Effect of Sports Massage on Performance and Recovery: A Systematic Review and Meta-Analysis

Executive summary

This is the most rigorous test anyone has run on whether massage does what it is widely assumed to do, and the answer is mostly no.

The authors searched PubMed, MEDLINE and Cochrane for randomised studies testing manual massage against measures of sporting performance or recovery. Twenty-nine eligible studies recruiting 1,012 participants were identified - which the authors describe as the largest examination of the effects of massage.

Separate meta-analyses were performed for strength, jump, sprint, endurance, flexibility, fatigue and delayed-onset muscle soreness. The result: no evidence that massage improves strength, jump, sprint, endurance or fatigue. Massage was associated with small but statistically significant improvements in flexibility and in delayed-onset muscle soreness.

The authors conclude that although their study finds no evidence that sports massage improves performance directly, it may somewhat improve flexibility and soreness - and that these findings help guide coaches and athletes about the benefits of massage.

For a massage chair buyer, this is the honest picture of what the underlying modality has been shown to do. It is a narrower claim than most chair marketing makes, and it is still a real one.

Why this research matters

Massage chairs are frequently sold on performance and recovery language. This meta-analysis tested exactly those claims for the underlying modality and found most of them unsupported.

It is also a good example of why separating endpoints matters. A review that pooled everything into 'recovery' might have reported a positive result; testing strength, jump, sprint, endurance, flexibility, fatigue and soreness separately showed the effect is confined to two of the seven.

What the researchers found

No evidence of improvement in strength, jump, sprint, endurance, or fatigue.

Small but statistically significant improvements in flexibility and in delayed-onset muscle soreness.

The authors summarise this as finding no evidence that sports massage improves performance directly, while it may somewhat improve flexibility and DOMS.

Specific pooled effect sizes, confidence intervals and p-values for each endpoint are not reported in the source abstract and are therefore not reproduced here.

What the results mean

Five of seven endpoints showed nothing. That is a substantial null result across a reasonably large evidence base, and it should be taken seriously rather than explained away.

The two positive findings are described by the authors themselves as small. Improved flexibility and reduced soreness are legitimate outcomes - people generally want to feel less sore and move more easily - but they are not performance benefits, and they should not be sold as such.

Notably, this review found no effect on fatigue, whereas the larger 2018 review of 99 studies found massage the most powerful technique for perceived fatigue. That disagreement between two meta-analyses of overlapping literature is itself informative about how firm the evidence is.

Strengths and limitations

Strengths

• Largest systematic examination of massage effects at the time of publication.
• Seven endpoints analysed separately rather than pooled into a single construct.
• Restricted to randomised studies.
• Published in a peer-reviewed BMJ journal.
• Reports null findings prominently rather than emphasising the two positive results.
• Conclusions stated in appropriately measured language.

Limitations

• Effect sizes and confidence intervals not reported in the source abstract.
• Massage protocols varied substantially between trials.
• Blinding is not possible for a manual intervention, so expectation effects cannot be excluded - particularly relevant for the subjective soreness endpoint.
• Population demographics not reported in the source abstract.
• Findings conflict with a larger 2018 meta-analysis on the fatigue endpoint.
• Does not address non-athletic populations or non-performance outcomes.

Evidence in context

This review sits in mild tension with the 2018 meta-analysis of 99 recovery studies, which found massage the most powerful technique for both soreness and perceived fatigue. Both are meta-analyses of overlapping literature reaching different conclusions on fatigue.

Where they agree is on soreness: both found a benefit. Where they disagree, this review is the more conservative and the more narrowly targeted, having tested massage alone across separated endpoints.

No larger or better-designed massage meta-analysis has been published since, and no equivalent body of evidence exists for mechanical massage chairs.

Related research

1. An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue, and inflammation Dupuy O, Douzi W, Theurot D, Bosquet L, Dugué B. Frontiers in Physiology 9:403. 2018. PMID 29755363; PMC5932411; doi:10.3389/fphys.2018.00403.The larger recovery meta-analysis, which reached a more favourable conclusion on massage and fatigue.
2. Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise Bleakley C, McDonough S, Gardner E, et al. Cochrane Database of Systematic Reviews 2012(2):CD008262. 2012. PMID 22336838; PMC6492480; doi:10.1002/14651858.CD008262.pub2.The equivalent standard of evidence for cold immersion, useful for comparing modalities.
3. Contrast water therapy and exercise induced muscle damage: a systematic review and meta-analysis Bieuzen F, Bleakley CM, Costello JT. PLOS ONE 8(4):e62356. 2013. PMID 23626806; PMC3633882; doi:10.1371/journal.pone.0062356.Contrast water therapy, another recovery method assessed against multiple comparators.