Contraindications

of

massage
 Contraindications of Massage

• Treatment by massage is not completely free from risk.

• There are several conditions where application of
massage may be ineffective and also it may be harmful.
• *Contraindications are the conditions in which
particular techniques of massage cannot be given.
• To avoid any harm and to gain maximum benefits of
massage before starting the application of techniques
contraindications should be ruled out in sick and
healthy people.
The contraindications of massage are divided
into two categories:
• *1. General: massage must not be given to
any part of the body.
• *2. Local: a particular area of the body
affected by a condition must not be massaged,
but it can be done to other unaffected parts of
the body.
 General contraindications
• Before physical examination and positioning of the patient
ruled out the contraindications.
• *High Fever
• *Severe renal and cardiac diseases
• *Deep x-ray therapy
• *Osteoporosis
• Severe Spasticity
• Vary hairy skin
• Diabetes
• Patient preference
 High Fever:
• *if the patient has a risen fever of about 37.5°C, the massage should not be
given.
• (Systemic manifestation of the inflammation there is generalized rise in
temperature)
• *Massage may increase the overall body temperature will further increase the
metabolic state which is already elevated due to fever.
• *There are some conditions associated with high fever in which massage may
damage underlying tissues.
• It should be done very carefully so that it does not compromise the tissue
function.
• (In acute poliomyelitis complete rest is required as any trauma to the tender
muscle may result in the complete loss of function in that muscle.
• In systemic Arthropathies massage may exaggerate the symptoms
 Severe renal and cardiac diseases

• *Oedema is a feature of renal and cardiac conditions.

• *There is Peripheral oedema due to cardiac failure and
generalized oedema due to nephroitic syndrome.
• *As the cause of oedema is not mechanical but the
pathology of the involved system massage may
provoke serious consequences like pulmonary
embolism.
• Different positions and techniques of massage may
have adverse effects may prove to be fatal in cardiac
patients
• *.(Generalized increase in venous pressure in cardiac
failure raise the pressure at the venous end of
capillaries counteract the osmotic pressure of the
plasma protein and impedes the reabsorption of the
tissue fluid leading to the production of edema.
• *In renal failure increase concentration of sodium
ions in tissue fluid leads to increased salt retention
by distal tubules of kidney, which ultimately increase
the osmotic pressure. This interfere with tissue fluid
reabsorption and oedema results)
 Deep x-ray therapy:
(Ionizing radiation by x-rays, CTscan, barium and
angiography cause harmful effect.
Non ionizing radiation by USG, MRI has no harmful effect.
Depending upon the dose and exposure effects on cellular
level can damage DNA leads to cancer or leukemia over
longer period of time.
Organ level if effects on Testicle and ovaries lead to sterility.
An effect on ocular lence leads to visual impairment.
On skin Erythema develops, dry and mild desquamation,
epidermal and deep skin necrosis may occur.
If whole body irradiation is given has acute sickness effect.)
• *It has a devitalizing effect on the body tissues.
• In all irradiated tissues be it normal or abnormal the
vascular changes are prominent.
• During immediate post irradiation period, vessels may
show only dilatation.
• Later after higher dose regressive changes appear which
ranges from endothelial cell swelling to the total necrosis
of the wall of the small vessels.
• Affected vessels may thrombosed or ruptured leading to
haemorrhage.
• At this stage tissues will not sustain any kind of
mechanical trauma.
• * As massage gives mechanical energy to the soft tissues it
leads to more harmful effects.
 Osteoporosis:
• *In Osteoporosis in its latter stage can cause bones to become
extremely brittle which can easily be broken or cracked.
• *Skeleton becomes fragile and may not tolerate the pressure
and force applied to body.
• *Due to lack of structural stability of bone a minimal trauma can
produce fracture.
• Be careful while applying massage to the suspected cases of
osteoporosis (Old age group, postmenopausal women, patient
on prolonged steroid therapy) and in conditions where bones
become fragile (osteomalacia, Paget’s disease, osteogenesis
imperfect, etc)
 Severe Spasticity:
• (The muscle tone is maintained by muscle
spindles. The sensitivity of muscle spindle is
maintained by alpha and gamma fibers which
keep them sensitive to stretch. In UMNL the
fusimotor activity is increased and therefore
the threshold of intrafusal muscle fibre to
stretch (exerted by massage) can activate the
myotatic reflex arc and provoke hyper tonicity,
spasm and flexor withdrawal).
• *Spasticity is the abnormal increased tone of
muscles due to lesion of upper motor neuron.
• *Characteristic feature of all UMNL including
Hemiplegia, cerebral palsy, spinal cord injury,
multiple sclerosis, etc.
• *The abnormal handling, pain and discomfort
will lead to increase the spasticity.
• *Massage may increase the tone of the spastic
muscles.
 Vary hairy skin:
• *Rubbing the hairy skin, opposite to the
direction of the hair follicle is painful.
• *Usually massage is not administered to a
very hairy skin but it is a relative
contraindication as the excessive hair can be
shaved off and the part can be massaged.
 Diabetes:
• *In patients with diabetes there is a decreased ability to
sense the amount of pressure you're putting on them when
you massage or to feel pain.
• *Additionally bruises can occur easily because blood vessels
are more fragile even on the side of a lighter touch.
• *Patients with diabetes have a tendency to have a very thin,
papery skin that bruises easily.
• They are also prone to arteriosclerosis, high blood pressure
and oedema
• *Also if they have loss of sensory nerve function they will be
unable to give accurate feedback on pressure.
• When medical clearance has been obtained to treat
diabetic patients who use insulin, care should be taken to
avoid massage on recent injection sites.
• Patients should be advised to have their medication with
them when they attend for treatment in case of an
emergency.
• Also remind the patient to make sure they have eaten
sufficient food prior to a massage to avoid the risk of their
blood sugar level dropping dangerously low if they have
not eaten recently.
• Note: Once medical clearance is obtained massage should
be applied lightly and gently.
 Patient preference:
• *On account of social, religious, cultural and
personal reasons some people do not prefer
massage.
• *They also feel embarrassed while exposing the
body part during massage, if the therapist is of
the opposite sex.
• * In this situation as far as possible the people’s
wish must be respected and they should not be
forced until it is very essential in some
conditions.
 Local Contraindications:

• In presence of these conditions the affected

body part should not be massaged but if
required the techniques can be administered
to the other parts of the body.
• These contraindications should be ruled out
during pretreatment physical examination of
the patient.
 *
• Acute inflammation:
• Skin conditions:
• Recent fracture:
• Varicose Vain:
• Thrombosis and Arteriosclerosis:
• Myositis Ossificans:
• Malignancy:
• Open Wound:
• Poisonous Foci:
 Acute inflammation:
• Acute inflammation is absolute local contraindication of
massage as
• Massage may exacerbate the vascular changes
taking place during acute inflammatory period
(increase blood flow, vasodilatation and
vascular permeability) makes the condition
worse.
• * Massage during inflammation (acute phase)
will further increase swelling, pain, tenderness
and may lead to more tissue damage.
• Granulation tissue (formed within 48 to 72
hours after injury) has a very delicate blood
supply which can easily be damaged by
movements and shearing forces of massage
techniques.
• This interferes with repair process and delays
the healing.
• (If an individual has some acute inflammation, a
massage will only add to the irritation and further the
spread of the inflammation. If you have sustained an
injury in the past twenty-four hours like an ankle sprain
or hurt something in your back, then you should
submit yourself to the first aid principle of RICE (Rest,
Ice, Compression, and Elevation.
It is also advisable at this point to make a call to your
doctor.
• Receiving a massage to an inflamed area will only
cause you more harm.
• You should apply ice in fifteen-minute intervals- homemade
ice packs of ice cubes and a towel will work as well as a
commercial one. You do not want to put the ice pack directly
to the skin or let it put on the area for long periods.
Even though massaging directly on that are will be
contraindicated, it may be very beneficial to a person to
massage not on the area but around that area so that you
can relax the muscles and prompting the body to naturally
heal itself.
• After a person has had the inflammation subside after 72-96
hours, having a massage can dramatically help a person's
mobility of joints as well as helping reduce scar tissue
forming.)
 Skin conditions:

• *Recent scar tissue- massage should only be applied

once the skin is fully healed and can withstand
pressure. Avoid the affected area until such a time.
• Skin which is thin, papery or damaged.
• *Non infectious skin disorders e.g. eczema or
dermatitis. If the eczema or dermatitis is localized you
can avoid working over the affected area. If the patient
is very sensitive a patch test of the massage medium
should be carried out to ensure that the patient is not
sensitive to the product.
• *Acne spots and other conditions-
characterized by purities, oedematous vesicle,
pustules and papules can occur on the face, arms,
back chest and neck.
• You must avoid the area as there is a risk of cross
infection.
• The treatment may spread from one part to other
or worsen the condition.
• You could massage any area that is free of spots.
• *Sunburn- If the sunburn is localized then the area may
be avoided.
• *Contagious skin diseases e.g. scabies, ringworm,
head lice, Impetigo, cold sores, conjunctivitis as there is a
high risk of cross infection patients must not be treated.
• Once the infection has been treated with medication and
has cleared up treatment can be carried out.
• *Viral or fungal diseases e.g. Athlete’s foot, Warts, Nail
infections. Do not treat until the area is clear of infection.
• *Septic wounds, boils, folliculate,–do not treat until
the infection has been treated and has cleared up as cross
infection can occur.
 Recent fracture:

• *In initial stage massage should not be given as it

disturbs the healing process and also very painful
and uncomfortable.
• The shearing movement of massage may hamper
the organisation of hematoma and callus formation.
• It may damage delicate capillaries and flexible
granulation tissues that bridge the fracture in initial
stage which leads to non union or mal union.
• If the fracture is immobilized massage may be
administered to the area proximal to the fracture
site to reduce swelling, spasm and pain.
 Varicose Vain:
• A condition in which due to incompetency of valves,
veins become dilated and tortuous results in the
venous congestion and walls of vein become thin.
• When the valves of veins have a break down it is due
to back pressure causing the veins to stick out and
bulge.
• You can usually see this happen in your legs because
of gravity, this occurs when the legs crossed or are put
in other sitting positions that hinders blood circulating
to your legs.
•
• Standing for a long time will also do this and
add to it.
• *Women in pregnancy can experience this
from pressure on the veins of the pelvic region
and can cause varicose veins.
Massage an area where varicose veins are
present can cause a blood clot to be set loose
in your body's circulatory system and renders
the massage contraindicated
• *In this condition veins may not tolerate
even a minor pressure. It may rupture and
due to high pressure in congested vessels,
profuse bleeding may occur.
• The vein becomes tender and firm.
• Overlying skin becomes red and
Oedematous. So in this condition massage
provoke complications like haemorrhage and
phlebitis.
 Thrombosis and Arteriosclerosis:

• *There is a formation of fatty plaque in arterial

lumen known as thrombus.)
• *Massage should not be given in the presence of
thrombus as emboli may break off from the wall
due to mechanical squeezing of blood vessels.
• It may travel to some other part of the body
through blood stream and block the circulation of
vital organs such as brain, heart and lungs, giving
rise to serious consequences (pulmonary embolism)
• If Arteriosclerosis is severe then it's a massage
contraindication. Otherwise, avoid the back of
the calf (posterior tibial artery), back of the
knee (Popliteal artery), the inside of the thighs
(femoral artery), armpit area (Axillary artery),
the soft part of the upper inside of the arm
(brachial artery), lower arm (radial artery), and
the front part of the neck (temporal artery –
anterior triangle.)
 Myositis Ossificans:
• *(The joint capsule and periosteum is stripped
from the bone by violent displacement and Due to
this blood collect under the stripped soft tissue
forming haematoma.
• The haematoma is invaded by osteoblasts and
becomes ossified forming callus in the soft tissues.
• *This gives limitation of movement and pain.
Complete rest is essential to minimize
haematoma.)
• *Strain and stretching of soft tissue might
provoke more bleeding beneath the soft tissue
and may exaggerate the condition.
• *This condition is more common around the
elbow joint so massage should not be given
around elbow joint after any injury.
 Malignancy:

• (Metastasis – spread of tumour cells from one

area to the other, is the essential feature of all
malignant tumours. Tumour cells disseminate
through lymphatic and haematogenous
pathways. )
• *Anything which increases the lymphatic flow
also increases the chance of spread of tumour.
In order to avoid metastasis massage is
contraindicated in malignant conditions.
 Open Wound:

• *Massage over open wounds, cuts and bruise is not only

painful but may further damage the healing tissue is a
causative factor for delayed healing of tissue.
• *Mechanical movement of massage over the damaged skin is
contraindication.
• Localized bruising must be avoided as massaging directly over a
bruise can be very uncomfortable and could make the bruise
worse e.g. a bruise on the knee must be avoided but the rest of
the lower and upper leg may be treated if clear.
• Note: If the bruising is more widespread (and it is not the
result of a recent accident) this may be an indication of an
underlying medical condition in which case the client must not
be treated and referred to her GP for advice.
 Poisonous Foci:

• *In case of snake bite, stings and insect bite

massage should not be administered as
massage increases the circulation and may
facilitate the release of poison into the
circulation leading to serious systemic effects.
 Other Conditions:

• Some techniques can elicit adverse autonomic

response in pregnancy, cardio respiratory
conditions and psychological disorders such as
panic attack in which massage is contraindicated.
• Infectious diseases e.g. Flu, Measles, Mumps,
T.B, Scarlet Fever, Chicken Pox etc
• Patients with hemophilia may have no blood
clotting capacity and could bleed.
• Patients with severe asthma or lung conditions
• Patient’s with epilepsy as there is a risk that
over-stimulation or deep relaxation may provoke
a convulsion (although this has never been
proven) some types of epilepsy may be triggered
by smells so care should be taken when
choosing a massage medium.
• Note: Once medical clearance is obtained
massage should be applied lightly and gently.
Never leave the patient unattended on the
couch and if the Patient is light sensitive ensure
all lights are turned down low in the treatment
room
• Cardiac condition, high or low blood pressure,
a stroke or thrombosis or are on prescribed
medication as they are susceptible to
thrombosis. Note: Once medical clearance is
obtained massage should be applied lightly and
gently and the following precautions taken:
• Patients with low blood pressure can often feel
faint when they sit up from the lying position
or may fall.
• To prevent this to occur the patient’s head
should be raised slightly higher than normal.
• Care must be taken when the patient is turned
over to massage the back to ensure they are in
a comfortable position.
• Similarly high blood pressure sufferers should
not be laid flat and the head must be higher
than the heart to avoid palpitations.
• Hernia :
• Surgeries: Immediately before or after surgery
e.g. hysterectomy or caesarean section.
• Certainly the area where the surgery occurred
is a local massage contraindication, but also,
there may be things going on relating to the
surgery that makes massage inadvisable for the
whole body. Seek doctor’s approval prior to
massage.
• Nut Allergies:
• As people in general have become more sensitive to a wide number of food stuffs
and cosmetic products it is always advisable to check that they do not have a known
allergy prior to commencing treatment.
• If they have a sensitive skin it is important to carry out a patch test with a small
amount of product that you intend to use as a massage medium.
• This can be carried out by washing the inner bend of the elbow with mild soap and
water and then applying a small amount of product to the area.
• This should be left for 15-30 minutes to see if there is a reaction e.g. redness, itching.
• If a reaction occurs then the product must not be used.
• Patients with nut allergies can go into anaphylactic shock and this requires
immediate medical attention.
• It is therefore extremely important that you know what your massage oils or creams
are made up of.
• There are a wide range of vegetable oils available to use as a massage medium e.g.
sunflower oil, olive oil, corn oil etc.
•  If you suspect that the patient is suffering from a
medical condition that would prevent you from
offering them a massage treatment you must
always refer them to their GP for a diagnosis and
consent to carry out the treatment in the future.
• Therapists must never treat a patient who to their
knowledge at the time of treatment is under the
care of a medical practitioner for a condition that
is likely to be made worse by massage.