massage decreases blood flow and lactic acid removal post-workout?

[TPT]

well a presentation this week at the annual meeting of the american college of sports medicine will showcase how massage mechanically inteferes with blood flow. thus, limit lactic acid removal. what i have read is interesting.

i know many bodybuilders have recently increased their use a massages over the past few years and it has gained some popularity.

personally, massages will always "feel" good to me. but, discriminating whether it actually decreases inflammation or generates placebo effects is something to think about.

Title
Massage Impairs Rather Than Enhances Lactic Acid Removal From Muscle After Strenuous Exercise
Presentation Start/End Time:
Saturday, May 30, 2009, 8:00 AM - 9:30 AM
Topical Category
1001 athlete medical evaluation and care
Authors
Victoria Wiltshire, Veronica Poitras, Melissa Pak, Terence Hong, Jay Rayner, Michael E. Tschakovsky. Queen's University, Kingston, ON, Canada.
Email: [email protected]
Sports massage has been widely accepted among the athletic community as an aid to promote muscle recovery from exercise. The Canadian Sports Massage Therapists Association (CSMTA) website (www.csmta.ca) states that it “relieves soreness and assists in the removal of lactic acid and other waste products”. To date no studies have investigated the claim about lactic acid removal. PURPOSE: To test the hypothesis that massage improves muscle lactic acid removal post exercise. METHODS: Twelve healthy young University undergraduate male subjects lay supine and performed 2 min of isometric handgrip at 40% maximal voluntary contraction (MVC). Forearm blood flow (FBF; Doppler and Echo ultrasound of the brachial artery) and deep venous forearm blood lactate


concentration (DV[La-]; StatProfile M Blood Gas Analyzer, Nova Biomedical) were measured every 30 s for 10 min post-handgrip under three conditions: Control (passive rest), Massage (effleurage and petrissage), and Active Recovery (rhythmic exercise at 10% MVC). RESULTS: Data are mean ±SE. DV[La-] at 30 s post handgrip increased by a similar amount above baseline across conditions (Control 6.1 ±0.5, Massage 5.5 ±0.6, Active Recovery 5.7 ±0.6 mmol/L). From 4.5 min post handgrip onwards, it was lower in Active Recovery than Control or Massage, P<0.05. FBF was highest in Control vs. Massage and Active Recovery for the first 3.5 min post-handgrip, all P<0.05. Examination of beat by beat flow tracings revealed markedly reduced flow during limb compression with rhythmic Massage and during the contraction phase of rhythmic exercise in Active Recovery. Total FBF area under the curve (AUC; ml) for 10 min post handgrip was significantly higher in Control vs. Massage (4203 ±531 vs. 3178 ±304) but not vs. Active Recovery (3584 ±284, P=0.217). La- efflux (mmol; FBF x DV[La-]) AUC mirrored FBF AUC (Control 20.5 ±2.8 vs. Massage 14.7 ±1.6, P=0.03 vs. Active Recovery 15.4 ±1.9, P=0.064). CONCLUSIONS: Massage impairs lactic acid removal from muscle following strenuous exercise by mechanically impeding blood flow.

http://www.abstractsonline.com/viewer/viewAbstract.asp?CKey={8E08CBEB-A7CB-43DF-9ED8-D3300FD358A0}&MKey={EA46E0BC-C249-49A0-AC61-CC3E8D773D05}&AKey={EE40F514-DBDD-4E5E-B299-2E312F980A6E}&SKey={2EBC562C-1BCF-4ADA-9ABC-6BE487431EEE}

[Frosty]

What do you think is the best recovery post-workout? I personally think it's just laying down in bed between your PWO shake and PWO meal if possible, even if you don't fall asleep it feels like you recover better.

[Dr Pangloss]

i thought there was some evidence that massage reduced DOMS, but it was performed later after initial muscle soreness.

guess i'll have to look, but i thought it reduced dOMS.

[TPT]

i thought there was some evidence that massage reduced DOMS, but it was performed later after initial muscle soreness.

guess i'll have to look, but i thought it reduced dOMS.



dr. pangloss,

it depends what literature we read. this reference was novel in regards to the measures and how close in time those measures were taken. the outcomes were initially counterintuitive to me. but the outomes were applicable because we might have a massage prior to the onset of doms, during or after.

most of the massage literature is filled with poor methodology and the tighter studies seem to trend towards the lack of efficacy.

smith et al. (1994) suggested massage two hours later. http://www.ncbi.nlm.nih.gov/pubmed/8148868

tiidus (1997) suggested massage sucks for us. http://www.ncbi.nlm.nih.gov/pubmed/9007768

this systematic review just adds to the confusion (ernst 2003). but, the read demonstrates the further skeptism in using massage for doms and other reasons. http://bjsportmed.com/cgi/content/abstract/32/3/212

[TPT]

What do you think is the best recovery post-workout? I personally think it's just laying down in bed between your PWO shake and PWO meal if possible, even if you don't fall asleep it feels like you recover better.


that certainly is the option for the least response effort.

[TPT]

that certainly is the option for the least response effort.


actually laying out with my post workout shake is what i prefer when i have time but interesting is the growing interest and body of research with active recovery.

the following is the abstract and full text link to a paper by gill et al. (2006). http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2491972

the investigators compared passive recovery, active recovery, compression garmets, and water contrast therapy. creatine kinase (ck) of rugby players immediately post workout was used as an outcome measure for recovery. large increases of interstitial ck were found in the players post workout and all options for recovery showed greater effects than passive recovery. active recovery intervention showed 88.2% recovery after 84 hours the smallest rate of post‐match was following passive recovery.

you could imagine the effects of high intesity or large volume programs on ck values of bodybuilders similiar to rugby players. we might have to reassess whether we should lay out and do nothing versus some low impact exercise post workout.

[Frosty]

actually laying out with my post workout shake is what i prefer when i have time but interesting is the growing interest and body of research with active recovery.

the following is the abstract and full text link to a paper by gill et al. (2006). http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2491972

the investigators compared passive recovery, active recovery, compression garmets, and water contrast therapy. creatine kinase (ck) of rugby players immediately post workout was used as an outcome measure for recovery. large increases of interstitial ck were found in the players post workout and all options for recovery showed greater effects than passive recovery. active recovery intervention showed 88.2% recovery after 84 hours the smallest rate of post‐match was following passive recovery.

you could imagine the effects of high intesity or large volume programs on ck values of bodybuilders similiar to rugby players. we might have to reassess whether we should lay out and do nothing versus some low impact exercise post workout.



This seems simple in my opinion!!! The active recovery utilized only 7 minutes of stationary bike riding. So to me you could ride a bike for 7-10 minutes PWO and then go home and take a nap for 30 minutes :) Then when you get up time for the PWO meal!

Although this study is concentrating on aspects of muscle, not nervous system. I think the nap would be of huge benefit to CNS recovery. Perhaps the combo of active recovery for muscular recovery and a nap for CNS recovery would be best.

The contrast bath recovery method I have questions on. Sure it reduced CK levels, but what about the hormonal response to cold water immersion?? My guess is this would have negative impact on the testosterone to cortisol ratio by raising cortisol levels in response to the cold water, greatly reducing anabolic potential.

[Frosty]

ThePhysicalTherapist,

One other thing that came to mind regarding the original study--cortisol levels. Massage therapy seems to have a lot of evidence to support reduction in cortisol levels. Given the importance of the testosterone to cortisol ratio, I do wonder if massage overall would lead to better gains at least.

But then again, I also wonder about the TYPE of massage. This one study uses sport massage 2 hours PWO and actually found higher levels of cortisol in the sport massage treated group:

http://www.ncbi.nlm.nih.gov/pubmed/8148868

However there were reductions in DOMS and reduced CK.


I would imagine different types of massage would yield different hormonal responses. This is getting too complicated.

[TPT]

ThePhysicalTherapist,

One other thing that came to mind regarding the original study--cortisol levels. Massage therapy seems to have a lot of evidence to support reduction in cortisol levels. Given the importance of the testosterone to cortisol ratio, I do wonder if massage overall would lead to better gains at least.

But then again, I also wonder about the TYPE of massage. This one study uses sport massage 2 hours PWO and actually found higher levels of cortisol in the sport massage treated group:

http://www.ncbi.nlm.nih.gov/pubmed/8148868

However there were reductions in DOMS and reduced CK.


I would imagine different types of massage would yield different hormonal responses. This is getting too complicated.


yes, i referenced that paper in post # 4. maybe two hours post workout is optimal. and this stuff is complicated. lol.

this paper by field et al. (2005) speaks to the relationship between massage and cortisol. http://www.hawaii.edu/hivandaids/Cortisol_Decreases_and_Serotonin_and_Dopamine_Incr ease_Following_Massage_Therapy.pdf



In this article the positive effects of massage therapy on biochemistry are reviewed
including decreased levels of cortisol and increased levels of serotonin
and dopamine. The research reviewed includes studies on depression (including
sex abuse and eating disorder studies), pain syndrome studies, research on autoimmune
conditions (including asthma and chronic fatigue), immune studies
(including HIV and breast cancer), and studies on the reduction of stress on the
job, the stress of aging, and pregnancy stress. In studies in which cortisol was
assayed either in saliva or in urine, significant decreases were noted in cortisol
Received 22 November 2004.

[Frosty]

So perhaps vigorous massage types like deep tissue, fascia release, rolfing, and sports massage may increase cortisol levels since they're not so nice and relaxing like other forms? lol Would make sense that your cortisol levels may increase with someone digging their elbow into your IT band lol.

[Frosty]

Yoga I bet would have benefits to recovery done PWO, if you're into that kinda thing. I also bet meditation would be good if you do that...but I think forcing someone to do meditation or yoga in the hopes of recovery when they hate it might actually be a negative on cortisol response lol. But if someone already meditates it might be good timing to do it PWO.

Yesterday I felt sick and crappy after my workout...just unwell, so I went home and laid down in the dark in front of a fan and I felt a lot better in just 15-20 minutes.

[TPT]

Yoga I bet would have benefits to recovery done PWO, if you're into that kinda thing. I also bet meditation would be good if you do that...but I think forcing someone to do meditation or yoga in the hopes of recovery when they hate it might actually be a negative on cortisol response lol. But if someone already meditates it might be good timing to do it PWO.

Yesterday I felt sick and crappy after my workout...just unwell, so I went home and laid down in the dark in front of a fan and I felt a lot better in just 15-20 minutes.


yoga is no joke. i perform yoga twice a week for 60 minutes. it is serious work. the sustained isometric contractions in novel postures can be quite aversive.

[Frosty]

yoga is no joke. i perform yoga twice a week for 60 minutes. it is serious work. the sustained isometric contractions in novel postures can be quite aversive.

Well there are different types of yoga, right? Some are very intense and relatively difficult, while others are more relaxing types if I'm not mistaken. I was thinking along the lines of a more relaxing yoga type instead of the more intensive.

[Big Dave Smith]

I've had massages right after training along with a day or two after. I'm going to go with emprical evidence and say i always feel better after a massage.

[Frosty]

I've had massages right after training along with a day or two after. I'm going to go with emprical evidence and say i always feel better after a massage.


Well lactate and CK clearance are only two variables. There are a ton of others when it comes to recovery and anabolism. Cortisol is one of them, and the right massage is going to reduce it. I don't know that this is cut and dry. It would require more testing than just clearance of metabolic factors in order to truly assess what is the best method.

[freak]

how about the effects on blood-flow after having a chronically tensed muscle released?? long term effects of continued massage therapy?

i know that a chronically tense muscle can cause a lot of problems and pain. having them released by massage seems to be the only cure, at-least for me. this study says that lactic acid concentration was increased in the massaged forearms, but since this was a static contraction, it is useful to the muscle tissue. according to Bohr's effect, hemoglobin's affinity for oxygen is increased in basic pH. so, lactic acid is converted to bicarbonate by carbonic anhydrase in red blood cells (CO2 + H20 <----> H+ + HCO3-). This drop in pH lowers hemoglobin's (Hb) affinity for oxygen, which causes the Hb to release its oxygen to the tissue to be used in respiration.
could it be that the increase in lactic acid is not due to reduced blood flow, but an increase in cellular response to energy/fuel demands??

[stinger]

Your artical is very interesting on the effects of a massage right after a workout. But what about sitting in a hot tub a few hours after a hard workout. What do they say about the effects of that comparied to the effects of a massage.

Did they research that?

[TPT]

how about the effects on blood-flow after having a chronically tensed muscle released?? long term effects of continued massage therapy?

i know that a chronically tense muscle can cause a lot of problems and pain. having them released by massage seems to be the only cure, at-least for me. this study says that lactic acid concentration was increased in the massaged forearms, but since this was a static contraction, it is useful to the muscle tissue. according to Bohr's effect, hemoglobin's affinity for oxygen is increased in basic pH. so, lactic acid is converted to bicarbonate by carbonic anhydrase in red blood cells (CO2 + H20 <----> H+ + HCO3-). This drop in pH lowers hemoglobin's (Hb) affinity for oxygen, which causes the Hb to release its oxygen to the tissue to be used in respiration.
could it be that the increase in lactic acid is not due to reduced blood flow, but an increase in cellular response to energy/fuel demands??


yes, blood flow might be different with people with chronic and tense muscles. the research on extreme levels of "tense" muscles including neuro patients with contractures and spasticity showcases this. these studies suggest differences in properties including within the the blood and muslces.

and yes their are many causal variables to consider with increased lactic acid post exercise. maybe we'll start a thread on them.

[TPT]

Your artical is very interesting on the effects of a massage right after a workout. But what about sitting in a hot tub a few hours after a hard workout. What do they say about the effects of that comparied to the effects of a massage.

Did they research that?


hey stinger, the hot tub does feel nice post-workout. no studies yet on hot tubs but a lot and different modalities.

the following is one study that used deep heat in the form of ultrasound to measure differences in doms for people post execise. actual temps of the biceps were found. although no differences in doms occured for the heat group vs the control group.
of course ultrasound to your arms is different from a hot tub. i bet a hot tub would showcase differences in symtoms of doms but would not be very reliable.

Abstract:

The effects of increased muscle temperature via continuous ultrasound prior to a maximal bout of eccentric exercise were investigated on the symptoms of delayed onset muscle soreness (DOMS) of the elbow flexors. Perceived muscle soreness, upper arm circumferences, range of motion (ROM), and isometric and isokinetic strength were measured over 7 days on 14 college-aged men (n = 6) and women (n = 8). Ten minutes of continuous ultrasound (ULT) or sham-ultrasound (CON) were administered. Muscle temperature was measured in the biceps brachii of both arms. Muscle temperature increased by 1.79[degrees] +/- 0.49[degrees] C (mean +/- SD) in the experimental arm of the ULT group. Muscle soreness was induced by a single bout of 50 maximal eccentric contractions. The ULT group did not differ significantly (p < 0.05) from the CON group with respect to perceived muscle soreness, upper arm circumference, ROM, and isometric and isokinetic strength. In conclusion, increased muscle temperature failed to provide significant prophylactic effects on the symptoms of DOMS.
(C) 2004 National Strength and Conditioning Association

Go to Full Text of this Article (http://forums.rxmuscle.com/nsca-jscr/Abstract/2004/02000/Effects_of_Deep_Heat_As_A_Preventative_Mechanism.2 3.aspx)




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