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Why Am I So Tired After My Deep-Tissue Massage? [The theory behind metabolic reactions, DOMS, and PMSM]

Posted Aug 22 2013 12:22am


This doesn’t look very, um, relaxing. Also, he’s wearing “jorts” and a mesh tank – officially the worst masseuse outfit ever.

I fell asleep on the toilet. Yes, today. I’m pretty sure I haven’t done that since I was potty training. Other places I fell asleep today: in the waiting room at the doctor’s office, in my car before preschool pickup, right before dinner, during dinner and right after dinner. Oh and sitting in front of my laptop, working. That last one was like ten minutes ago. So what’s up with my sudden narcolepsy?

I’m pretty sure it was the massage I got earlier today. Yeah that thing people do to relax and rejuvenate themselves? Knocked me out colder than Kanye at a press conference.


I would not find this massage at all relaxing. Not at all.

It started with a good friend (who’s excellent, by the way, and I totally recommend her to any locals!) starting a massage business at home and offering an awesome introduction rate. Despite the fact that I’ve only ever had one real massage before and it was a super awkward experience, I decided that this would be the best way to celebrate my new-found preschool-provided freedom (and also to work out the kinks in my shoulders and back from the eleventy million push-ups T25 has us doing).

At first it was all sunshine and roses as I relaxed on the massage table. But then she asked me how much pressure I like. You may recall that I’ve learned from my previous massage experience and from karate and Krav Maga that apparently I have no pressure points. It’s not that I have a crazy high pain tolerance – I scream like a dying cow every time I give birth. It’s also not that I’m good at enduring or gritting my way through the pain. It’s that I truly, honestly don’t feel anything. I mean, I can feel the person touching me but no matter how hard they lean on their elbow wedged under my shoulder blade I don’t experience any pain. I can’t brag about this because it’s not a talent I honed (while daily dosing myself with iocaine powder) and it also doesn’t seem to have any good practical application (look ma! A lady with compromised nerve endings!) but rather it just seems that I’m made funny. This is the reason I hate foam rolling. I had a trainer sit on me while I was doing it and I still couldn’t feel it.

This weird lack of sensation doesn’t normally come up in my daily life but for a massage it’s kind of the whole point. So I told her to go nuts. Over the course of an hour she told me that she’d never pushed this hard on anyone ever. And it felt awesome! I was all tingly and a little loopy and could talk and stay relaxed through the whole thing so neither one of us thought much of it. Until about an hour after I left and I was suddenly hit – nay, attacked – with THE TIREDS. I can not stay awake. I ache and feel like I might be getting the flu. All I want to do is lay down. (Truth: I’m typing this laying on my stomach on my bed with my arms propped up by a pillow.

As I lay here it occurred to me that I have felt like this before – except it is usually after a particularly hard and/0r novel workout. The Gym Buddies and I used to call it a “metabolic reaction”. We’d feel fine during the workout but then we’d get home and start to feel tingly, spacey, achy and would end up passing out asleep in some random spot. (You can read all about my first experience with one if you like.) But over the years even though I now know what triggers them and what they feel like, I still had no idea why exactly they happened. Especially today when the T25 workout was simply the “stretching” one (super easy and super boring, by the way). So it had to be the massage, right?

And after this massage reaction I became even more interested in figuring it out. (Why sleep when you can Google?) This remarkably in-depth post  - hyperbolicly titled “Poisoned by Massage” -  by Paul Ingraham for SaveYourself provided some interesting answers. Apparently it all comes back to a condition called  Rhabdomyolysis . If you’ve ever heard of Rhabdo then you’re probably freaking out right now because it’s known as basically The Worst Possible Complication of Exercise, Like Ever. It turns your pee the color of Coca Cola. It kills people. In that order.

Basically what happens is that when your muscles are subjected to some sort of trauma – whether it be from working out too hard, getting a piano dropped on your legs (because you live in a cartoon, you wascally wabbit!) or from getting a particularly deep massage – your muscle cells get squished and leak their guts out into your intercellular fluid. The cell guts are most notably myoglobin molecules that in large numbers can cause you to have extreme fatigue, headaches, flu-like symptoms and generally feeling spacey. In extremely high numbers all the extra myoglobin can become so toxic that your kidneys shut down (hence the soda pee) and without immediate hospitalization you’ll die.

But Rhabdo to that extreme is very rare -which I knew. (And note there has never been a documented occurrence of a death from Rhabdo brought on by massage.) What I didn’t know is that you can have Rhabdo by degrees. A very light case of Rhabdo – what Ingraham calls “recreational rhabdo” – is what weight lifters affectionately refer to as the DOMS (delayed onset muscle soreness), what the Gym Buddies and I termed “toilet sore” (i.e. being so sore in your legs that you have to drop the last 6 inches to the toilet seat) and what massage therapists refer to as PMSM (post massage soreness and malaise). All different terms for the same metabolic reaction! Painful yes, but not deadly. And also very, very common.

Ingraham writes, “Stronger massage tends to cause more PMSM — though the effect is highly variable. The worst cases of post-massage malaise feel like a touch of the flu. It has to be caused by something unpleasant.It is often characterized by therapists as a necessary evil, a “healing crisis” that we must endure to get to the benefits on the far side. No pain, no gain is the (usually) unspoken message. ” He goes on to explain that contrary to popular belief, the massage isn’t releasing trapped toxins in the muscles but rather creating the toxins by slightly traumatizing the muscle tissue to the point where the cell guts get squished out like popped zits. The more cell popping the more PMSM.

All of which sounds really bad and scary but as Ingraham points out, “This is all very interesting, but it may not be very important.” He adds, “ I think the evidence and reasoning is good, and I have high confidence that massage actually does “poison” us a little. But so what? So does exercise! And we aren’t quitting that. It is nearly impossible to progress in fitness without “poisoning” yourself with a little DOMS, almost regularly. It is not entirely unreasonable to call it a “healing crisis” — an unpleasant price to pay for clear benefits.”

He then goes on to say that unlike exercise, the benefits of a good massage are less concrete. It feels good. It can be relaxing. It can help work out knots and tension. But that “Being toughened up by massage might be as dubious as toughening up your feet so you can walk barefoot — that’s all fine and good, but do you need tough feet? Probably not.” He advises people to keep their massages firm enough to be relaxing but not so deep that they cause an uncomfortable level of Rhabdo. A suggestion I’ll definitely keep in mind for my next massage. Right after I sleep for the next 12 hours.

Anyone else ever fallen asleep on the toilet? Do you have a funny massage story? Have any of you ever experienced this effect post-massage? Post-hard-workout? Also, does “recreational Rhabdo” not sound like the newest designer drug?!?

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