And it was really a lot of massage (expensive in the real world). And the pure “kinesiotherapy” treatment was super basic — this control group barely did more than wiggle their toes and clench their thighs, so it’s hardly surprising that they didn’t improve much. I wish the study had included a third group doing more exercise, perhaps a half hour of brisk walking per day. I think there’s an excellent chance walkers would have performed as well or even far better than massage. And walking is notably a lot cheaper than massage. 

Each of your feet contains 26 bones, 33 joints, and more than 100 muscles, tendons, and ligaments. Oh, and the soles of your feet have over 20,000 nerve endings. Researchers believe going barefoot keeps the information highway to your brain open and refreshed, so kick off your shoes, put your feet on the floor, and walk around to feel the full effects.
For instance, basic research has shown that touch is neurologically complex and probably has many physiological effects. Skin is fantastically rich in nerve endings — up to about 10,000 per square centimetre9 — and in 2009, Swedish researchers identified specialized nerve fibers that respond only to light stroking of a certain speed.10 This reinforces the obvious: massage can provide people with a rich and novel sensory experience, which could be a major mechanism for pain relief and other therapeutic benefits. If massage works, it’s mainly because of the neurology of touch (as opposed to, say, changing tissues).11
In massage therapy, so much can be achieved while inflicting only good pain on patients that bad pain must be justified by vivid, quick, and somewhat lasting benefits — which is a high bar to clear. All health care practices must be justified by benefits. As risk and pain and expense increase, the benefits must also. There is simply no point in tolerating — and paying for — painful treatment without an obvious return on the investment.

Deep tissue massages are not for everyone, and it’s very important to find a well-trained therapist. If you’re actively healing from surgery, have nerve damage or an existing injury, you’re wearing a cast or brace, or you’re pregnant, then talk to your doctor before seeking a massage therapist. Although it’s rare, massages that are poorly performed can sometimes cause increased pain, inflammation and other complications in high-risk patients. (16)

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So what should runners book instead? Anna Gammal, a massage therapist who works with elite runners at the Boston Marathon each year and also massaged athletes at the 2004 and 2012 Olympics, recommends either a sports massage (i.e. targeted therapeutic treatment for the unique physical and biomechanical needs of athletes) or a myofascial release massage (i.e. the application of gentle, sustained pressure on soft tissue restrictions). Both specifically target muscle release and will help improve flexibility, reduce pain and increase range of motion.
So presenting lactic acid as some kind of metabolic bogeyman that massage can purge from the flesh is wrong on many levels. This is another nail in the coffin of the daft notion that massage “detoxifies,” and yet another reason to be suspicious of any therapist who talks about “detoxification” — as is sometimes unethically done to rationalize adverse effects of therapy that actually have other causes, including potentially serious conditions.69

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Taking care of a pet can help you deal with anxious fear and a sense of aimlessness. Caring for your pet by providing food, love and safety may give you affection and satisfaction that will help you when you are feeling anxious. You want a caring companion, so make sure that you get a pet you can manage and look after without too much trouble or expense. Alternatively, you can borrow a friend’s dog and take him for a walk!
A traditional Swedish massage involves the whole body. You will begin on either your back or your stomach and flip over at the halfway point. If you have an area of particular concern, such as a tight neck, you can ask your therapist to spend more time in this area. Depending on your preferences, you can ask your massage therapist to use light, medium, or firm pressure.
The skin does get flushed and warm, of course. That’s just superficial, cutaneous hyperaemia: capillaries in the skin respond to mechanical stimulation by dilating (which is likely an immune function: the body transports blood to the site of possible skin breakage). Blood is hot, so the skin gets quite toasty! But it’s clinically trivial and superficial only, and it has nothing to do with the intention of the claim that massage works by increasing circulation. BACK TO TEXT

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The results are underwhelming. Although they did a little better than just guessing, the results suggest that it’s difficult even for expert examiners to detect the location of neck and back pain by feel. As well, they were only attempting to detect the side of pain. Imagine how much worse their performance would have been if they had had to identify the location more precisely, or if the pain could have been anywhere or nowhere. So they barely passed the easiest possible test, and probably would have failed a harder one and done no better than guessing.
Relaxing is increasingly difficult in our always-on digital world. This first struck me a couple of years ago when I had to stop exercising after an injury. Exercise had always been my go-to “me-time” activity, and without it I felt totally lost. I recently started again, but having only one means to de-stress now feels very limited and I am not even sure it counts as relaxing – it is quite hard work, and inherently competitive. When I find myself at home with a free evening, I often have no idea what to do and inevitably end up staring emptily at one screen or another for hours, before stumbling off to bed, wondering where the time has gone.
“It is your body, your session, your outcome,” advises Rotenberger. “There’s a fine line between pain and discomfort, and it’s unique to the individual.” What’s more, deep pressure is not the same as deep tissue. It’s a common misconception, Rotenberger explains, and in reality, a therapist that is muscle-specific needs to exert little pressure to be effective. 
Flushing. If massage can “improve” any tissue — unknown — one way it might do it is through simple hydraulics: physically pumping tissue fluids around, and/or stimulating the circulation of blood and lymph. I won’t get into the evidence about it here. Suffice it to say that it might be true, and if it’s true then it may not much matter if the process is uncomfortable. While gentler massage may feel pleasant and satisfying, it is possible that more biological benefits can only be achieved hydraulically — whether it’s comfortable or not. This is even more plausible because of trigger points: it’s likely that the tissue fluids of a trigger point are quite polluted with waste metabolites, and the need for flushing is greater, but it’s especially uncomfortable to squish those polluted patches of tissue.
Low back pain is a huge health problem, and massage therapists claim to get good results when treating low-back pain. Indeed, low back treatments are the bread and butter of the profession. I’d guess that about 70% of massage purchases are for back pain. The amount of money that patients around the world spend on massage for back pain must be simply huge, at least in the tens of millions annually, and probably much more. As with chiropractic care, massage therapists might not have much of a business model if people didn’t have low back pain.
Everyone I know, including myself, is busy and distracted on an infinite loop. It’s a curious conundrum, considering we’re all armed with more than enough information on how to de-stress. But the “surprising benefits” of exercise, meditation and work-life balance, documented ad nauseam, are beginning to feel like drawn-out humblebrags. Sometimes, they just seem insurmountable. And try as we might to convince ourselves that binge-watching TV helps, I don’t know anyone who feels refreshed after two+ episodes.

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