Bone Pathology and Developmental Disorders

Bone Pathology

• Osteonecrosis:
  • Blood supply interruption to the bone marrow (ischemia)
  • Causes: trauma, fractures, thrombosis, embolism, sickle cell disease, idiopathic, corticosteroids
  • Symptoms: Bone death, pain (even at rest), mobility issues (limited ROM)
  • Massage considerations: Often treated after medical interventions like surgery. Risk of infection. Avoid treatment until cleared by doctors. Address any associated pathology or immobilization-related issues.

Developmental Disorders (A)

• Legg-Calvé-Perthes:

  • Unknown cause, potentially related to trauma or malnutrition affecting the femoral head.
  • Symptoms: Pain in the thigh and knee, difficulty walking, limping, limited abduction and internal rotation, disturbed growth pattern.
  • Massage considerations: Can help with compensatory symptoms like posture or gait issues.

• Osgood-Schlatter:

  • Overuse during development of the quad muscles, strain on patellar tendon. Primarily affects white males aged 3-12.
  • Symptoms: Abnormal tibial tuberosity, pain in front of knee, pain with activity, and swelling/thickening of the patellar tendon.
  • Massage considerations: Focus on decreasing quad tone and addressing inflammation.

Developmental Disorders (B)

• Scheuermann Disease:

  • Lax ligaments, more common in left hip than right, usually found in females.
  • Symptoms: Structural hyperkyphosis, most common in adolescents
  • Massage considerations: Treat associated dysfunctions via bracing/splinting or surgery.

• Genu Varum:

  • Bow legged. Mostly in infants from ages 0-18 months. Can also occur in adults.
  • Symptoms: Gait awkwardness.
  • Massage considerations: Address medial collateral ligament laxity and gait awkwardness, focus on postural symptoms.

• Genu Valgum:

  • Knock-kneed. Infants are typically knock-kneed around 3.5 years when crawling. Can also occur in adults
  • Symptoms: Gait awkwardness. Lax medial collateral ligaments
  • Massage considerations: Address medial collateral ligament laxity and gait awkwardness, focus on postural symptoms.

Scoliosis

• Causes: Congenital (hemi/wedge vertebra, uneven limb length), Neuromuscular (Cerebral palsy, muscular dystrophy), other diseases affecting nerves or muscles. Often seen in females, adolescents, right thoracic area. Can be idiopathic (unknown cause).
• Symptoms: Structural scoliosis; pain secondary to structure compression; rib humping, uneven shoulders, one hip higher than the other
• Massage considerations: Address pain from secondary structure compressions, treat associated rib humping, uneven shoulders, or hip differences. Consider other associated conditions that may require caution.

Metabolic Diseases

• Osteopenia:

  • Decrease in bone mass. Bone deformation. Can occur with or in conjunction with other pathologies. This can happen in individuals with anorexia
  • Symptoms: Decreased bone mass, deformation of bones, possible remineralization issues.
  • Massage considerations: Treatment of underlying causes, physical therapy to improve bone mass and density, weight-bearing exercises.

• Osteoporosis:

  • Imbalance between bone resorption and formation. Can often occur in aging individuals, as more bone is resorbed than formed. Can occur as a result of mineral deficiency.
  • Symptoms: Susceptibility to fractures, vertebral collapse, Dowager's hump, deep bony pain. Often asymptomatic.
  • Massage considerations: Address fractures, vertebral collapse, and other associated pain issues. Consider surgical interventions. Educate on routine screening for earlier detection and proactive approaches.

• Osteomalacia:

  • Deficiencies in calcium, vitamin D, and phosphate. Lack of intestinal mineral absorption.
  • Symptoms: Bone pain and tenderness, muscle weakness, fractures that have poor healing, potential hyperparathyroidism.
  • Massage considerations: Focus on strengthening and pain reduction. Be mindful of potential stress fractures.

• Rickets:

  • Similar pathologies in relation to osteomalacia. These pathologies are in relation to the growing skeleton, bone is made of cartilage and is not yet fully developed or calcified.
  • Symptoms: Less long bone growth, enlargement of epiphyseal cartilage (which isn't properly replaced with bone, delayed ossification, enlarged soft skull/lumbar lordosis.
  • Massage considerations: Cautious approach necessary, as the bone is still made of cartilage.

Other (Page 6)

• Paget's disease:

  • Osteoclasts resorb bone at a fast rate followed by chaotic bone formation. This process is caused by genetic or environmental influences, or it can be viral.
  • Symptoms: Bone pain, skull involvement leading to headaches/vertigo/tinnitus; osteogenic sarcoma (bone tumor); potential for fractures/bowing due to poorly formed bone.
  • Massage considerations: Address pain and potential need for external support.

• Acute Fatigue:

  • Increased activity, viral/bacterial infection, mental stress, using crutches
  • Symptoms: Muscle stress and fatigue.
  • Massage considerations: Treatment of underlying conditions.

• Chronic Fatigue:

  • Prolonged exhaustion, often related to bedridden periods and loss of muscle mass and endurance, associated with anxiety or depression.
  • Symptoms: Prolonged exhaustion/anxiety/depression, muscle weakness/disuse, symptoms of recurrent exacerbations/remissions
  • Massage considerations: Address symptoms; observe for other underlying medical and/or psychological complications.