Pathology and Contraindications Flashcards

A client presents with a history of deep vein thrombosis (DVT) that was medically resolved 8 months ago and is currently on long-term anticoagulant therapy. Which approach is MOST appropriate?

Answer: Perform full-body massage with physician clearance, avoiding deep pressure on the previously affected limb

Resolved DVT with physician clearance allows massage with modification. Long-term anticoagulant therapy is a relative contraindication requiring physician clearance and avoidance of deep pressure on the previously affected area. DVT is not a permanent absolute contraindication once medically resolved, but ongoing anticoagulant use increases bruising risk and warrants conservative pressure throughout.

A client with diabetes mellitus type 2 reports peripheral neuropathy in both feet and lower legs. Which physiological risk makes distal work a LOCAL contraindication in this scenario?

Answer: Impaired sensation preventing the client from accurately reporting pain or pressure discomfort

Peripheral neuropathy impairs sensory feedback, meaning the client cannot reliably report excessive pressure or pain. This removes the therapist's primary safety mechanism for gauging technique intensity, making deep or friction work locally contraindicated on affected areas. Autonomic dysreflexia is associated with spinal cord injury, not diabetic neuropathy, making option C incorrect.

During intake, a client discloses they were diagnosed with malignant melanoma 14 months ago, completed treatment 6 months ago, and are currently in remission with no active lesions. Their oncologist has provided written clearance for massage. What is the MOST clinically sound approach?

Answer: Perform massage with care to avoid vigorous lymphatic work over regional lymph nodes and document oncologist clearance

Cancer in remission with oncologist clearance permits massage, but melanoma's propensity for lymphatic metastasis warrants avoiding aggressive lymphatic drainage or deep work over regional lymph nodes (axillary, inguinal). Remission is not a permanent absolute contraindication, but the therapist must modify technique and document physician clearance. Full unrestricted massage (option B) ignores the relevant pathophysiology.

A client taking corticosteroids long-term for rheumatoid arthritis presents for a relaxation massage. Which tissue-level pathology most directly dictates technique modification?

Answer: Skin and connective tissue fragility from collagen degradation, increasing bruising and skin tear risk

Long-term corticosteroid use causes steroid-induced atrophy of skin and connective tissue through collagen catabolism, resulting in fragile, paper-thin skin prone to bruising and tearing. This directly contraindicates friction, deep pressure, and vigorous petrissage. Decreased synovial fluid viscosity is not a corticosteroid side effect, and accelerated nerve conduction is pharmacologically unrelated to steroids.

A therapist is working with a client who has uncontrolled hypertension (BP reading of 168/102 mmHg taken that day) and declines physician referral. Which statement BEST reflects the correct professional and clinical decision?

Answer: Decline to perform massage until the client obtains physician clearance, documenting the refusal and your recommendation

Stage 2 hypertension (≥160/100 mmHg) that is uncontrolled and without physician oversight is a systemic contraindication for massage. While massage can transiently lower BP, it also causes vasodilation and cardiovascular demand changes that can be unpredictable in uncontrolled hypertension. Proceeding without clearance and documentation exposes the client to risk and the therapist to liability. Partial sessions (options B and D) do not adequately address the systemic nature of the contraindication.

A client presents with fibromyalgia and reports a current flare-up with widespread allodynia. They specifically request deep tissue massage, insisting it helps them. What is the most clinically defensible approach?

Answer: Educate the client that during active flare with allodynia, deep pressure can upregulate central sensitization and offer modified gentle techniques instead

Fibromyalgia involves central sensitization, and during active flare with allodynia (pain from normally non-painful stimuli), deep pressure can paradoxically increase the sensitization response and worsen symptoms, even if the client has experienced temporary relief previously. The therapist's clinical responsibility includes educating the client about this mechanism and offering appropriately modified, gentle techniques. Blindly honoring the deep tissue request without clinical rationale is not within the therapist's scope of responsibility. Complete refusal (option D) is unnecessarily restrictive.