Adverse Event Reporting and Safety Data in Massage: What Is Known

Urgent first. Call 911 in the United States (or your local emergency number elsewhere) if, during or after any neck work, you or someone with you has signs of a stroke. The NHS lists these as face weakness, where one side of the face may droop and it may be hard to smile; and speech problems, such as slurred or confused speech [1]. The NHS also notes stroke symptoms can sometimes stop after a short time, so you may think you're OK, and advises getting medical help straight away anyway [1]. For other worrying symptoms after a session, see Massage Warning Signs Checklist and Soreness or Injury After Massage.

This page is information only. It describes what safety data exist, not whether massage is safe for you. Do not use massage to put off seeing a health care provider about a medical problem [2].

The big picture

The U.S. National Center for Complementary and Integrative Health says the risk of harmful effects from massage therapy appears to be low, with rare reports of serious side effects such as a blood clot, nerve injury, or bone fracture [2]. It adds that some reported cases involved vigorous massage, such as deep tissue massage, or people who might be at increased risk of injury such as older adults [2]. Evidence label: low risk overall, serious harms rare but reported; data limited.

What the safety research is made of

Why the data are thin

Three gaps matter. First, trials rarely report harms well: the neck-pain review could not analyse serious adverse events because reporting was inadequate [7], and only half of the reviews in the VA map collected adverse event data [9]. Second, case reports show that something can happen, not how often. The Ernst review found that most effects were tied to exotic types of manual massage or massage given by laymen, with massage therapists rarely implicated, and concluded serious events are probably true rarities [3]. Yin and colleagues likewise said the incidence is low [4]. Third, terms vary: reports of "massage" harms sometimes include spinal manipulation; Yin found spinal manipulation within massage repeatedly associated with serious events [4].

We did not find, in the sources we read, a national system for reporting massage injuries or a statistic on how many occur per session. Reporting routes for misconduct are covered on Boundaries, Misconduct and Reporting Problems.

Neck manipulation is a separate caution

Forceful neck manipulation (chiropractic or manual-therapy territory, not massage) is sometimes confused with neck massage. An American Heart Association/American Stroke Association statement describes cervical manipulative therapy as a high or low amplitude thrust applied to the cervical spine by a healthcare professional [10]. It reported an epidemiologic association between cervical artery dissection and the therapy, but it is unclear whether this is due to missed pre-existing dissection or to trauma from the manipulation, and current biomechanical evidence is insufficient to establish that it causes dissection [10]. This is a caution only. We do not describe techniques. If you have new neck pain with a sudden headache or any stroke sign above, get emergency care first. More at Neck Massage and Neck Manipulation.

What to do with this

Tell your therapist about clots, bleeding problems, cancer, pregnancy, fragile bones, recent surgery, injuries and skin problems, and ask for lighter pressure if anything feels wrong. Which conditions need a clinician first is covered on Massage Safety and Contraindications. Increased pain was the most common side effect in low-back pain trials [5]; pain that is severe or getting worse needs care, not more pressure.