Is Your Massage Really Safe?

Filipinos don’t just love massages. We revere it. We pass down our favorite types like family recipes, swearing by that one tita’s go-to in Quezon City or the lolo in the province who sorted out our backache with coconut oil. 

But how safe are massages, really?

In an era of wellness trends and where bodywork is seen as both therapy and luxury, traditional massages are being challenged by science. To answer our questions, Allure Philippines asked orthopedic surgeon Rich Pasion, MD, to bring in a surgical and sports medicine lens, especially when pain signals something more serious than tight muscles. He is a fellow of multiple orthopedic and surgery associations, and a founding board member of the ASEAN Society for Sports Medicine and Arthroscopy.

We also sat down with licensed physical therapist Dani Mojal, RTPT, of Cancio Chiropractic. In her practice, massage therapy is not a catch-all cure, but a tailored, medically-informed treatment that’s built on careful assessments, anatomical awareness, and red-flag spotting that most unlicensed practitioners aren’t trained for. 

Vetting your therapist

First things first: Both Dr. Pasion and Mojal agree on the importance of qualifications and communication. For those looking for a licensed massage therapist, Mojal advises, “Check for a certification—like TESDA’s NC II or a national certificate level two—which signifies that your therapist is licensed in their particular area of specialization. Also look for therapists [specifically] trained in orthopedic, medical, or sports massage, and ask if they have experience with your specific condition.”

While the massage you get from a licensed therapist at the spa and the one employed by a licensed physical therapist such as Mojal aren’t the same—the former focuses on relaxation, while the latter on rehabilitation—Dr. Pasion says the right one will always approach the massage professionally. “A good therapist will perform an initial intake or assessment, ask about your medical history, medications, and symptoms, and customize their approach,” he affirms.

What makes a safe massage for a physical therapist? While the tips below are generally used for physical therapy treatment, many of them may also be used with a massage therapist, who may augment their treatment or even rule out a massage in case there’s a risk for further injury. 

Mojal starts by sharing the importance of understanding the person, not just the pain. “I take my patient’s history, and ask about health problems, injuries, medications, and pain. Then I check for red flags and rule out serious conditions like fractures, infections, or severe illnesses and acute injuries.” 

At every stage, therapists must be attuned to the needs of their clients. “Monitoring and feedback are important,” she says. “I [also] monitor for adverse effects like pain, sensory changes, nausea, vertigo, and autonomic responses, observing both verbal and nonverbal cues.”

When massage can do more harm than good

Dr. Pasion shares a complementary perspective on the warning signs that your massage, whether done at home or in a facility, might actually be harming rather than helping. 

“Some soreness is normal, especially after deep tissue work, but if the pain lasts more than 24 to 48 hours or [if it] worsens, that’s a red flag that needs to be checked by a specialist,” he says.

Numbness, tingling, or radiating pain? These symptoms can indicate nerve impingement or irritation. “Anyone experiencing these signs should consult an orthopedic or spine specialist for proper treatment and clearance,” he warns.

Excessive bruising, joint instability, swelling, dizziness, or feeling lightheaded post-massage are also concerning symptoms. 

“Bruising may mean the pressure was too intense or improper, especially in people prone to bruising or on blood thinners,” Dr. Pasion explains. “Manipulating unstable or inflamed joints can worsen symptoms. And dizziness might signal overstimulation of the nervous system or blood pressure issues, which can be risky for older adults.”

Your age is a factor, too

Dr. Pasion also points out that massage safety varies across different groups:

• Older adults have thinner skin, more brittle bones due to osteoporosis, and reduced circulation, so gentler techniques are safer than deep tissue.
• Children and teens require gentler pressure because their bones and joints are still developing. Ideally, a pediatric-trained therapist should attend to them.
• Adults, especially athletes, can usually tolerate deeper pressure but need targeted care to avoid overuse or injuries.

For specific conditions, certain techniques should be avoided or adapted. In individuals with scoliosis, for example, Dr. Pasion says it’s best to “avoid strong lateral pressure on the spine or any attempt to ‘straighten’ it. Instead, gentle myofascial release and neuromuscular therapy around the curve are safer.” 

In cases of herniated discs, “avoid spinal manipulation or strong direct pressure near the affected vertebrae. Focus on relaxing surrounding muscles and decompression support.” 

And for joint inflammation like arthritis or injury, he advises, “Skip the massage during flare-ups, deep pressure on inflamed joints, and any stretching of those joints. Instead, gentle effleurage or lymphatic drainage can help reduce swelling.”

When to stop and seek help

Despite its reputation for healing, massage can sometimes cause harm. Mojal cautions, “Untrained therapists can cause injuries like fractures, nerve compression, joint sprains, and bruising. Improper massage can worsen existing conditions like slipped discs or blood clots. Lack of hygiene [also] increases infection risk.” 

You also shouldn’t hesitate to establish boundaries and ask to stop if you no longer feel comfortable. Open communication during the massage is always critical. “Pain is always a signal to stop or adjust the technique. If you’re in pain, always speak up,” Mojal stresses.

Dr. Pasion concurs, “If you feel persistent or increasing pain after sessions, numbness, dizziness, or unusual symptoms, stop immediately and seek medical advice.” 

He highly recommends avoiding the “no pain, no gain” mindset, especially if you have an existing condition.

How often should you get a massage?

Healing continues after the massage ends. Mojal advises patients to hydrate, avoid strenuous activity for 24 hours, and use ice if needed. “Watch for persistent pain, numbness, swelling, or signs of infection, and consult a doctor if these occur,” she says.

With regard to frequency, she explains that “there’s no one-size-fits-all.” 

“Wellness massage can be once or twice a week, while chronic pain conditions might require more frequent sessions initially.”

A tradition worth protecting

Because massages are so commonplace in the Philippines, it’s important to work with licensed professionals. Regardless if you’re with a massage therapist or a physical therapist, you need to listen to your body and voice out concerns if you’re unsure about an aspect of the treatment.  Even rituals born from love and trust must evolve to meet the standards of safety and science. The body, after all, is sacred—and how we care for it should be, too.