Theory Exam #4 Review
Medical massage, pathology, modifications, modalities and pharmacology. Study the reasoning behind each decision, not just a list of diagnoses.
50-question exam blueprint
20 · Conditions & pathology
Definition, common presentation and massage-relevant implications.
Definition, common presentation and massage-relevant implications.
12 · Modifications & red flags
Local vs general contraindications, stage of condition, positioning, pressure and referral.
Local vs general contraindications, stage of condition, positioning, pressure and referral.
8 · Techniques & modalities
Choosing or avoiding approaches based on tissue state and client presentation.
Choosing or avoiding approaches based on tissue state and client presentation.
10 · Pharmacology
ADME, routes, medication classes, side effects and massage modifications.
ADME, routes, medication classes, side effects and massage modifications.
The clinical reasoning rule
For every condition ask: What is it? What stage is it in? What does the client present with today? What are the red flags? What medications matter? Is massage appropriate? If yes, what changes in pressure, position, duration, area or technique?
Conditions you need to know
Fibromyalgia
Chronic widespread pain and sensitivity. Start conservatively and avoid provoking a flare.
Chronic widespread pain and sensitivity. Start conservatively and avoid provoking a flare.
Headaches & migraine
Differentiate muscular/tension patterns from migraine features and red-flag headache presentations.
Differentiate muscular/tension patterns from migraine features and red-flag headache presentations.
Strain
Muscle/tendon injury. Acute swelling and pain call for protection, not aggressive local work.
Muscle/tendon injury. Acute swelling and pain call for protection, not aggressive local work.
Spasm & cramp
Involuntary contraction. Recurrent unexplained cramping may reflect medication, hydration, electrolyte, vascular or neurologic issues.
Involuntary contraction. Recurrent unexplained cramping may reflect medication, hydration, electrolyte, vascular or neurologic issues.
Osteoarthritis
Degenerative joint disease. Modify around painful or acutely irritated joints.
Degenerative joint disease. Modify around painful or acutely irritated joints.
Tendinitis / tendinopathy
Acute inflammatory/reactive tissue and chronic degenerative tendon change aren't treated identically.
Acute inflammatory/reactive tissue and chronic degenerative tendon change aren't treated identically.
Plantar heel pain
Often worse with first steps after rest. Consider calf/foot contributors without irritating the painful attachment.
Often worse with first steps after rest. Consider calf/foot contributors without irritating the painful attachment.
Disc conditions & sciatica
Sciatica describes nerve-related symptoms. Progressive weakness, saddle anesthesia or bowel/bladder changes are urgent red flags.
Sciatica describes nerve-related symptoms. Progressive weakness, saddle anesthesia or bowel/bladder changes are urgent red flags.
Shin splints
Overuse-related lower-leg pain. Focal bony pain can suggest a stress injury requiring evaluation.
Overuse-related lower-leg pain. Focal bony pain can suggest a stress injury requiring evaluation.
Carpal tunnel syndrome
Median nerve compression at the wrist. Avoid pressure that increases paresthesia and consider the whole upper extremity.
Median nerve compression at the wrist. Avoid pressure that increases paresthesia and consider the whole upper extremity.
Thoracic outlet syndrome
Neurovascular compression between neck/chest and upper extremity. Vascular signs increase concern.
Neurovascular compression between neck/chest and upper extremity. Vascular signs increase concern.
Sinusitis
Inflamed sinus tissue may accompany infection or allergy. Fever/systemic illness changes whether massage is appropriate.
Inflamed sinus tissue may accompany infection or allergy. Fever/systemic illness changes whether massage is appropriate.
GERD
Reflux can make flat positioning and deep abdominal work uncomfortable, especially after meals.
Reflux can make flat positioning and deep abdominal work uncomfortable, especially after meals.
Peripheral neuropathy
Altered sensation makes client feedback less reliable. Be conservative with pressure and heat.
Altered sensation makes client feedback less reliable. Be conservative with pressure and heat.
Spondylosis
Degenerative spinal changes. Work for comfort/mobility without forcing painful end ranges.
Degenerative spinal changes. Work for comfort/mobility without forcing painful end ranges.
Joint replacement
Respect healing stage, surgical precautions, positioning restrictions and medical guidance.
Respect healing stage, surgical precautions, positioning restrictions and medical guidance.
Whiplash
Acute cervical injury may involve muscle, ligament, joint and neurologic symptoms. Early aggressive work is inappropriate.
Acute cervical injury may involve muscle, ligament, joint and neurologic symptoms. Early aggressive work is inappropriate.
Menopause
Hormonal transition may involve hot flashes, sleep changes and changing comfort needs. Massage is adapted to the person, not the label.
Hormonal transition may involve hot flashes, sleep changes and changing comfort needs. Massage is adapted to the person, not the label.
Joint disruption
Sprain, subluxation or dislocation requires respect for tissue healing and joint stability.
Sprain, subluxation or dislocation requires respect for tissue healing and joint stability.
Varicose veins
Avoid deep direct pressure over affected veins. New unilateral heat/swelling/pain raises DVT concern.
Avoid deep direct pressure over affected veins. New unilateral heat/swelling/pain raises DVT concern.
Raynaud syndrome
Vasospasm and color change in digits. Avoid cold exposure and extreme temperature shifts.
Vasospasm and color change in digits. Avoid cold exposure and extreme temperature shifts.
Hypertension
Controlled hypertension may tolerate massage. Symptoms suggesting hypertensive emergency require medical care.
Controlled hypertension may tolerate massage. Symptoms suggesting hypertensive emergency require medical care.
Postural deviations
Posture is an observation, not a diagnosis. Treat functional goals and relevant tissues rather than trying to force a person into an ideal shape.
Posture is an observation, not a diagnosis. Treat functional goals and relevant tissues rather than trying to force a person into an ideal shape.
Rheumatoid arthritis
Systemic autoimmune inflammatory disease. Avoid aggressive work over actively inflamed joints.
Systemic autoimmune inflammatory disease. Avoid aggressive work over actively inflamed joints.
Psoriasis
Inflammatory skin disease and not inherently contagious. Avoid irritated, cracked or painful lesions as needed.
Inflammatory skin disease and not inherently contagious. Avoid irritated, cracked or painful lesions as needed.
Multiple sclerosis
Neurologic condition with variable fatigue, weakness, sensory change and heat sensitivity. Adapt each session to current function.
Neurologic condition with variable fatigue, weakness, sensory change and heat sensitivity. Adapt each session to current function.
Bunions
Structural change at the first MTP joint. Massage can address comfort and surrounding tissues but doesn't mechanically correct the deformity.
Structural change at the first MTP joint. Massage can address comfort and surrounding tissues but doesn't mechanically correct the deformity.
Bursitis
Inflamed bursa. Avoid deep direct pressure over an acutely irritated bursa.
Inflamed bursa. Avoid deep direct pressure over an acutely irritated bursa.
TMJ dysfunction
Jaw pain/clicking/locking may involve masseter, temporalis and other structures. Stay within training and scope.
Jaw pain/clicking/locking may involve masseter, temporalis and other structures. Stay within training and scope.
Tennis & golfer's elbow
Lateral and medial epicondylar tendinopathy. Stage and irritability determine whether direct friction is appropriate.
Lateral and medial epicondylar tendinopathy. Stage and irritability determine whether direct friction is appropriate.
Modalities & modifications
Swedish / relaxation work
Useful when the goal is comfort, circulation, relaxation and tolerable movement without provoking irritated tissue.
Useful when the goal is comfort, circulation, relaxation and tolerable movement without provoking irritated tissue.
Deep tissue
Not automatically better. Avoid deep work over acute inflammation, vulnerable vessels, unstable injury, altered sensation or tissue with poor tolerance.
Not automatically better. Avoid deep work over acute inflammation, vulnerable vessels, unstable injury, altered sensation or tissue with poor tolerance.
Friction
May be selected for appropriate subacute/chronic soft-tissue problems. It isn't the choice for fresh inflammation, open tissue or suspected vascular pathology.
May be selected for appropriate subacute/chronic soft-tissue problems. It isn't the choice for fresh inflammation, open tissue or suspected vascular pathology.
Stretching / ROM
Stay within pain-free, stable ranges. Avoid forcing unstable, acutely injured, hypermobile or surgically restricted joints.
Stay within pain-free, stable ranges. Avoid forcing unstable, acutely injured, hypermobile or surgically restricted joints.
Heat
Can support comfort but requires caution with impaired sensation, acute inflammation, vascular compromise and medication patches.
Can support comfort but requires caution with impaired sensation, acute inflammation, vascular compromise and medication patches.
Cold
May be poorly tolerated with Raynaud syndrome and other cold-sensitive presentations.
May be poorly tolerated with Raynaud syndrome and other cold-sensitive presentations.
Positioning
Bolster and reposition for pregnancy, reflux, respiratory comfort, joint limitations, pain and neurologic symptoms.
Bolster and reposition for pregnancy, reflux, respiratory comfort, joint limitations, pain and neurologic symptoms.
Duration
Shorter sessions can be appropriate with fatigue, systemic illness recovery, fibromyalgia, older/frail clients or medication-related tolerance issues.
Shorter sessions can be appropriate with fatigue, systemic illness recovery, fibromyalgia, older/frail clients or medication-related tolerance issues.
Red flags you shouldn't massage through
New unilateral calf swelling/warmth/pain; chest pain or unexplained shortness of breath; new significant neurologic deficit; saddle anesthesia or bowel/bladder change; suspected fracture/dislocation; fever with acute systemic illness; rapidly worsening unexplained symptoms; uncontrolled bleeding; severe sudden headache or other emergency presentation. Recognize the concern, stay within scope and refer appropriately.
Pharmacology
ADME
Absorption, distribution, metabolism and excretion.
Absorption, distribution, metabolism and excretion.
Routes
IV reaches circulation directly. Oral medication is affected by absorption and first-pass metabolism. Topical/transdermal drugs create local treatment considerations.
IV reaches circulation directly. Oral medication is affected by absorption and first-pass metabolism. Topical/transdermal drugs create local treatment considerations.
Anticoagulants
Bruising/bleeding risk can require lighter pressure and extra caution.
Bruising/bleeding risk can require lighter pressure and extra caution.
NSAIDs
Reduce pain/inflammation and may mask how irritated tissue actually is.
Reduce pain/inflammation and may mask how irritated tissue actually is.
Opioids
Sedation, dizziness and altered pain perception affect pressure and transfer safety.
Sedation, dizziness and altered pain perception affect pressure and transfer safety.
Muscle relaxants
Drowsiness, dizziness and reduced protective feedback may change treatment.
Drowsiness, dizziness and reduced protective feedback may change treatment.
Beta blockers / antihypertensives
Can lower heart rate or blood pressure. Change positions gradually if the client is prone to dizziness.
Can lower heart rate or blood pressure. Change positions gradually if the client is prone to dizziness.
Diuretics
Fluid/electrolyte changes can contribute to dizziness or cramping in some clients.
Fluid/electrolyte changes can contribute to dizziness or cramping in some clients.
Corticosteroids
Long-term/systemic use can affect tissue integrity, inflammation and immune response.
Long-term/systemic use can affect tissue integrity, inflammation and immune response.
Transdermal medication
Don't massage directly over a patch or apply heat unless specifically known to be safe.
Don't massage directly over a patch or apply heat unless specifically known to be safe.
Practice reasoning
A client taking an anticoagulant wants very deep work because they “never bruise.” What matters?
The medication still increases bleeding/bruising concern. Modify pressure based on risk rather than assuming past experience guarantees safety.
A client with diabetes has numb feet and asks for hot stones on them. Best reasoning?
Impaired sensation makes heat feedback unreliable. Avoid unsafe heat and use conservative pressure while monitoring tissue.
A client with chronic tendinopathy has no heat/swelling and tolerates focused work. Is friction automatically contraindicated?
No. Appropriately dosed friction may be considered for selected subacute/chronic tissue, unlike fresh acute inflammation.
A client with RA has a visibly hot, swollen wrist during a flare.
Avoid aggressive local massage and joint stress over the actively inflamed area. Adapt the rest of the session to current symptoms.
A client reports new calf swelling, warmth and pain after a long flight.
Don't massage the calf. The presentation raises concern for DVT and needs prompt medical evaluation.
Why isn't memorizing “massage is good/bad for condition X” enough?
Massage decisions depend on stage, current presentation, red flags, medications, tissue tolerance and the technique being considered.