Whether you are applying deep tissue, sports massage, Swedish techniques or another bodywork modality, some clients will bruise. Since massage therapy is often implicated in creating black and blues, practitioners should be aware of why bruising might occur, and when it is indicative of a more serious problem.

Getting a phone call from a client that their previous massage with you left several bruises is never easy to deal with. However, explaining this possibility beforehand can eliminate a lot of needless worry. On the other hand, severe or unwarranted bruising could be a sign of a condition requiring a physician’s referral.

Why Do Clients Bruise?

Also known as ecchymosis, bruises are a discoloration and tenderness of the skin or mucous membranes due to the leakage of blood from an injured blood vessel. Although typically resulting from an injury, capillaries may break and cause an ecchymosis from any kind of tissue contact. In a healthy individual, there are several reasons why a person might bruise after massage therapy:

  • More common with deep tissue massage, great amounts of pressure can cause capillaries to break.
  • Hypertonic tissue is more prone to bruising from massage because more force may be used to release tight musculature.
  • Older people are more susceptible to bruising because of weakened capillary walls and thinner skin.
  • Medications increase susceptibility to bruising.

Medications Increasing Bruise Risk

There are many reasons a massage therapist needs to know what medications their clients are taking and how those drugs might impact massage. A perfect example of why bodyworkers must learn how pharmacology relates with massage is the large number of drugs that increase the likelihood of bleeding. If a client is taking any of the following medications, they will be especially susceptibility to bruising and require a gentler touch:

  1. Blood Thinners – Aspirin, ibuprofen (Advil), naproxen (Aleve), warfarin (Coumadin) and clopidogrel (Plavix) are examples of drugs that either thin the blood or reduce the blood’s ability to clot. These drugs could cause even the slightest capillary damage to bleed extensively.
  2. Dietary Supplements – Fish oil, ginkgo, ginger, dang gui and garlic are supplements that also have blood-thinning properties. Although typically exerting a milder blood-thinning effect than the pharmaceuticals, a client who takes these supplements may be more prone to bruises.
  3. Corticosteroids – Cortisone, hydrocortisone, methylprednisolone and prednisone are examples of corticosteroids typically administered to stop the inflammatory response. Because these drugs cause the skin to thin, it is much easier to cause bruising.

When To Be Concerned

While bruising can be a normal side effect from massage therapy, it may indicate a more severe problem. Practitioners should be aware that some types of bruising could indicate a blood-clotting disorder, a blood disease, domestic violence/abuse or another serious condition. By using the following assessments, massage therapists can decide whether to refer out and/or call for help. Be cautious if:

  • Your client has unusually large or painful bruises – especially if the bruises seem to develop without reason. This could indicate abnormal platelet function and requires a physician referral.
  • Your client bruises easily AND has abnormal bleeding elsewhere, such as from the nose, gums or intestinal tract. This could indicate abnormal platelet function and requires a physician referral.
  • Your client has no history of bruising but suddenly experiences bruises, especially if he/she recently started a new medication. This could indicate abnormal platelet function and requires a physician referral.
  • Your client repeatedly presents with inexplicable bruises in unusual locations like the eye or face. This should prompt an inquiry into the possibility of abuse.
  • Your client has bruising around the navel. This could indicate dangerous internal bleeding and requires an immediate physician referral.
  • Your client has bruising behind the ear (also known as Battle’s sign). This could be due to a skull fracture and requires an immediate physician referral.
  • Your client has raised bruises. This may indicate an autoimmune disease and requires a physician referral.

While most of the bruises resulting from massage pose no danger, there are times when a caregiver must be on alert. Even though pain and bruising is never wished upon anyone, the occasional ecchymosis resulting from a therapeutic massage is likely worth the benefits. However, bodyworkers can prevent angst by discussing the possibility of bruising prior to treatment and by using a lighter touch on those more likely to bruise. In addition, massage therapists who are aware of when bruising is abnormal can safely guide their clients towards the care they might need.

Recommended Study:

Advanced Anatomy and Pathology
Advanced Anatomy and Physiology
Pharmacology and Massage