By Dov Michaeli
Posted 1/6/12 on The Doctor Weighs In
Massage therapy feels good, everybody loves it. But is it also good for your health? Intuitively we “know” that it is “good for you,” but where is the objective evidence?
For the weekend warriors, which is most of us, the feeling is familiar. You run 10 miles, or do one hundred pushups; you feel great, and disgustingly self-rightous. But then comes the morning-after, and it’s payback time: your muscles are sore, you are waddling like a duck, and you feel generally stupid for overdoing it. First thing you do is reach for the ibuprofen or aleve, or some other NSAID (non-steroidal anti inflammatory drug). Don’t! There is a better way to deal with it.
A February 1, 2012 paper in Science Transnational Medicine by Mark A. Tarnopolsky and his colleagues from McMaster University in Hamilton, Ontario, is the first study that puts our intuitive “gut feeling” on solid experimental ground. The paper is also featured in an article in the New York Times. To assess the effects of massage, they administered either massage therapy or no treatment to separate quadriceps of 11 young male participants after exercise-induced muscle damage. They “inflicted” the damage by having the volunteers exercise on a stationary bicycle for over an hour, to exhaustion. Muscle biopsies were acquired from the quadriceps (vastus lateralis). On a first visit, they biopsied one leg of each subject at rest. At a second session, after the exercise on the stationary bicycle they massaged one thigh of each subject for 10 minutes, leaving the other to recover on its own. Immediately after the massage they biopsied the thigh muscle in each leg again. After allowing another 2.5 hours of rest, they did a second biopsy to track the process of muscle injury and repair.
They found that two intracellular signalling cascades were activated: one that respond to mechanical stimulation (FAK) and one that responds to extra-cellular chemical signals (ERK). Mechanical deformation of tissue is what the kneading and pushing and pressing is what a massage does.
But wait, that’s not all. By examining the biopsies they found an increase in the bio-genesis of new mitochondria. These are the tiny organelles in the cytoplasm that are the cell’s powerhouses. How could the cell increase it’s content of mitochondria in response to massage? By receiving a signal from a protein (PCG-1α) that triggers the synthetic mechanism of mitochondrial biogenesis. This protein was elevated in the massaged tissue.
These finding make perfect sense. After vigorous exercise there are tiny tears in the muscles that need to be repaired. This explains the rise in cell growth and division signals, like FAK and ERK. And the intensive cellular activity that takes place during wound healing requires a lot of extra energy -which is supplied by the newly-formed mitochondria.
These findings explain the enhanced healing of the muscle, but there is another aspect to exercise-induced trauma: the injury itself. It turns out that massage of the injured muscle also helped reduce damage to the muscle fibers. When tissue is injured the body responds with inflammation.
Inflammation is a double-edged sword. It serves to clean out the cell debris caused by the trauma, but in the process it causes damage to the innocent bystanders who happen to reside in the neighborhood; “collateral damage” in military parlance. Only when the inflammation subsides does the re-building of new tissue begin. The instigators of inflammation are the injured cells themselves, as well as white blood cells rushing to the injured site. They secrete proteins called cytokines with such colorful names as interleukin 6 (IL 6), tumor necrosis -α (TNF-α), as well as intracellular factors such as Heat-shock Protein 27 (HSP27), and Nuclear Factor κB (NFκB), all of which all signals for initiating and sustaining inflammation. Is there an effect of massage on the mediators of inflammation? Yes. It reduces their release, thereby limiting their injurious effect on the surrounding muscle fibers.
So now we have the complete picture of what we can call the cell biology of massage. It limits inflammation and its destructive activity, and it promotes rapid healing of the injured tissue.
One last question: why not simply take anti-inflammatory drugs? For two reasons: first, they can interfere with wound healing and actually delay your return to full activity. Second, they are not as pleasant and emotionally healing as a massage given by a masseur or masseuse who know what they are doing. This of course assumes that massage has an effect of the brain, and it does. More on that tomorrow.