Massages

What general uses and basic beliefs?

Massage is used in general approaches, such as preparation for competition, between competitions or to aid recovery after an event, rather than to treat specific problems (1). It is probably the most popular technique within the sports belief system but, although many studies have looked at its effects for recovery purposes, there is little evidence to date that it has been used for any specific purpose. To date, there is little scientific evidence on its effects. Thus, many do not support its use for performance enhancement, injury recovery or muscle injury prevention as much of this research tends to highlight the limitations of massage rather than its significant effects (2). Some studies have even gone so far as to show no effect of massage on recovery parameters (3). However, these statements should be taken with a grain of salt and this article will highlight the realistic, theoretical or erroneous effects of massage so that everyone can make up their own mind about recovery. 

What physiological effects?

The main characteristic of massage is that it heats up the tissues, irreducibly reducing muscle-tendon stiffness. Massage has also been shown to increase parasympathetic activity by reducing heart rate, lowering blood pressure, increasing relaxation substances such as endorphins and increasing heart rate variability (2). By stimulating endorphins, it thus has a direct effect on relaxation, mood and the sensations felt by the individual. These different characteristics are important data to take into account for the psychological recovery of the player. This is exactly what the studies by Weinberg et al(4) and Hemmings (5) focused on, since these researchers attributed significant positive psychological effects to massage, based on scientific evidence, despite the participants’ initial state of mind. Massage can, beyond its physiological effects, allow a return to calm after a demanding match in order to allow the athlete to engage in a healthy and optimised recovery process. 

These techniques can play a role on pain via the notion of Gatecontrol (this modality aims to stimulate fast nerve fibres by bombarding them with information in order to block the slower fibres, thus reducing the sensation of local pain. The best known example is rubbing your elbow after hitting it so that the pain goes away). Following this theory, it would be rather interesting to use it on a sportsman feeling a particular discomfort or already aching? 

However, other studies have claimed that there is an effect of massage on pain sensations. Smith et al reported that massage 2 hours after exercise had a beneficial effect on muscle soreness by reducing the inflammatory process (6). Hilber et al stated that the effects of massage on muscle recovery and soreness did not appear until 48 hours after exercise (7). Thus, multiple points of view converge and diverge around the real influence of massage on pain sensations but also their real physiological explanations. 

According to other researchers, massage could help reorganise muscle fibres after significant effort or injury, but these effects are also difficult to prove, and it is to be hoped that many studies on the subject will be carried out in the coming years.

What is the basis for all these disputes?

In terms of the limitations of massage and its effects on recovery, there is evidence that it increases skin temperature, but there is also evidence that after 10 minutes the effects have already worn off. Other obvious limitations of the administration of the effleurage technique were that skin temperature did return to baseline quickly (8) but that muscle temperature did not increase in deep muscles (more than 2.5 cm deep)(9). 

There is also little or no evidence of increased blood flow via massage (2) and it is this feature that underpins everyone’s most popular beliefs about the benefits of sports massage in recovery. In theory, it is this increase in muscle blood flow that should help eliminate waste products after exercise and also improve the supply of proteins or nutrients needed for muscle repair (10). Increased lymphatic flow could also, in theory, reduce post-exercise swelling and stiffness by reducing muscle interstitial content and, therefore, reduce muscle discomfort (11). However, there is little or no evidence to support this significant increase in blood or lymph flow. It is also difficult to stand back from all these studies, whether they support massage or not, as a multitude of techniques, durations or application modalities have been identified. 

In conclusion…

In summary, the results of most studies showed that the massage intervention significantly increased perceptions of recovery without improving physical ability. The majority of evidence indicates that massage is effective in relieving muscle soreness and improving perceptions of recovery, although its effects on muscle function, performance and recovery are unclear (12). Thus, it is important to keep in mind that massage is always a way to soothe the patient psychologically and physically, to involve them in a positive dynamic regarding their recovery and to offer follow-up. If, in addition, physiological effects occur, regardless of their intensity, then this is even more of a luxury that the therapist cannot afford to sideline. 

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