SUBJECT 4 Foundations of Massage 2 - Evolve€¦ · This section of Foundations of Massage 2 describes the medical terminology that the massage professional most often encounters,

Subject 04 Foundations of Massage 2 Evolve College 2015 Page 1

SUBJECT 4

Foundations of Massage 2

HLT50307 Diploma of Remedial Massage HLT40312 Certificate IV in Massage Therapy Practice

studymassage.com.au National Office: 98 York Street South Melbourne Victoria 3205

© Evolve College Pty Ltd, 2015 This document is copyright. No part of this document may in any form or by any means (electronic, mechanical, micro copying, photocopying, recording or otherwise) be reproduced, stored in a retrieval system or transmitted without permission.

Contents

Subject Details ...................................................................................................... 5

General Information ................................................................................... 5

Suggested Lesson sequence ................................................................ 5

Suggested Equipment for Practical Component .......................... 5

Assessment ................................................................................................... 6

Final Subject Result ................................................................................. 6

Practical Assessment ............................................................................... 6

Medical Terminology.......................................................................................... 8

Competencies .............................................................................................. 8

Objectives ...................................................................................................... 8

Key Terms....................................................................................................... 8

Introduction .................................................................................................. 9

Fundamentals of Medical Terminology ............................................... 9

Terms Related to Diagnosis and Diseases ..................................... 11

General Structural Plan of the Body .................................................... 13

Anatomical Position .............................................................................. 16

Midline of the Body ............................................................................... 16

Fundamental Divisions of the Body................................................. 17

Abdominal Quadrants and Regions ................................................ 19

Body Regions ........................................................................................... 20

Directional Terms ................................................................................... 23

Body Planes .............................................................................................. 27

Body Cavities ............................................................................................ 30

Medical Imaging Devices ....................................................................... 31

Structure of the Body ............................................................................... 33

The Skeletal System ............................................................................... 33

The Muscular System ............................................................................ 35

The Nervous System .............................................................................. 36

The Cardiovascualar System............................................................... 38

The Lymphatic System ......................................................................... 39

The Immune System ............................................................................. 40

The Respiratory System ........................................................................ 40

The Digestive System ............................................................................ 41

The Endocrine System .......................................................................... 42

The Integumentary System ................................................................ 43

Summary ...................................................................................................... 43

Indications and Contraindications ............................................................... 44

Competencies ............................................................................................ 44

Objectives .................................................................................................... 44

Key Terms..................................................................................................... 45

Introduction ................................................................................................ 46

Indications for Massage .......................................................................... 46

Approaches to Care .................................................................................. 48

Therapeutic Change .............................................................................. 48

Condition Management ...................................................................... 48

Palliative Care .......................................................................................... 49

Pathology, Health and Therapeutic Massage .................................. 62

Disease ....................................................................................................... 63

Functioning Limits ................................................................................. 63

Development of Pathology ................................................................ 63

Pathological Conditions and Indications for Massage.............. 64

Contraindications to Massage Therapy ............................................. 67

Tumors and Cancer ................................................................................ 68

Medications .............................................................................................. 69

Endangered Sites.................................................................................... 69

Referrals ..................................................................................................... 70

Summary ................................................................................................... 70

Subject Details

Welcome to training with Evolve College.

Evolve College aims to bring massage awareness, education and recognition to the community as a valued means of health care.

Massage is perhaps one of the most popular forms of complimentary health care. In recent times massage has become much more formalised and massage associations have been formed to promote the science of massage as well as to safeguard the interests of the public and the profession.

Evolve College is a Nationally Accredited course provider and as such is listed on the National Register of Providers. This is your assurance that the College is a nationally recognised educator offering approved courses and administration services.

General Information

Suggested Lesson sequence

In order to gain the most from each lesson it is suggested that you work through them in the order they are presented.

Suggested Equipment for Practical Component

Equipment required for this subject includes:

Two large size towels (Beach Towel size) or two cotton sheets

Two smaller towels

One pillow or footroll

Massage oil (cold pressed vegetable oil) - do not use baby oil

A massage table (you do not need to bring your massage table to class)

Isowipes, viraclean or any equivalent hospital grade disinfectant

Assessment

Depending on the subject, the type and number of assessments will vary, and may include theory assessments such as Multiple Choice, Short Answer, True/False questions; Matching Exercises; Assignments and Project Reports and practical assessments such as Role plays and Demonstrations.

Access your assessments via the Student Portal - Student Login on the bottom of the Homepage. Answers will only be accepted and recorded through the Student Portal.

Clinic Log Book

Your Clinic Log Book is used to record practical massage hours for this subject.

When can l start my Log Book?

Once you have practiced all the techniques in this subject and feel confident in applying these techniques within a massage treatment you are ready to complete the required Log Book entries.

Your treatments should be performed without referring to your manual and must relate to the subject being studied.

Refer below for details on your Log Book entries.

How to complete the Log Book:

ý Access the Student Portal via the Student Login (bottom of Homepage)

ý Log books will only be accepted and recorded through the Student Portal

STEP 1 Record your Log Book hours

Enter a minimum of 15 hours of massage treatments in your on-line Log Book

To successfully complete your Log Book entries, you must list details under Date, Gender, Description, Age and Duration

Add comments if required

STEP 2 Confirm completion of your Log Book

Record completion of this task by clicking on the final submission tab Submit Log Book

Final Subject Result

When you have completed all the required assessments for the subject you will receive a Satisfactory or Unsatisfactory result. For further details refer to your Student Portal and Student Handbook.

Practical Assessment

This subject requires you to undertake several practical assessments. These will be in the form of role plays and demonstrations including 1 Hour Full Body Relaxation Massage Treatments.

1 Hour Full Body Relaxation Massage Treatment

You will be required to demonstrate relaxation massage techniques from:

Introductory Massage



Further details on practical assessments are provided in the Massage Practice 1 Subject, Student Portal/Hub - Assessments, Student Handbook and at the end of this manual.

Medical Terminology

Textbook Reference: FUNDAMENTALS of Therapeutic Massage, 5th

Ed. Chapter 4 - Massage and Medical Terminology for Professional Record Keeping

This section of Foundations of Massage 2 describes the medical terminology that the massage professional most often encounters, particularly as it relates to charting and record-keeping procedures. To study this section, you may find a medical dictionary or Google beneficial to search certain medical terms. Exploring medical terminology automatically provides an overview of anatomy and physiology. This section is not meant to replace an anatomy and physiology text, but rather to provide a quick reference in preparation for the development of effective record-keeping and charting skills. When used with a standard anatomy and physiology textbook, this section can help focus the information so that it is more specific to the field of massage.

Competencies

After completing this section, you should be able to:

Identify the three word elements used in medical terms

Combine word elements into medical terms

Comprehend unfamiliar medical terms

Identify pertinent abbreviations used in health care and their meanings

Use relevant anatomic and physiologic terminology correctly

Use the information in this chapter for effective professional record keeping

Objectives

Using the information presented in this section, you will be able to perform the following:

Medical Terminology Define words by breaking them down into their word elements Identify indications for and contraindications to massage List and define anatomic and physiologic terms by body system List and identify common abbreviations

Key Terms

The following key terms are referred to in this section:

Abbreviations Assessment Body, mind, and spirit Bodywork Care or treatment plan Charting Client Client records Clinical massage Contraindication

Modality Motor tone Muscle tone Nomenclature Patient Physical agent Prefix Progress or session notes Qualifiable Quantifiable

Database Deep tissue Deep tissue work/massage Discipline Documentation Goals Indication Language Massage therapist Massage therapy Medical massage Mobilization

Root word SOAP notes Soft tissues Special tests Standards of care Standards of practice Suffix Taxonomy Technique Terminology Therapeutic process Wellness

Introduction

The study of medical terminology provides a key to understanding the accepted language of the sciences. As massage therapy again moves into the position of a medically valid service, the massage professional will find it increasingly important to be able to speak, write and understand scientific language. In addition, the massage professional must be able to maintain client records accurately.

The ability to record written information accurately and concisely depends on the correct use of terminology and an organized approach to charting procedures. This section provides an outline of the medical terminology most often encountered by the massage professional.

Fundamentals of Medical Terminology

Having agreement with regard to terminology is important. Without a common language, we cannot communicate. To be able to communicate with their clients in a common language that both can understand is the responsibility of massage professionals.

ý Because most structures in the body have formal Greek and Latin names, learning Anatomy is similar to learning a new language.

ý To prevent misunderstanding, anatomists have a universally accepted terminology that allows body structures to be located and identified with a minimum of words and a high degree of precision.

ý The use of such precise terminology precludes ambiguity and ensures accuracy in descriptions.

. Discuss why multiple terms for the same method might have developed.

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. Discuss difficulties that may occur as a result of differences in terminology.

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Medical terms are made up of combined word elements. A term can be interpreted easily by separating the word into its elements. These word elements include prefixes, roots and suffixes.

. The beauty of medical terminology is that it allows new words to be created as needed. Example: Oligorhinoscoliosis: oligo, small; rhino, nose; scoliosis, curve. From the lists of prefixes, root words and suffixes in the table provided create your own example.

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- SHORT ANSWER QUESTIONS

1. What are the three word elements and how are they used?

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Abbreviations are shortened forms of words or phrases. When you use abbreviations in any record keeping, including charting, provide an abbreviation key either on the forms or in a conspicuous place in the file. Using an overabundance of abbreviations makes reading difficult and requires interpretation. Jargon should also be avoided in record keeping.

. Provide two examples of how to determine the meaning of medical language.

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2. Define abbreviations and provide guidelines for their use.

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. Discuss the use of abbreviations and jargon.

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Terms Related to Diagnosis and Diseases

An indication exists when an approach would be beneficial for health enhancement, for treatment of a particular condition, or to support a treatment modality other than massage.

A contraindication exists when an approach might be harmful. When contraindications exist, one of the following should occur:

General avoidance of application - do not massage.

Regional avoidance of application - massage is permissible, but avoid a particular area.

Application is performed with caution, usually requiring supervision from appropriate medical or supervising personnel. Massage is permissible, but carefully select the type of methods to be used, duration of the massage, and frequency.

- PROFICIENCY EXERCISE

1. In a medical dictionary, look up and define each of the following terms related to the diagnosis of disease conditions of the body:

Acute _____________________________________________________________

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Ambulatory ________________________________________________________

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Anomaly ___________________________________________________________

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Atrophy ___________________________________________________________

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Benign ____________________________________________________________

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Chronic ____________________________________________________________

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Clinic ______________________________________________________________

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Clinical ____________________________________________________________

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Diagnosis __________________________________________________________

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Malignant __________________________________________________________

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Metastatic __________________________________________________________

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Prognosis __________________________________________________________

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Sign _______________________________________________________________

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Symptom __________________________________________________________

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Syndrome __________________________________________________________

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Systemic ___________________________________________________________

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2. In a medical dictionary, look up and define each of the following terms related to diseases:

Bacterial ___________________________________________________________

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Cancer ____________________________________________________________

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Congenital _________________________________________________________

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Degenerative _______________________________________________________

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Epidemic ___________________________________________________________

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Exacerbation _______________________________________________________

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Fungal _____________________________________________________________

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Idiopathic __________________________________________________________

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Infectious __________________________________________________________

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Trauma ____________________________________________________________

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Viral _______________________________________________________________

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3. Write a descriptive statement about a fictional client. Use at least five terms listed in this section.

Example: Mr. X reveals during the client history procedure that he is suffering from an acute exacerbation of a chronic viral infectious process.

Your Turn. __________________________________________________________

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General Structural Plan of the Body

Directional terms are used to describe how one body part relates to another.


Consult your medical dictionary or medical terminology text to define the following terms:

Anterior ___________________________________________________________

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Caudad ____________________________________________________________

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Cephalad __________________________________________________________

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Deep ______________________________________________________________

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Distal ______________________________________________________________

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Dorsal _____________________________________________________________

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External ___________________________________________________________

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Inferior ____________________________________________________________

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Internal ____________________________________________________________

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Lateral _____________________________________________________________

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Medial _____________________________________________________________

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Peripheral __________________________________________________________

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Plantar ____________________________________________________________

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Posterior ___________________________________________________________

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Proximal ___________________________________________________________

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Superficial __________________________________________________________

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Superior ___________________________________________________________

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Valgus _____________________________________________________________

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Varus ______________________________________________________________

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Volar ______________________________________________________________

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The body consists of tissues. A tissue is a collection of specialized cells that perform a special function. Histo is a root, meaning tissue. Histology is the study of tissue. The primary tissues of the body are epithelial, connective, muscular and nervous.


Look up each of the following tissues in a medical terminology reference, anatomy and physiology textbook, or medical dictionary, and list the function of each tissue type.

Connective _________________________________________________________

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Epithelial ___________________________________________________________

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Muscular ___________________________________________________________

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Nervous ___________________________________________________________

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An organ is a collection of specialized tissues. An organ has a specific function or functions but does not act independently of other organs. Organs make up systems.

Anatomical Position

The Anatomical Position is a standard body position that provides an initial reference point to help describe body parts and position accurately. Most directional terminology used in these notes and the accompanying text book refer to an individual's body as if it were in the anatomical position, regardless of its actual position.

If you get confused about a particular body position or directional term always refer back to the anatomical position. You will note that many body system charts depict the body in this position.

The anatomical position is with:

the body erect

head, eyes and toes forward

upper limbs by the sides

palms facing forward

Other positions used in anatomical description:

Prone lying face down

Supine lying face up

Neutral the position adopted by a body part midway between two opposite positions

Resting the position adopted by the body or body part where its mass is supported by an external force, eg. lying in bed or sitting in a chair

Midline of the Body

dy positions or directions. The midline is an imaginary line that passes through the middle of the body.

Midline

Fundamental Divisions of the Body

The most fundamental divisions of the body are the axial and appendicular regions.

Axial Region

The axial region makes up the axis of the body, consisting of the:

1. Head

2. Neck

3. Trunk

3.1 Thorax

3.2 Abdomen

Head

Neck

Thorax

Abdomen

Trunk

Appendicular Region

The appendicular region makes up the appendages of the body, consisting of the:

1. Upper Extremity

1.1 Shoulder

1.2 Upper Limb

2. Lower Extremity

2.1 Pelvis

2.2 Lower Limb

Shoulder

Arm

Pelvis

Leg

Lower Extremity

Upper Extremity

Abdominal Quadrants and Regions

The abdomen is divided into four quadrants and nine regions, the names of which are used to describe the location of body structures, pain, or discomfort.

. List the four abdominal quadrants in the picture below.

. Study the diagram of the nine abdominal regions below. Once you have memorised the names and numbers, test yourself by touching each landmark on yourself.

Body Regions

The human body is divided into 6 major regions, all identifiable on the surface. These 6 body regions can be subdivided into more specific localised areas.

Head Region

1. Cranium (Skull, Braincase) Cranial Auricular (Ear) 2. Face Orbital (Eye) Nasal (Nose) Buccal (Cheek) Oral (Mouth) Mandibular (Chin)

Neck Region

3. Anterior Neck (Cervical Region) 4. Posterior Neck (Nuchal Region)

Trunk Region

5. Thorax Pectoral (Chest) Scapular (Shoulder Blade)

Interscapular (Between Shoulder Blades)

6. Abdomen (Stomach) 7. Pelvis Inguinal (Groin) Perineum (Floor of Pelvis)

Upper Extremity

8. Deltoid (Shoulder) 9. Axillary (Armpit) 10. Brachial (Upper Arm - Humeral

Region) 11. Cubital (Elbow) 12. Antebrachium (Forearm) 13. Carpal (Wrist) 14. Hand

Back

15. Thoracic (Ribs) 16. Lumbar (Lower Back) 17. Sacroiliac (Between Buttocks)

Lower Extremity

18. Gluteal (Buttock) 19. Femoral (Upper Leg, Thigh) 20. Patellar (Anterior Knee) 21. Popliteal (Posterior Knee) 22. Crural (Lower Leg) 23. Malleolar (Ankle) 24. Tarsal (Foot)

ý Stand in front of a mirror and identify each landmark and point of surface anatomy and body region. Say the words out loud.

ý Study the diagram below. Once you have memorised the terms test yourself by touching each landmark on yourself.

Mandibular

Directional Terms

A number of directional terms are used by anatomists to explain precisely where one body structure is in relation to another. Although most of these terms are also used in everyday conversation, keep in mind that their anatomical meanings are very precise.

Superior

situated above or directed upward

in human anatomy, situated nearer the vertex of the head in relation to a specific reference point

also known as cranial or cephalad

opposite of inferior

Inferior

situated below or directed downward

situated nearer the soles of the feet in relation to a specific reference point

also known as caudal/caudad

opposite of superior

Anterior

denoting the front surface of the body; often used to indicate the position of one structure relative to another, i.e. situated nearer the front part of the body

also known as ventral

opposite to posterior

Posterior

denoting the back surface of the body

often used to indicate the position of one structure relative to another, i.e. nearer the back of the body

also known as dorsal

opposite to anterior

Medial

relating to the middle or center; nearer to the median or midsagittal plane

opposite to lateral

Lateral

on the side

farther from the median or midsagittal plane

opposite to medial

Superior

Inferior

Anterior Posterior

Midline

Medial (ear)

Intermediate (shoulder)

Lateral (thumb)

Intermediate

lying between two structures one of which is medial and the other lateral

Proximal

nearest the trunk/centre of the body , or the point of origin

employed only with reference to the limbs

opposite to distal

Distal

situated away from the trunk/center of the body, or from the point of origin

employed to the extremity or distant part of the limb

opposite to proximal

Superficial

pertaining to or situated near the surface.

opposite to deep

Deep

further away from the surface

opposite to superficial

Ipsilateral

on the same side, with reference to a given point

eg. a dilated pupil on the same side as an extradural hematoma

also known as homolateral

opposite to contralateral

Contralateral

relating to the opposite side

eg. as when pain is felt or paralysis occurs on the side opposite to that of the lesion

also known as heterolateral

opposite to ipsilateral

Proximal

Distal

Proximal

Distal

Superficial

Deep

Contralateral Ipsilateral

Reference Point

Radial

used in the upper limb

or hand

paired with ulnar

Ulnar

use in the upper limb

medial, or nearer, to the little finger side of the forearm or hand

paired with radial

Palmer

used in the upper limb for anterior

Planter

used in the lower limb for the sole of the foot

Internal

inner aspect of a body cavity or organ

opposite to external

External

outer aspect of a body cavity or organ

opposite to internal

Peripheral

towards the outer part or surface of the body

opposite to central

Central

towards the centre of the body

opposite to peripheral

Ulnar

Radial

Palmer

Planter

External Internal

Review

The following sentences use directional terms to describe the position of body parts.

The head is superior to the abdomen

The navel is inferior to the chin

The breastbone is anterior to the spine

The heart is posterior to the breastbone

The heart is medial to the arm

The arms are lateral to the chest

The collarbone is intermediate between the breastbone and shoulder

The elbow is proximal to the wrist

The knee is distal to the thigh

The skin is superficial to the skeletal muscles

The lungs are deep to the skin

The wrist is distal to the elbow

The hip is lateral to the navel

The nose is superior to the chin

The toes are anterior to the heel

The scalp is superior to the skull

Quadruped

Whereas the terms ventral and anterior are synonymous in humans, this is not the case in four-legged animals. Ventral specifically refers to the belly of a vertebrae animal and thus is the inferior surface of four-legged animals.

Likewise, although the dorsal and posterior surfaces are the same in humans, the term e dorsal surface of four-legged

animals is their superior surface.

Additionally, the superior/inferior term pair mean toward and away from the head end respectively in humans, but the term pair cephalad/caudal conveys this meaning in four-legged animals.

Dorsal

Cephalad Caudal

Body Planes

The study of Anatomy often involves dissection, in which the body or its organs are sectioned (cut) along an imaginary line called a plane.

Sagittal Plane

vertical plane

runs longitudinally and divides the body into right and left portions

also known as Medial Plane

many saggital planes are possible

There are two types of saggital planes:

1. Midsaggital

passes through the midline of the body and divides it into equal left and right portions

2. Parasaggital

passes through the body, offset from the midline and divides the body into unequal left and right portions.

. Color in the midsaggital and parasaggital planes shown below.

Frontal Plane

vertical plane

runs longitudinally and divides the body into anterior and posterior portions

also known as Coronal Plane

lies at right angles to the Sagittal Plane

Transverse Plane

horizontal plane

runs horizontally across and at a right angle to the long axis of the body dividing it into superior and inferior parts

also known as Horizontal Plane

many transverse planes are possible

runs at right angles to both the sagittal and frontal planes

cross-sections are Transverse Planes, eg. cross section of a limb or the heart

. Color in the frontal and transverse planes shown below.

. Color in and label the body planes. . Label the directional terms.

Body Cavities

The body cavities contain the organs and are divided into ventral and dorsal regions. The back or posterior surface of the trunk is also divided into the following regions:

Cervical region: the neck (seven cervical vertebrae)

Thoracic region: the chest (twelve thoracic vertebrae)

Lumbar region: the loin (five lumbar vertebrae)

Sacral region: the sacrum (five sacral vertebrae that are fused into one bone)

Coccyx: the tailbone (four coccygeal vertebrae that are fused into one bone)

Closed Body Cavities

Within the axial portion of the body are two major closed body cavities that contain internal organs.

Ventral Body Cavity

Located nearer to the ventral, or anterior surface of the body, and is the larger of the closed body cavities housing a group of internal organs collectively called the viscera.

There are two main subdivisions:

The more superior Thoracic Cavity is surrounded by the ribs and muscles of the chest.

The inferior Abdominopelvic Cavity is separated from the Thoracic Cavity by the diaphragm.

Dorsal Body Cavity

Located nearer to the dorsal, or posterior, surface of the body and is subdivided into:

The Cranial Cavity within which the brain is encased by the skull.

The Vertebral Cavity running between the bony vertebral column which encloses delicate spinal cord.

Open Body Cavities

In addition to the major closed body cavities, there are other smaller and generally tubular body cavities which are open to the body's exterior:

Oral Cavity

Commonly called the mouth which is continuous with the Digestive Tract and also opens to the exterior at the anus.

Nasal Cavity

Located posterior to the nose and is part of the Respiratory Tract.

Perineum Cavities

Part of the reproductive tract and urinary tract.

Orbital Cavities

House the eyes and present them in an anterior position.

Ear Cavities

Carved into the temporal bone of the skull and contain the tiny bones associated with the transmission of sound.

. Shown is a diagram of the body cavities listed below.

Label and color in the cavities and list the structures found in each.

Vertebral Cavity

Abdominal Cavity

Thoracic Cavity

Cranial Cavity

Pelvic Cavity

. The main cavities of the body include the abdominal and pelvic cavities. List three organs in each of these cavities.

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Medical Imaging Devices

The ability to interpret sections through the body is becoming increasingly important in the clinical sciences because new medical imaging devices produce sectional images rather than three dimensional images.

X-ray Images

Conventional X-rays are still the workhorse of diagnostic imaging techniques and account for half of all imaging currently done. What x-rays do best is visualise hard, bony structures and peer at the chest to locate abnormally dense structures in the lungs.

Radiograph

X-rays produce a shadowy negative of the internal structures of the body. Dense structures absorb the X-rays most and so appear as light areas on the

radiograph, whereas hollow air-containing organs and fat, which absorb x-rays to a lesser extent, appear as dark areas.

As an example, following is a list of structures, from darkest (black) to lightest (white), as they would appear on an X-ray film 1 being the darkest, 2 being the next darkest and so on.

1 air in lungs

2. soft tissues

3. femur (bone of the thigh)

4. gold (metal) filling in a tooth

Fluoroscope

In a variation of radiography, X-ray images are viewed on a fluorescent screen, or fluoroscope as they are being generated.

Scanning

New imaging techniques introduced in the 1970's not only reveal the internal structure of our body but also provide information about the workings. The CAT and PET scans now account for about 25% of imaging.

CAT Scan

CAT (Computed Axial Tomography) is a refined version of X-ray equipment. CAT ends the confusion resulting from images of overlapping structures seen in conventional X-rays and has all but eliminated exploratory surgery.

PET Scan

PET (Positron Emission Tomography) advantage is that it can send images about metabolic processes by scanning the injected radioisotopes.

MRI Scan

MRI (Magnetic Resonance Imaging) uses magnetic fields to obtain information on the body's structure.

Sonography

Sonography or ultrasound has some distinct advantages over the above approaches to investigating the body. Firstly, the equipment is inexpensive and secondly the high-frequency sound waves (ultrasound) used as its energy source have no adverse effect of the body.

Structure of the Body

The Skeletal System

The skeletal system consists of three elements: bones, cartilage and ligaments.


1. Consult your medical dictionary or medical terminology text to define the following terms:

Ankylosing spondylitis ________________________________________________

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Fracture ___________________________________________________________

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Osteoarthritis _______________________________________________________

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Osteochondritis _____________________________________________________

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Osteochondrosis ____________________________________________________

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Osteoporosis _______________________________________________________

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2. Using Appendix A of FUNDAMENTALS, choose one condition from the previous list and note any indications or contraindications involved.

Condition: __________________________________________________________

___________________________________________________________________

Indications or contraindications: ________________________________________

___________________________________________________________________

3. Palpate each bone listed on the skeleton and say its name.


1. Consult your medical dictionary or medical terminology text to define the following terms:

Ankylosis __________________________________________________________

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Arthritis ____________________________________________________________

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Bursitis ____________________________________________________________

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Degenerative joint disease ____________________________________________

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Diastasis ___________________________________________________________

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Dislocation _________________________________________________________

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Ganglion cyst _______________________________________________________

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Genu valgum _______________________________________________________

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Genu varum ________________________________________________________

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Gout ______________________________________________________________

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Hallux malleus ______________________________________________________

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Kyphosis ___________________________________________________________

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Lordosis ___________________________________________________________

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Rheumatoid arthritis _________________________________________________

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Scoliosis ___________________________________________________________

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Slipped disk ________________________________________________________

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Spinal curvature _____________________________________________________

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Spondylolisthesis ____________________________________________________

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Sprain _____________________________________________________________

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Subluxation ________________________________________________________

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Tendinitis __________________________________________________________

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Tenosynovitis _______________________________________________________

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2. Using Appendix A in FUNDAMENTALS, choose one condition from the previous list and note any indications or contraindications involved.

Condition: __________________________________________________________

___________________________________________________________________

Indications or contraindications: ________________________________________

___________________________________________________________________

The Muscular System

Tissues that are contractile make up the muscular system.

The three types of muscle tissue include cardiac muscle, smooth muscle and skeletal muscle.


1. Locate a more complete list of muscles in your anatomy and physiology textbook or medical dictionary. Break down five muscle names not listed in this section into their word elements. You will need a medical terminology book and/or medical dictionary to complete this exercise.

Example: Auricularis superior: Aur- means ear; ar- means pertaining to; superior means above or upward.

a. _______________________________________________________________

b. _______________________________________________________________

c. _______________________________________________________________

d. _______________________________________________________________

2. An excellent way to remember the names of muscles is to make up ridiculous sentences that explain listed muscle names. The crazier these sentences are, the better you will remember them. Use this memory aid as you study muscles in your anatomy and physiology classes.

Examples: Rectus femoris: Part of the quadriceps muscle that is straight (rectus) and lies near the femur (femoris) Memory aid: Attention rectus! Straighten up and the other three of you in the quads head out to the femur. Flexor carpi ulnaris: Muscle that flexes (flexor) the wrist (carpi) and hand and is attached to the ulna (ulnaris) Memory aid: Help! There is a big carp pulling my wrist into flexion. It has my ulna in its mouth and my hand has it around the gills.

The Nervous System

Study of the nervous system is important for the massage professional and focuses on the following:

Central nervous system (CNS)

Peripheral nervous system (PNS)

Autonomic nervous system (ANS)


1. List five of the disease conditions of the nervous system described in the indications and contraindications section in Appendix A of FUNDAMENTALS.

a. _______________________________________________________________

b. _______________________________________________________________

c. _______________________________________________________________

d. _______________________________________________________________

e. _______________________________________________________________

2. Using Appendix A from FUNDAMENTALS, choose one condition from your list and note any indications or contraindications involved.

Condition: _________________________________________________________

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Indications or contraindications: _______________________________________

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3. Choose one of the reflexes and look it up in a medical dictionary. Define the term and then write down how you think the reflex is implicated during massage.

Example:

Reflex: Psychogalvanic

Definition: Psycho- relates to the mind and galvanic pertains to electricity

Implication: This reflex involves changes in electrical activity in the body connected with mind processes or thoughts. With the galvanic skin response, changes in electrical activity are related to activity of the sweat glands. Massage stimulates the skin as well as electrical activity in the body, which in turn may influence the mind.

Your Turn:

Reflex: ____________________________________________________________

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Definition: _________________________________________________________

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Implication: ________________________________________________________

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The Cardiovascualar System

The cardiovascular system consists of two parts: the heart and the blood vessels.


1. List five of the disease conditions of the cardiovascular system described in the indications and contraindications section in Appendix A of FUNDAMENTALS.

a. _______________________________________________________________

b. _______________________________________________________________

c. _______________________________________________________________

d. _______________________________________________________________

e. _______________________________________________________________

2. Using your list, choose one condition and note any indications or contraindications involved.

Condition: _________________________________________________________

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3. FUNDAMENTALS and in a pharmacology reference text.

List contraindications and side effects of these medications. Also describe contraindications to massage that may exist if someone is taking anticoagulant medication.

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4. Choose a willing participante and draw the major arteries and veins on the body with washable markers. Use red for arteries and blue for veins. Notice that you can almost trace the veins because they are located near the surface of the body.

The Lymphatic System

The lymphatic system is responsible for several functions and operates in the following ways:

Returns vital substances, such as plasma protein, to the bloodstream from the tissues of the body

Assists in maintaining fluid balance by draining fluid from the body tissues

Helps the body defend against disease-producing substances

Helps absorb fats from the digestive system

- MATCHING EXERCISE

Match the lymph nodes and plexuses to their correct description.

1. Parotid 2. Occipital 3. Superficial cervical 4. Subclavicular 5. Hypogastric 6. Facial 7. Deep cervical 8. Axillary 9. Mediastinal 10. Cubital 11. Para-aortic 12. Deep inguinal 13. Superficial inguinal 14. Popliteal 15. Mammary plexus 16. Palmar plexus 17. Plantar plexus

a. deeply situated nodes in the groin b. nodes in the groin close to the surface

c. nodes under the collarbone d. nodes draining the tissue in the face e. lymphatic vessels in the sole of the foot (plantar) f. lymphatic vessels in the palm of the hand (palmar) g. nodes around or in front of the ear h. nodes over the bone at the back of the head i. nodes in the area beneath the stomach j. nodes around the aorta k. deeply situated nodes in the neck l. lymphatic vessels around the breasts m. nodes in the armpit n. nodes of the elbow o. nodes close to the surface of the neck p. nodes in back of the knee q. nodes in the mediastinal section of the thoracic cavity

The Immune System

The human body is able to resist organisms or toxins that tend to damage the tissues and organs that make up the body.


1. List five of the disease conditions of the lymphatic and immune system described in the indications and contraindications section in Appendix A of FUNDAMENTALS.

a. _______________________________________________________________

b. _______________________________________________________________

c. _______________________________________________________________

d. _______________________________________________________________

e. _______________________________________________________________

2. Using Appendix A of FUNDAMENTALS, choose one condition from your list and note any indications or contraindications involved.

Condition: _________________________________________________________

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The Respiratory System

The respiratory system supplies oxygen and removes carbon dioxide from the cells of the body. The two phases of respiration are external and internal.


1. List five of the disease conditions of the respiratory system

described in the indications and contraindications section in Appendix A of FUNDAMENTALS.

a. _______________________________________________________________

b. _______________________________________________________________

c. _______________________________________________________________

d. _______________________________________________________________

e. _______________________________________________________________


Condition: _________________________________________________________

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The Digestive System

The anatomy of the digestive system can be compared with that of a long muscular tube that travels a path through the body. The organs of the digestive system break down food and transport food and waste through these muscular tubes.


1. List five of the disease conditions of the digestive system described in the indications and contraindications section in Appendix A of FUNDAMENTALS.

a. _______________________________________________________________

b. _______________________________________________________________

c. _______________________________________________________________

d. _______________________________________________________________

e. _______________________________________________________________


Condition: _________________________________________________________

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The Endocrine System

The endocrine system is composed of glands that produce hormones that are secreted directly into the bloodstream to stimulate cells in a specific way or to set a body function into action.


1. List five of the disease conditions of the endocrine system described in the indications and contraindications section in Appendix A of FUNDAMENTALS.

a. _______________________________________________________________

b. _______________________________________________________________

c. _______________________________________________________________

d. _______________________________________________________________

e. _______________________________________________________________


Condition: _________________________________________________________

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The Integumentary System

The integumentary system consists of the skin and its appendages, including hair and nails.


1. Using Appendix A of FUNDAMENTALS, list at least three skin conditions that could be contagious.

a. _______________________________________________________________

b. _______________________________________________________________

c. _______________________________________________________________


Condition: ____________

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Summary

Without a common language, we cannot communicate. Massage professionals must be able to communicate with their clients in a common language that both can understand; it is just as important that they understand the communications of other health professionals.

The information presented in this section is especially pertinent to an understanding of massage as it relates to anatomy, physiology, pathophysiology, and client records. Because the basis for medical terminology is scientific language, understanding this information helps the massage student understand massage therapy research, as well as articles and books on subjects related to massage. Learning the names of muscles, bones, joints, and other anatomic structures lays a firm foundation for understanding and correctly using medical terminology.

Indications and Contraindications

Textbook References: FUNDAMENTALS of Therapeutic Massage, 5th

Ed. Chapter 6 - Indications and Contraindications for Therapeutic Massage

The massage professional must be able to identify indications and contraindications for therapeutic massage. This section of Foundations of Massage 2 provides the information necessary to make important decisions regarding the application of massage based on the benefits that therapeutic massage provides.

on and realistic goals that may be achieved through using therapeutic massage.

Contraindications are also presented along with guidelines for decision making with regard to the type of contraindications and whether massage should be avoided, should be modified, or is applicable only with appropriate supervision. Case studies that model the decision-making process are presented.

Competencies

After completing this section, you should be able to:

Define the terms indication and contraindication

Define therapeutic change, condition management and palliative care as a therapeutic approach

Use a clinical reasoning model to determine the appropriate intervention process

Develop a basic understanding of pathology and its connection to contraindications to massage

Explain the stress response, inflammatory response and pain response

Identify indications for massage therapy and justify those indications

Determine when to refer clients to licensed medical professionals

Objectives

Using the information presented in this section, you will be able to perform the following:

Indications for Massage Identify and chart the benefits of massage Explain the difference between objective and subjective massage benefits Explain the benefits of massage to others

Approaches to Care Define the term therapeutic change Explain the concepts of condition management and palliative care Implement a clinical reasoning process for making appropriate decisions as to the type

of care most beneficial for the client

Pathology, Health and Therapeutic Massage Define the terms health, dysfunction, and pathology

provider

List the mechanisms and risk factors that predispose people to disease processes Explain the general inflammatory response Explain the mechanisms of pain and evaluate pain for referral purposes

Contraindications to Massage Therapy Effectively refer a client to a primary health care provider Interpret the reference list of indications and contraindications provided Recognize the warning signs of cancer List the endangerment sites for massage

Key Terms

The following key terms are referred to in this section:

Acute Antagonistic Benign tumors Caution Chronic Communicable diseases Compensation Condition management Contraindication Dysfunction Endangerment site General adaptation syndrome (GAS) Homeostasis Impingement syndromes Indication Inflammatory response Malignant tumors Medications Metastasis Pain-spasm-pain cycle Palliative care Pathology Peak performance Referral Referred pain Signs Suffering Symptoms Syndrome Synergistic Therapeutic change Trauma

Introduction

An indication tells when an approach would be beneficial for health enhancement, for treating a particular condition, or to support a treatment modality other than massage.

A contraindication tells when an approach might be harmful. Types of contraindications are:

General avoidance of application do not massage.

Regional avoidance of application massage is permitted, but avoid a particular area.

Application with caution, usually requiring supervision from appropriate medical or supervising personnel massage is permitted, but carefully select the type of methods to be used, the duration of the massage and the frequency.

Indications for Massage

The benefits of massage occur as a result of therapeutic change, condition management, and palliative care. This section explains each of these approaches to care.

. Discuss criteria that would help categorize the three types of contraindications.

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Indications for massage are based on the health-enhancing benefits of massage. The benefits of massage therapy are both objective and subjective. That is, some results of massage can be measured (objective), whereas others are only assumed to be effective based on experience (subjective).

. Discuss the difference between subjective and objective benefits.

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1. What is an indication for a massage?

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2. What is a contraindication to a massage?

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In the spaces provided, write two dialogs that explain the benefits of massage.

Direct one discussion to a group of health care professionals such as physicians, chiropractors, nurses, physical therapists and psychologists; direct the other discussion to a group of business professionals, factory workers, construction workers, food service workers and athletes.

Choose one: Physicians, chiropractors, nurses, physical therapists, psychologists

Type of health professional: ______________________

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Choose one: Business professionals, factory workers, construction workers, food service workers, athletes

Type of group: ______________________

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Approaches to Care

Therapeutic Change

The benefits of massage occur as a result of therapeutic change, condition management, and palliative care.

Any change process, including beneficial change, requires energy and resource expenditure by the client. Decisions need to be made about the ability of the client to expend the energy required for active change and about the availability of the support and resources that are often necessary during a change process. The practitioner requires appropriate knowledge and skills (current or acquired) and often a network of support from other professionals to facilitate a change process.

. Why is the change process dependent on energy expenditure?

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Condition Management

Condition management involves using massage methods to support the clients who are unable to undergo a therapeutic change process but wish to be as effective as possible within an existing set of circumstances. On a physical level, massage can offer benefit by managing the existing physical compensation patterns and sometimes slowing the progress of the chronic conditions or preventing a situation from becoming worse. Condition management accounts for the largest client base for therapeutic massage.

. Why is condition management the largest client base for therapeutic massage?

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Palliative Care

To palliate is to soothe or relieve. Massage is soothing and provides comfort regardless of whether the client is seeking relaxation to meet pleasure needs or to cope with chronic pain. In a health care context, the term palliative care means to relieve or reduce the intensity of uncomfortable symptoms but not to produce a cure.

Palliative care is provided when the condition is most likely going to become worse and when degenerative processes will continue, as in terminal illness or dementia. Palliative care often relates to approaches that reduce suffering.

Palliative care is also appropriate when the condition should not be changed or the person does not desire a specific outcome other than pleasure and relaxation.

. Discuss the importance of pleasure and relaxation as outcomes in the palliative care process

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Metaphor

Cleaning the house - Offer palliative and management care, reduce suffering, and encourage better coping in the existing situation

or

Remodelling the house - A process of active change

lling the materials, difficulties, disruption in daily living and other factors.

Example:

Cleaning the house Professional - Ongoing service Client - Ongoing appointments

Remodeling the house Professional - Defined number of appointments with a specific outcome Client - Commitment to a specific set of appointments

Your Turn:

List three differences in each area.

Cleaning the house

Professional

1. ______________________________________________________________

2. ______________________________________________________________

3. ______________________________________________________________

Client

1. ______________________________________________________________

2. ______________________________________________________________

3. ______________________________________________________________

Remodelling the house

Professional

1. ______________________________________________________________

2. ______________________________________________________________

3. ______________________________________________________________

Client

1. ______________________________________________________________

2. ______________________________________________________________

3. ______________________________________________________________

- PROFICIENCY EXERCISE After reading the following client case situations, decide whether you would introduce therapeutic change, condition management, or palliative care. Explain your reasons for the decision using the clinical reasoning model. An example is provided.

Example Case Study

A male client, age 47, is experiencing fatigue and neck and shoulder pain. He is a cross-country truck driver. He is married, has three children and has the normal financial obligations of a house payment, car payment, and other responsibilities. One child just started college and the client is somewhat concerned about the tuition expenses. He likes his job and is content with his family and sociashoulder hurts. He can think of no reason for the pain other than the strain of the driving position and the long work hours. This pain never bothered him before. He went to the doctor for a physical examination and nothing out of the ordinary was identified. The physician thinks that an old football injury, coupled with some age-related changes, is responsible. The doctor also thinks that the pain in the shoulder might be interfering with the cmight be a cause of fatigue. The doctor recommends an over-the-counter anti-inflammatory agent and painkiller, such as aspirin, and suggests that massage might help. The doctor also recommends that the client cut back on his work hours anstomach. He does not want to cut back on work hours. He is seeking help for shoulder pain and would like more physical energy.

Identify the Facts

Questions that can help with this process include the following:

What is considered normal or balanced function?

The ability to work pain free with reasonable stamina at a job one enjoys.

What has happened? (Spell out events.)

Nothing substantial has occurred to account for the changes other than age-related influences and a previous football injury.

What caused the imbalance? (Can it be identified?)

A previous injury, long work hours, a static seated position with the arms elevated on the steering wheel and repetitive looking to the left during driving.

What was done or is being done?

Treatment with aspirin

What has worked or not worked?

maintain his current work schedule.

Brainstorm the Possibilities

Questions that help with this process include the following:

What are the possibilities? (What could it all mean?)

The fatigue and pain could be a result of age-related changes and the previous injury, coupled with repetitive use; this in turn could interfere with sleep, as suggested by the doctor. The condition could be related more to emotional stress caused by financial concerns. The client may have an undiagnosed health condition that is not sufficiently evident to allow a definitive diagnosis.

What is my intuition suggesting?

unexpressed emotional stress over financial concerns, particularly the tuition costs for the child in college.

What are the possible patterns of dysfunction?

The static driving position may be aggravating the old football injury. What are the possible contributing factors? Worry, postural distortion from the static position and age-related tissue changes, because the body becomes somewhat less flexible with age and lack of exercise.

What are possible interventions?

A job change A stretching program Massage therapy Short-term mental health support

stomach

What might work?

Massage and a stretching program

What are other ways to look at the situation?

The client does not seem to want to use medications, does not want to change his job, and does not seem to think that there is anything wrong with his emotional or social life. Maybe if the financial situation were different, the stress load would be low enough so that his energy levels

would increase and he could ignore the pain. Maybe a financial advisor would be helpful, or maybe his wife could get a job.

What does the data suggest?

Emotional stress seems to be a factor. The data seem to suggest that an age-related process and a previous injury are aggravated by repetitive job strain and a static seated position.

Consider the Logical Outcomes of Each Possibility

Questions that can help determine outcomes include the following:

What is the logical progression of the symptom pattern, contributing factors, and current behaviors?

If the pain remains or worsens and sleep continues to be interrupted so that fatigue worsens, the immune system can be compromised and other disease processes might occur. The client could become unable to work. His mood would be altered, which would affect family and social relationships.

What is the logical cause and effect of each intervention identified? What are the pros and cons of each intervention suggested?

Job change - Would remove repetitive strain on the shoulder and eliminate static seated position; drastic change in lifestyle, finances and work environment Stretching program - Would increase flexibility and counterbalance the static seated position; could make the situation worse if the stretching is too aggressive, not progressive, and intermittent instead of used daily; is self-initiated and once learned would not incur any ongoing costs; does not require a regular appointment schedule (helpful because client is frequently on the road); requires discipline to do the stretches Massage therapy - Would help alleviate pain symptoms and support better sleep; does not require extensive self-discipline other than making regular appointments; would incur a financial obligation; would support a daily stretching program; would reduce the use of medication Short-term mental health support - Would not require extensive self-discipline other than making regular appointments; would incur a financial obligation; does not address the physical condition but does address emotional strain

stomach - Would help alleviate pain symptoms and support better sleep; does not require extensive self-discipline; would incur a small financial obligation; does not need regular appointment schedule because he is on the road; possible side effects and development of dependency on the medication Consultation with a financial advisor - Would help client achieve better control of finances, eliminating the basis for worry and emotional stress; does not address physical conditions, long work hours, or job stress Wife getting a job - Would eliminate financial burden; could create stress in the marriage; requires action on the part of a person other than the client; does not address physical conditions, long work hours, or job stress

What are the consequences of not acting?

condition could become more problematic, requiring more drastic intervention measures in the future.

What are the consequences of acting?

The problem would remain stable or improve. The client would be better able to cope with the current situation.

Identify the Effect of Each Possibility on the People Involved

Questions that can help identify possible effects include the following:

In terms of each intervention being considered, what would be the impact on the people involved: client, practitioner and other professionals working with the client?

Job change - Client is not supportive; wife may or may not like idea. Stretching program - Client does not like to fuss with himself and avoids activities having to do with self-care. Massage therapy - Client is open to idea but nervous; wife, doctor and massage practitioner are supportive. Short-term mental health support - Client and wife are not open to this possibility at this time; they do not think that this is an emotional problem. Massage practitioner is hesitant about the client being unwilling to seek mental health services and does think emotion is involved (worry over finances) and would like client to remain open to this possibility. Treatment

tomach - Client does not like to take medication and the doctor is unwilling to prescribe at this time until other measures are explored. Consultation with a financial advisor - Client and wife think this is a good idea and will pursue this possibility. Wife getting a job - Not an option at this time.

How does each person involved feel about the possible interventions?

Job change - None are supportive. Stretching program - Client is ambivalent; massage practitioner and wife are supportive. Massage therapy - All are supportive. Short-term mental health support - Massage therapist is supportive; client and wife are not supportive.

stomach - Doctor and client are not supportive. Consultation with a financial advisor - Client and wife are supportive. Wife getting a job - Not an option.

Is the practitioner within his or her scope of practice to work with such situations?

Yes

Is the practitioner qualified to work with such situations?

Yes

Does the practitioner feel qualified to work with such situations?

stretching program and his lack of interest in a mental health referral. These concerns raise questions for the practitioner about the ability to work

exist.

Is there a feeling of cooperation and agreement among all parties involved?

There is a degree of cooperation, as well as some resistance. All agree on the benefit of massage therapy.

Based on this analysis of the information provided, the massage practitioner would recommend a condition management program rather than a therapeutic change process, for the following reasons: Causal factors are involved that the client may not be able to address during a change process. Also he is resistant to the idea of an exercise or a stretching program that would interfere with his driving schedule.

Case Study 1

A 17-year-old volleyball player is in training for a playoff tournament in 4 weeks. She has been somewhat sore after practice and anxious about the

and her parents think that massage would be helpful to her. She is in good health and takes no medications, but she does have an erratic eating pattern and recently has been drinking soda with caffeine in it. She also has been working with visualization and progressive relaxation before sleeping. She thinks these methods help her sleep better.

Identify the Facts



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What are the possible contributing factors?

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What might work?

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What are the logical cause and effect of each intervention identified? What are the pros and cons of each intervention suggested?

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Questions that can help identify effects include the following:


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Based on this analysis of the information provided, the massage practitioner would recommend ____, for the following reasons:

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Case Study 2

A 39-year-old woman is experiencing mood swings and headaches. She was in a car accident 3 years ago and suffered a whiplash injury, which was treated successfully with physical therapy. She still has some residual stiffness in her neck. She recently had visited her doctor because of the mood swings and headaches. She is premenopausal. No treatment other than stress management and moderate exercise has been recommended at this time. The

military. The woman was divorced 2 years ago. She has a supportive circle of friends and is financially stable and secure in her job. She says that she wants to feel more in control of her body and wants to be able to self-manage the mood swings and headaches. She is not opposed to hormone therapy for menopause but would like to see if she can manage without it. She is seeking massage as part of her lifestyle self-care program and is motivated.

Identify the Facts



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What might work?

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Case Study 3

A 26-year-old man with asthma is experiencing an increase in symptoms. He was recently married and has just moved to a new city because of a job transfer. His wife is 3 months pregnant. He takes good care of himself and is careful with his diet. His exercise program was disrupted by the move, and he has not re-established a regular exercise program. Medication is effective in treating the asthma. His respiratory therapist recommends massage because she feels that the increased stress is a possible cause of the more severe asthma.

Identify the Facts



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What might work?

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Pathology, Health and Therapeutic Massage

Pathology

Massage professionals need to understand basic pathology. Although the diagnosis of disorders is not a function of a massage professional, to refer appropriately, the massage

irregularity that should be evaluated by his or her primary health care provider. When working with a referral and under proper supervision, the massage professional also needs to be able to alter the application of massage in terms of any present disease process such that the client receives the benefits of massage without harm. The massage professional also needs a basic understanding of pharmacology and the possible interactions between medications and massage.

ý See FUNDAMENTALS Appendix C for specific information

. Discuss indications for referral and health care supervision. Also discuss other forms of supervision in different environments such as the athletic trainer when working with athletes.

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Health

Health is defined as optimal functioning with freedom from disease or abnormal processes. Health is influenced by many factors, including inherited (genetic) and constitutional conditions. Lifestyle, activity, level, rest, loving relationships, exercise, a balanced diet, empowering beliefs and attitudes, self-esteem, authentic personality and freedom from self-hindering patterns all support health.

Dysfunction

Dysfunction is the in-between state of not healthy but also not sick (experiencing disease). Western medicine has difficulty identifying and dealing with dysfunctions because they are pre-pathologic states and are often not apparent within current diagnostic methods. Prevention methods, many modelled after more Eastern or holistic approaches, are beginning to address this area called dysfunction.

Peak Performance

Disease or pathologic conditions occur when homeostatic and restorative body mechanisms break down and can no longer adapt. Seldom does one thing contribute to disease; instead a series of events occurs.

Disease

Disease, or pathology, occurs when homeostatic and restorative body mechanisms break down and can no longer adapt. It is seldom one thing that contributes to pathology, but rather a series of events.

Functioning Limits

The body has anatomic and physiologic functioning limits. Extraordinary events push the functioning. Normal physiologic mechanisms inhibit the tendency to

function at body limits. Dysfunction occurs when the reserve runs low because restorative mechanisms are not able to function effectively or when the body begins to limit function in an attempt to maintain higher energy reserves.

Massage professionals serve many people at the beginning of dysfunctional patterns, when clients do not feel their best but are not yet sick. The practitioner must monitor clients to make sure they do not continue to progress further into dysfunctional patterns. Early intervention and referral to the appropriate health care professional are important to identify potential problems before they develop. The benefits of massage are most effectively focused when they help people stay within the healthy range of functioning.


5. What is dysfunction as defined in FUNDAMENTALS and how is massage beneficial in dysfunctional situations?

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Development of Pathology

Because most diseases have similar symptoms, determining the specific underlying causes of disease is difficult. Disease conditions are usually diagnosed or identified by signs and symptoms. Certain predisposing conditions may make developing a disease more likely. Usually called risk factors, these conditions may put an individual at risk for developing a disease but often do not actually cause the disease.

. Discuss various risk factors.

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General Adaptation Syndrome

The general adaptation syndrome describes how the body mobilizes different defence mechanisms when threatened by harmful (actual or perceived) stimuli.

. Discuss the general adaptation syndrome and its relationship to health and disease.

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Pathological Conditions and Indications for Massage

Inflammation may occur as a response to any tissue injury. Local inflammation occurs in a limited area, for example, a small cut that becomes infected. Systemic inflammation occurs when the irritant spreads throughout the body or when inflammation mediators cause changes throughout the body. Conditions involving chronic inflammation are classified as inflammatory diseases. Therapeutic massage seems to be beneficial in cases of prolonged inflammation.

The processes of inflammation trigger tissue repair. A goal in the healing process is to promote regeneration and minimize replacement. Massage has been shown to slow the formation of scar tissue and keep scar tissue pliable when it forms.

Inflammatory Response

Because the inflammatory response is part of a healing process, the deliberate creation of Certain methods of

massage can be used to create a controlled, localized area of therapeutic inflammation.

generate a healing process. If healing mechanisms are suppressed, do not use methods that create therapeutic inflammation. Therapeutic inflammation is not used in situations in which disturbed sleep, compromised immune function, a high degree of stress load, or

systemic or localized inflammation is already present. These methods should also be avoided if any condition such as fibromyalgia exists, which consists of impaired repair and restorative functions, unless carefully supervised as part of a total treatment program.

Consideration needs to be given to using anti-inflammatory medications. If a person is using such a medication, either steroidal or non-steroidal, the effectiveness of therapeutic inflammation is negated or reduced and restoration mechanisms are inhibited. When these medications are present, any methods that create inflammation should be avoided.

. Discuss the indications and contraindications, including cautions, for using therapeutic inflammation.

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Pain

The massage therapist especially needs to understand the mechanisms of pain. The main types of pain are:

Acute

Chronic

Intractable

Phantom

Pain has many characteristics. Location of pain can be divided into four categories:

Localized pain is pain confined to the site of origin.

Projected pain is typically a result of proximal nerve compression. This pain is perceived in the tissue supplied by the nerve.

Radiating pain is diffused pain around the site of origin that is not well localized.

Referred pain is felt in an area distant from the site of the painful stimulus.

Five types of pain experience include the following:

Pricking or bright pain

Burning pain

Aching pain

Deep pain

Muscle pain

The origins of pain can be divided into two types, somatic and visceral.

The ability of the cerebral cortex to locate the origin of pain is related to experience. In most instances of somatic pain, and in some instances of visceral pain, the cortex accurately projects the pain back to the stimulated area.

In general, the area to which the pain is referred and the visceral organ involved receive their innervation from the same segment of the spinal cord. As already stated, irritation of the viscera frequently produces pain that is felt not in the viscera but in some somatic structure that may be located at a considerable distance.

Pain is a complex problem with physical, psychologic, social, and financial components. Pain can be alleviated in many ways. As a therapeutic intervention, massage may help reduce the need for pain medication, thus reducing the side effects of medication use. Intervention for acute pain is less invasive and more focused on supporting a current healing process. Chronic pain is managed with either symptom relief or a more aggressive rehabilitation approach incorporating a therapeutic change process.

. Discuss pain origin.

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. Discuss the difference in massage for acute pain and chronic pain.

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Impingement Syndromes

The two types of nerve impingement are compression and entrapment. Massage is beneficial for entrapment and can manage some symptoms of nerve compression, even though the direct causal factor is not addressed. Massage methods can soften and stretch connective tissues that may impinge on nerves, as well as normalize muscle tension patterns, restoring a more normal resting length to short muscles to reduce pressure on nerves.

. Discuss the difference between impingement and compression syndromes.

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Psychologic Dysfunctions

Science has validated the body/mind link in terms of heath and disease. Many risk factors for developing physical (body) disease are mentally (mind) influenced, such as stress level and lifestyle choices. The major mental health dysfunctions affecting Western society are trauma and post-traumatic stress disorders, anxiety and depression, pain and fatigue syndromes often coupled with anxiety and depression, and stress-related illness.

Because massage intervention has a strong physiologic effect resulting from the comfort of the connection through touch, as well as an influence on mental state through the effect on the autonomic nervous system and neurochemicals, massage may be beneficial for individuals experiencing mental health problems. Soothing of any hyperactivity or hypoactivity of the autonomic nervous system provides a sense of inner balance. Normalizing the breathing mechanism allows a person to breathe without restriction and can reduce the tendency toward breathing pattern disorder, which feeds anxiety and panic.

Strong and appropriate indications exist for using massage therapy in restoring mental health, but caution is indicated in terms of establishing dual roles and boundary difficulties. Working in conjunction with mental health providers in these situations is important.

. Discuss the benefits of massage intervention for mental health.

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. Discuss breathing pattern disorder and the link between mental and physical interactions.

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Contraindications to Massage Therapy

A contraindication is any condition that renders a particular treatment improper or undesirable, or when cautions concerning treatment exist and supervision is required.

Contraindications can be separated into three types: general, regional and cautions.

Therapeutic massage is often beneficial for clients who are receiving treatment for a specific medical or mental health condition, but caution is indicated. The general effects of stress and pain reduction, increased circulation and physical comfort of therapeutic massage complement most other medical and mental health treatment modalities. However, when other therapies, including medication, are being used, the physician must be able to evaluate accurately the effectiveness of each treatment the client is receiving. If the physician is not aware that the client is receiving massage, the effects of other therapies may be misinterpreted.

Immediately refer patients with any vague or unexplainable symptoms of fatigue, muscle weakness and general aches and pains to a physician. Many disease processes share these symptoms.

Tumors and Cancer

Massage is not necessarily contraindicated for individuals with cancer. Current research indicates that massage can support the immune system battle with cancer cells. However, massage must be used as part of the entire treatment program and supervised by qualified medical personnel. As with any stressful condition, when working with people with cancer, it is important not to overtax their system, but to instead use massage for general support to the healing mechanisms of the body.

. Discuss various contraindications and factors that influence how to determine whether massage is appropriate.

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. Discuss how interventions that might be contraindicated without medical supervision might be appropriate with proper supervision.

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Medications

In general, a medication is prescribed to do one of the following:

Stimulate a body process

Inhibit a body process

Replace a chemical in the body

Therapeutic massage can also stimulate, inhibit and replace body functions. When the medication and massage both stimulate the same process, the effects are synergistic and the result can be too much stimulation. If the medication inhibits a process and massage inhibits the same process, the result is again synergistic, but this time with too much inhibition. If the medication stimulates an effect and massage inhibits the same effect, massage can be antagonistic to the medication. Although massage seldom interacts substantially with medications that replace a body chemical, the massage practitioner must be aware of possible synergistic or inhibitory effects.

Massage can often be used to manage undesirable side effects of medications. Be aware of any over-the-counter medications, herbs and vitamins that the patient may be taking as well. If a client is taking medication, the physician must be contacted for recommendations about the advisability of therapeutic massage.

. List the various classifications of medication. See FUNDAMENTALS Appendix C.

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Endangered Sites

Endangerment sites are areas in which nerves and blood vessels surface close to the skin and are not well protected by muscle or connective tissue. Consequently, deep sustained pressure into these areas might damage the vessels and nerves. Areas where fragile bony projections might be broken off are also considered endangerment sites. The kidney area is included as such a site because the kidneys are loosely suspended in fat and connective tissue. Heavy pounding is contraindicated in that area. Avoidance or light pressure is indicated if working over an endangerment site to avoid any damage to the area.

. List and identify the location of various endangerment sites.

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Referrals

Referral is a method by which a client is sent to a health care professional for diagnosis and treatment of a disease.

. Discuss indications and methods for referral.

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Summary

Indications for massage are based on the physiologic effects that provide the benefits of massage. Massage is beneficial for most people, yet contraindications do exist. The responsible massage professional always refers a client for diagnosis and treatment by a qualified healthy professional, without delay, as soon as any condition is noticed that may suggest an underlying physical or mental health problem.

After a condition has been diagnosed and appropriate treatment established, the massage professional may provide massage under the supervision of the medical professional. Massage may become beneficial and supportive to the interventions by the health care professional.

Continued massage treatment may enhance the healing process by temporarily reducing pain, relaxing the client, reducing stress responses, increasing circulation and much more.

-on-one contact given by the massage professional may provide support and compassionate touch during a difficult time, thereby reducing feelings of frustration, isolation, anxiety and depression that often accompany illness or periods of stress.

Documents

SUBJECT 4 Foundations of Massage 2 - Evolve€¦ · This section of Foundations of Massage 2 describes the medical terminology that the massage professional most often encounters,