Does massage work?

Well, obviously the fact that I have dedicated a large part of my career to massage therapy is probably a spoiler…

BUT - as always - there is some nuance here (and, well, I guess the fact that the other part of my career is dedicated to strength & conditioning coaching is probably also a spoiler here - but there is more to it than just combining the two).

Let’s be clear: the research basically says massage doesn’t work. I’m not here to contradict that! It is tempting to go on a tangent here and question whether the desire to make everything “scientific” and “evidence-based” maybe goes a little too far at times - but I won’t, because I will lose those of you who rely on scientific evidence to buy into a therapy, and really you are the ones I am talking to.

But there’s a bit of a fallacy here that everyone may not be aware of. The gold standard in scientific research is the double-blind randomised controlled trial (RCT): one group gets an intervention, the other group gets a placebo, nobody in the group knows what they’re receiving and neither do the people giving the intervention or placebo. It is very clear why this won’t work for a study on massage: you know you are receiving a massage, and you know if you are giving a massage.

Other modalities, such as acupuncture, have worked around this by using “sham acupuncture”: needles are indeed inserted, but not in relevant acupuncture points.

Unfortunately (or fortunately, from my point of view), we know that any from of touch between two humans has an effect on the receiver, whether they are trained to give massage or not. In fact, in one of my favourite studies, “tonic heat stimuli” were administered to women (i.e. they were mildly burnt) under several different conditions: their partner touching their hand, their partner in the room, a stranger touching their hand, or no interaction. The women receiving touch from their partner rated the pain they experienced as lower than in the other conditions. (no, I don’t know why they chose to burn the women and not the men - ironic, given how little research is actually done on women)

Now, I know what you’re thinking, but rest assured I am the first person to admit that my job is not rocket science: you touch someone, and they’re likely to feel better. The other part of that study I mentioned is empathy: more empathy from the person giving the touch resulted in less pain for the person receiving the touch. Granted, I am not trained in empathy and to my knowledge this isn’t something other massage therapists get trained in - but there’s a chance those of us in this profession are empathetic people! Or, well - we are for our clients (I famously had to imagine that a particular person close to me in my personal life was in fact a client, in order for me not to lose my temper with them). If we are any good at our jobs, we leave our stuff at the door when we come to work, so we can be fully present for you and your pain. If you’re lucky enough to have someone in your life who can do that and give you a little neck rub… honestly save yourself a few € and take advantage of that!

So if that’s all there is to it, why have I spent 3+ years studying massage and scar therapy and IASTM and cupping and dry needling and and and…?

Well, it’s important here to say what does work to get people out of pain: movement.

And yes, if someone is not moving at all, maybe just getting them to start walking a bit, or taking the stairs, or doing squats while they wait for the kettle to boil, will help with some of their issues.

But for many people (including the example above, but you have to start somewhere) the problem they have has arisen from repetitive movements and postures: for example, spending a lot of time in hip flexion; sitting in the car, sitting at the office, going to the gym to sit on the exercise bike and then do some hip thrusts but not realising you are stuck in an anterior pelvic tilt because your hip flexors are used to being short and tight (don’t worry if you don’t know what all that means: the point is, you can be doing the right things but not actually achieving the outcome you want, because your tissues won’t let you), then sleeping on your side with your knees tucked up in the foetal position.

I think these women think they’re working their glutes, and maybe their abs… but they’re working neither of those effectively; see how their backs arch and their pelvises are spilling forwards?

It’s the reason I can’t/won’t go to mainstream gyms… it breaks my heart too much to see all these people pouring time and energy into exercises they think are good for them but aren’t doing what they think they are.

So your physio gave you exercises to work your hip extensors (i.e. your glutes) - but that’s hard because your glutes aren’t used to working, and your body has already found other ways to do the movements you need (like using your lower back to pull you upright), so it’s very helpfully going to keep using those muscles instead of troubling you with a whole new movement pattern. And no, your body isn’t “weak” or “lazy”: it’s super efficient! This muscle has been switched off because it’s been comfortably bunched up for 23 hours a day, but this one is already all tight and hyperactive, so let’s just let it jump in - it’s like your overeager colleague; I mean, it would be rude not to give them the satisfcation of getting the job done… right?

This is where massage can come in:

We can ease the tension in those overactive muscles, making it just a little harder for them to jump in all the time.

We can release the tension in the underactive muscles: have you heard the adage “long muscles are strong muscles”? Well, when they get all tight and bunched up they are not in a position to contract, so they can’t do the work you need them to do: a muscle works by contracting, so if it’s already fully contracted, it’s got nowhere else to go. And, well, long muscles are not necessarily strong muscles; if they’re all stretched out and stuck there (as is the case for the abdominal muscles during pregnancy, or even when people carry a lot of fat on their bellies), they also can’t work properly because they get “locked” into that long position from which they keep trying to contract unsuccessfully - so those can also develop trigger points and adhesions that may benefit from manual releasing.

But another very interesting, and rarely talked about, benefit of massage is in the recalibration of your body schema. Your body schema is your sense of the shape of your body and what is where. It’s how when someone touches you with your eyes closed, you know where they touched you (to a certain extent: in chronic pain sufferers, this ability is diminished - fascinatingly, we see the corresponding areas of the brain become “smudged”). Touch can help your brain map out your body schema more accurately: so when you’re trying to use those glutes that never get used, your brain is better at communicating with them and making them work.

So what I’m saying is that massage can allow you to do the thing that really helps get you out of pain: move.

In fact, I may be biased but I think massage is an essential part of the process: it helps decrease your pain so you can move more comfortably for the next day or even week, it gets dormant areas of your body back online so you’re actually working what you’re meant to be working, and it helps balance muscle tension in the appropriate places so you can do your exercises more accurately (or move through life without deepening the patterns that got you into pain in the first place).

Can’t you just stretch?

Well, you can try. In fact, maybe you should try that first, because it’s free and you can do it anytime. But the truth is, you can only stretch the most flexible part of a muscle… and also, why was that muscle tight in the first place? Probably because it wasn’t strong enough to do what it needed to do, so it got all scrunched up on itself - you release that poor muscle and keep trying to do what you want to do, and it’ll go right back to where it was. And if you love my writing (!), I have a whole blog post on stretching.

The bottom line:

If you like massage, and it works for you and your goals (which could be just enjoying a great treatment, it doesn’t have to be something super big and serious), great! Then it works! End of story.

If you like massage but it doesn’t help with your pain, maybe (probably) you need to add the exercise component or modify how you’re moving in your day-to-day, but remember that even just enjoying the treatment is a good enough reason to keep getting it.

And if you don’t like massage, well, you’re probably not reading this. But if you are, there is absolutely nothing that says you need massage or manual therapy to get out of pain.

Enjoy being your own unique individual with your own preferences and goals and needs! I think you know what you need to do but, if you want some guidance or reassurance, you know where to find me ;)