2.Body Massage course notes

SCHOOL OF HAIRDRESSING & APPLIED THERAPIES

NVQ Level 3 in Beauty Therapy

B20 Swedish Massage

Course notes

Student Name:

Course Name:

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Hygiene for the Therapist

1. The therapist’s appearance must be clean, tidy and professional.

2. Jewellery should be kept to a minimum as it may catch the client and look unprofessional. A wedding ring is permissible.

3. Hair should be clean and off the face.

4. Oral Hygiene is most important as is the use of soap, water and deodorant, as the therapist is often in close contact with the client.

5. Hands should be well manicured with short unvarnished nails.

6. The working area should be clean and tidy and well maintained at the start, during and at the end of treatment.

Professional Attitude

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Clients will be impressed by a professional attitude. This means:

Treating the client as an individual, giving your full attention to her problem. Be prepared to listen sympathetically but remain objective.

It is important not to discuss other client’s with the one that you are treating, they may go away thinking that you are doing the same to them

. It is said that the client “is always right” however it is up to

you to use your professional discretion. Take into account your clients wishes but not to the extent where you think the treatment would be wrong or unwise.

Be a good listener, clients do not come to hear your problems.

Important Requirements

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A pair of well trained hands, which should be completely relaxed, warm and moulded to the part.

Rate of movement should be carried out at a moderately slow speed [as a general rule] but this depends upon the effect required.

Rhythm and flow of movement should be even, continuous and consistent. The rhythm is produced by swaying backwards and forwards from the ankles, knees and hips.

Stance is very important to allow a good rhythm and freedom of movement, also to avoid back strain and to utilise body weight correctly. The 2 main standing positions are known as Walk standing and Stride standing. Stooping not only gives a poor performance but results in an aching back!

Depth of pressure will depend on a number of factors, such as the area being treated, the client’s physique and the preference of the client. Care must be taken where tissues are delicate or stretched offering little or no protection to underlying bones and organs. Greater depth of pressure can be obtained by correct use of body weight and wider leg stance.

Position of the client should be such that they are well supported, accessible, warm and comfortable. Clothing should be removed completely for a full body massage and removed from the part locally where required. All areas of the body which are not being treated should be kept covered with towels to ensure warmth. Pillows and towel rolls should be used to support the limbs where necessary, preventing stress or strain.

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Contra-Indications of massage

1. Recent injuries

2. Over recognisable lumps and bumps.

3. Over varicose veins, phlebitis and thrombosis.

4. Acutely painful areas.

5. Over contagious skin diseases.

6. Over open wounds.

7. Recent scar tissue.

8. Heart Problems.

9. Degree and type of diabetes.

10. Epilepsy.

11. Recent fractures.

12. High blood pressure.

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Hand exercises

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Posture and positioningTo perform a successful massage, you need to use treatment techniques that will benefit the client and also yourself as the therapist.

Posture

Performing massage treatments can be physically demanding on a therapist. It is very common for therapists to suffer with repetitive strain injuries (RSI). It is important to protect yourself when performing these treatments by following this advice:● Do not lean from the waist as this may result in back

problems.● Squat and bend your knees, which will protect your back

when in the stride-standing position.● When in the walk-standing position, lunge forward and

bend your front leg.● Use your body weight to increase pressure.● Avoid trying to create deep pressure with just your

thumb. Create a larger surface area, i.e. heel of the hand.

● Use mechanical massage where appropriate to ease the pressure on your body.

● Ensure the couch is at a suitable height so you can use your body weight.

Walk standing Position Stride standing Position

Support for the client

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Certain areas of the client’s body will need supporting during the treatment to prevent discomfort; for example:● Place a prop under the client’s knee when working on

the front of the leg, and avoid putting pressure directly over the knee.

● When working on the back of the leg, place a prop underneath the ankle. This will prevent the ankles turning in, which can cause discomfort.

● When working on the back, bring the client’s arm back and place a support underneath it. This will expose the scapula, where there is often a lot of tension and fibrocystic nodules.

● Couches should have a face hole for clients to use when working on the back. This will keep the spine straight and allows the therapist to work on all areas.

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Consultation

An initial consultation is carried out prior to or linked with the initial treatment, but it is also a continuing process carried out prior to every treatment to update background information e.g. change of medication. It provides an opportunity for the therapist to meet the client and obtain certain information from them. The information required is obtained by oral questioning and visual assessment of the area treated before treatment begins.

The aim of a client consultation is to: Establish what the client wants and needs from the treatment. Assess client’s suitability for treatment. Determine if special care is required. Build a good rapport. Answer client’s questions. Determine and agree a treatment plan with the client.

Tact has to be employed with consultation technique, especially with elderly or disabled clients, as an offer of help must not be shown as patronising or over protective.

Details of the information obtained during consultation and of every treatment given must be kept on a record card or on computer. The record card is used for reference where the information taken will indicate the best way results can be achieved effectively.

Record card information must include: Client’s title, name and address Home and work telephone numbers [ to cancel /update appointments ] Date of birth Medical history Doctors name and address State of health at consultation period

The purposes of asking personal and medical questions are to find out: The presence of conditions where medical referral is necessary Whether there are contra-indications present If any conditions present require special care If any localised conditions affect treatment of specific areas

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A professional and courteous manner must be maintained whilst asking such personal questions maintaining client’s privacy. An explanation of the reasons for asking such detailed personal questions must be explained to the client with reassurance of confidentiality.Once a course of treatment has been agreed, clients must fully understand what is involved, i.e length of treatment, frequency and cost.

The record card must be checked by the client that the information is correct and signed by both the therapist and the client. There may be times that the clients GP may need to give approval to treatment if certain contra-indications become present. This may only be carried out with the client’s permission and a GP will not release personal details to a therapist apart from a written approval letter but only if this has been requested by the client. Record cards contain confidential information and must not be left around for other people to see. Computer recorded details must appear by law in the Data protection register, which allows the client access to see their personal data and correct it. [Data Protection Act]

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Theory of massage

Care of the client

Check that she/he has no contra-indications. The client should be always physically and mentally at ease. Give them Privacy to dress and undress. Give clear, precise instructions about how to undress and place clothing. Do not keep them waiting and standing around. Make sure they are warm and comfortably placed on the couch.

Equipment for massage

Massage couch of suitable height Trolley with suitable products [ see trolley layout at front of book ] Towels

Lubricants/ Massage mediums

Oil

The advantages of using oil, is that it is relatively cheap, easy to use and is good for lubricating and softening dry skin. The disadvantages are that excessive oil can soil towels and clothing and is difficult to wash out,too much oil can lead to little pressure being applied, due to hands sliding over the surface of the area being worked on.

Talcum Powder

The advantages of using powder is that it is suitable for excessively hairy areas and is comparatively cheap to use, whilst the disadvantages are that it is not suitable for dry skin conditions and it can form a dust in the air which can cause an allergic reaction.

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Massage creams/lotions and gels

The advantage of creams and lotions are that it gives the client a feeling of a much more luxurious treatment, but it may not be cost effective to use on large areas due to the need to replenish regularly.Gels can also be expensive due to the rate that they absorb into the skin.

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Classification of Massage Massage is a method of manipulating body tissues and can be performed manually [by hand] and mechanically [G5].

The main groups of massage manipulations are:

Effleurage

Petrissage [Pressure]

Tapotement [Percussion]

Vibrations

Frictions

A. Effleurage

Effleurage means to “stroke” but the two terms have slightly different meanings in massage. Effleurage can be:

Superficial – the pressure is lighter. Deep – the pressure is deeper.

Effleurage is a continuous movement performed with the whole palmar aspect of the hand, but on very small areas the padded surface of the fingers and thumbs may be used.

The movement follows the direction of the venous return [flow of blood back to heart] and along the flow of lymphatic vessels ending at lymphatic nodes.

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The hands must be relaxed and moulded to the area being treated. Pressure is even for the whole stroke but it is increased more at the end where pressure is directed towards the nearest lymph nodes. At the end of the stroke the hands return each time to the start.

Effleurage is the stroke used at the beginning and end of massage, as well as for specific local dispersion of fluid or to increase circulation.

Effects and uses of Effleurage

Used as an introductory and completing movement. As a linking movement between strokes Induce relaxation Increase venous return Increase lymphatic flow Warming skin and producing erythema An increased circulation will improve nutrition to superficial organs, i.e

in skin it will promote healing and help carry away waste products of metabolism

Increases desquamation by removal of dead skin cells, stimulation of sweat and sebaceous glands improves elasticity and suppleness of the skin

Has an effect on nerve endings- can be soothing or stimulatory depending on rate or depth.

B.Petrissage [Pressure]

Petrissage are movements where the soft tissues are compressed against underlying structures [namely bone] or squeezed.

Petrissage movements are the deepest movements and include movements such as:

Kneading Picking up Wringing Rolling Elbow and fist work

All these movements have a compression effect on the blood and lymph and will thus, stimulate drainage of these systems.

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1.KneadingThis movement has many variations according to the shape, size and bulk of the area being treated and is thus adapted accordingly.

Pressure is in the direction of the venous return and the tissues are pressed and released against underlying bone. Kneading is a circular movement where the hand moves and applies pressure in an upward direction. The right hand always applies the movement in a clockwise direction whilst the left hand applies the same movement in an anti- clockwise direction. It is necessary to use body weight to increase pressure and depth.

Effects and uses An increased blood flow to muscles and skin taking oxygen and

nutrients with it Increased lymphatic flow aiding removal of waste products of fatigue

[lactic acid] Aids peristalsis when giving over the colon To relieve tension nodules To relieve tension nodules

2. Picking upPicking up is a petrissage movement where the muscle is lifted away from deeper tissue or bone it can then be squeezed and released. One or both hands may be used, working simultaneously longitudinally along the length of the muscle, avoiding pinching between the fingers and thumb. The hands form a W shape when picking up with 2 hands, but form a V shape when applying a single handed movement.

Effects and uses of picking up Stimulates venous flow and lymphatic flow To loosen tight subcutaneous tissue/muscle tone

3. Wringing

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Wringing is a petrissage movement where the tissues are compressed, lifted and gently stretched from the underlying structures. Once the tissues are held and stretched the motion concentrates on manipulating the fingers of 1 hand to the thumb of the other. Care must be taken to ensure that the hands do not pinch the skin.

Effects and uses of Wringing Improves circulation Improves muscle tone and elasticity

4. Rolling

Rolling is generally performed transversely across limbs, abdomen and back areas and can help drain waste products from the area to the nearest lymph node.

Effects and uses of Rolling

Stimulates blood circulation to muscles and skin thus increasing nutrients and function

Can stretch tight areas e.g old scar tissue Helps drain waste products

C.Frictions

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Frictions are small, deep, concentrated movements applied with much pressure to localised areas. They are performed in circular or transverse directions with fingertips or thumbs.

Effects and uses of Frictions

To produce localised erythema To loosen and soften tight scar tissue Can breakdown muscle adhesions thus relieving “fibrositis” Increase joint mobility due to localised erythema Stimulating effect on spinal postural muscles

D.Tapotement [Percussion]

Tapotement/ Percussion manipulations are those which strike the body in a controlled manner. Both hands are used, which alternately provide stimulation to the area being worked on.

1. Hacking

Hacking is performed with the arms in abduction, elbows bent and wrists in extension. The hands alternately strike the area with the ulna side of the hand and little finger. The fingers must be relaxed and slightly apart so that as the manipulation is being performed the fingers fall successively on each other [should sound like raindrops]. Do not use the whole side of the hand as it is painful to the client.

Effects and uses of Hacking

Stimulates nerve endings Increases underlying muscle tone Can produce a stimulating, refreshed and invigorating feeling

2. Cupping

This manipulation is performed with the hands relaxed in a deeply cupped shape. The action is a rapid alternating flexion and extension of the wrist

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producing a hollow sound [horse’s hooves]. This action can cause underlying tissue to vibrate.

Effects and uses of Cupping

Produces immediate erythema Stimulates nerve endings Improve muscle tone

3. Beating and Pounding

These are heavier tapotement movements and consequently their use should be limited to heavier areas such as the gluteals.Effects and uses of Beating and Pounding

Increase circulation Stimulates muscle tone quickly Increases nerve ending response

E. Vibrations

These are fine trembling movements using either 1 or 2 hands with the vibrations being transmitted to the area treated via the therapist’s hands. The whole palmar surface of the hand and fingers [or only 1 or 2 fingers for fine vibrations] must remain in contact with the skin with the arms and hands fully relaxed, taking care not to dig in the fingers. Vibrations can be static or running.

Effects and uses of Vibrations

Over the abdomen to relieve flatulence To loosen scar tissue

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Anatomical Spaces

Leg areas

The Femoral Triangle is an area of soft tissue found at the medial aspect of the thigh. Care must be taken when performing treatments around this area and it should never be worked on directly.The structures that make up this triangle are:Sartorius muscle which borders it laterally and medially by the adductors of the thigh. The floor is formed by deep thigh muscles. It contains the femoral artery, vein, nerve and inguinal glands and vessels.

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The Popliteal Fossa

The Popliteal Fossa is an area found at the back of the patella or Knee joint, the posterior of which forms the floor of the space. It is diamond shaped and is formed above by the medial and lateral tendons of insertion of the Hamstring muscle group and below by the medial and lateral origin tendons of Gastrocnemius. It contains the popliteal artery, vein and nerve endings along with the Popliteal lymphatic nodes.

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The arm area

The Cubital Fossa is found at the bend of the elbow. The floor of this cavity is formed by brachialis muscle. It contains the brachial artery, and the tendon of the biceps muscle.

The Axilla

The Axilla is a pyramidal shaped space between the arm and the space of the chest. It contains the axillary artery, vein, the brachial plexus of nerves and numerous lymphatic vessels. Much of the lymphatic drainage of the breast is to glands of the axilla and therefore any enlargement of glands in this area should be carefully observed

The Vertebral column

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The vertebral column is made up of 33 vertebrae. The column is made up as:

7 Cervical 12 Thoracic 5 Lumbar 5 Sacral 4 Coccygeal

Each group of vertebrae, whilst having individual characteristics are generally constructed on the same lines. They thus become progressively stronger and heavier from the cervical region down.

The vertebral column or spine provides the body with its central axis around which and from which all movements take place. It also serves to protect the spinal cord and to support the weight of the trunk.

Specific Postural Defects

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1. Lordosis

Lordosis is a disorder defined by an excessive inward curve of the spine. It differs from the spine's normal curves at the cervical, thoracic, and lumbar regions, which are, to a degree, either kyphotic or lordotic. The spine's natural curves position the head over the pelvis and work as shock absorbers to distribute mechanical stress during movement. Lordosis can be found in all age groups. It primarily affects the lumbar spine, but does occur in the neck (cervical). When found in the lumbar spine, the patient may appear swayback, the buttocks more prominent, and in general an exaggerated posture. A lumbar lordosis can be painful sometimes affecting movement.

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2. Kyphosis

Kyphosis is a progressive spinal disorder that can affect children or adults. This disorder may cause a deformity described as humpback or hunchback

Kyphosis in the thoracic spine means exaggerated kyphotic angle from the spine's normal kyphotic curve. Normal lordotic curves in the cervical and lumbar regions may also be diminished to contribute to the overall pitched-forward posture. The spine's natural curves position the head over the pelvis and work as shock absorbers to distribute mechanical stress during movement.

3. Kypho-Lordosis

This is a combination of the two above conditions.

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4. Scoliosis

Scoliosis causes a sideways curve of your backbone, or spine. These curves are often S or C-shaped. Scoliosis is most common in late childhood and the early teens, when children grow fast. Girls are more likely to have it than boys. It can run in families. Symptoms include leaning to one side and having uneven shoulders and hips.

Sometimes the curve is temporary. It might be due to muscle spasms, inflammation or having different leg lengths. A birth defect, tumor or another disease might cause the spine to have a curve that isn't temporary. People with mild scoliosis might only need checkups to see if the curve is getting worse. Others might need to wear a brace or have surgery.

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5. Winged Scapula

This is a condition in which the vertebral column and the angle of the scapula, protrudes backwards away from the ribs when the arm is lifted forwards to shoulder level. The client is unable to punch the arm forward or perform forward pushing movements. It is often due to a weakness of Serratus Anterior muscle.

Somatotyping/Body types

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Somatotyping is a way of classifying athletes or performers by their BODY TYPES. Individuals of one particular body type or somatotype are sometimes more suited to a particular game or even a particular position in a game than others. It is important to stress that HEIGHT is NOTHING to do with working out somatotypes. There are three classifications:Endomorph

Wide shoulders and hips. Large amount of body fat. Pear shaped body. Rounded head.

Mesomorph

Minimum fat - narrow front. Wide shoulders narrow hips. Wedge shaped body. Broad shoulders and leg/ arm muscle. Massive Head.

Ectomorph

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Little muscle or fat. Thin arms/ legs. Narrow chest and abdomen. Fragile, delicate body. Narrow shoulders/ hips.

Scoring:Each type has a 1-7 score; 1 is low and 7 is high. Each person is measured to find their mark. A non sports person may have a 4-3-3: Medium Endomorphy, Low Mesomorphy and Low Ectomorphy.

Audio Sonic

Audio sonic is a hand held electrical massage treatment, which can be applied to the face and body.

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An electromagnet is used in audio sonic.

The current flows in one direction and then the other – causing a coil of the electromagnet to move back and forth.

Movement passes to the head of the machine and when applied to the skin, it transmits to the tissues as a vibration.

Audio sonic produces sound waves which are between 100 – 10,000 hertz.

The sound waves vibrate through skin’s cells and tissues, with the

vibrations travelling approximately 5cm into the skin without causing damage.

The depth of the sound waves that create the vibrations can be increased or decreased, affecting the depth they travel to the tissues.

The sound waves cause the nodules to be shaken, therefore causing compression and decompression of the soft tissues.

During COMPRESSION - cells press together which moves tissue fluid (toxins and waste).

During DECOMPRESSION of the tissues, fresh blood circulates, allowing for fresh oxygen and nutrients.

Intensity control is via an adjustment knob. Frequency – number of vibrations per second. As no friction occurs, it is an ideal treatment for sensitive areas or

hypersensitive skin.

The Main Effects: Blood circulation is increased – improved skin colour and transport of

oxygen and nutrients to skins cells and muscles. Venous and lymphatic circulation is increased – aid removal of waste

products and lactic acid. Desquamation (removal of dead skin cells) occurs – resulting in an

improved skin texture. Tense muscles are relaxed. Areas of soft adipose tissues are softened. Stimulates the skin to function more efficiently by increasing the

sebaceous gland activity.

Body use: Cellulite (especially soft fat which has least resistance than hard fat). Deeper relaxation to contracted hard muscles. Ideal for use on fibrocystic nodules e.g. especially of the trapezius

muscle.

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Facial use: Vascular skin conditions. Hypersensitive. Mature skins.

Contra-indications .

Excessive broken veins. Varicose veins. Severe skin disorders. Bony areas. Small, slim clients. Cuts, abrasions. Swollen, inflamed joints. Metallic plates and pins (implants). Broken bones. Eye area (due to sensitivity and fine skin) prone to

bruising.

Attachment Heads

Flat disc – used on face and body, especially over larger areas. Hard ball – Fibrocystic nodule. Deep body treatments. Ideal for smaller

areas for an intensified treatment. Cleaning attachments – soapy water, surgical spirit and then placed

into a UV cabinet.

Pre-treatment Reminders

Check for contra-indications. Remove jewellery. Explain treatment sensation, including warmth and erythema. Demonstrate the noise of the machine. Expose only the areas to be treated. Prepare the skin –cleanse and dry. Apply selected and appropriate medium.

Treatment Application Select attachment head. Switch machine on and test on self and client’s upper arm.

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Select frequency. Apply following the length of the muscle where tension is present – move in vertical or horizontal direction in straight lines or circular movements towards venous return. Alter frequency (increase/decrease) to suit area worked on. Reduce frequency over bony areas. Place your hand over the area to be treated and apply audio sonic over the hand – thus reducing vibrations and irritation (ideal for treating the facial area).

Aftercare Advise skin products to support audio sonic treatment. Advise on correct posture to prevent tension nodules. Continue relaxation with relaxing bath products and massage

techniques that clients can be applied at home.

Contra-actions

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Anterior

Posterior


Insufficient protection and frequency over bony areas. Treatment applied too long – excessive erythema. Too much pressure applied – skin irritation. Bruising to delicate areas – excess frequency intensity

Heat Treatments

Infra-red TreatmentInfra-red lamps emit infra-red rays – these have a heating and therapeutic effect on the epidermal tissues. Therefore:

Skin becomes warmer.

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Blood circulation increases locally as blood vessels dilate. Hyperaemia occurs - when skin reddens. Sensory nerve endings are soothed as a result of the heating action.

Application Apply to a clean skin – free from products. Carry out a tactile and thermal skin test prior to treatment and record results. Check for contra-indications (same as for general electro-therapy). Heat the lamp in advance of treatment. Apply at a distance of 20 – 40 cms (depends on skin sensitivity and area

treated). The rays emitted from the bulb must strike the skin at right angles

(perpendicular) for maximum penetration. For a pre-heat treatment apply 10 minutes prior to treatment. An effective treatment is to apply manual massage whilst the infra-red lamp is

currently on the area. Apply the lamp and massage for 15 minutes, then remove the lamp and continue the massage to complete the treatment e.g. the back area.

Warning – over exposure and incorrect treatment technique can cause: Burns, headaches, feeling or actually fainting.

G5 Vibratory Treatments

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There are three types of vibratory treatments which may be applied to the body, the large gyratory vibrators, smaller hand held percussion vibrators and audio sonic machines.

The gyratory vibrators work on a vertical and horizontal plane creating a circular movement whilst vibrating up and down thus achieving effects similar in action to manual massage. By altering the applicator heads and method of use, effects such as effleurage, petrissage, tapotement and frictions can be obtained.

Contra -indications that restrict treatment

Varicose veins Hairy pigmented moles and skin tags Menstruation Piercings Pregnancy Cuts/abrasions and bruises Certain types of medication that causes skin thinning and sensitivity

Contra – indications that prevent treatment

Epilepsy Pacemaker Dysfunction of nervous system Undiagnosed lumps or bumps

General effects and benefits of Vibratory treatments

Improves general stimulation of blood supply to the area worked on resulting in erythema and a feeling of warmth.

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Improvement of muscle tone due to interchange of blood through the tissues bringing oxygen and nutrients.

Increases cellular metabolism Skin desquamation.

Back areaMethod of work

Horseshoe effleurage head from hip to Deltoid x5 Ball shaped head three sections each side stroking and circular Multi nodular head three sections each side stroking and circular 4 nodular head stroking up on erector spine x3 Lighthouse shaped head stroking and circular around scapulae on

Rhomboids ( clients arm is placed back) Tapotement spiky head stroking and circular x3 Horseshoe effleurage head from hip to Deltoid x5

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Documents

2.Body Massage course notes