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Chapter 9 / Massage Strokes andFlow 401
rest of the body. The draping process described in Box 9-1
maintains the client’s modesty and warmth.
Abdominal massage for digestive enhancement uses
an approach similar to that for venous enhancement and
lymphatic drainage, in which you start closest to the outlet
or drain and progressively move farther away from it. The
sequence of strokes is a counterclockwise pattern, but the
7
8
56
4
3
individual strokes move clockwise along the large intestine
(Fig. 9-17). These directions are determined as if the client is
holding a clock on his or her abdomen so that you can read
9
10
2
1
the face of the clock. Strokes should be slow and firm rather
than quick and light. The abdominal massage backtracks
through the large intestine, starting with the rectal area and
moving counterclockwise toward the cecum. Clearing the
Figure 9-17. Abdominal massage stroke sequence.
exit end first is more effective than pushing from the other
end, which could compact the contents in the passage.
Having the abdomen exposed often makes a person feel vulnerable and unsure. Be careful to help maintain the client’s physical and mental safety, and be especially sensitive to the client’s
acceptance or discomfort with the work. Stay attuned to the
client’s verbal or nonverbal communication to be aware of the
client’s comfort level throughout the abdominal massage. Box
9-14 includes a suggested flow for massaging a client’s abdomen.
BOX 9-14
Client’s Abdomen
1. Position your fully draped client supine, with both knees bent to soften the abdomen, and place a towel across the
chest, on top of the draping.
2. Ask your client to rest the hands on the chest. Explain that the hands act as a physical barrier to stop you from
touching the abdomen any higher than the hands. (Some clients will rest their hands close to their navel, while others may not need a barrier. Whatever your client’s modesty, keep your work inferior to the xiphoid process.)
3. Establish the inferior limit for your work by tucking the sheet tightly under the client’s hips, just inferior to the ASIS. You
can place a second towel over the client’s pelvis to cover the area inferior to the ASIS for additional modesty or warmth.
4. With the superior and inferior borders determined, ask the client to firmly hold onto the towel on the chest.
5. Gently pull the draping sheet out from under the towel to expose the abdomen down to the pelvis, stopping at the
inferior barrier.
6. Stand at your client’s side in a symmetric stance
and apply effleurage with both hands crossing
the abdomen in an alternating pattern to spread
the lubricant and help the client get used to
abdominal contact, 8 strokes.
402 INTRODUCTION TO MASSAGE THERAPY
BOX 9-14
Client’s Abdomen (continued)
7. Place the palms of both hands against the near
side of your client’s abdomen and firmly effleurage across the abdomen, your hands moving
away from you. Before your fingertips reach the
client’s midline, relieve some of the pressure
by lifting your hands slightly, and reach across
the gathered tissue to the far side of the client’s
abdomen.
8. Use both of your flat hands to slowly and firmly effleurage the abdomen toward you. Repeat steps 7 and 8 several
times with slow, rhythmic, wavelike strokes across the abdomen.
9. Change to an asymmetric stance beside the
client’s femur, angled toward the client’s head,
and effleurage with the flats of your alternating
hands in a clockwise pattern to enhance
peristaltic activity, as in Figure 9-17.
10. Apply a resting stroke with both palms on the client’s abdomen.
11. Redrape the abdomen by pulling the sheet up,
leaving the chest drape in place underneath
the sheet. Apply a resting stroke on top of the
drape, connecting the abdomen to the upper
part of the client’s sternum.
Chapter 9 / Massage Strokes andFlow 403
Indications and
Contraindications for
Abdominal Massage
Abdominal massage is beneficial for enhancing digestion
and relief from intestinal discomfort, constipation, diarrhea, colic, gas, and nausea. It also helps the uterus return
to its normal size during the postpartum period. For clients who are generally healthy, it is unnecessary to obtain
a healthcare professional’s consult before doing abdominal
massage. If, on the other hand, the client is pregnant; has
a history of diverticular disease or pelvic disorders such
as endometriosis or pelvic inflammatory disease; or fits
the profile for aneurysm (history of heart disease, atherosclerosis, and high blood pressure), you should encourage
BOX 9-15
Client’s Leg and Foot
that client to get clearance from his or her healthcare
professional.
Supine: Leg and Foot
Feet are especially ticklish, but slow movements and firm
pressure can minimize or prevent the ticklish sensation. The
legs and feet can be treated in both the supine and prone
positions, and whether you use one or both positions in
your massage depends on your client’s treatment goals, your
preference, the amount of time you have, and your instructor’s or school’s recommendations. Applying massage to
the leg when your client is supine can be done as shown in
Box9-15.
1. Stand, kneel, or sit at the foot of the table, or sit on the end of the table, expose the client’s foot, and apply compression by squeezing both sides of the client’s foot, about five times.
2. Deep effleurage the sole of the foot, distally with your thumbs, three times.
3. Apply circular friction to the ball of the foot with your thumbs, about 20 seconds.
4. Apply deep effleurage with your thumbs or finger pads around the ankles, and along the tops of the metatarsals
andeach toe, moving distally, two to three times.
5. Perform joint movements by passively:
• Extending each toe
• Moving the ankle through a circular motion from dorsiflexion, to eversion, to plantarflexion, to inversion
6. Hold the client’s foot for a resting stroke.
7. Expose the leg and stand near the client’s foot in an asymmetric stance, facing the client’s head.
8. Effleurage and petrissage the anterior and lateral aspects of the lower leg, in a proximal direction, using your
thumbs and the heels of your hands, for about 30 seconds.
9. Effleurage and petrissage the anterior, medial, and lateral aspects of the client’s thigh, using your palms, the heels
of your hands, or your fists, for about 30 seconds.
10. Redrape the leg and apply nerve strokes from the client’s hip to toes, two times.
404 INTRODUCTION TO MASSAGE THERAPY
Prone: Back
The prone position allows you access to the entire back, and
also gives you a good opportunity to make visual assessments. As you massage the back, remember that the kidneys
are relatively unprotected.
Use light applications of tapotement over the kidneys to
avoid traumatizing or injuring them.
Prone clients are easily startled when you establish
initial contact. To minimize the stimulation, you can tighten the draping near the area where you will contact the
body, and use that sensory input to ease clients into your
touch. You can apply massage to the back as illustrated in
Box 9-16.
Prone: Leg and Foot
By using both the prone and supine positions to massage a
client’s legs and feet, you can easily access all the soft tissues
of the legs.
Do not apply direct pressure over the endangerment site
at the popliteal fossa behind the knee.
The steps in Box 9-17 can be used to apply massage to
the client’s legs and feet in the prone position.
Closing Sequence
One way to finish a massage is to reconnect all the parts of
the body and apply a last resting stroke to signal the end of
the physical contact. Whether a client is supine, prone, or sidelying, the following steps can be used as a closing sequence:
1. Apply one or two slow nerve strokes from head to toe.
2. Apply a series of resting strokes:
a. Both feet
b. Both knees
c. Both hips (anterior superior iliac spine [ASIS] if
supine, posterior superior iliac spine if prone, or the
protruding greater trochanter if side-lying)
d. Head
BOX 9-16
Client’s Back
1. Stand with an asymmetric foot position at the client’s left side, facing the client’s head, and expose the client’s
back.
2. As you tuck the sheet near the hips, leave your hand on the sheet and transition onto the client’s skin to minimize
the stimulation of initial contact. Apply effleurage to the left side of the client’s back, using flat hands or the heels
of your hands, first to spread lubricant and then progressively deeper, about six times.
3. Apply effleurage and petrissage, using the heel of your hand or your thumbs all over the left side of the client’s
back, from the iliac crest to the occipital ridge and from the spine all the way out to the muscular attachments at
the proximal humerus.
4. Use the hacking form of tapotement over the left rhomboids, for 10 seconds.
5. Apply gentle effleurage over the left side of the client’s back, using flat hands in a superior direction, about four
times.
6. Maintain contact with client’s left shoulder as you walk around the client’s head to the client’s right side, and
repeat steps 2 to 5 on the right side of the client’s back.
7. Redrape the back and apply a resting stroke on top of the sheet with one hand on the middle of the client’s back,
and the other hand over the sacrum.
Chapter 9 / Massage Strokes andFlow 405
BOX 9-17
Client’s Leg and Foot
1. Stand beside the client’s leg, undrape the leg, and give a little tug on the sheet at the client’s hip as sensory input
to minimize the stimulation of your initial contact as you apply a resting stroke to the client’s thigh.
2. Apply effleurage strokes in a proximal direction, first to spread lubricant on the client’s thigh, and progressively
deeper, for about 20 seconds.
3. Effleurage and petrissage the upper leg, using your fists and the heels and palms of your hands, from the knee to
the ischial tuberosity, making sure to address the lateral and medial aspects of the thigh, about 30 seconds.
4. Support the client’s ankle on a bolster and apply effleurage and petrissage to the lower leg in a proximal direction,
using your palms and thumbs, making sure to address the lateral aspects of the lower leg and the entire gastrocnemius muscle, which goes past the knee joint, for 20 seconds.
5. Redrape the leg and apply nerve strokes, hip to heel, two times.
6. With the bolster still supporting the client’s foot, expose the foot and apply compression to the sole of the foot.
7. Apply deep effleurage to the sole of the foot in a distal direction, using your thumbs or the heel of your hand, three times.
8. Redrape the foot and apply a resting stroke to the sole of the client’s foot.
Chair massage , also called seated massage, event mas-
sage, onsite massage, or corporate massage, gives people
an opportunity to receive massage during the workday or
at an event. Although some people think that getting a
massage at work may slow them down and make them
sleepy for the rest of the day, this is not the case. Research
has found that massage in the workplace increases productivity and employee job satisfaction. One of the
leading researchers in the field of massage is Tiffany
M. Field, PhD, of the Touch Research Institute at the
University of Miami’s School of Medicine. Dr. Field’s
work is well received by the medical and scientific communities because her studies incorporate critical scientific
methods, using control groups and objectively measured
responses. By measuring hormone levels, blood pressure, brain wave activity, and math test performance,
she showed that after a massage, employees were more
alert, felt less job stress and anxiety, could perform more
efficiently, and were more accurate with math calculations. After chair massage, most people feel more relaxed
and less anxious, feel that they can think more clearly, and
have increased energy. (Box 9-18 identifies some highlights of chair massage.)
When clients are at work, they can be comfortably and
modestly supported in a seated position using a massage
chair (Fig. 9-18). They remain fully clothed, which means
the massage is applied through their clothing. You typically use no lubricant. You work primarily on the client’s
posterior neck and shoulder muscles, the back muscles,
and the arms and hands. This massage usually lasts only
10 to 15minutes, the general pace of the massage is faster
and brisker, and the flow follows somewhat of a routine.
Often performed in a well-lit, open area, with upbeat or no
music, the strokes used are quick and brisk to keep the client awake and invigorated. (See Box 9-19 for a sample chair
massage flow.)
W
406 INTRODUCTION TO MASSAGE THERAPY
Safety and Sanitation
Highlights of Chair Massage
for Chair Massage
• Clients are fully clothed
• Clients receive massage in the seated position, usually
in a massage chair
• 10- to 15-minute treatment
• Fast-paced, brisk compression and tapotement are the
major strokes
• Focus on the neck, shoulders, upper back, arms, and
hands
• No lubricant
• No draping
A massage chair is a great piece of equipment to use to
market your skills and gain access to persons who may not
otherwise experience massage. It is a good first exposure for
persons who are hesitant or have misconceptions regarding
massage therapy, and it is a good vehicle for educating clients about the benefits of regular massage.
You must be sure to consider safety and sanitation as part
of performing chair massage. Safety considerations include
transporting equipment safely, adjusting the equipment
properly, and inspecting the chair with each use. You should
follow the universal precautions and guidelines for hygiene
and sanitation as covered in Chapter 13.
Alert
When carrying your massage chair, you should be
sure to use proper lifting procedures to avoid injuring
yourself.
Keep your back as vertical as possible and bend your
knees until your arms can grab whatever you want to lift.
With a firm grip on the item you are lifting, straighten your
knees while keeping your back as vertical as possible. If you
use your massage chair frequently, you might consider buying a chair or a cart that has wheels for easier mobility. Once
you have determined where your chair will be set up, make
sure that all adjustments are securely tightened to prevent
the chair from shifting during the massage. It is also a good
idea to periodically check for cracks in the wood and damaged hinges.
There are three primary sanitation considerations with
chair massage:
Figure 9-18. Chair massage client positioning.
• Chair surfaces
• Client’s face
• Massage therapist’s hands and forearms
All of the chair’s surfaces that contact the client’s skin must be properly sanitized with every use.
Because clients are often in the middle of their workday, it is especially important to keep the face cradle
clean and sanitary. You should sanitize the face cradle
before each chair massage session and use a covering
of some kind. Examples include paper towels, bouffant
caps, and washable fabric covers (Fig. 9-19). Finally, your
hands and forearms must be properly disinfected using
proper handwashing procedures between each client
as well as immediately prior to beginning the massage
(see Chapter13). In a corporate or event setting where
handwashing is not available to you, gel hand sanitizer
is a convenient option to consider as long as you follow
the product’s directions. If you or your client has a cut,
wound, or open skin, you may choose or the client may
request you to use gloves.
Chapter 9 / Massage Strokes andFlow 407
BOX 9-19
1. Welcome the client:
a. Greet the client.
b. Inquire about spine or neck injuries or conditions,
wrist and shoulder issues, or recent surgeries.
c. Orient the client to the massage chair and
demonstrate how to sit in it.
d. Ask client to sit in the chair, and adjust the chair to
the client’s body.
2. Apply a resting stroke to both of the client’s shoulders.
408
INTRODUCTION TO MASSAGE THERAPY
BOX 9-19
(continued)
3. Stand behind the client in an asymmetric position and
warm up the shoulder and back muscles by applying
compression and pétrissage:
a. With loose fists on either side of the spine, from
shoulder to sacrum, two to three times
b. With the heel of the hand, compressing the erector
spinae muscles laterally, from shoulder to iliac crest,
on one side of the spine at a time
c. With the thumb, down the erector spinae muscles,
working into the intercostal spaces, one side of the
spine at a time
d. With the forearm, into the upper trapezius and levator
scapulae, one side at a time
4. Apply 8 seconds of moderate hacking over the whole
upper back.
Chapter 9 / Massage Strokes andFlow 409
BOX 9.15
BOX 9-19
Leg and Foot (continued)
(continued)
5. Stand by the client’s right side, and apply compression
to the right arm, from the deltoids to the hand, two to
three times.
6. Apply compression and pétrissage to the right hand,
paying extra attention to the thenar eminence, and passively extend and stretch the hand and finger flexors.
7. Move to the client’s left side and repeat steps 4 to 7 on the left arm.
8. Move to face the client and apply compression and petrissage strokes with both hands, moving medially from
the shoulders toward the neck.
410
INTRODUCTION TO MASSAGE THERAPY
BOX 9-19
(continued)
9. Apply circular friction to the base of the occiput, moving
laterally.
10. Apply brisk effleurage strokes:
a. Starting at the neck and brushing off the shoulders