by Gloria Coppola, L.M.B.T.

Recognize How Pharmacology and Herbs Work in a Massage Practice, MASSAGE MagazineIn today’s world, many individuals are taking prescription medications and using herbal supplementation. For the most part, massage therapists are not attuned to the effects these have with each other and how they might interact with massage techniques. It is imperative to understand these implications and make adjustments as necessary.

I was recently teaching about this topic, and a former physician attended the class. He advised us the average patient takes four to five prescription drugs–and that is on the rise.

So my question is: How many of you had training where you were taught how your massage techniques might affect the use of a prescription drug? How many of you know how prescription drugs interact with herbs?

Pharmacology for Massage Therapy, written by Jean Wible and published by Lippincott Williams & Wilkins, is an excellent resource to help you get started. Wible has done her research, and she provides you with a chart of how different techniques are categorized and proceeds to give examples of how anti-inflammatories or painkillers might be affected by deep-tissue or effleurage techniques.

Massage therapists need to be aware of these indications in order to provide the best possible treatment and outcome. Many of the drugs people take can affect the central nervous system. Our techniques and these drugs react to each other, even if only minimal. Note that any massage technique that might create a therapeutic inflammation should be avoided if a patient is taking a drug that might change his or her perception of pain and pressure. Consider the possibility of performing strokes that are more local, perhaps myofascial release. You might want to consider bringing more rapid effleurage or tapotement at the end of a session to bring alertness to your client.

Many drugs and herbs have sedative effects. Consider the direction of your strokes and the amount of pressure. We have been taught in school not to massage someone who is under the influence of alcohol because it may enhance alcohol levels. Therefore, can these sedatives one might be taking, such as valerian root in an herbal formula, have any effect on our massage techniques? Although there may not be much, if any, research, we need to consider the fact and the use of these herbs. If certain massage strokes in a downward movement provide for deeper relaxation, are we going to alter clients’ levels if they are also taking something else for this same effect? Should we be using precautionary measure? Of course! If a client’s ability to move after a massage is hindered because of these reactions, then we need to make sure we advise them to get up slowly or tell them we will be back in the room to assist them in a seated position.

Many antidepressants, including St. John’s Wort, Prozac, Paxil, etc., change the chemistry of the nervous system by increasing the production of certain chemicals or, perhaps, blocking specific pathways. If a client utilizes an herbal formula and a prescription drug together, these effects may be enhanced. There have been research and news reports stating St. John’s Wort can adversely affect a patient and cause complications. Common sense-wise, if you take any two formulas that have similar effects, then it would be twofold. For instance, if you were to have an alcoholic drink and then take a cough remedy that also included alcohol, you would be putting twice the dosage in your body. If you were to move this alcohol through the body with massage strokes, like effleurage, then you would also be moving the rate of the alcohol and its absorption more quickly into the body. Someone might feel “drunk” or very lightheaded, nauseous or dizzy.

The normal response in massage of relaxation and euphoria may be increased significantly, as stated by Wible. To counter this, she suggests we remember to keep the body in balance and alter the systemic, reflexive-type strokes of effleurage and petrissage by making them more rapid.

It is important for massage therapists to note the variety of symptoms someone might complain of, because it may be a direct interaction between the combination of drugs with other drugs, drugs with herbs or even foods. While we are not expected to know and understand all of this because it may not be in our scope of practice, we should be aware of these possibilities, have good resources to consult about possible interactions and side effects and always be able to refer our clients to the proper health-care profession.

Massage therapists can also purchase through Lippincott Williams & Wilkins a reference guide specifically for massage therapists about the various pharmacology one might be taking. This would provide pertinent information and contraindications you may need to know for your specific treatments.

Also remember that if a client has had any recent injections of medications, such as insulin, we must avoid those sites. By applying techniques directly at the injection site, we might rapidly increase the rate of absorption, which might have some negative effects.

Massage may also cause clients to feel more fatigued or dizzy if they are taking any cardiovascular types of drugs. Some of these medications might be antihypertensives like Vasotec or medicines for high cholesterol like Lipitor. It is advised to make sure their physician approves receiving massage prior to your first session.

Two thirds of our American drugs were originally based on our medicinal plants. Most modern drugs are now more chemically refined.

Even some herbs have been refined, which is one of the causes of these negative side effects when utilized with medicines. Herbs should be used as a whole food. By separating parts for manufacturing purposes and cost control, the herb may not provide the full benefit that is intended and actually create a toxic reaction. Be sure you know your source of herbs, and don’t settle for cheap varieties. Remember, even herbs can have side effects. Do not self-prescribe or combine herbal remedies unless a qualified naturopath or herbalist is suggesting this treatment. Herbs work synergistically, and combining the right herbal formulas is crucial.

There is a lot of confusing information about herbs and interaction with medicines. Do your research, talk to professionals and never assume anything. There are very few qualified experts in these fields, and so most of the information that is supplied comes from small tests or stories we tell.

Although some practitioners might feel the use of herbs are easy enough to prescribe, unless you are totally aware and qualified to do so, avoid this, as you might create a harmful reaction.

The reason for a lot of the bad publicity about herbal formulas is not because the formulas are bad; we must remember herbs are medicine. Caution is advised and one should work with a qualified herbalist to make sure not to create toxic effects if clients are taking prescription medication.

Many of our lotion formulas also contain herbs, such as lavender, chamomile and arnica. Lavender and chamomile are used to calm and relax. If your client also takes muscle relaxants like Flexeril, sleeping aids like Ambien or mood elevators like Elavil, you must ask yourself if there will be any indication using your products might have–and if so, if it will be minimal. What strokes might you need to perform to bring more alertness at the end of a session?

Also note many herbal supplements have a mild, blood-thinning effect. If your client takes blood thinners like Coumadin and herbs, arnica or baby aspirin, keep in mind that as you perform effleurage and move the circulation, you are altering the rate of blood pressure and circulation.

In Wible’s book, she has a chart describing the effects of every technique. For example, effleurage, petrissage and friction can be used as a local mechanical technique, providing effects like warming the area, softening the tissue and bringing blood and lymph to the area. Consider each factor before proceeding, and use common sense to see if the medications a client might be taking and your strokes are going to create any adverse reactions. Remember, systemic, reflex strokes like rocking, tapotement and sports massage effect changes in the whole body. Local reflex techniques, such as compression, friction or vibration, stimulate local sensory receptors in muscle tendon and ligaments that cause a central nervous system response on contraction and relaxation of the muscles.

In addition, there are essential oils, homeopathy and flower essences to name a few natural alternatives one might use. Although they may be on more subtle levels, we should never combine any of these without knowing the full effects, benefits and contraindications if we are not trained and qualified.

Other resources I recommend are: Healthy Healing, by Linda Page, Ph.D.; Staying Healthy with Nutrition, by Elson Haas, M.D.; and Mosby’s Pathology for Massage Therapists, by Susan Salvo. You can also find many online resources.

Gloria Coppola, MASSAGE MagazineGloria Coppola, L.M.B.T., has been a massage therapist for more than 20 years and is the former owner of a massage school and curriculum writer for several massage schools across the U.S. Today, she is an approved continuing-education provider. For more information, contact her at or visit