Written By Graham H

© Trusted Touch Therapies

Today we are looking at some common contraindications, which would prevent a massage therapist being able to provide treatment. 

First of all, lets look at the word contraindications, as for those not in the health and massage industry, it might seem like a rather confusing word. A contraindication is a specific situation in which a drug, procedure, treatment or surgery must not be used to treat a patient or client because doing so, may be harmful to the person. This applies in medicine, health and fitness, physical therapy and pretty much anything involving the treatment of the physical body. By the same token, ‘indication’ denotes a course of treatment that should definitely be pursued on a specific situation.

Regarding massage, contraindications fall into 2 main categories: Total and Local.

Total contraindications, refers to conditions that require a confirmed diagnosis by a medical practitioner who has advised that massage or other physical therapies are suitable. In this case, some form of medical exception should be provided. Clients can also self certify as long as they have had prior approval and diagnosis by a qualified medical practitioner.

Total contraindications include (but are not limited to):

• Pregnancy – prenatal and postnatal if a C-Section was the method of delivery. Prenatal because the pressure from a therapist who is not trained in prenatal massage, could trigger labour, miscarriage and a range of other complications. Postnatal when C-section was performed, as there will be a recent surgery – see below.
• Cardiovascular conditions – this includes several conditions listed below:
• Thrombosis – occurs when blood clots block a vein or artery. Symptoms include pain and swelling in one leg, chest pain, or numbness on one side of the body. Complications can be life-threatening, and include stroke or heart attack.
• Hypertension – high blood pressure – as massage stimulates the flow of blood around the body, although can also be helpful as massage can also slightly lower blood pressure
• Hypotension – low blood pressure – massage can cause vasodilation which may result in slightly lower blood pressure, so full body massage may not be advisable. Observe clients when they are getting off the massage table to check for dizziness or blackouts
• Medical oedema – is swelling usually occurring in the limbs. Fluid retention can happen for a variety of reasons but is usually a good indication of recent trauma to the body and so must not be worked on until any underlying pathologies have been sufficiently diagnosed. If a therapist is unsure, then treatment should not commence until further medical diagnosis has been sought.
• Osteoporosis - is a systemic skeletal disorder where bone mass decreases with age, leading to deterioration of bone tissue, resulting in bone fragility, and increased risk of fracture. The body needs calcium for a variety of metabolic processes and can sometimes leach calcium from bones to facilitate these other processes.
• Arthritis – This is a blanket terms for a variety of conditions that affect joints, the symptoms of which include oedema, pain, heat and decreased range of motion. As arthritis affects the connective tissues of joints, it comes under rheumatic disorders or rheumatism, which covers all pathologies relating to soft/connective tissues in the body.
• Nervous /psychotic conditions – as massage can affect a clients mood and emotions, treatment should only be pursued if recommended by a trained psychologist, psychiatrist, etc.
• Diabetes – It is important for a therapist to be aware of conditions such as diabetes as the stimulated blood flow during treatment can affect blood sugar levels, so a client may need to manage their medication accordingly. So, diabetes is not contraindicated as long as it is properly managed.
• Epilepsy – covers a group of conditions, which have one thing in common. They involve seizures which start in the brain. Seizure triggers can vary and are hard to predict. As this is the case, it is best to have medical consent before commencing treatment.
• Acute soft tissue injury – Soft tissue must not be manipulated in any way during this phase of healing as the tissues are still susceptible to further trauma. This includes, but not limited to open wounds, muscle tears, sprained ligaments, contusions, chilblains, frostbite, sunburn and more.
• Inflamed nerve – Can be caused for various reasons such as injury, infection and possible autoimmune disease. The cause is important, as this will inform the treatment. If it is due to injury, massage may be a suitable treatment can be used to release soft tissue that may be compressing a nerve. Equally so, to much soft tissue manipulation, could cause temporary inflammation in the muscle tissue around the nerve, which could exacerbate the symptoms.
• Bursitis – a bursa is a sealed, closed fluid filled sack that acts as a cushion between tissues of the body, commonly found next to tendons in major joints to reduce or prevent friction during articulation. Bursitis is when one of these bursa becomes inflamed. In the case of bursitis, it is best to rest the area and use treatments that facilitate a reduction in inflammation and work around the area.
• Slipped disc – This is a slang medical word that encompasses a variety of spinal disc pathologies – a blanket term. A herniated disc or disc protrusion is where the disc is squashed or squeezed out in 1 or more directions. A herniated, ruptured or torn disc is when the tough layer of thick cartilage on the outside of the disc ruptures, allowing the softer inner cartilage to protrude out of the disc itself. In either cases a massage therapist can work on the soft tissue around the spine, to ease of any areas that may be putting pressure of the spine and which over time may have contributed to the slipped disc itself. But, longer term a Physiotherapy will be needed to effectively rehabilitate the spine.
• Acute trauma – This includes any injury to the body that may need to be addressed by a qualified medical practitioner before massage can take place and be of any real value. It may be that massage could greatly exacerbate this condition, especially if there is tissue damage. Relevant examples are torn muscle or fractured bones. Massage would only be effective at a much later stage of rehabilitation
• Periostitis – This is inflammation of the periosteum – a layer of connective tissue that surrounds the bone. Broadly periostitis can be chronic or acute. Acute injury/illness are defined by a recent or sudden onset, and are usually painful. Chronic is any pathology/injury, which has lasted more than 3 months or built up in intensity over many months or years. Acute Periostitis, may be caused by infections in other parts of body affecting the periosteum, usually of long bones, and usually show up as intense pain, pus formation, fever, chills and swelling of surrounding tissue. Chronic Periostitis is caused by running, jumping and weight lifting. This shows up as swelling, inflammation, localised tenderness, e.g. shin splints, but without the infection.

Local contraindications refers to conditions that happen in a specific area of the body and only affect that specific localised area. Often, but not always, local contraindications may require a confirmed diagnosis by a medical practitioner who has advised that massage or other physical therapies are suitable. Depending on the condition, a massage therapist may be able to apply certain techniques that may help to improve the healing of a condition.

Local contraindications include (but are not limited to):

• Localised Oedema – Same as medical oedema listed above. Local swelling is usually suggestive of localised trauma and any massage of other soft tissue treatment would need prior medical approval before it could take place. The most common is pitting oedema where the skin does not rebound after pressure has been applied to an area. A less common form of oedema is non-pitting oedema which is usually a symptom of more a more specific conditions and would require referral to a medical practitioner for further diagnosis.
• Varicose Veins – usually occur in the legs and are the result of failed valves in the veins that prevent to back flow of blood, resulting in blood pooling. Light massage techniques in the direction of the heart can be applied, but best to check with the client to establish if they are receiving medical treatment for this condition.
• Scar tissue – Minor <6 months, Major <12 months – Scar tissue forms where there has been a break, tear or incision though muscle tissue. The type of scar tissue that massage therapists can work with forms during the 3rd phase of healing known as the remodelling phase where the formation of scar tissue is progressed and stable. Depending on the injury, this can be from 3 weeks to 1 year. Referral from a medical practitioner or physiotherapist would be required by a massage therapist if working on scar tissue less that 6 months for minor injury and 1 year for a major injury. More on the healing process of acute tissue injury will be covered in subsequent posts.
• Sunburn – See Acute soft tissue injury above.
• Hernia - A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. A hernia usually develops between your chest and hips. Referral from a medical practitioner would be required before a massage therapist could work on the affected area.
• Recent fractures > 3 months old. See Acute trauma above for more details.

More on total and local contraindications will be covered in subsequent posts. See also posts about Red Flags and Yellow Flags

Written by Graham H

© Trusted Touch Therapies.