Feb 13 2012
Does massage therapy decrease inflammation and stimulate mitochondrial growth? An intriguing study oversold
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23 Responses to “Does massage therapy decrease inflammation and stimulate mitochondrial growth? An intriguing study oversold”
http://www.sciencedaily.com/releases/2009/05/090507164405.htm Massage does NOT remove lactic acid and improve circulation post-exercise. So there! Neener!
And because I’m not familiar with the genes involved, the number that struck me was this: n=11 ELEVEN ?
Did they show graphs of the individual responses for those genes? One wonders if they were all over the place, but had a random slight increase in the few genes they chose to report on. One strong outlier could drag the rest of the small group up. Way up.
This would be hard to do with animals. Ever try to massage hamsters? Rats?
This study and it’s overselling bothers me quite a bit, particularly as a researcher who works on mitochondria. They literally haven’t shown that mitochondrial biogenesis is upregulated. Full stop. What happened to effective peer review? There’s boatloads of assays these guys could have run in order to probe for higher levels of mitochondrial biogenesis, not to mention a plethora of genes related to biogenesis, fission, and fusion whose mRNA levels were not analyzed. Weak sauce.
@DrGorski:
I cringe every time I hear that from a massage therapist. Thank you for pointing that out.
I cringed equally hard when I read about this study on one of the quack news sites that quoted massage therapists as claiming they “intuitively knew these results.” Wow.
Massage therapy is a weird thing. They couldn’t be happy just being masseuses. They had to become “massage therapists.” In their education, they are taught reflexology, acupressure points, aromatherapy, and energy healing along with a high-school level of knowledge in anatomy and physiology. It’s almost similar to naturopaths, where they become more “dangerous” as their “education” increases.
Very nicely done. Thank you.
- pD
This paper is a nice example of why I could no longer read the sports medicine literature – absolutely cringe-worthy nonsense.
I’m too lazy to pull out the original paper so perhaps these points are addressed by the authors. If massage is increasing mitochondrial proliferation, then surely other mito markers ought to have emerged from their arrays as well. Table 1 shows none of that. Moreover, is 2.5hr really sufficient time to claim a meaningful expression change in anything, let alone muscle? It really does take a long time to ramp up transcription sufficiently to detect an expression change using a relatively insensitive technique as the array.
At 2.5hr, I rather wonder if they aren’t detecting the contributions of altered vascular flow between the massage / non-massage leg. Arrays sample *all* cells in the biopsy and includes the vasculature, not just muscle. I wonder how many of their changes were in the vascular portion of their sample – we’ve certainly experienced this in our array studies.
The first thing I noticed about Table 1 was the complete absence of statistics to justify cherry-picking these candidates. The second thing was the complete absence of an orthagonal measure, such as RT-PCR, to validate the array studies. We learned years and years ago that array data are suspect and must be validated by an independent technique on a independent sample. Even the transcriptome analysis we’re doing now, which counts absolute transcript numbers, still has to be back-validated by an independent technique.
Interesting. Is it a foregone conclusion that inflammation in this context is necessarily bad? I haven’t looked into it much, but I was under the impression that although the effects of inflammation are perceived as undesirable, in general, (non-chronic) inflammation was basically beneficial.
Massage seems to be a practice which is really in no need of the woo, pseudoscience, and unvalidated scientific claims, but is nonetheless fairly steeped in all of it anyway.
TheLabMix: veeeery interesting comment. Can you elaborate a bit? I picked up on the most elementary limitation of the finding, but you clearly have much deeper insight into it. Tell us more?
An old roommate of mine use to say she would get sick to her stomach after her woo-crazy massage guy would give her a massage. The reason for this is, as claimed by her massage guy, was that massage releases toxins from the muscles and this can make you sick. This claim sounded comical to me and I couldn’t help laughing..which she didn’t appreciate. Later my girlfriend took me for a couples massage and I found that place parroting the same garbage about massage releasing toxins and it may make you feel ill. I think we are all in the wrong business….there is far too much money to be made just by making stuff up. If it weren’t for that darn conscience and brain getting in the way of our financial success. I also overheard her massage guy talking to her about how he had convinced some of his clients to abandon their medicine to heal themselves naturally and that there is a cure for Diabetes, but the drug companies would never allow it to go public at the cost of impacting their profits. WOW! I’m not a doctor, I don’t even play one on t.v., I just make things up.
Muscle biopsies?
Dear McMaster University Research Ethics Board:
You got some splainin’ to do.
What’s that? Uh, no. Doesn’t matter, no way, no how. If you don’t know enough to ding this trial, you might as well close up shop right now.
Gosh, I wish I understood the more technical aspects of this post, but it was interesting, regardless. Personally, I wouldn’t let someone cut out little bits of my muscle for just any old reason.
I have found massage to be somewhat beneficial to me in controlling some muscle and joint pains. I occasionally get shoulder pain (diagnosed as either impingement or bursitis, ehhhh? we don’t know). When the pain acts up, the muscles in my shoulder and upper arm get very tight, tender and knotted feeling. This tightness feels like it pulls on the joint causing more pain. NSAIDS alone don’t seem to help that much, but I have found that NSAIDS with deep tissue massage of the tight muscles does seem to help. For me, self massage with a tennis ball is just as effective as a professional massage.
I have heard various rationals from physical therapists, massage therapists and doctors for why this might work, from increasing blood flow, to flattening bunched muscles, lowering friction in inflammed muscles by moving them about, lactic acid reduction, releasing trapped nerves…I haven’t got a clue what is going on, but I am curious.
As far as I can see, I don’t really have a lot of options besides the massage, NSAIDS. I’ve used up to the two corticosterioid injections that the orthopedic surgeon believes is safe (that really helped) Most of the targeted exercises I’ve tried make the pain worse. Stretching gets no results. Imaging doesn’t show an operable condition. So, I consider myself lucky to get the relief that I do from the massage, even if it is inexplicable.
Like David Gorski suggests, though, it just seems important to not make claims unsupported claims of therapeutic value.
oh sorry, I’m formerly MinM for those who care about such things.
Did the paper reveal how much they paid the volunteers to let them cut out pieces of their flesh? I hope it was a lot!
I’ve quit getting massages, which I used to enjoy, because I can no longer find anyone who doesn’t make ridiculous claims about it. The last one I got had the provider coming into the room with a clipboard to take my “history” and wanting to know my “treatment goals”! I told her I didn’t like this and just wanted a “feel good” massage–which only fell on deaf ears as she proceeded to go on and on about all the “healing” that was “going on”. At the end, she insisted I take a bottle of water (free!) and said I should drink it all to “get the toxins out”. While this last one was the most extreme, some version of this has gone on at all the massages I’ve tried from very diverse places in the last five or six years, so I just gave up and take hot baths now–at home.
My spouse goes to Vegas with his brothers once a year and says this doesn’t happen there–that they just give the massage. I hate Vegas, but I may tag along this year just to get a woo-free massage!
Thanks for taking the study apart step-by-step. I keep learning more about how to read these things (in spite of my not-so-successful attempt last week).
@Janet, next time, tell the masseuse that you have progressive multifocal leukoencephalopathy and you want to be able to cut down on your non-nucleoside reverse transcriptase inhibitors. Haha, or ask them what good is the massage if it just releases toxins into the body?
I have a question: just what are the ethical implications of doing these muscle biopsies. Dr. Gorski wrote that he believed they may have been open biopsies, which are more invasive than needle biopsies. Is the primary lapse in ethics here that they an invasive procedure in a study without “a priori probability?” And they should have been done in animal studies first? I have one idea: is it possible that these gene chips (sorry, genetics research is completely beyond me) or whatever don’t work in animals? Or is their genome sufficiently similar that they would work?
(In no way am I defending this study – I just want to have a better understanding of why it was so bad to do the muscle biopsies. When I read the abstract a couple of weeks ago I immediately felt that it was very invasive to do the biopsies for a study of this purpose.)
After reading Dr. Gorski’s post, it’s pretty bad that they did a study like this, and then really got no useful information from it .
I’m in Janet’s camp, haven’t had a beautiful massage in long while now. It’s not just the verbal nonsense, it’s also that massage therapists seem to want to steer you towards modalities that are easier on the therapist physically, offering the customer “massages” that are harder to call massage at all. If there were a good study showing certain benefits, it may apply to something that isn’t for sale any longer in your locale. Massage therapy cannot be counted on to feel good, you might not feel much of anything from these newfangled variations. Massage has grown similar to herbal medicines; sometimes what’s written on the label doesn’t even exist in the bottle.
There are gene chips made specific to different species; i.e., human, mouse, rat, dog, etc.
http://www.genomics.agilent.com/ProductFinder.aspx?PageType=Platform&SubPageType=PlatformProductFinder&PageID=288&GroupId=120
http://www.biocompare.com/ProductListings/12488/Canine-Microarrays.html
There are even microarrays for cows, chickens, C. elegans, Drosophila, horse, pig, rabbit, Rhesus macaques, sheep, frog, zebrafish, etc.
http://www.genomics.agilent.com/CollectionSubpage.aspx?PageType=Product&SubPageType=ProductData&PageID=1508
@ Janet … Caesar’s Palace! Hunky well-trained masseuses in sexy Roman soldier kilts and NO claims of being at all therapeutic, just pure feel-good massage.
This study is an alleged mechanism looking for an outcome. Put another way, there was no clinical reason to think that massage does these things in the first place, so why try to study the “mechanism”? It is equivalent to saying, “since massage therapists assert that massage ‘boosts the immune system,’ let’s try to figure out how it does that”—rather than submitting the fanciful claim to scrutiny in the first place (which would not consist of looking at some aspect of the immune system, but in waiting for massage therapists to provide real evidence for the claim before even considering it further). So yes, in a sense it has to do with prior probability, but that term probably obscures the real point in this case.
Muscle biopsies are invasive, they hurt, they usually require sedation or even general anesthesia, they inconvenience the subjects for at least a few days, they can get infected. Moreover, there are serum markers of inflammation, so another possible way to have studied this preliminarily, other than in animals, would have been to look at those (it would have required a somewhat different protocol, of course, and I would argue that even that would have been silly—but at least much less invasive). To start with a muscle biopsy trial is beyond the pale.
aren’t feel good message an extra 50 bucks?
@Drs Gorski and Atwood,
Thank you kindly for explaining that to me. All the more reasons this study should never have been performed in the first place.
[...] observation I have about nutrition applies. Massage? Since when is that “alternative,” badly interpreted studies of it notwithstanding? Pharmaceuticals? You might as well see a real doctor! Yoga? Stripped of its woo, it’s just a [...]
Thanks for the intelligent non-wo slinging. But first: a masseuse is a MISS, a masseur is a MISTER. All words of French origin, constructed along the similar principles.
I am a practicing RN AND LMT and suffered through several classes in my massage training about “meridians”, “chi” and the like. My friends baiting me to call their bluff. Thankfully one of my teachers took it all with a grain of salt, as we were required to answer questions about these topics on the boards. Due diligence to the state curricula was warranted and time was devoted to the skeptical view as well. Interestingly some of the adherents to the doctrine of meridians and chi were quite pragmatic in their view of same: one practitioner about meridians said: “you can see them right there…” drawing her fingertip across visibly connected structures of musculature and bone, equating the meridians of the ancient Chinese doctor with the more conventional anatomy of the ancient Greek hands-on physician. Certainly relevant structures to any good massage therapist (as to the designation masseur vs. massage therapist I think masseur implies a purely pleasurable, sybaritic or even prurient experience, whereas the term massage therapist hopefully encompasses a scope of practice that helps alleviate symptoms of stress, muscle tension etc. and might also be working under the guidance of a doctor’s or physical therapist’s diagnosis and recommendations. LMTs should NEVER make medical diagnoses and at most aid in the assessment process of skin lesions etc. referring a patient/client to an appropriate medical professional). On another occasion an instructor equated “chi” to respiration or circulation, processes that are well known and far from woo. In contract other CAM adherents would swear that “chi” and “meridians” were not in fact really physical per se, yet “manipulating” them produced physical affects. Poor westerners straying into eastern practices, dragging Cartesian dualism with them all the way!
But before we paint all CAMs with the same brush we should remember the days when nutrition, exercise, yoga, massage etc. were lumped in with acupuncture, Reiki, homeopathy and the like. How many conversations I’ve endured where all this c*** was hailed as an alternative to evil cut-it-all-out western medicine. Without citing the appropriate abstracts I don’t think I am on shaky ground to advocate yoga, nutrition and massage as health practices with some basis in reality. To focus on massage I would just like to mention that touch has been shown to aid in relaxation and I remember more than one study linking stress reduction to lower cortisol levels. As to the strange claim of helping preemies gain weight the (creepy) landmark Harlow studies about touch deprived infant primates suffering from a failure to thrive when deprived of touch. Many of my clients for one reason or another are deprived of touch and I like to think that massage is a pleasant, socially acceptable, structured and safe (with a licensed no-woo practitioner) to achieve some good ‘ol oxytocin release from skin contact, and even if it lasts for only a day or two a sense of well being and relaxation that might promote a generalized stress reduced state and decrease the level of stress hormones that are clearly detrimental. None of these effects are permanent. None replace conventional medicine for serious medical conditions. None work without the additional psychological (placebo?) effect of a good massage. And if they do, they will work without the woo woo about “toxins” and such. I do think massage can increase range of motion, when like PT, it incorporates assisted stretches. Again, none of this is permanent and probably wont work when accompanied by a lack of exercise and isn’t followed with posture training and a active participation by the patient/client.
Just two more points about the culture of massage that seems to have eluded the practitioners themselves. That bottle of water at the end of the massage isn’t for “flushing out toxins” its for replacing water that is inevitably lost through urination due to the Swedish massage technique of pushing inter-cellular fluids towards the heart. Anyone who tells you it’s for flushing out toxins doesn’t know what they are talking about and didn’t pay attention in Clinical Massage 101. That clip board and the medical questions? Relevant to prevent injury to areas that were previously injured or susceptible to pressure (dialysis shunts, artificial joints, etc.), and if the “treatment goals” are feeling good and relaxation, great, on with it (off with it?) and dispense with the woo-ooo.