swedish massage learner guide · massage is a useful and integral part of the healing process. the...

Swedish Massage Learner Guide

Massage Schools of Queensland

Swedish Massage

of 42 Version Control Document: V/Swedish Notes March 2017

METHOD OF DELIVERY: Each session is of 3 hours duration and is a combination of theory and practical hands on work. Hand out notes and session review sheets are provided and students are advised that some note taking is recommended. The best way to learn is to form a study group. Get together and practice on each other. Our massage classes run for three (3) hours. The first hour is spent on theory and the rest of the time is spent practising hands on massage techniques on each other and with guidance from the trainer/assessor. RESOURCES REQUIRED: Students are required to bring their own stationary and dress casually to prevent damage to good clothes. Students are also required to bring towels to each class. You may also like to bring a pillow for comfort. All other required resources to facilitate learning will be supplied by MSQ. REGARDING CLASSES

All classes will start at scheduled times, if you are delayed for some VITAL reason – be respectful of your fellow students and enter class quietly.

The onus is on you to catch up on any missed theory or practical.

If you expect to miss a class – approach a fellow student to collect notes and assist you to assimilate.

Your trainers are available to you at all times – however, as class time is limited to course structure it may be necessary to arrange tutorial time with your trainer.

At the end of class, students are required to disinfect and cleanse tables with cleaner provided and paper towels – replace chairs and tables that have been moved. We aim to finish class 5 minutes ahead of time so that students may attend to correct Workplace Health and Safety processes of cleaning tables and equipment used in class.

Recommended reading and references: Carla-Krystin Andrade, Paul Clifford Outcome Based Massage, Lippincott Williams & Wilkins Jolanta Basnyet 1997, Alternative Health Massage, Salamander Books London Sandy Fritz 1995, Fundamentals of Therapeutic Massage, Mosbys Mel Cash 1996, Sport & Remedial Massage, Edbury Press Mary Beth Braun, Stephanie Simonson, 2005, Introduction to Massage Therapy, Lippincott Williams & Wilkins James H. Clay, 2003, Basic Clinical Massage Therapy, Lippincott, Williams & Wilkins Please refer to the student handbook for: Code of ethics Code of practice Guidelines for students


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METHODS OF ASSESSMENT

1. Written Assessment: Written assessment will be conducted throughout the course and will contain short answer, diagrams and some questions to be researched. This is an open book exam to be completed and handed in by session 12 for assessment.

2. Practical Assessment: The practical assessment will be conducted on last session and will assess the students’ ability to plan and provide a massage within a Swedish massage framework.

3. Self Directed Learning: The learner will work at their own pace to complete workbooks that are relevant to the training and competency assessment requirements.

The following units contribute to this framework :- HLTMSG001, HLTMSG004

HLTMSG001 – Develop massage practice

Elements & Performance Criteria

1. Establish foundations of massage practice 1.1 Identify, access and interpret information on the central philosophies of massage practice 1.2 Evaluate the massage system of treatment and its application to current health issues 1.3 Compare and contrast massage, other complementary health modalities and broader health practice

2. Represent the massage framework 2.1 Determine information needs of different individuals and groups 2.2 Identify key messages that represent the philosophy and practice of massage 2.3 Communicate information about massage at level of depth appropriate to audience needs

3. Determine requirements for sustainable massage practice 3.1 Identify key issues that affect the development and sustainability of professional practice 3.2 Identify economic, environmental, human and social considerations, and their impact on professional

practice 3.3 Establish a personal health strategy that supports massage practice 3.4 Access, interpret and collate current information that supports professional practice

4. Develop approach to own practice 4.1 Reflect on professional goals and aspirations 4.2 Identify and assess professional opportunities in massage 4.3 Reflect on the opportunities and constraints of individual personal circumstances 4.4 Make decisions about practice direction, based on reflection and research 4.5 Develop practical strategies that address own practice goals.


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HLTMSG004 – Provide massage treatments

1. Prepare client for treatment 1.1 Clearly outline how the treatment will be provided and managed based on assessment and agreed

treatment approach 1.2 Explain factors which may interfere with the effectiveness of the treatment 1.3 Inform the client of possible physical or emotional reactions during and following a session, and the

appropriate course of action to take 1.4 Follow established protocols to physically prepare the client for treatment 1.5 Confirm client consent for treatment

2. Use massage techniques and sequences 2.1 Determine treatment sequence, location and degree of pressure according to assessment indications

and scope of practice 2.2 Position client to optimise comfort and support while allowing for effective application of techniques 2.3 Maintain client dignity through use of draping 2.4 Maintain therapist postures that ensure a controlled distribution of body weight 2.5 Maintain client-focused attention throughout sessions 2.6 Adjust treatment techniques and pressure based on client feedback

3. Monitor treatment 3.1 Use the condition and response of the client during treatment as feedback to the initial assessment 3.2 Use established massage assessment frameworks 3.3 Recognise reactions to treatment and respond promptly if necessary 3.4 Seek feedback during and after treatment, and evaluate need for ongoing or additional treatment,

including referral to other health services

4. Provide advice and resources to the client 4.1 Provide client education in relation to self-care 4.2 Answer client queries with clarity, using appropriate language 4.3 Provide accurate details of treatment plans, schedules and recommendations to the client 4.4 Clearly document treatment details and recommendations made


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Introduction Welcome to the world of massage therapy! You are about to embark on a most rewarding journey, discovering what is involved in becoming a professional massage therapist. Massage is the systematic and scientific manipulation of the soft tissues of the body. The various systems of massage give us access to the precise therapeutic function of touch. Massage has the potential to relax body and mind, or invigorate and stimulate. It is an unparalleled method for treating many diverse complaints and conditions. Massage is the supreme balancer, bringing peace to a troubled mind and relief to a tense body. Massage is an ancient healing art which is now recognised as an extraordinary method of treatment for so many modern diseases. However massage goes beyond the relief of pain and stress. It works on our overall well-being, our spirit. Massage is a useful and integral part of the healing process. The history of massage. Throughout thousands of years people have used massage for communication, relieving pain or discomfort, healing, protecting, or improving one’s health. Historical references to massage have been found in cultures all around the world. The history of massage is well documented and probably dates back to 3000Bc. The Indian books of Ayer Veda, written in 1800Bc refer to massage as a therapeutic healing art. In ancient Babylonia, 300Bc clay tablets refer to massage. In China the Nei Ching, the oldest recorded medical treatise witten in 1000Bc references the art of massage. In ancient Greece and Roman cultures, the benefits of massage were praised. Socrates and Plato both wrote about the benefits of massage. Hippocrates, an ancient Greek physician who is known as the “father of medicine” spoke of the healing powers of human touch, you could say he was the most famous massage therapist of all time! Historically, massage techniques were based upon the practices of anointing and bathing as well as variations of gymnastics and the Swedish Movements. Per Henrik Ling (1776-1839) from Sweden was the man who developed the Swedish movements and is considered by some as the father of “Swedish Massage” but he did not invent it. He learned it from others and through persistent experimentation put the information together in a workable form. Sweden was the first country to systematically introduce massage to Europe, where it became known as “Swedish Massage”. Swedish massage is the most widely recognised and commonly used category of massage. While the public commonly identifies it as a gentle and superficial massage, the techniques vary from light to vigorous, it involves a set series of strokes designed to provoke specific physiological effects in the body.


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Benefits of Swedish Massage Swedish Massage has been found to have many benefits, including:- ≈ Reduction in muscle spasm, pain and tension ≈ Release of endorphins, the body’s natural painkillers ≈ Relaxation and therefore reduction in anxiety ≈ Improved blood circulation ≈ Improved lymphatic drainage ≈ Improved mobility ≈ Reduction of swelling caused by an accumulation of fluid in the tissues ≈ Balancing the overall flow of natural life energy through the body ≈ Inducing a feeling of well-being through the comfort of human touch

Objectives of Massage:

SOOTHING STIMULATING THERAPEUTIC Soothing:

Relaxing the patient

Soothing the nervous system

Relaxing muscle spasm

Relieving tension

Stimulating:

Improves circulation-relieving congestion

Stimulates lymph flow, hastens the elimination of wastes

Improves muscle tone especially in cases of inactivity by increasing blood supply and nutrients to muscles

Encourages the excretion of fluids and waste products via the kidneys


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Therapeutic:

Massage helps to repair tissue damage

Helps to reduce oedema following injury to ligaments and tendons

Helps to improve circulation and nutrition of joints and hastens the elimination of harmful deposits and lessens inflammation and swelling in joints alleviating pain

Prevents formation of adhesions by stretching the connective tissue, improves its circulation and nutrition supply, reducing the danger of fibrositis

CLINIC PRACTICE Hygiene At all times be clean, have neat hair and keep your nails short.

ALWAYS use a good deodorant etc. ALWAYS before and after every massage, wash your hands. ALWAYS have clean towels on your table

Clinic Environment Avoid bright lights in your massage room. Try to make it a place of peace and tranquillity. Nice soft music, perhaps anatomical charts on the walls, candles, aromatherapy oils burning are some suggestions. Clean and fresh, use common sense. Make it an area where you feel happy and comfortable to work in, this will help with setting your mood and frame of mind. Your work environment will also represent who you are, this in turn will attract clients that are suited to you and you to them. Massage Tables & Anatomical Charts To be able to massage properly, you will need to obtain a massage table. A good portable massage table must be of correct height or at least adjustable, for you to protect your back and to be able to apply the correct pressure on the client. It must also be stable and sturdy, and one that is light enough to carry is recommended. When you set up your practice room, it is a great idea to have anatomical charts on the wall, as you will always find you will refer to them. Use of Oils Oils, creams, talc and liniment may be used for massage to eliminate friction according to personal taste and convenience. Vegetable oils are excellent and most commonly used. Be cautious when using oils extracted from nuts as nut allergies are common, always check with clients regarding allergies. Adding essential oils like lavender to the carrier oil is often used. Use just as much oil that is necessary. For clients with lots of hair, use lots of oil or hair burn and sore hands may occur. Towels Towels (or similar) should be used to keep the client covered, with only the area being treated left exposed. This has both physical and psychological benefits. Towels give the client a feeling of comfort and security that will further help relaxation, a towel can create a psychological security barrier, putting the client more at ease, especially the groin and chest areas (in women). The student needs to use common sense and and practice to develop a good, confident towel procedure.


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Massage terminology and movements Anterior Front of the body

Posterior Back of the body

Superior Toward the head

Inferior Toward the feet

Lateral A movement away from the therapist (towards the outside/away from the midline)

Medial A movement toward the therapist (towards the centre/midline)

Proximal The clients side closest to the therapist

Distal The clients side away from the therapist

Prone Laying face down

Supine Laying face up

Major Methods of Treatment: (each stroke has a purpose) Effleurage Soothing, stroking movements made with the palm of the hand.

Light or heavy but always slow. Stimulates circulation. Warms muscles. First and last movements of massage.

Petrissage Kneading, squeezing and rolling.

Relieves spasm and congestion. Stimulates lazy wasted muscles. Increases circulation, removes fatigue products.

Friction Deep rubbing movements, to muscle and joints areas.

Breaks down deposits and thickenings of tissue around joints, tendons and tendon sheaths. Assists to remove waste products through lymph system.

Tapotement Cupping, hacking, pummelling, plucking.

Breaks down congestion in large muscle areas. Stimulates muscles. Increases circulation to muscles.

ALWAYS MAKE CONTACT WITH THE CLIENTS BODY IN A SECURE AND CONFIDENT WAY AND REMAIN FOCUSED ON THE CLIENT FOR THE ENTIRE SESSION.


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EFFLEURAGE Is a smooth, even, sliding / gliding stroke. Pressure is usually constant throughout the entire length of the stroke, but maybe increased or decreased on successive strokes. The most sedating stroke in all of massage, it is usually done parallel to the superficial muscle fibres and / or toward the heart. Moderate pressure strokes tend to move venous fluids while light strokes tend to move lymphatic fluids. Deep strokes are used for affecting muscle tissue. Longitudinal / superficial strokes are used at the start of treatment to spread the oil and give initial warmth and comfort. The strokes should be performed with both hands covering a large area. The hands stay in contact with the skin at all times. At the end of the stroke it is more pleasant to make a rounded, sweeping movement than a sudden stop and change direction. These strokes should run the full length of the muscle from attachment to attachment and should be slow enough to allow good observation of how the tissues feel. Try to feel for areas that feel harder or tighter than adjacent areas. The primary effect of effleurage is to pump the circulation and to identify areas of tension. Transverse / superficial strokes are used exactly the same way as above, but the strokes are applied across the direction of the muscle fibre. The effect of transverse strokes on the circulation is not as effective as longitudinal strokes, but they are very good diagnostically. Tension in soft tissues tends to build up in bands running lengthwise through the muscle. As the stroke crosses the muscle, these bands can be felt more easily as they do not pass as smoothly under the hand. Transverse strokes help to loosen and separate individual muscles and compartments, which may be binding together. PETRISSAGE Is a grasping, kneading, and rolling technique applied between the thumb and fingers using one hand, both hands together, or with alternating hands. This technique lifts the tissue away from the bone or off the deeper tissues separating layers of tissues, thus enhancing tissue movement and blood flow. Petrissage is a warming stroke, generating heat in the muscle tissues and it has a mildly invigorating effect on the nervous system. Petrissage can be used as a palpatory stroke for examination of the tissues and as a treatment technique for abnormal tissues. Kneading is performed with both hands working together in a smooth. Rhythmical way. Each hand in turn is opened fully to grasp across the muscle, then squeezes and lifts the tissues. As one hand releases its grip, the other takes up a grip adjacent to it, very much like kneading dough. A steady rhythm should be maintained with the two hands and the technique should slowly travel up and down the specific part of the body. This technique stimulates the circulation, generally loosens and softens the tissues, and has a warming effect. FRICTION Is used to warm the tissues for palpation and examination and for treatment, friction techniques are powerful tools for affecting the body.


Swedish Massage


There are two primary types of friction strokes: superficial and deep. Superficial friction and deep friction do not refer to the amount of pressure used, but to the layers of tissue affected by the stroke. Superficial friction primarily affects the skin and superficial fascia, wheras deep friction primarily affects the muscle layers. Superficial Friction is an invigorating stroke to the nervous system, its primary effect is to produce heat in the skin and superficial layers of fascia and muscle, thus making them more pliable. Deep friction is used to soften or loosen muscle adhesions, scar tissue and knotted areas of compacted fibrous tissue, great sensitivity is required to use as much pressure as possible but staying within the client’s pain tolerance. This technique is used in deep tissue massage. TAPOTEMENT It involves sharply striking the body in a rhythmic, typically rapid pattern with loose wrists and fingers. Sometimes categorized as percussion technique, tapotement can be done with both hands at the same tome or alternating hands in a one-two pattern. The rapid action comes from the elbow, with the wrist remaining fairly loose, and the hands withdraw as soon as they strike the surface of the skin. Tapotement is very stimulating to the nervous system. As you strike the muscle, a slight stretch occurs to the muscle. It is great for warming the tissues and is used in pre-event sports massage. Types of tapotement techniques are hacking, cupping, plucking and pummelling. Avoid these techniques directly on the spine, endangerment sites, bruising, acute injury, inflammation, clients with osteoarthritis and the elderly. GOOD BODY MECHANICS To minimize fatigue and to prevent injury, we use good structural alignment. The body should move fluidly, using the movements and energy of the whole body instead of using the muscles of the upper body that moves the shoulders, arms, hands, fingers , and thumbs. To generate power and stability direct the strength of your lower body and the energy of your entire body through your hands. Movement of the whole body improves the fluidity and rhythm of the massage. Increase your stability by keeping your centre of gravity low with bent knees. You can increase your balance with a shoulder-width stance. Slightly bent knees improve your balance as well, acting as shock absorbers. Massage is a physically demanding career that requires strength and flexibility, so always use good body-mechanics and look after your health and well-being. Hand Positions There are five (5) different positions in which the hands may be used in massage Palmar Using the palm of the hands such as in overall effleurage. Digital Using the fingertips such as in most petrissage and friction movements. Radial The radial side of the hand is the thumb side; the root of the thumb is used in some deep

rubbing movements and friction. Ulnar The ulnar side of the hand is the little finger side and this part of the hand is also used in some

deep rubbing movements. (Is also includes the forearm.) Dorsal The dorsal or dorsum is the back of the hand which is sometimes used in the neck and shoulder

massage


Swedish Massage


Contra-indications of Massage A contra-indication is a condition that makes the applicable treatment, in this case, Swedish massage, dangerous or at the very least unadvisable. Below is a list of contra-indications:

Sever heart condition

Varicose veins

Open or infected wounds

Torn or inflamed tissue

Broken bones

Contagious conditions e.g. Rashes, tinea etc

Convalescence

Various forms of cancer

Minor – Under the age of 18

Any conditions or problem that you are not absolutely not sure of THIS MEANS WHEN IN DOUBT – DON’T, CONSULT OR REFER TO A DOCTOR

(this can be a GP or doctors of physiotherapy, osteopath or chiropractor)

Please note: As a therapist it is also contra indicated to provide a massage if you are suffering a contagious

condition, e.g. cold, flu, rash etc.

Draping procedures for massage: Proper and conservative draping techniques are required when practicing massage therapy in a school setting. Draping should always cover parts of the body not being treated. In arranging the draping the client should not be unnecessarily exposed to the point of embarrassment. The client should feel at ease and confident in the person who is treating them. Draping movements should be business-like and professional. Client comfort is paramount, if the draping is tight or uncomfortable or there is discomfort due to being too warm or too cold, the positive outcomes of the massage may not be accomplished. AS you move beyond Swedish massage, your draping skills will need to become more flexible, so as to perform a variety techniques for examination and treatment Use of Towels (Draping) Respect for the client’s body is essential, some may be inhibited and others not.

Client must be kept warm

Ensure client modesty

Protect client’s underwear from oil

Towels also offer protection to the massage table from oils


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SCOPE OF PRACTICE The scope of practice identifies the limits and boundaries for a practitioner and is determined by several factors, including the law, education and competency. The massage therapy scope of practice outlines: Which activities are allowed When specific methods are used Where specific methods are applied How specific methods are applied Why specific methods are used STANDARDS OF PRACTICE Standards of practice are specific rules and procedures for professional conduct and quality of care that all members of a profession should follow. These standards involve the public image of a practitioner as well as the legal and ethical obligations that protect both clients and therapists. The professional characteristics outlined by some of the current professional massage associations are fairly similar. A code of practice is followed by staff and students of Massage Schools of Queensland. ETHICS A code of ethics is a set of priniciples or guidelines for decisions and professional conduct that all massage therapists should follow. It serves as a basis for establishing and maintaining the reputation of massage therapists as honest, respectable professionals. In today’s society we are multi-cultural. With this in mind, as massage therapists we have to be aware of these sensitivities. The main factor to remember no matter the cultural background, race, creed, colour, size, health, we need to remember one word, RESPECT. Respect for all clients you deal with, no matter who they are, being kind and understanding of their needs, will make your clients feel safe and well cared for. If you become a member of a massage association you will be made aware of a code of ethics, please ensure you read and fulfil these ethical requirements. This will help avoid any complaints or worse, law suits. This statement is from the AAMT web site:

“Code of Ethics The Australian Association of Massage Therapist's Code of Ethics is a statement about appropriate and expected conduct of AAMT members. It reflects the values of the Association. The Code of Ethics describes the professional conduct expected of members to preserve and enhance their professional reputations as well as the general reputation of the massage industry in Australia. The Code of Ethics also seeks to protect the general public. The Code of Ethics applies to all members of the Australian Association of Massage Therapists Ltd.” You can view the full Ethics document at: http://aamt.com.au/about-aamt/code-of-ethics/

http://aamt.com.au/about-aamt/code-of-ethics/


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Full information on these subjects can be viewed on the websites of the various Australian Professional Massage Associations :- MMA – MASSAGE AND MYOTHERAPY AUSTRALIA (FORMERLY AAMT) ANTA- AUSTRALIAN NATURAL THERAPISTS ASSOCIATION AMT- ASSOCIATION OF MASSAGE THERAPISTS MAA – MYOTHERAPY ASSOCIATION AUSTRALIA ATMS – AUSTRALIAN TRADITIONAL MEDICINE SOCIETY STAA- SHIATSU THERAPIST ASSOCIATION OF AUSTRALIA IAAMA- INTERNATIONAL AROMATHERAPY & AROMATIC MEDICINE ASSOCIATION RAA- REFLEXOLOGY ASSOCIATION OF AUSTRALIA See next page for an example of a Code of Ethics…


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PROVIDING MASSAGE TREATMENT Communication One of the most important skills of a successful massage therapist is their ability to efficiently and effectively communicate with the client. Communication includes client intake (information gathering) and adjusting the equipment to best support the client’s body as well as communication with the client during the massage and after the massage. Pre-massage Greet the client Determine the client’s needs-(main complaint and secondary complaints) Ask the standard questions- with clarity, client case history- review client intake form. Identify and review effects of previous treatments Assessment An assessment is a means of evaluating the client’s condition, complaint, or injury to determine whether massage is appropriate for the complaint. Assessment is not a diagnosis; a diagnosis is a statement by a physician of what condition the client has. Assessment is done for the safety of the client and to guide you to do the procedures and techniques best suited for their condition. Assessment makes you a more efficient and effective therapist. Informed Consent Is the client’s agreement to participate in an activity after the benefits and risks of the activity have been explained and the client understands that he or she has the right to withdraw anytime. Basically, clients who are informed about treatment give their consent to try it. For the therapist, informed consent provides a signed statement that represents the therapist’s good intentions and the client’s education and awareness about massage. Communication during massage. You need to be in touch with the client during the massage, getting feedback from them, asking questions about how the massage feels, and giving them directions if necessary. Often client’s are reluctant to communicate feedback to the therapist during massage or are not sure how to communicate this feedback. Thus, it is useful to coach the client on communicating feedback to you. There are four specific areas for which you will need client feedback; these are to be established with the client before beginning the treatment, or at least before beginning any specific work. They are: Tenderness Normal healthy soft tissue is not tender, even to firm pressure. Soft tissue becomes tender because it is ischemic, as you massage a client you are looking for these tender, ischemic areas so you can normalize them. The client needs to tell you when you touch a tender area, so as you can massage it and bring relief to the client. Improvement Now that you have found a tender place and with appropriate pressure have massaged it, the client needs to tell that it feels better, often this verbal acknowledgement of the improvement by the client psychologically reinforces the actual improvement. Referred Pain If you touch a point or area on the client’s body and they feel a sensation somewhere else, they are experiencing a referred sensation. Referred sensations are most commonly pain but may be tingling or


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other sensations. You will not know they are happening unless the client tells you. It is important to know when a referred sensation is present, as this usually means you have found a trigger point. However you could be touching a nerve, so always have the client inform you when referred sensations or pain are experienced. Adjustment of Pressure. It is essential that you use appropriate pressures when doing massage. The amount of pressure that is appropriate will vary from client to client, and even from one area of the body to another on the same client. Too much pressure can injure the soft tissues causing pain therefore reducing the therapeutic benefit of massage, to little pressure can agitate the client and again reduce the therapeutic benefit of massage. Always check in with the client about pressure, remember healing is a two-way street! Recognise client’s reactions to treatment, their breathing pattern, any sudden movements, or jerking, stiffening up of the body or limb, strange auditory sounds, client constantly rearranging their position slightly. These can be signs that the pressure is not appropriate or they feel anxious or uncomfortable about the treatment. Always observe and respond appropriately to clients reactions. Always adjust massage treatments according to the individuals needs and reactions and the presence of complicating factors, such as pregnancy, serious medical conditions, acute injury, infectious conditions, swelling, oedema, inflammation, age, chronic pain conditions, language barriers, religious and ethnic factors. The only way you can clarify these signs and complicating factors is by communicating with the client, if you don’t communicate you are working like a blind artist! Referral and working with other healthcare and complementary professionals Referral is a method by which a client is sent to a health acre professional for diagnosis and treatment of a disease. Clients must always be referred to their own personal health care professional. It is important that you develop a referral network of other health care professionals so that your clients can receive the best possible outcome for their health and well-being, never go beyond your scope of practice. Other healthcare professionals might be your local GP, Psychologist, Physiotherapist, Osteopath, Chiropractor, Remedial therapist, Acupuncturist, Naturopath, Nutritionist and Dietician. Physiotherapy, Osteopathy, Chiropractic and Remedial massage are similar as in they are all Bodywork modalities. But what are the differences? Physiotherapy Is a health care profession primarily concerned with the remediation of impairments and disabilities and the promotion of mobility, functional ability, quality of life and movement potential through examination, evaluation, diagnosis and physical intervention. Osteopathy Is a philosophy and form of alternative healthcare which emphasises the interrelationship between structure and function of the body, as well as the body’s ability to heal itself. Osteopaths claim to facilitate the healing process, principally by the practice of manual and manipulative therapy.


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Chiropractic Is a complementary and alternative medicine health care profession and an approach to healing concerned with the diagnosis, treatment and prevention of disorders of the neuromuscular skeletal system and the effects of these disorders on general health. Remedial Massage Is a deep massage done by a trained massage therapist to create the conditions for the body’s return to normal health after injury or with muscular-skeletal disorders. It is used to treat chronic muscular-skeletal imbalances, and injury where the skin is intact. The similarities between these therapies are that they all work on the muscular-skeletal system and facilitate and rely on the body’s innate ability to heal it’s self under the right conditions. ALLOPATHIC AND NATUROPATHIC APPROACHES TO TREATMENT The primary goal of allopathic medical practices is to diagnose and treat the symptoms of disease through suppression or removal, your doctor practices allopathic medicine. The primary goal of naturopathic medicine is to diagnose and treat a disease process through supporting and strengthening the body’s natural resources. In doing so the patient is highly involved and therefore plays a large role in the outcome of the healthcare being offered. OTHER COMPLEMENTARY THERAPIES / MODALITIES USED IN MASSAGE. A modality is a collection of manual therapies that tends to use similar applications of movement or massage strokes to reach a similar goal. These would include: Deep Tissue Modalities Treatment and specialized massage techniques designed to affect the tissues deep within the body, eg: Trigger Point Therapy, Connective Tissue Therapy, Myofascial Therapy. Neuromuscular modalities Engage the relationship between the nervous and muscular systems to create reflex responses. eg: NMT (neuromuscular therapy), MET (muscle energy technique) PNF (proprioceptive neuromuscular facilitation) and Reflexology. Oriental / Eastern Modalities In traditional Eastern philosophies, the Qi travels through a series of pathways called meridians. The philosophies teach that a balanced, unrestricted flow of Qi is required for the body to maintain good health. eg: Shiatsu, Acupressure, Tuina. Structural and Postural Modalities They generally focus on realigning the skeletal system to relieve pain from postural distortions and compensations. eg: Rolfing, Hellerwork. Movement Modalities They use movement to reorient the body for more optimal function. eg: Feldenkrais, Alexander Technique. Energy Modalities Energy bodywork uses very light touch or off the body application to manipulate the human body’s energy fields and restore the flow of life force energy. eg: Reiki, Polarity Therapy, Bio-energetic Healing, Chakra Balancing Massage, Colour Therapy, Crystal Therapy.


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COMMON MUSCULO-SKELETAL DISORDERS & INJURIES Back Pain Back pain is pain felt in the back that can originate from the muscles, nerves, bones, joints or other structures of the spine. The pain can be divided into the various regions of the back, the most common being neck and lower back pain. It may have a sudden onset (acute) or can be chronic pain (has continued for more than 12 weeks), it can be constant or intermittent, be in one place or radiate to other areas. The type of pain can be a dull ache or a sharp, piercing or burning sensation. Pain may also radiate other areas of the body like the arms and legs and other symptoms can include weakness, numbness or tingling. The spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments and all are capable of producing pain. It is the large nerves that originate in the spine and go to the legs and arms which can create the radiating pain. Back pain is classified as either nonspecific or secondary back pain. Approximately 98% of back pain is nonspecific acute back pain which has no serious underlying pathology. Secondary back pain which is being caused by underlying conditions accounts for 2% of cases, the most common being disc herniation. Causes of nonspecific back pain:

Muscle strains

Muscle spasm

Muscle imbalances

Inflammation In today’s society most causes arise from stress, poor posture, lack of exercise and poor nutrition. Treatment: Most doctors will prescribe medications such as muscle relaxants, paracetamol or anti-inflammatory drugs. More and more people today are seeking more natural therapies, massage being one of the most popular, as it is highly effective in reducing stress levels, increasing circulation to strained muscles, softens tight muscles which are creating muscle imbalance and helps strengthen those that are weakened. Other ways individuals can assist in reducing pain is by applying heat for circulation (hot baths, hot water bottles, heat wheat) or ice in the instance of inflammation, stretching, gentle exercise, also increase water intake and natural supplements eg: magnesium. It must be stressed though, that if there are no changes to the level of pain after a number of massages or any other treatments, referral to a medical practitioner is necessary to determine if there is a more serious underlying condition.

. Sciatica: Compression or irritation of the sciatic nerve. The sciatic nerve is the thickest nerve in the body. The spinal roots originate from the spine from L4, L5, S1, S2 and S3 which then converge together to form the sciatic nerve. This then runs through the deep lateral rotators of the hip, down the back of the leg, where it branches off to continue along the rest of the leg and foot. Sciatica is a common form of lower back pain which is caused by irritation and or compression of the spinal nerve roots or one or both of the sciatic nerve. It can be caused by misalignment of the vertebrae, disc bulging or disc herniation this is vertebral sciatica. Muscular sciatica is caused by active trigger points, tightness or spasm of the lower back and gluteal muscles. Trigger points occur when muscles become ischemic (having low blood flow) due to injury or chronic muscular contraction (over use). These muscles become so tight they can compress or entrap the nerve that runs through


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or beside them. The most commonly associated muscles with trigger points that affects the sciatic symptoms are: Quadratus lumborum, Gluteus medius and minimus and the deep hip rotators mainly Piriformis. Due to the size of the nerve pain can also be felt in the buttocks and various parts of the leg and foot, depending on which part of the nerve is irritated. Massage for sciatica: In the acute stages (i.e. when the condition is so painful that it interferes with walking, heat and rest is desirable until the pain has settled down sufficiently to enable massage). Commence treatment in the prone position by first placing a pillow beneath the feet to keep the knee flexed and so relaxes the tension on the nerve. Before massage apply heat to lumbar and gluteal area – the heat eases the pain and softens the muscles. Start with light effleurage of the lumbar and gluteal area, followed by deep kneading then frictions especially through the deep section of the hip, working the trigger points and tight muscles. Finish with light effleurage and stretching.

Torticollis Torticollis or “wryneck” is an umbrella term for any condition that causes the head to be pulled to one side. A unilateral spasm/contraction of a neck muscle (eg: sternocleidomastoid) or muscles causes the head to become stuck in flexion and rotation. The causes can be from simply sleeping in a bad position, or some other event or trauma that may cause irritation in the neck muscles. A cervical misalignment may also create the problem, which will not be relieved until both the muscles and bony alignment have been addressed. Torticollis related only to muscle spasm and trigger point responds well to heat and massage. Once again if the condition is not improving with massage and the client is showing other symptoms like swollen glands, a more complete diagnosis is necessary. Arthritis Arthritis is a term that refers to more than 100 disorders that can cause joints to become swollen, hot and painful. One of most common forms is osteoarthritis. In addition to attacking joints, these illnesses may also strike neighbouring structures such as muscles or even distant parts of the body such as heart, kidneys, lungs and liver. These conditions tend to be chronic, that is once a person has them they are likely to last a long time and may be a source of pain on and off for the rest of their life. This is why people seek treatments to manage the pain. Acute arthritis, like any other acute inflammatory condition contraindicates massage. However clients who suffer osteoarthritis seldom experience acute swelling with pain, heat and redness. Chronic osteoarthritis indicates massage, when goals would be to reduce pain through release of the muscles surrounding the affected joints and to maintain range of motion through gentle stretching and passive movement. MUSCULO-SKELETAL INJURIES Sprains and Strains Injuries that involve body tissues apart from bone are classified as soft tissue injuries. A sprain is an injury that involves the ligaments and other soft tissues around a joint, eg. Ankle or wrist. A strain occurs away from a joint and involves a torn or over stretched muscle or tendon, eg. calf, hamstrings, lower back. A bruise is a soft tissue injury involving the blood vessels that are broken as a result of a blow to the skin and can also result in the event of a strain or sprain, when the force is great enough to rupture the blood vessels.


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Treatment First 24 to 72 hours – depending on the severity of the injury.

R - Rest I - Ice C - Compression E - Elevation D - Diagnosis

Rest the injured soft tissues.

Ice application for 10 – 20 minute periods every 3 – 4 hours. If a prepared ice pack is not available, fill a plastic bag with crushed ice and seal well, or a pack of frozen vegetables is also an alternative. Never apply the ice pack directly over skin, wrap in a damp cloth or tea towel first then apply to injured area

Compression of a firm bandage should be applied between ice treatments and maintained for at least 48 hours or longer if swelling persists.

Elevation of the injured area enhances venous return and so reduces swelling.

Diagnosis is essential for early functional recovery. Treatment after 72 Hours Ice – Continue using ice until the swelling subsides. If icing is uncomfortable, heat may be used instead after 72 hours. Heat – Should be comfortable warmth only. Useful home methods are hot water, hot water bottles, hot towels and infra-red lamps. Exercise – Must be within the limits of pain. Graduated resistance. Commence with non-weight bearing and functional activity. Gradual muscle stretching. Early Treatment of Sports Injuries When to seek treatment for an injury? If pain, swelling, loss of movement or instability persists after 24 hours, treatment will probably be required. It is recommended to see a doctor or who will then arrange for diagnosis and/or treatment. If a fracture, dislocation or other serious injury is suspected, you should go straight to a doctor or emergency department. Only an x-ray will determine if the injured area is broken. Important Don’ts after injury……. Don’t apply heat for at least 48 – 72 hours. Heat increases blood supply and can increase swelling. Don’t drink alcohol. It also increases blood supply by dilating the blood vessels. Don’t rub the injury. Treatment of Joints – Dislocations The more moveable a joint the more liable to dislocation it is eg. shoulder and hip. The wrist and ankle are subject to sprains and strains.


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Dislocation is characterised by the following:-

Severe pain on dislocation worse than by a fracture. Often a tearing sensation.

The joint becomes fixed.

The limb appears deformed.

The limb will lose its function. The first aid steps when dealing with dislocations (and fractures) is to immobilise the injured part, make the person comfortable, place them in a restful position of greatest comfort, then seek professional help eg: ambulance/doctor/hospital. Do not give food or fluids because an anaesthetic may be needed. Cramp This is a very common complaint due to over contraction of muscles without relaxation – a condition of fixed spasm, due to irritation of a nerve by pressure or excitability of a motor nerve, which is in poor condition. When cramp occurs, stretching of the affected muscle group is indicated eg. Calf muscle in cramp. The knee would be straightened and the ankle dorsiflexed by the weight of the body. Stroking and kneading finally relaxes the muscle. All free active exercises are good for this condition. Magnesium phosphate and calcium are the two (2) deficiency factors here. Magnesium phosphate deficiency enables the nerve fibres to contract causing spasm and cramp and also effects muscular movement. These supplements should be taken daily to rectify this condition. Calcium is needed for the elasticity of muscular tissue and supporting membrane which become impaired when the body is deficient causing constant cramping pains in torso or legs. Varicose Veins A degeneration of the walls of the veins, caused by a number of reasons, mainly HEREDITARY – deficiency factors of calcium which causes the walls of the veins to become flaccid. This deficiency is passed on by mother to child and possibly a deficiency in vitamin E also. With these deficiency factors the occupation of the person when in situations causing constant standing, can aggravate the condition causing a continued over-distension of the veins and an inability of the one-way valves to close properly. The force of gravity tends to keep the blood in the lower parts of the body. Pregnancy also raises pressure in the abdomen impeding the flow of blood to the legs and so worsening the condition. The aim – in massaging this condition is to help the circulation and the lymph flow. When giving massage, the leg should be comfortably supported and raised just above heart level. Commence with light effleurage in the direction of the heart followed by medium then heavy effleurage coupled with light palmar kneading of the thighs. This is very beneficial for relieving pressure in veins and also for circulation and lymph flow. All pressure is applied according to the condition of the veins and can be gauged by the patient upon questioning. Digital pressure is unwise and can cause pain, omit tapotement also. Do not massage over ropy, engorged veins as this may break the weakened skin and thus cause an ulcerated condition to occur in the vein. Abdominal massage should also be given to relieve portal congestion especially in the cases of constipation, which can cause pressure on the veins.


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Anatomy of the Abdominal Cavity The abdominal cavity contains the main organs of the digestive, urinary and reproductive systems. The digestive system includes: the stomach, pancreas, gall bladder, liver, spleen, small and large intestines. Surrounding the organs and lining the walls of the abdomen is a lubricating layer of membrane, the peritoneum. This membrane layer allows the muscular movements of the intestines during the digestive process. Also running through the abdominal cavity are major blood vessels leading to and from the heart. The back wall of the cavity is formed by the spine and associated muscles, the side and front walls are comprised of four layers of abdominal muscles including rectus abdominus. The diaphragm forms the roof and the floor is formed by the pelvic floor.

Benefits of Abdominal Massage

Promotes digestion by stimulating the digestive organs

Helps with constipation

Alleviates gastric upsets eg: wind pain, bloating

Soothes the nerves related to the region reducing the effect of stress

It promotes elimination, and secretion of hormones

Stimulates circulation and lymphatic flow

Reduces adhesions in the the fascia so the organs can lay unrestricted in their natural position in the abdominal cavity.

It helps in aligning the pelvic bones

Can strengthen weak abdominal muscles which contribute to lower back pain

Releases deep tissue muscle spasms in the abdominal area

http://en.wikipedia.org/wiki/File:Anatomy_Abdomen_Tiesworks.jpg


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Abdominal massage is not only good for digestion, it is also an area that holds a lot of tension. In the oriental medicine approach, there is a place they call the "Hara" it has a relationship with many of the different organs and meridians and it also has a lot of emotional aspects to it. When we are stressed or hold onto tension we often get “gut feelings” or literally feel sick to the “pit of our stomach”, so massage in the abdomen not only relaxes but stimulates the flow of energy throughout the body. Cautions with Abdominal Massage

Abdominal massage should not be done if a person has inflammation of the uterus, bladder, ovaries and fallopian tubes.

Abdominal massage should not be done if a person has stones in the kidneys, bladder or gall bladder, ulcers of the stomach or intestines.

Abdominal massage should not be done after a heavy meal.

The bladder should be emptied before the massage.

Since blood pressure increases during abdominal manipulation, patients with hypertension should avoid abdominal massage.

Massage is contraindicated for the first trimester in pregnancy

Before commencing abdominal massage consent must be gained. Not all people are comfortable with having this type of massage for many different reasons, and we as therapists must respect that. Discussion as to how the massage will be delivered, the benefits and how draping will be appropriate may alleviate their fears and concerns.

Today’s session is discussion, open forum regarding planning a massage treatment. The use of the client information and consent forms (attached) to help plan that treatment.

Communication: Interviewing your client, setting clear guidelines as to how the massage will be conducted, following guidelines for hygiene, OH&S and code of ethics. Keeping client records, confidentiality. Referring to other health practitioners: Physiotherapy Chiropractor Osteopath Remedial Massage Naturopath Allopathic Councillors/Psychologist/Psychiatrist General Practitioner Other complementary therapies

http://www.essortment.com/benefits-stomach-massage-therapy-16311.html

http://www.essortment.com/benefits-stomach-massage-therapy-16311.html


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Notes_______________________________________________________________________________


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CONFIDENTIAL CLIENT RECORD NAME ___________________________________________________ Dr Mr Mrs Ms Miss Master (Male/Female)

ADDRESS________________________________________________________________P/CODE____________

PHONE (Mob) ________________________ (Home) ________________________ DOB _____ /______/______*

EMAIL ___________________________________________ OCCUPATION ____________________________

REGULAR ACTIVITIES/SPORT _________________________________________________________________

CURRENT PRACTITIONER __________________________________________ PHONE ___________________

How did you hear about us? Newspaper Facebook Internet Friend Previous student

Would you like to receive email alerts about future discounts and special offers YES / NO

* Clients under 18 years of age must be accompanied by a parent or legal guardian

Medical History:

Are you currently being treated for any medical conditions? YES / NO (if yes, please give details)

___________________________________________________________________________________________

___________________________________________________________________________________________

Medications _________________________________________________________________________________

Please tick all current conditions:

Pregnant Allergies Asthma Any skin problem Blood clots Heart problems Headaches Migraines Bone fractures Blood pressure Varicose veins Arthritis Whiplash Sciatica Spinal injuries

Epilepsy Osteoporosis Joint replacements Dizziness/fainting Numbness/tingling Contagious disease Chronic pain Car accident Surgeries Diabetes Fever Cancer Hepatitis HIV/AIDS

X =

Ind

icat

e

area

s o

f co

nce

rn

Other health concerns?

______________________________________

________

_____________________________________

REASONS FOR MASSAGE

___________________________________________________________________________________________

___________________________________________________________________________________________

CONSENT TO TREATMENT

Off

ice u

se o

nly


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I understand that the massage therapy given to me by students is for the purposes of education and practice. There is always some risk associated with any treatment. Some potential risks from massage include pain, bruising, dizziness,

fainting and aggravation of your condition. To minimise the above possible risks please tell your therapist if you become uncomfortable or experience pain during treatment, if you bruise easily or are on any blood thinning medications, or feel

light headed or dizzy during or after the treatment. I affirm that I have notified my therapist of all known medical conditions and injuries. NOTE: Student therapists in our Student Clinic are currently studying their chosen massage

course. They are bound by, and provide this student service under the National Council of Massage and Allied Health Practitioners Code of Ethics, but are not yet registered therapists. All due diligence will be exercised.

Please note: to be signed by parent/legal guardian if client is under 18 years of age.

Signature ______________________________________ Date _____/______/_____

Date Student

Assessment (CERT IV & DIPLOMA) Eg. Client History, Body language, General Health, Posture & Gait

Assessment (DIPLOMA only) Eg. Palpation, Trigger points, Neuromuscular, Motion, Muscle testing, Special tests

Treatment

Reassessment

Aftercare

Date

Student




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Treatment

Reassessment

Aftercare

Date Student



Treatment

Reassessment

Aftercare


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Swedish Massage Anatomy Section.


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SKELETAL SYSTEM


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MUSCULAR SYSTEM (ANTERIOR VIEW)


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MUSCULAR SYSTEM (POSTERIOR VIEW)


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QUADRATUS LUMBORUM FLEXORS & EXTENSORS OF LOWER ARMS


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Review Questions What is the basic definition of massage? Who is the person who is accredited with developing the Swedish massage movements? What are the 3 physiological effects of massage? Name 5 benefits of Swedish massage? What are the 3 objectives of massage? What does Prone & Supine mean?


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What are the major methods of treatment in Swedish massage?

Why do we need to have good Body Mechanics? Describe these 5 hand positions, Palmer, Digital, Radial, Ulner & Dorsal. What is a Contra-Indication? List 3 Contra-Indications & 3 Cautions to massage. List 4 reasons why we use towels (draping). List the 5 outlines to describe the Scope of Practice What is the definition of Standards of Practice?


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What is a Code of Ethics? Name the 4 phases of clinical care What is the definition of client compliance? What is an assessment? What is informed consent? What are the 4 specific areas that we need to communicate with the client?


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Name 3 Healthcare Professionals we could refer our clients to. What is the difference between Allopathic & Naturopathic treatment? Name 3 other complementary modalities. What is a sprain & a strain? What is the appropriate treatment of an injury in the first 24-72 hours? Name 3 important “Don’ts” after an injury


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Name 3 cautions to Abdominal massage. Name the Rotator Cuff muscles.

What is the Group name for the large postural muscles that run parallel to the spine? What are the major muscles of the upper posterior and anterior leg?

Name a major neck flexor & rotator Name 2 muscles located in the posterior hip.


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Name the 2 major groups of muscles in the lower arm

Name the most superficial muscle on the neck, shoulder and back

What are your feelings, perceptions & understanding of the term “ENERGY” & why do you think it is important in massage work?

(take time to think about this)

swedish massage learner guide · massage is a useful and integral part of the healing process. the...

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