The guest mentions, as he lies down, that his calf has been sore and swollen since the flight. He wants you to work on it. You are now the only person on this yacht standing between him and a potentially fatal outcome — and the correct action is to put your hands in your pockets. Contraindications are the most important technical knowledge you will ever carry.
Absolute contraindications: do not treat
| Condition | Why |
|---|---|
| Fever or acute infection | Systemic illness; massage may worsen and you may spread it |
| Contagious skin conditions | Impetigo, scabies, fungal infection, active herpes lesions |
| Suspected DVT or blood clot | Hot, swollen, painful calf. Emergency — never massage. Call the doctor. |
| Severe uncontrolled hypertension | Cardiovascular risk |
| Intoxication | Cannot consent, cannot give reliable feedback |
| Recent surgery or acute injury | Tissue is healing; you may cause harm |
| Undiagnosed lumps, severe unexplained pain | Needs a doctor, not a therapist |
Relative contraindications: do not treat without medical clearance
| Condition | The rule |
|---|---|
| Pregnancy | Requires specific pregnancy training. First trimester: refer. Never treat without training. |
| Cancer | Oncology massage is a separate specialism. Do not treat on a general qualification. |
| Diabetes | Impaired sensation and skin integrity. Gentle only, no heat, no hot stone. |
| Epilepsy | Avoid stimulating oils; know the guest's seizure plan. |
| Anticoagulants (warfarin, DOACs) | Bruising and bleeding risk. Light pressure only, never deep tissue. |
| Heart disease, recent cardiac event | Doctor clearance first, always |
| Osteoporosis | Fracture risk. Very light pressure or decline. |
| Varicose veins, bruises, open wounds, recent scars | Local contraindication — work around, never over |
The rule
If you are in doubt, you do not treat. You refer to a doctor and you document.
Say it kindly and clearly: "I'd love to work on that, but with what you've described I'm not able to treat you safely today until a doctor has looked at it. Let me speak to the chief stew about getting you seen." Then tell the chief stew and, where there is any suspicion of a medical emergency, the captain — the yacht has telemedical support and it exists for exactly this.
Guests will push. They will say it is fine, that their own therapist does it, that they are on holiday. It does not matter. No guest has the authority to override a contraindication, and no insurer will defend you if you let them.
Onboard Notes
- Hot, swollen, painful calf: never massage. Escalate immediately.
- Blood thinners means light only — a bruise on an anticoagulated guest is a serious event.
- Cancer, pregnancy, cardiac: doctor clearance or no treatment.
- Refer, do not treat, document. Every single time.
- Preparatory study only. Nothing here qualifies you to treat. Massage requires an accredited vocational qualification (for example ITEC, CIBTAC or VTCT) and professional insurance.