Did You Know?
for Integrative Healthcare Studies
Indication or Contraindication?
Being a responsible massage
therapist often means combining information from various sources to arrive at an
educated conclusion. In the case of treating a client with hypertension,
choosing the best way to proceed can be tricky. While modern research touts its
ability to reduce blood pressure, massage therapy is also one of the most
commonly taught contraindications for hypertension.
Nicole Cutler, L.Ac.
Hypertension, or high blood
pressure, is a serious condition affecting one in four American adults. Blood
pressure is the force of the blood pushing against the walls of the arteries.
Each time the heart beats, it pumps blood into the arteries. Blood pressure is
at its maximum at this time; this is known as the systolic blood pressure. When
the heart is at rest between beats, blood pressure falls; this is known as the
diastolic pressure. Hypertension is defined as an average systolic blood
pressure above 140 mm Hg, a diastolic blood pressure above 90 mm Hg, or both.
Although there aren't many noticeable signs of hypertension, it increases the
risk of both heart disease and stroke.
When a person has hypertension, excessive pressure is exerted against their
blood vessel walls. An activity that might increase an already heightened
intra-vascular pressure risks rupturing the blood vessel, a potentially
dangerous scenario. One of the physiological effects of massage, especially a
circulatory massage, is blood circulation augmentation.
Massage frees tissue
congestion by moving stagnant blood out of a tightened area and flooding it with
new, fresh blood. An increase in blood circulation can increase intra-vascular
pressure. This is the reasoning behind a massage therapist's caution with a
While many new therapists adhere to the contraindications as if they were
absolute, there is considerable evidence to the contrary. Overwhelming evidence
demonstrates that massage therapy can reduce blood pressure:
• As early as 1999,
researchers from the Touch Research Institute, the University of Miami School
of Medicine and Nova Southeastern University in Florida conducted the study
"High blood pressure and associated symptoms were reduced by massage therapy".
In this study, participants with controlled hypertension were randomly
assigned to either a massage therapy group or a progressive relaxation group.
Results showed that while both groups had lower anxiety levels and lower
levels of depression, only the massage therapy group showed decreases in
sitting diastolic and systolic blood pressure as well as cortisol
• Published in 2005,
researchers at the University of South Florida tested the effects of a
regularly applied back massage on the blood pressure of patients with
clinically diagnosed hypertension. Based on significant point reductions in
both systolic and diastolic pressure readings, researchers concluded that
regular massage lowers blood pressure in people with hypertension.
• As a result of the
general understanding that massage lowers blood pressure, a 2006 National
University of Health Sciences study sought to determine blood pressure changes
following different types of therapeutic massage modalities. Researchers
Swedish massage had the greatest effect in reducing blood pressure
readings, while potentially painful techniques, such as trigger point therapy,
might have the opposite effect.
According to medical massage
expert, Boris Prilutsky, massage's mobilization of skin, connective tissue,
muscle tissue and the periosteum, stimulates receptors that send messages of
relaxation to the central nervous system. These reflexes cause vasodilation,
resulting in decreased blood pressure and heart rate.
What is a practitioner to do when a client presents with high blood pressure?
Conventional texts claim this condition to be a contraindication to massage,
while research consistently demonstrates massage can be helpful to someone with
elevated blood pressure. With conflicting information about working with
hypertensive clients, massage therapists must take this investigation one step
further before making their decision. The following suggestions will help devise
an action plan:
• If a client's high blood
pressure is not controlled, get permission from their healthcare practitioner
prior to massage. Determining if their blood pressure is controlled will
require extra effort during the intake process. Some clients may be alarmed at
a request to consult with their doctor, but explaining your concerns will
foster their trust in you. When in doubt, always seek the permission from the
physician treating a client with high blood pressure.
• When working with
hypertension, choose massage modalities to encourage the relaxation response
in lieu of intense and possibly painful techniques. Examples of modalities
particularly suited for relaxation and hypertension include
cranial-sacral therapy and
information places you in a professional quandary, further evaluation is
required. This is certainly the case in administering massage to a client with
high blood pressure. Although massage therapy will likely increase the
circulation within the blood vessels, relaxing strokes will concurrently dilate
those vessels. The net result of massage's simultaneous circulation enhancement
and vessel dilation is a reduction in body tension and blood pressure. The
danger of enhanced circulation is typically only dangerous when a person's blood
pressure is not controlled, requiring the client's physician to give a massage
therapist the green light to commence with bodywork.
Cambron JA, Dexheimer J, et
al., Changes in Blood Pressure After Various Forms of Therapeutic Massage,
Journal of Alternative and Complementary Medicine, January/February, 2006.
Gottlieb, Bill, New Choices
in Natural Healthcare, Rodale Press, Inc., 1995.
Olney CM, The Effect of
Therapeutic Back Massage in Hypertensive Persons, Biological Research for
Nursing, October 2005.
Prilutsky, Boris, Medical
Massage and Control of Arterial Hypertension, Massage and Bodywork,
Blood Pressure Reduced by Massage Therapy, Massage Magazine, Inc., 2001.
A.D.A.M., Inc., 2006.