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When NOT to Massage

As practicing massage therapists with many years of experience we have had our share of success stories working with our clients.  As educators we strongly believe that keeping boundaries around the limitations of massage therapy is important.  There are times that professionals and amateurs alike take on situations that should be cleared medically before massage therapy is attempted.

Here is some basic information to consider before doing massage work on anyone.


If you are uncertain about anything regarding a person’s condition do not massage.  If you have any questions seek the advice of qualified medical personnel.  The best procedure is to contact their personal physician, explain that you recognize the condition may be a contraindication to massage.  Explain completely what you propose to do during the massage.  Ask their advice about proceeding as planned and follow their recommendation.  If the personal physician is not available, or if they do not have one, contact a physician with whom you have developed a good working relationship.  In the absence of medical personnel, contact a professional licensed massage therapist.

Do not take on the role of a doctor. Diagnosis of medical conditions is beyond your expertise. Know the benefits as well as the limitations of massage therapy in any given situation.  Be prepared to refer out to professional health practitioners when the condition is beyond your abilities and knowledge.

Prescription Medications

If the person receiving massage is taking a prescription medication there are precautions you should take.  You should investigate the side effects of the medication and learn about the physical conditions that led their doctor to prescribe the medications in the first place.  Understand that due to the increased blood circulation the circulation of medications is also improved which can affect such things as insulin injections or any drug that is dose and time dependent.

Blood thinners

DO NOT use deep pressure at any time during the massage since bruising is certain to occur.  Always check with the doctor first.  Light strokes applied in a direction toward the heart may be OK if you are given a green light from the doctor.

 Acute inflammation

Inflammation is the body’s initial response to any physical injury/trauma, intense heat, irritating chemicals as well as to invasion by viruses, fungi, bacteria and other potentially harmful microorganisms.  The inflammatory response is considered part of the immune and sometimes autoimmune physiology.  Massage is contraindicated during the acute phase because of the complex physiologic changes involved, including chemicals released into extracellular fluid, dilation of blood vessels, and increased permeability of capillaries, local edema and associated pain.

Communicable diseases, infections – viral/bacteria, etc.

Many infectious/communicable diseases may be spread by either direct or indirect contact, putting you or your partner at increased risk.  Massage can also transfer germs from an infected site to an uncontaminated site.  Individuals suffering from infectious/communicable disease are undergoing physiologic stress and should not receive massage during the acute phase of illness.  There are other, non-massage approaches that may be appropriate to relieve stress such as reflexology or energy work that is done with light touch or off-the-body.

Cancer, tumors and neoplastic disease

There are approximately 200 diseases that may be considered under these categories.  Determination of the style, duration and appropriateness of massage for each individual requires consultation with the recipient’s physician, taking into consideration the specific type and stage of cancer.  Surgical intervention, radiation, chemotherapy and other treatment modalities will influence how and when the person should get massage work.  If you are unsure of your skills in these situations, find a professional massage therapist who has experience with such clients to do the work.

Scientific advances in the diagnosis and treatment of cancer have significantly altered the prognosis and survival rates for many cancer patients.  New research has demonstrated the positive impact of massage therapy in many phases of disease and recovery.

Thrombus or suspected blood clot

Be safe and avoid doing massage on someone with a history of blood clots or who is on blood thinning medication to prevent clots.

Swedish massage techniques may dislodge blood clots, debris/plaque creating an embolus (free floating blood clot).  Emboli that move through the circulatory system can cause significant problems if they become lodged in narrow vessels and impair the ability of the tissue to obtain oxygen.  In the brain (Cerebral emboli) they may cause a stroke; in the lungs (pulmonary emboli) they may compromise lung function; in the heart (coronary emboli/thrombosis) may cause a fatal heart attack.

Unstable heart conditions –

These include congestive heart failure (CHF), coronary artery disease (CAD), myocardial infarction (MI/heart attack) and similar.

Due to the circulatory effects of swedish massage the increasing workload can be increased for even a healthy heart.  If the heart muscle function is impaired by a pre-existing condition (such as a prior heart attack), the heart muscle may not be able to accommodate the additional stress leading to failure and/or other problems.  Physician clearance is required.

It is important to consider which areas you are intending to massage and for how long.  If you intend to do a full body massage, that may be too much.  If you are intending to massage one or two areas, say the neck only or back only, then it may be alright.  Make your intentions known to the person’s doctor.

Fresh burns, open cuts/abrasions, etc.

It is common sense to stay away from recent burns and open wounds.  In acute stages (first 72 hours), inflammation exists as the healing process goes into full swing.  Swedish massage may disrupt the healing process, thereby reopening a wound.  If the therapist (you) has a small cut, or other open wound, there is a risk of transmission of blood borne diseases.  These include bacterial, viral and other infections, most notably Hepatitis B, Hepatitis C, and HIV.

After the body has had time to heal, massage of the areas above the wound or around the wound can improve healing time by bringing much needed circulation , nutrition into the area and flushing waste products out of the area.  Get medical clearance that enough time has passed and it is OK to do massage.

Fever or elevated body temperature

Fever or high body temperature is a sign that the body is fighting an infection.  Let the body do its thing.  Swedish massage increases lymphatic and blood circulation which could cause the spread of disease that the body is trying to isolate and destroy.  You should ALWAYS stay away from swollen lymph nodes.  Fever and/or elevated body temperature, often associated with an immune response also impact heart rate and circulation, and increase metabolic demands.  Massage is inappropriate and counter productive in this instance.

If you want to apply some appropriate essential oils to the skin to help fight infection keep the application local and do not apply with massage oil or with long strokes. 

Bleeding disorders or any condition prone to hemorrhage

Anything that interferes with the clotting mechanism can result in abnormal bleeding.  The most common causes are platelet deficiencies, deficits that might result from impaired liver function, certain genetic conditions and certain medications.  Massage applications that increase blood flow (circulation) could intensive the problem. Deep compressive techniques may cause spontaneous bleeding from small blood vessels.

Use of alcohol or psychogenic drugs, narcotic or other painkillers (illegal or prescription)

MUI (Massaging Under the Influence) or RUI (Receiving Under the Influence) can be an invitation for disaster since the ability to feel and report discomfort is impaired.  Since massage increases circulation, it impacts effects of substances carried by the blood and circulatory system.  Drugs and alcohol impair the ability of your partner report excessive pressure or pain which can be harmful.