Massage Contraindications

Before receiving a massage, anyone suffering from an undiagnosed skin condition or anyone with undiagnosed pain should refer to a medical doctor. Even after a doctor has diagnosed the condition, massage may still be contraindicated. What follows is NOT a comprehensive list of all conditions and illnesses for which massage is contraindicated. If there is any question or concern regarding any medical reason that massage should not be performed, a medical doctor should be consulted prior to scheduling a massage.

Massage therapist holding a sign asking that customers consult a doctor as there are many contraindications to massage therapy

Absolute Massage Contraindications

There are certain illnesses and medical conditions for which massage is absolutely contraindicated meaning that anyone suffering from these conditions should NOT receive a massage.

The following are Absolute Massage Contraindications:

Acute Injury- Acute injuries may be the result of a fall, an automobile collision, or even a sport mishap and are often accompanied by pain or tenderness, redness, swelling, and/or inflammation.  Massage should be avoided for at least the first two days (48 hours) following an acute injury. The decision when to begin massage should be left to a medical doctor.  Typically rest, ice, compression, and elevation are important immediately following an injury while heat, the use of alcohol, running or other exercise, and massage are not.

Aneurysm- Massage should not be performed on a patient with a suspected or diagnosed aneurism including those exhibiting abnormal budging of a vein or artery.

Appendicitis- Massage should not be administered if appendicitis is suspected or if there has been a confirmed diagnosis.  Neither should massage be performed if the patient is experiencing pain in the lower right quadrant of the abdomen. Other symptoms may include nausea, fever, or vomiting.

Arteriosclerosis- Arteriole flexibility decreases with age. Hardening of the arteries is a contraindication to massage, especially deep tissue massage. If you suffer from any arterial disease or injury, including peripheral artery disease it is extremely important that you consult a doctor before receiving a massage.

Atherosclerosis- Atherosclerosis is a particular form of arteriosclerosis whereby fats, cholesterol and other substances (plaque) build up on the artery walls. This buildup of plaque can restrict blood flow and can burst, creating a blood clot.  Massage, especially deep tissue massage, could trigger such an event and is therefore contraindicated in patients with atherosclerosis.

Blood Thinners- Deep Tissue massage is contraindicated for those taking blood thinners.

Cancer- Cancer patients should not receive a massage without prior approval from a medical doctor. Deep massage is contraindicated in cases of osteomyelitis. For breast cancer patients, direct pressure on the tumor location is contraindicated. Cancer treatments, such as surgery, radiation, or chemotherapy, can have their own contraindications, especially when deep bodywork is involved.

Cirrhosis of the liver- Cirrhosis of the liver is often caused by hepatitis, alcoholism, and even obesity (Non-alcoholic fatty liver disease). It presents as scarring of the liver which, if left unchecked, can continue to deteriorate the liver function. If you suffer from Cirrhosis of the liver it is important that your doctor approve of any treatment plan that includes massage.

Congestive heart failure- While gentle massage on the head, feet, and hands may be ok with doctor’s permission, other more aggressive massage is contraindicated.

Contagious diseases- Diseases such as influenza may be spread from person to person. Anyone suffering from a cold or flu should not receive a massage. This includes anyone with a contagious bacterial or viral skin disease including acute psoriatic arthritis, boils, ringworm, carbuncles, cellulitis, erysipelas, exfoliative dermatitis, folliculitis, herpes, impetigo, necrotizing fasciitis, scalded skin syndrome, scarlet fever, staphylococcal infection, chicken pox, hepatitis, measles, mononucleosis, mumps, tonsillitis, or tuberculosis.

Deep Vein Thrombosis- Deep Vein Thrombosis occurs when a blood clot develops in the veins, usually in the deeper-lying veins of the legs. As massage can cause these clots to break loose and travel in the bloodstream toward the lungs causing serious injury or even death, massage should not be performed.

Diabetes- Diabetes affects nerves and blood vessels in the hands, fingers, feet, and toes, inhibiting the ability to judge pressure and heat. Deep tissue massage or other aggressive forms of massage, as well as hot stone massage, are contraindicated. Nor should deep work be performed on areas of recent insulin injection.

Diarrhea- Anyone experiencing diarrhea should not receive a massage.

Embolism- An embolism is a blockage within a blood vessel. Massage is contraindicated for all embolisms. Whether the blockage is caused by a blood clot, fatty deposit, gas, etc. massage should be avoided.

Endocarditis/Pericarditis- In anyone suffering from inflammation of the interior lining of the heart (endocarditis) or inflammation of the sac surrounding the heart, massage should be postponed until the condition is medically resolved and a doctor allows massage treatment.

Fever- Those suffering from a fever may spread germs to others. Also, their body temperature may not regulate correctly, especially when hot stone massage is applied.  Anyone with a fever, therefore, should not receive a massage.

Gout (Acute)- Massage should not be performed during the acute phase of a gout flare up.

Heart Attack- Massage should of course be avoided on anyone suffering a heart attack and immediate medical attention should be sought. During the recovery stages of a heart attack, and thereafter, massage should only be performed with the consent of a cardiologist.

Hemophilia– Hemophilia is a genetic hemorrhagic disease wherein a person will experience spontaneous bleeding. The degree of bleeding varies on a case to case basis, and a person can have mild, moderate, or severe hemophilia.  Even the slightest trauma to joints and muscles might cause internal bleeding in people with moderate and severe hemophilia.

Hernia- A hernia is a protrusion of tissue through some type of defect in the encapsulating walls.  Any massaging of a hernia should be done by a medical doctor and not a massage therapist.

Intoxication- Drugs and alcohol impair the ability of the patient to give necessary feedback and affect the patient’s judgment. Massage should not be performed on intoxicated individuals.

Kidney Disease- Those suffering from any type of kidney disease or kidney failure should consult a doctor before receiving any massage. In many cases massage may not be permitted. There is some evidence that massage can be beneficial in some circumstances, such as relieving leg cramping that is common following kidney dialysis. The question always becomes whether the benefit outweighs the risk and that is a question only a doctor can answer.

Lung Abscess or Tumor- Anyone suffering from a lung abscess or tumor should consult a doctor before receiving a massage. The doctor may suggest that only active areas of inflammation, metastasis, or scarring be avoided, or he/she may disallow massage altogether.

Lupus- Avoid massage during the inflammatory stage of lupus.

Meningitis- Meningitis is inflammation of the meninges, the linings around the brain and spinal cord. It presents as either a viral or bacterial infection and can be very contagious. It is a complete bar to massage therapy and can be life-threatening.

Metastatic Cancer- Massage is traditionally contraindicated for those suffering from metastatic cancers such as malignant melanoma or lymphoma.

Osteoporosis- Those persons suffering from low bone density should consult their doctor prior to receiving a massage. In any event, deep tissue massage should be avoided as the bones of osteoporosis sufferers can be brittle and subject to easy breakage.

Pain medication- People taking pain medication often have a reduced sensation to touch increasing the possibility of tissue or nerve damage with deep tissue massage or other aggressive massage modalities.

Phlebitis- Phlebitis is inflammation of a vein and can be the symptom of a very serious condition including thrombosis. Massage is contraindicated on anyone suffering from an undiagnosed raised or bulging vein.

Pneumonia (Acute)- Massage is contraindicated during the acute stages of pneumonia. During the recovery stage of pneumonia, however, percussion or tapotement massage techniques can be extremely beneficial in accelerating pulmonary drainage. Get doctor’s approval.

Respiratory Failure- Massage should not be performed on anyone suffering from respiratory failure.

Rheumatoid Arthritis- Avoid massage during inflammatory stage.

Scleroderma- Avoid massage during inflammatory stage.

Sepsis- Sepsis occurs when your body overreacts to an existing bacterial infection within your body. The infection may have started as a skin infection or wound, a urinary tract infection, or even as pneumonia in the lungs.  Sepsis can lead to tissue damage, organ failure, or even death. Some of the symptoms of sepsis include fever, shortness of breath, elevated heart rate, disorientation or confusion, and extreme pain or discomfort that is unexplained.  Anyone suffering from sepsis should seek immediate medical care.

Shock- Our bodies can go into shock when there is not sufficient blood flow within the body or when we lose an extraordinary amount of other bodily fluid. This is often the result of internal or external bleeding, severe burn, extreme vomiting or diarrhea.  Also, a severe allergic reaction may cause anaphylactic shock. Shock is a life -threatening condition for which immediate medical attention should be sought.

Stroke- Stroke occurs when blood flow to the brain is cut off or severely restricted. When our brain is deprived of nutrients and oxygen, brain cells begin to die. It is extremely important to diagnose a stroke as quickly as possible and to receive immediate medical care.

Thrombosis- There are many types of thrombosis including Deep Vein Thrombosis, Femoral Vein Thrombosis, Myocardial Infarction, Paget-Schroetter Syndrome, Pulmonary Embolisms, Superior Vena Cava Thrombosis, and Jugular Vein Thrombosis, etc.  These conditions are all associated with a narrowing or squeezing of veins or arteries and all present dangerous conditions for which massage therapy is contraindicated and medical attention is imperative.

Local Massage Contraindications

For some illnesses, injuries, and medical conditions, massage is only contraindicated in or about the affected area of the body.

The following are local contraindications to massage:

Arthritis or other inflammation- Massage is contraindicated in areas of acute arthritis or inflammation.

Bruises- areas of recent or severe bruising should be avoided.

Discs Problems- Avoid massage in acute cases of intervertebral disk issues as muscles may have become tight as a natural protection for irritated nerves.  Releasing these muscles may exacerbate the condition. In non-acute cases, shearing motions, longitudinal compression, and extreme twisting or bending should be avoided.

Hemangioma- These are congenital benign tumors, made up of newly formed blood vessels. Different types, usually on the skin, yet sometimes also in brain and viscera. Particularly in cases of known visceral type (e.g. hepatic hemangioma), no deep work in this area should be applied because of the danger of internal bleeding.

HematomaA hematoma is a collection of blood (a blood clot) that develops outside of our larger blood vessels. A bruise is a collection of blood that develops outside our smaller blood vessels. Hematomas can develop in arteries, vein, and capillaries. Massage is contraindicated in areas of acute hematoma.

Herpes- Massage is contraindicated during an active outbreak and at minimum a local contraindication during the healing process even if a lesion has healed over.

Implants- Special precaution must be taken and massage may be contraindicated in areas of implants, including pace makers and implanted stents.

IUD- Caution should be taken in female patients with Intra-uterine devices (IUD) regarding any deep abdominal work.

Pace Maker- Massage should not be performed in the immediate area where a pacemaker has been implanted.

Pregnancy- As a precautionary measure, NO deep tissue work should be performed throughout the pregnancy.  Massage should not be performed without a doctor’s permission. Conservatively, massage should not be performed during the first trimester. Massage should be avoided if you are at high risk of miscarriage (placental abruption, preterm labor), are experiencing nausea, vomiting, or morning sickness.

Scleroderma- Pressure contraindicated during inflammatory phase.

Skin disease- Athletes foot, nail fungus, ringworm, etc.

Sunburn- It would be extremely uncomfortable if not downright painful to receive a massage on sunburnt skin.

Undiagnosed lumps or bumps- Any unidentified lumps or bumps should be check out by a medical doctor as soon as possible.  Areas of identified lumps or bumps should not be massaged.

Vaccination/Immunization- Areas of the skin where recent injections of any kind have been administered should not be massaged as these areas are susceptible to infection.

Varicose Veins- Affected veins should be avoided.

Whiplash: If recent, unstable, or inflamed, deep bodywork should be avoided.

Warts- Don’t touch infected areas without gloves

Wounds- Areas of cuts, scrapes, legions, lacerations, and abrasions are at a greater risk for further tissue damage and infection being introduced via bacteria from the massage oils, lotions, hot stones, etc. It can also be uncomfortable or even painful to massage open or recently healed wounds.

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