13.2 Contraindications of massage.pptx

Notes

1. Contraindications of massage By : Dr. Alpa J. Dhanani MPT(Musculoskeletal & Sports)

2. Contraindications of Massage Contraindications are the conditions in which particular techniques of massage cannot be given. To avoid any harm and to gain maximum benefits of massage before starting the application of techniques contraindications should be ruled out in sick and healthy people.

3. The contraindications of massage are divided into two categories: General: massage must not be given to any part of the body. 2. Local: a particular area of the body affected by a condition must not be massaged, but it can be done to other unaffected parts of the body.

4. General contraindications Before physical examination and positioning of the patient ruled out the contraindications. High Fever Severe renal and cardiac diseases Deep x-ray therapy Osteoporosis Severe Spasticity Vary hairy skin Diabetes Patient preference

5. Local Contraindications : Acute inflammation: Skin conditions: Recent fracture: Varicose Vain: Thrombosis and Arteriosclerosis: Myositis Ossificans: Malignancy: Open Wound: Poisonous Foci: Others

6. High Fever: If the patient has a risen fever of about 37.5°C, the massage should not be given. (Systemic manifestation of the inflammation there is generalized rise in temperature) Massage may increase the overall body temperature will further increase the metabolic state which is already elevated due to fever. There are some conditions associated with high fever in which massage may damage underlying tissues. Massage may exaggerate the symptoms.

7. Severe renal and cardiac diseases As the cause of oedema is not mechanical but the pathology of the involved system massage may provoke serious consequences like pulmonary embolism. Different positions and techniques of massage may have adverse effects may prove to be fatal in cardiac patients. Oedema is a feature of renal and cardiac conditions. There is Peripheral oedema due to cardiac failure and generalized edema due to nephroitic syndrome.

8. Deep x-ray therapy: Ionizing radiation by x-rays, CTscan, barium and angiography cause harmful effect. Non ionizing radiation by USG, MRI has no harmful effect. If whole body irradiation is given has acute sickness effect. It has a devitalizing effect on the body tissues. At this stage tissues will not sustain any kind of mechanical trauma. As massage gives mechanical energy to the soft tissues it leads to more harmful effects.

9. Osteoporosis: In Osteoporosis bones become extremely brittle which can easily be broken or cracked. Skeleton becomes fragile and may not tolerate the pressure and force applied to body. Due to lack of structural stability of bone a minimal trauma can produce fracture. Be careful while applying massage to the suspected cases of osteoporosis (Old age group, postmenopausal women, patient on prolonged steroid therapy) and in conditions where bones become fragile (osteomalacia, Paget’s disease, ontogenesis imperfect, etc)

10. Severe Spasticity: Spasticity is the abnormal increased tone of muscles due to lesion of upper motor neuron. Massage may increase the tone of the spastic muscles.

11. Vary hairy skin: Rubbing the hairy skin, opposite to the direction of the hair follicle is painful. Usually massage is not administered to a very hairy skin but it is a relative contraindication as the excessive hair can be shaved off and the part can be massaged.

12. Diabetes: In patients with diabetes there is a decreased ability to sense the amount of pressure you're putting on them when you massage or to feel pain. Additionally bruises can occur easily because blood vessels are more fragile even on the side of a lighter touch. Patients with diabetes have a tendency to have a very thin, papery skin that bruises easily. They are also prone to arteriosclerosis, high blood pressure and oedema. Also if they have loss of sensory nerve function they will be unable to give accurate feedback on pressure. When medical clearance has been obtained to treat diabetic patients who use insulin, care should be taken to avoid massage on recent injection sites. Note: Once medical clearance is obtained massage should be applied lightly and gently.

13. Patient preference: On account of social, religious, cultural and personal reasons some people do not prefer massage. They also feel embarrassed while exposing the body part during massage, if the therapist is of the opposite sex. In this situation as far as possible the people’s wish must be respected and they should not be forced until it is very essential in some conditions.

14. Local Contraindications: In presence of these conditions the affected body part should not be massaged but if required the techniques can be administered to the other parts of the body. These contraindications should be ruled out during pretreatment physical examination of the patient.

15. Acute inflammation: Acute inflammation is absolute local contraindication of massage as …….. Massage during inflammation (acute phase) will further increase swelling, pain, tenderness and may lead to more tissue damage. If an individual has some acute inflammation, a massage will only add to the irritation and further the spread of the inflammation. Receiving a massage to an inflamed area will only cause you more harm. Massage interferes with repair process and delays the healing.

16. You should apply ice in fifteen-minute intervals- homemade ice packs of ice cubes and a towel will work as well as a commercial one. You do not want to put the ice pack directly to the skin or let it put on the area for long periods. Even though massaging directly on that are will be contraindicated, it may be very beneficial to a person to massage not on the area but around that area so that you can relax the muscles and prompting the body to naturally heal itself. After a person has had the inflammation subside after 72-96 hours, having a massage can dramatically help a person's mobility of joints as well as helping reduce scar tissue forming.)

17. Skin conditions: Recent scar tissue- massage should only be applied once the skin is fully healed and can withstand pressure. Avoid the affected area until such a time. Skin which is thin, papery or damaged. Non infectious skin disorders- e.g. eczema or dermatitis . If the eczema or dermatitis is localized you can avoid working over the affected area. If the patient is very sensitive a patch test of the massage medium should be carried out to ensure that the patient is not sensitive to the product. Acne spots and other conditions- characterized by purities, oedematous vesicle, pustules and papules can occur on the face, arms, back chest and neck. You must avoid the area as there is a risk of cross infection. The treatment may spread from one part to other or worsen the condition. You could massage any area that is free of spots .

18. Sunburn- If the sunburn is localized then the area may be avoided. Contagious skin diseases- e.g. scabies, ringworm , head lice, Impetigo, cold sores, conjunctivitis as there is a high risk of cross infection patients must not be treated. Once the infection has been treated with medication and has cleared up treatment can be carried out. Viral or fungal diseases- e.g. Athlete’s foot, Warts, Nail infections. Do not treat until the area is clear of infection. Septic wounds, boils, folliculate- do not treat until the infection has been treated and has cleared up as cross infection can occur.

19. Recent fracture: In initial stage massage should not be given as it disturbs the healing process and also very painful and uncomfortable. The shearing movement of massage may hamper the organization of hematoma and callus formation. It may damage delicate capillaries and flexible granulation tissues that bridge the fracture in initial stage which leads to non union or mal union. If the fracture is immobilized massage may be administered to the area proximal to the fracture site to reduce swelling, spasm and pain.

20. Varicose Vain: A condition in which due to incompetency of valves, veins become dilated and tortuous results in the venous congestion and walls of vein become thin. When the valves of veins have a break down it is due to back pressure causing the veins to stick out and bulge. You can usually see this happen in your legs because of gravity, this occurs when the legs crossed or are put in other sitting positions that hinders blood circulating to your legs.

21. Massage an area where varicose veins are present can cause a blood clot to be set loose in your body's circulatory system and renders the massage contraindicated. It may rupture and due to high pressure in congested vessels, profuse bleeding may occur. Massage provoke complications like hemorrhage and phlebitis. The vein becomes tender and firm .

22. Thrombosis and Arteriosclerosis: There is a formation of fatty plaque in arterial lumen known as thrombus. Massage should not be given in the presence of thrombus as emboli may break off from the wall due to mechanical squeezing of blood vessels. It may travel to some other part of the body through blood stream and block the circulation of vital organs such as brain, heart and lungs, giving rise to serious consequences (pulmonary embolism) If Arteriosclerosis is severe then it's a massage contraindication. Otherwise, avoid the back of the calf (posterior tibial artery), back of the knee (Popliteal artery), the inside of the thighs (femoral artery), armpit area (Axillary artery), the soft part of the upper inside of the arm (brachial artery), lower arm (radial artery), and the front part of the neck (temporal artery – anterior triangle.)

23. Myositis Ossificans: The joint capsule and periosteum is stripped from the bone by violent displacement and Due to this blood collect under the stripped soft tissue forming hematoma. The hematoma is invaded by osteoblasts and becomes ossified forming callus in the soft tissues. Strain and stretching of soft tissue might provoke more bleeding beneath the soft tissue and may exaggerate the condition. This condition is more common around the elbow joint so massage should not be given around elbow joint after any injury.

24. Malignancy: Metastasis – Spread of tumour cells from one area to the other, is the essential feature of all malignant tumours. Tumour cells disseminate through lymphatic and haematogenous pathways. Anything which increases the lymphatic flow also increases the chance of spread of tumour. In order to avoid metastasis massage is contraindicated in malignant conditions.

25. Open Wound: Massage over open wounds, cuts and bruise is not only painful but may further damage the healing tissue is a causative factor for delayed healing of tissue. Mechanical movement of massage over the damaged skin is contraindication.

26. Poisonous Foci: In case of snake bite, stings and insect bite massage should not be administered as massage increases the circulation and may facilitate the release of poison into the circulation leading to serious systemic effects.

27. Other Conditions: Some techniques can elicit adverse autonomic response in pregnancy, cardio respiratory conditions and psychological disorders such as panic attack in which massage is contraindicated. Infectious diseases e.g. Flu, Measles, Mumps, T.B, Scarlet Fever, Chicken Pox etc Patients with hemophilia may have no blood clotting capacity and could bleed. Patients with severe asthma or lung conditions

28. Patient’s with epilepsy as there is a risk that over-stimulation or deep relaxation may provoke a convulsion (although this has never been proven) some types of epilepsy may be triggered by smells so care should be taken when choosing a massage medium. Cardiac condition, high or low blood pressure , a stroke or thrombosis or are on prescribed medication as they are susceptible to thrombosis. Hernia Surgeries : Immediately before or after surgery e.g. hysterectomy or caesarean section.

29. Nut Allergies: As people in general have become more sensitive to a wide number of food stuffs and cosmetic products it is always advisable to check that they do not have a known allergy prior to commencing treatment . If they have a sensitive skin it is important to carry out a patch test with a small amount of product that you intend to use as a massage medium. This can be carried out by washing the inner bend of the elbow with mild soap and water and then applying a small amount of product to the area.

30. This should be left for 15-30 minutes to see if there is a reaction e.g. redness, itching. If a reaction occurs then the product must not be used. Patients with nut allergies can go into anaphylactic shock and this requires immediate medical attention. It is therefore extremely important that you know what your massage oils or creams are made up of. There are a wide range of vegetable oils available to use as a massage medium e.g. sunflower oil, olive oil, corn oil etc.

31. Book reference 1.Principles and practice of therapeutic massage , 2 nd edition :Akhoury gourange sinha .