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116 Cards in this Set

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Local Contraindications
Localized swelling/inflammation
Localized broken area of skin/irritation
Acute Injury
Tumor sites
Complete Contraindications
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
Progression of inflammation
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
Clinical Presentation of Inflammation
*Pain, heat, redness, swelling
*Loss of function (esp. @ joints)
*Pus; itching; clotting
Main components of Inflammation
Chemical - histamine, cytokines
Vascular - vasocontriciton/vasodilation
Cellular - WBC, platelets
Define Wound
A break in continuity of any soft tissue. ie: incision, laceration, puncture, abrasion
Define Wound Healing
Process involving filling the gap in damaged tissue (wound)
Categories of body tissue
Functional tissues (parenchyma)
Support/Connective tissues (stroma)
Competing methods of wound healing
Regeneration of functional tissues
Laying down of connective tissue repair (scarring)
Modes/Types of Healing
Primary Intention
Secondary Intention
Describe Primary Intention
* 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
Describe Secondary Intention
*space defect present with wound (large area tissue loss)
*must fill defect, takes longer, more scar replacement
*heals w/ elastic & collagen fibers
When does process move from Primary to secondary?
Interference with simple healingie: infection will shift to secondary intention. Factors: adequate blood supply, infection, irritating agent, wound separeation, hormones, age
Wound healing massage implications
*avoid interfering w/ repair process
*wounds should be dry - no oil/lotion
*if acute, ROM mid range only
Wound healing massage goals
*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
Describe scar formation
Wound filled 24-48 hrs w/fibroblasts, macrophages, exudates, debris, budding capillaries
Pinkish tissue, Granulation Tissue which forms scar
3 Phases of scar formation
Inflammation
Proliferation
Maturation/Remodeling
Describe Inflammatory phase of Scar Formation
*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
Describe Proliferation phase of Scar Formation
*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
Describe Maturation/Remodeling phase of Scar Formation
*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
Describe remodeling of scar
*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
Define Fever
an abnormally high body temperature caused by an infectious source ie: virus or bacteria or tissue damage
Etiology of Fever
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
Clinical presentation of Fever
Elevated body temp 101 or higher
Shivering
Pale skin
Fatigue & malaise
Achiness
Massage implications of fever
Systemically contraindicated
Energetic work is OK if doesn't affect blood flow
Definition of spasm/cramp
Involuntary contraction of skeletal muscle(s)
Sprains are
tears to ligaments
Strains are
tears of muscle/muscle unit/tendon
Spasm involvement
more variable
may involve one muscles, part of a muscle, parts of several muscles
Cramp involvement
typically entire muscle
Spasm pain
vary, may come & go in waves

can shift location
Cramp pain
strong & acute
Spasm duration
varies
Cramp duration
typically a few minutes, possibly longer
Spasm - possible cause
nervous system attempt to deal w/ underlying injury or are of irritation (splinting)

Ischemia (pain spasm pain)
Cramp - possible cause
muscle fatigue stemming from metobolic imbalance

associated w/ exercise

dehydration & electrolyte imbalance
Spasm massage implications
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
Cramp massage implications
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
Sprain massage implications
Acute - local contraindication

Lymph drainage during sub acute

Passive ROM / Stretching

Reduces adhesions & influences healing process
Strain massage implications
Acute - local contraindication

Lymph drainage sub acute

Cross-Fiber/Linear friction for new/old scar tissue for efficiency of function

Stretches & strength exercises
Define Whiplash
Cervical acceleration-deceleration (CAD)
A collection of injuries including ligament sprains, muscle strains, joint trauma.
May include bone fracture, damaged discs, concussions, nerve impingement
What is the most common cause of disc herniation in the cervical spine?
Whiplash
Discuss Massage Implications for Whiplash
Avoid Mechanical, manipulative massage when acute
Energetic/reflexive are appropriate
Work conservatively
Define Tendonitis
Injury to tendons WITH inflammation
Discuss Massage Implications for Tendonitis
Help w/ development of scar tissue
Speed Healing
Reduce risk of future injury
XFiber, w/fiber, stretching, exercise useful
Reduce Adhesions
Name 2 common Tendonitis conditions
Lateral Epicondylitis (tennis elbow)
Medial Epicondylitis (golfer's elbow)
Describe Tenosynovitis
Irritation @ tenosynovial sheath, covering around tendons that cross bone expansions

deQuervain - Thumb
Wrist & Foot
Describe Carpal Tunnel Syndrome
Entrapment of the MEDIAN nerve @ the carpal tunnel
Clinical Presentation of Carpal Tunnel Syndrome
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
Discuss Massage Implications for Carpal Tunnel Syndrome
Depends on type of CTS
Helpful w/ edema, fibrosis, nerve entrapment in the arm, thoracic outlet
Stop if work worsens symptoms
Local contraindication
Rotator Cuff Syndrome
Most common cause shoulder pain

Muscle tear in SITS muscles

Supraspinatus most common
RC Syndrome Presentation
Painful movement - arm

Severe night pain - prevent sleep

May refer pain down arm

May have weakness in arm
Massage Implications RC Syndrome
Decrease Pain

Increase ROM

Avoid locally if acute

Assist w/ re-positioning

Follow w/ ice
Describe Frozen Shoulder
Stiff shoulder

Restricted & painful w/ active & passive movement
Massage implications Frozen Shoulder
Decrease Pain

Increase ROM

Support other practicioners & client
TMJ Disorders
Collection of problems in & around Temporomadibular Joint
TMJ Clinical Presentation
Jaw, neck, shoulder pain

Limited ROM @ jaw

Popping, locking

Bruxism

Ear pain

Headaches

Chronic subluxation of cervical vertebrae
TMJ - Similar Syndromes
Trigeminal Neuralgia - Cranial Nerve 5 (motor to mastication muscles)

Occipital Neuralgia - head pain, tight muscles
Massage Implications TMJ
Decrease stress, increase relaxation

Useful for bruxism, can halt or slow progress

Address referred pain patterns from trigger points
Describe Osteoporosis
Porous bones, calcium is removed faster than replaced

Women > Men 5:1
Osteoporosis Clinical Presentation
Kyphosis - hump often from fracture

Chronic or acute back pain

Spontaneous or compression fractures

Bone density tests don't show until > 30% loss
Massage implications Osteoporosis
Depends on client's resilience

May help with pain, tight muscles

Symptomatic relief, not undoing the process

Watch depth & ROM work
Describe Degenerative Joint Disease/Osteoarthritis
Wear & tear of synovial joints.

Considered non-inflammatory arthritis.

Effects weight bearing joints & often used joints.
Etiology Osteoarthritis
Most common type

Progression includes:
*Cartilage damage
*bony adaptation
*debris in joint capsule
*muscles react/adapt
Causes of Osteoarthritis
Lax ligaments

age

weight

dehydration

pounding stress

food triggers

repetetive joint trauma

possible genetic predisposition
Osteoporosis clinical presentation
Asymmentrically in joints around body

Pain & stiffness

Hips, knees, spine

Crepitus is common

Swelling only with overuse
Massage Implications Osteoarthritis
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
Describe Rheumatoid Arthritis
Autoimmune attack on synovial membranes & other tissues
Clinical Presentation RA
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
Massage implications FA
Avoid circulatory massage during flare

Appropriate in remission

Maintain/improve ROM

Reduce stress

Decrease pain

Can apply heat directly

Use caution joint replacements
Describe Gout
Inflammatory arthritic condition due to improper protein metabolism

aka gouty arthritis
Etiology of Gout
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
Describe Fibromyalgia
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
Massage Implications Fibromyalgia
Appropriate within pain tolerance

Be guided by client tolerance

Be patient w/ client

DONT treat tender points the same as Trigger Ponts
Describe Plantar Fasciitis
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
Upper Motor Neuron Injury involves.....
Spastic Paralysis

UMN - Brain spinal to spinal cord
Upper Motor Neuron Injury conditions
Brain Lesions

Cerebral Palsy

MS

ALS

Spinal Cord Injury
Massage Goals UMN Injury
Decrease Spasticity

Maintain Muscle Awareness

Increase circulation

Maintain mobility

Reduce Pain

Provide Encouragement
Contraindications for UMN Injury
Anything that might increase spasticity

Any vascualr risk present

Too vigorous a massage
Lower Motor Neuron Injury involves
Flaccid Paralysis

LMN Spinal Cord to muscle
Lower Motor Neuron Injury conditions
Spinal cord injury

Polio

Peripheral nerve lesions
Massage goals LMN injury
Help maintain tone

maintain muscle awareness

Increase circulation

Maintain mobility

Reduce pain

Provide encouragement
Contraindications for LMN injury
Anything that might compromise the stability of a joint

Any vascular risk that may be present

Too vigorous a massage
Describe Multiple Sclerosis
Inflammation, degeneration of myelin sheath in CNS
Etiology MS
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
Clinical Presentation MS
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
Massage Implications for MS
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
Amyotrohic Lateral Sclerosis
Progressive destruction of Motor Neurons in CNS & PNS

Lou Gehrig's disease

ALS
Clinical Presentation ALS
Stiffness, loss of coordination, usually starts distally & progresses to core

Painful as muscles atrophy & skeleton collapses

No impact on intellect

Differential diagnosis
Massage Implications ALS
Sensation stays intact

May help with pain related to degeneration

Work w/ health care team

Relaxation
Describe Parkinson Disease
Shaking palsy

Degeneration of motor center in brain
Etiology of Parkinson Disease
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
Clinical Presentation Parkinson Disease
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
Massage Implications for Parkinson Disease
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
Describe Alzheimer Disease
Progressive degeneration of the brain, leading to memory loss, personality changes & death
Etiology Alzheimer Disease
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
Massage implications Alzheimer Disease
Touch is calming influence, even in advanced stages

Beware of other accumulated disorders, inability to communicate verbally

Caregiver can help
Describe Bell Palsy
Damage to Cranial Nerve VII (facial nerve) motor control for the face
Etiology of Bell Palsy
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
Clinical presentation Bell Palsy
Unilateral flaccid paralysis of face

Can lead to corneal damage

Sudden onset

Not sharply painful

Taste distortion
Western Medical Treatment Bell Palsy
Self limited
Anti inflammatory meds, anti viral meds, antibiotics
Surgery if necessary
Massage Implications Bell Palsy
Sensation intact
Massage safe & IMPORTANT to maintain the health of facial muscles during recovery

Get information on underlying cause

Work w/ health care team
Describe Cerebral Palsy
Any of a group of injuries to the brain that occur prenatally, during birth or in early infancy
Etiology Cerebral Palsy
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
Clinical Presentation of CP
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
Massage Implications for CP
Can be useful for helping with muscle tone, balance between flexors & extensors

Be cautious when client cannot communicate well, areas of numbness
Describe Traumatic Brain Injury
Injury to brain, not related to disease
Clinical Presentation TBI
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
Massage Implications TBI
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
Describe Disc Disease
Nucleus pulposus or annulus fibrosis extends outside of normal borders, putting pressure on nerve tissue

Age leads to..... shrinking of nucleus, degeneration of annulus
Clinical Presentation Disc Disease
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)
Massage Implications for Disc Disease
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
Thoracic Outlet Syndrome
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
What are 3 types of Thoracic Outlet Syndrome?
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
Clinical Presentation TOS
Shooting pain
Numbness
Reduced sensation
weakness
parasthesia
Fullness, coldness, discoloration
Massage Implications TOS
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