Taken from the Massage Therapy Body of Knowledge (MTBOK) Version 1.0

Section 210.4 Pathology

Knowledge, skills and abilities related to the physiologic and psychological processes resulting from injury and/or illness as they relate to massage therapy.

Knowledge: Understand patho-physiological terms and processes resulting in/from injury and disease as they relate to massage therapy.

Understand mental health illnesses and common associated terms as they relate to massage therapy.

Common pathologies along with their etiology, signs/symptoms, complications and treatment considerations as they relate to massage therapy

• Prevalent pathologies by body system.
• Indications for massage therapy.
• Local and absolute contraindications for massage therapy.
• Cautions, adaptations and limitations based on:
- Specifics of condition.
- Techniques/approaches.
- Therapist’s knowledge, skills and abilities.
• Proper sanitary procedures - their purpose and use.
• Knowledge of how to access authoritative information on pathological conditions and general medical information.

Common disabilities and their specific restricting characteristics and considerations in relation to massage therapy

• Identify characteristics of common disabilities and impairments.
• Identify limitations presented by common disabilities and impairments.


• General classification and types of drugs, herbs, supplements, their effects and their side effects.
• Massage therapy considerations and potential responses to general classes of drugs, herbs and supplements.
• Use of authoritative, medically accepted drug reference to look up drugs, their effects and their side effects.

Chronic versus acute onset

• Definitions.
• Massage therapy considerations and cautions.

Dysfunctions caused by improper body mechanics, posture and repetitive movements

Inflammatory processes

• Functions, effects on tissues/structures, effect of treatments and contraindications and adaptive measures.
• Wound/tissue repair process.
• Stages of healing – acute, sub-acute and maturation stages.
• Level of severity.

Muscular pain patterns

• Trigger point and referred pain.
• Fascial planes and their relation to trigger or tender point pain/tenderness and referred pain.

Nociception and pain pathways, physiological processes, functions, effects on tissues/structures, client/patient response [76, 95, 120].

Standard precautions and sanitary practices for infection control and special methods for handling biohazards

• Compliance with Operational Safety and Health Administration (OSHA) regulations relevant to the practice of massage therapy.

First Aid and CPR – American Red Cross or equivalent

• Emergency action plan.


• Conduct a client/patient health history and intake with an understanding of the implications of reported pathologies on a massage treatment.
• Adapt massage treatments according to client’s disabilities and impairments.


• Demonstrate how to adapt massage therapy to clients/patients based on pathologies/conditions, stage of healing and level of severity present.
• Accommodate clients/patients who have disabilities resulting from diseases or injuries.
• Apply standard precautions and procedures of infection control for the individual, the equipment and the practice environment.
• Demonstrate when to refer a client to his/her physician because of potential for contraindication.
• Demonstrate researching a pathological condition, medications and herbs and determine appropriateness of massage therapy.
• Research information about common disabilities and impairments.
• Identify and appropriately respond to medical emergencies using applicable first aid and CPR as needed.
• Observe and identify signs of autonomic (sympathetic and parasympathetic) nervous system activation.
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