NCBTMB Pathology and Contraindications 4 — Questions and Answers
Question 1: Which type of fracture would be classified as a SYSTEMIC contraindication to massage?
- A healed fracture from two years ago
- An acute fracture with internal bleeding and shock (Correct answer)
- A stress fracture in the contralateral foot
- A stable hairline fracture in a non-massage area
Correct answer: An acute fracture with internal bleeding and shock
An acute fracture accompanied by internal bleeding and shock is a medical emergency and a systemic contraindication until the client is medically stabilized.
Question 2: A therapist notices a client has a rash with clearly defined borders, redness, and vesicles on one side of the torso following a dermatomal pattern. The therapist should:
- Massage around the rash and proceed with the session
- Recognize possible herpes zoster and refer the client to a physician (Correct answer)
- Apply cold packs to the rash before massaging
- Proceed with lymphatic drainage to reduce inflammation
Correct answer: Recognize possible herpes zoster and refer the client to a physician
A dermatomal rash with vesicles is characteristic of herpes zoster (shingles), which is contagious and requires medical referral before massage.
Question 3: Why is massage contraindicated directly over a malignant tumor site?
- It causes pain that cannot be managed during the session
- It may stimulate lymphatic flow and potentially spread cancer cells (Correct answer)
- It breaks down scar tissue that protects the tumor
- It increases localized body temperature excessively
Correct answer: It may stimulate lymphatic flow and potentially spread cancer cells
Massage over a malignant tumor can stimulate local circulation and lymphatic flow, potentially facilitating metastasis to other areas.
Question 4: A client on warfarin (Coumadin) therapy wants a deep tissue massage. The MAIN concern is:
- Warfarin interacts with massage oils causing skin reactions
- Increased risk of bruising or internal bleeding due to anticoagulation (Correct answer)
- The medication causes muscle cramping that worsens with massage
- Warfarin users cannot receive any form of bodywork
Correct answer: Increased risk of bruising or internal bleeding due to anticoagulation
Warfarin is a blood thinner that impairs clotting, making clients susceptible to bruising or internal bleeding from deep tissue pressure.
Question 5: In which stage of wound healing is massage MOST beneficial and safe to apply near the area?
- Hemostasis stage (0–3 hours post-injury)
- Inflammatory stage (1–4 days post-injury)
- Proliferative/remodeling stage (days to weeks post-injury) (Correct answer)
- Any stage, as long as the skin is intact
Correct answer: Proliferative/remodeling stage (days to weeks post-injury)
During the proliferative and remodeling stage, gentle massage can help align collagen fibers and reduce excessive scar tissue formation.
Question 6: Which of the following is a contraindication to massage for a client with osteoporosis?
- Gentle Swedish massage on the back and limbs
- Deep compression and joint mobilization techniques on fragile bones (Correct answer)
- Light effleurage on areas without bone involvement
- Scalp massage and cranial work
Correct answer: Deep compression and joint mobilization techniques on fragile bones
Osteoporosis significantly reduces bone density, making deep compression and forceful joint techniques capable of causing fractures.
Question 7: A client discloses they have a history of epilepsy well-controlled with medication. How should the therapist respond?
- Decline the session as seizure risk is too high in a massage setting
- Proceed with massage, noting seizure first-aid protocols and avoiding seizure triggers (Correct answer)
- Only perform massage with a physician present
- Limit the session to reflexology only
Correct answer: Proceed with massage, noting seizure first-aid protocols and avoiding seizure triggers
Well-controlled epilepsy is not an absolute contraindication; the therapist should be prepared with seizure first-aid knowledge and avoid known triggers.
NCBTMB Pathology and Contraindications 4
Which type of fracture would be classified as a SYSTEMIC contraindication to massage?