Massage Warning Signs Checklist: When to Stop a Session and When to Call for Help

Urgent first: call 911

Stop the session and call 911 (in the US) for any of these. The warning signs below come from the NHS, the UK health service, which uses 999 as its emergency number.

• Possible blood clot reaching the lungs. Pain and swelling in one leg together with shortness of breath or chest pain. [1] A lung clot can also cause sudden difficulty breathing, chest pain that is worse when you breathe in, or coughing up blood. [2]
• Possible heart attack. Chest pain that feels crushing or squeezing, pain spreading to the arm, neck or jaw, shortness of breath, sweating or nausea. [3]
• Possible stroke. Face drooping, arm weakness or numbness, slurred or confused speech. Other signs include loss of sight in one or both eyes, dizziness or falling over, and a severe headache. [4] The NHS says signs that stop after a short time still need medical help straight away. [4]
• Serious illness with a skin infection. A hot, painful, swollen skin patch with a very high temperature or shivering, fast heartbeat or breathing, faintness, or confusion. [5]

The NHS says not to drive yourself to the hospital; call for an ambulance instead. [1]

Stop the session now, then decide what next

You do not need a medical reason to stop. The NCBTMB code of ethics tells certified practitioners to respect the client's right to refuse, modify or end treatment at any time. [6] A massage-industry health site says that if massage feels worse than a "hurts good" sensation, it is too much and you should speak up. [7] Say it plainly: "Please stop," "lighter, please," or "I need to end the session."

Hours to days later: call a clinician

• Dark, red or cola-colored urine, much less urine, weakness, or muscle tenderness. MedlinePlus lists these as symptoms of rhabdomyolysis, the breakdown of muscle tissue that can damage the kidneys. [9] It is rare. One case report links it to a deep tissue massage in a man with influenza, and another considers heated massage-bed use as one possible contributor among several factors after surgery. [10][11] Seek prompt medical care and mention the massage.
• One-sided leg pain, swelling, warmth or color change. The NHS lists these as DVT symptoms and advises urgent medical advice. [1]
• Severe bruising, bleeding, blood in urine or black stools if you take blood thinners. The NHS lists these among the bleeding problems of anticoagulants. [12]
• Hot, red, swollen, painful skin. Possible cellulitis; the NHS advises an urgent appointment. [5]
• Ongoing or worsening pain, or pain that began after the session. NCCIH lists rare serious reports including a blood clot, nerve injury and bone fracture, some involving vigorous massage such as deep tissue massage or people at higher risk, such as older adults. [8] See soreness or injury after massage and what is normal bruising.

After neck work

Forceful neck manipulation (a quick thrust applied to the neck, done in chiropractic or manual therapy rather than in a standard massage) is a separate topic. An American Heart Association and American Stroke Association statement says patients may present with one-sided headache, neck pain, or signs of reduced blood flow to the brain or eye, and that most population studies found an association between neck manipulation and a type of stroke in young patients. It says current biomechanical evidence is insufficient to establish that manipulation causes artery tears (dissections), that it is unclear whether the cause is trauma or an existing tear, and that the incidence is probably low. [13] If you develop sudden headache, neck pain, or stroke signs after any neck work, call 911 and tell the responders. See neck massage and neck manipulation: stroke-risk reports. Nothing on this page teaches neck techniques.

How common are serious harms?

A 2003 systematic review found 16 case reports and four case series of harms and concluded serious adverse events are probably true rarities, mostly with techniques other than Swedish massage. [14] NCCIH says the risk of harmful effects appears low. [8] That review is from 2003. A 2026 review of massage trials in people with cancer found that 53% of the 63 studies did not report on adverse events and called the quality of harm reporting poor, so rare problems may be undercounted. [15] See adverse event reporting and safety data.

Tell your therapist before you start

Mention blood clots, blood thinners, heart conditions, cancer, pregnancy, recent surgery, injuries, fever or infection, and skin problems. Kaiser Permanente lists fever, contagious disease, bruises, a clot in a vein, bleeding disorders, blood thinners, recent surgery and broken bones as reasons not to get a massage. [16] See preparing for a massage and the massage safety quick reference.