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Total Contraindications

If a potential client or massage receiver has any of the following 'total contraindications', it means
you must not perform any massage techniques on them.

Ignoring contraindications can be dangerous or even fatal.

The following are total contraindications:

After recent operations (recovery times will vary and can be long - seek medical advice)
Ankylosing spondylitis
Bell’s palsy
Bone diseases (e.g. osteomalacia, rickets, Paget's disease)
Brain haemorrhage or tumor / tumour
Cardiovascular conditions (e.g. thrombosis, phlebitis, hypertension, hypotension, any heart
conditions, recent stroke)
Cervical spondylosis
Head lice
Hematoma / haematoma
Hepatitis (acute stage, then seek written medical permission)
Diarrhea / darrhoea
Fever
Fungal infections (if large area of the body is affected)
Hemophilia / haemophilia
Infectious disease (e.g. common cold, flu, meningitis)
Intoxication (alcohol or recreational drugs - can distort sensory awareness)
Impetigo (if not medically treated yet or sores still weeping)
Kidney infections, stones or failure
Meningitis
Migraine (during an episode)
Osteoporosis
Paget's disease
Pregnancy
Scabies
Vomiting
Whiplash
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Medical Permission Conditions

These are potentially dangerous conditions. You need medical permission to give massages to these
receivers, and to follow the doctor's specific written advice very carefully.

Consider these contraindications the same as total contraindications unless:

1) The client's doctor has provided written permission for the client to have the treatment.
2) The named doctor knows what qualifications and experience you have, e.g. whether you have
completed online courses only.

If the doctor gives specific instructions and you do not fully understand them, do not massage until
these instructions have been 100% clarified and understood. If in doubt, do not massage.

The following are medical permission conditions:

Arthritis (e.g. osteoarthritis, rheumatoid arthritis)
Cancer
Cirrhosis of liver (advanced)
Edema / oedema
Emphysema / COPD
Epilepsy
Diabetes (see further information provided)
Gastric ulcers
Headaches (when severe and unexplained you must not perform any massage - medical attention is
needed)
Inflamed nerve
Lower back pain / lumbago (refer to osteopath or doctor)
Medical condition already being treated
Multiple sclerosis (contraindicated during acute episodes / attacks / relapses; seek doctor's advice
for massage during remission)
Muscular disorders (e.g. muscular dystrophy, myasthenia gravis)
Neck - any condition
Nervous system dysfunction (e.g. muscular sclerosis, Parkinson’s disease, motor neurone disease)
Neurological conditions (e.g. dementia, severe autism, severe learning difficulties)
Parkinson's disease
Postural deformities
Respiratory infections (except chronic sinusitis)
Rheumatism
Skin diseases
Slipped disk / disc (see below)
Spastic conditions
Stroke (must not be recent, must be fully recovered, otherwise dangerous)
Swelling in a particular area (localized)
Transient ischemic attack / Transient ischaemic attack (ITA)
Tuberculosis
Undiagnosed pain, lumps or bumps
Unlisted medical conditions
When taking prescribed medication
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Local Contraindications

Local contraindications are conditions that restrict massage treatments.

Do not apply any massage techniques, include pressure or stretches, to areas of the body affected
by:

Acne (depending on severity and degree of inflammation)

After a heavy meal (avoid the abdomen)
Arthritis
Athlete's foot
Bedsores
Blisters
Boils and carbuncles
Bursitis (acute, seek medical advice if unsure)
Cold sores
Cramps (acute, severe; massage can help long-term spasms)
Endometriosis (avoid the abdomen)
Fibrosis
Fractures (wait until fully healed, recovery time vary - seek medical advice)
Fungal infections (if only a small area of the body is affected, otherwise consider a total
contraindication)
Gall stones (avoid the abdomen when painful)
Goitre (avoid the neck)
Gout (avoid acute flare-ups)
Hernia (avoid the abdomen)
Hormonal implants
Impetigo (must be after treatment, in recovery stage)
Injuries (acute or undiagnosed)
Menstruation (abdomen, lower back, thighs can be sensitive - apply with softer touch)
Pelvis inflammatory infection (avoid the abdomen)
Prolapsed uterus / vagina (avoid the abdomen)
Recent abrasions, bruises, cuts, swelling, areas of inflammation
Scar tissue (recovery times will vary and can be long - seek medical advice)
Shin splints (acute or severe; severe cases need medical attention, but mild cases may benefit from
gentle massage)
Shingles (usually ribs, sometimes face)
Sprains
Strains ('pulled muscle')
Sunburn
Tendonitis (acute stage)
Trigeminal neuralgia (when acute, avoid the face)
Varicose veins (avoid area around these, as well as area directly below these - as a beginner or if in
doubt, leave more distance, not less)
Warts
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Further Essential Warnings For Massage:

Joint hypermobility syndrome

Do not apply stretches on people who have joint hypermobility syndrome as you may cause harm
without them realizing.

Asthma

It is safest to avoid using any scented or perfumed oils with asthma sufferers. Warn them exactly
what is in the oil(s) you are going to use and ensure they are okay with it.

Lying flat can make breathing more difficult for some people with asthma. They may breathe
easiest when their upper body is supported, or when they are in the side position, so you can discuss
these possibilities with them.

Cancer

Instructions vary according to type of cancer and treatment received that may prohibit or restrict
treatments, seek specific medical advice from the client's doctor, ensuring the doctor knows you are
not trained in oncology massage. Despite lack of clear evidence that massage techniques can spread
metastatic cancer, the whole affected body part should be considered a local contraindication, so
avoid e.g. limb, torso, head - as relevant.

Diabetes

Diabetics often have fragile blood vessels, as well as areas of thin skin, and other skin conditions.

As such, to ensure you do not hurt someone with diabetes, it is definitely essential to get a doctor's
written permission for the receiver, ensuring they know your own particular skill level.

To give someone with diabetes a massage, to avoid causing damage, their muscle tissue must be
healthy and their circulation must be good. Only these areas can be massaged - all areas with tissue
damage, vascular damage and thinning skin should be avoided.

Skin Disorders that are fine to massage

These are not contraindications, you can massage them without worrying:

1) Vitiligo
2) Skin tags - but be cautious not to break with with vigorous movements
3) Liver spots / age spots.

Acquired Immune Deficiency Syndrome (AIDS)

Only use gentle strokes if the person is feeling unwell.

For your own protection:

1) Avoid open cuts or weeping skin on the receiver

2) Cover-up any cuts on your own skin, and wash any towels used.
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Colitis, Crohn's disease, diverticulitis, ulcers of the stomach or duodenum

For these conditions, only perform very gentle massage on the abdomen.

Allergies

Ensure the receiver isn't allergic to any oil you plan to use before the treatment starts, or
anaphylactic shock and death can result.

Spinal curvature:

If the receiver has abnormal spinal curvature, massage, cautiously applied, can help relieve muscle
tension and enhance mobility. However, ensure the receiver is comfortable, using pillows/cushions
to provide support where they might need it.

Hiatus hernia, indigestion and heart burn

The massage receiver may not be comfortable lying down. Some people may wish to be massage
sitting upright while others may prefer to have their upper body or head raised with cushions or
pillows.

Recommend that massages should take place when the receiver has an empty stomach to help
prevent any pain or discomfort.

Stretch marks

Do not apply deep massage techniques to stretch marks.

Inflammatory conditions you may encounter

These might include: ankle tendon injuries, frozen shoulder, deltoid bursitis, housemaid's knee and
tennis elbow. Note that all these conditions should be considered local contraindications - do not
massage inflamed areas of the body.

Massage of the muscles of the surrounding areas may, however, be beneficial.

Neurological conditions

Massage therapists need to be aware if a prospective massage receiver has any sort of neurological
condition that either affects their ability to understand what is happening, or to communicate with
the therapist effectively. If trying to treat someone with severe learning difficulties, dementia or
autism, they need to ensure that the intended treatment is fully understood. Guidance from a
person's carers may be necessary before proceeding with any treatment and non-verbal
communication skills and strategies may make the process easier.

Thin skin

You should not perform stretches or percussive movements on areas of thin skin as this can causing
tearing. Only very gentle massage movements should be performed.
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Osteoporosis

This is an example of a condition which makes a receiver much more fragile, and should be
considered a total contraindication unless you have received professional massage qualifications in
person - not just online sources.

If you are confident that you are sufficiently skilled and experienced to treat someone with
osteoporosis, then this condition should be considered a 'medical permission condition', requiring
the client's doctor to put consent and guidance into writing. This consent should acknowledge your
skill level and particular qualifications, and if certain areas of the body are to be avoided, it should
state this.

Once a doctor's permission has been received, certain areas of the body may need to be considered
local contraindications and avoided.

Any massage on someone with osteoporosis, needs to be:

1) Very gentle
2) Avoid all stretches and joint manipulations
3) Avoid all percussive strokes
4) Integrate extra cushions and supports for the receiver, ensuring they are always well-supported
and comfortable
5) Take extra care helping clients onto and off tables
6) Integrate extra caution with all techniques, starting slowly and very softly, and continuously
asking for feedback.

Elderly Clients

Be aware that elderly clients may have osteoporosis without realizing it yet. Also be aware that
osteoporosis is most common in elderly women.

As such, massage with extra caution for elderly receivers; start slowly and softly, only increase your
pressure gradually with elderly receivers. Consider avoiding all stretches and joint manipulations -
if they insist that it is all right, then apply these with extra caution, slowly and gently, while asking
for feedback.

Fibromyalgia

Be cautious when treating people with fibromyalgia, as they can be extremely sensitive to pain.
Ensure not to massage them too hard or too frequently.

Fibrositis and Muscular Rheumatism

Any massage needs to be applied carefully so that you do not cause irritation.

Pregnancy

Massaging a pregnant woman requires special training and specific certification in pregnancy
massage. As such, you need to consider this a total contraindication for treatment, and refer the
receiver to someone who is sufficiently qualified, unless you yourself have the necessary credentials
and insurance in your country.
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Common prescription medications to watch out for

The following is a list of common prescribed drugs that can cause side effects which can affect a
massage treatment.

As such, you may want to watch out for the following - but please note, these are just common
examples you might come across – not a complete list:

Antiarhythmics
Antihypertensives (e.g. sympatholytics, ACE-inhibitors, and vasodilators)
Beta blockers
Calcium channel blockers (CCBs)
Diuretics
Dopaminergics
Muscle relaxants
Narcotic pain relievers.

Myasthenia gravis and muscular dystrophy

Gentle massage can help alleviate muscle spasm and pain.

The client may be experiencing a loss of sensation, so apply pressure gently and carefully; avoid
stretches and joint manipulations, or be very slow, gentle and cautious when performing these.

Myalgic encephalitis (ME)

People with ME may be experience heightened sensitivity, so you must be careful when performing
any massage techniques.

Potential energy work consideration with menstruation and massage:

Thai massage therapists generally teach students not to massage the abdomen during the first few
days of menstruation. This is, however, mainly to prevent the massage giver from absorbing an
intense energy from the receiver.

While most Western people probably will not worry about this, some holistic therapists may like to
bear this energy-related consideration in mind.

Epilepsy and energy work

After getting permission from an epileptic client's doctor to perform a massage, massage therapists
who also do energy work are advised not to do energy work on the receiver's head.