One Dirty Magazine

The Science Of Percussive Massage Tools 

Can percussive therapy support recovery and performance? Probably, but it depends.

David Roche November 23rd, 2020

The Science Of Percussive Massage Tools 

Two weeks ago, it finally came in the mail—my brand new Theragun. I unwrapped it like a kid on Christmas who accidentally opened his parents’ new vibrator. 

Yes, the Theragun and similar percussive massage tools are just what they sound like … 14-inch wide vibrators with an array of settings and attachments ostensibly designed for self-massage on the legs, arms and back. 

“Sure,” I can already imagine the TSA agent saying as it vibrates uncontrollably in the security line. “I bet that’s what you use it for.”

Now that the obligatory vibrator joke is out of the way, let’s get down to the nitty gritty. Do percussive therapy tools work for their stated purpose of enhancing recovery and performance? I was very skeptical for the longest time.

Short answer: yes, there is solid evidence that percussive therapy may have some benefits, though the extent of those benefits is uncertain based on protocol, machine style/quality and individual variation. 

Come on … just look at it. It’s like the evolutionary descendent of a Roomba and a Shake Weight. Then I heard plenty of supportive anecdotes from athletes I coach, which led me to gathering research papers for this article. It culminated in seeing many NBA players using percussive therapy on the bench. If those players are using it with millions of dollars on the line, then there is at least some smoking anecdotal evidence that it may have benefits. But is there hard-science fire?

Short answer: yes, there is solid evidence that percussive therapy may have some benefits, though the extent of those benefits is uncertain based on protocol, machine style/quality and individual variation. 

 

Let’s break it down.

Percussive therapy provides rapid bursts of pressure into muscles, often 40 or more percussions per second at more than a centimeter of amplitude. This vibrator means business. Companies claim that these tools increase blood flow, which can help reduce inflammation and muscle tension, and possibly increase range of motion. Physiologically, it relies on many of the same principles as foam rolling or regular old massage, just with a motor and, as our Theragun box says, “antimicrobial attachments for essential, whole-body use.” OK, now they are not even trying to hide the euphemisms.

On the possible positive end, there could be loosening of chronically tight muscles and fascia, enhanced blood flow and maybe even parasympathetic-nervous-system effects related to cellular responses (a controversial topic, so we’ll keep that description vague). If you watch a track race start line, you often see the athletes banging their fists into their legs before the gun goes off. If that has any non-placebo benefit, it’s likely neuromuscular, and the percussive tools are like that but multiplied by 200 cups of coffee. There is also similarity with a Swedish massage technique called tapotement, which is when the masseuse does the world’s smallest karate chops on an affected area.

For possible downsides, muscle tension can be a good thing in some cases, leading to muscles that have stronger contractions (a big reason that the conventional wisdom is not to static stretch before activity). In addition, banging the crap out of your muscles like you’re a determined little hummingbird could possibly cause its own trauma. Blood flows to muscles during spa massages, and it also flows to muscles in Fight Clubs. If it hurts, it’s unlikely to be helpful (or should be done by a professional). Finally, reduction in inflammation could also reduce subsequent adaptation processes, since those two concepts are intertwined along with many other variables.

 

When there are debating physiological theories, it’s time to go to the studies. 

The first major study was conducted in 2014 for the Journal of Clinical and Diagnostic Research. The study involved 45 female subjects split into three groups of 15 receiving vibration massage, regular massage and no treatment prior to eccentric exercise (a reverse arm curl). Yes, you heard that right, the study was on female participants, which is so rare in the exercise-physiology world that I think those authors deserve a Nobel Prize and a Pulitzer. Heck, let’s give them an MTV Music Video of The Year Award while we are at it.

At 24, 48 and 72 hours post exercise, the vibration and massage treatment groups had less muscle soreness, less muscle lactate dehydrogenase, reduced creatine kinase (a proxy for muscle damage) and increased recovery of range of motion. Those findings overlap with what we see with massage techniques—there is a reason pro-athlete training camps often have a resident physical therapist and masseuse, and those benefits were seen in vibration tools too. Many studies followed, with a generally rosy picture for vibration massage. 

 

All aboard the disclaimer train!

The exact tools used in the interventions vary, and sometimes may be operating with different protocols, so it’s important to read the findings together with your specific response. Vibration massage is different than percussive therapy, though there is likely overlapping physiological mechanisms.

For example, multiple studies use the Vibralagic 5, which looks vaguely similar, but definitely has less of a high-priced-adult-store feel. Other studies used vibrating foam rollers. Also, the studies are usually not related to endurance performance, which could be a different response entirely, and are often conducted on non-athlete populations, which could change outcomes.

 

Pre-exercise 

A 2020 study in the International Journal of Environmental Research and Public Health found that pre-exercise vibration massage increased ankle range of motion, muscle strength, and agility. A 2019 study in the Journal of Physical Therapy Science found that pre-exercise local vibration reduced signs of fatigue in the quadriceps muscle. A 2017 study in the same journal had similar findings, backing up the findings of reduced soreness, creatine kinase and muscle lactate in the 72 hours after exercise. However, there is no universal agreement on how it influences endurance performance. 

 

Post-exercise 

A 2019 review study in the International Journal of Medical Research analyzed 10 previous studies with 258 participants, finding that post-exercise delayed-onset muscle soreness was reduced with vibration techniques at 24 and 48 hours, but not 72 hours. The most notable measurements were related to self-assessed soreness and creatine kinase levels.

A 2017 review study in Frontiers of Physiology also found post-exercise massage reduced muscle soreness and improved muscle performance. Interestingly, those improvements were similar to what was seen with vibration massage, so there are likely similar physiological mechanisms underpinning the results.

Given the similarities with regular massage in studies, and the ubiquity of massage among most high-performance athletes competing at the very top level of their sports, I imagine that the short-term benefits are only magnified as training stress mounts up.

What we don’t have are long-term studies on how vibration and percussive massage influences adaptation and injury rates, along with a consensus of how it affects runners specifically. Given the similarities with regular massage in studies, and the ubiquity of massage among most high-performance athletes competing at the very top level of their sports, I imagine that the short-term benefits are only magnified as training stress mounts up. Or maybe overuse or misuse of these devices can cause damage that undercuts growth. Right now, there is a multi-million person real-world study underway, as athletes use massage guns and train their asses off. 

 

Here’s what I experienced.

After two weeks using the device before and after exercise, I feel better than ever. However, I am so subject to the placebo effect that it’s almost a superpower. Call me Gullible Man, capable of great feats fueled only by a sugar pill.

Based on the studies, I have encouraged athletes I coach that talk about persistent soreness to invest in one of these vibrators-with-a-God-complex. But in history, way more athletes have excelled without percussive therapy than have excelled with it, so you definitely don’t need it. As the 2017 review study on massage techniques said: “It seems that the psychological effect is larger than the physiological effect.”

 

Protocol

The study approaches vary and don’t often use the same tools we have at home, so it’s all about applying the science to find what works for you. I recommend 30 to 60 seconds pre-exercise for possible nervous system benefits, followed by five to 10 minutes after exercise, adjusting based on how you feel. Float over the muscles, rather than digging down deeply. Remember: it’s a dose of love for your body, not a one-person Fight Club (which now that I think about it, is kind of the whole plot twist in the movie Fight Club). If it hurts, don’t do it. 

Finally, before starting any new protocol, talk to your doctor and physical therapist and coach. And given the house-shaking vibrations, you may also want to consult your partner and/or priest, depending on the nature of your concerns.

 

David Roche partners with runners of all abilities through his coaching service, Some Work, All Play. With Megan Roche, M.D., he hosts the Some Work, All Play podcast on running (and other things), and they wrote a book calledThe Happy Runner

 

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