If you’ve trained as a therapist, you’ve probably encountered the list.
Absolute contraindications.
Local contraindications.
Conditions requiring adaptation.
Conditions where you might need further advice.
Learn them. Remember them. Pass the assessment.
Except there’s a problem.
Real clients don’t arrive as a list.
They arrive with health conditions, medications, old injuries, recent diagnoses, symptoms they haven’t mentioned until halfway through the consultation and occasionally something they “didn’t think was relevant”.
This is why understanding contraindications needs to be about much more than memorising them.
What is a contraindication anyway?
A contraindication is essentially a reason why a particular treatment, technique or approach may not be appropriate in a particular situation.
But that doesn’t always mean:
“You cannot treat this person.”
Sometimes treatment needs to be postponed.
Sometimes one area needs to be avoided.
Sometimes the treatment can go ahead with adaptations.
And sometimes you simply need more information before making that decision.
The important part is understanding why something might present a concern.
The same diagnosis doesn’t always mean the same decision
Imagine two clients both tell you they have high blood pressure.
One has well-managed hypertension, takes prescribed medication, has regular reviews and feels perfectly well.
The other has recently been diagnosed, their medication is still being adjusted and they’ve been experiencing headaches and dizziness.
Same condition.
Very different consultation.
That’s why simply memorising:
High blood pressure = do this
isn’t enough.
We need to look at the person, not just the name of the condition.
Ask better questions
When a client writes a medical condition on their consultation form, that should often be the beginning of the conversation rather than the end of it.
When were you diagnosed?
How does it affect you?
Is it currently well managed?
Are you receiving treatment for it?
Are you taking medication?
Have there been any recent changes?
Does anything make the symptoms worse?
The questions you ask will depend on the condition and the treatment you’re providing, but the principle remains the same.
Gather enough information to make an informed decision.
Ticking a box isn’t a consultation.
Medication matters too
Clients don’t always think medication is relevant to a complementary therapy treatment.
It can be.
Medication may tell you something about a health condition the client has forgotten to mention. It may affect bruising, sensation, blood pressure, skin integrity or other factors relevant to treatment.
That doesn’t mean therapists need encyclopaedic knowledge of every medicine available.
You won’t.
But if a client mentions a medication you don’t recognise, don’t guess.
Ask what they take it for and, if necessary, check reliable information before proceeding.
“I’d just like to check that first” remains one of the most useful sentences in a therapist’s vocabulary.
Be careful with blanket rules
Therapy training has historically included plenty of blanket statements.
Never massage somebody with X.
Always get a doctor’s letter for Y.
Avoid treatment completely if somebody has Z.
Healthcare changes. Evidence changes. Treatments change. Our understanding changes.
That’s why therapists need to continue learning rather than relying forever on a contraindications list they were given when they first qualified.
It also means recognising the limits of our role.
We aren’t there to decide whether somebody is medically fit.
We’re deciding whether the treatment we are qualified to provide is appropriate based on the information available to us.
Those are two very different things.
What about asking the GP?
“Get GP permission” has traditionally appeared on plenty of therapy contraindication lists.
But this can create its own problems.
A GP may have little knowledge of the particular complementary therapy you’re proposing, and a request to “confirm this patient is safe for massage” asks them to make a decision about a treatment they aren’t providing.
Where appropriate, it may be more useful for the client to seek medical advice about their condition or specific symptoms while the therapist remains responsible for deciding whether the proposed treatment falls within their own competence and scope of practice.
There will still be situations where additional medical information is appropriate.
The point is that referral shouldn’t replace professional reasoning.
Red flags are different
Sometimes a consultation reveals something that isn’t simply a question of adapting the treatment.
A client may describe a new or unexplained symptom that needs medical assessment.
Your role isn’t to work out what it is.
It’s also not to reassure them that it’s probably nothing.
You can explain that, because the symptom is new or unexplained, you’d recommend they seek appropriate medical advice before treatment continues.
Knowing when not to treat is every bit as important as knowing how to treat.
Document your decision
Good treatment records shouldn’t simply say:
“Client has arthritis.
