Massage Therapy Canada

Features Research
Client Centre: Spring 2005

Knowing when to touch is important, knowing when not to touch is crucial. If applied without a clear understanding of a patient/client’s health status, massage can actually worsen a present condition or cause harm.

September 29, 2009  By Massage Therapy Magazine

Knowing when to touch is important, knowing when not to touch is crucial. If applied without a clear understanding of a patient/client’s health status, massage can actually worsen a present condition or cause harm.

Your massage therapist will conduct an intake session that will include reviewing your health history. This is extremely important as it provides the massage therapist with information that will help to determine whether a treatment may need to be altered or even refused. When massage would be considered inadvisable or harmful it is described as being contraindicated.

A contraindication is any condition or symptom that renders a particular treatment improper or undesirable. Contraindications to massage are unique to each client, as well as to each region of the body.

If your massage therapist is unsure about a condition you have, or its potential reaction to massage, they will either refer you  to your doctor or ask for your written permission to consult with your doctor. This may cause a delay in the commencement of your massage treatment, but it is a responsible step in assuring both safe and ultimately effective care.


Contraindications are separated into regional (local) and general (absolute) types.

Regional (local) contraindications are those that relate to a specific area of the body. Massage may still take place, as long as it is not within the vicinity of the problematic area. For example if a client were to present with a bruise or cut, the therapist would avoid treating the immediate area in the event that the contact would make these presentations worse.

General (absolute) contraindications are those conditions that when present, massage cannot take place. For example, massage can never occur if a client presents with a fever. A fever is a sign of a systemic infection and massage would negatively impact on it.

A precaution is a situation where a condition is not necessarily contraindicated, but requires an awareness of possible adverse reactions to massage treatment unless the treatment is modified. Generally these situations require a physician’s evaluation of the symptoms to rule out serious underlying conditions, before massage can   proceed. An example of a precaution would be a post myocardial infarction (heart attack).

A massage therapist is not permitted by law in Ontario to “diagnose” symptoms presented, however they are able to conduct a thorough assessment, which will assist them to determine the best way to treat the symptoms they find.  Massage therapists have an extensive amount of education in the area of identifying symptoms that may give rise to more serious concerns. In these cases they may refer you to your doctor for further examination and diagnosis.

There are certain symptoms that may indicate a more serious situation than the main complaint you brought to the massage therapist. Some serious conditions involve muscular pain, that on their own do not create great alarm. However, after further investigation regarding past health, family health and other presenting symptoms, massage therapists may suspect a more serious underlying condition. Some symptoms create “red flags” which indicate the need for immediate medical attention.

For example: Low to mid back pain is a common complaint. However, if the massage therapist cannot find any specific physical activity or trauma responsible for this complaint, and particularly, if the pain is accompanied by a fever and a history of urinary tract difficulties, the pain may be indicative of a kidney infection and the Massage Therapist will refer the client to a medical doctor for treatment first before any massage therapy is commenced.


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Massage therapists also have general knowledge of the effects of pharmaceutical drugs and their possible interaction with massage treatment. Be sure to inform your massage therapist of all medications that you are taking. This includes pain managing drugs such as tylenol, advil, aspirin etc. Medication can alter the results of a treatment, and massage can alter the effects of medication. The need for or function of certain drugs can cause a massage treatment to be modified or contraindicated.

Massage therapists need to be specifically aware if you are currently taking  anti-inflammatories, muscle relaxants, anticoagulants (blood thinners) analgesics (pain reduction), or any other medications that alter sensation, muscle tone, standard reflex reactions, cardiovascular function, kidney or liver function, or personality.

It is crucial that the massage therapist know everything about your present treatment regime, while they are at the information-gathering stage of the intake session. This combined effort will help to ensure effective and appropriate massage treatment.

Ultimately, communication, before, during and following massage therapy treatment, is the key to accomplishing the maximum benefit possible.

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