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Ep 44 - Flu Vaccines and Massage:"I Have a Client Who ..."Pathology Conversations with Ruth Werner

A syringe being inserted into a vial of liquid

A massage therapist has an opinion about when to work after a client’s flu shot. Her colleague has a different opinion. Who is right, and based on what data? Join me for a discussion of flu shots, appropriate delays (or not) for massage therapy, and intriguing possibilities for future research.


Berbari, G. “Experts Say There Might Be A Hidden Benefit To Hitting The Gym Right After Your Flu Shot.” Elite Daily. October 23, 2018.

“Flu Shots Boosted by Exercise.” The University of Sydney. April 23, 2013.

Author Images
Ruth Werner, author of A Massage Therapist's Guide to Pathology
Author and educator Ruth Werner's logo
Author Bio

Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology, now in its seventh edition, which is used in massage schools worldwide. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. Werner is also ABMP's partner on Pocket Pathology, a web-based app and quick reference program that puts key information for nearly 200 common pathologies at your fingertips. Werner’s books are available at And more information about her is available at


This episode sponsored by Books of Discovery and Anatomy Trains.

Full Transcript

00:00 Speaker 1: Ruth Warner's best-selling book, A Massage Therapist's Guide to Pathology, is a highly-regarded comprehensive resource that sets the standard for pathology education. Written for massage therapy students and practitioners, this groundbreaking resource serves up a comprehensive review of the pathophysiology, signs, symptoms and treatment of more than 500 diseases and disorders. Learn more at


00:39 Ruth Werner: Hi, and welcome to I Have a Client Who, Pathology Conversations with Ruth Werner, the podcast where I will discuss your real life stories about clients with conditions that are perplexing or confusing. I'm Ruth Werner, author of A Massage Therapist's Guide to Pathology, and I have spent decades studying, writing about and teaching about where massage therapy intersects with diseases and conditions that might limit our client's health. We almost always have something good to offer even with our most challenged clients, but we need to figure out a way to do that safely, effectively and within our scope of practice. And sometimes, as we have all learned, that is harder than it looks.

01:26 RW: This week's episode is an extremely timely question, this comes from a massage therapist in Denver who sent me this note, "Hi, Ruth, I have a question. Do you have any information about getting the flu shot and then getting a massage? I've always learned that the injection site is a contraindication, but I have a massage therapist who works with me, and she learned that she shouldn't treat anyone if they've had a flu shot that same day, or even in the past few days. I can't find any information on this. What do you think?" So first, as always, thank you so much to this massage therapist who's asking a terrific question, especially for this time of year in general, and for this year in particular. As I record this podcast, we are seeing, depending on how you count it, a second or third big spike in positive COVID diagnoses, and we're also seeing that many hospital systems around the country are strained to the breaking point with ICUs that are full to overflowing. It's really important for people to not add to the strain on our healthcare system by getting sick with a flu, which always carries the possibility of pneumonia and maybe requiring hospitalization. Let's not make this situation any more dire than it absolutely has to be, and let's also protect the people around us from the risk of getting flu by taking responsibility and getting a flu shot.

03:00 RW: I also want to express my gratitude to this massage therapist for sharing her question, because I think it's one that a lot of people might be asking around now. If you have questions or experiences that have come up mid-session that might prompt an interesting pathology-related conversation, please feel free to share them at That's ihaveaclientwho, all one word, all lowercase Let's talk about flu shots. I know I am running the risk of opening a can of worms that is uncomfortable for a lot of people. If you are someone who believes strongly that flu vaccines are a bad idea, or if you are against vaccines in general, then I can save you some time right now, because this podcast is not for you, so I suggest you skip it and go to whatever is next in your listening queue.

04:01 RW: It will not come as a surprise that I am strongly in favor of safe effective vaccines. And given the circumstances that we're living in this fall, this podcast is being made in October of 2020, I feel it is especially important for massage therapists who have gone back into practice to make a strong commitment to their own well-being and the well-being of people around them by getting the flu vaccine. The paradigm under which I operate is informed by science and scientists who work specifically for the benefit of humans everywhere. The topic of vaccines is not entirely black and white, but it is dark, dark, gray compared to really, really light gray.

04:48 RW: Not all vaccines are equally successful for every person, not all vaccine schedules are the best match for every person, but overall, I'm just not gonna argue the point that the benefits of tested and approved vaccines outweigh the risks for the vast majority of our population. Further, even the people who are not good candidates for vaccines like really young babies and children or cancer patients or just a few others, they still benefit when other people vaccinate because it puts them less at risk for being around someone who is actively sick with a contagious pathogen. Because vaccines are on lots of people's minds right now as we look for the possibility of a safe and effective vaccine for COVID-19, maybe many of our listeners are a little better informed about this topic than they would otherwise have been.

05:40 RW: Vaccines use a variety of strategies to alter immune system function, but the basic idea is that a vaccine is meant to initiate an immune system response against a pathogen, so that if a person is consequently exposed to that pathogen, they already have the cellular tools in place to be protected from it. The pathogens associated with flu very enormously, and they undergo substantial genetic mutations from year to year. There isn't just one flu virus, and this is why flu vaccines need to be updated annually. They're not 100% effective, no one ever claims that they are, but they do reduce the risk of getting flu by anywhere from 40% to 60%, and if a person gets the vaccine and does indeed get the flu, they are likely to have a less severe version of it.

06:34 RW: As I dug a little deeper into this topic, I was really intrigued to find that exercise has been seen to actively increase the efficacy of flu shots. This is exercise done right before and or right after a person's flu shot. It seems to activate immune system activity that makes the vaccine even more effective, and I'll put a couple of links in the show notes for interested listeners who might wanna learn more about this. However, I found nothing, bupkis, nada on massage therapy around flu shots, except for a thread on Reddit that said to avoid the sore area. Yeah, good advice. I think our contributor's colleague who doesn't wanna work with a person who has recently received a flu shot, is acting out of an abundance of caution. Typically, I am completely in a favor of having an abundance of caution. After all, I'm a pathology teacher, and it's my job to help people be more careful than they absolutely positively have to be. But in this situation, a closer look suggests that massage therapy really has no particular risks for someone who's recently had a flu vaccine, and by recently, I mean within the last call it 2-48 hours.

07:56 RW: So unless they're having some kind of negative response to their shot, there are no particular reasons to delay a massage therapy. What I'm really interested to see if someone might be able to do some day, is to look at what message might do to vaccine efficacy for someone who just got the flu shot, just to see if it might have a similar kind of effect on the body that we see with exercise. We do see some hints in the literature that massage might make certain medications more effective, it would be fascinating to see if this was also true with flu vaccines. If you have connections in the research field and you wanna explore this question, I hope you'll do that and then let me know what you find out. In the meantime, if your clients come in and they recently got their flu shots, it's good practice to find out if they're having any negative reactions. If yes, delay your session. But for most people, especially those who get yearly updates on their flu shots, massage therapy does not need to be delayed or adapted in any way other than to avoid the tender area where the injection happened.

09:07 RW: Hey everybody, thanks for listening to I Have a Client Who, Pathology Conversations with Ruth Werner. Remember, you can send me your I Have a Client Who stories to That's ihaveaclientwho, all one word, all lowercase I can't wait to see what you send me and I'll see you next time.

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