air quality

Air quality has emerged as an important safety component related to the novel coronavirus (COVID-19).

As a massage therapist, you may be practicing massage right now with the aid of several pieces of personal protective equipment (PPE) during sessions, as well as following general anti-coronavirus guidelines such as washing your hands frequently and maintaining social distancing of six feet away from other people.

But there is still much we are learning about COVID-19.

In July, the U.S. Environmental Protection Agency (EPA) stated1 that there is accumulating scientific evidence that COVID-19 can remain airborne “for longer times and further distances than originally thought”; that means it is more likely you can be exposed to the virus if you are near an infected person.

On Oct. 5,  the CDC acknowledged that evidence points to some people being infected with COVID-19 by others who were more than six feet away, in enclosed spaces with inadequate ventilation. This makes managing air quality in your establishment increasingly important as we learn more about COVID-19. The CDC website reads, “Some infections can be spread by exposure to virus … that can linger in the air for minutes to hours … These viruses may be able to infect people who are further than 6 feet away from the person who is infected or after that person has left the space.”  

How is the Air Quality in Your Session Room?

While the best practice to avoid COVID-19 acquisition or transmission is to self-isolate, many massage therapists must be back at work, in close personal contact with others who may be infected, before the pandemic ends—and most massage therapists often work in small and poorly ventilated treatment rooms for long periods of time.  

Fortunately, we have better information today about how to help decrease the risk of COVID-19 acquisition and transmission. The EPA recommends: “ … increasing ventilation with outdoor air and air filtration as part of a larger strategy that includes social distancing, wearing cloth face coverings or masks, surface cleaning and disinfecting, handwashing, and other precautions.2

In this article, we will focus on how to improve your massage therapy treatment room air quality to combat the invisible but potentially dangerous threat of airborne COVID-19.

There are three key factors in addressing massage therapy treatment room air quality to reduce the risks of COVID-19 acquisition or transmission:

• Increase the amount of air ventilation or air exchange around your massage service;

• Increase the amount of air filtration to purify the air in your massage workspace; and

• Alter your massage therapy service to avoid prolonged exposure to a client’s airway.

1. Improve Air Ventilation

The best and safest overall air quality (that we know of to date in this highly evolving pandemic), can be achieved by practicing massage therapy service outdoors, where there is an unlimited amount of air ventilation.

A cabana, rooftop or balcony could be a better massage option than most indoor treatment rooms during the COVID-19 pandemic. Just ensure that your massage service has privacy and is protected from direct sunlight to avoid sunburn. Use outdoor fans to cool yourself and your client if needed and ensure that the air or wind is not blowing directly onto you.

If you must practice massage indoors, then choose the largest or best-ventilated room available. When you are the only one working in a massage establishment, consider using the reception area or any other room to provide massage if any of them are larger or have better ventilation than the massage therapy treatment room itself.

Open all massage establishment windows and doors that lead to the outside when it is safe to do so. The EPA states, “Ensuring proper ventilation with outside air can help reduce the concentration of airborne contaminants, including viruses, indoors.”3

If the massage establishment has a bathroom fan that vents to the outside of the building, turn it on and leave it running.

When using a window air conditioning unit, leave the air vent control open.4 If a window or door in the massage treatment room can be safely opened with sufficient privacy for bodywork, then place the head of the massage table closest to the open window or door so that the client’s breath can be ventilated and diluted with as much outside air as possible.

Additionally, a massage therapy table can be positioned where any available air vent blows past the client’s airway toward an opening outside of the treatment room. Even allowing an air vent to blow past the client’s airway toward a hallway is better ventilation than being sealed in a treatment room with possibly infected air.

Avoid working in a position where an air vent would blow air past a client’s airway directly onto you in any room or situation.

2. Filter the Air

Be sure all air filters in your establishment are clean and changed regularly. The EPA recommends “upgrading air filters to the highest compatible with the system and checking the filter fit to minimize filter air bypass.”5 Keep general ventilation systems, such as a HVAC, actively running. Move any material or debris away from air vents and fans for the best possible air exchange.

In the Guidance on Preparing Workplaces for COVID-19 booklet provided by the Occupational Health and Safety Administration (OSHA), it is suggested to add HEPA (high-efficiency particulate air) filter(s) in workspaces. A HEPA filter will increase air filtration by suctioning airborne germs away from the massage service; it can also help purify the air.

Consider investing in UV-C or ultraviolet light options (if available and affordable) to disinfect the air. UV-C systems can be found in some air filters and HVAC systems. While there is no peer-reviewed published science that shows UV light can eliminate COVID-19, there is a June 24, 2020, report from Columbia University Irving Medical Center6 that states: “More than 99.9% of seasonal coronaviruses present in airborne droplets were killed when exposed to a particular wavelength of ultraviolet light that is safe to use around humans.” At the very least, this study proved UV light is germicidal against airborne droplets. Be sure to research your investment prior to purchasing such a system for proper safety and efficacy in a massage therapy setting.

You can seek greater guidance about your professional workspace air filtration system from any professional air filtration organization such as ASHRAE (formerly known as American Society of Heating, Refrigerating and Air-Conditioning Engineers).7

3. Avoid the Client’s Airway

Try to provide the greatest portion of your massage therapy service with the client in the prone position to reduce exposure to the client’s airway. Because we know COVID-19 is spread through respiratory droplets, our goal is to prevent the client from directly breathing onto the massage therapist.

Think of it as massage therapy social distancing. The highest and most likely risk of viral transmission is when a massage therapist is standing or sitting directly over a client’s airway when the client is in supine position—so avoid working from the top of the table in supine position whenever possible.

Most therapists massage a client’s neck and arms in the supine position. To reduce exposure to a client’s airway, try to massage the neck and arms in a prone position instead. Tissues such as a client’s palms and fingers can be easily massaged while the client is in the prone position. And, depending on the techniques being used, triceps and biceps are easily accessible when the client’s arms are hanging off the side or front of the massage table.

If a client wishes to redeem a gift certificate before the pandemic ends, then suggest services such as a back scrub with a back massage to keep the client in the prone position. If a client insists on lying supine during their service but is open to treatment suggestions, offer foot massage or foot reflexology, which will keep the therapist furthest away from the client’s airway.

If you are concerned about a client’s sinus pressure in a prolonged prone position, you should be. If you have table pegs, buttons or notches, try raising the forward legs of the table one notch higher than the back legs of the table so that the client’s head and upper body lie on a slight incline. Therapists can also provide a thicker face cradle cushion to help alleviate a client’s sinus pressure during prone massage therapy services.

Reduce Risk

The massage client and therapist should always wear face coverings whether the massage is provided indoors or outside. Wearing a face shield in addition to your face covering could increase protection.

Reducing the number of occupants in your massage establishment will improve the massage establishment’s air quality.8 The greater number of occupants, the greater amount of pollutant in the air. If you have multiple therapists, try scheduling them in shifts or on different days that would place the fewest amount of people in the massage establishment at one time.

If there is poor ventilation in your massage therapy establishment, try contacting some of your commercial neighbors who may be working from home to see if using their space is an option. Or if you have a landlord or employer, explain the need for better air quality to see if they have alternatives or other solutions.

While social distancing and self-isolation offer the best protection against COVID-19, improving your workspace air quality and changing your work habits could reduce your risks at work. Practicing the above air quality measures will not guarantee safety or eliminate the risk of COVID-19 acquisition and transmission—but it could make your massage therapy practice safer.

About the Author:

Selena Belisle is the founder of CE Institute LLC in Miami, Florida. She is a retired professional athlete and has been practicing massage therapy for 30 years. As an approved CE Provider of the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) and the Florida Board of Massage, she now teaches full-time for the complementary and alternative health care industries. You can learn more about her training and CE classes at Her article for MASSAGE Magazine include “How to Sanitize Massage Stones: 7 Steps to Reduce Your Risk Related to COVID-19” and “The MT’s Guide to Choosing the Best Products Manufacturer.”


1. “Indoor Air and Coronavirus (COVID-19).” Environmental Protection Agency, 16 July 2020, Found online August 9, 2020,

2. Ibid.

3. “Ventilation and Coronavirus (COVID-19).” Environmental Protection Agency, 16 July 2020, Found online August 10, 2020,

4. Ibid.

5. “Air Cleaners, HVAC Filters, and Coronavirus (COVID-19).” Environmental Protection Agency, 16 July 2020,

6. “Far-UVC Light Safely Kills Airborne Coronaviruses.” Columbia University Irving Medical Center, 5 Aug. 2020, Found online August 9, 2020,

7. “Coronavirus (COVID-19) Response Resources from ASHRAE and Others.” COVID-19: Found online August 10, 2020, Resources Available to Address Concerns,

8. “Ventilation and Coronavirus (COVID-19).” EPA, Environmental Protection Agency, 16 July 2020, Found online August 10, 2020,