A contra-indication is a factor which will prevent you from carrying out your treatment, whilst contra-actions are things which may occur as a result of the treatment, either during or after it.
Contra-Indications That Prevent Treatment
Deep Vein Thrombosis
Problems with veins can lead to an inflammation of the vein or skin ulceration. A blood clot can dangerously be moved around the body through massage.
Chemotherapy And Radiotherapy
As massage can increase circulation, drug therapies such as chemotherapy and radiotherapy can increase in rate and alter their effects. If your client has been diagnosed with any form of cancer and has or is receiving chemotherapy or radiotherapy you must not treat without obtaining written consent from their GP prior to offering treatment.
Impetigo
This is recognisable by the reddening of skin and soon becomes a cluster of blisters or pustules which have a crusty ‘stuck-on’ appearance. It is a highly contagious bacterial infection which spreads very easily, and treatment may cause cross infection. The therapist should recommend that the client goes to see their GP for medication. The treatment can be carried out once the condition has cleared completely.
Boils
A boil is a painful, red bump on the skin usually caused by an infected hair follicle. As white blood cells fight the infection, pus forms inside and the boil grows larger.
Eventually, it will rupture and the pus will drain away. Boils usually occur on the neck, face, thighs, armpits and buttocks. You should recommend that the client goes to see their GP for medication. The treatment can be carried out once the condition has cleared completely.
Shingles
Shingles are an infection of a nerve and the area of skin around it. It is caused by the herpes zoster virus which also causes chickenpox. Most people have chickenpox in childhood but after the illness has gone, the virus remains dormant (inactive) in the nervous system. The immune system keeps the virus in check, but later in life it can be reactivated and cause shingles. Shingles usually affects a specific area on either the left or right side of the body. The main symptoms are:
• Pain
• A rash which develops into itchy blisters and then scabs over
You should recommend that the client goes to see their GP for medication. Treatment can then be carried out once the condition has cleared completely.
Ringworm
This is a general term used to refer to a skin infection caused by a fungi called dermatophytes. The condition is known as ringworm because it can leave a ring-like red rash on the skin, it does not have anything to do with worms. It can affect different parts of the body.
Ringworm is highly contagious. It can be passed between people through skin contact and by sharing objects such as towels and bedding. It can also be passed on from pets such as dogs and cats. You should recommend that the client goes to see their GP for medication. The treatment can be carried out once the condition has cleared completely.
Scabies
Scabies is a contagious skin condition where the main symptom is intense itching. It is caused by tiny mites that burrow into the skin. Scabies can be spread through:
• skin-to-skin contact for long periods of time with someone who is infected
• sexual contact with someone who is infected
Scabies can also be passed on through sharing clothing, towels and bedding with someone who is infected. However, this is less likely than getting the infection through skin-to-skin contact. The incubation period for scabies is up to eight weeks.
Make sure you recommend that the client goes to see their GP for medication. The treatment can be carried out once the condition has cleared completely.
Lice
This is an infestation of the hair and body with wingless insects that cause intense irritation. As they cause itching, you can scratch your skin, leaving marks and maybe even causing a rash. They are spread by head-to-head contact and climb from the hair of an infected person to the hair of someone else. You should recommend that the client goes to see their pharmacist for treatment. The treatment can be carried out once the condition has cleared completely.
Contra-Indications That Restrict Treatment
The following disorders and diseases do not prevent treatment, but your treatment may have to be adapted to suit the condition. In extreme cases or if you are uncertain, you should refer your client to their GP before treatment.
Varicose Veins
This is an inflammation of the vein. Massage can worsen the condition and make the client feel uncomfortable so you should make sure you avoid the area.
Epilepsy
When discussing this illness with your client you have to be very careful not to offend and be accused of discrimination on the grounds of disability. Ask the client if they know what causes a seizure and how often they experience them. Ensure that you have a contact number for their next of kin recorded on their consultation card and discuss with the client what action you would be required to take if they have a seizure whilst with you. All therapists should undertake a first aid course so that they know how to help someone that may have an epileptic seizure, or any other medical emergency, whilst visiting the salon.
If the client has any concerns about whether they should go ahead with the treatment, you should recommend that they seek advice from their GP.
Diabetes
You can offer massage treatments to diabetic clients whose condition is controlled by diet or medication, thus removing the need for the therapist having to obtain written consent from the client’s medical practitioner. However, therapists must ensure that there are no other medical complications related to diabetes present in the area to be treated, such as neuropathy, as this can restrict the client’s ability to feel heat or pain in a specific area. If any loss of sensation is present in the area to be treated then refer the client to their medical practitioner for advice and consent prior to any treatments.
Heart Disease
As massage can alter circulation, clients suffering with any type of heart condition should be assessed on an individual basis and their treatment amended accordingly.
High And Low Blood Pressure
Massage can stimulate the circulation and so you should avoid heavier movements on high blood pressure sufferers. A client who suffers from low blood pressure can feel faint when standing up after lying down for any period of time. Raising the clients head slightly during treatment can help to prevent this.
Recent Scar Tissue
Do not massage over scar tissue that is less than six months old and only then if there is no sign of redness and the scar looks healed. If in doubt, refer the client to their GP for advice before treating.
Recent Fractures And Sprains
Do not massage over recent fractures and sprains until completely healed. You can massage areas that remain unaffected.
Undiagnosed Lumps & Bumps
If the client has any undiagnosed lumps and bumps you must refer them to their GP for written consent prior to offering treatment.
Product Allergies
If the client indicates they have had a previous reaction to a massage treatment or product then treatment must not go ahead. Some clients may have allergies to the ingredients found in certain massage mediums. If this is the case, you should not treat the client.
Medication
Caution needs to be exercised in people using oral retinoids. Treatment should not be performed until these medications have been stopped for at least six months to a year. Individuals using products including ingredients such as Retin A should stop the medication three to four weeks prior to their treatment to avoid skin injury and soreness. Prolonged use of steroid creams can also thin the skin. Refer the client to their GP for written consent prior to treating.
Pregnant Clients
Massage is not recommended in the first trimester and it must be remembered that pregnancy is not an illness. However, if the client advises you that she has a history of problems such as miscarriages then you should not offer treatment without a GP’s written consent.
Also, if the pregnant client has advised you that she has developed certain medical conditions during the pregnancy that are contra-indications to the treatment that she has requested, they must obtain a letter from their GP prior to offering treatment of any kind. Massage can be carried out on a healthy pregnant client, but this can be a little tricky as the pregnancy progresses as the bump can get in the way and the client can be uncomfortable.
Pregnant clients must not be allowed to lie on their backs for too long. You really need to use a level of common sense to know if it is going to be possible to carry out the treatment safely and effectively. There are specialised pregnancy massage courses available and we recommend that if you have a lot of pregnant clients that you consider attending such training. Remember, when massaging a pregnant client never massage over the abdomen, no matter what stage of pregnancy the client is at.
Psoriasis
Psoriasis is a collection of dull red papules that appear on the skin and are covered in silvery scales that can become infected. This disorder often affects the hair line and outsides of joints such as elbows and knees. You can work on areas of the body that are not affected. However, if there is any sign of infection or weeping the client should take advice from their GP.
Eczema
This appears on the skin as a red rash that sometimes is raised or itchy and there may be blisters. The skin can weep and crack and scaling of skin can occur. It is commonly found on the insides of joints and backs of the knees.
Do not massage over any area of the body that is affected by eczema. If the client has very severe eczema it is best for them to obtain GP’s consent prior to treating as certain products may irritate the condition further.
Dermatitis
Dermatitis is similar to eczema in appearance but is usually caused by a reaction or allergy to something in contact with the skin. You should refer any client who presents for a pedicure treatment with this condition to their GP, and should not treat them. If the client has a history of dermatitis you should advise them to obtain written consent from their GP prior to offering a massage treatment.
If this is obtained a series of patch tests must be carried out to establish that the client is not allergic to anything that you may use. Hypo-allergenic products are recommended when treating a client with a history of dermatitis.
Contact Dermatitis
As well as taking care of the client, you should also make sure that you think about yourself. You should be aware that as a therapist you may be vulnerable to contact dermatitis or allergies. If this is the case, follow the procedure as you would with a client, and take precautions during further treatments. Disposable gloves worn during some treatments can cause contact dermatitis in some therapists.
GP’s Written Consent
Some GP’s refuse to write letters for their patients and others will write a letter but charge a fee for it. If you cannot get a GP’s letter then you will not be insured to carry out the treatment and this must be made clear to the client. Some salons ask their clients to sign a disclaimer to say they are willing to go ahead with the treatment without the GP’s letter or without having a patch test. However, disclaimers are not guaranteed to stand up in court if a personal injury claim is pursued.
If you are not certain whether to treat a client then you should refer them to their GP for a letter prior to offering them treatment. You are not qualified to diagnose medical conditions or understand medication. If you explain to the client that you require a letter to avoid offering them a treatment that could have an impact on their health, they are usually happy to go to their GP.