muscles and encourages feelings of calmness and contentment. As an aside, oxytocin happens to be the same hormone that flows through women before labor. It relaxes the uterus and helps cement the bond between mother and infant, earning it the nickname “love hormone.” Massage may also change the way the brain senses pain. As Stanford neuroscientist Robert Sapolsky has said, the short, sharp sensations of a good massage can temporarily make the brain forget about other aches.
How effective is a massage for pain relief?
There’s little doubt that a good rub-down can ease pain and tightness in stressed, overworked muscles. Now there’s growing evidence that it can also help relieve chronic (long-lasting) pain, especially the lower-back variety. A study of 262 patients published in the Archives of Internal Medicine found that massage was far superior to acupuncture or patient education for relieving back pain. After 10 weeks, 74 percent of patients said massage was “very helpful.” Only 46 percent for those who received acupuncture and about 17 percent of those who read a self-help book had the same response. Massage patients were also four times less likely than other patients to report being bedridden with pain. The authors concluded that “massage might be an effective alternative to conventional medical care for persistent back pain.”
In a true test of its value, massage has even been shown to ease the chronic pain and other miseries suffered by cancer patients. A study of more than 1,200 patients at Memorial Sloan-Kettering Cancer Center published in the Journal of Pain and Symptom Management found that massage reduces symptoms such as anxiety, nausea, and pain by about 50 percent.
Is massage safe?
Massage is very safe, especially when performed by an experienced, licensed professional. It’s not entirely risk-free, however. A study published in the journal Rheumatology found 16 separate cases where massage caused serious injuries, including nerve damage and, in one instance, a bruised liver. The study concluded that such complications are “true rarities” that are most likely to occur at the hands of laypeople or the use of more forceful techniques such as shiatsu.
According to the National Center for Complementary and Alternative Medicine, massage can be hazardous for anyone with deep vein thrombosis, burns, skin infections, eczema, open wounds, broken bones, or advanced osteoporosis. Cancer patients should consult with their oncologists about the safety of massage therapy as there may be a greater risk of certain adverse effects, such as internal hemorrhage or the dislodging of blood clots. They can also ask for a referral to a massage therapist who has a certification in oncology massage and works in conjunction with a medical school or cancer treatment program.
And although massage has been found useful for relieving the aches and stiffness that show up during pregnancy, some experts recommend waiting until the second trimester to receive prenatal massage. Also, check with your doctor or midwife before undergoing massage or any other new procedure. If he or she signs off on prenatal massage, look for a certified massage therapist who has an additional certification in prenatal massage.
Finally, the University of Washington Department of Orthopaedics and Sports Medicine warns against massaging joints that are swollen or extremely painful. The university offers this advice: If massage causes pain, stop.
If you feel pain during a therapy session, tell your massage therapist immediately. You’re the expert on whether the treatment is helping or worsening your pain.
How do I find a massage therapist?
Get a recommendation from people you trust most, including friends, family, coworkers, or your doctor’s office. The American Massage Therapy Association and the National Certification Board for Therapeutic Massage and Bodywork also have handy locators on their Web sites for therapists in your area.
Once you do find a therapist, you can include the following questions:
Are you licensed to practice massage?
Are you a member of the American Massage Therapy Association?
Where did you receive your massage therapy training?
Are you Nationally Certified in Therapeutic Massage and Bodywork? (Certification involves 500 hours of training and a written exam.)
Not all states, however, require professional massage therapists to get a license.
Which type of massage works best?
There’s no clear evidence that one form of massage works better than any other. A 2006 review of back pain studies found that acupressure or pressure point massage may be slightly more effective than the classic “Swedish” method of rubbing and kneading.
The most important thing to consider when choosing a massage technique is the quality of the therapist. Not only are experienced practitioners safer, they’re also more effective. The 2006 study of back pain found that the “greatest benefit came from trained massage therapists who had many years of experience.”
There’s only one amateur that should have your complete trust: yourself. As reported by the University of Washington, you can give yourself an effective massage. Just put a little oil or lotion on your hands and glide them over the sore spots. You’ll be in the perfect position to know what helps and what hurts.
Further Resources
National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) 1901 S. Meyers Rd., Ste. 240. Oakbrook Terrace, IL 60181-5243 800-296-0664 http://www.ncbtmb.org/
American Massage Therapy Association 877-905-2700 http://www.amtamassage.org/consumers.html
References
Corbin L. Safety and efficacy of massage therapy for patients with cancer. Cancer Control. July 2005. 12(3): 158-164.
Ernst E. The safety of massage therapy. Rheumatology. 2003. 42: 1101-1106.
National Center for Complementary and Alternative Medicine. Manipulative and body-based practices: An overview. December 2004.
University of Washington Department of Orthopaedics and Sports Medicine. Managing arthritis pain: Other pain management techniques. January 2005. http://www.orthop.washington.edu/uw/livingwith/tabID__3376/ItemID__96/PageID__136/Articles/Default.aspx
Furlan AD et al. Massage for low-back pain. Cochrane Database of Systematic Reviews. 2006. http://www.cochrane.org/reviews/en/ab001929.html
Cherkin DC et al. Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Archives of Internal Medicine. April 23, 2001. 161(8): 1081-1088.
Cassilbeth BR and AJ Vickers. Massage therapy for symptom control: outcome study at a major cancer center. Journal of Pain and Symptoms Management. September 2004. 28(3): 244-249.
Waring B. A cuddle a day keeps the doctor away. NIH Record. February 24, 2006. http://www.nih.gov/nihrecord/02_24_2006/story03.htm
American Massage Therapy Association. Massage therapy: facts for physicians. http://www.amtamassage.org/pdf/FactsForPhysicians.pdf
American Massage Therapy Association. What every consumer needs to know before visiting a massage therapist. http://www.amtamassage.org/news/beforevisit.html
National Certification Board for Therapeutic Massage and Bodywork. Applicant’s corner. http://www.ncbtmb.com/applicants_corner.htm#application
American Massage Therapy Association. 2008 Massage Therapy Industry Fact Sheet. http://www.amtamassage.org/pdf/2008IndustryFactSheet.pdf
American Massage Therapy Association. 2009 Massage Therapy Industry Fact Sheet. http://www.amtamassage.org/news/MTIndustryFactSheet.html
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