Massage, is it all in your head? By Simon Hone
Massage, or forms of massage, have been around for many hundreds of years. Back then massage would have been used to relax and calm people and although it is still used in that manner to this day massage has become a popular recovery method for athletes competing in high level sport (Hemmings et al., 2000). Massage has large following and many positive expectations about it and how it can lead to a wide variety of benefits including a lowering of heart rate, increase of blood flow, removal of blood lactate from the muscles, increased range of motion of joints, as well as having a positive effect on the athletes mind (Hemmings et al., 2000, Hume et al., 2005, Robertson et al., 2004).
A study carried out by Hemmings et al, (2000) looked at massage as a recovery method after repeated work periods. The study was carried out on boxers with at least 2 years experience of the sport and focused on whether massage could lower blood lactate levels in the muscle after a period of work. They found that massage post exercise did nothing to help the removal of blood lactate from the muscles; in fact the group that received the massage actually had higher levels of blood lactate post exercise. However they did find that massage, as opposed to standard static recovery, showed a large perceived increase of recovery. There has also been work looking at whether a combination of active recovery, which has been shown to have a positive effect on recovery, mixed with massage as a recovery method could be highly beneficial (Martin et al., 1998). So if the massage was actually causing them to have higher blood lactate levels in the body how come they were feeling more recovered? What was at play? Placebo!
The concept of placebo is fairly simple; a stimulus which has minimal to nil proven benefits is applied or taken and then an improvement in condition or performance follows (Bialosky et al., 2011). An easy to understand example would be a doctor prescribing a “new” form of medication. The medication may be nothing different to what the patient is already taking but the pill might look different or have a slight different colour. This change, with a newly perceived outcome, may show a placebo effect (Benedetti et al., 2003, Geers et al., 2005).
The level of response observed from a placebo is reliant on several key factors; negative mood, expectation and conditioning (Bialosky et al., 2011). A person who is suffering from an injury may look into recovery methods and the placebo surrounding them. If they are willing, open minded and positive towards the treatment a faster recovery will likely be observed (Gaitan-Sierra et al., 2011, Geers et al., 2005) as opposed to someone with a negative mood or expectation about treatment where negative expectations will offer a slower recovery and poorer results (Benedetti et al., 2003).
Overall massage is shown to have very few physiological benefits for the body after sports performance however the psychological benefits are not to be over-looked. Being able to appear fresher and feel like you have recovered faster is good. Massage would appear to have no negative benefits, so why not use it all the time? This notion brings into play that if you do sustain an injury during sport but it feels better after a massage could the massage be in fact masking the injury? If you do muscle tissue damage and your immediate response is, I will get a massage and it will feel better, are you actually masking the problem and possibly risking a further and worse injury?
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Bialosky, J, E., Bishop, M, D., George, S, Z & Robinson, M, E., (2011). Placebo Response to Manual Therapy: Something out of Nothing? The Journal of Manual and Manipulative Therapy. 19(1): 11–19.
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Hemmings, B., Smith, M., Graydon, J & Dyson, R. (2000). Effects of Massage on Physiological Restoration, Perceived Recovery, and Repeated Sports Performance. British Journal of Sports Medicine. 34 (2), 109-114
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Martin, N, A., Zoeller, R, F., Robertson, R, J & Lephart, S, M. (1998). The Comparative Effects of Sports Massage, Active Recovery, and Rest in Promoting Blood Lactate Clearance after Supramaximal Leg Exercise. Journal of Athletic Training. 33 (1), 30-35.
Robertson, A., Watt, J, M & Galloway, S, D, R. Effects of Leg Massage on Recovery From High Intensity Cycling Exercise. Journal of Sports Medicine. 38 (2), 173-176.