A contraindication is something which prevents or restricts a treatment being carried out because of risk of cross infection, client discomfort, or worsening a condition.
A contraindication is a physical or behavioural reason that would prevent a massage treatment from taking place in full (or in part) due to the risk of cross infection, client discomfort, or worsening a condition. A consultation form must be completed prior to a treatment in order to find out about any contraindications or ‘special care’ conditions present. This is done to ensure your health and safety of the therapist and client and allows for the massage to be more suited to the needs of the client. Some conditions require written medical approval.
Special care areas and localised avoidance, open, skin, rashes, bites, stings, wounds, sun burns, localised swelling, redness, lumps, bumps, broken bones, pustilar acne, menstruation, a heavy meal, diarrhoea or constipation, scars, allergic reactions.
Low blood pressure – special care -The client may need help when getting off the table as the sudden lowering of blood pressure when they get up too quick could make them pass out or fall over or they may feel faint on sitting up and require support.
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High blood pressure – special care – One of the effects of massage is the lowering of blood pressure. This can be a good thing for hypertension, but not for uncontrolled hypotension. Clients may need to avoid lying flat so raise the top of the bed. If their blood pressure is controlled by medication, they can get massaged. They may need help when getting off the table as there has been a sudden drop in blood pressure during the massage, if they get up too quick could make them pass out or fall over. If their condition is severe then massage is contraindicated. If the person is to receive regular massage then they should get medical approval as it is possible that their medications may need adjusting. Keep massages on the mild to lighter side as by increasing the fresh blood flow through the skin there is a danger of rupturing the blood vessels which are already under excessive pressure.
Heart conditions/disease – special care – The client may need to avoid lying flat. Adjust the massage to suit the client. A heart murmer is a minor problem and not a contraindication. Chronic problems like a weakened heart or blocked arteries are contraindicated as massage might not be good as it can put stress on the circulatory system [caused when blood and blood are moved around]
Pacemakers – special care – As long as care is taken around the area of the pacemaker, and the person is in good health, a massage is fine.
Thrombosis or phlebitis – absolute contraindication- “thrombo” means clot, and “phlebitis” means a vein with inflammation. There is a serious risk that the clot could be moved during massage and travel to the heart causing a heart attack, or to the lungs causing a blockage in one of the blood vessels in the lungs, or to the brain causing a stroke. Do not massage as the results could be fatal.
Varicose/ painful veins – special care – Do not massage directly over varicose veins as this can cause further problem. A very light massage can be applied beside the varicose veins. Always work in a direction toward the heart. Do not massage anywhere that is further from where the varicose veins are located in relation to the heart. For example. If you have varicose veins on the back of the knee, don’t massage the back of the knee or anything below the knee. Anything above the varicose veins behind the knee is okay to massage, as long as there are no other massage contraindications. Let’s say you have varicose veins in the back of the knee (the vascular system is compromised at that area of the body) so massaging the lower leg and feet would then only add more vascular stress to that compromised area and it could just be dangerous.
Circulatory disorders -. Depends on the specific type of circulatory disorder. Check with your doctor before starting therapy; massage will be light and soothing.
HIV infection – Immune deficiencies –
With AIDS or other immune deficiencies, Get medical approval prior to massaging. Precautions should be taken to prevent any transfer of fluids. Think also about what you can pass to those who already have a compromised immune system. If you even think you are unwell then no massage as you could be putting somebody in danger by being around them when they already have a compromised immune system. Wear a mask, wear surgical gloves, be clean. It’s a good rule of standards to keep this up with all clients as it may be you that is the contraindication to massage.
Always wear surgical gloves if you have any cuts etc on your hands or if a client has HIV/hepatitis or anyone with visible rashes, sores, lesions or swelling. AIDS cannot “caught” through skin-to-skin contact as long as there is no exchange of bodily fluids (blood, genital fluids, or mother’s milk), HIV cannot be transmitted during massage. Gentle contact should be used but in the case of any visible rashes, sores, lesions, or swelling, then medical approval should be obtained for your own safety. If in doubt do not massage.
Infectious diseases/virus -contraindication – Massage is not a good idea for someone coming down with anything infectious, and you would expose yourself to the disease/virus as well. Massage may worsen the condition and spread infectionand it puts the person doing the massage, in danger. So, no massage would be given until the client had fully recovered.
Shingles – Shingles (Herpes Zoster) is highly painful and very contagious so you would not massage the client until they have written medical consent to say it is safe to do so then avoid the affected area as it may still be sore. Do not want to massage on any infected or inflammed area. If you have any doubt at all then don’t massage.
Shingles are only a local contraindication. You can give them massage elsewhere on the body, but be careful that you observe proper precautions with sheets,gloves, cleaning your table and washing your hands!
Increased temperature/fever/ feeling unwell/acute infectious disease – contraindication – fever is your body is trying to fight a virus/infection of some kind. Massage increases overall circulation and could work against your body’s natural defenses. High Fever is definately contraindicated. Massage can be taxing on a weakened body. It can also spread the infection and make it feel worse. The therapist is at risk of catching infection, if the fever is caused by something contagious, like a cold/flu. Infection is anyone weak or clinically exhausted i.e. recovering from a viral infection, generally unwell, infectious skin complaints, scabies, herpes, warts, cancer, flu, bronchitis, kidney infection. Feeling unwell is vomiting, bloating, constipation, diarrhoea, headache. Fever indicates there’s an infection somewhere within the body. Massage can worsen and work counter to what you’re body is doing to fight things off. So, no massage would be given until the client has fully recovered.
Inflammation – You should not massage an area of inflamed skin as this will irritate it. Inflamed conditions usually end in -itis, such as phlebitis dermatitis arthritis etc. It is still possible to massage around the affected area avoiding the inflammation itself. Clients with rheumatoid arthritis are prone to inflammation, look for area that are red, hot and swollen. Do not massage. A local massage is a contraindication because it works counter to what the body is trying to do in order to heal. Indications of inflammation are pain, swelling, heat, redness and pain. It’s always a good idea to know where the inflammation stems from. Is it an injury or something more advanced? With an injury, it’s alright to massage so long as you stay away from the injured area and structures that irritate that area. For example, An ankle sprain. It’s possible to irritate that area by massaging the back of the lower leg because some of those muscles that surround the ankle originate higher up on the leg.
Skin problems -You should avoid anything that looks like it shouldn’t be there as they may spread them, such as rashes, wounds, bruises, burns, boils, blisters, types of bacterial infection, skin disease, disorder i.e. acne vulgaris, eczema/psoriasisor or skin cancer. Nail disease and scalp infections. Irritation of the skin. Scar tissue, bruises, burns, blisters, cuts & grazes, abrasions, rashes, bites, wounds, sun burn.. Usually these problems are local, so you can still massage in other areas.
Skin Conditions – If the area is painful then no massage. There is a risk of the therapist catching the condition. Some local conditions like ringworm, a client can still get massaged, as long as the infected area is avoided. If it is not contagious and not painful, it can be massaged as long as the therapist is okay with that.
Undiagnosed lumps and bumps – If you find a lump it isn’t always a major problem. Ask the client to get written medical approval prior to massage.
Burns/Sunburn – contraindication/special care – If it was just a small area of the body i.e the finger then massage could be carried out on the rest of the body but if the body was sunburned then massage would not be carried out until the skin had fully recoverd
Cancer – contraindication – medical approval needed unless the patient is free from cancer and no longer on treatments etc. in terminal cancer treatment may be given as special care as the massage would be adapted to suit the clients therapeutic needs. Cancer can spread through the lymphatic system, and because massage increases lymphatic circulation/flow, it can spread the disease. Apply light pressure but do not use massage strokes that stimulate circulation. As long as it is not a lymphatic cancer (which can spread easily and quickly), and as long as they are in good health, it is fine. This can relieve stress, and makes the client happier which may help them fight the disease. Get written medical approval about the type of massage, as the client may still be allowed to get a different type of massage i.e. scalp massage, and foot and hand reflexology depending on their condition.
Under the influence of alchohol or drugs or on Heavy medication – Anyone under influence of recreational drugs or alcohol. Just one reason this is a massage contraindication is because the person getting the massage has senses that are dulled or distorted making it unsafe. The client could have unpredictable behaviour or become incoherent, or distracting to other clients, or they could be a danger to themselves and the therapist.
Lack of sensation -If a person has no feeling in a part of their body, they will be not be able to tell you if you are applying too much pressure, and the muscles may get damaged. Areas that are numb should be avoided or very lightly pressure used.
Sensory Impairment – special care – Except for neuropathy, people with sensory impairment are fine for massage, although a method of communication should be worked out before hand i.e if a person is deaf then you might tap them on their shoulder when you want to communicate with them.
Bruising/cuts/abrasions – special care – Always wear gloves. Stay away from that area as you could make it worse. It is a contraindication as you are increasing fluid exchange in an area of the body that is in the process of trying to repair itself and there may be blood so high hygiene standards should be maintained and surgical gloves worn and ensure working area is cleaned thoroughly after massage.
Do not massage over a new bruise or if the bruise is painful or tender. Older bruises are okay to massage using flushing effleurage strokes as long as it’s not painful and there are no other contraindications. For those with vascular problems it’s probably best to leave alone altogether. Massaging around the area will be beneficial.
Bleeding – External or internal – contraindication -massage will increase bleeding as it increases the flow of blood around the body.
HAEMOPHILIA – contraindication – Haemophilia is contraindicated because the client’s body cannot clot blood normally, and can experience a lot of bleeding from something very simple. Massage, especially deep tissue, could cause a lot of bruising, or subdermal hematomas, which can cause a lot of pain and problems later. If the client’s haemophilia is mild, or well controlled with medications, they might be okay for a light massage. Ask for written medical approval prior to massage.
Recent scar/sprain/injury/surgery – special care -SURGERY: Anyone who had major surgery in the last 24 months. Anyone who had minor surgery in the last 6 months.
Recent operations are a contraindication to massage because the body is already trying to heal an injury, and massage can be quite stressful to a weakened body. There is also the risk of infecting the unhealed incision, and causing tearing and pain if massaged.
PINS & PLATES: Anyone with pins & plates to stabilise bones and joints. You would avoid these areas.
MENSTRUATION: 1st few days of period. During Menstruation – it can help ease low back pain and cramps, and ease the stress felt during this time. It is only a contraindication if the client is not comfortable enough to be massaged or if she is in a lot of pain, she probably could not lie still enough for a massage or if her flow is heavy. A light massage over the abdomen is alright .
Broken/fractured bones – Broken bones: Stay away from an area of mending bones. A little light massage to the surrounding areas, though, can improve circulation and be quite helpful.
Osteoporosis – special care – Elderly people with a severe stoop to the shoulders often have this condition, in which bones become porous, brittle and fragile. There is not as much natural stimulation within the bone to grow due to age and hormone change. Massage may be too intense for this condition so caution should be used. Massage can be of benefit to the bones as we gently move the muscles they tug on the bone which stimulates and strengthens it and improves circulation. Massage is fine, as long it is not done deeply or vigorously. With brittle bones, you could run the risk of accidentally breaking or cracking one.
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NECK / BACK PROBLEMS – contraindication -Get written medical approval. Never touch a persons neck if they have something wrong. If you do anything wrong with it you could severly injure them, damage something, or kill them.
Arthritis – If it’s not inflamed then massage providing there are no other contraindications. Be gentle with no unnecessary joint movements. Try to relax the muscles without inflaming them or the joints. Muscles cross joints so the more relaxed and lengthened they are the more joint space is available for joints to move. Rheumatoid arthritis get medical approval.
If the condition is bad then it’s a massage contraindication. Otherwise, avoid the back of the calf back of the knee the inside of the thighs armpit area the soft part of the upper inside of the arm lower arm the front part of the neck If atherosclerosis that is severe then
It’s entirely possible for embolism
NERVOUS / PSYCHOTIC CONDITION – Anyone suffering from this condition and or is on medication to control the condition.
Nervous system disorder is a difficult term to describe. IT can mean something as severe as multiple sclerosis and cerebral palsy to loss of feeling and a many other things. Massage is contraindicated depending on the condition. Something like MS and CP can be massaged, but often requires extra training in dealing with special-needs populations. This also applies with conditions like epilepsy. The worry here is that either the therapist or the client could come to some harm, either in moving the client or if they have an episode. If the problem is something like peripheral neuropathy, the problem here is that the client cannot give you accurate feedback as to pressure and pain, and might accidentally get injured.
spastic conditions-disfunctions of the nervous system – mechanical types of massage are appropriate only where sensation is present and no underlying pathologies may be exacerbated by the work. Areas without sensation contraindicate massage that intends to manipulate and influence the elasticity of tissue.
Hernia – are protrusions of part of an organ (such as the intestines) through a muscular wall. It’s not a good idea to try to push these organs back inside. Surgery works better. Local massage contraindication, but also note to avoid the area and also avoid any area that causes pain or effects that area. When we massage we’re moving tissues. Those displaced tissues as we massage can sometimes effect other areas adjacent to where we are presently massaging. It’s just like water displacement in a tub, when we get in the tub, water rises
Lung disease – special care – clients may have lung disease such as Chronic Obstructive Pulmonary Disease (COPD) and may use an oxygen tank, work carefully around any tubing etc. Their bodies may be weak, use lighter strokes, such as those in a general relaxation Swedish Massage, energetic therapies such as Reflexology Reiki, or Polarity, can be used also.
If the client cannot lye on the massage table then a chair massage can be offered. Change your massage techniques and pressure used to suit clients individual needs. Ask for written medical approval.
Haemophilia [danger of bleeding if bruised] – Haemophilia is contraindicated because the client’s body cannot clot blood normally, and can experience a lot of bleeding from something very simple. Massage, especially deep tissue, could cause a lot of bruising, or sub dermal hematomas, which can cause a lot of pain and problems later. Now, if the client’s haemophilia is mild, or well controlled with medications, they might be candidates for a light massage. If ever in doubt, get the okay from the person’s doctor before massaging.
pregnancy – special care – avoid abdominal massage once pregnancy is known. Anyone in their 1st or last Trimester of Pregnancy or experiencing any problems with their pregnancy. Anytime where high blood pressure exists, with pre eclampsia or excessive edema. Also, be careful with the depth of pressure and where you massage
Around painful/hot/swollen joints – Bursitis, inflammation of the bursa around a joint, is locally contraindication since any movement of the joint would cause a lot of pain. They would probably tense out of fear, undoing any good from the massage. The other areas can be massaged, as can the limb, if done gently.
Rheumatism – This depends on how healthy the client is. If the client is in no pain from their condition then massage may help relax their muscles that are tight around their joints.
Joint Disfunction – Same as above massage may help increase the range of motion in the clients joints. Special care should be taken if the client has dislocated a joint in the past as it can re-dislocate if pulled too hard, or if something prevents a joint from moving like a spur of bone then that is not something that can be worked through.
Directly over moles and warts – Warts are caused by a virus, are definately contagious, so they locally contraindicate massage. Moles are simply raised and discoloured groups of melanocytes, are not contagious, so they are fine to massage. We can be aware of changes to a mole that they do not know about as we can see their back and they cannot. Remember the ABCD’s of cancer: if a mole is Assymetrical, if the Border is uneven, if the Colour changes, or if the Diameter is larger than a pencil eraser. Never cause alarm or try to diagnose but suggest discretely that they might want to get it checked out by a medical professional.
Asthma -If massage does not trigger Asthma it is ok to perform the treatment. GP should give consent first. Sufferers should carry inhaler and discuss an emergency care plan with therapist prior to massage.
Diabetes – special care – in some diabetes circulation is poor, skin sensation may be altered and the skin can become very fragile. The healing process can be very slow, this is especially a problem in the lower leg and foot. Two things to be aware of are that blood sugars drop after a massage, so discuss this with client and have a snack ready just incase. The therapist needs to be aware of any peripheral neuropathy, if there is then deep tissue work is contraindicated as the person will not be able to tell you how the pressure feels.
A client with diabetes may have a decreased ability to feel the amount of pain or pressure applied when you massage. Additionally bruises can occur easily because blood vessels are more fragile. Use a lighter touch. Gentle massage is okay as long as tissues are healthy and circulation is unimpaired. Many people with advanced or poorly treated diabetes experience numbness, cardiovascular problems, and/or kidney failure. Circulatory massage in these situations is not appropriate. If in doubt ask for written medical approval.
Epilepsy – special care -most people with epilepsy will have their condition well under control with medication, but special care must be given not to leave them unattended on a couch. Controlled epilepsy is ok with medical approval. Nevertheless, if the seizures tend to come on fast with no warning, the therapist should be alert to the possibility of this happening during an appointment and have a care plan worked out with the client prior to massage.
Elderly – Be careful not to cause any bruising. Additionally, be careful about the pressure you use. Bones could be more brittle than you think. When dealing with elderly there are a lot more illnesses and ailments to consider. If you’re not sure about something then don’t massage until you have written medical approval.
Emotional responses – special care – The client you’re massaging could get emotional. There may be personal things happening in their private lives. Ensure your client is okay and not hurt in any way and reassure them, give them a moment to compose themselves and ask if they want to continue.
Fatigue – If it’s not known what is causing the fatigue then suggest your client gets medical advice. Keep everything very light and subtle in the massage. Massage on regular basis can be a good for healthy sleep.
Headaches – Migraines, tension, sinus – The only way to know what you’re dealing with is to get written medical approval. Migraines do not massage. It could be a sinus infection, a chemical imbalance of sorts, all the way up to a brain tumour. If your client is having frequent headaches suggest they see a doctor or optician to get checked out.
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