Massage Guns – Friend or Foe?

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In recent years, massage guns have become one of the most ‘in vogue’ tools for athletes and gym goers around the world, with popular celebrities including the likes of British heavyweight boxer Anthony Joshua, Gal Gadot a.k.a superwoman, and footballer Cristiano Ronaldo, all lauding their benefits.

With its power drill-like appearance, the massage device uses what is called ‘percussive massage therapy’ to pound the body at 40 beats per second, supposedly to relieve improve muscle performance, improve flexibility and improve recovery times.

Google trends shows that it was early 2019 when google searches for the devices became more and more numerous, indicating when the massage gun started to make waves in the commercial scene

However, what evidence is there that shows these high powered devices offer what they’re promising?

Since 2008 – when the devices were supposedly invented – popular medical science journal database ‘Pubmed’ throws up only 3 trials putting the claims made about the devices, to the test. Let’s take a look at them…

Study 1
No. of participants = 12
Measuring: Muscle performance 
Exercise: Vertical jump
Percussive therapy: 5 minutes of massage therapy administered after warm-up
Massage gun brand: Theragun
Massage gun settings: Amplitude = 16 mm, torque = 60 pounds, and frequency = 40 hertz

The first study from 2019, looked at the difference in muscle performance after 5-minutes of massage therapy administered by a Theragun device, by noting changes in vertical jump height. 12 participants were recruited and their jump height was recorded over two days, both with and without the massage therapy. The results showed that there was no change in vertical jump height following the treatment compared to not having the treatment.

Study 2
No. of participants = 16
Measuring: Muscle performance & flexibility
Percussive therapy: 5 minutes of massage therapy administered after warm-up
Massage gun brand: Hypervolt
Massage gun settings: Frequency = 53 hertz (no other information given)

A following study looked at the impact of using a hypervolt massage gun on both the flexibility and muscle performance of the calf muscle, in 16 individuals. The trial used a similar method to the 2019 study, testing the groups of participants over two separate days, both with and without the application of the massage therapy. Again, the participants were subject to the massage for 5-minutes following a warm-up, and before the flexibility and muscle performance exercise was carried out. The study revealed that, similarly to the previous study, muscle performance remained unaffected, however, there was an improvement of 5.4 degrees in range of ankle flexion.

Study 3
No. of participants = 24
Measuring: Muscle performance
Exercise: Bench press
Percussive therapy: 15 seconds of massage applied between sets
Massage gun brand: Theragun
Massage gun setting: Amplitude = 16 mm, torque = 60 pounds, and frequency = 40 hertz

The most recent study, published in July 2021, looked into whether the application of percussion therapy between bench press sets increases the number of repetitions (rep) performed before the participant struggles to lift the weight. Rather than applying the therapy before the exercise, the massage gun was applied to the pectoral muscle for 15 seconds after the final rep of each set. The results showed that whereas the control group were unable to perform the same number of reps from sets 1-4, the group that received the therapy consistently hit the peak number of reps until the final set.

Although these studies do show some evidence that massage guns provide some tangible benefit, their main limitations are their small sample size, and low sample diversity i.e. the participants being limited to only healthy males. To gain more statistical power, and to be able to provide more robust conclusions, more studies need to be carried out enrolling a larger number of diverse participants.

Another point to be noted is that each of these trials is performed over only a couple of days, and therefore only looked at the short terms effects.

What is the long-term impact of percussive massage therapy?

In 2020, an interesting case-study was published in the Physical Therapy Association Journal telling of a young Chinese woman who was admitted to hospital claiming to have suffered from significant fatigue, pain in her thigh muscles, and tea-coloured urine for the previous three days. Upon inspection, the physicians found quite severe bruising on her legs.

It turns out, the woman was an avid cyclist, and everyday, after her training, her coach had subjected her to 10 minutes of percussion massage therapy with one of these new fangled massage guns. Through shear force of repeated impact, these tools had started to break down the muscle tissue, resulting in the leaking of protein into the bloodstream. This caused a severe case of Rhabdomyolysis, a condition in which muscle fibres are transported by the bloodstream to major organs, causing kidney failure and, if left untreated, cardiac arrest and death. Thankfully, the woman was treated, and made a full recovery, with no long-term damage evidence.

It needs to be stressed that this is a severe, and likely, quite rare event. But it just goes to show that these tools do carry an element of danger with them, and they are not to be used frivolously. It also highlights the main misconception with massage gun use, which is that they should be used for the purposes of warming up muscles in preparation for exercise, rather than post-workout to relieve muscle pain.

This point was summed up extremely well by, of all people, wrestling royalty, John Cena:

This is a hammer, and if you have a hurt arm, and your arm is in pain, and your body is in full defensive mode, you’re essentially taking a hammer to it. It’s not relaxing the tissue at all. It’s aggravating. Percussion can be really good by, like, waking up all those muscles and getting them ready for activity. But man! If you’re in pain, don’t put a hammer on something that already hurts…

John Cena. Source: John Cena & Pete Davidson Test Workout Gadgets – Wired

We might not be able to see him, but we can definitely heed Johns words.