Winning Hands Massage

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Types Of Bodywork/Modalities

Partner Massage Handouts

Definition of Massage

What is massage? According to RCW 18.108.010, the State of Washington defines massage as:

“Massage” and “massage therapy” mean a health care service involving the external manipulation or pressure of soft tissue for therapeutic purposes. Massage therapy includes techniques such as tapping, compressions, friction, Swedish gymnastics or movements, gliding, kneading, shaking, and fascial or connective tissue stretching, with or without the aids of superficial heat, cold, water, lubricants, or salts. Massage therapy does not include diagnosis or attempts to adjust or manipulate any articulations of the body or spine or mobilization of these articulations by the use of a thrusting force, nor does it include genital manipulation.

RCW 18.108.030 further states that “(1) no person may practice or represent himself or herself as a massage practitioner without first applying for and receiving from the department a license to practice” and “(2) A person represents himself or herself as a massage practitioner when the person adopts or uses any title or any description of services that incorporates one or more of the following terms or designations: Massage, massage practitioner, massage therapist, massage therapy, therapeutic massage, massage technician, massage technology, massagist, masseur, masseuse, myotherapist or myotherapy, touch therapist, reflexologist, acupressurist, body therapy or body therapist, or any derivation of those terms that implies a massage technique or method.”

RCW 18.108.040 adds that “It shall be unlawful to advertise the practice of massage using the term massage or any other term that implies a massage technique or method in any public or private publication or communication by a person not licensed by the secretary as a massage practitioner or without printing in display advertisement the license number of the massage practitioner.” However, RCW 18.108.050 specifically exempts “An individual giving massage to members of his or her immediate family.”

Types of Massage

In general, there are two basic categories of massage and/or bodywork: Spa/Relaxation and Medical/Treatment. The legal definition, however, correctly stipulates massage as a “a health care service involving the external manipulation or pressure of soft tissue for therapeutic purposes” because even basic relaxation massage has therapeutic benefits.

Within these broad definitions, there are literally dozens of different types or modalities of massage. When most people think of massage, they think of basic Swedish massage. This consists of long, gliding strokes (effleurage), kneading and squeezing (petrissage), rubbing (friction) and tapping (tapotement). All of these techniques can be done light or deep and for either relaxation or treatment. They can be therapeutic because they affect heart rate, circulation and blood pressure. They are also effective in treating various muscle aches and pains, sprains and strains.

But they just scratch the surface of what can be done by some of the advanced, specialized modalities.

Here is a sample list from “The Encyclopedia of Bodywork” by Elaine Stillerman. Actinotherapy, Acupressure, Acupuncture, Alexander Technique, AMMA therapy, Applied Kinesiology, Aromatherapy, Aston-Patterning, Aura Therapy, Ayurvedic Medicine, Bartenieff Fundamentals, Bindegewebsmassage, Bioenergetics, Bowen, Breema, Chi Nei Tsang, Cupping, Deep Tissue, Ericksonian Hypnotherapy, Esalen Massage, Feldenkreis, Hellerwork, Hydrotherapy, Johrei, Light Therapy, Lymphatic Drainage, Moxibustion, Muscle Energy Work, Myofascial Release, Neuro-Linguistic Programming, Neuromuscular Therapy (NMT), Ortho-Bionomy, Polarity Therapy, Qigong, Reflexology, Reiki, Rolfing, Rosen, Russian, Shiatsu, Swedish, Thai, Therapeutic Touch, Tibetan, Touch for Health, Trager, Trigger Point Therapy, Watsu, Yoga, Zero Balancing, Zone Therapy.

The above list is only a portion of what she lists in her encyclopedia. And her encyclopedia is NOT all inclusive. As examples, she does not list Craniosacral Therapy and only one form of Lymphatic Drainage (there are actually several ways to do lymphatic work). Nor does she list Acutonics, which is working with the acupoints and meridians vibrationally using precision tuning forks. In addition, many of the individual modalities can more appropriately be grouped under umbrella headings. For example, Alexander, Feldenkreis, Heller, all forms of Myofascial Release including MFR and Rolfing, can be grouped together under the catch-all category of Structural Integration work.

History of Massage

The first recorded reference to massage dates to 4,000 years ago in China. The first actual “book” about massage is also Chinese, dating to 2,500 years ago. It is “The Yellow Emperor’s Classic of Medicine” and is still used today. (I have two different translations of it in my own reference library.) Various forms of massage were commonly used for wellness, healing and sports by both the Greeks and Romans. Massage was in common practice in Europe through the middle-ages and has never gone out of favor in Eastern-Oriental cultures.

Massage in general, in that it was associated with bodily pleasures, fell out of favor in European or Western culture with the rise of Puritans and other strict religious groups. Consequently, the health and wellness benefits of massage and touch therapy was pretty much lost to Western culture until very recently. The rebirth of massage in general was started by a Swede, Per Henrik Ling (1776-1839). He called it Swedish Gymnastics and it was the foundation for what is known today as Swedish Massage.

Benefits (Indications) of Massage Versus Contraindications

There are many, many general therapeutic and specific treatment benefits from the various types of massage. There are also, however, very serious risks of injury if done improperly or by the untrained in certain situations. These are called “contraindications.”

“Mosby’s Fundamentals of Therapeutic Massage” on page 183 states that “An indication is when an approach is beneficial for health enhancement, treatment of a particular condition, or support of a treatment modality other than massage.” Various massage techniques can effectively lower blood pressure, improve circulation, treat strains and sprains, and release chronically contracted muscles, as well as providing relief for things such as headaches, constipation, and breathing difficulties. Massage also provides temporary relief from muscular pain and tension, relaxes muscle spasms, helps improve muscle tone, and delays or prevents muscle atrophy in cases of forced inactivity caused by injury, illness or age.

A Contraindication is when an approach or technique could be harmful. There are three types of contraindication:

1. General – do not perform any massage techniques
2. Regional – avoid a specific area or region of the body
3. Cautionary – requires supervision by an appropriate medical or supervising person or careful selection of method, duration or frequency of massage.

For the untrained, the following conditions should be considered absolute contraindications. The operative word here is “untrained.” There are numerous situations where an untrained person performing any kind of massage or bodywork could unintentionally cause serious harm or injury. Yet, those very same conditions might be indicated for massage or bodywork by a trained person, or with very specific techniques. Instead of being potentially harmful, the work could in fact be beneficial.

General Contraindications

1. Acute stage Pneumonia
2. Advanced kidney failure
3. Advanced respiratory failure
4. Diabetes with complications
5. Hemophilia
6. Hemorrhage
7. Liver failure
8. Unstablized Stroke
9. Unstablized Heart Attack
10. Unstable Hypertension
11. Shock
12. Head Colds or Flu at onset
13. High Fever (above 101 degrees) . Massage can accelerate or increase the fever.
14. Acute conditions requiring first aid or medical attention
15. Pregnancy - Several points in the body, especially around the ankles, can cause fetal distress and even induce premature labor.
16. Drug and alcohol consumption prior to massage - Client taking anti-inflammatory drugs, muscle relaxants, anticoagulants, analgesics, or any other medications that alter sensation, muscle tone, standard reflex reactions, cardiovascular function, kidney or liver function, or personality.

Regional Contraindications

1. Acute flare-up of inflammatory arthritis
2. Acute neuritis
3. Aneurysms deemed life-threatening
4. Ectopic pregnancy
5. Frostbite
6. Local contagious infections
7. Local irritable skin condition
8. Malignancy
9. Open wound or sore
10. Recent burn
11. Undiagnosed lump
12. Swelling or inflammation caused by an injury, pitting edema
13. Recent Surgery
14. Advanced Varicose Veins
15. Phlebitis
16. Unexplained pain or pain or an unknown origin outside of your knowledge

Massage Basics

• Environment (Lighting, Music, Candles, Scents)
• Sanitation (Cleanliness and Personal Hygiene)
• Equipment (Table or work platform, stool)
• Clothing
• Draping
• Lubrication (oil, lotion, gel, powder, cream, none)
• Body Mechanics
• Grounding and Centering
• Opening Protocol
• Basic Massage Strokes (Effleurage, Petrissage, Tapotement, Vibration/Shaking, Friction)
• Doing an Actual Massage
• Holding Patterns and Releases

Environment

The environment sets the stage. It should be quiet, comfortable, and with no expected interruptions. Appropriate lighting, music and scents not only enhance the mood, they help trigger the body’s relaxation response. Lighting should be subdued, avoiding harsh or glaring light in the eyes of the person receiving the massage. Some practitioners like to work with music while others do not. If you are going to have music, it should be low in volume and non-rhythmic (New Age music is great) because rhythmic music tends to cause the mind to focus on the repetitive pattern. Excessive volume and mental focus on the music can both be distracting. Scented candles and/or other aromatics should be used with caution, particularly if potential allergies exist.

Sanitation

This includes both cleanliness of the equipment and personal hygiene of both the giver and receiver. The giver should thoroughly wash both hands AND arms at least to the elbow. The receiver should either bathe or shower before the massage, not only for obvious reasons, but to assure that no particles of “grit” are present which can be picked up by the lubricant and literally act as an abrasive on the skin.

Equipment

The ideal equipment arrangement is a massage table, without or without a massage stool for the giver, as well as a bolster or pillow to support the receiver’s knees. Some people also like a small pillow under the head or neck when supine. If an actual massage table is not available, other suitable substitutes can include a sturdy dining room table (properly padded for comfort of the receiver), a sofa, or the side or foot of a bed, even the floor. The big issues or concerns when an actual massage table is not available are the comfort and body mechanics of the giver to avoid unnecessary muscle tension, stress, discomfort or even injury to the giver.

Clothing

The giver should wear loose fitting, comfortable, clothing that does not restrict movement or bind while giving the massage. Sleeves should be short to avoid dragging across the receiver in a distracting manner. All jewelry should be removed before the massage, by both the giver and receiver. In addition, contact lenses should also be removed to avoid discomfort while prone in a face cradle. The receiver should disrobe to their level of comfort and modesty with the understanding that clothing is not compatible with use of lubricants.

Draping

Draping is the term for preservation of modesty by covering with a sheet or towel. For professional, licensed massage for hire, it is a legal requirement that the genitals must ALWAYS be properly draped. Draping of female breasts is subject to both legal and ethical considerations depending strictly on the circumstances. Unlike the genitals, there is no absolute legal prohibition on exposing the breasts. However, there ARE legal and ethical issues involved if so doing is deemed inappropriate.

Lubrication

Use of lubrication, and which kind, is a personal decision or preference of the giver and receiver and a function of the type of massage being done. The basic kinds of lubricants are oils, lotions, gels, powders, and creams, all of which can be either scented or unscented. For previously untried lubricants, it is always wise to “test” for sensitivity in a small area to assure no allergic reactions. No lubricants of any kind are ever used when doing a clothed massage or for certain types of treatment work, such as myofascial release. In general, lubricants should also be avoided for the head and face. Do not use an excessive amount of any lubricant. The purpose of the lubrication is to reduce friction on the skin. Too much lubricant, however, is not only ineffective, it can be downright messy.

Body Mechanics

Body Mechanics refers to those things the giver can do to prevent stress or injury to the giver’s body. These include posture, angle of joints, and leverage. The average career span for massage therapists is approximately seven years. There are many reasons why, but one is the toll the work takes on their bodies if they do not use proper body mechanics. This includes low back injury, rapid onset of osteoarthritis in joints, and repetitive stress injury. Most of these problems can be avoided through knowledge and awareness.

Grounding and Centering

To a certain degree, grounding and centering are used interchangeably and mean the same thing.

Grounding is similar to grounding electricity. But in bodywork, it means more of an anchoring, stabilizing, or connecting with your immediate working environment.

According to “Mosby’s Fundamentals of Therapeutic Massage,” centering is “The ability to focus the mind by screening out sensation.” I personally don’t care for this definition. I prefer to think of it in terms of achieving a sense of inner calm or stillness where my attention and intention is completely focused on what I am doing, where I am blocking out extraneous distractions. When I first got into the massage program, I used to refer to it as mentally “going within.”

How do you do it? There are a number of ways and what works best for one person doesn’t necessarily work as well or even at all for someone else. I have never personally had a problem with it myself, even in the beginning. It was just something that came naturally for me. There are times, however, when I will deliberately reinforce it with certain mental and/or breathing routines while I am working.

One technique used by many energy workers is to go into a “squat” position with feet flat on the floor and hind-end as low to the ground as the knees will comfortably permit, and to then do a series of deep breathing exercises. One breathing routine is called the microcosmic orbit. Breathe in through your nose, visualizing the breath coming from your feet, up through your spine. Do it slowly on a count of 3-5 seconds for the inhalation, hold for a count of 3-5, and then breathe out through your mouth (also on a 3-5 count) while visualizing your breath going out and down the front

If you are into mediation, you can also do that.

Regardless of whatever kind of spin the modality involved puts on it, the real issue with Grounding and Centering is that it allows the practitioner to achieve the necessary brain wave state to facilitate entrainment with the client.

Opening Protocol

Virtually every bodywork modality starts with some kind of opening hold or technique. First term in massage school, we were taught to stand at the client's left side with the client prone on the table and to place the palm or flat of our right hand over their sacrum and the palm or flat of our left hand at the base of the skull along the occipital ridge. We would then gently "jostle" them with a side to side rocking motion. We were told that this was to "acclimate the client to our touch." Second term, they expanded on it by telling us that the real reason to do this was that it helped engage the client's parasympathetic nervous system (PNS) and to trigger the relaxation response. Craniosacral Therapy uses a cranial vault hold to "induce a still point." Other modalities use similar techniques, each with their own stated reasons for doing so.

All of these opening holds or techniques do in fact do exactly what they say they do – acclimate to touch, engage the PNS, trigger the relaxation response, induce a still point, or whatever else is claimed for them. But they do something else as well. Combined with grounding and centering, they bring the respective brain wave states into synchronization or entrainment and entrainment is what allows you to engage deeper levels beyond just the physical.

Basic Massage Strokes

There are five basic types of strokes used in general Swedish Massage: Effleurage, Petrissage, Tapotement, Vibration or Shaking, and Friction.

Effleurage

Effleurage is a sliding or gliding stroke across the surface of the skin. It can be done with the fingers, surfaces of the hand (palm, edge of hand, heel of hand), forearm, or even the elbow. It generally follows the fiber direction of the underlying tissue (muscle or fascia). It can be done superficially or deep, as in deep tissue work. Done superficially, slowly and gently, it is an excellent relaxation or sedation technique.

Petrissage

Petrissage is a kneading, squeezing, wringing or lifting of the skin or underlying soft tissue. It too can be done superficially or deep. Variations of Petrissage are frequently used to release restricted fascia or to break up adhesions.

Tapotement

Tapotement (also called percussion) is a rapid, rhythmic, compression of the tissue. It can be done with the fingers, closed fist, or flats of the hands. It is frequently used in Sports Massage and is used to stimulate the tissues. It can also be effective to overcome drowsiness and restore alertness.

Vibration

Vibration includes jostling, shaking, rocking, and quivering motions. It can be done both slowly and gently (very relaxing), or rapidly and with vigor (to stimulate or tonify).

Friction

Friction is specific circular or transverse movements, generally across the grain of fiber of the underlying tissues. It is not a sliding/gliding action like Effleurage and is focused on a confined area. A variation called Cyriax Cross Fiber Friction is a very specific treatment technique frequently used to break up adhesions and scar tissue.

Doing an actual Massage

Should you start face down or face up (prone or supine)? That is entirely up to the giver and receiver. In general, it makes no difference whatsoever whether you start or end prone or supine. Some people prefer to have their back done first while others prefer to end with their back. Total length of time prone or supine, however, can be a deciding factor, especially if the receiver has low back or joint issues which cause discomfort, or breathing difficulties.

Where on the body should you start? Again, there is no absolute requirement that any particular starting point be observed. Generally, work will start with the head, neck and face and progress down the body from there. But this is by no means mandatory. From a serious treatment perspective, there will be reasons why specific starting points and patterns will be observed. Such is not the case, however, for a general relaxation massage. Assuming starting prone, a general sequence might be an opening protocol, followed by the head/neck, shoulders, back, legs and feet. After finishing the feet, the receiver would turn over and the fronts of the legs, arms, hands, and upper chest would be done. The massage could end with a light facial or scalp massage.

Before starting, it is advisable to determine how much total time will be allotted for the complete session and to then mentally block time segments for each area. As an example, assume an hour for the full massage. How much time will be devoted to the head, neck, back, arms, hands, legs, and feet? It is NOT necessary to have an equal division of time for each area. Time management should be observed, however, so there is enough time to do the full body without either running out of time or finishing an area in a rushed or hurried manner.

One generality that needs to be observed for standard Swedish type work is the requirement that strokes be toward the heart or body core. This is primarily because of direction of superficial blood and lymph flow. Compressive strokes away from the heart will tend to cause a pooling of blood and lymph in the extremities, i.e. hands and feet. LIGHT, gentle, effleurage away from the heart is acceptable, but no heavy, compressive strokes. Another generality is to do at least three strokes of any given type, in sequence, per body area. Also, at least try to match one side of the body with the other in terms of type and number of strokes. Whatever work is done on one side should be repeated on the other.

One area of caution is abdominal massage. It is very useful and very effective for a number of purposes. However, it is necessary to be aware of the direction of flow within the intestines to avoid causing unnecessary complications. The large intestine starts at the iliocecal valve in the lower right abdomen. It then goes toward the right shoulder (ascending colon) to approximately just below the rib cage, where it becomes the transverse colon and goes laterally across the body. On the left side, it becomes the descending colon and flows toward the left hip. When facing the receiver, the flow is in a clockwise pattern. Any abdominal massage needs to observe this flow pattern.

Proper support for the head, neck and all joints also needs to be observed. Whenever it is necessary, for instance, to lift someone’s leg for any reason, it is important that the knee be supported with one hand to avoid stressing the knee joint. If at any time, the receiver experiences pain, immediately STOP whatever you are doing. This is especially important if the pain is associated with the neck or spine, or if it is a sharp, stabby, nerve pain.

Holding Patterns and Releases

The body holds stress and tension in different areas. For one person, it might be the shoulders. For another, it might be the low back. For a third, it might be in the neck. The point is that everyone has their own stress or tension pattern that is unique to them. The body also compensates. It does not like pain or discomfort so it will adjust posture (compensate) to reduce or eliminate that pain or discomfort.

As a general rule of thumb, what and where it hurts is the actual problem only for acute situations. Trip on a tree root and sprain your ankle, the actual problem is in fact your ankle. Over time, however, because of compensations, that is not true. Your ankle hurts so you shift your posture to reduce the strain on it. That puts added strain on your opposite knee, which in turn continues on up the body. You could easily end up with a neck problem that is actually caused by continuing to favor an ankle that has already healed physically. The symptom is the neck; the problem is the ankle.

This is because the body also remembers. For most people, the term “muscle memory” is associated with either athletics or combat training. Specifically, the same actions are performed repeatedly, to the point where conscious thought to trigger action is no longer necessary. The body simply responds in an automatic reaction. But there is a different meaning where “bodywork” is involved. The body “remembers” whatever caused it past stress or trauma. This can include physical, psychological, or emotional trauma. Part of the body’s protective defense mechanism is to shield or guard itself against that occurring in the future. For a stretch injury to a tendon, for example, the body will remember the position it was in when the injury occurred. To prevent it happening again, the body will “muscle guard” any time that tendon reaches the same point, even well after the physical injury has healed. This is partly why people will end up with “frozen” joints or restricted ranges of motion.

In addition, the more traumatic the injury or event (this can include abuse situations), the more likely that an emotional charge or component will attach to the physical dysfunction. This is important to know for two reasons. The first is that full healing can not occur until that emotional charge is addressed and released. The second is that massage and bodywork can be instrumental in achieving that release. Sometimes the release will occur spontaneously during a session. Both the giver and receiver of massage or bodywork need to be aware of what is involved to be able to appropriately deal with it if it happens.