The word Avoid

Avoid. I used this word a lot in my description of what an MT should do. This was not always accurate. Usually special training or different types of massages such as stretching or joint mobilization could be applied. It was really hard for me to determine the red, yellow and green lights. I would assume all would be yellow except for the total contraindication.

List of total contraindications. 

Vulnerable areas (Hot Yellows!) 

What is Endangerment Sites and Why are certain areas of the body sites for potential endangerments?

Endangerment Sites. Areas of the body where delicate structures are less protected and may be more easily damaged during a massage. They are more at a potential for endangerment because they are less protected. 

1. Arteries and Veins

Arteries and Veins. Arteries are blood vessels responsible for carrying oxygen-rich blood away from the heart to the body. Veins are blood vessels that carry blood low in oxygen away from the body back to the heart for reoxygenation. They are two of the body's main type of blood vessels. 

MT's avoid this area because of potential blood clots. Direct pressure can cause further damage.

2. Nerves

Nerves. These are fiber bundles that transmits impulses of sensations to the brain or spinal cord, and impulses from these to the muscles and organs. 

MT's use caution in these areas as nerves may be compressed during a massage. The client may experience numbness, tingling, burning or shooting pain. The massage will damage the nerve is doubtful, but it may alarm your client to make him feel uncomfortable. If the pressure is prolonged, then the client may experience a temporary loss of motor control which is restored when the pressure is reduced or removed. (Mosby's Pathology for Massage Therapist text book). 

3. Joints

Joints. These are areas where two or more bones meet. Most joints are mobile, allowing the bones to move. Joints consist of cartilage. A type of tissue the covers the surface of a bone at a joint. 

MT's are aware of the limitations in joints and use caution not to overwork or hurt the joints. Massage overall is really good for joints with the proper care exercised. 

4. Eyeballs

Eyeballs. Eyes are organ of the visual system. Eyes detect light and convert it to chemical impulses in neurons. 

MT's avoid this area because too much pressure on the eye is not good for the eyes. You could cause retinal detachment and this is an organ. Even rubbing your eyes a lot is not good for them - see article. 

5. Facial arteries

Facial arteries. This is a branch of the external carotid artery that supplies structure of the superficial face. It provides oxygen and nutrients. 

MT's avoid this area because of being connected to the blood stream and carotid artery. Here are some tips to massage more effective. 

6. Brachial Plexus

Brachial Plexus. This is a network of nerves formed by the ventral rami of the lower four cervical nerves and the first thoracic nerve (C5-C8 and T1). This plexus extends from the spinal cord, through the cervicoaxillary canal in the neck over the first rib and into the armpit. It supplies afferent and efferent nerve fibers to the chest, shoulder, arm and hand. 

MT's avoid this area because of nerve damage. 

7. External Jugular Vein

External Jugular Vein. This receives the greater part of the blood from the exterior of the cranium and the deep parts of the face, being formed by junction of the posterior division of the retromandibular vein with the posterior auricular vein.

MT's avoid this area because the neck is a sensitive area during massage as a lot of nerves, veins and more are located in this area. A poor skilled massage therapist could cause some damage to client if they are not careful. 

8. Subclavian Artery

Subclavian Artery. There are two subclavian arteries that supply our arms with blood. The subclavian arteries branch to the vertebral arteries. These carry oxygenated blood up to the brain from the base of the neck. 

MT's avoid this area because of arteries.

9. Styloid Process

Styloid Process. This is a slender pointed piece of bone just below the ear. It projects down and forward from the inferior surface of the temporal bone, and serves as an anchor point for several muscles associated with the tongue and larynx. 

MT's avoid this area because deep pressure may break it off. 

10. Brachial Arteries

Brachial Arteries. The major blood vessel of the (upper) arm. It is the continuation of the axillary artery beyond the margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa at the elbow.  

MT's avoid this area because it is deep within the arm and branches into two smaller arteries the radial and ulnar arteries.

11. Median Nerve

Median Nerve. It is one of the five main nerves originating from the brachial plexus. It originates from lateral and medial cords of the brachial plexus, and has contributions from ventral roots of C5-C6 and C8 and T1. The median nerve is only nerve that passes through carpal tunnel. Carpel tunnel syndrome is the disability the results from the median nerve being pressed in carpal tunnel. 

MT's avoid this area because of the potential for nerve damage.   Good article to describe median nerve compression. 

12. Radial Arteries

Radial Arteries. This is the major blood vessels of the (upper arm). It is the continuation of the axillary artery beyond the lower margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa at the elbow. It then divides into the radial and ulnar arteries which run down the forearm.

MT's avoid this area because of the major blood vessel and close proximity to median nerve. 

13. Ulnar Arteries

Ulnar Arteries. This is the main blood vessel, with oxygenated blood, of the medial aspect of the forearm. It arises from the brachial artery and terminates in the superficial palmar arch, which joins with the superficial branch of the radial artery. It is palpable on the anterior and medical aspect of the wrist. 

MT's avoid this area because the area is an artery. 

14. Thoracic Outlet

Thoracic Outlet. This is a condition in which there is compression of the nerves, arteries, or veins in the passageway from lower neck to armpit. There are three main types: neurogenic, venous and arterial. The neurogenic type is the most common and present with pain, weakness and occasionally loss of muscle at the base of thumb. The venous type results in swelling, pain and possibly a blush coloration of the arm. The arterial type results in pain, coldness, and paleness of the arm. 

MT's avoid this area because of nerves, arteries or veins in the area. Also would avoid if swelling had occurred. 

15. Common Carotid Artery

Common Carotid Artery. This is a large elastic artery which provides the main blood supply (oxygenated) to the head and neck. These are present on the left and right sides of the body. 

MT's avoid this area because of it is nerve endings that can respond to changes in the blood pressure. Massaging these sensors can decrease the heart rate, sometimes enough to cause fainting. 

16. Carotid Sinus

Carotid Sinus. This is the reflex area of the carotid artery, consisting of various nerve receptors for baroregulation (pressure regulation of the body in sync to the external conditions).

MT's avoid this area because of nerve receptors. Doctors perform a massage to diagnose carotid sinus hypersensitivity which can cause dizziness. It can also diagnose paroxysmal supraventricular tachycardia.

17. Parotid Salivary Gland

Parotid Salivary Glands. Two glands are present on each side of the mouth in front of both ears. They are the largest of the salivary glands. Each wrapped around the mandibular ramus, and secretes serous saliva through the duct into the mouth, to facilitate swallowing and chewing. A number of different structures pass through the gland. From lateral to medial, these are Facial nerve, Retromandibular vein, External carotid artery, Superficial temporal artery, branches of the great auricular nerve, and maxillary artery. 

MT's avoid this area because nerves and arteries passing through. 

18. Submandibular Salivary Gland

Submandibular Salivary Gland. AKA as the submaxillary glands are major salivary glands located beneath the floor of the mouth. They each weigh about 15 grams and contribute some 60-67% of unstimulated saliva secretion on stimulation. The gland receives its blood supply from facial and lingual arteries. The gland is supplied and drained by common facial veins. 

MT's avoid this area because opening jaw would expose nerves more. The excretory ducts are crossed by the lingual nerve. This area can become infected and get stones. Lymph drainage may be appropriate for someone with issues. 

19. Axilla

Axilla. This is also known as the armpit. Under the joint where the arm connects to the shoulder. The axilla contains several nerves and blood vessels such as the axillary and brachial arteries, as well as axillary, median, musculocutaneous, radial and ulnar nerves, all branches of the brachial plexus (Mosby's Pathology for Massage Therapist Book). 

MT's avoid this area because of several nerves and blood vessels. There are effective techniques for working with the muscles of the pecs, subscapularis, through the armpit. However, make sure you are trained on these. 

20. Ulnar Groove

Ulnar Groove. This is a fibro-osseous tunnel holding the ulnar nerve and its vascular accompaniment. It is slightly distal to the medial epicondyle.  

MT's avoid this area because of potential nerve damage. 

21. Xyphoid Process

Xyphoid Process. This is a small cartilaginous process (extension) of the lower (inferior) part of the sternum. 

MT's avoid this area because heavy direct pressure could break off the bone. 

22. Carpal Tunnel

Carpal Tunnel. This is a medical condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel. The main symptoms are pain, numbness and tingling the fingers. Pain may extend up the arm. Weak grip strength may occur as the muscles begin to waste away. As more and more people use electronics carpal tunnel is on the rise. Currently, it affects more than 3 million people per year. Starting as early as 14 years old. 

MT's avoid this area because of the median nerve. There are some techniques to help relieve the pain of carpal tunnel.

23. Hook of Hamate Bone

Hook of the Hamate Bone. This is found at the proximal, ulnar side of the hamate bone. The hook is a curved, hook-like process that projects 1-2 mm distally and radially. The hook forms the ulnar border of the carpal tunnel and the radial border for Guyon's Canal. This area can become fractured by a massage therapist who uses their palm for compression and other strokes. 

MT's avoid this area it is near the ulnar nerve. 

24. Liver

Liver. This is an organ found in the right upper quadrant of the abdomen below the diaphragm. It metabolites synthesizes proteins and produces biochemicals necessary for digestion. Also regulates glycogen storage, decomposition of red blood cells and production of hormones. 

MT's avoid this area because it is an organ and pressure in the abdomen area could cause discomfort or damage. Press liver down as you press under the rib cage to work diaphragm. 

25. Descending Aorta

Descending Aorta. This is part of the aorta, the largest artery in the body. The descending aorta begins at the aortic arch that runs down the chest and abdomen. This travel down the chest and supplies blood to the ribs and some chest structures. 

MT's avoid this area because it is an artery. Move off if you feel a pulse. May cause blackouts. 

26. Appendix

Appendix. This is a blind-ended tube connected to the cecum, from which it develops in the embryo. The cecum is a pouchlike structure of the colon, located at the junction of the small and large intestines. The appendix has been called a vestigial organ. Usually located in the lower right quadrant of the abdomen, near the right hip bone. The base of the appendix is located 2 cm beneath the ileocecal valve that separates the large and small intestine. 

MT's avoid this area because it is an organ and may play a role in the immune system. 

27. Femoral Triangle

Femoral Triangle. This is an anatomical region of the upper third of the thigh. It is a subfascial space which appears as a triangle depression below the inguinal ligament when the thigh is flexed, abducted and laterally rotated. Bounded by: Superiorly (inguinal ligament); Medially (adductor longus); Laterally (sartorius).

MT's avoid this area because many nerves travel through this such as cutaneous nerve of the thigh, femoral nerve, the nerve to pectineus. It also includes the femoral arteries, veins, greater saphenous vein and part of lymph nodes. 

28. Lymph Nodes

Lymph Nodes. They are an ovoid or kidney-shaped organ of the lymphatic system. Each group drains a specific area of your body. You may be more likely to notice swelling in certain areas, such as in the lymph nodes in your neck, under your chin, in your armpits, and in your groin. Lymph carries white blood cells and is responsible for protecting the body against viruses and bacteria. They are located throughout the body but the largest groupings are found in the neck, armpits and groin areas. 

MT's avoid this area because is a part of the immune systems/organ and requires special training. You can find the certification (here) to do this type of massage. 

29. Tarsel Tunnel

Tarsel Tunnel. This is the space in the foot between the bones and overlying fibrous tissue. Within the tarsal tunnel lies a nerve called the posterior tibial nerve, as well as arteries, veins, and tendons. 

MT's avoid this area because of nerves and arteries. You can do some flexion to help the pain. 

30. Bursea

Bursea. These are thin, lubricated cushions located at points of friction between bone and surrounding soft tissue, such as skin, muscles, ligament, and tendons. It lies between a bone and opposing surface (skin) like a tiny water balloon with only a few drops of fluid in it, wedged between two surfaces. 

MT's avoid this area because of its possible tenderness and closeness to the surface. While it is common to have these in your body it is hard to distinguish between aseptic and septic bursitis. A fever, localized skin warmth, and redness, joint pain could be signs of a septic bursitis. 

31. Floating Ribs

Floating Ribs. Is any of the lower ribs that are not attached directly to the breastbone (sternum). There are usually 12 pairs of ribs in all. Each pair of ribs is attached to the vertebrae in the back.

MT's need to be careful especially the lateral surface and avoid any aggressive percussion movement on this structure.