CE INSTITUTE LLC BLOG

We’ve been wanting to introduce Thai massage education at the school for a while now; however, it’s usually quite inexpensive to fly to Thailand to study this modality over there, at one of several Thai massage schools that welcomes Americans to their studies.

Thai massage is usually performed on a floor mat, fully clothed, with a balance of passive stretching exercises and compressions where some clients might describe it as being twisted into a pretzel in the best imaginable way possible.  Thai massage gently and passive moves human joints through normal ranges of motion to increase function, relieve stress and other health benefits.

In this Thai Spa that I got to visit as a walk-in client on the streets of Paris, I found a well decorated and clean establishment with welcoming staff.  We looked through their menu of services and while I had originally wanted a Thai massage, I thought it would be a better learning experience to see what or how a Thai practitioner would provide an oil massage, so I booked the oil massage instead. Oil massage is the more typical practice of what we teach at CE Institute LLC, so I have been consuming as many different massage appointments as possible to see if I can learn or experience anything different to continually share in updated education at our training facility.

After I had established which type of appointment I would experience at this Thai Spa, the service provider immediately had me remove my footwear in place of theirs.  This is a Thailandese traditional and cultural norm that promotes sanitation and conveys mutual respect and care. I asked to use the bathroom first which every practitioner should offer prior to massage, so that the appointment is not disrupted with a need to use it!

For this Thai oil massage experience, the massage therapist brought me into a small treatment room and asked me where I wanted the massage focused. I told her my legs were sorest of all from walking the city of Paris, and then she told me to disrobe and to lay pronated on the massage table.

The table was covered with a narrow sheet of paper over what looked like a cotton printed sheet from Thailand which was beautiful.  Towels were folded on the corner of the table to cover myself with and the therapist split a hole in the paper where my face was to be placed to breathe.  I opted to put my sweater over the hole and leave my head turned to the side for sanitation reasons.  The room was dimly lit and beautifully decorated with wallpaper; however the lighting in the ceiling was neon in color which gave off the wrong vibe for me.  I would have enjoyed lightning to be in a soft warm yellowish tone which would have felt more comforting than being in a neon lit room. I believe soft yellowish lighting would significantly improve the spa’s existing beautiful assets.

When the therapist re-entered the room, she started her service with hot towels to my feet, then strong compressions on the soles of my feet.  She worked superiorly moving into compressions with her palms over my heels and upwards through my calves and hamstrings.  At some point during the posterior lower extremity compressions, she jumped onto the table between my legs and continued her compressions through my hips and low back without missing a beat. Most clients would probably not know the practitioner was now on top of the table instead of beside it; however, it was clear the direction and pressure she was provided could only be achieved from being directly over the top of me. A while ago, some massage organizations required that a massage therapist maintain one foot on the ground at all times during a massage appointment.  I’m not sure if that requirement still exists, but it would be hard to follow in Thai practice where therapists usually hop onto the table for better leverage.

The massage began with warm oil with a bottle she kept in an oil warmed in the corner of the room.  For sanitation reasons, we would recommend to elevate this oil warmer onto a higher shelf area, and to wash both the oil warmer itself and the oil bottle between clients to avoid cross contamination.

The massage itself was slightly disappointing, as the therapist repeated the same strokes over and over again.  I was surprised when the initial oil application started from the hips and was applied towards my feet inferiorly which is against venous return and ill-advised.  Once the oil was applied, the massage therapist changed direction and started strokes superiorly from the feet to the hips, to promote venous return.  Unfortunately the same stroke was applied over and over again, repeatedly, in a manner that simply felt boring and uninteresting.  It’s almost like she was going through the motions of providing the massage without any clear intention or care for its purpose.  It’s been a long time since I’ve felt such a detached massage as this one.  The speed and contact of the massage were decent, but it felt like the massage therapist was not mentally present, in the moment, and that feeling was overly emphasized when she left our treatment room in the middle of the massage without explanation, to speak to other incoming customers and staff at least three times within a 30-minute period.

We did have a language barrier where I speak enough French to get by; however, no attempt to discuss contraindications or goals were made other than asking where I wanted the oil massage applied on my body.  In the end, I regretted not scheduling a Thai massage in this Thai spa, wondering if that would have been a better service than what I had received.

When I dismounted the massage table, my legs did feel better so I was glad to experience some therapeutic effect from the appointment because when I was on the table, it felt like there would be little to none.  I did notice that the paper sheet that had been used to cover the table was no longer intact, which concerns me from a sanitation standpoint, especially if they are not changing that beautiful cotton sheet directly underneath it.

When I re-entered the reception area to pay, I encountered another client who was putting on the spa’s footwear so I asked her what she had scheduled. She responded she did not know but was a regular client who lived on the same street.  I was pleasantly surprised to find this regular client going to this establishment for her own benefit despite not knowing what she was receiving.  I asked her if she was disrobing for oil massage or being stretched through her clothes, and she described a Thai massage that was finished with some brief oil massage application which she said she thoroughly enjoyed and has come back many times to receive.

In the end, what I received at this Thai spa would not be the same experience for all Thai establishments.  The phrase “when in Rome” kept coming to mind during my massage here, which said to me that while I’m in a Thai spa, I might have benefited most from a Thai service such as Thai massage.

Have you ever wondered where spa’s come from?  Who thought of this concept?  When? How? Why?  Modern day spas today are most closely related to ancient Greek practices with an eventual Roman evolution of bath houses from thousands of years ago.  Our earliest known spa use is tainted by muddled history stories, with whatever evidence feels strongest for one to follow or believe. 

In ancient Greek and Roman times, bath houses were frequented amongst multiple classes of society. While the wealthiest may have had a private bath within their own home, they would still frequent the public bath houses as a way of life. They were places for recreational, health and social activities, in addition to the most obvious use of bathing for personal hygiene and sanitation.  

Detoxifying and Vasoconstriction with a Cold Plunge and Contrast Baths at the Spa

Did you know that Roman bath houses had different baths, usually at different levels and with different temperatures? Public bath houses could be heated with fire under the floors, and cold baths or cold plunges would usually be the lowest level of the bath house, where they are dug deep into the ground to preserve a chilly temperature.  

So, while today, cold plunges are all the rage as it can vasoconstrict soft tissues which helps eliminate waste products held within the body in an ultimate detoxification, it’s likely this cold plunge process started in Roman public bath houses, with its multi-temperature baths which would also known as contrast baths. An ancient Roman bath house is where these multi-temperature baths were collected and housed or used together in one establishment.

Muscular Soft Tissue Healing, Recouperation and Vasodilation at the Spa

Today’s modern day spas will offer a variety of bodywork and massage services that will manually increase circulation whether it’s pressing the soft tissue to create an ischemic effect, then releasing the soft tissue which will in turn produce a resurgence of blood and nutrients to the affected area.  This increases circulation and all the riches of newly oxygenated blood to an area for increased cellular metabolism and healing.  By contrast in ancient Roman bath houses, participants would exercise in a yard or dedicated area to sport to increase their circulation.  

We have gone one step further today by creating machinery and electrical devices to increase circulation within the spa business.  This is anything between pressotherapy garments that even hospitals use, with air pressurized balloons gently squeezing the soft tissue then releasing it, which will help increase cardiovascular circulation as well as help prevent blood clots if an individual is sedentary.  We also have massage chairs that we can sit in to help increase circulation with pressing and releasing soft tissues, as well as hand held devices and much more.

Do Any Ancient Spa Establishments Still Exist?

Yes, many old bath houses which might also be known as the world’s first spas still exist, although most fell into a period of disrepair until being rehabilitated or repaired for mostly tourism attractions today. For example, it’s the Musee de Cluny at 28 rue Du Sommerard, 75005 Paris, France which is the ancient Roman spa that is mostly pictured throughout this article. 

Today’s modern Paris Museum which is called the Mussee de Cluny was built on an approximate 2,000 year old ancient Roman bath house which was actively used for approximately 200 years. The museum’s curators suggest that any Roman city conquered was fairly worthless without a set of Roman baths, and in this particular area, there were three of them.  The bath house we have pictured throughout this article at the Musee de Cluny was the center of the area’s social activity, where people came to relax, exercise, have their hair cut and read.  Some ancient Roman baths had a public library. That’s fairly similar to what is practiced today, where magazines and travel books are shared common fare in a modern day’s spa reception area.

The Musee de Cluny’s ancient Roman bath or spa was split into three different levels.  This included an area deep underground, where hydraulics and drainage were routed.  

The ground floor entrance was an open exercise area.  This ground level area consists of both indoor and outdoor rooms with more rooms above.  

The museum curators suggest that bathers would start at the bath house with a hot bath, which was also called the caldarium. Then bathers would move onto the warm baths with tepid water in a tepidarium.  The last place the bathers would go in their spa ritual would be the frigidarium which is also known as the cold room.  

The Archaeological Crypt from the Ile de la Cité, just in front of Notre Dame Church, has another ancient Roman Bath in ruins available for public display with the purchase of a ticket, similar to how one would view the Musee de Cluny.  The crypt's Roman bath was believed to have been in use until the 4th century. Below shows a map of how this 2nd Roman Bath was configured. 

The following video without narration shows the Roman bath ruins that were buried for centuries and recently unearthed between 1965 and 1970 at the Archaeological Crypt from the Ile de la Cité.  The map showing above is flipped or in reverse to what will be shown on the video below, so the video starts at the left of the unearthed baths and starts with the entrance, then leads to the frigidarium, them moves on to the tepidarium and ultimately ends in caldarium.  

There are many other spas or bathing houses throughout the world that still remain, some in better conditions than others with one of the most popular being “Bath” in Somerset England, where many have gone throughout time to “take the waters.” And pictured below is a peasant spa in Yugoslavia where public bathing and cupping was practiced for health around the 1900s.

The oldest spa in the world may be in Pakistan which is dated back to 2500 BC, approximately 4,500 years ago.  But the truth is, we may never know where the oldest spa originated given volcanic eruption, time and dust has covered most of the earth’s surface as well as the loss of areas due to sea erosion and more.  What we do believe is that the ritual of spa is a centuries old practice that has evolved into a wonderful modern day marvel that continues to restore health through the ages.

Many pathogens including harmful parasites can be microscopic, meaning they are not visible to the naked eye. If your client suggests they have a new unknown itch or rash, it’s always safest to have them see a doctor prior to potentially spreading a harmful infection.  Working on a client with an unknown rash or itch is too big of a risk, given the practitioner could acquire the infection themselves and/or spread it onto other clients.  Even if a practitioner wears gloves, that is not good enough, because parasites or other harmful pathogens could spread into your treatment area causing further infection later on down the road.

Different parasites commonly harbor in different areas of the human body depending on which type of infection is present.  Some integumentary or skin infections may be more prevalent between the fingers while others may harbor in areas of where clothing meets the skin, such as underwear, shirt or pant lines.  Other infections might show a “line” of parasitic infection on human skin, such as what is pictured in this article on the individual's posterior lower leg. 

It is critical to conduct a proper and thorough client intake process before a client disrobes or infects your treatment space.  This would include devising your own written client health intake form for the modalities that you offer or practice.  Most liability insurance companies provide general client health intake forms for free to their customers, and then a practitioner can determine if that form makes sense for their practice, or if it should be modified for their own practical needs with legal counsel or other options. Once the client has filled out their intake form, practitioners should take notes of each treatment provided to ensure the client’s goals are being met for overall quality and improvement measures.  Upon each new client appointment, practitioners should then ask the client if there’s anything new since their last visit, and that is when a practitioner should be notified if a client has a new itch or rash.

If the client does not disclose a new rash or itch (that developed for an unknown reason) until they are on the treatment table, it is probably best to immediately terminate the session until a medical diagnosis is determined that it was not caused by something that could be contagious.  While that may seem inconvenient, continuing the session with a possible contagion puts everyone at higher risk and is ill-advised.

It is also important to prohibit clients from bringing their own linens, cushions and other fabric type items into your work space, given they can be difficult to sanitize and can also harbor harmful pathogens beyond our clients themselves.

The following is a general list of medical conditions where massage and bodywork is generally not advised/contraindicated.  Seek a physician’s advice about an individual’s specific medical condition PRIOR to providing bodywork.

Active Chicken Pox: Highly Contagious Virus – usually includes excessive skin lesions and broken skin. 

Cellulitis: Commonly Cause by a Bacterial Skin Infection 

Fever: Possible infection in the body (and potentially infectious to the therapist and their clients)

Flu/Influenza: Viral Infection of Respiratory System. HIGHLY CONTAGIOUS.

Impetigo: Bacterial Infection of the Skin.  Rash with fluid-filled blisters. HIGHLY CONTAGIOUS. Ensure all lesions are healed before massage can be considered.

Infections and/or Inflammations: Appendicitis, Bronchitis, Fungal, etc.

Someone recovering from a recent infection (i.e. bronchitis) may be “okay” for massage.  It is always best to check with their physician FIRST, prior to providing bodywork. Discontinue bodywork services immediately if client with recent infection or inflammation shows any signs of medical or physical distress.

Lymphangitis: Infection of Lymph Capillaries

Meningitis: Infection of the Meninges. Viral Meningitis is HIGHLY CONTAGIOUS.

Pneumonia: Infection in the lungs.

The Pneumonia itself may not be contagious; however, the microorganisms that caused the pneumonia could be HIGHLY CONTAGIOUS. Anyone in respiratory distress is most likely contraindicated for bodywork services – check with a physician for greater information and direction.

Scabies, Mites & Lice: Parasitic Infection – HIGHLY SPREADABLE. No contact should be made until infestation is completely eradicated

Systemic Swelling/Edema: Individual could have serious organ failure, infection or other serious medical illness for systemic swelling. Obtain physician’s diagnosis, direction and approval with these clients.

Active Tuberculosis: Bacterial Infection that usually begins in the lungs but can infect other areas of the body. HIGHLY CONTAGIOUS when active. Generally considered not contagious in latent stage. Can lay dormant/latent/non-contagious for years. Seek physician approval and direction for “latent” infected clients who are coughing, or for any other concerns. 

This is a partial list of massage contraindications. For more information, please register for training with us on this website! 

To learn more, you can register for training at https://ceinstitute.com/

#massage #massagetherapy #massageprecautions #massagecontraindications

 There are 7 basics steps to table sanitation:

1. Strip Your Table of Unnecessary Items.
2. Protect Yourself When Removing Linens and Sanitizing.
3. Launder Correctly.
4. Clean Your Table.
5. Disinfect Everything, Including Accessories.
6. Employ Contact Time.
7. Alternate Face Cradle Cushions.

To learn more, view our training video, or please register for training at https://ceinstitute.com/

Dwell time, also known as contact time, is the amount of time that a surface should remain wet to achieve a sanitization product’s desired result.  For example, some products advertise that they kill 99.9% of germs; however, to kill those 99.9% of germs there is usually a dwell time where the surface area must remain wet with that sanitizing product.  

A dwell time on average can last between 30 seconds to 10 minutes or more.  Sanitizing is less effective when proper dwell times are not observed. Dwell times also require a proper amount of sanitizing product to be applied, which is just as important as the dwell time itself.  Here are some examples where dwell times should be practiced and adhered with sanitizing products:

Disinfectant Wipes:   Some of the most popular household wipes (including Lysol and Clorox) recommend that the surface being sanitized must remain wet for 4 minutes after being wiped. 

Disinfectant Sprays:  In addition to dwell time, sprays may have further directions such as distance to spray a surface to sanitize it.  Lysol recommends spraying for 3-4 seconds within 6” to 8” of the surface being sanitized with a dwell time of 3 minutes where the surface must remain wet.

Bleach Solution Soak:  When 1/3 cup household bleach is mixed with 1-gallon water, objects should usually be immersed for not less than 60 seconds and not more than 10 minutes, depending on what is being sanitized. 

Hand Sanitizer:  Hands should remain wet with a hand sanitizer for at least 20 seconds after application.  Dwell time language is usually not used with hand sanitizer, but we felt it’s appropriate because many will not wet their entire hands with hand sanitizer, nevermind keep them wet for at least 20 seconds with plentiful product.  Our sparing use of sanitizing agents today is mostly born from the appalling shortage of sanitizing agents available during this pandemic, which has not been helpful in preventing the spread of germs.

The four sanitizing products and practices listed above have dwell times that range from 20 seconds and up to 10 minutes, where the surface areas or objects being sanitized must remain wet.  Proper sanitation is regularly not achieved if a product’s dwell time is not provided.

Some people will spray or wipe a surface area with a sanitation product, and then wipe it dry without allowing for dwell time.  This is one of today's most popular and improper uses of a sanitizing product.  It is important to not rush the sanitization process by adhering to proper dwell times, or else the entire effort could be an expensive waste of time and leave you exposed to a dirty or infected workspace.

Hard surfaces versus porous objects can have different dwell times.  Different kinds of sanitary agents, as well as different sanitation manufacturers could have contrasting instructions.  It is extremely important to follow each product’s individual instructions to keep yourself safe, and your clients happy and healthy during this viral age.  It only takes a few seconds to read and practice these various uses, but those few seconds could make the difference of properly sanitizing your business, or leaving it exposed to germs.

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

#massage #massagetherapy #massageprecautions #massagecontraindications 

There are three key factors in addressing massage therapy treatment room air quality to reduce the risks of airborne contaminants:

1. Increase the amount of air ventilation or air exchange around your massage service;
2. Increase the amount of air filtration to purify the air in your massage workspace; and
3. Alter your massage therapy service to avoid prolonged exposure to a client’s airway, through socially distant services (suggestions can be found here on our school blog)

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

Step Up Your Massage Business with Socially Distant Appointments

COVID-19 is an illness that is primarily spread through respiratory droplets.  The greatest risk of contracting this virus is through close contact with an infected individual, which is why social distancing has been recommended during the COVID-19 pandemic.  As such, efforts should be made whenever possible during a massage or bodywork appointment to create as much distance as possible between a client's airway and a practitioner.

Some massage and bodywork services offer a greater amount of distance from a client’s airway than others.  Here are two appointment examples that can incorporate a COVID-19 social distancing theme at work: 

Foot Reflexology

This ancient healing art is a service that can provide full body relaxation while producing the greatest amount of distance from a client’s airway.  Foot reflexology can be provided in a supine or prone position, although prone position is preferred during the COVID-19 pandemic.   

This appointment can also start with a tranquil foot soak to cleanse the feet and set a relaxing mood of utopia during these stressful times.  Best practices are to provide the foot soak outside, on a rooftop or balcony for best air quality.  A soak also allows for an easy and enjoyable socially distant appointment as most do not require a practitioner to be present.

The Foot Makeover

aka Happy Feet or Renew You or Pleasure Paws or Service of the Month

This appointment can be renamed and produced as an add-on or independent appointment.  It is generally provided as a 30-minute session with 10 simple steps:

1. Sit the client in a relaxing sudsy aromatic foot soak. Leave magazines for the client to entertain themselves during this relaxation time.  The foot soak will help cleanse the client’s feet of physical debris and odor. 
2. It is usually recommended within the industry to provide water with lemon, an assortment of teas and spa snacks such as individually wrapped nuts or fruit during a relaxing foot soak. However, due to the pandemic, everyone at the establishment should wear a face covering.  As such, it is not recommended to serve refreshments so that the client will retain their face covering for their entire appointment.
3. After an appropriate amount of foot soak time, lay towels or a clean bath matt between the foot soak and massage table, or provide spa slippers for the client to wear to the massage table. Dry off the client’s feet with a clean towel and lead them to the table where they will lie face down in the prone position.
4. Place an ankle bolster underneath the client’s ankles to bolster their feet in the air and a large clean dry towel in between. 
5. Apply a foot scrub to the client’s feet. Salt or sugar scrubs are the best choice in a dry massage treatment room. Focus the scrub on the bottoms of the feet and around the heels.  Use less vigor on the tops of the feet and around the toes. 
6. After a thorough foot scrub, rinse hands with water and do not dry. After rinsing the hands, use wet hands to rescrub the client’s feet. This wet moisture on a practitioner’s hands will start to dissolve a salt or sugar scrub for easier removal.  Repeat rinsing hands and using wet hands to rescrub the feet until the scrub abrasives are dissolved.
7. Apply wet hot towels to the client’s feet with gentle compressions. Begin to pull and rub away any remaining debris or stickiness of the foot scrub. Repeat the process with new fresh hot towels as needed until the feet are clean of all scrub material.
8. Place a new clean large dry towel underneath the client’s feet. Wrap one foot with the corner end of the dry towel and start foot massage on the other foot then switch.  Use massage cream or skincare moisturizer for the foot massage.  Oils or gels are not recommended.  The goal is to moisturize and soften the foot. 
9. Pat and rub the bottom of the client’s feet dry with corners of the clean dry towel that is underneath their feet. The goal is to remove any excess moisture from the bottom of the client’s feet so that they do not slip in their shoes or on any other surface. 
10. Help the client off the table.  The client’s blood pressure has likely decreased during this heavenly service, so allow them to sit-up for a moment before standing to reorient themselves.  This service is now complete.

Socially Distant Massage Service Summary

Both foot reflexology and foot makeover appointments can be provided in the prone position and allow a client to remain dressed for the appointment duration.  Reducing the time a client spends in an establishment plus providing service in the prone position could help reduce a practitioner’s exposure to infectious agents such as COVID-19.

The best way to prevent the acquisition or transmission of COVID-19 is to self-isolate, so if you do work with clients, it is critical to seek education on how to improve air quality, sanitation, and other work-related preventative measures.  This includes getting creative to create and promote services that generate the greatest amount of social distancing between a practitioner and client during our new normal of COVID-19.

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

#socialdistant #painrelief #medical #healthcare #generalmassage #massagetherapy #lmt #mt #massage #massagetherapist #bodywork #bodyworker

We teach orthopedic cupping massage at CE Institute LLC. This newer westernized modality has emerged as a new, distinct form of bodywork. Massage therapists have increasingly purchased and intuitively used cups in their respective practices over the several years. What transpired was a bodywork evolution, with orthopedic cupping massage emerging as a new form of bodywork.

To learn more, please register for training at: https://ceinstitute.com/collections/eastern

It is critical to sanitize your massage cups between every client.  Here is a visual hands-on instructor demonstration of how to sanitize cups used in orthopedic cupping massage, as offered at our school:

#sanitation #cleaning #clean #cupping #cleaningcups #cuppingmassage #lmt #massage #massagetherapist #bodywork #bodyworker #massagetherapy #tcm #westerncupping #sportscupping