hello massage nurse today i'm going to be doing part one of um pathologies of
the skeletal system i'll do part two in a couple of days and before i start i just want
to remind you guys that anytime there's acute inflammation to any of the body parts from your
client that that is a contraindication that you stay away from it until the
inflammation has gone down you know they can apply eyes or follow their doctor recommendations
but you that is a contraindication so be very careful and if you uh you know if you can talk
to your client before they come in especially if it's a new client just to make sure that you know
about that pathology you remember google is your new mother you could just research it real quick
so with that being said uh adhesive capsulitis is the first one that i'll be talking to you
an adhesive capsulitis is also known as frozen shoulder you know all the tissue around there
gets really fixed around the glenohumeral joint and it's decreased range of motion so that usually
happens with prior injuries or arthritis or beside us or scapular injuries and they
come back to haunt you many years later it's common between the ages of 40 and 60
mainly for females so you want to make sure that the client is comfortable you working wait until
the inflammation goes down before you do any kind of range of motions especially so you you might
want to recommend mce which would be to move it you know the best thing to do is really to move it
to compress it you know and to elevate it you know to make sure that they rest it so one of the
things that i recommend for my clients to do is to put their arm against the wall and the shower
because they have the support of the wall and they can just walk up the wall supporting that arm and
take it as far as they can while it's being supportive you know because if the arm is just
loose for them to move it it's painful so remember all we can do is just make recommendations and
you all you you want to do a passive range of motion remember that passive means that the client
it's always referring to the client anatomical position or passive or active range of motion that
you're always talking about the client so passive means that the client is not doing the movement
you're doing the movement for them with their guidance make sure you don't go above their pain
tolerance and that you are maybe able to do some range of motion after you've you know released
some of the the muscles so um be very careful with this one because it is very painful so if
they want a full body massage and they're still very swollen you might want to stay away from that
shoulder until like i said until that inflammation has gone down so number two would be the baker's
cyst and this is an accumulation of the synovial fluid behind the knee it starts coming out and
again it's also uh one of the indications is people that have had prior knee injuries it's
uh called a popliteal cyst you can feel it it can be as big as you know is a as a small lime because
i have had clients with that you want to make sure that your client is comfortable and put a bolster
behind their knees especially when they are supine because you want to keep them comfortable
and i know that one of the the things that causes it is a meniscus tear semitendinosus
membranosis also pulling tightness of the the insertions of those muscles and um let me see what
else you want to avoid the area remember that the popliteal is behind the t the knee and your blood
vessels going through there so you don't want to put pressure you don't want to burst that bursa
and you want to just work the muscles around there the attachments around there keep the client um
keep the client comfortable so that would be the baker's cyst bursitis now bursitis is inflammation
of the bursa remember all synovial joints which are the uh musk the muscular the skeletal muscle
joints all of those have a bursa so when a lot of it has to do with repetitive motion
a lot of it has to do with the pressure that that the joints can handle and let me just
explain to you a little bit like what i uh explained to my students is like the joints are
made to handle so much weight correct so let's say you have a 200 pound man or woman and that
pressure they put one and a half times their body weight on those joints so it would be like 300
pounds on their joints for every pound that you uh that you have you put four pounds of pressure on
that the knee joint and six pounds of pressure on the hip joints because you have more muscles there
so let's say that you're 10 pounds overweight that's 40 more pounds of pressure on your knee
so the the weight also has to do with the joints and a lot of times why people get
bursitis you know inflammation usually that happens too with overuse and bursitis is named
different for the different locations like you have subscapular bursitis you have subacromial
uh olecranon uh infrapatellar depending on where the synovial joint is swollen that's how it's
going to be named you want to do passive range of motion with clients like that like i said
they don't do the moving you do the movement for them however you really have to be careful and
wait until the acute inflammation is down um if you want to work around these areas you want to
if there's no chronic or acute inflammation you want to keep that pain threshold like a three
on a scale from one to ten you want to keep it very minimal like at three you don't want to
go above that because they you know you could do more damage too so that would be bursitis
inflammation of the bursas dislocation and subluxations so dislocation is a temporary
temporary displayment of the bones so that means that it comes off there's no contact
like the glenohumeral joint like if it's dislocated there's no contact it comes
completely off uh some laxation would be like maybe it's dislocated from this side
but there's still some attachment on this side left a lot of these are due to trauma
or you know injuries or a blow this is common with sports uh their joint movement is contraindicated
so you do not want to do any passive range of motion or anything like that with uh dislocations
or subluxation subluxations you don't want to do any range of motion with with any client that you
um you have to wait until it is healed this is for a doctor to diagnose not for you so if they think
that they have it please refer them out and wait until they are completely healed
so now we move to fractures there's different types of fractures there's complete incomplete
open or closed and open it means that it it went through the skin closed means that the fracture
did not go through the skin uh complete is when the bone completely breaks and uh incomplete is
work you know like the green fractures where you just um it's just kind of splintered so
again you do not want to do any range of motion or any movement to anybody that has a fracture
you can give a massage you know up to the full body except eliminating or not working
the area that's in a cast you have to wait until they're off a cast and once they're off a cast and
completely healed then you really do want to go and work the muscles because they've been you know
traumatized and you want to get that blood flowing so that would be good to give a massage
after they've had fractures and after they've removed um you know there are cast if you do have
a client with a cast you want to make sure that you elevate it you know prop them up with pillows
whether it's their leg or their arm just prop it up with pillows hopefully above heart rate so it
doesn't hurt too much especially at the beginning you know and you want to again keep the massage
with a slow flow you don't want to increase too much blood flow to that area or near that area
because it will cause you know some pain so maybe just a very light relaxing massage to anybody
that has a fracture uh ganglion cyst is next and that's a a pouch filled with synovial fluid
i'm sure some of you have had this you know they're common in the hands like with hairdressers
or people that do a lot of movement you know even computer work it looks like a pea size or
it can be as big as you know as a nickel and it's really really hard and you touch it and it moves
moves around usually it can it can dissolve by itself however uh some people i know one of my
clients had to have surgery for it to remove it so um one of the things that you know that you want
to do is keep the client comfortable you don't want to massage directly on it you might want to
massage you know around and um just keep the level again at a three four nothing more than that it is
common in the wrist the hands the ankles the knees um it is the cause is unknown but they
think that it has to do with repetitive motion uh so you you like i said you don't want to work
directly on the ganglion because you could burst it so stay away from that one and uh kyphosis
oh no i'm sorry i missed gout sorry let me go back gout is the type of arthritis are caused by
an elevation of uric acid this is usually common people that eat a lot of red meat or drink beer
you know the uric acid levels go out go up and up it's very painful usually happens
on the toe on the big toe and it gets inflamed and red so you don't want to work on that because let
me tell you they can't even handle a sheet when they have a flare-up of gout i had a client who
i care for deeply one time called me i gotta tell you this funny story call me up one time he says
he was very calm very very calm because oh i need to reschedule my appointment because you know i'm
having a a heart attack and that's what i heard i said i heard heart attack and he sounded so calm
so i'm just gonna stay home and i'll give you a call in a couple of weeks and here i am freaking
i was like what he's having a heart attack and he sounds so calm and he's he's not going to the
doctor or anything because he says oh i know what to do and then i called him up and he goes no i'm
having a gout gout attack not a heart attack so anyway i just you know we still laugh about that
sometimes that be careful what you hear because that really stressed me out that he was having
a heart attack so gavin attack is swelling of the big toe it's the buildup of the uric acid in the
joint you want to make sure you keep your client comfortable especially when they're prone you want
to put a bolster by their ankles so that their big toe does not touch the table because like i said
sometimes they can't even handle the the sheets so it usually affects the metatarsal phalangeal joint
so it's it's you know there's nothing really much you can do until the inflammation has gone down
you know maybe to massage it gently but again if it's acute inflammation you stay off of it
so next will be the kyphosis and that's a curvature of the uh of the thoracic spine
and that's the the hunchback you know the hunch back up here that's getting to be more common
now with people that are always looking down which i've had this beef for the longest time
with students when they i would see like some of my kids and grandkids when they were going
to school carrying those big backpacks and the weight wasn't not evenly distributed
between the shoulders so they would hunch you know they would carry it with the shoulders
so this gives you kyphosis which is um you know it can start being painful as you get older and
so it's caused by bad posture and by injuries previous injuries to the you know to the cervicals
or the thoracic um spine so you want to make sure that if you have a client that has severe
you know kyphosis that you prop them up with pillows because it is painful they might not be
able to lay on their back they might be able to go you know sideways you know sideline positions so
this is more common seen in the elderly however i'm serious i'm seeing it more
now with younger people you know always looking down you know the uh the person start you know
putting pressure against the vertebrae from you the pressure looking up so make sure that you
remind your clients you know to keep you know their face like their computer ergonomics is so
important guys the way they have their computer set up their screen right in front of them
you know i'll go into this real quick is that your head approximately weighs around 10 pounds
however that's when the c1 and c2 are holding it up you know if you're straight your head
should be held up by the by the c1 and c2 the atlas and the axis which is the
number one and two of the uh cervical and however if you deviate even just a half an inch from that
you know where it's not c1 and c2 holding it up that if you deviate from that your head doubles
in weight so if it weighs 10 pounds now it becomes 20 pounds and it's being held up by the muscles
so that's why posture is so important you know when you're standing in anatomical position
you know your skeletal system will help you you know your posture will you know help you keep keep
your keep your uh muscles in the right place it'll hold you up but if you deviate from that then
it's the muscles that take over and that causes specifically one of the things that it may cause
will be the kyphosis where your you know your neck is jotting forward so now lower doses is something
similar to that but lower doses is in the lumbar lumbar spine your curvature is forward so your
hips are tilted forward so that your back your lumbar area is pushed back that's the one that
gives you a big booty you know the big booty where it's sticking out where you can almost put a plate
under you know the back of the the booty so it's usually it's a hurt you usually cause or may cause
herniated discs because your pelvis is so tilted forward rotate it forward that it sticks out your
your lumbar area it's common with women you know with pregnancy people that are very overweight
and their abdominals are weak this is why it's so important that when you go to the
you know work out that you work your internal and externals oblique that you know give you a natural
girdle in your abdomen your rectus abdominis and your transverse abdominis which is your deepest
of the abdominal walls so it's really mainly the external internal obliques so that will help you
from preventing the lower doses you know from that forward tilt of the pelvis so um again
if your client has a severe lumbar curvature you want to make sure that you position them
in a position that's comfortable for them they might not be able to lay supine for very long
you definitely have to have a pillow you know behind their knees and a lot of times the
bolsters not you know because i know my bolster is only like four inches so usually when they have
really uh severe lower doses i put a pillow which is a little bit higher you know it's about 18
inches you know i mean not 18 inches i'm sorry about eight inches high so no not 18 inches guys
so anyway uh just be sensitive to any of these you know like i said you can always talk on the phone
with your client before they come in find out any of these and uh that's it for part one we'll
tackle part two in a few days i hope you enjoyed this and until the next time create a great day
and let me know if you like this better or with a whiteboard leave me comments thank you you