Exhausted after deep tissue massage. Why?
September 2, 2016 10:41 AM   Subscribe

I had a 90 minute massage yesterday at noon. I came home and was extremely fatigued the rest of the day. Went to bed at 8 p.m. Still pretty tired today. I can understand being sore after the work the therapist did, but I have never been this wiped out after a professional massage. Anybody have a clue what is going on? Google has been of little help except to confirm that others feel like this post-massage sometimes.

I have a big knot in my trapezius muscle to the left of my right shoulder blade. It's causing me additional pain in my neck and shoulder. The therapist worked on it more than any other spot. It's more relaxed today and I feel better. But the weird fatigue afterward is puzzling. It was almost flu-like last night. I was freezing cold (which never happens), sleepy, low-energy, and really could not concentrate. And as sleepy as I was I had trouble sleeping. I feel better today, including my trap muscle, but I'm still weirdly sleepy and my energy is middle-to-low. Google had only responses, and they cited vague "toxins." No decent sources. Anybody got a clue? I want to go back and have the therapist work on this muscle some more (and do my stretches that also help), but, dang, I don't care to be wiped out again for 2 days if I can help it! Thanks, everybody!
posted by sister nunchaku of love and mercy to Health & Fitness (19 answers total) 4 users marked this as a favorite
That should read "Google had only responses that cited vague 'toxins.'" Oops.
posted by sister nunchaku of love and mercy at 10:43 AM on September 2, 2016 [1 favorite]

Release of lactic acid. In the future, drink a ton of water after your massage and it will help mitigate.
posted by veery at 10:47 AM on September 2, 2016 [23 favorites]

I do not have an answer to the massage question, but I do tend to get terrible muscle knots to the inside of my shoulder blades, with significant neck and shoulder pain. Massage has always helped me short term, as have stretches. But when I took up weight lifting two years ago, the knots virtually disappeared - I almost never get them, where I used to have them every day. (Partner testifies to this now that they no longer need to provide back rubs.)

I would not normally offer unsolicited advice, but it was transformative and very fast. It literally cleared up a problem I'd had for twenty years, since my late teens, after about two weeks of three times a week exercise.

This link is to a cheesy website, but it gives a clear illustration of the most important exercise for me, the bent over dumbbell row using a bench.

I also do barbell presses and some other stuff which helps, but the bent over rows are the most important.

My feeling is that not only did this strengthen the muscles, but the increased use of the muscles kept them from knotting up so much.

I lift weights two or three times a week and I do two sets of 12 for each arm.
posted by Frowner at 10:54 AM on September 2, 2016 [16 favorites]

Have you hydrated a lot since your massage? I think it would help. Drink a ton of water over the course of the day, and see whether that helps.
posted by janey47 at 10:59 AM on September 2, 2016

Google had only responses that cited vague 'toxins.'

Your lymphatic system is how the body removes various wastes from the system. If those aren't being adequately removed and are backing up, deep tissue massage can help the body dump the backed up wastes.

Walking is one of the best ways to power your lymphatic system so it gets more done. You might try walking more as a preventive measure. Also, my guess would be that the first time will be the worst and subsequent visits will have less dramatic impact because there will be less backlog of wastes in the system. Unless you put it off too long and let another backlog develop.
posted by Michele in California at 11:02 AM on September 2, 2016 [2 favorites]

Basically, this is a known response to massage (it's happened to me), but none of the goofy unscientific hypotheses (usually having to do with mysterious backed-up toxins of unknown nature) actually hold up to any scrutiny.

How massage even works, and in what ways it works, is still mostly a mystery.
posted by praemunire at 11:05 AM on September 2, 2016 [15 favorites]

Release of lactic acid.
I have no opinion about the effectiveness of drinking more water, other than that being adequately hydrated can never be bad. However, blaming lactic acid is essentially a slightly dressed up version of the "toxins" theory. Most everything people say about lactic acid is wrong. It isn't a toxin; your body really produces lactate, not lactic acid; it doesn't cause muscle soreness, but rather is a reaction to the forces that led to muscle soreness in the first place; it certainly doesn't linger in your muscles waiting to be squeezed out. It is probably best thought of as an emergency fuel.

I think praemunrie has it, we really don't understand how or why massage works at all.
posted by Lame_username at 11:18 AM on September 2, 2016 [16 favorites]

As a massage therapist (but not YMT), I'll echo praemunire's comment (as well as Lame_username's refutation of the lactic acid theory) and just add that 90 minutes is a long stretch of time for deep-tissue work. If someone scheduled 90 minutes of "deep tissue work" with me, I'd call them and recommend either switching to a 60-minute session, or integrating 30 minutes of gentler Swedish work into the 90-minute session. Receiving 90 minutes of deep tissue massage would wipe out most people, and not in a relaxing way.
posted by duffell at 11:19 AM on September 2, 2016 [4 favorites]

FWIW, when I get a massage, I am always told to drink lots of water afterwards and prepare to be able to rest (not go back to work or do laundry)
posted by mumimor at 11:20 AM on September 2, 2016 [2 favorites]

This may not be the case with you, but I tend to be more fatigued after a massage when I'm PMSing. Oh, and also when I was pregnant and didn't know I was.
posted by Everydayville at 11:21 AM on September 2, 2016

I have that response when I have deep tissue work on an area that is knotted. I respond to a deep knot in my trap, by unconsciously holding tension everywhere. It's exhausting. For me, it feels like freeing up the knot allows the other complementary muscles to relax. I associate the tiredness and fatigue with having held my muscle more tensely for a period of time, rather than toxins getting released.

However, I have not found anything conclusive on what causes post massage fatigue.
posted by 26.2 at 11:32 AM on September 2, 2016 [1 favorite]

Imagine spending 90 minutes in which you flex and release many of the muscles of your body very firmly and repeatedly. In front of a relative stranger in a semi-public place.

Or having someone throw a tennis ball at you for 90 minutes. You'd be tired. (And confused and angry, I assume.)

I can barely make it through a 90-minute training class standing in front of a whiteboard, periodically lifting one arm to point or write, without needing a nap.
posted by Lyn Never at 12:20 PM on September 2, 2016 [1 favorite]

I get exhausted after massage and other kinds of deep tissue work, too. If I have to do something later that day and can't afford to just sleep it off, I find that a hot shower or an Advil (or other anti-inflammatory/NSAID) helps.

Not sure why, though, since I don't know what causes it. When I speculate, I tend to agree with Lyn Never: I've always assumed it must come from the muscle being "worked," similar to if you were flexing or holding it.)
posted by stellarc at 12:33 PM on September 2, 2016

Everyone else has answered much better than I could, but I just wanted to add an anecdote. I've gotten tons of the "gentle back rub" type massages with no problem. Then one time I accidentally got a deep tissue massage and thought I was going to have to go to the hospital the next day. I had to leave work because I was nauseous with pain. I was so freaked out! Wish I had has this thread to read :)
posted by silverstatue at 2:01 PM on September 2, 2016 [2 favorites]

A recent study out of the University of Alabama at Birmingham and Johns Hopkins shows that, for people with CFS, merely passively stretching a muscle to the point of strain can cause a flare-up:
Chronic fatigue syndrome flare-ups caused by straining muscles and nerves

Eighty individuals, 60 with CFS and 20 without CFS, reported their levels of fatigue, body pain, lightheadedness, concentration difficulties and headache every five minutes while undergoing 15 minutes of either a passive supine straight leg raise -- the raising and holding up of one of an individual's legs while they lie on their back on an exam table -- or a sham leg raise that did not cause strain.

Participants were contacted 24 hours later and again reported their symptoms. Compared to those with CFS who underwent the sham leg raise, individuals with CFS who underwent the passive leg raise that actually strained their muscles and nerves reported significantly increased body pain and concentration difficulties during the procedure. After 24 hours, these same individuals who underwent the true strain also reported greater symptom intensity for lightheadedness and the overall combined score for symptoms. The individuals with CFS who underwent the true strain also reported more symptoms during, and 24 hours after, the true strain compared to individuals without CFS.
I'm not saying you have CFS, but this study shows that merely passively straining muscles, which deep massage seems certain to do, can cause a lot of pain, fatigue, and other problems for some people -- and CFS does appear to cast a long shadow into the normal population.
posted by jamjam at 3:29 PM on September 2, 2016 [3 favorites]

Thank god people have nipped the "lactic acid"/toxins theory in the bud. I'm a licensed massage therapist, and I am so frickin' tired of hearing that shit trotted out. Lactic acid is cleared out of the body with no problem almost immediately. It is not responsible for DOMS nor for post-massage fatigue. Period.

Unless you were under-hydrated to start with, drinking more water will not help you. That's another myth I wish would die.

It's really no fun to have a client on the table who is demanding ultra deep work while their muscles are tensing in response to the too extreme pressure. The "no pain no gain" theory has no place in massage.

It's also really no fun to hear from clients about their horrible experiences with poorly done "deep tissue" massage and how much it harmed them.

I will echo that a 90-minute deep tissue session is probably too long. Although it's very common for deep tissue to be offered as its own service at many spas and chains, I and some other independent massage therapists do not offer it as its own service. When you pay more for a special deep tissue massage, there can be the perception on the part of the client as well as the therapist that you should get ultra mega tons of pressure throughout those 90 minutes, or else not get your money's worth.

The way a good therapist works, who is not hampered by that expectation, is to give you the amount of pressure that will be therapeutic for you individually on a given day. It's an art, and all kinds of knowledge and feedback goes into that decision. Look for "integrative massage" next time (I'm hoping you do not go back to the same therapist!!)

As for what was actually happening that caused you to feel wiped out, the rhabdo theory is I suppose possible; here's an article that discusses that (and the site as a whole is also excellent): https://www.painscience.com/articles/poisoned-by-massage.php.

Another possibility is that your "fight or flight" response kicked in. Adrenaline surges can make you feel shitty later. People who have anxiety attacks are often very fatigued later on. Were you lying there tolerating pressure that was upsettingly extreme? Sometimes clients do that because they assume the therapist knows what they're doing. This therapist provably did NOT know what they were doing.

Don't tolerate a massage with unpleasantly firm pressure, unless the therapist has explained very specifically what they are trying to do and why (for example, some trigger point work feels temporarily painful, although it's usually a good pain), and even then, it's your call and that unpleasant pressure shouldn't continue for 90 minutes!
posted by mysterious_stranger at 3:25 PM on September 3, 2016 [4 favorites]

I have done the opposite of threadsitting, I guess. The therapist did not do 90 entire minutes of deep tissue work only; rather, about 30 minutes total on that one knot, and with breaks to work on the rest of my body. That misunderstanding here is my fault. I have had many professional massages before, including work like this, but have never been so wiped out before afterward!

I didn't want to go into my medical history in my question, but I have had trap/rotator cuff issues resulting from repetitive stress, specifically mobile phone use and iPad use. I had physical therapy late last year to stretch my trap and to strengthen my shoulder. I recovered full motion and relief from pain. However, using my smartphone for browsing or gaming can quickly fark up my trap and shoulder again, as I learned.

Not PMSing nor pregnant (54 and post-meno), no CFS.

I did hydrate. The pressure was not too firm. I was just looking for an explanation for the weirdo fatigue. I think the best hypothesis is that my muscles got a workout, but a passive one. And my trap got beaten up gently for an extended time.

If I were a medical researcher and ran across the number of people who reported this experience, I'd think it would be a fab area to explore.

Thanks for all the input. At least when people google it from now on they will find this question.
posted by sister nunchaku of love and mercy at 4:30 PM on September 3, 2016

30 minutes on one "knot"* is, without any question at all, way too much. I say this as a licensed massage therapist with eight years experience and lots of continuing education in medical and therapeutic massage. This was a bad massage. This was a bad massage therapist. I'm sorry you've had similar massages before, and if so, you're lucky not to have experienced bad aftereffects.

* What was this exactly? Just an area of tension? A trigger point? Scar tissue? Layers of muscle/fascia sticking together? I have known of some bad therapists overworking a " knot" that was simply an intersection of two muscles, or a palpable attachment point. This could easily have occurred in the area you're speaking of especially.
posted by mysterious_stranger at 4:53 PM on September 3, 2016 [2 favorites]

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