Massage question - Does stroke direction matter?

Always, always away from the heart. Your heart does not need any extra fluid pushed towards it after all of that work!

Does this also apply to massage many hours after exertion? I usually work out in the early morning, but I like to use the foam roller on my calves in the evening. I'll concentrate on any knots I find and then I like to do a little rolling, and I do go forward and backward.

I don't know about many hours after exertion, the way I learned it was when I was training for my half marathon and I commented to my friend that I was self-massaging after running and she made me promise that I'd only use stroke towards the "tips" and that was her reason. She was a certified massage therapist, so I am assuming that there was a good reason for her statement (and mild freak out on me).

You're not gonna affect bloodflow by massage.

You most definitely can... Maybe less so be self massage, but most certainly a therapist can have an huge impact on blood flow...

Im currently finishing up my first year in a 3000hr Massage program, and we almost always stroke towards the heart encouraging venous blood return to the heart so that all the bad things in your blood can be removed.

Massaging towards the heart isnt going to cause any detrimental effects, while stroking away can impede venous flow!

Massage towards and increase circulation!

take it for what you will, thats my knowledge!

Yes stroke direction does matter.  Massage should be performed in movements going towards the heart, which helps your circulatory system return blood to your heart+lungs to be re-oxygenated.  Basically your heart pumps the blood thru the arteries, each pump pushes the blood out.  On the return trip, the veins move the blood by muscle contraction and valves (which prevent the blood from moving in the wrong direction).  If you were to massage away from the heart you would be working against the natural flow and could damage valves.  

You'd think I might learn something about all this in medical school.

You're not gonna improve or detract from blood flow through a few pushes here and there.  It sound nice though.

Uhm...no. Unless you're going directly from your workout onto the massage table still sweaty, your blood pressure and fluid balances have evened out within 5-15 minutes of the workout ending.

I'm still stuck on the OP's statement about breaking up scar tissue formed during exercise...uhm...what?

John




Edited by tkd.teacher 2010-06-23 5:19 PM

So...if that were the case (Removing "bad things" from the blood), shouldn't you be trying to shunt the blood to the liver/kidneys, not the heart?

John

Edited by tkd.teacher 2010-06-23 5:23 PM

When you are sleeping, you are completely relaxed with almost no muscle contractions at all (or coma for that matter) other than breathing.

why doesn't your blood just pool, since there are no muscle contractions to drive it?

John

I'll gladly stand corrected on this issue =D. My friend (certified therapist) was adamant about it though - wonder if this is a recent (past three years) change or she was just wrong.

Would you care to elaborate on this for those of us who didn't attend medical school?

ETA - Didn't intend this to seem sarcastic, just your position is contrary to everything I've ever learned and I would like to hear the reasoning behind your point of view. 

Edited by Mainer22 2010-06-23 6:20 PM

Yes, I'd be interested to hear this, too, since I'm in med school right now and have seemingly been taught otherwise.   I mean, all those post-op knee and hip replacement folks walking around the physical therapy room wearing compression socks to prevent DVT's can't be wrong, can they?  Maybe doctors (and triathletes) just enjoy looking at people wearing silly socks

 Also, one of my Dr. professors in particular would probably appreciate it if I pointed out that you also increase  movement in the lymphatic system, which can increase waste removal in the body, which may be what the massage therapist student was referring to earlier.  

No worries.  I'm direct about my opinions, but I don't take any of this personally.

Not quite sure what to elaborate on though.  You can push blood around that is in the capillaries of the muscle you're working on, but that's transient and not a large volume.  Also those small capillaries empty into larger and larger veins to return blood to the heart, but those are not necessarily physically located between the area massaged and the heart.  You could be pressing towards the heart and away from the actual draining vein.

It sure feels good though.   

Big difference between continuous compression that lasts for hours and days versus very transient compression. 

Aren't there massage techniques which are used to improve lymphatic drainage in cases of oedema?  Certainly I know people whose physicians have explicitly advised this, and who claim to have had success in reducing peripheral oedema with these techniques.

My wife, an LMT, never refers to improving "blood flow", just lymphatic drainage.  I'm unaware of published research either way.



Edited by frogomatic 2010-06-23 7:05 PM

Lymphatic drainage, absolutely. 

I am very knowledgeable about venous flow and treat venous problems as a large part of my medical practice. Massage is a great treatment for swelling (edema/ lymphedema)  No matter which way you compress the veins, as long as they are not diseased, the blood will flow towards the heart because the veins contain one way valves. I demonstrate this everyday using directional flow ultrasound.

The question about compression and deep vein clots is a little more complex.The legs have 2 separate venous compartments, the deep and superficial. The main reason for deep clots (DVTs) is described by Virchow's Triad: hypercoagulable state, intimal damage, and stasis (low blood flow).  By compressing the superficial system with compression hose you increase the flow through the deep system.

I am not a massage therapist and don't plan to become one but I would think the biggest advantage to massage would come from assisting lymph flow toward the nodal basins which in turn is returned to the venous system albeit in very small quantities and definitely not enough to put a strain on the heart

Double ditto on the lymphatics.  

I see what you're saying about the blood flow to the heart when considered in scale with the overall venous return to the hear vs. blood flow to a specific area being worked on "transiently."  Maybe a more appropriate way of framing the discussion would be to focus on the blood flow benefits of massage as improving blood flow to/from specific muscles, while not really having any overall effect on the amount of blood actually returning to the heart.  

This study, at least, seems to support that idea: http://www.ncbi.nlm.nih.gov/pubmed/15114265

In which case it, getting back to the original question, it probably doesn't really matter whether you push toward or away from the heart.  From my own painful experience, I will say that more important than the direction in relation to the heart is the direction in relation to the muscle fibers.  


 

I am a Certified Massage Therepyst in regards to stroke if performing a deep long stroke it should always be towards the heart to prevent accidentally damaging veinus valves by putting pressure in the wrong direction especially if a patient shows signs of spider veins a sign of improper blood movement during a massage is a light-severe burning sensation in the limbs. This also is to prevent moving blood in the wrong direction as to not dislodge any unknown clots.

In regards to sports massage you will tend to do brisk strokes to warm up the muscle and increase blood flow to the area to prepare the muscle for a workout or break up cortisol build up and scar tissue after and promote healing as well as mobility stretches and gently rocking joints also known as rolling.

If its scar tissue specifically then doing slight opposing pulls away and towards the joints example holds below the knee and above the ankle will stretch the skin increasing elasticity and then performing friction circles around the edges of the scar not directly to soften the tissue.

Lymphatic you use no more than what's needed to move the skin usually what's described as a nickles weight without putting pressure on the muscle as to not fully compress lymph nodes and gently provide a pump like motion towards the axillary nodes such as the hips/pelvis and arm pits/clavical

Different massage provides different strokes for different reasons but in most cases you always want blood and lymph to move towards the heart or specifically to the torso for waste removal. The only time you are allowed to move in the opposite direction is on the torso itself as you are close enough to the heart and most of the veins and arteries are deeper and the torso has muscles that attach in different directions.

Edited by MT_Mainer 2022-06-30 10:25 AM

I don't mean this to be snarky, but there's a hell of a lot they don't teach you in medical school. RN and MT here. Obviously, I'm not a doctor, but I will tell you that there is a LOT about the body that I learned in massage school that never showed up in any of my medical training. I'm hoping you'll keep an open mind about this instead of leaning on your credentials, because when doctors start thinking they know everything - they stop growing as professionals.

There have been a few studies that show massage therapy does indeed improve systemic blood flow. Here's a link to an article, the journal reference is included at the bottom.

https://www.sciencedaily.com/releases/2014/04/140416125434.htm

Cheers