CE INSTITUTE LLC BLOG

Elderly clients usually require many special considerations including:

• Communication issues/brain disease
• Loss of sensation/nervous tissue atrophy
• Drier skin including brittle fingernails and toenails
• Frailty i.e. thinning skin, osteoporosis, etc.
• Lost range of motion, muscular contractures, poor movement/coordination
• Difficulty dressing/undressing, difficulty sitting/standing, getting on/off table 

One of the most important considerations for geriatric clients is to keep your work entrance and work area clear and clutter free.  According to American Family Physician Magazine[i], accidental falls account for 70% of deaths in persons 75+ years old.

It is advised for bodyworkers who service elderly and geriatric clients to seek out specific classes and training in geriatric care.  The care of geriatric clients could be an entire book on its own.  A solid investment in geriatric training could be a good investment to properly work with this vulnerable population. 

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

#massage #massagetherapy #massageprecautions #massagecontraindications

[i] Fuller, George F. “Falls in the Elderly.” American Family Physician, 1 Apr. 2000, www.aafp.org/afp/2000/0401/p2159.html.

A fever is a temporary increase in your body temperature, often due to an illness. Having a fever is a sign that something out of the ordinary is going on in your body.  For an adult, a fever may be uncomfortable, but usually isn't a cause for concern unless it reaches 103 F or higher.

Fever occurs when an area in your brain called the hypothalamus — also known as your body's "thermostat" — shifts the set point of your normal body temperature upward. When this happens, you may feel chilled and add layers of clothing or wrap up in a blanket, or you may shiver to generate more body heat, eventually resulting in an elevated body temperature.

Normal body temperature varies throughout the day — it's lower in the morning and higher in the late afternoon and evening. Although most people consider 98.6 F normal, your body temperature can vary by a degree or more — from about 97 F to 99 F — and still be considered normal.

Fever or elevated body temperature might be caused by:

• A virus
• A bacterial infection
• Heat exhaustion
• Certain inflammatory conditions (i.e. rheumatoid arthritis)
• A malignant tumor
• Some medications (i.e. antibiotics, seizure or blood pressures medications)
• Some immunizations
• Sometimes the cause of a fever can't be identified[i]

A fever can be a sign of a more serious medical illness, which could include infectious or contagious disease.  It is usually best to refer a feverish client to a physician for medical diagnosis or care. Do not work on a client who has a fever until serious illness including contagious disease has been ruled out as a potential cause.

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

#massage #massagetherapy #massageprecautions #massagecontraindications

[i] Mayo Clinic Staff. “Fever.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 21 July 2017, www.mayoclinic.org/diseases-conditions/fever/symptoms-causes/syc-20352759.

Hemophilia is a rare inherited bleeding disorder in which the blood does not clot properly. This can lead to spontaneous bleeding as well as bleeding following injuries or surgery.  Hemophilia is caused by a mutation, or change, in one of the genes that provides instructions for making the clotting factor proteins needed to form a blood clot. This change or mutation can prevent the clotting protein from working properly or could be missing altogether.

Hemophilia can result in: 

• Bleeding within joints that can lead to chronic joint disease and pain
• Bleeding in the head and sometimes in the brain which can cause long term problems, such as seizures and paralysis
• Death can occur if the bleeding cannot be stopped [i]

Bodyworkers/massage therapists should obtain physician approval and direction for massage or bodywork with a hemophiliac.  A simple bump or bruise could be a life-threatening situation for them. 

Range of motion or aggressive bodywork techniques should not be used.  Anything that would cause pressure on the skin (thus underlying blood vessels) could create potential damage.  It is always best to seek approval and/or direction for services from a medical physician regarding medical conditions where a client could easily bleed from any type of pressure.  

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

#massage #massagetherapy #massageprecautions #massagecontraindications

[i] National Center on Birth Defects and Developmental Disabilities. “Hemophilia.” Centers for Disease Control and Prevention, 2 Mar. 2017, www.cdc.gov/ncbddd/hemophilia/facts.html.

Mayo Clinic reports that there are more than 3 million Herpes Simplex I United States cases per year.  Herpes simplex is a common viral infection that is contagious. If you’ve ever had a cold sore or fever blister, you picked up the herpes simplex virus. Most cold sores are caused by herpes simplex virus type 1 (HSV-1). 

Other names for cold sores caused by HSV-1 are:

• Cold sore
• Oral herpes
• Mouth herpes
• Herpes simplex labialis[i]

This virus can be spread by skin-to-skin contact with an adult who carries the virus. An adult does not have to have sores to spread the virus.

The herpes simplex virus is spread from person to person through close contact. You can get a herpes simplex virus from touching a herpes sore. Most people, however, get herpes simplex from an infected person who does not have sores. Doctors call this “asymptomatic viral shedding.”

Once a person becomes infected with a herpes virus, the virus never leaves the body. After the first outbreak, the virus moves from the skin cells to nerve cells. The virus stays in the nerve cells forever, but it usually just stays there. In this stage, the virus is said to be dormant, or asleep. However, it can become active again.[ii]

Some people have no symptoms from the infection, while others develop painful and unsightly cold sores. Cold sores usually occur outside the mouth, on or around the lips. When they are inside the mouth, they are usually on the gums or the roof of the mouth. They are not the same as canker sores, which are not contagious.[iii] 

Do not touch on or around a cold sore.

Herpes Whitlow (aka Herpetic Whitlow)[iv]

Herpes whitlow is a viral infection of the hand and is contagious with person to person contact[v]. As such, it is a massage contraindication. Herpes whitlow results from exposure to type 1 or type 2 herpes simplex virus (also contagious) into broken skin. The infection may occur as a complication of primary oral or genital herpes lesions.

Health care workers specifically exposed to oral secretions are the most susceptible (e.g., dental hygienists, respiratory therapists). They can be affected if they are not using universal precautions.

Signs and symptoms of herpetic whitlow include the abrupt onset of edema, erythema, and significant localized tenderness of the infected finger. Often, the pain is out of proportion to the physical findings. Fever, lymphadenitis, and epitrochlear and axillary lymphadenopathy may be present. Small, clear vesicles are present initially. These may eventually coalesce and mimic a bacterial infection.

Herpes whitlow usually is self-contained and resolves in two to three weeks. Pharmaceutical treatment within the first 48 hours of symptom onset may lessen the severity of infection. This infection recurs in 30 to 50 percent of cases, but the initial infection is typically the most severe.

Herpes Zoster aka Shingles

Almost 1 out of every 3 people in the United States will develop shingles, also known as herpes zoster, in their lifetime. There are an estimated 1 million cases of shingles each year in this country. Anyone who has recovered from chickenpox may develop shingles; even children can get shingles.

Shingles is caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays dormant (inactive) in the body. Scientists aren’t sure why the virus can reactivate years later, causing shingles.  The risk of shingles increases as you get older.[vi]

Shingles cannot be passed from one person to another. However, the virus that causes shingles, the varicella zoster virus, can spread from a person with active shingles to cause chickenpox in someone who had never had chickenpox or received chickenpox vaccine. 

The virus is spread through direct contact with fluid from the rash blisters caused by shingles.  Shingles is less contagious than chickenpox and the risk of a person with shingles spreading the virus is low if the rash is covered.

A person with active shingles can spread the virus when the rash is in the blister phase. A person is not infectious before the blisters appear. Once the rash has developed crusts, the person is no longer infectious.

People who have shingles are advised to:

• Cover the rash and avoid touching or scratching it.
• Wash hands often to prevent the spread of varicella zoster virus.
• Avoid contact with “vulnerable” people until the rash has developed crusts.[vii]

For bodyworkers, someone who has never had chickenpox should avoid contact with shingles (close contact could lead to virus transmission).  It is ill-advised to work on or over the blister-like sores (shingles) – even when virus transmission is not a concern.  While all blister patterns are different, herpes zoster regularly breaks out on one side of the body and may form a pattern that looks like a line.  Allow blisters to heal and skin become fully intact prior to working over the affected area and as always, it’s 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] American Academy of Dermatology. “Herpes Simplex.” Herpes Simplex | American Academy of Dermatology, Retrieved online: 1 May 2018, www.aad.org/public/diseases/contagious-skin-diseases/herpes-simplex#overview.

[ii] American Academy of Dermatology. “Herpes Simplex.” Herpes Simplex | American Academy of Dermatology, 1 May 2018, www.aad.org/public/diseases/contagious-skin-diseases/herpes-simplex#causes.

[iii] National Institutes of Health. “Cold Sores.” MedlinePlus, U.S. National Library of Medicine, 23 Apr. 2018, medlineplus.gov/coldsores.html.

[iv] Clark, Dwayne C. “Common Acute Hand Infections.” American Family Physician, 1 Dec. 2003, www.aafp.org/afp/2003/1201/p2167.html.

[v] Higuera, Valencia, “What you Need to Know About Herpetic Whitlow”  Healthline, 21 June 2017, https://www.healthline.com/health/herpetic-whitlow

[vi] National Center for Immunization and Respiratory Diseases. “Shingles (Herpes Zoster).” Centers for Disease Control and Prevention,  19 Jan. 2018, www.cdc.gov/shingles/about/overview.html.

[vii] National Center for Immunization and Respiratory Diseases. “Shingles (Herpes Zoster).” Centers for Disease Control and Prevention,  19 Jan. 2018, www.cdc.gov/shingles/about/transmission.html.

Hepatitis is an inflammation of the liver, the largest organ inside the body.  The liver helps the body to digest food, store energy, and remove poisons. Hepatitis is not contagious through casual human contact such as massage, especially when proper professional sanitation practices are used, such as:

• do not work on broken skin and wash hands before/after client service
• wear gloves or use other protective measures when a practitioner has a skin cut
• do not touch one’s own mouth, nose, eyes or other mucous membranes after working with clients until the practitioner has washed their own hands

Viruses cause most cases of hepatitis. The hepatitis type is named for the virus that causes it (i.e., hepatitis A, hepatitis B or hepatitis C). Drug or alcohol use can also cause hepatitis. In other cases, the body mistakenly attacks healthy cells in the liver which causes the inflammation and disease.

Clients with hepatitis may vomit or have nausea. Discontinue service if a client begins to vomit (with hepatitis or for any condition).  Vomiting can be a sign of serious medical distress.  The client must ascertain why they vomited so it can be determined if medical care is required.

Normally clients infected with hepatitis would not be contraindicated for massage or bodywork, however, when a client has any type of acute infection, it’s important for them to seek proper medical care outside of massage.  Massage might help a client feel better, but that does not mean a client should avoid or discontinue conventional medical care for their disease.

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

#massage #massagetherapy #massageprecautions #massagecontraindications

Hives are red (and often itchy) bumps on the skin. An allergic reaction to a drug or food usually causes them. Allergic reactions cause the body to release chemicals that can make the skin swell up in hives. People who have other allergies are more likely to get hives than others. Other causes include infections and stress.  Hives are not contagious.  

Hives are very common. They will usually go away on their own, but in a serious case, medicine, a shot or medical treatment may be required. When hives last longer than six weeks, it is called chronic hives. Usually no cause can be found. Most chronic hives resolve on their own in less than one year.  In rare cases, hives can cause a dangerous swelling in of the airways, making it hard to breathe—which is considered a grave medical emergency.[i] 

It is important to use extreme caution when working on someone who has hives. 

The client is most likely experiencing an allergic reaction which could become life threatening.

Avoid massage or bodywork practice on any area that is affected by hives.

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

#massage #massagetherapy #massageprecautions #massagecontraindications

[i] U.S. National Library of Medicine. “Hives | Rash | Skin Rash | Itchy Skin.” MedlinePlus, U.S. National Library of Medicine, 23 Apr. 2018, medlineplus.gov/hives.html.

Impetigo is a contagious common bacterial skin infection that is a massage contraindication. It can produce blisters or sores anywhere on the body, but usually on the face (around the nose and mouth), neck, hands, and diaper area. It’s preventable and manageable with antibiotics, says pediatrician Thomas D. Smith, MD, of the FDA.

Two types of bacteria found on our skin cause impetigo: Staphylococcus aureus and Streptococcus pyogenes (which also causes strep throat). Most of us go about our lives carrying around these bacteria without a problem, Smith says, but then a minor cut, scrape or insect bite allows the bacteria to cause an infection, resulting in impetigo.

Anyone can get impetigo — and more than once, Smith says. Although impetigo is a year-round disease, it occurs most often during the warm weather months. There are more than 3 million cases of impetigo in the United States every year.

Untreated, impetigo often clears up on its own after a few days or weeks. The key is to keep the infected area clean with soap and water and not to scratch it. The downside of not treating impetigo is that some people might develop more lesions that spread to other areas of their body.

Dr. Smith states: “To spread impetigo, you need fairly close contact — not casual contact — with the infected person or the objects they touched.” This implies that it is possible for impetigo to be transmitted during massage or bodywork.

Because impetigo spreads by skin-to-skin contact, there often are small outbreaks within a family or a classroom. Avoid touching objects that someone with impetigo has used, such as utensils, towels, sheets, clothing and toys. If you have impetigo, keep your fingernails short so the bacteria can’t live under your nails and spread. Also, don’t scratch the sores.[i]

The lesions shown in this photo on the person’s left forearm proved to be Streptococcal impetigo, a dermatologic condition quite often caused by Staphylococcus aureus bacteria.[ii]

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

#massage #massagetherapy #massageprecautions #massagecontraindications

[i] Office of the Commissioner. “Consumer Updates - How to Treat Impetigo and Control This Common Skin Infection.” U S Food and Drug Administration Home Page, Office of the Commissioner, 12 Dec. 2017, www.fda.gov/ForConsumers/ConsumerUpdates/ucm048837.htm.

[ii] Miranda, Dr. Herman, Chambers, Peru A. “Public Health Image Library (PHIL).” Centers for Disease Control and Prevention, 20 Dec. 2017, phil.cdc.gov/Details.aspx?pid=14927.

Jaundice causes the skin and the whites of the eyes to turn yellow. Too much bilirubin causes jaundice. Bilirubin is a yellow chemical in hemoglobin, the substance that carries oxygen in red blood cells. As red blood cells break down, your body builds new cells to replace them. The old ones are processed by the liver. If the liver cannot handle the blood cells as they break down, bilirubin builds up in the body and the skin may look yellow.

Here are some common causes of jaundice:

• Blood diseases
• Genetic syndromes
• Liver diseases, such as hepatitis or cirrhosis
• Blockage or cancer of bile ducts
• Infections
• Medicines[i] 

If a client presents with jaundice, ask them about this observation and recommend they consult a physician if they were unaware of the condition.  Be clear that you are not making a medical diagnosis but a referral instead.  A client could have a serious medical condition with jaundice, so use caution and be vigilant in their service, until greater information is procured about their jaundice condition.   

The photo on this page is picture of a person with jaundice.  The picture is from Emory University in 1963 and published on the CDC website.  The photo caption states: the viral disease Hepatitis A is manifested here in this photo as icterus, or jaundice of the conjunctivae and facial skin.  HAV is usually spread from person to person by putting something in the mouth (even though it may look clean) that has been contaminated with the stool of a person with hepatitis A. Adults will have signs and symptoms more often than children.

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

#massage #massagetherapy #massageprecautions #massagecontraindications

[i] U.S. Department of Health and Human Services. “Jaundice | Icterus.” MedlinePlus, U.S. National Library of Medicine, 1 Mar. 2018, medlineplus.gov/jaundice.html.

Meningitis is an inflammation (swelling) of the protective membranes covering the brain and spinal cord. A bacterial or viral infection of the fluid surrounding the brain and spinal cord usually causes the swelling. However, injuries, cancer, certain drugs, and other types of infections also can cause meningitis.^xxxix It is important to know the specific cause of meningitis because bacterial and viral meningitis are considered contagious and can be lethal.

Bacterial Meningitis

Generally, the germs that cause bacterial meningitis spread from one person to another. Certain germs can spread through food. How people spread the germs often depends on the type of bacteria.[i]

Viral Meningitis

People can spread the viruses that cause viral meningitis to other people. If you have close contact with someone who has viral meningitis, they may spread the virus to you. However, you are not likely to develop meningitis. That is because most people infected with these viruses will not develop meningitis.^xxxix

If your client has been diagnosed with meningitis, you need to learn the cause and whether or not their meningitis is infectious. 

Any disease that is infectious is a massage therapy and bodywork contraindication.

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

#massage #massagetherapy #massageprecautions #massagecontraindications

[i] National Center for Immunization and Respiratory Diseases. “Meningitis.” Centers for Disease Control and Prevention, 9 Apr. 2018, www.cdc.gov/meningitis/.