Bruises after a massage: why they appear and how to deal with them

The next morning you stretch in front of the mirror. There on your thigh or shoulder is a small bluish mark. Where did that come from? It was a massage, not a wrestling match. The first reaction is usually a puzzled one: did they do something wrong?

Take a breath. In most cases it's completely harmless. A small bruise after a more intense massage is nothing out of the ordinary and fades within a few days. It isn't a sign of a "bad" massage or anything to worry about. But we'll give you the other half of the truth just as plainly: a good massage shouldn't leave you covered in bruises. Let's look at why they occasionally appear, when they're fine, how to keep them to a minimum, and when it's worth paying attention.

Where did that bruise actually come from

A bruise is a small thing at heart. A few of the finest blood vessels (capillaries) burst under the skin and a little blood spreads into the surrounding tissue. Hence the colour. First blue, then green and yellow as the blood is gradually reabsorbed. For this to happen during a massage, several things usually come together:

• Firmer pressure on a sensitive spot. A strong grip, thumb or elbow deep in a muscle, combined with an area of thinner skin, like the inner arms, thighs, or around the shoulder blades. That's where a bruise is most likely.
• More fragile capillaries. Some people simply have more delicate blood vessels and bruise from bumping a table corner. On that kind of skin, a firm massage shows more easily than on other people.
• Individual predisposition. Age and thinner skin, hormonal changes, and a shortfall of certain vitamins all play a part. That's why one person has nothing after the same massage and another has a small mark.
• Blood-thinning medication. Anticoagulants, but also everyday aspirin or supplements such as fish oil or ginkgo, increase the tendency to bruise. If you take them, tell your therapist beforehand. She'll adjust the pressure.

When it's likely and when it almost never is

Here's the key to the whole topic: not every massage carries the same risk. It mostly comes down to how deep the work goes.

• A gentle relaxation massage. Flowing, gliding strokes over oil work with the surface of the body and the nervous system rather than the depth of the muscle. After a relaxation massage a bruise is genuinely rare. The point is to unwind you, not to crush you.
• Deeper, restorative work. With a sports massage or targeted work on knotted muscles, the pressure deliberately goes deeper. This is where a small bruise can appear, especially on a sensitive spot. It's worth expecting.
• Traditional Thai massage. It combines pressure, stretching and bodywork. Even so, bruises are the exception. When they do show up, it's usually where the pressure was strongest.

In other words: a couple of small marks after deep work on a stiff back makes sense. Bruises after an easy relaxation massage do not. They're a sign the pressure was too much for your skin. That's easy to fine-tune, more on it next. Not sure which type suits you? Our guide Which massage is right for me will help.

How to keep the risk to a minimum

The best prevention costs nothing and fits into a single sentence: talk to your therapist about pressure. A massage can be adjusted at any time, but only if we know how you feel.

• Ask for your intensity up front. Do you prefer a gentler touch (SOFT) or a firmer hand? Just mention it at the start and we'll tailor the grip to match.
• Speak up the moment pressure hurts. Pain is not a sign of effectiveness. If something feels sharp, it's perfectly fine to say "gentler, please". That's exactly what your therapist is there for.
• Mention medication and a tendency to bruise. Blood thinners, a fresh bruise, varicose veins or sensitive skin. These all change the approach and choice of technique in advance.
• Come rested and hydrated. Well-perfused, hydrated tissue takes pressure better. For how to prepare, see our guide What to bring to a massage.

And afterwards? No pressing or "finishing off" the area that felt intense. What tends to do the body more harm than good after a massage is covered in What not to do after a massage.

How a bruise heals and how to help it

Left alone, your body handles it by itself. The colour actually tells you how far along it is: from blue-purple it turns green and finally yellow-brown before it disappears. Usually within a few days, and up to two weeks for a larger bruise. You can't speed up healing much, but you can ease the discomfort:

• Cool it on the first day. A cold compress for a few minutes calms a fresh bruise and limits how far it spreads.
• Then switch to gentle warmth. From day two, warmth supports circulation and helps the blood reabsorb.
• Go easy on the spot. Don't press on it, and hold off on another massage right there until the bruise is gone.
• A gel is fine. Cooling or arnica gels from the pharmacy make healing more comfortable; a pharmacist can advise on how to use them.

A bruise is just one of the reactions your body can surprise you with after a massage. Muscle soreness and tiredness arrive just as innocently. You'll find the full overview in Reactions after a massage: what's normal and when to pay attention.

When to pay attention

The line is thankfully clear. A small, well-defined bruise that gradually fades is harmless. In some cases, though, it's sensible to talk to a doctor.

These are no longer reactions to a massage but something a doctor should know about. Be sure to mention it to your therapist before you book again, too. A massage is deep care and relief, not a medical treatment. It's no substitute for a check-up or examination.