More Myths of Massage

Last week I wrote a post on Facebook about some of the myths of massage. My statement on this issue was and continues to be that I am not accusing anyone of telling a deliberate lie, nor am I attacking the character of any teacher who has helped to perpetuate these myths. I choose to believe that everyone has good intentions.

Before I became interested in the evidence-based practice of massage, I’ve been just as guilty as sharing some of them myself. There seem to be so many of them, and in my opinion  people tend to blindly accept what they learn in massage school. We view teachers as authority figures, but the fact is, teachers have a tendency to repeat what they were taught in massage school…so they pass that on to their students, who in turn share that false information with their clients, with the best of intentions. Some of those same students go on to become the next generation of teachers, and those same myths just keep being perpetuated.

Yesterday I heard from Lee Kalpin of Ontario, who shared a few more of these massage myths with me. I am presenting them here, and if anyone has any valid research references that will back these up as fact, please feel free to post it for our enlightenment.

– Massage removes toxins from the muscles.

– Lactic acid is responsible for DOMS (Delayed Onset Muscle Soreness).

– Massage can get rid of cellulite.

– It is contraindicated to massage a person who has cancer (or had cancer).

– If you massage a person who has consumed alcohol, it will increase the effects and make them more intoxicated.

– You can strengthen muscles by performing tapotement.

– You can straighten a scoliosis by doing tapotement on the weak side and stretching on the tight side.

– Manual Lymph Drainage causes the lymphatic channels to collapse for 20 minutes so you cannot do any other manipulations after MLD.

– You should never do more than 3 trigger point releases in a treatment (no reason stated for this one – it was just stated as a fact).

– Ischemic compression for trigger point release should be done as deep as possible.

– Only deep massage is therapeutically effective – as deep as possible. Lighter massage is just for relaxation.

– You should not massage pregnant women during the first trimester.

– You should not massage the feet and ankles of a pregnant woman as it may cause her to miscarry.

– Drinking lots of water flushes toxins out of the system – encourage the client to drink water after a massage.

– You cannot massage a person who has “high blood pressure” – definition needed about how high is high, and cause of hypertension.

– You must massage toward the heart or you could damage the heart valves.

– It is contraindicated to massage pitted edema.

I must say that I have heard all of these at one time or another. Where did they come from? I don’t know. As one FB friend said “I heard it from some reputable teachers.” And they probably heard it from their reputable teachers.  So let’s just let the buck stop with us. If the words “research shows” are going to come out of your mouth, then back that up with the actual research reference, and if you can’t produce any, don’t say it–to your students or to your clients. If all the evidence you need is that massage helps people feel better, then let that stand for itself and don’t make wild claims. And please, as I said above, if you have the research to prove any of these statements, share that with the rest of us.

20 Replies to “More Myths of Massage”

  1. Alexei,

    That is actually dictated by each individual states’ practice act–with the exception of the word “prescribe.” No, we can’t “prescribe” anything. But many practice acts spell out that stretching is within scope, including my state. You can demonstrate and recommend that a neck stretch might help someone, for example–but NEVER prescribe. That ticks off those people with the more important letters after their name than we have 🙂


  2. Laura,
    Thanks, I did not know that therapeutic stretching was within the scope of practice in any state. Do you know if therapeutic exercise is in the practice act of any state?

  3. Laura,

    Thanks. I have been sharing that kind of information with my students and continuing education participants for a long time now. Quite frankly, I am often looked at by those same people, as if I had two heads when I make such statements. What has been clinically proven about massage is still a short list. Let’s keep the research coming!

  4. Perhaps you can point your readers to the research that disproves these statements? I mean, you seem to be doing the same as those who espouse them: you just say “This is the truth, believe me.” I agree that most of those above are, in fact, myths, but I continue to be confused by the whole “toxins” thing. I’ve heard arguments both for and against it, and frankly, it frustrates me. I can never seem to find a medial or scientific study in my internet searches. I just find answers by who knows who who think massage as a whole is a one big quackfest anyway.

    And why would you want to massage pitted edema anyway? I guess you could flush the edema out, but isn’t there also the risk of increasing it by increasing circulation to the area? Another frustrating point to me.

    I believe the pregnancy myths are (in part anyway) to reduce liability. If a woman in her first trimester gets a massage and then miscarries shortly thereafter, she could turn around and sue the MT if someone says to her that massage is bad in the first trimester. So it’s a bit of a vicious cycle. The public believes it is true, so MTs are taught that it is true to prevent liability, but it only prevents the real truth from taking hold.

    We were taught that massaging on the limbs away from the heart didn’t damage the heart valves, but was to help venous flow back to the heart, and that arterial flow doesn’t need any help since it’s being shot out of the heart. We were also taught it could possibly damaged the one-way valves in the veins. Again, perhaps this was to reduce liability?

    I give all my clients water after their massages because it’s good for them and if they are like most of the population, they are dehydrated. If a client asks why, that’s what I tell them. I just think it’s courteous, too.

    Now I’m beginning to think my education wasn’t up to snuff and that my instructors whom I respect greatly were grossly misinformed 🙁 Time to think for myself, I guess! It’s okay, I like it. I’ve been massaging for 5 years, and I still find myths very thought-provoking (as you might be able to tell by my rambling comments). Thanks for calling out misinformation!

  5. Good discussion! I figured this would start something when Lee sent it to me.

    First of all, the burden of proof is on the person making the claim–not the other way around. Unless and until something is proven, it is a myth. There are around 600 research citations about massage on PubMed, and you’re not going to find any of these on there. I know because I have read almost all of the abstracts in the past week or two in looking for things like this myself.

    Second, prescribing: if I say that a 1958 Chateau Rothschild is a good wine that you might enjoy, I am not prescribing that you drink it. It is no different with a stretch. I can demonstrate and say “this helps me when my neck is hurting, and it may help you.” That is not prescribing.

    As for the therapeutic exercise, that was not listed in the practice act of my state–nor was it excluded. I will say, however, that here in NC, personal trainers are not licensed or regulated and they give people exercises all the time. Exercise is not my area of expertise so I personally don’t go there with clients.

    It is appalling to me that most MTs have never read the practice act in their own state and have no idea what it allows them to do and what it doesn’t. And I am basing that observation on the fact that I travel all over the place teaching and I ask that question in every class–how can you follow the rules when you don’t know what they are? In the average class of 20 people, I get maybe 2 of them who say they have read it all.

    Finally, Hi Monica! Thanks for weighing in! And Stephanie, most of us have had instructors who perpetuated the same myths they were taught. As I said above, it isn’t because they’re bad people. They’re repeating what they blindly accepted in school themselves. No one wants to think they’re paying tuition to receive false information.

    Here is a good place to look up valid, peer-reviewed research studies.

  6. Thanks Laura,
    I really enjoy your blog. You challenge our assumptions, and that’s a good thing. I thought practice acts were like zoning regs, in that if something is not included, then it doesn’t have to be explicitly excluded for it not to be allowed. Unless something like, for example joint mobs, are explicitly included in the scope of practice, then they are legally excluded. When it comes to exercise, I’m referring to therapeutic exercises, You know, the stuff you get prescribed by physical therapists when your trying to rehabilitate from trauma etc. This is a whole different ballgame than what personal trainers do.
    Evidence based practice in massage has got a lot of work to do if Chris Moyers (name?) recent meta analysis of cortisol based outcome measures is correct. That’s going to mean a lot of the research done in recent years needs to be redone with different outcome measures. Looks like massage research might be a growth profession 🙂

  7. Alexei, having never had any PT-type therapeutic exercises myself, I can’t speak to that, because I really don’t know exactly what they make you do. I’ve seen some of their tools, the balls, the bands, balance boards, etc. It appears to me that they just target injured areas with specific exercises. If you want to build a certain muscle, the personal trainer does the very same thing. Different intent, but probably lots of overlap in the methods.

    I am a supporter of the Massage Therapy Foundation. I hope that MUCH research will be done. I teach a class in How to Use Research to Market Your Massage Therapy Practice, and when anyone hires me to teach that (it’s only 3 hours) and one other class of at least 3 hours duration, I will donate my fee for the research class to the Foundation. I also just try to support them by spreading the word about them. I believe research literacy and study is crucial.

  8. Therapetic exercise is part of our course of study in Ontario and it is examined on the Entrance to Practice examinations. It is expected that therapists will demonstrate and advise the client to do exercises when appropriate. Not just stretches, but all types of therapeutic exercise. Obviously this does vary from one jurisdiction to another, and we should not go beyond what our training prepared us for.

  9. To Stephanie: To address some of your points
    As Laura said, it is not our job to disprove myths. If we think something may be true, we have to look for research to prove it is true. We cannot just guess and throw the information out there!

    As for the “toxins thing” – it is important to have a good definition of the word Toxins. Toxins are poisons, – according to the dictionary they are protein based poisons. If a person is unfortunate enough to ingest them or otherwise be exposed to them, toxins will either kill them or make them very ill. Toxins are typically stored in the body fat or in the bones (there are good scientific articles on this). Toxins are not stored in the muscles, and no matter where they are, you cannot squeeze them out of the body by doing massage.
    The word “Toxin” has come to be improperly used to describe “stuff that is not very good for you” such as sugar, caffeine, Macdonald’s fries, etc. These are not great nutritiants but they are not toxins, and the body can deal with them. Whatever the body cannot use, it will filter out in the liver or the kidneys and excrete through the bowels or the urine. Again, you cannot squeeze it out by doing massage.

    You ask “why would you want to massage pitted edema?” Well, why would you want to massage ANY edema – you would do MLD techniques to move the edema back into the circulatory system if possible. The important thing to find out, is what is causing the edema?

    I believe you are right about the pregnancy issue being fear-based around liability. The thing is that most women do not know they are pregnant until they are well into the first trimester, so they may be having massage anyway. Most doctors advise pregnant women to carry on with all normal activities, such as walking, exercising, doing housework, yardwork. Massage is no more stressful on the body than any of these activities.

    You are correct about the reason for massaging toward the heart (or at least, massaging the limbs toward the heart). It about returning the venous circulation and not damaging the one-way valves in the veins. Apparently some massage therapists got the idea that it was about the valves in the HEART, which is not accurate.

    It’s courteous and pleasant to offer a client water after a massage. But the statement that everyone is dehydrated is not supported by any research that I can find. The kidneys regulate the amount of fluid in the body. To put in bluntly, if you drink a lot of water you will pee a lot. If you don’t drink so much water, you won’t pee so much. Either way the amount of fluid in the body will stay the same. Dehydration occurs most often when fluid is lost in another way that the kidney’s can’t control, such as heavy perspiration. Or if there is just no fluid available to drink. And we also get fluid in other ways besides water. Anything you drink will rehydrate the body and there is also lots of fluid in many foods.

    Thanks to Laura for posting my list of MYTHS, and to everyone for their participation in the discussion

  10. It is always fascinating to me to compare the attitude towards massage in the western world with the Asian attitude. I have spent most of my 12 year long massage career in Thailand. People in Asia tend to be less intellectual about the benefits of massage. They just accept that it is beneficial, but few ask specific questions. One of the main reasons for that is that most Asian massage modalities are not so much based on anatomical, physiological and scientific considerations, but on the concept of energy flow through subtle energy lines.

    This concept has a long history in Asia and has been used for literally thousands of years, but it is very difficult to validate it by the standards of the western model. But it is widely accepted as a truth, albeit a not very clearly defined one. As a result, few Asians would even think of asking such specific questions and no practitioner is expected to know the exact science behind what they are doing.

    An Asian therapist would notice energy blocks, would attempt to move or stimulate the energy, increase energy flow etc. Some Asian therapies are quite specific about these energy line like the Japanese Shiatsu whereas Thai Massage is less specific.

    For me, as a westerner living in Asia, it is like having one foot in both worlds, east and west. Your observations in your post are very interesting and relevant to western audiences, and in contrast most Asian therapists would just shake their heads, wonder what this is all about, and largely disregard it.

    So the focus of east and west can be very different, and I have seen great results in both systems. Sometimes there is no right and wrong, but just a difference in perspective.

    Thanks for your informative post.

  11. Laura, you forgot to put the myth that bothers me the most: Massage moves energy, or affects the “energy body” or “energy system.” Thank you Shama Kern for bringing this up. In Asia, people do not care about science because they do not have the background to understand it in relation to bodywork. Even in America, many people choose to believe this, but science has not found any reliable substantiation for this belief.

    I think that precisely what Laura is trying to achieve is a focus on verifiable facts, not merely on tradition or belief.

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