What Happens When We Get Massaged? - pt.1 Muscles
Where better to start a blog about massage than what happens when we get massaged? This is the thing I wish to sort out in my own mind. All the better to talk to my clients about what's going on and all the better to plan effective treatment from both a physical and mental perspective.
And where better to start on what happens when we get massaged than with the muscles? I don't know about you but when I get a massage or when I'm giving a massage, the main experience is the muscles being worked. In my training as a massage therapist we were told that our main aim was to 'find and remove tension.' I do still stand by this and I feel it is a good heuristic approach to massage. We all know what tension in our muscles is when we feel it and it can sometimes be overwhelming and not entirely useful to atomise things too much. But the question has still remained creating tension in my brain - what actually is muscle tension?
So let me try and break down the muscle (t)issue for you..
Disclaimer - This isn't an essay on the way things actually definitely are in the body but a working through of the various bits of evidence and writing I've managed to find and tried to weave into coherence. I invite any corrections, retorts or rebuttals as I am on a learning journey here.
Things Stuck Together
Actually we won't be breaking down muscle tissue just yet. It appears that what is most commonly and easily broken down isn't so much the muscle itself but the connecting fibres between the skin layer and the muscles and other organs: The fascia. And when I say 'broken down', I actually mean moved around, loosened and lubricated (glad we wriggled out of that muddled pun. Phew!). The muscles and the fascia together make up what we call the Myofascial System.
Fasciae are connective fibres that allow the muscles and organs to slide around next to each other, keeping you as a solid(ish) looking human whilst still maintaining fluid movement. However, if the body or an area of the body is held in position, with little or no movement, for an extended period, these fibres become less lubricated and stick together. As Gil Hedley explains in his entertaining Fuzz Speech, fascial adhesion or 'fuzz' forms even over night while we sleep. That's why it feels good to stretch like a cat in the morning.
Where massage comes in is if these adhesions become thicker through lack of movement over time and stretching just won't cut it. This is likely to happen to some extent in most people's lifestyles in at least some parts of the body. Introducing deeper movement manually into the body tissue should more effectively un-stick these fibres. That's what I attribute that feeling of being a couple of inches taller after a massage. There is more space between the fibres. It will also create that extra ease of movement. You know, when you glide down the road after your massage. That's probably your fascia literally gliding more easily around your muscles.
I'd venture that the chances of someone un-fuzzing their whole bodies effectively on any given day is restricted to the most obsessive, and probably annoying to be be around, yogi. But for the massage therapist, easing fascial adhesion or Myofascial Release is an easy win. Deep strokes and movement into and around muscles can lead to real changes within a session as connecting fibres become unstuck and start gliding against each other again.
However, things aren't always so easy to shift..
Things Even More Stuck Together
Adhesion might also take place within the fibres of the muscles themselves. This appears to happen through the body's self-healing processes, that create scar tissue. By my reading, muscle adhesion and scar tissue appear to be synonymous, so I will use them interchangeably. Also by my reading, there is no solid scientific evidence that any small amount of damage to the muscle tissue creates a corresponding area of scar tissue but it is the most likely theory as far as I can make out. I am going to make the assumption here that at least something like this is going on until a better theory comes my way...
I know! isn't it amazing that in this world of boundless technological advancement and scientific knowledge there is very little certainty as to why areas of the muscle become hard and painful!
Scar tissue - a collagen based fibre that is harder and less functional/flexible than the body tissue it replaces - forms when the muscle fibre is damaged. This could firstly be through postural issues, when an area of muscles is put under constant strain/contraction - I'm thinking of those really tough shoulder knots that many a desk worker develops. The muscles will remain contracted for long periods of time and the scar tissue will form around the strained area to support it. This in time will leave less movement in the area and progressive pain in the position of contraction.
Scar tissue might also be formed through physical excursion, where muscles are built, overused or damaged from sport or other strenuous activities. Muscle fibres tear and scar tissue forms to protect the muscle, allow it to heal and stop the same type of injury happening again. However, as the collagen based scar tissue is much tougher and less functional than the original muscle fibre and can cause restrictions to its free movement, the muscles will be unable to contract and relax as effectively - Here I'm thinking of the hard, tight calves and quads of the runner (especially the ones that don't stretch or foam roll!).
This Sidekick blog explains this in a bit more detail. As does this Mike Reynold guy.
There is conflicting evidence on how effectively massage can break down scar tissue and in certain cases it is known to do more harm than good. The advice around massaging a frozen shoulder, for example, is basically not to, otherwise the scar tissue becomes aggravated and continues to form. Massage directly into the area should wait until the third and final phase of healing when the scar tissue has softened. However, such services as Scarwork suggest great healing potential for massage on scar tissue. Research on massage treatments for dermatological scar tissue also goes both ways.
It stands to reason that although all scar tissues are collagen based, they are not all the same. Would the scar tissue from micro-tears in the muscle likely be the same as that of a stabbing trauma or a broken leg? There appears to be a gaping gap in research on whether different types of scar tissue respond more or less effectively to massage. Does some respond better to hard, pin-pointed pressure? Does some respond to slow and light pressure? Is something else entirely going on?
What I do know is that having my legs massaged after some serious running has the magical power to release pressure from the tight calf and quad areas. I have also witnessed personally the relief given from tight, hard shoulder knots over a number of sessions. If muscle tension has anything to do with the formation of scar tissue then, although it is tough stuff and may take some time, there appears to be a discernible assisting effect in some kind of breakdown or integration back into the normal muscles fibre from massage. But more research please!
Things Stuck on the Way Round
Another matter, in the theoretical realm, that could contribute to the troublesomeness of adhesion in and around the muscles is the prevention of blood flow through the adhesive area. Because fibres are stuck closer together, blood, along with the helpful oxygen it carries with it, as well as the metabolic waste products it carries away with it, can't flow so easily through the area. In the words of the informative Paul Ingraham from painscience.com, "some evidence shows that a knot may be a patch of polluted tissue: a nasty little cesspool of waste metabolites." This would compound any discomfort in an already stiff and stubborn patch of muscle and I can only hope that by applying manual pressure and movement, a massage can help bust these little acrid dams of poison - massage is at least very well documented to help increase blood flow!
A Sticky Situation
Now I've waded my way through the (t)issue (sorry...) and given some suggestions of what might be going on. Some more certain than others. I find myself re-enamoured with the more vague idea of 'tension' when thinking about how to approach specific muscle issues presented by clients. Raynor massage, like many other techniques, is hinged on knowing a system and finding tension along the bands of that system and working them in a systematic and intuitive way.
It would be great to have more research and a deeper consensus within the industry on what is going on when working the muscles with massage. However, it strikes me that at the moment, if any massage therapist tells you for sure they know what is going on with your muscle tension and how to deal with it outside of the fact that they have a system they work in and it appears to work for a lot of people, then their yoga pants are or fire. They should only be giving you suggestions of what might be happening beyond this.
Preventing Things Getting Stuck
As I disclaimed at the beginning of this article, the above is from the evidence I could gather within a reasonable amount of time, that felt reliable and sensical. One of the main reasons I think there is still a lot of uncertainty about what happens when you get a massage is because it is rather hard to see what happens on the inside of the body before and after (the problems with researching massage being a whole other piece for another time). People going for a massage don't usually want to be cut up before and after to see what's changed. It's not very relaxing or remedial!
However, once upon a time, 11 people did agree to be cut up for a small but significant massage experiment before and after vigorous exercise. They found that when massage was given after the exercise, it "reduced the production of compounds called cytokines, which play a critical role in inflammation. Massage also stimulated mitochondria, the tiny powerhouses inside cells that convert glucose into the energy essential for cell function and repair."
Inflammation is the first part of the healing process of muscular damage that can then results in the formation of scar tissue. So it appears, at least, that if massage is given soon after damage to the muscle, which would include the standard micro-tears from normal exercise, it will not become as inflamed. Does less inflammation, then, lead to less scar tissue? Perhaps the prevention of scar tissue build-up in the healing process by massage soon after straining muscles is your best bet, rather than leaving it to form then break down over a longer period? - I have at least found this piece which suggests that excessive inflammation leads to excessive scarring, so we can reason than the reverse is also true.
I should say, however, before you get all excited about some certainty in what's going on here, that I have found two detailed refutations of this research... here and here.. They criticise the research design, the premise of massage reducing inflammation and the usefulness of reducing inflammation in the first place. Goodness gracious we really don't know anything for sure..
Again, I do know from my own experience and from clients' experience that the effect of massage on sore muscles is palpable and something must be happening to relax them and help with the healing process. I will again choose to adhere to the best theory available to me at the present time but also explore other possible avenues going forward.
Anyyywayyy... With all this talk of cytokines and mitochondria we find that the mechanical muscular responses appear to be merging with the body's chemical responses to massage. This is a nice Netflix Original mini-series style segue cliff-hanger for my next piece into what the hell is happening when we get massaged.
Stay tuned!
Conclusions
- Massage can break down the 'fuzz' that forms in the fascia over time and allow for more lubrication and greater mobility in the connective fibres between the muscles.
- Theoretically adhesion in the muscles (scar tissue in damaged and strained muscles) causes tension and tightness and massage might help break this down over time.
- More research is needed on if and how scar tissue forms in the muscles and how different types of scar tissue respond to massage in general.
- Theoretically, where blood flow is restricted to the muscles, metabolic waste products may gather, further aggravating the area, and massage can increase blood flow and help shift them.
- Massage after strenuous exercise may reduce cytokine production, decreasing inflammation and allowing for effective healing through mitochondria stimulation. This may prevent excess scar tissue forming in the first place.
- There is a surprising amount still unknown about what muscle tension in its various forms actually is!