Absolute and Relative Contraindications

(Applicable to both Medical Massage and Manual Lymph Drainage unless otherwise specified)

Absolute Contraindications (Do NOT perform treatment)

Systemic / Medical Conditions

1. Acute infections (bacterial, viral, or fungal) → massage/MLD could spread pathogens.
2. Untreated or acute deep vein thrombosis (DVT) or thrombophlebitis → risk of embolism.
3. Acute or decompensated cardiac failure (CHF not medically managed) → MLD increases venous/lymphatic return, adding cardiac load.
4. Acute renal failure → kidneys cannot handle increased lymphatic fluid volume.
5. Severe, unstable hypertension → increased circulatory demand may raise risk.
6. Acute bleeding or internal hemorrhage → massage may worsen bleeding.

Oncologic Considerations

Untreated or active malignancy without physician clearance → MLD may theoretically mobilize malignant cells; oncology-trained therapists may proceed only with written medical approval.

Local or Regional Conditions

1. Localized acute inflammation (cellulitis, erysipelas) → avoid affected area.
2. Recent or unhealed surgical wounds (unless cleared for post-op lymph drainage by surgeon).
3. Fever or systemic inflammatory state → defer treatment until resolved.

Relative Contraindications (Require Medical Clearance or Treatment Modification)

Cardiovascular / Circulatory

1. Controlled cardiac conditions (e.g., compensated CHF, arrhythmias, pacemaker) → proceed gently and with clearance.
2. Chronic venous insufficiency or varicose veins → avoid direct, deep pressure over affected veins.
3. Hypotension → MLD can lower blood pressure further; monitor for dizziness.

Endocrine / Metabolic

1. Diabetes mellitus (especially with neuropathy, fragile skin, or vascular compromise) → reduce intensity; avoid skin trauma; monitor response.
2. Thyroid disorders → avoid direct techniques over thyroid region.

Renal / Hepatic

Chronic kidney or liver disease (not acute failure) → physician clearance advised; modify duration/intensity.

Respiratory

Bronchial asthma → abdominal MLD can trigger vagal response; proceed cautiously.

Pregnancy

1. Generally safe if uncomplicated, but avoid deep abdominal work.
2. Obtain OB/GYN clearance for high-risk or medically complicated pregnancies.

Oncology

• Controlled or treated malignancy → safe with oncology massage training and medical approval; modify pressure and duration.

Other

1. Recent surgery or trauma → avoid direct manipulation over healing tissue unless post-surgical clearance given.
2. Severe chronic edema due to unknown cause → rule out systemic disease before MLD.

Special Notes

1. For oncology and post-surgical MLD, obtain written medical clearance and coordinate with the treating physician or surgeon.
2. For medical massage, always adapt pressure, duration, and techniques according to tissue tolerance, vascular health, and systemic load.
3. Documentation should reflect clinical reasoning, physician communication, and informed consent when working under relative contraindications.