2022 massage-techniques (1)

1A New Type of Massage Client: COVID-19
Long-Haul Survivors
By David Weintraub, LMT
3
2Tape for Pain Relief, Decompression &
Neurological Re-Education
By Adam Wolf, PT, LMT
9
3The Top 3 Things to Understand About
CBD in Massage Practice
By Tara Donna Grodjesk
12
4Choose a Biopsychosocial Approach
to Preventing Chronic Pain
By Steven Capobianco, DC
15
5The MT’s Guide to Building a Chair
Massage Practice
By Jimmy Gialelis, LMT, BCTMB
20
6Manual Lymphatic Drainage:
A Light-Touch Modality
By Selena Belisle
26
7Touch the Future with Infant Massage
By Aiyana Fraley, LMT
30
Bonus7 Steps to Marketing
a New Technique
By Melinda Hastings, LMT, BCTMB, MTI
34
All photos: stock.adobe.com unless otherwise noted.
THE TOP 7 MASSAGE TECHNIQUES FOR 2022 | 2

A New Type of
Massage Client:
COVID-19 Long-
Haul Survivors
By David Weintraub, LMT
COVID-19 survivors who experience long-term symptoms—often called long-
haulers, with the condition itself termed Long COVID Syndrome—are a type
of client who could increasingly show up on your massage table.
Some research has indicated an estimated 10% of recovered COVID-19
infections produce longer-term symptoms, while newer research puts that
number at 30%. That latter study, from the University of Washington, states
that close to one-third of COVID-19 survivors report “worse health and quality
of life” than before their COVID-19 diagnosis, while 8% report they are no
longer able to do such normal tasks as “lift heavy objects, or stand or walk
unassisted for more than a short period of time.”
Typical long-haul symptoms range from mild to debilitating fatigue,
headaches, breathing difficulties, coughing, heart palpitations, joint or muscle
pains, loss of taste and smell, digestive issues, mood changes, dizziness and
brain fog, according to the Centers for Disease Control and Prevention.
With Delta and other, newer COVID-19 variants emerging, there will likely be an
even larger population of clients dealing with long-haul COVID-19 symptoms.
I have worked with about 40 clients who had been infected with COVID-19. Of
these, a dozen have complained of mild, lingering symptoms, and at least three
have complained of debilitating long-term symptoms. While massage therapy
cannot always help alleviate such symptoms, there are several that can be
helped with massage.
The obvious ones to look out for are joint-and-muscle pain and headaches.
Clients presenting with these conditions are very likely to find relief with
massage therapy. Breathing difficulties, coughing, digestive issues, dizziness
and brain fog may also be helped. In my opinion, often these issues involve
Some research
has indicated an
estimated 10% of
recovered COVID-19
infections produce
longer-term
symptoms, while
newer research puts
that number at 30%.

a protective stress response to the situation. Massage therapy can help re-
teach the client’s nervous system so it can release the protection.
Be on the lookout for clients complaining about any of these conditions and let
them know you may be able to help.
Functional vs. Structural Symptoms
When a client’s symptoms have largely functional sources (nervous system
firing muscles inefficiently), massage therapists can provide great relief. If
symptoms have largely structural sources (damaged or malformed tissues),
massage might be able to help. However, massage may be contraindicated
at first and clients will also need to work with physical therapists and other
specialists. As with any client, if someone presents with a condition you don’t
feel is within your scope or education, refer out.
Here are some examples of how symptoms can have functional sources.
Many of these will be related to the stress response from getting and surviving
COVID-19:
• Joint and muscle pain from protective compression
• Headaches due to jaw clenching and teeth grinding
• Coughing due to tight sternocleidomastoid (SCM) muscles
• Breathing difficulties due to overtired diaphragm and intercostal
muscles
Here are some examples of symptoms that have structural sources:
• Breathing difficulties due to damaged lung tissue
• Headaches due to neurological damage or degeneration
• Loss of taste or smell due to neurological damage or degeneration
• Digestive issues due to damage to GI lining
Long-Haul Condition: Overworked Breathing Muscles
The COVID-19 virus replicates by fusing with ACE2 receptors and in the
process destroys the healthy cells it invades. These receptors are found in
many tissues in the body, including the lungs, heart, blood vessels, kidneys,
liver and gastrointestinal tract. However, the easiest pathway into the body for
the virus is through the air and into the lungs.
As the lung tissues are damaged, they fill up with fluid and debris, causing
pneumonia. This makes it harder and harder to process oxygen from the
air you breathe. As difficulty increases and the diaphragm fatigues, you
compensate by recruiting ancillary breathing muscles to inhale and exhale.
These can include intercostals, scalenes, SCM, pectorals, trapezoids,
abdominals and serratus sets.
As with any client, if
someone presents
with a condition
you don’t feel is
within your scope or
education, refer out.

As with any protective compensatory muscular pattern, the longer the pattern
is used, the more the body treats it as “safe.” In this case, it learns to breathe
using ancillary muscles as “safe.” Without intervention to teach the brain that
normal, relaxed diaphragmatic breathing is OK, it may never return to fully
relaxed breathing.
Relaxed breathing should involve a noticeable expansion and contraction of
the ribcage. It also does not always have to be deep, despite what we hear in
wellness cultures. Efficient breathing is relaxed, doesn’t take conscious effort,
and only takes as much air as is needed for whatever activity the person is
engaged in.
If you haven’t learned to work directly on diaphragm and intercostals, now is
a great time to learn ways to release those muscles. In addition, releasing the
ancillary muscles listed above is equally important.
One technique I use a lot is light compression of the abdomen with my palms
after working directly on the diaphragm. Lightly taking away the ability to use
the abdominals for respiration makes the brain have to figure out another way
to inhale and exhale. It should choose the diaphragm as the obvious muscle to
recruit. This helps the brain relearn that diaphragmatic breathing is safe again.
However, if the brain isn’t ready to trust the diaphragm yet, this may induce
feelings of panic and anxiety. Go easy at first and slowly increase the length of
time you hold the abdominals in each session. It may take several sessions to
restore easy movement in the ribcage.
“I was having a very difficult time breathing deeply post-COVID-19 and had
been unable to exercise,” related one long-haul client, David (name changed),
whose symptoms included post-traumatic stress disorder and chronic stress.
After receiving massage therapy and working with a respiratory therapist,
he added, “I’m back in the gym. I’m not back to 100% yet, but am steadily
improving and feel that I will make a full recovery.”
In Some Ways, We Are All COVID-19 Survivors
This crisis has affected every single client I’ve seen in the past 20 months,
whether they contracted COVID-19 or not. Many clients are unaware they
are exhibiting low-to-medium chronic stress and PTSD symptoms. These
can show up as headaches, fatigue, brain fog, digestive problems and
muscle hypertension. (Notice the overlap between chronic stress and PTSD
symptoms and long-haul COVID-19 symptoms.)
Chronic stress and PTSD share many traits and symptoms. An easy
distinction is that chronic stress is when a body is stuck in its sympathetic
Many clients are
unaware they are
exhibiting low-to-
medium chronic
stress and PTSD
symptoms.

If you’ve been
avoiding these more
advanced techniques
in your practice, now
is a great time to
learn some and start
incorporating them
into your work with
clients.
nervous system (fight or flight) and can’t easily switch to its parasympathetic
system to restore. PTSD differs in that a client can swing from sympathetic to
parasympathetic in uncontrollable and unpredictable ways.
For clients who contracted COVID-19 and recovered, a PTSD or chronic
stress reaction is even more likely. COVID-19 is still a new virus. While we
are learning more and more about it, its short- and long-term effects are
unpredictable. Contracting the virus means not only dealing with the physical
symptoms, but also not knowing what the virus will do to you in the long term.
In short, it can be super scary!
Massage can assist clients to restore balance between their sympathetic
and parasympathetic systems. Basic techniques that release muscle
tension, promote circulation and soothe the nervous system all signal
safety and give the body space to induce its parasympathetic responses.
Advanced techniques such as direct psoas and diaphragm releases,
ancillary breathing muscle releases, and breathwork can have even more
profound results.
If you’ve been avoiding these more advanced techniques in your practice, now
is a great time to learn some and start incorporating them into your work with
clients. All of your clients will thank you and you will be able to serve a much
wider pool of people in your area!
Long-Haul Condition: Compensating Muscle Patterning
A “mild” case of COVID-19 can mean days to weeks of grueling fatigue,
breathing difficulty, fever and whole-body aches. If a client was hospitalized, at
minimum they were bedridden for several days to weeks. At worst they might
have been bedridden and intubated for weeks to months.
For clients recovering from COVID-19 there will be all sorts of breathing
compensations to address. Clients will favor ancillary breathing muscles due
to an overworked diaphragm. Pay particular attention to the serratus anterior,
posterior superior and posterior inferior. These muscles’ main function is
for forced exhalation (i.e., coughing). These muscles will likely be stuck in
hypertension due to long bouts of coughing and also being used for breathing.
In addition, chronic hypertension is likely throughout the muscular system.
The fight to expunge the virus results in long bouts of fever and sweating,
dehydration, stress and inaction due to fatigue. There will be a lot to unwind,
and it will take time for their system to fully recover.
I’m known for doing mostly focused work in my practice; however, I’ve had
to adjust this predilection and start with more full-body sessions for stress

With COVID-19,
headaches might be
simply due to muscle
tension and chronic
stress. However,
COVID-19 has known
neurological effects.
reduction and relaxation. Most clients seem to need a full-body session or two
to help get out of crisis mode before they can handle more focused work.
We can follow up with sessions that involve more focused work on breathing
musculature, hips, shoulders, neck and jaw. As clients ease back into a normal
routine, including exercise, we also need to follow up with any injuries that crop
up if they try to push too hard too fast in their recovery.
Helping guide clients through the process step-by-step and supporting them
taking time for their recovery to avoid new injuries is a particularly valuable
service we can offer.
Another client, Christina (name changed), said her massage team has
“become an integral part of my support system in recovering from these long-
haul symptoms”—not only due to the relief from fatigue, mysterious muscle
soreness and general stress related to the illness, but also because of the
therapeutic space that allowed her to feel comfortable talking about how
difficult being sick has been.
Long-Haul Condition: Headaches
Headaches can come from a wide variety of sources, but are basically of two
main types: tension headaches and migraines.
With tension headaches, the source comes from a functional pattern of
muscle tension. These broadly include jaw muscles, neck muscles and
shoulder muscles. Since the source is muscular, massage can be very helpful
in not only relieving symptoms but also in relieving the root causes and
providing a long-term solution.
Migraines have a neurological source that triggers a severe tension headache.
In general, massage can usually help relieve symptoms; however, the root
cause needs a specialist to determine if medication or specialized therapy
is warranted. Massage can help to raise the threshold before the migraine
triggers, mostly by relieving the long-term buildup of tension from multiple
episodes.
With COVID-19, headaches might be simply due to muscle tension and
chronic stress. However, COVID-19 has known neurological effects. Clients
who never previously suffered from migraines may now be having them
after contracting the virus. If a client is having severe headaches, definitely
encourage them to speak to a neurologist. Even mild headaches that keep
recurring despite multiple massage sessions are worth a visit to a specialist to
rule out a neurological source.

Clients who have
recovered from
COVID-19 and are
past the indicated
quarantine period
potentially have a
host of issues that
can be helped with
massage therapy—
and helping these
people recover and
return to normal
activities can be
highly rewarding.
For all headache sufferers, basic muscular sources to look into can include the
external jaw muscles, scalenes, SCM, traps, levator scapula, suboccipital and
frontalis muscles. Any of these can either directly be causing achy pain or be
referring pain to the head from trigger points or compressed nerves.
More advanced techniques to learn and incorporate, where allowed by
scope of practice, are inner mouth work on the medial and lateral pterygoids,
release of the hyoid muscles, working behind the trachea on longus colli and
capitis, and detailed rebalancing of cervical vertebrae rotatores and multifidus
muscles.
Any of these advanced techniques will help you serve a much wider variety of
client issues.
Expect COVID-19 Survivors in Your Practice
Too often in online discussions on whether we can “massage a client with
_____,” I see many massage therapists immediately shying away from
giving treatment—and sending clients away to more “established” medical
professionals such as physical therapists and orthopedists before even
considering working with them.
We absolutely should be doing a thorough intake to rule out contraindications
and sometimes massage really isn’t contraindicated. But I often hear massage
therapists basically assuming massage is contraindicated when a client
comes in with some medical-sounding term.
We do ourselves and our clients a disservice when we rule out massage even
though there aren’t any actual contraindications present.
Clients who have recovered from COVID-19 and are past the indicated
quarantine period potentially have a host of issues that can be helped
with massage therapy—and helping these people recover and return to
normal activities can be highly rewarding. Given the wide-ranging spread of
COVID-19, it’s likely you’ll run into clients who are recovering from long-haul
COVID-19 symptoms. I highly encourage you to learn everything you can
about working with this growing population and open your practice to this
growing clientele.
David Weintraub, LMT, owns Bodyworks DW Advanced Massage Therapy, a pair of medical
massage studios in New York, New York. Bodyworks DW, a National Certification Board for
Therapeutic Massage & Bodywork-approved continuing education provider in New York
and nationally, is designed to support talented new massage therapists in attaining the skills
needed to be successful professional therapists. His courses offer training on advanced
technique, assessment and treatment design, and rebooking practices.

Tape for
Pain Relief,
Decompression
& Neurological
Re-Education
By Adam Wolf, PT, LMT
Early in my career, I had the idea that kinesiology tape had no efficacy, a
belief that was reinforced via the educational literature of the time, which
talked about taping one direction to facilitate and another direction to inhibit
a muscle. This information was contrary to how I learned about tissue and
movement, because I learned that combinations of tissue work together to
control forces and that oftentimes musculoskeletal injuries occur when forces
are presented to the body that it can’t handle efficiently.
Itdidn’tmakesenseformetotryandfacilitateorinhibitamusclebecauseIdidn’t
believeinit,andthereforedidn’tusethisapproach.However,mybeliefschanged
aboututilizingadhesive-elastictape,oftenknownaskinesiologytape,witha
fewconversationsthatshiftedmyperspectiveandmademerecognizethat
kinesiologytapeisinactualityafantasticadditiontothemanualworkIperform.
It was pointed out to me that it’s all about how one applies the research,
which shifted my lens to recognize that the tape can, from a neurocentric
perspective, make a huge difference in helping people move and feel better.
I tape for three primary reasons, all of which also encompass a manual therapy
paradigm, and include:
1. Pain
2. Decompression
3. Neurological re-education
Anchoring to principles, it’s recognized that pain produces less representation
in the somatosensory cortex to the painful region. Also, oftentimes people in
pain have a behavior that contributes to the pain, which can result in tissue
overload. It’s also recognized that pain is an output.
Also, oftentimes
people in pain
have a behavior
that contributes
to the pain, which
can result in tissue
overload.

In practice, I often tape to both change the sensory input to a certain region,
such as the low back, and also for behavior change. Taping to change input
is as simple as placing a piece of the kinesiology tape over the region that
has pain, because the skin is linked directly to the brain due to embryonic
development. In other words, as soon as the client’s brain starts developing in
utero, their skin does too.
Therefore, it’s possible to utilize kinesiology tape on the largest organ in the
body—the skin—to change sensory input into the brain (remember, they’re
linked), changing output. At the same time, I might choose to also, or instead
of, run a tape longitudinally along the skin over the thoracic spine and link it via
education to behavior change because oftentimes those with back pain have
a forward head/kyphotic position.
In addition, most times these people don’t realize they’re not in a great
position. In these situations, kinesiology tape can provide neurofeedback to let
someone know when they’re in a less-than-desirable position.
For example, the person who sits at a desk for extended periods of time
with a forward-head/kyphotic position and has low-back or neck pain might
benefit from a couple of different taping applications. The application to the
low back may include strips with slightly more tension in order to stimulate the
skin receptors responsible for tension or compression. This application can
simultaneously decompress a region by changing the pressure, promoting
blood flow. It also changes input into the brain, bringing more representation to
the brain to the painful region and helping to change output. Remember, pain is
an output, so we want to change the input.
The client with low-back or neck pain who sits at their desk for extended
periods also needs to learn the new behavior of taking breaks or sitting in a
better position. A longitudinal strip along the skin over the thoracic spine can
easily provide feedback when people are in a forward head/kyphotic position,
because the kinesiology tape I use has 30% tension when it’s applied with
taper-off tension. Therefore, theoretically, when someone has a forward head
the tape will increase its tension, providing feedback about position. In other
words, the tape can be used to trigger behavior change.
For instance, I say to the person when I’m applying the tape something along
the lines of, “When you feel the tape in the middle of your back, I want you to
ask yourself what position you’re in.” Most times, people will find themselves in
a position that contributes to their dysfunction.
Another population that can benefit greatly from use of kinesiology tape are
those with inflammation conditions, such as a sprained ankle, contusion or
bruise. The very nature of adhesive elastic tape means that when it’s applied it
The client with low-
back or neck pain
who sits at their desk
for extended periods
also needs to learn
the new behavior
of taking breaks or
sitting in a better
position.

When placing the
tape on the skin,
remember that less
is more, meaning a
lot of tension in the
tape isn’t necessary
and that the skin can
easily get irritated
with too much
tension in the tape.
lifts the superficial skin, changing the pressure of what’s underneath it versus
what’s around it, as evidenced in numerous ultrasound imaging studies.
While there are many strategies to edema taping, the one I prefer is a fan
application where the tape is cut into thin strips and placed over the inflamed
region in a fan-like manner. When this is performed, there are pieces of skin
that hold zero, one and two pieces of tape, creating a nice pressure differential
in the tissue that helps promote fluid removal and healing.
The above examples are but a few of the numerous applications and
populations that can benefit from kinesiology tape, and while it’s a relatively
safe modality for most populations, it is contraindicated for some populations,
including those with kidney and heart failure, cancer, those whose skin irritates
easily and more. (Please check for a full list.)
I’m often asked how to get started with taping if you’ve never taped before.
The advice I like to give is to start simply and remember that less is more.
Personally, I think you can’t go wrong with taping as a reminder to the brain by
linking it to behavior change and trying to change the output.
When placing the tape on the skin, remember that less is more, meaning a lot
of tension in the tape isn’t necessary and that the skin can easily get irritated
with too much tension in the tape. In addition, because the tape is a fixed
end point, it’s important to ensure there is no tension at the ends of the tape. I
teach to keep at least a finger’s worth of tape that’s paper-off tension, ensuring
the ends of the tape won’t pull the skin and cause a blister or tear, and that if
the tape is uncomfortable to the client to simply take it off. I also encourage
those interested in this powerful tool to seek out education about the various
applications, because there are so many.
In conclusion, kinesiology tape can be a powerful adjunct when working
with people to help lock in changes. This is especially true when applying
the concepts that the tape can help those in pain by changing input,
decompressing tissue and providing neurological re-education.
Adam Wolf, PT, LMT, FAFS, is co-owner of REAL pt in Chicago, Illinois. His professional
career spans nearly two decades and includes clinical, management, consulting,
education, performance/strength and conditioning, as well as ownership roles. He is the
author of REAL Movement: Perspective on Integrated Motion & Motor Control. Wolf is also
a RockTape Functional Movement Techniques (rocktape.com) instructor who presents to
fitness and rehabilitation professionals internationally.

The Top 3 Things
to Understand
About CBD in
Massage Practice
By Tara Donna Grodjesk
Cannabidiol (CBD) has proven to be a very viable complement to just
about any massage modality. Many clients are already using various forms
of CBD for self-care, and they are open to having a massage with this
nonpsychoactive enhancement. And guess what? They are happy to pay
for it. CBD can help with inflammation and that is especially beneficial when
working with stress and strained muscle tissues. The great news is that at
proper dosage it is safe and will do no harm, so try incorporating it into your
massage practice and share your results with our massage community.
1. How CBD Works
CBD is one of over 85 compounds produced in cannabis plants
known collectively as phytocannabinoids. The two most abundant
phytocannabinoids possessing therapeutic properties are CBD and
tetrahydrocannabinol (THC).
The endocannabinoid system (ECS) evolved in primitive animals over 600
million years ago. It is shared by all vertebrate species including humans and
is essential to health and well-being. Its goal is to promote homeostasis and
balance in the body as changes happen in external and internal environments
and to control communication between cells. It regulates appetite, pain
sensation, stress response, and mood and memory. It also serves as a bridge
between body and mind through actions in our immune system, nervous
system and all the body’s organs.
Endocannabinoids are neurotransmitters the body produces that are
recognized by CB1 and CB2 receptors. These receptors also recognize plant
based phytocannabioids. Endocannabinoids or phytocannabinoids plug into
CB1 and CB2 receptors activating and supplementing the ECS.
CBD can help with
inflammation and
that is especially
beneficial when
working with stress
and strained muscle
tissues.

Because the chemical makeup of the cannabis-produced phytocannabinoids
closely resembles that of our naturally produced endocannabinoids,
phytocannabinoids are also recognized by the numerous cannabinoid
receptors and their therapeutic benefits are made available to our bodies.
Stressful lifestyles and unhealthy diet are some factors that can negatively
impact ECS functioning and lower its endocannabinoid production, resulting
in a cannabinoid deficiency. If the amount of endocannabinoids produced
is lower than considered essential to health and well-being, many important
bodily functions are thrown out of balance. Scientists believe this may be a
cause factor in many conditions such as fibromyalgia, anorexia, depression,
IBS, MS, migraines, PTSD, Parkinson’s and autism.
2. Legal Awareness
Hemp cultivation and the transfer of hemp-derived CBD products across
state lines was legalized December 2018, although laws in individual states
must still be acknowledged.
Whether it’s legal depends on the source (hemp vs. marijuana), what’s in
the final product and where you’re located. It is up to you to explore and
understand the laws in your own state. Check your local and state laws to
ensure using CBD topics is within your legal scope of practice.
Stressful lifestyles
and unhealthy
diet are some
factors that can
negatively impact
ECS functioning
and lower its
endocannabinoid
production, resulting
in a cannabinoid
deficiency.

CBD-infused
products not only
amp up treatment
benefits for your
clients, but also
make your job easier.
As the CBD topical
begins loosening
muscles and relieving
stress, clients are able
to sink into a deeper
state of relaxation.
3. Using Topical CBD Products in Massage
Using topical CBD products in your practice can enhance the therapeutic
benefits of the massage , and many therapists feel that it is great benefit for
themselves as well. CBD extracted from hemp contains less than .3% (.003)
THC. You should not feel high or experience any negative change in your mind
or mental process with this level of THC.
It makes your work easier. CBD-infused products not only amp up treatment
benefits for your clients, but also make your job easier. As the CBD topical
begins loosening muscles and relieving stress, clients are able to sink into a
deeper state of relaxation. This lets you work deeper with less effort, which
isparticularly helpful when performing deep tissue massage. It’s also been
reported that clients experience less soreness and recover more quickly after
treatments using CBD products.
It eases your own aches and pains. CBD also benefits you as a therapist who is
providing physically demanding services. A cannabis product company visited
a local spa that had been offering CBD-enhanced massage for two years.
They spoke with one of its therapists, who reported that “giving a cannabis
massage was less stressful on her muscles than a traditional one.”
Tara Donna Grodjesk is VP of Earthlite Spa and Wellness Products and founder of Tara
Spa Therapy. She is a certified holistic health educator, massage therapist, Ayurvedic
practitioner and aomatherapist. She is also s co-founder of Green Spa Network and
The Northern California Spa Alliance. For 30 years Grodjesk has been training massage
therapists internationally.

A Biopsychosocial
Approach to
Preventing
Chronic Pain
By Steven Capobianco, DC
It is very clear that chronic pain is a global health concern, and the evidence is
suggesting that the current health care system is underprepared to manage
the complexity of the problem. Pain, lasting greater than three months, affects
more than 20% of the US population with health care cost estimated to be
between $500 to $653 billion dollars annually.
What confuses many people, afflicted with chronic pain, is the fact that with all
the technological and therapeutic advances over the past 20 years, why aren’t
we doing better? The answer, in my professional opinion, lies in how we have
identified the problem. Most clinicians, including myself, have been formally
trained to treat the machine.
What I mean is we have been inundated with a biomedical, mechanistic, view
to care that focuses its attention body. If someone presents with low back
pain, the traditional medical process is to address the local area of pain with
little regard of the individual attached to the body part.
What is Pain?
Pain is defined in the International Association for the Study of Pain as an
unpleasant sensory and emotional experience associated with actual or
potential tissue damage or described in terms of such damage.
Dissecting this definition with our clients is a valuable opportunity to identify
the non-biomechanical influences of the pain experience. Having an open
discussion about the fact that pain, as stated, could be associated with actual
or potential tissue damage is eye opening to many. It allows us to question the
linearity that tissue trauma equals pain and to acknowledge one’s brain plays
an important role in the experience. We have been chasing the root cause or
what has been described as the pathoanatomical Holy Grail of pain with little
success.
Pain, lasting greater
than three months,
affects more than
20% of the US
population with
health care cost
estimated to be
between $500 to
$653 billion dollars
annually.

May I suggest that sometimes the search for the causative pain gremlin can
lead to an increase in fear and anxiety that magnify the symptoms. It is clear
now that pain is an output generated by the brain and that it is highly influenced
by many factors including biological, psychological, and sociological inputs.
What is not clear, as stated by George Engle, MD, who coined the term
biopsychosocial approach, is how pain is diffused by cultural, social, and
psychological considerations. This is where the art joins manual therapy.
The key, here, is how the therapist interacts with the client to discover
what component of the biopsychosocial is fueling their pain and address
its, concurrently, as we intervene with therapeutic touch modalities. With
consideration of the psychosocial drivers, let’s discuss the how we can
augment our traditional manual therapy practices with some guidelines to
follow.
Observe, Inquire & Listen
First, embracing a biopsychosocial approach requires the therapist to
observe, inquire and listen more than we’ve done in the past. The goal is to
gather information from the individual as to what is the meaningful movement
that motivated them to seek care. In short, what moves them? It could be a
tennis serve, a paddle stroke, a swim stroke, a bending motion to pick up a
child. Whatever it is will be the anchor to focus on rather than the pain.
The meaningful movement is what is motivating them, not necessarily the
pain. So focus on that. The goal here is to redirect attention from the chronic,
debilitating, pain experience and address the meaningful movement they are
seeking to return to.
The approach may seem subtle, but the landscape now has changed from
one of them as a body part to be passively treated to an athlete actively
participating with a movement goal. Now the tool used to help manage the
movement becomes embedded into a therapeutic experience to show the
client that there is possibility in regaining the meaningful movement pattern
without pain.
Moving beyond the focus around pain and providing a sense of HOPE (Hold
On, Pain Ends) that one can return to a sport or activity that is psychologically
and socially meaningful is paramount.
The meaningful
movement is what is
motivating them, not
necessarily the pain.
So focus on that.

Validation can’t
be overstated. The
pain they feel is
real to them and
it’s important that
we establish an
empathetic alliance,
so they recognize
that we are in it
together.
10 General Guidelines
Before you embark on applying this approach to manual therapy here are
some general guidelines to consider:
1. Communication is critical when intervening with someone
experiencing chronic pain.
2. Inform the client of the movement-based approach to your care: “Let’s
try an experiment or exercise.”
3. Validation can’t be overstated. The pain they feel is real to them and it’s
important that we establish an empathetic alliance, so they recognize
that we are in it together.
4. The tool (if used) should be introduced and explained to reinforce
the scientific efficacy in practice. This sets the stage for therapeutic
confidence in the intervention that psychologically arms the nervous
system to accept the process as palliative.
5. Make sure to get the clients buy in.
6. Safety first – they must understand that they have control of the
experience.
7. Remind them that the brain and body is moldable to build confidence
in the process.
8. Pay attention to psychosocial cues (dilation of the pupils, holding of
the breath, clenching of the jaw, aversion away from the tool)—honor
the boundaries and adjust when necessary.
9. Track success—as you incorporate the therapy with a meaningful
movement, ensure to document the positive changes.
10. Get feedback and celebrate the wins.
Meaningful Movement Experiment: Practical Example
Client: 62-year-old male
Complaint: Chronic Shoulder Pain
Diagnosis: ‘Too many birthdays’ (idiopathic–no known cause)
In the initial information-gathering phase it was identified that throwing a
baseball with his grandson was the meaningful movement target. With that

in mind we commenced with a careful exploration of the body part with a
technique we call body mapping. The therapist will articulate the tool over the
tissue in a light, feathering, stroke while the client brings attention, in a non-
judgmental manner, to the shoulder.
In effect, they are instructed to draw a picture of the body part in their mind.
The tool acts a tuning fork of sorts allowing both the therapist and the client
to better appreciate and connect to the body part in a non-threatening
way. As the person builds confidence, the identified meaningful movement
can be explored while using the tool. The combination of the instrument-
assisted technique with curious attention has been shown to mitigate the
fear associated with moving the body part. This can and generally does lead
to an improvement in symptoms as well as confidence in returning to the
movement lost.
The goal of this approach to manual therapy is to bring along the person
attached to the tissues as an active participant in the therapeutic
experience. Have them join in the process to reconnect to the body and
the meaningful movement. That is the goal, isn’t it? All that is required is a
thoughtful guide—you!
References
1. International Association for the Study of Pain. Declaration of Montreal. Declaration That
Access to Pain Management Is a Fundamental Human Right. Available online: https://www.
iasp-pain.org/ Declaration of Montreal (accessed on 8 March 2019).
2. Robert Jason Yong, Peter M. Mullins, Neil Bhattacharyya. The prevalence of chronic pain
among adults in the United States. Pain, 2021; Publish Ahead of Print
3. Macfarlane, G.J. The epidemiology of chronic pain. Pain 2016, 157, 2158–2159.
4. International Association for the Study of Pain. IASP Terminology: Pain. Available online:
https://www.iasp-pain.org/terminology?navItemNumber=576#Pain (accessed on 8 March
2019)
5. Engle L George The Need for a New Medical Model: A Challenge for Biomedicine.
Psychodyn. Psychiatry, 2012; 40(3) 377–396. Reprinted with permission. © 1977 American
Association for the Advancement of Science.
6. Moseley Lorimer G, Butler David S. Explain Pain Supercharged. Noigroup Publications;
2017
7. 6Duncan Grant. Mind-Body Dualism and the Biopsychosocial Model of Pain: What did
Decartes Really Say? J Med Philos. 2000;25(4):485-513
The goal of this
approach to
manual therapy is
to bring along the
person attached to
the tissues as an
active participant
in the therapeutic
experience.

8. GBD 2016 DALYs and HALE Collaborators (2017). Global, regional, and national
disability-adjusted life- years (DALYs) for 333 diseases and injuries and healthy life
expectancy (HALE) for 195 countries and territories, 1990–2016: A systematic analysis for
the global burden of disease study 2016. The Lancet, 390(10100), 1260–1344.
9. Jevne, J. (2016). Stabbed in the back: Catalysts for a paradigm shift in back pain care.
British Journal of Sports Medicine, 50(4), 198–199
10. Mills SEE, Nicolson KP, Smith BH. Chronic pain: A review of its epidemiology and
associated factors in population-based studies. Br J Anaesth 123(2):e27383. 2019.
Steven Capobianco, DC, DACRB, CSCS, has been a practicing chiropractor since
2003. His professional aspiration is to help people move in a more meaningful way. He
supplemented his traditional chiropractic education with a diplomate in rehabilitation from
the ACA Rehab Council and is certified as a Strength and Conditioning Specialist from
the NSCA and Performance Specialist from the NASM. As co-founder of RockTape, Dr.
Capobianco lectures globally on topics related to kinesiology taping, IASTM modalities,
myofascial cupping, compressional floss therapies, and movement/performance
strategies.

The MT’s Guide to
Building a Chair
Massage Practice
By Jimmy Gialelis, LMT, BCTMB
Many massage therapists use chair massage as a viable means of income for
their businesses. There are numerous ways to facilitate this for one’s private
practice. This article will examine the means and ends toward generating
success with chair massage.
We have to first look at the elephant in the room: the coronavirus (COVID-19)
pandemic and how that might change the way chair massage is delivered.
Grocery stores and banks, for example, have traditionally been places where
a therapist could set up a chair. As vaccines continue to be distributed, those
venues could return as environments that customers are willing to hang out
in, but that might take some time—we just don’t know yet. Staff massage at
businesses and corporations has also been a sound choice when choosing
a chair-massage venue—but with so many employees working from home
either full-time or in a hybrid arrangement, the therapist’s marketing to HR
needs to reflect an awareness of this development.
A new normal is taking shape, and marketing agility is needed to navigate it
successfully. I am confident that the predominant features of building a chair
massage practice will mold themselves into that new normal.
Looking toward the future, I’m presenting traditional venues, including
offices, entertainment venues and sporting facilities, as viable chair massage
environments even if those types of businesses aren’t yet reopened in your
area. As the economy recovers from the pandemic, companies that once
had employer health care plans will rekindle these plans. Often, massages,
including chair massage, were included in health care plans.
As with any new business venture, you should keep yourself educated about
business and public-health trends. And as our new normal forms, there’s no
reason to not make plans for your practice’s success.
With so many
employees working
from home either
full-time or in a
hybrid arrangement,
the therapist’s
marketing to HR
needs to reflect an
awareness of this
development.

Your Equipment
The first consideration is to ensure you have a durable, high-quality chair.
Ideally, you are going to use this chair frequently. Make sure to check for key
features with any chair considered for purchase. If you are unable to physically
be present to purchase the chair, ensure you purchase a new chair. Truly, the
phrase “buyer beware” will apply to any used item purchased online.
When you receive the chair, be sure to check all knobs, handles and fasteners
to ensure nothing is immediately broken or overly loose. Check the quality of
the padding. New padding should have great resiliency. If the padding lacks
resiliency, this chair will not last the long haul of frequent use. Inquire of the
weight capacity the chair may hold. Will this chair be able to hold someone
250 or more pounds?
Legal Details
As you build your business, make sure you have your business elements in
place. Ensure your massage liability insurance is current and in good standing.
Be sure to adhere to state and city laws regarding business operations,
including business licensing and other components of operating legally. In
some cities, this may include a massage establishment license for the building
from which you operate.
Some massage therapists make chair massage their business’ primary source
of income. For others, chair massage becomes a catalyst to boost clients into
their massage studio. Determine which approach you will take with your chair
massage efforts. For the latter, create goals on how many clients you wish to
work on daily and how many of these people will become regular clients in
your massage studio.
You may be offered a chance to provide chair massage at a community facility.
Perhaps a public recreation center, public library or other public part of town.
If an event is held at a public park or facility, a permit will most likely be needed.
Be sure to check with your local city hall to determine the name of and fees for
this permit.
Assess the Marketplace
When you feel ready to begin, assess the marketplace of businesses available
at which to offer chair massage. Some examples of businesses that may be
feasible options to offer chair massage services include:
• Homes during workday hours—again, because an increasing number
of employees are working remotely, either full-time or hybrid (at home
some days and in the workplace some days). You can set up your
chair indoors or outdoors.
When you receive
the chair, be
sure to check all
knobs, handles
and fasteners to
ensure nothing is
immediately broken
or overly loose. Check
the quality of the
padding.

• Dentists’ offices (for patients and staff)
• Doctors’ offices (for patients and staff)
• Banks
• Grocery stores
• Colleges and universities
• Retail outlets
• Hospitals
• Sporting facilities
• Entertainment venues
How Much to Charge
Determining how much to charge for chair massage services may depend on
several factors. Questions to ask yourself include: Am I performing services
alone or will I have other therapists joining me? Is this a one-time or once-a-
quarter gig, or will my services be ongoing regularly? How expensive are the
supplies used? How frequently must these supplies be replaced?
The general rule of $1 per minute may not apply anymore as inflation and
additional supplies may warrant more income for the same profit margin years
ago. Asking for $1.25 to $1.50 per minute equates to an hourly range of $75 to
$90.
Making the Pitch
There are many benefits of chair massage to share with potential businesses
when you pitch your services to the firm representative. Most of these read
the same as general benefits of massage therapy: boosting blood circulation,
aiding muscle tension, promoting pain relief and relaxation, and stress relief.
Some benefits specific to workplace environments include aiding carpal
tunnel pain, easing issues related to sciatica, increasing mental alertness,
clearing brain fog and alleviating stress within the body. Managers at a
business may want to hear these benefits to justify paying someone for chair
massage services.
Once you establish a professional relationship with a company, maintain this
relationship with a consistently professional approach to business. Continue
to communicate with appropriate points of contact. Be open to feedback and
changes that make the experience better for you and all you touch. Show
gratitude and appreciation for the opportunity to service their company. Show
up just as professionally (if not more) the 10th time you work with the company
as you did the first time.
The general rule of
$1 per minute may
not apply anymore
as inflation and
additional supplies
may warrant more
income for the same
profit margin years
ago. Asking for $1.25
to $1.50 per minute
equates to an hourly
range of $75 to $90.

What You Need
As you prepare for chair massage gigs and events, here are items to consider
bringing with you:
• Chair and carrying case
• Hand sanitizer
• Disposable face masks
• Cleaning agents
• Tissues
• Paper towels
• Water and snacks
• Towel
• Tip jar
• Oil (unscented)
• Display table
• Your business card and
brochures
• Products for sale/samples
• Gift certificates
• Banner/sign
• Music
• Fingernail file
• Timepiece
• Intake forms
• Disposable face rest covers
• Small trash bag
• Small bills, for change
• Massage license or use
permit
• Aromatherapy
• Mechanical devices
• Comfortable apparel
• Trash bag to clean up
workspace
• Mat for chair if working
outdoors
• Shade covering if outdoors
• An air purifier if working
indoors
• Your “A” game
The Intake
Intake forms are mentioned on the above list of items to bring. Keeping them
in a three-ring binder ensures they will not slide around or away from your
table. Keep these short (about half a page) and ask essential questions about
general state of health, if clients have chronic health concerns, including any
lingering effects from coronavirus, the medications they take, and any areas of
desired focus. Also have them sign a basic liability waiver.
Ask for Help
A helpful suggestion is to consider having someone you trust join you in
handling money, keeping track of products and ensuring a smooth chair
massage event. The list of 30 items can be quite daunting to bring alone.
Having assistance with hauling these items will be most helpful and ensure
nothing is forgotten.
Further, it can be difficult to massage with proper intention if other people are
distracting or demanding your time. Having someone to deflect this attention
will ensure you give clients the attention their bodies deserve.
Perhaps you can find a fellow therapist willing to share massage duties with
you. Each therapist could massage clients, switching off each hour, to allow
A helpful suggestion
is to consider having
someone you trust
join you in handling
money, keeping
track of products and
ensuring a smooth
chair massage event.

the other to relax, eat, speak to clients walking up to the display table and
manage people checking in for their session.
10 Questions to Ask Before Unpacking Your Chair
There are 10 key pieces of information to acquire when booking either a
single event or a consistent position offering chair massage. Here is a list of
questions to ask when creating your proposal.
1. Who exactly is providing payment? At some companies, the company
itself provides full payment, whereas at others the employees may pay
a portion of fees.
2. When is payment provided? It can be a matter of days, weeks or
months to receive payment depending on the company. Can you
afford to wait awhile to obtain a paycheck?
3. Are you providing services on the company site or at another venue?
Ensure you know who you will greet when you arrive to be pointed
in the right direction. Be sure to determine if you will be indoors or
outdoors to plan appropriately.
4. Is there an opportunity cost? The term opportunity cost represents
that which you give up when you make a choice. If you choose to
accept a chair massage gig on a particular date, would you be losing
out on income from other current work?
5. Who are typical attendees? Find out who will be receiving your
massage services. Knowing your clientele can help you decide how to
best serve these individuals as well as which products you may want
to showcase to these people.
6. Who is point of contact at this service date? Be sure to know who you
will connect with and of whom to ask questions.
7. How much promotion am I allowed? Some companies may frown
upon you doing much self-promotion. Make sure you are on the same
page with your point of contact on this concept.
8. How do attendees sign up? Will the point of contact at the company fill
appointment spots? If not, who will? If the sign-up sheet is on a random
sheet of paper in the break room, chances are good spots will not be
filled as expected. Help the company by creating a professional sign-
up sheet or create an online sign-up registration if possible.
The term opportunity
cost represents that
which you give up
when you make a
choice. If you choose
to accept a chair
massage gig on
a particular date,
would you be losing
out on income from
other current work?

9. How long are sessions expected to be? Be clear on the expectation of
session times.
10. May I accept tips? Some companies may not want you to openly
accept tips, especially if the company feels you are already being
compensated fairly. Do not allow this trite idea to become a potential
deal-breaker.
Keep Track of Converts
Circling back to the major goal of chair massage efforts, keep track of how
many people at each event and paid gig eventually become regular paying
clients upon your massage table. This will provide valuable information about
your efforts and how they contribute to business success.
Jimmy Gialelis, LMT, BCTMB, is owner of Advanced Massage Arts & Education
(advancedmassagece.com) in Tempe, Arizona. He is a National Certification Board for
Therapeutic Massage & Bodywork-approved provider of continuing education, and
teaches “Professional Ethics for LMTs” and many other CE classes. He is a regular
contributor to MASSAGE Magazine, and his articles include “Massage Cupping Technique
as an Opportunity for Professional Growth” and “These 5 Keys Will Unlock the Door to
Massage Session Re-Bookings” (massagemag.com).
Circling back to the
major goal of chair
massage efforts, keep
track of how many
people at each event
and paid gig eventually
become regular paying
clients upon your
massage table.

Manual Lymphatic
Drainage: A Light-
Touch Modality
By Selena Belisle
Manual lymphatic drainage (aka lymphatic drainage) is a light-touch modality
that is applied to reduce swelling of the face or body through specialized skills,
techniques and practices. It is often applied by massage therapists despite
being quite different from massage.
In Swedish massage, clients can request work almost anywhere they wish,
in any order they wish, with a variety of pressures that can be changed from
one appointment to the next. In lymphatic drainage, a specific order or routine
is followed, with minimal pressure that cannot be altered without medical
reasoning.
Why Massage Therapists Learn and Practice
Lymphatic Drainage
Lymphatic drainage can be practiced on clients who are contraindicated for
massage therapy because of swelling. A reduction of excess swelling will
often decrease pain and increase healing, especially in most oncology, sports
injury and post-surgical medical situations. That is why massage therapists
learn and practice lymphatic drainage. Lymphatic drainage skills can provide
extra appointments for clients who would be normally contraindicated for
massage.
Forexample:Aclientwithastrained,swollenanklemightbookafull-body
massageappointmentbecausetheyareinpain.However,itiscontraindicated
tomassageanacutelyswollenankle.Assuch,thepractitionercanprovide
lymphaticdrainageontheswollenankleandregularmassageskillsthroughout
therestofthebody.Atrainedlymphaticdrainagepractitionerismorelikelyto
relievethisclient’spainratherthansendthemhomewithoutworkingontheone
areatheclientmightwantorneeditmost:theirswollenankle.
The Practice of True Lymphatic Drainage
A practitioner’s lymphatic drainage goal is to encourage excess interstitial
fluid—swelling or edema—within the body’s tissues to enter the lymphatic
capillaries to form lymph. When this fluid is within the body’s interstitial tissues,
it is called interstitial fluid. Once the interstitial fluid enters a lymphatic capillary,
it is called lymph.
Lymphatic drainage
can be practiced
on clients who are
contraindicated for
massage therapy
because of swelling.
A reduction of excess
swelling will often
decrease pain and
increase healing,
especially in most
oncology, sports injury
and post-surgical
medical situations.

This fluid transference is known as forming lymph. This newly formed lymph
is then gently manipulated toward regional lymph nodes where it is filtered
and then travels through progressively larger lymphatic vessels back to the
cardiovascular system.
Lymphatic drainage follows different pathways than a typical Swedish
massage therapy session. Massage is generally provided in one direction—
toward the heart—to increase overall cardiovascular circulation through
venous return. Lymphatic drainage has several different pathways that include
working toward the cervical, inguinal or axillary nodes. These sophisticated
pathways become complicated when a client has an obstruction due to
surgery, oncology treatment, birth defect or other physical trauma. (A high-
quality CE course in lymphatic drainage will explain the different directions,
pressures and tissues that are manipulated and used in this highly specialized
bodywork.)
Lymphatic Drainage Bodywork Pressure
and Application Explained
True lymphatic drainage is commonly called capillary work because
practitioners work to encourage permeable superficial lymphatic capillaries
to absorb excess interstitial fluid to form lymph, with extremely light touch and
highly specialized skills. Gentle techniques are then applied to encourage
this newly formed lymph to travel to lymph nodes and progressively larger
lymphatic vessels.
Extremely light pressure is used because applying any type of moderate-
to-deep pressure around a swollen or stretched tissue could further stretch
or tear the swollen tissue. Also, too much pressure bypasses the initial
lymphatics where most of the interstitial fluid is collected to form lymph and
reduce swelling.
Despite this fact, there are some who perform lymphatic massage, skipping
the light, skilled touch of lymphatic capillary work by claiming to do greater
work on larger lymphatic vessels. A lymphatic massage applies kneading
or ischemic compression over the lymphatic system’s unique pathways
with moderate pressure, which is not a true holistic application of lymphatic
drainage, nor is it an appropriate amount of pressure to work with on swollen
tissues. Some of these lymphatic massages are performed through clothing,
which requires a practitioner to apply even more pressure which could harm a
swollen client.
It is critical to properly advertise and provide lymphatic drainage services.
In the State of Florida, a licensed massage therapist was recently served an
emergency restraining order for advertising lymphatic drainage as forcibly
True lymphatic
drainage is commonly
called capillary work
because practitioners
work to encourage
permeable superficial
lymphatic capillaries
to absorb excess
interstitial fluid to form
lymph, with extremely
light touch and highly
specialized skills.

expelling bodily fluids out of their client’s surgical incisions. In the emergency
restraining order, the state focused on the fact that lymphatic drainage
bodywork is a gentle application that would not include any such forceful
practice.
Is Your Lymphatic Drainage Client Taking Opioids?
Many acute medical conditions that cause swelling are indicated for lymphatic
drainage but contraindicated for massage. Most acute medical conditions
such as surgery, sports injuries or oncology treatments can be traumatic to
the body, which could result in that client’s doctor prescribing an opioid.
Lymphatic drainage is one of the lightest forms of hands-on bodywork. It is
difficult for a client to feel the light touch of lymphatic drainage bodywork when
they are swollen and in pain but on opioids. As such, a client on opioids may
ask a practitioner for more pressure during their lymphatic drainage session
so they can “feel it working.”
Unfortunately, the excessive use of opioids over the past few decades has
likely led to practitioners feeling compelled to apply greater pressure in
lymphatic drainage to satisfy their clients’ request to feel the work.
Instead of applying more pressure, it is a practitioner’s ethical duty to explain
how lymphatic drainage works with light, skilled touch and to find different
It is difficult for a client
to feel the light touch
of lymphatic drainage
bodywork when they
are swollen and in pain
but on opioids.

ways to show the client how their lymphatic drainage is working, especially
when the client cannot feel it.
How to Show Lymphatic Drainage Therapeutic Results
Practitioners should physically show a client their tangible lymphatic drainage
appointment results though pre-treatment and post-treatment measurements
or pictures. This is important because some lymphatic drainage clients might
not be able to feel their lymphatic drainage bodywork for various reasons.
Cloth-type measuring tapes can be used to measure a swollen extremity and
photos are the best option to review any reduction of swelling or puffiness in
the face.
To conclude, almost the only thing in common between massage and
lymphatic drainage is it can be offered by a massage therapist on a standard
massage therapy table. Beyond the practitioner and table, these two
modalities are extremely different for important therapeutic reasons, which
becomes increasingly apparent with greater lymphatic drainage training.
Selena Belisle is the founder of CE Institute LLC (ceinstitute.com) in Miami, Florida.
She originally trained in the Vodder method of manual lymphatic drainage in 1995 at
the Massage Institute of New England. Today, she teaches evidence-based, National
Certification Board for Therapeutic Massage & Bodywork-approved lymphatic drainage
CE courses. She has over 25 years of lymphatic drainage research, practice and
experience.
Read about 5 common types of lymphatic drainage treatments in an expanded version of
“How is Manual Lymphatic Drainage Different from Swedish Massage?” on massagemag.
com.
Practitioners should
physically show a
client their tangible
lymphatic drainage
appointment results
though pre-treatment
and post-treatment
measurements or
pictures.

Touch the Future
with Infant
Massage
By Aiyana Fraley, LMT
Infant massage is a specialization that focuses on teaching caregivers and
parents how to massage their babies. Research shows correctly performed
infant massage promotes weight gain in premature babies and improves the
mother-infant relationship for mothers with postpartum depression. There
is also evidence that it reduces mortality and infections in preterm infants.
Among anecdotal benefits there is improved sleep, soothes, decreased
pain, increased happiness and increased attachment with the non-birthing
parent.
Babies are People
Diana Moore, LMT, the founder of the International Loving Touch Foundation,
came upon infant massage early on in her now 47-year career. Call her the
grandmother, an elder, and pioneer in the field of infant massage education in
the U.S. Moore has spent the majority of her career developing and teaching
infant massage around the world. Her driving factor, “Babies are people. They
are little people who grow up to be big people and they need lots of tender
loving care when they are infants and children to be good people,” she says.
Moore has participated in nine mission trips to orphanages in Romania and
trained healthcare workers on infant massage. The babies that weren’t being
touched and handled had huge developmental delays and many stopped
crying. “We got the staff more interested in understanding that there is a
mental health piece about how we handle our children and we can make a
better world if we start when they are babies and not try to fix things when they
are adults and they have all these issues,” says Moore.
Massage is a natural way of connection and a form of soothing touch that has
been documented as far back as 2760 BC in China. Therapeutic touch and
infant massage is a cultural tradition practiced in India, China, Asia, and Africa.
It is, however, not exclusive to humans. It is done in the animal kingdom and
most of us have likely seen a dog or cat lick their newborns stimulating them to
breathe as they enter this world.
Therapeutic touch
and infant massage
is a cultural tradition
practiced in India,
China, Asia, and Africa.

“Touch is the first of our senses to develop and our most fundamental means
of contact with the external world. It’s more than just a comforting sensation.
Touch is critical for healthy development. The abundance or absence of touch
we receive in our childhood shapes our emotional balance, physiological well-
being and our capacity to lead a normal and healthy life,” says Tina Allen, LMT,
Certified Pediatric Massage Therapist, and founder of Liddle Kidz Foundation.
Sally Hayes, CMT and infant massage educator based in Los Angeles,
California, integrated her infant massage training into her pregnancy massage
practice after receiving numerous requests from her clients.
“I got really interested in not just pregnancy massage but preconception
and fertility work, and postpartum work. I think it is one of the best and
underutilized facets of bodywork out there. Within that came a question
of what about babies. Can babies get massaged,” explains Hayes. For her
infant massage fit in nicely into her practice. She worked on clients during
their preconception period, pregnancy, postpartum and then saw her clients,
particularly first-time parents, gain confidence with their ability to soothe their
babies with massage.
“I think it is such a beautiful thing to witness,” says Hayes. “It is very important
especially in American culture where we are touch deprived. Therapeutic
touch is not woven into the fabric of our society and culture and it is very
important to start at a young age. Therapeutic touch gives them healthy
coping mechanisms for life, consent and boundaries. And all those great
lessons comes within a 20-minute infant massage instruction.”
How to Get Certified in Infant Massage
Becoming certified as an infant massage educator allows you to teach
parents how to effectively massage their babies in group or private instruction.
There are many programs available to become certified and they typically
include a weekend training with hands-on experience and review of theory
and research.
The International Loving Touch Foundation offers a hybrid online and live
stream course which can be completed over 90 days. Their in-person
courses are held over a weekend. Liddle Kidz Foundation has courses for
infant and pediatric massage, with additional levels for advanced studies.
As an infant massage educator, it recommended to be up to date on current
research. There are hundreds of studies available to support infant massage
including the research of Tiffany Fields PhD, director of the Touch Research
Institute in the Department of Pediatrics at the University of Miami School of
Medicine.
Becoming certified
as an infant massage
educator allows you
to teach parents how
to effectively massage
their babies in group or
private instruction.

How Infant Massage is Taught
Infant massage is taught in person with a certified instructor in short classes
ranging from 20 to 45 minutes over a set number of weeks. The instructor
typically places themselves side-by-side with the parent and demonstrates
the technique on a doll as the parent follows along. The classes are kept
short because an infant’s attention is often interrupted with needs for sleep,
changing or food. Parents take in the information and apply them throughout
the week and meet with the instructor again. Classes can continue until the
parent feels fully confident in making it a part of their everyday routine.
While most parents are introduced to infant massage while their babies are
under 6 months, it is never too late to start as the techniques can be applied as
they grow.
“You can massage your baby from birth. You can also massage your baby
when they are moving, it is a bit tougher, granted as they are busy little people
but it can be done. Our little people love touch and respond so beautifully to it.
You can start at any age,” says Melissa Gorry www.melissagorry.com , a baby
massage instructor and coach based out of Australia.
Infant Massage Online and In-Person Classes
COVID may have closed the doors for instructors to meet with parents one-
on-one but it opened online windows for live-stream instruction, says Moore
and Hayes. Moor, who certifies infant massage instructors, created a hybrid
course that includes guided lectures and tutorials along with live-stream
instruction. Hayes who works with parents took her practice online and says it
expanded her audience.
Gorry, a new mom herself, developed a self-paced, five-week online course
where she demonstrates techniques and bonding with her infant daughter.
She says this gives parents the opportunity to see a real-life example at a
baby-led pace.
Teaching Infant Massage as a Career
Kickstarting an infant massage career takes adjusting to a different dynamic
between massage therapist and client, since the clients are parents and
infants. It also requires some networking within parenting circles and a natural
liking to parents and children.
“You have to understand that it is not so mechanical that you’re going to get
in there and do so many strokes. It’s not like that, it’s about relationship,” says
Moore. “You’re entering the aura of the parent baby diad at a very vulnerable
time. As a parent, you want someone who is going to be sensitive to you. You
don’t want someone who is going to boss you around. You have hormones and
the sensitivity of a parent and a baby is high.”
While most parents
are introduced to
infant massage while
their babies are under
6 months, it is never
too late to start as the
techniques can be
applied as they grow.

Since clients are parents and soon-to-be mothers, infant massage naturally
fits into a massage therapy practice that tailors around pregnancy and
perinatal clients. Massage therapists who are dually licensed as doulas or
childcare educators can easily work this into their business.
Hayes added infant massage to her practice five years ago and says it brought
excitement to her clients as they took their pregnancy massage treatment
plan farther. The additional encouragement and hand holding during those
first months postpartum gave clients a sense of calm as they navigated their
way into parenthood she says.
“Thebestpartofinfantmassageisthatitfallsnicelywithinthesphereof
pregnancy.Thegreatthingaboutworkingwithpregnancyandpostpartum
workisthereisaschedulewediscuss.Mostpeoplenaturallyaskhowoftenthey
shouldgetmassaged,dotheyhavetostopgettingmassagedatacertainpoint,
andwhencantheystartgettingmassagedagain.Itisreallynicetobeableto
explaintheirmassageplanandthatthereisalsotheoptionofinfantmassage
afterwards.Itexcitespeoplethroughouttheirpregnancy,”saysHayes.
For massage therapists without a built-in clientele like pregnancy massage,
you can network to parenting groups and seek referrals from pediatric
doctors, doulas and other healthcare providers who work with expecting
parents and infants. Hayes says her pregnancy massage practice was started
with her very first client upon graduating who was pregnant and referred
her mommy group friends for a massage with Hayes. “I was booked with
pregnancy massages for weeks after,” she says.
Mooresuggestsifyouplanontakinginfantmassageasacareer,build
relationshipswithparentsandgettrainedinpregnancymassage.Whilemanyof
themedicalpractitionerswhoofferinfantmassagedoitthroughstateprograms
andhospitals,thereisgreatdemandforitinthegeneralpublic,saysMoore.
“I get so much joy watching a parent connect with their baby and they get
this gleam in their eye and their face brightens up and they have this little
conversation going with their baby. It makes for a happy world,” says Moore.
Aiyana Fraley, LMT, is a freelance writer and health care professional with more than 18
years of experience in the massage field. She teaches yoga and offers sessions in massage,
Reiki, sound healing and essential oils. Her articles for MASSAGE Magazine include “Will
Touch in Long-Term Care Facilities be Changed Forever by COVID-19?” and “The Massage
Therapist’s Guide to Assisted Stretching Techniques” (both, massagemag.com).
For massage
therapists without a
built-in clientele like
pregnancy massage,
you can network to
parenting groups and
seek referrals from
pediatric doctors,
doulas and other
healthcare providers
who work with
expecting parents and
infants.

7 Steps to
Marketing a New
Technique
By Melinda Hastings, LMT, BCTMB, MTI
Continuing education classes expand your technical skills and help you build
a stronger authority position—but did you know that you can, and should,
leverage your newly learned massage technique in a way that goes beyond
simply adding it as a new menu item?
Going further will provide an incredibly powerful marketing strategy.
By implementing the tips outlined below, you can increase your authority
position, build excitement, and get heaps of appointments—even before the
class is completed.
Market Your New Massage Technique
1. Register for Class
As soon as you register for a new CE class, let your clients know! Send out a
short email with a concise description of the class and why you believe your
clients will benefit from this new modality or technique. When you show your
excitement, your clients will get excited too.
2. Two Weeks Prior to Class
Repurpose your email by creating posts for all of your social media accounts.
Share one or two ways your clients will benefit from your new skill set. Ask an
engaging question, such as, “Who’s excited to experience these benefits for
yourself? Post your favorite gif or emoji in the comments.”
3. One Week Prior to Class
Send out a second email and repurpose that into new social media posts. This
time, in addition to information about the modality or technique itself and how it
will benefit your clients (make sure you are including different benefits in each
email), invite clients to pre-schedule feedback sessions.
Offering a very limited number of these sessions will continue to build
excitement, provide you with the bodies you need to perfect the delivery of
Offering a very limited
number of these
sessions will continue
to build excitement,
provide you with the
bodies you need to
perfect the delivery
of your new skills,
and allow clients
to experience the
expanded results you
can offer.

your new skills, and allow clients to experience the expanded results you can
offer. And a fantastic bonus? Your bank account will thank you!
4. During the Class
Capture the excitement with photos. Ask the instructor for permission to
photograph their banner or the title slide of their presentation. If the instructor
allows, take a few up-close snapshots of the practice sessions, making sure to
get your fellow students’ permission in writing as well.
Post these photos and some exciting commentary about what you are doing
in class. Remind your followers to pre-schedule feedback sessions if your
schedule has not already filled up. Include a deadline (the end of class) to
create urgency and exclusivity.
5. After the Class
Send a third email, again repurposed into new social media posts, describing
what you learned in class, how it will benefit your clients, and why you are
excited to share this new modality or technique with them. Invite clients to
schedule a session so they can experience these benefits for themselves.
6. Leveraging CEs to Increase Your Rates
Expanding your skill set, whether you accomplish that by offering a new,
stand-alone modality or by adding new techniques to your existing routine,
Expanding your skill
set, whether you
accomplish that by
offering a new, stand-
alone modality or by
adding new techniques
to your existing routine,
can prime you for a
rate increase.

can prime you for a rate increase. But before you slap a new price tag on your
service, it is a good idea to give weight to the following question:
7. Is it an Add-on or Add-in?
Integrating a new technique into your current session structure is an excellent
way to increase your rates. To do so effectively, you will want to consider the
increased results your clients will experience as a result of this new technique
compared to the results they get from your existing session structure.
The more powerful those results are, the more valuable they are, and the
higher your fee can be. The most significant factor in choosing add-in versus
add-on is scalability. Offering valuable add-ons is a good way to boost your
income, but it is limited to client interest.
Add a Massage Technique into Session Structure
By adding your massage technique into your session structure, you are able
to scale your income by increasing your base session fee. That means all
clients will be paying a higher fee (and experiencing the best results you have
to offer), not just clients who opt for the add-on. This allows you to rapidly and
significantly increase your income.
Leveraging your new skills through effective marketing can help you grow your
clientele and set the stage for you to increase your session rates. Now, the
only question is: Which CE class will you register for next?
Melinda Hastings, LMT, BCTMB, MTI, has practiced massage therapy since 1996. She
holds active licenses in Washington and Texas, and is also a Texas Massage Therapy
Instructor. She is a Nationally Approved Continuing Education Provider through the
National Certification Board for Therapeutic Massage and Bodywork, and her CE classes
are offered through her seminar business, Inspired Therapist Seminars.
The most significant
factor in choosing
add-in versus add-on
is scalability. Offering
valuable add-ons is a
good way to boost your
income, but it is limited
to client interest.

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