We make extensive use of massage to treat Musculoskeletal injuries. These include trigger point massage, myofascial releases, as well as some lymphatic drainage for swollen joints and muscles. The 11 Myofascial Trains as advocated by Thomas Meyers are used to integrate various body areas into a holistic approach to treat the cause-of-the-cause as well as to prevent recurrences by improving body alignment through myofascial gliding. Massage is a great adjunct to dry needling and manual therapy techniques such as joint mobilisations. Kinesiotaping may also be employed to maintain myofascial alignment. Combining these approaches with exercise makes postural control and optimisation of movement easier.

 A review in 2021, described massage as mechanotherapy that can provide skeletal muscle improved recovery after exercise and sport by combating atrophy through it's affects on protein and ribosome turnover, extracellular matrix (ECM) turnover, satellite cell proliferation and immunomodulation (Van Pelt DW et al 2021, Ex & Sp Sc Rev, 49, 2, 107-114).

A rabbit animal model of eccentric exercise was used, where muscle architecture was examined 5 days post exercise, comparing the massaged to non-massaged tibialis anterior. The rabbits without massage, demonstrated severe damage, including widening of the endomyseal space between myofibres, disruption of myofibrillar membrane, damage within myofibres and a large infiltration of inflammatory cells. This was in stark contrast to those muscles which had been massaged (Butterfield TA et al 2008, Med Sci Sp Ex, 40, 7, 1289-1296). Peak torque in the massaged muscles was 4 times that of the unmassaged and moreover, optimal recovery occurred in muscles massaged immediately post exercise.  

Massage improves recovery of muscle mass after disuse atrophy. Here a rat model of 2 weeks of hindlimb suspension was used, where 8 days after suspension, the rats who had been massaged demonstrated greater cross sectional muscle mass compared to those that hadn't. (Miller BF et al 2018, J Physiol, 596, 1, 83-103)

Massage has an immunomodulatory effect in skeletal muscle. An abundance of of CD68+ and CD163+ immune cells responded in a dose/force dependent manner (Butterfield et al 2008) In humans, exhaustive cycling ergometer exercise was used to examine the difference between Vastus Lateralis in the 10 minutes of massaged compared to the unmassaged limb. The massaged limb demonstrated reduced TNF-alpha, IL-6 and Nuclear Factor (p65) - all the hallmark of inflammatory markers. In addition it reduced the elevation of Heat Shock Protein (HSP) 27, a marker of cellular oxidative stress response ((Crane et al 2012 Sci Trans Med, 4, 119).

Muscle mass is a balance between protein synthesis and degradation. Massage applied during the reloading phase of training resulted increased protein synthesis compared with reloading alone. Rate of protein synthesis is attributed to the translational efficiency and capacity of ribosomes. Some evidence suggests the value of massage during disuse to attenuate ribosomal degradation.

Integrins of the ECM are a critical response to resistance training. Massage may have a mechanical effect on these integrins which plausibly could lead to mechanosensitive anabolic signalling Additionally, stem cells are known to be mechanosensitive, which may explain the proliferation of stem cell activity in massaged muscle, during muscle recovery, in both healthy muscle and after disuse atrophy (Hunt et al 2019, Physiol Rep, 7, 17, c14200). .

Crossover effect of massage impacts contralateral non-massaged homologous muscle has been a clinical myth. In terms of neurophysiology, there is evidence of transcortical inhibition when it comes to physical activity. However, it is plausible that massaging one area of the body stimulates a myokine or extracellular vesicle response. Certainly, Jay Shah has demonstrated movement of fibroblasts along the myofascial membrane, which presumably is a mechanism for moving substances needed for 'rebuilding' and 'regrowth' from area of the body to another. It's also one of the suppositions upon which myofascial train therapy construct validity is based upon. 

Massage in aged skeletal muscle may play a significant role both post exercise as well as after disuse atrophy for the reasons outlined previously. Moreover, in the rat model, aged muscles demonstrated a unique heat shock protein response involving HSP-25, HSP-70 and cold shock protein RBM3 (Van Pelt DW, et al 2019, J Appl Physiol, 127, 6, 1782-91), which have all been considered as important substances for the avoidance of apoptosis in the mitochondria of myofibres.

Also see Fascial Manipulation elsewhere on this site

and Trigger Point Therapy/Dry Needling 

Updated : 28 October 2021