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Endangerment Sites: Examining fact and myth
Everyone has learned about endangerment sites, right? These are areas containing structures that lie near the body’s surface and, because of their location, heavy and/or sustained downward pressure is avoided.
Well, this idea deserves a little examination…
I’m in the process of working on my next book. I’m a big believer in an extensive review process because “two heads are better than one.” This book project has over 90 reviewers (so far). I also insist on scholarly reviewers, so the cardiovascular chapter was reviewed by a cardiologist (who also happens to gets weekly massages).
Her comment about endangerment sites was “With the exception of the carotid artery, I don't think this and following arteries should be called something that invokes fear. Unless one puts sustained, unrelenting pressure on these arteries for more than several minutes, no damage will result. As an example, you can massage my temples for 10 minutes and I'll roll over like a dog and kick my legs. You're not consistently occluding the artery for those 10 minutes.”
When she read about avoiding sustained pressure on the abdominal aorta while address for the psoas through the abdominal wall, she writes “Unless there is an abdominal aortic aneurysm, not a problem.”
Is what we know about endangerment sites fact or myth?
What does the research say?
Share your thoughts…..Views: 3480
Replies to This Discussion
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Permalink Reply by Carl W. Brown on
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Talk to your cardiologist because I think that sustained unrelenting pressure also applies to the carotid artery as well even though the time where permanate dammage will occur is less.. Also becasue to the circle of willis crossover the blockage would have to be bilateral. This assumes a health person. If the circulation is compromised it may take less to cause real dammage.
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Permalink Reply by Jody C. Hutchinson on
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Susan,
Great that you're putting this out for comments. I'd like to chime in on a couple of endangerment sites (es).
The psoas not only has the aorta, but many nerve and other circulatory structures near it-saw this at Body World a few years ago. I'm still on the fence about palpating the psoas, especially after talking to the head of Orthopedic at Stanford, Calif, who says it's more the iliacus that we feel. I remember many years ago in one of the St. John NMT classes I attended. One of the TAs pushed so hard into my psoas that I fainted. hmmm.
Another one is the posterior knee. James Waslaski teaches that it's fine to work there. I've had luck with working the plantaris and popliteus muscles. So- not big deal here. Hope this helps.
In health,
Jody
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Permalink Reply by Allan J Jones on
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Common peroneal Nv at the fibular head ! No myth....dropsy.
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As regards abdo aorta....if you can feel it pulsing you shouldnt be compressing it !!!
Psoas can be accessed beside the artery. T12 - L5 attachments should be the target....not the muscle belly.
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Permalink Reply by Susan G. Salvo on
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Thanks Carl, Jody, Allan, and Rick.
What about other areas such as the axilla and popliteal space?
What do you think about those as endangerment sites?
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Rick Morgan said:Carotid artery endangerment is also about vagal stimulation as well as the risk of helping dislodge clots. The carotid has baro-receptors that when massaged trick the brain into thinking the Blood Pressure is too high and the vagus nerve is stimulated resulting in decreased HR and force of contraction which can lead to a severe drop in BP. This is an intervention that medical professionals use to help with tachycardia. Also not good if people have underlying arrhythmia issues. The carotid is also very susceptible to plaque buildup and pressure or striping of the artery can dislodge an emboli.
I don't know of any reason for striping of anything even in healthty people. However when people have specific health issues special precautions are needed. I was speaking of healthy people only.
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Jody C. Hutchinson said:One of the TAs pushed so hard into my psoas that I fainted. hmmm.
It is rare that I work the psoas through the adominal wall. Instead with the person prone I place on hand on the back at the origin and the other hand on the inside of the thigh and pull the leg lateraly rotating it as I strech the muscle. At first I though it was crazy to work through the spine but when my hand were in place it felt right. Move your hand down the back to just above the plevis and also enguage the palm of your had to work iliacus to psoas adheasions. The psoas minor involves on hand on the back at the origin and the other pressing lightly at the insertion just above the plevis. Some times the psoas minor need work from the front. Raise the leg put mild pressure on the psoas minor at the insertion and low the leg slowly. Place one hand behind the back on one just below the ribs to free the origin from diaphram adheasions.
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Permalink Reply by Julie Onofrio on
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Tracy Walton once said in a class that most of what is taught in massage school has not been proven.
http://www.massagetherapyfoundation.org/pdf/Contraindications%20for...
Julie
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Thanks Julie,
With the huge interest in research that's going on in our profession right now, I keep thinking about the story by Hans Christian Andersen entitled “The Emperor's New Clothes.”
When in massage school, I was not taught about endangerment sites. I added them in the second edition of my first book because it was on the NCE exam. Thought it would better prepare students if they took the exam.
Now, as revise my textbooks, I run across these concepts and find myself saying “Now wait a minute… What is this really about?”
Research, along with the Internet, is having a huge influence on the advancement of our profession.
The fact that you and I can share ideas with thousands of others quickly is amazing. Truly amazing.
Thanks again.
PS – Ironically, I just signed up for class Ms Walton is teaching.
PSS – When I wrote my pathology book (2009 pub date), all suggested modifications are based on infection control, standard precautions, and anatomic and physiologic facts, knowledge of signs, symptoms, and disease complications. It was reviewed by numerous medical physicians and clinicians to be sure the data was accurate and reasonable. I noticed your article has a 2003 pub date, which means that we have made huge strides in 5 years. I also noticed the author of the article you mentioned, Batavia (who is a PT). He was invited to be a reviewer of the patho book. He declined because he was too busy on other projects. Just thought you’d like to know.
Julie Onofrio said:Tracy Walton once said in a class that most of what is taught in massage school has not been proven.
http://www.massagetherapyfoundation.org/pdf/Contraindications%20for...
Julie
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Permalink Reply by Robin Byler Thomas on
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Hi Susan,
I'm enjoying catching up on everyone's comments and always like to hear what you're thinking about and working on. I just read the attachment Julie posted, by Batavia, who brought up a point about relative vs absolute contraindications. As as become experienced MTs we realize most are relative, but for a student or someone just starting out......
Information is changing and disseminates quickly, as you said. I'm learning to preface my research with "to the best of my knowledge." We do the best with what we know at the time (in practice and in research), and as long as we're willing to hear what others have experienced (which might be something we hadn't considered) our intentions are good. Intention is what I remember emphasized in school. Intention was used recently in the MTBOK to decribe our work to the public.
We all know research isn't the "end all be all" for massage therapy, either. It is, however, one way to answer questions, evolve our field, and gain respect from the public. Practicing ethically, improving curriculum, writing and publizing, addressing policy, lobbying for insurance reimbursement, and applying public health applications to the disadvantaged are other ways we gain positive support and promote our industry.
Whew... can you tell I haven't posted for some time?
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Hey Robin,
Nice to hear from you again.
I agree with you about students and newbies just starting out and how the think about and screening clients for contraindications. I hope schools are spending more time on treatment planning, clinical reasoning, pathologies, medications, and discussing case studies. Student clinics are also great ways to get these guys to hone their skills before graduation.
I ended up just mentioning endangerment sites, primarily arterial sites and reduced it about 3, then presented very specific reasons WHY deep prolonged pressure over these sites may harm the client. Most reasons had to do with undiagnosed pathologies.
Many folks I spoke with preferred the term “cautionary sites” over endangerment sites (which I have grown to like). Even with previously taught structures such as the styloid process of the temporal bone prone to injury from massage, there are no reported instances.
To quote you “We do the best with what we know at the time...”
Thanks for sharing your thoughts.
Robin Byler Thomas said:Hi Susan,
I'm enjoying catching up on everyone's comments and always like to hear what you're thinking about and working on. I just read the attachment Julie posted, by Batavia, who brought up a point about relative vs absolute contraindications. As as become experienced MTs we realize most are relative, but for a student or someone just starting out......
Information is changing and disseminates quickly, as you said. I'm learning to preface my research with "to the best of my knowledge." We do the best with what we know at the time (in practice and in research), and as long as we're willing to hear what others have experienced (which might be something we hadn't considered) our intentions are good. Intention is what I remember emphasized in school. Intention was used recently in the MTBOK to decribe our work to the public.
We all know research isn't the "end all be all" for massage therapy, either. It is, however, one way to answer questions, evolve our field, and gain respect from the public. Practicing ethically, improving curriculum, writing and publizing, addressing policy, lobbying for insurance reimbursement, and applying public health applications to the disadvantaged are other ways we gain positive support and promote our industry.
Whew... can you tell I haven't posted for some time?
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