A big Debate seems to be Emerging: About the Value of Massage for DOMS Delayed Onset Muscle Soreness 

Article by G Rieger

Posted September 9, 2014 Last Updated November 7, 2017

It is true that a vast number of highly skilled and trained practitioners in the massage industry have been misled by their institutions of training.  This oversight has been based on a traditional use of anecdotal evidence and historical descriptions of the benefits of massage therapy rather than any intention to mislead students. This miss information is still a systematic part of many massage schools today. It has only been in the last 2 decades that massage has been the focus of any significant research studies. 

A BIG misunderstanding that has traveled throughout the threads of the massage industry grape vine is that lactic acid is a culprit in delayed onset muscle soreness.  A bigger misunderstanding is that lactic acid is some kind of physiologically produced toxin that massage therapy can eliminate from the body. So one may be asking themselves what is lactic acid and what is its physiological function in the human body?

Glad you asked!   Lactic acid has developed a bad reputation.  Can it be in any way responsible for those sore, achy muscles a day after intene physical exertion?  It is important to point out that DOMS is produced by uncommon physical exertion.  Those who regularly participate in a strong physical activity at the same daily level rarely experience delayed onset muscle soreness, unless they do more than average on any given day.   A look at the specific role lactic acid plays in the human body will produce a clearer picture for those massage therapists who talk about lactic acid during their massage sessions every day. 

It was commonly believed that lactic acid built up in the muscle tissue during exercise and was a factor in muscle soreness after a good workout.  This belief was common within the fitness, alternative health and massage industries.  It was even thought that lactic acid continued to build up in the muscle tissue after the end of the unusual or extended workout.  Today we know that the source of this mild to severe pain and discomfort is much more complex.

The really exciting revelation is that lactic acid plays a role in generating energy.  Wow, it has a positive role to play and is not simply an unwelcome waste product of physical exercise.  Lactate is an essential fuel used by the muscles mitochondria (the power house) during prolonged physical activity.  Lactic acid is cleared from the muscle tissue following physical exertion by normal metabolic process and is insignificant within one hour. 

Lactic acid is formed from glycogen within muscle cells that have inadequate oxygen supply to sustain a high level of physical activity and exertion.  Not a useless byproduct of the mitochondria and ATP production.    Yes, it is true lactic acid and lactates are not responsible for fatigue during exercise or the stiffness and pain that can result hours to days later more popularly referred to as (DOMS) Delayed Onset Muscle Soreness. 

Exercise physiologists have known this for decades, as a result of the immense increase in digital forms of communication like the internet it has now become commonly known to many.  Massage therapists you have not been given the complete picture in the past.  You have never been entirely wrong and you have never been accurate in your beliefs about how lactic acid works in the muscle tissue of the body. 

Let’s review for a moment lactic acid and lactates are not responsible for delayed onset muscle soreness.  Massage does not flush lactic acid out of the muscles; natural metabolic process will clear lactic acid within an hour of any strenuous activity. It is time as a practitioner of massage to change your dialogue about lactic acid.  It is time for this oral tradition to end. 

What does Trigger DOMS: Delayed Onset Muscle Soreness?

Now that we have a handle on what does not cause delayed onset muscle soreness we can now turn our focus to what does.  Unfortunately little is now known as to what mechanisms are involved in delayed onset muscle soreness.  Medical science is at a loss to truly explain this phenomenon.  Yet it is well known that it does exist.

DOMS or Delayed Onset Muscle Soreness can be caused by many types of physical activity such as walking, running, jogging, bicycling, swimming, stair climbing and cross country skiing.  The cause seems to be a complex of bio-chemical reactions and   damage to microscopic muscle fibers as a result of strenuous exertion. 

What is known is that the specific physical activity that causes DOMS is muscle lengthening exercises or eccentric muscle actions. This type of contraction happens as you walk or jog downhill or the lowering action of a biceps curl.   Genetics seem to play a role too, as some individuals will experience a greater degree of discomfort vs those that only have an occasional and mild case of DOMS upon increased physical activity.  

Conditioning can help control and moderate delayed onset muscle soreness, but even the best conditioned athlete can develop DOMS if they up the intensity of their workout.  DOMS has also historically been referred to as muscle fever.  Muscle fever was first identified by Theodore Hough in the year 1902; he came to the conclusion that it was a result of tissue damage and ruptures within the muscle.

Can Massage Play a Role in the Treatment of DOMS & Muscle Recovery?

Pain and soreness after an increase or unusually physical demand on the muscles of the human body is a given.  It is simply a part of how our bodies function under extreme physical stress.  So, what does the research evidence say about massage.  Can massage reduce the duration of DOMS and speed up the recovery of the muscles?

The good news is that massage seems to have some positive effects in reducing pain and soreness within 24 to 48 hours in several studies.  There are several small studies that indicate variable results and are inconclusive on the effects of massage on pain perception and others that conclude that massage has a positive effect on PPT pressure pain threshold.  The general conclusion is that massage has an effect on pain and pressure, the degree is variable.   It is also clear that although massage may provide a reduction in pain perception in DOMS, it does not enhance muscle strength and recovery.

So Why the Big Debate?

The evidence is often inconclusive and results vary as to the methods of testing.  It seems that massage at this time cannot be described as a magic bullet for DOMS based on the evidence.  Ah but massage has repeatedly been shown to decrease pain and increase the individuals sense of wellbeing.  Are these effects purely psychological in nature or are they a component of our fundamental neurology and pain perception.  The jury is still out.

The results of evidence based research have clearly defined lactic acid production as a positive biological process in the body which provides energy under extreme physical activity.  Lactic acid is not merely a waste product and massage does not remove lactic acid from the body.  It is time to change the massage to client dialogue concerning muscle soreness and its sources.   Medical science is unclear as to the cause of DOMS and it is ok as a massage practitioner to simply state that it is not known what causes delayed onset muscle soreness. 

Does massage help athletes and weekend worries reduce their pain sensation and perception a day or two after heavy physical activity?  The results of evidence based research say a subtle yes, but the results are variable.  Massage is a personal experience and results will vary from individual to individual.


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