Can Massage Be Dangerous?

You anticipate relief. But will you walk away from the massage table worse off than you were before? (MoMo Productions/Getty Images)

When you book a massage, you expect relaxation — perhaps a little discomfort, but with the ultimate goal of relief. Occasionally, however, massages take a dangerous turn, as was the case for a 41-year-old man who developed a blood clot around his spine after a particularly vigorous rubdown, according to a new case report in the journal Spine.

After a trip to Thailand, where he received the massage, the patient showed up to his local emergency room, barely able to walk and complaining of severe back pain. The trouble had started shortly after his massage, which wasn’t exactly your traditional rubdown — it involved bending, twisting, and stepping on his back and waist. His diagnosis: spinal subdural hematoma, or a blood clot between his spinal cord and the tough, leathery membrane surrounding it, says Richard Senelick, M.D., a neurologist and medical director of The Rehabilitation Institute of San Antonio.

“This [condition] is really rare,” says Senelick. “And it sounds like this wasn’t your typical massage — it was incredibly aggressive.”

But this isn’t the only crazy tale of a massage gone wrong. In a 2011 study, Taiwanese researchers reported a case where a 47-year-old man felt suddenly weak in all four limbs during a neck massage. Later, he noticed numbness in his fingers, especially while lying down. He was subsequently diagnosed with a spinal cord injury, possibly as a result of lying flat on his back without neck support during the massage, the researchers said.

Related: 3 Steps to a Fitter, Slimmer, Younger You

If you dig deep enough into the scientific literature, the reports become increasingly bizarre, with cases of hearing or vision loss after a rubdown and even blood clots forming in the liver. It’s enough to make massage seem like a serious gamble, but Senelick isn’t alarmed. “It’s more dangerous to drive to work every day than it is to go get a massage,” he says. Or as Patricia Coe, massage therapy clinic supervisor at National University of Health Sciences puts it, “think of all the millions of people who get massages per year — this is kind of a fluke event. A rarity.”

In the United States, Swedish massage — which involves stroking, gliding, and kneading — is the most popular technique. “It’s the standard sort of relaxation massage,” says Coe. It tends to be very gentle, so it’s not likely to leave you limping. In fact, in a review of massage-related injuries published in Rheumatology, the researchers concluded, “Serious adverse effects were associated mostly with massage techniques other than ‘Swedish’ massage.”

At her clinic, which focuses on the Swedish style, Coe has never seen (or heard of) cases of serious injury after a rubdown. In fact, in an analysis of 100 patients, her colleagues found that the most common reported side effect was delayed onset muscle soreness. “It tends to be that level of adverse side effects,” she says.

It’s really only when massages are vigorous or involve “high-thrust” movements that you should be concerned, says Senelick. “There’s feel-good massage, Swedish massage, where you go to a spa and you just get your back rubbed,” he says. “Then there’s deep-tissue massage, where you go to be loosened up.” In these settings, he warns against sudden movements or rapid twisting, similar to chiropractic manipulations, which have been suggested to increase risk of stroke. “There’s a sudden, thrusting movement of the neck,” he explains. “The artery that goes up the neck to the brain tears or gets a clot in it.”

However, even if the technique is gentle, you should be vigilant about keeping your spine in a neutral position throughout your massage. “Any position that doesn’t allow you to achieve and maintain a neutral spinal alignment can cause problems, especially if you have any preexisting spinal injuries, like a herniated or slipped disc,” says Nina Cherie Franklin, exercise physiologist and licensed massage therapist at the University of Illinois at Chicago. How to tell if your spine is safe? You should be able to draw a straight line from your ear to your shoulder to your hip at all times. (This is why your practitioner might put a pillow or bolster between your legs.)

Despite these risks, Coe still says she wouldn’t necessarily avoid even Thai massage, a notoriously vigorous technique. You just need to be a proactive patient.

Your first step: Choose a certified massage therapist, and at your appointment, fill out your medical history as thoroughly as possible (a good masseuse will require this). “They’re not trying to be nosy,” Coe says. “They just want to be able to provide the safest possible experience.”

In fact, there are conditions where even the gentlest massage may be a bad idea: People with heart failure, liver failure, certain infections (such as phlebitis or cellulitis), blood clots in the legs, bleeding disorders, or contagious skin diseases should steer clear of the table, according to University of Maryland Medical Center experts. If you have cancer, ask your oncologist before getting a massage, since your skin may be more sensitive after chemotherapy or radiation.

Related: 5 Exercises That Combat ‘Computer Body’ (Yes, It’s a Thing!)

Certain techniques also may not be suitable for certain conditions. If you have diabetes with numbness due to nerve damage, for example, skip the hot stone massage, since you may not be able to tell your masseuse if the rocks are burning you, cautions Coe. Deep, pressure-point massages may be a bad idea if you have osteoporosis. If you have an infection (like the flu), Swedish massage, which is designed to boost circulation, probably isn’t advisable.

And as tempting as it is to race to your masseuse after hurting yourself — say, you pull a muscle in the gym or slip a disc — you shouldn’t treat new injuries with massage for three months (unless prescribed by a licensed physical therapist). “You don’t want to interrupt the healing process,” explains Franklin.

Your best bet? Inform your therapist of any health concerns, so he or she can adjust the treatment to your needs. “A practitioner should be able to pinpoint what’s not a good treatment for you specifically,” says Franklin. From there, your masseuse can tweak the technique, level of pressure, body positioning, or the duration of the massage as necessary.

Regardless, you shouldn’t be shy about speaking up if something feels a little funky. What’s the difference between “good” and “bad” pain? If your masseuse presses on a tender point, the discomfort should ease up fairly quickly, says Senelick. “If it’s just making your pain worse, tell them to stop. ’No pain, no gain’ is nonsense.” Adds Franklin: “With trigger-point therapy, people just assume that it’s supposed to be painful, so they take it. Mild discomfort is normal — pain is not.”

And don’t worry about offending your masseuse — he or she will most likely welcome the feedback. “I know it’s hard to speak up, because you’ve put yourself in the hands of a person who’s trying to help you,” says Coe. “But I’m happy when people tell me, ‘That doesn’t feel good.’ The person on the table is the one experiencing the massage, not the therapist giving it.”

Your Next Read: 8 Sneaky Symptoms of Stress