Two articles on PainSci cite Sutham 2020: 1. Massage Therapy Side Effects 2. Does Massage Increase Circulation?
PainSci commentary on Sutham 2020: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
This is a case study of a pregnant woman who fell into a coma after a traditional Thai massage at a shopping center in Chiang Mai, Thailand. Her baby miscarried. The cause was a clot in her leg, which was dislodged and carried to her lungs, where it stuck, cutting off lung circulation.
About 10 minutes after her massage, the woman developed shortness of breath, became disoriented, convulsed, lost consciousness, and had a heart attack. She was initially resuscitated at the hospital, but remained comatose, and she remained unconscious for two months until the case report was written.
“Pregnant women are at a higher risk of undetected or subtle thromboembolism…” and “it is reasonable to conclude that the patient had undetected preexisting deep vein thrombosis, which was mechanically dislodged by the massage and travelled massively to both lungs, leading to a life threatening condition.”
~ Paul Ingraham
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
BACKGROUND: Traditional massage seems to be safe but not entirely risk free, though serious adverse events are very rare. This report is aimed at illustrating a rare but fatal presentation of massive pulmonary embolism caused by leg massage and also to encourage both massage providers and pregnant women to be aware of undetected or subtle deep vein thrombosis, which could be a life threatening condition as a consequence of leg massage.
CASE PRESENTATION: A 25-year-old primigravid Thai woman underwent massage at a traditional massage shop at 25th week of gestation. Shortly after leg and foot massage, she had a sudden onset of dyspnea, followed by consciousness alteration, brief spastic-like convulsion, became unconscious and suffered a cardiac arrest. Basic life support (BLS) at the event scene as well as during transfer and advanced cardiovascular life support (ACLS) at the hospital were provided, resulting in successful resuscitation but persistent coma. Bedside echocardiography showed poor contractility of the dilated right ventricle, and pulmonary embolism was suspected. CT angiography (CTA) revealed multiple concentric intraluminal filling defects within the right and left pulmonary arteries, indicating massive pulmonary embolism. The fetus died in utero and spontaneous labor and vaginal delivery occurred.
CONCLUSION: Leg massage in patients with deep vein thrombosis can dislodge thrombi, leading to life threatening pulmonary embolism, and should be contraindicated. Since pregnant women are at a higher risk of undetected or subtle thromboembolism, traditional massage in pregnant women should be contraindicated unless they are proven to have no such risk.
- “Pulmonary embolus originating below knee,” S E Warren, Lancet, 1978.
- “Renal artery embolization after back massage in a patient with aortic occlusion,” A Mikhail, J F Reidy, P R Taylor, and J E Scoble, Nephrol Dial Transplant, 1997.
- “Massive pulmonary emboli after legs massage,” Fadi I Jabr, Am J Phys Med Rehabil, 2007.
- “Massaging the outcome: an unusual presentation of pulmonary embolism,” Danny Chin Guan Lim, Hari Kishan Jayanthi, Andrew Money-Kyrle, and Punit Ramrakha, BMJ Case Rep, 2009.
- “Leg massage by mother resulting in fatal pulmonary thromboembolism,” Chittaranjan Behera, Shinto Devassy, Asit R Mridha, Mohit Chauhan, and Sudhir K Gupta, Med Leg J, 2018.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.
- Exercise and education versus saline injections for knee osteoarthritis: a randomised controlled equivalence trial. Bandak 2022 Ann Rheum Dis.
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.