Body Art: Tattoos and Piercings

By Ruth Werner, LMP, NCTMB
May 29, 2009

Body Art: Tattoos and Piercings

By Ruth Werner, LMP, NCTMB
May 29, 2009

A couple of years ago, I was teaching a class about massage and the parasympathetic effect. To make my point, I stood behind a student, put my hands on her trapezius and then began to do some gentle petrissage through her sweater. Chatting blithely away about blood vessel dilation, changes in breathing, and dropping blood pressure, I failed to notice that this poor, polite student was not enjoying her massage. She was wincing, tightening up and leaning away. When I finally noticed and asked her what was going on, she said she had just had a big tattoo put on her shoulders. The whole class gasped in sympathy.

On a related topic, a reader named Tamra sent me this note: "I was standing behind a person in the grocery store with surgical steel ball implants in her cervical area (bilaterally) from about C3 to C7, in what would be considered the lamina groove. I wondered as I was standing there: If she were my client and she had neck pain, what would I do? How would I treat her? I had no answers, only avocados."

I know that I am a good deal older than many of my peers in the massage profession, and I freely confess to being a bit of a fogey about body art. I was so grateful that the threat, "Whatever you have pierced, I'll have pierced. And then I'll show all your friends," worked on my children and I never had to shop for a navel ring. That said, for many people tattoos, piercings and other physical modifications are a mode of self-expression that is important and deeply meaningful. While, like anything, body art can be abused, it can also be very creative and empowering. In the words of Andy Barnett, a professional piercer and tattoo artist, "I want to adorn the body, not mutilate it."

Many of us have clients with various forms of body art. Under some circumstances this can require some adjustments in our work. This article offers a brief primer on tattoos and piercings, the challenges that they may pose for massage, and strategies that can help us be safe and effective practitioners in this context.


Tattoos are pictures drawn on the skin through shallow injections of colored ink. Tattoo artists use tiny needles and a rapidly pulsating machine to deposit the ink just under the skin. Standards for hygiene in licensed tattoo studios are high, so the risk of infection from contaminated equipment is minimal. With "garage artists," this is not always the case, meaning blood-borne infections like HIV, or hepatitis B or C can be spread this way.

The dyes in tattoo ink can be a problem for some people. While inks are safer than they used to be, a lack of regular oversight means that not all inks are hypoallergenic. Allergic reactions are rare, but not unheard of. Because they most often occur in reaction to any color in the red family, new tattoo clients may be counseled to begin using red in small amounts until they know how they'll react. Reactions can cause itching, blisters and bumps (called granulomas) around the edges of a tattoo.

A person with a new tattoo is usually counseled to cover it for a day, avoid submerging it in water for up to two weeks, and rub it frequently with ointment and then with unscented lotion to promote speedy healing. New tattoos involve compromised skin - an obvious contraindication for massage. After the initial tenderness subsides, many people experience intense itching for a few days. This is another caution for massage, which can make itching worse by drawing blood to an area. The safest course in this situation is to wait for any pain and itching to resolve before doing massage in an area with a new tattoo.


Piercings are self-evident, and the variety of body parts that are pierced continues to expand. I remember being both shocked and vastly curious the first time we had a massage student with a nipple ring. (In my own defense, I will point out that these were the days when it was daring to have more than one hole in an earlobe.)

Piercings involve using a special needle to penetrate the skin. Various types of instruments are then inserted into the opening and secured from both sides. The piercing heals when scar tissue forms a tunnel around the instrument. The young woman Tamra described had several long instruments that were inserted to reach horizontally under her skin across the back of her neck.

Depending on the site, piercings can take anywhere from a few weeks to several months to heal completely. At that time, jewelry can be removed and replaced easily. (There's the answer to Tamra's question, by the way: She can take the studs out of her neck to receive massage, if necessary.) Most piercing jewelry is made of surgical steel. Surface piercings, like those on the young woman with the nape studs, have a relatively high rejection rate, but they tend to be most successful when the jewelry is made of surgical-grade Teflon or acrylic, which can conform to the body's curvature. While piercings are healing, the person is advised to keep the area clean and avoid letting anything like hair or clothing catch on the jewelry.

The size of the jewelry is an important safety factor. If it is too short, it can be drawn into the skin, and if it is too long, it can create unnecessary friction as it rubs on nearby structures. Tongue studs that are the wrong size are notorious, for instance, for causing damage to teeth and gums. Other risks with piercings include the possibility of excessive scar tissue or keloids, or trauma if the jewelry is torn out.

Guidelines for massage in the context of piercings are clear: New piercings involve injured skin and must be locally avoided until the lesion has scarred over. On the other hand, older piercings pose no contraindications, and the jewelry can be removed to make massage more effective whenever necessary.

Many thanks to Tamra, who posed this interesting question, and to Andy Barnett of Frankie's Tattoo in Clearfield, Utah, who generously allowed himself to be interviewed for this article. For next time, the floor is once again open. We can continue in this vein with additional information about body art (implants, braiding, scarification, etc.), or we can pick up something entirely different. It's up to you: What's on your table?

Until then, many thanks and many blessings.


  1. Body Art Establishments: Frequently Asked Questions. Cambridge Public Health Department.
  2. Piercings: Proper Care Can Help Prevent Complications. Mayo Foundation for Medical Education and Research.
  3. Tattoos: Risks and Precautions to Know First. Mayo Foundation for Medical Education and Research.
  4. Health and Safety of Tattoo Artists, Body Piercers, and Their Clients. National Institute for Occupational Safety and Health and Divisions of HIV/AIDS prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.
  5. Shagam JY. "Tattoo Safety." UNM Hospitals Health Quarterly Newsletter, Summer 2005;14(2).