To massage or not to massage? Contraindications in sports massage therapy.
Despite the array of benefits quality sports massage brings us, there are times when certain areas of the body need to be avoided with massage techinques, or when massage needs to be avoided altogether. These situations are called contraindications, and it's vital that therapists and in some cases clients, understand them. As a therapist you should follow a simple rule.
If in doubt do without!
If you're not sure whether it's safe for you to massage an area or massage at all, then don't do it. Safety comes first in all situations.
So let us take a look at the circumstances when massage is not a good idea.
1. Fever, bacterial or viral infections. Sports massage work moves fluid around the body increasing and improving circulation. However in a situation where a viral infection exists you will also help to spread the infection. This also applies to infections of the skin and fungal infections. Clearly it's best to wait until the client has fully recovered.
2. Rash or visible skin disorder. Massaging over a rash can cause the client unnecessary discomfort and depending on it's cause, may spread it further (see above). If it's contagious you also do not want to be putting your hands there. In the case of Eczema, this condition is not contagious unless the area itself has become infected. Appropriate massage can be performed here but be sure to check in with the client that any oils or salves used will not cause the eczema to trigger a reaction. Sports massage may not be a suitable medium for some eczema sufferers as it can often be triggered by stress. If the massage is too intense a reaction could occur.
3. Open wounds. Any area of the skin where there is a cut (even a small one), graze or other such injury, should be avoided. You will cause discomfort and interfere with the healing process.
4. Some post surgery situations. Massage can be performed in some post surgical scenarios, but this is dependent upon the type of surgery and the length of time since the surgery took place. If a client has had extensive and invasive knee surgery for example, you may actually need to wait for up to 2-3 years before sports massage can be provided to that area. In other cases massage can actually be of excellent benefit in the 2 stage of the healing process and beyond by encouraging circulation and the removal of waste products from the site, along with properly aligning scar tissue. In a post surgery situation, I would always check with the client's medical practitioner.
5. Bruising (contusions). If a client shows signs of bruising then you should avoid the area for obvious reasons. It will be uncomfortable and will regress the healing process.
6. Unusual anatomy. By this I mean locating something that you know is out of the ordinary. For example you feel a lump near the client's spine. Avoid work on the area, calmly draw the client's attention to it and suggest after the session that they should have a doctor check it out. Something like that may be trivial but could also be potentially very serious. Do not alarm the client but do suggest they check it reasonably quickly.
7. Major trauma (especially neck, head, or spinal trauma). If a client has suffered a fall or banged their head for example, the first question I'm going to ask them is 'have you seen a doctor'? This is particularly true for any trauma that has been suffered involving the head or neck. You should not start to work on someone who has had recent severe trauma without clearance from a medical professional first. There could be a serious problem that could potentially be made worse and, God forbid, be fatal if you start manipulating it. Always check for things like.
Headaches since the trauma
Loss of feeling in a particular area.
These people need to see a doctor straight away.
8. Acute injuries. The acute stage of healing is around 4 days after the injury occurred. During this stage, sports massage should not be performed on the site. There may still be bleeding and massage will negatively interfere with the recovery process. Massage should only be performed in stage 2 and 3 of the healing process.
9. Burns and broken bones - pretty obvious this one! Don't use massage under these circumstances.
10. Tendon ruptures - this type of injury requires medical care and usually surgery, not massage or remedial therapy. Massage can be beneficial in the recovery process.
11. Cancer patients. Gentle massage can be used for this population but only by specially qualified therapists and only with the clearance of the individuals medical practitioner.
12. Pregnancy - massage is contraindicated in the first trimester, but can be performed after that by properly qualified therapists.
13. Inlammatory conditions. Bursitis, rheumatoid arthritis, and gout for example are examples of this. Massaging over inflammatory areas will simply lead to an increase in inflammation. Also included here is periostitis which is the inflammation of the sheath that surrounds the bone. As long as you stay clear of the bone massage is ok with this one.
14. Thrombosis. The former is a potentially lethal blood clot in a vein and is most common around the lower leg. Massage on a blood clot can dislodge it and leave it to potentially travel toward the heart with fatal consequences.
15. Varicose veins. These are veins where the valve has collapsed to an extent and is making venous return (blood flow back to the heart via veins) difficult or impossible. The severity of varicose veins varies a lot. Very mild varicose veins can be massaged lightly to improve blood flow and help clear the vein, more moderate veins should not be massaged directly but you can massage around them to help blood flow. Severe varicose veins are noticeable through a bulging and obvious dark red/purple blueish colour. Steer clear of this area to avoid causing damage. Please note that thread veins (or spider veins) are reddish very fine veins but are not the same as varicose veins. Thread veins can be massaged over without issue.
16. Bleeding disorders. In these cases massage will worsen the condition and so should be avoided completely.
Always err on the side of caution. If you are unsure of whether or not massage therapy or remedial treatment will cause harm then it is always better to check first. Avoid areas you are unsure about and check with a medical professional if necessary. As a therapist you should always have a medical questionairre completed by the client, and have a taken a good history. Do not attempt treatments or techniques that are outside your scope of practice and refer out if that is what is best for the client. Thanks for reading!