Sie sind auf Seite 1von 450

E D I T I O N

SPA BODYWORK
A Guide for Massage Therapists
A n n e W i l l i a m s, LMT, CHT, BFA

Williams_2E_FM_printer_file.indd i

10/24/13 3:43 AM

Acquisitions Editor: Jonathan Joyce


Product Manager: Linda G. Francis
Marketing Manager: Leah Thomson
Design Coordinator: Joan Wendt
Compositor: Absolute Service, Inc.
2nd edition
Copyright 2015 Anne E. Williams
Copyright 2007 Anne E. Williams
351 West Camden Street
Baltimore, MD 21201-2436 USA
Printed in China.
All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any
means, including photocopying, or utilized by any information storage and retrieval system without written permission
from the copyright owner.
The publisher is not responsible (as a matter of product liability, negligence, or otherwise) for any injury resulting from
any material contained herein. This publication contains information relating to general principles of medical care which
should not be construed as specific instructions for individual patients. Manufacturers product information and package
inserts should be reviewed for current information, including contraindications, dosages, and precautions.
Library of Congress Cataloging-in-Publication Data
ISBN: 9781451176780
Cataloging-in-Publication Data available on request from the publisher.
The publishers have made every effort to trace the copyright holders for borrowed material. If they have inadvertently overlooked any, they
will be pleased to make the necessary arrangements at the first opportunity.
To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to
(301) 223-2320. International customers should call (301) 223-2300.
Visit Lippincott Williams & Wilkins on the Internet: http://www.LWW.com. Lippincott Williams & Wilkins customer service
representatives are available from 8:30 am to 6:00 pm, EST.
06 07 08 09 10
1 2 3 4 5 6 7 8 9 10

Williams_2E_FM_printer_file.indd ii

10/24/13 3:43 AM

Acknowledgments

Writing and producing Spa Bodywork: A Guide for Massage


Therapists has involved the contributions of many people,
some of whom are unknown. I am thankful to all of them
and would like to acknowledge those who stand out here.
I am grateful to have had the opportunity to work with the
team at Lippincott Williams & Wilkins, and I am thankful
for their tireless enthusiasm and hard work. I would particularly like to thank Linda Francis for her great organization,
understanding, and support. I also want to acknowledge
Pete Darcy who approved the proposal for the first edition
of Spa Bodywork and suggested me for the Massage Mastery
project. Pete, Ill always appreciate your creativity, vision,
and insight. Many thanks also to Spa Bodyworks first project
manager, David Payne, who was always sensible and practical (while remaining flexible) and to Susan Schlosstein who
inspired me with her support and interest.
During its development, Spa Bodywork has been reviewed by
a number of professionals in the massage industry, each of
whom have given thoughtful and helpful input, so I would
like to thank them for their time and contribution.
Thanks to the photographer Mel Curtis and his team,
Connie and Doug, for their visual contribution to the first
edition of the book and to Rick Giase for the additional
photos needed for the second edition of the book. Thank
you also to June Pendleton of Universal Companies and
Professor Jim Simon of Rutgers University for help with
some of the images. Thank you to the team at Savi Day Spa
for allowing us to use their facility for the location shots,
especially Kelly Wilson and Mary Wilson. Thank you to
the models that gave up their weekends and did their best
with body mechanics on the slippery floor! The models
were Debbie Bates, Destiny Harrison, Catharine Jakeman,
Sunny Kim, Melody Lickert, Faithann McVeigh, Natalie
Mayer-Yeager, Erin Murphy, Earl Nabritt, Jason Priest, Keith
Shawe, Jenni Shires, Jill Wells, and Tiffany Williams. In the
second edition, thank you to Ronie Werner, Aleya Littleton,
and Brian Halterman.
The material for this book was originally developed for four
different spa programs, and so I am deeply grateful to the
individuals who believed in spa/aromatherapy training for
massage therapists and were willing to invest in the equipment and training necessary to launch these programs.
These individuals include Feliz Rodriguez for the original
program at Ashmead College and Meredyth Given, Kim
Lothian, Lorine Hill, Siri McElliott, and Eric Rasmussen for
the second program at Ashmead College (Washington and

Williams_2E_FM_printer_file.indd iii

Oregon). Chris Froelich and the team at Somerset School of


Massage Therapy (New Jersey), Ray Siderius and Jill Stanard
and the team at Oregon School of Massage Therapy
(Oregon), and Lisa Hensel at Seattle School of Reflexology
for the Reflexology Foot Spa Workshops.
I want to say a grateful Thank you to Keith Shawe whose
considerate feedback on the first edition and unwavering
support helped me develop my confidence and skill as a
writer.
I extend my sincere appreciation to my family and friends
for understanding when I couldnt be at events because of
the book and for their unwavering support and encouragement during the time that I was writing. Thank you to
Mom and Dad; Jill Shawe; Cindy, Larry, Jason, and Sarah
Rantanen; Pam, Kurt, Joe, Gloria, and Natalie Mayer; Rick,
Sharon, Jeff, and Gayle Selden; Anthony Knoll; Derek
Peace; Deanna Scalf; Edana Biddle; Gretchen Pelsma; and
Kim Virant. Thank you to my amazing and inspiring fitness
trainer, Burt Henry.
I am especially grateful to my rock climbing and adventure family who keep life in Colorado so fun. Thank
you Abram Herman, Jon Barr, Jessica Barr, Ronie Warner,
Arthur Nisnevich, Michael Pastko, Tyler Knowles, Adele
Schopf, Chris Devenney, Ryan Jaret, David Weinstein,
Christy Sims, Tiffany and Zack Shocklee, Aleya Littleton,
and Brian Halterman.
I would also like to thank the amazing massage and spa professionals, spa instructors, aromatherapists, administrative
staff, workshop participants, and individuals who I have had
the privilege of working with and learning from, especially
Alicia Chapman, Alla Kammers, Amanda Flynn, Amy Klein,
Amy Stark, Andrea McClelland, Andrea Niemeyar, Andrew
Biel, Angie Parris-Raney, Angie Patrick, Angie Schneider,
Anita Harper, Ben Benjamin, Bill Fee, Bill Langford, Carey
Rosen, Carrie Ebling, CG Funk, Cherie Sohnen-Moe, Cheryl Young, Chris Damalas, Christy Cael, Cindy Babb, Cliff
Korn, Clint Chandler, Cynthia Ribeiro, Darren Buford,
David Christian, Debra Persinger, Deby Giske, Dennis
and Gina Simpson, Diana Thompson, Elan Schacter, Erin
Murphy, Faithann McVeigh, Felicia Brown, Gemini Sanford,
Geraldine Thompson, Gini Ohlson, Ingrid Martin, Jack Elias,
Jacki Borde, Jade Shutes, James Sutherlin, Jan Schwartz, Jeff
Mahadeen, Jenni Shires, Jenny Good, Jesse Cormier, Jill Stanard, Jim OHara, Jolie Griffin, Judy Scheller, Julie Carico,
Kate Bromley, Kate Zulaski, Katharine Appleyard, Kathy
Thielen, Katie Armitage, Kim Precord, Kitty Lawrence, Lara

10/24/13 3:43 AM

iv

Acknowledgments

Bracciante, Laura Allen, Leslie Young, Lincoln Heartsong,


Margie Miller, Marla Gold, Marsha Elston, Marti Mornings,
Mary Ann Foster, Mary Bryan, Meghan Lawrence, Melanie
Hayden, Melody Lickert, Pat Archer, Patty Glen, Rick Garbowski, Rick Rosen, Roger Patrizio, Roz Burnet, Ruth Werner, Scott Dartnall, Shannon Alyea, Shelly Johnson, Su Bibik,
Susan Salvo, Terri Zelepuza, Til Luchau, Tom Lochhaas, Veronica McHugh, Vickie Branch, Vicky Karr, Victoria Roberson, and Whitney Lowe.

Thank you to everyone at Associated Bodywork & Massage


Professionals, with a special thank you to our leaders, Les
Sweeney and Bob Benson, and to our education team Cindy
Williams, Kathy Laskye, Taffie Lewis, Katie Mills, Kristen
Coverly, and Brian Halterman.
Last but not least, thank you to my amazing partner, Eric
Brown, for being an inventive thinker and collaborator and
an endless source of wisdom, support, and inspiration.

I would like to dedicate the second edition of Spa Bodywork:


A Guide for Massage Therapists with love to my dear friend, Erin Murphy, who
is an inspiration to massage and spa students, fellow teachers,
administrators, and professional therapists who have the
privilege of working with her and knowing her.

Williams_2E_FM_printer_file.indd iv

10/24/13 3:43 AM

Preface

Spa Bodywork: A Guide for Massage Therapists is primarily a


textbook for the massage student enrolled in a spa program. It is also a guide for the practicing massage therapist
who wishes to add spa treatments to a private practice or
work in the spa profession. To some extent, the text can be
used by estheticians to improve their product knowledge
and develop new skills for full-body skin care.
As the title implies, Spa Bodywork aims to illuminate
the powerful links between massage and spa treatments.
Many of the spa products often used just for beauty have
the same physiological effects as massage or act in synergy
with massage techniques. Seaweed, for example, stimulates
local circulation and metabolism and supports the natural
detoxification process of the body. Many useful minerals in
seaweed can be absorbed through the skin. Seaweed treatments can have a pronounced effect on the thyroid, so they
must be used carefully. This requires a good knowledge of
the products and application methods being used. Similarly, therapeutic mud such as Dead Sea mud and Moor
mud have proven anti-inflammatory properties, so they are
used in Europe to treat arthritis and other musculoskeletal
disorders. Such products can be used to support relaxation
and stress reduction or as part of a treatment plan for injury
rehabilitation.
Spa Bodywork breaks each spa treatment down into an
easy-to-understand sequence of steps that have been carefully
designed to provide an efficient routine for the practitioner
and a satisfying experience for the client. It gives instructions
for standard methods of delivery as well as for some creative
options that make sense when the service is provided by a
massage therapist. In these cases, the service is designed to
incorporate a natural healing substance such as mud, seaweed,
shea butter, or essential oils into the massage. Clients do not
have to give up their massages to enjoy spa treatments.
The basic concepts and application methods covered
earlier in the book lay the foundation for more advanced
techniques that are described in later chapters. All aspects
of a treatment are addressed including indications and contraindications for the treatment, equipment needs, product
choices, promotion, combining one service with another,
and client management during the treatment.
Although wet room treatments (i.e., treatments that depend on expensive hydrotherapy equipment such as Vichy
showers) are discussed in Chapter 5 and 6, the emphasis
is on the delivery of spa treatments in a dry room setting
(no shower). This makes the book usable in a wide range of
surroundings because it shows how spa services that are usually thought to be too difficult to deliver in a dry room (e.g.,
seaweed and mud) can be used in both the day spa and small
private practice without the need for expensive equipment.

Williams_2E_FM_printer_file.indd v

Organization and Structure


Spa Bodywork is practical and comprehensive in its approach.
For example, spa instructors will find that the materials
are presented in a format that can be easily referenced and
that is flexible enough to allow them to use as little or as
much of the information as they choose. Students can be
directed to the treatment considerations and procedure
section, whereas advanced therapists will find the detailed
background on spa products useful. The topics have been
divided into three main areas.
Part 1: Spa Foundations
Part 1: Spa Foundations provides a framework for massage
therapists venturing into the world of spa. The first chapter gives a history of the spa industry and defines the types
of spas that are common in the United States. Chapter 2
describes the equipment needed to deliver spa treatments
and the different types of spa products therapists encounter
in spa body treatments. In Chapter 3, client and therapist
safety issues such as ethics, scope of practice, sanitation and
hygiene, cautions, contraindications, and safety protocols
are discussed. Although skin care is out of the scope of practice for massage therapists in most states, every therapist
working in a spa should have a basic understanding of the
skin. This information is provided in Chapter 3 along with
a clear discussion of scope of practice restrictions related to
spa work for massage therapists.
Chapter 4 (Your Spa Massage) is a new topic added to the
second edition to support new therapists as they venture
into spa work. It looks at the subtle elements of massage
application that help create a vivid and lasting positive
impression for clients. It also explores the creative use of enhancers to elevate the massage experience toward an artistic
expression of touch that exceeds client expectations.
Chapter 5 teaches core techniques that are essential to
the effective application and removal of spa products. These
techniques include modest spa draping, positioning the client for product application, and removal techniques for the
dry room and wet room. In Chapter 6 (Water Therapies),
the basic principles of hydrotherapy are discussed together
with the proper use of wet room equipment such as Vichy
showers, Swiss showers, and hydrotherapy tubs.
It is important to have a solid understanding of aromatherapy when working in a spa environment. Chapter 7
introduces aromatherapy, provides an overview of the
physiological and psychological effects of essential oils,
describes basic methods of application, and presents
some simple ways to add essential oils to any treatment.
Smell-scapes refer to the aroma landscape that a therapist

10/24/13 3:43 AM

vi

Preface

creates to enhance a spa treatment. This concept is defined,


and readers are given practical advice about creating a variety of unique smell-scapes. New to the second edition is an
extended discussion on methods for blending essential oils
creatively and safely.
Part 2: Spa Treatments
In Part 2: Spa Treatments, the lessons learned in Part 1
become a stepping-stone for more advanced techniques.
Common treatments delivered routinely at most spas are
described in step-by-step detail in Chapter 8 (Exfoliation
Treatments) and Chapter 9 (Body Wraps). In Chapter 10
(Spa Foot Treatments), reflexology, satisfying massage techniques, and various products such as clay and seaweed are
combined for pain-relieving and revitalizing foot services.
The sample treatments described at the back of the book
for each chapter demonstrate how basic treatments can be
combined with different treatment concepts and promotional descriptions to create many ready to use treatments
or inspire therapists to create their own services.
Fangotherapy, the use of clay, mud, and peat for healing
purposes, is discussed in Chapter 11. This chapter looks at
the traditional use of fango in Europe as well as its evolution in the United States. Popular relaxation treatments are
described, as are the use of fango for acute, subacute, and
chronic muscular conditions.
In Chapter 12 (Thalassotherapy), the therapeutic benefits of seaweed are explored in relationship to a number
of popular services. In each of these chapters, traditional
approaches are described along with variations in techniques and creative departures that suit the special skills
of a massage therapist and allow application in a dry room
environment.
Stone massage (Chapter 13) is a popular massage system at spas and clinics across the country. It requires focus
and commitment to the treatment, attention to detail, and
excellent massage skills. The routine taught in this chapter walks the reader through the basic elements of a stone
massage before teaching more advanced techniques that
require practice. The goal is to move beyond effleurage with
stones to a more satisfying form of bodywork that includes
a variety of techniques, including deep tissue and range of
motion work. New in the second edition is an increased
focus on working with stones safely. Associated Bodywork &
Massage Professionals (ABMP), the largest massage therapy
association in the United States, reports that burns from
hot stone massage are the highest liability claim area experienced by massage therapists. The revised Stone Massage
chapter in Spa Bodywork is based on best practices for safe
stone massage as required by ABMP for stone massage
liability insurance coverage.
Ayurvedic-inspired spa treatments and Indonesianinspired spa treatments are based in countries that have
rich histories and complex cultures and described in
Chapter 14. The environment, the people, the traditional
medical systems, and the myths from India and Indonesia

Williams_2E_FM_printer_file.indd vi

come alive through these massage methods, natural spa


products, and unique treatments. The first section of this
chapter explores ayurvedic bodywork and spa applications
including Indian head massage, abhyanga, udvartana, and
shirodhara. The second section of this chapter looks closely
at the natural plant products from Indonesia, which infuse
their medical and spa practices with luxury and opulence.
For students who are rapidly advancing in their spa skills,
ayurvedic and Indonesian treatments will offer some new
challenges that keep learning fun and interesting.
Part 3: Your Spa Career
Part 3: Your Spa Career helps massage therapists bring all of
their new skills together into well-designed spa treatments,
a spa program, a signature spa service, and a satisfying
spa career. In Chapter 15 (Your Spa Program and Menu of
Services), therapists explore their personal life missions and
visions and weave these into a spa philosophy to inform
their ideas about meaningful spa programs. Individual
treatment design and in-depth session planning help readers turn standard spa applications into multidimensional
and dynamic pieces of performance art in Chapter 16 (Treatment Design and Your Signature Spa Treatment). Chapter
17 (You in the Spa Profession) looks at career opportunities
and choices to help students plan their first career steps after graduation. An expanded section on starting a private
practice or spa that includes spa bodywork treatments is
new in this second edition.

Chapter Organization
Each chapter in the book begins with an outline and a
list of key terms with definitions. The treatment chapters
have the same internal structure so that information can
be found quickly. Each of these chapters has the following
components:
Introduction: At the beginning of each chapter, the
topic is introduced and the framework for the treatment is set up. If the treatment has a unique history, as
is the case with thalassotherapy, this is briefly described.
Product details are also described in this section when
appropriate. For example, a number of different types of
fango are used in spa treatments, and each has a different set of therapeutic benefits. When developing a spa
service, the therapist needs to have enough information
to be able to choose the fango most likely to achieve the
desired therapeutic goal.
General Treatment Considerations: This section discusses the indications, contraindications, and any other
special considerations for the delivery of each service.
For example, in a body wrap, claustrophobia is always
a concern. Even clients who have no previous history
of claustrophobia may become panic-stricken when
wrapped. This section gives practical advice about how
to avoid or deal with such situations.

10/24/13 3:43 AM

Preface vii

Treatment Overviews: Treatment overviews allow therapists to get a speedy snapshot of the indications, contraindications, supplies, and treatment steps involved in
each service. These overviews benefit the therapist who
likes a concise list and wants to find information quickly
and also provide a framework for understanding treatment details in the procedure sections.
Treatment Procedures: Each treatment procedure describes how to prepare for the treatment and position
the client at the beginning of the service. The treatment
is broken down into easy-to-follow steps accompanied by
photos that illustrate how to position the client and how
to apply the products. When appropriate, variations in
treatment delivery methods are discussed, taking into account the available equipment, positioning of the client,
timing limitations, and the implications of combining a
treatment with enhancers or other treatments. Although
wet room options are described when appropriate, all of
the treatment steps are based on dry room delivery.
Sanitation Boxes: Sanitation boxes appear in the procedure section to remind the therapist about cleanliness
and hygiene. Methods for cleaning specific equipment
used in the treatments are described.
Broaden Your Understanding Boxes: Some chapters
contain a box that helps to give the therapist an understanding of the broader application of spa therapies.
Some of these boxes focus on the use of a unique product in other countries (i.e., the use of fango in Europe),
whereas others focus on treatments or techniques used
by estheticians (e.g., What is a facial?).
Spa Fusion Sections: At the end of each chapter, a Spa
Fusion section provides useful information, a study tip,
review questions to test knowledge and comprehension,
and a chapter summary.

Appendices
Appendix A provides sample treatments that can be used,
as they are, to guide treatment design in the therapists
private practice, clinic, or spa. The sample treatments also
show how a basic treatment procedure is delivered within
the context of an overall treatment concept. Promotional
descriptions and ready-to-use recipes provide a valuable
resource for planning how to add spa services to an existing
massage practice. By using the main treatment as a starting
point and adding other therapeutic elements to it, the therapist can learn to develop highly original spa services.
A master list of essential oils with botanical names is provided
in Appendix B, and Appendix C provides a list of sources for spa
products and equipment to help therapists find the necessary
materials for the delivery of treatments. Appendix D provides
ready-to-copy forms for the spa business, and Appendix E gives
answers to the chapter review questions.

Williams_2E_FM_printer_file.indd vii

Online Resources
On the inside front cover of this book, you will find information and a scratch-off code for accessing the many online
resources developed to enhance your learning and practice
experience.
Students and all readers may access a series of engaging
video clips created especially for Spa Bodywork, as well as an
online quiz to test their knowledge and understanding.
Instructors will find an array of resources designed to
help them present the materials in this text effectively.
Instructor resources include a test generator, PowerPoint
slides, and a Teaching Resource document developed for
each chapter. This resource contains learning objectives,
lecture outlines, instructor demonstration checklist, and
student activities.

Summary
In the last 10 years, complementary therapies such as massage, traditional Chinese medicine, acupuncture, aromatherapy, meditation, yoga, and hydrotherapy have gained a
wider acceptance with the general public. At the same time,
stress in the workplace has increased, resulting in a higher incidence of diseases such as repetitive musculoskeletal injury,
heart disease, high blood pressure, and panic attacks. There
has never been a better time for therapists to promote the
use of spa therapies, and the continuing expansion of the spa
industry is evidence for the strong demand that exists. From
spas origins in ancient cultures and from its established
use in Europe, it is plain that spa assimilates many forms of
therapy into a comprehensive system that leads to wellness.
The spa experience can be life changing. Far from being just
a luxury, spa therapy represents the bold first step toward a
better form of health care. Its future is in the hands of those
dedicated therapists and visionary spa owners who have the
ability to provide a space where clients can experience balance and celebrate life while receiving exceptional care.
I hope that this book inspires massage therapists to include spa therapies in their practices or to find a job in the
spa industry that is challenging and rewarding. I believe
that the use of the products and treatments described in
these chapters will support better health and wellness. I am
grateful for the opportunity to share spa with all of the talented therapists and students who populate this wonderful
profession, and I invite therapists to share their spa experiences, best practices, and suggestions. These can be sent by
email to anne.williams20@yahoo.com.
Anne Williams
Boulder, Colorado

10/24/13 3:43 AM

Williams_2E_FM_printer_file.indd viii

10/24/13 3:43 AM

Table of Contents

Acknowledgements
Preface v

iii

3 Client and Therapist Safety

Commitment to Personal and Professional


Boundaries 33
Scope of Practice 35

PART ONE Spa Foundations 1

Spa Sanitation and Hygiene

1 Spa from Past to Present 2


A Brief History of Spas

European Spas in the 18th and 19th Centuries


The Modern European Spa 4
Spa in the United States 5

Basic Spa Categories 6

50

Spa-Specific Considerations 56
Common Conditions That Require Caution 56
Critical Thinking and Contraindications 61

Documentation of Sessions in a Spa

62

4 Your Spa Massage 68


Overview of a Wellness Massage Session

Spa into the Future 10

2 Spa Equipment and Products 13

Massage Enhancers

23

25

What the Client SeesDcor 25


What the Client Hears 28
What the Client Smells 28
What the Client Tastes 29
What the Client Feels 29
Accessibility and Functionality 29
Planning Spa Treatment Rooms 29

78

Warm Packs 79
Steamy Aromatic Towels 79
A Simple Hand or Foot Treatment 80
Paraffin Dip 81
Easy Aromatherapy Enhancements 81

Wet Room Equipment 19

Cleansers 23
Toners and Astringents 23
Exfoliation Products 23
Treatment Products 24
Moisturizers 24
Important Product Terms 24
Product Exploration 25

73

Resting and Holding Strokes 74


Breathwork 74
Aromatherapy Inhalations 78
Use of an Auditory Cue 78

Massage Tables 15
Basic Linens 17
Hot Towel Heating Units 17
Product Warmers 18
Paraffin Warmers 18
Body Wrap Materials 18
Body-Warming Equipment 18
Spa Clothing 19
Other Dry Room Supplies 19
Tubs 19
Showers 20
Specialized Environments 22
Purchasing and Maintaining Equipment

69

Before the Massage 69


The Massage 72
After the Massage 73

Opening and Closing the Massage

Dry Room Equipment 14

Williams_2E_FM_printer_file.indd ix

48

Cautions and Contraindications

Your Spa Environment

43

Safety of the Facility 48


Safety of the Client 48
Safety of the Therapist 49

Spas for Women 9


Spas for Men 9
Spas for Families 10
Programs for Teens 10

Spa Products

37

Diseases 37
How Diseases Are Transmitted 39
Preventing the Transmission of Disease 40
Sanitation of the Facility, Equipment, and Supplies
Universal Precautions 46

Creating a Safe Environment

Destination Spas 6
Resort Spas 6
Amenity Spas 7
Medical Spas 7
Day Spas 8
Hot Spring Spas 8
Mobile Spas 8

The Spa Client

32

Spa Ethics 33

Putting Your Spa Massage Together

23

82

Sequencing 82
Routines 84
Subtle Factors That Influence the Massage

85

5 Foundation Skills for Spa Treatment


Delivery 96
Spa Draping

97

Posterior Leg 97
Anterior Leg 97
Breast Drape 97
Anterior Pelvic Drape 97
Turban Drape 97
Gluteal Drape 97
Simple Hair Drape 97
Side-Lying Drape 97

10/24/13 3:43 AM

Table of Contents

Aromatherapy Massage 149


Aromatherapy Baths 150
Aromatherapy Wraps 150
Aroma Mists and Aura Mists 151
Support Lotions 151

Positioning the Client When Applying


Spa Products 100
The Side-Lying Position 101
The Sit-Up Method 101
The Flip-Over Method 101

Basic Application Techniques

101

Application by Hand 101


Application with One Hand Gloved 101
Application by Brush 101
Application with Gauze or Fabric 101
Application by Mist 101
Application of Product with a Sugar Shaker

Dry Room Removal Techniques

PART TWO Spa Treatments 154


8 Exfoliation Treatments 155
101

103

Steamy Rosemary Towels 104


Herbal-Infused Towels 104
Hot Towel RemovalLegs 104
Hot Towel RemovalFeet 104
Hot Towel RemovalBack 104
Hot Towel RemovalArms 105
Hot Towel RemovalAbdominal Area and
Upper Chest 105
Other Dry Room Removal Techniques 105
Moving a Client from Plastic to a Preset
Massage Sheet 105

Wet Room Removal Techniques

105

The Handheld Shower 105


The Standard Shower 105
The Swiss Shower 106
The Vichy Shower 107

Hydrotherapy Benefits and Effects

112

113

Benefits of Using Hydrotherapy in a Massage and


Spa Practice 113
Effects of Hydrotherapy Applications 113

The Salt or Sugar Glow

160

The Salt or Sugar Glow Procedure 162

The Full-Body Polish

165

The Full-Body Polish Procedure 165

The Body or Loofah Scrub


The Buff and Bronze 167

167

117

7 Introduction to Aromatherapy for Spa 129


Safety Considerations 134
Pathways In and Out of the Body

The Hot Sheet Wrap

The Cocoon

AromatherapyAn Art and Science


Essential Oils 131

130

176

181

Cocoon Types 182


The Cocoon Procedure 186

Tension Wraps

189

Techniques for Tension Wrapping

10 Spa Foot Treatments

137

The Physiological and Psychological Effects of


Essential Oils 137
Physiological Effects 137
Psychological Effects 142

143

Carrier Products 143


Essential Oil Concentrations 145
Synergy 145
Top, Middle, and Base Note Blending
Approach to Blending 146

174

Contraindications 175
Healing Crisis 175
Allergies or Sensitive Skin 175
Modesty 175
When the Wrap Goes Wrong 175
Claustrophobia 175
Wrapping Materials 176
Hot Sheet Wrap Types 176
The Hot Sheet Wrap Procedure 177

117

General Treatment Considerations


Hydrotherapy Applications 120

189

194

General Treatment Considerations

146

148

195

Contraindications 195
Reflexology Certification 195
Possible Reactions to Reflexology 195
Therapist and Client Comfort during Reflexology

Elements of a Spa Foot Treatment

Inhalations 149
Aromatic Exfoliations and Body Shampoos 149

Williams_2E_FM_printer_file.indd x

156

Dry Skin Brushing Techniques 157


The Enhanced Dry Skin Brushing Procedure 158

General Treatment Considerations

Therapeutic Characteristics of Water

Application Methods

Dry Skin Brushing

9 Body Wraps 173

General Uses for Hydrotherapy 111


Introduction to Hydrotherapy 111

Blending Essential Oils

Scope of Practice 156


Skin Conditions 156
Overexfoliation 156

The Buff and Bronze Procedure 168


Home Care and Retail 171

6 Water Therapies 110

Hydrotherapy Applications

Types of Exfoliation Treatments 156


General Treatment Considerations 156

A Quick Foot Assessment 196


Soaking and Cleansing the Feet
Exfoliation 197
Foot Massage 199
Reflexology 203
Treatment Products 208
Finishing Products 211

195

196

197

10/24/13 3:43 AM

Table of Contents

A Sample Foot Treatment Procedure

211

Session Start 211


Step 1: Soak and Cleanse 211
Step 2: Exfoliation 211
Step 3: Move the Client to the Treatment Table 211
Step 4: Foot Massage 212
Step 5: Reflexology 212
Step 6: Application of a Treatment Product 212
Step 7: Process 212
Step 8: Removal of the Treatment Product 212
Session End 213

11 Fangotherapy

215

Fangotherapy in Europe 216


Fangotherapy in the United States 217
Types of Products Used in Fangotherapy

217

Clay 217
Mud 219
Peat 220

220

Session Start 238


Step 1: Exfoliation of the Posterior Body 238
Step 2: Application of a Cellulite Cream to Target Areas
of the Posterior Body 239
Step 3: Exfoliation and Cellulite Cream Application on
the Anterior Body 239
Step 4: Application of Seaweed 239
Step 5: Cocoon 239
Step 6: ProcessMassage the Face and/or Feet 240
Step 7: Unwrap 240
Step 8: Application of Firming Products 241
Session End 241

The Seaweed Breast Treatment 241


Other Seaweed Treatments 242

The Full-Body Fango Cocoon 221


The Fango Back Treatment Procedure

General Treatment Considerations

249

Contraindications 249
Stone Temperatures 249
Therapist Safety 249
Draping and Insulation for Placement Stones
Essential Oils 249

Contraindicated Individuals 220


Broken or Inflamed Skin 220
Fango Temperature 221
Mixing and Storing Fango Products 221
Preventing Dry Out 221

Equipment and Setup


222

Session Start 222


Step 1: Steam the Back with Hot, Moist Towels 223
Step 2: Cleanse the Back 223
Step 3: Exfoliate the Back 224
Step 4: Massage the Back 224
Step 5: Application of Warm Fango 224
Step 6: ProcessMassage the Legs and Feet 224
Step 7: Remove the Fango 224
Step 8: Application of a Finishing Product 224
Session End 224

The Fango Scalp and Neck Treatment


Procedure 225
Session Start 227
Step 1: Steam the Head and Face 227
Step 2: Massage the Neck 227
Step 3: Massage the Scalp 227
Step 4: Application of Warm Fango to the Head 227
Step 5: ProcessMassage the Feet and Hands 227
Step 6: Remove the Fango from the Hair 227
Step 7: Face Massage 227
Session End 228

Fango Applications for Musculoskeletal Injury and


Disorder 228
Acute Conditions 228
Subacute Conditions 230
Chronic Conditions 230

232

A Brief History of Thalassotherapy 233


The Therapeutic Benefits of Seaweed for the
Body 233
General Treatment Considerations 235
Contraindications 235
Sensitive Skin 236
Product Form and Application Considerations 236

Williams_2E_FM_printer_file.indd xi

238

The Slimming Seaweed Cocoon Procedure 238

13 Stone Massage 247

General Treatment Considerations

12 Thalassotherapy

Seaweed Odor 237


Cellulite and Cellulite Products

xi

Stones 250
Heating Units 250
Equipment Organization

249

250
251

Core Techniques 251


Introduction of the Stones to the Clients Body
Stone Flipping 251
Stone Transitions 252
Bad Stone Body Mechanics 252
Heating Unit Speed versus Body Speed 252
Remove Enough Stones 252
Draping 252
Stones on the Face 252

Basic Strokes

251

253

Long Strokes with the Stone Flat 254


Stone Ptrissage 254
Wringing with Stones 255
Stone Stripping 255
Rotation of a Stone with Compression 255
Stone Vibration 255
Deep Tissue with the Edge of a Stone 255
Deep Tissue with the Flat of the Stone 255
Friction with Stones 255
Stone Tapotement 255
Vascular Flush with Stones 255

Stone Strokes for Specific Areas 255


Posterior Leg: Gastrocnemius and Soleus Pin and
Stretch 255
Posterior Leg: Hamstring Pin and Stretch 255
Posterior Leg: Double-Arm Deep Tissue Stroke 259
The Back: Stoning the Lamina Groove 259
The Back: Latissimus Pin and Stretch 259
Anterior Leg 259
Anterior Leg: Quadriceps Pin and Stretch 259
Anterior Leg: Tensor Fasciae Latae and Iliotibial Tract
Stretch with Stones 259
Arm: The Triceps 259
Arm: Flexor or Extensor Pin and Stretch 259

10/24/13 3:43 AM

xii

Table of Contents

Hands 259
The Neck: Prone 259
The Neck: Supine 259

16 Your Spa Program and Menu of Services 334

A Basic Full-Body Stone Massage Procedure 260


Session Start 260
Step 1: Posterior Placement 260
Step 2: Massage the Posterior Legs 261
Step 3: Massage the Back 261
Step 4: Transition to the Supine Position 262
Step 5: Anterior Placement 262
Step 6: Massage the Anterior Legs 262
Step 7: Foot Massage 262
Step 8: Abdominal Massage (Optional) 262
Step 9: Arm and Hand Massage 262
Step 10: Neck Massage 263
Step 11: Face Massage 263
Session End 263

14 Culturally Based Spa Treatments 265


Ayurvedic-Inspired Spa Treatments
Core Concepts in Ayurveda 266
General Treatment Considerations
Indian Head Massage 281
Abhyanga 286
Udvartana 293
Shirodhara 295

266

273

Indonesian-Inspired Spa Treatments

297

Indonesian Spa Products 297


Treatment Considerations 298
Indonesian-Inspired Massage 299
Indonesian-Inspired Exfoliation and Body Wrap
Treatments 308
Balinese BorehInspired Treatment 310
Javanese Lulur Ritual 310

Benefits and Drawbacks of Spa Body Treatments 335


Your Spa Philosophy 336
Your Life Mission

336

Creating Your Spa Program

340

Choosing Spa Treatments for Your Program 340


Balance Your Spa Program 343
Review Other Spa Programs 343
Design Individual Treatments 346
Write Detailed Treatment Guides 348
Refine Your Treatments 348

Your Spa Menu


Design 348
Writing Style 348
Essential Contents

348
351

17 You in the Spa Profession 353


Your Career Plan 354
Self-assessment for Career Planning 354
Explore Your Options 354
Have a PlanIt Can Change 360
Activities for Further Exploration 360
Plan to Thrive 360
Write Your Career Plan 361

Work as an Employee

363

Identify and Research Potential Spa Employers


Write a Resume 363
Write a Cover Letter 364
Interviewing 364
Negotiating the Employment Package 367
Meeting and Exceeding the Employers
Expectations 368

Starting a Private Practice


Your Business Plan

363

369

369

PART THREE Your Spa Career 316


15 Treatment Design and Your Signature
Spa Treatment 317
Individual Treatment Design

318

The Therapeutic Goal 319


Finding Inspiration through a Treatment
Concept 319
Treatment Texture 320
Enhancing Treatments 324
Transitions 324
Product Planning 325
Client Management 325
Retail Sales as Part of the Treatment 326
Treatment Planning Forms 326
Considerations When Pricing Services 330

The Signature Spa Treatment

Williams_2E_FM_printer_file.indd xii

330

APPENDICES
Appendix A. Sample Spa Treatments 386
Appendix B. Essential Oils and Their Botanical
Names 407
Appendix C. Resources 409
Appendix D. Ready-to-Copy Forms 411
Appendix E. Answers to Chapter Review
Questions 420
Glossary 421
References 426
Index 431

10/24/13 3:43 AM

P A R T

ONE

Spa
Foundations

Williams_2E_CH01_printer_file.indd 1

10/24/13 1:04 AM

1
Spa from Past to
Present
Chapter Outline

K e y Te r m s

A Brief History of Spas

Ayurveda: The 5,000-year-old medical system of India. Ayurveda influences are often used in spa treatments.
Esthetician: This word is a variant of the word aesthetician, which is
derived from aesthetic, a branch of philosophy dealing with the nature
of beauty. Estheticians are beauty specialists with around 300 to 750
hours of training. Their scope of practice includes skin care, hair removal, and makeup application.
Exfoliation: A procedure that removes dead skin cells from the surface of
the skin, stimulates lymph circulation, and increases muscle tone when
used with manual friction.
Hamam: An Islamic bath characterized by a vaulted ceiling and a raised,
heated marble platform called a hararat, which is used for massage or
exfoliation.
Hydrotherapy: The use of water in one of its three forms (liquid, solid, or
vapor) at specific temperatures for therapeutic purposes.
The Kur system: A German medical system that includes spa treatments
as part of a wider system for health and wellness. Kur treatments are
medically prescribed and paid for by the national health care system.
Luxury spa: A spa with exceptional accommodation, a full range of treatments, the latest advances in spa technology, a full array of wet room
equipment, and well-trained staff.
Radon: A naturally occurring atmospheric gas that is radioactive and is
released as uranium in rock and soil as it breaks down. It is used in
trace amounts in Europe for the treatment of arthritis and asthma.
Spa: A commercial establishment that provides health and wellness treatments.
Spa therapy: A general term for a wide range of spa treatment methods
or techniques used by various professionals in different settings to support health and wellness.
Spa treatment: A general term for a treatment that uses water, specialized
products, and various techniques to bring about relaxation, address a
specific pathology, and/or support overall health and wellness.
Terme: From the Greek therme meaning heat, and thermai meaning of or
related to hot springs.
Thermal mud: Thermal mud comes from the areas around hot springs. It
can be applied at the site while still hot from the spring water, or it can
be extracted and heated for later application elsewhere.

European Spas in the 18th and 19th Centuries


The Modern European Spa
Spa in the United States

Basic Spa Categories


Destination Spas
Resort Spas
Amenity Spas
Medical Spas
Day Spas
Hot Spring Spas
Mobile Spas

The Spa Client


Spas for Women
Spas for Men
Spas for Families
Programs for Teens

Spa into the Future


SPA FUSION
INTEGRATION OF SKILLS
STUDY TIP: Group Discussion
SPA INSPIRATION: My Spa Experience
CHAPTER WRAP-UP

Williams_2E_CH01_printer_file.indd 2

10/24/13 1:04 AM

Chapter 1

The spa profession is dynamic, changeable, and difficult


to define or categorize. It employs a variety of professionals
that may include physicians, chiropractors, ayurvedic
doctors, massage therapists, estheticians, life coaches,
counselors, dietitians, yoga instructors, spiritual leaders,
cosmetologists,

dermatologists,

cosmetic

surgeons,

naturopathic doctors, hypnotherapists, fitness trainers,


and others. A wide range of therapies may be offered in an
array of different settings under the heading of spa. This
chapter aims to briefly describe the historical roots of the
spa profession and its evolution in the United States and to
define broad categories of spas and the types of individuals
that frequent them. It also looks at the future of spas and
the potential role that spa plays in a broader system of
health care.

A Brief History of Spas


It is hard to pin down the origin of spa therapy. Mineral
springs and thermal muds were probably used long before
the first civilizations developed. In Finland, for example,
nomadic people heated holes in the ground with hot rocks
and covered them with a tarpaulin to have a warm place
for bathing.1 These saunas were also holy places where
births and deaths took place. In much the same way, North
American Indian tribes used a separate hut or a covered
sweat lodge built partly into the ground. Large stones were
heated in a fire and taken inside the hut, where they were
sprinkled with water. Many early civilizations had a version
of the spa bath, which combined some form of social interaction with cleanliness. Russian steam baths, which can
still be found in Europe, combine hot air and steam piped
from a boiler. The atmosphere is humid, and the aim is to
get the body to perspire continuously for a period after the
bath has finished.
Traditionally, Arabs would bathe only in cold water
and would never use a tub because this would subject the
bather to his or her own filth.2 Cleanliness is intertwined
with Islamic spirituality. The hamam (bath) became popular around 600 AD after Muhammad recommended sweat
baths. They gained religious significance after this and began to be built close to mosques. When the Arabs conquered
Syria, they quickly adopted Roman and Greek forms of
bathing with hot water and steam, and cold water bathing
fell out of fashion. The hamam became central to the community, serving as both a place of spiritual retreat and for
socializing with friends. The beautiful vaulted ceilings cut

Williams_2E_CH01_printer_file.indd 3

Spa from Past to Present

through to allow disks of natural light to shine down on the


bathers were more modest than their Roman counterparts.
Bathers would stop first at the camekan, a small court of
changing cubicles surrounding a fountain, before entering
the hararat (hot marble baths). Bathers would receive a vigorous massage or kese (exfoliation with a rough cloth) on
a raised marble platform above the wood or coal furnaces
that are used to heat the hararat.
Although the use of the public hamam is on the decline,
travelers to Istanbul can still experience a Turkish bath
complete with an exfoliating scrub and a brief invigorating massage. Historical hamams such as the Galatasaray
Hamam in Beyoglu give visitors a glimpse of the lasting
splendor of the Ottoman Empire.
Perhaps the most famous ancient spas were those of
the Roman Empire, where public baths were a part of the
culture that served an important social function as well as
providing a means of hygiene. The central role of spas in
Roman culture led to a well-developed use of hydrotherapy
(healing with water), and garrisons were often built around
hot springs so that the soldiers could heal their battle
wounds. By 43 AD, the Roman public viewed the baths as
a way to relax and maintain health, and by the early fifth
century AD, there were 900 baths in Rome alone. Although
not everyone could afford a massage, all classes used the
baths. Apart from the bath itself, there would usually be an
area that served as a community center, a restaurant, fitness
center, bar, and a performance center where a juggler, a
musician, or even a philosopher might entertain.

European Spas in the 18th and 19th Centuries


In the 18th and 19th centuries, Europeans would take
the waters for common ailments such as rheumatism and
respiratory disorders. Often, spas were built in secluded
mountain towns, providing visitors with spectacular views;
fresh, clean air; and exercise on nature walks. A trend in
spas at the time was to employ medical professionals who
carefully monitored each visitors treatment. Eventually,
spas expanded to include restaurants, casinos, theaters,
racetracks, and other forms of entertainment. One such
mineral spring town is Spa in Belgium (Fig. 11). The rich,
royal, and famous have been visiting the mineral springs
of Spa since the 16th century. The writer Victor Hugo was
an advocate of Spas curative waters and visited it often.
The town, situated in a wooded valley surrounded by undulating hills and mineral-rich springs and rivers, is still a
favored destination for those seeking rest and relaxation.
Some speculate that the word spa can be traced to the
name of the town, but it is more likely that it comes from
the Latin words espa (fountain) and sparsa (from spargere
or to bubble up). Health through or by water is sanus
per aquam (SPA) and solus per aqua (SPA) is Latin for by
water alone.
The use of water has long been central to spa therapy
because bathing in mineral-rich waters has some positive

10/24/13 1:04 AM

Spa Bodywork: A Guide for Massage Therapists

administering last rites to the gravely ill, he used water


and herbs to cure them. Kneipps healing system, which
combined physical exercise, simple food, hydrotherapy
and herbs, forms the basis of modern naturopathy. He is
well known for the wet nightshirt treatment in which the
remedy was to wear a shirt that had been dipped into water with salt or hay flower.

The Modern European Spa


The modern spas of Europe are still based on the hydrotherapy principles developed by Priessnitz and Kneipp. Visitors
to the Bad Hofgastein Spa in Austria stay at a comfortable
hotel with an indoor thermal pool fed by the mountains
waters, a whirlpool, sauna, Turkish bath, fango (mud) treatments, massage, radon baths, and a bar with a fireplace.
Arthritic patients at the Spa are given the Gastein cure.
This treatment consists of visits to the radon caves of the
Radhausberg Mountain and seems to be effective for arthritis, sinusitis, and chronic asthma sufferers (Fig. 12). Radon
is a naturally occurring radioactive gas released by rock, soil,
and water from the breakdown of uranium. It is absorbed
by the body in very small doses through inhalation and
through the skin in the 70% to 80% humidity that is found
deep in the mountain caves. The use of environments with
trace amounts of radon is not unique in Europe. In fact,

FIGURE 11 Spa, Belgium. The copper tubs used at Termes de Spa in


Belgium date back to the 1800s.

effects on the body. The medical benefits of taking the


waters were advanced in Europe by two natural healers
who developed their ideas in the early 1800s. The first was
the Austrian Vincent Priessnitz (17991852) who promoted
the cold water cure. The cure consisted of drinking large
amounts of cold water, bathing in cold water, following
a simple diet, and participating in physical activity in the
open air. Priessnitz was able to use the cold water cure to
care for a personal injury that doctors of the time thought
untreatable. In 1826, Priessnitz opened a water cure establishment at Grfenberg in the mountains of Silesia, where
his ideas were adopted by many prominent physicians.3
The second natural healer was Father Sebastian Kneipp
(18241897), a German priest who cured himself of pulmonary tuberculosis by bathing in the icy Danube and
shocking his body into health. In one of his many books,
My Water-Cure (1894), Kneipp writes, Being a priest, the
salvation of immortal souls is the first object for which
I wish to live and die. During the last 30 or 40 years,
however, the care for mortal bodies has absorbed a considerable portion of my time and strength.4 Instead of

Williams_2E_CH01_printer_file.indd 4

FIGURE 12 Bad Hofgastein Radon Cave at Bad Hofgastein Spa


in Austria.

10/24/13 1:04 AM

Chapter 1

some research appears to support the use of radon inhalation and radon baths for asthma, hypertension, osteoarthritis, and diabetes.58
Visitors to the little spa town of Le Mont-Dore in Auvergne,
France, can take the radon-rich air in the form of a nasal irrigation with a tube inserted up one nostril. They breathe in a gas
drawn from a nearby natural hot spring. Although this gas is
mostly carbon dioxide, it also contains a radon concentration
that is well above average. The radon is supposed to activate
the blood, combat allergies, improve digestion, and stimulate
the immune system.9
The Italian towns of Abano, Montegrotto, Galzignano,
and Battaglia, which lie in a broad, green plain northeast
of the Euganean Hills in the Veneto of Italy, are famous for
their ancient thermal baths. The spa at Montegrotto dates
from the 76th century BC, and the remains of Roman spas
in the area can still be seen. Abano Terme (terme means
thermal bath) is considered to be one of the oldest spa
centers in the world. According to legend, the Abano waters
were warmed when Phaeton, the offspring of the sun,
fell and landed in the mineral springs. It is likely that the
inactive volcano there feeds the 130 hot springs in the area
that still flow at a constant temperature of 188F (86C).
Guests enjoy thermal treatments under the supervision of
medical staff, and the Euganean Hills mud found in the
area is used for arthritis and fibrosis neuritis as well as for
gout and metabolic problems.
It is common in Italy, as in many European spas, for the
guest to stay up to 3 weeks and receive daily treatments. In
Germany, for example, spa therapies are regarded as medical treatments and as a general preventive against poor
health. Over 9 million Germans enjoy the benefits of the
Kur system each year. In the Kur (cure) system, a person
spends 2 to 4 weeks in a climate chosen for his or her condition. Patients receive a wide range of treatments, including
massage; mud, herbal, and seaweed applications; inhalation
therapy; and the use of mineral and thermal water. Part
of the treatment is enjoying leisure time in a beautiful,
efficiently run natural setting. Long-term studies show that
the number of sick days taken by German workers who received a Kur treatment drop by an average of 60%.10 Medical drug consumption and other health care costs also decrease. The long-term effects of the Kur system include a
drop in the number of early retirements and an increase in
productivity throughout the patients working life.

Spa in the United States


After the Industrial Revolution, spa treatments were seen as
less scientifically viable than fast-acting, medically measurable drugs. As a result, the European concept of spa did not
cross the Atlantic intact. Even though hydrotherapy cures
quickly gained popularity in mid-1800s America, spa and
complementary therapies developed in different directions.
In the early 1900s, water-cure centers became rallying
points for new medical ideas including meat-free diets

Williams_2E_CH01_printer_file.indd 5

Spa from Past to Present

and drugless healing that were among the forerunners of


alternative medicine as we know it today. Dr. John Harvey
Kellogg pioneered many of the practices that have been
proven in modern medicine at the Battle Creek Sanitarium
(the San) in Michigan. Kellogg recommended a good vegetarian diet, regular exercise, correct posture, fresh air, and
proper rest. He persuaded women to discard their corsets
and ignore fashion to improve their breathing. Kellogg
also practiced some questionable medicine, including electropathy and radium cures. Many regarded him as a quack,
even though he was one of the nations leading surgeons.
Kelloggs program was offered in a luxurious, restful, and
elegant setting that was often attended by the rich and
famous.11
In 1934, Elizabeth Arden turned her Maine summer
home into a beauty and health spa called the Maine Chance.
She targeted two groups of women; those that were middle
aged trying to recapture youth and plain women looking
for a means to achieve beauty in a jar.12 With cosmetics
as her primary product, Arden pioneered the integration of
diet, exercise, sports, yoga, facials, massage, beauty training, and pampering into a focused spa program. She used
science and technology to develop her concept of beauty
and to turn that concept into a $20-million industry.
Today, Ardens signature, Red Door Salons are recognized
worldwide.
Spas in the early 1960s developed the stigma of fat
farms for wealthy women who wanted to lose weight and
detoxify (sometimes from drug and alcohol addictions).13
The fat farm stigma may have slowed the growth of the spa
industry for some time, but the concept of an integrated
program of fitness, diet, and healthy lifestyle training balanced with pampering treatments and beauty became established. This comprehensive approach differentiates the
American spa from its European counterpart, where the
focus is usually on treating a recognized medical condition.
In the 1970s, hair salons seeking to expand their businesses started to offer la carte spa treatments as well as
regular salon services. This transformation of the salon into
the day spa was the idea of Noelle De Caprio.14 She regularly attended spas in Europe and wanted to offer her clients a mini-spa experience in the convenience of her salon.
She also recognized that Americans rarely had the time or
the money to travel for 3 or 4 weeks to experience spa treatments in Europe. Making these services available locally,
in easy-to-manage, half-day or full-day packages, added to
their popularity. Other salon owners quickly followed De
Caprios lead. By 2010, there were an estimated 19,900 spas
in the United States, and 7 out of every 10 of these establishments is a day spa.15
Over the last 10 years, complementary therapies such
as massage, traditional Chinese medicine, acupuncture,
aromatherapy, meditation, yoga, and hydrotherapy have
gained acceptance with the public, especially for illnesses
and injuries that are not so effectively treated using conventional medical approaches.16 At the same time, Americans

10/24/13 1:04 AM

Spa Bodywork: A Guide for Massage Therapists

now have greater access to information about health care


options. This has led to the birth of integrative approaches
in which alternative and conventional medicine are practiced side by side in many spas to improve health and fight
disease.17 Another factor in the growth of the spa industry is
the general increase in the level of stress being experienced
by the American public and a decrease in the amount of leisure time.18 Spas offer guests a way to decrease stress while
improving their health at the same time.
According to a survey conducted by the International
Spa Association (ISPA), 150 million visits were made to U.S.
spas in 2010, producing $12.8 billion in revenue. Over a
decade, the amount of spa revenue has grown from $5 billion in 1999 to $12.8 billion in 2010. Shopping malls, cruise
ships, and fitness clubs are adding spas, and they have even
become a feature or focus of large hotels and resorts. Once,
spa was only for the wealthy and privileged, but today, there
is a spa experience available for every budget. American spa
owners are a vibrant and creative bunch and draw inspiration from a range of healing modalities, spiritual systems,
and cultural influences to create a unique experience for
their guests.

Basic Spa Categories


Because of the diversity that currently exists within the
industry, spas are difficult to place into clear categories.
For example, spas might be grouped on the length of
the clients stay or on the focus of the spa program. A
destination spa might be a weight loss spa, or it might be
a spiritual retreat. A resort spa might be an adventure spa
focusing on healthy athletes or a family spa with programs
for both adults and children. Spas might be luxury spas
with expensive treatments and high-tech equipment or
budget spas with moderately priced services and a relaxed
dcor. The following list of spa types will help you begin
to understand the general differences between basic spa
categories.

FIGURE 13 New Age Health Spa, New York.

wish to detoxify, a juice fast replaces regular meals. Body


treatments include a full range of services such as a shirodhara spiritual treatment, aromatherapy body wrap, and a
maple sugar body scrub. As the name suggests, this type of
spa targets a client who is looking for a spiritual as well as
physical experience.19

Resort Spas
A resort spa offers different recreational opportunities
such as hiking, rock climbing, water sports, shopping,
tennis, golf, and horseback riding as well as spa services.
Often, it is the beautiful natural landscape around a resort that is the primary reason for the visit, and the spa
itself is just one of many activities offered to the resort or
hotel guest. Some resort spas are a cross between the destination and hotel spa where health programs are on offer,
and guests can choose from low-fat spa cuisine or more
traditional fare. The Watermark Hotel and Spa in San Antonio, Texas, is a resort spa that sits right on San Antonios famous River Walk (Fig. 14). Guests can explore the
2.5 miles of trails that follow the San Antonio River, shop
in boutiques, or make an excursion to the Alamo. The spa,

Destination Spas
Guests visit a destination spa for a weekend, a 4-day program or longer to make significant lifestyle changes or to relax completely. Spa programs focus on fitness, healthy diet,
detoxification, and lifestyle education. Some destination
spas offer classes and services geared toward spiritual as
well as physical renewal. Many destination spas offer a full
menu of beauty services in addition to the spa program. A
good example is the New Age Health Spa (Fig. 13). This is a
destination spa with a philosophy of mindful living, a calm
mind, and a strong body. They offer guests a program that
is spiritual while promoting fitness, good nutrition, and enjoyment of the outdoors. A typical day includes a morning
meditation, a 3-mile hike, and yoga classes. For those who

Williams_2E_CH01_printer_file.indd 6

FIGURE 14 The Watermark Hotel and Spa in San Antonio, Texas.

10/24/13 1:04 AM

Chapter 1

Spa from Past to Present

which occupies the entire second floor of the hotel, offers various beauty services, massage, and hydrotherapy
la carte.20

Amenity Spas
At one time, amenity spas, which are usually found in hotels, offered basic services only and were really an afterthought even in large hotels. A massage room, a simple
fitness center containing little more than a treadmill, and
a basic salon were usually all that was offered to guests.
Many hotels now view spa services as an important contributor to the bottom line, so they have started to offer
full-service facilities.21 Keeping pace with this trend, smaller hotels, bed-and-breakfasts establishments, and even
some time-shares have moved toward offering in-room
massage or mobile spa services if they do not have room
for a full-service spa.

Medical Spas
In many ways, the medical spa is a direct counterpart of a
European spa at which guests receive health care services
in a relaxing and beautiful natural setting. Some hospitals
are adding spas to ease the discomfort of the terminally ill
and to help with pain management. Three different types of
medical spas (sometimes called medi-spas or medspas) are
listed by SpaFinder. 22
The first type is the esthetics-oriented medical spa, which
includes services such as Botox or collagen injections, chemical skin peels, laser hair removal, laser skin treatments,
liposuction, plastic surgery, and sclerotherapy (spider vein
elimination). In this type of spa, medical cosmetic and clinical esthetics procedures are offered together with revitalizing treatments (such as massage) to support the recovery process. A good example is the Juva MediSpa, which is
linked to the Juva Health and Wellness Center.23 Skin health
and beauty are addressed with anti-aging and skin damage
treatments, Botox injections, liposuction, and breast augmentation. The bodymind connection and its effect on
health are treated using hypnotherapy, psychotherapy, fitness training, and nutritional consultations (Fig. 15).
The second type of medical spa is the complementary
or alternative medicine spa, where the program designed
for each guest is based on one of the alternative medicine
systems such as ayurveda or Chinese traditional medicine.
Naturopathic medicine, nutrition therapy, Western herbal
medicine, and acupuncture all fall into this category. The
Maharishi Vedic Health Center in Lancaster, Massachusetts,
uses authentic ayurveda treatments for disease prevention
and chronic disorders.24 Traditional diagnostic procedures
such as Vedic pulse diagnosis are used in designing the
treatment and spa regime. Guests can also take part in yoga
classes, healthy cooking instruction, and evening lectures
on Maharishi Vedic medicine.

Williams_2E_CH01_printer_file.indd 7

FIGURE 15 Juva MediSpa, New York.

The third type of medical spa is the preventive health


care spa in which medical staff carry out a number of tests
(blood tests, bone density screening, etc.) before designing the treatment program. Sometimes, the spa specializes
in general areas such as weight loss, pain management,
or prenatal or postnatal care. They may also offer specific
programs for particular conditions such as diabetes, high
blood pressure, or chronic insomnia. The Canyon Ranch
Health Resort in Tucson, Arizona, combines the wellknown luxury and pampering of the famous Canyon Ranch
Spas with a health and healing center (Fig. 16).

10/24/13 1:04 AM

Spa Bodywork: A Guide for Massage Therapists

FIGURE 16 Canyon Ranch Spa Executive Health Program.

The Executive Wellness Program is a 4-day health program


that includes a complete physical examination as well as lifestyle assessment. The general approach of Canyon Ranch is
to encourage guests to make a long-term commitment to
healthy living so as to decrease the occurrence of disease.25

Day Spas
Day spas are mini-retreats with services delivered la carte
or in half-day to full-day packages. The Day Spa Association defines a day spa as a spa that offers a full range of
treatments including massage, body treatments, hydrotherapy treatments, esthetic services, weight management,
yoga, or meditation, with hair care, manicures, and pedicures. Many business owners are using the term day spa
loosely to indicate an establishment that focuses on beauty
and/or wellness. An example of a creative day spa concept
is Embodywork, a day spa in Decatur, Georgia, that offers
daily retreats based on the principle that a good life begins
with being good to ourselves (Fig. 17).
Clients can choose a half-day or full-day retreat that
begins with a conversation about health, diet, relationships,
and exercise goals. Conscious breathing exercises progress
to a full-body massage and full-body polish. After lunch,
the client can choose between a facial, reflexology, hand and
foot treatment, or body wrap for their final service.26

FIGURE 17 Embodywork, a creative day spa concept in Decatur,


Georgia.

Hot Spring Spas


Hot springs spas use the natural thermal waters from hot
springs in their spa regime or treatments. The Ojo Caliente
Spa surrounds the Ojo Caliente hot springs in New Mexico
(Fig. 18). This spring was sacred to the ancestors of the
Tewa tribes that still live in the region.27 The mineral pools
are open to the public for an entry fee, or spa guests can
opt for a private pool and spa treatments that include
facials, massage, and body wraps.

Williams_2E_CH01_printer_file.indd 8

Mobile Spas
Mobile spas bring day services directly to clients at their
home, office, hotel room, or at a party. The treatments
are designed to be set up and delivered on-site and are
popular as a feature at bachelorette parties, prom parties,
and corporate retreats. Treatments include seated massage, manicures, pedicures, reflexology, facials, and diet
consultations.

10/24/13 1:04 AM

Chapter 1

Spa from Past to Present

Although massage remains the most accepted treatment at spas, facials, manicures, and pedicures are popular. Clients report that they want to focus on health,
fitness, anti-aging, increased energy, and stress reduction.31
Many clients visit spas simply to revitalize themselves and
give themselves a break from work stresses. Cultural elements that include ayurvedic medicine, Native American
wisdom, and Asian influences are used to inspire treatments and create links to the environment and the global
community.
In general terms, spas attract clients by adopting a philosophy and creating a menu of services that appeal to a
specific group of clients. The facility, its visual appearance,
the equipment available, and the price of its services will
also play a role in attracting these target clients to the spa.
Clients are as diverse and difficult to define as the spas they
attend, so it is helpful to look at the different ways that spas
design their programs to attract a particular type of client.

Spas for Women


FIGURE 18 Ojo Caliente Hot Spring.

The Spa Client


In Roman times, the local spa was a focal point of the community and enjoyed by all social classes. This is still the
case in some parts of Europe where spas are a part of the
mainstream health care system. Although the American spa
industry encourages the idea that spa is for everyone and
should be a regular part of a healthy lifestyle, there is still a
bias in the social status of individuals that attend spas.
In the 1960s and the 1970s, the average American spa
client was most likely to be wealthy, female, and overweight. Her goals for visiting the spa probably included
weight loss, exercise, and pampering in the form of beauty
treatments. She expected the best possible service and was
a discriminating customer.28 The ISPA Spa-Goer Survey for
2003 showed that the primary spa client was still female
but has a middle to upper middle class income ($72,200 annual household income).29 This client is most likely to be
Caucasian (87%), with African Americans, and those of
Asian descent making up only 9% of the spa-going population. In 2010, the ISPA reports that spas are branching out,
and spa owners are targeting various income backgrounds
and age groups. The industry study reveals that 80% of spas
have introduced special packages targeted at diverse client
groups, including men, couples, teens, families, athletes,
and seniors. Over 6 in 10 spas introduced discounts and
incentives to attract first-time clients, although franchises
with membership rates took off in 2010.30 The number of
men attending spas is growing rapidly, and men currently
comprise 29% of the market. Products and services for
teenagers are also on the rise.

Williams_2E_CH01_printer_file.indd 9

Spas for women can take many forms. A spa for women
might offer expensive high-tech skin care or detoxification,
vegetarian cuisine, and yoga. Anything and everything is possible. A spa might cater to brides, to mothers and babies, to
athletes, or to grandmothers. For example, the target client
of the Body Shop Spa in Utah, close to Zion National Park,
is a female on a budget (services are moderately priced), between the ages of 18 and 65 years, who wants to lose weight
and enjoy the outdoors. The program at the spa is based
on a seven-point philosophy that addresses nutrition, endurance, strength, flexibility, self-awareness, education, and
relaxation. Manicures, pedicures, and massage are available,
but rock climbing lessons and hiking replace other normal
spa services.32
The Olympus Health Spa in Washington is a womenonly spa because clothing throughout the spa is optional.
Body scrubs and massage are offered in a Roman bath setting while other guests lounge nearby in the hot pools or
converse in the sauna. It is a communal experience that
caters to groups of women enjoying each others company
while they relax and renew. This spa has built its business by
selling the just for women experience.33

Spas for Men


Research carried out using SpaFinder shows that nearly
29% of men book their own appointments, and the number
of men attending spas has tripled since 1987. The International Spa and Fitness Association suggests that spas can
target men by linking spa treatments to health and fitness,
by offering discount treatments for men, and by using spa
treatments as interesting giveaways at business meetings
and conventions. The Nickel Spa in New York City, which
has cobalt and silver dcor, was designed specifically for
men. It has a menu of massage and facials that meet the

10/24/13 1:04 AM

10

Spa Bodywork: A Guide for Massage Therapists

special needs of men including a Love Handle Wrap, a fullbody wax called the Bodybuilders Special, and 15 different
skin care lines.34

Spas for Families


Spas that target families offer services that fit every members needs. There may be a full spa offering services for men
and women as well as programs geared toward teens. Child
care facilities for the younger members of the family might
be offered with programs designed to get everyone together
such as horseback riding or hiking. The Pointe Hilton in
Phoenix, Arizona, is a good example of this because they
offer a full-service spa, coyote camp for the kids, a family
pool, and a golf course.35

Programs for Teens


Some day spas focus on the needs of teenagers with treatments that address oily skin, acne, and sports injury. Spa
prom parties are a clever way to introduce young women and
men to the benefits of spa treatments. Teens enjoy the chance
of preparing for the big event surrounded by a group of
friends getting manicures, pedicures, facials, and body wraps.

Spa into the Future


By its very nature, spa is indefinable, ever changing,
diverse, and evolving. Therapists and clients alike are
embracing spa treatments as a means of promoting health
and wellness. This seems likely to continue as the public understanding of spa treatments develops. The rate
of growth in the industry is expected to become steadier
as the dramatic boom of recent years slows down. It is
likely that spa will continue to drive a movement toward
a more integrated form of medicine. Currently, one-third
of all Americans are in favor of complementary medicine
becoming more widely available within the conventional
medical system. This is the trend in Europe, where 60%
of the public in Belgium and 74% of the public in the
United Kingdom use alternative forms of medicine for
wellness. Spas provide a place where conventional medicine and exceptional client care have become integrated.
Taking care of oneself by being willing to receive care
and pampering is an important aspect of healing in a spa
environment. Although spa is still often considered as
just a luxury, it is likely that spa services will come to be
viewed as necessary for thriving in a fast-paced contemporary lifestyle.

SPA FUSION
INTEGRATION OF SKILLS
STUDY TIP: Group Discussion
We all learn most effectively when we are actively
involved with information. One way to get involved is to
form a study group and hold group discussions about
reading assignments and class lectures. Get together
two to four other students and explore the elements
shown in the image developed by the ISPA Education
Committee (Fig. 19) through the questions provided
below. Have one person keep notes on ideas that came
up during your discussion. Photocopy these notes so
that everyone in the group has a copy. Instructors can
also use these questions for in-class discussions.
1. Four words are used on the outside of the image
(revitalize, rejoice, relax, reflect). Describe what each
of these words means to you and how these words
are mirrored in different activities you undertake in
your life.
2. The words body, mind, and spirit are shown in the
next level of the image. Describe one way you
support the health of your body each day. How do

Williams_2E_CH01_printer_file.indd 10

you support the health of your mind? What about


your spirit?
3. Explore each of the following words as part of a
meaningful spa experience. What does each word
mean to you? How might it be expressed in the
activities a client participates in at a spa?
a.
b.
c.
d.
e.
f.
g.
h.

Nourishment
Movement
Touch
Aesthetics
Environment
Cultural expression
Social contribution
Waters

SPA INSPIRATION: My Spa Experience


Create your own collage of words and images that
express the type of spa experience you would like to
offer clients or receive yourself. Share your collage
with your classmates and explain why the visual elements and words you use express your ideas of spa.

10/24/13 1:04 AM

Chapter 1

Spa from Past to Present

11

SPA FUSION
INTEGRATION OF SKILLS (continued)

S P I R I T

REVITALIZE

REJOICE

S P A C E
R

NOURISHMENT

MOVEMENT

WATERS

TOUCH

INTEGRATION
SOCIAL
CONTRIBUTION

I N

CULTURAL
EXPRESSION

ENVIRONMENT
S

I M

REFLECT

R H
S P A C E

B O

AESTHETICS

RELAX

FIGURE 19 ISPA 10 Elements Image.

CHAPTER WRAP-UP
The ISPA Education Committee developed the
10 Elements of the Spa Experience image shown in
Figure 19 that we discussed previously.36 Their goal
was to help define the elusive and ever changing
nature of the spa experience and to create a foundation, a common language, and career path for the
emerging spa professional. Many concepts, important
to the practice of spa, emerge from the ISPAs dialog
around the 10 Elements image. The most important perhaps is the idea of integration. Everything is
connected. Feeling beautiful, feeling joyous, feeling
healthy, and feeling energetic are signs of a balanced
life. A balanced life requires both reflection and action.

Williams_2E_CH01_printer_file.indd 11

Spas provide a space where clients can experience each


element represented in the image and reflect on its
presence or absence in their lives. Movement, touch, an
appreciation of beauty, our connection to the environment, cultural expression, social contribution, the healing quality of water, and nourishment both of the body
and the soul are the essential concepts on which spa
is founded. The spa experience can be life changing.
Far from being just a luxury, spa therapy represents
the bold first step toward a better form of health care.
Its future is in the hands of those dedicated therapists
and visionary spa owners who have the ability to provide a space where clients can experience balance and
celebrate life while receiving exceptional care.
(continued on page 12)

10/24/13 1:04 AM

12

Spa Bodywork: A Guide for Massage Therapists

SPA FUSION
INTEGRATION OF SKILLS (continued)
REVIEW QUESTIONS
Multiple Choice
1. Many early civilizations had a version of a:
a.
b.
c.
d.

Spa shower
Exfoliation treatment
Meditation center
Spa bath

2. Roman baths may have originally been built to


treat soldiers battle injuries. By 43 AD, they were
used by:
a.
b.
c.
d.

Field soldiers only


Emperors only
All classes of the Roman Empire
Men only

3. The Turkish bath is called a:


a.
b.
c.
d.

Sweat lodge
Garrison
Hamam
Camekan

4. In the 18th and 19th centuries, Europeans would


go to spa towns to heal common ailments such as
rheumatism and respiratory disorders. This practice
was known as:
a.
b.
c.
d.

Take the mud


Take the waters
Take the cure
Take the air

Williams_2E_CH01_printer_file.indd 12

5. The word spa originated from:


a.
b.
c.
d.

A mineral spring town in Belgium named Spa


The Latin words for fountain (espa)
The Latin words for by water alone (solus per aqua)
No one is really sure although more than likely
it is from a Latin source.

Fill in the Blank


6. In Germany, there is widespread acceptance
of spa therapies as a viable form of treatment
for individuals who have not responded to
conventional medicine. This system is called the
___________ system.
7. An Austrian healer named Vincent Priessnitz was
an advocate of the ________ cure.
8. Naturopathic medicine is rooted in the
healing methods of a German priest named
______________.
9. At Bad Hofgastein, patients with arthritis,
sinusitis, and chronic asthma take part in the
Gastein cure. This cure consists of visits to
caves where __________ is absorbed and inhaled
in small amounts.
10. The ISPA Spa-Goer Survey for 2003 indicates that
the primary spa client will be of middle to upper
middle class income and _______________.

10/24/13 1:05 AM

2
Spa Equipment and
Products
Chapter Outline

K e y Te r m s

Dry Room Equipment

Antioxidants: Antioxidants are substances that prevent damage to cells


and DNA by free radicals.
Astringents: Astringents are skin toner for oily skin. They contain alcohol
to dissolve excess oil during facial treatments to ensure the skin is clean
before a treatment product is applied to the face.
Botanicals: Botanicals are plant extracts used in spa products to achieve a
specific therapeutic goal.
Cleansers: Cleansers are skin care products used to remove impurities
from both the skins surface and the pores during routine face cleaning
or during a facial or spa body treatment.
Dry room: A treatment room in which there is no shower or hydrotherapy
equipment.
Exfoliation products: Skin care products used to remove trapped debris
while sloughing off dead skin cells, smoothing the skins surface,
stimulating circulation in the local region of the skin, and relaxing or
invigorating the body.
Fragrance: An ingredient in spa products used to enhance the smell of
a product. Fragrances added to spa produces will be either natural or
synthetic (human-made).
Hot towel cabinet (cabbi): A piece of spa equipment used to heat up
towels for spa treatments.
Hydrotherapy tub: A specialized tub with multiple air and water jets used
to deliver professional therapeutic hydrotherapy immersion treatments.
Moisturizers: Skin care products formulated to soften the epidermis and
increase the skins hydration (water content) by reducing evaporation.
Paraffin warmer: Paraffin warmers (sometimes called dips) hold paraffin wax that is used to cover the hands and feet of the client.
Sauna: Saunas are rooms constructed of cedarwood used to promote
perspiration through dry heat.
Steam room: A steam room is an enclosure that can be filled with steam
from a steam generator so that people can bath in the vapor to induce
sweating or to aid respiratory conditions.
Swiss shower: A specialized shower stall with multiple shower heads that
surround the client with jets of water directed at specific areas of the body.
Toners: Skin care products used to complete the cleansing process and
help to restore the skins acid mantle.
Treatment products: Products such as seaweed or mud that are used
during a spa treatment to elicit a particular therapeutic benefit.
Vichy shower: A specialized shower with a horizontal rod with holes or
water heads that rain water down onto the client from above a wet table.
Wet room: A special treatment room that is tiled, has drains in the floor,
and houses equipment such as Vichy showers or hydrotherapy tubs.

Massage Tables
Basic Linens
Hot Towel Heating Units
Product Warmers
Paraffin Warmers
Body Wrap Materials
Body-Warming Equipment
Spa Clothing
Other Dry Room Supplies

Wet Room Equipment


Tubs
Showers
Specialized Environments
Purchasing and Maintaining Equipment

Spa Products
Cleansers
Toners and Astringents
Exfoliation Products
Treatment Products
Moisturizers
Important Product Terms
Product Exploration

Your Spa Environment


What the Client SeesDcor
What the Client Hears
What the Client Smells
What the Client Tastes
What the Client Feels
Accessibility and Functionality
Planning Spa Treatment Rooms

SPA FUSION
INTEGRATION OF SKILLS
STUDY TIP: Up to the Test!
SPA INSPIRATION: There Is No Substitute for
Direct Experience!
CHAPTER WRAP-UP

13

Williams_2E_CH02_printer_file.indd 13

10/24/13 1:05 AM

14

Spa Bodywork: A Guide for Massage Therapists

There is no doubt that the luxurious surroundings of


an upscale spa enhance the mood and character of the
spa experience. But with attention to detail and with an
eye toward functional ambiance, spa treatments can be
delivered satisfactorily in a small spa, massage clinic, or
private practice without inordinate expense.

equipment, wet room equipment, spa product categories,


and methods for creating a relaxing spa environment. The
detailed procedures for using each piece of equipment
and additional equipment and supplies, which are needed
for specific spa bodywork treatments, are discussed in
greater detail in other appropriate chapters. Sanitation of
equipment is discussed in Chapter 4.

The term spa equipment refers to all items and tools a


therapist might use in his or her spa bodywork practice.
The equipment must be well made, safe, attractive, and
comfortable for the client and not cause undue stress to
the therapists body. Each piece of equipment represents
an investment in your business and in your clients. When
you purchase your own equipment, do so carefully after
researching brands, understanding available options, and
comparing products. This chapter describes dry room

Dry Room Equipment


The term dry room refers to a treatment room in which
there is no shower or hydrotherapy equipment. Instead, hot
towels are used to remove spa products from the clients
body, or clients take showers in a different area. Essential
dry room equipment includes massage tables, linens, hot
towel heating units, product warmers, paraffin warmers,
body wrap materials, body-warming equipment, and other
treatment room supplies (Fig. 21).

FIGURE 21 Examples of dry room equipment. (A) Hot towel cabinet (cabbi). (B) Product warmer. (C) Treatment bar. (D) Paraffin warmer. (E) Body
wrap materials including a wool blanket, thermal space blanket, wet wrap sheet, and plastic body wrap sheet. (F) Free-standing heat lamp. (G) Fomentek
water bottle. (H) Electric (thermal) booties and mitts.

Williams_2E_CH02_printer_file.indd 14

10/24/13 1:05 AM

Chapter 2

Massage Tables
Portable massage tables are a popular choice for massage
therapists who do outcall work or work from their homes
because these tables are designed to fold up for easy transport to different locations. If you intend to offer spa treatments as part of your private massage practice, you may
want to consider investing in a stationary, hydraulic lift,
or electric lift table with additional features such as sit-up
options, side extenders, arm shelves, and plush padding.
Stationary tables are constructed with solid frames that
often include built-in storage space for items such as towels, lotions, oils, and cleaning products. Some newer models include features such as hot towel cabinets, foot soaking
tubs, and sit-up options. Most tables have some type of lift
to raise or lower the table. With a manual lift, the therapist
simply turns a handle to raise and lower the table height.
Hydraulic lifts use a system of pumps and motors to power
the mechanical motion. Electric lift tables use motors to
change the table height. The height of both hydraulic and
electric tables can be adjusted during the treatment, using
a foot pedal, to facilitate different massage or spa techniques or make it easy for the client to get on or off the
table. Because they have heavier bases and height-adjusting
equipment, stationary tables are usually much more expensive than portable tables (Fig. 22).
Table Padding
The padding on massage tables varies from a single-layer to
multiple-layer systems. Multiple-layer systems are typically
more comfortable because the deeper foam layers are firm,
giving support, whereas the upper foam layer is softer and
conforms to the clients body. Padding comes in 1-inch to
4-inch thicknesses. Firm table paddings (1.5 to 2.5 inches)
are sometimes preferred by therapists who offer deeper
techniques because the client doesnt sink away from the
stroke. Therapists who offer spa bodywork or relaxation

FIGURE 22 Stationary table. A stationary table is a good choice for


spa environments because the frame often includes built-in storage space
for items such as towels, lotions, oils, and cleaning products.

Williams_2E_CH02_printer_file.indd 15

Spa Equipment and Products

15

massage sometimes prefer plush padding because the table


feels more comfortable and nurturing.
Covers
Most massage table manufacturers today use different
types of vinyl, with different degrees of softness, to cover
the table surface. Because a sheet covers the table surface,
the softness of the table cover usually does not make a difference to the client. Most important, the cover should be
durable and easy to clean. Oil, creams, and spa treatment
products can break down the top layer of the vinyl, so the
table must be cleaned to ensure that it lasts. Wipe the table
down with a suitable cleaning product between clients and
use diluted bleach solutions only if the table comes into
contact with body fluids. Some therapists use antibacterial
wipes to give the table a quick cleaning and prevent drying
out of the vinyl top.
Accessories
A variety of massage table accessories are available from
table manufacturers to increase the clients comfort and
help you work efficiently without undue stress on your
body (Fig. 23):
Arm shelf: An arm shelf can be attached to the front of
the table to provide a place for clients in the prone position
to rest their arms. This is useful because it gives you easy
access to the sides of the clients body. In the supine position, side extenders can be placed on each side of the table
to widen the table and provide more space for the arms.
Side extenders: Side extenders provide a resting place
for the arms in both the prone and supine positions.
Sit-up feature: Some massage tables allow the therapist to place the client in a sitting position. This is a nice
feature if you plan to work with pregnant clients, if you
offer reflexology, or if you are also an esthetician and
offer facials. A cushion is often needed to support the
clients lower back because the steep angle of the upper
portion of the table tends to create a gap.
Bolsters: Bolsters are used to support the clients body
for complete relaxation while on the table. These pillows
and cushions come in a variety of shapes and sizes and
are usually placed under the knees and neck when the
client is supine and under the ankles when the client is
prone.
Massage stool: Massage stools usually have wheels
so that they can be rolled around the massage table.
Sitting down at appropriate points during the massage
or spa treatment helps rest your feet. Most stools can
be adjusted to different heights, and some are available
with back supports. Some therapists instead sit on a
Swiss exercise ball during sessions, which can encourage
good body mechanics.
Step stool: A stepping stool is useful for clients for getting on and off the table. A long, flat exercise step also
works well because it is wide enough to prevent missteps.

10/24/13 1:05 AM

16

Spa Bodywork: A Guide for Massage Therapists

E
FIGURE 23 Massage table accessories. (A) Arm shelf. (B) Side extenders. (C) Bolsters. (D) Massage stool.
(E) Step stool.

Williams_2E_CH02_printer_file.indd 16

10/24/13 1:05 AM

Chapter 2

Spa Equipment and Products

17

Basic Linens

Blankets

The centerpiece of a well-designed and comfortable spa


room is the massage table well made up with linens. For
therapists on a budget, plain sheets and a large bath towel
can be used. Multi-tonal colors in slightly varying shades
give an impression of texture and depth. Take care to match
the linens to the dcor of the room. An upscale spa might
opt for Egyptian cotton and a matching coverlet with a multitude of different throw pillows. Massage and spa suppliers
provide everything from the basics to very expensive linens.

Have washable cotton blankets on hand to keep the client


warm. Clients often experience a drop in peripheral body
temperature as their blood pressure lowers during the massage or beginning of a spa treatment. This is normal, but a
chilled client cannot relax completely. Heavy blankets feel
nurturing and comforting for many clients and give the
client the sensation of being snug and secure. Some clients
find that heavy blankets feel suffocating and restrictive.
Have a few options on hand to accommodate each clients
needs. The blanket is always placed over the top massage
sheet. If a blanket comes into contact with the clients body
(which is likely), it should be laundered before it is used
with another client.

Massage Sheets
Purchase massage sheets from a massage or spa supplier or
department store (twin size). Cotton, flannel, and cotton
blends all work well and feel soft and comfortable. Make
sure that the material is thick enough to provide sufficient
coverage, avoiding thin see-through sheets that are inappropriate for draping. Make sure that sheets are small enough
not to touch the ground during the session, an unsanitary
condition. White, cream, earth-toned, and pastel colors are
easy to bleach, but darker colors tend to show oil stains.
Massage and spa suppliers sell laundry products that help
to get oil out of massage sheets, but over time, oil usually
build up in the fabric and can smell or look dirty. Plan to
replace massage sheets regularly to prevent this situation.
Disposable sheets are available from spa suppliers, but
these are not as cost-effective as washable linen and impact
the environment with unnecessary waste.
Face Cradle and Bolster Covers
A pillowcase can be used to cover the face cradle, provide
draping material (breast drape, anterior pelvic drape, etc.), or
cover bolsters. Fitted face cradle covers available from massage suppliers are better than a pillowcase because they fit
the face rest snugly and do not fall off. Fitted bolster covers
that enclose the entire bolster prevent cross-contamination
between clients; often, a bolster is not covered but placed
under the bottom massage sheet. Face cradle and bolster
covers that come in contact with the clients skin must be
laundered and changed for each client.
Towels
Bath towels and larger bath sheets are often used over
the top massage sheet to provide warmth and additional
draping material. Choose lightweight ones that will not
be bulky during draping. They are also easy to launder.
Bath towels are often used to wrap hydrocollator packs or
other hot packs to prevent burning the client. Hand towels
are sometimes used as draping material to protect the clients hair from oil or to make a roll to support the neck.
Hot, moist hand towels are used to remove spa products
from the clients skin or to provide a warming body steam
(placed over the face, wrapped around the feet, etc.) during
the session. Any towel that comes into direct contact with
the clients skin or hair must be laundered between clients.

Williams_2E_CH02_printer_file.indd 17

Linen Storage
Linen is washed in hot water with detergent, dried with
heat, and stored in a closed container. You want to have
enough linen on hand to get through 2 days of business
without doing laundry if possible. The amount of linen you
need varies based on the type of massage and spa work you
do. For example, if you provide dry room spa treatments,
you are likely to go through 16 hand towels and 2 bath
towels per client. A good start for a new spa bodywork practice might be 10 sets of sheets, 10 face cradle covers, 15 bath
sheets, 15 bath towels, 100 hand towels, and 2 cotton blankets. Dirty linen is stored in a closed, ventilated container,
preferably outside the treatment room, until it is laundered.

Hot Towel Heating Units


Hot towels are required throughout spa body treatments,
even when a shower is available. You have a number of
options in the way you heat and maintain your towels.
These options include the following:
Hot towel cabinet (cabbi): Hot towel cabinets (often
called a cabbi) range in size from small 6-towel units to
much larger 72-towel units. They look like small refrigerators and are placed somewhere convenient close to
the treatment table.
Hydrocollator: Hydrocollators are most often used to
heat hydrocollator packs but also heat towels and hot
sheets for body wraps. They keep water at a constant
165F and, in busy spas, are useful as a source of hot
water for filling foot soaking containers.
Hot stone heaters: For massage practices and spas that
are on a budget, a hot stone heating unit filled with water
is a cheap and efficient alternative to the more expensive
cabbi. A hot stone heater can hold up to 20 towels and is
also a useful heater for hot sheet wraps, spa products, and
the stones used in a hot stone massage. Remove the towels from the heating unit and wring out the excess water
before putting them into an insulated soda cooler to keep
them hot until use. If only a few towels are needed for the
treatment, a crock pot serves the same purpose.

10/24/13 1:05 AM

18

Spa Bodywork: A Guide for Massage Therapists

Soda cooler: When you remove product with hot towels,


the towels must be close at hand to keep the process
quick and efficient. Walking back and forth to a hot
towel cabbi disrupts the flow of the treatment and is
time-consuming. Instead, transfer the towels from any
of the previously mentioned heating units to a small
soda cooler (9 to 12 quarts) and place this near to the
treatment table for convenience. Make sure to close the
lid of the soda cooler to maintain the heat inside each
time you open it to remove a towel.

Product Warmers
There are some situations where a spa product is meant to
be applied cold, but in most cases, spa product is warmed
before it is applied to the body. There are many different
types of spa product warmers. Some are effectively double
boilers with two pots so that the spa product can warm
inside a small pot placed inside a second larger water-filled
heating pot or an electrically heated outer pot. Lotion
warmers heat spa products to around 122F with a thermostat to control the temperature. A hot stone heating unit
can hold towels on one side and a metal or Pyrex container
full of spa product on the other. To avoid contamination,
cover the container with a lid while it is in the heating unit.
Metal warmers will contaminate seaweed and mud, so usually, these products are heated in a Pyrex glass container in a
water bath and then placed in a plastic container before the
treatment (glass may break, so it is dangerous). Never use a
microwave oven to heat spa products because microwaves
are likely to affect many of the products therapeutic properties. Lastly, many products will break down, change consistency, or lose their therapeutic benefits if left in a warmer
for too long.
Treatment bars are an expensive but handy way to heat
several products at the same time. These bars are usually built
into the treatment room and have a number of inlaid pans
on a large heater, rather like the food heaters used in buffets
at restaurants. The heater pans can hold such varied items
as towels, hot stones, products, hot soapy water for hand
washing, hot wrap sheets, and product application brushes.

Paraffin Warmers
Paraffin warmers (sometimes called dips) hold paraffin
wax that is used to cover the hands and feet of the client.
Paraffin has been used to treat arthritis or sore joints but is
most often applied to enhance other spa services. It is best to
use a high-quality professional unit on a rolling stand rather
than an ordinary home care unit, which usually heats up
more slowly and does not have good temperature control.

Body Wrap Materials


In many spa body treatments, the client is wrapped to
allow the treatment product to absorb or to encourage

Williams_2E_CH02_printer_file.indd 18

perspiration. The type of material used for the wrap will


depend on the amount of trapped body heat needed for
the wrap to be effective and the type of treatment product
being used during the session. These body wrap materials
are commonly used:
Heavy wool blanket: A heavy wool blanket is ideal for
trapping enough heat to make the client perspire in
detoxification wraps. The blanket must be large enough
to wrap up and around a large person (80 to 90 inches
works well). Washable wool is essential because the blanket will need to be washed between clients.
Thermal space blanket: The thermal blanket is a
heavy emergency blanket. It is plastic on the outside and
has foil on the inside to prevent loss of body heat.
Wrap sheets: Hot (or cold) wet wrap sheets (for wet
wraps such as herbal, coffee or milk, and honey) are
made of 100% cotton, heavy muslin, or a combination
of linen and either cotton or fleece. Flannel is never used
with hot wet sheet wraps because it is difficult to wring
out completely, so it may burn the client.
Body wrap plastic and Mylar: Plastic and Mylar sheeting (Mylar is like a light tinfoil) are used with messy products such as seaweed or mud. If the body was wrapped in
a fabric, the fabric rather than the skin would absorb the
product. Plastic and Mylar come on large rolls that are
cut to about 6 feet per client. Mylar tends to keep the
body warmer but is a bit more expensive.

Body-Warming Equipment
In a spa body treatment, the client might be draped with
only a hand towel across the breasts and a hand towel
across the genitals. If external heating is not provided, the
client might get cold during the treatment. Here are some
of the ways you might ensure the clients warmth and comfort during a session:
Heat lamps: Heat lamps can be hung above the treatment table and placed on a dimmer switch to allow for
more or less heat. Free-standing units with flexible necks
are available, but these have large heavy bases that take
up a good deal of space in the treatment room.
Electric table warmers: Electric table warmers can be
used to heat up the sheets before the client gets onto the
treatment table. For body wrap treatments, the client
will often be lying on a piece of plastic sheeting that
sits on top of a thermal blanket and wool wrap blanket. Electric table warmers cannot warm the client sufficiently through all of these layers and are not used in
this situation.
Table pads: Wool and fleece table pads provide extra
softness and warmth on the massage table. Many contain electrical heating devices with adjustable heat controls to keep the client warm during the session. Some
therapists believe that electrical devices disrupt the
clients electromagnetic energy field, however, and use

10/24/13 1:05 AM

Chapter 2

such pads only to warm the table; they turn off the pad
once the client arrives. Wool is a desirable material because it breathes and allows the body to regulate its own
temperature a little better. The drawback of wool pads is
that they require dry cleaning and may cause some clients to experience allergic reactions. Synthetic fiber and
cotton pads are also available.
Fomentek: A Fomentek is a large water bottle designed
to sit flat on the treatment table. Put the bottle under a
pillowcase and place it directly beneath the plastic layer
or the wet sheet. This provides warmth and comfort during a body wrap.
Microwavable packs: Corn, rice, or flax packs heated in
a microwave are a good way to apply external heat to a
client during a spa treatment. Do not use a hydrocollator pack because the client may get burned if he or she
lies down on top of the pack. Instead, hydrocollator
packs can be placed under the feet to increase core body
temperature.
Booties and mitts: Electric or microwavable booties
and mitts are good for keeping spa products warm on
the feet or hands. They can be used at any time to keep
the client warm, but if used for too long, the clients
limbs may start to feel heavy and swollen. Because thermal booties and mitts cause increased vasodilatation in
the distal limb, it is important to use flushing strokes
toward the heart after removing them.

Spa Clothing
Clients receiving a spa body treatment may feel uncomfortable with the degree of skin exposed during the session. Although the breasts and genitals are never exposed,
the client might only be draped over these areas. Disposable undergarments preserve client modesty and make spa
product application easier because they are made of a thin,
permeable fabric that allow spa product to reach the skin.
Small-, medium-, and large-sized womens briefs, thongs,
and bras and mens briefs or boxers should be made available to clients. For wet room treatments, dark blue or black
disposable undergarments are much better than white ones,
which become transparent when wet. A fluffy terry robe,
washable spa slippers, terry hair protectors, and terry body
wraps allow clients to move about in the spa or to move
from one treatment room to another in comfort.

Other Dry Room Supplies


Dry rooms used for massage and spa treatments need certain basic items to be functional and efficient. These items
might include the following:
Reference library: During the course of your professional practice, you will need to look up a condition,
medication, or other information. Key reference books
that should be available include an up-to-date medical
dictionary, drug reference, and a pathology reference

Williams_2E_CH02_printer_file.indd 19

Spa Equipment and Products

19

book. Access to the Internet is also a plus because it


allows you to quickly look up information on emerging
drugs, pathologies, and recommendations for session
protocols.
Clock: A visible clock helps you stay on schedule and
adjust your treatment plan as the session progresses.
Spa treatments and treatment elements requiring specific application times (body wraps, mud or seaweed
applications, etc.) are easily tracked using a digital timer.
Storage area: A cabinet with hinged or sliding doors is
best to keep extra supplies such as table cleaners, extra
hand gel sanitizer, boxes of tissue, and clean linens out
of sight. Soiled linens should be stored in a closed, ventilated container, preferably outside the treatment room
in a separate laundry area.
Wastebasket: Wastebaskets in massage treatment rooms
should have a lid opened and closed with a foot pedal to
prevent hand contamination. Dispose of paper towels
used for cleaning the massage table and hard surfaces,
used vinyl gloves, used tissues, and other items in the
wastebasket. The wastebasket should be cleaned and sanitized at the end of each day.
Music system: Music often significantly impacts the
clients ability to relax and enjoy the session. The music
system might be as simple as a CD player or MP3/
iPod system. Ensure the sound has a clean quality and
that the system is in good working order (no skipping
CDs, etc.).
Supplies for cleanliness and safety: Approved cleaning products (discussed in Chapter 3), paper towels,
extra tissue boxes, gel hand sanitizer, alcohol, finger cots
(vinyl finger covers to protect against the transmission of
pathogens if your cuticles are rough or if your skin is broken), vinyl gloves, and a first aid kit should be stored in
the treatment room for ease of access. Also, have a large,
battery-operated flashlight in case of a power failure.

Wet Room Equipment


The term wet room refers to a treatment room that contains specialized hydrotherapy equipment such as professional grade tubs, showers, and wet tables. Often, wet rooms
will be tiled and have drains in the floor for easy cleaning.
The unique pieces of equipment that might be found in wet
room environments can be broken into three categories:
tubs, showers, and specialized environments.

Tubs
Therapeutic baths (sometimes called balneotherapy) use a
variety of tubs in different sizes with different features to
provide clients with a relaxing and beneficial experience
(Fig. 24). Essential oils (aromatherapy bath), herbs (herbal
bath), seaweed, seawater or algae (thalassotherapy or algotherapy), and mud or clay (fangotherapy) are common

10/24/13 1:05 AM

20

Spa Bodywork: A Guide for Massage Therapists

FIGURE 24 Tubs. (A) A full-body immersion could be offered in a whirlpool, professional hydrotherapy tub,
or soaking tub. It may contain additives such as seaweed, fango, or herbs. (B) Professional hydrotherapy tub with
underwater massage.

additives that increase the therapeutic benefit of the water


treatment. Tub features will vary based on the manufacture.
Read the instruction manual that comes with each piece
of equipment carefully for proper operation and sanitation. The types of tubs commonly used at spas include the
following:
Foot soaking tubs: Foot soaking tubs range from inexpensive basins filled with warm water and additives to
deluxe pedicure stations with whirlpool features. Pedicure stations consist of a comfortable reclining chair
with an attached foot soaking basin plumbed for water
and drainage. They often have a whirlpool feature with
jets that agitate the water, which feels pleasant to the
feet, and a handheld spray used to remove spa product
or rinse the feet. Although they are most often used during the delivery of pedicures, which is out of the massage
scope of practice and provided by nail technicians, they
work well for therapists offering reflexology-based foot
spa treatments as discussed in Chapter 10.
Soaking tub: Soaking tubs at spas are like standard
bathtubs but much more luxurious. They tend to be high
sided, roomy, and design savvy. Soaking tubs might be
used to warm the body before a treatment or soothe the
body and remove product at the conclusion of a session.
Whirlpool tub: Whirlpool tubs have jets that agitate
the water and bounce it against the clients body. This
manipulates the soft tissue and causes effects similar to
some massage strokes. Whirlpool tubs might be used
as a standalone treatment or as the beginning or ending to a combined session where multiple treatments are
strung together.
Hydrotherapy tub: The main type of tub used in a spa
setting is a hydrotherapy tub. These tubs are designed for
professional use with multiple air and water jets. Professional hydrotherapy tubs have an underwater massage
hose that uses air pressure aimed at specific body areas to

Williams_2E_CH02_printer_file.indd 20

improve circulation and lymph flow. Modern hydrotherapy tubs come with a self-cleaning function that makes
sanitizing the jets of the tub easier. The therapist puts a
concentrated disinfectant (formulated by the manufacture of the tub) in a special holder and then pushes a
button.

Showers
Therapeutic showers are used to remove a product from the
client, to facilitate a desired physiological effect, to warm
the body in preparation for another treatment, or to cool the
body at the end of a treatment (Fig. 25). Shower features
will vary based on the manufacture. Read the instruction
manual that comes with each piece of equipment carefully
for proper operation and sanitation. In a spa wet room, five
main types of showers are used:
Handheld shower and wet table: A handheld shower is
used in combination with a wet table for the easy removal
of product. Some handheld showers can deliver a pulsating water massage and may also have an attachable body
brush for exfoliation. A wet table has a special surface to
channel water into a receptacle under the table or a drain
in the wet room floor. The table is often constructed of
heavy plastic or acrylic for easy clean up and sanitation.
A soft waterproof insert makes the table comfortable for
the client.
Standard shower: A standard home shower is less expensive than a Swiss or a Vichy shower but does not allow
the same range of control. The pressure of the water, the
degree of pulsation, and the temperature of the water cannot be controlled by the therapist as they can with more
specialized equipment. The client is moved between the
massage table and the shower as needed during the treatment to remove product, or the client uses the shower to
freshen up at the end of a session.

10/24/13 1:05 AM

Chapter 2

Spa Equipment and Products

21

E
C

FIGURE 25 Showers. (A) This image shows a handheld shower used in combination with a wet table. (B) A standard shower is less expensive than specialized showers but does not allow the same range of therapeutic control. It is
used primarily for removing spa treatment products or cleaning up at the end of a session. (C) A Swiss shower surrounds the client with jets of water directed at specific areas of the body. (D) A Vichy shower is a horizontal rod with
holes or water heads that rain water down onto the client from above the wet table. (E) A Scotch hose directs a strong
stream of water at the client to increase vital energy and for other therapeutic purposes.

Williams_2E_CH02_printer_file.indd 21

10/24/13 1:05 AM

22

Spa Bodywork: A Guide for Massage Therapists

Swiss shower: A Swiss shower surrounds the client with


jets of water directed at specific areas of the body. Usually, the shower stall has pipes in all four corners with 8
to 16 water heads coming off each pipe. The water heads
are adjusted according to the clients height and the
treatment goals of the session. A control panel outside
the shower stall allows a therapist to control contrasting
warm and cool jets of water.
Vichy shower: A Vichy shower is a horizontal rod with
holes or water heads that rain water down onto the client
from above the wet table. Vichy showers are used to rinse
spa products off the client, but they can also be used as
a treatment in themselves. A control panel allows the
therapist to alternate between hot and cool water, which
increases the therapeutic benefits of some products and
uses the mechanical effects of water on soft tissue. Vichy
showers have an adjustable face guard that is meant to
keep water off the clients face.
Scotch hose: A Scotch hose is an apparatus that directs
a strong stream of water at the client for therapeutic purposes. Clients stand at the end of the wet room holding
on to handles that are attached to the wall while a therapist directs the pressurized stream in a specific sequence
over the clients body.

Specialized Environments
Specialized environments are used at spas to produce a
specific therapeutic effect by forcing the body to maintain
homeostasis in response to calculated environmental influences (Fig. 26). The types of therapeutic rooms or adaptations often found at spas include the following:
Steam room: A steam room is a room or enclosure that
can be filled with steam from a steam generator so that
people can bath in the vapor to induce sweating or to
aid respiratory conditions. There are many special considerations when building a steam room because it is a
moist environment where all building materials must
be waterproof or resistant to corrosion and decay. Seats
inside the steam room are built with a slop to allow condensation to run off of their surfaces. A floor drain and
nonskid floor ensures a clean and safe environment.
Steam showers: Steam enclosures are specialized showers that produce the same effects as a steam room but in
a shower-like environment. They often have steam heads
that fill the enclosure with steam vapor and a shower fixture that can be used alternately with steam.
Steam cabinet: Steam cabinets are like small steam
pods. The client sits down on a plastic bench, and the

FIGURE 26 Specialized environments.


(A) Steam shower. (B) Steam canopy. (C) Sauna.

Williams_2E_CH02_printer_file.indd 22

10/24/13 1:06 AM

Chapter 2

cabinet is closed around him or her, leaving the head


exposed. Steam cabinets are often used to warm and
moisten product while it is absorbing into the skin.
Steam canopy: A steam canopy fits over the top of a wet
table or massage table and can be used in place of a blanket for body wraps. Like a steam cabinet, the head of the
client resides outside the warm and steamy interior environment, which may be used to promote detoxification
or to encourage product absorption.
Sauna: A sauna is a room that is constructed of either
cedarwood or hemlock because these woods can withstand moisture and resist fungi. Saunas are used to promote perspiration through dry heat and to help the body
to naturally detoxify. Saunas contain a kiuas. This is an apparatus that heats rocks that are used to heat the air inside
the sauna. Water is poured on the rocks to briefly elevate
the humidity in the air and the temperature in the sauna.

Purchasing and Maintaining Equipment


The right equipment is an absolute necessity to the spa
therapist. Keep these items in mind when you source, assess,
compare, and decide on equipment purchases:
Durability: Many therapists purchase economical home
care equipment such as paraffin warmers or hot stone
warmers with an eye to cutting costs. This type of equipment is meant for infrequent home use and cant hold
up to continuous use in a busy spa or massage clinic.
Purchase professional equipment that will last your
business for at least 5 years.
Manufacturers time in business: Assess any equipment manufacturers for the amount of time they have
been in business. Some equipment comes with warranties that can protect your investment should the item
malfunction or break down. You want to know that the
manufacturer is going to be in business should you need
replacement parts or equipment.
Consumer reports: Before purchasing equipment, read the
consumer reports on the item to find out about the experiences of people who have worked specifically with the piece
of equipment you are contemplating for your business.
Return on investment: Spa equipment is often luxurious and opulent. Its easy to get enticed to purchase
something that is beautiful but wont provide an appropriate return on investment. Think about how many
specific treatments you will have to deliver in order to
pay off the equipment when you contemplate what you
really need for your business.

Spa Products
If you add spa treatments to your menu of services in your
private practice or if you work as an employee at a spa, you
will be surrounded by a multitude of different spa products.

Williams_2E_CH02_printer_file.indd 23

Spa Equipment and Products

23

Its important to know some basics as you start to explore


the differences in spa products and methods for working
with them effectively. You will also want to review the safety
recommendations related to the skin and spa products discussed in Chapter 3 (Client and Therapist Safety).
Spa products fall into basic categories including cleansers, toners or astringents, exfoliation products, treatment
products (sometimes called masks), and moisturizers.

Cleansers
Cleansers rid the skin of dead cells, excess sebum, dirt, and
other impurities. An effective cleanser removes impurities
from both the skins surface and the pores. Soaps are alkaline and will strip the skin of its acid mantle upsetting the
proper pH of the skin and leaving it dry. Soaps also leave
a dulling film on the surface of the skin. It is important
to find a gentle body cleanser that rinses off completely.
A cleanser will often be used at the beginning of a treatment
to purify the skin before a second product, such as a treatment mask, is applied. A cleanser applied with warm water
provides enough lubrication for Swedish massage strokes
to be used. This relaxes muscles, stimulates circulation, and
adds a textural experience for the client. The use of water
with the massage strokes stimulates and energizes the body.

Toners and Astringents


Toners complete the cleansing process and help to restore
the skins acid mantle. They are usually glycerine based and
do not contain alcohol, so they are suitable for dry skin
types. Astringents are a stronger form of toner designed
for oily skin. Astringents usually contain alcohol to dissolve excess oil. Toners leave the skin feeling fresh and cool.
Alcohol is very drying for the skin, but a gentle toner applied
with massage strokes feels invigorating and refreshing. As
we progress through chapters, you may notice that a skin
toner is often used as a treatment step in the procedures
section. This is a good skin care practice but also acts as a
safety measure. Toners return the skin to a balanced pH,
which decreases the chances of the client developing skin
sensitivity to strong treatment products such as seaweed.

Exfoliation Products
Exfoliation products are used to remove trapped debris
while sloughing off dead skin cells, smoothing the skins
surface, stimulating circulation in the local region, and relaxing or invigorating the body. The salt glow is a classic
exfoliation treatment that first developed as a friction
technique in traditional hydrotherapy. At the time, its primary focus was to increase the vital energy of the body and
not to smooth the skin. These treatments were applied to
patients in weakened conditions who had various, often undiagnosed, chronic medical conditions. Now, it is a popular
and refreshing body treatment offered at most spas.

10/24/13 1:06 AM

24

Spa Bodywork: A Guide for Massage Therapists

New therapists and clients practicing skin care at home


often overexfoliate the skin by working too vigorously or by
using exfoliation products too often. Overexfoliation on a
regular basis can lead to an increase in epidermal thickness
resulting in a leathery skin appearance. The skin should
not be exfoliated more than once a week except by estheticians for a specific treatment goal.

Treatment Products
Treatment products, sometimes referred to as masks are
usually applied with a specific purpose or treatment goal in
mind. One treatment product might be applied to the body,
or a series of treatment products might be applied in a particular order. There are many different treatment products
options you might try depending on the session goals and
the type of consistency you want in the product (the feel of
the product on the skin).
Treatment products tend to have benefits for the skin
and may also have benefits for muscle, stress reduction, or
enhanced body energy. An example is Parafango, which is a
mixture of mud and paraffin. Massage therapists might apply
Parafango to relax hypertonic muscles, soothe arthritis pain,
and promote greater range of motion. An esthetician would
find it useful in improving the appearance of cellulite. A fullbody seaweed mask is an effective treatment for fibromyalgia,
stress reduction, and low energy. The mineral elements in
many seaweed products are absorbed through the skin and
support the general health of the entire body by stimulating
metabolism and the natural detoxification processes of the
body (see the safety information on seaweed before using it
on yourself or with clients). An esthetician will apply a mask
to the facial or body skin to tighten sagging skin, absorb
excess oil, hydrate and moisturize the skin, soothe irritated
skin, and beautify the skin.

Moisturizers
Moisturizers are usually applied at the end of a session to
replace any natural skin oils and moisture lost during the
other steps of the treatment. Moisturizers are most often
formulated to soften the epidermis and increase the skin
hydration (water content) by reducing evaporation. They
might also be formulated to tighten the skin so that it
appears firmer or to deliver therapeutic components such
as retinol (vitamin A), which reduce the appearance of fine
lines, wrinkles, and skin discoloration. Moisturizing components can be broken into three areas:
Occlusives: These are components in moisturizers that
work by forming a thin film on the surface of the skin to
reduce moisture loss from evaporation.
Humectants: This type of component attracts water
from the air in order to hydrate skin.
Emollients: These components restore oils to skin that
is deficient in factors such as amino-lipids to make the
skin softer, pliable, and more resilient.

Williams_2E_CH02_printer_file.indd 24

Moisturizers can be classified depending on their oil, water,


and wax content. In general, from heavier to lighter, you
will find:
Balms or butters: These types of products are often
water free and contain mixtures of oil and beeswax that
are very heavy and protective. They might be used in
cold weather seasons to lock moisture into the skin and
guard against lower temperatures and the elements such
as wind, which can chap the skin.
Creams: Creams are combinations of oil and water but
tend to have more oil than lotions.
Lotions: A lotion tends to have a lower emollient content
than a cream and may be water based or aloe vera based.
It feels lighter on the skin because it is less occlusive.

Important Product Terms


Learning to read a product label is an important skill for
anyone applying spa products to clients. A product label
will indicate the type of seaweed or botanical product which
has been added, if dyes or fragrances have been added, if the
product has ingredients that might be potential allergens
for a particular client, or that the product has undesirable
fillers or chemicals. Miladys Skin Care and Cosmetic Ingredient
Dictionary by Natalia Michalun is an excellent guide to
product ingredients.1 The following terms are used widely,
so they require a basic explanation.
pH
The pH of a product refers to its level of acidity or alkalinity;
pH is measured on a scale of 1 to 14, from acid to alkaline.
A pH of 7, which is in the middle of the scale, is considered
to be neutral. If the products pH is lower than 7, it is acidic.
If its pH is higher than 7, it is alkaline. The skin is naturally
slightly acidic with a pH between 4 and 6 depending on the
skin type. In general, the less acidic the skin (the higher the
pH number) is naturally, the more prone it is to irritation
and sensitivity. The more acidic the skin (the lower the pH
number) is naturally, the less prone it is to sensitivity.
Antioxidants
Antioxidants are substances that prevent damage to cells
and DNA by free radicals. Free radicals are compounds produced by chemical reactions in the cell that involve oxidation. Normal metabolic reactions and external factors such
as UV radiation, exposure to chemicals such as pesticides,
air pollution, drugs, and cigarette smoking can produce
free radicals. Free radicals interfere with a cells biochemistry and play a role in some diseases associated with age
including heart disease and cancer. They attack fats, carbohydrates, proteins, and enzymes including the collagen
in the dermis. This results in decreased skin elasticity and
pliability. Common antioxidants include vitamins E and
C, carotenoids (lycopene, lutein, beta-carotene), selenium,
green tea, and honey. These ingredients are often found in
anti-aging cosmetics or after-sun products.

10/24/13 1:06 AM

Chapter 2

Botanicals
Botanicals are plant extracts used in spa products to
achieve a specific therapeutic goal. The botanical extracts
added to a preparation are often chosen because they are
anti-inflammatory, soothing, or antiseptic, although they
may have a wide range of other actions depending on the
extract. The concentration of the botanical extract and
other components in the preparation will determine the
overall therapeutic value of the preparation. Sometimes, an
extract is added to a preparation for marketing purposes in
very low concentrations, so it will add very little if anything
to the therapeutic properties of the product. Sometimes,
the preparation only contains an isolated chemical component of the original botanical extract.

Spa Equipment and Products

25

to remove from the clients body and may require a foaming cleanser to lift it off the clients skin. Some products
may dry out quickly and need a plastic cover to keep them
moist. It is not a good idea to find these things out during
a session. Ordering and trying out new spa products is the
best way to discover new treatments and new ways of using
products. Only by practicing regularly with products will
the treatment steps and transitions between the steps become easier. For example, there is an exfoliation product on
the market that goes on wet and dries as it is rubbed in. It is
brushed away with a dry towel. It requires only one towel for
removal on the entire body (eight towels would normally be
required). This is faster and easier than a wet exfoliation
requiring hot towel removal, and it feels just as satisfying as
dry skin brushing (discussed in Chapter 8).

Fragrance
Fragrances enhance the smell of a product, and even products such as seaweed and mud are often fragranced. The
fragrance used will be either natural or synthetic. Natural
fragrances are usually based on natural essential oils or botanical extracts. Synthetic fragrances are usually composed
of a small number of artificially synthesized compounds,
which on their own may cause skin irritation or unwanted
side effects such as headaches or a slightly sore throat. The
popularity of aromatherapy has led to the increased use of
essential oils in expensive skin care lines. Although this is
a positive move, it is difficult to determine the quality and
purity of the essential oils that are being used.
Natural Ingredients
The term natural is not regulated in the cosmetic industry.2
A company can legally put just about anything in their
product and call it natural if they want to. A product line
claiming to be all natural will usually still contain some synthetic ingredients, dyes, or preservatives. In aromatherapy,
it is well known that an essential oil may smell differently
from batch to batch. The smell of the oil is naturally variable due to the climatic conditions during the year in which
it was grown, the time of day at which it was harvested, the
skill of the distiller, and the means by which it was stored
and shipped. All of these circumstances will affect the final
chemical composition of the oil and therefore its therapeutic properties and its smell. If the oil smells the same from
batch to batch, the consumer would be right to wonder if
the oil has been adulterated with isolated components or
synthetic additives to achieve a reliable fragrance. Many
products claiming to be all natural have a consistent fragrance, which is not possible without the addition of other
chemicals to standardize the scent.

Product Exploration
It is important to know the products that you are using
and to play with the products before you apply them to
a client. Individual seaweeds will have different mixing and
spreading properties. Some types of mud will be difficult

Williams_2E_CH02_printer_file.indd 25

Your Spa Environment


The clients perception of the massage business is created
or altered through his or her five senses because this is how
we interpret our environment. We create a special spa environment by paying attention to what the client sees, hears,
smells, tastes, and feels during the session. If you own your
spa business, you have control of many of the issues we are
about to discuss. If you work as an employee, you will have
less opportunity to determine how the environment of the
business is set up. Still, by considering client perception and
comfort issues, you can make good choices in the development of your own business space or make good recommendations to your employer if it is necessary.

What the Client SeesDcor


Every business has its own unique focus and personality.
A therapist who practices relaxation massage, soothing spa
body treatments, and stress reduction is likely to operate in
a different environment from the therapist who practices
clinical massage and spa body treatments with a rehabilitative or health care focus. The first may choose soothing
color combinations and images of natural beauty for the
walls, whereas the second might choose a neutral color
palate, medical charts, and anatomical models. To choose
your own appropriate dcor, consider the techniques you
will use and the types of clients you desire. Color, window
treatments, flooring, lighting, wall decorations, and extra
touches are all elements of decoration.
Color
There are many ways to think about color, and choose the
colors that are right for your business. Therapists can learn
from color psychology and color symbolism in making
their decisions.
Color psychology is a field of study that evaluates the
effect of color on human behavior and emotion. Color symbolism explores the cultural significance of color and what

10/24/13 1:06 AM

26

Spa Bodywork: A Guide for Massage Therapists

Yellow:

Blue:

Stimulating
Increased mental attention
Increased anxiety ratings
People argue more in
yellow rooms
Babies cry more in
yellow rooms

Decreased irritation levels


in stressful conditions
Decreased anxiety ratings
Decreased blood pressure
Slowed breathing patterns
Increase of physical
performance

Orange:
Creative stimulant
Increases enthusiasm
Used in color therapy for
respiratory conditions
Increased metabolism

Color
Psychology
Purple:

Red:

Appetite suppressant
Decreased anxiety
Mentally balancing
Creative stimulant

Green:

Increased blood
pressure
Adrenal stimulant
Increased anxiety
Increased performance
on tasks

Decreased tension and


stress
Decreased anxiety ratings
Decreased blood pressure
Decreased performance
on tasks
Balancing

FIGURE 27 Color psychology is a field of study that evaluates the effect of color on human behavior and
emotion. This diagram shows some of the effects of color based on research.

colors mean to different groups of people. Color psychology is appropriate for situations in which the business has
no cultural overtones. For example, a therapist who delivers
relaxation treatments might use a green palate because studies have demonstrated that green colors decrease tension and
stress, slow breathing patterns, and, in some cases, decrease
blood pressure.3,4 A clinical massage therapist or a spa focused
on physical fitness might note the results of a study showing
weight lifters can lift more weight in rooms with a blue palate;
blues seem to promote strength and physical gains.5 A therapist working with pregnant mothers, parents, and infants
would not choose a yellow palate because research shows that
babies cry more frequently in yellow rooms (Fig. 27).6
Color symbolism works well when a business has cultural
overtones or a specific client group (Fig. 28). For example,
a business focused on Eastern bodywork might choose colors with cultural significance in Asian countries. The color
red might play a decisive role because in Asia, red is the color of good luck and a wedding color. It has positive, joyful
overtones. A business set in a busy urban area and wanting
to attract businessmen might choose a blue palate because,

Williams_2E_CH02_printer_file.indd 26

in Western society, blue is associated with excelling (blue


ribbon), loyalty (true blue), and noble descent (blue blood).
It is also associated with intelligence (bluestocking) and
morality (blue laws).
Window Treatments
Window treatments are an important design feature in
any room and provide privacy, light control, and style. In a
spa environment, privacy is very important. Window treatments should not be so sheer that people outside can look
in and see the body treatment session. Window treatments
also control light entering the room. Natural light streaming through sparkling windows might be desirable during
the client consultation or assessment. When the spa treatment starts, softer, dimmer light is more relaxing. You can
choose between semi-sheer fabrics that diffuse the light and
rich opaque fabrics that shut it out completely.
Windows are often the main focal point in the treatment
room. Interesting and well-planned window treatments
add style and eye-catching appeal. They also absorb sounds
from outside and from the room itself, helping create a

10/24/13 1:06 AM

Chapter 2

Spa Equipment and Products

27

Yellow:

Green:
Nature and the beauty
of nature
Movement forward
Youth
Naivet
Jealousy
Envy
Victory (in Greece)

Blue:
Travel
Loyalty
Feelings of sadness
Unexpected opportunities
Social prominence
Achievement
A noble character
Intelligence
Protection from harm
Morality

Warmth
Stimulating conversation
A warning
Cowardliness
(in Western cultures)
Courage (in Japan)
The season of spring
Support to soldiers who
are in battle
Sourness (the flavor)

Black:
Sophistication
Elegance
Expertise
Darkness
Loss of consciousness
Things that are
underground or illegal
Punishment

Purple:

White:
Heaven
Gods
Angels
Truce and peace
Things that are rare
Purity
Cleanliness

Red:
Energy
Aggression
Passionate love
Beauty (in Russia)
Luck and happiness
(in Asian cultures)
Battle (in Roman times)

Royalty
Authority
High-ranking official
Exaggeration
Ornamentation
Meditative states

FIGURE 28 Color symbolism explores the cultural significance of color and what colors mean to different
groups of people. This diagram shows some of the cultural associations of color.

quieter overall environment while conserving energy by


insulating the glass.

In the treatment room, dimmer switches work well. Lights can


be made bright for cleaning or sanitizing equipment, put at a
medium setting for the health intake consultation, and turned
down for the spa treatment. Several pools of soft, diffused
light or diffuse natural light are more relaxing than one bright
light in a corner or the room being too dark. Avoid the use of
candles because open flames are a safety hazard, and they can
pollute the air, especially when they are used in small rooms.

used to help clients feel connected to the earth and nature.


Clinical or rehabilitative businesses benefit from medical
charts and images that allow clients to see and understand
the structures involved in their soft tissue condition. Businesses specializing in Eastern bodywork or Eastern-inspired
spa treatments are likely to hang Asian images or objects on
the walls to evoke a sense of that culture and create continuity in the clients experience. Wall decorations can be functional as well as beautiful. For example, fabric wall hangings
dampen noise, whereas a stylish mirror gives the client a place
to freshen up at the end of the session and allows the therapist
to check his or her body mechanics during the session.

Wall Decorations

Extra Touches

Wall decorations can promote the image of the business,


make a soothing impression on the client, and dampen sound.
In relaxation-oriented spas, images of natural beauty are often

Decorative items on shelves, side tables, and windowsills help


create interest and define the rooms style. A relaxation business
using an all-natural theme might display shells, nonblooming

Lighting

Williams_2E_CH02_printer_file.indd 27

10/24/13 1:06 AM

28

Spa Bodywork: A Guide for Massage Therapists

plants (to avoid allergies), or interesting stones. A clinical or


rehabilitative business might feature anatomical models of
the body. Rattan baskets, bamboo, and Japanese river stones
might adorn an Eastern bodywork business. Items can be functional as well as decorative. For example, in a business focusing
on ayurvedic bodywork, one therapist has different types of
Indian, Nepalese, and Bhutanese bells and chimes on display.
They are beautiful to look at but also sound lovely when she
rings one to signal the beginning and end of the session.

What the Client Hears


The auditory environment is also important because it sets
the tone for the session and may mask outside noise. Consider the treatment room flooring. A tile or wood floor may
cause echoes that are annoying or distracting. The wrong
sort of music may also be disturbing and irritating to the
client. Most therapists have probably heard spa or massage
CDs that are downright alarming. One CD on the market
features wolves howling incessantly in every songit is difficult for a client who feels like prey to relax!
The right music can evoke strong feelings and beneficial
physiological changes in the client. Research shows that
music decreases anxiety, decreases systolic blood pressure,
and decreases heart rate even when the person is actively
stressed.7 Music also exerts complex influences on the
central nervous system and can, in a short period of time,
change brain waves associated with an alert state to brain
waves associated with a relaxed state.8 In a single session of
music therapy delivered to hospice patients with chronic
pain conditions, music decreased the participants overall levels of pain and increased their physical comfort.9
Research also shows that the positive physiological benefits
of music are increased when patients can choose their own
music.10 It is a good idea to have a variety of musical styles
available and to ask clients about their musical preferences
during the client consultation. Clients can also be encouraged to bring their own appropriate music for the session.

morning until after the last session of the day. The use of a
sea salt scrub on your hands can help to exfoliate skin that
holds the aroma of cigarette smoke. Although this might
seem harsh, clients who do not smoke often find the lingering smell of cigarette smoke intolerable.
In a therapeutic setting, the good smells from natural essential oils used in aromatherapy can promote relaxation
and a pleasant mood. This is important because stress is at
the core of many modern diseases, and studies suggest that
decreasing stress improves ones health and immunity.11,12
Smells can evoke intense emotional reactions and can even
be used to change behavioral patterns. Credible evidence
shows agreeable aromas can improve our mood and sense
of well-being.13 This is not surprising because olfactory receptors are directly connected to the limbic system, the oldest and most emotional part of the human brain.
In a study of how scent impacts social relationships,
people in photographs were given a higher attractiveness
rating when the test subjects were exposed to a pleasant
fragrance. In a test of shampoos, a product initially ranked
last in performance was ranked first in a second test after its
aroma was adjusted.14
Therapists can use gentle, soft aromas to enhance the
clients perception of the business and to provide an emotionally satisfying experience. For example, diffusing citrus
essential oils throughout an area can purify the air, repel
insects, enhance mood, and make the area smell clean and
fresh. A commercial nebulizing diffuser works well to eliminate microbes and promote a clean, healthy living or working space (Fig. 29). Avoid the use of strong scents and even

What the Client Smells


Good ventilation and fresh air are important in the spa
treatment space. In the warm, closed environment of the
treatment room, aromas from a previous client (e.g., heavy
perfume, cigarette smoke) can persist into the next session
if the room is not well ventilated. Open the windows between clients if possible or point a fan at the ceiling to circulate the air. Leafy, nonblooming foliage plants make good
natural air purifiers. Because many clients have allergies to
blossoms, flowers, despite their beauty, should not be used
in the treatment room.
Therapists must also consider their own smells and how
they may impact a client. Avoid strong-smelling deodorants, perfumes, and aftershave products. Brush your teeth
after meals and rinse your mouth with mouthwash between
clients. Smokers should not smoke after showering in the

Williams_2E_CH02_printer_file.indd 28

FIGURE 29 Nebulizing diffuser. A commercial nebulizing diffuser


works well to promote a clean, healthy living, or working space without
overscenting the air.

10/24/13 1:06 AM

Chapter 2

too much of a soft scent. Dont use scented carpet sprays,


laundry detergent, or fabric softeners because these have
synthetic ingredients and may irritate clients.
When using aromas, use products with natural rather
than synthetic fragrances. Synthetic fragrances are artificial
and do not come from aromatic plants, fruits, or flowers.
Clients often develop adverse reactions to synthetic fragrances (headaches, sore throat, sneezing, coughing, and
emotional irritation) and may come to dislike all aromas as
a result. Aromatherapy and the use of pure, natural essential oils are discussed in detail in Chapter 7, Introduction to
Aromatherapy for Spa.

What the Client Tastes


In most cultures, food and drink have celebratory associations. Children commemorate their birthday with ice
cream parties, cake is eaten at weddings, and special friends
are invited over for a meal. Incorporating small food items
in the session is a pleasant and smart practice. Clients can
sometimes get up from a session and feel shaky and dizzy
from low blood sugar. A small snack provides an opportunity for the client to wake up and come back to the real
world before venturing back out into the busy world. It
doesnt have to be elaborate and can be as simple as a cup
of green tea served from a Chinese tea set after an Asian-inspired service or a complementary chocolate on Valentines
Day. Similarly, a treatment developed for athletes might
serve a sports drink as part of the session. In the summer,
clients might enjoy leaving their treatment with a colorful
Popsicle to remind them that spa is fun. Granola bars and a
bowl of fresh fruit might be offered to clients. Fresh, filtered
water should be provided before, during, and after the session. Food and drink should be simple and manageable but
focus on the intention of the offering: to welcome; to nourish on a spiritual level; and to show care, thoughtfulness,
and appreciation.

What the Client Feels


Once on the treatment table, the client should be enveloped in warm, soft textures whenever possible. Bolsters
support the joints in a relaxed position. Blankets, warm
packs, Fomentek water bottles, and heat lamps help keep
clients warm throughout the session. Lotion warmers heat
massage oil or spa products so that it does not feel cold
when applied. Never use a microwave oven to heat products
because microwaves may affect the products therapeutic
properties. Because many products break down when heated, it is recommended to use 1-oz bottles with flip or pump
lids. These small bottles are filled with fresh product at the
beginning of each day so that the larger container is not
exposed to heat and can remain in the refrigerator.
Some therapists have chronically cold hands, which can
feel shocking to the client at the beginning of the session.
Warm your hands as much as possible by holding them

Williams_2E_CH02_printer_file.indd 29

Spa Equipment and Products

29

under warm water, holding a warm pack, or rubbing them


briskly before the session.

Accessibility and Functionality


When designing your spa space, think about each area of
the business and analyze its accessibility and functionality.
Consider the entrance and reception area, dressing area,
and the bathroom.
Entrance and Reception
When choosing a business location, consider its accessibility. Are doorways, hallways, and bathroom entrances wide
enough to accommodate a wheelchair? Is there enough space
around furniture to accommodate someone in a cast and on
crutches? Does a long flight of stairs make the business prohibitive for elderly clients? Is parking convenient and userfriendly or will clients be spending the first 10 minutes of
their sessions looking for a space and feeling stressed?
The reception area must be friendly, neat, and functional. Clients generally fill out paperwork in this area while
waiting for their session. They might also pay for the session and book additional sessions in this area. Magazines, a
retail area, tea or water, and comfortable chairs and attractive furnishing help ensure the clients comfort.
The Undressing and Dressing Space
Carefully plan the space where clients remove their clothing
before the session and get dressed afterward. A screened-off
area provides a sense of privacy and decreases the clients
anxiety that the therapist might walk into the room unexpectedly. Place a chair and hooks behind the screen where
clients can hang their clothing. A small container for personal items such as keys and jewelry helps ensure clients do
not misplace or forget them. A box of tissue, disposable wet
wipes, and mirror are useful as well.
The Bathroom
In the bathroom, provide only liquid soap. Have on hand
amenities that make it easy for clients to tidy up after
the session. Gentle face cleanser, makeup remover, and
moisturizer allow women to remove their makeup before
a session or fix it up afterward. Disposable combs, bobby
pins, spray gel, and hair bands come in handy, especially
after a neck massage using oil. Contact lenses solution,
spray antiperspirant (solids or gels used by more than
one person are unsanitary), and mouthwash are also
appreciated.

Planning Spa Treatment Rooms


If you are planning your own spa business, you need to
think about how each treatment room can be organized
and equipped to allow for the delivery of multiple treatments. In Chapter 15 (Treatment Design and Your Signature Spa Treatment), you will learn about how to organize

10/24/13 1:06 AM

30

Spa Bodywork: A Guide for Massage Therapists

and develop a meaningful menu of services to entice clients


to your business and build their loyalty. If you develop a
highly specialized treatment, you may need a highly specialized treatment room to enable its delivery. The problem
is that a treatment room designed solely for a specialized

treatment it is unlikely to generate revenue on a daily basis


and becomes a wasted space. Plan your menu and your
treatment rooms with enough flexibility so that each room
is generating income for your business every hour you
are open.

SPA FUSION
INTEGRATION OF SKILLS
STUDY TIP: Up to the Test!
To do well on any written test, you must not only
know the information but also have a good test-taking
plan. A good plan helps prevent test anxiety and leads
to better test scores. Try the PASS method to do your
best on the next test:
P Prepare: Prepare for the test by breaking the test
topics into different study sessions. Dont try to learn
a whole chapter the night before the test. For example,
for a test on a chapter with three key subject headings,
you might plan four study sessions. Study one subject
in each of the first three study sessions and then study
all the topics together in the final study session. Write
yourself a test from the chapter. By combing the chapter
for test questions, you predict what the instructor might
ask and have a good chapter review in the process.
A Arrive early: Before leaving for school, eat a light
meal but avoid sugar, which can adversely affect your
thinking. Drink lots of water because people think
better when they are hydrated. Get plenty of sleep the
night before the test so you are well rested. Arrive early
and read through your notes one last time. Then put
the notes aside and focus on your breathing while you
clear your mind.
S See success: Dont fall into negative thinking (e.g.,
I dont know this chapter well enough and Im sure
to fail!). Give yourself positive energy (e.g., I studied.
Im ready. Ill do great!). See yourself succeeding and
answering every question with ease. Visualizing success
helps your mind relax and focus on the test content.
S Strategize: Proven test-taking strategies can help
you score high. First, read the directions carefully.
Many students assume they understand the directions and then make wrong choices based on false
assumptions. Next, answer everything you know first.
This warms up your brain and gives you confidence.
If youre stuck, underline key words and define them
in the margins of the test or on scrap paper. Thinking
about key terms often unlocks the answer to a test
question. Look for absolutes such as always and never.

Williams_2E_CH02_printer_file.indd 30

Absolutes in an answer choice often signal that its the


wrong choice. Finally, when your tests are returned
to you corrected, look it over carefully and determine
the sources of the tests information, which helps you
know what to study next time. For example, if you
missed two lectures but know the textbook material
well, you still might have difficulty on a test if the
instructor asks questions primarily from lecture content. You now know that attending every lecture is a
must if you want a good grade in this particular class.

SPA INSPIRATION: There Is No Substitute for


Direct Experience!
Isadora Duncan, the famous American dancer,
remarked, What one has not experienced, one will
never understand in print. Spa equipment is best
understood through direct experience. Have some fun
by contacting local spas in your area. Let them know
that you are a student in a spa program and would
like to visit the spa as part of your learning process.
Ask a therapist to show you around and describe the
different types of products and equipment he or she
uses in their facility. This way, you will have an excellent point of reference when you start to think about
purchasing your own equipment and create your own
spa environment.

CHAPTER WRAP-UP
The quality of the equipment that you use, the quality
of lubricants and spa products that you use for massage and spa treatments, and the time and care you
put into planning your spa space convey your level of
professionalism to your clients. Although it may seem
early to start thinking about equipment needs and
dcor for your business, its not too early to explore
options. Try out different massage tables and different
lubricants. Purchase sample sizes of spa products such
as mud, salts, and seaweed. Start to explore interior
design and think about color choices and window
treatments and visit a spa show in your area for demonstrations of specialized equipment. Starting now

10/24/13 1:06 AM

Chapter 2

Spa Equipment and Products

31

SPA FUSION
INTEGRATION OF SKILLS (continued)
helps ensure you to be prepared to enter the massage
and spa profession with a clear and informed plan.
This also helps you keep your spa career vision alive,
an important motivator when the massage and/or spa
program gets challenging!
REVIEW QUESTIONS
Multiple Choice

5. A shower with a horizontal rod with holes or water


heads that rain water down onto the client from
above the wet table is called:
a.
b.
c.
d.

A Swiss shower
A Kneipp shower
A Vichy shower
A Dutch shower

True or False

1. Dry room equipment is:


a. Equipment that has a self-drying feature
b. Equipment used in a room where water
treatments are delivered
c. Equipment used in a room where water
treatments are not delivered
d. Equipment that is meant to get wet

6.

There are some situations where


a spa product is meant to be applied warm, but,
in most cases, spa product is cooled before it is
applied to the body.

7.

The main type of tub used in a


spa setting is a common bathtub designed for
professional use with color therapy to cause the
water to change colors during the session.

8.

Steam cabinets are like small steam


pods. The client sits down on a plastic bench,
and the cabinet is closed around him or her,
leaving the head exposed.

9.

A sauna is a room that can be filled


with steam from a steam generator so that people
can bath in the vapor to induce sweating or to aid
respiratory conditions.

2. A Fomentek is:
a. A shower with seven water heads
b. A large water bottle designed to sit flat on the
treatment table
c. A type of wrap blanket that is highly insolated
d. A heat lamp hung over the top of the massage table
3. A wet table:
a. Has a plush, comfortable velvet-like cover that
resists water
b. Has a cold hard surface to channel water
c. Has a special surface to channel water covered
by a plastic mat for comfort
d. Has a special surface that has a self-drying finish
for use between clients
4. A shower that surrounds the client with jets of water
directed at specific areas of the body from shower
heads in the four corners of the stall is called:
a.
b.
c.
d.

10.

Exfoliation products are used to


remove trapped debris while sloughing off dead
skin cells, smoothing the skins surface, and
invigorating the body.

A Swiss shower
A Kneipp shower
A Vichy shower
A Dutch shower

Williams_2E_CH02_printer_file.indd 31

10/24/13 1:06 AM

3
Client and
Therapist Safety
Chapter Outline

K e y Te r m s

Spa Ethics

Antiseptics: A type of cleaning agent that is generally appropriate for use


in a spa setting so long as no blood or body fluid is present.
Code of ethics: A document or creed that states a professional groups
ethical principles and the values by which the group abides.
Direct contact: The transfer of a pathogen from an infected person to
an uninfected person through touch, sexual contact such as kissing or
intercourse, or expelling body fluid droplets onto a person by sneezing,
coughing, or touching mucous membranes and then touching an
uninfected person without having washed the hands.
Disinfectants: A type of cleaning product that should not be used on the
skin and that is stronger than an antiseptic. Disinfectants kill or are
effective against most bacteria and viruses.
Estheticians: People licensed to practice professional skin care.
Indirect contact: The transfer of a pathogen from an infected person to
an uninfected person via an inanimate object (known as a fomite) such
as a countertop, doorknob, toy, or magazine.
Lice: Parasitic animals that can be spread via direct and indirect contact
that suck the blood of their hosts and cause itching.
Mites: Parasitic animals, similar to lice, that can be spread via direct and
indirect contact that suck the blood of their hosts and cause itching.
Pathogen: A producer of disease.
Power differential (power advantage): The authority a massage
therapist is granted by a client based on the clients perception of the
massage therapist as a knowledgeable and skilled health care provider.
Scope of practice: A term used by regulating boards of health care professions to describe the techniques, activities, and methods that are
permitted to a therapist under the law.
Sterilization: The elimination of all microorganisms on and in an object
through heat, chemical substances, or irradiation.
Universal precautions: A protocol used in health care settings that
reduces the risk that health care workers will be exposed to bloodborne
diseases transmitted through broken skin, mucous membranes, or
contact with blood and body fluid.
Vector transmission: The transmission of a pathogen via vectors (insects
or animals capable of transmitting diseases, including mosquitoes,
flies, fleas, ticks, mites, rats, dogs, and cats).
Vehicle transmission: The transmission of a pathogen by a vehicle
such as air, food, and liquid.

Commitment to Personal and Professional


Boundaries
Scope of Practice

Spa Sanitation and Hygiene


Diseases
How Diseases Are Transmitted
Preventing the Transmission of Disease
Sanitation of the Facility, Equipment, and Supplies
Universal Precautions

Creating a Safe Environment


Safety of the Facility
Safety of the Client
Safety of the Therapist

Cautions and Contraindications


Spa-Specific Considerations
Common Conditions That Require Caution
Critical Thinking and Contraindications

Documentation of Sessions in a Spa


SPA FUSION
INTEGRATION OF SKILLS
STUDY TIP: Graphic Organizers
SPA INSPIRATION: Your Spa Journal
CHAPTER WRAP-UP

32

Williams_2E_CH03_printer_file.indd 32

10/24/13 1:08 AM

Chapter 3

Client and Therapist Safety

33

to spa equipment and spa environments. Reviewing the

relationship involves learning how to assert and maintain


your own boundaries while respecting the boundaries of
clients. One area where this is particularly important is in
issues related to sex (see number 8 of the ABMP Code of
Ethics in Table 31).
There are various levels of sexual misconduct, ranging
from lack of attention to sexual innuendo, to sexual impropriety, to sexual abuse of clients. You must always control
the atmosphere of the spa business. Allowing clients to
act inappropriately is as serious as acting inappropriately
yourself.

details of contraindications and understanding how spa

Lack of Attention to Sexual Innuendo

treatments might adversely affect a clients condition is

It is not uncommon for people to compliment each other


and express their affection by positively commenting on
another persons appearance. In a spa setting, this can
lead to mistrust. If you tell a client, you look really good
in those jeans, it plants a seed of doubt and mistrust in
a clients mind about your intentions, regardless of how
long you have known each other or how innocent the comment. Because of the intimate nature of spa work, refrain
from making any body comments that indicate approval
or disapproval of a clients body and physical features such
as the eyes, mouth, or hair. Do not carry magazines, pictures, or written material of a sexual nature to the work
environment. Do not allow the client to make sexual jokes
and discourage clients from commenting on your personal
appearance by downplaying those types of compliments
with a brief thank you and then a return to the business
at hand.

This chapter aims to introduce new spa therapists to


areas that will need attention and careful planning before
spa treatments are offered as an employee or in a private
practice. The first area we will explore is ethics and how
massage ethics are applied to spa-related situations. Next,
is a closer look at sanitation, hygiene, and safety as it relates

also important. We will discuss common conditions and


spa-specific contraindications that will help you know
when to postpone a treatment or suggest a different service
to ensure the clients health.

Spa Ethics
Ethics is a major branch of philosophy exploring values,
morals, right and wrong, good and evil, and responsibility.
Also called moral philosophy, ethics is a system of principles governing the appropriate conduct for an individual
or group. It is concerned with values and the standards by
which human actions can be judged right or wrong. Ethics
are different from laws, which are rules of conduct that are
recognized by a community as binding or enforceable by
authority. Some behaviors may be legal but nonetheless are
not ethical. For example, it is not illegal for a therapist to
date a client, but the massage community actively discourages this as unethical because dating a client may cause the
client harm.
A code of ethics states a professional groups ethical
principles. It suggests values by which the group abides.
Table 31 shows the code of ethics for members of Associated Bodywork and Massage Professionals (ABMP), the
largest massage therapist membership organization in the
United States. Review this code of ethics as a reminder of
ethical principles that guide your work as a massage therapist. In a spa setting, certain ethical standards are placed in
greater focus than in other work environments. Lets review
those areas now.

Commitment to Personal and Professional


Boundaries
Boundaries are conscious and subconscious imaginary lines
that mark the limits of an individuals personal space or territory. Boundaries create a separation or a border between
a person and other people and between a person and the
environment. Part of establishing a healthy therapeutic

Williams_2E_CH03_printer_file.indd 33

Sexual Impropriety
Sexual impropriety is more serious than a general lack
of attention to sexual innuendo and could lead to sexual
harassment charges. Behaviors that could be labeled as
sexual impropriety include the following:
Any behavior that is immodest or encourages immodesty in clients; for example, a therapist who stands in the
treatment room while the client undresses in front of
him or her or allows a client to place himself or herself
on top of the drape exposing the genitals or breasts
Draping loosely or deliberately looking at a clients body
while adjusting a drape; not using draping practices or
pressuring a client to take off his or her underclothing
when he or she leaves it on; and not providing disposable
spa underclothing, which allows a client to receive a fullbody spa treatment without a loss of modesty
Using nicknames for clients, especially those that have a
sexual connotation, or allowing the client to use sexual
nicknames for you such as Romeo, Handsome,
Baby, Honey, or Sexy
Telling a client jokes or listening while a client tells jokes
of a sexual nature
Discussing ones own sexuality within hearing of a client
(its a bad idea with coworkers as well because it could
lead to a sexual harassment claim)

10/24/13 1:08 AM

34

Spa Bodywork: A Guide for Massage Therapists

TABLE 31 Associated Bodywork & Massage Professionals Code of Ethics


1. Commitment to High-Quality Care
I will serve the best interests of my clients at all times and provide the highest quality of bodywork and service possible. I recognize that the obligation for building and maintaining an effective, healthy, and safe therapeutic relationship with my clients is my responsibility.
2. Commitment to Do No Harm
I will conduct a thorough health history intake process for each client and evaluate the health history to rule out contraindications or determine
appropriate session adaptations. If I see signs of, or suspect, an undiagnosed condition that massage may be inappropriate for, I will refer that
client to a physician or other qualified health-care professional and delay the massage session until approval from the physician has been granted.
I understand the importance of ethical touch and therapeutic intent and will conduct sessions with the sole objective of benefitting the client.
3. Commitment to Honest Representation of Qualifications
I will not work outside the commonly accepted scope of practice for massage therapists and bodywork professionals. I will adhere to my states
scope of practice guidelines (when applicable). I will only provide treatments and techniques for which I am fully trained and hold credible
credentials. I will carefully evaluate the needs of each client and refer the client to another provider if the client requires work beyond my capabilities, or beyond the capacity of massage and bodywork. I will not use the trademarks and symbols associated with a particular system or
group without authentic affiliation. I will acknowledge the limitations of massage and bodywork by refraining from exaggerating the benefits of
massage therapy and related services throughout my marketing.
4. Commitment to Uphold the Inherent Worth of All Individuals
I will demonstrate compassion, respect, and tolerance for others. I will seek to decrease discrimination, misunderstandings, and prejudice. I
understand there are situations when it is appropriate to decline service to a client because it is in the best interests of a clients health, or for my
personal safety, but I will not refuse service to any client based on disability, ethnicity, gender, marital status, physical build, or sexual orientation; religious, national, or political affiliation; social or economic status.
5. Commitment to Respect Client Dignity and Basic Rights
I will demonstrate my respect for the dignity and rights of all individuals by providing a clean, comfortable, and safe environment for sessions,
using appropriate and skilled draping procedures, giving clients recourse in the event of dissatisfaction with treatment, and upholding the integrity of the therapeutic relationship.
6. Commitment to Informed Consent
I will recognize a clients right to determine what happens to his or her body. I understand that a client may suffer emotional and physical harm if
a therapist fails to listen to the client and imposes his or her own beliefs on a situation. I will fully inform my clients of choices relating to their
care, and disclose policies and limitations that may affect their care. I will not provide massage without obtaining a clients informed consent
(or that of the guardian or advocate for the client) to the session plan.
7. Commitment to Confidentiality
I will keep client communication and information confidential and will not share client information without the clients written consent, within the
limits of the law. I will ensure every effort is made to respect a clients right to privacy and provide an environment where personal health-related
details cannot be overheard or seen by others.
8. Commitment to Personal and Professional Boundaries
I will refrain from and prevent behaviors that may be considered sexual in my massage practice and uphold the highest professional standards
in order to desexualize massage. I will not date a client, engage in sexual intercourse with a client, or allow any level of sexual impropriety
(behavior or language) from clients or myself. I understand that sexual impropriety may lead to sexual harassment charges, the loss of my
massage credentials, lawsuits for personal damages, criminal charges, fines, attorneys fees, court costs, and jail time.
9. Commitment to Honesty in Business
I will know and follow good business practices with regard to record keeping, regulation compliance, and tax law. I will set fair fees and practice honesty
throughout my marketing materials. I will not accept gifts, compensation, or other benefits intended to influence a decision related to a client. If I use the
Associated Bodywork & Massage Professionals logo, I promise to do so appropriately to establish my credibility and market my practice.
10. Commitment to Professionalism
I will maintain clear and honest communication with clients and colleagues. I will not use recreational drugs or alcohol before or during massage
sessions. I will project a professional image with respect to my behavior and personal appearance in keeping with the highest standards of the
massage profession. I will not actively seek to take someone elses clients, disrespect a client or colleague, or willingly malign another therapist
or other allied professional. I will actively strive to positively promote the massage and bodywork profession by committing to self-development
and continually building my professional skills.
Used with permission from Associated Body & Massage Professionals.
Members commit to follow ABMP Code of Ethics to protect clients, themselves, and the massage profession.

Gender-based comments or harassment, which includes


verbal, nonverbal, or physical intimidation or hostility
based on sex or sex-stereotyping such as comments
about another therapists sexual orientation or criticism
of a sexual orientation
Displaying or distributing sexually explicit drawings,
pictures, and written materials (i.e., showing pictures of

Williams_2E_CH03_printer_file.indd 34

undraped bodies, no matter how artistic they are, in


the reception area)
Requests to date or acceptance of an offer to date
E-mailing or phoning clients or sending them notes or
cards that are not specifically and exclusively related to
the spa session; for example, it is acceptable to call a
client the day after a session and ask how the muscles

10/24/13 1:08 AM

Chapter 3

are feeling. It is not acceptable to call a client for a conversation about personal details of events the client mentioned in the session.
Sexual Abuse
In a therapeutic relationship, the therapist develops a
power advantage over the client because the therapist is
the caregiver (For Your Information 31). For this reason,
any sexual misconduct, whether or not the client consents,
is considered sexual abuse. The therapist is responsible
and liable for sexual abuse, even if the client initiates it.
Never engage in any sexual activity with a client, whether
in or out of the treatment room. This includes behavior
that could reasonably be interpreted as sexual, including
touching with the hands, body, mouth, or genitals the
clients genitals, breasts, mouth, or anus; allowing the client to touch you; or allowing or encouraging the client to
touch himself or herself or masturbate during the session
in your presence, or directly after the session, in the treatment room. If the therapist masturbates or touches himself
or herself in a sexual manner in the presence of the client,
it is sexual abuse.
Sexual impropriety may lead to sexual harassment
charges and the loss of massage credentials. Sexual abuse
could lead to loss of massage credentials, lawsuits for personal damages, criminal charges, fines, attorneys fees, court
costs, and jail time.

Scope of Practice
In number 3 of ABMPs Code of Ethics, therapists make a
commitment to honest representation of qualifications by
agreeing to work within a defined scope of practice. The
term scope of practice is used by regulating boards of health
care professions to describe the techniques, activities, and
methods that are permitted to a therapist under the law.
Although most states define the scope of practice for massage in similar terms, small variations require the therapist
to carefully inspect and understand the scope of practice in
the state where he or she practices massage. Ohios scope of
practice for massage therapy provides a good example and
states, Massage therapy is the treatment of disorders of the
human body by the manipulation of soft tissue through
the systematic external application of massage techniques
including touch, stroking, friction, vibration, percussion, kneading, stretching, compression, and joint movements within the normal physiologic range of motion; and
adjunctive thereto, the external application of water, heat,
cold, topical preparations, and mechanical devices.
Floridas definitions show an example of a variation
that is uncommon. It states that massage means the manipulation of the soft tissues of the human body with the
hand, foot, arm, or elbow, whether or not such manipulation is aided by hydrotherapy, including colonic irrigation,
or thermal therapy; any electrical or mechanical device;
or the application to the human body of a chemical or

Williams_2E_CH03_printer_file.indd 35

Client and Therapist Safety

35

FOR YOUR INFORMATION 31


The Power Differential
In a spa setting, a power differential is defined as the authority
a massage therapist is granted by a client, based on the clients perception of the massage therapist as a knowledgeable
and skilled health care provider. Take a moment to contemplate your relationship with these people: parent, boss, best
friend, physician, teacher, counselor, spiritual leader, or spouse.
Each of these relationships involves differing levels of trust,
closeness, loyalty, respect, and responsibility. It is likely that you
perceive some of these people as having more authority than
you in some situations. For example, if you go to your spiritual
leader to discuss a personal concern, you grant him or her the
power of an advanced understanding of spiritual concepts. It
is easy to assume that history teachers are more knowledgeable about history than other people or that dentists know
more about teeth than other people. When clients make an
appointment with a massage therapist, a power differential is
at play in the relationship because the client assumes and respects the therapists understanding of soft tissue structures and
manual techniques that reduce tension and pain. Furthermore,
during the session, the client shares details of his or her personal
health history and is situated at a level below the therapist, in a
vulnerable reclining position, while unclothed under a drape.
The therapist by virtue of his or her knowledge and skill in the
area of massage is granted control of the situation, so he or
she has a power advantage over the client.
Ethical massage therapists remain aware of the power differential and seek to minimize it as much as possible to ensure
the mental, emotional, and physical safety of clients. When
the power differential is minimized, clients are better able to
Take an active role in the decision-making process to
determine reasonable treatment goals.
Alert a therapist to an uncomfortable technique or voice
concerns.
Give honest feedback on the quality of treatment or the
effectiveness of sessions.
Maintain their boundaries, personal power, and responsibility for health.
Actively practice self-care activities and other types of
therapy to augment the results achieved from massage or
spa sessions.
You can actively minimize the power differential by listening
carefully to clients and responding compassionately to their
needs while representing the benefits of massage, spa treatments, and your personal skill level realistically. You can give
clients choices about the types of techniques that might be
used in the session and product options. If you remain attentive, you will notice when a client tenses because of discomfort
and urge the client to speak up if a technique causes pain.
Finally, you can encourage clients to seek out other therapists
that might help them meet treatment goals and discuss selfcare options that speed or enhance treatment outcomes.
In all cases, whether the client actively gives all of the
power to the therapist or not, the therapist is always responsible for what happens in a session and must constantly
strive to understand and minimize the power differential.

10/24/13 1:08 AM

36

Spa Bodywork: A Guide for Massage Therapists

herbal preparation. Colonic irrigation, also called colon


hydrotherapy, or colonics, involves the low-pressure injection of water into the colon for cleansing purposes using a
mechanical device. It is believed to flush toxic buildup out
of the colon, leading to better overall health. This type of
treatment is usually not included in the massage scope of
practice.

that he or she must apply the aromatherapy balm four


times a day for 2 weeks is prescribing.
Clients sometimes ignore messages from their bodies
that indicate something is wrong. When a massage therapist
listens, is empathetic, and suggests that a medical opinion
be sought, it provides a space for the client to acknowledge
his or her concerns and seek help.

Restrictions to Scope of Practice

Adjusting Bones Is Out of Scope


A chiropractor is a medical professional who adjusts bones
to improve structural alignment and free nerve tissue, leading to better overall function. Sometimes, a clients bones
will shift naturally during the application of a massage
stroke. This is normal and should not cause alarm. A therapist is working outside his or her scope of practice if he or
she tries to get a bone to move. It is not uncommon for massage therapists to developed highly refined palpation skills.
Sometimes, therapists can feel that a bone is not aligned
normally. If a therapist attempts to shift the bone by using
a thrusting movement or even holds in his or her mind the
intent to move the bone with a massage stroke, he or she
is working out of his or her scope of practice. Instead, the
therapist should refer the client to a chiropractor.

Usually, the definitions will list some of the restrictions


to the practice of massage. Arizona definitions state that
practice of massage therapy means the application of massage therapy to any person for a fee or other consideration.
Practice of massage therapy does not include the diagnosis of illness or disease, medical procedures, naturopathic
manipulative medicine, osteopathic manipulative medicine, chiropractic adjustive procedures, homeopathic neuromuscular integration, electrical stimulation, ultrasound,
prescription of medicines or the use of modalities for which
a license to practice medicine, chiropractic, nursing, occupational therapy, athletic training, physical therapy, acupuncture or podiatry is required by law.
You may notice that three primary restrictions to scope
of practice come up repeatedly in massage law. Massage
therapists cannot diagnose a patients condition, prescribe
a medication or treatment, or adjust a clients bones. Lets
look at each of these areas in more depth.
Diagnosing Is Out of Scope
Some therapists fall into diagnoses accidentally and do not
realize the serious ramifications of their actions. The term
diagnose means to identify an illness or disorder through
an interview, physical examination, and medical tests. For
example, a client may describe to the therapist a set of symptoms that the therapist recognizes as a particular soft tissue condition such as carpal tunnel syndrome. A therapist
who says, Oh, your condition is carpal tunnel syndrome
and you need to take 1,200 mg of ibuprofen a day, wear a
wrist splint, and receive treatment massage has crossed the
line and is diagnosing. Anytime the therapist labels a set
of symptoms as a defined medical condition, he or she is
diagnosing. Instead, the therapist should acknowledge the
seriousness of the clients symptoms and suggest the client
visit a physician for a diagnosis.
Prescribing Is Out of Scope
The term prescribe means to direct a patient to follow a particular course of treatment, specifically to use a particular
drug at set times, and in specified dosages. When the therapist in the example stated earlier advised the client to take
1,200 mg of ibuprofen a day and wear a wrist splint, he was
prescribing. Therapists sometimes accidentally prescribe
things such as herbal remedies or aromatherapy cures.
To say to a client, You should drink six glasses of peppermint tea a day for your stomach condition, is prescribing.
To suggest a client take supplements offered in the spa gift
shop to improve health is prescribing. To explain to a client

Williams_2E_CH03_printer_file.indd 36

Counseling Is Out of Scope


Another area where massage therapists may venture out of
their scope of practice is counseling. People seek out counseling from a mental health care provider to gain insight
into personal or psychological problems. It is not uncommon for clients to share personal issues with their massage
therapists during sessions. This is not a scope of practice
violation so long as the therapist listens compassionately
but does not give advice or professional input. At other
times, listening is not enough, and the client expresses a
need for guidance or becomes emotional. The massage
therapist must be very careful not to counsel the client or
try to talk the client through the situation. If listening is
not enough, the massage therapist should refer the client to
a professional mental health care provider. In all cases, the
massage therapist must know and understand the scope of
practice and its restrictions in the state where he or she provides massage services.
Skin Care Is Out of Scope
The spa industry has grown so rapidly that this has created
some confusion about the scope of practice for therapists
delivering spa services. Much of this has centered on massage therapists and estheticians (people licensed to practice skin care). In many states, the board of cosmetology has
raised concerns that massage therapists are encroaching on
the scope of practice of estheticians when they provide such
services as a seaweed wrap or body polish. On the other
hand, in some states, massage therapists are concerned that
estheticians are using massage techniques that manipulate
soft tissue while applying products, so they are encroaching
on the scope of practice for massage therapists.
The basis of such concerns is that many of the products
used in the spa industry affect the physiological health

10/24/13 1:08 AM

Chapter 3

of the muscle tissue and body as well as the health and


appearance of the skin. A seaweed wrap could be used for
relaxation or as an active treatment to support a client with
fibromyalgia, sore muscles, or low energy (general massage scope of practice). A seaweed wrap can also be used
to soften, hydrate, and beautify the skin (general esthetics
scope of practice). Body polishes stimulate local circulation
to superficial soft tissue structures, tone muscle tissue, and
increase the vital energy of the body as in a classic friction
rub (general massage scope of practice). They are also an
exfoliation treatment that deep cleans, softens, smooths,
and beautifies the skin (general esthetics scope of practice).
This issue is further complicated because laws and regulations vary widely from state to state. A treatment that is
within the scope of practice for massage therapists in some
states may be banned for massage therapists in another
state. For example, massage therapists cannot cleanse, exfoliate, mask, or tone the facial tissue in most states. They
can apply creams or lotions (including essential oils) to the
face to perform a massage. In many states, massage therapists cannot use the word facial even when describing a facial massage (they must say face massage). In a few states,
however, massage therapists can provide facials using certain types of product only. Usually (but not always), massage therapists can use an exfoliation product such as salt
on the body (except the face) to increase local circulation
and relax muscle. Products such as seaweed and mud can
be used to promote changes in soft tissue or for relaxation
or revitalization.
In many states, estheticians cannot apply products
with any stroke other than effleurage. They can use various strokes on the face, arms to the elbows, feet to the
knees, and on the dcollet (upper chest) for beautification purposes only. They cannot manipulate soft tissue, so
they should avoid strokes that lift, knead, or broaden the
muscles. Again, in certain states, the previous statement is
not true, and estheticians even receive training in full-body
massage.
This textbook is written on the premise that spa body
treatments are a shared practice. It assumes that massage
therapists will focus on the benefits of a treatment for the
body, and estheticians will focus on the benefits of the
treatment for the skin. The treatment steps for the massage
therapist may be the same steps that an esthetician uses,
but the goals of the treatment (therapists intention) will
be different. This may also be expressed in the promotional
descriptions used to sell the treatments to the public. The
massage therapist markets the benefits of the treatment for
the body, whereas the esthetician markets the benefits of
the treatment for the skin.
Throughout the treatment chapters, esthetically oriented
information is included in Broaden Your Understanding
boxes. This information has been separated from the main
body of the text to avoid confusing new spa therapists who
are still unclear about their scope of practice. Estheticians
who are using the book as a reference will want to be aware

Williams_2E_CH03_printer_file.indd 37

Client and Therapist Safety

37

of the properties of products such as mud and seaweed for


the skin. Massage therapists who want the broadest possible understanding of a treatment will also want to understand its implications for the skin, even though they will
probably not market these effects to their clients.
Therapists should check to see if there are any treatments or practices that are not allowed by the regulatory
body in the state where they are practicing. Both ABMP and
the American Massage Therapy Association (AMTA) cover
spa treatments delivered by massage therapists with some
various restrictions. Call your professional association to
check that your liability insurance policy covers the treatments you are offering.
Therapists who are trained both as massage therapists
and as estheticians are growing in numbers. These therapists can market and deliver spa treatments for both the
body and skin at the same time.

Spa Sanitation and Hygiene


Spa therapists are required by health standards and professional ethics to provide a clean environment for clients
that ensures they dont pick up any diseases while they are
at a spa or massage clinic. Therapists must understand
how infectious diseases are spread and then adopt standard sanitation procedures to prevent the spread of these
diseases. Sanitation protocols include therapist hygiene; the
sanitation of the treatment room, equipment, and product
containers; and general cleanness of the facility. The state
board of massage, the state board of cosmetology, the state
department of health, and the Centers for Disease Control and Prevention (CDC) are useful sources of additional
information for people working in spas or massage clinics.

Diseases
A disease is defined as an infectious or noninfectious
abnormal condition that results in medically significant
symptoms and often has a known cause. Diseases may
cause changes in the appearance, structure, or function of
cells, tissues, organs, or systems in the human body. The
signs and symptoms of diseases may result from the disease
process itself or the immune systems attempt to defeat an
infectious agent. Such signs and symptoms include but are
not limited to fever, nausea, elevated white blood cell count,
fatigue, and cardiovascular and metabolic changes.
The terms acute, subacute, and chronic are often used to
note a diseases severity or stage. When a disease is in an
acute stage, the symptoms are severe, and in some cases, the
situation is more dangerous. The acute stage usually lasts a
short time before the symptoms decrease, and the body enters a subacute stage. A chronic disease, persists for a long
time or regularly recurs.
Types of diseases include autoimmune, cancerous, deficiency, genetic, metabolic, and infectious diseases. You

10/24/13 1:08 AM

38

Spa Bodywork: A Guide for Massage Therapists

probably learned something about each of these disease


types in your massage training so our focus here is a review
to prevent the spread of infectious diseases in a spa environment.
Infectious Diseases
Infectious diseases, also known as communicable diseases,
are caused by an infectious agent referred to as a pathogen.
The term pathogen comes from the Greek pathos meaning
suffering or disease and gen meaning producer. Therefore, a pathogen is a producer of disease. The term refers
to infectious organisms such as bacteria, viruses, fungi,
and protozoa. Parasitic animals can also be passed from
person to person or from animals to people and cause
disease.
Bacteria
Bacteria are one-celled living organisms found in every
environment on earth, including inside and outside the
human body. They divide and multiply independently of a
host and can thrive in almost any environment including
on nonliving surfaces such as plastic. Most bacteria are not
harmful, and many bacteria are necessary for good health.
The immune system relies on probiotic bacteria (sometimes
referred to as the intestinal flora), which live in the intestinal track. Probiotic bacteria aid normal food digestion and
provide immune support against certain viruses, yeasts,
parasites, and pathogenic bacteria.
Pathogenic bacteria such as Escherichia coli (E. coli) and
Salmonella enteritidis (Salmonella) may enter the body through
improperly handled food or unwashed hands (especially
after toilet use) and cause food poisoning or acute diarrhea.
Staphylococcus aureus is the species of bacteria that causes
staph infections. It commonly lives harmlessly on the
skin and hair and around the nose. It can potentially be
passed to massage clients by therapists who touched their
own hair or nose and then touched a client without first
decontaminating their hands. If staph gets into a cut and
rapidly reproduces, it may cause serious infection and blood
poisoning. Streptococcus pneumoniae, known informally as
pneumococcus, causes pneumonia when it is inhaled into
the lungs and cannot be cleared. Its relative, Streptococcus
pyogenes, causes strep throat among many other diseases.
Pathogenic bacteria normally live on the skin and hair, in
the nose, throat, and lungs or in the intestines without
causing a problem. They infect the body only when its defenses are low or when the pathogenic bacterium suddenly
comes into contact with vulnerable tissue.1
Rickettsiae and chlamydiae are smaller than bacteria but
still classified as bacteria. These pathogens are parasites
that must live inside a cell at the expense of their hosts. In
most instances, these organisms are transmitted through
the bites of insects such as lice, ticks, and fleas. Rickettsiae are responsible for a number of serious diseases such
as typhus and Rocky Mountain spotted fever. Chlamydiae
cause trachoma, an eye infection that causes blindness; the

Williams_2E_CH03_printer_file.indd 38

sexually transmitted diseases chlamydia and lymphogranuloma venereum; and some respiratory diseases.
Viruses
Viruses are smaller than bacteria and cannot self-replicate
or self-reproduce outside a living host cell (plant, animal,
or human). To grow and spread, they effectively take over
the host cell, causing the cell nucleus to replicate both its
own genetic material and that of the virus. The cell is usually eventually destroyed when it ruptures, and the new viral
particles formed are released into the extracellular fluid to
infect more cells. Viruses mutate quickly, making them difficult to treat effectively. Some viruses lie dormant in cells
until a stimulus or a decline in the hosts defenses activates
them. Some persistent viruses, such as HIV which causes
AIDS, can enter or exit a cell without killing it.
Viruses are present in infected body fluids such as
blood, saliva, or droplets from the nose, mouth, or genitalia. They are transmitted person to person or animal to
person. Although most viruses cannot live long without a
host, some, such as the herpes simplex virus, can linger on
surfaces for several hours and infect a person via indirect
contact. This is one reason why the proper sanitation of linens and equipment in a spa environment is so important
(discussed below).
Fungi
Fungi, which include molds and yeasts, comprise a large
group of simple plantlike organisms that are larger and
more complex than bacteria. Warm, moist environments
promote the reproduction of fungi through simple cell
division and the production of large numbers of spores.
A common fungus, Candida albicans, is present in the
mouth, mucous membranes, vagina, and rectum. It can also
travel through the bloodstream and affect the throat, intestines, and heart valves. Candida becomes dangerous when
some change in the body environment allows it to grow out
of control. When it grows out of control in the mouth, it is
called thrush. When it grows out of control in the vagina,
its often called a yeast infection or vaginitis. In individuals
with low resistance due to other diseases such as leukemia
or AIDS, Candida can enter the bloodstream and cause a serious infection in vital organs.
A group of related fungi cause skin infections characterized by red, scaly patches known commonly as ringworm,
but despite the name, it is not caused by a worm (Fig. 31).
Ringworm might be found on the skin (tinea corporis),
scalp (tinea capitis), around the groin (tinea cruris, sometimes called jock itch), or feet (tinea pedis, most often
called athletes foot). Ringworm is highly contagious and
is transmitted via skin-to-skin contact or contact with contaminated items such as unwashed sheets, flooring, and
combs. Therapists who practice spa treatments or massage
barefoot can pass an undetected fungal infection to clients
or pick up a fungal infection when clients walk barefoot in
the same area.

10/24/13 1:08 AM

Chapter 3

FIGURE 31 A group of related fungi cause skin infections characterized by red, scaly patches known commonly as ringworm, but despite
the name, it is not caused by a worm. Ringworm might be found on
the skin (tinea corporis), scalp (tinea capitis), around the groin (tinea
cruris, sometimes called jock itch), or feet (tinea pedis, most often called
athletes foot).

Protozoa
Protozoa (from the Greek protos meaning first and zoon
meaning animal) is a single-celled organism regarded as
the simplest form of animal life. They grow in moist environments such as fresh water, marine environments, decaying organic matter, wet grass, and mud. Protozoa cause
diseases such as amoebic dysentery, which is usually contracted through contaminated water or food; African sleeping sickness, which is spread by the tsetse fly; and malaria,
which is transmitted by the anopheles mosquito.
Parasitic Animals
The parasitic animals of most concern to massage therapists are mites and lice because they are spread very easily
through direct contact or contact with infected sheets and
clothing. Lice and mites do not carry infectious bacteria,
viruses, or fungi to the host. Instead, their wastes cause intense itching that leads the host to scratch the skin, leaving
it open to more serious infection.
Lice
Head lice (Pediculus humanus capitis), body lice (Pediculus
humanus), and pubic lice (Pthirus pubisoften called crabs)
suck the blood of the host and cause itching (Fig. 32).
Head lice often spread among grade school children and
must be treated with repeated applications of special
shampoos. A fine-tooth comb is passed through the hair to
remove eggs. Body lice live in the seams of clothing rather
than directly on the host. This type of lice is usually seen in
homeless people who do not have regular access to laundering facilities. Body lice are transmitted through unwashed

Williams_2E_CH03_printer_file.indd 39

Client and Therapist Safety

39

FIGURE 32 Head lice (Pediculus humanus capitis), body lice (Pediculus


humanus), and pubic lice (Pthirus pubisoften called crabs) suck the blood
of the host and cause itching.

clothing but could be passed from clothing to massage


sheets. Pubic lice are nicknamed crabs because of their
crab-like appearance. They are usually spread through sexual contact but might also be spread to clothing or linens.
Although they tend to inhabit the groin area, they can live
in any course body hair (armpits, eyebrows).
Mites
Mites (Sarcoptes scabiei) like warm, moist areas of the body,
especially skinfolds. They burrow under the skin and live off
the blood of the host (Fig. 33). Mite infestations are often
referred to as scabies. The excrement of the mite is highly
irritating and leads to itchy, red allergic reactions. Like lice,
mite infestations are highly contagious and spread through
person-to-person contact or from clothing and linens.
If a lice or mite infestation occurs at your massage clinic
(e.g., a client calls to say she just found out that she has
lice), cancel all appointments until the facility can be deep
cleaned. Wash in hot water and detergent any linens or
cloth materials that may have come into contact with the
infected person and then dry them with heat. Vacuum carpeted floors carefully and change bath mats and towels in
the bathroom. Mop hard floors and wipe down all hard surfaces. Lice and mites live only about 38 hours off the host,
but care should be taken that they are not spread to an unsuspecting client.

How Diseases Are Transmitted


An infectious pathogen must breach the bodys defenses
to cause a disease. Some pathogens, called opportunistic
pathogens, cause disease only if the hosts immune system is depressed. Others, called virulent pathogens, readily

10/24/13 1:08 AM

40

Spa Bodywork: A Guide for Massage Therapists

fomite where an uninfected person touches it obtaining the


pathogen via indirect contact.
Vehicle Transmission

FIGURE 33 Mites (Sarcoptes scabiei) like warm, moist areas of the body,
especially skinfolds. They burrow under the skin and live off the blood of
the host.

cause disease when they gain entrance to the body. Pathogens are transmitted by direct contact, indirect contact,
vehicle transmission, or vector transmission.

Air, food, and liquid that are routinely taken into the body
provide a mode of transport for pathogens. This type of
pathogen transmission is called vehicle transmission.
Pathogens can travel in the air in droplets (usually mucous
droplets such as are released by a sneeze), aerosols (very
small droplets that may have evaporated from droplets on a
surface), or dust particles. This is why people often get sick
after flying on a plane; because cabin air is recycled, pathogens have repeated opportunities to infect passengers.
A number of pathogens are found in food. If these pathogens are not killed during food processing, they are transmitted directly to the gastrointestinal tract. Bacteria in the
intestinal flora of animals may be safe for those animals but
unsafe for humans. For example, Salmonella is part of normal chicken intestinal flora but can cause serious illness in
humans if it is not destroyed during food preparation. The
food preparer may also be infected and transfer pathogens
to otherwise uncontaminated food.
In the United States, drinking water is generally safe,
but if the water supply is contaminated with human or animal fecal matter (e.g., sewage), it may cause serious illness.
Homes and businesses with a private well should have the
water tested annually to ensure its safety. Pathogenic organisms as well as harmful chemicals such as lead and radioactive isotopes such as radon can enter well water and cause
health problems.

Direct Contact
The sweat and sebum in skin provide some natural protection against the transfer of pathogens via direct contact of
the skin. But if the skin is damaged by cuts, scrapes, wounds,
burns, or even dryness that leaves the skin with microscopic
breaks, the chances of infection increase.
Pathogens often reside around areas with mucous membranes such as the nose, lips, eyes, gastrointestinal tract,
genitourinary tract, genital area, and anus. Lymph tissue
such as the tonsils, mucus, and cilia provides some protection for the mouth and respiratory system. Other mucous
membranes provide less protection.
An infected person can transfer a pathogen to an uninfected person through touch, sexual contact such as kissing or intercourse, or expelling body fluid droplets onto a
person by sneezing, coughing, or touching mucous membranes and then touching an uninfected person without
having washed the hands.
Indirect Contact
An infected individual can transfer a pathogen to an inanimate object (known as a fomite) such as a countertop, doorknob, toy, or magazine. A person might touch his or her
nose or mouth and then touch the fomite, sneeze or cough
on a fomite, or fail to wash his or her hands after using the
toilet and then touch a fomite. The pathogen lingers on the

Williams_2E_CH03_printer_file.indd 40

Vector Transmission
Vectors are insects or animals capable of transmitting diseases, including mosquitoes, flies, fleas, ticks, mites, rats,
dogs, and cats. Vectors are mobile and can easily spread a
disease to previously uninfected areas. The vector usually
breaks the skin through a bite or sting but may also cause
disease through its feces. A pathogen might be located on
the outside surface of a vector and spread through physical
contact with food or a surface when it lands (e.g., flies).

Preventing the Transmission of Disease


It is impossible to know if a client who walks in through the
door of your business is infected with a pathogen. Similarly,
you may be infected and not know it. Because pathogens
that cause serious illness are all around us, sanitation and
hygiene practices are required at all times to prevent the
spread of disease. These practices include therapist hygiene;
sanitation of equipment, supplies, and the building; and
the use of universal precautions.
Therapist Hygiene
As health care providers, spa therapists must adhere to
the highest standards of personal hygiene. This includes
cleanliness of the body and hair; wearing clean, appropriate

10/24/13 1:08 AM

Chapter 3

clothing; removing jewelry; proper hand washing; and


attending to issues such as smoking and illness.
Cleanliness of Body and Hair
Shower daily and wash your hair on work days. Avoid the
use of scented antiperspirants, perfumes, colognes, aftershaves, and body care products because these may cause
sensitivity or allergies in some clients. As described earlier, the hair can act as a reservoir for pathogens such as
Staphylococcus aureus and must be tied back so that it does
not touch the client during the delivery of a spa treatment
or massage. Men should shave before each work shift or
keep facial hair neatly trimmed. If you touch your own hair
during a session, including facial hair, you must sanitize
your hands before touching the client.
For better hygiene and client comfort, keep your nails
short, natural, and filed to a smooth edge. Long nails, nail
polish, and artificial nails are breeding grounds for pathogens and may scratch a client; they are best avoided. Brush
and floss your teeth before the shift and directly after eating food during breaks in the day. Because therapists and
clients come into close contact during spa treatments, it is
a good idea to rinse your mouth with mouthwash before
each new client.
Therapists who perspire heavily while giving spa treatments can wear sweatbands on the forehead and wrist to
prevent droplets of perspiration from falling onto the
client. A clean towel can be used to absorb perspiration
throughout the session if necessary.
Clean and Appropriate Clothing
Launder your work uniform or clothing at the end of each
working day. Short sleeves are better for spa work because
long sleeves, which may touch the clients skin and become contaminated, may then contaminate the next client.
Although many therapists like to work barefoot, this is not
advised. Your feet may harbor an undetected fungal infection, which can be spread to an unknowing client getting
on and off massage table or wet table. For clients with suppressed immunity, this may cause serious complications.
Remove jewelry including rings, wristwatches, bracelets,
and necklaces. These items contain small crevices and sharp
edges that can harbor bacteria or potentially scratch a client. Small earrings that will not touch the client are fine.
Proper Hand Washing
Proper sanitation of the hands is probably the single most
important part of the sanitation protocol for therapists (For
Your Exploration 32). You need to clean your nails carefully and use foaming liquid soap to thoroughly wash your
hands up to your elbows. An alcohol-based hand rub is recommended for decontaminating the hands before the session, before or after certain treatment steps, and at the end
of a session. Nonalcohol-based hand rubs have not been
adequately evaluated by the CDC and are therefore not recommended. In those instances where you use gloves (see the
upcoming section for details), wash your hands and decontaminate them before putting gloves on and immediately

Williams_2E_CH03_printer_file.indd 41

Client and Therapist Safety

41

after removing gloves. Decontaminate your hands with an


alcohol rub before moving from a potentially contaminated
body area (such as the feet) to a clean body area (such as the
face) during a spa treatment or massage. Do the same when
moving from contact with an unsanitized inanimate object
(e.g., a product container) to the client. As well, wash and
decontaminate your hands before and after eating or using
the restroom.2 The CDC provides specific recommendations for hand washing and the use of alcohol-based hand
sanitizers for health care workers, as described in For Your
Information 32 and Figure 34.
Therapists Who Are Smokers
The smell of cigarette smoke lingers in hair, on clothing, on
skin, on the breath, on carpets, and on fabrics such as window treatments and linens. Smokers often become oblivious to the smoke odor and do not realize its impact on
nonsmoking individuals. Many nonsmokers intensely dislike the smell of cigarette smoke. Some are so sensitive that
they cannot tolerate the lingering smell of smoke anywhere
around them. Even clients who can tolerate the smoke odor
often associate it with an environment that is unclean, so
they may subconsciously feel uncomfortable.
Smoking should never be allowed in the treatment room,
reception area, bathrooms, hallways, office area, or laundry
area of a spa business. Therapists who smoke must strive
to balance their personal needs with the clients needs. In
the best case, a therapist would smoke before showering,
washing the hair, dressing, and brushing the teeth. After
showering and dressing, the therapist would not smoke
again until after all of that days spa sessions. A therapist
who is unable to finish the days spa sessions before having
a cigarette must make every effort to minimize the impact
on clients. Use a mechanics jumpsuit to cover and protect
clothing. Cover your hair with a plastic shower cap and
put hand lotion on your hands before handling cigarettes
(which rinses away when the hands are washed and keeps
smoke odor from seeping into skin). Smoke outside at a
good distance away from the spa business. After smoking,
wash any areas of skin that might come into contact with
smoke. You might include the use of a salt scrub on your
hands to help eliminate the smell of smoke. Your face, neck,
arms, and hands should all be washed. Brush your teeth
and rinse with mouthwash.
Therapists Who Are Sick or Have Allergies
A therapist who is sick or may have a contagious infection
must protect clients by canceling all spa appointments. The
common cold is caused by a large number of different viruses and is easily transmitted through the air or by direct
contact. In general, the viruses that cause colds incubate in
the body for 12 hours to 5 days and then become contagious
23 hours before the onset of symptoms. The person remains
contagious for about 5 days after the onset of symptoms.3
Therapists with allergies with symptoms similar to those
of a cold are not likely to be contagious but may need to
take extra precautions to prevent spreading pathogens.

10/24/13 1:08 AM

42

Spa Bodywork: A Guide for Massage Therapists

FOR YOUR INFORMATION 32


Proper Hand Washing and Hand Decontamination
1. Clean your nails before your hands using an orange stick or
a personal nailbrush that has not been used by anybody
else. Wash your hands with a nonantimicrobial soap or an
antimicrobial soap (liquid soap with a pump dispenser is the
most sanitaryavoid bar soap) for 30 seconds using fiction and
lather to lift contaminants off the skins surface.

2. Clean the area between your fingers and from your forearms
up to your elbows. Rinse your arms and hands thoroughly with
running water and dry them with a disposable towel.

3. Use the same towel to turn off the water tap and to open any
doors on the way to the treatment room.

Williams_2E_CH03_printer_file.indd 42

10/24/13 1:08 AM

Chapter 3

Client and Therapist Safety

43

FOR YOUR INFORMATION 32


Proper Hand Washing and Hand Decontamination (continued)
4. Use an alcohol-based hand sanitizer at these times: (A) Directly
after washing your hands and directly before touching the client. (B) Directly after washing your hands and directly before
donning gloves and directly after removing gloves. (C) Directly
after moving from a potentially contaminated body area (e.g.,
feet) and directly before working on a clean body area (e.g.,
face). (D) Directly after touching an unsanitized inanimate
object (e.g., product container) and directly before touching
the client. (E) If you accidentally touch your hair or a mucous
membrane (eyes, nose) or cough or sneeze during the session.
Do not retouch the client until your hands have been decontaminated with the hand sanitizer. (F) Directly after removing
soiled linens from the table and directly before handling fresh
linens.

For example, if your eyes are itchy and watering, you must
decontaminate your hands if you rub your eyes in the middle of a session. If sneezing is a problem, wear a face mask
as an extra precaution. Inform clients that you suffer from
allergies to prevent the impression that you are sick. If you
are uncertain whether your symptoms are those of a cold or
allergy, take your temperature. Allergies usually do not elevate body temperature, whereas even a low-grade cold will.

Sanitation of the Facility, Equipment,


and Supplies
A clean facility has a lower risk of pathogen transmission.
To provide a clean environment, pay attention to the proper
use of cleaning products, sanitation of the treatment room
and equipment, care of linens, proper product handling,
and general housekeeping activities.
Cleaning Products
A variety of cleaning products can be used in the spa business. Use dusting aids and wood polishes on wood surfaces
and glass cleaners on windows and mirrors. Antiseptics
and disinfectants are the most important types of cleaners
used in a health care setting because they reduce the transmission of disease. These types of cleaners are described in
detail below.
Note that cleaning products often contain ingredients
that cause irritation to eyes, the skin, and the respiratory

Williams_2E_CH03_printer_file.indd 43

system. Wear heavy cleaning gloves, a face mask, and eye


protection when handling cleaning products and increase
the ventilation in rooms where you are cleaning by opening windows or running ceiling fans. Many cleaning products also cause damage to the environment. In recent years,
interest has increased in using natural, environmentally
friendly products for cleaning. Finding suitable products
is often difficult because of the unique challenges of sanitation in health care environments. Some U.S. and Canadian health care workers have formed an association called
Health Care Without Harm: The Campaign for Environmentally Responsible Healthcare. This group offers a kit
to help health care providers go green. The kit can be
ordered through their website at http://www.noharm.org
/goingGreen. At the very least, avoid heavily scented cleaning products and look up cleaning product dangers at the
Occupational Safety and Health Administration (OSHA)
website at http://www.osha.gov.
Antiseptics
Antiseptics are safe for use on the skin and create an unfavorable environment for pathogen reproduction. Antiseptics are weaker than disinfectants and do not kill some
types of pathogens but are generally appropriate for use in
a spa setting so long as no blood or body fluid is present.
Hand soap, iodine, hydrogen peroxide, and rubbing alcohol
are commonly used antiseptics. Rubbing alcohol is often
used to spray clean countertops, doorknobs, and spa equipment in between clients.

10/24/13 1:08 AM

44

Spa Bodywork: A Guide for Massage Therapists

FIGURE 34 Proper use of gloves. (A) Directly before putting on gloves, wash your hands as described in the
section on Therapist Hygiene, and decontaminate your hands with an alcohol-based hand sanitizer. The gloves
should fit snugly and not roll down your hands while giving massage. When it is time to remove the gloves, peel
the first glove from the wrist to the fingers so that it is turned inside out. Any contaminants are now on the inside
of the glove away from you. (B) Place the fingers of your ungloved hand inside the second glove and peel it back
so that it is inside out. Make an effort not to touch the outside of the gloves with your ungloved hand. Dispose
of the gloves in a closed trash container and immediately wash and decontaminate your hands with alcohol after
removing the gloves.

Disinfectants
Disinfectants are stronger than antiseptics and should
not be used on the skin. They kill or are effective against
most bacteria and viruses. Disinfectants are also called germicides and bactericides. Commonly used disinfectants
include bleach solutions, phenols, and quaternary ammonium compounds (quats). Disinfectants are used for deep
cleaning at the end of the day, if an infectious agent may be
present (e.g., if a client denied having a cold but sneezed and
coughed throughout the session) or if blood or body fluids
are present.

including Staphylococcus, Streptococcus, hepatitis, HIV,


herpes, and tinea (the fungus that causes ringworm).
Phenols (also called cresols): Phenols are used on hard
surfaces and are effective against tuberculosis, bacteria,
fungus, herpes, and the flu virus. Phenols are irritating
for skin and the respiratory system.
Quaternary ammonium compounds (quats): Quats
are formulated to kill pathogens on a variety of hard surfaces and are effective against pseudomonas, Staphylococcus and Salmonella, certain bacteria, HIV, and the hepatitis B and C viruses.

Bleach solutions: Bleach mixed with water in a 10% concentration is used to clean hard surfaces such as countertops, equipment, and floors and to clean linens exposed
to body fluids. It is noted to be effective on pathogens

Sterilization is the elimination of all microorganisms


on and in an object through heat, chemical substances,
or irradiation. Sterilization is rarely used in massage environments but might be used in a spa environment. It is

Williams_2E_CH03_printer_file.indd 44

10/24/13 1:08 AM

Chapter 3

commonly used in hospitals where moist heat (hot water or


steam) or dry heat is used to sterilize medical instruments.
Sterilization with an autoclave (a device in which high temperature and pressure is used to sterilize instruments) may
be used in some spa environments where estheticians use
sharp implements to pierce the superficial layers of the skin
when performing deep cleaning facials that include extractions of whiteheads and blackheads.
Sanitation of the Treatment Room and Equipment
Sanitizing the treatment room and equipment involves a
cleaning step that removes visible dirt and a sanitation step
that removes most pathogenic organisms from inanimate
objects with an antiseptic. Follow these guidelines:
Wipe down countertops, equipment, treatment chairs
and tables, the floor, and any other hard surface such
as doorknobs, handles, and cabinets with an antiseptic
such as alcohol between clients.
If possible, open windows and doors to ventilate the
room and circulate air.
At the end of the day, deep clean the treatment room,
equipment, and hard surfaces with a disinfectant.
Usually, a sick client is sent home without receiving a spa
treatment. If you suspect that a client was on the verge
of a cold or the flu, deep clean the treatment room with
a disinfectant before proceeding with the next session.
Regularly dust window blinds, shelves, decorative items,
picture frames, and lamp fixtures. Keep electronic equipment and CDs neatly organized and free from dust.
Wash all reusable equipment such as metal or plastic bowls,
spatulas, application brushes used in spa treatments, and
soda coolers (used to hold hot towels) in hot, soapy water
and sanitize them with alcohol between clients.
Specialized equipment such as foot soaking basins,
hydrotherapy tubs, showers, and massage tools such as hot
stones used in stone massage must be cleaned and sanitized
with a disinfectant between clients. Foot soaking basins
are of special concern especially if they have jets that might
harbor bacteria:
Wash them with hot, soapy water and spray them with a
disinfectant.
Allow the disinfectant to remain for 10 minutes and
then wipe the basin dry.
If the basin has jets, flush a bleach solution through the
jets to eliminate pathogens.
Follow these guidelines for cleaning a shower:
Clean, disinfect, and dry the shower after use by each client.
Disinfect the shower curtain or door and the floor outside the shower.
Change all towels and the mat outside the shower for
each client.
Use only liquid soaps or shower gels. Bars of soap that
have been used by more than one person are unsanitary
and should not be left in the shower or sink.

Williams_2E_CH03_printer_file.indd 45

Client and Therapist Safety

45

Modern hydrotherapy tubs usually have a self-cleaning


function that makes sanitizing the jets of the tub easier:
Put a concentrated disinfectant (formulated by the manufacturer of the tub) into the special holder and then
push the button.
At the end of the cleaning cycle, dry the tub and put out
fresh bath mats and towels for the next client.
Between clients, wipe down the area around the tub, including the floor and any handrails, with an antiseptic, and deep
clean the area with a disinfectant at the end of the day.
Small, one-person steam cabinets should be completely
wiped with an antiseptic between clients. For larger steam
rooms or steam showers, sanitize the floor and seat between
clients, although the walls can be left until the end of the
day. Disinfect this equipment at the end of each workday.
Proper Care of Linens
Clean linens are stored in a closed cabinet until they are
brought out for use. Decontaminate your hands after
touching soiled linens and before placing fresh linens on the
table. Linens may include massage sheets, face cradle covers,
bolster and pillow covers, uniforms, smocks, hair wraps, robes,
washable slippers, blankets, draping material, and washable
floor mats. Any item that comes into contact with the clients
skin or hair during the session must be stored in a closed, ventilated container and washed before use with another client.
Soiled linens should not be stored in the treatment room but
should be moved to the laundry or work area. At the end of
the day, wash linens in hot water with regular detergent, dry
them with heat, and return them to the closed cabinet. Handle
linens soiled with body fluids with special caution as discussed
in the upcoming section on Universal Precautions.
Proper Product Handling
Keep lubricants and special treatment products refrigerated
between uses to prevent the breakdown of their natural oils or
therapeutic properties. Transfer lubricants used for massage
from larger, bulk containers to smaller bottles so that they
can be heated without damaging the unused product, which
would break down if heated, cooled, and reheated. Some
products are dispensed directly into your hand using a pump
top or flip lid. Take care to decontaminate the pump container with an antiseptic both before and after each session.
Remove spa products from their original closed containers with a sanitized spoon or spatula and placed them in presanitized holders for later use during the treatment. Cover
the spa product with plastic wrap to avoid contamination
before use. All products would become contaminated if you
used your hands to remove the product or dip into the original container during the treatment. Discard any unused spa
product rather than return it to the original container. During a body treatment, proper waste disposal procedures are
important. Some items used in the treatment are used only
once (e.g., gauze, sponges, and plastic body wrap). Dispose
of these items in a closed trash can immediately after use.

10/24/13 1:08 AM

46

Spa Bodywork: A Guide for Massage Therapists

Housekeeping Activities
The general cleanliness of the facility must be assessed and
maintained on a daily basis. The reception area, retail area,
office area, hallways, and bathrooms all need attention.
Vacuum or sweep and mop floors daily.
Wipe items such as coffee tables, beverage dispensers,
toys in the reception area, doorknobs, handrails, and the
reception countertops daily with an antiseptic.
Deep clean bathrooms and empty trash bins at the end
of each work day.
Clean window ledges, retail shelving, picture frames, and
light fixtures weekly.
Fish tanks and water fountains are not advised because
they may harbor pathogens and are difficult to keep
clean.
Think also about the safe use of food items in the business. Home-baked products are not advised, but individually wrapped items such as chocolates, granola bars, sports
bars, and popsicles can be used. Its a good idea to provide
filtered water from commercial dispensers. These water
containers come presealed to prevent contamination. Use
disposable cups for all beverages including tea, juice, or
water. Table 32 provides a checklist of tasks to ensure you
maintain a clean, sanitary, and safe facility.

Universal Precautions
The purpose of universal precautions is to ensure that
health care workers protect themselves from bloodborne diseases transmitted through broken skin, mucous

membranes, or contact with blood and body fluid. To understand universal precautions, it is helpful to understand
HIV/AIDS and hepatitis, to know when to use gloves, and
to know the proper methods for cleaning up body fluids
and items exposed to body fluids.
HIV/AIDS
HIV causes AIDS. HIV is transmitted through body fluids
including semen, vaginal secretions, and blood and can be
transmitted during pregnancy from a mother to her fetus
or after birth through breast milk. HIV can also be spread
by drug users sharing a needle, by accidental needle pricks,
and from infected blood used in a blood transfusion (rare
in developed countries). There is no evidence that HIV is
transmitted through saliva, sweat, tears, urine, or feces
unless the fluid contains blood. There is no evidence that
HIV is spread through casual contact such as sharing towels, food utensils, telephones, or swimming pools. HIV is
not believed to spread by biting insects such as mosquitoes
or fleas.3
HIV is a retrovirus that can live in the infected individual for a long time before causing symptoms. The National Institute for Allergies and Infectious Diseases reports
that people infected with HIV develop a flulike illness 1 to
2 months after their initial exposure to HIV. The symptoms
are often mistaken for another viral infection and clear up
within a week or two. Severe symptoms may not appear
for 10 years or longer. (Children born with HIV develop
symptoms around the age of 2 years.) During this period,
HIV is slowly multiplying and killing immune system cells.
Gradually, infected people experience periodic symptoms

TABLE 32 Tasks to Ensure a Clean, Sanitary, and Safe Facility


AFTER EACH SESSION
Open doors and windows to ventilate
room.
Remove soiled linen from table, face
cradle, bolsters, etc.
Wipe massage table, face cradle, and
bolster with disinfectant.
Cover table, face cradle, and bolsters
with fresh linens.
Disinfect countertops, door handles,
and any objects clients regularly touch.
Disinfect the lubricant container or
bottles used to hold spa product.
If tools (hot stones, massage tools,
etc.) were used during the session,
wipe them with a disinfectant.
If a shower or wet room has been
used, it must be disinfected and dried.
If a hydrotherapy tub or foot basin with
jets has been used, the jets must be
flushed with bleach or the manufacturer's recommended cleaner and dried.
Change bath mats and towels if
shower or tub has been used.

Williams_2E_CH03_printer_file.indd 46

END OF BUSINESS DAY


Wash all bowls, implements, application brushes, trays, and other equipment with hot, soapy water and wipe
with a disinfectant before storing them
in closed containers.
Wash cloth products such as massage
sheets, blankets, robes, slippers, hand
towels, bath towels, and shower mats
in hot water with detergent and dry
using heat before storing in a closed
container.
Deep clean and disinfect bathrooms.
Clean floors, clean and disinfect
items in the reception area, clean any
beverage service items, clean common
areas, and disinfect items such as
handrails and doorknobs.
Empty and disinfect trash bins.

WEEKLY
Clean windows, window frames, and window
ledges.
Deep clean the reception area and wipe down
chairs, the beverage service, magazines, and
decorative side tables.
Wipe down shelving used to hold retail items
and dust retail items.
Dust light fixtures, picture frames, the music
system, shelving, and decorative items in the
treatment room.
Organize CDs, storage cabinets, and
supplies.
Check smoke detectors to ensure they are in
good working order.
Check and replace light bulbs both inside
and outside the facility.
Water and dust plants.

10/24/13 1:08 AM

Chapter 3

such as swollen glands, decreased energy, weight loss, fevers


and night sweats, persistent yeast infections, short-term
memory loss, persistent pelvic inflammatory disease, frequent and severe herpes outbreaks, and shingles.
An HIV infection is called AIDS when the HIV-infected
person has fewer than 200 CD3T cells (the immune systems primary infection fighting blood cells). Uninfected
adults usually have 1,000 or more CD3T cells. The immune system, gradually destroyed by HIV, loses its ability
to fight off common pathogens that usually do not cause
illness in healthy individuals. In people with AIDS, these
opportunistic infections can be severe and often are fatal.
People with AIDS are also prone to developing various cancers, especially those caused by viruses and cancers of the
immune system (lymphomas).
Massage and many spa treatments are safe for HIVpositive clients who do not have symptoms. In the advanced
stages of AIDS, many forms of bodywork or spa treatments
may still be safe, but the most effective techniques depend
on the individual clients level of health. It is unlikely that
a therapist would contract HIV from a client during the
delivery of a spa treatment or massage, but the use of universal precautions is required. This is especially important
because an HIV-positive client must be protected from an
undetected infection the therapist may have.
Hepatitis
Several different viruses cause different forms of hepatitis,
termed hepatitis A through G. These are diseases characterized by inflammation of the liver. Hepatitis A, B, and C are
the most common forms.
Hepatitis A virus (HAV): HAV is transmitted through
contaminated food and water or by contact with feces. It usually resolves in a few weeks without medical
intervention.
Hepatitis B virus (HBV): HBV is spread through many
of the same routes as HIV but is a hundred times more
contagious than HIV. Many people who contract hepatitis B recover fully and have no long-term complications.
Some individuals develop chronic hepatitis B and become carriers of the disease. These people may develop
varicose veins on the stomach and esophagus, cirrhosis
of the liver, and liver cancer.4
Hepatitis C: Hepatitis C is transmitted primarily
through contact with infected blood (often by drug users sharing needles). Hepatitis C spreads less commonly
through sexual contact and childbirth, but these are possible routes. Of people who contract hepatitis C, 75% to
95% develop chronic long-term infections and have an
increased risk for cirrhosis and liver cancer.5
Spa treatments and massage are contraindicated for individuals with acute hepatitis. Clients with chronic hepatitis can benefit from many spa treatments, but techniques
should be chosen based on the individuals level of health.
Universal precautions are required.

Williams_2E_CH03_printer_file.indd 47

Client and Therapist Safety

47

When to Use Universal Precautions


Spa therapists rarely make contact with clients body fluids in
practice, but in some situations, a therapist may be exposed
to a body fluid and therefore be at risk for infection. A scab
may rub off during the application of a product, a blemish
may erupt under the pressure of a massage stroke, menstrual
blood may leak onto the treatment table, or a client may
experience nausea during treatment and vomit in the treatment room. Universal precautions are an approach to infection control in which all blood and body fluids are treated
as if infected with HIV, hepatitis, or another bloodborne
pathogen. Universal precautions are guidelines for dealing
with broken skin and mucous membranes, blood and other
body fluids, and the cleanup of body fluids. Important components of universal precautions include the following:
Correctly using gloves
Properly cleaning linen soiled with blood or body fluids
Properly cleaning surfaces contaminated with blood or
body fluids
Use of Gloves
Vinyl gloves are worn to protect both the client and therapist from the transmission of disease. Wear gloves at these
times:
Any time the potential exists to come into direct contact
with blood or body fluid
If the client has broken skin such as a scratch, open cut,
or blemish
If you have broken skin on your hands or forearms, such
as a scratch, hangnail, or blemish
If you are likely to come into contact with mucous membranes; this is rare in a spa environment, but in some
states, intraoral massage is sometime used with conditions such as temporomandibular joint disorder
When you are cleaning linens or hard surfaces soiled
with blood or body fluids
If the client is HIV-positive or has a condition that causes
weakened immunity
If you are HIV-positive or a hepatitis carrier
Wear gloves also any time you are concerned about the
potential for infection or the client requests it.
Latex gloves break down when exposed to oil-based
lubricants such as those used in massage. Latex may also
cause a mild to very serious allergic reaction or skin sensitivity. For this reason, vinyl gloves are recommended. Vinyl
gloves do not break down when exposed to oil-based lubricants or spa products and seldom cause allergic reactions
or skin sensitivity.
Proper Cleanup of Soiled Linen
Linens soiled with blood or body fluids should be handled
with gloves and stored in a leakproof bag until they can be
laundered. Wash these linens separately with laundry detergent and chlorine bleach. Dry them with heat and store
them as normal in a closed cabinet.

10/24/13 1:08 AM

48

Spa Bodywork: A Guide for Massage Therapists

Proper Cleanup of Blood or Body Fluids on


Hard Surfaces
Add one part bleach to nine parts water (10% bleach solution) to clean hard surfaces contaminated with blood or
body fluid. Wear gloves and use disposable cleaning materials such as paper towels to wipe up the spill. Dispose of the
cleaning materials in a closed trash container.
Because new information about communicable diseases is
issued often, keep up-to-date about the most recent standards
and guidelines issued by the CDC (http://www.cdc.gov).

Creating a Safe Environment


Injury or harm is unlikely to happen in a safe environment.
In such an environment, conditions that may cause injury
have been eliminated. Procedures are adopted to increase
security and plans made to efficiently handle any accidents
that may occur. The safety plan should include guidelines
for ensuring the safety of both clients and therapists. If you
decide to open your own practice, you have greater control
over safety issues than if you work as an employee. As an employee, maintain your awareness of safety issues and alert
your supervisor should you feel that the environment is not
conducive to your safety and/or the safety of your clients.

Safety of the Facility


The facility must be accessible to a wide array of clients,
including those who are unsteady on their feet and those
using wheelchairs. Assess the parking area, common areas,
equipment, and fire plan:
Parking area: Begin an assessment of the facility in the
parking area. Is the pavement smooth and even, or are
cracks or an uneven surface present that may cause a client to fall? Is lighting adequate and the pathway to the
front door unobstructed? If clients must climb stairs or
use a wheelchair ramp, are these areas well lit and handrails provided?
Common areas: All common areas such as the reception
area, hallways, and bathrooms should have good lighting and nonslip flooring and be free of area rugs (which
may cause a client to trip) and barriers. Bathrooms
should include a lavatory at wheelchair height and handrails. Doorways should be wide enough to accommodate
people with physical disabilities, and lever-style door
handles used.
Equipment: Regularly check equipment to ensure that
it is in good working condition. Check bolts, hinges, and
knobs for tightness before each spa session. Any exposed
electrical cords should be heavy-duty and taped down
around the edges of the room, behind furnishings and
equipment when possible. Do not run extension cords
across a doorway or in any area where therapists or
clients must walk.

Williams_2E_CH03_printer_file.indd 48

Fire plan: Check with state authorities to ensure that


proper fire and safety codes are followed. At least one
fire extinguisher and smoke detector should be in clear
view; more are likely needed. Check the fire extinguisher
and all smoke and heat detectors monthly to ensure they
are in good working order. A fire escape route should be
clearly indicated in every room. The use of candles, incense, and open flames is not advised.
Emergency numbers: Keep a list of emergency phone
numbers by the business phone. This includes the local
fire station, poison control center, police department,
ambulance, and local hospital or emergency medical
facility. Keep your liability insurance coverage up-to-date
and display a copy on the premises.

Safety of the Client


To ensure the safety of the client, stay up-to-date with your
training in CPR and first aid. A first aid kit should be kept
in each treatment room along with hydrocortisone cream,
which can be used to decrease any skin reactions to spa
products. Never give a spa treatment without first taking
a thorough health history. If you have any concern that a
spa treatment is contraindicated for a particular client, err
on the side of caution and contact the clients physician or
postpone treatment. Because all therapists will need to look
up a health condition, medication, or other information at
some point during their professional career, have available
key reference books including an up-to-date medical dictionary, drug reference, and pathology reference book.
Some clients need help getting on and off the treatment table. Provide a wide step stool and offer assistance
to elderly clients, pregnant clients, and clients with physical
challenges. Do not leave alone a client who is unstable and
may fall. Instead, assist the client to the treatment room
and help with undressing if appropriate. After the session,
wipe the clients feet with a paper towel to remove excess
lubricant from the foot massage, which could cause a client
to slip while getting off the treatment table, especially in
wet rooms with tiled floors.
Alcohol, Drugs, and Prescription Medications
It is a serious breach of professional ethics for the therapist
to work while under the influence of an illegal drug or alcohol. This would place clients at risk of emotional harm or
physical injury. These substances also interfere with logical
reasoning and decision making, which might lead to making a poor treatment choice for a client. Alcohol and drugs
also influence the therapists behavior and feelings and
may result in inappropriate communication or emotional
outbursts. Therapists who are suffering from a hangover
should cancel any spa appointments or refer their clients to
another therapist.
Sometimes, a therapist must take prescription medications for a condition or disorder. Each situation is unique,
as is the therapists response to the medication. Be aware

10/24/13 1:08 AM

Chapter 3

Client and Therapist Safety

49

that medications may alter your perception, change your


behavior, or affect your physical abilities. Talk with the prescribing physician about possible side effects in relation to
your spa duties and responsibilities. Always act in the best
interests of the client. If the medication interferes with your
physical or mental ability to provide a safe and beneficial
spa treatment, you may need to explore different medication options or take a break from your career until the situation improves.
Spa treatments may also be contraindicated for clients
taking a prescription or over-the-counter medication that
distorts their perceptions of hot, cold, pain, or pressure, or
you may have to adapt the treatment to each clients needs.
Do not provide a spa treatment to a client under the influence of an illegal drug or alcohol because it would place
both of you in an unsafe situation. Spas that serve alcohol
as part of a treatment should rethink this policy because it
places them at liability risk in the event the client has a slip
and fall accident at the spa facility or an accident while driving home from the spa.

to discuss the situation, document this conversation and


keep it with the accident file. If a client is involved, a signed
release is required before sending client information to an
outside entity (e.g., insurance company, equipment manufacturer). This protects the clients privacy.

Accident Report

Client Screening

Any time that anyone at a businessincluding employees,


the owner, clients, and visitorsis injured in an accident,
causes injury to another, or causes property damage, an
accident report should be written and filed. This report
should provide detailed and accurate information about
the accident, the people involved, injuries or property damage, and how the situation was resolved. This information
must be accurate and detailed because it may be used by an
insurance company to process a claim or may be evidence in
a lawsuit. The accident report should include the following:

In some areas, illegitimate massage at illegitimate spas is


still used as a cover for prostitution. Although most clients
understand that professional massage is for wellness and
good health, some people seek massage for sexual gratification. Regardless of whether your practice is based in
your home or office or as a call-out service, careful client
screening helps ensure your safety.
The screening process begins when the client calls to
book an appointment or inquire about fees and services.
Ask clients for their name, address, home phone number,
work phone number, occupation, and how they heard
about the spa business. Record all of this information in
a clients new file. Ask what type of spa treatment or massage they are looking for (e.g., relaxation, sports, hot stone
massage, an herbal body wrap). Ask if this is the first spa
treatment or massage and/or if they have received spa treatments or massage regularly. With clients who have had spa
treatments or massage before, ask them to describe the results they experienced and their current expectations for a
spa treatment or massage. If the answers do not seem legitimate, be courteous but continue to question and educate the client. For example, you might say, I would like
to inform you about our spa policy. This information can
include the policies for a no-show client, the draping policy,
and the policy on drugs and alcohol. A client who confuses
massage with sexual favors may say something such as, Do
you provide erotic massage or spa treatments? What will
you wear during the spa treatment? What do you look
like? Can I massage myself during the session? or Will
you help me if I get excited? Remain courteous but end the
conversation and refuse the appointment.
All therapists should be careful about booking new clients during times when they are alone in the office. Avoid
this situation whenever possible. If you cannot avoid such

The address and location in the premises where the


accident occurred
The date and time
The name of the person filing the report and his or her
job title
The name, address, e-mail, and phone number of all
individuals involved and those of any witnesses
A detailed account of what happened
Written witness accounts of what happened when
appropriate
A description of injuries or property damage
How the matter was resolved (e.g., the individual was
sent to the emergency room, the individual refused medical treatment and went home)
If more information later becomes available, it should
be documented and kept in the same file as the accident
report. For example, if a client was injured by falling off
a wet table and a physician diagnosed an ankle sprain the
next day, record this in the file. If the accident was caused by
equipment failure (e.g., the wet table suddenly buckled due
to a faulty brace), file a report with the manufacturer immediately. File a copy of this letter along with any response
from the manufacturer. If the manufacturer telephones

Williams_2E_CH03_printer_file.indd 49

Safety of the Therapist


While at work, you may be required to lift heavy objects
such as laundry, bulk spa products, or housekeeping supplies. Always use good body mechanics to prevent back injury. You will also come into contact with strong cleaning
products and should wear heavy gloves, a face mask, and
protective eyewear to prevent contact with your eyes, respiratory system, or skin.
When you take good care of yourself, you are less likely
to suffer an injury or illness while working as a spa therapist. Proper nutrition, adequate sleep, exercise, stress reduction activities, and good body mechanics all support your
health and longevity in the profession.

10/24/13 1:08 AM

50

Spa Bodywork: A Guide for Massage Therapists

a situation, make arrangements with someone available to


assist by telephone. Tell this person the time of the appointment and that you will call again after the intake interview.
If anything feels strange during the intake interview, cancel
the session and politely ask the client to leave. When the client leaves, call your backup person to say that you are safe.
The backup person should be instructed to call you if you
have not called by the time specified, and if you do not pick
up the phone, they should call emergency services.
Incident Report
An incident report is written whenever an unusual event
occurs that creates an unsafe environment or distress for
a client, therapist, or business owner. For example, a therapist might file an incident report if a client makes sexual
advances during a spa session and the therapist had to end
the session. The report should go directly to the business
owner, who should then inform the client that he or she
is no longer welcome at the spa. Another example is a client who is unhappy with the spa session and demands a
refund. The therapist should document why the client was
unhappy and actions taken to solve the problem. An incident report should include the following:
The date, time, and place the incident occurred
The name of the person filing the report and his or her
title
The name, address, e-mail, and phone number of all
involved individuals and any witnesses
A detailed account of what happened
Written witness accounts of what happened when
appropriate
How the matter was resolved (e.g., the client was told
that he or she is no longer welcome at the clinic, the client was given a refund and referral to another therapist)

Cautions and Contraindications


A contraindication is any condition that makes the application of spa treatments unadvised or potentially dangerous to the health of the client. Table 33 provides an
overview of conditions that may contraindicate spa treatments or require greater caution from the therapist. Following are the different types of contraindications and other
considerations:
Absolute contraindication: If the client has a condition
that is an absolute contraindication, the client should
not receive a spa treatment or a massage. Examples include a significant fever (100F or higher), vomiting, a
cold (unless the symptoms have been present for 5 days
or longer; usually, people are contagious from 24 hours
before they notice symptoms to 5 days after the first
symptom), an acute systemic condition (when the condition affects the entire body and not just one local region),

Williams_2E_CH03_printer_file.indd 50

an injury that requires medical attention, or symptoms


that are intense and unexplained (e.g., intense headache
pain). For example, a client with chickenpox or pink eye
should not receive a spa treatment because the client
is extremely contagious, and these conditions could be
passed to the therapist or to other clients. Similarly, massage should not be provided to relieve headache pain in
a client with a recent concussion. Not only would massage overstimulate this client, but the client also needs to
see a physician to rule out serious complications. Note in
Table 33 that many conditions are contraindicated in
an acute stage, when the body is inflamed and the condition flares up, but are not contraindicated in a subacute
or chronic stage. Usually, if massage is contraindicated,
spa treatments will also be contraindicated; sometimes,
the opposite is true. Sunburn is a good example. Massage is contraindicated, but a soothing aloe vera and
German chamomile essential oil wrap are not.
Local contraindication: A condition may affect only
one area of the body. Spa treatments can be applied to
the rest of the body, but the local area is avoided. If a client recently had a mole removed, you would not massage
or apply seaweed over the area of reforming skin. If a client has a swollen knee, you would not apply warm mud
to the area distal to the swelling and the swollen area,
but the area proximal to the swelling and the rest of the
body can be treated.
Advanced understanding: Some therapists receive extra training and specialize in working with clients with
specific conditions. Because of their experience, often
through participation on a health care team, they develop
an advanced understanding of the condition and know
the limits of spa treatments and massage. These therapists can often work safely with a condition that would
be contraindicated for a less experienced therapist. Novice therapists may avoid certain conditions early in their
practices and then work with the same condition later as
their knowledge increases with professional experience.
Regardless of your level of experience, it is important to
obtain a physicians release with complex conditions or
clients who are taking multiple medications.
Physicians release: Before providing spa treatments to
clients with certain conditions, it is prudent to obtain a
physicians release. The release indicates that the physician believes that the spa treatment will not harm the client and may prove beneficial to the clients health. Some
physicians do not understand spa treatments, their physiological effects, or the increased burden they might place
on a clients system. If possible, explain to the physician
or the physicians staff the types of methods you plan to
use in the clients session and the ways these methods
might affect the clients body systems. This may help the
physician make the best possible recommendations.
Use caution: In many cases, spa treatments are not contraindicated, but the session must be adapted to fit the
(text continues on page 56)

10/24/13 1:08 AM

Chapter 3

Client and Therapist Safety

51

MASSAGE

STONE MASSAGE

PARAFANGO

SHIRODHARA

UBVARTANA

FOOT TREATMENTS

UC

UC

UC

UC

UC

UC

SC

SC

SC

SC

SC

UC

UC

UC

SC

SC

UC

UC

UC

UC

UC

Acromegaly

UC

UC

UC

UC

UC

UC

UC

UC

Addisons disease

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

AIDS (client condition


good)

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Allergies: shellfish,
iodine, seafood
Alzheimers disease

Amenorrhea
Angina pectoris

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Anorexia nervosa
appendicitis

UC

UC

UC

UC

UC

Anxiety disorder

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

SC

SC

SC

SC

SC

SC

SC

SC

SC

Bed sore or pressure


sore

SC

AU

SC

SC

SC

SC

SC

SC

SC

UC

UC

SC

SC

Bipolar disorder

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

SC

UC

SC

SC

SC

SC

SC

SC

SC

UC

UC

UC

SC

SC

SC

Bronchitis

UC

UC

UC

Bruise

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Arteriosclerosis

Asthma
Atherosclerosis
Athletes foot

Boil

Burns, recent

Cardiac arrest,
history of
Cellulitis
X

Chickenpox

Cholecystitis

Xb

Chronic fatigue
syndrome

Colitis

Cerebral palsy

Cirrhosis of the liver

REFER TO SKIN CARE SPECIALIST

PEAT

UC

SC

COOL WRAPS

CLAY

UC

SC

WARM WRAPS

MUD

UC

UC

HOT WRAPS

SEAWEED

AU

EXFOLIATION
UC

DR. RELEASE

Abortion, recent
Acne vulgaris

CONDITIONa

HYDROTHERAPY

CONTRAINDICATED

TABLE 33 Contraindications Chart

For a description of the conditions, please refer to a pathology textbook.


Except under medical supervision or with advanced training or specialized understanding.
, indicated/safe; AU, advanced understanding required; C, contraindicated; SC, site contraindicated; UC, use caution.
b

(continued on page 52)

Williams_2E_CH03_printer_file.indd 51

10/24/13 1:08 AM

52

Spa Bodywork: A Guide for Massage Therapists

HOT WRAPS

WARM WRAPS

COOL WRAPS

SHIRODHARA

UBVARTANA

FOOT TREATMENTS

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

SC

UC

SC

SC

SC

SC

SC

SC

SC

UC

SC

SC

SC

UC

UC

Coronary artery
disease

UC

Cb

UC

UC

UC

UC

UC

UC

Crohns disease

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Cushings disease

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Cystic fibrosis

UC

AU

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Cystitis (chronic;
acute C)
Depression

UC

UC

UC

UC

UC

Diabetes insipidus

UC

Cb

Cb

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Diabetes mellitus
Diarrhea

UC

UC

UC

UC

Xb

Diverticulitis

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Diverticulosis

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Dysmenorrhea

UC

Eczema

SC

UC

UC

SC

UC

SC

UC

UC

UC

UC

UC

SC

UC

UC

Cb

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Embolism

Emphysema
Endocarditis

UC

UC

Cb

UC

UC

UC

UC

UC

UC

UC

UC

UC

Fibrocystic breast
disease

Fibroids

Fibromyalgia

AU

UC

UC

UC

UC

Endometriosis
Epilepsy
Fever

REFER TO SKIN CARE SPECIALIST

PARAFANGO

Contusion or
concussion, recent

STONE MASSAGE

Contact dermatitis

MASSAGE

Constipation

PEAT

CLAY

Conjunctivitis
(pinkeye)

MUD

Xb

SEAWEED

Congestive heart
failure

HYDROTHERAPY

Common cold (2 to
3 days after acute)

EXFOLIATION

DR. RELEASE

CONTRAINDICATED

CONDITIONa

TABLE 33 Contraindications Chart (continued)

X
X

Flaccid muscles

AU

UC

UC

UC

Folliculitis

SC

UC

UC

SC

UC

SC

SC

SC

SC

UC

UC

UC

SC

SC

Gastritis (chronic;
acute C)

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

For a description of the conditions, please refer to a pathology textbook.


Except under medical supervision or with advanced training or specialized understanding.
, indicated/safe; AU, advanced understanding required; C, contraindicated; SC, site contraindicated; UC, use caution.
b

Williams_2E_CH03_printer_file.indd 52

10/24/13 1:08 AM

Chapter 3

Client and Therapist Safety

53

AU

AU

SC

UC

UC

SC

SC

UC

UC

UC

UC

UC

SC

Graves disease

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Heart murmur

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Hemangioma

SC

UC

SC

SC

SC

SC

SC

SC

SC

UC

UC

UC

SC

SC

Hematoma

SC

Cb

SC

SC

SC

SC

SC

SC

SC

UC

UC

SC

SC

UC

UC

UC

UC

UC

UC

UC

UC

Hepatitis (chronic;
acute C)

UC

Cb

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Hernia

SC

UC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

Herniated disk

Hemophilia
Hemorrhage

Herpes simplex

SC

AU

SC

SC

SC

SC

SC

SC

SC

UC

UC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

SC

UC

SC

UC

Hypercholesterolemia

UC

Cb

UC

UC

UC

UC

UC

UC

UC

UC

UC

Hypertension

UC

Cb

UC

UC

UC

UC

UC

UC

UC

UC

UC

Hyperthyroidism

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Hypotension

UC

Cb

UC

UC

UC

UC

UC

UC

UC

UC

UC

Hypothyroidism

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Inflammation, acute

AU

AU

AU

AU

AU

SC

SC

SC

AU

UC

SC

Inflammation,
chronic

Inflammation, subacute

AU

AU

AU

AU

AU

UC

SC

AU

UC

UC

UC

SC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Ichthyosis vulgaris
Impetigo

Influenza

X
X

Irritable bowel
syndrome
Jaundice

Kidney stones
(acute C)
Lice

Insomnia
Intestinal obstruction

REFER TO SKIN CARE SPECIALIST

AU

UC

FOOT TREATMENTS

AU

UBVARTANA

AU

UC

SHIRODHARA

UC

UC

COOL WRAPS

UC

UC

WARM WRAPS

Goiter
Gout

UC

HOT WRAPS

UC

PARAFANGO

CLAY

UC

STONE MASSAGE

MUD

UC

MASSAGE

SEAWEED

UC

PEAT

HYDROTHERAPY

UC

Gastroenteritis

DR. RELEASE

Gastroesophageal
reflux disease

CONDITIONa

EXFOLIATION

CONTRAINDICATED

TABLE 33 Contraindications Chart (continued)

X
X

For a description of the conditions, please refer to a pathology textbook.


Except under medical supervision or with advanced training or specialized understanding.
, indicated/safe; AU, advanced understanding required; C, contraindicated; SC, site contraindicated; UC, use caution.
b

(continued on page 54)

Williams_2E_CH03_printer_file.indd 53

10/24/13 1:08 AM

54

Spa Bodywork: A Guide for Massage Therapists

Lou Gehrigs disease


(ALS)
Lupus (in remission)

Lymphedema

Xb

Meningitis

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

SC

SC

SC

SC

SC

SC

UC

UC

SC

SC

AU

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

SC

SC

SC

SC

SC

SC

UC

SC

SC

SC

SC

SC

SC

SC

SC

UC

SC

SC

Mononucleosis

Multiple sclerosis

Xb

Muscular dystrophy

Myocardial infarction
(history of)
X

Neuropathy
Obesity
Osteoarthritis

Ovarian cysts
Pancreatitis (chronic;
acute C)
Xb

Parkinsons disease
Pelvic inflammatory
disease

Pericarditis

Peripheral vascular
disease, mild
Xb

Phlebitis
Pleurisy, nonbacterial

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Polycystic kidney
disease

UC

UC

UC

AU

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Preeclampsia

Pregnancy
Pregnancy, high risk

REFER TO SKIN CARE SPECIALIST

FOOT TREATMENTS

UBVARTANA

SHIRODHARA

COOL WRAPS

WARM WRAPS

HOT WRAPS

PARAFANGO

STONE MASSAGE

MASSAGE

PEAT

CLAY

MUD

C
UC

Menopause

Peritonitis

SEAWEED

UC
UC

Lymphangitis

Paralysis

HYDROTHERAPY

Xb

Lyme disease

Myocarditis

EXFOLIATION

DR. RELEASE

CONTRAINDICATED

CONDITIONa

TABLE 33 Contraindications Chart (continued)

For a description of the conditions, please refer to a pathology textbook.


Except under medical supervision or with advanced training or specialized understanding.
, indicated/safe; AU, advanced understanding required; C, contraindicated; SC, site contraindicated; UC, use caution.
b

Williams_2E_CH03_printer_file.indd 54

10/24/13 1:08 AM

Chapter 3

Client and Therapist Safety

55

MASSAGE

STONE MASSAGE

PARAFANGO

HOT WRAPS

WARM WRAPS

Prostatitis

UC

UC

UC

Pseudo sciatica

Psoriasis

UC

UC

UC

UC

SC

AU

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Cb

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

AU

UC

UC

UC

UC

UC

SC

UC

UC

UC

UC

UC

Pyelonephritis

Raynauds syndrome
Rheumatoid arthritis

Ringworm

Scabies

Scars, old
Scars, recent

SC

AU

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Scleroderma

UC

AU

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

SC

SC

UC

UC

UC

Sebaceous cyst

UC

UC

UC

UC

UC

UC

UC

UC

UC

Sinusitis (no fever


present)

Site infection or
fungus

SC

SC

UC

SC

SC

SC

SC

SC

SC

SC

SC

Sickle cell disease

UC

UC

UC

UC

Stroke

UC

Cb

UC

UC

UC

UC

UC

UC

UC

UC

UC

UC

Substance abuse,
recovery from

UC

UC

UC

UC

AU

SC

SC

Skin tabs

Sunburn
Thromboangiitis
obliterans

SC

SC

SC

SC

SC

SC

UC

SC

SC

Thrombophlebitis

SC

SC

SC

SC

SC

SC

UC

SC

SC

UC

UC

UC

SC

UC

UC

UC

UC

UC

UC

SC

UC

UC

UC

UC

UC

UC

Ulcers

Varicose veins

Tuberculosis (no
longer infective)

Urethritis

Pulmonary edema

Tonsillitis

REFER TO SKIN CARE SPECIALIST

PEAT

FOOT TREATMENTS

CLAY

UBVARTANA

MUD

SHIRODHARA

SEAWEED

COOL WRAPS

HYDROTHERAPY

DR. RELEASE

Premenstrual
syndrome

CONDITIONa

EXFOLIATION

CONTRAINDICATED

TABLE 33 Contraindications Chart (continued)

For a description of the conditions, please refer to a pathology textbook.


Except under medical supervision or with advanced training or specialized understanding.
, indicated/safe; AU, advanced understanding required; C, contraindicated; SC, site contraindicated; UC, use caution.
b

Williams_2E_CH03_printer_file.indd 55

10/24/13 1:08 AM

56

Spa Bodywork: A Guide for Massage Therapists

clients overall vitality and stamina. Obviously, a client


who is young and in good physical condition can receive
a more vigorous spa treatment than an elderly client who
is thin and frail. Sometimes, the spa treatment is shortened or certain methods are avoided. Sometimes, the way
in which the client is positioned on the table is changed
to accommodate a particular condition. You may be able
to work with the client as you normally would but with
increased vigilance. Watch for any change in the clients
condition or for side effects or adverse effects that may
develop. A sudden increase in pain, moderate to intense
discomfort, agitation, nausea, headache, or excessive dizziness is a sign that the client is not responding to spa
treatments normally. If any of these symptoms occurs
during a treatment, stop the session, offer the client water, and allow the client to relax. Monitor the client at
all times and do not allow the client to leave until the
symptoms have disappeared. If symptoms persist after
the session has ended, you should consult a physician.
If the symptoms increase rapidly after the session has
ended, the client could be in danger, and you should call
emergency services.

Spa-Specific Considerations
The spa product chosen for a particular treatment, the
surface area of the body that it is to cover, and the overall condition of the client all need careful consideration.
A spot treatment may be safe when a full-body application is contraindicated. If the product, or some of its ingredients, can penetrate the skin and enter the circulation
(e.g., essential oils), it must be used with more caution.
In such a situation, a full-body application would allow
substantially more of the product to penetrate than a spot
application.
Seaweed applications can affect thyroid medications, so
they should be avoided in cases of hypothyroidism or hyperthyroidism (except when used under the direction of a physician). Peppermint, eucalyptus, and rosemary essential oils
will counteract the effects of many homeopathic remedies,
so they should not be applied to a client who is using such
remedies to treat a condition. If the client is taking a prescription or over-the-counter medication that distorts his
or her perception of hot, cold, pain, or pressure, postpone
the treatment. For the same reason, clients under the influence of drugs or alcohol should not receive a treatment.
Also, offering wine, champagne, or other alcoholic drinks
as part of the treatment or spa package endangers the client
and may affect the legal liability of the clinic or spa.
Clients who are pregnant, in a weakened condition, have
neurological conditions, have heart conditions, or have uncontrolled high or low blood pressure should not receive
hydrotherapy treatments except when under the care of a
physician. Similarly, such clients need a doctors release for
full-body spa treatments including mud, herbal hot sheet
wraps, and seaweed wraps.

Williams_2E_CH03_printer_file.indd 56

Common Conditions That Require Caution


Although the range of conditions you might see as a professional spa therapist is vast, hypertension, integumentary
issues, diabetes, and allergic reactions to spa products are
more common, so they require special attention.
Hypertension
Blood pressure refers to the force of blood pushing against
blood vessel walls as it circulates throughout the body.
A sphygmomanometer is an instrument that measures this
pressure at two different moments. The systolic pressure is
the peak pressure in the arteries, which occurs near the beginning of the cardiac cycle during ventricular contraction.
The diastolic pressure is the lowest pressure of the resting
phase of the cardiac cycle during ventricular relaxation.
A blood pressure cuff measures the pressure in the arteries in millimeters of mercury, which is why the abbreviation
mm Hg is used in blood pressure descriptions.
High blood pressure, called hypertension, is a blood
pressure consistently elevated above 140 mm Hg systolic
and 90 mm Hg diastolic. Usually in chart notes, physicians
or nurses would write this blood pressure as 140/90 mm
Hg. The top number refers to the systolic pressure and the
bottom number the diastolic number.
Essential hypertension is hypertension that is not due
to some other pathology. Secondary hypertension is high
blood pressure that is a symptom of a separate pathology
such as a hormonal disorder. Malignant hypertension is
a dangerous condition in which the diastolic pressure increases rapidly over the course of weeks or months and
requires immediate medical attention. Most hypertension
cases are essential hypertension and are caused by smoking, being overweight, a sedentary lifestyle, a salty diet, high
alcohol consumption, stress, age, and genetic factors as
evidenced in a family history of hypertension. Pregnancy,
kidney disease, and adrenal and thyroid gland disorders are
some of the causes of secondary hypertension.
Hypertension is a serious condition that causes damage
to the heart and blood vessels. Left untreated, it can lead
to atherosclerosis, aneurysms, stroke, heart failure, heart
attack, kidney failure, and vision problems. Blood pressure
parameters are the following:

Normal: less than 120/80 mm Hg


Prehypertension: 120/80 to 139/89 mm Hg
Stage 1 hypertension: 140/90 to 159/99 mm Hg
Stage 2 hypertension: 160/100 mm Hg and above

Some clients with hypertension take prescription medications to control their blood pressure and reduce their risks
of adverse effects related to the interplay of spa treatments
and hypertension. Still, some spa treatments should not
be delivered without first consulting the clients physician.
For example, any deep abdominal massage is contraindicated for clients with elevated blood pressure or who are
taking blood pressure medications, but gentle, superficial

10/24/13 1:08 AM

Chapter 3

abdominal massage for relaxation is usually fine. Also avoid


very vigorous or very stimulating massage or spa techniques
that trigger the sympathetic nervous system. This includes
intense hydrotherapy treatments such as contrast showers
or baths (discussed in Chapter 6, Water Therapies), cold
treatments, or exposure to heat in a sauna or steam room.
Saunas raise the temperature of the clients skin to above
103F. This change in skin temperature stimulates sweating, the elimination of wastes through the skin, a faster
heart rate, and lower blood pressure.
For healthy adults, the reduction of blood pressure is a
temporary reaction to the bodys rise in skin temperature.
When a healthy person exits the sauna, blood pressure returns to normal. People with high blood pressure also experience this temporary lowering of blood pressure, but after
leaving the sauna, their blood pressure can behave abnormally, sometimes rising dramatically.
Integumentary Conditions
A basic understanding of the skin is vital to every therapist working in a spa to ensure client safety. Massage lubricants and body treatment products affect the skin, so they
must be chosen with care. For example, although a product
might be indicated for a clients muscular condition, it may
be contraindicated for the clients skin condition. Massage
therapists therefore need a good knowledge of skin types
and skin problems so that they know when to direct the
client to an esthetician or dermatologist for professional
skin care.
The essential oils used in aromatherapy are often misused in skin care because the word oil is misleading. Essential oils do not directly address dry skin conditions by adding oil or moisture to the skin. In fact, most essential oils
are quite drying for the skin and can cause irritation if used
inappropriately on a particular skin type. Essential oils are
useful as antiseptics and for helping the body to relax.
Stress plays a role in many skin disorders, so massage
therapists and estheticians can work together for the benefit of the client. A full-body massage using spa products
that are appropriate for the clients skin condition can significantly reduce stress and have a significant impact on
skin health. Improvements in the condition of the skin take
a while and require patience. At least a month is required
before a significant improvement can be seen in most conditions. Often, skin conditions require many months to resolve. When estheticians and massage therapists recognize
the potential synergy of the work that they do, they can provide integrative and supportive treatment plans for clients.
Table 34 provides an overview of skin types and conditions which the massage therapist should be aware of. Some
essential oils appropriate for each condition are included
in the table. This information will be useful for massage
therapists making blends for a safe full-body massage and
for estheticians using essential oils in skin care treatments.
In addition, recommendations are given on products that
should be avoided. Go to the chapters on aromatherapy,

Williams_2E_CH03_printer_file.indd 57

Client and Therapist Safety

57

body wraps, fangotherapy, and thalassotherapy for more


detailed information.
The Skin
The skin is the largest organ of the body and has many important functions (Fig. 35). Color and texture changes,
such as paleness, redness, bumpiness, or yellowing, reflect
the overall health of the body and may indicate internal disease. Rashes and skin eruptions illustrate poor nutritional
habits, stress, allergies, and sensitivities.
The outer layer of the skin is called the epidermis. It
contains no blood vessels but has many nerve endings. The
epidermis has multiple sublayers called strata. The bottom
layer of the epidermis is the stratum basale layer, which produces a constant supply of new cells. Keratinocytes make
up 80% to 90% of the epidermis and produce keratin. As the
Keratinocytes mature, they lose water and flatten out. They
are shed when they reach the outermost layer of the epidermis called the stratum corneum.
The stratum corneum provides the barrier function of
the skin, protecting the body from microbial invasion and
injury. It also protects the body from water loss. In fact, this
layer is 1,000 times more impermeable to water than most
other membranes of living organisms.
A healthy stratum corneum is compact with an orderly
arrangement of cells in what is often referred to as the
brick and mortar of the skin. The bricks are dead cells
filled with keratin. The mortar is the lipids between the
cells that cement them together. When the corneum
layer is damaged, the cells are thin and arranged in an uneven pattern. Damage allows preparations applied to the
skin to penetrate more readily. This is way dry or scaly
skin may give a burning sensation when products are
applied to it.
On the stratum corneum, sebum, perspiration, and
other water-soluble acids produce a pH of 4.4 to 5.6. This
is the skins acid mantel that acts as a defense mechanism
against invading microbes (Fig. 36). Research indicates
that the low pH in the stratum corneum also plays a role in
corneocyte maturation (the maturation of the keratin-filled
cells that make up the stratum corneum).
The inner layer of the skin, the dermis, is thicker than the
epidermis and is composed of connective tissue that contains collagen and elastin. Collagen makes up a large part of
the dermis (70%) and gives the skin structural support for
cells and blood vessels. It forms a network of microscopic
interwoven fibers that allows for stretching and contraction
of the skin. It also aids in the healing of wounds. Moisture
is important for keeping the collagen network supple.
The follicles, sweat glands, sebaceous glands, most of the
sensory receptors, and nerve endings are all found in the
reticular layer of the dermis. The sebaceous glands secrete
sebum, an oily, waxy substance composed of various kinds
of lipids that lubricate the skin. Normally, it flows through
the oil ducts, leading to hair follicles. When sebum becomes
hardened, the follicle becomes blocked. This is what causes
blackheads (comedones). Excessive flow of oil from the oil

10/24/13 1:08 AM

58

Spa Bodywork: A Guide for Massage Therapists

TABLE 34 Important Skin Types and Conditions


BASIC SKIN TYPE OR
SKIN CONDITION

DESCRIPTION

GENERAL RECOMMENDATIONS

Normal

The skin is clear, with an even tone


and texture, and good color and is
blemish free.

Full-body massage blends with essential oils of lavender, neroli, Roman or German
chamomile, geranium, jasmine, frankincense, or rose. Citrus oils can also be
used in moderation. Seaweed, clay, mud, and peat can be used at full strength.

Oily

Characterized by the overproduction of sebum. Enlarged pores


(follicles) may be filled with visible
grease and debris. Blemishes may
be present on the face or back.

Full-body massage blends with essential oils of bergamot, tea tree, lemon,
grapefruit, lavender, geranium, German chamomile, or cedarwood in a jojoba
base. If inflammatory acne is present, products should be diluted or the client
should be referred to an esthetician before the treatment progresses. Seaweed
mixed with aloe vera and clay is appropriate. Mud and peat should be avoided.

Oil dry

Sebaceous output has slowed and


the skin is not receiving enough
natural oil. The skin appears dry
and dehydrated.

Full-body massage blends with essential oils of lavender, German chamomile,


geranium, rose, carrot seed oil, frankincense, myrrh, and Roman chamomile in
shea butter or a heavy carrier oil such as sweet almond. Keep products covered
and moist while on the skin and do not allow clay, peat, or seaweed to dry out.
Refer the client to an esthetician for a professional skin care evaluation.

Water dry

Skin that is water dry has sufficient


oil but lacks moisture. The skin is
thin in texture, with small capillaries
showing in certain areas. This type
of skin is prone to fine lines, early
wrinkles, and a flaky appearance.

Full-body massage blends with essential oils of carrot seed, seaweed essential
oil, frankincense, myrrh, German chamomile, Roman chamomile, yarrow,
helichrysum, rose, or geranium. Avoid citrus oils in high concentrations. Avoid
the use of clay and direct the client to mud, peat, seaweed, shea butter, or
honey applications instead. Refer the client to an esthetician for a professional
skin care evaluation.

Sensitive

The texture of the skin tends to be


fine with redness, heat, broken
capillaries, and itching patches.
Sensitive skin reacts to strong
chemicals, cleaning products,
dyes, and fragrances.

Full-body massage blends with essential oils of helichrysum, carrot seed,


lavender, rose, frankincense, geranium in sweet almond oil, or expellerpressed sunflower oil (12 drops maximum of essential oil in 2 oz of oil). Avoid
products with dyes and synthetic fragrances. Avoid hot treatments such as
sheet wraps or Parafango. Dilute seaweeds to half strength with aloe vera gel
or wheat germ oil. It is a good idea to keep hydrocortisone cream on hand in
case of skin irritation.

Acne on the back

Blackheads, whiteheads, pimples,


redness, and irritation may be
present. If the condition is inflamed
and hot, do not apply product to
the area.

If the condition is mild, then the massage therapist can proceed with massage
or a body treatment. Full-body massage blends that benefit oily skin and acne
include tea tree, lavender, German chamomile, Roman chamomile, yarrow,
grapefruit, bergamot, and lemon mixed in jojoba or hemp oil. Avoid the use
of peat, paraffin, Parafango, and mud and direct the client toward clay or
seaweed instead.

Psoriasis

Skin cells divide much faster than


normal, resulting in round, reddish patches with silvery scales.
Psoriasis usually affects the
elbows, knees, lower back, ears,
and scalp.

A wide range of essential oils is indicated because psoriasis is considered by


many to be a stress-related disorder. Nurturing oils that are unlikely to cause
irritation include neroli, ylang ylang, rose, lavender, cypress, helichrysum,
yarrow, and frankincense. A combination of these oils can be mixed in hemp
seed oil, apricot kernel oil, or expeller-pressed sunflower oil. Although mild
cases of psoriasis do not seem to be irritated by spa products, mud and peat
should be avoided. Direct the client to clay, Parafango, paraffin, honey, shea
butter, or diluted seaweed instead. Refer the client to a dermatologist.

Eczema and dermatitis

These terms are used to describe


many chronic and inflammatory
disorders of the skin. Scaling and
papule formation as well as red
oozing vesicles may accompany
burning and itching sensations.

If the condition is mild, the massage therapist can proceed with full-body
massage or the application of a product to the body. Essential oils of German
chamomile, Roman chamomile, yarrow, frankincense, helichrysum, lavender,
and myrrh can be used in shea butter, sweet almond oil, hemp oil, or borage
oil. Seaweed may cause irritation, so it should be diluted. Mud and peat
should be avoided, but clay or Parafango can be used. Avoid products with
synthetic fragrances or dyes. Refer the client to a dermatologist.

glands may produce seborrhea and problem skin. Emotional stress increases the flow of sebum.
The skin was thought to be impervious to most chemicals
until, in the 1960s, dimethyl sulfoxide (DMSO) was shown
to transport other substances through the skin barrier and
into the bloodstream. It is important to understand that
some of the ingredients of spa products do pass through the

Williams_2E_CH03_printer_file.indd 58

skin into the bloodstream where they may affect the body
on a physiological level. There are many factors that contribute to the passage of these ingredients through the skin.
Lipophilic (literally lipid-loving or fat-loving) ingredients penetrate better than hydrophilic (water-loving) ingredients. Essential oils pass rapidly through the skin due to
their lipophilic nature. The polysaccharides (mucilaginous,

10/24/13 1:08 AM

Chapter 3

Client and Therapist Safety

59

Stratum corneum
Stratum lucidum
Stratum granulosum

Epidermis

Stratum spinosum
Stratum germinativum

Epidermal ridge
Capillary loop

Dermis

Hair

Nerve ending

Epidermis lifted to reveal


papillae of the dermis
Dermal papillae
Epidermis

Dermis

Sweat pore
Papillary layer of dermis
Nerve endings

Sebaceous gland

Reticular layer of dermis

Arrector pili
muscle of hair

Hypodermis (subcutaneous tissue)

Blood vessels

Hair root
Sweat glands
Nerve to hair follicle
Adipose tissue
FIGURE 35 The skin is the largest organ of the body and has many important functions. Color and texture
changes, such as paleness, redness, bumpiness, or yellowing, reflect the overall health of the body and may
indicate internal disease. Rashes and skin eruptions illustrate poor nutritional habits, stress, allergies, and
sensitivities.

slimy substances) in seaweed also pass readily through the


skin. It is not surprising that small-sized molecules penetrate faster than larger molecules or that a viscous formulation will pass through more slowly than more fluid preparations. Dead cells and lipid accumulation in the stratum
corneum as well as sebum pH and skin thickness affect the
rate at which a substance passes through the skin.6 Some
natural components increase skin penetration. These include linoleic acid (found in evening primrose oil and some

Acidic

Less
sensitive

Skin

other seed oils),7 oleic acid (found in almond, cod liver oil,
and others),8 menthol (found in some essential oils such as
peppermint),9,10 and squalene (found in olives, wheat germ
oil, and shark liver oil).11
Any areas of broken skin such as open wounds, scratches,
blemishes, or scabs are local contraindications. Contagious
skin conditions such as cellulitis, impetigo, mites (scabies),
and lice are absolute contraindications, and spa treatments
or massage should not be provided. Hives is a reaction to

10

11

12

More
Neutral
sensitive

13

14

Alkaline

FIGURE 36 pH Graph. On the stratum corneum, sebum, perspiration, and other water-soluble acids produce
a pH of 4.4 to 5.6. This is the skins acid mantel that acts as a defense mechanism against invading microbes.

Williams_2E_CH03_printer_file.indd 59

10/24/13 1:08 AM

60

Spa Bodywork: A Guide for Massage Therapists

stress or an allergy that makes the skin hot, swollen, and


itchy. It is a local contraindication if it is confined to one
small region but an absolute contraindication if widespread.
With a skin condition that is contagious but confined
to one small area such as boils, fungal infections including
ringworm, herpes simplex, and warts, the area is locally contraindicated, but spa treatments or massage can be applied
to other areas of the body. Separate used linens that were exposed to contagious skin conditions, especially herpes, and
use bleach and hot water in the wash cycle. Sanitize your
hands, wear vinyl gloves, and clean all massage equipment
and the treatment room with extra care after the session.
Avoid massaging directly over areas of acne (a bacterial
infection of the sebaceous glands), using heavy creams in
these areas, or applying natural products such as mud that
may contain bacteria that could enter the body through
broken skin. Any of these activities might spread the infection to other areas of the clients skin or cause increased
blemishing by blocking pores.
Dermatitis is a nonspecific term describing many types
of skin inflammation. Often, dermatitis is caused by contact with an irritating substance or allergen. Eczema is
caused by hypersensitivity reactions of the skin. Psoriasis
is a noncontagious skin disorder in which epithelial skin
cells replicate rapidly in patches and turn itchy and scaly.
If the skin of a client with any of these conditions is very
inflamed, is open due to scratching, or is weepy or crusty
with delicate scabs, treat the areas as a local contraindication and avoid the application of spa products.
If the skin is in relatively good condition, not overly
inflamed, intact, and not crusty, it may respond well to
massage with a natural anti-inflammatory lubricant such
as hemp seed oil and skin-soothing essential oils such as
German chamomile and helichrysum oil (see Chapter 7 on
aromatherapy). Do not use mud, seaweed, or products with
synthetic fragrances, dyes, mineral oil, lanolin, coconut oil,
grapeseed oil, or cocoa butter on clients with dermatitis, eczema, or psoriasis.
Precancerous skin conditions such as actinic lesions and
skin cancers such as basal cell carcinoma and squamous
cell carcinoma are local contraindications. Malignant melanoma spreads rapidly and is treated aggressively, often with
chemotherapy and radiation. Any spa treatments for clients
with malignant melanoma should take place only under
the guidance of the clients physician.
Skin injuries such as burns (including moderate to severe sunburn), ulcers, or open wounds are local contraindications. Widespread burns and ulcerations may be an absolute contraindication, depending on their severity. The scar
tissue that forms over burns, ulcers, or wounds responds
well to massage, seaweed treatments, and mud treatments
in the subacute and chronic stages. These natural products
and massage can improve the appearance and mobility of
this type of scar tissue. Keloid scar tissue and raised moles
are local contraindications.

Williams_2E_CH03_printer_file.indd 60

Allergies
It is possible for clients to have allergies to spa products,
so therapists must understand something about allergies
and how they occur. A primary function of the immune
system is to differentiate self from nonself substances.
The immune system destroys or subdues anything identified as nonself as fast as possible. Allergies are an immune
system response and are not caused by an infectious agent.
Even substances that pose no threat to the body such as
pollen, pet dander, a component in a lubricant, or other
allergens (substances that causes an allergic reaction) are
perceived by the immune system as a threat. Common allergies such as hay fever induce mast cells (cells that play a
role in wound healing and protection against pathogens) to
release histamine and other chemicals that change vascular
permeability. This inflammatory response leads to symptoms such as watery eyes, itching skin, swelling, a runny
nose, or vomiting and diarrhea (with food allergies). In
severe allergic reactions, known as anaphylaxis, mast cells
release large amounts of histamine that lead to edema and
sudden low blood pressure. Symptoms can include hives,
redness, shortness of breath, coughing, sneezing, decreased
heart rate, fainting, and shock. The rapid onset of localized
swelling is called angioedema. Swelling that occurs in the
tongue, larynx, or pharynx might block airflow, creating a
life-threatening condition. Peanuts (and other nuts), fish
and shellfish, latex, bee stings, and some foods such as milk
and eggs can cause severe reactions of this sort. Clients with
known allergies to nuts should not receive massage with a
lubricant containing ingredients from that nut (e.g., peanut
oil, almond oil). Clients with a known allergy to shellfish
or seafood should not receive seaweed treatments or contact products with seaweed in them. People who know they
are at risk for anaphylactic reactions usually keep medication with them, such as Benadryl or injectable epinephrine
(EpiPen).
Diabetes
Diabetes is a group of related conditions that result in elevated levels of blood sugar (hyperglycemia). About 98% of
all diabetes cases are either type 1 (rare and more serious)
or type 2 diabetes (approximately 20.8 million cases in the
United States). Gestational diabetes affects about 4% of all
pregnant women and accounts for around 135,000 cases
each year.12
In type 1 diabetes, the body does not produce insulin,
the hormone needed to convert sugar (glucose) into energy. It may have genetic roots, as it runs in families, or be
caused by exposure to certain drugs, chemicals, or infections. It is caused by an autoimmune response in which
killer T cells damage parts of the beta cells in the pancreas
where insulin is created, causing a lifelong deficiency.
People with type 1 diabetes must take injections of insulin and monitor their blood sugar levels carefully to avoid
very high levels, which can cause ketoacidosis, or very low

10/24/13 1:08 AM

Chapter 3

blood sugar, which can cause insulin shock. Ketoacidosis is


a condition in which the body metabolizes fats for fuel because the lack of insulin does not allow glucose to be used
for energy in cells. The acidic waste of rapid fat metabolism
changes the pH balance of the blood and can led to shock,
coma, and death.
In type 2 diabetes, the body does not produce enough
insulin, or target cells have fewer receptor sites for insulin than needed. Although the exact cause of type 2 diabetes is unknown, it is linked to high-carbohydrate diets
and is often treated with diet, exercise, and medications.
Some people with type 2 diabetes have to supplement this
regime with self-administered insulin. Although people
with type 2 diabetes do not experience ketoacidosis, they
may develop a blood pH imbalance related to high blood
sugar, called hyperosmolality, that can lead to shock,
coma, and death.
Insulin shock, very low blood sugar, can occur in both
type 1 and 2 diabetes but can be treated effectively simply by
ingesting juice, milk, candy, or sugar-containing soft drinks
right away to increase blood sugar levels. Over time, diabetes can lead to serious complications, including cardiovascular disease, stroke, hypertension, aneurysm, edema,
ulcers, gangrene, amputations, kidney disease, impaired vision, blindness, and neuropathy.
The types of spa techniques that can be used with clients
who have diabetes depend on the state of the individuals
health. Clients with poorly treated diabetes may have serious edema, ulcerations on their extremities, impaired circulation, and/or severe neuropathy. Very light massage or
energetic techniques might be the only treatments that
are appropriate for such clients. Hydrotherapy treatments
using extremes of hot and cold temperatures, hot stone
massage, or the application of aggressive treatment products such as seaweed are contraindicated. On the other
hand, a client who monitors blood sugar carefully, eats a
healthy diet, gets exercise, and experiences few complications may benefit from a variety of spa treatments.
Keep in mind the fact that spa treatments often stimulate the body, which uses up available glucose and insulin
faster, which can lead to an imbalance, usually low blood
sugar.13 Its important to talk this over with the client who
may need to plan mealtimes and insulin injections to better accommodate the spa session. Clients can also monitor
their blood sugar immediately before the spa treatment and
make necessary adjustments by eating a small snack or injecting insulin if needed. Keep some form of sugar in your
office (juice, candy, regular soft drinks) in case a client becomes hypoglycemic. If a diabetic client becomes confused,
irritable, weak, or shaky or has clammy skin, stop the session and give the client some sugar. If the client does not
respond quickly to the sugar, call emergency services immediately. It is not in the massage therapy scope of practice to
test a clients blood glucose level or inject insulin.
Spa therapists should obtain a physicians release when
working with a client with advanced or poorly treated

Williams_2E_CH03_printer_file.indd 61

Client and Therapist Safety

61

diabetes. If possible, discuss with the physician the types


of methods you would like to use in the session and their
effects on the body to obtain the best possible recommendations to ensure the clients safety.

Critical Thinking and Contraindications


Therapists discover contraindications or situations that
require caution from the clients completed health intake
form and the intake interview, from observations of the client, and from palpation findings or reactions the client has
to the spa treatment.
Often, the client has a condition diagnosed by a physician and understands how that condition affects the body.
As long as the condition is not completely contraindicated,
the client and therapist can discuss session goals and plan
adaptive measures to ensure comfort during the session. In
some cases, a clients condition may be serious or complex
enough to cause concern, in which case the therapist should
contact the clients physician and obtain a release. Clients
who do not have a diagnosed condition but who complain of symptoms such as fatigue, muscle weakness, unexplained pain or stiffness, persistent headache, or feelings
of lethargy should see their physician and obtain a release
before receiving a spa treatment. Undiagnosed symptoms
may indicate a serious condition that might be exacerbated
by spa treatments. Following is the basic process by which
therapists rule out contraindications:
1. Administer a health intake form and review the form
carefully.
2. Conduct a health intake interview and ask the client to
describe symptoms, general health, goals for the spa session, and side effects from medications. Ensure that the
client has listed all medications and conditions on the
health intake form.
3. Look up unfamiliar diagnosed conditions in a pathology reference. A Massage Therapists Guide to Pathology by
Ruth Werner is highly recommended.
4. Determine if the clients condition has flared up (moved
suddenly from a chronic stage to an acute stage with
intense symptoms). A condition that has flared up is
more likely to be contraindicated. If the symptom level
is normal for the client and the condition has not flared
up, spa treatment is more likely to be safe for the client.
5. Look up medications in a drug reference. Note the side
effects of the medication and check these against the
clients experience. If the client describes symptoms
that are listed as adverse effects of a medication, the
situation needs further discussion. A call to the clients
physician is advised.
6. Conditions vary from client to client, depending on
other variables in the clients life. After researching the
condition and medication and questioning the client
about any side effects experienced from medications,
assess the client visually. Get an overall impression of

10/24/13 1:08 AM

62

Spa Bodywork: A Guide for Massage Therapists

the clients physical health, level of vitality, and stamina. Dont underestimate your intuition. Even if the
reference books say massage or spa treatment is okay,
but if your gut tells you no, listen to your gut.
7. Determine if the client is contraindicated, needs a
physicians release, has any area that should not receive
treatment, should be referred to a more experienced
therapist, or should be referred to another health care
provider. If you decide that a spa treatment is not
contraindicated and that you do not need a physicians
release but adaptive measures are required, discuss your
thoughts with the client. What does the client hope to
achieve from the session? What type of spa treatment
does the client want? How does the client feel right
now? How does the client hope to feel at the conclusion
of the spa session? Depending on the clients condition,
you may eliminate the use of some techniques or adjust
the temperature of some aspects of the treatment to
reduce the load on the clients body. You may decide
to avoid the use of hydrotherapy (e.g., a hot pack) and
shorten the sessions length (e.g., offer a 30-minute session instead of 60 or 90 minutes).
8. A client may list a few symptoms but not have a diagnosed condition or be taking medications. Question
the client carefully. Perhaps a client tells you about
weekly headaches believed to be from neck and shoulder tension. The client may have periods of nausea and
refer to them as nervous stomach. The nausea may
occur when the client must give a presentation at work.
The client also reports being unable to sleep for the
last week and feeling moody and irritable. The client
believes these symptoms are related to work stress and
not related to any serious condition. You palpate the
shoulders through the clients clothing and confirm the
neck and shoulders are very tense, and the headaches
could be the result of this tension. You have to decide if
it is safe to provide a spa treatment or massage. Probably it is. Although these symptoms could be related
to a more serious condition, the client has given you
a logical explanation, and your shoulder and neck
palpation supports the clients perception about the
headaches. Your visual assessment tells you the client is
in moderate physical health and has good skin coloring,
and your impression of the clients overall vitality and
stamina is good. You decide to proceed with the session
but remain vigilant and check in regularly to determine
that the client has not had an increase of symptoms or
pain related to the session.
A different client might tell you about waking up with
pain in all the joints, with a pounding headache, and feeling incredible fatigue. The client can give no explanation
for these symptoms. Because these symptoms came on very
suddenly with no logical explanation, you refer such clients
to their physician for a release and postpone the session.
Remember, when in doubt, refer out.

Williams_2E_CH03_printer_file.indd 62

As mentioned previously, Table 33 provides an overview of conditions for quick reference, but do not rely
completely on such a list. Each client and each situation is
different, and therapists need to learn to reason clinically
so that they can make appropriate decisions for each client. Novice therapists may shy away from conditions that
an experienced therapist can work with safely. If you have
any doubt about the suitability of a spa treatment for a
client, be cautious and postpone the treatment until you
have obtained a physicians release or can discuss the situation with your supervisor. Contraindications for specific
spa treatments are described in greater detail in upcoming
chapters.

Documentation of Sessions in a Spa


The client intake process is just as important for a spa treatment as it is for massage, and before being treated, all clients need an evaluation of their physical condition. Refer
to your massage therapy textbook to provide details of the
health intake process in the event you need a reminder. To
set a relaxing tone, you might provide a cup of herbal tea
and soak the clients feet in a decorative tub while he or she
fills out the health intake form (Fig. 37). The type of information included on the health form will depend on the
scope of the spa, the services offered at the spa, or the needs
of the therapist for that particular session. A nutritionist
may ask some questions about the clients diet, whereas an
esthetician will focus on the condition of the skin and a
massage therapist will ask about muscular conditions. Spas
can plan to have one intake form or several different forms
that suit individual therapists or services.
When the client has completed the form, introduce
yourself, describe the benefits of the treatment the client
is about to receive, and review the form verbally with the
client. Ask the client follow-up questions about health
conditions and medications to rule out contraindications.
Also ask clients about their expectations of the session
so that you can tailor methods and experiences to their
particular needs.
After the session, take a few moments to process the results with the client. Ask the client about methods he or
she found particularly enjoyable or effective. This is a good
time to recommend other beneficial services or home care
products for the client. Document what occurred during
the session, the clients results, and next steps if appropriate
on a form such as the spa treatment record (Fig. 38). In the
event of a liability claim, you will need this basic information to protect yourself and your business.
All therapists should plan some time at the beginning
and end of every treatment, even for retuning clients, to
discuss the clients current condition, determine the results
obtained from treatment, and document what happened
during the session.

10/24/13 1:08 AM

Chapter 3

Client and Therapist Safety

63

SPA HEALTH INFORMATION


Patient's Name

Date

Address

State

Phone

Zip

Occupation

Emergency Contact

Phone

Primary Health Care Provider


Name

Phone

Address

State

Zip

Current Health Information


Please list all conditions currently monitored by a health care provider.

Please list all the medications you took today (include pain relievers and herbal remedies).

Please list the medications you took in the past 3 months.

Please list and briefly explain (including dates and the treatment received) the following:
Surgeries
Accidents
Major
Illnesses
Tobacco Use:

Current

Past

Never

Comments

Alcohol Use:

Current

Past

Never

Comments

Drug use:

Current

Past

Never

Comments

Are you currently menstruating?

Yes

No

Have you received a spa treatment before?

Yes

No

If yes, what types of spa treatment have you received?

FIGURE 37 Spa health form. The type of information included on the health form will depend on the scope
of the spa, the services offered at the spa, or the needs of the therapist for that particular session. A nutritionist
may ask some questions about the clients diet, whereas an esthetician will focus on the condition of the skin and
a massage therapist will ask about muscular conditions. Spas can plan to have one intake form or several different
forms that suit individual therapists or services. (continued)

Williams_2E_CH03_printer_file.indd 63

10/24/13 1:08 AM

64

Spa Bodywork: A Guide for Massage Therapists

Current and Previous Conditions


Please check all current and previous conditions and give a brief explanation, if appropriate, in the comments section
at the end of this form.

Current

Past

Current

Past

Headache

Lymphedema

Pain

High blood pressure

Sleep disorders

Low blood pressure

Fatigue

Poor circulation

Infections

Swollen ankles

Fever

Varicose veins

Sinus condition

Asthma

Skin conditions

Bowel dysfunction

Athlete's foot

Bladder dysfunction

Warts

Abdominal pain

Skin sensitivities

Thyroid dysfunction

Sunburn

Diabetes

Burns

Pregnancy

Bruises

Fibrotic cysts

Aversions to scent

Pacemaker

Aversion to oils

Phlebitis

Allergies

Raynaud's syndrome

Sensitivity to detergents
Aversion to cold

Other Conditions:

Claustrophobia
Rheumatoid arthritis
Osteoarthritis
Spinal problems
Disc problems
Lupus
Tendonitis, bursitis

Comments:

Fibromyalgia
Dizziness, ringing in the ears
Mental confusion
Numbness, tingling
Neuritis
Neuralgia
Sciatica, shooting pain
Depression
Anxiety, panic attacks

Therapist's Name:

Heart disease

Signature:

Blood clots

Date:

Stroke

FIGURE 37 (continued)

Williams_2E_CH03_printer_file.indd 64

10/24/13 1:08 AM

Chapter 3

Client and Therapist Safety

65

SPA TREATMENT RECORD


Patient's Name
Date:

Date
Therapist:

Comments:

Retail items purchased:

Therapist:

Comments:

Retail items purchased:

Therapist:

Comments:

Retail items purchased:

Therapist:

Comments:

Retail items purchased:

Therapist:

Comments:

Retail items purchased:

Therapist:

Comments:

Retail items purchased:

Treatment received:

Date:
Treatment received:

Date:
Treatment received:

Date:
Treatment received:

Date:
Treatment received:

Date:
Treatment received:

FIGURE 38 Spa treatment record. Document what occurred during the session, the clients results, and next
steps if appropriate on a form such as the spa treatment record.

Williams_2E_CH03_printer_file.indd 65

10/24/13 1:08 AM

66

Spa Bodywork: A Guide for Massage Therapists

SPA FUSION
INTEGRATION OF SKILLS

Direct Contact
The transfer of a
pathogen via direct
contact with the skin

Vector
Transmission
The transfer of a
pathogen via an
insect or animal

Indirect Contact
The transfer of a
pathogen to an
inanimate object
and then to
another person

Vehicle
Transmission
The transfer of a
pathogen via air,
dust, food, or
water

Example of a graphic organizer.

STUDY TIP: Graphic Organizers


Graphic organizers are visual representations of
concepts, ideas, and other information. They can help
you organize and clarify information to improve your
comprehension and recall. They are especially useful
for visual and kinesthetic learners. Visual learners benefit from the structure of graphic organizers, whereas
the process of creating a graphic organizer motivates
kinesthetic learners.

SPA INSPIRATION: Your Spa Journal


Journaling can be a powerful practice during your
spa training program. It allows you to keep track of
the changes you are making on a mental, emotional,
physical, and spiritual level. You will face challenges
during your schoolingeveryone doesand when
you capture these in a journal you begin to see the
pattern of your strength. This is exciting! Ask yourself simple questions to begin the process of journaling such as, What did I learn in my class today that
was particularly interesting? How will this change
the way I approach my spa work? or What are
some of my challenges right now? How can I better
organize my life to get the most out of my training
program?

CHAPTER WRAP-UP
As a professional spa therapist, you want to practice
exceptional ethics at all times to maintain your personal integrity and the integrity of the massage and
spa professions. This means learning and following a
code of ethics as established by the organizations you

Williams_2E_CH03_printer_file.indd 66

join as a professional. Requiring a health intake form


and checking it carefully to ensure spa treatments are
not contraindicated for your client is just as important to your integrity and professionalism. Make sure
to keep the proper reference books on hand and to
research any unknown medications or client conditions before providing spa services. Document your
sessions to ensure you have good records to follow on
treatments and to protect yourself in the event of a liability claim. You are also required by health standards
to provide a clean, hygienic, and safe environment for
your clients. Good sanitation skills require practice.
Its easy to forget small things in the course of a busy
day, but such forgetfulness may cause a client to get
sick. For example, a new therapist might forget to sanitize her hands before moving from foot massage to
another area of the body. This client is now potentially
exposed to a fungus that can take hold and grow on
another area of the skin. A new therapist might forget
to disinfect the oil bottle between clients. The second
client is then exposed to pathogens from the first
because the therapist touches the skin, touches the
bottle, and then touches the new clients skin. Good
sanitation practices also require you to pay attention
to your every gesture. Did you touch your hair or
scratch your nose as you transitioned from one body
area to another? If you did, you should decontaminate your hands before you touch the client again. Be
vigilant and practice thinking about sanitation as part
of your spa treatment application. If you accidentally
skip a sanitation step, stop and practice incorporating the step. In this way, you will be ready when you
are a professional to provide your clients with the best
possible care.

10/24/13 1:08 AM

Chapter 3

Client and Therapist Safety

67

SPA FUSION
INTEGRATION OF SKILLS (continued)
REVIEW QUESTIONS
Multiple Choice
1. A creed that states a professional groups
principles and the values by which the group abides
is called:
a.
b.
c.
d.

A code of values
A code of principles
A code of professionalism
A code of ethics

2. The transfer of a pathogen from an infected


person to an uninfected person through touch
is called:
a.
b.
c.
d.

Direct contact
Indirect contact
Vector transmission
Vehicle transmission

3. A type of cleaning product that should not be used


on the skin is:
a.
b.
c.
d.

An antiseptic
Alcohol
A disinfectant
Hydrogen peroxide

4. The authority a massage therapist is granted by a


client because the massage therapist is a health care
provider is called:
a.
b.
c.
d.

The health care authority


The power differential
The authority difference
The health care differential

5. A term used by regulating boards of health care


professions to describe the techniques, activities,
and methods that are permitted to a therapist
under the law.
a.
b.
c.
d.

Health care authority


Power differential
Code of ethics
Scope of practice

Williams_2E_CH03_printer_file.indd 67

6. A protocol used in health care settings that


reduces the risk that health care workers will be
exposed to bloodborne diseases is called:
a.
b.
c.
d.

Universal precautions
General precautions
Code of precautions
Health workers precautions code

7. Showing artistic pictures of undraped bodies in


the massage or spa reception area is a form of:
a.
b.
c.
d.

Sexual assault
Sexual impropriety
Ethical conduct
Professional conduct

8. When regulations state that massage therapists


cannot diagnose a patients condition, prescribe a
medication or treatment, or adjust a clients bones
they are referring to:
a.
b.
c.
d.

Code of ethics restrictions


Sanitation and hygiene restrictions
Sexual impropriety restrictions
Scope of practice restrictions

9. Offering wine, champagne, or other alcoholic


drinks as part of a spa treatment:
a. Is fine if the client is of legal drinking age
b. Is fine so long as the client does not consume
more than two drinks
c. May lead to criminal charges against the
therapist
d. Endangers the client and may lead to liability
claims
10. A skin condition that is contagious but confined
to one small area such as boils, fungal infections
including ringworm, herpes simplex, and warts is:
a.
b.
c.
d.

A local contraindication
An absolute contraindication
Not a concern
Can receive treatment so long as the therapist
wears gloves

10/24/13 1:08 AM

4
Your Spa Massage
Chapter Outline

K e y Te r m s

Overview of a Wellness Massage Session

Aroma mist: A combination of distilled water and essential oils placed in


a misting bottle. It is misted over the client at the end of a session to fill
the treatment room with a refreshing scent.
Aromatherapy inhalation: One drop of an essential oil or 1 drop of a
blend of different oils is briefly rubbed together in the hands before the
hands are passed over the clients nose in an arc so that the oil can be
enjoyed on a deep inward breath.
Auditory cue: A cue, such as the ringing of a chime, used to signal the
beginning and ending of the massage session.
Diaphragmatic breathing: A breathing exercise that promotes deep,
relaxed breathing patterns.
Massage enhancers: Additional session elements or small complementary treatments that increase the clients enjoyment of the session.
Paraffin: Paraffin is a waxy substance obtained from the distillates of
wood, coal, petroleum, or shale oil. It is used to coat the skin and trap
heat and moisture at the skins surface.
Pursed-lip breathing: A breathing technique that promotes deep, relaxed
breathing patterns.
Routines: Routines are a series of strokes that are planned in advance,
delivered to body areas in a preset order, and practiced until they flow
smoothly together.
Sequencing: Sequencing refers both to the sequence of strokes (the order
in which strokes are applied to a given body area) and to the overall
sequence of the massage (the order in which body areas are massaged).

Before the Massage


The Massage
After the Massage

Opening and Closing the Massage


Resting and Holding Strokes
Breathwork
Aromatherapy Inhalations
Use of an Auditory Cue

Massage Enhancers
Warm Packs
Steamy Aromatic Towels
A Simple Hand or Foot Treatment
Paraffin Dip
Easy Aromatherapy Enhancements

Putting Your Spa Massage Together


Sequencing
Routines
Subtle Factors That Influence the Massage

SPA FUSION
INTEGRATION OF SKILLS
STUDY TIP: Party! Thats Right. Party!
SPA INSPIRATION: Spa Massage Olympics
ITS TRUE! Diaphragmatic Breathing Exercises
Support Different Client Groups
CHAPTER WRAP-UP

68

Williams_2E_CH04_printer_file.indd 68

10/24/13 1:13 AM

Chapter 4

Massage in a spa setting is just like massage in any


other setting; it is usually customized to fit the needs
of the individual client and can take many forms. All
types of massage, including Swedish, lomilomi, Thai,
sports, craniosacral, orthopedic, Shiatsu, myofascial
work, ayurvedic marma point therapy, stone massage,

Your Spa Massage

69

generally viewed as a healthy activity to promote a balanced,


functional life and is regularly promoted at spas, wellness
centers, private practices, and massage clinics. We are about
to examine the sequence of events that occur in a wellness
massage. Note that the sequence of events in a health care
massage (also called treatment or rehabilitative massage) is
likely to be different. Usually, a health care massage requires
more in-depth assessment of the client such as a posture
and range of motion assessment and more detailed treatment planning.

neuromuscular therapy, and many others, are offered in spas


around the country. Sometimes, the whole massage routine

Before the Massage

will be based on one style (e.g., lomilomi), and sometimes,

When a client arrives for his or her first massage appointment at the spa, make every effort to make the person
feel welcome. Orient the client to the new environment
and recognize that a new client is making numerous
boundary adjustments to participate in the massage session and is likely to feel some nervousness or discomfort
as a result.

a combination of techniques from many styles (e.g., Thai,


marma point massage) will be integrated with Swedish
massage strokes. The spa may train everyone to deliver the
same massage, or they may allow each therapist to do his
or her own massage routine. The goal is to develop your
massage skills so that you can fluidly adapt to the style of
massage requested by employers or meet the needs of your
clientele in a private massage or spa business. This chapter
provides an overview of a wellness massage session before
looking closely at the subtle factors that can influence a
clients enjoyment of a session. Finally, we put everything
together into a beautiful, flowing, and luxurious session.

Overview of a Wellness Massage


Session
Massage theory and techniques are sometimes taught in
isolation, especially in the early portions of a massage training program. Students focus on one skill at a time and then
put them all together into an organized whole. Alternately,
you may have completed your massage training program
so that you can focus on specialization in spa therapies.
In either case, it is helpful to preview the big picture to better understand where and how different skills are used during a wellness massage sessionthe type of massage session
often offered at spas.
Lets review the difference between wellness massage and
health care massage. The public seeks wellness massage
to decrease stress, promote relaxation, support the bodys
natural restorative mechanisms, and have an enjoyable experience that leaves the body feeling refreshed and revitalized. Wellness massage is also used to reduce temporary
pain from overexertion caused by activities such as weekend
athletics or by unusual work stress. This type of massage is

Williams_2E_CH04_printer_file.indd 69

The Greeting
As the client walks through the door, you or the receptionist should be on hand with a warm greeting. Step out from
behind the reception desk to shake the clients hand and
smile while making eye contact. Hand the client a clipboard with the required paperwork (usually, a health history form and documents relating to informed consent)
and explain each document. Show the client to a seat in the
reception area and perhaps offer a cup of herbal tea. The client fills out the paperwork and hands it in to you. In many
spas, this process might take place in a quiet room, apart
from the reception area, and be accompanied by a relaxing
foot soak.
The Tour
With paperwork in hand, you escort the client into the
treatment area. Point out where the bathroom is located
and any amenities such as the steam room or sauna the
client might use on his or her next visit. Let the client
know if a shower is available before or after the massage.
Show the client into the treatment room and explain
where to undress and hang clothing. Its a good idea to
remind clients to remove jewelry before the session because
lubricants can cause jewelry to look tarnished and delicate
pieces may be damaged during massage strokes. Use a small
dish to hold personal items so that jewelry is not lost or
forgotten.
The Interview
The client interview does not need to be a complex process,
but each of the items we preview here should be discussed
to ensure the safety of both client and therapist. The overview here is to describe where and how an interview occurs
in the progression of a wellness massage, so in-depth details

10/24/13 1:13 AM

70

Spa Bodywork: A Guide for Massage Therapists

are not included. Refer to your massage program training


materials or instructor for more information about any
processes you feel uncertain about. Offer the client a seat
and sit down facing the client. The initial intake interview
should accomplish a number of tasks but take no longer
than 10 minutes:
1. Policies and procedures: Briefly review the spas
policies and procedures and information relating to
informed consent, including the scope of practice
for massage and the limitations of massage. Ensure

that the client has signed an informed consent form.


An example is provided in Figure 41.
2. Rule out contraindications: Review the clients
completed health history form. In some cases, you may
need more information from the client about a particular condition to rule out contraindications. When
you feel you understand the clients medical picture
and that massage is not contraindicated, treatment
planning begins. A sample of a health history form
and a discussion of contraindications is provided in
Chapter 3.

FIGURE 41 Example of an informed consent statement and form. An informed consent statement and form
is a document that fully informs clients about choices related to their care. It discloses policies and limitations
of services that might affect their care. All of the national massage organizations require massage therapists to
provide informed consent documentation to their clients as part of their codes of ethics. (continued)

Williams_2E_CH04_printer_file.indd 70

10/24/13 1:13 AM

Chapter 4

Your Spa Massage

71

FIGURE 41 (continued)

3. Client expectations: Ask the client to share about


expectations for the session. Its sometimes helpful to ask, What results do you want to achieve? or
When you leave here today after your session, what
do you want your body to feel like? In a relaxation
session, it is common for clients to want to feel more
relaxed or to have less tension in a particular area.
First-time clients may not know what to expect and may
be anxious. They may have seen a picture of massage
or read about the benefits of massage in a magazine.
Perhaps, a friend described a positive massage experience. A client who has received only one previous

Williams_2E_CH04_printer_file.indd 71

massage is likely to expect this massage to be exactly


the same as the first. In this case, the client may wonder
whats going on when you use a different style or techniques. In each of these circumstances, you can set the
client up for a good experience by explaining that there
are many different types of massage and then describing some of the techniques you plan to use and their
effects.
Although concerns about the therapists gender
have diminished because people become more educated
about massage, some clients want to choose the gender
of their therapist and may be surprised if this was not

10/24/13 1:13 AM

72

Spa Bodywork: A Guide for Massage Therapists

discussed during the booking phone call. In our culture,


many men and women tend to feel more comfortable
with a female therapist. Many women may feel less selfconscious about how their bodies look to other women.
Some women have concerns about the potential sexual
misconduct of a man based on some past experience,
whereas others may worry that their male partners will
feel uneasy that they have received massage from a man.
Some men feel anxious about receiving an enjoyable
experience from a mans touch. Cultural and religious
beliefs can also influence clients. Although these stigmas can frustrate male therapists, this situation continues to improve because people embrace massage as a
regular health care practice. All clients have the right to
determine what happens to their body. If the client asks
for a therapist of a specific gender, this request must be
honored. Sometimes, a clients expectations of massage
are not reasonable, however. In this case, outline for the
client what is realistic and what is beyond the scope of
massage.
4. Determine treatment goals: With the clients input,
determine specific treatment goals for the session.
This can be fairly simple, as in the following example,
or fairly complex. In a wellness massage, treatment
goals are based on the clients expectations and often
help you focus on areas that need the most attention
during the session. For example, the goals for a session
might be to decrease bilateral neck tension, decrease
upper back tension, and decrease foot soreness. You
then know that you will be massaging this clients
back, neck, and feet. Will the client want other areas
massaged?
5. Plan the massage: Sometimes, clients only want
selected areas to be massaged, or they may want a
full-body massage with extra focus in certain areas.
Clarify the plan before the session starts. You might
say something like, Im going to start on your back to
focus on your upper back tension and your shoulders.
These tense areas are probably contributing to your
neck pain. Would you like me to work on the back
of your legs? Yes? Okay, then I will massage your legs
before I turn you over and focus on your neck. Would
you like me to massage your arms and the front of
your legs? Great. How about your abdominal muscles?
No? Okay, I will finish with a good 20 minutes on your
sore feet. This is a good time also to ask clients about
their music preferences and preferences for lubricants.
When all these things have been decided, the session
can begin.
Transition to Massage
Before you leave the treatment room, show the client the
massage table and explain the position you would like the
client to take on the table after undressing. Because clients
may feel very nervous about how much clothing they need
to remove, its important to reassure them. You might say

Williams_2E_CH04_printer_file.indd 72

something like this: Undress to your level of comfort.


Some clients choose to remove all of their clothing and
this is fine, and others prefer to leave on some of their
underclothing, which is also fine. You will always be draped
during the session, and I will only undrape the area where
I am working. This is to keep you warm but also to preserve modesty. This is also a good time to check if the client needs to use the restroom before undressing. Unless the
client needs assistance getting on the massage table, leave
the room while the client undresses. Because some clients
feel nervous that the therapist may walk back in while they
are partially undressed, it helps to say that you will knock
and wait to hear they are ready before you enter.
Prepare Yourself for the Massage
Usually, clients need no more than 5 minutes to undress
and situate themselves on the massage table. Use this time
to warm up your hands and to ground and center your
energy for the session. Use the restroom if you need to and
wash your hands carefully directly before returning to the
treatment room.

The Massage
Knock and wait for the clients response. Enter the treatment room and greet the client again. If the client is in the
prone position and cannot see what you are doing, explain
your actions or movements (e.g., Im just going to start the
music and turn on this space heater so you dont get cold.).
A client who doesnt know what you are doing may become
nervous when hearing you moving about the room.
1. Bolster: Decontaminate your hands and use bolsters to
support the clients position on the table.
2. Check in: Ask the client about the room temperature
and turn on a heater or add a blanket over the drape if
the client is cold. Warm packs might be placed on the
client at this time (discussed later in this chapter).
3. Open the massage: There are a number of ways to
open a massage. You might choose to use a breathing
exercise such as those described later in this chapter. You might apply a resting and holding stroke or
perhaps add a creative flourish such as ringing a small
chime to mark the start of the session.
4. Follow the treatment plan: Once the massage starts,
follow the plan you discussed with the client. If you
discover an area of particular tension that needs massage but was not part of the original treatment plan,
talk with the client about this. Its as easy as saying
something like, Carole, Ive found an area on your low
back where the tissue is very bound up. I would like to
spend some extra time working on this area. We didnt
discuss this earlier, but would you mind if I cut some
time off the massage of your legs to work longer on
your low back? Carole will answer yes or no or may ask
a question. This negotiation helps minimize the power

10/24/13 1:13 AM

Chapter 4

differential and encourages clients to make decisions


about their own body, as discussed in Chapter 3 in the
section on ethics. Make sure to address each area where
the client wants work.
Sometimes, new massage therapists frustrate clients
by not getting to important areas in a timely manner.
In one case, the client reported to the spa manager that
she specifically requested 30 minutes of work on her
back and 30 minutes on her neck. She told the therapist she didnt want any other areas massaged. The
therapist massaged the clients legs, feet, and arms, and
spent only 15 minutes on her back and 5 minutes on
her neck. The manager questioned the new therapist
and found that she felt uncomfortable with neck massage and was avoiding it. In school, she had learned a
full-body massage routine, and that was what she was
most comfortable doing. Ethically, this therapist should
have explained her limitations up front and referred
the client to another therapist until she had the skills
needed to meet the clients needs.
5. Close the massage: The massage can be closed in a
number of ways, as discussed later in this chapter. Many
therapists match their massage opening to their massage closing. For example, if they opened with a breathing exercise, they close with a breathing exercise.

4.
5.

6.
7.

8.

After the Massage


Your actions following the massage help ensure the client
has had a good experience:
1. Transition out of the massage: After closing the
massage, remove the bolsters and ask the client to get
dressed. Provide disposable wet wipes and a dry hand
towel for the client to clean up or explain that amenities
such as saunas, whirlpool baths, or showers are available. Sometimes, therapists give clients suggestions for
activities they can use at home to improve the condition
of their muscle tissue, such as stretches or self-massage.
If you intend to give home care, ask the client to dress
and remain in the treatment room. This way, you
can demonstrate the stretches or massage techniques
privately. If not giving home care, ask the client to meet
you at the reception desk after dressing.
2. Sale of retail product: In many spas, the sale of retail
product is required of all of the staff working at the spa.
If you intend to sell retail products, know each product
line well and think carefully about products that would
truly benefit your client. Ask clients if they would like to
hear about some of the products in the retail area that
might be of benefit. If the client says, yes, then outline
one of two key products and show the client these products before processing the clients fee for the session.
3. Collect the fee: Back in the reception area, collect the
fee for the massage and offer the client water. Clients
appreciate bottled water they can take with them.

Williams_2E_CH04_printer_file.indd 73

Your Spa Massage

73

Ask if the client would like to book another session.


Some therapists choose to collect the fee and schedule
additional sessions before the massage. This way, the
client can be on the way as soon as the session ends.
Both methods are fine.
Book a session: Book the session and give the client an
appointment card with the date and time.
Say goodbye: You might remind clients to pay attention to how their body feels as a result of the massage.
Phrase this in goodbye language to avoid opening a
new conversation that would be better in the privacy of
the treatment room. Say something like, Remember
to keep track of how your body feels so we can discuss
it when I see you at your next session. Shake the clients hand warmly as you walk toward the door. This
behavior helps the client transition out of the massage
session and back into the real world. It also helps to
maintain the boundaries of the therapeutic relationship, end the session on a friendly note, and keep you
on schedule with future clients.
Chart notes: Complete the chart notes and documentation for the session and file the clients record neatly.
Change the room: Cleaned, disinfect, and sanitize the
treatment room as needed to prepare it and the massage
table for the next session, as discussed in Chapter 3.
Self-care: You might now perform any regular self-care
activities such as stretching or eating a snack before the
next client arrives for a session.

Massage sessions involve interpersonal skills such as professional communication, ethics, and boundary setting and
practical skills such as draping, bolstering, along with the
actual massage techniques. The theory that underlies all of
these skills is of primary importance. Without an understanding of the physiological effects of massage techniques,
you wouldnt know which methods to use to address a
clients neck tension. Without an understanding of the
structures of the neck, you wouldnt know where to apply
techniques. Each skill is important, and together these different types of skills create an accomplished massage professional. As you review this outline of a wellness session,
think about areas where you would like to improve your
efficiency and smoothness. For example, if you find that
you always feel uncomfortable greeting clients and explaining the paperwork included in the health intake, practice
these skills with a friend or supervisor. Practice what you
will say and do out loud, as if it is really happening, until
you gain the desired fluidity.

Opening and Closing the Massage


Consider the following examples of how two different massage therapists open and close their sessions.
Steve pays attention to how he opens and closes his
massages. He likes to use resting and holding strokes

10/24/13 1:13 AM

74

Spa Bodywork: A Guide for Massage Therapists

and breathwork (described below). To open the massage,


he places his hands on the client with clear intent and
allows the client to accept and become use to his touch.
He asks the client to take three deep breaths and release
all body tension with each exhalation. Steves touch is
assured and firm. The client feels a therapist who is energetically balanced and focused and who has a plan. The
client relaxes before Steve even undrapes a body area,
confident that Steve knows what he is doing. The opening is a simple moment, and yet it can affect clients trust
level and willingness to allow their body to let go and
relax. At the end of the session, Steve finishes the massage, redrapes the client, and places his hands in the same
position as when he opened the massage; although this
time, the client is supine. Steve asks the client to breathe
deeply for three breaths and to slowly wake up with each
exhalation. The exhalation of each breath brings the
client gently back to the real world and leaves the client
feeling peaceful.
Jay doesnt worry much about how he starts and finishes
his massages. When he enters the treatment room, he fusses with the drape, leaves the client to look around for the
massage lubricant, and then struggles to place the bolster
under the clients knees. The clients body tenses to ward
off the irritating sensations of all this disjointed activity.
Jay undrapes the clients leg and starts massaging but soon
leaves to adjust the volume of the music. When he returns
to the client, he reminds the client to relax, but the client
remains watchful for the first 20 minutes of the session.
Once Jay settles into the massage, he has good massage
techniques, and the client eventually relaxes deeply when
Jay works on the posterior legs and back. The client is calmly drifting when Jay abruptly replaces the drape and says,
Okay, times up, and Ill meet you up front in the reception
area when youre dressed. He pulls out the bolster and
leaves the room. The client gets up quickly from the massage table and gets dressed. The client has less muscle tension but feels oddly irritated.
The opening and closing of the massage are important
moments because they frame the entire massage experience. The opening of a massage is a formal moment that
recognizes the importance of what is coming. Massage is
an opportunity for the body to change in a positive way,
to release long-held tension, to rest, to recover, and to have
a healthy experience of touch. In many ways, a massage
starts the minute a therapist enters the treatment room
and approaches the client. Even if the client is in a prone
position and cannot see the therapist, root hair receptors in
the skin will recognize changes in air movement and heat.
This may trigger instinctive survival responses that cause
the client naturally to be tense during the initial contact.
It is better to look at the client, offer a verbal greeting,
and approach slowly with therapeutic intent. Dont look
around for bolsters or massage lubricant. Have everything
ready before the client enters the treatment room so that
your entrance into the room can be calm and relaxed.

Williams_2E_CH04_printer_file.indd 74

The closing of the massage should leave a client feeling


complete, peaceful, and balanced. You want the client to
know the massage is ending before it actually ends and to
start to return to normal waking consciousness smoothly
without being jarred awake. Avoid abrupt closings that
leave a client feeling rushed or disturbed.
Therapists use a variety of techniques to formally open
and close the massage, including resting and holding strokes,
breathwork, aromatherapy inhalations, and auditory cues.

Resting and Holding Strokes


In a resting or holding stroke, the hands are placed, without lubricant, on the client with the intent to greet the client and allow the client time to become accustomed to the
unfamiliar touch. You might match your inhalations and
exhalations to those of the client during a resting stroke to
feel in sync with the clients rhythms. Tension in the clients
body, the clients temperature and breathing patterns, and
the quality of the tissue under your hands all convey an impression, which may affect how you proceed with the session (Fig. 42).

Breathwork
Breathwork in massage is an important skill. A breathing
exercise such as the diaphragmatic breathing technique
described in For Your Information 41, the pursed-lip

FIGURE 42 In a resting or holding stroke, the hands are placed,


without lubricant, on the client with the intent to greet the client and
allow the client time to become accustomed to the unfamiliar touch.

10/24/13 1:13 AM

Chapter 4

Your Spa Massage

75

FOR YOUR INFORMATION 41


Diaphragmatic Breathing
Diaphragmatic breathing is used with the client in a supine position both to assess the clients breathing pattern and to educate
the client about proper breathing. It works well to use this technique at the beginning of a session. Communication skills are key
because you will coach the client into a functional breathing pattern. Focus on ensuring that the clients breaths are slow,
rhythmic, and relaxed. Keep the exercise short enough that the client does not become concerned about losing time from the
massage.
1. Place your hand on the clients abdominal area and ask the client
to lift your hand with each inhalation up to three times.

2. Place one hand on each side of the ribs and ask the client to move
your hands outward with the breath up to three times.

(continued on page 76)

Williams_2E_CH04_printer_file.indd 75

10/24/13 1:13 AM

76

Spa Bodywork: A Guide for Massage Therapists

FOR YOUR INFORMATION 41


Diaphragmatic Breathing (continued)
3. Place the fingers of one hand on the lower section of the sternum and ask the client to lift your hand with each breath up to
three times.

4. Have the client put the breaths together by cueing your hands. Ask
the client to inhale first, filling up the abdominal area, then laterally
expanding the ribs, and then allowing the chest to rise. Touch each
area in order as the client inhales and pace the client on a full, even
breath. As the client exhales, it can be effective to gently massage
any areas of the upper neck that look tense, such as the shoulders,
which may tend to pull forward or up during breathing. Repeat the
cueing and coordinated breathing up to three times.

Williams_2E_CH04_printer_file.indd 76

10/24/13 1:13 AM

Chapter 4

Your Spa Massage

77

FOR YOUR INFORMATION 42


Pursed-Lip Breathing
Pursed-lip breathing tones and strengthens the diaphragm and
helps to reeducate the clients kinesthetic sense of breath. When
the client exhales with lips pursed (imagine the lips closing around
a straw), this creates resistance for the diaphragm. The diaphragm
contracts on the inhalation and relaxes on the exhalation. Pursedlip breathing keeps the diaphragm working at the same time that
it is relaxing. Use this technique at the opening or closing of the
massage session with the client in a supine position or sitting up in
a chair. As with diaphragmatic breathing, communication skills
are important as you coach the client through pursed-lip breathing. Place your hand on your clients abdominal area and instruct
the client to raise your hand with each inhalation by breathing in
through the nose on a slow 2- to 4-second count. Demonstrate
the pursed-lip position of the mouth for the client and instruct the
client to exhale through the lips on a slow 4- to 8-second count. The
client should exhale through the lips as slowly as possible. Practice
the technique a few times. Clients who are interested in improving
their breathing and toning the diaphragm can practice pursed-lip
breathing 20 to 40 times, twice a day at home.

breathing technique described in For Your Information 42,


or simply asking the clients to take three deep breaths
can help clients drop into their body, center themselves
energetically, and consciously release unnecessary muscle
tension. Breathwork helps you tune into the clients breathing rhythms and thereby pace the massage to the client.
Many people breathe with a disturbed pattern that can
disrupt the delicate balance of carbon dioxide and oxygen
in the blood. Proper breathing during a session revitalizes
the body by ensuring the correct levels of oxygen and carbon dioxide in the body. The use of breathwork in a session
helps clients become more aware of their breathing patterns
and can lead to better breathing on a regular basis. Still, spa
therapists must walk a careful line here. Too much focus
on a breathing pattern can disrupt the clients relaxation
experience and may cause resentment. Some clients resist
breathwork because they just want to get on with the massage. Breathing exercises used in wellness massage should
be brief and to the point.
The diaphragmatic breathing technique and the pursedlip breathing technique are brief enough to be used in every

Williams_2E_CH04_printer_file.indd 77

session, as desired by the client, and can help clients develop


greater breath awareness and help change poor breathing
patterns. These exercises set the client up to breathe more
evenly and deeply throughout the session, enhancing relaxation and ensuring proper amounts of carbon dioxide and
oxygen in the blood.
Breathwork throughout the Massage
Breathwork is important throughout the massage and can
be used in a variety of circumstances. Sometimes, you may
notice that a client is taking a breath, holding it without
conscious awareness, and then letting it out suddenly.
Some clients regularly hold their breath without realizing
it. You might say, As I massage, try to focus on the even
inward and outward movement of your breath. Try to make
each breath full and complete. This will help regulate your
breathing pattern and help relax your muscles. Clients
then become aware of their breathing. Clients typically
focus on breathing for a short time and then forget about
it, but they are likely to breathe more regularly throughout
the remainder of the session.

10/24/13 1:13 AM

78

Spa Bodywork: A Guide for Massage Therapists

You can also match your own breathing to the clients to


help pace the massage to the clients natural body rhythms.
Alternatively, focus on your own breathing to add intention
to a stroke or to ensure that your movements flow in harmony with breathing. In this case, you are likely to exhale
as strokes move away from your body and inhale as strokes
come back. Your breathing pattern can also cue a client to
breathe more regularly. For example, if you take an audible
inward breath at the start of the stroke, you may find that
the client joins in. As you exhale during the application of
the stroke, the client might again follow along.
Clients can be encouraged to release bound muscle
tissue with their breathing. As a muscle is lengthened,
as you move from the origin of a muscle to its insertion
during a stroke, or as you move from distal body areas to
proximal body areas, encourage the client to take a full
breath and then exhale as the stroke is performed. Your
directions to the client should be simple: Please take a
full breath, and now, release it. If an area is particularly
painful or tense, the client can use breathing to release the
area or decrease the pain. For example, if you are applying
a stroke on the back and, as you approach the rhomboid
muscles, the client tenses and you feel increased muscle
tension, you can say to the client, Im going to drop into
this bound tissue. Take a full breath and feel as if you
are using your breath to lift up my forearm. Good. Take
another deep breath and feel the tension dissipate as you
release the breath. Good!
In certain stretching techniques, such as active isolated
stretching and post-isometric relaxation, the use of breath
is fundamental to the technique. Potentially painful methods such as trigger point therapy require a client to breathe
through the technique to better tolerate the discomfort.

Aromatherapy Inhalations
Aromatherapy inhalations are used either at the begin-

ning or end of the massage (Fig. 43). One drop of an

oil or 1 drop of a blend of different oils is briefly rubbed


together in the hands before being passed over the clients nose in an arc so that the oil can be enjoyed on a
deep inward breath. The therapist then proceeds with the
massage. Choose soothing oils such as a drop of lavender, mandarin, or cardamom at the onset of the massage
to support the relaxation process. Stimulating oils such
as peppermint, rosemary, or eucalyptus help the client
wake up at the end of the session as part of closing the
massage.

Use of an Auditory Cue


An auditory cue, such as the ringing of a chime, can be
used to signal the beginning and ending of the massage
session. This opening might be paired with resting and
holding strokes, an aromatherapy inhalation (described
earlier in this chapter), or a breathing exercise. This form
of massage opening and closing creates a sense of ritual
and lends the session a more spiritual formality. Over
time, an auditory cue may become linked in the clients
mind with relaxation, causing an instantaneous relaxation response.

Massage Enhancers
Therapists who would like to work in an established
spa should make sure that their Swedish massage is
flowing and elegant. Work to engage the tissue so
that the strokes have depth and intent. Practice draping efficiently and incorporating a variety of strokes so
that the massage feels complete. When developing a spa
massage, try to make the service as luxurious as possible by adding several small but exceptional massage
enhancers. These enhancers might include the use of
steamy aromatic towels, aroma mists, a simple hand and

FIGURE 43 Aromatherapy inhalations. Aroma inhalations are used either at the beginning or end
of the massage. One drop of an oil or 1 drop of a blend of different oils is briefly rubbed together in the
hands before being passed over the clients nose in an arc so that the oil can be enjoyed on a deep inward
breath.

Williams_2E_CH04_printer_file.indd 78

10/24/13 1:13 AM

Chapter 4

Your Spa Massage

79

TABLE 41 Spa Massage and EnhancersSample Outline


SIMPLE AND SUMPTUOUS

AN EFFORTLESS INDULGENCE

1. Client supine, semireclined, and bolstered

1. Client prone and bolstered

2. Place a warm pack on the belly.

2. Place a warm pack on the back and on the bottom of the feet.

3. Place a drop of lemon oil in the hands and pass the hands in an arc over
the clients nose for one or two breaths.

3. Place 1 drop of lavender oil on a tissue and tuck it into the


bottom of the face cradle so that the client can smell a light
fragrance.

4. Place an aromatic hot towel over each foot and steam the feet. Remove
the towel and proceed with the foot massage.

4. Massage the posterior legs and gluteals. Undrape the back and
place a steamy rosemary towel on the back.

5. Massage the anterior legs.

5. Massage the back. At the end of the back massage, apply a body
wash gel with warm water and work it into lather. Remove the
lather with a hot towel. Redrape the back.

6. Massage the arms and hands. Apply an exfoliation product to the hands
and then remove it with a hot towel. Paraffin dip the hands and wrap
them in cellophane and a warm towel.

6. Remove the warm pack that is sitting on the feet. Turn the client
into a supine position. Place a warm pack under the neck and an
eye pillow over the eyes. Rebolster the client.

7. Remove the pillows from under the clients head and proceed with a neck
and face massage. Place a steamy aromatic towel on the face at the end
of the massage.

7. Massage the feet. At the end of the foot massage, apply exfoliation cream to the feet and scrub the feet. Remove the exfoliation
product with hot towels.

8. Remove the paraffin from the hands, remove the warm packs, and turn
the client into the prone position.

8. Massage the anterior legs and abdominals.

9. Rebolster the client and massage the posterior legs and gluteals.

9. Massage the arms and hands.

10. Massage the back. Apply a foaming exfoliation product to the back and
work it into lather. Remove with steamy aromatic towels.

10. Massage the neck and face. Place a steamy, aromatic towel
over the face to end the massage. Remove the towel and use an
aroma mist spritzed high over the client.

11. Spritz an aroma mist over the client and throughout the treatment room to
complete the massage. When the client gets off the table, they will smell
the fresh scent.

11. Allow the client to relax on the treatment table for an extra ten
minutes before they get up.

foot treatment, paraffin dips, the use of warm packs, an


eye pillow, and a firming face massage. The spa massage
outline presented in Table 41 is meant to provide some
structure for those developing a relaxation spa massage.
The outline helps the therapist to see how the massage is enhanced with little extras to make it special.
Step-by-step directions for some useful enhancers are
described below.

Warm Packs
Chapter 6 (Water Therapies) describes the use of hot
and cold packs to facilitate a change in muscle tissue
and to achieve a physiological effect on the body. In a
relaxation massage, the goal is to support client relaxation and help clients rest, breath, and reflect on their
inner thoughts and to feel revitalized at the end of the
session. Warm packs of rice, corn, or flax seed keep the
client warm but do not generate enough heat to produce
perspiration (Fig. 44). They are used to make the client
feel pampered and cozy and are placed on the back and
on the feet. In the supine position, a warm pack can be
placed on the belly, around the feet, and, if the shape is
appropriate, under the neck. Eye pillows filled with fragrant herbs can be warmed or cooled and placed over the
eyes to block out excess light. A Fomentek water bottle
might be placed under the bottom massage sheet to provide warmth, or the table can be heated with an electric
table warmer.

Steamy Aromatic Towels


FIGURE 44 Warm packs. Warm packs of rice, corn, or flax seed keep
the client warm and feel soothing and nurturing. Use them to enhance
your relaxation massages.

Williams_2E_CH04_printer_file.indd 79

Steamy aromatic towels make a pleasing enhancer when


used during a full-body relaxation massage (Fig. 45).
For example, a steamy aromatic towel can be applied to

10/24/13 1:13 AM

80

Spa Bodywork: A Guide for Massage Therapists

skin irritation because essential oils are volatile substances and begin to evaporate rapidly the minute that
they are placed on the hot towels in the cooler. They will
mostly burn off before the first towel is used, leaving
only some of the scent behind. Skin irritation is therefore minimized.
Herbal-Infused Towels

FIGURE 45 Steamy aromatic towels. Steamy aromatic towels make


a pleasing enhancer when used during a full-body relaxation massage.
They might be applied to the back, face, or feet as part of your massage
routine.

Muslin bags filled with fragrant herbs can also be used to


scent towels. A muslin bag of herbs is added to the water
that the towels are heated in. A nice combination is eucalyptus leaf, rosemary, clove buds, and juniper berry. A half
a cup of herbs to around 16 quarts of water provides a nice
concentration, although more or less herbs can be used
according to taste. Towels heated in herbal solutions will
be lightly stained.

A Simple Hand or Foot Treatment


the back directly before the back massage. This warms
the tissue and feels especially satisfying. Another way of
using a hot towel on the back is to apply a bit of body
wash gel or foaming exfoliation cream with warm water
at the end of the back massage. Lather it with the hands
and then remove the lather with a hot towel. This takes
only 1 minute out of the massage but becomes a memorable moment for the client. Another benefit is that
they dont feel oily at the end of the session. A steamy,
aromatic towel can be used in the same way on the feet
before the foot massage, on the face before the face massage, or on the face at the end of the service as a closing
gesture.

During a relaxation massage, a simple hand or foot


treatment can be added to make the massage special
(Fig. 46). These enhancers take up very little massage
time and are a memorable part of the experience for
the client. For a simple foot treatment, prepare the
massage table by placing a bath towel at the end of the
table where the clients feet will sit. Place two hot, moist
hand towels in a soda cooler. Just before or just after
the foot massage, simply apply a little exfoliation cream
(a cream that has rough textured ingredients that polish

Preparing Steamy Towels


To prepare the towels, pull off all the tags, then fold the
towels in half (the long way), and roll them up like a sausage. It is important that all the tags are removed because
they could scratch the client. Place the towels in a hydrocollator, hot towel cabinet, or stone massage heating unit for
20 minutes at 165F. With thermal gloves, remove a towel
from the water, wring it out, and place it in a soda cooler.
Close the lid of the cooler and remove the next towel. Keep
the lid of the cooler shut as much as possible so that the
towels stay hot throughout the treatment. Towels can be
enhanced by soaking them in herbal infusions or adding
essential oils just before use.
Steamy Rosemary Towels
Add 3 to 5 drops of rosemary essential oil to the soda
cooler full of hot towels. As each towel is removed, it
will fill the treatment room with a refreshing scent.
Most single oils such as eucalyptus, common sage
(Salvia officinalis), Spanish sage (Salvia lavandulifolia),
thyme and lemon oil smell good, but floral scents such
as ylang ylang and jasmine are not as pleasant in steam.
The essential oil on the towel is not likely to cause any

Williams_2E_CH04_printer_file.indd 80

FIGURE 46 A simple hand or foot treatment. During a relaxation


massage, a simple hand or foot treatment can be added to the session to
enhance the massage experience. Apply an exfoliation cream to the hand
or foot directly before or after the massage and then remove the cream
with hot, steamy hand towels.

10/24/13 1:13 AM

Chapter 4

Your Spa Massage

81

the skin) to each foot. Scrub the feet with the exfoliation cream and then place a hot towel over each foot.
After the feet have steamed in the towels (about 30 seconds), use the towels to remove the exfoliation product. A simple hand treatment is conducted in the same
way. An exfoliation cream is massaged into the hand
and up to the elbow. A hot, moist towel is placed over
each hand, and the product is removed directly before
or after the hand massage.

Paraffin Dip
Paraffin is a waxy substance obtained from the distillates

of wood, coal, petroleum, or shale oil. It is used to coat


the skin and trap heat and moisture at the skins surface
(Fig. 47). This increases local circulation, which improves
joint mobility and increases absorption of spa products
whenever they have been applied before using the paraffin.
It is an effective treatment for chronic arthritis, tight muscles, and painful joints. It also leaves the skin soft, and it
feels warm and sumptuous.
To apply paraffin to the hands or feet, wipe or mist the
area with alcohol so that it is properly sanitized. Dip the
hand or foot into the paraffin and allow the paraffin to
harden slightly before dipping the area again. Dipping the
area up to five times should be sufficient. Wrap the paraffincovered hand or foot in cellophane wrap or a plastic bag,
before placing it into a heated mitt or a warm towel. To remove the paraffin, simply peel off the cellophane wrap
together with the wax in one piece. The hands can be dipped
while the client is on the table in the prone or semi-reclined
position. The feet can be dipped while the client is on the
table in the supine position. Paraffin can also be applied
with a brush or on gauze strips, which wrapped around the
body area.

FIGURE 47 Paraffin application. Paraffin is used to coat the skin and


trap heat and moisture at the skins surface. Wipe or mist the hands or
feet with alcohol so that it is properly sanitized. Dip the hand or foot into
the paraffin and allow the paraffin to harden slightly before dipping the
area again.

Williams_2E_CH04_printer_file.indd 81

FIGURE 48 Aroma mist. An aroma mist is usually made from


distilled water with some added essential oils, but a hydrosol (flower
water) can also be used. The mist is spritzed high over the client while
he or she is in a supine position to fill the treatment room with a
refreshing scent.

Easy Aromatherapy Enhancements


Aromatherapy is the use of essential oils for healing and
wellness. It is discussed in depth in Chapter 7. Small aromatherapy enhancements stand out as moments of particular
radiance in a good relaxation massage. Essential oil massage blends create an olfactory reaction that may facilitate
deeper relaxation in the client. It is a good idea to provide a
selection of from three to five blends so that the clients can
choose which one they like best. Aroma mists are another
way to bring the pleasure of good smells into the massage.
An aroma mist is usually made from distilled water with
some added essential oils, but a hydrosol (flower water) can
also be used. The mist is spritzed high over the client while
he or she is in a supine position to fill the treatment room
with a refreshing scent (Fig. 48). The scents used in the
treatment can be varied to keep the clients olfactory palate stimulated.
Earlier, we discussed aroma inhalations, which might be
used either at the beginning or end of the massage. As was
mentioned previously, 1 drop of an oil or 1 drop of a blend
of different oils is briefly rubbed together in the hands
before being passed over the clients nose in an arc so that
the oil can be enjoyed on a deep inward breath. Relaxing
or calming oils are used at the beginning of the massage,
whereas refreshing, stimulating oils are used at the end of
the session.
Table 42 provides some nice aromatherapy blends
that are generally popular with clients. These blends
can be mixed into a plain massage cream or in expellerpressed vegetable oil for the massage, or they can be mixed
with water for an aroma mist. The table also includes a
list of single oils that work well for aroma inhalations.
Aromatherapy and blending techniques are discussed in
Chapter 7.

10/24/13 1:13 AM

82

Spa Bodywork: A Guide for Massage Therapists

TABLE 42 Easy Aromatherapy


MASSAGE BLENDS

AROMA MISTS

INHALATIONS

The following blends can be added to 1 fl oz of


an expeller-pressed oil (i.e., hazelnut, sweet
almond, sunflower) or plain massage cream.
The numbers refer to drops.

The following blends can be added to 1 oz of


distilled water.

The following blends can be mixed up and used


undiluted (1 drop) in the hands for an aroma
inhalation.

Relax Factor

Radiance

Inspiration

Frankincense 4
Mandarin 8
Ylang ylang 2
Cypress 2

Atlas cedarwood 5
Neroli 2
Lavender 4
Grapefruit 6

Rose 1
Mandarin 10
Clove 1

Refreshing

Revitalize

Verve

Rosemary 3
Clary sage 2
Lemon 7
Geranium 1

Grapefruit 8
Eucalyptus 1
Cypress 2
Sweet orange 6

Rosemary 2
Geranium 1

Citrus Star

Summer

Sparkle

Grapefruit 11
Jasmine 1

Mandarin 6
Lemon 7
Geranium 1

Peppermint 1
Grapefruit 8

Muscle Ease

Rain

Siesta

Sweet birch 3
Juniper berry 2
Lavender 6
Lemon 6

Juniper berry 4
Thyme 2
Lavender 6
Cypress 3

Lime 7
Jasmine 1

Detox

Mental Boost

Quietude

Sweet fennel 5
Juniper berry 4
Grapefruit 10

Rosemary 2
Basil 4
Lemon 7

Neroli 2
Clary sage 5
Sandalwood 10

Body Boost

Sweet Dreams

Wake Up

Peppermint 1
Tea tree 2
Lavender 6
Lemon 6

Neroli 2
Lavender 7
Mandarin 10

Peppermint 2
Rosemary 2
Basil 1

Putting Your Spa Massage Together


The techniques used in Swedish massage form the foundation of most therapists massage routine, even those
practicing specific different forms or systems of massage.
Swedish massage is sometimes called relaxation massage,
but Swedish techniques have many benefits in addition
to relaxation. In fact, Swedish massage techniques can
be delivered with light, moderate, or deep pressure for a
variety of treatment outcomes. Swedish massage still uses
the six traditional stroke techniques given French names
by Dr. Johann Mezger in the 1800s. These techniques are
effleurage, ptrissage, friction, tapotement, vibration,
and joint movements (also called Swedish gymnastics or
range of motion techniques). Each of these techniques is
performed with the depth and vigor most appropriate for
the individual client. Therapists often integrate Swedish

Williams_2E_CH04_printer_file.indd 82

strokes with other strokes, such as myofascial work, neuromuscular therapies, compression strokes, Asian bodywork
methods, or with resting/holding strokes used to open and
close massage sessions. An overview of Swedish techniques
and considerations is provided in Tables 43 and 44 for
review. Think about the individual strokes, how they tie
together, their effects on the body, and how you palpate
and adapt the techniques during a massage. The next step
is then to understand how to sequence the massage and use
the subtleties of massage skills.

Sequencing
Sequencing refers both to the sequence of strokes (the order
in which strokes are applied to a given body area) and to the
overall sequence of the massage (the order in which body
areas are massaged). In Swedish massage, the strokes often
follow a defined progression from effleurage to ptrissage,

10/24/13 1:13 AM

Chapter 4

Your Spa Massage

83

TABLE 43 Overview of Swedish Massage Techniques


STROKE

DEFINED

GENERAL EFFECTS

CONTRAINDICATION

VARIATIONS

Effleurage

A long, gliding stroke Desquamation of dead skin cells,


usually applied
increases circulation and lymph
toward the heart
flow, triggers parasympathetic
nervous system response, supports venous return, causes
relaxation

Should not be used distal to an area of in- Superficial; moderate;


flammation or injury; avoid application
or deep, shingling
over open skin lesions, skin diseases,
technique
or bruises. Avoid prolonged application
on the limbs of clients with cardiovascular disorders, high blood pressure, or
circulatory conditions.

Ptrissage

A rhythmic stroke
Stimulates sebaceous secretion,
that lifts the muscle
increases circulation and lymph
off the bone and
flow, activates Golgi tendon
compresses it
organs (GTOs) to relax muscles,
between the fingers
decreases adhesions

Avoid use with atrophied muscles that


lack moderate tone. Do not use over
open skin lesions, skin diseases,
bruises, acute injuries, inflammation, or
moderate to severe varicose veins.

Skin rolling, fulling ptrissage, and wringing


ptrissage

Friction

A heat-producing
chafing or rubbing
stroke

Superficial friction is stimulating


and warming and increases
blood and lymph flow. Deep
friction separates muscle fibers
and breaks up adhesions and
scar tissue.

Do not apply friction over open skin


lesions, skin diseases, bruises, acute
injuries, inflammation, or moderate to
severe varicose veins.

Superficial friction,
circular friction, linear
friction, and cross-fiber
friction

Vibration

A pulsating tremorlike or oscillating


stroke

Primarily stimulating and then


relaxing; sustained vibration is
numbing and analgesic and
decreases muscle guarding; fast
vibrations can cause muscle
contractions and stimulate
nerves.

Do not apply vibration over open skin


lesions, skin diseases, bruises, acute
injuries, inflammation, or moderate to
severe varicose veins.

Fine vibration; coarse


vibration including
jostling, shaking, and
rocking

Tapotement

A rapid and rhythmic


percussion stroke
with which the
hands are used in
various formations
to drum on the
client

Short applications are stimulating;


longer applications are relaxing.
Very light tapotement causes vasoconstriction of capillaries in the
local area. Moderate tapotement
causes increased circulation,
useful for loosening of mucus.

Do not apply tapotement over the kidneys, Light, moderate, hackover bony areas, especially directly over
ing, cupping, beating,
the spine, or over bruises or varicose
slapping, pincement,
veins.
and tapping

Stimulate the production of synovial fluid to nourish and protect


the joint structure; increase range
of motion

General contraindications include acute


injuries to bones, joints, muscles, or
nerves. Techniques that traction the
joint are contraindicated for sprains,
rheumatoid arthritis, and hypermobile
joints. See specific contraindications in
Table 131.

Joint movements Movements such as


flexion, extension,
abduction, and
adduction performed as part of
the massage

to friction, to vibration, to tapotement, with joint movement added as appropriate. Each stroke addresses the tissue in a different way, and the sequence of strokes takes
into account the physiological changes that have occurred
in soft tissue during the preceding stroke. In a traditional
Swedish massage, the therapist might simply deliver
each type of stroke to the body area in a predefined order
before moving on to the next body area. Alternatively, the
order of the strokes might be changed to meet the clients
particular needs.
Often, a therapist will combine different massage systems
in a session, which may change the sequencing of the strokes.
For example, if myofascial release techniques are being combined with Swedish massage and deep tissue work, myofascial techniques would probably be applied first because
they are used on dry skin without lubrication. Deeper work

Williams_2E_CH04_printer_file.indd 83

Active, passive, and


restricted

might be used directly after effleurage, ptrissage, and moderate friction with vibration and tapotement coming after.
Another factor determining the sequencing of techniques is
the quality of the clients tissue and how quickly it changes.
Some clients need a prolonged warmup, whereas others are
ready for deep work early in the session. Sometimes, areas of
taut muscle tissue require work with very specific techniques
to reset muscle length and promote better muscular balance.
As you contemplate how you want to sequence your
massage, remember that there are advantages to starting
the massage with the client supine and other advantages to
starting prone. When the massage starts in a supine position, clients can open their eyes and look at the therapist.
This is important if the client is new to massage and does
not know the therapist. Being able to visually check with the
client during the first half of the massage helps the client

10/24/13 1:13 AM

84

Spa Bodywork: A Guide for Massage Therapists

TABLE 44 Overview of Swedish Massage Considerations


GENERAL BENEFITS

APPLICATION CHOICES

PALPATION

SUBTLE FACTORS

Desquamation of dead
skin cells
Increased sebaceous
secretion to condition skin
Increased blood and
lymph circulation
(increased tissue warmth)
Improved nutrient and
waste exchange in local
tissue
Improved venous return
Decreased muscle
spasm, tension, and
soreness
Decreased adhesions in
myofascia
Decreased pain
Increased range of
motion and joint health
Increased relaxation
Decreased symptoms
relating to stress
Improved muscle tone

The effects of the massage


technique on the body
vary, depending on how
the stroke is applied. Pay
attention to the following:
Technique: gliding versus
lifting
Depth: light versus deep
Speed: fast versus slow
Direction: toward the
heart versus away from
the heart
Duration: brief application versus prolonged
application

Palpations skills increase with


more experience. Develop
palpation skills by being
aware of what you see and
feel during the massage
session.
Visual: How does the client
look (skin color, expression,
posture, etc.)?
Move: How does the client
move (stiffly, lightly, forcefully, smoothly, etc.)?
Touch: How does the tissue
feel (crackly, taut, fluid, hot,
cool, clammy, etc.)?
Sound: How does the client
sound when he or she communicates (relaxed, sleepy,
anxious, fretful, etc.)?

Intention: client centered


Contact: quality of touch
Use of lubricant: Use lubricant in
moderation. Remove excess lubricant if not absorbed into the skin.
Pacing and leading: Match the
clients pace and then lead a client
to more relaxing rhythms.
Depth: Engage the tissue unless a
superficial massage is requested.
Rhythm: Use regular patterns or
strokes and a regular tempo.
Flow and continuity: Techniques
should flow in an uninterrupted
action so the client experiences the
constant and steady pressure of
your hands.
Stroke length: Work the length
of the muscle or the length of the
body area.

gain confidence and relax. Clients often experience congestion when they are placed face down in a face cradle. One of
the advantages to starting the massage in the prone position
is that the clients sinuses have time to decongest during the
second half of the massage when they are turned into the
supine position. This sequencing allows the client to leave
the session feeling more alert and with less facial puffiness.
Specific treatment goals may also determine the sequencing of a session. For example, if the client has lower back
pain, the therapist might choose to release the hamstrings
and adductors of the legs before working the back and then
turn the client supine to finish with psoas work and low
back stretches. In health careoriented massages, some
regions of the body might not be massaged, allowing more
time for problem areas and their associated structures.
Most important to sequencing the massage is the information the client provides during the intake interview. This
process involves designing the session to meet the clients
needs. It is a little like a negotiation. The client might say,
I want a lot of work on my back and legs. The therapist
might say, Do you only want me to work on these areas,
or would you like a full-body massage with extra focus on
these areas? The client might then say, I want you to work
on my back, legs, feet, and neck with most of the work on
my back. The therapist can also suggest areas the client
needs to have massaged based on assessment findings. The
therapist and client now have an agreed plan for the session.
The term full-body massage often means something different to the client than to the therapist. Clients sometimes say
they want a full-body massage and then express dismay when
their abdominals or gluteals are undraped and massaged.

Williams_2E_CH04_printer_file.indd 84

Always be clear about what will happen during the massage


by saying things like, In a full-body massage, I massage the
legs, feet, arms, back, neck, gluteal muscles (the muscles of
the buttocks), abdominal muscles (the muscles of the belly),
and the face. Would you prefer I avoid any of these areas?
Although the clients wishes always prevail (unless they are
asking for techniques that are contraindicated, illegal, or out
of the massage scope of practice), the therapist can educate
clients about the benefits of massage for certain areas. For
example, clients often feel uncomfortable with the idea of
having their gluteals or abdominal muscles massaged. When
a therapist takes the time to explain the importance of releasing tension in these muscles, the client may feel safe enough
to give it a try. The three examples of massage sequences in
Table 45 demonstrate how diverse sequencing can be.

Routines
Routines are a series of strokes that are planned in advance,

delivered to body areas in a preset order, and practiced until


they flow smoothly together. Some spas and massage clinics
develop set routines that are delivered by all of the businesss therapists. These standardized wellness sessions often
include enhancing extras such as the use of warm packs,
aromatherapy, and foot soaks to increase the sense of luxury and relaxation experienced by the client as we discussed
previously. The drawback to standardized wellness sessions
is that clients may not get the specific work they need for
their particular areas of muscular tension. The advantage
is that clients know beforehand what the massage will be
like and can count on receiving the same massage when they

10/24/13 1:13 AM

Chapter 4

Your Spa Massage

85

TABLE 45 Examples of Different Massage Sequencing


EXAMPLE SEQUENCE 1
1. Begin with client prone.
2. Place warm pack on the lower back.
3. Open massage with holding strokes.
4. Massage posterior legs.
5. Remove warm pack and place on feet.
6. Massage back.
7. Remove warm pack.
8. Turn client supine.
9. Transition to anterior massage with
diaphragmatic breathing exercise.
10. Massage anterior legs.
11. Massage feet.
12. Massage abdominals.
13. Place fresh warm pack on abdominals.
14. Massage arms and hands.
15. Massage shoulders and neck.
16. Massage face.
17. Close massage with holding strokes.

EXAMPLE SEQUENCE 2
1. Begin with client supine.
2. Place warm pack on abdominals.
3. Open massage with diaphragmatic
breathing exercise.
4. Massage neck and face.
5. Massage arms.
6. Massage anterior legs and feet.
7. Remove warm pack from abdominals.
8. Turn client prone.
9. Transition to posterior massage with
holding strokes.
10. Massage back.
11. Massage posterior legs.
12. Close massage with three deep breaths.

return for another session. When massage is used purely for


relaxation, the predictable quality of a set routine can actually add to the clients sense of safety and ability to unwind.
The danger for the therapist is that a set routine makes it
easy to stop paying close attention to the individual client.
Routines for specific body areas are very useful in relaxation settings. For example, some therapists develop a very
effective foot routine that helps them to build a loyal clientele who especially like foot massage. In many spas, the
face is massaged while the body is cocooned in a body wrap.
If a therapist has taken the time to develop a face massage
routine that incorporates a variety of strokes, it is likely to
enhance the clients experience. For Your Information 43
demonstrates a nice face routine. A foot routine is provided
in Chapter 10 (Spa Foot Treatments).
The use of routines is not advised for health careoriented
massage or massage sessions in which the client and therapist have agreed on specific treatment goals. In these cases,
the therapist must adapt the massage to the clients specific
needs and to moment-by-moment changes that occur in the
clients soft tissue structures. The term routine should not
be confused with a treatment protocol in which a series
of techniques are used in a particular order. For example,
in trigger point work, the protocol is to warm the area with
friction strokes or skin rolling before the trigger point is
located and treated. Joint movement and flushing strokes
are applied after the trigger point has been treated to help
reset the muscles normal resting length.

Subtle Factors That Influence the Massage


If you are a novice massage therapist who is still a student
or entering your first massage-related job, you will want to
master each individual technique before trying to combine

Williams_2E_CH04_printer_file.indd 85

EXAMPLE SEQUENCE 3
1. Begin with client prone.
2. Place warm packs on hamstrings.
3.Open the massage with holding strokes.
4. Myofascial release to back.
5. Swedish massage back.
6. Deep tissue massage back.
7. Remove warm packs from hamstrings and
place on back.
8. Myofascial release to posterior legs.
9. Swedish massage posterior legs.
10. Remove warm packs.
11. Turn client supine.
12. Myofascial release anterior legs.
13. Swedish massage anterior legs.
14. Massage abdominals.
15. Psoas release work.
16. Passive hamstring stretches.
17. Passive lower back stretches.
18. Massage neck and upper arms.
19. Close massage with holding strokes.

techniques in a flowing, integrated professional massage.


After mastering these core skills, you can consider how subtle
factors such as intention, depth, stroke length, and rhythm
profoundly influence the clients massage experience.
Therapists Intention
It is always important to ground and center yourself before
a session. This helps to calm your energy and focus your
mind so that you are fully present during the session. Some
therapists forget this principle and talk loudly; bang into
things; fuss with supplies, the drape, or the music; and
cause such static in a room that the client cannot completely relax. Before entering the treatment room, take a
moment to center and ground your energy. Pay attention
to your tone of voice and volume. Talk softly but not so
softly that the client has difficulty understanding your verbal directions. Everything should be ready for the session
before the client undresses and moves into position beneath
the drape. If the music level is set and music is playing; if the
lubricant is warm and within reach; and if extra blankets,
bolsters, and draping material are readily available; you are
likely to feel more centered and grounded.
When working with a therapeutic intention, maintain
appropriate professional boundaries and work in such a
way that the client will not experience emotional, physical,
mental, or spiritual damage from the session. Therapeutic
intention also includes the idea that you are focused only
on the session. You are present, in the moment, and
paying attention to the clients facial expressions, sounds,
soft tissue, and communication. When you walk through
the door of the treatment room, everything but the client
should go away. Set aside all thoughts about bills, relationship problems, to-do lists, and plans with friends so that
you focus only on the client.

10/24/13 1:13 AM

86

Spa Bodywork: A Guide for Massage Therapists

FOR YOUR INFORMATION 43


Face Massage Routine
Ask clients if they would like their face massaged as part of their relaxation session, especially if the client is wearing makeup.
If the client is wearing makeup, she may want to remove it before the massage to enhance her enjoyment of the session and
protect her skin. Rich emollient face cream or whipped shea butter is recommended for this treatment. Massage oil, massage
cream, or massage gel are not recommended because these products may leave facial skin feeling clogged and bogged
down. Before touching the clients face, the therapists hands should be sanitized with an alcohol-based sanitizer. This will prevent any microbes that were picked up on the body or in the treatment room from being transferred to the delicate facial skin
and will ensure that the therapists hands smell clean to the client. The therapist may want to drape the clients hair to protect
it from face cream using the simple hair draping method described in the next chapter. To view a video demonstration of face
massage, visit thePoint.
Apply an aromatic towel to the face. Remove a steamy
rosemary or herbal-infused towel from a cooler and
drape it on the face by spreading it from under the chin
to the forehead. Allow the towel to sit on the face for
up to 1 minute and then gently press it into the face to
increase the sensation of heat. Remove the towel from
the face and repeat with a second towel if desired.

Apply a rich emollient facial cream starting under the


chin, coming up around the mouth, around the nose,
up the nose to the forehead, and down the sides of the
face to the chin. Repeat this technique six to eight times
to spread the cream evenly over the surface of the skin.

Perform gentle cross strokes between the eyebrows.

Williams_2E_CH04_printer_file.indd 86

10/24/13 1:13 AM

Chapter 4

Your Spa Massage

87

FOR YOUR INFORMATION 43


Face Massage Routine (continued)
Transition into s-bows and cover the whole forehead with
s-bow strokes.

Transition to glide down either side of the nose and


activate the pressure points at the top of the nose and
bottom of the nose as the fingers circle. Repeat this
technique three to six times.

Transition into small figure of eights using light finger pressure and glide over the entire face, chin, and forehead
with this technique.

(continued on page 88)

Williams_2E_CH04_printer_file.indd 87

10/24/13 1:13 AM

88

Spa Bodywork: A Guide for Massage Therapists

FOR YOUR INFORMATION 43


Face Massage Routine (continued)
Slide a relaxed hand over one eye in a circular motion
and finish the stroke with pats at the side of the eye.
Repeat this four times and transition to the other eye.

Make small circles around both eyes at the same time


and then transition to the chin using small finger circles.

Lightly ptrissage the jaw line and s-bow the chin, then use
a crossed thumb technique at the chin.

Williams_2E_CH04_printer_file.indd 88

10/24/13 1:13 AM

Chapter 4

Your Spa Massage

89

FOR YOUR INFORMATION 43


Face Massage Routine (continued)
Use the index finger and the thumb on both hands to apply a lifting technique around the upper and lower lips.

Bring the thumb and index finger of one hand around


the mouth in five to seven strokes to smooth the tissue at
the sides of the mouth.

Using soft hands and relaxed wrists, apply a gentle slapping tapotement to the underside of the jaw.

(continued on page 90)

Williams_2E_CH04_printer_file.indd 89

10/24/13 1:13 AM

90

Spa Bodywork: A Guide for Massage Therapists

FOR YOUR INFORMATION 43


Face Massage Routine (continued)
Bring the gentle slapping tapotement up the jaw line
and cheek area and then transition back to underneath
the jaw.

Transition from the slapping tapotement into a snapping tapotement and apply the stroke to the jaw line
and cheek area on both sides of the face.

To learn this stroke, make a pinching movement with


the thumb and index finger but instead of meeting the
fingers, lift them up off the face.

Williams_2E_CH04_printer_file.indd 90

10/24/13 1:13 AM

Chapter 4

Your Spa Massage

91

FOR YOUR INFORMATION 43


Face Massage Routine (continued)
Soothe the sides of the face with gentle upward strokes
toward the top of the forehead.

Gently massage the outer edge of the ear and push


the ear forward to stretch it. Massage the area directly
behind the ear and finish the area by laterally flexing the
neck to one side during a long stroke down the neck,
over the shoulder and down the arm. Repeat this stroke
on the opposite side.

The facial sequence can be repeated up to three times


for a longer face massage. To end the face massage,
place 1 drop of peppermint or lemon oil in the hands
and rub them together and cover the nose lightly for
30 seconds. A second steamy, aromatic towel can be
placed over the face, or place a cool towel over the
face to finish the service.

Williams_2E_CH04_printer_file.indd 91

10/24/13 1:13 AM

92

Spa Bodywork: A Guide for Massage Therapists

In a Swedish massage, most strokes require the use of lubrication to prevent undue friction between your hands and
the clients skin. Use the lubricant in moderation. When the
client is too slippery, your hands cannot sink into the tissue
and manipulate it effectively. After undraping a body area,
turn one hand over and set it on the clients skin with the
palm side up. Pour a small amount of lubricant into your
palm and warm it by rubbing your other hand across it,
staying in contact with the clients skin. Turn both hands
over and apply long strokes over the entire undraped body
area to spread the lubricant. As the lubricant is absorbed
into the skin, work the strokes deeper into the tissue. If the
skin becomes dry and the strokes start to drag, apply more
lubricant (some drag on the tissue is desirable with certain
strokes). Again, do not break contact with the client. Keep
one hand in contact with the clients skin while warming
the lubricant in your hands. If you accidentally apply too
much lubricant and it is not absorbed into the skin during
effleurage strokes, remove some of the lubricant with a hand
towel. Its better to take a moment and remove the lubricant
than give a slippery superficial massage of the body area.
Most clients do not want to feel oily at the end of the massage. It is a good idea to provide disposable wet wipe towels and a dry hand towel for the client to use at the end of
the massage if you use oil for the lubricant. Creams and
lotions cause less slip but also feel cooler on the clients skin.

the client halfway and tune in to the clients rhythm and


state of being. For example, it may be disconcerting for a
mildly depressed client to walk through the clinic doors and
encounter the therapist Chirpy Mary Sunshine. Similarly, it
may be off-putting for an upbeat client who is enjoying a
great day off to encounter the therapist Low Energy Larry.
Therapists can learn to pace the massage by matching
the first part of the massage to the client. As the massage
progresses, the therapist can lead the client into more
relaxing rhythms. To understand pacing and leading
better, consider one aspect of a counseling and life-coaching
technique from neuro-linguistic programming (NLP). NLP
uses the word pacing to describe techniques that build rapport between the counselor and the client. The idea is that
people tend to like people that they are liked, so the counselor
makes himself or herself more like the client. The counselor
tunes in to the clients breathing patterns, speech patterns,
body language, and personal rhythm. During the session,
the counselor uses speech and body language patterns similar to those of the client. When the client is relaxed and when
the counselor feels that a rapport has been established, he or
she starts to lead the client. The counselor breathes with a
new pattern, and the client follows (so long as good rapport
has been established). The counselor slows down (or speeds
up) his or her speech and changes his or her body language,
and the client follows. All of this is done while the client and
counselor are talking about other things. The benefit of this
for the client is that these new breathing patterns, body gestures, and/or speech patterns create a shift in the client.
It is almost as if these new patterns put a person in touch
with new internal resources that allow looking at a situation
from a new vantage point.1 NLP is much more complex than
this simple description, but this example can help massage
therapists think about how they pace and lead clients.
The goal is to match the clients basic energy levels but
not mimic the client or go to extremes of behavior. For a
client and therapist both to be bouncing off the walls with
hyperactive energy does not do the client any good. Instead,
be upbeat but remain grounded until the client can be led
to more relaxing patterns. If a client is downhearted, you
might still remain positive but subdue your personal energy
levels and speak in a quiet voice to respect the clients state
of being.

Pacing and Leading

Depth

All people have an internal pace or personal rhythm that


influences how fast they move, how quickly they react, the
speed and cadence of their speech, their physical mannerisms, the speed of their thought processes, and even their
breathing patterns. At the same time, a client is likely to
arrive in a particular state of mind and body (state of being).
Perhaps he or she encountered bad traffic and is running
late. Perhaps the client just came from a yoga class and
is feeling balanced. Maybe the client is feeling depressed
because of personal issues. Regardless of the cause of the
clients mental, emotional, and physical state, try to meet

Massage therapists sometimes call a superficial massage a


fluff and buff. Although some clients like gentle massage
that only skims the surface of the tissue, most clients want
the therapist to sink into the tissue, take hold of the tissue,
move the body with confidence, and address tension and
any adhered muscle and fascia. This should not mean that
you are working so deeply and with so much pressure that
the client feels pain. It means that you can feel the quality
of the tissue and understand how to engage it properly.
Working with appropriate depth is a product of good palpation skills and self-confidence.

Contact
The quality of your touch is important, and you must think
about what your hands are communicating to the client.
Warm, soft, dry, open, and confident hands tell the client that
you are relaxed and self-assured and know what to do. Cool,
damp, uncertain hands tell the client that you are anxious
or doubtful about the session. Cultivate confidence in your
touch. Do not just touch the client but feel the tissue, open
your hands, and sink into the muscle. Once you establish
contact, avoid disrupting it. Sometimes, novice therapists
take their hands off the client repeatedly while transitioning
between strokes or lift their hands off the body to get more
lubricant. Instead, try to keep at least one hand in contact
with the client at all times. This helps the client to keep track
of your presence and the progression of the massage.
Use of Lubricant

Williams_2E_CH04_printer_file.indd 92

10/24/13 1:13 AM

Chapter 4

To build these skills, pay attention to the way a clients


tissue feels and how it changes in different areas of the body.
In a Swedish massage, effleurage starts out light and quickly
gains depth as the body area softens. Circulation increases
in the local area, and the tissue begins to melt, signaling
that you can drop deeper into the muscle and fascia. Feel for
the bottom of the muscle. Think of sinking into a pillow
or other soft structure. Drop down and maintain an even
pressure as the stroke travels the length of the body area.
One way to learn about depth is to practice on clients or fellow students and ask for honest feedback. Ask direct questions like, Is my pressure deep enough or would you prefer
more pressure? If the client answers more pressure, sink
in and feel what it feels like to sink in. Ask again, Is this deep
enough or should I be deeper? Keep asking until the client
communicates that the pressure is just right. Feel what just
right feels like and remember that feeling. Remind clients
to speak up if something hurts or feels too forceful.
Remember to practice massaging a variety of body types
when learning to work with depth. Each body responds to pressure differently, and you must adapt to the tension levels and
density of the individual tissue. The more massages you give as
a student, the faster you develop these skills. If it happens that
you start out working with too much depth and a client complains about the pressure, try to avoid becoming fearful but
simply promise yourself to pay more attention to the quality
of the tissue. It is okay to work too lightly or too deeply at first.
No therapist walks out the training room door and has perfect
depth the first time he or she gives a massage. These skills are
developed over time through practice and mindfulness.
Rhythm
Rhythm in massage is a lot like rhythm in dancing. Therapists with good rhythm apply strokes in a regular pattern at a regular pace or tempo. The client relaxes to the
rhythm, much as a child relaxes when rocked by a parent.
Imagine how ptrissage strokes would feel if delivered in
an uneven pattern. That sensation may well be distracting
and disturbing for the client. Sometimes, the rhythm of the
massage changes naturally because you change strokes or
techniques. Deep work is most often applied very slowly,
whereas tapotement is applied more quickly. You might
deliver the first few passes of effleurage at a quicker tempo
and then slow down to lead a client into relaxation.
To build good rhythm, think about the regularity of
strokes and strive to keep them even in both depth and
speed. Use music to set the pace for the massage and
dance the strokes as a training exercise. Check in with
your practice clients and get feedback on their perception
of the rhythm of the massage. As with all massage skills,
rhythm is developed over time and with practice.
Flow and Continuity
Flow and continuity refer to the progression of massage strokes
from one technique to another and from one body area to
another. Think of a river streaming over rocks in one unbroken

Williams_2E_CH04_printer_file.indd 93

Your Spa Massage

93

movement. Strokes are like the river water. They should flow
in one uninterrupted action so that the client experiences the
constant and steady pressure of your hands. A therapist who
has not yet developed flow and continuity might pause during
strokes, lift the hands off the client, change techniques at the
wrong times, and feel disjointed and sporadic.
Changing techniques at the wrong times is a common
mistake of novice therapists. For example, it is a bad idea
to start with effleurage on the calf muscles, shift to tapotement at the hamstring, then to ptrissage as the stroke
approaches the gluteal muscles, and then back to effleurage
as the stroke moves into the gluteals. The nervous system
cannot process these rapid technique changes and may
become hyperalert and irritated. Instead, start effleurage at
the ankle, sweep all the way up the leg, and come all the way
back down the leg before shifting techniques.
The great ballet choreographer, Balanchine, often choreographed dance sequences in groups of three. He felt that the
first time an audience saw a dance sequence, it captured their
attention but they did not have time to really see the moves.
When the sequence was repeated a second time, Balanchine
believed that the audience studied the movement and analyzed the technique. The third time a sequence was danced,
the audience could simply enjoy the beauty of the movement. Although massage strokes would not be delivered in
strict groups of threes, the same philosophy applies. A client
needs time to be surprised by a sensation, analyze what is
happening, and then settle into enjoyment of the technique.
Stroke Length
A therapist with strong massage skills tends to use long
strokes that tie body areas together. He or she will travel the
length of a muscles fibers, or the length of a body area, before
changing techniques or lifting the hands away from the clients body. When a stroke is cut short, it leaves the client feeling oddly frustrated. One area where this happens is on the
posterior and anterior leg. Inexperienced therapists often
stop short in the stroke because they are taught to be careful
of draping and worry that the stroke will become invasive.
The stroke should travel all the way up to the gluteals and
around the greater trochanter, or all the way up to the anterior superior iliac spine (ASIS) and back again. On the arm,
the stroke should travel up to the shoulder or even up to the
neck. Understand the muscles and seek to work their entire
length whenever possible. Many therapists undrape one or
the other side of the client and travel from the foot, up the
leg to the back, and then return to the foot again. These
strokes build clients kinesthetic awareness of their bodies
and how different body areas relate to each other.
By learning and integrating the techniques and subtle
skills discussed in this chapter, you are preparing to give an
excellent relaxation massage that will help to reduce stress
in the clients, rejuvenate their energy levels, relieve muscular tension, and help the body to find balance. This level of
integrated work is what keeps clients coming to your business for repeat massages.

10/24/13 1:13 AM

94

Spa Bodywork: A Guide for Massage Therapists

SPA FUSION
INTEGRATION OF SKILLS

1 to 2 p.m.Aromatherapy reviewled by Steve


2 to 2:30 p.m.Essential oil properties flash cardsled
by Ellen
2:30 to 3:00 p.m.Food! Everyone brings one dish for
a potluck
3:00 to 4:00 p.m.Spa Massage Olympics (See explanation below.)
4:00 to 10:00 p.m.Watch a movie and more food!

medication levels and sedentary habits.2 Another study


showed that diaphragmatic breathing lowered blood
pressure as long as it was practiced regularly.3 Patients
with anxiety disorders and panic attacks found that
the diaphragmatic breathing exercise helped them
experience less fear, fewer cognitive symptoms, and
fewer catastrophic thoughts during an attack, and the
technique sometimes served as an intervention to prevent an attack.4 Finally, patients suffering from chronic low back pain improved significantly with breath
therapy (a variety of techniques were taught including
pursed-lip breathing and diaphragmatic breathing).
This study reports that changes in standard low back
pain, measures of pain and disability were comparable to those resulting from high-quality, extended
physical therapy. Again, the regular practice of these
methods was important for continued benefit.5

SPA INSPIRATION: Spa Massage Olympics

CHAPTER WRAP-UP

A beautiful, flowing spa massage requires careful


thought and lots of practice. One way to make this
process fun is to hold a Spa Massage Olympics. Ask
your instructor to set a date and arrange for three
judges. Make a set of large cards with the numbers 1
to 10 for each judge. It works well to have judges score
participants on areas such as correctness of stroke
application, draping skills, routines, sequencing,
use of enhancers, flow and continuity, rhythm, etc.
Arrange for prizes and generate some enthusiasm!
You can learn a lot by practicing for your event and by
watching your competition perform. If your instructor
does not have time for this in the class schedule, this is
a fun activity for a study party.

The topics in this chapter illustrate the diverse skills


needed by a professional massage therapist to manage
a client before, during, and after a relaxation massage
session. These skills involve four primary areas: communication skills, organization skills, client management skills, and exceptional hands-on skills. Getting
clients in and out the door involves many steps along
with giving them an exceptional bodywork experience in between. An organized therapist, skilled at
client management, can better plan and implement a
meaningful opening and closing of the massage that
add to the clients experience and help build client
loyalty. Therapists often emphasize learning advanced
soft tissue skills and fail to fully appreciate skills that
seem less technical, such as positioning and draping
and sequencing a relaxation massage appropriately.
Although it is desirable to master a range of therapeutic techniques, the foundation skills of draping and
fluid relaxation massage lead to an uninterrupted client experience and allow the client to relax completely
and enjoy the session. Underlying all of these skills is
the ability to communicate effectively when explaining
paperwork to clients, directing them to the treatment
room, describing the benefits of a technique, giving
direction during the session, and coaching the client
through an activity such as diaphragmatic breathing.
Lack of skills in any of these areas can directly impact
the therapists ability to attract and retain clients and
make a good living from massage.

STUDY TIP: Party! Thats Right. Party!


Students in massage and spa training programs sometimes feel like their social lives are curtailed by the
need to study. One way to study and also have some
social time is to hold a study party. To be productive,
the party should have clear learning objectives and
planned activities. For example, the schedule might be
planned like this:

ITS TRUE! Diaphragmatic Breathing Exercises


Support Different Client Groups
Several research studies on diaphragmatic breathing
exercises demonstrate that this technique can help
a diverse group of clients meet health care goals as
long as the technique is practiced regularly. In one
study, asthmatic adults who practiced diaphragmatic
breathing exercises experienced a significant reduction in the medication they used to treat asthma and
a lower intensity of their symptoms. This reduction
in symptoms led to increased physical activity, which
improved their overall health. Unfortunately, most
participants decreased their practice of diaphragmatic
breathing after the study and relapsed into previous

Williams_2E_CH04_printer_file.indd 94

10/24/13 1:13 AM

Chapter 4

Your Spa Massage

95

SPA FUSION
INTEGRATION OF SKILLS (continued)
REVIEW QUESTIONS
Multiple Choice
1. A waxy substance obtained from the distillates of
wood, coal, petroleum, or shale oil that is used to
coat the skin and trap heat and moisture at the
skins surface is called:
a.
b.
c.
d.

Seaweed
Fango
Paraffin
Steam

2. A series of strokes that are planned in advance,


delivered to body areas in a preset order, and practiced until they flow smoothly together is called:
a.
b.
c.
d.

A sequence
Pacing
Leading
A routine

3. Additional session elements or small complementary treatments that increase the clients enjoyment
of the session are called:
a.
b.
c.
d.

Add-ons
Up sells
Enhancers
Additions

4. This type of massage is used to decrease stress,


support the bodys natural restorative mechanisms,
and reduce temporary pain from overexertion
caused by activities such as weekend athletics or by
unusual work stress:
a.
b.
c.
d.

5. When 1 drop of an essential oil is briefly rubbed


together in the therapists hands before being
passed over the clients nose in an arc so that the
oil can be enjoyed on a deep inward breath it is
called:
a.
b.
c.
d.

Opening the massage


Closing the massage
An auditory cue
An aromatherapy inhalation

True or False
6. ______ Warm packs of rice, corn, or flax seed keep
the client warm and increase the clients enjoyment of the session.
7. ______ The tags on hand towels used to remove
product from the clients body should be left
intact so that you always know how to launder the
towels properly.
8. ______ The use of a paraffin dip on a clients
hands for stiff joints is outside the massage
therapy scope of practice.
9. ______ Essential oil massage blends create an
olfactory reaction that may facilitate deeper relaxation in the client.
10. ______ Flow and continuity refer to the progression of massage strokes from one technique to
another and from one body area to another.

Wellness massage
Health care massage
Orthopedic massage
Hospital massage

Williams_2E_CH04_printer_file.indd 95

10/24/13 1:13 AM

5
Foundation Skills
for Spa Treatment
Delivery
Chapter Outline

K e y Te r m s

Spa Draping

Dry room: A treatment room in which there is no shower or hydrotherapy


equipment. Instead, hot towels are used to remove the product from
the clients body, or the client takes a shower in a different area.
Exfoliation: A process by which dead skin cells are removed to improve
the skin texture and appearance. Other benefits include increased
circulation and lymph flow, increased immunity, and relaxation.
Flip-over method: A method of positioning the client for product application in which the client flips over after a treatment product has been
applied to the posterior of the body.
Side-lying position: A client positioning method where the client is
positioned on a treatment table on his or her side so that product can
be applied to both the anterior and posterior areas of the body without
changing positions.
Sit-up method: A client positioning method where the client sits up on
the treatment table so that product can be applied to his or her back.
Wet room: A treatment room in which there is specialized hydrotherapy
equipment such as showers that remove spa products from the clients
body, hydrotherapy tubs, and Scotch hoses.

Posterior Leg
Anterior Leg
Breast Drape
Anterior Pelvic Drape
Turban Drape
Gluteal Drape
Simple Hair Drape
Side-Lying Drape

Positioning the Client When Applying Spa Products


The Side-Lying Position
The Sit-Up Method
The Flip-Over Method

Basic Application Techniques


Application by Hand
Application with One Hand Gloved
Application by Brush
Application with Gauze or Fabric
Application by Mist
Application of Product with a Sugar Shaker

Dry Room Removal Techniques


Steamy Rosemary Towels
Herbal-Infused Towels
Hot Towel RemovalLegs
Hot Towel RemovalFeet
Hot Towel RemovalBack
Hot Towel RemovalArms
Hot Towel RemovalAbdominal Area and Upper Chest
Other Dry Room Removal Techniques
Moving a Client from Plastic to a Preset Massage Sheet

Wet Room Removal Techniques


The Handheld Shower
The Standard Shower
The Swiss Shower
The Vichy Shower

S
SPA
FUSION
IINTEGRATION OF SKILLS
STUDY TIP: Internet Work!
CHAPTER WRAP-UP

96

Williams_2E_CH05_printer_file.indd 96

10/24/13 1:15 AM

Chapter 5

This chapter focuses on the basic skills needed to deliver


spa body treatments. It begins with a discussion on how to
drape a client elegantly and efficiently, preserving the clients

Foundation Skills for Spa Treatment Delivery

97

Breast Drape
Align the top edge of the main drape with the bottom edge
of a hand towel or pillowcase. As the main drape is pulled
down, the hand towel or pillowcase becomes a breast drape
and takes its place.

modesty, while being able to apply spa products without


inconvenience. You may want to explore the many different

Anterior Pelvic Drape

ways therapists position the client on the treatment table

After the breast drape is in place, continue to pull the main


drape down until the abdominal muscles are uncovered.
Align the fold of the main drape with the bottom edge of a
hand towel or pillow case. As the main drape is pulled down,
the hand towel or pillow case will become a pelvic drape. Tuck
the bottom section of the pelvic drape between the legs leaving a safe distance between the tucking hand and the genitals.

to apply a variety of spa products effectively. Dry room


and wet room removal techniques are also discussed. After
mastering these foundation skills, different treatment steps
can be chosen and matched to develop more creative spa
services.

Spa Draping
In a massage session, range of motion techniques require
a tight drape that is tucked in, wrapped around the limb,
and, sometimes, held taut by the client. Clients receiving
spa treatments are draped slightly differently than they
would be in a normal massage. Although the client is always
draped, the aim is to preserve modesty and warmth without being too fussy. Spa draping should be quick, elegant,
and efficient. Disposable undergarments are useful for
treatments in which the client is more exposed because of
extensive spa product application. The draping methods
shown in Figure 51 work well. For a demonstration of spa
draping, visit thePoint.

Turban Drape
This type of drape protects the clients hair from spa products
and prevents heat loss during a treatment. Put a bath towel on
the table before the treatment. Bring the bath towel up over the
clients head to cover the forehead or the eyes. Using the hand
as a wedge on each side of the drape, bring the side portions
around the neck and tuck them into the top of the body drape.

Gluteal Drape
Uncover the back and fold the drape down to the gluteal
cleft. Grasp the folded edge of the main drape and the bottom edge of the hand towel or pillow case. As the main
drape is pulled down to expose the gluteals, the hand towel
or pillow case replaces it. Tuck the bottom of the gluteal
drape between the legs, leaving a safe distance between the
tucking hand and the genitals. Fold the edges of the gluteal
drape to create clean lines for product application.

Posterior Leg
To undrape the posterior leg, gather the drape at the greater
trochanter and at the ankle. Fold the bottom end of the
drape at an angle across the opposite leg while holding
the drape at the greater trochanter as a pivot point. With
the lower hand, grab the fold of the drape and tuck it under
the opposite thigh. Fold the top section of the drape across
the back, leaving the gluteals exposed. With practice, this
draping can be accomplished in three moves and provides a
clean line for the application of spa products from the toes
to the top of the posterior superior iliac spine (PSIS).

Anterior Leg
To undrape the anterior leg, gather the drape at the anterior superior iliac spine (ASIS) and at the ankle. Fold the
bottom section of the drape at an angle across the opposite
leg using the upper hand to hold the drape at the ASIS as a
pivot point. With the lower hand, grab the fold of the drape
and tuck it under the opposite thigh. Fold the top section
of the drape across the belly, leaving the ASIS exposed.

Williams_2E_CH05_printer_file.indd 97

Simple Hair Drape


Hold diagonally opposite ends of a hand towel at the corner
and allow the rest of the towel to drop into a triangle. Place
this on the treatment table before the client gets on it and then
bring the edges around the hair and secure the towel with a
bobby pin or by tucking the end into the fold of the towel.

Side-Lying Drape
Because spa products are applied to the clients while they are
in a side-lying position, this drape is different than it would
be for a massage. It is important to ask clients to wear disposable undergarments to preserve their modesty. The sheet is
kept over the client until he or she is moved into the side-lying
position. Undrape the clients upper body (females should
either wear a disposable bra or hold a towel over their breasts)
and place a bath towel across the clients hip. Grasp the folded
edge of the main drape and the bottom edge of the bath towel.
As the main drape is pulled down to expose the gluteals, the
bath towel will replace it, and the sheet is removed completely.

10/24/13 1:15 AM

98

Spa Bodywork: A Guide for Massage Therapists

A1

A2

B1

B2

B3

C1

C2

Williams_2E_CH05_printer_file.indd 98

FIGURE 51 Draping techniques. (A1 and A2) Posterior leg drape.


(B1B3) Anterior leg drape. (C1 and C2) Breast drape. (continued)

10/24/13 1:15 AM

Chapter 5

D1

D2

D3

E1

E2

F1

FIGURE 51 (continued) (D1D3) Anterior pelvic drape. (E1 and E2)


Turban drape. (F1 and F2) Gluteals drape.

Williams_2E_CH05_printer_file.indd 99

Foundation Skills for Spa Treatment Delivery

99

F2

10/24/13 1:15 AM

100

Spa Bodywork: A Guide for Massage Therapists

The client needs to be in disposable briefs because the bath


towel is used as a cover but is not pulled between the legs.

Positioning the Client When Applying


Spa Products
Rumi (12071273 CE), the well-known Sufi poet, said, There
are a thousand ways to kneel and kiss the earth. The same
could be said for spa treatments. There are a thousand ways
to deliver the same treatment. A good therapist will explore
a treatment thoroughly and arrange the treatment steps in
different ways until they can be delivered perfectly with maximum fluidity. Each therapist brings something different to a
treatment, and in a private practice, therapist can adapt the
basic steps and enhance the treatment in unique and creative
ways. By contrast, most spas want their therapists to deliver
the same treatment in the same way each time. It is important
to maintain this sort of consistency for returning clientele. The
techniques described below work well, but each can be done
in many different ways. Again, exploration is the best way for
therapists to find out what works for them. For a demonstration of product application, visit thePoint site for this text.
The choices made when delivering a treatment in a dry
room setting may well be different to those made for a wet

room setting. In a wet room, spa products are removed with


a specialized or handheld shower. Shower removal is quicker
and easier for the therapist than removal using hot towels.
Still, hot towel removal feels wonderful if the towels are hot
(rather than lukewarm), and the therapist works with purpose, flow, and attention to detail.
Many body treatments, regardless of their therapeutic
objectives, have the same basic steps:
Exfoliation step to cleanse, remove dead skin cells, and
invigorate the body
Application of the treatment product
Time for the treatment product to absorb and work
Removal of the treatment product
Application of a finishing product (usually a moisture
lotion, gel, or cream)
Sometimes, it is better to treat the body in segments because
this helps the treatment to flow more smoothly through the
product transitions. More often, you have to plan how to
apply several different products without turning the client
over too many times. The treatment procedures section in
each chapter discusses positioning for each treatment. It is
helpful if you are familiar with three different application
positions before continuing. These are the side-lying position, the sit-up method, and the flip-over method (Fig. 52).

B1

B2

FIGURE 52 Positioning the client for product application. (A) The side-lying position. (B1 and B2) The
sit-up method. (C) The flip-over method.

Williams_2E_CH05_printer_file.indd 100

10/24/13 1:15 AM

Chapter 5

The Side-Lying Position


The client begins the treatment in the supine position for
the exfoliation step. After exfoliation on the anterior body,
turn the client into a side-lying position for the posterior
exfoliation. The client remains in the side-lying position
while the treatment product is applied. Once the product
is applied, roll the client onto his or her back again before
wrapping them in warm blankets. The client needs to stay
alert throughout the treatment and roll from side to side.
As the spa product is being removed, the client again rolls
from side to side to be toweled off (in a dry room).

Foundation Skills for Spa Treatment Delivery

101

need to be considered. The following methods work well


and are shown in Figure 53.

Application by Hand
Smooth the product onto the skin using effleurage strokes.
Some products are oily enough to massage into the skin
with a full range of strokes. The use of massage enhances
the treatment and is more enjoyable for the client. If applying the spa product by hand, you need to decide if you will
use gloves or wash it off your hands after the application.
Gloves are quickest.

The Sit-Up Method

Application with One Hand Gloved

The client begins the treatment in a prone position, and the


posterior body is exfoliated. He or she turns into a supine position for exfoliation of the anterior side of the body. The knees
are bent, and the treatment product is applied to both the anterior and posterior sides of the legs. Flatten the legs against
the plastic body wrap and then wrap the legs in the body wrap.
Ask the client to sit up (remove the bolster first). Apply the
treatment product to the back and gluteals and ask the client to lie back down again. Finally, the belly, upper chest, and
arms are treated, and then the clients upper body is wrapped.
The product is removed using the same method, and the client is only turned over once during the entire treatment. For
some clients, sitting up is impossible because of lower back
problems or weak abdominal muscles. In this case, choose the
safest and easiest application method for the individual client.

You may want to apply product with one gloved hand. The
ungloved hand is used to undrape body areas as needed or
hold the container of product. This technique works well
with the flip-over position described previously.

Application by Brush
If the client is sunburned or has delicate skin, using a
brush works well so long as the product is thin enough to
be applied with a brush. A large brush (purchase natural
bristle paint brushes) is quicker and more efficient than the
smaller brushes used for facials. If massage is included as
part of a different treatment step, applying the product with
a brush will provide a different sort of texture and give the
overall treatment greater tactile variety. Using a brush also
keeps your hands clean if you need to drape and undrape
body areas during the application process.

The Flip-Over Method


In the flip-over method, the client starts the treatment in
the prone position for the exfoliation step. Apply the treatment product before turning the client. Ask the client to
flip over (the goal is to make sure that the client makes a
clean flip and does not get spa product all over the place).
You hold up a drape and look away to protect the clients
modesty. Exfoliate the anterior body and apply the treatment product before you wrap the client.
This application method can be messy if the client
doesnt make a clean flip. Sheets or bath towel drapes are
difficult to use because they will become covered in product. For this reason, the client will probably want to use disposable undergarments. The treatment product will be on
the clients back and posterior legs for an extra 10 minutes
while the anterior body is being treated. This may be problematic with some products (e.g., very strong seaweed).

Basic Application Techniques


When choosing an application technique, the thickness of
the product, the speed at which it needs to be applied, and
the way the product should feel as it goes onto the body

Williams_2E_CH05_printer_file.indd 101

Application with Gauze or Fabric


For some spa products, a piece of gauze or light fabric is
dipped into the product and then applied to the body area.
This method is used with paraffin, Parafango, herbal infusions, and mud, although it can be used with many different products. It allows you to cover body areas rapidly and
precisely. Paraffin and Parafango drip easily. The use of the
gauze prevents the product from getting onto the floor or
dripping onto the client. If the product is too warm, it may
burn the client or be very uncomfortable because the heat
feels intense because a large area is being covered at once.
This is the main drawback of this method of application.

Application by Mist
Very thin or watery products can be sprayed onto the body
with an atomizer or mister. Products that are misted onto
the body feel cool even when the product has been heated.

Application of Product with a Sugar Shaker


Dry products such as ground herbs, salt, sugar, medicated
powder, or flour can be applied to the body through a
sugar shaker. This is a unique sensory experience for the

10/24/13 1:15 AM

102

Spa Bodywork: A Guide for Massage Therapists

D1

D2

F
FIGURE 53 Application methods. (A) By hand. (B) Using a brush. (C) With one hand gloved.
(D1 and D2) Using gauze or fabric. (E) Using a mist. (F) Using a shaker.

Williams_2E_CH05_printer_file.indd 102

10/24/13 1:15 AM

Chapter 5

client because the product, even when it is dry, feels like


raindrops.

Dry Room Removal Techniques


Use hot, moist towels to remove treatment product from the
clients body in a dry room setting (Fig. 54). This is a warm
and satisfying experience when the towels are steamy hot
and you use long, elegant strokes. To prepare the towels, pull

Foundation Skills for Spa Treatment Delivery

103

off all the tags, then fold the towels in half (the long way),
and roll them up like a sausage. It is important that all the
tags are removed because they could scratch the client. Place
the towels in a hydrocollator, hot towel cabinet, or hot stone
heating unit for 20 minutes at 165F. With thermal gloves,
remove a towel from the water, wring it out, and place it in
the soda cooler. Close the lid of the cooler and remove the
next towel. Keep the lid of the cooler shut as much as possible so that the towels stay hot throughout the treatment.
You can enhance your towels by soaking them in herbal infusions or adding essential oils just before use. Some therapists

A1

A2

C1

C2

C3

FIGURE 54 Hot towel removal. (A1 and A2) Legs. (B) Feet. (C1C3) Back. (continued)

Williams_2E_CH05_printer_file.indd 103

10/24/13 1:15 AM

104

Spa Bodywork: A Guide for Massage Therapists

FIGURE 54 (continued) (D) Arm. (E) Abdominal area. (F) Upper chest. (G) Product removal with sponges and
hot water.

color coordinate their towels for the treatment (e.g., green


towels for seaweed treatments, brown towels for mud treatments, beige towels for herbal infusions) to camouflage any
product stains. For a demonstration of hot towel removal of
treatment product, visit thePoint site for this text.

towels are heated in. A nice combination is eucalyptus leaf,


rosemary, clove buds, and juniper berry. A half a cup of herbs
to around 16 quarts of water provides a nice concentration,
although more or less herbs can be used according to taste.
Towels heated in herbal solutions will be lightly stained.

Steamy Rosemary Towels

Hot Towel RemovalLegs

Add 3 to 5 drops of rosemary essential oil to the soda cooler


full of towels. As each towel is removed, it will fill the treatment room with a refreshing scent. Most single essential oils
such as eucalyptus, common sage (Salvia officinalis), Spanish
sage (Salvia lavandulifolia), thyme, and lemon oil smell good,
but floral scents such as ylang ylang and jasmine are not as
pleasant in steam. The essential oil on the towel is not likely to
cause any skin irritation because essential oils are volatile substances and begin to evaporate rapidly the minute that they
are placed on the hot towels in the cooler. They will mostly
burn off before the first towel is used, leaving only some of
the scent behind. Skin irritation is therefore minimized.

Remove a towel from the soda cooler and hold it by the edges
(because it is hot). Let it cool slightly and place it on the
proximal portion of the leg (anterior or posterior). Allow it
to sit on the leg and do not touch it again until it cools down
(about 30 seconds). Place both hands on the towel and pull
it toward the distal portion of the leg and off the foot. Turn
the towel over and use the clean side to make another sweep.

Herbal-Infused Towels

Hot Towel RemovalBack

Muslin bags filled with fragrant herbs can also be used to


scent towels. Add a muslin bag of herbs to the water that the

Place the hot towel horizontally on the lower back and allow
it to cool slightly without touching it. Place both hands on

Williams_2E_CH05_printer_file.indd 104

Hot Towel RemovalFeet


Place a hot towel around each foot to steam the feet and
provide a nice sensation and then remove the product from
one foot at a time.

10/24/13 1:15 AM

Chapter 5

the towel and pull it toward the clients head. As the towel
gets to the neck, pull it off to one side, removing the product
from the shoulder without getting it into the clients hair.
Turn the towel over and use the clean side to make a second
sweep removing the product from the second shoulder.

Hot Towel RemovalArms


Place the hot towel vertically on the proximal portion of the
arm and pull the towel toward the hand in one sweep. Lift
the arm by holding onto the clients hand and use the clean
side of the towel to wipe down the other side of the arm.

Hot Towel RemovalAbdominal Area and


Upper Chest
Place the hot towel horizontally on the belly and pull it from
the left side to the right side. Turn the towel over and use
the clean side to remove product from right to left. Place a
hot towel across the upper chest and remove the product by
pulling the towel from one side to the other.

Other Dry Room Removal Techniques


Sponges and warm water can be used to remove the product
in a dry room setting. In this case, place a bucket of warm
water close to the treatment table on a rolling cart. Dip a
sea sponge, large cosmetic sponge, or a washcloth into the
water and use it to wipe the product off. Dry the client with
a hand towel after the product has been removed. The only
problem with sponge removal is that it is difficult to keep
the linens under the client dry. Some therapists put a thick
bath towel on top of the linens before the treatment and get
the client to lift his or her body so that this can be removed
after the sponge bath. At one spa, the floor was tiled with
a drain in the middle of the room. The massage table was
covered by a plastic wrap and large bath towel. A bucket of
warm water was doused over the client to remove product.
This was a quick and efficient method of product removal
that was also invigorating, surprising, and fun. The client
was handed a thick terry robe and moved to a fresh treatment room for massage after the removal of spa product.

Moving a Client from Plastic to a Preset


Massage Sheet
In many different types of body wraps, the client is covered
in a spa treatment product and then wrapped in plastic.
After the treatment product is removed, a finishing product
is applied to the client often in a full-body massage. In a
dry room setting, you have to get the dirty plastic out from
underneath the client without asking the client to get off
the treatment table (a clean massage sheet has been preset
under the plastic). To do this, review Figure 55 and unwrap
the plastic leaving the client covered by the breast drape
and anterior pelvic drape (or disposable undergarments).

Williams_2E_CH05_printer_file.indd 105

Foundation Skills for Spa Treatment Delivery

105

Remove the product from the clients arms, upper chest,


and abdominal area and ask him or her to hold onto the
breast drape and sit up. Remove the product from the back
and the posterior arms. Roll up the plastic sheet so that the
dirty side is rolled in until it sits as close to the gluteals as
possible and ask the client to lie back down (onto the clean
massage sheet). Move down to the lower legs and wipe the
feet with a hot towel. Ask the client to bend the knees and
hold the feet up. Roll up the dirty side of the plastic (that
is underneath the clients feet). Place the clients clean feet
on the massage sheet, which is underneath the plastic (the
knees are still bent). Remove the spa product from both legs
with hot towels and roll the plastic up as high as possible
under the gluteals. Place the clean legs flat on the massage
sheet and cover the client with a sheet or towel for warmth.
The client then lies back down on the massage sheet and
slightly lifts his or her hips so that the plastic can be
removed. You need to work quickly and efficiently during
product removal because the client must stay alert during
this entire process.

Wet Room Removal Techniques


In a wet room, a specialized shower is used to remove
spa products from the clients body. Specialized showers
include a handheld shower, a standard shower, the Swiss
shower, and the Vichy shower. Always read the manufacturers instructions for the particular piece of equipment
beforehand. It is important to practice a treatment at least
two to three times when using a specialized shower so that
the temperature and pressure of the shower are safe and
comfortable for the client. Wet room removal techniques
are shown in Figure 56. Wet room equipment and considerations are also described in Chapter 6 (Water Therapies).

The Handheld Shower


A handheld shower is used in combination with a wet table
for the easy removal of product. Some handheld showers
can deliver a pulsating water massage and may also have
an attachable body brush for exfoliation. A wet table has a
special surface to channel water into a receptacle under the
table or a drain in the wet room floor. The table is often
constructed of heavy plastic or acrylic for easy cleanup and
sanitation. A soft, waterproof insert makes the table comfortable for the client. Sometimes, a bucket of warm water is
poured over the client to remove the spa product. This type
of removal provides an invigorating experience for the client,
but dry the client quickly so that he or she does not get cold.

The Standard Shower


A standard shower is less expensive than a Swiss or a Vichy
shower but does not allow the same range of control. The
pressure of the water, the degree of pulsation, and the

10/24/13 1:15 AM

106

Spa Bodywork: A Guide for Massage Therapists

temperature of the water cannot be controlled by the therapist. The client is moved between the massage table and the
shower as needed during the treatment. For example, if seaweed is applied after exfoliating the client with a dry brush,
the client is moved off the massage table after the seaweed
has been allowed to process and taken to the shower so
that it can be washed off. While being moved, the client
stays loosely covered in the plastic wrap until he or she gets
into the shower and passes it back to the therapist to throw
away. The therapist then places clean linen sheets on the
massage table while the client finishes his or her shower.

Williams_2E_CH05_printer_file.indd 106

FIGURE 55 Moving a client from plastic to a preset massage sheet.


(A) Unwrap the client. (B) Remove product from the arms, upper chest,
and abdominal area. (C) Remove product from the back and roll up
the plastic. (D) Remove product from the legs and roll up the plastic.
(E) Remove the plastic from under the client.

The client returns to the massage table for a massage or to


have a finishing lotion or cream applied.

The Swiss Shower


A Swiss shower surrounds the client with jets of water
directed at specific areas of the body. Usually, the shower
stall has pipes in all four corners with 8 to 16 water heads
coming off each pipe. Adjust the position of the water heads
for the clients height. A control panel outside the shower
stall allows you to control contrasting warm and cool jets

10/24/13 1:15 AM

Chapter 5

Foundation Skills for Spa Treatment Delivery

107

FIGURE 56 Wet room removal. (A) The handheld shower. (B) The Swiss shower.
(C) The Vichy shower.

of water. A shower can be used for product removal, as an


active treatment in itself, or to provide the heating phase of
the treatment for products such as a cellulite cream.

The Vichy Shower


A Vichy shower is a horizontal rod with holes or water
heads that rain water down onto the client from above the
wet table. Vichy showers are used to rinse spa products off
the client, but they can also be used as a treatment in themselves. A control panel allows you to alternate between hot
and cool water, which increases the therapeutic benefits of
some products and uses the mechanical effects of water on
soft tissue. Vichy showers have an adjustable face guard that
is meant to keep water off the clients face, although some
water invariably gets through. A soft, lightweight washcloth
can be used to cover the clients face and protect it from

Williams_2E_CH05_printer_file.indd 107

water droplets. Care must be used when moving the client


off the wet table because the area around the table may be
slippery with water. Although a finishing lotion or cream
can be applied while the client is on the wet table, it is nicer
to move the client to a dry room massage table for this final
step. Wet rooms may feel a little cold and can echo because
of the tiled floor.
SANITATION
The shower stall or wet table, the floor outside
the shower, the shower curtain (if there is one),
and any other surface that touches the client or water
must be cleaned, disinfected, and dried between clients.
Towels and floor mats will also need to be changed
between clients.

10/24/13 1:15 AM

108

Spa Bodywork: A Guide for Massage Therapists

SPA FUSION
INTEGRATION OF SKILLS
STUDY TIP: Internet Work!

REVIEW QUESTIONS

The Internet provides people with fast access to information, which can be very helpful when you want to
learn more about anything that is unfamiliar. Some
of the information on the Internet is from questionable sources, so we spend a lot of time sorting through
advertising, false claims, and other spam. One way
to avoid this sorting process is to use a teachingand research-oriented search engine such as Google
Scholar available at http://scholar.google.com when
youre looking for information. It can also be helpful
to look for massage and spa technique videos supplied by massage and spa teachers on TeacherTube
(http://www.teachertube.com) if you want to see
visual examples of techniques being applied to clients.
Finally, ask other massage professionals for information on http://www.massageprofessionals.com.
This social networking site created for the massage
profession by Associated Bodywork and Massage
Professionals lets you connect with massage people
across the country.

Multiple Choice

CHAPTER WRAP-UP
As an aspiring spa professional, you should practice
basic spa skills in preparation for the delivery of core
spa treatments rigorously. These skills include elegant
spa draping, appropriate positioning of the client for
product application, the use of a variety of application methods, and the smooth and efficient removal
of product with hot, moist towels. Enhancers such
as steamy aromatic towels, firming face massage, and
simple foot treatments provide moments of particular
radiance in a spa massage as described in Chapter 4
(Your Spa Massage). New spa therapists should perfect
their Swedish relaxation massage and offer several
enhancers while maintaining the flow of the massage.
If a wet room is used to remove product, practice with
the specialized equipment to ensure that the water
temperature and pressure are safe and comfortable for
the client. Once these skills are mastered, you will be
able to work more creatively with treatment steps to
develop unique services. Remember, you are responsible for checking the laws and regulations in your particular state to ensure that you are delivering services
within your scope of practice.

Williams_2E_CH05_printer_file.indd 108

1. A method of positioning the client for product


application in which the client turns over after a
treatment product has been applied to the posterior of the body is called:
a.
b.
c.
d.

The sit-up method


The flip-over method
The side-lying method
The pronator method

2. This type of drape protects the clients hair from


spa products and prevents heat loss during a
treatment.
a.
b.
c.
d.

Facial drape
Gluteal drape
Breast drape
Turban drape

3. When choosing an application technique, you want


to consider:
a.
b.
c.
d.

The thickness of the product


The color of the product
How the product will be removed
Face massage techniques

4. Oily products lubricate the skin enough so that:


a. They can be applied with steamy hot towels
b. They can be applied with a full range of massage
strokes
c. They can be sprayed directly onto the body with
a mist bottle
d. They can be applied with powders
5. Paraffin, Parafango, herbal infusions, and mud can
be applied with:
a. Gauze or fabric that has been coated with the
product
b. A full range of massage strokes
c. Gloved hands and a full range of massage
strokes
d. A mist bottle

10/24/13 1:15 AM

Chapter 5

Foundation Skills for Spa Treatment Delivery

109

SPA FUSION
INTEGRATION OF SKILLS (continued)
True or False
6.

9.

Clients receiving spa treatments are


draped slightly differently than they would be in a
normal massage.
10.

7.

Shower removal is slower and harder


for the therapist than removal of products using
hot towels.

8.

If the client is sunburned or has delicate skin, or if the product is thin, the use of a large
paint brush for product application works well.

Williams_2E_CH05_printer_file.indd 109

Products that are misted onto the


body feel cool even when the product has been
heated.
A Vichy or Swiss shower are used in
a dry room setting to remove products from the
clients body.

10/24/13 1:15 AM

6
Water Therapies
Chapter Outline

K e y Te r m s

General Uses for Hydrotherapy


Introduction to Hydrotherapy

Buoyancy: Buoyancy refers to floating in water because of the water is


displaced by bodyweight.
Compress: A wet cloth soaked in warm, hot, cool, or cold water (sometimes
with additives dissolved in the water) that is wrung out and applied to
the skin.
Cryotherapy: The therapeutic application of cold temperatures.
Father Sebastian Kneipp: A Bavarian priest who combined herbal treatments with water cures.
Friction treatments: Friction treatments include salt, sugar, dry brushing,
wet brushing or mitt treatments where the mechanical action of the
rough-textured product, brush, or mitts against the skin causes local
circulation to increase as the friction generates heat in the tissue.
Full immersion bath: A hydrotherapy treatment where the clients body
is fully immersed in cold, cool, warm, or hot water for a period of time
to stimulate or sedate the body.
Homeostasis: The bodys ability to maintain a relatively constant internal
environment despite changing external conditions.
Hunting reaction: Alternating cycles of vasoconstriction and vasodilatation
in response to cold.
Hydrostatic pressure: The amount of pressure exerted by a liquid, in this
case water, when the liquid is at rest. In other words, water has weight.
Hydrotherapy: The use of water for health and wellness.
Mechanical effects: The effects on the body caused by water that is pressurized in sprays, whirlpools or through jets to manipulate soft tissue.
Paraffin: A waxy substance obtained from the distillates of wood, coal,
petroleum, or shale oil. It is used to coat the skin and trap heat and
moisture at the skins surface.
Sauna: A room where hot air (60 to 210F) is combined with low humidity
to stimulate metabolism, increase core body temperature, and facilitate
detoxification.
Scotch hose: A hydrotherapy application in which a strong stream of water
is directed at the client to increase circulation, stimulate function, tone
muscles, decrease pain, and decrease congestion in a particular body area.
Steam bath: A hot air bath used to facilitate perspiration that helps the
body naturally detoxify.
Thermotherapy: The therapeutic application of heat.
Vasoconstriction: When the lumen of a blood vessel is contracted, reducing
the diameter of vessel and decreasing blood flow to a region of the body.
Vasodilatation: When the lumen of a blood vessel is relaxed, increasing the
diameter of the vessel and increasing the blood flow to a region of the body.
Vincent Priessnitz: An Austrian farmer who became famous for the cold
water cure, which consisted of drinking large amounts of cold water
and applications of cold water by packing, immersions, and douches.

Therapeutic Characteristics of Water

Hydrotherapy Benefits and Effects


Benefits of Using Hydrotherapy in a Massage and
Spa Practice
Effects of Hydrotherapy Applications

Hydrotherapy Applications
General Treatment Considerations
Hydrotherapy Applications

S
SPA
FUSION
IINTEGRATION OF SKILLS
STUDY TIP: Fact Sheets
SPA INSPIRATION: Self-care with Hydrotherapy
ITS TRUE! Hydrotherapy Improves Physical
Performance for People with Osteoarthritis
CHAPTER WRAP-UP

110

Williams_2E_CH06_printer_file.indd 110

10/24/13 1:17 AM

Chapter 6 Water Therapies

Hydrotherapy is the use of water for health and wellness

111

use hydrotherapy regularly to promote healthy changes in


soft tissue structures.

and is a historical cornerstone of the spa experience. As we


discussed in Chapter 1 (Spa from Past to Present), the

Introduction to Hydrotherapy

revitalizing effects of water were well known in ancient


cultures around the world. Vincent Priessnitz and Father
Sebastian Kneipp developed methods and procedures that
advanced the understanding of hydrotherapy. Although
spa treatments can be offered without wet room equipment
such as Vichy showers and hydrotherapy tubs, it is helpful to
be well versed in hydrotherapy principles. For the therapist
working in a spa offering hydrotherapy treatments, this
understanding is essential to providing safe and effective
client care.

General Uses for Hydrotherapy


The effects of hydrotherapy applications are the same even
when the focus of sessions is different. In a wellness setting
such as a spa or massage practice focused on reducing stress
and promoting enjoyment of sessions, hydrotherapy is
most often used to relax the body with hydrotherapy baths,
showers, steams, and saunas.
In spas, hydrotherapy is also used as part of the beautification process by estheticians. A particular product might
be applied to the legs to improve the appearance of cellulite. Specialized water applications such as a Swiss shower
or Scotch hose might then be used to activate the product
or stimulate the skin and circulation as part of the session.
In health care settings, such as those at some integrated
or resort spas, hydrotherapy is applied to support changes
needed in the body for the management of a particular
pathology or condition and to rehabilitate musculoskeletal
tissue after injury. In a health care setting, a sauna or steam
room might be used as part of the clients treatment plan.
If a client suffers a sports injury, ice packs are likely to be
applied to the area to reduce inflammation. As the clients
injury heals, heat applications might be used to soften scar
tissue and improve range of motion as the client returns to
full function.
In the first section of this chapter, we discuss the therapeutic characteristics of water that make it useful and beneficial for clients. The physiological, psychological, and
reflexive effects of hydrotherapy are explained in the next
section of the chapter, before hydrotherapy applications are
demonstrated at the end of the chapter. Whether you choose
to work on providing wellness massage and relaxation spa
work or work in a health careoriented spa providing condition management or injury rehabilitation, you are likely to

Williams_2E_CH06_printer_file.indd 111

The term hydrotherapy originates in two Greek words: hydro,


meaning water, and therapeia, meaning therapy. Stedmans
Medical Dictionary for Health Professions and Nursing defines
hydrotherapy as the external application of water as a
liquid, solid, or vapor for therapeutic purposes.1
The use of water for healing dates back before recorded
history, and many cultures around the globe have traditions that include hydrotherapy. North American Indian
tribes, for example, used a special hut or a covered sweat
lodge built partly into the ground. Large stones were heated
in a fire and taken inside the hut where they were sprinkled
with water to warm the air, causing the body to perspire as
a means of purification. There is evidence that every major
U.S. hot spring was used at some point by an Indian tribe.2
Native Americans considered hot springs to be sacred,
neutral ground. Warriors could rest by hot springs to heal
battle wounds without worry of attack from another tribe.
Early civilizations often had a version of the spa bath,
which combined some form of social interaction with
cleanliness. The hamam (bath) became popular in Islamic
countries around 600 AD after Muhammad recommended
sweat baths for spiritual cleanliness. Later, hamams became
central to the community both as a place of spiritual retreat
and for socializing with friends. Bathers would stop first at
the camekan, a small court of changing cubicles surrounding a fountain, before entering the hararat (hot marble
baths). Bathers would receive a vigorous massage or kese
(exfoliation with a rough cloth) on a raised marble platform
above the wood or coal furnaces used to heat the hararat.3
As mentioned in Chapter 1 (Spa from Past to Present), the
baths of the Roman Empire are probably the most famous
in history. The central role of public baths in Roman culture led to a well-developed understanding of hydrotherapy,
and garrisons were often built around hot springs so that
the soldiers could heal their battle wounds. By 43 AD, the
Roman public viewed the baths as a way to relax and maintain health, and by the early fifth century AD, Rome alone
had 900 baths.
The medical benefits of hydrotherapy were advanced in Europe by two natural healers who developed their methods in
the early 1800s. Many of these methods are still used today
as part of hydrotherapy. The first was the Austrian Vincent
Priessnitz (17991852), who promoted the cold water cure.
This cure consisted of drinking large amounts of cold water, bathing in cold water, following a simple diet, and participating in physical activity in the open air. Priessnitz used the
cold water cure to care for a personal injury that doctors of the
time thought untreatable. In 1826, Priessnitz opened a water
cure establishment at Grfenberg in the mountains of Silesia,
where his ideas were adopted by many prominent physicians.4

10/24/13 1:17 AM

112

Spa Bodywork: A Guide for Massage Therapists

The second natural healer was Father Sebastian Kneipp


(18241897), a Bavarian priest who cured himself of pulmonary tuberculosis by bathing in the icy Danube and
shocking his body into health. In one of his many books,
My Water-Cure (1894), Kneipp writes, Being a priest, the salvation of immortal souls is the first object for which I wish
to live and die. During the last 30 or 40 years, however, the
care for mortal bodies has absorbed a considerable portion of my time and strength. Instead of administering
last rites to the gravely ill, he used water and herbs to cure
them. Kneipps healing system, which combined physical
exercise, simple food, hydrotherapy, and herbs, forms the
basis of modern naturopathy. He is well known for the wet
nightshirt treatment that involved wearing a shirt that
had been dipped into water with salt or hay flower. He also
introduced classic methods of friction such as salt glows
and body wraps, which are widely used today in spas.5
Today, hydrotherapy applications are used successfully
to treat a broad range of conditions and are particularly useful for musculoskeletal problems. Modern research proves
what people throughout the ages have always known: Water
has healing characteristics that change the way we feel mentally, emotionally, and spiritually.

Therapeutic Characteristics of Water


Water is a unique substance that covers more than 70% of
the earths surface and provides the natural beauty of oceans,
rivers, rain, waterfalls, and snow. The human body is 55%
to 60% water, and tissues such as lean muscle (75%), blood
(95%), and bone (22%) contain significant amounts of water.
Water also has a number of characteristics that make it useful
as a therapeutic application. Water is versatile and changes
forms, dissolves other therapeutic substances, exerts hydrostatic pressure, causes buoyancy, and absorbs and transfers
hot and cold temperatures (For Your Information 61).
Water Is Versatile and Changes Forms
Water is a liquid that can easily be changed into ice or vapor.
It is therapeutically useful in all of these forms. As a liquid,
water is applied in baths and showers or used to heat special packs, called hydrocollator packs, that bring moist heat
directly to a specific body area. Ice packs and ice massage
FOR YOUR INFORMATION 61
Therapeutic Characteristics of Water
Water is versatile and changes forms (water, ice, vapor).
Water dissolves other therapeutic substances (minerals,
plant materials).
Water exerts hydrostatic pressure (weight of water).
Water causes buoyancy (lift of displaced water).
Water absorbs hot and cold temperatures.
Water transfers hot and cold temperatures
(conduction direct contact, convection via air).

Williams_2E_CH06_printer_file.indd 112

cool heated tissue and reduce inflammation, whereas saunas and steam rooms use water in a vaporized form to promote perspiration and detoxification.
Water Dissolves Other Therapeutic Substances
Water is known as the universal solvent because it dissolves
so many other substances. Many of the known elements
found on earth are dissolved in seas and lakes. For example,
people all over the world have noticed that they feel revitalized from a day at the beach and swimming in the ocean,
where seaweeds and minerals dissolve in the water, making
it a rich, therapeutic soup. Many different substances can
be dissolved from a solid to a liquid form for absorption
through the skin. Substances such as clay, minerals, powdered seaweed, ground oatmeal, and a variety of herbs are
routinely dissolved in water and applied to the body in baths
and body wraps as part of hydrotherapy at spas.
Water Exerts Hydrostatic Pressure
Hydrostatic pressure is a term that refers to the amount
of pressure exerted by a liquid, in this case water, when the
liquid is at rest. In other words, water has weight. If you
have swum underwater, you have probably noticed that the
deeper you go, the more pressure you feel in your ears from
the accumulated weight of the water above you. If you stand
neck deep in water, there is greater hydrostatic pressure on
the lower part of your body (deeper) than on your upper
body. Hydrostatic pressure pushes blood and fluid from the
lower body into the thorax. This characteristic of water has
been used effectively to treat edema in the extremities caused
by many different conditions. Pregnant women who exercise in water find that hydrostatic pressure reduces lower leg
edema, decreases the occurrence of varicose veins, improves
general blood circulation, and stabilizes blood pressure.6
Water Causes Buoyancy
Buoyancy refers to floating in water. When you enter a
swimming pool, you displace water and there is an upward
thrust of water that lifts you. This is why you feel weightless when you swim. The water you displaced supports the
weight of your body. Exercising in water reduces the stress
on joints, tendons, and bone that would occur with the
impact of the body moving on a hard surface. People who
have arthritis, are elderly, or have recently undergone surgery for a musculoskeletal condition benefit from movement in a buoyant environment.
Water Absorbs Hot and Cold Temperatures
Water can be heated or cooled to specific temperatures for
therapeutic application to the body as described later in the
chapter when we talk about the effects of hot and cold temperatures on the structures and function of the body. As you
can probably imagine, hot applications increase local blood
circulation, warm soft tissue structures, relax tense muscles,
and soften muscle tissue. Cold applications decrease local
blood flow to an area and increase muscle tone.

10/24/13 1:17 AM

Chapter 6 Water Therapies

Water Transfers Hot and Cold Temperatures


Water effectively transfers hot and cold temperatures to the
body in two different ways. When heated or cooled water
makes contact with your body, it transfers the warmth or
coolness to your body through conduction (the transfer of
hot or cold temperatures through direct contact). Water is
more effective at transferring hot or cold temperatures than
is air, which is why moist heat feels hotter than dry heat.
Convection is the process by which hot or cold temperatures are transferred via air or gas. For example, it feels
colder when the wind is blowing (wind chill) than if the air
is still. Saunas are an example of the transfer of temperatures via air; water poured over hot rocks turns quickly into
a vapor, which evaporates into the air and warms it.
These general characteristics of water help lay the foundation for better understanding the mechanisms by which
hydrotherapy is effective in the upcoming sections of this
chapter.

113

and prolongs the pleasure the client experienced during the


session. At the same time, dead skin cells desquamated during the massage or body wrap and impurities released from
the skin are removed, leaving the client feeling clean and
revitalized.
In both wellness and health care spas, therapists often
suggest that clients use hydrotherapy applications at home
for self-care. Use of hot packs on tight shoulder muscles
at the end of a workday can help the client maintain the
lengthening effects achieved through a massage session.
Regular Epsom salt baths help reduce stress, decrease muscle soreness, and improve sleep. Cold packs are applied during the early stages of inflammation to reduce swelling and
heat in the tissue and speed the healing process. The simple
act of taking a warm bath at night can serve as part of a
stress reduction regimen. These general benefits complement the significant physiological and psychological effects
of hydrotherapy applications.

Effects of Hydrotherapy Applications

Hydrotherapy Benefits and Effects


Hydrotherapy applications support many of the benefits
and effects of massage and can improve the results clients
experience from the massage or spa session. The benefits
of hydrotherapy include the pleasure and comfort clients
receive through hydrotherapy applications.
The effects of hydrotherapy usually depend on the temperature of the application and the delivery method (bath,
pack, shower, etc.). Lets consider the benefits of hydrotherapy
applications in a massage and spa practice and their physiological, psychological, reflexive, and mechanical effects.

Benefits of Using Hydrotherapy in a Massage


and Spa Practice
The use of hydrotherapy applications in both wellness and
health care spas increases clients enjoyment of sessions,
offers soothing comfort, ensures that clients stay warm, and
provides a useful means of empowering clients to manage
many conditions through self-care practices.
A recent study suggests that feelings of warmth are associated with a sense of relaxation and well-being. Researchers
have found that sensations of warmth alter neural circuits
controlling cognitive function and mood, influencing
serotonin levels. So, whether you are lying on a warm beach
in the Caribbean, sitting in a sauna or hot bath, or even
working up a sweat through exercise, your brain chemistry
changes and your mood is enhanced.7
Many clients begin to feel cold as a spa session progresses. A warm hydrocollator pack on the feet or low back
can warm the client and increase the clients enjoyment
of the session. A hydrotherapy tub immersion (bath) with
soothing additives such as essential oils or herbs after a
massage or body wrap boosts the benefits of the treatment

Williams_2E_CH06_printer_file.indd 113

Understanding hydrotherapys effects on the body begins


with the concept of homeostasis. Homeostasis is the relative
constancy of the bodys internal environment. The bodys
internal environment includes the extracellular fluid that
bathes cells. From this fluid, cells receive oxygen and nutrients, and into this fluid, cells excrete wastes from their metabolic activities. The health of each cell and an organisms
survival depends on the ability of the organism to sustain
a relatively constant internal environment. If the internal
environment is disturbed to the extent that it cant adjust,
such as by prolonged exposure to cold and hypothermia,
death of cells and potential death of the organism result.
Humans are able to maintain internal environmental
stability because intricate regulatory mechanisms continually monitor and correct the bodys internal environment
by adjusting physiological functions.8 The bodys core temperature is relatively constant, even in the face of widely
varying external environmental temperatures, because of
this ability. For example, the body produces heat when the
core becomes too cool and increases heat loss when the core
starts to overheat. Hydrotherapy applications are designed
to change the internal environment of the body by applying temperatures above, close to, or below that of the bodys
normal temperature (97F). The physiological effects of
hydrotherapy occur as a result of the bodys attempt to
return to a constant internal state. For example, a common
physiological effect of the application of heat is vasodilatation of blood vessels and increased blood flow to the local
area, which moves warm blood out toward the periphery,
cooling the core of the body. A common physiological effect of cold is decreased local edema and decreased pain.
The edema is reduced through vasoconstriction of blood
vessels, which drives warm blood back to the core, ensuring the core maintains the proper temperature. As a result,
pain is reduced by a decrease in nerve conduction velocity.

10/24/13 1:17 AM

114

Spa Bodywork: A Guide for Massage Therapists

Three key factors influence the degree to which the body is


affected by hydrotherapy applications:
The greater the temperature difference between the
body and the hydrotherapy application, the greater
the physiological effect on the body: If a client is placed
in a bath at 97F (close to normal body temperature),
neither the therapist nor the client will notice much of
a physiological difference (although a mild tonic effects
occurs with neutral applications). If the same client is
placed in a bath at 110F, the physiological changes
in the body will be readily apparent to both. The pulse
rate increases, the skin flushes, body temperature rises,
metabolism picks up, the blood becomes more alkaline,
and white blood cells increase in number. The client may
feel nervous or even agitated by the application and will
probably want to get out of the hot water.
The length of the hydrotherapy application influences
the physiological effect on the body: A client placed in
very cold water (32 to 55F) will have two very different reactions based on the length of the treatment. If the
application is brief (less than 1 minute), blood vessels will
constrict to prevent heat loss. A short time later, blood vessels will dilate as the body attempts to warm itself and prevent tissue loss at the periphery. Muscle tone is increased,
and there is an initial spike in blood pressure and respiratory rate. The client is likely to report feeling refreshed and
invigorated. If the application is longer than 1 minute,
the clients blood vessels constrict as the body attempts
to move blood to the core to keep the core temperature
consistent. After about 20 to 30 minutes of continuous
cold, vasodilatation occurs, which increases circulation
(For Your Information 62), although not above the baseline when the cold was first applied. The physiological
processes of the body are depressed, and if the client is not
removed from the cold water, death could result.

FOR YOUR INFORMATION 62


The H
Th
Hunting
ti R
Reaction
ti
The hunting reaction involves alternating cycles of vasoconstriction and vasodilatation. When an ice pack is
applied to an area, the body undergoes a series of distinct
physiological responses. In the first phase, the blood vessels constrict, and blood flow to the area is reduced. This
decreases local edema and causes the skin to appear pale.
In the second phase, the body attempts to warm the area
through vasodilatation that increases circulation. If the cold
persists, vasoconstriction resumes, and the cycle repeats
itself with irregular sequences in an apparent hunting for
equilibrium of skin temperature. The benefits of the hunting
reaction are that vasodilatation phases flush the area with
fresh blood, bringing nutrients and oxygen to the tissue.
Vasoconstriction phases squeeze the blood out of the tissue,
removing many metabolic wastes, before another vasodilatation phase again flushes the area with fresh blood.

Williams_2E_CH06_printer_file.indd 114

The larger the body area treated, the greater the


physiological effect on the body: Hydrotherapy applications can be used over the entire body or locally. If the
body is immersed in a bath, as in the previous examples,
the effect is more profound than if a cold pack is applied
to one local area, say the hamstring. If the cold application is a full-body immersion, the hunting reaction
described in For Your Information 62 is potentially
deadly because heat from the bodys core is used to delay
tissue loss at the periphery. If the cold is applied just to
the hamstrings, the hunting reaction acts as a pump
to flush out metabolic wastes in tissues and bring fresh
oxygen- and nutrient-rich blood to the area.
The effects of hydrotherapy applications can be understood
in terms of six primary categories, which overlap and interrelate (For Your Information 63):

Physiological effects
Psychological effects
Reflexive effects
Mechanical effects
Effects from dissolved substances
Effects from specific temperatures

A combination of different types of effects usually occurs


simultaneously during a hydrotherapy application. For
example, different temperatures cause physiological effects,
and dissolved substances, such as herbs, can influence the
psychological impact of an application.
Physiological Effects
As mentioned earlier, many of the effects of hydrotherapy
occur because the body responds to temperatures above or
below normal body temperature in an effort to maintain
homeostasis. Hydrotherapy applications have a strong
effect on blood circulation, causing vasodilatation of blood
vessels in some instances and vasoconstriction of blood vessels in others. Certain applications can shift blood from
one area of the body to another or cause cycles of vasoconstriction and vasodilatation that flush the local tissue of
metabolic wastes by bringing fresh nutrient- and oxygenrich blood into an area, pushing blood back out, and repeating the process. In this way, metabolic wastes are removed

FOR YOUR INFORMATION 63


Physiological Effects of Hydrotherapy
Homeostasis is the relative constancy of the bodys internal
environment.
Hydrotherapy seeks to change the internal environment of
the body.
Physiological effects occur as a result of the bodys attempt
to maintain homeostasis.
When the body is hot, it attempts to cool itself.
When the body is cold, it attempts to warm itself.

10/24/13 1:17 AM

Chapter 6 Water Therapies

from the area, leaving the tissue healthier. Certain types of


applications cause an increase in blood pressure and heart
rate, whereas others cause it to decrease.
The skin is also directly impacted by hydrotherapy
applications because sensory receptors are responding to all
the textures and nuances of feeling created by the application and sending rapid signals to the brain. Overheating the
body, as in a sauna treatment or hot immersion bath, stimulates sweat glands, which helps the skin excrete metabolic
wastes from the body. Metabolic wastes that have accumulated in the adipose layers under the skin can be metabolized and released during this process, helping the body to
naturally detoxify.
Psychological Effects
Although the psychological effects of water and hydrotherapy applications are not always as clearly defined as physiological effects, you have only to contemplate your feelings
as you visualize a warm tub full of water, the delights of a
swimming hole on a hot summer day, or the feel of warm
sea mist on your face to understand waters psychological impact. People love water. In fact, maps of the worlds
population show that most of humanity lives near water.
People gather along coastlines, along the course of rivers,
and on islands. Popular vacation spots are often located on
bodies of water.9 Water holds an important place in myth
and legend and is often viewed as a transformative power.
Artemis in Greek mythology ruled the tides as the goddess
of the moon. She also personified the unconscious depths
of the human mind, which are associated with water. Rituals of purification often involve water because it is a substance that washes away dirt from the body and, in some
religions, cleanses the soul. Many cultures believe that life
sprang from water and that special waters impart youth
and renewed beauty. Water can represent an important passage through difficulties to renewal of the spirit. All of these
conscious and subconscious factors can be at play during
hydrotherapy sessions and benefit clients through the pleasure they receive through interaction with water.
Reflexive Effects
Hydrotherapy applications can produce reflexive effects
(sometimes called a consensual response) that occur because
of a nervous system reaction to the treatment. Reflexive
effects happen in an area removed from the point of local application, usually between the skin and the viscera,
although heat applied to one limb will increase circulation
in the other limb. The reflex relationship between the skin
and the internal organs is due to a segmental connection.
Both receive sensory innervation from the same segment
of the spinal cord. For example, heat applied to the abdomen causes the activity of the intestines to decrease. A hot or
cold application to the sternum affects the function of the
esophagus. A cold application to the head stimulates mental
activity, whereas the application of a cold pack to the sacrum
or feet causes dilation of the uterine blood vessels.10

Williams_2E_CH06_printer_file.indd 115

115

Mechanical Effects
When water is pressurized in a spray, shower, hydrotherapy
jet, or whirlpool, the force of the water on the skins surface
and on the muscle tissue below manipulates the tissue for
a mechanical effect. The body may respond to the sensation of water striking the tissue defensively at first, causing
muscle tone to increase. Gradually, the body relaxes into
the sensation of the pressurized water, and muscular tension is reduced, circulation is improved, and overall body
function and vital energy are increased.
The hydrostatic pressure of water can be considered to exert
a mechanical effect on body tissue. Recall that water exerts
more pressure on body areas that are deeper in the water. This
effect can be used to squeeze fluid from the lower extremities
to the thorax; for example, exercising in water reduces edema
in the lower legs. In some types of hydrotherapy applications,
fluids are pulled from the upper body to the lower body.
A classic example is the use of a hot foot bath to decrease congestion in the sinuses due to a cold. The hot water pulls fluid
down toward the feet and out of the head. In folk medicine,
migraines are treated with a warm foot bath and an ice pack
on the back of the neck. The dilation of blood vessels in one
body area reduces the fluid congestion in another area.
Another type of mechanical effect of hydrotherapy applications occurs with classic friction rubs such as salt glows,
wet skin brushing (like dry skin brushing as described in
Chapter 8 except the skin is dampened with water or vinegar), or cold mitt friction. The mechanical action of the
rough-textured product, brush, or mitts against the skin
causes local circulation to increase as the friction generates
heat in the tissue.
Effects from Dissolved Substances
Earlier, you learned that water is called the universal solvent
because it dissolves many other substances such as minerals
and plants, creating a therapeutic soup. For example, the
Dead Sea is an ancient landlocked sea whose water has been
slowly evaporating over the centuries, producing a highly
concentrated natural salt solution. After bathing in the Dead
Sea, people often report a feeling of increased energy and wellbeing as well as soft skin. The main mineral elements in Dead
Sea water are chlorine, magnesium, sodium, calcium, potassium, and bromine.11 Research on the usefulness of bathing
in the Dead Sea confirms that it benefits a variety of skin conditions because it improves the barrier function of the skin.12
It is also used to reduce inflammation from musculoskeletal
injuries including back injuries,13 improves the function of
joints effected by both rheumatoid and osteoarthritis,14,15 and
decreases the severity of symptoms associated with fibromyalgia.16 Additives dissolved in water may have physiological or
psychological effects that enhance and support the benefits
of the hydrotherapy application. For example,
Herbs: When herbs are soaked in water, many of their
chemical components are transferred to the water along
with their therapeutic properties. Red clover, lavender

10/24/13 1:17 AM

116

Spa Bodywork: A Guide for Massage Therapists

flowers, chamomile flowers, powdered oatmeal, comfrey,


elderflower, and calendula petals soothe skin irritation and
are used to improve many skin conditions. Juniper berries,
ginger root, clove bud, allspice, rosemary, and sage warm
the body and support perspiration for detoxification treatments. A wide range of herbs and herbal products are used
in combination with hydrotherapy applications. Visit spa
and massage supplier websites to research your options.
Milk: Milk, powdered milk, buttermilk, and cream can
be dissolved in water to soften and condition the skin.
Minerals: Minerals in salts such as those from the Dead
Sea, regular sea salt, or Bearn salt from the mineral
springs of the Pyrenees Mountains of Southern France
dissolve in water, allowing the minerals to be absorbed
by the skin to improve both the texture of the skin and
overall body function. Epsom salts are inorganic mineral
salts that help the body detoxify and increase general
circulation. They are well known for use with sprains,
strains, and sore, fatigued muscles. They also relax the
body and are useful for insomnia.
Seaweed: Seaweed contains many bioactive compounds
that can be absorbed through the skin and used by the
body to support overall body function. Seaweeds have
high concentrations of vitamins A, B1, B2, B5, B12, C, D, E,
and K. They also contain polyphenols and carotenoids,
which play a role in protecting the body from oxidative
stress. Brown seaweeds such as Laminaria, Sargassum, Fucus,
and Ascophyllum species stimulate metabolism, raise body
temperature, and affect cell membrane transport, facilitating detoxification. All seaweeds contain some amount of
iodine, which influences thyroid activity. For this reason,
do not use seaweed with clients who have iodine, shellfish,
or seaweed allergies or who take thyroid medications.
Essential oils: Essential oils do not dissolve in water, as we
will discuss in the next chapter (Introduction to Aromatherapy for Spa), but they are commonly added to baths,
saunas, and steam rooms to increase the therapeutic benefits of these applications. Review Chapter 7 for specific
information on essential oils to use in such treatments.

TABLE 61 Degrees of Hot and Cold in


Hydrotherapy
DEGREES OF HOT AND COLD
Neutral to Very Cold
Neutral

9098F

Warm

98100F

Cool

7090F

Hot

100104F

Cold

5670F

Very Hot

104110F

Very Cold

3256F

Too Hot (dont use)

110F and abovea

Some products such as paraffin (122 to 126F), Parafango (120 to


126F), therapeutic mud, and peat (115F) are applied at temperatures
above 110F. These products transfer the heat slowly to the body area
and do not burn the client.

foot bath, the peripheral blood vessels dilate, and the client
begins to perspire. The blood flow to the area where hydrotherapy is applied increases significantly and flushes the tissue. The heart rate, pulse rate, respiratory rate, and overall
rate of metabolism rise, which increases the consumption
of oxygen in the tissues. The rise in core body temperature creates an artificial fever, which, in turn, stimulates
the immune system and causes the bodys white blood cell
count to increase, inhibiting the growth of some bacteria
and viruses. The higher blood flow to the area relaxes muscles, reduces muscular spasm, increases the extensibility of
collagen, melts the superficial fascia, increases the range
of motion in joints, reduces pain, and is generally relaxing.
Effects of Cold
The physiological responses of the body in reaction to cold
result from the bodys attempt to prevent a decrease in body
temperature. Like heat, brief applications stimulate the
body, whereas applications of longer duration sedate the
body. The use of external applications of cold for therapeutic purposes is sometimes referred to as cryotherapy.

TABLE 62 Effects of Heat and Cold


OVERVIEW OF THE EFFECTS OF HEAT AND COLD

Effects from Specific Temperatures


Different reflexive and physiological effects depend on the
temperature of the water applied to the body. Table 61 provides an overview of common water temperatures used in
hydrotherapy, whereas Table 62 summarizes the effects of
hot and cold temperatures. Hot, cold, neutral, and contrasting temperatures are used in hydrotherapy applications.
Effects of Heat
The physiological responses of the body to heat result from
the bodys attempt to prevent a rise in body temperature.
Brief applications stimulate the body, whereas applications
of longer duration sedate the body. The use of external
applications of heat for therapeutic purposes is sometimes
referred to as thermotherapy.
When heat is applied to a client with a full immersion
bath, steam bath, sauna, hot pack, or partial bath such as a

Williams_2E_CH06_printer_file.indd 116

Warm to Very Hot

Hot

Cold

Perspiration
Increased local blood flow
Tissue will flush
Increased heart rate
Increased pulse rate
Increased metabolism
Increased oxygen consumption
in body tissues
Increased white blood cell count
Stimulates immune system
Relaxes muscles
Decreased muscle spasm
Increased range of motion
Decreased pain
Short applications stimulate
Long applications sedate

Decreased local blood flow


Decreased tissue metabolism
Decreased edema
Increased numbing
Decreased pain
Initial increase in respiratory
rate
Initial increase in heart rate
Initial increase in blood
pressure
Respiratory rate, heart
rate, and blood pressure
gradually drop
Increased muscle tone
Short applications stimulate
Long applications sedate

10/24/13 1:17 AM

Chapter 6 Water Therapies

117

Cold penetrates more deeply into the tissues than heat


because vasoconstriction causes a decrease in local circulation and tissue metabolism. There is also a decrease in leukocytic migration through the capillary walls, which aids in the
reduction of edema and pain. Initially, there is an increase in
respiratory rate, heart rate, blood pressure, and muscle tone.
These gradually drop if the application of cold is prolonged.
The reduction of nerve conduction velocity leads to a numbing effect that significantly reduces pain. If the cold persists,
vasodilatation and circulation are briefly stimulated.
Clients often have difficulty with cold applications and
pass through distinct stages that might feel uncomfortable.
The first stage is a sensation of cold that progresses to a feeling of itchiness or tingling. As the cold continues, the tissue
feels as if it is aching and burning. Eventually, numbness
replaces the uncomfortable feelings, and the client relaxes
toward the later stages of the treatment.

hydrotherapy treatments were explained. This section of this


chapter discusses how to clean and sanitize hydrotherapy
equipment, how to recognize contraindications and adapt
sessions to ensure client safety, and how to apply common
hydrotherapy treatments.

Effects of Neutral Temperatures


Neutral applications are administered at or close to normal
body temperature and produce a tonic and balancing effect
in most clients. These types of applications are used to soothe
the nervous system and can be an effective treatment for
insomnia, nervous irritability, anxiety, or depression. Neutral
applications are sometimes used at the beginning or end of
a hot or cold application to help the body ease into or out of
more extreme temperatures. The use of external applications
for therapeutic purposes at temperatures close to the bodys
normal temperature is sometimes called neutrotherapy.

In Chapter 3 (Client and Therapist Safety), you learned how to


prevent the transmission of disease by properly cleaning and
sanitizing the treatment room and paying attention to your
own hygiene and hand washing habits. Hydrotherapy equipment often requires rigorous cleaning and sanitation between
treatments. Showers, tubs, steam rooms, wet tables, and
soaking basins must be cleaned, sanitized, and dried between
clients. Soaking basins without jets are simply washed with
hot, soapy water; dried; sprayed with alcohol; and left to air
dry. If the soaking basin has jets, it must be flushed with an
approved disinfectant. Modern hydrotherapy tubs usually
come with a self-cleaning function that makes sanitizing the
tub jets easier. You put a concentrated disinfectant (formulated by the manufacturer of the tub) into a special holder
and then push a button. At the end of the cleaning cycle, you
simply dry the tub. Small, one-person steam cabinets should
be completely wiped out with an antiseptic between clients.
For larger steam rooms or steam showers, the floor and seats
should be sanitized between clients, but the walls can be left
until the end of the day. The floor and walls around hydrotherapy equipment must also be cleaned with an approved
disinfectant and dried after each use. Pay particular attention
to handrails and door handles (e.g., the handle of the steam
cabinet). Bath mats, bath towels, robes, washable slippers,
and hand towels are changed between clients.
Clients should shower before entering hydrotherapy
treatment pools to decrease the spread of waterborne infections. The clients hair should be secured or covered with a
cap before using hydrotherapy equipment including tubs,
steam rooms, wet tables, or showers. In the event of body
fluid spills (e.g., the client suddenly gets sick and vomits on the wet table), follow the procedures for Universal
Precautions outlined in Chapter 3.

Effects of Contrasting Temperatures


Contrasting applications involve applying a heat application and then a cold application to the same body area in an
alternating sequence. This creates a vascular flush in which
the tissues are pumped free of metabolic waste buildup
due to the alternating vasoconstriction and vasodilatation
of the peripheral blood vessels. Often, the treatment uses a
pattern of 3 minutes of heat to 1 minute of cold for three
rounds. The treatment always ends with a cold application to prevent congestion in the local tissue. Sometimes,
a longer rotation is used with a ratio of 10 to 15 minutes
for the hot application followed by 10 to 15 minutes of
a cold application. Again, the treatment ends with a cold
application. When using packs to apply heat and cold, it
works well to place a cold pack on the area of injury and a
hot pack proximal to the injury site close to the cold pack.
This relaxes the client and makes it easier to tolerate the
cold pack. Contrasting applications are used with immersion baths, partial baths, showers, and packs.

Hydrotherapy Applications
Earlier in the chapter, you learned about the history of
hydrotherapy and the characteristics of water that make it
therapeutically beneficial. Next, the changes that occur on
both a physiological and psychological level as a result of

Williams_2E_CH06_printer_file.indd 117

General Treatment Considerations


Before you can offer hydrotherapy treatments, you will
want to understand these general considerations that
ensure your clients health and safety. Areas that require
particular attention include the sanitation of hydrotherapy
equipment and protocols that reduce the transmission of
germs and disease, safety issues, and cautions and contraindications to hydrotherapy services.
Cleanliness and Sanitation Guidelines for
Hydrotherapy Equipment

Safety Guidelines
Specific safety issues must be considered before you offer
hydrotherapy treatments:
Equipment: Check hydrotherapy equipment regularly
to ensure it is working properly. Maintain the equipment

10/24/13 1:17 AM

118

Spa Bodywork: A Guide for Massage Therapists

according to the manufacturers recommendations.


Dont allow bare electrical cords in wet rooms or any
areas where they might be exposed to water. Identify hot
equipment with a sign so that clients dont inadvertently
touch it. For example, the outside of a hydrocollator can
get very hot, and the heating units for saunas should be
surrounded with a grate.
Health history intake: Hydrotherapy applications
cause profound physiological changes in clients bodies.
Do not provide any hydrotherapy applications until you
have conducted a thorough health history intake process,
identified cautions, and ruled out contraindications.
Preparation: Install handrails around showers, wet
tables, and hydrotherapy tubs to ensure clients have
something solid to hold on to when they get into, out of,
or onto and off hydrotherapy equipment. Invest in robes
and disposable or washable slippers so that clients can
move about in warmth and comfort. Dont allow clients
to walk around the facility barefoot. Foot funguses can
be spread in this manner, and the client is more likely to
slip on a tile floor and sustain an injury.
Water spills: Water is often sloshed about during a
hydrotherapy treatment. For example, the area around
a wet table usually gets wet and slippery. Before allowing
clients to exit hydrotherapy equipment, take a moment
and dry the floor with a hand towel.
Oils and lotions: Clients who have had a massage or
who arrive at the clinic or spa covered in body lotion,
cream, or body oil should shower before using hydrotherapy tubs, saunas, pools, or steam rooms. The oil or
heavy cream can block perspiration and make it more
difficult for the body to detoxify. Clients are more likely
to slip when getting into and out of hydrotherapy equipment when covered in lubricants. Lotions and oils might
interact with a treatment product (such as mud, seaweed, essential oils) and decrease the effectiveness of the
session, or the client might leave a sticky residue on seats
and equipment making cleanup more difficult.
Prevent chills: Clients who are wet and exit either cold or
hot treatments may suddenly become chilled. As clients exit
hydrotherapy tubs, wet tables, steam rooms, and saunas,
wrap them in towels or a robe and get them entirely dried
off as soon as possible. Pay attention to the temperature of
treatment rooms and the facility so that clients stay warm.
Cold clients never respond well to cold treatments:
If a client is cold, dont put him or her into a cold treatment (e.g., cold plunge) or apply a cold application.
Warm the client before applying cold.
Dizziness and low blood sugar: Clients sometimes feel
a slight dizziness at the conclusion of the session, or low
blood sugar may cause shakiness. Make sure clients stay
hydrated during sessions by offering them water at regular intervals. Have packaged food items such as fitness
bars on hand in cases of shakiness. Educate clients not
to eat a heavy meal before a hydrotherapy session.
Temperatures: Use a thermometer to check the water
temperature in hydrotherapy tubs and permanently

Williams_2E_CH06_printer_file.indd 118

mounted temperature gauges to monitor the temperature


in saunas and steam rooms. Never rely on how hot or
cold an application feels to you. Use a thermometer to
ensure you are working at the correct temperatures.
Timers: In some situations, the client should receive a
particular type of treatment only for a fixed amount of
time. Use timers with alarms to monitor the clients session time. If you rely on a clock, you may forget to check
the start time and leave a client in an application for too
long, endangering his or her health.
Cautions and Contraindications
When used properly, hydrotherapy is safe for most clients.
Like massage, hydrotherapy treatments can be contraindicated completely, contraindicated without a physicians
release, contraindicated at a particular location on the
clients body, or require adaptive measures and increased
therapist vigilance. For example, in many full-body hydrotherapy treatments such as immersion in a hot bath, you
can decrease the cardiovascular load on the client by using
warm and cool applications rather than hot and cold ones.
The closer the temperature of the application to the clients
body temperature, the less intense the response will be.
In general, hydrotherapy is contraindicated for individuals who have serious heart, circulatory, nervous system, or
systemic conditions. Open wounds and skin rashes are also
contraindicated when using extremes of hot or cold. The
length of time that the client is exposed to the treatment
depends on the clients overall state of health and vitality.
Children, those in a weakened condition, the elderly, and
those with mental challenges may be contraindicated for
full-body treatments such as saunas, steam rooms, and
immersion baths. Children have thinner skin and become
overheated or chilled more easily than adults. Elderly clients have less subcutaneous adipose tissue and may be
burned by topical hot applications or chilled more easily
as a result. Blood vessels may not function efficiently, such
that repeated cycles of vasodilatation and vasoconstriction
may place a heavy burden on the circulatory system.
If the client seems healthy enough to benefit from such
treatments, or if treatments are conducted under the supervision or direction of a physician, start slowly. Begin with
10-minute sessions and progress up to 15-minute sessions.
Healthy individuals can remain in saunas, steam rooms,
and baths for 20 to 30 minutes. Very cold applications
longer than 20 minutes are not recommended for any client because of the risk for tissue damage, frostbite, or even
hypothermia. A client who is already cold will not benefit
from a cold treatment.
If a client feels light-headed, nauseous, headachy, or dizzy,
stop the treatment and monitor him or her while he or she
is relaxing in a quiet environment at a normal temperature
with a glass of water. If the clients symptoms increase or persist, consult a physician. If symptoms increase rapidly, contact emergency services because the client might be in danger.
Specific cautions and contraindications for hydrotherapy
applications are outlined in Table 63.

10/24/13 1:17 AM

Chapter 6 Water Therapies

119

TABLE 63 Cautions and Contraindications for Hydrotherapy


Acute inflammation

Warm and hot applications can increase swelling in injured tissue and thus are contraindicated. Cold applications are indicated.

Allergies

Check for allergies to any substances you dissolve into the water for the session. Allergies to iodine and shellfish indicate an allergy
to seaweed or products containing seaweed. Clients might also be allergic to herbs or essential oils, although this is rare.

Artificial devices

Hot or cold applications should not be applied over pacemakers, defibrillators, medication pumps, implants, or artificial devices.
Hot and cold applications may be indicated for use with hip and knee replacements.

Asthma

Avoid the use of cold applications on clients who have asthma. Ensure that clients with asthma do not get chilled or walk from a
hot environment such as a sauna to a very cool or cold environment such as an air-conditioned hallway. Movement from very
warm to cool environments can trigger asthma attacks.

Athletes

Athletes tend to have very low body fat and may be easily burned by topical hot applications or chilled by cold applications.
Use caution and monitor athletes carefully during sessions.

Autoimmune
conditions

Autoimmune conditions can flare up, causing contraindications for hydrotherapy applications, or a hydrotherapy application
might trigger a flare-up. Ask for a physicians release before providing hydrotherapy.

Cancer

Some types of cancer and cancer treatments cause the client to experience a condition that would not indicate hydrotherapy.
In other cases, hydrotherapy may prove beneficial. Discuss the particular treatment with the clients physician and obtain a
physicians release before providing hydrotherapy treatments.

Children

Children have thinner skin and become overheated or chilled more easily than adults. Avoid the use of extreme temperatures with
children, shorten applications, and monitor children closely. Dont apply hydrotherapy applications to infants or very young
children except under the guidance of a physician.

Decreased ability
to sense hot
and cold

Some pathologies and conditions including arteriosclerosis, nerve injuries, diabetes, spinal cord injuries, neuropathy, and multiple sclerosis decrease the clients ability to determine if something is too hot or too cold. In many situations, the extremities
are site-contraindicated, or you can choose warm and cool as opposed to hot and cold temperatures.

Diabetes

Diabetes can lead to cardiovascular diseases and affect the blood vessels in the legs and feet, depending on the way in which
the condition has been managed and its severity. Consult with the clients physician to determine if hydrotherapy applications
are contraindicated, site-contraindicated, or require adaptations. Obtain a physicians release before providing hydrotherapy.

Heart disease

Clients with heart disease such as coronary artery disease or congestive heart failure are likely to be contraindicated for hot
full-body treatments such as sauna and steam room use or baths. Medications may alter the way the heart functions, contraindicating cold applications. Consult with the clients physician and obtain a physicians release.

History of stroke

Clients with a history of stroke are contraindicated for full-body hydrotherapy such as saunas, baths, and steam rooms. Local, moderate applications such as a warm pack are likely to be safe. Consult with the clients physician and obtain a physicians release.

HIV/AIDS

The suitability of hydrotherapy applications for clients with HIV/AIDS depends on the condition of the individual. Consult with the
clients physician and obtain a physicians release.

Hypersensitivity to
hot or cold

Usually, treatments can be modified to temperatures that are warm and cool if the client has a hypersensitivity to hot or cold.
Hydrotherapy treatments should not be unpleasant, and you can adjust temperatures to suit the clients preferences.

Hypertension

At the beginning of both hot and cold full-body hydrotherapy applications, there is an initial spike in blood pressure that may
be dangerous for some clients. Additionally, clients are likely to be on medications that affect the way in which they respond
to hydrotherapy. Modify temperatures to warm and cool, consult with the clients physician, and obtain a physicians release
before providing hydrotherapy.

Hypotension

Hot or cold full-body hydrotherapy applications may cause fainting in clients with hypotension. Modify temperatures to warm and
cool, consult with the clients physician, and obtain a physicians release before providing hydrotherapy.

Lymphedema

Hot applications are contraindicated. Neutral and cold applications may be indicated, depending on the condition of the individual
client. For example, exercise in pools close to normal body temperature can be helpful. Consult with the clients physician and
obtain a physicians release before providing hydrotherapy.

Medications

Clients on various prescription medications may respond adversely to hydrotherapy applications. Consult with the clients physician and
obtain a physicians release before providing hot or cold full-body hydrotherapy (local applications are usually not contraindicated).

Mental conditions

Hot or cold full-body hydrotherapy applications should be provided to clients with mental conditions only under the direction of a
physician.

Multiple sclerosis

Hot applications can increase symptoms in people living with multiple sclerosis and are therefore contraindicated. Neutral and
cool applications are indicated.

Obesity

Because of the load on the cardiovascular system and because of the way in which adipose tissue holds heat and cold, extreme
hot or cold applications are contraindicated. Warm and cool applications are more appropriate. If the clients condition is weakened, consult with a physician and obtain a physicians release before providing hydrotherapy.

Osteoarthritis

In some cases, cold applications have caused an increase in symptoms in clients with osteoarthritis. Use cool applications or use
short applications of cold and monitor the clients responses carefully. Warm to hot applications are generally indicated.

Phlebitis

Hydrotherapy is contraindicated except under the direction and supervision of a physician.


(continued on page 120)

Williams_2E_CH06_printer_file.indd 119

10/24/13 1:17 AM

120

Spa Bodywork: A Guide for Massage Therapists

TABLE 63 Cautions and Contraindications for Hydrotherapy (continued)


Poor kidney
function

Cold applications are contraindicated.

Pregnancy

Hot full-body applications including baths, showers, saunas, and steams are contraindicated. Hot local applications to the
abdominal region are contraindicated. Cool or warm applications are usually not contraindicated, but it is best to consult with
the clients physician and obtain a physicians release.

Raynauds
syndrome

Cold applications are contraindicated.

Rheumatoid
arthritis

Hot and cold full-body applications are contraindicated. Warm local applications are contraindicated. Neutral and cool local
applications are safe.

Seizure disorders

Hot or cold full-body applications are contraindicated.

Skin conditions

Burns including sunburn, open wounds, rashes, and skin infections are contraindications for both full-body and local hydrotherapy applications. Because some skin conditions benefit from hydrotherapy, you should consult with the clients physician and
obtain a physicians release if the condition is pronounced or covers a large body area.

The elderly

Elderly clients are more likely to have less adipose tissue and prone to burns or chills from hydrotherapy applications. The heart and
circulatory system may not be strong enough to cope with the cardiovascular load caused by full-body applications. If the client
seems healthy enough to benefit from hydrotherapy, consult with the physician and obtain a physicians release.

Thyroid disorders

Regular hot or cold full-body applications are contraindicated for clients with thyroid disorders. Local applications are generally safe.

Varicose veins

Varicose veins are site contraindications for hot and cold packs. If the client has severe varicose veins, full-body applications such as
hot or cold baths may be contraindicated. Consult with a physician if you are unsure about the correct way to proceed with the client.

Hydrotherapy Applications
Common methods of application include hot, warm, or cold
packs, local applications such as ice massage and mustard
plasters, therapeutic showers and immersion baths, hot air
baths, friction treatments, and specialized body wraps. In
a wellness setting, hydrotherapy is most often used to relax
the client, revitalize the body, or remove a treatment product such as mud or seaweed. In medical spas, certain types
of wellness centers, many European spas, massage clinics,
and private massage practices, hydrotherapy applications
might not only be used for relaxation but also for condition
management or injury rehabilitation.
Hydrotherapy Packs and Compresses
Pack is a general term for any local hydrotherapy treatment
(hot, warm, cool, or cold) that uses a gel pack, hydrocollator
pack, fomentation pack (moist heat), or commercially made
chemical pack. Some packs are electric, some are heated
in the microwave, some are chilled in a freezer, and some
require specialized equipment. Probably the most effective
hot pack is the hydrocollator pack shown in Figure 61.
This type of pack has a canvas casing filled with either silicon granules or clay particles that can hold moist heat for
up to 30 minutes. These packs are submerged in water kept
at 65F in a specialized heating unit called a hydrocollator. Hot and warm packs are most often used to relax tense
muscles, keep the client warm and comfortable, or soften
tissue before massage is performed.
To apply a hot pack, remove the pack from the hydrocollator using tongs or thermal gloves and wrap it in a minimum of four to six layers of thick towels. Place the bundle
on the area to be treated for up to 20 minutes. Monitor the

Williams_2E_CH06_printer_file.indd 120

FIGURE 61 Hot pack. To apply a hot pack, remove the pack from the
hydrocollator using tongs or thermal gloves and wrap it in a minimum of
four to six layers of thick towels.

10/24/13 1:17 AM

Chapter 6 Water Therapies

FIGURE 62 Cold packs. Gel-filled commercial packs or homemade ice


packs can be used effectively as cold packs

pack constantly by lifting it every 5 minutes to check the


skin for extreme redness so that it does not burn the client.
Clients should never lie on top of hydrocollator packs.
Gel-filled commercial packs or homemade ice packs can
be used effectively as cold packs (Fig. 62). In fact, large
bags of frozen peas make an effective cold pack because the
small size of the peas feels lighter on an injury site than ice
in a plastic ziplock bag or large ice cubes. Gel-filled packs
are also useful because they dont freeze in a solid block and
can be shaped to fit a body area. Cold packs are an effective
treatment for acute inflammation or after a massage treatment using friction techniques. Apply cold packs on top of
a thin layer of insulation (rather than the thick layer used
with a hot pack) for up to 20 minutes.
Compresses are wet cloths soaked in warm, hot, cool,
or cold water (sometimes with additives dissolved in the
water) and wrung out before they are applied to the skin.
Compresses are used to provide comfort or enhance the
enjoyment of a session. A cool compress might be placed
over a clients forehead while he or she is wrapped in a detoxification wrap. Alternately, a warm compress might
be applied to the back of the neck, whereas a cold pack is
placed on a shoulder injury. The compress helps the client
deal more easily with the cold of the cold pack.
Local Applications
You might use a variety of local hydrotherapy applications
for condition management or injury treatments. Ice massage, mustard plasters, castor oil packs, and paraffin dips
are popular.
Ice massage is massage provided with ice. A paper cup is
filled with water and frozen. The edges of the cup are then

Williams_2E_CH06_printer_file.indd 121

121

peeled away while the base of the cup is left intact. Hold on
to the base of the cup while applying the ice to the affected
area in a circular motion. Ice massage of an area can last
up to 20 minutes and is used to reduce inflammation during the acute inflammatory stage or to cool tissue after using intensive heat-producing techniques such as friction.
The term plaster refers to herbal pastes (herbs mixed with
either water or oil) that are spread on a particular body area
or onto a piece of cloth that is then applied to a particular
body region. Mustard plasters are warming and useful for
the treatment of osteoarthritis, poor circulation, back stiffness, joint stiffness, and general muscular aches and pains.
To make a mustard plaster, mix 1 tbsp of mustard seed
powder and 4 tbsp of wheat flour with warm water until
you have a paste of medium consistency. Spread the paste
onto a muslin or cotton cloth and place it over the region
being treated. Because a mustard plaster gets hot and can
even blister the skin, monitor it constantly. Cover the plaster with a warm pack to increase the therapeutic benefits of
the application. Mustard plasters can irritate sensitive skin.
Castor oil packs and castor oil applications have been
used in both European folk medicine and ayurvedic medicine (the traditional medical system of India) for centuries
to increase blood and lymph circulation, relax tight muscles,
reduce pain, ease joint stiffness, and break down scar tissue.
Castor oil is extracted from castor beans and is high in the
fatty acid ricinoleic acid. It is believed to support natural detoxification in the body. Apply castor oil to the affected area
in a thick layer and cover it with plastic wrap. Place a hand
towel and an electric heating pack over the top of the plastic.
The castor oil pack can be left in place for 30 to 45 minutes.
As you learned earlier, paraffin is a waxy substance
obtained from the distillates of wood, coal, petroleum, or
shale oil. It is used to coat the skin and trap heat and moisture at the skins surface. This increases circulation and
softens the local tissue, which improves joint mobility and
decreases pain. A paraffin dip is an effective treatment for
chronic arthritis, tight muscles, and painful joints. It also
leaves the skin soft, and it feels warm and sumptuous. To
apply paraffin to the hands or feet, first wash the area to be
dipped or mist the area with alcohol so that it is properly
sanitized. Dip the hand or foot into the paraffin and allow
the paraffin to harden slightly before dipping the area again.
Dipping up to five times should be sufficient. Wrap the paraffin-covered hand or foot in cellophane wrap or a plastic
bag before placing it into a heated mitt or a warm towel.
To remove the paraffin, simply peel off the cellophane wrap
together with the wax all in one piece. The hands can be
dipped while the client is on the table in the prone or semireclined position. The feet can be dipped while the client is
on the table in the supine position.
Therapeutic Baths
Therapeutic baths (sometimes called balneotherapy) encompass a range of different hydrotherapy methods including foot baths, whirlpool baths, steam baths, saunas, full
immersion baths, partial baths, and sitz baths (Table 64).

10/24/13 1:17 AM

122

Spa Bodywork: A Guide for Massage Therapists

TABLE 64 Therapeutic Baths


BATH TYPE

LOCATION

TEMPERATURE

TIME

Partial

Feet

Warm to hot
(98110F)

1020 minutes

Cold feet, menstrual cramps, arthritis, gout, migraine headache,


insomnia, sinus congestion, relaxation, to warm a chilled client, to warm a client in preparation for a detoxification treatment

Cool to cold
(9855F)

115 minutes

To revitalize and stimulate the body, to cool the body, to reduce


inflammation from an injury to the feet or lower legs

Contrasting hot
(110115F)
with cold (50F)

2 minutes hot/
1 minute cold/
3 rounds and
end with cold

Poor circulation, repair stage in the inflammatory process for


a lower leg injury such as an ankle sprain, to revitalize and
stimulate the body

Warm to hot
(98110F)

1020 minutes

Cold hands, arthritis, hand fatigue, hand or arm injury in the


maturation stage of inflammation

Cool to cold
(9855F)

115 minutes

Inflammation from acute injury, hand fatigue

Contrasting hot
(110115F)
with cold (50F)

2 minutes hot/
1 minute cold/
3 rounds and
end with cold

Hand or wrist injury in the repair stage of the inflammatory


process, hand fatigue, arthritis

Hand

INDICATIONS

Paraffin dip

Feet or hands Hot (122126F)

1520 minutes

Hand, wrist, foot, or ankle soreness or stiffness; poor circulation;


to warm tissue and aid scar tissue reduction in the repair or
maturation stage of the inflammatory process for injury; hand or
foot fatigue; cold hands or feet

Full-body
immersions

Whole body

Warm to hot
(98110F)

520 minutes

To relax muscle tissue, soften fascia, and increase circulation; for


relaxation (warm); to decrease pain

Cool to cold
(9855F)

12 minutes

To stimulate and revitalize the body, to cool the body after a hot
treatment

Neutral (9498F)

1020 minutes

To reduce anxiety, insomnia, and depression; to provide gentle


revitalization

Epsom salt bath

Whole body

Warm (98104F)

1520 minutes

Sore and stiff muscles or joints, general fatigue, insomnia,


anxiety, general detoxification

Oatmeal bath

Whole body

Warm (98104F)

1520 minutes

Skin irritation, skin conditions, rashes, itchy skin, to soften


the skin

Baking soda bath

Whole body

Warm (98104F)

1520 minutes

Skin irritation, skin conditions, rashes, itchy skin, to soften


the skin

Sea salt bath

Whole body

Warm (98104F)

1520 minutes

General revitalization and detoxification, as part of the rehabilitation process for a soft tissue or bone injury

Mustard bath

Whole body

Warm (98104F)

1520 minutes

Sore and stiff muscles or joints, back pain, general detoxification

Herbal bath

Whole body

Warm (98104F)

1520 minutes

Effects depend on the herbs are used in the bath; skin soothing,
muscle soothing, revitalizing, and sedative herbs might be
chosen

Aromatherapy
bath

Whole body

Warm (98104F)

1520 minutes

Effects depend on the oils used in the bath; skin soothing, muscle
soothing, revitalizing, and sedative oils might be chosen

Thalassotherapy
bath (seaweed)

Whole body

Warm (98104F)

1520 minutes

To promote weight loss and detoxification, for general fatigue or


mental burnout, to stimulate circulation and firm skin, and to
revitalize the body

Fangotherapy
bath

Whole body

Warm (98104F)

1520 minutes

Sore and stiff muscles, joint pain, back pain, to soften and
condition skin

Steam bath

Whole body

104F with
100% humidity

520 minutes

To warm the body, for detoxification, to increase circulation, for


sore or stiff muscles, for joint stiffness or pain, for general relaxation, to unblock congested skin, for certain skin conditions

Sauna

Whole body

145200F with 6%
to 8% humidity

520 minutes

To warm the body, for detoxification, to increase circulation,


for sore or stiff muscles, for joint stiffness or pain, for general
relaxation, for certain skin conditions

Williams_2E_CH06_printer_file.indd 122

10/24/13 1:17 AM

Chapter 6 Water Therapies

123

Hydrotherapy tubs with multiple air and water jets are


designed for professional use and are used to apply full
immersion baths. Additives are often used with baths to
increase their therapeutic benefits.
Foot Baths
Foot baths ease foot fatigue or pain, cleanse the feet,
warm the body, and relax the client in preparation for
a massage or spa service (Fig. 63). Sometimes, they are
used therapeutically to draw fluids down toward the feet
as in a foot bath delivered to reduce sinus congestion.
Massage therapists often use foot baths as a complementary treat for the client while the client fills out paperwork before the session. Some clinics encourage clients
to arrive early and relax with a foot bath in a quiet room
where soothing music, a cup of warm herbal tea, and
dim lights to facilitate the process of releasing tension. A
therapist might start every massage with a 5-minute foot
bath while the clients neck and shoulders are massaged
in a seated position.
Prepare the foot bath by placing warm (not hot) water
in a soaking basin. One or two additives such as cup of
Epsom salt (for foot pain), cup of sea salt (energizing),
bubble bath (cleansing), herbal infusions (detoxifying),
3 drops of essential oil (properties based on the oil), or powered milk (relaxing) add to the experience. Place the basin in
front of a comfortable chair on top of a bath towel. A cup
of warm herbal tea on a side table is a nice touch. The client relaxes with the feet in the soak while you massage the
shoulders, neck, and scalp. It works well to have the client

FIGURE 63 Foot baths ease foot fatigue or pain, cleanse the feet,
warm the body, and relax the client in preparation for a massage or spa
treatment.

Williams_2E_CH06_printer_file.indd 123

FIGURE 64 Some therapists deliver the foot bath with the client
seated on the massage table. This way the client can simply lean back,
and the session can start.

change into a robe before the soak; otherwise, having to roll


up pant legs can be inconvenient and defeat the purpose of
the soak, which is to relax the client. At the conclusion of
the soak, ask the client to lift his or her feet from the basin.
Remove the basin and have the client place his or her wet
feet on the preset bath towel. Dry the clients feet by bringing the bath towel up and around the feet. Then move the
client to the massage table.
Some therapists deliver the soak with the client seated on
the massage table (Fig. 64). This way the client can simply
lean back, and the session can start. Notice that the client
wears a robe and that the drape is placed over the clients
lap. The client then removes the robe under the drape and
hands it to you.
Full-Body Baths
Full-body baths include whirlpool, steam, sauna, and full
immersion baths. Whirlpool baths contain turbines that
mix air with water. The agitated water is directed at specific
body areas so that soft tissues are manipulated by the force
of the water hitting the body.
Steam baths, steam showers, steam cabinets, and saunas
are considered hot air baths because the client is bathing
in water vapor. Steam baths use steam to facilitate perspiration and help the body to detoxify. Steam baths are often
applied before another treatment to warm and relax the
muscles or before the application of a particular product.
They are also used to clear the sinuses and respiratory congestion or to clear clogged and congested skin.
To prepare for a steam bath, the client should change
into a swimsuit or disposable undergarments for the session and take a shower to remove any oils or lotions from
the skin. Place a towel on the seat and floor of the steam
cabinet and close the door when the client sits down. Place
a towel around the clients neck to keep steam from escaping out the top of the cabinet. Set the timer for the session

10/24/13 1:17 AM

124

Spa Bodywork: A Guide for Massage Therapists

based on the clients health and treatment goals. At the end


of the session, offer the client water and wrap him or her
quickly in a robe or towel to prevent chilling.
A steam canopy fits over the top of a wet table or massage table and can be used in place of a blanket or thermal
space blanket for body wraps. Cover the massage table with
a plastic table protector and a large bath towel. With the client relaxing on the towel, lower the canopy into place. Wrap
a towel around the clients neck to prevent steam from
escaping out the top of the canopy and set the timer for the
session based on the clients health and treatment goals. At
the end of the session, cover the client in a robe or towels to
prevent chilling and offer a glass of water.
Saunas combine hot air (60 to 210F) with low humidity to stimulate metabolism, increase core body temperature, and facilitate detoxification (Fig. 65). They are
useful as a support treatment for a number of different
conditions. For example, people living with chronic fatigue
syndrome often experience debilitating feelings of fatigue,
musculoskeletal pain, and low-grade fever. One study
found that regular use of a sauna improved these symptoms significantly.17 The humidity in a sauna must not be
allowed to drop below 10%, or else, the hot air will start to
dry out the mucous membranes of the respiratory system.
Like a steam bath, a sauna can be used to preheat the body
in preparation for another treatment.
To prepare for a sauna, ask the client to change into a
swimsuit or disposable undergarments for the session and
to take a warm shower to remove any lotions or oils. Place
a bath towel on the sauna seat and have the client sit or recline on the towel. Set the timer for the session based on the
clients health and treatment goals. At the end of the session, the client can take a cool, warm, or graduated shower
to cool down. Wrap the client in a robe or towels to prevent
chilling and offer a glass of water.

FIGURE 65 Sauna. Saunas combine hot air (60 to 210F) with low
humidity to stimulate metabolism, increase core body temperature, and
facilitate detoxification.

Williams_2E_CH06_printer_file.indd 124

FIGURE 66 Full immersion baths use hot, warm, neutral, or cool


temperatures and pressure from water jets for therapeutic purposes.

Full immersion baths use hot, warm, neutral, or cool


temperatures and pressure from water jets for therapeutic purposes. Many treatments also use additives such as
seaweed, essential oils, or herbs to increase the therapeutic
value of the service or to achieve specific treatment goals
(Fig. 66).
To prepare for a session using a hydrotherapy tub, ask
the client to change into a swimming suit or disposable
undergarments for the bath. As you fill the tub, monitor
the temperature with a thermometer so that the bath is
hot, warm, neutral, cool, or cold, depending on your treatment goals. Help the client into the tub. If the application is hot, it is useful to have the client get into the tub
when it is half full of warm water and then fill the tub the
rest of the way with hot water to the desired temperature.
Place a towel behind the clients neck for support and set
the timer.
Professional hydrotherapy tubs have an underwater
massage hose that uses air pressure aimed at specific body
areas to improve circulation and lymph flow. Begin the
underwater massage by pointing the hose at the plantar
surface of the foot and work your way up and over the top
of the foot in small circles. Continue up the medial leg
and then return to the foot and repeat the process, this
time working up the lateral leg. Then direct the air flow
from the hose from the distal area of the body toward the
proximal area of the body. Work up the lateral leg and ask
the client to shift slightly to the side so that the gluteals
and back are treated. Treat both sides of the lower body
before moving to the upper body. Ask the client to lie low
enough in the water for the shoulders and neck to be treated; the hose will splash if it is not kept under the surface
of the water.
Partial Baths
Partial baths involve the submersion of body areas such as
the feet, legs, arms, or hands into baths of water heated to
specific temperatures. A sitz bath is a type of partial bath in

10/24/13 1:17 AM

Chapter 6 Water Therapies

which the patient sits in water that comes up to the navel


but no higher. Naturopathic doctors use it to treat reproductive or urinary disorders.
Therapeutic Showers
Chapter 5 (Foundation Skills for Spa Treatment Delivery) introduces the use of therapeutic showers for product
removal and demonstrates the use of a Swiss shower, Vichy
shower, handheld shower, and standard shower (Fig. 67).
Therapeutic showers use hot, warm, cool, or cold temperatures to facilitate desired physiological and reflex effects.
Often, they are used to warm the body in preparation for
another treatment or to cool the body at the end of a treatment. Swiss and Vichy showers have control panels with
which you can manage the temperature of the water. In
a standard home shower in which the client controls the
water temperature, the temperature will not be exact or provide the same benefits.
Hot showers (100 to 104F) are stimulating and pain
relieving. They might also be used to raise the core body
temperature of the client in preparation for another service
such as an herbal detoxification wrap. A hot shower begins
at 100F. As the client acclimates to the temperature, it is
gradually increased. A healthy client may tolerate very hot
temperatures up to 110F, but the temperature should not
exceed 110F. The hottest temperature that is safe and tolerable for the individual client is held for 2 minutes and
then decreased rapidly to a neutral temperature to end the
shower.

FIGURE 67 A Vichy shower is a therapeutic shower that rains water


onto the client from above a wet table.

Williams_2E_CH06_printer_file.indd 125

125

A graduated shower is used to cool the body after a prolonged heating treatment such as a steam bath or sauna.
The water temperature begins at 102F and is increased
quickly to the tolerance of the client. The elevated temperature is held for 2 minutes and then lowered at intervals.
Each interval is held for 1 to 3 minutes. The final ending
temperature is in the range of 80 to 85F. This temperature is held for 4 minutes to finish the shower.
Cold showers (56 to 70F) are stimulating and toning
for muscles and skin. They are often used to refresh the
body after the application of a treatment that heats the
body. They are short and used only on healthy individuals
with no contraindications.
Hot and cold contrast showers stimulate metabolism,
increase circulation, and revitalize the body. They are effective for fatigue, mental burnout, and low energy. Hot and
cold temperatures are reversed for three sets of one interval
each; the timing per interval ranges from 1 to 3 minutes.
The treatment ends on the cold water setting.
A Scotch hose directs a strong stream of water at the
client to increase circulation, stimulate function, tone muscles, decrease pain, and decrease congestion in a particular
body area. It is an effective treatment to use on areas that
are prone to poor circulation (Fig. 68).
Ask the client to change into a swimsuit and then stand
at the end of the wet room holding onto the handles attached to the wall. Direct the pressurized stream of water
over the clients body in the sequence as shown on this
diagram (Fig. 69). Start with a warm water temperature,
and graduate to hot for 1 minute. Then shift between
contrasting hot and cold temperatures. The pressure of
the hose can also be controlled based on the clients level
of comfort with the pressure. Avoiding the breasts and

FIGURE 68 Scotch hose. This is an image of the type of Scotch hose


used in a spa.

10/24/13 1:17 AM

126

Spa Bodywork: A Guide for Massage Therapists

FIGURE 610 Cold mitt friction. Cold mitt friction is still widely used
to prevent colds, boost immunity, increase circulation, increase endurance, and invigorate the body.

face, use long, smooth movements from the feet to the


shoulders.

table under a drape beginning in either the prone or supine


position. Place the terry mitts on your hands and dip them
into ice water. Rub him or her vigorously over the selected
body area with a back-and-forth motion. Then rub the area
dry with hand towels and drape the area just treated. Move
onto the next body area. Depending on the clients health
and the treatment goals, you may treat one body area or
many areas in a session. If the client is shivering and cold,
end the treatment.

Friction Treatments

Body Wraps and Wet Sheets

We will discuss salt glows, dry skin brushing, and loofah


scrubs in depth in Chapter 8 (Exfoliation Treatments). Each
of these treatments traces its origin back to the traditional
methods of Sebastian Kneipp. Kneipps classic frictions
were carefully chosen for each patient. Frictions could be
delivered soft and dry with the palms flat; covered in powder; buffed across the skin to warm and invigorate, or wet
and brisk, with water, vinegar, or rubbing alcohol mixed
with salt.
Cold mitt friction is still widely used to prevent colds,
boost immunity, increase circulation, increase endurance,
and invigorate the body (Fig. 610). To perform a cold mitt
friction treatment, ask the client to recline on a massage

Like frictions, body wraps, which we will discuss in depth in


Chapter 9 (Body Wraps), originated in Kneipp hydrotherapy. One of his most famous body wraps was the cold wet
sheet wrap. Kneipp believed that this treatment strengthened the patients body so that it could overcome a disease
or resist diseases. Kneipps patients lay on a cold wet sheet
or were covered with a cold wet sheet and then wrapped
in blankets for up to an hour.5 The patient would experience a vascular flush effect in which body temperature was
elevated so that the patient perspired. Kneipp used cold
wet sheet wraps successfully for menstrual cramps, digestive complaints, fever, weakness, lower back pain, and for
general revitalization.

Start

Start

FIGURE 69 Scotch hose application. Direct the pressurized stream


of water over the clients body in the sequence as shown on this diagram
when delivering a Scotch hose application.

Williams_2E_CH06_printer_file.indd 126

10/24/13 1:17 AM

Chapter 6 Water Therapies

127

SPA FUSION
INTEGRATION OF SKILLS
STUDY TIP: Fact Sheets
When you start to provide treatments with fixed
protocols, like many of the treatments that make up
hydrotherapy and spa work, it is helpful to develop
one-page fact sheets that outline pertinent information about the treatment (see the samples at the
back of this book). For example, write these headings equally spaced down one side of a blank page:
Indications, Cautions, Contraindications, Temperature Range, Time Frame, and Procedural Steps. Now
title the page with the name of the treatment, such
as Full Immersion Hot Bath, and write the key
information under each heading. Keep these fact
sheets in a binder. They are useful when preparing for an exam and may prove even more valuable
when you finish school and deliver the treatment at
a clinic or spa.

SPA INSPIRATION: Self-care with Hydrotherapy


Many of the hydrotherapy treatments you provide
clients at a spa or massage clinic you can try at home.
For example, get in the shower and gradually increase
the water temperature until it is as hot as you can
tolerate it safely for 2 minutes; then rapidly turn the
shower to cold for 1 minute. Repeat this cycle three
times and end with 1 minute of cold. Get out of the
shower and dry off briskly. How do you feel? You can
learn a lot by playing with different temperatures at
home and keeping track of your physiological and
psychological reactions in a journal. Remember to
check your own health history for contraindications
and check with your physician before experimenting
if you think any of the treatments might cause you to
experience adverse reactions.

ITS TRUE! Hydrotherapy Improves Physical


Performance for People with Osteoarthritis
Researchers studied 152 older persons with chronic
symptomatic hip or knee osteoarthritis to determine
if hydrotherapy or Tai Chi classes were more helpful
in managing their symptoms. Pain, physical function,
general health, psychological well-being, and physical
performance were assessed at 12 and 24 weeks in both
the hydrotherapy group and Tai Chi group. Although
both groups had improved scores, the hydrotherapy
group showed significantly greater improvement
at 12 weeks. Furthermore, the hydrotherapy group

continued to demonstrate improvements at 24 weeks,


whereas the Tai Chi group remained relatively the
same. Researchers noted that this difference probably
occurred because the hydrotherapy group had regular
session attendance, whereas 40% of the Tai Chi group
missed multiple classes.18

CHAPTER WRAP-UP
One predominant theme has ran throughout this
chapter: Most people like water. They like to swim
in it; they like to soak in it; they like to stand in it;
they like to have it sprayed on them; and they like
the moist, comforting warmth of a hot pack on their
shoulders, lower back, feet, and just about everywhere
else. Water generally conveys a sense of wellness and
health. It simply makes most people feel better. Think
about this as you enter your massage and spa career.
Whether you work in a clinic, a fancy spa, a chiropractors office, or a private practice and whether you
practice wellness massage and spa or health care massage and spa, many clients like waterand this gives
you a powerful way to boost the benefits your clients
receive from your sessions. Offer to apply a warm or
hot pack to a clients low back, even if they dont have
low back pain. Offer a foot soak to a client as he or she
fills out health intake forms, even if he or she doesnt
have sinus pressure or tired feet. Offer to place a cool
compress on a clients forehead on warm days. Offer
free paraffin dips to a client, even if he or she doesnt
have arthritis. Most people like water, and water is
good for people, and now you know how to use water
therapeutically.
REVIEW QUESTIONS
Multiple Choice
1. Hydrotherapy is best defined as:
a.
b.
c.
d.

The use of wet sheet wraps for healing


The use of hot temperatures for healing
The use of hydrocollator packs for healing
The use of water for healing

2. Hydrotherapy is traditionally used in three forms.


These are:
a.
b.
c.
d.

Solid, liquid, vapor


Vapor, syrup, herbal concoction
Ice, herbal rub, liquid
Steam bath, friction rub, ice
(continued on page 128)

Williams_2E_CH06_printer_file.indd 127

10/24/13 1:17 AM

128

Spa Bodywork: A Guide for Massage Therapists

SPA FUSION
INTEGRATION OF SKILLS (continued)
3. The polar bear plunge is a form of hydrotherapy. It
is best described by the word:
a.
b.
c.
d.

Thermotherapy
Cryotherapy
Neurotherapy
Aromatherapy

4. The hunting reaction could best be described as:


a. Never-ending vasoconstriction
b. Never-ending vasodilatation
c. Vasoconstriction of the heart with prolonged
applications of cold
d. Alternating cycles of vasoconstriction and vasodilatation with prolonged applications of cold
5. There are two types of effects that occur with
hydrotherapy applications. These are:
a.
b.
c.
d.

Cold and hot effects


Tonic and nontonic effects
Physiological and reflexive effects
Reflexive and psychosomatic effects

Williams_2E_CH06_printer_file.indd 128

Fill in the Blank


6. The greater the
differences between
the body and the water, the greater the physiological effect on the body.
7. The
of the application will influence the physiological effect on the body.
8. The
the body area treated, the
greater the physiological effect on the body.
9. A
effect occurs because of a nervous system response to the treatment.
10. Physiological effects occur with hydrotherapy
applications because the body is trying to
.
maintain

10/24/13 1:17 AM

7
Introduction to
Aromatherapy for Spa
Chapter Outline

K e y Te r m s

AromatherapyAn Art and Science


Essential Oils

Aromatherapy: The use of essential oils for healing.


Essential oils: Volatile plant oils extracted from certain aromatic
plants that have both physiological and psychological effects on the
human body.
Fixed oils: Vegetable oils that are nonvolatile such as sweet almond or
sunflower. Essential oils readily dissolve into fixed oils, so fixed oils are
often used as a carrier for essential oils.
Functional group: A reactive oxygen or nitrogen-containing unit of a
chemical compound (in an essential oil).
Learned-odor response: A response that occurs when an odor is paired
with a person, place, or thing, and a memory link is formed.
Limbic system: The oldest part of the brain where olfactory signals
activate smell-related responses.
Olfactory response: Olfaction is the sense of smell. An olfactory response
refers to the mental, emotional, or spiritual changes that may be
elicited by an aroma.
Oxidation: A reaction that occurs when the chemicals in essential oils
interact with the oxygen that is present in the air. This results in degradation of the oil.
Quenching: Process that occurs when the action of one compound in an
essential oil is suppressed by another compound, thereby making the
oil safer for use.
Synergy: When the whole is greater than the sum of its parts and those
parts are mutually enhancing.
Volatility: The rate at which a compound turns from a liquid to a gas at
room temperature (i.e., when it evaporates).

Safety Considerations
Pathways In and Out of the Body

The Physiological and Psychological Effects of


Essential Oils
Physiological Effects
Psychological Effects

Blending Essential Oils


Carrier Products
Essential Oil Concentrations
Synergy
Top, Middle, and Base Note Blending
Approach to Blending

Application Methods
Inhalations
Aromatic Exfoliations and Body Shampoos
Aromatherapy Massage
Aromatherapy Baths
Aromatherapy Wraps
Aroma Mists and Aura Mists
Support Lotions

S
SPA
FUSION
IINTEGRATION OF SKILLS
STUDY TIP: Botanical Flash Cards
CHAPTER WRAP-UP

129

Williams_2E_CH07_printer_file.indd 129

10/24/13 1:18 AM

130

Spa Bodywork: A Guide for Massage Therapists

Aromatherapy is both a complex area of study and a

AromatherapyAn Art and Science

simple enhancing technique that can be added to any spa

Looking at the many definitions of aromatherapy offered


by different authors, one that comes very close to describing
the reality of practice is that of Jade Shutes, president of
NAHA (20002004). She defines aromatherapy as follows:
Aromatherapy is the art and science of healing body, mind,
and spirit through essential oils.
Each client is unique, so an aromatherapist must reflect
on and synthesize numerous pieces of information when
determining the best form of essential oil support for a
client. This requires intuition, creativity, and the ability to
process information abstractly and then form it into a support plan. In other words, the practice of aromatherapy is
an art.
Aromatherapy is also a science. Essential oils are composed
of a complex mixture of chemical compounds, and the
skilled aromatherapist will select oils for a treatment based
on their known biological effects (Fig. 71). Understanding
the effects of different oils on the human body requires
rigorous study and careful observation over time. The
experienced practitioner will know that some compounds
can have negative effects on the human body under particular conditions, so understanding how to select and blend
different oils is both an art and a science.
Lastly, aromatherapy not only affects the body but also
the mind and the spirit. The psychological effect of essential
oils on the mind and spirit are based on the often powerful
emotions and memories elicited by an aroma.
Essential oils are regularly used for their relaxing effects and to ensure that the treatment area is clean and
healthy. It is important to point out that different types of
health care providers may use essential oils in quite different ways. Medical doctors in France can legally prescribe
essential oils to be taken internally for a specific pharmacological effect.2 This type of use is not often seen in a spa

service. The goal of this chapter is to provide an overview of


the topic and some guidance on safe and effective ways to use
essential oils in a spa for those without extensive training.
The National Association of Holistic Aromatherapy (NAHA)
suggests a formal course of study of no less than 230 hours
for professional therapists.1 A number of comprehensive
programs are described in the resources section at the
back of the book. Also at the back of the book is a chart
listing common names of essential oils with their botanical
names to help therapists order the correct oil indicated in
the text. In certain instances, the Latin names will be given
in the text to provide clarity. This is to prevent confusion
because sometimes the common name refers to more than
one botanical species, or very similar common names are
used for different species. For example, the common name
sage can cause problems. Common sage (Salvia officinalis) is
used differently than clary sage (Salvia sclarea) and Spanish
sage (Salvia lavandulifolia). Common sage contains up
to 42% thujone, a potentially dangerous ketone that is
contraindicated for the elderly, pregnant women, those
who are in a weakened condition, and children. Although
common sage is not dangerous when applied topically in
low concentration to healthy individuals, it does contain
methyl chavicol, which can cause skin irritation. Clary sage

Linalyl acetate (ester)


sedative

contains 75% esters, which support relaxation and stress


reduction and are safe for liberal use. Spanish sage contains
camphor and cineol, making it the best of the three oils for
respiratory support.

Limonene
(monoterpene)
antiviral

Clary sage

It is important to note that essential oils are not meant


to take the place of professional medical treatments and
should be used by massage therapists to provide general

1,8, cineole
(oxide)
expectorant

Caryophyllenal
(aldehyde)
anti-inflammatory

Linalool
(alcohol)
stimulant

support for their clients. Although blends can be created


that directly address the symptoms of many conditions,
therapists must always be careful not to make false claims
or go beyond their scope of practice.

Williams_2E_CH07_printer_file.indd 130

Camphor (ketone)
mucolytic
FIGURE 71 Essential oils are chemically complex. This diagram represents some of the chemical components that are found in clary sage and
their general properties.

10/24/13 1:18 AM

Chapter 7

setting. More often, the oils will be used by massage therapists, counselors or life coaches, and estheticians. Massage
therapists focus on topical applications of essential oils for
stress reduction, injury rehabilitation, detoxification, and
to help reduce chronic symptoms associated with an underlying soft tissue pathology. Psychologists, counselors,
and life coaches focus on inhalations of essential oils to reduce anxiety, facilitate emotional clearing, dissipate defensive relating, improve moods, or to associate a scent with a
positive experience for use as a resource in latter sessions.
Finally, estheticians will often use professional skin care
lines that incorporate essential oils as active ingredients to
increase the therapeutic benefits of skin care applications.
(e.g., Aveda, Decelor).
Aromatherapy can be viewed as the primary treatment
(e.g., aromatherapy massage, aromatherapy wrap) or as accent notes in treatments with a different focus (e.g., aroma
mists, cellulite cream, aromatic foot soak). All of these
uses enhance the spa experience. Figure 72 lists six easy
ways that aromatherapy can be added to any treatment,
whereas Figure 73 provides an overview of aromatherapy
treatments that are common in spas. As Susan Irvine writes
in The Mystery of Perfume, Scent passes under doors, seeps
through walls, crosses boundaries. It is the un-containable,
the symbol of being between one State and another.3

Essential Oils
Essential oils are complex mixtures of chemical compounds
that are found in aromatic plants. The compounds
contained in essential oils are mostly terpenes, a class of
chemical compound that is quite toxic to living plant
tissues, so they must be stored in specialized structures
such as glands, ducts, scales, and hairs (Fig. 74).
Most essential oil compounds are volatile to some degree,
depending on how many carbon atoms they have or, in other
words, their molecular size. Small molecules tend to be more
volatile than larger molecules. The term volatility refers to
the rate at which compounds turn from a liquid to a gas at
room temperature and evaporate.
The specialized structures storing essential oils can be
found in the leaves or needles, twig, bark, flowers, flower
buds, fruits, stems, roots, or, sometimes, as in the conifers,
all organs of the plant (Fig. 75). They are usually extracted
from fresh plant material using steam distillation, carbon
dioxide (CO2) hyperbolic production, solvent extraction, or
physical expression (Table 71). On average, most essential
oil species contain about 1% to 2% of their fresh weight in
essential oils. In some species of Eucalyptus, up to 10% of
the fresh weight of the leaves consists of essential oil (100 lb
of Eucalyptus leaves may yield up to 1 lb of oil). In rose and
jasmine, the essential oil is nearly all found in the petals,
so the yields are very low. For example, 60,000 whole rose
flowers produce about 1 fl oz (30 ml) of oil, a yield of about

Williams_2E_CH07_printer_file.indd 131

Introduction to Aromatherapy for Spa

131

0.05% of the fresh weight on average. It is no surprise then


that rose and jasmine are quite expensive, whereas Eucalyptus is inexpensive and readily available.
Many factors affect the chemical composition and therefore the therapeutic value of an essential oil. The chemical
composition can vary greatly, depending on climate, soil
conditions, air quality, and the variety or cultivar of the
plant being grown; the cultivation, harvesting, and extraction methods being used; the storage and transportation
conditions; and the age of the oil. No chemical compound
is likely to be present in any essential oil in exactly the same
proportion from 1 year to the next. The acceptable range
in the percentage of the main chemical constituents present in most commercial essential oils has been defined by
the International Organization for Standardization (ISO).
The purpose of the ISO standards is to describe the normal range of variability in the oil so that users can compare
samples with an agreed standard. Essential oils are costly to
produce, so they are often adulterated to increase the profit
margin of the grower or supplier.
Professional aromatherapists notice that the human
body responds differently to natural oils than to synthetic
oils. This is probably due to the relative chemical simplicity of synthetic oils compared to natural oils. A pure,
natural oil is so chemically complex that it is not economically viable to synthesize all of the compounds present in a
laboratory. Instead, only the most important aroma compounds are synthesized. Even the best synthetic oils used
in perfumery will seldom have more than about 30 chemical compounds compared to 100 to 400 or more present
in a natural oil. Although little is known about how the
chemical constituents interact with each other and thereby
affect the body, it is likely that both the trace compounds
as well as major constituents play a role in the overall
therapeutic action of the oil. Also, any quenching effects
due to the presence of particular compounds in an oil
could be compromised in oils that have been synthesized
or reconstructed from isolated components. Quenching
effects occur when the action of one compound (usually
negative) in an essential oil is suppressed by the presence
of another compound, making the oil safer to use in such
cases. For example, citral in a pure and isolated form is a
strong skin irritant, but when it is combined with the other
compounds in lemon oil, it is rarely irritating. (Lemon oil
contains approximately 5% citral and 95% other terpenes.)
The other terpenes present (particularly d-limonene and
-pinene) have a quenching effect on citral, so any side effects due to the presence of citral are minimized. Synthetic
oils often cause nausea, headache, skin sensitivities, and
emotional irritation. These symptoms are rarely, if ever,
seen when pure oils are used.
Lastly, there are companies that specialize in supplying therapeutic-grade essential oils for the aromatherapy
market and small suppliers who import oils based on
close relationships developed with producers. The oils
sold through such companies will be more expensive but

10/24/13 1:18 AM

132

Spa Bodywork: A Guide for Massage Therapists

D2

D1

FIGURE 72 Six easy ways to add aromatherapy to any treatment. (A) Diffuse oils in the treatment room.
When a client enters a clean and fragrant treatment room, the perception of the business and the treatment is
enhanced. Use light scents such as lemon, mandarin, or lavender and avoid heavy fragrances such as ylang ylang
or jasmine that some clients might dislike. (B) Steamy aromatic towels. Scent hot, moist towels with essential oils.
These towels can be used for product removal or as an accent before a step in the treatment (e.g., steamy rosemary
towel before the face massage). (C) Fragrant foot soaks. While the client fills in the health history form, its nice to
offer an aromatherapy foot bath. Foot soaks are warming and relaxing. (D1 and D2) Aromatherapy inhalations.
At the beginning of the treatment, place a drop of essential oils between your hands. Rub the hands together and
then hold them in an arc over the clients nose while he or she takes a deep breath. (E) Smell-scapes. Smell-scapes
are aroma landscapes that are created to fit the theme of the treatment. Essential oils are carefully chosen and
added to base product to treat the client to a unique olfactory experience. (F) Aroma mists. At any time during
a treatment, an aroma mist can be spritzed over the client to refresh the body and fill the treatment room with a
revitalizing fragrance.

Williams_2E_CH07_printer_file.indd 132

10/24/13 1:18 AM

Chapter 7

A1

A2
A2

E1

Introduction to Aromatherapy for Spa

133

E2

FIGURE 73 Overview of some common aromatherapy treatments. (A1 and A2) Aromatherapy consultation. In
a consultation, a blend of oils is created especially for a client. The blend can then be applied in numerous ways such
as in a bath or through massage. (B) Aromatherapy body shampoo. Essential oils are added to a foaming cleanser for
a revitalizing body shampoo. (C) Aromatherapy body polish. Essential oils might be added to a variety of granulated
exfoliation products for a fragrant body polish. (D) Aromatherapy massage. Essential oils are well known to balance
the central nervous system (CNS) and relax the body. A popular way to use essential oils is in a massage. (E1 and E2)
Aromatherapy body wrap. Essential oils can be used in numerous types of body wraps. For example, essential oils
might be added to melted shea butter and brushed on the body before it is wrapped. (continued)

Williams_2E_CH07_printer_file.indd 133

10/24/13 1:18 AM

134

Spa Bodywork: A Guide for Massage Therapists

FIGURE 73 (continued) (F) Aromatherapy baths. Essential oils can be added to hydrotherapy tubs or standard soaking tubs for therapeutic baths. Usually, the oils are mixed first into an emulsifier or carrier product to
prevent skin irritation or pooling of the oils. (G) Aromatic saunas. Essential oils are added to the water that
is used on the saunas heat source. Usually, respiratory support oils such as pine and eucalyptus are preferred.
(H) Aromatic steams. Essential oils can be used in steam rooms, steam cabinets, or under a steam canopy.
(I) Sunburn relief. Anti-inflammatory and skin soothing essential oils are added to aloe and brushed on the
skin to heal the tissue after it has been burned by the sun. (J) Spot application. Certain essential oils such as
German chamomile can be used at full strength for specific conditions such as carpal tunnel syndrome. Oils
from grapefruit, juniper berry, or thyme might be used as an application for cellulite. (K) Guided meditation
with aromas. Essential oils can be used during a guided meditation session or hypnotherapy session for their
psychological effects.

are much more attractive to professional aromatherapists.


Even with the best of intentions, it should be noted that
adulterated oils can sometimes be sold unknowingly by the
most knowledgeable and reputable suppliers. A number of
reputable suppliers who carry high-quality, therapeuticgrade essential oils can be found in the resources section at
the back of the book.
When oils are exposed to light, heat, and oxygen, their
chemical composition is altered (oxidation), and their therapeutic properties may change. To slow the rate of oxidation, keep the oils in dark bottles with as little air at the top
of the bottle as possible. Store them in a refrigerator and
replace them if they have not been used within a year. Citrus
oils oxidize more rapidly than other oils, so they should be
replaced every 6 months.

Williams_2E_CH07_printer_file.indd 134

Safety Considerations
When therapeutic-grade essential oils are used at low concentration (1% to 3% or 6 to18 drops to every fluid ounce
of carrier) and applied externally, negative reactions are
minimal. It is important for a therapist to understand the
potential undesirable effects that may occur if the oils are
used inappropriately or without understanding. It should
be emphasized that before using any oil, you should identify
any possible contraindications for use of the oil by checking
safety data sheets or reliable textbooks.
It is out of a massage therapists scope of practice to recommend the internal use of essential oils because all essential oils
are potentially toxic when taken internally, especially when
taken in doses that are larger than those used therapeutically

10/24/13 1:18 AM

Chapter 7

Introduction to Aromatherapy for Spa

135

FIGURE 75 Essential oil storage sites. Essential oils might be stored


in leaves, needles, twigs, resin tears, flowers, fruits, roots, bark, wood,
heartwood, zests, or the whole plant.

FIGURE 74 Essential oil storage structures. Magnification shows


essential oils storage in a trichome (hair) of basil (Ocimum basilicum).

by doctors. For this reason, oils must be kept out of the reach
of children and not used internally. Some oils contain chemical components that may cause liver or kidney irritation
when used for prolonged periods of time (even when they are
applied topically). The general rule of thumb is that an oil
should not be used continuously for longer than 2 weeks to
prevent sensitization of the kidneys, liver, or skin.
It is believed that most essential oil compounds are able
to pass through the placenta to the developing fetus. It is
also possible that certain essential oils may disrupt the
delicate hormonal balance of the body and cause unwanted
effects during pregnancy. With the exception of mandarin

TABLE 71 Methods of Extraction of Aromatic Materials


METHOD

DESCRIPTION

COMMENTS

Expression (essence or
essential oil)

Citrus fruit peels are subjected to lateral compression


(squeezing) or machine abrasion (puncturing or
grating) to extract the essence or essential oil from
the rind.

This method of extraction is used to obtain essential


oils from citrus fruits. Because no heat is used in the
process, the composition of the expressed oil is very
similar to that of the oil in the plant, and the smell is not
affected by high temperatures.

Steam distillation (essential


oil and hydrosol)

Steam is used to rupture the storage sites of volatile


essential oils. The oils vaporize in the steam and are
passed through a condenser, which cools the vapor so
that it becomes a liquid. The water (from the steam) and
the essential oils that have been condensed are separated. Some oils, such as rose oil, are slightly soluble in
water, so the infused water, known as a flower water or
hydrosol, is also sold as a valuable product.

Different plant species may require slightly different


distillation conditions. Sometimes the plant is placed in
the still directly after harvesting, sometimes it is left to
dry, sometimes it is placed on a grate above the water,
or sometimes it is mixed with the water. A variety of
methods are used.

Solvent extraction (concrete, Aromatic plant material is extracted by means of a


resinoid, and absolute)
hydrocarbon solvent. Solvent extraction yields either a
concrete or a resinoid, which is further processed with
pure alcohol to produce an absolute.

Solvent extraction is used with aromatic plants whose


delicate fragrance would be damaged by the heat used
in steam distillation. This includes jasmine, narcissus,
and violet. Some plants are offered as either an absolute
or an essential oil. Absolutes smell closer to the original
plant than essential oils.

Under high pressure, hypercritical (in a state between a


liquid, vapor, and gas) carbon dioxide is used as a
solvent to extract essential oils.

This is considered by many as an ideal form of extraction


because it happens at low temperature with no chemical
reactions between the solvent and aromatic substances.8

CO2 hyperbolic production


(CO2 oil)

Williams_2E_CH07_printer_file.indd 135

10/24/13 1:18 AM

136

Spa Bodywork: A Guide for Massage Therapists

Avoid tanning for


24 hours after the use
of phototoxic oils.

Use only therapeuticgrade essential oils.

Use oils at mild


concentrations to
avoid skin irritation.
Don't use known skin
irritants with heat.

Avoid the internal


use of essential oils
without advanced
training.

Best Practices
for Safe Essential Oil Use
Do not use essential
oils with pregnancy
without formal training
in aromatherapy.

Avoid the longterm use of any oil


or blend of oils.

Do not encourage
clients to use essential
oils internally.

Keep oils out of


the reach of children.

and lavender (used at 1% concentrations 6 drops/fl oz


of carrier), those without formal training in aromatherapy
should avoid the use of essential oils with pregnant clients.
The most likely undesirable effect that a spa therapist
will see when using essential oils is skin irritation or phototoxicity. Skin irritation is rare if the therapist is using
standard concentrations of 1% to 3% of therapeutic-grade
oils (irritation is more likely with synthetic oils). When large
amounts of certain oils are used topically, or when oils are

FIGURE 76 Best practices for safe


aromatherapy.

used with heat (e.g., stone massage, hot pack, hot sheet
wrap), irritation is more likely to occur.
The term phototoxicity refers to an increased sensitivity to
the sun. Oils containing compounds called coumarins and
furocoumarins increase the skins tendency to burn. Clients
should avoid suntanning and tanning booths for 24 hours after the application of these oils. Figure 76 lists some general
best practices for the safe use of essential oils. Table 72 lists
oils that should be avoided or used with caution.

TABLE 72 Essential Oils to Avoid or Use with Caution


ESSENTIAL OILS TO COMPLETELY AVOID
Bitter almond, boldo leaf, buchu, yellow camphor, brown camphor, sassafras, calamus, horseradish, mugwort, mustard, pennyroyal, rue, savin,
savory, tansy, thuja, wormseed, wormwood
ESSENTIAL OILS TO AVOID WITH PREGNANCY
Aniseed, basil, birch, wintergreen, cedarwood, clary sage, cypress, geranium, sweet fennel, jasmine, juniper berry, sweet marjoram, myrrh,
peppermint, rosemary, common sage, thyme, hyssop
ESSENTIAL OILS THAT ARE SKIN IRRITANTS
Ajowan, cinnamon bark, cinnamon leaf, sweet fennel, cassia, clove leaf, clove bud, costus, oregano, basil, fir needle, lemongrass, lemon verbena,
Melissa, peppermint, thyme
ESSENTIAL OILS TO AVOID WITH CLIENTS WHO HAVE HIGH BLOOD PRESSURE
Pine, hyssop, rosemary, common sage, thyme
ESSENTIAL OILS TO AVOID WITH CLIENTS WHO ARE TAKING HOMEOPATHIC REMEDIES
Rosemary, eucalyptus, peppermint
ESSENTIAL OILS TO AVOID WITH CLIENTS WHO HAVE EPILEPSY OR A HISTORY OF SEIZURE
Sweet fennel, bitter fennel, common sage, hyssop, basil
ESSENTIAL OILS TO AVOID WITH A HISTORY OF ESTROGEN-DEPENDENT CANCER
Aniseed, basil, birch, wintergreen, cedarwood, clary sage, cypress, geranium, sweet fennel, jasmine, juniper berry, sweet marjoram, myrrh, peppermint, rosemary, common sage, thyme, hyssop
ESSENTIAL OILS THAT ARE PHOTOTOXIC
Bergamot, lime, bitter orange, lemon, grapefruit, sweet orange, mandarin, ginger, angelica root

Williams_2E_CH07_printer_file.indd 136

10/24/13 1:18 AM

Chapter 7

Introduction to Aromatherapy for Spa

137

Pathways In and Out of the Body

Ingestion

Essential oils enter the body by absorption through the skin,


inhalation, and ingestion. They are eliminated through the
kidneys, through perspiration, and through exhalation.

Ingestion of essential oils is a form of treatment that is


mainly used by medical doctors in Europe. When an oil is
ingested, it is taken internally by placing 1 to 3 drops in
water, on a sugar cube, or in honey. Ingestion is not commonly used by anyone other than doctors because all of the
essential oil is rapidly absorbed by the body, making this a
potentially toxic and dangerous practice.

Absorption through the Skin


Compounds in essential oils that are absorbed through
the skin enter the capillary network of the bloodstream.
Although many aromatherapists take skin absorption for
granted, the research supporting this is not clear. A number of studies indicate that essential oils promote penetration of other substances through the skin.4 Some show that
certain compounds in essential oils pass through the skin,
whereas others do not.5
Absorption of essential oil compounds will be affected
by both the viscosity of the carrier product (thicker products slow the rate of absorption) and by the thickness of the
adipose layer in the skin, which varies from individual to
individual (the thicker the adipose layer, the slower the rate
of absorption is likely to be). The most permeable areas of
the body are the armpits, forehead, scalp, hands, feet, and
inguinal areas.
Inhalation
When an essential oil is inhaled, the scent triggers an
olfactory response, which will be discussed in the section
on the psychology of oils.
Inhaled essential oil molecules travel down the respiratory tract to the lungs, where they are either absorbed by
the mucous membrane lining of the respiratory tract or
are transferred to the blood circulating in the lungs at the
point of gaseous exchange between air and blood in the
alveoli and respiratory bronchioles. In the nose, where the
endothelium is thin, it is assumed that essential oil molecules reach local circulation in the brain fairly quickly and
easily.6

The Physiological and Psychological


Effects of Essential Oils
Aromatherapy has significant therapeutic potential because each essential oil has a unique combination of chemical compounds that interact with the bodys chemistry
and thereby affect specific organs, systems, or the body as
a whole (physiological effects). The inhalation of essential
oils also triggers an olfactory response that can lead to powerful mental and emotional behavioral changes (psychological effects).7 Holistic aromatherapy is concerned with both
the symptoms of a condition and its underlying causes.
Its aim is to address the body, mind, and spirit for mental,
emotional, and physical wellness.

Physiological Effects
Each essential oil has a set of potential therapeutic properties based on its chemical composition (Fig. 77). Sometimes, the properties of the individual compounds present
may seem to oppose each other. This is the case with lavender, which contains esters (generally sedative), and alcohols (generally stimulating). In fact, this check and balance
system of chemicals with opposing physiological effects allows essential oils to act in a balanced manner without side
effects.6

Aldehydes
Sedative
Anti-inflammatory
Antiviral
Alcohols
Stimulating

Oxides
Expectorants

Essential Oil
Chemistry
Esters
Antispasmodic
Balancing
Antifungal

FIGURE 77 Essential oil chemistry. Chemical


components in essential oils have therapeutic
effects on the body.

Williams_2E_CH07_printer_file.indd 137

Ketones
Cell regenerative
Mucolytic
Neurotoxic
Phenols
Strong antibacterial
Immune stimulating
Warming

10/24/13 1:18 AM

138

Spa Bodywork: A Guide for Massage Therapists

Therapists use oils with specific properties (actions) to


improve the functioning of a particular body system and
support health. For example, if the treatment aims to
decrease muscular tension and increase relaxation, oils that
are antispasmodic, pain relieving, warming, and sedative
will probably be chosen. Essential oils are often used in a
spa setting to treat the symptoms of mild lymphatic stasis.
These treatments can be focused on a cosmetic goal such as
the reduction of cellulite, or they can aim to boost immunity, facilitate natural detoxification processes, and support
general wellness. Lymph flow is hindered by a sedentary lifestyle or whenever a person sits or stands in one place for a
long period of time. When lymph flow is slow, excess fluid
may accumulate in the tissues and gradually overwhelm the
lymph nodes and liver. This metabolic buildup may lead to
infection and disease.
Citrus oils, such as lemon, grapefruit, and sweet orange,
and warming oils, such as clove, black pepper, and ginger,
are a good choice for lymph stimulation. Diuretics applied
topically, including sweet fennel, grapefruit, and juniper
berry, support elimination through the kidneys and increase the flow of urine. This accelerated elimination helps
to detoxify the body and reduce water retention. All of the
oils mentioned previously could be used in various ways to
support detoxification treatments such as slimming wraps
or herbal wraps. The oils may be applied to the body before
a warming soak, or they might be applied in a massage at
the end of the wrap. A blend of three to four of these oils
might be massaged into target areas to further stimulate
local circulation to the area.
A key benefit of using essential oils regularly is that they
kill many strains of pathogenic microorganisms. They either
destroy the pathogen or disrupt its life cycle so that it cannot
reproduce. Oils that kill pathogenic organisms are known as
antiseptics, antibacterials, antifungals, and antivirals. Certain essential oils also stimulate the production and activity
of white blood cells, which boosts immunity. This cytophylactic activity was noted by Gattefoss and Valnet and has
been observed by many other researchers.8,9 Phagocytosis,
the ability of white blood cells to ingest foreign bodies and
wastes, is increased by essential oils known as depuratives or
by the popular name of blood cleansers. Although a massage
clinic or therapists would not sell or market essential oils to
boost immunity because this would be out of their scope of
practice, they will likely notice that clients feel energized, rested, and revitalized by treatments that include essential oils.
Aromatherapy massage is a popular treatment at many
spas, and a wide variety of essential oils can be used in massage to achieve a broad spectrum of treatment goals. Often, essential oils are used for their pleasant aromas and to decrease
stress. Oils high in a functional group known as the esters
are usually effective antispasmodics. These oils, including Roman chamomile, clary sage, and petitgrain, are especially helpful in balancing the nervous system.10 Phenylpropane ethers
especially estragole, which is found in basilare thought to
stabilize an overactive sympathetic nervous system, whereas

Williams_2E_CH07_printer_file.indd 138

cypress, basil, and sweet marjoram are noted for skeletal


muscle spasm.6 Caution should be used with basil due to its
methyl chavicol content, which may cause skin irritation.
White birch (Betula alba), German and Roman chamomile, frankincense, wintergreen, clove, lavender, and mint
oils are all effective analgesics.11 White birch, yellow birch
(Betula alleghaniensis), sweet birch (Betula lenta), and wintergreen (Gaultheria procumbens) all contain a high percentage
(up to 98%) of methyl salicylate (an ester). Methyl salicylate is
the active ingredient used in pain rubs such as Bengay. These
oils would be effective in blends used in sports treatments
or to decrease general muscular soreness. They could also be
used in medical spas to decrease pain from a musculoskeletal
condition such as osteoarthritis or Osgood-Schlatter disease.
Mint oils contain menthol, which has been used traditionally for headache pain. It should be noted that peppermint oil should not be applied undiluted to the temples to
decrease headache pain. Used in this manner, it may cause
a burning sensation and skin irritation. However, it is very
effective for headaches when massaged, diluted in lotion or
oil, into the posterior neck and shoulders. Mint oils are often used in treatments that aim to refresh the body because
menthol increases peripheral circulation and affects cold
receptors in the skin, resulting in a cooling sensation.
Essential oils that support the respiratory system are effective when used in the steam room or sauna. In a study
by Eremenko et al.,12 96 patients suffering from chronic
bronchitis showed significant clearing of the airways as well
as reduced infection levels when inhaling vapors of camphor and menthol and particularly oils of eucalyptus and
peppermint. The oils improved the function of the lungs
and bronchi by reducing mucous congestion and dealing
with chest infections, colds, and influenza.12 When inhaling essential oils in steam, smaller doses are more effective
than large amounts of oils.13 Pine, rosemary, eucalyptus,
and thyme oil work well in both a sauna or steam room. Although a massage therapist at a spa will not focus on respiratory pathologies, a basic understanding of core respiratory oils will allow the therapist to support a clients overall
health and wellness. For example, floral oils would not be
used in a sauna or steam room because they may cause a
headache in a close, hot environment.
Oils with a high sesquiterpene content are likely to have
good anti-inflammatory properties. The most important
anti-inflammatory compounds in essential oils are chamazulene and -bisabolol (a sesquiterpene alcohol), both of
which are found in German chamomile and in Helichrysum.
The more effective compound of the two is -bisabolol,
which works mainly by inhibiting some of the enzymes involved in the inflammation response.2 Anti-inflammatory
oils will most often be used in a spa for skin irritations such
as sunburn. They can be used in a medical spa for soft tissue
pathologies such as carpal tunnel syndrome, plantar fasciitis, and tendonitis. Table 73 gives an overview of some of
the properties of essential oils and some of the treatments
they support.

10/24/13 1:18 AM

Chapter 7

Introduction to Aromatherapy for Spa

139

DEFINITION

SELECTED INDICATION

Alterative

An agent that corrects


disordered body
function and supports
balance in the body

Stress, for recent trauma


such as a car accident, as part of a
detoxification regime,
burnout, anxiety

Lavender, Melissa, geranium, fir, juniper


berry, petitgrain, lemongrass, valerian

Bath, body lotion, massage, as part


of any relaxation treatment, mist
inhalation, room scent, foot bath,
aromatherapy wrap, etc.

An agent that reduces


the sensation of pain

Soft tissue pain (use


analgesics that are
also anti-inflammatory
during acute injury)

Bay laurel, bay rum, bergamot,


birch, cajeput, German chamomile,
Roman chamomile, clove, coriander,
eucalyptus, fir, ginger, jasmine (mild),
lavender, lemongrass, sweet marjoram,
peppermint, nutmeg, black pepper,
rosemary, rosewood (mild), turmeric,
wintergreen

Local application for an area of pain,


massage, compress, muscle blends,
sports massage blends

Anti-depressant

An agent that helps to


alleviate depression

Depression, stress,
anxiety

Basil, bergamot, geranium, jasmine,


lavender, lemongrass, neroli, sweet
orange, patchouli, rose, rosewood,
clary sage, Spanish sage, sandalwood,
vanilla, ylang ylang

Massage, bath, mist, inhalation, room


scent, foot bath, with hypnosis or
guided meditation

Anti-inflammatory

An agent that decreases


inflammation

Recent soft tissue injury,


skin irritation or sensitivity, neuritis

Benzoin, birch, camphor (white), German


chamomile, frankincense, geranium,
helichrysum, jasmine, peppermint,
myrrh, bitter orange, sweet orange,
patchouli, common sage, Spanish sage,
spikenard, tea tree, turmeric, wintergreen, yarrow

Local application for area of


inflammation, skin lotion, cool bath,
sunburn wrap

Antimicrobial

An agent that destroys


or inhibits the life
cycle of pathogenic
microorganisms

Onset of a cold or the


flu, for skin infections,
in natural cleaning
products

Most essential oils to some degree

Massage, body lotion, lymph rub, bath,


foot bath, body wrap

Antineuralgic

An agent that relieves or


decreases pain from
irritated nerves

Neuralgia

Bay rum, cajeput, Roman chamomile,


clove, eucalyptus, helichrysum,
Scotch pine

Application to the nerve path, massage


to associated areas

Antipruritic

An agent that relieves or


prevents itching

Itchy skin, insect bite,


skin irritation, itchy
scalp, sunburn

Birch, peppermint, wintergreen

Cool bath, skin lotion, hair rinse, body


wrap

Antirheumatic

An agent that decreases Rheumatic conditions,


or relieves rheumatism
stiff, sore muscular
conditions

Bay laurel, bay rum, birch, clove,


coriander, cypress, eucalyptus, juniper
berry, lavender, lemon, lime, nutmeg,
Scotch pine, rosemary, thyme, turmeric,
yarrow

Massage, body wrap, dry skin brush,


body lotion, bath

Antisclerotic

An agent that helps to


prevent the hardening
of tissue

Scar tissue, mature


skin, wrinkles

Lemon, carrot seed

Spot treatment, application to scars,


massage with cross-fiber friction

An agent that controls


the production of
sebum

Oily skin, dandruff

Atlas cedarwood, clary sage (sebum


regulator), Spanish sage (sebum
regulator), valerian (antidandruff),
ylang ylang

Skin lotion, bath, hair rinse, in skin care


products for oily skin

Analgesic

ACTION

Antiseborrhoeic

TABLE 73 Therapeutic Actions and Properties of Selected Essential Oils


SELECTED ESSENTIAL OILS

SELECTED METHOD OF APPLICATION

(continued on page 140)

Williams_2E_CH07_printer_file.indd 139

10/24/13 1:18 AM

140

Spa Bodywork: A Guide for Massage Therapists

TABLE 73 Therapeutic Actions and Properties of Selected Essential Oils (continued)


SELECTED METHOD OF APPLICATION

An agent that firms or


tightens tissue

Saggy skin, skin lacking


in tone, oily skin, as a
support for inflammatory conditions

Balsam fir, bay rum, benzoin, birch,


atlas cedarwood, cypress, frankincense,
geranium, grapefruit, helichrysum, hyssop, juniper berry, lemon, lemongrass,
linden, peppermint, myrrh, bitter orange,
patchouli, rose, rosemary, clary sage,
common sage, Spanish sage, sandalwood, spruce (tsuga), tea tree, thyme,
wintergreen, yarrow

Skin care products, massage, cellulite


and firming treatments, body wraps,
body lotion

An agent that promotes


healing through the
formation of scar
tissue

Wounds, skin conditions, skin revitalization treatments

Balsam fir, German chamomile, Roman


chamomile, elemi, eucalyptus, geranium,
helichrysum, hyssop, jasmine, juniper
berry, lavender, lemon, myrrh, neroli, palmarosa, patchouli, rose, rosemary, clary
sage, sandalwood, thyme, yarrow

Skin care products, skin care


treatments, massage, baths

An agent that increases


the activity of leukocytes in the body,
therefore boosting
immunity

To boost general
immunity

German chamomile, frankincense,


lavender, oregano (caution), rosemary,
tea tree

Massage, reflexology, baths, foot baths,


lymph rubs, dry skin brushing, detoxification treatment

An agent that combats


impurities in the blood
and organs and aids
detoxification

Detoxification treatments, revitalization


treatments, to support
a diet

Angelica, birch, carrot seed, coriander,


eucalyptus, grapefruit, juniper berry,
lemon, rose, Spanish sage, vetiver

Massage, reflexology, baths, foot baths,


lymph rubs, dry skin brushing, detoxification treatment

An agent that promotes


the production of
urine and aids water
retention

Detoxification
treatments, water
retention, revitalization
treatments

Angelica, balsam fir, bay laurel, benzoin, ber- Massage, bath, body lotion, dry skin
gamot, birch, camphor (white), cardamom,
brush, body wrap, detoxification
atlas cedarwood, cypress, eucalyptus,
treatment
frankincense, geranium, grapefruit, helichrysum, hyssop, juniper berry, lavender,
lemon, linden, mandarin, sweet marjoram,
patchouli, black pepper, Scotch pine, rosemary, common sage, sandalwood, spruce
(tsuga), thyme, turmeric, valerian

An agent that softens


the skin

Dry skin, mature skin,


dehydrated skin,
rough skin

Linden (other oils are not specific emollients but support dry skin: frankincense,
myrrh, elemi, rose, lavender)

Skin lotion, massage, bath, skin care


products, body wraps

An agent that promotes


the removal of mucus
from the respiratory
system

These oils can be used


for general respiratory support to prevent
congestion and aid
breathing

Angelica, balsam fir, bay rum, benzoin,


cajeput, camphor (white), atlas cedarwood, eucalyptus, fir, frankincense,
ginger, hyssop, sweet marjoram, peppermint, myrrh, Scotch pine, Spanish sage,
spruce (tsuga), tea tree, thyme, yarrow

Inhalation, chest rub, steam bath,


shower, sauna

An agent that combats


fungal infection

Fungal foot infections

Angelica, bay laurel, atlas cedarwood,


coriander, geranium, helichrysum,
lemongrass, sweet marjoram, myrrh,
bitter orange, rosemary, sandalwood,
spikenard, tea tree, thyme

Direct application to the local area of


fungus, in cleaning products used at
the spa

An agent that tones and


stimulates the function
of the liver

As a support for liver


cleansing or detoxification treatments

Carrot seed, German chamomile, Roman


chamomile, cypress, helichrysum,
peppermint, rose, rosemary

Body wrap, dry skin brush, body lotion,


bath, massage

An agent that lowers


blood pressure

Stress, anxiety

Bay laurel, lavender, lemon, sweet


marjoram, neroli, sweet orange, clary
sage, Spanish sage, turmeric, valerian,
yarrow, ylang ylang

Massage, body lotion, room scent,


with guided meditation, hypnosis,
inhalation, mist

Fungicidal

Expectorant

Emollient

Diuretic

Cicatrisant

Astringent

Antiviral

Inhalation, massage, lymph rub, body


lotion, body wrap, bath

Cytophylactic

SELECTED ESSENTIAL OILS

Depurative

SELECTED INDICATION

Onset of a cold or the flu Camphor (white), clove, eucalyptus, hysor to generally boost
sop, lime, sweet marjoram, peppermint,
immunity
oregano (caution), patchouli, Scotch
pine, tea tree, thyme

Hepatic

DEFINITION
An agent that destroys
or disrupts the life
cycle of a viral
pathogen

Hypotensive

ACTION

Williams_2E_CH07_printer_file.indd 140

10/24/13 1:18 AM

Chapter 7

Introduction to Aromatherapy for Spa

141

SELECTED ESSENTIAL OILS

Stress, nervous tension,


burnout, neuritis,
neuralgia

Angelica, basil, helichrysum, hyssop, juniper berry, lavender, lemon, lemongrass,


linden, sweet marjoram, peppermint,
patchouli, petitgrain, rosemary, clary
sage, Spanish sage, spruce (tsuga),
thyme, ylang ylang

Body wrap, massage, body lotion,


bath, direct application to an area of
nerve pain

Relaxant

An agent that soothes


and relieves tension

Stress, anxiety,
insomnia

German chamomile, Roman chamomile,


lavender, neroli, nutmeg, sandalwood,
vanilla, ylang ylang

Body wrap, massage, bath reflexology,


body lotion, room scent, mist,
inhalation

Restorative

ACTION

An agent that revitalizes


and strengthens the
body

Low immunity, burnout,


mental exhaustion,
stress

Basil, coriander, lavender, lemon, lime,


myrrh, Scotch pine, rosemary, tea tree

Body wrap, massage, bath reflexology,


body lotion, room scent, mist,
inhalation

An agent that increases


local circulation to the
skin and is warming; may lead to skin
irritation

Tight muscles, detoxification, cellulite treatments, muscle pain


and soreness

Birch, camphor (white), eucalyptus, fir,


ginger, juniper berry, oregano (caution),
black pepper, Scotch pine, rosemary,
spruce (tsuga), thyme, turmeric, vetiver,
wintergreen

Cellulite application, massage, spot


treatment, muscle blends, sports
massage blends

An agent that sedates


or calms the CNS, a
body system, or the
body in general

Relaxation treatments,
stress, anxiety,
insomnia

Balsam fir, bay laurel, benzoin, atlas


Body wrap, massage, bath reflexology,
cedarwood, German chamomile, Robody lotion, room scent, mist,
man chamomile, frankincense, hyssop,
inhalation, with hypnosis or
jasmine, juniper berry, lavender (balancmeditation
ing), lemongrass, linden, mandarin,
sweet marjoram, myrrh, bitter orange,
sweet orange, rose, clary sage, sandalwood, spikenard, tuberose, valerian
(depresses CNS), vanilla, vetiver, yarrow, ylang ylang

An agent that increases


the function of a body
system or the body in
general

Mental and physical


burnout, stress, to
revitalize and energize

Angelica, bay rum, bergamot, camphor


Body wrap, massage, bath, reflexology,
(white), cove, cardamom, carrot seed,
body lotion, room scent, mist, inhalaatlas cedarwood (circulatory), coriander,
tion, dry skin brushing
elemi, eucalyptus, fir, geranium,
ginger, grapefruit (lymphatic), lavender (balancing), lemon (lymphatic),
mandarin (lymphatic), peppermint,
nutmeg, neroli (nerve), sweet orange
(lymphatic), palmarosa (circulatory),
patchouli, black pepper, petitgrain,
Scotch pine, rosemary, rosewood
(immune), common sage, Spanish
sage, spruce (tsuga), thyme, turmeric,
vetiver (circulation)

An agent that promotes or increases


perspiration

To warm an area,
detoxification
treatments, cellulite
treatments, sore
muscles

Bay laurel, cajeput, German chamomile,


Roman chamomile, cypress, ginger,
hyssop, juniper berry, sweet marjoram,
rosemary, tea tree, thyme, yarrow

Body wrap, massage, body lotion, spot


treatment

An agent that causes


narrowing of the blood
vessels

Varicose veins, broken


capillaries

Cypress, lemon, peppermint (rose,


lavender, German chamomile can be
used as support oils)

Direct application to the local area

An agent that is healing


for the skin

Skin conditions, wounds Balsam fir, benzoin, bergamot, German


chamomile, Roman chamomile, eucalyptus, geranium, hyssop, juniper berry,
sweet marjoram, rosemary, rosewood
(tissue regenerator)

DEFINITION

Vulnerary

Vasoconstrictor

Sudorific or
Diaphoretic

Stimulant

Sedative

Nervine

SELECTED INDICATION

An agent that strengthens and tones the


nerves and nervous
system

Rubefacient

TABLE 73 Therapeutic Actions and Properties of Selected Essential Oils (continued)

Williams_2E_CH07_printer_file.indd 141

SELECTED METHOD OF APPLICATION

Massage, body lotion, skin care


products

10/24/13 1:18 AM

142

Spa Bodywork: A Guide for Massage Therapists

Psychological Effects
In a therapeutic setting, good smells can be used together
with massage, hydrotherapy soaks, meditation, hypnotherapy, or any other treatments to promote relaxation. This
is important because stress is at the core of many modern
diseases, and studies suggest that by simply decreasing
stress, health and immunity can be improved. Smells can
evoke intense emotional reactions and can even be used
to change behavioral patterns. This psychological use of
aromas has ancient roots. Incense has been burned for
thousands of years to connect the human spirit with the
gods and to shift consciousness from the everyday to the
divine. There is credible evidence that agreeable fragrances
can improve our mood and sense of well-being. This is
not surprising because our olfactory receptors are directly
connected to the limbic system, the oldest and most
emotional part of our brain (Fig. 78).
One way that smells can be used for healing is through a
learned-odor response. In learned-odor responses, a smell
is used to form memory links to a person, place, or thing
(e.g., a positive experience or relaxed state). Hiramoto et al.14
paired camphor with fever induction and found that a fever response could be elicited by camphor afterward. Whole
memories, complete with all their associated emotions,
can be prompted by smell.15 This is entirely unconscious
and cannot necessarily be prompted voluntarily, although
countless studies have shown that recall can be enhanced if
the learning was done in the presence of an odor and that
same odor is presented at the time of recall. This information can be used by the therapist to help the client recall
resource states from a body treatment or meditation
session. For example, if the therapist uses an exfoliation
or body wash product scented with an uplifting mint fragrance in the treatment room, the client will remember the
session every time he or she uses a home care product with
the same fragrance. Not only will the client remember the
session mentally but also his or her body will remember
and, through that memory, feel more relaxed.
Therapists interested in designing a treatment that
would encourage their clients to relax completely would
turn to oils known as sedatives, calmatives, and relaxants.
These oils help the body to let go of mental, emotional, and
physical tension. For example, when the sedative essential
oils of lavender, rose, and valerian were dispersed in the air,
rats took longer to perform tasks.16 This shows that these
oils have the ability to sedate the CNS. Oils such as lavender, Roman or German chamomile, and sweet marjoram
sedate the body and decrease stress because they stimulate
the raphe nucleus, which releases serotonin. Ambient lavender was also shown to increase sleep and lead to better
waking moods in psychogeriatric patients under long-term
treatment for insomnia.17 During stressful magnetic resonance imaging medical testing, a vanilla-like scent was used
successfully to help patients relax and to reduce anxiety at
Memorial Sloan-Kettering Cancer Center in New York.18

Williams_2E_CH07_printer_file.indd 142

Olfactory signal

Smell center

Olfactory bulb

Olfactory nerve

Olfactory
epithelium

Cilia

Smell receptor

Odor
FIGURE 78 The limbic system. Olfactory receptors are directly
connected to the limbic system, the oldest and most emotional part of
the brain.

Stimulating scents are being used by many companies to


promote alertness and increase the efficiency and precision
of their workers.19 In one study, there was an increase of
cerebral blood flow in humans following inhalation of 1,8,
cineol (rosemary, eucalyptus oil).20 Rosemary, lemon, basil,
and peppermint offer a quick energy pickup because they
stimulate the locus ceruleus, which releases noradrenalin.
People do much better in a task that requires sustained attention if they receive regular puffs of an uplifting aroma.21
Peppermint, which is often the oil chosen to promote
alert states, enhanced the sensory pathway for visual detection, which allowed subjects more control over their
allocation of attention. Ambient peppermint aroma increased word learning and recall.19 A spa therapist would
use stimulating oils in treatments aimed at energizing the
body or at the end of a relaxation treatment to help wake
the client up.

10/24/13 1:18 AM

Chapter 7

Introduction to Aromatherapy for Spa

143

Spas spend large amounts of money to influence a


clients perception of their business. Perception can only
be created or altered through one of the five senses because
these are the means by which we interpret our environment.
The positive emotional effects of agreeable fragrances can
be used to affect our perception of other people, of a business, or of a product. In a study to show that scent impacts
social relationships, people in photographs were given a
higher attractiveness rating when the test subjects were
exposed to a pleasant fragrance. In a test on shampoos, the
product originally ranked last in performance was ranked
first in a second test after its fragrance was adjusted.22

with essential oils that have deep, pungent, heavy, and spicy
aromas, the body polish product might be scented with oils
that smell light, green, and of citrus. Table 74 breaks essential oils into smell categories for easy scent contrasts.
When therapists use smell-scapes in a treatment, they are
using oils psychologically. Blending oils for a physiological
effect requires a different set of considerations. Eventually,
therapists will find that they can achieve both a physiological and psychological balance in their blends. This type of
blending is called holistic blending because the formulation
aims to address the needs of the body, mind, and spirit.

Smell-Scapes

Blending Essential Oils

Olfaction provides the spa therapist with another form


of communication. It creates connections to the spiritual
aspect of self; to the cultural background of a treatment;
and to the natural world of field and forest, sea, and desert.
It adds dimension and texture to the treatment and provides an emotionally satisfying experience for the client.
When a designer plans a service, one of the aspects that
should be considered is the smell-scape. A smell-scape is
the aroma landscape that is planned for the treatment.
The therapist will want to keep all the scents in a particular
category but vary them in such a way that they maintain
the clients interest. For example, a citrus salt glow would
obviously include citrus oils. If the therapist used the same
scent for all of the products (massage oil, body mist, finishing lotion, etc.), the client will register the scent for the first
10 minutes of the treatment but then forget it. A therapist
that wants aroma to be an integral part of the treatment
will vary the smell-scape. He or she might use grapefruit in
the massage oil, mandarin with a floral accent in the body
mist, and lemon in the finishing lotion. Each time the product is changed, the room is filled with a new scent, and the
clients olfactory enjoyment is enhanced.
For culturally inspired treatments, the smell-scape creates a powerful emotional link to the region where the service originated. In ayurveda, the traditional medical system
of India, medicated oils called taila are used.23 Traditional
taila smell very strange to the Western nose, and some clients take time to adjust to the new aromas. As this adjustment takes place, it often brings a deeper curiosity about
ayurveda, which, in turn, enriches the clients experience of
the treatment. Culturally influenced treatments must be
designed carefully. It makes sense that a treatment named
the Nile body wrap would use plant products that were
known and used in ancient Egypt. North American pine oil
would be out of place in such a treatment, but frankincense,
myrrh, and rose are appropriate. In Chapter 15, Your Spa
Program and Menu of Services, a table of different themes,
smell-scapes, accents, and associations can be found that
provide more ideas on scents that might be used in a particular smell-scape.
One easy way to create interest is to contrast distinct smell
categories against their opposites. If the massage oil is scented

Williams_2E_CH07_printer_file.indd 143

The techniques outlined in this chapter are keys to blending only. They are meant to provide structure for those who
are learning how to blend by providing a way to think
about the blend and the many considerations that a therapist must have in mind when blending. Like smell itself,
the blending process is personal, biased, and inspired by
private memories and relationships with past events. There
is no such thing as a bad blend, and there are many different ways, beyond those outlined here, for the therapist to
approach blending. Before the blending begins, the therapist will need to choose the type of carrier product that is
to be used.

Carrier Products
A carrier product (some therapists refer to them as a vehicle)
is a general term for the product that is used to carry the
essential oil to the client. Essential oils are rarely applied
at full strength. More often, they are diluted into a carrier product before they are used in a treatment. Massage
therapists will most often use an expeller-pressed fixed oil
as a carrier for essential oils delivered in massage. Expellerpressed fixed oils are different from essential oils in that
they do not evaporate (they are composed of nonvolatile
compounds) and are classified as lipids. Fixed oils are sometimes used to adulterate essential oils because essential
oils dissolve completely and easily in fixed oils. Fixed oils
are lubricating for the skin and often therapeutically useful in their own right. Commonly used fixed oils include
expeller-pressed sunflower, sweet almond, apricot kernel,
hemp (anti-inflammatory and pain relieving), avocado,
borage, jojoba (sebum balancing), or hazelnut, although
many different types of fixed oils can be used. Some fixed
oils such as evening primrose, hemp, jojoba, wheat germ,
and pure vitamin E may be added in small amounts to other fixed oils to enhance the therapeutic properties of these
oils or act as a natural preservative (1 tbsp of preservative
oils to 1 oz of the main fixed oil).
Plain, unscented lotion or massage cream, bath gel,
exfoliation product, aloe vera, clay, and body gels can be
purchased as carrier products for essential oils. This is

10/24/13 1:18 AM

144

Spa Bodywork: A Guide for Massage Therapists

TABLE 74 Basic Scents of Essential Oils and Other Aromatic Materials


SPICY

REFRESHING

HERBACEOUS

SWEET

EXOTIC

Ajowan

Basil

Ajowan

Copaiba balsam

Bay rum

Allspice

Bay laurel

Angelica root

Peru balsam

Copaiba balsam

Angelica seed

Melissa

French basil

Tolu balsam

Peru balsam

Aniseed seed

Fir needle

Calamintha

Benzoin

Tolu balsam

Peru balsam

Bergamot

German chamomile

Sweet birch

Ginger CO2

Tolu balsam

Cajeput

Roman chamomile

Jasmine

Jasmine

Bay rum

Cypress

Helichrysum

Lavender

Myrrh

Caraway

Elemi

Hyssop

Lime

Narcissus

Cardamom

Eucalyptus

Marigold

Mandarin

Nutmeg

Cascarilla bark

Geranium

Marjoram

Mimosa

Oakmoss

Cassia

Juniper berry

Myrtle

Neroli

Neroli

Cinnamon

Lemongrass

Oregano

Carnation

Patchouli

Clove

Tilia absolute

Patchouli

Rose

Sandalwood

Coriander

Myrtle

Rosemary

Rosewood

Spikenard

Cubeb

Palmarosa

Common sage

Liquidamber

Liquidamber

Cumin

Pine

Santolina

Tonka

Tonka

Ginger CO2

Rosemary

Tarragon

Tuberose

Tuberose

Nutmeg

Spanish sage

Thyme

Vanilla

Turmeric

Black pepper

Clary sage

Valerian

Wintergreen

Valerian

Turmeric

Common sage

Yarrow

Ylang ylang

Vetiver

LIGHT AND FRESH

POWDERY

EARTHY

FLORAL

WARM/HOMEY

Rosewood

Copaiba balsam

Angelica root

Gardenia

Almond

Sweet orange

Peru balsam

Carrot seed

Geranium

Honey

Bay laurel

Tolu balsam

German chamomile

Hyacinth

Beeswax

Bergamot

Benzoin

Fennel seed

Jasmine

German chamomile

Grapefruit

Cedarwood

Ginger

Lavender

Cinnamon

Lavender

Frankincense

Myrrh

Tilia absolute

Clove

Lemon

Orris

Oakmoss

Mimosa

Inula

Lemongrass

Sandalwood

Patchouli

Narcissus

Lavender

Lime

Liquidamber

Spikenard

Neroli

Nutmeg

Litsea

Tonka

Vetiver

Rose

Vanilla

Mandarin

Vanilla

Yarrow

Carnation

Mandarin

Clary sage

Violet flower

Tuberose

Rose

Lemon verbena

Violet flower
Ylang ylang

Williams_2E_CH07_printer_file.indd 144

10/24/13 1:18 AM

Chapter 7

Introduction to Aromatherapy for Spa

145

TABLE 74 Basic Scents of Essential Oils and Other Aromatic Materials (continued)
LEMONY

CAMPHORACEOUS

MEDICINAL

LEATHER

ALPINE

Melissa

Exotic basil

Bay laurel

Cade

Fir needle

Elemi

Borneol

Sweet birch

Cypress

Bay laurel

Eucalyptus citriodora

Cajeput

Cajeput

Guaiacwood

Sweet birch

Lemon

White camphor

White camphor

Labdanum

Cedarwood

Lemongrass

Eucalyptus

Eucalyptus

Oakmoss

Cypress

Litsea

Niaouli

Niaouli

Opopanax

Juniper

Lemon verbena

Oregano

Spanish sage

Patchouli

Spruce

Tea tree

Valerian

Thyme

Vetiver
Yarrow

WOODY

GREEN

MINTY

CITRUS

Amyris

Galbanum

Cornmint

Bergamot

Ambrette seed

Cade

Tilia absolute

Peppermint

Grapefruit

Costus

Cascarilla bark

Myrtle

Spearmint

Lime

Cumin
Labdanum

Cedarwood

Narcissus (dark)

Lemon

Cubeb

Tagetes

Mandarin

Inula

Tarragon

Bitter orange

Rosewood

Valerian (dark)

Sweet orange

Sandalwood

Violet Leaf

especially helpful if the therapist is designing an original


service and wants to create a smell-scape for the client, although it is important to avoid products that contain components that block the absorption of essential oils through
the skin. Such products include mineral oil, petroleum,
lanolin, coconut oil, and coco butter. Sometimes, a spa
product will be fragranced when it arrives at the spa. If the
scent is light, it can easily be modified by adding essential
oils. This is not ideal, however, because the fragrance may
be synthetic and not appropriate for use in aromatherapy.

MUSKY

to a base or carrier for a particular concentration. Figure 79


illustrates which concentration to use on a particular type of
client or condition. Concentrations of between 1% and 4%
are standard in the field of aromatherapy and are low enough
to insure safety and minimize negative reactions. Concentrations of above 4% are used in acute situations or by experienced therapists; 100% (neat) applications are used for spot
treatments with specific oils such as tea tree for toe fungus;
helichrysum for trigger point therapy; lavender for small
burns; German chamomile for inflammation of soft tissue;
and lemon, tea tree, or lavender to dot on a skin blemish.

Essential Oil Concentrations


The term concentration refers to the amount of essential
oil in the final volume of massage oil or carrier product.
Table 75 outlines how many drops of essential oil are added

Synergy
A synergy is when the whole is greater than the sum of its
parts, and those parts are mutually enhancing. Derived

TABLE 75 Carrier Volume to Essential Oil Concentration


CARRIER (OZ)

EO 1% (DROPS)

EO 2% (DROPS)

EO 2.5% (DROPS)

EO 3% (DROPS)

EO 4% (DROPS)

12

12

15

18

24

12

24

30

36

48 ( tsp)

24

48

60

72

96

48

96

120

144

192

EO, essential oil.

Williams_2E_CH07_printer_file.indd 145

10/24/13 1:18 AM

146

Spa Bodywork: A Guide for Massage Therapists

Top, Middle, and Base Note Blending


1%
Children, the elderly,
pregnant women

2.5%
Standard full-body
applications

3.5%
Strong full-body applications

4%
Local applications for a specific purpose
(i.e. cellulite cream)

5% to 10%
5% to 10% concentrations are strong. They are used in acute
situations by practitioners with advanced training.
FIGURE 79 Standard concentrations in aromatherapy.

from synergios, which is a Greek word that means associate


or partner or, literally in this context, working together.
Synergistic interactions between chemical compounds create a greater spectrum of action than would be possible
using a single oil alone.
When creating synergistic blends, it is important to
remember that essential oils are chemically complex,
so blending too many oils at once tends to muddy the
result. Often, only three to four oils are needed to make a
good synergistic blend. When you put two, three, or four
oils together with similar or complementary therapeutic
actions, you create a blend that is much more effective than
a single oil working along.
To create a synergy for relaxation, fir could be chosen
for its alterative action, which helps the body to regain
balanced function. Sweet marjoram could be added for its
nervine qualities, which help to strengthen and support the
overall nervous system. Finally, lavender might be added as
a restorative that helps with burnout and exhaustion. These
three oils will have a broader action on stress than fir on
its own.
You can also use the action or property words in aromatherapy literature to create a synergy. For example, if
you wanted a blend that was antiviral, you would simply pick two to three oils that listed antiviral in the
action/property area associated with the essential oil.
The chemistry of oils can also be used. For example, if
you want a blend that is a powerful muscular antispasmodic, you would turn to essential oils high in esters,
such as Roman chamomile (77%), clary sage (70%), and
petitgrain (65%).

Williams_2E_CH07_printer_file.indd 146

Many perfumers and aromatherapists use the top, middle,


and base note classifications of essential oils and perfume materials to achieve a symphony of balance in the
fragrance. Top, middle, and base notes are determined by
their different rates of evaporation. Top notes are generally
composed of small molecules (i.e., they are lightweight and
evaporate quickly). They are the first aromas to hit your nose
and give you the initial impression of the fragrance. Middle
notes are slower to evaporate and create the substance or
main theme of the fragrance. Base notes appear last due to
their larger molecular size and slower rate of evaporation.
They also bind all the other ingredients in a scent, holding
the scent together. When using notes to create blends, the
idea is to include an oil that resonates on each note so that
the fragrance smells integrated and whole. If the blend does
not harmonize, try to use bridging oils such as jasmine
and ylang ylang that resonate on more than one note. If the
blend smells rough, you can soften it by adding a blend
smoother such as rosemary, marjoram, or a citrus oil. Blend
enhancers such as sandalwood, bergamot, clary sage, and
lavender will bring out the scent of the other oils, bridge
gaps, and generally enhance the aroma. Rose and chamomile species will often jump out of a blend and can be
modified with black pepper, geranium, lemon, or clove.
Table 76 provides an overview of the note classification of
some essential oils.

Approach to Blending
In a spa setting, therapists often approach blending by asking questions such as, What smells good? What combination of aromas will delight and inspire my clients? or
Can I create an aroma that will affirm and encourage the
spirit or cause deep restful relaxation? Each blending situation is different, and therapists must constantly evolve their
skills to integrate both practical and intuitive approaches
to blending. It is helpful to look at every specific classifications of blends.
Physiological blend: This type of blend aims to meet
the needs of the body. If the client has sore muscles, the
essential oils are chosen to decrease pain and spasm in
muscle tissue. If the client is stressed out, the oils are
chosen to balance the CNS and decrease stress.
Psychological blend: A psychological blend is focused
on changing a mood, overcoming an internal obstacle,
opening the mind to new ideas or new ways of being,
forming a connection to a resource state, refreshing the
mind, and alleviating mental fatigue and burnout.
Spirit blend: A spirit blend affirms characteristics of
the individual spirit. It reminds wearers to focus on the
aspects that they like most about themselves and want
to strengthen. For example, an individual who is having
difficulty in expressing or in experiencing joy might
build a blend around grapefruit, which affirms joy.

10/24/13 1:18 AM

Chapter 7

Introduction to Aromatherapy for Spa

147

TABLE 76 Top, Middle, and Base Notes of Essential Oils


TOP NOTES
Anise

Fennel

Mandarin

Petitgrain

Bay

Fir

Marjoram

Pine

Bergamot

Galbanum

Mimosa

Rosemary

Birch

Ginger

Nutmeg

Spearmint

Carrot seed

Grapefruit

Orange

Tangerine

Cedarwood

Juniper berry

Oregano

Taragon

Coriander

Lavender

Palmarosa

Thyme

Cypress

Lemon

Pepper

Wintergreen

Davana

Lime

Peppermint

Wormwood

Allspice

Clary sage

Melissa

Ylang ylang

Basil

Clove

Neroli

Beeswax

Geranium

Orris

Benzoin

Jasmine

Osmanthus

Boronia

Lavender

Pepper

Carnation

Lemon verbena

Rose

Roman chamomile

Lemongrass

Tagetes

MIDDLE NOTES

Champa

Linden

Tuberose

Cinnamon

Litsea cubeba

Violet leaf

Ambrette

Fir

Opopanax

Vanilla

Angelica

Frankincense

Patchouli

Vetiver

Benzoin

Galbanum

Peru balsam

Cassia

Hay

Sandalwood

BASE NOTES

German chamomile

Helichrysum

Seaweed

Clary sage

Myrrh

Tarragon

Copaiba balsam

Nutmeg absolute

Tolu balsam

Costus

Oakmoss

Tonka

An individual who is suffering from feelings of jealousy


and wants to amplify the more trusting aspects of his or
her spirit might build the blend around clary sage.
Holistic blend: A holistic blend includes an essential
oil(s) for the body, mind, and spirit to address the needs
of the entire individual.
Perfume blend: A perfume blend can include aspects
of the blends described previously but is intended to
be worn as a personal scent or to scent a product. In all
blends, the oils will amalgamate to form a new scent (as
opposed to smelling like a single oil). The scent created
by the merging of many aromas has its own personality
something entirely new and complete in itself. The perfume blend is a creative expression of themes.

Williams_2E_CH07_printer_file.indd 147

Smell-scape blend: A smell-scape blend is one blend in


a series of blends based on a unifying theme. The idea
is to keep the blend within the parameters of the theme
but to smell differently than every other blend in the
smell-scape to create the most olfactory interest for the
client.
Holistic Blending Type 1
Clients will often experience their physiological conditions
in a variety of psychological ways. A client who has moderate to severe back pain will also feel a certain way about
dealing with that pain on a daily basis. The ongoing pain
may cause irritation, firing of the sympathetic nervous
system (fight or flight response), agitation, and increased

10/24/13 1:18 AM

148

Spa Bodywork: A Guide for Massage Therapists

stress levels. A therapist who creates a blend that addresses


both the physiological situation and the psychological reaction to the situation is blending holistically.
Holistic blending type 1 is a blending method for novice
blenders that encourages them to identify their reasons for
using an essential oil and considering both the physiological and psychological state of the client. In this method, the
physiological oils will be chosen first. The psychological oil,
the most difficult of the oils to select, will be chosen last.
Holistic blends should be composed of a total of three to six
oils. A therapist who wants to weight the blend for its physiological action will choose more oils to address the physiological needs of the client. For a psychologically weighted
blend, the therapist would choose more oils to address the
psychological needs of the client.
Choose First: Core Physiological Oil
The core physiological oil should directly address the physiological condition of the client. For example, if the client requests a blend for neuralgia, the core physiological oil would
need to have an antineuralgic, or nervine, action. If the client
has recently been in a car accident and is experiencing mild
inflammation in the cervical vertebrae, the physiological oil
would likely be anti-inflammatory and analgesic.
Choose Second: Physiological Support Oil
The physiological support oil complements the actions
of the core physiological oil. It should address the condition but from a different direction. For example, suppose
that helichrysum is chosen as the core physiological oil for
its nervine action and usefulness in treating the neuralgia
mentioned previously in the first example. You might then
choose Roman chamomile as the physiological support oil
because it is a reliable antispasmodic and analgesic. Alternatively, for acute inflammation, you might choose German
chamomile oil for its anti-inflammatory abilities. For additional support, you might include frankincense, which is
mildly analgesic and also anti-inflammatory.
Choose Third: Psychological Balance Oil
The psychological balance oil is chosen to address the emotional aspect of the clients condition. It is often sedative for
the CNS but not always because some conditions require
stimulation of the CNS. If a client is feeling agitated about
a reduction in his or her work output because of neuralgia,
the psychological balance oil would be chosen to deal with
that agitation. An oil such as lavender might be used to balance out the CNS and bring mental/emotional relief. In the
second example, in which the client had recently been in a
car accident, the psychological oil might be chosen to combat the emotional imbalance often felt after such an event.
Neroli, which is used to combat shock and anxiety, might be
chosen. Geranium, lavender, or cypress would also be good
choices because they stabilize the endocrine system.
The psychological support oil is the most difficult to
choose because it requires the most thought. You must
choose an oil that will address the emotional/mental/
spiritual needs of the client but not contradict the

Williams_2E_CH07_printer_file.indd 148

physiological actions of the other two oils. For example, if a


warming oil such as clove was chosen as the psychological
balance oil for the neuralgia blend, it would counteract the
anti-inflammatory cooling actions of the helichrysum and
Roman chamomile. The warming, cooling, sedative, and
stimulating properties of the oils should be considered in
holistic blending.
Holistic Blending Type 2
The second type of holistic blend is very similar to the previous blend but equally balances the body, mind, and spirit.
It is composed of only three oils.
Choose First: Body Oil
The oil for the body will directly address the physiological state of the client. This is different from the first blend,
which provided support for a symptom of a specific condition or a body system. This time, the oil has a larger
focusthe entire physiological state of the client. Massage
therapists are not doctors, and we cannot diagnose a clients physical condition. Instead, we are trying to get an
impression of the clients body state. Perhaps you notice
that the client fidgets in the chair and gets up to walk nervously around the room. The body oil for this client would
be different from that for a client who looked at you listlessly during the health intake and slumped in the chair.
Choose Second: Mental Oil
The second oil addresses the mental state of the client and
seeks to bring balance and clarity to mental processes. The
first client in the previous example might be supported by
a mental oil that is expanding and positive to disrupt any
unchecked negative self-talk. Frankincense is an excellent
choice because frankincense is transformational, meditative, and expanding. The second client might best be supported by an oil that facilitates mental clarity and sharpness,
such as peppermint.
Choose Third: Spirit Oil
This oil is chosen to support the part of the self that the
client wants to affirm. It is helpful to ask clients what they
would like to radiate into the world or, in less esoteric
language, what they love and value most about themselves.
The oils should resonate with those qualities. For example,
if the client in the first example loved his or her openheartedness, rose might be chosen as the spirit oil. Rose directly
affirms the heart and openheartedness. If the second client
claims to really like the fact that he or she is good with
money, the therapist might choose basil as the spirit oil.
Basil is associated with wealth and abundance in many
cultures worldwide.

Application Methods
Well-trained, professional aromatherapists are assets to
spas. They can provide custom blending specifically tailored

10/24/13 1:18 AM

Chapter 7

to the needs of the individual client. They can also develop


signature blends for the business and provide smell-scape
recommendations for specific treatments. Even the simplest
aromatherapy treatment can benefit a client immensely by
decreasing stress and increasing the pleasure he or she derives from the service. The methods of application described
below focus on some of the common ways that essential oils
can be used in a spa. Figure 73 shown earlier in the chapter
provides an overview of common aromatherapy treatments.

Introduction to Aromatherapy for Spa

149

they should be generally avoided. If the candle is in a base of


beeswax or soy, it is more likely to contain a pure oil because
essential oils dissolve into beeswax and soy but not into regular candle wax.
SANITATION
Nebulizing diffusers have a glass chamber that
should be cleaned out with alcohol once a
day to keep the apparatus functioning well. Follow the
manufacturers directions.

Inhalations
Unless the spa has a medical focus, you will probably use
inhalations to facilitate clear breathing in saunas, steams,
and showers or to provide mental stimulation or mood
enhancement. Some steam baths have a special holder in
which essential oils are placed. If this is not available, the
oils can be placed directly onto the floor at the edges of the
cabinet or room; 4 to 6 drops provide a light but detectible
scent because the essential oils evaporate into the steam. In
the sauna, add the oils to the water that will be ladled on the
heat source; 2 to 6 drops of essential oil are used, depending
on the size of the water container. Oils added to the heat
source in a sauna must always be mixed in water because
essential oils are potentially combustible and could pop or
flame up if added plain. A drop of oil can be placed on a
tissue tucked in the face cradle to prevent congestion from
lying in the prone position during any treatment.
Diffusing essential oils throughout an area can purify
the air, repel insects, enhance mood, or simply make the
place smell good. A commercial nebulizing diffuser is the
best choice if the aim is to eliminate microbes and promote
a clean, healthy living or working space (Fig. 710). Earthenware burners, electronic fan diffusers, or items such as
lamp rings can be used to scent a room. Spa suppliers will
have a variety of different types of scenting diffusers. Aromatherapy candles are often scented with synthetics, so

FIGURE 710 Aromatherapy diffusers. A nebulizing diffuser is the


best choice if the goal is to decrease airborne pathogens and create a clean
and healthy environment.

Williams_2E_CH07_printer_file.indd 149

Aromatic Exfoliations and Body Shampoos


Essential oils can be added to a granulated exfoliation
product or applied in a foaming bath gel for a fragrant and
satisfying body polish or body shampoo. Add 24 drops of
an essential oil blend to 2 oz of either exfoliation product
or foaming body wash. Aromatic exfoliation can be the
first step in a larger treatment as discussed in Chapter 8,
Exfoliation Treatments.

Aromatherapy Massage
An aromatherapy massage provides both physiological and
psychological benefits for the client. Use a 2% (12 drops/oz
of carrier) to 3% (18 drops/oz of carrier) concentration of
essential oils in carrier oil or cream for a full-body massage.
Use a 1% (6 drops/oz of carrier) concentration when massaging the elderly, children, or pregnant women; 4% blends
(24 drops in 1 oz) can be used for spot treatments (trigger
point therapy, cross fiber friction, etc.) or for specific conditions (carpal tunnel, lateral epicondylitis, etc.). Certain oils
such as German chamomile can be used at 100% to decrease
pain and inflammation in a specific area.
In a classic aromatherapy treatment, the therapist meets
with the client during a formal aromatherapy consultation
in which the client fills out a health history form and the
client and therapist discuss the clients expectations of aromatherapy and health care goals. A custom blend is created
and then applied in a full-body massage. Some therapists
use methods such as applied kinesiology or body talking
to choose oils for the client. In such a method, the client
holds a bottle of oil and the therapist uses muscle testing to
determine which oil increases strength in the muscle. Some
therapists let the client pick all of the oils for the blend, believing that clients will only be drawn to oils that support
them in their particular healing process. Other therapists
take the opposite approach and choose oils that the client
has a mild dislike of. The assumption in this case is that clients are out of balance with what they need for healing and
that healing will happen slowly as the client develops an affinity to the oil or blend. Most often, choosing oils for the
blend is a joint process between the client and the therapist.
The therapist suggests oils that have physiological or psychological effects that would support the clients healing

10/24/13 1:18 AM

150

Spa Bodywork: A Guide for Massage Therapists

needs, and the client shares likes and dislikes until both are
satisfied with the oils chosen. The therapist will then check
for contraindications before creating the final blend of oils.
Some spas choose not to offer custom blending but create a series of premade blends from which the clients choose
a scent they like. This allows the clients to have more massage time for the same amount of money. It also enhances
retail opportunities because clients often become attached
to a scent and will purchase the body wash, body lotion,
and room mist that match their massage oil. A selection of
starter oils and ready to blend recipes is offered in Table 77
for easy adoption by a massage clinic or spa.

Aromatherapy Baths
A hydrotherapy tub is a specialized soaking unit that has
multiple air and water jets. Essential oils can be added to the
hydrotherapy tub or to a standard soaking tub for therapeutic
baths. Sometimes, the oils are added simply for the pleasure
of their fragrance, or they can be used to treat sore muscles,
stress, insomnia, low immunity, skin problems, depression,
irritability, or a variety of other conditions. The drawback to
using essential oils in a bath is that the oils will pool on the

top of the water. When the client gets into the bath, the oils
will stick to the area that hits the water first, or they will pool
around exposed area and may cause skin irritation. For this
reason, it is best to dilute the oils in carrier oil and massage
the blend into the clients skin. After the massage, the client
soaks in a warm tub where he or she can enjoy the fragrance
of the oils and allow for greater skin absorption. Sometimes,
essential oils are added to an emulsifier, which disperses
them in the body of the water to prevent pooling. In this case,
6 to 9 drops of essential oil are used for a bath.
Aromatic foot and hand baths can be used to treat disorders of the feet and hands, such as arthritis and athletes
foot, or used for relaxation, low immunity, or stress-related
disorders. The oils are diluted into a carrier product and
massage into the skin before the area is soaked, or the oils
are blended into an emulsifier and added directly to the
bath. In the case of a foot or hand bath, 2 to 4 drops of oil
might be used.

Aromatherapy Wraps
Aromatherapy wraps can take many forms. In the simplest
wrap, the client is cocooned in blankets at the end of an

TABLE 77 Starter Oils and Easy Blend Recipes

21 VERSATILE OILS

THESE BLENDS ARE FORMULATED AT A 2% CONCENTRATION FOR USE IN


1 OZ OF CARRIER PRODUCT (12 TOTAL DROPS TO 1 OZ OF CARRIER).
THEY ARE COMPOSED OF THE 21 STARTER OILS AT THE LEFT.

Bay laurel

Muscle ease: Bay laurel (3), rosemary (1), lemon (6), juniper berry (2)

Bergamot

Breathe easy: Eucalyptus (3), lemon (7), thyme (2)

Clary sage

Mother-to-be: Lavender (7), mandarin (7)

Cypress

Clarity: Thyme (1), grapefruit (9), cypress (2)

Eucalyptus

Rain: Cypress (7), thyme (2), geranium (2)

Frankincense

Equilibrium: Clary sage (3), neroli (2), bergamot (7)

Geranium

Girl power: Clary sage (2), lavender (6), geranium (1), frankincense (3)

German chamomile

Body boost: Lemon (4), thyme (1), bergamot (4), lavender (3)

Ginger CO2

Purity: Juniper berry (3), grapefruit (8), thyme (1)

Grapefruit

Revitalize: Bergamot (6), rosemary (2), lavender (4)

Jasmine

Ocean: Rosemary (3), frankincense (7), ylang ylang (2)

Juniper berry

Zen: Ylang ylang (2), ginger CO2 (2), mandarin (8)

Lavender

Renew: German chamomile (1), rosemary (2), clary sage (4), lavender (7)

Lemon

Shimmer: Bay laurel (3), ylang ylang (1), bergamot (7), frankincense (3)

Mandarin

Meditation: Frankincense (4), jasmine (1), ginger CO2 (2)

Neroli

Energy: Peppermint (1), thyme (4), bay laurel (4)

Peppermint

Summer: Neroli (2), lavender (4), bergamot (6)

Rose

Refresh: Peppermint (1), eucalyptus (2), lemon (8), geranium (1)

Rosemary

Moon mist: Jasmine (2), grapefruit (10)

Thyme

Relax factor: Rose (1), clary sage (2), mandarin (6), frankincense (3)

Ylang ylang

Circulate: Ginger CO2 (2), grapefruit (9), juniper berry (1)

Williams_2E_CH07_printer_file.indd 150

10/24/13 1:18 AM

Chapter 7

aromatherapy massage to relax while the essential oils continue to absorb into the bloodstream. Sometimes, essential
oils are blended into a very heavy carrier product such as
wheat germ oil or shea butter; massaged into the skin; left
to absorb during a wrap; and then removed with hot towels,
a Vichy shower, or a body shampoo. If a body shampoo is
used to remove the excess carrier, a light moisture lotion
may be applied at the end of the treatment to rehydrate
the skin. These treatments are sometimes called emollient
wraps because the heavy carrier product is nourishing for
the skin and softens very dry or dehydrated skin. Other carrier products might also be used. For example, aloe vera and
anti-inflammatory oils can be brushed on the skin for an
effective sunburn relief wrap. Essential oils can be added to
body milk (very light and watery lotion) and misted on the
body with an atomizer before the body is wrapped. Some
therapists soak cotton sheets in hot water and essential oils
and apply them in a hot sheet wrap. This is the least effective method of using essential oils in a wrap because the
oils tend to evaporate very quickly and do not really penetrate the skin. However, this type of sheet wrap does smell
nice. Alternatively, essential oilscented hand towels can be
layered on the body after it has been massaged with aromatic oils, and the body can be wrapped. Oils might also
be mixed up with clay (kaolin, French green, Sedona, etc.)
and applied to the body with a brush before the client is
wrapped. As you can see, there is no end to the ways that
different steps can be mixed and matched to form satisfying
treatments. Body wrap procedures are covered in Chapter 9,
Body Wraps.

Aroma Mists and Aura Mists


Aroma mists have a number of different uses in a spa
setting. They can be used as air purifiers and fresheners, as
linen fresheners, as mood enhancers, skin toners, or body
coolers. In many of the services described in upcoming
chapters, aroma mists are used as a treatment step. Aroma

Williams_2E_CH07_printer_file.indd 151

Introduction to Aromatherapy for Spa

151

mists make nice take home gifts for clients because they
can use them to refresh the car or to mist at any time as an
olfactory link to the relaxation they experienced in their spa
treatment.
An aura mist is an aromatherapy body mist that is used
only at the very end of the treatment. It is misted in a high
arch over the client from the head to the toes. It should be
scented with an aroma that contrasts with the treatment
products and fills the treatment room with a refreshing
scent. This helps to wake the client up and stimulate them
at the end of the session.
A number of different base fluids can be used when creating aroma or aura mists including purified water, herbal
teas, floral waters (hydrosols), lemon juice, witch hazel, and
vinegar. Add 30 drops of an essential oil blend to 2 oz of base
liquid in a bottle with a spray top. It is best to refrigerate
mists between uses to prevent the product from expiring. If
tea is used as a base, the product will have a short shelf life
(2 to 3 days) and should be made up in small batches only.

Support Lotions
A support lotion is a blend of essential oils mixed into a
lotion base that is given to the client to use as a form of selfcare. The oils might be chosen to give the client an energy
boost, to calm the client if he or she is feeling anxious, as a
link to a positive affirmation or new life choice (quit smoking, take a break, eat healthy, etc.), or as a pleasant reminder
of his or her stay at the spa. The lotion can be used at any
time by the clients in a variety of ways and gives clients a
simple way to bring aromatherapy into their lives. They can
rub it on their hands and then hold their hands over their
nose for a simple inhalation. They can spread the lotion
over the anterior neck, down the sternum, under the breast
tissue, and behind the neck, where lymph nodes come up
close to the surface of the body for a gentle immunity boost.
Finally, they can rub the lotion all over their body and take
a bath.

10/24/13 1:18 AM

152

Spa Bodywork: A Guide for Massage Therapists

SPA FUSION
INTEGRATION OF SKILLS
STUDY TIP: Botanical Flash Cards
Aromatherapists use the botanical names of plants
to ensure they are using the correct species in their
treatments. If aromatherapy is important to you,
learn the botanical names of essential oil, baring
plants with botanical flash cards. To create flash cards,
review Appendix B (Essential Oils and Their Botanical
Names) at the back of this book. List the common
name of an essential oil on one side of the card (e.g.,
Bergamot) and the botanical name on the other side
(Citrus x bergamia). When you pronounce Latin, you
usually simply sound out the word as it is spelled
there is nothing tricky about it. Work through five
cards a day until you have them memorized, and soon
you will have an excellent foundation of knowledge of
botanical names.

CHAPTER WRAP-UP
Aromatherapy is the use of essential oils for healing
the mind, body, and spirit. Different health care providers will use essential oils in diverse ways based on
their scope of practice. These modern-day uses mirror
ancient times, when aromatic substances were used for
both medical and spiritual practice.
Essential oils are volatile plant oils extracted from
certain aromatic plants that have both physiological
and psychological effects on the human body. These
oils are chemically complex and may contain as many
as 400 different components. The oils are stored in the
leaves, needles, twig, bark, flowers, flower buds, fruits,
stems, and roots; they are extracted through steam
distillation, expression, solvent extraction, or CO2
hyperbolic production. Essential oils are often adulterated on the international market to increase the profit
margin of the grower or supplier. Aromatherapists
believe that the human body responds differently to
natural oils than to those that are synthetic or adulterated. For this reason, it is important to purchase
high-quality, therapeutic-grade essential oils from a
reputable supplier.
The oils enter the body via the skin, inhalation
through the lungs, and ingestion (which is not used
without advanced training). Once in the body, the
chemical compounds in essential oils interact with the
bodys chemistry to affect specific organs, systems, or
the body as a whole (physiological effects). The inhalation of essential oils also triggers an olfactory response
that can lead to powerful mental and emotional
behavioral changes (psychological effects).

Williams_2E_CH07_printer_file.indd 152

Basic blending methods such as synergistic


blending and note blending allow the therapist to create interesting smell-scapes to enhance the clients spa
experience. Aromatherapy massage, exfoliation, wraps,
and hydrotherapy introduce clients to the benefits of
essential oils. The pleasing fragrances of the oils also
support their use as accent notes in other services.
REVIEW QUESTIONS
Multiple Choice
1. These compounds, present in essential oils, can
be toxic to the living plant and must be stored in
specialized structures such as glands, ducts, scales,
and hairs. These compounds are:
a.
b.
c.
d.

Mostly terpenes
Not chemical in nature
Only found in flowers
Mostly aldehydes

2. Aromatherapy is said to affect the mind, body, and


spirit. Essential oils have a physiological effect on
the body. How do they affect the mind and spirit?
a. Through their effect on the limbic system after
inhalation
b. Through absorption of the oil into the bloodstream
c. Through olfactory effects but only when paired
with hypnosis
d. Through the ability of black pepper oil to break
addictive behaviors
3. Volatility is best described as:
a. The ability to scent an area for a given period
of time
b. The ability to turn from a liquid to a gas at
room temperature
c. The ability to attract useful and needed insects
to the plant
d. The ability to defend the plant against microbial
infection
4. Essential oils are described as:
a. Chemically complex with 100 to 400 or more
chemicals present in the oil
b. Chemically simple with 3 to 7 chemicals found
in the oil
c. Not chemical when they are in a natural form
d. Chemically dangerous unless they are adjusted
in the lab before sale to the public

10/24/13 1:18 AM

Chapter 7

Introduction to Aromatherapy for Spa

153

SPA FUSION
INTEGRATION OF SKILLS (continued)
5. Distilled essential oils will smell:
a. Just like the plant from which it has been extracted
b. Burntdistillation should not be used to produce essential oils
c. Slightly different than the natural plant as some
chemical compounds are lost during the distillation process
d. Sweeter than the plant in its natural form
Fill in the Blank
6. In the process of extraction known as
, essential oils are placed in a still,
and steam is used to burst the essential oil storage
sites.
7. The therapeutic value of essential oils will
decrease with age even under ideal storage
conditions, mostly due to oxidation and the

Williams_2E_CH07_printer_file.indd 153

resulting chemical changes this causes. Replace


essential oils if they have not been used within
. Citrus oils should be replaced
every
.
8. When the potential unwanted side effects of one
compound are decreased or eliminated by one or
more other compounds present in an essential oil,
this is referred to as
.
9. Many factors affect the chemical composition
and therefore the therapeutic value of an essential oil. Three of these factors are
,
, and
.
10. The human body seems to respond differently to
natural oils compared to synthetic oils. Synthetic
,
,
oils often cause
and
.

10/24/13 1:18 AM

P A R T

TWO

Spa
Treatments

Williams_2E_CH08_printer_file.indd 154

10/24/13 1:24 AM

1
8
Exfoliation
Treatments
Chapter Outline

K e y Te r m s

Types of Exfoliation Treatments


General Treatment Considerations

Aura mist: An aromatherapy body mist that is used only at the very end
of the treatment. It is misted in a high arch over the client from the
head to the toes. It should be scented with an aroma that contrasts
with the treatment products and fills the treatment room with a refreshing scent.
Dihydroxyacetone (DHA): The component in autotanning products
that causes the skin cells to change color and appear tanned.
Dissolving exfoliants: Dissolving exfoliants are composed of alpha
hydroxy acids (AHAs) and beta hydroxy acids (BHAs). AHAs include
glycolic, citric, lactic, and malic acids. The most widely used BHA in
cosmetics is salicylic acid or its related substances, sodium salicylate
and willow extract.
Enzymatic exfoliation: Exfoliation that relies on biological action rather
than physical abrasion. They are applied to the skin and then rinsed
off. The enzymes used dissolve keratin in the skin, thereby removing
dead cells and supporting the natural process of exfoliation. Papain
from papaya is a good example of one of these enzymes.
Exfoliation: A process by which dead skin cells are removed to improve
the skin texture and appearance. Other benefits include increased
circulation and lymph flow, increased immunity, and relaxation.
Mechanical exfoliation: A physical process in which the body is rubbed
with an abrasive product or with a coarse handheld item such as a
loofah.
Ultraviolet A (UVA) rays: Sometimes referred to as aging rays, these
rays from the sun penetrate deeper into the skin than UVB rays and
cause photosensitivity reactions.
Ultraviolet B (UVB) rays: Also known as burning rays, these rays from
the sun are the primary rays associated with skin damage and cancer
from the sun.

Scope of Practice
Skin Conditions
Overexfoliation

Dry Skin Brushing


Dry Skin Brushing Techniques
The Enhanced Dry Skin Brushing Procedure

The Salt or Sugar Glow


The Salt or Sugar Glow Procedure

The Full-Body Polish


The Full-Body Polish Procedure

The Body or Loofah Scrub


The Buff and Bronze
The Buff and Bronze Procedure
Home Care and Retail

SPA FUSION
INTEGRATION OF SKILLS
STUDY TIP: Good Listening Skills
SPA INSPIRATION: Roll Tape!
CHAPTER WRAP-UP

155

Williams_2E_CH08_printer_file.indd 155

10/24/13 1:24 AM

156

Spa Bodywork: A Guide for Massage Therapists

In a manual exfoliation treatment, the skin is polished or


scrubbed with a coarse-textured product that gently sands

Broaden Your Understanding 81 provides an overview of


exfoliation treatments offered exclusively by estheticians or
physicians in a spa.

the skins surface. This brightens the skin by removing the


dull top layer of dead cells, deep cleanses the pores, and
improves the skins texture. These actions are important for
skin health and have other therapeutic benefits that work in
synergy with massage. During an exfoliation treatment, the
vital energy of the body is improved and the body is relaxed.
This chapter aims to describe the types of exfoliation
treatments commonly used by massage therapists. It also
provides a brief overview of other exfoliation treatments
provided by estheticians or physicians in the spa profession.
Before delivering the treatments described in this chapter,
you may wish to review the information in Chapter 4
(Your Spa Massage), Chapter 5 (Foundation Skills for
Spa Treatment Delivery), and Chapter 7 (Introduction to
Aromatherapy for Spa). You may also want to look at the
sample exfoliation treatments provided at the back of the

General Treatment Considerations


Before you provide exfoliation treatments at the spa or in
your massage practice, check with the state board of massage
to ensure that the types of treatments you want to provide
are in your scope of practice as defined by the state where
you work. You should also pay attention to the clients overall skin condition and the dangers of overexfoliation.

Scope of Practice
Massage therapists in most states (but not all) must be
careful not to encroach on the scope of practice for estheticians when they promote or deliver an exfoliation treatment. Massage therapists usually aim to decrease muscle
tension, increase the vital energy of the body, and relax the
body with exfoliation treatments. A fair amount of soft tissue manipulation is usually included in the service to meet
these treatment goals. To avoid problems, it is a good idea
to highlight these body-oriented goals in the promotional
description of the treatment rather than focus on the benefits of the treatment for the skin.

book for inspiration when developing your spa program.

Skin Conditions

Types of Exfoliation Treatments


There are two basic types of exfoliation: mechanical exfoliation, which is used by both massage therapists and estheticians, and enzymatic or dissolving exfoliation, which is
used by estheticians or delivered only by a physician.
Mechanical exfoliants rely on the skin being physically
rubbed with a mildly abrasive exfoliation product or a coarse
handheld item such as a loofah or cactus fiber cloth. Types
of mechanical exfoliation include dry skin brushing, salt or
sugar glows, body scrubs, friction, or body polish treatments.
Although the words brush, scrub, glow, friction, and polish
are often used interchangeably, each of these words implies
a type of product, type of implement, or the degree of abrasiveness in the treatment. The overview of manual exfoliation treatments provided in Table 81 will help you differentiate between these treatments.
The enzyme and dissolving exfoliants used by estheticians and physicians rely on their biological action rather
than simple physical abrasion. They are applied to the skin
and then rinsed off. The enzymes used in these treatments
dissolve keratin in the skin, removing dead cells and supporting the natural process of exfoliation. These types of
treatments are not described in this text because they are
usually out of the scope of practice of massage therapists.

Williams_2E_CH08_printer_file.indd 156

Exfoliation products should not be used on open wounds or


broken skin, on clients with chronic skin conditions (unless
recommended by a physician), on sunburned or inflamed
skin, over varicose veins, or immediately after waxing or
shaving. Using exfoliation products in these circumstances
may cause irritation or complicate the condition.

Overexfoliation
The overuse of manual exfoliation products during a treatment can leave the skin sensitive and inflamed. If such products are used too frequently, the skin will start to thicken
and grow leathery. Exfoliation treatments should not be
given more than once a week for the best results.

Dry Skin Brushing


Dry skin brushing is a technique in which the skin and lymphatic system are stimulated with a natural bristle brush,
rough hand mitts, or textured cloths. Dry skin brushing increases local blood flow to the skin, bringing fresh oxygen
and nutrients to the skin. The sebaceous glands are stimulated and dead skin cells are removed to reveal the healthy
new skin below.

10/24/13 1:24 AM

Chapter 8

Exfoliation Treatments

157

TABLE 81 Overview of Manual Exfoliation Treatments


Dry skin
brushing

Dry skin brushing is a treatment in which the body is brushed to stimulate local blood circulation to the skin, boost general immunity,
increase the vital energy of the body, and desquamate dead skin cells. It is usually performed with natural bristle brushes, but
rough hand mitts or terry cloths can also be used. This is a mild to moderate exfoliation treatment because only light pressure is
used with the body brushes.

Wet skin
brushing

Wet skin brushing is applied in the same manner as dry skin brushing except that the body is dampened with water, apple cider
vinegar, or a foaming body shampoo before it is brushed.

Salt glow

In a salt glow treatment, a specialized salt is mixed with oil, body wash, water, apple cider vinegar, or other wet or oily product and
applied to the body to stimulate local circulation to the skin, smooth the skin, increase the vital energy of the body, or relax the
body. The degree of vigor with which the therapist applies the strokes determines the abrasiveness of the treatment.

Sugar glow

A sugar glow treatment is less abrasive than a salt glow. Table sugar, brown sugar, or raw sugar is mixed with water, oil, milk, wine,
or a body wash product and then applied to the body to increase local circulation to the skin, relax the body, and smooth the skin.

Body polish

A body polish is different than a salt glow in that the exfoliation product is usually blended into an emollient base to protect the
skin. A body polish often has a skin care focus, so the steps of the treatment follow those of a facial. This is the most relaxing and
elegant of the manual exfoliation treatments, so stress reduction is often a primary treatment goal.

Body scrub or
loofah scrub

As the name suggests, a body scrub is a vigorous and revitalizing treatment. A loofah mitt, rough hand mitts, or cactus fiber cloths
are used with a foaming body wash to cleanse the skin, stimulate local circulation to the skin, and rejuvenate the body.

Friction

In Rational Hydrotherapy, Kellogg10 gives very specific recommendations for the way that friction should be applied to a particular
client for a specific physiological effect. For general purposes, a friction could best be described as a treatment in which the skin
is rubbed in a back-and-forth motion with dry hands or with a wet lubricant such as apple cider vinegar or a body shampoo. Terry
mitts or rough hand mitts may also be used with water at specific temperatures (i.e., cold mitt friction). The abrasiveness of a friction are based on the treatment goals of the individual service and the types of implements that are used.

Buff and
bronze

A treatment that includes a full-body exfoliation, moisture massage, and the application of an autotanning product that leaves the
client looking as if they are naturally tanned.

Dry brushing is a nice enhancer treatment before a fullbody massage. When the dry brushing is part of a spa treatment, each area can be brushed separately before applying
the treatment product, or the entire body can be brushed
first before applying the spa product. When planning such
a treatment, consider how many times the client will have
to turn over. The fewer times the client has to turn over, the
more relaxing the treatment will be.

Dry Skin Brushing Techniques


Use a natural fiber brush with very light pressure on dry
skin, working from distal to proximal with rhythmic
strokes. Although some claim that circular motions and
figure of eights are calming, dry brushing works best when
it is done in brisk, straight lines with very light pressure,
directed toward the heart. Brushing techniques for each
body area are described below and shown in Figure 81. For
a video demonstrating dry skin brushing techniques, visit
thePoint.
Posterior Legs
Undrape the first posterior leg and brush it with light, rhythmic strokes from the ankle to the knee. Overlap the strokes
so that the entire area is covered by brush strokes. Brush
from the knee to the hip across the top of the thigh with
overlapping strokes. To brush the inner thigh, stand at the
clients hip facing toward the foot of the table. Place both
brushes on the medial aspect of the thigh and pull them

Williams_2E_CH08_printer_file.indd 157

toward the lateral side of the leg in light, rhythmic strokes.


To brush the lateral thigh, stand by the knee and run the
brushes briskly up the iliotibial band to the hip. To finish
dry brushing the posterior leg, brush from the ankle all the
way up the leg with long, flushing strokes. Many therapists
brush from the knee to the hip before they brush from the
ankle to the knee. The reason for this is that they believe
that brushing the proximal area first clears and opens up
lymph flow, so that stagnation does not occur when the distal area is brushed.
The Back
Stand on one side of the client, facing across the clients
body. Place the brushes on the far side of the client and pull
them in light strokes toward the spine. Move around the
table to the other side of the client in order to repeat the
side brush. To dry brush the main area of the back, stand
at the head of the table and begin the stroke at the sacrum,
pulling the brush toward the head of the client. To ensure
that the strokes are rhythmic, only brush as far as the midback. Use a separate set of strokes from the mid-back to the
shoulders.
Anterior Legs
When dry brushing the anterior legs, it is easiest to start
with the medial leg by standing at the clients hip and facing toward the foot of the table. Start the strokes by the ankle and work up the leg. Each stroke runs from the medial
side of the leg to the midline of the leg. To dry brush the

10/24/13 1:24 AM

158

Spa Bodywork: A Guide for Massage Therapists

Broaden Your Understanding 81

EXFOLIATION TREATMENTS OFFERED BY


ESTHETICIANS AND PHYSICIANS IN THE
SPA INDUSTRY
Ideally, all the therapists at a spa would have a working understanding of the different types of exfoliation
treatments that are available. Massage therapists
who understand the types of exfoliation treatments
used by estheticians and physicians are better
placed to advise clients on possible treatment options
and can suggest appropriate providers for the client.
The following exfoliation treatments are often seen in
a spa but are not regularly performed by a massage
therapist.
Facial Exfoliation: A specially formulated product
is used to exfoliate skin cells from delicate facial tissue.
This treatment is usually part of a facial service.
Enzyme Exfoliation: An enzyme such as papain
is applied to the skin to dissolve keratin and remove
dead and dulling skin cells. The product should not
be rubbed in. Enzyme exfoliation treatments are most
often used by estheticians in facial treatments but can
also be used in full-body treatments.
Skin Peels: High concentrations of alpha hydroxy
acids (AHAs) and beta hydroxy acids (BHAs) can
be used to resurface the skin. Only estheticians
with advanced training should use these products.
Treatments should only be carried out under the
supervision of a physician.
Chemical Peels: Chemical peel products may
include trichloroacetic acid or tretinoin (a vitamin
A derivative) to decrease fine lines and wrinkles
and resurface the skin. Chemical peels (known
as chemosurgery) should be applied only by a
physician.
Dermabrasion: Dermabrasion and dermaplaning
help to refinish the skins top layers. These treatments
both involve a controlled surgical scraping and should
be performed only by a physician.
Microdermabrasion: Microdermabrasion is a
nonsurgical procedure used by qualified estheticians.
The skin is literally sandblasted with microcrystals
of aluminum oxide to treat sun damage, wrinkles,
hyperpigmentation, acne scarring, and stretch marks.
Laser Skin Treatments: Laser skin treatments use
a carbon dioxide laser beam to remove layers of
damaged skin. It is commonly used for wrinkles, fine
lines, scars, or uneven pigmentation. This treatment
should only be performed by a qualified, experienced
physician.

Williams_2E_CH08_printer_file.indd 158

top of the anterior leg, stand by the foot and brush upward
toward the knee with light, overlapping strokes. The thigh
is brushed from the knee to the hip in straight, overlapping
strokes. The lateral section of the leg is brushed from the
ankle to the knee along the peroneal muscles and from the
knee to the hip along the iliotibial band. As with the posterior leg, some therapists prefer to brush from the knee to
the hip before they brush from the ankle to the knee. To
complete the anterior leg, brush from the ankle all the way
to the hip with long, continuous strokes.
Abdominal Area
To brush the abdominal area, stand to one side of the client and brush from the far side of the body toward the centerline. Brush the sides of the client from the hip into the
armpit by standing at the head of the table and pulling the
brushes upward in a straight line.
Chest
Stand at the head of the table and brush from below the
navel, pulling in a straight line between the breasts with
overlapping strokes. To avoid the breast drape, simply lift
the brush and jump over it. Brush from the armpit up
and around the breast, ending at the upper portion of the
sternum. Again, jump the breast drape to keep the flow of
the stroke. To finish the chest area, stand to one side of the
massage table and brush across the upper chest from one
shoulder to the other in a straight line.
Arms
Brush from the fingers to the elbow and from the elbow to
the shoulder. Some therapists prefer to brush from the elbow to the shoulder before they brush from the fingers to
the elbow. To complete the arms, use long strokes all the
way from the fingers to the shoulder.
Feet
Brush the feet from the toes down to the heel. Brush firmly
to avoid tickling the client, but if they are too ticklish to
tolerate this, skip the feet and move on.
SANITATION
Before brushing the feet, check them carefully
for fungal infections. If athletes foot or any
other contagious condition exists, skip the feet to avoid
spreading the condition. When brushing the feet, wipe
them first with a disposable antibacterial cloth such as a
diaper wipe.

The Enhanced Dry Skin Brushing Procedure


In the enhanced dry brushing treatment described below,
an invigorating toning massage step, a herbal steam, and

10/24/13 1:24 AM

Chapter 8

Exfoliation Treatments

159

Chest area:
1. Navel to upper chest
2. Armpit to sternum
3. Upper chest
Anterior arms:
Back:

1. Fingers to elbow
2. Elbow to shoulder
3. Fingers to shoulder

1. Side to center
2. Sacrum to mid-back
3. Mid-back to shoulders

Abdominal area:
1. Side to center
2. Hip to armpit

Posterior leg:

Anterior legs:

1. Ankle to knee
2. Knee to hip
3. Medial thigh
4. Lateral thigh
5. Ankle to hip

1. Medial leg
2. Ankle to knee
3. Knee to hip
4. Lateral leg
5. Ankle to hip
Feet:
1. Toes to heel

FIGURE 81 Dry skin brushing techniques. (A) The posterior body. (B) The anterior body.

the application of a revitalizing support lotion are added


to the treatment. The addition of these simple enhancers creates a well-rounded and satisfying skin brushing
service. For an overview of the treatment, review the dry
skin brushing outline in Treatment Overview 81 and
Figure 82.
Session Start
The client can begin the treatment in either a supine or a
prone position because the order in which each area of the
body is brushed is not fixed. In this particular procedure,
the posterior legs, gluteals, back, and posterior arms are
treated first. The client is then turned into the supine position so that his or her anterior legs, abdominal area, upper
chest, anterior arms, and feet are treated.
To start the service, place one hand on the clients
sacrum and one hand on C7 and ask the client to take three
slow, deep breaths. Next, undrape the first posterior leg and
proceed with the treatment.
Step 1: Dry Brush the Area
Dry brush the particular area as described previously under
Dry Skin Brushing Techniques. It is important to note

Williams_2E_CH08_printer_file.indd 159

that people learning dry skin brushing often make the mistake of brushing too hard. The lighter the brush stroke, the
more effective the treatment.
Step 2: Toning Massage
Carefully pour skin toner into one hand from a bottle
with a flip-top lid. Apply the toner to the client with massage strokes. Add more toner as needed until there is sufficient lubrication for massage. Most alcohol-free toners
(avoid the use of products with alcohol because these dry
the skin) contain glycerin, which makes them feel slippery
and refreshing. Keep the toning massage brief because skin
toners tend to be cooling, and the client may get cold if this
step is carried on for too long.
Step 3: Application of a Steamy Herbal-Infused Towel
Remove a hot, moist, herbal-infused towel from the soda
cooler and lay it over the body area youre working on.
Allow the towel to sit without touching it for 30 seconds.
To activate the towel and increase the clients perception
of warmth, use compression strokes over the top of the
towel. Remove the towel and blot the client dry with a soft
hand towel.

10/24/13 1:24 AM

160

Spa Bodywork: A Guide for Massage Therapists

Treatment Overview 81:


Dry Skin Brushing Overview

Indications
Dull skin; low energy; stress; sore muscles; to supportt a llarger treatment aimed at detoxification; dull, congested skin;
as preparation for application of a treatment product (the
removal of dead skin cells supports product absorption)

Contraindications
Skin conditions, broken or inflamed skin, sunburn,
high blood pressure, heart or circulatory conditions,
illness or fever, lymphatic condition, cancer (except
under the supervision of a physician), any condition
contraindicated for massage

simple aura mist. Make sure to use an aroma that contrasts


with the scent of the herbal towels and revitalizing lotion
for the greatest olfactory impact as discussed in Chapter 7
(Introduction to Aromatherapy for Spa).
SANITATION
At the end of the treatment, the dry skin
brushes are washed in warm, soapy water
and placed in alcohol for 20 minutes. They are allowed
to air dry and then placed back into a closed container.
Because alcohol is very drying for the brushes, they will
need to be replaced regularly.

Supplies for the Treatment Table Setup


Massage sheet, blanket or bath sheet for warmth, bolster,
warm packs as needed

Supplies for the Work Table Setup


(for the Enhanced Procedure)
1) Skin toner in a bottle with a flip-top lid
2) Soda cooler with nine herbal-infused towels
3) Revitalizing support lotion in a bottle with a flip-top lid or
other finishing product
4) Aura mist

Basic Procedure
Dry brush the particular body area working from the distal
area toward the heart. Begin on the posterior legs; proceed to the gluteals and back; turn the client and brush
the anterior legs, belly, arms, and upper chest before
brushing the feet.

Enhanced Procedure
1) Dry brush the particular body area working from the
distal area toward the heart.
2) Apply a skin toner with a variety of massage strokes.
3) Steam the area with a herbal-infused towel.
4) Apply a revitalizing support lotion or seaweed gel to the
area.
5) End the session with an aura mist of a contrasting scent.

Revitalizing Lotion Recipe


2 fl oz of plain unscented lotion, lavender essential oil
(9 drops), grapefruit essential oil (15 drops), thyme
essential oil (4 drops), juniper berry essential oil (2 drops)

Step 4: Application of a Finishing Product


In this treatment, a revitalizing support lotion is used as the
finishing product, but seaweed gel, plain moisture lotion, or
aloe vera gel may also be used. A revitalizing support lotion
consists of a regular moisture lotion or gel product mixed
with essential oils that support the lymphatic system (see
Treatment Overview 81 for a recipe). Apply the lotion from
the distal area to the proximal area with long, flushing strokes.
Session End
Once each area of the body has been treated, end the service with a neck and face massage, a face steam, or with a

Williams_2E_CH08_printer_file.indd 160

The Salt or Sugar Glow


Salt and sugar glows are therapeutically useful because
they stimulate local circulation to the skin, increase the
vital energy of the body, remove dead cells and impurities from the skin, and improve skin health. The role of
minerals in healthy skin metabolism and body function
is not fully understood. Minerals from Dead Sea salt and
other salt deposits (e.g., Bearn salt from the Pyrenees
Mountains in the South of France) are believed to help
regulate some skin and certain body functions. In a study
published in the International Journal of Cosmetic Science,1
potassium from sea salt increased carbon dioxide (CO2)
transport, whereas calcium helped to regulate cell membrane permeability in the skin. Some minerals are hygroscopic (meaning they attract water molecules) and can be
used to restore skin moisture perhaps by increasing intercellular water capacity. Of the many different types of salt
that can be used for a salt glow, the cheapest and most
readily available is ordinary sea salt, which is available at
many local grocery stores. The most popular type of sea
salt for spa treatments is Dead Sea salt.
The Dead Sea is an ancient landlocked sea whose water
has been slowly evaporating over the centuries, producing a concentrated natural salt solution. After bathing in
the Dead Sea, people often report a feeling of increased
energy, well-being, and special baby-soft skin. The main
elements in Dead Sea water are chlorine, magnesium,
sodium, calcium, potassium, and bromine.1 These minerals
are absorbed through the skin by bathing in the dissolved
salts or by using a Dead Sea salt cosmetic preparation.
In the study noted previously, the skin-smoothing effects
of Dead Sea minerals in a cosmetic product were compared
with the same cosmetic product containing no Dead Sea
minerals. The control in the study, a plain gel with no active
ingredients, showed an average decrease in skin roughness
of only 10.4%. The cosmetic product containing no Dead
Sea minerals reduced roughness by 27.8%. The cosmetic
product containing Dead Sea minerals reduced roughness
by 40.7%.1

10/24/13 1:24 AM

Chapter 8

B1

B2

Exfoliation Treatments

161

FIGURE 82 Enhanced dry brushing procedure. (A) Dry brush the


area. (B1 and B2) Toning massage. (C) Herbal steam. (D) Application of
a finishing product.

Bearn salt, from springs in the Pyrenees Mountains of


Southern France, has well-known restorative and antistress
properties, making it especially useful for hydrotherapy tub
soaks. It is mined close to a small spa town called Saliesde-Barn, where the thermal waters are seven times more
salty than seawater. The thermal pool in the middle of
town is a favorite place to soak tired feet after hiking in the
Pyrenees. As early as the 16th century, the ladies of the court
of Navarre would leave their chateaus to bathe in Salies,
believing it would prevent premature aging. Today, the
salt springs are still used to heal urinary infections, to treat
arthritis, and for children with developmental problems.

Epsom salts are inorganic mineral salts that support


the body in its efforts to detoxify itself. Epsom salts are
often used for sore, tired muscles and as a soaking agent
for bruises, sprains, and strains. Because Epsom salts are
drying, they are best used on oily skin types.
Chemically, salt consists of 60.663% elemental chlorine
(C1) and 39.337% sodium (Na). Table salt is processed, so
it contains higher levels of chlorine than other types of salt.
The relatively high chlorine content of table salt can burn
a clients skin, and this is the reason that it is not suitable
for use in spa treatments. Sea salt and mineral salts are safer
for spa use because they contain a wider range of minerals

Williams_2E_CH08_printer_file.indd 161

10/24/13 1:24 AM

162

Spa Bodywork: A Guide for Massage Therapists

and proportionately less total chlorine. They are therefore


gentler, less irritating to the skin, and can be safely used in
spa treatments.
Sugar is gentler than salt and has emollient and humectant (moisturizing) properties that leave the skin feeling
soft and smooth. When dissolved, it can be applied to the
skin as a glaze to soften, increase water content, and aid in
healing. Brown sugar and table sugar are granular, so they
can be used for exfoliation, whereas honey, molasses, and
dissolved sugar are used as body glazes.

The Salt or Sugar Glow Procedure


As with all spa treatments, there are a number of different
delivery options for this service. Often, a salt or sugar glow
will be a quick 30-minute treatment that is used to prepare
the body for another service. Sometimes, the salt or sugar
glow is given together with a Vichy shower to take advantage
of the contrasting water temperatures, an equally important
part of the treatment. The treatment described here is not traditional in its approach but will quickly gain popularity with
clients. It is meant to be used in a dry room and delivered with
a full-body massage. The massage step is intertwined with the
salt or sugar step so that each part of the body is addressed
separately. Because so much massage is used in this treatment, it takes from 75 to 90 minutes to deliver the session.
For an overview of the treatment, review the salt or sugar glow
outline in Treatment Overview 82 and Figure 83. Table 82
describes different salt and sugar mixtures and various ways
to apply the salt or sugar to the body. Also, you can see a video
demonstrating this technique by visiting thePoint.
Session Start
Bolster the client as you would for a massage. The order in
which each body area is addressed is not fixed, but it works
well if the client starts in a prone position, beginning the
treatment with the posterior legs and gluteals and progressing to the back. The client can then be turned into a supine
position for the last half of the treatment while the anterior legs, feet, abdominal area, upper chest, and arms are
treated. The treatment ends with a neck and face massage.
Step 1: Massage
Undrape the desired body area and apply massage oil with
Swedish strokes. You can determine the length of the massage step, the depth you use, and the types of strokes you
use based on how you design the session or on the treatment goals you have agreed with the client. Many therapists
choose to offer a longer version of this treatment and include a full range of strokes during the massage step.
Step 2: Exfoliation
Be careful not to apply salt or sugar to a body area that is
not well oiled because this may cause irritation to the skin
and will feel abrasive to the client. After lubricating the area
with massage oil, lightly sprinkle the salt or sugar onto the
area with a cheese shaker or scoop it up from a bowl after it

Williams_2E_CH08_printer_file.indd 162

Treatment Overview 82:


The Salt or Sugar Glow Overview

Indications
Low energy; sore muscles; stress; dull, rough skin; or as a
preparation step before the application of a treatment
product in a larger service

Contraindications
Skin condition, inflamed skin, broken skin, poorly managed
diabetes, illness, fever, any condition contraindicated for
massage

Supplies for the Treatment Table Setup


(from the bottom layer to top layer)
1) Plastic table protector
2) Bottom massage sheet
3) Bath towelthe weave of the bath towel will catch
excess salt or sugar that falls off the client during the
first half of the treatment. When the client turns over,
the towel will prevent him or her from feeling the salt or
sugar granules.
4) Top massage sheet
5) Blanket or bath sheet for warmth

Supplies for the Work Table Setup


1) Salt or sugar in a bowl or a cheese shaker
2) Massage oil or body wash gel for mixing up salt or
sugar
3) Aroma mist or skin toner
4) Mist bottle or cosmetic sponges for applying aroma mist
or toner
5) Finishing product (lotion, gel, etc.)
6) Soda cooler and hot, moist towels
7) Bowl of warm water
8) Other items as needed for variations or enhancers (i.e.,
slippers, robe, foot soak, essential oils, etc.)

Dry Room Procedure


1) Massage the body area.
2) Apply salt or sugar and exfoliate the area.
3) Remove salt or sugar with a hot towel.
4) Apply aroma mist or skin toner.
5) Pat the area dry with a hand towel.
6) Apply a finishing lotion or gel.
7) Redrape the body area and move on to the next area.
8) At the end of the treatment, provide a massage of the
neck and face then finish with an aura mist of a contrasting scent.

Wet Room Procedure


1) Begin on the posterior of the body.
2) Wet the body with warm water.
3) Apply salt or sugar in a bath gel.
4) Add warm water and exfoliate the posterior body.
5) Rinse the salt or sugar from the body.
6) Turn the client and repeat on the anterior body.
7) Dry the client and move him or her to a massage table.
8) Apply a finishing lotion or gel.

Note
If a Vichy shower is used (instead of a handheld shower),
the rinsing step can take up to 10 minutes.

10/24/13 1:24 AM

Chapter 8

FIGURE 83 The salt or sugar glow. (A) Massage. Undrape the desired
body area and apply massage oil with Swedish strokes. (B) Apply salt or
sugar to the body with a shaker (the salt or sugar can be premixed with
oil or bath gel and applied by hand if preferred). (C) Exfoliation. Using
gentle, superficial strokes, rub the salt or sugar across the surface of the
body. (D) Product removal. Remove the salt or sugar with a moist, hot
towel and apply a skin toner to firm the skin and remove excess salt.
(E) Redrape. Dry the area with a soft hand towel, redrape, and move to
the next body area where the same steps will be repeated.

has been mixed with oil and apply it by hand. Avoid using
too much salt or sugar because a very small amount gives
good results. Also, be careful not to get the salt or sugar all
over the massage table when sprinkling.
Work the salt or sugar across the top of the skin with
gentle circular strokes to stimulate the soft tissue and to
remove dead skin cells. Massage therapists often overexfoliate because they tend to work into the muscle rather
than keeping the strokes superficial. With coarse crystalline products such as salt, this can cause some discomfort
to the client. It is advisable to check regularly if the client is
happy with the depth of the application and the sensation
of the exfoliation.

Williams_2E_CH08_printer_file.indd 163

Exfoliation Treatments

163

E
The salt or sugar will often trickle off the client onto the
bath towel you placed on top of the massage sheet. Although
you may want to avoid getting product all over the massage
table, there is no way to prevent some of the salt or sugar
from falling off the client. If large amounts of salt or sugar
fall off the client, it may feel uncomfortable when he or she
is turned over and has to lie on it. In this case, you are probably using too much salt or sugar and not enough oil.
Step 3: Product Removal
Remove the salt or sugar mix with a hot towel. It should
be possible to remove all of the salt or sugar using just one
hand towel per body part. Review Chapter 5 (Foundation

10/24/13 1:24 AM

164

Spa Bodywork: A Guide for Massage Therapists

TABLE 82 Salt and Sugar Mix Ups


SALT OR SUGAR SILK
Most often, salt or sugar is mixed with a fixed oil such as sunflower or sweet almond oil (a variety of fixed oils can be used) and then applied directly
to the skin by hand. You can choose from premixed products purchased through a spa supply outlet or you can mix your own.
Cream Silk

Sweet and Silky

Sea Silk

cup Dead Sea salt, cup table sugar,


2 tbsp milk powder, 1 tbsp sweet almond
or sunflower oil, and cup of body cream
will make a nice emollient salt or sugar glow
mixture. Depending on the granule size of the
salt, more or less lotion may be required.

cup table sugar, cup brown sugar, 1 tbsp


cup Dead Sea salt, cup plain sea salt,
ground lavender powder, and 1 tbsp aloe vera
1 tsp seaweed powder, and 1 tbsp aloe vera
gel. Add sweet almond or sunflower oil to
gel. Add sweet almond or sunflower oil to
create a slightly runny paste or to achieve the
create a slightly runny paste or to achieve the
consistency desired by the individual therapist.
consistency desired by the individual therapist.
SALT OR SUGAR FOAM

If the salt or sugar glow is delivered in a wet room with a Vichy, Swiss, standard, or handheld shower, a body wash gel makes a desirable
base. The gel will turn to bubbles that are easily rinsed away, leaving the skin clean and smooth. The dry room option is to apply the salt
or sugar with oil as noted above and then add foaming body wash over the top. You place your hands in warm water and then use the
water to work the body wash into lather. Remove the body wash, salt or sugar, and oil with one hot, moist towel and proceed to the next
body area.
Foamy Flowers

Foamy Fruits

Foamy and Flirtatious

cup plain body wash, cup brown sugar, 2


cup plain body wash, cup sea salt,
drops ylang ylang essential oil, 7 drops manda- 8 drops grapefruit, 8 drops lemon, and 1 drop
rin essential oils, and 5 drops lavender essential peppermint essential oil. You may choose
oil. You may choose to add more or less sugar
to add more or less sugar depending on the
depending on the consistency you desire.
consistency you desire.

cup plain body wash, cup table sugar,


11 drops lime oil, 2 drops jasmine oil, and
2 drops rosemary oil. You may choose to
add more or less sugar depending on the
consistency you desire.

SALT OR SUGAR SHAKE-UP


Dry salt or sugar is stored in a cheese shaker and sprinkled on the body after the body has been massaged generously with oil. This feels like cool
raindrops falling onto the body. Extra oil is added as needed to provide adequate lubrication for the salt or sugar exfoliation.
Sea Shake

Earth Shake

Milk Shake

Dead Sea salts mixed with 1 tbsp seaweed


powder stored in a cheese shaker

Table sugar with 1 tbsp Sedona clay stored in a


cheese shaker

Table sugar with cup powdered milk stored in


a cheese shaker

SALT OR SUGAR HAPPY HOUR


These mixtures are blended and applied directly to the skin as in the mixtures made with oil. Massage the client first with a generous layer of oil so
that there is sufficient lubrication for the exfoliation. The happy hour products are applied over the top of the oil, and then the entire mixture is
removed with a hot, moist towel.
Sangria

Japanese Plumb

Champagne Sparkler

cup of table sugar, cup of red table wine,


cup of table sugar, cup of Japanese plumb cup of table sugar, cup of champagne,
cup of orange juice, and 2 tbsp of grapeseed
wine, and 2 tbsp of sesame seed oil. You may
and 2 tbsp of sunflower oil. You may choose
oil. You may choose to add more or less sugar
choose to add more or less sugar depending
to add more or less sugar depending on the
depending on the consistency you desire.
on the consistency you desire.
consistency you desire.
Margarita

Cream de Coco

Sea Breeze

cup of finely granulated sea salt, 8 drops


of lime essential oil, and sunflower oil to the
consistency desired by the therapist

cup of table sugar, cup of powdered


cocoa, and sunflower oil to the consistency
desired by the therapist

cup of finely granulated sea salt, cup of


cranberry juice, and 2 tbsp of sunflower oil

Skills for Spa Treatment Delivery) for step-by-step direction


for using hot towels to remove product.
Step 4: Aroma Mist or Skin Toner
Apply an aroma mist or skin toner to the area and then
blot the skin dry with a soft, dry hand towel. Large facial
sponges can also be used to apply skin toner directly
to the skin. The mist or toner allows you to pick up
any stray salt or sugar while returning the skin to the
proper pH.

Williams_2E_CH08_printer_file.indd 164

Step 5: Application of a Finishing Product


Lotion, body cream, or a light gel product can be applied to
the skin to lock in moisture and add to the overall textural
enjoyment of the treatment. Redrape the finished body area
and move on to the next body area.
Session End
Once each area has been treated, massage the clients neck
and face with a massage cream. This rounds out and completes the treatment. The session can end with an aura mist

10/24/13 1:24 AM

Chapter 8

spritzed in a high arch above the client to fill the treatment


room with a refreshing scent.

Exfoliation Treatments

165

Treatment Overview 83:


The Full-Body Polish Overview

Indications

The Full-Body Polish

Dull, congested skin; stress; to facilitate relaxation; or as


preparation for the application of a treatment product

A full-body polish is usually delivered as a standalone


service and involves an elegant four-step exfoliation
process that focuses on skin care and deep relaxation.
This treatment also increases local circulation to the
skin, stimulates the vital energy of the body, removes
dead skin cells, and cleanses and smooths the skins
surface.
In a body polish, an exfoliation product, a cleanser, a
toner, and a moisturizer are used separately in each step
of the treatment to mimic the steps in a facial. Usually,
the exfoliation product has a fine-textured ingredient
such as mesh pumice that is suspended in a heavy emollient to protect the skin. This creates a softer sensation
than a salt, sugar, or dry brush exfoliation. For this
reason, a full-body polish is considered the more elegant
and gentle of the exfoliation treatments.
The development of a well-considered treatment concept and smell-scape will enhance the clients perception
of this service and give it a unique flair. For example, the
Four Seasons Hotel and Spa2 offers a crushed pearl and
lavender polish, whereas the Ritz-Carlton Hotel and Spa3
highlights the alpine berry body polish on their treatment menu. The sugar sand polish featured at the Beau
Rivage Spa on the Mississippi Gulf Coast uses the fine
white sand found only on the Gulf s barrier islands.4
Samasati Spa on the Caribbean Coast uses the refined
sand from their beaches in an avocado and black sand
body polish.5 Each of these treatment names suggests a
certain type of smell-scape that adds interest to the treatment. Matched products can be purchased from spa suppliers or you can create your own using essential oils as
discussed in Chapter 7 (Introduction to Aromatherapy
for Spa).

Contraindications
Skin conditions, broken or inflamed skin, sunburn,
poorly managed diabetes, illness, fever, any condition
contraindicated for massage

Supplies for the Treatment Table Setup


(from the bottom layer to top layer)
1) Plastic table protector
2) Bottom massage sheet
3) Bath towelthe bath towel will catch any excess moisture from the treatment, keeping the client dryer.
4) Top massage sheet
5) Blanket or bath sheet for warmth

Supplies for the Work Table Setup


1) Bowl of warm water
2) Exfoliation gloves (optional)
3) Exfoliation product
4) Body wash product
5) Body mist or skin toner product
6) Rich moisture cream
7) Soda cooler
8) Hot, moist towels
9) Dry hand towel

Dry Room Procedure


For each body area:
1) Dampen the body area with warm water.
2) Apply the body polish product with bare hands or
exfoliation gloves.
3) Apply the body wash product and work into a lather.
4) Remove the polish and body wash product with a hot,
moist towel.
5) Apply aroma mist or skin toner.
6) Blot the area dry with a soft hand towel.
7) Apply rich body cream with massage strokes.
8) Redrape the area and move onto the next area.
9) Finish the service with a neck and face massage and
an aura mist of a contrasting scent.

Wet Room Procedure

The Full-Body Polish Procedure


As with the salt or sugar glow, the treatment described below was developed for massage therapists to use in a dry
room. In a traditional body polish, massage would not
normally be included as part of the treatment. This takes
longer, but clients respond well to treatments that include
an exceptional massage, so aim to deliver this service in 75
to 90 minutes, depending on the length of the massage.
It should be noted that in a traditional body polish, the
cleanser step is always first (just as in a facial). In a dry room,
it is helpful to exfoliate before using the cleanser because
the cleanser helps to lift the fine-mesh exfoliant off of the
skin, leaving the skin smoother. The full-body polish outline in Treatment Overview 83 and Figure 84 provide a
useful snapshot of the service.

Williams_2E_CH08_printer_file.indd 165

1) Wet the posterior body with the handheld shower and


apply the body wash product.
2) Rinse the cleanser off with the handheld shower.
3) Apply body polish with the hands to the posterior body.
4) Rinse with the handheld shower (if a Vichy is used, the
rinse step can be a 10-minute contrast shower).
5) Turn the client into the supine position and repeat steps
1 to 4 on the anterior body.
6) Move the client to a massage table covered with massage sheets.
7) Apply the toner to the posterior body and blot with a
soft hand towel.
8) Apply moisture lotion, cream, or gel with massage
strokes to the posterior body.
9) Turn the client into the supine position.
10) Repeat steps 7 and 8 on the anterior body.
11) Provide a neck and face massage if desired.
12) Finish with an aura mist of a contrasting scent.

10/24/13 1:24 AM

166

Spa Bodywork: A Guide for Massage Therapists

FIGURE 84 The full-body polish. (A) Exfoliate and cleanse. Dampen the body area with warm water and
apply an emollient exfoliation cream. Textured exfoliation gloves can be worn if desired by the therapist. After the
exfoliation is applied, cleanser helps to lift the exfoliation product off the skin, leaving the body feeling clean and
smooth. Remove the cleanser and exfoliation product together in one step. (B) Tone. Apply a skin toner or aroma
mist with cosmetic sponges or a mist bottle. Dry the skin with a soft, dry hand towel. (C) Moisturize. Use a heavy
moisture cream if this will also be the massage step. If massage is not included, a light lotion or gel can be used.
(D) End the session with an aura mist.

Session Start
In this procedure, each body area is treated in exactly the
same way, so the sequence of body areas is not important. It
works well to begin in the prone position with the posterior
legs, gluteals, and back and then turn the client into the
supine position for the anterior legs, feet, abdominal area,
upper chest, and arms. End the treatment with a neck and
face massage and an aura mist to revitalize the client before
he or she leaves the spa.

the exfoliation product is not removed before the cleansing step. Instead, the cleansing product is applied on top
of the exfoliation product and both products are removed
with one towel.
Step 2: Cleansing
Apply a liquid or lotion-based cleanser to the body with the
hands and work it into a gentle lather. Remove the product
with a hot, moist towel. The body wash is used to lift exfoliant off the skin, leaving the skin smoother.

Step 1: Exfoliation
Wearing exfoliation gloves, the therapist places his or her
hands in a bowl of warm water and lightly wets the body
area in focus. Use the water sparingly. Do not allow droplets of water to roll down the sides of the client. Add a
small amount of body polish to the gloves and use circular
motions to manually exfoliate the area.
In a wet room setting, a Vichy or handheld shower is
used to rinse the product off. In a dry room, hot, moist
towels are used to remove the product. To save on laundry,

Williams_2E_CH08_printer_file.indd 166

Step 3: Aroma Mist or Skin Toner


Apply an aroma mist with a spritz top or apply skin toner
with large cotton pads or facial sponges. Blot the skin dry
with a soft hand towel.
Step 4: Moisturize
If the moisturizing step is also the massage step, a heavy moisturizing cream works best. If massage is not part of the treatment, a light body milk, lotion, or gel product may be used.

10/24/13 1:24 AM

Chapter 8

Session End
If the treatment ends in the supine position, a neck and face
massage can be given as a closing step. End the session with
an aura mist spritzed over the client in a high arch to fill the
treatment room with a refreshing scent.

Exfoliation Treatments

167

Treatment Overview 84:


The Loofah Scrub Overview

Indications
Low energy, to revitalize the body, to decrease stress, or as
preparation for the application of a treatment product

Contraindications

The Body or Loofah Scrub


The body or loofah scrub is the most invigorating and least
formal of the exfoliation treatments. It is often paired with
uplifting and refreshing smell-scapes such as eucalyptus
or citrus and mint. Like the salt glow or body polish, the
amount of massage you provide with this service will determine the amount of time required for delivery. Although
this treatment is not described in step-by-step detail, the
loofah scrub overview in Treatment Overview 84 and
Figure 85 provide a useful snapshot of the service.
SANITATION
The handheld loofahs (approximately $2.00
each) should be thrown away or given to the
client after each treatment because they deteriorate
when sanitized with alcohol.

The Buff and Bronze


As people became more aware of the dangers of natural tanning in the sun over the last few decades, tanning booths
became popular because they were marketed as a healthier
alternative. Tanning booths use mainly ultraviolet A (UVA)
rays to cause pigment changes without burning. Because
tanning booths are more or less ultraviolet B (UVB) free, it
was thought that they were safe. As more research has been
conducted, both UVA and UVB rays have been found to be
implicated in skin damage, immune suppression,6 premature
aging,7 and skin cancer.8
Artificial sunless tanning products provide an alternative to tanning booths. The professional products available through spa suppliers produce natural-looking results
that are safe for the skin and easy to maintain. Avoid overthe-counter products that are of lower quality and sometimes have an orange tint. Artificial tanning products can
be applied in many different ways, including air brushing,
buff and bronze spa treatments, and even in sunless tanning booths.
Although booths and air-brushing techniques are quick
and effective, full-body buff and bronze treatments are effective and also relaxing and enjoyable to receive. All three
types of application have linked home care products that
help to generate more income for the spa or clinic. Buff and
bronze treatments can also be used to attract male clientele,

Williams_2E_CH08_printer_file.indd 167

Skin conditions, broken or inflamed skin, sunburn,


poorly managed diabetes, illness, fever, any condition
contraindicated for massage

Supplies for the Treatment Table Setup


(from the bottom layer to top layer)
1) Plastic table protector
2) Bottom massage sheet
3) Bath towelthe bath towel will catch any excess moisture from the treatment, keeping the client drier.
4) Top massage sheet
5) Blanket or bath sheet for warmth

Supplies for the Work Table Setup


1) Body wash product
2) Two loofah mitts 3) Bowl of warm water
3) Body mist or skin toner
4) Dry hand towel
5) Moisturizer

Dry Room Procedure


1) Use a gluteal drape so that the entire posterior body
can be treated at one time.
2) Apply a foaming body wash with two handheld loofahs
to the posterior body.
3) Apply a body mist or skin toner to each body area.
4) Redrape the body and massage each posterior area
with a massage cream or moisturizing lotion.
5) Turn the client and repeat the steps on the anterior
body.
6) Provide a neck and face massage if desired.
7) Finish with an aura mist of a contrasting scent.

Wet Room Procedure


1) Wet the posterior body with the handheld shower
and apply the body wash product with two handheld
loofahs.
2) Rinse the cleanser with the handheld shower (if a Vichy
is used, the rinse step can be a 10-minute contrast
shower).
3) Turn the client into the supine position and repeat steps 1
and 2 on the anterior body.
4) Move the client to a massage table set with massage
sheets.
5) Apply the toner to the posterior body and blot with a soft
hand towel.
6) Apply moisture lotion, cream, or gel with massage strokes
to the posterior body.
7) Turn the client into the supine position.
8) Repeat steps 5 and 6 on the anterior body.
9) Provide a neck and face massage if desired.
10) Finish with an aura mist of a contrasting scent.

10/24/13 1:25 AM

168

Spa Bodywork: A Guide for Massage Therapists

especially bodybuilders who must look tan under the bright


lights of the competition stage. Bodybuilders often shave
their bodies, making application simple. With hairy men,
the therapist should plan extra treatment time so that they
can work the product into the skin well.
Most of the sunless tanning products use the chemical
interaction of dihydroxyacetone (DHA), a sugar, with the
amino acids in the dead skin cells in the upper layers of the
skin. The chemical interaction causes the cells to change
color, leaving the skin golden brown until the skin cells
naturally slough off.9 Although the rate at which skin cells
slough off varies from person to person, sunless tans usually start to fade in about 3 days, and the product needs to
be reapplied.

The Buff and Bronze Procedure


Clients should shave or remove unwanted hair from the
body the evening before the treatment. Exfoliation is usually not performed on freshly shaved or waxed skin. For
this reason, only a gentle, fine-mesh product should be
used in this treatment. If shaving or waxing takes place after the treatment, it will streak the autotanner even if the
tan has already developed. Usually, an exfoliation product is sold with the autotanning product and a specific

Williams_2E_CH08_printer_file.indd 168

FIGURE 85 The loofah scrub. (A) Loofah scrub. Apply a foaming


body wash with two handheld loofah mitts to the posterior body. Use a
gluteal drape so that the entire area can be treated at once. (B) Remove.
Use hot, moist towels to remove the foaming body wash from the posterior body and then dry the client with a hand towel. (C) Moisture massage.
Redrape the posterior body with a sheet and massage moisture cream
into each body area separately. Repeat the scrub on the anterior body
using a breast drape and anterior pelvic drape.

type of moisturizer to make product planning easy for the


therapist.
Autotanning product will stain clothing and the palms
of the therapists hands, so it is best to wear vinyl gloves.
An apron and beige or dark-colored treatment sheets
can be purchased to protect both bedding and clothing
from stains. The buff and bronze overview in Treatment
Overview 85 and Figure 86 provides a snapshot of this
service.
Session Start
Ask the client to get on the massage table in the supine
position. Exfoliate the anterior body and then turn the client to exfoliate the posterior body. Next, the moisturizing
and bronzing steps are carried out straight after the exfoliation on the posterior body. The client is turned over again
so that the moisturizing and bronzing steps can be completed on the anterior side of the body. This prevents the
wet exfoliation from streaking the bronzing product and
allows the client to finish the session face up.
If the client has extremely dry or patchy skin where
some areas are very dry, apply a cold pressed oil such as sunflower or sweet almond oil to the body before the rest of the
treatment. This conditions and softens the skin. When the
exfoliation product and cleanser are used in their normal

10/24/13 1:25 AM

Chapter 8

Exfoliation Treatments

169

Indications

apply the exfoliation product to the entire body; remove it


with a standard shower, Vichy shower, or handheld shower;
dry the client; and then move him or her to a massage table
for the rest of the service.

For cosmetic purposes to hide skin discolorations, to


t appear
tan while protecting the skin from the sun, relaxation

Step 1: Exfoliate Anterior

Treatment Overview 85:


The Buff and Bronze Overview

Contraindications
Broken skin, inflamed skin, sunburned skin, allergies to DHA,
illness, fever, any condition contraindicated for massage

Supplies for the Treatment Table Setup


(from the bottom layer to the top layer)
1) Beige or dark massage sheet
2) Bath towel
3) Top massage sheet
4) A warming device such as a heat lamp because the
client will air dry and may become cold if warming is
not planned

Supplies for the Work Table Setup


1) Bowl of warm water
2) Exfoliation product
3) Body wash product
4) Moisturizing product
5) Autotanning product
6) Vinyl gloves
7) Buffing mitts