Pathology A for Massage Therapists

Achilles Tendinitis/Tendinosis

Inflammation of the Achilles Tendon


Definition: Inflammation of the sebaceous gland ducts in the skin; bacterial infection.

Causes: overactive sebaceous glands secreting too much oil leads to clogging of pores; may be genetic, hormonal related, over consumption of fatty foods, junk foods, and meat, nutritional deficiencies, using cosmetics, allergies, stress, liver toxicity, toxins

Signs/Symptoms: black heads, white heads, small inflamed pustules

Indications: Massage to surrounding area, may want to avoid direct contact as it may be painful; may assist in detoxification

Contraindications: Detoxification process may lead to more acne; some oils or lotions may clog pores of client and cause acne. Use water based lotion or no lotion or oil at all. Remove oil with alcohol or shower directly after treatment. May be on antibiotics (may cause intestinal imbalance) or retinoids (may cause joint pain and hair loss) Refer to appropriate health care provider for nutritional support and detoxification.


Definition: when myofascial structures bind together due to excess scar tissue formation

Causes: limited movement, reduced hydration, compression, impingement, trauma, improper healing

Signs/Symptoms: inflammation, atrophy, reduced ROM, pain, stiffness, shortened muscles with increased risk of injury

Indications: Massage to break up adhesions using friction, trigger point therapy, deep tissue work as tolerated, ice massage, active and passive stretching; increase flexibility and circulation

Contraindications: May have inflammation present – treat accordingly.


Definition: Hypersensitivity to an antigen causing tissue damage

Causes: May be caused by depleted  immune system, hereditary, emotional , stress (depletes cortisol levels which is needed to reduce inflammation), anger, toxicity of the body, poor diet, deficient digestive enzymes

Signs/Symptoms: nasal congestion, coughing, itching, hay fever, asthma, eczema, hives, skin rashes, shock, asphyxia

Indications: Massage is OK.  Detoxification, lymphatic drainage

Contraindications:  Check for allergies to oils, detergents, latex. Refer to appropriate health care provider.


Definition: Neurological disorder in which the cerebral neurons become dysfunctional

Causes: Possible causes include metal toxicity (aluminum), nutritional deficiencies ( B vitamins, zinc, A, E and carotene)

Signs/Symptoms: progressive mental deterioration, depression, memory loss, inability to concentrate, loss of bladder and bowel control, build up of plaque in the brain

Indications: May help reduce stress; Aromatherapy for stress reduction- Chamomile, germanium, lavender, marjoram, rosemary, ylang ylang;  family members may need it more.

Contraindications:  May not be useful in later stages as mental capacities diminish:

ALS (Amyotrophic lateral sclerosis)  Lou Gherig’s disease

Definition: Progressive neuromuscular disease in which the motor cells in the spinal cord degenerate leading to muscular weakness

Causes: unknown

Signs/Symptoms: stiffness, weakness and wasting of muscles of hands and feet, followed by twitches and cramps; use of muscle decreases; affects the palate, pharynx, tongue, neck and shoulders in advanced stages leading to difficulty in speech and swallowing; affects mainly men between 40-70 years old.  There is no definite test for diagnosis.  Death usually occurs within 2-10 years.

Indications:  May help reduce stress; check for other contraindications. Communication may be difficult.

Contraindications:  Get physician referral.


Definition: Anemia is a sign not a disease. There are many kinds and are all characterized by reduced blood red blood cell count or hemoglobin

Causes: Nutritional- diet lacking in iron, amino acids or vitamin B12.  Pernicious- insufficient production of red blood cells from an inability to produce a necessary factor.  Hemmorrhagic- from excessive bleeding.  Hemolytic- red blood cells plasma membranes rupture prematurely.  Aplastic- destruction of bone marrow from toxins, radiation, or medications

Signs/Symptoms: fatigue, unable to tolerate cold, paleness of skin, mucous membranes, gums, nail beds; shortness of breath, palpitations.

Indications: May be helpful

Contraindications: Contraindicated in advanced stages where the heart is overworked. Work with the care of a physician. Refer to appropriate health care provider.

Angina Pectoris

Definition:  Chest pain

Causes: oxygen deprivation in the heart; usually from blocked arteries, anemia, or hyperthyroidism

Signs/Symptoms: heavy, tight pain in the chest, left shoulder, arm and jaw area usually after exertion

Indications: Massage Ok;  reduce stress;  Trigger point chest area, ribs, sternum with ok of physician

Contraindications: Refer to appropriate health care provider.  May be on beta blockers or other medications to dilate coronary vessels.


Definition: Arterial dilation caused by the pressure of blood on a section of the wall of the artery that may be thin and weak due to high blood pressure, atherosclerosis or unhealthy connective tissue.

Causes: May be due to surgical procedure, smoking, genetics, nutritional deficiency, coughing, inflammation, trauma

Sign/Symptoms: may have back pain, chest pain, coughing, or other problems in area where aneurysm is forming.

Indications: None

Contraindications: Depending on the region; Have area checked by physician, get medical clearance; avoid pressure on pulses: Refer to appropriate health care provider. Be sure to do a complete history – warning signs may be heart disease, atherosclerosis and/or high blood pressure.

Ankylosing Spondylitis (AS)

Definition: Type of rheumatic arthritis that affects the spine and sacroiliac joint

Causes: unknown, but may be viral, bacterial, fungal such as candida or genetic, auto-immune disorder

Signs/Symptoms: joints become inflamed, stiff and rigid and often calcification occurs at the articular surfaces: may affect breathing if between the ribs and spine; postural deformities often result (flexion)

Indications: Massage is OK when inflammation subacute.

Contraindications: Use caution when working around inflammation -inflammation may be in other areas. Refer to appropriate health care provider.  Acupuncture may relieve pain.


Definition:  Emotionally erratic or unusual behavior

Causes: Stress, food allergies, malfunction in brain chemistry, caffeine based stimulants (coffee, chocolate, sodas), blood sugar imbalances

Signs/Symptoms: panic attacks, heart palpitations, shortness of breath, chest pain, dizziness, nausea, hot flashes/chills, nightmares

Indications: Promote relaxation

Contraindications: For severe cases (dissociation, destructive behavior) have client consult a  psychologist or counselor, naturopath, acupuncturist or other health care provider.

A Meta-Analysis of Massage Therapy Research – Christopher A. Moyer, James Rounds, and James W. Hannum


Anorexia Nervosa Symptoms Reduced by Massage


Definition: inflammation of the mucosal lining of the  appendix usually followed by infection

Causes: obstruction of the appendix by fecal matter, inflammation, food , carcinoma, stenosis, or kinking of the organ

Structures Involved: mucosal lining

Signs/Symptoms: pain in lower right quadrant of abdomen, lack or loss of appetite, nausea, and vomiting.  Pain may intensify with sneezing, coughing or with movement

Indications: None

Contraindications: Refer to physician immediately if acute.  Refer to appropriate health care provider for treatment.


Definintion/Causes/ Symptoms: Inflammatory joint disease; approximately 25 different types
Most common:

Rheumatoid – chronic, systemic auto immune disease characterized by joint stiffness upon awakening that lasts longer than one hour, swelling in specific finger or wrist joints, movement sounds like crinkling cellophane; most painful and crippling; possible causes are nutritional deficiencies, stress, bacterial infection

Osteoarthritis – degenerative joint disease usually gradual in onset which may involve inflammation, enlargement of the joint and muscle contracture; cartilage deteriorates causing irregularities in the gliding surfaces of joints, usually affecting weight bearing joints; may be caused by previous injuries, loose joints, hormonal and nutritional deficiencies, poor diet, poor elimination

Infectious arthritis – caused by bacterial, viral or fungal infection.

Gout – high levels of uric acid crystals are deposited in the joint; usually the big toe causing swelling, redness heat and extreme pain; possibly caused by high intake of rich foods and alcohol

Indications: Massage Ok; work above area affected to increase circulation and assist in removing toxins; loosening muscles may be beneficial to osteoarthritis prevention and treatment

Contraindications: Avoid inflammation; Check medications; Steroid use may cause brittle bones and problems with internal organs. Refer to appropriate health care provider.


Definition : Muscular contraction of  the bronchial tubes of the lungs characterized by wheezing and breathing difficulty. The spasms are a result of chronic inflammation or hypersensitivity of the airways to certain stimuli such as an allergenic substance.

Causes: May be allergic reaction, may be due to lack of water, adrenal disorders, anxiety, exercise, low blood sugar, stress, possibly hereditary.

Signs/Symptoms: Bronchial tubes become filled with mucous, tightness in the chest, wheezing, coughing, difficulty exhaling, may be exercise induced

Indications:  May be induced by trigger points in the serratus posterior superior.  Also check scalenes, intercostals, serratus posterior inferior, diaphragm, psoas.  May be beneficial to open up the fascia of the thoracic region.  General relaxation for stress management.  Breathing exercises to activate nervous system.

Contraindications : Client may be taking steroids which may cause deterioration of internal organs and bones.  Refer to appropriate health care provider.


Definition:  Imperfect refractive powers of the eye in which refraction of several meridians of the eyeball is affected, usually due to a change in the curvature of the cornea and lens; images do not focus properly on the eye.

Indications:  Massage OK; refer to eye exercises and eye relaxation.

Contraindications: None; be alert for contact lenses. Refer to Bates Vision specialist.

Athlete’s Foot

Definition:  Fungal infection of the foot

Causes: Warmth and dampness of the feet; destruction of beneficial bacteria in the body may add to spread (antibiotic use)

Symptoms:  Inflammation, burning, itching, scaling, cracking, blisters

Indications:  Tea tree oil may help.

Contraindications:  May be contagious if the right environment exists:  Avoid inflammation.  Refer to appropriate health care provider.


Definition:  Hardening of the arteries due to build up of calcium (arteriosclerosis) or fatty substances (atherosclerosis); circulation becomes impaired causing high blood pressure, chest pain, heart attack, stroke

Causes:  Smoking, hypertension, diabetes, high cholesterol, genetics, lack of exercise, poor diet of fatty foods, obesity, stress:  The arteries are damaged by free radicals and the constant constriction that smoking causes.  The fatty substances are deposited in damaged areas, causing constriction.

Signs/Symptoms: may be in legs – aching muscles, fatigue, numbness, heavy feeling in legs, high blood pressure, aneurysms, thrombus, heart attack, arrhythmia

Indications:  Massage may assist in making lifestyle changes, reducing stress, detoxification.

Contraindications: May be on anticoagulant medications which may cause bruising during treatment; refer to appropriate health care provider;  Can be Reversed through Diet Modification and Exercise. Refer to appropriate health care provider for lifestyle changes.  Physician monitoring is recommended.

Atopic Dermatitis

Definition: Inflammation of the skin: sometimes eczema is given this general title.

Causes: allergies( wheat, chemicals, dairy), poor diet ( too much sugar, white flour, fats, fried foods, processed foods), stress, chronic tension, toxic colon, hereditary

Signs/Symptoms: itching,  red skin, papules, vesicles, crust, scaling, flaking, thickening of skin usually behind the knees, elbows or on face

Indications: Poultices may be helpful ( chaparral, dandelion, yellow dock root).  Vitamin E in oil may be beneficial

Contraindications: Refer to appropriate health care provider.

Attention Deficit Disorder (ADD/ADHD)

Definition: disorder of the nervous system seen mostly in children but also in adults

Causes: heredity, prenatal problems, deprivation of oxygen at birth, chemical pollutants, heavy metal toxicity, artificial food additives in diet, allergies to foods such as dairy products or  wheat, blood sugar imbalances, lack of protein in diet, phosphates in sodas may cause hyperkinesis ( exaggerated muscle activity)

Signs/Symptoms:  Hyperactivity, learning disabilities, lack of concentration, difficulty solving problems, sleep disturbances, emotional instability

Indications:  Massage for stress reduction: grounding

Contraindications:  Ritalin may cause slow down in growth in bones and muscles of children: Refer to appropriate health care provider for nutritional and lifestyle changes.

Attention Deficit Hyperactivity Disorder

“Adolescents with ADHD displayed less anxiety, daydreaming behaviors, inappropriate emotions and hyperactivity, and their conduct improved after participating in Tai Chi classes.

Hernandez-Reif, M., Field, T., & Thimas, E. (2001). Attention deficit hyperactivity disorder: benefits from Tai Chi. Journal of Bodywork and Movement Therapies, 5, 120-123.

Adolescents with ADHD rated themselves as happier and were observed to fidget less after massage sessions. Also, teachers rated adolescents receiving massage as less hyperactive and as spending more time on-task.

Field, T., Quintino, O. & Hernandez-Reif, M., & Koslovsky, G. (1998). Adolescents with attention deficit hyperactivity disorder benefit from massage therapy. Adolescence, 33, 103-108.

The present study involved 30 children and adolescents between the ages of 7 and 18 diagnosed with attention-deficit/hyperactivity disorder (ADHD). The children were randomly assigned to a wait-list control and a massage group. Mood state improved for the massage but not the control group based on smiley face and thermometer scales. The massage group also improved in classroom behavior in the areas of the Conners Teacher Rating Scales on anxiety, daydreaming and hyperactivity.

Khilnani, S., Field, T., Hernandez-Reif, M., & Schanberg, S. (2003). Massage therapy improves mood and behavior of students with attention-deficit/hyperactivity disorder. Adolescence, 38, 623-38.”

Nutritional Considerations for Attention Deficit/Hyperactivity Disorder David Seaman, MS, DC, DACBN


Definition: Mental, physical, neurological disorder in which children withdraw from life

Causes: viruses, vaccines, food allergies (wheat, dairy), brain injury, candida overgrowth

Signs/Symptoms: socially withdrawn, unable to communicate, lack of feeling or awareness, hyperactive, low blood sugar, digestive disorders ( celiacs disease, crohn’s, ulcerative colitis, anemia), malabsorption

Indications: Massage for stress reduction, release spastic muscles

Contraindications: Caution May lack feeling or awareness so begin lightly and work gradually deeper.


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