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Thai Massage Contraindications Part 2

thai massage contraindications

Are there contraindications for Thai Massage? Sure there are. However it is not so easy as to just post a list of them which clarifies it once and for all. I have written an article about the “big picture” in regards to this subject which I recommend you read as well.

How much are you expected to know about pathology?

Pathologists_looking_into_microscopes
Pathologists looking into microscopes

There are countless medical conditions and you as a massage therapist will never be able to know them all and neither are you expected to.

Even medical doctors don’t know them all. That’s why there are specialists. Actually pathology is a medical specialty by itself.

Even if a client tells you their exact condition, you won’t necessarily know what this means unless you studied a boatload of pathologies in depth – and this is beyond the job description of a massage therapist.

We have to understand that dealing with contraindications is not an exact science, it is not a clear cut, black and white affair.

Even in the actual medical field there are no certainties. After all, one of the leading causes of death in the US are medical mistakes, misdiagnosis, infections in hospitals, wrongly prescribed medications and their side effects. Hospitals can be very dangerous places.

Therefore we need to use some common sense and look at the most probable issues which we might encounter as Thai Massage therapists.

The “big picture” rule for massage therapy

The first rule is that the less you know, the more careful you need to be. If all you know about Thai Massage is a basic sequence of techniques, then you would not want to work on pregnant women, people with cancer or  significant injuries etc.

If you only have a couple of weeks of basic Thai Massage training and now assume that you pretty much know all about it, that’s a dangerous place to be, and that’s where you can easily hurt your clients, especially if they have specific issues.

If however you have a big repertoire of techniques, are familiar with various modalities, have lots of experience, are knowledgeable about pathology, are very intuitive and know how to work with energy, then you can work on many serious conditions.

Let’s group potential contraindications into two main categories:

1. Visible or obvious conditions

These include open wounds, broken bones, skin conditions, open sores, burns, sprains and other injuries, and advanced pregnancy (visible big belly).

The first thing we need to understand is that not every contraindication applies to Thai Massage in general. Often they just apply to a certain part of the body.

Here are some examples:

  • A client might have an open wound on the leg, but it is properly bandaged and you can easily work around it.
  • A client might have a burn on the calf, and you just skip this part of the body in your session.
  • A client might have a foot in a cast, but you can just work on the upper body, shoulders, arms, neck, head and face.
  • If you are experienced and skilled, you can easily work on pregnant women, even though you might avoid working directly on the abdomen.

There could be many more serious and very obvious contraindications, however it is highly unlikely that a client will show up at your door with a serious injury, joint dislocation, a fresh wound, with a high fever or with nausea or vomiting.

Almost everyone has enough common sense not to go to a massage therapist with such serious conditions.

2.  Not visible or less obvious conditions (to you as the therapist)

Examples are cancer, MS or Parkinsons in early stages, high blood pressure, nerve pain, arthritis, carpal tunnel syndrome, osteoporosis, blood clots, first trimester pregnancy, heart problems, implants, joint replacements and others.

These are not obvious conditions and you will need to find out from your clients if any of them exist, either by using an intake form or by conducting an interview.

Since you cannot run through a list of dozens of conditions, you will need to use categories and a catch-all phrase.

Here is an example for verbal questioning:

“Are there any health conditions that I should be aware of? Any diseases, operations, implants, breaks, injuries, any medications you are taking, any issues that you are consulting a doctor for, or any other conditions that might be affected by my massage work?”

If you are an inexperienced or not very skilled Thai Massage therapist, then many of the above-listed conditions might represent a contraindication for you, and you should not work on such clients.

If you don’t have the confidence and skills, or you don’t understand the condition, then you should err on the safe side.

If however you are skilled and experienced, then you can work on many of these conditions without causing any harm, and you might even be able to improve them.

However there are risky conditions like blood clots where you don’t know how they will be affected by your massage. It is advisable to stay away from such conditions unless you only work on the extremities like feet, hands or head and face.

Conditions/techniques to be aware of  in Thai Massage

Let’s talk about some very specific conditions which you might encounter, and about some techniques that you have to be careful with. They are generally not contraindications for Thai Massage, but they require certain adjustments:

1. Bending the feet out

In typical traditional Thai Massage, one of the early opening moves in a session is often a simultaneous bending out of the feet. This works fine if the client has an open hip and no knee issues.

foot stretch
This technique is contraindicated for clients with very tight hips or knee problems

What does this foot technique have to do with the hip? Easy – the rotation of the leg comes out of the hip. By bending the feet out you rotate the leg.

If the hip is locked up, the leg won’t rotate much and now you are twisting the knee joint. This is a hinge joint which is meant for one-directional movement.

Therefore rotating the leg sideways against the resistance of a stiff hip joint will twist the knee unnaturally and cause pain. The second reason when you should not do the foot bending techniques is if your client has knee problems.

The way to work around this is to skip this technique and use other ways to work on the feet which don’t affect the knee – and there are plenty of such techniques.

Also in the case of knee problems, if you have studied our Thai Knee Therapy course, you can suggest to the client that you work on the knee directly for part of the session.

2. Hypermobility

hyper mobile kneeYou might see clients whose leg is “hanging through” when you lift it from the foot. This means the leg is not in a straight line, but the knee is lower and seems to be “hanging through”.

This means that you should avoid techniques where you lift the straight leg from the foot, or you need to support the knee from underneath with one hand.

Another area which can be affected by hypermobility is the shoulder joint. You could easily yank the arm out of the joint with certain stretches and cause it to dislocate which is a very painful condition.

Along with certain stretches you should avoid traction moves of the arm, if you detect hypermobility.

3. Pregnancy

massage during pregnancyThere are many things written about pregnancy and massage therapy, some of them totally unsubstantiated, and some of them true.

The fact is that pregnancy is not a contraindication for massage, but a great relief.

Just like there are yoga classes for pregnant women, there are Thai Massage lessons for pregnancy massage.

There are some acupressure points on the sides of the ankles and on the webbing between thumb and index finger which can supposedly cause a miscarriage.There are three issues with this notion.

First, nobody knows for sure if this is true since you won’t find any pregnant women who would volunteer to be guinea pigs.It is presented as a fact in traditional Asian therapy, however there are no tests which have substantiated this claim and therefore it cannot be verified.

Second, if this would really be true, if it would be an established fact, there would be no need for abortions since women could just go to a massage therapists for some ankle pressing.

And third, in the course of a normal Thai Massage you would not apply the kind of deep and sustained pressure on those acupressure points that might conceivably have an effect on pregnancy.

So my point is that there is no need to panic over those points. However you should be aware of them and just as a precaution avoid pressing on the sides of the ankles or the thumb webbing – just in case.

On a side note, these acupressure points are sometimes being advocated as a way to induce labor in the final stage of pregnancy which would be a safe method regardless of the chance that this actually works or not.

You also need to know that the risk of miscarriage is greatest in the first trimester. If you practice in a litigious country like the US, you might want to protect yourself by having clients sign a release form that protects you from accusations in the case of miscarriage.

…Not that you would necessarily cause it, but just in case a client would blame it on you, it is better to be safe than sorry.

Ideally you would have specific training for pregnancy massage. However there is a lot you can do with a little common sense. Obviously you don’t want to do any moves which compress the abdomen.

You can safely work on the feet, legs, back, arms, neck and head. Bottom line is that pregnancy massage requires precautions, but does not have to be avoided.

4. Osteoporosis

hip fracture as a result of osteoporosis
Hip fractures are often a result of osteoporosis

This is a condition where the bones become brittle and break easily.

If a client has osteoporosis, you should avoid direct linear pressure on muscles which are on top of bones.

The way to work around this issue is to use non-linear techniques like circling or rocking motions. Those don’t put pressure on the bones.

If you don’t know how to do that, you can learn it from our Thai Rocking Massage course.

5. Spinal issues

Those might be fused vertebrae, spinal disk deterioration, spinal stenosis, slipped disks, and others. In such cases you should avoid strong stretches and work on the surrounding muscles instead.

Thai Massage "Bridge"
An “all or nothing stretch” example. The intensity cannot easily be reduced.

You also need to avoid rapid movements like sideways swinging twist techniques, or “all or nothing techniques” which cannot be applied gradually, or cannot be applied partially or to a lesser degree.

6. Varicose veins

While this is not a contraindication in general, you should avoid techniques like the “blood stop” and deep sustained pressure on the affected areas.

Other conditions

This article is not a listing of all pathologies which might affect Thai Massage therapy work, but only an indication what to be aware of with some examples of certain techniques and conditions.

There are cases where you just don’t know if there is any risk. It is always best to be safe rather than sorry. If you feel that there might be a possible problem, you can ask your client to clear it with their doctor first.

However in the vast majority of cases you can work on clients with all kinds of conditions as long as you are able to modify and adjust your work. This requires experience and some understanding of pathology.

It is very rare that you have to categorically refuse to work on a client because of a certain condition as long as you work intuitively and not mechanically. What do I mean with this?

Mechanical versus intuitive work

  • If all you know is a sequence of Thai Massage techniques – and that’s what pretty much every client gets – then this falls into the category of mechanical work. This is the most risky position to be in when working on potential contraindications.
  • If you have a large repertoire of techniques and the experience and the sensitivity to apply them selectively to suit a particular client’s needs, then this falls into the intuitive category. That’s where you can work on many conditions, including serious ones.

After all, Thai Massage has always been part of a traditional medical system which was used to deal with problems, diseases and medical conditions of the population in Thailand.

Contraindications seen in perspective

Contraindications are not an exact science. A list of rules of what can be touched, and what is off limits, can never be a substitute for the skill and experience of a practitioner.

Sometimes contraindications are obvious, and at other times they are in a gray zone which requires the therapist’s interpretation and judgment.

Here are four classifications of contraindications:

  • Total contraindications (i.e. intoxicated clients or clients with contagious diseases)
  • Partial contraindications which are limited to just one area of the body (i.e. a broken finger or varicose veins)
  • Subject to medical approval (i.e. you don’t know enough about the condition or don’t want to take the risk)
  • Subject to the skill level and experience of the therapist (i.e. an experienced therapist can do pregnancy massage whereas a new and inexperienced one should not)

You cannot and will not be expected to do an accurate whole body medical assessment for each client. Besides being outside the skill range of massage therapists, to attempt such a diagnosis would be illegal for you to attempt – at least in most countries.

However you can determine which category the potential contraindication belongs to and proceed accordingly.

False alarms and rigid standards

There are therapists who categorically state that you should “never” massage pregnant women, or cancer patients, or people with high blood pressure, or people with pacemakers etc.

These are generalizations and simply do not apply to everyone in every case. I have had clients with all those conditions, and many of my colleagues have as well.

Then there are massage institutions which protect themselves by setting more rigid standards regarding contraindications. This makes sense since they might employ many practitioners with various skill levels.

However there are therapists, both Thai Massage and other modalities, who specialize in pregnancy massage, or working on cancer patients or other serious conditions.

Granted, these are not scenarios for inexperienced therapists, but they are also not absolute contraindications.

Conclusion

Contraindications for Thai Massage are generally not fixed black or white medical issues. And with few exceptions, there is no indisputable list of conditions which stop you dead in your tracks when a client has one of those issues.

There is always a judgment call involved, and often common sense will be more important than precise medical diagnosis which you are not able to do.

Compared to modern medical science, the risk factor in Thai Massage therapy is very small since it is a non-invasive and totally natural treatment.

Nevertheless it is important to have a basic understanding of some pathologies that you are likely to encounter in your clients.

This article is not meant to be an all-inclusive list which covers every scenario of what to do or not to do in Thai Massage. There is no such list.

It is not about hard and fast rules, but about degrees of skill, knowledge, intuition, and experience. The more of those you develop, the smaller your list of contraindications for Thai Massage will become.

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image of Shama KernThe author, Shama Kern, is the founder and director of Thai Healing Massage Academy. He has been practicing and teaching Thai Massage for 18 years, and he is the creator of 20 online training courses. You can reach him at shama@thaihealingmassage.com

Related Reading:
Thai Massage And Serious Diseases
Thai Massage Contraindications Part 1

4 thoughts on “Thai Massage Contraindications Part 2

  1. Thank-you for expanding on this topic, Sharma! I am actually taking a Pathology course right now, as part of a Yoga therapy program…all of the things that can ‘go wrong’ with the physical body- yikes! Luckily, the greatest benefit of our work as Thai Massage therapists is relaxation. As the body relaxes, the parasympathetic nervous system activates, which in turn activates the body’s inherent healing capacity. Other keys lie in allowing our intention and intuition to guide us- for us to know that we are not the ones actually ‘doing’ the healing…to be in awe of the process of acting as a neutral, clear conduit to re-establish sacred connection.

  2. Thank you Shama, very worth information, essential topic. This helps expanding Thai massage. You doing great work to open people eyes, towards this beautiful healing art.

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