Different effects of massaging and stretching?

[Isak]

It became apparent to me after my first post on this forum, how little I actually know - or perhaps more accurately - how many unfounded assumptions I hold about how my body works.

I came to wonder what the different effects of massaging or stretching a muscle are?
In my limited perspective, I always thought of them as more or less the same, since they both release tension/tightness.
Are there cases where massage may be a better tool than stretching, and vice versa?
And can they be combined for a synergistic effect? (I imagine this is what RollStretch aims to accomplish)

[Nathan]

8 hours ago, Isak said:

It became apparent to me after my first post on this forum, how little I actually know - or perhaps more accurately - how many unfounded assumptions I hold about how my body works.

Beautiful! That's where the real learning begins 

Someone else will be able to give you a much better answer than I (we have several very skilled massage therapists here), but I would consider massage and stretching to be quite different. They do have some shared effects (relaxation, etc.), but the immediate goals tend to be different. You also have to consider that there are many different types of massage and stretching, each with different goals. That said, the goal of most stretching, generally speaking, is to increase (habitual) flexibility by changing how your body/nervous system reacts to placing a muscle in a stretched position (short- and long-term). As for massage... I hesitate to even answer, but from my limited knowledge, I would say the usual goal tends to be either relaxation or (temporarily) improving muscle tissue quality.

This is a great video from Kit about what stretching really is:

 

[Isak]

I really like that video. Had seen it before, but had not really grasped the message until now.

One thing I do keep wondering, is if I can stretch a muscle knot away, or if has to be massaged somehow?
Sometimes they are relieved by massage, other times it's like nothing can make a dent in them no matter what.
Muscle knots are probably my biggest barrier to experiencing grace and ease in the body. I have the kind that feels like marbles stuck under my skin.

[Nathan]

2 hours ago, Isak said:

Muscle knots are probably my biggest barrier to experiencing grace and ease in the body.

Regular stretching will help. SMR (self myofascial release, i.e. rolling) will help, and professional massage will help. A lying relaxation practice will help! (Search the forum for free guided scripts from Kit.)

But you should ask yourself, "why do I have these knots?" The knots are tension. Your body does not hold tension for no good reason. It is responding to the stresses placed upon it, both physical and mental. Searching for the cause and addressing that will be incredibly rewarding, although perhaps difficult.

[AlexanderEgebak]

On ‎7‎/‎6‎/‎2019 at 6:39 PM, Isak said:

It became apparent to me after my first post on this forum, how little I actually know - or perhaps more accurately - how many unfounded assumptions I hold about how my body works.

I came to wonder what the different effects of massaging or stretching a muscle are?
In my limited perspective, I always thought of them as more or less the same, since they both release tension/tightness.
Are there cases where massage may be a better tool than stretching, and vice versa?
And can they be combined for a synergistic effect? (I imagine this is what RollStretch aims to accomplish)

The effects of massage is mostly "none-specific".

The effects are derived from a relaxation response due to touch, expectations and it can be conditioned. The is essentially and classically called placebo.

The hypothesis by neuroscientists right now is that this lowers the threat level of the brain and lessens pain, tension and autonomous responses associated with danger. This favors relaxation.

[Naldaramjo]

6 hours ago, AlexanderEgebak said:

The effects are derived from a relaxation response due to touch, expectations and it can be conditioned. The is essentially and classically called placebo.

What is your source for this claim? There are many different kinds of massage, and this strikes me as far too simplistic and even dismissive. 

[AlexanderEgebak]

3 hours ago, Naldaramjo said:

What is your source for this claim? There are many different kinds of massage, and this strikes me as far too simplistic and even dismissive. 

The thing is; there is no scientifically proven effects of massage. Essentially, when compared to a placebo, massage works no better for pain treatment. There is a huge evidence base for that.

So when people feel better after a massage the effects must be none-specific, and this is me hypothesizing the possible effects. If you read Dan Moorman's "The Meaning Response" about the placebo effect it will make sense. Otherwise, there is a whole ton a litterature out there on the placebo effect.

About different types of massage; this is a big topic, and controversial.

As therapists we like to believe that a certain result we attain is due to a certain effect. The classic example is myofascial release where it is being hypothesized that by the applied force of our hands it is possible to break fascial adhesions. This has 1) not been proven to happen, 2) is not scientifically plausible due to force resistance of collagen tissue (and lucky for that because otherwise our whole body would be a bubbly mess if hands only could break collagen), and 3) all structures around the targeted one will absorb force application; the net force produced by the hands will spread out.

The possible specific effect of myofascial release, though not proven, is that the lateral static stretch applied to the skin will trigger a reflex through stimulation of Puccini corpuscles that are small receptor organs in the skin.

I can expand on the whole "touch thing" too and why theories suggest massage would provide relaxation as an effect.

[Naldaramjo]

1 hour ago, AlexanderEgebak said:

The thing is; there is no scientifically proven effects of massage. Essentially, when compared to a placebo, massage works no better for pain treatment. There is a huge evidence base for that.

What would a placebo form of a massage be in this case? A massage given without the intention of providing therapy? 

As for the rest of your post, I am not well versed in the literacy surrounding massage efficacy, so perhaps someone else with more experience/expertise will respond at some point.

I have to admit my experience is only as someone who has received massages, but, for me, they have been effective - generally, in the sense of relaxation, but also specifically, in the healing of localized injuries. 

I am also intending to study massage therapy next year, so this is especially interesting to me. Bluntly, I believe in the healing power of touch, though I won't make any claims about the mechanism.

 

[AlexanderEgebak]

23 hours ago, Naldaramjo said:

What would a placebo form of a massage be in this case? A massage given without the intention of providing therapy? 

As for the rest of your post, I am not well versed in the literacy surrounding massage efficacy, so perhaps someone else with more experience/expertise will respond at some point.

I have to admit my experience is only as someone who has received massages, but, for me, they have been effective - generally, in the sense of relaxation, but also specifically, in the healing of localized injuries. 

I am also intending to study massage therapy next year, so this is especially interesting to me. Bluntly, I believe in the healing power of touch, though I won't make any claims about the mechanism.

 

I think I need to clarify what placebo is first.

In short terms, placebo is positive none-specific effects of a given intervention that is heavily reliant on what meaning an individual places upon the intervention and the context.

Massage is not "a placebo". Massage just have not had any specific scientifically proven effects.

Touch is a "placebo effect" due to the fact that it is not specific to a massage, and it cannot be quantified how big/small the effect is.

Massage cannot heal injuries either though part of the placebo effect is a pain dampening response. Massage is usually claimed to increase blood flow to an area but that only happens superficially to the skin to my knowledge.

Massage can be both effective and ineffective. It really depends on the individual being given the massage and the provider. If it is not a persistent pain problem massage is generally more helpful. If the provider understands to create a calming atmosphere, looks good, dresses appropriately, has a nice room for treatment, calms the patient through talking, listening and addresses concerns… If the person believes touch will help them, if they expect a good result due to prior experiences, if their are "touch-deprived"... These are all parameters for how good a result a massage will have - transferred from placebo research. If you sort these out, you will have good results, and your patients will see you as empathic.

Massage school is generally about learning techniques and basic anatomy which is good but you will being thrown into some dogmas if you are not skeptical of the information that you are given. The most important about a massage is in my opinion learning to feel the response of the patients; that will let you know the optimal pressure, the optimal placement of your hands, the optimal technique just for them. Focusing on the muscle knots, targeting specific muscles, specific techniques if just a waste of time of the patient is not in on it.

[michaelsamsel]

Considering massage as a uniformly delivered product shows what usually happens, not what could happen (excellence) If one subscribes to an energy model, the hypothesis might be entertained that some massage uses one energy system (or person) to help move energy in another system (person). But if this happens, it probably happens less than people think it is. Most of the participants in this board are interested in excellence (what doesn't usually happen)

[Naldaramjo]

On 8/25/2019 at 4:47 PM, AlexanderEgebak said:

I think I need to clarify what placebo is first.

In short terms, placebo is positive none-specific effects of a given intervention that is heavily reliant on what meaning an individual places upon the intervention and the context.

Massage is not "a placebo". Massage just have not had any specific scientifically proven effects.

Touch is a "placebo effect" due to the fact that it is not specific to a massage, and it cannot be quantified how big/small the effect is.

Massage cannot heal injuries either though part of the placebo effect is a pain dampening response. Massage is usually claimed to increase blood flow to an area but that only happens superficially to the skin to my knowledge.

I know about the placebo effect, but I was having trouble reconciling it with how you had justified massage therapy's ineffectiveness, saying it didn't fare any better than a placebo. A placebo is, from my understanding, a treatment given that resembles the target treatment (e.g. a medicinal pill), yet is designed to be ineffective (e.g. a sugar pill). I couldn't imagine how, in this situation, a placebo would even be administered.

On 8/25/2019 at 4:47 PM, AlexanderEgebak said:

Massage can be both effective and ineffective. It really depends on the individual being given the massage and the provider. If it is not a persistent pain problem massage is generally more helpful. If the provider understands to create a calming atmosphere, looks good, dresses appropriately, has a nice room for treatment, calms the patient through talking, listening and addresses concerns… If the person believes touch will help them, if they expect a good result due to prior experiences, if their are "touch-deprived"... These are all parameters for how good a result a massage will have - transferred from placebo research. If you sort these out, you will have good results, and your patients will see you as empathic.

This suggests to me that what determines the effectiveness of massage therapy is nearly all within the ability of the therapist to control. Of course, nothing can really be done about a skeptical patient, and if that is a significant factor in the therapy's success, then perhaps such a patient would be better off searching for a form of treatment less subjective, but it doesn't invalidate massage therapy as a form of treatment. 

On 8/25/2019 at 4:47 PM, AlexanderEgebak said:

Massage school is generally about learning techniques and basic anatomy which is good but you will being thrown into some dogmas if you are not skeptical of the information that you are given. The most important about a massage is in my opinion learning to feel the response of the patients; that will let you know the optimal pressure, the optimal placement of your hands, the optimal technique just for them. Focusing on the muscle knots, targeting specific muscles, specific techniques if just a waste of time of the patient is not in on it.

 

Again, all this suggests that massage therapy can be effective. It seems to me that "scientifically verified" is an insufficient metric by which to assess the ways in which carefully administered massage therapy has helped countless numbers of people. 

Perhaps @Kit_L can weigh in here, since he practiced shiatsu for many years.

Edited August 28, 2019 by Naldaramjo
clarification of second to last paragraph

[AlexanderEgebak]

On ‎8‎/‎26‎/‎2019 at 9:56 AM, Naldaramjo said:

I know about the placebo effect, but I was having trouble reconciling it with how you had justified massage therapy's ineffectiveness, saying it didn't fare any better than a placebo. A placebo is, from my understanding, a treatment given that resembles the target treatment (e.g. a medicinal pill), yet is designed to be ineffective (e.g. a sugar pill). I couldn't imagine how, in this situation, a placebo would even be administered.

This suggests to me that what determines the effectiveness of massage therapy is nearly all within the ability of the therapist to control. Of course, nothing can really be done about a skeptical patient, and if that is a significant factor in the therapy's success, then perhaps such a patient would be better off searching for a form of treatment less subjective, but it doesn't invalidate massage therapy as a form of treatment. 

 

Again, all this suggests that massage therapy can be effective. It seems to me that "scientifically verified" is an insufficient metric by which to assess the ways in which carefully administered massage therapy has helped countless numbers of people. 

Perhaps @Kit_L can weigh in here, since he practiced shiatsu for many years.

I dont think you follow me completely. Maybe you should do a litterature search and read the studies conducted on massage. There are two kinds of studies that informs us of the placebo effect of massage.

1) The studies that compare massage with "natural cause". Which means doing nothing and let time use its healing powers on pain. It seems that for long term pain problems massage is having a very little effect compared to doing nothing.

2) Massage where specific techniques are being compared. When special techniques, for instance targeting specific tissues, going with a certain flow or grap etc. works no better than each other for a homogenized population it seems like there is no specific effect in the type of touch (or sensation being applied) - or it does not matter that much.

From that you can conclude massage has no specific effects and that long term effects on their own are inefficient.

But massage falls into a category of touch modalities along with manipulations, mobilizations og guided movements that may have a short term touch specific effect. Not proven, but in my opinion likely. But not long term.

You are only partly in control of the placebo effect. Genetics, personality traits, socioeconomics etc. are part of outcomes, and one has little to no control of those whatsoever. But beliefs, expectations, experiences and context you can control.

I disagree, a skeptical patient just needs a more patient approach. Though in my experience hardly anybody who comes FOR a massage is skeptical OF a massage. But they might have issues with certain techniques etc.

I have never said that massage therapy is not effective. If that was what you read from my post, then you need to read again. I am skeptical of why it is effective and how it is effective. Science is good at measuring outcomes, but not effects of treatments. The results for long term pain are of high quality and perfectly valid. But science is not good saying THIS EXACT THING HAPPENS.

I suspect we will never be sure of the effects of massage. We only know what it doesnt. Qualitative research might provide context to proposed placebo effects but there are limits.

[Naldaramjo]

Thank you for elaborating on your points. Are you a massage therapist? 

On 9/6/2019 at 7:03 PM, AlexanderEgebak said:

Though in my experience hardly anybody who comes FOR a massage is skeptical OF a massage. But they might have issues with certain techniques etc.

It sounds like you are, or at least you are working in a related field.

[AlexanderEgebak]

17 hours ago, Naldaramjo said:

Thank you for elaborating on your points. Are you a massage therapist? 

It sounds like you are, or at least you are working in a related field.

I practice massage so I guess I am
I am also studying physiotherapy and have a keen interest in pain science.

[Naldaramjo]

What do you think in general of your experience as a therapist? I'm looking forward to the training and the work, but I don't know a lot about it aside from an introductory weekend course I took on relaxation therapy.

[AlexanderEgebak]

On 9/11/2019 at 8:06 AM, Naldaramjo said:

What do you think in general of your experience as a therapist? I'm looking forward to the training and the work, but I don't know a lot about it aside from an introductory weekend course I took on relaxation therapy.

As a physiotherapist?

I am not working full time yet because I still attend education but other than that I love it! Physiotherapy school is in Denmark not that up to date with research and physiology but we learn decent hands on skills and people skills which I utilize in my work. Luckily, with this profession there is a multitude of ways you can go - you can draw from psychology, medical education, personal training, coaching and massage therapy to make up your own practice. You are not bound by what you learn in school - and thank god for that!

What I loved during the introductory course which was basically a standard massage school certificate was the exploration of touch. It may sound wrong but if you are a very physical and touchy person you can share that interest with other through examination and treatment relevant to massage studies. We quickly moved onwards from that though.

[Kit_L]

All I will say about Alexander's comments is (and we have had an extensive number of exchanges over about two years on this forum, which was deleted at his request) that in my view, he is over-reliant on the research. I strongly disagree with his position that something cannot work as its practitioners claim if there is no scientific evidence to support it.

In fact, anyone working at the cutting edge of any field will be working without evidence to support it, because that research will not have been done at that point. 

My background academically is medical anthropology, and later, logic (my PhD research was the relationships between multiply existing causes in complex systems), and the book Overcome neck & back pain was the result—that book describes a large number of causes of these problems that were at the time not even considered as causes (and there was no research to support the position I was taking) and now, 26 years later, what I wrote about then is now orthodoxy. Human beings are simply too eager to label interactions between a patient and a practitioner as "the placebo effect" if the causal mechanisms are not clearly understood. A far better position to take is, "I wonder how that could work?"

There is no doubt that in the hands of a skilful therapist, massage therapy can be an extremely powerful intervention in the experience of being human, capable of bringing about many beneficial effects and that includes pain phenomena. The fact that there might not be peer-reviewed research to support it is irrelevant to that interaction. Anyone considering a career in this field will, in time, be benefitting other human beings directly; this is a Good Thing.