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Posted by: Kate Onyett, 6 Feb 2006 11:30AM
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Question About Massage Contraindications

Hello, all I have a massage-related query that I want to research into. Basically, I feel very much that my confidence as a masseuse is dipping at the moment, and I always feel better if I feel I know enough about something; if I have the facts to grasp and examine. I don't like blank spaces forming in my conscious knowledge- although they seem to do so, still, with some regularity! I was thinking about massage contra indications. When you learn massage of any kind, of course these get flagged. Some are obvious: site-specific wounds/ swelling, injuries, etc are left to heal before they get seen to, naturally. But more chronic conditions: high blood pressure, low blood pressure, diabetes, heart conditions, breathing conditions, cancer, HIV, etc. I have my own training and ideas on how to deal with these. Working also on the premise of massage-as-circulation-inducer, I can work backwards and decide what's best in different situations. But to balance this is also, once a client is aware of the situation, potential problems, and is still happy to sign to the effect they understand, or have a doctor's certificate- above such considerations, when it comes to Swedish massage- a lying-down-stroking type: it can be as deep or shallow and light as needed: and surely the destressing properties have their own excellent PMA and healing attributes? What I wanted to ask my peers here in the group was: What is your approach to contra-indications? Have you any direct experience of working with clients who would be 'red flagged' under basic massage training rules? Where would you recommend I could look to find information about working with contra indications- books, articles, etc? What would you say are massage's most powerful aspects (circulation, etc) that are the basic premises around which deciding what is best for a client works? I just want to brush up properly- I am scared of doing more harm than good, and my confidence needs a boost at the moment, as being 'scared' is no good!


Rosemary Johnson
7 Feb 2006 8:16PM

Hi Kate, Sorry to hear about your confidence problems - hope you can get reassured and back in full swing soon. About contraindications, it has semed to me before that if you read all the "official line" on contraindications, you'd only ever massage people who were 100% fit and well and never those who might need it the most! Clearly, that's not quite right. And further to that, that you have to refer each little thing to the client's doctor so as to leave the poor client thinking you regard them as a helpless passive being totally under the doctor's control, not able to take their own responsibility for their health! So, where does that leave us? Well, for starters, with professional insurance, whose provisions we have to follow. Alas, since being puppets inthe hands of an insurance company is not why we went into this business either, but the world is getting such that we need to be careful about possible liability and not invalidating our insurance. If someone is actively "under the doctor", it would strike me as ordinary courtesy to run past him/her one's intentions of visiting complementary therapists (or "Other" c.t.s, it one is regularly oging to, say, an osteopath). Apart from anything else, they may be able to relay helpful suggestions. If it's an ongoing condition which the person is managing, is their doctor really going to know any better or worse than them whether this is a good week for having a massage? Or indeed generally? - how many prospective clients' doctors, if the prospective client went to them to say "Is it oK for me to go and have a massage?" might say "Well, how do you feel about it?" .... which is all probably not very helpful, but is a start for others to join in, I hope! SOme specifics, you mentioned: - cancer is said to be a total conraindication, bcause of the risk of spreading it around the body, and only for use in palliative care of terminal patients. But there are those who've treated cancer patients. - blood pressure - because it tends ot lower blood pressure, massage can be good for those with high BP and may be risky for those with low BP. Even if it's inherently "good", BP meds may need adjusting and certainly monitoring - HIV/AIDS is something your client may be unwilling to tell you about, because of the amount of prejudice there has been around the virus. It's also a prime case of a "managed condition" where the people with HIV/AIDS know more about how to manage their health/illness and how they are feeling than their doctors, and whether having a massage today is a good idea or not. But people with HIV/AIDS can change rapidly in how well they feel, so maybe a strict cancellation fee rule is less appropriate. Be aware that PWAs (or others with impaired immune function) can pick up any and every bug going round and get knocked for six by it, so don't treat them if you "might be getting a bit of a cold" or something. Rosemary
Rosemary Johnson
15 Feb 2006 8:53PM

Kate, DOn't know if you've spotted it - sorry if I'm teaching my grandmother, as it were. There's a thread in the Therapy Lecturers Association area of these Forums about massage, skin conditions and contraindications. You might like to take a look there. You don't have to be a therapy lecturer to read the thread, and there's a good chat going with some nice helpful people. Rosemary
Tina Maria Pritchard
15 Apr 2006 5:52PM

Hi Kate I understand wholeheartedly what it's like to go on a confidence dip, but take heart in the fact that ultimately you are trying to acheive that sense of harmony and balance that client's are trying to find. You sound like a caring individual with good intentions and that is a good place to start. Gaining your client's trust is important, show that sincerity, listen hard and form ideas as to where you are going to start. Begin with investigatory massage with a light touch, maybe sitting instead of lying on the couch. Ask questions, see how they feel thoughout the treatment, constantly monitoring their reactions to specific moves. Make concise notes on all aspects of your client's body, including emotions and physical movement. I have massaged client's who have had contraindications, but with care and vigilance have succeeded in inducing a relaxing, caring treatment with good results. It is their body and they will tell you immediately if something is not right. Also allow relaxation time in the treatment for them to 'ground themselves', maybe 10-15 minutes. I find this is very important. Rosemary has given sound advice, but as she says, if we read all the official info we would never massage unless the client was 100% fit. We are not taking risks, but finding confidence to treat people who need our help. with good wishes Tina Pritchard
Phyl Spence
13 Jul 2007 7:08PM

Hi Kate this reply is a year late but wanted to say how incredibly reassuring it is to hear that I am not the only one with problems dealing with contra-indications. I have just written to Embody to suggest that they might want to consider making supervision and reflective practice part of ongoing CPD. This would include working on one's own health and wellbeing I suppose, in my own case I would need to tackle some of my own fears . One of my colleagues on a course who works with people with cancer said that people can be very forceful when they are desparate for massage ,and not to let yourself be put under pressure. I found her sharing that experience very useful as I find it very hard to resist pressure. I think it is probably useful to talk to other people and to try and have a mental list of contraindications you might meet, and what you think you would do if you met those contra-indications, and which clients you might want to ask them to run it past their doc before proceeding. I have offered hand or foot massage to people (just a gentle soothing one) when I am not sure eg if people have turned up for on-site massage but are seeing a hospital consultant for investigations, and asked if they would like to check out massage with their Consultant when they next see them. Not sure if this is the "right" thing but it feels OK.I imagine that if you are Reiki-trained that might be useful as you can offer a "hands-off" treatment as an alternative, but again don't know if I am right saying that. My main problems as a not-very experienced practitioner have been when pople have travelled to my house for a massage,or have turned up on the day for on-site massage and have them sit there and tell me their symptoms and then think "I can't deal with this, what shall I do" .This is where advance preparation helps, but its easy to say that in hindsight. Feed back on this would be useful if anyone reads this! I'm sure supervision in your early years of practise would be very reassuring. You might need to pat your supervisor or barter!( I meant to say pay not pat!!) We all have to learn and we all make mistakes. Go well with your practice! Love Phyl
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