Monkeypox—a rare viral disease that is experiencing a worldwide outbreak, including in the U.S.—presents with a rash and also with symptoms that commonly lead a person to seek out massage therapy.
Rash is one symptom—and massage practitioners know that human skin must be whole and intact for massage and bodywork practice. Working directly on broken skin, skin lesions or skin rash is considered to be a massage therapy contraindication. This alone should help massage therapists avoid exposure to anyone infected with monkeypox.
According to the Centers for Disease Control and Prevention (CDC), as of June 2, monkeypox has been detected in 10 US states, including California, Colorado, Georgia, Florida, Massachusetts, New York, Pennsylvania, Utah, Virginia and Washington. There were 550-plus cases diagnosed worldwide throughout 30 non-African countries as of June 1, according to the World Health Organization (WHO). In Africa, thousands of cases of monkeypox are diagnosed annually.
The increase in monkeypox cases in the U.S. is a low-risk concern for massage therapists at this time. A WHO spokesperson, as reported by USA Today on May 30, said the organization does not expect a monkeypox pandemic to occur—so unlike COVID-19, it is doubtful the monkeypox virus will become prevalent among the U.S. population.
However, it is important to learn about any disease that could be presented at a massage establishment by an unsuspecting client, in order to prevent infections and workplace contamination.
What is Monkeypox?
The CDC reports that monkeypox can be confused with other diseases such as secondary syphilis, herpes, chancroid, and varicella zoster, which causes shingles.
Monkeypox was discovered in 1958 and has survived primarily on the African continent for decades. However, today’s concern is its spread to Western countries such as the U.S., and its ability to transmit from person to person—which is above and beyond previously known modes of transmission, such as exposure to an infected animal.
As of May 19, the WHO had reported, “Monkeypox is transmitted to humans through close contact with an infected person or animal, or with material contaminated with the virus.” This transmission can occur: “ … by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding.” WHO also reports that monkeypox resembles smallpox, has symptoms that can last from two to four weeks and has a fatality rate of approximately 3 to 6%.
The CDC states person-to-person monkeypox transmission is spread primarily through direct contact with infectious sores, scabs, body fluids, respiratory secretions during prolonged, face-to-face contact and touching parts of the body with monkeypox sores.
“Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a rash, often beginning on the face then spreading to other parts of the body,” the CDC adds. Infectious skin lesions progress through the following stages before eventually subsiding: macules, papules, vesicles, pustules and eventual scabs.
Non-Rash Symptoms
An individual infected with monkeypox could seek massage or bodywork to alleviate some of their other monkeypox symptoms, such as headache, muscle ache, backache and exhaustion. The CDC reports that monkeypox illness begins with:
- Fever
- Headache
- Muscle aches
- Backache
- Swollen lymph nodes
- Chills
- Exhaustion
Massage therapists are trained to know that fever and unexplained or undiagnosed pain are massage therapy contraindications. As such, a practitioner who uses their initial massage therapy training should be able to avoid working on infected individuals by exercising these basic service contraindications.
The main difference between smallpox and monkeypox symptoms is that monkeypox can cause lymph node swelling, which is also known as lymphadenopathy. Manual lymphatic drainage can be applied for some lymphadenopathy conditions that are not infectious.
However, a client with new, unexplained or undiagnosed swelling would be contraindicated. It is necessary to obtain a diagnosis for new swelling prior to applying MLD techniques. A licensed physician would be the professional to determine if the client’s new medical condition is infectious or requires different medical treatment.
What to Do if You Think You Have Been Exposed
If you think you have come into contact with an infected individual, you should practice superior hand hygiene and self-isolate until it can be determined that you have not been infected.
You can learn how to properly disinfect a massage table and equipment by reading the instructions provided during the COVID-19 pandemic.
Practitioners should also seek immediate medical attention after a suspected exposure and initiate contact tracing.
Review of Massage Therapy Instructions During Monkeypox Outbreak
• Massage therapists should work only on intact skin.
• If a client presents with a new ache, pain or swelling, they will be required to obtain an appropriate medical diagnosis prior to massage service.
• Fever is a basic massage contraindication regardless if other symptoms are present.
• Practitioners should keep up-to-date with new infectious diseases, information and warnings to ensure the best safety and practices for all.
• To learn more, visit:
The CDC page for monkeypox information.
The WHO’s page for monkeybox information.
About the Author
Selena Belisle is the founder of CE Institute LLC in Miami, Florida, where they teach massage, nursing and cosmetology industry CE courses. She has been practicing massage therapy and bodywork for over 30 years. She is approved as a continuing education provider by many industry state boards and the National Certification Board for Therapeutic Massage & Bodywork.
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