How Can Massage Help Runners?

Some runners swear by it, others say it’s a waste of money. The fact that most elite runners have regular massage suggests there must be something in it, but how valuable a tool is it for recreational runners? Is there any evidence it reduces injury or increases performance? Let’s take a look…

What Does Massage Do?

The most commonly proposed benefits of massage are:

• Massage helps flush away lactic acid
• Massage improves circulation
• Massage breaks down muscle/fascia adhesions.

It may therefore come as a surprise to hear that none of these are supported by research. In fact, the application of a little basic science suggests that such claims are either unlikely or simply not true.

“What?” …I hear you shout. “So all that time & money I’ve invested has been for nothing?“

No, hold on to your horses – I am a big fan of massage, I have after all taught it for several years. There is no doubt in my mind that it can help runners, just not in the way you think, and probably not as much as you may have been lead to believe.

Flushing Myths

Modern research has made it quite clear that muscle soreness is not caused by lactic acid build-up. Lactic acid (or more accurately ‘lactate’) actually clears from the bloodstream the moment you stop running, so the idea that massage helps ‘flush it out’ makes no sense.

How about flushing out toxins? Well, in all honesty, despite a lot of therapists using that as a reason, no one can actually say what these ‘toxins’ actually are. It’s an idea that sounds good but is certainly not scientifically based.

Linked with these flushing myths is the idea that massage ‘improves circulation’. Despite this being a very common claim, any increase in circulation would actually be minimal. Circulation increases when you raise metabolic demand; in other words, getting on and off the massage couch a few times will increase circulation far more than receiving a massage.

Breaking Down Knots

Ok, stay with me. Remember, I am a fan of massage and will get to the benefits soon. We just have to clear up the misconceptions first. Many runners put up with (and even expect) considerable discomfort during a sports massage in the belief that the therapist is applying the required force to break down ‘knots’ or ‘scar tissue’.

This idea is once again a myth; surgeons use scalpels to cut through scar tissue, so the belief that pressure from a thumb or elbow could break it down is obviously misplaced.

If your muscles feel more relaxed or lengthened after a sports massage, fantastic. But it’s not because the therapist has managed to force physical changes in your body’s tissues. It’s actually quite scary to think that a human being could do that with their bare hands.

How Does Massage Help Then?

So, what does massage do then? Studies show that massage after exercise can reduce the intensity of post-exercise soreness, so what is happening? Some of you may already be asking ‘why does it matter how it works, as long as it does?’

The answer to that question is as follows: if we know how something works, we can tweak it to make it work even better. If you (and your therapist) truly believe that the deep tissue massage is ‘breaking down scar tissue’, you will both be happy to put up with considerable pain, with shouts of “this hurts like hell but I know it’s necessary” and “no pain, no gain!”

Though there is a lot about pain that we do not yet understand, what we do know is that allowing a therapist to pummel you can actually lead to a delay in recovery. Pain is an output from a nervous system that is essentially trying to protect you from real or perceived damage. Trying to fight pain doesn’t make sense because all you’ll ultimately do is wind the nervous system up even more and cause it to output even more pain.

This is why stress, poor nutrition, lack of food, etc. can all increase pain. They all cause the nervous system to feel more vulnerable. And this is where we now reveal the most likely mechanism behind massage… it relaxes the nervous system

Relaxing The Nervous System

Studies show that massage can reduce both depression & anxiety. It relaxes the nervous system, removing threat and giving it less reason to output pain or restrict movement. This is why after a suitably deep massage we often feel less pain and can move more freely. The effect will not necessarily last forever (we have all seen how the initial pain often returns after a few days) but it can be a way to speed up recovery, allowing us to train more intensely without increasing the risk of overload and injury. We all enjoy a firm massage but putting up with too high a pressure runs the risk of doing the opposite.

Conclusion

Massage can help runners, just probably not for the reasons traditionally given. By relaxing the nervous system (as opposed to winding it up), massage can aid recovery, allowing you to train vigorously without increasing the risk of injury. The skill of the massage therapist, therefore, lies in applying a suitable amount of pressure at the right time. Talk of ‘breaking down scar tissue’ or ‘realigning tissues’ is outdated and can lead to runners putting up with unnecessary pain that can actually delay recovery.

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Articles Of The Week April 25, 2021

Admitted from the authors, more research has to be done on this, but this is important. Many in our profession use essential oils, however, after this study, you may want to re-think this in your practice if you are using them.

Scientists find new evidence linking essential oils to seizures – Beth Newhart

There have been studies to show how blue light therapy can help with sleep and Seasonal Affective Disorder (SAD), but could it help with concussions? Well, we know massage is effective with helping sleep, so maybe both could be good?

Can Blue Light Therapy Help Concussion Symptoms? – Conor Collins

“There is no shortage of press about the positive effects of meditation on people, and there are plenty of studies to back them up. But there is also evidence—evidence that’s been growing for decades—that prolonged meditation can have a drastic negative impact on some people. This doesn’t make the practice bad, or invalidate the help it has given to many … but ask yourself if you’ve ever heard anything about the possible dangers of meditation. Why is that?”

Why Does Nobody Talk About The Dangers Of Meditation? – Jordan Heath-Rawlings

Could these COVID lockdowns be affecting our mental health? For sure! But there’s good reason why and it’s affecting how we focus along with other cognitive functions.

Brain fog: how trauma, uncertainty and isolation have affected our minds and memory – The Guardian

A number of years ago I took an IASTM course so I could save my hands. There were some pretty bold claims in the course and honestly I never really questioned it till years later. However, here’s the good and the bad of this technique.

IASTM Whatever Butters Your Bread – Taylor Laviolette

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Helping Runners With Matt Phillips

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Downplaying Pathology

One of my favorite podcasts is Dr. Oliver Thomson’s Words Matter. Through his podcast, Dr. Thomson addresses a wide range of topics relevant to my practice, both as a physical therapist as well as an educator. While an entire hour spent unpacking concepts surrounding the way a clinician approaches a patient presenting with back pain may sound rather niche-y and not of particular interest to an SLP, voice professional, or other professionals, but the episode that I just finished listening to is completely relevant for all of us. If you can broaden the context to include all aspects of diagnoses and envision how our patients enter our clinic, you’ll see the immediate relevance of the information covered in this episode.

One of the takeaways is revealed in the portion of the talk that looks at patient expectations in how we assess, and the expectation of all of the things that we will find wrong with the patient.

Much of this feeds into the traditional medical model that is ramped up in manual therapy evaluations. Our patients pay us to find out what is wrong with them and then do things to make them less wrong. In past articles I’ve covered my views on concepts of causation and pathology and how, when presented in the silo-based format of a specific manual therapy mindset, makes us seem the expert on finding problems with their fascia (or joint, or muscle, or trigger points).

They expect this from us, but by telling them what is wrong, we may be doing a disservice at many levels.

First off, our silo-based training makes every problem look like a problem based on our training. In my post life as an MFR therapist, every problem was explained in fascial-based language. But that language, and the concepts that underpinned it, are not ones accepted by the outside medical community.

So by telling my patient what was wrong with their fascia, I may have been telling mistrusts.

Second, by telling what is wrong with them I am reinforcing how broken they are. Sure, I am offering solutions (my services), but layering on pathological perceptions builds strongly on nocebic concepts (not a good thing).

In the podcast episode, Dr. Thomson and his guest, Dr. Ben Darlow, speak about how reinforcing the positive during an evaluation can step our patients back from the edge of feeling broken. While most want a diagnosis, what most really want is reassurance that they are NOT broken.

Most patients come to us having seen a few other professionals and, most likely, have been told some rather sorry explanations for why they are having problems. 

If the poor input came from someone at the top of the food chain, such as the ortho surgeon, or similar, those explanations are hard to undo. One cannot forget what they’ve already heard. But many of the bad explanations for problems come from those on a equivalent level, professional-wise. It’s not easy to undo the crappy thoughts injected into our patient’s brains by others, but we can start by telling our patients what is NOT wrong as we assess. The podcast explains this much better than I can, and there are a whole lot more gems that I believe all will benefit from.

You can listen to the entire podcast from the links at this page.

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Articles Of The Week April 11, 2021

There is many a fanciful description behind many of the techniques that are taught in our profession. However, sadly, most of them aren’t true. It’s important for us to understand exactly how we are interacting with people while they’re on our table and the mechanisms behind what we do.

Mechanisms of Manual Therapy – Eric Purves

“In a major change of pain treatment policy, the National Institute for health and Care Excellence (Nice) say that in future, doctors should advise sufferers to use physical and psychological therapies rather than analgesics to manage their pain.” Good to see things are changing in the management of chronic pain.

Chronic pain sufferers should take exercise, not analgesics, says Nice – Denis Campbell

Marketing ourselves, or our practice can be time consuming and difficult, especially when it comes to social media. While this is directed at personal trainers, there’s a few tips you could use in promoting your practice as well.

How to Promote Personal Training on Instagram (Without Getting Half-Naked) – Meghan Callaway

Shin splints can be a difficult thing to help our patients manage. It’s a difficult area to try and stretch, but Rob gives some great advice on how to help with this video.

Shin Splints – Rob Haddow

I was honoured to be on The Concast podcast with Conor this week. We talk about exercise and movement within a clinical setting, make sure you subscribe to his podcast!

The Concast: Episode #63 – Conor Collins & Me!

 

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What Clinicians Say

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Should We Be Evidence-Based Or Evidence-Informed?

Evidence-based vs evidence-informed

I had an interesting conversation with my buddy, Matt Phillips, last week when he asked my opinion on the difference between “Evidence-Based” practice and “Evidence-Informed” practice.

When I gave it a bit of thought, this is what I came up with (which was just an uneducated opinion at the time).

Evidence-based to me means you’re building a foundation or a BASE to work from in your practice. You’re making that base around research and evidence and work from that standpoint in your clinical setting.

Evidence-Informed to me means you’ve been informed of the evidence and know what the evidence says, but you’re not necessarily working from that information; you know it’s there.

It was then pointed out to me that the research says we’re better to be evidence-informed.

So as always, I had to start looking at the research. 

Looking At Evidence-Based Practice

We have long preached about evidence-based practice, and as I start to look into the research, some other topics worth discussing came up. 

The first article to reference comes from evidence-based medicine or EBM. In general, I had no idea that medicine has faced many of the same issues we face in our profession. 

Much of the EBM arguments were based on creating government policies to identify different therapies or interventions that lacked science or evidence of treatment efficacy. ⁽¹⁾ The intent was to weed out an intervention that didn’t follow science or showed no evidence of treatment efficacy. 

This should generally be a good thing. Right?

It seems there were some limitations to this. 

When these new findings came out, some therapies would get pushed out while more expensive, technological ones became the preference, which was clearly not popular with insurance companies who had to pay for it. So, there are suggestions the root of EBM was to satisfy those insurance companies instead of focusing on patient care⁽²⁾, and even the possibility of some propaganda from pharmaceutical companies having an influence. ⁽³⁾ 

Some argued that the human side of treatment was being sacrificed for the more biomedical model (and we all know how our opinion on a strictly biomedical model), which led to a term I’ve never heard of; ‘scientism.’⁽¹⁾

Those who leaned more toward the humanistic approach were labelled with scientism and accused of being anti-science, where the word ‘dogma’ was also thrown around (where have I heard these kinds of things before!?). 

I would have thought this to be more prevalent in our profession by comparison. Many of the narratives and things we are taught come from what was once just opinion and then taken as gospel. Part of the issue here is that many of those narratives are overinflated claims, relying on anecdotal experience instead of what is actually happening. ⁽³⁾

Fortunately (at least within our profession), this is slowly starting to change. 

The argument is also made⁽²⁾ that when it comes to evidence-based practice (EBP), we evaluate the best evidence for the patients’ problem. It seems the ‘patient’ is not part of the equation. 

This isn’t to say science should not be used as a base for what we do. As this article points out, our challenge is to apply this within a humanistic framework that respects the patient and their values and recognizes the psycho-social aspects. ⁽¹⁾

Where Does Evidence-Informed Come In?

When I do a quick google search for definitions, there are two for the term, base that comes up which are applicable: 

a conceptual structure or entity on which something draws or depends.

and 

“have as the foundation for (something); use as a point from which (something) can develop” (clearly where I got my original idea from).  

When we look at informed, we get: 

give an essential or formative principle or quality to.

and

having or showing knowledge of a particular subject or situation.

We have often heard statements like “well, science just hasn’t caught up yet,” or: “my experience tells me what I’m doing is right.” Usually, statements like this are used as an argument against using research in our practice. 

When we look at that second definition for informed, we have to be careful with its interpretation. Having or showing knowledge of a particular subject or situation does not make us an expert, especially in our clinical practice and the techniques we use. 

This could be misconstrued with some research I’ve cited where it mentions the limitations to evidence-based practice was taking the patient out of the decision-making.

This brings me to a portion of one paper that I have to quote: 

While excluding entirely baseless interventions or interventions rooted in prejudice and superstition, evidence informed practice (EIP) should be understood as leaving ample room for the constructive and imaginative judgement and knowledge of practitioners and clients who must be in constant interaction and dialogue with one another for most interventions to succeed.⁽²⁾

This is where evidence-informed practice becomes a more accurate description of what we should do. 

The evidence-informed practice encourages that we still use research (while discarding those old, false narratives) and suggests we use a more comprehensive range of research to apply in our practice. While evidence-based practice suggests we only apply best practices and minimize social interventions⁽²⁾, evidence-informed promotes including qualitative research and including the patient’s values in the decision-making process. 

This is an essential inclusion for us as Massage Therapists because qualitative research isn’t simply relying on data; it includes looking at things like contextual factors of treatment (which our treatments have A LOT of). 

So, it becomes crucial for us to use our clinical decision-making appropriately. Part of the ability to do this is to apply the current evidence and effectively communicate with our patients, care for them, include them in the decision-making process and goal setting. Then be able to adjust each appointment appropriately. 

It is when we start to see care being informed by evidence rather than based on it, and the patient is the centre of care is where we will have success. ⁽¹⁾ 

So, we should be using evidence to inform or influence our practice. However, we still need to use our experience, patient values, preferences, and other contextual factors to affect outcomes positively. We can’t rely on narratives rooted in opinion or superstition and altogether avoid new research in favour of our own experience. BUT, our experience still plays a role as we progress to hopefully becoming a more evidence-informed profession. So, as it has been done so many times before, I stand proven wrong on my assumptions and will now start to promote evidence-informed over evidence-based (although I’m sure I’ll screw that up somewhere along the way…old habits die hard). A big thanks to Matt Phillips for his gentle nudge in this direction. You’ve got to love colleagues that help you change. And let’s make sure there’s ALWAYS a human element to our treatments and interactions. 

References: 

1. Miles A, Loughlin M. Models in the balance: Evidence‐based medicine versus evidence‐informed individualized care.
2. Nevo I, Slonim-Nevo V. The myth of evidence-based practice: Towards evidence-informed practice. British Journal of Social Work. 2011 Sep 1;41(6):1176-97. 
3. Gambrill E. Evidence-informed practice: Antidote to propaganda in the helping professions?. Research on Social Work Practice. 2010 May;20(3):302-20.

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Articles Of The Week April 4, 2021

Social media is an interesting thing. Sometimes people share things without thinking about it other times there’s plenty of thought put into it. When it comes to our professional associations, they have a responsibility to make sure anything they are sharing is not only accurate but also good for the profession as a whole. We need to hold them to a higher standard.

If professional associations don’t read the studies they share, then who does? – Tristen Attenborough

This could be a game-changer for the chiropractic profession (at least here in British Columbia). Their regulator is taking away their ability to do routine x-rays unless there is a history of red flags in a patient’s intake. We know that more imaging is not conducive to good outcomes, so it will be interesting to see what happens here.

Battle over chiropractors’ ability to do routine X-rays headed for B.C. court. – Bethany Lindsay

Great info around the limitations of MRI in detecting what someone is actually feeling or thinking, and whether MRI can find a ‘signature’ for pain. Along with emotional learning and pain. Make sure to give this one a listen.

Podcast With Dr. Melissa Farmer on Pain and Emotional Learning – Todd Hargrove & Melissa Farmer

Sometimes it can be tough spotting what is ‘good science’ vs ‘bad science’. This is especially true in many online debates within our profession. These are five great ways to know if someone is trying to mislead you in those arguments…I mean discussions.

5 ways to spot if someone is trying to mislead you when it comes to science. – Hassan Vally

I remember one of my teachers in college saying: “you may have people come in for treatment just to be touched”. We all know how important human touch is, but what happens during times like this where touch is limited, and how can we handle it? Read on to find out.

Humans are made to be touched — so what happens when we aren’t? – Mary Halton

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