As a long time teacher of Thai Massage I have often been asked if there are any contraindications to Thai Massage. Now, if you expect to see a neat little list of conditions that represent a no-go for Thai Massage work, you will be disappointed. However you will get something much more valuable:
>> THE BIGGER PICTURE <<
First of all let’s look at this from a broader massage perspective. Many therapists make statements that such-and-such condition (“pathology” in more scientific terms) is a contraindication for massage.
Such statements are a massive generalization – and here is why
Massage is not just one thing, like a “one-size-fits-all” therapy. There are dozens or even hundreds of various healing arts therapies out there.
What may be a contraindication for one style
might be perfectly okay for another style
The following examples will give you an idea why you cannot generalize and proclaim that a certain condition is a contraindication to massage therapy.
- A skin condition on the head would be a contraindication for head massage, but not for foot massage
- Pregnancy would be a contraindication for strong Thai Massage stretches around the mid section, but not for head massage or hand massage
- Osteoporosis (weak, brittle bones) might be a contraindication for deep tissue massage, but not for abdominal massage like Chi Nei Tsang for example
- A recent knee operation might be a contraindication for leg stretches, but not for Craniosacral therapy
Here is the idea: Contraindications generally only apply to certain types of bodywork, but not to ALL types in general. That would be like pouring the baby out with the bath water.
Now admittedly there are contraindications which really do apply to every kind of massage therapy. Let’s say someone has an infectious disease and just shouldn’t be around people to avoid infecting them.
But many other conditions are not so clear-cut. For example there are therapists who say that you shouldn’t work on cancer patients. However there are massage therapists who specialize in cancer patients.
Is pregnancy a contraindication for foot massage?
There are therapists who insist that you should not do foot massage on pregnant women because there are some acupressure points which can result in miscarriage.
They are mostly located on the sides of the ankle.
However again we have to take this with a grain of salt. It is one thing to apply strong and sustained pressure on such acupressure points.
But it is an entirely different thing to touch the sides of the ankle during a gentle foot massage without specifically pressing on these points.
Then you need to consider the stage of pregnancy. The risk of miscarriage is greatest in the first trimester.
If you practice in a litigious country like the US, you have to consider the possibility that a pregnant woman might miscarry and blame it on a massage therapist.
So to protect yourself you should rather be safe than sorry when it comes to those acupressure points. In other words you should avoid them on pregnant women, even if there is no actual risk.
The actual risk is hard to verify. After all, no pregnant woman will volunteer in an experiment which is designed to induce a miscarriage.
Contraindications are case specific
The bottom line is that you cannot categorically state that one particular condition is a contraindication to massage in general. Contraindications never apply to “massage therapy” across the board. It is always a case-by-case situation.
How to gather the required information
Since many or most conditions are not evident just by looking at a client, you have to ask. In some countries like the US it is common for first time clients to fill out an intake form which lists all kinds of medical conditions.
In other countries, like in Asia, intake forms are hardly ever used (except by high-end spas).
In the absence of a form, the therapist needs to verbally ask the client if there are any medical conditions, like previous or present diseases, fractures, operations, implants, other medical treatments, medications, etc.
In my experience, the clients will often not remember some conditions if they are not specifically asked.
How to adjust your work
In most cases it is not necessary to turn a client away for a particular condition. Instead you can adjust the treatment in various ways:
- Using different techniques
- Using a different style of massage
- Working only on certain parts of the body
- Working more gently
In the Thai Healing Massage family of bodywork there are many styles and variations represented. For example, just switching from direct pressure or stretch techniques to motion techniques from our Thai Rocking Massage system will often be a good solution.
For example, someone might have osteoporosis. In this case you should not apply strong pressure on the bones. However you can do rocking techniques instead which are very effective and pose no danger to the bones.
Contraindication or pathology knowledge
Sometimes therapists report that they have learned in their massage school that if someone has such-and-such condition, they should not receive massage.
However these schools are generally referring to the style of massage which they are teaching. Therefore such advice is generally not applicable across the board to all types of therapies.
If you want to know specifically about pathology and contraindications you could invest in a reference book like Ruth Werner’s “A Massage Therapist’s Guide to Pathology.”
If you don’t feel confident or knowledgeable enough to work on specific issues, then don’t. Refer the client to a therapist or health practitioner who specializes in this condition or who is more experienced with it. The old saying “If in doubt, get out” is quite applicable here.
Specific Thai Massage contraindications
The longer you do Thai Massage work and the more you expand your skills, you will find that the list of conditions which you cannot work on keeps shrinking.
In my 20 years of doing hands-on Thai Massage work I cannot remember a single case where I had to decline to work on a client for a particular condition.
Maybe I was a bit lucky, but mostly I attribute this to the fact that I can easily switch between massage styles and modify and adjust any of those styles in a way that works for a client.
Many times contraindications are not a black and white issue, but they require adjustment and modification of your work. So the real issue is often not the contraindication, but your experience, your skill level and your knowledge about those conditions.
So when students ask me if there are contraindications to Thai Massage, there is no easy answer that lists a number of conditions that you cannot work on. It’s always a case by case situation and depends on the condition and the kind of therapy.
Thai massage versus western massage
We have to remember that Thai Massage is an ancient healing system which was specifically designed to work on many conditions.
However it does not exist in a vacuum. It is part of a larger system of natural or traditional medicine in Thailand. This includes massage, herbal treatments, knowledge about energy flow in the body, and even shamanic practices.
Western massage is often seen as a way to relax the body and not much more. If there is any real health issue, the therapist will refer the client to someone who might be more qualified to deal with it.
In contrast, Thai Massage was never meant to be primarily a relax-massage system. It has existed for hundreds of years, long before there was modern medical science.
Along with the other aspects of traditional Thai medicine, Thai Massage was mainly used as a system to deal with and heal many different kinds of conditions.
Conclusion
Contraindications have to be evaluated on a case by case basis. The better your skills are, the more ways you know to work on people, and the greater your experience, the less you will encounter conditions that prevent you from working on someone.
Most people can be touched and worked on in some way, shape or form. Thai Massage is a system which has evolved in Thailand to heal, not just to relax.
Thai Healing Massage Academy offers a wide range of online therapy training courses which will go a long way in teaching you how to deal with many conditions. At the same time, it is important that you know what your limits are by learning about possible contraindications.
Contraindications are not a list of conditions which are summarily excluded from all types of massage therapy. They need to be seen in context and in a relationship with a specific healing arts modality, and with the skills of a particular therapist.
For in-depth training on Thai Massage therapy, browse Thai Healing Massage Academy’s extensive online training course library.
The author, Shama Kern, is the founder and director of Thai Healing Massage Academy. He has been practicing and teaching Thai Massage for 20 years, and he is the author of 20 Thai Massage online training courses.
Excellent article and many valid points made.The problem I find with liability here in the US is that the systems in place to protect the people also encourage the disingenuous to manufacture instances to sue for monetary gain and also relieving a lazy public from any responsibility for using their own common sense.
I can’t tell you how many times I have had someone stand there and tell me that they don’t have any health issues only to later discover obvious scars from surgery that they have undergone within too short a time to be receiving bodywork. And sadly it is all too true that here in the West any sort of massage is considered a pampering or strictly for relaxation thanks to the reluctance to be open to medicinal practices from other parts of the world esp. the orient and the closely guarded privilege and turf of medical professionals and the medical industry.
I believe in holistic and natural remedies vs so-called “drugs” and the tendency by the medical professionals in this nation to not heal a darn thing but to create an ongoing dependence on them to fill their pockets. This is one reason why I practice Thai Massage, vegetarianism, and natural herbal remedies. : )
We are certainly seeing eye to eye on this one Debbie 🙂
Hi Sharma
I read the article and was a bit disappointed that you didn’t talk much about actual contraindications to Thai massage.
Also I was surprised you didn’t mention the WHO article “Benchmarks for training in Nuad Thai” which has a section on contraindications for Thai massage.
Its great being able to do a massage by avoiding areas or doing techniques that negate any contraindications but you need to know what they are to begin with.
Maybe you need to write a series of articles about contraindications such as Heart disease or Hip replacement and talk about what not to do in these situations.
Cheers
Alan
Alan, my point in this article was that there is no standardized listing of contraindications for Thai Massage. Heart disease is not a contraindication and neither is hip replacement. You just need to know how to adjust your work so that you are not doing anything which could negatively affect the heart or hip.
How to do that exactly goes beyond a short article. Obviously if someone had a hip replacement you would not take this person through a full range of Thai Massage stretches. However you can do lots of Thai Massage work without even touching the hip.
Heart disease is not a contraindication in general either. For example you can do a wonderful Thai Massage with gentle rocking movements, or a foot massage, neck and head massage, arm and hand massage – none of these would effect a heart condition negatively.
Thai Massage is not a fixed standardized sequence of techniques. It is a creative and intuitive healing arts system which can even be adapted to some of those contraindications that are listed in the article that you mentioned.
The WHO article lists a number of possible contraindications, but without any explanations or details. The reference material which I mentioned in my article by Ruth Werner is far more in depth and much more specific, which is why I recommended it.
As is mentioned in the WHO article, the issue is primarily the knowledge, the skill and the experience of the practitioner. So the amount of conditions that a Thai Massage therapist cannot deal with will decrease with the amount of skill and experience he or she has.
As I mentioned in the beginning of my article, my intent was to show the “big picture”, not a specific list of contraindications which cannot be understood without being seen in the context of this bigger picture.
And you will see follow up articles from me where I get more into the specifics of certain contraindications 🙂
Hi Shama, great article, what we have done here at Ladysmith Thai Massage is we have put together a client intake form for therapeutic massage, we gather personal information and medical history of our guest on the first visit, and we have a waiver on the same form, people are accepting to disclose their medical history and this way we don’t have contraindications, if we need to avoid a certain area we already know what to do, this is working well for us.
That’s definitely the best way of doing it. It wouldn’t work well in Asia with all those people from all over the world, many of whom don’t speak English very well and couldn’t fill out the medical information properly because of that. But if the language is not a problem, then this form is definitely the way to go.
Very interesting article. Thank you
Great article! Thank you!
In one of my UTSA classes I put together a power point presentation on the history of massage. The following are just 3 dates to highlight how long Massage Therapy has been around and where it came from as far as we know today. As Shama pointed out, Thai Massage is part of a comprehensive medical approach:,”is part of the overall traditional Thai medical system. This includes massage, herbal treatments, knowledge about energy flow in the body, and even shamanic practices.”
3000 BC- Chinese: Cong-Fu of the Toa-Tse. Oldest known book written about massage. Translated to French in 1700’s.
2500 BC – Egyptians created reflexology.
776 BC-  Olympic Games. Athletes massaged prior to their events.
600’s – Japanese developed shiatsu (finger pressure or acupressure), anma is massage in Japanese
Massage Therapy, with all its modifications and sub-specialties, can be practiced on prematurely born infants, children, pregnant women, athletes, anybody that needs bodywork, to the elderly, the sick, and to the dying person, provided the giving therapist has the training and skills to work with that population. The same is true for Thai Massage. An ancient tradition, an art, that requires practice, and more practice, and practice, with teaching from a master. Not a quick fix, not a fast skill, a true ancient art of bodywork.
Thanks for your very interesting dates on the history of Massage. And the last paragraph of your post is an excellent summary of the potential of Thai Massage. 🙂
I so enjoyed this article with so much good info. Thank you Shama.
Glad you like it, Kathy! 🙂