Pathologies, Massage, and Contraindications Part 9 Stroke – By Vanessa Ragains

Last week, we discussed Cerebral Palsy, defined the different types, and that it is diagnosed either in the womb or early infancy. This is a Central nervous system injury which affects the development in motor skills and certain functions of our brain. They can affect our sensory and cognitive reactions as well. When massaging a client who has Cerebral Palsy, it is important to be able to read non-verbals as they may not be able to verbally communicate any discomfort to you. If the bodywork is too hard, it can cause a seizure. This means to use lighter pressure. Massage can relieve tension, pain, and stress for the client. Our next post is focused on clients who have been affected by a Stroke.

Pathologies, Massage, and Contraindications Part 9 Stroke

Stroke Defined: A CVA (cerebrovascular accident) stroke is damage to the brain tissue caused either by a blockage in blood flow or by an internal hemorrhage. It is the third leading cause of death in the United States, coming in behind heart disease and cancer.

Risk Factors (Controlled)

  • High Blood pressure
  • Smoking
  • Atherosclerosis
  • C-reactive protein
  • Atrial Fibrillation
  • High Alcohol Consumption
  • Drug Use
  • Obesity and sedentary lifestyle
  • Diabetes
  • High-Estrogen
  • Hormone replacement therapy
  • Depression
  • Overall Stress

Risk Factors (Uncontrolled)

  • Age
  • Gender
  • Race
  • Family History
  • Previous Stroke

Types of Strokes

Ischemic Stroke: The most common version of CVA. This is caused by a blood clot that travels to the brain and creates a blockage.

Transient Ischemic Attack: A.K.A a mini-stroke. This occurs when the blockage is due to a small clot that dissolves within a few hours. Damage may be mild, but cumulative. This client may have several TIA’s, which may be a sign of a more intrusive Stroke to come in the future. Ā Someone with many TIA’s may seem like they suffer from dementia.

Cryptogenic Stroke: The cause of this type is unknown. They have found a connection to an abnormal opening in the heart that allows blood to flow through, even clots! This is more likely with a person over the age of 55.

Hemorrhagic Stroke: 20% of strokes are diagnosed as this. They can involve bleeding deep in the brain or on the surface of the brain. This type is associated with aneurysms, which can be a result of genetics, chronic hypertension, bleeding disorders, head trauma, or a malfunction of blood vessels.

Signs and Symptoms

  • Sudden unilateral weakness, numbness, or paralysis on the face, arm, leg, or any combination of the three
  • Blurred vision in one or both eyes.
  • Difficulty speaking or understanding simple sentences; Confusion
  • Sudden dizziness, clumsiness, vertigo
  • Sudden extreme headache
  • Possible loss of consciousness

Massage Risks:

A client who has survived a stroke has an increased risk to have a repeat episode. Being aware of medications and being able to make adjustments when needed are important responsibilities for the Massage therapist. Massaging the carotid area should be done with caution, especially when the client has a risk of carotid artery disease.

Massage Benefits:

Massage is incredibly useful with clients who are rehabilitating from a previous stroke. Massage can be complemented with Occupational and Physical therapy to support healthy muscle tone and promote function in altered tissues.

My opinion:

I have had a client who I worked with who suffered from multiple strokes and heart attacks. She was unable to verbally communicate and I had to learn how to read her non-verbal’s. When I would hold her hand, she would always look at me straight in the eye and rub my hand with her thumb which I took as a “Thank-you” notion. I would perform techniques to support the range of motion and increase circulation to avoid her getting bed sores. The in-home nurse would support my work with turning her on her side so that I could access her back, work in between her shoulder blades, access her glutes, and lower back. Unfortunately, she did pass and I was devastated! The lesson that I took from my time working with her, is confidence with working with stroke victims in the future, being flexible and finding ways to support a client who is bedridden, and knowing whether or not they can verbally express it, that they are completely appreciative of your bodywork!

Is there a Pathology you would be interested in reading about? I would love your suggestions on certain pathologies that you may need to see in the breakdown. Check back next week for our next discussion on Pathologies, Massage, and Contraindications!

Thank you for taking time out of your day to read my blog. I am looking forward to reviewing common and uncommon Pathologies that we may encounter on our journey of being a Massage therapist. For all you awesome clients out there, I hope you learn why massage can actually be contraindicated with certain pathologies and precautions you and your therapist need to take.

I LOVE YOUR QUESTIONS!! Please feel free to ask me a question or comment about what you read today. Looking forward to hearing from radical Folks like yourself!


All this information come from one of my must-have books for the massage career: A Massage Therapist Guide to Pathology. 5th Edition Author: Ruth Werner



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