An increase in blood circulation to muscle tissue is one of the most promoted positive effects of massage. One reason for this is that improved blood circulation is supposed to deliver more oxygen and other nutrients to the muscle tissue. For example, a 2017 research study demonstrated a positive relationship between an increase in blood flow and performance recovery between bouts of high-intensity exercise. Some trials have been carried out to investigate the effect of massage on blood flow, but the results are inconclusive and conflicting.
Some studies measure the effect of massage (usually in the lower extremities) on arterial blood circulation using Doppler Ultrasound instruments. The Doppler Ultrasound measures changes in large arteries and veins. However, this method is not sensitive to blood circulation in the smaller vasculature, such as the capillary beds, thus this method measures blood velocity only in macro-regions rather than in specific micro-regions of muscle tissue.
Doppler Ultrasound Studies
- A study from the University of Illinois recruited 36 sedentary young adults that were each randomly assigned to 1 of 3 groups: (1) exertion-induced muscle injury followed by massage therapy; (2) exertion-induced muscle injury only, and (3) massage therapy only. Results showed that only groups #1 and #3 in which massage was done increased brachial artery flow-mediated dilation compared to baseline.
- Two studies by the research group in the University of Waterloo, Canada used Doppler Ultrasound to monitor average blood flow. In one study, a certified massage therapist performed massage on ten healthy individuals on the forearm or quadriceps, and the results showed no change in brachial or femoral artery blood flow.
- In another study, daily (for four days) massaging of the quadriceps femoris musculature of one lower extremity on subjects who had previously completed an intense bout of eccentric quadriceps work with both legs. Massage of the quadriceps muscles did not significantly elevate arterial or venous average blood velocity above resting levels, while gentle quadriceps muscle contractions post-exercise did.
- A study by Hinds et al. from the UK recruited 13 male volunteers in three 2-minute bouts of concentric quadriceps femoris exercise followed by two 6-minute bouts of deep massage or a control (rest) period. Massage did not change femoral artery blood flow, but skin blood flow did increase.
- A study from Queen’s University, Canada, looked at 12 subjects that performed two minutes of strenuous isometric handgrip exercise followed by either massage, active recovery, or passive recovery. They found greater forearm blood flow in the active and passive recovery groups than in the massage therapy group.
- A study from Germany assessed the effect of foam rolling on the lateral thigh. Results from 21 healthy participants showed that arterial blood flow of the lateral thigh increased significantly following foam rolling exercises compared to baseline.
- A study from Japan examined friction massage on the popliteal fossa for 15 healthy male university students. Popliteal venous blood flow increased after friction massage.
A study from Portugal tested application of massage in two directions: from ankle to knee and a reverse direction from knee to ankle in 16 healthy subjects. A 5-minute massage was applied to one knee while the other knee served as the control. Local microcirculation blood flow was measured using laser Doppler flowmetry. The results showed that both directions of massage increased surface blood circulation. It is interesting to note that the study showed that both treated and resting (control) limbs showed increased blood circulation.
- Even mechanical massage using compressed air or air cuffs on legs was found to increase peripheral blood circulation in the legs.
- Albert Moraska from the University of Colorado in a review commented that collectively, in the smaller draining vasculature, massage appears to effectively increase movement of chemicals, but may have a lesser effect on large blood vessels.
Comment by Joseph Muscolino
Blood circulation is primarily regulated by nervous system control of the heart and/or direct health of the heart tissue itself. However, to the extent that blood flow circulation is a mechanical process in the peripheral tissues, a mechanical treatment method such as soft tissue manipulation, in other words, massage, should be able to affect it.
This is especially true of venous flow and lymphatic flow because they are not “directly related” to heart function. Venous and lymphatic circulations are based on the “muscular pump” in which muscle contractions physically compress venous/lymphatic vessels, causing a mechanical flow back toward the heart.
However, the primary focus of this blog post article and the studies mentioned herein is to measure the effect of massage on arterial blood circulation. Again, given that there is a component of arterial circulation that is mechanical, after all, blood flow is technically a mechanical process, then it would make sense that massage would be able to affect arterial flow.
The mechanism for the ability of massage to increase arterial blood flow could be that it increases venous and lymphatic flow back to the heart, which then increases fluid in the system, thereby increasing blood pressure and therefore arterial blood flow. It is also possible that massage milks the fluid through the arteries, which then increases the draw from the capillary/venous end of the circulation. And perhaps the increased arterial circulation is due to a neurological stimulus of some kind in response to the work on the peripheral myofascial tissues. Or perhaps, it is due to a combination of all three of these factors, and perhaps others.
Regardless of the underlying mechanism, there seems to be a growing number of studies that do show a correlation between massage therapy and arterial circulation. Although these studies at present seem to be inconsistent in their findings, the fact that many of them do show a causal relationship is encouraging. There does seem to be sufficient evidence, and mechanically it does makes sense, to be able to claim that massage can have a beneficial effect on arterial blood flow, and therefore circulatory health. We certainly look forward to further studies on this subject.
This blog post article was created in collaboration with www.terrarosa.com.au.
(Click here for the blog post article: The Effect of Massage Therapy on Blood Pressure in Prehypertensive Women.)
Did you know that Digital COMT (Digital Clinical Orthopedic Manual Therapy), Dr. Joe Muscolino’s video streaming subscription service for manual and movement therapists, has an entire folder of video lessons on Complementary Alternative Medicine (CAM)? Digital COMT adds seven new video lessons each and every week. And nothing ever goes away! Click here for more information.
How can one tell if they have poor circulation?
If you’ve had high blood sugars over a long period of time, you lose the signals that are sent from nerve to nerve, thus your feeling in affected areas. Smaller blood vessels become weakened and depraved of needed oxygen and other nutrients. That’s why people with diabetes have a high rate of amputation. They will experience slower wound healing than people without diabetes, with increased risk of the infection turning to gangrene.
Neuropathy and poor circulation in extremities lead people with diabetes to ignore cuts and wounds until they become infected and are harder to treat. Blood vessels become thickened and the lumen narrows.
Not enough blood flow due to injury of vessels, no blood flow, and decreased sensation combine to increase risks for people in the diabetic population.
If you have diabetic neuropathy, you may feel…
- A pin and needles feeling or prickly feeling in your legs and feet
- Very cold or very hot temperature in feet
- Soreness or sensitivity
- No feeling of pain even with the presence of sores and cuts
- Injured feet feels has decreased pain level and discomfort (loss of protective sensation)
Why is it important to increase foot circulation?
What happens if circulation is bad?
Once you already have circulation issues and peripheral neuropathy in your feet, what can be done? You know you are at increased risk for problems with your feet, but there are steps you can take to help with it.
Regular foot examinations by a health care provider are a must for appropriate diabetes foot care. The examination can be done by a podiatrist, or “foot doctor,” or your primary care physician.
There is a difference between a regular foot examination and a comprehensive one. In the comprehensive examination, the provider will use a 10 mm fishing line type filament to test sensation on different areas of your feet. They will ask you to close your eyes, and tell them where they touched you with the monofilament. You will indicate by referring to your toes or other parts as you deem right.
If there are any calloused areas, wounds or non-healing ulcers, or if you’ve ever had a non-healing ulcer, the provider will make a note of it. You may be asked questions about your overall foot care practices, and the examiner may provide some foot care practice demonstration or instruction to you.
You should follow all foot care recommendations. It’s good for a person diagnosed with diabetes, poor circulation and peripheral neuropathy to see a podiatrist once per year. If you have thickened toenails, it may require you to visit more often and have your nails clipped or special treatments.
At any rate, taking care of your feet when you have diabetes should be of paramount importance to you.
How can one improve circulation in feet?
Let’s discuss some natural and medical ways that you can improve the circulation in your feet and prevent foot ulcers that won’t heal and lead to amputation.
Keep blood pressure and cholesterol under control, as well as blood sugars and A1C. Keep all your doctor check ups and wear diabetic socks, checking your feet daily and reporting any injuries or anything you are concerned about.
Certain medications can be given to improve circulation, such as blood thinners such as warfarin (coumadin), but they don’t stop the processes that lead to disease which is plaque build-up in arteries and narrowing vessels.
Angioplasty is one medical treatment that can treat arteries when they become narrowed or blocked from blood flowing freely. A catheter is placed in the artery and a balloon is used to unblock the problem area in the artery.
In worse cases, a stent may be placed in the blocked artery and left to keep blood flowing.
Coronary bypass surgery can improve leg circulation if the blockage is not too severe. The use of bypass grafts which can be made from a vein harvested from the patient’s own body can be used to try to improve blood flow to the extremities.
Exercises that help with circulation
Exercise is a great way to get the blood pumping and thus improving circulation to your feet. You will want to do a cardiovascular exercise that gets your heart rate up such as biking, walking, running, swimming or taking an exercise aerobics class.
Walking is a great exercise that most people can do with no problems. It’s great for poor circulation because you are moving your feet, toes, legs and ankles which improves circulation to the area.
8 Tips to taking care of feet
- Support socks can also help improve circulation in the legs only if worn correctly, otherwise they can be harmful. Your doctor should provide you with information how to properly use them
- Quit smoking – this is the number one thing that you can do to improve your circulation if you have diabetes (arteries harden when you smoke)
- Get your blood pressure under control – if it’s not under control, see your doctor and take steps to get it in range to improve circulation (high blood pressure stunts circulation, narrows and hardens arteries)
- Keep your cholesterol within the range recommended by your doctor – find out what your numbers are. Make sure you have the right amounts of good cholesterol, bad cholesterol, triglycerides and total cholesterol – work with a Registered Dietitian to get cholesterol in range if they are not there (many people with diabetes have a dyslipidemia)
- Keep blood sugar levels in your target range – if you’re not sure what they are ask, your doctor or Certified Diabetes Educator about measures to improve your numbers
- Exercise regularly – exercise can decrease blood pressure, raise good cholesterol and improve overall circulation – try performing 30 minutes of aerobic or cardiovascular activity such as walking or biking five days per week
- Always keep up with your doctor check ups and see a podiatrist once per year or more often if needed when you have diabetes
- Use socks that help with circulation – support socks are recommended by the American Diabetes Association. You can learn all about Diabetic Socks here.
- Inspect your feet daily
- Don’t walk anywhere barefoot to avoid infections, scabs, etc 1
Over to you
Let us know what you think about our article related to your feet and circulation with diabetes. Did you learn anything new? Let us know what you thought and how you work to improve your circulation in the comments box below.
TheDiabetesCouncil Article | Reviewed by Dr. Jack Isler MD on August 23, 2018
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Elisabeth Almekinder, a certified CDE and expert in Diabetes Self-Management Education Program, grew up in a small town in the piedmont of NC. During her time at St. Andrews Presbyterian College, she developed a love of writing and obtained a BA in English. After obtaining her nursing degree, her first job out of school was on the vascular surgery floor, where she saw many people with diabetes lose their limbs. She worked as an RN for 22 years in public health in South Carolina. In her spare time away from educating people about diabetes, she continues her passion by writing about diabetes.