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

Urgent Signs First

Get medical help rather than a massage if you have swelling, throbbing pain and red or darkened skin in one leg (possible deep vein thrombosis, a blood clot in a vein). The NHS says to get medical help as soon as possible, and to call 999 or go to A&E (UK) if you also feel short of breath or have chest pain; in the US, call 911. [1] Back pain with pain, tingling or numbness in both legs, loss of feeling around the genitals or anus, or bladder or bowel changes is also an emergency. [2]

Overall Picture

The risk of harm from massage appears low. There have been rare reports of serious effects such as a blood clot, nerve injury or fracture, some after vigorous types such as deep tissue massage or in people at higher risk, such as older adults. [3] A review of 40 reports covering 138 adverse events found that the incidence of such events is low, but that massage is "not totally devoid of risks." [4] The sections below cover the groups for whom extra care is most often discussed. A published, regulator-endorsed list of contraindications was not available in the sources we could read, so these sections rely on published reports and on health service information about each condition, and they are not a complete checklist. Always tell the therapist about your health and medicines. Medical advice from your own clinician comes before general information. See talking with a health professional.

Bruising and Discomfort

Soreness is the most common side effect. In the Cochrane review of massage for low-back pain, increased pain was the most frequently reported adverse event, in 1.5% to 25% of participants, while no serious adverse events were reported. [5] In the neck-pain review, reported events included treatment soreness, sweating and low blood pressure, but reporting was inadequate to say how often. [6] More serious bleeding under the skin is described in case reports, including a large buttock hematoma after deep tissue massage and a spinal subdural hematoma after vigorous back massage. [3] Pressure should feel tolerable. Pain that is severe, getting worse or not settling is worth discussing with a clinician; see reporting adverse events from therapies.

Skin Conditions and Infection

We did not find a regulator or clinical guideline that lists which skin conditions rule out massage, so we cannot give a verified list. What we can say from sources: Ontario's massage regulator requires cleaning and disinfecting tables, linens and equipment, including hot stones and oil bottles, after each client. [7] The same regulator says a therapist must not use a product, including topical products and lubricants, when they lack sufficient information about its risks and contraindications. [8] For lymphatic drainage, UCLA Health says the technique can spread infection and lists cellulitis among the conditions needing medical advice first. [9] If you have an open wound, a spreading rash, a fever or an infected area, tell the therapist and ask a clinician before booking; for allergies to oils or lotions, say so at the start.

Possible Blood Clots

NCCIH notes rare reports of a blood clot after massage. [3] The literature includes a case report of venous thromboembolism after vigorous deep tissue massage. [3] Another report described a pregnant woman at 25 weeks with an unrecognized DVT who collapsed with a massive pulmonary embolism shortly after leg and foot massage. [10] Warning signs of leg DVT include throbbing pain in one leg, usually in the calf or thigh, swelling in one leg and red, blue or darkened skin. [1] If you have had a clot, ask your clinician before leg massage.

Anticoagulant Considerations

Anticoagulants ("blood thinners") reduce clotting; the NHS lists excessive bleeding, such as severe bruising, nosebleeds and bleeding gums, as the main side effect. [11] Firm massage can bruise anyone, and we found published bleeding complications of vigorous massage. [3] But proper evidence not found for specific pressure limits, techniques or guidance for people taking anticoagulants: we searched PubMed for massage with anticoagulant, warfarin, bleeding and hematoma, and the NHS and NCCIH pages, and found no recommendation. The practical step is to tell your prescriber and the therapist that you take a blood thinner, and never to stop or change the medicine because of massage. See medication interactions.

Osteoporosis

Osteoporosis weakens bones, making them fragile and more likely to break; breaks of the spinal bones are common. [12] Fractures after massage have been reported: a vertebral pedicle fracture after a back massage in a 66-year-old man with osteoporosis [13], and an osteoporotic compression fracture in an elderly woman using an automated massage chair, whose authors advised care for people with or at risk of osteoporosis. [14] NCCIH lists fracture among the rare serious effects. [3] If you have osteoporosis, low bone density or a history of fracture, ask your clinician what level of pressure is appropriate, and tell the therapist. See osteoporosis and bone health.

Cancer-related Care

NCCIH says massage is usually safe when used appropriately, but special precautions may be needed for people with cancer. [15] Therapists may need to use less pressure than usual in areas sensitive because of cancer or its treatments. [3] One review found conventional cancer care can safely include massage, although people with cancer may be at higher risk of rare adverse events. [16] Check with your oncology team first. For the evidence on symptom relief, see massage evidence by goal; for lymphedema, see manual lymphatic drainage.

Pregnancy

A review of 12 trials of relaxation massage in healthy women past 12 weeks of pregnancy reported only minor, temporary side effects, and discussed precautions such as preventing pulmonary embolism. [17] Because trials often excluded complicated pregnancies, this does not cover high-risk pregnancies. [17] NCCIH notes that special circumstances such as pregnancy may affect the safety of an approach. [18] Ask your midwife or obstetric provider first, and tell the therapist how far along you are; leg pain or swelling needs medical review rather than massage. See pregnancy and breastfeeding safety and therapies in pregnancy.