Massage Guns: Do or Don't?
"Should I use a percussion device or massage gun?"
That is an excellent question; unfortunately, many patients and athletes assume devices they see at race expos, post-race recovery tents, or in magazine articles are safe and don't question it.
My answer is no; you should not use a percussive device or massage gun. Before you discard yours or ignore my answer and go ahead and use it anyway - yes, I know who you are - please hear me out.
The reason I do not recommend the use of percussive devices or massage guns is that the risks outweigh the benefits. Unlike vibrating massage heads or foam rollers, these devices create a downward force into the body's tissue like a jackhammer, and the smaller the head(s), the more concentrated the power. This hammering force can cause damage, sometimes severe.
Unfortunately, athletes, in particular, associate "pain" with stretching or massage as beneficial. "It hurts, so it must be working." That is rarely the case. It is difficult for injured or sore athletes to discern when it is acceptable to feel discomfort with a self-treatment method like a massage gun.
Risks of using a massage gun
Safely using a percussive or massage gun requires a thorough command of human anatomy. Besides a general knowledge of where the claves, glutes, and hamstrings reside, most athletes and patients are unaware of the location of nerves, blood vessels, lymph nodes, bursae, organs, tendons, or ligaments. Improper device placement over these structures can cause severe damage.
Massage guns on injured and inflamed connective tissue can further damage the structure and increase inflammation. For example, use on a torn ligament, like an ankle sprain, could injure it further.
There are many examples of patients in my clinic who improperly used a massage gun to treat their soreness, pain, or injury. Below are four cases.
Case #1
A patient attempted to treat his groin pain, in this case, psoas tendonitis, and placed the gun in the area where the femoral nerve, artery, and vein reside. Not only is it contraindicated to use the device on the injured, inflamed psoas tendon, but the risk for vessel and nerve damage was high in this area.
Case #2
A patient tried to treat his pectoral muscle strain and aimed the device in his armpit on a large bundle of nerves called the brachial plexus. Damage to these nerves could cause temporary or permanent disability to the entire arm/hand.
Case #3
A patient attempted to treat her knee pain and aimed the device at the painful spot but didn't realize that what "hurt so good" was the peroneal nerve. Damage to this nerve could cause foot drop - or lack of the ability to lift the foot.
Case #4
A patient tried to treat her sore "glute" with the massage gun but didn't realize she aimed it at a bursa (a fluid-like sack) in the same area. Because this was my initial visit with her, it is hard to know if she was suffering from bursitis before using the gun or afterward, but in either case, her injury and pain were worse.
Dangers and contraindications for massage gun use
While rare, a percussive massage tool can sometimes cause severe or life-threatening injuries, including fractures or joint damage, deep vein thrombosis, and rhabdomyolysis.
Using a percussive massage gun can cause a fracture in persons with osteopenia or osteoporosis. Never use a massage gun at the site of a fracture - even a stress fracture. If you suspect a fracture go to the emergency room or an orthopedic urgent care center.
Deep vein thrombosis is a rare but life-threatening condition, especially for post-surgical patients. It tends to show up as calf pain and soreness. A massage gun on that sore calf could dislodge the blood clot and cause a pulmonary embolism and death. If you are experiencing symptoms consistent with a blood clot, go to the emergency room.
Rhabdomyolysis is a severe and potentially life-threatening condition. Endurance sports athletes are particularly at risk of acute exercise-induced rhabdomyolysis (AER), which can occur after profound overexertion, such as after a long run, ride, or race. Endurance athletes using percussion massage to treat delayed onset muscle soreness after an endurance event or training session may be at a higher risk.
There is a case in the literature of a patient who suffered a case of severe rhabdomyolysis after percussion massage: Chen, J., Zhang, F., Chen, H., & Pan, H. (2021). Rhabdomyolysis After the Use of Percussion Massage Gun: A Case Report. Physical Therapy, 101(1). https://doi.org/10.1093/ptj/pzaa199
Not ready to throw your massage gun in the trash?
Limited research supports that a percussion device can help with increased mobility when used on healthy tissue and when operated by a healthcare professional. The risks outweigh the benefits, but if patients and athletes insist on using them, I recommend scheduling an appointment with a physical therapist to learn how to use them safely.
While your health is serious business, we can also take a minute to laugh about the massage gun. Check out comedian Tom Papa’s bit about these “weapons-grade jackhammer massage guns.” Tom Papa: What A Day!
Alternatives to achieve mobility
Physical therapists, patients, and athletes have many safer alternatives to achieve mobility. Subscribe to Coach Amy Says to receive upcoming posts on how to achieve mobility and why Coach Amy does not recommend stretching as well as other tips on injury prevention, wellness, and performance.
Coach Amy discusses massage guns and all things endurance sport with Coach Liz in their podcast, The Coach Amy and Coach Liz Show. Coming soon to Apple Podcasts, Google Podcasts, and Spotify.