|Occipital Foramen Magnum||Base of skull superior to 1st cervical vertebra
greater occipital nerve, suboccipital nerve, cranial nerves II (optic) III (oculomotor) IV trochlear
|Do not work the occipital area during passive extension.
Static pressure ok in lengthened position
|Trigeminal Nerve (V Cranial)||TMJ||pressure on nerve may cause Trigeminal neuralgia or tic de la ru with nerve inflammation.
Caution when working with jaw open.
|Brachial Plexus||-above lateral clavicle
-posterior triangle of neck
-insertion of deltoid, pec Major and biceps
-medial upper arm between the biceps and triceps
|Impingement can cause pain/tingling down arm/hand|
|Axillary Nerve||-deep inside arm on the humerus|
|-lateral to biceps and triceps at the elbow||-accessed when elbow is bent. Work with the arm straight|
|Lumbar Plexus||-between the 12th rib and T12 along top edge of quadratus lumborum
-along the transverse processes of T12 and lumbars
|Vagus Nerve||-deep in abdomen||-deep psoas work is risky with people with high blood pressure as it may over stimulate the vagus nerve and cause sweating, nausea|
|Femoral Nerve||-anterior pelvis lateral to psoas
|-caution when doing iliacus work
follow the contour of the pelvis
|Common peroneal Nerve
Common popliteal Nerve
|-back of knee
-tendon flattens when knee is straight
|-hamstring work done with knee bent|
|Veins and Arteries|
External Jugular Vein
|medial to SCM in anterior triangle||pressure may cause dizziness or blackouts|
|Subclavian Artery/Vein||behind clavicle in the hollow under the clavicle between the Pec Major and deltoid|
|Aorta||lateral to navel||-move off if you feel pulse
– may cause blackouts
|Cephalic Vein||anterior to deltoid, medial to triceps, lateral to pectoralis||can be impinged to the humerus|
|Basilic Vein||upper arm||can be trapped between the biceps and triceps|
|Heart||heavy compression on sternum is contraindicated|
|Liver||below rib cage extending from the right side to the left of center||press liver down as you press under ribcage to work diaphragm|
|Spleen||left abdominal region behind stomach||feels mushy|
|Kidneys||protected by lower rib cage between T10 and T12 on both sides||No compression or vibration over kidneys on back.
No high psoas work through abdomen
|Lymphatic Structures||many locations: cervical area, axillary, abdomen, femoral triangle, popliteal area||avoid|
|Eyes||do not apply pressure on eyeballs:
retinal detachment indicated by flashes of light or color
ELAP recommendation: Having completed 15.5 hours of instruction on massage cautions and contraindications, the learner is expected to:
• Demonstrate knowledge of the terms and concepts related to massage cautions and contraindications including endangerment areas, medications and side effects, and contraindications on a written examination.
• Demonstrate the use of a clinical reasoning process to identify contraindications, an understanding of when there is a need for increased therapist caution, and the capacity to choose appropriate adaptive measures for session planning on a written examination.
• Demonstrate the integration of knowledge and skills from other topics with this topic including the use of health intake forms, pathology reference books, drug reference books, and research literacy when determining if conditions are contraindicated or require caution, a physician’s release, or adaptations on a graded assignment.
• Correctly adapt massage strokes and techniques in endangerment areas or based on client feedback on a practical evaluation.
• Obtain training and certification from the American Red Cross in adult first aid, cardiopulmonary resuscitation (CPR), and use of an automated external defibrillator (AED).
Sandy Fritz, Owner of Health Enrichment Center School of Massage, Author of Fundamentals of Therapeutic Massage.”Generally massage is safe especially if it is provided by a massage therapist that has been trained in making good decisions about massage therapy so in order for us to really understand indications and contraindications then we’ve got to look at what the massage therapy practice kind of entails and how we think about each session we provide for a client. If we’re going to determine contraindications then we’ve got to have a working knowledge and know how to find information related to pathology so that we can use that information as we’re developing a care plan for each client”