The Omicron wave of COVID-19 in the spring impacted so many people that an estimated 70% of the population has caught it now in one form or another (here’s an article on WebMD with that information). Ok, so you’ve just recovered from a COVID-19 infection. Maybe it was mild, like the sniffles. Maybe you felt terrible for several days and you’re feeling better now. Either way, you’re ready to schedule your next therapeutic massage. So, when is it safe to receive a massage after COVID? Based on what we know about COVID-19 and how it impacts the body, even in the mildest cases, a conservative approach is to wait a full 90 days after you recover to schedule your next massage. Wait, what? 90 days???!!!! I know, that’s three months. It seems like a long time, doesn’t it? Well, bear with me while I explain the reasoning.

COVID-19 Increases Your Risk of Heart Damage

COVID-19 has been shown to have an inflammatory effect on the heart, even in mild cases. Actually, it impacts all of the organs, but for the sake of massage, I’m most concerned about the heart and the blood vessels. In an article published in Nature Medicine on September 5, 2022 and titled, “Long-term cardiac pathology in individuals with mild initial COVID-19 illness,” 73% of the 346 participants in the study who had contracted mild COVID-19 reported cardiac symptoms that weren’t present before their illness. 38% had mild cardiac symptoms, 33% had moderate symptoms, and 3% had severe symptoms. These symptoms included shortness of breath, heart palpitations, atypical chest pain, and fainting. Anywhere between 274 and 383 days later, cardiac symptoms were still present in 57% of the participants. Yikes!

Here’s another research study published in Nature Medicine on February 7, 2022 and titled: “Long-term cardiovascular outcomes of COVID-19.” This was a research study conducted by the US Department of Veterans Affairs. The participants in the study suffered from mild to severe COVID-19 infections, and the abstract of the study states that: “Our results provide evidence that the risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial.”

Why does this matter for massage? Well, an hour Swedish massage has the same impact on the circulatory system as going on a 5-mile hike. It moves blood and lymph from the extremities back up to the heart very effectively. If I were concerned about possible heart damage, I wouldn’t go on a 5-mile hike and I would certainly avoid a full-body massage for a while. You want your heart muscle to rest and recover after COVID. And your heart and other organs could take up to a year to heal. Take your time returning to activities that will place a greater workload on your cardiovascular system. No massage therapist wants to be the one with a client experiencing a heart attack on their massage table. That would suck.

COVID-19 Increases Your Risk of Stroke

Here’s the other scary bit. Having a mild case of COVID-19 (meaning, you weren’t hospitalized) increases your risk of blood clotting disorders. On page 16 of the Washington State Massage Therapy Association’s Interim Guidance on Practice Guidelines, it states that “blood clotting can occur in people over 30 days past the point of when they were deemed COVID-19 free and can cause a stroke, heart attack, pulmonary embolism or thrombosis anywhere in the circulatory system.”

Here’s an article from WebMD about blood clots with mild COVID-19 cases. Those post-COVID blood clots could be lurking anywhere in your body after a COVID-19 infection. They might be silent, with no symptoms. You have the greatest risk of throwing a blood clot for the first three months after your COVID-19 infection. That’s where the 90-day massage avoidance recommendation comes in. Yes, you can throw a clot for up to a year after the COVID-19 infection, but the risk diminishes the further away you get from the illness.

The areas of the body where a massage therapist is most likely to loosen blood clots include the legs, arms, armpits, and iliopsoas region (read this for more information about the psoas).While we’re still having COVID surges, a massage therapist should be cautious around those regions and avoid deep tissue work for post-COVID clients.

Symptoms of a Possible Blood Clot in a Vein or Artery

Before you schedule that massage, pay attention to your body. The most common symptoms of a blood clot in a leg or arm vein are swelling or cramping, pain, warmth, and change of color in the area that contains the clot. You might also experience itchiness or notice a skin rash in that area. And you might not notice any symptoms at all. Deep vein thrombosis can be a silent killer. Let your massage therapist and also your doctor know if you notice any of those symptoms.

This article from WebMD is incredibly informative about all the possible symptoms of blood clots that could be anywhere in the body, not just the arms and legs.

Recommendations for Massage Therapy After COVID-19

Some of these recommendations were taken from page 22 of the Washington State Massage Therapy Association’s Interim Guidance on Practice Guidelines. Others are common sense. My hope is that both massage therapists and massage clients will read this and increase their awareness and mindfulness around post-COVID massage therapy.

1. Wait for at least 90 days after recovering from COVID-19 before you schedule a full body massage. If you’re experiencing any cardiac symptoms, go see your doctor. You’ll need a doctor’s clearance before you get that massage. And the cardiac symptoms need to be resolved.
2. If you can’t wait 90 days for your next massage because of injuries, surgeries, or chronic pain, here’s what you can do:
   1. Spot massage treatments here and there are ok. Just avoid full body massage.
   2. Especially avoid receiving deep massage on the legs, arms, armpits, psoas and neck (where the risk of throwing a clot is the highest).
   3. Energy work, like Reiki, is fine. And lighter massage on the arms and legs and neck should be fine, too.
3. If you’re a massage therapist, treat all post-COVID massage clients with caution, and act like every single one of them has a hidden blood clot that you might dislodge with the work you’re doing.

Here’s to your health and continued well-being! I know that this is an uncomfortable and scary topic (and I don’t want to scare you away from massage!), but knowledge is power. And therapeutic massage has incredible benefits that accelerate your healing and alleviate stress (here are the top 10 benefits of massage). We’re all doing the best we can to return to a sense of normalcy after this pandemic. Let’s do it mindfully.