During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that require research and writing. Some of these assignments result in very insightful and well thought out information and decision-making outcomes. I am happy to share some of their assignments for you to enjoy.
Society has assumed for many decades that the application of massage holds a valuable mechanical influence on the human body's circulatory system with the truism that effleurage will directly push the blood through the arteries/veins and petrissage will force metabolites, toxins, and blood out of the muscles. With this straight-forward thinking of mechanical influence, particularly in the sports scene, it was very popular to hear that lactic acid was a waste product from exercise that caused muscle fatigue and/or delayed onset muscle soreness (DOMS). One of the most misconceived benefits of massage is that it helps to flush lactic acid from the muscle cells.
A few methods of research have convinced me that this removal of metabolites cannot be so mechanical. There's a quantitative approach taken by the School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada, where "Twelve subjects performed 2 minutes of strenuous isometric handgrip (IHG) exercise at 40% maximum voluntary contraction to elevate forearm muscle lactic acid. Forearm blood flow (FBF; Doppler and Echo ultrasound of the brachial artery) and deep venous forearm blood lactate and H+ concentration ([La-], [H+]) were measured every minute for 10 minutes post-IHG under three conditions; passive (passive rest), active (rhythmic exercise at 10% maximum voluntary contraction), and a massage (effleurage and petrissage). Arterialized [La-] and [H+] from a superficial heated hand vein was measured at baseline" (Wiltshire). Through this method, it was found that massage actually impaired lactic acid removal by mechanically inhibiting the circulation of blood through the arm.
Another approach would be through qualitative research. In order to understand a complex topic, it is essential to have a qualitative breakdown of the topic that dissects the key elements of the research at hand. To understand the effects of massage on flushing lactic acid from the muscle cells, we need to observe what exactly lactic acid and lactate are, as well as the effects of massage on the muscle cells and circulation of blood. Shirley Vanderbilt, a staff writer for Massage & Bodywork Magazine, translates this question into concise explanations using references with backgrounds in Physiology, Kinesiology, Physics, and many other relevant credentials.
Vanderbilt compiles several sources to express that the body breaks down glucose into pyruvate. The muscles perform best during the initial "aerobic glycolysis" while O2 is present in the muscles. When the muscles become O2 depleted, they enter a phase of "anaerobic glycolysis" where the glucose turns to pyruvate
. The pyruvate then turns to lactic acid and rapidly dissociates from its hydrogen ion to form lactate. If exertion continues while O2 is still depleted, then lactate will continue to accumulate, thus creating an acidic blood pH. This acidic environment will cause the muscle to slow down (fatigue) in order to regain O2 and to then break down glucose aerobically again. Lactate cannot be utilized by the muscle cells so it will travel through the blood on its' own and be utilized by the liver for glycogen storage. Within 30-60 minutes of ceasing exertion, lactate levels will return to normal along with blood pH levels. Research supports that the best way to flush lactic acid from the muscle cells is through active recovery such as light jogging, and that massage is no more effective than passive rest. This is not to say that massage doesn't affect the circulatory system through stimulation of the nervous system. With this information, I found that the belief, "massage flushes lactic acid from the muscle cells" to be unsupported and false. Lactic acid is an element of our metabolism that doesn' not get "worked" out but will naturally make its way out with time. I
With this information, I found that the belief "massage flushes lactic acid from the muscle cells" to be unsupported and false. Lactic acid is an element of our metabolism that doesn't get "worked" out but will naturally make its way out with time. It is especially silly to think that lactic acid even needs to leave the muscle in order for our muscular pain to cease because lactate/lactic acid has nothing to do with our DOMS! The DOMS is a side effect of micro tears in our muscle fibers. Even if lactic acid were the cause of pain produced by over-exertion, then it doesn't explain the disproportion of blood lactate to the amount of pain felt 1-2 days later as the lactate levels have retreated by then.
In my opinion, particularly with a topic of this complexity, I find that research containing a mixture of more qualitative and scientific explanatory depth, along with a smaller portion of quantitative research, is most valid. This is most true for the massage profession, because we cannot simply take someone's word on their experience with a client, or the simplistic idea that the body should react in such a way through basic means of mechanical influence. We require a deeper look in a biological and physiological perspective to understand the Krebs cycle, where lactic acid/lactate is produced, and how massage cannot simply force a metabolite out of tissue through pressure.
The criterion in which I find information to be valid is when the research is supported by scientifically accepted principles. The chemical and biological function of lactic acid through the metabolic process of glycolysis is widely understood amongst doctors; along with the physiological effect on the circulation of blood flow from the application of massage.
From this research, I have found a new spark of interest in "myth busting" massage related controversies. Massage is struggling to be seen as part of the medical field. It is because of these false truisms that the incorporation of massage into hospitals and other medical environments has been set back. I'd like to aid the progress of this incorporation by properly educating my clients with valid research and evidence.
As professionals in the massage field, it is absolutely important for us to take research in our live of work seriously. Our techniques, and knowledge that we apply to our clients, is much like the medicine prescribed by a doctor. If we aren't truly informed in our line of work, then we can easily endanger a human life, or at best, unnecessarily misinform a whole population with an idea that teaches "creative physiology."
References:
Vanderbilt, Shirley. "Peak Bodywork's Wellness Journal" Massage & Bodywork Magazine, Oct/Nov 2001, http://www.peakbodywork.com/journal/spring07.pdf
Wiltshire, E. Victoria, et al. "Massage Impairs Post Exercise Muscle Blood Flow and 'Lactic Acid' removal." Medicine & Science in Sports & Exercise, 2009, p 1. doi:10.1249/mss.0b013e3181c9214f