Contraindications for Massage:

As part of the assessment before performing massage therapy, the therapist must ask himself/ herself the following questions prior to treating a patient:

Does this patient have a pre-existing condition? – If yes, then:

  • Could the application of massage exacerbate this condition?
  • Could general massage aggravate this patient’s symptoms?
  • Could massage cause or create problems that weren’t there before?
  • Could massage place more stress on a body that is already in a highly stressed state?
  • Could treating this patient be dangerous to the health of the therapist?

In cases where a patient is not entirely healthy, Massage Therapy is either locally, relatively, or absolutely contraindicated:

Massage Contraindication Definition:

Contraindication (sometimes abbreviated as CI or CI’s) is a condition that serves as a reason to withhold or refuse a treatment due to the harm that it would cause a patient. Contraindication in massage means that massage treatment SHOULD NOT BE USED; Massage being contraindicated means massage should not be applied in the given condition or circumstance. (The opposite word for contraindication is ‘indication,’ which means the treatment is advised.)

The following lists the conditions where I. Massage Is Totally, Completely or Absolutely Contraindicated, II. Massage is Relatively Contraindicated, and III. Massage is Locally Contraindicated.

ABSOLUTE Full Body Massage Contraindication: No Massage At All

In an absolute massage contraindication or total massage contraindication, Massage Therapy treatment is not suitable and is not recommended at all in any part of the body. This is  to protect the patient from aggravated symptoms and to prevent exacerbation of their injury or disease. This may also be for the protection of the massage therapist from legal liability. In some cases, such as infections or contagious diseases, absolute contraindication to massage is for the safety of the massage practitioner and succeeding/ future massage clients and patients.

Relative Contraindications to Massage

This means that Massage Treatment must be MODIFIED. Relative Massage Contraindication means that the massage therapist needs to carefully take into consideration the patient’s presenting condition (and health history) in order to prevent adverse effects. Modifications to the massage treatment may include change in pressure or direction of certain massage techniques, avoiding the use of certain massage techniques, shortening the massage treatment duration, staying away from an injured area,  modifying the position of the patient on the massage table – using pillows or towels etc.

If a massage therapist is unsure, it is recommended that they contact (with the patient’s consent) their patient’s medical doctor and talk about their patient’s condition.

Relative/ Partial Massage Contraindications: The following conditions require treatment modifications:

  • Aneurysm (may be absolute contraindication – it is recommended to get patient’s physician’s permission)
  • Bell’s Palsy
  • Cancer
  • Chronic Arthritic Conditions
  • Chronic or Long Standing Thrombosis
  • Conditions of Spasticity (Cerebral palsy, Hemiplegia, MS, spinal cord injury)
  • Conditions of Rigidity such as Parkinson’s disease
  • Contusion
  • Chronic Congestive Heart Failure
  • Chronic Kidney Disease
  • Debilitation
  • Diabetes
  • Drug Withdrawal
  • Epilepsy
  • Fibromyalgia
  • Flaccid Paralysis
  • Fracture
  • Frozen Shoulder
  • Hypertension and Hypotension
  • Inflammatory Arthritis’s (Rheumatoid Arthritis (RA), Systemic Lupus Erythematosus (SLE), Rheumatoid arthritis (RA), systemic lupus erythematosus, gout, pseudo-gout, ankylosing spondylitis (AS), psoriatic arthritis (PsA), gonorrhoea, tuberculosis, and osteomyelitis)
  • Joint Dislocation
  • Joint Hypermobility / Joint Instability
  • Kidney Infection / Kidney Stones
  • Lymphedema
  • Osteoporosis / Osteomalacia
  • Patients with Compromised Immune System
  • Pregnancy
  • Raynaud’s Disease
  • Recent Head injury
  • Severe Asthma massage therapy contraindications
  • Severe Emphysema c
  • Seizure Disorders
  • Spasmodic Torticollis
  • Temporomandibular Joint (TMJ) Disfunction
  • Uncontrolled High Blood Pressure

Massage Contraindications: ABSOLUTE Local CONTRAINDICATION

Massage Therapy in the Local Area is Contraindicated – NOT appropriate: This means that it is NOT advised to massage the local area that is affected. Massage for the surrounding area must be done with care.

  • Areas of acute inflammation
  • Acute Flare-Ups of Inflammatory Arthritis’s  ( Rheumatoid Arthritis, Systemic Lupus Erythematosus, Ankylosing Spondylitis, Reiter’s Syndrome)
  • Acute Neuritis (inflammation of a peripheral nerve or nerves, usually causing pain and loss of function)
  • Burns (recent burns)
  • (severe) Causalgia (severe burning pain in a limb caused by injury to a peripheral nerve)c
  • Local Contagious Conditions ( note: some locally contagious conditions may be considered absolute contraindications such as athlete’s foot, warts, impetigo etc.)
  • Deep vein thrombosis
  • (undiagnosed) Lump, Cysts, Moles
  • (during) Radiation therapy treatment
  • Open Wounds or Scars
  • Phlebitis contraindications for massage
  • Severe Varicose Veins
  • Thromboangiitis Obliterans (Buerger’s disease)
  • (Acute) Trigeminal Neuralgia
  • Venomous Bites or Stings

General Massage Precautions

  • Take proper precautions when massaging acute injuries – make sure you are trained to treat the presenting condition in its acute stage (If local massage is contraindicated, careful ROM movements in the proximal joints may be helpful).
  • Use proper pillowing techniques. For example, ensure that an injured body part is properly supported, use towels or pillows to prop up patients who have breathing difficulties.
  • Massage areas of the body that are compensating to the injury.
  • Massage is contraindicated over inflamed and painful areas.
  • Be sensitive to non verbal cues from patient. Do not force a patient into a position they find uncomfortable.
  • Remember to get patient consent and feedback during and after a modified massage treatment (just as in a regular massage therapy treatment).
  • Do not massage skin areas that are open, bleeding, broken, weeping bodily fluids (blood, lymph, pus) as it may contain infectious agents, which could be transmitted to the massage therapist or other parts of the patient’s body.
  • After replacing linens following each massage treatment, remember to also clean other surfaces in the therapy room such as door knobs, pens etc.
  • Pay attention to patient’s allergies to avoid allergy attacks.