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COMPETENCY BASED LEARNING MATERIAL
Sector: HEALTH, SOCIAL AND OTHER COMMUNITY
DEVELOPMENT SERVICES
Qualification Title: MA...
You are required to go through a learning activities in order to complete
each learning outcome of the module. In each lea...
QUALIFICATION: MASSAGE THERAPY NC II
UNIT OF COMPETENCY: WORK WITH A HOLISTIC THERAPEUTIC
MASSAGE FRAMEWORK
MODULE TITLE: ...
5. Additional complementary therapies used in therapeutic massage
are identified and described
6. Massage assessment techn...
LEARNING OUTCOME
#1
DEMONSTRATE COMMITMENT TO
CENTRAL PHILOSOPHIES OF
THERAPEUTIC MASSAGE PRACTICES.
CONTENTS:
• Effects o...
• Written Evaluation / Paper and Pen Test
• Observation
Learning Experiences
Learning Outcome 1
DEMONSTRATE COMMITMENT TO ...
INFORMATION SHEET 1.1
Learning Objectives:
After reading this INFORMATION SHEET, YOU MUST be able to—
1. Define clearly th...
around them, hold or stroke them to comfort, support and reassure them
in their times of need.
Body and mind should not be...
applied forms of massage for many ailments; and Hippocrates wrote papers
recommending the use of rubbing and friction for ...
application of these techniques may include, but is not limited to, stroking,
kneading, tapping, compression, vibration, r...
INFORMATION SHEET 1.1-A
History of Massage
Massage is safe and effective combination of techniques that almost anyone
can ...
Greek and Roman era, prescribed it both for its restorative powers and for
general preservation of the body and mind.
In t...
quoted), and in 1899 Sir William Bennet inaugurated a massage department
at St. George's Hospital, London.
Although the pr...
method most familiar to Westerners, was developed in the 19th century by a
Swedish doctor, poet, and educator named Per He...
INFORMATION SHEET 1.1-1-B
Therapeutic Effects of Massage
By Kim Markiecki, LMT
MASSAGE AFFECTS THE BODY AS A WHOLE
NERVES
...
on gravity, muscle contraction, passive movement and external pressure.
Massage can dramatically aid the movement of lymph...
INFORMATION SHEET 1.1-1-C
BENEFITS OF MASSAGE
(www.wikipedia.org)
Peer-reviewed medical research has shown that the benefi...
Single dose effects
Mechanical massage chairs at VivoCity in Singapore.
• Pain relief: Relief from pain due to musculoskel...
• Attention: After massage, EEG patterns indicate enhanced
performance and alertness on mathematical computations, with th...
In the United States there are about 90,000 massage therapists. Training
programs in the US are typically 500–1000 hours i...
or by calling themselves that protected title. Certification allows only
those who meet certain educational criteria to us...
Steambath. A small part of their training will include special forms of
massage which are decided by the local college, fo...
Alternatively, the effects of massage on the nerves may be stimulating,
promoting an increase in the activity of the muscl...
problems. The heartbeat strengthens, the rate of the heartbeat decreases
and high blood pressure is reduced.
Benefits to t...
and tone are greatly improved - the skin is healthy and glowing following a
treatment.
Benefits to the Genito-urinary Syst...
• Improve the condition of the body’s largest organ—the skin.
• Increase joint flexibility.
• Lessen depression and anxiet...
• Enhanced sleep quality.
• Greater energy.
• Improved concentration.
• Increased circulation.
• Reduced fatigue.
Furtherm...
Research continues to show the enormous benefits of touch—which range
from treating chronic diseases, neurological disorde...
INFORMATION SHEET 1.1-1-E
Massage Contraindications (When not to massage)
Avoid massage in the following conditions, insta...
o Open wounds, cuts and bruising
Apply only light touch drainage massage around the site, to assist the
blood flow towards...
o Infectious skin diseases
Bacterial infection, Lymphangitis, Fungal infection, Viral infections,
Herpes, in these conditi...
Consult a qualified medical practitioner if you having high blood
pressure, diabetes or any heart disease prior to receivi...
6. Massage: The application of soft-tissue manipulation techniques to the
body, is not intended to reduce stress and fatig...
16. Apurveda, the traditional Indian system of medicine, places great
emphasis on the therapeutic benefits of massage with...
27. The genito-urinary system, the use of abdominal and back massage
promotes the activity of kidneys, which enhances the ...
5. True
6. False
7. True
8. True
9. False
10. False
11. False
12. True
13. True
14. False
15. False
16. False
17. True
18....
INFORMATION SHEET 1.1-2-A
Ethical issues in therapies
General Principles of Ethics
Ethics is defined by Webster as the stu...
risks are involved, what are the possible benefits of a treatment, how much
time will the treatment take, how much money w...
experiences, values and morals. The physical space is the actual physical
limits of space that is needed by each person to...
Boundary violations usually begin quietly, little by little, and without many
problems. When you go through the process of...
Knowing the basic principle of ethics is just the beginning to building a
successful practice.
Reference: http://www.thebo...
comfortable. Regardless, the therapist will appropriately drape the client so
that only the areas of the body being massag...
And let's be clear. While there are documented benefits of breast massage,
it is not, and should not be, included in a tot...
expand beyond the massage table to a social or even romantic connection
is to invite a host of ethical dilemmas. A therapi...
SELF-CHECK 1.1-2
TRUE OR FALSE
Write T if the statement is true and F is the statement is false in your
answer sheet.
1. E...
8. Conversations that occur during a session should not be repeated or
included in the chart notes unless it is describing...
19. Contra-Indications of transference are things like the client brings you
additional gifts or asks to see you for lunch...
12. true
13. true
14. false
15. true
16. false
17. true
18. true
19. false
20. true
INFORMATION SHEET 1.1-3-A
OHS requirem...
contribute to accidents by hiding hazards that cause injuries. If the sight of
paper, debris, clutter and spills is accept...
To avoid these hazards, a workplace must "maintain" order throughout a
workday. Although this effort requires a great deal...
A good housekeeping program plans and manages the orderly storage and
movement of materials from point of entry to exit. I...
• removal of unused materials
• inspection to ensure cleanup is complete
Do not forget out-of-the-way places such as shelv...
places like shelves, piping, conduits, light fixtures, reflectors, windows,
cupboards and lockers may require manual clean...
and dust before they reach the floor or cleaning them up regularly can
prevent their accumulation. Areas that cannot be cl...
Spill Control
The best way to control spills is to stop them before they happen. Regularly
cleaning and maintaining machin...
maintenance program provides for the inspection, maintenance, upkeep
and repair of tools, equipment, machines and processe...
Flammable, combustible, toxic and other hazardous materials should be
stored in approved containers in designated areas th...
INFORMATION SHEET 1.1-3-B
Hygiene for Massage Therapists
Understanding hygiene is essential for massage therapists to keep...
Sepsis - poisoning due to a pathogen
Sterile - free from germs and spores
Sterilization- to make sterile and free from bac...
SELF-CHECK 1.1-3
TRUE OR FALSE
Write T if the statement is true and F is the statement is false in your
answer sheet.
1. E...
ANSWER KEY 1.1-3
1. True
2. False
3. False
4. True
5. False
6. False
7. True
8. True
9. False
10. False
CSAT
QA
SYSTEM
MAS...
INFORMATION SHEET 1.1-4
Communicating in group and one-on-one settings
Massage Client Interview Skills
The Massage Client ...
• learn to communicate just what it is that you do in a massage or
what happens when different massage is applied to the b...
about their real issues. This isn't psychotherapy but getting people to
become more aware of their bodies.
Most massage th...
Being able to communicate with clients in this way requires that massage
therapists be able to set aside their own views a...
• Are you seeing other health care providers like physical therapists,
acupuncturists, Naturopaths, chiropractors, sports ...
clients to describe their circumstances in their own words.
Questions about the client’s problem:
What brings you to physi...
problem have on your life? What are you unable to do because of this
problem, with respect to all aspects of your life: se...
"What medications are you currently taking?"
"Have you had any previous physical therapy?" (If yes, describe;
was it succe...
• Insurance companies accept it as proof of reasonable care and
it provides evidence for attorneys as proof of significant...
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  1. 1. COMPETENCY BASED LEARNING MATERIAL Sector: HEALTH, SOCIAL AND OTHER COMMUNITY DEVELOPMENT SERVICES Qualification Title: MASSAGE THERAPY NC ll Unit of Competency: WORK WITHIN A HOLISTIC THERAPEUTIC MASSAGE FRAMEWORK Module Title: Working within a Holistic Therapeutic Massage Framework Technical Education and Skills Development Authority CAMIGUIN SCHOOL OF ARTS AND TRADES Lumad, Mambajao, Camiguin HOW TO USE THIS COMPETENCY BASED LEARNING MATERIAL Welcome to the module in Working within a Holistic Therapeutic Massage Framework. This module contains training materials and activities for you to complete. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 1 of 271
  2. 2. You are required to go through a learning activities in order to complete each learning outcome of the module. In each learning outcome are information Sheets, Self-Checks, Operation Sheets and Job Sheets. Follow these activities on your own. If you have questions, don’t hesitate to ask your facilitator for assistance. The goal of this module is the development of practical skills. To gain these skills, you must learn basic concepts and terminology. For most part, you’ll get this information from the Information Sheets. This module is prepared to help you achieve the required competency, in Massage Therapy NC ll. This will be the source of information for you to acquire knowledge and skills in this particular competency independently and at your own pace, with minimum supervision or help from your instructor. Work through all the information and complete the activities in each section. Read information sheets and complete the self-check. Suggested references are included to supplement the materials provided in this module. Most probably your trainer, Mr. Manny P. Daleon, will also be your supervisor or manager. He/she is there to support you and show you the correct way to do things. You will be given plenty of opportunity to ask questions and practice on the job. Make sure you practice your new skills during regular work shift. This way you will improve both your speed and memory and also your confidence. Use the Self-checks, Operation Sheets or Job Sheets at the end of each section to test your own progress. When you feel confident that you have had sufficient practice, ask Mr. Manny P. Daleon,your Trainer to evaluate you. The results of your assessment will be recorded in your Progress Chart and Accomplishment Chart. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 2 of 271 Remember to:
  3. 3. QUALIFICATION: MASSAGE THERAPY NC II UNIT OF COMPETENCY: WORK WITH A HOLISTIC THERAPEUTIC MASSAGE FRAMEWORK MODULE TITLE: WORKING WITHIN A HOLISTIC THERAPEUTIC MASSAGE FRAMEWORK INTRODUCTION: This unit covers the knowledge, skills and attitudes required to work effectively within a therapeutic massage framework. SUMMARY OF LEARNING OUTCOMES: At the end of this module you will be able to: 1. Demonstrate commitment to central philosophies of therapeutic massage practice 2. Identify and describe the principles and practices of therapeutic massage 3. Develop knowledge of complementary therapies 4. Represent therapeutic massage framework to the community 5. Work within clinic and regulation guidelines ASSESSMENT CRITERIA: 1. Concept of massage and treatment are clearly defined based on the medical manuals or relevant references. 2. Massage principles are identified and explained based on medical manuals. 3. Healths issues are interpreted based on therapeutic massage philosophy. 4. Major methods of treatment used in therapeutic massage are identified and described CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 3 of 271
  4. 4. 5. Additional complementary therapies used in therapeutic massage are identified and described 6. Massage assessment techniques are identified and described 7. Information on other complementary therapies is provided 8. Similarities and differences between physiotherapy, osteopathy, chiropractic therapy and massage therapy are explained. 9. The characteristics between the allopathic and naturopathic approaches to treatment are described 10.Relationship between therapies is identified 11.Practices and principles of therapeutic massage can be explained in an easily understood way and explained in a one-to-one group setting 12.Enquiries are clarified and appropriate information is provided 13.Requests for client / patient to bring relevant data to the consultation are made 14.Alternative sources of information / advice are discussed with the client / patient. 15.Clinic guidelines are accessed and followed according to health care facility policy. 16.Legal and regulatory guidelines are accessed and followed based on government regulation. 17.Relevant documentations are established based on the clinic guidelines. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 4 of 271
  5. 5. LEARNING OUTCOME #1 DEMONSTRATE COMMITMENT TO CENTRAL PHILOSOPHIES OF THERAPEUTIC MASSAGE PRACTICES. CONTENTS: • Effects of therapeutic massage on the body surface • Ethical issues in therapies • Communicating in group and one-on-one settings ASSESSMENT CRITERIA: 1. Concept of massage and treatment are clearly defined based on the medical manuals or relevant references. 2. Massage principles are identified and explained based on medical manuals. 3. Healths issues are interpreted based on therapeutic massage philosophy. CONDITION: Students/trainees must be provided with the following: EQUIPMENT TOOLS AND ACCESSORIES • OHP • TV, LCD • Massage Table • Ultraviolet Lamp • Heat Pacts • Thermometer And Bp Apparatus SUPPLIES AND MATERIALS LEARNING MATERIALS • Pentel Pens • Eraser • Paper • Oils, Powder • Alcohol • White Board • White Board Marker • Handouts • Texts and Medical Manuals ASSESSMENT METHOD: • Interview/ Question and Answer CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 5 of 271
  6. 6. • Written Evaluation / Paper and Pen Test • Observation Learning Experiences Learning Outcome 1 DEMONSTRATE COMMITMENT TO CENTRAL PHILOSOPHIES OF THERAPEUTIC MASSAGE PRACTICES. Learning Activities Special instructions 1. Read Information Sheet 1.1.1- Effects of therapeutic massage on the body surface Read information sheet. After reading the learner is encourage to answer the self check. 2. Answer self check 1.1.1 Practice answering self-check. 3. Answer Key 1.1.1 Compare your answers to the answer key. 4. Read Information Sheet 1.1.2- Ethical Issues in Therapies Read information sheet. After reading the learner is encourage to answer the self check. 5. Answer self check 1.1.2 Practice answering self-check. 6. Answer Key 1.1.2 Compare your answers to the answer key. 7. Read Information Sheet 1.1.3- Communicating in group and one-on-one settings Read information sheet. After reading the learner is encourage to answer the self check. 8. Answer self check 1.1.3 Practice answering self-check. 9. Answer Key 1.1.3 Compare your answers to the answer key. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 6 of 271
  7. 7. INFORMATION SHEET 1.1 Learning Objectives: After reading this INFORMATION SHEET, YOU MUST be able to— 1. Define clearly the concepts of massage and treatment based on the medical manuals or relevant references. 2. Identify and explain massage principles based on medical manuals. 3. Interpret health issues based on therapeutic massage philosophy. INTRODUCTION MASSAGE is an instinctive therapy that everyone has the ability to learn. Our goal is to encourage your natural abilities and give you the knowledge and expertise to practice safely and effectively on your family and friends. The information, which we will provide will also be useful to the students choosing massage therapy as a career or practicing therapist. You employ your innate ability to touch therapeutically in your daily life. If you have a headache, you instinctively rub around the neck and the temples to soothe away the pain and tension. If you hurt your knee or bang your elbow, your first reaction is to massage it to relieve the pain. Children will hold and rub their tummies when they have stomach-ache and eventually the pain will go. A parent feels a child's feverish forehead to check for a high temperature and will massage in response to a child's bumps and cries of pain. The healing power of therapeutic massage is also used for emotional problems. To comfort distraught friends or relatives you may put your arms CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 7 of 271
  8. 8. around them, hold or stroke them to comfort, support and reassure them in their times of need. Body and mind should not be regarded as separate entities. Physical symptoms such as headaches or constant fatigue are often an indication of what is 'on our mind'. Muscles contract and tighten in response to anger and anxiety or may become slack as we assign ourselves to what is happening in our lives. Within the physical body is buried a whole lifetime of experience and emotions - birth, childhood, pleasure and pain, shock, frustration, fear, grief, joy and much more besides. Massage is an excellent tool for enabling us to become more aware of what is happening deep within us. The importance and need for touch is reflected in our everyday language. We talk of being 'deeply touched' when trying to express a reaction. We ask friends to keep 'in touch' or stay in contact' with us. We speak of 'being in touch' or 'out of touch' with our feelings. We describe others as being a 'soft touch' or a bit 'touchy'. We also experience 'gut feelings' about a particular situation. Touch is essential for our growth and well-being. It is the first sense to be developed in the womb, and early touching while the fetus grows in the womb enhances the development of the nervous system and encourages communication between mother and baby. Children need cuddles from their parents to give them a feeling of security and to show them how much they are loved. Massage is one of the oldest healing arts: Chinese records dating back 3,000 years document its use; the ancient Hindus, Persians and Egyptians CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 8 of 271
  9. 9. applied forms of massage for many ailments; and Hippocrates wrote papers recommending the use of rubbing and friction for joint and circulatory problems. Today, the benefits of massage are varied and far-reaching. As an accepted part of many physical rehabilitation programs, massage therapy has also proven beneficial for many chronic conditions, including low back pain, arthritis, bursitis, fatigue, high blood pressure, diabetes, immunity suppression, infertility, smoking cessation, depression, and more. And, as many millions will attest, massage also helps relieve the stress and tension of everyday living that can lead to disease and illness. So What Is It Exactly? Massage, bodywork and somatic therapies are defined as the application of various techniques to the muscular structure and soft tissues of the human body. Specifically: Massage: The application of soft-tissue manipulation techniques to the body, generally intended to reduce stress and fatigue while improving circulation. The many variations of massage account for several different techniques. Bodywork: Various forms of touch therapies that may use manipulation, movement, and/or repatterning to affect structural changes to the body. Somatic: Meaning “of the body.” Many times this term is used to denote a body/mind or whole-body approach as distinguished from a physiology- only or environmental perspective. There are more than 250 variations of massage, bodywork, and somatic therapies and many practitioners utilize multiple techniques. The CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 9 of 271
  10. 10. application of these techniques may include, but is not limited to, stroking, kneading, tapping, compression, vibration, rocking, friction, and pressure to the muscular structure or soft tissues of the human body. This may also include non-forceful passive or active movement and/or application of techniques intended to affect the energetic systems of the body. The use of oils, lotions, and powders may also be included to reduce friction on the skin. Please note: Massage, bodywork and somatic therapies specifically exclude diagnosis, prescription, manipulation or adjustments of the human skeletal structure, or any other service, procedure or therapy which requires a license to practice orthopedics, physical therapy, podiatry, chiropractic, osteopathy, psychotherapy, acupuncture, or any other profession or branch of medicine. ( http://www.massagetherapy.com/learnmore/index.php) CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 10 of 271
  11. 11. INFORMATION SHEET 1.1-A History of Massage Massage is safe and effective combination of techniques that almost anyone can learn. It is a holistic therapy and offers benefits for the physical, mental, spiritual and emotional wellbeing of the person giving the massage as well as the person receiving it. It works well on young and old, male and female, and can even be applied as a self-help therapy. The word 'Massage' is most likely to have emerged from the Greek word 'Massein', meaning 'to knead' or the Arabic word 'mas'h' meaning 'to press softly'. Massage is a successful tool for healing and has been practiced throughout the world for thousands of years. In adults as in babies, massage has many benefits from a preventive health perspective as well as stimulating the body's own natural healing mechanisms to aide in the recovery from trauma, depression, back pain and physical or emotional stresses. References to massage are found in Chinese medical texts 4,000 years old. The Chinese have long recognized the powerful benefits of touch in healing.They recorded centuries of history behind their therapeutic massage techniques. This ancient culture claim they were the first people to systemize and turn massage into a true healing art.A Chinese book from 2,700 B.C., The Yellow Emperor's Classic of Internal Medicine, recommends 'breathing exercises, massage of skin and flesh, and exercises of hands and feet" as the appropriate treatment for -complete paralysis, chills, and fever." Physicians mostly of the CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 11 of 271
  12. 12. Greek and Roman era, prescribed it both for its restorative powers and for general preservation of the body and mind. In the 5th century B.C., Hippocrates (the father of medicine), who had learned massage from the Greeks, prescribed the use of rubbing and friction for joint and circulatory ailments. It is recognized that rubbing can bind a joint that is too loose and loosen a joint that is too rigid. Furthermore, rubbing can make the flesh and cause parts to waste, it is these latter beliefs that are so important for those concerned with figure improvement. In 1363 Guy de Chaulic published a book about surgery, where he described different methods of bodywork in conjunction with surgery. Paracelsus found that bodywork was not only an important therapy but that it was necessary. Doctors such as Ambroise Pare, a 16th-century physician to the French court, praised massage as a treatment for various ailments. Massage became popular throughout Europe, due to the work of Henrik Ling (1776-1839) during the eighteenth and nineteenth century. He developed a system of massage that used many of the positions and movements of Swedish gymnasts. This system was based on the newly discovered knowledge of the circulation of blood and lymph which he Chinese had been using these methods for centuries. In 1813 he established with royal patronage the Royal Central Institute of Gymnastics. Ling's system is generally known as Swedish Massage. It spread quickly from Sweden. In 1895 a society of Trained Masseuses was formed in Britain to increase the standard of training (the date 1894 is sometimes CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 12 of 271
  13. 13. quoted), and in 1899 Sir William Bennet inaugurated a massage department at St. George's Hospital, London. Although the practice of massage has been discredited in the past, mainly by advocates of modern medicine, it has recently been growing in practice. Now, commonly accepted throughout the medical world as an effective and true medical art, massage is successfully used in hospitals, pain clinics, rehabilitation facilities, and drug treatment clinics for people of all ages with a variety of medical conditions. Massage may be the oldest and simplest form of medical care. Egyptian tomb paintings show people being massaged. In Eastern cultures, massage has been practiced continually since ancient times. A Chinese book from 2,700 B.C., The Yellow Emperor's Classic of Internal Medicine, recommends 'breathing exercises, massage of skin and flesh, and exercises of hands and feet" as the appropriate treatment for -complete paralysis, chills, and fever." It was one of the principal method of relieving pain for Greek and Roman physicians. Julius Caesar was said to have been given a daily massage to treat neuralgia. "The Physician Must Be Experienced In Many Things," wrote Hippocrates, the father of Western medicine, in the 5th century B. C., "but assuredly in rubbing.. . for rubbing can bind a joint that is too loose, and loosen a joint that is too rigid." Ayurveda, the traditional Indian system of medicine, places great emphasis on the therapeutic benefits of massage with aromatic oils and spices. It is practiced very widely in India. Doctors such as Ambroise Pare, a 16th-century physician to the French court, praised massage as a treatment for various ailments. Swedish massage, the CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 13 of 271
  14. 14. method most familiar to Westerners, was developed in the 19th century by a Swedish doctor, poet, and educator named Per Henrik Ling. His system was based on a study of gymnastics and physiology, and on techniques borrowed from China, Egypt, Greece, and Rome. Physiotherapy, originally based on Ling's methods, was established with the foundation in 1894 of the Society of Trained Masseurs. During World War I patients suffering from nerve injury or shell shock were treated with massage. St. Thomas's Hospital, London, had a department of massage until 1934. However, later breakthroughs in medical technology and pharmacology eclipsed massage as physiotherapists began increasingly to favor electrical instruments over manual methods of stimulating the tissues. Massage lost some of its value and prestige with the unsavory image created by "massage parlors." This image is fading as awareness of the value and therapeutic properties of massage grow. Massage is now used in intensive care units, for children, elderly people, babies in incubators, and patients with cancer, AIDS, heart attacks, or strokes. Most American hospices have some kind of bodywork therapy available, and it is frequently offered in health centers, drug treatment clinics, and pain clinics. A variety of massage techniques have also been incorporated into several other complementary therapies, such as aromatherapy, reflexology, Rolfing, Heller work, and osteopathy. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 14 of 271
  15. 15. INFORMATION SHEET 1.1-1-B Therapeutic Effects of Massage By Kim Markiecki, LMT MASSAGE AFFECTS THE BODY AS A WHOLE NERVES Tends to normalize hyperactivity of nerves, that is, it has a sedating effect. Massage can also be used to stimulate the nervous system depending on the technique used. Massage also provides pain relief. MUSCLE TISSUE Massage enhances the nutrition of muscles, accelerates recovery from fatigue by the removal of lactic acid and relieves muscle spasm. Massage does not increase strength, muscle bulk or muscle tone. BLOOD Venous circulation is stimulated. Capillaries are dilated by direct pressure and by a neurological reflex. The red blood cell count increases, hemoglobin levels increase and the oxygen carrying capacity of blood is facilitated. LYMPH CIRCULATION Lymph is a milky white fluid that carries impurities and waste away from the tissues and passes through gland-like structures spaced throughout the lymphatic system that act as filtering valves. Its circulation depends CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 15 of 271
  16. 16. on gravity, muscle contraction, passive movement and external pressure. Massage can dramatically aid the movement of lymph. SKIN The secretive function of the skin is improved when the sebaceous glands are stimulated. Skin temperature increases 2-3 degrees as a result of friction and improved circulation. The texture of the skin is improved though increased tissue oxygenation and because massage aids the removal of dead cells from the skin surface. BONES While massage is not recommended for 2-3 weeks after a fracture, after this period, if the fracture is healing normally, massage increases the deposition of callus (the fibrous tissue around a fracture) and improves the healing rate of the soft tissues. METABOLISM Massage increases the secretion of urine, through pressure over the kidneys and kidney neurological reflex. It increases the excretion of sodium, phosphorous and sodium chloride. There is a cumulative improvement in metabolic function. Massage has no effect on blood ph, oxygen consumption, pulse rate or blood pressure except indirectly as a result of relaxation. Reference: http://www.atpeacemassagetherapy.com/benefitsofmassage.htm CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 16 of 271
  17. 17. INFORMATION SHEET 1.1-1-C BENEFITS OF MASSAGE (www.wikipedia.org) Peer-reviewed medical research has shown that the benefits of massage include pain relief, reduced trait anxiety and depression, and temporarily reduced blood pressure, heart rate, and state anxiety. Theories behind what massage might do include blocking nociception (gate control theory), activating the parasympathetic nervous system, which may stimulate the release of endorphins and serotonin, preventing fibrosis or scar tissue, increasing the flow of lymph, and improving sleep, but such effects are yet to be supported by well-designed clinical studies. Massage is hindered from reaching the gold standard of scientific research, which includes placebo-controlled and double blind clinical trials.Developing a "sham" manual therapy for massage would be difficult since even light touch massage could not be assumed to be completely devoid of effects on the subject.] It would also be difficult to find a subject that would not notice that they were getting less of a massage, and it would be impossible to blind the therapist. Massage can employ randomized controlled trials, which are published in peer reviewed medical journals. This type of study could increase the credibility of the profession because it displays that purported therapeutic effects are reproducible. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 17 of 271
  18. 18. Single dose effects Mechanical massage chairs at VivoCity in Singapore. • Pain relief: Relief from pain due to musculoskeletal injuries and other causes is cited as a major benefit of massage.In one study, cancer patients self-reported symptomatic relief of pain. This study, however, did not include a placebo control group so these effects may be due to the placebo effect or regression towards the mean. Acupressure or pressure point massage may be more beneficial than classic Swedish massage in relieving back pain. However, a meta- study conducted by scientists at the University of Illinois at Urbana- Champaign failed to find a statistically significant reduction in pain immediately following treatment. • State anxiety: Massage has been shown to reduce state anxiety, a transient measure of anxiety in a given situation. • Blood pressure and heart rate: Massage has been shown to reduce blood pressure and heart rate as temporary effects. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 18 of 271
  19. 19. • Attention: After massage, EEG patterns indicate enhanced performance and alertness on mathematical computations, with the effects perhaps being mediated by decreased stress hormones. • Other: Massage also stimulates the immune system by increasing peripheral blood lymphocytes (PBLs). However, this immune system effect is only observed in aromatherapy massage, which includes sweet almond oil, lavender oil, cypress oil, and sweet marjoram oil. It is unclear whether this effect persists over the long term. Multiple dose effects • Pain relief: When combined with education and exercises, massage might help sub-acute, chronic, non-specific low back pain. Furthermore, massage has been shown to reduce pain experienced in the days or weeks after treatment. • Trait anxiety: Massage has been shown to reduce trait anxiety; a person's general susceptibility to anxiety. • Depression: Massage has been shown to reduce subclinical depression. • Diseases: Massage, involving stretching, has been shown to help with spastic diplegia resulting from Cerebral palsy in a small pilot study.[35] The researchers warn that these results should "be viewed with caution until a double-blind controlled trial can be conducted". Massage has been used in an effort to improve symptoms, disease progression, and quality of life in HIV patients, however, this treatment is not scientifically supported. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 19 of 271
  20. 20. In the United States there are about 90,000 massage therapists. Training programs in the US are typically 500–1000 hours in length, and can award a certificate, diploma, or degree depending on the particular school. There are around 1,300 programs training massage therapists in the country and study will often include anatomy and physiology, kinesiology, massage techniques, first aid and CPR, business, ethical and legal issues, and hands on practice along with continuing education requirements if regulated. The Commission on Massage Therapy Accreditation (COMTA) is one of the organizations that works with massage schools in the U.S.. • Thirty-nine states, the District of Columbia and four Canadian provinces currently offer some type of credential to professionals in the massage and bodywork field---usually licensure, certification or registration. Thirty-eight states and the District of Columbia require some type of licensing for massage therapists. In the US, 32 states use the National Certification Board for Therapeutic Massage and Bodywork's certification program as a basis for granting licenses either by rule or statute. The National Board grants the designation Nationally Certified in Therapeutic Massage and Bodywork (NCTMB). There are two tests available and one can become certified through a portfolio process with equivalent training and experience. Between 10% and 20% of towns or counties regulate the profession. These local regulations can range from prohibition on opposite sex massage, fingerprinting and venereal checks from a doctor, to prohibition on house calls because of concern regarding sale of sexual services. • In the US, licensure is the highest level of regulation and this restricts anyone without a license from practicing massage therapy CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 20 of 271
  21. 21. or by calling themselves that protected title. Certification allows only those who meet certain educational criteria to use the protected title and registration only requires a listing of therapists who apply and meet an educational requirement. • In late 2007, the Federation of State Massage Therapy Boards launched a new certification exam titled the MBLEx. Approximately 13 states have accepted this certification exam. • In Canada only three provinces regulate massage therapy: British Columbia, Ontario, and Newfoundland and Labrador. The Canadian Massage Therapists Alliance (CMTA) has set a level of 2200 practice hours in Ontario, and Newfoundland and Labrador and 3000 hours in British Columbia, which has the highest education standard in North America. • In Germany Massage is regulated by the Government on a federal and national level. Only someone who has completed 3,200 hours of training (theoretical and practical) can use the professional title "Masseur und Medizinische Bademeister" or Medical Masseur and Spa Therapist. This person can prolong his training depending on the length of professional experience to a Physiotherapist (1year to 18 months additional training). The Masseur is trained in Classical Massage, Myofascial Massage, Exercise and Movement Therapy. During the training they will study: Anatomy, Physiology, Pathology, Gynecology, Pediatry, Psychiatry, Psychology, Surgery, and probably most importantly Dermiatry and Orthopedics. They are trained in Electrotherapy, and Hydrotherapy. Hydrotherapy includes: Kneipp, Wraps, underwater Massage, therapeutic washing, Sauna and CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 21 of 271
  22. 22. Steambath. A small part of their training will include special forms of massage which are decided by the local college, for example: Foot reflex zone massage, Thai Massage etc. Finally a graduate is allowed to treat patients under the direction of a doctor. He is regulated by the professional body which regulates Physiotherapists. This includes the restriction on advertising and Oath of confidentiality to clients. INFORMATION SHEET 1.1-1-D Benefits of Massage Therapy Massage is an excellent preventive treatment essential for the maintenance of health and fitness. Prevention is always far better than cure. Nowadays, people of all ages are increasingly considering natural therapies as a way to encourage an improved sense of well-being and as a means to a long, happy and harmonious life free of illness. People have been enjoying the benefits of massage for thousands of years. Records indicate that it was used in several ancient societies for a variety health reasons. Today, massage still provides benefits to all the systems of the body, some of which are outlined below. Benefits to the Nervous System The nervous system is profoundly influenced by the application of massage. The effects of massage may be soothing and sedative, providing relief from nervous irritability. Disorders such as insomnia, tension, headaches and other stress-related conditions respond to the healing power of touch as peace and harmony returns to the troubled mind. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 22 of 271
  23. 23. Alternatively, the effects of massage on the nerves may be stimulating, promoting an increase in the activity of the muscles, vessels and glands governed by them. It is invaluable in cases of lethargy and fatigue. Benefits to the Muscular System The muscular system derives enormous benefits. Muscles maintain a balance in relaxing and contracting. Some massage movements relax and stretch the muscles and soft tissues of the body, reducing muscular tension and cramp. Fibrous tissues, adhesions and old scar tissue can be broken down and cleansed of waste deposits. As muscles contract, toxic products are eliminated. Other movements produce the contraction of muscles promoting good muscle tone. Muscle fatigue and stiffness caused by overactivity, and the resulting build-up of toxic substances in the muscles, is reduced by muscular contraction and relaxation. Benefits to the Skeletal System The skeletal system is strengthened by using massage. Bone is indirectly affected by massage. Improvements to the circulation of blood and lymph in the muscles lead to better circulation in the underlying bones, benefiting their nutrition and growth. Stiffness of the joints, and pains resulting from conditions such as arthritis, are reduced providing comfort and ease of movement. Benefits to the Circulatory System The circulatory system also benefits from the action of massage. It takes the pressure off the arteries and veins, accelerating the flow of blood through the system providing relief for poor circulation and cardiac CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 23 of 271
  24. 24. problems. The heartbeat strengthens, the rate of the heartbeat decreases and high blood pressure is reduced. Benefits to the Lymphatic System The lymphatic system is stimulated and the flow of lymph is accelerated throughout the system. As the massage strokes are performed, the waste and poisonous substances which have accumulated in our overstressed bodies are rapidly eliminated. Benefits to the Respiratory System The respiratory system responds an increased activity in the lungs is stimulated by massage. As the treatment proceeds, the breath slows and deepens. If necessary, mucus and bronchial secretions can be encouraged to leave the lungs by percussive movements on the back and over the lungs. Benefits to the Digestive System The digestive system benefits when massage promotes the peristaltic activity (wave like motion) in the colon enhancing the elimination of faecal matter and combating constipation. It stengthens the muscular walls of the intestines and abdomen, and stimulates the secretion of digestive juices from the liver, pancreas, stomach and intestines. Benefits to the Skin The skin, both the activity and the nutrition of the benefit from massage. The sweat and sebaceous glands are stimulated, improving their function and ensuring the elimination of waste products. Skin condition, texture CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 24 of 271
  25. 25. and tone are greatly improved - the skin is healthy and glowing following a treatment. Benefits to the Genito-urinary System The genito-urinary system, the use of abdominal and back massage promotes the activity of kidneys, which ehnances the elimination of waste products and reduces fluid retention. Benefits to the Reproductive System The reproductive system can also be improved. Abdominal and back massage can help to alleviate menstrual problems such as period pains, irregular menstruation, PMS and the symptoms of menopause. The Benefits Of Massage What exactly are the benefits of receiving massage or bodywork treatments? Useful for all of the conditions listed below and more, massage can: • Alleviate low-back pain and improve range of motion. • Assist with shorter, easier labor for expectant mothers and shorten maternity hospital stays. • Ease medication dependence. • Enhance immunity by stimulating lymph flow—the body’s natural defense system. • Exercise and stretch weak, tight, or atrophied muscles. • Help athletes of any level prepare for, and recover from, strenuous workouts. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 25 of 271
  26. 26. • Improve the condition of the body’s largest organ—the skin. • Increase joint flexibility. • Lessen depression and anxiety. • Promote tissue regeneration, reducing scar tissue and stretch marks. • Pump oxygen and nutrients into tissues and vital organs, improving circulation. • Reduce postsurgery adhesions and swelling. • Reduce spasms and cramping. • Relax and soften injured, tired, and overused muscles. • Release endorphins—amino acids that work as the body’s natural painkiller. • Relieve migraine pain. There’s no denying the power of bodywork. Regardless of the adjectives we assign to it (pampering, rejuvenating, therapeutic) or the reasons we seek it out (a luxurious treat, stress relief, pain management), massage therapy can be a powerful ally in your healthcare regimen. Experts estimate that upwards of ninety percent of disease is stress related. And perhaps nothing ages us faster, internally and externally, than high stress. While eliminating anxiety and pressure altogether in this fast- paced world may be idealistic, massage can, without a doubt, help manage stress. This translates into: • Decreased anxiety. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 26 of 271
  27. 27. • Enhanced sleep quality. • Greater energy. • Improved concentration. • Increased circulation. • Reduced fatigue. Furthermore, clients often report a sense of perspective and clarity after receiving a massage. The emotional balance bodywork provides can often be just as vital and valuable as the more tangible physical benefits. Profound Effects In response to massage, specific physiological and chemical changes cascade throughout the body, with profound effects. Research shows that with massage: • Arthritis sufferers note fewer aches and less stiffness and pain. • Asthmatic children show better pulmonary function and increased peak air flow. • Burn injury patients report reduced pain, itching, and anxiety. • High blood pressure patients demonstrate lower diastolic blood pressure, anxiety, and stress hormones. • Premenstrual syndrome sufferers have decreased water retention and cramping. • Preterm infants have improved weight gain. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 27 of 271
  28. 28. Research continues to show the enormous benefits of touch—which range from treating chronic diseases, neurological disorders, and injuries, to alleviating the tensions of modern lifestyles. Consequently, the medical community is actively embracing bodywork, and massage is becoming an integral part of hospice care and neonatal intensive care units. Many hospitals are also incorporating on-site massage practitioners and even spas to treat post surgery or pain patients as part of the recovery process. Getting a massage can do you a world of good. And getting massage frequently can do even more. This is the beauty of bodywork. Taking part in this form of regularly scheduled self-care can play a huge part in how healthy you’ll be and how youthful you’ll remain with each passing year. Budgeting time and money for bodywork at consistent intervals is truly an investment in your health. And remember: just because massage feels like a pampering treat doesn’t mean it is any less therapeutic. Consider massage appointments a necessary piece of your health and wellness plan, and work with your practitioner to establish a treatment schedule that best meets your needs. Assignment: 1. Review the clinical research studies examining the benefits of massage. 2. Review massages information from the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 28 of 271
  29. 29. INFORMATION SHEET 1.1-1-E Massage Contraindications (When not to massage) Avoid massage in the following conditions, instances and disorders: o During the first three months of pregnancy It is generally not considered safe to massage pregnant women, particularly in the first trimester, when the risk of miscarriage is highest. However, a gentle head massage, without oils, is acceptable, and a light gentle, loving, stroke appied to the face and brow will relieve anxiety and release stress. o High temperature/fever The body is already fighting off toxins as indicated by the rise in temperature. A massage would release even more unwelcome toxins into the system. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 29 of 271
  30. 30. o Open wounds, cuts and bruising Apply only light touch drainage massage around the site, to assist the blood flow towards the heart and encourage healing where bruising is present. Oil may aggravate an open wound. While giving a massage, cover up any open cuts or scratches on your hands with a plaster or other dressing. o Inflammation Avoid massage over an area of inflammation, (which could be due to fatty deposits causing a cyst) and massage will spread the infection. However in case of localised problems, adding a strong base of essential oil to your bath may help you to overcome, suffering with prickly heat and redness. Inflammation would include conditions such as thrombosis and phlebitis (painful clot in vein). o Blood Clots As massage could dislodge and move clot possibly causing a heart attack or stroke. o Varicose veins, or history of thrombosis Do not massage over broken or varicose veins as the blood supply is impaired in this area. Massage will increase blood flow and flood the over-worked capillaries and veins, possibly causing coagulation and affecting blood flow to the heart. Professionally trained therapists may effleurage gently when advised by consultant or general practitioner of patient. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 30 of 271
  31. 31. o Infectious skin diseases Bacterial infection, Lymphangitis, Fungal infection, Viral infections, Herpes, in these conditions it is always advisable to get consent of your medical practitioner before having massage. In case of severe skin problems, such as eczema or psoriasis - massage can add to dermal irritation. o Cancer Cancer can spread through the lymphatic system, and because massage increases lymphatic circulation, it may potentially spread the disease as well. Simple, caring touch is fine, but massage strokes that stimulate circulation are not. Always check with a doctor first. o Broken bones / Fractures Stay away from an area of mending bones. A little light massage to the surrounding areas, though, can improve circulation and be quite helpful. When a bone is weakened by a metastasis (spread of the cancer), deep pressure over it may worsen the pain or even cause a fracture. o Acute back pain Avoid massage, particularly if the pain shoots down the arms or legs when the back is massaged. Do not apply massage or pressure to the spinal column or other bony processes unless gently passing over the area to reach other areas of the body. o Other chronic conditions and diseases CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 31 of 271
  32. 32. Consult a qualified medical practitioner if you having high blood pressure, diabetes or any heart disease prior to receiving massage therapy. Take Note: IT IS NOT ADVISABLE to expose your skin to the sun's rays within 12 hours of dermal application of base and essential oils. SELF-CHECK 1.1-1 TRUE OR FALSE Write T if the statement is true and F is the statement is false in your answer sheet. 1. MASSAGE is an instinctive therapy that everyone has the ability to learn. 2. The healing power of therapeutic massage is not used for emotional problems. 3. Physical symptoms such as headaches or constant fatigue are often an indication of what is 'on our mind'. 4. Body and mind should not be regarded as separate entities. 5. Massage, bodywork and somatic therapies are defined as the application of various techniques to the muscular structure and soft tissues of the human body. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 32 of 271
  33. 33. 6. Massage: The application of soft-tissue manipulation techniques to the body, is not intended to reduce stress and fatigue while improving circulation. 7. Bodywork: Various forms of touch therapies that may use manipulation, movement, and/or repatterning to affect structural changes to the body. 8. Somatic: Meaning “of the body.” Many times this term is used to denote a body/mind or whole-body approach as distinguished from a physiology-only or environmental perspective. 9. Massage is a successful tool for healing and has been practiced throughout the world for 1000 years. 10. References to massage are found in Chinese medical texts 1,000 years old. 11. Physicians mostly of the Greek and Roman era, does not prescribed massage both for its restorative powers and for general preservation of the body and mind. 12. In the 5th century B.C., Hippocrates (the father of medicine), who had learned massage from the Greeks, prescribed the use of rubbing and friction for joint and circulatory ailments. 13. In 1363 Guy de Chaulic published a book about surgery, where he described different methods of bodywork in conjunction with surgery. 14. Paracelsus found that bodywork was not only an important therapy and that it was not necessary. 15. Doctors such as Ambroise Pare, a 16th-century physician to the Roman court, praised massage as a treatment for various ailments. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 33 of 271
  34. 34. 16. Apurveda, the traditional Indian system of medicine, places great emphasis on the therapeutic benefits of massage with aromatic oils and spices. 17. Massage lost some of its value and prestige with the unsavory image created by "massage parlors." 18. Massage is now used in intensive care units, for children, elderly people, babies in incubators, and patients with cancer, AIDS, heart attacks, or strokes. 19. Massage can also be used to stimulate the nervous system depending on the technique used. 20. Massage does increase strength, muscle bulk or muscle tone. 21. The effects of massage may be soothing and sedative, providing relief from nervous irritability. 22. Some massage movements relax and stretch the muscles and soft tissues of the body, reducing muscular tension and cramp. Fibrous tissues, adhesions and old scar tissue can be broken down and cleansed of waste deposits. 23. The skeletal system is not strengthened by using massage. 24. As the massage strokes are performed, the waste and poisonous substances which have accumulated in our overstressed bodies are rapidly dissiminated. 25. The olfactory system responds an increased activity in the lungs is stimulated by massage. 26. The respiratory system benefits when massage promotes the peristaltic activity (wave like motion) in the colon enhancing the elimination of faecal matter and combating constipation. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 34 of 271
  35. 35. 27. The genito-urinary system, the use of abdominal and back massage promotes the activity of kidneys, which enhances the elimination of waste products and increases fluid retention. 28. Abdominal and back massage can help to alleviate menstrual problems such as period pains, irregular menstruation, PMS and the symptoms of menopause. 29. Massage enhance immunity by stimulating blood flow—the body’s natural defense system. 30. Massage promotes tissue degeneration, increasing scar tissue and stretch marks. ANSWER KEY 1.1-1 1. True 2. False 3. True 4. True CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 35 of 271
  36. 36. 5. True 6. False 7. True 8. True 9. False 10. False 11. False 12. True 13. True 14. False 15. False 16. False 17. True 18. True 19. True 20. false 21. True 22. True 23. False 24. False 25. False 26. False 27. False 28. True 29. False 30. False CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 36 of 271
  37. 37. INFORMATION SHEET 1.1-2-A Ethical issues in therapies General Principles of Ethics Ethics is defined by Webster as the study of standards of conduct and moral judgment; this system or code of morals of a particular person, religion, group, profession, etc. Since each person is unique with their own experiences and beliefs, ethics can be difficult to define. There is no concrete answer. As a professional, we are responsible for the comfort and safety of our clients. We can serve them best when we understand their needs and rights. We can serve them best when we have examined ourselves and worked through our own issues. We can serve them best when we focus on the development of ourselves. We can only guide the client to places that we have been willing to go ourselves. The healing process can begin only when we realize that we are just facilitators in the process itself. The healing is the responsibility of the client alone. They must be given the information to determine what is right for them and what they are going through. Informed Consent Clients need to be able to make a decision as to whether they want you to work on them and what they want you to do. This is informed consent. They must be given enough information, such as : what are the goals and purpose of the session, what are the possible consequences of the treatment, what CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 37 of 271
  38. 38. risks are involved, what are the possible benefits of a treatment, how much time will the treatment take, how much money will the treatment cost and how will it be paid for. With this information, a client will be able to determine if they want the treatment for themselves or do they refuse the treatment. Right of Refusal Clients have the right to refuse the service for any reason at any time. If they determine that the session should be stopped right in the middle, their needs must be respected. Be aware that a session interrupted before completed may also cause a problem in the financial agreement. Does the client owe for the whole time? This same right also applies for the practitioner. You can end a session at any time, for any reason. The bottom line is to work on only people who are nurturing to you and do not drain your energy. If your mother just died of lung cancer it may not be advisable to work on someone who smokes. Confidentiality A client’s information, both written and verbal belongs to the client. Conversations that occur during a session should not be repeated or included in the chart notes unless it is describing their physical condition. A client may also not want to be approached outside the treatment clinic. If you see a client walking down the street and stop and say hello, this may violate their right of confidentiality, as they may not want it be known that they are seeking treatment. Boundaries A Boundary is a space within a perimeter that may be a physical, emotional or mental space. The emotional (mental) space is determined by past CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 38 of 271
  39. 39. experiences, values and morals. The physical space is the actual physical limits of space that is needed by each person to feel safe and secure. Boundaries can be communicated by verbal conversations or body language. Some people, especially those with a history of abuse of some sort, may not be aware of their boundaries let alone able to maintain their boundary. Boundaries may be determined before a session to ensure the clients comfort. Boundaries are often difficult to determine. What may be good for one person, may not be appropriate for another. It is important to explore boundaries and constantly readjust limits to accommodate each individual. When boundaries are crossed, respect may be lost in the relationship. There are a main types of boundaries we deal with include: Legal boundaries, professional boundaries, and personal boundaries. Legal boundaries are those that of course deal with the law and the rules and regulations that are set up by each state, city or county. Your scope of practice is defined legally. Your scope of practice is the limits or boundaries that apply to your practice. This may include areas you can work on and what you can or can not do. This will determine if you can do things like make diagnoses, do physical adjustments, work in the mouth or other body cavity and sell vitamins and other related items. The laws vary so much that it is impossible to discuss here. Make sure you contact your local authorities to determine what your legal boundaries are and that you work within the law. Professional boundaries are determined by many things such as your type of practice, your business rules and practices. Personal boundaries are just that- everything that determines your safety zone. They may be influenced by past experiences, beliefs and values. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 39 of 271
  40. 40. Boundary violations usually begin quietly, little by little, and without many problems. When you go through the process of looking at your values and needs and set your framework, boundary violations can be minimized. Recognizing your own boundaries will be based on your values and needs. There is no right or wrong here - only what is what is important to you. Transference occurs when the client makes the professional relationship, personal. Indications of transference are things like the client brings you additional gifts or asks to see you for lunch or outside the treatment. Personal conversation can also be an indicator. What you do depends on each situation. This can occur when a client is lacking in sufficient resources to take care of themselves. Unresolved needs, feelings and issues are transferred to the helper or caretaker. Counter-transference occurs when the therapist is unable to separate the therapeutic relationship from their personal feelings surrounding the client. Some of examples of this is when a therapist feels inadequate if the client is not making progress or excessive thinking about the client after the treatment is over. This occurs usually when the therapist plays the helper or fixer role. We begin thinking that we can get rid of the person’s pain when we really don't do anything but facilitate the clients’ growth for their own healing of pain. We begin to think that only we can fix the problem and we have all the correct answers. Boundary violations usually begin quietly, little by little, and without many problems. It is important to think of your practice as one of service to the client. How can you serve that client best? CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 40 of 271
  41. 41. Knowing the basic principle of ethics is just the beginning to building a successful practice. Reference: http://www.thebodyworker.com/ethicsprinciples.htm INFORMATION SHEET 1.1-2-B Massage Therapy Ethics and Etiquette By Terry McDermott There is no avoiding this simple fact about massage therapy: Providing or receiving the healing power of touch is intimate. And intimacy, even in the most professional settings, can expose vulnerabilities and lead to uncomfortable and even awkward situations. It is the responsibility of the massage therapist to create an environment that is conducive to a healthy, relaxing and satisfying experience for the client. On the other hand, it is the responsibility of the client to communicate with the massage therapist in a manner that allows the therapist to provide the service in a manner that puts the client at ease. An experienced massage therapist will be able to guide the recipient through the massage process so that there is little confusion about some of the basic areas that cause embarrassment or confusion. Take It All Off? The amount of clothing worn during a massage is dependent on the type of massage being administered. It is normal to be completely undressed during a full body Swedish massage but is not absolutely necessary. If a client prefers to wear panties or briefs during the massage that is fine. Frankly, the client should be able to wear whatever makes them most CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 41 of 271
  42. 42. comfortable. Regardless, the therapist will appropriately drape the client so that only the areas of the body being massaged are exposed. The therapist will usually instruct the client about what to expect before they begin undressing. The therapist will then leave the room and allow the client to undress and get comfortable on the massage table under a sheet or towel. The massage therapist will then uncover only the area of the body being massaged. Touchy Feely There are a variety of reasons that an individual may want a massage: stress relief, relaxation, general wellness, enhances circulation, improved flexibility, etc. No matter what the reason for the massage the therapist is always under the obligation to respect the boundaries set by the client and to establish his or her own boundaries. Therapeutic massage is, by nature, a sensual experience. However, it is not intended to be a sexual experience. If a client, male or female, makes any overtly sexual requests or suggestions then the therapist is obligated to professionally and forcefully identify the inappropriateness of these comments. Conversely, no therapist should take liberties or make assumptions relative to what parts of the body can be touched. In general, it is never appropriate to touch the genitals during a massage session. The client cannot expect to be touched sexually and the therapist cannot touch a client in a sexual manner. Either case will betray the trust in the relationship between the two parties...to say nothing of the potential for legal and ethical issues. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 42 of 271
  43. 43. And let's be clear. While there are documented benefits of breast massage, it is not, and should not be, included in a total body massage. Breasts are off limits unless a very special request is made of a qualified therapist. The National Certification Board for Therapeutic Massage and Bodywork includes a specific policy in its Standards of Practice. The Board states that therapists may "only provide therapeutic breast massage as indicated in the plan of care, and only after receiving informed voluntary consent from the client." That being said, breast massage is legally restricted in some states. An experienced massage therapist, male or female, will know how to deflect sexual advances by a client. If a subtle response does not do the job then a forceful statement or ending the session will be the correct response. Any client who feels that they are being touched inappropriately should feel confident in their right to speak up. If it is incidental contact or just an accident the therapist will apologize and continue with the client's discomfort noted accordingly. Extracurricular Activity As stated earlier, touch is intimate. Permission for such intimacy is accorded based on the massage therapist's professionalism and the trust of the client. At the same time, a relationship is established...a professional relationship but a relationship nonetheless. Understanding and honoring the boundaries of that relationship will allow both parties to fill their roles appropriately. It is generally accepted that there ought not to be any personal relationship between the therapist and a paying client. Allowing the relationship to CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 43 of 271
  44. 44. expand beyond the massage table to a social or even romantic connection is to invite a host of ethical dilemmas. A therapist could be perceived as taking advantage of a client who might be in a vulnerable state due to stress or physical ailment. In the state of Washington it is illegal to date a client within two years of the last session. That is strict stuff and is as likely to protect a therapist from misunderstandings as it is to protect a client. Borders and Boundaries Providing the healing power of touch is an honorable and ancient profession. The benefits of massage therapy are numerous and continue to gain acceptance as a mainstream health practice. No one should ever have to feel uncomfortable about getting a massage and they won't if they are in the hands of a well-trained and ethically centered massage professional. Article Source: http://EzineArticles.com/1018344 CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 44 of 271
  45. 45. SELF-CHECK 1.1-2 TRUE OR FALSE Write T if the statement is true and F is the statement is false in your answer sheet. 1. Ethics is defined by Webster as the study of standards of conduct and moral judgment; this system or code of morals of a particular person, religion, group, profession, etc. 2. As a professional, we are responsible for the comfort and safety of our clients. 3. Clients need not to make a decision as to whether they want you to work on them and what they want you to do. 4. Clients have the right to refuse the service for any reason at any time. If they determine that the session should be stopped right in the middle, their needs must be respected. 5. Be aware that a session interrupted before completed may also cause a problem in the financial agreement. Does the client owe for the whole time? 6. As a massage therapist, you can end a session at any time, for any reason. 7. A client’s information, both written and verbal does not belongs to the client. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 45 of 271
  46. 46. 8. Conversations that occur during a session should not be repeated or included in the chart notes unless it is describing their physical condition. 9. A Boundary is a space within a perimeter that may be a physical, emotional or outer space. 10. The emotional (mental) space is determined by future experiences, values and morals. 11. The physical space is the actual physical limits of space that is needed by each person to feel safe and secure. 12. Boundaries can be communicated by verbal conversations or body language. 13. Some people, especially those with a history of abuse of some sort, may not be aware of their boundaries let alone able to maintain their boundary. 14. Boundaries may be determined before a session to ensure the clients discomfort. 15. Legal boundaries are those that of course deal with the law and the rules and regulations that are set up by each state, city or county. 16. Professional boundaries are not determined by many things such as your type of practice, your business rules and practices. 17. Personal boundaries are just that- everything that determines your safety zone. 18. Transference occurs when the client makes the professional relationship, personal. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 46 of 271
  47. 47. 19. Contra-Indications of transference are things like the client brings you additional gifts or asks to see you for lunch or outside the treatment. 20. Counter-transference occurs when the therapist is unable to separate the therapeutic relationship from their personal feelings surrounding the client. ANSWER KEY 1.1-2 1. True 2. True 3. False 4. True 5. False 6. True 7. False 8. True 9. false 10. false 11. true CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 47 of 271
  48. 48. 12. true 13. true 14. false 15. true 16. false 17. true 18. true 19. false 20. true INFORMATION SHEET 1.1-3-A OHS requirements in the workplace Workplace Housekeeping - Basic Guide Why should we pay attention to housekeeping at work? Effective housekeeping can eliminate some workplace hazards and help get a job done safely and properly. Poor housekeeping can frequently CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 48 of 271
  49. 49. contribute to accidents by hiding hazards that cause injuries. If the sight of paper, debris, clutter and spills is accepted as normal, then other more serious health and safety hazards may be taken for granted. Housekeeping is not just cleanliness. It includes keeping work areas neat and orderly; maintaining halls and floors free of slip and trip hazards; and removing of waste materials (e.g., paper, cardboard) and other fire hazards from work areas. It also requires paying attention to important details such as the layout of the whole workplace, aisle marking, the adequacy of storage facilities, and maintenance. Good housekeeping is also a basic part of accident and fire prevention. Effective housekeeping is an ongoing operation: it is not a hit-and-miss cleanup done occasionally. Periodic "panic" cleanups are costly and ineffective in reducing accidents. What is the purpose of workplace housekeeping? Poor housekeeping can be a cause of accidents, such as: • tripping over loose objects on floors, stairs and platforms • being hit by falling objects • slipping on greasy, wet or dirty surfaces • striking against projecting, poorly stacked items or misplaced material • cutting, puncturing, or tearing the skin of hands or other parts of the body on projecting nails, wire or steel strapping CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 49 of 271
  50. 50. To avoid these hazards, a workplace must "maintain" order throughout a workday. Although this effort requires a great deal of management and planning, the benefits are many. What are some benefits of good housekeeping practices? Effective housekeeping results in: • reduced handling to ease the flow of materials • fewer tripping and slipping accidents in clutter-free and spill-free work areas • decreased fire hazards • lower worker exposures to hazardous substances (e.g. dusts, vapours) • better control of tools and materials, including inventory and supplies • more efficient equipment cleanup and maintenance • better hygienic conditions leading to improved health • more effective use of space • reduced property damage by improving preventive maintenance • less janitorial work • improved morale • improved productivity (tools and materials will be easy to find) How do I plan a good housekeeping program? CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 50 of 271
  51. 51. A good housekeeping program plans and manages the orderly storage and movement of materials from point of entry to exit. It includes a material flow plan to ensure minimal handling. The plan also ensures that work areas are not used as storage areas by having workers move materials to and from work areas as needed. Part of the plan could include investing in extra bins and more frequent disposal. The costs of this investment could be offset by the elimination of repeated handling of the same material and more effective use of the workers' time. Often, ineffective or insufficient storage planning results in materials being handled and stored in hazardous ways. Knowing the plant layout and the movement of materials throughout the workplace can help plan work procedures. Worker training is an essential part of any good housekeeping program. Workers need to know how to work safely with the products they use. They also need to know how to protect other workers such as by posting signs (e.g., "Wet - Slippery Floor") and reporting any unusual conditions. Housekeeping order is "maintained" not "achieved." Cleaning and organization must be done regularly, not just at the end of the shift. Integrating housekeeping into jobs can help ensure this is done. A good housekeeping program identifies and assigns responsibilities for the following: • clean up during the shift • day-to-day cleanup • waste disposal CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 51 of 271
  52. 52. • removal of unused materials • inspection to ensure cleanup is complete Do not forget out-of-the-way places such as shelves, basements, sheds, and boiler rooms that would otherwise be overlooked. The orderly arrangement of operations, tools, equipment and supplies is an important part of a good housekeeping program. The final addition to any housekeeping program is inspection. It is the only way to check for deficiencies in the program so that changes can be made. The documents on workplace inspection checklists provide a general guide and examples of checklists for inspecting offices and manufacturing facilities. What are the elements of an effective housekeeping program? Dust and Dirt Removal In some jobs, enclosures and exhaust ventilation systems may fail to collect dust, dirt and chips adequately. Vacuum cleaners are suitable for removing light dust and dirt. Industrial models have special fittings for cleaning walls, ceilings, ledges, machinery, and other hard-to-reach places where dust and dirt may accumulate. Special-purpose vacuums are useful for removing hazardous substances. For example, vacuum cleaners fitted with HEPA (high efficiency particulate air) filters may be used to capture fine particles of asbestos or fibreglass. Dampening (wetting) floors or using sweeping compounds before sweeping reduces the amount of airborne dust. The dust and grime that collect in CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 52 of 271
  53. 53. places like shelves, piping, conduits, light fixtures, reflectors, windows, cupboards and lockers may require manual cleaning. Compressed air should not be used for removing dust, dirt or chips from equipment or work surfaces. Employee Facilities Employee facilities need to be adequate, clean and well maintained. Lockers are necessary for storing employees' personal belongings. Washroom facilities require cleaning once or more each shift. They also need to have a good supply of soap, towels plus disinfectants, if needed. If workers are using hazardous materials, employee facilities should provide special precautions such as showers, washing facilities and change rooms. Some facilities may require two locker rooms with showers between. Using such double locker rooms allows workers to shower off workplace contaminants and prevents them from contaminating their "street clothes" by keeping their work clothes separated from the clothing that they wear home. Smoking, eating or drinking in the work area should be prohibited where toxic materials are handled. The eating area should be separate from the work area and should be cleaned properly each shift. Surfaces Floors: Poor floor conditions are a leading cause of accidents so cleaning up spilled oil and other liquids at once is important. Allowing chips, shavings and dust to accumulate can also cause accidents. Trapping chips, shavings CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 53 of 271
  54. 54. and dust before they reach the floor or cleaning them up regularly can prevent their accumulation. Areas that cannot be cleaned continuously, such as entrance ways, should have anti-slip flooring. Keeping floors in good order also means replacing any worn, ripped, or damaged flooring that poses a tripping hazard. Walls: Light-colored walls reflect light while dirty or dark-colored walls absorb light. Contrasting colours warn of physical hazards and mark obstructions such as pillars. Paint can highlight railings, guards and other safety equipment, but should never be used as a substitute for guarding. The program should outline the regulations and standards for colours. Maintain Light Fixtures Dirty light fixtures reduce essential light levels. Clean light fixtures can improve lighting efficiency significantly. Aisles and Stairways Aisles should be wide enough to accommodate people and vehicles comfortably and safely. Aisle space allows for the movement of people, products and materials. Warning signs and mirrors can improve sight-lines in blind corners. Arranging aisles properly encourages people to use them so that they do not take shortcuts through hazardous areas. Keeping aisles and stairways clear is important. They should not be used for temporary "overflow" or "bottleneck" storage. Stairways and aisles also require adequate lighting. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 54 of 271
  55. 55. Spill Control The best way to control spills is to stop them before they happen. Regularly cleaning and maintaining machines and equipment is one way. Another is to use drip pans and guards where possible spills might occur. When spills do occur, it is important to clean them up immediately. Absorbent materials are useful for wiping up greasy, oily or other liquid spills. Used absorbents must be disposed of properly and safely. Tools and Equipment Tool housekeeping is very important, whether in the tool room, on the rack, in the yard, or on the bench. Tools require suitable fixtures with marked locations to provide orderly arrangement, both in the tool room and near the work bench. Returning them promptly after use reduces the chance of being misplaced or lost. Workers should regularly inspect, clean and repair all tools and take any damaged or worn tools out of service. Maintenance The maintenance of buildings and equipment may be the most important element of good housekeeping. Maintenance involves keeping buildings, equipment and machinery in safe, efficient working order and in good repair. This includes maintaining sanitary facilities and regularly painting and cleaning walls. Broken windows, damaged doors, defective plumbing and broken floor surfaces can make a workplace look neglected; these conditions can cause accidents and affect work practices. So it is important to replace or fix broken or damaged items as quickly as possible. A good CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 55 of 271
  56. 56. maintenance program provides for the inspection, maintenance, upkeep and repair of tools, equipment, machines and processes. Waste Disposal The regular collection, grading and sorting of scrap contribute to good housekeeping practices. It also makes it possible to separate materials that can be recycled from those going to waste disposal facilities. Allowing material to build up on the floor wastes time and energy since additional time is required for cleaning it up. Placing scrap containers near where the waste is produced encourages orderly waste disposal and makes collection easier. All waste receptacles should be clearly labelled (e.g., recyclable glass, plastic, scrap metal, etc.). Storage Good organization of stored materials is essential for overcoming material storage problems whether on a temporary or permanent basis. There will also be fewer strain injuries if the amount of handling is reduced, especially if less manual materials handling is required. The location of the stockpiles should not interfere with work but they should still be readily available when required. Stored materials should allow at least one metre (or about three feet) of clear space under sprinkler heads. Stacking cartons and drums on a firm foundation and cross tying them, where necessary, reduces the chance of their movement. Stored materials should not obstruct aisles, stairs, exits, fire equipment, emergency eyewash fountains, emergency showers, or first aid stations. All storage areas should be clearly marked. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 56 of 271
  57. 57. Flammable, combustible, toxic and other hazardous materials should be stored in approved containers in designated areas that are appropriate for the different hazards that they pose. Storage of materials should meet all requirements specified in the fire codes and the regulations of environmental and occupational health and safety agencies in your jurisdiction. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 57 of 271
  58. 58. INFORMATION SHEET 1.1-3-B Hygiene for Massage Therapists Understanding hygiene is essential for massage therapists to keep themselves safe from infectious diseases and to keep them from spreading between their clients. The main goal is to discourage and prevent growth or spread of pathogens and allergens. Sanitizing and disinfecting your massage office consists of keeping your table, face cradle, sheets, bottles of lotion/oil, hydrotherapy equipment as well as the carpet, walls and counters clean and sanitary. Clients also may have allergies and sensitivities to mold and any scents or laundry detergent that you use so using hypo-allergenic products can help. After every massage you must wash your hands and forearms to keep them free from bacteria. Proper manicure skills will keep nail beds clean and smooth to not leave scratches on clients. Glossary of Hygiene Terms for Massage Therapists Antiseptic - a chemical agent used to retard the growth of germs. It does not kill them. Antiseptics can retard bacterial growth. They do not affect viruses or funguses. Asepsis - free of disease and germs Bactericide - a chemical agent that destroys bacteria but not their spores Disinfectant- a chemical agent that destroys germs Sanitize - to clean by the use of an agent using one of the above types of products CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 58 of 271
  59. 59. Sepsis - poisoning due to a pathogen Sterile - free from germs and spores Sterilization- to make sterile and free from bacteria, viruses and funguses Recommended products for cleaning massage tables: 10 parts water and 1 part bleach Use hot water for sheets and hot dryer cycle. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 59 of 271
  60. 60. SELF-CHECK 1.1-3 TRUE OR FALSE Write T if the statement is true and F is the statement is false in your answer sheet. 1. Effective housekeeping can eliminate some workplace hazards and help get a job done safely and properly. 2. Proper housekeeping can frequently contribute to accidents by hiding hazards that cause injuries. 3. If the sight of paper, debris, clutter and spills is accepted as abnormal, then other more serious health and safety hazards may be taken for granted. 4. Effective housekeeping is an ongoing operation: it is not a hit-and-miss cleanup done occasionally. 5. Periodic "panic" cleanups are costly and effective in reducing accidents. 6. A poor housekeeping program plans and manages the orderly storage and movement of materials from point of entry to exit. 7. Often, ineffective or insufficient storage planning results in materials being handled and stored in hazardous ways. 8. Worker training is an essential part of any good housekeeping program. 9. The final addition to any housekeeping program is infection. 10. Compressed air should be used for removing dust, dirt or chips from equipment or work surfaces. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 60 of 271
  61. 61. ANSWER KEY 1.1-3 1. True 2. False 3. False 4. True 5. False 6. False 7. True 8. True 9. False 10. False CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 61 of 271
  62. 62. INFORMATION SHEET 1.1-4 Communicating in group and one-on-one settings Massage Client Interview Skills The Massage Client Interview is one of the most important parts of the massage session. The Interview is how you gather information on what the client expects from their session as well as what they need. It will help you create a plan of action in applying what you know about massage and help you to perform an effective massage. It is the beginning of educating your clients about massage and what it is that it does and what you do specifically with massage. Here are some things to remember when talking with clients: • be sensitive to the personal information you will be getting from each client • be aware of the non-verbal factors such as posture, gait and holding patterns of the body.. Be aware of your own body language too. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 62 of 271
  63. 63. • learn to communicate just what it is that you do in a massage or what happens when different massage is applied to the body in different ways and explain what is best for their condition • allow enough time to complete a thorough interview. You can also ask questions as you are working • use active listening and show that you understand the client by para-phrasing or telling them what you heard them say • ask yes or no questions and also open ended questions. • most of the healing process happens in just being heard and acknowledged. Create an intake form to make the process easier asking the questions you want to ask there first. Expand on them in the verbal interview. Just asking the standard questions to rule out contraindications is really just the beginning of a good massage client interview. Engaging clients in their own healing process and becoming aware of their bodies is crucial for helping people to feel better and to also build your massage business. What most people need no matter what they are suffering from or dealing with is to be listened too and believed. Just the act of listening can give people such a sense of relief and start the healing process. It doesn't really matter what technique you use in your massage session. Learning to listen is often a difficult challenge for massage therapists. It is also about asking the right questions of clients to get them to open up CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 63 of 271
  64. 64. about their real issues. This isn't psychotherapy but getting people to become more aware of their bodies. Most massage therapists are taught to ask questions so that they will understand the clients condition better and know how to use their techniques on a client. This assumes that knowing about the condition will help find a solution or fix the problem. Most often issues do not have just one pat answer. When you change the goal of asking questions to one of empowering clients rather than fixing them the massage client interview will look quite different. It puts healing back in the hands of the massage client and focusing on what the client wants to have in their life rather than focusing on the problem. Empowering clients help clients discover their own powers of healing and helps guide them out of the victim mode that so often goes along with injuries and illness. A great book to help you to think of the massage client interview in a very different way than just trying to fix clients issues is called "Interviewing for Solutions by Peter DeJong. In it he describes a process of learning to interview clients with the goal of helping them to come up with their own solutions. Asking questions usually shows more about the person asking the question and their views and values. Being able to set your views and agendas aside will be the constant challenge for massage therapists especially since they are often taught to fix in massage schools. Using open ended questions can help. These are questions that open up a client’s perspective. They can't be answered with just yes or no. Once the question is asked active listening is used to repeat the information back to the client so that clarification can be made. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 64 of 271
  65. 65. Being able to communicate with clients in this way requires that massage therapists be able to set aside their own views and really listen to the client. This process can be made easier when the massage therapist engages in supervision to work in getting their own needs met outside of the massage office. In doing so, it allows the massage therapist to be more fully focused on the massage client rather than on their own need to fix. Supervision can also help massage therapists become more aware of their own fixing and helping issues which will lead to a higher level of integrity in a massage business which often is what will also create a more profitable and successful massage business. Massage Client Interview Questions • Have you ever had a massage? If so what type? or by what therapist? • Are you taking any medications like pain relievers or blood thinners? • Do you have any heart problems? • Are you allergic to any oils or nuts? When someone is in pain: • Where is the pain exactly? Have client point or fill out body chart to pinpoint location • When did it start? • Did you have it before? When? What did you do to relieve it? CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 65 of 271
  66. 66. • Are you seeing other health care providers like physical therapists, acupuncturists, Naturopaths, chiropractors, sports medicine physicians? • How did it start? With traumatic injury? Just came on over time? • What makes it feel better? • Does it cause other pain in other areas? • What kind of pain is it? Aching, sharp? Other? • Is there anything that makes it better or worse? • What do you hope to get out of today’s session? THE HEALTH FORMS ACQUIRING INFORMATION The primary goals of acquiring a client's history are to accurately determine the origin of the person's problem and its impact on the person's life. Remember to LISTEN to your client, and let those responses guide your interview: Make every effort to be as sure as is possible that you understand what your client is trying to tell you. Be ready to recognize from your clients’ communication any gaps they leave which you the therapist should endeavor to fill by asking appropriate questions. Make use of every possible opportunity to use your non-verbal expressions to show your understanding and concern for the client. The questions that the therapist asks should be, for the most part, open- ended in that they require more than a yes or no response. This allows CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 66 of 271
  67. 67. clients to describe their circumstances in their own words. Questions about the client’s problem: What brings you to physical therapy? (if not obvious) Location: "Where is it located?" Indicate the primary area of pain. If the person uses: o Finger: indicates a small area, no spreading of discomfort, problem probably not severe, relatively superficial, or both. o Whole hand: diffuse area as primary site : suggests lesion is more severe, more deeply situated, or both o Moving hand: spreading or radiating of the pain : if along a well-defined pathway : dermatome: probably nerve root problem o General area, diffuse: most likely referred pain, possibly visceral in origin Onset: "How and when did it occur?" (Include a description of the mechanism and position of injury.) How and when did the problem arise (mechanism of injury and date of onset)? o Gradual versus sudden onset o Sudden onset. o Gradual Position the person was in when the injury was acquired (whether sudden or gradual onset). Have you started any out-of-the-ordinary activities recently? o Characteristics: "Describe your problem," "How does it feel (pain or other symptoms) and how does it make you feel?" "Does your problem occur at certain times?" o Intensity: "How bad is your problem?" (What impact does this CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 67 of 271
  68. 68. problem have on your life? What are you unable to do because of this problem, with respect to all aspects of your life: self-care, home, work, and leisure?) Have the client rank the problem, using a scale, such as 0 to 10 (give criteria for 0 and for 10, such as 0 = at its best, 10 = at its worst). o Duration: "If certain activities cause you pain, how long does it last after you stop the activity?" "Is it constant, or intermittent?" o Aggravating factors: "What makes the problem worse?" "What do you notice this problem to be associated with?" When do you typically feel the pain? o Alleviating factors: "What makes the problem better?" Assess the Impact of the Problem on the Person's Life: Questions about the person should focus on the activities that the person performs and the environments in which they perform them. The activities should address home, work, and leisure/play and should reflect a typical day for the client. "Tell me about yourself." "Tell me about your home life." (What physical activities do they have to perform at home, describe the home environment, is the person married, do they have children. etc.) "Tell me about your work." (What physical activities do they have to perform, describe the work environment, etc.) "What do you like to do in your spare time?" (Describe the physical activities and their environments related to hobbies, recreation, etc.) "Prioritize the activities from each of these areas that you want to return to doing." "Describe your ‘typical day’ before your problem and after your problem." Additional Questions: What is it that this problem is keeping you from doing that you want to get back to doing?" This is the client's Outcome Statement. (Have the client prioritize those affected activities, from most to least important). "Do you have any other problems?" CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 68 of 271
  69. 69. "What medications are you currently taking?" "Have you had any previous physical therapy?" (If yes, describe; was it successful?) "How do you feel right now?" "Is there anything else you would like for me to know?" During the interview and subsequent treatment, therapists continually seek to gather information from their clients CHARTING BASICS SOAP Charting Format A medical charting system, in which: S = Subjective (what the client says, or subjective impressions). O = Objective (what the provider's findings are, or clinical data). A = Assessment (Any changes, the diagnosis, or what the client's condition is). P = Plan for the next treatment, (further studies and suggested treatment). Note: Not noted in the usual SOAP format, but nonetheless important, is Functional Outcome: What the client can do (or expect to do) because of the treatment rendered. Which charting format is best - Any charting format will do in a jury trial. Reasons for charting • Other health care professionals find the format and language familiar and it is a good way to communicate with other health care professionals. • Use of charting enhances the image of massage and charting validates massage as curative adjunctive treatment by providing client progress. CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 69 of 271
  70. 70. • Insurance companies accept it as proof of reasonable care and it provides evidence for attorneys as proof of significant injury. • It suggests a structure for research using case studies. • The main reason is: “Memory is limited and if it is not written, it did not happen.” Rules for charting • Chart in chronological order • Black ink (Blue is sometimes acceptable) • Write clearly, concisely and legible • No ditto marks or initials • Do not skip lines • Use correct grammar and spelling. • Write objectively (no bias, opinions, judgments) • Draw a line through empty space • Include the Date, Session #, Time started and Length of session in the left hand corner • Re-date your entry if moving onto another page • Write notes ASAP after giving the massage treatment • Sign the end of the chart with your first name, last name and professional title • Use phrases – not full sentences. • Client’s name must be on every page. • Use correct terms and abbreviations. • Name of client, physician and page # all can go on the top right corner CSAT QA SYSTEM MASSAGE THERAPY NC III Working Within a Holistic Therapeutic Massage Framework Date Developed: April 14, 2011 Document No. Developed by: Manny P. Daleon Issued by: Page 70 of 271

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