OVERVIEW.

Therapeutic massage (also called Western, Swedish, or classic) is a “hands-on,” rhythmical application of pressure and stretching-type soft tissue stimulation that has been used to relieve pain, reduce edema, break up adhesions, stretch fascia, stretch skin scars, decrease muscle tightness and spasm, and increase sedation (relaxation).¹

TYPES OF MASSAGE.

Massage comprises both Western and Eastern techniques: Western massage includes classic (therapeutic) massage of effleurage, kneading, tapotement, friction, deep friction massage, connective tissue massage, and soft tissue mobilization. Rolfing involves very deep soft tissue massage. Urut is a regional practice involving abdominal massage. Mechanical devices can also administer massage (see vibratory device). Eastern approaches include Shiatsu, acupressure, and reflexology. These finger pressure techniques subscribe to a theoretical framework (e.g., Chi, energy) foreign to Western thinking and will be covered elsewhere (see Shiatsu). The present section will largely address therapeutic (Western) massage concerns.

Therapeutic massage’s actions are mechanical (physiologic, reflexive) and psychological in nature.¹ Note: Because massage mobilizes fluid and exerts force on soft tissue, the potential exists for irritating skin, spreading infection, dislodging clots and malignancies, and causing compression-type injuries to pressure-sensitive tissues such as superficial nerves.

SUMMARY: CONTRAINDICATIONS AND PRECAUTIONS.

Nine sources expressed a total of 67 therapeutic massage concerns that ranged from 3 to 42 per source, with a licensed massage therapist (LMT) source noting the most concerns. The largest proportion of concerns were contained under vulnerable tissues (endangerment sites such as the neck), circulatory, skin, musculoskeletal, and injury categories. Massaging over malignancies, DVTs, and infected tissue or in patients with bleeding/anticoagulation, compromised cardiac systems, or fragile skin were the seven most frequently cited concerns. More than one source cited ACIs.

Note: De Domenico and Wood¹ used the term usually contraindicated (UCI) to classify some concerns.