Thera/ Massage And Vibration Guns. Do They Work?

Picture taken by iPhone 11 Pro from Shopee

Earlier in the week, I read an article on the same topic written by CNA Lifestyle. Actually, I already wrote half of the article on that exact same topic last week but decided to publish the article on bicycle lanes in Sigapore since bicycles are much closer to my heart.

The author did a good introduction on what massage or thera guns are and what they do in that article. She also interviewed other health professionals for their thoughts. So my article will be different. It will explain the science behind why thera or massage guns feel so good when you use them. And of course the evidence available.

Thera or massage guns are being advertised with all kinds of benefits like helping with aches, pain and stimulating "muscle recovery". They can certainly vibrate your muscles/ tissues but almost all the medical claims are not totally true.

Vibration therapy definitely is relaxing for most people especially if it's not too strong or sudden or in an uncomfortable location. Sitting in a warm pool with bubble jets (like a jacuzzi) come to mind and I'm sure all of you who tried will agree that it's a pleasant sensation.

And vibration, waves and frequencies are what some physiotherapists already use for treatment. These include ultrasound, electrical (TENs) and magnetic stimulation, infrared radiation and even lasers. The above are mainly microscopic vibrations aimed at cells at the cellular level and a wider range of frequencies and smaller amplitudes.

Even ESWT (or shock wave) uses high intensity waves to smash kidney stones, (used by doctors) and/ or stimulate bone healing. Many other physiotherapists also uses ESWT to treat plantar fasciitis.

An article published in the British Journal of Sports Medicine showed that runners who receive daily sessions of vibration therapy on the legs were less sore  and had fewer blood markers associated with soreness compared to runners who did not (Broadbent et al, 2010).

Coarse vibrations have interesting neurological effects too. Vibrations added to really flexible gymnasts appears to increase their flexibility further (Kinser et al, 2008).

One reason why vibrations help is a change in our proprioceptive state. Proprioception is how we sense or judge our position. When the body is being vibrated or shaken, plenty of input goes to our cerebellum in the brain. When there is no danger perceived by the cerebellum, the nervous system send signals for the body to relax. That's why the body calms down and you feel good.

Another reason is the strong and distinctive vibratory sensations are quite the opposite of feeling stiff and tight. Just like splashing cold water on your face when you're hot, vibration feels like a natural remedy to your stiffness.

So patients with conditions like muscle strains, neck pain and especially low back pain with fear being a big part of it may feel better after using massage guns or other vibration therapy.

However, if you have shin splints (will hurt more actually), plantar fasciitis and nerve entrapment issues then they probably will not help.

So, still thinking about splashing your your earned cash on this? Save your money. Or better still come see us in our clinic to treat the cause of your problem.



References

Broadbent S, Rousseau JJ et al (2010). Vibration Therapy reduces Plasma IL6 And Muscle Soreness After Downhill Running. BJSM. 44(12): 888-894. DOI: 10.1136/bjsm.2008.052100

Kinser AM, Ramsey MW et al (2008). Vibration And Stretching Effects On Flexibility And Explosive Strength In Young Gmynasts. Med Sci Sp Exer. 40(1): 133-140. DOI: 10.1249/mss.0b013e3181586b13.

Does Lactic Acid Affect Your Appetite?

One of our blog's more popular post was regarding lactic acid or lactate. For our new readers, that post came about after a massage therapist asked me if lactic acid in our bodies can form 'crystals' in our muscles with too much running.

A few of his patients who run had gone to this particular massage place and was told by a massage therapist there that 'crystals' left there by the lactic acid/ lactate will affect their running if the 'crystals' are not removed by sports massage.

Yes, lactic acid/ lactate is produced as a by product during intense exercise, but it starts to clear or leave your body once you slow down and especially when you stop your exercise. You do not need help to get rid of it. It certainly won't form 'crystals' in your muscles!

What lactic acid/ lactate does according to recent research is that it can blunt your appetite by altering your appetite hormones (Vanderheyden et al, 2020).

What the researchers in the study did was to have volunteers do an interval workout of 10 x 1 min really hard with 1 min recovery on an exercise bike. They repeated this protocol twice at the same intensity on separate days at least a week apart. For the first time, the participants were given a dose of baking soda and the other time a dose of salt as a placebo.

Baking soda (or sodium bicarbonate) helps to partially counteract rising acidity in your bloodstream during intense exercise (to prevent you from accumulating too much lactic acid in your bloodstream). It is often used as a legitimate and legal performance enhancing drug by some runners (especially middle distance) and track cyclists.

Please note that consuming baking soda can be associated with stomach distress although there was no apparent difference in this particular study.

This allowed the researchers to compare lactate levels in the subjects' bloodstream during and after the 10 x 1 minute intervals since baking soda will decrease lactate levels.

The researchers found that the response of the subjects' appetite hormones were lower when there was more lactic acid/ lactate in the bloodstream.

Ghrelin (which measure hunger levels were lower meaning less hunger) and two appetite suppressing hormones, *GLP-1 and PYY were higher meaning less hunger were indeed different in the two groups during and 90 minutes after the intense exercise.

Previously, when I use to compete and still did really intense training, I definitely do recall that I do not feel like eating after the workout ends. I usually only felt like drinking an ice cold Coke. Well, those were the days .....

What I'm actually wondering is whether changes in our appetite hormones can affect our eating patterns on a long term basis and thus affect weight for serious endurance athletes. If you're training reasonably hard, surely weight isn't gonna be something you worry about.

To conclude, you do not need to flush lactate (lactic acid) out from your body after intense exercise, it starts to dissipate once you stop exercising. Nor do you want to take too much baking soda in a race if you're trying to lower your lactate levels as it can give you stomach distress especially if you haven't tried it in training.


Reference

Vanderheyden LWN, McKie GL et al (2020). Greater Lactate Accumulation Following An Acute Bout Of High Intensity Exercise In Males Suppresses Acylated Ghrelin And Appetite Post Exercise. J App Physiol. DOI: 10.1152/japplphysiol.00081.2020.

*GLP -1 glucagon like peptide-1

*PYY - active peptide tyrosine-tyrosine

Too Much Lactic Acid Causes "Crystals" To Form In Your Muscles?

*What a load of  sh--!

One of my massage therapist asked me today if it's true that with too much exercise, lactic acid can form crystals in your muscles? His friend had been been told by a massage therapist that "crystals" can form in his muscles with too much running and no sports massage to "break the crystals."

This is the 3rd time in two weeks someone asked about this. The first two were my patients.

Apparently they had gone to this particular massage place and were told by the massage therapist there that if "the crystals" in the muscles were not "broken up" it's bad for them and they can't run well. The massage therapist(s) then WhatsApp their patients an article to read.

Now I find this really ludicrous to say the least. I've addressed this issue before. Massage does not flush lactic acid from your muscles.

Any textbook on Exercise Physiology (or you can check online) will explain that you can only accumulate lactic acid in your muscles during intense exercise (e.g. while racing or running intervals). As there is not enough oxygen available, a substance called lactate is formed. Our bodies then try to convert this lactate to energy without using oxygen.

However, this lactate or lactic acid can build up faster in your bloodstream than you can use it. The point where lactic acid starts to build up is called the "lactate threshold." So if you run just below your lactate threshold you won't fill the "burn" in your muscles.

That is what interval training is all about - trying the raise your lactate threshold so you can run at your race pace longer without incurring oxygen debt (or that burning sensation in your muscles).

This "burn" you feel is temporary. Once you slow down and/ or stop exercise, your body can then easily convert the lactic acid to energy. After a short while there isn't any more lactic acid in your muscles. The "burning" sensation in your muscles happen only during intense exercise.

Lactic acid clears very quickly on its own. By the time an athlete has a chance to "use" anything that claims to flush out lactic acid, the lactic acid is probably gone. You don't need help to dissipate it.

Lactic acid definitely does not cause soreness. The soreness you sometimes feel in your muscles a day or two (especially if you've pushed too hard) isn't from the lactic acid accumulation in your muscles. It's most likely delayed onset of muscle soreness or DOMs.

Back to my conversation with my colleague. He then said that his friend said that after a massage session there "to break his crystals" he normally can't run for three days! That's how sore he got. More likely how brutal or how heavy handed the massage therapist was.

When I was still racing, I get sports massage done so I can train/ run long and hard the next day and the day after and after. That's what the sports massage is supposed to do. Helping me to recover better so I can run long and run hard every day if possible. As an athlete, that's what I want to do. If I have to rest three days after a sports massage how do I get my training done?

So be very wary if your massage therapist or even physiotherapist tells you that that you need to "get your crystals broken" or that you need to flush the lactic acid out of your muscles.

*Thanks to my patient for forwarding the article to me.