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Contraindications – Do you know when to stop?

by Lisa Rose August 28, 2015 0 Comments

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!


Lisa Rose
Lisa Rose


Massage Table Size Guide

Massage tables comes in many different shapes and size. It can be confusing for you, the customer, to choose the right one but we are here to help!

A lot of customers call us up after they have bought the wrong size massage table elsewhere and we would like to help you avoid this mistake. It normally goes something like this; they like the look of a picture of a massage table on a website, they like the low price and then they check the carrying weight is ok. If the carrying weight fits their needs they click add to cart and the new massage table turns up at their doorstep in a few days. They unfortunately assume all massage tables are pretty much the same width and size.

The standard size of a massage table is 28 inches wide (71cms) and 73 inches (185cms) long. One of the reasons many "lightweight" budget massage tables are so cheap is because

  1.  They are smaller in size (normally around 61cms wide) and as such have less materials
  2. They are sold by specialist retailers who also sell anything else they can import and turn a profit on. As such they just buy the cheapest massage tables they can find in China. They go for smaller sizes as they are cheaper.

Make sure the massage table is the right size for you and your clients as the narrow massage tables at 61cms can be very uncomfortable for anyone who isn't petite and many clients cannot relax with their shoulders and arms unsupported.


The Width of the Massage Table:

Almost all therapists choose the standard 28 inch wide massage table. All our massage tables are the same length so it is only the width and shape our customers need to decide on.

Your massage table should be wide enough to cater for the wide variety of shapes and sizes of your clients. It needs to be wide enough to comfortably accommodate your treatment style, while being narrow enough to ensure you don’t have to strain your own back during treatments.

Each therapist's postural training and ability is different, so only you will know what massage table width you can handle. We have spoken to therapists who are five feet tall and get the wider 30 inch massage tables, and we speak to six foot therapists who have back problems and go for a 25 inch wide massage table. Everyone is different.

Generally speaking, if you are of smaller stature, you may do better with one of the narrower 25-inch massage tables. If you're quite tall, or are particularly keen to offer your clients a very spacious experience, a 30-inch massage table might be more suitable.

If you are in doubt, see if you can go into your local training college and see whether the massage tables there suit you. However, there is another way to get a feel for what will work of you don’t have access to a couch when you are deciding:

Cut out a piece of cardboard to the dimensions of both sizes you are deciding between. Put it on top of the kitchen table and lean over it. Visualise a client lying there, and see which width will suit you and your client best.

measuring the width of a massage table

Make sure you can get close enough to the table that you can pivot at the waist and have your shoulders squared to the clients hips, with your hands parallel to the clients' spine. Working in this position will ensure an injury-free career, so it's an important factor in your decision.

The most popular massage table widths are 28 and 30 inches. We sell 25-inch massage tables but you should really only choose this width if you are shorter in height and having a wider massage table might put your own back at risk over the course of your career.

You can also choose the 25-inch if you want to have the lightest massage table possible. By reducing the width of the massage table, the weight is also reduced. Now, this can mean a trade-off of some client comfort, but this trade is often worthwhile if you are a fully mobile therapist and use public transport frequently, where saving a kilogram or two will make a difference to you over time.


The Height Of the Massage Table

Nowadays, almost all portable massage tables come with height adjustable legs. Whichever massage table you choose should come with a large height range to accommodate you, and to cater for a broad range of therapies.

A common height range of massage tables is between 60 to 80cm, and this height range should cater for everyone. To check which height you need your massage table to be at follow this rule of thumb:

1. Stand up straight with your hands by your sides. Clench your fists.
2. Measure the distance between the floor and your knuckles
3. This distance should equal the height of your massage table.
4. Add a few inches in height to allow for the body of the patient on the massage table.

The height of a massage table is usually only adjusted when different therapists are using the same massage table, or if you have a client that is outside the average size you normally treat. So for example, if someone with a lot of body depth comes for a treatment after an average size person, you may need to adjust the height a notch or two.

You should be able to adjust the height of a massage table in just 2-3 minutes. Even though you mightn't adjust the height very often, the faster the better when you do have to!

There are 2 types of height adjustment mechanisms found on modern massage tables.

1) Twisting knobs (found only on wooden massage tables):

If you are working with a wooden massage table, it is better to have two knobs on each of the four legs for greater strength and reliability. When buying online, make sure to check how many knobs are on the legs. Cheap massage tables often only have one knob, and when you raise the legs to the highest heights they are less stable and have been known to snap.

2) Telescopic push-buttons (found only on aluminium massage tables):

The mechanism to adjust the height of an aluminium massage table is much the same as the push-button method on aluminium crutches. It only takes a few seconds to adjust each leg, and the mechanism is very reliable. Check out the video to see how it’s done.


Massage Table Shape:

The following are the different shapes of massage tables on the market.

1. Rectangle shaped with square corners 

This is the traditional shape of a massage table and the one you are probably familiar with seeing. Our Combi-lite 3 in 1 and Affinity Portaflex are shaped like this.

2. Rectangle shaped with rounded corners

Same as no 1 above in every way except the corners are rounded. Does not affect function in any way, just a different design/look.


3. Hour glass shaped with gradual gradient 

A fabulous massage table innovation in recent years, which solves a lot of the problems around choosing the correct width is the hourglass shaped massage table.

This style of massage table is wider at the ends, and tapers somewhat at the middle. This provide a spacious and comfortable experience for your client (as the shoulder and feet area are 30 inches wide) without compromising your own posture and health, as the middle of the couch where you lean over is a much narrower 26 inches wide.Having recently upgraded to one of these hourglass massage tables myself, I can vouch that my working days are much more comfortable, and many of my clients have commented on the extra comfort from the wider shoulder area.


4. Hour glass shaped with sharp gradient
Same as point above but instead of the it gradually going from wide to narrow, the massage table changes quickly from normal width to narrow width so people of very short stature can get in close.
5. Oval Shaped

 The name says it all! There are no corners on the massage table. Therapists normally choose this for one of two reasons. They simply like the look of this massage table and it is aesthetically more pleasing in their treatment room and/or they find it easier to move around the massage table during the treatment without having to side step the corners. This is particularly handy when space is limited in your treatment room.

oval massage table


Have any questions or comments about anything above? Please let us know in the comments below!