Issue link: https://www.massageandbodyworkdigital.com/i/1234356
46 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 2 0 Bony Prominences Bony prominences include the floating ribs, the xiphoid process, and others. Under typical circumstances, massage over bony prominences poses no particular risks. However, vigorous or forceful massage over the spine or other protuberances has been seen to cause injury, especially if some other bone-related compromise (e.g., osteoporosis, ankylosing spondylitis, cancer metastasis, or bone thinning due to medications) is present. Nerves Nerves include the brachial plexus, the sciatic nerve, and others. Nerves are identified as endangerment sites in areas where they are easily pinned onto other tissues—especially underlying bones. They are less at risk when they are surrounded by thick layers of soft tissues. Pinning, stretching, or compressing nerves can bruise, irritate, or otherwise damage them. This may elicit sharp shooting, tingling, electric, or hot sensations. It is important to know the pathways of the most vulnerable nerves because, unfortunately, we cannot always count on clients—some of whom expect massage to hurt—to give accurate feedback about whether what they are feeling is "good" pain or "bad" pain. Another issue to bear in mind about nerves is that they can become subtly inflamed along their entire length. In other words, if the median nerve is compressed at the carpal tunnel, then it may also be irritated at the antecubital fossa, and at the posterior triangle of the neck. Blood Vessels Blood vessels include the common carotid artery, the great saphenous vein, and others. Arteries generally run deeper than veins, and are less vulnerable to injury. However, anywhere a pulse can be taken, an artery can be compressed, and sustained pressure must be avoided. The general risk of arterial entrapment is the blocking of circulation. Too much pressure can cause reduced sensation, discomfort, or even blackouts if applied at the carotid artery. Irritation of veins, since they are more delicate and tend to run more superficially than arteries, may cause varicosities, hemorrhages, or blood clots that lead to pulmonary emboli. Medical literature records many such events. Massage therapy education promotes a common wisdom that we must always exert pressure from distal to proximal on the extremities in order not to damage veins. This may be an overstated concern for healthy clients, particularly in the arms. However, for clients who are pregnant, a variety of physiologic changes increases their risk for deep vein thrombosis, so massage and bodywork for the medial leg and inguinal area must be modified to minimize this risk. In other words, use broad, light pressure, rather than specific intrusive pressure in these areas. Organs Organs include the eyes, liver, kidneys, ovaries, and others, which can be trapped and impaired by massage therapy, especially if they are close to the surface or if they are anchored in a way that makes them vulnerable to being pinned or compressed. Organs are especially at risk for damage if they are compromised by disorders. The scarring and inflammation of endometriosis may displace the uterus and ovaries, for instance. The spleen ordinarily isn't accessible, but if it is enlarged as a consequence of mononucleosis or liver disease, it could be damaged with careless abdominal massage. Many conditions can cause the liver to become enlarged and be palpable outside its normal boundaries. And while massage usually helps to resolve constipation, if the bowels are impacted, then intrusive pressure here may cause injuries. Lymph Nodes Lymph nodes include the cervical, axillary, and inguinal nodes, among others, and may be palpable when they are enlarged—which indicates the risk of infection and immune system activation. If lymph nodes are healthy, then they are typically not palpable with massage. What is an Endangerment Site? Endangerment (or cautionary) sites are places where careless massage could damage some of the body's most delicate tissues. This article provides a list of widely recognized cautionary sites, with some important caveats: inappropriate and insensitive pressure can damage any kind of tissue—not just especially delicate ones. This article provides a list of widely recognized cautionary sites, with some important caveats. First, inappropriate or insensitive pressure can damage any kind of tissue—not just especially delicate ones. Also, this discussion pertains specifically to clients who are not pregnant. Much more stringent cautions must be observed for clients who are pregnant, as they are vulnerable to injuries that nonpregnant people don't have to considers. And lastly, many potential cautions are related to dysfunctional organs and other tissues. Good education and skill can allow us to work safely in areas that would otherwise be "off limits" to inexperienced practitioners. For instance, important work can be done in the axillary area, if we know how to avoid the brachial plexus and other vulnerable structures. Generally speaking, we avoid causing injury to endangerment sites by using broad, flat, and often light pressure in these areas— as opposed to more intrusive work that may injure or irritate delicate tissues. Identifying an area as an endangerment or cautionary site doesn't mean it can't be touched; it just has to be touched and incorporated into the massage with special care. We can classify cautionary sites by tissue type or by location.