Okay, I admit it; until recently, I didn’t really know how or why massage works; I just knew from experience – both as a practitioner and a recipient – that it relieves a variety of symptoms and reduces stress.
However, having just recently left the world of research after almost a decade in academia, I have been taught to dismiss claims that are not supported by data. In the Western world we are taught to ask “why,” to seek answers, to uncover “proof,” and we as a society are relying more and more on science to offer explanations of long accepted beliefs and practices. So although I believe that every research study is inherently biased (because they are designed and conducted by us inevitably flawed – yet lovely – humans), the double-blind randomized control trials is the closest thing we have to a gold standard.
Yet for all that’s been “proven” about pharmaceuticals, surgical procedures, and other Western medicine practices, we know relatively little about the science behind “alternative” or “non-traditional” modalities. We spend our time and money on massage therapy and similar alternatives because we know from experience that they work for us and because they generally carry very little risk of side effects or adverse reactions. But the state of the research lags behind; despite several reports that long-term massage therapy reduces chronic pain and improves range of motion in clinical trials, the biological effects of massage on skeletal tissue have remained unclear. However, all that is beginning to change…
A 2012 study in Canada that was recently featured in both Runner’s World and Science Daily has begun to help us understand the mechanisms by which massage reduces chronic pain and improves range of motion. Eleven research participants exercised to exhaustion on a stationary bicycle, and then researchers randomly assigned only one of their legs – the quadriceps group, in fact – to receive massage. Biopsies were taken on each leg prior to exercise, immediately after massage, and 2.5 hours after massage.
Interestingly some long held beliefs about why massage works were not supported, while some other less popular explanations were upheld. Here’s what they found…
What massage therapy DOES do:
o Softens fascial tissue
o Helps clenched muscles relax
o Removes adhesions between fascia and muscles
o Reduces intensity of DOMS (delayed onset muscle soreness)
o Improves immune function by increasing white blood cell count
o Reduces cortisol (“stress hormone”) levels
o Speeds up muscle/cell repair
o Reduces inflammation
What massage therapy DOESN’T do:
o Doesn’t push toxins out of muscles and into bloodstream
o Probably doesn’t flush lactic acid* out of muscles
So that’s what one study found. More recently the claim that massage is an effective means to reduce inflammation was supported by two double-blind randomized control trials, one using rabbits and one using rats. These findings are of particular clinical interest because chronic inflammation has been shown to be a major causal factor for a variety of chronic diseases such as heart disease, autoimmune disease, asthma, diabetes, and some forms of cancer. Here I focus on the rabbit study because rabbits are so much cuter than rats — but the two studies are very similar in design and in their findings.
So one important thing to understand about this study performed by a group of rabbit loving researchers is that not only was it a randomized control trial, but it was also double-blind. This means that neither the subjects nor those administering the massage were aware of which condition they were assigned. How is this possible, you ask? Well, as you might have guessed, those receiving massage were rabbit and those giving massage were machines. (Pretty genius if you ask me).
Another unique feature of this study is that it looked at the effects of massage on healthy undamaged tissue, rather than the tissue of people with systemic illness, acute injuries, or even people who had just exercised to exhaustions like the older study of mad Canadian cyclists.
In addition to being pretty ingenious, these researchers did a really good job of explaining what massage seems to be doing at the cellular level. In essence, they explain the “how” behind the “why,” i.e. how massage can help clenched muscles relax, speed up muscle/cell repair, and reduce inflammation. Their explanation also supports the claim that massage can fight stress in general, i.e. why it’s just plain good to do even if you aren’t a mad Canadian cyclist who just rode your bicycle to exhaustion.
This study, the rat study, and the Canadian cyclist study all suggest that massage functions as an “immunomodulator,” which means that it directly impacts the immune system. As Simon Melov, PhD, a researcher on the Canadian cyclist study explained, “Our research showed that massage dampened the expression of inflammatory cytokines in the muscle cells and promoted biogenesis of mitochondria, which are the energy-producing units in the cells.”
Okay, so that’s nice, but what does it mean? To answer that question, let’s first explore how massage affects the immune system’s response to a muscle that has been damaged in some way, either through high intensity exercise or injury. So say you just had a pretty hard workout, or you walked a lot more than you’re used to, or you tweaked your neck. Here’s what generally happens next….**
Your body’s natural response to this type of effort is inflammation. This is not necessarily a bad thing, as long as your body is able to respond effectively. However, adequate rest time and reasonable levels of stress in your body are absolutely necessary for your body to respond effectively. And as it turns out, many of us don’t rest enough and also have too much stress. (Check out this great article for more on this).
The “first responders” of your immune system– white blood cells known as neutrophils — arrive en masse on the scene. Neutrophils comprise 50 to 70% of all immune cells, are the hallmark of acute inflammation, and are the main ingredient in what is commonly referred to as “pus.”
The next immune cells to arrive on the scene are the “big eaters, or macrophages. The “big eaters” show up as either M1 cells or M2 cells. M1 and M2 cells both eat an amino acid called arginine. But when an M1 cell eats arginine for dinner, it is metabolized into a “killer molecule,” while M2 converts that same meal into a “repair molecule.” And this is where things get interesting.
So remember our first responders, the neutrophils? Well, it turns out that M1s also like to eat dead neutrophils, and when an M1 cell eats a dead neutrophil, that M1 cell literally transforms into an M2 cell. That’s right: the “bad guys” turn into the “good guys” when they eat dead neutrophils. I’m not making this up; it’s really cool, and it happens in our bodies all the time.
So then, wouldn’t it be great if we could get all the M1s to eat dead neutrophils and morph into their more constructive cousins, a.k.a. the M2s? Exactly! To my delight, the super smart rabbit researchers found that this is exactly what seems to be occurring as a result of massage. So when inflamed tissue is massaged, neutrophils receive a chemical signal to die; then M1 cells feast on the dead neutrophils and turn into M2 cells. And there you have it! Massage creates an environment that promotes repair and regeneration, rather than inflammation and swelling.
This finding happens to support our Canadian bicyclist researcher friends’ hunch that the pain reduction associated with massage may involve the same mechanism as those targeted by conventional anti-inflammatory drugs. And, as you might have guessed, medical researchers and pharmaceutical companies are developing their own methods of “immunomodulation,” touting “therapeutic macrophage targeting” as a promising new frontier in treatment for a variety of conditions caused by inflammation. The nice thing about massage, assuming these studies’ findings are valid, is that it can modulate the immune system without side effects and at a much lower cost than complex medical procedures and pharmaceutical interventions.
And, as an added bonus, all of this may be able to prevent temporary and even permanent changes in the density of nerves that send signals to the brain about pain and other sensations, thereby potentially preventing chronic pain.
But what about people who don’t have an acute injury or don’t work out that hard? What if you simply have pain or are just stressed out? Well, good news for you too! The anti-inflammatory effects of massage appear to be beneficial even to healthy undamaged muscle tissue. So basically the effects of massage on the immune system are body wide, thus increasing the body’s ability to fight stress and be resilient, whether in the form of a tough workout, a drama filled day at the office, or unexpected traffic delays.
Researchers have just begun to scratch the surface in terms of what is happening in our bodies when we receive massage, but I am excited by these latest findings. As researcher Mark Tarnopolsky, MD, PhD explains, “The potential benefits of massage could be useful to a broad spectrum of individuals including the elderly, those suffering from musculoskeletal injuries and patients with chronic inflammatory disease.”
*Lactic acid buildup was previously believed to be responsible for DOMS (delayed onset muscle soreness); however, this study of Canadian cyclists indicates otherwise.
**Please understand that I am not a biomedical scientist. The information contained in this article is simply my honest interpretation of peer-reviewed academic literature.