The Client Who Wants a Deep Tissue Massage She Should Not Have
A regular client books a 60-minute deep tissue back and shoulder massage. On the health form she ticks 'yes' to recent surgery and writes 'gallbladder removed three weeks ago'. She also mentions she is six weeks pregnant, is on blood-thinning medication, and has a mole on her upper back that has changed shape and colour in the last month. She says her doctor 'said it was fine' but cannot recall what was cleared. She wants firm pressure because she is stressed and has been sleeping badly. The salon's policy says pregnancy massage is offered from the second trimester with written clearance.
1. Which of these findings stops the service, which modifies it, and why?
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Three findings change the plan and one stops it. The recent gallbladder surgery at three weeks means the tissue is still healing and deep pressure over the abdomen, ribs and back is contraindicated; even lying prone may be uncomfortable. The blood-thinning medication raises bruising risk, so deep tissue pressure is unsafe regardless of how much she wants it. The pregnancy at six weeks is inside the salon's first-trimester exclusion and inside the policy's written-clearance requirement, so the booking as described cannot proceed.
The changing mole is the finding that stops everything. A mole that has changed shape and colour in a month is a referral, not a massage target, and I would not work over it or around it while it is unexplained. I would say plainly that I am not qualified to assess it and that she should have it looked at promptly.
The service is not simply cancelled. I would offer a gentle, side-lying or seated relaxation massage of the upper back and shoulders with light pressure, avoiding the abdomen and the mole, only if she provides written clearance covering the pregnancy and surgery. Otherwise I rebook her for when clearance is in hand.
2. She says her doctor cleared her but cannot remember the details. How do you handle consent and documentation?
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A vague recollection is not clearance. I would ask her to contact her doctor and get the clearance in writing, specifying what is permitted: pregnancy massage, pressure limits, and any restriction related to the surgery and blood thinners. I would not proceed on a verbal 'it's fine' for a client who is pregnant, post-surgical and on anticoagulants, because if something goes wrong the record is what protects her and me.
In the meantime I offer the modified service only if it falls inside what she can confirm, or I rebook. I document the disclosure, the advice given, the referral for the mole, the clearance requested and the client's decision, with a time and date. I also record that she declined to wait for clearance if that is what happens, and I note that I offered alternatives.
3. How would you actually deliver the session if she returns with written clearance for a modified massage?
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With written clearance I would still work within limits. Position her side-lying with pillows supporting the abdomen and between the knees, or seated, rather than prone. Pressure stays light to medium over the upper back and shoulders, avoiding the lumbar and abdominal area, and I avoid the mole entirely. I keep the session shorter if she is uncomfortable and check in every few minutes.
I would not use heat packs over the area given the blood thinners, and I would watch for bruising. Afterwards I give aftercare advice, water and rest, and note the positions, pressure and areas avoided on her record. If she asks for deep tissue again, I explain that the medication and surgery make it unsafe for now and that the plan can be reviewed when her doctor changes the clearance.