As part of their education, massage therapists learn which pathological conditions could render bodywork as potentially dangerous. However, the rising popularity of massage coupled with our increasingly unaffordable healthcare system means that many bodywork patrons have not visited a physician in a long while. Thus, medical problems often go undiagnosed. Although diagnosing is beyond their scope of practice, bodyworkers must be able to recognize ailments where massage would be unsafe. As such, reviewing the early indicators of appendicitis can help therapists identify and quickly refer out clients in danger of a ruptured appendix.
The vermiform appendix, commonly referred to simply as the appendix, is a 3½ inch long tube of tissue extending from the large intestine. Some doctors believe it serves as a reservoir for immune cells because a high concentration of lymph cells have been found in the appendix. However, those without an appendix don’t appear to suffer any negative consequences. Therefore, most physicians believe it to be a non-functioning remnant of an earlier stage in human evolution. Normally found in the lower right abdomen, the appendix becomes inflamed in one of every 15 people.
An inflammation of the appendix, appendicitis is a medical emergency that requires prompt surgery for removing the organ. There is a debate regarding why people get appendicitis, but a blockage within the appendix is one of the more likely causes. Several of the suspected reasons for an appendix blockage include:
- A buildup and hardening of mucus or stool
- Cancerous tissue
- A foreign body
- A swelling of lymphatic tissue
An obstructed appendix leads to local distention, bacterial overgrowth, a lack of circulation and inflammation. Left untreated, an inflamed appendix will eventually burst and spill its infection into the abdominal cavity. The reason appendicitis is an emergency is because infection in the abdominal cavity (peritonitis) can be fatal.
Anytime appendicitis is suspected, immediate action must be taken because the appendix often ruptures within 24 hours of presenting symptoms. Thus, a massage therapist who recognizes the signs of appendicitis should cease massage immediately and arrange for swift emergency care. The most common six indicators of appendicitis include:
- Pain beginning around the navel, then moving to the lower right quadrant of the abdomen
- Pain that is sharp and severe
- Pain that progressively worsens and intensifies with movement or coughing
- Low-grade fever
- Loss of appetite, nausea or vomiting
- Inability to pass gas
While a physician employs many techniques for diagnosis, these four tests can guide a bodyworker to better identify appendicitis:
- McBurney’s Point Test – Rebound tenderness at the junction of the middle and outer thirds of the line joining the umbilicus to the anterior superior iliac spine
- Rovsing Sign – Pain felt in the right lower quadrant with palpation of the left lower quadrant of the abdomen
- Psoas Sign – An increase in pain from passive extension of the right hip joint that stretches the iliopsoas muscle
- Obturator Sign – Pain caused by passive internal rotation of the flexed thigh
Healthcare practitioners are usually weary of jumping to conclusions that would cause their clients to worry. Since appendicitis can be fatal if not addressed immediately, suspecting your client’s appendix is inflamed should be disclosed without hesitation. By reviewing these symptoms and tests, massage therapists are best prepared to spot a possible case of undiagnosed appendicitis – and their quick action could end up saving a client’s life.