Does sports massage have a significant impact on the process of recovery after maximal exercises?

From 1960s to the mid 1980s, a large percentage of the Olympic gold medals used to go to the former Soviet Union, Eastern Germany, Bulgaria, Romania, and other countries in the Soviet bloc. I do not believe that these athletes had a greater physiological potential. However, I know that protocols of Medical and Sports Massage that were developed through extensive research in these countries greatly contributed to the athletes’ achievements, as well as to the prevention of sports-related injuries.

The foundation of the modern medical massage began in the early 20th century with Anatoly Sherbak, a leading Russian physician and scientist of the time. Spending more than 20 years on research and clinical studies, Sherbak investigated and developed medical massage procedures as a powerful reflex therapy method. His basic approach was to eliminate abnormalities in reflex zones — specific areas that include the skin, muscles, connective tissue, periosteum, which could be the result of inner organ diseases as well support and movement system disorders.

He believed that inner organ diseases transmit pathological impulses via a given spinal segment of innervation to the various somatic structures on that segmental level. As a result of these pathological impulses, abnormalities develop in all structures of that particular reflex zones, and are expressed in the form of higher skin density, muscular tension, the development of trigger points, high tension and immobility of connective tissue, hypertrophy or atrophy of the periosteum. These abnormalities cause pain, discomfort, limited range of motion and a variety of other symptoms. When diseased inner organs are the cause of abnormalities, the reflex phenomenon is termed “viscero-somatic reflex.”

At the same time, spinal disorders such as spondylosis can promote the development of abnormalities in the reflex zone — in both somatic and visceral components. The pathological impulse generated by such a disorder can not only cause pain at its somatic origin, but also reach inner organs and disturb their function. This reflex phenomenon is termed somato-visceral reflex. Hippocrates, the “father of medicine,” once said, “If a patient has a health problem, first check his spine.” There is much truth in this statement.

According to Sherbak, the application of medical massage techniques by a practitioner helps to eliminate abnormalities from somatic elements, which will then reduce pain and increase range of motion. Additionally, a therapeutic effect on inner organs via medical massage application can be observed.

It is very important to understand that not always abnormalities in skin, fascia and periosteum could be detected because of needed time for incubation. On the other and any inner organ diseases, stress or support and movement system disorders, causing to muscles reflect almost immediately. In any of the mention above case scenario all components of soft tissue (skin, fascia, muscle, other connective tissue) still biologically active zones. By mobilizing this soft tissue we awaken significant positive changes in function of organs and systems.

Sherbak left a tremendous database of research behind. Before his death in 1936, he made appearances before various European medical community. He asked physicians and scientists to take over his database and continue his work in developing a medical massage procedural protocol.

Two German physicians, O. Glezer and V.A. Dalicho, answered the call. They spent an additional 20 years on medical massage studies and clinical work. In 1955, Glezer and Dalicho introduced a complete medical massage protocol to the medical community, including detailed information on the physiological effects of massage. Additionally, they published more than 20 maps of reflex zone abnormalities, including those associated with cervical spondylosis, cardiovascular diseases, digestive system disorders and many others. These maps have proven to be of tremendous use, aiding the practitioner to look for abnormalities in the skin, muscles, connective tissue and periosteum. One of Glezer and Dalicho’s greatest contributions to medical massage was their development of palpation diagnostic procedures, enabling the practitioner to detect abnormalities. In other words, they made the work of the massage therapist easier, leading to safe, rapid and stable results. Is the use of O. Glezer and V.A. Dalicho maps is a must and whether it’s possible to reach results without using O. Glezer and V.A. Dalicho, maps?

No doubt, this could be accomplished because all techniques of soft tissue mobilization that are in massage therapist arsenal are automatically eliminate mentioned above abnormalities. In my opinion use of O. Glezer and V.A. Dalicho maps just a tremendous help to a massage therapist yielding saving much time and allowing to detect abnormalities much more precisely.

Subsequently, Medical Massage methodology was further developed in the Soviet Union and other countries of the Soviet bloc by multiple research centers. The developed protocols weren’t available to the general public. By making these methodology available to only elite Olympian athletes it was used as a tool in the ideological war between the West and the Soviet system during Olympic Games. The usage of these protocols improved athlete’s performance and kept sports injuries to a minimum these athletes allowing to extend the athletic longevity and provided a great medal count all through 1960’s and 19080’s.

However, after the fall of the Soviet Union, the government support to the research institutions interrupted and for a while the methodology was only left in the books and in minds of a few practitioners such as Dr. Turchninov or myself.

The possibility of speeding up the athlete’s recovery by massage captured the attention of Western European and American scientists working in the field of Sports Medicine and there has been an ongoing discussion about the benefits of Sports Massage to athletes. However, authors of numerous studies in different centers mostly concluded that massage does not have any significant impact on the process of recovery after maximal exercises (Drews, et al., 1990; Carfarelli, et al., 1990; Rodenberg, et al., 1994; Tiidus, et al., 1995; Gupta, et al., 1996, and more). All these studies were conducted by very responsible scientists and published in respected professional journals.

Thus, everyone who became familiar with this matter deserves the clear answer to the question: Who is right?

Let me point out that the research studies have been conducted based on the Swedish rather than Medical Massage. The reason why the Western scientific community is apprehensive in utilizing Medical Massage methodology lies in the fact that Medical Massage protocols were developed in the Soviet Union. Even though these protocols were developed through research via rigorous RTCs, it was conducted and recorded in Russian and hasn’t been translated in into English due to the fact that at the time the Soviet Union and the USA were in the midst of the Cold War. Thus this research is not in any of the English existing educational databases such as Medline; PsycINFO; the Cumulative Index to Nursing, Applied Health; Educational Resources Information, Center (ERIC), the National AGRIcultural OnLine Access, Cochrane Collaboration libraries, etc. Because of that reason it is dismissed as empirical.

There is no doubt in my mind, that the issue of sports massage importance is significantly misunderstood and misrepresented.

I feel that the ”right” opinion manifest itself by the greater clinical outcome. At the same time it is a good practice to put science behind the concept that will explain the great outcome.

In the meanwhile, one published article on this matter, puts everything in the correct perspective. In this study, a group of North Carolina and Virginia authors (Smith, L.L et al., 1994) formulated a protocol based on recommendation of Russian scientists, proving its value. The authors examined the effect of massage on delayed onset muscle soreness, and creatine kinase (an enzyme indicator of muscle damage) and neutrophil (an inflammatory white blood cell) count. The authors adjusted their experimental protocol according to the practical recommendations of the Russian authors. These authors considered that vigorous exercises damaged muscular tissue with the development of aseptic (noninfectious) inflammation and interstitial edema. The body reacts to these events by mobilizing neutrophils to the affected area. Neutrophils enter tissues and start their cleaning job (i.e., phagocytosis) to remove the debris produced by the muscular injury and inflammation. Their increased concentration also attracts other types of phagocytic cells, macrophages. In the process of phagocytosis, catabolic enzymes are released from neutrophils, additionally damaging already injured muscular fibers. Dr. Smith and associates, through their research, noticed that two major events indirectly support this theory: the temporary reduction of neutrophil count and increased concentration of creatine kinase in local blood vessels, and their following migration into soft tissues as critical elements responsible for the long lasting muscle soreness after vigorous exercises.

This study showed that this process precisely matches the 2 hour time limit after vigorous exercise. By starting post event sports massage 2 hours after vigorous exercise we prevent injuries and re-injuries of soft tissues by phagocytosis process. At the same time, massage therapy regulates and supports phagocytosis – the removal of debris, produced by the muscular injury and inflammation.

The fact I have described above, makes us realize the crucial importance of sports massage, in prevention of sports related injuries and performance improvement.

Side effects of vigorous exercise leading to elevated muscular resting tone. Blood vessels within muscles constrict as well, and provide less blood supply to muscles, fascia, tendons and ligaments. Increased peripheral vascular resistance, increasing cardio work. In such case, in order to support heavy cardio work, increase in the production of stress hormones is necessary. As you can observe, the process unwinds into a negative chain reaction caused by side effects of vigorous exercise. Since this process starts from accumulation of tension within skeleton muscles, the therapy have to start on level of muscles as well.

This is what Smith, et al., had to say in conclusion:

“During acute inflammation, blood flow slows as vessels dilate in an area of injury. When this occurs, the white blood cells, including neutrophils, are displaced from the central, axial zone of blood flow to the peripheral, plasmatic zone and subsequently marginate along the vessel walls. Since sport massage appears to increase blood flow through the vascular bed, we theorized that this increased flow rate in the area of microtrauma could prevent the typical outward displacement of neutrophils. In addition, we speculated that the mechanical action of sports massage could shear marginated cells from vessel walls and thus hinder emigration of cells from the circulation into tissues spaces. …control group exhibiting a more rapid and steeper increase CK (i.e. creatine kinase) values than the massage group. …sports massage rendered hours after termination of unaccustomed eccentric exercise reduces the intensity of delayed onset muscle soreness and reduces serum creatine kinase levels.”

Let’s keep in mind that these findings are strongly supported by clinical outcome.

The father of theoretical medicine, Hippocrates, once said: ”the human body carry natural potentials to heal himself, and we doctors, must stimulate this potentials.” In other words, we are not healing human body, we just capable of intensely stimulating the healing process. This is what massage therapy is about.

For additional reading, refer to:

Smith, L.L., Keating, M.N., Holbert, D., Spratt, D.S., McCammon, M.R., Smith, S.S., Israel, R.G.: The Effect of Athletic Massage of Delayed Onset Muscle Soreness. Creatine Kinase and Neutrophil Count: Preliminary report. J. Orthp. Sports Phys. Ther., 19(2): 93-99, 1994.

Dr. Dembo’s study was published in “Physical Culture & Sports” from the book series “Science for Sports.” (1981)