Massage: INDICATIONS AND CONTRAINDICATIONS

Question 1

Indications for Massage

Answer 1

1. Pain
2. Edema
3. Muscle Spasm
4. Trigger Points
5. Insufficiencies of Circulation
6. Contracted Tissues
7. Specific or general Relaxation

Question 2

Painful Musculoskeletal

Answer 2

Back pain

General orthopedic conditions

Post-operative conditions

Fibromyalgia

Degenerative joint conditions

Question 3

Types of Edema

Answer 3

Local - Edema is confined to an area (ex. ligament sprain)

Systemic Edema - Occurs throughout the body (ex. Congestive Heart Failure)

Lymphedema - Edema resulting from compromise of lymphatic system, tends to be regional. (ex. Removal of cancerous lymph nodes)

Question 4

Functions of the Lymphatic System

Answer 4

1. Remove excess fluids from tissues
2. Absorbtion of fatty acids and subsequent transport of fat to the circulatory system
3. Production of immune cells

Question 5

Lymphedema

Answer 5

Is an accumulation of high-protein fluid that can collect in any body part, but most typically in arms or legs. It usually occurs when the lymph vessels or lymph nodes are blocked or removed.

Question 6

Primary Lymphedema

Answer 6

Is a rare and congenital. Caused by poor development of lymph vessels. (ex.Milroys Disease)

Question 7

Secondary Lymphedema

Answer 7

Is caused by damage to lymph vessels or nodes. May result from surgery, radiation, or infection.

Question 8

Lymphedema Massage

Answer 8

Manual Lymphatic Drainage: form of massage utilizing light pressure (30-40mmHg) and brush like strokes to encourage the movement of lymph through lymphatic vessels and lymph nodes.

Question 9

Muscle Spasms

Answer 9

Involuntary contraction due to inflammation, irritation

Often are tissues that are gaurding other injured tissues.

Question 11

Muscle Spasm Massage Purpose

Answer 11

Used to relax muscle spasms

Help local blood flow.

reduce pain associated with spasm

Helps break the pain - spasm - pain cycle

Question 12

Trigger Points

Answer 12

A focus of irritability in a tissue that, when compressed, is locally tender and, if sufficiently hypersensitive gives rise to referred pain and tenderness, and sometimes are reffered to autonomic phenomena and distortion of proprioception,

Question 13

Benefits of Massage and Relaxation

Answer 13

Relaxation is a nice side effect which can enable us to carry out other treatments.

Question 14

Contraindications

Answer 14

1. When increased circulation is not desired
2. Severe Distress (severe pain, febrile state)
3. Contagious skin condition
4. Over foreign bodies or sharp bony prominences
5. Massage Too soon: Acute conditions
6. Areas of decreased sensation
7. Over Recent surgery
8. Systemic Edema
9. Areas of Active Bone growth
10. Tuberculosis
11. Pregnancy (over abdomen)

Question 15

Conditions where increased Circulation is not Desired

Answer 15

Systemic Edeman - Occurs throughout the body (ex Congestive Heart failure. If you push back too much fluid it overwhelms the heart leading to more damage)

Primary Lymphedema - Edema resulting from compromise ot the lymphatic system

Infections - May be spread by blood or by lymph (ex. Osteomyelitis, Septic arthritis, dermatitis, cellulitis, myositis

Blood Clots - DVT mechanical stimulation can break down clot and release to freely roam.

Question 16

Contraindication for Severe Distress

Answer 16

Do not perform massage on patient that has severe distress or is in a febrile condition.

Physically ill or Nauseated

Is in severe pain

Has a fever or a systemic process occuring.

Question 17

Skin Conditions (Contraindications)

Answer 17

Avoid massage in areas where a condition may be contagious or worsened or spread by applying pressure or rubbing,.

Rashes

Boils

Athlete’s foot

Allergies (oils or lotions always good to double check)

Question 18

Foreign Bodies or sharp prominences (contraindication)

Answer 18

Massage can shear and compress tissues.

Massage over foreign bodies (nails, screws, shrapnel) or over sharp bony prominences (scap, Shoulder) may lead to tissue damage.

Question 19

Acute Conditions (contraindications)

Answer 19

Massaging leaking or damaged blood vessels will increase bleeding and form edema.

Should wait a minimum of 48 hours after acute episode.

If you massage too early you may damage the cellular and fibrous network and delay healing.

Avoid massaging any conditions with the ending “itis” (RA, Phlebitis- vein inflammation)

Question 20

Areas of Decreased Sensation (Containdication)

Answer 20

Patients cannot give proper feedback.

(diabetes, stroke, spinal cord injury, frostbite)

Question 21

Recent Surgery / Loss of structural function (contraindication)

Answer 21

Careful of MD’s protocol, special care taken with scar massage techniques.

SKin grafts - tisssue may not accomodate shearing forces.

Question 22

Active Bone growth (Contraindication)

Answer 22

Healing fracture site

Myositis Ossificans

Osgood-Schlatters Disease

Severs disease

Question 23

Tuberculosis (Contraindication)

Answer 23

Highly contagious bacterial infection that usually begins in the lungs, Spread through bodily fluids (especially coughing and spitum).

Goal is to avoid distributing or spreading the infection through massage.

Question 24

Pregnancy

Answer 24

Jusat dont rub over the baby.

Question 25

Precautions

Answer 25

Hematomas

Non-union Fractures

Herniated Disks

Debilitated patients

Malignancies

Conditions with collagen weakening (steriods, diabetes, RA)