04/11/2025
There is a valid, though relatively rare and specific, reason why deep or intense massage of the neck, particularly in the front or sides, could potentially cause a temporary rise or fluctuation in blood pressure.
However, it's important to know that standard, relaxing neck massage is generally associated with lowering blood pressure due to the relaxation response.
Here's the breakdown of the mechanism that could cause a rise, and why a skilled therapist takes precautions:
⚠️ The Carotid Sinus Reflex (The Potential Cause)
The primary concern is stimulating the Carotid Sinus, a slight widening near the base of the internal carotid artery, located on the front/side of your neck (below the angle of the jaw).
Function: The carotid sinus contains baroreceptors, which are stretch receptors that monitor blood pressure. Their job is to tell the brain if the blood pressure is too high.
The Misinterpretation: If a therapist applies strong, deep, or sustained pressure directly to the carotid sinus, the receptors can be mechanically stimulated (they are "fooled" into thinking the artery wall is stretching outward).
The Reflex: Normally, this stimulation would trigger a reflex to lower the heart rate and blood pressure (called the Carotid Sinus Reflex). However, in some individuals, particularly those with pre-existing conditions or plaque build-up, deep pressure in this area can sometimes have an unpredictable and sometimes opposite effect, leading to a temporary increase, or a dangerously sudden drop in heart rate and blood pressure, causing dizziness or fainting.
🛡️ Therapist Safety and Best Practice
Because of the unpredictable nature of this area and the presence of major blood vessels and nerves, qualified massage therapists are taught to treat the anterior (front) and lateral (side) neck with extreme caution, lightness, or avoidance altogether, especially over the carotid area.
✅ The Typical and Expected Effect
For the back of the neck (occipitals, traps, scalenes, and the cervical muscles near the spine) where most massage is performed, the effect is overwhelmingly to reduce blood pressure.
Mechanism: Massaging the tension out of these muscles (often referred to as the "stress muscles") promotes relaxation, reduces the activity of the sympathetic nervous system (the "fight or flight" response), and lowers levels of stress hormones like cortisol.
Result: This shift to the parasympathetic nervous system (the "rest and digest" state) typically leads to a reduction in heart rate and a lowering of blood pressure, which is why massage is often recommended as an adjunct treatment for mild hypertension.
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