Massage in Special Populations and Conditions
Domain 7 tests adaptation: the same stroke is not safe or comfortable for every client. The exam expects condition-specific positioning, pressure, duration, and referral rules.
Core rules and concepts
- Pregnancy: after the first trimester, use side-lying positioning with pillows under the abdomen and between the knees. Avoid prone positioning, deep abdominal pressure, and aggressive lower-back work. High-risk pregnancies need medical clearance.
- Older adults: skin is thinner and more fragile, osteoporosis increases fracture risk, and medications may affect bruising or blood pressure. Use lighter pressure and shorter sessions.
- Children and adolescents: obtain parent or guardian consent, keep sessions short, and use gentle play-oriented communication.
- Diabetes: inspect the skin, reduce pressure where sensation is poor, and avoid working over ulcers.
- Cancer: obtain medical clearance, avoid the tumor site and radiation fields, and do not perform deep work on a limb with lymphedema; refer to a certified lymphedema therapist.
- Hypertension, fibromyalgia, and varicose veins: reduce pressure, monitor response, and avoid deep work over distended veins.
Worked example
A client at 32 weeks of pregnancy requests relief for low-back pain. Reasoning: prone positioning is no longer appropriate. Use side-lying with a pillow under the abdomen and between the knees, support the top leg, avoid deep abdominal and lower-back pressure, and limit the session to about 30-40 minutes. Ask about swelling, headache, or visual changes and refer if any are present.
Traps
Placing a late-pregnancy client prone, massaging directly over varicose veins, assuming all cancer is an absolute contraindication, and treating a minor without guardian consent.