As more people survive the novel coronavirus (COVID-19), it’s essential for massage therapists to become knowledgeable about contraindications, benefits of massage and side effects of medication.

Ruth Werner, author of the textbook “A Massage Therapist’s Guide to Pathology”, presented on these topics in her “A Massage Therapist’s Guide to COVID-19” at Northwestern Health Sciences University’s virtual massage therapy symposium in March.

She spoke on demographics and other statistics related to the coronavirus (COVID-19), as well as pathophysiology and new variants. Her presentation also focused on recommendations related to massage sessions with clients who have had COVID-19.

Ruth Werner

“The way I talk about this is not to rubber-stamp, yes, this is indicated and, no, that’s contraindicated,” Werner said. “The way I like to talk about this is to talk about relative risks and benefits. What are the risks we can think of? What are the benefits we can think of? And how can we create a session? How can we make accommodations to maximize the benefits and minimize the risks?”

Werner suggested massage therapists:

• Take the enhanced hygienic precautions that have been presented to massage therapists over the past year, related to how one’s surfaces, linens, table and hands are kept sanitized.

• Ensure good air quality and ventilation in their massage rooms, because the risk of contamination from aerosolized virus is substantial. Note that if a humidifier is used, it means aerosols can fall on surfaces and those surfaces must be washed.

• Skip face massage for now as it entails very close contact.

• Learn about COVID-19-related blood clotting and the risk of embolism. Ask if clients have any signs of deep vein thrombosis, which might include deep, aching pain, edema, redness, swelling, or any kind of unusual or new sensation.

• Ask if clients are using anticoagulants or other medications, and whether those medications have side effects—remembering the major side effect of using anticoagulants is that some people then bruise very easily, and so massage pressure must be adjusted.

• Include a question about how clients tolerate activities of daily living on the intake, to find out what complications they might be living with.

• Ask clients about such signs of cardiopulmonary distress as chest pain or shortness of breath, or edema or cramping, when they exercise, after they receive massage or in general.

• Consider looking for an opportunity to work with a respiratory therapist focused on helping COVID-19 survivors in pulmonary rehabilitation, where they are learning to build up some stamina and the ability to use and breathe freely, without resistance and without pain.

• Work for small, incremental improvements rather than for big results all at once. “I recommend for our clients who are recovering from COVID that we work very conservatively,” Werner said. “We work gently, and we will go for incremental increases in intensity and incremental increases in the challenge that we offer for our clients as they are coming back to full health.”

For more information about Northwestern Health Sciences University’s virtual meetings and classes, visit To order “A Massage Therapist’s Guide to Pathology,” visit For more information about massage therapy and COVID-19, visit MASSAGE Magazine’s Coronavirus section of articles.