Massage therapists, and others in the holistic arts … seem to be a particularly gullible bunch. And there are a lot of people who have seized upon that, and marketed their products, their classes, their modalities, and their wild claims to us … and many of us have fallen for it, hook, line and sinker … and unfortunately, gone on to convince our clients to buy into it, as well. … Our profession has turned into the snake oil medicine show.
Excuse me, exactly how does that work?, by Laura Allen
In addition to the many not-really-massage therapies that massage therapists may offer, there are also many claims that massage therapists make about massage itself that are all-too-questionable. The scientific case against massage largely consists of debunking the list of lame claims that define it to a surprising degree — and if you take them away, there’s not a great deal left. Most are just carelessly perpetuated minor myths. Some are not entirely or definitely wrong, but when presented to patients, are often misleading exaggerations and oversimplifications. For instance, massage probably does sometimes modestly increase circulation — just too little and too erratically to matter. It all adds up to a pattern of intellectual laziness in the profession that undermines its credibility and legitimacy.
Tightness matters. “You’re really tight” is a predictable phrase in massage therapy, but it’s mostly meaningless, or just illusory,42 and yet it is often the major rationale for therapy. Tissue texture correlates poorly with pain and other symptoms, and therapists have failed tests of detecting the painful side of low back or neck pain by feel43 — it’s actually an understandable and unimportant failure,44 but it also flies in the face of the popular mythology that therapists can zero in on tissue problems with uncanny accuracy. For more information, see You’re Really Tight.
Massage increases circulation. Massage therapists are particularly fond of claiming that massage “increases circulation,” but it doesn’t, really — certainly not consistently.454647 It’s kind of a silly claim. It doesn’t really matter if massage increases circulation, because even a modest boost would be clinically trivial, dwarfed by the effect of any amount of exercise. Metabolic demand is clearly the primary driver of circulation. The most optimistic perspective — and it is actually good news, albeit with some caveats — comes from a study that showed that a lot of massage improved “venous insufficiency”48 over several weeks. Unfortunately for the good news, regular brisk walking is very likely still better and cheaper.49 Or you could give a massage, instead of receiving one — it’s quite a lot of work!
Massage detoxifies or flushes lactic acid from your muscles. Detoxification myths are among the most embarrassing of all massage myths. “Detoxification” sounds good and means little or nothing. There are such things as toxins in the world, but not only is massage unable to “flush” any that matter from the body, it likely produces a mildly toxic state known as rhabdomyolysis.50 But if you challenge massage therapists to name a “toxin” that they are “flushing,” most will name lactic acid, not rhabdomyolysis. And again, the truth is ironically the reverse of to the myth: evidence has actually shown that massage interferes with lactic acid elimination. See the lactic acid section below.
Massage treats delayed onset (post-exercise) muscle soreness. Supposedly, massage therapy can stop that awful soreness that develops after an intense workout, known as delayed-onset muscle soreness (DOMS) — which is ironic, because massage is also well-known to cause a little next-day soreness. Although some studies have shown that massage can take the edge off DOMS, that’s about as good as it gets51 — perhaps a 30% temporary pain reduction when the planets align. It certainly doesn’t restore your strength any sooner. As with increasing circulation, it’s important to maintain perspective: it wouldn’t matter much even if massage did cure DOMS. Although DOMS can be pretty unpleasant, it’s one of the most trivial of all pain problems, guaranteed to solve itself within three days. On a closely related note…
Fascia matters. Many massage therapists are selling “fascial therapy” to patients. The main idea is that fascia — sheets of tough connective tissue found throughout the body — can get tight and restricting, and needs to be “released” by pulling on it. Fascia science is considered an exciting frontier in manual therapy. Unfortunately, although some fascia biology is interesting, the stuff does not seem to have any properties that are actually relevant to healing and therapy. Key examples of fascia research either fail to support fascial therapy or actually undermine it. Enthusiasm about fascia seems to be an unjustified fad. See Does Fascia Matter? A detailed critical analysis of the clinical relevance of fascia science and fascia properties.
Some readers may not get this joke. It’s a reference to Pulp Fiction; it means, “I’m so sick of hearing about ‘release’ I might shoot the next person who says it.” The term has reached annoying buzzword status when paired with faddish excitement about fascia. While many therapists may find the frustration hard to understand, many professionals really are that fed up with hearing about fascia in general, and release in particular.
Massage reduces inflammation. Um, no. The opposite, if anything.52 According to a sensationalized science news item in early 2012, supposedly massage “reduces inflammation” and “promotes muscle recovery.” But this was a small and technical gene profiling study, several steps removed from clinical reality, trying to explain a phenomenon that doesn’t clearly exist: we already knew that massage doesn’t do much for DOMS.53 All of the evidence about this and DOMS is explored in detail in a separate DOMS article.
Massage gives you an endorphin rush. The word “endorphin” reached buzzword status a few years back and is now often invoked carelessly. Endorphins are a class of neuropeptides that act on the nervous system to reduce pain and increase euphoria. But although massage therapy may reduce pain by a variety of mechanisms, it probably doesn’t do it by putting more endorphins into the bloodstream.54 And, yet again, it wouldn’t be that big a deal even if it were true. Like relaxation, endorphins are good, but they can only do so much — at best, such an effect would mostly just explain the pleasantness of massage itself.
Massage reduces cortisol. This is a much more specific idea than “massage reduces stress.” Cortisol, the “stress hormone,” is justifiably perceived as a villain, and reducing it is often touted as a meaningful rescue from being run-down, chronically anxious or depressed, or in pain. Unfortunately, the evidence that massage actually does anything helpful to cortisol production is conflicting and inconclusive at best, and commonly cited research to support it has major flaws.55 Even in the unlikely event that massage actually does reduce cortisol levels, the phsyiology of stress is much too complex to assume cortisol reduction is in itself a meaningful, good thing. Cortisol levels after a massage do not give a meaningful picture of the organism, and there is no direct relationship between a temporary cortisol reduction and any health benefit. What matters is cortisol levels over time, but even that isn’t exactly straightforward: stress and cortisol have a complex and chaotic relationship regulated by many variables out of our control.