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Who doesn’t like a massage? I certainly do! But there are a lot of people who don’t. They say it feels good, but they have trouble relaxing and actually get tense. Or lying in the prone position makes their neck hurt. I wish massages weren’t so expensive because I would have one every week or two.

Massage therapy has become a big business. There are at least 15 massage studios within 5 miles of my home. That doesn’t count the spas at the many resorts in the area. To staff all these facilities must be a nightmare, but I think massage therapy is a popular career choice. 

So what’s the big deal? Why do so many women and men, athletes, and people with musculoskeletal disorders have massages? Why do competitive bicyclists always mention getting a massage after a 125-mile ride? Medical researchers have done extensive studying of the subject and have found a lot of good reasons. Besides the tactile pleasure one enjoys there is an interesting biochemical response that contributes to the emotional satisfaction and the positive biomechanical benefits.  

Biomechanically, massage therapy increases blood flow in the muscles, reduces muscle stiffness and soreness, increases muscle temperature, and improves range of motion of the joints. In turn, these benefits lead to relaxation, decrease in short term pain, changes in mood, and improved overall function. Mechanical pressure on the muscles affects the parasympathetic nervous system so during massage we experience changes in heart rate and blood pressure. 

Additionally, a massage done prior to exercise (a pre-event massage) theoretically prevents injury, improves performance, and “promotes a mental state more conducive to performance.” How this actually happens is still undetermined, but it’s possible neurotransmitters play a role. There is a significant decrease in muscle tension compared to placebo (no massage), but the psychological effects may be the big benefit.

The biochemical response to massage therapy is the subject for greater investigation and results are consistent with what one would suspect. Responses in cortisol, dopamine, and serotonin are involved in many of the positive benefits we see. Cortisol, a hormone produced by the adrenal glands, is called the stress hormone. It affects almost every organ and tissue in the body by suppressing inflammation, regulating blood pressure and blood sugar, and contributing to the body’s use of fats, proteins, and carbohydrates. Massage therapy reduces cortisol levels by 31% thus reducing our reactions to stress through improved good sleep, greater sense of enjoyment, and laughter. 

Dopamine, a neurotransmitter (a chemical that transports nerve impulses), plays a significant role in determining one’s mood, feelings of pleasure and satisfaction, and helps memory, sleep, and concentration. Massage therapy increases dopamine levels in the urine and saliva by 31%, thus contributing to the relaxation and sense of well-being one feels.

Serotonin, another neurotransmitter, is responsible for happiness, calmness, and mental focus. Drugs like Prozac, Zoloft, and Celexa, among others, are serotonin reuptake inhibitors and increase serotonin levels in the brain improving mood and counteracting depression. Massage therapy has been shown to increase urine serotonin levels by 28%, again suggesting a good reason why it works.  

Medical science, in its infinite curiosity, does its best to explain every symptom, every ailment, every emotion on a scientific basis. For massage therapy, it turns out to be a reduction in cortisol and an increase in dopamine and serotonin levels. It seems to make good scientific sense. But for me, and every other red-blooded American, who enjoys having his neck, back, arm, legs, feet, and, even scalp, massaged it’s just a matter of the enjoyment we gain from having tired, sore, achey muscles rubbed into submission. It’s nice to know these hormones play a role, but tactile stimulation is still where it begins and ends. It’s been a year since my last massage, and the generous massage gift card I received for Christmas is still waiting to be used. What am I waiting for?

References: Dakic M, Toskic L, Ilic V, Duric S, Dopsaj M, Simenko J. The effects of Massage Therapy on Sport and Exercise Performance: A Systematic Review. Sports 2023;11(110):1-15. 

Weerapong P, Hume PA, Kolt GS. The mechanisms of massage and effects on performance, muscle recovery, and injury prevention. Sports Med 2005;35(3):235-256.

Field T, Hernandez-Reif M, Diego M, Schanberg S, Kuhn C. Cortisol decreases and serotonin and dopamine increase following massage therapy. Int J Neurosci 2005 Oct;115(10):1397-1413.

Arroyo-Morales M, et al. Psychopysiological effects of performance massage before isokinetic exercise. J Strength Conditioning Res. 2011 Feb;25(2):481-488.

Bervoets DC, Liujsterburg PAJ, Alessie JJ, Buijs MJ, Verhagen AP. Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review. J Physiother 2015 July;61(3):106-116.

Tiidus PM. Manual massage and recovery of muscle function following exercise: a literature review. J Orthopedic Sports Phys Ther 1997 Feb;25(2):107-112.

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