A Massage Therapist’s Guide to Pathology FIFTH EDITION Ruth Werner, LMP, NCTMB WWeerrnneerr__FFMM..iinndddd ii 1122//88//22001111 44::1133::4466 PPMM Acquisitions Editor: Kelley Squazzo Product Manager: Linda G. Francis Editorial Assistant: Courtney Shell Design Coordinator: Steven Druding Manufacturing Coordinator: Margie Orzech Prepress Vendor: SPi Global Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their offi cial duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market St., Philadelphia, PA 19103, via email at [email protected], or via our website at lww.com (products and services). Printed in China Library of Congress Cataloging-in-Publication Data Werner, Ruth (Ruth A.) A massage therapist’s guide to pathology / Ruth Werner. p. ; cm. Includes bibliographical references and index. ISBN 978-1-60831-910-7 I. Title. [DNLM: 1. Massage. 2. Diagnosis, Diff erential. WB 537] 615.8¢22—dc23 2011040201 Care has been taken to confi rm the accuracy of the information presented and to describe generally accepted practices. However, the author, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations. The author, editors, and publisher have exerted every eff ort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant fl ow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in his or her clinical practice. LWW.com 9 8 7 6 5 4 3 2 1 WWeerrnneerr__FFMM..iinndddd iiii 1122//88//22001111 44::1133::5500 PPMM This book is and will forever be dedicated to the memory of my grandmother, Dora Charak Beckhard, who probably never got a massage in her life— but she sure could have used one. WWeerrnneerr__FFMM..iinndddd iiiiii 1122//88//22001111 44::1133::5500 PPMM WWeerrnneerr__FFMM..iinndddd iivv 1122//88//22001111 44::1133::5511 PPMM Foreword T he massage therapy profession is not the same as what it was, even just a few short years ago. Regardless of the work environment where a massage therapist practices, he or she is likely to encounter a wide diversity in clientele who may present with all kinds of different health complications. Consequently, the educational preparation a mas- sage therapist needs is constantly evolving as well. In the years since this book first appeared on the market, the explosion of accessible information about medical pathologies has been enormous. While there is no question that this increased access to valuable clinical information is a great benefit, there is also a serious challenge for the consumer or student to evaluate high-quality information. The hallmark of a great textbook is one that can both deliver a great quantity of content and help the reader become a discerning evaluator of quality information at the same time. That is no easy task, and with each edition, Ruth Werner has demonstrated an excellent ability to accomplish this challenge. An example of this improvement in accessibility comes in the new “At a Glance” sec- tions where practitioners can rapidly and easily find concentrated information about special topics of interest. In many cases, the topics presented in these sections are the key ques- tions a practitioner needs immediate information about with a presenting client challenge. With so many different and exceptional books available on the market today, it can be difficult for the practitioner to determine what should reside in his or her clinical library. Because most clinical books have new editions every few years, there is always the ques- tion about what is brought forth in a new edition. However, pathology is one subject where keeping current with the most recent research is a crucial aspect of relevance for the text. Werner’s work leading the Massage Therapy Foundation gives her a particular advantage in recognizing the crucial importance of staying current with research findings and implementing them into her writings. A great example in this text is a new section devoted specifically to conditions affecting fascia. Worldwide interest in the role of fascia in musculoskeletal disorders has blossomed in recent years, particularly as a result of the Fascia Research Congress held every two years. Inclusion of this information in the new edition highlights the necessity of massage practitioners knowing much more about the crucial role played by fascia in many pain complaints. One of the key challenges of teaching clinical practitioners in every field is helping them move past information they learn in basic training as pure content. In professional practice, the individual is often faced with gray areas that are not answered by simple con- tent knowledge alone. Clinical reasoning and critical thinking skills are crucial to prepare practitioners for the realities they face in clinical practice. In this edition, discussions of massage are framed as risks and benefits. This is a key issue of importance, as we must teach practitioners that decisions are not simply black-and- white, but evidence must be weighed to make appropriate decisions. Spelling out the use of massage in this fashion with risks and benefits discussed is a great way to encourage the development of these key reasoning skills that are so critical. v WWeerrnneerr__FFMM..iinndddd vv 1122//88//22001111 44::1133::5511 PPMM vi Foreword When asked to write this foreword, there is another reason that I agreed without hesi- tation. In the past two decades, I have spent a great deal of effort studying education and how to teach well. There are a handful of educators in our field who clearly stand out above others. From the first time I saw Ruth Werner present, I recognized her as having that great gift that makes an outstanding educator. Through each edition of her book, I see her infuse that same energy and skill of mak- ing it easy, enjoyable, and stimulating to learn about pathology. The ability to take a chal- lenging subject like pathology and make it fascinating for massage therapy students is a clear sign of how skilled and valuable her contributions to our profession have been. This is one book where I’ll always want the most recent edition so I can keep inspired and learn as much as possible from what she so generously shares with us all. Whitney Lowe Sisters, OR 2011 WWeerrnneerr__FFMM..iinndddd vvii 1122//88//22001111 44::1133::5522 PPMM About the Author R uth Werner is a retired massage therapist and lifelong educator with a passionate interest in the role of mas- sage and bodywork for people who struggle with illness. She began teaching while she was still a student of massage and discovered she has a gift for taking complex topics and breaking them down to easily assimilated pieces so that learners can rebuild those ideas in their own framework. Her love of teaching has been a center-point of her career, and in 2005, Ruth was honored with the Jerome Perlinski Council of Schools Teacher of the Year award. Ruth wrote what became the framework for A Massage Therapist’s Guide to Pathology as a resource for a massage school in 1993. The first edition of this text was published in 1998. Her second book, Disease Handbook for Massage Therapists, was published in 2010. In addition to keeping A Massage Therapist’s Guide to Pathology up to date, Ruth is a columnist for Massage and Bodywork magazine and is a frequent guest writer in other trade journals. Her success as a writer has allowed her to devote time and energy to many volunteer efforts. Ruth has served on committees for the American Massage Therapy Association, the National Committee for Therapeutic Massage and Bodywork, the Federation of State Massage Therapy Boards, and the Department of Professional Licensing for the state of Utah. Her most consuming volunteer passion has been to serve first as a Trustee and then as President for the Massage Therapy Foundation: a 501 (c) 3 public charity dedicated to advancing the knowledge and practice of massage therapy by supporting scientific research, education, and community service. In 2010, Ruth and her family fulfilled a lifelong dream of moving to the Oregon Coast. Now she can see and hear and smell the ocean as she writes. vii WWeerrnneerr__FFMM..iinndddd vviiii 1122//88//22001111 44::1133::5522 PPMM WWeerrnneerr__FFMM..iinndddd vviiiiii 1122//88//22001111 44::1144::0000 PPMM