Level: Beginner

• Explain in simple language what a contraindication to massage is.
• Name and describe the contraindications to massage.

Quick List:

• Open wounds and sores
• Contagious or Infectious skin conditions.
• Recent Scar Tissue
• Deep Vein Thrombosis
• Recent operations

Most contraindications are plain common sense:

Open wounds and sores.

I mean come on; who in their right mind is going to massage broken skin? As a contraindication this one has to be up there with 'do not dry pets in this microwave oven'. But then this is human beings we're talking about. Don't massage broken or bleeding skin. It hurts, it's messy and it adds to the damage. You didn't really need to be told that did you? No, thought not. Except in extreme cases (use your common sense) this does not apply to the common or garden spot (zit) incidentally - as a massage therapist you will become something of an authority on zits. It really can be amazing what the average person can grow on their back.

Contagious or Infectious skin conditions.

Now this one can be a bit deceptive; massage can be a fine way to relieve chronic itching, and there are a number of skin complaints (eczema, psoriasis) which are treated by topical creams. The best advice here is to fear to tread. Don't rush in, talk to the client's doctor / health visitor. Don't forget to talk to the client of course; if it's a chronic complaint they can be the best authority available. You don't want to spread anything, you don't want to damage any healing that's been taking place. If you don't know exactly what you're dealing with, leave well alone.

Recent Scar Tissue

Wounds heal from the top down; the body's priority is to get the skin closed against infection, so there could still be damaged tissue under the scar weeks or in some cases months after the cause. Beware ulcers! They heal from the skin down, they heal incredibly slowly, especially in the elderly, and can still be very painful and very fragile months after the skin's closed over them.

Deep Vein Thrombosis

As I write this two young healthy people have died in the UK from a condition you wouldn't normally expect to see in anyone in reasonable health under 70. The British Medical Association made a study of massage in 1993 in which they expressed concern that some massage therapists did not know what deep vein thrombosis (DVT) was. This is the contraindication that can cause amputation or death (yes I know I'm being alarmist but it's in a good cause; you don't prat about with a DVT), so let's take our time with it.

What is a DVT?

The blood has decided to clot. This can happen if the bloodflow is stopped, for example if the vein is compressed for long periods (such as sitting in one position for twenty hours), if the blood has been exposed to something that'll make it it clot more easily (such as cigarette smoke), or as a response to injury or bruising. A small lump has formed and has become lodged in a vein, blocking it. Most of the time this won't be a problem; the vein blocked tends to be small and if the body can't use one vein then there are plenty of spares available. Clots near the surface (ie caused by bruising) are almost invariably safe; it's a good rule of thumb that the nearer the surface a blood vessel is the smaller it will be, and the smaller the vein the more spares will be available. Which is why the deep thromboses are the ones to really worry about.

If the clot is large and it gets into a larger, deeper vein, especially somewhere which doesn't have a huge selection of spare veins, such as a leg, then it can stop blood getting out of whatever's blocked. If blood can't get out then blood can't get in. If blood can't get in than neither can oxygen and the structure (usually a leg) will die. The most common cause of DVT-related amputation is smoking, so if your client is a heavy smoker tread carefully.

How do you spot a DVT?

Think about it. The vein is blocked, fluid is being backed up in the limb, unable to return to the rest of the body.

• It hurts. Or at the very least it feels uncomfortable. A strange ache or feeling in the leg (or any part of the body for that matter) should ring alarm bells every time, but especially if:
• there's swelling. Fluid can't escape from the limb so the limb swells up. It'll be bigger than the other one and the skin may feel tight.
• Without oxygen (or with less oxygen) the nerves will complain. You could get pins and needles, or feel numb.

Don't rely on all the symptoms all turning up just like they do in the textbooks; they never do. The pain and swelling should be enough to ring alarm bells.

What do you do about a DVT?

You see a doctor asap (as soon as possible).

Recent operations.

Obviously we aren't going to work over a wound but you have to be careful here - surgical scars can heal from the outside in.  Or to put it another way they can still be fragile under the skin when the surface skin itself looks well healed.