cautions and considerations
You might wonder if it’s alright to get a massage when you have a health issue or condition. Here’s a brief reference list of the massage contraindications and indications for some of the more common health issues and how we may modify your massage for these health conditions. A massage contraindication means massage is not advisable on a particular part of the body or in general. An indication means it’s alright to massage without any additional caution. This information may help you determine if massage is appropriate for you
Abdominal aneurysm - massage of abdomen is contraindicated.
Abnormal lumps – we’ll avoid massaging the immediate area and it’s advised that you see a doctor.
Abnormal sensations – we’ll use caution and may need to obtain a doctor's approval.
Acne – is not contagious but we’ll avoid massage if affected areas are painful, itching, or weeping.
Alzheimer's disease - massage may sooth muscular spasm, improve motor function, and improve psychological well-being; please consult your doctor before beginning massage therapy; strongly consider having a family member or friend accompany you during massage sessions.
Amputation – if there is broken skin we’ll use caution; tapotement and other tissue manipulation can increase circulation and reduce scar tissue.
Amyotrophic lateral sclerosis (Lou Gehrig's disease) - massage may sooth muscular spasm and improve motor function and psychological well-being; you may need to consult your doctor.
Anemia - extreme fluid movement or pressure on surface vessels may be harmful so massage will be light and soothing.
Angina pectoris - all massage will be light and soothing - avoiding endangerment areas and abdominal massage (may cause increased pressure on the heart); you’ll be positioned supine with a cushion under your right hip to avoid pressure on the inferior vena cava; because massage can overwork the heart, check with your doctor before receiving any bodywork.
Arteriosclerosis – we’ll avoid localized massage around the carotid artery (may break loose plaque), and not use deep tissue work; please get doctor's approval before starting massage therapy.
Rheumatoid arthritis – we’ll avoid affected joints when they’re in an acute and inflamed stage; paraffin bath is the medical treatment of choice.
Osteoarthritis – we’ll use very slow range of movement and avoid friction of affected areas. If your spine is affected (degenerative disk disease) please check with your doctor before starting therapy; we may need to avoid affected area during acute phase; massage can prevent contracture or inhibit associated protection of the affected disk.
Asthma - massage can reduce stress and loosen the intercostal muscles so massage will be relaxing rather than deep work which can cause stress or pain and possibly trigger an episode.
Atherosclerosis – we’ll avoid areas of concern such as posterior tibial, popliteal, femoral, axillary, brachial, radial, carotid, and temporal arteries; general massage is contraindicated in severe cases because fluid movement could cause an embolism (i.e., blood vessel clogged by a foreign substance or blood clot).
Bell's palsy - massage can reduce anxiety related to Bell's palsy and reduce swelling of the nerve; we’ll use caution on the cervical vertebrae.
Benign tumor – we must avoid massage of immediate area because pressure may break the capsule.
Bone fracture – we’ll work proximal and distal to the site of injury, but not on the fracture until there is complete union (usually 6 to 8 weeks); check with your doctor before starting therapy; energy work promotes healing during the acute phase of healing; exercise and stretching may be applied to atrophied muscles when bone has healed appropriately.
Bronchitis (chronic) - can be infectious, so check with your doctor before starting massage therapy; massage can reduce thoracic muscular spasms; but we must avoid massaging if there is a fever.
Burns- check with your doctor before starting therapy; we’ll avoid affected area if painful; energy work is effective; deeper massage can reduce scarring if completely healed.
Bursitis – we’ll avoid deep work on affected areas and use caution because it can be a painful condition; massage can increase inflammation in acute cases; we’ll check the bicipital groove of the humerus for tendon dislocation.
Cancer - please obtain approval from your doctor before starting massage therapy because massage may promote metastasis; energy work and relaxing massage has been shown to reduce stress and anxiety.
Carcinoma (basal cell, squamous cell) - please obtain approval from your doctor before starting massage therapy because massage can promote metastasis; energy work and relaxing massage has been shown to reduce stress and anxiety.
Carpal tunnel syndrome - massage of the cervical muscles, pectoralis minor muscle, and arms can relax involved muscles and improve circulation and nerve enervation.
Cerebral palsy - check with your doctor before starting massage therapy; massage may improve motor control and reduce related anxiety; we must deep tissue work.
Chronic fatigue syndrome - massage may reduce associated stress and anxiety and allow the body to relax; we’ll avoid deep tissue work because it may overwork the immune system.
Circulatory system disorders - please check with your doctor before starting therapy; massage will be light and soothing.
Cirrhosis of the liver – please obtain approval from your doctor before starting therapy because there may be liver damage; we’ll avoid abdominal massage and massage for fluid movement which may stress the liver; massage of lower extremities may reduce related edema.
Compromised immune system [acquired immunodeficiency syndrome (AIDS)] - please obtain approval and advice from your doctor before starting massage therapy; we’ll follow universal precautions and hygiene requirements.
Constipation – we’ll massage the abdomen in the direction of normal peristaltic action (clockwise) and use caution during pregnancy.
Contracture - massage can reduce or prevent contraction and adhesions.
Contusion – we’ll watch for bleeding and avoid the area of the bruise; energy work promotes healing; we will not massage directly on the bruise until clotting has been reabsorbed and the color of the bruise changes.
Cystic fibrosis – please obtain approval from your doctor before starting massage therapy; we must avoid the area of the pancreas, if inflamed; tapotement is most effective in relieving blockage in the lungs.
Decubitus ulcer – we must not massage affected area; massage as a preventive measure is most effective in improving circulation and alleviating pressure.
Degenerative disk disease - please check with your doctor before starting therapy; we may need to avoid affected area during acute phase; massage may promote undesirable contracture or inhibit associated protection of the affected disk.
Dermatitis – because this condition is not contagious, we’ll only avoid massage if affected areas are painful, itching, or weeping.
Diabetes mellitus – please obtain approval and advice from your doctor before starting massage therapy; caution must be used, especially in advanced cases; progression may include neuropathy, atherosclerosis, and kidney problems so we’ll consider these additional issues and proceed as necessary.
Digestive problems – we’ll use caution during pregnancy, especially during the first trimester; massage can facilitate peristalsis if done in a clockwise pattern on the abdomen.
Dislocation – please obtain advice from your doctor before starting massage therapy; we must never try to "set" a dislocation; no stretching or massage will be done until pain and inflammation subside; energy work is appropriate.
Dysmenorrhea - massage can reduce circulatory congestion and associated pain; energy work is most effective.
Ecchymosis - see subcutaneous bleeding.
Edema - obtain approval from client's doctor before starting therapy; massage is contraindicated for edema due to heart decompensation, infections, and kidney diseases; massage for general edema can improve movement of blood and lymph and reduce swelling; watch for edema in pregnancy, which could be a symptom of toxemia.
Elderly clients - watch for diseases common in the elderly, such as osteoporosis (in pelvis, lumbar vertebrae, and cervical vertebrae), atherosclerosis, and parchment skin; client may bruise e_sily; avoid deep work and extreme neck range of movement, especially in the area of the carotid artery; massage should be shorter but more frequent than usual.
Emphysema - check with client's doctor before starting therapy; massage can relax muscles involved with breathing and reduce associated anxiety.
Endometriosis - avoid localized massage on the lower abdomen; energy work can be effective. .
Extreme fatigue - may be a serious condition such as acquired immunodeficiency syndrome (AIDS), cancer, chronic infection, or hepatitis; use caution and check with client's doctor before starting therapy.
Fever - usually defined as a core temperature of 99.6°F or higher - massage is contraindicated; even energy work will reduce the fever, which will inhibit the immune system at work (fever is an immune system response to infection); there is the possibility of a contagious condition.
Fibromyalgia (fibrositis, fibromyositis) - caution is important due to possible extreme sensitivity to touch; kneading, petrissage, and friction can break up adhesions and prevent further formations, but perform only as client's tolerance allows.
Headache (tension or cluster) - massage can reduce tension and relax tense muscles, primarily in the neck and shoulders, that typically cause these types of headaches.
Hematoma – we must avoid massage of the affected area.
Hernia – we must avoid massage of affected area.
Herniated disk - in acute phase, please obtain advice from your doctor before starting massage therapy; we must avoid massage of the area; energy work is okay.
Hypertension – please check with your doctor before starting massage therapy; massage is contraindicated in extreme cases due to possible thrombus (clot) formation; we’ll avoid deep tissue work or painful massage in all cases; soothing massage may reduce high blood pressure and associated stress.
Infants - tissue is very pliable, sensitive, and in extreme growth, so we’ll avoid deep or painful work; ideas of touch develop at an early age, so massage will be short and sweet.
Infectious diseases - these are typically contagious; massage is contraindicated if a fever is present and during the acute phase; massage can aggravate the condition and spread infection; some forms of energy work are okay.
Infectious skin conditions – because all infectious skin conditions are contagious, we must not massage you at this time; please consult a physician.
Inflammation (acute) – please obtain approval from your doctor for general massage; we’ll avoid areas of inflammation; energy work can reduce inflammation.
Injured limb (non-acute) – we’ll massage you according to your condition; working proximal to the injury can increase circulation and assist in healing.
Insomnia - massage will be soothing and relaxing; effleurage from the occiput to the coccyx can sedate the energy in the governing vessel meridian.
Laminectomy - in acute phase, please check with your doctor before starting massage therapy; it’s usually necessary to avoid the area; energy work could be effective.
Lipoma (or sebaceous cyst) - if you have not seen a doctor, please do; we’ll avoid direct deep work but massage is generally okay.
Loss of tissue integrity - massage is generally indicated, but it’s advisable to obtain advice from your doctor.
Malignant melanoma – please obtain approval from your doctor before any massage; if you have not seen a doctor, it’s advisable to do so; we must avoid massage of the immediate area.
Mental conditions – please tell us about any medications you’re taking that may affect pain sensitivity; massage can aggravate some conditions and we must avoid deep work in stressful cases; when in doubt, please obtain advice from your doctor; energy work may be beneficial.
Migraine headache – we must use caution during an episode; check with your doctor, if necessary; massage of the neck and shoulders and pressure point therapies can be most effective.
Multiple sclerosis – we must use caution because of impaired neurologic sensitivity; massage can reduce muscle spasm and associated anxiety.
Muscle cramps – we’ll use short effleurage from tendons to muscle belly which can reset proprioceptors; compression, strain-counterstrain, proprioceptive neuromuscular facilitation, and reciprocal inhibition stretching may be beneficial.
Neuralgia - massage can release tension, soothe pain, and release endorphins (natural pain killers).
Nonunion fracture – we must avoid the immediate area until it’s sufficiently healed; energy work is best until healed.
Open sores (and lacerations) – we must avoid the immediate area; please see a doctor for medical care.
Osteitis deformans (Paget's disease) - massage is contraindicated due to fragile bones.
Osteitis fibrosa cystica - massage is contraindicated due to fragile bones.
Osteomalacia (rickets) - massage is contraindicated due to fragile bones.
Osteoporosis - check with your doctor before starting massage therapy; any massage and bodywork will be light.
Parkinson's disease - check with your doctor before considering massage; massage may reduce muscle spasm and associated stress and anxiety.
Peripheral neuritis - light massage, vibration, and soothing techniques are best; deeper tissue techniques may be contraindicated because they can cause further inflammation.
Phlebitis – we’ll avoid the affected area; energy work is beneficial.
Poliomyelitis - in post-acute phase, massage can increase circulation to affected areas, reduce associated anxiety, and promote muscle tonus.
Postural deviations - massage can reduce stress on postural muscles.
Pregnancy - includes entire pregnancy (first, second, and third trimesters) – we’ll normally avoid any work on the abdomen but if necessary, use caution on the abdomen, especially during the first trimester; deep or stressful techniques and abdominal kneading are contraindicated; we’ll use cushions for your comfort and to reduce physical stress on the spine and baby; we’ll also watch for edema.
Psoriasis – we must avoid affected areas if painful, itching, or weeping; massage can reduce stress but can also aggravate the condition.
Raynaud's disease - massage may increase circulation, reduce associated stress, and relax affected muscles; application of warmth works best.
Scar tissue – please avoid massage for 6 to 8 weeks after surgery or injury - energy work is effective during this acute phase; after 6 to 8 weeks, cross-¬fiber massage work breaks up adhesions and stretches polarized fibers of the scar.
Sciatica - when piriformis muscle is the issue, massage may reduce stress on the lumbar area and legs and reduce pain and associated anxiety; when degenerative disc pressure is the issue, we must avoid the affected area (see “Degenerative disk disease” above)
Severe muscle injury – please avoid massage for the first 5 to 7 days; use the standard First Aide procedure "RICE" (rest, ice, compression, elevation) concept; energy work is effective during the acute phase.
Sprains and strains - ice and energy work are most useful during the first 48 to 72 hours; massage proximal to the injury may improve circulation and healing.
Subcutaneous bleeding (ecchymosis, hematoma) –we must avoid the affected area.
Subluxation - check with your doctor, if necessary; we’ll use caution, but massage can reduce spasm and stress of musculature involved; energy work can be effective.
Substance abuse – we must not treat any client who is under the influence of drugs or alcohol because massage at this time can stress the liver and kidneys; we will be happy to reschedule your appointment.
Tempromandibular joint dysfunction (TMJ, TMD) - condition can change position of jaw, causing natural teeth, dentures, and bridges to fit together improperly; massage can relax muscles and relieve symptoms; we’ll be happy to work with your dentist or physician if necessary.
Tendonitis and tenosynovitis - ice is often the treatment of choice; deep friction is the preferred massage treatment because it breaks up adhesions and promotes temporary pain relief; compression of surrounding tissues releases tension.
Thoracic outlet syndrome – we’ll use caution working on the brachial plexus; massage of cervical muscles, shoulder girdle, and pectoralis minor muscle could relieve compression and stress on the plexus.
Trigeminal neuralgia (tic douloureux) - massage of nerve root area may reduce spasms and associated pain.
Torticollis (wryneck) - massage may relieve stress of affected muscles and associated anxiety.
Tuberculosis - is highly infectious and infectious disease is a contraindication for massage; please obtain approval and advice from your doctor before starting massage.
Unexplained pain; any pain with an unknown cause – we must determine cause before proceeding; it may be necessary to reschedule and/ or refer you to an appropriate health care professional.
Varicose veins – we will not massage directly on or distal to the affected area; work done proximal to the area can be beneficial.
Whiplash (post-acute) - massage may relax affected muscles and relieve associated anxiety.