Pathology and Contraindications Flashcards

A client presents with a diagnosis of thromboangiitis obliterans (Buerger's disease) affecting the lower extremities. Which of the following best describes the most appropriate massage approach?

Answer: Avoid all massage to the lower extremities; focus only on the upper body with physician clearance

Thromboangiitis obliterans (Buerger's disease) is an inflammatory occlusive vascular disease affecting small and medium arteries and veins, predominantly in the distal limbs. Massage to affected extremities is contraindicated because it can dislodge clots, worsen ischemia, or cause tissue damage in an already compromised vascular bed. Physician clearance and avoidance of the lower extremities is the safe protocol.

A client with systemic lupus erythematosus (SLE) arrives for massage during a period of remission. She mentions she is on long-term corticosteroid therapy. Which precaution is MOST specific to the corticosteroid use — beyond the SLE itself?

Answer: Use lighter pressure due to increased risk of skin fragility, bruising, and osteoporosis

Long-term corticosteroid use causes skin thinning, increased bruising, and reduced bone density (osteoporosis), all of which necessitate lighter pressure and careful technique. This is distinct from SLE contraindications. The corticosteroids do not fully contraindicate massage, but the therapist must adapt pressure to account for tissue fragility and fracture risk, particularly over the spine and long bones.

During intake, a client reports a recent diagnosis of hepatic encephalopathy secondary to liver cirrhosis. He states his physician has not specifically restricted massage. What is the therapist's PRIMARY concern when proceeding?

Answer: Impaired detoxification capacity may lead to toxic accumulation from metabolic byproducts of deep massage

In hepatic encephalopathy, the liver's ability to detoxify metabolic waste — including ammonia and other byproducts released during vigorous muscle manipulation — is severely compromised. Deep or vigorous massage increases metabolite release into circulation, which a failing liver cannot adequately clear, potentially worsening encephalopathy. This is the primary physiological concern, separate from general cirrhosis considerations like portal hypertension or coagulopathy.

A client presents with a Baker's cyst in the popliteal fossa confirmed by ultrasound. She has no pain at rest but experiences tightness with full knee flexion. Which massage approach is MOST appropriate?

Answer: Address hypertonic gastrocnemius and hamstring muscles with caution, avoiding direct pressure on the cyst itself

A Baker's cyst is a synovial fluid-filled cyst in the popliteal fossa, often secondary to intra-articular pathology. Direct compression risks cyst rupture, which can cause sudden severe pain and mimic deep vein thrombosis. However, massage to surrounding hypertonic muscles (hamstrings, gastrocnemius) can relieve compressive tension contributing to discomfort. The cyst itself must be avoided while the surrounding musculature can be addressed thoughtfully.

A client who underwent a renal transplant 14 months ago is on immunosuppressive therapy and presents with no acute symptoms. Which consideration is MOST clinically relevant when planning massage?

Answer: The transplanted kidney must never have direct pressure applied to the flank region, and infection control is paramount due to immunosuppression

Post-transplant clients on immunosuppressive therapy have elevated infection risk, making impeccable hygiene and infection control a primary responsibility of the therapist. Additionally, the transplanted kidney is typically placed in the iliac fossa (not the natural kidney location), and direct mechanical pressure to that region must be avoided. Massage can otherwise be beneficial, but must be adapted to the client's immunocompromised status and surgical anatomy.

A client reports a history of complex regional pain syndrome (CRPS) Type I in the left forearm, currently in a 'cold phase.' She requests massage to that extremity for pain relief. What is the MOST evidence-informed response?

Answer: Avoid direct massage to the affected limb; consider gentle proximal work and refer to a pain specialist if not already consulting one

CRPS (formerly RSD) involves abnormal pain processing, vasomotor instability, and extreme hypersensitivity (allodynia). Even in the 'cold phase,' where active inflammation has diminished, the affected limb remains highly sensitized. Direct massage — even light touch — can trigger severe allodynia flares, pain crises, or sympathetic surges. Conservative management means avoiding direct work on the limb, possibly addressing proximal tissues only, and ensuring the client is under appropriate pain specialist care.