When This Is, That Is

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Does Massage Release Toxins that Must Be Flushed out with Lots of Water?

Water glasses

Massage therapy works in many ways to relieve stress, alleviate muscle pain, and otherwise promote good health and well-being. 

However, massage is not something you have to believe in for it to work any more than you have to believe in a root canal for it to relieve pain from an abscess. It’s not a placebo, although the placebo effect sometimes may be at work.

A recent study, reported in the New York Times in February 2012, revealed new information about why massage after a vigorous workout helps relieve muscle soreness and inflammation. The culprit is not lactic acid (as was once thought), but cytokines, which are part of the inflammatory response that occurs when muscle tissue is damaged during a workout. The experiment involved several muscle biopsies taken from different volunteers rather than anecdotal evidence. 

“This is important research, because it is the first to show that massage can reduce pro-inflammatory cytokines which may be involved in pain,” said Tiffany Field, director of the Touch Research Institute at the University of Miami Medical School. She was not involved in the study. “We have known from many studies that pain can be reduced by massage based on self-report, but this is the first demonstration that the pain-related pro-inflammatory cytokines can be reduced.” she said.

The abstract of the research article is here. It’s called “Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage,” in case you ever want to refer to it.

I was glad to read of this research, because it’s conclusion is evidence based. It’s something massage therapists can use when they talk about how and why massage works, instead of making vague references to things like “releasing toxins.” 

When I was in massage school, more than a dozen years ago now, I learned that after receiving a massage it’s very important to drink lots of water to “flush out the toxins” released by the massage. No one ever told me what those toxins were, where they were hiding, and how massage released them. Rather, it seemed a matter of faith. Many massage therapists still claim this as a benefit of massage. For example: 1, 2, 3. 

Massage therapists do make a legitimate reference to the lymphatic system, which massage does have an effect on. Lymph is the fluid that is within the lymphatic ducts and glands. Lymph is essentially the same thing as blood plasma (the liquid component of blood) and interstitial fluid (the liquid substance filling the empty spaces around cells in various tissues).

The lymphatic system does not have a pump behind it to move lymph through its intricate network of ducts and glands, like the heart moves blood through arteries. It relies on the movement of the body to exert gentle pressure on the ducts to keep lymph flowing toward the base of the neck, where it drains into the subclavian veins on either side and is thus returned to the blood stream. Lymph becomes plasma, which is filtered through the kidneys.

Meanwhile, blood pressure pushes some of the plasma out of the blood capillaries into the surrounding tissues, where it then becomes interstitial fluid. The same gentle pressure that moves lymph through the ductwork, also pushes interstitial fluid back into the lymphatic ducts. The fluid goes round and round and round.

Movement of the body—through contractions of muscles—moves lymph through the system. Massage does the same thing, only it’s someone else’s muscles doing much of the work.

The lymphatic system is part of our immune system. An immune response is how the body responds to and fights infection. White blood cells, many of which are stationed at lymph nodes, attack and destroy all sorts or invaders. The byproducts of battle are eventually excreted in a well-functioning system.

So what are toxins? A toxin is a poison of plant or animal origin that induces an immune response. If the body cannot fight the infection on its own, or without serious intervention otherwise, death is the result. 

Something else you learn in massage school is that massage is contraindicated for someone with a systemic infection. Massage is not an appropriate intervention for acute infectious diseases caused by toxins. 

But what about drinking all that water? Well, you don’t need sophisticated studies to know that without enough water, eventually you’ll die of dehydration. But after a massage, do you need to (as I once overheard one LMT tell her client) “drink lots and lots and lots and lots and lots of water”?

No, you don’t. You may develop a thirst after a massage, in which case you should drink some water—just as you would any other time you are thirsty. After all, you do need to replenish your fluid supply to keep from dehydrating. And the brain is good at telling you when you need more water. But when your massage therapist routinely hands you a bottle of water after a massage and reminds you to drink it all to “flush out the toxins,” you are getting a placebo.

Here is more information about what drinking lots of water can and won’t do for you:

Five myths about drinking water
The water myth
Eight glasses
Recommended water intake a myth

24 Responses to Does Massage Release Toxins that Must Be Flushed out with Lots of Water?

  1. Jennifer Stelzer, LMT says:

    To J. McCrackan:
    I often become congested after laying down, whether it is on a massage table, at home in bed or out camping under the stars. I personally do not think it is related to massage, but the position of the body when laying down. Gravity assists in draining the sinuses, so when we are laying flat there may be a potential for increased congestion. Just a thought.

  2. Jennifer Stelzer, LMT says:

    Thank you for responding Paul. I wonder if those who are claiming it is ‘illegal’ to suggest water after a massage are perhaps stretching the truth. And you may well be right about the practical exam, I would not be surprised. I think the reason it is so hard to give scientific backing to massage is that every therapist has a unique approach of their own, as well as every client has their own personal history, both physically & emotionally. These are intangible elements which do not fit well into a research study approach. Appreciate your thoughts & blog.

  3. J. McCrackan, I’d like to understand why, too.

  4. Jennifer, thanks for sharing the post on Facebook. I read through some of the comments and it’s clear opinions are strong. We know massage works and is good for a person, yet we don’t know much about how and why. There are hundreds of years worth of anecdotal evidence there isn’t much in the way of scientific evidence. The water recommendation falls into the same category — lots of anecdotal evidence but not much science. Of course, if you are in pain or otherwise feeling down, whatever makes you feel better — scientific evidence or not — is what you need. I haven’t been following state statutes at all, but it was interesting in reading through the FB posts how in some states it’s illegal to recommend water after a massage. It seems to me that once upon a time in Oregon you’d get marked down on your practical exam if you didn’t.

  5. Praveen, thanks for the comment. No question about the benefit of massage, although after all these years I’m still not sure why.

  6. J. McCrackan says:

    I still would like to understand why I and most of my clients become congested about half way thru a Swedish massage (never deep tissue).m

  7. Jennifer Stelzer, LMT says:

    Hi Paul, Oregon LMT here. Just wanted to let you know I shared this post in a Facebook MT group, here is the link if you are interested:


    Response has been positive (so far)!

    Appreciate your time & writing skills,

  8. I loved your article about massages and hydration. I have been a member of massage envy since January and i get massages every month which definitely have helped me from getting sick and give me more energy through the next 2 weeks. Massages are very beneficial for your health and well worth the cost.

  9. Maureen, I can’t say for certain that your lethargy is a direct result of massage. But I do know from my own experience that pain itself is exhausting. If the massage is painful, which I suspect it could be you your case because the intent would be to loosen and mobilize injured tissue, then that may answer your question. Massage is great therapy to increase range of motion, but it’s a slow process. I hope you feel better soon. Thanks for the comment and your kind words.

  10. Maureen says:

    I appreciate your article Paul. I recently broke my shoulder in 4 places and have just started getting massages to help loosen the muscles and get things moving. My shoulder has healed but motion is limited. I noticed that I am dog tired for the next two days and at first thought maybe it was just life in general etc….but it seems to happen after the massage. I didn’t drink lots of water (even though I was told to) because I just didn’t think it would make any difference (thus, I Loved your article and it made sense to me) but I did drink water as I normally do. Would the massages have anything to do with this lethergy? Thanks for your insight and your truths…appreciate it.

  11. Tara, absolutely. People repeat what they’ve heard as fact. Sometimes even when logic and reason say otherwise. Oh, well. Thanks for the comment.

  12. Tara says:

    This is a very enlightening post – seems like there is so much misinformation out there that the media spreads and people just assume is fact, and then people repeat what they’ve heard.

  13. Todd, sorry to hear you’ve been chronically ill. I can only imagine what it’s done to your life and psyche. I know for sure that a massage I gave brought negative results to one person, because she told me. Of course, there may have been others who just didn’t come back. But the woman in question was not in good health to begin with. Although I was careful to massage her only with very light strokes, she still complained of illness afterward. I have no idea why or what mechanism may have triggered such a result… other than falling back on the “moving lymph and releasing toxins” explanation followed by: “Be sure to drink lots and lots and lots of water to flush out the toxins.” My gripe is with those massage therapists who give these responses only because they were taught to give them, most likely by people who were taught to say the same things by their teachers without any real science to back them up. As always, my questions are: “What toxins, and where do they come from?” Anyway, I hope you feel better soon.

  14. Todd says:

    I’ve been really sick for months now (symptoms began within 12 hours of last years flu shot and seem immune related) and I’ve noticed that when I get a massage, especially a deep tissue massage, I feel much worse within 24 hours of the massage. Like I’m being overwhelmed by something. Coincidence?

  15. J, yes we need to be hydrated, and yes the kidneys continually filter the blood. And I agree massage helps move lymph through the system. My gripe, if you can call it that, is that so many massage therapists don’t know what they’re talking about—specifically—when they use “flush out the toxins” language, and they just parrot what they were taught by others who don’t know either. A few of my own questions are: What toxins? How did they get there? Did massage unleash them? If I don’t drink lots and lots and lots and lots of water, what will happen? Will I be poisoned?

    The real point of my piece is the NYT article that suggests that cytokines are responsible for muscle pain and massage helps get rid of them. This is an evidence-based claim. Frankly, I don’t tell my clients to drink lots of water to flush out anything. So I guess I don’t think there is much point to drinking lots of water after a massage. Unless you’re really thirsty, of course.

  16. J Hewitt says:


    I know I am commenting on an article written some time ago, but I have some questions. I would never want to mislead anyone in my practice. This being said after reading your article and others, I have come away with some questions. Since lymph is moved through our kidneys does it not make sense if we have moved lymph during massage to be well hydrated when they pass through the kidneys? I am not sure why but this just makes (logical not factual) sense to me. Also a few of the readers talked about the whole toxins being flushed being BS, from this article I did not gather you think that? Thank you for your article and I a hopeful for some answers.

  17. Geoffrey, thanks for the affirmation and encouragement. Truth in any field is worthy of pursuit, however unpopular. I’d appreciated it if you sent me that link you mentioned.

  18. Geoffrey says:

    Paul, I applaud your efforts to ask difficult (and I imagine unpopular) questions about massage. In the pursuit of science and truth their can be no sacred cows. Yes, water is good for the body. We should drink water after a massage just like we drink water everyday: because battling dehydration is a never ending battle.
    “Flushing toxins” is one of those slippery terms that sounds good as a mantra but, like you have so nicely explained, doesn’t really mean anything.

    There is an interesting article about the (McMaster University) study you have cited. It questions the methods and conclusions.

    If you have not read it, I can send you a link.

  19. Dr Sean, I agree “that it would be ok to say that massage may help the body in its own naturally occuring processes of self cleaning.” It’s a very straightforward and, to my understanding, a real outcome of massage. But drinking lots of water after a massage to “flush out the toxins” leaves me wondering what kinds of poisons are in my body. Does massage create the poisons? Does massage release them from captivity? If so, how did they get there? What will happen if I don’t drink lots and lots and lots of water?

    “Flush out the toxins” is a vague term passed down from one class of massage therapists to the next without any real understanding of what it means—or if it means anything at all. As a massage student, I learned the flush-out-the-toxins benefit from my teacher who also taught that drinking lots of water will “totally, totally cure” any disease (yes, she said that). That’s nonsense. It would be beneficial to the consumer if massage therapists could explain what really happens to muscle tissue during a massage. But as the article that formed the basis of this post points out, what really happens has not been well understood. So “flush out the toxins” has become a metaphysical mantra rather than a physiological fact.

  20. Dr Sean says:

    Hmmm, great article, with great info! Toxins are, therefore from outside the body or not part of the natural processes of the body but from ‘outside’. That was a good determinant and straight from the dictionary. However I guess that it would be ok to say that massage may help the body in its own naturally occuring processes of self cleaning? (At least offering better blood and lymph flow) Which helps any irritants or regular waste products to be removed from the massaged muscles and back into circulation for clearing and processing??

  21. @TWF. I hadn’t made the association between toxins and sins. But it’s appropriate, at least on a metaphorical level. It could take the discussion in new direction, complete with the washing away thereof. Thanks for the kind words.

  22. I now cringe whenever I hear alt health people proclaiming about mysterious toxins… when I am not busy getting sucked into believing it. There is something so seductive about “toxins.” It’s kind of like sins, you know. You try to eat well, but you don’t always, so you know you are going to collect those big bad toxins, just like no matter how good you try to be, you still end up sinning here and there.

    Anyway, great write up.

  23. @Sabio. Thanks for the kind support. Not too many people in my circles read this, but one who did used the word “heresy.” I guess so, in some circles.

  24. Sabio Lantz says:

    Yeah !! Another “alternative” medicine guy debunks the bullshit. Well done.

    Something may work, but often not for the reason the ardent believers put forth!

    “Toxin” jargon has always driven me crazy — people buy into it all the time. I use to also — how embarrassing.

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