CE INSTITUTE LLC BLOG

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

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

^[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

Monkeypox is a virus that is new to the United States which can be transmitted from person to person. This is concerning for massage therapists, because it is thought that contact with an individual's skin lesions will transmit the virus.  Fortunately, most massage therapists already know that skin must be whole and intact prior to working on it.

One of the reasons why skin must be intact for massage service is because of the risk of infection, even when a client does not have an infectious condition.  Your integumentary system is part of your physical immunity.  Intact skin helps prevent harmful pathogens from physically entering your body. Pathogens can find almost a direct route to a client's blood circulation when skin is compromised or broken.  Also, our hands cannot be sterilized.  Excellent hand hygiene will never eliminate all bacteria, viruses and pathogens on our hands.  As such, massaging broken skin is not an option because we would be literally introducing all pathogens from our hands, direct into the client's soft tissues, which leads direct to the client's blood stream, not to mention all of the pathogens on the client's own skin would also be introduced.

There are other monkeypox symptoms that could lead a client to a massage establishment office seeking relief.  Luckily, therapists know not to work on clients with fever, or new undiagnosed swelling or pain, which are also side effects and symptoms of monkeypox.

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

Massage Magazine published our article on What Massage Therapists Need to Know About Monkeypox this morning. You can review this article on Massage Magazine's website by clicking HERE. Today's article examines up-to-date information as of Friday, June 3, 2022.  To stay up-to-date, please visit the CDC and WHO organization's websites for the latest information at:

The Centers for Disease Control and Prevention website link for monkeypox information is: https://www.cdc.gov/poxvirus/monkeypox/index.html

The World Health Organization’s website link for monkeypox information is: https://www.who.int/health-topics/monkeypox#tab=tab_1

#monkeypox #massage #lmt #massagetherapy #massagetherapist #bodywork #bodyworker #contraindications #spa #virus #healthcare #mld #manuallymphaticdrainage

There is a website promoting free resources for massage therapists to share to help prevent illicit client solicitations within the industry.  The following information is available at there website which you can view by clicking: https://respectmassage.com/

The website states and we concur:  It would be weird to hang a sign on the front door of your practice saying, “We don’t give happy endings here.” Let Respect Massage do the talking for you. Allow our logo downloads and videos to open up a conversation with the public and your clients about the intentions of your practice.

They also encourage massage therapists to download and post their logo from their website with the following statement. 

Massage therapists that are members of Respect Massage hold themselves to the highest standards of an ethical, boundary-driven practice. Respect Massage members have a zero-tolerance policy for solicitations of any kind. Jokes, innuendo, and inappropriate requests are taken seriously and will result in the swift termination of the session. 

Respect Massage and the ABMP are third party agencies. Neither are affiliated with CE INSTITUTE LLC.  However, we always attempt to share valuable insights and information whenever possible, and this promotion may help save others from uncomfortable if not illegal business situations with unwanted solicitations.

The massage industry has been an unfortunate, vulnerable place for unwanted solicitations. Such practices often create an unsafe space for legitimate massage therapists to operate and work. It is past time to lend a voice and put a stop to unethical and illegal practices, so we hope all will spread this message!

If you are a victim of sexual assault, which in our opinion, includes unwanted solicitation of sexual acts, you can chat anonymously with a support specialist by visiting: https://hotline.rainn.org/online

Please also call 911 if you ever find yourself in danger or feel threatened in any way or by anyone. Safety is paramount for every individual, especially for those who unwillingly find themselves in dangerous or illegal situations. What's most important is to establish your safety first and foremost, and above all else.

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

#respect #respectmassage #ethics #healthcare #healthcarepractices #lmt #massage #massagetherapist #massagetherapyethics #bodywork #bodyworker #massagetherapy #massageethics 

by Selena Belisle, Founder/Instructor, CE Institute LLC

Professional massage experts agree that all therapists should refrain, under all circumstances, from initiating or engaging in any sexual conduct, sexual activities, or sexualizing behavior involving a client, even if the client attempts to sexualize the relationship.

I Met My Soulmate Situation

What experts “disagree” about is the “meeting of a soulmate” situation when working with a massage client.

As our culture works longer hours, a good deal of relationships start at work. So, this poses the question – what is someone supposed to do when two consenting adults would like to start a personal relationship above and beyond a practitioner/client relationship? What is someone supposed to do when they feel they have met their “soulmate” at work – and are in a forbidden practitioner/client relationship?

Apply the Following for Ethical Considerations

Some massage experts agree that it is okay to terminate the practitioner/client relationship to start a personal relationship. Ways to address this could include:

• Determine the “end-date” of the practitioner/client relationship to start a personal relationship. A specific date creates a clear defining moment of when the relationship changed for both parties, and with each other’s consent.
• Draw up a written contract that clearly states the practitioner/client relationship has been terminated for purposes of to start a personal relationship. Include details such as there is no payment exchange for massage or bodywork services in the new personal relationship.
• Consult a licensed attorney or whomever seems most appropriate for the situation when needed.  This includes whether or not the therapist should inform colleagues or superiors of this decision to change the client relationship status.

What to Do When You Are a Massage Therapist Employee
Informing an employer that you wish to start a personal or sexual relationship with a client would likely result in a reasonable loss of employment.  Also, not informing an employer could also result in a loss of employment if they found out.  It's almost a no win situation.

Every individual situation is different, and each individual must weigh their own pros, cons and ethical obligations to make their own decision to determine if changing a professional relationship with a client to a personal one is worth it.

Personal Experience

As a previous large employer of massage therapists, sometimes employing more than 40 at one-time, I've seen several instances where massage therapists have dated each other from work, which sometimes caused friction at work and was not a great idea for the staff as a team.

I also experienced one therapist tell me very professionally that she was mutually interested in dating one of her regular weekly clients, and they wanted to continue their massage sessions so this would not affect me.  My response was I was okay if they wanted to start dating, but that would mean it would be the end of his clientship at our massage establishment, which they both accepted.  We would no longer be able to service his massage appointments at our business to establish a clear line that the professional relationship has ended and a personal relationship has begun.

It is Never a Good Idea to Pursue a Personal Relationship with a Client

How you chose or navigate your own personal choices or interests with clients is a personal decision that each therapist must make for themselves.  What is important to remember is your professional and ethical obligations to the client, including how a power differential might have influenced the interest or start of the personal relationship.  It is NEVER a good idea for a health care provider to start dating their client.  However this has happened with proper and professional discretion amongst a few therapists, with successful navigation when ethics and clear communications were applied.

Soulmates are supposed to be a once in a lifetime person.  Any massage therapist who is regularly dating their clients, regardless of professionally terminating the client relationship, would likely be seen as a sexual predator or someone who is abusing their power differential in the client relationship.  While some may understand that someone has met a soulmate at work, dating multiple people from work would not be appropriate and is extremely ill-advised. In fact, it could be deemed unethical by a licensing board and result with a suspension, training requirements, fines, loss of licensure and become extremely damaging to your public image, nevermind a client who may have felt taken advantage of in the power differential. A therapist also risks personal lawsuit or criminal action if a client claims a sexual relationship started during licensed healthcare services.

Also, even just one inappropriate sexual engagement with a client at work or outside of the establishment would be considered highly unethical, if not illegal.  A once in a lifetime exception, if there ever was one, would only apply when the professional client relationship is mutually terminated to consent to a new personal relationship that would strictly occur outside of the workplace to establish and maintain clear boundaries.

To learn more about massage therapy practice, please click here to find or register for training: https://ceinstitute.com/

#client #clientrelations #ethics #healthcare #healthcarepractices #lmt #massage #massagetherapist #massagetherapyethics #bodywork #bodyworker #massagetherapy #sexualrelationship 

by Selena Belisle, Founder/Instructor, CE Institute LLC

It is important for massage therapists and bodyworkers to learn their scope of practice within their own state, city or municipal regions. In many states, the scope of massage includes the manipulation of soft tissues; however, this definition can vary from state-to-state.  For example, the Florida Board of Massage allows for "chemical preparations" of the body, which might include allowing a licensed massage therapist to practice a body scrub, foot scrub or spa body wrap.  But, in other states, licensed massage therapists may be prohibited from providing these types of spa therapies due to a narrower scope of practice.

Proper Training and Experience is Required for Client Service Applications

Some states may also have tricky or hypocritical scopes as well.  In Florida, a licensed massage therapist scope also includes electrical applications; however, almost all massage therapists know that LMTs do not receive rudimentary training in using electricity for therapeutic purposes.  So even when a scope of practice allows for techniques beyond your training, be wary of providing such a conundrum.  Just because something may be within your scope of practice, does not mean it would be correct or ethical to practice it - especially when a practitioner has limited or no training in the application.  It could be considered fraud, a medical error and more to apply any form of client services without proper training.

Massage Therapists do not Diagnose a Client's Medical Conditions

In any state, the scope of massage does not include medical diagnosis or other “more serious” medical procedures, i.e. surgery. Practitioners must recognize their limitations within their scope of practice, and educate clients about their scope of work, especially when a client requests work that is beyond the scope of practice. Examples include when a client asks a bodyworker about a suspicious mole on their body, the bodyworker must advise the client to see a dermatologist or other appropriate physician because the bodyworker cannot diagnose or treat suspicious moles.

Recognizing Changes in Your Client During Massage Appointments

If a client’s health is deteriorating over the course of bodywork appointments, whether it be during a single session or over a more extended period of time, the therapist should verbally recognize this with their client, and suggest the client seek appropriate medical attention for their health. For example, if a massage therapist notices a client is losing a drastic amount of weight (greater than 10% of total body mass per month), and the client is not on a diet or trying to lose this weight – then the practitioner should recommend the client to see a physician to address their changing body.

Never Operate Outside of Scope of Practice

Bodyworks should never operate outside of their scope of practice, even when:

1. They may possibly know the client’s body or health better than most physicians.
2. They feel they could provide better medical treatment than the treating physician for an ailment outside of a bodyworker’s scope of practice.
3. Even when the client recognizes that the bodyworker is not a doctor but wants their medical advice regardless.
4. A client cannot afford proper medical care.

While some massage therapists may be able to provide better care than others or none at all, it's important to not operate outside of a scope of practice, because this could put your license and the client in jeopardy.  Most massage therapists want to help, but it's never helpful when working outside of your scope of practice.  It's usually illegal, risky or dangerous to do so - and should be avoided at all costs.

To learn more about massage therapy practice, please click here to find or register for training: https://ceinstitute.com/

#scopeofpractice #massagescope #ethics #healthcare #healthcarepractices #lmt #massage #massagetherapist #massagetherapyethics #bodywork #bodyworker #massagetherapy 

by Selena Belisle, Founder/Instructor, CE Institute LLC

Communication is one of the most important keys or tools to a successful massage session.  It is a vital ethical duty to provide superior communication skills for a client.

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.

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

For professional aromatherapy training, please visit and register for class at: https://ceinstitute.com/collections/aromatherapy

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 Sandy Fritz

A scar is the body's natural way of healing and replacing lost or damaged tissue. A scar results from the biologic process of wound repair in the skin and other tissues.

Most wounds, except for very minor ones, result in some degree of scarring. We can see and touch scars on the body surface but scar tissue can form inside the body as well.

A scar is usually composed of fibrous tissue that can have altered tissue texture including stiffness, denseness, roughness, etc. Scars may be formed for many different reasons, including as a result of infections, surgery, injuries, or inflammation of tissue.

The mechanical forces applied during massage can load the scar tissue resulting in short term shifts in the texture including increases in sliding and pliability. The sensory stimulation may reduce the feeling of the pulling or itching of the scar for a short time.

Regular attention to scar tissue may over time provide a longer-term result. To work with scar tissue, it is important to understand the healing phase of the scar and to appreciate the compensation of the body to the scar.

Early mobilization of the tissue containing the wound can help the scar tissue heal more mobile. Those who have had various types of surgery are encouraged to move the area very soon after the procedure to prevent or reduce internal scar tissue formation.

More importantly, every scar has a story. Sometimes the client will share the story. Sometimes not. It is their choice.

It is not our role to have the client explore, understand or resolve issues related to the story. If they share, our role is to LISTEN compassionately. It is their story not ours.

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

_____

Sandy Fritz a well renowned massage therapist with more than 35 years of experience. She dedicates her time to writing massage texts for Mosby Publishing (Elsevier), educating, consulting, teaching, and providing massage to a mixed clientele. You can view or purchase Sandy's textbooks at: https://www.us.elsevierhealth.com/catalogsearch/result/?filter_multi_product_type=&q=sandy+fritz

Disclaimer: The opinions expressed in this blog are those of the author. They do not purport to reflect the views or opinions of CE Institute LLC.

#massage #LMT #bodywork #bodyworker #massagetherapy #thought  #learning #education #scar #scartissue #respect

Trigger Point Therapy Injections, also known as a TPI, are applied when a healthcare professional inserts a small needle into a trigger point.

WebMD reports:  "The injection contains a local anesthetic or saline, and may include a corticosteroid. With the injection, the trigger point is made inactive and the pain is alleviated. Often, a brief course of treatment will result in sustained relief. Injections are given in a doctor's office and usually take just a few minutes. Several sites may be injected in one visit. If a patient has an allergy to a certain drug, a dry-needle technique (involving no medications) can be used."

To provide trigger point therapy, we would prefer manual hands-on application instead of the more invasive use of needles which risks infections, allergic reactions to injected substances or more.  However, if your client receives a TPI and then seeks manual therapy from you afterwards, the manual service such as massage therapy could be temporarily contraindicated.

Massage, trigger point therapy and any other hands-on manual service would be contraindicated immediately after a TPI because of broken skin. Skin must be whole and intact prior to manual application to prevent infection and infection causing disease. 

Please also keep in mind that there could be blood exposure on the skin on the same day as injectable application.  Blood exposure is another service contraindication, especially on the day of service when the client's skin has been punctured by a needle.

Providing massage or other bodywork services is usually acceptable depending on WHEN the TPI is provided. Services immediately AFTER a needle injection in the affected area are generally contraindicated due to broken skin, however, manual services such as massage therapy or bodywork should be acceptable to resume once the skin has healed.

If you're concerned that your bodywork or other service could interfere with the client's injections, you should contact the client's TPI provider to discuss this more with them.

To learn more, please register training with us at:  https://ceinstitute.com/collections/trigger-point-therapy

#tp #triggerpoint #triggerpointtherapy #injections #contraindication #massagecontraindication #serviceprecaution #bodywork #bodyworker #massage #massagetherapist #mt #LMT