BLUE SKY SCHOOL OF PROFESSIONAL MASSAGE AND THERAPEUTIC BODYWORK FULL BODY RELAXATION MASSAGE HANDS ON MANUAL

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1 Learning Objectives: BLUE SKY SCHOOL OF PROFESSIONAL MASSAGE AND THERAPEUTIC BODYWORK FULL BODY RELAXATION MASSAGE HANDS ON MANUAL Demonstrate the correct way to carry a table in carrying case. Long strap across shoulders. Hold on to smaller strap at the side of the table. Tables are not to be pushed or dragged. Demonstrate the proper way to carry a table without a carrying case. Hold the handle and lift. Tables are not to be pushed or dragged. Demonstrate the proper procedure for table set-up. 1. Remove table from carrying case. 2. Stand table on side with rubber feet down and handle side up. 3. Unlock table latches and flatten latches. 4. Open table to 90 degrees. 5. Straighten table legs-making sure no cables are twisted. 6. Open table to straight position/flat position/180 degrees. 7. Place your foot on a leg that is touching the floor, grab table handle and pull table toward you, allowing the table to get to a standing position. 8. Lift one end (head or foot) of the table to be sure table is standing completely flat/secure/stable. 9. Adjust legs/table height as needed 10. Check the legs to insure they are set to the correct height and the leg knobs are tight. 11. Insert face cradle. 12. Place a sheet on the table for protection. Demonstrate how to adjust the face cradle position for client comfort. Demonstrate proper cleaning procedures for the massage table. Direct students where cleaning bottles are kept. Tables should ALWAYS be cleaned before they are put away. Bring a towel or old t-shirt to wipe the table down after it has been sprayed off. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 1

2 Demonstrate the proper procedure for table take down. 1. Spray table and face cradle down with disinfectant spray. 2. Reverse steps listed in Table Set-up. 3. Face cradle goes inside the table NOT in the pocket of the carrying case. 4. Table goes into carrying case when applicable. Demonstrate proper draping techniques. Demonstrate how to create a toga. Wearing socks to and from the table (wipe the client s feet before they get off the table). Maintain a client s comfort and modesty. Cover the client for warmth. Sheet turned length wise, as not to drag on the floor. Demonstrate appropriate bolstering techniques. Items that can be used for bolstering (bolsters, pillows, rolled up towels, and blankets) Bolsters should always be offered. When the client is supine/on their back there should be a bolster under the client s knees for low back support. When the client is supine/on their back a bolster may be needed under their head and/or neck. When the client is prone/on their stomach the bolster is placed under their ankles to protect their ankle joint. When the client is prone/on their stomach a pillow might need to be placed under the client s hips and stomach to help protect the client s low back. Place bolstering under the client s shoulders to take the pressure off her breasts when she is prone/on her stomach. This position also works for any client who has shoulder problems. Demonstrate an initial contact that allows the client to become accustomed to you and your touch. The first time you touch a client it is called the resting position. This initial touch is done with respect and is client-centered. Demonstrate a respectful and flowing end to the massage, allowing a respectful break in contact and energy. Demonstrate the proper application of oil/cream/gel/lotion. Warm up lubrication in your hands before applying to client. Keep contact with client. Keep track of you lubricant. Demonstrate the ability to maintain a physical and/or energetic contact with the client as you perform a full body massage. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 2

3 Demonstrate and explain the necessity for good client communication. Introduce yourself. Establish and clarify the goal for today s massage. Directions for disrobing and placement of the client s clothes. Directions for the client are starting position on the table. Directions for how and what the client should do when the session has ended. Directions for getting on/off the table. Instructions for follow up care or home program (i.e. drink water). Demonstrate a professional presence. Appropriate dress. Client centered sessions. Appropriate massage related conversations. Professional attitude. Demonstrate good personal hygiene. Clean hair that is tied back. Body bathed and free of body odor. Clean, short nails, free of nail polish. No jewelry or watches. Clothes comfortable and non-restricting, but do not drag on the client. Body free of strong smells (smoke, foods, perfumes or essential oils. Breath fresh. Wear gloves as needed if the therapist has any broken skin. Demonstrate safe and effortless body mechanics. Shoulders down Bent knees Straight back Relaxed shoulders, arms, forearms, wrists and hands Feet in the direction of force Bending from the hips, not waist Head up Power from the feet/core of the body/the legs Breathe, relaxed and freely 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 3

4 RULES OF MASSAGE Promote client comfort through a restful environment, appropriate bolstering and applicable use of a blanket. The client should be in a comfortable position and able to breathe freely throughout the entire treatment. Have good intentions. Be present, be focused and respect the client. Ground yourself so that sessions are client-centered. (Go to your happy place/be present for the client to enhance the quality of your massage) (Be there for the client). A good massage therapist thinks less of the manner of moving his hands than of the tissues upon which he is working Mat Bullock, University of Illinois Athletic Trainer (1925). In other words, don t get caught up in the moves keep the flow going. Allow your hands to work the tissue it is touching. Be confident. Lack of confidence is transmitted through the therapist s hands. (The client won t know if you re doing it wrong anyway!!). Use good body mechanics. The massage therapist should place themselves in comfortable and relaxed positions for carrying out the massage session and should be able to breathe freely during the entire massage session. Care should be taken at all times to support the extremities while they are being moved, rotated, stretched or massaged. Avoid endangerment sites. Learn indications and contraindications. All movements should be performed rhythmically during relaxation massage. The muscles being massaged should be relaxed. The massage therapist s hands should be warm and comfortable. This will allow the client s entire body to relax. Begin with lighter pressure and work progressively deeper based on client s tolerance to avoid guarding that is counterproductive to massage. Be thorough and complete. Always connect body parts to themselves and to one another. Work deep enough to effect muscle and release tension, but not so deep that you cause tension and pain. Depth of pressure is a result of leverage and leaning on the body. Pressure increases as the angle of the lean increases. Increases in pressure are NOT achieved by pushing with muscle strength. Practice personal hygiene and sanitation. Such as the therapist washing their hands before and after a massage. If the therapist sneezes, coughs into their hands or wipes their nose during a session, hands must be washed again. Avoid scratching the skin of the client by having nails properly trimmed. Avoid overly loose-fitting clothing that drags on the client during the session. Also very tight clothes that will restrict therapist ability to move or may be suggestive in nature. Hair should be pulled back: Out of the eyes of the therapist, as it is not appropriate to touch your hair during a massage session. To avoid dragging on or tickling the client. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 4

5 Keep a towel handy to: 1. Remove excess lubrication from your hands and the client. 2. Provide additional draping as needed. 3. Wipe the sweat from your brow. 4. Cleaning the table at the end of the session. KEY TERMS: (just a few to get started with) Bony Landmarks PSIS Posterior Superior Iliac Spine ASIS Anterior Superior Iliac Spine AC joint Acromioclavicular Joint EOP External Occipital Protuberance Muscle/Muscle Groups Paraspinal muscles Erector Spinae group ITB Iliotibial Band SCM Sternocleidomastoid TFL Tensor Fascia Latte BASIC STROKES: Effleurage Friction Petrissage *Compression Vibration *Rocking *Shaking ROM Tapotement EFFLEURAGE: from the French word effleurer, which means to flow or glide. Definition gliding stroke whose result is determined by pressure, drag, speed, direction and rhythm; application is horizontal in relation to the tissues. Uses To calm or sedate tissue. To apply lubrication. To warm or prepare tissue. Precautions: Therapist should avoid hyperextension on their wrist, by keeping it between degrees. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 5

6 Techniques One-handed Two handed Alternate hand Circular Nerve stroke PETRISSAGE: from the French word petrir meaning to mash or to knead (Including: Compression). Definition kneading; requires that soft tissue be lifted, roll and squeezed rhythmically; application is vertical in relation to the tissues; main purpose is to lift tissue. Uses Good for decreasing muscle tension. Good for mechanically softening superficial fascia (compare to breaking in new shoes). Skin rolling is safe to use over the spine. Stretches and broadens the tissue. Precautions Techniques Skin rolling Kneading Wringing One handed Two handed Alternate hand COMPRESSION: Definition rhythmic, pumping action where the muscle is pressed at a 45 to 90 degree angle against bone to achieve spreading action; stimulating to the muscles and nervous system. Uses Working over clothing or without lubricant. Sports massage Chair massage Hairy clients Acupressure points Trigger points Main method used in shiatsu and other Oriental approaches. Compression bypasses the tickle response by activating deep touch receptors. Client prefers more stimulating massage. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 6

7 Precautions Because of its stimulating effect, compression is less desirable for a relaxing or soothing massage. If using the palm of the hand or heel of the hand be cautious of wrist position. Techniques 1. Very specific pinpoint compression is called direct pressure or ischemic compression. 2. Fist 3. Knuckles 4. Thumb 5. Braced finger(s) 6. Forearm 7. Palm of hand 8. Heel of the hand 9. Fingertips 10. Heel squeeze TAPOTEMENT (A.K.A. PERCUSSION): Definition Springy blows to the body at a fast rate to create rhythmic compression of the tissue; to rap, drum or pat. Uses Initiates or enhances sympathetic nervous activity. Stimulates weak muscles. Precautions Do not use vibration or tapotement directly on the spine. Use light pressure over the kidneys and floating rib and other endangerment sites. Vary pressure with body area. Not to be used after physical activity as it may set off spasms or cramps. Techniques All are less invasive when applied parallel to muscle fibers. 1. Hacking 2. Pounding/Beating 3. Slapping 4. Cupping (good for chest/lung congestion; used for children with cystic fibrosis) 5. Star hands 6. Tapping 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 7

8 FRICTION: Definition vertical pressing down to apply movement to underlying tissues; skin moves with the fingers. Uses Creates therapeutic inflammation. Prevents adhesions in connective tissue (ligaments; tendons) and scars. Breaks up adhesions in connective tissue (ligaments; tendons) and scars. Precautions Not to be used over acute injury or fresh scars. Friction burns may result if fingers are allowed to slide back and forth over the skin. Tissue should be placed in a soft or slack position. Creates a good hurt. Client my have feeling of mild exercise soreness for up to 48 hours after treatment. Creates increased circulation that results in mild puffiness/swelling. The area should not bruise. Techniques 1. Fingertip 2. Thumb 3. Braced finger 4. Fist 5. Palm of hand 6. Transverse 7. Circular VIBRATION: ( includes shaking and rocking) Definition Fine or coarse tremulous movement that creates reflexive responses. Uses Used to wake up nerves (stimulates nerve endings). Loosens connective tissues. Encourages deeper lymphatic and venous circulation. Precautions Do not use vibration or tapotement directly on the spine. Use light pressure over the kidneys and floating rib and other endangerment sites. Vary pressure with body area. Not useful on skin or superficial fascia. Requires a lot of energy on the therapist s part. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 8

9 Techniques 1. Heel of hand 2. Side of hand/lamina groove 3. Thumb along side of spine 4. Fist 5. Motorized versions (i.e. the Thumper) SHAKING: Definition/Logic Uses Sometimes classified as rhythmic mobilization. A technique in which the body area is grasped and shaken in a quick, loose movement. Shaking manipulations confuse the positional proprioceptors because the sensory input is too unorganized for the integrating systems of the brain to interpret and muscle relaxation is the natural response in such situations. Sometimes classified as vibration but the difference is that vibration begins with compression and shaking begins with lifting. Large muscle groups Entire limbs Performed on antagonist muscles (ex. Work on quads to relax hamstrings) Stimulates weak muscles Precautions Do not use vibration or tapotement directly on the spine. Use light pressure over the kidneys and floating rib and other endangerment sites. Vary pressure with body area. Not to be used anywhere there is pain or discomfort. ROCKING: Soothing and rhythmic to calm. Works through the vestibular system of the inner ear and feeds directly to the brain to initiate parasympathetic mechanisms (hint: parasympathetic = calming; sympathetic = fight or flight; Para = paramedics who come to help); One of the most productive methods to produce entrainment. Used within the client s natural body rhythm. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 9

10 RELAXATION Posterior Body In the informational boxes Therapist position notations are guide lines, suggested starting points. The exact placement will have to be adapted for the therapist body type, framework, height and any restrictions the therapist may have. Posterior Body Spine & Thorax Therapist position: Standing at the level of the client s gluteal region and facing superior/toward the head of the client. Client position: Prone; Ankles bolstered. Draping: Sheet folded down just superior to the sacrum and sides of sheet tucked around hips of client at the level of the PSIS. Muscles/Tissue affected: Fascia Common uses: Warm the tissue. Definition of Fascia: Fascia is a form of dense fibrous connective tissue that is found in abundance throughout the body. It not only wraps the entire body (superficial fascia) but also surrounds each organ and muscle (deep fascia). Pulling the skin off the chicken is fascia. Definition of Connective Tissue: It is the most abundant and widely distributed tissue in the body. It has various types with a variety of functions WARMING TECHNIQUES NOTE: These moves are performed without lubrication and can be performed on almost any part of the body. MYOFASCIAL RELEASE WITH CROSSED HANDS (NO OIL IS USED AT THIS TIME) a) Cross your hands your arms/hands in a X formation. b) Place your flattened hands on the client s back. c) Apply a slight amount of down and outward pressure, use only enough pressure to prevent you from slipping. (i.e., pushing your hands away from each other, yet your hands are stuck on the client s skin) d) Wait until you feel the tissue give / release. e) Slowly remove your hands to another starting position. MYOFASCIAL RELEASE WITH OPPOSING THUMBS a) Cross your hands your thumbs in a X formation. b) Place your flattened thumb pad on the client s back. c) Apply a slight amount of down and outward pressure, use only enough pressure to prevent you from slipping. (i.e., pushing your hands away from each other, yet your hands are stuck on the client s skin) d) Wait until you feel the tissue give / release. e) Slowly remove your thumbs to another starting position. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 10

11 SKIN ROLLING DO NOT PINCH THE CLIENT Slowly picking the client s skin up between the therapist thumbs and fingers gently, yet firmly lift and proceed to roll the skin in a long continuous motion in varying directions. (Longitudinal, diagonal, transversely). Like rolling a pencil between your fingers and thumbs. POSTERIOR BODY OPENING STROKES Therapist position: Standing at the level of the client s waist. Client position: Prone; Ankles bolstered. Draping: Draping to uncover back to PSIS. Therapist may want to use a folded towel on top of the draping at the sacrum for added weight to secure the sheets. Remember to keep the person appropriately draped/covered at all times. Common uses: Warms the tissue. NOTE: DO NOT put direct pressure on spinous processes of the vertebrae. 1. OPEN-HAND EFFLEURAGE: a) Begin by placing open palms bilaterally/on either side of the spine on top of the erector spinae/paraspinal muscles just superior to the iliac crest/hip bone. b) With equal and firm pressure glide superiorly to the top of the thoracic spine (T1). c) Once at the top of the thoracic spine, grasp the upper trapezius, and then glide straight down/inferiorly, with open hands, to the inferior angle of the scapula. d) Move out and around (lateral and superior) the axillary/lateral border of the scapula and continue superiorly to the upper trapezius. e) Once again, grasp the upper trapezius and glide inferiorly with firm pressure to the level of the iliac crests. f) Repeat above series 3 times. 2. FISTS UP CENTER/EFFLEURAGE: Use the flatten surface of the phalanges. Do not use the knuckles. a) Begin by placing loosely clenched fists bilaterally on top of the erector spinae/paraspinal muscles just superior to the iliac crests. b) With equal and firm pressure glide superiorly to the top of the thoracic spine (T1) c) Once at the top of the thoracic spine, allow your hands to open, grasp the upper trapezius, and then glide straight down/inferiorly, with open hands, to the inferior angle of the scapula. d) Move out and around (lateral and superior) the axillary/lateral border of the scapula and continue superiorly to the upper trapezius. e) Once again, grasp the upper trapezius and glide inferiorly with firm pressure to the level of the iliac crests. Allow your hands to gently fold into a loose fist. f) Repeat above series 3 times. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 11

12 3. CIRCULAR FISTS/EFFLEURAGE: a) Begin by placing loosely-clenched fists bilaterally on top of the erector spinae/paraspinal muscles just superior to the iliac crests. b) With equal and firm pressure move fists in a circular motion (medial to lateral) superiorly to the top of the thoracic spine (T1) NOTE: make 3-4 circles up the back, depending on the size of the client. c) Once at the top of the thoracic spine,, allow your hands to open, grasp the upper trapezius, and then glide straight down/inferiorly, with open hands, to the inferior angle of the scapula. d) Move out and around (lateral and superior) the axillary/lateral border of the scapula and continue superiorly to the upper trapezius. e) Once again, grasp the upper trapezius and glide inferiorly with firm pressure to the level of the iliac crests. Allow your hands to gently fold into a loose fist. f) Repeat above series 3 times. Note: For steps 4, 5 & 6, use the spine as the mid-line and work on the half of the back opposite where you are standing. 4. PUSH/PUSH, PULL/PULL/EFFLEURAGE Therapist position Working on the opposite side of the body from which you are standing and using open hands, glide from mid-line to the lateral aspect of the trunk. Begin at the level of the gluteal region and move superiorly to the shoulder region, and then move inferiorly returning to the gluteal region. a) With open, flat hands, move one hand from mid-line to the lateral aspect of the body (latissimus dorsi, serratus anterior, and obliques) and keep that hand there. Move the second hand from mid-line to the lateral aspect of the body next to the first hand (PUSH/PUSH). b) Next, move you re first hand from the lateral aspect of the body back to mid-line and keep that hand there. c) Move the second hand from the lateral aspect of the body back to mid-line next to the first hand (PULL/PULL). d) Repeat steps a), b) & c) moving superiorly then inferiorly covering the entire thoracic and lumbar area. 5. PUSH/PULL, PUSH/PULL/PETRISSAGE a) With open, flat hands, place one hand on at mid-line and the second hand on the lateral aspect of the trunk (latissimus dorsi, serratus anterior, and obliques). Simultaneously, move first hand laterally and the second hand medially (one hand pushes while the other hand pulls) and continue alternating movement of hands laterally and medially (PUSH/PULL). b) Repeat movements while moving superiorly then inferiorly covering the entire thoracic and lumbar area. When working on a woman beware of the breast tissue that may move lateral (to the side of her body) when the woman lays in a prone position. Do not massage the breast tissue. (if the table you are using has breast recesses you do not need to be so concerned about this.) 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 12

13 6. PETRISSAGE/KNEADING/PAC-MAN FAMILY: a) Daddy Pac - Large petrissage covers large area (more open and flat handed) b) Mommy Pac - Medium petrissage covers a more specific area (using more of the full length of your fingers) c) Baby Pac - small petrissage is in quite a specific area (using more finger pad and tips of the fingers Note: Strokes can be varied depending on surface area to be covered. The difference is determined by how wide you spread your hands. This technique is great for transitioning to other moves. Note: For steps 7-9, Resting hand/arm should not place any pressure on the sacrum. 7. FOREARM GLIDING/EFFLEURAGE Therapist position: Stand on the side of the client s body that will be worked (work same side) at the level of the client s waist. Use the spine/spinous processes of the vertebral column as the mid-line and work just lateral to mid-line. Start with the proximal portion/ulnar side of the forearm (thumb points to the ceiling). Superior arm is the one closest to the client s head; Inferior arm is the one closest to the client s feet. Each half of the body will be divided into thirds the long way and worked for each technique. Client s sacrum Client s head Client s spine Client s trunk/thorax divided in half by the spine and then in thirds a) Gently place/rest inferior arm on client s sacrum and place superior arm at just superior to the iliac crest. Begin moving/gliding superior arm firmly toward the client s shoulder (superiorly) and stop stroke just inferior to cervical region. (Erector spinae, rhomboids, trapezius). b) Lighten pressure of superior arm circling laterally glide inferiorly to starting position. c) Repeat steps a) and b) 2 to 4 times beginning more laterally each time. The number of times of repeating this stroke will depend on the size of the person s back. d) When the most lateral portion of the trunk/thorax has been reached, repeat above steps beginning laterally and moving more medially each time. (latissimus dorsi, obliques). Note 1: Be sure to adjust arm over inferior angle of the scapula to avoid inflicting discomfort to the client. The number of times of repeating this stroke will depend on the size of the person s back. Note 2: One set for this move means working once from medial to lateral in thirds, then working lateral to medial in thirds. Note 3: Therapists shoulder should line-up with elbow; DO NOT use muscle strength therapist weight shifting will move the arm. Note 4: The goal is to stretch the tissue. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 13

14 8. FOREARM SKATING/EFFLEURAGE Therapist position: Stand on the side of the client s body that will be worked (work same side) at the level of the client s waist. Use the spine/spinous processes of the vertebral column as the mid-line and work just lateral to mid-line. Start with the proximal portion/ulnar side of the forearm (thumb points to the ceiling). Superior arm is the one closest to the client s head; Inferior arm is the one closest to the client s feet. Each half of the body will be divided into thirds the long way and worked for each technique a) Gently place/rest inferior arm on client s sacrum and place superior arm at just superior to the iliac crest. Begin moving/gliding superior arm firmly toward the client s shoulder (superiorly) and stop stroke just inferior to cervical region. (erector spinae, rhomboids, trapezius). b) Gently rest superior arm at the level of T1, lift inferior arm and place next to superior resting arm. c) Glide inferior arm toward iliac crest (inferiorly) and rest inferior arm just superior to the iliac crest. d) Lift superior arm, place superior arm next to inferior arm at the iliac crest. As in a above. e) Repeat steps a) to d) (skating inferiorly and superiorly) moving laterally with each set of moves. f) When the most lateral portion of the trunk/thorax has been reached, repeat above steps beginning laterally and moving more medially each time. (latissimus dorsi, obliques). SEE NOTES 1-4 in section 7 9. BUTTERFLY/EFFLEURAGE Therapist position: Stand on the side of the client s body that will be worked (work same side) at the level of the client s waist. Use the spine/spinous processes of the vertebral column as the mid-line and work just lateral to mid-line. Start with the proximal portion/ulnar side of the forearm (thumb points to the ceiling). Superior arm is the one closest to the client s head; Inferior arm is the one closest to the client s feet. Each half of the body will be divided into thirds the long way and worked for each technique a) Place arms approximately halfway between T1 and the iliac crest on the lateral aspect of the ribs. b) Firmly glide slightly medially with both arms and then spread the arms superiorly and inferiorly (inferior arm moves inferiorly and superior arm moves superiorly) (erector spinae, trapezius). c) When superior arm reaches T1 and inferior arm reaches the iliac crest, lighten pressure of both arms but remaining in contact with client s skin, move both arms laterally and then toward each other. d) Place arms approximately halfway between T1 and the iliac crest further laterally on the ribs than placement in step a). e) Repeat above steps until the last third of the trunk has been worked. (Obliques, latissimus dorsi). f) Repeat above steps again beginning step a) as far laterally as possible and move medially with each successive stroke. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 14

15 g) Repeat all the forearm strokes on other side of the client s body. ***The movement is like making 2 ovals circling away from each other across the client s back. Moving more lateral with each oval (2-4 times depending on the size of the client s back) then medial 2-4 times back to the starting point. SEE NOTES 1-4 in section 7 Posterior body Shoulders/Cervical region Therapist position: Standing at the side of the table, at the level of the client s mid thoracic. Client position: Prone; Ankles bolstered. Draping: Draping to uncover back to PSIS. Therapist may want to use a folded towel on top of the draping at the sacrum for added weight to secure the sheets. Remember to keep the person appropriately draped/covered at all times. Muscles/Tissue Affected: Rhomboids, subscapularis, and upper trapezius. Palpation hints: The acromioclavicular (AC) joint is the V on the superior-lateral aspect of the shoulder. Common uses: Tight scapula/shoulder blades, sore rhomboid area and decreased shoulder range of motion. NOTE: A hair clip, hair tie or towel may be used to keep client s hair out of the way and minimize lubrication in the client s hair. SHOULDER DANCE a) The therapist inferior hand is open and palm down, starts just superior to the ilium and just lateral to the spinous processes. b) That hand followed by its forearm glides superiorly along the erector spinae until the shoulder has been reached. c) At the same time the superior forearm followed by its hand starts at the neck/shoulder area just lateral to the spinous process. It moves along the top of the shoulder to the deltoid. d) Gently pick up the superior arm and reposition that arm to repeat this stroke several times. At the same time the inferior arm continues, lightens its pressure and makes a gentle oval down the lateral side of the client s body back to the starting point in a. e) Continue this stroke several times. f) Each time working more and more under scapula to loosen it up. MONEY ROLL/PINCER COMPRESSION WITH A TWIST THE UPPER TRAPEZIUS ALONG SHOULDER AND NECK ( WATCH DEMO CLOSELY) PETRISSAGE AROUND THE SHOULDER PETRISSAGE THE SUPRA AND INFRA SPINATUS 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 15

16 Posterior Body Neck & Shoulders/Cervical region Therapist position: Standing or sitting at the head of the client. Client position: Prone; Ankles bolstered. Draping: Client exposed to axillary/arm pit area, client covered from axillary/arm pit region to feet. Palpation hints: The acromioclavicular (AC) joint is the V on the superior-lateral aspect of the shoulder. Common uses: Headaches, whiplash, neck restrictions, general neck soreness, TMJ dysfunction NOTE: A hair clip, hair tie or towel may be used to keep client s hair out of the way and minimize lubrication in the client s hair. 1. DRY SHAMPOO Muscles/Tissue affected: epicranial/ cranial fascia, occipitals; temporalis a) Perform circular friction with both hands on client s scalp/cranium. Note: Pressure can be light or deep, depending on client s preference. Remember to ask client s permission and goal is to work scalp NOT hair. 2. SCOOPING Muscles/Tissue affected: upper trapezius, levator scapula, and cervical paraspinals a) Open hand scoop along the upper trapezius on both sides of the neck (from AC/acromioclavicular joint to occiput) with your hands alternating from one side of the neck to the other. NOTE: This move can be used as a transitional move. 3. LET YOUR FINGERS DO THE WALKING/EFFLEURAGE Muscles/Tissue affected: upper trapezius; levator scapula; cervical paraspinals a) Gently place the therapist s thenar eminences/heel of the hands on the client s occiput and place fingers on posterior cervical musculature. b) Rhythmically flex fingers one at a time superiorly from the base of the neck to the occiput, working superior onto the nuchal line of the occiput. Working the whole back (posterior)portion of the neck Note: This move can be used as a transitional move. 4. NEIGHBORING THUMBS/EFFLEURAGE Muscles/Tissue affected: upper trapezius; levator scapula; cervical paraspinals; supraspinatus a) Place thumbs together (next to each other or one on top of the other for more depth, you can vary the technique) and glide from occiput to AC joint, following the upper trapezius. Moving inferior and lateral working one side of the neck at a time. b) Repeat at least 3 times moving slightly lateral each time. c) Repeat on other side of the neck Note: Do not work directly on the cervical vertebrae 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 16

17 5. THUMB-ROLLING/EFFLEURAGE Muscles/Tissue affected: upper trapezius; levator scapula; cervical paraspinals; supraspinatus a) Place one thumb at the occiput and begin glide from occiput toward AC joint moving inferior and lateral working one side of the neck at a time. Place second thumb at occiput after first thumb has begun movement. Alternate thumbs, using thumb-over-thumb movement until the AC joint has been reached. b) Repeat entire movement from occiput to AC joint at least 3 times. c) Repeat on other side of the neck. Note: Do not work directly on the cervical vertebrae 6. THREE (3) PRESSURE POINTS ALONG THE SHOULDERS Muscles/Tissue affected: upper trapezius; supraspinatus (deep to the upper trapezius) a) Place thumbs at occiput on both sides of the client s neck (not on the cervical vertebrae). Glide down to base of the neck until upper trapezius stops the inferior movement of your thumbs. b) Gently but firmly press into upper trapezius at the base of the neck and hold for a count of three to five seconds. c) Glide thumbs laterally approximately halfway between the base of the neck and the AC joint and press gently but firmly into the upper trapezius holding for a count of three to five seconds. d) Once again, glide thumbs laterally stopping just medial to the AC joint (in the V of the AC joint) and gently but firmly press into the upper trapezius holding for a count of three to five seconds. 7. INTERLACED FINGERS Muscles/Tissue affected: posterior suboccipitals a) Interlace fingers and place hypothenar eminences (medial/pinkie side) at the base of the client s neck and the pads of the thumbs at the base of the occiput. b) Apply static pressure with thumbs on the superior and inferior nuchal line of the occiput c) Move thumbs in small circular friction movements from mastoid process to EOP and return back to mastoid. 8. FINGERS AT BASE OF SKULL (NUCHAL LINE OF THE OCCIPUT) STATIC PRESSURE Muscles/Tissue affected: posterior suboccipitals a) Place pad of index, middle or both fingers of each hand on occipital ridge just lateral to EOP. Do both sides of the occipital ridge at the same time b) Gently but firmly press into the occipital ridge just lateral to EOP. c) Move finger(s) laterally and press again. d) Continue lateral movement until mastoid process has been reached. e) Repeat movements moving medially back to the EOP. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 17

18 CIRCULAR PRESSURE MOVEMENTS Muscles/Tissue affected: posterior suboccipitals a) Repeat the moves as in Static Pressure, a-e, above except use circular friction movements with your fingers instead of static pressure. 9. PALM-KNEADING SHOULDERS/KITTY MOVE Muscles/Tissue affected: upper trapezius; levator scapula; cervical paraspinals a) Place palms of hands on upper trapezius just lateral to the base of the neck. b) With alternating movements, gently but firmly press palms (compression) into the upper trapezius moving laterally to AC joint and then medially to the base of the neck. c) Repeat several times 10. GLIDING FISTS Muscles/Tissue affected: upper trapezius; levator scapula; cervical paraspinals a) Place loosely clenched fists on upper trapezius just lateral to the base of the neck. b) With firm pressure, glide laterally from the base of the neck to the AC joint and then medially back to the base of the neck. c) Repeat move at least three times, moving posteriorly and anteriorly (do not choke the client by moving too far anteriorly onto the throat). 11. CIRCULAR FISTS Muscles/Tissue affected: upper trapezius; levator scapula a) Place loosely clenched fists on upper trapezius just lateral to the base of the neck. b) Rotate your wrists in a circular motion several times remaining at the base of the neck. c) With gentle, yet firm pressure, rotate your wrists laterally from the base of the neck to the AC joint and then medially back to the base of the neck. d) Repeat move at least three times, moving posteriorly and anteriorly (do not choke the client by moving too far anteriorly onto the throat). 12. PETRISSAGE SHOULDERS & UPPER BACK NOTE: This move can be used as a transitional move. SMILE!! IT INCREASES YOUR FACE VALUE. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 18

19 Posterior Body Finishing Strokes Therapist position: Standing or sitting at the head of the client Client position: Prone; Ankles bolstered Draping: Client exposed to sacrum; client covered from sacrum to feet. Common uses: Closing, ending 1. EFFLEURAGE DOWN THE BACK/WAVE UP a) Place open hands on the shoulders next to the neck. b) Glide inferiorly from upper thoracic paraspinal region to ilium. c) Glide laterally along ilium. d) Glide superiorly along the lateral area of the rib cage and around the scapulas using a wave-like motion. e) Repeat 3 times, using any of the following variations. VARIATIONS: From the Procedure 1, (a-d) above, perform the strokes with the following variations CONTOUR SHOULDER/NECK/OCCIPUT a) Complete the stroke by scooping around the shoulders, up the neck to the base of the occiput. A. CONTOUR ELBOW/ SHOULDER/NECK/OCCIPUT a) Complete the stroke by gliding laterally around the shoulders, down the arms to the elbow gently squeeze and hold the elbows, and move back up the arms, around the shoulders, up the neck to the base of the occiput. Note: Making sure not to hyperextend the elbow. B. CONTOUR WRIST/ELBOW/ SHOULDER/NECK/OCCIPUT a) Complete the stroke by gliding laterally around the shoulders, down the arms to the wrists, gently squeeze and hold briefly at the wrists, and move back up the arms, around the shoulders, up the neck to the base of the occiput. Note: The above strokes can be performed one to several times time each for each stroke. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 19

20 2. CIRCULAR OPEN HANDS a) Start medially, moving in an inferior, and then laterally, returning superior motion (Making circles in a downward and outward motion). All the way down (inferior) the back 3. CRAB WALK Muscles/Tissue affected: erector spinae; mid and lower trapezius. a) Place fingertips of each hand on both shoulders at the base of the neck. b) Extend (spread open) fingers of each hand alternately while simultaneously moving inferiorly down the back to the sacrum. (Opening fingers then bringing fingers back together) c) You can do this movement with both hands at the same time 4. SEWING MACHINE / ZIGZAGS Muscles/Tissue affected: rotatores; interspinales; multifidus a) Place thumbs on either side of the spinous process of C7. b) Glide thumbs in half circles around each spinous process in both directions, moving inferiorly toward the sacrum. Left thumb movement Right thumb movement Left thumb movement Right thumb movement Note: Movements can vary between slower/deeper strokes or quicker/lighter strokes. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 20

21 POSTERIOR BACK - RIBS Therapist position: Standing at the client s head, start on one side of the rib cage working in a continuous motion flow to the other side of the rib cage Client position: Prone; Ankles bolstered. Draping: Draping to uncover back to PSIS. Therapist may want to tuck sheets under client s hips or use a folded towel on top of the draping at the sacrum for added weight to secure the sheets. Remember to keep the person appropriately draped/covered at all times. Muscles/Tissue affected: intercostals Palpation hints: Common uses: breathing problems 5. RIB RAKE Start inferior and move superior. a) Place fingertips of one hand in the spaces between the ribs on the lateral (side) edge of the rib cage and pull fingers medially (towards the spine) following the intercostals spaces. b) As the first hand completes one stroke, the other hand is placed on the lateral edge of the rib cage and the stroke is repeated alternating hands. Moving from inferior to superior and then back inferiorly. c) Move from one side of the rib cage in a continuous motion flow to the other side of the rib cage and back again. d) In can add in the following stroke, Rocking Horse, as you move to the other side of the ribs 6. ROCKING HORSE/FEATHER STROKES a) Place two fingertips of each hand (one hand more superior than the other) on both sides of the spine just superior to the sacrum. b) Lightly rake superiorly along the spine, one hand alternating to the other hand. Hand over hand in short continuous rolling segments up the back to the upper thoracic/lower cervical regions. Note: This move can be used to transition from one side of the body to the other while performing the rib rake. 7. VIBRATION Heel of hand Side of hand/lamina groove Thumb along side of spine Fist Note: Reference your text book for explanation and procedures. Watch the demo very closely. Vary the pressure depending on the area of the body. Be careful of the endangerment zones of the body, light pressure in these areas 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 21

22 8. TAPOTEMENT Hacking alternating open hand, using 5 th metacarpal side Pounding - alternating closed fists using 5 th metacarpal side Slapping alternating flat open hand Cupping - alternating cupped hand Star Hands hands are placed together as if in prayer, spread your fingers apart, and use 5th metacarpal side of your hands Tapping alternating tapping with the therapist s finger tips varying pressure depending on the area of the body being worked on. Note: Reference your text book for explanation and procedures. Watch the demo very closely. Tapotement is rapid striking motion; vary the pressure depending on the area of the body. Be careful of the endangerment zones of the body, no or light pressure to these areas Posterior Body Gluteals Therapist position: Standing at the level of the client s gluteal region and working same side. Client position: Prone; Ankles bolstered. Draping: Draping to uncover ½ of buttocks keeping sacral sulcus covered. Therapist and/or client may want to use a folded towel on top of the draping at the sacrum for added weight to secure the sheets. Remember to keep the person appropriately draped/covered at all times. Muscles/Tissue Affected: gluteals (gluteus medius, gluteus minimus and gluteus maximus) Common uses: Sciatica, low back pain, gluteal pain, people who sit for long periods of time. NOTE: To address the deep six/lateral hip rotators, a deeper pressure can be used if client can tolerate it 1. ROCKING THE GLUTEAL REGION a) Placing the therapist s hands on top of the covered gluteals, gently rock back and forth at a rate that is comfortable to the client. NOTE: This step is performed through the sheets at the beginning and end of work in this area. 2. COMPRESSIONS OF THE GLUTEAL MUSCULATURE a) Heel Squeeze. b) Direct Compressions. NOTE: This step can be performed through the sheets/before the client is draped. 3. PETRISSAGE GLUTEAL REGION Note: This step can be performed through the sheets/before the client is draped. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 22

23 4. GLUTEAL STRIPPING (Movement is superior to inferior) a) Place the therapist s superior hand (closest to the client s head) on top of sheet at the sacrum with the rest of the therapist s forearm gently resting along the spine. This arm is used as an anchor for the sheet. There is basically no weight on this arm; it s a very light pressure. b) With the therapist inferior arm, place the olecranon process/elbow of inferior arm at the iliac crest, just lateral to the sacrum (to side of the sacrum). The hand of the therapist is in the direction of the client s head. c) With firm pressure, within the tolerance of the client, begin gliding the therapist s inferior arm inferiorly (downward towards the client s feet) toward the gluteal tuberosity, follow through with the therapist s forearm to the upper part of the thigh (leg). Making an oval circle laterally, then superiorly lightly glide the arm back to the starting position. d) Repeat step b & c, 2-3 more times depending on the size of the client s gluteal area. Working slightly more laterally each stroke. Be careful not to run into the greater trochanter. Move around the greater trochanter to avoid running into it. Note: The whole gluteal area can be very tender for some clients, always work within the client s tolerance. Ask for feedback often. Follow the contour of the client s gluteal muscles. These are not just straight line strokes, they curve with the form of the muscle. 5. SPOKES OF A WHEEL/PIE SLICES (Movement from medial to lateral) a) Keeping the therapist s superior arm in the same position as in a in the procedure above. b) Using the sacrum as the hub or center part of a wheel. Place the elbow (olecranon process) of inferior arm just lateral to the PSIS. With firm pressure, within the tolerance of the client, begin gliding therapist s inferior arm laterally toward the table. Lightly glide back to the starting position. c) Repeat the stroke in b above. 2-3 more times depending on the size of the client s gluteal area. The starting point for the therapist s elbow is the same. Though, each time moving the therapist s elbow more on an angle or diagonal towards the greater trochanter. Then, with following strokes, work the angle of the move, towards the thigh (upper leg). Follow through on these moves with the therapist s forearm. Note: Use caution not to run into the greater trochanter. The whole gluteal area can be very tender for some clients, always work within the client s tolerance. Ask for feedback often 6. NO SAGGY BUTTS (Movement from inferior to superior) a) Now switch anchoring arms. Place the therapist s inferior hand on top of sheet at the sacrum to secure the sheet from moving. There is basically no weight on this arm, it s a very light pressure. b) Place the elbow (olecranon process) of the therapist s superior arm, inferior (below) the gluteal tuberosity moving superiorly toward the iliac crest, following through with therapist s forearm, being careful not to run into the greater trochanter. Follow the contour of the client s gluteals. Lightly glide back to the starting position. c) Repeat the stroke in b above, 2-3 more times depending on the size of the client s gluteal area. Moving more medially (towards the sacrum) each time, to the original starting positions in movement #4 above. Note: The whole gluteal area can be very tender for some clients, always work within the client s tolerance. Ask for feedback often. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 23

24 Follow the contour of the client s gluteal muscles. These are not just straight line strokes, they curve with the form of the muscle. 7. SHORTENED GLUTEAL MUSCLE a) Bend the hip and the knee, so the knee is flexed/bent and the hip is laterally rotated (as if they are going over a hurdle) Circular motion around the greater trochanter, using the flat of your hand or a loosely closed fist. b) Gradually increase the size of the circle, until all of the gluteal area has been worked. c) Work very deliberately along the sacrum with the fibers and cross fiber. d) Straighten the leg. Note: Use proper draping, make sure the client feels secure with the draping. 8. ROCKING THE GLUTEAL REGION a) Placing the therapist s hands on top of the covered gluteals, gently rock back and forth at a rate that is comfortable to the client. Note: This step is performed through the sheets at the beginning and end of work in this area. 9. REPEAT THE ABOVE STEPS ON THE CLIENT S OTHER SIDE OF THEIR BODY POSTERIOR BODY Thigh Therapist position: Standing on the same side of the client that the massage will be performed on. Standing approximately between the client s knee and ankle, modify as needed. Client position: Prone; Ankles bolstered. Draping: One leg draped securely from hip to ankle. No diaper draping necessary. Remember to keep the person appropriately draped/covered at all times. Common uses: knee problems; edema; people who stand a lot. NOTE: The edema drain should be performed first if edema is present or to increase circulation to the legs. Always clear upper leg first and then clear lower leg. Always apply pressure centripetally, or WORK TOWARD THE HEART/CENTER. 1. EDEMA DRAIN a) Using effleurage strokes, starting several inches inferior of the gluteal area. Moving from distal to proximal, elongating your movement with each stroke (using strokes towards the heart.) Continue to do the whole posterior thigh. Moving onto the calf continue the same distal to proximal movement. Note: Beneficial for reducing in the fluid in the ankle. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 24

25 2. UPWARD RAKING Muscles/Tissue affected: hamstrings Therapist position: Standing on the same side of the client that the massage will be performed on, at the level of the client s knee, facing the client s head. a) Place fingertips of both hands just superior to the crease of the client s knee and at the midline of the client s thigh. b) Keeping fingers straight and alternating hands, begin moving hands just superior from the knee crease working your way just slightly inferior to the gluteal region. c) Repeat this stroke several times moving slightly medial and lateral from the midline of the thigh. Covering the whole back of the thigh with this move. Note: Do not do the medial aspect (inner) thigh on this move, it can feel invasive 3. STRAIGHT FISTS Muscles/Tissue affected: hamstrings Therapist position: Standing on the same side of the client that the massage will be performed on, at the level of the client s knee, facing the client s head. a) Place loosely clenched fists just superior to the crease of the client s knee and at the midline of the client s thigh. b) Moving from the therapist s hips, begin gliding one or alternating one fist then the other or both (next to each other) fists superiorly. The therapist can vary the strokes. c) Begin moving fists just superior from the knee crease working your way just slightly inferior to the gluteal region. d) Repeat this stroke several times moving slightly medial and lateral from the midline of the thigh. Covering the whole back of the thigh with this move. 4. CIRCULAR FISTS Muscles/Tissue affected: hamstrings Therapist position: Standing on the same side of the client that the massage will be performed on, at the level of the client s knee, facing the client s head. a) These strokes are the same as above except the therapist fists are moving in a circular motion. If the therapist is using only one fist the therapist should stabilize lightly with their other hand on the client s leg. 2/12 Blue Sky School of Professional Massage and Therapeutic Bodywork 25