Tuesday 4th January, 2022

Are percussion massagers (massage guns) safe?

Massage gun usage
Percussion massagers use a jackhammering effect that can cause injury , sometimes serious or life threatening

Massage guns (percussion massagers) are widely marketed but are they safe, or even effective?

How safe are they?

Colleagues mention seeing damage caused by these instruments. This usually involves things such as the aggravation of injuries, intramuscular bleeding and the build up of scar tissue. To our knowledge there is no official reporting of these events so the extent is unknown, however one such episode was recently written up in a medical journal because the damage caused by a massage gun was so severe it became life threatening.

This danger is totally un-necessary

The tragedy is that this is totally un-necessary. The reason is that although advocates of percussion claim that having the head of the massager driving into the muscles adds the benefits of conventional massage, doing so only reduces the primary benefit of vibration and make it much more dangerous. The gimmick of percussion is such a poor idea that scientists recently doing clinical trials of percussion massagers deliberately used specialised softer heads, thus deliberately eliminating the percussion effect that is supposed to get the extra benefit, while of course making them a lot safer.

In this article

In this article we’ll go over the differences between percussion and vibration massagers, the science and safety, then most importantly how you can get something that is safe and does a great job.

CONTENTS

What is the difference between percussion and vibration massage
Percussion massage (massage guns) can be unsafe
Are there any extra benefit from percussion?
Appendix: how to tell the difference between a percussion and vibration massager
Appendix two: example of scientists modifying a percussion massager to make it safe
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.

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

Percussion massage (massage guns) can be unsafe

Just looking at this picture it’s pretty obvious that driving the head of a percussion massager in like a jackhammer is potentially dangerous, especially when massage guns come with hard heads and some drive these in up to 16mm (eg. Theragun)

As reported in a medical journal (1) (quote below) a massage gun caused so much damage it became life threatening. In this case a massage gun was used to relax tired muscles after cycling but afterwards there were multiple hematomas (bruises) on the person’s 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

Quote from report of life threatening damage caused by a massage gun

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 (1)

Are there any extra benefit from percussion?

We’ve seen that there is a lot more risk when using percussion rather than vibration, but percussion advocates claim extra benefits. Are there any extra benefits to justify those risks?
We discussed this in a lot more detail in our article Is percussion massage (massage guns) scientific. However, in short there isn’t. Lets summarise how the gimmick of percussion has come about and how advocates have misrepresented science to promote it. We’ll use our compactors and jackhammers as an analogy.

Using a compactor

Vibration massage is a tried and proven therapy

Vibration massage as been used for a long time. It has a host of scientifically proven effects and an excellent safety record. For further information please see our article The scientifically proven effects of vibration massage with clinical applications

Using a jackhammer

Lets drive the head in like a jackhammer

Someone got the idea that by driving the head of the massager into the muscle it would penetrate better and give better results.

Making false claims about percussion

Falsely claiming that science supports their usage

To justify their machines they got the scientific studies of compactors and basically said "our jackhammers vibrate to so that proves that they work".

Scientists modifying percussion massagers so they are safer

Scientists modify percussion massagers in trials so they are safe and work

When scientists were asked to test these machines they realised that the jack hammering was a very poor idea. They put special heads on the percussion massagers so they wouldn’t do any damage and would at least do some good (2,3)⁠. Of course the scientific reports say the results were obtained using a percussion massager and the fact that they were modified to remove the percussion gets buried in the fine print.

Good for people who sell percussion massagers, but bad for you

As a result we have advocates of percussion telling people it’s good to jackhammer muscles and supporting it by misrepresenting the science. In the real world people use the jackhammer heads with no supervision and instruction so we end up people damaging themselves, sometimes to the extent that it becomes life threatening.

Vibration massage: the therapy that is much safer and actually gives you the benefits

As discussed, vibration massage is the original tried and proven therapy with an excellent safety record and a host of scientifically proven benefits. It is very easy to use because it doesn't need any specialised skills. One only needs to place the head of a vibration massager on the part to be massaged. Please check out the following vibration massage resources.

Vibration massage resources

Article: How to use a massager
Article: How to choose a massager
Article: The practical, science based guide to post exercise recovery
Article: How to treat trigger points at home

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.

Appendix two: example of scientists modifying a percussion massager to make it safe

As an example, a study tested the effect of percussion massage using a Theragun on the performance of bench press, 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. (3)⁠⁠

Quote showing that scientists modify percussion massagers to make them safe and work better

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. This was applied on both pectoralis muscles, around the medial half of the anterior border

References

  1. Chen J, Zhang F, Chen H, Pan H. Rhabdomyolysis After the Use of Percussion Massage Gun : A Case Report. Phys Ther. 2021 Jan 4;101(1)
  2. 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.
  3. Garc M, Jurado-castro JM, Ben J. Acute Effects of a Percussive Massage Treatment on Movement Velocity during Resistance Training. Environ Res Public Health. 2021 Jul 21;18(15):7726.

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



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