Endurance athletes, while being incredibly fit, are not necessarily very healthy. The demands placed on their bodies by intense and prolonged training regimes can leave them with high levels of inflammation – something that is linked to immunosuppression and potentially an increased risk of cancer. This article describes how massage can be used to reduce inflammation levels in athletes, helping perhaps to reduce their risk of cancer, as well as in patients with cancer to improve their well-being through the course of their disease and its treatment.
Historically, massage has mistakenly been viewed as a contraindication for individuals who are currently undergoing treatment for, or who have a history of, cancer. Cancer is a broad term used to describe a set of diseases characterised by cell mutation and uncontrolled division of cells in the body that often spread to surrounding tissue, forming tumours. Traditionally, it was believed that massage could exacerbate a plethora of illnesses and that massage therapists would even potentially expose themselves to contracting illnesses while spreading it around the body via soft tissue therapy. With advancements in science and a more comprehensive understanding of how the body works, we now know these myths to be just that, myths.
However, with some of these misconceptions so ingrained within our society it will take both patience on our part and unequivocal proof in order to dispel these falsehoods. Cancer is not a new disease; archaeological studies have even found it prevalent in the autopsies of dinosaurs. Nevertheless, it has become so pervasive in our society today that, according to the statistics, 1 in 2 people will develop cancer at some point in their lives; some preventable through healthy living, others not. With varying survival rates ranging from 5% (in sufferers of lung cancer) to 78% (in breast cancer) (1*), there are myriad factors that can affect an individual’s chance of developing cancer and surviving it. In this article, we will look at the implications of exercise in the development of cancer and how oncological massage has been attributed to greatly improved recovery post-treatment, along with a better quality of life.
Societal Misconceptions Surrounding Athletes
Athletes have long been considered the epitome of health by society; however, recent research has suggested that such perceptions are, in fact, false. Athletes face fairly high health risks both competing and training. A compromised immune system coupled with the great strain that professional sport places on the body have been linked to a greater probability of athletes developing recurrent infections during periods of intense training and competition.
In order to examine why athletes may be at a greater risk of developing cancer and how massage can benefit individuals throughout recovery, we must first, briefly define two notable factors that influence damaged cell growth: inflammation and stress. One definition explains inflammation as a localised physical condition in which part of the body becomes reddened, swollen, hot and painful, as a direct reaction to injury or infection. However, there are also other forms of inflammation that arise from lifestyle choices such as diet, smoking and drugs.
Stress, often recognised as a factor that could contribute to increased cancer risk, is defined by physiological disturbance or damage caused to an organism by adverse circumstances, such as the previously mentioned lifestyle choices. Stress is often cited as a significant contributing factor to the development of inflammation. Stress, and the production of serum cortisol, provide prime conditions for mutated cell division and damaged growth. Sheldon Cohen, a professor at Carnegie Mellon University, says, “stressed people’s immune cells become less sensitive to cortisol. They are unable to regulate the inflammatory response when they’re exposed to a virus” (2). It has also been seen that stress can result in a reduced immune response following vaccination. Hence, higher stress levels may mean that vaccination against cancer-causing viruses is less effective, leaving patients more vulnerable to cancers caused by those viruses (3).
The phrase ‘athlete and cancer’ feels like an oxymoron. What we see when we look at a strong, fit athlete would be the general interpretation of health. But, unfortunately, being fit is not the same as being healthy. Most people can immediately think of a number of famous athletes who developed cancer during their careers. There are a number of plausible theories about why athletes may develop cancer, including the demands put on them through incredibly intense and strenuous training regimes. In order for any professional athlete to compete to the best of their ability, they must constantly push their bodies to the max. This, in turn produces an inflammatory state within the connective tissue. Our connective tissue is considered to be the home of the immune system and long-term inflammation has been linked to cancer, providing conditions which allow the disease to thrive. Intense training schedules that can last 6–8 months put a gruelling strain on the body and athletes often put off waiting for a full recovery in order to continue their necessary training.
Endurance Sports and Cancer
Endurance sports have been proven to have the greatest negative impact on an athlete’s immune system. Oxidative stress is a process the body goes through during long periods of exercise, producing an imbalance of highly reactive free radical molecules and antioxidants. These extended periods of training bring with them increased free radical production and thus oxidative stress; placing a great strain on the immune system and causing an inflammatory response, and even in some cases immunosuppression – partial or complete suppression of the immune system (4). This allows higher levels of free radicals to react with other cells in the body causing mutation and division of cells, a symptom characteristic of cancer (5). The progressive build-up in training intensity, coupled with a lack of rest, leave athletes’ immune systems extremely depleted and vulnerable.
Inflammation, Cancer and Massage
Serious inflammation has been linked to a range of chronic diseases including diabetes, heart disease and cancer. Among professional athletes, the main sports noted as significantly contributing to an increased risk of cancer are endurance swimming, cycling and running. Chronic phases of inflammation are hypothesised to increase the risk of cancers developing by facilitating the degradation of healthy cell growth, in turn creating prime conditions for damaged cellular growth to continue and heighten the risk of tumour development (6*).
The repetitive muscle movements in cycling, running and swimming cause inflammation to the soft tissue around the joints, making recovery an essential component of the training schedule. In their 2004 study on the effect of selected recovery conditions on performance of repeated bouts of intermittent cycling separated by 24 hours, Lane and Wenger reported that massage was the most effective recovery method, in combination with active rest, as it allowed an athlete’s body to recover for the next training session (7). As well as causing a lot of inflammation to the soft tissue around the joints, the sports that put the greatest strain on the immune system are also endurance cycling, swimming and running (5).
In relation to the impact of inflammation on the body, Helene Langevin, a prominent researcher in the use of complementary medicine, completed a study with her colleagues, looking at the effects of how stretching impacts inflammation resolution in connective tissue (8*). In her work she explains that cancer is not just a collection of tumour cells growing out of control, but rather that primarily these cells need a base in which the cancer can spread. She describes the base like railway tracks of dense connective tissue that allow the cancer to grow undisturbed and then use these tissue tracks to travel along. Therapists often refer to these areas as ‘tension’ or ‘adhesions’, but in reality they are areas where there is poor movement and persistent inflammation.
Langevin also discusses the enthusiasm of massage therapists to make a change in the ‘length’ of the tissue, in order to make it more pliable, flexible and attempt to return it to a more normal length. A common consequence of this approach, however, is that the treatment used is often administered with too much aggression – resulting in the fibroblasts reacting in such a way that more inflammation is actually caused, rather than moving the tissue into a state of healing (8*).
In a study conducted by McMaster University, Toronto, Canada, researchers found that massage after prolonged periods of physical activity stimulated production of mitochondria and reduced inflammation. In addition to this, the university also found that massage between workouts and athletic events decreased recovery time; highlighting the importance of massage in aiding recovery (9*).
Massage Within Medical Discourse and the Development of Oncology Massage Therapy
Massage is a medicinal practice that has been observed for nearly 5,000 years and was first noted in Ancient China, at around 2,700 BCE. It would take around 4,550 years for the word massage, to make its way into modern medical discourse in the US. However, today, the practice is as widespread as it has ever been. Defined as the manipulation of soft tissue of the body, massage has been linked to reduced inflammation, a reduction in cortisol levels and improved circulation among its users. Yet, over the last 20 years one specialisation within the massage therapy discipline has seen its prevalence in post-treatment cancer programmes increase significantly.
Oncology massage therapy (OMT) uses conventional massage techniques and applies a tailored approach to individuals suffering from cancer. Unlike regular massage therapy, OMT places a heavy stress on the client’s needs and is a complimentary therapy that works in tandem with conventional medicine; helping to alleviate potential side effects that may develop from cancer treatment, it provides clients with a greater sense of mental wellbeing which improves their quality of life. The practice ensures that therapists are able to modify massage techniques on an ad hoc basis, and are engaging with the client at all times in order to meet their physical needs.
Recent studies have yielded positive results; one US study of 39 patients suffering from cancer of the blood found an overall decrease in the production of serum cortisol – a stress hormone. The study randomised patients that were to receive either aromatherapy, massage or told to rest. They found that massage significantly decreased stress hormone levels in patients suffering from cancer of the blood, highlighting the importance of massage in recovery after cancer treatment (10).
Widely cited as most effective in relieving symptoms of cancer, OMT in recent years has been used primarily to tackle what is commonly known as the Big Five: pain, fatigue, nausea, depression and anxiety. In one of the largest studies to date, the Memorial Sloan-Kettering Cancer Centre in New York interviewed 1,300 patients receiving either a 20- or 60-minute massage therapy session following treatment. While conducting the study, staff at the centre noted an improvement in all of the ‘Big Five’ among the patients. Results showed a 47% improvement in pain levels, 42% improvement in fatigue, 59% improvement of anxiety levels, and 48% in depression levels (11*). Findings of the study found that prolonged massage time provided longer lasting relief for patients while showing significant improvement among all five of the ‘Big Five’ – highlighting the importance of conventional medicine working alongside complimentary therapies.
OMT’s holistic approach towards clients equips therapists with the skills to adapt massage techniques in real time, including speed, duration and depth of massage. By taking a holistic approach to massage, OMT training ensures that therapists are able to adapt moment by moment to what they observe while working with clients. In doing so, students learn to pull information together and organise it, resulting in better decision-making and communication skills to offer a more effective session.
In terms of working with athletes, this approach emphasises recovery from treatment, as well as recovery from training. Studies have shown that clients undergoing treatment have reduced levels of side effects from cancer treatment, such as chemotherapy and radiotherapy. Therapists are also able to create a comfortable environment, for both themselves and the client, that promotes communication and a clear dialogue that enriches the therapists’ ability to tailor the massage. ‘Less is more’ and ‘inch forward’ are values that are instilled from the onset of training and underpin OMT. This tailored approach is what allows oncology massage therapists to work effectively in conjunction with conventional medicine and produce some of the aforementioned results in this article.
Contrary to societal perception, athletes, although physically fit, actually suffer from a suppressed immune system, which in some instances mirrors that of degenerative diseases such as HIV and cancer. As touched upon earlier, this suppression of the immune system during heavy training and competition, places them at a great risk of contracting recurrent infections and could lead to the development of more serious conditions.
As we can see from the evidence provided above, athletes in a number of disciplines run an enormous risk of contracting illness, owing to their heavy training schedules suppressing the immune system and making them more vulnerable to infection. We can even go as far as to say that prolonged endurance exercise (such as that undertaken by elite athletes) can increase inflammation in the body, and that inflammation can contribute to the development of cancer; hence there is the potential for endurance athletes to be at a higher risk of cancer than the general population.
As outlined in this article, the importance of massage is evident, not only to aid recovery from the extreme stress an athlete’s training schedule imposes, but also to prevent inflammation that can lead to cancer, and improve physical and mental well- being.
Susan Findlay BSc RGN, Dip SMRT, MSMA, MCNHC, MLCSP, Director NLSSM, is director of the North London School of Sports Massage, where she is a sport and remedial massage therapist and lecturer. Susan’s experiences as a ballet dancer, gymnast, personal trainer, and nurse have allowed her to develop both an applied and a clinical understanding of human movement, physical activity, anatomy, and physiology. Susan is the co-founder of the Institute of Sport and Remedial Massage. She also serves as chair of communications on the General Council of Massage Therapies and as an educational advisor to the Sport Massage Association. In her free time, Findlay enjoys motorbiking, cycling, and yoga.
References 1. Data and statistics. Cancer Research UK [Website] Open access https://spxj.nl/3a4ilEp 2. Sifferlin A. Why stress makes it harder to kick the common cold. Time 2012 Open access https://spxj.nl/2vhwXBK 3. Kress R. Stress, inflammation, immunity. RN.com (AMN Healthcare Education Services) 2018 [Website] Open access https://spxj.nl/2PrJlpI KEY POINTS 4. Elkington LJ, Gleeson M, Pyne DB et al. Inflammation and immune function: can antioxidants help the endurance athlete. In: Lamprecht M (ed.) Antioxidants in Sport Nutrition. CRC Press 2014. ISBN 978-1466567573. (Print £85 Kindle £41.99) Buy from Amazon https://amzn.to/2TN8CNv 5. McTiernan A. Mechanisms linking physical activity with cancer. Nature Reviews. Cancer 2008;8(3):205–211 6. Brown JC, Winters-Stone K, Lee A et al. Cancer, physical activity, and exercise. Comprehensive Physiology 2012;2(4):2775–2809 Open access https://spxj.nl/3a7oRuh 7. Lane KN, Wenger HA. Effect of selected recovery conditions on performance of repeated bouts of intermittent cycling separated by 24 hours. Journal of Strength and Conditioning Research 2004;18:855–860 8. Berrueta L, Muskaj I, Olenich S et al. Stretching impacts inflammation resolution in connective tissue. Journal of Cellular Physiology 2016;231(7):1621–1627 Open access https://spxj.nl/3a8I1jc 9. Crane J. Massage is promising for muscle recovery: McMaster researchers find 10 minutes reduces inflammation. McMaster University 2012 [Website] Open access https://spxj.nl/2TbG2E8. Full paper: Crane JD, Ogborn DI, Cupido C et al. Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Science Translational Medicine 2012;4(119):119ra13 10. Stringer J, Swindell R, Dennis M et al. Massage in Patients undergoing intensive chemotherapy reduces serum cortisol and prolactin. Psycho-Oncology 2008;10:1024–1031 11. Cassileth BR, Vickers AJ. Massage therapy for symptom control: outcome study at a major cancer centre. Journal of Pain and Symptom Management 2004;28(3):244–249 Open access https://spxj.nl/382QCT8.