CE INSTITUTE LLC BLOG

by Sandy Fritz

Massage is one form of manual therapy. Massage Therapy can be considered a manual therapy specialization.

In the health and wellness sector, massage therapy can be a stand-alone approach to support wellbeing and self-care prevention and management of stress and stress related issues massage can be an autonomous practice. When dysfunction and pathology is present, massage therapy, within the broader manual therapy spectrum, is indicated within interdisciplinary medical care.

Scope of practice respect and violation needs consideration. In an interdisciplinary team, the professional with the broadest scope of practice and the most education required for entry level practice would be responsible for the plan of care and delegation of portions of the treatment plan to the specialists within the team. Remember, massage is the massage therapist's specialization.

The various occupations using similar manual therapy methods need to determine who is best to perform the assessment and specific intervention and refer if another professional is more specifically trained and experienced. For example, in a health and wellness setting a massage therapist may incorporate aspects of fluid movement (example: lymphatic focus), BUT this same method would be out of scope for a massage therapist if pathology exists unless part of an interdisciplinary team and delegated to perform the method.

Another example: In a general massage session a massage therapist can incorporate safe stretching methods BUT in a sport and fitness setting the athletic trainer is better trained and should be professional providing stretching as an intervention.

It is ok to learn and augment massage therapy with other manual therapy approaches so long as scope of practice is respected. And the manual therapy methods other than massage SHOULD NOT replace massage as the primary approach used by massage therapists.

If you want to call yourself a "manual therapist" and you are working under a massage therapy license and scope of practice, I would suggest that there is an ethical concern.

If you want to practice autonomously as a manual therapist, but do not want to practice massage therapy, then maybe actually committing to the academic training to become a physical therapist, chiropractor, or osteopathic physician is the ethical thing to do or practice massage therapy as part of an interdisciplinary team.

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

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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 #manualtherapy #manualtherapist #LMT #bodywork #bodyworker #massagetherapy #scopeofpractice #ethics #massageethics #health #wellness

by Selena Belisle, Founder/Instructor, CE Institute LLC 

One of my favorite goats named Creamy has developed caprine arthritis encephalitis which is also known as CAE. Creamy was delivered to us with an original herd of approximately 100 goats.  She is of unknown age but is likely over five years old, and she has a lovely cream colored coat which contributed to her name.

We were told that CAE did not exist within the herd when it was acquired, despite there appearing to be visual scars on the animals that indicated otherwise. CAE is a devastating disease which usually results in culling the herd, and termination of infected animals.

Creamy has been with us for a couple years without any signs of CAE. Then, during her last pregnancy and delivery, things went awry.  She was pregnant with two calves which is fairly normal for a goat. She delivered one calf, and then didn't deliver the second calf until five days later.

CAE Symptoms Develop

Immediately after delivery, Creamy started showing significant symptoms of CAE. They were gradual and became worse with each day, until she was walking on three legs only within about 2-weeks. She was separated from the herd, kept dry with a sawdust bed, provided anti-inflammatories and other medicine to no avail. 

Her right front knee was excessively swollen, and I thought I may be able to manually manipulate the fluid away from the knee joint, but despite Creamy being an incredibly patient and mild mannered goat, she wouldn't allow me to touch her knee for very light manual lymphatic drainage techniques.  At one point, during her medical care, her knee was shaved which provided better access to directly manipulate the skin with MLD, but unfortunately she was not having it, and I did not press the matter to avoid distressing the animal.

Creamy's Weight Loss

It took about 2-weeks of non weight-bearing on Creamy's right front leg before her right shoulder atrophied. The atrophy was slight but clear between her right and left shoulder. Creamy also lost weight which is normal for goats after delivering their calves, so it's unknown if Creamy's weight loss was from her delivery or CAE or likely both.

Goat with CAE Gets Even Dirtier

Like all farm animals, goats can be fairly dirty and Creamy was no exception. Unfortunately this situation worsened when another animal peed on her which was weird given she was fairly isolated.  I found half her head and a rear back quarter soaked in urine.  It might have been possible that she hobbled to one of the horse stalls and laid down in the urine too.  Unfortunately we'll never know how it happened, but it was important for me to remove it and get her clean.

Making the Decision to Provide a Caprine Spa Session to an Ill Goat

I asked Creamy's more experienced care givers if it would be acceptable to wash Creamy and we were all at a loss. This was a no win situation where the animal's coat would have either remained soaked in urine for a good amount of time, or risked health issues from being wet in the cold. 

We ultimately agreed that I if I worked quickly to clean Creamy and dry her, it could be successful.  Luckily, I was able to clean Creamy in local spots only with multiple, inexpensive disposable washcloths within about 30-minutes, then quickly dry her within another half hour, so her health was not compromised with her quick and efficient, one-hour caprine spa session.

Goat Spa Session

Our barn is in northern Vermont where it is very cold in the Winter, so washing an ill animal during sub-zero temperatures (end of February) in a moderately heated barn was undesirable. Nevertheless, I wanted this goat to feel clean while ill, so I did it.  I purchased:

From Dollar Tree at $1.25 each:

• Disposable washcloths
• Extra large puppy pads
• Animal brush

From Walmart:

• Heated radiator ($50)
• Hair dryer ($10)
• Set of towels ($10)
• Oatmeal gentle dog wash ($5) 

Creamy received similar to what most ICU patients would receive as a sponge bath with the following steps:

• I collect a clean pail of tepid water
• I dunked an individual disposable washcloth into the tepid water
• I rinsed Creamy with the disposable washcloth
• I repeated this process over and over with clean cloths, until all urine was removed from her coat

I did not use the oatmeal cleanser on Creamy. The disposable washcloths seemed to have some type of gentle cleanser on them which satisfied the cleansing and rinsing process with individual cloths.

Once Creamy was clean in the two areas that were soiled of urine, I then used a hair dryer to dry the areas that were cleaned.  It was important to get Creamy as dry as possible to prevent pneumonia or other illness in the dead of Winter with this severely compromised goat.

Spa Session Tired Goat with CAE

Creamy was fairly tired when I finished her mini-spa session. She was standing on three legs the entire time, leaning into me.  I also believe the hair dryer noise was likely unnerving to her, but she accepted it without much issue.  It's almost like she was aware that it was necessary, and the warm heat of the hair dryer might have even felt good to her.  It's hard to say given the goats cannot speak and you have to take their physical cues as communication.

 A Satisfied Clean Goat

Creamy jumped up onto her three legs to greet me the next time I entered the barn after her spa session.  It's like she wanted to show me that she was doing much better.  Please keep in mind that Creamy has been receiving round-the-clock medical care from her care givers, so I will never know if her improvement was from her spa session or medical care or both.  But there was no mistaking that she was happy to see me again, and excited to get another rub down.

Eating During Massage

Creamy is a hearty goat and she continued to eat despite being ill.  Sometimes when I went to the barn to massage Creamy, she would eat the hay that was left for her. Prior to her spa session, she would be lying down and she would not get up when I entered which was sad to see, given during previous visits without CAE, Creamy would patiently follow me around with the rest of the herd until it was her turn for attention.  Some of the goats demanded immediate and nonstop attention, but Creamy was patient and different. Very loveable.  I also do not know if Creamy was eating before I arrived for her rub down, or if she started eating while I massage her, but she did eat during her massage and she seemed to enjoy it.

Creamy's Rub Down

Massaging Creamy was simple bodywork, and similar to what she's been receiving from me for two years now.  I applied a circular effleurage/friction technique. The goat herd seems to favor this style of massage over anything else such as traditional straight effleurage or petrissage. 

I usually wear either vinyl or nitrile gloves when physically working with the goat herd. This herd has the common orf virus which can be transmissible to humans; however, the herd did not have any active outbreaks during this Winter 2022 visit.

The goats favorite circular therapy technique is bilateral alternating massage with both hands on their lower mandible or hips. The more mild manner goats enjoy their mandible massaged, and all of the goats enjoy the alternating bilateral circulatory massage of their hips.  They'll either stay in place until you stop, or start leaning into you for more pressure. Then when you do stop, they'll usually follow you around for more.

Important Disclosure

It is important to note that I am NOT an expert in animal care nor caprine livestock, despite being a born and raised Vermonter. I have bottle fed over 100 calves from this goat herd, and massaged them all.  But, my real health care experience is massage therapy practice for over three decades, and I have provided spa services for the past 27 years - for humans (although some humans have equally behaved like animals if not worse).  Today, I teach CE hours for the massage, nursing and cosmetology fields as an expert instructor of multiple modalities for human health and cosmetology care. 

I am often asked about bodywork techniques including MLD for animals, especially given equestrian massage has been a nonstop growing industry for years. While I have multiple horses available to work with including beautiful Clydesdales, I prefer to work most with the goat herd and their kids. These goats are the most affectionate, loving animals and a true pleasure to work on.

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

#caprinemassage #goatmassage #goatmld #goatspasession #goatcleaning #cae

by Selena Belisle, Founder/Instructor, CE Institute LLC

Hot stone massage can be started in either prone or supine position.  At CE Institute LLC, we teach a general full body hot stone massage to be started in the prone position with a sacral stone.

A sacral placement stone is usually arranged on a client's sacrum through multiple barriers, as an opening ritual to a full body hot stone massage. After the sacral stone is placed, and any other placement stones desired, a massage therapist can then drape the client and apply oil to start their full body hot stone massage.

The stone used for sacral placement should be the largest of your set. The sacral stone is usually left on the body for the longest period of time. As such, the largest stone will usually retain the heat the longest and allow for long standing thermal therapy enjoyment.

As with any placement stone, a massage therapist should visually check the skin repeatedly after placement to ensure the stone is not too hot for the client, in addition to verbally asking the client if the temperature is comfortable for them.  The number one injury in bodywork practice today is from hot stone massage practice, and those injuries are usually a result from client burns.

Here is an instructor explanation and demonstration of sacral stone placement in hot stone massage:

Learn professional hot stone massage practices at: https://ceinstitute.com/collections/hot-stone

#hotstonemassage #bodywork #massage #massagetherapist #lmt #massagetherapy #stonemassage #bodywork #bodyworker #hotstone #LMT #hotrock #hotrockmassage #massageontherocks #sacralstone #placementstone #sacrum #technique

Body brushing is practiced as an opening and closing holistic ritual in massage and bodywork appointments. Massage therapists can additionally provide body brushing any time they feel it is needed, which includes prior to turning the client over on the table from pronated to supine position, or supine to prone position.

Body brushing is usually practiced over the client's draping on a massage table, or over the client's clothes on a professional massage chair.

Body brushing usually entails the massage therapist starting up near the posterior neck line and brushing outside on the client's lateral body, inferiorly towards their feet.  On a massage table:

• in supine position, the practitioner would start around the client's manubrium and brush laterally to the client's shoulders, then inferiorly towards the client's feet and off the table.
• in pronated position, the practitioner would start inferior to the client's spine of their scapula, and brush laterally to the client's shoulders, then inferiorly towards the client's feet and off the table.

In a massage chair, an LMT would brush the back of the body, with bilateral hands on both sides of the spine, brushing from around the client's spine of their scapula inferiorly towards their lower hips and off the chair.

Body brushing is a method used to connect the entire body for a holistic sense or feeling.  It connects almost the entire body.  Think about when you provide a massage.  You might end your massage with the feet, or the client's back.  Leaving the client after working on a specific region may not feel like a holistic treatment to the client. Providing body brushing strokes at the end of a massage session can allow the customer to feel like the therapist has addressed and connected their entire body.

Some practitioners who are sensitive to energy medicine may also feel that negative energy could emerge from the tissues during bodywork. Body brushing could also remove these negative energies or spirits from the body, when it is applied with that mental intention.  To provide energetical body brushing, simply brush the body as explained in the instructor video demonstration, and allow the hands to continue moving the energy out a door or window of your treatment area, once your hands have left the client's body.

Here's a demo and explanation of body brushing techniques that can be used in both massage and bodywork, in the supine or prone positions:

For massage and bodywork training, please register for training with us at: https://ceinstitute.com/

#massage #bodybrush #bodybrushing #massagetherapy #massagetherapist #manualtherapy #bodywork #bodyworker #massagepractices #LMT #technique 

by Selena Belisle, Founder/Instructor, CE Institute LLC & 3x WAF World Arm Wrestling Champion

Sports event massage is usually performed clothed. It can be provided on a massage table, portable chair, regular chair, and I've even worked on some athletes on the ground. In the world of professional athletics, time is usually of the essence so massage therapists must make do with what they've got!

Sports massage therapists must find quick and efficient practical methods when there is little time to practice all required elements, which includes ruling out potential contraindications and observe precautions plus provide the bodywork itself.

Sacral rocking is a great opening ritual to practice when therapists have 10-minutes or less to provide sports massage at a sporting event. Sacral rocking allows a practitioner to view the client's body in passive motion, and observe if any regions are "holding" or not moving as they should.  Any form of guarding of any regional area is usually a good indicator that bodywork or additional attention is needed in that region.

While some athletes may have experienced physical impairments prior to their sporting event that would create a loss of motion, it's important to address these losses whenever possible.  So whether you're working at a pre-sporting event or post-sporting event, this sacral rocking can be practiced at both.

Here's a free quick youtube instructor explanation and demonstration of what sports massage sacral rocking looks like in the prone position on a massage table: 

by Selena Belisle, Founder/Instructor, CE Institute LLC

Prenatal massage therapists should always screen their pregnant clients over the phone prior to their appointment.  Sometimes a pregnant women could be contraindicated for massage, and would need to either be rescheduled for a different form of bodywork or cancelled altogether.  It would be extremely inconvenient for any client to show for an appointment, only to learn that they are not eligible to receive it which is why prenatal clients must be screened prior to the actual visit.

In addition to a thorough screening and health intake process, practitioners should also discuss what areas will be worked, such as a back massage or full body, etc. Determining this prior to allowing the client to get onto the table will determine what type of positioning or bolstering the client will receive.

Pregnant women who are a little past their first trimester should not lie flat in prone or supine position on a massage table. Special prenatal positioning and bolstering is usually provided for mid-second to third trimesters pregnancies.   

Prenatal massage can be provided in semi recumbent or side lying positions.  Prone position can also be achieved with professional prenatal massage cushions for the latter stages of pregnancy.

Side lying position can be accommodated fairly economically with three pillows as explained in this instructor demonstration video:

To learn professional prenatal massage, please register at: https://ceinstitute.com/collections/prenatal

#prenatalmassage #pregnancy #prenatal #massage #massagetherapy #massagetherapist #bodywork #bodyworker #sidelyingposition #sidelyingbolstering #relaxin #relaxinhormone #sidelying #sidelyingmassage 

by Selena Belisle, Founder/Instructor, CE Institute LLC

Foot reflexology practice usually starts with grasping both feet at the same time.  A reflexologist might traction both legs, inspect the feet, apply lotion or all of the above as their opening ritual. 

Reflexology closing rituals usually end with a bilateral solar plexus hold prior to wiping any massage medium off from the client's feet, prior to their table dismount.

A foot reflexology closing ritual solar plexus hold would include the reflexologist to singular place their thumb pads on the solar plexus point which is between 1/3 to 1/2 way from the medial portion of the foot, under the ball of the foot.  The practitioner will press their thumb pad into this plexus reflex point with their thumb pad only, and slowly decrease pressure and allow the thumbs to gradually exit the feet.

It is common practice to ask the client to take a deep breath during the solar plexus hold, and then upon the exhale to start the release of the thumb pads.

Here is an instructor video demonstration explaining the technique and more:

To learn foot reflexology and more, please register with us at: https://ceinstitute.com/collections/reflexology

#reflexology #massage #massagetherapist #bodyworker #massagetherapy  #foot #feet #solarplexus #solarplexuspoint #solarplexushold #footmassage 

by Selena Belisle, Founder/Instructor, CE Institute LLC

Myofascial release bodywork is usually started with skin rolling  Skin rolling is achieved by lifting dry skin and rolling it through an opposing thumb and fingers. In this video demonstration, we are skin rolling the back from superior around C7 of the spine to inferior, just above the client's ileums.

It is thought that myofascial release is like peeling an onion, where a practitioner would start by stretching the superficial fascia with techniques such as skin rolling, prior to applying deeper myofascial techniques with different applications such as palming or using an elbow to stretch the underlying fascia.

Here is an instructor demonstration video exhibiting skin rolling:

To learn myofascial release, please visit and register with us at: https://ceinstitute.com/collections/myofascial-release

#massage #massagetherapy #massagetherapist #LMT #bodywork #painrelief #MFR #myofascialrelease #myofascialreleasetherapy #bodyworker #bodywork #increasecirculation #scartissuerelease #scartissue