Swedish Massage Contraindications/Endangerments by System

Nerves location Notes
Occipital Foramen Magnum Base of skull superior to 1st cervical vertebra 
greater occipital nerve, suboccipital nerve, cranial nerves II (optic) III (oculomotor) IV trochlear
Do not work the occipital area during passive extension.
Static pressure ok in lengthened position
Trigeminal Nerve (V Cranial) TMJ pressure on nerve may cause Trigeminal neuralgia or tic de la ru with nerve inflammation.
Caution when working with jaw open.
Brachial Plexus -above lateral clavicle
-posterior triangle of neck
-insertion of deltoid, pec Major and biceps
-medial upper arm between the biceps and triceps
Impingement can cause pain/tingling down arm/hand
Axillary Nerve -deep inside arm on the humerus
Musculotaneous Nerve
Median Nerve
-lateral to biceps and triceps at the elbow -accessed when elbow is bent. Work with the arm straight
Lumbar Plexus -between the 12th rib and T12 along top edge of quadratus lumborum
-along the transverse processes of T12 and lumbars
Vagus Nerve -deep in abdomen -deep psoas work is risky with people with high blood pressure as it may over stimulate the vagus nerve and cause sweating, nausea
Femoral Nerve -anterior pelvis lateral to psoas
-femoral triangle
-caution when doing iliacus work
follow the contour of the pelvis
Common peroneal Nerve
Common popliteal Nerve
-back of knee
-tendon flattens when knee is straight
-hamstring work done with knee bent
Veins and Arteries
Common Carotid
External Jugular Vein
medial to SCM in anterior triangle pressure may cause dizziness or blackouts
Subclavian Artery/Vein behind clavicle in the hollow under the clavicle between the Pec Major and deltoid
Aorta lateral to navel -move off if you feel pulse
– may cause blackouts
Cephalic Vein anterior to deltoid, medial to triceps, lateral to pectoralis can be impinged to the humerus
Basilic Vein upper arm can be trapped between the biceps and triceps
Heart heavy compression on sternum is contraindicated
Liver below rib cage extending from the right side to the left of center press liver down as you press under ribcage to work diaphragm
Spleen left abdominal region behind stomach feels mushy
Kidneys protected by lower rib cage between T10 and T12 on both sides No compression or vibration over kidneys on back.
No high psoas work through abdomen
Lymphatic Structures many locations: cervical area, axillary, abdomen, femoral triangle, popliteal area avoid
Eyes do not apply pressure on eyeballs:
retinal detachment indicated by flashes of light or color

ELAP recommendation:  Having completed 15.5 hours of instruction on massage cautions and contraindications, the learner is expected to:
• Demonstrate knowledge of the terms and concepts related to massage cautions and contraindications including endangerment areas, medications and side effects, and contraindications on a written examination.
• Demonstrate the use of a clinical reasoning process to identify contraindications, an understanding of when there is a need for increased therapist caution, and the capacity to choose appropriate adaptive measures for session planning on a written examination.
• Demonstrate the integration of knowledge and skills from other topics with this topic including the use of health intake forms, pathology reference books, drug reference books, and research literacy when determining if conditions are contraindicated or require caution, a physician’s release, or adaptations on a graded assignment.
• Correctly adapt massage strokes and techniques in endangerment areas or based on client feedback on a practical evaluation.
• Obtain training and certification from the American Red Cross in adult first aid, cardiopulmonary resuscitation (CPR), and use of an automated external defibrillator (AED).

Leave a Comment