Anatomy, Physiology, and Contraindications Relevant to Massage
Domain 2 tests anatomy and physiology that a massage therapist actually uses: bony landmarks, muscle actions, tissue layers, circulation, and the contraindication decisions that follow from them.
Core rules and concepts
- Palpate landmarks rather than guessing: mastoid process, C7, scapular spine, iliac crest, and greater trochanter.
- Know fiber direction and action for major groups: trapezius, erector spinae, gluteals, hamstrings, quadriceps, and pectorals. Strokes follow fiber direction unless the goal is cross-fiber friction.
- Skin, superficial fascia, deep fascia, and muscle respond differently to pressure. Deep pressure is not automatically therapeutic.
- Blood flows toward the heart; lymph moves through superficial vessels and nodes. Massage supports relaxation and circulation but does not "flush toxins" or replace medical care.
- Absolute contraindications include fever, acute infection, suspected DVT or phlebitis, uncontrolled hypertension, hemorrhage, recent fracture, contagious skin disease, and intoxication. Local contraindications include open wounds, bruises, varicose veins, and undiagnosed lumps.
Worked example
A client reports a painful, warm, swollen calf after a long flight. Reasoning: unilateral swelling with warmth suggests deep vein thrombosis. Massage could dislodge a thrombus, so do not work the area; refer urgently for medical assessment and document the referral. This is an absolute contraindication, not a case for "light pressure."
Traps
Massaging directly over varicose veins, treating a febrile client because the request is only for relaxation, and repeating "detoxification" claims. Also remember that cancer is not an automatic whole-body contraindication, but it requires medical clearance and avoidance of the tumor site and affected lymph nodes.