New study shows Massage Reduces Inflammation
Randomized trials have shown that massage can ease low back and neck pain, but the actual cellular and molecular processes involved have remained unclear. Now, a recent study in Ontario Canada, has found that massage reduces levels of inflammatory cytokines known to activate peripheral nociceptors and produce hyperalgesia- in other words, it directly influences substances that can cause nociception and therefore contribute to pain.
The authors suggest that massage may reduce pain in a manner similar to that of non-steroidal anti-inflammatory drugs, and blogs across the internet have jumped onto the apparent positive message of this finding. Indeed- if massage did produce similar effects to NSAIDs, then it would have anti-inflammatory actions without the negative gastrointestinal side effects that NSAIDs have Massage could have a biochemically legitimate role in pain treatment.
Indeed, some have been getting very excited, seeing this as a fully drawn conclusion as to why we should all have massage. I even saw one (very popular American Personal Trainer) using this research as evidence that we should all be using foam rollers to self-massage after exercise. I’ll come back to the conclusions that can be drawn later.
Tarnopolsky and coworkers subjected 11 young males to a bout of intense aerobic exercise on an upright bicycle. After exercise, subjects received a 10-minute massage on one outer thigh and no treatment on the other, enabling each subject to serve as his own control. Muscle biopsies were taken at baseline, immediately after the massage, and after a 2.5-hour recovery period.
Results from cDNA microarray analyses revealed variations in messenger RNA levels indicating increased production of mitochondria and decreased inflammation. Next, the investigators looked at proteins known to play roles in these processes. Indeed, they found increased nuclear levels of peroxisome proliferator-activated receptor gamma coactivator 1-α (PGC-1α), a protein that helps to make new mitochondria, in massaged legs 2.5 hours after treatment, compared to untreated legs.
In addition to their mitochondrial findings, they also found reduction in inflammatory mediators. There was an observed decreased levels of nuclear factor kB (NFkB), a regulatory protein that mediates inflammation, immediately after massage, as well as decreased activity of HSP27, a heat shock protein that sits downstream of NFkB, at the 2.5-hour mark.
Tarnopolsky and coworkers also showed a reduction in the inflammatory cytokine interleukin-6 (IL-6) at 2.5 hours, as well as a decrease in the ratio of mature tumor necrosis factor-α, (another inflammatory cytokine), to the precursor form immediately after massage. These reductions in inflammatory markers suggested that some of the therapeutic effects of massage could be linked to direct reductions in molecules that mediate inflammation and pain.
The time frame of the data collected could be a major limitation- they looked solely at effects observed at 10 minutes and 2.5 hours post-massage. The authors themselves caution in their discussion that “inflammation is usually maximal 24 to 48 hours following high-intensity exercise, [therefore] the next step would be to determine whether the actual inflammatory response 24 to 48 hours following unaccustomed or very high-intensity exercise is attenuated [by massage], and whether this leads to a more rapid recovery,”
Also and potentially of greatest significane to findings here- inflammation may actually allow muscles to heal after they are damaged, so any strategy based on reducing inflammation could actually interfere with the natural healing process.
The findings of this study have lead to comparisons being drawn between the actions of massage and NSAIDs. Asides from the commonly accepted gastrointestinal side-effects of these medications, they are also known to have potential negative consequences for tissue healing. See here for some papers discussing NSAID’s and healing. Here is a link to some studies on the effects of NSAIDs on tissue healing.
NSAIDs work (primarily) on Prosteglandins, and are primarily directed against the protein PGE2 (prosteglandin-E2). More specifically NSAIDs inhibit substances known as “Cox” (Cox 1 and Cox 2), which are one of the metabolites of Arachidonic Acid (AA). AA is released when cells break down, and aims to contribute to local tissue repair where the damage occurred.
PGE2 is one of the most active algogens (a substance that causes nociception or ‘pain’), and plays an important role in the so-called “inflammatory soup”. This inflammation mediates peripheral sensitization in connection with tissue damage.
So far it would seem logical to knock-out PGE2- the problem is that in addition to being algogenic, PGE2 plays an important role in stimulating healing after any tissue injury. Therefore, many recent recommenations say that we should not give oral NSAIDs for acute injuries, for example ligament injuries, as it may inhibit or impair the healing process in the long term.
Lots of unanswered questions
The study is one of the first to demonstrate that massage causes measurable physiological changes with could have direct effects on levels of discomfort following exercise. However, there remain lots of unanswered questions. The finding that massage can affect inflammation has many positives and means that massage now has legitimate biochemical basis as a pain treatment. However, we know from studies of NSAIDs that reducing inflammation in the early stages of an injury can negatively affect the quality of long-term healing. A question here is to what extent is tissue healing a priority or concern after standard exercise bouts when compared to acute injury situations?
Further research is needed to determine optimal dosing and timeframes for massage to maximize symptomatic relief while promoting (or at least not impeding) tissue healing processes.
People who use massage regularly feel many benefits and regular sports massage is used by the vast majority of elite sports people. But, we do have a long way to go to fully elucidate the mechanisms behind the benefits these individuals perceive- and it’s likely that changes in peripheral biochemistry form only part of the picture.
As for foam rollers- We do not yet have a study to show if these produce the same biochemical changes. Indeed a great deal of the effects from massage (and other manual therapies) may be to do with human touch and interaction. This will be a fascinating area for future research.
Cornwall Physio provide Sports Massage treatments on Thursdays and Saturdays at Carlyon bay, St Austell. Members of locals sports teams may be eligible for 10% off all treatments. To book an appointment or find out more email or call us: firstname.lastname@example.org; 07824 700 934