Key Topics: - Causes and transmission of disease - Common pathologies - Drugs and drug interactions - Working with particular populations - Tips for answering questions on pathology
Pathology is the study of the nature and cause of disease. The term pathology is also used to describe the manifestation of a condition or disease (e.g., the pathology of dermatitis). Pathology is an important topic for massage therapists due to your close proximity to clients during treatment. You should be able to recognize the signs and symptoms of various conditions and understand how these conditions impact your ability to treat (or avoid treating) clients. This is important for two reasons: (1) you should understand when massage is contraindicated due to the way treatment may affect and interact with a particular condition and (2) you can avoid the spread of disease by recognizing its presence and preventing further transmission. For examination study, at a minimum you should be able to do the following seven things: (1) discuss the causes of disease and common modes of disease transmission; (2) recognize and describe common pathologies; (3) distinguish conditions that indicate or contraindicate the performance of massage; (4) describe the healing process; (5) identify biological, psychological, and environmental factors that aggravate and alleviate disease; (6) classify drugs and recognize how they might interact with the massage process; and (7) discuss how to work with special populations. This guide highlights important information and gives you some practice questions in these areas. If you are having trouble understanding the information or answering the practice questions, take some time to review your textbooks and notes. The number of questions you will need to answer on pathology varies by exam. If you are taking the MBLEx, you will be required to answer a total of 125 questions; of these, about 13 percent, or around 16 questions, are on this topic. If you are taking the NCETMB, you will be required to answer a total of 160 questions; of these, about 13 percent, or around 21 questions, touch on this topic.
Causes and Transmission of Disease Disease is defined as a health condition that interferes with the body’s normal functioning. Disease is an abnormal state that prevents all or part of the body from functioning properly. Diseases can be recognized by their symptoms and signs. Symptoms are indicators of illness that are perceived by the sick individual; for example, typical symptoms might include pain, dizziness, itchiness, weakness, or nausea. Signs, on the other hand, are tangible indicators of a condition that can be observed by others. For example, typical signs might include an elevated pulse, high fever, or physical irregularities such as red patches, skin blisters, or lesions. Note: Chronic conditions such as Tay-Sachs disease and cystic fibrosis used to be referred to as genetic diseases. Now they are more appropriately referred to as genetic disorders.
Diseases can be acute or chronic. Acute conditions are characterized by a relatively rapid, severe onset of symptoms. Acute conditions, such as chicken pox or pneumonia, are usually short-lived and responsive to therapeutic treatment. Chronic conditions, on the other hand, are those that persist over a long period of time. Although their symptoms may be less severe than an acute phase of the same disease, chronic conditions can be progressive and degenerative, such as rheumatoid arthritis. Chronic conditions can sometimes result in complete or partial disability or even death. Disease can be caused by any number of conditions, such as exposure to viruses, bacteria, or fungi; trauma; environmental factors such as exposure to asbestos; personal issues such as chemical imbalances or high levels of stress; degenerative processes such as osteoporosis; and so on. In addition, other factors, such as genetics, age, and lifestyle, can predispose a person to certain conditions. Most diseases can be classified as infectious, non-infectious, or of unknown origin. Infectious diseases are caused by invading pathogens such as viruses or bacteria. Infectious disease can be transmitted from one person to another either directly or indirectly. Direct contact modes of transmission include touch or via water, food, air, saliva, or blood. Infectious disease can also be transmitted indirectly via vectors: animals that carry germs from one person to another, such as insects. Examples of infectious disease include influenza, impetigo, and malaria. Non-infectious or non-communicable diseases are not caused by pathogens and therefore cannot be passed from one person to another. Rather, non-infectious diseases are caused by any number of factors, such as the environment, nutritional deficiency, lifestyle, and/or genetics. Examples of non-infectious disease include asthma, heart disease, and cancer.
Exercises: Causes and Transmission of Disease Choose the option that best answers the question.1. One example of a chronic condition is (A) influenza. (B) bone fracture. (C) fibromyalgia. (D) heart attack. A chronic condition is one that persists over time, such as fibromyalgia, osteoporosis, diabetes, or epilepsy. In an acute condition, symptoms appear suddenly but will only persist for a relatively short period of time (acute conditions such as bone fractures and heart attacks will require medical intervention). The correct answer is (C).2. All of the following are symptoms of bursitis EXCEPT (A) tenderness. (B) stiffness. (C) inflammation/pain. (D) limited range of motion. Symptoms are subjective indicators of an illness or condition, such as tenderness, stiffness, and pain. Signs are more objective indicators of illness; a limited range of motion is a tangible indicator that a condition may exist. The correct answer is (D).
Common Pathologies Pathologies are best understood in the context of healthy body functioning. In other words, understanding how a body system is designed to function will help you to recognize what happens when functioning is impaired or less than optimal. For your examination, you may be asked to differentiate between normal functioning and functioning in the context of particular diseases or conditions. You may be asked to identify diseases and conditions based both on signs (what you see) and symptoms (what the client feels). You may be asked to indicate if treatment is contraindicated based on the signs, symptoms, or conditions presented. As a massage practitioner, it is your responsibility to know when it is or is not appropriate to treat clients. This part of the examination is meant to test your ability to make this call. In this section, we will review some common pathologies you may have to deal with in your practice. You should be able to recognize the signs of common conditions and know whether massage is indicated or contraindicated.
Note: In health care, an indication is a condition that makes a particular treatment or procedure advisable to pursue; likewise, a contraindication is a condition that makes a particular treatment or procedure inadvisable or unacceptable to pursue. Some contraindications are absolute—inadvisable under all circumstances—while others are relative, or acceptable only under certain circumstances. For massage practitioners, contraindications are conditions under which massage is inappropriate, either locally (on or near the affected body part) or in an absolute sense (the patient should not be treated at all). For example, massage is always contraindicated during an impetigo outbreak unless the lesions have completely healed.
Some contraindications apply only to the affected area, while others contraindicate any form of treatment. In addition, some contraindicated conditions may be treatable in consultation with the client’s physician.
Massage is generally contraindicated if the client presents with the following: - Acute infectious disease - High body temperature - Inflammation (tissue damage, bacterial infestation) - Intoxication - Osteoporosis - Skin problems - Varicose veins
The following lists of common conditions are not meant to be comprehensive. You should refer back to your school materials for more complete information.
Integumentary (Skin) Conditions Some of the most common pathologies you will work with include those related to the integumentary system, or the skin. For obvious reasons, massage is contraindicated for clients who present with various skin conditions. Infection can easily invade skin that is compromised (that is, if the client presents with open, broken, or scabbed skin), making massage a high-risk activity for the client. Other conditions, such as impetigo, have a high degree of contagion and can easily spread from the client to you to other clients.
Some of the common infectious skin conditions you should be able to identify and recognize how to deal with include: - Boils - Erysipelas (St. Anthony’s Fire) - Fungi (such as ringworm, athlete’s foot, jock itch) - Herpes simplex - Impetigo - Lice/mites - Warts
Some of the common non-infectious skin conditions you should be able to identify and recognize how to deal with: - Acne - Eczema - Hives - Moles - Psoriasis
You should also be able to recognize signs of skin cancer as you may get a closer look at some areas of the client’s skin than the client can (the back, for example). Finally, you should be able to recognize and handle clients who present with burns, open wounds, or ulcers (bedsores).
Musculoskeletal Conditions - Bone disorders, such as fractures, osteoporosis, or postural issues - Connective tissue disorders, such as bunions, bursitis, or cysts - Joint disorders, such as gout, arthritis, or sprains - Muscular disorders, such as fibromyalgia, myofascial pain syndrome, shin splints, or muscle cramps - Neuromuscular disorders, such as carpal tunnel syndrome or herniated discs
Nervous System Disorders - Alzheimer’s disease - Parkinson’s disease - Herpes zoster (shingles)
Circulatory Conditions - Pulmonary embolism - Heart conditions - Hemophilia - Hypertension - Thrombosis - Varicose veins
Lymph/Immune System Disorders - Chronic fatigue syndrome - Edema - Fever - HIV/AIDS - Inflammation - Lymphoma
Respiratory System Conditions - Infectious disorders such as bronchitis, common cold, influenza, or pneumonia - Obstructive pulmonary disease such as asthma or emphysema
Digestive System Conditions - Disorders of the large intestine such as appendicitis or irritable bowel syndrome - Disorders of the stomach/small intestine such as Crohn’s disease or ulcers - Other related disorders such as cirrhosis or hepatitis
Endocrine System Disorders - Diabetes - Hypoglycemia Urinary System Conditions - Bladder/urinary tract disorders such as urinary tract infections - Kidney disorders such as kidney stones Reproductive System Conditions - Breast cancer - Endometriosis - Pelvic inflammatory disease - Pregnancy Note: Getting ready for your licensing examination is a lengthy process. Occasionally you may find it difficult to maintain your motivation to study. One way to stay motivated is to remind yourself of the ultimate reward for your hard work—the ability to make a living from a discipline you love. You might also set up a reward system for yourself at each milestone in your study; for example, after you have mastered a particularly complex topic like pathology, you might reward yourself with a night out or the purchase of some item you really desire. In addition, keep reminding yourself of how much gratification and pride you will feel when you have successfully achieved your goal.
The Healing Process During the healing process, damaged tissue is repaired. The degree of repair and the length of time needed for the healing process to do its work vary greatly depending on the condition in question, the location on the body where the injury or condition occurred, and the severity level of the illness or injury. Healing involves a complex sequence of physiological events, starting with the restoration of damaged tissue at the cellular level. The body then goes through a series of phases, depending on the type and severity of the wound or condition. In general, conditions of the skin and surface tissue are more easily repaired by the body. Conditions impacting the bones and ligaments usually require a period of immobilization and a lengthier healing time. Conditions affecting muscles and tendons tend to take a significant amount of healing time and generally result in perceptible scarring and weakness. Trauma to the central nervous system is generally irreparable. For infectious diseases, the healing process cannot begin until the invading pathogens have been destroyed. For some conditions, friction massage and stretching of the tissue during the healing process can minimize or prevent the formation of scar tissue.
Aggravating and Alleviating Factors The healing process can be aggravated or alleviated by factors beyond the body’s physiological ability to repair itself. For example, biological factors such as a person’s weight, nutrition level, and the presence of secondary conditions such as hypertension or cardiovascular disease can impact the ability to heal. Behavioral factors have a definite impact and include activities such as tobacco use, level of exercise, dietary choices, alcohol consumption, and sexual practices. Psychological and environmental factors such as socioeconomic level, exposure to secondhand smoke, access to medical care, anxiety/depression level, ability to cope with stress, and the strength of the family system can all delay or facilitate the healing process.
Exercises: Common Pathologies Choose the option that best answers the question.1. Heat treatment during massage is contraindicated for which of the following conditions? (A) Myopia (B) Muscular dystrophy (C) Myofibrositis (D) Multiple sclerosis For clients with multiple sclerosis, massage is appropriate for stress and pain reduction as well as the maintenance of mobility. However, heat treatments should be avoided as it can trigger MS symptoms or cause symptoms to worsen. For the other conditions listed, heat treatments are not contraindicated. The correct answer is (D).2. During what stage of wound healing do fibroblasts start to enter the site of injury? (A) Inflammatory (B) Clotting cascade (C) Proliferative (D) Remodeling During the proliferative stage of wound healing, fibroblasts enter the area and carry out important functions such as producing collagen. The inflammatory phase (which includes the clotting cascade) helps close the wound and remove debris and bacteria. The remodeling phase follows the proliferative phase. The correct answer is (C).3. For which of the following conditions is massage absolutely contraindicated? (A) Irritable bowel syndrome (B) HIV (C) Deep vein thrombosis (D) Pancreatitis A person with deep vein thrombosis should not receive massage. The increase in blood flow associated with massage might cause a thrombus to detach from a vessel wall, resulting in an embolism. Individuals with irritable bowel syndrome, HIV (as long as the client’s overall health is good), and pancreatitis (as long as the condition has been treated by a physician) are all appropriate candidates for massage treatment. The correct answer is (C).4. Which of the following should be avoided when providing massage therapy to a client with scleroderma? (A) Warming massage (B) Cold therapy (C) Massage while sitting up (D) ROM exercises Cold therapy and the application of extreme heat should be avoided when treating an individual with scleroderma. The other treatment options listed may be beneficial or useful in treating the client. The correct answer is (B).
Drugs and Drug Interactions Massage therapy may be contraindicated when clients are taking certain substances due to potentially harmful interactions between the substance and the treatment. Your goal is always to administer safe and effective therapy to clients. This means you need to be aware of all the client’s medical conditions as well as any medications he or she is taking. One of the ways to determine if the client is taking contraindicated substances is to ask questions during the intake interview. Ask questions such as the following: What medical conditions do you have? What medications are you taking to treat this? When did you start the medication? What kind of side effects are you experiencing? The client’s answers can give you a fuller picture of his or her current state of health. Note: Make sure any client on antibiotics has been taking them for at least three full days before conducting treatment. Otherwise, the underlying bacterial infection may not yet be completely eradicated from the client’s system and the massage treatment may spread the infection through the bloodstream.
Recreational Drugs If a client is intoxicated from recreational drugs such as alcohol, marijuana, or other substances, massage is always contraindicated. Massage treatment can intensify the effect of recreational substances such as alcohol by increasing the amount of the substance in the bloodstream. In extreme cases, massage can overtax the liver.
Prescription and Over-the-Counter Medications Massage therapy is sometimes contraindicated when the client is using prescription or over-the-counter medications, because treatment can exaggerate the effects of certain medications. For example, if a prescription makes the client dizzy, drowsy, or lightheaded, massage can exacerbate that condition, leaving the client feeling in much worse shape than he or she was in before getting on the table. If a prescription is taken to relieve pain, massage can reinforce this effect, potentially causing serious problems for the client. In addition, the side effects of some medications can be more severe during their first few days of use.
Some medications to watch for include the following: - Antibiotics - Antidepressants - Cardiovascular drugs - Insulin - Pain medication (including over-the-counter)
Exercises: Drugs and Drug Interactions Choose the option that best answers the question.1. A client is currently taking painkillers for a medical condition. How should you alter treatment based on this information? (A) You should make the treatment more conservative. (B) You should avoid irritating the client by asking for feedback. (C) You should massage the tissues more aggressively. (D) You should ask the client to sit up during treatment. The biggest risk when treating a client on painkillers is overtreatment. Due to the effects of the drug, the client’s tissues will be less sensitive and he or she may not be able to provide you with accurate feedback. Thus, your work should err on the conservative side to avoid the adverse effects associated with overtreating an area. The correct answer is (A).2. You want to find more information about a specific drug. Which of the following references would be the BEST one to use? (A) A Web site such as Wikipedia (B) A drug reference book for physicians (C) A promotional pamphlet from a popular pharmaceutical company (D) A personal conversation with a current user of the drug When researching drugs, you should rely only on authoritative sources accepted by the medical community, such as drug reference books designed for physicians, pharmacists, and other health-care providers. The other sources listed may not provide accurate or sufficient information. The correct answer is (B).
Working with Particular Populations You may work with any number of populations over the course of your career. Some populations require specialized or specific treatment based on underlying conditions. It is important to utilize safe and appropriate accommodations and techniques for all clients.
For the examination, you should be able to identify accommodations you may need to make for various populations, including (but not limited to) the following: - Athletes (healthy and rehabilitating) - Children (infants and school-age) - Chronically ill - Developmentally disabled - Elderly - Mentally ill - Physically disabled - Pregnant women - Terminally ill
Exercises: Working with Particular Populations Choose the option that best answers the question.1. All of the following are contraindicated massage treatments for pregnant women EXCEPT (A) utilizing a prone position after the first trimester. (B) kneading on or near the abdominal area. (C) practicing heavy percussion movements. (D) placing pillows under the knees or head. Properly trained massage therapists should be able to conduct massage on clients undergoing a normal, non-problematic pregnancy. However, the client should never be placed in a prone (face down) position after the first trimester, you should not knead anywhere near the abdominal area, nor should you use heavy percussion or deep tissue movements. The correct answer is (D).2. All of the following are benefits of conducting massage treatment on the critically ill EXCEPT (A) reducing disorientation or confusion. (B) providing comfort and relaxation. (C) allowing the client to think the treatment is a cure. (D) controlling pain or easing physical discomfort. When working with the critically ill, your goal should be to provide a gentle, caring experience that helps to ease some of the issues the client is experiencing. However, you should never allow the client to think you are providing a cure to his or her condition. The correct answer is (C).
Tips for Answering Questions on Pathology - It’s ALL related. Anatomy, physiology, and pathology are intimately intertwined topic areas: anatomy defines the structures and systems of the body; physiology describes the body’s functioning; and pathology indicates when something has gone awry with a structure, system, or function. You will find it easiest to study each body system as an integrated whole; for example, describe the integumentary system, explain how it functions, then identify common pathologies that you may encounter. - Remember that massage exacerbates the effects of any substance. When considering the interaction between therapeutic massage and medication, remember that one of the benefits of massage is encouraging the movement of blood through the circulatory system. Thus, any substances in the client’s system will be pushed through the body, exacerbating their effects. - How would you feel? As you study appropriate treatments for a particular population, try to imagine yourself as a member of that population. Why might certain treatments be indicated or contraindicated, based on a client’s condition? For example, imagine you are an athlete rehabilitating from an ankle injury. What treatment approaches would or would not make sense, based on that condition? Visualizing how treatment would feel or be perceived by the client may help you to remember appropriate treatment protocol.
Join 4M+ learners. Unlock unlimited quizzes, wrong-answer tracking, flashcards + reminders, study guides, and 1-on-1 challenges.