Pathology and Contraindications Flashcards

A client with a history of deep vein thrombosis (DVT) completed anticoagulation therapy 6 months ago and presents no current symptoms. A Doppler ultrasound from 3 months ago confirmed resolution of the clot. What is the most appropriate course of action for the massage therapist?

Answer: Perform massage with caution, avoiding deep pressure to the previously affected limb and monitoring for any signs of recurrence

A resolved DVT confirmed by imaging is not a permanent contraindication. However, the previously affected area warrants cautious technique — avoiding aggressive deep tissue work — because the vessel wall may retain some structural compromise and the client has an elevated lifetime risk of recurrence. Full clearance from the treating physician and ongoing vigilance are essential.

A client discloses they are taking methotrexate for rheumatoid arthritis and presents with a localized skin rash on the forearm. Which of the following is the most clinically accurate statement about this situation?

Answer: Methotrexate causes immunosuppression, making the client more susceptible to infection; the rash should be evaluated by a physician before massage over that area proceeds

Methotrexate is an immunosuppressant and DMARD used in RA. Immunosuppressed clients are at heightened infection risk, and an undiagnosed skin rash in this population could represent a fungal, bacterial, or drug-related reaction — all of which require medical evaluation before local massage. The systemic immunosuppression also informs broader session modifications (shorter sessions, gentler pressure).

During a session, a therapist notices that a client with Type 2 diabetes has a small, non-painful ulcer on the plantar surface of the foot that the client says 'has been there for weeks.' The client has been cleared by a physician for massage. What is the correct approach?

Answer: Avoid the foot entirely and work proximal to the lesion; document findings and recommend the client inform their physician about the ulcer

Diabetic neuropathy can mask pain perception, making plantar ulcers a serious concern — they can progress to deep tissue infection rapidly. A physician clearance for massage does not authorize working directly on or around an active ulcer. The therapist must avoid the area, work proximally to support circulation without stressing the lesion, document the finding, and encourage medical follow-up. Friction over an ulcer risks worsening tissue damage.

A client presents with fibromyalgia and reports a flare-up in the past 48 hours with diffuse hyperalgesia and allodynia. She insists she wants a 'deep tissue session to work out the knots.' What is the pathophysiologically informed response?

Answer: Explain that during an active flare, the central sensitization underlying fibromyalgia makes the nervous system hypersensitive; light effleurage or gentle Swedish techniques are more appropriate and may reduce symptom load

Fibromyalgia is characterized by central sensitization — amplified nociceptive processing — rather than peripheral tissue pathology. During a flare, allodynia (pain from non-painful stimuli) and hyperalgesia are exaggerated, meaning deep pressure can provoke a pain crisis rather than relief. Research supports gentle, non-invasive techniques during flares. The common misconception that fibromyalgia involves 'knots' requiring deep work reflects a misunderstanding of its pathophysiology.

A client who recently completed radiation therapy for breast cancer (last session was 8 weeks ago) presents for massage. The irradiated area of the chest wall appears erythematous and the skin feels thickened. Lymph node dissection was also performed. Which of the following best describes the contraindication picture?

Answer: The irradiated skin is a local contraindication due to compromised tissue integrity and reduced healing capacity; the side of lymph node dissection requires modified lymphatic drainage precautions to avoid lymphedema risk

Post-radiation tissue undergoes fibrosis, has impaired vascular supply, and heals poorly — making it a local contraindication even weeks after treatment completion. Erythema and skin thickening indicate ongoing tissue response. Separately, axillary lymph node dissection permanently disrupts lymphatic drainage on that side, creating lifetime risk for lymphedema. Massage on the affected side must follow oncology massage protocols (MLD-trained therapist, no heat, no compression), not standard Swedish or deep tissue techniques.

A client reports taking warfarin following cardiac valve replacement surgery. His INR was 2.8 at his last check, within his therapeutic range. He requests deep tissue massage for chronic low back tension. Which consideration is MOST clinically significant?

Answer: Warfarin impairs clotting; deep tissue massage can cause subcutaneous hematomas even with a therapeutic INR, making deep pressure contraindicated and light-to-moderate Swedish technique more appropriate

A 'therapeutic' INR of 2.0–3.5 for valve replacement does NOT mean clotting is normal — it means coagulation is intentionally suppressed 2–3× the baseline. Deep tissue massage creates microtrauma and capillary rupture that a healthy clotting system resolves quickly, but an anticoagulated client risks significant subcutaneous hematoma formation even within the therapeutic range. The massage therapist must modify to light-to-moderate pressure, document the medication, and ensure the client's physician is aware massage is occurring.