Among the different modalities of physiotherapy, massage is comparatively easy to manage and can be self-administered at home. The following information outlines the benefits, contraindications, and precautions of massage for elders' and their caregivers' reference.

Benefits of Massage

Massage can stimulate the circulation of blood and lymph in skin and muscle, which in turn helps decrease pain, accelerate healing of injured joints and muscles, reduce swelling and bruising, relieve muscle tiredness and soothe muscle tension and spasms.

Contraindications to Massage

• Acute inflammation (i.e., if the affected area is diagnosed by doctor to be acutely inflamed or there is redness, heat, pain or swelling, medical personnel should be consulted first.)
• A wound or fracture that has not yet healed or a recent joint dislocation
• Severe osteoporosis
• Contagious skin diseases or severe skin problems (e.g. psoriasis)
• Acute deep vein thrombosis
• Site of malignant tumor
• Unstable heart disease, hypertension or high fever
• Massaging the abdominal area is not advisable during pregnancy, menstruation or when feeling too full or nauseous.

Precautions for Massage

1. Receiving massage by others

• Massage should be performed about once to thrice per week. Each time it should last for 10-20 minutes when applied to local area, and 40-50 minutes for whole body message.
• To prevent injury or exacerbation of symptoms due to incorrect method or failure to recognize contraindications, receive massage only at legally operated places by professional (e.g. registered physiotherapist, registered Chinese medicine practitioner, trained masseur).
• Joint manipulation, like passively thrusting the neck or back to produce a ‘click' sound, should only be performed by recognized professionals, so as to avoid injury to joints and potential serious complications such as limb numbness or paralysis.

2. Self-massage

• Massage in localized areas can be performed once to thrice daily. Each time it can last for 10-20 minutes with about 50-60 repetitions per minute using moderate pressure, i.e., comfortable and not causing pain.
• Only the area being massaged should be exposed, with the other parts of the body should be covered to avoid catching a cold.
• The area being massaged should be well supported, e.g., by using pillows or a chair with a backrest.
• Joints should not be pulled or compressed too forcefully during massage.

3. Using massage machines

Electrical massage machine 

•  Persons with a cardiac pacemaker installed should not use any electro-massaging machine to avoid interference.

Heat function of massage machines:

• Heat function should not be used on areas of acute inflammation or in conditions with impaired skin sensation to hot and cold (e.g. neuropathy caused by diabetes mellitus)
• Whole body heat function should not be used for persons with heart disease or hypertension.
• The level of heat applied should be moderate and comfortable, instead of “the hotter the better” as there is risk of burn.
• Do not sleep while using the heat function, as the sensation for heat is diminished after falling asleep. Prolonged heating may lead to burn.

•  Electrical stimulation massage machines:

Electrical stimulation massage machine 

• Electrical stimulation should not be used on persons with metallic implants or decreased skin sensation for pin-prick.
• The level of electrical stimulation applied should be moderate and comfortable, instead of “the stronger the better” as this may lead to burn.

•  Avoid applying massage machines on bony prominences, as the superficial soft tissues at these sites can be easily injured by pressure.

•  Remember to follow general safety precautions for electrical appliances when using electro-massaging machines:

• Follow the instructions in the user's manual.
• Do not let the massage machine get wet.
• Do not use the same electrical socket for too many electrical appliances.
• Ensure that electrical plugs are earthed.
• Do not use or repair a dysfunctional electro-massaging machines by yourself.

Although massage is beneficial in many circumstances, there are limitations to its therapeutic effects. To achieve better results, it can be applied in combination with other appropriate therapies (such as the application of hot/cold, rest and exercise). Massage cannot totally replace other physiotherapy modalities, therapeutic exercise or prescribed medications. It is important to consult medical personnel promptly for conditions with unknown cause, and those which are serious, persisting or deteriorating. Never delay proper treatment and simply rely on temporary symptomatic relief.