Mosby’s PATHOLOGY Lesson 5.1 Objectives Massage Therapists · Chapter 5 Musculoskeletal Pathologies Mosby’s PATHOLOGY for Massage Therapists Copyright ©2010, 2006 by Mosby, Inc.,

Chapter 5Chapter 5

Musculoskeletal Musculoskeletal

PathologiesPathologies

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.2

Lesson 5.1 ObjectivesLesson 5.1 Objectives

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

processes related to the musculoskeletal processes related to the musculoskeletal

system.system.

�� Define skeletal disorders and list appropriate Define skeletal disorders and list appropriate

massage considerations.massage considerations.

�� List risk factors for osteoporosis.List risk factors for osteoporosis.

�� Identify spinal deviations featured in this chapter Identify spinal deviations featured in this chapter

and list massage considerations.and list massage considerations.

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

3

Musculoskeletal System OverviewMusculoskeletal System Overview

��Three types of muscle tissueThree types of muscle tissue

��Cardiac Cardiac •• found in the heart; involuntaryfound in the heart; involuntary

��SmoothSmooth•• found in walls of hollow structures (i.e., blood vessels, air found in walls of hollow structures (i.e., blood vessels, air passageways), and most passageways), and most abdominopelvicabdominopelvic organs; involuntaryorgans; involuntary

��SkeletalSkeletal•• move bone, skin, or other skeletal muscles; voluntarymove bone, skin, or other skeletal muscles; voluntary


4

Skeletal MusclesSkeletal Muscles

From Herlihy B, Maebuis NK: The human body in health and illness, ed 3, Philadelphia, 2007, Saunders.


5

Muscle StructureMuscle Structure� Skeletal muscle (cont'd.)

– Consists of individual muscle cells called muscle

fibers, which contain myofibrils

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


6

Muscular ContractionMuscular Contraction

�� Sliding filament theorySliding filament theory

�� Myosin pulls on Myosin pulls on actinactin

�� ActinActin shortens myofibrilsshortens myofibrils

�� Myofibrils shorten muscle fibersMyofibrils shorten muscle fibers

�� Muscle fibers shorten muscleMuscle fibers shorten muscle


7

Muscle FunctionMuscle Function

�� Produces body movementsProduces body movements

�� Stabilizes body positionsStabilizes body positions

�� Stores and moves substances within the bodyStores and moves substances within the body

�� Generates heat; helps maintain normal body Generates heat; helps maintain normal body

temperaturetemperature


8

Muscle Function GroupsMuscle Function Groups

�� Muscles work in pairs or groups to coordinate Muscles work in pairs or groups to coordinate

movement.movement.

�� Groups classified by functionGroups classified by function

�� AgonistsAgonists

�� SynergistsSynergists

�� AntagonistsAntagonists

�� FixatorsFixators


9

Skeletal SystemSkeletal System

�� Components:Components:

�� BonesBones

�� CartilageCartilage

�� LigamentsLigaments

�� JointsJoints


10

Skeletal System Skeletal System (cont(cont’’d.)d.)

From From HerlihyHerlihy B, B, MaebuisMaebuis NK: NK: The human body in health and illness,The human body in health and illness, eded 3, Philadelphia, 2007, Saunders.3, Philadelphia, 2007, Saunders.


11

Structure of Bone TissueStructure of Bone Tissue



12

�� DiaphysisDiaphysis

�� EpiphysesEpiphyses

�� PeriosteumPeriosteum

�� MedullaryMedullary cavitycavity

Structure of Long BonesStructure of Long Bones


13

Bone Shape ClassificationBone Shape Classification

�� Long Long –– longer than they are widelonger than they are wide

�� Short Short –– cube shapedcube shaped

�� Flat Flat –– thin and flattenedthin and flattened

�� Irregular Irregular –– do not fit in other categoriesdo not fit in other categories

�� SesamoidSesamoid –– small, round, embedded in small, round, embedded in

certain tendonscertain tendons


14

Joint ClassificationJoint Classification

�� SynarthroticSynarthrotic jointjoint

�� AmphiarthroticAmphiarthrotic jointjoint

�� DiarthroticDiarthrotic jointjoint

�� Synovial jointsSynovial joints


15

Synovial Joint StructureSynovial Joint Structure



16

Types of Synovial JointsTypes of Synovial Joints

�� Hinge jointHinge joint

�� Pivot jointPivot joint

�� Ellipsoidal jointEllipsoidal joint

�� Saddle jointSaddle joint

�� Gliding jointGliding joint

�� Ball & socket jointBall & socket joint


17

Skeletal DisordersSkeletal Disorders

�� OsteoporosisOsteoporosis

�� OsteomalaciaOsteomalacia and Ricketsand Rickets

�� Paget diseasePaget disease

�� SpondylolysisSpondylolysis

�� OsteomyelitisOsteomyelitis

�� MarfanMarfan syndromesyndrome


18

OsteoporosisOsteoporosis

�� Loss of normal bone Loss of normal bone density resulting in density resulting in increased susceptibility to increased susceptibility to fractures fractures

�� Use lighter pressure and Use lighter pressure and avoid joint mobilizations avoid joint mobilizations and compressions or and compressions or administer carefullyadminister carefully

A, from Kumar V, A, from Kumar V, AbbasAbbas AK, AK, FaustoFausto N: N: Robbins & Robbins & CotranCotran pathologic basis of disease, pathologic basis of disease, 7e, Philadelphia, 2005, WB Saunders; 7e, Philadelphia, 2005, WB Saunders;

B and C, from B and C, from ThibodeauThibodeau GA, Patton KT: GA, Patton KT: Anatomy & physiologyAnatomy & physiology, , eded 6, St. Louis, 2007, Mosby. 6, St. Louis, 2007, Mosby.


19

OsteoporosisOsteoporosis

�� Bone deformity is Bone deformity is

most common most common

manifestation manifestation

(spinal curvature, (spinal curvature,

loss of height)loss of height)

From From DamjanovDamjanov I: I: Pathology for the healthPathology for the health--related professions,related professions, eded 2, Philadelphia, 2000, WB Saunders.2, Philadelphia, 2000, WB Saunders.


20

OsteomalaciaOsteomalacia and Ricketsand Rickets

�� OsteomalaciaOsteomalacia: inadequate mineralization of : inadequate mineralization of

mature bonesmature bones

�� Rickets: Rickets: osteomalaciaosteomalacia in childrenin children

�� Use lighter pressure and avoid joint Use lighter pressure and avoid joint

mobilizations and compressions or administer mobilizations and compressions or administer

carefullycarefully


21

Paget Disease Paget Disease

�� Progressive bone disease with Progressive bone disease with abnormal and excessive bone abnormal and excessive bone remodeling resulting in weak and remodeling resulting in weak and deformed bones of increased massdeformed bones of increased mass

�� Use lighter pressure and avoid joint Use lighter pressure and avoid joint mobilizations and compressions or mobilizations and compressions or administer carefullyadminister carefully



22

SpondylolysisSpondylolysis

�� Structural defect in a vertebra (usually L5) Structural defect in a vertebra (usually L5)

leading to its weakness and impaired weightleading to its weakness and impaired weight--

bearing capacity bearing capacity

�� Use lighter pressure over lower back and Use lighter pressure over lower back and

sacrum; avoid joint mobilizations or sacrum; avoid joint mobilizations or

compressions of these areas or administer compressions of these areas or administer

carefully carefully


23

OsteomyelitisOsteomyelitis

�� Bone infection most often caused by bacteriaBone infection most often caused by bacteria

�� Massage is contraindicatedMassage is contraindicated

From From McCanceMcCance KL, KL, HeutherHeuther SE: SE: PathophysiologyPathophysiology: the biologic basis for disease in adults and children, : the biologic basis for disease in adults and children, eded 5, St. Louis, 2006, Mosby.5, St. Louis, 2006, Mosby.


24

MarfanMarfan SyndromeSyndrome

�� Genetic disorder; Genetic disorder; abnormality in bodyabnormality in body’’s s connective tissue; affects connective tissue; affects many body systems, most many body systems, most often the skeletal and often the skeletal and cardiovascular systems cardiovascular systems and eyesand eyes

�� Modifications are based Modifications are based on disease severity on disease severity

From 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.


25

Spinal DeviationsSpinal Deviations

�� KyphosisKyphosis

�� LordosisLordosis

�� ScoliosisScoliosis


26

KyphosisKyphosis

�� Exaggeration of the Exaggeration of the

normal posterior thoracic normal posterior thoracic

curvecurve

�� Avoid overstretching Avoid overstretching

spine; if due to spine; if due to

osteoporosis, use lighter osteoporosis, use lighter

pressurepressure

From From KamalKamal A, A, BrockelhurstBrockelhurst JC: JC: Color atlas of geriatric medicine,Color atlas of geriatric medicine, eded 2, St. Louis, 1992, Mosby.2, St. Louis, 1992, Mosby.


27

LordosisLordosis

�� Exaggeration of the normal anterior lumbar Exaggeration of the normal anterior lumbar

spinal curvespinal curve

�� Position the client for comfort; use deep stroking Position the client for comfort; use deep stroking

and kneading on affected musclesand kneading on affected muscles


28

ScoliosisScoliosis

�� Lateral curvature in the normally straight vertical Lateral curvature in the normally straight vertical spinal line, usually in the thorax spinal line, usually in the thorax

�� Use deep stroking and kneading on affected Use deep stroking and kneading on affected muscles; avoid overstretching the spinemuscles; avoid overstretching the spine

From Gould BE: From Gould BE: PathophysiologyPathophysiology for the health professions,for the health professions, eded 3, 2006, St. Louis, Saunders.3, 2006, St. Louis, Saunders.


29


�� Define foot deformities and list massage Define foot deformities and list massage

considerations.considerations.

�� Define miscellaneous joint disorders and list Define miscellaneous joint disorders and list


�� List types of arthritis and discuss massage List types of arthritis and discuss massage

considerations.considerations.

�� Contrast and compare Contrast and compare ankylosingankylosing spondylitisspondylitis

with rheumatoid arthritis.with rheumatoid arthritis.


30

Lesson 4.2 Objectives Lesson 4.2 Objectives (cont'd.)(cont'd.)

�� Name muscular and Name muscular and myofascialmyofascial conditions and conditions and

state massage considerations.state massage considerations.

�� Delineate types of headaches.Delineate types of headaches.

�� List several clinical manifestations of fibromyalgia.List several clinical manifestations of fibromyalgia.

�� Contrast and compare fibromyalgia and Contrast and compare fibromyalgia and

myofascialmyofascial pain syndrome.pain syndrome.

�� Name several types of muscular dystrophy.Name several types of muscular dystrophy.


31

Foot DeformitiesFoot Deformities

�� BunionsBunions

�� Hammertoes and Mallet toesHammertoes and Mallet toes

�� PesPes planusplanus and and PesPes cavuscavus


32

BunionBunion

�� Medial displacement of the Medial displacement of the

first first metatarsophalangealmetatarsophalangeal

joint (great toe) joint (great toe)

�� Avoid area or use lighter Avoid area or use lighter

pressure if tender; avoid pressure if tender; avoid

joint mobilizations joint mobilizations

Courtesy Charles W. Bradley, DPM, MPA and Caroline Harvey, DPM, Courtesy Charles W. Bradley, DPM, MPA and Caroline Harvey, DPM, California College of Podiatric Medicine. In Seidel HM et al: California College of Podiatric Medicine. In Seidel HM et al:

MosbyMosby’’s guide to physical examinations, s guide to physical examinations, eded 6, St. Louis, 2006, Mosby.6, St. Louis, 2006, Mosby.


33

Hammertoes and Mallet ToesHammertoes and Mallet Toes

�� Hammer toeHammer toe: : metatarsophalangealmetatarsophalangeal joint joint

extended and proximal extended and proximal interphalangealinterphalangeal joint joint

flexedflexed

�� Mallet toeMallet toe: distal : distal interphalangealinterphalangeal joint flexedjoint flexed

�� Avoid area or use lighter pressure if tender; Avoid area or use lighter pressure if tender;

avoid joint mobilizations avoid joint mobilizations


34

Hammer Toes and Mallet ToesHammer Toes and Mallet Toes



Hammer toeHammer toe

Mallet toeMallet toe


35

PesPes PlanusPlanus and and PesPes CavusCavus

�� PesPes planusplanus (flatfoot) (flatfoot) –– Medial longitudinal arch is Medial longitudinal arch is reduced or collapsedreduced or collapsed

�� PesPes CavusCavus (high instep) (high instep) –– both medial and both medial and lateral longitudinal arches are excessively raised lateral longitudinal arches are excessively raised

�� Deep gliding, kneading, and friction strokes to Deep gliding, kneading, and friction strokes to loosen tight calf muscles; avoid any related loosen tight calf muscles; avoid any related corns or calluses or use lighter pressure if corns or calluses or use lighter pressure if tendertender


36

PesPes PlanusPlanus and and PesPes CavusCavus, , (cont(cont’’d.)d.)



Pes planus

Pes cavus


37

Joint DisordersJoint Disorders

�� SpondylolisthesisSpondylolisthesis

�� PatellofemoralPatellofemoral syndromesyndrome

�� Ganglion cystGanglion cyst

�� Baker cystBaker cyst

�� BursitisBursitis

�� TemporomandibularTemporomandibular joint dysfunctionjoint dysfunction


38

SpondylolisthesisSpondylolisthesis

�� AnteriorlyAnteriorly displaced vertebra; displaced vertebra;

usually affects lower spineusually affects lower spine

�� Use lighter pressure over Use lighter pressure over

affected area; avoid joint affected area; avoid joint

mobilizations and mobilizations and

compressions or administer compressions or administer

carefullycarefully

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.


39

PatellofemoralPatellofemoral SyndromeSyndrome

�� Softening and degeneration of Softening and degeneration of articulararticular cartilage cartilage

located on posterior patella located on posterior patella

�� Avoid area if swollen, inflamed, or tender; deep Avoid area if swollen, inflamed, or tender; deep

gliding, kneading, friction, gliding, kneading, friction, myofascialmyofascial release release

techniques on quads and hamstrings but avoid techniques on quads and hamstrings but avoid

stretching of quads stretching of quads


40

�� Benign mass usually located on wrist tendonBenign mass usually located on wrist tendon

�� Local contraindicationLocal contraindication

Ganglion CystGanglion Cyst

A, from A, from HoppenfeldHoppenfeld S: S: Physical examination of the spine and extremities,Physical examination of the spine and extremities, Upper Saddle River, NJ, 1976, Pearson Education;Upper Saddle River, NJ, 1976, Pearson Education;

B, from B, from CallenCallen J et al.: J et al.: Color atlas of dermatology,Color atlas of dermatology, Philadelphia, 1993, WB Saunders.Philadelphia, 1993, WB Saunders.


41

Baker CystBaker Cyst

�� Cyst behind knee Cyst behind knee

caused by caused by

accumulation of accumulation of

synovial fluidsynovial fluid

�� Local Local

contraindication; contraindication;

use soft bolster use soft bolster

behind knees while behind knees while

client is supine client is supine

From Courtesy Dr. M Sherlock. In From Courtesy Dr. M Sherlock. In 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.


42

BursitisBursitis

�� Chronic or acute inflammation of the Chronic or acute inflammation of the bursaebursae

�� Local contraindication in acute stage; deep Local contraindication in acute stage; deep

friction and jt. mobs helpful in chronic stage (use friction and jt. mobs helpful in chronic stage (use

ice afterwards); avoid jt. mobs if they cause painice afterwards); avoid jt. mobs if they cause pain

From From KlippelKlippel JH, JH, DeippeDeippe PA PA edseds: : Rheumatology,Rheumatology, eded 2, London, 1998, Mosby.2, London, 1998, Mosby.


43

TemporomandibularTemporomandibular Joint Joint

Dysfunction (TMJD)Dysfunction (TMJD)

�� Disorders of the jaw joint, its musculature, or Disorders of the jaw joint, its musculature, or

both causing pain in the jaw, teeth, head, and both causing pain in the jaw, teeth, head, and

earsears

�� Massage is indicated using advanced Massage is indicated using advanced

techniques to techniques to intraorallyintraorally treat jaw musculature treat jaw musculature

(where legal) (where legal)


44

ArthritisArthritis

�� OsteoarthritisOsteoarthritis

�� SpondylosisSpondylosis

�� Rheumatoid arthritisRheumatoid arthritis

�� Juvenile rheumatoid arthritisJuvenile rheumatoid arthritis

�� AnkylosingAnkylosing spondylitisspondylitis

�� Gouty arthritisGouty arthritis

�� Lyme diseaseLyme disease

�� Septic arthritisSeptic arthritis


45

OsteoarthritisOsteoarthritis

�� Progressive damage and eventual loss of Progressive damage and eventual loss of articulararticular cartilage; also called degenerative joint cartilage; also called degenerative joint disease disease

�� Avoid joints that are red, hot, or tender; use mildAvoid joints that are red, hot, or tender; use mild--to moderateto moderate--pressure; neck movements are best pressure; neck movements are best omitted or carried out with extreme caution omitted or carried out with extreme caution


46

Osteoarthritis Osteoarthritis (cont'd.)(cont'd.)

From From McCanceMcCance KL, KL, HeutherHeuther SE: SE: PathophysiologyPathophysiology: the biologic basis for disease in adults and children, : the biologic basis for disease in adults and children, eded 5, St. Louis, 2006, Mosby; and 5, St. Louis, 2006, Mosby; and

LemmiLemmi FO, FO, LemmiLemmi CAE: CAE: Physical assessment findings CDPhysical assessment findings CD--ROM,ROM, Philadelphia, 2000, WB Saunders.Philadelphia, 2000, WB Saunders.


47

SpondylosisSpondylosis

�� Degeneration of the spineDegeneration of the spine

�� Avoid undue pressure over the spine; joint Avoid undue pressure over the spine; joint

mobilizations of the spine (including cervical mobilizations of the spine (including cervical

area) are best omitted or carried out with area) are best omitted or carried out with

extreme cautionextreme caution


48

Rheumatoid ArthritisRheumatoid Arthritis

�� Systemic arthritis affecting Systemic arthritis affecting

synovial membranes, then synovial membranes, then

articulararticular cartilages and cartilages and

other joint structuresother joint structures

�� Massage contraindicated Massage contraindicated

during exacerbations; during exacerbations;

otherwise, adjust pressure otherwise, adjust pressure

to client toleranceto client tolerance



49

Juvenile Rheumatoid ArthritisJuvenile Rheumatoid Arthritis

�� Any joint inflammation of at least 6 weeks in a Any joint inflammation of at least 6 weeks in a

childchild

�� Massage contraindicated during exacerbations; Massage contraindicated during exacerbations;

otherwise, adjust pressure to client toleranceotherwise, adjust pressure to client tolerance

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.


50

AnkylosingAnkylosing SpondylitisSpondylitis

�� Systemic arthritis leading to Systemic arthritis leading to

calcification and fusion calcification and fusion

((ankylosisankylosis) of joints, usually spine ) of joints, usually spine

and sacroiliac joints and sacroiliac joints

�� Reduce pressure over tender Reduce pressure over tender

areas; avoid joint mobilizations; areas; avoid joint mobilizations;

avoid rib cage compressions avoid rib cage compressions

From Shipley M: A From Shipley M: A colourcolour atlas of rheumatology,atlas of rheumatology, eded 3, London, 1993, Mosby Year Book Europe.3, London, 1993, Mosby Year Book Europe.


51

Gouty Arthritis (Gout)Gouty Arthritis (Gout)

�� Inflammatory arthritis Inflammatory arthritis resulting from uric acid resulting from uric acid crystals in jointscrystals in joints

�� During attacks, massage During attacks, massage is adjusted according to is adjusted according to symptoms; in chronic symptoms; in chronic cases, use lighter cases, use lighter pressure over nodules pressure over nodules and avoid mobs of and avoid mobs of deformed deformed jtsjts..

From Dieppe P et al: From Dieppe P et al: Arthritis and rheumatism in practice,Arthritis and rheumatism in practice, London, 1991, Gower.London, 1991, Gower.


52

Lyme DiseaseLyme Disease

�� Recurrent arthritis Recurrent arthritis

affecting not only joints, affecting not only joints,

but skin, heart, and but skin, heart, and

nervous system nervous system

�� Massage contraindicated if Massage contraindicated if

fever is present; otherwise, fever is present; otherwise,

tailor massage to tailor massage to

symptoms and avoid symptoms and avoid

lesions and red, swollen lesions and red, swollen

joints joints From From CallenCallen J et al.: J et al.: Color atlas of dermatology,Color atlas of dermatology, eded 2, 2,

Philadelphia, 2000, WB Saunders.Philadelphia, 2000, WB Saunders.


53

Septic ArthritisSeptic Arthritis

(Infectious Arthritis)(Infectious Arthritis)

�� Infection in a joint; usually Infection in a joint; usually

caused by bacteriacaused by bacteria

�� Massage is contraindicatedMassage is contraindicated

From From ZitelliZitelli BJ, Davis HW: BJ, Davis HW: Atlas of pediatric physical Atlas of pediatric physical

diagnosis,diagnosis, eded 5, St. Louis, 2007, Mosby.5, St. Louis, 2007, Mosby.


54

Muscular and Muscular and MyofascialMyofascial

DisordersDisorders

�� Muscular atrophyMuscular atrophy

�� ContracturesContractures

�� DupuytrenDupuytren contracturecontracture

�� HeadachesHeadaches

�� Fibromyalgia syndromeFibromyalgia syndrome

�� MyofascialMyofascial pain syndromepain syndrome

�� Muscular dystrophyMuscular dystrophy

�� MyositisMyositis ossificansossificans


55

Muscular AtrophyMuscular Atrophy

�� Decrease in muscle Decrease in muscle

cell diameter; muscle cell diameter; muscle

appears smaller, appears smaller,

looser, flattenedlooser, flattened

�� Begin slowly and Begin slowly and

superficially; superficially;

gradually increase gradually increase

pressure to tolerancepressure to tolerance

From From KamalKamal A, A, BrockelhurstBrockelhurst JC: JC: Color atlas of geriatric medicine,Color atlas of geriatric medicine, eded 2, St. Louis, 1992, Mosby.2, St. Louis, 1992, Mosby.


56

ContractureContracture

�� Transient or permanent Transient or permanent

shortening of muscle shortening of muscle

causing flexed and fixated causing flexed and fixated

position of jointposition of joint

�� Reduce pressure in areasReduce pressure in areas

with little or no sensation; contractures are difficult with little or no sensation; contractures are difficult

or impossible to reduce with massage; this should or impossible to reduce with massage; this should

be conveyed to the clientbe conveyed to the client

From Forbes CD, Jackson WF: A color atlas and text of clinical medicine, London, 1993, Mosby Europe.


57

DupuytrenDupuytren’’ss ContractureContracture

�� Fibrosis of the Fibrosis of the palmarpalmar

fascia; rare conditionfascia; rare condition

�� Reduce pressure in Reduce pressure in

areas with little or no areas with little or no

sensation; contractures sensation; contractures

are difficult or impossible are difficult or impossible

to reduce with massage; to reduce with massage;

this should be conveyed this should be conveyed

to the clientto the client

From From KamalKamal A, A, BrockelhurstBrockelhurst JC: JC: Color atlas of geriatric Color atlas of geriatric

medicine,medicine, eded 2, St. Louis, 1992, Mosby.2, St. Louis, 1992, Mosby.


58

HeadachesHeadaches

�� Pain in the head from any cause; types are Pain in the head from any cause; types are

tension (muscular contraction), cluster, and tension (muscular contraction), cluster, and

migrainemigraine

�� Massage is indicatedMassage is indicated

From Black JM, From Black JM, MatassarinMatassarin--Jacobs E: Jacobs E: LuckmannLuckmann and Sorensenand Sorensen’’s medicals medical--surgical nursing, surgical nursing, eded 4, Philadelphia, 1993, WB Saunders.4, Philadelphia, 1993, WB Saunders.


59

Fibromyalgia SyndromeFibromyalgia Syndrome

�� Chronic, generalized syndrome of diffuse softChronic, generalized syndrome of diffuse soft--

tissue pain and multiple tender pointstissue pain and multiple tender points

�� Massage tailored to how client is feeling at time Massage tailored to how client is feeling at time

of treatment; begin with slow increments in of treatment; begin with slow increments in

pressure from session to sessionpressure from session to session


60

Fibromyalgia Syndrome Fibromyalgia Syndrome (cont(cont’’d.)d.)

From Redrawn from From Redrawn from FreundlichFreundlich B, B, LeventhalLeventhal L: The fibromyalgia syndrome. In Schumacher HR L: The fibromyalgia syndrome. In Schumacher HR JrJr, , KlippelKlippel JH, JH, KoopmanKoopman, WJ, , WJ, edseds: :

Primer on the rheumatic diseases,Primer on the rheumatic diseases, eded 11, Atlanta, 1977, Arthritis Foundation. Copyright 1997. Reprin11, Atlanta, 1977, Arthritis Foundation. Copyright 1997. Reprinted with permission of the ted with permission of the

Arthritis Foundation, 1330 W. Peachtree St., Atlanta, GA 30309.Arthritis Foundation, 1330 W. Peachtree St., Atlanta, GA 30309.


61

MyofascialMyofascial Pain SyndromePain Syndrome

�� Disorder associated with presence of localized Disorder associated with presence of localized

trigger pointstrigger points

�� Massage and stretching is indicated over trigger Massage and stretching is indicated over trigger

points and adjacent areas; avoid oscillating points and adjacent areas; avoid oscillating

movements (percussion and vibration) to avoid movements (percussion and vibration) to avoid

producing localized contractionsproducing localized contractions


62

MyofascialMyofascial Pain Syndrome Pain Syndrome (cont(cont’’d.)d.)

�� Types of trigger points are:Types of trigger points are:

�� Active: pain is produced by pressure or stretching; Active: pain is produced by pressure or stretching; this pain is experienced locally and in a referred this pain is experienced locally and in a referred area that is familiar area that is familiar

�� Latent: pain is produced by pressure or stretching; Latent: pain is produced by pressure or stretching; this pain is experienced both locally and in a this pain is experienced both locally and in a referred area that is unfamiliarreferred area that is unfamiliar


63

Fibromyalgia vs. Fibromyalgia vs.

MyofascialMyofascial Pain SyndromePain Syndrome

VariableVariable FibromyalgiaFibromyalgia MPSMPS

LocationLocation GeneralizedGeneralized RegionalRegional

Primary symptomPrimary symptom Tender points Tender points

with pressure with pressure

applicationapplication

Trigger points and Trigger points and

referred pain referred pain

patterns with patterns with

pressure pressure

applicationapplication

GenderGender Female/Male Female/Male

ration (10:1)ration (10:1)EqualEqual

Systemic signsSystemic signs ManyMany FewFew

Adapted from Adapted from McCanceMcCance KL, KL, HuetherHuether SE: SE: PathophysiologyPathophysiology: the biologic basis for disease in adults and children, : the biologic basis for disease in adults and children, eded 5, St. Louis, 2006, Mosby.5, St. Louis, 2006, Mosby.


64

Muscular DystrophyMuscular Dystrophy

�� Collection of rare genetic Collection of rare genetic

muscle diseases muscle diseases

characterized by characterized by

progressive muscle atrophyprogressive muscle atrophy

�� Massage modifications Massage modifications

based on disease severity based on disease severity

From From JordeJorde LB et al: LB et al: Medical genetics,Medical genetics, eded 3, St. Louis, 3, St. Louis,

2006, Mosby.2006, Mosby.


65

Muscular Dystrophy Muscular Dystrophy (cont(cont’’d.)d.)

From From FromFrom HockenberryHockenberry MJ: MJ: WongWong’’s nursing care of infants and children,s nursing care of infants and children, eded 8, St. Louis, 2007, Mosby.8, St. Louis, 2007, Mosby.


66

MyositisMyositis OssificansOssificans

�� Deposition of calcium in Deposition of calcium in

traumatized area of traumatized area of

musculature caused by musculature caused by

injuryinjury

�� Local contraindicationLocal contraindication

From Kumar V, From Kumar V, AbbasAbbas AK, AK, FaustoFausto N: N: Robbins & Robbins & CotranCotran pathologic basis of disease: with student consult online accesspathologic basis of disease: with student consult online access, , eded 7, 7,



67


�� Discuss musculoskeletal injuries and include Discuss musculoskeletal injuries and include


�� List several types of fractures.List several types of fractures.

�� Explain the three degrees of sprains and Explain the three degrees of sprains and

strains.strains.


68

Musculoskeletal InjuriesMusculoskeletal Injuries

�� Dislocations and Dislocations and subluxationssubluxations

�� FracturesFractures

�� SprainsSprains

�� StrainsStrains

�� Volkmann contractureVolkmann contracture

�� Tendinitis, Tendinitis, EpicondylitisEpicondylitis, and , and TenosynovitisTenosynovitis

�� De De QuervainQuervain tenosynovitistenosynovitis


69

Musculoskeletal Injuries Musculoskeletal Injuries (cont(cont’’d)d)

�� OsgoodOsgood--SchlatterSchlatter diseasedisease

�� TorticollisTorticollis

�� WhiplashWhiplash

�� Repetitive strain injuriesRepetitive strain injuries

�� Adhesive Adhesive capsulitiscapsulitis

�� Compartment syndromeCompartment syndrome

�� Shin splintsShin splints

�� Plantar fasciitisPlantar fasciitis


70

Dislocation and Dislocation and SubluxationSubluxation

�� Dislocation Dislocation ––temporary temporary displacement of displacement of bones at the jointbones at the joint

�� SubluxationSubluxation ––contact is only contact is only partially lostpartially lost

�� Local Local contraindication for contraindication for recent injuries and recent injuries and inflamed areasinflamed areas

From Gould B: From Gould B: PathophysiologyPathophysiology for the health professions,for the health professions, eded 2, Philadelphia, 2002, WB Saunders.2, Philadelphia, 2002, WB Saunders.


71

FracturesFractures

�� Disruption or break in bone Disruption or break in bone

continuitycontinuity

�� Local contraindication if Local contraindication if

bone is immobilized, but bone is immobilized, but

massage to proximal and massage to proximal and

distal areas is usefuldistal areas is useful

From Frazier MS, From Frazier MS, DrzymkowskiDrzymkowski JW: JW: Essentials of human diseases and conditions,Essentials of human diseases and conditions, ed. 2, Philadelphia, 2000, WB Saunders.ed. 2, Philadelphia, 2000, WB Saunders.


72

SprainSprain

�� Overstretching or tearing Overstretching or tearing

of ligaments without bone of ligaments without bone

displacement; three displacement; three

degrees (first, second, degrees (first, second,

and third)and third)

�� Avoid affected area for Avoid affected area for

72 hrs after injury72 hrs after injuryFrom Frazier MS, From Frazier MS, DrzymkowskiDrzymkowski JW: JW: Essentials of human diseases Essentials of human diseases

and conditions,and conditions, ed. 2, Philadelphia, 2000, WB Saunders.ed. 2, Philadelphia, 2000, WB Saunders.


73

Strain (Pull)Strain (Pull)

�� Overstretching or tearing Overstretching or tearing

of muscle or its tendons; of muscle or its tendons;

three degrees (first, three degrees (first,

second, and third)second, and third)

�� Avoid affected area for Avoid affected area for

72 hrs after injury72 hrs after injury

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


74

Volkmann ContractureVolkmann Contracture

�� Contracture of hand, Contracture of hand,

fingers and sometimes fingers and sometimes

wrist; from reduced blood wrist; from reduced blood

flowflow

�� Reduce pressure in areas Reduce pressure in areas

with little or no sensation; with little or no sensation;

contractures are difficult contractures are difficult

or impossible to reduce or impossible to reduce

with massage; this should with massage; this should

be conveyed to the clientbe conveyed to the clientFrom From ShankmanShankman GA: GA: Fundamental orthopedic Fundamental orthopedic

management for the physical therapy assistant, management for the physical therapy assistant, eded 2, 2,

Philadelphia, 2004, Mosby.Philadelphia, 2004, Mosby.


75

Tendinitis (Tendonitis)Tendinitis (Tendonitis)

�� Inflammation of a tendonInflammation of a tendon

�� Avoid affected area if Avoid affected area if

less than 72 hrs after less than 72 hrs after

injury; initial sessions are injury; initial sessions are

short and become longer short and become longer

as the area becomes use as the area becomes use

to pressure; follow with to pressure; follow with

iceice

From From McCanceMcCance KL, KL, HeutherHeuther SE: SE: PathophysiologyPathophysiology: the biologic basis for disease in adults and children, : the biologic basis for disease in adults and children, eded 5, St. Louis, 2006, Mosby.5, St. Louis, 2006, Mosby.


76

Tendinitis Tendinitis (cont(cont’’d)d)

�� Conditions associated with tendinitis are:Conditions associated with tendinitis are:

�� TenosynovitisTenosynovitis: tendinitis that also involves the : tendinitis that also involves the

sheathsheath

�� TendinosisTendinosis: degeneration of the tendon: degeneration of the tendon

�� EpicondylitisEpicondylitis: inflammation of the tendon where it : inflammation of the tendon where it

attaches to a bone attaches to a bone

�� Bursitis: inflammation of the Bursitis: inflammation of the bursaebursae


77

de de QuervainQuervain’’ss TenosynovitisTenosynovitis

�� Inflammation of Inflammation of

tendinoustendinous sheath on sheath on

radial side of wristradial side of wrist

�� Local contraindicationLocal contraindication if if

area is inflamedarea is inflamed

From From ShankmanShankman GA: GA: Fundamental orthopedic Fundamental orthopedic




78

OsgoodOsgood--SchlatterSchlatter DiseaseDisease

�� Patellar tendinitis in immature bone at the Patellar tendinitis in immature bone at the tibialtibial

tuberositytuberosity (where quads attach)(where quads attach)

�� Avoid area if swollen, inflamed, or tender; avoid Avoid area if swollen, inflamed, or tender; avoid

overstretching quads on affected sideoverstretching quads on affected side

From From ZitelliZitelli BJ, Davis HW: BJ, Davis HW: Atlas of pediatric Atlas of pediatric

physical diagnosis,physical diagnosis, eded 5, St. Louis, 2007, Mosby.5, St. Louis, 2007, Mosby.


79

TorticollisTorticollis

�� Congenital or acquired Congenital or acquired

spasms of spasms of

sternocleidomastoidsternocleidomastoid

�� Avoid affected area if injury Avoid affected area if injury

is less than 72 hours old; is less than 72 hours old;

otherwise, avoid otherwise, avoid

overstretching affected overstretching affected

muscles muscles From Perkin GD: From Perkin GD: MosbyMosby’’s color atlas and text of s color atlas and text of

neurology,neurology, London, 1998, MosbyLondon, 1998, Mosby--Wolfe.Wolfe.


80

WhiplashWhiplash

�� A sprain/strain of the cervical spine and A sprain/strain of the cervical spine and

spinal cord (most commonly at the junction of spinal cord (most commonly at the junction of

C4 and C5); most common cause is injury C4 and C5); most common cause is injury

from being pushed or struck from behind from being pushed or struck from behind

�� Avoid affected area for 72 hrs after injuryAvoid affected area for 72 hrs after injury


81

Repetitive Strain Injury (RSI)Repetitive Strain Injury (RSI)

�� Injuries that develop over time; caused by Injuries that develop over time; caused by

prolonged repetitive or constant motion, prolonged repetitive or constant motion,

usually combined with compressive forcesusually combined with compressive forces

�� Avoid area if inflamed; otherwise, deep Avoid area if inflamed; otherwise, deep

pressure within client tolerance pressure within client tolerance


82

Adhesive Adhesive CapsulitisCapsulitis

�� Disorder of shoulder joint Disorder of shoulder joint

and capsule; initially and capsule; initially

inflamed and eventually inflamed and eventually

stiff or frozenstiff or frozen

�� Avoid area if inflamed; Avoid area if inflamed;

afterward, address afterward, address

surrounding muscles with surrounding muscles with

heat and massageheat and massage

From From ShankmanShankman GA: GA: Fundamental orthopedic Fundamental orthopedic




83

Compartment SyndromeCompartment Syndrome

�� Occurs when pressure Occurs when pressure within a within a nonyieldingnonyieldingfascialfascial compartment compartment increases; types are increases; types are acute and chronic acute and chronic

�� Avoid area if client Avoid area if client reports intense, reports intense, stabbing pain or is stabbing pain or is hypersensitive to hypersensitive to pressure pressure

From Black JM, Hawks JH, Keene AM: From Black JM, Hawks JH, Keene AM: MedicalMedical--surgical surgical

nursing: clinical management for positive outcomes, nursing: clinical management for positive outcomes, eded 6, 6,



84

Shin SplintsShin Splints

�� Pain along the tibia; Pain along the tibia;

usually bilateralusually bilateral

�� Avoid area if pain is severeAvoid area if pain is severe

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

human diseases and conditions,human diseases and conditions, eded 4, St. Louis, 4, St. Louis,

2009, Saunders.2009, Saunders.


85

Plantar FasciitisPlantar Fasciitis

�� Chronic inflammation of Chronic inflammation of

the plantar fascia (the plantar fascia (““pain pain

in the heelin the heel””))

�� Avoid area if pain is Avoid area if pain is

severe; be sure affected severe; be sure affected

foot is not excessively foot is not excessively

dorsiflexeddorsiflexed

From Frazier MS, From Frazier MS, DrzymkowskiDrzymkowski JW: JW: Essentials of human diseases and conditions,Essentials of human diseases and conditions, ed. 2, Philadelphia, 2000, WB Saunders.ed. 2, Philadelphia, 2000, WB Saunders.

Documents

Mosby’s PATHOLOGY Lesson 5.1 Objectives Massage Therapists · Chapter 5 Musculoskeletal Pathologies Mosby’s PATHOLOGY for Massage Therapists Copyright ©2010, 2006 by Mosby, Inc.,