BLOG: Massage Myth Busting, Part One

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by Marlene Mayman | Dec 17, 2017 | Myth, Research

This is the first in a series of massage myth blog posts. If you’ve received a massage, you may have heard one or more of the following massage myths. You may have even heard them from me in the past, since I’d been told the following myths, in some cases by teachers, and I believed several of them (though not all). Luckily, I’m capable of doing research, learning from it and admitting I was wrong.

Okay, let’s bust ’em myths!

Massage Myth #1: You should drink water after a massage to flush toxins the massage released out of your body.

Reality: First, massage does not release toxins in your body, so there’s nothing to treat by drinking water unless you’re thirsty. Second, the body is really good at detoxifying itself, so unless you’ve been exposed to a life-threatening toxic situation, let the body do its thing. How does the body detox itself? Through the liver and kidneys.

When a massage therapist makes this claim, it’s likely s/he doesn’t even know what said toxins are. Lactic acid? It’s not a toxin (more on that in Myth #2 below). Metabolic waste? Metabolism is a natural process of the body, not a threat.

According to ScienceBasedMedicine.org, “In the setting of real medicine, detoxification means treatments for dangerous levels of drugs, alcohol, or poisons, like heavy metals. Detoxification treatments are medical procedures that are not casually selected from a menu of alternative health treatments, or pulled off the shelf in the pharmacy. Real detoxification is provided in hospitals when there are life-threatening circumstances.”

Laura Allen, LMT has put together this engaging 3 minute video on the topic of massage, toxins and drinking water. It’s full of some good, humorous, old fashioned common sense, so have a gander:

Bonus: This massage myth goes hand-in-hand with the mistaken beliefs that you need to drink 8 glasses of water a day, that caffeine is a diuretic (dehydrates you), and that you can detox your body using the much hailed “master cleanse” detox beverage (water, lemon, sweetener and cayenne), by taking supplements or adhering to a “detox diet.” All false and unsupported by actual science and medical research.

Massage Myth #2: Massage removes lactic acid from your muscles.

Reality: Contrary to popular belief, lactic acid doesn’t cause muscle sorenessLactic acid is a fuel, not a waste product. Also, lactate clears with body within 30 to 60 minutes of exercising.

According to a 2009 study published in Medicine & Science in Sports & Exercise, massage actually interferes with lactic acid removal.

Busted!

If you’re getting massage after exercise as a way to decrease delayed onset muscle soreness (DOMS), yes, massage can help. It’s just not because of lactic acid removal, it’s because of other mechanisms, some of which we know, some we don’t.

Massage Myth #3: Massage softens muscles and breaks up knots by a mechanical action.

Reality: Not really, at least not the way you think. It’s not because of massage’s signature techniques of effleurage (long strokes), petrissage (kneading, lifting), tapotement (rhythmic percussive strokes), friction or vibration—or any other manual manipulation—that your tissues change, your muscles soften. Massage doesn’t break up so-called knots because we’ve cross-frictioned, pummeled, rubbed or elbowed them into submission.

Canadian Physiotherapist Diane Jacobs recently wrote about manual therapy, “You cannot change any tissue or structure (for the better) from the outside of someone else’s body (if you are a manual therapist): but you can do harm.” Harm means bruising, cuts, broken bones and painful techniques, things a thoughtful manual therapist stays away from.

“But wait,” you say! “I know massage can soften muscles and knots, it’s happened to me!”

What are knots anyway? Does anyone know? Muscles don’t detach from the bones, tie or braid themselves, and reattach … so it’s not that. I used to describe knots as the realigning of a muscle’s collagen fibers into criss-cross bunches, like scar tissue. But that would be a scar (I address scar tissue massage in a forthcoming myth). Some describe knots as bands of taught, hypersensitive tissue, a la Trigger Points, but it’s been shown that’s a problematic hypothesis. The truth is we’re not really sure what causes a so-called knot.

So what are good massage therapists doing to achieve results?

They are working with the nervous system! (Whether they know it or not.)

When you receive a quality massage, it’s likely the environment is warm and serene. You trust your massage therapist. The table is soft, possibly heated and you’re snuggled under covers. You close your eyes and you try to turn your attention away from the day’s stresses. You do your best to relax.

Along with all of that comes touch. Touch is the first sense we develop as a fetus and it’s critical for an infant to thrive. Touch is the most comforting experience most of us can have. Your massage therapist provides touch that is reassuring, warm and the pressure feels good. These are all signs of safety to the nervous system. There are, on average, 1000 nerve ending per square inch of skin, and your body is reveling in calming touch.

A primary job of the nervous system is to be aware of possible threat. When threat is suspected or perceived, breathing and heart rate quickens, tension is triggered, and blood moves away from the organs and into the limbs, readying the fight or flight response. A good example is when someone jumps out at you unexpectedly or a sudden loud noise occurs nearby. The body physically tenses and recoils and you’re instantly alert.

The opposite of fight or flight is rest and digest. When you feel safe, blood flows into the organs to nourish and repair the body, your heart rate and breathing calm and tension is released. Imagine being on a warm beach and hearing the lap of the surf, or lying in a sunny spot on the grass with birds chirping around, or camping among tall trees, crickets and frogs sounding away. As long as you’re warm, you’re golden, you can relax and drift away on a dream. These are all scenarios that, for most people, calm the nervous system.

A calm nervous system releases tension. Combined with soothing, unhurried and skillful touch, muscle tension and knots relax away. Sometimes it helps to be verbally reminded to let go of an unconscious holding pattern, such as letting a shoulder drop, or to bring your attention away from your thoughts and back into your body, or to take slower breaths. Pressure may need to be firmer to help you reconnect with a body part that you’ve been “turning off” or ignoring due to discomfort. Or sometimes that same body part just needs some skin stretching, or rocking, or gentle strokes. That’s what we’re here for, but it’s not the specific technique, it’s the sum of the whole experience that helps your muscles relax and your knots dissipate.

If your nervous system feels threatened during a massage, such as a cold room, ice cold hands, a therapist who reminds you of someone you don’t like, pressure that is annoyingly light or painfully deep and unrelenting … or if you can’t stop obsession about your deadline at work, NO amount of massage is going to relieve muscle tension or undo those knots. So it’s not technique that matters as much as how your nervous system feels.

Massage Myth #4: Massaging a pregnant woman’s wrists and/or ankles can induce labor.

Reality: This is unsupported by research. If massage inducing labor were true, massaging pressure points in the ankles and wrists would be widely used by medical practitioners in helping women induce labor (desired by many pregnant women nearing their due date).

Labor is largely hormone dependent and massaging an ankle or pressing on special pressure points (“with intention” one massage therapist claimed) won’t suddenly cause a spike in hormones. Why would we have abortion procedures if women could simply rub wrists and ankles the right way to start contractions? There is little, apparently, that can induce labor naturally. Even the acupuncture that WebMD mentions showed promise was disproven by this study.

So sorry, ladies—especially my pregnant readers—massaging your wrists and ankles isn’t going to bring your baby to term any sooner.

That said, getting a nurturing and skillful massage will probably make you feel a whole lot better during your pregnancy!

Massage Myth #5: Massage breaks up connective tissue adhesions and stretches fascia (“fah-shah”), using techniques like Myofascial Release (MFR), Rolfing, etc.

Reality: Ooof, I’ve told these to many, many clients in years past. I blame well-intentioned but poorly informed teachers.

Backing up a moment, let’s start with a description of what a fascial (“fah-shul”) adhesion is: the bonding of two normally distinct anatomical structures—such as two organs, or a muscle and adjacent bone—due to surgery, infection, trauma, or radiation. Adhesions are a type of scar tissue made up of the collagen tissue found in fascia.

You ask, “Surely massage will stretch fascia, why else would there be a thing called ‘Fascial Stretch Therapy’? And everybody knows you can break up connective tissue adhesions, why else would you foam roll?”

Fascia, muscle, tendon, bone diagram.

Nope. Sorry. Here’s a little easy-to-understand anatomy: Every muscle fiber is wrapped in fascia, bundles of muscle fibers are also wrapped in fascia, and all the bundles that make up entire muscle bellies are wrapped in fascia. That fascia then extends to create tendons to attach muscle to bone.

An action of healthy fascia is to allow these structures to slide against neighboring structures, such as other muscles, organs and bone. So while it may seem that fascia can stretch under the hands of a manual therapist, what’s actually stretching is skin, or maybe muscle is shifting its position over neighboring muscle or bone, or muscle is sliding within fascial sheaths, if the therapist is moving a joint while pressing on or sliding over a muscle.

Think about it for a minute. If sustained pressure over several seconds or minutes permanently altered our fascia, we’d all have really aggressively sagging bottoms from sitting for hours, day in and day out. Butt as you can see, that doesn’t happen! (Hee hee.) Thanks goodness, because we also sleep for long periods, and yet we awake (hopefully) refreshed and less saggy, without needing to gather our soft tissues up in a bundle from pressure of body against bed.

Many manual therapists of all ilk—including physical therapists, osteopaths and massage therapists—have a mistaken belief that fascial adhesions can be “relieved” simply by pushing, pulling, shearing, stretching, scraping or kneading them. However, fascia is really tough stuff; pound for pound it’s stronger than steel cable (two or more steel wires twisted together). Could you lay a single wire hanger down on a table and push longitudinally on the wire with your hands, as if to stretch it, and succeed in changing its length? No.

The face you'd make if someone really was stretching your fascia.

When it comes to fascial adhesions, it turns out the only thing that can actually “break adhesions up” is — ta da — a surgeon with a knife! When you’ve eaten steak, you’ve probably chewed on some gristle and found it unpalatable and unbreakable, eventually (and hopefully discreetly) removing it into your napkin … or if you’re uncouth, back onto your plate, you barbarian. That, folks, is the same connective tissue that is found in your fascia. There’s a reason steaks come in cross-cut sections, not in long tubes, and that steak knives are sharp!

When massage therapists are sliding our hands over skin, or stretching skin, we are not engaging fascia. There is a slippery barrier between the skin and underlying fascia, muscle and bone. Cute physiotherapist and chiropractor Greg Lehman explains this phenomenon quite clearly in his video “Frictionless interface in manual therapy” using his equally cute kids to demonstrate:

For more info, smart and no-nonsense massage therapist Alice Sanvito at Massage St. Louis does a great job of answering the question, “If We Cannot Stretch Fascia, What Are We Doing?” Further, fascia is currently all the rage as the scapegoat of many kinds of pain (e.g. Trigger Points, whose hypothetical causes have been debunked), the selling of fantastical painful treatments (Dry Needling and Gua sha … do we really need to resolve pain with more pain? I think not!) and tools (FasciaBlaster, EEK!). Thankfully Paul Ingraham over at PainScience.com opines on the question, “Does Fascia Matter?

To Be Continued…

Keep an eye out for part two!

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