Student Work: Contraindications for foot and ankle massage during pregnancy Research Paper by Sandra Dryden

Michelle Burns
October 6, 2016

During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and  well thought out information and  decision-making outcomes. I am happy to share some of their assignments for you to enjoy.



There are many types of research, each designed for a specific purpose, or to answer a particular type of questions. A few examples are exploratory, explanatory, qualitative, quantitative, descriptive (such as a case-study, observation, or survey), correlational (case-control study, observational study), semi-experimental (field experiment, quasi-experiment), experimental (experiment with random assignment), review (literature review, systematic review), meta-analytic (meta-analysis), and mixed methods research (such as the integration of quantitative and qualitative components). Any type of research that clearly shows empirical data relating to a research question, and answers that question in a clear and unbiased manner with evidence well designed to apply to the question at hand would be valid for massage therapy.

When determining if information found on a topic is valid and correct, it is important to make a few considerations. Who published the information? Where did they find it? If the information came from a research study, how was the study designed? How was the study performed? There have been cases, for example, where a research study was designed to produce an unbiased result; however, in the performance of the study, it became apparent that there was an inherent bias skewing the outcome. One way to test for bias is to replicate the study, something that often happens through peer review. For this reason, information is more often generally accepted as valid once it has been proven through a research study which has been published in a peer reviewed journal, and even more so if the study has been replicated, with those results also published. It is through this process of study, replication, and review that a body of work is built for s specific field of study.
Is research important in the massage profession? The importance of the research may vary, depending on the audience and the research topic in question. Let's consider a client that has been receiving massage therapy throughout their entire life, and, with each session, they experience an increased sense of well-being, incomparable to that achieved by other services that they may have received. This person very well may not be interested in the why and the how of the benefits of massage. Instead, they may be content with the proof of their own experience. On the other hand, we may also consider someone who is new to the massage profession, and who has had few or no massages. This person may not be sure about whether or not continuing to receive massage is worth the time and financial commitment massage sessions entail. In this case, it may be beneficial to be able to share scientifically objective information with this person, helping to paint a larger picture of what benefits they are likely to experience through undergoing massage therapy. It is also critical to have objective answers to questions about massage and disease, especially when it comes to contraindications or treatment for a condition.

pregnantMany people have heard the phrase "You should not massage the feet and ankles of a pregnant woman." It is something that comes up often on message boards and pregnancy blogs, with many women very concerned about the possibility of inducing preterm labor. Unsurprisingly, this idea inspires quite a bit of anxiety in someone who is, or may be, pregnant while seeking massage. This idea may have come from the fact, according to Pacific College of Oriental Medicine, that a small amount of oxytocin--a natural chemical involved in contracting the uterus--is produced by foot massage.

However, there is also a lot of contradictory information available. actually contradicts themselves on this issue. In the article titled "Pressure Points to Avoid While Pregnant," author Erica Roth states that "according to the American Pregnancy Association, pressure points near the ankle are contraindicated during pregnancy, because, when manipulated, they can cause the pelvic muscles and uterus to contract. Contractions well before a woman's due date can lead to preterm labor, which is not safe for the child." Similarly, in the article "Foot Massage & Pregnancy," writer Jean Jenkins quotes a certified prenatal massage therapist, Rebecca Leary, as saying that  "There are acupressure points in the legs, ankles and feet that correspond to the reproductive system. [Therapists are] trained to recognized and avoid these points on the feet of pregnant women, as they could send them into early, naturally induced labor." However, Jenkins also mentions the counter argument that "many professionals in the medical field disagree, not with foot massage in pregnancy per se, but with claims that massage and reflexology can be powerful enough to induce labor." Jenkins also states that "most obstetrician/gynecologists agree that foot massages, done gently, help to decompress agitation and anxiety and therefore, can make the experience of pregnancy more comfortbale and enjoyable, for both mom and baby."

In an article on the website for the Associated Bodywork & Massage Professionals trade organization,, titled "Proceed with Caution: Foot/Ankle Massage for Pregnant Client," Leslie Stager writes that "despite the prevalence of this contraindication, there is no evidence that ankle massage is dangerous. The concern may have developed from specific information that was gradually altered through oral transmission, eventually becoming generic and essentially useless."

From the information presented, it would seem that the idea that acupressure points on the feet and ankles could inadvertently trigger contractions, and possible preterm labor, is more myth than fact. While based in small truth, it is a story that has been told, and retold, and become part of the fabric of common knowledge. However, common knowledge does not hold the same weight as empirical, fact-based, evidence and there is no evidence found to support the claim that massage and reflexology can be powerful enough to induce labor in pregnant women, at any stage of pregnancy.

As a massage therapist considering performing massage on pregnant clients, it is always best practice to be certified in prenatal massage, and make sure not to work outside your scope of practice. If you feel unsure, or unsafe about massaging a client, it is always best to err on the side of caution until you have acquired more and valid information of the subject. Take CEU classes on pregnancy massage, talk to certified prenatal massage therapists, and keep up with the latest research in respected research journals.



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