Factors associated with changes in pain and fatigue after post-race massage therapy in Ironman triathletes: an observational study

Objectives Massage therapy is widely used as a post-race recovery strategy in endurance sports, yet individual responsiveness varies considerably. Identifying which athletes are most likely to experience meaningful symptom relief may improve the clinical efficiency of massage delivery in high-demand post-event settings. Therefore, the study aim was to investigate whether demographic, anthropometric, performance-related, and clinical factors are associated with changes in pain and fatigue following post-race massage in triathletes, and to identify predictors of clinically meaningful improvement.Methods This study included 738 triathletes who received a single massage session after completing Ironman events in Brazil. Pain and perceived fatigue were assessed using numerical rating scales before and immediately after massage. Linear regression models examined factors associated with changes in pain and fatigue, while logistic regression identified predictors of clinically meaningful improvement (≥2-point reduction).Results Greater reductions in pain were associated with older age and higher baseline pain, whereas higher baseline fatigue was associated with smaller pain reductions. Reductions in fatigue were associated with older age and higher baseline fatigue. Sex, body mass index, perceived race performance, and muscle cramps were not associated with changes in pain or fatigue. Higher baseline pain predicted clinically meaningful pain reduction (OR = 1.6 per point), while higher baseline fatigue predicted fatigue improvement (OR = 1.3 per point).Conclusion Post-race massage was associated with clinically meaningful reductions in pain and fatigue, particularly in older athletes and those with greater baseline symptoms. These findings support a targeted, symptom-driven approach to massage delivery in large endurance events.