Contraindication

L/G

Description of Condition/Symptoms

Medication Commonly Used (If Appropriate)

How you would adapt massage

Epilepsy

G

Epilepsy is a seizure or fit that can last for several minutes.  A person with this condition may have vigorous muscle twitching (contractions, convulsions) normally in the legs and arms or the whole body may shake or become stiff.  They may even lose consciousness.  There are three types of seizures:

General:  A person will lose consciousness but then regains consciousness within a few minutes.

Simple Partial:  A person will not lose consciousness but will have muscle twitching or pins and needles in an arm or leg.

Complex:  A person will not lose consciousness but they may mumble or act confused. This seizure tends to indicate that a general seizure is about to happen.

Anti-epileptic medication is available as tablets, capsules, liquids or suppositories.  These are taken daily.

If the client had a seizure within the last 12 months I would seek medical permission from the client's doctor before performing a massage.

If the client is taking any medication that I am unfamiliar with, I would also seek advice on any effects that may be linked to oil absorption through the skin.

Excitement, anxiety, stress or photosensitivity can induce a seizure so I would try to relax the client by using calming oils and calming massage movements such as effleurage.  I would also avoid using strong fragrances and flickering lighting as these may trigger a seizure.

I would pre-plan what to do in the event of a seizure and minimise the risk of a client falling off the couch in the event of a seizure.

Diabetes

G

The pancreas produces insulin to control sugar levels in the blood.  If sugar levels are too high the pancreas becomes unable to cope and this leads to diabetes.  There are two types of diabetes:

Type I:  The pancreas produces little or no insulin.  It usually develops before the age of 40.

Type II:  The pancreas does not produce enough insulin or the insulin is not used efficiently.   It usually develops after the age of 40 or is linked to obesity.

The main symptoms for diabetes include high levels of urine, feeling tired and very thirsty, weight loss and blurred vision. 

A Type I diabetic can have a hyperglycemic attack if they don’t take their insulin and as a result their sugar level becomes too high.

Hyperglycemic symptoms include dehydration and drowsiness.  If ignored, this could lead to unconsciousness or even death. 

Too much insulin will result in low sugar levels and can lead to a hypoglycemic attack.  Symptoms of this include feeling shaky and irritable.

Insulin is the main medication taken however diabetes is also controlled with diet.

I would seek medical permission from the client's doctor before performing a massage.

I would perform lighter massage movements such as effleurage and have a small snack including a drink for the client, if they felt unwell.

A diabetic could pass out during treatment so I would also pre-plan what to do in case this event occurred.

Skin Disorders

L

There are many types of skin disorders for example ringworm, hypersensitive skin, eczema and psoriasis. 

Ringworm is a fungal infection and looks like a red ring on the skin.

Eczema is skin inflammation that is very itchy and looks like a reddish rash.

Psoriasis is a non-infectious, dry skin condition that has reddish patches covered with silvery scales.  It is mostly found on the knees, lower back, elbows and scalp.

Antifungal cream is mostly given for ringworm.

Antihistamine tablets and steroids are a type of medication given for hypersensitive skin.

Antihistamine and steroids are given for eczema.  Eczema is sometimes controlled by diet and environmental factors.

For psoriasis, medications include steroids, antibiotics and even aromatherapy.

For a localised skin disorder that I was not familiar with, I would avoid the area.  This is because a lot of skin conditions are too painful to massage and there is a risk of cross contamination.  There is also a risk of spreading an infection to other body parts.

If an area has been treated with a cream medication, I would avoid massaging that area as it may not be healthy for me to have contact with the cream.  Also, I could spread the cream to other body parts on the client.

I would try and use a nourishing oil that does not irritate the skin, for example, grape seed oil.

For skin conditions that are not painful and contagious, I would massage if the client and myself were both comfortable with the massage.

If ringworm was localised I would avoid the area and massage other body parts, however if the infection was on several body parts I would not perform a massage.

For hypersensitive skin and eczema I would test my oil on a skin patch and allow 24 hours for the results.  I would try and use nourishing oils on the skin, for example wheat germ.

Eczema is often located on the back of the knees and on the elbows and would be too painful to massage so I would avoid these areas. 

Severe Bruising

L

A bruise occurs when an injury causes the small blood vessels under the skin to break but the skin itself does not break. The blood gets trapped and forms a purple, black, blue patch that is tender to touch.

Taking arnica acts as an anti-inflammatory.

I would avoid the bruised area and massage other body parts as the bruised area would be painful to touch.

Recent Haemorrhage

L/G

A haemorrhage is internal bleeding.  It can occur in any part of the body.  Types of haemorrhage include:

Intracranial haemorrhage: Bleeding within the skull.

Cerebral haemorrhage: A bleed into the substance of the cerebrum.

Postoperative haemorrhage: Bleeding following an operation.

Postpartum haemorrhage: Heavy bleeding during pregnancy or labour.

Arterial haemorrhage from an artery

Sub-dermal haemorrhage: Bleeding under the skin.

Symptoms of a haemorrhage can include headaches, feeling sick, passing out, epilepsy, stroke and bruising.

Medication can include anti-epileptic drugs such as carbamazapine and calcium channel blockers to reduce blood pressure.

If there was a severe haemorrhage then I would seek medical permission from the client's doctor before performing a massage.

I would perform a light massage and avoid the haemorrhage area.

For a localised haemorrhage, I would avoid the area and massage other body parts.

Cuts & Abrasions

L

A cut is a tear in the skin, for example, paper cut or a cut from shaving.

An abrasion is an injury to the skin where the skin is scraped, for example, an abrasion to the knee or hand after falling over.

Symptoms may include some bleeding and pain.  A scab normally forms during the healing process.

Generally medication is not given for cuts and abrasions; however a tetanus jab might be given.

For a localised cut or abrasion, I would avoid the area and massage other body parts as it would be painful to massage.

Recent Operations

Major/Minor

G/L

For major operations, a general anesthetic is used and the patient tends to stay in hospital overnight or for several nights, for example, heart or lung surgery.

Minor operations are done under local anesthetic in an out-patient department or day surgery unit and the patient can normally go home afterwards, for example removing a mole or cyst.

For pain relief, paracetamol or codeine can be given and where necessary, morphine.

Other drugs such as antibiotics may be given.

I would seek medical permission from the client's doctor before performing a massage if a major operation had occurred within 12 months and a minor operation had occurred within 3 months.

If the client is taking any medication that I am unfamiliar with, I would also seek advice on any effects that may be linked to oil absorption through the skin.

Fracture/Sprain

L

A fracture is a broken or cracked bone.  Symptoms can include swelling, pain, bruising, the affected bone looking unusually bent, unable to move or put weight on the affected bone.

A sprain is an over-stretch, twist or tear of a ligament around a joint.  Symptoms include pain, bruising, or inflammation. 

There are three grades of sprains:

Grade 1:  A slight stretch or tear of the ligament with little pain or swelling

Grade 2:  A partially torn ligament with sever to moderate pain and bruising

Grade 3:  A completely torn ligament with sever pain and bruising

Pain killers can be taken for pain relief.

For a localised fracture or sprain, I would avoid the area and massage other body parts as it would be painful to massage.

I would also make sure the client is comfortable and can undress, dress and get on and off the couch in a safe way.

High Blood Pressure

G

High blood pressure is known as hypertension and is a systolic pressure of 140mmHg or more, or a diastolic pressure of 90mmHg or more at rest.

Systolic pressure is the blood pressure just after a heart beat and a diastolic pressure is the blood pressure between each heart beat.

High blood pressure can cause problems in areas such as the arteries, eyes, kidneys and brain.

Drugs such as diuretics, calcium channel blockers and ACE inhibitors can be taken.  Also aspirin is sometimes taken.

A controlled diet can also help reduce blood pressure to a normal level.

I would seek medical permission from the client's doctor before performing a massage.

If the client is taking any medication that I am unfamiliar with, I would also seek advice on any effects that may be linked to oil absorption through the skin.  Pine, rosemary and sage are examples of oils I would avoid.

Anxiety and stress would increase blood pressure therefore I would try to relax the client by using calming oils and calming massage movements such as effleurage.

Low Blood Pressure

G

Low blood pressure is known as hypotension and occurs when the blood pressure is lower than 90/60mmHg.  Symptoms can include fainting or light-headedness when suddenly standing up, tiredness, blurred vision, and dizziness

Generally there is no medication for this, however low blood pressure can be the result from taking other medication for another condition.

I would seek medical permission from the client's doctor before performing a massage.

If the client is taking any medication that I am unfamiliar with, I would also seek advice on any effects that may be linked to oil absorption through the skin.  Geranium is an example of oil I would avoid.

I would avoid deep massage, use lighter movements and massage upwards towards the heart to help blood flow return back to the heart.

Heart Disorders

G

There are many types of heart disorders for example, angina, heart block, and a heart murmur.

Angina is caused by insufficient blood flow to the heart and is very painful.  It is   usually a symptom of coronary heart disease. There are three types of angina:

Stable Angina:  This is brought about during high levels of effort and is the most common form of angina.

Unstable Angina:  This is brought about during light levels of effort such as walking a few steps or resting in bed.

Variant Angina:  This usually affects women and occurs without warning such as resting in bed.

Symptoms of angina include pain in the middle of the chest, neck, back or arms; a choking feeling and feeling exhausted.

A heart block is strong irregularity of the heart beat sometimes including stoppage for a few seconds. Symptoms can include fainting or light headedness, pain in the chest and feeling out of breath.

A heart murmur is a sound variation from a normal heart as blood passes through it. There are two types:

Innocent Murmur:  Is a harmful sound variation from a normal heart.

Abnormal Murmur:  Are normally due to heart valve problems caused by defect, infection, disease, or aging.

Someone with angina would take a pain relief drug called glyceryl trinitrate (GTN) which is a tablet or spray that is put under the tongue.  Other medications taken for angina include beta blockers and aspirin.

There is no medication for heart block as the patient normally has a pacemaker fitted.

There is no medication for heart murmurs.

For any heart disorder I would need a doctor's certificate.  A deep massage would increase lymph and blood flow, therefore I would avoid these movements and apply lighter movements such as effleurage.

If the client is taking any medication that I am unfamiliar with, I would also seek advice on any effects that may be linked to oil absorption through the skin, and adapt as appropriate.

Angina can be triggered by stress so I would try and assist the client by making then as comfortable and relaxed as possible.

If a client had a pacemaker and was in good health, I would carry out a massage but avoid massaging the chest area.

A general heart murmur is not a contra-indication, therefore I would massage the client, however if the client knew that their heart murmur was linked to a heart condition I would require a doctor’s certificate.

Swellings

L

Swelling can be caused by many factors such as injuries or diseases and can cover many body parts, for example, a fall or varicose veins can lead to a swollen ankle, an infection, cancer and arthritis can lead to swollen glands or joints.

For most swellings no medication is given, however if the swelling is a result of another condition, medication may be given for that condition.

If the client knew the cause of the swelling, I would avoid the area and massage other body parts if appropriate.

Varicose Veins

L

When the valves in the veins don’t work properly this causes slow blood flow which leads to varicose veins.  They normally occur in the legs.  The veins look twisted, blue, swollen and bumpy.  The legs usually ache and the ankles swell.

Varicose veins can lead to deep vein thrombosis, ulcers and a build up of fluids in the legs.

There are no drugs for varicose veins but there are complementary therapies such as horse chestnut.

For localised varicose veins, I would avoid the area and massage other body parts as it would be painful to massage.

If the veins were removed over 3 months ago, I would perform a very light effleurage over the treated area, however   intuition and common sense would be applied.

Cancer

L/G

When a group of abnormal cells multiply and group together they grow into a solid or non-solid tumor.  There are two types of tumors:

Benign:  A non cancerous tumor that won't spread in the body

Malignant:  A cancerous tumor that is invasive to other body parts and causes damage to the body.

Cancer can be localised or generalised, for example, breast and throat cancer would be localised and bone and lymph cancer would be generalized.

Symptoms that may indicate cancer include undiagnosed lumps, weight loss, tiredness and poor appetite.

Depending on the type of cancer, chemotherapy can be used.  A combination of drugs can be taken orally or by injection into a vein.

I would seek medical permission from the client's doctor before performing a massage if a generalised cancer had occurred within 7 years and a localised cancer had occurred within 6 months.

Massage will give a client with cancer emotional support through the therapeutic use of touch so I would not want to refuse them a massage; however I need to be guided by their doctor, therefore medical permission would be required. 

If the client is taking any medication that I am unfamiliar with, I would also seek advice on any effects that may be linked to oil absorption through the skin, and adapt as appropriate.

If the cancer were benign and in a localised area only I would avoid the area or use a very light massage movement depending on the client's feedback.

For malignant cancers such as leukemia or cancer in the lymph nodes I would not start a massage unless medical approval is given.  Once given light massage movements would be used and continuous feedback would be maintained.

Embolism

G

An embolism is a blockage in the blood stream that is normally caused by a blood clot or bubble of air. If blood is cut off, tissues in that part of the body will die.

An embolism in the artery of the heart can cause a heart attack.

Symptoms of an embolism in an artery can include pain, muscular twitches, paralysis, or numbness to that area. 

An embolism in an artery in the brain can cause a stroke.

Symptoms of an embolism in a vein can include swollen veins, pain in one leg or the skin feeling hot in the affected area.

Depending on the type and size of embolism drugs can be taken to dissolve a clot or thin the blood (anticoagulant).

As massage increases lymph and blood flow, I would not give a massage as I could dislodge a blockage that may cause damage in another body part or even death.  I would advise the client of this and ask them to speak to their doctor.

Thrombosis

G

Thrombosis is the clotting of blood in an artery or vein that reduces or stops blood flow. If blood is cut off, tissues in that part of the body will die. Thrombosis in the artery of the heart can cause a heart attack. Thrombosis in an artery in the brain can cause a stroke. Thrombosis can also occur in the veins and arteries of the leg.  In the leg, veins can become red, swollen and painful.

Some forms of thrombosis can be treated with clot busting drugs.  Aspirin can also be taken to thin the blood.

I would seek medical permission from the client's doctor before performing a massage.

If the client is taking any medication that I am unfamiliar with, I would also seek advice on any effects that may be linked to oil absorption through the skin, and adapt as appropriate.

A deep massage would increase lymph and blood flow, therefore I would avoid these movements as I could dislodge a blockage that may cause damage in another body part

Dysfunctions of the nervous system to include spastic conditions

G

There are many types of dysfunctions of the nervous system, for example, multiple sclerosis (MS), Parkinson’s Disease, Alzheimer’s Disease and spastic conditions.  These are all progressive degenerative diseases.

MS:  All nerves are covered by a myelin sheath.  In MS the immune system breaks down the myelin sheath and the proper conduction of the nerve is lost.

There is a variety of symptoms for MS which can include speech difficulties, clumsiness, muscle spasms, memory loss, numbness and incontinence.

Parkinson’s Disease:  Dopamine is a neuro transmitter.  If there is not enough dopamine the basal ganglia of the brain is affected, therefore fine motor skills are lost.

Symptoms include speech problems, rigid movement and the person appears very shaky.

Alzheimer’s Disease is a complex disease with symptoms including lost of memory, confusion, incontinence, loss of personal hygiene, speech & language problems, disorientation and the loss of one’s inhibitions.

Spastic Conditions:  The nervous systems to the muscle does not work correctly, affecting flexor or extensor muscles, making the muscle rigid, hence movement is very difficult.  This condition can be the outcome from a stroke.

Medication includes steroids and even fish oils for MS.

There are several drugs that can be given for Parkinson’s Disease including dopamine.

There are also lots of drugs for Alzheimer’s Disease including tranquillisers and ginko biloba (herbal remedy).

For spastic conditions no medication is given, however if the condition is a result of another condition, medication may be given for that condition, for example, a stroke.

I would seek medical permission from the client's doctor before performing a massage.

If the client is taking any medication that I am unfamiliar with, I would also seek advice on any effects that may be linked to oil absorption through the skin, and adapt as appropriate.

Clients with conditions that have symptoms including the lack of personal hygiene, incontinence or lack of social awareness, I would prefer to perform a massage in their home or day centre with their carer present.

I would also ensure that I have appropriate products available to sterilize and senitise my couch and work area in the event of an accident occurring.

I would avoid any areas of numbness due to the risk of causing damage to that area.

Oedema

Medical

Non-Medical

G

Oedema is too much fluid (mainly water) that has accumulated in the body.  This can be in a localised area, for example, the ankles or in a generalised area like in the lungs or abdomen.

Medical oedema can indicate heart and kidney diseases.  Whilst non-medical oedema can be an indication of pre-menstrual tension (PMT).

Symptoms of oedema include puffiness of the localised area.  If oedema is present a hollow may be left when the area is pressed. 

Diuretic drugs can be used to increase urinary water output.

I would seek medical permission from the client's doctor before performing a massage.

If the client is taking any medication that I am unfamiliar with, I would also seek advice on any effects that may be linked to oil absorption through the skin and adapt as appropriate.

I would massage upwards towards the heart and towards lymph nodes to improve lymphatic drainage.   If any limbs were affected I would raise those limbs and apply effleurage.