A Massage Therapist’s Guide to Pathology, 4e

1. A Massage Therapist’s Guide to Pathology, 4e Chapter 1 Fundamental Concepts in Pathology

2. Introduction • Part I: Terminology • Part II: Hygienic Practices • Part III: Infectious Agents • Part IV: The Inflammatory Process • Part V: Bodywork Modalities

3. A- , an-: without Acro-: extremity Adeno-: glandular -Algia: pain Angio-: blood or lymph vessels Arthr-: joint Brady-: slow Carcin-: crab (cancer) Cardio-: heart Cervi-, cervico- : neck -Cele: swelling, hernia Cep-, Ceph-: head, brain Chole: bile Com-, con-: with, together Contra-: against Cyst: hollow organ Demo-: people Derm-: skin Dia-: through Dys-: difficulty Ecto-, -ectomy: outside, removal -Emia: blood Terminology

4. Endo-: inside Epi- upon Erythr-: red Ex-: out of -Gen: beginning, producing Glyco-: relating to sugar -Graphy: recording, writing Hemo-: blood Hemi-: one-half Hepat-: liver Hydro-: water Hyper-: above, too much. Hypo-: below, too little -Itis: inflammation -Lepsis: seizure Leuko-: white Lipo-: fat Litho-: rock -Logy: study -Lysis, -lyso: destruction Mega-: large Meno-: month Terminology, cont.

5. Metr-: mother (uterus) Micro-: small Myco-: fungus Mye-: marrow or spinal cord Myo-: muscle Narco-: stupor Necro-: death Neo-: new Nephro-: kidney Neuro-: nerve -Oid: resembles -Oma: tumor Onco-: tumor Orchi-: testes -Osis: pathologic condition Osteo-: bone Para-: alongside, near Peri-: around Phagia-: eating -Philia: affinity Phleb-: vein Phyto-: plants -Plasia: growth -Plasm, -plasma: formed Terminology, cont.

6. Patho-: disease state Physio-: nature Pseudo-: false Psych-: the mind, mental Ren-: kidney -Rrhagia, -rrhea: flowing Rhino-: nose Sarco-: flesh Sclero-: hardness, scarring Spondy-: spine -Stasis: stagnation, standing still Stoma-: an opening; mouth Syn-, Sym-: with Thrombo-: clot Therm-: temperature -Trophy, -trophic: nutrition, growth Vaso-: blood vessel Terminology, cont.

7. Acute Chronic Complication Contraindicated Demographic Diagnosis Endemic Epidemic Idiopathic Incidence Indicated Kinesis Lesion Morbidity Mortality Pandemic Prevalence Prognosis Sign Stenosis Subacute Symptom Syndrome Trauma Terminology, cont.

8. Infectious Agents Pathogen: disease-causing organism • Resistance is based on genetics, virulence, and lifestyle habits Five basic classes • Prions No DNA, RNA Grow within CNS Spread through eating contaminated tissue • BSE (mad cow disease), Creutzfeldt-Jakob disease, kuru

9. Infectious Agents, cont. • Viruses Packets of DNA, RNA Reprogram target cell to produce virus Infected cells rupture, releasing viral copies Cannot replicate outside a host Many disintegrate outside a host Some are stable, especially herpes simplex, hepatitis B, hepatitis C

10. Infectious Agents, cont. • Bacteria Single-celled microorganisms Can survive outside a host Not all pathogenic; some are beneficial Pathogenic bacteria attack cells, release toxic wastes that damage cells Antibiotics interfere with bacterial reproduction (Slow-growing infections less responsive) Some bacteria have spore: tough waxy coat

11. Infectious Agents, cont. • Types of bacteria: • Cocci: spherical • Diplococci (Fig. 1.1) • Staphylococci (Fig. 1.2) • Associated with local skin infections • Some are becoming antibiotic resistant

12. Figure 1.1

13. Figure 1.2

14. Infectious Agents, cont. • Streptococci (Fig. 1.3.): associated with systemic infections • Bacilli: elongated, rod shaped (most likely to form spores) • Spirochetes: spiral (Fig. 1.4) • Mycoplasma: very tiny

15. Figure 1.3

16. Figure 1.4

17. Infectious Agents, cont. • Fungi • Yeasts and molds • Internal: associated with imbalance between yeasts and bacteria • External: skin infections

18. Infectious Agents, cont. • Animal Parasites • Single-cell or multicellular organisms • Live in or on a host • Can be vector for other diseases • Protozoa (Fig. 1.5) • Helminths and roundworms • Arthropods Head lice, crab lice, mites • Others: mosquitoes, ticks, fleas don’t live on or in host but can spread disease (Figs. 1.6–1.8)

19. Figure 1.5

20. Figure 1.6

21. Figure 1.7

22. Figure 1.8

23. Infectious Agents, cont. • Can be vector for other diseases • Protozoa (Fig. 1.5) • Helminths and roundworms • Arthropods Head lice, crab lice, mites • Others Mosquitoes, ticks, fleas don’t live on or in host but can spread disease (Figs. 1.6–1.8)

24. Hygienic Practices • Definition of terms • Antisepsis • Disinfection • Sterilization • Plain soap • Antimicrobial soap • Detergent • Alcohol-based hand rub • Universal and Standard Precautions

25. Hygienic Practices, cont. • Handwashing • Work to preserve lipid layer, skin health (Fig. 1.9) • Transient bacteria: superficial, easy to remove • Resident bacteria: deep, harder to remove (generally less aggressive) Running warm water, plain soap, 30 seconds • Liquid soap is preferable • Antimicrobial soap more likely to cause allergic reaction (being watched for increased bacterial resistance)

26. Figure 1.9

27. Hygienic Practices, cont. • Alcohol-based gel • Can be faster, more convenient • Doesn’t remove dirt • Use according to manufacturer’s recommendations • Alcohol-soaked towelettes not adequate • Moisturizing lotions are important

28. Hygienic Practices, cont. • Other Hand Care • Hangnails and other lesions • Cuticle nippers, cover sores • Trim, clean fingernails

29. Hygienic Practices, cont. • Care of surfaces • Goal: create an environment where nothing that one client touches directly or indirectly touches another client before it is cleaned • Fabrics • All surfaces touched by client or therapist must be cleaned or replaced with each appointment • Linens, face cradle covers, bolster/pillow covers, etc. • Therapist’s clothing: consider changing shirt or apron with each client

30. Hygienic Practices, cont. • Laundering • Professional laundering services use water that is 160º F (71°C), 25 minutes of agitation • 71–77°F (21.6–25°C) with adequate detergent for anti-microbial effect • Bleach is most active at 135–145°F (57.2–62.7°C), ratio of 50-150 ppm (parts per million)

31. Hygienic Practices, cont. • Thoroughly rinse bleached laundry • Never leave laundry damp • Dry on high heat; iron for extra protection • Wrap, isolate clean laundry • Laundry services rent out sheets: little quality control • Other items must be laundered at home: • Clothing, bolster covers, face cradle covers, etc. • Watch for seepage of fluids through to fabrics usually covered by linens

32. Hygienic Practices, cont. • Other equipment • Swab massage tables, face cradles, vinyl-covered furniture • CDC recommends 10% bleach solution Loses potency quickly: replace often Alcohol evaporates too quickly to be useful • Isolate massage lubricants Solid at room temperature: individual dispensers • Wash oil and lotion bottles with hands • Keep bottles off floor, other contaminated surfaces

33. Hygienic Practices, cont. • Other items: • Hot or cold rocks and crystals may be sterilized • Tools, hot/cold packs, etc: wash contacting surfaces • The massage environment • Curtains, upholstery, carpets probably not major vectors Can harbor allergens: vacuum regularly If carpet gets wet, can grow mold: replace • Other surfaces should be cleaned frequently: Doorknobs, switch plates, bathroom surfaces, telephones, etc. • Cash is often contaminated

34. The Inflammatory Process • What is inflammation? • Response to tissue damage or the threat of invasion by antigens • Triggered by Physical trauma Invasion with foreign bodies Hormonal changes Autoimmune activity

35. The Inflammatory Process, cont. • Purpose: • Protect from pathogenic invasion • Limit range of contamination • Prepare damaged area for healing • Outcomes: • Complete resolution with no scar tissue • Accumulation of scar tissue • Formation of cysts/abscesses • Chronic inflammation

36. The Inflammatory Process, cont. • Components of inflammation: vascular activity • Vasoconstriction • Protective response, short lived • Vasodilation • Chemicals released by damaged endothelium and mast cells Increase permeability of capillaries Reinforce capillary dilation Attract platelets Slow blood flow away from area • May last several minutes to hours or days

37. The Inflammatory Process, cont. • Components of inflammation: cellular activity • Many cells are recruited to manage tissue damage and contamination risk with injury. • Endothelial cells: • Release chemicals to activate platelets, allow white blood cells to migrate out of capillaries • Proliferate to grow new capillary beds in later stages • Platelets: • Become jagged and sticky, adhere to damaged area • Release chemicals to bind with plasma proteins to create fibrin, blood clots

38. The Inflammatory Process, cont. • White blood cells • Several types involved • Granulocytes • Smallest, fastest • Neutrophils first on the scene for bacterial infection, musculoskeletal injury • Eosinophils for allergies, parasites • Basophils for allergies and histamine release

39. The Inflammatory Process, cont. • Mast cells • In tissues vulnerable to injury • Release histamine to prolong inflammatory response • Monocytes and macrophages • Monocytes = large, mobile white blood cells • Can become permanently fixed macrophages • Associated with late-stage inflammation to clean up debris • Lymphocytes • Work with macrophages to clean up debris, promote scar tissue, angiogenesis

40. The Inflammatory Process, cont. • Fibroblasts • Produce collagen, extracellular matrix • Drawn to local blood clots, may proliferate to form more scar tissue

41. The Inflammatory Process, cont. • Chemical mediators • Many sources of chemical mediators that help coordinate cellular activity • Suspended in plasma, from platelets, mast cells, basophils, endothelial cells

42. The Inflammatory Process, cont. Stages of healing • Acute stage • Damaged cells release chemicals • Edema develops • Platelets, early white blood cells arrive • Tissue exudate begins to form • Time: depends on severity (usually 1–3 days)

43. The Inflammatory Process, cont. Subacute stage • Also called the proliferative stage • Cells accumulate to fill in damaged area • Endothelial cells grow new capillaries • Fibroblasts create collagen fibers • Slower white blood cells arrive to start cleanup • Time varies; 2–3 weeks

44. The Inflammatory Process, cont. Postacute stage • Also called the maturation stage • Collagen becomes denser and aligns according to force

45. The Inflammatory Process, cont. Chronic inflammation • Inflammatory process is not successful • Pathogens/irritants not removed • Immune system continues to attack tissue • Musculoskeletal structures never regain full function

46. The Inflammatory Process, cont. • Complications • Cysts, abscesses • Fistulas, sinuses • Tendinosis • Keloid scarring

47. The Inflammatory Process, cont. Signs and symptoms • Pain, heat, redness, swelling, and sometimes loss of function • Dolor (pain) • Calor (heat) • Rubor (redness) • Tumor (swelling) • Functio laesa (loss of function)

48. The Inflammatory Process, cont. • Massage • Acute local infections locally contraindicate circulatory massage • Post acute stage, maturation phase can benefit from fluid turnover, mechanical influence on scar tissue