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/

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[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/

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

Multiple Sclerosis MS is an idiopathic nervous system disease that affects the spinal cord and brain. It damages the material that surrounds and protects your nerve cells, known as the myelin sheath. This damage slows down or blocks 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. 

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] 

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 training at https://ceinstitute.com/

#massage #massagetherapy #massageprecautions #massagecontraindications

[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.

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.”

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

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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

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

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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/

#massage #massagetherapy #massageprecautions #massagecontraindications

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