Effect of sports massage on performance and recovery: a systematic review and meta-analysis

Key points

1. 01No significant effect on strength, jump, sprint, endurance, or fatigue measures
2. 02Massage reduced DOMS by approximately 13% (statistically significant but highly heterogeneous across studies)
3. 03Flexibility improved by approximately 7% with massage versus no intervention
4. 04High heterogeneity in several outcome analyses limits confidence in effect size estimates
5. 05Two studies suggested massage may have a small detrimental effect on strength performance

How it was conducted

Design

Systematic review and meta-analysis of randomised studies

Databases searched

PubMed, MEDLINE, and Cochrane

Included studies

29 studies (12 RCTs and 17 randomised crossover studies)

Participants

1012 total across all included studies

Intervention

Manual sports massage (qualified professional, purpose of improving performance or recovery); non-manual techniques excluded

Outcomes analysed

Strength, jump, sprint, endurance, flexibility, fatigue, and DOMS in separate meta-analyses

What they found

• Strength: no overall effect (SMD 0.17, 95% CI -0.08 to 0.42; 346 participants, 12 studies; I2=23%; p=0.17)
• Jump: no overall effect (SMD 0.16, 95% CI -0.20 to 0.51; 132 participants, 5 studies; I2=5%; p=0.39)
• Sprint: no overall effect (SMD -0.35, 95% CI -0.98 to 0.28; 257 participants, 7 studies; I2=82%; p=0.27)
• Endurance: no overall effect (SMD 0.21, 95% CI -3.45 to 3.87; 96 participants, 3 studies; I2=97%; p=0.91)
• Fatigue: no significant effect (SMD 0.47, 95% CI -0.28 to 1.22; 171 participants, 5 studies; I2=86%; p=0.22)
• Flexibility: statistically significant 7% improvement (SMD 1.07, 95% CI 0.21 to 1.93; 246 participants, 7 studies; I2=90%; p=0.01)
• DOMS: statistically significant 13% improvement (SMD 1.13, 95% CI 0.44 to 1.82; 311 participants, 10 studies; I2=86%; p<0.05)

Limitations

• Most included studies were small, limiting statistical power to detect modest effects
• Very high heterogeneity in several meta-analyses (I2 up to 97%) driven partly by single outlier studies, making true effect size uncertain
• Wide variety of massage protocols, durations, and timing across studies prevents identification of an optimal approach
• DOMS outcomes rely on subjective rating scales susceptible to placebo effects; no placebo-controlled sham massage condition in most DOMS studies

Why it matters

For patients

Athletes seeking recovery from muscle soreness or improved flexibility may get a modest benefit from sports massage, but should not expect it to directly boost their performance in strength, speed, or endurance.

For clinicians

Sports massage can be recommended for DOMS reduction and flexibility gains, but there is no evidence to justify it for performance enhancement, and the cost-to-benefit ratio should be weighed against alternatives such as cold-water immersion or compression.

For readers

This is the largest meta-analysis of sports massage to date, synthesising 29 randomised studies and 1012 participants, and provides the clearest evidence yet that performance benefits are not supported while recovery benefits (DOMS, flexibility) are small but real.