Abstract
Many coaches, athletes and sports medicine personnel hold the belief, based on observations and experiences, that massage can provide several benefits to the body such as increased blood flow, reduced muscle tension and neurological excitability, and an increased sense of well-being. Massage can produce mechanical pressure, which is expected to increase muscle compliance resulting in increased range of joint motion, decreased passive stiffness and decreased active stiffness (biomechanical mechanisms). Mechanical pressure might help to increase blood flow by increasing the arteriolar pressure, as well as increasing muscle temperature from rubbing. Depending on the massage technique, mechanical pressure on the muscle is expected to increase or decrease neural excitability as measured by the Hoffman reflex (neurological mechanisms). Changes in parasympathetic activity (as measured by heart rate, blood pressure and heart rate variability) and hormonal levels (as measured by cortisol levels) following massage result in a relaxation response (physiological mechanisms). A reduction in anxiety and an improvement in mood state also cause relaxation (psychological mechanisms) after massage. Therefore, these benefits of massage are expected to help athletes by enhancing performance and reducing injury risk. However, limited research has investigated the effects of pre-exercise massage on performance and injury prevention.
Massage between events is widely investigated because it is believed that massage might help to enhance recovery and prepare athletes for the next event. Unfortunately, very little scientific data has supported this claim. The majority of research on psychological effects of massage has concluded that massage produces positive effects on recovery (psychological mechanisms). Post-exercise massage has been shown to reduce the severity of muscle soreness but massage has no effects on muscle functional loss. Notwithstanding the belief that massage has benefits for athletes, the effects of different types of massage (e.g. petrissage, effleurage, friction) or the appropriate timing of massage (pre-exercise vs post-exercise) on performance, recovery from injury, or as an injury prevention method are not clear. Explanations are lacking, as the mechanisms of each massage technique have not been widely investigated. Therefore, this article discusses the possible mechanisms of massage and provides a discussion of the limited evidence of massage on performance, recovery and muscle injury prevention. The limitations of previous research are described and further research is recommended.
Similar content being viewed by others
References
Galloway S, Watt J, Sharp C. Massage provision by physiotherapists at major athletics events between 1987 and 1998. Br J Sports Med 2004; 38 (2): 235–7
Cafarelli E, Flint F. The role of massage in preparation for and recovery from exercise. Sports Med 1992; 14 (1): 1–9
Tappan F, Benjamin P. Tappan’s handbook of healing massage techniques: classic, holistic, and emerging methods. Stamford: Appleton & Lange, 1998
Goats GC. Massage-the scientific basis of an ancient art: part 1. The techniques. Br J Sports Med 1994; 28 (3): 149–52
De Domenico G, Wood E. Beard’s massage. 4th ed. Philadelphia (PA): WB Saunders Company, 1997
Braverman D, Schulman R. Massage techniques in rehabilitation medicine. Phys Med Rehabil Clin N Am 1999; 10 (3): 631–49
Bell A. Massage and physiotherapist. Physiotherapy 1964; 50: 406–8
Magnusson S. Passive properties of human skeletal muscle during stretch manoeuvres. Med Sci Sports Exerc 1998; 8: 65–77
Gleim GW, McHugh MP. Flexibility and its effects on sports injury and performance. Sports Med 1997; 24 (5): 289–99
Stanley S, Purdam C, Bond T, et al. Passive tension and stiffness properties of the ankle plantar flexors: the effects of massage [abstract]. XVIIIth Congress of the International Society of Biomechanics; 2001 Jul 8–13; Zurich
Leivadi S, Hernandez-Reif M, Field T, et al. Massage therapy and relaxation effects on university dance students. J Dance Med Sci 1999; 3 (3): 108–12
Nordschow M, Bierman W. The influence of manual massage on muscle relaxation: effect on trunk flexion. J Am Phys Ther 1962; 42 (10): 653–7
Wiktorsson-Moller M, Oberg B, Ekstrand J, et al. Effects of warming up, massage, and stretching on range of motion and muscle strength in the lower extremity. Am J Sports Med 1983; 11 (4): 249–52
McNair P, Stanley S. Effect of passive stretching and jogging on the series muscle stiffness and range of motion of the ankle joint. Br J Sports Med 1996; 30: 313–8
Clarkson H. Musculoskeletal assessment: joint range of motion and manual muscle strength. 2nd ed. Philadelphia (PA): Lippincott Williams & Wilkins, 2000
Black C, Vickerson B, McCully K. Noninvasive assessment of vascular function in the posterior tibial artery of healthy humans. Dyn Med 2003; 2 (1): 1
Longworth J. Psychophysiological effects of slow stroke back massage in normotensive females. Adv Nurs Sci 1982; 4: 44–61
Drust B, Atkinson G, Gregson W, et al. The effects of massage on intra muscular temperature in the vastus lateralis in humans. Int J Sports Med 2003; 24 (6): 395–9
Tiidus P, Shoemaker J. Effleurage massage, muscle blood flow and long term post-exercise recovery. Int J Sports Med 1995; 16 (7): 478–83
Shoemaker J, Tiidus P, Mader R. Failure of manual massage to alter limb blood flow: measures by Doppler ultrasound. Med Sci Sports Exerc 1997; 29 (5): 610–4
Dubrosky V. Changes in muscle and venous blood flow after massage. Soviet Sports Rev 1982; 4: 56–7
Dubrosky V. The effect of massage on athletes’ cardiorespiratory systems. Soviet Sports Rev 1983; 5: 48–9
Hansen T, Kristensen J. Effect of massage, shortwave diathermy and ultrasound upon 133Xe disappearance rate from muscle and subcutaneous tissue in the human calf. Scand J Med Sci Sports 1973; 5: 179–82
Hovind H, Nielsen S. Effect of massage on blood flow in skeletal muscle. Scand J Med Sci Sports 1974; 6: 74–7
Tiidus P. Massage and ultrasound as therapeutic modalities in exercise-induced muscle damage. Can J Appl Physiol 1999; 24 (3): 267–78
Hernandez-Reif M, Field T, Krasnegor J, et al. Lower back pain is reduced and range of motion increased after massage therapy. Int J Neurosci 2001; 106: 131–45
Ironson G, Field T, Scafidi F, et al. Massage therapy is associated with enhancement of the immune system’s cytotoxic capacity. Int J Neurosci 1996; 84: 205–17
Field T, Grizzle N, Scafidi F, et al. Massage and relaxation therapies’ effects on depressed adolescent mothers. Adolescence 1997; 31 (124): 903–1003
Corley M, Ferriter J, Zeh J, et al. Physiological and psychological effects of back rubs. Appl Nurs Res 1995; 8 (1): 39–43
Fraser J, Kerr J. Psychological effects of back massage on elderly institutionalized patients. J Adv Nurs 1993; 18: 238–45
Groer M, Mozingo J, Droppleman P, et al. Measures of salivary secretary immunoglobulin A and state anxiety after a nursing back rub. Appl Nurs Res 1994; 7 (1): 2–6
Labyak S, Metzger B. The effects of effleurage backrub on the physiological components of relaxation: a meta-analysis. Nurs Res 1997; 46 (1): 59–62
Kaada B, Torsteinbo O. Increase of plasma beta-endorphins in connective tissue massage. Gen Pharmacol 1989; 20 (4): 487–9
Delaney J, Leong K, Watkins A, et al. The short-term effects of myofascial trigger point massage therapy on cardiac autonomic tone in healthy subjects. J Adv Nurs 2002; 37 (4): 364–71
Spielberger CD, Gorsuch RL, Lushene RE. The State-Trait Anxiety Inventory. Palo Alto (CA): Consulting Psychologists Press, 1970
Zeitlin D, Keller S, Shiflett S, et al. Immunological effects of massage therapy during academic stress. Psychosom Med 2000; 62: 83–7
Morelli M, Seaborne D, Sullivan S. Changes in H-reflex amplitude during massage of triceps surae in healthy subjects. J Orthop Sports Phys Ther 1990; 12 (2): 55–9
Morelli M, Seaborne D, Sullivan S. H-reflex modulation during manual muscle massage of human triceps surae. Arch Phys Med Rehabil 1991; 72: 915–9
Morelli M, Chapman C, Sullivan S. Do cutaneous receptors contribute to the changes in the amplitude of the H-reflex during massage? Electromyogr Clin Neurophysiol 1999; 39: 441–7
Sullivan S, Williams L, Seaborne D, et al. Effects of massage on alpha motoneuron excitability. Phys Ther 1991; 71 (8): 555–60
Zehr E. Considerations for the use of the Hoffmann reflex in exercise studies. Eur J Appl Physiol 2002; 86: 455–68
Gam A, Warming S, Larsen L, et al. Treatment of myofascial trigger-points with ultrasound combined with massage and exercise: a randomized controlled trial. Pain 1998; 77: 73–9
Pope M, Phillips R, Haugh L, et al. A prospective randomized three-week trial of spinal manipulation, transcutaneous muscle stimulation, massage and corset in the treatment of subacute low back pain. Spine 1994; 19 (22): 2571–7
Puustjarvi K, Airaksinen O, Pontinen P. The effects of massage in the patients with chronic tension headache. Acupunct Electrother Res 1990; 15: 159–62
Guyton A, Hall J. Textbook of medical physiology. 10th ed. Philadelphia (PA): WB Saunders Company, 2000
Lund I, Lundberg T, Kurosawa M, et al. Sensory stimulation (massage) reduces blood pressure in unanaesthesized rats. J Auton Nerv Syst 1999; 78: 30–7
Weinberg R, Jackson A, Kolodny K. The relationship of massage and exercise to mood enhancement. Sport Psychol 1988; 2: 202–11
Hemmings B. Psychological and immunological effects of massage after sport. Br J Ther Rehabil 2000; 7 (12): 516–9
Hemmings B, Smith M, Gradon J, et al. Effects of massage on physiological restoration, perceived recovery, and repeated sports performance. Br J Sports Med 2000; 34: 109–15
McNair DM, Lorr M, Droppleman LF. Profile of mood state manual. San Diego (CA): Educational and Industrial Testing Service, 1971
Terry P, Lane A, Lane H, et al. Development and validation of a mood measure for adolescents. J Sports Sci 1999; 17: 861–72
Thayer RE. Measurement through self-report. Psychol Rep 1967; 20: 663–78
Hemmings B. Sports massage and psychological regeneration. Br J Ther Rehabil 2000; 7 (4): 184–8
Callagan M. The role of massage in the management of the athlete: a review. Br J Sports Med 1993; 27 (1): 28–33
Tiidus P. Manual massage and recovery of muscle function following exercise: a literature review. J Orthop Sports Phys Ther 1997; 25: 107–12
Smith L, Keating M, Holbert D, et al. The effects of athlete massage on delayed onset muscle soreness, creatine kinase and neutrophil count: a preliminary report. J Orthop Sports Phys Ther 1994; 19 (2): 93–9
Starkey J. Treatment of ankle sprains by simultaneous use of intermittent compression and ice packs. Am J Sports Med 1976; 4 (4): 141–4
Rinder A, Sutherland C. An investigation of the effects of massage on quadriceps performance after exercise fatigue. Complement Ther Nurs Midwifery 1995; 1: 99–102
Viitasalo J, Niemela K, Kaapola R, et al. Warm under water water-jet massage improves recovery from intense physical exercise. Eur J Appl Physiol 1995; 71: 431–8
Zelikovski A, Kaye C, Fink G, et al. The effects of the modified intermittent sequential pneumatic device (MISPD) on exercise performance following an exhaustive exercise bout. Br J Sports Med 1993; 27 (4): 255–9
Benjamin P, Lamp S. Understanding sports massage. Champaign (IL): Human Kinetics, 1996
Cinque C. Massage for cyclists: the winning touch. Phys Sportsmed 1989; 17 (10): 167–70
Danneskiold-Samsoe B, Christiansen E, Lund B, et al. Regional muscle tension and pain (fibrositis): effects of massage and myoglobin in plasma. Scand J Med Sci Sports 1982; 15: 17–20
Murphy A, Wilson G. The ability of tests of muscular function to reflect training-induced changes in performance. J Sports Sci 1997; 15 (2): 191–200
Harmer P. The effect of pre-performance massage on stride frequency in sprinters. J Athl Train 1991; 26: 55–8
Samples P. Does ‘sport massage’ have a role in sport medicine? Phys Sportsmed 1987; 15 (3): 177–83
Balke B, Anthony J, Wyatt F. The effects of massage treatment on exercise fatigue. Clin Sports Med 1989; 1: 189–96
Boone T, Cooper R. The effect of massage on oxygen consumption at rest. Am J Chin Med 1995; 13 (1): 37–41
Monedero J, Donne B. Effect of recovery interventions on lactate removal and subsequent performance. Int J Sports Med 2000; 21: 593–7
Bale P, James H. Massage, warmdown and rest as recuperative measures after short term intense exercise. Physiother Sport 1991; 13: 4–7
Dolgener F, Morien A. The effect of massage on lactate disappearance. J Strength Cond Res 1993; 7 (3): 159–62
Gupta S, Goswami A, Sadhukhan A, et al. Comparative study of lactate removal in short term massage of extremities, active recovery and a passive recovery period after supramaximal exercise sessions. Int J Sports Med 1996; 217 (2): 106–10
Ernst E. Does post-exercise massage treatment reduce delayed onset muscle soreness? A systemic review. Br J Sports Med 1998; 32: 212–4
Appell H, Soares J, Durate J. Exercise, muscle damage and fatigue. Sports Med 1992; 13 (2): 108–15
Ebbeling C, Clarkson P. Exercise-induced muscle damage and adaptation. Sports Med 1989; 7: 207–34
Clarkson P, Sayers S. Etiology of exercise-induced muscle damage. Can J Appl Physiol 1999; 24 (3): 234–48
Howell J, Chleboun G, Conaster R. Muscle stiffness, strength loss, swelling and soreness following exercise-induced injury in humans. J Physiol 1993; 464: 183–96
Chleboun G, Howell J, Baker H, et al. Intermittent pneumatic compression effect on eccentric exercise-induced swelling, stiffness, and strength loss. Arch Phys Med Rehabil 1995; 76: 744–9
Clarkson P, Nosaka K, Braun B. Muscle function after exercise-induced muscle damage and rapid adaptation. Med Sci Sports Exerc 1992; 24 (5): 512–20
McHugh M, Connolly D, Eston R, et al. Electromyographic analysis of exercise resulting in symptoms of muscle damage. J Sports Sci 2000; 18: 163–72
McHugh MP, Connolly D, Eston R, et al. Electromyographic analysis of repeated bouts of eccentric exercise. J Sports Sci 2001; 19: 163–70
Dolezal B, Potteiger J, Jacobsen D, et al. Muscle damage and resting metabolic rate after acute resistance exercise with an eccentric overload. Med Sci Sports Exerc 2000; 32 (7): 1202–7
Smith L. Causes of delayed onset muscle soreness and the impact on athletic performance: a review. J Appl Sport Sci Res 1992; 6 (3): 135–41
Glesson M, Blannin A, Zhu B, et al. Cardiorespiratory, hormonal and haematological responses to submaximal cycling performed 2 days after eccentric or concentric exercise bouts. J Sports Sci 1995; 13 (6): 471–9
Hone L, Siler W, Schwane J. Does delayed muscle soreness affect oxygen consumption and selected gait parameters during running [abstract]? Med Sci Sports Exerc 1990; 22: s34
Harris C, Wilcox A, Smith G, et al. The effect of delayed onset muscular soreness (DOMS) on running kinematics. Med Sci Sports Exerc 1990; 22: s34
Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness: treatment strategies and performance factors. Sports Med 2003; 33 (2): 145–64
Armstrong R. Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. Med Sci Sports Exerc 1984; 16: 529–38
Evans WJ, Cannon JG. The metabolic effects of exercise-induced muscle damage. In: Holloszy J, editor. Exerc Sport Sci Rev. Baltimore (MD): William & Wilkins, 1991: 99–125
Faulkner J, Brooks S, Opiteck J. Injury to skeletal muscle fiber during contractions: conditions of occurrence and prevention. Phys Ther 1993; 73: 911–21
Friden J, Lieber R. Structural and mechanical basis of exercise-induced muscle injury. Med Sci Sports Exerc 1992; 24 (5): 521–30
Armstrong R. Initial events in exercise-induced muscular injury. Med Sci Sports Exerc 1990; 22 (4): 429–35
Armstrong R, Warren G, Warren J. Mechanisms of exercise-induced muscle fibre injury. Sports Med 1991; 12 (3): 184–207
Smith L. Acute inflammation: the underlying mechanism in delayed onset muscle soreness? Med Sci Sports Exerc 1991; 23: 542–51
Clarkson P, Hubal M. Exercise-induced muscle damage in humans. Am J Phys Med Rehabil 2002; 81 (11 Suppl.): s52–69
deVries H, Housh T. Physiology of exercise: for physical education, athletics and exercise science. Madison (WI): Brown & Benchmark, 1996
Barles P, Robinson J, Allen J, et al. Lack of effect of acupuncture upon signs and symptoms of delayed onset muscle soreness. Clin Physiol 2000; 20 (6): 449–56
Ciccone C, Leggin B, Callamaro J. Effects of ultrasound and trolamine salicylate phonophoresis on delayed-onset muscle soreness. Phys Ther 1991; 71 (9): 675–8
Craig J, Bradley J, Walsh D, et al. Delayed onset muscle soreness: lack of effect of therapeutic ultrasound in humans. Arch Phys Med Rehabil 1999; 80 (3): 318–23
Eston RG, Peters D. Effects of cold water immersion on the symptoms of exercise induced muscle damage. J Sports Sci 1999; 17 (3): 231–8
Kraemer W, Bush J, Wickham R, et al. Influence of compression therapy on symptoms following soft tissue injury from maximal eccentric exercise. J Orthop Sports Phys Ther 2001; 31 (6): 282–90
Bourgois J, MacDougall D, MacDonald J, et al. Naproxen does not alter indices of muscle damage in resistance-trained men. Med Sci Sports Exerc 1999; 31 (1): 4–9
Hasson S, Daniels J, Divine J, et al. Effects of ibuprofen use on muscle soreness, damage, and performance: a preliminary investigation. Med Sci Sports Exerc 1993; 25 (1): 9–17
Mekjavic I, Exner J, Tesch P, et al. Hyperbaric oxygen therapy does not affect recovery from delayed onset muscle soreness. Med Sci Sports Exerc 2000; 32 (3): 558–63
Nosaka K, Clarkson P. Influence of previous concentric exercise on eccentric exercise-induced muscle damage. J Sports Sci 1997; 1997 (15): 477–83
High D, Howley E, Franks B. The effects of static stretching and warm-up on prevention of delayed-onset muscle soreness. Res Q Exerc Sport 1989; 60 (4): 357–61
Johansson P, Lindstrom L, Sundelin G, et al. The effects of preexercise stretching on muscular soreness, tenderness and force loss following heavy eccentric exercise. Scand J Med Sci Sports 1999; 9: 219–25
Lund H, Vestergaard-Poulsen P, Kanstrup I, et al. The effects of passive stretching on delayed onset muscle soreness, and other detrimental effects following eccentric exercise. Scand J Med Sci Sports 1998; 8: 216–21
Rodenburg J, Steenbeek D, Schiereck P, et al. Warm-up, stretching and massage diminish harmful effects of eccentric exercise. Int J Sports Med 1994; 15: 414–9
Wenos J, Brilla L, Morrison M. Effect of massage on delayed onset muscle soreness [abstract]. Med Sci Sports Exerc 1990; 22: s34
Hasson S, Cone M, Ellison C, et al. Effect of retrograde massage on muscle soreness and performance [abstract]. Phys Ther 1992; 72 (6): s100
Weber M, Servedio F, Woodall W. The effects of three modalities on delayed onset muscle soreness. J Orthop Sports Phys Ther 1994; 20 (5): 236–42
Lightfoot J, Char D, McDermont J, et al. Immediate post-exercise massage does not attenuate delayed onset of muscle soreness. J Strength Cond Res 1997; 11 (12): 119–24
Yackzan L, Adams C, Francis K. The effects of ice massage on delayed muscle soreness. Am J Sports Med 1984; 12 (2): 159–65
Farr T, Nottle C, Nosaka K, et al. The effects of therapeutic massage on delayed onset muscle soreness and muscle function following downhill walking. J Sci Med Sport 2002; 5 (4): 297–306
Hilbert J, Sforzo G, Swensen T. The effects of massage on delayed onset muscle soreness. Br J Sports Med 2003; 37: 72–5
MacIntyre D, Reid W, Lyster D, et al. Different effects of strenuous eccentric exercise on the accumulation of neutrophils in muscle in women and men. Eur J Appl Physiol 2000; 81 (1–2): 47–53
Acknowledgements
The authors would like to acknowledge Huachiew Chalermprakiet University (Thailand), New Zealand Institute of Sport and Recreation Research (Division of Sport and Recreation, Auckland University of Technology, New Zealand) and the American Massage Therapy Association Foundation, for funding assistance in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this review.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Weerapong, P., Hume, P.A. & Kolt, G.S. The Mechanisms of Massage and Effects on Performance, Muscle Recovery and Injury Prevention. Sports Med 35, 235–256 (2005). https://doi.org/10.2165/00007256-200535030-00004
Published:
Issue Date:
DOI: https://doi.org/10.2165/00007256-200535030-00004