mosby’s pathology lesson 6.1 objective massage therapists ... · 19 copyright ©2010, 2006 by...

Chapter 6Chapter 6

Neurologic PathologiesNeurologic Pathologies

Mosby’s PATHOLOGY

for Massage Therapists

Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.2

Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Lesson 6.1 ObjectiveLesson 6.1 Objective

�� Discuss anatomic structures and physiologic Discuss anatomic structures and physiologic

processes related to the nervous system.processes related to the nervous system.

3Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Overview of Nervous SystemOverview of Nervous System

�� FunctionsFunctions

�� Helps maintain homeostasisHelps maintain homeostasis

�� Responsible for: Responsible for:

•• Mental processesMental processes

•• BehaviorsBehaviors

•• Emotional responsesEmotional responses


Neuron StructureNeuron Structure

�� DendritesDendrites

�� Cell bodyCell body

�� NucleusNucleus

�� AxonAxon

From Applegate E: From Applegate E: The anatomy and physiology learning The anatomy and physiology learning

system,system, eded 3, St. Louis, 2006, Saunders.3, St. Louis, 2006, Saunders.


SynapseSynapse

From Salvo S: Massage therapy:From Salvo S: Massage therapy: principles and practice, principles and practice, eded 3, 2007, St. Louis, Saunders.3, 2007, St. Louis, Saunders.


Functions of Nervous SystemFunctions of Nervous System

�� Sensory function: receptors detect stimuli and Sensory function: receptors detect stimuli and

respond by sending information to the CNSrespond by sending information to the CNS

�� Integration function: CNS integrates this Integration function: CNS integrates this

information and decides on a responseinformation and decides on a response

�� Motor function: motor neurons carry impulses Motor function: motor neurons carry impulses

from the CNS to the muscles and glandsfrom the CNS to the muscles and glands


Central Nervous SystemCentral Nervous System

�� BrainBrain

�� Housed in skullHoused in skull

�� Spinal cordSpinal cord

�� Housed in vertebral Housed in vertebral

columncolumn

�� Both brain and spinal Both brain and spinal

cord protected by cord protected by

meningesmeninges and and

cerebrospinal fluidcerebrospinal fluidFrom Applegate E: From Applegate E: The anatomy and physiology The anatomy and physiology

learning system,learning system, eded 3, St. Louis, 2006, Saunders.3, St. Louis, 2006, Saunders.


Spinal Cord and Spinal NervesSpinal Cord and Spinal Nerves

From Rudy EB: From Rudy EB: Advanced neurological and neurosurgical nursing,Advanced neurological and neurosurgical nursing, St. Louis, 1984, Mosby.St. Louis, 1984, Mosby.


Brain StructureBrain Structure

�� BrainstemBrainstem

�� CerebellumCerebellum

�� DiencephalonDiencephalon

�� CerebrumCerebrum

From From VidicVidic B, Suarez FR: B, Suarez FR: Photographic atlas of the human body,Photographic atlas of the human body, St. Louis, 1984, Mosby.St. Louis, 1984, Mosby.


Peripheral Nervous SystemPeripheral Nervous System

�� Somatic nervous systemSomatic nervous system

�� Consciously controlled (voluntary)Consciously controlled (voluntary)

�� Autonomic nervous systemAutonomic nervous system

�� Not consciously controlled (involuntary)Not consciously controlled (involuntary)

�� Divided into parasympathetic and sympathetic Divided into parasympathetic and sympathetic

nervous systemsnervous systems


Autonomic Nervous SystemAutonomic Nervous System

�� ParasympatheticParasympathetic

�� RestRest--andand--digestdigest

�� SympatheticSympathetic

�� FightFight--oror--flightflight

From From ThibodeauThibodeau GA, Patton KT: GA, Patton KT: Anatomy & physiology,Anatomy & physiology, eded 6, St. Louis, 2007, Mosby.6, St. Louis, 2007, Mosby.


Lesson 6.2 ObjectivesLesson 6.2 Objectives

�� Identify central nervous system disorders and list Identify central nervous system disorders and list

appropriate massage considerations.appropriate massage considerations.

�� List first aid measures to be implemented when a List first aid measures to be implemented when a

person is experiencing a seizure.person is experiencing a seizure.

�� Describe appropriate measures used when Describe appropriate measures used when

working with wheelchairworking with wheelchair--bound clients.bound clients.


Lesson 6.2 Objectives Lesson 6.2 Objectives (cont(cont’’d.)d.)

�� Define infectious diseases of the nervous system Define infectious diseases of the nervous system

and list appropriate massage considerations.and list appropriate massage considerations.


CNS DisordersCNS Disorders

�� Cerebral palsyCerebral palsy

�� SpinaSpina bifidabifida

�� Seizure disordersSeizure disorders

�� Spinal cord injurySpinal cord injury

�� Attention deficitAttention deficit--hyperactivity disorderhyperactivity disorder

�� AutismAutism


Cerebral PalsyCerebral Palsy

�� Group of motor disorders; Group of motor disorders;

damage to cerebrum from damage to cerebrum from

inadequate or reduced blood inadequate or reduced blood

flow flow

�� Lighter pressure; avoid joint Lighter pressure; avoid joint

mobilizations or administer mobilizations or administer

carefully; instruct parents to carefully; instruct parents to

massage if affected person is massage if affected person is

a childa child

From From ZitelliZitelli BJ, Davis HW: BJ, Davis HW: Atlas of pediatric physical diagnosis,Atlas of pediatric physical diagnosis, eded 5, Philadelphia, 2007, Mosby.5, Philadelphia, 2007, Mosby.


SpinaSpina BifidaBifida

�� Group of neural tube defects; failure of posterior Group of neural tube defects; failure of posterior spinousspinous processes to close (usually lumbar processes to close (usually lumbar spine)spine)

�� Local contraindication; avoid joint mobilizations Local contraindication; avoid joint mobilizations and compressions or administer carefully; and compressions or administer carefully; instruct parents to massage if affected person is instruct parents to massage if affected person is a childa child

A and C, Courtesy Michael J. Painter, M.D., ChildrenA and C, Courtesy Michael J. Painter, M.D., Children’’s Hospital of Pittsburgh. In s Hospital of Pittsburgh. In ZitelliZitelli B, Davis H: B, Davis H: Atlas of pediatric physical diagnosis,Atlas of pediatric physical diagnosis,

eded 5, 2007, Mosby; B, from Cohen BA: 5, 2007, Mosby; B, from Cohen BA: Atlas of pediatric dermatology,Atlas of pediatric dermatology, London, 1993, MosbyLondon, 1993, Mosby--Wolf.Wolf.


Seizure DisordersSeizure Disorders

�� Explosive episodes of uncontrolled and Explosive episodes of uncontrolled and excessive electrical activity in the brain; two excessive electrical activity in the brain; two typestypes

�� Partial: limited to single area of brainPartial: limited to single area of brain

�� Generalized: more diffuse involvementGeneralized: more diffuse involvement

�� Postpone massage if condition is untreated; Postpone massage if condition is untreated; avoid known triggers; use first aid measures if avoid known triggers; use first aid measures if client experience tonicclient experience tonic--clonicclonic seizure seizure


Seizure Disorders Seizure Disorders (cont(cont’’d.)d.)


FirstFirst--Aid for SeizuresAid for Seizures

�� Remain calm and begin to time seizureRemain calm and begin to time seizure

�� Clear area of objectsClear area of objects

�� Gently place person on floor (if possible)Gently place person on floor (if possible)

�� Place soft material or cushion under head; lift Place soft material or cushion under head; lift

chin slightly to open airwaychin slightly to open airway

�� Roll on side if choking or vomitingRoll on side if choking or vomiting

�� Remain with person until seizure has endedRemain with person until seizure has ended


FirstFirst--Aid for Seizures Aid for Seizures (cont(cont’’d.)d.)

�� If seizure lasts more than 5 minutes or If seizure lasts more than 5 minutes or

immediately repeats, call 911, then:immediately repeats, call 911, then:

�� Talk calmly to person until help arrivesTalk calmly to person until help arrives

�� Inform medical personnel how long seizure Inform medical personnel how long seizure

occurred and symptoms exhibitedoccurred and symptoms exhibited

�� Write incident reportWrite incident report


Spinal Cord InjurySpinal Cord Injury

�� Damage to the vertebrae and neural tissues Damage to the vertebrae and neural tissues causing loss of movement (paralysis) and causing loss of movement (paralysis) and loss of sensation distal to area of insultloss of sensation distal to area of insult

�� Paraplegia: paralysis of the lower extremities and Paraplegia: paralysis of the lower extremities and trunktrunk

�� Quadriplegia: paralysis of the trunk and all Quadriplegia: paralysis of the trunk and all extremitiesextremities

�� Medical clearance is neededMedical clearance is needed


Spinal Cord Injury Spinal Cord Injury (cont(cont’’d.)d.)

From Lewis SL et al: From Lewis SL et al: MedicalMedical––surgical nursing, surgical nursing, eded 7, St. Louis, 2007, Mosby.7, St. Louis, 2007, Mosby.


Spinal Cord Injury Spinal Cord Injury (cont(cont’’d.)d.)

From Lewis SL et al: From Lewis SL et al: MedicalMedical––surgical nursing, surgical nursing, eded 7, St. Louis, 2007, Mosby.7, St. Louis, 2007, Mosby.


Attention DeficitAttention Deficit--Hyperactivity Hyperactivity

Disorder (ADHD)Disorder (ADHD)

�� Array of behaviors associated with Array of behaviors associated with

inattentiveness, hyperactivity, impulsivity, or inattentiveness, hyperactivity, impulsivity, or

combination of thesecombination of these

�� Reduce treatment time; instruct parents to Reduce treatment time; instruct parents to

massage if affected person is a childmassage if affected person is a child


AutismAutism

�� Syndrome of social withdrawal and obsessive Syndrome of social withdrawal and obsessive

behavior; five types ranging from mild and behavior; five types ranging from mild and

highly functional to severehighly functional to severe

�� Reduce treatment time; use firm gliding and Reduce treatment time; use firm gliding and

compressive strokes with full hand contact; compressive strokes with full hand contact;

instruct parents to massage if affected person instruct parents to massage if affected person

is a childis a child


WheelchairWheelchair--Bound ClientsBound Clients

�� Maintain eye level during intake interviewMaintain eye level during intake interview

�� Inquire about any medications and their side Inquire about any medications and their side

effects such as drowsinesseffects such as drowsiness

�� If indicated, use stimulating strokes at the end of If indicated, use stimulating strokes at the end of

session and ask client to move slowly and carefully session and ask client to move slowly and carefully

�� Observe wheelchair etiquetteObserve wheelchair etiquette


WheelchairWheelchair--Bound ClientsBound Clients (cont(cont’’d.)d.)

�� Avoid skin lesions such as bedsoresAvoid skin lesions such as bedsores

�� Use light to moderate pressure depending on Use light to moderate pressure depending on

sensation levelsensation level

�� Trigger points are often located in shoulders Trigger points are often located in shoulders

and chest areaand chest area

�� Limit ROM exercises, especially on neck, spinal Limit ROM exercises, especially on neck, spinal

column, and hip jointscolumn, and hip joints


Infectious DiseasesInfectious Diseases

�� MeningitisMeningitis

�� EncephalitisEncephalitis

�� Poliomyelitis and Poliomyelitis and PostpolioPostpolio syndromesyndrome


MeningitisMeningitis

�� Inflammation of the Inflammation of the meningesmeninges most often the most often the

result of a viral or bacterial infection result of a viral or bacterial infection

�� Massage is contraindicated until client Massage is contraindicated until client

completely recoverscompletely recovers


EncephalitisEncephalitis

�� Inflammation of the brain Inflammation of the brain

usually the result of a viral usually the result of a viral

infection infection

�� Massage is contraindicated Massage is contraindicated

until client completely until client completely

recoversrecovers

From Stevens A, Lowe J: From Stevens A, Lowe J: Pathology,Pathology, eded 2, London, 2, London,

2000, Mosby.2000, Mosby.


PoliomyelitisPoliomyelitis

�� Highly contagious viral infection that is now Highly contagious viral infection that is now

rare rare

�� Massage contraindicated until client completely Massage contraindicated until client completely

recoversrecovers


PostpolioPostpolio SyndromeSyndrome

�� Collection of symptoms seen in individuals Collection of symptoms seen in individuals

who have previously recovered from polio or who have previously recovered from polio or

who were misdiagnosed, but now considered who were misdiagnosed, but now considered

to have been infectedto have been infected

�� Light massage of shorter duration; omit or Light massage of shorter duration; omit or

only cautiously apply passive stretches and jt. only cautiously apply passive stretches and jt.

mobs mobs


Lesson 6.3 ObjectivesLesson 6.3 Objectives

�� Name neurodegenerative diseases and state Name neurodegenerative diseases and state

appropriate massage considerations.appropriate massage considerations.

�� List warning signs of Alzheimer disease.List warning signs of Alzheimer disease.

�� Define vascular disorders and list appropriate Define vascular disorders and list appropriate

massage considerations.massage considerations.

�� List warning signs of stroke.List warning signs of stroke.

�� Name conditions of the peripheral nervous Name conditions of the peripheral nervous

system and list appropriate massage system and list appropriate massage

considerations.considerations.


Neurodegenerative DiseasesNeurodegenerative Diseases

�� DementiaDementia

�� Alzheimer diseaseAlzheimer disease

�� Huntington diseaseHuntington disease

�� Parkinson diseaseParkinson disease

�� Multiple sclerosisMultiple sclerosis

�� Amyotrophic lateral sclerosisAmyotrophic lateral sclerosis


DementiaDementia

�� Group of disorders characterized by a decline Group of disorders characterized by a decline

of mental facilities and personality changes of mental facilities and personality changes

that interfere with work, social activities; two that interfere with work, social activities; two

most common types are Alzheimer and most common types are Alzheimer and

vascular vascular

�� Gentle massage of shorter duration during Gentle massage of shorter duration during

later stages; behavior tolerance is neededlater stages; behavior tolerance is needed


Alzheimer DiseaseAlzheimer Disease

�� Progressive degenerative disease of the brainProgressive degenerative disease of the brain

�� Gentle massage of shorter duration during later Gentle massage of shorter duration during later

stages; behavior tolerance is neededstages; behavior tolerance is needed

From From ChabnerChabner DE: DE: The language of The language of

medicine,medicine, eded 8, 2007, Saunders.8, 2007, Saunders.


Warning Signs of Alzheimer Warning Signs of Alzheimer

DiseaseDisease

�� Recent memory loss that impairs functioning at Recent memory loss that impairs functioning at

work or homework or home

�� Problems with languageProblems with language

�� Disorientation in time and space; getting Disorientation in time and space; getting

confused or lost in familiar placesconfused or lost in familiar places

�� Difficulty completing familiar tasksDifficulty completing familiar tasks

�� Distorted judgmentDistorted judgment

�� Problems with abstract thinkingProblems with abstract thinking


Warning Signs of Warning Signs of

Alzheimer Disease Alzheimer Disease (cont(cont’’d.)d.)

�� Misplacing thingsMisplacing things

�� Repeated and sudden changes in mood and Repeated and sudden changes in mood and

behaviorbehavior

�� Changes in personalityChanges in personality

�� Loss of initiative to do thingsLoss of initiative to do things


Huntington DiseaseHuntington Disease

�� Inherited disorder characterized by motor Inherited disorder characterized by motor

disturbances, mental deterioration, and disturbances, mental deterioration, and

abnormal behaviorabnormal behavior

�� Light massage of shorter duration; omit or only Light massage of shorter duration; omit or only

cautiously apply passive stretches and jt. mobscautiously apply passive stretches and jt. mobs


Parkinson DiseaseParkinson Disease

�� DisorderDisorder producing abnormal producing abnormal movements marked by movements marked by destruction of dopaminedestruction of dopamine--producing neurons in the producing neurons in the brainbrain

�� Gentle massage of shorter Gentle massage of shorter durationduration

A, from A, from DamjanovDamjanov I: I: Pathology for the health professions,Pathology for the health professions, eded 3, St. Louis, 2006, Saunders; 3, St. Louis, 2006, Saunders;

B from Perkin DG: B from Perkin DG: MosbyMosby’’s color atlas and text of neurology,s color atlas and text of neurology, London, 1998, MosbyLondon, 1998, Mosby--Wolfe.Wolfe.


Multiple SclerosisMultiple Sclerosis

�� Progressive neural Progressive neural

demyelinationdemyelination

�� Massage Massage

contraindicated during contraindicated during

flareflare--ups; otherwise ups; otherwise

gentle massage of gentle massage of

shorter duration; shorter duration;

evaluate client at each evaluate client at each

visit as symptoms visit as symptoms

changechange

From Phipps WJ, Sands J, From Phipps WJ, Sands J, MarekMarek JF: JF: MedicalMedical--surgical nursing: concepts and clinical practice,surgical nursing: concepts and clinical practice, eded 5, St. Louis, 1999, Mosby.5, St. Louis, 1999, Mosby.


Amyotrophic Lateral Sclerosis Amyotrophic Lateral Sclerosis

(Lou Gehrig(Lou Gehrig’’s Disease) s Disease)

�� Degeneration of motor neurons leading to Degeneration of motor neurons leading to

secondary secondary demyelinationdemyelination; this causes ; this causes

generalized paralysis leaving the affected generalized paralysis leaving the affected

person immobileperson immobile

�� Gentle massage of shorter durationGentle massage of shorter duration


Vascular DisordersVascular Disorders

�� CerebrovascularCerebrovascular accident (stroke)accident (stroke)

�� Transient ischemic attackTransient ischemic attack

�� Migraine headacheMigraine headache


Transient Ischemic AttackTransient Ischemic Attack

�� Brief episode of impaired brain functioning Brief episode of impaired brain functioning

caused by temporary reduction of blood flow; caused by temporary reduction of blood flow;

lasts a few seconds to possibly hours and is lasts a few seconds to possibly hours and is

characterized by visual disturbances, speech characterized by visual disturbances, speech

difficulties, and difficulty understanding othersdifficulties, and difficulty understanding others

�� No modifications needed No modifications needed


CerebrovascularCerebrovascular Accident (Stroke)Accident (Stroke)

�� Sudden disruption in Sudden disruption in

cerebral blood flow by cerebral blood flow by

occluded or ruptured blood occluded or ruptured blood

vesselvessel

�� Obtain medical clearance Obtain medical clearance

during rehab stage; initial during rehab stage; initial

sessions should be brief sessions should be brief

(up to 30 min), gradually (up to 30 min), gradually

increasing to 1 hr increasing to 1 hr

From Cotran RS, Kumar V, Collins T: Robbins pathologic basis of disease, ed 6, Philadelphia, 1999, WB Saunders.


CerebrovascularCerebrovascular Accident Accident (cont(cont’’d.)d.)

From From CotranCotran RS, Kumar V, Collins T: RS, Kumar V, Collins T: Robbins pathologic basis of disease,Robbins pathologic basis of disease, eded 6, Philadelphia, 1999, WB Saunders.6, Philadelphia, 1999, WB Saunders.


Stroke Warning SignsStroke Warning Signs

�� Sudden or transient weakness, numbness, or Sudden or transient weakness, numbness, or

tingling in face, arm or leg, or on one side of the tingling in face, arm or leg, or on one side of the

bodybody

�� Temporary loss of speech, failure to Temporary loss of speech, failure to

comprehend, or confusioncomprehend, or confusion

�� Sudden loss of visionSudden loss of vision

�� Sudden severe headacheSudden severe headache

�� Unusual dizziness or loss of balanceUnusual dizziness or loss of balance


Migraine HeadacheMigraine Headache

(Vascular Headache)(Vascular Headache)

�� Severe, recurrent headaches accompanied by Severe, recurrent headaches accompanied by

symptoms such as visual disturbances and symptoms such as visual disturbances and

nausea; often provoked by a trigger factornausea; often provoked by a trigger factor

�� Massage is contraindicated during attackMassage is contraindicated during attack


Peripheral Nerve DisordersPeripheral Nerve Disorders

�� Trigeminal neuralgiaTrigeminal neuralgia

�� Bell palsyBell palsy

�� Myasthenia gravisMyasthenia gravis

�� GuillainGuillain--BarrBarréé syndromesyndrome

�� Peripheral neuropathyPeripheral neuropathy

�� Degenerative disc diseaseDegenerative disc disease

�� Herniated and bulging discs, and Herniated and bulging discs, and radiculopathiesradiculopathies

�� SciaticaSciatica

�� Carpal tunnel and thoracic outlet syndromesCarpal tunnel and thoracic outlet syndromes


Trigeminal NeuralgiaTrigeminal Neuralgia

(Tic (Tic douloureuxdouloureux))

�� Condition characterized Condition characterized by excruciating episodic by excruciating episodic pain in areas supplied by pain in areas supplied by the trigeminal nerve the trigeminal nerve (cranial nerve V) (cranial nerve V)

�� Avoid prone position and Avoid prone position and avoid massage to the avoid massage to the face and scalpface and scalp

From Frazier MS, From Frazier MS, DrzymkowskiDrzymkowski J: J: Essentials of human diseases and conditions, Essentials of human diseases and conditions, eded 3, St. Louis, 2004, Saunders.3, St. Louis, 2004, Saunders.


BellBell’’s Palsys Palsy

�� Condition of facial nerve Condition of facial nerve

(cranial nerve VII) (cranial nerve VII)

causing muscle causing muscle

weakness or paralysis on weakness or paralysis on

one side of faceone side of face

�� Use light gliding strokes Use light gliding strokes

directed upward, and directed upward, and

kneading, percussion, kneading, percussion,

and vibration on facial and vibration on facial

musclesmuscles

From From ChabnerChabner DE: DE: The language of The language of

medicine,medicine, ed 8, 2007, Saunders.ed 8, 2007, Saunders.


Myasthenia GravisMyasthenia Gravis

�� Disorder caused by Disorder caused by

loss of acetylcholine loss of acetylcholine

receptors within the receptors within the

neuromuscular neuromuscular

junction resulting in junction resulting in

progressive weakness progressive weakness

and paralysisand paralysis

�� Gentle massage of Gentle massage of

shorter durationshorter duration

From Perkin GD, Hochberg FH, Miller DC: From Perkin GD, Hochberg FH, Miller DC: Atlas of clinical neurology,Atlas of clinical neurology, eded 2, London, 1993, Gower Medical Publishing.2, London, 1993, Gower Medical Publishing.


GuillainGuillain--BarrBarréé SyndromeSyndrome

�� Neurologic inflammatory disease of the Neurologic inflammatory disease of the

peripheral nerves; typically begins as leg peripheral nerves; typically begins as leg

weakness and ascends to trunk and armsweakness and ascends to trunk and arms

�� Massage is contraindicated until the client Massage is contraindicated until the client

has fully recovered has fully recovered


Peripheral NeuropathyPeripheral Neuropathy

�� Inflammation or degeneration of PNS causing Inflammation or degeneration of PNS causing

symptoms of impaired sensations and symptoms of impaired sensations and

movement difficultiesmovement difficulties

�� Reduced pressure while avoiding Reduced pressure while avoiding

hypersensitive areas; if neuropathy in in lower hypersensitive areas; if neuropathy in in lower

extremities, avoid bolster useextremities, avoid bolster use


Degenerative Disc DiseaseDegenerative Disc Disease

�� Deterioration of the Deterioration of the intervertebralintervertebral discs discs

resulting from the aging processresulting from the aging process

�� Medical clearance required; once obtained, Medical clearance required; once obtained,

reduce pressure over affected areas and reduce pressure over affected areas and

avoid spinal mobilizations avoid spinal mobilizations


Herniated Disc, Bulging Disc, and Herniated Disc, Bulging Disc, and

RadiculopathiesRadiculopathies

�� Herniated disc Herniated disc –– protrusion of nucleus protrusion of nucleus pulposuspulposus

through tear in annulus through tear in annulus fibrosusfibrosus

�� Bulging disc Bulging disc –– similar to herniated disc but similar to herniated disc but

nucleus nucleus pulposuspulposus contained within annular wallcontained within annular wall

�� RadiculopathyRadiculopathy –– pain radiating along the path of pain radiating along the path of

a compressed nervea compressed nerve


Herniated Disc, Bulging Disc, and Herniated Disc, Bulging Disc, and

RadiculopathiesRadiculopathies (cont(cont’’d.)d.)

�� Symptoms include severe, sharp pain that may Symptoms include severe, sharp pain that may

worsen with movement; limited ROM; worsen with movement; limited ROM;

tenderness; tenderness; paresthesiasparesthesias

�� Postpone massage if pain is severe; otherwise, Postpone massage if pain is severe; otherwise,

reduce pressure over affected areas and in reduce pressure over affected areas and in

areas of areas of paresthesiasparesthesias; avoid spinal ; avoid spinal

mobilizations mobilizations


SciaticaSciatica

�� Inflammation of the sciatic Inflammation of the sciatic

nervenerve

�� Reduce pressure in areas Reduce pressure in areas

of of paresthesiasparesthesias; avoid use ; avoid use

of bolsters on lower of bolsters on lower

extremities extremities

From Frazier MS, From Frazier MS, DrzymkowskiDrzymkowski J: J: Essentials of human Essentials of human

diseases and conditions, diseases and conditions, eded 3, St. Louis, 2004, Saunders.3, St. Louis, 2004, Saunders.


Carpal Tunnel SyndromeCarpal Tunnel Syndrome

�� Compression of the Compression of the

median nerve within the median nerve within the

carpal tunnel carpal tunnel

�� Local contraindication if Local contraindication if

area is inflamedarea is inflamed

From Courtesy ARO Tool Products/IngersollFrom Courtesy ARO Tool Products/Ingersoll--Rand Professional Tools. In Frazier MS, Rand Professional Tools. In Frazier MS, DrzymkowskiDrzymkowski JW: JW: Essentials of human diseases Essentials of human diseases

and conditions,and conditions, eded 2, Philadelphia, 2000, WB Saunders; and 2, Philadelphia, 2000, WB Saunders; and BeareBeare PG, Myers JL: PG, Myers JL: Adult health nursing,Adult health nursing, eded 3, St. Louis, 1998, Mosby.3, St. Louis, 1998, Mosby.


Avoiding Carpal Tunnel SyndromeAvoiding Carpal Tunnel Syndrome

�� Strengthen forearm and hand musclesStrengthen forearm and hand muscles

�� Keep wrists neutral while workingKeep wrists neutral while working

�� Perform regular selfPerform regular self--massage of forearms and massage of forearms and

handshands

�� Use variety of strokes during the massageUse variety of strokes during the massage

�� Rest hands by spacing clientsRest hands by spacing clients

�� Stretch between sessionsStretch between sessions

�� Lower table heightLower table height


Thoracic Outlet SyndromeThoracic Outlet Syndrome

�� Compression or Compression or

entrapment of entrapment of

neurovascular neurovascular

bundlebundle

�� Avoid vigorous Avoid vigorous

massage if swollen massage if swollen

or inflamed; or inflamed;

otherwise, massage otherwise, massage

is helpfulis helpful

From Crossman AR, From Crossman AR, NearyNeary D: D: NeuroanatomyNeuroanatomy: an illustrated color text,: an illustrated color text,

Edinburgh, 1995, Churchill Livingstone.Edinburgh, 1995, Churchill Livingstone.

mosby’s pathology lesson 6.1 objective massage therapists ... · 19 copyright ©2010, 2006 by...

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