Most people are great candidates for the relaxation and health benefits of massage therapy. However, there are times when a massage may not be the right choice. Certain conditions contraindicate massage, either because of the risk it may pose to the client or the risk to the therapist.

Infections

For example, if a client has a cold, flu or other contagious viral or bacterial infection, the therapist may choose not to work with them because they don't want to catch a cold and risk passing the infection to other clients.

"When a client has a cold or flu, a massage might seem comforting," said Patricia Coe, DC, ND, clinic supervisor for National University of Health Science's massage therapy program. "However, when someone has an infection, their body is already working hard to fight it and recover. A massage can be very stimulating internally and place certain demands on the body during a time when your client should be simply resting."

Since massage is based on skin-to-skin touch, massage may also be contraindicated if the client has a rash or infectious skin condition. If the skin condition is infectious, it could spread to the therapist and, in turn, to other clients. Even if a skin condition is not contagious, massage can make some skin irritations even worse.

Intoxication

Another occasion when a massage should be postponed is if the client is intoxicated. Many folks seek out massage while on vacation or under stress. They may have also had a few cocktails to relax as well. "Intoxication is a risk during massage," said Dr. Coe, "primarily because it desensitizes the client. This makes it hard for the client to give reliable feedback. A massage therapist needs to know what level of pressure is comfortable and what is too much. With intoxication, those sensations are unreliable."

Medical Conditions

"Certain medical conditions may contraindicate specific types of massage. For example, if someone has heart or kidney failure, circulatory massage may place excess demands on already failing organs," said Dr. Coe. "An acute injury is also likely to be a contraindication to massage. Although it may seem like a great idea to get a massage immediately after straining a muscle, if there is damage to the area, massage may actually interfere with the healing process."

Finally, massage may not be advised, or may need to be modified, if a client is currently on certain medications, such as:

• Blood thinners, which may result in bruising with heavy pressure or deep tissue work.
• Blood pressure medications, which can result in low blood pressure and dizziness upon sitting up or standing after a massage.
• Topical drugs such as hormone or antibiotic creams, as the medications can be transferred to the therapist. Also, the massage cream may interfere with the client's absorption of the medication.
• Injectable medication, such as insulin. The therapist should avoid the injection site, since massage can interfere with how the drug is absorbed.
• Muscle relaxers. In this case, the therapist may want to avoid static stretches, which might overstretch the muscles.
• Pain killers. "If a client can't give good feedback on whether massage pressure hurts and where it hurts, a massage therapist may choose to stick with light pressure massage, " said Dr. Coe.

"A good therapist will guide the discussion on the client's health issues in order to determine the right technique and whether or not a massage is contraindicated [for] that client on that day," said Dr. Coe. "A massage therapist should not be afraid to ask for a note or consultation with the client's physician when concerned about how a massage will affect their health condition."

"The healing benefits of massage therapy are many, and it is fairly rare to encounter situations where massage is contraindicated for very long," according to Dr. Coe. "But it is important to understand potential issues, and talk with clients prior to their session to rule out any concern."