CE INSTITUTE LLC BLOG

by Selena Belisle, Founder/Instructor, CE Institute LLC

Evidence Informed Massage Practices

LMTs can share research and evidence to support the validity of massage work on websites or with clients, such as Swedish massage can be used to treat headaches.  That in-part is of an evidence-informed practice when you have that research.

Evidence-Based Massage Practices

Using the actual hands-on massage protocol itself, from the research for any type of beneficial outcome, creates an evidence-based massage practice. 

Massage-related Research which includes Machine, Equipment or Product Use

Some massage-related studies use machines, equipment and products because their manufacturers usually have larger budgets to produce research, to demonstrate efficacy for sales.

Practicing massage with manufactured items would require additional information and/or training for manufactured item use and more considerations beyond anything discussed in this article.

Other Variables

There are other variables and considerations that can be applied to define evidence-based and evidence-informed practices.  These two explained above are simplified examples for evidenced massage therapy practices.

Practicing Evidence-Informed and Evidence-Based Massage
Sometimes a massage instructor will collect published research study data and provide the information in a neat, consolidated presentation.  And there are plentiful industry trade articles available free of charge for LMTs to learn more about research terms and language, on their own.

In Summary

We hope this brief summary helps clarify the difference between evidence-based and evidence-informed massage.  You can this and more by registering for training with us at:  https://ceinstitute.com/

by Selena Belisle, Founder/Instructor of CE Institute LLC

All CE Institute LLC hands-on classes are taught from an evidence informed and evidence-based stance.  It is important to practice from evidence and research to validate the work itself.

Here are some tips for practicing massage from evidence:

Seek Large Sample Size Research Studies for Use

When using researched protocols for hands-on practice, one recommendation is to review studies with large subject numbers. Following hands-on protocols that are provided to a large control group is preferred to using something practiced in a single case study.

Unfortunately, usually due to budgetary constraints, most massage studies are researched with exceedingly small subject numbers. However, in research, there are other studies called a meta-analysis and systematic reviews. These can collect similar massage studies, regardless of size, to review their data in totality to provide a broader and enhanced picture of results and outcomes from similar studies.

Finding Massage-Related Research

There are thousands of massage-related published studies with valuable information that can be used to improve massage efficacy, notably when using resources such as pubmed.gov. Unfortunately, there are still many massage topics that have not been studied or published yet, and when they are published, they might not provide the specific information you are seeking given there are millions of possible variables.

Do not let this information process frustrate you. Instead, we should all be grateful. There is a massive amount of available information, only seconds away at the stroke of a keyboard, which provides incredible and increasing access for evidence-based practices.

Sometimes you will find rare or unknown information while reviewing research because foreign published studies often fail regular massage keyword searches from language translations. Research can be a lot of fun, but it can also take a lot of time and practice to become efficient in finding what you need, if it is published.

I have spent decades scouring massage-related studies in both journals and online. Seeking usable researched hands-on protocols for evidence-based massage training can be long and hard work. However, it is always worth it when you learn something new.

What to do if a client is not Benefiting from Massage

Sometimes clients may not benefit from massage at all, regardless of research, training, protocols used or hands-on work. Every available method in your bodywork arsenal may not work! If or when this happens, the client could be suffering with an undetected underlying disease causing whatever prompted their reason to schedule their massage appointments.

Massage therapist should refer their client back to their doctor for further medical recommendations when the client is not reasonably achieving mutually agreed massage goals.

How to Learn which Massage Studies are Considered Better Quality

There are many industry trade magazine articles that provide language of how to read or interpret a research study.  LMTs can learn much of the language interpretation on their own with these magazines.

We now spend twelve hours teaching about this and more in an evidence-based massage CE course, so there are various opportunities available for practitioners to learn more about how to use research to establish an evidence-based massage.  You can this and more by registering for training with us at:  https://ceinstitute.com/

by Selena Belisle, Founder/Instructor, CE Institute LLC

Massage sheets are supposed to cover a client for warmth, modesty and protection.  Massage draping is provided to prevent nudity, excessive exposure and demonstrate a clear and professional line between a massage therapist and client.  There is no excuse to provide excess nudity in a professional massage therapy session when the draping itself is supposed to be a physical barrier to prevent it.

Massage Clients Who Do Not Want Any Massage Draping

So what should massage therapists do when a client doesn't want to be draped or use a sheet to cover themselves.  Massage therapists and bodyworkers should simply explain to the client that the draping is required as a professional standard and that the service cannot proceed without.

If the client requests to remove their drape after the massage has started, repeat the standard that it is required or that you can terminate the service if the client does not want to be professionally draped.

How to Drape When it's Too Hot

Women who are experiencing hot flashes, or any client who's overly warm can expose their feet, legs and arms to minimize the draping or heat, but removing the draping or using a hand towel should never be an option. 

An NFL Player Who Wanted Only Minimal Massage Draping

Recently, there were several massage therapists who publicly complained about an NFL player who only wanted to use a hand towel to drape himself, and he exposed himself to the therapists as well by removing the hand towel.  This is unacceptable behavior on the behalf of the client.  More so, the practitioner should have never started the service with just a hand towel over a client's genitals.

When a client is draped minimally with a hand towel, there is a larger chance that they could expose themselves, whether it was intentional or not.

A Doctor's Office Experience with Draping

Think about when you go to the doctor's office.  Your annual physical might be a lot more violating than a massage!  But what does the doctor's office provide you for your invasive exam?  Most clients are regularly provided a full paper gown and sometimes even a paper sheet to place on top of your paper gown.  

Doctor's could provide paper panties or a small paper towel if that was professional, but it's not.  It would be cheaper to give out paper panties or a paper towel but they don't.  So why would a massage therapist think it is acceptable for a client to drape themselves with a hand towel when this standard is not practiced anywhere in modern day medicine?  

Unacceptable Massage Draping Practice Standards

The NFL player who insisted on only using a hand towel and exposed himself to unsuspecting therapists stated he was allowed to do this with other therapists.  And indeed he was.  There were massage therapists that spoke up on his behalf, saying they were fine in just using a hand towel.  In our opinion, this is an unacceptable standard and practice.  Massage therapists need to provide more than a hand towel to provide comfort, warmth, protection and professionalism.

Very large bath sheet towels are acceptable to use as a massage drape.  A hand towel is not.  Remember, draping is to prevent excess nudity, so proper and professional draping should be practiced at all times. 

Draping for a Professional Massage Therapy Session

Draping is provided for professional reasoning.  Draping is not a suggestion, nor is it a client dictated protocol.  Massage therapists must execute and reliably practice professional draping standards at all times if they want to be seen as massage professionals.

Professional massage therapy draping with a sheet or very large towel should always cover the buttocks, genitalia and the client's chest area.  The draping should be large enough to cover the entire client if so desired.

Therapists should only undrape the area that they are working on, and that area should be immediately draped and covered again, once the work has concluded in that area.

The Only Time a Hand Towel Could be Incorporated Into Professional Draping Practices

Practitioners may use a hand towel to work on a client's abdomen when a client is lying in supine position on the treatment table.  The hand towel would usually be folded in half long-ways or horizontally, depending on the amount of coverage required.  Then the hand towel would cover the client's breast area as the top draping sheet is lowered to expose the abdomen.  At no time should the client's breast area be exposed during this draping practice.

Massage therapists should seek additional training if they do not know how to use a second drape such as a hand towel to cover a client's breast while exposing the abdomen.

Business Standards with Draping

Massage therapists can incorporate a draping policy within their massage therapy or bodywork practice.  Adding a draping policy will help provide a standard that can be shared with clients if or when they are demanding something different.  

Preplanning ahead of time by creating a standard draping policy could help a therapist prevent an awkward situation by simply falling back on the policy. Therapists can always state they are simply following company policies whenever a client wishes for different draping, especially if it feels like the request is for nefarious purposes.  Citing a company policy may feel less confrontational or less uncomfortable than telling the client no for other reasons.

If a client continually requests less draping, simply inform them that they are requesting you to violate a company policy, which cannot be done.  The only action you have beyond breaking the company policy is to either proceed with the service in accordance with your policies, or to provide no service at all because their request cannot be provided within the company's policies.

In addition to adding a draping policy to your website, a practitioner could also print their draping policy on any standard client intake form or paperwork.  Having a standard preprinted policy in writing where it is accessible to the client may help prevent clients from approaching your business for something different than what is professionally practiced.

To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/

#massage #draping #massagetherapy #massagetherapist #manualtherapy #bodywork #bodyworker #cosmetology #sportsmassage #massagebusiness #massagepractices #LMT 

Massage as a Health Care Service

Many massage therapists and bodyworkers view their work as health care practice, and tipping is not normal in most medical settings.  To start, we should be clear that massage therapy is health care.  In fact, massage can be used in both preventative and rehabilitative health care management which doubles its viable application. Even if a client schedules a massage on vacation for enjoyment purposes, the increased circulation and other healthy therapeutic benefits achieved in massage practice cannot be avoided.  Massage provides health care by almost any basic standard.

To answer the question of accepting tips, ask yourself:  do you consider your massage to be health care or service?  Most massage therapists will find it is both.  This places massage in two separate categories where tipping is accepted in service but not practiced in health care. This is what creates the dilemma.  How does a practitioner navigate tipping practices and policies when they simultaneously operate in two opposite worlds?

Is Your Massage Straight-up Health Care? Or is it Health Care Service?

Here’s an example of massage practiced as health care without a service-oriented approach: working in a medical setting where the practitioner applies therapeutic touch to achieve the best health outcome, at a health care office, weekdays only, Monday through Friday, between 9 am to 5 pm, during normal business hours.

A large element of service can be extracted from massage health care practice.  I am not suggesting that anyone should extract their service element but it can be done.  And it is your service element that should be considered if you are questioning whether or not you should accept tips, because it’s the service industry where tipping is normally accepted and practiced.  Providing a service element with your massage is commonly accepted and expected as an American standard. 

What Massage Looks Like When it is Executed with Service

Massage therapy service standards usually place a client's personal wishes and directions first. That in itself is service. And it’s the service industry where gratuities are normally exchanged. Accepting gratuities does not make you any less of a health care provider.  Its simply acknowledging that you are providing a high level of service with your health care.  

The following are some questions to help determine the level of massage therapy service provided. The more you answer yes to these questions, the greater level of service you are likely providing with your massage:

• Do you often work outside of regular business hours, sometimes providing appointments as late as 7 pm or later at night or on weekends, giving up valuable personal time with your friends and family to serve your customers' wishes and needs?
• Do you accommodate last minute emergencies, making a choice to cancel your plans to care for someone else's?  Massage therapists often serve their client's needs first because they recognize that their client reciprocally pays for their plans.
• Have you worked in temperatures or spaces that you would not find comfortable, to keep a client comfortable?
• Have you hauled massage stones or acquired other equipment to provide better service without charging extra for it?
• Do you offer a client a choice of working with oil, lotion, gel, cream, aromatherapy or anything else they desire?
• Do you provide whatever type of appointment a client wishes over the type of bodywork that you would prefer for that client?

These questions have been provided to help inspire thoughts to create your own tipping policies. Now ask yourself, does your massage practice lean towards a high level of service? Or is it a straight-up health care operation with normal weekday business hours and best medical objectives practiced at all times? 

Do No Harm While Providing Massage Service

All forms of massage are generally healthy, so there's usually no harm unless your client is asking you to burn them with rocks or apply more pressure than they can tolerate or lie prone and flat on the table while nine months pregnant.  As long as you’re practicing within normal service standards, there’s little harm that can be achieved through quality therapeutic massage or bodywork.

While its difficult to do harm with proper practice, there are many times that massage therapists do less satisfying work, not from our own volition but because of our client’s choices, and because we regularly provide our massage appointments as a service-oriented business.

Providing Massage Service Instead of Practicing for Best Medical Outcomes

There are times that a client does not want to receive the bodywork that I believe would be in their best medical interest, such as deep cross fiber friction to break-down scar tissue.  Instead, some of my clients have preferred a good foot rub or nice oily back massage.  All of this is health care, but I feel like I am providing more service-oriented treatment when I practice what the client wants instead of fulfilling what I think would be best for their medical needs. 

Of course, best medical outcomes with massage therapy could be highly subjective.  For example, some clients would prefer a nice relaxing generic full body Swedish massage when they are in pain because of their bad posture.  It would probably be best to try to improve their posture with more technical bodywork, but instead the client has chosen a different form of massage to temporarily mask or relieve their pain. 

Most of the time I would prefer to work for best medical outcomes that can be achieved with highly technical bodywork, but to provide the best service, I'll explain my bodywork recommendations, and then I'll let the client choose whatever type of massage they would like to receive.  That is providing a service.

Accepting Tips for Massage Therapy Health Care Service

My clients have recognized the many selfless contributions I have made to provide them exceptional health care service and they appreciate it. One of the ways they show their appreciation is through gratuities. And yes, I accept them, graciously.  I appreciate them.  Their tips are one of the rewards I receive for a lot of selfless work that could be easier or more rewarding, but sometimes it is not. 

I answered yes to the list of questions above, often working outside of regular business hours, following a client’s requests at all times I can reasonably provide them, and as long as I do no harm with their service directions. Their gratuity seems like a fair exchange to compensate me for my level of provision and service.

Setting Your Own Tipping Policies

Tipping policies are a personal decision that each therapist must make for themselves. There is no massage industry tipping standard nor should there be. If you work for an employer, hopefully your attitude regarding tipping matches theirs.  And just know that there is no wrong or right answer about accepting tips.  This is a personal decision that must be made in a manner that aligns with your practice and best serves you.

To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/

___________________

This article is written by Selena Belisle, the founder and one of the instructors at CE Institute LLC in Miami, Florida.  There, they teach massage, nursing and cosmetology industry CE courses. Selena has been practicing massage therapy and bodywork for over 30 years. She is approved as a continuing education provider by many industry state boards and the National Certification Board for Therapeutic Massage & Bodywork.

#massage #bodywork #bodyworker #massage #massagetherapist #mt #LMT #tip #tips #gratuitites #massagebusiness #massageservice #healthcare #medical #medicalcare #serviceindustry #tipping

The Following are Workplace Tips to Help Prevent Aches and Pains that can be Utilized for Massage Therapists, Estheticians, Cosmetologists and Personal Care Services Providers:

Industry workers can get aches and pains from long period of work, performing repetitive movements and resting hands, wrists, hips and forearms and/or elbows against hard surfaces or other undesirable body mechanics. 

Ergonomics is the science of “fitting the task to the worker” so that you are more comfortable and efficient when doing your job. Good ergonomic practices will reduce stress to your body and help you avoid aches and pains.

Steps You Can Take to Reduce Aches and Pains from Work (recommended by OSHA):

• Use an adjustable chair. Sit so that your feet are flat on the floor and your back is supported. Use a footrest if your feet do not touch the floor when sitting.
• Make sure there is enough space between the back of your knees and the front edge of your seat to improve blood flow to your legs.
• Adjust the lighting. Good lighting can help you see without having to bend over.
• Raise the client’s hand or foot. Use a cushion to raise the client’s hand or foot so you do not have to bend over as far.
• Use safety glasses with magnifying lenses. These glasses reduce the need for you to bend over to see the client’s hand or foot.
• Put a towel or foam pad on the table edge to soften it for hands, arms, wrists, and elbows.
• Put soft pads on tools to make handles larger and easier to hold.
• Take frequent breaks if possible; changing positions and doing a different task is also helpful.
• Pace your work. When you work too fast, your body can become tense, which could cause muscle pain.
• Do gentle stretching exercises, but check with your doctor before starting any exercise regimen.

To learn more, please register for training with us at:  https://ceinstitute.com/

#cosmetology #nailtechnician #manicure #pedicure #safety #safetyfirst #salon #spa #business #ergonomics #mani #pedi #massage #massagetherapy #massagetherapist #bodywork #bodyworker #lmt #massageestablishment 

Here is some information from the EPA about Latex Glove Use and Skin Sensitivity

The CDC reports:  "Studies indicate that 8% to 12% of health-care workers regularly exposed to latex are sensitized, compared with 1 percent to 6 percent of the general population..." (https://www.cdc.gov/niosh/updates/latexpr.html)

Sensitization or hypersensitivity reactions usually occur as a result of repeated or prolonged contact with a chemical substance that interacts with the body’s immune system. In some cases, an individual may develop a reaction only after encountering a material repeatedly or after continuous prolonged contact. Red or itchy skin, water blisters, and areas that throb or feel warm are signs of possible sensitization of the skin.

FOR EXAMPLE: After wearing latex gloves daily for several weeks or months, a previously unaffected person may develop a persistent rash on their hands and wrists. This sensitization may be caused by one of several components of the gloves acting as an allergen (allergy-causing substance).

If this occurs, gloves made from other materials, such as nitrile, may be used.

If you chose to wear gloves, it is recommended to use vinyl or nitril gloves given the overwhelming latex sensitivities that have developed over the years.  And if you notice that you have any of the signs or symptoms above with latex, immediately stop wearing or using latex products and adapt to using something that will not irritate your skin (or others). 

To learn more, please register for training with us at:  https://ceinstitute.com/

#cosmetology #nailtechnician #manicure #pedicure #safety #safetyfirst #salon #spa #business #sanitation #disinfection #cleaning #mani #pedi #latex #latexallergy #latexsensitivity #gloves #massage #massagetherapy #massagetherapist #bodywork #bodyworker #lmt #massageestablishment 

The EPA has created a “Best Practices” List for Salon Owners and Managers.  These include:

• Post “No Smoking”, “No Eating”, and “No Drinking” signs in shop’s work area.

• Post a sign near the shop’s sink to remind workers to wash their hands before and after each customer, after handling chemicals, and before eating.

• Require all customers to wash their hands before receiving service.

• Perform services only on healthy nails and intact skin.

• Post step-by-step procedures near the shop’s sink and in the shop’s work area on how to clean and disinfect nail instruments and other equipment that comes in contact with clients’ skin.

• Properly ventilate each work station. Preferably, install an effective exhaust system with individual exhaust vents for each work table. If possible, the exhaust should be vented outdoors in a manner that meets local building code requirements.

• Keep the general ventilation system (HVAC) on during work hours.

• Place a metal trash can with a self-closing lid at every work station.

• Label all product containers clearly and properly.

• Purchase appropriate masks and gloves recommended in the SDS for staff.

• Do not buy or use any nail product containing liquid methyl methacrylate (MMA) monomer.

• Designate a chemical storage area far away from the dining area and equipped with local exhaust ventilation.

• Provide an adequately ventilated dining area for nail salon workers, partitioned from the shop’s work area.

• Designate a storage place for a binder of SDSs for all nail salon products.
• Ask for the most up-to-date SDS for each product at least once a year.
• Inform employees where SDSs are kept.

• Provide training required for reading and understanding SDSs.

• Provide worker training on hazard communication and proper storage and handling of flammable liquids as required by OSHA.

• Maintain the latest copy of the state cosmetology board’s rules and regulations.

When working in a cosmetology establishment, be sure to protect yourself and others.  To learn more, please register for training with us at:  https://ceinstitute.com/

#cosmetology #nailtechnician #manicure #pedicure #safety #safetyfirst #salon #spa #business #sanitation #disinfection #cleaning #mani #pedi #sds #sdssheet #massage #massagetherapy #massagetherapist #bodywork #bodyworker #lmt #massageestablishment 

Learning about and using Safety Data Sheets (SDS) will help with workplace environment situations.  An SDS is an important document that explains the risks, precautions, and response actions related to exposure to a particular hazardous material used as an ingredient in a product. An SDS also explains the appropriate and best course of action should accidental over-exposure occur.

Federal law requires that SDSs must be kept in a work environment and be available to employees during working hours. SDS should be properly maintained to ensure that all employees:

• Are aware of the dangers posed from potentially hazardous materials stored in the establishment.
• Know how to respond in an emergency or if overexposure occurs.
• Know how to dispose of unused products properly.
• Know what protective equipment (e.g., masks, gloves) should be worn when working with professional products.

Owners, managers and workers should review and understand the content of an SDS and know where they are kept in the establishment for both products and cleaners.

When working in a cosmetology establishment, be sure to protect your own skin and airway with proper PPE.  To learn more, please register for training with us at:  https://ceinstitute.com/

#cosmetology #nailtechnician #manicure #pedicure #safety #safetyfirst #salon #spa #business #sanitation #disinfection #cleaning #mani #pedi #sds #sdssheet #massage #massagetherapy #massagetherapist #bodywork #bodyworker #lmt #massageestablishment 

In the state of Florida, a licensed massage therapist scope of practice includes "chemical preparations of the body".  As such, adding some sliced cucumber to a massage appointment should be acceptable for FL LMTs!  Just slice up some cucumbers and place these over the client's eyes in supine position during your massage (just make sure the cucumbers are not dripping wet to ensure that this moisture does not excessively drip into their eyes.)

MedicalNewsToday.com and other various websites purport many health benefits of placing cucumbers over eyes.  These include:

• having a cooling effect on the skin
• hydrating the eyes and surrounding tissues
• reducing dark circles due to the high levels of vitamin K
• reducing inflammation due to the presence of lignans
• helping treat sunburn
• brightening the skin due to its ability to inhibit tyrosinase, an enzyme that is involved in the production of melanin

Want to make them pretty?  In equal parts, skin the cucumber longways leaving enough skin in place to create long stripes on your cucumber and then slice.  This will create a pretty striped cucumber for enhanced visual presentation.

Want to get really creative?  How about creating a massage for hangovers?  Why not?  While treating hangovers is NOT within a massage therapists' scope of practice, that shouldn't stop creating a fun massage therapy service menu.  Just be sure to disclaim that you are not providing medical treatment for hangovers if you choose to advertise this option.

In a Hangover Massage you could:

• Serve lots of water and liquids with your appointment
• Keep the appointment short, such as a 30-minute service and allow the client to extend the service if they're feeling well enough to do so
• Place cucumbers over the client's eyes in the supine position.
• Consider using cool packs with the massage
• Consider adding menthol the massage medium which could enhance skin blood flow response and increase circulation

Dressing up your massage with cucumbers can provide some fun alternatives in your practice.  Slice up your fun today!

To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/

#hangovermassage #hangover #massage #lmt #massagetherapy #massagetherapist #bodywork #bodywork #fun #servicemenu