Rehabilitation Science

Submit a Manuscript

Publishing with us to make your research visible to the widest possible audience.

Propose a Special Issue

Building a community of authors and readers to discuss the latest research and develop new ideas.

Determining the Benefits of Massage Mechanisms: A Review of Literature

Many coaches, athletes, and sports medicine professionals hold the perception, based on observations and encounters, that massage can provide several benefits to the body. These include improved blood flow, reduced muscle pressure and neurological excitability, and increased sense of well being. Massage can produce mechanical pressure, which is expected to increase muscle mass, compliance, resulting in increased collection of joint motion, decreased unaggressive stiffness, and decreased energetic stiffness, known as biomechanical mechanisms. Mechanised pressure might help to enhance blood circulation by increasing the arteriolar pressure, and accumulating muscle tissue temperature from rubbing. Regarding the massage technique, mechanical pressure on the muscle is likely to increase or decrease nerve organs excitability as measured by H-reflex, which is known as neurological mechanisms. This is seen in parasympathetic activity (as assessed by heart rate, blood pressure, and heart rate variability) and junk levels (as simply measured by cortisol levels following therapeutic massage, causing a relaxation response), known as physiological mechanisms. A reduction in anxiety and an improvement in mood condition also cause relaxation, which is referred to as psychological mechanisms after the massage. Post-exercise, therapeutic massage has been recognized to lessen the severity of muscle soreness, but massage does not have any effects on muscle practical loss. Nevertheless, regarding the belief that massage therapy has benefits for sports athletes, there are no clear effects of different types of massage (Petrissage, Effleurage, Friction) or the appropriate timing of massage (pre-exercise and post-exercise) on performance, recovery from injury, or as a personal injury prevention method. Explanations are lacking because the mechanisms of each massage technique have not been broadly investigated. Therefore, this article investigates the possible mechanisms of massage and provides a discourse on the limited evidence of therapeutic massage on performance, recovery, and muscle injury prevention. The main purpose of this article is to examine mechanisms of massage and its benefits in performance, muscle recovery, and injury prevention. This study may help coaches, sport and health professionals, and researchers to understand massage mechanisms and benefits for performance, muscle recovery, and injury prevention.

Massage benefits, Massage mechanism, Blood Flow, Massage Technique

Qais Gasibat, Wurida Suwehli. (2017). Determining the Benefits of Massage Mechanisms: A Review of Literature. Rehabilitation Science, 2(3), 58-67.

Copyright © 2017 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Drust, B., Atkinson, G., Gregson, W., French, D., & Binningsley, D. (2003). The effects of massage on Intramuscular temperature in the vastus lateralis in humans. International Journal of Sports Medicine, 24, 395-399.
2. Cafarelli, E., & Flint, F. (1992). The role of massage in preparation for and recovery from exercise. Sports Medicine, 14, 1-9.
3. Braverman, D., & Schulman, R. (1999). Massage techniques in rehabilitation medicine. Physical Medicine and Rehabilitation Clinics of North America, 10, 631-649.
4. Nordschow, M., & Bierman, W. (1962). The influence of manual massage on muscle relaxation: effect on trunk flexion. Journal of American Physical Therapy, 42, 653-657.
5. Gleim, G., W, & McHugh, M. P. (1997). Flexibility and its effects on sports injury and performance. Sports Medicine, 24, 289-299.
6. Galloway, S., Watt, J., & Sharp, C. (2004). Massage provision by physiotherapists at major athletics events between 1987 and 1998. British Journal of Sport Medicine, 38, 235-237.
7. Tappan, F., & Benjamin, P. (1998). Tappan's handbook of healing massage techniques: classic, holistic, and emerging methods. Stamford, TP: Appleton & Lange.
8. Goats, G. C. (1994). Massage-the scientific basis of an ancient art: Part 1. The techniques. British Journal of Sports Medicine, 28, 149-152.
9. De Domenico, G., & Wood, E. (1997). Beard's massage (4th ed.). Philadelphia: W. B. Saunders.
10. Bell, A. (1964). Massage and physiotherapist. Physiotherapy, 50, 406-408.
11. Magnusson, S. (1998). Passive properties of human skeletal muscle during stretch manoeuvres. Scandinavian Journal of Medicine & Science in Sports, 8, 65-77.
12. Stanley, S., Purdam, C., Bond, T., & McNair, P. (2001, July). Passive tension and stiffness properties of the ankle plantar flexors: the effects of massage. Paper presented at the XVIIIth Congress of the International Society of Biomechanics, Zurich.
13. McNair, P., & Stanley, S. (1996). Effect of passive stretching and jogging on the series muscle stiffness and range of motion of the ankle joint. British Journal of Sports Medicine, 30, 313-318.
14. Clarkson, H. (2000). Musculoskeletal assessment: Joint range of motion and manual muscle strength (2nd ed.). Philadelphia: Lippincott Williams & Wilkins.
15. Leivadi, S., Hernandez-Reif, M., Field, T., O'Rourke, M., D'Arienzo, S., Lewis, D., et al. (1999). Massage therapy and relaxation effects on university dance students. Journal of Dance Medicine and Science, 3, 108-112.
16. Wiktorsson-Moller, M., Oberg, B., Ekstrand, J., & Gillquist, J. (1983). Effects of warming up, massage, and stretching on range of motion and muscle strength in the lower extremity. American Journal of Sports Medicine, 11, 249-252.
17. Black, C., Vickerson, B., & McCully, K. (2003). Noninvasive assessment of vascular function in the posterior tibial artery of healthy humans. Dynamic Medicine, 2, 1.
18. Longworth, J. (1982). Psychophysiological effects of slow stroke back massage in normotensive females. Advances in Nursing Science, 4, 44-61.
19. Shoemaker, J., Tiidus, P., & Mader, R. (1997). Failure of manual massage to alter limb blood flow: measures by Doppler Ultrasound. Medicine & Science in Sports & Exercise, 29, 610-614.
20. Tiidus, P., & Shoemaker, J. (1995). Effleurage massage, muscle blood flow and long term post-exercise recovery. International Journal of Sports Medicine, 16, 478483.
21. Dubrosky, V. (1982). Changes in muscle and venous blood flow after massage. Soviet Sports Reviews, 4, 56-57.
22. Dubrosky, V. (1983). The effect of massage on athletes' cardiorespiratory systems. Soviet Sports Reviews, 5, 48-49.
23. Hansen, T., & Kristensen, J. (1973). Effect of massage, shortwave diathermy and ultrasound upon 133Xe disappearance rate from muscle and subcutaneous tissue in the human calf. Scandinavian Journal of Medicine & Science in Sports, 5, 179-182.
24. Hovind, H., & Nielsen, S. (1974). Effect of massage on blood flow in skeletal muscle. Scandinavian Journal of Medicine & Science in Sports, 6, 74-77.
25. Tiidus, P. (1999). Massage and ultrasound as therapeutic modalities in exercise induced muscle damage. Canadian Journal of Applied Physiology, 24, 267-278.
26. Corley, M., Ferriter, J., Zeh, J., & Gifford, C. (1995). Physiological and psychological effects of back rubs. Applied Nursing Research, 8, 39-43.
27. Fraser, J., & Kerr, J. (1993). Psychological effects of back massage on elderly institutionalized patients. Journal of Advanced Nursing, 18, 238-245.
28. Groer, M., Mozingo, J., Droppleman, P., Davis, M., Jolly, M., Boynton, M., et al. (1994). Measures of salivary secretary immunoglobulin A and state anxiety after a nursing back rub. Applied Nursing Research, 7, 2-6.
29. Labyak, S., & Metzger, B. (1997). The effects of effleurage backrub on the physiological components of relaxation: a meta-analysis. Nursing Research, 46, 59-62.
30. Kaada, B., & Torsteinbo, O. (1989). Increase of plasma b-endorphin in connective tissue massage. General Pharmacy, 20, 487-489.
31. Delaney, J., Leong, K., Watkins, A., & Brodie, D. (2002). The short-term effects of myofascial trigger point massage therapy on cardiac autonomic tone in healthy subjects. Journal of Advanced Nursing, 37, 364-371.
32. Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). The State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.
33. Zeitlin, D., Keller, S., Shiflett, S., Schleifer, S., & Bartlett, J. (2000). Immunological effects of massage therapy during academic stress. Psychosomatic Medicine, 62, 83-87.
34. Gam, A., Warming, S., Larsen, L., Jensen, B., Hoydalsmo, O., Allon, I., et al. (1998). Treatment of myofascial trigger-points with ultrasound combined with massage and exercise-a randomized controlled trial. Pain, 77, 73-79.
35. Guyton, A., & Hall, J. (2000). Textbook of medical physiology (10th ed.). Philadelphia, PA: W. B. Saunders.
36. Hernandez-Reif, M., Field, T., Krasnegor, J., & Theakston, H. (2001). Lower back pain is reduced and range of motion increased after massage therapy. International Journal of Neuroscience, 106, 131-145.
37. Pope, M., Phillips, R., Haugh, L., Hsieh, C., MacDonald, L., & Haldeman, S. (1994). A prospective randomized three-week trial of spinal manipulation, transcutaneous muscle stimulation, massage and corset in the treatment of subacute low back pain. Spine, 19, 2571-2577.
38. Puustjarvi, K., Airaksinen, O., & Pontinen, P. (1990). The effects of massage in the patients with chronic tension headache. Acupuncture & Electro-Therapeutics Research, 15, 159-162.
39. McNair, D. M., Lorr, M., & Droppleman, L. F. (1971). Profile of Mood State manual. San Diego: Educational and Industrial Testing Service.
40. Terry, P., Lane, A., Lane, H., & Keohane, L. (1999). Development and validation of a mood measure for adolescents. Journal of Sports Sciences, 17, 861-872.
41. Weinberg, R., Jackson, A., & Kolodny, K. (1988). The relationship of massage and exercise to mood enhancement. The Sport Psychologist, 2, 202-211.
42. Thayer, R. E. (1967). Measurement through self-report. Psychological Reports, 20, 663678.
43. Hemmings, B., Smith, M., Gradon, J., & Dyson, R. (2000). Effects of massage on physiological restoration, perceived recovery, and repeated sports performance. British Journal of Sports Medicine, 34, 109-115.
44. Hemmings, B. (2000a). Psychological and immunological effects of massage after sport. British Journal of Therapy and Rehabilitation, 7, 516-519.
45. Hemmings, B. (2000b). Sports massage and psychological regeneration. British Journal of Therapy and Rehabilitation, 7, 184-188.
46. Callagan, M. (1993). The role of massage in the management of the athlete: a review. British Journal of Sports Medicine, 27, 28-33.
47. Tiidus, P. (1997). Manual massage and recovery of muscle function following exercise: a literature review. Journal of Orthopaedic & Sports Physical Therapy, 25, 107-112.
48. Smith, L., Keating, M., Holbert, D., Sprattt, D., McCammon, M., Smith, S., et al. (1994). The effects of athlete massage on delayed onset muscle soreness, creatine kinase and neutrophil count: a preliminary report. Journal of Orthopaedic and Sports Physical Therapy, 19, 93-99.
49. Starkey, J. (1976). Treatment of ankle sprains by simultaneous use of intermittent compression and ice packs. American Journal of Sports Medicine, 4, 141-144.
50. Rinder, A., & Sutherland, C. (1995). An investigation of the effects of massage on quadriceps performance after exercise fatigue. Complementary Therapies in Nursing and Midwifery, 1, 99-102.
51. Viitasalo, J., Niemela, K., Kaapola, R., Korjus, T., Levola, M., Mononen, H., et al. (1995). Warm under water water-jet massage improves recovery from intense physical exercise. European Journal of Applied Physiology, 71, 431-438.
52. Zelikovski, A., Kaye, C., Fink, G., Spitzer, S., & Shapiro, Y. (1993). The effects of the modified intermittent sequential pneumatic device (MISPD) on exercise performance following an exhaustive exercise bout. British Journal of Sports Medicine, 27, 255-259.
53. Benjamin, P., & Lamp, S. (1996). Understanding sports massage. Champaign, IL: Human Kinetics.
54. Cinque, C. (1989). Massage for cyclists: the winning touch. Physician and Sportsmedicine, 17, 167-170.
55. Danneskiold-Samsoe, B., Christiansen, E., Lund, B., & Anderson, R. (1982). Regional muscle tension and pain (fibrositis): effects of massage and myoglobin in plasma. Scandinavian Journal of Medicine & Science in Sports, 15, 17-20.
56. Murphy, A., & Wilson, G. (1997). The ability of tests of muscular function to reflect training-induced changes in performance. Journal of Sports Sciences, 15, 191200.
57. Harmer, P. (1991). The effect of pre-performance massage on stride frequency in sprinters. Journal of Athletic Training, 26, 55-58.
58. Samples, P. (1987). Does "sport massage" have a role in sport medicine? Physician and Sportsmedicine, 15, 177-183.
59. Balke, B., Anthony, J., & Wyatt, F. (1989). The effects of massage treatment on exercise fatigue. Clinical Biomechanics, 1, 189-196.
60. Monedero, J., & Donne, B. (2000). Effect of recovery interventions on lactate removal and subsequent performance. International Journal of Sports Medicine, 21, 593597.
61. Boone, T., & Cooper, R. (1995). The effect of massage on oxygen consumption at rest. American Journal of Chinese Medicine, 13, 37-41.
62. Ernst, E. (1998). Does post-exercise massage treatment reduce delayed onset muscle soreness? A systematic review. British Journal of Sports Medicine, 32, 212-214.
63. Appell, H., Soares, J., & Durate, J. (1992). Exercise, muscle damage and fatigue. Sports Medicine, 13, 108-115. Clarkson, P., & Sayers, S. (1999). Etiology of exercise-induced muscle damage. Canadian Journal of Applied Physiology, 24, 234-248.
64. Ebbeling, C., & Clarkson, P. (1989). Exercise-induced muscle damage and adaptation. Sports Medicine, 7, 207-234.
65. Howell, J., Chleboun, G., & Conaaster, R. (1993). Muscle stiffness, strength loss, swelling and soreness following exercise-induced injury in humans. Journal of Physiology, 464, 183-196.
66. Chleboun, G., Howell, J., Baker, H., Ballard, T., Graham, J., Hallman, H., et al. (1995). Intermittent pneumatic compression effect on eccentric exercise-induced swelling, stiffness, and strength loss. Archives of Physical Medicine and Rehabilitation, 76, 744-749.
67. Clarkson, P., Nosaka, K., & Braun, B. (1992). Muscle function after exercise-induced muscle damage and rapid adaptation. Medicine & Science in Sports & Exercise, 24, 512-520.
68. McHugh, M., Connolly, D., Eston, R., & Gleim, G. (2000). Electromyographic analysis of exercise resulting in symptoms of muscle damage. Journal of Sports Sciences, 18, 163-172.
69. McHugh, M. P., Connolly, D., Eston, R., Gartman, E., & Gleim, G. (2001). Electromyographic analysis of repeated bouts of eccentric exercise. Journal of Sports Sciences, 19, 163-170.
70. Dolezal, B., Potteiger, J., Jacobsen, D., & Benedict, S. (2000). Muscle damage and resting metabolic rate after acute resistance exercise with an eccentric overload. Medicine & Science in Sports & Exercise, 32, 1202-1207.
71. Harris, C., Wilcox, A., Smith, G., Quinn, C., & Lawson, L. (1990). The effect of delayed onset muscular soreness (DOMS) on running kinematics. Medicine & Science in Sports & Exercise, 22(Suppl.), 34.
72. Hone, L., Siler, W., & Schwane, J. (1990). Does delayed muscle soreness affect oxygen consumption and selected gait parameters during running? Medicine & Science in Sports & Exercise, 22(Suppl.), 34.
73. Smith, L. (1992). Causes of delayed onset muscle soreness and the impact on athletic performance: a review. Journal of Applied Sport Science Research, 6, 135-141.
74. Armstrong, R. (1984). Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. Medicine & Science in Sports & Exercise, 16, 529-538.
75. Cheung, K., Hume, P., & Maxwell, L. (2003). Delayed onset muscle soreness: treatment strategies and performance factors. Sports Medicine, 33, 145-164.
76. Faulkner, J., Brooks, S., & Opiteck, J. (1993). Injury to skeletal muscle fiber during contractions: conditions of occurrence and prevention. Physical Therapy, 73, 911-921.
77. Friden, J., & Lieber, R. (1992). Structural and mechanical basis of exercise-induced muscle injury. Medicine & Science in Sports & Exercise, 24, 521-530.
78. Armstrong, R. (1990). Initial events in exercise-induced muscular injury. Medicine & Science in Sports & Exercise, 22, 429-435.
79. Armstrong, R., Warren, G., & Warren, J. (1991). Mechanisms of exercise-induced muscle fibre injury. Sports Medicine, 12, 184-207.
80. Clarkson, P., & Hubal, M. (2002). Exercise-induced muscle damage in humans. American Journal of Physical Medicine and Rehabilitation, 81(Suppl.), 52-69.
81. Smith, L. (1991). Acute inflammation: the underlying mechanism in delayed onset muscle soreness? Medicine & Science in Sports & Exercise, 23, 542-551.
82. Devries, H., & Housh, T. (1996). Physiology of exercise: for physical education, athletics and exercise science. Madison, WI: Brown & Benchmark.
83. Barles, P., Robinson, J., Allen, J., & Baxter, G. (2000). Lack of effect of acupuncture upon signs and symptoms of delayed onset muscle soreness. Clinical Physiology, 20, 449-456.
84. Ciccone, C., Leggin, B., & Callamaro, J. (1991). Effects of ultrasound and trolamine salicylate phonophoresis on delayed-onset muscle soreness. Physical Therapy, 71, 675-678.
85. Craig, J., Bradley, J., Walsh, D., Baxter, G., & Allen, J. (1999). Delayed onset muscle soreness: Lack of effect of therapeutic ultrasound in humans. Archives of Physical Medicine and Rehabilitation, 80, 318-323.
86. Eston, R. G., & Peters, D. (1999). Effects of cold water immersion on the symptoms of exercise induced muscle damage. Journal of Sports Sciences, 17, 231-238.
87. Kraemer, W., Bush, J., Wickham, R., Denegar, C., Gomez, A., Gotshalk, L., et al. (2001). Influence of compression therapy on symptoms following soft tissue injury from maximal eccentric exercise. Journal of Orthopaedic & Sports Physical Therapy, 31, 282-290.
88. Bourgeois, J., MacDougall, D., MacDonald, J., & Tarnopolsky, M. (1999). Naproxen does not alter indices of muscle damage in resistance-trained men. Medicine & Science in Sports & Exercise, 31, 4-9.
89. Mekjavic, I., Exner, J., Tesch, P., & Eiken, O. (2000). Hyperbaric oxygen therapy does not affect recovery from delayed onset muscle soreness. Medicine & Science in Sports & Exercise, 32, 558-563.
90. High, D., Howley, E., & Franks, B. (1989). The effects of static stretching and warm-up on prevention of delayed-onset muscle soreness. Research Quarterly for Exercise and Sport, 60, 357-361.
91. Johansson, P., Lindstrom, L., Sundelin, G., & Lindstrom, B. (1999). The effects of preexercise stretching on muscular soreness, tenderness and force loss following heavy eccentric exercise. Scandinavian Journal of Medicine & Science in Sports, 9, 219-225.
92. Lund, H., Vestergaard-Poulsen, P., Kanstrup, I., & Sejrsen, P. (1998a). The effects of passive stretching on delayed onset muscle soreness, and other detrimental effects following eccentric exercise. Scandinavian Journal of Medicine & Science in Sports, 8, 216-221.
93. Hasson, S., Cone, M., Ellison, C., Goehrs, L., Hall, L., Van Vyven, E., et al. (1992). Effect of retrograde massage on muscle soreness and performance. Physical Therapy, 72 (Suppl.), 100.
94. Lightfoot, J., Char, D., McDermont, J., & Goya, C. (1997). Immediate post-exercise massage does not attenuate delayed onset of muscle soreness. Journal of Strength and Conditioning Research, 11, 119-124.
95. Rodenburg, J., Steenbeek, D., Schiereck, P., & Bar, P. (1994). Warm-up, stretching and massage diminish harmful effects of eccentric exercise. International Journal of Sports Medicine, 15, 414-419.
96. Weber, M., Servedio, F., & Woodall, W. (1994). The effects of three modalities on delayed onset muscle soreness. Journal of Orthopaedic & Sports Physical Therapy, 20, 236-242.
97. Wenos, J., Brilla, L., & Morrison, M. (1990). Effect of massage on delayed onset muscle soreness. Medicine & Science in Sports & Exercise, 22(Suppl.), 4.
98. Bale, P., & James, H. (1991). Massage, warmdown and rest as recuperative measures after short term intense exercise. Physiotherapy in Sport, 13, 4-7.
99. Yackzan, L., Adams, C., & Francis, K. (1984). The effects of ice massage on delayed muscle soreness. American Journal of Sports Medicine, 12, 159-165.
100. Hilbert, J., Sforzo, G., & Swensen, T. (2003). The effects of massage on delayed onset muscle soreness. British Journal of Sports Medicine, 37, 72-75.
101. Farr, T., Nottle, C., Nosaka, K., & Sacco, P. (2002). The effects of therapeutic massage on delayed onset muscle soreness and muscle function following downhill walking. Journal of Science and Medicine in Sport, 5, 297-306.
102. Clarkson, Priscilla M., and Stephen P. Sayers. "Etiology of exercise-induced muscle damage." Canadian journal of applied physiology 24. 3 (1999): 234-248.‏
103. Nosaka, Kazunori, and Priscilla M. Clarkson. "Influence of previous concentric exercise on eccentric exercise-induced muscle damage." Journal of sports sciences 15. 5 (1997): 477-483.‏