The Fitness Fixer
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Keeping Thai Massage Healthy Part III - Should You Do "The Blood Stop?"

The previous three posts have started telling about Thai Massage. Thai massage is done lying comfortably on a soft mat on the ground. No table is needed. It is done clothed, except for bare feet. Most places in Thailand have Thai massage going on in the stores, on street corners, in the internet cafes, at restaurants, on the beaches, and other organized or impromptu sites. Southern Thai Massage style concentrates more on pressure points. Northern style adds wonderful stretches.


Thai massage is generally helpful, but there are a few moves to avoid. One is the "blood–stop."  There is much discussion about this maneuver, both for and against. It helps to understand what is really going on to be able to decide.


The practitioner may press their palms, knees, elbows, forearms, shins, or feet over the big blood vessels that bring blood to your legs, or over the arteries that conduct blood to your arms. They press enough to slow or stop blood from flowing to your legs or arms as long as 30 seconds, a minute, sometimes more, depending on the style and school where they learned. When they release the pressure that was restricting the blood, blood flows back down the limbs in a warm rush that some people enjoy. Thai massage practitioners are taught to never do the blood stop on anyone with high blood pressure, varicose veins, heart or circulatory problems, or pregnancy. But it turns out that it is also not healthy for others.


It is often taught in massage schools that the blood stop helps unplug clogged arteries. The theory is that if there were deposits that block the artery, the rush of blood returning would "unplug" the blockage and carry it away, like cleaning a clogged plumbing pipe. This does not work for several reasons. First, the rise in blood pressure from stopping (or slowing) blood flow is small and not enough to dislodge anything when flow is released. You increase your own blood pressure more from ordinary walking and exercise. Next, even if it could dislodge anything, anything that dislodges from your big blood vessels can travel to a smaller place to become a foreign clog there - in the same way that damage occurs from a brain clot or heart attack or phlebitis.


Another idea taught is that slowing arterial blood helps draw away "stagnant" venous blood from the limbs. This is not how circulation works, even if it sounds good. Even though the blood stop will not help, you can easily do exercise that improves circulation both arterial and venous. When you exercise, the contracting muscles squeeze your limb vessels and push blood that pools in the limbs. The post Collapsing Astronaut Gives Healthy Reminder explains more on blood pooling and what exercise does for circulation.


Another of the theories of the blood stop sometimes taught in massage schools is that it helps counter the phenomenon of "legs falling asleep" during long sitting or meditation. The belief is that "legs falling asleep" is caused by lack of blood flow, and the blood stop will strengthen or increase circulation to alleviate that problem in the future. A little knowledge of physiology shows why neither is true. Compressing arteries to slow or stop blood does not cause any increase in the number or size of blood vessels, or ability to pump blood, any more than having clogged arteries improves circulation. The blood stop does not reroute the blood or encourage the body to find new pathways which give circulatory benefit. Exercise will increase all these good things, but doing the blood stop does not, even if we wish it does, or were taught that it does. Next, when a limb "falls asleep" it is not lack of blood flow, but nerve compression. There is no reduction in blood flow when you get the tingling and the "pins and needles" feeling of a limb falling asleep. The tingling is called neuropraxia, which just means a temporary interruption of sending nerve signals resulting in pins and needles feeling. During the blood stop maneuver, there is no pins and needles feeling, and when you stand up after your legs "fall asleep" there is no warm rush of blood as after the blood stop. They are two different things.


The next problem is an interesting phenomenon. When you stop blood to an area, it is not healthy for the area. Cells starve. Nerve cells are the most sensitive to lack of oxygen. Thai massage practitioners are sometimes taught that it is not stopping blood but "opening the wind" to release stagnant blood or energy. Still, no matter what you call it, lack of blood flow is not great for the area. Then the interesting paradox occurs. When blood flow, called perfusion, is restored to any body area that was deprived, oxygen flows back into the area. That would sound helpful, but the oxygen itself causes a second injury. It floods the area with a kind of oxygen that is not healthy along with other harmful products. It causes a serious injury called a reperfusion injury. This same kind of injury occurs with heart attack or in a limb that may have been crushed or caught under something, depriving it of blood. First, areas of the heart or the limb that are shut off from oxygen begin to die. When blood flow is restored, oxygen flows back into the area and with it, and a cascade of oxygen damage.


You may have heard of anti-oxidant compounds in foods. Many processes can damage your cells by oxidizing them. Oxidation is a natural process and needed for many things. But too much is not healthy. Free radicals were thought to be involved in oxidative damage. Your body naturally produces anti-oxidants to balance this and other oxidative stress from other sources. Many people take anti-oxidant vitamins hoping that more is better, which is not always the case, and only works to sell products. Separately, anti-oxidant vitamins and your own body's defenses can't do enough to protect you against a sudden reperfusion injury. Much interesting work in high-pressure oxygen science deals with trying to understand and avoid the paradox of the reperfusion injury.


There is more, but in short, none of this means that Thai massage is not good, just that it is best to avoid the blood stop move. It is easy to avoid the pitfalls and hype of massage, and use Thai massage and other kinds of massage for the benefits.

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Dr. Bookspan is an award-winning scientist whose goal is to make exercise easier and healthier.