Articles, Client Education Series

Fallen elderly woman with hip pain

Client Education Series 7: Osteoporosis and Massage

April Heath


“Break a leg,” means good luck only on Broadway

I had a client for a deep tissue massage a few years back. She was face down on the table and several minutes into the massage, she said, “I guess I should let you know I have osteoporosis.”

Holy Jesus. I stood back, shaking my head. “Yes, when I asked about medical conditions, that would have been a good time to tell me. I’m afraid I can’t continue with deep pressure. We’ll switch to Swedish.”

She was pretty angry. “I get deep tissue all the time.”


“Home in Boston. I have a regular massage therapist, and she gives me deep.”

“I see,” I said. It made no difference to me. “I’m not licensed in Massachusetts and I don’t know your body well enough to know where firmer pressure can be tolerated.”

I figured she would complain to a manager, but that didn’t concern me anywhere near as much as possibly breaking her bones and having a lawsuit on my hands.

According to Mayo Clinic: Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses such as bending over or coughing can cause a break. Osteoporosis-related breaks most commonly occur in the hip, wrist or spine.

Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn’t keep up with the loss of old bone.

Osteoporosis affects men and women of all races. But white and Asian women, especially older women who are past menopause, are at highest risk.

Massage Considerations: 

Forceful and/or vigorous massage, like deep tissue and sports massage, is risky for individuals with osteoporosis due to the potential for fracturing fragile bones.

However, according to Ann Harman, NASA studied bone density loss on astronauts and discovered that vibration stimulates bone growth. Tapotement (manual vibration and percussive) techniques can be performed in order to create vibration… Bones also respond to mild pressure, so putting gentle pressure on the bone (assuming that the bone is not so fragile that this would be dangerous) is another possibility. Florida School of Massage Therapy

The National Osteoporosis Foundation advises that gentle pressure massage can benefit people who have osteoporosis

Contraindications for Massage: 

  • Deep tissue massage: Avoid deep pressure that could potentially cause fractures.
  • Spinal manipulation: Avoid techniques that put pressure on the spine.
  • Joint mobilization: Be cautious with techniques that involve joint manipulation.
  • Local avoidance: Avoid areas with known fractures or areas of pain.

As usual, the key to a safe and enjoyable experience comes down to communication between client and massage therapist. There are risks and limitations, but a soothing pressure is appropriate for clients with osteoporosis.


Osteoporosis makes bones brittle and fragile

Deep tissue massage is not suitable for people diagnosed with osteoporosis, but gentle pressure can benefit

Client safety is always at the top of the priority list.

New to my Client Education Series? Read #6 in the series – Medications and Massage

Eager to learn more? Read #8 in the series – Checklist when looking for a massage therapist

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