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Florida HB197 Rules & Laws for Massage Therapy Establishment Documentation and Recordkeeping Requirements

Florida HB197 Rules & Laws for Massage Therapy Establishment Documentation and Recordkeeping Requirements

by: Selena Belisle, Founder/Instructor, CE Institute LLC

On May 6, 2024, Florida Gov. Ron DeSantis signed Florida House Bill (HB)197 into law. It took effect July 1, 2024. The bill appears to have been unanimously passed by both the Florida Senate and House of Representatives.

The new law is designed to strengthen legal cases against human trafficking and other abuses within the Florida massage therapy industry. Some of this law’s rules, updates, and changes are critical to understand while working in the Florida massage therapy industry. 
Violations of some of these rules could result in disciplinary action or misdemeanor or felony criminal charges. If you would like legal details for any of these newly installed and/or revised rules, it is recommended to consult a licensed attorney for their legal opinion.

 

While these new rules will be applicable for licensed massage therapists, establishment owners and designated managers, we will review HB197 in a condensed and perhaps more comprehensible manner for massage therapists throughout our HB197 laws and rules lessons. If you’d like to review the bill, and its various proposed versions, you can do so by visiting flsenate.gov/Session/Bill/2024/197. This HB197 information is available on various government websites, including those of the Florida House, Senate and Board of Massage.

According to HB 197, a massage establishment must maintain a complete set of legible records in English or Spanish, which must include each employee’s start date of employment, full legal name, date of birth, home address, telephone number, employment position and a copy of the employee’s government identification.
 
All required employee information must be recorded before the employee may provide any service or treatment to a client or patient. A massage establishment must conspicuously display a 2-inch-by-2-inch photo of each employee, which, for massage therapists, must be attached to the massage therapist’s license. Such a display must also include the employee’s full legal name and  employment position before providing services or treatments.

A massage establishment must maintain a complete set of legible records in English or Spanish, which must include the date, time, and type of service or treatment provided; the full legal name of the employee who provided the service or treatment; and the full legal name, home address, and telephone number of the client or patient.  Medical records may satisfy this requirement if the records include specified information. A copy of the client’s or patient’s photo identification may be used to provide the full legal name and home address of the client or patient. 

 

These required client records must be collected prior to providing service and maintained for at least one year after a service or treatment is provided. The establishment must confirm the identification of the client or patient before any service or treatment is provided to the client or patient.

The State Surgeon General is the government office, or board, which can make a legal determination when safety to the public is jeopardized. A massage establishment that operates in violation of certain laws and rules is declared a nuisance and may be abated or enjoined, in addition to possible criminal charges.

These are just some of the highlights of Florida's House Bill 197 to help prevent trafficking victims with the massage therapy industry.  To learn more rules, laws, human trafficking prevention and more, please visit: https://ceinstitute.com/collections/mandatory

 

 

How to Download or Print a Florida Healthcare License or eLicense

How to Download or Print a Florida Healthcare License or eLicense

The Florida Board of Health and MQA (Medical Quality Assurance) departments no longer mail licenses to healthcare professionals.  Healthcare professionals must download, carry and post their own licenses as required by law.

In this video, CE Institute LLC founder Selena Belisle will demonstrate where and how a Florida licensee can download their own e-license from Florida state's website. She will use a Florida massage therapist license as an example; however, this example can be used with almost any healthcare license or provider within Florida State:

 

 

 

 

Good Samaritan Law - Providing Medical Healthcare in Emergencies

Good Samaritan Law - Providing Medical Healthcare in Emergencies

Some healthcare providers might want to provide medical intervention during emergencies, but are afraid of doing so for liability reasons such as committing a medical error due to the emergency circumstances, such as when a person is unconscious and unable to provide dialog that led to their medical condition. Unless you're a trained emergency medical professional, it's possible that things could go wrong during an emergency, even if you had the proper training!

As such, it’s important to know that there is something called Good Samaritan Law, which can be different from state-to-state, and even internationally. On a recent airline flight, a flight attendant in international airspace loudly proclaimed the good samaritan law when no one volunteered to provide urgent medical care to an individual in need. The flight attendant proclaimed a caregiver cannot be held accountable for providing emergency medical assistance to that individual if any harm is done during a reasonable effort to provide care.

This Good Samaritan Law is important to know because in September 2025, Javier's restaurant in the Aria Resort & Casino and MGM Resort International was sued for wrongful death when no life saving medical care measures were attempted which they claim resulted in well-known actor Mike Heslin’s death. The wrongful death lawsuit claims:
Staff "stood by, took no immediate lifesaving action, and failed to initiate or support efforts that could have saved Michael’s life."

  • Failed to perform CPR and did not retrieve an automated external defibrillator (AED).
  • Failed to keep a stock and inventory of emergency response equipment, including, but not limited to, an automated external defibrillator (AED), or failed to train their staff on where the AEDs were stored.
  • It was also stated that a woman allegedly attempted to perform CPR on Heslin at one point. However, the complaint alleged that an employee “forcefully interfered” and removed her from the scene.

If an attorney can sue waiters and a restaurant for failure to provide emergency medical assistance, can you imagine what they would do if a healthcare worker did not provide the same?

While it’s important to always work within your own licensed scope of practice, emergency life threatening situations when other more qualified healthcare providers are not available can become exceptions to what can be practiced. All healthcare providers should know basic emergency life saving measures. These include:

  • Learn the heimlich maneuver for choking patients.
  • Learn or update CPR certifications and install or locate the nearest AED device to your workplace, especially if you work on cardiovascularly compromised patients, which includes more vulnerable populations such amongst retirement villages or hospice care.
  • It would also be important to learn of any medical equipment requirements that are required by law at your healthcare practice, and to ensure you are properly trained to use anything within your scope of practice that could provide life saving measures to anyone in need.

Florida's Good Samaritan Law provides immunity from civil liability for individuals who provide emergency assistance in good faith, protecting them from lawsuits if their actions are not grossly negligent or malicious, even if the aid doesn't succeed or causes minor harm. The law's purpose is to encourage people to help in emergencies without fear of legal repercussions for good-faith efforts or resulting medical errors.

A good samaritan law would generally apply to private citizens, although it could also extend to medical professionals acting in an emergency outside of their usual healthcare setting or scope of practice. 

Exceptions to the good samaritan law are, it should not to be regularly used to operate a medical facility without sufficient medical staff. For example, if patients are regularly coding in the medical facility, then there should be a doctor on staff and other trained medical professionals to run the codes. Consistently operating outside of one’s licensed scope under the good samaritan law is a manipulative abuse of practice and likely punishable by law when proper licensed healthcare is not being provided by medical staff.

Good samaritan laws usually do not protect individuals from liability if their actions involve gross negligence, manipulative conduct, complete recklessness, or malicious intent. 
An example of this would be cutting a person’s abdomen open on an airplane, without proper training, sanitation or reason to do so. There must be some good faith in your emergency medical care for the good samaritan law to apply.

To learn more about healthcare laws and medical errors prevention, please register for one of our courses at:  https://ceinstitute.com/collections/mandatory

 

 

Avoidable versus Unavoidable Medical Error Examples

Avoidable versus Unavoidable Medical Error Examples

Medical errors are defined as an unintended injury that happened to a patient as a result of their medical care.  An example of an unexpected error is exposing a client to an unknown and uncommon allergen.  The only way they would know they were allergic is by being exposed to it, and that could happen for the first time in your workplace. 

Applying an unscented cream or lotion to a client’s skin that contains an ingredient that the client is allergic to, such as parabens or other preservatives is an example of an unexpected medical error when the result is severe contact dermatitis or rash. It is not a common standard of care to test a client for allergens to preservatives prior to applying a lotion or cream to the skin, unless extreme allergens are disclosed during their health intake prior to medical intervention.

While that is an example of an unavoidable medical error, a similar medical error that would be considered AVOIDABLE is applying essential oil(s).  That’s because essential oils are commonly known to cause skin irritations or worse. In extremely rare cases of essential oil exposure, anaphylaxis could result, which could prove life threatening if a proper emergency medical response is not immediately and effectively provided. 

One study titled Art of Prevention: Essential Oils - Natural Products Not Necessarily Safe published Nov 2020 stated: “Approximately 80 essential oils have been shown to cause contact allergy…”1  Healthcare professionals utilizing essential oils should know that skin and allergic reactions are common with essential oil use. They should also learn which oils more commonly cause skin sensitization and irritations, plus how to perform a patch test prior to exposing a client to a new essential oil to avoid a negative result or medical error. 


Healthcare providers must know how to respond to potential common adverse effects of their medical care. In the case of essential oil allergic reactions, a practitioner could respond by pouring whole milk or unscented host oil over the exposed area. This would show that a trained duty of care was provided during an adverse medical reaction to the essential oil use.

The difference between avoidable and not avoidable medical errors here is within your medical expertise for DUTY OF CARE, which is what a patient is paying for and counting on. Medical error malpractice claims and financial awards are harder to achieve when the error is unexpected and a proper duty of care was provided prior to, during or after the unexpected injury.  

Medical errors that result from gross negligence are likely going to be the most susceptible to medical error malpractice action.  Malicious injuries sustained in healthcare practices, such as applying a known essential oil to a client because you do not like them would not be considered a medical error.  In that case, the provider could be charged criminally for assault as well as be liable for medical malpractice and abuse.

For greater medical errors prevention training in healthcare, please visit: https://ceinstitute.com/collections/mandatory

1. Sindle A, Martin K. Art of Prevention: Essential Oils - Natural Products Not Necessarily Safe. Int J Womens Dermatol. 2020 Nov 12;7(3):304-308. doi: 10.1016/j.ijwd.2020.10.013. PMID: 34222588; PMCID: PMC8243157.

Medical Error Prevention Management and Vicarious Liability

Medical Error Prevention Management and Vicarious Liability

Medical errors are unintended consequences of medical treatment, regardless if it was unexpected, avoidable, evident or harmful to a patient. Any type of unexpected injury to a patient resulting from medical care would be considered a medical error.

Sometimes a healthcare provider could have avoided an error but did not through negligence. Contrarily, a medical error can happen that was unexpected and not avoidable. Regardless of how a medical error occurs, a healthcare provider, and sometimes even managers and/or establishment owners are liable for the error.

Any type of medical error could result in a medical practice claim. Our newest Medical Errors Prevention training here at CE Institute LLC is to teach healthcare providers how to minimize their risk with medical errors that could result in malpractice claims, regardless of how the error occurred.

Almost all healthcare practices are filled with managers. If you’re self-employed, then you are your own manager and responsible for your entire practice. Managers could be culpable for medical errors when the error occurs under their management role. VICARIOUS LIABILITY can hold employers and managers liable for actions of their subordinates. Vicarious liability practices might be enforced differently from state to state.


In the state of Florida, even a 1-person licensed massage establishment must have an assigned DEM (designated establishment manager) registered with the state of Florida, per Florida state law. Different states could impose various management requirements in healthcare practices, beyond a private or public healthcare institution’s requirements.
While Florida’s DEMs were initially installed to help prevent human trafficking in illegitimate massage establishments, these DEMs are now being held responsible for other provider’s treatments and their results within the establishment.

If you are wanting to, or considering moving into a managerial role at work, or perhaps you are already managing, then you should request your managerial tasks be provided to you in writing, to negotiate and/or fulfill them. If you’re offered a managerial role, here are some medical error prevention issues to consider prior to accepting the position. Feel free to request a tour of a potentially new work facility and/or speak to other staff PRIOR to accepting the offer, or ask the employer if your managerial position will provide the budget and resources to create a safe, quality workplace. A partial list of possible managerial medical error malpractice issues you should look out for in addition to facility medical error risks are:

  1. Staffing i.e. staff are overbooked to provide quality care.  Shortening or not providing services billed to insurance would be considered insurance fraud and could be criminally prosecuted.
  2. Scope Creep i.e. staff are providing responsibilities outside of their licensed scope of practice.
  3. Quality Issues i.e. existing management is unqualified to manage by leaving potential malpractice issues unresolved, and you do not have a budget to fix problems, such as the upholstery on treatment tables is ripped or torn so it cannot be properly sanitized between patients, etc.
  4. Supply Issues: i.e. there’s not enough towels or sheets, so they’re being reused causing more sanitation concerns. Adding a shortage of sanitation supplies to this would create catastrophic negligence.
  5. Managerial experience: if your role is to manage others but you do have managerial experience or training, or those managing you do not have the expertise to make good work decisions to avoid error.

Maintaining or accepting a managerial role in healthcare is regularly a negotiation. 
Not only would salary or compensation be negotiable, but you should also negotiate for a quality work environment or work-related training (i.e. management classes) to reduce YOUR risk of being responsible for medical errors that were completely avoidable.
Remember that your risk for malpractice claims is likely greater when avoidable medical errors are committed. These issues we just reviewed can be proactively addressed prior to an avoidable medical error occurring. For greater medical errors prevention training in healthcare, please visit: https://ceinstitute.com/collections/mandatory

 

 

What is Cryotherapy? How Can Cyrotherapy Be Applied in Massage, Spa and Healthcare Establishments?

Cyrotherapy is one of the latest and greatest modalities for spas and healthcare establishments. While it has been practiced for decades, there are many new uses, offerings and applications within the cold thermal therapies industry. 

Cyrotherapy is generally recommended for a variety of medical benefits or purposes. These range from natural, opioid-free, pain relief options to applications intended to reduce swelling. Human body detoxification might be a goal when heated and cryotherapy applications are contrasted. There are endless indications and noninvasive uses with thermal therapies that include cold applications.

Cyrotherapy offerings range from cold plunges to exfoliating ice treatments, ice massages and more; there are plentiful cryotherapy applications available to almost any practitioner at any budget.  Cryotherapy applications can be budget friendly with simple applications such as ice packs to multi-thousand-dollar investments with various cryotherapy machinery or equipment. Because of the opioid epidemic, there's been a lot of research as of late investigating non pharmacological pain relief including the use of hydro and thermal therapies.

Cyrotherapy is one of the latest and greatest modalities for spas and healthcare establishments. While it has been practiced for decades, there are many new uses, offerings and applications. It is generally recommended for a variety of medical benefits or purposes. These range from natural, opioid-free, pain relief options to applications intended to reduce swelling. Human body detoxification might be a goal when heated and cryotherapy applications are contrasted. There are endless indications and noninvasive uses with thermal therapies.

Cyrotherapy offerings range from cold plunges to exfoliating ice treatments, ice massages and more; there are plentiful cryotherapy applications available to almost any practitioner at any budget.  Cryotherapy applications can be budget friendly with simple applications such as ice packs to multi-thousand-dollar investments with various cryotherapy machinery or equipment. We will primarily review hydro cryotherapies that utilize large quantities of water for therapeutic value here.

Le Spa du George V in Paris France offers a fancy ice chip production in a tiny cold room as pictured above. The ice chips can be rubbed on the skin for exfoliation of dead skin cells, and to affect cardiovascular circulation.  A client can also wrap the ice chips in a towel around a swollen ankle, wrist or other area to create an analgesic affect and/or to help reduce swelling.

MSC cruise lines offers a “snow room” on some of their cruise ships.  Customers could literally lie down on top of snow and pack their bodies with snow on top too; although, this would not be recommended due to sanitary reasons.  While cold temperatures often kill germs, the temperatures in this snow room are not cold enough to eliminate all pathogens.

If you can find a clean area of newly manufactured snow in a room like this (pictured below), you could also rub that new snow against the skin for exfoliation practices, as well as place any area of the body against the snow itself to create an analgesic affect or reduce swelling.

 

Cold plunges (pictured below) are generally a tub filled with cold water, around 40 to 60 degrees Fahrenheit, depending on the individual and their tolerance level.  Some are more tolerant of cold than others.  Even a few seconds of full immersion in a cold plunge can create a hunting response, which is the body’s defense against soft tissue damage where the skin of any area exposed to cold starts to turn pinker or reddish. It is not recommended to immerse oneself in a cold plunge for more than a couple of minutes.  Customers can also contrast between a cold plunge and hot tub to increase circulation and detoxification.

It's usually quite easy to spot a cold plunge tub amongst various hydrotherapies.  Cold plunges are usually smaller than the average hydrotherapy equipment, because people usually are not moving within them.  They might only spend a few seconds in a cold plunge before exiting. Good cold plunge tubs have superior handles available to enter and exit as well.  That’s because entering or existing a cold plunge could be difficult, which is why there could be extra handles in this cryotherapy feature, as shown below in the Eurospa’s small cold plunge in Quebec, Canada.

Another cryotherapy water feature can be found at Claridge’s Spa in London, England.  While their spa provides private changing rooms with bathrooms and showers, they do have a stone “cold” shower (pictured below) next to their steam room and shower. The cold shower features a water fall where cold water drops from a ceiling mounted fixture, plus there’s a hand-held wand that can be used for cold shower application.

 

When it comes to pain relief, anyone can apply an ice pack or follow R.I.C.E. (Rest, Ice, Compression & Elevation) for an analgesic affect, or to treat their own injuries; however, ice massage uses a slightly more skillful approach and can be additionally applied to treat areas where a client may not be able to comfortably reach on their own.

Ice massage is inexpensive and easy to apply when properly trained. There are a variety of applications or supplies that can be used to add ice massage to your practice:

Purchase 2-ounce paper cups, fill with water to the top of the cup and freeze. Tear away the top three-quarters inch of the cup, turn the ice cup upside down and massage the surface area with the exposed surface of ice. Continually tear away the upper part of the paper cup to continually expose the ice to the soft tissue through the ice massage application.  Next is a video showing our ice massage application:

 

Re-useable plastic cups are also available amongst retailers for ice cup massage applications. Please follow the manufacturer’s instructions when using this type of specialty equipment.  Practitioners can also use regular ice cubes with a small piece of paper towel or jar gripper. It is recommended to drape a client with a towel during ice massage to absorb melted ice from running over the client’s body or your equipment.

Ice massage is regularly practiced with lightly massage the skin with small, circular movements in a small, local area with ice. Leaving ice in one place for too long can damage the underlying soft tissues, causing greater pain and problems for your customer.

Ice massage is usually extremely uncomfortable when it is first applied. It will feel very cold if not painful to the client. Prolonged appropriate application of a couple of minutes will provide an analgesic effect, with pain relief and other benefits. Do not massage an area with ice for more than 10 minutes or less as needed, depending on a client’s medical condition and response to the treatment.

There are many other cryotherapy applications, including cryo chambers and machines to create cold rooms as pictured above and below.  The cryotherapy examples listed here are just a few.  Each cryotherapy modality would have its own specific indications, applications, uses, precautions, contraindications and more. To learn other thermal or manual therapy techniques, please visit our school for training option at: https://ceinstitute.com/

 

 

 

 

How to Make a Strawberry Rose Spa Body Scrub in Aromatherapy Practice

How to Make a Strawberry Rose Spa Body Scrub in Aromatherapy Practice

Did you know that strawberries and roses are from the same Rosaceae family?  The Rosaceae family of plant species, also known as the rose family, has over 4,000 known flowering species. It is thought to be one of the most important plant species of all.

Combining strawberries and roses can make both aromas more expansive. They would be naturally considered compatible within the same family with sweeter floral aromas.

Strawberry seeds can be used as the grit or exfoliator of a scrub.  Because they’re not water dispersable, this strawberry rose spa body scrub would need to be practiced in a wet room, where a client could shower off the seed exfoliant to wash down the drain.  A practitioner wouldn’t want to provide too many strawberry seed scrubs to avoid clogging drains.

In this video, we’ll watch Selena Belisle, Founder and Aromatherapy Instructor make a strawberry rose scrub from the heart of Paris, France.

 

 



An Aromatherapy Wood Massage Experience in London, England

An Aromatherapy Wood Massage Experience in London, England

By Selena Belisle, Founder/Instructor, CE Institute LLC

Did you ever experience that rolling pin massage back in the 1990s for cellulite?  There were instructions everywhere for it. It was a fad.  It was practiced with various essential oils such as orange and cinnamon, and you would vigorously roll the upper thighs with a rolling pin after neat essential oil application to the skin.  The instructions could vary to roll directly on the skin and through saran wrap too.  It seemed more appropriate to apply in your mother’s kitchen rather than a real treatment room too.

Fast forward to Summer 2025, and as I was walking through St. Christopher’s Place to Bond Street in London, England, where I came upon a sidewalk sign for SKH London Clinic. They were advertising various complimentary healthcare services including massage.  I like to try as many different services possible from the largest variety of practitioners to learn as much as possible.  One of the ways that massage therapists learn more about a service is by receiving it.  Naturally, I was intrigued when I saw Wood Massage advertised.  I went inside and asked what type of wood they used, and if it was bamboo?  They responded it was not, and then showed me a unique wood tool. So we booked an appointment, and I went back the next day to receive the bodywork.

The receptionist had told me their wood massage would focus primarily on the back of my legs and my abdomen.  However, my massage therapist, who was trained in India, asked if I would like to receive the wood massage as a full body treatment, so I said yes and agreed.  We started tart in the pronated position. She tucked two kleenexs in my underwear before she began to massage my back with oil.  She then started rolling a wooden massager over my back in various directions. She started with a larger broader massage tool, and then progressively worked into smaller tools.

The smaller tools used on my back massage included what looked like a wooden bell and a small round wooden brush with very large teeth.  Both were used to twist and friction the skin and underlying soft tissue.  To me, the bell and round brush felt better than the larger broader wooden tools. One of the more unique wooden massage techniques was when the wooden bell was placed over several vertebral spine at a time and twisted in opposing clockwise and counterclockwise directions. The entire back massage was performed from the left side of the table.  The therapist reached over the back to work the opposite side.

Once she finished with the back, she then moved onto one leg, then the other, with the smaller broad tool that was used on my back, plus the bell and round brush. She massage both legs with oil first prior to applying the wooden massage tools.  She did work from both sides of the table when she performed the leg massage with wood.  My feet were not worked on while in pronated position.  She then removed the tissue from my underwear and had me roll over onto my back.

Once in supinated position, she placed another two tissues on the anterior of my bottom underwear. The therapist then began to massage my abdomen with oil, which was solely provided from the left side of the table again.  Then she started the massage with another curved broad wooden tool.  She worked up to the rib cage and down to the ASIS. The middle of the abdomen was worked all the way inferiorly to just above the pubic hair line. The abdomen massage felt perhaps the best of all areas.  Once the larger broader tool was completed, she then moved onto the bell where it was twisted in clockwise and counterclockwise motions amongst others.

The practitioner then moved onto my arms, one at a time.  Oil was applied first and then she supinated my arm to work primarily the inside of it.  Both upper and lower extremities were worked from superior to inferior, opposite of the venous return strokes that would regularly be applied in regular Swedish massage appointments.

Once she finished with the arms, she moved onto the anterior legs.  Careful attention was spent around the knees and the same wood tools used on the posterior were continued on the anterior legs. She did place the bell and twisted it over the patella which was unusual but good. The tools were used lightly but directly over my tibias but it was not painful.  The same over the vertebral spine. She finished some of the massaged areas with a smooth long round tool that was similar to a stick of bamboo.

The full body wood massage ended with an oil foot massage on the feet without any tools.  It was probably one of the least favorite massages I’ve had in an almost 40 year career.  It was not smooth, was occasionally painful, especially when working with too much pressure over the heads of the humerus. I was also worried about sanitation given I refused to start until the table sheet was replaced given it was partially soiled with splotched oil and facial make-up around the hole for the face. Some of the strokes felt good in some areas but most of the strokes did not. The massage therapist applied her skills with fairly rough application with just oil, so when hard tools were added, it felt worse. 

Notes that could have improved this bodywork appointment:

  1. Allow privacy for the clients to disrobe, dress and mount or dismount the massage table.
  2. Bolster the clients ankles in pronated position and knees in supinated position.
  3. Provide a sheet or towel to cover the client with during the treatment instead of leaving a client fully exposed while draping underwear with klenex.
  4. Wipe oil off feet at the end of the treatment prior to table dismount.
  5. Use extra caution running wood over bony protuberances.
  6. Provide cleaner linens by either changing these between clients and/or employer better laundering techniques.

 

 

What is that Lump Under the Skin? What is the Difference Between a Lipoma and Swollen Lymph Node?

What is that Lump Under the Skin?  What is the Difference Between a Lipoma and Swollen Lymph Node?

By Selena Belisle, CE Institute LLC

The human body is made up of hundreds of lymph nodes. They filter harmful substances such as viruses and bacteria from our lymphatic fluid (aka lymph), before it enters the cardiovascular system.  Lymph nodes are an important part of our natural defense system or human immunity.  

Unfortunately, lymph nodes are a common place where cancer spreads as well. That’s why oncologists regularly biopsy a sentinel node in the same region as other cancers, to determine if an existing cancer has metastasized. 

In the medical illustration below, the lymphatic system is represented in red in the human body.  The little bean shaped balls on the lymphatic vessels represent lymph nodes in various regions. Clusters of lymph nodes are commonly found within the joints of the skeletal system:

 

Swollen lymph nodes typically exhibit themselves within lymph node regions, which can be viewed on the following medical illustration of the lymphatic system:

 

Lipomas are fatty lumps that form under the skin and usually over the muscle.  While all abnormal growths are cancers by definition, lipomas are not harmful and do not metastasize like a harmful cancer might.  

 

Telling the difference between a swollen or damaged lymph node versus a lipoma can be difficult, because they are visibly similar in size, shape and texture under the skin. Both could cause an obstruction of circulation, with the swollen lymph node being medically worse of the two, especially if it is a sentinel node.  In some cases, swollen or damaged lymph node(s) can lead to a condition called lymphedema. 

Medical institutions may claim that lipomas are softer and more mobile under the skin than a damaged lymph node; however, with almost 40 years of tactile palpation skills, I can state that it's impossible to determine the difference between the two by viewing or feeling them. They're both usually quite firm or hard, and neither is very mobile under the skin either.

Pressing on either may or may not cause pain, and is ill-advised regardless of what the diagnosis is. It is contraindicated to apply pressure on abnormal growths/cancers or any form of swelling, especially while the skin remains intact. Removing a damaged lymph node or lipoma would require surgery with sterilization methods to prevent infection and other medical problems.

You likely wouldn’t know the difference between a swelling lymph node or lipoma without a client telling you, or a medical diagnosis.  Lipomas often develop slowly over time, while a swollen lymph node might appear more quickly, due to trauma or an acute infection.  

Lymph nodes can also temporarily swell when they’re exposed to harmful viruses, bacteria and other agents, as the immune cells multiply within the nodes to kill the infection. This would be different from a permanent swelling of a lymph node which may appear visually similarly to a lipoma.

Here are some examples of each:

The picture at the top of his article depicts swollen lymph nodes, and here are some more images of swollen lymph nodes below around cervical area:


Here are some images and examples of lipomas:

This woman has a lipoma next to her axillary lymph node region. This lipoma could be easily confused as a swollen lymph node because of the proximity to her axillary nodes plus the tiny surgical incision over it appears similarly to an "old-school" biopsy too: 


Medical practitioners viewing the lipoma in the image above may automatically assume that is a swollen of infected lymph node when one considers the proximity of it to other lymph nodes. The medical illustration below depicts axillary region lymph nodes and vessels with breast cancer:



These lipomas represent an individual with familial lipomatosis:


This is a real life medical image of a lipoma that has been excised from the human body:


Lymph nodes could also swell with cancer of the lymphatic system, otherwise known as lymphoma. Below is a medical image of cancer within a lymph node:



Sarcomas can also exhibit as a lump under the skin. Sarcomas are a group of cancers that start in soft tissues and the skeletal system. While any new abnormal growth or lump under the skin is often concerning, when a sarcoma is left undiagnosed or untreated, a sarcoma will likely continue to increase in size, beyond how most swollen lymph nodes or lipomas would present.  Below is an image depicting a child with giant cell sarcoma, also known as GCS:
Sarcomas are a fairly rare type of cancer which affects less than 1% of adults. Children are more widely affected by sarcomas. 15% of childhood cancers are said to be sacrcomas.  The image below shows an adult survivor of childhood sarcoma.  The sarcoma and her entire deltoid muscle were surgically removed when she was a teenager, and then treated with radiation.  While we do not have an image of her sacroma before it was surgically removed, this is how she appears over a decade after her successful oncology treatment:
If you are practicing Manual Lymphatic Drainage or any type of massage, bodywork or healthcare service and detect a new lump, especially in an area of swelling, it would be important to discuss this with the client, especially if they are unaware of it.  Seeking a medical diagnose for any new or suspicious lumps with early medical intervention might be life saving in more serious cases like lymphoma, and may provide better medical treatment options with cases such as filariasis, which is a parasitic infection of the lymphatic system, particularly within the lymph nodes.


Learning what the abnormal growth is might change your treatment plan as a licensed massage therapist or medical provider.  Lymphoma with local oncology radiation would receive different local care than a lipoma, etc. 

While all of these lumps could cause circulation impairments, defining/discussing them and then definitely learning what they are through a medical diagnosis will help you provide the correct treatment to your client when they have new or suspicious lumps.




What is an Appropriate Amount of Massage Cream, Oil or Lotion for Massage Therapy and Bodywork Appointments?

What is an Appropriate Amount of Massage Cream, Oil or Lotion for Massage Therapy and Bodywork Appointments?

By Selena Belisle, Founder and Instructor, CE Institute LLC

I experience a LOT of massage therapy and bodywork from others. The number of massages I’ve received over my almost 40-year massage therapy career would be in the thousands. Any good massage instructor would seek constant massage from others as part of an experiential learning process to continually share with others.

In this article, we’re going to discuss what an appropriate amount of massage oil, cream, lotion or gel would be appropriate for a massage therapy appointment. I will refer to these substances as massage mediums or mediums, which are common lingo in the massage therapy industry.  Mediums can be oils, lotions, powders, cream or gels used for bodywork or massage therapy services.

I recently went to a Vermont massage school student clinic for a massage therapy appointment and shared a unique experience with the student’s massage medium application.  That was, whenever the student therapist applied their massage medium to a new work area, it always felt like they were not using or applying enough.  A lack of massage medium during Swedish massage in particular can cause an undesirable drag or skin friction, which is usually contrary to a Swedish relaxation appointment.

At first, it was easy and erroneous to discount the lack of appropriate massage medium to the situation where I was receiving massage from a student; however, once the medium was applied to the new work area with longer effleurage application, it never felt like there was a lack of an appropriate medium.  In fact, their massage therapy strokes which included ringing, petrissage, bone tracing and more felt really wonderful! So, in the end, it created this puzzling feeling of what is an appropriate amount of massage medium?

 

Usually in massage appointments, the amount of massage medium feels less and less as appointment time continues, which requires reapplication of the massage medium to avoid drag and friction.  So how could a massage medium feel like it’s not enough at the beginning and more appropriate during later strokes, such as what happened with this student’s massage? The answer is there was not enough massage medium applied for a longer effleurage stroke, but there was an appropriate amount of massage medium applied for the remaining shorter strokes like ringing and petrissage.

So, this partly answers the question about whether you’re using enough massage medium in your bodywork or massage appointments. Enough massage medium should be used to avoid undesirable skin friction or drag.  Contrarily, less medium should be used when friction or drag are essential to the treatment.

We do not recommend using excessive amounts of massage mediums, unless you’re using massage tools such as hot stones which require quick glide over the skip and  cups where you want to reduce skin friction while working the deeper levels of soft tissue. In examples such as Orthopedic Cupping Massage or Hot Stone Massage, we refer to the phrase “make it shine”, because we want the client’s skin to shine with enough massage medium for proper modality engagement.

The correct answer as to whether you are using enough massage medium in your bodywork or massage appointments also depends on your client.  As long as you are able to execute your massage or bodywork skills with ease, any amount of massage medium the client wishes for would be appropriate, as long as it’s not excessive or causing physical harm.

The massage therapy and bodywork goal for proper medium application is to use enough but never too much. Using too much massage medium becomes expensive, can unnecessarily soil sheets, towels and clothing, make other massage equipment or floors sticky and unsanitary, can cause laborious cleaning efforts amongst other problems. Not using enough massage medium can hurt or in a worst-case scenario, cause injury such as skin friction burns.  Your massage medium application should allow the massage therapist to practice their hands-on skills with ease, feel good to the client and provide a therapeutic result from the hands-on work as well.

After almost 40-years of practice, I’ve seen all types of massage medium monitoring application by employers, most of which is unpractical.  The worst I saw was a lightweight cream provided in a 2-ounce cup per appointment, and the therapist was not allowed to use more than 2 ounces of massage medium per client which was beyond impractical. Anyone who assigns a specific number of ounces of massage medium to be used with any particular client is likely inexperience and uneducated.  That’s because:

  • Massage clients can be of various sizes. A 90-pound female client will almost always require less massage medium than a 400-pound client with a larger surface area to cover. As such, providing a 2-ounce ratio per client is likely wasteful with some clients and painfully short with others.

 

  • Massage recipients can have skin hydration differences, with anything between skin dryness and dehydration to oiliness or any other combination.  Some massage clients can have such oily skin that you might not need to use much massage medium at all.  While others can have such dry skin, that massage medium reapplication may be constant, especially if you’re using a highly absorbent product.

  • The massage medium’s absorbency rate can also change the amount of massage medium required for the specific task at hand, whether it’s to glide over the underlying soft tissue, compress the underlying soft tissue, cause friction or other purposes.  Changing the massage medium being used on the same exact client can change the amount of massage medium required depending on the product’s absorbency.  Some massage mediums sit on the skin and are not very absorbent, such as Vaseline.  While other massage mediums might instantly absorb, requiring more frequent re-application.

 

  • Some clients may have excessive body hair requiring greater massage medium application too.  Massage therapists should be prepared to use extra massage medium on a hairy client to reduce a painful pulling of the client’s body hair.

In general terms, massage oils and creams would provide the greatest amount of slip or glide with the least amount of absorption while gels, lotions and powders provide the greatest amount of friction and fastest absorption rates.  While every product is different, those generalities amongst massage mediums apply to most but not all.   Relaxation appointments usually require massage mediums with greater while deep tissue and focal bodywork such as myofascial release or trigger point therapy would generally use massage mediums with less slip, such as gels, powders, lotions or perhaps no massage medium at all.

In conclusion, there is no exact amount of massage medium that should be used for clients because this is an individual situation that is based upon client size, modality type, body hair, absorption rate and other factors which require customized amounts.  The right amount will be what feels best to you and your client with an effective result.