Does Massage Enhance Recovery?

After a tough workout or competition, it's tough to beat a good massage. After all, a thorough massaging can unkink tight tendons, mollify painful muscles, and spur the recovery process.

Or can it? Scientific evidence supporting massage as a recovery-promoting technique has actually been quite scanty. Although athletes, coaches, and managers are generally positive about the potential benefits of massage, few carefully controlled research studies have been able to link massage with athletic advantages.

So, to help us understand the effects of massage more completely, scientists at the Institutionen Sodersjukhuset and the Karolinska Institute in Stockholm, Sweden recently carried out an ingenious study (1). In this new investigation, 16 recreational athletes (eight men and eight women, age range 20- 38 years) took part in a rugged workout which was guaranteed to produce quadriceps-muscle soreness and distress.

After warming up properly, the 16 Swedes performed 300 maximal eccentric contractions with their quads (during which the quads were stretched as they tried to shorten), one leg at a time, on a Kin-Com& dynamometer. The velocity of movement was 180 degrees per second, and only eccentric contractions were carried out (the dynamometer rotated the leg back to the starting position after each eccentric contraction while the subjects relaxed their quads, so that no concentric work was performed). The order of which leg was to be exercised first was randomly chosen, and the total workout lasted approximately 30 minutes.

When the study began (before the extreme exercise and subsequent massaging were carried out), there were no strength differences between the to-be-massaged legs and the control limbs. Within 10 minutes after the workout ended, an experienced sports physical therapist descended on each athlete and administered a thorough sports massage to one leg only, chosen at random; the other leg served as control. After this initial hopefully therapeutic intervention, massage was administered to the experimental leg again, once daily, for two additional days. Control legs were not massaged at any time.

Immediately after the workout and the first massage session, maximal strength had plummeted by about 25 percent. On the third day, max strength was still diminished - by around 13 percent or so. However, a key point was that there was no difference in strength between the massaged and non-massaged legs. Thorough massaging simply did not boost the recovery of quadriceps-muscle strength after a very challenging workout.

The 16 athletes also completed a functional test of strength which involved three maximal one-leg vertical jumps on each leg; the best performance on each leg was recorded. As you might expect, jumping height declined significantly (by about 11 percent) immediately after the enormous eccentric exertion. On the third day, jumping prowess returned to normal, but again there was no difference between the massaged and control legs. Massage simply did not quicken the return to normal function of the quads, the key leg sinews involved in vertical jumping.

You might be thinking that surely the three bouts of massage had some effect on the pain and overall muscular discomfort. Surely not! Pain was evaluated by means of a visual analog scale (VAS), with 0 representing no pain or discomfort at all and 10 being the worst pain imaginable. Immediately after the initial bout of exercise, the VAS score was approximately 2.0 for treated and control legs. After the first massage intervention, the VAS averages moved up slightly to 2.2 for the massaged legs and 2.1 for controls, and on the third day the scores had gained some loft at 3.1 for thoroughly massaged legs and 3.2 for control appendages. As you have already anticipated (from the closeness of these scorings), there were no significant differences in discomfort between legs.

In this investigation, the Swedish investigators pulled off another foxy feat. Some research has shown that massage produces vasodilatation in skin tissues (basically, an expansion of the diameters of blood vessels within the skin), a distension which some massage proponents believe is beneficial, since it might speed the passage of nutrients and healing factors to ailing muscles and connective tissues, while simultaneously carrying away "waste products" and inflammatory agents. This vasodilatation appears to be caused by the release (from the nervous system) of chemicals called "neuropeptides" (2).

Two of these neuropeptides, calcitonin gene-related peptide (CGRP) and neuropeptide Y (NPY), have an uncanny ability to broaden small arteries (3) and may even be able to modulate muscle pain (4). The Swedish investigators utilized special microdialysis and radio-immunoassay techniques to analyze the fluids surrounding quadriceps muscle fibers for both CGRP and NPY; these analyses were conducted immediately after the hard workout, right after the first massage session, on the third day, and after two weeks.

Unfortunately (for massage advocates), these meticulous inspections of muscle fluids uncovered no differences at any time in CGRP and NPY levels between massaged and cold-turkey legs. In short, massage struck out completely in this Swedish study, failing to boost muscle recovery in any way, alleviate pain to even a small degree, or even change concentrations of key chemicals probably be involved in recovery processes.

Naturally, there are some potential problems with this Scandinavian work. For one thing, the workout which produced the quadriceps distress and loss of function was rather extreme - perhaps too damaging for massage to produce any positive effects. It is possible that massage might work better with smaller degrees of muscle mayhem (the actual physiological mechanism for this, however, remains unclear).

It's also possible that the 12-minute massage interventions were too short - and that longer bouts of massaging might have done the trick. However, note that three separate massages were administered over three consecutive days, a higher rate of massage than is enjoyed by most sprint and endurance athletes.

You may be worried that the Swedish whitecoats did not investigate muscle or blood lactate levels during their probings. Is not one of the key benefits of massage the elimination of lactate from muscle tissues, and is it not possible that the Swedish masseurs and masseuses might have at least accomplished that?

Bear in mind that there is no hard evidence at all that massage speeds lactate removal in muscles, and note, too, that lactate is actually a good thing - an important muscle fuel. If massage did cause lactate to scurry away from sinews, it would actually be a bad thing. And so, a key question: Why do athletes ask for sports massage? It might be that the primary benefits of sports massage may be associated with "central effects," i. e., beneficial effects on the central nervous system. It is certainly possible, for example, that massage helps to quell the mental stress associated with intense or prolonged workouts, by easing an athlete into a more tranquil and comfortable psychological state. This has not been quantified in any scientific study, however.

More research will have to be done before massage qualifies as a proven recovery booster. Of course, a couple of other strategies - appropriate post-exertion intakes of nutrients (around one gram of carbohydrate per pound of body weight during the two-hour "window" after workouts and races) and post- training muscular stretching - have been linked with upgraded recovery processes and should be used routinely by serious athletes. &

References

(1) "Sports Massage after Eccentric Exercise," The American Journal of Sports Medicine, Vol. 32(6), pp. 1499-1503, 2004

(2) "Firm Stroking of Human Skin Leads to Vasodilatation Possibly due to the Release of Substance P," Journal of Dermatological Science, Vol. 22, pp. 138- 144, 2000

(3) "Calcitonin Gene-Related Peptide Is a Potent Vasodilator," Nature, Vol. 313, pp. 54-56, 1985

(4) "Arthritic Calcitonin/Alpha Calcitonin in Gene-Related Peptide Knockout Mice Have Reduced Nociceptive Hypersensitivity, Pain, Vol. 89, pp. 265-273, 2001

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Personal Note from Owen Anderson :

I have not received a massage since a Russian man-of-arms oppressively flattened all my fibers in the spa of the famed Gellert Hotel in Budapest in 1993, so I do not have a wealth of personal experience in this area. However, many of the runners with whom I work tell me that a key benefit of the technique is the mental relaxation which it produces.

For some runners, a massage is, in effect, the true endpoint for a tough workout or a series of strenuous efforts over a period of several days; the massage can help "wash away" psychological distress and the memory of the painful process which the athlete has completed. This leaves a runner with tabla rasa when it comes to the mental scoreboard for anxiety and perceived fatigue, which is always a good thing, since it allows subsequent high-quality workouts to be carried out with a clear and untroubled mind. When a runner carries excess mental baggage, particularly the negative kind, into a quality workout, the session is almost always completed at a pace which is below what is actually possible.