Massage Safety: Bruising, Skin Conditions, Blood Clots, Anticoagulants, Osteoporosis, Cancer Care and Pregnancy

Urgent Signs First

Get emergency help, not a massage, if you have signs of a blood clot or a stroke. In the US, call 911.

• Possible clot in a leg vein (deep vein thrombosis, or DVT): the NHS lists throbbing pain in one leg, usually in the calf or thigh, swelling in one leg, and red, blue or darkened skin around the painful area. [1]
• Possible clot in the lungs: the NHS says to call 999 (UK) or go to A&E if DVT symptoms come with shortness of breath or chest pain, because a clot can travel to the lungs. [1] Sudden difficulty breathing, chest or upper back pain, a very fast heartbeat or fainting are also emergency signs. [2]
• Stroke: the NHS lists face drooping, weakness in one arm, and slurred or confused speech, and says to call 999 (UK) straight away. [3] Stroke after neck work is covered on the neck massage and neck manipulation page.
• Back pain with warning signs: the NHS says pain, tingling, weakness or numbness in both legs, loss of feeling around the genitals or anus, or bladder or bowel changes need an emergency response. [4]

The Overall Picture

The National Center for Complementary and Integrative Health (NCCIH, a US government agency) says the risk of harm from massage appears low, with rare reports of serious effects such as a blood clot, nerve injury or bone fracture. It adds that some cases involved vigorous massage, such as deep tissue massage, or people who might be at higher risk, such as older adults. [5] A 2014 systematic review found 40 reports describing 138 adverse events linked to massage over 11 years, and concluded that massage is "not totally devoid of risks" but that such events are uncommon. [6]

Two limits matter. Most serious events are known only from single case reports, which cannot show how often they happen or prove that massage was the cause. And a list of conditions that rule massage in or out, endorsed by a regulator, was not described in the sources we read. So this page and the pages it links to rely on health service information about each condition plus published reports. They are not a complete checklist, and your own clinician's advice comes first. See talking with a health professional.

Who Should Check With a Clinician First

Other situations people ask about, such as heart conditions, varicose veins, diabetes with reduced skin sensation, fever and recent surgery, have their own pages: heart conditions and blood pressure, varicose veins and circulation problems, diabetes, neuropathy and fragile skin, illness and fever and massage after surgery or injury.

Soreness and Bruising

Soreness is the most commonly reported problem. In the Cochrane review of massage for low-back pain, increased pain was the most common adverse event, reported in 1.5% to 25% of participants, and no serious adverse events were reported in those trials. [16] The Cochrane neck-pain review could not tell whether massage increases adverse events such as treatment soreness, sweating or low blood pressure, because the evidence on adverse events was very low certainty and data on serious adverse events were not available. [17] More on what is normal is on the bruising page and the page on soreness or injury after massage.

Consent and Your Right to Stop

Ontario's massage regulator says patients can withdraw consent at any time and that treatment will be stopped or modified at their request. [18] That is one jurisdiction's rule; the same principle is a sensible expectation anywhere. Pain that is sharp, worsening or not settling is a reason to stop and seek care, not to push on. The warning signs checklist lists what to watch for.

What To Tell Your Therapist

Tell the therapist about any condition, medicine or recent surgery listed above, any area that is swollen, painful, bruised or broken, and any allergy to oils or lotions. Ontario's regulator says a therapist must not use a product, including lotions and lubricants, if they lack enough information about its risks and contraindications. [18] Do not stop or change a medicine because of a massage; ask your prescriber. For preparation tips, see preparing for a massage. Massage is at most an addition to medical care. NCCIH advises against using it to postpone seeing a health care provider about a medical problem. [5]