Who should avoid deep tissue massage?

September 22, 2025 •

4 min read

According to research, massage is generally a safe intervention, but serious adverse events, though rare, can occur. Knowing who should avoid deep tissue massage is crucial for preventing injury and ensuring a safe therapeutic experience.

Quick Summary

Individuals with serious conditions like deep vein thrombosis, osteoporosis, or active infections should steer clear of deep tissue massage, as the intense pressure can be dangerous. Certain medications, recent surgeries, and advanced-stage cancer are also major contraindications that require a doctor's clearance before any massage therapy.

Key Points

Blood Clots (DVT): Never get deep tissue massage if you have or suspect a blood clot, as it can dislodge and cause a life-threatening embolism.
Severe Osteoporosis: Avoid intense pressure if you have brittle bones to prevent fractures.
Active Cancer: Deep tissue massage is contraindicated, especially near tumors or during chemotherapy, due to risks of spreading cancer or causing bruising. Seek specialized oncology massage instead.
Recent Surgery or Acute Injury: Postpone deep tissue massage in the immediate aftermath of an injury or operation to allow for proper healing and avoid worsening inflammation.
Pregnancy: Expectant mothers, particularly those with high-risk pregnancies, should avoid deep tissue massage and opt for prenatal massage from a certified specialist.
Skin Infections: Do not get a massage over open wounds, burns, or contagious skin conditions to prevent spreading infection and hindering healing.

Understanding deep tissue massage

Deep tissue massage is a technique that uses slow, forceful strokes to target the deeper layers of muscle and connective tissue. It is commonly used to treat chronic pain, muscle adhesions, and injuries. By applying firm pressure, therapists can break down knots and scar tissue that cause tension and restrict movement. While it offers significant benefits for many, the intensity of deep tissue massage makes it unsuitable for certain individuals with specific health conditions.

Blood clots and circulatory issues

One of the most critical reasons to avoid deep tissue massage is the presence of blood clots, particularly Deep Vein Thrombosis (DVT). A DVT is a blood clot that forms in a deep vein, most often in the leg. Massaging a clot can dislodge it, causing it to travel to the lungs, brain, or heart, which can lead to a fatal pulmonary embolism or stroke. Individuals with a history of blood clots, those taking blood-thinning medication (anticoagulants), or people with clotting disorders like hemophilia should absolutely avoid this therapy. Any signs of DVT, such as swelling, pain, or redness in the leg, require immediate medical attention, not a massage.

Conditions affecting bone health

For individuals with severe osteoporosis, a condition characterized by fragile and brittle bones, deep tissue massage poses a significant fracture risk. The firm pressure and manipulation involved can place undue stress on weakened bones, potentially causing them to break. Those with cancer that has metastasized (spread) to the bones should also avoid deep tissue massage for the same reason. If you have any bone density issues, it is essential to consult a doctor before considering massage.

Cancer and its treatment

While gentle massage can be beneficial for cancer patients, especially those with specialized oncology massage training, deep tissue massage is generally contraindicated. During treatments like chemotherapy and radiation, the body's immune system is often compromised, and blood cell counts can be low, increasing the risk of bruising and bleeding. Furthermore, massaging a tumor site could theoretically stimulate its growth or spread, though evidence is inconclusive. Any massage therapy for a cancer patient should be guided by a doctor's recommendation.

Skin conditions and open wounds

Direct massage over areas with skin conditions is ill-advised for several reasons. For contagious conditions like ringworm, impetigo, or active shingles, massage can spread the infection. For non-contagious issues like severe psoriasis, eczema flare-ups, open wounds, burns, or recent surgical sites, the pressure can cause pain, disrupt healing, and increase the risk of infection. Therapists must avoid these areas to ensure the client's safety and prevent contamination.

Acute injuries and inflammation

During the acute phase of an injury—typically the first 48 to 72 hours—deep tissue massage can do more harm than good. Conditions like severe sprains, strains, or recent fractures are characterized by inflammation and swelling. Applying intense pressure can exacerbate these symptoms, increase bleeding in the tissue, and prolong the healing process. Following the RICE protocol (Rest, Ice, Compression, Elevation) is the recommended first-line treatment for acute injuries.

Pregnancy precautions

Deep tissue massage is not generally recommended for expectant mothers, particularly in the first trimester, due to potential risks. A specialized prenatal massage therapist can offer modified, gentler techniques. High-risk pregnancies with conditions like preeclampsia may have absolute contraindications for massage. Massaging certain pressure points, or areas like the abdomen and legs where blood clots are more common, can also be risky.

Cardiovascular and nervous system conditions

Cardiovascular: Individuals with uncontrolled hypertension (high blood pressure), congestive heart failure, or those who have had a recent heart attack should avoid deep tissue massage. The increased circulation can put extra strain on a compromised cardiovascular system.
Nervous System: People with advanced diabetes may experience nerve damage or neuropathy, causing a loss of sensation. This makes it difficult to gauge a safe amount of pressure during a deep tissue massage, increasing the risk of injury. Conditions causing significant nerve injury or compression, such as a large hernia, are also contraindications.

Comparison of massage types for at-risk individuals


Condition	Avoid Deep Tissue Massage?	Consider Alternative	Notes
Deep Vein Thrombosis	Absolutely. High risk of embolism.	None, must be cleared by a doctor.	DVT is a total contraindication for all massage.
Severe Osteoporosis	Yes. Risk of bone fractures.	Light Swedish massage, oncology massage.	Must get doctor's clearance. Avoid strong pressure.
Active Cancer	Yes, especially deep work or near tumors.	Specialized oncology massage.	Requires doctor's note and an oncology-trained therapist.
High-Risk Pregnancy	Yes. Risk of complications.	Prenatal massage by a certified specialist.	Avoids specific pressure points and techniques.
Recent Surgery/Injury	Yes, in the acute stage.	Light lymphatic drainage (doctor's approval)	Wait for doctor's clearance and initial healing.
Skin Infections	Yes, on affected area.	Work around the infected area.	Total contraindication if infectious or systemic.
Bleeding Disorders	Yes. High risk of bruising/bleeding.	Light touch massage with caution.	Requires doctor's approval and careful technique.

Conclusion: Prioritizing safety

Deep tissue massage is a powerful therapeutic tool, but it is not a one-size-fits-all solution. For individuals with certain health conditions, it can pose significant, even life-threatening, risks. The best practice is always to be fully transparent with your massage therapist about your complete medical history before a session. When in doubt, consult with a healthcare professional to determine if deep tissue massage, or any other type of massage therapy, is safe for you. Prioritizing your safety by understanding these contraindications ensures a positive and beneficial experience. For more information on assessing a client's health history, you can read more at The Institute for Integrative Healthcare.

Frequently Asked Questions

Yes, deep tissue massage is highly risky for individuals with Deep Vein Thrombosis (DVT). The increased circulation from the massage can dislodge a blood clot, which can then travel to the lungs and cause a potentially fatal pulmonary embolism. Anyone with a history of blood clots should avoid it.

No, it is not recommended for those with severe osteoporosis. The condition causes bones to become fragile and brittle, and the firm pressure used in deep tissue massage can increase the risk of bone fractures. A lighter, gentler massage may be a safer alternative after consulting a doctor.

Patients undergoing cancer treatment, such as chemotherapy or radiation, often have a compromised immune system and may bruise easily. Deep tissue massage can exacerbate these issues. Additionally, there is a risk of affecting tumor sites. It's crucial for cancer patients to consult their oncologist and seek therapists trained in oncology massage.

Pregnant women should opt for prenatal massage performed by a therapist with specialized training. This type of massage uses gentler techniques and positioning to ensure the safety of both the mother and the baby, avoiding high-risk areas and pressure points.

No, you should wait until the acute phase of the injury has passed, typically at least 48 to 72 hours, and often longer. During the initial healing period, deep pressure can increase inflammation, swelling, and bleeding, delaying recovery. Follow the RICE method first and consult a professional before proceeding.

Yes. Individuals on blood thinners are at a higher risk of internal bleeding and bruising from the intense pressure of deep tissue massage. It's best to consult your doctor before getting any massage and inform your therapist of your medication.

If you have a contagious skin infection, massage is completely contraindicated. For non-contagious conditions like eczema, massage should be avoided on affected areas, especially during a flare-up, as it can cause irritation, pain, and slow down the healing process. Inform your therapist so they can work around the area.