SaveYourself.ca • Sensible advice for aches, pains & injuries
updated 5/30/11
People think of massage therapy as a “safe” therapy, and of course it mostly is. But things can go wrong. Serious side effects in massage therapy are rare, and common side effects are minor. A 2007 survey of 100 massage patients1 found that 10% of 100 patients receiving massage therapy reported “some minor discomfort” in the day following treatment. This would mainly be a familiar slight soreness that is common after a massage — I’m surprised only 10% reported it. The massage must have been quite gentle.
Interestingly, 23% reported unexpected benefits that had nothing to do with aches or pains.
(Also interesting is that this means that most of these patients experienced no noteworthy effect at all, good or bad! Hopefully they enjoyed the massage at the time …)
This study is the only one of its kind that I know of. It’s underpowered (small) and cannot and does not rule out rare and/or serious side effects of massage therapy, which certainly do exist. You could probably do several studies of 100 patients without encountering a single nasty situation. But what if you surveyed 1000 patients? Or 10,0000? Massage is not completely safe. Some adverse effects would almost certainly turn up in a large enough survey.
Massage can:
In my decade as a massage therapist, I met many patients who had been harmed by massage therapy to some degree: several dozen of them who experienced nothing but minor negative effects and a light wallet, expensive disappointments; and perhaps a dozen whose chronic pain problems were worsened; and a handful more who were quite clearly injured by massage.
A painful, alarming sensory experience can actually dial up pain sensitivity — even long term.2 Furthermore, vulnerability to this awful phenomon is much more common and significant in desperate patients who already have chronic pain — so they seek and tolerate intense therapy.
The experience of pain is affected by many factors, including emotional and psychological ones. People in chronic pain usually experience some degree of pain neurology dysfunction, and a breakdown of the relationship between how bad things feel and how much is really wrong. That breakdown can be seriously worsened by threatening sensations. Thus, people experiencing pain system dysfunction can have minor and major setbacks in response to excessively painful massage.
One of my readers suffered this kind of disaster. She was injured by “fascial release” therapy, a style which is often too intense and may focus on treating connective tissues to the exclusion of considering the patient’s comfort and nervous system. Her story is told in A Critical Review of Myofascial Release (MFR) Therapy.
I may have been too aggressive with a few patients over the years. I never did serious harm this way as far as I know, but I’m sure that I occasionally did more harm than good. This failure was due entirely to ignorance of pain science. I simply did not know that an intense massage could change pain sensitivity itself. Does your therapist?
The neck is not generally a fragile structure, but it is in some people. Another serious example of an adverse effect of massage is what happened to my barber — either a brain stem injury or mini-stroke caused by careless massage of a vulnerable neck. One of my own patients was injured the same way by another therapist, vomiting and retching for a hours afterwards (a nasty symptom of brain stem impingement). I came close to doing this to another patient — that’s three examples of such patients in my career — but I’m proud to say that I spotted the warning signs and avoided disaster.
I also know of a patient whose femur (the big leg bone!) was fractured by a massage — it was a weak and injured femur already … but wow!
Nerves aren’t nearly as vulnerable to pressure as people generally think — most of them can actually take quite a licking and keep on ticking without a single symptom — but they aren’t invulnerable. And I once caused a nerve injury myself: it was a minor injury, but it did result in weeks of aggravating for my client.
These are rare but real incidents. Healthy people are unlikely to be injured by massage. Most of dangers are related to undetected vulnerabilities, and they emphasize the importance of alternative health professionals being trained to spot the scary stuff. The measure of a health professional’s competence is not what they do with relatively healthy patients, but whether they have the training and humility to realize when they are on thin ice.
Manual therapists need to know that the most important part of their job is the smart management high-risk situations that they may see only a handful of times in their entire career. It’s like being on guard duty: 99.9% of the time, nothing bad happens. But how do you handle a curve ball when it finally comes?
Consumers need to know that cocky, overconfident therapists who trash-talk “mainstream” health care are all-too-likely to be ignorant of critical warning signs, or dismissive of them. The skeptical salamander thinks these therapists shouldn’t be allowed to touch anyone.
BACK TO TEXT Comments: Pain itself often modifies the way the central nervous system works, so that a patient actually becomes more sensitive and gets more pain with less provocation. That sensitization is called “central sensitization” because it involves changes in the central nervous system (CNS) in particular — the brain and the spinal cord. Victims are not only more sensitive to things that should hurt, but also to ordinary touch and pressure as well. Their pain also “echoes,” fading more slowly than in other people.