PF Episode 24: Massage: The Original Medicine

Massage: The Original Medicine

Jen: Welcome to Practically Fit, Real Fitness Over 40. I'm Jen Chamberlain.

Alex: And I'm Alex Johnson.

Jen: And today we're going to talk about bodywork, a broad category of therapeutic practices including massage, acupuncture, acupressure, cupping, cryotherapy, and my favorite, myofascial release. But before that, let me just say I am recovering from a cold, so I might sound a little rougher than usual.

Alex: Yeah, you can definitely hear it.

Jen: So anyway, we're going to talk about bodywork today. What are the benefits? Does it work? And of course, we'll share some of our key takeaways in case you want to give it a try. So, Alex, I feel like you're kind of a regular. I mean, you get a massage, what, like twice a week?

Alex: Not twice a week. But yeah, I do go pretty often. It's something I've enjoyed for many years, since my late 20s, and I've been able to increase the frequency over time. So yes, I do go pretty often, and I have a lot of experience with massages.

Jen: Yes, I know you do. And one time we were recording for this podcast and you had these weird round lesions, and I'm like, what is that about? And then you told me it was cupping, which I tried one time, but I really thought it was bogus, to be honest, until recently a vet tech told me there's actually something scientific to it. That's really one of the reasons I wanted to take a deeper dive for this episode. So we'll talk about that, we'll talk about massage, and we'll talk about my favorite forms of bodywork, which are deep tissue massage, myofascial release, and the occasional plunge into an ice bath.

Alex: Oh yeah. Now, on the cupping, you're being hard on it. It's not lesions, it's just sort of marks. It looks like bruising, but it doesn't hurt. It's interesting, we'll talk about it. I've kind of turned around my viewpoint on the whole cupping thing, so we can talk more about that.

Jen: Yeah. But as always, we wanted to take a look at the science behind some of these practices. So, Alex, what did you find?

The Science of Massage

Alex: We thought we'd start with massage, since that's something we both have some personal experience with, and it's also been practiced for a very long time. According to an article we found in American Psychologist, quote, "massage therapy is older than recorded time, and rubbing was the primary form of medicine until the pharmaceutical revolution of the 1940s." And I shouldn't be laughing, but that's just freaking hilarious.

Jen: I know, it's funny. And also, I mean, before medicine, we just had rubbing. That's pretty sad, too.

Alex: Well, no, massage is great. It just does not strike me that it should be our only form of medicine. According to the same article, massage has, quote, "empirical support for facilitating growth, reducing pain, increasing alertness, diminishing depression, and enhancing immune functions."

Jen: Wow, lots of benefits.

Alex: Yeah, and those benefits are more on the mind-body side of the equation, but massage has also been shown to have direct physical benefits. We found an article dating all the way back to 1994 — one of the older ones we've cited — from the British Journal of Sports Medicine, which is a well-respected journal, titled "Massage — The Scientific Basis of an Ancient Art: Part 2. Physiological and Therapeutic Effects." Some of the effects the article highlighted include the dilation of superficial blood vessels and an increase in the rate of blood flow that you get with gentle massage. Forceful massage, which is what I like, increases both local blood flow and cardiac stroke volume. That sounds bad when you hear "stroke," but it's the amount of blood your heart can pump out to meet demand, so it's a good thing, and it can accelerate healing.

Jen: Yeah, exactly.

Alex: I've got to say, this whole gentle-massage thing is not my thing.

Jen: You need the deep tissue.

Alex: You've got to go deep. That's right. Fascinatingly, research cited in this review found that when massage is applied to one limb, blood flow also increases in the other, which could be useful if you have an injured limb that's too sensitive for direct massage. So that's really interesting. The review also says massage decreases the incidence of deep vein thrombosis by 82%. The only time I've ever worried about that was when I broke my leg and had to fly, so massage being beneficial there is good to know.

Jen: Oh yeah, so you had both risk factors at the same time. I didn't think about that — an injury, or anytime you're debilitated, is one, and flying is the other.

Alex: Yeah, that was not a fun flight. I should have gotten a massage before I got on the plane. It also reduces swelling, and according to the journal article, the mechanism by which it does so is uncomplicated, but we found it too complicated to explain, so we'll just take their word for it. Massage can also help alleviate connective tissue damage, which, according to the article, many people suffer from by failing to warm up properly before exercise. Who would that be? And what they term deep friction massage helps maintain or improve the mobility of joints, tendons, and muscles, and prevents adhesions from forming in your muscles. In fact, deep friction used to treat athletes suffering from overuse injuries of the knee was a more effective treatment for reducing pain than rest, ice, stretching, or ultrasound — which I can say I've experienced myself with my knee, for example, when I was having issues with my IT band.

Jen: Really? That's cool.

Alex: A couple more findings from the study: massage can ease the pain from muscle spasm, which the article notes is extremely uncomfortable. And finally, massage has been scientifically demonstrated to alleviate pain by activating the so-called "pain gate" mechanism. Basically, this is the idea that a non-painful stimulus can close the gates to a painful stimulus. Although I will say my massages are often painful, so I'm not sure what they were looking at when they came up with that finding. Clearly not deep tissue massage on somebody with a lot of stress knots in their shoulders. So the article concludes that massage is a safe, low-technology therapy — again, this was our only medicine up until the 1940s — and a valuable treatment option in sports medicine.

Myofascial Release and Foam Rolling

Jen: Wow. I mean, if I wasn't a believer before, I definitely am now. I'm going to feel a lot better about splurging on a massage from now on. I've found particularly good results recovering from injuries through deep tissue massage and also myofascial release, which I wanted to talk a little about. This is massage that specifically targets the muscles and the muscle fascia, as well as foam rolling, which is supposed to target the same areas — those are the foam rollers we've talked about that you can use for some self-massage. So I looked into some research on this specifically, and I found an article in the Journal of Bodywork and Movement Therapies titled "Effects of Self-Myofascial Release: A Systematic Review." It found similar benefits for myofascial release as for massage in general, all the things you just mentioned, Alex. It seems to increase flexibility and reduce muscle soreness, and it can lead to improved arterial function — that's kind of like the blood flow we talked about — and also increased parasympathetic nervous activity. When that's activated, it's an interesting response: it slows our heart rate and breathing rate, reduces our blood pressure, and improves our digestion, and all of these can aid in recovery. So, all really good things.

Alex: Yeah, I've always heard that about blood pressure as well, so that's another benefit if you have high blood pressure. It can be very helpful.

Jen: Yeah. One interesting note when I was researching this: in terms of side effects, one was reduced blood pressure. So for people with very low blood pressure, like me, you could actually get a little lightheaded, because it reduces it even further. That makes me realize why they tell you to get up slowly from the table.

Alex: Have you ever had that, where you feel lightheaded after a massage?

Jen: I haven't, but it just made me think about it — an interesting side effect. So do get up slowly from the massage table. The verdict was less clear on foam rollers, I have to say. And Alex, you and I have been big users of these for a while. I found a 2019 article in Sports Medicine, which I didn't buy because it cost $50, but according to the abstract, "there is insufficient evidence to support that the primary mechanisms underlying rolling and other similar devices are the release of myofascial restrictions. Thus, the term 'self-myofascial release' is probably misleading." Womp womp.

Alex: I mean, I think more study is needed. Don't you feel the release sometimes when you're using those foam rollers, especially on the IT band? I think they need to do more study on this.

Jen: Well, my theory is also that it might be hard to control the results, because, as you and I talked about before, there are varying levels of these foam rollers, and it probably depends on the technique the person's using. So I'd agree with you, probably more study is needed.

Does Cupping Work?

Jen: But Alex, what about that painful-looking cupping that we talked about? Is there any actual science behind that?

Alex: Yeah, as a matter of fact, there is. An article in the Journal of Acupuncture and Meridian Studies titled "Cupping Therapy: An Overview from a Modern Medicine Perspective" tells you everything you wanted to know and more about the practice.

Jen: Let's hear it.

Alex: It's been around a long time — much like massage, it goes all the way back to ancient Egypt, circa 1550 BC. There was a medical text called the Ebers Papyrus, which is one of the oldest medical texts to mention cupping therapy. There are various theories about how it works, but according to the article, quote, "there is no clear identified mechanism of action of cupping therapy." Nevertheless, it concludes that there is growing evidence of potential benefits in the treatment of some diseases, especially pain-related conditions.

Jen: Yeah, very cool. And that's kind of what my vet tech was saying: basically, it stimulates your body to send certain enzymes and chemicals to the area so that you heal faster, which is why it would be useful in areas where you're particularly tight or sore. Very interesting, but it still looks pretty awful, I have to say.

Ice Baths vs. Cold Showers

Jen: But while we're talking about things that look or maybe seem awful: prior to moving to San Francisco, my favorite form of self-torture was plunging into an ice bath after a particularly hard run or a race or a marathon. As it turns out, there's not much scientific support for that one. I looked at several articles, but I'll cite one in particular in the Journal of Physiology titled "Is the Ice Bath Finally Melting? Cold Water Immersion Is No Greater Than Active Recovery upon Local and Systemic Inflammatory Cellular Stress in Humans." A clever title for a research publication, I have to say. But basically the title says it all: it's no greater than active recovery.

Alex: Yeah, I've never done an ice bath, never, but I've been doing the cold shower lately.

Jen: Yeah.

Alex: For the listeners, I think the cold shower is awesome. I do it because I think it's good for your muscles — I've read both hot and cold showers can be good for your muscles — but also it's a great anxiety reliever. If you're feeling that stress, that cortisol, fight-or-flight feeling, a cold shower can really get you out of it. My advice, if you do it: rather than just taking a cold shower, which is miserable if you're used to hot ones, I'll do my normal hot shower, then stand under the water and slowly turn the dial until the heat starts to go out of it. I let it sit, and then it gets a little colder, and a little colder. It's still really cold when you get to the cold side of the dial, but I've found that's an easier way to do it. And if you're able to take it for just a few minutes, I feel so relaxed when I come out. So — plug for cold showers on the podcast.

Jen: Well, I have to say, though, you also still live in Texas, and I took a lot of cold showers when I was in Texas and it wasn't that uncomfortable, because for one thing, the water's not that cold in the middle of the summer, and for another, if you've been out on a hot day, it feels a lot more refreshing. That's why I said "prior to moving to San Francisco" — it's a lot less appealing when it barely gets above 55 on any given day. But to your point, Alex, there is actual science behind the relaxation properties of cold showers, so they're definitely good for anxiety and for just making you feel generally relaxed.

Alex: Yeah, absolutely. So you're saying if you live somewhere like Colorado or Canada or Norway, you don't want to do it — it's just miserable, not even worth it.

Jen: Yeah, it's just psychological. You've just spent an hour being cold, and do you really want to be more cold?

Alex: That's a good point, although it might actually feel less cold than being outside. I don't know.

Jen: I'll have to try. No, just take my word for it on that one.

Acupuncture and Acupressure

Jen: I want to talk about one more thing before we get to some of our own stories and experiences. A friend suggested I include acupuncture and acupressure in this episode. I don't have any personal experience, but I did want to talk briefly about it from the scientific perspective. Like cupping and massage, acupuncture has been practiced for thousands of years, but it's only been studied scientifically relatively recently. There's a solid body of literature that supports acupuncture, particularly for pain management — especially back or neck pain, knee pain associated with osteoarthritis, and post-operative pain. One of the theories is that it works on that pain gate mechanism we talked about earlier, where the idea is that you have an intense stimulus — so, to your point about deep tissue massage — that sort of shuts off the pathway to pain, which is also an intense stimulus. I can't say I understand it a hundred percent scientifically, but it's pretty well recognized.

Alex: It's a dumb question, but I've always wondered this, so I'm glad we're talking about it, and maybe you know or saw it in your research: does acupuncture actually hurt?

Jen: My friend who does it says it does not. Others have said mildly. This is probably an unscientific way of putting it, but it's almost tricking your body into a sensation you don't actually read as pain, though it gets right to the nerve point where there would be pain. So your body reads it as pain and then shuts off the gate to future pain, if that makes sense. That's my understanding of the mechanism.

Alex: Interesting.

Jen: Yeah, it's really interesting. She says she's had really great success with it for a lot of different conditions, both physical — she had the dreaded piriformis injury that I've struggled with, which is so hard to treat, and she said acupuncture really helped for that — and also with some stress-relief and anxiety issues. So I just wanted to put that out there. I also wanted to cite an article from the National Library of Medicine that had similar results for acupressure, which is often an alternative for people who have a fear of needles or maybe just don't want to try acupuncture. I'll quote from that article: "As a whole, acupressure is a manually operated, needle-free, non-invasive, cost-effective, and non-pharmacological healing intervention to promote patients' well-being." So that's something to consider if you're dealing with these pain conditions, especially.

Our Own Experiences: Deep Tissue, Medical Massage, and More

Jen: So I thought we'd talk a little about our own experiences in this area — do's and don'ts, that sort of thing. What about you go first, Alex?

Alex: Yeah, I think people should be open to trying different things when it comes to bodywork. A lot of people think of massage as that Swedish-type massage, which is supposed to be very relaxing, sort of rubbing your body. But you should be open to deep tissue massage — I really think that's where the benefit comes in. I get that pretty frequently, as Jen mentioned, and it helps me a lot with all the knots. If you're active, you're going to cause knots in your muscles. If you have a lot of stress at work, which both of us often do, you'll get knots in your neck. If you're working from home a lot and sitting, all these things compound upon each other. So I'd be open to deep tissue if you have that kind of situation in your life.

Jen: Yeah, I have two things to add on that. First, in terms of the knots, those are the adhesions I was talking about earlier in the research. There was one study specifically that looked at frozen shoulder, which my mom had briefly — it's where you lose range of motion in your shoulder and actually can't move it beyond a certain point. It happens to a lot of people for a variety of reasons, and massage is one of the best ways to alleviate it, so it really works. When they work those knots out, it's really helping prevent further immobility down the line. And then I wanted to mention one very specific incident I had with massage. I was in a car accident in my 20s, and it was the classic thing where it didn't hurt at first, and then three days later I had the neck pain you get from whiplash. I went to a massage therapist, and with about three sessions she was able to completely work it out. It's just really impressive. And I didn't have to call up one of those ambulance-chaser lawyers.

Alex: Yeah, and I want to go back to the shoulder thing, because I have trouble with my right shoulder. I injured it doing barbell bench presses about five years ago now, and it's been weird ever since. It gets sore sometimes when I lift weights. And I feel that in the US there's just this bias toward surgery — tons of people say go to the doctor, go to a specialist, oh, you need surgery on your shoulder, and it's for little small things. So I'd second this idea that massage can really help if you have problems with your shoulder. I get some pretty deep, intense work done on my shoulder sometimes, and it really helps loosen it up and makes me feel more mobile again. The other thing I'd say about deep tissue is to look for somebody who practices medical massage. The last two people I've gone to have done that. The previous person I went to had studied this in Mexico and was amazing — I didn't know it was a discipline in massage, and it was totally different from even the deep tissue massages I'd had before. It's very much rooted in sports medicine. So medical massage, I think, is the way to go. Jen, have you ever tried any different types of massage, like Thai massage? Where they walk on top of you? I'm curious.

Jen: I've tried a few new ones since I moved to San Francisco, because we have a huge range of massage options. I went to a Thai massage place — they didn't walk on top of me, but they did a lot of stretching of my limbs as they were doing the massage, which I thought was really helpful. I also did shiatsu, which is a very intense deep tissue massage that they only do on your back, basically. That was super helpful for the knots you're talking about. It was one of the more intense massages I've ever had, but I felt it was really beneficial in getting to some of the places that really needed to be worked out. But that's a great tip about medical massage. I've been going to a sports massage therapist here who's worked with some NFL teams, actually, which is kind of cool, and I've had really great results with him. I didn't know medical massage even existed before I started researching this.

Alex: Yeah, I like the stretching too. They'll do this with medical massage sometimes, depending on what you're feeling in your body — they'll literally get up on the table and stretch you out. It's amazing. I did Thai massage as well, and they actually did the thing where they walk on top of you. I didn't like that. I don't mind it on my legs, actually — that feels good — but I've had somebody walk on my lower back, and it feels like it's pressing your inner organs down. I didn't like that, personally. The stretching part of it, though, is amazing. I guess the other thing I wanted to go back to was cupping.

Jen: Yeah.

Alex: I've only experienced it recently, and I find it most beneficial when I have a deep knot. Sometimes the person who does my massage will use cupping on that knot, and I can definitely feel that when she puts the cup on and takes it off, it's helped loosen up the knot. So I definitely think there's something to it. I've had it on my shoulder when I'm having trouble with that, too. The other reason I think the evidence is going in the direction of it being beneficial is that you see athletes doing this — like Luka Dončić, who plays for the Dallas Mavericks. He's got cupping marks on him all the time. He's an elite athlete, and if I see an elite athlete doing something, most of the time it's not nonsense, right?

Jen: Right, exactly.

Alex: I've had a pretty good experience with it. Facial cupping feels really good, and it's not supposed to leave marks, but I actually have two marks on the side of my face from last week. So watch out for that one.

Jen: So I'm curious, have you had any bad experiences with any of the alternative therapies?

Alex: No, I wouldn't say bad experiences. The closest to a bad experience, like I said, was the walking on my back. That felt like it was doing more harm than good, so that's what I'd say as far as a bad experience. I think it's an amazing form of therapy, and it also cuts down on some of the self-myofascial release you have to do. The one downside, again, is that it can be expensive — that's the tough part about massage. I don't know, will insurance cover this for some folks?

Jen: It depends. But I did want to talk about the expense, because while I haven't had any bad experiences, I've had some disappointing ones, where I wanted a deep tissue massage and even though I communicated that, I didn't really get it. Because it's expensive, that can be really disappointing. So one of my tips is to get recommendations from somebody who's gotten a massage from that person and had good results, if you can — a personal recommendation, or at least read the Yelp reviews or something like that — because it is expensive, and you don't want to spend your money and feel like you didn't get much out of it.

Alex: Yeah, that reminded me of one bad experience I had forgotten about. It was a Groupon many years ago, a couples massage, and it was just horrible. Maybe I just got unlucky with the therapist, but I'll never forget her intensely rubbing the top of my feet, on the bones, and it was just pain. I'm like, what is this? This doesn't feel good.

Jen: Right.

Alex: There can't be much benefit to it. It was excruciatingly painful, and I felt like, okay, it's not like you're getting a knot out of the top of my foot. It's bone. You're rubbing bone. So that was a bad experience.

Jen: That doesn't sound good, because the people who've taught me about foam rolling have always said don't roll over the bones. You shouldn't really mess with your bones too much — it's supposed to be your muscles, the tendons, and the fascia. So that sounds like a really bad idea. I wouldn't go back to that massage therapist.

Alex: I did not. So maybe don't do your massages through a Groupon would be my advice.

Jen: Right. But I will say you can sometimes save money if you buy a package, if you find a good masseuse — packages can cost less. I had a friend here in the city who shared a package with me, which was really nice. She bought a certain number of sessions, and then we were each able to use them. So there are ways to save some money, but I would still say get a recommendation. And the other thing I learned through researching this podcast is to have an open mind. When you showed me this cupping thing, I very closed-mindedly said, oh, that's totally bogus. But it turns out there's science behind it. And like you said, Alex, our bias in the United States is so much toward medication and surgery, when a lot of times there are other things that could be an intervention beforehand.

Alex: Yeah, exactly. My big takeaway from all of this research, which sort of reinforces the experiences I've had, is that massage and some of these other techniques are really amazing, and there's a reason people have been doing them for such a long time. They can be beneficial for your body. So, highly recommended if you have the chance to get a massage, especially deep tissue.

Wrap-Up

Jen: And tell us about your results. We'd love to hear it. We're always open to stories, and we're going to be having some special guests on soon, so we'd love to hear your stories on this topic or any others.

Alex: Yeah, that's right. So that's our podcast on massage. Hope you learned something this week, and maybe opened your mind to something new in terms of bodywork treatment. Until next week, remember you can always check us out over at practically.fit. Sign up for the newsletter — we've been getting a lot of new subscribers, so that's exciting. Just head to practically.fit and put your email address in, and you'll get our great content every week in your inbox. And of course, the podcast will come directly to you as well. If you're enjoying the podcast, please feel free to go out and comment over at practically.fit if you'd like to share your story, or you can also rate the podcast — it's really helpful if you do so on Apple Podcasts. We appreciate that. Until next week, remember: fitness is for everybody.