Massage Foundations 1-4 Levels PDF

1 Massage Foundations – Levels 1-4 Introduction: Welcome to the massage foundations and techniques course of study. The following notes will be used for the 4 levels which comprise this comprehensive study of massage and its foundational techniques. Subject Description: Massage Foundations 1-4 presents the background and theory for therapeutic massage, along the application of basic/foundational skill techniques. These 4 levels of study include:  an overview of the history of massage therapy  the effects of massage on the body’s system  the technical components of massage  using proper body mechanics and contra-indications to massage Manuals/Reference Materials: Class notes; List of contraindications and modifications CMTO document ‘Where’s My Line?’ Manuals: Class notes; List of contraindications and modifications; CMTO document ‘Where’s My Line?’ Method of evaluation: Advanced techniques principles of treatment 1 - 4 Type Number % value Part A Oral/practical: Oral/Practical midterm exam 1 30% Oral/Practical final exam 2 60% Oral/practical informed consent 1 10% _____ 100% Part B Written portion Written Midterm exam 1 30% Written final exam 1 50% Assignments/Quiz 1 10% Informed Consent 1 10% _____ 100% For subjects offered in the weekend format, there will be a different grading system, as each level will contain an examination. The grading format will be advised at the start of the first unit of study. Each unit of study is an independent subject. © 2021 International Academy of Applied Health Inc. 2 Objectives: Throughout this course the student will: 1. Develop a complete and thorough understanding of the fundamentals of massage theory, terminology and the practice of Swedish massage. 2. Gain an appreciation of the breadth & depth of massage both historically and globally. 3. Understand how massage influences the body systems. 4. Demonstrate proper body mechanics and draping procedures using Swedish massage techniques to perform a full body massage. 5. Begin to garner an understanding of the contraindications and modifications to massage. 6. Gain knowledge of massage equipment and tools, and their safe use. 7. Appreciate the importance of having professional boundaries and behaving ethically. © 2021 International Academy of Applied Health Inc. 3 Table of Contents History of Massage 4 Geographic influence in the evolution of massage 5 Forbearers of massage therapy in the West 14 Definition of Massage Therapy 16 Terminology for massage techniques 18 Equipment 19 What you bring to the table 28 Practice What You Preach 30 Body Mechanics and Self Care 31 Major Muscle Groups 38 Principles of Massage 40 Technical Components of Massage 42 Effects of Massage on Body Systems 46 Contraindications and cautions for massage therapy 49 Swedish Massage 58 Effleurage 58 Petrissage 60 Tapotement 64 Rocking and Shaking 67 Stroking 68 Vibrations 69 Massage can have a relaxing and stimulating effect on body 71 Draping 72 Endangerment Sites / Areas of Caution 76 Sensitive areas 78 Hygiene 81 Informed Consent 87 Boundaries in the therapeutic relationship 88 Some Questions About Yourself 96 Relaxation and Stress Reduction 97 Appendix: Where’s My Line © 2021 International Academy of Applied Health Inc. 4 History of Massage The practice of using ‘touch’ as a healing modality dates back at least 5000 years and, quite possibly, back to the origin of human history. The use of massage (though it was not called massage in earlier times) can be traced to the customs and traditions of various cultures and various nations in and around a similar historical timeframe. While the history of ‘therapeutic bodywork’ can only be dated back to the beginning of written history, it seems that it is instinctual for us to use touch in some capacity for comfort and healing. One example of this is the immediate impulse to put our hand on our sore stomach or injured arm. Civilizations throughout the world believed that massage could reduce stress, heal injuries, prevent, and reduce pain and prevent and even cure illness. It has been employed as a remedy, as a hygienic method, as a luxury and sometimes, it had a symbolic religious sense - not unlike how it continues to be used today. History demonstrates to us that the development& evolution of massage has been truly a global endeavour and widely influenced by several cultures. This insight provides a connection to the deep and far-reaching roots of the massage therapy profession and to the endurance of the acceptance of touch for the purpose of healing and personal wellness. It is a reminder for one to appreciate that the healing & wellness benefits provided by massage, encompass the body, mind, and the spirit. Prehistory (before recorded history) Though there is little evidence that massage was used as a healing modality before recorded history, it seems likely that it was. Humans and other animals seem to have an instinct to hold, squeeze and stroke to comfort and soothe. When we have a stomachache, we tend to put our hands on our stomachs, if we fall and hurt our arm, we will tend to hold our arm, if a loved one is in emotional pain, we may rub their arm or put a hand on them or hug them. It can be said that it is instinctive for us to touch for healing purposes and that it likely always was. Evidence from many countries suggests that prehistoric people massaged their muscles and rubbed plants, herbs, oils, and various substances on their bodies to heal and provide protection. In many cultures, “special healers” were said to have powers of healing by touch. There are cave paintings in Egypt from around 1500 BCE depicting massage. © 2021 International Academy of Applied Health Inc. 5 Geographic Influence in the Evolution of Massage Massage in India Massage in India can be traced back to at least 3000 BCE and written records of massage as part of the Ayurvedic system of healing have been traced to 5000 BCE.  Ayurveda is the traditional holistic medical system that focuses on restoring an individual’s internal mental and physical balance by reestablishing internal harmony with an individual’s outer world.  Ayurvedic treatments include nutrition, herbalism, sound therapy, colour therapy, aromatherapy and touch therapy. Approaches to bodywork include:  Garshana, silk-glove lymphatic massage  Abhyanga, full-body herbalized oil massage  NetraBasti, an Ayurvedic eye treatment  Shirodhara, a forehead massage using oil  Vishesh, a deep muscular herbal oil massage. Ayurvedic massage encompasses a body mind approach with a focus on restoring circulation so the body can renew and expel toxins and to induce deep relaxation so the body can rest and heal. Oils are selected for an individual’s constitution and are used to reduce friction, disperse heat and provide nutrition for the skin. For more information about Ayurveda: Go to: http://www.sanatansociety.org/ayurvedic_massage.htm © 2021 International Academy of Applied Health Inc. 6 Lakshmi Massaging Vishnu’s Feet © 2021 International Academy of Applied Health Inc. 7 Egypt and China Massage in Egypt and China has been recorded since 3000-2500 BCE. These are the earliest written records of massage that have been found. As previously mentioned, there are cave paintings in Egypt dating back to 1500 BCE. Depicted below is a painting of a prominent member of society whose burial site is called The Physician’s Tomb. It dates to 2330 BCE and shows images of people receiving hand and foot treatments. Egyptians are credited in some literature with creating reflexology, which is a system of massaging the feet and hands, based on a representational map of body found on the foot and hand. 5500 years ago, the use of aromatic oils (now referred to as essential oils or aromatherapy oils) was recorded by an Egyptian physician/architect called Imhotep. Image from Ankhmahor’s Tomb Egyptian Tomb Painting – artist’s interpretation © 2021 International Academy of Applied Health Inc. 8 Evidence suggests that reflexology was also being practiced in China at this time and that similar healing systems were later used in early Japan, India and Russia and then the Roman Empire and Greece. Interestingly, reflexology was practiced in China as a complementing part of Acupuncture. It is described in the Chinese medical text, the Yellow Emperor's Classic of Internal Medicine, where it is called the Examining Foot Method. A Japanese monk studying in China is given credit for introducing reflexology to Japan upon his return home. In China today, reflexology is accepted by the central government as a means of preventing and curing diseases and preserving health. Over 300 research studies have shown reflexology provided some improvement to 95% of the over 18,000 cases covering 64 illnesses studied. In Japan and Denmark, reflexology has been incorporated into the employee health programs of several large corporations. Massage in China developed from knowledge from Traditional Chinese Medicine, martial arts, Buddhist, and Taoist teachings that viewed massage as essential to spiritual growth. One type of massage practiced is tui na, which means pushing and pulling. It is a form of physical medicine that uses the meridians (energy channels) and various acupuncture points, with the aim of healing disease by addressing the root cause(s). Other approaches include guasha, amno, acupressure and as previously stated, reflexology. For more information about Chinese massage methods see: www.tuina.ca (see section called ‘massage videos’) Reflexology is taught in the International Academy of Natural Health Practitioners and Oriental Acupressure + Tuina is part of the Acupuncture Practitioner diploma presented by the International Academy of Traditional Chinese Medicine. © 2021 International Academy of Applied Health Inc. 9 Japan The Japanese started recording massage around 1000 BCE. It is thought that Japanese monks living in China began to import and practice Chinese massage techniques that they evolved into traditional Japanese massage known as Shiatsu. Shi meaning “finger” and atsu “pressure” has the goal of restoring healthy energy flow throughout the body. According to the theory, treatments have a regulating effect on the body’s autonomic nervous system and, thereby, improve the function of the organs and reduce muscle tension. Shiatsu is a holistic treatment focused on the whole body rather than applied to where the symptoms are most obvious. It is no longer taught in Ontario. The reason for this has nothing to do with its benefits and healing capabilities; it is due to the current Ministry requirement for it to be only taught as a 2200-hour diploma which leads a practice that is not recognized by most insurance/benefit plans or by the regulated health professions. The final remaining school stopped its program in 2017. For more information about Shiatsu: Go to: www.Masteracupuncture.ca © 2021 International Academy of Applied Health Inc. 10 Europe and North America Massage has endured cultural shifts in the West that transformed it from being perceived as a spiritual, mental, and physical form of healing to the idea that it was frivolous and indulgent and even sinful in the atmosphere of religious dogma. In the last few centuries, it has made its way back again to where it now establishes itself as a respected and powerful healing method. In ancient Greece, athletes and physicians practiced and promoted massage beginning around 800 BCE. Massage was performed by slaves, who treated athletes prior to competitions, to keep their bodies in peak condition. Physicians of the time such as Hippocrates (460 to 377 BCE), often referred to as 'the father of medicine’, used massage techniques with herbs with oils to treat many medical conditions. He stated, "Anyone wishing to study medicine must master the art of massage and he referred to medicine as ‘the art of rubbing”. Alexander the Great’s soldiers were credited with spreading tshampon (Sanskrit for head massage”) in the Mediterranean upon returning from India in 327 BCE. Slaves massage athletes in Ancient Greece © 2021 International Academy of Applied Health Inc. 11 The Romans learned many massage techniques from the Greeks and began using them in 200-100 BCE. Possibly the most famous Greek physician in Rome, Claudius Galenus (130 – 201 CE), otherwise known as Galen, was a follower of Hippocrates. Galen revolutionized anatomy and medicine and wrote many books on the subject. In one of his books, Hygiene, he went into some detail promoting the use of morning and evening massage with oil for health and wellbeing. After the fall of the Roman Empire sometime in the 5th century, massage was not practiced much in Europe until the Renaissance in the late 15th century when bodywork grew in popularity again as knowledge of anatomy advanced. A physician by the name of Paracelsus believed that emotions lay trapped in the body and that bodywork and hot springs could help to get them out. Native Americans also used heat and massage with herbs to treat many symptoms. The Cherokee and Navaho were among many tribes who rubbed their warriors before they went to war and when they returned. Massage was used to ease the labour pains of women and colic in infants. Europe and North America – 19th Century to Now From the late nineteenth century through to about World War I, a great number of physicians wrote books and articles about the Swedish Movement Cure, mechanotherapy, massage and Medical Gymnastics. Massage was used extensively in sanitariums and taught to nurses. The first professional organizations (which would evolve into today's professional organizations for physical therapists) were founded. But shortly after World War II, massage had largely been dropped from physical medicine and its status went back to being viewed as an alternative health practice. Instead, the field of physical therapy continued with the exercises from gymnastics and new electrical methods that were less labour intensive than massage. The father of Swedish massage, Per Henrik Ling (1776-1837), developed a system of medical gymnastics that included manual therapy. Ling established The Royal Central Gymnastic Institute in 1813 in Stockholm. The most famous physician embracing massage was certainly Dr Kellogg. Dr. Kellogg published The Art of Massage in 1895 that sold, along with following editions, some 27 000 copies. His book explains the physiological effects of massage as well as the effects of Ling’s Medical Gymnastics. © 2021 International Academy of Applied Health Inc. 12 Canada In 1919, The Ontario Board of Regents first regulated the practice of massage. Under the Drugless Practitioners Act, the massage profession was further validated in 1935. In 1991, the Regulated Health Professions Act was passed in Ontario. The College of Massage Therapists of Ontario (CMTO) has been regulating the practice of massage therapy since 1919. In 1994, the Drugless Practitioners Act was revoked and the RHPA was proclaimed. This provided the governmental framework for the issuance of the Massage Therapy Act in 1991 and provided the modern-day platform to define and formally control and regulate the profession by reserving the use of the name, massage therapist and the phrase, massage therapy, specifically for registrants of the CMTO, as well as establish entry-to-practice competencies. Currently, massage therapy is fully regulated in five provinces: Ontario, British Columbia (1946), Newfoundland and Labrador (2002) and New Brunswick (2014), and Prince Edward Island (2019). Dedicated Colleges of Massage Therapy have several responsibilities in their mission to protect the public, under the RHPA mandate.  Sets and maintains standards for eligibility to enter the massage therapy profession in their province  Sets and maintains standards for the practice of massage therapy in their province  Sets and maintains standards for who may use the Registered Massage Therapist title and other similar titles that will be specified under the Act  Provides the public with a higher level of protection  Provides the public with a means to confirm whether or not an RMT is eligible to practice in their province  Provides the public with a means to register a concern or complaint regarding treatment they’ve received from an RMT in their province  Provides other healthcare providers with reassurance to be able to make more appropriate referrals to qualified RMTs. Status of Regulation - Other Provinces:  Alberta has been over 13 years since the massage therapist associations started into the process of acquiring government approval and legislation. Since there are divisions in the philosophy of regulation among various associations, it will take time for regulation to evolve.  Saskatchewan passed the Massage Therapy Act in December 2020 to commence the regulation of massage therapy and to form the Saskatchewan College of Massage Therapists. This College is now in the early stages of formation.  Manitoba moved towards the regulation of massage therapy in November 2015 and in 2020 the Provincial Massage Therapy Association and the Natural Health Practitioners of Canada Association submitted their rough draft for Ministry review of the Regulation Workbook. It will likely take © 2021 International Academy of Applied Health Inc. 13 another 2 years to invoke regulation and to commence the initiation of the formation of a regulatory college.  Nova Scotia took its first step to regulate Massage Therapy in 2019, so it has recognized the need for regulation, however, it will take time to evolve.  Quebec is not regulated, and the practice of massage is overseen by private member associations of which there are many (e.g. 34 in 2018). There is no timeline for regulation in the Province at this date. The future freedom of movement across Canada to practice. The Colleges in these provinces have worked together to develop a set of inter- jurisdictional competencies to create federal standards for the massage therapy profession in Canada. What that means for RMTs/MTs is that they will be able to practice in any regulated province without taking more challenging exams or formal courses—likely just an update on specific provincial laws and regulations. Since unregulated Provinces like Alberta accept the Ontario training, only a City license approval is required to work in that province. So—the barriers to inter-provincial movement are falling year by year. Massage has a long and rich history as a mode of physical, mental, and spiritual healing in various cultures. While it evolved a great deal over the centuries, it has grown exponentially in the West in the last 50 years. It is becoming woven into the fabric of healthcare as research validates its efficacy. © 2021 International Academy of Applied Health Inc. 14 Forbearers of Massage Therapy in the West Hippocrates: (460-377BCE) Greek physician and “father of modern medicine” advocated for the use of massage. Ambrose Pare: (1510-1590) French surgeon (not physicians at the time!). Credited by some to have revived the use of massage therapy to speed healing post-surgery. Per Henrik Ling: (1776-1839) Developed Swedish Massage. After he learned the French and German’s system of gymnastics and strengthening the body, he extrapolated from that but changed the focus from developing muscular strength to the harmonious development of the body. In addition to the active movements of gymnastics, his system included passive movements: spanning, stemming, holding, balancing, rocking, Russian swinging, perpherical, pendulum, swinging, pressing, squeezing, ligature, shaking, knocking, tapping, clapping, chopping, sawing, kneading, stroking, frictions, standing, and walking. We can see a number of these ‘movements’ in the pages of these notes. Dr Johann Mezger: (1839-1909) Dutch physician. Credited by some with bringing massage back to the attention of the 19th century medical community. His specific contribution to Swedish massage history was to reduce the numerous passive movements of Ling's system into 4 basic strokes and give them the (French) names still used today: effleurage, petrissage, friction and tapotement. Dr Janet Travell: (1901-1997) American physician and medical researcher. She is remembered as President John F Kennedy’s personal physician and as the researcher of Trigger Points as a cause of musculoskeletal pain. Dr Ida Rolf: (1896-1979) American. PhD in biochemistry. Developed an approach to manual therapy called Structural Integration which later became know as Rolfing. The core principle of this modality is organizing the human bodily structure in relation to gravity. © 2021 International Academy of Applied Health Inc. 15 Dr Emil Vodder: (1896-1986) Danish. PhD in Historical Art and 8 semesters of medical school completed (but had to leave due to malaria), pioneered the specialty of lymphology. He developed a system of careful hand movement that stretches and twists the skin to move the lymph. His method is still taught in its unaltered form today and is the gold standard for Manual Lymphatic Drainage. Dr James Cyriax: (1904-1985) British osteopath known as the “father of orthopedic medicine”. He developed a system of assessment based on using passive and resisted range of motion to test soft-tissues. He is well known for developing a technique called cross-fiber friction to reduce fibrosis and encourage the formation of strong, pliable scar tissue at the site of healing injuries. Sebastian Kneipp (1821-1897) Bavarian Priest and Dr John Harvey Kellogg (1852-1943) American medical doctor are both credited with, among other things, developing modern hydrotherapy techniques. © 2021 International Academy of Applied Health Inc. 16 Definition of Massage Therapy An individual, may practice other forms of massage, such as relaxation, Thai, aroma or spa without registration within the Province, however, the practice of ‘massage therapy’ or for one to refer to themselves as a ‘massage therapist’, he/she must have passed a comprehensive program of study and met the entrance-to-practice competencies as established by the provincial regulating body. Let’s examine what massage therapy actually means and why it continues to be such an important resource to help change people’s health conditions. In Ontario, Massage Therapy is legislated by The Regulated Health Professions Act, 1991 and The Massage Therapy Act, 1991. In it, a massage therapist’s scope of practice is defined in the following way: The practice of massage therapy is the assessment of the soft tissue and joints of the body and the treatment and prevention of physical dysfunction and pain of the soft tissue and joints by manipulation to develop, maintain, rehabilitate or augment physical function, or relieve pain. (Massage Therapy Act, 1991) The key differences from all other forms of massage is the massage therapist has the ability to assess, establish a treatment plan, inform the client about the benefits and any side effects, understand the impact of the treatment plan on the anatomy, physiology or the specific pathology and then perform the skilled techniques, advise the client of post treatment home exercises to support the goal of the treatment and by the end of the treatment plan, likely to have improved the client’s/patient’s health condition. A massage therapist often works in conjunction with other regulated health professionals to jointly work co-operatively together to help the health of their co-patient. While other forms/practices of massage have benefits felt by the client immediately afterwards, they are generally forms of body relaxation applied through various practices of touch and smell and are not viewed to be therapeutic in nature, nor to be changing a person’s day to day health condition. Thus, they are not regulated. History of the Profession in Ontario Massage Therapy came into increased prominence during World War I, as Canada helped to care for its soldiers overseas. Among the many makeshift hospitals set up at this time were orthopaedic centres offering hydrotherapy and massage. During the war, nearly 2,000 soldiers were treated daily with massage, establishing Massage Therapy as a necessary and valued form of health care. The Toronto class of 1917-1918 graduated 70 women and six men. The College of Massage Therapists of Ontario has been regulating Massage Therapy in the province since 1919. In 1919, The Ontario Board of Regents first regulated the © 2021 International Academy of Applied Health Inc. 17 practice of massage. At that time, leaders in the massage profession organized efforts to petition the government to raise the level of protective legislation. The Ontario Government expanded the professional recognition of massage therapy in 1935 through enactment of a specified set of regulations for the practice of masseurs under the Drugless Practitioners Act. After 72 years of regulation under the Drugless Practitioners Act, the Regulated Health Professions Act, 1991 was passed in Ontario and the College of Massage Therapists of Ontario was established to govern the profession replacing the Board of Directors of Masseurs. Subsequently, the Regulated Health Profession Act was proclaimed in 1994 and the Drugless Practitioners Act revoked. The College of Massage Therapists of Ontario (referred to as the College, or CMTO) is the not-for-profit organization established by the provincial government to regulate the conduct of Registered Massage Therapists (RMTs) in the province of Ontario through the provisions of the Regulated Health Professions Act, 1991 (RHPA). Its mandate is to ensure the public interest is placed at the centre of all College activities. This means that the focus is maintained on consumer needs including the right to the provision of high quality, safe and ethical health care and that Massage Therapists are held accountable for the care they provide to the public of Ontario. In short, the principal role of the CMTO is to “protect the public”. The CMTO describes massage therapy to the public as follows: Massage therapy consists primarily of hands-on manipulation of the soft tissues of the body, specifically, the muscles, connective tissue, tendons, ligaments and joints for the purpose of optimizing health. Massage therapy treatment has a therapeutic effect on the body and optimizes health and well-being by acting on the muscular, nervous and circulatory systems. Physical function can be developed, maintained and improved; and physical dysfunction and pain and the effects of stress can be relieved or prevented through the use of Massage Therapy. To this end, the College has developed Massage Therapy Competency Standards and Standards of Practice, documents that describe the knowledge and skills of a RMT as well as the tasks and techniques that are within the “scope of practice”. These documents can be found on the College’s website: http://www.cmto.com/for-the-public/about-the-profession/policies- publications/standards-of-practice/ © 2021 International Academy of Applied Health Inc. 18 Terminology for Massage Techniques Prone - lying face down Supine - lying face up Draping - covering a client’s body with a sheet or towel Undraping - removing the sheet or towel to uncover the area to be treated Indication - when it is appropriate to perform a type of therapy Contraindication - when it is not appropriate to perform a certain therapy Caution/Precaution - extra care or caution is required with certain therapy Mechanical Effect - a direct effect on the tissues being treated Reflex effect - an effect on tissue or a system away from the site being treated Palpation - touch for assessment or landmarking Effleurage - a gliding technique over the surface of the skin affecting the circulation of blood and lymph Petrisage - a technique characterized by alternating pressure and relaxation often with a pumping action Tapotement - percussive technique Anatomical and medical terminology will be covered in both Anatomy/Physiology and Terminology classes. © 2021 International Academy of Applied Health Inc. 19 Equipment Massage tables Definitions: Table - apparatus on which a client lies as we perform a massage Face Cradle – apparatus to support the face, head and neck in prone Massage tables come in a variety of arrangements. They are of various widths and lengths; some have wooden legs and others metal. There is the stationary type or a portable style. There are hydraulic or manual tables that are height adjustable and even some that split down the middle so one side can be adjusted to allow for seated comfort. Some tables have extra panels that can be easily added to the table to widen it or lengthen it. The choices are varied and so are the prices. The beginning therapist would be wise to select a sturdy and reasonably priced table to get started until he or she develops a good sense of preferences so he/she can make an informed choice about the table that is best suited to them. There are chairs built for massage as well. They support the torso, arms, head, and legs and are beneficial for clients who are unable to lie down on a table and for treating clients at public events. It is essential that you keep your table and face cradle clean by using a specified table cleaner between treating each client. It is important that your table is set to a height that is ideal for your body to optimize your ability to use proper body mechanics and prevent injury. If your table is too low, you may be placing undue stress on your lower back and if your table is too high, you may find that your neck and shoulders become overworked. A general guideline for optimal table height is to stand right next to your table with your arm hanging by your side. If you make a fist, the backs of your fingers will just brush the top of the table. © 2021 International Academy of Applied Health Inc. 20 Table maintenance is an essential safety component. The practitioner should be in the habit of checking and tightening the table’s cables and knobs before each day’s work. If the student finds a table, or any equipment, that is broken, he or she must bring it to the attention of the teacher, so that the proper paperwork can be filled out and the table can be removed from circulation to be repaired. The goal is to maintain a safe environment for students, faculty and the public. Table Set-Up  When setting up the table, place it in a manner that it will be suitable for you to work around the table  Place the head rest in a direction that will provide privacy and comfort for your client.  Ensure you have a towel to cover the pillow or place it (them) under the sheet o Avoid getting oil on the vinyl pillow covers and be careful to avoid ripping them  At off-site events, place the client's feet away from the receiving area  Set the height of the table to your comfort level * Clean the table and set the linens appropriately * Check to ensure the table is firmly set up and that all legs are stabilized o Push the table gently from either end to help check its stability o Place the step-up stool ready for the client and if you require a personal stool, ensure that it is ready 12 minutes before the appointment time o Why is a step-up stool helpful? It allows the client to safely, move up on to the table and prevents a person hopping up on to the table centre which will likely then significantly damage the table. If the client is unsure or unstable, hold their hand to add to their balance and confidence. o Ensure your client’s safety and protect your equipment.  Ask yourself - Is the table properly set up and safe for the client to get on?  Supervisory faculty will check tables for proper set up. o Improper set up can lead to demerit points. © 2021 International Academy of Applied Health Inc. 21 How to set up a massage table correctly:  Remove table from closet or carrying bag  Place table on its side, firmly on the floor in the clinic room making sure the floor area is clear  Release the latches at the end of the table – be careful not to catch your fingers  Fully extend the table and then fully extend the table legs  Remove any application parts such as head rests or armrests if they are stored inside the massage table  Using the table handles turn the table into an upright position  Adjusts the table legs to the appropriate height.  To assess the appropriate table height stand beside the table with arms hanging at your side.  The proximal knuckles of your hand will determine the proper height of your table.  To adjust the table height unscrew the adjustment knobs and raise or lower the table leg to the appropriate height  Screw the knobs back into the holes in the legs of the table.  Count of holes from the bottom of the leg to the bottom adjustment knob.  Make sure all legs are the same height for the massage table  When checking the security of table legs, check the leg screws and the adjustment knobs. Both the screw and the knob on each table leg should fit tightly together.  Each table leg should have 2 adjustment knobs.  Ensure the table vinyl has been cleaned properly after its last use – if not wipe it down to remove any noticeable oil or perspiration from the previous client  Always treat the pillows with sanitation in mind – clients and student heads/faces will rest on or lie on the pillow, so it is important to keep them clean and free of body odors © 2021 International Academy of Applied Health Inc. 22 Table Take-down  At the conclusion of the clinic/practice session, clean the table, stand back and look to see all visible oils and perspiration have been removed  Close it up and return it to its normal storage area.  Stack or place the table in an orderly fashion, so that it is ready for the next use by your student peers.  Return all pillows, equipment and stools to their appropriate storage areas  Clean your clinic area removing all papers and supplies  Inspect your area to ensure no item is near a floor heater  If you identified any table or equipment deficiency, please report it to the supervisor before storing the table or returning the equipment to storage. Give the table number (underside) to the supervisor. If the table deficiency involves the legs, ask the supervisor where to place the table for immediate repair…do not put it back into storage. © 2021 International Academy of Applied Health Inc. 23 Linens, Pillows and Bolsters A student receives 3 sets of sheets 3 face cradle covers and hand towels for their use throughout the course of studies. The student will use one set during hands-on class time and will be expected to use two sets when they are working in the school’s student public wellness massage clinic. (Semester #2). The Academy will provide the 3rd set for use during clinics. At the beginning of semester 4, another flat sheet is provided. (For weekend interest classes, the sheets will be provided by the Academy). Sheets, face cradle covers, and pillow covers that come into contact with the client must be washed with soap in hot water, in order to comply with sanitation regulations. Pillows or bolsters are used to ensure client comfort. They will be placed appropriately according to your client’s specific needs based on your assessment and the position you are treating them in. They are put between the bottom sheet and the table after your client has assumed her/his position on the table. Often, when a client is in the prone position, the therapist will place one pillow under their shins to reduce plantar flexion and one under the abdomen to reduce the lordotic curve. When a client is in side-lying position, the therapist will generally place one pillow under their head to keep their neck in line with the rest of their spine, one or two pillows under their top leg to keep their knees and ankles in-line with their hips and one pillow in front of the client’s torso that the client can ‘hug’ in order to prevent them from rolling forward. When a client is in supine, the practitioner places a pillow under the client’s knees and, if the client is seated, they are facing the table and several pillows are placed on the table so the client can lean on them for comfort. Bolsters and towel rolls may be used to enhance individual comfort and to place the body in a more neutral position, as you will learn throughout the program. Limbs that are swollen may be elevated using several pillows for drainage; a client with chronic bronchitis may be positioned to enhance drainage of the affected lobe using appropriate pillowing. © 2021 International Academy of Applied Health Inc. 24 Oil bottles Oil bottles may be made of glass or plastic, though it is advised that you use plastic during your studies to prevent the possibility of having to deal with broken glass. Pump or squeeze bottles are most desirable for hygienic reasons and the nozzles, pump exterior and the outer bottle area must be washed between each client. Hand tools There are a variety of hand tools on the market today designed to protect the therapist’s body from overuse and fatigue and to facilitate the use of deeper pressure. They are made from a variety of materials – mostly plastic or wood. It is recommended that you do your research and try to test out the tool before purchasing since individual needs vary and the tool may actually put undue strain on an unexpected area. (Consider that wood is a porous material and perhaps not a hygienic choice. ) Some examples include: The Thumbsaver The Indexknobber The Jackknobber © 2021 International Academy of Applied Health Inc. 25 The Standards of Practice: Infection, Prevention, Control © 2021 International Academy of Applied Health Inc. 26 Lubricants Some of the oldest mediums used by those who practiced massage throughout history included such items as: hog fat, lard, olive oil, alcohol, cloths, talc powder, rice powder, Vaseline, glycerin, lanolin, arnica oil, coconut oil, cocoa butter and natural mineral water - just to name a few. Lubricants help to decrease friction on the skin and reduce the potential for irritation. There are many different lubricants to choose from and experimenting with several will be the best way for you decide what your preferences are. Whatever lubricant you choose, be sure to select one that is hypo-allergenic and perhaps fragrance-free (as many people are sensitive to and allergic to scents). Remember to prevent cross-contamination from client to client by cleaning your oil bottle before/after each treatment. © 2021 International Academy of Applied Health Inc. 27 Here are some exploratory guidelines to follow: Oils  Have varying viscosities, absorption rates, odours, colours and nourishment values  Provide maximum glide when compared with lotions, gels or powders  Be aware that some clients may be allergic to specific oils – in particular, sesame and nut oils are relatively common allergens  Coconut oil is solid at room temperature so preventing cross-contamination takes extra care (cannot use a pump or a pour bottle)  Mineral oil tends to clogs pores  Corn, soy, olive can be ‘heavy on the skin’ and also it may make the client feel like they need to be wash/shower after the treatment  Almond and avocado oils can be expensive  Avocado oil can stain linens/clothing (as can others to varying degrees) Recommended Oils  Grape seed is light and fragrance-free  Jojoba is anti-inflammatory  Sesame is nourishing  Apricot is nourishing  Walnut oil is anti-fungal  Avocado oil is very rich and great for aging skin  Holly Oil Lotions  Absorb quite quickly into the skin, so must be reapplied often  Can be good for deep tissue work when less glide is desired  Check ingredients for potential allergens  Many lotions contain parabens and other undesirable ingredients Gels  Consistency is somewhere between and oil and a lotion  Absorbs more slowly than lotion  Not as much glide as oil  Check ingredients for potential allergens or undesirables Powders  Powders are used frequently as massage mediums in Ayurvedic medicine  They provide a small amount of glide  Mediums include cornstarch and clay © 2021 International Academy of Applied Health Inc. 28 What You Bring to the Table Some Ideas to Consider Intention The importance of your intention when approaching a therapeutic treatment with your client cannot be understated. Some researchers suggest that intention is the most important determinant of therapeutic effectiveness. Questions to ask when setting your intention prior to a treatment are: “Why am I here/treating this client? Who am I as a therapist? What is my role here? What do I hope to accomplish?” Intention has been described as “that mysterious ability and attitude that somehow allows us into the tissue” by David Zulak MA, RMT, who further states that “…if we cannot focus our intention we are often unable to be invited into the tissue” and hence less able to be of any help to our clients. Your intention can be as precise or as general as you wish and can be the same for all of your work or specific to each client or each treatment. One example of intention comes from Art Riggs, Advanced Rolfer and Deep Tissue massage practitioner and author of Deep Tissue Massage and Myofascial Release, who approaches his work with the intention “Let’s see if I can help here.” Other examples include “I intend to work with the body and not fight with the body” and “I intend to help this client reduce their level of pain.” The options are really endless. Presence Hand in hand with your intention, lies your ability to remain present and in the moment with your client. As a massage therapist, you need to find a way to keep your “stuff” at the door and bring a clear and focused mind to each massage therapy session. You will be absorbed and attentive to what you are doing, so you can constantly respond to what you are feeling and sensing. © 2021 International Academy of Applied Health Inc. 29 Knowledge/Skill One major advantage of the massage therapy program of study is the knowledge a student will acquire about the body in the fields of anatomy, physiology, pathology, and neuroscience. The skills developed about assessment techniques, massage techniques, treatments for specific injuries and issues, sports massage, remedial exercises will create the ability to combine knowledge and skill to create a treatment. Shortly into the program the student will understand muscle actions, joint ranges, muscle and fascial attachments, the relationship of muscles to one another and to fascia, ligaments, tendons, nerves, and bones. Furthermore, they will learn business skills, communication skills, research skills and more. All this knowledge & skill gleaned will combine to formulate your specific approach to massage therapy and will then be enhanced by what you personally bring to the table and to your client through your personal communication capabilities. Art and Intuition Learning to focus on quiet, subtle information that you are receiving during a massage such as a shift in your client’s breath, or a letting go of fascia or muscle or a limb can be seen as an element of the art of massage. Other impressions of the art of massage include viewing the body as clay to be sculpted or thinking of a massage session as a dance. Intuition is defined as knowing something without going through a conscious process of thinking. Using your intuition in the context of your work means, using your feelings and instincts to help guide your treatments. Hans Selye, a renowned Canadian researcher on the effects of stress, emphasized the importance of both intuition and science, since if there is not an idea first (intuition), there is nothing to research. Further, without research (science), an idea does not develop form and usefulness. One really does not function without the other according to Selye. © 2021 International Academy of Applied Health Inc. 30 Practice What You Preach When performing massage, understanding how to employ good body mechanics is wise. Massage is physically demanding, and the use of proper body mechanics will allow you to work more efficiently and effectively. It is not an overstatement to say that the quality of your body mechanics may determine the length of your career! As a massage therapist, you will be offering clients advice and guidance about taking care of themselves, reducing their stress, preventing, and recovering from injury. You will teach your clients exercises to do between visits in order to speed healing. It is essential that you practice what you preach not only to prevent burnout or injury but also because you will have a great deal more of yourself to offer your clients. This section we will briefly discuss self-care, body mechanics during treatment and stretching between treatments. Self-care Self-care includes such lifestyle factors as, getting enough quality sleep, eating nutritious foods, staying hydrated, stretching, strengthening, relaxing, having meaningful relationships and receiving massage therapy. Further self-care measures for massage therapists/practitioners include:  wearing appropriate footwear while working to protect the joints of the lower limb;  warming up and stretching before beginning your work;  taking breaks between clients to stretch the muscles you use most during treatment;  using self-massage and cold-hydrotherapy on your hands and forearms after a long day’s work. The ideal height of the table will depend on your height, they types of techniques you use and the size of your client. As you will recall the general rule to follow is that the tabletop should be at around the level of the therapist’s fist or fingertips. Start here and experiment with what works best for you. Sitting on a stool when possible during a massage session will help to prevent fatigue by allowing you to rest. Opportune times to sit are when treating the neck, hands or feet. © 2021 International Academy of Applied Health Inc. 31 One more note about self-care involves being aware of your intention as you practice. If you are approaching your work by trying too hard to please people, muscling your way through tissue, trying to do too much, fighting your client’s tension, or sacrificing your body to perform a particular technique, then perhaps you are setting yourself up for fatigue and injury. Another way to approach your work is to pay attention to your own body (being sensitive to changes or localized stresses) and to your client’s body cues (breath, clenching, etc.) and then strive to work with both in a conscious way. Body Mechanics and Self Care Definition: The application of kinesiology to the use of proper body movement in daily activities, to the prevention and correction of problems associated with posture, and to the enhancement of coordination and endurance. http://medical-dictionary.thefreedictionary.com/body+mechanics Body mechanics allow you to use your body in a careful, efficient and deliberate way using good posture, balance and using the strongest and largest muscles to perform the work. This section is meant to teach methods to help a practitioner work more efficiently in order to save energy and prevent injury. Using proper body mechanics will allow you to have a long and prosperous career that doesn’t get derailed or cut short by injury. Massage therapy has unique postural and physical demands and places repetitive demands on the forearms, wrists, hands, fingers and thumbs. Also at risk are the neck, shoulders, low back, knees, ankles and feet, particularly if you are using your body in awkward positions. Be Proactive A great idea is for you and your classmates to look out for one another and tell each other when you notice the use of poor body mechanics. Though you can always retrain yourself to modify your body mechanics, the best time to develop good habits is right now, as you are learning. Think about it as if you are learning how to play golf, or play the piano or a musical instrument –if you learn good mechanics at the outset, your ability to play and play for long periods or practice for concerts, will only get better. © 2021 International Academy of Applied Health Inc. 32 Guidelines The basic concept of reducing strain on your body is to use gravity rather than strength to deepen your techniques. By leaning you are significantly reducing muscle tension around the joints of your neck, shoulders, elbows, wrists, fingers, thumbs, and lower back.  Your feet should provide a wide base of support in an asymmetrical stance.  As you lean into your strokes, the weight should primarily be on your back leg.  Use your body weight to apply pressure rather than your muscle strength  Keep your shoulder, elbow and wrist joints in-line with one another.  Your hands and wrists should remain relaxed throughout.  Incorporate motion and variety into your massage Protect your wrists by minimizing the wrist angle and staying behind your strokes rather than on top of application. © 2021 International Academy of Applied Health Inc. 33 Protect your fingers and thumbs by minimizing your use of them and by keeping them neutral, relaxed, and reinforced. Protect your neck and shoulders by avoiding looking at what your hands are doing and instead keeping your neck in line with your spine and your head in a neutral position. Protect your low back by ensuring that your table is not too low and/or by bending your knees to get lower rather that flexing your low back to get lower. Protect your knees by keeping them in-line with your toes and not bending them past your toes. © 2021 International Academy of Applied Health Inc. 34 © 2021 International Academy of Applied Health Inc. 35 © 2021 International Academy of Applied Health Inc. 36 Stretching Your body needs activity to maintain good circulation, endurance, and strength. Ideally you have or will develop a strength and conditioning program that works for you. The following are some stretches for your upper limb - parts of your body that you will use most repetitively during practice. Remember to only stretch a warm muscle (so after a shower, after treating a client, after exercise, after massage or some self-massage); a stretch should not be painful – go to the point of a mild to moderate stretch sensation; you should hold each stretch for a minimum of 15 seconds. © 2021 International Academy of Applied Health Inc. 37 © 2021 International Academy of Applied Health Inc. 38 Major Muscle Groups Later in your program of studies you will learn the muscles in detail. For now, just referencing these pictures while you are working on your classmates can help you to begin to get a sense of what muscles lie under your hands. Overview of the Superficial Muscles of the Body © 2021 International Academy of Applied Health Inc. 39 © 2021 International Academy of Applied Health Inc. 40 Principles of Massage A massage therapist will follow four sequencing principles when applying the techniques that they use for a massage treatment. The principles describe the direction and progression of techniques and keep the massage fluid, comfortable, effective and safe for the client. The principles are as follows:  GeneralSpecificGeneral  Superficial Deep Superficial  Proximal Distal Proximal  Peripheral Central Peripheral GeneralSpecificGeneral Superficial Deep Superficial These principles work together and refer to how a group of techniques are applied to a part of the body. First the therapist uses general (broad) and superficial (light) techniques and then gradually uses more specific and deeper techniques and then returns to general and superficial strokes. The benefits of these two principles are:  The client gets accustomed to the therapist’s touch which helps to allow the therapist to use deeper pressure later without it feeling painful or invasive  They allow the therapist to palpate different layers of tissue systematically  They prepare the tissue by increasing local circulation  Using them reduces SNS (sympathetic nervous system) firing (aka fight or flight response) because doing is predictable and systematic  Using them helps to reduce the chances of kickback pain (post-treatment soreness) Proximal Distal Proximal This principle refers to how techniques are applied to the limbs (arms and legs) to increase circulation of blood and lymph. © 2021 International Academy of Applied Health Inc. 41 When techniques are applied to the limbs, they are first applied to the proximal limb (closest to the trunk) to reduce hypertonicity and restrictions in these tissues to open up the area to receive more circulation from the lower part of the limb. Remember, the direction and pressure of circulatory techniques work towards the heart. Benefits of this principle are:  Increased venous and lymphatic return  Increased local circulation of blood and lymph Peripheral Central Peripheral This principle is used when dealing with acute and subacute local injuries and when dealing with scar tissue or with a painful area. The therapist first works around the periphery of the area and then gradually moves more central and then back out toward the periphery. The therapist can get closer to the center during the same treatment or over the course of several treatments. Benefits of this principle include:  Removal of toxins and waste products  Facilitates breakdown of scar tissue since it is less adhered at the edges  Helps reduce the chance of post-treatment soreness  Helps reduce the sensation of discomfort when an area is painful or a client is apprehensive © 2021 International Academy of Applied Health Inc. 42 Technical Components of Massage Each massage stroke that you perform can be classified in the following ways. You should be aware of how your technique measures in each of these categories, as variances will affect the outcomes you achieve. Keep reading! The components are:  Rate  Rhythm  Duration  Pressure  Direction  Contact Rate The rate of your stroke means its speed. Generally speaking, the faster you are moving, the more stimulating the effect while the slower you are moving, the more relaxing its effect. Rhythm This component refers to the overall fluidity of your strokes. Is your rhythm even and steady or erratic and choppy? An even and steady rhythm is predictable to your client’s nervous system and is therefore soothing and relaxing while, as you can imagine, and erratic or choppy application of technique is unpredictable and will keep a client’s nervous system on alert and impede relaxation. Duration The time you spend performing a particular technique, working in a specific area of the body, or performing the entire treatment is discussed as the duration of treatment. Very often a relaxation massage will last for 50 minutes to one hour. Pressure The amount of force applied directly over a client’s tissue is referred to as pressure. A therapist should be careful not to apply to much pressure over bony areas such as the ribs. Further a therapist should strive to use their body weight and gravity to apply pressure rather than using muscle force. Doing so will protect the therapist’s body and also be better received by the client’s body. © 2021 International Academy of Applied Health Inc. 43 Direction As a rule, the direction in which techniques are applied is generally towards the heart in Swedish massage. Particularly when discussing circulatory techniques, our emphasis is on increasing lymphatic and venous return towards the heart. There are a few exceptions to this rule that you will learn later in your program. For now, all techniques that involve long strokes should be performed towards the heart. Contact When performing Swedish massage, you will do your best to maintain contact with the client’s body at all times. All contact should be intentional. Incidental contact such as leaning against a client’s arm or head or allowing your clothing to brush against a client’s skin should be avoided. Generally speaking, the broader your contact, the lighter the pressure will feel and the more specific your contact point, the deeper the technique will feel. Palpation Definition: Examination by application of the hands or fingers to the external surface of the body to detect evidence of disease or abnormalities… Taber’s Cyclopedic Medical Dictionary Touch receptors, known as mechanoreceptors, in our skin receive tactile information from our environment such as texture, pressure and vibration. Believe it or not, there are approximately 100 such receptors in each fingertip! As massage therapists, we are continuously taking in information through palpation. It is part of our pre-massage assessment and an ongoing part of each treatment. Our hands can perceive very subtle shifts and changes. As we work with a client, we are feeling for the health of the muscles and soft tissues of the body. Soft tissues include tissues that support, connect, or surround other structures in the body and include but are not limited to, skin, muscles, tendons, ligaments and fascia. The information that we acquire from palpation perpetually informs our clinical decision- making. The skill of palpation is developed through experience and will continue to improve throughout your career. Like any skill, it takes a lot of practice. The more people you can © 2021 International Academy of Applied Health Inc. 44 work with, both during your training and then in the field, the more you will be able to compare tissues and the more precise you will become. According to author, massage instructor and chiropractor Joseph E Muscolino, “muscle palpation is so integral to the field of massage therapy that it’s likely that the massage therapy profession leads all other health fields in muscle palpation skills.” (AMTA Journal 2010) When we are assessing a client and as we apply massage strokes, we can interpret what we feel by using the structure of the “4 Ts” of palpation: Temperature, Texture, Tension and Tenderness All the information we gather will be recorded in our client’s file.  Temperature – This is best felt when sweeping just over the skin with the back of the hand as the back of the hand is very sensitive to heat. Is the tissue under your hands cold, cool, the same as other areas, warm or hot? Local coolness indicates reduced circulation and local heat may indicate inflammation.  Texture – The skin may feel smooth, rough, hairy, dry, oily, scaly, or bumpy. You can feel warts, moles, rashes, scars, varicose veins and lumps. You may feel calcification or adhesions under the skin which would feel rough and bumpy.  Tension – Often referring to the muscles, healthy tension feels smooth and consistent. Unhealthy muscle can feel like it has a guitar string running through it if only a few strands of muscle are in spasm or it can feel thick, taut or rope-like if the whole muscle is hypertonic (increased tension at rest). It can feel soft if it is hypotonic (abnormally low tension) or flaccid if it’s atonic (without tone)  Tenderness – Tenderness will be felt by your client who will report it to you either verbally or through body language. They may suddenly tense up, clench their fists or you may notice that their breathing becomes faster. Tender areas are very important to note in order to guide you in the right direction for treatment. Hands on: As you are practicing in class, try closing your eyes and “feeling” through your fingers and hands. Take note of what you are feeling…is the tissue hot, warm, or cool? Does it feel smooth or grainy? Do you feel areas that are ropey, taut, or soft? Does your client find any areas tender? Do these areas feel different to you? © 2021 International Academy of Applied Health Inc. 45 Tips: -The more relaxed your fingers, hands and arms are, the more you will be able to perceive. Use your body weight and not your muscle strength to apply pressure. -Take a few relaxing breaths before you begin as the more relaxed and focused you are, the more you will feel. -Be patient. This is a skill that takes a lot of practice. You will have ample opportunity to improve over the course of your program. Besides what you palpate, notice areas with colour changes – areas of paleness (or even bluishness) may have reduced circulation while areas of redness may be irritated or inflamed. Further, notice moles, lumps, and bumps. If you notice anything suspicious, gently refer your client to their physician. It is not uncommon to be the first to notice a lump, particularly on an area not readily visible to your client such as their back. Many lumps are benign so be sure not to frighten your client. By suggesting they point out any area of concern to their doctor during their next visit you are bringing their attention to the importance of the situation while calming the urgency of the situation. Try this exercise at home Further exploration: (with your eyes closed…)  Put a dime in a phone book under two pages. Locate the dime. Keep increasing the number of pages over the dime until you cannot feel it.  Try the same exercise using a hair instead.  Using a pair of dice and without looking at them, discern the number on each side of a die with your fingertips alone.  Put coins in your pocket or in a small sac and determine by touch the number of coins, their denomination and which side is heads and which side is tails.  Begin to let your senses become more engaged with your consciousness © 2021 International Academy of Applied Health Inc. 46 Effects of Massage on Body Systems The benefits and physiological mechanisms of massage therapy are being researched continuously by researchers, such as Tiffany Field at the Touch Research Institute at the University of Miami (http://www6.miami.edu/touch-research/) and The Massage Therapy Foundation (http://www.massagetherapyfoundation.org/). The Touch Research Institute has conducted studies demonstrating the effectiveness of massage in the following areas (and others): 1. Facilitates weight gain in preterm infants 2. Enhances attentiveness 3. Alleviates depressive symptoms 4. Reduces pain 5. Reduces stress hormones 6. Improves immune function Effects of Massage on the Body Systems Massage has been shown to have the following mechanical (direct) and reflexive (through the nervous system) effects on the body: Circulatory system Composed of the heart and blood vessels Mechanical:  Increases venous return back to the heart  Helps the heart to work more efficiently (increased blood flow stretches the ventricular wall which causes the heart to contract more forcefully to expel the blood. See Starling’s Law of the heart)  Increases the elimination of waste  Increases lymphatic return to the circulatory system Reflexive:  Over the long term can help to reduce blood pressure  Vasodilation of the arteries which leads to increased blood supply and therefore more oxygen and nutrients to the tissues © 2021 International Academy of Applied Health Inc. 47 Musculoskeletal system Consisting of skeletal muscle, bones and joints, ligaments, tendons and fascia Mechanical:  Reduces adhesions  Increases the length of muscle fibers  Increases secretion of synovial fluid of joints (increases nutrition to joint)  Increases range of motion of joints  Increases circulation to muscles therefore enhancing repair Reflexive:  Reflexively relaxes (or stimulates depending on application) muscle tone  Decreases muscle guarding  Decreases spasm  Decreases pain Nervous system  Made up of the brain, the spinal cord and nerves Reflexive:  Helps promote neural activity  Encourages relaxation (or stimulates alertness depending on application)  Can help reduce stress, anxiety, depression, insomnia Respiratory system  The lungs and air passageways Mechanical:  Assists with loosening adherent mucous Reflexive:  Results in deeper breathing as parasympathetic nervous system is stimulated  Increases amount of oxygen and nutrients to tissues of the body  Increases amount of carbon dioxide being released from body tissues  Increases exchange of gases between alveoli and blood © 2021 International Academy of Applied Health Inc. 48 Digestive system The digestive system is made up of the digestive tract—a series of hollow organs joined in a long, twisting tube from the mouth to the anus—and other organs that help the body break down and absorb food Mechanical:  Can help to move fecal matter in colon and relieve constipation Reflexive:  Helps promote peristalsis (muscular contractions of the GI tract) and therefore the elimination of wastes  Reflexively relaxes or stimulates deeper organs such as the intestines Integumentary system Involving the skin and subcutaneous tissue, hair, nails, glands. Mechanical:  Increases cutaneous circulation (skin appears red aka hyperemic)  Decreases adhesions between cutaneous and subcutaneous layers Reflexive:  Increases sebaceous (oil) gland activity Lymphatic System Mechanical:  Increases lymphatic drainage and the removal of wastes  May strengthen the immune system by increasing white blood cell count  Reduces edema of the extremities (arms and legs) Practical After receiving a massage, write down the objective and subjective benefits that you experienced from the massage. © 2021 International Academy of Applied Health Inc. 49 ►Contraindications and Cautions for Massage Therapy A contraindication means that massage therapy should not be used when a particular condition exists. A caution refers to a condition where the massage therapy application needs to be modified from the way it would be used on a healthy person. (These are very important terms to remember) The following list is extensive and will take some time to get comfortable with but it is essential that you memorize it. It is our utmost responsibility to keep our clients safe before anything else while they are in our care. Throughout your program of study, you will learn more specifically how to make the necessary modifications for specific conditions. For now, it is enough to know that a modification must be made. Absolute Contra-indications to General Conditions  Acute conditions requiring first aid, or medical attention  Acute pneumonia – difficulty breathing that is life-threatening – may be caused by bacteria or viruses  Acute seizure – over-firing of neurons in the brain, causing muscle spasms  Advanced kidney failure – inability of the kidneys to filter blood adequately  Advanced heart disease – loss of heart function due to enlargement, weakening, or coronary artery restrictions  Advanced respiratory failure – inability of the trachea or lungs to transport gases normally  Anaphylaxis – severe, life threatening allergic reaction when someone comes into contact with an allergen (e.g. bee sting, shellfish, peanut oil, aerosols)  Appendicitis – inflammation of the appendix, associated with great pain  Atelectasis – all or partially collapsed lung; lung cannot expand  Cerebrovascular accident – trauma to the head or neck affecting blood flow to the brain including but not limited to, stroke  Diabetes with complications such as:   gangrene – loss of circulation to one or more appendages, resulting in cellular necrosis  advanced heart disease – loss of heart function due to enlargement, weakening, or coronary artery restrictions   unstable high blood pressure – blood pressure which is known to fluctuate readily, such as large increases under mild stress © 2021 International Academy of Applied Health Inc. 50  Diabetic coma – a coma induced by extremely high blood sugar evels, from eating wrong type of foods & not getting exercise or taking insulin as required  Insulin shock – opposite of above, did not eat enough, exercised too much or too much insulin for amount of sugar in their blood  Myocardial infarction – heart attack (due to lack of oxygen/blood to the heart muscle)  Pneumothorax – collapsed lung, air escaping between lung & chest wall, can lead to “tension pneumo”- cardiac arrest, symptoms may resemble drug overdose or debilitating back pain  Severe asthmatic attack – inability to breath or extreme difficulty breathing, due to poor air quality or physical exertion in those that are susceptible  Status asthmaticus – difficulty breathing due to poor air quality or physical exertion, to those that are susceptible  Syncope – fainting  Unstable high blood pressure – blood pressure which is known to fluctuate readily, such as large increases under mild stress  Eclampsia– convulsions during pregnancy  Hemophilia – inherited condition where there is an inability of blood to clot  Hemorrhage– internal bleeding, usually of one or more major organs  Liver failure – inability of the liver to carry out, one or more, of its essential functions  Post-cerebrovascular accident where the condition has not stabalized – after a stroke or head injury where the client demonstrates signs of instability  Post-myocardial infarction where the condition has not stabalized – after a heart attack, where the client shows signs of instability  Severe atherosclerosis – client's arteries have been determined to be highly blocked/restricted  Severe, undiagnosed headaches in those over 50 – may be indicative of stroke activity  Severe, unstable hypertension – a blood pressure of 160/95, or above, that tends to fluctuate easily  Shock – protective state in which there is a reduction in blood supply to superficial areas of the body in order to ensure adequate supply to internal vital organs. Often includes denial, more serious resulst in lack of consciousness  Significant fever – temperature of 101.5 F or greater, resulting in brain damage or potential brain damage, depending on duration of the high temperature  Some highly metastatic cancers not judged terminal – an aggressive cancer (reproduces quickly) where the client may survive if removal and appropriate post- operative treatment prevent the spreading of cancer to other parts of the body  Systemic contagious/infectious condition – a condition that can spread from person to person, such as a cold or flu © 2021 International Academy of Applied Health Inc. 51 Absolute Contra-indications to Local Conditions  Acute flare-up of inflammatory arthritides such as:   Rheumatoid Arthritis - a chronic systemic disease marked by inflammation of multiple synovial joints  Systemic Lupus Erythematosus- a chronic auto-immune inflammatory disease involving multiple organ systems and marked by periodic acute episodes. Its name is derived from the characteristic erythematous “butterfly” rash over the nose and cheeks Ankylosing Spondylitis - a chronic progressive inflammatory disorder that involves primarily the joints between articular processes, costovertebral joints, and sacroiliac joints and occasionally, the iris or the heart valves  Acute neuritis – inflammation of the nerve/s  Acute trigeminal neuralgia – a disease of the trigeminal nerve (CNV) marked by brief attacks of severe lightning-like stabs along the distribution of one or more of its branches, but usually along the maxillary nerve. The attacks last from a few seconds to 2 minutes and may be triggered by touch, cold, chewing, brushing teeth, smiling, or talking. It occurs most frequently in persons over 40 and in women more often than men  Aneurism (life threatening) - localized abnormal dilatation of a blood vessel, usually an artery; due to a congenital defect or weakness in the wall of the vessel (life threatening would be in a vessel that impacts one or more vital organs)  Deep vein thrombosis - a blood clot in one or more of the deep veins of the legs (the most common site), or the veins of arms, pelvis, neck, axilla or chest. The clot may damage the vein or may embolize to other organs (e.g., the heart or lungs)  Thrombophelbitis- inflammation of a vein in conjunction with the formation of a thrombus (adhering blood clot)  Arteritis – inflammation of an artery  Ectopic prgenancy – pregnancy where fertilized ovum attach outside of the uterus, usually in a fallopian tube  Esophageal varicosities – distended, swollen veins near the esophagous  Frostbite - severe tissue and cell damage caused by freezing  Local contagious condition – a condition which may be contagious to another person in the same area of the body (e.g. plantar warts)  Local injection site up to 21 days post-injection – e.g. location of a recent epi-pen injection to treat a life-threatening allergy attack; insulin injection site; vaccination site  Local irritable skin condition – any condition of skin irritation (e.g. psoriasis, eczema, contact allergy, scab)  Malignancy, especially if judged unstable – cancerous cell tissue that is not benign © 2021 International Academy of Applied Health Inc. 52  Open wound – a contusion in which the skin is also broken, such as a gunshot, incised, or lacerated wound  sore– a lesion of the skin or mucous membranes marked by inflammation, necrosis and sloughing of damaged tissues  Decubitus ulcer – a sore resulting from being bedridden  Pain syndromes:  Causalgia- intense burning pain accompanied by trophic skin changes, due to injury of nerve fibers Reflex sympathetic dystrophy - an abnormal response of the nerves of the face or an extremity, marked by pain, autonomic dysfunction, vasomotor instability, and tissue swelling (usually initiated by trauma)  Radiation therapy site, both during and up to several weeks post-radiation therapy with physician's consent – site which is exposed to radioactive energy, in order to attempt to destroy all malignant cells  Recent burn – a burn that is recent and is still in the healing process  Sepsis – infection evidence by pus  Undiagnosed lump – any lump which has not been identified  Varicosities – varicose veins, including up to 24 hours post-treatment © 2021 International Academy of Applied Health Inc. 53 General Conditions Requiring Treatment Modifications  Cerebral palsy – any nonprogressive but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain, arising in the early stages of its development  Hemiplegia – paralysis in one side of the body  Multiple Sclerosis – a condition having temporary, repetitive or sustained disruptions in nerve impulse conduction, causing symptoms such as muscular weakness or numbness, due to destruction of myelin sheaths of neural axons  Spinal cord injury or rigidity  Parkinson’s - chronic degenerative disease of the central nervous system that produces movement disorders in elderly people  Asthma - disease caused by increased responsiveness of the tracheobronchial tree to various stimuli which results in episodic narrowing and inflammation of the breathing airways  Cancer - malignant neoplasia marked by the uncontrolled growth of cells  Congestive heart failure - inability of the heart to circulate blood effectively enough, to meet the body's metabolic needs  Chronic kidney disease – permanent loss of sufficient function of the kidney  Immunosuppressed – immune system is suppressed due to disease (e.g. AIDS) or medication (e.g. anti-rejection medications)  Coma - a state of unconsciousness from which one cannot be aroused  Debilitation – lack of strength impairing ability  Diagnosed atherosclerosis – hardening of the artery/arteries  Drug withdrawal – undergoing symptoms due to the reduction or elimination of an addictive substance (medical or non-medical)  Emphysema - chronic pulmonary disease marked by an abnormal increase in the size of air spaces, distal to the terminal bronchiole, with destruction of the alveolar walls; also pathological distention of interstitial tissues by gas  Fibromyalgia – chronic pain in muscles and soft tissues surrounding joints  Hypertension – high blood pressure  Hypotension – low blood pressure  Inflammatory arthritides – arthritic diseases involving inflammation  Major surgery or abdominal surgery – surgery involving the abdomen or otherwise seemingly obvious major, such as brain surgery, heart bypass and transplant operations  Medications:  Anti-inflammatories – reduce inflammation  Muscle relaxants – relax muscles  Stimulants – stimulate the brain and/or muscles  Anticoagulants – blood thinners  Analgesics – pain killers or any others that affect sensation, muscle tone, reflex reactions, cardiovascular, kidney or liver function or emotions © 2021 International Academy of Applied Health Inc. 54  Moderate diabetes mellitus – disease with problem regulating blood sugar (risk of hypoglycemic, i.e. low blood sugar, attack)  Osteoporosis – loss of bone density (increased porosity of bones)  Osteomalacia – softening of the bone tissue  Pregnancy – carrying a fetus  Labour – giving birth  Post-cerebrovascular accident – after a head injury or stroke, where the condition has stabilized  Post-myocardial infarction – after a heart attack, where the condition has stabilized  Recent head injury – recent trauma to the head, such as concussion or puncture  Seizure disorders – any condition in which neurons fire in excesses causing muscle spasms  Spasticity – a motor disorder that demonstrates velocity-dependent increased muscle tone, exaggerated tendon jerks © 2021 International Academy of Applied Health Inc. 55 Local Conditions Requiring Treatment Modifications  Acute disc herniation – a condition where an intervertebral disc has slipped, in a direction causing sensitivity or pain  Aneurysm - localized abnormal dilatation of a blood vessel, usually an artery  Acute inflammatory conditions and injuries – a recent injury such as a concussion, bruise, infection, sprain or strain, in which swelling is present  Chronic or long-standing thrombosis – blood clot adhering to blood vessel or other tissue  Bell's palsy – sudden unilateral facial paralysis  Buerger's disease- chronic, recurring, inflammatory, vascular occlusive disease, chiefly of the peripheral arteries and veins of the extremities  Bursitis – swelling of the bursa within or around any joint  Chronic arthritic conditions – longstanding joint pain  Chronic abdominal or digestive disease – longstanding disease of the intestines/stomach and other organs of the abdominal cavity, or any disease related to the digestive tract (e.g. colitis)  Chronic inflammation:  Sinusitis – inflammation of the sinuses  Chronic bronchitis – longstanding inflammation in the bronchioles/bronchia  Contusion – bruise  Diarrhea- the passage of fluid or unformed stools instead of a normal bowel movement  Endometriosis - the presence of functioning ectopic endometrial glands and stroma outside the uterine cavity  Flaccid paralysis or paresis - paralysis in which there is loss of muscle tone, loss or reduction of tendon reflexes, atrophy and degeneration of muscle, and reaction of degeneration; for paresis, loss of feeling in the muscles  Flare-up of irritable bowel syndrome (IBS) – a condition marked by abdominal pain (often relieved by the passage of stool or gas); disturbances of evacuation (constipation, diarrhea, or alternating episodes of both); bloating and abdominal distention; and the passage of mucus in stools  fracture while casted and post cast removal, until muscle tone has returned and tissuefragility has decreased – broken bone not completely healed  Frozen shoulder - adhesive capsulitis of shoulder, a condition that causes shoulder pain, with restricted movement even though there is no obvious intrinsic shoulder disease  Hematoma – area of the body where blood has pooled and stagnated  Herniation - the displacement of body tissue through an opening or defect  Indwelling medication catheter – tube inserted into the thorax to provide medication  Infection, including parasites – invasion of a foreign body causing animmune reaction © 2021 International Academy of Applied Health Inc. 56  Inflammatory bowel disease – any of a number of chronic, relapsing inflammatory diseases of the gastrointestinal tract, including Crohn's and colitis  Joint instability or hypermobility – weak joints, double joints and joints that hyperextend easily  Joint hypomobility due to pins, screws, wires, plates or surgical shortening of ligaments – reduced range of motion due to surgery  Lymphedema – accumulation of excessive lymph in the extracellular spaces  Kidney infection – foreign bodies in the kidney causing an immune response  Kidney stones – hard crystalline residues in the kidney or ureters, often calcium based  Mastitis - inflammation or infection of the breast  Migraine – severe headache  Minor surgery – surgery which involves simple procedures normally in low-risk areas of the body ,such as removing superficial foreign bodies, biopsy and many other surgeries which are 'quick in and quick out'  Ostomy site – location where something was removed  Pelvic inflammatory disease – infection of the uterus, fallopian tube and adjacent pelvic structures when not associated with surgery or pregnancy  Pitting edema - edema, usually of the skin, of the extremities. When pressed firmly with a finger, the skin maintains the depression produced by the finger  Portal hypertension - increased pressure in the portal vein caused by an obstruction of the flow of blood through the liver  Prolonged constipation – difficulty with bowel movements over a long time  Raynaud's disease - an exaggerated response of vasomotor controls, to cold, or emotion  Raynaud's phenomenon - intermittent attacks of pallor or cyanosis of the small arteries and arterioles of the fingers, as the result of inadequate arterial blood flow  Recent abortion – medical termination of pregnancy, normally in first term  Recent vaginal birth – recent birthing by normal/traditional method  Spasmodic torticollis – recurring stiff neck associated with muscle spasm, classically causing lateral flexion contracture of the cervical spine musculature  Stress fracture site – hairline fracture usually due to stress, such as shin splints in runners  Temporomandibular joint dysfunction – overuse or imbalance of jaw muscles which may result in teeth grinding (bruxism) or locked jaw  Tracheotomy site – location where some of the trachea has been cut  Trigeminal neuralgia between attacks- disease of the trigeminal nerve (CN V) marked by brief attacks of severe lightning-like stabs along the distribution of one or more of its branches, but usually along the maxillary nerve. The attacks last from a few seconds to 2 minutes and may be triggered by touch, cold, chewing, brushing teeth, smiling, or talking. It occurs most frequently in persons over 40 and in women more often than men © 2021 International Academy of Applied Health Inc. 57  Varicosities – areas where veins are varicose (protruding, normally due to lack of effective valve/s) Keep in mind…  Clients may be allergic to some oils, cleaners, detergents  Medications can impact your treatment (e.g., Pain medications will alter a client’s perception of pain so your pressure should be modified accordingly)  If a client has pins, staples, any metal implants then your use of temperature applications will be altered © 2021 International Academy of Applied Health Inc. 58 Swedish Massage Swedish massage, called ‘classic massage’ in Sweden and other countries, includes techniques that make up the classical strokes used by a massage therapist. The five basic strokes include: 1. effleurage (sliding or gliding) 2. petrissage (kneading or pumping) 3. tapotement (rhythmic tapping) 4. friction (cross-fiber) 5. vibration/shaking The development of Swedish massage is credited to Per Henrik Ling. (You will learn how to perform frictions later in your course of study) Effleurage Effleurage refers to a gliding stroke. Technique  Direction is centripetal or toward the heart (therefore therapist maintains contact on return stroke but uses no pressure)  Pressure varies to feel even to client (lighter over bony areas and deeper over areas with bulky muscle  Hands are relaxed and follow the contours of client’s body  Tools include fingers, palms (most often), ulnar border of forearm Uses  Spreads lubricant  Introduces client to therapist’s touch  Acts as a transition stroke between other techniques  Warms the tissue for deeper or more specific work  Provides the therapist an opportunity to palpate for temperature, muscle tone, texture of tissue and possibly tenderness  Used when deeper techniques are contraindicated © 2021 International Academy of Applied Health Inc. 59 Effects Circulatory system effects: If light pressure, has a more reflexive effect and if deeper, has a more mechanical effect.  Promotes venous and lymphatic return  Helps decrease peripheral congestion or edema  Increases circulation so assists arterial blood flow  Promotes vasodilation and capillary permeability by stimulating parasympathetic nervous system activity Lymphatic system effects:  Assists in the mechanical drainage of lymphatic vessels Muscular system effects:  Increases blood supply to muscles  Improves muscle efficiency and speeds recovery  Can increase of decrease muscle tone depending on rate of application Nervous system effects:  Increases circulation to nerves  Can decrease or increase nerve firing depending on rate and pressure of application ►Contraindications  Effleurage is not used distal to an area of inflammation, distal to an acute or early subacute injury, or on or distal to an area of infection  Not used over open or contagious skin lesions (covered or uncovered)  Should not be performed repetitively on the limbs of clients with hypertension, heart disease, varicose veins or edema caused by thrombus  All general and local contraindications © 2021 International Academy of Applied Health Inc. 60 Petrissage Petrissage means ‘to knead’ and refers to 6 techniques, most of which alternate pressure and relaxation. The techniques are generally deeper and more specific than effleurage. Kneading – using the thumb, fingertips, palm, fists or ulnar border of the hand or forearm, the therapist performs short, rhythmical, unidirectional circles. The pressure peaks in the middle of the technique. Muscle squeezing – using the fingers and palm of one hand or the palms or fingers of both hands, the therapist compresses the muscle. Muscle s

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