I first noticed something in 2019 when a UK professional massage association shared an infographic about recovery strategies for amateur half-marathon runners. It appeared to suggest that a either an ice bath or massage after the run improved recovery at 24 hours better than other recovery strategies. Hence they posted with an enthusiastic, “Get sharing..!”. They did, 145 members shared it from that page alone.

These are some of the genuine headers that massage therapists used when sharing this infographic from the professional association page. As we can see, the message is that massage speeds up recovery and is proven to do so.

The actual study

Let’s have brief look at the study by Wiewelhove et al (2018) that the infographic refers to. The researchers took 46 healthy male runners and randomly allocated them into 4 groups after completing the half-marathon. These were:

1. Active recovery (ACT) – jogging lightly

2. Passive recovery (PAS) – sitting

3. Cold water immersion (CWI) – sitting waist-deep in water at 15°

4. Massage (MAS) – massage the legs

All lasted 15 minutes.

The researchers took a number of measurements at the start, just after the race and 24 hours later, including a self-reported pain rating for muscle soreness and rated their sense of recovery. This showed that at 24 hours, soreness and recovery were significantly improved for the CWI and MAS groups and were better than ACT and PAS. So cold water and massage for the win.

They also took some other measurements too, of blood and muscle contractile markers that indicate physiological changes associated with recovery. These didn’t change significantly in any of the groups, in fact, they all returned to normal regardless of the recovery strategy. The subjective measures show positive effect while the objective measures show otherwise. So, what’s going on here? Well, there is one very well-known phenomenon that has a strong effect on subjective outcomes, and that is a placebo. We also know that placebo effects are enhanced when they are more theatrical or have the appearance of being more specialised processes – surely getting in an ice bath or having a massage seems more helpful than jogging or sitting? The researchers did actually point out that their study design did not rule out placebo effects.

The actual difference in muscle soreness is also worth a look. These are reported using a score out of ten, 0 is no pain, 10 is the worst. The average muscle soreness after the run for the massage group was 4.1, while 24 hours later the average was 3.3. Still no cigar. When we look at research we are interested in what’s called clinical significance, or minimally important clinical difference. This means will it actually make a real difference to the client. The degree of change we accept as meaningful varies, but a drop in soreness of 0.8 out of 10 doesn’t cut it.

I’m inclined to believe that no-one has read the study. Do we expect therapists to read studies? Well that’s a bigger question. But I would suggest that professional associations should.

So what, feels good, right?

You might well feel better after 24 hours if you have a nice massage after a run, no problem with that I’ve given plenty of massages for people while recovering, and I’ve had plenty myself – I love it. This research is not any kind of proof that massage speeds up recovery, just that you might feel better and it could well be a placebo as no physiological changes took place, and that difference really matters if we are to be honest with our clients. And YES it does matter if a therapy is a placebo! Strictly speaking, if we are not providing accurate information to clients, they cannot give informed consent.

We have a problem of well-intentioned sharing of information effectively becoming misinformation that is readily propagated and no-one is accountable. That’s the issue, and I’ve seen it many times.

Thanks for getting to here.