Musings on massage

There have been a couple of comments on the WHW board recently about massage and it seems an opportune moment for me to share my possibly eccentric views on the subject.

Firstly, no tittering at the back, I'm talking about "sport" massages, not the kind with a happy ending. Now I must admit to having little experience of either but that doesn't stop me having an opinion, the wackiness of which I leave for you to judge.

It is probably true that appropriate massage can help with the treatment of some injures and I'm not about to go tilting at that particular windmill. My concerns lie with it's use (or perhaps that should be "abuse") for the enhancement of recovery by the release of "toxins" or other unexplained mechanisms. This article makes quite interesting reading about "toxins" and massage.

Like everything in life, moderation is the key but it's tempting to believe sometimes that if a bit of something is good, more is better. Following the experience of a runner in last year's race, I'm not so sure that you can't have too much of this particular "good thing".

This particular runner suffered from renal failure post-race due to a condition called rhabdomyolysis. This is breakdown of the muscle cells which then release their cell contents & myoglobin (the muscle cell equivalent of haemoglobin in the blood) into the blood stream. This mixture causes clogging of the kidneys and renal failure (of a type known as "acute tubular necrosis" - ATN for short). Now fortunately, if treated appropriately, this is something from which you can recover but in the short term, you may need to be placed on renal dialysis (a kidney machine) until such time as your kidneys recover. If undetected & untreated, it can be fatal. This particular runners condition never quite got to the point of needing dialysis but it was touch and go.

So, what's all this got to do with massage? Well, the cause of rhabdomyolisis isn't always known. Sometimes it's due to heatstroke, sometimes a "crush" injury where a large muscly body part has been crushed in an accident. Sometimes it's caused by extreme exercise and there seems to be a genetic predisposition involved (which is really just another way for doctors to say "we don't know").

When I read the runner's account of his race, I started looking for anything that might have caused his rhabdomyolysis and one feature of his race struck me. Namely, he underwent massage four times during the race.

Now this is far from being conclusive proof but I'm sure every ultra runner is familiar with the feeling of owning a couple of sacks of mince where we used to have quads during the latter stages of an ultra. It seems reasonable to me to ask the question, "If my quads feel this bad, is pummelling them more or less likely to make them leak their cell contents?".

Common sense is a dangerous tool but it seems to me that the balance of probabilities is that it certainly won't make them less likely to leak. Indeed, I think it's much more likely that pummelling an abused muscle is likely to increase leakage of cell contents.

So, is there any evidence? Well, there are the odd case reports of renal failure following massage (see this article here). Now that case refers to an 88 yr old man, but I dare say there might be a few similarities between 88 yr old men and WHW runners at the end of the race! There is lots of information on rhabdomyolysis and extreme levels of exercise.

Now I'd be the first to admit that I'm trying to link the two in the absence of published evidence, but the question is, to paraphrase the words of Dirty Harry, "'Do you feel lucky?".

To my mind, it just seems a risk not worth taking. If you're a fan of post race massage then you'll no doubt claim that you recover faster but to my mind, recovering a day or two faster doesn't justify the potential risk. It would probably be far more beneficial (in the long term), to delay the massage for a few days until the muscle stiffness has settled.

This article isn't intended as a criticism of that runner's actions. I have a medical background and what I've said is just my tentative hypothesis of why perhaps he developed renal failure. I think it's reasonable to voice my misgivings about a practice which I think may carry an unusual level of risk for ultra runners.

So there you go. Hit or myth, you decide. ;-)