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I have faith in sports massage … for some reason

Paul Ingraham ARCHIVEDMicroblog posts are archived and rarely updated. In contrast, most long-form articles on PainScience.com are updated regularly over the years.

I’ve been discussing some surprising bad-news scientific evidence with my readers on Facebook and Twitter: Wiltshire et al found that post-exercise massage actually impaired muscle blood flow and lactic acid removal (not that anyone should actually want their lactic acid removed).

As usual, some folks bristle at the “negativity” of sharing bad science news about massage, and have shot back with claims like this one: “massage is more likely to improve recovery then impair it.” I actually share that faith. I believe that, one way or another, whatever it is that we love about massage probably results in a net benefit after a workout, at least a modest one. I think. I hope.

Unfortunately, the evidence doesn’t support my belief. “Aiding recovery” is the Holy Grail of sports massage, and it barely exists.

Quick review of sports massage evidence

Way back in 1997, when I was just starting to study massage therapy, Tiidus proposed that facilitation of recovery by massage would require an effect on the following:

  1. muscle damage caused by eccentric muscle action
  2. retention and recovery of muscle strength and performance following "eccentric-mechanical" muscle damage
  3. reduction of delayed onset muscle soreness following "eccentric-mechanical" muscle damage; an
  4. recovery of muscle strength and performance following anaerobic exercise.

And he concluded:

Because manual massage does not appear to have a demonstrated effect on the above, its use in athletic settings for these purposes should be questioned.

There’s been a smattering of more encouraging evidence about it since then, like Franklin 2014, which fairly persuasively showed that “massage therapy restores peripheral vascular function after exertion” (seems like a good thing). The best of the encouraging studies is probably Zainuddin 2005. But it all amounts to just damning sports massage with faint praise, and there’s still plenty of bad news (like the train wreck of hype over “reducing inflammation,” see Massage Does Not Reduce Inflammation). After many years of following the research, I’ve decided that “it’s mostly a myth that delayed onset muscle soreness (DOMS) can be effectively treated by massage.” And surely that’s what “aiding recovery” is mostly about. If sports massage doesn’t clearly reduce DOMS and the associated weakness, it’s not of much use.

All of this is covered thoroughly in my DOMS article, and there’s a section in my massage article going into detail about the old “flushing lactic acid” myth.

Given all of that, I’m not sure where my optimistic belief could possibly be coming from at this point! There are still other vaguely plausible mechanisms, other than good ol’ placebo: maybe post-exercise massage migitates the formation of so-called “trigger points”? It’s possible, but I’m not aware of any good evidence to support that, and there are certainly reasons to doubt it.

I like massage so much that, just like some of my critics, I refuse to heed the evidence, and stubbornly seek out massage, especially when I’m stiff and sore (though not if I’m too, stiff and sore). And not too intense, which may do more harm than good. Fortunately, I can live with my hypocrisy — it’s an over-rated sin anyway.

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