Absolute contraindications to massage include fever, active infection, deep vein thrombosis, acute injury in the first 48 to 72 hours, and untreated heart or kidney failure for lymphatic work. Many other conditions are relative contraindications, meaning treatment can proceed with adaptation. Disclose everything on the health form: it determines what the therapist can safely do.
Key takeaways
- Absolute means do not treat at all
- Fever, active infection, DVT, acute injury and contagious illness fall into this category.
- Relative means adapt rather than avoid
- Most conditions are in this group, including diabetes, high blood pressure and varicose veins.
- Local means avoid that area only
- A skin infection, open wound or recent tattoo rules out one area, not the whole treatment.
- DVT is the most important one
- A hot, swollen, painful calf must never be massaged and needs urgent medical assessment.
- Blood thinners increase bruising risk
- Not a bar to treatment, but pressure should be moderated and you must disclose it.
- Cancer requires care, not avoidance
- Massage is widely used in cancer care, but needs oncology approval and a suitably trained therapist.
- The health form exists for this reason
- Omitting information is the single most common cause of an avoidable problem.
The three types of contraindication
Therapists categorise contraindications in three ways, and the distinction matters because most conditions do not rule out treatment entirely.
- Absolute. Treatment should not go ahead at all. Usually temporary, such as a fever.
- Local. One area is avoided while the rest is treated normally. A verruca rules out the feet, not your back.
- Relative. Treatment can proceed with adaptation: lighter pressure, different positioning, or medical advice first. Most long-term conditions sit here.
The practical upshot is that very few people cannot have any massage at all. What changes is which treatment, how firm, and whether a GP should be consulted first.
Absolute contraindications
Do not have a massage if you have:
- Fever or raised temperature. Your body is fighting something and massage adds demand.
- Active or contagious infection. Flu, sickness and diarrhoea, chickenpox, and anything else transmissible.
- Deep vein thrombosis, or symptoms of it. A hot, swollen, painful calf must never be massaged and needs urgent medical assessment. This is the single most important item on the list.
- Acute injury in the first 48 to 72 hours. Fresh sprains, strains and bruising, where pressure can increase bleeding and swelling.
- Suspected fracture or dislocation.
- Severe uncontrolled hypertension. Until reviewed medically.
- Undiagnosed lumps, swellings or severe pain. Get assessed first.
- Acute inflammatory conditions in a flare.
- Under the influence of alcohol or recreational drugs.
- Recent surgery, until your surgeon has cleared soft tissue work.
For lymphatic drainage specifically, untreated congestive heart failure and untreated kidney failure are also absolute, because moving fluid back into circulation places load on systems that cannot handle it. See lymphatic drainage side effects.
Local contraindications
These rule out one area while the rest of the treatment proceeds normally:
- Open wounds, cuts, burns or unhealed scars
- Bruising
- Skin infections: impetigo, ringworm, cold sores, athlete's foot, verrucas
- Eczema or psoriasis in an active flare over that area
- Sunburn
- Recent tattoo, until fully healed, usually two to four weeks
- Varicose veins, which are worked around rather than over
- Recent injection or vaccination site
- Undiagnosed moles or skin changes
- Hernia
- Recent fracture site, even once healed
Mention these when booking so the therapist can plan, though most are dealt with easily on the day.
Relative contraindications
Treatment usually goes ahead, with adaptation and sometimes with medical advice first.
| Condition | What changes |
|---|---|
| Pregnancy | Requires a pregnancy-trained therapist; positioning and pressure adapted. See the pregnancy massage guide |
| Diabetes | Care with pressure and heat where sensation is reduced; feet checked |
| High blood pressure | Fine if controlled; deep tissue and hot stone may be avoided |
| Blood-thinning medication | Lighter pressure to reduce bruising risk |
| Osteoporosis | Lighter pressure; no strong joint mobilisation |
| Epilepsy | Certain essential oils avoided; therapist should know what to do |
| Cancer, current or past | Oncology approval and a suitably trained therapist |
| Lymphoedema | Specialist input; standard massage on the affected limb is avoided |
| Heart conditions | Medical advice first; heat treatments often avoided |
| Recent stroke | Medical clearance required |
| Kidney disease | Lymphatic drainage in particular needs medical advice |
| Fibromyalgia or ME | Much lighter pressure; shorter sessions |
| Rheumatoid arthritis | Avoid during a flare; gentle work between flares |
| Asthma | Care with strong essential oils and prone positioning |
| Recent whiplash | Medical clearance; no neck work initially |
| Mental health conditions | Not a barrier; worth discussing what would help |
Treatment-specific
Hot stone massage. Additionally avoided in pregnancy, with diabetes and reduced sensation, neuropathy, poor circulation, uncontrolled blood pressure and heart conditions.
Lymphatic drainage. Absolutely contraindicated with untreated heart or kidney failure, active infection, DVT and untreated cancer.
Thai massage. Additional caution with osteoporosis, joint replacements, disc problems, spinal instability, hypermobility and pregnancy.
Cupping. Avoided with blood thinners, bleeding disorders, fragile skin and over inflamed skin conditions.
Aromatherapy. Oil-specific restrictions in pregnancy, epilepsy, high blood pressure and asthma, as covered in best essential oils for massage.
What to disclose and why
The health form is not bureaucracy. It determines what the therapist can safely do, and omitting something is the most common cause of an avoidable problem.
Always disclose:
- All medication, including over the counter and supplements
- Any surgery in the last twelve months
- Pregnancy, or if you are trying to conceive
- Current or past cancer treatment
- Heart, circulatory, kidney or liver conditions
- Diabetes
- Skin conditions and allergies, including nut allergies for carrier oils
- Recent injuries
- Anything you are currently seeing a doctor about
Nothing on that list will surprise a therapist or cause them to judge you, and in most cases it changes the treatment rather than preventing it. What it does prevent is a therapist using firm pressure on someone taking anticoagulants, or heat on someone with reduced sensation.
If a therapist does not take a health history at all, that is a warning sign in itself, as discussed in how to choose a qualified massage therapist.
Every therapist listed on Massages Bristol is checked for relevant qualifications and current public liability insurance before publication[1], and you book direct so you can discuss any of this in advance. Browse the full directory.
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This article is researched by the Massages Bristol editorial team using NHS guidance, professional body standards and published research, and is checked against the practice of the qualified therapists listed in our Bristol directory. It is reviewed and updated when guidance or standard practice changes. It is general information, not medical advice: speak to your GP if you have a health condition that may affect treatment.