Amateur athletes frequently experience delayed-onset muscle soreness (DOMS), impacting training and daily activities. Myofascial release, a massage technique for DOMS management, can be performed manually or with instruments. Recently, percussion devices, such as massage guns, have gained popularity. While several studies have examined foam rollers for self-myofascial release, no research has compared physiotherapist-administered manual myofascial release with instrument-assisted or percussion-based techniques for DOMS treatment.

To evaluate the effects of a single session of manual myofascial release alone or combined with instrument-assisted soft tissue mobilization or a percussion device massager on DOMS in amateur athletes.

Randomized controlled trial. Amateur athletes were classified as "very active" according to the International Physical Activity Questionnaire (IPAQ), and pain reporting associated with exercise practice was included. Exclusion criteria included athletes with pain due to a previously diagnosed musculoskeletal injury and those unable to read and understand the questionnaire. Athletes were randomized into one of three groups: Manual Myofascial Release (MMR), Manual + Instrument-Assisted Soft Tissue Mobilization (MMR+IASTM), or Manual + Percussion Device Massager (MMR+PDM). An assistant researcher conducted the randomization process. Assessments were carried out by a trained evaluator blinded to group allocation. Initially, participants identified the muscle group experiencing pain. The evaluator then palpated the affected muscle group and asked the athlete to quantify their pain using the Visual Analog Scale (VAS) from 0 to 10. Following this assessment, a trained physiotherapist administered the assigned intervention. Each session lasted 40 minutes. The session was evenly divided for interventions combining manual therapy with another approach, with 20 minutes allocated to manual therapy and 20 minutes to the instrument/device intervention. Immediately after the session, the same evaluator reassessed pain levels using the VAS. Twenty-four hours later, the research team contacted participants, instructing them to palpate the painful area and self-report their pain score on the VAS. To assess normality, the Shapiro-Wilk test was applied. For group comparisons, repeated measures ANOVA and one-way ANOVA were used.

A total of 159 athletes completed the protocol: 73 in the MMR group, 47 in the MMR+IASTM group, and 39 in the MMR+PDM group. There was a loss of 24-hour follow-up data in the last two groups due to non-responsiveness to the 24-hour evaluation. No significant differences were found between the three groups in baseline VAS scores: 4.63 for MMR, 4.79 for MMR+IASTM, and 5.59 for MMR+PDM (p = 0.099). Immediately after the intervention, VAS scores were 2.30 for MMR, 2.34 for MMR+IASTM, and 5.28 for MMR+PDM. At the 24-hour follow-up, VAS scores were 2.38 for MMR, 2.82 for MMR+IASTM, and 4.44 for MMR+PDM. When comparing groups, no significant difference was found between MMR and MMR+IASTM (p = 0.714), while both showed superior results compared to MMR+PDM (p < 0.001 for both comparisons).

MMR alone or in combination with IASTM yielded better outcomes than MMR combined with PDM in treating DOMS.

A percussion device should not be combined with MMR for DOMS management.