Contraindications – Do you know when to stop?

Any decent massage course leading to a qualification that will allow you to practice must cover common contraindications. So most practicing therapists are likely to have at least a basic knowledge of what is ok to work with and what should be avoided at all costs. Of course, a lot of this is common sense. But there are pitfalls. Many of us rarely come across contraindications and they are perhaps infrequent for various reasons; often clients will know their problem well enough to exercise a certain amount of caution - they are even sometimes embarrassed about it, especially if it’s something like a serious skin condition.

The ones that pose the biggest problems may not be quite so obvious. The client may not be fully educated about their condition, or the condition may be something complex or rare that wasn’t covered by our training. There are so many conditions out there, and naturally, the list continues to evolve alongside disease and modern medication. If a therapist did their training ten years ago, it makes sense that there could be new conditions that they haven’t been educated on. On top of this, the less we are faced with such conditions, the memory of our education about them may well fade over time, leaving us feeling unsure of whether it is safe to go ahead. Even if we do know a lot about the conditions themselves, there is still a chance that we don’t know how the condition may be affected by massage. But let’s be realistic… It would be a full time job to keep ourselves up to speed with all the possibilities and most of us don’t have the time or inclination for such an undertaking, understandably. It could be said that the responsibility lies mainly with the client to research their condition fully and consider the implications of massage treatment, but we wouldn’t be good therapists if we didn’t have a sound work ethic – and that involves concern for our clients’ wellbeing after the treatment.

What about me?

It’s certainly not all about the client either. Close physical contact with anyone is quite obviously putting us at risk of contracting all sorts of conditions. Even when they aren’t contagious, they can just be downright unpleasant to deal with, and uncomfortable as it may be to refuse a client and the business they bring, we are well within our rights to assert ourselves if we feel that it is inappropriate to go ahead with the treatment. As massage therapists, we must learn to be non-judgmental and critical. Compassion is a necessary part of the job, although you’ll never see it written in a training manual. We must hone our interpersonal skills so as to handle all clients with tact, consideration and understanding. If we can master this, then it shouldn’t be quite so difficult to assert ourselves when faced with an unsure client presenting a sensitive contraindication.

If a client comes in with flu, for example, we are well within our rights to refuse to treat them. It isn’t fair of the client to insist on close physical contact when suffering from something contagious, but perhaps they haven’t thought about it much and are disappointed after looking forward to it. For those of us not fully confident in turning people down – and I’m guessing there are many, given that society teaches us to put others before ourselves – it can be a daunting thought; something that feels like a potential confrontation. If we are caring, we don’t like letting people down or embarrassing them, but it would be unkind to consider treating somebody if we know that there may be adverse effects to their health or to ours.

Which guidelines should you be following?

There is a lot of information out there about contraindications, so it is not difficult to do our homework. However, the guidelines around contraindications need to be consistent within literature supporting professions. If they are not, the variations may result in inconsistent treatments – not to mention a lot of confusion – for students and therapists alike. We should also seriously consider the sources of information and apply critical thinking, making sure that there is sufficient evidence supporting the claims regarding contraindications. The industry could well be at a disadvantage if the vast range of textbooks about massage therapy don’t contain enough supporting evidence to enable good decision making on the part of therapists wishing to handle contraindications appropriately.

Do you feel confident in handling contraindications, and is it important to you to brush up on your knowledge at regular intervals? Which sources of information do you trust the most, and do you feel that your course covered the subject extensively? How do you handle refusing a client, especially if their condition is likely to be a sensitive one? Please share your opinions with us!