There has been much on the web lately dispelling the myth perpetuated by Massage Therapists over the years promoting false benefits of what massage can do or when massage is contraindicated. These myths include statements like, “massage is contraindicated in the first first trimester of pregnancy,” “massage can spread cancer,” and the topic of this discussion, “massage detoxifies.”
When I originally posted the article “Poisoned by Massage” on Facebook, it was in response to the link to Laura Allen’s YouTube video dispelling the myth “Massage detoxifies;” which Dr. David Katz of CortivaConnect posted. Laura Allen on Toxins Paul Ingraham, the author of the article, was supporting Laura Allen’s statement that massage detoxifying the body is a myth. The author said in the first paragraph he meant the title to be, “provocative and sensational.” However he also says he feels massage is, “a valid and valuable treatment for a lot of pain problems.” He goes on to say the article, “is not an anti-massage article. It’s a fascinated by massage article.”
I believe the point both Laura Allen and Paul Ingraham were trying to make is that the word toxins, as Angie Reiter, LMT stated in response to the post, “gets thrown around loosely.” Both Ingraham and Allen question the concept of toxins, what toxins are exactly and how does massage detoxify, if I am understanding both authors correctly. Ingraham notes he has, “argued that toxin talkers should be specific when they talk about toxins, or stop talking about toxins.” Allen agrees, saying, “the presence of toxins in the body is something that can be measured,” but questions, “what exactly is it that we are calling a toxin?” arguing the word toxin is a “vaguely defined term.” Ingraham goes one step further, taking the position that massage may actually release or create toxins as, “by-products of minor muscle injury.”
I have to agree with Dr. Nicholas Warner, who responded to the post saying, ” It talks about a very rare issue. With poor correlation to massage,” My agreement lies in the fact that this is a rare condition, as it relates to massage being the cause of death. However, in researching rhabdomyolysis, I found that it is most commonly brought on by extreme trauma to the muscle tissue, such as a vehicular accident, a fall, or the muscle being crushed. Extreme muscle trauma can also include deep tissue or deep pressure massage. According to MedicinePlus the US Government’s National Institute of Health web site, other causes include alcoholism, drugs, dehydration, heatstroke, ischemia and severe exertion. In this condition the protein myoglobin is released from the muscle tissue into the bloodstream where it is then filtered out by the kidneys. The byproducts of the breakdown of the myoglobin, however, can damage the kidneys resulting in renal failure. Dr. Raymond Vanholder, of the University Hospital of Gent; Gent, Belgium; in the Journal of the American Society of Nephrology states some of the common causes of rhabdomyolysis include Trauma and Compression, Strainful Exercise of Muscles, and Drugs and Toxins.
While he makes no mention of massage as being a possible cause, Vanholder, in citing Trauma and Compression as a cause, says in general, “Traumatic rhabdomyolysis is mainly the result of traffic or occupational accidents. Compression of the muscles may also be induced by torture, abuse, or long-term confinement in the same position.” He also adds, “strenuous muscular exercise may cause myolysis, especially in untrained subjects or in individuals exercising under extremely hot or humid conditions.” This also would indicate extreme compression, such as may be received in massage, could be a contributing factor, as Ingraham states.
As a side note, one of the more common causes of rhabdomyolysis, which has been discussed in the media lately, is the use of statins for the control of cholesterol levels. Mayo Clinic cardiologist Thomas Behrenbeck, M.D., Ph.D states, “The higher the dose of statins, the higher the risk of rhabdomyolysis becomes.” (Mayo Clinic Article) Another recent and controversial cause of rhabdomyolysis was the intake of high doses of creatine supplements by athletes. LiveStrong.com warns, “The disorder can be induced by extreme activity, and causes your body to produce high levels of creatine kinase.” This would indicate the additional intake of creatine is a contributing factor. However no empirical evidence has shown that the intake of creatine alone was cause for rhabdomyolysis, it has been determined that athletes ingesting large amounts of the supplement were also undertaking intense workouts and this was probably the underlying factor in the development of rhabdomyolysis. LiveStrong supports this theory saying, “Strenuous exercise can result in rhabdomyolysis irrespective of your age, gender or level of physical fitness. When striated skeletal muscle fibers located on your arms and legs break down following excessive and prolonged exercise, creatine kinase and myoglobin leaks into the bloodstream. Myoglobin can cause severe damage when filtered through your kidneys, blocking structures and limiting the flow of oxygen to kidney tissue. Marathon running, weight lifting and other intense strenuous exercises and activities can lead to rhabdomyolysis and, the more intense your exercise routine, the more severe your symptoms will be.” This brings us back to the question of massage therapy.
Can massage actually release toxins rather than detoxify the body as Ingraham claims? Based on the evidence I found, yes it can. In his article he states, “When muscle is injured, cellular guts are spilled into the blood, most notably myoglobin molecules, which messes with blood chemistry…” This is confirmed by the previously cited National Institute of Health article. Ingraham explains that rhabdomyolysis resulting from massage is a mild form and “relatively minor, exertional rhabdomyolysis is actually common,” especially in the extreme athlete. He also points out that death by massage, as in the case of the 88 year old man, is the exception and not the rule.
In the case cited of the 88 year old man (Ming-Yu Lai, Su-Pen Yang, et al: “Fever with acute renal failure due to body massage-induced rhabdomyolysis”, Oxford Journals; Medicine: Nephrology Dialysis Transplantation, Volume 21,Issue 1, Pp. 233-234.) it was determined that, “The strength of this massage session was significantly stronger than (what he experienced in) the past.” The authors also put part of the onus of responsibility on the patient saying, “He drank little water before and after the massage session. Generalized muscle pain and soreness developed that night but was not given attention.” However, they did state, “Compression or pressure-induced rhabdomyolysis has been reported in coma or immobilized patients, prolonged cardiopulmonary resuscitation and obese men who received bariatric surgery,” indicating the extreme pressure the patient received during the massage by two inexperienced therapists along with his ignoring the signs and symptoms and not properly hydrating was the cause of the condition leading to his demise. Although the authors did attribute the patient’s condition to the vigorous massage he received, they also did emphatically point out rhabdomyolysis, “has never been associated with body massage.”
I would then have to conclude that, while the possibility of rhabdomyolysis from a prolonged and extremely vigorous or deep massage causing death does exist, it is an extremely rare occurrence which has only been cited once. I feel then, that the onus lies on us as Massage Therapists, to educate both ourselves and our clients in the benefits of massage. This can only be done through examining empirical research data and promoting evidence based scientific facts as opposed to propagating the Myths of Massage.
Laura Allen has more Myths of Massage posted on her blog.