Percussion Massager: Dangers? Side Effects ? Contraindications

Do you have questions about dangers, side effects and contraindications of massage gun? I am a physiotherapist and I will provide you with my opinion and the findings of my research on this subject.

I have decided to create articles about percussion massager because I have noticed a gap between what my patients expect from such a tool and what can reasonably be expected.

Today, I will address some of the most frequently asked questions regarding massage guns: What are the risks associated with their use? What are the contraindications and side-effects?

My opinion is based on:

• Feedback from some of my patients or colleagues who have used them. My general knowledge of how our bodies function and the factors that contribute to our physical and mental well-being.
• My extensive research and readings in international scientific literature, as well as in the French and English-speaking web.

I am also happy to answer any questions and address any comments you may have in the comments section 🙂.

What is a massage gun?

You may have noticed it yourself: throughout history, various tools have been used in addition to hands for massaging different parts of the body. In recent years, one of the most popular tools has been the massage gun.

The graph below illustrates this trend, showing a significant surge in interest for this device since 2019.

The massage gun is simply a small, over-the-counter device shaped like a gun. It operates mechanically and is powered by a rechargeable battery. It can be used for self-massage or applied by another person, such as a physical therapist, on different areas of the body.

Different attachments can be fitted onto the device depending on the body part being targeted.

How does percussion massager work?

Most of these devices deliver percussion therapy (low amplitude, high frequency) to “relieve muscle tension.” On many models, the number of impulses per minute can be adjusted.

It is somewhat like small “taps,” vibrations that are non-painful, similar to a small jackhammer.

Vibration therapy (sometimes called vibrotherapy) has been used in medicine and sports for decades. Today, there is a renewed interest in it, particularly due to these massage guns.

What are the benefits of massage gun?

Those who sell this device are quite praising of it. They claim that it is supposed to:

• Help stretch muscles and connective tissues
• Reduce pain in soft tissues (ligaments, muscles, tendons, etc.)
• Increase muscle strength
• Improve blood circulation in the affected area
• Enhance overall physical recovery and performance.

Source: Konrad 2020; Lupowitz 2022

I take the time to delve into the theoretical and empirical benefits of massage guns.

This allow us to see if the manufacturers’ “promises” are truly supported by our current scientific knowledge and if we have empirically observed an effect on people from these massage guns. I provide also my perspective as a physical therapist on this matter.

It’s worth noting that the medical literature dedicated to massage guns is very limited: only five publications have been published in scientific journals as of the time I am writing this.

Today, I am focusing on the potential dangers associated with the use of percussion massager.

Are there any dangers using percussion massager? Any side effects?

In the vast majority of cases, there are no dangers associated with the use of massage guns.

However, it’s similar to driving a car to work: in the majority of cases, you won’t experience any adverse events. Sometimes, though, you may have an accident or a health problem while driving. When you choose to drive a car, you are aware that you are exposing yourself to these risks (even if they are minimal), and you still decide to take the car.

Well, if you’re reading this article, it’s likely because you want to be in the same situation: knowing the risks (even rare and minimal) you are exposing yourself to in order to decide whether or not to use a massage gun, considering the advantages and benefits that percussion massager can provide.

Therefore, I will present to you these known risks.

Increase (slightly) in pain instead of relief

The most common “risk” is that you may not find the massage very pleasant and may feel worse after using the massage gun than before. But this “risk” is equally present with hand massage: back massage can increase pain in 1.5% to 25% of people who receive it!

The most frequent “danger” (although rare: theoretically 1 person out of 100 to 1 person out of 4) is to experience increased pain after using the massage gun.

Source: Cochrane 2015

Now let’s look at three much rarer but more serious risks.

Vertebral artery dissection

Dissection of the vertebral artery is a very rare occurrence (3 people out of 100,000 per year). What happens in this case? There is bleeding in an artery in the neck. If not treated in time, it can lead to a stroke, which often results in lifelong disabilities and paralysis.

These dissections can occur a few hours, days, or weeks after a trauma, even a minor one. Among the traumas that can be responsible (although very rare) are:

• neck massages;
• use of massage guns in the neck area.

Indeed, a team of doctors from the United States reported a case of vertebral artery dissection following the use of a massage gun.

It involved a 27-year-old woman who presented to the emergency department with worsening dizziness for the past two weeks. For the past four days, she had also been experiencing headaches and neck pain. She had no recent trauma but had started using a handheld massage gun on her neck three weeks prior.

Doctors conducted several tests and diagnosed her with a vertebral artery dissection, most likely due to the use of the massage gun as no other explanation could be found. She was treated with medications and did not have any neurological complications, at least during the time she was followed.

Lesson to be learned: Although the risk of vertebral artery dissection is low, it is better not to use the massage gun on the neck!

Unfortunately, the people who sell or manufacture these devices do not provide sufficient information about this.

While the user manual often states not to use it on the neck, if you browse the web and social media, you will find numerous advertisements showing the massage gun being used on the upper and lateral parts of the neck, and even on muscles slightly more anterior! Exactly where these arteries pass.

Source: Sulkowski 2022

Rhabdomyolysis after using a massage gun

Another research team tells the story of a 25-year-old Chinese woman. She consulted doctors due to severe fatigue and pain in the thigh muscles for the past three days. She had difficulty walking, and her urine had a tea-like color for one day. She had a preexisting untreated anemia (iron deficiency).

Two and three days prior, she had cycled at a gym for 30 minutes. Immediately after cycling, she received a 10-minute percussion massage on both thighs using a commercial percussion gun to massage and relax the tired muscles. This treatment was administered by her trainer, who was unaware of the patient’s medical history before the treatment.

On the same evening, the patient experienced pain in both thighs, and urine discoloration was observed two days later.

The medical team conducted tests and diagnosed rhabdomyolysis. This is a rare condition that affects the muscles, where muscle cells are destroyed. The destruction of these cells triggers various reactions in the bloodstream, which can be detrimental to the kidneys and other organs. It is a problem that can have serious consequences.

The doctors found that the rhabdomyolysis in this woman was not caused by the usual factors (heat stroke, alcoholism, crayfish consumption, excessive exercise, etc.).

Based on the patient’s medical history (anemia = iron deficiency) and clinical characteristics, trauma is highly suspected as the dominant cause of rhabdomyolysis. Cycling for half an hour per day for two days is not considered excessive exertion for this patient, as she had previously cycled without developing rhabdomyolysis.

However, the repeated percussions of the massage gun on the affected muscles after exercise may have caused the destruction of muscle fibers and subsequently led to rhabdomyolysis, resulting in pain and hematomas in her thighs.

Source: Chen 2021

Acute glaucoma after using a massage gun

A 69-year-old Chinese man had been using a percussion massage gun around his right eye for the past two months to alleviate his headaches. After experiencing eye pain and blurred vision for five days, he went to the ophthalmic emergency department.

The doctors diagnosed ophthalmic complications (injuries to the eye):

• subluxation of the crystalline lens acute angle-closure glaucoma;
• pterygium (thickening of eye tissue).

Surgical procedures were performed, and the patient used specific eye drops for three months.

Three months later, visible lesions were still present during examinations, but the patient no longer reported pain or discomfort.

The research team concludes that the instructions for massage guns should clearly state to never use the gun above the neck.

Source: Jiancheng 2022

Another study reports another case of ocular issues in a 28-year-old man. He applied the massage gun to his eye for one hour per day for several months to “relieve the sensation of ocular pressure”!

Source: Seider 2023

Conclusion: side effects of massage gun

When using a massage gun, there are three known possible side effects:

1. Increased pain (theoretically affecting 1 in 100 to 1 in 4 individuals).
2. Much more rarely, severe consequences such as bleeding in the aorta of the neck leading to a stroke (or even death), rhabdomyolysis, or ophthalmological issues.
3. It is possible that new adverse effects related to its use may be described in the medical literature in the coming years.

There have been few publications on this topic as the popularity of this device is recent. The first scientific publication dates back to 2021!

What are the contraindications?

Massage guns are a form of vibration therapy. Here are the usual cases in which vibration therapy is not typically used:

1. Fracture in the area to be treated.
2. Neuropathy.
3. Fibromyalgia.
4. Epilepsy.
5. Pregnancy.
6. Recent surgery (e.g., knee replacement).
7. Presence of metal pins or plates in the target area.
8. Cardiac pacemakers or implanted devices.
9. Skin eruptions or open wounds.
10. Hypertension or risk of blood clotting (thrombosis, phlebitis).

Please note that these are precautionary guidelines. While it is not certain that using mechanical vibration is harmful in these cases, there are concerns that it may be. Therefore, as a precaution, it is recommended not to use mechanical vibration when in one or more of the listed situations.

You will also find a list of contraindications on the user manual of each massage gun, which should be similar to the one listed here.

Sometimes, there are so many contraindications that one might wonder how many people can actually use the device if all of them are followed! For example, diabetes, sprains, herniated discs, etc. Manufacturers also cover themselves by listing a significant number of contraindications in case of any issues.

Source: Lupowitz 2022

What precautions should be taken using a percussion massager?

To use a massage gun properly, here are some things to keep in mind:

1. Check for contraindications. If you have any, consider discussing with a healthcare professional (doctor, physical therapist) the benefit-risk ratio of using the massage gun anyway.
2. Avoid using the massage gun on the neck (front and sides). Be cautious when using it on the back of the neck.
3. Do not use it around the eyes and be cautious when using it on the face, according to certain recommendations.
4. Like with any new thing, start using it gradually and slowly increase the duration, frequency, and intensity if you are responding well to it.

Which massage gun to choose? Comparison

Massage guns are sold almost everywhere in stores and online: Aliexpress, Amazon, … the list is almost endless! Just like the list of brands and models: renpho, hypervolt, theragun mini, homedics, vibe pro, toloco, hyperice, bob and brad, fitrx, dacorm, taotronics, legiral, chirogun, aerlang, aldomn infinity…

If you’re looking to buy a massage gun for self-care and immediate relief, there are a few criteria you can consider when choosing your device:

1. Durability: Make sure it doesn’t break down after just a few uses.
2. Battery Life: Ensure that the battery provides sufficient usage before needing a recharge.
3. Power: The device should have enough power to apply significant pressure to different areas of your body.
4. Best value for money based on these criteria.
5. Personal preferences: You may have your own subjective criteria regarding battery life, aesthetics, or other factors.

Keep in mind that, in principle, no massage gun is inherently safer than another. The level of danger is more related to the manner of use and your overall health rather than the specific type of massage gun. However, this is based on our current knowledge.

Here are 2 massage guns that I think meet all these criteria, sold by a reliable site: