Science says massage may not be worth the expense

Massage may be one of the recovery techniques of choice for pro cyclists, but science doesn't entirely confirm its efficacy.

Editor’s note: This article was originally published in the October issue of Velo magazine.

As a team manager, I could be a jerk. For example, my mechanic and I loved tricking gullible riders who obsessed over their cycling image with a game we called “do what the Euros do.” We’d tell them that European riders never opened windows at night, or ate raw pasta, or slept with plants in the room because they stole oxygen — just to see how stupid a thing we could get them to do. (Turns out, a lot.)

So much of what we do to become better cyclists has more to do with what we’ve seen other people do than with scientific evidence. Take the practice of massage: Every major team has a therapist on staff working daily on riders at the races. Pros on both sides of the Atlantic are willing to pay out of pocket for weekly treatments, and few question the benefits.

“It’s going to help you recover a little bit better,” says Eric Young (Optum-Kelly Benefit Strategies), a two time U.S. national champion. “It’s going to flush stuff out, move blood around. Those are good things for your muscles.”

But is there a real, measurable performance benefit here, or is this another case of habit and assumption?

“All we have now is clinicians giving us their own personal impressions as opposed to any systematic study,” says Dr. Peter Tiidus, dean of applied health sciences at Canada’s Brock University.

Tiidus’ work on muscle damage and repair has included research into massage. In one controlled 12-week study, his team tested the effects of weekly massage on female recreational runners training for a 10-kilometer race, measuring claimed benefits like improved performance and perceived pain.

“Much to our surprise and disappointment, we saw absolutely no difference,” Tiidus says. “They reported the same amount of soreness, the same amount of pain, the same amount of beneficial effects of training adaptations.”

Among the presumed benefits of massage is that it increases blood flow, which would ostensibly mean more oxygen and faster removal of waste. Other believed benefits are improved muscle recovery and flushing of lactic acid to reduce soreness. Unfortunately, in assessments of the current research, including a highly cited review by a team from New Zealand, the science simply isn’t there. Multiple studies using a variety of techniques to measure blood flow have found no difference. In fact, one study found that massage impedes blood flow by as much as 25 percent.

While Tiidus says some studies have measured small reductions in self-reported soreness, most human studies have found no improvement in muscle recovery.

Scientists have long since dismissed lactic acid as a villain. “We’ve known for a long time that lactic acid has absolutely nothing to do with muscle soreness,” says Tiidus. “Muscle soreness is an inflammatory response.” That inflammation is caused by the immune system responding to muscle damage and not by lactate.

Of course, absence of evidence isn’t evidence of absence. Perhaps researchers spent so much time chasing blood flow and lactic acid they’ve only now started to scratch the surface of the inflammation angle and massage’s role in it. “Maybe there are things that we’re not measuring that we should be measuring better,” Tiidus says.

Inflammatory claims

A small but growing body of research suggests that researchers have been following the wrong leads. Tiidus points to two recent massage studies — one on rabbits and one on humans — indicating that massage’s potential benefits may have something to do with inflammation.

When we train hard, we damage our muscles, and the immune system responds. White blood cells such as neutrophils and macrophages travel to the damaged tissue, where they release inflammatory chemicals, break down the damaged parts, and signal muscle repair. While this results in soreness, you want this inflammation, because without it the muscles can’t rebuild.

But there can definitely be too much of a good thing.

“If you get too many neutrophils coming in, you cause secondary damage,” Tiidus explains. “They start to injure some of the healthy tissue as well.” On the flip side, blocking inflammation inhibits the repair process. So the trick is finding a happy medium.

In the rabbit study, massage reduced neutrophil and macrophage flow to the injured muscles by 53 and 70 percent, respectively. The massaged muscles were back to peak force after four days, a 119 percent improvement over the non-massaged controls.

The human study found that massage immediately after exercise shifts the balance in two key chemicals released by immune cells: NF-κB and PGC-1α. The former slows muscle repair, while the latter controls inflammation and promotes the growth of mitochondria, which are our muscle’s aerobic power plants.

Massage reduced NF-κB and increased PGC-1α, promoting repair and preventing too much inflammation. The study was limited, however, in that it looked only at a period of 2.5 hours after training.

So clearly much more research needs to be done. Unfortunately, there isn’t a lot of money for massage research. And unless a big drug company can patent some form of deep-tissue manipulation, things will probably stay that way.

Based on our current knowledge, Tiidus says he wouldn’t discourage massage. But if you’re getting on fine without it, “I wouldn’t necessarily recommend spending your $60 per hour,” he says.

Eric Young is equally pragmatic. “There are a thousand things that impact your performance and are important for recovery and racing,” he says. “I think [massage] is just one more piece of the puzzle.”

Sadly, until science catches up, you’re going to have to decide for yourself. But feel free to hang onto your houseplants.