Image shows yellow "caution" tape with the word "error" repeated on it, in order to illustrate the concept of medical errors.

Massage therapy is generally considered to be one of the safest health care practices available in modern medicine; however, it is possible for a massage therapist to commit a medical error if they execute an erroneous choice or action. This article will look at the prevention of medical errors in a massage practice.

In massage-related practice, applying the wrong technique would be considered a medical error; this would fall under the definition of “misapplication.” Another possible error is when the massage application itself created a harmful effect. While massage therapy medical errors rarely result in substantial bodily harm, it is vital to avoid errors.

Medical Errors Training is a Frequent Licensure Requirement

It is estimated that hundreds of thousands of medical errors occur in the U.S. each year. Medical errors can be minimal, grave, singular, compounding, harmful, not harmful, realized, unrealized, near misses and more. The most catastrophic medical errors can result in death.

Because of the number of errors, and the serious implications that can result from them, many states and licensing boards require health care professionals to complete medical errors prevention training to obtain and renew their licensure. 

Medical Errors in Massage vs. Mainstream Medicine

Recognizing medical errors in massage practice is different from recognizing them in mainstream medicine. Massage therapists do not commit the most common medical errors, such as a delayed diagnosis, misdiagnosis or erroneous medication administration, because none of these are within a scope of massage therapy practice.

While mainstream medicine might use a blood test, X-ray or exploratory surgery to determine therapeutic interventions, a massage therapist primarily relies on communication, which includes learning the client’s individual medical situation for application. Client communications are vital to determine the correct techniques and ensure the massage itself is appropriate.

The Most Common Massage-Related Medical Errors

In an extensive review of published case reports, research and legal action, our school found the greatest amount of massage-related medical errors occurred for two primary reasons:

1. Dismissing, not initiating and not actively engaging in client communications.

2. Improper massage application, likely due to inadequate training or planning.

While this article focuses on these two primary causes, additional massage-related medical errors can occur from incomplete record keeping, operating outside of scope of practice and more.

Massage-Related Medical Errors Due to Inadequate Client Communications

One example of a preventable medical error is a case where a therapist dismissed a client’s feedback that a stone was too hot during a hot stone massage. The client was severely burned and sued after the therapist assured them otherwise.

Another instance of a therapist dismissing customer feedback resulted in a nearly $800,000 financial award. The client suffered from hematomas, a newly diagnosed ruptured disc with lumbar radiculopathy, and other injuries.

In the lawsuit, the customer, who was a licensed physician, stated she provided repeated verbal and nonverbal communication that the massage hurt and the pressure was too hard. The therapist ignored her communications and continued the painful treatment.

The expert who testified on behalf of the massage recipient additionally reported that the therapist did not initiate or engage in communications with this client who was new to massage and did not know what to expect.

Takeaway: Initiating, listening to and responding to client feedback could have helped avoid this harmful error.

In another lawsuit, also pertaining to a situation where proper communications were not provided, an accident victim was supposed to receive rehabilitative treatment that was paid for by insurance. The therapist did not communicate any massage plans or goals, and it was insinuated by the client that the sessions were solely provided for exploitive financial gain.

Takeaway: Communicating a treatment plan with attainable goals and then reporting palpable changes in pain thresholds or hypertonic musculature could have helped establish the treatment’s therapeutic and rehabilitative nature.

Improper Research Can Contribute to Medical Errors

Social media has provided platforms for massage therapists to reach out to ask questions about client care and application techniques. Often, there is not enough client detail for commenters to provide adequate advice.

Google searches and seeking advice from strangers could provide incomplete, erroneous and unreliable information, which can contribute to poor planning and a medical error.

Medical Error Examples Due to Massage Therapy Misapplication

In one case report, a 67-year-old man was newly diagnosed with venous thromboembolism after a vigorous deep tissue massage.

Takeaway: Applying aggressive and excessive massage techniques within the geriatric population is often ill-advised, and could result in a life-threatening injury like this example.

In another event, vigorous massage was applied to a 62-year-old male who was taking the medication Warfarin. This resulted in a painfully large 8-inch by 5-inch hematoma on his back. He was hospitalized with orthostatic hypotension, slight anemia and required a blood transfusion. 

Takeaway: This massage was too aggressive and excessive for the client’s medical condition. Professional massage training urges us to use light pressure only on clients taking blood thinners like Warfarin, Heparin, Xarelto and Eliquis.

In yet another misapplication, a 51-year-old woman learned in the emergency room that her ureteral stent was displaced after experiencing severe and recurrent left-flank pain subsequent to her deep tissue massage, which included Rolfing techniques. Ureteral stents are not displaced with traditional massage application.

Takeaway: A thorough client intake process could have elucidated this rare contraindication to avoid deep penetrating massage over the local area.

There are several documented hot stone massage incidents that include third-degree burns with keloid scarring. These resulted when massage therapists told clients to lay directly on top of hot stones in addition to laying placement stones directly onto the clients’ skin.

Takeaway: Updated hot stone massage education warns of the burn injury risks with these practices.

While all of these clients may have benefited from massage practice, the treatment provided was incorrect, and resulted with significant consequence for all parties involved.

For Prevention of Medical Errors, Seek Ongoing Education in Methods Practiced

Like all health care practices, massage therapy methods continually evolve to improve outcomes. Updated professional education should be sought to learn methods that are not safe or effective.

Continuing education can review new discoveries, techniques, precautions, contraindications and more. Massage therapists should continually train in their respective modalities to provide the best available treatment and prevent avoidable medical errors.

Medical Errors Are Often Preventable and Sometimes Debated

Some health care professionals disagree about the nature of a true medical error. Beyond the debate is the ongoing effort to not cause harm.

Medical errors are vast and include incidents that can be illuminating. Self-awareness and self-assessment can improve safety and foster lifelong learning with the acquisition of experiential wisdom.

The incidents described in this article can be interpreted in many ways. Regardless of the legal outcomes, the undeniable consensus is that these medical error examples were preventable. That is why medical errors prevention education is crucial to becoming the best provider you can be, to do no harm.

Wendy Hoon Langen
Wendy Hoon Langen

About the Authors

Selena Belisle
Selena Belisle

Wendy Hoon Langen is a licensed physician assistant and massage therapist who currently works as a Barry University Associate Professor in the Physician Assistant Program. Selena Belisle is a retired professional athlete, licensed massage therapist and founder of CE Institute LLC. Combined, they offer over 60 years of massage therapy experience in their classes at as NCBTMB approved continuing education providers.