Mononucleosis is a disease that is most commonly caused by the Epstein-Barr virus; it causes lack of energy and stamina. Significant complications of mononucleosis include enlargement of the spleen. In extreme cases, the spleen may rupture, causing sharp, sudden pain in the left side of the upper abdomen. Occasionally, a streptococcal (strep) infection accompanies the sore throat of mononucleosis, and antibiotics are prescribed for these infections.

Flu

The influenza virus is generally passed from person to person by airborne transmission (i.e., by sneezing or coughing). It may also be spread by touching something that has been handled by someone infected with the virus and then touching your own mouth, nose, or eyes. Fever, headache, and body aches usually last for 3 to 5 days, but upper respiratory symptoms and fatigue may last for 2 weeks or longer.

Colds

A cold is a viral infection of the upper respiratory system. A cold usually begins with fatigue, a feeling of being chilled, sneezing, and a headache, followed in a couple of days by a runny nose and a cough. Symptoms typically peak 2 to 3 days after onset of infection and usually resolve in 7 to 10 days. Cold viruses are spread by personal contact and by breathing the air near people with colds. Therefore, if at all possible, athletes should avoid being around sick people before and after important events.

Gastroenteritis

Gastroenteritis (also known as gastric flu, stomach flu, or gastro and stomach virus) is inflammation of the gastrointestinal tract involving both the stomach and the small intestine and resulting in diarrhea, vomiting, and abdominal cramps.

Most cases are caused by rotavirus or norovirus. Less common causes include bacteria or their toxins, as well as parasites. Transmission may occur as the result of improperly prepared foods, contaminated water, or close contact with those who are infectious.

The foundation of management is adequate hydration. For mild or moderate cases, this typically can be achieved via oral rehydration solution.

Staph

Staphylococcus is a bacterium that can cause a wide variety of infections, from minor skin infections, such as impetigo, boils, cellulitis, carbuncles, and abscesses, to life-threatening diseases such as pneumonia, meningitis, osteomyelitis, endocarditis, and sepsis.

Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for several difficult-to-treat infections in humans. Antibiotic resistance makes MRSA infection more difficult to treat. MRSA is especially troublesome for athletes because they are in close physical contact and may have open wounds and weakened immune systems.

Herpes Simplex

Herpes infection is caused by the herpes simplex virus (HSV). After an incubation period of 3 to 10 days, symptoms are similar to those of viral influenza–like illness; the difference noted is that fluid-filled lesions usually surround the mouth and the nose. HSV is a painful, often recurring, infection seen as clusters of small, fluid-filled sacs on a base of red skin. Viruses may remain dormant in the body for years, manifesting themselves in situations of depressed immunity and stress. The outbreak is usually preceded by symptoms that can include irritability, headache, tingling, and burning or itching of the skin at the site of recurrence. Recurrent HSV labialis (fever blisters or cold sores) can shed the virus intermittently between episodes and in the absence of lesions. Treatment of primary HSV is most effective with antiviral drugs such as acyclovir or valacyclovir.

Fungal Infections

Infections involving fungi may occur on the surface of the skin, in skin folds, and in other areas kept warm and moist by clothing and shoes. Candida is a yeast—similar to a fungus. It most often affects the skin around the nails or the soft, moist areas around body openings.

• Tinea capitis: a common fungal infection of the scalp manifested by gray scaly patches accompanied by mild hair loss in many cases

• Tinea corporis: a fungal infection on the body commonly referred to as “ringworm”—a name gleaned from its characteristic ring-like appearance

• Tinea cruris: a fungal infection in the groin area, commonly referred to as “jock itch”

• Tinea pedis: the most common fungal infection that affects the feet; it is commonly referred to as “athlete’s foot.”

Fungal infections may be treated initially with topical preparations for 2 to 4 weeks. More widespread, inflammatory, or otherwise difficult-to-treat cases may require the use of systemic antifungal drugs.

Common and Plantar Warts

Warts are epithelial tumors caused by several types of human papilloma virus. Common warts present as cauliflower-shaped, raised lesions. Plantar warts occur as flat lesions with pinpoint bleeding on weight-bearing surfaces; they can be debilitating in athletes because of the pain. Transmission occurs by direct skin-to-skin contact, by contact with floors, or by cryotherapy with liquid nitrogen.

Massage Implications

When an athlete is ill, DO NOT overmassage. Regardless of the ongoing treatment plan, back off and apply general, nonspecific massage for no longer than 45 to 60 minutes with a relaxation/palliative outcome, and encourage rest, sleep, proper fluid intake, and nutritional support. If low-grade productive fever is present, the client may benefit more from sleep than from massage. The presence of a fever indicates caution for massage application. If massage is provided when low-grade fever is present, the duration and intensity of the massage should be adjusted to support comfort care only.

If massage is indicated, it would be palliative and targeted to support parasympathetic dominance, sleep, and reduction of general aching. Do not massage if fever is above 100° F (38° C), or if the client is fatigued. In general, if symptoms are manifested primarily above the shoulders, it is acceptable to massage the client. If symptoms involve the whole body, then massage could strain adaptive capacity. Ask whether the client has any sort of skin infection, and be aware of skin changes. Avoid local areas where suspected infection is present. Hand hygiene is the single most important practice in reducing the transmission of infectious agents. Cleaning and disinfection are primarily important for frequently touched surfaces. Follow all Standard Precautions from the Centers for Disease Control. Remember that athletes may be immunosuppressed. Do not expose athletes to illness. If the massage therapist is ill, he or she should avoid working until no longer contagious.

Inflammation

Objective

1. Apply appropriate massage interventions for clients with inflammation.

Within limits, inflammation is a valuable aspect of the immune response. Inflammation is the body’s normal protective response to infection and injury. Antigens are molecules, usually protein, that are on the surfaces of pathogens such as bacteria or viruses. Our bodies attack such foreign materials using white blood cells, which can produce antibodies. These antibodies help the immune system destroy antigens.

Inflammation triggered by injury operates slightly differently from an infection. When tissues are damaged, they release chemicals, such as histamine and serotonin. These chemicals attract white blood cells. This natural “defense” process brings increased blood flow to the area, resulting in an accumulation of fluid. As the body mounts this protective response, symptoms of inflammation develop. These include the following:

Inflammation can be acute or chronic. When it is acute, inflammation occurs as an immediate response to trauma or infection. The inflammatory response supports the removal of cellular debris caused by trauma and any pathogens present, but if excessive, it causes damage to surrounding tissues.

Chronic inflammation is a perpetuating factor in many chronic conditions. Chronic inflammation is a factor in disorders such as asthma, lupus, and rheumatoid arthritis, as well as in tendinopathies caused by microdamage in the collagen fibers, followed by an acute inflammation, which can evolve to chronic inflammation if healing processes are disrupted (Solomonow, 2012).

Overuse tendinopathies are a common cause of pain and disability in athletes. These conditions occur as failed healing responses to overuse tendon injury (Battery and Maffulli, 2011; Del Buono et al., 2011). Substance P (SP) is a neurotransmitter involved in the transmission of pain impulses from peripheral receptors to the central nervous system.

Substance P may be produced by primary fibroblastic tendon cells called tenocytes (Backman et al., 2011). When tendons are submitted to mechanical loading, substance P production is increased. Massage may suppress substance P levels (Field et al., 2002). If this is the case, then massage might be beneficial in the reduction of pain perception.

Having a massage after strenuous exercise appears to reduce inflammation in muscles at the cellular level. Massage may reduce the activity of inflammation-inducing proteins called cytokines in muscle cells. Massage may alter genes, thus reducing inflammation and supporting muscle adaptation to exercise (Crane et al., 2012).