Pathology

Pathology:
Pathology is the study of disease processes or of any deviation from a normal, healthy condition.
Pathology looks at things that can go wrong with anatomical and physiological functions
You study pathology because it aids/guides therapists through the process of assessing the appropriateness of massage for a client. It informs you so that better judgments about whether massage is appropriate for a particular client can be made or whether client should be referred to another healthcare professional.

Indications: The action of pointing out the advisability or necessity of carrying out a certain treatment or procedure

Contra: Against, contrasting

Contraindications: An indication, symptom or condition that makes inadvisable a particular treatment or procedure

A time factor may enter into this, if a person presents to you just after eating a meal that person’s body is working too hard on digestion to gain benefit from your treatment. It is advisable to let three to four hours elapse after the person has eaten a large meal before performing the massage. On the day of the treatment the person should not take any alcohol or non-prescribed drugs either before or after the treatment to derive maximum benefits. If they are not ‘present’ with you the treatment can be of little use.
Thrombosis (blood clot): Do not massage this person at all. Recommend they discuss the possibility of massage with their consultant before commencement of any massage treatment.
After major surgery do not massage the person for 12 months unless referred to you by their doctor. Allow 6 months to lapse after minor surgery. For key-hole surgery and minor procedures clearance from their consultant or GP is recommended.
In instances where a person has extreme unexplained tenderness or acute swelling in a generalised way on the body it is necessary to refer them to their general practitioner or hospital and not to treat them. In these instances the body is not in homeostasis and the reason is not known. You do not want to add to any problems before diagnosis. All massage is contra-indicated if a person has a high temperature (pyrexia). The body is very busy working towards balance and you do not want to divert any energy away from the job in hand. Massage may be very supportive a few days later when the person has begun to feel better if the illness was a minor one. If a person has epilepsy you need to get clearance from their consultant or GP and find out how long they have had it, how serious it is and what length of time there is between attacks. If ‘Grandmal’ and attacks are at six to twelve month intervals avoid or proceed with extreme caution following clearance. If attacks occur at intervals longer than twelve months, effleurage and light petrissage can be used - no stimulation strokes.
Where cancer has been diagnosed, and treatment is being given, all massage is contra-indicated to avoid interfering with treatment or the condition. If a person is in treatment, then let the treatment do its work of detoxifying. However, after treatment is completed, and following clearance from the principal person treating the cancer patient, light stroke work could be very supportive. This has been the guidance to date. However, some texts now state that massage may be supportive of treatment. Be guided by the healthcare team who are involved in the delivery of the treatment. When terminal cancer has been diagnosed, and the wellbeing of the person in the short term is the major concern, massage can be performed to help relieve aches and pains and to counter mental lowness. As little as a hand/arm, foot or head massage can be very relaxing, reassuring and supportive at this stage of a person's life.

There are times when parts of the body need to be avoided during a treatment. Skin surface problems such as excessive weeping skin and dry flaky skin that is deep enough to cause skin inflammation should be avoided. Avoid the area and advise the person to seek treatment. If the flakes of skin are small and not deep work can proceed. Bruised tissue should not be worked on for fear of secondary damage. Wait some time before massaging the area and ensure that area is not painful before working on it. The time factor will vary greatly depending on the type of bruising you are dealing with.
Varicose veins can be very lightly effleuraged. In fact it is beneficial as it aids in venous return and supports the faulty valves. Other strokes, wringing and petrissage may be used above and below the area but not on the varicose area itself. You do not want to burst the vein.
A similar condition with the same considerations would be where unexplained lumps or bumps are found in the body. Do not work them with friction or tapotment in order to break them up. It may be the body's way of dealing with a foreign body/ rogue cell and you do not want to reintroduce it to the system.
Massage is contra-indicated for scar tissue if less than eighteen months old. It is still not advisable after this time if the scar is red, painful, swollen or hot as there may be infection, damaged tissue or some unexplained reason why the body cannot heal itself. Otherwise massage in general and friction in particular can be very helpful to break up adhesions.

Nervous trembling and nervous exhaustion must be treated in a way that is very supportive and nourishing for the person. Effleurage is the main stroke to use and very light petrissage can be used also. Friction, vibrations and tapotement are contra-indicated. Effleurage may be the only stroke one can use when the need is for a gentle building process, not a breaking down and expanding process. The massage is being used to calm and focus, to support the person and help them to build up again.
Where a person is holding emotionally once again stimulating work is contra-indicated. Do not work deeply or stimulate to force a change in the persons state. Effleurage and light petrissage are the strokes to use to encourage the person to relax and tune into their experience. In these last three conditions recuperation is what is needed. Time and gentle work will help best in supporting the person in their process of recuperation.
During pregnancy all tapotement is contra-indicated. Effleurage is always helpful. Petrissage can be used with discretion except on the lower back or pelvic area. Avoid massaging women who have a risk or history of miscarriage when they are trying to conceive.
First Trimester: It is often recommended not to massage during the first three months of a pregnancy but it is often 2 months before people confirm they are pregnant and some people keep it secret even after that. Positioning of client is not crucial in this phase.
Rest of Pregnancy: Lie client on their side. Bolster as necessary. Relaxin is in the system at this stage so avoid full range of motion movements and over stretching of ligaments, especially in the pelvic area. Oedema may be a problem towards the end. Perform lymphatic drainage.
After birth massage can be very supportive – relaxing strokes.
If a person has osteoporosis avoid deep and heavy work. Enquire about the degree of osterporosis and use caution on the effected area. (delete this bit) tapotement and friction as bones can be crumbly
After a heart attack or stroke effleurage only in the first six to ten months following consultant or doctor's advice. Introduce petrissage with discretion after this time and pay close attention to the person’s breathing, colour, and reactions. Tapotement may be introduced after eighteen months but once again with caution. If the person has angina and they have been cleared for massage, only use light strokes and avoid tapotement and friction. Caution is needed when treating people with high or low blood pressure. Pay attention to the clients breathing, sweating, colour, and pain. People with low blood pressure need careful monitoring when recovering from the prone position – so always stay with them after massage and help them off plinth.
Normally work one joint above the area of a treated broken bone. After the cast is removed and physiotherapy is completed (or with the clearance of the physiotherapist) effleurage and moderate petrissage are very useful to rehabilitate the area.
If scar tissue is red or sore or swollen or hot and over 18 months old you still avoid the area. Otherwise massage in general and friction in particular can be useful to break down possible adhesions. Multi-directional friction
Effleurage and petrissage are very useful to help in venous return of an overweight or obese person. Avoid deep, extensive or very stimulating work so as not to over-tax the heart. Consideration should be given to the patient's body image.
Massage is beneficial to the majority of people but there are times when for one reason or another it is contra-indicated. It is important to trust one’s own judgment and to proceed to the best of ones knowledge and ability. But when in doubt it is vital to err on the side of caution as you do not want to add to anybody's discomfort. Refer them to a medical practitioner, modify techniques to avoid specific conditions or body areas, choose the strokes best suited to the person’s state at that time, whichever is most relevant on the occasion. The person one is working on is the most important component in any massage and their comfort is foremost in the whole process.

Contraindications to all massage:
• At least three hours after a meal
• Drink or drugs on the day
• Extreme unexplained tenderness *
• Acute swelling*
• Cysts, lumps and bumps*
• Epilepsy*
• Thrombosis*
• High temperature
• Treatable cancer
• 12 months after major surgery
• 6 months after minor surgery
*refer client to doctor for report and clearance

Contraindications to specific strokes:
• Nervous exhaustion – do not friction, do not use tapotement strokes. Use petrissage with discretion.
• Pregnancy – avoid tapotement and petrissage on the lower back.
• Osteoporosis – (find out degree). Avoid tapotement and friction on affected areas.
• Heart-attack and stroke – effleurage only in first 6 –10 months, introduce petrissage with discretion after 10 months, introduce tapotement after 18 months but caution on back.
• Angina – avoid direct tapotement or friction (Check layout in site)

Contraindications to specific body areas:
Avoid
• excessive weeping skin
• dry flaky skin
• varicose veins
• scar tissue
• bruising
• unexplained lumps and bumps.

Caution needed
• High/low blood pressure
• thrombosis (delete)
• treated broken bones
• scar tissue
• varicose veins
• overweight/obesity