Friday 24th December, 2021

Is percussion massage (massage guns) scientific?

Massage gun usage
The effectiveness, scientific validity and safety of percussion massage is badly misrepresented

Percussion massage is a form of therapy where the head of a machine, typically a massage gun, is driven into one’s muscles like a jackhammer. Proponents say it is likely to combine the benefits of conventional massage and vibration therapy, and claim a host of scientifically proven benefits (1)⁠.

Summary of the science:

While vibration massage is an excellent scientifically proven therapy, to our knowledge there is no merit what so ever in driving the massager heads into muscles like mini jackhammers. The scientific validity of percussion massage (massage guns) has been misrepresented the following ways

  • supporters use scientific studies of vibration (not percussion) to claim benefits,
  • recently there have been some clinical trials, but the scientists have used special heads on the percussion massagers to make them work more like a vibration massager, and
  • they are represented as being safe although the percussion effect of driving the heads in has been shown to cause serious damage.
What that means is:

Vibration massage is the safe, effective scientifically proven therapy, while the jackhammering effects of percussion massage has not been shown to add any benefits. Percussion is likely to be a lot less effective and certainly a lot more dangerous.

In this article:

In this article I’ll explain the difference between vibration massage and percussion, and how to tell them apart. I’ll share with you how percussion advocates use science in an inappropriate and misleading manner, and how reports show percussion massagers sometimes cause serious harm. Finally, I’ll finish by showing you the treatment that the scientific evidence actually supports.

CONTENTS

What is the difference between percussion and vibration massage
The scientifically proven effects of vibration massage
What is the science behind percussion therapy (massage guns)
Are percussion massagers (massage guns) safe
Vibration massage: the therapy that actually gives you the benefits
Appendix: how to tell the difference between a percussion and vibration massager
Professionals
References

Percussion vs vibration massage

What is the difference between percussion and vibration massage

The simplest way to explain the difference between a percussion and vibration massager is that vibration massagers use vibration to penetrate whereas percussion massagers use mechanical vibration to assist physical penetration. This is like comparing a jackhammer with vibrating compactors used in the construction industry. Please see our appendix for how to tell these apart.

The scientifically proven effects of vibration massage

The scientifically proven effects of vibration massage

With vibration massage vibrations (rather than the massager heads) penetrate deeply into the muscles. Scientists have found that these have the following effects. For more info please see: The scientifically proven effects of vibration massage- with clinical applications.

  • Relaxing muscles
  • increasing blood flow
  • “stretching muscles”
  • reducing post exercise soreness and speeding recovery
  • improving performance
  • reducing pain
  • helping musculoskeletal conditions
  • increasing healing

What is the science behind percussion therapy (massage guns)

Short summary: to our knowledge there is none. In this section I’ll discuss:

  1. the false claims that percussion helps the massage penetrate further,
  2. how advocates of percussion wrongly claim the benefits of vibration, and
  3. how in clinical trials they use special heads to make the percussion massagers work more like vibration massagers so they can get half decent results.

The false claims about percussion massage penetrating better

In our research we found many unsubstantiated claims that percussion massagers penetrate 60% better than vibration massagers. We believe the source of this claim is the following statement on Theragun’s website, claiming that their professional grade percussion massagers penetrate 60% more than consumer grade vibration massagers. This is probably true, but consumer grade vibration massagers are generally poor quality, poorly designed and not very effective (2)⁠. A comparison with these is neither valid or flattering.

Quote from Theragun regarding penetration
Quote from Theragun website regarding penetration
Earthquakes can penetrate 100s of km

Vibration penetrates much better

It is a fundamental principle of physics that properly applied vibration penetrates much further than physical penetration. For example, according to a scientific journal article on the effects of vibrations in the construction industry (3)⁠⁠ vibrations from a pile driver travel from 18- 247m, whereas vibrations from a quarry blast travels 1.6-6.4km. There is no question that a properly designed vibration massager can penetrate much further than a percussion massager.

How percussion massage advocates misleadingly claim the benefits of vibration

We were not aware of any research or other scientific information supporting the use of percussion massagers so we did an extensive search of websites claiming to show the benefits of percussion massage. In every case where they referenced a scientific study it was a study of vibrations, not percussion. For example: on Hydragun’s website their article 5-scientific reasons percussive therapy is good references the following journal articles (4–9)⁠⁠. They are all studies of vibration therapy, not percussion.

An example

What I’d like to do here is show you an example (below) of how even scientists use a “slight of hand” to mislead you. This is from a university based author and has the impressive title: A critical evaluation of percussion muscle gun therapy as a rehabilitation tool focusing on lower limb mobility. A literature review (10)⁠.

Please note the logic it uses. It says vibration therapy has effects such as stimulating reflexes and increasing temperature, therefore percussion massage may used during warmups etc. Percussion is not vibration therapy so this is not a logical or scientifically valid conclusion.

The trouble is people read this not picking up that it is illogical and misleading. In this scientific paper two popular percussion massagers Theragun and Hyperice are mentioned a lot so draw your own conclusion about whether the author made a mistake or was deliberately misrepresenting the science to promote these.

Quote showing inappropriate logic supporting percussion

Previous literature has reported that vibration therapy leads to mechanical oscillatory motions, thus enhancing reflex activity by stimulating the muscle spindle to initiate a tonic vibratory reflex. Lee et al. (2018) demonstrated that vibration therapy corresponds with an increase in intramuscular temperature. Further to this finding, Lee et al. (2018) also reported an increase in muscle temperature from vibration therapy increases counter-movement jump height. Therefore, handheld percussion massage devices may be used during a warm-up before physical activity to promote increased muscle temperature (Cochrane et al., 2008) and muscle activation (Cochrane et al., 2010).

How scientists make percussion massagers like vibration massagers for their clinical trials

The premise behind percussion massage is that there is extra benefit from driving their heads into your muscles (like a jackhammer). As you will see in the appendix to do that percussion massagers:

  1. have heads designed to penetrate muscles rather than flatter heads designed to transmit vibration, and
  2. their heads tend to go up and down further to “jackhammer” your muscles.

As the next quote (below) shows, the previously mentioned scientific literature review (10)⁠ of massage guns looked at 19 studies and found that in all of them the scientists chose to use a soft attachment head. The scientists know that the benefit comes from the vibration, not the jack hammering, so what they do is put on a head that flattens out for better vibration transfer and has a bit of give in it so it goes up and down a bit less. In other words they remove the percussion effect and make them more like a vibration massager.

Quote showing that in trials of percussion scientists try and make their machines be like vibration massagers so they actually work

thirteen used a muscle gun that delivered percussions at 53 Hz. Six studies used a handheld percussive device operating at 80+ Hz. All of the experiments used a soft attachment head for the device

Example

As an example, a study tested the effect of percussion massage using a Theragun on the performance of bench press exercises, and found slight improvement. However, as shown in the following quote the scientists used the optional damper attachment. The Dampener attachment is specifically designed to lower the impact and increase the surface area, creating more efficient contact with the body. Basically, to get decent results the scientists ignored the things that are supposed to make percussion better (the physical penetration) and made the Theragun act more like a vibration massager.(11)

Example of a trial of Theraguns where the scientists used a damper to reduce percussion and increase vibration

The Theragun® G3 Pro (Therabody, Los Angeles, CA, USA) device was used for the
experimental treatment in the PTG. The PT treatment provided by the device during this
study had the following mechanical characteristics: amplitude (16 mm), torque (60 pounds), and frequency (2400 per minute). PT was applied to each participant immediately following completion of the last rep at the end of each set. PT was applied to the pectoralis major and minor, given that the standardized grip used in our study was 100% or more of the biacromial width [24], and the bench had no inclination (0) [25], with the pectoral as
the muscle group with the highest activation during the BP exercise. PT was applied
to the muscle in the PTG with the dampener attachment
using moderate force and fast
movement, gliding up and down along the muscle belly from the origin to the insertion for
15 s, ensuring constant pressure at all times, and following the direction of the muscle fibers.

Dangerous use of a massage gun
Driving in heads like a jackhammer can do serious damage

Are percussion massagers (massage guns) safe

This picture illustrates the danger of using machines that are like mini jackhammers. When driving a hard massager head into a muscles there is always a danger of causing damage to the muscle, or worse impacting a nerve or blood vessel. Colleagues are reporting to me that they are seeing many people with these injuries, and more recently serious damage is being reported in the scientific literature .

Example

The following quote is self explanatory

Quote from a published scientific report

there are no published clinical or evidence-based reports on percussion guns regarding their benefits, indications,contraindications, and even side effects. The purpose of this case report is to describe the first case of rhabdomyolysis as a severe and potentially life-threatening illness following use of a percussion gun (12)⁠

In this case a massage gun was used to relax tired muscles after cycling but afterwards there were multiple hematomas (bruises) on her thighs and the damage was so severe:

  1. the breakdown of the muscles caused the release of products that were highly toxic, and
  2. there was so much internal bleeding that the woman suffered iron deficiency anaemia
Dr Graeme's comments

Graeme’s comments

Hopefully from that you can see that although percussion claims to combine the benefits of conventional massage and vibration therapy, it actually doesn’t effectively deliver vibration and the penetration of the head adds nothing worthwhile. Further, it’s actually dangerous. What I’d like to do now is share with you something you will actually get the promised benefits from: genuine vibration massage.

Vibration massage: the therapy that actually gives you the benefits

The benefits claimed for percussion massage are actually those for vibration massagers. Please see the appendix for how to tell which is which. Better still, for how to choose an quality massager that will do a great job and that you will be extremely happy with please see our article How to choose a massager, or you can go straight and check out our economical, easy to use professional standard vibration massagers: the General Purpose Massager or our Ultimate Quad Head Massager.

Appendix: how to tell the difference between a percussion and vibration massager

So, if you’re after a massager how do you tell the difference? There is some crossover between the two types of machine, but there are certain characteristics to look for.

The shape of the heads

The most obvious is the shape of the heads. Again, if you think jackhammer vs compactor your percussion massagers are going to have heads that look like they’re for driving in, while vibration massagers will tend to have flatter heads designed for vibration transfer.

Percussion vs vibration massage: amplitude

The amplitude of the head movement

The next thing to look at is the amplitude, which is how far the head goes up and down. You can easily see this if you look at the head side on while it’s running. A good vibration massager will have an amplitude of about 3-5 mm, while a percussion massager will have more. Looking at our jackhammer and compactor again, a jackhammer head might go up and down a few cm to drive the head in, but if the big flat plate on the compactor went up and down that far it would just bounce around uncontrollably.

Professionals

Most of our massagers are sold through professional clinics where where the professionals use them themselves and recommend them to patients or clients. If you are a professional and wish to know more about vibration massage please check out practitioner page for more information and possibly a sample massager to try this therapy yourself. Our DrGraeme massagers were originally built by Dr Graeme for use in his clinic, and to prescribe to his patients for additional self use at home. Now these are used by colleagues and other professionals for similar purposes.

References

  1. Konrad A, Glashüttner C, Reiner MM, Bernsteiner D, Tilp M. The acute effects of a percussive massage treatment with a hypervolt device on plantar flexor muscles’ range of motion and performance. J Sport Sci Med. 2020;19(4):690–4.
  2. McDonagh D, Wilson L, Haslam C, Weightman D. Good vibrations: Do electrical therapeutic massagers work? Ergonomics. 2005;
  3. Svinkin MR. Minimizing Construction Vibration Effects. Pract Period Struct Des Constr. 2004;9(2):108–15.
  4. Imtiyaz S, Veqar Z, Shareef MY. To compare the effect of vibration therapy and massage in prevention of delayed onset muscle soreness (DOMS). J Clin Diagnostic Res. 2014;
  5. Johnson PK, Feland JB, Johnson AW, Mack GW, Mitchell UH. Effect of whole body vibration on skin blood flow and nitric oxide production. J Diabetes Sci Technol. 2014;8(4):889–94.
  6. Herrero AJ, Menéndez H, Gil L, Martín J, Martín T, García-López D, et al. Effects of whole-body vibration on blood flow and neuromuscular activity in spinal cord injury. Spinal Cord. 2011;49(4):554–9.
  7. Lau RWK, Liao LR, Yu F, Teo T, Chung RCK, Pang MYC. The effects of whole body vibration therapy on bone mineral density and leg muscle strength in older adults: A systematic review and meta-analysis. Vol. 25, Clinical Rehabilitation. 2011. p. 975–88.
  8. Thompson WR, Yen SS, Rubin J. Vibration therapy: Clinical applications in bone. Curr Opin Endocrinol Diabetes Obes. 2014;21(6):447–53.
  9. King LK, Almeida QJ, Ahonen H. Short-term effects of vibration therapy on motor impairments in Parkinson’s disease. Vol. 25, NeuroRehabilitation. 2009. p. 297–306.
  10. Martin JD of H and WU of winchester. A critical evaluation of percussion muscle gun therapy as a rehabilitation tool focusing on lower limb mobility. A literature review. 2021.
  11. Garc M, Jurado-castro JM, Ben J. Acute Effects of a Percussive Massage Treatment on Movement Velocity during Resistance Training. International journal of environmental research and public health vol. 18,15 7726. 21 Jul. 2021,
  12. Chen J, Zhang F, Chen H, Pan H. Rhabdomyolysis After the Use of Percussion Massage Gun : A Case Report. Phys Ther 2021;1–5.

We are continually adding more information on research and uses. Subscribe below to have us email them to you "hot off the press".

Dr Graeme

About Dr Graeme

Several years ago Dr Graeme, a Chiropractor practicing in Victoria, Australia was looking for a serious hand held massager his patients could use at home to get the extra quality massage they needed. The ones he found in the shops and on-line for home use looked nice but were not serious, and... read more



Other Articles You May Like

The practical, science based guide to post exercise recovery

There are a lot of articles with shopping lists of things to do to help your muscles recover after exercise, but which are the most... Read Article  

The scientifically proven effects of vibration massage- with clinical applications

In this summary we investigate the science behind the use of vibration massage. This helps us envisage uses and to develop protocols. ... Read Article  

What is the best treatment for trigger points

The best trigger point therapy for you depends on your goals. If you are after pain relief clinical trials show that there is little to... Read Article  

Why shoulder pain keeps coming back

Although shoulder pain is usually diagnosed as an impingement syndrome a study published in BMC Medicine states that evidence does not... Read Article  

What is a vertebral subluxation complex, and how are they fixed

As a chiropractor for over 27 years vertebral subluxation complexes are a very real problem that can cause pain, long term spinal damage... Read Article