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Can Massage Damage Nerves?

It is possible, but hard to do, rare, and the damage is usually minor

updated (first published 2008)ARCHIVEDArchived pages are rarely or never updated. Most featured articles on PainScience.com are updated regularly over the years, but not archived pages.
by Paul Ingraham, Vancouver, Canadabio
I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of ScienceBasedMedicine.org for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about memore about PainScience.com
EXCERPT This article is an excerpt from a detailed tutorial about neck pain. The same question is also addressed as a common question about massage in the trigger points tutorial.

Yes, you can damage nerves by massaging your neck, but it’s rare and rarely serious. I did it to someone just once in ten years working as a professional massage therapist — I tell the story below. Mostly nerve trauma is not something we need to worry about, but it’s a common concern anyway, driven by excessive “nerve fear” in our society.1 I get a lot of questions like this one:

One thing that helps sometimes when my neck pain gets excruciating is to really dig my fingers hard into a couple of muscle knots in the back of the neck (not right on the spine but off to each side, below the occipitals), or to use a Thera Cane to do the same thing. Is there any chance of causing nerve damage from so much pressure?

reader Peter Spaeth, Boston

I’m going to answer this in detail so that you have good confidence about this issue. I’ll discuss the physical protection most nerves have, some of the potentially more vulnerable locations (endangerment sites), the toughness of nerves, and the extra caution needed with tools.

Why nerves are not very vulnerable to massage

If you are even slightly cautious, it is nearly impossible to damage your nerves with self-massage, because:

  1. larger nerves are mostly padded well by other tissues
  2. healthy nerves are not especially fragile or sensitive
  3. if actually threatened by trauma, nerves produce plenty of warning sensations that will stop any sensible person before much harm is done

Let’s look at those in more detail…

Larger nerves are mostly protected

The larger nerves and nerve roots — the only nerves of any concern — are mostly shielded by skin, fat, muscle, and bone. It’s particularly unlikely that you could harm yourself by massaging in the location Peter asked about, on the back of the neck (beside and behind the spine). The only prominent nerves in the back of the neck are the nerve roots, the bundles of nerve tissue that emerge from between each pair of vertebrae. But these are under at least a half inch of sturdy musculature, the meaty paraspinal muscles.

But not all nerves are well-protected, of course.

Endangerment, Will Robinson!

There are a few places in the body where nerves are more exposed and can be injured by stronger pressures. All of these sites are familiar to any well-trained massage therapist: we call them “endangerment sites,” but the danger is minimal. Perhaps a better thing to call them would be “unpleasant places to rub.”

Here are all of the commonly cited endangerment sites (nerves highlighted):

Endangerment sites
anatomic location (plain English) potentially vulnerable anatomy
Anterior Triangle of the Neck (throat) carotid artery, jugular vein, vagus nerve; under sternocleidomastoid
Posterior Triangle of the Neck (side of the throat) nerves of the brachial plexus, proximal; brachiocephalic artery; subclavian artery & vein
Axillary Area (armpit) brachial artery, axillary vein & artery, cephalic vein; nerves of brachial plexus, distal
Medial Epicondyle, Humerus (inside elbow) ulnar nerve
Lateral Epicondyle, Humerus (outside elbow) radial nerve
Umbilicus region (belly) descending aorta & abdominal aorta
lateral 12th rib (lowest rib) kidneys
Greater Sciatic Notch (buttocks, beside tailbone) sciatic nerve
Inguinal Triangle (groin) external iliac artery; femoral artery; great saphenous vein; femoral vein; femoral nerve
Popliteal Fossa (back of the knee) popliteal artery & vein; tibial nerve
Hollow under the earlobe parotid salivary gland, facial nerve

The endangerment sites are debatable and in some cases definitely misleading. Nerves are everywhere, and there are many locations where they are potentially just as vulnerable to pressure as some of the ones listed above… but no one has ever proposed them an endangerment site.2 The idea that the sciatic nerve is “exposed” to any degree in the sciatic notch, for instance, is a bit ridiculous (compared to the ulnar nerve, say).

And you can easily massage the scalene muscle group (in the posterior triangle of the neck) without ever bothering a nerve fibre. Extra caution is justified in this area, but not because the brachial plexus is notoriously sensitive — it’s more because of the blood vessels.

If you massage these locations with reasonable caution, you might feel electrical, zappy, funny-bone-esque pains, but you will feel them before there is any actual danger. Healthy nerves aren’t particularly sensitive, but they will speak up if they are on the verge of being crushed or torn (like any tissue).

Nerves aren’t very fragile or sensitive

Most nerves, most of the time, can be firmly squeezed without producing any symptoms whatsoever. The ulnar nerve — the “funny bone” — is tolerant of almost any fingertip pressure, and only produces that infamous zing with much greater force. However, there are almost certainly circumstances where nerves can be more sensitive. For instance, they may only be sensitive to pressure when oxygen-starved (or otherwise vulnerable). Which may be exactly what’s going on with some of the nerve tissue in your neck — muscles rotten with trigger points are measurably hypoxic, low-oxygen.3

And so, one way or another, nerve roots in the posterior of the neck might sometimes be sensitive enough that you may get some stranger, nervier sensations when self-massaging in the neck. However, this sensation tells you nothing you didn’t already know: your soft tissues are cranky. There is no cause for concern if the sensations are easily tolerable.

In my experience, however, blatant nerve sensitivity in the neck is rare in association with neck cricks, even quite severe ones.

Or maybe they are naturally sensitive? But not in a “zappy” way

Another intriguing possibility is that the sensitivity of nerves and trigger points are actually the same thing — trigger points might be the sensitivity of vulnerable nerves. This is in contrast to the much more widely believed “tiny cramp” model of a trigger point.4 This idea is highly speculative; I’m including it just because it’s quite an interesting notion in this context.

If so, then pressing on them isn’t likely to injure them, or even cause clasically zappy nerve pain: just the familiar aching and burning of common muscle pain. The nerves are clearly vulnerable in some sense, but probably not to injury.

What happens if you push your luck and push too hard on nerves?

Push hard enough, and you can injure a nerve, of course. In a 2017 incident, a woman’s radial nerve was crushed by an aggressive massage in her upper, inner arm. It’s rare, but it happens.5 Deliberately ramping up pressure on a sensitive nerve is hard to do, like sticking your hand into a jar of scorpions. And yet, surprisingly, sometimes people still do it! It’s surprising what we can put up with if think it’s necessary, and the no-pain-no-gain attitude inspires a lot of foolishness.

Nerves can recover from a lot of abuse, up to and including being mangled in nasty accidents, or being pinched hard for years. For instance, many people who have severe carpal tunnel syndrome — years of disabling median nerve impingement — often recover just fine once pressure on the nerve is finally relieved by surgery.

In the unlikely event that you cause yourself a nerve injury, it would probably only result in annoying but trivial symptoms that would take a few days to resolve, or perhaps a few weeks at the worst. But I have rarely heard of this happening by self-massage — it’s just too unpleasant as you approach the point of injury to actually get there.

Please beware of tools

I’m sure that there are people, somewhere out there, who have hurt their nerves with self-massage. And I bet most of them were using a massage tool. When you use massage tools, it may be easier to apply too much pressure too quickly… before you have that “I’ve made a huge mistake” moment.

It’s harder to control tools, and hard to tell what’s going on when you’re sensitive fingers and thumbs aren’t involved. For example: you can easily feel the pulse of an artery when you are massaging with your fingers, for instance, but you can’t feel it at all when you use a tool.

So if you use a tool, use it with extra caution.

The Jacknobber

A nice, simple massage tool… but not recommended for use in vulnerable areas like the sides & front of the throat!

That one time I injured a client’s nerves

Once upon a time I pushed my luck, and injured a patient’s cervical plexus — this area where most people will probably never self-massage strongly. I injured him by applying strong pressures in a vulnerable area too quickly. It was one of my more reckless moments in a decade of mostly quite gentle massage.

He was alarmed and unhappy with me, of course, but his symptoms were minor: he had annoying flashes of moderate pain that slowly faded over about three weeks, and probably the worst thing about it was simply that he was less sure of his prognosis than I was. I knew he’d get better steadily, but he didn’t know if he could trust my opinion! Fair enough.

Plagued by a neck crick?

One of PainScience.com’s most popular tutorials is all about neck cricks — a detailed, sensible and scientific survey of what makes a neck crick tick — and your treatment options. Ideal for any frustrated patient with a jammed cervical spine, it’s also helpful for many a therapist not really sure how to treat this quirky phenomenon. Ships with a free bonus, PainScience.com’s valuable trigger point tutorial — a $20 value! Add it to your shopping cart now ($19.95) or read the first few sections for free!


About Paul Ingraham

Headshot of Paul Ingraham, short hair, neat beard, suit jacket.

I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.

Related Reading

What’s new in this article?

NovemberAdded much more information about endangerment sites, discussion of the potential relieve of neuritis, extensive clarifications and editing, and some footnotes.

Notes

  1. Nerves make people nervous! So to speak. The whole idea of nerves gets people anxious. Could it be a nerve? people ask. Is this a nerve problem? What if it’s a nerve? Is something pinching my nerve? Something must be pinching a nerve. BACK TO TEXT
  2. A good example is the mandibular notch, which is just under the cheekbone and in front of the jaw joint. It’s full of nerves, but completely safe to massage — indeed, it’s a particularly nice spot to massage. See Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome. BACK TO TEXT
  3. PS Ingraham. Toxic Muscle Knots: Research suggests myofascial trigger points may be quagmires of irritating molecules. PainScience.com. 1784 words. BACK TO TEXT
  4. Quintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger point phenomenon. Rheumatology (Oxford). 2015 Mar;54(3):392–9. PubMed #25477053. This infamous paper in the field firmly concludes that the integrated hypothesis of trigger point formation is “flawed both in reasoning and in science,” and they propose some replacements, including inflamed nerves. Neuritis is undoubtedly worth investigating, but it requires us to believe that nerve axons are routinely inflamed for no apparent reason, which doesn’t seem much different than the theory it is supposed to replace. The evidence cited to support it is just as limited as the evidence for trigger points, if not more so (just a few papers, all from the authors themselves, or their research colleagues). BACK TO TEXT
  5. Hsu PC, Chiu JW, Chou CL, Wang JC. Acute Radial Neuropathy at the Spiral Groove Following Massage: A Case Presentation. PM R. 2017 Apr. PubMed #28400223. BACK TO TEXT