When This Is, That Is

Exploring the world of conditionality

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

Teaching Kinesiology

One of my jobs (doesn’t everyone have more than one?) is teaching at Oregon School of Massage. I teach a class called kinesiology to aspiring massage therapists.

Kinesiology is the study human movement, so for me and my students, that means bones, joints, and muscles. Lots of muscles. 

I teach two classes, one covering muscles of the upper extremities (arms) and trunk, the other covering muscles of the lower extremities (hips and legs). Oregon School of Massage has two campuses, one in Portland and one in Salem. I teach at both—Tuesdays in Salem and Wednesdays in Portland. 

Massage therapy is usually thought of as a luxury, something people do to relax. In advertisements, people—women, mostly—are shown receiving a massage in some spa-like setting. But it’s much more than that. Many soft-tissue injuries—for the most part meaning muscles and connective tissue—are best treated by massage. Outside of massage, achy and strained muscles are treated with pain relievers and muscle relaxants, which are not always the best choice. Especially when there are so many other benefits of massage therapy.

So it stands to reason that massage therapists need to know about the muscles they work on. Most states regulate massage therapy and have strict requirements about what’s included in a student’s education. In Oregon, broad knowledge of kinesiology is one of those requirements. That’s where I come in.

I’ve taught kinesiology for more than eight years now. It’s one of the more difficult classes for massage students. A lot of memorization is necessary—where a given muscle connects on which bones and what the muscle does. A few muscles have only two attachments and do only one thing, but most of them have many attachments and are active in several different movements. Students need a grasp of many concepts as well. So for some students, it’s difficult to put it all together.

It’s similar to acting in a play, I tell my students. An actor who merely memorizes lines and recites them rote will not give a good performance. Good performances come from actors who can make their lines come alive. Memorizing a long list of muscles and their attachments and actions will get a student only so far. Massage is a skill to be developed, just as acting is.

A requirement for licensure is passing the dreaded Practical Exam conducted by the Oregon Board of Massage Therapists. The practical covers several areas, including massage technique, communication, pathology, and kinesiology. It’s the kinesiology part that freaks people out the most. 

You can read more about my involvement with OSM and a lot of other stuff about me and  some of my other jobs here, in an article written by owner and president Ray Siderius.

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