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What are the contraindications for Thai massage?

Contraindications are conditions or situations in which Thai massage is inadvisable because it may harm the recipient.

Contraindications are conditions where Thai massage is inadvisable because it may harm the recipient. The term contra means against or contrary, and indications are symptoms that suggest that a specific medical treatment is necessary. The recipient’s health history information is essential to evaluate any contraindications and best serve the recipient’s needs.

Thai massage contraindications are a crucial aspect that new practitioners often seek guidance on. It’s not just about knowing when it’s not advisable to perform a Thai Massage session on someone; it’s a critical element of your professional knowledge. The answer might surprise you, but equipping yourself with this understanding is essential.

How Do You Recognize Thai Massage Contraindications?

Contraindications can be straightforward cases, such as someone with an infectious disease who shouldn’t be around people to avoid infecting them. Fortunately, people in such a condition rarely come to you for a massage.

Instead, what typically happens is that you will have a client who, for example, has a skin condition on their head, had a knee replacement, is pregnant, or has osteoporosis.  Knowing that many contraindications apply to specific body areas is essential in such cases. So, while you may not be able to massage the affected area, a Thai massage contraindication does not necessarily exclude the possibility of massaging other body parts. And what may be a contraindication for one Thai massage modality might be perfectly okay for another modality. So, contraindications are always a case-by-case situation.

In previous cases, a skin condition on the head was a contraindication for head massage but not for foot massage. A knee replacement would be a contraindication for leg acupressure and stretches but not for upper body work. Pregnancy would be a contraindication for Thai Massage stretches around the midsection, but not for head or hand massage. Osteoporosis (weak, brittle bones) might be a contraindication for deep tissue massage, but not for abdominal massage like Chi Nei Tsang.

Since many or most conditions are not evident just by looking at a client, it’s crucial to ask the client for this information using an intake form. Intake forms are standard practice for first-time clients in Canada, who often fill out an intake form that lists all kinds of medical conditions. Without a form, the practitioner must verbally ask the client for any medical conditions, like previous or present diseases, fractures, operations, implants, other medical treatments, and medications.

What Are The Contraindications for Thai Massage?

There are more contraindications for Thai massage than you might expect, but Thai massage is safe when performed with adequate knowledge of the recipient’s physical condition.

Abdominal Conditions. A hernia is a protrusion of an organ through the muscular wall. Do not perform a Thai massage on this area or attempt to push the organ back inside. Do not massage clients with an umbilical hernia or unknown causes of abdominal pain. If the condition is not severe, proceed cautiously and monitor the client closely.

Injury or Inflammation of Muscles. If an injury is chronic and shows no signs of trauma, you may proceed cautiously. Inflamed conditions include conditions that end in ‘-is,’ such as phlebitis (inflammation of a vein), dermatitis (inflammation of the skin), arthritis (inflammation of the joints) and so on. Thai massage can further irritate inflammation, so do not massage this area, especially if an injury shows trauma, such as bruising or swelling.

Bone Fracture or Joint Dislocation. Only massage this area if the recipient’s physician has given you written consent. Do not apply pressure directly on the mending bones; a light massage beside this area can improve circulation.

Severe Ache and Pain. If the pain is due to the muscles, proceed with caution. If the pain is nerve-related, prevent further harm and do not massage.

Fever. A fever indicates your body is trying to isolate and expel an invader. Do not massage the body, but you may gently massage the recipient’s hands, face and head for relaxation. Thai massage will exacerbate inflammation and might spread infection if bacteria cause the fever. 

Acute Non-Severe Illnesses. Respiratory conditions like colds, influenza or sore throats are contagious to the practitioner and anyone in the clinic. These symptoms may also coincide with other contraindications, such as fever.

Severe Headache. If the cause of the severe headache is unknown, do not massage because underlying conditions may require a physician’s consent.

Migraines. Massage will aggravate the symptoms, so the recipients should rest and take their medications if required.

Osteoporosis. Osteoporosis is when bones become porous, brittle and fragile. Be sure to apply light pressure, as deep pressure can cause be too intense for this condition.

Post Surgery. The practitioner must have written consent from the recipient’s physician before doing Nuad Boran.

High blood pressure is one of the more serious Thai massage contraindications.

High Blood Pressure. This condition means that there is excessive pressure against the blood vessel walls. Recipients with high blood pressure should only receive light pressure, if at all. Regardless of whether they are on medication, a recipient with high blood pressure must have consent from their physician.

Stroke with Chronic Condition. A person who suffers from a stroke will need physiotherapy and massage. Apply light pressure, as deep pressure can cause bruising or dislodge blood clots to the heart or brain.

Vascular Conditions. Do not massage any person with vascular issues without approval from their physician. 

Cancer. Thai massage increases lymphatic circulation, and cancer can spread through the lymphatic system, so massage can potentially spread cancer. Reduce your pressure, and do not apply pressure to the lymph nodes. Only massage with physician approval, and avoid the tumour site and surrounding tissue.

Edema. Edema is the accumulation of fluid in the interstitial tissue space. If you treat someone with edema, the direction of the massage should be towards the heart only. Do not massage if heart, liver or kidney diseases cause the edema, as the movement of the fluid may overload the affected organs.

HIV Infection. HIV is only transferred through the exchange of body fluids (blood, semen, vaginal fluids or mother’s milk), not through massage. However, infections people suffer from in the later stages of AIDS can be contraindications. Stay away from any visible rashes, sores, lesions or swelling. Wear thin surgical gloves if you have any open cuts or scrapes on your hands.

Varicose Veins. Varicose veins are enlarged veins that tend to clot and damage tissue. Apply very light pressure beside the varicose veins toward the heart. Do not massage near the enlarged veins, as massage may dislodge clots in the vein, which, in turn, can obstruct the heart, lungs or brain.

Contagious Skin Diseases. Do not massage the infected area, as massage may spread the disease to other body parts or even infect the practitioner. If you cannot avoid the area, do not massage.

Non-Contagious Skin Problems. Do not massage directly over rashes, wounds, bruises, burns, boils, blisters and other localized skin problems. You may still perform Thai massage away from these conditions.

Pregnant Women. Pregnant women need permission from their physician for a massage but never massage a pregnant woman who has any complications with her pregnancy.

Women in Menstruation Cycle. You may massage menstruating women, but observe the contraindication positions listed in the following section.

Drug or Alcohol Intoxication. Do not massage any person intoxicated by drugs or alcohol, as massage may intensify the effects of the agent. The recipient will also be more unpredictable and uncontrollable when intoxicated.

Becoming Confident with Thai Massage Contraindications

In most cases, turning a client away for a particular condition is unnecessary. Contraindications are always a case-by-case situation, and knowing that Thai massage is not a “one-size-fits-all” treatment is essential. So, when you face a particular contraindication, you can adjust the treatment in various ways:

Using different techniques
Using a different style of Thai massage
Working only on certain parts of the body
Working more gently

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 have the confidence and knowledge to work on specific issues, don’t. Instead, refer the client to a practitioner who specializes in or is more experienced with this condition.

Remember, you need to evaluate every situation on a case-by-case basis. The better your skills are, the more ways you know how to work with people. The greater your experience is, the less you will encounter conditions that prevent you from working with someone. So, the longer you practice Thai massage and the more you expand your skills, the list of conditions you cannot work on will shrink. This reassurance should keep you hopeful and motivated on your journey of continual improvement, emphasizing the importance of ongoing learning and growth in your practice.

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