mosby’s pathology lesson 5.1 objectives massage therapists · chapter 5 musculoskeletal...
TRANSCRIPT
Chapter 5Chapter 5
Musculoskeletal Musculoskeletal
PathologiesPathologies
Mosby’s PATHOLOGY
for Massage Therapists
Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.2
Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.2
Lesson 5.1 ObjectivesLesson 5.1 Objectives
�� Discuss anatomic structures and physiologic Discuss anatomic structures and physiologic
processes related to the musculoskeletal processes related to the musculoskeletal
system.system.
�� Define skeletal disorders and list appropriate Define skeletal disorders and list appropriate
massage considerations.massage considerations.
�� List risk factors for osteoporosis.List risk factors for osteoporosis.
�� Identify spinal deviations featured in this chapter Identify spinal deviations featured in this chapter
and list massage considerations.and list massage considerations.
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3
Musculoskeletal System OverviewMusculoskeletal System Overview
��Three types of muscle tissueThree types of muscle tissue
��Cardiac Cardiac •• found in the heart; involuntaryfound in the heart; involuntary
��SmoothSmooth•• found in walls of hollow structures (i.e., blood vessels, air found in walls of hollow structures (i.e., blood vessels, air passageways), and most passageways), and most abdominopelvicabdominopelvic organs; involuntaryorgans; involuntary
��SkeletalSkeletal•• move bone, skin, or other skeletal muscles; voluntarymove bone, skin, or other skeletal muscles; voluntary
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4
Skeletal MusclesSkeletal Muscles
From Herlihy B, Maebuis NK: The human body in health and illness, ed 3, Philadelphia, 2007, Saunders.
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5
Muscle StructureMuscle Structure� Skeletal muscle (cont'd.)
– Consists of individual muscle cells called muscle
fibers, which contain myofibrils
From Salvo S: From Salvo S: Massage therapy: principles and practice,Massage therapy: principles and practice, eded 3, St. Louis, 2007, Saunders.3, St. Louis, 2007, Saunders.
6Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
6
Muscular ContractionMuscular Contraction
�� Sliding filament theorySliding filament theory
�� Myosin pulls on Myosin pulls on actinactin
�� ActinActin shortens myofibrilsshortens myofibrils
�� Myofibrils shorten muscle fibersMyofibrils shorten muscle fibers
�� Muscle fibers shorten muscleMuscle fibers shorten muscle
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7
Muscle FunctionMuscle Function
�� Produces body movementsProduces body movements
�� Stabilizes body positionsStabilizes body positions
�� Stores and moves substances within the bodyStores and moves substances within the body
�� Generates heat; helps maintain normal body Generates heat; helps maintain normal body
temperaturetemperature
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8
Muscle Function GroupsMuscle Function Groups
�� Muscles work in pairs or groups to coordinate Muscles work in pairs or groups to coordinate
movement.movement.
�� Groups classified by functionGroups classified by function
�� AgonistsAgonists
�� SynergistsSynergists
�� AntagonistsAntagonists
�� FixatorsFixators
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9
Skeletal SystemSkeletal System
�� Components:Components:
�� BonesBones
�� CartilageCartilage
�� LigamentsLigaments
�� JointsJoints
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10
Skeletal System Skeletal System (cont(cont’’d.)d.)
From From HerlihyHerlihy B, B, MaebuisMaebuis NK: NK: The human body in health and illness,The human body in health and illness, eded 3, Philadelphia, 2007, Saunders.3, Philadelphia, 2007, Saunders.
11Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
11
Structure of Bone TissueStructure of Bone Tissue
From Salvo S: From Salvo S: Massage therapy: principles and practice,Massage therapy: principles and practice, eded 3, St. Louis, 2007, Saunders.3, St. Louis, 2007, Saunders.
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12
�� DiaphysisDiaphysis
�� EpiphysesEpiphyses
�� PeriosteumPeriosteum
�� MedullaryMedullary cavitycavity
Structure of Long BonesStructure of Long Bones
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13
Bone Shape ClassificationBone Shape Classification
�� Long Long –– longer than they are widelonger than they are wide
�� Short Short –– cube shapedcube shaped
�� Flat Flat –– thin and flattenedthin and flattened
�� Irregular Irregular –– do not fit in other categoriesdo not fit in other categories
�� SesamoidSesamoid –– small, round, embedded in small, round, embedded in
certain tendonscertain tendons
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14
Joint ClassificationJoint Classification
�� SynarthroticSynarthrotic jointjoint
�� AmphiarthroticAmphiarthrotic jointjoint
�� DiarthroticDiarthrotic jointjoint
�� Synovial jointsSynovial joints
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15
Synovial Joint StructureSynovial Joint Structure
From Salvo S: From Salvo S: Massage therapy: principles and practice,Massage therapy: principles and practice, eded 3, St. Louis, 2007, Saunders.3, St. Louis, 2007, Saunders.
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16
Types of Synovial JointsTypes of Synovial Joints
�� Hinge jointHinge joint
�� Pivot jointPivot joint
�� Ellipsoidal jointEllipsoidal joint
�� Saddle jointSaddle joint
�� Gliding jointGliding joint
�� Ball & socket jointBall & socket joint
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17
Skeletal DisordersSkeletal Disorders
�� OsteoporosisOsteoporosis
�� OsteomalaciaOsteomalacia and Ricketsand Rickets
�� Paget diseasePaget disease
�� SpondylolysisSpondylolysis
�� OsteomyelitisOsteomyelitis
�� MarfanMarfan syndromesyndrome
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18
OsteoporosisOsteoporosis
�� Loss of normal bone Loss of normal bone density resulting in density resulting in increased susceptibility to increased susceptibility to fractures fractures
�� Use lighter pressure and Use lighter pressure and avoid joint mobilizations avoid joint mobilizations and compressions or and compressions or administer carefullyadminister carefully
A, from Kumar V, A, from Kumar V, AbbasAbbas AK, AK, FaustoFausto N: N: Robbins & Robbins & CotranCotran pathologic basis of disease, pathologic basis of disease, 7e, Philadelphia, 2005, WB Saunders; 7e, Philadelphia, 2005, WB Saunders;
B and C, from B and C, from ThibodeauThibodeau GA, Patton KT: GA, Patton KT: Anatomy & physiologyAnatomy & physiology, , eded 6, St. Louis, 2007, Mosby. 6, St. Louis, 2007, Mosby.
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19
OsteoporosisOsteoporosis
�� Bone deformity is Bone deformity is
most common most common
manifestation manifestation
(spinal curvature, (spinal curvature,
loss of height)loss of height)
From From DamjanovDamjanov I: I: Pathology for the healthPathology for the health--related professions,related professions, eded 2, Philadelphia, 2000, WB Saunders.2, Philadelphia, 2000, WB Saunders.
20Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
20
OsteomalaciaOsteomalacia and Ricketsand Rickets
�� OsteomalaciaOsteomalacia: inadequate mineralization of : inadequate mineralization of
mature bonesmature bones
�� Rickets: Rickets: osteomalaciaosteomalacia in childrenin children
�� Use lighter pressure and avoid joint Use lighter pressure and avoid joint
mobilizations and compressions or administer mobilizations and compressions or administer
carefullycarefully
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21
Paget Disease Paget Disease
�� Progressive bone disease with Progressive bone disease with abnormal and excessive bone abnormal and excessive bone remodeling resulting in weak and remodeling resulting in weak and deformed bones of increased massdeformed bones of increased mass
�� Use lighter pressure and avoid joint Use lighter pressure and avoid joint mobilizations and compressions or mobilizations and compressions or administer carefullyadminister carefully
From From DamjanovDamjanov I: I: Pathology for the healthPathology for the health--related professions,related professions, eded 2, Philadelphia, 2000, WB Saunders.2, Philadelphia, 2000, WB Saunders.
22Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
22
SpondylolysisSpondylolysis
�� Structural defect in a vertebra (usually L5) Structural defect in a vertebra (usually L5)
leading to its weakness and impaired weightleading to its weakness and impaired weight--
bearing capacity bearing capacity
�� Use lighter pressure over lower back and Use lighter pressure over lower back and
sacrum; avoid joint mobilizations or sacrum; avoid joint mobilizations or
compressions of these areas or administer compressions of these areas or administer
carefully carefully
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23
OsteomyelitisOsteomyelitis
�� Bone infection most often caused by bacteriaBone infection most often caused by bacteria
�� Massage is contraindicatedMassage is contraindicated
From From McCanceMcCance KL, KL, HeutherHeuther SE: SE: PathophysiologyPathophysiology: the biologic basis for disease in adults and children, : the biologic basis for disease in adults and children, eded 5, St. Louis, 2006, Mosby.5, St. Louis, 2006, Mosby.
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24
MarfanMarfan SyndromeSyndrome
�� Genetic disorder; Genetic disorder; abnormality in bodyabnormality in body’’s s connective tissue; affects connective tissue; affects many body systems, most many body systems, most often the skeletal and often the skeletal and cardiovascular systems cardiovascular systems and eyesand eyes
�� Modifications are based Modifications are based on disease severity on disease severity
From From DamjanovDamjanov I: I: Pathology for the health professions,Pathology for the health professions, eded 3, St. Louis, 2006, Saunders.3, St. Louis, 2006, Saunders.
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25
Spinal DeviationsSpinal Deviations
�� KyphosisKyphosis
�� LordosisLordosis
�� ScoliosisScoliosis
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26
KyphosisKyphosis
�� Exaggeration of the Exaggeration of the
normal posterior thoracic normal posterior thoracic
curvecurve
�� Avoid overstretching Avoid overstretching
spine; if due to spine; if due to
osteoporosis, use lighter osteoporosis, use lighter
pressurepressure
From From KamalKamal A, A, BrockelhurstBrockelhurst JC: JC: Color atlas of geriatric medicine,Color atlas of geriatric medicine, eded 2, St. Louis, 1992, Mosby.2, St. Louis, 1992, Mosby.
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27
LordosisLordosis
�� Exaggeration of the normal anterior lumbar Exaggeration of the normal anterior lumbar
spinal curvespinal curve
�� Position the client for comfort; use deep stroking Position the client for comfort; use deep stroking
and kneading on affected musclesand kneading on affected muscles
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28
ScoliosisScoliosis
�� Lateral curvature in the normally straight vertical Lateral curvature in the normally straight vertical spinal line, usually in the thorax spinal line, usually in the thorax
�� Use deep stroking and kneading on affected Use deep stroking and kneading on affected muscles; avoid overstretching the spinemuscles; avoid overstretching the spine
From Gould BE: From Gould BE: PathophysiologyPathophysiology for the health professions,for the health professions, eded 3, 2006, St. Louis, Saunders.3, 2006, St. Louis, Saunders.
29Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
29
Lesson 4.2 ObjectivesLesson 4.2 Objectives
�� Define foot deformities and list massage Define foot deformities and list massage
considerations.considerations.
�� Define miscellaneous joint disorders and list Define miscellaneous joint disorders and list
massage considerations.massage considerations.
�� List types of arthritis and discuss massage List types of arthritis and discuss massage
considerations.considerations.
�� Contrast and compare Contrast and compare ankylosingankylosing spondylitisspondylitis
with rheumatoid arthritis.with rheumatoid arthritis.
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30
Lesson 4.2 Objectives Lesson 4.2 Objectives (cont'd.)(cont'd.)
�� Name muscular and Name muscular and myofascialmyofascial conditions and conditions and
state massage considerations.state massage considerations.
�� Delineate types of headaches.Delineate types of headaches.
�� List several clinical manifestations of fibromyalgia.List several clinical manifestations of fibromyalgia.
�� Contrast and compare fibromyalgia and Contrast and compare fibromyalgia and
myofascialmyofascial pain syndrome.pain syndrome.
�� Name several types of muscular dystrophy.Name several types of muscular dystrophy.
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31
Foot DeformitiesFoot Deformities
�� BunionsBunions
�� Hammertoes and Mallet toesHammertoes and Mallet toes
�� PesPes planusplanus and and PesPes cavuscavus
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32
BunionBunion
�� Medial displacement of the Medial displacement of the
first first metatarsophalangealmetatarsophalangeal
joint (great toe) joint (great toe)
�� Avoid area or use lighter Avoid area or use lighter
pressure if tender; avoid pressure if tender; avoid
joint mobilizations joint mobilizations
Courtesy Charles W. Bradley, DPM, MPA and Caroline Harvey, DPM, Courtesy Charles W. Bradley, DPM, MPA and Caroline Harvey, DPM, California College of Podiatric Medicine. In Seidel HM et al: California College of Podiatric Medicine. In Seidel HM et al:
MosbyMosby’’s guide to physical examinations, s guide to physical examinations, eded 6, St. Louis, 2006, Mosby.6, St. Louis, 2006, Mosby.
33Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
33
Hammertoes and Mallet ToesHammertoes and Mallet Toes
�� Hammer toeHammer toe: : metatarsophalangealmetatarsophalangeal joint joint
extended and proximal extended and proximal interphalangealinterphalangeal joint joint
flexedflexed
�� Mallet toeMallet toe: distal : distal interphalangealinterphalangeal joint flexedjoint flexed
�� Avoid area or use lighter pressure if tender; Avoid area or use lighter pressure if tender;
avoid joint mobilizations avoid joint mobilizations
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34
Hammer Toes and Mallet ToesHammer Toes and Mallet Toes
Courtesy Charles W. Bradley, DPM, MPA and Caroline Harvey, DPM, Courtesy Charles W. Bradley, DPM, MPA and Caroline Harvey, DPM, California College of Podiatric Medicine. In Seidel HM et al: California College of Podiatric Medicine. In Seidel HM et al:
MosbyMosby’’s guide to physical examinations, s guide to physical examinations, eded 6, St. Louis, 2006, Mosby.6, St. Louis, 2006, Mosby.
Hammer toeHammer toe
Mallet toeMallet toe
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35
PesPes PlanusPlanus and and PesPes CavusCavus
�� PesPes planusplanus (flatfoot) (flatfoot) –– Medial longitudinal arch is Medial longitudinal arch is reduced or collapsedreduced or collapsed
�� PesPes CavusCavus (high instep) (high instep) –– both medial and both medial and lateral longitudinal arches are excessively raised lateral longitudinal arches are excessively raised
�� Deep gliding, kneading, and friction strokes to Deep gliding, kneading, and friction strokes to loosen tight calf muscles; avoid any related loosen tight calf muscles; avoid any related corns or calluses or use lighter pressure if corns or calluses or use lighter pressure if tendertender
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36
PesPes PlanusPlanus and and PesPes CavusCavus, , (cont(cont’’d.)d.)
Courtesy Charles W. Bradley, DPM, MPA and Caroline Harvey, DPM, Courtesy Charles W. Bradley, DPM, MPA and Caroline Harvey, DPM, California College of Podiatric Medicine. In Seidel HM et al: California College of Podiatric Medicine. In Seidel HM et al:
MosbyMosby’’s guide to physical examinations, s guide to physical examinations, eded 6, St. Louis, 2006, Mosby.6, St. Louis, 2006, Mosby.
Pes planus
Pes cavus
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37
Joint DisordersJoint Disorders
�� SpondylolisthesisSpondylolisthesis
�� PatellofemoralPatellofemoral syndromesyndrome
�� Ganglion cystGanglion cyst
�� Baker cystBaker cyst
�� BursitisBursitis
�� TemporomandibularTemporomandibular joint dysfunctionjoint dysfunction
38Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
38
SpondylolisthesisSpondylolisthesis
�� AnteriorlyAnteriorly displaced vertebra; displaced vertebra;
usually affects lower spineusually affects lower spine
�� Use lighter pressure over Use lighter pressure over
affected area; avoid joint affected area; avoid joint
mobilizations and mobilizations and
compressions or administer compressions or administer
carefullycarefully
From From ZitelliZitelli BJ, Davis HW: BJ, Davis HW: Atlas of pediatric physical diagnosis,Atlas of pediatric physical diagnosis, eded 5, Philadelphia, 2007, Mosby.5, Philadelphia, 2007, Mosby.
39Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
39
PatellofemoralPatellofemoral SyndromeSyndrome
�� Softening and degeneration of Softening and degeneration of articulararticular cartilage cartilage
located on posterior patella located on posterior patella
�� Avoid area if swollen, inflamed, or tender; deep Avoid area if swollen, inflamed, or tender; deep
gliding, kneading, friction, gliding, kneading, friction, myofascialmyofascial release release
techniques on quads and hamstrings but avoid techniques on quads and hamstrings but avoid
stretching of quads stretching of quads
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40
�� Benign mass usually located on wrist tendonBenign mass usually located on wrist tendon
�� Local contraindicationLocal contraindication
Ganglion CystGanglion Cyst
A, from A, from HoppenfeldHoppenfeld S: S: Physical examination of the spine and extremities,Physical examination of the spine and extremities, Upper Saddle River, NJ, 1976, Pearson Education;Upper Saddle River, NJ, 1976, Pearson Education;
B, from B, from CallenCallen J et al.: J et al.: Color atlas of dermatology,Color atlas of dermatology, Philadelphia, 1993, WB Saunders.Philadelphia, 1993, WB Saunders.
41Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
41
Baker CystBaker Cyst
�� Cyst behind knee Cyst behind knee
caused by caused by
accumulation of accumulation of
synovial fluidsynovial fluid
�� Local Local
contraindication; contraindication;
use soft bolster use soft bolster
behind knees while behind knees while
client is supine client is supine
From Courtesy Dr. M Sherlock. In From Courtesy Dr. M Sherlock. In ZitelliZitelli BJ, Davis HW: BJ, Davis HW: Atlas of pediatric physical diagnosis,Atlas of pediatric physical diagnosis, eded 5, Philadelphia, 2007, Mosby.5, Philadelphia, 2007, Mosby.
42Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
42
BursitisBursitis
�� Chronic or acute inflammation of the Chronic or acute inflammation of the bursaebursae
�� Local contraindication in acute stage; deep Local contraindication in acute stage; deep
friction and jt. mobs helpful in chronic stage (use friction and jt. mobs helpful in chronic stage (use
ice afterwards); avoid jt. mobs if they cause painice afterwards); avoid jt. mobs if they cause pain
From From KlippelKlippel JH, JH, DeippeDeippe PA PA edseds: : Rheumatology,Rheumatology, eded 2, London, 1998, Mosby.2, London, 1998, Mosby.
43Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
43
TemporomandibularTemporomandibular Joint Joint
Dysfunction (TMJD)Dysfunction (TMJD)
�� Disorders of the jaw joint, its musculature, or Disorders of the jaw joint, its musculature, or
both causing pain in the jaw, teeth, head, and both causing pain in the jaw, teeth, head, and
earsears
�� Massage is indicated using advanced Massage is indicated using advanced
techniques to techniques to intraorallyintraorally treat jaw musculature treat jaw musculature
(where legal) (where legal)
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44
ArthritisArthritis
�� OsteoarthritisOsteoarthritis
�� SpondylosisSpondylosis
�� Rheumatoid arthritisRheumatoid arthritis
�� Juvenile rheumatoid arthritisJuvenile rheumatoid arthritis
�� AnkylosingAnkylosing spondylitisspondylitis
�� Gouty arthritisGouty arthritis
�� Lyme diseaseLyme disease
�� Septic arthritisSeptic arthritis
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45
OsteoarthritisOsteoarthritis
�� Progressive damage and eventual loss of Progressive damage and eventual loss of articulararticular cartilage; also called degenerative joint cartilage; also called degenerative joint disease disease
�� Avoid joints that are red, hot, or tender; use mildAvoid joints that are red, hot, or tender; use mild--to moderateto moderate--pressure; neck movements are best pressure; neck movements are best omitted or carried out with extreme caution omitted or carried out with extreme caution
46Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
46
Osteoarthritis Osteoarthritis (cont'd.)(cont'd.)
From From McCanceMcCance KL, KL, HeutherHeuther SE: SE: PathophysiologyPathophysiology: the biologic basis for disease in adults and children, : the biologic basis for disease in adults and children, eded 5, St. Louis, 2006, Mosby; and 5, St. Louis, 2006, Mosby; and
LemmiLemmi FO, FO, LemmiLemmi CAE: CAE: Physical assessment findings CDPhysical assessment findings CD--ROM,ROM, Philadelphia, 2000, WB Saunders.Philadelphia, 2000, WB Saunders.
47Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
47
SpondylosisSpondylosis
�� Degeneration of the spineDegeneration of the spine
�� Avoid undue pressure over the spine; joint Avoid undue pressure over the spine; joint
mobilizations of the spine (including cervical mobilizations of the spine (including cervical
area) are best omitted or carried out with area) are best omitted or carried out with
extreme cautionextreme caution
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48
Rheumatoid ArthritisRheumatoid Arthritis
�� Systemic arthritis affecting Systemic arthritis affecting
synovial membranes, then synovial membranes, then
articulararticular cartilages and cartilages and
other joint structuresother joint structures
�� Massage contraindicated Massage contraindicated
during exacerbations; during exacerbations;
otherwise, adjust pressure otherwise, adjust pressure
to client toleranceto client tolerance
From From DamjanovDamjanov I: I: Pathology for the healthPathology for the health--related professions,related professions, eded 2, Philadelphia, 2000, WB Saunders.2, Philadelphia, 2000, WB Saunders.
49Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
49
Juvenile Rheumatoid ArthritisJuvenile Rheumatoid Arthritis
�� Any joint inflammation of at least 6 weeks in a Any joint inflammation of at least 6 weeks in a
childchild
�� Massage contraindicated during exacerbations; Massage contraindicated during exacerbations;
otherwise, adjust pressure to client toleranceotherwise, adjust pressure to client tolerance
From From ZitelliZitelli BJ, Davis HW: BJ, Davis HW: Atlas of pediatric physical diagnosis, Atlas of pediatric physical diagnosis, eded 5, Philadelphia, 2007, Mosby.5, Philadelphia, 2007, Mosby.
50Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
50
AnkylosingAnkylosing SpondylitisSpondylitis
�� Systemic arthritis leading to Systemic arthritis leading to
calcification and fusion calcification and fusion
((ankylosisankylosis) of joints, usually spine ) of joints, usually spine
and sacroiliac joints and sacroiliac joints
�� Reduce pressure over tender Reduce pressure over tender
areas; avoid joint mobilizations; areas; avoid joint mobilizations;
avoid rib cage compressions avoid rib cage compressions
From Shipley M: A From Shipley M: A colourcolour atlas of rheumatology,atlas of rheumatology, eded 3, London, 1993, Mosby Year Book Europe.3, London, 1993, Mosby Year Book Europe.
51Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
51
Gouty Arthritis (Gout)Gouty Arthritis (Gout)
�� Inflammatory arthritis Inflammatory arthritis resulting from uric acid resulting from uric acid crystals in jointscrystals in joints
�� During attacks, massage During attacks, massage is adjusted according to is adjusted according to symptoms; in chronic symptoms; in chronic cases, use lighter cases, use lighter pressure over nodules pressure over nodules and avoid mobs of and avoid mobs of deformed deformed jtsjts..
From Dieppe P et al: From Dieppe P et al: Arthritis and rheumatism in practice,Arthritis and rheumatism in practice, London, 1991, Gower.London, 1991, Gower.
52Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
52
Lyme DiseaseLyme Disease
�� Recurrent arthritis Recurrent arthritis
affecting not only joints, affecting not only joints,
but skin, heart, and but skin, heart, and
nervous system nervous system
�� Massage contraindicated if Massage contraindicated if
fever is present; otherwise, fever is present; otherwise,
tailor massage to tailor massage to
symptoms and avoid symptoms and avoid
lesions and red, swollen lesions and red, swollen
joints joints From From CallenCallen J et al.: J et al.: Color atlas of dermatology,Color atlas of dermatology, eded 2, 2,
Philadelphia, 2000, WB Saunders.Philadelphia, 2000, WB Saunders.
53Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
53
Septic ArthritisSeptic Arthritis
(Infectious Arthritis)(Infectious Arthritis)
�� Infection in a joint; usually Infection in a joint; usually
caused by bacteriacaused by bacteria
�� Massage is contraindicatedMassage is contraindicated
From From ZitelliZitelli BJ, Davis HW: BJ, Davis HW: Atlas of pediatric physical Atlas of pediatric physical
diagnosis,diagnosis, eded 5, St. Louis, 2007, Mosby.5, St. Louis, 2007, Mosby.
54Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
54
Muscular and Muscular and MyofascialMyofascial
DisordersDisorders
�� Muscular atrophyMuscular atrophy
�� ContracturesContractures
�� DupuytrenDupuytren contracturecontracture
�� HeadachesHeadaches
�� Fibromyalgia syndromeFibromyalgia syndrome
�� MyofascialMyofascial pain syndromepain syndrome
�� Muscular dystrophyMuscular dystrophy
�� MyositisMyositis ossificansossificans
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55
Muscular AtrophyMuscular Atrophy
�� Decrease in muscle Decrease in muscle
cell diameter; muscle cell diameter; muscle
appears smaller, appears smaller,
looser, flattenedlooser, flattened
�� Begin slowly and Begin slowly and
superficially; superficially;
gradually increase gradually increase
pressure to tolerancepressure to tolerance
From From KamalKamal A, A, BrockelhurstBrockelhurst JC: JC: Color atlas of geriatric medicine,Color atlas of geriatric medicine, eded 2, St. Louis, 1992, Mosby.2, St. Louis, 1992, Mosby.
56Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
56
ContractureContracture
�� Transient or permanent Transient or permanent
shortening of muscle shortening of muscle
causing flexed and fixated causing flexed and fixated
position of jointposition of joint
�� Reduce pressure in areasReduce pressure in areas
with little or no sensation; contractures are difficult with little or no sensation; contractures are difficult
or impossible to reduce with massage; this should or impossible to reduce with massage; this should
be conveyed to the clientbe conveyed to the client
From Forbes CD, Jackson WF: A color atlas and text of clinical medicine, London, 1993, Mosby Europe.
57Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
57
DupuytrenDupuytren’’ss ContractureContracture
�� Fibrosis of the Fibrosis of the palmarpalmar
fascia; rare conditionfascia; rare condition
�� Reduce pressure in Reduce pressure in
areas with little or no areas with little or no
sensation; contractures sensation; contractures
are difficult or impossible are difficult or impossible
to reduce with massage; to reduce with massage;
this should be conveyed this should be conveyed
to the clientto the client
From From KamalKamal A, A, BrockelhurstBrockelhurst JC: JC: Color atlas of geriatric Color atlas of geriatric
medicine,medicine, eded 2, St. Louis, 1992, Mosby.2, St. Louis, 1992, Mosby.
58Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
58
HeadachesHeadaches
�� Pain in the head from any cause; types are Pain in the head from any cause; types are
tension (muscular contraction), cluster, and tension (muscular contraction), cluster, and
migrainemigraine
�� Massage is indicatedMassage is indicated
From Black JM, From Black JM, MatassarinMatassarin--Jacobs E: Jacobs E: LuckmannLuckmann and Sorensenand Sorensen’’s medicals medical--surgical nursing, surgical nursing, eded 4, Philadelphia, 1993, WB Saunders.4, Philadelphia, 1993, WB Saunders.
59Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
59
Fibromyalgia SyndromeFibromyalgia Syndrome
�� Chronic, generalized syndrome of diffuse softChronic, generalized syndrome of diffuse soft--
tissue pain and multiple tender pointstissue pain and multiple tender points
�� Massage tailored to how client is feeling at time Massage tailored to how client is feeling at time
of treatment; begin with slow increments in of treatment; begin with slow increments in
pressure from session to sessionpressure from session to session
60Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
60
Fibromyalgia Syndrome Fibromyalgia Syndrome (cont(cont’’d.)d.)
From Redrawn from From Redrawn from FreundlichFreundlich B, B, LeventhalLeventhal L: The fibromyalgia syndrome. In Schumacher HR L: The fibromyalgia syndrome. In Schumacher HR JrJr, , KlippelKlippel JH, JH, KoopmanKoopman, WJ, , WJ, edseds: :
Primer on the rheumatic diseases,Primer on the rheumatic diseases, eded 11, Atlanta, 1977, Arthritis Foundation. Copyright 1997. Reprin11, Atlanta, 1977, Arthritis Foundation. Copyright 1997. Reprinted with permission of the ted with permission of the
Arthritis Foundation, 1330 W. Peachtree St., Atlanta, GA 30309.Arthritis Foundation, 1330 W. Peachtree St., Atlanta, GA 30309.
61Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
61
MyofascialMyofascial Pain SyndromePain Syndrome
�� Disorder associated with presence of localized Disorder associated with presence of localized
trigger pointstrigger points
�� Massage and stretching is indicated over trigger Massage and stretching is indicated over trigger
points and adjacent areas; avoid oscillating points and adjacent areas; avoid oscillating
movements (percussion and vibration) to avoid movements (percussion and vibration) to avoid
producing localized contractionsproducing localized contractions
62Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
62
MyofascialMyofascial Pain Syndrome Pain Syndrome (cont(cont’’d.)d.)
�� Types of trigger points are:Types of trigger points are:
�� Active: pain is produced by pressure or stretching; Active: pain is produced by pressure or stretching; this pain is experienced locally and in a referred this pain is experienced locally and in a referred area that is familiar area that is familiar
�� Latent: pain is produced by pressure or stretching; Latent: pain is produced by pressure or stretching; this pain is experienced both locally and in a this pain is experienced both locally and in a referred area that is unfamiliarreferred area that is unfamiliar
63Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
63
Fibromyalgia vs. Fibromyalgia vs.
MyofascialMyofascial Pain SyndromePain Syndrome
VariableVariable FibromyalgiaFibromyalgia MPSMPS
LocationLocation GeneralizedGeneralized RegionalRegional
Primary symptomPrimary symptom Tender points Tender points
with pressure with pressure
applicationapplication
Trigger points and Trigger points and
referred pain referred pain
patterns with patterns with
pressure pressure
applicationapplication
GenderGender Female/Male Female/Male
ration (10:1)ration (10:1)EqualEqual
Systemic signsSystemic signs ManyMany FewFew
Adapted from Adapted from McCanceMcCance KL, KL, HuetherHuether SE: SE: PathophysiologyPathophysiology: the biologic basis for disease in adults and children, : the biologic basis for disease in adults and children, eded 5, St. Louis, 2006, Mosby.5, St. Louis, 2006, Mosby.
64Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
64
Muscular DystrophyMuscular Dystrophy
�� Collection of rare genetic Collection of rare genetic
muscle diseases muscle diseases
characterized by characterized by
progressive muscle atrophyprogressive muscle atrophy
�� Massage modifications Massage modifications
based on disease severity based on disease severity
From From JordeJorde LB et al: LB et al: Medical genetics,Medical genetics, eded 3, St. Louis, 3, St. Louis,
2006, Mosby.2006, Mosby.
65Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
65
Muscular Dystrophy Muscular Dystrophy (cont(cont’’d.)d.)
From From FromFrom HockenberryHockenberry MJ: MJ: WongWong’’s nursing care of infants and children,s nursing care of infants and children, eded 8, St. Louis, 2007, Mosby.8, St. Louis, 2007, Mosby.
66Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
66
MyositisMyositis OssificansOssificans
�� Deposition of calcium in Deposition of calcium in
traumatized area of traumatized area of
musculature caused by musculature caused by
injuryinjury
�� Local contraindicationLocal contraindication
From Kumar V, From Kumar V, AbbasAbbas AK, AK, FaustoFausto N: N: Robbins & Robbins & CotranCotran pathologic basis of disease: with student consult online accesspathologic basis of disease: with student consult online access, , eded 7, 7,
Philadelphia, 2005, WB Saunders.Philadelphia, 2005, WB Saunders.
67Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
67
Lesson 5.3 ObjectivesLesson 5.3 Objectives
�� Discuss musculoskeletal injuries and include Discuss musculoskeletal injuries and include
massage considerations.massage considerations.
�� List several types of fractures.List several types of fractures.
�� Explain the three degrees of sprains and Explain the three degrees of sprains and
strains.strains.
68Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
68
Musculoskeletal InjuriesMusculoskeletal Injuries
�� Dislocations and Dislocations and subluxationssubluxations
�� FracturesFractures
�� SprainsSprains
�� StrainsStrains
�� Volkmann contractureVolkmann contracture
�� Tendinitis, Tendinitis, EpicondylitisEpicondylitis, and , and TenosynovitisTenosynovitis
�� De De QuervainQuervain tenosynovitistenosynovitis
69Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
69
Musculoskeletal Injuries Musculoskeletal Injuries (cont(cont’’d)d)
�� OsgoodOsgood--SchlatterSchlatter diseasedisease
�� TorticollisTorticollis
�� WhiplashWhiplash
�� Repetitive strain injuriesRepetitive strain injuries
�� Adhesive Adhesive capsulitiscapsulitis
�� Compartment syndromeCompartment syndrome
�� Shin splintsShin splints
�� Plantar fasciitisPlantar fasciitis
70Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
70
Dislocation and Dislocation and SubluxationSubluxation
�� Dislocation Dislocation ––temporary temporary displacement of displacement of bones at the jointbones at the joint
�� SubluxationSubluxation ––contact is only contact is only partially lostpartially lost
�� Local Local contraindication for contraindication for recent injuries and recent injuries and inflamed areasinflamed areas
From Gould B: From Gould B: PathophysiologyPathophysiology for the health professions,for the health professions, eded 2, Philadelphia, 2002, WB Saunders.2, Philadelphia, 2002, WB Saunders.
71Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
71
FracturesFractures
�� Disruption or break in bone Disruption or break in bone
continuitycontinuity
�� Local contraindication if Local contraindication if
bone is immobilized, but bone is immobilized, but
massage to proximal and massage to proximal and
distal areas is usefuldistal areas is useful
From Frazier MS, From Frazier MS, DrzymkowskiDrzymkowski JW: JW: Essentials of human diseases and conditions,Essentials of human diseases and conditions, ed. 2, Philadelphia, 2000, WB Saunders.ed. 2, Philadelphia, 2000, WB Saunders.
72Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
72
SprainSprain
�� Overstretching or tearing Overstretching or tearing
of ligaments without bone of ligaments without bone
displacement; three displacement; three
degrees (first, second, degrees (first, second,
and third)and third)
�� Avoid affected area for Avoid affected area for
72 hrs after injury72 hrs after injuryFrom Frazier MS, From Frazier MS, DrzymkowskiDrzymkowski JW: JW: Essentials of human diseases Essentials of human diseases
and conditions,and conditions, ed. 2, Philadelphia, 2000, WB Saunders.ed. 2, Philadelphia, 2000, WB Saunders.
73Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
73
Strain (Pull)Strain (Pull)
�� Overstretching or tearing Overstretching or tearing
of muscle or its tendons; of muscle or its tendons;
three degrees (first, three degrees (first,
second, and third)second, and third)
�� Avoid affected area for Avoid affected area for
72 hrs after injury72 hrs after injury
From Courtesy Barbara Cousins. In From Courtesy Barbara Cousins. In ThibodeauThibodeau GA, Patton KT: GA, Patton KT: Anatomy & physiology, Anatomy & physiology, eded 6, St. Louis, 2007, Mosby.6, St. Louis, 2007, Mosby.
74Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
74
Volkmann ContractureVolkmann Contracture
�� Contracture of hand, Contracture of hand,
fingers and sometimes fingers and sometimes
wrist; from reduced blood wrist; from reduced blood
flowflow
�� Reduce pressure in areas Reduce pressure in areas
with little or no sensation; with little or no sensation;
contractures are difficult contractures are difficult
or impossible to reduce or impossible to reduce
with massage; this should with massage; this should
be conveyed to the clientbe conveyed to the clientFrom From ShankmanShankman GA: GA: Fundamental orthopedic Fundamental orthopedic
management for the physical therapy assistant, management for the physical therapy assistant, eded 2, 2,
Philadelphia, 2004, Mosby.Philadelphia, 2004, Mosby.
75Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
75
Tendinitis (Tendonitis)Tendinitis (Tendonitis)
�� Inflammation of a tendonInflammation of a tendon
�� Avoid affected area if Avoid affected area if
less than 72 hrs after less than 72 hrs after
injury; initial sessions are injury; initial sessions are
short and become longer short and become longer
as the area becomes use as the area becomes use
to pressure; follow with to pressure; follow with
iceice
From From McCanceMcCance KL, KL, HeutherHeuther SE: SE: PathophysiologyPathophysiology: the biologic basis for disease in adults and children, : the biologic basis for disease in adults and children, eded 5, St. Louis, 2006, Mosby.5, St. Louis, 2006, Mosby.
76Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
76
Tendinitis Tendinitis (cont(cont’’d)d)
�� Conditions associated with tendinitis are:Conditions associated with tendinitis are:
�� TenosynovitisTenosynovitis: tendinitis that also involves the : tendinitis that also involves the
sheathsheath
�� TendinosisTendinosis: degeneration of the tendon: degeneration of the tendon
�� EpicondylitisEpicondylitis: inflammation of the tendon where it : inflammation of the tendon where it
attaches to a bone attaches to a bone
�� Bursitis: inflammation of the Bursitis: inflammation of the bursaebursae
77Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
77
de de QuervainQuervain’’ss TenosynovitisTenosynovitis
�� Inflammation of Inflammation of
tendinoustendinous sheath on sheath on
radial side of wristradial side of wrist
�� Local contraindicationLocal contraindication if if
area is inflamedarea is inflamed
From From ShankmanShankman GA: GA: Fundamental orthopedic Fundamental orthopedic
management for the physical therapy assistant, management for the physical therapy assistant, eded 2, 2,
Philadelphia, 2004, Mosby.Philadelphia, 2004, Mosby.
78Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
78
OsgoodOsgood--SchlatterSchlatter DiseaseDisease
�� Patellar tendinitis in immature bone at the Patellar tendinitis in immature bone at the tibialtibial
tuberositytuberosity (where quads attach)(where quads attach)
�� Avoid area if swollen, inflamed, or tender; avoid Avoid area if swollen, inflamed, or tender; avoid
overstretching quads on affected sideoverstretching quads on affected side
From From ZitelliZitelli BJ, Davis HW: BJ, Davis HW: Atlas of pediatric Atlas of pediatric
physical diagnosis,physical diagnosis, eded 5, St. Louis, 2007, Mosby.5, St. Louis, 2007, Mosby.
79Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
79
TorticollisTorticollis
�� Congenital or acquired Congenital or acquired
spasms of spasms of
sternocleidomastoidsternocleidomastoid
�� Avoid affected area if injury Avoid affected area if injury
is less than 72 hours old; is less than 72 hours old;
otherwise, avoid otherwise, avoid
overstretching affected overstretching affected
muscles muscles From Perkin GD: From Perkin GD: MosbyMosby’’s color atlas and text of s color atlas and text of
neurology,neurology, London, 1998, MosbyLondon, 1998, Mosby--Wolfe.Wolfe.
80Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
80
WhiplashWhiplash
�� A sprain/strain of the cervical spine and A sprain/strain of the cervical spine and
spinal cord (most commonly at the junction of spinal cord (most commonly at the junction of
C4 and C5); most common cause is injury C4 and C5); most common cause is injury
from being pushed or struck from behind from being pushed or struck from behind
�� Avoid affected area for 72 hrs after injuryAvoid affected area for 72 hrs after injury
81Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
81
Repetitive Strain Injury (RSI)Repetitive Strain Injury (RSI)
�� Injuries that develop over time; caused by Injuries that develop over time; caused by
prolonged repetitive or constant motion, prolonged repetitive or constant motion,
usually combined with compressive forcesusually combined with compressive forces
�� Avoid area if inflamed; otherwise, deep Avoid area if inflamed; otherwise, deep
pressure within client tolerance pressure within client tolerance
82Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
82
Adhesive Adhesive CapsulitisCapsulitis
�� Disorder of shoulder joint Disorder of shoulder joint
and capsule; initially and capsule; initially
inflamed and eventually inflamed and eventually
stiff or frozenstiff or frozen
�� Avoid area if inflamed; Avoid area if inflamed;
afterward, address afterward, address
surrounding muscles with surrounding muscles with
heat and massageheat and massage
From From ShankmanShankman GA: GA: Fundamental orthopedic Fundamental orthopedic
management for the physical therapy assistant, management for the physical therapy assistant, eded 2, 2,
Philadelphia, 2004, Mosby.Philadelphia, 2004, Mosby.
83Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
83
Compartment SyndromeCompartment Syndrome
�� Occurs when pressure Occurs when pressure within a within a nonyieldingnonyieldingfascialfascial compartment compartment increases; types are increases; types are acute and chronic acute and chronic
�� Avoid area if client Avoid area if client reports intense, reports intense, stabbing pain or is stabbing pain or is hypersensitive to hypersensitive to pressure pressure
From Black JM, Hawks JH, Keene AM: From Black JM, Hawks JH, Keene AM: MedicalMedical--surgical surgical
nursing: clinical management for positive outcomes, nursing: clinical management for positive outcomes, eded 6, 6,
Philadelphia, 2001, WB Saunders.Philadelphia, 2001, WB Saunders.
84Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
84
Shin SplintsShin Splints
�� Pain along the tibia; Pain along the tibia;
usually bilateralusually bilateral
�� Avoid area if pain is severeAvoid area if pain is severe
From Frazier MS, From Frazier MS, DrzymkowskiDrzymkowski J: J: Essentials of Essentials of
human diseases and conditions,human diseases and conditions, eded 4, St. Louis, 4, St. Louis,
2009, Saunders.2009, Saunders.
85Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
85
Plantar FasciitisPlantar Fasciitis
�� Chronic inflammation of Chronic inflammation of
the plantar fascia (the plantar fascia (““pain pain
in the heelin the heel””))
�� Avoid area if pain is Avoid area if pain is
severe; be sure affected severe; be sure affected
foot is not excessively foot is not excessively
dorsiflexeddorsiflexed
From Frazier MS, From Frazier MS, DrzymkowskiDrzymkowski JW: JW: Essentials of human diseases and conditions,Essentials of human diseases and conditions, ed. 2, Philadelphia, 2000, WB Saunders.ed. 2, Philadelphia, 2000, WB Saunders.