Massage has been a traditional practice since early civilization in many countries due to its positive physiological, psychological, biochemical and neurological effects. Till now, many people still believe the old saying that massage increases blood flow or blood circulation. Yet some studies have argued that this is not the case.
Despite many benefits that massage has been claimed to have lacks scientific evidence, massage is still broadly used by athletes and active individuals to enhance performance, reduce muscle soreness and improve recovery.
Image by Angelo Esslinger from Pixabay
Now sitting on a yoga mat and looking at your foam roller, you may wonder, if massage does not work, why should I “torture” myself every time before or after workout? Wouldn’t I be better off spending money on a big meal, or throwing my foam roller away and just sitting there doing nothing?
Well, unfortunately the benefits of massage are not that black and white at the moment. I have that same doubt as you. Therefore, I did some research today, and here is what I found.
Does Massage Before Workout Really Work?
Although pre-workout massage is said to have a lot of benefits such as increased Range of Motion (ROM), enhance performance and improve muscle strength, many of them have not yet been proven scientifically.
A recent meta-analysis shows that the largest average effect of foam rolling i.e. self-myofascial massage before workout was flexibility[1]. A few mechanisms may contribute to this effect.
One of them is a change in thixotropic property of the fascia surrounding the muscle[2]. Thixotropy is a property of certain gels or fluids, which are thick or viscous under static condition but will become thinner and less viscous temporarily when shaken, agitated or stressed[3]. Fascia is similar in that it can become more gelatinous when it encounters heat and mechanical stress, such as massage or massage-like treatments.
Ketchup is a classic example of a thixotropic material from painscience.com
Another mechanism is said to be the effect of foam rolling on the central pain-modulatory systems[4]. Constant and vigorous pressure exerted on the soft tissues through foam rolling may overload the skin receptors, decrease their sensitivity, therefore inhibits or minimizes pain sensation and increases stretch tolerance.
Studies also show that improvement in flexibility does not negatively affect muscle performance.
However, the increase in flexibility caused by these mechanisms is short lived.
Does Massage After Workout Really Work?
Post-workout massage is claimed to reduce Delayed Onset Muscle Soreness (DOMS), improve recovery and performance etc. However, similar to pre-workout massage, many of these claims are not scientifically evident either.
Perhaps the reduction of DOMS is the most likely and closest one. The same meta-analysis shows that the largest average effects of foam rolling after workout is the alleviation of perceived muscle pain. The most plausible explanation is the central pain-modulatory system mentioned above.
Be it for increased flexibility or reduced perceived muscle pain, if the mechanism is what the study said to be – central pain-modulatory system, it means that massage or massage-like treatments may have a temporary painkilling effect. And if it doesn’t affect performance in a negative way, as was suggested by the study, then massage is definitely something worth considering before or after workout. At least it can reduce the risk of injury due to limited ROM, get us better prepared for the next session, or improve our well-being in general by reducing DOMS. (Related: Foam Rolling Moves to Reduce DOMS and Prevent Injury - Upper Body and Foam Rolling Moves to Reduce DOMS and Prevent Injury - Lower Body)
Painkiller cocktail from gogogogourmet.com
What Type of Massage Should I Get?
The types of massage mentioned in the studies and in this article generally refer to Swedish massage, sports massage, and self-myofascial release or self-massage.
Swedish massage includes five basic techniques. They are effleurage, petrissage, friction, tapotement and vibration. This video below shows a brief introduction to each technique.
Sports massage uses similar techniques as Swedish massage but usually focuses on a particular muscle group and involves greater pressure to work deeper into the tissues[5].
Self-myofascial massage is defined as a self-massage technique using a device such as a foam roll or roller massager[6].
Despite its long practice, Swedish massage techniques may be too gentle to induce sufficient therapeutic effects[7]. On the other hand, using a technique that is too intense can be painful and keep you away from doing it. Therefore, a sports massage and a deep tissue massage that involves greater pressure, or self-myofascial massage with which you can control the intensity yourself to make sure it’s not too gentle and below pain threshold is optimal.
When Should I Get a Massage?
Since the effect that massage has on improving flexibility or ROM is short-term, it makes sense to include a short massage session right before workout.
Yet opinions on when to do post-workout massage varies. Early study showed that soreness sensation did not change immediately after exercise and/or 24 hours after exercise[8]. Another study in 2018[9] seems to justify this statement. Although the same early study also mentioned that massage performed 2 hours after exercise was reported to benefit DOMS by reducing inflammation, and neutrophil value in the massage group was significantly higher than in the control group at 8 and 24 hours (neutrophils are the most abundant white blood cells in human body, accounting for 50 – 70% of the white blood cell population and are chemically attracted to sites of inflammation[10]).
Some studies hold a different opinion. According to their analysis, massage after exercise and the consecutive days reduces muscle soreness rating at all time periods (0/24h/48h/72h)[11][12]. One study even shows that the 48- and 72-hour periods are more efficacious at alleviating muscle pain[13].
Forest plot summarizing the effects of post-rolling on muscle pain. The size of the rectangles indicates the weight of the study from PubMed Central
So, when should I get a massage? I think from now on I will start experimenting. Try immediately after workout, 2 hours after workout, and 48 even 72 hours after workout to see which one works best for me.
How Long Should a Massage Last for?
Duration of a massage also varies widely, from 30 seconds of foam rolling per muscle group, to 30 minutes of whole-body Swedish massage.
So basically, if you are rich and have plenty of time, go for the whole-body Swedish massage, but if you are poor and busy as hell like me, stick to the self-myofascial massage.
Foam Rollers Versus Roller Sticks
When it comes to self-myofascial massage, there are various kinds of tools or devices you can use, including foam rollers, roller sticks, massage balls or tennis balls, massage guns and more.
Foam rollers utilize body weight and work best for large muscle groups like muscles in the lower body. Roller sticks, massage balls and massage guns may work better for smaller muscle groups or deep tissues (Related: Tensor Fascia Latae Secret Unveil). Roller sticks can also be used to massage larger muscle groups.
[1] Thimo Wiewelhove, Alexander Döweling, Christoph Schneider, Laura Hottenrott, Tim Meyer, Michael Kellmann, Mark Pfeiffer and Alexander Ferrauti, A Meta-Analysis of the Effects of Foam Rolling on Performance and Recovery, Front Physiol. 2019 Apr 9;10:376. doi: 10.3389/fphys.2019.00376. eCollection 2019.
[2] See 1
[3] Thixotropy, Wikipedia.
[4] See 1
[5] Dr Paul Irvine, Swedish Vs Sports Massage- What’s the difference? Complete Chiropractic. February 9, 2018.
[6] Scott W. Cheatham, PT, DPT, OCS, ATC, CSCS, Morey J. Kolber, PT, PhD, OCS, CSCS*D, Matt Cain, MS, CSCS, and Matt Lee, PT, MPT, CSCS, THE EFFECTS OF SELF‐MYOFASCIAL RELEASE USING A FOAM ROLL OR ROLLER MASSAGER ON JOINT RANGE OF MOTION, MUSCLE RECOVERY, AND PERFORMANCE: A SYSTEMATIC REVIEW, Int J Sports Phys Ther. 2015 Nov;10(6):827-38. PMID: 26618062 PMCID: PMC4637917.
[7] Pui W. Kong, Yao H. Chua, Masato Kawabata, Stephen F. Burns, and Congcong Cai, Effect of Post-Exercise Massage on Passive Muscle Stiffness Measured Using Myotonometry – A Double-Blind Study, J Sports Sci Med. 2018 Nov 20;17(4):599-606. eCollection 2018 Dec. PMID: 30479528 PMCID: PMC6243630.
[8] Pornratshanee Weerapong, Patria A. Hume and Gregory S. Kolt, The Mechanisms of Massage and Effects on Performance, Muscle Recovery and Injury Prevention, Sports Med. 2005;35(3):235-56. doi: 10.2165/00007256-200535030-00004.
[9] See 8
[10] Elaine N. Marieb, Katja Hoehn, Human Anatomy and Physiology, Eleventh Edition.
[11] See 7
[12] See 6
[13] See7