Cancer, Exercise and Massage

The Young african woman running on runing track on white background. Studio shot

Historically, massage has mistakenly been viewed as a contradiction 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 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 masseuses would even potentially expose themselves to contracting illnesses whilst 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 the statistics say 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 the case of breast cancer, there are a myriad of factors that can affect an individual’s chance of developing cancer and surviving it[1]. In this article, we will look at the implications of exercise in the development of cancer – and tumours – and how oncological massage has been greatly attributed to 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 professional sport places on the body, have been linked to a greater probability of athletes developing recurrent infections during intense periods of training and competition.

In order to examine why athletes are at a greater risk of contracting cancer and how massage can benefit individuals throughout recovery, we must first, briefly define the two notable factors that influence damaged cell growth: inflammation and stress. One definition of inflammation is explained 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, but there are also other forms of inflammation that arise from lifestyle choices such as diet, smoking and drugs.

Stress, is often recognised as a precursor leading to cancer, is defined by physiological disturbance or damage caused to an organism by adverse circumstances such as previously mentioned lifestyle choices. Stress is often cited as a significant contributing factor to developing 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 that ‘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]’ In the case of cancer, this means that changes caused by stress can profoundly impact antibody responses to viral vaccines, such as those used in cancer treatment; making it harder for the body to respond to the division of tissue caused by cancer[3].

The word 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 all contracted cancer during their careers. There are a number of plausible theories about why athletes 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 athletes 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 cause 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 developing tumours[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 most effective recovery method, in combination with active rest, as it allowed an athlete’s bodies 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[8].

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’[9]. In her work she explains that cancer is not just a collection of tumour cells growing out of control; 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 allows 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.[10]

In a study conducted by MacMaster University, Toronto, researchers found that massage, after pro-longed periods of physical activity, stimulated production of mitochondria – the cells responsible for delivering oxygen around the body, allowing faster delivery of oxygen to the cells. 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[11].

Massage Within Medical Discourse and the Development of Oncology Massage Therapy (OMT)

Massage is a medicinal practice that has been observed for nearly 5000 years and was first noted in Ancient China, at around 2700 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 a widespread as it ever has 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 it’s prevalence in post-treatment cancer programs increase significantly.

Oncology massage therapy, or OMT, utilities 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 well-being while improves the their quality of life. The practice ensures that therapists are able to modify massage techniques on an ad-hoc basis, and are engaging 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 post cancer treatment[12].

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 1300 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’ amongst patients. Results showed 47% improvement in pain levels, 42% improvement in fatigue, 59% improvement of anxiety levels, and, 48% in depression levels[13]. Findings of the study found that prolonged massage time provided longer lasting relief for patients while showing significant improvement among all 5 symptoms of the ‘Big Five’ – highlighting the importance of conventional medicine working alongside complimentary therapies.

OMT’s holistic approach toward clients equips therapists with the skills to adapt techniques to the massage 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 whilst 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 less 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 Oncology Massage therapy. This tailored approach is what allows OMTs to effectively work in conjunction with conventional medicine and produce some of the aforementioned results in this article.

Contrary to societal perception, athletes, whilst physically being 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 that could lead to developing more serious illnesses.

As we can see from the evidence provided above, athletes in a number of disciplines, run an enormous risk of contracting illness, due to their heavy training schedules suppressing the immune system, making them more vulnerable to infection. We can even go as far 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. This understanding therefore shatters society’s misconstrued concept that athletes are the peak of physical health.

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 quality of life for those that already have the disease.

  1. accessed 20/12/2019
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  4. Elkington, Lisa J., et al. “Inflammation and Immune Function.” Antioxidants in Sport Nutrition. CRC Press/Taylor & Francis, 2015.
  5. McTiernan, A. (2008) Mechanisms linking physical activity with cancer. Nature Cancer Reviews. 8 (3) p.205-11
  6. Brown, .J. et al (2012) Cancer, Physical Activity, and Excercise. Compr Physiol 2 (4) p.2775-809
  7. Lane, Kirstin & Wenger, H.A.. (2004). Effect of Selected Recovery Conditions on Performance of Repeated Bouts of Intermittent Cycling Separated by 24 Hours. Journal of strength and conditioning research / National Strength & Conditioning Association. 18. 855-60. 10.1519/14183.1.
  8. McTiernan, A. (2008) Mechanisms linking physical activity with cancer. Nature Cancer Reviews. 8 (3) p.205-11
  9. Berrueta, Lisbeth et al. “Stretching Impacts Inflammation Resolution in Connective Tissue.” Journal of cellular physiology vol. 231,7 (2016): 1621-7. doi:10.1002/jcp.25263
  10. Berrueta, Lisbeth et al. “Stretching Impacts Inflammation Resolution in Connective Tissue.” Journal of cellular physiology vol. 231,7 (2016): 1621-7. doi:10.1002/jcp.25263
  11. accessed 21/12/2019
  12. Stringer J et al. Massage in Patients undergoing intensive chemotherapy reduces serum cortisol and prolactin. Pyscho-Oncology [2008] (10): p.1024-31
  13. Cassileth, B.R, Vickers, A.J. Massage Therapy for Symptom Control: Outcome Study at a Major Cancer Centre. Memorial Sloan-Kettering Cancer Center, NY. [2004] (3): p.244-9

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Sports Massage

by Susan Findlay