Athletes, the immune system and the
benefits of massage
HUMPHREY BACCHUS                     CMT

Illness and the Athlet...
The Immune System

Our immune system can be split into parts. Firstly our innate immunity and secondly our adaptive.
Our i...
fight infection to specific sites throughout the body but also acts a way for the debris from injury and
infection to be cle...
Similar results showed when investigating the effect of massage on women with breast cancer. In
this study 80% of the group...
Athletes, The Immune System & Massage
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Athletes, The Immune System & Massage


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Sport Ex Dynamics 2009

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Athletes, The Immune System & Massage

  1. 1. Athletes, the immune system and the benefits of massage HUMPHREY BACCHUS CMT Illness and the Athlete Immunity against coughs, colds and flu are probably some of the biggest challenges for any athlete whether professional or amateur. A spell of illness means a reduced training load, decreased fitness levels, decreased VO2 capacity and a period of reacclimatisation to the training program during recovery. There is much written in sports science literature about the clear benefits of nutrition, recovery, adaptation periods and specific vitamins such as B Vitamins, Zinc and Phytonutrients 1. There are also possible benefits of L-Glutamine, for example, to help support the immune system, positive research into immunoceuticals such as protogylcans and simple advice of avoiding public places following heavy training due to the window of decreased immunity. Upper respiratory infections (URI) for example can commonly be seen among athletes after extreme physical exertion and unfortunately for some, they become regular. It is has been noted that up to 2/3rd of people having completed an ultra marathon develop a URI shortly after. Recent research has confirmed that intense training can result in chronically depressed immune function for as much as up to 24 hours 2. Although it would be hard to find conclusive evidence of cause and effect in terms of the breakdown of immune function in athletes, there are a myriad of cellular states that can be maintained and improved to keep optimum health and performance in athletes. I have regularly noticed a lack of knowledge about the benefit of massage in keeping the immune system working at its peak condition, so this article seeks to address the way in which massage benefits both the innate and adaptive immune systems as well as stabilising stress hormones that can cause a breakdown of immunity. Although athletes can think of stress as being associated with training volume and load, there are a myriad of other factors such as emotional stress, job stress as well diet and habits that influence the maintained health of an individual. Massage is starting to be well documented as an effective intervention in supporting weakened immune systems as well as providing psychological and rehabilitative support. I feel that the immune boosting properties of massage can offer key gains to those training year in, year out - and as research continues into the efficacy of soft tissue therapies we will discover more ways in which it has a direct influence on the health of the human body. 1 2 Immune System adaptation in elite athletes. University of Loughborough. 2006 Nov;9(6):659-65
  2. 2. The Immune System Our immune system can be split into parts. Firstly our innate immunity and secondly our adaptive. Our innate system is our primary defense, which if breached is then is backed up by the adaptive system. With so many bacteria, viruses and infectious agents floating in our environments we need both systems to be working optimally to ensure we don’t become ill. The innate system is composed of biochemical defenses and physical defenses. These include mucus, stomach acid, sebaceous gland secretions & gut organisms amongst other things. Several cells are derived from bone marrow stem cells. These are phagocytes. Their role is to surround infectious particles which penetrate through the skin/external barriers and destroy them. Another key proponent of our innate immunity are the NK Cells (Natural Killer). The NK cells help to reject any cells that have viral infections. These NK cells strength lie in the fact that they can recognise changes in cells that are virally infected, which then enables them to attach themselves to the infected cells and kill them. Just as with an injury during sport, inflammation is a response to infection. Whilst we bring oxygen and glucose to the muscles during exercise with increased blood flow, so we also must bring immune activity to sites of inflammation. Leucocytes and Macrophages are attracted to the sites of inflammation in order to combat infection. The phagocytes, after recognising the infectious agents, can then surround it and destroy it. The adaptive immune system is based around the activity of antibodies and lymphocytes. The antibodies role become more prominent when the phagocytes can not recognise the infectious cells. The antibodies role is to provide a link between the infectious cell and the phagocytes that can not attach themselves. These antibodies are flexible adaptors which can bind to a specific location on an infectious cell called an antigen. The antibodies are produced by the B Lymphocytes of the adaptive immune system so that the phagocytes can attach themselves to the infectious agents and neutralize them. The Lymph System The lymphatic system has an important role in immune system function as well as functioning to absorb excess fluids return to the blood stream and aid in the absorption of fat. It has capillaries throughout the body much like vessels of the circulation system and between 600 to 800 lymph nodes, whilst the contractions of skeletal muscle help to move the lymph fluid the body in conjunction with the volume of lymph fluid in the system. There are 4 main lymph organs. These are the lymph nodes are areas which have concentrated amounts of lymphocytes and macrophages. The spleen which filters the lymph fluid and blood that passes through it. Bone marrow which produces lymphocytes, monocytes and leukocytes; and finally the thymus gland. The lymph system has a key role in distributing B-Cells which produce antibodies as well as helper T-cells, which are developed in in the thymus. These are paramount in aiding the combat of infection if the inflammation response from the damaged cells has not done enough to neutralize the microbes. The immune system is called into play at this point to supplement the inflammatory response. The immune system not only brings essential cells to
  3. 3. fight infection to specific sites throughout the body but also acts a way for the debris from injury and infection to be cleared away and then filtered by the spleen. Hormonal modulation of immunity It is important to remember that the inflammation response is induced by the immune system to combat the pathogens. A cold, sore throat or fever is the bodies way of trying to expel infection from the body. This inflammatory response is not solely caused by invading pathogens. Hormones also have a role. Hormones, being chemical messengers of the body, have a unique position in directing specific processes in the body. Insulin, produced by the pancreas, sending messages to our cells to take in more glucose is one of the most well known. Cortisol and Dehydroepiandrosterone (DHEA) are another two important hormones. Cortisol, released by the adrenal glands under stress, elevates blood sugar, blood pressure and heart rate. Cortisol is known to suppress the inflammatory response that is triggered by invasion of pathogens while DHEA boosts the immune system. In early studies it was shown that cortisol levels were raised in people with stress, physically, mentally or emotionally. Further studies showed seem to show however that people under chronic stress have lower levels of cortisol. As cortisol was released under acute stress and depleted under chronic stress, it has been thought that cortisol is actually a regulator in our immune system. Although acute stress may allow external pathogens to enter our bodies, cortisol then can suppress the inflammation process that is triggered when ill, until such time as cortisol returns to more normal levels. Under chronic stress when we have depleted amounts of cortisol being produced, our immune system is open to a full inflammatory process that pathogens or exhaustion can cause. The role of DHEA is a little less clear though more is understood more as research continues. It seems that the effect of DHEA’s production in the adrenal glands, is to indirectly stimulate the lymphocytes, immune hormones and lymph organs. In this way it helps to enhance immune response. Massage effects on immunity, related hormones & lymph activity Collective studies are now showing many positive effects that massage therapy has on decreasing anxiety and cortisol levels whilst increasing immune function in both healthy and immune deficient parts of the population. Research at the Kessler Medical Rehabilitation centre,USA, showed that healthy individuals under stress from exams had increased natural killer cell cytotoxicity following massage3. The research also showed that there was an immediate reaction on the body following massage, not after a series of treatments. The benefits appear not only in healthy individuals but in those suffering from HIV and cancer. Research into HIV positive men at the University of Miami School of Medicine, showed that massage increased natural killer cells and also decreased cortisol4 . 3Zeitlin, D., Immunological Effects of Massage Therapy During Academic Stress. Psychosomatic Medicine. 62:83-87; Jan/Feb 2000. 4Ironson, G., Field, T., et. al. Massage Therapy is Associated with Enhancement of the Immune System’s Cytotoxic Capacity. Intern. J. Neuroscience. 84:205-217; 1996.
  4. 4. Similar results showed when investigating the effect of massage on women with breast cancer. In this study 80% of the group receiving massage therapy three times a week for 5 weeks showed better immune function, whilst only 30% of those not receiving treatment could shoe similar results5. Similar positive results have been recorded when monitoring the improvement of the lymphatic system following massage. The increase in lymphatic flow is one of the more commonly known benefits of massage. Though it is difficult to link it directly to to increased immune function, there are indirect benefits that cannot be disputed. Elkins et Al. found that massage increased lymph flow by seven to ten times6 while Mortimer et Al. found a strong influence of massage on lymph flow when measuring lymph flow by isotope clearance7. As yet there have been no studies into the effects of massage on DHEA regulation, but since it appears that its only effect on the immune system is through the stimulation of immune cells and hormones, much evidence of massage efficacy already supports its role in this process. Effects of massage on athlete immunity So, what does this mean for athletes? Training, as most people now know, can upset the regulation of cortisol, either through acute or chronic training loads. This training can also lead to decreased white cell blood count and natural killer cells. Immunity is decreased, and our energy resources can be diverted towards keeping the body healthy state. Depleted energy resources, dysfunctional cortisol levels and decreased immunity are three states that any athlete would be wise to avoid during any period of training. Whilst the jury is out on so many of the numerous supplements that are on offer, massage comes up as one of the best things that athletes can be doing to support themselves not only on physical level by ironing out aches, pains or strains, but also primarily as a boost to the innate and adaptive immune systems. Regular massage can bringing about a more flexible body, not in a musculoskeletal sense, but in terms of adaptability to fight off pathogens, lower blood pressure, increase a sense of well-being and decrease any symptoms of fatigue which unregulated can lead to illness. 5 Field, T., Hernandez-Reif, M., Ironson, G. Massage Therapy Effects on Breast Cancer. (unpublished); 1998. 6Elkins, E.C., Herrick, J.F., Grindlay, J.H., et. al. Effects of Various Procedures on the Flow of Lymph. Arch. Phys. Med. 34: 31; 1953. 7Mortimer, P.S., Simmonds, R., Rezvani, M., et. al. The Measurement of Skin Lymph Flow by Isotope Clearance — Reliability, Reproducibility, Injection Dynamics, and the Effect of Massage. J. Invst. Derm. 95: 766-682; 1990.