High blood pressure, blood thinners, varicose veins, diabetes, osteoporosis, and one sore calf after a long flight: what four massage books say, with page numbers, why the home-massage books and the professional textbook seem to disagree, and what each one changes on our spa menu.
Facts checked · next review
Yesterday's page was about the things that pass: a sunburn, a fever, a hangover. This one is about the things you bring with you: high blood pressure, blood thinners, varicose veins, diabetes, fragile bones, and the long flight it took to get here. None of them usually means no massage. Each one changes what a good massage looks like, and the therapist can only make that change if you say so. The answers below come from four books on our shelf, led by Ruth Werner's A Massage Therapist's Guide to Pathology (5th edition), with page numbers so you can check them. We are Nghê Prana, a riverside hotel and spa on the Thu Bồn in Hội An; what we add is what each answer means on our own menu.
| If you have… | Massage? | What changes | Source |
|---|---|---|---|
| High blood pressure, managed | Yes | Sit up slowly afterwards; think twice about the jacuzzi and sauna if you take blood-pressure tablets | Werner pp. 258, 504–505 |
| High blood pressure, uncontrolled | Not until it is managed | "Uncontrolled high blood pressure" is on the contraindication list | Davies p. 38; Werner p. 258 |
| Blood thinners (warfarin, heparin and similar) | Lightest pressure only | Bruising "even with relatively light massage" | Werner p. 507 |
| Aspirin or Plavix | Yes, lighter | "The risk of bruising must still be respected" | Werner p. 507 |
| Mild varicose veins, healthy skin | Yes, but not on them | Gentle gliding at most; the home-massage books say no pressure at all | Werner p. 262; Mumford p. 13; Davies p. 267 |
| Severe varicose veins or damaged skin over them | Not on the legs | A local contraindication | Werner p. 262 |
| Diabetes, well managed | Yes | Eat first, bring sugar, skip injection or pump sites, tell us about numbness | Werner pp. 404, 408 |
| One calf painful, swollen or warm after a long flight | No: see a doctor first | It can be a blood clot | Werner p. 248; Davies pp. 25, 267; Hoyme ch. 3 |
| A diagnosed blood clot | No | "Massage should not be given" | Werner p. 507 |
| Osteoporosis | Yes, gently | Fracture risk from pressure or positioning | Werner pp. 72, 75 |
| Pregnancy | Yes, the side-lying treatment | Our pregnancy page covers it | Werner pp. 479–481 |
Werner's page numbers are the printed pages of the 5th edition (Lippincott Williams & Wilkins). The other books are Susan Mumford's The Massage Bible (Sterling), Clair and Amber Davies's The Trigger Point Therapy Workbook (3rd edition, New Harbinger) and Ryan Hoyme's The Complete Guide to Modern Massage (Althea Press), which has no printed page numbers, so we cite its chapter and section.
Read side by side, the books look as if they contradict each other. Mumford's list says don't massage someone with "high blood pressure" or "heart problems", and don't massage over varicose veins (p. 13). Davies lists "uncontrolled high blood pressure" as a contraindication (p. 38) and advises against massaging varicose veins at all (p. 267). Werner says a client whose high blood pressure is managed and who "can exercise safely" can "probably also receive massage safely" (p. 258), and that over mild varicose veins with healthy skin "gentle gliding pressure is safe" (p. 262). Two words reconcile them. The first is uncontrolled: Davies's list, which cites Werner, is about blood pressure nobody is managing, not the tablets many of our older guests take. The second is over: every book agrees that nobody presses on a varicose vein, and they differ only on whether a light glide across one is acceptable. The rest is audience. Mumford writes for someone massaging a partner at home, who has no training to adapt; Werner writes for professionals whose job is to adapt. Where a difference remains, our advice is the stricter reading.
High blood pressure "is usually silent", Werner notes (p. 256), which is why so many guests take tablets for it without feeling ill. Her test for massage is the one you already live by: if you can exercise safely, you can probably receive massage safely, and "judgments about massage must be made by comparing the challenges of bodywork with activities of daily living" (p. 258). The practical point is the medication. People who take it "may feel dizzy or lethargic" afterwards and "may need more time after a massage to make the transition back to full speed" (p. 258); her drug appendix adds that clients "should be instructed to sit up and move slowly after their massage" (p. 504). So take the extra minute on the table before you stand.
The same appendix is the reason for our least welcome piece of advice. "Many clients with cardiovascular diseases should avoid total immersions in favor of smaller, localized hydrotherapy applications" (p. 504), and beta blockers "can lead to excessively low blood pressure, especially when the client is in a relaxed state", so hydrotherapy "is generally safer with local applications than systemic immersions in hot tubs, saunas, or other facilities" (p. 505). Our jacuzzi (300,000₫ each for two or more, 30 minutes) is a total immersion, and so is the sauna that comes with Packages 1 and 2 and the Nghê Special. If you take blood-pressure tablets, the massage is the part to keep; the jacuzzi and the sauna are the parts to ask your doctor about, or to skip.
Werner is direct about anticoagulants such as warfarin, heparin and Lovenox: "All blood-clotting medications carry a risk for bruising, even with relatively light massage", and the reason you take them "indicates a tendency to form blood clots that may contraindicate all but the lightest forms of bodywork"; if a clot is present, "massage should not be given" (p. 507). Aspirin and Plavix are milder, but "the risk of bruising must still be respected". On our menu that rules out the firm end: the bamboo massage, which the menu itself calls "firmer than hands", the Thai massage, and deep work on the back, neck and shoulders. Book the oil massage (450,000₫ for 60 minutes) and ask for light pressure from the first stroke.
They are common: "About one-half of all people over 50 years old have varicose veins" (Werner, p. 260). Milder ones "locally contraindicate deep specific work, but are safe for superficial massage as long as the skin is healthy"; severe ones, or any with damaged skin over them, at least locally contraindicate massage; and massage "is unlikely to change or improve varicose veins" (pp. 260, 262). She also warns that people with varicose veins have a higher risk of deep vein thrombosis, the reason Davies advises against massaging them at all (p. 267). Our advice follows the stricter reading: mark them "avoid" on the consultation form's body map and the therapist works around them. The treatment to skip is the bamboo massage, which our own menu calls "especially good for legs and back".
Well-managed diabetes is no bar to massage, and Werner's cautions are specific (pp. 404, 408). Numbness from diabetic neuropathy "can interfere with a client's ability to give accurate feedback about pain and pressure", so say so even if nothing hurts. "Massage has been seen to drop blood sugar": eat before you come, and bring the sugar tablets, juice or whatever you use for a low into the room. Insulin injection sites and pump attachments are local contraindications. And if you take insulin, book for the middle of your cycle, "rather than just after or just before" a dose (p. 408).
Two points are our reading of hers rather than her words. If numbness means you cannot judge pressure, it also means you cannot judge heat, so the hot stones, the warm herbal compresses and the steam need the same care. And because she names skin damage and ulcers "especially to the legs and feet" as cautions (p. 404), tell us before a foot massage, and before the special foot treatment (650,000₫ for 90 minutes), which includes a heel scrape and a cuticle trim.
Many of our guests arrive after a long flight, and all four books agree on one warning. Werner lists immobility among the causes of deep vein thrombosis — "Sitting for long periods can contribute to DVT", hence the layman's name "coach class syndrome" (p. 245) — and notes that "fewer than one-half of all DVT patients experience significant symptoms" (p. 246). A client with signs of a clot, "which can be simply deep unilateral calf pain", is not a candidate for circulatory massage until a clot has been ruled out, because a clot "could fragment, embolize, and land in the lung" (p. 248). Hoyme names "long-haul travelers" among those most prone to it and says that with intense pain, swelling and tenderness in the calf, "it's best not to massage the area" (ch. 3, "The Calves"). Davies is the most urgent: with pain, swelling, heat and redness in the calf, "see a physician immediately" (p. 25; again p. 267).
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The distinction is one side against both. Stiff, heavy legs and a sore neck after twelve hours in a seat are normal, and exactly what a massage is for; our back, neck and shoulder page is about the three muscles a flight loads. One calf that is painful, swollen, warm or red is not a spa question: see a doctor today. Sudden chest pain or breathlessness is an emergency; the ambulance number in Vietnam is 115.
Werner's rule is short: "Acute fractures or risk of fracture contraindicates rigorous massage" (p. 72), and the primary risk "is that a fracture may occur because of undue pressure or problematic positioning on the table" (p. 75). She adds that older clients "are unlikely to have only one pathology", which is one more reason to fill in the whole consultation form. On our menu, skip the Thai massage, which works by assisted stretching, and the bamboo; book the oil massage at light pressure, and say if lying face down is uncomfortable.
The consultation form you fill in before the visit asks what to focus on and what to avoid, with a body map: tap an area twice for "avoid here". Write the condition and the medication, not just "careful": "warfarin" tells the therapist more than "blood problem". If you are pregnant, our pregnancy massage page explains why that treatment is side-lying. For the short-term things — sunburn, fever, a stomach bug — see our page on when to wait. If the honest answer is "not today", we would rather move your booking than work on you.
The couple spa books two massages side by side, and they do not have to be the same: one of you can have light pressure and the other firm. If either of you takes blood-pressure tablets, the massage side by side is the part to keep, and the jacuzzi afterwards is the part to think twice about.
We are a hotel spa, not a clinic, and our therapists do not diagnose. Werner's book is a textbook for massage therapists, Davies's is a self-treatment manual, and Mumford's and Hoyme's are guides for massage at home; we quote them because they answer, with page numbers, the questions guests ask us. None of them is a substitute for your own doctor, whose advice about your condition overrides this page. If you have had a blood clot before, ask your doctor about the flight as well as the massage.
Nghê Prana Riverside Hotel & Spa, Hẻm 384 Nguyễn Tri Phương, Cẩm Nam, Hội An, Đà Nẵng 51312 — on the Thu Bồn, a few minutes from the Old Town. Phone or WhatsApp +84 896 687 961, or email sales.nghehotel@gmail.com. An hour's notice is enough; walk-ins are welcome when a therapist is free. You do not need to be staying with us.
Sources: Ruth Werner, A Massage Therapist's Guide to Pathology, 5th ed. (Lippincott Williams & Wilkins), pp. 72, 75, 245–248, 256, 258, 260, 262, 404, 408 and 504–507; Clair Davies and Amber Davies, The Trigger Point Therapy Workbook, 3rd ed. (New Harbinger), pp. 25, 38 and 267; Susan Mumford, The Massage Bible (Sterling, 2009), p. 13; Ryan Jay Hoyme, The Complete Guide to Modern Massage (Althea Press, 2018), chapter 3, "The Calves". Page numbers checked against the printed pages on 27 September 2026. Where we extend a book's point, we say so. Prices read from our live spa menu on 27 September 2026. We are a hotel spa, not a clinic; nothing here is a diagnosis.
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Book your stayYes, if it is managed. Ruth Werner's A Massage Therapist's Guide to Pathology (5th ed.) says a client who manages hypertension and can exercise safely can probably also receive massage safely (p. 258); "uncontrolled high blood pressure" is the contraindication (Davies, The Trigger Point Therapy Workbook, p. 38). Blood-pressure medication can leave you dizzy afterwards, so sit up slowly (Werner pp. 258, 504), and Werner advises cardiovascular clients to avoid total immersion in hot tubs and saunas (pp. 504–505). At Nghe Prana, keep the massage and ask your doctor about, or skip, the jacuzzi and sauna.
Only at the lightest pressure. Werner writes that all blood-clotting medications carry a risk of bruising even with relatively light massage, and that if a clot is present massage should not be given; aspirin and Plavix also call for care (p. 507). At Nghe Prana that means skipping the bamboo and Thai massages and deep back work, and booking the oil massage (450,000₫ for 60 minutes) with light pressure requested from the start.
Not on them. Werner says mild varicose veins on healthy skin take superficial or gentle gliding pressure but no deep work, and severe ones or damaged skin over them are a local contraindication (pp. 260, 262); Mumford (The Massage Bible, p. 13) and Davies (p. 267) say not to massage over them at all. We follow the stricter reading: mark them "avoid" on the consultation form and the therapist works around them.
Usually yes: stiff legs and a sore neck after a long flight are what a massage is for. The exception is one calf that is painful, swollen, warm or red. Werner lists long sitting ("coach class syndrome") as a cause of deep vein thrombosis (p. 245) and says a client with deep pain in one calf should not have circulatory massage until a clot is ruled out (p. 248); Davies says to see a physician immediately (pp. 25, 267). See a doctor first; for chest pain or sudden breathlessness in Vietnam, call 115.
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