Regenerative ~ Reconstructive ~ Rehabilitative

Lactic Acid, DOMS, and Massage

It has been a long held in teaching in schools of massage therapy that massage reduces the amount of lactic acid within a muscle. Though most of the evidence presented is largely subjective- the muscle feels better after massage, overall muscle soreness is reduced leading to quicker recovery, and then there is that awful taste left in the mouths of some clients after deep tissue work- there has been little hard scientific evidence to prove the efficacy of massage therapy. The reasons for this are wide and varied- as wide and varied for the lack of study of any complimentary or integrative modality.

But is there any hard, scientific evidence that supports the suggested relationship between lactic acid and massage therapy? In order to answer this, we must look at what lactic acid, how it’s produced and its’ role in the body fist.

What is lactic acid?
Within the human body, Lactic acid is created as Glucose- otherwise known as “blood lactic_acidsugar”- is broken down to fuel the muscles during anaerobic (muscle, power or speed building activities such as weightlifting or sprinting- as opposed to aerobic, or endurance, exercises such as distance running, cycling, or hiking) activities into Pyruvate through a process called glycosis (1). From there, Adenosine triphosphate (ATP) is created to help fuel metabolic functions (2). This requires certain amount oxygen to accomplish. If there isn’t sufficient oxygen present in the system, a process of fermentation begins, creating Lactate (also known as Lactic acid) (3).

How is Lactic acid flushed from the body?
4165061Through the process of Gluconeogenysis, which takes place in the liver, the Pyruvate and Lactate are converted back into Glucose. But if there is too much lactic acid in the muscle, it is then flushed into the circulatory system to be used in other areas (lactic acid, though a byproduct, is still a form of useable energy for the body) flushed out of the body (4) in the matter of a couple of hours after anaerobic activity.

There is no hard scientific evidence, however, that suggests massage a massage therapist can directly “push” or “flush” a muscle of lactic acid. In a recent study published in February 2012, published in Science of Translational Medicine” journal, entitled “Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage” found that massage after rigorous exercise only has a minimal effect on the level of lactic acid (5)

2012-9-27-SoreMuscleIn the study, 11 athletes were subjected to 6 separate biopsies of the Vastus lateralis muscle- 1 on each leg pre activity to establish a base line, 1 on each VL 10 post exercise, and 1 each 3 hours post exercise, with one leg one each athlete being put through an identical massage routine consisting of 2 min of effleurage, a light stroking technique delivered with a moderate pressure; 3 min of petrissage, a firm motion involving compression and subsequent pressure release from the muscle; 3 min of slow muscle stripping, consisting of repeated longitudinal strokes; and an additional 2 min of effleurage. All members of the study team were blinded as to which leg was massaged, with the exception of the massage therapist. All biopsies were acquired from separate incisions, about 2 to 3 cm apart.

The biopsies revealed no changes in muscle glycogen levels nor in muscle lactate. This suggests that the beneficial effects of massage occur independently of glucose uptake, or lactate clearance. (5)

What did the study show?

What the study revealed, though, wasn’t just a refutation of the claims that massage can reduce the level of lactic acid in the muscle. It found that the “mechanical manipulation marked metabolic responses” and it points to the benefits of isolated stretching on glucose levels.

The study showed strong evidence to the cellular benefits of manual manipulation of muscles post exercise and the researches concluded: “… when administered to skeletal muscle that has been acutely damaged through exercise, massage therapy appears to be clinically beneficial by reducing inflammation and promoting mitochondrial biogenesis.” (5)
A critical review of 17 case studies and 10 randomized controlled trials titled: “Effectiveness of Sports Massage for Recovery of Skeletal Muscle from Strenuous Exercise” done in September of 2008 found “most studies evaluating post-exercise function suggest that massage is not effective, whereas studies that also evaluated the symptoms of DOMS (Delayed Onset Muscle Soreness) did show some benefit.” And further goes on to report “Data from 10 randomized controlled trials (RCTs) do, however, provide moderate evidence for the efficacy of massage therapy.” And interestingly enough “The search identified no trend between type and timing of massage and any specific outcome measures investigated.” (6)

Those studies listed in the above mentioned critical review which specifically measured Blood Lactate (BLa) levels reported showing no significant change in BLa levels after massage. Those studies specifically mention some combination of effleurage, petrissage, tapotement, compression, and or friction- i.e. Swedish massage, specifically. Those studies which focused on Delayed Onset Muscle Soreness (DOMS) in place of or in addition to BLa , reported positive findings in the reduction DOMS symptoms. Smith, et al reports specifically “Sports massage significantly reduced CK levels and symptoms of DOMS when used 2 hours AE (after exercise)” (7)

In fact, 15 out of 26 of the studies cited showed some beneficial results at some point in the study on the athlete. Very few noted absolutely no benefits to athletes receiving massage. Dawson, who reported “Massage had no significant physiological or psychological benefits” on recreational runners (8) and Jonhagen reported “Massage treatment did not significantly affect pain or the loss of strength or function after exercise” in 16 individuals who “exercised at least 2-3 times per week” (9)

What is Delayed Onset Muscle Soreness?

Delayed Onset Muscle Soreness (DOMS) is often the result of eccentric muscular exercises (10) and consequently resulting in a temporary decrease in muscle force production, a rise in passive tension, increased muscle soreness and swelling, and an increase in intramuscular proteins in blood. (11) Specifically, muscles engaging in activities in which they are forced to contract while lengthening (stabilizing the joint against a load or force) suffer from micro tears in the fibers. (13) This creates an inflammatory response within the muscle and the healing process begins. Multiple studies have concluded that massage does, to some degree, aid in the reduction of inflammation (5) (6) (7) (11) (13)

Typically DOMS untreated will dissipate fully within 10 days (6) (10) (12), peaking around 48-72 hours. Some studies suggest that the effectiveness of massage is on par with commercially available NSAIDs (6), though practically every study mentioned thus far does point to massage having a beneficial effect on reducing inflammation and the overall duration of DOMS.

In Conclusion

Though there doesn’t appear to be any research which correlates a distinct reduction of lactic acid and post event massage, there is plenty of scientific data showing the benefits of massage on inflammation, exercise induced muscle soreness and DOMS. But then why is the “myth” that massage therapy flushes lactic acid from the muscle so prevalent in the face of multiple scientific studies spanning close to two decades?

First, there is a disconnect between massage therapists and the scientific community. Though groups like the National Center for Complementary and Alternative Medicine (NCCAM) are trying to bridge that gap, there are still a large population of massage therapists who have little interest in the scientific basis for the modalities they practice. It certainly is apparent in reading multiple studies that different researchers have different methods of testing which seem to either influence, or be influenced by, their attitudes towards the effectiveness of complimentary and alternative medicine (CAMs). Controversy exists, even between researchers, as to the effectiveness of CAMs- massage, specifically- and their role in treatment plans. It certainly appears that more than the data, it is the way the data is presented which causes the controversy.

Second, there is enough subjective evidence to satisfy most therapists and consumers curiosity on the subject. For instance, we know that excess amounts of lactic acid created through muscular exertion will be expelled into the circulatory system for processing in the liver. We also know that massage therapy increases circulation through vasodilation. Ergo, the assumption is that because of the increased blood flow, lactic acid will be flushed from the muscles faster than on its’ own. This, combined with the belief that muscle soreness is caused by an excess of lactic acid in the muscles, has lead to the belief that massage removes lactic acid from the muscles. Becuase there is often a both an unpleasant taste left on the palette and generally feeling of increased well being after a session, it is easy to believe that lactic acids, or toxins in general, have been flushed from the system.

Even though the predominant number of studies shows this is not the case, there have been very few studies done to explain why massage therapy has had as much of both a positive effects on the life of individuals and a huge following, beyond quoting other studies showing the positive effect on depression, anxiety, blood pressure and general relaxation, or pointing an accusatory finger towards a psychosomatic or placebo effect.

In truth, the issue of lactic acid removal has been resolved as far as today’s science can resolve it. With scientific methods improving as fast as technology advances, these finding may be obsolete in 10 years. Or, in that same 10 years, it may reveal that these findings are warranted. What is obvious is that the need for further research in order to better educate massage therapist, not only on the benefits, but the why’s behind them.


References and Notes




5. Justin D. Crane, Daniel I. Ogborn, Colleen Cupido, Simon Melov, Alan Hubbard,
Jacqueline M. Bourgeois, Mark A. Tarnopolsky “Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage” Science Translational Medicine, 1 February 2012: Vol. 4, Issue 119, p. 119ra13

6. Best, Thomas M MD, PhD; Hunter, Robin DC; Wilcox, Aaron BS; Haq, Furqan PhD “Effectiveness of Sports Massage for Recovery of Skeletal Muscle From Strenuous Exercise” Clinical Journal of Sport Medicine: September 2008, Volume 18, Issue 5 pp 446-460 doi: 10.1097/JSM.0b013e31818837a1

7. Smith LL, Keating MN, Holbert D, et al. The effects of athletic massage on delayed onset muscle soreness, creatine kinase, and neutrophil count:a preliminary report. J Orthop Sports Phys Ther. 1994;19:93–99. as reported in the quoted critical analysis (6) above

8. Dawson L, Dawson K, Tiidus PM. Evaluating the influence of massage on leg strength, swelling, and pain following a half-marathon. J Sports Sci Med. 2004;3:37–43. as reported in the quoted critical analysis (6) above

9. Jo¨nhagen S, Ackermann P, Eriksson T, et al. Sports massage after eccentric exercise. Am J Sports Med. 2004;32:1499–1503.

10. Declan A.J. Connolly, Stephen P. Sayers, and Malachy P. McHugh “Treatment and Prevention of Delayed Onset Muscle Soreness” Journal of Strength and Conditioning Research, 2003, 17(1), 197–208

11. Howatson G, van Someren KA. “The prevention and treatment of exercise-induced muscle damage.” Sports Med. 2008;38(6):483-503

12. A Moraska “Sports massage: A comprehensive review” Journal of Sports Medicine and Physical Fitness; Sep 2005; 45, 3; ProQuest Nursing & Allied Health Source

13) Kenneth Jay, MSc, Emil Sundstrup, MSc, Stine D. Søndergaard, BSc, David Behm, PhD, Mikkel Brandt, MSc, Charlotte A. Særvoll, MSoSc, Markus D. Jakobsen, MSc, Lars L. Andersen, PhD “SPECIFIC AND CROSS OVER EFFECTS OF MASSAGE FOR MUSCLE SORENESS: RANDOMIZED CONTROLLED TRIAL”


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