As an increasing number of people seek their services, the profile of massage therapists will continue to grow within the medical community. Delivering therapeutic results while maintaining the safety of each session are the backbone of bodywork’s value within medicine. As such, it is the responsibility of bodyworkers to stay current on factors that may pose an additional risk to the work they perform.

While energizing blood circulation can relieve pain, relax muscles, flush accumulated toxins out of the body and infuse new healthy cells to areas in need, enhancing circulation can also initiate an embolus. According to, an embolus is: Something that travels through the bloodstream, lodges in a blood vessel and blocks it. Depending upon the location, an occluded blood vessel can have dire repercussions by lodging in:

  • the lungs, causing a pulmonary embolism
  • the brain, causing a stroke
  • the heart, causing a myocardial infarction

Being prepared to recognize what may pose a risk can help massage therapists avert a potentially lethal combination of performing circulatory massage on a client at high risk for an embolus. While there are many health problems that predispose a person to developing a blood clot, there are also seemingly innocuous lifestyle choices fostering the same predisposition.

The Pill

The oral contraceptive pill is the leading method of birth control in the United States. Approximately 12 million American women (19% of those aged 15-44) use the birth control pill. Historically, oral contraceptives have posed a considerable risk of emboli development. This risk is the reason women with other predisposing factors for blood clots, including smoking, hypertension or being over age 40, are encouraged to find other methods of birth control. By using lower doses of the active ingredients, safer oral contraceptive options have become the norm.

New Options

In addition to the birth control pill, two newer contraceptive options are increasing in popularity:

  • Transdermal contraceptive patch (the patch) – The contraceptive patch (brand name: Ortho Evra) is placed on your upper arm, buttocks, stomach or chest (but not on the breasts). It releases birth control hormones in a method similar to birth control pills.
  • Vaginal ring – The vaginal contraceptive ring (brand name: NuvaRing) uses the same hormones as most birth control pills. This flexible ring is inserted in the vagina, where its ring releases hormones that prevent pregnancy.

Ring and Patch Blood Clot Risk

Because they are relative newcomers to the contraceptive market, assessing the risk of a blood clot for the transdermal patch and vaginal ring hinges on the most recently published research. According to reputable studies published in 2006, the transdermal patch demonstrates a significantly higher risk of blood clots compared to oral contraceptives.

In the July 2006 issue of American Journal of Obstetrics and Gynecology, researchers reported that when comparing a contraceptive vaginal ring with an oral contraceptive, the ring does not pose a higher risk of causing a blood clot. On the other hand, research on the patch revealed a different level of blood clot safety. In September 2006, the US Food and Drug Administration updated the warning label on the Ortho Evra transdermal contraceptive patch, cautioning users about the higher risk of blood clots associated with its use. The study, commissioned by drug manufacturer Johnson and Johnson, revealed that patch users faced twice the risk of clots in the legs and lungs compared to women taking traditional birth-control pills. Dr. Daniel Shames, the acting deputy director of FDA’s Office of Drug Evaluation in the Center for Drug Evaluation and Research, said, “Blood clots occurring in the legs or lungs are serious and rare events that are a potential risk for all hormonal contraceptive therapies.”

Applicability to Bodyworkers

For massage therapists, the implications for Ortho Evra’s higher blood clot risk lie in determining possible contraindications for a circulatory massage. This information also serves to expand a therapist’s questioning during an intake interview. While simply inquiring about a client’s medications is imperative to rendering a responsible massage, the news about Ortho Evra demonstrates the need to probe beyond medications. While asking whether a client uses any type of hormonal contraception may accurately cover the contraceptive patch, a client may not consider it to be a medication since it’s not taken orally. With the reported increase of risk for developing blood clots in Ortho Evra users, a responsible massage therapist must ask all of the appropriate questions to determine whether their clients are exposed to this risk.

Recommended Study:

Deep Vein Thrombosis

References:, Choosing a Birth Control Method, Association of Reproductive Health Professionals, 2005., Contraceptive Options Update, American Academy of Family Physicians, 2004., Oral Contraceptives, Cardiovascular Research Foundation Publications, 2005., Definition of emboli, MedicineNet, Inc., 2006., Contraceptive Patch Carries risk of Blood clots, MedIndia, 9/21/06., Oral Contraceptives, Thomson Healthcare, 2006., Johnson & Johnson Sued Over Ortho Evra Damage; Texas Woman Says Drug Caused Life-Threatening Blood Clots, Miscarriage, Law Offices of John David Hart, 9/5/2006.