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Does massage help improve blood flow to muscles?

There was a recent article http://well.blogs.nytimes.com/2010/06/02/phys-ed-does-massage-help-... in the NY Times where associate professor, Michael Tschakovsky performed a study to answer this question: “Does massage increase blood
flow to muscle and/or reduce the quantity of lactic acid after
treatment?" His specialty is the study of blood flow to muscles,
particularly in diseases like diabetes by the way.

I love science. I love testing things so this type of study I think is perfect. It’s not trying to determine too much at one time. So, it’s not
the type of test that is trying to determine, “Does massage make people
feel better or reduce depression or improve our ability to endure
stress.” See, those types of tests are very vague not to mention bias.
Those things are very hard to determine because it’s very relative to
each individual and seeing we are all so diverse… and so on. Here what
we have is a smart professor who was curious about if massage was doing
what many massage therapist say their hands-on work does.

Regardless of the benefits or effects of increasing blood flow or reducing lactic acid, they are simply testing if massaging a body right
after bringing a muscle to total fatigue does either. It’s not
dismissing that massage has benefits of some nature and in the article
even Tschakovsky says he gets a massage frequently regardless of what
his study shows.

So basically how they performed the study is they had 12 dudes squeeze a handgrip repeatedly, putting their forearm to exhaustion and then put a
catheter into a deep vein that “drains” the muscle to test lactic acid
build up and viewed blood flow with an ultrasound machine.

You would think that massaging a muscle right after doing strenuous muscular exercise would increase blood flow to the muscle, help improve
muscle performance and strength. But if you think about it, if you
squeeze your arm, do you think your squeeze increased or decreases blood
flow? The answer is, it decreases blood flow and that’s just what
Tschakovsky found. Think about it. You squeeze a body part, blood flow
will be pushed away from where you are squeezing, at least for a moment.

As for lactic acid, it has been widely thought of as the “waste” that is created during excessive muscle contraction that inhibits muscles
from efficiently firing in a consistent way. Fatigue sets in and
ultimately your body goes to failure.

However, the lactic acid is understood as a chemical reaction that actually provides an entirely different function in my field of
expertise. The production of lactic acid is a good thing. After
movement, lactic acid is actually reabsorbed and used as fuel that
muscles absorb to regenerate and return to efficient function. So
removing it in the first place doesn’t sound like something you want to
do anyway… and of course they also found that massage decreases muscle
absorption of lactic acid, which is totally contradictory to many
massage therapists beliefs. I of course am not a massage therapist so I
am not surprised at the finding but hey, to my massage lovers, it’s okay
that it’s not improving muscle absorption of lactic acid because it
feels sooo good!

Last month I wrote a blog about DOMS (Delayed Onset Muscle Soreness) and linked to an article where new science is proposing DOMS is actually
CAUSED by an adaptation in the CONNECTIVE TISSUE and the ache you feel
24-48 hours after strenuous activity is caused by that adaptation. The
fatigue or damage is in the connective tissue, the muscle cell
adaptation is relatively unnoted and lactic acid is NOT what makes you
feel sore a day or two after exercise. So let’s not be too bummed about
the fact that right after muscle use massage doesn’t eliminate lactic
acid or help with it’s absorption into muscle.

Because, here’s the thing… who in the heck is getting a massage between sets of bench press or push-ups anyway? Will these findings stop you
from getting a massage? Did it stop the professor? Nope. And even his
wife told him not to cancel her appointment for her massage.

No one is saying that getting a massage the day after you do a serious leg day at the gym and have sore muscles isn’t going to make you feel
better. Believe me, it helps. But it’s not because it’s helping your
muscles anyway. And here’s where I must yet again put in my two cents.

What I would love to see is SOMEONE in the US actually do a study on CONNECTIVE TISSUE and what affects massage has on this tissue. Also what
happens when the connective tissue is dehydrated and adhered or less
extensible than it should be for optimal movement efficiency which IS
happening in everyday living!

In any event, it’s a relevant article, and I’d love to sit with the professor and see if we could elaborate on his findings and sway him to
do his next study on something even more important. The behavior of
connective tissue after massage. Go science!

For those of you like me who want more info on the science part and actually like reading the abstracts, check out the actual study: http://www.ncbi.nlm.nih.gov/pubmed/19997015

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Comment by Boris Prilutsky on July 21, 2010 at 8:42pm: I spent a bit time to read Tchaikovsky research findings, and conclusions. Honestly his research protocol design are flawed. Onset muscle soreness has nothing to do with lactic acids but due to migration of white blood cells, including neutrophils, to injured tissue to clean up debris that are results of vigorous “to the muscle exhaustion exercise” .At the time of “cleaning” this white blood cells, including neutrophils injuring healthy tissue which causing all this next day inflammation ,pains, muscular tension est. Professors Smith of North Carolina medical schools was advised by former Soviet Union scientists I should say clinical scientists to conduct the real research protocol not similar to Tchaikovsky ‘s.please everyone forgive me this but in my opinion Tchaikovsky don't know what his research was about, and we don't know who performed massage at a time of the research experiment ? Again please forgive me but I cannot be respectful to claims like this.
This is what Prof. Smith, had to say in conclusion:
“During acute inflammation, blood flow slows as vessels dilate in an area of injury.(My commentary. Vigorous exercise to exhaustion as professor Tchaikovsky described ,always causing soft tissue injury and producing debris) When this occurs, the white blood cells, including neutrophils, are displaced from the central, axial zone of blood flow to the peripheral, plasmatic zone and subsequently marginate along the vessel walls. Since sport massage appears to increase blood flow through the vascular bed, we theorized that this increased flow rate in the area of microtrauma could prevent the typical outward displacement of neutrophils. In addition, we speculated that the mechanical action of sports massage could shear marginated cells from vessel walls and thus hinder emigration of cells from the circulation into tissues spaces. …control group exhibiting a more rapid and steeper increase CK (i.e. creatine kinase) values than the massage group. …sports massage rendered hours after termination of unaccustomed eccentric exercise reduces the intensity of delayed onset muscle soreness and reduces serum creatine kinase levels.”

By the way . Massage therapy is most powerful methodology in treatments of PADs (thromboangitis oblitterans) including in cases of diabetes .here in the US, few years ago with group of MDs I repeat protocol that was research and developed in former Soviet Union .this little scientific experiment proved not only that massage does increase PVR to lower extremities and in general but much more .
This case study I offered to Dr.Ross Turchaninov to feature in his book”Medical Massage” I will ask him to provide details.
Best wishes to all.
Boris Prilutsky

Comment by Andrea Kimmerer on July 21, 2010 at 9:21am: hmm.. well if massage doesnt increase blood flow to muscles, than all my books in school are wrong... interesting.. what i dont understand is how are muscles taken out of the equation when massage in fact does increase blood flow?

Comment by Steven D. Dyviniak on July 15, 2010 at 8:15pm: Was it forearm flexors? Extensors? Both?
And what stokes /pressure were used? Plucking? x-fiber? MFR spreading?
I concur that it is all about fascia and more work is kneaded (sic) in this area.

Comment by Angela Raymond on July 7, 2010 at 1:54pm: Tom Meyers - Anatomy Trains, James Waslaski - Orthopedic and Sports Massage, Art Riggs - Deep Tissue Techniques -great resources when it comes to connective tissue and CT studies. I do a lot of myofascial release massage and find it to one of the most affective techniques in my toolbox.

Comment by Sandy Fritz on June 29, 2010 at 8:59am: Hello all
It is ok for what we thought to be true and end up not being what we thought. As reseach contiues the massage community will be challeged by findings that go contrary to what we hold to be true and validate massage as well. It is time for the massage profession to grow up and embrace the process of critical thinking and applying this ability to clinical reasoning during massage practice.

Comment by Christopher A. Moyer on June 28, 2010 at 9:28pm: One more thought - earlier in your post you state that this isn't "the type of test that is trying to determine, “Does massage make people feel better or reduce depression or improve our ability to endure stress.” See, those types of tests are very vague not to mention bias."

I partially agree with you; 'feeling better' and 'stress' are very vague concepts. But I wouldn't put depression in the same category with those other two. Even though experts may disagree about the finer details, depression is a well-validated concept, and we have some valid and reliable ways of measuring it. What's more, massage therapy's effect on depression is one of its most well-researched and promising effects. (However, we need to add some context to that - most massage therapy effects have not been very well researched, yet.)

There are now several research reviews that show massage therapy has strong effects on reducing depression, and that it is a promising treatment that should continue to be examined. Some of these are studies that I have been involved with, and are available at my faculty webpage (the full studies, not just the abstracts - the link is in my profile), but I can add that a brand new one has just recently been published, too. This latest review was just completed by a team of researchers in Taiwan:

http://www.ncbi.nlm.nih.gov/pubmed/20361919

The results are very strong, statistically speaking.

Comment by Christopher A. Moyer on June 28, 2010 at 9:15pm: This is an interesting post, Sue. Thanks for making it.

You and Daniel, each in your own way, challenge the external validity of this study - that is, you both point out that the study does not actually test massage the way it is down in the real world. It's good of you to be on the lookout for that. As you note, who exercises to exhaustion, and then gets immediate massage of that anatomical site? Nobody.

However, keep in mind that there sometimes are very good reasons to do a study that has little or no external validity (also known as generalizability). If this researcher was interested in the effect of massage on blood flow, he may have determined that this artificial situation was the best way for him to begin to test that possible mechanism with the currently available tools.

To put it another way, this researcher made a conscious decision to maximize 'internal validity' - the precise experimental control he and his team had over the situation - in the hope that this would help them test a theory (whether massage promotes blood flow).

Comment by Sue Hitzmann on June 28, 2010 at 2:33pm: I totally agree with you Daniel. No one gets a massage DURING a workout or between sets so it sort of skews the study. But it shows that what we may think is happening may not be. The benefits of massage are clearly there but the WHY it's beneficial isn't very scientific. More soon...

Comment by Daniel Cohen on June 28, 2010 at 10:16am: I am not sure what the value is in this study. Isn't the increased circulation value of massage from relaxing over tightened (contracted) muscles? Why would it be tested a such an immediate time frame to exhaustion. I was never taught anything but Acupressure affects at that point. Is massage in this case defined as Swedish?

I agree that we need more study of fascia response from massage (various modalities) in a variety of situations.
As massage goes so far beyond just relaxation in today's society, we need validations of assumption to know how and what to do in specific situations. While I regret the loss of intuitive application that is such a part of a good massage, the scientific allows more Therapists to be taught to achieve specific results for specific conditions.