SaveYourself.ca • Sensible advice for aches, pains & injuries
Most massage therapists believe that “toxins” are “released” by massage, and need to be “flushed” by drinking extra water after you get off the table. They don’t know which toxins they are talking about, they don’t know how they are released by massage, and they don’t know how extra water intake is supposed to help. Many therapists are aware that it’s all a bit vague but still apply the precautionary principle: drinking water certainly won’t hurt, right?1 Not really, but it’s also no more worthwhile than a recommendation to “think positively” or “go for a short walk to get your blood moving.”
Here’s a quick, rational tour of the topic by video from Laura Allen, a massage therapist in Rutherfordton, North Carolina. I get a kick out of her folksy 3-minute debunking of this classic massage myth. Her no-nonsense Southern twang and well-chosen words are perfect for this job!
How many massage therapists are still out there telling their clients that massage gets rid of toxins in the body? On any given day on Facebook, I see about half dozen people at least making that claim … Would you maaahnd sharing with us exactly how that happens?
The toxin-talkers do not know.
Whether you’re talking environmental toxins or metabolic wastes, you still have to know what molecule you’re talking about Whether you’re talking environmental toxins or metabolic wastes, you still have to know what molecule you’re talking about., how it normally works, and how massage or water intake supposedly improves on its processing in any meaningful way upon its normal pathway.
When pressed, many massage therapists will cite “metabolic wastes” as a safely vague fallback answer that makes them sound just a little bit smart — because “metabolic” is a smart-sounding word! Four syllables! However, this does not significantly narrow things down. It’s like answering “which people of the world exactly?” with “the beige ones.”
Cellular chemistry produces a lot of molecules, and it’s not nice to call them wastes — it’s a bit of a slur, a chemical prejudice based in ignorance. In fact, many of them are not really “wastes” at all …
Nothing in cellular chemistry is really a waste. Chemicals are re-used and re-cycled. There are many (many, many, many) of them, and they all go through complex pathways, many never even see the bloodstream (they hang out only in cells and between cells), and many are probably completely unaffected by any fluid balance issue (short of dying of thirst, which affects pretty much everything).
Indeed, most metabolic “wastes” actually have utility throughout a cascade of functional interactions. You literally don’t want to “get rid of” them. You want them to go through their normal chemical lifecycle, processed and re-processed. Trying to flush them out would be sort of like trying to improve a car engine by getting rid of the exhaust before it hits the turbocharger.4 Metabolic by-products are not just nasty chemicals pooped out by cells that just hang around, stuck in tissue, waiting for your friendly neighbourhood massage therapist to come along and flush them away.
So, while there is a class of molecules loosely described as “metabolic wastes,” it’s unfair to paint them all with the same brush, assuming that they are harmful. In most cases, it would actually be harmful to “flush” them — they are a critical part of beautiful chemical you!
Since it’s clear that we can’t really know which “toxins” therapists are talking about, let’s just go with the waste metabolites hypothesis so that we have something to work with.
Lactic acid, for instance.
Lactic acid is the poster boy for the waste metabolites, probably the only waste metabolite that’s a household name, and most massage therapists still assume that lactic acid can be squished out of muscle tissue and into the bloodstream. This is not a difficult thing to test, and it has been tested,5 and the results were a bit shocking: massage actually “impairs lactic acid and hydrogen ion removal from muscle.”
Whoops.
This is not really surprising. If people needed massage to help them “clear” lactic acid, sprinters would drop like flies without emergency massage after every race. The effect must be minor or non-existent.
In any case, it’s worth emphasizing that lactic acid is not the cause of muscle pain at any time except the immediate aftermath of intense exercise, and probably not even then. Recent (2008-2010) research has shown that muscle fatigue and the “burn” that you feel as you exercise intensely is probably caused by calcium physiology, not an accumulation of lactic acid.6 In particular, lactic acid does not cause soreness the day after exercise — it’s long gone by then.
So presenting lactic acid as some kind of metabolic bogeyman that massage can get rid of is probably wrong on many levels. And any other metabolic waste is even less likely to fit the bill. So this is another nail in the coffin of the daft notion that massage somehow “detoxifies.”
Even if there are problematic waste metabolites in your tissues, and even if they can be mostly liberated into the bloodstream … why would drinking a couple extra glasses of water help get rid of them?
There’s a prevalent and vague belief that drinking water somehow “rinses” your blood vessels or cells … or something. But your circulatory system is not a simple system of tubes that you can flush out by imbibing extra water. This makes about as much sense as adding fuel to a car to make it go faster.
In fact, fluid balance is quite stable and somewhat independent of modest changes in water intake. Drink some extra, drink some less — your blood volume will stay almost exactly the same. Your body is an “ugly bag of mostly water,” but the total amount of water in circulation — in your blood and between your cells — remains nice and steady. You only need so much of the stuff. Just like your respiratory system excels at maintaining constant levels of oxygen and blood acidity, your guts cleverly keep your insides just the right amount of wet. Drinking more water than you need doesn’t add it to your bloodstream — you just piss away the extra!
The liver and the kidneys are the primary detoxifying organs: this is where most junky molecules are transformed, disarmed, and/or excreted. And they don’t require extra water to work any more than they need extra food to work. Their elaborate chemistry marches on unperturbed, whether you drink 4 glasses of water per day or 12. If you are significantly dehydrated, of course you would certainly start to have problems — but liver and kidney failure are not among the early consequences!
Carbon dioxide is a prevalent waste metabolite, and an easy one to understand: your cells produce it via combustion of fuels with oxygen, like a trillion7 teensy car engines. It is found at high levels in myofascial trigger points (muscle knots), which are metabolically “revving.”8 To hammer home that this stuff really is a “toxin,” CO2 is also chemically equivalent to acidity: to be CO2-polluted is to be acidic!
But CO2 disposal just has nothing to do with water, nothing at all. Its fate is completely separate from fluid balance.
Carbon dioxide is processed at extreme speeds — quite “aggressively,” because we cannot tolerate much variation in acidity — primarily by a chemical pathway through the bloodstream and lungs: a pathway that does not much involve the kidneys, fluid balance, or fluid excretion. And the amount of CO2 involved in trigger point toxicity is a drop in an ocean of chemistry anyway. Even if massage squished a trigger point’s full cargo of CO2 into the bloodstream, that’s an infinitesimally small amount of CO2 compared to the total CO2 produced in a single second by all of the body’s cells. We produce and process vast quantities of CO2 constantly, and we do it effortlessly.
So much for that prominent toxin being flushed away by water!
And so it is with all the other “toxins” in a trigger point — problematic when concentrated in a patch, they are otherwise trivial and unaffected by water intake in any case. Even supposing that squishing a trigger point magically forces every molecule of every pain-causing metabolite into the bloodstream (not just into adjacent intercellular fluids, which is actually more likely), they still wouldn’t require further “flushing” by any means. Once in the bloodstream, they would be lost like motes in a sandstorm, joining billions of their metabolic siblings that are routinely produced — and processed — by all the cells of the body, and drinking water has no relevance to those processes.
The idea that drinking water after massage matters is just empty — a hopeless oversimplification easily debunked with a cursory understanding of biochemistry. Metabolic wastes are already ubiquitous in tissue fluids, and they are constantly being produced and recycled, and while massage has never been shown to have any significant effect on these processes — except to actually impair lactic acid removal! — it doesn’t even make logical sense that water would have anything to do with it. Anything the body can get rid of it is going to get rid of, with or without massage, and with or without extra water. The body is good at handling metabolic wastes, and even many exogenous poisons, without any special help.
If it wasn’t, we’d really be up the creek.
Laura Allen, Massage Therapist, on Toxins & Massage on YouTube.com.
Comments: One of the classic claims of massage therapy is that it “aids muscle recovery from exercise … by increasing muscle blood flow to improve ‘lactic acid’ removal.” Unfortunately, new evidence shows that just the opposite is probably the case. This straightforward experiment subjected 12 people to intense hand-gripping exercises and then measured their blood acidity with and without basic sports massage. Their measurements showed that massage significantly “impairs lactic acid and hydrogen ion removal from muscle following strenuous exercise by mechanically impeding blood flow.”
Comments: This important paper demonstrates that the biochemical milieu of trigger points is acidic and contains a lot of pain-causing metabolites: good evidence in support of the energy crisis theory of trigger point formation and/or perpetuation. It’s an improvement on an earlier paper from 2005 (Shah), with improved methods. It is cogently summarized by Simons, and in my short article Toxic Muscle Knots. BACK TO TEXT