Sports massage. It’s not hot sauce.

The term sports massage reminds me of the terms functional, or pain science.  
Terms like this conjure up a powerful idea of what we think they mean. Is it more feeling than content though? Does it really mean what we think? 

Sometimes, an attractive hypothesis is based on conjecture and mixed with pseudoscience to justify our own narratives about what we *think* is happening on our treatment tables. 

The next thing you know, someone is going to create a course called “Functional Pain Science”. 

In my experience, when a patient comes in looking for a “sports massage”, it’s code for one of two things: either they really like strong pressure, or they have a nagging issue that they think is a direct result of their regular fitness routine. The goals of sports massage, as we were taught in massage college, are to decrease recovery time, decrease DOMS severity and duration, increase the amount of time an athlete can train, and decrease pain and fatigue, which all sounds great, but is it really doing what we think it’s doing?

Massage is both expensive and time-consuming. If we’re going to be blowing this trumpet, it ought to be something worth talking about. 

Let’s dive in a bit!

In this systematic review and metanalysis of the topic, it’s unclear at best if we can offer any special benefit. Ouch. 

How would you feel about it if that was being said about a headache medicine? Would you take it? I wouldn’t. What if you were talking to a salesperson about buying a new car, and when you asked about the safety features, they said, well, it’s unclear if these airbags offer any benefit. Um…no thanks…I’ll just look elsewhere.

A previous meta-analysis, here, of 22 RCTs (Randomized Controlled Trials) found a small and inconsistent benefit of massage on performance and recovery. At best, “it remains questionable if the limited effects justify the widespread use of massage as a recovery intervention in competitive athletes.”

Well, that’s not confidence-inspiring. *awkward face*.

It’s safe to assume that if a patient comes to us for sports massage they are a sporty or athletic person. We can also assume that they are looking for a massage therapist who understands a bit more about exercise and sport-related injury. The patient can find comfort, and a better therapeutic bond with the therapist because they might speak the same lingo. It nourishes that need for a sense of community. 

A therapist who is invested in the patient’s community is much more likely to have a good idea of what the patient is going through. Doesn’t everyone just want to be seen, heard, and understood? It’s bound to have a positive effect on the therapeutic relationship.

Looking into some research on sports massage is pretty uninspiring, and doesn’t support *any* of the things I was taught in school. 

Most of what I found said that massage negatively affects, or has zero effect, on strength or performance. (1-9) It appears that massage applied for post-exercise soreness, or speeding up recovery, is only effective when compared to nothing at all. Ouch. If that’s the case, then our only solid justification for applying it is hey…people like it. That works for me though. 

You like massage & I like giving them.
Everyone wins. 

What about massage therapy for DOMS? Surely there’s something there!

So far, I’m not seeing any difference in DOMS between people who received intermittent, post-exercise, or regular massage compared to those that did not. Here, Zainuddin et al similarly found massage did not alleviate DOMS or muscle swelling. These studies said massage had no effect on the rate of return to baseline levels of DOMS and swelling. (14-16)

Well, crap.

Typically, after exercise, both groups (massage and no-massage) decrease in performance significantly. That’s expected, they’re fatigued. The group that receives massage is just slightly less fatigued. 

Instead of saying that those who received massage “performed significantly better” (10), it would be more correct (or less wrong) to say that they performed a little less-worse than the control, who received nothing at all.  

If this is confusing to you, this is how I would say it plainly. It’s like asking if ketchup is spicy. Um…I guess…when compared to water, or nothing at all, but is it hot sauce? No. 

Sports massage is not hot-sauce.

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REFERENCES:

1. Arroyo-Morales M, Fernández-Lao C, Ariza-García A, et al. Psychophysiological effects of preperformance massage before isokinetic exercise. J Strength Cond Res 2011;25:481–8.
2. Kumar S, Narayan Y, Zedka M. An electromyographic study of unresisted trunk rotation with normal velocity among healthy subjects. Spine 1996;21:1500–12. 
3. 10 Jönhagen S, Ackermann P, Eriksson T, et al. Sports massage after eccentric exercise. Am J Sports Med 2004;32:1499–503. 
4. Hemmings B, Smith M, Graydon J, et al. Effects of massage on physiological restoration, perceived recovery, and repeated sports performance. Br J Sports Med 2000;34:109–14. 
5. Hunter AM, Watt JM, Watt V, et al. Effect of lower limb massage on electromyography and force production of the knee extensors. Br J Sports Med 2006;40:114–8.
6. Hilbert JE, Sforzo GA, Swensen T. The effects of massage on delayed onset muscle soreness. Br J Sports Med 2003;37:72–5. 
7. Jönhagen S, Ackermann P, Eriksson T, et al. Sports massage after eccentric exercise. Am J Sports Med 2004;32:1499–503. 
8. Delextrat A, Calleja-González J, Hippocrate A, et al. Effects of sports massage and intermittent cold-water immersion on recovery from matches by basketball players. J Sports Sci 2013;31:1–9. 
9. Mancinelli CA, Davis DS, Aboulhosn L, et al. The effects of massage on delayed onset muscle soreness and physical performance in female collegiate athletes. Phys Ther Sport 2006;7:5–13. 
10. Sykaras E, Mylonas A, Malliaropoulos N, et al. Manual massage effect in knee extensors peak torque during short-term intense continuous concentric–eccentric isokinetic exercise in female elite athletes. Isokinet Exerc Sci 2003;11:153–7.
11. Brooks CP, Woodruff LD, Wright LL, et al. The immediate effects of manual massage on power-grip performance after maximal exercise in healthy adults. J Altern Complement Med 2005;11:1093–101. 
12. Farr T, Nottle C, Nosaka K, et al. The effects of therapeutic massage on delayed onset muscle soreness and muscle function following downhill walking. J Sci Med Sport 2002;5:297–306 
13. https://bmjopensem.bmj.com/content/6/1/e000614.abstract
14. Dawson KA, Dawson L, Thomas A, et al. Effectiveness of regular proactive massage therapy for novice recreational runners. Phys Ther Sport 2011;12:182–7. 
15.  Zainuddin Z, Newton M, Sacco P, et al. Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function. J Athl Train 2005;40:174. 
16.  Hilbert JE, Sforzo GA, Swensen T. The effects of massage on delayed onset muscle soreness. Br J Sports Med 2003;37:72–5.