Massage ist wirksam, das wird kaum jemand bestreiten. Worin diese Wirksamkeit allerdings exakt besteht, wann sie auftritt und in welchem Maß, durch welche Methode, wo ihre Grenzen sind und vieles mehr allerdings ist umstritten.

Ein Beispiel ist die – auch in der Podiumsdiskussion zur Frage ob Heilmassage mehr ist als nur eine ergänzende Maßnahme zur Aktivtherapie – aus dem Publikum erwähnte Studie von J. Crane et al.[1] 2012 („Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage“).[2]

Ausgangspunkt der Studie ist, dass Massage-Therapie in der Rehabilitation angewendet wird, um Schmerzen zu lindern und die Erholung nach Verletzungen zu fördern. Wie die Massage allerdings konkret wirkt, ist unbekannt. Aus diesem Grund haben die Autoren elf Freiwillige in eine Studie einbezogen, in der sie auf Hometrainern so lange radeln mussten, bis ihre Muskeln brannten. Anschließend wurden die Probanden massiert – aber nur einer der beiden Oberschenkel. Gewebeproben wurden vor dem Training, unmittelbar nach der 10-minütigen Massagebehandlung und nach einer zweieinhalbstündigen Ruhepause aus beiden Beinen entnommen (M. vastus medialis).

Die Massage drosselt, so die Studie, die Produktion zweier entzündungsfördernden Botenstoffe (Tumor-Nekrose-Faktor-alpha und Interleukin-6) und regt die Produktion von Mitochondrien an, was helfen dürfte, die Muskelfunktion zu verbessern. Ein Effekt auf den Milchsäurespiegel, der nach starker Muskelarbeit deutlich ansteigt, war hingegen nicht nachweisbar.[3]

Mediale Berichterstattung und Kritik an der Studie

Zufrieden folgte die Berichterstattung den Ergebnissen der Studie, scheint doch damit nachgewiesen, dass Massage nicht nur wirkt, sondern dass der Wirkmechanismus nun auch belegt wurde[4]: Die Schmerzlinderung beruhe auf demselben Mechanismus, der auch bei der Einnahme von Schmerzmitteln wie Aspirin oder Ibuprofen wirksam ist, schreiben die Wissenschaftler im Wissenschaftsjournal Science Translational Medicine.[5]

Zwei Veröffentlichungen Anfang Februar allerdings widerlegen die Aussagen der Studie, sowohl vom Inhalt her als auch von der Aussagekraft:

• Paul Ingraham: Massage does not reduce inflammation and promote mitochondria. The making of a new massage myth from a high-tech study of muscle samples after intense exercise.[6]
• David Gorski: Does massage therapy decrease inflammation and stimulate mitochondrial growth? An intriguing study oversold.[7]

David Gorski kommt zum Schluss: „Yet that’s not what was concluded. They did not report what was in essence a negative study.

Instead, the authors concluded that they had found that massage was anti-inflammatory, and that that’s how it ‘works.’ They concluded that it ‘promoted mitochondrial biogenesis’ without showing any evidence for anything other than the thinnest of thin evidence, a small increase in one signaling protein that promotes mitochondrial formation. And the news media ate it up.

None of this is to say that massage is useless or that it might not have therapeutic benefit in some circumstances. What this is to say is that this study, contrary to how it’s being portrayed, is not slam-dunk evidence that massage is some sort of ‘non-drug’ treatment for inflammation that can replace non steroidal anti-inflammatory drugs. Unfortunately, whether because the authors were naive or desperate to salvage something from a study that didn’t show very much, that’s not how it was sold. The media might be guilty of overselling this study, but at least one of the authors was either complicit or didn’t realize how his words would be represented. Now this study is out there; look for massage therapists who are into woo to be pointing to this study for years to come as ‘proof’ that massage is anti-inflammatory and ‘regenerates mitochondria.’”

Auszüge aus den Darlegungen von Gorski[8]

• Ten years ago these cDNA microarrays, as they’re called, were state of the art. They aren’t now. Next generation sequencing (NGS) techniques, such as RNAseq, are, but that doesn’t mean cDNA microarrays aren’t still useful. NGS probably would have been overkill for this study – or at least prohibitively expensive.
  These days, more sophisticated analyses, known as network analyses, are usually done. These involve looking for groups of genes that are turned on and off in synchrony that indicate broader pathways that are being turned on and off. Single genes don’t actually mean all that much. It’s the groups of genes going up and down together as part of a pathway that truly indicate specific pathways being turned on and off.

• „Independent of the massage treatment, the control leg muscle exhibited a change in 943 probes (representing 592 genes) at 0 hours after massage (30 min after exercise) and 2307 probes (representing 1309 genes) at 2.5 hours after massage (3 hours after exercise), significant changes that were induced by exercise alone (tables S1 and S2)”, führen J. Crane et al. aus – und Gorski antwortet darauf:
  In other words, these five genes were a tiny subset of the genes altered by exercise to exhaustion. Less impressive is that none of them were particularly strongly turned on or turned off. The gene most turned on only reached a level 1.68 times control at time zero after massage and was not detectably different from control by 2.5 hours. The gene most turned off only decreased to 0.73 times control, a 27% decrease. Not impressive, at least not to me. This was particularly true after I perused the supplemental data list, in which I found a whole bunch of genes whose expression appeared to change more than this, due to exercise. Unfortunately, the authors didn’t include the table I really wanted to see, namely the table doing the head-to-head comparison of massage versus no massage.
  
  
• „One of the five genes whose expression was altered by massage immediately after the treatment was functionally related to actin dynamics (filamin B, b) (Table 1). One of the four genes induced by massage after recovery from treatment (2.5 hours) was related to NFκB nuclear trafficking (nucleoporin 88) (Table 1). Overall, this profile suggested that massage altered processes related to the cytoskeleton the former process being activated early after massage and the latter induced later in recovery”, so die Autoren der Studie.
  Replik von Gorski: I found this very questionable based on my own experience analyzing a cDNA microarray. The reason is that what I found my gene of interest to do was to decrease nuclear factor-κB (NF-κB) signaling. I’ve also done studies looking at the nuclear localization of NF-κB using confocal microscopy and NF-κB. When NF-κB is activated or turned off in my experience the changes seen in whole-genome expression profiling assays are not subtle and do not involve just a single gene, like nucleoporin, whose messenger RNA was elevated (but, it should be noted, whose protein was never verified to be also elevated after massage). NF-κB changes the activity of dozens of genes in a pattern that’s so obvious that when I showed my initial microarray results to an NF-κB expert several years ago, he immediately recognized that pattern by “eyeballing it” (and now I can recognize that pattern too). The changes were also much more dramatic. Indeed, I was looking at fold-changes that ranged from two-fold to over a hundred-fold. While it is true that I was studying cultured cells, which are an inherently less noisy system than tissue biopsies, I would have still expected to see a lot more genes altered if massage were truly impacting inflammation in general and the NF-κB signaling pathway in particular.
  
  
• Finally, the authors looked at another signaling molecule, nuclear peroxisome proliferator–activated receptor γ coactivator 1α (PGC-1α), because they found evidence that upstream signaling pathways that activates PGC-1α were turned on by massage (hmmm, I have to be more careful about how I phrase things). Sure enough PGC-1α levels were slightly increased (by maybe about 20% to my eyeballing the graphs) at 2.5 hours after massage. However, contrary to the way some news outlets reported this story, the number of mitochondria did not increase. Worse, this is a misstatement promoted by Dr. Melov himself.
  
  
• This paper doesn’t show that massage promotes biogenesis of mitochondria, only that massage might—I repeat, might—increase the level of one molecule that promotes the development of mitochondria by 20% at most. Paul Ingraham put it very well in his own article about this research:[9]
  “What the authors actually reported is: “potentiated mitochondrial biogenesis signaling” and “promotes mitchondrial biogenesis.” In other words, they didn’t find more mitochondria … they found a mitochondrial growth signal. It’s the difference between finding bigger plants or just some bags of fertilizer.
  Whether or not mitochondrial growth actually happens probably depends on many biological inputs, like everything else that our cells do. Inferring from one signal in a small sample that “massage increases mitochondria” is really just an enormous leap. Fortunately, the authors themselves didn’t make that leap — but lots of other people are making it.”

• Except that at least one of the investigators certainly is implying it very strongly—so much so that it’s a claim appearing in mainstream news articles about the study as though it were fact. As Paul also points out, the very design of this study indicates a lack of clinical insight into how massage therapy is usually used in the real world. What Crane et al. were studying was acute muscle injury in response to exercise to the point of exhaustion. Massage is not often used for that, and, in fact, as he summarizes, we already know that massage has only at best modest effects on exercise recovery; i.e., there isn’t much of a clinical benefit to explain. Rather, massage tends to be used used for chronic soreness. In fact, it might well be that a vigorous massage after a workout to the point where one’s muscles are so exhausted that one can’t even pedal a bicycle anymore would actually be painful.

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[1] Justin D. Crane, Daniel I. Ogborn, Colleen Cupido, Simon Melov, Alan Hubbard, Jacqueline M. Bourgeois and Mark A. Tarnopolsky.

[2] Veröffentlicht in Science Translational Medicine (1. Feb 2012), Vol. 4, Issue 119 (DOI: 10.1126/scitranslmed.3002882), http://stm.sciencemag.org/content/4/119/119ra13. Zugriff 28.01.2018.

[3] „We found that massage activated the mechanotransduction signaling pathways focal adhesion kinase (FAK) and extracellular signal–regulated kinase 1/2 (ERK1/2), potentiated mitochondrial biogenesis signaling [nuclear peroxisome proliferator–activated receptor γ coactivator 1α (PGC-1α)], and mitigated the rise in nuclear factor κB (NFκB) (p65) nuclear accumulation caused by exercise-induced muscle trauma. Moreover, despite having no effect on muscle metabolites (glycogen, lactate), massage attenuated the production of the inflammatory cytokines tumor necrosis factor–α (TNF-α) and interleukin-6 (IL-6) and reduced heat shock protein 27 (HSP27) phosphorylation, thereby mitigating cellular stress resulting from myofiber injury. In summary, when administered to skeletal muscle that has been acutely damaged through exercise, massage therapy appears to be clinically beneficial by reducing inflammation and promoting mitochondrial biogenesis”, so die Autoren in ihrem Summary.

[4] Z.B. Gisela Telis: Massage's Mystery Mechanism Unmasked. 1. Februar 2012; http://www.sciencemag.org/news/2012/02/massages-mystery-mechanism-unmasked. Zugriff 28.01.2018.

[5] Susanne Mauthner-Weber: Warum Massage wirklich wirkt. In: Der Kurier, 9.2.2012; https://kurier.at/wissen/warum-massage-wirklich-wirkt/767.552. Zugriff 28.01.2017.

[6] Veröffentlicht am 15. Februar 2012, https://www.painscience.com/articles/research-crane.php. Zugriff 28.01.2018.

[7] Veröffentlicht am 13. Februar 2012, https://sciencebasedmedicine.org/massage-therapy-decreases-inflammation. Zugriff 28.01.2018.

[8] David Gorski: Does massage therapy decrease inflammation and stimulate mitochondrial growth? An intriguing study oversold. https://sciencebasedmedicine.org/massage-therapy-decreases-inflammation. Zugriff 28.01.2018.

[9] Paul Ingraham: Massage does not reduce inflammation and promote mitochondria. The making of a new massage myth from a high-tech study of muscle samples after intense exercise. https://www.painscience.com/articles/research-crane.php. Zugriff 28.01.2018.

(Autor: Eduard Tripp)