CE INSTITUTE LLC BLOG

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! Thanks!

 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:

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.

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)

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.

#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.

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

by Selena Belisle, CE Institute LLC

Contagious disease is something that everyone should consider when working in a close, person-to-person, service occupation. This includes estheticians, nail technicians, cosmetologists, massage therapists and all staff in a spa or salon setting.

Today, we have a new contagious disease threat with monkeypox.  Monkeypox was first detected as a rare viral disease in Africa in 1958; however, transmission of the virus was thought to only occur with infected animals. Unfortunately, we now know that person-to-person transmission is possible, and this progression with increasing prevalence threatens us today.

The WHO (World Health Organization) labelled monkeypox as a Global Health Emergency on July 23, 2022.  In the United States, monkeypox infections are on the rise with a few thousand cases detected in 46 states (at the time of when this article was printed). Health experts state that monkeypox will not become a worldwide pandemic.  Monkeypox is still a very rare disease; however, it is important to learn about new and increasing contagious threats with monkeypox being our newest.

Monkeypox Transmission

The CDC (Centers for Disease Control and Prevention) states person-to-person transmission of monkeypox primarily occurs through direct contact with body fluids, respiratory secretions during prolonged face-to-face contact and touching parts of the body with monkeypox sores.

In 2018, a few individuals were infected when handling an infected individual’s bed sheets.  That means anyone who changes a treatment table or handles linens which are in direct contact with an infected individual could be exposed at your establishment.

Monkeypox can also be transmitted with infected animals, pregnant women passing the virus to their unborn baby and sexual contact; however, we will only focus this article on what seems to be relevant for salon or spa workers. There is a lot more one could learn about monkeypox beyond what we will share here.

Monkeypox Rash: Blister-like Sores

Monkeypox sores might appear as blister, bump, whitehead, acne, milia, an ingrown hair, sebaceous cyst and other benign possibilities. Past monkeypox pictures usually depict an individual covered in blisters. 

With today’s person-to-person transmission, an infected individual may only exhibit a few random sores.  With less sores, infected individuals might dismiss their illness as something other than monkeypox. The CDC states^[1] that monkeypox sores and symptoms could be confused or misdiagnosed as chickenpox, smallpox, syphilis, herpes, chancroid, and varicella zoster which causes shingles.

Monkeypox sores usually progress through the following stages before eventually subsiding: macules, papules, vesicles, pustules, and eventual scabs. Those who have been infected with monkeypox have described their sores as being very painful.

Monkeypox Signs and Symptoms

Monkeypox symptoms can last from 2 to 4 weeks. Infected individuals can experience a different combination of symptoms. Some could have one or two symptoms while others might experience all of these symptoms and more. The CDC reports^[2] monkeypox symptoms include:

• Fever
• Headache
• Muscle aches
• Backache
• Swollen lymph nodes
• Chills
• Exhaustion
• A rash that can look like pimples or blisters

If you have a client exhibiting a new skin sore or rash with any of these symptoms, you should reconsider providing service until the client obtains a medical diagnosis for their illness. 

How Does Monkeypox Affect a Spa or Salon Worker

There are three areas of concern for spa and salon service providers with monkeypox:

1. Prolonged person-to-person contact is reported to transmit the monkeypox virus through respiratory secretions. Coughing and sneezing respiratory droplets is likely the largest airborne risk of all.
2. Most spa and salon services involve touching the client. According to WHO, monkeypox sores are found on face in 95% of cases, and the palms of the hands and soles of the feet in 75% of cases^[3]. These bodily areas are where the greatest amount of spa and salon services are provided, and monkeypox is reported to be transmitted by touching an infected individual’s sore(s).
3. Touching linens or towels that have come into contact with an infected individual has also been reported to transmit the monkeypox virus. That means even if you did not provide the service, if you touch an infected individual’s clothing, towels or linens, you have been exposed.

How Can I Protect Myself from Monkeypox at Work?

• Work on in-tact, whole skin only. If you see a sore on the skin, ask the client about it. Are they aware of their sore?  Did they already receive a diagnosis for it?  What is their medical diagnosis? Some clients will know if they have a sebaceous cyst, eczema or some other skin disruption.  However, if a client is unaware of their sore, it is best to avoid the area and acceptable to request the client to seek proper medical attention or diagnosis prior to providing service(s).

• Always wear gloves when working intra-orally or around mucous membranes given monkeypox is reported to be transmitted through bodily fluids.

• Wearing a facial masking similar to what has been practiced with COVID-19 may help prevent monkeypox transmission through respiratory secretions.  Using a higher level of protection mask such as a N-95 will provide better filtration for contagious virus than a cloth or other lesser disposable masks.

• Wear a facial mask and gloves when cleaning a treatment area or handling dirty sheets and towels. Be sure to keep the mask over your mouth and nose for the best possible protection.

• Open all available windows and doors when working, cleaning or generally occupying any work area. Keep your workspace well ventilated.

• Follow general service contraindications at all times.

General Service Contraindications

• Service should not be provided when a client has a fever.  Fever is a regular sign of infection, and that infection could be a contagious disease.

• New undiagnosed swelling is a local service contraindication. Service should not be provided to an area where swelling is present.

• Undiagnosed flu-like symptoms are a service contraindication.  Flus and colds are also a contagious viral disease.  If your client shows for service with excessive coughing, sneezing, sore throat or other flue like symptoms, service should be denied even when fever is not present. It is not worth risking exposure to contagious disease because this could be passed onto other clients, coworkers, friends and family, in addition to acquiring the disease yourself.

• New undiagnosed pain is also a service contraindication.  An individual may seek a spa or salon service to help them feel better or take their mind off their pain.  But we would never want someone with a blood clot, kidney stone obstruction or other type of serious illness in our treatment space while they should be in the emergency room. Unfortunately, there is a growing aversion to seek medical care; however, utilizing appropriate medical care is still an important process to being and staying well.

What to do if You Think You’ve Been Exposed

Wash your hands and contact your doctor immediately to discuss your potential exposure. Self-isolate until you receive instructions from your doctor. Your doctor will determine any potential treatment and how long you should self-isolate.

Do not allow anyone in the workspace where potential contamination has occurred, until proper precautions are taken to sanitize the area.

• Here is the National Institute for Occupational Safety and Health website with personal protection equipment (PPE) information: https://www.cdc.gov/niosh/ppe/. 
• Here is information from the CDC of how to clean and disinfect a facility every day, and when someone is sick: https://www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html

If you are diagnosed with monkeypox, assist professionals with contact tracing to notify other potentially exposed individuals in your circle.

The Takeaway

To date, we do not have any reported cases of monkeypox transmission from providing spa or salon services. Monkeypox has affected less than a fraction of one percent of the US population. However, according to the information provided by the CDC, monkeypox cases are on the rise, and transmission could be possible in spa or salon services when there is close prolonged contact with an infected individual.

Spa and salon service providers are generally required to complete basic certification training to obtain licensure in their respective fields. Educational certification usually includes training in pathologies and services contraindications.  Following basic service contraindications and learning about new threats at the workplace can help a practitioner avoid contagious disease. You can obtain more information about monkeypox from the CDC’s website:  https://www.cdc.gov/poxvirus/monkeypox/index.html

^[1] https://www.cdc.gov/poxvirus/monkeypox/response/2022/index.html#anchor_1653687460218

^[2] https://www.cdc.gov/poxvirus/monkeypox/symptoms.html

^[3] https://www.who.int/news-room/fact-sheets/detail/monkeypox

Here is our published Monkeypox update in Massage Magazine: 

by Selena Belisle, Founder/Instructor, CE Institute LLC

With today's sanitation supply shortages due to COVID-19, finding what you need may be difficult.  When working onsite chair massage corporate events, marathons or other sporting events and more, it's important that therapists are not spraying and inhaling chemical sanitation supplies multiple times per hour.

We recommend massage therapists use wet wipes for sanitation to avoid inhaling chemical sanitizers.  But, wet wipes can often be expensive if they're available for purchase.

We recommend visiting a place like Dollar Tree, and purchasing a small roll of paper towels.  Their paper towel rolls for $1.25 usually has about 80 towels.  Then purchase any liquid disinfectant you chose, plus some gallon size ziplock bags. Clorox and Lysol disinfectants are also available at Dollar Tree for $1.25 each, so creating your own wet wipes is achievable and extremely economical when shopping at dollar stores for required materials.

All you need to do is remove the brown cardboard roll inside the paper towel holder, then pour the sanitation liquid over the paper towels in the ziplock bag to create your own wet wipes.

Here's a Free Instructor Video Demonstration of How to Make Your Own Wet Wipes for Sporting Events, Corporate Onsite Chair Massage and More!

Please visit us for all of your professional massage therapy training needs at:  https://ceinstitute.com/

#wetwipes #sanitation #cleaning #clean #lmt #massage #massagetherapist #bodywork #bodyworker #massagetherapy

by Selena Belisle, Founder/Instructor, CE Institute LLC

Cups can be reused many times in massage therapy practice when proper handling and sanitation are applied.  Every used cup must be individually washed prior to new application.

Here's a FREE Instructor Video Demonstration of How to Sanitize Massage Cups wish grease-cutting dish detergent and water.  The instructor will also demonstrate how to open the cupping hand held pump for greater cleaning:

For professional massage cupping practice, please visit and register for training at: https://ceinstitute.com/collections/eastern

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