What foam rollers, massage guns and hospital massage deliver

For several weeks, a 38-year-old woman in Iowa held a percussion massager, the handheld device that drums on muscle with rapid pulses, against her temple and around her left eye. She was trying to relieve stubborn headaches. By the time she reached an emergency department, the vision in that eye had fallen to 20/600. University of Iowa eye doctors, reporting the case in 2024, ruled out other causes and blamed a cataract brought on by the device.

Her story sits at one end of a quiet change in how Americans get massaged. A lot of it now happens with no therapist in the room: a foam roller on the floor, a massage gun from a gym bag, a parent working a sore calf. At the other end, massage has become a hospital service. Since January 2018, hospitals accredited by the Joint Commission have had to offer non-drug pain treatments, and the commission’s report explaining that standard lists massage therapy among its examples.

The two settings teach the same lesson. In the best hospital and hospice trials, massage brought relief that was real and brief, and in hospice a good share of it also came from simple touch. At home, rollers and massage guns deliver small gains, and the injury reports cluster around where the pressure landed and on whom. Neither setting supports the belief that more force, or a machine, buys more benefit, or that a gadget sold for sore muscles can’t hurt you.

What a massage license proves, and how hands-on massage fares condition by condition, are the business of our article on massage credentials. This one follows the tools people use on themselves and massage at the hospital and hospice bedside.

What rollers and massage guns do

A 2019 meta-analysis led by researchers at Ruhr University Bochum in Germany pooled 21 studies of foam rollers and roller sticks. Rolling before exercise improved sprint performance by 0.7% and flexibility by 4%, while effects on jumping and strength were negligible. Rolling after exercise reduced perceived muscle pain by about 6%. The authors called the effects minor and partly negligible, and ended on a pointed line: “Evidence seems to justify the widespread use of foam rolling as a warm-up activity rather than a recovery tool.”

Even the flexibility gain is not unique to rolling. A 2024 meta-analysis of 38 studies and 1,134 participants found that neither foam rolling nor stretching improved immediate range of motion more than other warm-up activities did. A second 2024 review of multi-week programs found that in programs of four weeks or less, stretching produced a clear gain in range of motion and rolling did not.

Massage guns have thinner evidence. A 2023 review by Portuguese researchers found only 11 eligible studies, none at low risk of bias. The devices may improve flexibility and some recovery measures in the short term. For strength, balance, acceleration, agility and explosive movement, they showed no improvement or made performance worse, and the reviewers advised against using them before those activities.

For pain itself, the trial evidence is small. A 2013 New Jersey trial randomly assigned 40 adults with knee osteoarthritis to a narrated 20-minute self-massage of the thigh muscles twice a week or to a waiting list. The self-massage group reported better pain, stiffness and function scores, though knee range of motion did not change. With no sham comparison, that counts as preliminary. Why muscles ache for days after hard exercise belongs to our muscle soreness coverage.

In the library’s terms, rollers and massage guns are measured but below the threshold that matters for athletic performance, with small, real effects on how sore and how loose people feel.

Sold for sore muscles, with no review before sale

Many people assume a device sold to ease muscle pain has passed some federal check. The Food and Drug Administration puts an electrically powered massager intended for medical purposes, such as relieving minor muscle aches and pains, in Class I, its lowest-risk category. That class is subject only to general controls, and this device type is exempt from premarket notification, the filing in which a manufacturer shows the agency that a new product closely matches one already on sale. In practice, a company can market such a massager without submitting it to the FDA first. Class I is a judgment about a type of device, not a test of the one in your hands, and it does not mean the product was approved or cleared.

The hazards the government has formally documented are not the ones most people picture. The Consumer Product Safety Commission announced a recall of about 12,360 percussion massagers in January 2021 because their lithium-ion batteries could overheat, after three fires. In January 2024 it recalled about 46,000 more in the US that could overheat while charging, after 17 reports including one burned thumb.

Battery fires are a product defect. The injuries in the medical literature are a different problem.

Where the injury reports cluster

Journals now carry a growing file of case reports on these devices. Read them with one rule in mind: a case report describes one patient. It cannot tell you how often a harm occurs, because nobody counted the uneventful uses, so no injury rate for home devices can be calculated from them. What case reports can reveal is a pattern.

Around the eyes. Besides the Iowa cataract, at least three more eye-injury reports have appeared since 2022. A 69-year-old man in Chengdu, China, used a percussion device around his right eye for two months against headaches; the lens slipped out of place and set off acute glaucoma, a sudden rise in eye pressure, and three months after surgery his uncorrected vision in that eye was still at counting fingers. His doctors recommended against using the devices above the neck. Two 2026 reports followed: retinal tears in both eyes of an Edinburgh student who used one on his eyes against tiredness, and both lenses dislocated in a 62-year-old man in China with diabetes who pressed one to his closed eyelids for three days to ease dry eyes.

On the neck. Emergency physicians in Las Vegas reported a 27-year-old woman with headache, neck pain and dizziness who turned out to have a vertebral artery dissection, a split in the inner lining of one of the arteries supplying the brain, after repeated use of a handheld massage gun on her neck. The authors noted that causality is hard to establish.

On muscles already under strain. In what its authors called the first reported case of its kind, a young woman in China with untreated iron-deficiency anemia had her thighs worked over with a percussion gun by her coach after cycling. Within days she had aching thighs and tea-colored urine, the mark of rhabdomyolysis, a breakdown of muscle tissue whose contents can damage the kidneys. She recovered after intensive intravenous fluids in hospital.

Over a blood thinner. A New York kidney specialist described a hospitalized man with COVID-19 and leg clots who was taking two anticoagulants. A handheld percussion device was applied repeatedly to the spot on his abdomen where his blood-thinner injections went, in attempts to relieve pain. The report describes a 14-by-17-centimeter bleed in his abdominal wall and pelvis, which it associates with that device use, blocking drainage from both kidneys so that tubes had to be placed into them. He later died of cardiac arrest. The report does not attribute his death to the device.

On a leg with a hidden clot. These involve hands, not machines. In India, a 23-year-old man with a hairline ankle fracture died suddenly after his mother massaged his leg; the autopsy found that a clot in his leg veins had broken loose and lodged in his lungs, and his doctors had never warned him of the risk. In Thailand, a woman 25 weeks pregnant collapsed shortly after a leg and foot massage at a traditional massage shop. A massive pulmonary embolism, a clot blocking the lung’s arteries, left her in a coma after resuscitation, and the fetus died.

In none of these reports did trouble come from too little pressure. It came from the site (an eye, the neck, an abdomen prone to bleeding), the person (a hidden clot, anemia, anticoagulation) or both. That lines up with the National Center for Complementary and Integrative Health, the federal research center for these therapies, which reports that serious injuries from massage are rare and that several of the cases on record involved forceful techniques like deep tissue work or more vulnerable patients, older people among them. The classic review of massage harms is summarized in our credentials article.

Massage became a hospital service. What did the trials find?

Hospitals have lived under standard LD.04.03.13, the Joint Commission’s pain requirement, since January 1, 2018. One of its required elements obliges the hospital to provide non-drug pain treatments. The commission’s explanatory report offers examples, among them acupuncture, chiropractic care, osteopathic manipulation, massage therapy and physical therapy, alongside relaxation therapy and cognitive behavioral therapy.

What a patient gets depends on the hospital. In guidance reviewed in November 2022, the commission says no particular complementary therapy is mandated and hospitals need not grant every request; if a preferred safe therapy isn’t offered, staff are expected to explain where to find it after discharge.

The largest trial of hospital massage measured the outcomes hospitals care about most. Researchers at Veterans Affairs hospitals in Ann Arbor, Michigan, and Indianapolis enrolled 605 veterans, average age 64, having major surgery between 2003 and 2005. One group got routine care, one got 20 minutes of individual attention from a massage therapist, and one got a back massage each evening for up to five days. The massage group had short-term drops in pain intensity, pain unpleasantness and anxiety, and its pain eased faster over the first four days. But there was no difference in long-term anxiety, length of stay, opioid use or complications.

A smaller Mayo Clinic trial of 113 heart surgery patients found that massage lowered pain, anxiety and tension more than quiet relaxation time did. A 2016 review from the Samueli Institute in Alexandria, Virginia, pooled 16 trials of massage around surgery and found sizable effects on pain and anxiety against active comparisons, yet its expert panel offered only weak recommendations. That panel was grading research, not writing a clinical guideline.

Massage around surgery, in short, eases pain and anxiety for a while. In the largest trial, it did not reduce opioid use or send anyone home sooner.

In hospice, simple touch did much of the work

The most revealing trial in seriously ill people compared massage not with nothing but with simple touch. That NIH-backed study, reported in the Annals of Internal Medicine in 2008, enrolled 380 adults with advanced cancer and moderate to severe pain, 90% of them in hospice. Each was offered six 30-minute sessions of massage or simple touch over two weeks. Both groups felt better right after sessions. Pain fell by 1.87 points on a 10-point scale after massage and by 0.97 after simple touch, so massage added roughly 0.9 of a point, plus a smaller edge in mood. Over the following weeks, the groups did not differ in sustained pain, quality of life, symptom distress or use of pain medicine. Therapists who knew which treatment they had given collected the immediate ratings, a weakness the authors acknowledged. They concluded that “the potential benefits of attention and simple touch should also be considered in this patient population.”

Larger-sounding numbers come from weaker designs. Memorial Sloan-Kettering Cancer Center tracked 1,290 patients over three years and found that self-rated symptom scores fell by about half from before a massage to after it. With no comparison group, that describes what happened after a session, not what the massage caused. A 2016 Cochrane review of 19 studies and 1,274 people with cancer rated all of the evidence very low quality. It found short-term pain relief in a single trial of 72 people and no clear effect on anxiety, depression, fatigue, nausea or quality of life. Only two of the 19 studies reported adverse events at all, so this literature says little about harm either way.

The cancer guidelines follow the evidence closely. The Society for Integrative Oncology and the American Society of Clinical Oncology, in a 2022 pain guideline, name massage for one group: people with pain in palliative or hospice care, at moderate strength. Their 2023 guideline on anxiety and depression named options such as mindfulness programs, yoga, music therapy and reflexology (a foot-pressure practice); massage is not among the recommendations listed in its summary. The two societies’ 2024 update on fatigue in cancer survivors found one 66-person trial in which weekly Swedish massage beat both light touch and a waiting list, and light touch also beat the waiting list; the panel asked for larger trials and left massage among therapies with too little evidence to recommend for or against.

Cancer brings its own precautions. The federal center notes that therapists may need to press more lightly over spots left tender by cancer or its treatment. A 2017 Oncology Nursing Society article, written by a team that included a nurse who is also a licensed massage therapist, goes further: extreme caution when platelet counts are very low, no massage over a known deep vein clot or pulmonary embolism, care around ports and drains, no work on skin made sensitive by radiation, and a warning that deep massage may not suit some people with multiple bone metastases because of fracture risk. Whether, where and how firmly someone in cancer treatment is massaged is a call for the oncology team.

Before anyone presses: when a clinician’s okay comes first

This list is built from the case reports and trials above. It is not the general list of cautions for booking a therapist; that list sits with our coverage of massage licensing.

• A leg that is newly swollen, painful, warm or red, especially after a fracture, cast, surgery or long trip, or during pregnancy. MedlinePlus, a federal consumer health site, lists those as signs of a deep vein clot, and two reports above involved a clot nobody had found. Whether anyone, family included, can safely rub that leg is for a clinician who has examined it to judge.
• The face, eyes or neck, with a percussion device. Eye-injury case authors have called for warnings against use near the eyes, one team recommended against use anywhere above the neck, and the artery case involved repeated use on the neck.
• An injection site, a bruise or the belly, in someone taking a blood thinner. The hematoma case involved exactly that. The federal center’s massage page doesn’t address anticoagulants, so this caution rests on case evidence and on how those drugs work; whether a device or deep pressure is reasonable is a question for the prescriber.
• Muscles freshly worked hard, in someone with a known muscle or blood disorder, the combination in the rhabdomyolysis case.
• Any area affected by cancer or its treatment, where the oncology team sets the limits on pressure and sites.
• A symptom that hasn’t been explained, such as headaches or dry eyes. The federal center warns against letting massage delay a medical visit for a health problem.

Signs that need help now

• Sudden shortness of breath, chest pain that gets worse when breathing in deeply, a racing heart, coughing up blood, or fainting, especially soon after a leg was massaged: call 911. MedlinePlus lists these as signs of a pulmonary embolism, which needs treatment right away.
• Blurred vision, eye pain or a white haze after a device was used near the eye: same-day eye care.
• Headache, neck pain and dizziness after a device was used on the neck: urgent medical assessment, because artery tears like the one in that case are a recognized cause of stroke in young adults. Any sign of a stroke is a reason to call 911.
• Dark, tea-colored urine with severe muscle pain or swelling after hard exercise: prompt medical care.

Not how hard, but where and on whom

The same finding runs from the living-room floor to the hospice bed: relief from massage is real, modest and mostly brief. In the hospice trial, people given simple touch got about half as much immediate pain relief as people given massage, and none of the studies here showed that harder, faster or mechanical pressure buys more. The case reports add the other half of the picture: the danger sits in a handful of body sites and a handful of situations.

So the most useful question about massage, from any source, is not how hard but where, and on whom. In a hospital, the 2018 accreditation standard makes it fair to ask which non-drug pain options that hospital offers, and where to find the one you wanted after you go home.

Sources

1. National Center for Complementary and Integrative Health, National Institutes of Health. “Massage Therapy: What You Need To Know (Last Updated May 2019): serious side effects rare; some reported cases involved vigorous types such as deep tissue massage or people at increased risk such as elderly people; less pressure over areas sensitive from cancer; do not use massage to postpone seeing a provider.” nccih.nih.gov
2. National Center for Complementary and Integrative Health, National Institutes of Health. “Cancer and Complementary Health Approaches: What You Need To Know (Last Updated October 2021): limited evidence for massage; therapists may need less pressure in sensitive areas.” nccih.nih.gov
3. MedlinePlus, National Library of Medicine. “Deep Vein Thrombosis (last updated November 20, 2025): warmth and tenderness over the vein, pain or swelling, skin redness; a clot can break loose and cause a pulmonary embolism.” medlineplus.gov
4. MedlinePlus, National Library of Medicine. “Pulmonary Embolism (last updated August 3, 2026): symptoms including trouble breathing, chest pain worse with deep breaths, fast heartbeat, coughing up blood, fainting; needs treatment right away.” medlineplus.gov
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