When (not) to get a massage – contraindications

First – what does contra–indication even mean?!
Contraindications are situations, injuries and conditions where using soft tissue therapy techniques including massage,
> can be used, but with caution
> is overall not advised, or
> massage could provoke more harm than good.

Below are some examples of situations in which massage would need some extra consideration or should not be used at all. For fun you can learn both the English and German name for some common conditions.

This is not an exhaustive list and if you have any questions or doubts about a condition you have and how any soft tissue technique, including sports massage, might impact it, please contact me directly to discuss it before your appointment.

Pregnancy (Schwangerschaft)- Abdominal massage is not recommneded in the first 3 months of pregnancy and deeper abdominal massage is a contraindication for the remaining pregnancy. However, massage is still possible for other areas. Please consult your nurse, mid-wife (Hebamme) or doctor to make sure massage is ok for you.

Tatoos – if you recently got a new tatoo then you don’t want massage or tissue work on the area. It will hurt and possibly disturb your beautiful new art work. Wait at least 3 weeks (just a recommendation) until the skin tissue has completely healed. And then still let me know about new tatoos so we can take care of them!

Open skin wounds/infections (Hautinfektion)– Any cuts, lacerations or grazes or skin infection. Doh! Obvious really, but it has to be said. Bacterial infections, viral infections, and fungal infections can be spread to other areas of the body by the therapist and also to the therapist – which I really don’t want. You should wait until the skin is healthy or a scar has properly formed before having manual therapy on that area.

Bruising (contusions) (Blaue flecken, Prellungen)– result from impact injuries usually, causing bleeding within the skin, muscle or tissue. Did you know you can even bruise a bone! Massage to a contusion too soon after the injury may cause further damage. It will also likely hurt, so lets not do that.

Muscle and tendon partial tears – If it’s a low level injury, like a sprain or small micro tear, massage may be suitable after a minimum period of 48 hours. For more intense injuries or tears then it is recommended to wait 2-4 weeks until the first healing phase is well under way before soft tissue work begins.

Muscle ruptures – These are serious so see a doctor or physiotherapist first! In the acute stage, there may still be some bleeding in the muscle that you won’t always see from the outside. Massage could increase the bleeding, induce more local tissue damange and prolong recovery. It will also really hurt, so we don’t want to work on a ruptured muscle too soon. About 72 hours post injury, massage may be possible but it will very much depend on the extent of the injury. Please have a serious discussion with me or a doctor/physio to plan the best recovery for this and the optimal time to start with tissue work.

Tendon ruptures (Sehnenruptur)– Complete ruptures are also really serious! They are contraindications for massage and need surgery. I’m good, but I can’t put tendons back together.

Myositis ossificans – A fancy medical term to describe the case where you got a really bad impact injury with tissue bruising or muscle rupture that didn’t heal properly and the body’s response was to form calcifications in the soft tissue. Massage in an area with these calcifications could make the damage worse, and be pretty uncomfortable, so avoid it and ask a orthopedic doctor what to do.

Shin Splints and Periostitis – pain down the inside or front of the shin bone (Schienbein). This is a common problem for runners and anyone who does a lot of jumping or running type activity. Severe cases of shin-splints need medical attention before anything else to asses the severity of the injury. Periostitis is inflammation of the connective tissue sheath that surrounds the bone and it happen in bone irritation injuries like shin-splints. Massaging directly over periostitis is very painful (contraindication), but massage for other tissues can be beneficial in the treatment of shin-splints. Acute and/or severe episodes of shin-splints can just be too painful to work on, so wait a while until the situation is a little better (subacute) before booking in.

Bursitis – Inflammation to a bursa. A bursa is a small sack of fluid that helps tendons pass over bones easily at joints. We have quite a few bursa at key joints in our bodies where there is high wear & tear action, think knee, hip and shoulder. Bursa can get irritated, inflamed and sore. If there is pain, swelling, and redness in the skin near or over the bursa massage should be avoided directly in that area but can be beneficial for the muscles that load the tendon(s) around the bursa.

Thrombosis (Deep Vein Thrombosis or DVT) – This is a rare condition where your blood clots in a vein. It is total contraindication for massage because there is a risk massage might dislodge the clot from the side of the vessel, mobilising it. once it can free flot in the blood it will travel with the blood flow to the heart, lungs or brain and could cause a life threatening blockage in another vessel. Blood clots are often found in the lower leg, e.g. calf muscle and the symptoms would be deep, sore pain in the belly of the muscle, redness, swelling. If you have a reason to suspect a blood clot please see a doctor immediately.

Artificial blood vessels – Admittedly not a condition I see often, but if you have had artificial blood vessels surgically implanted massage to this area should be avoided. So let me know about them.

Severe bleeding disorders such as haemophilia – Severe bleeding disorders are definite massage contraindications. Deep tissue massage techniques can (but don’t always) cause low levels of damage to soft tissues that might result in microbleeding in the tissue which could then become uncontrolled bleeding. 

Tumors/Cancer – Massage is not contraindicated for people with cancer, but it must be used with caution. I advise anyone who has cancer or is in treatment for cancer to check with their oncologist first if massage is a problem for you and your specific case. If we get the “ok” then massage can be a really great part of your strategy.
If you are unsure of any lumps and bumps in the muscle or skin have these checked before massage to the area.