Palpation Skills for Massage Therapists

palpation for massage therapists1

ELAP recommendations: 

Subject: Palpation and Movement
Topic: Orientation to Palpation and Movement
Learning Outcomes
Conditions: Having completed 4 hours of instruction on an orientation to palpation and movement, the learner is expected to:
Demonstrate knowledge of the key terms and concepts related to the development of palpation skills and the basics of human movement on a written examination.

Why should you learn palpation skills?

What ‘tools’ can you use to palpate?

What are the goals of palpating?

Learn to discriminate levels of tissue, muscle, bone and joints.  Sense differences in tissue quality.
Palpation skills for massage therapists is learning to use touch to identify the various soft tissue structures of the body and the condition of those tissues. What you learn from touching is used to assess the somatic responses of the body and for making treatment decisions. Through palpation, soft tissue such as ligaments, muscles, tendons, joint capsules and other body parts can be identified. Palpation of the physical aspects of the body is only the beginning. Once you can feel the physical aspects then you can use what you learn to assist clients in learning to feel their bodies more.

Touch is the only sense where you are also touched when you touch someone else. Learning to touch others with intention and care you will be also able to tune into what you are feeling when you touch. This is one of the keys to working in a therapeutic relationship with a client.

Learning Palpation Skills

Learning to palpate and feel a clients body is a matter of just practicing and figuring out what it is that you are touching. With supervised practice and guidance your skills can constantly improve as you begin to trust your senses. Only you know what you are feeling. The client only knows what they are feeling.

Palpation is done mainly with the hands but some of your other senses may also come into play when working with clients. Sight, smell and hearing may also be used.  It is also necessary to have a good understanding of anatomy and physiology so you can begin to understand the structures and what you are feeling under your fingers/hands when you touch.

Begin by recognizing how you use your senses. Palpation is a collection of several abilities. The dominant eye is used to focus on the object while the non-dominant eye provides depth perception. You can find your dominant eye by holding your arm out in front of your eyes and holding up your thumb. Aim it at something in the distance and alternately close one eye at a time. The eye that sees the thumb as aiming at the object is your dominant eye.
Peripheral vision is important in sensing movement.

learning to touchDifferent areas of the hand are sensitive to different types of stimuli.

  • Pads of the fingers are most sensitive for fine tactile discrimination. You can use them to sense texture, tension, surface resistance, small areas and pulses. The tips of the fingers are not as sensitive and are not large enough to sense the full shape of most structures.
  • The back of the hand and fingers are most sensitive to temperature
  • The palm of the hand is most sensitive to vibration and shapes. You can switch between the palmar surface of the fingers and the palm.

Use a light touch to keep your senses open and to prevent distorting the tissue being touched. Too much pressure will override the sensitivity of your touch as well as solicit various responses in the client such as guarding and increased tension.

You can adjust the depth, direction and duration of your touch to assess the tissue.

Knowing your underlying anatomy is important here. Find the prominent landmarks and muscles.

You are the only one who can determine how things feel to you.

Keep in touch with your client at all times. Get as much feedback as you can.

  • Use client feedback to educate the student about palpation
  • use information to educate clients about touch and their bodies
  • Ask questions that are open ended (not yes or no questions) Use where, what, why
  • The client is always right. Your role is to just provide feedback and mirror what you find.

Ask questions:
What do you feel when I am touching here?
What physical or non-physical sensations do you feel here?
What in your body needs attention?
Can you feel the tension here?
Can you feel the difference now?

Observation is the act of gathering objective signs. A sign is a measurable or observable indication of less than normal function. A sign is not a feeling. You can observe injuries and how the body compensates for those injuries. Look for signs of heat, swelling, cold areas, redness, paleness, contours and tension.

5 Objectives of Palpation

(Mentioned in the book Palpation Skills by Leon Chaitow, as summarized by Philip Greenman in Principles of Manual Medicine)

  1. Detect abnormal tissue texture
  2. Evaluate symmetry in the position of the structures, both tactically and visually.
  3. Detect and assess variations in range and quality of movement during the range, as well as the quality of the end of the range of any movement.
  4. Sense the position in space of yourself and the person being palpated.
  5. Detect and evaluate change in the palpated findings, whether these are improving or worsening as time passes.

Also important to note the texture, resilience, warmth, humidity of the skin and tissues.

 

Resources:

Know your anatomy and physiology.

Know your kinesiology and insertions, origins of muscle attachements

The seven-step palpation method: A proposal to improve palpation skills Andree Aubin, Karine Gagnon, Chantal Morin.  Journal of Osteopathic Medicine (PDF)

Learning to Touch for massage therapists

Learning to touch for massage therapists is usually one of the most basic level classes in massage school.  How you touch others and the quality of your touch along with your own history of touch will influence your success as a massage therapist.  Being a massage therapist is much more than just doing a massage.  Your role as a massage therapist requires that you be as present as you can for the client who is on your table.  You will need to know what you intend to communicate through your touch and find out if you actually do communicate that through your touch.

Through massage school you may become aware of some of your past issues with touch.  It is one of the most important parts of massage school.  Touch is the only two way sense – when you touch someone you are touched back.  What you feel when you touch others as a massage therapist will affect how your touch is perceived.  People don’t really care what technique you are doing.  All they know is how it feels to them.  It may remind them (consciously and more often unconsciously) of how they were held and attended to as a child.  It may remind them of what they were lacking as an infant.  It may remind them of people in their past.  If there was physical, sexual or even mental/emotional abuse it is most likely a part of their physical body.

Knowing your own past touch issues is important when working with all types of clients.  It can help you to be more present with people no matter what their level of touch receptivity is.  How touch was used or withheld in your family, what the rules were around touch all influence your image of yourself and your self esteem.  Infants who are not touched enough will respond by becoming avoidant to touch and will often grow up with defense mechanisms to protect themselves from the pain of not having their early needs met.

Take the time to look into your history of touch – being touched and giving touch.

Touch can be used to punish or hurt.  Touch can be used to nurture, reassure and support.  It can be used to stimulate and excite as in shaking someone to wake them up or tickling.  And of course there is sexual touching which is not a part of massage but is an important part of your touch history.

Your clear intention is really the most important thing you can bring to the massage profession.  It can only come when you have personally worked through your own touch issues first before working with others.  It actually will be a constant learning process as your massage practice develops and matures.

Learning to touch and use touch as a framework for communicating with clients in the healing process you will encounter various elements of touch.

Trust is necessary for clients to be able to get on your massage table and is the foundation for the therapeutic relationship that occurs with the massage therapist/client.  Your awareness of yourself and your personal and professional boundaries are what create the framework of trust for clients.

You may also be using all of your senses to work with clients sensing your own feelings first and becoming aware of your own body as you work on others.  You will be learning to touch various body parts and various levels of tissue of the body which requires you to be aware of your own body.  The depth, quality of touch, type of pressure and applications of massage requires this.

Getting feedback from clients is often a challenge because many  will not know what pressure or technique is best for them at first.  They also will think that you will know best but encouraging them to find out for themselves can create an even more powerful massage session.

Presence is the ability to stay present and aware of your own feelings while you are working on someone else and not let those feelings affect your work or get in the way of what the client needs or letting those feelings take your attention off of your clients needs.  It also requires that you trust more in the healing process and have a deep understanding that you are just a guide on the journey with the client.

 

Swedish Massage Strokes

Stroke
Purpose/Uses
Mechanical effect Reflexive effect Contraindications
LIGHT EFFLEURAGE

Gliding, Fanning, Tree branching,
shingling etc.

  • Transitioning
  • Spreading oil
  • Evaluating tissue
  •  Relaxes muscles (parasympathetic
    nervous system)
  • Relieves pain (Gate control theory,
    endorphins)
  •  Increases arterial and
    capillary circulation
  •  Increases vasodilation
    (slowing heart rate and blood pressure)
  •  Hyperesthesia
  •  Marked or pitted edema
  •  Gross swelling
  • Open wounds
  • distal to inflammation or infection
DEEP EFFLEURAGE

Knuckling,

  •  Increases venous and lymphatic
    flow removing wastes, reducing edema
  •  Improves nutritional status
    of tissues
  •  Increases arterial and
    capillary circulation, bringing nutrients
  •  Warms superficial tissue
  •  Desquamation of dead skin
Same as above

    •  Deeper muscle relaxation
    •  Capillary dilation longer
      lasting

 

 

  •  Same as light effleurage
  •  Very hairy skin
  •  New scar tissue
  •  Venous stasis
PETRISSAGE

Picking up, wringing, kneading,
open C/closed C, alternating thumb, squeezing, lifting, skin rolling (lifting
tissue away from underlying structures)

    • Used after effleurage
    •  Relieves congestion
    •  Reduces swelling
    •  Digestive disorders 
    •  Muscle shortening 
    •  Spastic paralysis
    •  Fatigue

 

 

  •  Stretches muscle fibers
    and stimulates muscle tone, broadens fibers
  •  Breaks up adhesions
  •  Increased circulation
    and waste elimination
  •  Moves interstitial fluid
  •  Slow-relaxes nervous system
  •  Fast-stimulates NS
  •  Increases glandular activity
    of skin
  •  Increases peristalsis
    when done over abdomen
  •  Affects proprioception
  •  Atrophied muscles
  •  Flaccid paralysis
  •  Acute inflammation
DIRECT PRESSURE FRICTION

Compression

  • Use after tissues have been
    warmed up
  •  Hypertonic muscles
  •  Treatment massage
  •  Deep tissue work
  •  Compresses and spreads
    tissue
  •  Temporary ischemia
  •  Mobilizes muscle/tendon
    junction
    •  Reduces pain and spasm
    •  Hyperemia
    •  Increases peristalsis
      when done over abdomen

 

 

For all frictions:

  •  Acute inflammations
  •  Neuritis
  •  Recent injuries
  •  Osteo and rheumatoid arthritis-especially
    acute stages
  •  Muscles lacking innervation(paralysis)
  •  Debilitating neuromuscular
    dysfunction such as MS, ALS, MD.
LINEAR OR CIRCULAR FRICTION same as above
  •  Myofascial releasing-separating
    adhered fascial planes
  •  Broadens and stretches
    muscle fibers
  •  Increases muscle 
  •  Decreases tension through
    stimulating Golgi tendon reflex
  • Increases circulation
  • Creates hyperemia
Cross fiber friction
  •  Use only after a thorough
    warming of involved tissue
  • Apply at right angles to scar/fibrotic
    tissue
  •  Superficial tissue must
    move over underlying structure
  •  Apply frequently enough
    to have an impact
    •  Breaks up adhesions
    •  Assists in realigning
      scar tissue

 

 

  •  Relaxes muscles by stimulating
    Golgi tendon reflex
Heat rub friction
  •  Heats skin
  •  Warms tissue
  •  Vasodilatation
  •  Relaxes muscles
TAPOTEMENT

Tapping, Pincement, Slapping
Hacking, Cupping, Beating, Pounding

  •  Stimulation of tired muscles
  •  Relaxation of hypertonic
    muscles
 Loosens mucus in thoracic
cavity
  •  Stimulates nervous system,
    muscles, vessels
  •  Enhances muscle tone via
    contract-relax response
  •  Increases circulation
  •  Stimulates organs through
    low back
  •  Increases gaseous exchange
  •  Stimulates skin and glandular
    activity
  •  Muscles is spasm or cramping
  •  Spastic paralysis
  •  Atrophied muscles
  •  Flaccid paralysis
  •  Insomnia, neurasthenia
    or complete exhaustion
  •  Neuritis or painful conditions
  •  Over bony area
  •  No heavy tapotement over
    the kidneys
  •  No heavy tapotement over
    low back in pregnancy or menstruation
FINE VIBRATION

Static or moving

Relaxation
  •  sedates nervous system
  •  reduces pain(gate theory)
  •  relaxes muscle 
same as tapotement
COARSE VIBRATION

Static or moving

loosens ligaments  Penetrating stimulation
JOSTLING/SHAKING
  •  Increases synovial activity
  •  Increases circulation
  •  Stimulates organs
  •  Reduces muscle guarding
  •  Rejuvenating  tired
    muscles
same as tapotement
SWEDISH GYMNASTICS

Active free, active assisted,
passive, resistive

  • Stretches muscles and ligaments
  •  Increases circulation
    and nutrition
  •  Increases waste elimination
  •  Loosens adhesions
  •  Increases ROM and flexibility
  •  Stimulates NS
  •  Increases blood pressure
    and temperature
    •  Torn ligament, tendon
      or muscle
    •  Unhealed fracture
    •  Post surgery
    •  Heart conditions 

( active and resistive)

    •  Acute injuries

 

Hydrotherapy Applications

General Hydrotherapy Applications, Temperatures, Effects of Hot and Cold

  1. Local Heat : Applying heat to specific areas of the body such as joints, chest, throat, shoulders, spine: use moist hot compress, hot water bottle, hot pack, heating pad, Thermophore.
  2. Local cold: Apply cold to specific area of the body; use cold compress, ice bag, ice pack, ice hat, frozen bandage.
  3. Cold compress that heats the body: A cold wet cloth that is in contact with the skin and then covered with a water resistant covering will create a physiological response that warms the body from within.  This is called a cold double compress.  It can be applied to any area of the body or the entire body.
  4. Tonic friction: Water sponging or washing combined with some form of friction on the skin produces a tonic effect on the body
  5. Sponging: Use alcohol, water or which hazel applied to a sponge to wash the body.
  6. Baths: Body is immersed in cold, hot or tepid water.  Any part of the body may be bathed; arm bath, eye bath, finger bath, hand bath, foot bath.
  7. Showers: Many kinds of water streams can be directed against the body.
  8. Steam: Water particles dispersed through the air that affects the skin, lungs and air passages. Cold steam moistens dry rooms in winter and can help prevent colds and sinus headaches.  Hot steam increases body temperature and perspiration to release toxins.
  9. Sauna: Dry heat which increases body temperature and increases perspiration;  May put strain on nasal and lung passages.
  10. Shampoo:  Soap and water used on one or all parts of the body

Temperatures for Hydrotherapy Treatments

Degrees Fahrenheit Description of Sensation Sensation on forearm when immersed in
this water temperature
Degrees Celsius
32
Ice Pain
0
33-55
Very cold Pain and numbness
1-13
56-65
Cold Sensation of coldness
14-21
66-80
Cool Cool
22-27
81-92
Tepid slightly cooling
28-32
body temp
Neutral No sensation body temp
93-98
Warm Comfortably warm
33-38
99-102
Hot Skin redness with prolonged immersion
39-40
103-110
Very Hot Tolerable for a short time
41-43
111 +
Painfully Hot Pain and possible tissue damage
44-49
113+
Damaging Pain and tissue damage
49+

 

Hydrotherapy Effects of Cold and Hot Water

Primary Effect Secondary Effect
Cold Water -peripheral vascular constriction
-Pallor of skin, chilliness, shivering,
chattering
-Increases respiratory rate
-Increases muscular tone
-Increases blood pressure and heart rate
Occurs if you warm up:
-Peripheral vascular dilation, causing redness of skin
-Decrease in respiratory rate
-Decrease in blood pressure and heart rate
-Muscle relaxation
Hot Water -Increases Body Temperature
-Increases Pulse rate (by 10 for every
1 degree increase in body temp)
-Increases respiration rate
-Increases oxygen consumption and metabolic
rate
-Peripheral vasodilatation
-Increases Circulation
-Decreases blood pressure
-pH becomes more alkaline
-Increases in excretion from kidneys
Generally the same as secondary effects
of cold;  Gradual reduction of these effects as body returns to normal.

 

Hydrotherapy MassageGeneral Therapeutic Effects of Cold:

Reduces muscle spasm by breaking the pain-spasm-pain cycle.

Reduces spasticity when muscle temperature is reduced. Used to move muscles so that they can be reprogrammed to increase motor skills as in subacromial bursitis.

Relieves pain through its direct effect on nerve fibers and receptors

Reduces Inflammation in the early phase

Reduces swelling an edema in the acute phase

Secondary effect of cold is heat ad body restores normal temperature

Types of cooling:

Convective: blowing air over skin

Evaporative: removal of heat by using ethyl chloride sprays

Conductive: contact with cooled substances such as ice packs or compresses

Application Times:

Application times must be adjusted to reach the area to be treated. Ligaments need more time because of the depth and type of collagen fibers.

Times must be adjusted according to the size of the injured area, the nervous system sensitivity and the amount of adipose tissue present.

Start with a minimum of about 5 minutes and check to see how cold the area is.

It also depends on what source of cold you use- straight ice in zip-lock or gel packs.

Contraindications:

Impaired or compromised circulation – diabetes, peripheral artery disease

Previous frostbite or other hypersensitivity to cold such as Raynaud’s disease or Lupus

Poor kidney function

Hypothyroidism – causes further reduction in basal metabolic rate

Advanced Cardiovascular disease because of increase in systolic blood pressure

Slows wound healing by slowing cell metabolism

Open wounds, rashes

Hypertension – may temporarily increase blood pressure

Very young or very old – may have impaired regulatory systems and limited communication

Cold allergy or sensitivity

Adverse Effects of Cold:  burns when temperature is below 59 degrees F.

General Therapeutic effects of Heat:

  • Increases the extensibility (ability to stretch) of collagen fibers
  • Decreases chronic joint stiffness
  • Increases range of motion
  • Relieves pain
  • Relieves muscle spasm
  • Increases blood flow
  • Can assist in removal of edema and waste products from areas of injury

Transmissions of Heat:

  • Conduction: contact with warmed substances such as hot packs, paraffin
  • Radiation: luminous and infrared lamps
  • Conversion: Heat produced as energy from high frequency currents such as ultrasound; penetrates to deeper layers of body

Indications/Applications:

  • Joint contractures to stretch tendons and increase flexibility; Heat and stretch fibers
  • Rheumatoid Arthritis- heat increases the viscosity of the synovial fluid in the joint. Heat and follow with ROM exercises
  • Chronic muscle spasm

Contraindications:

  • Any acute inflammation such as bursitis, arthritis, tendonitis, sprains or strains
  • diabetes
  • Deep vein thrombosis
  • impaired circulation or reduced sensation
  • congestive heart failure
  • acute injury, inflammation and edema
  • Pregnancy – no immersion baths or hot packs to the abdomen
  • Very young and very old may be unable to communicate
  • Open wounds, rashes or previous burns

Adverse Effects of Heat

Burns – keep temeratures below 113 degrees, use insulation between the heated object and the skin, use heat packs that cool down.

Fainting –  usually due to lack of blood and oxygen to the brain from peripheral vasodialation, change in body positions that cause a change in blood pressure.

Basic Swedish Massage

Swedish Massage1
Basic Swedish Massage is such a wonderful technique when you really think about it.  It is what is taught in basic massage school and is also what is used in most couples massage classes.  Swedish Massage is really a big part of the history of the massage therapy profession.  The term may also be used in spas or massage offices, but massage today has gone way beyond the basic Swedish Massage techniques.

Swedish Massage consists of 5 or so basic strokes or movements and varying depths of pressure for each strokes makes it widely used in various situations.

  •  Effluerage – Light and Deep
  • Pettrissage -Picking up, wringing, kneading, openC/closed C, alternating thubm, squeezing, lifting, skin rolling
  • Friction -compression, circular, cross fiber, heat rub
  • Taopotement- tapping, pincement, slapping, hacking, cupping, beating, pounding
  • Vibration – static or moving
  • Swedish Gymnastics – passive and active range  of motion and stretching

With a good working knowledge of Basic Swedish Massage, you can help relieve muscle tightness, work to relieve pain from muscle spasms, and much more.  If you understand the basic mechanics of posture, you can even help to relieve scoliosis, carpal tunnel syndrome and many other conditions that affect muscles and fascia.  It is just a matter of learning to apply it to various conditions and understanding how the condition affects the body.  It is a process of learning and testing what works and what doesn’t.

Contrary to popular belief – Swedish Massage was not created by Peter Per Ling in Sweden and in Sweden, there is no Swedish Massage!  This is cleared up by the late Robert Calvert, a historian for the massage profession, in his book “The History of Massage”.

Per Ling actually was involved in the Swedish Gymnastics movement therapies.

You can also read an except of the article at Massage Magazine.

Here is a chart that summarizes the basic Swedish Massage Strokes.

Learn more about the basic Massage Theory classes offered in Massage school.

Resources:

 


Swedish Massage Contraindications/Endangerments by System

Nerves location Notes
Occipital Foramen Magnum Base of skull superior to 1st cervical vertebra 
greater occipital nerve, suboccipital nerve, cranial nerves II (optic) III (oculomotor) IV trochlear
Do not work the occipital area during passive extension.
Static pressure ok in lengthened position
Trigeminal Nerve (V Cranial) TMJ pressure on nerve may cause Trigeminal neuralgia or tic de la ru with nerve inflammation.
Caution when working with jaw open.
Brachial Plexus -above lateral clavicle
-posterior triangle of neck
-insertion of deltoid, pec Major and biceps
-medial upper arm between the biceps and triceps
Impingement can cause pain/tingling down arm/hand
Axillary Nerve -deep inside arm on the humerus
Musculotaneous Nerve
Median Nerve
-lateral to biceps and triceps at the elbow -accessed when elbow is bent. Work with the arm straight
Lumbar Plexus -between the 12th rib and T12 along top edge of quadratus lumborum
-along the transverse processes of T12 and lumbars
Vagus Nerve -deep in abdomen -deep psoas work is risky with people with high blood pressure as it may over stimulate the vagus nerve and cause sweating, nausea
Femoral Nerve -anterior pelvis lateral to psoas
-femoral triangle
-caution when doing iliacus work
follow the contour of the pelvis
Common peroneal Nerve
Common popliteal Nerve
-back of knee
-tendon flattens when knee is straight
-hamstring work done with knee bent
Veins and Arteries
Common Carotid
External Jugular Vein
medial to SCM in anterior triangle pressure may cause dizziness or blackouts
Subclavian Artery/Vein behind clavicle in the hollow under the clavicle between the Pec Major and deltoid
Aorta lateral to navel -move off if you feel pulse
– may cause blackouts
Cephalic Vein anterior to deltoid, medial to triceps, lateral to pectoralis can be impinged to the humerus
Basilic Vein upper arm can be trapped between the biceps and triceps
Organs
Heart heavy compression on sternum is contraindicated
Liver below rib cage extending from the right side to the left of center press liver down as you press under ribcage to work diaphragm
Spleen left abdominal region behind stomach feels mushy
Kidneys protected by lower rib cage between T10 and T12 on both sides No compression or vibration over kidneys on back.
No high psoas work through abdomen
Lymphatic Structures many locations: cervical area, axillary, abdomen, femoral triangle, popliteal area avoid
Eyes do not apply pressure on eyeballs:
retinal detachment indicated by flashes of light or color

ELAP recommendation:  Having completed 15.5 hours of instruction on massage cautions and contraindications, the learner is expected to:
• Demonstrate knowledge of the terms and concepts related to massage cautions and contraindications including endangerment areas, medications and side effects, and contraindications on a written examination.
• Demonstrate the use of a clinical reasoning process to identify contraindications, an understanding of when there is a need for increased therapist caution, and the capacity to choose appropriate adaptive measures for session planning on a written examination.
• Demonstrate the integration of knowledge and skills from other topics with this topic including the use of health intake forms, pathology reference books, drug reference books, and research literacy when determining if conditions are contraindicated or require caution, a physician’s release, or adaptations on a graded assignment.
• Correctly adapt massage strokes and techniques in endangerment areas or based on client feedback on a practical evaluation.
• Obtain training and certification from the American Red Cross in adult first aid, cardiopulmonary resuscitation (CPR), and use of an automated external defibrillator (AED).

Depression and Massage

depression1Massage therapy is being used more and more to work with conditions such as Depression and for a good reason:  The strongest evidence we have in massage research shows that massage has a significant impact on these conditions and because stress and anxiety are also known to be the cause of other health conditions.

While massage therapists are not psychotherapists, massage might help people even more than talk therapy according to research a Meta Analysis of Massage Therapy Research. by Christopher Moyer

“Reductions of trait anxiety and depression were MT’s largest effects, with a course of treatment providing benefits similar in magnitude to those of psychotherapy”

Depression is a term used to classify a group of disorders that causes debilitating changes to one’s emotional state. It is often described in many ways such as:

  • feelings of hopelessness
  • fatigue/lacking energy or motivation – not being able to get out of bed or off of the couch
  • sleeplessness, restlessness
  • lost of interest in people and in activities
  • feelings of isolation and loneliness
  • thoughts of ending own life or not taking care of one self when sick
  • aches and pains throughout the body
  • digestive issues
  • overeating/under-eating
  • weight gain/weight loss
  • lack of focus or drive

There is a really good book  Why Zebras Don’t Get Ulcers, by Robert Sapolsky with a description of depression. He classifies depression as “a genetic-neurochemical disorder requiring a strong environmental trigger whose characteristic manifestation is an inability to appreciate sunsets.”

Depression is a whole body illness that affects the nervous system, moods, thoughts and behavior as well as sleep patterns, eating habits and your ability to respond and act in your life.   Symptoms of depression include chronic fatigue, insomnia, sleep problems, headaches, backaches, digestive disorders, restlessness, irritability, loss of interest in relationships and life, feelings of worthlessness and inadequacy.   A person with depression may be chronically angry or sad or go to the other extreme of having no emotions at all.

Causes of Depression

The causes of depression are wide and varied and not very well understood.  It may be triggered by stressful events, chemical imbalances, poor diet, allergies, thyroid and other hormone disorders, hypoglycemia and some hereditary and social conditioning factors. It can just be genetic and run in the family. There is the depression that occurs after the death of a loved one or the birth of a baby. Depression comes in all shapes, sizes and forms.

There are many levels or degrees of depression and different types of depression that I won’t go into here but it is enough to mention that depression is a vary complex situation.  It can range from annoying to life threatening.  It can be mild, moderate or downright overwhelming.

We don’t really know why or how massage helps depression but there are many theories.  Touch is just one of the most basic ways of soothing whatever ails you.  When we touch, we are touched back meaning massage/touch is a two way street.  Both parties are engaged in the process.  When we perform a massage technique on a client, they don’t really know what technique we are doing.  All they know is that it feels good (for the most part!).  It is through touch that we get to know ourselves better.  We learn we are human.

It seems massage may offer benefits similar to psychotherapy when it comes to decreasing anxiety and depression, an exciting find says Christopher Moyer, whose research recently appeared in Psychological Bulletin (January 2004). But just to be clear Moyer’s findings do not suggest the substitution of massage, as a stand-alone modality, in place of professional psychological or medical treatment for these conditions. “We may find it is a good complement for (treatment of) depression,” he says, especially in combination with other forms of care.

Resources for learning more about massage for depression:

AMTA position paper on massage and depression.

Depression and the Stress Response System: Part I of III By Ruth Werner, LMP, NCTMB  Part II , Part III

 

Treating Depression with Massage By Don McCann, MA, LMT Massage Today

Massage therapy for the treatment of depression: a systematic review. Coelho, Boddy, Ernst Pub med Study

Mosby’s Complementary & Alternative Medicine By Lynda W. Freeman Google Books

Entry level Analysis Project (ELAP) (PDF) recommendations for working with depression with massage therapy

Affective Massage Therapy by Christopher Moyer in the International Journal of Massage and Bodywork

Statics on Mental health disorders from the National Institute for Mental Health

 CDC statistics on Depression

 

Types of Sports Massage and it’s benefits

Event massage – Pre-event, during event and Post-event.  This usually occurs on-site at the actual sports events.  Pre-event massage is different than post event massage.  Pre-event massage is done before the event to further assist in the athletes warm up (but does not replace their physical warm up process) which requires that you have an understanding of the sport that they are participating in.  Massage can change the timing of an athlete’s movement and make them feel weak if too much is done before and event.   Event massage is usually between 5-15 minutes so you have to know what you are doing and be able to get right to the heart of the issue.

Massage done during an event such as a basketball or baseball game is done to keep the athlete warmed up and address any tightness or stiffness and keep the athlete going.  In sports like baseball where there is time on the bench between innings, this could be valuable to athlete’s performance.

 Post event massage is done directly after the event to help the athlete recover from their exertion.  The massage therapist will also need to be skilled in assessing an athletes condition after an event to see if massage is indicated or to know when and athlete need further medical attention for over-exertion or other problems.   Many athletes will push themselves beyond their capabilities and that could lead to dehydration, injuries and even shock.

Training massage applied during training for events including maintenance massage in the off season.  Training may involve other activities besides their regular sport such as weight lifting, cross training in other sports and cardio training.  The massage therapist will need to be aware of various kinds of work out routines and know when to apply and when not to apply massage.  The main goal is to keep the athlete injury free so they can continue their training.

Rehabilitation for injuries and issues that stop athletes from participating in their activities.

The massage therapist will need an understanding of strains and sprains and how to treat them accordingly to avoid further injury and to get back to training as quickly as possible.  Athletes are prone to injuries like Achilles tendonitis, tennis elbow, knee pain, hip  pain, back and neck pain, Plantar Fasciitis (foot pain), shoulder strains and sprains, Iliotibial Band Tendonitis and many other debilitating conditions.  You will need to understand the principles of healing and how to apply massage during every phase of healing.

 

Benefits of massage for athletes.

 

  • Reduces anxiety and depression which allows for better training and performance.
  • Reduces muscle tension.
  • Reduces muscle hypertonicity (chronic contraction of a muscle in response to genetic, mechanical, chemical, or psychological stressors. Increased tonus results in a shortened, tight muscle.)
  • Reduces the risk of injury in athletes allowing them to focus on training.
  • Increases Mobility and range of motion: Flexibility is one of the keys to strength.
  • Helps in relaxation – the more relaxed an athlete, the better they are generally in their sport.
  • Facilitates healing of scar tissue.
  • Reduces swelling.
  • Relieves triggerpoints or knots in muscle tissue.
  • Helps athlete build strength during training seasons.
  • Helps athlete achieve peak performance.

 

Sports Massage Careers: Training

Education Requirements:Become a Sports Massage Therapist

Basic Massage School is required to become a sports massage therapist.  Each state has a different number of hours of education that are required to become a professional massage therapist.  You will have to find out what is required in your state and then find a massage school that will fulfill those requirements just to become licensed to practice massage. Basic massage school will consist of anatomy and physiology courses (learning the structure of the body and how the body works), kinesiology courses (how the muscles move the body), pathology (diseases and conditions), Ethics (learning to set boundaries that support you), Massage Theory and Practice and Business/Marketing.  Many schools will offer the beginnings of classes in clinical massage (massage for injuries) as well as other types of massage such a pregnancy massage, hydrotherapy, spa massage, hot stone massage and deep tissue massage basics.

Most schools will offer some type of basic training in sports massage so that you can get some ideas of what it is and how to start thinking about working with athletes.  It is usually enough information to get you started working with weekend athletes and people who work out regularly.

Working with sports teams at any level will require more training and experience as each sport is unique and requires that you know how the body is used in each sport so that you can apply the massage in the correct way, at the appropriate times.  Consider taking advanced training in Anatomy and Kinesiology such as cadaver classes that can be of great assistance in learning how the body works.  You will always be learning more anatomy, physiology and kinesiology so you really must love those areas to be a great sports massage therapist.  Most athletes are also very aware of their body and how their muscles work so you will need to know how to talk to them in their language.

After you graduate from massage school, you will need more experience doing massage and extra training.  There are advanced classes geared specifically to learn sports massage.  The American Massage Therapy Association has chapters in each state and many have their own sports massage team that does provide training and also a chance to get hands on experience working at local amateur events.

You will need to have a very in depth knowledge of anatomy and physiology that will focus on the movements that occur in various sports.  You will also need an extensive knowledge of injuries, pathologies and an in depth knowledge of how muscles work in order to work more effectively with athletes.  You will need continuing education beyond massage school to become a sports massage therapist.

 Continuing Education in Sports Massage

Regular Sports Massage Classes offered by individuals, schools or groups like American Massage Therapy Associations sports massage teams.
Example: WA  AMTA sports massage training manual
www.amtawa.org/clientuploads/WSMT/WSMT_Calibration_Manual_FINALMANUAL.pdf

Clinical Massage is a type of massage that is geared toward working with injuries that requires that you learn to make assessments of clients and have a basic understanding of pathology so that you can make decisions on the care of athletes.

Triggerpoint therapy. A type of massage that focuses on releasing the triggerpoints or knots that develop in muscles.  There are a few different methods of treating triggerpoints.

Myofascial release is a type of massage that deals with the fascial covering of the muscles and the muscle fibers.  There are many different techniques of working with the fascia system.  Some popular ones can be found on my website.

Orthopedic massage is a type of massage that has it’s foundation in orthopedic medicine which deals with injuries of the muscles and joints.  There are many different methods of orthopedic massage to choose from.

Lymphatic drainage massage is a type of massage that deals with inflammation and the lymphatic system.

Stretching

Hydrotherapy which is using hot and cold therapies at appropriate times during training and events.

Deep tissue massage is more of a description of massage than a specific technique.  It entails applying pressure to the deeper muscles of the body and often entails using more pressure from elbows and fists.  There is some controversy over the pain levels that can be felt as a result of this deep pressure.  There are regular deep tissue massage courses and also things like Rolfing® and the structural integration types of bodywork, that work in a deep manner with the body and can be quite effective yet painful.

See also:  Sports Massage Part 1 – Job/Career Opportunities

Learn Chair Massage

Learn Chair Massage/Build a Chair Massage Business

History of Chair Massage

David Palmer was the first to popularize the concept of doing seated massage on fully clothed people in a public or office setting.  His

 article A Brief History of Chair Massage in Positive Health Magazine tells a story of how he was just wanting to help give the massage profession a boost in making massage accessible to all.
His idea for creating chair massage came out of his realization of how difficult it is to build a massage practice and the challenges of educating the public.  He says in his article

“I was mystified. Hadn’t massage changed my life? Hadn’t it had a significant impact on the life of every bodyworker that I new? Why was the interest in professional massage growing so slowly that practitioners seemed to be fighting over the same 5% of the population who appreciated the benefits of skilled touch? What was the point in training skilled touch professionals if there were no clients for them to massage?

Often it seemed that the bodywork community somehow felt that the problem was not with professional massage,

 but rather with the lack of sophistication on the part of the public. Most people, the notion went, were too “uptight” or “unconscious” to appreciate what our service had to offer. I realized, however, that we wouldn’t be able to solve this problem if we simply chose to blame the potential clients. Another perspective was called for and it occurred to me that the problem might be more in the packaging, not the product. That is to say, when looked at from a marketing perspective, the general public clearly did not perceive massage to be safe, convenient, or affordable.”

Chair massage or seated massage has been around for centuries and doing seated massage is often a part of many different types of massage such as structural integration and Feldenkrais

Chair massage has developed into a way of marking your table massage practice and also into corporate chair massage, airport massage and massage kiosks in public places such as convention centers, busy office building lobbies and hotels.

David Palmers’ early massage chairs are pictured in this article by Robert Calvert, founder of massage magazine, a noted author and massage historian. 

This article Seated Massage In History (PDF)
The modern massage chair revived this form of bodywork in the 1980s. By Patricia J. Benjamin has some great pictures of seated chair massage in it’s early history.

Ideas for Chair Massage Businesses

  1. Airports
  2. Convention Centers
  3. Natural Grocery Stores such as Whole Foods
  4. Hospitals for nurses, patients families, visitors
  5. Public Schools
  6. Colleges
  7. Office Building Lobbies
  8. Fairs
  9. Community Centers
  10. Beaches, Parks
  11. Corporations – either paid for by the company or the individuals or partially subsidized by the employer.
  12. Wellness Centers at Corporations
  13. Special office events – retirements, end of project, mid-project rewards
  14. Graduations
  15. Wedding Showers
  16. Baby Showers
  17. Dentist offices
  18. Sporting events
  19. Massage Parties
  20. Charity events
  21. Nursing homes

chairmassageSetting up a  Corporate Chair Massage Account

  1. Provide research articles and information as to how workplace massage can assist the employee’s in areas of productivity, well being, health, mental abilities
  2. Offer Free chair massage to the managers
  3. Set up a trial basis to provide your services to employees
  4. Provide handouts or a regular newsletter for employees to learn about massage.
  5. Set up rules and regulations for no- shows, appointments, late comers
  6. Set up your schedule to allow breaks, enough time for each clients

Chair Massage Business Tools, Supplies

  1. Massage Chair
  2. Luggage cart to transport chair if necessary
  3. Face covers – disposable
  4. Chair massage intake forms
  5. Chair massage brochures
  6. Hand sanitizer
  7. Spray and paper towels for cleaning massage chair
  8. Portable music system
  9. Clock or timer

 Chair Massage Resources

Business Ideas

Massage O-gram Boosts Massage Therapy Business-  Massage Magazine

 

Airport Massage Takes off – Massage Mag article about XPresSpa

Learning Chair massage

Fainting and Chair Massage by David Palmer – Massage and Bodywork

www.Touchpro.com  – David Palmers Classes

Massage Nerd – Chair Massage some ideas for setting up a business, cleaning your massage chair, ideas for events

 

  Robert Calvert‘s Pages from History at Massage Magazine

Seated Massage In History by Patricia Benjamin   

Marketing Chair Massage Negotiating An Agreement
by David Palmer Massage Depot

 

 Massage and Bodywork magazine

Free Your Hands and The Rest Will Follow
Hands-Free Chair Massage By Lisa Santoro

Seated Massage A Time to Sit Up Straight and Relax By Mary Kathleen Rose

Contract Considerations for Seated Massage: Get It In Writing Business Side By Sandra Gill

Massage for the Masses David Palmer, Chair Massage, and Zubio By Karrie Osborn

Fainting and Chair Massage Cause, Prevention and Management By David Palmer

 

 

Fainting and Chair Massage Cause, Prevention and Management By David Palmer

Setting up a Free event like an open house offering Free chair massage

Working for a corporate or public massage chair outlet
Getting the Contracts

Setting up contracts with chair massage employees

Learning how do massage on a portable massage chair
Resources, articles, books, DVD’s, videos chairs

Chair Massage Client Intake Form (.doc)