By: Selena Belisle, Founder/Instructor CE Institute LLC, Miami FL

Alopecia[i] is another name for hair loss

You lose up to 100 hairs from your scalp every day. That's normal, and in most people, those hairs grow back; but many men—and some women—lose hair as they grow older. Humans can also lose hair due to certain diseases, such as thyroid problems, diabetes, or lupus.

Alopecia Areata is a medical condition that can also cause hair loss.  It is an autoimmune disorder that results in hair loss on the scalp, face, and body; recurrence and amount of hair loss depends on the severity of the condition.[ii]

If someone takes certain medicines or receives chemotherapy for cancer, they may also lose their hair.  The cells that produce hair in the human body have some of the fastest growing cells of the body; and, seeing many chemotherapies attack the fastest growing cells in the body (given cancer is one of the fastest growing cells), many will experience hair loss when taking chemotherapy. 

Other causes of hair loss are thought to be: stress, a low protein diet, family history, or poor nutrition.

Treatment for hair loss depends on the cause. In some cases, treating the underlying cause will correct the problem. Other treatments include medicines and hair restoration.

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

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By: Selena Belisle, Founder/Instructor CE Institute LLC, Miami FL

Nails are often used in acute medical situations to determine a person’s health or fitness.  A capillary nail refill test is a quick test done on the nail beds to monitor dehydration, lack of circulation or the amount of blood flow to tissue.  While this is rarely practiced in massage therapy practices, spas or salons, it’s good to know, because it can be applied quickly and can HELP rule out a life-threatening medical circulatory issue. Keep in mind that this is NOT the only test that would be performed in a life-threatening circulatory concern, nor are we trained medical professionals and as such, should not be attempting to practice medicine.  This test is simply something that can be done if you ever find yourself in an acute medical situation and need greater information about the individual who is in distress.

How the Test is Performed

Pressure is applied to the nail bed until it turns white. This is called “blanching” when the blood has been forced out of the tissue: in this case, the blood has been forced out by squeezing. Once the tissue has blanched, pressure is removed and the time it takes for blood to return to the tissue is measured. Return of blood is indicated by the nail turning back to a pink color.  If there is good circulation, a pink color should return to the nail bed in less than 2 seconds after pressure is removed.

What Abnormal Results Mean

Blanch times that are greater than 2 seconds may indicate: dehydration, shock, peripheral vascular disease (PVD), hypothermia, or blood-circulation disruption.

How to Prepare for the Test

Remove colored nail polish before this test.  The test should only use minor pressure to the bed of your nail. The pressure should not cause discomfort.

Why the Test is Performed

Tissues need oxygen to survive. Oxygen is carried to various parts of the body by the blood (vascular) system.  This test measures how well the vascular system works in your hands and feet—the parts of your body that are farthest from the heart.

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

This BLOG was written by Selena Belisle, the Founder of CE Institute LLC in Miami FL.  She is a retired professional athlete and has been practicing massage therapy for over 30 years.  Selena is an approved CE Provider with NCBTMB & the Florida Board of Massage.  She now teaches full time for the Complementary and Alternative Health Care Industries. You can learn more about Selena’s training and CE classes at www.CeInstitute.com

Author:  Selena Belisle, Owner/Instructor, CE Institute LLC, Miami FL 

The definition of “pH” is also know as Potential or Power of Hydrogen.  Many earthly substances have a pH “rating”.  The rating/assignment system of pH uses a numeric scale of 1-14. 

• Substances rated below a pH of 7 are considered “acidic”
• Substances rated with a pH in the 7ish range are considered “neutral”
• Substances rated above a pH of 7 are considered “alkaline”

Most of human body’s internal fluids such as saliva, urine and blood have a pH rated between 7-8 on the alkaline side of the pH scale.

The external skin of our body however has an acidic pH, around 4.7 pH. The level of skin acidity can differ from person to person, and this pH difference can be further altered when topical ingredients are applied to the skin (i.e., sunscreen, perfumes, moisturizers, etc.)

According to research published in the International Journal of Cosmetic Science, the “natural skin surface pH is on average below 5”.[i]  This research about the skin’s pH states the following:

• the use of water, soaps or cosmetics can change the skin’s pH to a 6+
• it is estimated that the 'natural' skin surface pH is on average 4.7 after refraining from showering and cosmetic product application for 24 hours
• skin is in “better condition” when it has a pH value below 5

This acidic pH of the skin is also known as the “acid mantle” or “acidic mantle”.  This slightly acidic film on the skin (aka acid mantle) is formed when sebum and sweat mix together on the skin.  The acid mantle creates an “unfriendly” environment for bacteria, viruses, and other pathogens that come in contact with human skin.

As such, it is important for service providers to work with products that are “pH balanced” to preserve a client’s acid mantle, especially with geriatrics, oncology or HIV clients, or any other population that has a suppressed or compromised immune system. 

If your service required a product that is not “pH balance” – such as an acidic peel, it is important to use products that can return the skin’s pH to its normal value after the "peel" service is complete.

When selecting professional products, it is important to review the pH of products with the manufacturer.  Ask the manufacturer about the pH of their products and ensure that the clients leave your place of business with properly balanced pH skin after salon or spa services.  SDSs often list the pH value of an individual product, so ask a product manufacturer for their SDSs when evaluating their products and use.

It’s important to know about pH because many moisturizers and creams can be very alkaline.  This alkaline pH can feel soothing and wonderful to the skin; however, extreme alkaline moisturizers are not recommended because they alter the skin’s pH/acid mantle to “fight” skin bacteria.  Your skin and it's acid mantle are one of your body's best defense systems to fight external bacteria, virus and overall germs.  As such, it's important to know the pH of skin, and the pH of everything we use in our work when we apply a product to it :) 

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

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[i] Lambers, H, et al. “Natural Skin Surface PH Is on Average below 5, Which Is Beneficial for Its Resident Flora.” Advances in Pediatrics., U.S. National Library of Medicine, Oct. 2006, www.ncbi.nlm.nih.gov/pubmed/18489300.

#cosmetology #nailtechnician #manicure #pedicure #safety #safetyfirst #salon #spa #business  #disinfection #cleaning #mani #pedi #massage #massagetherapy #massagetherapist #bodywork #bodyworker #lmt #massageestablishment 

Author:  Selena Belisle, Founder/Instructor, CE Institute LLC, Miami FL 

Antiseptics: are germicides applied to living tissue and skin.  You can use an antiseptic on yourself (or others) to try to kill germs.

Disinfectants: are antimicrobials applied only to inanimate objects.  You can apply disinfectants to objects or surface areas to try to kill germs (you should always clean prior to disinfecting an object or area).  Disinfectants are not made to apply to a human body.  You should use gloves when handling disinfectants.

In general, antiseptics are used only on the skin and not for surface disinfection, and disinfectants are not used for skin antisepsis because they can injure skin and other tissues.

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

Author:  Selena Belisle, Owner/Instructor, CE Institute LLC, Miami FL 

Question: Is Prenatal Massage in the 1st Trimester (or any trimester) Safe?

Answer: YES, when performed by someone who is specially trained in Prenatal Massage

I hear this question a lot - is prenatal massage safe?  Or is massaging someone in their 1st trimester safe? The answer is yes it's safe, as long as the therapist is training to work with prenatal conditions.  There are some special contraindications with prenatal massage such as toxemia.  And there are some specialized positions, skills, strokes and equipment that can be used for prenatal massage clients too.  All of this requires specialized prenatal massage training, which can be easily provided in any board approved continuing education class.

So, why do so many people think that massage is not safe in the first trimester of pregnancy?  It is mostly because about 1/3 of pregnancies will miscarry, and about 80% of those miscarriages will happen in the first trimester - and there is regularly NO REASON WHATSOEVER to explain the miscarriage.  Miscarriages happen in both healthy and unhealthy women, active or sedentary women and so forth.  Unfortunately, a pregnant woman who has just miscarried could blame their massage appointment as a reason for why they miscarried.  But fortunately for massage therapists, common sense usually prevails when statistics are provided - which show that many pregnancies miscarry whether a woman has a massage, or not.

The safety of a prenatal massage should not be confused with employer or liability insurance requirements.  I teach prenatal massage and have been practicing prenatal massage in all trimesters for over 25 years now.  I have worked closely with Boston Hospital OBGYN Department Heads to provide prenatal massage to their pregnant clients.  But, when I worked at the Ritz Carlton in South Beach, FL, even I was not able to provide prenatal massage for celebrities, or any clients, during their 1st trimester at this hotel.  The spa manager told me that it was their liability insurance that would not cover a prenatal massage in the 1st trimester which created their policy to deny 1st trimester prenatal massage appointments - and not because the Ritz felt that a prenatal massage appointment would be unsafe with a trained and licensed therapist.  It is important to note that therapists should respect and follow whatever employment policies are provided to them - there are legal remedies to take if you feel your employer is being unfair in their policies, or you can simply find another job where their standards will match with own if you do not agree with what your current employer is telling you to do.  I liked my job at the Ritz Carlton so I followed their policies with prenatal massage as requested - even though I thought some were wrong - I understood they made this policy because of their insurance requirements.  Once I understood their reason for their decision (total transparency), I was okay in following it. This was a morality and ethical choice on my behalf to continue with the Ritz even when I thought their denial for 1st trimester prenatal massage appointments was wrong.  This was a personal choice that I decided to make, and any other therapist would have to make if they were in similar shoes. 

Back in the 1990s, I used to own a massage therapy center that employed over 40 Licensed Massage Therapists.  We often hired incredible therapists from a local school who taught that all prenatal massage was contraindicated (at least this is what their therapists told us when they continually refused prenatal massage training and clients).  So, I called the school and told them we would stop hiring their graduates if they continued providing such bad and erroneous information in their basic training.  And today, from what I understand, they no longer teach that pregnant women are contraindicated for massage.  Hopefully no school does.

Luckily, today, we have better information about the practice of massage therapy.  Massage has become professionally prevalent, and licensed massage therapists are being less associated with other elicit industries.  Our professionalism has helped establish the health benefits of our industry over the past 2 decades - which has helped people understand the benefits and qualities of prenatal massage.  Unfortunately, because of past teachings that were inaccurate, and because of bad insurance requirements and so forth, we have a lot of misinformation about what is safe (and what's not) with pregnant women and massage. 

I hope this BLOG post clears up some of the misinformation that is still being passed and provided today with prenatal massage.  Luckily, one of the reasons we have CE hour requirements for licensed professionals, is to gain updated information about our trade.  1st trimester prenatal massage is one of those updates that should be shared - it is safe when the client is not medically contraindicated - all massage modalities have some form of contraindication.  There are plentiful reasons why we have misinformation regarding this prenatal massage, but communication and education should get us all on the same page that prenatal massage is safe, including in the 1st trimester, when practiced by a trained prenatal massage therapist.

On a side-note - if you're not comfortable working with pregnant women, then you might not want to seek prenatal training or attempt to provide prenatal service.  Each therapist should pursue and practice whatever is in their hearts - because that is sincerely the best practice for all.  So, if you're not comfortable practicing on pregnant women, that's okay - but please do not tell others that prenatal massage practice is unsafe.  It is not.  Prenatal massage is one of the most wonderful relationships a therapist can share with a client, and it should not be prohibited for nefarious reasons.

Please click HERE to learn more about pregnancy massage and available prenatal massage CE classes at CE Institute LLC.

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Author Selena Belisle is the Founder of CE Institute LLC in Miami FL.  She is a retired professional athlete and has been practicing massage therapy for over 30 years.  Selena is an approved CE Provider with NCBTMB & the Florida Board of Massage.  She now teaches full time for the Complementary and Alternative Health Care Industries. You can learn more about Selena’s training and CE classes at www.CeInstitute.com

Author:  Selena Belisle, Owner/Instructor, CE Institute LLC, Miami FL 

Question: Can Moderate or Deep Pressure be Applied in Lymphatic Drainage?

Answer: No, No, No, No, and HELL NO!!!!!

Lymphatic Drainage is typically considered a bodywork to reduce facial or body swelling through specialized skills, techniques and practices.  It is not the same as Swedish massage which would encourage strokes towards the heart to promote venous return.  In massage we promote blood circulation.  In lymphatic drainage, we teach you to work with something entirely different. 

While massage generally promotes strokes towards the heart, some lymphatic drainage strokes work away from the heart to promote a reduction in swelling.  Lymphatic drainage is different from almost any other form of massage or bodywork.  Lymphatic drainage requires specialized training, and should be sought in a live hands-on board approved CE class where an instructor can observe and provide feedback of your hands-on practice.

Some leading reasons why a client might want a specialized lymphatic drainage session is because they suffer from lymphedema - which is a permanent medical dysfunction of the lymphatic system.  They could also have swelling from an orthopedic or cosmetic surgery, sports strain, or swelling from oncology treatments such as radiation or a lymphadenectomy.  Lymphatic drainage is a wonderful modality to relieve swelling without pharmaceutical intervention.

In order to relieve swelling in the body via lymphatic drainage, we take extra interstitial fluid within the tissues and encourage this fluid to enter the lymphatic system.  The lymphatic capillaries that collect this fluid are miniscule.  In theory, if you apply too much pressure to these miniscule capillaries, they will simply collapse and not collect any fluid, until they reconstitute themselves. This is explained further in CE Institute's live lymphatic CE classes.

Lymphatic drainage strokes are designed to encourage extra interstitial fluid to be collected by these miniscule capillaries to promote true drainage of the tissues.  This excess fluid will then travel through larger and larger lymphatic vessels and ducts - and eventually make it's way back to the heart and cardiovascular system.

I believe the reason why some therapists are practicing deep tissue and misnaming it lymphatic drainage, is because there can be some tissue changes leading to some fluid drainage with a deep tissue massage.  That is because common problems such as stress, overuse, and misuse of the body, can lead to muscle tightness.  This muscle tightness will create excessive pressure on circulatory vessels which can obstruct overall general circulation.  So, when an effective deep tissue session is provided, these tight tissues relax and allow better "drainage" of the tissues via newly unrestricted circulatory vessels.  However, this deep tissue massage result should NOT be called lymphatic drainage - it's NOT.  Better fluid exchange within the tissues is a simple benefit of increased circulation with a good massage.  Deep tissue or moderate pressure massage should never be confused with the specialized skills and strokes developed to encourage the uptake of interstitial fluid into miniscule lymphatic capillaries for true lymphatic drainage. 

What's more important to note is that any deep tissue pressure applied to swelling is likely to produce more swelling and tissue damage.  That is because applying pressure to swollen and stretched tissues may further stretch or tear the swollen tissues.  That is why swelling is a general massage therapy contraindication; however, swelling IS indicated for lymphatic drainage (minus a few contraindications which you would learn in any of our live lymphatic CE classes). 

It's one thing to practice deep tissue massage and increase overall circulation as a result - but it could be extremely harmful to apply that same deep pressure on post-surgical swelling or a damaged lymphatic system and expect something positive to happen - you'll likely be sorely disappointed (or have a claim for malpractice).

There are some people who get lucky by claiming they are performing lymphatic drainage while trying to "force" bodily fluid/swelling out of surgical incisions, etc. That type of unthinkable, forceful, painful, swollen tissue manipulation could cause a greater amount of scar tissue, fibrosis and/or infection than the initial trauma or surgery itself.  Keep in mind, a client may appreciate a forceful physical temporary removal of swelling while on opioids.  And that type of client could unknowingly seek even more of the same when they become additionally swollen from improper care.  It's difficult for a client on opioids who has just had surgery and is being told that they are receiving "therapy" to understand that the "therapy" of forcibly working on swelling is hurting them - not helping!  We asks therapists to use some common sense in realizing that applying moderate to deep pressure to swollen tissues is NOT helping your client, or you.

To learn more, because there are so many more erroneous practices, you really need to take a board approved live CE class where you can have instructor interaction with questions, answers and scientific theory.  Try to take a course with an instructor who has clear scientific, evidence-based education of the lymphatic system itself and extensive practice in the modality of lymphatic drainage.  There are too many factors that go into the practice of lymphatic drainage which cannot be solely collected off from a blog, youtube or the internet in general. 

In summary to address the important question about pressure with lymphatic drainage in this blog, deep tissue, myofascial release and other moderate to deep pressure techniques are NOT, and will never will be, appropriate lymphatic drainage bodywork techniques - 24/7/never. 

Please click HERE to if you would like to learn more about lymphatic drainage and other available classes at CE Institute LLC.

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This lymphatic drainage post was written by CE Institute LLC Founder, Selena Belisle.  Selena initially studied Vodder-style Lymphatic Drainage in 1995 at the Massage Institute of New England in Cambridge, Massachusetts - – the same city where other schools such as MIT and Harvard University are located.

Selena has attended and studied in numerous lymphatic online and live classes (including initial lymphatic re-mapping research and studies in 2003).  She found her studies of lymphatic drainage to be “frustrating”, given the amount of conflicting and misinformation amongst instructors.  As such, Selena spent hundreds of additional hours sorting through research and published studies to create this evidence-based course where the efficacy of our teachings are 100% backed by scientific data.  You can view a more complete list of Selena’s accolades including her publications, training and experience by clicking HERE.

In addition to practicing lymphatic drainage for 25 years, Selena managed/owned an alternative health care practice for 10 years that serviced thousands, and employed over 40 massage therapists, 4 chiropractors and 4 acupuncturists in Quincy & Braintree, Massachusetts, until she sold in 2005.  Lymphatic Drainage was one of the many modalities offered in this large group practice.  The lymphatic drainage appointments that were practiced for over a decade at Selena's health clinic provided much relief for her clients, and was a wonderful healing alternative for customers who were contraindicated for regular massage. 

Selena is a also a retired professional athlete with 3 WAF World Championships.  She has competed in places like the Athens Olympic Stadium and has worked on scores other athletes, including a player from every single team in the NFL (and accolade not many have accomplished). She also earned a 2017 Award from Dana Farber & the Jimmy Fund for: “in recognition of extraordinary support of research and patient care at Dana Farber Cancer Institute, leading to breakthroughs against cancer”. She has worked as a volunteer at the Miami Cancer Institute in the infusion wings, and has spent decades working to help cancer and lymphedema patients.

Selena’s long history, experience, studies, practice and instruction of manual lymphatic drainage makes her one of the foremost leading instructors of the modality today.

Author:  Selena Belisle, Founder/Instructor, CE Institute LLC, Miami FL

Bacterial Cellulitis

Cellulitis is a common, potentially serious bacterial skin infection. Cellulitis is much different than cellulite, which is a non-life threatening cosmetic condition.

In bacterial cellulitis, the affected skin appears swollen and red and is typically painful and warm to the touch.  Left untreated, the infection can spread to your lymph nodes and bloodstream and rapidly become life-threatening. It isn't usually spread from person to person. It is important to obtain an early diagnosis for cellulitis, because the condition can spread rapidly throughout the body.^liii

Cellulitis occurs when bacteria, most commonly streptococcus and staphylococcus, enter through a crack or break in the skin. The incidence of a more serious staphylococcus infection called methicillin-resistant Staphylococcus aureus (MRSA) is increasing.[i] Cellulitis is often treated through a simple course of antibiotics.

In this photo (below), this person has presented with staphylococcal orbital cellulitis. Note the periorbital swelling and erythema.  The symptoms associated with cellulitis can evolve and worsen due to systemic bacterial migration via the bloodstream, and include fever, malaise, and chills.[ii]

Bacterial cellulitis is not considered highly infectious because it is an infection of the deeper layers of the body (the dermis and subcutaneous tissue).  The epidermis provides a “protective covering” for this infection.

Personal service workers should use caution in working with someone who has bacterial cellulitis.  This is a medical condition that can spread rapidly throughout the body once someone has this infection.

Services such as waxing or body scrubs, which could compromise or break the epidermis and possibly lead to further infection are not advised until the bacterial cellulitis has been medically treated.  Further massage, spa or salon services that could increase blood circulation such as heat or body wraps should also be avoided.  Bacterial cellulitis can spread (and is made worse) through blood circulation.  Increasing a client’s circulation with bacterial cellulitis is ill-advised.

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

__________________

 Author Selena Belisle is the Founder of CE Institute LLC in Miami FL.  She is a retired professional athlete and has been practicing massage therapy for over 30 years.  Selena is an approved CE Provider with NCBTMB & the Florida Board of Massage.  She now teaches full time for the Complementary and Alternative Health Care Industries. You can learn more about Selena’s training and CE classes at www.CeInstitute.com

[i] Mayo Clinic Staff. “Cellulitis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 10 Apr. 2018, www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762.

[ii]  Sellers, Dr. Thomas F. , Emory University.  “Public Health Image Library (PHIL).” Centers for Disease Control and Prevention, 20 Dec. 2017, phil.cdc.gov/Details.aspx?pid=2843.

Author:  Selena Belisle, Founder/Instructor, CE Institute LLC, Miami FL

Here are Five Steps from the CDC on how to Properly Wash Your Hands [i]

Washing your hands is easy, and it’s one of the most effective ways to prevent the spread of germs. Clean hands can stop germs from spreading from one person to another and throughout an entire community—from your home and workplace to childcare facilities and hospitals.

Follow these five steps every time:

1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails
3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
4. Rinse your hands well under clean, running water.
5. Dry your hands using a clean towel or air dry them.

Here/below is a diagram that shows areas that are commonly missed when using hand sanitizer, and areas that should receive extra attention when handwashing:

Use Hand Sanitizer When You Cannot Wash with Soap and Water

You can use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.

Washing hands with soap and water is the best way to get rid of germs in most situations. If soap and water are not readily available, you can use an alcohol-based hand sanitizer that contains at least 60% alcohol. You can tell if the sanitizer contains at least 60% alcohol by looking at the product label.  

Sanitizers can quickly reduce the number of germs on hands in many situations. However:

• Sanitizers do not get rid of all types of germs.
• Hand sanitizers may not be as effective when hands are visibly dirty or greasy.
• Hand sanitizers might not remove harmful chemicals from hands like pesticides and heavy metals.

How to use hand sanitizer:

• Apply the gel product to the palm of one hand (read the label to learn the correct amount).
• Rub your hands together.
• Rub the gel over all the surfaces of your hands and fingers until your hands are dry. Use plentiful product – your hands should remain wet for at least 20 seconds until they are dry.

In addition to regular hand hygiene practices, during the COVID-19 pandemic, you should also clean hands:

• After you have been in a public place and touched an item or surface that may be frequently touched by other people, such as door handles, tables, gas pumps, shopping carts, or electronic cashier registers/screens, etc.
• Before touching your eyes, nose, or mouth because that’s how germs enter our bodies.

Sometimes massage therapists use their forearms and elbows in massage.  Any area of a therapist's body that is used during massage should be washed or sanitized before and after working on each client.

Hand hygiene is critical during this COVID-19 pandemic, where commonly spread respiratory droplets can cause serious disease.  Massage Therapists should take heed with more frequent hygiene habits to protect themselves, and to protect the health and safety of their clients as well.  The best method to prevent transmission of COVID-19 is to self-isolate and avoid contact with others, which would not allow for work as a massage therapist.  However, if you find yourself at work, or you must work, which is ill-advised, be sure to practice superior personal hygiene, take steps to improve your air quality at work and wear your PPE (personal protective equipment).  Please stay safe during these challenging times. 

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

Author Selena Belisle is the Founder of CE Institute LLC in Miami FL.  She is a retired professional athlete and has been practicing massage therapy for over 30 years.  Selena is an approved CE Provider with NCBTMB & the Florida Board of Massage.  She now teaches full time for the Complementary and Alternative Health Care Industries. You can learn more about Selena’s training and CE classes at www.CeInstitute.com

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[i] “When and How to Wash Your Hands.” Centers for Disease Control and Prevention, 2 Apr. 2020, Found online: July 4, 2020, www.cdc.gov/handwashing/when-how-handwashing.html.

By: Selena Belisle, Founder/Instructor CE Institute LLC, Miami FL

Fibromyalgia is a frequently debilitating and painful condition that can have "tender points" on the body. Tender points are specific places on the neck, shoulders, back, hips, arms, and legs. These points can elicit extreme pain when pressure is applied to them.

The American College of Rheumatology approved new revised diagnostic criteria in 2010 for fibromyalgia that eliminated the 1990 tender point testing criteria. The new 2010 diagnostic criteria uses the Widespread Pain Index, and symptom severity scale in place of tender point testing under the 1990 criteria.[i] The 2010 “Widespread Pain Index” (WPI) is shown here in this colorful picture of the body below:   

Despite the new 2010 WPI criteria testing, it’s still important to know where the “tender spots” are when working with fibromyalgia clients.  It is not recommended to place pressure or press directly into these tender point spots as this can be very painful for a fibromyalgia client. Also, avoid massaging any areas of lost sensation or numbness.  Massage therapists and personal care service providers should never work on an area where the client cannot feel because they cannot provide feedback about the pressure or work that is being done in the area.  Below is a 1990 fibromyalgia tender point chart:

Fibromyalgia can also cause disability, a lower quality of life and widespread pain all over the body beyond the “tender points”.  People with fibromyalgia may be more sensitive to pain than people without fibromyalgia. This is called “abnormal pain perception processing”. Fibromyalgia affects about 4 million US adults, about 2% of the adult population. The cause of fibromyalgia is not known, but it can be effectively treated and managed.^l 

People with fibromyalgia can sometimes be GREAT candidates for relaxing spa & salon services!  They need it!

The CDC reports US adults with fibromyalgia may have complications such as:

• More hospitalizations. People with fibromyalgia are twice as likely to be hospitalized as someone without fibromyalgia.
• Lower quality of life, especially for women. A woman with fibromyalgia has 40% less physical function & 67% less mental health than a healthy woman.
• Higher rates of major depression. Adults with fibromyalgia are more than 3 times more likely to have major depression than adults without. Screening and treatment for depression is extremely important.
• Higher death rates from suicide and injuries. Death rates from suicide and injuries are higher among fibromyalgia patients, but overall mortality among adults with fibromyalgia is similar to the general population.
• Higher rates of other rheumatic conditions. Fibromyalgia often co-occurs with other types of arthritis such as osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis.[ii]

Fibromyalgia is not a general contraindication for massage therapy or spa/salon service, unless the client is having a "flare-up" or has other medical issues that would create a contraindication.  Each client should be serviced on a case-by-case basis with their overall medical health considered prior to servicing the client. Some clients might receive massage during an acute flare-up, again on a case-by-case basis which should be supervised by a licensed physician. Always consult a physician regarding complex client medical conditions. Local contraindications for fibromyalgia include areas of lost sensation.  There are many CE Providers across the United States that teach in-depth classes on working with fibromyalgia.  It is advised to attend one of these specialized board-approved training classes for service providers who wish to work regularly with this condition.

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

_______________________

Author Selena Belisle is the Founder of CE Institute LLC in Miami FL.  She is a retired professional athlete and has been practicing massage therapy for over 30 years.  Selena is an approved CE Provider with NCBTMB & the Florida Board of Massage.  She now teaches full time for the Complementary and Alternative Health Care Industries. You can learn more about Selena’s training and CE classes at www.CeInstitute.com

[i] Wolfe, F; et al. (May 2010). "The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity" (PDF). Arthritis Care Res. 62 (5): 600–610. doi:10.1002/acr.20140. PMID 20461783

[ii] National Center for Chronic Disease Prevention and Health Promotion | Division of Population Health. “Arthritis.” Centers for Disease Control and Prevention,  3 Apr. 2018, www.cdc.gov/arthritis/basics/fibromyalgia.htm.