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I'm embarrassed that after 2 years as an MT I don't know this, but I was reading today that you should always do effleurage on the legs upward (towards the heart) and never downward because you could damage their veins.

Really?? Have you guys heard this?

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I hope someone corrects me if I'm wrong.  We were taught in massage school that what you say is correct.  As far as I know, it's one of the myths perpetuated in the massage world.  The theory is that because blood flow in the veins is toward the heart, if you go contra to that you will push the blood the wrong way through the veins.  BUT, the veins have valves in them to prevent backflow (otherwise we'd have issues just from gravity!), so it's kind of a silly myth.

Besides, why is it always and only effleurage, one of the lightest strokes?  Given that we are taught it's a good idea to do deeper strokes proximal to distal to lengthen a muscle, wouldn't that be worse than effleurage?!

Pam, where did you read this? I hope it's not anything current, because it's pretty much a myth.

Here is a Q&A about this topic from AMBP magazine a while back:

I saw it on an instructional video on Thai massage. I'm happy to know it's a myth because I do downward strokes all the time!

Lee Edelberg said:

Pam, where did you read this? I hope it's not anything current, because it's pretty much a myth.

Here is a Q&A about this topic from AMBP magazine a while back:


It is a myth.  I took James W's Orthopedic Massage class for the lower body a few years ago. He said he had spoken with a vascular surgeon who said it was fine to work down the leg and work behind the knee as well.  I also believe that in Rolfing and Structural Integration, that one works the back of the body in a down direction.

Hope this helps.


I thought it was only contraindicated if the client had varicose veins?

The approach in Swedish is to "support venous return"--that is, to stroke in the direction of venous blood flow, toward the heart, in the limbs (arms and legs). This is not because it will "damage the veins" but because it can improve circulation and usually feels more comfortable. 
It won't damage their veins.
Effleurage is a very light stroke, and so effleurage on the limbs generally runs in both directions. Firmer strokes are usually done in the direction of venous blood flow. 

As far as varicosities, if they're significant, they are a local contraindication and you should work proximal to the varicosity. 

An important rule of Swedish massage is that most movements or strokes are directed toward the heart (centripetal). Many massage techniques are intended to enhance venous blood and lymph flow and are directed toward the heart and eliminative organs. Only very light strokes that have little mechanical effect on fluid flow should be directed away from the heart. When a massage movement is directed away from the heart, it's called centrifugal.

Massage movements should be directed upward along the limbs and lower parts of the body and downward from the head.

(Theory & Practice of Therapeutic Massage by Mark F. Beck)

The goal is to not put undue pressure on vein valves by directing strokes against the normal flow of venous circulation.

Yes, of course, i guess the massage direction during a thrapy should be towards the heart as it will alow the right flow of blood in our veins, as doing it in the opposit direction could make it more resistive for blood to flow.

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