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Rheumatology Advance Access published online on May 30, 2003
Rheumatology, doi:10.1093/rheumatology/keg306
Rheumatology © British Society for Rheumatology 2003; all rights reserved
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© 2003 British Society for Rheumatology

Original Papers

The safety of massage therapy

E. Ernst 1*

1 Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, Exeter, UK

* Corresponding author. E-mail: E.Ernst{at}ex.ac.uk.

Received 2 May 2002 ; accepted 5 February 2003

Abstract

Objectives. After many years out of the limelight, massage therapy is now experiencing a revival. The aim of this systematic review is to evaluate its potential for harm.

Methods. Computerized literature searches were carried out in four databases. All articles reporting adverse effects of any type of massage therapy were retrieved. Adverse effects relating to massage oil or ice were excluded. No language restrictions were applied. Data were extracted and evaluated according to predefined criteria.

Results. Sixteen case reports of adverse effects and four case series were found. The majority of adverse effects were associated with exotic types of manual massage or massage delivered by laymen, while massage therapists were rarely implicated. The reported adverse events include cerebrovascular accidents, displacement of a ureteral stent, embolization of a kidney, haematoma, leg ulcers, nerve damage, posterior interosseous syndrome, pseudoaneurism, pulmonary embolism, ruptured uterus, strangulation of neck, thyrotoxicosis and various pain syndromes. In the majority of these instances, there can be little doubt about a cause-effect relationship. Serious adverse effects were associated mostly with massage techniques other than ‘Swedish' massage.

Conclusion. Massage is not entirely risk free. However, serious adverse events are probably true rarities.

Key words: Complementary and alternative medicine, Massage, Adverse effects, Safety, Risk.
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