When Not to Get a Massage: Who Should Wait or Check First

How risky is massage, really?

For most healthy adults, not very. The US National Center for Complementary and Integrative Health (NCCIH) says the risk of harmful effects from massage appears to be low. It also notes rare but serious side effects, including blood clots, nerve injury and bone fractures, and that reported cases often involved vigorous massage such as deep tissue work, or people at higher risk of injury, such as older adults.

A 2014 systematic review in Evidence-Based Complementary and Alternative Medicine reached a similar view. Over 11 years of published case reports, it found 40 reports describing 138 adverse events, with forceful techniques and spinal manipulation most often linked to serious problems. The authors concluded that massage is not totally free of risk, but that the incidence of such events is low.

In other words, the point of a contraindication list is not to scare you off. It is to catch the small number of situations where pressure on the body could make an existing problem worse.

When should you postpone a massage?

These are situations where the safest choice is to reschedule, and in some cases to see a doctor instead.

Fever, flu or a contagious illness

Guidance for massage therapists from the New York State Office of the Professions lists a fever or contagious disease, in either the client or the therapist, as a reason for caution. A massage room is a close-contact space, and you are unlikely to enjoy a session while you feel unwell anyway. Wait until you have recovered.

Infected, broken or burnt skin

Mayo Clinic advises that massage should not be performed over burns, open wounds or recent surgical incisions, and the New York guidance asks therapists to avoid open wounds and to get a doctor’s recommendation for infections of the skin or deeper tissues. A small cut can simply be avoided, but a spreading rash, a hot, red area or an open sore on the feet or legs is a reason to postpone.

A fresh injury or recent surgery

Cleveland Clinic asks people to talk with their provider before massage if they have an acute injury or recent surgery, and Mayo Clinic advises never massaging a surgical incision. Inflammation in its acute stage is also on the New York list. At FootNote, our own policy is more cautious: we do not book anyone who is nursing an injury or who has had surgery in the past three months.

Signs of a blood clot

Massage should not be done near a deep vein thrombosis (DVT), according to Mayo Clinic. The NHS lists the usual signs as throbbing pain and swelling in one leg, usually the calf or thigh, with red or darkened skin around the painful area. It also lists recent surgery, a hospital stay and long journeys of more than four hours among the situations that raise the risk. If you notice these signs, skip the massage and see a doctor urgently. A clot that travels to the lungs, called a pulmonary embolism, can be life-threatening, so chest pain or breathlessness needs emergency care.

When should you check with your doctor first?

These conditions do not automatically mean no massage. They mean your doctor, who knows your history, should give the go-ahead and may suggest limits, such as lighter pressure or areas to avoid.

Past blood clots, blood thinners or a low platelet count

Cleveland Clinic asks people taking blood thinners to talk with their provider first, as these medicines may cause bruising. Mayo Clinic recommends medical clearance for people with a low platelet count (thrombocytopenia) or a past pulmonary embolism. If you are cleared, ask for gentle pressure rather than deep work.

Osteoporosis and fragile bones

Cleveland Clinic notes that osteoporosis or a spine disorder can put you at risk of fractures, and Mayo Clinic advises medical clearance for severe osteoporosis. Firm pressure on the back is where this matters most, so let your therapist know even if your doctor is happy for you to go ahead.

Cancer and cancer treatment

Massage is not off limits for people with cancer, and NCCIH notes it may be part of supportive care, although the evidence that it relieves symptoms is not strong. The right approach depends on your situation. Mayo Clinic recommends medical clearance if cancer has spread to the bones, and the New York guidance asks therapists to get a doctor’s recommendation for anyone with cancer or other tumours. Your oncology team can tell you what is safe for you right now.

Implanted devices and other long-term conditions

Cleveland Clinic lists medical devices implanted in or attached to the body as a reason to speak to your provider first, and Mayo Clinic extends its clearance advice to any other chronic condition. That includes heart conditions and high blood pressure that is not well controlled. There is no single rule for these, which is exactly why your doctor’s view matters more than a general checklist.

What should you tell your therapist before a massage?

Some things do not need a doctor’s note but do change how the session should go. Mention these when you arrive:

• Diabetes or reduced feeling in your feet. The New York guidance lists decreased sensation, for example with diabetes, as a reason for caution, because you may not notice if pressure is too strong. Ask for lighter pressure, and postpone if you have any wound or sore on your feet.
• Varicose veins. Therapists are advised to avoid working directly over them.
• Recently healed scars, burns or implanted hardware. These areas are also on the list to avoid.
• Medicines you take regularly, especially ones that affect bleeding or bone strength.
• Any area that hurts, and the pressure you prefer.

During the session, Cleveland Clinic’s advice is simple: if anything causes discomfort, tell your therapist right away.

At FootNote, our therapists can adjust pressure or skip an area once you tell them about any of the points above. Our Signature Foot Reflexology costs $38 for 30 minutes or $58 for 60 minutes ($33 and $52 for members), and our Acupressure Body Massage is $75 for 60 minutes ($65 for members). Every session starts with a complimentary organic foot soak, and prices are nett.

Can you get a massage when you are pregnant?

Prenatal massage exists, but it needs care. Cleveland Clinic advises speaking to your obstetrician before massage during pregnancy, especially if the pregnancy is high-risk, and notes that a therapist should avoid deep pressure on the abdomen, lower back and legs.

At FootNote, we do not book clients who are pregnant. That is a house policy rather than a judgement on prenatal massage in general. If you are expecting and would like a massage, ask your doctor first and look for a provider that specialises in prenatal care.

Ready to book with peace of mind?

If none of the postpone or check-with-your-doctor situations apply, you are good to go. Book through our contact page or WhatsApp either outlet: PLQ Mall at Paya Lebar (8908 0415) or NEX at Serangoon (8138 9887), both open daily from 11am to 10pm. Afterwards, our guide to what to take note of after a massage explains what to do in the hours after your session.

Frequently asked questions