You raise an interesting question about the possible association between massage and DCS risk. Some have cautioned against massage before diving. The clearest justification is to avoid muscle pain that might be attributed to DCS. A more speculative concern is to minimize the development of micronuclei. The nature and action of micronuclei has not been confirmed, but it is believed that they are the seeds from which bubbles form. There is a theoretical concern that tissue massage may induce micronuclei formation and thus precipitate bubble formation. Tissue stimulation could also increase blood flow which may either positively enhance tissue gas elimination or precipitate problematic bubble formation.

As you can see, there is no clear sense of what massage might do and this effect would likely vary depending on dive profiles and intensity of the massage. 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. 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.

Dr. Nick Bird MD.