ashiatsu trainingWritten by: Nancy DeLong, Certified DeepFeet Instructor

Recently, during a DeepFeet Bar Therapy workshop, a guest client fainted only 15 minutes into receiving an Ashiatsu treatment. While this is a rare occurrence for Ashiatsu clients, whenever something such as this occurs, we take the opportunity to learn from the experience, and share with students the outcome and additional precautions to take within their practices. This is a great opportunity for all of us to learn from so we can be better prepared should it happen to a client in the future. Our number one priority is always client and therapist safety.

This incident recently took place within a Barefoot Basics workshop. The client was a young male in his mid-20’s, who was recently diagnosed with borderline low blood pressure. This client had received prior Ashiatsu treatments without any negative side effects. He only had one occurrence of fainting prior to the one which took place in the workshop. The incident also coincided with a morning where he happened to get out of bed more quickly than recommended due to his low blood pressure diagnosis. With the first fainting spell, he had a follow up appointment with his doctor, who concluded that it was nothing to be concerned about, and that he should use extra caution with quick movements from a lying down or resting position. During the instructor demonstration, he fainted and became unconscious while receiving one footed Ashiatsu strokes in the prone position. Luckily, the instructor was checking in verbally more than usual about pressure levels, when the client was not responsive she quickly realized he was unconscious and jumped into action to get him turned over and back to consciousness.

Our instructors always talk in length in class about blood pressure and the effects Ashiatsu has on the circulatory system. With Ashiatsu, therapists are using gravity and bodyweight which results in applying up to three times more force and pressure than traditional hands-on treatments.


One major physiological effect which clients experience is an increase in blood flow, which is normally a good thing for the average, healthy person. Lower blood pressure usually equates to easier flow of blood through the body, as there is less resistance keeping the blood moving smoothly throughout. People with high blood pressure often are faced with more resistance of blood flow due to the effects of clogged arteries. These conditions are often the result of unhealthy attributes such as smoking, poor diet or too much salt. The harder it is for blood to flow through the body, the greater the chance for an episode such as stroke or heart attack.

These risks can be lessened by lowering blood pressure overall, which massage can help achieve; however extra precaution must be taken with Ashiatsu techniques due to the depth of compression which can quickly shift blood pressure in either direction depending on the client.


For people diagnosed with low blood pressure, they can experience symptoms related to not getting enough blood flow to the brain. If blood pressure is too low for any given reason, blood is not pumping oxygen through the body at a healthy rate. Low blood pressure conditions can result in episodes of fainting upon standing or with fast movements (also known as Syncope), dizziness or lightheadedness, nausea, fatigue and other symptoms. It is the increased likelihood of these symptoms which we must watch for with clients diagnosed with low blood pressure conditions, so we advise you to use even more caution when working on these clients; they are the ones most likely to faint during a treatment or afterwards when getting off the table.

Even if a client has “controlled high blood pressure” you must use caution, because they are most likely on a medication which lowers their blood pressure; add Ashiatsu to that equation and it may lower it below a healthy, normal level.


List of productive questions to ask clients with high & low pressure conditions:hypertension word cloud

1. Is your condition “controlled” or “uncontrolled”?
2. Are you currently taking medication? if so what kind, and what are   the side effects?
3. Do you bruise easily as a result of the medication you are taking?
4. Does the medication you take lower or raise your pressure?
5. Are you able to sit in a hot tub or sauna for more than 10 minutes without side effects?

6. Do you get lightheaded when standing up from a seated or lying down position?

Avoid Ashiatsu on the following blood pressure conditions:

1. If your client has a condition which is considered “uncontrolled”.

2. If the condition is considered “controlled” but medication lowers their blood pressure, and they experience lightheadedness or dizziness when in a heated environment, when working out
vigorously or when standing up from a resting position.

3.They bruise easily due to side effects from medication.


We recommend only working on healthy clients who have controlled blood pressure conditions, that do not experience adverse side effects from medication, heated environments, or vigorous workouts. To learn more about blood pressure and how it affects the body, check out the American Heart Association, where they have informative articles on low and high blood pressure, how heart rates interact with blood pressure, and more.



Helpful Tips: Communicate regularly throughout your session. We always advise students to check in at least one time per region of the body. When working on clients with high/low blood pressure or diabetic conditions, it’s best to check in more than usual and not have them in the prone position with their head in the head rest for more than 30 minutes.  Mix it up with some side lying Ashiatsu and always end with a minimum of 15-30 minutes of supine bodywork. After the massage assist them from a lying to a seated position, and stay close to the door when you leave the room, to assure they have gotten up and dressed without any complications. For diabetic patients, offer them orange juice or chocolate to help bring their blood sugar back up post treatment.


We recommend withholding Ashiatsu treatments and/or using precaution on the following circulatory conditions:

History of Deep Vein Thrombosis, Arteriosclerosis, Hemophilia, Prior heart attack, Aneurysm, Stroke, Pacemaker, Stent, Varicose Veins, Severe Anemia, Advanced Diabetes.


What to do if a client faints during a massage?

1. Check their pulse and breathing, if one or both are not happening immediately call 911 and start CPR.

2. If client has a pulse and is breathing, quickly try and find someone nearby to help you roll them onto their side or their back (if in prone position); use the bottom sheet to cocoon the client on both sides while rolling them over. When lying supine, prop pillows under their legs to promote venous and arterial flow to the heart & brain.

3. Call 911 if client does not start to come back to consciousness in 30 seconds or more.

4. Engage and ask the client questions to try to keep their attention and focus on you.

5. Always assist the client off the table and make sure someone is present while they are getting dressed. Call a friend, spouse or car service to come pick the client up and never let them drive.

6. Check out what the Mayo Clinic has to say about first aid applications when someone faints to learn more.


Final Thought: Keep in mind that not all clients are the same in their pathologies and their reactions to bodywork. If you are ever in doubt, withhold treatment completely and ask your client to receive a doctor’s clearance prior to treatment. Use the DeepFeet-provided Doctor Clearance Form to assure you are educating the doctor on the type of massage the client will be receiving and the pathologies that are contraindicated.



Special Thanks to Lisa Yao, Cardiologist and Ashiatsu Patient for helping us with this blog!

DeepFeet Bar Therapy, 2017