You already know how beneficial massage therapy can be for a wide variety of ailments and conditions. You offer relaxation, pain reduction and therapy to your clients on a daily basis. And when a client calls to book an appointment, whether it’s a new client or one of your regulars, your automatic response is to say, “Yes, of course. What time would be good for you?”

However, there are times when you’re going to have to say “no” to a client, even if they insist that a massage is the only thing that will help them feel better. In your massage classes, you learned about contraindications to massage, but sometimes it’s easy to ignore those when a client is very insistent, or when you’re afraid of losing their business. Just remember that in some cases, massage can actually be detrimental to a client’s health. With some conditions, you can also put yourself at risk of contracting illness or disease.

One of your tasks in providing client education is to inform them of the contraindications to massage so that you can ensure that, if one of these conditions crops up, the client informs you before you begin the massage.

The best way to protect yourself and make sure you and your clients act in an ethical manner is to provide ongoing education. Remind your clients that there are times when massage is not appropriate.

Massage Contraindications

You may want to start with the definition of “contraindication.” “Contra” means against, as in contrary, and indications are signs that tell you what to do one way or the other. Therefore, contraindications are signs or signals indicating that massage should not be performed.

The term “massage contraindication” may mean that a client is not able to receive massage at all, or it may mean that massage must be limited to certain areas of the body.

Local contraindications may include illness, disease or an acute injury. These conditions usually mean caution the therapist must exercise caution and adapt massage to the condition. For some conditions, you may wish to have your client obtain a doctor’s release — in writing — before proceeding with massage. Other conditions may mean that massage cannot be performed at all for this client, although you may be able to offer light touch or energy work if the client is in need of relaxation and stress reduction.

Remember, also, that not all absolute contraindications are permanent. Once the condition has resolved, you may again offer massage. These include illnesses such as fever, viral infections and inflammation, among others. ; meaning you may have a condition that, once it clears, you can receive a massage.

A massage may be adjusted for a local contraindication in several ways. You may simply need to avoid the affected area, such as varicose veins or a recently sprained ankle. You may need to use lighter pressure or avoid deep tissue work, or position the client to avoid undue pressure on affected areas. With pregnancy massage, you may need to adjust the client’s position on the table.

Common contraindications include:

• Fever
• Inflammation in general
• Phlebitis (inflammation of a vein)
• Dermatitis (inflammation of the skin)
• arthritis (inflammation of the joints)
• High blood pressure
• Infectious diseases such as colds or flu
• Hernia

The following conditions require caution when performing massage:

• Osteoporosis - light massage may be performed with doctor’s permission
• Varicose veins - massage directly over varicose veins can worsen the problem
• Broken bones - never work directly over broken bones, but light massage to surrounding areas may be helpful
• Skin problems such as rashes, wounds, bruises, burns, boils, and blisters

Always have the client with any of the following conditions obtain written permission from a physician before performing massage:

• Heart problems
• Cancer
• Diabetes
• Asthma
• HIV and AIDS

When in doubt, always exercise caution, even if it means angering a long-time client. By providing ongoing client education and having printed materials on hand to explain the reasons behind contraindications, you can avoid a lot of problems — and potentially a lawsuit.