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Swedish Massage
Lesson 1:

Definition of Massage

Definition of Massage
Massage is a method wherein the superficial soft parts of the body are rubbed or
stroked or knead or tapped for remedial, aesthetic or hygienic purposes.
Therapeutic Massage
It is a remedial, rehabilitative and medical type of massage which is used for
recovery after physical injury, supplementary to medical treatment and to relieve muscle
soreness and minor injury pain.
Wellness Massage
It is a preventive, hygienic and relaxation type of massage which is used for
general health wellness. It provides a sensuous, pleasurable indulgence to remove the
results of stress of daily life.

Modalities of Massage
Massage therapy covers a wide range of modalities or styles practiced by
massage therapists.
The following are descriptions of the most common types of massage modalities.

Swedish massage - is a scientific treatment by certain passive systematic

manipulation upon the nude skin of the human body with the object of promoting and
maintaining a balanced circulation.
Shiatsu - "Shiatsu" is a Japanese word meaning "finger pressure". It is a "hands-on"
therapy used both as a compliment to conventional medicine and as a
preventative/alternative therapy.
Thai massage - What is known in the West as Thai massage is not massage at all,
but rather an ancient energy-based healing system that combines acupressure,
reflexology, and assisted yoga postures. Treatment effects are enhanced when the
patient is fully relaxed and breathing deeply. This traditional healing practice, called
Nuad or Nuad Boran in the Thai language, stands in sharp contrast to western
massage therapies.
Reflexology - is an ancient Chinese technique that uses pressure-point massage
(usually on the feet, but also on the hands and ears) to restore the flow of energy
throughout the entire body. The science of Reflexology has been around for

thousands of years. It is based on the premise that there are reflexes in our hands,
feet and ears that relate to every organ and part of our body. By stimulating these
reflexes with pressure and manipulation, nerve function and blood supply may be
improved, which may alleviate stress and other health problems.
Lesson 2:

Massage Therapist

What is Massage Therapist

The massage therapist will be the one conducting the therapy session to the
respective clientele/patient. Due to the extensiveness of massage therapy as a practice,
the massage therapist should be trained and be knowledgeable to a certain degree.

Job Opportunities
As massage therapy is rising in popularity, there are numerous places where you
may find work, such as:
Massage franchises
Fitness clubs and gyms
Physical therapy offices
Chiropractors offices
Hospitals, nursing homes, extended care facilities
Luxury resorts and spas
Shopping malls
Private practice

Advantages and Disadvantages

Advantages of being a massage therapist:
Schedule - As a massage therapy practitioner, you have the flexibility with the hours
you are available to work.
Mobility - Due to the flexibility of the practice, you are free to work in any specific
Money - A job in this industry can be a very lucrative one. The money you can
potentially earn depends on a number of factors. As a masseuse, you also have the
opportunity to earn tips. As your experience and reputation go up, so too will your
Disadvantages of being a massage therapist:
Long hours standing - This job is one that can be physically taxing on your body.
As such, it is not hard to get burned out. If you're constantly seeing patients and
performing services, without taking breaks, you're more prone to injury.
Money - The money you earn as a licensed masseuse can also be a disadvantage.
This business is client-based which means your pay is directly affected by the
number of clients you see. Less clients means less money. To prepare for when
you're not bringing in as much money, you'll want to make sure you're good at
budgeting and saving.
Unrealistic client expectations - Some of your clients may expect for you to
completely rid them of their pain and discomfort. Given that this is an unrealistic
expectation, massage therapists can be negatively affected as this can result in
dissatisfied clients. It will be your duty to correct the clients beliefs so as to not have
them expecting permanent healing.

Lesson 3.


Most people are eligible for the relaxation and health benefits of massage
therapy. However, there are times when a massage may not be the right choice. Certain
conditions contraindicate massage, either because of the risk it may pose to the client
or the risk to the therapist.
Since massage is based on skin-to-skin touch, massage may also be
contraindicated if the client has a rash or infectious skin condition. If the skin condition is
infectious, it could spread to the therapist and, in turn, to other clients. Even if a skin
condition is not contagious, massage can make some skin irritations even worse.
Intoxicated Patient
Another occasion when a massage should be postponed is if the client is
intoxicated. Many folks seek out massage while on vacation or under stress. They may
have also had a few cocktails to relax as well. "Intoxication is a risk during massage,"
said Dr. Coe, "primarily because it desensitizes the client. This makes it hard for the
client to give reliable feedback. A massage therapist needs to know what level of
pressure is comfortable and what is too much. With intoxication, those sensations are
Challenging Behavior of Clients
The first step in keeping your cool when a client proves to be a challenge, is to
own your contribution to the problem. As outlined by the universally understood Law of
Attraction, like begets like. When viewed within the framework of a difficult client, this
translates to a therapists own negativity has the potential to bring people into their
practice with energy to match.
Whether a therapist believes that he or she has or has not contributed to
attracting or perceiving a challenging personality into his or her practice, there are
several steps to make the session more pleasant. Depending on the situation, the
following suggestions may or may not be appropriate:
Seek Positive Traits Look for a great quality in your client and focus on that.
De-stress Release any stress you may be holding before seeing clients to clear
away your negative energy.
Create Boundaries If your client pushes limits or is disrespectful, assertively
define appropriate behavior within your practice.
Refer Out If the stress associated with a specific client cannot be overcome,
remember your prerogative to refer elsewhere.
Lesson 4:

Code of Ethics

Code of Ethics for Massage Therapists

Ethics and professionalism are the corner stones for a successful massage
practice. The massage therapy profession follows a set of guiding principle based on
the right and wrong. The fundamental ethical principle for massage therapy is client
centered care, which focus on the attitudes, decisions and activities on whatever is best
for the clients health and well being.
General Responsibilities
The services rendered by Massage Therapists are universal and unrestricted by
considerations of nationality, race, creed, color, politics or social status. The
professional relationship of Massage Therapists towards various industry stakeholders
are characterized as follows:
Duties toward the client The clients health and wellbeing are the paramount
of the Massage Therapists.
Duties toward the profession The Massage Therapist shall strive for
excellence and advance the moral reputation of the profession by conducting
himself/herself with honor and dignity.
Duties toward co-practitioners The Massage Therapist shall foster
fellowship, mutual assistance, and professional respect among co-practitioners.
Duties toward employers The Massage Therapist shall be fair, honest, and
loyal in dealings with employers.
Duties toward allied professionals The Massage Therapist shall respect the
dignity, competence, and the scope of services of allied professionals, working
harmoniously with them for the good of the community.
Duties toward the general public The Massage Therapist shall obey the laws
of the land and all laws governing the practice of the profession, as enforced by the duly
constituted authority.
* For more information about the code of ethics for Massage Therapists (CEMT
Resolution No. 2010-001), visit the Department of Health website (
Lesson 1:

Body Regions

Basic Anatomy and Physiology

Knowledge on anatomy and physiology is important to be an effective massage

therapist. As the massage therapist begins to study anatomy and physiology, the
massage therapist becomes more aware and conscious in implementing massage plan
that will benefit the client.
Anatomy is the branch of science concerned with the bodily structure of humans,
animals, and other living organisms, especially as revealed by dissection and the
separation of parts.
Physiology is the branch of biology that deals with the normal functions of living
organisms and their parts.
The study of anatomy and physiology is inseparable because as one study the
structure of the body it is important to also know how the particular structure functions.

Body Regions
The human body is bilaterally symmetrical. It has the right and left halves. Most
of the body parts are found in pairs, one in each half of the body.
1. Head and Neck - The head contains the core elements of the nervous system. The
head is held upright by the muscles and bones of the neck.
2. Trunk - The trunk or torso is the main part of the body, to which the head and limbs
are attached. The trunk has two sections: the thorax (upper part) and the abdomen
(lower part)
3. Upper Extremities - The upper extremities is divided into three regions: the arm,
forearm and hand.
4. Lower Extremities - The human leg is the entire lower extremity or limb of the
human body, including the foot and thigh.

Lesson 2:

Body Positions

Body Positions
Before clients get on the massage table, the massage therapist must be familiar
with the different body positions that the clients can use.
1. Supine - a position where the client is lying on the back, or spine with face up. When
the clients are in supine position the massage therapist has access to the anterior
surface of their body.
2. Prone - a position where the client is lying face down on the massage table. When
the clients are in this position the massage therapist has unrestricted access to the
client's back.
3. Side Lying - a position of the body lying on one side, usually with the knees slightly

Lesson 3:

Major Organ Systems

Skeletal System
The Skeletal system is all of the bones in the body and the tissues such as
tendons, ligaments and cartilage that connect them. The skeleton gives the body its
basic framework, providing structure, protection, and movement.
The cartilage is a flexible connective tissue that links the ribs to the sternum,
forms the framework of the ear and nose, and covers the ends of bones inside the
joints. Ligaments are strong strips of fibrous connective tissue that hold bones together
at joints, thereby stabilizing the skeleton during movement.
Major bones and bone groups of the body
Bones of the Head

Skull This is the cranium, the bony framework of the head composed of the
cranial and facial bones plus the maxilla and mandible (upper and lower jaws).
The skull houses and protects the brain.
Vertebral column
o Vertebrae are any of the 33 bones of the vertebral column, comprising of 7
cervical, 12 thoracic, 5 lumbar, sacral, and coccygeal vertebrae. The sacral and
coccygeal vertebrae are fused into single units. The spinal cord passes through
and is protected by the vertebrae.
Thoracic Cage
o Ribs Twelve pairs of narrow curved bones that extend from the vertebrae to
the sternum. The upper seven enclose the thoracic or chest cavity and protect
the heart and lungs. The lower five enclose part of the abdominal cavity.
o Sternum It is found on the midline of the anterior chest wall. It extends from the
throat down to the upper abdominal area. The anterior end of each rib is attached
to the sternum.
Pectoral Girdle
o Clavicle This is the elongated, slender curved bones of the anterior shoulder
known as collarbone. It extends laterally from the top of the sternum to the
scapula. The connection of the sternum and the clavicle is an important landmark
in locating the internal carotid artery.
o Scapula The shoulder blade provides for attachment of the clavicle (collar
bone) and the humerus (upper arm bone). The blade portion extends downward
over the dorsal surface of the rib cage.
o Humerus This is the long bone of the upper arm.
Upper Extremities
o Radius The shorter and the lateral two bones of the forearm. It attaches on the
thumb side of the wrist.
o Ulna The medical and longer bone of the forearm. It attaches on the little finger
side of the wrist.
o Carpals are bones found in the hand. They are also called wrist bones as they
are in the wrist.
o Metacarpals The five long bones of the hand. They are slightly concave on the
palmar surface.
o Pelvic Girdle Three pairs of bones: the ilium, ischium and pubis, fuse to form
the pelvic girdle. It attaches to the lower spine, provides support to the internal
organs and has sockets where the upper legs bones (femur) are attached.
Lower Extremities
o Femur The longest, strongest, and heaviest bone of the body located in the
thigh area.
o Fibula The lateral and smaller two bones of the lower leg.
o Patella The kneecap
o Tibia The medical and larger two bones of the lower leg.
o Tarsals The bones in the ankle.
o Metatarsals The five long bones of the foot that are concave on the plantar or
the lower surface.

Phalanges The bones of the toes and fingers.

Muscular System
The muscular system is the series of muscles throughout the body that moves
the skeleton, maintains posture through steady contraction, and generates heat through
cell metabolism.
Types of Muscle
Skeletal Muscle- These are voluntary muscles that are attached to the bones of the
Smooth muscle These are involuntary muscles that are found in hollow organs
like small intestines and blood vessels.
Cardiac muscle Is a type of involuntary muscle that can be found in the heart.
Skeletal Muscle Distribution with Corresponding Contents
Upper Extremities
o Arm deltoid, biceps, triceps
o Forearm brachioradialis, pronator, supinator
o Fingers thenar muscles, hypothenar
Lower extremities
o Upper leg rectus femoris, quadriceps, hamstrings
o Lower leg gastrocnemius muscle, tibialis anterior


Upper back trapezius, erectors spinae

Lower back gluteals (buttocks)

Integumentary System
The skin is the largest organ of the body. As a physical barrier, skin stops water
from leaking out of or into tissues; prevents the entry of bacteria and other diseasecausing microorganisms, filters out the harmful and potentially carcinogenic ultraviolet
(UV) radiation in sunlight; repairs itself if cut or torn. Skin also helps maintain the bodys
temperature at a constant 37 oC (98.6 oF); and contains a range of sensory receptors.
Skin layers and components
Epidermis It is the upper layer of the skin. It consists of keratin and melanin.
Dermis It is the lower, thicker part of the skin. It consists of blood vessels, sensory
nerve endings and receptors, sebaceous glands, adipose cells, and tiny veins and

Circulatory System
The circulatory or cardiovascular system consists of the blood vessels and the
blood that is pumped along them by the heart. It plays a vital role in maintaining
homeostasis by controlling the concentration and composition of tissue fluid, by
supplying cells with essential materials and moving their wastes, by helping to keep the
body warm, and by protecting the body against attack by pathogens.
Circulatory system organs, structure and functions
o Red blood cells transport oxygen through hemoglobin.
o White blood cells antibodies that deals with foreign materials like disease
o Platelets blood clotting.
o Plasma and plasma proteins carries foods and wastes from tissues.
Blood vessels
o Arteries carries blood away from the heart.
o Capillaries exchange of materials between blood and tissue cells.
o Veins carries blood towards the heart.
o Arch of the aorta carries oxygenated blood to the rest of the body.
o Abdominal aorta and thoracic aorta supplies blood to the abdominal and
thoracic area.
o Inferior and superior vena cava carries deoxygenated blood from the rest of
the body

Digestive System
The digestive system is responsible for digestion and absorption of food and
water and for the elimination of solid wastes. Food contains nutrients essential for
normal cell function, growth and repair, therefore to keep the body alive. Digestion is the
breaking down of complex nutrients into simple substances that can be absorbed by the
Digestive system division and functions.
Alimentary Canal
o Mouth Used in chewing and breaking down of food.
o Pharynx Swallowing mechanism of food.
o Esophagus It serves as a passage of food.
o Stomach It is where digestion takes place.
o Small intestine It is where absorption takes place.
o Large intestine It is where food is further processed and ends up as feces.
o Anus It serves as exit of waste products.
Accessory Digestive Organs
o Liver It detoxifies drugs and alcohol.
o Gall bladder It serves as reservoir of bile.
o Pancreas It produces the digestive enzyme.

Urinary System
The two kidneys play a vital role in homeostasis by processing the blood to
produce a waste fluid about 1 ml per minute called urine that is expelled from the body.
Functions of the kidneys
Excretion of unwanted and potentially poisonous metabolic wastes produced by
Regulation or removal of excess water and salts (such as sodium and potassium
salts) in order to maintain constant levels of water and salts in the blood and other
body fluids.
Urinary system organs and functions
Kidney site of urine production.
Ureter connects kidney to urinary bladder.
Urinary bladder- serves as storage of urine.
Urethra passage through which urine is discharged outside the body.

Respiratory System
The respiratory system takes air into the body and supply the blood with oxygen
in order for the blood to deliver oxygen to all parts of the body.
Respiration is achieved through the mouth, nose, trachea, lungs, and diaphragm.
Oxygen enters the respiratory system through the mouth and the nose. The oxygen
then passes through the larynx and the trachea which is a tube that enters the chest
Respiratory system structure, organ and functions
Upper Respiratory tract
o Nose where air passes and organ of smell.
o Pharynx serves both digestive and respiratory system.
Lower respiratory tract
o Trachea wind pipe; transport air to and from lungs.
o Bronchi, bronchioles where the air entering the lungs are sent to each lung.

Lung transport air to alveoli for gas exchange.

o Diaphragm muscular partition that separates abdominal and thoracic cavities

Physiology of Respiration
Inspiration (inhalation) the process of taking air into the lungs
Expiration (exhalation) the process of letting air out of the lungs.

Nervous System
The nervous system is the major controlling, regulatory, and communicating system
in the body. It receives information from both outside and inside the body, gathered by
sensors such as the eyes and proprioceptors then sends out instruction to effectors such as
muscles and glands to make the body react. It enables a person to think, create, remember,
and feel. It is also responsible for regulation of internal events such as heart rate and body

Two main parts of the Nervous system

Central nervous system (CNS)
o Brain
o Spinal cord
Peripheral Nervous system (PNS)
o Somatic System
o Autonomic system

Endocrine System
The endocrine system releases chemicals known as hormones that are carried
by the blood and regulate metabolic activities of cells thereby controlling processes
such as growth, metabolism, and reproduction.
Endocrine system organs and functions
Pituitary gland It is the master gland that regulates metabolism, growth, sexual
development and immune response.
Thyroid gland Influences the rate of body metabolism.
Parathyroid gland The parathyroid gland regulates calcium levels.
Thymus Stimulates the immune system.
Pancreas Secretes insulin when carbohydrates are being digested.
Adrenal gland Produces hormones that balance electrolytes and water in the
Ovary Female organ which produce female sex hormones and ova.
Testes Male organ which produce male sex hormones and spermatozoa.

Lymphatic System
The lymph system is a network of organs, lymph nodes, lymph ducts, and lymph
vessels that make and move lymph from tissues to the bloodstream.
Lymphatic system organs and functions
Lymph nodes Stores lymphocytes or white blood cells.
Spleen Removes worn out red cells, bacteria and cell fragments from the blood
Thymus Generates t-cells lymphocytes
Tonsils Provides protection against pathogens that enters the body.


Lesson 1:


Basic Pathology and Microbiology

Pathology is a branch of medical science primarily concerning the examination of
organs, tissues, and bodily fluids in order to make a diagnosis of disease.
Microbiology is the study of microorganisms, which are microscopic, unicellular,
and cell-cluster organisms.
Physiology is the branch of biology that deals with the normal functions of living
organisms and their parts.
As massage therapist you may encounter clients that have disorders, under
medical treatment, or who are taking medications. Therapist needs information
regarding these conditions to safely conduct massage sessions in these situations.
Various microorganisms are always present and could easily be transmitted that
could cause diseases. It is therefore important that the massage therapist study
Microbiology and Pathology to prevent transmission of disease from client to massage
therapist and vice versa.
Basic Terminologies
Disease This refers to a condition of illness that impairs bodily functions,
associated with specific signs and symptoms.
Carrier An individual who is host to a pathogenic microorganism and who has the
potential to transmit the pathogen to others.
Communicable disease An infectious disease transmissible by direct contact with
an affected individual or the individual's discharges or by indirect means.

Contagious disease - An infectious disease communicable by contact with one who

has it, with a bodily discharge of such a patient, or with an object touched by such a
patient or by bodily discharges.
Microbe A microorganism that is able to carry on living process and may or may
not cause disease.
Pathogen A microorganism or parasite that can cause disease.
Endemic A disease that exists permanently in a particular region or population.
Epidemic An outbreak of disease that attacks many people at about the same
time and may spread through one or several communities.
Pandemic When an epidemic spreads throughout the world.

Common Microorganisms
Small one-celled microorganisms of the class Schizomycetes.
Some are round (cocci), rod-shaped (cacilli), spiral (spirochetes), or comma-shaped
A virus is a small infectious agent that replicates only inside the living cells of other
More than 200 viruses have been found to cause disease in humans.
Some kinds of viruses are adenovirus, arenavirus, enterovirus, herpesvirus, and
Self-limiting, hence development of resistance is the only treatment without further
A simple parasitic plant that lacks chlorophyll.
It is unable to make its own food and depends on other life forms.
A simple fungus reproduces by budding. Many-celled fungi reproduce by making

Single-celled, tiny living things that are the lowest form of animal life.
About 30 kinds of protozoa cause diseases in humans-protozoal, protozoan.
An organism living in or, obtaining nourishment from another organism.
A facultative parasite may live on another organism but is cable of living
An obligate parasite is one that depends entirely on another organism.

Infection Process

Infection is an invasion to the body tissue by pathogenic microorganisms,

resulting in signs and symptoms as well as an immunologic response. The patients
immune response may compound the tissue damage; such damage maybe localized or

Signs and Symptoms of Inflammation

The body reacts to microbial invasion by producing inflammatory response. The
inflammatory response is controlled by chemical, cellular and vascular functions that
have the ability to adjust that response to the severity of the threat. Other manifestations
include fever, malaise, nausea, vomiting and purulent discharge from wound.
The signs and symptoms of inflammation are the following:
Redness (rubor)
Swelling (tumor)
Heat (calor)
Pain (dolor)
Loss of function (function laesa)
Lesson 2:

Pathology Relevant to Practice of Massage Therapy

Pathology Relevant to practice of Massage Therapy

Musculoskeletal System



Dislocations Dislocation are

traumatic injuries to
joints in which the
articulating bones are
forcefully separated.

Is massage indicated or

How is it recognized?
Acute dislocations are
extremely painful. The
bones may be visibly
separated and a total loss of
function occurs at the joint.

Massage is indicated in the subacute stage for dislocations, as

long as work is conducted within
pain tolerance.


Fatigue is a state of
less than optimal
performance because
the body has had
inadequate rest and
recovery time.

A person suffering from

mental or physical fatigue
feels tired, moves
inefficiently and may be
more prone to injury.

In the absence of other

contraindicated conditions,
massage is systemically indicated
for fatigue.


A fracture is any kind

of broken or cracked

Most fractures are painful

and involve loss of function
at the nearest joints, but
some may be difficult to
diagnose without an X-ray.

Massage is locally contraindicated

for acute fractures, but work done
on the rest of the body can yield
reflexive benefits. Massage is
indicated for people in later stages
of recovery from fractures.


Sprains are injured


In the acute stage,

symptoms include pain,
redness, heat, swelling and
loss of joint function. In the
sub-acute stage these
symptoms will be abated,
although not entirely absent.

Massage is indicated for subacute sprains. It can influence the

healthy development of scar
tissue and reduced swelling.


Strains are injured


Pain, stiffness and

Massage is indicated for muscle
occasionally palpable heat
strains, to influence the production
and swelling will be present. of useful scar tissue, reduce
adhesions and edema and
reestablish range of motion.

Pathology Relevant to practice of Massage Therapy

Integumentary System

Acne is a bacterial
infection of sebaceous
glands usually found on
the face, neck and upper

How is it recognized?
It looks like raised inflamed
pustules on the skin, sometimes
with white or black tips.

Is massage indicated or
Massage is locally
contraindicated fro acne
because of the risk of
spreading infection.


Burns are caused by

damage to the skin that
causes the cells to die. It
can be caused by fire,
overexposure to the sun
and extreme cold.

These include injury to the
wounds skin that has not healed
and sores and vulnerable to infection
if exposed to bacteria or
other microorganism.

First-degree burn involves mild

inflammation. Second-degree
burns include blistering and
damage at deeper levels of the
epidermis. Third degree burns
penetrate the dermis itself and will
often show white or black charred

Massage is locally
contraindicated for all
burns in the acute stage.

A crust of scab appears at the site

of the injury.

Massage is locally
contraindicated for any
unhealed skin injury with
which bleeding has

Scar tissue is the growth of Scar tissue on the skin often lacks
new tissue, skin or fascia
pigmentation and hair follicles.
after injury.

Massage is locally
contraindicated during
the acute stage of any
injury in which the skin
has been damaged.

Pathology Relevant to practice of Massage Therapy

Circulatory System
Heart Attack

A heart attack or
myocardial infraction
(MI) is damage to the
myocardium caused by
a clot or plague
fragment getting lodge
somewhere in a
coronary artery,
depriving the cardiac
muscle of oxygen.

Hypertension Hypertension is the

technical term for high
blood pressure.

How is it recognized?

Is massage indicated or

Symptoms of heart
attacks include angina,
shortness of breath,
feeling of grate pressure
on the chest, pain around
the left shoulder, arm, jaw
and back.

Massage is contraindicated for

patients recovering from heart
attacks. After complete recovery,
heart attack patients may be good
candidates for massage but not
without medical clearance.

High blood pressure has

no dependable
symptoms. The only way
to identify it is by taking
several blood pressure
measurements over time.

For mild high blood pressure,

massage may be useful to control
stress. High blood pressure
requires medication usually
contraindicates circulatory
massage, but some
circumstances, massage may be
appropriate with a doctors


Varicose veins are

distended veins, usually
in the legs, caused by
valvular in competence
and a backup of blood
returning to the heart.

Varicose veins are ropey,

slightly bluish, elevated
veins that twists and turn
out of their usual course.

Massage is locally contraindicated

for extreme varicose veins and
anywhere distal to them. Mild
varicose veins contraindicate
deep, specific work, but are
otherwise safe for massage.


A hematoma is a deep
bruise (leakage of
blood) between muscle

Superficial hematomas
are simple bruises. Deep
bleeds may not be
visible, but they will be
painful and if extensive
bleeding is present, the
affected tissue will have a
gel-like feel

Massage is locally contraindicated

for acute hematomas because of
the possibility of blood clots and
pain. In the sub acute stage,
when the surrounding blood
vessels have been sealed shut
and the body is in the process of
breaking down and reabsorbing
the debris, gentle massage within
pain tolerance around the
perimeter of the area and
hydrotherapy can be helpful.

Pathology Relevant to practice of Massage Therapy

Nervous System
Is massage indicated or



How is it recognized?


Headaches are pain caused

by any number of sources.
Muscular tension is the
most common source of
pain; congestive headaches
are less common and
headaches due to serious
underlying pathology are the
rarest of all.

Tension headaches may be

bilateral and general painful.
Vascular headaches are often
unilateral and have distinctive
throbbing pain from blood
flow into the head. Headaches
brought about by central
nervous system disease are
extreme, severe and

Massage is systematically
contraindicated for
headache due to infection
or CNS disturbance.
Massage is indicated for
tension headaches.


Insomnia is the inability to

attain adequate amounts of

Signs of insomnia include

general fatigue, reduced
mental capacity and slow
healing processes.

Massage is systematically
indicated for insomnia.

Disorder /

Seizure disorders are

usually caused by
neurological damage,

Seizure disorders are

diagnosed through CT scans
and MRI, seizure may take

Massage is
contraindicated during
seizures, but is indicated

although it may be
impossible to delineate
exactly what the damage is.
Epilepsy is one type of
seizure disorder.

very different forms for different at all times.

people, and they range from
barely noticeable to life

Pathology Relevant to practice of Massage Therapy

Endocrine System


How is it recognized?

Is massage indicated or


Is a group of metabolic
disorders characterized by
glucose intolerance or
deficiency and disturbances in
carbohydrate, fat and protein

Early symptoms of diabetes

include frequent urination,
thirstiness, and increased
appetite along with weight
loss, nausea and vomiting.

Massage is indicated for

people with diabetes as long
as their tissue is healthy and
they receive medical

Pathology Relevant to practice of Massage Therapy

Excretory System
Is massage indicated or



How is it recognized?


A kidney stone is a
deposit of crystalline
substances inside
the kidney or the

Small stones may show no

symptoms at all, but larger stones
can cause extreme pain that may
be accompanied by nausea and

Massage is contraindicated for

someone experiencing renal
colic (a kidney stone attack)
although it is appropriate for
people with a history of stones,
but no current symptoms.


An infection of the
urinary tract, usually
by bacteria that live
normally and
harmlessly in the
digestive tract.

Symptoms of the UTI include pain

and burning sensations during
urination. In the acute stage fever
and general malaise may also be

Circulatory massage is
systematically contraindicated
for both acute and chronic renal

Renal failure is a
situation in which
the kidneys are
incapable of
functioning at
normal levels.

Symptoms of acute and chronic

renal failure differ in severity and
type of onset, but they have in
common reduced urine output,
systemic edema and changes in
mental state brought about by the

Massage is systematically
contraindicated for both acute
and chronic renal failure.


accumulation of toxins in the

Lesson 1:

Massage Flow

Massage Therapy Flow

The massage therapy process are divided into three phases:
1. Pre-massage This consists of two main actives conducted prior to massage
a. Client Assessment The therapist interviews the client in order to understand
the clients needs and requests. This includes the identification of
contraindications, taking the clients vital signs, and formulating a massage plan.
Results of the assessment are recorded in the S.O.A.P form.
b. Preparation The therapist prepares the venue and paraphernalia for massage
while the client prepares for the massage.
2. Massage Proper This is the application of massage techniques, in accordance
with the previously formulated massage plan.
3. Post-massage This consist of two main activities conducted after the massage
a. Aftercare Means providing assistance to the client after the massage proper.
b. Documentation Final completion of the S.O.A.P form, and the therapists
recommendation for future sessions.

Lesson 2:


Pre-massage: Client Assessment

Client Intake Form
Before conducting an interview, prepare the client intake form with the following
Clients Information
Date of Initial Visit

Additional information that will be used to help plan safe and effective massage
Medical History
Signature of the client and date accomplished
Signature of Massage Therapist and date accomplished

After greeting the client, escort him/her to a quiet area with adequate lighting for
reading and writing.
The location of the interview is important to establish productive exchange of
information between the client and attendant. This is achieved by the atmosphere of
warmth, safety and comfort.
Wait till the client is seated and in comfortable position before asking questions.
The condition and age of the client should always be considered such as:
Healthy client does not need a lengthy interview. It should be a maximum of 4
Client who undergone surgery should undergo careful and focus evaluation.
The interview should be thorough and fast. It should be a maximum of 10 minutes.
Write the clients answers in the client intake form. Ask the client to sign the form
and the date accomplished. Then sign the form and the date accomplished

Pre-massage: Client Assessment

Subjective, Objective, Assessment and Plan (SOAP) is a method of
documentation used by massage therapists to write out notes in a clients chart.
The SOAP Form must contain the client information and the four components.
The Therapist should always sign the form and the date accomplished.
Four components of SOAP form:
1. S (SUBJECTIVE) - It is the clients report of how he or she has been doing since the
last visit. Should indicate the clients complaints, if any. It includes the following
o Symptoms (clients complaints):
o Location
o Intensity
o Frequency
o Duration
o Onset
2. O (OBJECTIVE) - The objective component is straightforward and includes the

Vital Signs
Range of Motion
3. A (ASSESSMENT) - The therapist gathers the information from the Subjective and
Objective Information. The long term and short term goals should also be indicated.
4. P (PLAN) - This includes what type of treatment will be given such as:
o Future Treatment
o Frequency

Pre-massage: Client Assessment

Vital Signs
A massage therapist must conduct assessment before recommending what type
of therapeutic massage service to be conducted. All the information gathered during the
physical assessment is written in the SOAP form.
To observe the general condition of the client.
To serve as a guide in meeting the needs of the client.
To aid the massage therapist in planning the clients massage program.
To prevent possible injury and complication to the client.
Blood Pressure
The following are the steps on how to get the blood pressure of the client:
1. Gather the necessary equipment.
2. Position the client comfortably on chair with arms rested alongside his body.
3. Look for clients radial artery and palpate for the palpatory pulse.
4. Position the cuff two inches above the antecubital fossa. Inflating bladder directly
over brachial artery ensures that proper pressure is applied during inflation.
5. Position the sphygmomanometer so that the measuring scan is turned away from
the clients line of vision and the mercury column vertical.
6. Place the stethoscope disc over the brachial artery to ensure good amplification of
sounds for accurate reading. Each earpiece should follow angle of ear canal to
facilitate hearing.
7. With the stethoscope in position, inflate the cuff until the mercury rises to
approximately 20 30 mm. above the anticipated systolic pressure.
8. Release the air in the cuff slowly while noting the reading on the manometer.
9. Note the first clear and strong sound as the systolic reading and the last audible
sound as the diastolic reading.
Respiratory Rate
The following are the steps on how to get the respiratory rate of the client:
1. Note the rise and fall of the patients chest with each inspiration and expiration.
Observation can be made without disturbing the clients bed clothes.

2. Using a watch with a second hand count the number of respiration for one minute. If
the respiration is abnormal repeat the count in order to determine accurately the rate
and characteristics.
Pulse Rate
The following are the steps on how to get the pulse rate of the client:
1. Press clients wrist with the thumb at the back of the wrist and the first two fingers
over the radial artery with moderate pressure.
2. Count for the number of pulsation for one full minute.
3. Observe for the rise and fall of the clients chest while fingers are still on the clients
radial artery after counting the pulse rate.
4. Inform the client about the results and its significance.
The following are the steps on how to get the temperature of the client:
1. Clean the thermometer with antiseptic solution, from the valve towards the stem in a
circular motion.
2. Turn on the digital thermometer.
3. Place the thermometer to the client's axilla.
4. Hold the thermometer in place in 2 to 3 minutes or until you hear the beep sound.
5. Remove the thermometer from client's axilla and note the reading.
6. Inform the client about the results and its significance.
7. Disinfect the thermometer with an antiseptic solution from the stem going towards
the valve in a circular motion.

Pre-massage: Client Assessment

Visual Assessment
Visual assessment is done to evaluate conditions / abnormalities of the area.
To provide information regarding the conditions of the soft tissues of any variations
of skin color.
To observe the differences in bilateral symmetry of tissues.
To check for any kind of marks or wound on the skin.


The following are the steps on how to conduct visual assessment:

Identify the differences in color (areas of redness or paleness)
Identify the marks, bruises, moles, wounds and scars
Identify the symmetry of soft tissues
Write all findings in SOAP form

Pre-massage: Client Assessment


Palpation assessment is done to evaluate different temperature, textures and

movement of the soft tissues.
Locate the target muscle that is being palpated and assess its health by feeling for
its tone and texture.
Possible problem that may be encountered:
Fever - Clients with fever should deny massage
Inflammatory - Need to know how long the pain and discomfort have been present.
An acute injury that has existed less than 72 hours is local contraindications to
massage but general massage will help the rest of the body relax.


The following are the steps on how to conduct palpation:

Place the client in a comfortable position.
Expose & Palpate the affected area.
Note for any changes in skin temperature.
Look for any soft tissue restricted fascia, trigger points and tissue ederma / swelling.
Note for skin flexibility / movement.
Write all findings in SOAP form.

Pre-massage: Client Assessment

Sensory Assessment
Sensory assessment is done to evaluate the severity of pain.
To gather information regarding the conditions, and pain tolerance of the client.
To assess the clients pain through a pain scale.
Possible problem that may be encountered:
Unidentifiable pain - Refer to the healthcare professionals
Uncooperative client - Refer to the healthcare professionals
Acute pain - Cold Compress
Chronic pain - Hot compress, contrast bath, massage


The following are the steps on how to conduct sensory assessment:

Place the client in a comfortable position
Ask the affected area.
Ask if the condition is acute or chronic.
Ask if the pattern of pain are constant, intermittent or others.
Ask if what causes the pain to increase.
Observe if the pain occurs upon movement or in resting position.
Ask the intensity of pain 0 to 10 scale.
o 0 no pain
o 2-3 mild pain

4-5 moderate pain

6-7 severe pain
8-9 maximum pain
10 seek healthcare professionals
8. Write all findings in SOAP form.

Pre-massage: Client Assessment

Range of Motion
To gather information regarding the conditions, and pain tolerance of the client.
To assess the clients pain through a pain scale.
Active Range of Motion Limb is actively moved; with no muscle contraction.
Passive Range of Motion Lim is passively move with the help of massage
therapist; no muscle contraction.
1. Assess only the affected area / joints.
2. Place the client in a comfortable position
3. Let the client move (active) or help the client move (passive) the affected area.
4. Note for any restriction in movement.
5. Write all the findings in SOAP form
Lesson 3:

Basic Strokes

Basic Stroke: Effleurage

The term Effleurage comes from the French word effleurer, which means to flow
or glide. The application of unbroken gliding movement that are repeated and followed
the contour of the clients body. These movements maybe linear or circular. The stroke
maybe applied by the therapist hands using palms, fists, thumbs, fingertips or forearms.
The pressure maybe superficial (gentle) or deep.
It is used to introduce touch and for applying lubricant and excellent for
assessing and exploring surface and underlying tissues. It is also the stroke used to
begin and end a massage because it is so proficient at moving blood and lymph. It can
be used to prepare tissue for deeper massage and to flush out the tissue after using
other strokes and on virtually every type of body surface, making it the preferred
transition stroke to use between other strokes.
Purposes / Benefits:
Warm bodily tissues, making them more extensible.

Relax the client and prepare an area for deeper strokes.

Soothe an area after deep work.
Soothe places too painful for deep work.
Calm the nervous system when done slowly.
Stimulate the nervous system when done quickly.
Aid in the moving of wastes out of congested areas (also known as flushing).
Create length in a muscle, if applied with fiber direction.
Increase blood and lymph circulation.
Soothe tired, achy muscles.
Relieve insomnia.

Techniques/ Variations
One-Handed - This variation implies that one hand or one thumb is used to apply
gliding pressure and is used for small areas such as in between the metacarpals or
o Raking To use the raking technique, the fingers should be together or apart
moving in one direction. The purpose of this is to check the proper alignment.
o Ironing (using forearms / knuckles) A deep one-handed effleurage often done
with the forearm, knuckle, fist or palm of the hand. The deeper the glide the
slower the move. This technique calms the nervous system when done slowly.
o Circular It can be performed around the shoulder, hip, knee and abdomen. It
relaxes the client and prepares an area for deeper stroke.

Two-Handed - This variation works well up or down the back in a heart shape or
heart effleurage, up the leg, or up the arm.
o Heart Performed up and down for the back in a heart shape up the leg or up
the arm. It increases blood and lymph circulation and relaxes the client.
o Circular One hand may be placed next to or on top of the other hand. This
technique relieves insomnia.

Alternate hand - To perform alternate hand effleurage, glide on hand or thumb

across the skin, lifting it up as the other hand or thumb follows behind in succession.
The sequence resembles a paddlewheel.
o Raking The index and middle finger forming the letter V may be placed on
either side of the spine. It is used to move from one side of the table to the other
without losing contact with the client.
o Circular/ Sun Moon It can be performed as one-hand circles a region and the
other hand move behind the first hand in a half circle or a crescent shape.

Nerve stroke - It is considered as light effleurage, feather-light like finger tracing

over the skin used as a finishing stroke in massage therapy and is typically done at
the end of massaging a body segment and at the completion of the massage.
Avoid pressure that is too light because it may be perceived as ticklish or
produce goose bumps.
The direction of nerve stroke is superior to inferior or proximal to distal
because downward movements are more relaxing.

Basic Stroke: Petrissage / Kneading

It comes from the French word petrir meaning to mash or to knead. It typically
follows effleurage strokes. It consists of cycle of rhythmic lifting, squeezing, and
releasing of tissue.
It is the stroke of choice to milk the tissue of metabolic wastes and draw new
blood and oxygen into the tissues. It stretches and broadens the tissue. Grasp the skin
or muscle with the hand in a C formation. Lift up the skin and the underlying muscle
tissue and firmly knead, wring, or squeeze. Focus is on lifting the tissue and moving it
vertically or horizontally rather than just pinching it. The pressure should be applied in a
rhythmic circular pattern to achieve alternate compression and relaxation of the muscle.
Purposes / Benefits:
Increasing blood flow.
Working out metabolic wastes.
Reducing local swelling.
Relieving general fatigue.
Improving cellular nutrition.
Mechanically relaxes and lengthens the muscle.
Addressing tension under the surface.
Reducing muscle soreness and stiffness.
Stimulating the nervous system.
Softening superficial fascia.
Producing analgesia by stimulating the release of pain-relieving substances such as
Techniques/ Variations
One-Handed - The entire hand or the pads of the fingers and thumb can be used to
lift the tissue. This variation is well suited for smaller muscular areas, such as the
arms, top of the trapezius, or the arms and legs of a child. Both hands are lifting,
compressing, and releasing the tissue simultaneously. It is often used to address
larger muscular areas such as the back.

Two-Handed - The technique used for this is the same as one-handed petrissage
except both hands are lifting, compressing, and releasing the tissue simultaneously.

o Praying hands Fingers are interlaced in a praying hand position. It helps
maintain proper position.
o Ocean Waves Use a back and forth movement while the hand opposes each
other, lifting the sides and pressing down while on top. It is typically applied
across a larger muscular area or horizontally down the back.

Alternate hand - Lift the skin and underlying tissue with one hand and compress.
Next is lightens the grip enough to allow the muscle tissue to be released while still
remaining in contact with the skin. Repeat the first move with the opposite hand. Do
not lose contact with the skin while switching hands. It is done to stimulate the
nervous system and improve cellular nutrition

Fulling - Grasp the tissue with both hands; lift it up and away from the bone while
spreading it out laterally. Repeat the movements until the tissues feel warm and
elastic. It is effective for broadening muscles and their related tissues and mimics
the movement of a muscle when it contracts (broadening).

Skin rolling - Involves lifting and compressing the skin and superficial fascia. It is
the technique essential to Bindegewebsmassage (connective tissue massage) and
myofascial release. It is one of the few massage techniques that may be applied
over bony areas. Grasp and lift the skin between the fingers and thumbs
compressing the tissue. Roll the skin as though youre rolling a pencil using your
fingers to scoop up the skin as you move across the area.

Basic Stroke: Friction / Rubbing

Friction comes from the Latin word friction, meaning to rub. It typically follows
petrissage in the sequential order of massage strokes. It is performed by compressing
tissues in several directions and typically done dry, using little or no lubricant. It is often
used for areas that have little or no blood supply, such as ligament and tendons. It is
also used to address large areas such as the back or the arm.
The stroke is well suited for areas that lack muscle bulk such as the ankle, the
sides of the head, or the suboccipital region. It may be applied with the palm of one or
two hands, or specific work may be done with the tip of the thumb, fingers, or elbow. It is
delivered superficially by sliding the therapists hands, palms, finger, or knuckles back
and forth over the clients skin or to deeper tissue layers.
Purposes / Benefits:
Generating heat.
Dilating the capillaries.
Increasing circulation.
Promoting venous blood flow.
Loosening stiffness in joints.
Relaxes muscles.

Improving the glandular action of the skin.

Promoting proper scar formation by reorganizing collagen, creating a more
biofunctional pattern.
Breaking down and freeing adhesions.
Mimicking muscle broadening and stretching that occurs in normal muscle
Reducing trigger and tender point formation/activity.

Techniques/ Variations
Superficial Warming - Also known as Heat Rub. It generates heat by creating
resistance to motion. Place both hands palm down on the client skin. The fingers of
each hand should be together firmly. Move the hands briskly and simultaneously in
opposite directions, one hand moving towards you and the other moving away from
you. The hands should pass each other in mid stroke and continue to alternate.
Begin to pick up speed to build resistance. The muscles of the shoulder and upper
arm are used to propel the hands, reducing the stress on the therapists hands. May
also be done with a towel, rubbing it quickly on the clients skin.
o Sawing Fingertips, knuckles, or ulnar surface of one or both hands may be
used if the surface area treated is small. Compress the tissue firmly with open
palms and extended fingers of both hands. It is best suited for the extremities.

Rolling - Roll the skin, muscle, and surrounding tissues around the bone, moving
both hands in opposite directions. As you roll the tissue around extremity, use a
back and forth movements while you compress the tissue and slide your hands from
distal to proximal.

Wringing - While compressing the lubricated tissue on all sides with palmar
surfaces of the hands and fingers, move the hands in opposing directions. Slide the
hands toward the trunk of the body during the massage movement (distal to
proximal). Wringing friction is performed vigorously, like wringing water out of a
cloth. The movement is best suited for arms, legs and fingers.

Cross fiber - It is also known as Deep Transverse Friction. It is a very precise and
penetrating form of friction. The direction of movement should be across and
perpendicular to the pattern of muscle fibers. One or more fingers are placed on the
skin at the exact site of a pain or injury. Apply firm, consistent pressure in one or
both directions, move the fingers in a back and forth motion.
Chucking - It is also known as Parallel Friction. It refers to deep friction applied in
the same direction in muscle tendons or ligamentous fiber. It uses the thumbs or
fingers to rub back and forth moving the superficial tissue over the underlying
structure. It is usually performed one handed, while the other hand is supporting the
limb that is being massaged. This movement is often applied between bony areas.

Circular Friction - It uses small circular movement that glides superficial tissue
layer over underlying tissue layer in different direction using the fingers or palms of
the hand. Particularly useful around the joints and in bony areas.

Basic Stroke: Tapotement / Percussion

The word Tapotement is a French derivation of an Old French term taper that
means a light blow, which in turn was derived from Anglo-Saxon term taeppa, meaning
to tap, in the sense of draining fluid from a cavity.
It involves repetitive staccato striking movements of the hands, moving either
simultaneously or alternately. May be delivered with the ulnar surface of the hand, tips
of the fingers, open palm, cupped palm, or back or ulnar surface of a loosely closed fist.
It is use to finish an area or end the massage. Avoid the application immediately after
exercise because this stroke can activate muscle spindles and stimulate cramping.
Heavy tapotement over the kidneys in the low back area is not advised because
they are not adequately protected by bodily tissue. May be applied directly to the skin or
through the drape. Begin with light pressure and moderate strike speed, gradually
increase speed, and finally diminish speed and depth. It is delivered rhythmically,
allowing your hands to spring back after contact.
Purposes / Benefits:
Stimulate nerve endings initially, becoming more sedative if continued.
Aid in decongesting the lungs by loosening and mobilizing phlegm in the respiratory
Tone atrophied muscles.
Increase local blood flow.
Access deeper structures such as hip rotators.
Create an ultrasound effect manually.
Desensitize a hypersensitive area after a few minutes of tapotement stimulation.
Techniques/ Variations
Tapping - Using your fingertips of one or both hands strike the bodys surface. It
increases local blood flow.
o Punctuation Using your fingertips of one or both hands, strike the bodys
surface rapid, but consistent delivery of pressure and speed. A hard version of
tapping punctuation tapotement is excellent for the soles of the feet.
o Pulsing It is performed one handed, with an alternate deep and light tap. The
deep tap is comparable to a full note, and the light tap is comparable to a half
o Raindrops Commonly used on the face or scalp. Feels like light rain - each
fingertips of the hand strikes the skin lightly at a different time.

Pincement - Also known as plucking, done the same as the skin rolling technique.
The skin is grasped using a quickly delivered striking motion, lifted, and released
while the fingers of the opposite hand follow suit.

Hacking - Also known as Karate Chop. Produces a slight vibratory action coupled
with the percussive action. Hacking along muscle fibers with fingers parallel,
produces relaxation in muscles. It is applied across large muscles, with the fingers
perpendicular, stimulates muscle spindle activity. Minute contractions of the muscles
are the result.
o Quacking Places the palms of both hands together. The skin is struck using
only the sides of the third, fourth, and fifth finger. The air moving out of the hands
during the strike make a quacking sound.

Cupping - Curve the palmar surface of the hand into a cup, as if holding water.
Strike the clients skin with the edge of a cupped hand, making a muffled horse-hoof
sound. A vacuum is created when lifting the palm from the skins surface, hence, the
hollow sound of suction. This is the stroke of choice for loosening mucus and
phlegm in the chest cavity. it is very vigorous stoke and may induce coughing.

Pounding - It is performed with the sides of one or both loose fists contacting the
skin alternately. Loose fist beating is used on large, muscular areas such as the
posterior legs and the hips.
o Rapping Performed using a loose fist placed palm down striking the skins
surface like the therapist knocking on a door.

Diffused - It is commonly used over the abdominal region. Drag the open hand
across the skin, as you move across the skins surface.

Clapping - Also known as Slapping. It is performed with the palmer surface of the
hands and finger striking the skin with alternate strokes. The fingers are held
together. A loud smacking sound is heard if done correctly. A light upward slapping
may be done on the sides of the face. It is not recommended for use on clients who
are known to be survivors of abuse as it may trigger painful past episodes of abuse.

Basic Stroke: Vibration

Vibration comes from the Latin term for a shaker. It is rapid shaking, quivering,
trembling, or rocking movements applied with the fingertips, full hand, or an appliance.
Purposes / Benefits:
Enhances general relaxation.
Increases circulation.

Stimulates muscle spindles, thus creating minute muscle contractions.

Relieves upper respiratory tract congestion, including sinus congestion.
Stimulates peristalsis of the large intestine.
Moves gas in the lower gastrointestinal tract.
Stimulates synovial fluid production in joints when applied with traction.
Reduces trigger and tender points activity

Techniques/ Variations
Fine - Place fingertips on the skin and begin a trembling movement by rapidly
contracting and relaxing the arm keeping the fingers and wrist stiff. Fingers should
be moving from side to side while maintaining contact with the skin. The therapists
hand may remain in one location or glide down or around an area, such as the back,
legs, or arms, while applying quivering movement.
Another way to apply fine vibration is to compress and lift the tissue into your
hands. The stroke feels as if you are slurping up the tissue in your hands.
Once this is done, begin trembling the hand that is in direct contact with the
tissue. This type of vibration is especially useful over the abdomen to increase
peristalsis, stimulating digestion and elimination.

Jostling - It also known as Coarse. It can be used on a muscle belly or limb. When
applying it to muscle, grasp the muscle belly or bellies and shake vigorously, but
rhythmically, back and forth. This may feels like rolling friction. Shortening the
muscle by moving the attachment closer together create slack in the muscle before
applying vibration. If applied to a limb, use one or both hands to grab the limb
securely. The most proximal joint is preferred. Add a small degree of traction by
leaning back, shaking the limb. Coarse vibration can loosen up muscles surrounding
a joint and is the principle stroke used in the Tracer technique.

Rocking - It is done by pushing the clients body with one hand or tossing the body
back and forth on the table between two hands. It requires a pitch-and-catch motion.
Push, or pitch, the body with one or both hands, retrieving, or catching it, as the
body swings back toward you. Pitch and catch the body until it begins to move easily
or finely. You can also pitch and catch the body using one hand on each side of the

Coarse Vibration - The therapist grasps the muscle or limb with one or both hands
and shakes or pulls it vigorously.

Lesson 4:

Post Massage

Post Massage: Aftercare and Documentation

Aftercare is the assistance provided at the end of the massage session. It should
be tailored to each individuals situation. Recommendations for self-care is necessary to
achieved best results of the massage session
Documentation is used to create and maintain a patients record and develop
initial and session-to-session treatment plans as well as for communication between
healthcare professionals. Documentation is a guideline for safe and effective treatment
and proof of the clients progress.
Characteristic of a good medical record:
Lesson 1:

What is Swedish Massage

Swedish Massage
It is scientific treatment by certain passive, systematic manipulation upon the
nude skin of the human body, with the object of promoting and maintaining balance
Benefits of Swedish massage
Relaxation it is the refreshment of body and mind.
Treatment application to a patron for disease or injury.
Aesthetic preserving beauty
Hygienic tending to promote or preserve health.
Remedial tending to restore health.
Hemorrhages may inflict more damage to the blood vessels, tend to lose more
blood (example: menstruation).
Infection to avoid the spread of pathogens.
Malignancy example: cancer, ectopic.
Fracture to avoid additional injury.
Burns can inflict or cause additional pain and injury.
Contagious skin disease example: warts and impetigo (characterized by blisters
that form yellow-brown scabs).

Lesson 2:

Endangerment Site

Endangerment Site

During the massage, deep sustained pressure should not be performed on areas
where nerves and blood vessels surface to the skin, and are not well protected by
muscles and connective tissues. The following are the areas to be avoided:
Anterior Triangle of the Neck front part of the neck which includes the
parathyroid and thyroid glands.
o Thyroid glands found below the larynx. Secretes three (3) hormones the
Thyroxin and triiodothyronine that act on all body cells increasing the metabolic
rate and the pace of cell division. Calcitonin decreases level of calcium in the
blood reducing the rate at which the bone is broken down.
o Parathyroid gland found posterior embedded in the thyroid gland. Four (4) tiny
parathyroid glands secrete the parathyroid hormones (PTH) which has opposite
effect to calcitonin because it increases the level of calcium in the blood by
stimulating bone breakdown.
Posterior Triangle of the Neck also called the Nape and the parts include
cervical vertebrae
Anterior in the Throat
o Jugular Vein the jugular veins are in the neck and drain blood from the head,
brain, face and neck and convey it toward the heart.
o Vagus Nerve a remarkable nerve that supplies nerve fibers to the pharynx
(throat), larynx (voice box), trachea (windpipe), lungs, heart, esophagus and
intestinal tract as far as the transverse portion of the colon. The vagus nerve also
brings sensory information back to the brain from the ear, tongue, pharynx and
Areas of the Suprasternal Notch It is a small notch at the top of the sternum. It
can be seen by seeking the hollow at the base of the throat
Axilla lymph drainage is found, veins and arteries
Sternum is a long flat bony plate shaped like a capital T located anteriorly to the
heart in the center of the chest.
Spinal Column a series of contiguous or interconnecting bony or cartilaginous
segments that surround and protect the spinal cord. Also known as the backbone.
Sciatic Notch - affecting the back of the human hip and lower limbs.
Sciatic Nerve It begins in the lower back and runs through the buttocks and down
the lower limb. It is the longest and widest single nerve in the human body going
from the top of the leg to the foot on the posterior aspect.
Umbilical Area descending and abdominal aorta.
Twelfth Rib dorsal body (kidney) where the kidney has no protective area.
Inguinal angle femoral artery, saphenous vein.
Popliteal Fossa veins and artery.
Varicose Veins carries unoxygenated blood, swollen and knotted especially found
in the legs as a result of flaws in the valves of the affected veins.
Antecubital Fossa a triangular cavity of the elbow that contains a tendon of the
biceps, the median nerve and the brachial artery.
Lateral and Medial Epicondyle rounded particular areas in the joints.
Lesson 3:

Preparation Before the Massage

To control infection, wash and dry hands thoroughly before and after the
massage therapy or after using the toilet. The following are the recommended hand
washing procedure:
1. Turn on the faucet
2. Wet hands, forearms and elbows.
3. Use liquid soap and apply to the hands up to forearms in a circular motion. In
washing, include the areas in between fingers. (Liquid soap is preferred over bar
soap because bar soap becomes contaminated after use). Wash for 15 seconds.
Use nail brush to clean underneath your nails. If there is a broken skin, extend the
washing up to 2 minutes.
4. Rinse the hands and forearms thoroughly.
5. Use clean paper towel in drying the hands and forearms. Use the same paper towel
to turn off the faucet.
6. Discard the paper towel.
7. When hand washing is not convenient or possible, use a high alcohol content gel /
hand sanitizer

Warm up
The following are the warm up exercises in preparation for the massage session:
1. Rub your palms and fingers together creating friction and warmth.
2. Put your both hands on the stomach and inhale/exhale for nine (9) times. Do not
remove both hands on the stomach.
3. Breath in and Breath out nine (9) times.
4. Shake your hands and fingers at the wrist. Do not perform this movement vigorously.
Do this for nine (9) times.
5. Roll your shoulders forward for nine (9) repetitions.
6. Reverse the direction and rotate your shoulders backward for nine (9) repetitions.
7. Circle wrist in one direction for nine (9) rotations and then reverse the direction for
nine (9) rotations.
8. Press your finger pads together as you keep your wrist apart away from your body.
9. Keep your fingers spread apart.
10. Close your eyes and count from nine (9) to one (1) as you meditate.
11. To do the reach and pull exercise.
o Start with your open palms at your sides.
o Pull your hands up to chest high closing your palms into fists.
o Without stopping, continue the upward towards your hands over your head
stretching your finger tips out and inhaling simultaneously.
o Reverse the direction bringing your arms back down.
o Close your hands as you pass your chest and reopen them as you reach your
side exhaling forcefully.
o Keep your pace slow and your movements graceful.
o Repeat the sequence five (5) times.

Stop immediately when you become lightheaded.

Lesson 4:

Client Positioning

Client Positioning
In the supine position, the person is lying horizontally on the back.
Place bolster under the clients ankles.
Cover the eyes using clean linen.
Be sure the neck is not flexed.
Assist the client to the massage bed.
Tell the client to lie face down in a horizontal position.
The most supported areas in this position are anterior ankles and the face.
Use a face rest frame and cushion to keep your clients neck straight while lying
Lesson 5:


The process of using linens to keep a client covered while performing the
massage. The following are the methods use for draping:
Towel Draping
One (1) towel is use for male client and two (2) towels for female client with the
sheet drape over the table. When using the towel, fold the towel back or under to reveal
the area to be massage.
Accessing the abdominal area on female clients fold the bottom towel down and
upper towel up to reveal the abdomen. The folded towel acts as the bikini top.
Sheet Draping
Two (2) sheets are required for each client, one for the table and one for the
client. As you undrape specific part of the body of the client, tuck the end of the fabric
underneath the clients body. Untuck the sheet and re-drape when moving different
areas for massage. The preferred sheet material is flannel because it is thick and heavy
and will stay on place. It not advisable to lift, fluff or remove a sheet in such a way that
will make the fabric leaves the clients body.
Accessing the abdominal area on female clients it requires the use of the towel
and pillowcase. A towel is drape on top of the sheet across the breast and
perpendicular to the body. The sheet is pulled down while the top drape remains
covering the breast acting as a bikini top. Remember to make sure the knees are

flexed while working on the abdomen. Place a bolster behind the knees and under
the neck.
Turning client supine to prone with the client on the supine position, grasp the
sheet along the opposite edge of the table while anchoring the sheet with your thighs
on the side of the table. Instruct the client to lie face down.

Lesson 6:

Full Body Massage

Full Body Massage: Prone Position - Trunk

Prone Position
Assist the client to position on the massage table in prone position or lying
horizontally on the massage table face down.
Ask the client to remove his clothes. To do this properly, use a towel to prevent the
client from being exposed.
Cover the lower body of the client using the towel you are holding.
Place the bolster under the shin (front of the legs).
Then put another towel to cover the upper body.
Sanitize. Apply alcohol or hand sanitizer on your hands and forearms before starting
the massage.
Stretching. Perform stretching on the clients body.
Undraping the back. Pull the towel on the upper body down to the lower body,
exposing the back of the client.
Applying lubricant. Apply lubricant (oil) on your hands.

Perform each of the following massage techniques for three (3) repetitions:
Heart (Effleurage)
Two-Handed Effleurage (using knuckles)
Two-Handed Circular (Effleurage)
Chucking (Friction)
Fulling (Petrissage)
Wringing (Friction)
Ocean Waves (Petrissage)
One-Handed Ironing
Two-Handed Ironing
Cross-Fiber (Friction)
Skin Rolling (Petrissage)
One-Handed Raking
Superficial Warming
Sawing (Friction)
One-Handed Circular
Heart (Effleurage)
Alternate Hand (Petrissage)
Heart (Effleurage)

Full Body Massage: Prone Position - Head and Neck

Perform each of the following massage techniques for three (3) repetitions:
Two-Handed Circular
Two-Handed Effleurage (using knuckles)
Thumb (Effleurage)
Alternate Hand (Petrissage)
Heart (Effleurage)

Full Body Massage: Prone Position - Lower


Perform each of the following massage techniques for three (3) repetitions:
Heart (Effleurage)
One Handed Petrissage
Chucking (Friction)
Alternate Hand (Petrissage)
One-Handed Effleurage (using knuckles)
Two-Handed Effleurage (using knuckles)
Heart Effleurage
One-Handed Ironing
Alternate Hand Effleurage
Wringing (Friction)
Fulling (Petrissage)
Praying Hands (Petrissage)
One-Handed Circular (Effleurage)
Chucking (Friction)
Fulling (Petrissage)
Jostling (Vibration)
Punctuation (Tapotement)
Heart Effleurage

Full Body Massage: Supine Position - Head

Ask the client to turn from prone to supine position.

Perform each of the following massage techniques for three (3) repetitions:
Fulling (Petrissage)
Circular (Effleurage)
Effleurage (using fingertips)
One-Handed Circular (Effleurage)
One-Handed (Effleurage)

Superficial Warming

Full Body Massage: Supine Position - Upper


Perform each of the following massage techniques for three (3) repetitions:
Heart Effleurage
Chucking (Friction)
One-Handed (Petrissage)
Heart Effleurage
Wringing (Friction)
Praying Hands (Petrissage)
Chucking (Friction)
Fulling (Petrissage)
Chucking (Friction)
Jostling (Vibration)
Heart Effleurage

Full Body Massage: Supine Position - Trunk

Perform each of the following massage techniques for three (3) repetitions:
Circular Effleurage (follows small intestine to large intestine)
Fulling (Petrissage)
Ocean Waves
Fine (Vibration)

Full Body Massage: Supine Position - Lower


Perform each of the following massage techniques for three (3) repetitions:
Heart Effleurage
One-Handed Circular
Heart Effleurage
Praying Hands (Petrissage)
One-Handed Circular
Pulling the Fingers

Clapping (Slapping)
Heart Effleurage


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