Contraindications To Equine Massage

Firstly, what is a contraindication?

A contraindication is a medical reason why a treatment should be avoided, either because it may be harmful to the horse or because it could pose a risk to the therapist or other horses.

Contraindications may relate to a symptom, injury, illness, infection or known medical condition.

They can generally be divided into two categories:

• Total contraindication: Massage should not be performed at all until the underlying problem has been assessed and, where appropriate, veterinary clearance has been given.

• Local contraindication: Massage may still be appropriate, but the affected area must be avoided.

Total contraindications

Viral, bacterial or fungal disease/infection

Examples include equine influenza, strangles and ringworm. A systemic infection can leave the horse generally unwell, and massage should be avoided until the horse has recovered. Many infectious diseases are also highly contagious, creating a risk of transmission to the therapist, other horses and other yards.

Undiagnosed lameness

The cause of lameness should be established before massage is undertaken. A veterinary examination may be required to diagnose the underlying problem and determine whether massage is appropriate.

Acute inflammation or acute injury

For example, a horse that has recently been kicked in the field may have an acute injury requiring veterinary assessment. Massage should not be performed until the injury has been assessed and it is considered appropriate to do so.

Dehydration or shock

A horse suffering from significant dehydration or shock requires appropriate veterinary assessment and stabilisation. Massage should not be used as a treatment while the horse is in this compromised state.

Colic or tying-up (exertional rhabdomyolysis)

Both conditions require prompt veterinary attention. Massage should not be used instead of veterinary treatment. In a horse with colic, the priority is assessment and treatment of the underlying gastrointestinal problem. In a horse that is tying-up, the muscles are acutely damaged and painful, so massage of affected muscles would be inappropriate during the acute episode.

Horse is generally unwell

Signs such unusual quietness, fever, laboured breathing or abnormal capillary refill may indicate an underlying systemic problem. Massage should be postponed and veterinary advice sought where appropriate.

Active lice infestation

Massage should be avoided where the horse has an active lice infestation. Close physical contact may cause discomfort and can contribute to transmission, so the infestation should be appropriately treated first.

Local Contraindications

Open cuts or wounds

The affected area should not be massaged because pressure may cause pain or further tissue damage and could introduce or spread contamination. Veterinary advice may be appropriate depending on the wound.

Sunburn

Sunburn causes inflammation and sensitivity of the affected skin. The area should be avoided until the skin has recovered.

Sarcoids, tumours or other abnormal masses

These areas should not be directly massaged. Any unexplained lump, mass or skin lesion should be assessed appropriately before treatment. The therapist should also avoid causing trauma or irritation to existing lesions.

Swelling/oedema of unknown cause

Any unexplained swelling should not touched! The cause should be established first, as swelling may indicate injury, inflammation, infection or another underlying problem.

Pressure sores or girth/rub sores

Any area of damaged, irritated or broken skin caused by tack, rugs or rubbing should be left alone until healed.

Healing surgical sites or recent sutures

Massage should not be performed over or immediately around a surgical wound unless specifically authorised by the treating veterinary professional.

Fresh scar tissue

A newly formed or healing scar must be avoided. Once fully healed - approximately 3 months post-injury, although this can vary depending on the size, location and complexity of the injury - scar-tissue work may be beneficial in supporting the formation of good-quality, more elastic tissue.

However, any scar-tissue techniques must be within the therapist's training, competence and scope of practice to avoid causing further tissue damage or delaying the healing process.

Important considerations

This list is a general guide and is not exhaustive. The therapist should always use professional judgement and consider the horse's overall health, behaviour and presentation before treatment.

If there is any doubt about whether a horse is fit to receive massage, treatment should be postponed and veterinary advice sought. Massage should complement, never replace, appropriate veterinary diagnosis and treatment.