Cblm-Massagecore1new-2-638 (9 Files Merged)

QUALIFICATION : MASSAGE THERAPY NC II
UNIT OF COMPETENCY : WORK WITH A HOLISTIC THERAPEUTIC

MASSAGE FRAMEWORK
MODULE TITLE : WORKING WITHIN A HOLISTIC

THERAPEUTIC
MASSAGE FRAMEWORK
INTRODUCTION:
This unit covers the knowledge, skills and attitudes required
to work
effectively within a therapeutic massage frame\\1ork.
SUMMARY OF LEARNING OUTCOMES:

At the end of this module you will be able to:
I. Demonstrate commitme nt to central philosophies of
therapeutic massage practice
Identify and describe the principles and practices of
therapeutic
massage
Dev elop knowledge of complementary therapies
Represent therapeutic massage framework to the community
Work within clinic and regulation guidelines
ASSESSMENT CRITERIA:
Concept of massage and treatment are clearly defined based on the

medical manuals or relevant references.
Massage principles are identified and explained based on medical
manuals.
Healths issues are interpreted based on t h e r a p e u t i c massage
philosophy.
Date Developed: Document No.

Develop Massage Practice
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MASSAGE THERAPY NC II Developed by: Revision #
47
1. Major methods of treatme nt used m therapeutic massage
are identified and described
2. Additional complementary therapies used m therapeutic

massage are identified and described
3. Massage assessment techniques are identified and described
4. Information on other complementary therapies is provided
5. Similarities and differences between physiotherapy,
osteopathy, chiropractic therapy and massage therapy are
explained.
6. The characteristics between the allopathic and
naturopathic approaches to treatment are described
7. Relationship between therapies is identified
8. Practices and principles of therapeutic massage can be
1
explained in an easily understood v. ay and explained in a
one-to-one group setting\
9. Enquiries are clarified and appropriate information is provided
10. Requests for client / patient to bring relevant data
to the
11. consultation are made
12. Altemative sources of information / advice are discussed with
the client / patient.
13. Clinic guidelines are accessed and followed according to
health care facility policy.
14. Legal and regulatory guidelines are accessed and followed based
on
15. government regulation.
16. Relevant documentations are established based
on the clinic guidelines.

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LEARNING OUTCOME DEMONSTRATE COMMITMENT TO CENTRAL
#1 PHILOSOPlllES OF
THERAPEUnc MASSAGE PRACTICES.
CONTENTS:
• Effects of therapeutic massage on the body surface
• Ethical issues in therapies
• Communicatine: in orouo and one-on-one settine:s
ASSESSMENT CRITERIA:
1. Concept of massage and treatment are clearly defined
based on the medical manuals or relevant references.
2. Massage principles are identified and explained based on
medical
manuals.
3. Healths issues are interpreted based on therapeutic
massage ohilosoohv.
CONDITION:
Students/ trainees must be provided with the following:
EQUIPMENT TOOLS AND ACCESSORIES
• OHP • Ultraviolet Lamp

• 1V, LCD • Heat Pacts
• Massage Table • Thermometer And Bp
Apparatus
SUPPLIES AND MATERIALS LEARNING MATERIALS

• Pentel Pens • Handouts
• Eraser • Texts and Medical Manuals
• Paper
• Oils, fuwder
• Alcohol
•,. White Board
• White Board Marker
ASSESSMENT METHOD:
• Interview/ Question and Ansv•.rer

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• \Vritten Evaluation / Paper and Pen Test
• Observation
Leaming Experiences
Leaming Outcome 1
DEMONSTRATE COMMITMENT TO CENTRAL PlllLOSOPlllES OF
THERAPEU11C MASSAGE PRAC11CES.
Learning Activities Special instructions

!. Read Information Sheet Read information sheet. After
1.1.1- Effects of therapeutic reading the learner is encourage
massage on the body surface to
answer the self check.
2. Answer self check I.I.I Practice answering self.·check.
3. Answer Key I.I.I Compare your ansv.1ers to the
ansv..rer key.
4. Read Information Sheet Read information sheet. After
1.1.2- Ethical Issues In reading the learner is encourage
Therapies to answer the self check.
5. Answer self check 1.1.2 Practice answering self-check.

6. Answer Key 1.1.2 Compare your ansv.1ers to the
ansv.1er key.
7. Read lnforma tion Sheet Read information sheet. After
1.1.3- Communicating In reading the learner is encourage
group and one-on-one settings to
answer the self check.
8. Answer self check 1.1.3 Practice answering self-check.
9. Answer Key 1.1.3 Compare your ansv.1ers to the
ansv.1er key.

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INFORMATION SHEET 1.1
Leaming Objectives:
After reading this INFORMATION SHEET, YOU MUST be able to-
1. Define clearly the concepts of massage and treatment
based on
the medical manuals or relevant references.
2. Identify and explain massage principles based on
medical
manuals.
3. Interpret health issues based on therapeutic massage
philosophy.
INTRODUCTION
MASSAGE is an instinctive therapy that everyone has the ability to
learn. Our goal is to encourage your natural abilities and give you the
knowledge and expertise to practice safely and effectively on your
family and friends. The information, which we wiU provide will also
be useful to the students choosing massage therapy as a career or
practicing therapisl
You employ your innate ability to touch therap<>
. utically in your daily
life. If you have a headache, you instinctively rub around the neck
and the temples to soothe away the pain and tension. If you hurt
your knee or bang your elbow, your f1rst reaction is to massage it to
relieve the pain. Children will hold and rub their tummies when they
have stomach-ache and eventually the pain .,.;11 go. A parent feels a
child's feverish forehead to check for a high temperature and will
massage in response to a child's bumps and cries of pain.
The healing power of therapeutic massage is also used for
emotional problems. To comfort distraught friends or relatives you
may put your arms
around them, hold or stroke them to comfort, support and

reassure them
in their times of need.

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Body and mind should not be regarded as separate entities.
Physical symptoms such as headaches or constant fatigue are often
an indication of what is 'on our mind'. ?vluscles contract and
tighten in response to anger and anxiety or may become slack
as \\ie assign oursetves to v.rhat is happening in our lives.
\!/ithin the physical body is buried a whole lifetime of experience
and emotions - birth, childhood, pleasure and pain, shock,
frustration, fear, grief, joy and much more besides. Massage is an
excellent tool for enabling us to become more aware of what is
happening deep v.rithin us.
The importance and need for touch is reflected in our everyday
language.
\!/e talk of being 'deeply touched' when trying to express a reaction.
\!/e ask friends to keep 'in touch' or stay in contact' with us. We
speak of 'being in touch' or 'out of touch' " th our feelings. We
describe others as being a 'soft touch' or a bit 'touchy'. We also
experience 'gut feelings' about a particular situation.
Touch is essential for our growth and weU -being. It is the first sense
to be
developed in the womb, and early touching while the fetus grows in
the
v.1omb enhances the development of the nervous system and
encourages communication between mother and baby. Children need
cuddles from their parents to give them a feeling of security and to
show them how much they are loved.
Massage is one of the oldest healing arts: Chinese records dating
back 3,000 years document its use; the ancient Hindus, Persians
and Egyptians
applied forms of massage for many ailments; and Hippocrates wrote

papers recommending the use of rubbing and friction for joint and
circulatory problems. Today, the benefits of massage are varied and
far-reaching. As an accepted part of many physical rehabilitation
programs, massage therapy has also proven beneficial for many
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chronic conditions, including low back pain, arthritis, bursitis,
fatigue, high blood pressure, diabetes, immunity suppression,
infertility, smoking cessation, depression, and more. And, as many
millions will attest, massage also helps relieve the stress and
tension of everyday living that can lead to disease and illness.
So What Is It Exactly?
Massage, bodywork and somatic therapies are defined as the

application of various techniques to the muscular structure and
soft tissues of the human body. Specifically:
Massage: The application of soft-tissue manipulation techniques to

the body, generally intended to reduce stress and fatigue while
improving circulation. The many variations of massage account for
several different techniques.
Bodywork; Various f<rms of touch therapies that may use

manipulation, movement, and/or repatterning to affect structural
changes to the body.
Somatic: Meaning "of the body." Many times this term is used to
denote a body/ mind or whole-body approach as distinguished from
a physiology- only or environmental perspective.
There are more than 250 variations of massage, bodyv.1ork, and

somatic
therapies and many practitioners utilize multiple
techniques. The
application of these techniques may include, but is not limited to,

stroking, kneading, tapping, compression, vibration, rocking, friction,
and pressure to the muscular structure or soft tissues of the human
body. This may also include non-forceful passi\i·e or active
movement and/or application of techniques intended to affect the
energetic systems of the body. The use of oils, lotions, and powders
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may also be included to reduce friction on the skin.
Please note: Massage, bodywork and somatic therapies specifically

exclude diagnosis, prescription, manipulation or adjustments of the
human skeletal structure, or any other service, procedure or
therapy which requires a license to practice orthopedics, physical
therapy, podiatry, chiropractic, osteopathy, psychotherapy,
acupuncture, or any other profession or branch of medicine.
( http://www.massagetherapy.com/ learnmore/index .php)

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INFORMATION SHEET 1.1-A
History of Massage
Massage is safe and effective combination of techniques
that almost anyone can learn. It is a holistic therapy and
offers benefits for the physical, mental, spiritual and
emotional wellbeing of the person giving the massage as
well as the person receiving il It works well on young and
old, male and female, and can even be applied as a self-
help therapy.
The word 'Massage' is most likely to have emerged

from the Greek word 'Massein', meaning 'to knead' or the
Arabic word 'mas'h' meaning 'to press softly'.
Massage is a successful tool for healing and has been

practiced throughout the world for thousands of years. In
adults as in babies, massage has many benefits from a
preventive health perspective as well as stimulating the
body's own natural healing mechanisms to aide in the
recovery from trauma, depression, back pain and
physical or emotional stresses.
References to massage are found in Chinese medical texts

4,000 years old. The Chinese have long recognized the
powerful benefits of touch in healing.They recorded
centuries of history behind their therapeutic massage
techniques. This ancient culture claim they were the first
people to systemize and turn massage into a true healing
arlA Chinese book from 2,700 B.C., The Yellow Emperor's
Classic of Internal Medicine, recommends breathing
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exercises, massage of skin and flesh, and exercises of
hands and feet" as the appropriate treatment for -complete
paralysis, chills, and fever." Physicians mostly of the

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Greek and Roman era, prescribed it both for its
restorative powers and for general preservation of the body
and mind.
In the 5th century B.C., Hippocrates (the father of

medicine), who had learned massage from the Greeks,
prescribed the use of rubbing and friction for joint and
circulatory ailments. It is recognized that rubbing can
bind a joint that is too loose and loosen a joint that is
too rigid. Furthermore, rubbing can make the flesh and
cause parts to waste, it is these latter beliefs that are so
important for those concerned with figure improvement.
In 1363 Guy de Chaulic published a book about surgery,

where he described different methods of bodywork in
conjunction with surgery. Paracelsus found that
bodywork was not only an important therapy but that it
was necessary.
Doctors such as Ambroise Pare, a !6th-century physician to

the French court,
praised massage as a treatment for various ailments.
Massage became popular throughout Europe, due to the

work of Henrik Ling (1776-1839) during the eighteenth and
nineteenth century. He developed a system of massage
that used many of the positions and movements of Swedish
gymnasts. This system \\1as based on the nev..rly
discovered knov..rledge of the circulation of blood and
lymph which he Chinese had been using these methods
for centuries.
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In 1813 he established with royal patronage the Royal
Central Institute of Gymnastics. Ling's system is
generally known as Swedish Massage. It spread quickly
from Sweden. In 1895 a society of Trained Masseuses
was formed in Britain to increase the standard of
training (the date 1894 is sometimes

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quoted), and in 1899 Sir \!/illiam Bennet inaugurated a
massage department at SL George's Hospital, London.
Although the practice of massage has been discredited in the

past, mainly by advocates of modern medicine, it has
recently been growing in practice . Nov.r, commonly
accepted throughout the medical world as an effective and
true medical art, massage is successfully used in hospitals,
pain clinics, rehabilitation facilities, and drug treatment
clinics for people of all ages with a variety of medical
conditions.
Massage may be the oldest and simplest form of medical

care. Egyptian tomb paintings show p<'.<>ple being
massaged. In Eastern cultures, massage has been
practiced continually since ancient times. A Chinese book
from 2,700 B.C., The Yellow Emperor's Classic of Internal
Afedidne, recommends 'breathing exercises, massage of
skin and flesh, and exercises of hands and feet" as the
appropriate treatment for -complete paralysis, chills, and
fever." It was one of the principal method of relieving pain
for Greek and Roman physicians. Julius Caesar was said
to have been given a daily massage to treat neuralgia.
"The Physician Must Be Experienced In Many Things," wrote
Hippocrates, the father of Western medicine, in the 5th
century B. C., "but assuredly in rubbing. . . for rubbing
can bind a joint that is too loose, and loosen a joint that
is too rigid."
Ay11rv1>da, the traditional Indian system of medicine,

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places great emphasis on the therapeutic benefits of
massage \\th aromatic oils and spices. It is practiced
very widely in India.
Doctors such as Ambroise Pare, a 16th-<:entury physician to

the French court,
praised massage as a treatment for various ailments. Sv.redish massage,
the

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method most familiar to Westerners, was developed in
the 19th century by a Swedish doctor, poet, and
educator named Per Henrik Ling. His system was based
on a study of gymnastics and physiology, and on
techniques borrowed from China, Egypt, Greece, and
Rome. Physiotherapy, orinaUy based on Ling's methods,
was established with the foundation in 1894 of the
Society of Trained Masseurs. During \!/orld \!/ar I
patients suffering from nerve injury or shell shock were
treated with massage. St. Thomas's Hospital, London,
had a department of massage until 1934. However, later
breakthroughs in medical technology and pharmacology
eclipsed massage as physiotherapists began increasingly
to favor electrical instruments over manual methods of
stimulating the tissues.
Massage lost some of its value and prestige with the

unsavory image created by "massage parlors." This
image is fading as awareness of the value and
therapeutic properties of massage grow.
Massage is now used in intensive care units, for children,

elderly p<'.<>ple, babies in incubators, and patients with
cancer, AIDS, heart attacks, or strokes. Most American
hospices have some kind of bodywork therapy available,
and it is frequently offered in health centers, drug
treatment clinics, and pain clinics.
A variety of massage techniques have also been

incorporated into several other complementary therapies,
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such as aromatherapy, reflexology, Rolling, Heller work,
and osteopathy.

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INFORMATION SHEET 1.1-1-B
Therapeutic Effects of
Massage By Kim
Markiecki, LMT
MASSAGE AFFECTSTHE BODY AS A WHOLE
NERVES
Tends to normalize hyperactivity of nerves, that is, it

has a sedating effect. Massage can also be used to
stimulate the nervous system depending on the
technique used . Massage also provides pain relief.
MUSCLE TISSUE
Massage enhances the nutrition of muscles,

accelerates recovery from fatigue by the removal of
lactic acid and relieves muscle spasm. Massage does
not increase strength, muscle bulk or muscle tone.
BLOOD
Venous circulation is stimulated. Capillaries are dilated

by direct pressure and by a neurological reflex. The red
blood ceO count increases, hemoglobin levels increase
and the oxygen carrying capacity of blood is facilitated.
LYMPH CIRCULATION
Lymph is a milky white fluid that carries impurities

and waste away from the tissues and passes through
gland-like structures spaced throughout the
lymphatic system that act as filtering valves. Its
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circulation depends

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on gravity, muscle contraction, passive movement and external pressure .
Massage can dramatically aid the movement of lymph.
SKIN
The secreti'v·e function of the skin is impro'v·ed \\'hen

the sebaceous glands are stimulated. Skin temperature
increases 2-3 degrees as a result of friction and
improved circulation. The texture of the skin is
improved though increased tissue oxygenation and
because massage aids the removal of dead cells from
the skin surface.
BONES
While massage is not recommended for 2-3 weeks

after a fracture, after this period, if the fracture is
healing normally, massage increases the deposition of
callus (the fibrous tissue around a fracture) and
improves the healing rate of the soft tissues.
METABOLISM
1vlassage increases the secretion of urine, through

pressure o\>·er the kidneys and kidney neurolocal
reflex. It increases the excretion of sodium,
phosphorous and sodium chloride. There is a
cumulative improvement in metabolic function.
Massage has no eflect on blood ph, oxygen
consumption, pulse rate or blood pressure except
indirectly as a result of relaxation.

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Reference:
http·// WWW atpr>ac.ema s sawthrraµy com/bc> nefi tsofmassaw
htm

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INFORMATION SHEET 1.1-1-C
BENEFITS OF MASSAGE
(www.wild pedia .orgj
Peer-reviewed medical research has shown that the

benefits of massage include pain relief, reduced trait
anxiety and depression , and temporarily reduced blood
pressure, heart rate, and state anxiety. Theories
behind what massage might do include blocking
nociceotion (gate control theoiyl, activating the
oarasympathetic nervous system, v.rhich may stimulate
the release of endorohins and serotonin. preventing
fibros is or scar tissue, increasing the flow of lymph , and
improving sleep, but such effects are yet to be
supported by well-designed clinical studies.
Ailassage is hindered from reaching the gold s tandard of

scif•ntjfic res<>-arcb, which includes plac t"bo-
controlled and do1 1ble bl jnd rtinjcal trials
.Developing a "sham" manual therapy for massage
would be difficult since even light touch massage
could not be assumed to be completely devoid of
effects on the subjecl 1 It would also be difficult to find
a subject that v.1ouki not notice that they v.1ere getting
less of a massage, and it VlOuld be impossible to blind
the therapist. Massage can employ randomized
controlled trials, v.1hich are published in oeer reviev.1ed
medical journals . This type of study could increase the
credibilitv of the profession because it displays that
purported therapeutic effects are reproducible.
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Single dose effects
Mechanical massage chairs at Vivo City in Singapore.

• Pain relief: Relief from pain due to musculoskeletal injuries and
other causes is cited as a major benefit of massage. In one
study, cancer patient’s self-reported symptomatic relief of pain.
This study, however, did not include a placebo control group so
these effects may be due to the placebo effect or regression
tov.1ards the mean. Acupressure or pressure point massage may
be more beneficial than classic Sv.1edish massage in relieving
back min. Hov.1ever, a meta study conducted by scientists at the
University of Illinois at Urbana Champaign failed to find a
statistically significant reduction in pain immediately following
treatment.
• State anxiety: Massage has been shown to reduce state
anxiety, a transient measure of anxiety in a given situation.
• Blood pressure and heart rate: Massage has been shown to
reduce blood pressure and heart rate as temporary effects.

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• Attention; After massage, EEG patterns indicate
enhanced performance and alertness on
mathematical computations, .,. th the effects
perhaps being mediated by decreased stress
hormones.
• Other: Massage also stimulates the jmm11n e system

by increasing peripheral blood lymphocytes (PBLs).
However, this immune system effect is only
observed in aromatherapy massage, which includes
S\\1eet almond oil , lavender oil . cyoress oil . and
S\\ieet marioram oil . It is unclear v.1hether this
effect persists over the long term.
Multiple
dose effects
• Pain relief: \!/hen combined .,. th education and
exercises, massage might help sub-acute,
chronic, non -specific low back roin. Furthermore,
massage has b,een shov.1n to reduce pain
experienced in the days or weeks after treatment.
• Trait anxiety: Massage has b£>en shown to reduce trait
anxiety; a
person's general susceptibility to anxiety.
• Depression; Massage has been shown

to reduce subclinical
depression .
• Diseases: Massage, involving stretching, has

been shown to help th spastic diplegia resulting
from Cerebral palsy in a small pilot study.llil The
researchers warn that these results should "be
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viewed
.,. th caution until a double-blind controlled trial can be
conducted". Massage has been used in an effort to
improve symptoms, disease progression, and quality of
life in HIV patients, however, this treatment is not
scientifically supported.

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In the United States there are about 90,000 massage
therapists. Training programs in the US are typically
500-1000 hours in length, and can award a certificate,
diploma, or degree depending on the particular school.
There are around 1,300 programs training massage
therapists in the country and study will often include
anatomy and physiology, kinesiology, massage
techniques, first aid and CPR, business, ethical and
legal issues, and hands on practice along .,. th
continuing education requirements if regulated. The
Commission on Massage Therapy Accreditation (COMTA)
is one of the organizations that \\1orks \\rith massage
schools in the U .S..
• Thirty-nine states, the District of Columbia and

four Canadian provinces currently offer some type
of credential to professionals in the massage and
bodywork field---usually licensure, certification or
registration. Thirty-eight states and the District of
Columbia require some type of licensing for
massage therapists. In the US, 32 states use the
National Certification Board for Therapeutic
Massage and Bodywork's certification program
as a basis for granting licenses
either by rule or statute. The National Board
grants the designation Nationally Certified in
Therapeutic Massage and Bodywork (NCTMB).
There are tv.10 tests available and one can become
certified through a

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portfolio process .,;. th equivalent training and experience. Between
10% and 200/o of towns or counties regulate the profession. These local
regulations can range from prohibition on opposite sex massage,
fingerprinting and '"enereal checks from a doctor, to prohibition on house
calls because of concern regarding sale of sexualservices.
In the US, licensure is the highest level of regulation and this
restricts anyone ...;thout a license from practicing massage therapy

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or by calling themselves that protected title. Certification
allows only those who meet certain educational criteria
to use the protected title and registration only requires
a listing of therapists who apply and meet an
educational requirement.
• In late 2007, the Federation of State Massage

Therapy Boards launched a new certification exam
titled the MBLEx. Approximately 13 states have
accepted this certification exam.
• In Canada only three provinces regulate massage

therapy: British Columbia, Ontario, and
Newfoundland and Labrador. The Canadian
Massage Therapists Alliance (CMTA) has set a level
of 2200 practice hours in Ontario, and
Newfoundland and Labrador and 3000 hours in
British Columbia, which has the highest education
standard in North America.
• In Germany Massage is regulated by the

Government on a federal and national level. Only
someone who has completed 3,200 hours of
training (theoretical and practical) can use the
professional title "Masseur und Medizinische
Bademeister" or Medical Masseur and Spa
Therapist. This person can prolong his training
depending on the length of professional
experience to a Physiotherapist (!year to 18
months additional training). The Masseur is
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trained in Classical Massage, Myofascial
Massage, Exercise and Movement Therapy.
During the training they will study: Anatomy,
Physiology, Pathology, Gynecology, Pediatry,
Psychiatry, Psychology, Surgery, and probably
most importantly Dermiatry and Orthopedics.
They are trained in Electrotherapy, and
Hydrotherapy. Hydrotherapy includes: Kneipp,
\I/raps, underwater Massage, therapeutic washing,
Sauna and

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Steambath. A smaU part of their training will include
special forms of massage which are decided by the
local college, for example: Foot reflex zone massage,
Thai Massage etc. Finally a graduate is allowed to treat
patients under the direction of a doctor. He is
regulated by the professional body which regulates
Physiotherapists. This includes the restriction on
advertising and Oath of confidentiality to clients.
INFORMATION SHEET l. l·l·D
Benefits of Massage Therapy

Ailassage is an excellent preventive treatment
essential for the maintenance of health and fitness.
Prevention is always far better than cure. Nowadays,
people of all ages are increasingly considering natural
therapies as a way to encru.rage an improved sense
of \\'ell-being and as a means to a long, happy and
harmonious life free of illness.
People have been enjoying the benefits of massage for

thousands of years. Records indicate that it \\•as used
in several ancient societies for a variety health
reasons. Today, massage still provides benefits to aU
the systems of the body, some of which are outlined
below.
Benefits to the Nervous System

The nervous system is profoundly influenced by the
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application of massage. The effects of massage may be
soothing and sedative, providing relief from nervous
irritability. Disorders such as insomnia, tension,
headaches and other stress-related conditions respond
to the healing power of touch as peace and
harmony returns to the troubled mind.
CSAT r.1ASSAG£ THRRAPY NC Ill Date Docun1ent .

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Alternatively, the effects of massage on the nerves may
be stimulating, promoting an increase in the activity of
the muscles, vessels and glands governed by them. It is
invaluable in cases of lethargy and fatigue.
Benefits to the Muscular System
The muscular system derives enormous benefits.

Ailuscles maintain a balance in relaxing and
contracting. Some massage mo\i·ements relax and
stretch the muscles and soft tissues of the body,
reducing muscular tension and cramp. Fibrous
tissues, adhesions and old scar tissue can be broken
down and cleansed of v.1aste deposits. As muscles
contract, toxic products are eliminated. Other
movements produce the contraction of muscles
promoting good muscle tone. Muscle fatigue and
stiffness caused by overactivity, and the resulting build-
up of toxic substances in the muscles, is reduced by
muscular contraction and relaxation.
Benefits to the Skeletal System
The skeletal system is strengthened by using

massage. Bone is indirectly affected by massage.
Improvements to the circulation of blood and lymph in
the muscles lead to better circulation in the underlying
bones, benefiting their nutrition and growth. Stiffness
of the joints, and pains resulting from conditions such
as arthritis, are reduced providing comfort and ease
of movement.
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Benefits to the Circulatory System
The circulatory system also benefits from the action of

massage. It takes the pressure off the arteries and
veins, accelerating the Dow of blood through the
system providing relief for poor circulation and
cardiac

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problems. The heartbeat strengthens, the rate of the
heartbeat decreases and high blood pressure is
reduced.
Benefits to the Lymphatic System
The lymphatic system is stimulated and the Dow of

lymph is accelerated throughout the system. As the
massage strokes are performed, the waste and
poisonous substances v.ihich have accumulated in
our o\i·erstressed bodies are rapidly eliminated.
Benefits to the Respiratory System
The respiratory system responds an increased activity

m the lungs is stimulated by massage. As the treatment
proceeds, the breath slows and deepens. If necessary,
mucus and bronchial secretions can be encouraged to
leave the lungs by percussi\i·e mo\,.ements on the
back and o\i·er the lungs.
Benefits to the Digestive System
The digestive system benefits when massage promotes

the peristaltic activity (wave like motion) in the colon
enhancing the elimination of faecal matter and
combating constipation. It stengthens the muscular
walls of the intestines and abdomen, and stimulates
the secretion of digestive juices from the liver,
pancreas, stomach and intestines.
Benefits to the Skin

Issued by:
Page 33 of
47
The skin, both the activity and the nutrition of the
benefit from massage. The sweat and sebaceous glands
are stimulated, improving their function and ensuring
the elimination of v.1aste products. Skin condition,
texture
SYSTE Holistic Therapeutic Amill4 20 11
Developed Issued Page 24
M Massage Framev.rork by: Manny P. by:
of
Oaleon
271

Issued by:
Page 34 of
47
and tone are greatly improved - the skin is healthy and glowing
following a
treatment.
Benefits to the Genito-urinary System
The genito-urinary system, the use of abdominal and

back massage promotes the activity of kidneys, which
ehnances the elimination of waste products and
reduces Ouid retenlion.
Benefits to the Reproductive System
The reproductive system can also be improved.

Abdominal and back massage can help to alleviate
menstrual problems such as period pains, irregular
menstruation, PMS and the symptoms of menopause.
The Benefits Of Massage
What exactly are the benefits of receiving massage or

bodywork treatments? Useful for all of the conditions
listed below and more, massage can:
• Alleviate low-back pain and improve range of motion.
• Assist " th shorter, easier labor for expectant
mothers and shorten maternity hospital stays.
• Ease medication dependence.
• Enhance immunity by stimulating lymph Dow-

the body's natural defense system.
• Exercise and stretch weak, tight, or atrophied muscles.
• Help athletes of any level prepare for, and recover from,

Issued by:
Page 35 of
47
strenuous
\\orkouts.
1

Issued by:
Page 36 of
47
• Improve the condition of the body's largest organ-the skin.
• Increase joint flexibility.
• Lessen depression and anxiety.
• Promote tissue regeneration, reducing scar tissue and stretch

marlts.
• Pl.lmp oxygen and nutrients into tissues and vital organs,

improving
cin:ulation.
• Reduce postsurgery adhesions and swelling .
• Reduce spasms and cramping.
• Relax and soften injured, tired, and overused muscles.
• Release endorphin,,_amino acids that work as the

body's natural painkiller.
• Relieve migraine pain.
There's no denying the power of bodywork Regardless of the

adjectives we assign to it (pampering, rejuvenating,
therapeutic) or the reasons we seek it
out (a luxurious treat, pain management), massage therapy
stress relief, can be in your healthcare regimen.
a ally
Experts estimate that upwards of ninety percent of disease

is stress related. And perhaps nothing ages us faster,
internally and externally, than high stress. While eliminating
anxiety and pressure altogether in this fast paced world

Issued by:
Page 37 of
47
may be idealistic, massage can, \\1thout a doubt, help
manage stress. This translates into:
• D<>. ereased anxiety.

SYSTE Holistic Therapeutic Amil 14 2011
Developed Issued
M Page 26
Massage by: Manny by:
of
Framev.rork P. Oaleon
271

Issued by:
Page 38 of
47
• Enhanced sleep quality.
• Greater energy.
• Improved concentration.
• Increased circulation.
• Reduced fatigue.
Furthermore, clients often report a sense of perspective and

clarity after receiving a massage. The emotional balance
bodywork provides can often be just as vital and valuable as
the more tangible physical benefits.
Profound Effects
In response to massage, sp<-.>eific physiological and chemical

changes cascade throughout the body, with profound effects.
Research shows that with massage:
• Arthritis sufferers note fe\\1er aches and less stiffness and pain.
• Asthmatic children show better pulmonary function and
increased
peak air Dow.
• Burn injury patients report reduced pain, itching, and anxiety.
• High blood pressure patients demonstrate lower diastolic

blood
pressure, anxiety, and stress hormones.
• Premenstrual syndrome sufferers have decreased water retention and

Issued by:
Page 39 of
47
cramping.
• Preterm infants have improved weight gain.

Issued by:
Page 40 of
47
Research continues to shov.r the enorm<Als benefits of
touch---v.1hich range from treating chronic diseases,
neurological disorders, and injuries, to alleviating the
tensions of modern lifestyles. Consequently, the medical
community is actively embracing bodyv.1ork, and massage
is becoming an integral part of hospice care and neonatal
intensive care units. Many hospitals are also incorporating
on-site massage practitioners and e\i·en spas to treat post
surgery or pain patients as part of the recovery process.
Getting a massage can do you a world of good . And getting

massage frequently can do even more. This is the beauty of
bodywork. Taking part in this form of regularly scheduled
self-care can play a huge part in how healthy you'll be and
how youthful you'll remain "1th each passingyear.
Budgeting time and money for bodywork at consistent

intervals is truly an investment in y<Alr health. And
remember: just because massage feels like a pampering treat
doesn't mean it is any less therap<>
. utic.Consider massage
appointments a necessary piece of your health and wellness
plan,
and work " th your practitioner to establish a treatment schedule
that best
meets your needs.
Assignment:
I. . Reviev.r the clinical research studies examining the

benefits of
massage.
Issued by:
Page 41 of
47
2 Review massages information from the National
Center for Compl em<mtaQI and AUe matit1e Medicine,
a division of the National Institutes of Health.

SYSTE Holistic Therapeutic Amil 14 2011
Developed Issued
M Page 28
Massage Framev.rork by: Manny P. by:
of 27
Oaleon
1

Issued by:
Page 42 of
47
INFORMATION SHEET l.· E
Massage Contraindications (When not to
massage)
Avoid massage in the foOov.ring conditions, instances

and disonJers: o During the first three months of
pregnancy
It is generally not considered safe to massage pregnant

v.romen, particularly in the first trimester, when the risk of
miscarriage is highest. However, a gentle head massage,
without oils, is acceptable, and a light gentle, loving, stroke
appied to the face and brow will relieve anxiety and release
stress.
o High temperature /fever

Issued by:
Page 43 of
47
The body is already fighting off toxins as indicated by the
rise in temperature. A massage v.1ruld release even more
unv.1elcome toxins into the system.
o Open \\1ounds, cuts and bruising
Apply only light touch drainage massage around the site, to

assist the blood Dow towards the heart and encourage healing
where bruising is present. Oil may aggravate an open wound.
\!/hile giving a massage, cover up any open cuts or scratches
on your hands with a plaster or other dressing.
o Inflammation
Avoid massage over an area of inflammation, (which could be
due to fatty deposits causing a cyst) and massage will spread
the infection. However in case of localised problems, adding a
strong base of essential oil to your bath may help you to
overcome, suffering \\ th prickly heat and redness.
Inflammation \\'Ould include conditions such as thrombosis
and phlebitis (painful clot in vein).
o Blood Clots
As massage could dislodge and move clot possibly causing a
heart attack or stroke.
o Varicose \i'eins, or history of thrombosis
Do not massage over broken or varicose veins as the bk>od

supply is impaired in this area. Massage \\ U increase blood
Dow and Dood the over-worked capillaries and veins, possibly

Issued by:
Page 44 of
47
causing coagulation and affecting blood Dow to the heart.
Professionally trained therapists may emeurage gently when
advised by consultant or general practitioner of patient.

Issued by:
Page 45 of
47
or by calling themselves that protected title. Certification allows only those
who meet certain educational criteria to use the protected title and
registration only requires a listing of therapists who apply and meet an
educational requirement.
• In late 2007, the Federation of State Massage Therapy Boards

launched a new certification exam titled the MBLEx. Approximately
13 states have accepted this certification exam.
• In Canada only three provinces regulate massage therapy: British

Columbia, Ontario, and Newfoundland and Labrador. The Canadian
Massage Therapists Alliance (CMTA) has set a level of 2200 practice
hours in Ontario, and Newfoundland and Labrador and 3000 hours
in British Columbia, which has the highest education standard in
North America.
• In Germany Massage is regulated by the Government on a federal

and national level. Only someone who has completed 3,200 hours of
training (theoretical and practical) can use the professional title
"Masseur und Medizinische Bademeister" or Medical Masseur and
Spa Therapist. This person can prolong his training depending on
the length of professional experience to a Physiotherapist (!year to
18 months additional training). The Masseur is trained in Classical
Massage, Myofascial Massage, Exercise and Movement Therapy.
During the training they will study: Anatomy, Physiology, Pathology,
Gynecology, Pediatry, Psychiatry, Psychology, Surgery, and probably
most importantly Dermiatry and Orthopedics. They are trained in
Electrotherapy, and Hydrotherapy. Hydrotherapy includes: Kneipp,
\I/raps, underwater Massage, therapeutic washing, Sauna and
CSAT r.1ASSAG£ TH RRAPY NC Ill Date Developed: Docun1ent No.
QA Amil 14 2011
Working \l/ithin a Holistic Date Developed:
SYSTEM Document No.
Therapeutic Massage Developed by: Issued by: Page 21
Framev.rork Manny P. Oaleon
Issued by:
of 271
Page 46 of
47
Steambath. A smaU part of their training will include special forms of
massage which are decided by the local college, for example: Foot reflex
zone massage, Thai Massage etc. Finally a graduate is allowed to treat
patients under the direction of a doctor. He is regulated by the
professional body which regulates Physiotherapists. This includes the
restriction on advertising and Oath of confidentiality to clients.
INFORMATION SHEET l.l·l·D
Benefits of Massage Therapy

Ailassage is an excellent preventive treatment essential for the maintenance
of health and fitness. Prevention is always far better than cure. Nowadays,
people of all ages are increasingly considering natural therapies as a way to
encru.rage an improved sense of \\'ell-being and as a means to a long,
happy and harmonious life free of illness.
People have been enjoying the benefits of massage for thousands of years.
Records indicate that it \\•as used in several ancient societies for a variety
health reasons. Today, massage still provides benefits to aU the systems of
the body, some of which are outlined below.
Benefits to the Nervous System

The nervous system is profoundly influenced by the application of
massage. The effects of massage may be soothing and sedative, providing
relief from nervous irritability. Disorders such as insomnia, tension,
headaches and other stress-related conditions respond to the healing
power of touch as peace and harmony returns to the troubled mind.
CSAT r.1ASSAG£ TH RRAPY NC Ill Date Developed: Docun1ent No .

Amil 14 20 11
Issued by:
Page 47 of
47
QA Working \Vithin a Holistic Developed by: Issued by: Page 22
SYSTEM Therapeutic Massage Manny P. Oaleon
of 27 1
Framev.•ork

Issued by:
Page 48 of
47
Alternatively, the effects of massage on the nerves may be stimulating,
promoting an increase in the activity of the muscles, vessels and glands
governed by them. It is invaluable in cases of lethargy and fatigue.
Benefits to the Muscular System
The muscular system derives enormous benefits. Ailuscles maintain a

balance in relaxing and contracting. Some massage mo\i·ements relax and
stretch the muscles and soft tissues of the body, reducing muscular
tension and cramp. Fibrous tissues, adhesions and old scar tissue can be
broken down and cleansed of v.1aste deposits. As muscles contract, toxic
products are eliminated. Other movements produce the contraction of
muscles promoting good muscle tone. Muscle fatigue and stiffness caused
by overactivity, and the resulting build-up of toxic substances in the
muscles, is reduced by muscular contraction and relaxation.
Benefits to the Skeletal System
The skeletal system is strengthened by using massage. Bone is indirectly

affected by massage. Improvements to the circulation of blood and lymph
in the muscles lead to better circulation in the underlying bones, benefiting
their nutrition and growth. Stiffness of the joints, and pains resulting from
conditions such as arthritis, are reduced providing comfort and ease of
movement.
Benefits to the Circulatory System
The circulatory system also benefits from the action of massage. It takes
the pressure off the arteries and veins, accelerating the Dow of blood
through the system providing relief for poor circulation and cardiac

Amil 14 20 11
Issued by:
Page 49 of
47
SYSTEM Manny P. Oaleon
Therapeutic Massage of 27 1
Framev.rork

Issued by:
Page 50 of
47
problems. The heartbeat strengthens, the rate of the heartbeat decreases
and high blood pressure is reduced.
Benefits to the Lymphatic System
The lymphatic system is stimulated and the Dow of lymph is accelerated

throughout the system. As the massage strokes are performed, the waste
and poisonous substances v.ihich have accumulated in our o\i·erstressed
bodies are rapidly eliminated.
Benefits to the Respiratory System
The respiratory system responds an increased activity m the lungs is

stimulated by massage. As the treatment proceeds, the breath slows and
deepens. If necessary, mucus and bronchial secretions can be encouraged
to leave the lungs by percussi\i·e mo\,.ements on the back and o\i·er the
lungs.
Benefits to the Digestive System
The digestive system benefits when massage promotes the peristaltic

activity (wave like motion) in the colon enhancing the elimination of faecal
matter and combating constipation. It stengthens the muscular walls of the
intestines and abdomen, and stimulates the secretion of digestive juices
from the liver, pancreas, stomach and intestines.
Benefits to the Skin
The skin, both the activity and the nutrition of the benefit from massage.
The sweat and sebaceous glands are stimulated, improving their function
and ensuring the elimination of v.1aste products. Skin condition, texture
Amill4 20 11
Issued by:
Page 51 of
47
SYSTEM Therapeutic Massage Manny P. Oaleon of 271
Framev.rork

Issued by:
Page 52 of
47
and tone are greatly improved - the skin is healthy and glowing following a
treatment.
Benefits to the Genito-urinary System
The genito-urinary system, the use of abdominal and back massage

promotes the activity of kidneys, which ehnances the elimination of waste
products and reduces Ouid retenlion.
Benefits to the Reproductive System
The reproductive system can also be improved. Abdominal and back

massage can help to alleviate menstrual problems such as period pains,
irregular menstruation, PMS and the symptoms of menopause.
The Benefits Of Massage
What exactly are the benefits of receiving massage or bodywork

treatments? Useful for all of the conditions listed below and more, massage
can:
• Alleviate low-back pain and improve range of motion.
• Assist " th shorter, easier labor for expectant mothers and shorten
maternity hospital stays.
• Ease medication dependence.
• Enhance immunity by stimulating lymph Dow-the body's natural

defense system.
• Exercise and stretch weak, tight, or atrophied muscles.
• Help athletes of any level prepare for, and recover from, strenuous
\\ orkouts.
1

Issued by:
Page 53 of
47
QA Working \Vithin a Holistic Amil 14 20 11
SYSTEM Therapeutic Massage Developed by: Issued by: Page 25
of 27 1

Issued by:
Page 54 of
47
• Improve the condition of the body's largest organ-the skin.
• Increase joint flexibility.
• Lessen depression and anxiety.
• Promote tissue regeneration, reducing scar tissue and stretch

marlts.
• Pl.lmp oxygen and nutrients into tissues and vital organs, improving
cin:ulation.
• Reduce postsurgery adhesions and swelling .
• Reduce spasms and cramping.
• Relax and soften injured, tired, and overused muscles.
• Release endorphin,,_amino acids that work as the body's natural

painkiller.
• Relieve migraine pain.
There's no denying the power of bodywork Regardless of the adjectives we

assign to it (pampering, rejuvenating, therapeutic) or the reasons we seek it
out (a luxurious treat, stress relief, pain management), massage therapy
can be a ally in your healthcare regimen.
Experts estimate that upwards of ninety percent of disease is stress

related. And perhaps nothing ages us faster, internally and externally, than
high stress. While eliminating anxiety and pressure altogether in this fast-
paced world may be idealistic, massage can, \\1thout a doubt, help manage
stress. This translates into:
• D<>. ereased anxiety.

Issued by:
Page 55 of
47
CSAT r.1ASSAG£ THRRAPY NC Ill Date Developed: Docun1ent No.
QA Working \Vithin a Holistic Amil 14 2011
of 271

Issued by:
Page 56 of
47
• Enhanced sleep quality.
• Greater energy.
• Improved concentration.
• Increased circulation.
• Reduced fatigue.
Furthermore, clients often report a sense of perspective and clarity after

receiving a massage. The emotional balance bodywork provides can often
be just as vital and valuable as the more tangible physical benefits.
Profound Effects
In response to massage, sp<-.>eific physiological and chemical changes

cascade throughout the body, with profound effects. Research shows that
with massage:
• Arthritis sufferers note fe\\1er aches and less stiffness and pain.
• Asthmatic children show better pulmonary function and increased
peak air Dow.
• Burn injury patients report reduced pain, itching, and anxiety.
• High blood pressure patients demonstrate lower diastolic blood

pressure, anxiety, and stress hormones.
• Premenstrual syndrome sufferers have decreased water retention and

cramping.
• Preterm infants have improved weight gain.

Issued by:
Page 57 of
47
of 271

Issued by:
Page 58 of
47
Research continues to shov.r the enorm<Als benefits of touch---v.1hich range
from treating chronic diseases, neurological disorders, and injuries, to
alleviating the tensions of modern lifestyles. Consequently, the medical
community is actively embracing bodyv.1ork, and massage is becoming an
integral part of hospice care and neonatal intensive care units. Many
hospitals are also incorporating on-site massage practitioners and e\i·en
spas to treat post surgery or pain patients as part of the recovery process.
Getting a massage can do you a world of good . And getting massage

frequently can do even more. This is the beauty of bodywork. Taking part
in this form of regularly scheduled self-care can play a huge part in how
healthy you'll be and how youthful you'll remain "1th each passingyear.
Budgeting time and money for bodywork at consistent intervals is truly an

investment in y<Alr health. And remember: just because massage feels like
a pampering treat doesn't mean it is any less therap<>
. utic.Consider
massage appointments a necessary piece of your health and wellness plan,
and work " th your practitioner to establish a treatment schedule that best
meets your needs.
Assignment:
I. . Reviev.r the clinical research studies examining the benefits of

massage.
2 Review massages information from the National Center for
Compl em<mtaQI and AUe matit1e Medicine, a division of
the National Institutes of Health.

Issued by:
Page 59 of
47
of 27 1

Issued by:
Page 60 of
47
INFORMATION SHEET l.· E
Massage Contraindications (When not to massage)
Avoid massage in the foOov.ring conditions, instances and disonJers:

o During the first three months of pregnancy
It is generally not considered safe to massage pregnant v.romen, particularly

in the first trimester, when the risk of miscarriage is highest. However, a
gentle head massage, without oils, is acceptable, and a light gentle, loving,
stroke appied to the face and brow will relieve anxiety and release stress.
o High temperature /fever
The body is already fighting off toxins as indicated by the rise in

temperature. A massage v.1ruld release even more unv.1elcome toxins into the
system.
Amil 14 2011

Issued by:
Page 61 of
47
of 271
Framev.rork

Issued by:
Page 62 of
47
o Open \\1ounds, cuts and bruising
Apply only light touch drainage massage around the site, to assist the blood
Dow towards the heart and encourage healing where bruising is present. Oil
may aggravate an open wound. \!/hile giving a massage, cover up any open
cuts or scratches on your hands with a plaster or other dressing.
o Inflammation
Avoid massage over an area of inflammation, (which could be due to fatty
deposits causing a cyst) and massage will spread the infection. However in
case of localised problems, adding a strong base of essential oil to your bath
may help you to overcome, suffering \\ th prickly heat and redness.
Inflammation \\'Ould include conditions such as thrombosis and phlebitis
(painful clot in vein).
o Blood Clots
As massage could dislodge and move clot possibly causing a heart attack or
stroke.
o Varicose \i'eins, or history of thrombosis
Do not massage over broken or varicose veins as the bk>od supply is

impaired in this area. Massage \\ U increase blood Dow and Dood the over-
worked capillaries and veins, possibly causing coagulation and affecting
blood Dow to the heart. Professionally trained therapists may emeurage
gently when advised by consultant or general practitioner of patient.
CSAT r.1ASSAG£ TH R RAPY NC Ill Date Developed: Docun1ent No.

Amil 14 2011

Issued by:
Page 63 of
47
of 271
Framev.rork

Issued by:
Page 64 of
47
o Infectious skin diseases
Bacterial infection, Lymphangitis, FunI infection, Viral infections,

Herpes, in these conditions it is always advisable to get consent of
your medical practitioner before having massag<?. In case of severe
skin problems, such as eczema or psoriasis - massage can add to
dermal irritation.
o Cancer
Cancer can spread through the lymphatic system, and because massage
increases lymphatic circulation, it may potentially spread the disease as
weU. Simple, caring touch is fine, but massage strokes that stimulate
circulation are not. Always check with a doctor first.
o Broken bones / Fractures
Stay away from an area of mending bones. A little light massag<? to

the surrounding areas, though, can improve circulation and be quite
helpful. \\/hen a bone is weakened by a metastasis (spread of the
cancer), deep pressure over it may v.1orsen the pain or even cause a
fracture.
o Acute back pain
Avoid massage, particularly if the pain shoots down the arms or legs
when the back is massaged. Do not apply massage or pressure to the
spinal column or other bony processes unless gently passing over the
area to reach other areas of the body.
o Other chronic conditions and diseases

Issued by:
Page 65 of
47
QA Working \Vithin a Holistic Amil I4 2011
SYSTEM Therapeutic Massage Developed by: Issued by: Pag<! 31
Framev.rork Manny P. Oaleon of 271

Issued by:
Page 66 of
47
Consult a qualified medical practitioner if you having high blood
pressure, diabetes or any heart disease prior to receiving massage
therapy.
Take Note:
IT IS NOT ADVISABLE to expose your skin to the sun's rays within 12

hours of dermal application of base and essential oils.
SELF-CHECK 1.1-1
TRUE OR FALSE
Write T if the statement is true and F is the statement is false in your answer
sheet.
1. MASSAGE is an instinctive therapy that everyone has the ability to learn.
2. The healing power of therapeutic massage is not used for emotional

problems.
3. Physical symptoms such as headaches or constant fatigue are often an
indication of Vlhat is 'on our mind'.
4. Body and mind should not be regarded as separate entities.

5. Massage, bodywork and somatic therapies are defined as the application
of various techniques to the muscular structure and soft tissues of the
human body.

Amil I4 20 11
Issued by:
Page 67 of
47
Therapeutic Massage of 27 1
Framev.rork

Issued by:
Page 68 of
47
6. Massage: The application of soft-tissue manipulation techniques to the
body, is not intended to reduce stress and fatigue while improving
circulation.
7. Bodywork: Various forms of touch therapies that may use

manipulation, movement, and/or repatteming to affect structural
changes to the body.
8. Somatic: Meaning "of the body." Many times this term is used to
denote a body/ mind or whole-body approach as distinguished from a
physiology-only or environmental perspective.
9. Massage is a successful tool for healing and has been practiced

throughout the world for 1000 years.
I 0. References to massage are found in Chinese medical texts 1,000 years

old.
11. Physicians mostly of the Greek and Roman era, does not prescribed
massage both for its restorative pov.1ers and for general preservation of
the body and mind.
12. In the 5th century B.C., Hippocrates (the father of medicine), who had
learned massage from the Greeks, prescribed the use of rubbing and
friction forjoint and circulatory ailments.
13. In 1363 Guy de Chaulic published a book about surgery, where he

described different methods of bodywork in conjunction " th surgery.
14. Paracelsus found that bodywork was not only an important therapy
and that it v.as not necessary.
1
J S. Doctors such as Ambroise Pare, a 16th-century physician to the

Roman court, praised massage as a treatment for various ailments.

Issued by:
Page 69 of
47
of 27 1

Issued by:
Page 70 of
47
16. Apurveda, the traditional Indian system of medicine, places great
emphasis on the therapeutic benefits of massag<? with aromatic oils
and spices.
17. Massage lost some of its value and prestige " th the unsavory image
created by "massage parlors."
18. ?vlassage is nov.r used in intensi\i·e care units, for children, elderly
people, babies in incubators, and patients with cancer, AIDS, heart
attacks, or strokes.
19. Massage can also be used to stimulate the nervous system depending
on the technique used
20. Massage does increase strength, muscle bulk or muscle tone.
21. The effects of massage may be soothing and sedative, providing

relief from nervous irritability.
22. Some massage movements relax and stretch the muscles and soft
tissues of the body, reducing muscular tension and cramp. Fibrous
tissues, adhesions and old scar tissue can be broken dov.rn and
cleansed of waste deposits.
23. The skeletal system is not strengthened by using massage.
24. As the massage strokes are performed, the waste and poisonous
substances v.ihich have accumulated in our O\"erstressed bodies are
rapidly dissiminated.
25. The olfactory system responds an increased activity in the lungs is

stimulated by massage.
26. The respiratory system benefits when massage promotes the

peristaltic activity (wave like motion) in the colon enhancing the
elimination of faecal matter and combating constipation.

Issued by:
Page 71 of
47
SYSTEM Therapeutic Massage Developed by: Issued by: Pag<! 34
Framev.rork Manny P. Oaleon of 271

Issued by:
Page 72 of
47
27. The genito-urinary system, the use of abdominal and back massage
promotes the activity of kidneys, which enhances the elimination of
waste products and increases fluid retention.
28. Abdominal and back massage can help to alleviate menstrual

problems such as period pains, irregular menstruation, PMS and
the symptoms of menopause.
29. Massage enhance immunity by stimulating blood flow-the body's

natural defense system.
30. 1vlassage promotes tissue degeneration, increasing scar tissue and
stretch marks.
ANSWER KEY 1.1-1

1. True 3. True
2. False 4. True

Issued by:
Page 73 of
47
of 27 1

Issued by:
Page 74 of
47
5. True 18. True
6. False 19. True
7. True 20. false
8. True 21. True
9. False 22. True
J O. False 23. False
II. False 24. False
12. True 25. False
13. True 26. False
14. False 27. False
15. False 28. True
16. False 29. False
17. True 30. False

Issued by:
Page 75 of
47
of 271

Issued by:
Page 76 of
47
INFORMATION SHEET 1.1-2-A
Ethical issues in therapies
General Principles of Ethics
Ethics is defined by \!/ebster as the study of standards of conduct and moral

judgment; this system or code of morals of a particular person, religion, group,
profession, etc.
Since each person is unique v. th their own experiences and beliefs, et.hies can
be difficult to define. There is no concrete anStuer. As a professional, v.1e are
responsible for the comfort and safety of our clients. \!/e can serve them best
v.1hen v.1e understand their needs and rights. \Ve can serv·e them best v.1hen v.ie
ha\i·e examined oursetves and VlOrked thrrugh our own issues. \Ve can serve
them best when we focus on the development of ourselves. \!/e can only guide
the client to places that we have been willing to go ourselves. The healing
process can begin only when we realize that we are just facilitators in the
process itself. The healing is the responsibility of the client alone. They must
be given the information to determine what is right for them and what they are
going through.
lnform£d Consent
Clients need to be able to make a decision as to whether they want you to

v.1ork on them and v.1hat they v.1ant you to do. This is informed consent. They
must be given enough information, such as : what are the goals and purpose
of the session, what are the possible consequences of the treatment, v.rhat

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risks are involved, what are the possible benefits of a treatment, how much
time will the treatment take, how much money will the treatment cost and
how will it be paid for. \!/ith this information, a client will be able to determine
if they want the treatment for themselves or do they refuse the treatment.
Right of Refusal
Clients have the right to refuse the service for any reason at any time. If they
determine that the session should be stopped right in the middle, their needs
must be respected. Be aware that a session interrupted before completed may
also cause a problem in the financial agreement. Does the client owe for the
whole time?
This same right also applies for the practitioner. You can end a session at any
time, for any reason. The bottom line is to work on only people who are
nurturing to you and do not drain your energy. If your mother just died of
lung cancer it may not be advisable to v.ork on someone v.rho smokes.
1
Confi d£nt iality

A client's information, both written and verbal belongs to the clienl
Conversations that occur during a session shouki not be repeated or included
in the chart notes unless it is describing their physical condition. A client may
also not want to be approached outside the treatment clinic. If you see a
client walking down the street and stop and say hello, this may violate their
right of confidentiality, as they may not want it be known that they are
seeking treatmenl
Boundaries
A Boundary is a space within a perimeter that may be a physical, emotional or
mental space. The emotional (mental) space is determined by past

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experiences, values and morals. The physical space is the actual physical
limits of space that is needed by each person to feel safe and secure.
Boundaries can be communicated by verbal conversations or body language.
Some p<>.ople, especially those with a history of abuse of some sort, may not be
aware of their boundaries let alone able to maintain their boundary.
Brundaries may be determined before a session to ensure the clients comforl
Boundaries are often difficult to determine. What may be good for one person,
may not be appropriate for another. It is important to explore boundaries and
constantly readjust limits to accommodate each individual
\!/hen boundaries are crossed, respect may be lost in the relationship.
There are a main types of boundaries we deal \\th include: Legal boundaries,
professional boundaries, and personal boundaries.
Legal bound aries are those that of course deal th the law and the rules
and regulations that are set up by each state, city or county. Your scope of
practice is defined legally. Your scope of practice is the limits or boundaries
that apply to your practice. This may include areas you can work on and
what you can or can not do.This U determine if you can do things like make
diagnoses, do physical adjustments, work in the mouth or other body cavity
and seU vitamins and other related items.
The laws vary so much that it is impossible to discuss here. Make sure you
contact your local authorities to determine what your legal boundaries are and
that you work thin the law.
Profe ssional boundaries are determined by many things such as your type of
practice, yru.r business rules and practices.
Personal boundaries are just that- everything that determines your safety
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Boundary violations usually begin quietly, little by little, and without many
problems. \!/hen you go through the process of looking at your values and
needs and set your framework, boundary violations can be
minimized. Recognizing your own boundaries will be based on your values
and needs. There is no right or wrong here - only what is what is important to
you.
Transference occurs when the client makes the professional relationship,

personal. Indications of transference are things like the client brings you
additional gifts or asks to see you for lunch or outside the treatment. Personal
conversation can also be an indicator. \!/hat you do depends on each
situation. This can occur \\ihen a client is lacking in sufficient resources to
take care of themselves. Unresolved needs, feelings and issues are transferred
to the helper or caretaker.
Counter-transference occurs \\'hen the therapist is unable to separate the

therapeutic relationship from their personal feelings surrounding the client.
Some of examples of this is when a therapist feels inadequate if the client is
not making progress or excessive thinking about the client after the treatment
is over. This occurs usually when the therapist plays the helper or fixer role.
We begin thinking that we can get rid of the person's pain when we really don't
do anything but facilitate the clients' growth for their own healing of pain. \Ve
begin to think that only we can fix the problem and we have all the correct
answers.
Boundary violations usually begin quietly, little by little, and without many
problems.
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It is important ID think of your practice as one of seroice to the clienL
Hotu can you serve that client best?
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Knowing the basic principle of ethics isjust the beginning to building a
successful practice.
Reference: http·/ /v.,ry.,ry.r thebodyv.rodcer c.om/ etbicsprincjples htm

Massage Therapy Ethics and Etiquette
By Terry McDermott
There is no avoiding this simple fact about massage therapy: Providing or

receiving the healing pov.1er of touch is intimate. And intimacy, e\.·en in the
most professional settings, can expose vulnerabilities and lead to
uncomfortable and even av.1kv.1ard situations.
It is the responsibility of the massage therapist to create an environment

that is conducive to a healthy, relaxing and satisfying experience for the
client. On the other hand, it is the responsibility of the client to
communicate v.ii.th the massage therapist in a manner that alk>v.1s the
therapist to provide the service in a manner that puts the client at ease.
An experienced massage therapist wiU be able to guide the recipient

through the massage process so that there is little confusion about some of
the basic areas that cause embarrassment or confusion.
Take ItAll Off?
The amount of clothing worn during a massage is dependent on the type of

massage being administered. It is normal to be completely undressed
during a full body Swedish massage but is not absolutely necessary. If a
client prefers to wear panties or briefs during the massage that is fine.
Frankly, the client should be able to wear whatever makes them most

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comfortable. Regardless, the therapist will appropriately drape the client so
that only the areas of the body being massaged are exposed.
The therapist will usually instruct the client about what to expect before
they begin undressing. The therapist will then leave the room and allow the
client to undress and get comfortable on the massage table under a sheet
or towel. The massage therapist will then uncover only the area of the body
being massaged.
Touchy Feely
There are a variety of reasons that an individual may v.1ant a massage:

stress relief, relaxation, general v.1ellness, enhances circulation, improved
flexibility, etc. No matter what the reason for the massage the therapist is
always under the obligation to respect the boundaries set by the client and
to establish his or her ov..rn boundaries.
Therapeutic massage is, by nature, a sensual experience. Hov.1ever, it is not

intended to be a sexual experience. If a client, male or female, makes any
overtly sexual requests or suggestions then the therapist is obligated to
professionally and forcefully identity the inappropriateness of these
comments. Conversely, no therapist should take liberties or make
assumptions relative to what parts of the body can be touched.
In general, it is never appropriate to touch the genitals during a massage

session. The client cannot expect to be touched sexually and the therapist
cannot touch a client in a sexual manner. Either case will betray the trust
in the relationship between the two parties...to say nothing of the potential
for legal and ethical issues.

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And lef s be clear. While there are documented benefits of breast massage,
it is not, and should not be, included in a total body massage. Breasts are
off limits unless a very special request is made of a qualified therapist. The
National Certification Board for Therapeutic Massage and Bodywork
includes a specific policy in its Standards of Practice. The Board states that
therapists may "only provide therapeutic breast massage as indicated in
the plan of care, and only after receiving informed voluntary consent from
the client." That being said, breast massage is legally restricted in some
states.
An experienced massage therapist, male or female, will know how to deflect

sexual advances by a client If a subtle response does not do the job then a
forceful statement or ending the session will be the correct response. Any
client who !eels that they are being touched inappropriately should feel
confident in their right to speak up. If it is incidental contact or just an
accident the therapist will apologize and continue " th the client's
discomfort noted accordingly.
Extracurricular Activity
As stated earlier, twch 1s intimate. Permission for such intimacy is

accorded based on the massage therapist's professionalism and the trust of
the client. At the same time, a relationship is established ..a protessional
relationship but a relationship nonetheless. Understanding and honoring
the boundaries of that relationship will allow both parties to fill their roles
appropriately.
It is generally accepted that there ought not to be any personal relationship

between the therapist and a paying client. ADoMng the relationship to

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expand beyond the massage table to a social or even romantic connection
is to invite a host of ethical dilemmas. A therapist could be perceived as
taking advantage of a client who might be in a vulnerable state due to
stress or physical ailment. In the state of \\lashington it is illegal to date a
client within t\\10 years of the last session. That is strict stuff and is as
likely to protect a therapist from misunderstandings as it is to protect a
client.
Borders and Boundaries
Providing the healing power of touch is an honorable and ancient

profession. The benefits of massage therapy are numerous and continue to
gain acceptance as a mainstream health practice. No one should ever have
to feel uncomfortable about getting a massage and they won't if they are in
the hands of a well-trained and ethically centered massage professional.
Article Source: http:/ /EzineArticles.com/ J O 18344

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SELF-CHECK 1.1-2
TRUE OR FALSE
Write T if the statement is true and F is the statement is
false in your answer sheet.
I . Ethics is defined by \l/ebster as the study of standards of conduct and
moral judgment; this system or code of morals of a particular person,
religion, group, profession, etc.
2. As a professional, we are responsible for the comfort and safety of our
clients.
3. Clients need not to make a decision as to \\'hether they v.1ant you to v.1orlc
on them and what they want you to do.
4. Clients have the right to refuse the service for any reason at any time. If
they determine that the session should be stopped right in the middle,
their needs must be respected.
5. Be aware that a session interrupted before completed may also cause a

problem in the financial agreement. Does the client owe for the whole
time?
6. As a massage therapist, you can end a session at any time, for any
reason.
7. A client's information, both written and verbal does not belongs to the
clienl

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8. Conversations that occur during a session should not be repeated or
included in the chart notes unless it is describing their physical
condition.
9. A Boundary is a space within a perimeter that may be a physica

emotional or outer space .
J O. The emotional (mental) space is determined by future experiences,

values and morals.
11. The physical space is the actual physical limits of space that is needed
by each person to feel safe and secure.
12. Boundaries can be communicated by verbal conversations or body

language.
13. Some people, espc>cially those " th a histnry of abuse of some sort,
may not be aware of their bou ndaries let alone able to maintain their
boundary.
14. Boundaries may b,e determined before a session to ensure the clients
discomfort.
15. Legal boundaries are those that of course deal with the law and the
rules and regulations that are set up by each state, city or county.
16. Professional boundaries are not determined by many things such as

your type of practice, your business rules and practices.
17. Personal boundaries are just that- everything that determines your
salety zone.
18. Transference occurs when the client makes the professional

relationship, personal.

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19. Contra-Indications of transference are things like the client brings you
additional gifts or asks to see you for lunch or outside the treatment.
20. Counter-transference occurs when the therapist is unable to separate

the therapeutic relationship from their personal feelings surrounding
the client.
ANSWER KEY 1.1-2

I. True
2. True
3. False
4. True
5. False
6. True
7. False
8. True
9. false
JO. false
11. true

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12. true
13. true
14. false
15. true
16. false
17. true
18. true
19. false
20. true
INFORMA110N SHEET 1.1-3-A

OHS requirements in the workplace
Workplace Housekeeping • Basic Guide
Why should we pay attention to housekeeping at work?
Effective housekeeping can eliminate some workplace hazards and help get
a job done safely and properly. fuor housekeeping can frequently

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contribute to accidents by hiding hazards that cause injuries. If the sight of
paper, debris, clutter and spills is accepted as normal, then other more
serious health and safety hazards may be taken for granted.
Housekeeping is not just cleanliness. It includes keeping work areas neat

and orderly; maintaining haUs and Doors free of slip and trip hazards; and
removing of waste materials (e.g., paper, cardboard) and other fire hazards
from work areas. It also requires paying attention to important details such
as the layout of the whole workplace, aisle marking, the adequacy of
storage facilities, and maintenance. Good housekeeping is also a basic part
of accident and fire prevention.
Effecti'v·e housekeeping is an ongoing operation: it is not a hit-and-miss

cleanup done occasionally. Periodic "panic" cleanups are costly and
ineffective in reducing accidents.
What is the purpose ofworkplace housekeeping?
Poor housekeeping can be a cause of accidents, such as:
• tripping over loose objects on floors, stairs and platforms

• being hit by falling objects
• slipping on greasy, wet or dirty surfaces
• striking against projecting, poorly stacked items or misplaced

material
• cutting, puncturing, or tearing the skin of hands or other parts of the

body on projecting nails, wire or steel strapping

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To avoid these hazards, a workplace must "maintain" order throughout a
workday. Although this effort requires a great deal of management and
planning, the benefits are many.
What are some benefits of good housekeeping practices?
Effective housekeeping results in:
• reduced handling to ease the !low of materials

• fewer tripping and slipping accidents in clutter-free and spill-free
v. ork areas
• decreased fll"e hazards
• lov.1er Vlorker exposures to hazardous substances (e.g. dusts,

vapours)
• better control of tools and materials, including inventory and

supplies
• more efficient equipment cleanup and maintenance
• better hygienic conditions leading to improved health
• more effective use of space
• reduced property damage by improving preventive maintenance
• lessjanitorial v.rorlc
• impro'Y·ed morale
• improved productivity (tools and materials will be easy to find)
How do I plan a good housekeeping program?

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A good housekeeping program plans and manages the orderly storage and
movement of materials from point of entry to exil It includes a material
Dow plan to ensure minimal handling. The plan also ensures that work
areas are not used as storage areas by having \\1orkers move materials to
and from work areas as needed. Par! of the plan oould include investing in
extra bins and more frequent disposal.
The oosts of this investment oould be offset by the elimination of repeated

handling of the same material and more effective use of the workers' time.
Often, ineffective or insufficient storage planning results in materials being
handled and stored in hazardous ways. Knowing the plant layout and the
movement of materials throughout the workplace can help plan work
procedures.
\l/orker training is an essential part of any good housekeeping program.

Workers need to know how to work safely with the products they use. They
also need to know how to protect other workers such as by posting signs
(e.g., "\I/et - Slippery Floor") and reporting any unusual conditions.
Housekeeping order is "maintained" not "achieved." Cleaning and

organization must be done regularly, not just at the end of the shift.
Integrating housekeeping into jobs can help ensure this is done. A good
housekeeping program identifies and assigns responsibilities for the
following:
• clean up during the shift

• day-to-day cleanup
• astedisposal
\\ 1

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• removal of unused materials
• inspection to ensure cleanup is canplete
Do not forget out-of-the-way places such as shelves, basements, sheds,

and boiler rooms that would otherwise be overlooked. The orderly
arrangement of operations, tools, equipment and supplies is an important
part <:X a good housekeeping program.
The final addition to any housekeeping program is inspection. It is the only

way to check for deficiencies in the program so that changes can be made.
The documents on workplace inspection checklists provide a general guide
and examples of checklists for inspectinf!'. offices and manufacturinf!'.
facilities.
What are the elements of an effective housekeeping program?
Dust and Dirt Removal
In some jobs, enclosures and exhaust ventilation systems may fail to

collect dust, dirt and chips adequately. Vacuum cleaners are suitable for
removing light dust and dirt. Industrial models have special fittings for
cleaning walls, ceilings, ledges, machinery, and other hard-to-reach places
v.1here dust and dirt may accumulate.
Special-purpose vacuums are useful for removing hazardous substances.

For example, vacuum cleaners fitted with HEPA (high efficiency particulate
air) filters may be used to capture fine particles of asbestos or fibreglass.
Dampening (wetting) Doors or using sweeping compounds before sweeping

reduces the amount of airborne dust. The dust and grime that collect in

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places like shelves, piping, conduits, light fixtures, reflectors, windows,
cupboards and lockers may require manual cleaning.
Compreued air should not be used for removing dust, dirt or chips from
equipment or \\1ork surfaces.
Employee Facilities
Employee facilities need to be adequate, clean and well maintained.

Lockers are necessary for storing employees' personal belongings.
Washroom facilities require cleaning once or more each shift. They also
need to have a good supply of soap, towels plus disinfectants, if needed.
If workers are using hazardous materials, employee facilities should

provide special precautions such as showers, washing facilities and change
rooms. Some facilities may require tv.10 locker rooms v.rith shov.iers betv.1een.
Using such double locker rooms allows workers to shower off workplace
contaminants and prevents them from contaminating their "street clothes"
by keeping their work clothes separated from the clothing that they wear
home.
Smoking, eating or drinking in the work area should be prohibited where

toxic materials are handled. The eating area should be separate from the
work area and should be cleaned properly each shift.
Su.races
Floors: Poor Door conditions are a leading cause of accidents so cleaning up

spilled oil and other liquids at once is important. Allowing chips, shavings
and dust to accumulate can also cause accidents. Trapping chips, shavings

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and dust before they reach the Door or cleaning them up regularly can
prevent their accumulation. Areas that cannot be cleaned continuously,
such as entrance ways, should have anti-slip Dooring. Keeping Doors in
good order also means replacing any worn, ripped, or damaged Dooring
that poses a tripping hazard.
\!/aUs: Light-colored walls reflect light while dirty or dark-colored walls

absorb tight. Contrasting colours warn of physical hazards and mark
obstructions such as pillars. Paint can highlight railings, guards and other
safety equipment, but should never be used as a substitute for guarding.
The program should outline the regulations and standards for colours.
Maintain Light Fixtures
Dirty light fixtures reduce essential tight levels. Clean light fixtures can
improve lighting efficiency significantly.
Aisles and SWrways
Aisles should be wide enough to accommodate people and vehicles

comfortably and safely. Aisle space allows for the movement of people,
products and materials. \'laming signs and mirrors can improve sight-lines
in blind corners. Arranging aisles properly encourages people to use them
so that they do not take shortcuts through hazardous areas.
Keeping aisles and stairways clear is irnportan They should not be used
for temporary "overftow" or "bottleneck" storage. Stairways and aisles also
require adequate lighting.

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Spill Control
The best way to control spills is to stop them before they happen. Regularly
cleaning and maintaining machines and equipment is one way. Another is
to use drip pans and guards where possible spills might occur. \Vhen spills
do occur, it is important to clean them up immediately. Absorbent
materials are useful for wiping up greasy, oily or other liquid spills. Used
absorbents must be disposed of properly and safely.
Tools and Equipment
Tool housekeeping is very important, whether in the tool room, on the rack,
in the yard, or on the bench. Tools require suitable fixtures with marked
locations to provide orderly arrangement, both in the tool room and near
the work bench. Returning them promptly after use reduces the chance of
being misplaced or lost. \Vorkers should regularly inspect, clean and repair
all tools and take any damaged or worn tools out of service.
Maintenance
The maintenance of buildings and equipment may be the most important

element of good housekeeping. Maintenance involves keeping buildings,
equipment and machinery in sate, efficient \\1orking order and in good
repair. This includes maintaining sanitary facilities and regularly painting
and cleaning walls. Broken windows, damaged doors, defective plumbing
and broken Door surfaces can make a workplace look neglected; these
conditions can cause accidents and affect \\1ork practices. So it is import.ant
to replace or fix broken or damaged items as quickly as possible. A good

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maintenance program provides for the inspection, maintenance, upkeep
and repair of tools, equipment, machines and processes.
Waste Disposal
The regular collection, grading and sorting of scrap contribute to good

housekeeping practices. It also makes it possible to separate materials that
can be recycled from those going to waste disposal facilities.
Allowing material to build up on the floor wastes time and energy since
additional time is required for cleaning it up. Placing scrap containers near
where the waste is produced encourages orderly waste disposal and makes
collection easier. All waste receptacles should be clearly labelled (e.g.,
recyclable glass, plastic, scrap metal, etc.).
Storage
Good organization of stored materials is essential for overcoming material

storage problems whether on a temporary or permanent basis. There will
also be fewer strain injuries if the amount of handling is reduced,
especially if less manual materials handling is required. The location of the
stockpiles should not interfere with work but they should still be readily
available when required. Stored materials should allow at least one metre
(or about three feet) of clear space under sprinkler heads.
Stacking cartons and drums on a firm foundation and cross tying them,
v.rhere necessary, reduces the chance of their movement. Stored materials
should not obstruct aisles, stairs, exits, fire equipment., emergency
eyev.1ash fountains, emergency shov.1ers, or first aid stations. All storage
areas should be clearly marked.
SYSTEM Therapeutic Massage
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Flammable, combustible, toxic and other hazardous materials should be
stored in approved containers in designated areas that are appropriate tor
the different hazards that they pose. Storage of materials should meet all
requirements specified in the fire codes and the regulations of
environmen taJ and occupational health and safety agencies in your
jurisdiction.

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Hygiene for Massage Therapists
Understanding hygiene is essential for massage therapists to keep

themselves safe from infectious diseases and to keep them from spreading
between their clients.
The main goal is to discourage and prevent growth or spread of pathogens

and allergens. Sanitizing and disinfecting your massage office consists of
keeping your table, face cradle, sheets, bottles of lotion/ oil, hydrotherapy
equipment as well as the carpet, walls and counters clean and sanitary.
Clients also may have allergies and sensitivities to mold and any scents or
laundry detergent that you use so using hypo-allergenic products can help.
After every massage you must wash your hands and forearms to keep them
free from bacteria. Proper manicure skills will keep nail beds clean and
smooth to not leave scratches on clients.
Glossary of Hygiene Terms for Massage Therapists
Antiseptic - a chemical agent used to retard the growth of germs. It does

not kiU them. Antiseptics can retard bacterial growth. They do not affect
viruses or funguses.
Asepsis - free of disease and germs
Bactericide - a chemical agent that destroys bacteria but not their spores
Disinfectant- a chemical agent that destroys germs
Sanitize - to clean by the use of an agent using one of the above types of
products

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Sepsis - poisoning due to a pathogen
Sterile - tree from germs and spores
Sterilization- to make sterile and free from bacteria, viruses and funguses
Reoommended products for cleaning massage tables:

J O parts water and I part bleach
Use hot water for sheets and hot dryer cycle.

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SELF-CHECK 1.1-3
TRUE OR FALSE
Write T if the statement is true and F is the statement is lillse in your
answer sheet.
I. Effective housekeeping can eliminate some workplace hazards and

help get a job done safely and properly.
2. Proper housekeeping can frequently contribute to accidents by hiding

hazards that cause injuries.
3. If the sight of paper, debris, clutter and spills is accepted as abnormal,

then other more serious health and satety hazards may be taken for
granted.
4. Effective housekeeping is an ongoing operation: it is not a hit-and-miss

cleanup done occasionally.
5. Periodic "panic'" cleanups are costly and effective in reducing

accidents.
6. A poor housekeeping program plans and manages the orderly storage

and movement of materials from point of entry to exit.
7. Often, ineffective or insufficient storage plarming results in materials

being handled and stored in hazardous ways.
8. \!/orker training is an essential part of any good housekeeping
program.
9. The final addition to any housekeeping program is infection.

I 0. Compressed air should be used for removing dust, dirt or chips from
equipment or v.'Ork surfaces.

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ANSWER KEY 1.1-3
I. True
2. False
3. False
4. True
5. False
6. False
7. True
8. True
9. False
J O. False

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INFORMATION SHEET 1. 1-4
Communicating in group and one-on-one settings
Massage Client Interview Skills
The Massage Client Interview is one of the most important parts of the
massage session. The lnterviev.r is how you gather information on v.rhat the
client expects from their session as well as what they need. It will help you
create a plan of action in applying what you know about massage and help
you to perform an effective massage. It is the beginning of educating your
clients about massage and what it is that it does and what you do
specifically \\th massage.
Here are some things to remember when talking \\th clients:
• be sensitive to the personal information you \\II be getting from each

client
• be aware of the non-verbal factors such as posture, gait and holding
patterns of the body .. Be aware of your own body language too.

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• learn to communicate just what it is that you do in a massage or
what happens when different massage is applied to the body in
different ways and explain what is best for their condition
• allow enough time to complete a thorough interview. You can also

ask questions as you are v.'Orking
• use active listening and show that you understand the client by
para-phrasing or telling them what you heard them say
• ask yes or no questions and also open ended questions.
• most of the healing process happens in just being heard and

acknowledged.
Create an intake form to make the process easier asking the questions you
Vlant to ask there firsl Expand on them in the verbal interviev..r.
Just asking the standard questions to rule out contraindications is really

just the beginning of a good massage client interview. Engaging clients in
their own healing process and becoming aware of their bodies is crucial for
helping people to feel better and to also build your massage business.
What most people need no matter what they are suffering from or dealing
with is to be listened too and believed. Just the act of listening can give
people such a sense of relief and start the healing process. It doesn't really
matter what technique you use in your massage session.
Learning to listen is often a difficult challenge for massage therapists. It is

also about asking the right questions of clients to get them to open up

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about their real issues. This isn't psychotherapy but getting people to
become more av.1are of their bodies.
Most massage therapists are taught to ask questions so that they wiU
understand the clients condition better and knov.1 hov.1 to use their
techniques on a client. This assumes that knowing about the condition
will help find a solution or fix the problem. Most often issues do not have
just one pat answer. \\/hen you change the goal of asking questions to one
of empov.1ering clients rather than fixing them the massage client interviev.1
will look quite diflerent. It puts healing back in the hands of the massage
client and focusing on v.1hat the client v.1ants to have in their life rather
than focusing on the problem Empowering clients help clients discover
their own powers of healing and helps guide them out of the victim mode
that so often goes along .,. th injuries and illness.
A great book to help you to think of the massage client interview in a veiy
different way than just tiying to fix clients issues is caUed "Interviewing tor
Solutions by Peter DeJong. In it he describes a process of learning to
interview clients with the goal of helping them to come up .,. th their own
solutions. Asking questions usuaUy shows more about the person asking
the question and their viev.1s and values. Being able to set yrur views and
agendas aside wiU be the constant chaUenge for massage therapists
especially since they are often taught to fix in massage schools.
Using open ended questions can help. These are questions that open up a
client's perspective. They can't be answered with just yes or no. Once the
question is asked active listening is used to repeat the information back to
the client so that clarification can be made.

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Being able to communicate \\ii.th clients in this \\'8.Y requires that massage
therapists be able to set aside their own views and really listen to the
client. This process can be made easier when the massage therapist
engages in supervision to work in getting their own needs met rutside of
the massage office. In doing so, it allows the massage therapist to be more
fully focused on the massage client rather than on their own need to fix.
Supervision can also help massage therapists become more aware of their
own fixing and helping issues which will lead to a higher level of integrity in
a massage business which often is what will also create a more profitable
and successful massage business.
Massage Client Interview Questions
• Have you ever had a massage? If so what type? or by what

therapist?
• Are you taking any medications like pain relievers or blood thinners?
• Do you have any heart problems?
• Are you allergic to any oils or nuts?
When someone is in pain:
• Where is the pain exactly? Have client point or fill out body chart to
pinpoint location
• When did it start?
• Did you have it before? \!/hen? \!/hat did you do to relieve it?

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• Are you seeing other health care providers like physical therapists,
acupuncturists, Naturopaths, chiropractors, sports medicine
physicians?
• How did it start? With traumatic injury? Just came on over time?
• \!/hat makes it feel better?
• Does it cause other pain in other areas?
• \!/hat kind of pain is it? Aching, sharp? Other?
• Is there anything that makes it better or worse?
• \!/hat do you hope to get out of today's session?
THE HEAL111 FORMS

ACOU!RING IN FORM ATION
The primary goals of acquiring a client's history are to accurately
determine the origin of the person's problem and its impact on the
person's life.
Remember to LISTEN to your client, and let those responses guide your
interview:
Make every effort to be as sure as is possible that you understand
what your client is trying to tell you.
Be ready to recognize from your clients' communication any gaps they
leave which you the therapist should endeavor to fill by asking appropriate
questions.
Make use of every possible opportunity to use your non-verbal
expressions to shO\\'your understanding and concern for the client.
The questions that the therapist asks should be, for the most part, open-
ended in that they require more than a yes or no response. This allows

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clients to describe their circumstances in their ov.rn v.'Ords.
Questions about the client's problem :

\!/hat brings you to physical therapy? (if not obvious)
Location: "\!/here is it located?" Indicate the primary area of pain. If the
person uses:
o Finger: indicates a small area, no spreading of discomfort, problem
probably not severe, relatively superficial, or both.
o \!/hole hand : diffuse area as primary site : suggests lesion is more
severe, more deeply situated, or both
o Moving hand : spreading or radiating of the pain : if along a well-defined
pathway : dermatome: probably
nerve root problem
o General area, diffuse: most likely referred pain, possibly visceral m
origin
Onset: "How and when did it occur?" (Include a description of the mechanism
and position of injury.) How and when did the problem arise (mechanism of
injury and date of onset)?

o Gradual versus sudden onset
o Sudden onset.
o Gradual
Position the person v.1as in when the injury v.1as acquired (v.1het.her sudden
or gradual onset).
Have you started any out-of-the-ordinary activities recently?
o Characteristics: "Describe your problem," "How does it feel (pain or

other symptoms) and how does it make you feel?" "Does your problem
occur at certain times?"
0 Intensitv: "Hov.1 bad is vour oroblem?" !\!/hat imr act does this

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problem have on your lile? \\/hat are you unable to do because of this
problem, with resp<>.et to all asp<>.ets of your life: self-<:are, home, work,
and leisure?) Have the client rank the problem, using a scale, such as 0 to
JO (give criteria for 0 and for J O, such as 0 = at its best, JO = at its worst).
o Duration : "If certain activities cause you pain, how long does it last
after you stop the activity?" "Is it constant, or intermittent?"
o Aggravating factors: "\\/hat makes the problem worse?" "\\/hat do
you notice this problem to be associated " th?" \\/hen do you
typically feel the pain?
o Alleviating factors: "\\/hat makes the problem better?"
Assess the Impact of the Problem on the Person 's Life:
Questions about the person should focus on the activities that the person
performs and the environments in which they perform them The activities
should address home, work, and leisure/ play and should reflect a typical
day for the client
'Tell me about yourself."
"Tell me about your home life." (\\/hat physical activities do they
have to pertorm at home, describe the home environment, is the
person married, do they have children. etc.)
"Tell me about your work" (\\/hat physical activities do they have to
perform, describe the \\'Ork environment, etc.)
"\I/hat do you like to do in your spare time?" (Describe the physical
activities and their environments related to hobbies, recreation, etc.)
''Prioritize the activities from each of these areas that you \\1ant to
return to doing."
"Describe your 'typical day' before your problem and after your
problem."
Additional Questions:
What is it that this problem is keeping you from doing that you
want to get back to doing?" This is the client's Outcome Statement.
(Have the client prioritize those affected activities, from most to least
importan tj.
"Do you have any other problems?"

Amil 14 20 11
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QA Working \l/ithin a Holistic Developed by: Issued by: Page 68
SYSTEM Manny P. Daleon
Therapeutic Massage of 27 J
Framev.rork

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''\!/hat medications are you currently taking?"
"Have you had any previous physical therapy?" (If yes, describe;
was it successful?)
"How do you feel right now?"
"Is there anything else you would like for me to know?"
During the interview and subsequent treatment, therapists
continually seek to gather information from their clients
CHAR'DNG BAS ICS

SOAP Charting Format
A medical charting system, in which:
S = Subjective (what the client says, or subjective impressions).
0 = Objective (what the provider's findings are, or clinical data).
A = Assessment (Any changes, the diagnosis, or what the client's

condition is).
P = Plan for the next treatment, (further studies and suggested

treatment).
Note: Not noted in the usual SOAP format, but nonetheless important, is
Functional Outcome: \!/hat the client can do (or exp<>.ct to do) because of
the treatment rendered. Which charting format is best - Any charting
format will do in a jury trial.
Reasons for charting
• Other health care professionals find the format and language
familiar and it is a good way to communicate \\th other health
care professionals.
• Use of charting enhances the image of massage and charting
validates massage as curative adjunctive treatment by
providing client progress.

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• Insurance companies accept it as proof of reasonable care and
it provides evidence for attorneys as proof of significant injury.
• It suggests a structure for research using case studies.
• The main reason is: "1vlemory is limited and if it is not written,
it did not happen."
Rules for charting

• Chart in chronological order
• Black ink (Blue is sometimes acceptable)
• \I/rite clearly, concisely and legible
• No ditto marks or initials
• Do not skip lines
• Use correct grammar and spelling.
• \I/rite objectively (no bias, opinions, judgments)
• Draw a line through empty space
• Include the Date, Session #, Time started and Length of session in
the left hand comer
• Re-date your entry if moving onto another page
• Write notes ASAP after giving the massage treatment
• Sign the end of the chart \\ th your first name, last name and
professional title
• Use phrases - not full sentences.
• Client's name must be on every page.
• Use correct terms and abbreviations.
• Name of client, physician and page # all can go on the top right
corner

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QA Working \l/ithin a Holistic Amil 14 2011
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• The person v.rho observed an occurrence or completed a procedure,
records it.
• Use quotes around what the client said
• Never alter therapy records
• Some people say to keep your files for 7 years
SOAP CHARTING
SUBJECTIVE
• To make it simple it means, "\\lhat is the client telling you?"
• The subjective part can also include anything the client writes on the
health form and any verbal and nonverbal communication they give
you
• (Studies indicate that as much as 94 percent of communication is
nonverbal).
• Here are more things that can go in the subjective part Medications
they are on, diseases they have, previous accidents, special
precautions to take, current problems, what type of massage they
want, what areas they want massaged and what areas do they not
v.rant massaged.
• A good way to find out how they handle their day-to-day activities is
with a pain questionnaire (The form is one that rates all activities
and how much pain they have \\th each).
Pain questions to ask:

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• \I/here is the location of the pain?
• How bad is the pain at any given time?
• How long have you had the pain?
• Have you ever had this pain in the past?
• \I/hat is the frequency of the pain?
• How does the pain start?
• Is the pain more on one side than the other?
• Does your job increase your pain?
• \I/hat aggravates the pain?
• Does anything relieve the pain?
• Ifyou do not know how you got the pain, have you ever
injured yourself there before?
• "Tell me about yourself ."
• "Tell me about your home life." (\I/hat physical activities do
they have to perform at home, describe the home
environment, etc.)
• "Tell me about your work." (\I/hat physical activities do they
have to perform, describe the work environment, etc.)
• "\I/hat do you like to do in your spare time?" (Describe the
physical activities and their environments related to
hobbies, recreation, etc.)
• "Prioritize the activities from each of these areas that you
want to return to doing."
• "Describe your 'typical day' before your problem and after
your problem"
• \I/hat is it that this problem is keeping you from doing that
you want to get back to doing?"
QA Amil 14 20 11
Working \Vithin a Holistic Date Developed: Document No.
SYSTEM Therapeutic Massage
Developed by: Issued by: Page 72
Issued
Manny P. Oaleon by:
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Page
47
This is the client's Outcome Statement. (Have the client prioritize those
affected activities, from most to least important).
• "Do you have any other problems?"
• "\!/hat medications are you currently taking?"
• "Have you had any previous physical therapy?" (If yes,
describe; was it successful?)
• "How do you feel right now?"
• "Is there anything else you would like for me to know?"
• Characteristics: "Describe your problem, " "How does it feel
(pain or other symptoms) and how does it make you feel?"
"Does your problem occur at certain times?"
• Intensity: "How bad is your problem?" (\!/hat impact does
this problem have on your life? \!/hat are you unable to do
because of this problem, with resp<>
. et to all aspects of your
life: self-care, home, work, and leisure?) Have the client
rank the problem, using a scale, such as 0 to J 0 (give
criteria for 0 and for J O, such as 0 = at its best, JO = at its
worst).
• Duration: "If certain activities cause you pain, ho\\' long
does it last after you stop the activity?" "Is it constant, or
intermittent?"
• Aggravating factors: "\!/hat makes the problem worse?"
"\!/hat do you notice this problem to be associate with?"
\!/hen do you typically feel the pain?
• Alleviating factors: "\!/hat makes the problem better?"
Su bje cti v e si mpli fie d :

• Any info the client tells you (I had my right femur broke in 97),

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• Health history, client goals (what the client wants out of the
massage),
• update (what happened since last massage},
• symptom's (headaches}, location (upper back},
• intensity (scale of 1-10),
• duration (couple hours after sitting for a long time},
• frequency (3 times a week},
• onset (when sitting for long periods of time},
• aggravates (lifting hea"Y things},
• relieves (aspirin, ice},
• Pain questionnaire.
OBJECTIVE
To make it simple it means, "The data the therapist takes from palpation."
It also means: visual-postural analysis, limps, muscle guarding, holding
patterns, inconsistencies in movements, atrophy, hypertrophy, bruises,
abrasions, scars, sv.ielling, redness, skin irregularities, varicose veins,
breathing patterns and prosthetics.
Treatment goals can be added to define the intention of your massage

choices and that they insure that your treatment-plan has a purpose.
Objective simplified
- Visual observations (scars, postural analysis}, palpable findings

(hypertonic, spasm}, test results (change in ROM findings}, treatment
goals (why you are doing the treatment you are doing}, the massage and
techniques you did (sports massage, trigg er point therapy, worked right

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CSAT r.1ASSAG£ TH R RAPY NC Ill Date Developed: Docun1ent No.
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rhomboid and hypertonic).
ASSESSMENT
To make it simple it means, "The therapist evaluates what she or he is
doing." It also means: Changes in client's condition because of treatment
and changes in symptoms. (Sometimes people include the application in
the assessment part)
Assessment simplified
- Changes in the client's condition (more flexibility m neck), and
symptoms after or during the massage
(headache slightly improved).
S.O.A.A.P. (Application) - Sometimes therapists will include the

treatment given in the assessment or make "S.O.A.A P." notes.
PLAN
To make it simple it means, ''The client's next session \\iill consist
of, and any homework given to the client." A treatment plan for
next session can be included: what worked, what did not, what you
did not address. and v.rhat you v.iant to make sure to v.1ork on next
time. If no changes have been noted in the assessment part, you
may have ideas for next time. Recommend the client to get a
massage on a regular basis: Ix / wk /4wks = eval (one time a week
for four weeks and then evaluate them at the end of the four
weeks). Always recommend how many times for them to come back,
they might not follow it but at least you tried and you are looking
out for their best interesl

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Homework is just that, things the client can perform at home to
help with the process of their treatment (stretching, exercise, ice/ heat
packs, change in diet) try alternatives to pain medication (ice / heat
packs). Do not contradict what the primary health care provider
instructed. Help them make short and long-term goals, short-term is
weekly or monthly (J would like you to sit more th an an hour without
hurting in the next month) and long-term is 3, 6, 9 or 12 month periods.
Plan simplified - \!/hat worked and did not work (trigger point work was
too much on right rhomboids, continue to concentrate on right low back),
what to work on next time Oow back, left leg...), how often to come in for
treatment (2x / wk / 4wks = evaluation), what things they can do on their
own (stretching, ice, heal..).
S.O.A.P.P. (Procedure) - Sometimes therapists will include "S.O.A.P.P."

and the Procedure part will include the treatment you gave and the last
"P' will be the Plan.
Next visit - Reviev.r your notes on the client, before he or she arrives for
their appointment. The subjective part is just an update since the last
time you ga\i·e them a massage.
ANOTHER FORMS OF CHARTING
HOPS CHAR11NG
• History (\!/hat the client tells you and what he or she writes down)
• Observation (Any visual things you see)
• Palpation (Anything you feel)
• Special tests (Muscle testing, R.O.M.or other tests)

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CARE CHARTING
• Condition <:X the client (Current condition of the client)

• Action taken (Type of massage given and length of treatment)
• Response of client (Physiological changes noted during and after
the session)
• Evaluation (Overall evaluation of the session)
FOCUS CHARTING
Goal : to make the client's concerns and strengths the focus of care. This
is the first holistic charting.
Format of charting is "DAR ."

D -Data
•Subjective and Objective
A -Action
•Actual and future massage actions. This includes changes in
plan of care.
R -Response
•Client response to massage treatment.
Osteopaths often use a system of examination called ARTT to look for

signs of somatic dysfunction:
A = Asymmetry \\'here there is an obv·ious difference in the appearance in

an area compared to the OPPOSITE SIDE
R = Range of motion where an area is either moving normally, in a

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QA Working \Vithin a Holistic Amil I4 20 11
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restricted way, or is showing signs of hypermobility.
T = Tissue texture \\ihere there is a difference betv.ieen two areas \\ihen

touching the soft tissues (skin, fascia, muscles).
T = Tissue tenderness v.rhere there is a difference in the painful pressure

threshold to touch in the muscles in an area.
INFORMED CONSENT
I, ------------ understand that the massage therapy

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given to me by a massage t h erapist is for the pur poses of stress
reduction, pain r ed u ction, relief from muscle tension, increasing
circulation, or specific reasons noted
here : ----------------------------
•1understand that massage therapy does not diagnose illness or disease, or

any other disorder, and that the massage therapist does not prescribe
medical treatment or pharmaceuticals, nor are spinal manipulations part of
massage therapy.
•1 understand that massage therapy is not a substitute for medical

examinations or medical care, and that it is recommended that I am
concurrently working with my primary caregiver for any condition I may
ha\i·e.
•1 understand that I have the right to have any part of my body not
massaged (Please let the therapist kno.,. .I have stated all my known
physical conditions, medical conditions, and medications, and I will keep
the massage therapist updated on any changes.
Client Signature: ----------------

Date:------
Client Health Information Sheet

Name: --------------- Date: --------

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Who relerred you to this office? Name: _
Yellow Pages Advertisement Sign Other: _
Present symptoms: What is your major complaint or condition you \\1ant to
improve?
\I/hen did you first notice major complaints?
\I/hat brought it on?
\I/hat activities aggravate the condition?
Is this condition getting progressively worse? Yes No

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PleaseExplain:. _
Does this condition interfere "1th work? Y N Does this condition interfere "
Does this condition interfere "1th your Daily Routine? Y o N
Please Explain:. _ What
Has there been a medical diagnosis? y N

If so, by .,. om? Please Exp
Have you had X-rays taken? y N

If yes by whom?
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What are the major methods of treatment used in therapeutic massage?

What are the major methods of treatment used in therapeutic massage?

What are the massage assessment techniques?

What are the massage assessment techniques?

QUALIFICATION : MASSAGE THERAPY NC II

UNIT OF COMPETENCY : WORK WITH A HOLISTIC THERAPEUTIC

MODULE TITLE : WORKING WITHIN A HOLISTIC

SUMMARY OF LEARNING OUTCOMES:

Dev elop knowledge of complementary therapies

Represent therapeutic massage framework to the community

Work within clinic and regulation guidelines

Concept of massage and treatment are clearly defined based on the

Date Developed: Document No.

2. Additional complementary therapies used m therapeutic

Date Developed: Document No.

• OHP • Ultraviolet Lamp

SUPPLIES AND MATERIALS LEARNING MATERIALS

Date Developed: Document No.

Learning Activities Special instructions

5. Answer self check 1.1.2 Practice answering self-check.

Date Developed: Document No.

around them, hold or stroke them to comfort, support and

Date Developed: Document No.

applied forms of massage for many ailments; and Hippocrates wrote

Massage, bodywork and somatic therapies are defined as the

Massage: The application of soft-tissue manipulation techniques to

Bodywork; Various f<rms of touch therapies that may use

There are more than 250 variations of massage, bodyv.1ork, and

application of these techniques may include, but is not limited to,

Please note: Massage, bodywork and somatic therapies specifically

( http://www.massagetherapy.com/ learnmore/index .php)

Date Developed: Document No.

The word 'Massage' is most likely to have emerged

Massage is a successful tool for healing and has been

References to massage are found in Chinese medical texts

Date Developed: Document No.

In the 5th century B.C., Hippocrates (the father of

In 1363 Guy de Chaulic published a book about surgery,

Doctors such as Ambroise Pare, a !6th-century physician to

Massage became popular throughout Europe, due to the

Date Developed: Document No.

Although the practice of massage has been discredited in the

Massage may be the oldest and simplest form of medical

Ay11rv1>da, the traditional Indian system of medicine,

Doctors such as Ambroise Pare, a 16th-<:entury physician to

Date Developed: Document No.

Massage lost some of its value and prestige with the

Massage is now used in intensive care units, for children,

A variety of massage techniques have also been

Date Developed: Document No.

MASSAGE AFFECTSTHE BODY AS A WHOLE

Tends to normalize hyperactivity of nerves, that is, it

Massage enhances the nutrition of muscles,

Venous circulation is stimulated. Capillaries are dilated

Lymph is a milky white fluid that carries impurities

Date Developed: Document No.

The secreti'v·e function of the skin is impro'v·ed \\'hen

While massage is not recommended for 2-3 weeks