Massage for recovery
Massage is one of the oldest means of recovery, and athletes rate it consistently highly. But what exactly does it change in the muscles: does it speed up the recovery of strength, reduce pain, or simply give a pleasant feeling of relaxation? The editorial team gathered data from systematic reviews and explains what to realistically expect from massage.
Massage in sport: types and tasks
Sports massage is not a single technique but a set of methods: stroking, rubbing, kneading, vibration, tapping, as well as work with trigger points and deep tissues. Depending on the goal, the specialist changes the pace, the force of pressure and the duration.
In practice a distinction is made between pre-event massage (before training or an event), recovery massage (after a load or on a rest day) and therapeutic massage (in rehabilitation after injuries). Their goals differ: the first is to prepare the tissues and nervous system, the second to relieve fatigue and pain, the third to promote healing under a doctor’s supervision.
Self-massage — work with rollers, balls and percussion massagers — is often counted as massage too. This is a separate topic, which we examine in detail in the material on mobility and myofascial release, but the mechanisms and expectations are in many respects similar.
For an athlete it is important to understand: massage does not replace sleep, nutrition and competent planning of loads. Its role is to complement them, primarily by affecting well-being, subjective fatigue and pain.
| Type of massage | When | Main task | Nature of the techniques |
|---|---|---|---|
| Pre-event | 10–30 min before the event | Getting ready, a feeling of being ‘warmed up’ | Short, energetic, without deep pressure |
| Recovery | 1–2 hours after a load or the next day | Reduction of pain and fatigue, relaxation | Moderate pressure, slow pace, 20–40 min |
| Therapeutic | In rehabilitation | Work with scars, spasms, restricted mobility | Targeted, as prescribed by a specialist |
| Self-massage | At any time | Maintenance, reduction of stiffness | Rollers, balls, massagers |
Mechanisms: what happens in the tissues
The most common explanation for the effect of massage is ‘improved blood flow that flushes out lactic acid’. The study by Wiltshire and co-authors (2010) tested this directly: after intense arm work, massage did not accelerate but, on the contrary, somewhat slowed blood flow in the muscle and the removal of lactate compared with active recovery. So this classic argument does not stand up to scrutiny.
More interesting are the data on the effect on inflammation. In the work of Crane and co-authors (2012), published in Science Translational Medicine, participants performed an exhausting load, after which one leg was massaged and the other not. Biopsies showed that in the massaged leg some inflammatory signalling pathways were weakened and signals associated with mitochondrial biogenesis were strengthened. This is a small study, but it provides a biological basis for the reduction of pain.
A significant part of the effect of massage is probably connected with the nervous system. Touch and pressure activate mechanoreceptors of the skin and muscles, change the perception of pain at the level of the spinal cord and brain, and lower the tone of the sympathetic system. People feel relaxation, reduced anxiety and an improved mood.
The review by Weerapong, Hume and Kolt (2005) classified the possible mechanisms of massage into biomechanical, physiological, neurological and psychological. The authors emphasised that the evidence base is strongest precisely for psychological effects and the feeling of recovery, while the effect on performance indicators is less consistent.
What the meta-analyses say
The meta-analysis by Poppendieck and co-authors (2016) in the journal Sports Medicine assessed the effect of massage on the recovery of performance. The overall effect turned out to be small; massage worked somewhat better over short recovery intervals and in disciplines requiring repeated efforts than with long breaks between loads.
Davis, Alabed and Chico (2020), in a meta-analysis for BMJ Open Sport & Exercise Medicine, found no evidence that massage improves strength, sprinting, jumping or endurance. At the same time they found small improvements in flexibility and a reduction in delayed-onset muscle soreness.
The large meta-analysis by Dupuy and co-authors (2018), which compared different recovery methods, showed: among all the techniques, massage had some of the most noticeable effects on reducing muscle pain and subjective fatigue. The authors also noted that combinations of methods do not necessarily give more than a single well-chosen one.
The overall picture is this: massage reliably improves well-being and reduces pain, but does not make the muscles stronger or more enduring the next day. This is not little — after all, subjective readiness affects the quality of training — but expectations should be assessed soberly.
- Well confirmed:reduction of delayed-onset muscle soreness, reduction of subjective fatigue, relaxation.
- Moderately:a short-term increase in range of motion.
- Not confirmed:accelerated recovery of strength and speed, ‘elimination of toxins’ and lactate.
When and how to use massage
Before an event a short and light massage that does not overload the muscles is appropriate. A deep, prolonged massage immediately before explosive work is not recommended: it relaxes and can temporarily reduce ‘readiness’ for maximal efforts.
For recovery, massage is usually done some time after training or the next day, when muscle soreness appears. The length of a session is from 15–20 to 40 minutes depending on the areas. The pressure should be comfortable: pain during massage does not mean greater benefit and can increase tissue damage.
In a tournament regime, when there are several hours between events, a short recovery massage of the legs can help relieve the feeling of ‘heaviness’. Here an experienced specialist who knows what to do in limited time will be needed.
Self-massage with a roller or a percussion device is a practical option for everyday use. It is cheaper, always available and, according to studies, gives similar short-term effects on pain and mobility, although it does not replace the work of a qualified massage therapist on specific problems.
Contraindications and safety
Massage is a safe procedure for most healthy people, but it has contraindications. It is not performed in acute injuries in the area of application (tears, fresh bruises, haematomas) in the first days, at an elevated body temperature and in acute infections, or on areas of skin with damage or infection.
Special caution is required for people with varicose veins, a history of deep vein thrombosis, blood-clotting disorders, and also those taking anticoagulants. Massage of an area with a possible thrombus is dangerous.
Too deep a massage after very intense eccentric loading can increase muscle damage. Rhabdomyolysis — a serious complication in which muscle cells are destroyed — is associated primarily with the load itself, but deep, intense mechanical intervention during this period is inappropriate.
It is worth choosing specialists with a medical or special sports education. A massage therapist must understand anatomy, know the contraindications and be able to refer a person to a doctor in time if the pain is atypical.
Editorial conclusions
Massage reliably reduces delayed-onset muscle soreness and subjective fatigue and helps you relax. Its effect on the recovery of strength, speed and endurance is small or absent in studies.
The classic explanation about ‘flushing out lactic acid’ is not confirmed; the effects of massage are probably connected with the nervous system, the perception of pain and, possibly, with the modulation of inflammatory signals.
Massage is useful as a complement to sleep and nutrition, and its format — from a light pre-event one to a deep recovery one — should be chosen for the specific task.
The editorial team also recommends reading our materials on mobility and MFR, on active recovery and on cold procedures.
References
- Dupuy O, Douzi W, Theurot D, Bosquet L, Dugué B. An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue, and inflammation: a systematic review with meta-analysis. Front Physiol. 2018;9:403.
- Poppendieck W, Wegmann M, Ferrauti A, et al. Massage and performance recovery: a meta-analytical review. Sports Med. 2016;46(2):183–204.
- Davis HL, Alabed S, Chico TJA. Effect of sports massage on performance and recovery: a systematic review and meta-analysis. BMJ Open Sport Exerc Med. 2020;6(1):e000614.
- Crane JD, Ogborn DI, Cupido C, et al. Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Sci Transl Med. 2012;4(119):119ra13.
- Wiltshire EV, Poitras V, Pak M, et al. Massage impairs postexercise muscle blood flow and "lactic acid" removal. Med Sci Sports Exerc. 2010;42(6):1062–1071.
- Weerapong P, Hume PA, Kolt GS. The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Med. 2005;35(3):235–256.
Andriy Melnyk
A strength-sports coach and author of programs for beginner and intermediate levels. Writes about training planning.
