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What’s the Harm?

Adverse effects of massage therapy

by Paul Ingraham, Vancouver, Canada MORE
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Credentials and qualifications

I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.

For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.


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.

When massage goes bad

Massage can:

Don’t forget that pointlessly draining your wallet is another kind of hazard! If someone spends $5,000 on massage therapy that has only a minor therapeutic effect, or none at all, is that an injury? It would certainly add insult to one.

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.

Pain system dysfunction

An intense, no-pain-no-gain massage style is popular, and it’s certainly dangerous for some patients.

The most common, insidious bad outcome of massage, I think, is a painful massage that frightens a patient whose experience of pain is already a bit off. People experiencing pain system dysfunction can have a minor and major setbacks in response to excessively painful massage. The experience of pain is affected by many factors, including emotional and psychological ones. People in chronic pain always experience some breakdown of the relationship between how bad things feel and how much is really wrong. (See Pain Is an Opinion.) That breakdown can be seriously worsened by a painful, frightening experience.

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.

Other examples

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.

Lessons for professionals and patients

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.


Notes

  1. Cambron et al. J Altern Complement Med. 2007. Return to text.