Realizing clients may faint during massage therapy does not mean you possess the confidence to handle the real, live situation. A formal massage education does not include an emergency room internship, where challenging experiences take place under the watch of a professional. Often, the first time a client faints during massage, the practitioner is on their own.

Why do Clients Faint?

Fainting, or syncope, is a sudden, brief loss of consciousness. Someone who faints may only pass out for several seconds or for as long as an hour. There are hundreds of possible causes of syncope, most of which are due to the vasovagal reflex, where blood vessels relax and dilate, causing a sudden drop in blood pressure.
Some of the most common reasons clients faint include:

  • Low blood sugar (hypoglycemia), common in early pregnancy and diabetes
  • Anemia
  • Heat stroke or heat exhaustion
  • Dehydration
  • Eating disorders such as anorexia, bulimia
  • A sudden change in body position like standing up too quickly (postural hypotension)
  • Extreme pain
  • Sudden emotional stress or fright
  • Anxiety
  • Taking some form of prescription medication. Examples include medicines that lower high blood pressure, tranquilizers, antidepressants, or excessive use of some over-the-counter medicines.
  • Being in a hot, stuffy room or hot, humid surroundings
  • Alcohol consumption

Fainting Prevention

The number one way to prevent client syncope is through being prepared and communication with clients.

  • Be familiar with the medications clients are taking, including new medications and anything that may lower blood pressure.
  • If your client has just come from physical activity and is overheated, allow them to cool down and re-hydrate.
  • Know if your client has a history of orthostatic hypotension, fainting or dizzy spells.
  • Be aware if your clients are diabetic and make certain they have checked their blood sugar or have sugar pills, juice or cookies available if necessary.
  • If your client is hypoglycemic, or hasn’t eaten within the past five hours, provide them with a light snack or refuse treatment.


Even if you have no reason to suspect that a client may faint, there are a few signs that may precede a temporary loss of consciousness. If any of these signs appear, verbally check with your client to see if they are okay prior to continuing a session.

  • The skin becomes hot and sweaty or cold and clammy.
  • A client suddenly becomes fidgety.
  • Complaints of dizziness or light-headedness.
  • The person lifts their head out of the face cradle to yawn or take a breath. According to David Palmer, this is an involuntary reaction to not getting enough oxygen to the brain.

What to do

Although a client becoming fully unconsciousness is rare, it is best to be prepared. The following is the preferred order of steps to address syncope:

  1. Be Calm – The number one thing to remember if a client loses consciousness is to remain calm.
  2. Proper positioning – If the client is not lying down, assist them into a position where they can’t fall, their head is below their heart and the legs are elevated. This position promotes blood flow to the brain. If a victim who is about to faint can lie down right away, he or she may not lose consciousness. Call for assistance if you need help in accomplishing this, but do not leave the client’s side.
  3. Check breath and pulse – If there are no sounds of breathing, make sure the airway is open and begin rescue breathing. If there is no pulse, begin CPR. Look for a medical identification bracelet, necklace or card that identifies a medical problem, such as epilepsy or diabetes. In either case, have someone call 911 for emergency help.

If the client has a pulse and is breathing, it is not necessary to call 911 unless the client does not regain consciousness in a few minutes or if the person is diabetic. A diabetic may be in insulin shock, requiring additional support.

  1. Comfort measures – Make sure there is no tight-fitting clothing around the client’s neck, that there is adequate air circulation, and keep the client from getting chilled.
  2. Acupressure – Only after the first four steps have been taken, consider this age-old technique for fainting. Oriental meridian theory suggests applying firm pressure to the following locations to revive someone from syncope:
    • Governing Vessel 26 – Located in the philtrum, about 1/3 the distance from the bottom of the nose to the top of the lip.
    • Stomach 36 – Located four finger breadths below the eye of the knee, one finger breadth lateral to the anterior crest of the tibia, in the tibialis anterior.

Additional Tips

Upon fainting, a common mistake is to try to give the person something to eat or drink, including water. This gesture must wait until the client is fully conscious. Additionally, don’t allow the person who’s fainted to get up until the sense of physical weakness passes. Then be watchful for a few minutes to be sure he or she doesn’t faint again. Once again, don’t leave your client’s side until they have fully recovered.

Other Reasons to call 911

If your client also has signs of a heart attack, call for emergency help. Such symptoms include:

  • Chest pain or pressure.
  • Pain that spreads to the arm, neck or jaw.
  • Shortness of breath or difficulty breathing.
  • Nausea and/or vomiting.
  • Sweating.
  • Rapid, slow or irregular heartbeat.

If your client also shows signs of a stroke, call for emergency help. Such symptoms include:

  • Numbness or weakness in the face, arm or leg.
  • Temporary loss of vision or speech, double vision.
  • Sudden, severe headache.


While episodes of syncope in the massage setting don’t occur every day, most massage therapists may encounter a few in their career. A thorough intake will provide the therapist with the information to prevent such an episode by alerting them to a fainting possibility, discovering if the client hasn’t had anything to eat or drink prior to a session, or by prompting modification of the session. Such modifications include avoiding strokes or techniques that further lower blood pressure or those drawing energy away from the head. Reviewing the causes of syncope, including these warnings and procedures, will build your confidence so if you do encounter syncope, you are both calm and prepared.

Editor’s Note: This information is for education purposes only, and is not intended to replace professional medical care. If not completely sure of your client’s well being, seek emergency medical help.