A contraindication is a condition or factor that serves as a reason to withhold a certain medical treatment due to the harm that it would cause the patient.
Many times, contraindications are not a black and white issue, but they require adjustment and modification of the therapist’s work. So, the real issue is often not the contraindication themselves, but the experience, the skill level, and the knowledge about those conditions.
Nevertheless, there are conditions, like pregnancy, cancer, heart problems, that should be treated only after the written permission of client’s GP and by specialized therapists.

Below, I provide a list, in alphabetical order, of the most common contraindications.

BONES

Arthritis
In general, the client should be taken gradually to her limits. Avoid massaging the joint in pain, so just massage it gently. Also, avoid stretches that may press that joint.

Bone fractures – recent
Pressure or stretches directly on the fracture or near it should be avoided.

Osteoporosis
Even if the practitioner does not apply pressure directly to the problematic bone, it may be damaged by the load of stretches. So, gentle presses around those bones should be applied, while continually asking the client how she feels.

Postural deformities
The practitioner should alter some poses, in order to fit client’s condition. A pillow may be helpful for making client lying down with ease.

Slipped disc
The client must have visited her GP or an osteopath to ensure that the treatment is permitted. Depending on the nerve that the slipped disk affects, the practitioner should be cautious not to put too much pressure on slipped disk’s area.

Whiplash
Apply only gentle neck movements; for keeping the neck mobile from an early stage of the injury will improve its functionality and speed up the recovery.


NERVOUS SYSTEM

Bell’s palsy
When the muscles of the face are temporary weak or are paralysed, massage on the head should not be given.

Nerves – trapped/pinched (e.g. sciatica)
In cases of sciatica, the practitioner should first work on the area around the trapped nerve and then on it. Avoid strong presses over muscles that have trapped or push the nerve.

Nervous system dysfunction (e.g. muscular sclerosis, Parkinson’s disease)
The client must have visited her GP to ensure that the treatment will be safe for her specific condition.

Psychotic conditions (e.g. epilepsy)
It is important to know the intensity, and the frequency of the epilepsy. In any case, GP’s consent should be given. A relative or friend of the client should be in the room as well, in the case that there is a risk of any psychotic episode that must be dealt with.


SKIN

Cuts and bruises
Massage should be avoided on those areas of the body.

Lumps and Bumps – undiagnosed
The client should be sent to GP. Massage should be avoided on those areas of the body.

Oedema
Avoid massaging the affected skin and areas around heart and kidney.

Scar tissues
The area cannot be massaged for 2 years following a major operation, or for 6 months for a small scar.

Skin diseases (contagious, or infectious)
Massage should be avoided, as the disease may spread to the practitioner. In the case it is necessary avoid the infected areas, use gloves for not affecting other clients, and wash well the mat cover and the pillow cases afterwards.

Sunburn
Massage on sunburned skin should be avoided. However, depending on the degree of the burn, the practitioner may apply light pressures to relax the muscles underneath the sunburn. Also, herbal compresses could be used to ease the pain.

Varicose veins
Massaging the veins that are elevated from the skin may cause more damage to the vessel tissue, so those areas should be avoided or pressure should be very light.


WOMEN

Pregnancy

Treatments should not be given to pregnant women. Only specialist should make these treatments, without applying face down position but instead side lying position.

Menstruation
Pressure on abdominal area should be avoided. Also, avoid any poses where legs are raised above head, as they may cause inverted flow.


OTHER

Asthma
When the client has asthma, the practitioner must know how bad the asthma gets. Keep the inhaler close to the client. Also, be extra cautious when giving deep stretches that modify the volume of the lungs, like spinal twist stretches.

Cancer
If the client is under cancer treatment, massage should be avoided at all, unless the therapist has had specific training in this area.

Cardiovascular conditions (thrombosis, hypertension, hypotension, heart conditions)
If the client has heart problems, all inverted poses (where the legs are placed higher than the head) should be avoided.
In case of hypertension, Thai massage should be avoided because it improves the bloodstream and it will raise the blood pressure.
Nevertheless, there are some stretches that can be modified for people with high blood pressure, for example by raising client’s upper body with a blanket.

Diabetes
Pressure at abdominal area should be avoided. Nevertheless, it is important to know which type of diabetes the client has and how it is controlled. Diabetes may cause low sensitivity at legs and feet, so the client may not be able to identify strong pressures that may cause damage.

Diarrhoea and Vomiting
No treatment should be provided, as the practitioner must protect other clients as well. Also the massage may make the condition worse.

Fever
Massage should be avoided, suggest visit to GP.

Haemophilia
Stretches on joints should be done with caution, as they may lead to joint damages and internal bleeding.

Hernia
Pressure on abdomen and groin should be avoided. Also, the client may feel uncomfortable lying on her stomach.

Implants (hormonal)
Do not put pressure in the area of the implantation, as it may break inside the body.

Kidney infections
The client should seek appropriate medical attention and recover before they receive a massage.

Medication (prescribed)
The contraindications of the prescribed medication should be studied and the massage routine should be altered, in order to fit client’s condition. In the case of strong painkillers, the client should not be massaged, as she may not feel a really strong pressure, which could harm her.

Obesity
Back massage should be given from the side position, so not much pressure is put on the abdomen. Also, the practitioner must protect himself, so avoid poses (eg. inverted ones) that could not be completed successfully. Furthermore, the client may feel frustration, disappointment or self pity, if the practitioner struggles manipulating client’s body during those poses.

Operations (recent)
The operated area should be fully healed before any massage, and also the doctor must give consent. Massage should be done preferably 6 months after the surgery.

Pain – undiagnosed
Massage should be avoided, as it may be caused by blood clots or some injury. The client should visit her GP first.


After a heavy meal
Avoid positions which may cause discomfort such as lying face down (prone), refrain from abdominal massage and from inverted poses.

In case of any doubt, please contact your GP.