Does Massage Really Increase Blood Flow? What the Evidence Actually Says

One of the most common explanations given for massage is that it “increases blood flow” or “flushes toxins from the muscles.” You’ll often hear people say things like “it brings fresh blood into the area” or point to red skin as proof that healing is happening.

But how accurate are these explanations?

Modern research suggests the answer is more nuanced, and far more interesting than the traditional mechanical explanations many of us were taught.

The Traditional Explanation: “Pushing Blood Through Tissue”

Historically, massage was explained as a mechanical process:

• Pressure squeezes tissues

• Blood is forced out

• When pressure is released, fresh blood rushes back in

• This supposedly delivers oxygen, removes waste, and speeds healing

This idea is intuitive. After all, rubbing your hands together makes them warm and red – surely that must mean more blood flow?

The problem is that human physiology doesn’t quite work like a sponge.

Does Massage Increase Blood Flow?

Locally? Sometimes – briefly.

Systemically? Not really.

Research suggests that massage may cause temporary, local changes in circulation, but these effects are often:

• Short-lived

• Variable between individuals

• Influenced more by the nervous system than by mechanical pressure

Importantly, massage does not significantly increase overall (systemic) blood flow in the body in the way exercise does.

So if massage isn’t dramatically “pushing blood around”, what is happening?

The Skin Turning Red: What’s Actually Going On?

One of the most persistent myths in massage therapy is:

Redness (erythema) after massage is not proof of tissue healing.

Instead, skin redness is largely explained by:

• Neurovascular responses

• Activation of sensory nerve endings in the skin

• Local release of vasoactive substances (such as histamine and nitric oxide)

• Changes in sympathetic nervous system activity

In other words, the redness you see is often a nervous system response, not evidence that blood is being forcefully driven into deeper muscles or damaged tissues.

This distinction matters – because visible redness doesn’t automatically mean therapeutic benefit.

The Nervous System: The Real Key Player

Modern understanding places the nervous system at the centre of massage effects.

Rather than working purely through mechanical pressure, massage appears to influence:

• Autonomic nervous system balance

• Pain modulation

• Perception of tension and discomfort

• Local vascular tone (vasodilation and vasoconstriction)

When massage encourages a shift toward parasympathetic activity (“rest and digest”):

• Muscle tone may reduce

• Blood vessels may dilate locally

• Pain sensitivity may decrease

This helps explain why people often feel:

• Warm

• Relaxed

• Less guarded

• More comfortable moving

Not because toxins were flushed out – but because the body’s threat and protection responses were reduced.

The “Flushing Toxins” Myth

The idea that massage flushes toxins is one of the most enduring – and misleading – claims in the industry.

Here’s what we know:

• Metabolic waste products are primarily cleared by the liver, kidneys, lungs, and lymphatic system

• There is no strong evidence that massage “pushes toxins” out of muscle tissue

• Terms like toxins are rarely defined clearly in these explanations

What massage can do is:

• Support relaxation and breathing patterns

• Encourage movement after treatment

• Potentially influence lymphatic flow in specific, limited contexts

But this is very different from the idea that toxins are being squeezed out of muscles during a session.

So Why Do People Feel Better After Massage?

If it’s not flushing toxins or mechanically forcing blood through tissues, why does massage help so many people?

Likely contributors include:

• Reduced pain sensitivity through nervous system modulation

• Decreased protective muscle tone

• Improved body awareness

• Psychological effects such as reassurance, safety, and expectation

• Short-term changes in local circulation secondary to neural input

These effects are real and meaningful, but they work through neurophysiology, not outdated mechanical myths.

Why This Matters for Clients – and Therapists

Understanding the true mechanisms of massage:

• Improves how we explain treatment to clients

• Prevents unrealistic expectations

• Encourages ethical, evidence-based practice

• Reduces dependency-based narratives

Clients don’t need to believe toxins are being flushed out to benefit from soft tissue therapy. They deserve explanations that reflect modern science.

How This Is Taught on the Level 4 Diploma in Soft Tissue Therapy

These concepts are explored in depth within the diploma, particularly in:

Unit 1: Anatomy & Physiology for Soft Tissue Therapists

• The cardiovascular system and how blood flow is regulated

• The nervous system and its role in vascular tone and pain modulation

• Understanding local vs systemic physiological effects

Rather than relying on outdated explanations, learners are taught to:

• Critically evaluate traditional massage claims

• Apply modern, evidence-informed reasoning

• Communicate honestly and professionally with clients

This approach prepares therapists to work confidently with people experiencing pain, dysfunction, and long-term conditions – not just those seeking relaxation.

Want to Learn More?

If you’re interested in understanding why soft tissue therapy works – not just how to apply techniques – the Level 4 Diploma in Soft Tissue Therapy explores these principles through a modern, research-informed lens that reflects current best practice.

References & Further Reading

1. Weerapong, P., Hume, P. A., & Kolt, G. S. (2005).The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Medicine, 35(3), 235–256.A foundational paper discussing proposed mechanisms of massage, including circulatory and neurological effects, and highlighting the limitations of purely mechanical explanations.

2. Best, T. M., Hunter, R., Wilcox, A., & Haq, F. (2008).Effectiveness of sports massage for recovery of skeletal muscle from strenuous exercise. Clinical Journal of Sport Medicine, 18(5), 446–460.Reviews evidence for massage effects and questions assumptions around enhanced blood flow and waste removal.

3. Poppendieck, W., Wegmann, M., Ferrauti, A., Kellmann, M., & Pfeiffer, M. (2016).Massage and performance recovery: A meta-analytical review. Sports Medicine, 46(2), 183–204.Demonstrates limited evidence for systemic circulatory changes while supporting perceptual and recovery-related benefits.

4. Bervoets, D. C., Luijsterburg, P. A., Alessie, J. J., et al. (2015).Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: A systematic review. Journal of Physiotherapy, 61(3), 106–116.Supports symptom improvement while reinforcing uncertainty around proposed physiological mechanisms.

5. Nijs, J., George, S. Z., Clauw, D. J., et al. (2013).Central sensitisation in chronic pain conditions: Latest discoveries and their potential for precision medicine. The Lancet Rheumatology.Key reading for understanding pain modulation and the role of the nervous system rather than tissue damage alone.

6. McGlone, F., Wessberg, J., & Olausson, H. (2014).Discriminative and affective touch: Sensing and feeling. Neuron, 82(4), 737–755.Explores how touch influences the nervous system, emotional regulation, and perception of safety.

7. Sluka, K. A., & Walsh, D. (2003).Transcutaneous electrical nerve stimulation and pain: Basic science mechanisms and clinical effectiveness. Journal of Pain.Although focused on TENS, this paper is widely cited for understanding neural pain modulation relevant to manual therapy.

8. Mense, S., Gerwin, R. D. (2010).Muscle Pain: Diagnosis and Treatment. Springer.Provides insight into muscle pain mechanisms and neurophysiology rather than mechanical models.

9. Standring, S. (2021).Gray’s Anatomy: The Anatomical Basis of Clinical Practice (42nd ed.). Elsevier.Authoritative reference for vascular and nervous system anatomy underpinning massage effects.

10. Butler, D. S., & Moseley, G. L. (2013).Explain Pain. Noigroup Publications.Widely used in modern pain education; challenges outdated tissue-based explanations and supports nervous system-led models.