Mythbusting: Massage Removes Lactic Acid
This is a modified version of a blog post I wrote for the Association of Massage Therapists in 2019 as part of a series that challenged some common but unfounded notions of the massage industry.
You can find the original blog @ https://blog.amt.org.au/index.php/2019/10/23/mythbusting-massage-removes-lactic-acid/
Lactic acid is about as popular as a rattle snake in a lucky dip.
When it comes to the art of removing that nasty lactic acid, massage therapists have long proclaimed to be the experts at getting the job done.
But is lactic acid simply misunderstood?
And does massage remove lactic acid?
What is Lactic Acid?
Lactic acid, or lactate, is a compound that is produced during glycolysis.
OK, so what is Glycolysis?
Glycolysis is a constantly occurring process within the liver and muscles that works to replenish and supply our body with glucose. Given that glucose (a form of sugar) is the primary source of energy for every cell in the body and lactate is produced during glycolysis, it already sounds pretty important. But even important people can be arsehats, so let’s not let lactate off the hook this easily.
Glycolysis can be split into two categories:
1. Aerobic Glycolysis
Think of the Tour De France cyclists or the recent efforts by the likes of marathon runners Eliud Kipchoge and Brigid Kosgei, who were able to produce energy for a long sustained period. Their muscles require a constant source of adenosine triphosphate (ATP) to fuel their bodies, and when there is enough oxygen available during exercise, their body utilises aerobic glycolysis to produce the ATP.
Say we attempted to keep pace with Kipchoge for just a single kilometre of his record breaking (sub 2 hour) marathon, with every single kilometre split being between 2:48min/km to 2:52min/km.
It is a pretty fair assumption that our demand for oxygen would very quickly exceed its availability.
This would force our body to undergo anaerobic glycolysis, which produces less ATP.
2. Anaerobic Glycolysis
Initially, stored glycogen is converted to glucose. Glucose is then broken down by a series of enzymes.
As glucose is broken down to synthesise ATP, it results in the creation of a substance called ‘pyruvate’ and hydrogen ions.
As more hydrogen ions are created, the muscle becomes increasingly acidic.
This results in pyruvate binding with some of the hydrogen ions and converting them into a substance called lactate.
Somewhere around here, the rumours that lactate was some sort of devil juice began, but we are yet to get the whole picture.
Lactate is then quickly removed from the muscle cell, protecting the cell from becoming too acidic, so exercise can continue for a little longer.
Lactate that is removed from the muscle is carried to surrounding muscles that have oxygen available.
It is also carried to the liver, where it goes through various chemical reactions to convert it back to pyruvate and/or glucose for further glycolysis and energy production via the aerobic energy system.
As the name ‘anaerobic’ suggests, there isn’t exactly an abundance of oxygen available to break down pyruvate and continue synthesising ATP.
So, despite copping such a bad rap for all these years, poor old lactate realised that hydrogen ions were filling up the place like a centipede’s sock draw and was just trying to buffer/prolong the energy production process.
What can we blame the burn on then?
One could point the finger at those hydrogen ions that accumulated and created the acidic environment – what a bunch of a*holes! Or we could shout profanities at that damn aerobic system that couldn’t keep up – what a slacker!
But really, pointing the finger of blame isn’t going to help our clients.
Assuming you can breathe, your body will bring itself back into balance rather quickly and, if you cannot breathe, a bit of a burning sensation in your muscles probably isn’t going to be your primary concern.
But wait … what on earth have massage therapists been doing all this time?
Well, this Wiltshire et al study decided to take a look at exactly that.
What they did: Twelve subjects performed 2 min of strenuous isometric handgrip (IHG) exercise at 40% maximum voluntary contraction to elevate forearm muscle lactic acid. Forearm blood flow (FBF; Doppler and Echo ultrasound of the brachial artery) and deep venous forearm blood lactate and H+ concentration ([La-], [H+]) were measured every minute for 10 min post-IHG under three conditions: passive (passive rest), active (rhythmic exercise at 10% maximum voluntary contraction), and massage (effleurage and pétrissage). Arterialized [La-] and [H+] from a superficial heated hand vein was measured at baseline.
What they found: Massage impairs La(-) and H+ removal from muscle after strenuous exercise by mechanically impeding blood flow.
What does this mean: That massage is not helping to remove lactic acid and our attempts to remove lactic acid are actually impeding what is a normal function of the human body.
So how do I apply all of this in the clinic?
Stop making lactic acid out to be the bad guy.
Even if your client had sprinted to your clinic door and was using anaerobic glycolysis for energy production, by the time you conduct your assessment and they get on the table, the body has likely taken care of itself (i.e. removed the lactic acid).
If you happen to be waiting at the finish line ready to immediately treat your client, you must understand that (a) you are weird and (b) treatment may impede blood flow and actually delay your client’s recovery.
Why does this myth persist?
There are a few reasons:
It is heavily ingrained in the public’s mind and most of them feel better having something to blame their pain on. For post-exercise pain, lactic acid is the cultural go-to culprit of choice. As long as people feel better after a massage, they are happy and likely don’t care what it is we did.
People feel smart when they get to use fancy words. If they wanted to learn the ins and outs, they would.
Lactic acid is still blamed by massage therapists, personal trainers, old guys at footy clubs, young guys at footy clubs, all the way to those honest Instagram influencers selling magic water. But keep in mind that these are all people; they too feel and look smart when they get to use fancy words, specially if they’re selling stuff.
Most courses skim over this stuff and most teachers are happy to do so because it’s the easy option. Otherwise, they would be making the effort.
Like most careers, we learn more on the job than we do at college. However, most therapists just pass down what they do and why they think it works and get defensive when pushed for further insight or, god forbid, evidence or even a valid explanation of concept.
Most therapists just want to help people and the thought of having to unlearn and relearn everything is overwhelming. Therefore, they continue to dish out the common catchphrases and figure that as long as clients are happy, who cares? And the profession remains in the dark ages yet again.
Rumour has it if you put a silicone cup to your ear, you can still hear massage therapists removing lactic acid.