When to Avoid Massage

I am a fan of massage therapy. There are so many benefits both physically and mentally, and it can be a great addition to your healthcare and to treatment plans for many diseases and disorders. That being said, there are times when massage is not an appropriate choice. Many of the things on this list may come as a surprise, and can sometimes be avoided, which is why I think it is so important to share them.

First, let's start with a little bit of terminology. The first terms I would like to introduce are indicated vs. contraindicated. If something is indicated, it means that it is safe and appropriate. If something is contraindicated, it means that it is inappropriate for the situation and potentially unsafe. Next we have systemic vs. local. Systemic refers to the entire body, while local refers to a specific area. So, if you have a systemic contraindication, all massage is inappropriate. If you have a local contraindication, massage is indicated except at the area affected.

In today's post, we will go over instances of both systemic and local contraindications to help you know if massage is the right choice for you.

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Systemic Contraindications
If you have any of the following, massage is generally not a good idea:

Viruses
If you are contagious, please stay home. Coming in for a massage when you are contagious not only puts your therapist at risk for getting sick, but it puts other clients who will be touched by that therapist, on that table, in that room at risk as well.  While we clean the room and wash our hands between massages, there isn’t much we can do about airborne illnesses, and in some massage establishments, therapists are not given sufficient time in between sessions to properly clean and disinfect the room.

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Fever
If you have a fever, massage is systemically contraindicated. A fever is a sign that your immune system is working to kill off an infection, virus, or anything else that has gotten into your body and doesn’t belong.  Generally having a fever is a good thing because it is a sign that your body is taking care of you.  The best thing to do for a fever is to let it run its course. Don’t try to get rid of a fever that is under 104 because getting rid of the fever can actually prevent your immune system from doing what it needs to.  If it is 104 or more, seek medical attention immediately.  So, why not massage? Massage increases your circulation which can not only increase your fever, but by causing fluids to circulate faster, it can cause whatever your body is trying to get rid of to spread.  If you have a fever, staying home and resting is the best thing you can do for yourself

Alcohol
There are many reasons why you should not get a massage if you have been drinking.  First and foremost, alcohol alters your perception of pain. Things that should hurt don’t because the pain receptors have been dulled. This can be very harmful because you can get injured on the table without being aware of it.  Secondly, alcohol impairs your judgement.  This can cause you to act in ways that are inappropriate and put your safety and that of the therapist at risk. Third, it can make you more drunk.  Because circulatory massage causes your blood vessels to dilate, or increase in size, your blood alcohol level can rise because your blood is moving faster. Fourth, as you get more drunk on the table while lying down and receiving soft tissue manipulation (massage) you are more likely to vomit. Your massage therapist doesn’t want to clean up your vomit.  If you have been drinking, don’t try to get a massage.  If you are at one of those “upscale” establishments who offer you a glass of wine or champagne, or a cocktail, decline. Be aware that if you have that drink before your massage, your therapist can refuse to work with you due to safety concerns.  

Prescription and Over-the-Counter Pain Meds
Massage is about touch.  It is very important for your therapist to know if their touch creates negative sensations.  If you have taken pain medication, it can alter the way you feel touch, and you are likely not going to be as aware if something is wrong.  If you have any injury or illness that requires the use of pain medications, it is best to schedule your massage just before you take a dose so that you are able to feel touch in an unaltered way.  Even over-the-counter(OTC) pain medications like ibuprofen or acetaminophen can alter sensation enough to interfere with your massage.  Just wait to take them until after your session.  If you are in so much pain that waiting to take your medication would be unbearable for the duration of your massage, then you probably aren't well enough to receive massage in the first place.

Recreational drug use
As a massage therapist, I do not make judgements based on lifestyle choices, however, it is important that you share any information about recreational drug use with your therapist due to the same reasons mentioned in the sections about alcohol and prescription/OTC pain meds.

Some other medications
There are some medications that contraindicate certain types of massage. These are evaluated on a case by case basis, as they can each have different uses and side effects. If you are on any medications, make sure to tell your massage therapist to make sure that massage is a safe option.  Sometimes, massage itself may not be contraindicated, but must be modified because some techniques or therapies become unsafe.

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Local contraindications
It is important to note that based on many of these factors, while massage itself is safe, it will need to be modified or avoided in specific areas.

Injury
If you have an injury, it is generally a local contraindication.  I know when you strain something, it seems like getting it massaged right away is a good idea, but most injuries are contraindicated for at least 72 hours.  If you pulled a muscle in your back, I don’t doubt that it is very painful, but getting a massage right away will only serve to make it worse.  As long as the injury is acute, bodywork is contraindicated in that area.  Just be aware that if your massage therapist avoids working on your sprains and strains, it is for a good reason.  Wait a few days, then book your massage.

Vaccinations/immunizations
As adults there aren’t really many vaccinations that we are encouraged to get, but when it does come time to get immunized, it is considered a local contraindication for massage for the next few days.  Many people experience some pain or irritation at the injection site which makes getting massage there an uncomfortable experience.  It is also common for some people to experience immune responses after getting a vaccine.  This can be relatively common with the flu vaccine which can cause symptoms similar to those one might experience with the flu virus itself such as stuffiness, headache, or in some cases even a fever.  If you experience any of these side effects, it is important to avoid massage until you make sure that the side effects are caused by the vaccine, and not that you have actually gotten sick.  Because we get flu shots around the same time as cold and flu season, it is entirely possible to catch a different virus around the same time that you receive a flu shot.  Because certain vaccines are designed to disperse into our bodies at specific rates, we also advise against massage around an injection site for the first few days because some massage techniques can increase circulation to the areas where they are performed.  While there is not a lot of evidence to see how much of an affect circulatory massage would have for a recent injection site, I was taught that it is better to be safe than sorry until more research can be done.  Unless you are experiencing immune responses such as a fever, it is alright to get a massage, it is only the injection site that should be avoided.

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Rashes
Depending on the cause, a rash may or may not be a local contraindication.  Some rashes like eczema and psoriasis can vary in severity. If you have any open skin or pain, it is best to avoid working on the area.  If you have a non-contagious skin condition that is not causing pain, massage may be fine.  If your rash is contagious, it is a local contraindication.  Let your therapist know where any rashes are, what kind it is, and how severe, and they should be able to make proper judgement for your treatment.

Infection (bacterial, fungal, etc) and inflammation
In cases of infection, the type will dictate how safe it is to receive massage.  Some infections will cause a systemic contraindication, others will be local.  If you have athlete's foot or a nail fungus, massage is locally contraindicated.  Any work will have to be done over the sheet to avoid spreading it. If it is something like a cut that has become inflamed, that is generally a local contraindication as well. Your therapist will avoid any areas affected (areas with heat, redness, swelling, etc.) If the infection is internal, it is more of a systemic contraindication.  The decision is made based on where the infection is, if it has spread, and where it could go if it continues to do so.

Pregnancy and postpartum
Prenatal and postpartum massage are generally perfectly safe as long as you are seeing someone who is qualified.  Be wary of going to day spa type places because very often the people they assign to you are unqualified.  That is how I got into prenatal massage in the first place. The spa I was working at kept scheduling prenatal massages for me and when I said that I wasn’t qualified, they said they didn’t care.  Once I got certified in pre-and perinatal massage, the spa that I was working at(a different one than the one mentioned before) would schedule prenatal massages for whomever was up next in the queue. So it didn’t matter that I was qualified and the other therapist wasn’t, the massage would go to her because she was next in line.  There are certain local contraindications for prenatal and postpartum massage that should be observed especially if you have any complications or high risk factors.  Any massage therapist who has been trained to work with women during pregnancy and the postpartum period should be aware of each of these contraindicated areas and know how to use techniques and positioning safely and effectively.

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