Multiple Sclerosis (MS)

MS is an idiopathic nervous system disease that affects the spinal cord and brain. It damages materials that surround and protects nerve cells, known as the myelin sheath. This damage can block or slow down messages between the brain and body.  MS symptoms can include:

• Visual disturbances
• Muscle weakness
• Incontinence issues
• Trouble with coordination and balance
• Sensations such as numbness, prickling, or "pins and needles"
• Thinking and memory problems

Not all MS patients have these symptoms.  MS is symptomatic from patient to patient, and symptoms can vary.

No one knows what causes MS. It may be an autoimmune disease, which happens when the immune system attacks healthy cells in the body by mistake. Multiple sclerosis affects women more than men. It often begins between the ages of 20 and 40. Usually, the disease is mild, but some people lose the ability to write, speak, or walk.[i]

Advisements to provide massage or bodyworker service include: allow extra time for a MS client.  Depending on the severity of their disease and/or length of their service appointment, they may have to use the bathroom frequently, have trouble sitting down, standing up or moving, have communication problems, etc.  Do not work on any areas where the client has numbness or cannot feel.  Check with their physician for additional instructions or directions.

To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/

[i] U.S. Department of Health and Human Services. “Multiple Sclerosis | MS.” MedlinePlus, U.S. National Library of Medicine, 30 Apr. 2018, medlineplus.gov/multiplesclerosis.html.

Parkinson's Disease (PD)

Parkinson's Disease is a type of movement disorder. It happens when nerve cells in the brain do not produce enough dopamine.  PD symptoms begin gradually, often on one side of the body. Later in more advanced disease, it will eventually affect both sides of the body. Symptoms can include: 

• Trembling of hands, arms, legs, jaw and face
• Slowness of movement with muscle stiffness plus poor balance/coordination

As symptoms get worse, people with the disease may have trouble walking, talking, or doing simple tasks. They may also have problems such as depression, sleep problems, or trouble chewing, swallowing, or speaking.

Allow extra time to work with someone who has moderate or advanced PD.  While there are few contraindications to work with PD clients, they usually do require extra patience and time.  And as always, ask the client’s physician for any special precautions or considerations for their medical condition.

To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/

Acne is a noncontagious skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. Blockages, inflammation, and infection can develop deep inside the skin and produce a cyst-like lump within the skin.  

Depending on its severity, acne can cause emotional distress and scar the skin.  In older adults, a sudden onset of severe acne may signal an underlying disease requiring medical attention.[i] 

It is important to note that some instructors teach different “grades” of acne (i.e. Grade I, Grade II, Grade III & Grade IV – or another system).  However, the American Academy of Dermatology states that “…there is no universally agreed upon grading system, and systems can differ greatly between studies…”[ii]

Massage Therapists should never work on or over broken skin.

That means that service or touch should be avoided over facial or body areas that have severe acne break-out.  Not only is the skin broken and prone to infection, but there could be underlying medical condition as well.  Refer a client (with severe acne) to a dermatologist or physician for proper medical care.

To learn more, please register for training at: https://ceinstitute.com/

#massage #massagetherapy #massageprecautions #massagecontraindication. 

[i] Mayo Clinic Staff. “Acne.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 31 Oct. 2017, www.mayoclinic.org/diseases-conditions/acne/symptoms-causes/syc-20368047.

[ii] “Practice Management Center.” Systems for the Grading and Classification of Acne: Recommendations | American Academy of Dermatology, Retrieved on: 25 Apr. 2018, www.aad.org/practicecenter/quality/clinical-guidelines/acne/systems-for-the-grading-and-classification-of-acne.

Spinal Stenosis:

The abnormal narrowing of a passage in the body. Examples include:

• Cervical Spinal Stenosis
• Lumbar Spinal Stenosis
• Foraminal Stenosis
• Aortic Stenosis

There are several surgical options available for  spinal stenosis today.  No amount of massage will create a larger or “better” opening in the spinal canal; however, massage therapy can help relieve pain and irritation for some of the painfully affected or “referring pain” areas.

Lamina:  It is the bone that forms the backside of the spine and creates a “roof” over the spinal cord.

Laminectomy: Is a surgical procedure where a portion of the lamina is surgically removed to release pressure within the spinal column.

Bodywork Precautions & Contraindications for Laminectomy

• Do not apply pressure on laminectomy site
• Pull skin to the left or right of laminectomy scar to perform cross fiber friction techniques (specialized training required)
• Do not work around or over a laminectomy without physician referral and specialized training

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Every client must be able to provide informed consent for each service they request or receive. Informed consent includes telling the client of any possible consequences for the service, including known risks and benefits. The client can only provide consent for the service once this information is understood/shared.

A person who is under the influence of alcohol or drugs is not of legal capacity to provide informed consent, therefore their service would be  contraindicated and inappropriate to provide. This person may exhibit slurred speech, could be off-balance or is unable to make sense of their surroundings, etc.  They are not of “sound mind” to provide consent.

As bodyworkers, we are not able to make medical diagnoses.  Unfortunately, a person exhibiting imbalance, slurred speech, etc., may be having an acute medical episode that requires immediate medical attention.  Regardless of the situation of why a client might exhibit unsteadiness, service can only be provided when an individual can provide informed consent and is competent enough to provide it.

Bodywork, massage, etc. should not be provided to an individual who is under the influence of alcohol or drugs that reduces the client’s capability to provide informed consent. Not obtaining informed consent for a service appointment for any reason would be considered unethical in most to all cases.

To learn more, please register for training at https://ceinstitute.com/

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Sciatic Nerve & Piriformis Syndrome:

• Starts in the lower back, typically at L3
• At each level of the lower spine a nerve root exits from the inside of the spinal canal, and each of these roots then come together to form the large sciatic nerve
• The sciatic nerve runs from the lower back, through the buttock, and down the back of each leg
• The sciatic nerve is the same size as your thumb
• Researchers estimate sciatica will affect up to 43% of the population at some point of life

Sciatica is also known as Lumbar Radiculopathy

6 Common Causes of Sciatica

1. Lumbar Spinal Stenosis

2. Herniated Lumbar Disc

3. Degenerative Disc Disease

4. Isthmic Spondylolisthesis

5. Sacroiliac Joint Dysfunction

6. Piriformis Syndrome

Occurs when the piriformis muscle contracts/spasms and irritates/compresses the sciatic. 

Symptoms include low back tenderness and pain, accompanied by sciatica-like pain, numbness and weakness that runs down the back of the leg, calf and foot.

In many people, the sciatic nerve pierces the piriformis muscle, splits the piriformis muscle, or both, predisposing these individuals to piriformis syndrome in up to 22% of the population.

Spine-Health.com Recommends Deep Massage for Piriformis Syndrome*
“Manual release by a PT or other qualified specialist is thought to enhance healing by increasing blood flow to the area and decreasing muscle spasm.”

 * https://www.spine-health.com/conditions/sciatica/sciatica-causes

To learn more, please register for training at https://ceinstitute.com/

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Arthritis includes more than 100 diseases and conditions that affect joints, the tissues that surround the joint, and other connective tissue. Symptoms vary depending on the specific form of the disease, but typically include pain and stiffness in and around one or more joints.  Some rheumatic conditions can also involve the immune system and various internal organs of the body.[i]

Arthritis affects more than 1 of 4 U.S. adults (that’s about 54.4 million people). It is a leading cause of work disability in the United States and one of the most common chronic conditions in the nation. Arthritis is a common cause of chronic pain. 

There is a lot of conflicting information and little scientific research or published studies about arthritis indications and contraindications for massage therapy or bodywork.

Arthritis sufferers usually have a good deal of joint irritation and inflammation. As such, it is usually contraindicated to massage (or provide heat around) an “inflamed” area.  However, some arthritis sufferers state that their pain is greatly relieved by heat, and there has been research over the years that shows heat was helpful with chronic medical conditions such as arthritis in SOME cases.

Some arthritic sufferers may find that a gentle massage therapy session could provide pain relief. Others could say this same work irritated their inflammation. It’s up to the bodyworker and client to evaluate and decide what services can safely be provided to that arthritic client. 

The client usually knows what irritates and soothes them. It’s important to ask questions and listen to their answers because each individual usually knows their own body best. If there are ever any questions about safely providing service, it is best to seek physician approval and/or direction.

Osteoarthritis (OA)

Osteoarthritis affects over 30 million Americans and is the most common form of arthritis in the US. It is caused by the damage or breakdown of joint cartilage between bones.  It is sometimes called degenerative joint disease or “wear and tear” arthritis. These changes usually develop slowly and get worse over time. It most frequently occurs in the hands, hips, and knees.

Osteoarthritis can cause severe joint pain, swelling, and stiffness. In some cases, it also causes reduced function and disability; some people are no longer able to perform their daily tasks and, in some cases, are not able to work. Severe cases may require joint replacement surgery, particularly for knees or hips.[ii]

Heberden’s Nodes

Heberden's nodes are often seen in osteoarthritis. They are hard bony swellings and growths that develop on distal interphalangeal joints. Precaution – do not press or apply pressure to swollen joints!

Bouchard’s Nodes

Bouchard's nodes are often seen in osteoarthritis.  They are hard bony swellings and growths that develop on proximal interphalangeal joints. Precaution – do not press or apply pressure to swollen joints!

Rheumatoid Arthritis (RA)

Rheumatoid Arthritis, is an autoimmune and inflammatory disease, which means that your immune system attacks healthy cells in your body by mistake, causing inflammation (painful swelling) in the affected parts of the body.

RA mainly attacks the joints, usually many joints at once. These attacks are also commonly called “flare-ups”.  In some cases, it may be contraindicated to work on a client while they are experiencing a “flare-up”. That’s because the client could have extreme irritation which might become worse by any type of pressure or touch. Unfortunately one of the only ways to know if their medical condition would be worsened by massage is through experimentation - and it would be unwise to experiment on clients. Also, just because a client has had massage in the past without irritation, does not mean they will have the exact same result with every massage session.  Unfortunately we do not know why different responses can happen with what seems like similar massage sessions; and as such, practitioners should avoid doing anything where it feels like an experiment with a client where they could be worse off than before they started their massage or bodywork session. Just think of the old adage when performing massage or bodywork: do no harm!

It is up to the bodyworker and client to decide if they should proceed with service during a “flare-up”. It is always best to seek approval and/or direction for services from a medical physician regarding medical conditions if you and/or the client are unsure about which service(s) are safe and/or beneficial.

Rheumatoid arthritis commonly affects joints in the knees, hands and wrists. In a rheumatoid arthritic joint, the lining of the joint becomes inflamed, causing damage to joint tissue. This tissue damage can cause long-lasting or chronic pain, a lack of balance, and deformity within the joints themselves.

Rheumatoid arthritis can also affect the lungs, heart, and eyes.  RA usually attacks many joints at once. [iii]

Fibromyalgia

Fibromyalgia is a frequently debilitating and painful condition that can have "tender points" on the body. Tender points are specific places on the neck, shoulders, back, hips, arms, and legs. These points can elicit extreme pain when pressure is applied to them.

The American College of Rheumatology approved new revised diagnostic criteria in 2010 for fibromyalgia that eliminated the 1990 tender point testing criteria.

The new 2010 diagnostic criteria uses the Widespread Pain Index, and symptom severity scale in place of tender point testing under the 1990 criteria.[iv] 

The 2010 “Widespread Pain Index” (WPI) is shown here in the colorful picture of the body (top).  The 1990 “Tender Point” criteria body chart is shown here with the red dots on the body (to the right).

As a bodyworker it is important to know where the “tender spots” are when working with fibromyalgia clients.  It is questionable whether pressure should be applied to these tender point spots as this can be very painful for a fibromyalgia client. Always avoid working on any areas of lost sensation or numbness.

Fibromyalgia can also cause disability, a lower quality of life and widespread pain all over the body beyond the “tender points”.  People with fibromyalgia may be more sensitive to pain than people without fibromyalgia. This is called “abnormal pain perception processing”. Fibromyalgia affects about 4 million US adults, about 2% of the adult population. The cause of fibromyalgia is not known, but it can be effectively treated and managed.^vii 

People with fibromyalgia can also be GREAT candidates for Massage Therapy!

The CDC reports US adults with fibromyalgia may have complications such as:

• More hospitalizations. People with fibromyalgia are twice as likely to be hospitalized as someone without fibromyalgia.
• Lower quality of life, especially for women. A woman with fibromyalgia has 40% less physical function & 67% less mental health than a healthy woman.
• Higher rates of major depression. Adults with fibromyalgia are more than 3 times more likely to have major depression than adults without. (Screening and treatment for depression is extremely important.)
• Higher death rates from suicide and injuries. Death rates from suicide and injuries are higher among fibromyalgia patients, but overall mortality among adults with fibromyalgia is similar to the general population.
• Higher rates of other rheumatic conditions. Fibromyalgia often co-occurs with other types of arthritis such as osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis.[v]

Gout

Gout is a form of arthritis generally caused by a build-up of uric acid in the joint. It regularly starts in the big toe joint and other joints that are furthest from the heart where our body’s temperature is coolest, where the uric acid can “crystalize”.  

Gout is considered one of the most painful kinds of arthritis.  Symptoms include:

• Pain/tenderness
• Tightening of the skin
• Swelling
• Redness or discoloration
• Warm to the touch

Gout is generally caused by consuming purine rich foods, such as alcohol, anchovies, dried beans, gravies, liver and peas.

Most people who have gout are house-bound and are unable to stand or walk without extreme pain.  It is ill-advised to press on the affected area, and it is recommended to seek approval and/or direction for bodywork from a medical physician regarding medical conditions.  This may include rescheduling any services that involve the affected area (i.e., foot reflexology for someone who has gout in their big toe).  Massage and bodywork services should never elicit extreme pain.

To learn more, please register for training at https://ceinstitute.com/

#massage #massagetherapy #massageprecautions #massagecontraindications

[i] Centers for Disease Control & Prevention.  Arthritis. (2018, February 21). Retrieved May 03, 2018, from https://www.cdc.gov/arthritis/basics/index.html

[ii] US Health & Human Services. “Arthritis.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 Apr. 2018, www.cdc.gov/arthritis/basics/osteoarthritis.htm.

[iii] US Health & Human Services. “Arthritis.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 Apr. 2018, www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html.

[iv] Wolfe, F; et al. (May 2010). "The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity" (PDF). Arthritis Care Res. 62 (5): 600–610. doi:10.1002/acr.20140. PMID 20461783

[v] National Center for Chronic Disease Prevention and Health Promotion | Division of Population Health. “Arthritis.” Centers for Disease Control and Prevention,  3 Apr. 2018, www.cdc.gov/arthritis/basics/fibromyalgia.htm.

Athlete’s foot (also known as tinea pedis) is an infection of the skin and feet that can be caused by a variety of different fungi. Although athlete’s foot can affect any portion of the foot, the infection is most often between the toes. Athlete’s foot is typically characterized by skin fissures or scales that can be red and itchy.

Athlete’s foot is spread through contact with infected skin scales or contact with fungi in damp areas (for example, showers, locker rooms, whirlpools, etc.) Athlete’s foot can be a chronic infection that can recur frequently.

Appropriate hygiene techniques may help to prevent or control Athlete’s foot.[i]

WebMD reports: “Athlete's foot is mildly contagious. It can be spread through direct contact with the infection and by skin particles left on towels, shoes, or floors.”[ii]

Bodyworkers should avoid working directly on or around athlete’s foot. 

They should also make sure that all areas touched by this infection (i.e. the floors, linens, etc.) are disinfected. 

It is always best to seek approval and/or direction for services from a medical physician regarding medical conditions.

To learn more, please register for training at https://ceinstitute.com/

#massage #massagetherapy #massageprecautions #massagecontraindications

[i] National Center for Emerging and Zoonotic Infectious Diseases. “Water, Sanitation & Environmentally-Related Hygiene.” Centers for Disease Control and Prevention,  6 Feb. 2017, www.cdc.gov/healthywater/hygiene/disease/athletes_foot.html.

[ii] Debra, Debra MD. “Understanding Athlete's Foot -- the Basics.” WebMD, WebMD, reviewed on: 9 Mar. 2017, www.webmd.com/skin-problems-and-treatments/understanding-athletes-foot-basics.

Having high blood glucose for many years can damage blood vessels that bring oxygen to some nerve endings. Damaged nerves may stop, slow, or send messages at the wrong times, especially during a massage appointment. Numbness, pain, and weakness in the hands, arms, feet, and legs may develop over time with diabetic neuropathy. Problems may also occur in various organs too. Diabetic neuropathy is the medical term for damage to the nervous system from diabetes. The most common type is peripheral neuropathy, which affects the arms and legs or upper/lower extremities.

Sometimes nerve damage can deform or misshape feet, causing pressure that can turn into blisters, sores, or ulcers. Poor circulation can make these injuries slow to heal. Sometimes this can lead to amputation of a toe, foot, or leg or any area that cannot heal, usually from a cut of the dermis which can lead to infection. This is one of the reasons why it is so important for massage therapists to maintain good fingernail hygiene.

 It is ill-advised to work on any bodily surface area that the client cannot feel.  Diabetic clients can experience numbness, especially in the distal extremities, due to the common nerve damage that can occur with this life-long disease. Furthermore, a diabetic’s capacity to heal from skin nicks or cuts is poor.  The smallest unhealed cut on a diabetic could result in infection, necrosis (tissue death), amputation, sepsis and/or death.  It is important to use special caution when working with diabetics, and as always, seek approval and/or direction for services from a medical physician regarding medical conditions.

To learn more, please register for training at https://ceinstitute.com/

#massage #massagetherapy #massageprecautions #massagecontraindications