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116 Cards in this Set
- Front
- Back
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Local Contraindications
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Localized swelling/inflammation
Localized broken area of skin/irritation Acute Injury Tumor sites |
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Complete Contraindications
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Fever
Multiple/large areas of inflammation Large areas of acute injury Current infection/noticeable start of infection (flu, cold, sinus infection) Active blood disorders Cancers prone to metatasis - leukemia, lymphoma Client under influence drugs/alcohol |
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Progression of inflammation
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Acute Vascular response
*vasoconstricion then vasodilation Immediate Cellular Response *Neutrophils followed by antibodies, platelets, clotting factors, blood clots woven Long Term Cellular Response *macrophages, lymphocytes, pus forms *fibroblasts produce delicate collegen to begin scar tissue Resolution & Maturation *Blood clots dissolved *Scar tissue becomes denser, aligns according to weight-bearing stress |
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Clinical Presentation of Inflammation
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*Pain, heat, redness, swelling
*Loss of function (esp. @ joints) *Pus; itching; clotting |
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Main components of Inflammation
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Chemical - histamine, cytokines
Vascular - vasocontriciton/vasodilation Cellular - WBC, platelets |
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Define Wound
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A break in continuity of any soft tissue. ie: incision, laceration, puncture, abrasion
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Define Wound Healing
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Process involving filling the gap in damaged tissue (wound)
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Categories of body tissue
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Functional tissues (parenchyma)
Support/Connective tissues (stroma) |
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Competing methods of wound healing
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Regeneration of functional tissues
Laying down of connective tissue repair (scarring) |
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Modes/Types of Healing
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Primary Intention
Secondary Intention |
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Describe Primary Intention
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* minimal tissue loss @ injury site
*wound edges are closely approximated *quick healing *little, minimal, or no scarring *exact tissue makeup with no functional or structural impairment |
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Describe Secondary Intention
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*space defect present with wound (large area tissue loss)
*must fill defect, takes longer, more scar replacement *heals w/ elastic & collagen fibers |
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When does process move from Primary to secondary?
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Interference with simple healingie: infection will shift to secondary intention. Factors: adequate blood supply, infection, irritating agent, wound separeation, hormones, age
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Wound healing massage implications
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*avoid interfering w/ repair process
*wounds should be dry - no oil/lotion *if acute, ROM mid range only |
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Wound healing massage goals
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*start w/ light effleurage
*gradually progress to more vigorous techniques if needed *decrease pain & edema w/relaxing techniques *prevent or reduce adhesions - promote healthy, mobile scar *maintain ROM *encouragement & support |
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Describe scar formation
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Wound filled 24-48 hrs w/fibroblasts, macrophages, exudates, debris, budding capillaries
Pinkish tissue, Granulation Tissue which forms scar |
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3 Phases of scar formation
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Inflammation
Proliferation Maturation/Remodeling |
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Describe Inflammatory phase of Scar Formation
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*1-4 days RICE
*edema, pai, redness/warmth, muscle spasm, decreased ROM *prepares wound for healing *no direct work on affected area *energy work is OK |
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Describe Proliferation phase of Scar Formation
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*2 days to several weeks
*decreasing pain, swelling, inflammation, decreased ROM *growth factors from macrophages & fibroblasts (collagen) *heavy collagen synthesis *light circulatory assist; decrease swelling; clear waste/debris |
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Describe Maturation/Remodeling phase of Scar Formation
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*several weeks to months, years
*pain, muscle weakness, NO inflammation, risk or scarring & deformity *More aggressive work for remodeling & restoring function *Granulation tissue is sety be end of inflammatory phase *Collagen synthesis by fibroblasts peaks 5-7 days *Collagen fibers mature, shortening, tightening wound, scar blanches & shrinks |
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Describe remodeling of scar
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*continues for weeks to 6 months or more
*continued collagen formation & lysis *occurs along the lines of stress *architecture of scar reorganizes to meet demands of tissue *can return to 70-80% of original strength |
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Define Fever
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an abnormally high body temperature caused by an infectious source ie: virus or bacteria or tissue damage
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Etiology of Fever
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Infection
WBC attack pathogen & display antigen WBC release chemicals to circulate toward brain Chemicals reach hypothalamus, sending signals to body to increase core body temp Shivering begins & superficial cappilaries constrict & metabolism increases |
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Clinical presentation of Fever
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Elevated body temp 101 or higher
Shivering Pale skin Fatigue & malaise Achiness |
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Massage implications of fever
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Systemically contraindicated
Energetic work is OK if doesn't affect blood flow |
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Definition of spasm/cramp
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Involuntary contraction of skeletal muscle(s)
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Sprains are
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tears to ligaments
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Strains are
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tears of muscle/muscle unit/tendon
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Spasm involvement
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more variable
may involve one muscles, part of a muscle, parts of several muscles |
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Cramp involvement
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typically entire muscle
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Spasm pain
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vary, may come & go in waves
can shift location |
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Cramp pain
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strong & acute
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Spasm duration
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varies
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Cramp duration
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typically a few minutes, possibly longer
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Spasm - possible cause
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nervous system attempt to deal w/ underlying injury or are of irritation (splinting)
Ischemia (pain spasm pain) |
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Cramp - possible cause
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muscle fatigue stemming from metobolic imbalance
associated w/ exercise dehydration & electrolyte imbalance |
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Spasm massage implications
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respect splinting
focus on reducing spasm to allow muscle to relax increase circulation, flushing waste & bring in nutrients decrease pain improve posture cold therapy following session |
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Cramp massage implications
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determine primary cause, ensure not contraindication
acute cramping - stretch tendons & antagonists (no fluffing) Use care w/ deep work Decrease pain Flush waste, bring in nutrients & oxygen |
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Sprain massage implications
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Acute - local contraindication
Lymph drainage during sub acute Passive ROM / Stretching Reduces adhesions & influences healing process |
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Strain massage implications
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Acute - local contraindication
Lymph drainage sub acute Cross-Fiber/Linear friction for new/old scar tissue for efficiency of function Stretches & strength exercises |
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Define Whiplash
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Cervical acceleration-deceleration (CAD)
A collection of injuries including ligament sprains, muscle strains, joint trauma. May include bone fracture, damaged discs, concussions, nerve impingement |
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What is the most common cause of disc herniation in the cervical spine?
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Whiplash
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Discuss Massage Implications for Whiplash
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Avoid Mechanical, manipulative massage when acute
Energetic/reflexive are appropriate Work conservatively |
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Define Tendonitis
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Injury to tendons WITH inflammation
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Discuss Massage Implications for Tendonitis
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Help w/ development of scar tissue
Speed Healing Reduce risk of future injury XFiber, w/fiber, stretching, exercise useful Reduce Adhesions |
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Name 2 common Tendonitis conditions
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Lateral Epicondylitis (tennis elbow)
Medial Epicondylitis (golfer's elbow) |
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Describe Tenosynovitis
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Irritation @ tenosynovial sheath, covering around tendons that cross bone expansions
deQuervain - Thumb Wrist & Foot |
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Describe Carpal Tunnel Syndrome
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Entrapment of the MEDIAN nerve @ the carpal tunnel
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Clinical Presentation of Carpal Tunnel Syndrome
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Numbness/tingling/sharp shooting pain into lateral to middle hand
Can lead to perm. atrophy of the thenar area w/ weakness to muscles Tinel's test/ Phalen's maneuver Nerve conduction test Rule out other contributing factors/conditions *Neck Injuries *Shoulder Injuries *Thoracic Outlet Syndrome *Nerve entrapment/elongation (pronator teres) *other wrist injuries |
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Discuss Massage Implications for Carpal Tunnel Syndrome
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Depends on type of CTS
Helpful w/ edema, fibrosis, nerve entrapment in the arm, thoracic outlet Stop if work worsens symptoms Local contraindication |
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Rotator Cuff Syndrome
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Most common cause shoulder pain
Muscle tear in SITS muscles Supraspinatus most common |
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RC Syndrome Presentation
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Painful movement - arm
Severe night pain - prevent sleep May refer pain down arm May have weakness in arm |
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Massage Implications RC Syndrome
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Decrease Pain
Increase ROM Avoid locally if acute Assist w/ re-positioning Follow w/ ice |
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Describe Frozen Shoulder
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Stiff shoulder
Restricted & painful w/ active & passive movement |
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Massage implications Frozen Shoulder
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Decrease Pain
Increase ROM Support other practicioners & client |
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TMJ Disorders
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Collection of problems in & around Temporomadibular Joint
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TMJ Clinical Presentation
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Jaw, neck, shoulder pain
Limited ROM @ jaw Popping, locking Bruxism Ear pain Headaches Chronic subluxation of cervical vertebrae |
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TMJ - Similar Syndromes
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Trigeminal Neuralgia - Cranial Nerve 5 (motor to mastication muscles)
Occipital Neuralgia - head pain, tight muscles |
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Massage Implications TMJ
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Decrease stress, increase relaxation
Useful for bruxism, can halt or slow progress Address referred pain patterns from trigger points |
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Describe Osteoporosis
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Porous bones, calcium is removed faster than replaced
Women > Men 5:1 |
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Osteoporosis Clinical Presentation
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Kyphosis - hump often from fracture
Chronic or acute back pain Spontaneous or compression fractures Bone density tests don't show until > 30% loss |
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Massage implications Osteoporosis
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Depends on client's resilience
May help with pain, tight muscles Symptomatic relief, not undoing the process Watch depth & ROM work |
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Describe Degenerative Joint Disease/Osteoarthritis
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Wear & tear of synovial joints.
Considered non-inflammatory arthritis. Effects weight bearing joints & often used joints. |
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Etiology Osteoarthritis
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Most common type
Progression includes: *Cartilage damage *bony adaptation *debris in joint capsule *muscles react/adapt |
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Causes of Osteoarthritis
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Lax ligaments
age weight dehydration pounding stress food triggers repetetive joint trauma possible genetic predisposition |
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Osteoporosis clinical presentation
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Asymmentrically in joints around body
Pain & stiffness Hips, knees, spine Crepitus is common Swelling only with overuse |
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Massage Implications Osteoarthritis
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Local contraindication if inflammation is present
Maintain ROM & reduce muscle spasm Increase circulation Decrease pain Passive/Active stretching beneficial Heat is recommended Caution @ joint replacements |
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Describe Rheumatoid Arthritis
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Autoimmune attack on synovial membranes & other tissues
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Clinical Presentation RA
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Joints involved - bilateral & symmetrical
Common in fingers, hand, wrist, feet & knees Spinal joint limited to cervical spine fatigue, weight loss, anorexia, fear, generalized aching, stiffness common 1st episode preceded by weeks/months of malaise Rheumatic nodules Flare - inflammation, Flare followed by remission |
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Massage implications FA
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Avoid circulatory massage during flare
Appropriate in remission Maintain/improve ROM Reduce stress Decrease pain Can apply heat directly Use caution joint replacements |
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Describe Gout
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Inflammatory arthritic condition due to improper protein metabolism
aka gouty arthritis |
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Etiology of Gout
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Due to improper metabolism of proteins
Uric acid build up & crystallizes, deposits in joints Most common in big toe Also thumb, hand, foot Men>Women |
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Describe Fibromyalgia
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Fiber muscle pain
aka fibrositis, myofibrositis, fibromyositis Whole body - common in women tender points - 9 pairs, all 4 quadrants, 11 of 18 must be positive, widespread pain Tender points are hypertonic Exacerbated w/ presssure Stiffness after rest, poor stamina Hypersensitivity |
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Massage Implications Fibromyalgia
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Appropriate within pain tolerance
Be guided by client tolerance Be patient w/ client DONT treat tender points the same as Trigger Ponts |
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Describe Plantar Fasciitis
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Inflammation of plantar fascia
Common in runners & overwieght Acutely painful on first movement after rest, then subsides Bruised feeling @ anterior aspect of calcaneus Massage can help w/ healthy scar tissue & reducing tension in deep calf flexors |
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Upper Motor Neuron Injury involves.....
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Spastic Paralysis
UMN - Brain spinal to spinal cord |
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Upper Motor Neuron Injury conditions
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Brain Lesions
Cerebral Palsy MS ALS Spinal Cord Injury |
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Massage Goals UMN Injury
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Decrease Spasticity
Maintain Muscle Awareness Increase circulation Maintain mobility Reduce Pain Provide Encouragement |
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Contraindications for UMN Injury
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Anything that might increase spasticity
Any vascualr risk present Too vigorous a massage |
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Lower Motor Neuron Injury involves
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Flaccid Paralysis
LMN Spinal Cord to muscle |
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Lower Motor Neuron Injury conditions
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Spinal cord injury
Polio Peripheral nerve lesions |
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Massage goals LMN injury
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Help maintain tone
maintain muscle awareness Increase circulation Maintain mobility Reduce pain Provide encouragement |
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Contraindications for LMN injury
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Anything that might compromise the stability of a joint
Any vascular risk that may be present Too vigorous a massage |
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Describe Multiple Sclerosis
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Inflammation, degeneration of myelin sheath in CNS
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Etiology MS
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Myelin in CNS is attacked & replaced with scar tissue
Electrical insulation is lost, prevents proper impulse transmission Inflammation damages myelin & nerve tissue Prob. Autoimmune Flare/remission Efffects motor, sensory & cognition Common in those far from equator Whites & women more than other groups |
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Clinical Presentation MS
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Fatigue, weakness, spasm, difficulty walking
changes in sensation, paresthesia, reduced sensation, numbness optic neuritis Urologic & sexual dysfunction loss of cognitive function depression Lhermitte's sign - test Digestive Disturbance Flare/remission Differenctial diagnosis |
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Massage Implications for MS
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Most appropriate in remission
Pt. has poor tolerance for rapid tem changes - avoid heat/cold Watch for accurate sensation, be conservative in numb areas Energetic work is ok during flare MT1 techniques appropriate as disease progresses |
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Amyotrohic Lateral Sclerosis
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Progressive destruction of Motor Neurons in CNS & PNS
Lou Gehrig's disease ALS |
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Clinical Presentation ALS
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Stiffness, loss of coordination, usually starts distally & progresses to core
Painful as muscles atrophy & skeleton collapses No impact on intellect Differential diagnosis |
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Massage Implications ALS
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Sensation stays intact
May help with pain related to degeneration Work w/ health care team Relaxation |
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Describe Parkinson Disease
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Shaking palsy
Degeneration of motor center in brain |
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Etiology of Parkinson Disease
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Substantia Nigra die off - can't make dopamine which is needed by basal ganglia (motor center in brain)
Causes: unknown, environmental, repeated head trauma, death of substantia nigra Men > women 3:2 1.5 M in US |
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Clinical Presentation Parkinson Disease
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Primary - non specific pain, fatigue, resting tremor, bradykinesia, rigidity, poor postural reflexes
Secondary - Shuffling gait, changes in speech, changes in handwriting, sleep disorders, depression, mental degeneration |
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Massage Implications for Parkinson Disease
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May be appropriate
Helpful w/ muscle stiffness & quality of life issues Clients have trouble w/ table Elderly clients may have other conditions Rigidity is safer for massage than spasticity Full body work is best Can do ROM & Stretching |
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Describe Alzheimer Disease
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Progressive degeneration of the brain, leading to memory loss, personality changes & death
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Etiology Alzheimer Disease
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Plaques - sticky deposits of beta amyloid trigger inflammatory response
Neurofibrility tangles: proteins degenerate, causing neurons to collapse & move out of relationship to each other Low neurotransmitters - as neurons degenerate, less neurotransmitters are produced, fewer synapses are functional |
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Massage implications Alzheimer Disease
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Touch is calming influence, even in advanced stages
Beware of other accumulated disorders, inability to communicate verbally Caregiver can help |
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Describe Bell Palsy
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Damage to Cranial Nerve VII (facial nerve) motor control for the face
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Etiology of Bell Palsy
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Reactivation of herpes simplex virus puts pressure on CN VII
Lyme disease connection Depressed immunity, lack of sleep, stress may trigger episode 75% cases preceded by cold Could be tumor, bone spur, other mechanical irritation |
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Clinical presentation Bell Palsy
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Unilateral flaccid paralysis of face
Can lead to corneal damage Sudden onset Not sharply painful Taste distortion |
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Western Medical Treatment Bell Palsy
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Self limited
Anti inflammatory meds, anti viral meds, antibiotics Surgery if necessary |
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Massage Implications Bell Palsy
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Sensation intact
Massage safe & IMPORTANT to maintain the health of facial muscles during recovery Get information on underlying cause Work w/ health care team |
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Describe Cerebral Palsy
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Any of a group of injuries to the brain that occur prenatally, during birth or in early infancy
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Etiology Cerebral Palsy
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Damage to basal ganglia & cerebrum
Multifactoral problems Prenatal causes: *maternal illness - infection, hyperthyroidism, diabetes, Rh sensitivity Birth trauma: anoxia/asphyxia, head trauma Acquired CP - head trauma in infancy, infection, hemorrhage, neoplasm |
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Clinical Presentation of CP
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Spastic CP - most common, spasticity & clasp knife effect (flexors win the battle for tightness, extensors give up)
Athetoid CP - 30% weak muscles, writhing movements Ataxic CP <10%, chronic shaking & tremors, poor balance Mixed CP - any combination of the above |
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Massage Implications for CP
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Can be useful for helping with muscle tone, balance between flexors & extensors
Be cautious when client cannot communicate well, areas of numbness |
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Describe Traumatic Brain Injury
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Injury to brain, not related to disease
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Clinical Presentation TBI
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May result from skull fracture, penetrating wound, concussion, contusion, internal tearing, low oxygen, hemorrhage, hematoma, edema
Depends on location & severity of injury Frontal lobe most common - language & motor dysfunction Injuries closer to brainstem lead to massive loss of function Seizures, cognitive dysfunction, movement disorders, emotional volatility |
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Massage Implications TBI
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Can be helpful for rehab, maintenance
Can work for best efficiency of muscles, connective tissue Get info about type of injury, possible complications Work w/ health care team |
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Describe Disc Disease
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Nucleus pulposus or annulus fibrosis extends outside of normal borders, putting pressure on nerve tissue
Age leads to..... shrinking of nucleus, degeneration of annulus |
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Clinical Presentation Disc Disease
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Local & radicular pain
Specific muscle weakness, only in muscles supplied by irritated rerve root Parasthesia Numbness Caution - Spinal Cord compression * cauda equina syndrome (severe muscle weakness, ED, Urinary & Bowel incontinence) |
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Massage Implications for Disc Disease
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Work w/ rest of health care team
Work to create more room for injured disc to recede Helps flush out toxins & bring healthy fluid to disc Respect muscle splinting Postiioning - prone may be uncomfortable Don't work directly over herniated/injured disc |
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Thoracic Outlet Syndrome
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Neurovascular entrapment of the brachial plexus or the blood vessels running to & from the arm
Entrapment can ooccur in 1 or more of 3 places - betw. ant. & middle scalenes, betw. clavicle & 1st rib, under coracoid process |
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What are 3 types of Thoracic Outlet Syndrome?
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True neurogenic TOS (traceable w/ nerve tests)
True vascular TOS (traceable w/ blood vessel tests) Nonspecific or disputed TOS (symptoms are present, tests are negative) - most common |
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Clinical Presentation TOS
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Shooting pain
Numbness Reduced sensation weakness parasthesia Fullness, coldness, discoloration |
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Massage Implications TOS
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Depends on contributing factors - if musculare then will do well with massage
Useful for muscle imbalance Encourage stretching & strengthing exercises to scalenes, pec minor & antagonists |
