Pathology, Contraindications & Areas of Caution
Pathology
How disease is described
Pathology asks you to recognize conditions, not diagnose them. Know the difference between a sign (observed, e.g., redness) and a symptom (reported, e.g., pain). Conditions are described as acute (sudden, short) or chronic (long-standing), and as local or systemic.
Inflammation and healing
Acute inflammation shows five cardinal signs: heat, redness, swelling, pain, and loss of function. Healing proceeds through inflammation → proliferation (repair) → remodeling (maturation), and massage pressure is generally lighter during the earliest phase. Infection is caused by a pathogen and may produce fever; inflammation is the body's response and does not require a pathogen.
Conditions frequently tested
- Osteoarthritis: degenerative wear of cartilage, asymmetrical, worse with use; rheumatoid arthritis is an autoimmune, symmetrical, systemic disease with joint deformity.
- Strain = muscle or tendon; sprain = ligament.
- Tendinopathy/tendinitis, bursitis, contusion, fascial restriction, fibromyalgia (widespread pain, tender points, fatigue).
- Systemic disease - diabetes, hypertension, cancer, autoimmune disease - changes pressure, positioning, and whether you need medical clearance.
Traps
Questions swap strain and sprain, acute and chronic, or osteoarthritis and rheumatoid arthritis. Watch for "-itis" used loosely: not every painful tendon is inflamed.
Rule of thumb
Decode the suffix: -itis = inflammation, -algia = pain, -pathy = disease, -oma = tumor, -ectomy = removal. And remember: massage manages symptoms and function; it does not treat the disease.
Contraindications & Areas of Caution
Three categories
A general (absolute) contraindication means no massage at all today: fever, acute contagious illness, acute fracture or suspected fracture, deep vein thrombosis or thrombophlebitis, uncontrolled hypertension, severe bleeding disorders, recent heart attack, or any unstable medical emergency. A local contraindication means avoid that area and work elsewhere, ideally with the client's consent after explanation.
Common local contraindications
Open wounds, burns, recent bruises, localized infection, undiagnosed lumps, varicosities (do not compress), recent injections, skin rashes, and tumor sites without physician clearance. Acute injury in the first 24–72 hours is handled with caution and light pressure.
Areas of caution
- Anterior neck: carotid arteries, carotid sinus, trachea, and the vagus nerve - light pressure only, no deep work.
- Axilla: brachial plexus and vessels.
- Medial elbow: ulnar nerve.
- Popliteal fossa and femoral triangle: major vessels and nerves.
- Flank/kidney region, xiphoid process, floating ribs, anterior abdomen in pregnancy.
- Pacemaker site and any area with medical devices, implants, or ports.
- Neuropathy or circulation impairment: reduced sensation means heat and pressure can injure without the client noticing.
Traps
The exam frequently swaps local for absolute. A cold sore is a local contraindication, not a reason to cancel the whole session. Also remember: the presence of a disease does not automatically prohibit massage - the stage, severity, and stability do.
Rule of thumb
When in doubt, ask, document, and get written clearance - or work elsewhere and refer.