Massage Bruising: What Is Normal and What Is Not

Urgent signs first

Severe back pain with pain, weakness or numbness in both legs, or with changes in bladder or bowel control, is an emergency, not a bruise. The NHS lists these among its "call 999" signs for back pain. [1] In the US, call 911. A case report of bleeding around the spinal cord after vigorous back massage described exactly this pattern: severe back pain, leg weakness and numbness, and urinary problems. [2]

For anything else, this page helps you tell an ordinary bruise from one that needs a clinician. It is general information, not a diagnosis.

What an ordinary bruise looks like

A bruise is a mark on the skin caused by blood trapped under the surface. [3] Most bruises last about two weeks, though some take months to fade. [3] They start reddish, then turn bluish-purple and greenish-yellow before returning to normal. [3] A bruise that follows a firm session and then follows that colour pattern is the ordinary kind.

How common is bruising after massage? Proper evidence not found. We searched PubMed for massage together with bruising, ecchymosis, hematoma and anticoagulant, and read the Cochrane review of massage for low-back pain and the 2024 Cochrane review of massage for neck pain. The back-pain review reported increased pain as the most common adverse event and no serious ones. [4] The neck-pain review said adverse events were too poorly reported to analyse. [5] Neither gave a bruising rate.

When bleeding is a bigger deal

Serious bleeding after massage is described in case reports, which show that something can happen but not how often.

• A published case report is titled "Large Buttocks Hematoma Caused by Deep Tissue Massage Therapy." [6]
• A man developed a spinal subdural hematoma (bleeding in the space around the spinal cord) after vigorous back massage. The authors note that traumatic spinal subdural hematoma is extremely rare, and he had no lasting neurological deficit at follow-up of more than 12 months. [2]
• A report describes small bowel intramural hemorrhage (bleeding in the bowel wall) in a person on warfarin after abdominal massage. [7]

A systematic review of adverse events after pain-related massage found 40 reports covering 138 events over 11 years, and concluded that massage is not free of risk but that the incidence is low. [8] The NCCIH, a US government research centre, says the risk of harm appears low and that the rare serious reports have sometimes involved vigorous massage such as deep tissue. [9] See deep tissue massage risks and pressure limits.

Medicines and conditions that make bruising more likely

• Anticoagulants ("blood thinners"). The NHS says the main side effect is that you can bleed too easily, including severe bruising, prolonged nosebleeds and bleeding gums. [10]
• Other causes of bleeding into the skin. MedlinePlus lists anticoagulants such as warfarin or heparin, aspirin, steroids, and antiplatelet medicines such as clopidogrel, along with low platelet counts and some medical treatments, among causes. [11]

Pressure limits for people on blood thinners: Proper evidence not found. We looked in the NHS and NCCIH pages above and in PubMed (massage with anticoagulant, warfarin and hematoma) and found no recommended pressure or technique, only the abdominal-massage case report. Tell your therapist and your prescriber that you take a blood thinner. Never stop or change a medicine because of massage. See massage with blood thinners and bleeding disorders and how medicines interact.

When to contact a clinician

MedlinePlus advises contacting a provider if you bruise for no reason, if a bruise appears infected, or if sudden bleeding into the skin has no apparent cause. [3] [11] Also get care if a bruise is very large, keeps growing, or comes with severe pain or any numbness or weakness. Those last signs come from the case reports and the NHS back-pain list above, not from a bruise-specific guideline.

MedlinePlus suggests that, to reduce bruising from an injury, you ice the area and raise it above your heart. [3] Do not rub or press a bruise to "break it up." We found no source supporting that.

Practical steps

• Before a session, tell the therapist about blood thinners, aspirin, steroids, bleeding or platelet problems, and recent chemotherapy or radiation. See preparing for a massage.
• Say if pressure is more than you want. You can ask for lighter work or to stop at any time.
• Keep a short note of when the bruise appeared and what you took, in case you need to show a clinician.