Massage Therapy Attenuates Inflammatory Signaling After Excercise-induced Muscle Damage

Massage reduced signs of inflammation, and massaged muscles cells were betterable to make new mitochondria promoting faster recovery from exercise-inducedmuscle damage. Massage activates mechanosensory sensors. Massage activates the formation of additional mitochondria, presumably acceleratinghealing of the muscles. Massage reduced accumulation of inflammatory mediator nuclear factor kappa B(NFkB), and reduced the activity of immune cytokines interleukin-6 (IL-6) and tumornecrosis factor alpha (TNF-a), a sign of less cellular stress and inflammation. However, massage did not help clear lactic acid from tired muscles. FROM ABSTRACT Massage therapy is commonly used during physical rehabilitation of skeletal muscle toameliorate pain and promote recovery from injury. Although there is evidence thatmassage may relieve pain in injured muscle, how massage affects cellular functionremains unknown. To assess the effects of massage, we administered either massage therapy or notreatment to separate quadriceps of 11 young male participants after exercise inducedmuscle damage. Muscle biopsies were acquired from the quadriceps (vastus lateralis)at baseline, immediately after 10 min of massage treatment, and after a 2.5-hourperiod of recovery. We found that massage: * Activated the mechanotransduction signaling pathways * Increased mitochondrial biogenesis * Mitigated the rise in nuclear factor kB (NFkB) Moreover, despite having no effect on muscle metabolites (glycogen, lactate), massage attenuated the production of the inflammatory cytokines tumor necrosis factor – a (TNF-a) and interleukin-6 (IL-6), thereby mitigating cellular stress resultingfrom myofiber injury. In summary, when administered to skeletal muscle that has been acutely damagedthrough exercise, massage therapy appears to be clinically beneficial by reducinginflammation and promoting mitochondrial biogenesis. KEY POINTS FROM THIS STUDY: 1) Complementary and alternative medicine (CAM) is increasingly used as a costeffective adjunct to conventional medical care. Many CAM techniques, such asacupuncture, massage therapy, or chiropractic manipulations, are aimed at managingpain, relieving stress, and preventing injury. 2) The increasing use of massage therapy as an adjunct to conventional care formusculoskeletal injury recovery and the growing number of physician referrals for massage represent a shift toward nondrug-based therapies for personal health. 3) Given the spiraling cost of primary care and medications in the US, it is likelythat more patients will seek out this therapy as well as other nontraditional medicalalternatives to complement more conventional approaches to their healthcare. 4) Massage therapy is a well-known form of alternative medicine that consists ofphysical manipulation of muscle and connective tissue at a site of injury, inflexibility,or soreness to reduce pain and promote recovery. 5) Massage has been hypothesized to moderate inflammation, improve blood flow,and reduce tissue stiffness, resulting in a diminished sensation of pain. 6) The potential benefits of massage could be useful to a broad spectrum ofindividuals including the elderly, those suffering from musculoskeletal injuries, andpatients with chronic inflammatory conditions. 7) There are several reports that long-term massage therapy reduces chronic painand improves range of motion in clinical trials. 8) Muscle inflammation and pain are typically present when damage to themyofibrillar structure has occurred. 9) Muscle trauma initially results in inflammation with immune cell activation andcytokine release. 10) The inflammatory immune response is led by NFkB. Repression of NFkBactivation improves tissue repair and reduces immune cell infiltration into muscle. 11) A mechanical stimulus to a muscle will physically alter the cells membrane andthe extracellular matrix and transmit signals via proteins known as integrins.Integrins in turn activate and propagate mechanotransduction signals that modulateprotein synthesis, glucose uptake, and immune cell recruitment. 12) The mechanical stretch during massage activates mechanotransductionsignaling that increases muscle glucose uptake, protein synthesis and muscle growth. 13) Any physiological benefits due to massage would likely be initiated throughmechanical effects on skeletal muscle followed by changes to intracellular regulatorycascades. 14) Massage alters processes related to the cytoskeleton and to inflammation. 15) After activating cellular signaling pathways through mechanotransduction,massage attenuated the rise in several other signaling pathways indicative of muscleinflammation and cell stress regulated by NFkB. 16) Damage to skeletal muscle activates the inflammatory NFkB pathway, whichincreases prostaglandin synthesis [like PGE2] and inflammatory cytokine expression[IL-6, TNF-a]. These inflammatory cytokines impede muscle repair by increasingmuscle protein breakdown and suppressing myosin synthesis. 17) Also these inflammatory cytokines activate nociceptors, causing increasedsensitivity to pain (hyperalgesia). 18) Cyclooxygenase inhibitors blunt most of the hyperalgesia derived from local IL-6and TNF-a, indicating that prostaglandins are largely responsible for the sensitizationof muscle-associated nerves caused by inflammatory cytokines. 19) Similarly, pain and inflammation in human patients are often treated withanalgesic medications that block the local formation of prostaglandins, suggesting thatmassage may act in a similar fashion. 20) One class of analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), are some of the most commonly consumed drugs in the world. Massagemay provide similar benefits without side effects. Massage may be useful insituations where areas of low blood flow (the muscle tendon interface) restrict theaccess of circulating analgesics to a site of inflammation. 21) The positive effects of massage are a result of an attenuated production ofinflammatory cytokines, which may reduce pain by the same mechanism asconventional anti-inflammatory drugs such as NSAIDs. 22) These results elucidate the biological effects of massage in skeletal muscle andprovide evidence that manipulative therapies may be justifiable in medical practice. Massage Does The Following: * Activates the mechanotransduction signaling pathways * increases muscle glucose uptake, protein synthesis and muscle growth * Increases the biosynthesis of mitochondria; this increases the production of theATP energy required for protein synthesis and repair of injury. * Reduces the production of NFkB. * Reduces the production of inflammatory prostaglandins [PGE2]. * Reduces the production of inflammatory cytokines [TNF-a, IL-6]. * Reduces pain. * Accelerates healing, faster recovery.