Dear massage customers everywhere, I get this question a lot! Whether you are contemplating your very first massage or have been enjoying regular massage and endorsing its benefits for years, you want to know how it works! After all, you spend a significant amount of time, money, and make a big emotional investment to trust us when we tell you that massage will make you feel better.
Unfortunately, I don’t have a simple answer. For starters, there is still a lot we don’t know. While a lot of good research shows that massage is an effective treatment for low back pain, knee osteoarthritis, and muscle recovery to name just a few conditions, the research on the process of how it does it is scarce. The Touch Research Institute and the Massage Therapy Foundation are good resources and have been at the forefront of research in the field. While there is a growing interest to explain why more than 25% of Americans are getting massages*, the healthcare community still has more questions than answers. Our bodies are complex systems and our needs are very individual. Massage therapy is commonly used in hospitals, sports facilities, addiction centers, and delivery rooms. How does one therapist make all these people feel better? While our work is very adaptive to the individual needs of a patient, it is almost impossible to describe the process in words. While I use the science of anatomy and movement every day, I didn’t learn how to do a massage from a textbook. I learned by tuning into my teachers and practicing for many hours under their observation. But, I still didn’t answer your question! The following is a brief summary of the knowledge passed on to me in school, what I read in scientific journals but most of all, it is a story of what I experienced in my hands.
Conventionally, the increase in circulation is the most commonly cited benefit of massage. If you pick up a brochure at a spa, there is a high chance the word circulation will be used to promote its services. The increase in circulation is easily shown and explained. Mechanically rubbing the soft tissues (muscle, skin and all the connective tissue) will produce visible localized erythema (redness). The popularity of Swedish massage, which uses many gliding fluid and rhythmic strokes (wonderful for circulation), is another factor why the cardiovascular system is often the first one to be mentioned. Healthy blood and lymph circulation is of course vital; it brings oxygen and nourishment to the cells and removes toxins from the system. However, not all clients equally benefit from an increase in circulation. A patient who is immobilized due to a serious injury or accident can be helped a great amount by a therapist who will manually push and flush the tissue to reduce the onset of muscle atrophy. Likewise, the painful scar tissue that forms at the site of a surgery or past injury can be helped by a technique called cross-fiber friction. Applying deep friction to the area will mechanically realign or “free-up” the scar tissue and supply new blood to the area that is needed for healing. A person with a lymph system dysfunction or weakness will benefit from manual lymph drainage performed by a specialist to manually stimulate the flow of lymph to remove metabolic waste. On the contrary, an athlete with severe muscle soreness or a person with a headache will usually not benefit from increased circulation to the area of their complaint. Not all massage modalities and techniques have a significant effect on circulation. Many of the new (and very successful) modalities that massage therapists employ such as myofascial release, active release, neuromuscular therapy to name a few do not emphasize circulation and don’t affect circulation any more than a handshake.
Massage returns short muscles to normal length. Short muscles usually give us a sense of discomfort and tension; they also have a negative impact on our posture and movement. Some of the techniques that are used include myofascial, stripping technique, compression, active release, neuromuscular, trigger point techniques, and manual traction. Muscle (and connective tissue) lengthening can also be accomplished through passive or active stretching. Stretching can be great, but it has limitations. Static stretching has the risk of overstretching, especially if done without a proper assessment. Active dynamic stretching does not always stretch the entire muscle. Overuse and tension can over time create adhesions (scar tissue) and trigger points (tender painful nodules). Our bodies will stretch through the path of least resistance (compensate) to avoid pain. Effectively, existing scar tissue and trigger points will “block” a stretch, leaving a portion of the target muscle or specific fibers unchanged. Massage is like stretching with a scalpel. It is precise and the therapist’s assessment will ensure that you don’t overstretch. Relaxing contracted stiff tissue can also help to release the pressure around many organs and nerve pathways, thus giving relief to conditions such as sciatica, Crohn’s disease, and carpal tunnel. One of the scientific premises of manual therapy is based on the mechanisms called the Muscle Spindle and Golgi Tendon Organ. Manual manipulation of the muscle fibers induces muscle relaxation by neural feedback and built-in reflex. Science aside, some of you may enjoy and relate to this explanation from one of my textbooks to explain how tender points and taut bands of muscle tissue are treated with pressure:
“The term release is commonly used by massage therapists to refer to the softening and lengthening of soft tissue in response to therapy. Although the therapist’s sense of release in soft tissue is a subjectively experienced phenomenon that is difficult to describe, it is difficult to miss when you do feel it, and it is a very gratifying feeling for the therapist and client alike.”
Massage stimulates underactive (often weak) tissues. Movement, activity, strength happen because of the neuromuscular chain between our central nervous system and our muscles. Touch activates and stimulates our nerve pathways, which is why massage is often used in helping stroke patients to regain function. The neuromuscular pathways can also be affected by poor posture, past injuries and repetitive movement, leaving some of our muscles weak and inactive. The focus here is removing scar tissue, trigger points (the pain that blocks normal movement and function), and often bringing about circulation. This may sound a lot like the process used on short muscles, except we are very careful not to lengthen the muscles that are already overstretched. Techniques used range from deep tissue for stubborn adhesions (scar tissue) to light touch that can get the nervous system to fire. The big picture is muscle “balance” or normalizing muscle tone and length around a joint so that the body can move and function in an efficient manner with less pain. It is believed that our body is strongest and most resilient against injury when it moves efficiently. How does a massage therapist know what’s short, overactive, lengthened, weak, not firing? Through observation of your posture, your pain patterns, your lifestyle and activity, and of course through palpation. An experienced and trained massage therapist can quickly spot changes in soft tissue and identify mechanical restrictions and kinetic chain dysfunction patterns.
Massage is often used in sports recovery. In simple terms, we get stronger and faster because we undergo increased physical demands followed by a period of rest (recovery). The full cycle of physical stress and recovery is needed to improve performance. Increased or high-intensity training produces micro-tearing of the muscles and an inflammatory response. When all goes well and we recover from our strenuous workouts, our body replaces old cells with new stronger ones. On the other hand, when we under-recover our bodies break down, we feel fatigued and are more susceptible to injuries. A breakthrough study examining the effects of massage on sports recovery was published in 2012. The New York Times summarized the researchers’ findings: “massage reduced the production of compounds called cytokines, which play a critical role in inflammation. Massage also stimulated mitochondria, the tiny powerhouses inside cells that convert glucose into the energy essential for cell function and repair.” Thus massage promotes recovery on both fronts. Getting a massage speeds up the anabolic process (cell growth) by stimulating cells to replace damaged muscle tissue with healthy, new muscle. It also controls the catabolic process (cell breakdown) by reducing inflammation and the associated post-exercise soreness. That’s right! Massage is productively multitasking while you are taking a nap. Massage is also a great feedback tool for the athlete. It encourages physical awareness of how the body is adapting to training.
The hormones play a role. Human touch is the most basic act to comfort and nurture. When a baby cries, we pick it up. When a friend is sad, we give him a hug. It is not surprising that an hour of therapeutic touch floods our system with feel good hormones such as oxytocin, serotonin and endorphins. It also lowers stress hormones such as noradrenaline and cortisol, which in high amounts correlates to accelerated cell aging. As a result, we worry less, smile more and sleep better. It has been shown that massage activates the parasympathetic nervous system, the rest and digest response, during which our bodies repair and heal from within. Thus getting a massage has a self-healing component; it is supportive of our body’s powerful innate mechanism to heal and adapt. Of course our daily lives provide multiple opportunities for healing touch from our friends and loved ones. I just want to add that there are times that therapeutic, professional and trained touch in a safe environment has its own merits. During my career, I had the privilege of working in many different settings. I held an Alzheimer’s patient’s hand in a hospice, I volunteered at the Hurricane Sandy relief effort at the Rockaways and I worked with a woman who lost her life partner and started her massage by apologizing that she was going to “cry through the whole thing” (she did and it was okay). In instances like these, I am reminded of the unique set of skills gifted to me and my colleagues by our training to ease the burden placed on loved ones and emergency employees in strenuous circumstances.
Perhaps, it’s now worth mentioning how massage does not work. Massage does not heal by causing pain. There is a strong misconception that massage is painful. Most of us saw a massage on TV before we had one. This comical reenactment usually involves a lot of ouching and bone cracking. There is a pervasive misconception in our culture that when it comes to massage more pain is better. In fact, forceful aggressive pressure is often counterproductive. When too much pressure is applied – the muscle will contract in order to protect itself from damage, sometimes leading to a long lasting cycle of spasm and trigger points. Deep change occurs when the patient is able to relax and feel safe as the pressure is applied. As therapeutic practitioners, we take great care to ensure that our pressure is suitable to your needs and preference.
Phew! Aren’t you glad that I didn’t go into all this detail during your 1 hour massage? It may seem like a lengthy answer, but I feel like I barely warmed up. My brief summary is based on the focus of my practice – medical, sports, and therapeutic. I didn’t even get to mention any of the energy modalities, Eastern bodywork, craniosacral work, and many more practices that heal people every day. My list is limited and of course, biased on the positive feedback reported by hundreds of my patients. Like many of my colleagues, I came into this profession because of a positive personal experience with massage. I am a firm believer in our work and therefore cannot be neutral. I apologize for any scientific errors and any science I simplified for the sake of clarity. As I started writing this blog, I knew that science alone is not (yet) able to provide a complete understanding of what we do. However, I do hope it shines a light on just how complex and versatile the work of a massage therapist is. I was once in a room where someone promoting a high-tech “suit” suggested that massage therapists merely “push blood”. As an athlete, I think it’s great that we have a gadget suit to help us recover faster. However, we do not yet have a suit that will alert us of potential injury, pause in that spot, remind us to breathe, reassure that the body is stronger than any injury and create a safe space to let go.
I welcome your feedback and questions.
Other opinions and sources from the World Wide Web:
How Does Massage Work? University of Minnesota
How Massage Heals Sore Muscles. The New York Times
The Pros and Cons of Massages for Runners. Runner’s World
Does Massage Therapy Work? by Paul Ingraham, Vancouver, Canada
* 26% of Americans had a massage in the last 5 years, according to AMTA 2013 consumer survey.