close up of hands massaging a person's back

Massage Therapy and Bleeding Disorders

The benefits are myriad, but a smart approach is crucial
Author: Lisa Fields

 If you have a bleeding disorder and you feel achy, you might crave the comforting relief of a massage. But before anyone lays a hand on you, it’s critical to get your physical therapist’s approval, be particular about using a licensed massage therapist and discuss in advance how much pressure is recommended.

“The main thing we’re concerned with is the prevention of bleeds,” says Bruno Steiner, PT, RMSK, a physical therapist at the Washington Center for Bleeding Disorders in Seattle. “The overarching ethic is: First, do no harm. Therefore, we have to caution practitioners that may want to go too deeply into tissues.”

Soft-tissue mobilization
Many hemophilia treatment center (HTC) physical therapists avoid using the term “massage” to describe their work.

“I’d rather call it soft-tissue mobilization,” Steiner says. “I believe when people think of massage, they think of people kneading and mashing down on tissues in a nonspecific way.”

Based on the severity of your bleeding disorder and your reason for seeking care, it may be safe for you to see a licensed massage therapist, but consult your HTC’s physical therapist first.

“Maybe someone has back pain unrelated to hemophilia,” says Susan Knight, PT, PCS, a physical therapist at the Hemostasis and Thrombosis Center at Children’s Hospital Los Angeles. “But if you are seeking out massage for a recent joint bleed, I would say no, work with your physical therapist and not a massage therapist.”

Seeking relief from your HTC physical therapist has numerous benefits. For one, she or he already knows your medical history. An HTC physical therapist also is a professional with know-ledge of anatomy and bleeding disorder concerns.


Prepare with prophy
“I’m a great proponent for manual therapies for hemophilia patients, provided that they do their prophylaxis,” Steiner says. “They should be protected at all times—and as much as they can when going through treatment.”

If your physical therapist clears you to see a licensed massage therapist, be sure both practitioners connect before your appointment. The massage therapist needs to hear that deep-tissue massage, like Rolfing, and stretching maneuvers, such as Thai massage, may be too vigorous.


“The provider of the massage must have some awareness of bleeding disorders and the willingness to understand and learn and take feedback,” Knight says.


In the end, some versions of massage therapy may indeed be beneficial for pain relief, if they’re approached carefully and under the supervision of an HTC physical therapist. Plus, you’ll probably enjoy the added benefits of relaxation and stress reduction.