Fungal nail infections are common infections of the fingernails or toenails that can cause the nail to become discolored, thick, and more likely to crack and break. Infections are more common in toenails than fingernails. The technical name for a fungal nail infection is “onychomycosis.” This is a local contraindication where the practitioner should not touch any part of the fungal infection or surrounding area.

Nails with a fungal infection are often:

• Thick & Discolored (yellow, brown, or white)
• Fragile or cracked

A fungal nail infection usually isn't painful unless it becomes severe. Some people who have fungal toenail infections also have a fungal skin infection on the foot.

Fungal nail infections can be caused by many different types of yeasts or molds that live in the environment. Small cracks in the nail or surrounding skin can allow these germs to enter and cause infection.[i]

The Mayo Clinic States:  Fungal nail infection can develop in people at any age, but it's more common in older adults. As the nail ages, it can become brittle and dry. The resulting cracks in the nails allow fungi to enter. Other factors — such as reduced blood circulation to the feet and a weakened immune system — also may play a role.

Toenail fungal infection can start from athlete's foot (foot fungus), and it can spread from one nail to another, but it is uncommon to get an infection from someone else. [ii]

Despite the CDC and Mayo Clinic discounting nail fungus as highly contagious from person to person, bodyworkers who work with the hands and feet are at high risk for transmission. Nail fungus IS contagious from person to person, and more exposure creates more risk of infection or transmission.  It’s important to avoid touching any fungal infection, keep your own hands clean and disinfect anything that contacts the fungus.

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

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[i] National Center for Emerging and Zoonotic Infectious Diseases. “Fungal Diseases.” Centers for Disease Control and Prevention,  25 Jan. 2017, www.cdc.gov/fungal/nail-infections.html.

[ii] Mayo Clinic Staff. “Nail Fungus.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 6 Mar. 2018, www.mayoclinic.org/diseases-conditions/nail-fungus/symptoms-causes/syc-20353294.

The Human Spine is Made up of 5 Distinct Sections:

Cervical = 7 Vertebra

Thoracic = 12 Vertebra

Lumbar = 5 Vertebra 

Sacrum = 5 (fused) Vertebra

Coccyx = 3-5 Vertebra

There are many differences between Cervical, Thoracic and Lumbar Vertebra.  Here are some Highlights:

 Cervical Vertebra (pictured)

• 1^st & 2^nd Axis & Atlas (different from all other vertebra in the body)
• C3-C7 Are Similar
• Vertebral Artery Openings in Transverse Foramen

Thoracic Vertebra

• Have Little Motion

• Affixed to the Ribs

• Least Common Area of Back Pain

Lumbar Vertebra

• Largest Vertebra

• Weight Baring

• Most Common Area of Back Pain

Each Veterbra has ”foramen” where important vessels pass through to other areas of the body.  Vessels exiting these foramen often become ”pinched” or damaged.  Sometimes there are no symptoms with this impingement, and sometimes it can cause great pain. 

”FORAMEN” Definition:

An opening, hole, or passage, especially in a bone.

Facet Joints

• Made of small, bony knobs

• Create flexibility/limitations for flexion, bending & twisting of the spine

• Nerves exit between the facet joints

• Facet joints are located on the back of the spinal column

• 2 facet joints are between each pair of vertebrae

There are 23 Vertebral Discs in the Spinal Column. These may also be called:

Discs

Spinal Discs

Vertebral Discs

Intervertebral Discs

Annulus Fibrosus

These Discs Have a Tough Outer Ring (Annulus Fibrosus) with an Inner Softer Nucleus (Nucleus Pulposus)

When damaged, the discs may be replaced with a “Disc Implant” (pictured).

Bodyworker Precaution:

Working OVER Implants is Generally Contraindicated.  Always check with a physician prior to working with a contraindication!

Vertebral discs are Shock or Compression Absorbers & Nerve Protectors

The Discs Are Constantly “at Work”, and are “At Risk” for Injury

Spine-Health.com Reports*:

“There are many terms used to describe spinal disc pathology and associated pain, such as "herniated disc," "pinched nerve," and "bulging disc," and all are used differently and, at times, interchangeably.

Unfortunately, healthcare professionals do not agree on a precise definition of any of these terms, and patients may be frustrated when they hear their diagnosis referred to in different terms. The unusually wide range of terms used to describe spinal disc problems (such as ruptured disc, torn disc, slipped disc, collapsed disc, disc protrusion, disc disease, and black disc) can add to the confusion.”

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*https://www.spine-health.com/conditions/herniated-disc/whats-a-herniated-disc-pinched-nerve-bulging-disc

 The Special Relationship of C1 & C2

• C1 = Atlas

• C2 = Axis

• C2 “spins/rotates” around C1

• The Atlas/Axis Joint provides 50% of cervical neck rotation

• The Atlas does not have a Spinous Process

• The Axis does not have Foramen or Transverse Process

• Approximately 2% of all spinal injuries are C1-C2

• C1-C2 injuries are considered the worst

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There are Endless

Disc Injury Terms:

• Degenerative Disc Disease
• Ruptured Discs
• Herniated Disc
• Slipped Disc
• Bulging Disc

Remember, any of these ruptured bulging, herniated disc terms could be used interchangeably by other medical professionals or clients. Most medical professionals make no distinction between these terms.

 Spine-Health.com Reports:

“It should be kept in mind that all the terms—herniated disc, pinched nerve, bulging disc, slipped disc, ruptured disc, etc.—refer to radiographic findings seen on a CT scan or MRI scan.

While these test results are important, they are not as meaningful in determining the cause of the pain as the patient's specific symptoms and the doctor's physical exam results.”

“When a patient has a symptomatic herniated disc, the disc itself is not painful, but rather the material that is leaking out of the inside of the disc is pinching or irritating a nearby nerve.” 

 “This type of pathology produces pain called radicular pain (e.g., nerve root pain) leading to pain that may radiate to other parts of the body, such as from the low back down the leg or from the neck down the arm. Leg pain from a pinched nerve is usually described as sciatica.”

Radicular Pain (aka Radiculitis)

Pain-related symptoms caused by the inflammation of a spinal nerve root in the spinal column.

PINCHED NERVE Consensus:

Clients May Not Have Pain At Pinched Nerve Site.  Pinched nerves can create REFERRED PAIN to the areas affected by the pinched nerve.

Bodywork Precaution

• Massage on a Pinched Nerve/Herniated Disc itself is CONTRAINDICATED
• Do Not Press Into a Disc Injury

Bodywork May be Applied for “Pinched Nerve”

• Work to Relieve Affected Radicular Pain
• GOAL: Soothe Muscular Contractions & Pain
• Massage Can Often Help with the Symptoms & Side Effects of Disc Disease & Injuries

CHECK WITH A PHYSICIAN PRIOR TO WORKING ON A CLIENT WITH AN ACCUTE DISC INJURY

Disc Herniations/Pinched Nerves According to Spine-Health.com:

https://www.spine-health.com/conditions/herniated-disc/typical-symptoms-a-herniated-disc 

 C4-C5 Herniated Disc Could Cause:

• Weakness in the deltoid muscle
• Shoulder pain
• Do not usually feel numbness or tingling sensations

C5-C6 Herniated Disc Could Cause:

One of the most common areas for a cervical disc herniation

• Weakness in the biceps and wrist extensor muscles
• Pain, numbness and tingling can radiate to the thumb side of the hand

C6-C7 Herniated Disc Could Cause:

One of the most common areas for a cervical disc herniation

• Weakness in the triceps and forearm extensor muscles
• Numbness and tingling along with pain can radiate down the triceps and into the middle finger

C7-T1 Herniated Disc Could Cause:

• Weakness when gripping with the hand
• Numbness, pain, and tingling that radiates down the arm and to the little finger side of the hand

90% of Herniated Discs Occur at L4-L5 & L5-S1

L4-L5 Herniated Disc Could Cause:

• Sciatica pain
• Weakness when raising the big toe
• Possible weakness in the ankle (aka as “foot drop”)
• Numbness and pain on top of the foot

L5-S1 Herniated Disc Could Cause:

• Sciatica pain
• Weakness when standing on the toes
• Numbness and pain can radiate down into the sole of the foot and the outside of the foot

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

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Chronic Obstructive Pulmonary Disease (COPD)

COPD makes it hard to breathe. The main cause of COPD is long-term exposure to substances that irritate and damage the lungs. This is often seen with cigarette smoking, air pollution, chemical fumes, or dust.

At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more severe. They include:

• A cough that produces a lot of mucus
• Shortness of breath, especially with physical activity
• Wheezing
• Chest tightness

Doctors use lung function tests, imaging tests, and blood tests to diagnose COPD. There is no cure. Treatments may relieve symptoms. They include medicines, oxygen therapy, surgery, or a lung transplant.

The two main types of COPD are:

• emphysema
• chronic bronchitis

Emphysema

Emphysema is a type of COPD involving damage to the air sacs (alveoli) in the lungs. As a result, the body does not get the oxygen it needs. Emphysema makes it hard to catch one’s breath. A chronic cough and having trouble breathing during exercise is common with emphysema as well.

Bronchitis

Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to the lungs. It causes a cough that often brings up mucus. It can also cause shortness of breath, wheezing, a low fever, and chest tightness.

COPD Service Precautions & Advisements

Providing general body massage which could increase circulation to a struggling or failing organ (such as the lungs), would be ill-advised, specifically depending on the severity of the disease, treatment goals and other factors.  It is best to check with a physician for approval and direction of bodywork for such clients.

If a physician does approve bodywork, try the work on an inclined table, where the top of the table/client’s head is slightly elevated above the bottom of the table/client’s feet, if the table can be adjusted in this manner.

ADDITIONAL SERVICE PRECAUTION: Keep extreme heat/fire away from “oxygen therapy”.  Oxygen therapy use can be highly flammable and a safety hazard.

A Brief 101 About Dementia & Alzheimer’s Disease for Massage Therapists & Bodyworkers

Both diseases can cause mental incapacitation. 

These diseases usually do not produce physical medical issues that could be problematic for bodywork although there are many special considerations that should be made for these clients: 

First is the client’s ability to provide informed consent.  Clients with either disease may not be legally sufficient to provide consent for bodywork.  It would be important to learn who has power-of-attorney (POA) over a mentally incapacitated client and discuss the service with the POA. 

Secondly, it would be important to obtain specialized training to work with individuals affected by diminished mental capacity. For example, all work areas should be free of clutter (given that physical navigation is often a problem), and the client should remain clothed given that they may forget where they are and subsequently panic upon realizing they are naked. Specialized training should provide many tips and tools on how to work with this vulnerable population.

Remember, it is always best to seek approval and/or direction for services from a medical physician regarding medical conditions – and their physician may have additional tips that could help provide a more successful service too.

Dementia

Dementia is the name for a group of symptoms caused by disorders that affect the brain. It is not a specific disease. People with dementia may not be able to think well enough to do normal activities, such as getting dressed or eating. They may lose their ability to solve problems or control their emotions. Their personalities may change. They may become agitated or see things that are not there.

Memory loss is a common symptom of dementia. However, memory loss by itself does not mean you have dementia. People with dementia have serious problems with two or more brain functions, such as memory and language. Although dementia is common in very elderly people, it is not part of normal aging.[i]

Alzheimer’s Disease (aka AD)

AD begins slowly. It first involves the parts of the brain that control thought, memory and language. People with AD may have trouble remembering things that happened recently or names of people they know. A related problem, mild cognitive impairment (MCI), causes more memory problems than normal for people of the same age. Many, but not all, people with MCI will develop AD.

In AD, over time, symptoms get worse. People may not recognize family members. They may have trouble speaking, reading or writing. They may forget how to brush their teeth or comb their hair. Later, they may become anxious or aggressive, or wander away from home. Alzheimer's disease (AD) is the most common form of dementia among older people.[ii]           

[i] US Health & Human Services. “Dementia.” MedlinePlus, U.S. National Library of Medicine, 2 Apr. 2018, medlineplus.gov/dementia.html.

[ii] US Health & Human Services. “Alzheimer's Disease | AD.” MedlinePlus, U.S. National Library of Medicine, 2 May 2018, medlineplus.gov/alzheimersdisease.html.

Cancer is a group of diseases that cause cells in the body to change and grow out of control. Most types of cancer cells form a lump or mass called a tumor, although not all tumors are cancer. A tumor that is cancerous is called “malignant”.  A tumor that is not cancerous is called “benign”.

Not all cancers form tumors.  Some cancers circulate through the body such as leukemia (a cancer of the blood) and lymphoma (a cancer of the lymphatic system including white blood cells).  

The US National Cancer Institute[i] provides specific directives for massage therapists working with cancer.  Their instructions include to avoid working on:

• Open wounds, bruises, or areas with skin breakdown
• Anything connected to or directly over the tumor site
• Areas with a blood clot in a vein
• Sensitive areas following radiation therapy

Working with Cancer: Precautions

It is recommended to avoid applying unnecessary pressure anywhere on the body of a leukemia or lymphoma client, because pressing anywhere on the body will be pressing directly on the cancer – which is the opposite of what the National Cancer Institute advises.  It is also recommended to avoid applying pressure anywhere there is a cancerous tumor or lesion.

Noncompressive bodywork or energy work may be okay for some circulatory cancers; however, it is always best to seek approval and/or direction for services from a medical physician regarding medical conditions.

[i] “Massage Therapy for Health Purposes.” National Center for Complementary and Integrative Health, U.S. Department of Health and Human Services, 20 Nov. 2015, nccih.nih.gov/health/providers/digest/massage-science.

What is Cancer Metastases?

When cancer spreads, it is still named after the part of the body where it started. 

For example, if colon cancer spreads to the liver, it is still called colon cancer, not liver cancer.

As such, when a client exhibits a new pain or illness, this could be from the metastases or spreading of cancer, but only a doctor would be able to determine this.  An oncology client could experience any number of issues and further training in oncology should be sought to learn these and more to work on oncology clients and survivors.

What is Chemo Brain?

Is a condition of mental cloudiness that can occur with a person who has cancer.

Despite its many names, people with cancer do not require chemotherapy to experience these effects.  Oncology researchers are finding other factors that link mental cloudiness with cancer.[i]

People with “chemo brain” may also have problems with motor coordination, so offer extra assistance for sitting, standing, lying down, getting up or any other muscle coordination events required of the client.

Recommendations for Scheduling Appointments for Oncology Clients

1. Book appointments later in the day so that the client has a chance to check their calendar or “remember” they have an appointment!
2. Provide 2 reminder calls for the appointment. Call the day before and 2 hours before their appointment to remind them!

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

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[i] “Glossary: Definitions & Phonetic Pronunciations.” American Cancer Society, 23 May 2018, www.cancer.org/cancer/glossary.html.

Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Heart failure does not mean that your heart has stopped or is about to stop working. It means that your heart is not able to pump blood the way it should. It can affect one or both sides of the heart, and can also be diagnosed in various stages.

The weakening of the heart's pumping ability causes:

• Blood and fluid to back up into the lungs
• The buildup of fluid in the feet, ankles and legs - called edema
• Tiredness and shortness of breath

Common causes of heart failure are coronary artery disease, high blood pressure and diabetes. It is more common in people who are 65 years old or older, African Americans, people who are overweight, and people who have had a heart attack. Men have a higher rate of heart failure than women.[i]

CHF is a Body Massage Precaution/Contraindication.  It is thought that circulatory body massage increases the body’s circulation.  In CHF, the heart is already failing to process its existing circulation; therefore, increasing the circulation on a failing organ could be harmful.  There is disagreement upon experts whether this CHF precaution/contraindication should be exercised for acute cases only, or if all chronic and acute CHF should be treated the same.  We advise speaking to the client’s medical physician and ask them for approval to increase circulation through bodywork or massage in their CHF client.

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

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[i] US Health & Human Services. "Heart Failure" National Heart, Lung, and Blood Institute. 2 Aug 2018, https://medlineplus.gov/heartfailure.html

A pulmonary embolism (aka PE) is when a clump of material, usually a blood clot, obstructs an artery in the lungs.  

DVT & PE conditions are often underdiagnosed and serious, but preventable medical conditions.

It is important to know about DVT & PE because it can happen to anybody and can cause serious illness, disability, and in some cases, death. ^xiii

Deep Vein Thrombosis & Pulmonary Embolism Complications

The most serious complication of DVT happens when a part of the clot breaks off and travels through the bloodstream to the lungs, causing a blockage called pulmonary embolism (PE). If the clot is small, and with appropriate treatment, people can recover from PE. However, there could be some damage to the lungs. If the clot is large, it can stop blood from reaching the lungs - a fatal condition.

In addition, nearly one-third of people who have a DVT will have long-term complications caused by the damage the clot does to the valves in the vein called post-thrombotic syndrome (PTS). People with PTS have symptoms such as swelling, pain, discoloration, and in severe cases, scaling or ulcers in the affected part of the body. In some cases, the symptoms can be so severe that a person becomes disabled.

For some people, DVT and PE can become a chronic illness; about 30% of people who have had a DVT or PE are at risk for another episode.[i]

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

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[i] Division of Blood Disorders National Center on Birth Defects and Developmental Disabilities. “Venous Thromboembolism (Blood Clots).” Centers for Disease Control and Prevention, 18 Apr. 2018, www.cdc.gov/ncbddd/dvt/facts.html.

Thrombosis

A local coagulation or clotting of the blood in a part of the blood circulatory system.

Thrombophlebitis

An inflammatory condition that causes a blood clot to form and block one or more veins, typically in the legs.

Superficial thrombophlebitis means that the blood clot occurs in a vein close to the surface of the skin. 

DVT (Deep Vein Thrombosis)

A blood clot within a deep vein, typically in the thigh or lower leg.

Signs/symptoms of the above conditions include:

• Localized redness
• Pain
• Swelling
• Numbness
• Warmth/heat in localized area 

Contraindication:

Do not massage or work on someone who shows signs of a blood clot.

Refer for immediate emergency medical attention.

You may save a life!

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

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