Understanding Endangerment Sites and Why Safe Neck Work Matters

Gentle stretching during a massage session.

Endangerment sites are areas of the body where critical structures such as major arteries, veins, nerves, and organs lie close to the surface. These areas require extreme caution, refined skill, and a deep understanding of anatomy. One of the most sensitive and potentially dangerous endangerment sites is the neck, especially around the carotid artery. Massage in this region must always be conservative, controlled, and intentional.

I work very carefully around the neck, and I do not use deep pressure in any endangerment site. Pressing too firmly near the carotid artery or along major veins can create serious complications, including the possibility of triggering a vascular response, causing a clot to move, or aggravating pre-existing conditions. These risks are even higher for clients with connective tissue disorders such as EDS, who may have fragile tissues, unstable joints, or vascular vulnerabilities. Because of this, any sign of a pulse under my fingers is a clear indicator to release pressure immediately and never something to push into.

I regularly have clients request deep work in areas that are considered dangerous, and my answer is always no. An ethical and knowledgeable massage therapist will not apply deep pressure in these areas. Doing so is unsafe, unnecessary, and irresponsible. I have no problem setting firm boundaries and explaining why certain techniques are not appropriate.

Safety is always the priority, and avoiding dangerous maneuvers is part of responsible practice. This is not just about technique. It is about protecting the client from potential harm and protecting both parties from liability.

I take a conservative approach to neck work. No aggressive manipulations, no deep stripping, and no risky angles. You never know if a client has a connective tissue disorder, an undiagnosed vascular issue, a previous stroke, or any other condition that could increase the risk of complications. This is why proper training, anatomical knowledge, and professional judgment matter. Massage therapists must understand endangerment sites, listen to the body, and be willing to say no when something is unsafe.

By respecting these boundaries and practicing with caution, the work can be both therapeutic and safe. It supports the health of the client without ever putting them at risk.

With care and support,

Suzan (Susan) Walker LMT

Massage therapy is not a substitution for medical treatment. The massage therapist cannot diagnose, treat or prevent disease. The therapist can only recommend products and services. Please consult a medical physician for further treatment.​

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