Objectives: The purpose of this study is to quantitatively evaluate the combined effects of sports massage, blood flow restriction (BFR), and cold therapy on quadriceps recovery in mixed martial arts (MMA) athletes following eccentric exercise, focusing on muscle biomechanical properties, pain, and strength. Methods: This randomized, single-blind clinical trial involved 36 men and women MMA-trained participants, divided into three groups: massage (n = 12) received massage, BFR/cool (n = 12) received combined BFR and cooling, and control (n = 12) received passive rest as a control. The fatigue protocol involved MMA fighters performing five sets of plyometric jumps on a 50 cm box until exhaustion, with 1-min breaks between sets. After that, the massage group received a 20-min massage overall using standardized techniques; BFR/cool underwent a 20-min alternating blood flow restriction (200 mmHg) and cooling treatment with ice bags on the quadriceps; and the final group served as the control group with passive rest and no intervention. Participants were assessed four times—before exercise, immediately after exercise, 24 h post-exercise (after two recovery sessions), and 48 h post-exercise (after four recovery sessions)—for perfusion unit (PU), muscle elasticity, pressure pain threshold (PPT), reactive strength index (RSI), and total quality recovery (TQR). Results: The statistical analysis revealed significant effects of both massage and BFR/cooling interventions across key recovery outcomes, with large effect sizes for time-related changes in RSI (p < 0.0001; η² = 0.87), elasticity (p < 0.0001; η² = 0.84), and PPT (p < 0.0001; η² = 0.66). Notably, post-exercise 48 h values for RSI, elasticity, PU, and TQR were significantly improved in both the massage and BFR/cool groups compared to control (p < 0.05)), while no significant group differences were observed for PPT. Conclusions: The study concludes that both massage and combined blood flow restriction with cooling interventions significantly enhance post-exercise recovery—improving muscle perfusion, elasticity, reactive strength, and perceived recovery—compared to passive rest.

Tendinopathies are prevalent in athletic populations, particularly in sports requiring repetitive high-load activities. Eccentric training is widely recommended for rehabilitation, yet variability in protocols and inconsistent methodological reporting limit standardization. This scoping review aimed to map existing evidence on eccentric training for tendinopathies in athletes, characterize intervention parameters, evaluate clinical outcomes and safety, and identify methodological gaps to inform future practice and research. Searches of PubMed, Scopus, and Web of Science were conducted. Eligible studies included athletes with tendinopathy undergoing eccentric training interventions. Randomized and non-randomized controlled trials were considered. Data extraction included intervention design, tendon site, loading parameters, outcomes, and adverse events. Critical appraisal was performed using RoB 2 and ROBINS-I tools. Thirty-one studies were included. Most examined patellar tendinopathy in volleyball and basketball players or Achilles tendinopathy in runners and soccer athletes. Protocols varied substantially in load, frequency, and progression strategies. Pain monitoring was integral, often allowing exercise into moderate discomfort. Eccentric training consistently improved pain and function, with heavy slow resistance and adjunct modalities showing comparable or additive effects. Return-to-sport rates were high, and adverse events were minimal. However, performance outcomes, tendon structure, and safety reporting were inconsistently assessed. Eccentric training consistently reduces pain and improves function in athletes with tendinopathy. Evidence is less consistent regarding performance outcomes, tendon remodeling, and comparative superiority over alternative interventions. Standardized reporting of protocols, safety, and sport-specific adaptations is needed to strengthen recommendations for athletic rehabilitation.