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Distance Education -> Prevention of Medical Errors for the Massage Therapist -> Chapter: 08
Identification of Contraindications
The word contraindication comes from the Latin roots, contra meaning: against, and indicare meaning: to show, or, to point out. It can be defined as: Any symptom or circumstance indicating the inappropriateness of a form of treatment otherwise advisable. 16 Knowledge of contraindications is an imperative for a massage therapist or body worker in private practice. Performing a massage technique on an area of the body that should be contraindicated for treatment may fall under the medical "error of execution," or "error of planning," or both, as defined in chapter 1 of this document.
Sometimes massage therapists and body workers have difficulty making recommendations for a specific treatment when each treatment situation may be different. Each situation needs to be individually evaluated to determine whether massage is indicated or contraindicated for treatment. The existence of contraindications doesn't always mean massage or bodywork is inappropriate. The contraindication may fall under one or more or the following general categories 17:
1. General avoidance of application -Do not perform any massage or bodywork techniques.
2. Regional avoidance of application -Do perform massage but avoid particular areas.
3. Application with Caution -Requiring supervision from appropriate treating physician, or supervising personnel. Do perform the massage, but carefully select the method, duration, and frequency of application.
Applying massage on contraindicated areas can be avoided if the massage therapist and body worker takes the time to perform an intake and assessment of the client's health prior to starting the therapy session. This information should then be confidentially kept in a client file. That file should include at least the following information:
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Pertinent Client information, such as name, address, phone, other contact numbers, emergency contact, etc.
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A complete health history should be taken from the client, including the following:
- a history of recent and past injuries and conditions.
- a list of all prescription, over the counter, and herbal medications.
- A written assessment form by the therapist/body worker stating the client's current condition.
- An informed consent form signed by the client agreeing to receive treatment.
- A medical information release form signed by the client, allowing the therapist to consult with their physician.
- And documentation notes of each treatment received by the client.
Taking the time to obtain this information from the client will help the therapist reduce the incident of a medical error in execution of a massage therapy technique, or an error in planning a wrong treatment approach.
The massage community generally accepts the following contraindications 18 :
Cardiovascular Disorders
• Over any bruises, or vessels that are inflamed, diseased or could be easily damaged.
• On a bleeding wound, because of the possibility of infection.
• On clients with known blood clots, or with conditions were clotting may be a symptom. Clots in blood vessels could be
dislodged by massage, creating a risk for heart attack, stroke.
• Depending on severity, general conditions that may contraindicate for massage include (but are not limited to):
• Aneurysm
• Arteriosclerosis and atherosclerosis
• Congestive heart failure
• Deep vein thrombosis
• Hemophilia
• Phlebitis
• Varicose Veins
Sensory Abnormalities
- When the client cannot feel heat, pain or pressure.
- When a condition is present where the client may experience hypersensitivity to touch.
Skin Disorders
- Any infectious skin disorder, because of the possibility of spreading the infection to other parts of the body, to the therapist, or even to other clients.
- Any skin disorder that could be irritated by the massage strokes.
Inflammation
Massage therapy over tissues that are inflamed could increase the inflammatory response of that tissue.
Infection
The possibility exists that any infectious condition might be spread to other parts of the client's body, to the therapist, or even to other clients.
Fever
When a client has an elevated body temperature. This symptom may be an indication the client has a serious disease or condition.
Edema
Areas of edema (swelling) that are unexplained or are caused by kidney problems, heart failure or some other serious disorder.
Pregnancy
- Deep massage on the abdomen and around the ankles.
- Heavy tapotement anywhere in the body
- Massage therapists and body workers should receive specialized training in pregnancy massage before working with pregnant women.
Gastrointestinal Disorders
Conditions that may show symptoms of abdominal pain, diarrhea, nausea, or vomiting.
Mental and Emotional Disorders
- Clients with serious mental or emotional disorders require knowledge out of the scope of practice of massage therapists and body workers.
- To work with such clients the massage therapist or body worker should work as a part of a health care team under the supervision of the treating physician, psychologist, psychiatrist, or other licensed health care provider.
Loss of Integrity
- When the normal anatomy of a client has been disrupted by an event such as surgery, soft tissue trauma, joint replacement, or severe bone degeneration.
- Contraindicated for Massage therapists and body workers unless working with authorization from the treating physician.
Cancer
1. Malignant cancer may spread (metastasis) through the blood or lymphatic vessels.
2. Because massage therapy increases the circulation in these vessels it may be contraindicated to prevent the spread of any malignant cancer.
3. Treatment should be done with prior approval from the treating physician.
Benign Tumors
Benign tumors are not malignant and do not metastasize throughout out the body. But massage therapy could damage the tumor itself, so it is contraindicated for the tumor area, but not other parts of the body.
Endangerment Sites
Endangerment sites are specifically covered in the next chapter.
PRACTICE QUESTIONS FOR CHAPTER 8.
Please answer the following questions:
1. Any symptom or circumstance indicating the inappropriateness of a form of treatment otherwise advisable, is defined as:
a. Indication
b. Contraindication
c. Treatment Plan
2. Some of the generally accepted contraindications for massage therapy include:
a. Cardiovascular disorders, depending on severity
b. Skin disorders
c. Cancer
d. All of the above
3. Your client is recovering from a recent knee surgery. She is using crutches, and the knee is bandaged and slightly swollen. Because of the crutches she is experiencing back pain. Which would be the appropriate choice for treatment of the back pain?
a. Generally avoid the massage
b. Regionally avoid the leg with the knee surgery, but treat the back
c. Give a full body massage, including the leg with the recent knee surgery
16 Thomas, M. D., M.P.H., Clayton L., Editor, Taber's Cyclopedic Medical Dictionary 16 th Ed ., Philadelphia, F. A. Davis Co., 1989.
17 Fritz, Sandra, Mosby's Fundamentals of Therapeutic Massage, 2 nd Ed ., St. Louis, MI, Mosby's Inc. 2000, pg. 183.
18 Newton, M.A., D.C., Don, Clinical Pathology for the Professional Bodyworker, Scappoose , Oregon, Simran Publications, 1998.
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