While lightheadedness can be a known side effect of antihypertensive medications like lisinopril, any new or worsening symptom reported by a client with a pre-existing condition warrants clarification with their healthcare provider. The therapist’s role is not to diagnose or dismiss the symptom, but to gather information to ensure safety. Asking if the client has consulted their physician is a professional and collaborative step before making a decision about modifying or proceeding with the session.

The infraspinatus originates on the infraspinous fossa of the scapula (largely its medial and vertebral border) and inserts on the greater tubercle of the humerus. To lengthen the muscle fibers, gliding strokes should follow the direction of the fibers from origin (medial on the scapula) toward its insertion (laterally on the humerus).

The client is describing a psychophysiological pattern common in chronic stress. The HPA axis is the primary neuroendocrine system that mediates the body’s response to stress, leading to the release of cortisol. Chronic activation can contribute to increased muscle tension, particularly in postural muscles like the upper trapezius. Explaining how massage can help mitigate this systemic stress response is more comprehensive than focusing solely on local muscular mechanisms.

The anterior cervical region contains vital structures including the trachea, esophagus, carotid arteries, and internal jugular veins. The suprahyoid muscles are superficial to these structures. Therefore, extreme caution with pressure depth and direction is paramount. Light to moderate pressure is standard, and any work in this area requires clear communication with the client about comfort and any sensations of choking or pulse pressure.

Lateral epicondylalgia typically involves the extensor muscles of the forearm, particularly the extensor carpi radialis brevis, which originate on the lateral epicondyle. The action of these muscles includes wrist extension and radial deviation. Turning a screwdriver (especially against resistance) requires forceful supination of the forearm, which co-contracts the wrist extensors to stabilize the wrist, thereby aggravating the condition.

Psoriasis is a non-contagious, autoimmune skin condition. When plaques are not inflamed, cracked, or bleeding (i.e., in a remission phase), it is generally safe to work directly on the skin with normal lubricant and pressure, assuming the client finds it comfortable. There is no need for special lubricants or complete avoidance unless the skin is compromised. Always communicate with the client about pressure tolerance on these areas.

A significant difference between full passive ROM and limited/painful active ROM typically points to a neuromuscular or muscular issue, rather than a joint capsule or articular problem. The client’s inability to perform the action themselves suggests weakness, inhibition, or pain in the prime movers for abduction (primarily the deltoid and supraspinatus), even though the joint itself can be moved through its range by an external force.

Warfarin is an anticoagulant that slows the blood’s clotting ability. The principal concern for massage therapists is the increased risk of internal or external bleeding and easy bruising (ecchymosis). This necessitates modifications in practice, primarily avoiding deep, sustained pressure, deep friction, and techniques like petrissage that could cause shearing forces on blood vessels. Communication with the client’s physician may be warranted to determine their INR levels and establish safe pressure guidelines.

Superficial effleurage, when applied with appropriate pressure and direction (centripetal, toward the heart), primarily affects the superficial venous and lymphatic systems. These vessels have one-way valves. The gliding stroke externally compresses (or ‘milks’) these vessels, assisting the movement of blood in the veins and lymph in the lymphatic vessels against gravity back toward the trunk, supporting circulation and reducing edema.

While lightheadedness can be a known side effect of antihypertensive medications like lisinopril, any new or worsening symptom reported by a client with a pre-existing condition warrants clarification with their healthcare provider. The therapist’s role is not to diagnose or dismiss the symptom, but to gather information to ensure safety. Asking if the client has consulted their physician is a professional and collaborative step before making a decision about modifying or proceeding with the session.0