Pathology for Massage Therapists

Pathology1(alphabetical by disease, syndrome or problem)


Disclaimer: This information is provided as reference material only. A massage therapist is not legally allowed to diagnose disease, but should be able to recognize various symptoms and determine when a client needs to be referred to another

Practitioner: It is also necessary to know about diseases that your clients may have so that you may develop a safe and appropriate treatment plan. Contact the referring physician with any questions. Discontinue treatment if you do not feel comfortable treating someone with any of the diseases, signs, or symptoms listed here. This information is provided to be used at your own risk. There may be other treatment guidelines. Keep searching until you find one that works for you and your client. The information here has been collected from a variety of sources and personal experience.

Pathology is the study of disease and disease processes. Health is more than just an absence of disease. It is a combination of mental, physical and spiritual functioning. The body has the amazing ability to adapt to the stress of living and maintain itself. It is influenced by genetics, lifestyle, diet, mental processes, spirituality and even past lives. Dysfunction occurs when the disease process is beginning. A person may not be really sick yet, but not be feeling well. A person may not be diagnosed with a disease until it has progressed beyond dysfunction. Disease occurs when the body can no longer adapt to a stress (mental, physical, emotional, spiritual). Diseases are usually diagnosed by signs (measurable changes) and symptoms (things that are felt by the client only).

Appropriate health care providers include Naturopaths, Acupuncturists, Hypnotherapists, Psychologists, Counselors, and Physicians. It is important to develop a good working relationship with all practitioners and keep them informed of any changes in your clients condition.

The links are provided as a resource to continue investigation into the disease or symptom. does not endorse products or sites nor do I have any association with the site or information provided.

Contraindications for Massage -When I first started massage in 1987, giving a massage to anyone with cancer in any shape or form was strictly contraindicated. Today, after much research and practice, cancer is no longer contraindicated. If it says somewhere that massage is contraindicated, do your research, talk to physicians, chiropractors, naturopaths, acupuncturists and massage clients safely.

Contraindications for Swedish Massage

Condition Symptoms Possible consequences Acceptable Interaction
Inflammatory Conditions -heat, redness, swelling, pain

-sprains, strains, bursitis, synovitis, tenosynovitis,

could aggravate and worsen condition RICE,
Sub-acute- general massage above area
chronic inflammation- direct massage may be ok.
Varicose Veins -veins that are enlarged and twisted due to damaged valves

-can be painful

-direct pressure can cause further damage

-deep draining stokes below varicosity is not advised as it may put more pressure on the valve

-spider veins ok

-work around vein or move it out of the way

-nutritional supplementation with Vit C and bioflavinoids recommended

blood Clots -inflammation of vein

-warmth, redness,

-found in elderly or after trauma

-may be discolored (reddish cyanotic hue)

-massage could dislodge and move clot possibly causing a heart attack or stroke Wait for medical clearance; blood thinner medications may be necessary
Cardiac conditions -severe high blood pressure that is unstable


-heart/body may not tolerate increase in circulation -work only when medicated or controlled by diet and stress reduction methods
Hemophilia – inability of the blood to coagulate

-abnormal tendency to bleed

-may cause swelling in joints

-usually medicated with cumaden or other blood thinners

-deep pressure may bruise or cause tissue damage

-light pressure until you find out what the client can tolerate
Diabetes -advanced cases: loss of feeling and circulation in extremities

-pitted edema: pressing into tissue leaving indentation that stays

may cause tissue damage -circulatory strokes may still be beneficial: proceed with caution
Pregnancy -reduced circulation in legs

-possible blood clots due to hormonal changes

-miscarriage Use Common Sense
Work with physician or midwife.
Local or systemic infections -fever

-inflamed lymph nodes

-some examples: chicken pox, measles, influenza, scarlet fever, nephritis, hepatitis

-massage may be too stressful on the body and the immune system -energy work
-physicians approval needed
Infectious Skin Diseases -bacterial infections (staph, impetigo, tuberculosis)

-viral infections (herpes simplex and zoster, warts, chicken pox,

-parasites (scabies, fleas, lice, ticks)

-Fungal Infections (athletes foot, ringworm, yeast infections)

-may spread disease to yourself and other clients -physician approval

Swedish Massage: General Areas of Endangerment

Area of concern Anatomy Notes
Temporal and forehead Temporal artery- lateral sides of cranium

Temporal branches of facial nerve

Opthalmic branch of trigeminal nerve

Temporomandibular joint (TMJ)
submandibular areas
-parotid gland on ramus of mandible on top of masseter

-facial nerve anterior and superior to parotid gland

-facial artery inferior to parotid gland

-styloid process of temporal bone posterior to mandible, anterior to mastoid process

-styloid process may break with excessive pressure

-opening the jaw exposes nerves more

-compressing or damaging the nerves can cause trigeminal neuralgia

Anterior triangle of Neck -SCM, mandible, trachea

-carotid artery

-internal jugular vein



-hyoid bone

-submandibular salivary glands

-pressure on carotid can slow heart rate or cut off blood supply to head causing dizziness or black out-vaso-vagul reactions
Posterior Triangle of Neck -SCM, clavicle, trapezius

-external jugular vein

-brachial plexus

-subclavian artery and vein

-pressure on brachial plexus can cause pain down arm and hand
Occipital area -occipital foramina

-greater occipital nerve (C2)

-suboccipital nerve (C1)

Digging too deep in the occipital area with the head in passive extension, can entrap the nerves there. Static pressure with caution is ok.
Delto-pectoral triangle -inferior fibers of anterior deltoid, clavicle, and superior fibers of the clavicular head of the Pec Major

-cephalic vein

-brachial plexus

-axillary artery and vein

Axillary region -anterior border: deltoid, biceps and Pec Major

-posterior border: deltoid, triceps, latissimus

-Axillary nerve, artery, vein, lymph nodes

-cephalic vein

-brachial plexus

-median nerve

-brachial artery

There are many very effective techniques for working the muscles of the pecs, subscapularis, through the armpit. Know what you are doing before proceeding.
Brachial region -superior border: inferior aspect of the biceps
inferior border: superior aspect of the triceps-Median nerve-Brachial Artery-Basilic, brachial and cephalic veins-radial nerve
Basilic Vein can be trapped medial to the humerus between the biceps and triceps.
Cephalic Vein can be pinned to the humerus just lateral to the biceps
Antecubital fossa- anterior elbow -distal to biceps brachii

-border: lateral common extensor tendon, medial- common flexor tendon

-median and radial nerve

-basilic vein

-brachial artery

Caution when using Cross fiber friction on the insertions of the biceps and brachialis in the shortened position as it may entrap the median nerve
Cubital notch-posterior elbow -posterior to medial epicondyle, anterior to olecranon

-ulnar nerve

“Funny bone”
cross fiber wok on the triceps insertion requires a lengthened position to protect ulnar nerve
Anterior surface of distal forearm and wrist -radial nerve and artery

-median nerve

-ulnar nerve and artery

Xiphoid process -xiphoid process -heavy direct pressure could break off bone
Abdominal Region -Liver, spleen, stomach, gall bladder, reproductive organs, intestines, colon

-abdominal aorta, vena cava

-vagus nerve

Visceral manipulation is an advanced technique that can be learned.
Deep pressure on the psoas may over stimulate the vagus nerve and cause symptoms such as sweating, nausea
Femoral Triangle -Sartorius, Inguinal ligament, adductor longus

-femoral nerve, artery and vein

-inguinal lymph nodes
-great saphenous vein

-area prone to herniation

-avoid pulse when palpating psoas tendon

Gluteal region -between sacrum and greater trochanter

-Sciatic nerve

When working the piriformis watch for referred pain
Posterior Knee -tibial and peroneal nerve (split off from sciatic nerve)

-Popliteal artery and vein


Related Products


Latest Posts

Most Commented