Massage Therapy for Clients with Breakthrough COVID-19 Infections

Massage therapist wearing a face mask while massaging a client's back in a treatment room.

By Ruth Werner

I recently received a message from a massage therapist who is struggling with an issue many practitioners will be facing in the coming months: What are the best screening protocols for clients who have been vaccinated and boosted, but who have recently been through a breakthrough COVID infection—with Omicron or any other variant?

Specifically, this practitioner was looking for guidance on the issue of coagulopathy and the risks of blood clots that could create an adverse event due to massage therapy.

This is a wonderful question! Before we dive deeply into it, let’s do a quick review of the issue of vaccinations, Omicron, and breakthrough infections.

Variants and Vaccines

The COVID-19 vaccines that were introduced in fall 2020 were effective beyond any reasonable expectation. Vaccines may be approved for widespread use when they show anything over 50 percent effectiveness—that is, the vaccines are safe, and they keep over 50 percent of vaccinated people from life-threatening infection. The effectiveness rates for the Johnson & Johnson, Pfizer, and Moderna vaccines were closer to 90 percent: really, an unprecedented success. But that was with the initial form of the virus.

Since then, viral variants have emerged that are more able to elude some of the vaccines’ effectiveness, but vaccines continued to keep the vast majority of vaccinated people out of the hospital.

With Delta, we saw a variant that even vaccinated people could spread, and that put a major speedbump on our road to pandemic recovery. Still, the vaccines kept most vaccinated people safe. And the booster that is suggested for people who are at least six months out from their last vaccine appears to prolong resistance. (Note: the booster recommendation has now been expanded to include any vaccinated person age 12 and older.)

With the Omicron variant, the rules are changing again. Omicron is different enough from the original forms of the virus that previously infected people, and even those who were vaccinated and vaccine-boosted are vulnerable to this infection. Fortunately, vaccine-boosted patients are still likely to have less serious infections.

Although Omicron appears to be slightly less virulent than Delta, it is both dangerous and very infectious (some experts suggest it is the most infectious virus ever detected), and it is moving through the population quickly. US hospitals—which had a short break from being at full capacity—are filling with people infected with Omicron. Most of them are unvaccinated—including children under 5 years old, who don’t qualify for COVID-19 vaccines. On January 3, 2022, the US broke a new record, with over 1 million new COVID-19 diagnoses in a single day.

The takeaways from all this include these guidelines:

  • Just because Omicron is sometimes less severe doesn’t mean it’s trivial. Every Omicron patient is also susceptible to long COVID, which I guarantee you do not want!
  • Get vaccinated, then get your booster.
  • Upgrade your masks to N95 or KN95, which are more effective than cloth or paper masks to screen out Omicron viruses.
  • Don’t relax on other infection-control measures, like handwashing, surface cleaning, and air filtration.
  • Be ready for clients who have been vaccinated, boosted, and who have had a breakthrough infection.

Screening for Vaccinated Clients

Now, let’s return to this massage therapist’s question about screening for vaccinated clients who have had a breakthrough infection. This massage therapist started with the screening protocols I suggested way back in June 2020. As a reminder, here they are:

Questions to Ask Clients Who Have Had COVID-19 (June 2020)

  • What does your medical doctor say about your risk of communicability?
  • What does your medical doctor advise about getting physical activity?
  • What do you do in terms of physical activity?
  • Do you have any new skin marks, lesions, or rashes, especially on the toes, but anywhere on the body?
  • Do you have any new experience of severe deep muscle or joint pain that is unrelated to recent physical activity?
  • Do you have any new discomfort with exertion?
  • Are you taking any drugs to manage blood clotting?
  • What other long-term consequences of your infection affect your life? 

You can click here to find the original blog post, which includes a detailed rationale for each question.

The absolutely legitimate concern about blood clotting that had us all scrambling for information in the early days of the pandemic is still an issue, but we have learned that most of the time this is a problem for people who have had very severe infections that required hospitalizations—which means most vaccinated people with breakthrough infections have a low-but-not-zero risk of this complication.

We see coagulopathy less often in people who have had “mild” infections. (I use the term “mild” with ironic quotations marks, because even a mild COVID infection feels extreme to many people who have it.)

It is still a good idea to ask about whether a client who had an infection has blood clotting issues, and if the answer is yes, what they do to treat it. But I predict this will not be a major problem for most people who get breakthrough infections. If they are using an anticoagulant, then of course this requires accommodations in massage pressure.

So, to address this massage therapist’s question—and to provide some ideas for anyone else who has the same concerns—here is a list of questions specifically for vaccinated clients who have recently been through a breakthrough COVID-19 infection:

Questions to Ask Vaccinated Clients Who Have Had Breakthrough COVID-19 Infections (January 2022)

  • When did your symptoms begin and end?
  • When was your last positive test? Have you tested negative since then?*
  • What kind of medical care did you receive?
  • Describe your daily physical activity. What activities are the most challenging?
  • Do you have any new discomfort with exertion?
  • Are you taking any drugs to manage blood clotting?
  • What other long-term consequences of your infection affect your life?**

*Be aware that certain kinds of tests show a positive result after the infection is no longer contagious. If it has been at least 10 days from the onset of symptoms, and any fever or cough has been resolved, then it is safe to move forward with massage—with the use of high-quality masks and air filtration systems.

**This line of questioning is targeted at clients who have been through a breakthrough infection, but who are not experiencing signs of long COVID—that is an entirely different topic, and you can find more information about it, along with a list of screening questions and rationales, here.

As with all things COVID, these suggestions will continue to evolve as we learn more. I hope this is a useful starting place as we enter our third year of dealing with the pandemic.

author bio

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 now in its seventh edition, which is used in massage schools worldwide.        

Related Content:

COVID-19 Variant Updates for the United States” by Ruth Werner

COVID-19 Hygiene Updates—A List of Suggestions” by Ruth Werner

Questions for Clients Who Have Had COVID-19” by Ruth Werner



I don't think the vaccines for COVID are safe or effective at this point.  Just look at he numbers being reported in the VAERS website.  DOD numbers are just as scary.

So I sent a client home 17 days since testing positive.  Claims they're no longer 'contagious' however, still has upper chest congestion and hoarse voice.  So this seems the virus is still working it's way out of the system.  My concern was getting my client sicker.  Is Massage a "go"? or "No go"?  

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