There is a common belief that massage therapy can help relieve sore muscles and aid exercise recovery by removing lactic acid from the muscles after exercise. However, this belief is not supported among scientific research since the 1990s, nor is it accordant to the basics of human physiology. One of the earliest studies on this was published in the International Journal of Sports Medicine in 1996, and it compared the effects of massage with active recovery after a bout of heavy exercise. Researchers from the Netaji Subhas National Institute of Sports in India found that short-term massage therapy is “ineffective in enhancing the lactate removal” and active recovery is a much better modality for lactate removal after exercise. A small 2013 study from the University of Milan in Italy also showed that massage therapy (and stretching) had no significant influence on blood lactate removal.
First, the terms “lactic acid” and “blood lactate” are often used interchangeably, but they are not the same products nor are they wastes. According to Sports Fitness Advisor, lactic acid was once thought of as a waste product during glycolysis, which is a cellular metabolic process that produces short-term energy. Glycolysis produces lactic acid, which quickly releases hydrogen ions (H+). The remaining compound latches on to electrolytes, such as sodium and potassium, to form lactate. This is the substance that scientists use to measure athletes’ recovery and metabolic processes in a laboratory.
“The idea behind the myth that massage removes toxins from tissues comes from visualizing the physiology in a mistaken way,” said licensed massage therapist Ravensara Travillian, Ph.D., in an online interview with Guardian Liberty Voice, who also volunteers with Massage Therapy Foundation. “The visualization goes something like this: Exercise and other regular metabolic activities of normal life produce toxins that need to be removed from tissues. Since massage increases circulation, this increase flushes the toxins out of the tissues, leaving them detoxified. The problem is that each of these steps in the concept—although they sound like they could be reasonable—are not what happens in reality.”
A British study published in Medicine and Science in Sports and Exercise in 2004 found no significant increase of circulation in the femoral artery within the quadriceps muscle or the rate of blood lactate removal after massage therapy was performed after exercise. Researchers from Manchester Metropolitan University found that increases in skin blood flow “provide no nutritive benefit to the muscle in post-exercise conditions.” Since massage therapy is suggested to increase skin blood flow, it is possible that massage could “reroute” blood from the skeletal muscle and may hinder recovery process.
“Vertebrates—animals with backbones, like us—have closed circulatory systems, so if circulation increases in one part of the system, it has to decrease somewhere else to compensate for that constant overall amount,” Travillian explains. “So if it were true that massage increased circulation, we would also have to say that massage decreases circulation elsewhere in the system.”
“Massage can cause minute local changes,” Travillian continued. “You can see the skin redden (rubor) as blood rushes to fill areas made temporarily ischemic by rubbing. But overall, it does nothing to either increase blood amount (more blood cells and plasma) or more blood flow (faster rate per unit time). If you look at all we can touch—just skin and nerve endings—and how superficial and narrow capillaries are, versus how deep and wide the femoral artery really is—this is actually quite plausible. It makes sense, and it matches the material, physical, natural reality.”
In fact, another study that was published in the same journal in 2010 found that massage therapy could mechanically reduce blow flow which impedes blood lactate removal. If massage does not work in exercise recovery, then one must question if any technique works better.
A fairly recent study from Shiraz University in Iran showed evidence to support the 1996 Indian study that exercise is better than massage therapy to remove “lactic acid” from muscles. However, the experiment, which involved 17 professional male swimmers, compared three groups where one performed active recovery, one received massage and one performed passive recovery as a control group. What the researchers found was that active recovery was more effective in blood lactate removal than massage, and massage therapy was more effective than passive recovery. They found that there were no differences in performance between the active recovery group and the massage group.
“Lactic acid is not a toxin; it’s a normal metabolite, and the body gets rid of it normally, with or without massage,” said Travillian. “While it is true that too much concentration of metabolites can be toxic, that’s true of almost any substance, including water. And water’s not considered a toxin. In biology, the word ‘toxin’ means a foreign, naturally-produced substance, such as bee or snake venom, or Botulinum toxin, a by-product of microbes. If we appropriate a well-known scientific word and use it to mean something totally different that does not match reality, such as ‘metabolite,’ we’re sending a message to other healthcare professionals, who are our potential partners, and to clients that we’re not interested in participating in the shared body of knowledge that the rest of the healthcare team has in common.”
“In fact, if massage did increase blood flow, we would expect to see higher blood pressure after massage,” Travillian continued, “as the body compensates to push that higher flow through the same amount of vessels in the same time. But that’s not what we see; in fact, when we consult the final authority—the human body itself —we see the opposite: lower blood pressure after massage. Additionally, the model assumes ‘flushing’ in only the ‘right’ direction. But actually, when we press on the skin, the effects or the pressure radiate out in all directions—as much as we’re ‘pushing fluid’ forward, we’re also pushing it backwards and sideways, which makes the net (overall) effect much less than if it were only in one direction.”
While massage therapy does not significantly increase circulation or remove “lactic acid” from muscles after exercise, there are other benefits to massage after a workout, such as lowering stress and anxiety. Travillian posed her final thoughts. “I believe that massage is good after exercise for the same reasons it’s good at other times. We are social animals who derive a great deal of benefit on many levels—biological, psychological, and social—from the focused caring attention of another human being.”
By Nick Ng
International Journal of Sports Medicine
Medicine and Science in Sports and Exercise 1
The Journal of Sports Medicine and Physical Fitness
The Journal of Sports Sciences
Sport Fitness Advisor
Interview with Ravensara Travillian, PhD, LMT
International Journal of Massage Therapy and Bodywork