Monday, October 18, 2010

Massage doesn't remove lactic acid

Published: June 19, 2006

WHILE joggers, weightlifters, recreational softball players and other fitness enthusiasts will surely be delighted to hear that exercise science now sees lactic acid as a force of good and not evil, the fact remains that people are sore. What can be done about it?

Martin Kozlowski

While lactic acid can cause a burning sensation during hard exercise (because it is, as the name suggests, acidic) recent research has confirmed that the real culprits for the so-called delayed muscle soreness that comes one to three days after a big game or heavy workout are microscopic tears and trauma to the muscles and inflammation.

By the time delayed muscle soreness happens, "The lactic acid is pretty much back to normal levels," said Allan H. Goldfarb, a professor in the department of exercise and sport science at the University of North Carolina at Greensboro.

Lactic acid, which is produced by the breakdown of glucose in the body, was once seen as little more than a waste product. That view has changed, and lactic acid is now seen as an important fuel source for the body. "We're finding now that lactic acid is a major player in metabolism," said Thomas Fahey, an exercise physiologist at California State University, Chico.

The working muscles of the body, the heart, the diaphragm, even the brain, all "thrive" — as Dr. Fahey described it — on lactic acid as an important energy source. It may even help stimulate weight loss, he added.

The thinking about how to deal with the soreness has changed as well. In "The Complete Book of Running," published in 1977, the author and marathoner Jim Fixx said that soreness was "pretty much unavoidable," and recommended "a hot bath followed by a massage with some liniment." In the book, a best seller generally credited with helping to spark the running boom, the author, who died in 1984, went on to write that, "once you have sore muscles, there isn't much you can do about them except take a sauna and wait for the pain to go away."

Wait? In today's impatient culture, athletes and trainers take a more active approach to soreness. National Football League players, for example, may be some of the sorest athletes in the world. Every Sunday during their season, their muscles, to use the exercise physiologists term, suffer "insult" to a degree most of us could not withstand. "It takes these guys sometimes until Wednesday or Thursday to feel human again," said Todd Durkin, a licensed massage therapist and strength and conditioning coach in San Diego, who works with many N.F.L. players. "Recovery is a real important part of their training regimen."

Repairing these well-paid muscles is a high priority for both the team and their trainers. Typically, it starts with a postgame "ice plunge," five minutes immersed in a tub filled with ice. "The cold is one of the best things you can do to reduce inflammation," Mr. Durkin said. "Cold constricts the cells, basically closing them down, and gets rid of any toxicity or inflammation through trauma."

One of Mr. Durkin's clients is LaDanian Tomlinson, the San Diego Chargers' star running back, who gets tackled about 30 times a game. On Mondays during the season, Mr. Tomlinson spends much of the day with Mr. Durkin trying to minimize soreness, reduce inflammation and speed what Mr. Durkin calls "the regeneration process." To do so, more ice will be applied, and Mr. Tomlinson gets 60 minutes of deep massage and body work. But he also does light exercises — walking on a treadmill and weight-training movements — which may sound counterintuitive, but are basic to most treatments of sore bodies.

Although research has been unable to prove its value, "keep it moving" is a principle long prescribed by trainers and therapists. "The day after a race, you bike or swim or walk, something to just loosen yourself up," said David Balsley, a physical therapist in Manhattan who is also a competitive runner and triathlete. In the past, the reason for moving was often described as being to work the lactic acid out of muscles and reduce soreness. We know better now. Lactic acid isn't the problem, but soreness still is. Can the microtrauma and inflammation that are fingered as its causes be prevented? To some extent, the experts say yes.

"First off, try not to get damaged," Dr. Goldfarb said. "When you increase your workload, you should be doing it gradually." The rule of thumb is no more than 10 to 15 percent increases a week. For example, if you walk three miles this week, you should be doing no more than about three and a half next week.

Still, said Jeffrey A. Potteiger, a professor of exercise science at Miami University in Ohio, Mr. Fixx might have been partly correct when he wrote of the inevitability of mild soreness. "If you run a marathon, you're going to get sore, and there's not a whole lot you can do about it," Dr. Potteiger said. "If you do almost anything you're not accustomed to doing, you'll get some soreness. The good news is that if you continue to do that activity, the soreness will not be as prevalent and in some instances will go away. The body will adapt to that workload."

In the meantime, ice, stretch and perform light activity to help work the soreness from your muscles. Just be clear that it's not lactic acid you are working out. That soreness, Dr. Thomas Fahey of Chico said, "is completely due to muscle injury and inflammation." And yet, he added, "even today, massage therapists talk about getting rid of the lactic acid after a race or hard workout. This is just completely false.

Why the benefits of massage may be a myth

Athletes use post-exercise rubdowns to boost recovery but the gains could be all in the mind

To top athletes and anyone else who exercises a lot or has put him or herself through the rigours of a marathon or triathlon, a regular massage is considered almost as essential to keeping the body in condition as diet and training. After all, the kind of deep-tissue massage practised by registered sports massage therapists promises to increase blood flow to aching muscles and flush out metabolic waste products such as lactic acid after a hard workout.

Nothing could be better for your aching limbs. Or could it? In a study presented at the American College of Sports Medicine’s annual conference in Seattle this week, researchers claimed to have blown the myth that massage speeds up recovery from exercise. Professor Michael Tschavovsky of the health studies department at Queens University in Ontario, Canada, says that while most massage therapists believe that their work boosts circulation to the muscles and reduces fatigue, no study before his had tested the validity of this theory.

Tschavovsky asked 12 healthy male subjects to perform isometric hand-grip exercises for two minutes at a time while he and his team measured blood flow and lactic acid build-up every 30 seconds and for ten minutes after the exercise had finished. They also took the same measurements during rest, when the subjects had massage and during “active recovery” such as gentle jogging, walking or stretching. What they found was that massage did not increase — but decreased — blood flow to the muscles and hindered rather than improved the removal of lactic acid and other waste materials by as much as 25 per cent compared to “active recovery”.

“Anyone who believes that lactic acid symptoms are relieved by massage is wrong because the alleviation of discomfort is not due to waste products being flushed out after exercise,” Tschavovsky says. So does this mean that post-workout massage is a waste of time? Tschavovsky thinks not. He is a fan himself and admits to having massage to help his legs to recover after football tournaments. But he says that the benefits could all be in the mind. “It feels good, that’s the truth of it,” he says. “A lot of sports performance is psychologically based so if you feel you are in a better situation to train with massage then, yes, it probably does have the ability to improve your performance.”

What his study shows, Tschavovsky says, is not that massage is useless but that it isn’t helpful for the claimed reasons. If it does work, scientists have yet to prove how.

Massage therapists are taking the findings with a pinch of salt. “Any sort of physical activity produces a cocktail of waste products — not just lactic acid — that vary according to the activity, the intensity of the workout, your age and diet,” says Mel Cash, principal tutor of the London School of Sports Massage, where many of Britain’s Olympic sports masseurs have trained. “A qualified therapist will be able to reduce the swelling of tissues and aid minor soft tissue injuries so that you are ready for your next workout.” Bob Bramah, a spokesman for the Sports Massage Association, the governing body of sports massage in the UK, says that there is plenty of evidence that massage is helpful after exercise. “But I also know by personal experience that what I do works,” he says. “I know that my players feel better afterwards. I know that as a result of that their performance is enhanced.”

But is it? Experts who have reviewed other types of massage claim that not only are many approaches ineffective but that some hold potential risks. Professor Edzard Ernst, a researcher into complementary medicine and director of the Peninsular Medical School in Exeter, says that part of the problem is that the profession is unregulated. While studies do show that massage can help to relieve a range of ailments from stress, migraines and infertility to back pain, sickle cell anaemia and joint problems, many are inconclusive.

A study at Ohio State University last year, for example, showed aromatherapy treatment to be relaxing because of a placebo effect, while a study of hot stone treatment (heated stones placed on the body) found that while the warmth was comforting there was no scientific evidence of a reduction in ailments. In the case of Thai massage, which aims to realign the body by using pressure on acupressure points, after a five-week study by the Touch Research Institute in Florida, subjects reported reduced job stress and elevated moods.

“In most cases the evidence is highly contradictory and while some studies suggest an effect others don’t,” Ernst says. “There is reasonably good evidence that massage can be helpful for back pain, but rigorous investigations are difficult to carry out because a good placebo does not exist.”

Susan Findlay, a spokeswoman for the General Council for Massage Therapies, the UK’s governing body for all soft-tissue techniques, says: “The lack of reputable studies boils down to massage being very difficult to investigate because there are so many variables, including technique, perception of benefits and the standard of a practitioner.” There are groups of people — including those with low platelet counts or who are taking blood-thinning medications, pregnant women and people with cancer, osteoporosis or rheumatoid arthritis — who should be cautious about having a massage and should do so only on medical recommendation. For them — and others — massage could do more harm than good.

Research by Dr Robert Gotlin, a sports and orthopaedic rehabilitation specialist at the Beth Israel Medical Centre in New York, suggested that 15-20 per cent of people who have massage for injuries end up having corrective treatment afterwards: problems they attributed to muscular pain were more likely to be linked to spine or bone abnormalities. Massage could make the problem worse, injuring nerves, causing muscle spasms or inflammation. Gotlin suggests that thin people avoid deeptissue techniques such as shiatsu and Swedish massage. They are good for easing tight muscles, he says, but can lead to damaged muscle tissue, nerves or bones, particularly around the spinal area, in people without much body fat to act as protection.

Ernst says that serious problems linked to massage are rare. A review of evidence he conducted for the journal Rheumatology uncovered a few adverse effects; the majority were associated with “exotic” types of manual massage or techniques delivered by underqualified practitioners. “Massage is not risk-free, but significant adverse events are true rarities.”

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