Who doesn't love getting a massage while vacationing on a tropical island? It's a relaxing, muscle-soothing way to completely unwind and alleviate any physical or emotional tensions. But if you're on a scuba diving vacation, is it safe to get a massage after you've just completed a dive?
The concern is that getting a massage could increase your risk for decompression sickness. As Divers Alert Network describes on its website: "During a dive, the body tissues absorb nitrogen from the breathing gas in proportion to the surrounding pressure. As long as the diver remains at pressure, the gas presents no problem. If the pressure is reduced too quickly, however, the nitrogen comes out of solution and forms bubbles in the tissues and bloodstream. This commonly occurs as a result of violating or approaching too closely the diving table limits, but it can also occur even when accepted guidelines have been followed." It is this last part that DAN and other researchers explore — identifying the risks that could cause DCS. Is massage one of the risks?
"We should note that massage has not been confidently associated with any of the cases of DCS that have come to us, and we are not aware of any study done to address this question," says Nick Bird, M.D., of Divers Alert Network. "The clearest piece of advice is that deep tissue massage should probably be avoided, so that the potential of post-dive pain and diagnostic confusion are minimized."
As Dr. Bird notes, and as far as I am aware, there isn't any research showing a cause-and-effect relationship between massage and decompression sickness. The weak possible exception could be the massage technique known as Rolfing — an aggressive deep tissue massage — or other similar assault taking place under a high N2 loading. Anything resembling a customary, soothing massage during a dive trip would seem extremely unlikely to play any direct role in an event of DCS. However, it could play an indirect role in that lying down or otherwise becoming sedentary soon after diving impedes circulation in tissues and thus inert gas elimination.
In the situation where there is a significant residual nitrogen loading (for example, multiple dives over multiple days, deco dives) and the diver then gets a very vigorous musculoskeletal manipulation in close proximity to the last dive, it might be theoretically possible this could contribute to DCS through the formation of microbubbles. These microbubbles serve the seed or core for bubble formation and expansion. However, this remains entirely conjectural.
Of far more concern than massage to DCS risk is laying down and taking a nap or placing a heavy load on knee or hip joints (e.g., climbing ladders back onto the boat with weights or tank on) immediately post-dive.
Note: This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.
DocVikingo has been scuba certified for more than 35 years and has dived all over the world. He is a practising doctor in the Baltimore/Washington, D.C., area and has held faculty positions at several major hospitals, including Johns Hopkins. With an interest in diving medicine, he serves as administrator at Scuba Clinic Online.