COVID Vaccine and Massage: When is it Safe to Offer Massage?
By Ruth Werner
Several weeks ago, I had a great conversation with the good people at The ABMP Podcast about COVID-19 vaccines and what we knew at that point in time.
Now that the COVID vaccines have begun to be distributed, we have a new question to ponder: When is it appropriate to offer massage therapy to clients who are going through this process?
My answer: My recommendation is to wait at least two days after each injection (it’s a series of two, about a month apart), just in case the person has a negative reaction. Most people will have some local arm pain and swelling, but some people will have more severe, flu-like symptoms. For the latter, delay massage until they are back to full speed.
My rationale: The Pfizer and Moderna vaccines currently being administered in the United States are m-RNA vaccines. This is a new technology that induces an immune system response to SARS-CoV-2 without exposure to the virus. In other words, this vaccine cannot possibly cause even a low-grade form of COVID-19, but it equips the immune system to launch a powerful response to fight off an infection.
A terrific explanation of how the m-RNA strategy works can be found here—it will be the best 3 minutes you can spend to understand this process.
The m-RNA vaccine strategy appears to be safe and effective—that’s the good news. It also appears to initiate robust T-cell activity, which leads to longer-lasting protection than B-cells alone—also good news. However, these vaccines have a higher rate of side effects than we see with some other vaccines: they are reactogenic (likely to create reactions). This is good; it shows the body is creating a healthy and aggressive stance. But it is also uncomfortable. Specifically, side effects include pain and swelling at the injection site (this happens for most patients), along with systemic symptoms like fatigue, headache, muscle pain, joint pain, chills, nausea, vomiting, and fever.
Follow-up surveys about systemic post-vaccine reactions suggest they are more common in younger patients than in older ones, and they are often more severe after the second dose than after the first dose. If these reactions happen at all, they develop within 48 hours of the injection, and most people find they resolve after a day of discomfort.
Which leads me to my recommendation: if a client has had a COVID-19 vaccination, it is wisest to avoid massage for at least two days, just in case they have a delayed, uncomfortable reaction. If they do have symptoms, then delay massage until they feel better. (By “massage” here I mean Swedish-based, mechanical-manipulation-of-the-tissues type of massage, rather than less intrusive forms.)
The vaccines require two doses, a month apart. My suggestion is to use the same caution for both doses—especially the second dose, which is more likely to elicit an uncomfortable reaction.
Note: the flu-like symptoms that some patients experience are not the same as the life-threatening anaphylaxis that a very few people develop. This allergic reaction happens within a few minutes of the injection and is treatable with epinephrine. People with a history of strong allergic reactions to vaccines are counseled not to take the COVID-19 vaccine at this time.
The COVID-19 vaccine can cause unpleasant side effects, but I guarantee they are not as unpleasant as having a severe case of COVID-19 or being responsible for infecting someone else with the virus. For that reason, I hope most massage therapists will take advantage of this opportunity as soon as it is available. I know I will.
Learn more about massaging safely during a pandemic from the 2020 ABMP CE Summit’s Massage Therapist’s Guide to COVID-19.
Discover other COVID-19 resources for massage professionals:
“COVID-19-Related Coagulopathy” by Ruth Werner
“Questions for Clients Who Have Had COVID-19” by Ruth Werner
“A Conversation with a Hematologist” by Ruth Werner
Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved provider of continuing education. She wrote A Massage Therapist’s Guide to Pathology (available at BooksofDiscovery.com) now in its seventh edition, which is used in massage schools worldwide.
Centers for Disease Control and Prevention. “Frequently Asked Questions about COVID-19 Vaccination.” February 11, 2020. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html.
Centers for Disease Control and Prevention. “Local Reactions, Systemic Reactions, Adverse Events, and Serious Adverse Events: Pfizer-BioNTech COVID-19 Vaccine.” December 14, 2020. https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/reactogenicity.html.
Miller, K. “Here’s Why You’ll Still Need to Wear a Mask After Getting Vaccinated for COVID-19.” Prevention. January 4, 2021. https://www.prevention.com/health/a34904463/wearing-face-mask-after-covid-19-vaccine.
Pollard, A. J. and E. M. Bijker. “A Guide to Vaccinology: From Basic Principles to New Developments.” Nature Reviews Immunology, 1–18. 2020. https://doi.org/10.1038/s41577-020-00479-7.
NPR. “What You Need to Know as the First COVID-19 Vaccines Head Your Way.” (n.d.) Accessed December 23, 2020. www.npr.org/sections/health-shots/2020/12/12/945288710/what-you-need-to-know-as-the-first-covid-19-vaccine-heads-your-way.
Zhang, S. “What the Vaccine’s Side Effects Feel Like.” The Atlantic. December 18, 2020. https://www.theatlantic.com/health/archive/2020/12/what-expect-when-you-get-covid-19-vaccine/617428.
RE: COVID-19 Vaccine and is it safe to offer massage?
Thank you Ruth for another excellent post on massage-specific guidance regarding massage after a client receives a COVID-19 vaccination. I would think this "wait 48 hours / 2 days" recommendation would apply to just about all injected vaccines -- not just COVID-19 vaccine. Also I was privileged to watch a FaceBook Livestream Q&A featuring Dr. Michael Okun, neurologist Movement Disorder Specialist on the topic of COVID-19 Vaccines and Parkinson's Disease. During the course of the session Dr. Okun offered some tips when receiving vaccination that can be very helpful for most folks including massage therapists and not just PwPs (Persons With Parkinson's). His tips : Be very hydrated (SUPER hydrated!), okay to take Tylenol an hour prior to reduce potential arm soreness and get vaccinated in your non-dominant arm.
Dr. Okun very much recommends folks get the COVID-19 vaccination and continue to practice the Three Cs: Cover, Control and Contain. The archived video of his presentation available on YouTube here for source reference.