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Guns blazing: What do RMTs and patients need to know about massage guns before pulling the trigger?

 Massage guns have exploded in popularity since the start of the COVID-19 pandemic. Therabody, the company that makes the Theragun, reported in a February 17, 2021 press release that in 2020 the company tripled its revenue over 2019. Meanwhile, Google Trends data shows that Canada-wide interest in massage guns spiked around Christmas 2020.

Massage gun manufacturers are also attracting high-profile investors and spokespeople. Therabody’s list of investors includes celebrities like Daniel Craig and Rihanna. Hyperice, maker of the Hypervolt, has sponsorship agreements with the L.A. Lakers, the New York Yankees, the NFL, the PGA Tour, and the UFC. These influencers are leveraging their considerable reach to promote massage guns – and it’s working. Absolute Marketing Insights predicts the global massage gun market will grow at a compound annual rate of 9.8% through to 2027.

Some consumers say they purchased a massage gun during the COVID-19 lockdowns, when they couldn’t see their RMTs in person. Meanwhile, some RMTs are incorporating massage guns into practice as part of a sports massage offering. With these devices growing in popularity, it’s worthwhile to take a closer look at them. Are they safe? Are they effective? Should RMTs be talking to patients about potential risks of home use? And what do RMTs need to know before using one in practice?

Regulatory, maintenance, and safety precautions
Chris Semenuk, RMT, is the owner and director of ATLAS Consulting & Education in London, Ontario. Semenuk is the Head of Massage Therapy for the University of Western Ontario cross country/track and field teams and a member of the Registered Massage Therapists’ Association of Ontario (RMTAO) Board of Directors.

Semenuk says that RMTs who plan to use massage guns in practice should take several precautions. First and foremost, RMTs must check with their provincial regulator to ensure these devices are permissible within the scope of practice.

“British Columbia, for instance, has a clause that says RMTs aren’t supposed to use electrical devices within the scope of RMT therapy,” Semenuk explains. “They might be able to use it in a different scope, like as an athletic trainer. ”

Beyond regulatory concerns, there are other issues to consider – namely, safety and efficacy. Do your research before buying a massage gun. Independent reports by other RMTs, scientific research in clinical journals, and patient accounts can all inform an RMT’s decision to use (or not use) a massage gun.

From there, Semenuk says RMTs need to understand their maintenance and reporting obligations. In Ontario, there are no mandated absolutes regarding maintenance standards, but there are some guidelines in place:

“The college’s recommendation is to follow manufacturer recommendations. That means read the manual and follow the maintenance plan. We’re also supposed to indicate in our logs when we check our equipment, whether that’s once a week, once a month, whatever the manufacturer recommendation is.”

Your maintenance schedule should be tailored to your level of use. If you’re using the massage gun more frequently than is considered normal, then you should be doing maintenance checks more often. A monthly check could become a weekly check depending on your circumstances.

“Maintenance is always much more important for anything that has a battery in it,” Semenuk says. “You have to be aware that malfunctions are possible. Water could get into it, or it could short out, or maybe someone changed the settings on you.”

The battery itself demands specific attention. Some massage guns run on rechargeable lithium-ion batteries that require certain care and maintenance procedures. Keep a note in your maintenance logs of when the battery will reach its end-of-life, and be ready to replace it when necessary.

When using a gun in practice, it is the RMT’s responsibility to understand how it works and what risks it presents. Regarding at-home use, Semenuk says RMTs should ensure that patients who are using these devices know how to use them correctly. Massage guns aren’t intended for use on every part of the body, nor are they intended for prolonged use:

“When you start going over boney prominences, the device can cause trauma. So you’re not going to use it on someone’s forehead. Prolonged use creates an analgesic effect where the patient can no longer tell whether something hurts or not.”

One example of improper use causing harm was chronicled in the January 2021 issue of Physical Therapy & Rehabilitation Journal, the official journal of the American Physical Therapy Association. This case report described the effects of a massage gun on a 25-year-old woman with a mild iron deficiency. The patient cycled at her local gym for about 30 minutes per day, and after each workout, her personal trainer used the gun on her thighs for five times the manufacturer-recommended treatment time.

The patient developed severe thigh pain and blood bruises, and when her urine turned dark brown, she went to her local hospital. Initial lab tests revealed that her creatine kinase level (a biomarker of muscle damage) was too high to measure. She was diagnosed with severe rhabdomyolysis, was admitted to hospital for a two-week stay, and gradually recovered over the next six weeks.

Proper application of massage guns in treatment
While the above case report may be an extreme example, stories like it are why RMTs need to understand the correct way to use massage guns. Misuse can cause harm, but responsible use may offer RMTs some considerable advantages.

Mike Booth, RMT, is the owner of Massage Athletica, a chain of sports massage therapy clinics in Winnipeg, Manitoba. Booth says he incorporated massage guns into his practice after using them in his own athletic training, explaining that massage guns are particularly effective at breaking up adhesions and increasing range of motion.

“It’s a targeted treatment,” Booth notes. “A lot of massage therapists will use Swedish massage and a structural approach, which involves slower movements. We learn percussive techniques in school, but we don’t use them a lot in practice. The percussion gun has brought that back.”

Booth says massage guns offer a lot of value to RMTs; the gun can increase the client’s blood flow and range of motion while sparing the RMT’s hands the demanding work of manual therapy. Massage guns can also penetrate deeper, and with more force and specificity, than a therapist’s hand.

Massage Athletica typically uses massage guns at the request of clients who have a stubborn ache or pain that doesn’t respond to manual treatment. A session will involve using the gun in short two-minute intervals on a specific body part, interspersed with manual therapy. Massage Athletica’s therapists will typically use the device for a total of 8 to 10 minutes during a massage session lasting up to 90 minutes. Booth says that Massage Athletica’s clients enjoy the novelty of the experience:

“Most massage therapists don’t use percussive techniques, so our clients usually experience it with us for the first time. The majority of them love it. I use it a lot for nervous system activation.”

While Booth acknowledges that massage guns can carry risks, he says that manufacturers are doing an excellent job of providing education around proper use. Therabody, for instance, provides an instructional mobile app for Apple and Android devices with recommended routines. The app can also wirelessly sync with Bluetooth-enabled models, enabling users to control speed and force.

But despite these resources, user error is always a danger.

“Overusing the guns leads to bruising,” Booth notes. “The guns all say how much pressure you can use. But even at the professional level, you have to be using an awful lot of pressure to actually hurt someone.”

Overuse concerns have prompted some manufacturers to build automatic safety stops into their newer models. The Theragun Mini and Theragun Pro, for instance, will automatically stop upon sensing 20 and 60 pounds of force, respectively.

Booth says that massage guns can come with contraindications, so massage therapists should ensure they are using the gun in an appropriate manner and for appropriate patients:

“Make sure you’re using the gun on the meaty part of the tissue. The guns are pretty easy to use, so if a patient is interested in purchasing one for at-home use, I always explain how we use it and how much pressure I would use. But at the end of the day, treatment duration is the big thing.”

Beyond patient safety, RMTs also need to consider whether a massage gun will produce a return on investment. In Massage Athletica’s case, buying multiple guns for each of four locations was a significant expense, so Booth sent a survey to his clients to gauge their level of interest in percussion therapy. Massage Athletica’s client base is athletes, who Booth says tend to be more open to experimentation than other clients, so Booth moved forward with the purchase. He says the response has been quite positive.

Fire away?
Whether at home or in practice, the key to using massage guns is to exercise caution. While massage guns can offer certain advantages, like easing the strain on an RMT’s hands or penetrating into tissue deeper than manual techniques would allow, they are still powered instruments with the potential to cause harm. That means safety is paramount, and RMTs and patients must follow some basic protocols when using massage guns, whether in practice or at home.

First, start slow. Always start on the lowest setting, with little pressure, and increase as needed. Second, manufacturer guidelines around treatment time and contraindications exist for a reason; do not violate them. Third, no massage gun should ever cause bruising or pain; immediately stop using the gun if it does. Finally, if you intend to offer massage gun treatments to clients, check with your province’s regulator to determine whether or not massage guns fall within the RMT scope of practice.

Massage guns are simple-looking devices that raise complicated issues. There are plenty of safety concerns to address, and improper use can result in serious harm. But when used safely, a massage gun can be an effective tool for addressing treatment-resistant issues while also giving RMTs’ hands a much-needed break. Massage therapists who can responsibly handle a massage gun could find a whole new modality to add to their practice.

Mike Straus is a freelance writer based in Kelowna, British Columbia. He has written on health and science topics for Chiropractic + Naturopathic Doctor, Nutritional Outlook, Grow Opportunity, and more.