Virtually all massage therapists are taught that massaging varicose veins is contraindicated. The argument that is use is that increasing the back pressure in the veins either at the site of the varicose veins or distal to the varicose vein can increase vascular pressure, dislodge clots and the client runs the risk of a deep vein thrombosis. Massaging proximal to the site of the varicose vein is generally considered as being safe.
For most therapists this is probably reasonable advice although asking whether we can safely massage clients who have varicose veins is a fair question.
Varicose veins are fairly prevalent amongst the general population although there are recognised risk factors such as gender (females are more susceptible to getting them), if you have been pregnant and if you need to stand a lot at work. Genetics can also play a significant role in whether or not you will develop varicose veins during your life. However, if you regularly exercise and have a high fibre diet then the risk of you getting varicose veins is reduced.
Within the veins of the body are valves which prevent blood flowing backwards through them. Whilst blood flow in the arteries is the result of the pressure exerted by the heart, the flow in the veins is more the result of a muscular pumping action. For example, in the legs which is where most varicose veins occur, the flow of blood against gravity is achieved by what is known as the calf pump mechanism. When the valves in the veins do not close properly as the veins become dilated then the blood can flow into superficial veins which cause them to dilate further. If there is continued constriction of blood flow in the veins to the heart (eg from constant standing) then the blood can pool in the legs and the veins can lose their elasticity. The result is the bulbous thick veins as shown in the above picture.
Blood clots are likely to develop, particularly in larger varicose veins and the risk of dislodging these clots are why therapists are taught never to massage varicose veins (directly or distal to the veins).
However, with suitable training and approval of client’s doctors, some therapists consider that massage can provide benefit for those who are affected by this condition. The massage strokes would tend to be short and of light pressure, more aimed at promoting local circulation and/or lymphatic drainage. Strokes such as petrissage, deep tissue frictions, stripping and cross-fibre are never recommended. Some therapists who have received training in massage veins would often consider having the leg elevated to promote venous return.
If you suffer from varicose veins yourself then there are a number of steps you can take yourself to reduce any pain associated with them. Firstly move and exercise as much as possible. As mentioned previously, movement assists the calf muscle pump mechanism and even moving your ankles backwards and forwards can provide some benefit (particularly if you are sedentary and have limited mobility). Secondly, if possible, stop standing for long periods of time. If you do have to stand then try to shift your weight from time to time. For some, compression clothing can help although probably a good idea to discuss this with your doctor to determine whether such garments will be appropriate for you.