Following the lead of human athletic training, equine massage therapy is becoming a more common part of the management of equine athletes and pleasure horses alike. The basic science rationale for massage is supported by research indicating that massage may affect a number of physiologic systems as well as cellular and fascial components of the muscular system. Equine therapeutic massage, or sports massage, employs a number of techniques first developed in humans and has been reported to increase range of motion and stride length, reduce activity of nociceptive pain receptors, and reduce physiologic stress responses. Additional preliminary research indicates that massage therapy also may improve some aspects of exercise recovery. Although important evidence has begun to document the potential benefits of massage therapy for equine athletes, the current review may say less about the true clinical effects of massage therapy than it does about the current state of research in this field. Additional prospective study of massage therapy using sufficient scientific rigor will be necessary to provide veterinarians, trainers, and owners with definitive data and scientifically based confidence in the use of equine massage. In the meantime, the preliminary research, anecdotal positive effects, and case studies indicating potential benefit are not to be ignored; equine massage therapy already plays a valuable practical role in the care and training of many equine athletes.