Saturday, 30 May 2009

Why the benefits of massage may be a myth

Athletes use post-exercise rubdowns to boost recovery but the gains could be all in the mind

Peta Bee
To top athletes and anyone else who exercises a lot or has put him or herself through the rigours of a marathon or triathlon, a regular massage is considered almost as essential to keeping the body in condition as diet and training. After all, the kind of deep-tissue massage practised by registered sports massage therapists promises to increase blood flow to aching muscles and flush out metabolic waste products such as lactic acid after a hard workout.

Nothing could be better for your aching limbs. Or could it? In a study presented at the American College of Sports Medicine’s annual conference in Seattle this week, researchers claimed to have blown the myth that massage speeds up recovery from exercise. Professor Michael Tschavovsky of the health studies department at Queens University in Ontario, Canada, says that while most massage therapists believe that their work boosts circulation to the muscles and reduces fatigue, no study before his had tested the validity of this theory.

Tschavovsky asked 12 healthy male subjects to perform isometric hand-grip exercises for two minutes at a time while he and his team measured blood flow and lactic acid build-up every 30 seconds and for ten minutes after the exercise had finished. They also took the same measurements during rest, when the subjects had massage and during “active recovery” such as gentle jogging, walking or stretching. What they found was that massage did not increase — but decreased — blood flow to the muscles and hindered rather than improved the removal of lactic acid and other waste materials by as much as 25 per cent compared to “active recovery”.

“Anyone who believes that lactic acid symptoms are relieved by massage is wrong because the alleviation of discomfort is not due to waste products being flushed out after exercise,” Tschavovsky says. So does this mean that post-workout massage is a waste of time? Tschavovsky thinks not. He is a fan himself and admits to having massage to help his legs to recover after football tournaments. But he says that the benefits could all be in the mind. “It feels good, that’s the truth of it,” he says. “A lot of sports performance is psychologically based so if you feel you are in a better situation to train with massage then, yes, it probably does have the ability to improve your performance.”

What his study shows, Tschavovsky says, is not that massage is useless but that it isn’t helpful for the claimed reasons. If it does work, scientists have yet to prove how.

Massage therapists are taking the findings with a pinch of salt. “Any sort of physical activity produces a cocktail of waste products — not just lactic acid — that vary according to the activity, the intensity of the workout, your age and diet,” says Mel Cash, principal tutor of the London School of Sports Massage, where many of Britain’s Olympic sports masseurs have trained. “A qualified therapist will be able to reduce the swelling of tissues and aid minor soft tissue injuries so that you are ready for your next workout.” Bob Bramah, a spokesman for the Sports Massage Association, the governing body of sports massage in the UK, says that there is plenty of evidence that massage is helpful after exercise. “But I also know by personal experience that what I do works,” he says. “I know that my players feel better afterwards. I know that as a result of that their performance is enhanced.”

But is it? Experts who have reviewed other types of massage claim that not only are many approaches ineffective but that some hold potential risks. Professor Edzard Ernst, a researcher into complementary medicine and director of the Peninsular Medical School in Exeter, says that part of the problem is that the profession is unregulated. While studies do show that massage can help to relieve a range of ailments from stress, migraines and infertility to back pain, sickle cell anaemia and joint problems, many are inconclusive.

A study at Ohio State University last year, for example, showed aromatherapy treatment to be relaxing because of a placebo effect, while a study of hot stone treatment (heated stones placed on the body) found that while the warmth was comforting there was no scientific evidence of a reduction in ailments. In the case of Thai massage, which aims to realign the body by using pressure on acupressure points, after a five-week study by the Touch Research Institute in Florida, subjects reported reduced job stress and elevated moods.

“In most cases the evidence is highly contradictory and while some studies suggest an effect others don’t,” Ernst says. “There is reasonably good evidence that massage can be helpful for back pain, but rigorous investigations are difficult to carry out because a good placebo does not exist.”

Susan Findlay, a spokeswoman for the General Council for Massage Therapies, the UK’s governing body for all soft-tissue techniques, says: “The lack of reputable studies boils down to massage being very difficult to investigate because there are so many variables, including technique, perception of benefits and the standard of a practitioner.” There are groups of people — including those with low platelet counts or who are taking blood-thinning medications, pregnant women and people with cancer, osteoporosis or rheumatoid arthritis — who should be cautious about having a massage and should do so only on medical recommendation. For them — and others — massage could do more harm than good.

Research by Dr Robert Gotlin, a sports and orthopaedic rehabilitation specialist at the Beth Israel Medical Centre in New York, suggested that 15-20 per cent of people who have massage for injuries end up having corrective treatment afterwards: problems they attributed to muscular pain were more likely to be linked to spine or bone abnormalities. Massage could make the problem worse, injuring nerves, causing muscle spasms or inflammation. Gotlin suggests that thin people avoid deeptissue techniques such as shiatsu and Swedish massage. They are good for easing tight muscles, he says, but can lead to damaged muscle tissue, nerves or bones, particularly around the spinal area, in people without much body fat to act as protection.

Ernst says that serious problems linked to massage are rare. A review of evidence he conducted for the journal Rheumatology uncovered a few adverse effects; the majority were associated with “exotic” types of manual massage or techniques delivered by underqualified practitioners. “Massage is not risk-free, but significant adverse events are true rarities.”

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