Deep Tissue Massage Risks and Pressure Limits

Urgent signs first

After deep or vigorous work, call 911 (or your local emergency number) for sudden breathlessness or chest pain, or for severe back pain with weakness or numbness in both legs or bladder or bowel changes. [1] [2] Dark or cola-coloured urine, less urine than usual, a swollen painful leg, or new numbness or weakness in an arm also need urgent medical care. [3] [4] [5] More in soreness or injury after massage.

What this page is, and is not

Deep tissue massage uses slower, firmer work aimed at deeper layers of muscle; see deep tissue massage: what it is and evidence for the full description and benefits. This page covers risk only. It gives no instructions for applying pressure, and it does not suggest that pain or strong pressure is better.

What the sources report

• Overall risk is low but not zero. The NCCIH says the risk appears low, with rare reports of serious effects such as a blood clot, nerve injury or fracture. It adds that some reported cases involved vigorous types such as deep tissue massage, or people at higher risk such as older adults. [6]
• Soft-tissue and nerve injury. A woman with low body weight developed acute nerve-root injury (cervical radiculopathy) after a 3-minute deep massage of a neck muscle, with sudden one-sided paralysis, shoulder pain and wrist weakness. She recovered by 6 months. The authors advise care with that muscle, particularly in underweight people. [5]
• Bleeding. A report is titled "Large Buttocks Hematoma Caused by Deep Tissue Massage Therapy." [7] Another describes bleeding around the spinal cord after vigorous back massage, with full recovery of strength. [8]
• Muscle breakdown. A man developed symptoms of rhabdomyolysis immediately after a 2-hour deep-tissue massage while infected with influenza A. The authors describe only a "possible temporal association." [9]
• Overall counts. A review of pain-related massage found 40 reports of 138 adverse events over 11 years, and judged the incidence low. [10]

These are single case reports. They show that harm is possible. They cannot show how often it occurs or whether the massage was the cause.

Is there a safe pressure limit?

Proper evidence not found. We searched PubMed for massage pressure or intensity with adverse events or safety limits, and for deep tissue massage adverse effects, and read the NCCIH page. We did not find a trial or guideline that sets a safe pressure, session length or force, or that compares harm between light and firm pressure. So we cannot give a number.

What the sources do say:

• In the Cochrane review of massage for low-back pain, increased pain was the most common adverse event (1.5% to 25% of people), and serious adverse events were not reported. [11]


• NCCIH notes that therapists may need to use less pressure in areas sensitive because of cancer or its treatments. [6]


• No source we read says pain during a massage is needed for benefit. Painful pressure is not something this site endorses.

Who should check first or ask for lighter work

The conditions below are where the reports and health-service pages point to more risk. Ask a clinician before booking.

• Blood thinners or bleeding problems. The NHS says anticoagulants can cause severe bruising. [12] See bruising after massage and blood thinners and massage.
• Possible or past blood clot. Leg DVT signs are throbbing pain in one leg, swelling and red or darkened skin. [4] See massage and blood clots.
• Osteoporosis. Fracture reports involve people with osteoporosis. [13] [14] See massage and osteoporosis.
• Cancer or cancer treatment. See massage and cancer.
• Pregnancy, recent surgery or injury, fever or infection. See massage safety and contraindications.

Speaking up

You decide the pressure. Say if it is more than you want and ask for it to be lighter or stopped. Consent can be withdrawn at any time. See massage pressure levels and how to talk to your therapist. Never stop or change a medicine because of massage.