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A discussion about localized, medical, and absolute contraindications, and how to talk with your clients about them.

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Discussion Forum

Pityriasis rosea 2 Replies

Started by Olga Chwascinska. Last reply by Olga Chwascinska Jun 8, 2010.

Pulmonary Emboli (more than one clot in lungs)

Started by Lara Rininger May 25, 2010.

Leg clots

Started by Donna C. Agrinsonis, LMT May 25, 2010.

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Comment by Gabriele G. La Vone on October 2, 2009 at 9:00pm
Thanks, Susan for the helps to review this stuff periodically!
Comment by Susan G. Salvo on October 2, 2009 at 6:18am
Hey Don,

Here is the complete entry from my book. I can provide numerous references and the chapter was reviewed by several RNs and a cardiologist. Let me know what you think.

Inflammation of a vein with thrombus formation, restricting blood flow, is called thrombophlebitis. It can affect superficial or deep veins. Deep vein involvement may be referred to as deep vein thrombosis. Inflammation attracts platelets, where they aggregate to form a thrombus (often near a venous valve) (Figure 8-49). Phlebothrombosis is spontaneous thrombus formation in a vein that is not inflamed. In either case, when thrombi become dislodged, it is referred to as a thromboemboli. The most critical issue with a thromboemboli is the possibility of its lodging in a pulmonary artery, leading to pulmonary embolism, which is a life-threatening condition.
Etiology – Several factors predispose a person to venous thrombus formation. Venous stasis is the most common cause and is due to prolonged inactivity, such as from long periods of sitting (airplane or automobile travel, lengthy bed rest after surgery, paralysis) or standing (professions such as cosmetology or sales). Venous stasis can also be from restrictive clothing. The second cause is injury to venous wall by trauma (IV’s), chemicals (irritating IV solutions), and local or systemic inflammatory processes (Figure 8-50). Another cause is increased blood coagulability from inherited tendencies, dehydration, cancer treatments, pregnancy, and use of oral contraceptives or hormone replacement therapy.
Signs and Symptoms – Typical signs and symptoms are pain, swelling, heaviness, redness, and warmth in the affected area. There may be a positive Homan’s sign (pain in calf muscle when foot is dorsiflexed), a common but not always a reliable indicator of thrombophlebitis (Figure 8-51). Systemic signs include chills, fever, and fatigue. In deep vein thrombosis, the skin may appear discolored; in some persons, there are no symptoms.
Treatment – The affected area is immobilized to prevent thrombus from spreading and dislodging to become an embolus. Anticoagulants such as heparin and warfarin are prescribed to address clot formation. Antiembolic (support) stockings may be used in conjunction with anticoagulants. Antiinflammatories are needed to reduce inflammation. In some cases, the thrombus may be surgically removed (thrombectomy).
Massage Considerations – Local massage to the affected area is contraindicated until the risk of thrombus has been eliminated (physician determined) and the condition has resolved.
Comment by Don Solomon on October 1, 2009 at 8:54pm
I just read Susan G. Salvo Comment on August 5, 2009 at 3:32am "Deep vein thrombosis is essential thrombophlebitis of deep veins. Just avoid the affected area or use only gentle pressure applied centripetally (toward the heart)". I have to respectfully disagree with this position. DVT's are not essentially thrombophlebitis. They are instead a component of thrombophlebitis! They are a blood clot (or could be many little clots) that can break off and lodge in the lungs (Pulmanary Embolism (PE)) or can travel to the brain (a stroke). Make no mistake a DVT is a medical emergency and must be treated with respect. If there is a DVT in the lower extremity there is 3% chance of a PE killing the patient (1).
This condition MUST be evaluated further before you massage the area. Refer the person back to their primary care health provider to be evaluated immediatly.
If in doubt you could perform clinical prediction rules such as: The Scarvelis and Wells score (2)
The Scarvelis & Wells Score is a far more accurate way to quickly assess this condition than the old Physical examination tests: Holmans Sign and Pratt's sign (3)
1.Homans' sign: Dorsiflexion of foot elicits pain in posterior calf. However, it must be noted that it is of little diagnostic value and is theoretically dangerous because of the possibility of dislodgement of loose clot.
2.Pratt's sign: Squeezing of posterior calf elicits pain.

(1) Alexander G.G. Turpie, MD. "Deep Venous Thrombosis - The Merck's Manuals Online Medical Library
(2) Scarvelis D, Wells P (2006). "Diagnosis and treatment of deep-vein thrombosis". CMAJ 175 (9): 1087–92. PMID 17060659
(3) Wells PS, Owen C, Doucette S, Fergusson D, Tran H (2006). "Does this patient have deep vein thrombosis?". JAMA 295 (2): 199–207. doi:10.1001/jama.295.2.199. PMID 16403932

Yours Don Solomon, RMT (Vancouver, BC Canada)
Comment by Denarah McHold, LMT on September 12, 2009 at 5:10pm
here's a goodie, but oldie. The first 48 hours of a cold or flu.

Today, my client and I decided to do a session even after she said she was getting a cold. I asked how long she had felt like she was "getting a cold," and she said yesterday, she woke up with a sore throat, but used positive thinking to kick it out, and it worked, but today her nose was runny.

I explained that massage increases circulation, and moves lymph through the lymph system faster, so the nodes have less time to process the lymph than it might normally, which can cause cold symptoms to be more severe, but may shorten the length of the cold. Since she was an MD, I didn't explain that the lymph nodes process the lymph, and filter and phagocytize "bad germs."
I told her the facts, and let her decide.
Later she told me she was moving to a different house, and the "cold" was probably just from all the dust she was stirring up and inhaling. :) guess we made the right choice.
Comment by Susan G. Salvo on September 6, 2009 at 8:38am

Help is only a keystroke away.
Comment by Denarah McHold, LMT on August 15, 2009 at 12:18pm
i don't know about cranial sacral work, but hope he is better. now i guess it has been just over three weeks. Anyone who does cranial sacral work want to comment?
Comment by noreen zakrajsek on August 8, 2009 at 12:42pm
My son had a concussion 8 days ago. When he fell he was out for about minute.
A cat scan and x x rays were taken. They came out all clear.
He is getting better daily but still shows signs of the accident.
Do you think I can do some cranio sacral work on him?
Thanks for your input.
Comment by Andrea McCully on August 4, 2009 at 10:21pm
My grandmother is 83 and has what I think I remember them saying was DVT. Also she is on Actonel for osteoporosis. Contraindications?
Comment by Jacob Kelly on August 3, 2009 at 1:05pm
Hello all. Peace from Colorado Springs!

This is in response to your comment/ question about your muscle spasm, Denarah.

I experience the symptoms of muscles tightening and going into spasm because of overuse -particularly hard workouts and such- quite often. My understanding is that even moderate strength training can be considered injury, as tissue rips (strains) and then regrows stronger, bigger and tighter in order to accomodate more strenuous activity. That is the point, to feel the burn, as it were. This is the pricipal of training the body so long as it is not overdone and enough recovery time is given.

I think that it comes down to a matter of pain tolerance, timing and preference. For example, if I get a massage one or two days after a strenuous yoga session (that's right, no oxymoron here! =)), I can barely stand moderate pressure to my quads and gluts, but if I wait just a couple of days, I can tolerate it much better. My body has already recovered. It is not that the massage works better for me, if I can only get in earlier than later, I will still "power through" some of the pain, but the results are relatively the same. My therapist helped squeeze out toxic by-product so that there is more room for optimally functioning, more fully nourished tissue to thrive.

From experience giving and receiving bodywork, I disagree that massage was contraindicated in your case. When I am in bad shape, or someone comes to see me who is really tight (in many cases due to acute injury) the only thing that really helps is to get the body to let down its guard is deep myofascial stretching (though the relaxation response is key to doing this comfortably) and bringing space fro all of the energies to flow and circulate -bad out, good in (so long as it is at least a week or so after the incident of injury, and depending on severity, of course, it may be longer -this is my guideline).

Thank you for this wonderful forum to investigate new ideas and ways of doing things. I look forward to more.


As far as considering what you were experiencing inflamation goes, technically it seems sound, but I really don't see it as a cntraindication for deep work.
Comment by Susan G. Salvo on July 31, 2009 at 11:07am
Another excellent textbook resource is Mosby’s Pathology for Massage Therapist, second edition (2009), written by Salvo (hey, that’s me) published by Elsevier. It covers over 360 pathologies and has over 750 illustrations and photographs.

If it’s a question I can answer, I’ll do what I can to help.

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