Osteomyelitis

Recognition

Presentation: Sudden onset of localized bone pain (often severe and constant), fever, chills, and malaise. Localized swelling, warmth, erythema, and tenderness over the affected bone. Restricted movement of the adjacent joint
Populations at risk: Children (hematogenous form — long bone metaphyses). Older adults with vascular compromise (vertebral osteomyelitis). Individuals with diabetes (foot osteomyelitis from contiguous spread). IV drug users. Immunocompromised individuals. Post-surgical patients
Chronic form: Intermittent pain, draining sinus tracts, and recurrent episodes. Dead bone (sequestrum) harbors bacteria and resists antibiotic penetration
Vertebral form: Insidious back pain without fever, mimicking mechanical back pain — a dangerous mimic
Key pathology: Bacteria trigger acute inflammation with edema. Increased intraosseous pressure compresses blood vessels causing ischemia and necrosis. Dead bone fragments (sequestra) become isolated, harboring bacteria. New bone (involucrum) forms around sequestra as a periosteal response

Absolute contraindication: Do not massage over or near the infected site during acute osteomyelitis. Do not compress, mobilize, or apply heat to the region
Systemic massage: May be performed on unaffected regions only if the client is medically stable and cleared by their physician
Chronic in remission: Local massage may be cautiously considered only with physician clearance and no active drainage or inflammation
Active draining sinuses: Remain an absolute local contraindication regardless of chronicity

Red flag recognition: Unexplained deep bone pain with fever, especially in children, diabetic patients, or post-surgical clients — refer immediately
Do not treat locally — bone infections can progress rapidly to life-threatening sepsis
When in doubt, refer — this condition is outside MT scope to diagnose or manage

Osteomyelitis is a bacterial bone infection most commonly caused by Staphylococcus aureus. Acute osteomyelitis is an absolute contraindication to local massage
The hallmark presentation is localized bone pain with fever, swelling, and warmth — a red flag requiring immediate medical referral
Dead bone (sequestrum) harbors bacteria and resists antibiotic penetration, making chronic osteomyelitis difficult to eradicate
Vertebral osteomyelitis can mimic mechanical back pain (insidious back pain without fever) — a dangerous diagnostic pitfall
Systemic massage requires physician clearance. Active draining sinuses are an absolute local contraindication