Physical TheraPT
Clinical Wisdom
Shannon Vigil
Superbill Best Practices
The Recovery Mindset
Nina Szemis, ATC
Can You Outrun Illness?

General common sense, as well as scientific research, tells us that lifelong physical activity acts as a protecting agent against chronic illness and disease. If you’re able to consistently rack up 300 minutes of moderate intensity activity per week, you’re at much lower risk for things like cancer, cardiovascular disease and other inflammatory disorders. Regular physical activity also increases your resilience against communicable diseases, like bacteria and viral infections. However, here’s where the research starts to diverge.

Manual Therapy

Water Wins

You've probably heard you need to drink lots of water after a massage. But is that really necessary? Let's look at what the science actually says about hydration, massage, and athletic performance.

Why Water Matters for Athletes

Water makes up about 60% of your body weight and plays essential roles in nutrient transport, temperature regulation, and joint lubrication. For athletes and active individuals, staying hydrated is particularly important because it affects how your muscles and tissues function.[1]

When you're dehydrated, your tissues become stiffer and less flexible. Research shows that dehydration increases the force needed to compress soft tissues and reduces tissue thickness. Even mild dehydration (losing just 3% of your body weight in fluids) can decrease muscle endurance by about 8% and reduce strength by about 5%.[2][3]

Dehydration also creates extra stress on your muscles at the cellular level. Studies show that exercising while dehydrated increases oxidative stress and can impair muscle protein metabolism. Over time, severe dehydration may even slow down muscle recovery and glycogen (energy) storage after workouts.[4][5]

 

The Truth About Massage and "Toxins"

Here's the reality: the idea that massage releases toxins requiring extra water is a myth. There's no scientific evidence supporting this claim.[6][7][8]

Your body already has highly effective systems for removing waste products—your liver, kidneys, and lymphatic system handle this 24/7. Massage doesn't create a sudden release of toxins that needs to be flushed out with water.

What about lactic acid? This is another common misconception. Lactic acid doesn't cause muscle soreness, and it's cleared from your muscles within 30-60 minutes after exercise—long before you'd typically get a massage. Massage doesn't remove lactic acid, and you don't need extra water to flush it out.[9][10][11]

That said, massage does produce real physiological effects. Studies show it can temporarily reduce cortisol (a stress hormone), lower heart rate, and cause modest changes in inflammatory markers. But none of these effects require you to drink extra water.[12][13][14]

 

How Much Water Do You Actually Need?

For general health, aim for about 40-45 mL per kilogram of body weight per day from all beverages and food combined. For a 150-pound (68 kg) person, that's roughly 2.7-3 liters (90-100 ounces) total per day.[15][16]

If you're training hard or sweating heavily, you'll need more. A good rule of thumb: replace about 1.5 times the fluid you lose during exercise. For example, if you lose 1 pound during a workout, drink about 24 ounces of fluid.[17]

Simple ways to monitor your hydration:

  • Check your urine color—pale yellow is ideal

  • Pay attention to thirst during moderate activity

  • Weigh yourself before and after intense workouts to estimate fluid loss

  • Add 0.5-1 liter of water after high-sweat sessions


Important: Don't overdo it. Drinking excessive plain water during prolonged exercise can dilute your sodium levels and cause problems.

 

The Bottom Line

Hydration is important for athletic performance and recovery—but not because of massage. Staying well-hydrated helps maintain tissue flexibility, supports muscle function, and enables efficient recovery from training.[2][4][3]

After your next massage, feel free to drink water if you're thirsty. But don't feel pressured to chug extra water based on myths about toxins or lactic acid. Instead, focus on consistent daily hydration as part of your overall training and recovery strategy.

The real reason to stay hydrated isn't about flushing anything out—it's about keeping your body functioning at its best.

 

References

  1. Water as an Essential Nutrient: The Physiological Basis of Hydration. Jéquier E, Constant F. European Journal of Clinical Nutrition. 2010;64(2):115-23. doi:10.1038/ejcn.2009.111.

  2. Investigating the Impact of Dehydration and Hydration on in-Vivo Hip Soft Tissue Biomechanics. Khorami F, Foroutan Y, Sparrey CJ. PloS One. 2025;20(8):e0328054. doi:10.1371/journal.pone.0328054.

  3. Effect of Hypohydration on Muscle Endurance, Strength, Anaerobic Power and Capacity and Vertical Jumping Ability: A Meta-Analysis. Savoie FA, Kenefick RW, Ely BR, Cheuvront SN, Goulet ED. Sports Medicine (Auckland, N.Z.). 2015;45(8):1207-27. doi:10.1007/s40279-015-0349-0.

  4. Passive Dehydration Increases Oxidative Stress and mTOR Signalling Pathway Activation in Young Men Following Resistance Exercise. Luk HY, Jiwan NC, Appell CR, et al. The Journal of Physiology. 2025;603(12):3551-3570. doi:10.1113/JP288434.

  5. Hydration, Hyperthermia, Glycogen, and Recovery: Crucial Factors in Exercise Performance-a Systematic Review and Meta-Analysis. López-Torres O, Rodríguez-Longobardo C, Escribano-Tabernero R, Fernández-Elías VE. Nutrients. 2023;15(20):4442. doi:10.3390/nu15204442.

  6. Side-Effects of Massage Therapy: A Cross-Sectional Study of 100 Clients. Cambron JA, Dexheimer J, Coe P, Swenson R. Journal of Alternative and Complementary Medicine (New York, N.Y.). 2007;13(8):793-6. doi:10.1089/acm.2006.6401.

  7. The Safety of Massage Therapy. Ernst E. Rheumatology (Oxford, England). 2003;42(9):1101-6. doi:10.1093/rheumatology/keg306.

  8. The Mechanisms of Massage and Effects on Performance, Muscle Recovery and Injury Prevention. Weerapong P, Hume PA, Kolt GS. Sports Medicine (Auckland, N.Z.). 2005;35(3):235-56. doi:10.2165/00007256-200535030-00004.

  9. Delayed Onset Muscle Soreness : Treatment Strategies and Performance Factors. Cheung K, Hume P, Maxwell L. Sports Medicine (Auckland, N.Z.). 2003;33(2):145-64. doi:10.2165/00007256-200333020-00005.

  10. Delayed Muscle Soreness: A Review. Francis K. The Journal of Orthopaedic and Sports Physical Therapy. 1983;5(1):10-3. doi:10.2519/jospt.1983.5.1.10.

  11. Lactate: Friend or Foe. Hall MM, Rajasekaran S, Thomsen TW, Peterson AR. PM & R : The Journal of Injury, Function, and Rehabilitation. 2016;8(3 Suppl):S8-S15. doi:10.1016/j.pmrj.2015.10.018.

  12. Physiological Adjustments to Stress Measures Following Massage Therapy: A Review of the Literature. Moraska A, Pollini RA, Boulanger K, Brooks MZ, Teitlebaum L. Evidence-Based Complementary and Alternative Medicine : eCAM. 2010;7(4):409-18. doi:10.1093/ecam/nen029.

  13. Influence of Classical Massage on Biochemical Markers of Oxidative Stress in Humans: Pilot Study. Skubisz Z, Kupczyk D, Goch A, et al. BioMed Research International. 2021;2021:6647250. doi:10.1155/2021/6647250.

  14. Effect of Single Session of Swedish Massage on Circulating Levels of Interleukin-6 and Insulin-Like Growth Factor 1. Stenbäck V, Lehtonen I, Mäkelä KA, et al. International Journal of Molecular Sciences. 2024;25(17):9135. doi:10.3390/ijms25179135.

  15. Hydration for Health Hypothesis: A Narrative Review of Supporting Evidence. Perrier ET, Armstrong LE, Bottin JH, et al. European Journal of Nutrition. 2021;60(3):1167-1180. doi:10.1007/s00394-020-02296-z.

  16. Hydration and Health at Ages 40-70 Years in Salzburg Austria Is Associated With a Median Total Water Intake Over 40 mL/kg Including at Least 1 L/D Plain Drinking Water. Stookey JD, Langthaler PB, Felder TK, et al. Frontiers in Public Health. 2025;13:1668981. doi:10.3389/fpubh.2025.1668981.

  17. Selected Issues for Nutrition and the Athlete: A Team Physician Consensus Statement. Medicine and Science in Sports and Exercise. 2013;45(12):2378-86. doi:10.1249/MSS.0000000000000174.

Understanding the Role of Myofascial Decompression in Sports Rehab

Cupping massage, an ancient practice rooted in traditional Chinese medicine, has grown in popularity for its potential health benefits. In this therapy, suction cups are applied to the skin to create a vacuum, which pulls skin and underlying tissue upward. In western medicine, this technique is more commonly referred to as myofascial decompression. In both systems, similar tools are used- cups can be made of glass, plastic, or silicone and can be applied to the skin in a variety of strategies. The technique is often used to promote blood flow, relieve pain, and support recovery from muscle tension or injury.

If you haven’t experienced this technique first-hand, you may be wondering: what are the distinctive marks left by cupping, what does science reveal about one of its most frequently touted benefits, and is this right for me? Let’s dive into the details!

Myth #1: Cupping Marks aren’t Bruises

The short answer: Yes, actually they are.

Many sources try to claim that cupping marks are not bruises. Most notably, they will cite that bruises are defined as both painful and a result of blunt force—two characteristics that are notably lacking in cupping application. But these flat-out denials seem to conflate the definitions of bruise and contusion.

For starters, bruise is mostly synonymous with a medical term: ecchymosis. Ecchymosis can be defined simply as bleeding under the skin due to broken capillaries. Whether these tiny blood vessels leak due to blunt force or suction is irrelevant, as the end result is the same. On the other hand, contusion is most commonly defined as ecchymosis due to blunt force, usually accompanied by pain and damage to underlying tissue.

As the purplish mark left behind by cupping therapy is a result of broken capillaries, this mark is technically a bruise. However, since the mode of achieving this bruise is suction instead of blunt force trauma, a cupping mark is not a contusion.

Myth #2: Creating damage actually helps healing

While the idea of intentionally breaking capillaries might sound counterintuitive, it can have a therapeutic effect. Cupping increases blood flow to the area, triggering the body’s inflammatory response—a natural healing mechanism.

Studies suggest that cupping may stimulate the release of cytokines and other inflammatory mediators, which help repair tissues and reduce pain (Kim et al., 2018). Moreover, the pooling of blood and interstitial fluid under the skin can encourage lymphatic drainage and reduce swelling, further promoting recovery (Al-Bedah et al., 2019).

Myth #3: Cupping releases Toxins

One of the most debated claims about cupping is whether it helps the body detoxify. To better understand the evidence, it’s important to first distinguish between wet and dry cupping. Wet cupping, an ancient form of bloodletting, involves making small incisions on the skin to draw out blood. This practice is NOT common in the United States and is not part of treatment offered at Physical TheraPT. In contrast, the more widely practiced dry cupping involves applying suction cups to unbroken skin.

Some studies suggest that wet cupping may help lower levels of uric acid and cholesterol in the body (Sutriyono et al., 2014). Current research has not shown a significant connection between dry cupping and toxin removal. The enduring association between cupping and detoxification may be attributed to the specific effects of wet cupping rather than the dry cupping methods commonly used today.

The Takeaway

Despite the lack of evidence for the detoxifying effects of dry cupping, other benefits of this modality tend to be a larger focus in physical therapy. The lifting of the skin due to suction draws blood into the area, bringing oxygen and nutrients to tissues. The mechanical stretching and lifting of the skin can help to release fascia, also known as myofascial decompression, helping to release tension surrounding muscles. And, while cupping does cause microscopic injury, targeted application of it can help us bring your body’s attention to the areas that need extra care by jump-starting the inflammatory process.

If you’re considering cupping, talk to your practitioner to see how it can fit into your recovery or wellness plan.


To learn more, check out these resources:

Al-Bedah, A. M., Elsubai, I. S., Qureshi, N. A., et al. (2019). The medical perspective of cupping therapy: Effects and mechanisms of action. Journal of Traditional and Complementary Medicine, 9(2), 90–97.

Kim, J., Lee, H., & Lee, M. (2018). Effects of cupping therapy on chronic back pain: A systematic review and meta-analysis. Complementary Therapies in Medicine, 41, 129–137.

Sutriyono, S., Robbina, M. R., & Ndii, M. Z. (2019). The effects of wet cupping therapy on blood pressure, glucose, uric acid, and total cholesterol levels. Biology, Medicine, & Natural Product Chemistry, 8(2), 33–36.