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.
2 Immune System adaptation in elite athletes. University of Loughborough. 2006 Nov;9(6):659-65
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
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
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
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., et.al. 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.
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.