Does Sports Massage Contribute to Post-Workout Recovery?

By: Boris Prilutsky

According to Sven Jonhagen, MD, of the Institutionen Sodersjukhuset in Stockholm, Sweden, Post-Event Sports Massage has no positive therapeutic impact on post-workout recovery in athletes. The results of this study were published in the American Journal of Sport Medicine, (September, 2004). The following is an excerpt from the paper: “In this study, participants worked out for 30 minutes, giving their leg muscles intense eccentric exercise which emphasizes extending muscles, not contracting them. Within 10 minutes after their workout, each volunteer received sports massage on only one leg. The benefits of sport massage in which muscles are kneaded harder than regular massage were recently tested by Sven Jonhagen, MD Researchers saw no sign that sport massage helps in post workout recovery. Strength tests taken before, directly after, and 2 days after the exercise session showed similar results for the massaged and unmassaged legs. Both legs were sore for roughly the same lengths of time, the participants report.”
We found Dr. Jonhagen’s protocol design to be flawed. One such design flaw was the emphasis on flexion of muscles and not extension. Clearly, exercise is not possible without the use of antagonist muscle groups responsible for flexion and extensions. In order to understand the importance of Post-Event Rehabilitative Massage Therapy for professional athletes as well as for the general gym-going enthusiast, we would like to discuss the side-effects of vigorous exercise. Vigorous, intense, exercise overloads the skeletal-muscular apparatus and the cardiovascular system, causes accumulation of metabolic waste products in tissues (some of which are toxic), strains the endocrine system, and much more. When overloaded, the muscular system reacts by accumulating tension in muscles. This, in turn, disturbs metabolic processes in the skeletal and muscular systems. A higher muscular tonus (especially in the extremities) contributes to an increase in the peripheral vascular resistance, which is the main opposition mechanism for left-side cardiac work. In such a case, the cardiovascular system is not only overloaded during vigorous exercise, but also is prevented from resting due to higher peripheral vascular resistance. Given the facts described above, the endocrine system cannot function in its normal physiological regime. Additionally, over-tensed muscles produce pain, soreness, and fatigue.

Understandably, if an athlete is not rehabilitated from the side-effects of vigorous exercise, we can assume that in some cases, the athlete can possibly do more harm than good to the body. The athlete can, as a matter fact, achieve less than his or her physiological potential with lack of proper rehabilitation.

As you know, from 1960s to the mid 1980s, most of the Olympic gold medals used to go to the former Soviet Union, Eastern Germany, Bulgaria, Romania, and other countries in the Soviet block. We do not believe that these athletes had a greater physiological potential. However, we 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. Discussions about the benefits of Sports Massage to athletes have been ongoing for a while.
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. 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? After analysis of Western European and American sources we concluded that the problem is a significant misunderstanding and misrepresentation. First of all, Russian scientists always pointed out the importance of four equally important components of rehabilitative massage treatment after vigorous exercises. Failure to include even one of them will ruin all efforts:

All Eastern-European authors agreed that massage has to be started no earlier than 2-2.5 hours after vigorous exercises.

The massage session has to last from 30-40 minutes to 1 hour. During this time the massage therapist works on the athlete’s whole body with special attention to the muscular groups which were overloaded during the exercises or competition.

It is best to use the combination of effleurage, kneading, permanent vibration, compression, stretching and long range shaking. However, 40-50% of massage time has to be spent on kneading. With the proper execution of this technique the operator is able to alternate stimulation and relaxation of the massaged muscles. Thus, kneading is the best tool for restoring muscular strength.

The applied pressure has to be significant but without the activation of the pain analyzing system. The threshold of pain varies from one part of the body to another, or even within the borders of the same massaged segment. Thus, the pressure has to be continually adjusted.

All Western articles which reported about the failure of massage therapy to speed up the recovery process were united by one striking similarity. Despite a truly scientific approach to the evaluation of treatment and its duration, these studies neglected to follow the proper protocol:




Cafarell, et al., 1990

immediately after exercise

4 min

Drews, 1990

immediately after exercise

30 min

Wenos, et. al., 1990

48 hours after exercise


Rodenberg, et al., 1994

15 minutes after exercise

15 min

Tiidus, 1995

48 hours after exercise

10 min

Gupta, 1996

48 hours after exercise

10 min

However, in our opinions, 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 that of Russian scientists, proving its value. The authors examined the effect of massage on delayed onset of 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 Russian authors. These authors considered that vigorous exercises damage 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 waste products 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: temporary reduction of neutrophil count and increased concentration of creatine kinase in local blood vessels, and their following emigration 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

This is what Smith, et al., had to say in their 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.”

As we stated above, the reduction and elimination of muscular soreness are not the only goals of Post-Event Sports Massage. The objectives and goals of Post-Event Sport Massage are:

1. To reduce the tension in muscles and connective tissue.
2. To reduce peripheral vascular resistance.
3. To accelerate drainage of venous blood as well as lymphatic fluid.
And ultimately:
4. To balance, to the extent possible, the activities of the sympathetic and parasympathetic divisions of the nervous system.

Working in the “Inhibitory Regime” (massaging while gradually increasing pressure), we awaken reflexes to the original stimuli. These are expressed in vasodilation (reduction of peripheral vascular resistance, reduction of left cardiac work, etc.) As a matter of fact, with Post-Event Sports-Massage, we also prevent the enlargement of the heart muscles (hypertrophy), balance the biomechanics that prevent sports-related injuries, as well as improve the performance of the athlete.

In 1981, Professor Dembo, MD, Ph.D. (of the Leningrad Medical School), following extensive research, shed more light on how Post-Event Sports Massage rehabilitation can prevent hypertrophic heart syndrome. He tested 20 healthy male athletes ages 17-23 for the effects of Post-Event Sports Massage. Dr. Dembo recorded a decrease in peripheral vascular resistance and a decrease in left cardiac work following the administration Post-Even Sports Massage protocol. Among other machinery, Dr. Dembo used electroencephalograph (reflecting electrical activity in the brain) in this study. He also performed 24-hour hemodynamic studies. The athletes were observed over a 6-week period during their regular professional workout routine. Prior to the administration of massage treatments, the athletes have undergone sleep studies, where it was shown that they experienced abnormal peripheral vascular resistance and high levels of left cardiac work (particularly between 1am and 4am). Based on the database of the electroencephalograph it was evident that the quality of sleep was disturbed. During the next six weeks, following the same workout regimen, and having received Post-Event Sports Massage twice a week, there was a significant reduction in peripheral vascular resistance, left cardiac work, and an increase in deep sleep. In his conclusion, Professor Dembo stated that during the day normal hemodynamic study readings included heart rate, blood pressure, and other cardiovascular parameters. During the nighttime the data indicated a worsening due to the overload of skeletal muscles (expressed mostly at nighttime) and in turn leading to the abnormalities mentioned above.

At this point, we would like to refer you again to the article of Dr. Sven Jonhagen. As we already quoted, Dr. Jonhagen, like many other scientists, did not follow the guidelines presented in this article (time of the treatment, duration of treatment, massage techniques, and pressure). Additionally, in our opinion, he set up the wrong objectives, such as coming to the conclusion that massage therapy does not contribute to the strength of muscles. To the best of our knowledge, no European or American massage therapy organizations ever claimed that massage therapy directly increases muscular strength. It is, however, an accepted fact that by reducing the tension in a muscle, we contribute to its return to the normal physiological potential. Another problem with Dr. Jonhagen’s study is that instead of having a real control group, he used the contralateral leg as a control. This made us think that this doctor started researching massage therapy with no knowledge of the physiological effects of massage on the human body. The scientifically proven fact is that massaging one extremity awakens the vasomotor reflex which leads to significant increase of arterial blood supply to both the massaged and unmassaged extremity. There’s no doubt that articles such as Dr. Jonhagen’s are very confusing and lack any benefit for the general public as well as for massage therapists. Therefore, we are happy to take this opportunity to once and for all shed a light on this controversy by presenting a correct Post-Event Sports Massage protocol based on scientific and clinical evidence.

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)

A note from Boris Prilutsky: As you can understand from this article, using proper protocols is what makes the difference between proper and improper utilization of Sports Massage. Scientifically-proven protocols are designed through extensive research and thorough analysis of data on efficacy and safety of any treatment. The methods and techniques I present in my Medical Massage video series are proven safe, and in most cases can lead to rapid results.

Post-Event Sports Massage contains important methods used to improve the performance of athletes, rehabilitate from exercise stress, eliminate side effects, and prevent sports-related injuries.

In Volume 7 of Boris Prilutsky’s Medical Massage DVD series, Boris demonstrates specific techniques of sports massage, as well as stretching of different groups of muscles. Given the fact that many people work out on a regular basis, and tend to overload themselves, it is important for massage therapist to have the skills and knowledge to help not only professional athletes, but also the general gym-going public. In Volume 7, you will find the following topics: Advanced Full-Body, Deep, Post-Event Rehabilitative Massage Therapy, Full-Body Stretching Techniques, and Full-Body Pre-Event Preparation Sports Massage.

My views on continuing education for massage therapists

Even with the best intentions in mind and best efforts of school personnel, many massage therapy schools cannot teach graduates the full scope of practice.


  1. Massage schools program have time limitations standing in the way of teaching students the full scope of practice, including advanced programs.
  2. Many massage schools do not have enough faculty members who possess profound knowledge and clinical experience to teach more than 70 disciplines that the full scope of practice contains.
  3. In order to develop professional skills and to prepare for advanced training, prior to attending advanced classes, practitioners should acquire some clinical experience by providing at least 100 hands-on therapy procedures on real clients in a professional setting.


Continuing education programs, most likely, are the more appropriate way for continued progress in professional skills development.

Is there a massage therapy discipline that is superior to other ones?

There is a notion that one who knows how to perform orthopedic massage for painful back and limb disorders is a more advanced professional than the one who provides full body stress management massage. Is this really true? People in the modern society are susceptible to stress. Are those who have made their careers providing full-body stress management massage less qualified professionals? I think not.

Stress-related illnesses include heart attacks, strokes, high blood pressure, diabetes, anxiety, clinical depression, tension headaches, sleep disorders and more. It should be noted that the American economy loses $350 billion annually due to stress-related illnesses. According to many surveys and statistical data 90% of doctor visits are related to the above-mentioned disorders.

Full-body stress management massage is scientifically and clinically proven as a most powerful method from all the available healthcare modalities for managing stress. Surely, those suffering from back pain have a disrupted quality of life. Yet, people are not dying from back or joint pain while as people die from stress-related heart attacks, strokes and diabetes. Why then are therapists who perform full-body stress management massage are lesser professionals?

A person, who knows how to perform stress management massage with a great clinical output, is practicing a very advanced modality. In short, both of these disciplines are equally important.

Why continued education program is advanced training?

Prior to approving a continued education provider NCBTMB and other massage boards check to see if a prospective instructor has enough clinical experience as well as extended body of knowledge to teach “advance” knowledge to others practitioners.

One cannot teach continued education, i.e. teach already professional people, if one has insufficient clinical experience. When teaching a CE class, instructors should not just share the knowledge that is taken from books or scientific references only. Books contain knowledge that professionals can obtain themselves by reading. Instructors share hands-on details that will allow program participants to apply them on clients and obtain results. That’s what advance training is; not the presented discipline itself, but the training by an experienced clinician.

Massage therapy is about delivering results.

Any professional participating in CE programs must acquire knowledge and hands-on skill to deliver results. Certainly, an instructor must have qualifications and motivation to deliver information and hands-on training in an understandable manner so that students can acquire the material. But participants also have to demonstrate high level of professional consciousness, discipline and motivation. Teaching many continued education courses, I often witnessed professional ego of participants standing in the way of their learning. The worst damage to learning is done when a participant arrives to be trained with the following mind set: ”I already know it all and just need a CE certificate.” In order for participants to learn more they have to give instructors a chance to share their knowledge. No matter how much you know there is always a room for improvement. I have been in practice for over 40 years and am still finding room for improvement my hands-on performance and other aspects of professional activity.

Do home CE programs provide adequate training?

People of my generation, in the beginning of their career, had no luxury of studying from educational videos, but only from books and by means of classroom hands-on training. Today, because of technological advancements, people have the opportunity to learn from instructional DVDs. For those who are looking to advance in our field, instructional video materials present invaluable advantages in improving your professional skills. Many people learn material better at their own pace in their home environment with no time limitation. This has a lot to do with fatigue that you can experience in the classroom situation. After a while your attention slips away and your mind starts drifting. At home you can avoid these detrimental factors – just press the button, start the lesson and learn as long as you feel alert.

Often instructors don’t feel the difference between newly introduced complex concept and trite self-explanatory facts, and go over material of uneven difficulties at the same pace. There is also a high chance that the other members of the class could be more advanced than you are and would already know material that is being presented. In such a case you might be hesitant to ask multiple questions and appear “slow” or simply feel uneasy about the fact that you are taking too much time from the rest of the class. Often these circumstances lead to gaps in knowledge, which will detrimentally affect the learning processes. Having educational materials on DVDs also allows you to review the material as many times as necessary, without being subjected to a humiliating question “Did you understand?”

Repeating techniques after instructor and studying his movements, including frequency of these movements, are very important components in reaching positive results. By viewing a DVD numerous times you are not only learning how to perform techniques and concepts underlying a particular protocol, but also, and not less importantly, is learning to reproduce the movements that instructors have developed during many years of practiMy views on continuing education for massage therapistsce. Our brain functions in a way that by viewing the same images over and over, it allows us to copy these movements.

There are no doubts that live seminars are advantageous as well. They allow you to interact with others participants, to work under supervision and to receive treatments at the time of training. This is also a great way to learn. Learning from DVDs and attending live seminars on the same subject is a great educational combination.

How much should continuing education programs cost?

As massage therapists we are in business and financial gain is a part of a business. The more you are able to deliver results the more successful financial gain your occupation will bring. Massage therapy is about results, and success in our career depends on our ability to deliver these results. Consequently, continued education programs have to be geared toward your ability to deliver results. For example: regardless of whether you took CE course for tension headaches, stress management, lower back or legs disorders, shoulders or sports massage training, a person who spent $150 for particular continued education program, upon completion of this program, should be able to apply newly learned methods and during two or three treatments reimburse CEs investment. Business is business.

To me CEU pricing is defined by the following motto: ”Massage therapy is about results. Success in your career depends on your ability to deliver results, and continued education programs have to improve your ability to deliver results, as well as to increase your financial gain.” If you would like to get familiar with the continuing education courses offered on this site please

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The role of Medical Massage in stress management, discovery of sexuality, and improvement of sexual satisfaction

The most common causes of male and female orgasmic disorders are both physiological and psychological in nature. Among other factors defining such disorders are: depression, feelings of guilt, anger, fear, low self-esteem, anxieties, etc. Since all of listed factors are either directly linked or caused by stress, we can generalize that one of the major detrimental factors in couples’ inability to reach top sexual satisfaction, and discover the maximum of what sexual act can offer is stress.

According to many surveys today stress is responsible for pandemics of medical diseases, such as anxiety, tension headaches, essential hypertension, stomach aches, sleep disorders and more. Practically each of us to a certain degree suffers from anxieties, which is a result of higher than normal sympathetic activity.

It is impossible to get maximum satisfaction from intimacy, if to get satisfaction at all, at the time of high level of sympathetic activities. Sexual responses are regulated by the mutual activities of sympathetic and parasympathetic divisions of nervous systems, but under domination influence of parasympathetic division as well as involvement of somatic innervations. Even considering the differences in female and male reflex pathways before intimacy, and at the time of sexual activities, the functions of autonomic nervous system are similar. That includes blood vessel dilation, which causes penis and clitoris erections, vaginal smooth muscles contractions at the time of orgasm, as well as smooth muscles constrictions at the time of ejaculations.

In addition, activities of parasympathetic division of autonomic nervous system regulate digestive system, pulmonary system, as well as sexual reproductive organs. At the same time, it is the main inhibitor of over active sympathetic activities. When most of the parasympathetic potentials are directed to inhibit over active sympathetic activity, it is impossible to expect normal parasympathetic function at a time of sexual act. While as only normal parasympathetic functioning is necessary for sexual satisfaction as well as for discovery of sexualities. Also it is important to mention that under stress our skeletal muscles demonstrate higher muscular tensions, which in turn limit the range of muscular constrictions. Contractions of the skeletal pelvic muscles are accompanied orgasm in both sexes, and unless these muscles are relaxed, it is hard to expect full sexual satisfactions.

As you can see, stress presents the number of serious challenges to a quality of sex and sexual satisfaction to its maximum extent. Many people try to manage stress by being sexually very active. Factually it doesn’t work and causes trouble in personal relationship because in such cases and under stress no harmony can be achieved. The good news is… that it is clinically and scientifically proven, that massage can address and eliminate these challenges, but let me first tell you about another serious challenge to sexual relations.

Storing negative emotion in body parts.

Spending many years in a treatment room, at times, I witnessed patients’ seemingly bizarre behavior. While massaging an absolutely healthy, with no signs of pain, part of a body, suddenly, a person starts crying, shaking or complaining about cold in a room with 75 degrees temperature. Often in the aftermath people feel embarrassed and even ask for an apology.

Although science doesn’t have a well established explanation for this phenomenon, there is a working hypotheses described as “Body cells carrying emotional memory.” Negative memories stored in body part that started to come up to the surface. Crying, shaking or complaining of cold – all is expression of emotional release, accompanied by muscular contractions, followed by a relaxation of a part or the entire body.

Notice, incidentally, that some additional well known psychological factors that cause male and female orgasmic disorders are: past history of traumatic sexual encounters such as sexual abuse, rape or incest, or having been raised in an atmosphere of strict sexual taboos. These and many other negative emotions that people couldn’t deal with or chose not to deal with at the time they occurred consciously, or simply divert from our awareness without any conscious efforts, while coming to the surface at a much later time during massage session, case described above emotional outbursts.

Today many people in the scientific community are also skeptical of it. However this skepticism isn’t based on any scientific research.

As for clinician, witnessing described above phenomena in the treatment room, year after year, brought a realization that this hypothesis is a true one. In my book “Simple Approach to Medical Massage” I presented an example of how a heavy weight boxer – a World champion, started to cry during the massage session, releasing emotions connected with events that have happened when he was 8 years old. To me this is already not a hypothesis, but a clinically proven phenomenon and until there is major scientific study disproving it, I will keep it as working theory.

Emotions stored in any part of the body, especially in the pelvic floor, if not released, will trigger a reaction to a touch such as a constriction of muscles. Harmony as well as top sexual satisfaction could not be achieved under these conditions. Imagine that at a time of a sexual act one of the partners touches a part of a body while this body part carrying an emotional memory or a psychological scar. At the time when this happen a person might pay no attention to such constriction. But will such a person get a complete satisfaction from such an act?

Therefore emotional scars must be eliminated. It is proven scientifically and, most importantly, clinically that massage therapy is the most powerful methodology in stress management. In addition it releases emotions stored in body parts.

The simplified protocols that address this condition give professional outcome from the point of view of stress management, improvement of sexuality, and in discovery of sexuality. Rather than offer you a complete medical protocols I will combine different protocols of stress management, sports massage or orthopedic massage.

Currently you can rent a $2.99 video, devoted to this topic.”The role of Medical Massage in improvement of sexual satisfaction” To obtain results, fifty percent of massage should be spent on kneading. In this video I present a few easy to perform, various kneading techniques used in Medical Massage. But, as it was mentioned before, we alternate and Boris teaches a combination of different types of easy to perform massage techniques that include kneading.

Using these protocols you might not get results compared to what professional therapists would achieve when they perform kneading. Maybe it would take two or three treatments but in the end you would achieve desirable results in stress management and quality improvement of sexual life. I teach you how to prepare yourself for these emotional releases, how to hold hands on body parts that stores these emotional scars, and more.

One important advice if you are to provide therapy for your partners. When you perform a massage on your partner, try to conduct yourself professionally like therapy provider would. Your attraction to each another might compel you to do otherwise. It is very important that treatment wouldn’t be interrupted. These 45 to 55 minutes must be dedicated to treatment, and treatment only. During this procedure your partner will get a sense of trust to your touch and for a long run releasing bad memories and healing emotional scars would do wonders to your sex life. Your sexual act in the future would be much more prolonged; you would be able to pick up sexual energy from each other and to bring this to the greatest sensation possible. By managing stress and releasing emotions quality of your life including sexual life will be improved tremendously. Undoubtedly, your clients’ quality of life, including sexual life, would improve due to constantly receiving therapy for stress management. Just urge them to receive full body stress management massage on weekly basis.

You are also welcome to learn our free self-massage lessons. In the theoretical part, in details, I present a mechanism of stress debilitation of human body as well as explaining why massage therapy is the most powerful methodology in healthcare for stress management.

This link will take you to e-book where I demonstrate the full body stress management massage. You can also learn all 12 Medical Massage petrissage techniques.

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