Falcon Massage & Bodywork 321-952-6633 2174 Harris Ave Ste 4 Palm Bay,FL 321-952-6633 By Appointment

Medical Errors

Medical Errors 2CEU

 

This class is designed to help the massage therapist in the prevention of medical errors. To protect and best serve our clients, a thorough intake form listing medical history and current medications is absolutely essential. The focus of our attention should be on which medical conditions and current medications would cause massage therapy to be contraindicated or adjusted to correlate with the specific needs of the client at this time.

 

A contraindication is any condition where treatment could be harmful. Contraindications can be categorized in the following ways.

General- Do not perform any massage techniques.

Regional- Massage but avoid a particular area.

Conditional- Massage but carefully select the methods used, depth of pressure and duration of treatment.

 

While the following lists are fairly comprehensive, you may encounter conditions that fall into gray areas or that have mitigating circumstances. Please consult a qualified health care professional before you proceed with any uncertain treatment. Do no harm!

 

General Contraindications

 

Aneurisms deemed life threatening

Ascites

Atherosclerosis/Arteriosclerosis, severe

Bronchiectasis

Contagious or infectious disease/conditions

Diabetes Mellitus 1 or 2 with advanced heart or kidney disease or advanced vascular complications (atherosclerosis and/ or advanced hypertension)

Eclampsia/Toxemia in pregnancy

Ectopic Pregnancy

Emphysema, acute

Endocarditis/Pericarditis (infective and non-infective)

Fever

Heavy Intoxication- drugs and/or alcohol

Hemophilia or Hemorrhage (other than menses)

Hepatitis, chronic and active

Hypertension (high blood pressure), severe and unstable

Hypoxemia

Lung Abscess or Tumor

Organ failure, advanced

Pelvic Inflammatory Disease, acute

Pitting Edema- heart, kidney, cancer

Pneumonia, acute

Pregnancy, high risk or first trimester

Pulmonary Edema/Hypertension

Sepsis

Unstable Conditions: Post Cerebrovascular Accident or Post Myocardial Infarction

 

Regional Contraindications

 

Ankylosing Spondylitis, acute

Burns

Cancer (highly metastic) - May be an absolute contraindication to the whole body depending on the case

Causalgia, severe

Contagious or infectious conditions, local

Deep Vein Thrombosis

Goiter

Hypertension (no abdominal massage)

Inflammatory conditions of the skin

Lupus Erthematorus, acute

Neuritis, acute

Open wounds/Sores

Phlebitis

Psoriasis, acute

Raynaud's, acute (cold applications)

Reiter's Syndrome, acute

Rheumatoid Arthritis, acute

Thromboanglitis Obliterans (Buerger's Disease)

Trigeminal Neuralgia, acute

Ulcerative Colitis/Crohn's Disease, acute

Varicose Veins, severe

Venemous bites/stings

 

Conditional Contraindications

 

These conditions and/or pathologies are not contraindications but require treatment adaptation and/or medical consultation.

 

Aids

Amyotrophic Lateral Sclerosis (ALS)

Angina, chronic

Asthma

Atherosclerosis, diagnosed

Cancer

Cerebral Palsy

Congestive Heart Failure

Contusion

Diarrhea/Constipation

Diabetes Mellitus, moderate

Disk Herniation, acute

Diverticulitis

Drug Withdrawal

Emphysema, chronic

Endometriosis

Fracture (while casted)

Gestational Diabetes

Head Injury, recent

Hemiplegia

Hernia

Hypertension

Hypotension

Inflammatory conditions (acute/chronic)

Irritable Bowel Syndrome

Joint Instability

Joint Mobilizations (in pregnancy)

Kidney Disease, chronic

Major Surgery

Mastitis

Multiple Sclerosis

Osteomalacia

Osteoporosis

Paralysis, flaccid or paresis

Parkinson's

Patient is Immunosuppressed

Pelvic Inflammatory Disease, chronic

Pneumonia, chronic

Post-Cerebrovascular Accident or Myocardial Infarction

Radiation treatment site (several weeks post treatment)

Seizure disorders

Ulcerative Colitis/Crohn's Disease, chronic

 

Medical conditions are only part of the equation when it comes to avoiding medical errors. Medications are frequently the cause of many side effects and should carefully be considered when a client comes to us for treatment. The following list contains some common prescription and over the counter medications that we should be familiar with.

 

Abatacept- see Orencia

Acetaminophen- see Tylenol

Acyclovir- see Zovirax

Advil (Ibuprofen)

Uses: anti-inflammatory, analgesic, fever reducer

Side Effects: headache, ringing in the ears, upset stomach

Considerations: decreases pain perception (use caution with deep massage)

Aleve (Naproxen)

Uses: anti-inflammatory, analgesic, fever reducer

Side Effects: headache, ringing in the ears, upset stomach

Considerations: decreases pain perception (use caution with deep massage)

Allegra (fexofenadine Hydrochloride)

Uses: allergies

Side Effects: drowsiness, fatigue

Considerations: Do not position prone, help client on/off the table

Ambien (Zolpidemtartrate)

Uses: sedative

Side Effects: abdominal pain, dry mouth, nausea, vomiting

Considerations: ask about positioning. Use caution with deep massage

Amitriptyline Hydrochloride- see Apo-Amitriptyline

Anacin- see Tylenol

Anaprox- see aleve

Apo-ami Triptyline (amitriptyline Hydrochloride

Uses: depression

Side Effects: constipation, drowsiness, dry mouth

Considerations: help client on/off the table

Apokyn (apomorphine hydrochloride)

Uses: Parkinson's

Side Effects: drowsiness, flushing, nausea, vomiting, yawning

Considerations: help client on/off the table, use caution with deep massage

Aspirin- see astrin

Astrin (Aspirin)

Uses: analgesic, fever reducer

Side Effects: increased bruising, upset stomach

Considerations: decreases pain perception. use caution with deep massage

Atarax (Hydroxyzine Embonate)

Uses: promotes calmness, reduces nausea and vomiting

Considerations: use caution with deep massage

Ativan (Lorazepam)

Uses: anxiety, promotes calmness and sleep

Side Effects: drowsiness, dry mouth, restlessness

Considerations: use caution with deep massage

Avonex (Interferon Beta-1A, Recombinant)

Uses: MS

Side Effects: depression, flu-like symptoms, liver problems,

Considerations: do not massage day of or day after injection. never perform deep massage

Azulfidine (Sulfasalazine)

Uses: relieves G.I. tract inflammation

Side Effects: abdominal pain, depression, headache, nausea, vomiting

Considerations: alter positioning, use caution with deep massage

Baclofen- see lioresal

Benztropine Mesylate- see Cogentin

Betaseron (Interferon Beta-1B, Recombinant)

Uses: MS

Side Effects: anxiety, depression, dizziness, flu-like symptoms, hemorrhage

Considerations: do not massage day of or day after injection, help client on/off the table, never perform deep work

Carbidopa- see Sinemat

Celebrex ( Celecoxib)

Uses: osteoarthritis, rheumatoid arthritis

Side Effects: dizziness, upset stomach

Considerations: decreases pain perception, help client on/off the table, use caution with deep massage

Cogentin (Beztropine Mesylate)

Uses: increases physical mobility in Parkinson's patients

Side Effects: cardiac complications, confusion, constipation, dry mouth, incoherence

Compazine (Prochlorperazine)

Uses: anti-psychotic, reduces anxiety, relieves nausea

Side Effects: constipation, dry mouth

Comtan (Entacapone)

Uses: Parkinson's

Side Effects: abdominal pain, anxiety, constipation, depression, diarrhea

Coumadin (Warfarin Sulphate)

Uses: anti-coagulant

Side Effects: anorexia, cramps, headache, increased bruising, mouth sores

Considerations: never perform deep work

Cyclobenzaprine Hydrochloride- see Flexeril

Cymbalta (Duloxetine)

Uses: anti-depressant, treats anxiety disorders

Side Effects: constipation, dry mouth, dulled thinking, gas, mild nausea, slow reaction time

Depakote (Divalproex Sodium)

Uses: bipolar disorders, seizure disorders

Side Effects: drowsiness, nausea, vomiting

Considerations: create a plan for seizure, help client on/off the table. no percussive techniques

Diazepam- see Valium

Dihydroergotamine Mesylate- see Migranal

Doxepin Hydrochloride- see Sinequan

Ecotrin- see Astrin

Effexor (Veniafaxine Hydrochloride)

Uses: anti-depressant

Side Effects: agitation, constipation, increased blood pressure, nausea, weakness

Condiderations: use caution with stimulating techniques

Eletripton Hydrochloride- see Relpax

Empirin- see Astrin

Enbrel (Etanercept)

Uses: rheumatoid arthritis

Side Effects: abdominal pain, dizziness, headache

Considerations: elevate the head, help client on/off the table

Enfuvirtide- see Fuzean

Entacapone- see Comtan

Escitalopram oxalate- see Lexapro

Flexeril (Cyclobenzaprine Hydrochoride)

Uses: muscle relaxer

Side Effects: constipation, drowsiness, dry mouth, tachycardia

Considerations: help client on/off the table, use caution with deep massage

Fluoxatine Hydrochloride- see Prozac

Fuzeon (Enfuvirtide)

Uses: anti-viral

Side Effects: abdominal pain, bruising, constipation, depression, diarrhea, peripheral neuropathy

Considerations: deep tissue contraindicated

Gabapentin- see Neurontin

Gabitril (Tiagabine Hydrocloride)

Uses: prevents partial seizures

Side Effects: abdominal pain, dizziness, drowsiness, speech problems

Considerations: avoid prone position, help client on/off the table

Hydroxychloroquine Sulfate- see Plaquenil

Ibuprofen- see Advil

Imipramine Hydrochloride- see Totranil-PM

Imitrex (Sumatriptan Succinate)

Uses: anti-migraine

Side Effects: abdominal discomfort, cardiovascular abnormalities, drowsiness

Considerations: avoid prone position, help client on/off the table

Interferon Beta-1A, Recombinant- see Avonex

Interferon Beta-1B, Recombinant- see Betasaron

Lexapro (Escitalopram)

Uses: anxiety, depression

Side Effects: abdominal pain, abnormal dreams, cardiac complications, dizziness, gas, heartburn, indigestion, migraine

Consideration: do not let client fall asleep, help client on/off the table, position for comfort

Lioresal (Baclofen)

Uses: muscle relaxer

Side Effects: constipation, drowsiness

Considerations: deep tissue contraindicated

Lorazepam- see Ativan

Lyrica (Pregabali)

Uses: anti-convulsant

Side Effects: blurred vision, dizziness, drowsiness, easy bruising

Considerations: elevate the head, employ lighter work, help client on/off the table

Migranal (Dihydroargotamine Mesylate)

Uses: migraine and cluster headaches

Side Effects: abdominal pain, anxiety, nausea, sweating, vomiting

Motrin- see Advil

Naproxen- see Aleve

Neupro (Rotigotine)

Uses: Parkinson's

Side Effects: constipation, dry mouth, fatigue, joint pain

Considerations: do not massage around patch

Neurontin (Gabapentin)

Uses: anticonvulsant

Side Effects: amnesia, dizziness, dry mouth, nausea

Considerations: help client on/off the table

Orencia (Abatacept)

Uses: rheumatoid arthritis

Side Effects: dizziness, headache, mild pain at injection site

Considerations: use caution around injection site

Oxycontin (Oxycodone)

Uses: opoid analgesic

Side Effects: constipation, dry mouth, sedation, vomiting

Considerations: help client on/off the table, use caution with deep massage

Paxil (Paroxetine Hydrochloride)

Uses: antidepressant

Side Effects: abdominal pain, constipation, diarrhea, insomnia, nausea, sexual dysfunction

Plaquenil (Hydroxychloraquine Sulfate)

Uses: reduces inflammation

Side Effects: abdominal cramps, anorexia, fatigue, irritability

Prozac (Fluoxetine Hydrochloride)

Uses: antidepressant

Side Effects: abdominal pain, constipation, diarrhea, insomnia, nausea

Considerations: help client on/off the table

Relpax (Eletriptan Hydrobromide)

Uses: antimigraine

Side Effects: abdominal pain, dizziness, flushing, palpitations

Considerations: help client on/off the table

Requip (Ropinirole Hydrochloride)

Uses: Parkinson's

Side Effects: cardiac complications, difficulty breathing, fatigue, hallucinations, impotence, weakness

Considerations: help client on/off the table

Sertraline Hydrochloride- see Zoloft

Sinemet (Carbidopa)

Uses: Parkinson's

Side Effects: cardiac irregularities, constipation, dry mouth, involuntary grimacing

Sinequan (Doxepin Hydrochloride)

Uses: anxiety, depression

Side Effects: constipation, drowsiness, dry mouth, tachycardia

Considerations: help client on/off the table

Sonata (Zalepion)

Uses: sedation

Side Effects: abdominal pain, chest pain, dry mouth

Considerations: use caution with deep massage

Tofranil-PM (Imipramine Hydrochloride)

Uses: depression

Side Effects: cardiac complications, confusion, constipation, drowsiness, dry mouth

Considerations: help client on/off the table

Tramadol Hydrochloride- see Ultram

Tylenol (Acetaminophen)

Uses: mild analgesic, fever reducer

Side Effects: liver damage from prolonged use

Considerations: use caution with deep tissue

Ultram (Tramadol Hydrochloride)

Uses: analgesic

Side Effects: constipation, nausea, sedation

Considerations: help client on/off the table, use caution with deep tissue

Valium (Diazepam)

Uses: reduces muscle spasm, anxiety and seizure, promotes calmness

Side Effects: bradycardia, constipation, drowsiness, nausea, physical or psychological dependence, vomiting

Considerations: deep tissue contraindicated, help client on/off the table

Warfarin Sodium- see Coumadin

Zoloft (Sertraline Hydrochloride)

Uses: depression

Side Effects: abdominal pain, constipation, diarrhea, insomnia, nausea, sexual dysfunction

Zovirax (Acyclovir)

Uses: antiviral

Side Effects: headache, hypotension, nausea

Considerations: help client on/off the table

 

 

 

 

 

 

 

 

The following reference material was used in the making of this class.

Sandy Fritz

Mosby's Fundamentals of Therapeutic Massage Third Edition

Missouri 2004

 

Charlotte Michael Versagi

Massage & Bodywork Magazine July/August 2014

"Medications Matter: Know What Your Clients are Taking"

 

 

College of Massage Therapists of British Columbia contraindications to massage therapy April 2010

victoriamassagetherapy.ca