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Preface ix
Student Resources
Students who have purchased Introduction to Massage Therapy, Third Edition, have access to the fol-
lowing additional resources:
• Videos of procedures and flow sequences including body mechanics, sheet draping, sidelying, seated massage, client supine art, client leg and foot, client prone back, lymph drainage, and reflexology.
• Animations
• Coloring Exercises
• Stedman’s Vocabulary and Pronunciation Guide
• Case Studies
• Interactive Quiz Bank
• Study Guide
In addition, purchasers of the text can access the searchable full text online by going to the
Introduction to Massage Therapy, Third Edition, Web site at http://thePoint.lww.com. See the inside
front cover of this text for more details, including the passcode you will need to gain access to the
Web site.
Final Note
The functional and practical approach of this text makes it appropriate for entry-level massage therapy students and practicing massage therapists alike. The step-by-step procedures will help students
learn and practice basic massage techniques relatively easily. The special muscle section enables
practicing massage therapists to use the book as a resource for client education and for treating specific client conditions. Supported by effective instruction, this text is an excellent way to prepare for
the National Certification Exam for Therapeutic Massage and Bodywork.
We wish every reader success in learning about massage therapy, and we hope this book will
serve as a valuable resource to practitioners in all settings.
Mary Beth Braun
Stephanie J. Simonson
How to Use This Book
Key Terms
Anointing: Ritualistic or religious activity of rubbing oil
into the skin.
Bodywork: Treatment that involves manipulation of
the client’s body as a way to maintain or improve
health.
Gymnastics: Activity at ancient gymnasiums that
included exercise, massage, and baths.
Massage: Manual therapy involving pressure applied
with the hands (term started by the French explorers
in the 1700s).
Mechanical effects: Therapist applies pressure or
manipulation to physically change the shape or
condition of the client’s tissues.
Metabolic effects: Combined result of mechanical and
reflex effects on the whole body.
Modality: A collection of manual therapies that tends
to use similar applications of movement or massage
strokes to reach a similar goal.
Movement Cure: American version of Ling’s
movement system.
Reex effects: Therapist stimulates the client’s sensory
neurons, which triggers the client’s nervous system to
change the shape or condition of the tissues in areas
that were addressed as well as other, related areas.
Swedish Gymnastics: A therapeutic movement
system developed by Per Henrik Ling.
Swedish Movements: Europe’s version of Ling’s
movement system.
Qi (CHEE): A dynamic, changing energy force that
runs through the whole body, supplying and being
supplied by body processes and activities.
Objectives
Upon completion of this chapter, the student will be
able to:
■
Identify the four ancient river valley civilizations
that used massage
■
Describe the essence of the Hippocratic Oath
and its relation to massage therapy
■
Name at least three ancient Greek and Roman
physicians who recommended massage
■
Explain the difference between development of
the arts, science, and massage in Europe and
that in the Arab countries during the Middle Ages
■
Describe how massage therapy was affected by
the Renaissance period
■
Identify the transition that occurred in American
healthcare in the 19th century
■
Describe the difference between massage and
bodywork
■
List the nine categories of bodywork
modalities
■
Name at least two indications that massage is
evolving in the American healthcare system
■
Identify at least two attributes of a massage
therapist that are needed for successful
employment in a spa
■
Name at least three current trends in massage
education
Introduction to Massage Therapy, Third Edition, provides the fundamentals you need to develop as a massage therapist. This exquisite
text gives you a well-rounded and informed understanding that will
help build your massage therapy skills—including anatomy and
LEARNING OBJECTIVES
Objectives listed at the start of each chapter clearly outline what
you must accomplish upon completion of the chapter.
KEY TERMS
Terms with de nitions at the beginning of each chapter (as
well as in the glossary) introduce you to basic massage therapy
terminology.
physiology, pathology, pharmacology, biomechanics and kinesiology, basic techniques, fundamentals of history, assessment, documentation, ethics, self-care, and more. This User’s Guide shows you
how to put the book’s features to work for you!
The skin is the main structure of the integumentary system,
but there are also some specialized structures located in or
near the skin, including hair, nails, and cutaneous glands.
The skin, sometimes called the integument, is the largest organ
of the body.
ALERT BOXES
Marked with a , these boxes warn you about special circumstances in which caution is necessary.
KEY POINTS
Key point sentences within the text are highlighted in red to emphasize information important for client education and practical
application.
Alert
Massage techniques that are too aggressive may
create fatigue-like symptoms or initiate a protective
reflex contraction in the muscles.
xi
Fibromyalgia in Brief
Pronunciation: fy-bro-my-AL-je-ah
What is it?
Fibromyalgia syndrome (FMS) is a chronic pain syndrome
involving sleep disorders and the development of a predictable pattern of tender points in muscles and other soft
tissues.
How is it recognized?
Fibromyalgia syndrome is diagnosed when other diseases
have been ruled out and when 11 active tender points are
xii How to Use This Book
CONTRAINDICATION BOXES
Marked with a , these boxes point out contraindications to speci c conditions that your client may have.
BOX 6.1
1. Greet first-time clients with good eye contact and a friendly, confident handshake.
2. Explain your policies and intake form(s) and offer reasons for documentation.
3. Ask clients to fill out forms. Meanwhile, start filling out their SOAP note.
4. Interview clients:
a. Clarify their purpose for coming to you for a massage.
i. Is there any area in particular they want you to address or avoid?
ii. Are there any techniques they prefer or dislike?
b. Clarify their chief complaint, if there is one. This helps you better understand the client’s current condition to
know if any progress was made when you perform the posttreatment assessment.
i. Is there anything that makes the pain worse or better?
ii. Do they notice the discomfort all of the time, only during certain activities, or only after certain activities?
iii. How long have they had this condition?
iv. Ask them to try to rate the discomfort, using a scale of 1 to 10 or on a scale of mild to severe.
v. Ask them to try to describe the discomfort (sharp, achy, numb, tingling, heavy, throbbing,etc.).
PROCEDURE Client Interview
Deep pressure can damage lymphatic vessels, and
damaged lymphatic vessels cannot drain lymph
properly, which is why massage is contraindicated
over areas of inflammation.
PROCEDURE BOXES
O er step-by-step procedures for speci c treatments or assessments for practice both in and outside the classroom.
RESEARCH BOXES
These boxes present evidence-based references that apply the latest research to practice.
BOX 9-6
RESEARCH Massage and Pain:
The Gate Control Theory
of Pain
In 1965, researchers Ronald Melzack and Patrick Wall
published the now-famous Gate Control Theory that
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IN-BRIEF BOXES
Provide a “nutshell” description of conditions relevent to massage
therapists.
Eastern physicians familiar with the practice of cupping
have discovered a variety of additional benefits. Application of the cups usually creates short-term bruises,
particularly if the patient is ill. To the practiced eye, this
discoloration can be a valuable diagnostic clue. A skilled
practitioner applying cups along the acupuncture meridians can recognize certain internal organ problems that
may reside a considerable distance from the bruise.
Client Information
Eastern physicians familiar with the practice of cupping
have discovered a variety of additional benefits. Application of the cups usually creates short-term bruises,
particularly if the patient is ill. To the practiced eye, this
discoloration can be a valuable diagnostic clue. A skilled
practitioner applying cups along the acupuncture meridians can recognize certain internal organ problems that
may reside a considerable distance from the bruise.
Recommendations
Eastern physicians familiar with the practice of cupping
have discovered a variety of additional benefits. Application of the cups usually creates short-term bruises,
particularly if the patient is ill. To the practiced eye, this
discoloration can be a valuable diagnostic clue. A skilled
practitioner applying cups along the acupuncture meridians can recognize certain internal organ problems that
may reside a considerable distance from the bruise.
Summary of Short Term Goals and Progress
Eastern physicians familiar with the practice of cupping
have discovered a variety of additional benefits. Application of the cups usually creates short-term bruises,
particularly if the patient is ill. To the practiced eye, this
discoloration can be a valuable diagnostic clue. A skilled
practitioner applying cups along the acupuncture meridians can recognize certain internal organ problems that
may reside a considerable distance from the bruise.
Next Steps
Eastern physicians familiar with the practice of cupping
have discovered a variety of additional benefits. Application of the cups usually creates short-term bruises,
particularly if the patient is ill. To the practiced eye, this
discoloration can be a valuable diagnostic clue. A skilled
practitioner applying cups along the acupuncture meridians can recognize certain internal organ problems that
may reside a considerable distance from the bruise. ■
Box 12-1
CRITICAL THINKING SCENARIOS ■ CLIENT #1
How to Use This Book xiii
Components of Good
Body Mechanics
VIDEOS
Marked with a , lead the student to view the video on thePoint
companion Web site of the concepts and ows to foster deeper
learning.
Critical components of good body mechanics include efficient structural alignment of your body, proper stance, and
ergonomics. The body should move fluidly, using gravity
and the movement of the whole body to deliver the massage
instead of using the muscles of the shoulders, arms, hands,
fingers, and thumbs. Movement of the body as a whole
improves the fluidity and rhythm of the massage.
Maximizing the amount of pressure and minimizing
CRITICAL THINKING SCENARIOS
CLEAR ILLUSTRATIONS AND
PHOTOGRAPHS
Numerous high-quality illustrations and photographs throughout
the book illustrate the most important information, make complex details easy to understand, and facilitate comprehension of
basic information and hands-on practice.
Provide a decision-making framework to help you develop a treatment plan to meet a particular client’s unique needs.
Transverse
process (C-4)
Articular
process (C-5)
Cervical
rotatores
C-7
Obliquus capitis
superior
Longissimus capitis
Semispinalis cervicis
Middle scalene
Posterior scalene
Cervical multifidi
Rectus capitis posterior minor
Rectus capitis posterior major
Obliquus capitis inferior
Rotatores (cervical)
Multifidi (representative portion)
Rotatores (thoracic)
xiv How to Use This Book
Case Studies
CASE STUDIES
Progressive case studies present sample clients and walk you
through the documentation process for di erent stages of a massage session.
SPECIAL MUSCLE SECTION
Action Movement Muscle Origin
SHOULDER
Elevation Levator scapula Transverse
Rhomboid major C7, T1–5 Medial border of
Trapezius (upper) Occiput,
Depression Serratus anterior Outer surfaces of ribs
Subclavius Junction of first rib and
Trapezius (lower) T4–12 Root of spine of SCAPULA Accessory (C3,4) Plate 4-1
Protraction Serratus anterior Outer surfaces of ribs
processes of C1–C4
ligamentum nuchae
8–10
costal cartilage
8–10
Insertion (bone that is
moved is CAPITALIZED)
Medial border of
SCAPULA
SCAPULA
Lateral end of clavicle,
lateral spine of SCAPULA
Anterior surface of medial
border of SCAPULA
Inferior surface of
CLAVICLE
Anterior surface of medial
border of SCAPULA
Nerve (spinal segment
nerve numbers) Plate(s)
Cervical & dorsal
scapular (C3,4,5)
Dorsal scapular (C4,5) Plate 4-1
Accessory (C2,3,4) Plate 4-1
Long thoracic (C5,6,7) Plate 4-2
Branch of brachial
plexus (C5,6)
Long thoracic (C5,6,7) Plate 4-2
Plate 4-1
Plate 4-3
Introducing . . . The Case Studies
Three different case studies are presented throughout
this text. The participants are introduced with brief
biographies followed by the documentation forms used to
record their information: health history and SOAP notes.
The SOAP note will be highlighted differently in each
chapter that includes the Case Studies, showcasing the
information that is most appropriate for those chapters.
Here, we introduce Rob Blackwell, Timothy Roberts, and
Kirsten Van Marter.
Progressive Case Study 1:
Rob Blackwell
Rob Blackwell is a
42-year-old man who is
trying massage for the first
time and hopes to restore
his sleep and reduce pain
in his neck, shoulder,
back, and knees so he can
with his activities the most. He complains that his
sleep is affected by his pain, and his health history
reveals osteoarthritis and tendinitis in his knees,
multiple sprains in his ankles, sinus trouble, and
multiple head injuries. Your interview determines that
the osteoarthritis diagnosis was made more than 10
years ago. On a pain scale of 1 to 10, with 10 being
the worst pain, Rob says all of his areas of concern
are about 4. He soaks in the hot tub, which helps the
pain, and he occasionally takes ibuprofen, which could
affect his pain perception during massage. All of the
information Rob tells you is subjective information,
and you record anything that is pertinent to his chief
complaints (Figs.6-6 and 6-7).
The massage for Rob is designed to reduce pain
and tension and find fascial adhesions, but you focus
on the condition of the soft tissues in his shoulders.
You use your standard massage flow, with the addition
of some therapeutic techniques. After the massage,
you perform the posttreatment assessment, prioritize
Rob’s functional limitations, and determine short- and
MUSCLE TABLE
Special muscle section, at the end of Chapter 4: Kinesiology and
Biomechanics, presents the speci c movements and muscles involved in the soft tissue area of concern with reference to color
plates to identify the muscle.
CHAPTER SUMMARIES
Review key topics and concepts of the chapter to understand and
retain.
CHAPTER EXERCISES
At the end of each chapter, these exercises provide review questions to test your knowledge of the material.
300 INTRODUCTION TO MASSAGE THERAPY
does not like to drink water. Your general
Massage therapists should always maintain a client-centered
focus for care. The treatment plan for client care is part of
that professional focus. With space and time constraints,
you can write only brief notes in your massage treatment
records, but you still need to document details accurately.
Another therapist should be able to read your SOAP note
and understand what the treatment plan includes, which
self-care activities were recommended between sessions, and
any referrals you may have made.
Self-care techniques give you a good topic of discussion
for the next session, asking about which self-care techniques
clients used or which ones were more effective. Soft tissue
health and healing should always be the objective of selfcare techniques recommended to clients. The effective and
AQ8
efficient documentation of treatment and self-care are vital
aspects of a professional practice.
1. Use abbreviations and symbols to rewrite the
following treatment plans:
a. 60-minute massages, twice a month, for 2
months. Try vibration over the left scapula,
and stay away from the client’s feet. Reevaluate
AROM of left shoulder extension to see if the
triceps stretches that were demonstrated and
recommended once a day, every day, were
helpful.
b. 90-minute full body relaxation massages, once
a month, for 3 months. Avoid proprioceptive neuromuscular facilitation and AROM
evaluations, because the client does not like
to actively participate during the session.
Referred to Dr. Park for pain upon right
elbow PROM.
c. 30-minute massages, once a week, for 4
weeks. Only use supine, since client is claustrophobic and does not like to be prone.
Discussed use of a bolster under the knees
during sleep to relieve low back pain.
2. Develop and properly document treatment plans
for the following sample clients:
a. A 20-year-old man, at least 50 pounds overweight,
quietly complains of bilateral knee pain. His
physical activity is limited to his walk to and
from work, 5 days a week. At work, he sits at
a computer all day and drinks diet soft drinks
all day long. He eats fast food every day and
assessments discover bilateral symmetry with a
forward posture, rolled shoulders, and knockknees. He reports pain upon active and passive
ROM of his knees, suggesting that some passive
structures that are outside the massage scope of
practice are involved.
b. A 50-year-old man who appears in good
physical condition explains that his friend got
a massage from you and convinced him to try
one even though he has no areas of concern.
He swims for 30 minutes, at least five times a
week, and drinks at least 60 ounces of water
a day. He has a wife, three kids, and two dogs
and is self-employed in an established and
stable business. His posture is bilaterally symmetrical, but his head is forward, and he experiences occasional neck pain and tightness. You
found fascial restrictions all around the cervical
area, but did not have enough time to address
it. He reports that he was able to relax but not
until the massage was almost over and asks if
massages can be longer than 60 minutes.
c. A 70-year-old woman has been coming to
you regularly, once a month, for over a year.
She is retired and enjoys her gardening club
activities and worldwide travel. Every day, she
drinks a glass of juice, a cup of tea, a glass
of water, and a cup of coffee. Every day, she
eats a lot of fruits and vegetables, very few
carbohydrates, and a small amount of protein.
In the past, she has always responded well to
a full-body relaxation massage that includes
some craniosacral work. She has not incorporated any self-care in the year you have been
treating her, but she always asks about what
she should do between sessions.
3. Explain the difference between an initial treatment
plan and a treatment plan for the subsequent massage sessions.
4. List the six components included in the plan sec-
tion of the SOAP note.
5. List at least f ive questions you can use to evaluate
clients’ internal healing environment to estimate
their healing time and length of treatment.
6. Explain why it is not always better to recommend
massage sessions that last longer and are more
frequent.
7. Explain why it is not always better to recommend
a lot of self-care activities.
AQ9
Reviewers
Kelley Aliffi, MA, CMT
Clinical Massage Therapist
Minneapolis, Minnesota
Erica Baern, BA, MA
Director of Education
East West College of the Healing Arts
Portland, Oregon
Carla Bashaw, BS, LMT, LA, LM
Licensed and Nationally Certified
MassageTherapist
Ogunquit, Maine
Kathy Calise, BS
Program Coordinator
Continuing Education/
Massage Therapy Program
Lane Community College
Eugene, Oregon
Julia Mims Edwards
Massage Therapist
Nashville, Tennessee
Beth B. Habig, AA
Licensed Massage Therapist
A Bodywork Center for Massage Therapy
Cary, North Carolina
Cher Hunter
Program Director
Massage Therapy
Community College of Baltimore County
Baltimore, Maryland
Carole Koenig, BA, MA
Massage Therapist
Los Angeles, California
Becky SanGregorio, Director
Laurel Highlands Therapeutic Academy
Edensburg, Pennsylvania
Matthew Sorlie, LMP
Director of Education
Cortiva Institute - Seattle
Seattle, Washington
Lori Vargas, Founder
Spa Vargas University
Bloomingdale, Illinois
Jean Wible, RN, BSN, NCTMB, CHTP
Assistant Professor of Massage Therapy
Community College of Baltimore County
Baltimore, Maryland
xv
Acknowledgments
e extend our sincere appreciation to The Crew at Lippincott Williams & Wilkins for working
tirelessly on this project since its inception. In particular, we want to thank:
W
• Paula Williams, LWW Product Manager
• Jonathan Joyce, LWW Senior Acquisitions Editor
• Stephen Druding, LWW Book Designer
• Freddie Patane, LWW Media Director
• Jennifer Clements, LWW Art Director
• Jessica Sillers, Project Manager
We also thank the follow people for their incredible work, who have played a significant part in
making this such a visual and user-friendly textbook:
Artist: Rob Duckwall and Dragonfly Media Group
1 st and 2 nd edition photographer: Don Distel
3 rd edition photographer: Mark Lozier
3 rd edition video team: Directed by Freddie Patane, with support from Mike Licisyn, Ed Schultes, Jr.
3 rd edition photography and video models: Kay Chen, Grace McKissick, Henry Lopez, and
LisaKotokis
For the third edition, we thank Ruth Werner, friend and author of A Massage Therapist’s Guide
to Pathology, for her unwavering belief in our ability to complete this extraordinary text. We would
also like to extend our gratitude to Diana Thompson, friend and notable author of Hands Heal, who
helped us with the details of documentation.
This edition has been through an extensive review process by professionals in the massage therapy field (see the reviewer list), each of whom we thank for their time and input.
To best showcase some techniques and modalities, we invited several people to write about
their particular field of expertise. Young Ki Park, DO, explained the philosophy and ancient practice
of cupping. Debra Howard detailed the Asian bodywork therapies and described their overlap with
massage therapy. Marybetts Sinclair provided an in-depth look at hydrotherapy and spa treatments.
We sincerely appreciate these authors and value their input.
We thank everyone who served as models throughout the book and video: Rob Blackwell,
Steve Benham, Jeff Braun, Leo Braun, Kylie Clevenger, Anne Jordan, Kathy Latimer, Stephen Lich,
Kathleen Lich, Andy Simonson, Bob Simonson, Claire Simonson, Dr. Robert T. Simonson, Annie
VanderLinden, and Kirsten VanMarter-Clevenger.
Mary Beth Braun would particularly like to thank her family, friends, and clients for their love,
encouragement and support throughout this third edition of our beloved book project, including
her husband, Tom Hanson, her parents, Leo and Mary Jane Braun; her brothers, Jim and Jeff Braun;
Tracy Wilson, Kirsten VanMarter-Clevenger, Kathy Latimer, Steve Benham, Larry and Michelle
Marietta, Christopher Sovereign, Eric Stephenson and Debra Koerner.
From Stephanie: Thank you to everyone who supported me throughout this endeavor. I could
not have done it without your help.
xvii
