CRD summary

This review assessed the effectiveness of sports massage for improving recovery after strenuous exercise and concluded that RCTs provided moderate support for this intervention. This was a poorly reported review with significant flaws. The conclusions should not be regarded as reliable.

Authors' objectives

To review the effectiveness of sports massage for improving recovery after strenuous exercise.

Searching

MEDLINE, EMBASE and CINAHL were searched without language restrictions from 1950 to 2007 (search terms were reported). Reference sections of included papers were scanned for additional studies.

Study selection

Studies were eligible for this review if they included people who were performing strenuous exercise, received massage by hand to the exercised limbs and were assessed for muscle recovery and strength. Possible outcome measures included intensity of muscle soreness, subjective levels of pain, range of motion, muscle peak torque and muscle circumference. Study design was not specified.

This review included case series and randomised controlled trials (RCTs). A wide variety of massage protocols were used varying in type, duration and frequency of treatment. In the RCTs, massage was given within 20 minutes of exercise (most studies) or delayed up to 24 hours post-exercise. Session length varied from five to 30 minutes. Session number varied between one and four sessions. Participants were either healthy but untrained volunteers or athletes of various levels. Both men and women were included. Age ranged from 18 years to 51 years. The most common outcome measures used in the RCTs were peak torque, maximum voluntary muscle contractions, blood lactate levels and serum neutrophil count.

The authors did not state how many reviewers performed study selection for this review.

Assessment of study quality

All included RCTs were assessed using the Delphi scoring system (a validated tool) by three unblinded authors. Disagreements were resolved by consensus.

Data extraction

Data appeared to be extracted by one reviewer.

Methods of synthesis

Included studies were presented according to study design, and then by outcome measures in tables and textual summaries.

Results of the review

Twenty-seven papers were included in this review: 10 RCTs (around 240 patients); and 17 studies labelled as case series (around 200 patients) . The latter group appeared from the data presented to have been within-participant controlled studies, rather than case series. Ten of these studies used randomisation to determine which limb received the intervention. Methodological quality in the RCTs was reported as moderate (Delphi scores ranging from 2 to 6). The most common limitations included small sample size, lack of equivalence across treatment and control groups and inadequate blinding of outcome assessors.

Within-participant controlled studies: 10 studies reported post-exercise function showing no benefit of the intervention; seven studies reported delayed-onset muscle soreness (DOMS) showing some benefits. The 17 studies suggested that the physiological benefits of sports massage for recovery and performance enhancement should be questioned.

RCTs: Four studies reported on post-exercise function only; six studies also reported on delayed-onset muscle soreness. The RCTs were considered to offer moderate support for using massage therapy to facilitate recovery from repetitive muscular contractions. The beneficial effects of massage therapy were most evident when treatment was administered within two hours of exercise (based on seven studies).

Authors' conclusions

RCTs provided moderate support for using massage therapy to facilitate recovery from repetitive muscular contractions in comparison to case series, which provided little support for use of massage; further investigations were required.

CRD commentary

This review addressed a broad question with appropriate inclusion criteria, but would have benefited from specifying the population and intervention in more detail (for example, neither strenuous activity nor massage and sports massage were defined. The searches appeared appropriate, but grey literature was not searched, resulting in possible publication bias. No language restrictions were mentioned, suggesting that language bias may have been minimised. Validity assessment was carried out using recognised criteria for the RCTs, but not for the other study types. Quality assessment was carried out by more than one reviewer. Duplicate selection and data extraction would have been advisable to reduce the chances of reviewer error and/or bias. The primary studies included a variety of designs, some of which did not appear to have been described correctly by the authors. The division into RCTs and case-control in particular may have resulted in reliable data produced by a randomised within-subjects design being relegated to case-control status. Numbers of patients were reported inconsistently between the tables and text. The results were presented as a narrative summary, however, there was little synthesis of the grouped trials in the text making it difficult to assess the authors' conclusions of effectiveness. Overall this was a poorly reported review with a number of significant flaws. The conclusions should not be regarded as reliable.

Implications of the review for practice and research

Practice: The authors stated that the beneficial effects of massage therapy were most evident when treatment was administered within two hours of exercise.

Research: The authors stated that there was a need for further research that standardised the application and techniques used within massage therapy.

Funding

Not stated.

Bibliographic details

Best T M, Hunter R, Wilcox A, Haq F. Effectiveness of sports massage for recovery of skeletal muscle from strenuous exercise. Clinical Journal of Sport Medicine 2008; 18(5): 446-460. [PubMed: 18806553]

Indexing Status

Subject indexing assigned by NLM

MeSH

Athletic Injuries /therapy; Female; Humans; Male; Massage /methods; Muscle, Skeletal /blood supply /injuries; Physical Exertion /physiology; Sports; Treatment Outcome

AccessionNumber

12008107821

Database entry date

08/07/2009

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.