Level 3 Massage Course Handbook

Course Information

Welcome

Dear course member,

This is your guide to supplement your hands-on course.

You can read it before, during or after the course.

You will not be tested on it, you are only assessed on:

  • The practical assessment on the last day of the course.
  • The case studies (12 practice treatments – instructions are located in the learning resources)
  • The online Thinktree Anatomy/ health and safety modules (if you opt to take these. Instructions are located in the learning resources).

 

© Content is protected by Devon Collier t/a Lake District School of Massage. Copying and pasting forbidden!

School Policies

Just like with your own practice, your policies should be outlined in writing to your clients. Here are LDSOM policies.

Respect
The school has a zero tolerance policy on inappropriate comments or actions including those related to age, gender identity, ethnicity, religion, sexuality, physical or mental ability, learning styles, or other. Such comments or actions can result in suspension from the course without a refund. To avoid such incidents, please think before you speak and treat the teacher/ other staff/ students with respect at all times.

Confidentiality: please respect your classmates by not sharing their information and sensitive information they may disclose to you.

Safety
Any harmful actions whether verbal or physical experienced on the course by any student or staff member are to be reported immediately to the teacher.

The teacher may refuse your acceptance on the course if you are not well enough to attend, based on the questions and answers from the Student Intake Form.
If you are unwell at the start or during the course, in a way which might seriously affect your learning, or other learners (such as having a contagious virus), the teacher can refuse your right to attend. A refund will not be issued, but you may attend a future course subject to availability.
Best practice: communicate with the teacher as soon as you begin to feel unwell before the course starts so that your place can be filled.

It is your responsibility to decide if you are fit and well enough to complete a massage course, which is quite active in nature, but the teacher has the right to make a judgement also.

The teacher and the school are not responsible for your safety during any activities you may pursue outside of massage element of your course, these may include (but are not limited to) exercise, yoga, outdoor swimming, hiking. For such activities it is your responsibility to decide if you are fit and well enough to take part safely. It is your responsibility to make sure you have the correct equipment and clothing to ensure your safety carrying out any activities during or outside classtimes.

Complaints
Any complaints are to be made in writing to the teacher, and/or school manager.

Deposits, deferrals and refunds
Please refer to the below page for more information:

Plagiarism & Cheating
All theory work is to be completed by yourself, in your own words. The reason for studying is to help you learn and help you become the best massage therapist you can be, by cheating you are not only letting yourself down, you are letting your future clients down. If you are struggling please get in touch with the course tutor and we will do what we can to help. Any breaches of this could result in withholding your certificate.

Your compliance with these policies will be agreed by your signature on the student intake form.

Learning Outcomes

Carry out a full body massage routine.

Demonstrate a real life massage therapy client consultation.

Understand how to prepare for treating clients with health conditions

Understand how to set up a therapy space.

Understand the principles of massage business.

What the course consists of

-This course handbook to read through and refer to.

-Online modules to complete in your own time in Anatomy & physiology, Health & Safety, and Business (if you do not already have a L3 qualification in massage).

-The face to face course, full of practical learning, and massage business discussion topics. As well as the practical assessment on day 5.

-Assessed practice treatment case studies for you to complete after the hands-on week to consolidate your learning, which also act as a means for you to gather reviews for your new business.

Work to do in your own time:

-Read through this course handbook thoroughly

-If you do not already hold a level 3 qualification in a holistic therapy subject, you must complete the online modules in anatomy & physiology, health & safety, and business structures. They are at an additional cost to the course and details about these are provided in your welcome letter. You receive your certificate once these have been completed.

-Carry out 12 case studies on 4 practice clients (3 treatments on 4 people) to help instil what you learnt on the course, using the form in the resources section.

-Familiarise yourself and make use of the resources to support your practice including the massage videos, the blog posts and the Facebook group.

After the 5 day course:

After the face-to-face lessons, your certificate will be provided once you have…

1) Completed the 3 Thinktree modules in Anatomy, Health/Safety and Business. Please send me a copy of the certificates for these modules by email or whatsapp- a photo/ scan is fine.

2) Completed the case studies and sent me a copy.

Approximate lesson schedule

Day 1  – Welcome! Let’s find out about you. Basic anatomy lesson. Learn a back massage routine.

Day 2 – Discussion topic- client safety and contraindications. Revise back massage. Massage- back of the legs, feet, arms.

Day 3 – Self care day- Discussion topics- How to protect yourself from unwanted clients and set boundaries. Pricing and self worth. Light exercise- stretching and self massage. Massage revision.

Day 4 – Discussion- Business: the basics of setting up working self employed.
Massage front of body- feet, legs, arms, head & face.

Day 5 – Revision of full body massage routine. Treatment on a practice client: carrying out a client consultation and 60 min treatment on a someone new (not a course member). (On the last day the assessments take place in sets with half the group at a time, if you have your assessment first you can leave earlier. We say final goodbyes in the morning before the assessments).

Timings: 10am-5pm

Residential/retreat course timings can vary from this.

Assessment

You will be assessed on the last day of the course by carrying out a 60 minute treatment on a member of the public.

Criteria: 

  • Posture– therapist uses safe body mechanics to minimise physical strain and the amount of energy used.
  • Communication with client– therapist encourages their client to communicate their preferences for pressure, and gauges a comfortable level of massage pressure whilst carrying out firmer techniques with their client. 

Technique: 

  • Warming up– therapist builds up the amount of pressure slowly, initial movements are lighter.
  • Speed– therapists moves slowly when carrying out firmer movements
  • Depth– adequate pressure for the client is achieved based on communication with them in the consultation and throughout the treatment, and meeting their expectations.

The above criteria will be assessed visually, and by asking the practice clients for feedback.

Assessing theory– your anatomy and health and safety studies will be assessed as part of your online modules (if you haven’t already got these).

About Massage

What is massage?
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Massage is a form of therapy to reduce tension and improve wellbeing. Pressure is applied to the body using hands and arms (and feet in some practices). This can be carried out through clothing or directly on the skin. The result is typically relaxation on a physical and emotional level, and when relaxed the body and mind can undergo healing from stress and pain.

Benefits of massage

Massage activates the parasympathetic nervous system which is the ‘rest and digest’ mode, allowing minds and bodies to relax and heal. The sympathetic nervous system is the opposite, it is the ‘fight or flight’ response we get when adrenaline is released to help us to act fast. When we are stressed, the sympathetic nervous system is overstimulated. Massage helps to rebalance this.

Reduces stress

Unwinds tense muscles and fascia which in turn relaxes the mind

Improves mood

Releases endorphins which boost optimism

Restores flexibility

Gets rid of tension which can cause rigidity, and improves the range of motion of joints.

Boosts the immune system

According to an experiment from the BBC, massage significantly increased the amount of disease-fighting white blood cells.

Improves sleep 

Massage relieves stress and is very calming. This results in a better quality of sleep.

Pain reduction

Tension in muscles and fascia can cause blockages, stiffness and pain. Massage gets rid of this tension to help to reduce pain.

Mindfulness

Touch therapy can bring your attention to the body, away from the mind and overthinking.

Massage mediums (read for useful safety tips!)

Oil is the most common massage medium and comes in many forms. Water dispersible and fractionated coconut oil tend to be better for avoiding staining on fabric.

Other light oils are grapeseed, sunflower and light olive oil.

Thicker oils include almond (be careful with clients with allergies) and jojoba.

Pre-blended scented oils are another option, but be careful with clients who have health conditions, are pregnant or are taking medication as essential oils can react with certain physical states.

A word of warning- oil on towels/drapes can cause tumbledryer fires, to avoid, clean your towels/drapes well with bio powder, and consider using wax and/or drying outdoors. If you do tumbledry- don’t do it for too long and don’t leave the machine unattended.

Lotion can be a useful alternative to use for clients who have a lot of body hair.

Wax is especially useful in slow or firm massage because it is not as slippery as oil. Songbird is a very popular brand and smells very pleasant. You can also get a professional discount from their site if you apply for one- very easy to do.

Types of massage

Swedish/holistic
A light to medium pressure massage method. The techniques are mostly carried out with the hands in a fairly quick, rhythmic way. Often associated with Spa type treatments.

Deep tissue
This refers to a firm pressure massage. It is mostly conducted slowly, which allows the client’s body and mind to adjust to the amount of pressure being applied. It is useful when someone has a lot of tension which is manifesting as pain.

Sports
There are different types of sports massage. That which is for professional athletes to prevent injury. And that which is a maintenance treatment, for either sporting or non sporting types.

-Pre-event massage tends to help athletes to warm up and feel centred. Moves are light to medium, and are carried out quickly to stimulate the nervous system and assist in warming the body up.

-Post-event massage helps athletes bodies to unwind tension after a competition to prevent injury. A light to medium pressure is applied and stretching is often involved.

-Maintenance massage is the version that most standard clients (ie. non-professional athletes) refer to when they want an effective, firm treatment. It’s often a medium to firm pressure massage at a medium pace.

Indian Head
This commonly involves massage of the scalp, face, neck and shoulders. It’s very useful for clients experiencing headaches or stress. It can be carried out on a client whilst lying down in either or both the prone position (face down), or the supine position (face up), or can be carried out on clients when they are seated.

Pregnancy
Pregnancy massage is quite similar to light to medium pressure Swedish massage and can include some firmer movements too, as long as key areas are massaged safely. The main difference is that clients in the second and third trimester should lie sideways on the massage table to prevent pressure on the baby. There are also some specially adapted massage tables whereby the client can face down.

Manual Lymphatic Drainage
A specialist treatment for clients with lymphoedema which can help improve the flow of lymph fluid, mainly linked with clients post cancer treatment.

Thai
Thai massage is almost like manual yoga, in that the therapist moves the client through a series of stretches to relieve tension. The therapist might also apply pressure using their hands and feet. Traditional Thai massage is mainly carried out with the client fully clothed. However lots of variations exist too including oil based methods too, often with the use of menthol balm (such as Tiger balm).

Shiatsu
Another clothed version of massage where the therapist applies pressure to meridian lines (bands of tension) in small compression movements.

Aromatherapy massage is similar to Swedish massage, using light, sweeping movements. Essential oils are mixed to create blends which can affect mood, or relieve physical and mental discomfort.

Reflexology
Is focused on the hands and/or feet. It encourages healing of the body and mind, by stimulating related reflex points.

Myofascial Release
This word is comprised of the Latin words for muscles and skin. It is massage focused on the upper layers of skin and muscle and can involve the skin being lifted and rolled, stretched and kneaded, often no or very little medium is applied to the skin.

Hands-free
Massage mainly using the forearms and occasional elbow pressure. This can be carried out through drapes or with oil on skin. The pace is slow and the therapist pays excellent attention to their position whilst working, with the goal to minimise strain and fatigue. The other main name for this style is ‘No Hands’ but this is a trademarked term so its best to avoid using it unless you were trained on an official ‘No Hands’ course!

Seated acupressure/ onsite/ chair massage
A simplified version of massage carried out with the client fully clothed and seated either on a standard chair, or a specially designed massage chair. Areas typically covered are the upper body; back, neck, shoulders, head and sometimes arms. Oil is not used, the massage moves are a series of compressions using pressure applied with the hands, forearms and elbows. It is a convenient treatment for carrying out at the workplace for office workers for example, or at events. Treatments typically last from 5-25 minutes with 10-15 minutes being the most common treatment lengths.

Massage techniques

Deep Tissue Massage techniques – as shown in the videos section of the course resources

Effleurage – One palm on either side of the spine, start at lower back with the hands flat and smooth over the surface avoiding pressure on the downwards stroke.

Wringing/ side glides – Stand to the side of the client and place one hand on each side of the back and start to draw them together and bring them past one another in a big sweep to massage the sides of the back.

Reinforced hands – One hand on top of the other and push upwards to create a pinkness in the skin, can point fingers downwards for more pressure. Same concept with knuckles, keep the arm very straight and avoid pressure on the downwards stroke.

Knuckles – Keep wrist straight and use other hand as a support

Forearm – Use the arm which is closest to the client (ie. massage the left side of the client’s back with your right forearm). You can support your massaging arm by holding it with the other hand. Draw your forearm up one side of the client’s back.

Elbow – You can hold your elbow on tense areas for a good while and apply as much pressure as the recipient feels comfortable with.

After all the firm movements are done, smooth over the area lightly to relax it (using hands or a light forearm pressure).

Top of shoulders (Trapezius/ traps):

Forearms – Position yourself at the end of the table with the client’s head facing your body. Lean into their trapezius muscle with your forearm, small circular motions work well.

Neck

Kneading the neck – Stand at the side with both hands on the back of the client’s neck, clasp your hands in a sort of crab- hands motion repeatedly so that the skin and muscles move through your fingers.

Thumb Frictions – Or you can apply thumb pressure by placing both thumbs together on a tense spot and leaning in.

Posture tips for massaging

Keep fluid; avoid tensing any area of your body, for example, by not clenching fists when doing forearm movements. Don’t hold your breath. Less strain= more gain!

If your hands/arms etc fatigue, check your posture is right: the power is from the feet and legs, not your back or arms. Switch to another method such as elbow.

Excellent webpage for posture images

Traditional massage technique terms are effleurage, petrissage (kneading) and tapotement/ percussion (which includes pummelling and hacking with the side of the hand).

Your safety

Staying safe

These things can help to prevent disrespectful people booking from appointments:

-Not having your mobile number or home address online. Instead, you can buy a virtual landline (which either looks like a local area home phone or a business line), which redirects to your mobile. It means that you won’t receive silly text messages from strange people at night! Plus it can look more professional.

-Using a booking system with prepayment: most dodgy people prefer to book by text or phone call. So having a booking system, especially one with compulsory advance payment helps to deter unreasonable people.

Policies– make sure clients read your policies (such as those related to payments and behaviour) before they book. Having those listed on your booking system with a tickbox or signature box helps.

Intuition– If something seems odd then don’t second guess yourself

 

What if a client becomes aroused during a treatment? Sometimes we might notice that a male client has become aroused, but there is a difference between a client becoming accidentally aroused and intentionally acting upon it. To be clear, sometimes male clients get an erection during a treatment. It can be a natural response to being relaxed and being massaged, and more often than not the client will be embarrassed and desperately wishing it would go away! What to do in this situation? Just ignore it and carry on the treatment as normal. You can even place a blanket over them to create more privacy. If they apologise you can say ‘Don’t worry, it’s a natural physical reaction’. However, if the client says anything suggestive such as ‘do you ever get sexual requests?’ or asks you to touch them in the genital area, or if they move their hands towards that area then you must stop the treatment immediately and ask them to leave. It is for this reason that you should outline your policies before a client books an appointment; have them on the booking form/ on your website/ in your booking text policies. This helps to deter wrong doers.

Self care

If you want to sustain your career in the long term then self care is a priority. You will not be good at your job (or anything else) if you feel terrible. So self care should be viewed as a work responsibility. Massage can be like competing in athletic exercise, you need to really look after your body. Strengthening the back is a great way to avoid postural issues, such as toning the rhomboids, as well as core exercises such as pilates for posture. And after doing some massage work you will benefit from stretching out the muscles you’ve been using, in the same way that athletes stretch after a run.

As well as other obvious wellbeing practices like eating whole foods, exercise and resting, it’s really important to receive lots of massages! Not only will this benefit your mind, body (and soul), but you can also pick up extra techniques or business ideas from other therapists. It all adds to your skillset. Setting up a therapy swap with another massage therapist is an amazing way to get free treatments, to practise techniques, share resources and get feedback. It’s also just a great way to talk about massage work related things too which can be useful if you work solo most of the time.

Client safety

Client consultations

Once you have your client’s health consultation form and know about any possible conditions, allergies or medication, and the client is in the room prior to their appointment, all that is left to discuss is the treatment room and their treatment. Clarity is very important, especially with new clients.

Here is the checklist I use:

-I make sure they know where the facilities are.

-I explain about the room, for example, that the bed is heated and can be adjusted.

-I ask what kind of treatment they want, for example, focused on certain areas or a full body treatment. If they have an hour I often advise that this is more suitable for focusing on certain areas or one side of the body.

-I ask what kind of pressure they like. I explain about the level of pressure which is ideal for massage: so that it feels satisfying, but not so firm that they tense up or hold their breath. This is important because some clients think that massage has to hurt in order to be effective. This is not true, it can feel slightly challenging if an area is very tense, but as long as the client can breathe and allow the tension to unwind then the pressure is not too much.

-I also state that I encourage communication, about the pressure of the massage, the heating or anything else, so that they should speak up if they want anything to change.

-I explain how to get on the table and how to undress, for example, keep their boxers/knickers on and place the other items out of the way. Be very clear and specific, explain where to lie, for example, face down on top of the white couch cover and use this black towel to cover yourself.

Contraindications

Contraindications are conditions and physical states which may be affected by massage. For example, receiving a massage whilst ill with a cold can make someone feel worse, as well as potentially pass this on to the therapist. We need to make sure that the client and therapist will be safe and not negatively affected by massage. Asking clients for their medical history is very important to protect them. It also protects your business; if you massage someone with a precarious state of health such as a serious unmedicated condition, and then they claim that you have harmed them, it can damage your reputation or lead to legal issues.

The best way to ensure that you can treat a client is to ask them to complete a consultation form before their appointment. This can help you to work out if they are suitable for treatment. It is wise to do this at the booking stage, before the appointment date. This has the advantage of not having to turn a client away once they are in your treatment room. In addition, once they have provided you with health information including medication they take, or any conditions they have, you then have the chance to research a suitable course of action in advance.

An example to illustrate this is from a client I treated. They had listed that they have epilepsy on their consultation form. I knew that this could be a contraindication, but that there is a lot of variety with this condition. So I took the time to do some research. I searched about treating a client with epilepsy in online medical articles and found that it can be useful depending on the severity of the condition. I also searched on the Massage Warehouse’s Facebook group for other therapist’s advice. Other people who had queried this had been advised that massage can be very helpful for epilepsy and that the client should be contacted in advance to find out more about their condition. In addition, applying firm pressure to the neck area should be avoided. I messaged the client with some questions about their condition:

‘’Thank you for completing the consultation form, you have listed that you have epilepsy. Would you mind answering a few follow up questions to ensure that I can provide you with a safe and effective treatment?

-Is there anything that triggers seizures?

-Could you generally tell me a bit more about your condition, such as which type it is, how often you may experience seizures and if you know you are about to have a seizure?

-Do you have a contact I can call in the case of a seizure happening?

I found out that the client had not had a seizure for over a decade. That  they would know in advance if they were going to have a seizure, so they could tell me and I could stop the treatment. I added their emergency contact to my phone who I could call if necessary.

I also decided to research what to do if someone has a seizure.

Therefore, having this information in advance was incredibly useful to protect my client and myself. This is the level of research you should carry out prior to treating a client with contraindications.

Localised contraindications- Conditions which are localised to a specific area of the body

Burns

Bruises

Varicose veins

Inflammation

Cuts or wounds

Fractures, sprains and strains

Skin conditions like eczema which only affect a certain area

You can massage clients with these issues, except over the affected area. In most cases mild varicose veins or mild bruises can be massaged over lightly, but you need to discuss this in the treatment plan with the client to agree on a course of action.

Sprains and strains:

You can massage lightly over strained areas (such as a pulled muscle), avoid firmer movements until the area feels much less sore, around 3 days-2 weeks.

A sprain is an overstretched or torn ligament (ligaments are connective tissue which bind bones together), wait until the pain/inflammation has subsided, then very light massage can be applied.

Whole body contraindications- Conditions and physical states which affect the whole body

These conditions mean that massage may not be suitable because treatment can make the symptoms worse. Or that special precautions need to be taken to ensure your client is kept safe.

Asthma

It is not contraindicated but with it would be worth asking your client to bring their inhaler. An easy way around asking them to do this would be to include on your consultation forms or pre -treatment advice info, that they should bring any medication or devices such as inhalers/ epipens which they need on a regular basis. It’s common sense, and it’s very likely they will already do this, but there’s no harm in over-informing clients on health and safety topics.

Blood Clots and a note on post covid

Massage can cause blood clots to move around the body and to possibly reach vital organs. Therefore, clients with current blood clots or a history of them should ask for medical approval before receiving treatment to ensure this is not a risk. If a client has had serious repercussions of covid and were hospitalised, its worth noting that there has been some links with covid and blood clots, and checking if they have a history of this and asking for medical consent.

Cancer

Clients with cancer can really benefit from massage. You do not need a specific oncology massage qualification in order to practise as long as the client is in remission*, and they are not undergoing chemotherapy. So make sure you understand as much as you can about their situation first, and if in doubt, feel free to refer them to an oncology trained massage therapist.

*Remission means that the signs and symptoms of your cancer are reduced. Remission can be partial or complete. In a complete remission, all signs and symptoms of cancer have disappeared. If you remain in complete remission for 5 years or more, some doctors may say that you are cured. Source: Article from the National Cancer Institute.

Here is a nice, clear article about breast cancer and massage. Please read it, especially if you are preparing for a treatment with someone relevant.
Some of the main messages from the article:

Areas to avoid: As a therapist you should avoid directly massaging the arm/shoulder area if your client has lymphoedema. There are specialist lymphoedema massage treatments (known as manual lymphatic drainage) which can help improve the flow of lymph fluid. If your client has had lymph nodes removed, it is best to avoid working on and close to the area. For example, for lymph nodes near the armpit, avoid massaging the arm closest to the operation site.

Comfort: If your client has any soreness or discomfort from surgery, you should provide extra cushions to protect any areas of discomfort or allow/ encourage the client to adjust their position.

Pain: Explain to your client before treatment that they need to communicate to you if they are in pain. And during the treatment, check in with your client in case they have pain in their arm or shoulder, if so, stop working on that area.

Chemotherapy and radiotherapy: If your client has recently completed treatment, ask them to check with their treatment team if it is safe for them to have a massage on the area that’s been treated.

Contagious Diseases

Although massage might be beneficial to the individuals, massage is not suitable for people with contagious diseases due to the risk of cross infection to the therapist.

Epilepsy

Massage can be very helpful for clients with epilepsy but precautions need to be taken. Ask the client if they are taking medication to control this. Ask them what the triggers are for a seizure so that you do not aggravate the condition. And make sure you have a plan of action in case of a seizure.

Fever/colds/flu

When ill with a type of fever, the body is undergoing immune responses to fight the illness. It is best to let the body heal naturally before having an appointment. Massage can exacerbate symptoms. In addition, as a therapist, you need to protect yourself from catching germs. You can always recommend your client to self massage by leaning onto tennis/ other massage balls to relieve shoulder tension whilst they wait until they are ready for an appointment.

Fibromyalgia and autoimmune diseases

Clients who experience conditions which cause them to feel pain should be treated the same as other clients, but pay extra attention to communicating about how much pressure they would like in their massage. During the verbal consultation prior to treatment, discuss a treatment plan which includes the amount of pressure they prefer, and the areas you will work on. Communication is key, so you need to check in with your client to make sure they are comfortable at various points throughout the treatment.

High blood pressure (hypertension)

High blood pressure is common, and if the condition is managed with medication, and the client is otherwise healthy overall then massage is safe. However, unmedicated clients who have (uncontrolled) high blood pressure require medical consent.

Low blood pressure (hypotension)

Massage can furthermore lower blood pressure so make sure the client feels well on the day of their appointment, for example, when you receive their consultation form you could message them to say, ‘As you have stated that you have low blood pressure, please feel free to contact me in the days leading up to your appointment or on the day if you feel unwell’.

During their appointment, pay special attention to allowing the client time to lie down or be seated for their treatment, as well as lots of time to get up. Make sure they are hydrated and encourage them to communicate with you if they feel lightheaded.

Kidney Conditions or Liver Conditions

Clients should speak with a medical professional to discuss if massage is suitable for them. Once you have approval, make sure you only massage the areas over or near these organs lightly.

Pregnancy

Massage is very beneficial in pregnancy. A woman’s body is going through a lot of changes and massage can help someone to physically and mentally adjust to these changes; by soothing backache, for example.

Massage is not known to be harmful during pregnancy. However, precautions need to be taken. In the first instance, find out from your insurers if you are covered to treat pregnant clients, they might require to take a specific pregnancy massage workshop. Most insurers will not cover you for claims on a pregnant client in the first 12 weeks of pregnancy (the first trimester). Massage does not have a negative affect at this stage, the reason behind the caution is that women have a higher likelihood of miscarriage during the first 12 weeks of pregnancy. So insurers want to steer clear of any cases of a woman linking a miscarriage with a massage appointment. In addition, if a pregnant client has any health conditions you should ask them to obtain medical approval, such as from a midwife or GP.

How to massage a pregnant client

Position: Clients should lie on their side with pillows to support their hips and bump. Place the leg underneath the client straight on the table and encourage her to bend the top leg, this adds stability on the table. Place a pillow in between the knees, this raises the hip to keep the joints in alignment. A pillow under the ankle, bump and head is also required to keep the body aligned and supported.

Speed: Keep a slow, calm speed to relax your client and to avoid shocking the nervous system.

Avoid pressure on these points:

Image Source: https://acuproacademy.com/acupuncture-practice-tcm-resources/

Contraindications – a summary

Communication is key: speak with the client in advance of their appointment to find out more if necessary.

Ask the client to get approval from a medical professional if you are in doubt.

Holistic therapies can be incredibly helpful to clients experiencing pain and/or stress, providing that they are applied with care and that your client is comfortable.

Aftercare

After the treatment make sure your client has water available. When they are dressed and you speak with them post treatment you can ask how they feel. You can encourage them to keep hydrated and to avoid strenuous activity. If they received a firm pressure treatment you can inform them that some mild discomfort is possible the day after in the areas where firm pressure was applied. Massage can also bring on tiredness or a cold if the client has been run down or overly busy; the body’s way of encouraging healing.

It is good practice to explain about emotional release to your clients, where feelings may surface during or post treatment (mainly relevant to firmer treatments) so they can be reassured that this is normal. Such feelings may show up as laughter, sadness/crying or intense dreams.

Another option in delivering this aftercare advice is to provide your clients this information in their booking confirmation letter- before their treatment, depending on which booking system you use. This can help your client to plan their day, for example, to aim to leave the following few hours free. On Ovatu or Timely for example, you can edit an appointment confirmation/ and or reminder email. In my practice, I prefer to provide as much information as possible. This includes: the address and parking info/info on where to leave a bike, what to wear, advice on not eating a heavy meal before-hand and the aftercare advice. This helps clients to prepare, especially if they are new to massage and are not sure what to do.

Professionalism

Being professional – an introduction

Your clients need to feel at ease with you, right from the outset from your advertising, your appearance, to the way you talk with them in the treatment room. This is achieved by being professional in all your work activities in the areas discussed below including appearance, hygiene and your role as a therapist.

Appearance & personal hygiene

Whether you prefer a sporty, new age or smart style, keep your work clothes very clean and oil free to set a professional tone. You should be comfortable to move, but covered up, with no cleavage showing as this can give the wrong impression. You could even opt for a plain apron to protect your clothes from oil stains.

Smelling fresh is key, so frequent showering and deodorising is very important, especially if you get warm whilst working. Keep your nails incredibly short with nail clippers plus a nail file to soften the edges of your nails. When your client is getting ready before and after treatment, wash your hands.

Your role

Your role as a massage therapist is to provide therapeutic treatments only. If a client shares details of problems they’re having, it’s because they need to offload, and the best thing that you can do is simply listen. You can say supportive things which show that you sympathise with them, such as ‘That sounds really tough’ or ‘No wonder you’ve been feeling stressed’. This is sometimes all someone needs, to feel heard and validated.

It is important to not voluntarily provide any advice or solutions to their problems. Why? Because it is not your role, and you may influence them negatively without meaning to. If they ask you a direct question seeking advice, for example, ‘I’m having trouble sleeping, can you recommend anything?’ You can say something generally well known, such as ‘I’ve heard that lavender oil helps’. However, this should always be followed with, ‘but please do your own research on this, or consult a professional because I am not an expert. And check that anything you try does not interfere with any medication you are on’.

It can be tempting to try and fix people, especially if you’re full of great ideas and are genuinely inspirational, and caring but the main purpose of your service is to provide the healing quality of touch therapy, beneficial for mind and body. This is enough. If someone talks about wanting to eat better or do more exercise for example, what you can do is provide a recommendation. Such as ‘I know a great personal trainer’, or ‘I follow a brilliant blog’. That way you are giving them the option to seek advice instead of providing it yourself in an area you are unqualified in.

Confidentiality

What the client talks about in the room with you or writes on their consultation form must be kept secret. Clients are in a vulnerable position even before they enter the treatment room as they share personal information in their form. In the treatment room they may talk about their physical health. They may also open up about issues in their life or share good news. This information is meant to be heard by you only, not to be shared with another therapist, their partner, your partner, another client or anyone else. The only instance where you can share information is if you believe that the client is at serious risk of hurting themselves or others. In which case you can ask the client if you can contact a relevant supporting service on their behalf, or you can ask such a service for their advice.

Talking

Interacting with clients can be enjoyable, especially if you are both chatty people. It is fine to engage in a bit of conversation prior to treatment if they are talkative. And a little small talk is good practice, to make clients feel welcome. Just keep what you say neutral and think carefully before you speak. You are there in a professional context, no matter how well you get on with your client.

During a treatment you should never start a conversation. However, if the client is talking and asking you questions it is fine to engage in conversation, but aim to keep it minimal. Sometimes people talk too much because of nervous energy, a useful way to help the client centre themselves is to incorporate a few deep breaths into your massage techniques. For example, ask them to take a deep breath in, to hold for a moment, and when they breathe out, you can apply pressure up the muscles on the side of the spine, alternatively, you can just ask them to take some nice deep breaths as you work.

Another point about verbal communication: be careful when commenting on a client’s physical appearance. A compliment on a new hairstyle is fine, but avoid any comments about their body, such as how strong someone seems.

Draping

Draping refers to the way in which clients are covered in towels, sheets or blankets during a treatment.

Effective draping is a way to keep your client feeling secure and cosy. The barrier of fabric also acts as a boundary, in that only the undraped area is worked on. For example, during massage of the right leg, the rest of the body should be completely covered including the left leg. Only the area you are working on should be uncovered. Undraping an area tells the client that you are going to work there. Massage should never be applied underneath the towel or drape, because it confuses the boundary of where you are working and where you are leaving covered. If the weather is warm you should have some lighter drapes/sheets available so that the client can still remain covered, or you may leave the back or legs uncovered whilst you are working on other areas if you prefer this.

The treatment room

Sample treatment room

The video below is of my treatment room in Manchester filmed in 2022 🙂

Keeping everything clean, fresh and uncluttered in the treatment room. It makes the client feel at ease. Wipeable surfaces are ideal. Ventilating the room during, or at least in between clients. Spraying all surfaces clients come into contact with with gentle antibacterial cleansers. Eco-friendly brands tend to contain less harsh chemicals, which is important as some cleaning products can aggravate asthma. Washing or drying drapes/towels at heat helps to kill germs.

Temperature level is key as a warm room can help someone to relax. You can buy an electric blanket to place under the couch cover, just be mindful of any cables on the floor and tape them down.

It’s useful to have these items available for you or the client to use: baby wipes, tissues, hand gel, and of course some water to drink.

Washing towels/ drapes

Most massage oil leaves drapes and towels stained over time. To avoid this, choose the right oil. Despite grapeseed oil’s popularity amongst massage therapists due to its light texture and low price, it can often lead to a buildup of grease on fabric. Choose fractionated coconut oil, or those labelled as ‘water dispersible’, or massage wax. Then choose the right detergent, it has to be ‘bio’. Biological washing powder is designed to break up grease, where non-bio is too gentle on oil stains. I use eco-friendly versions of washing powder and buy it in bulk, it smells good and is gentler on skin.

A word of warning- oil on towels/drapes can cause tumbledryer fires, to avoid, clean your towels/drapes well with bio powder, and consider using wax and/or drying outdoors. If you do tumbledry- don’t do it for too long and don’t leave the machine unattended.

Regarding fabrics, I personally avoid using fleece throws and synthetic fibres because they release microplastics into the sea when you wash them. Although, regular towels and cotton drapes do take longer to dry.

Aromatherapy

Aromatherapy is the use of scent usually from essential oils, which have an effect on the body and mind. Think of how peppermint smells refreshing, and how lemon smells cheerful. Smells can really affect mood. Common uses of aromatherapy scents are found in essential oils, either pure or premixed, massage oils which can be premixed, candles and incense sticks. Essential oils are highly concentrated tinctures of natural herbs, fruits and flowers which have a powerful smell. They can be added to massage oil or to a diffuser which produces steam to fill a room with scent.

Potential issues

Certain essential oils can negatively affect certain clients. This is possible if they have an allergy to the oil, or if the oil interferes with their health condition or medication. This might involve increasing or decreasing blood pressure, or strengthening or weakening the effect of medication.

To be safe

-Check any health conditions your client has for possible interactions with aromatherapy oils, here is a useful article: https://escentsaromatherapy.com/pages/introduction-to-essential-oils-safety-and-contraindications

-Use a pre-mixed oil, and only if the client has no conditions or is not on medication. Neal’s Yard make nice premixed essential oil blends, follow the instructions, usually adding a few drops to a base oil or a diffuser.

-Make sure you keep the room ventilated.

-If using a diffuser or candles, turn it off/ blow them out after 30-60 minutes to avoid the effect being too strong.

Equipment

A massage table can often be bought second hand on Ebay or Gumtree, make sure it is sturdy and test it out first before your first client tries it.

Massage warehouse are a great source of tables and accessories. Other additions you may find useful are an electric blanket, a wipeable couch cover to place over the electric blanket, the fabric table cover, a bolster for under the knees, then drapes, sheets or towels to cover the client.

Table width guide: the ones from the course are 70cm wide. They are a bit less portable than thinner ones, but better for comfort.

Music

It’s great to be able to play music in the treatment room! You can find all sorts on the likes of Youtube, Amazon and Spotify (Massage Warehouse have some nice mixes on Spotify). Bear in mind however, that legally, according to music licensing laws, because you are playing music in a commercial sense (ie. for paying customers) you are required to purchase a music licence which is around £300 a year, even if you work from your own home or other people’s homes! If you get caught out, I have heard that the claim will be backdated per year, so that you may be fined for previous years.

I discovered this website which allows you to play and download licence free music at no cost: https://www.no-copyright-music.com

Another option is buying licence free music from ichill (you can subscribe or buy albums/songs) so that you don’t have to bother with a music licence.

Getting set up in business

Different work options

Self Employment

Pros: Freedom with a flexible timetable, taking all the profits from your work, creativity- such as the treatment room decor and your website.

Cons: Having to set everything up and promote yourself, no holiday or sick pay.

Working in a home treatment room

Pros: Convenience. No commute. Save on costs.

Cons: Being at home a lot. Sometimes harder to keep the workplace tranquil because of cooking smells, noises like neighbours, postmen etc

Tips: Keep any area the client might see like the corridor and bathroom clean, smelling nice and free from clutter.

Hiring space in a centre or clinic

Pros: Could get passing trade from the other businesses clients or useful links. Can be good to separate work from home.

Cons: Costs of hiring the space.

Working Mobile (home visits to client’s homes)

Pros: No need for a treatment room so minimal cleaning, clients provide towels so no laundry, can be a change of scene to visit different houses, an appealing service for lots of clients

Cons: Travel time needs to be factored in, it takes time to set up your table each time, you cannot fully control the room such as temperature, lighting, level of cleanliness, there can be minimal space to work in

Working for a company

Pros: No overheads, no need to organise bookings, or advertising, cleaning, accounting systems etc (unless you are classed as self employed and work at a company).

Cons: A lower hourly rate, could involve long hours with short breaks.

Keeping client notes & legislation

Healthcare professionals are legally required to keep client notes for 6 years. This means storing your consultation forms and treatment notes. If you have a paper system, make sure any documents are stored in a lockable place, away from clients. Online systems store forms and data for you. If you decide to change systems, make sure you download the data including consultation forms as a CSV file and store it digitally.

Insurance and professional associations

You are strongly advised to obtain massage therapist insurance before you start working on the public. There are so many companies to choose from. Some I’ve used or communicated with and notes on my experience are:

Salon Gold – approx £55 a year – good for the basics, but I found to be restrictive once I expanded my services.

FHT – approx £120 a year with membership too. I found it to be very restrictive with listing my services and training options on my policy.

Balens – approx £85 a year. Very good and flexible with what you can include in your policy, if you do extra training for example. Very slow with emails and applications.

Westminster – approx £120 a year. Very speedy emails, very helpful on the phone. Very good and flexible with what you can include in your policy, if you do extra training for example. I have a £10 discount I can offer you can access here.

*2023 prices

Notes on insurance companies:

Some require a copy of your certificate before you are insured and some don’t. If you are trying to get insurance before you have your certificate, then you can sometimes opt for student insurance in the meantime.

Professional associations are organisations who support holistic therapists by providing advice, insurance, use of their logo on your marketing, and other benefits depending on the PA such as monthly magazines, a listing on their website and discounts. You do not need to join a (PA), but you can if you prefer. I was with the FHT but over the years I realised that I wasn’t getting anything out of it, and in terms of seeking advice from them, especially in the pandemic, I found that posting or reading posts in the Massage Warehouse facebook group (linked in the learner zone) was much more helpful. I am now a member of Thinktree for £47 a year, who provide discounted insurance, a listing on their site and are fantastic with providing advice.

Accounting

It’s important to do things by the book incase you get audited.

What you need to have in place:

A business bank account such as Monzo. Then make sure all your work related income and expenses are linked to this account. Monzo have a payment request feature too which enables you to send a client a link.

You also need to keep all the receipts– whether pdf or photo of paper ones in date order.

If you are making money for carrying out massage and are not employed by a company, or are considered as self employed by a company you work for, then you need to file a self assessment tax return each year. Failure to do so can result in monthly fines of approx £100. Just go onto the HMRC site and opt to list yourself as self-employed, and you will be given a unique tax reference (UTR). Then each year, from approx April 5th onwards, you list your income and expenses for the previous year.

Expenses can be anything related to the business such as clothing, massage oil, buying massage music etc. See a full list here.

Booking systems

Booking systems provide you with a way for your clients to book an appointment online. You list your availability and prices, then clients can book this directly online. There are lots of free systems out there which do this, but the best ones are paid for, because clients can pay for their appointment in advance, and depending on the system, complete their consultation form in advance.

These systems save you loads of time (no texting/calling/working out each other’s schedules/no payments/consultation forms in the treatment room), plus you get more business when you have one, because lots of people prefer to book online without having to call someone- its just easier sometimes!

You can find a link to Solo on the course resources which is a great option, you also get 3 months free using the link. But there are tons more so see what works best for you!

Google & social media

Google can be the best way to advertise your business for free! Make a free business listing so that people can search for massage in the area they are in. Make sure you update your listing often by adding new images, and by asking clients to leave a review there (you can send them the review link).

Social media like Facebook and Instagram are also great, free ways of advertising. Some tips: social media means social, so keep your posts varied, interesting and a bit fun. Analyse other business pages to see what you like and use this as inspiration.

Canva is a great free graphic design app which you can use to make posts, and a logo etc.

‘Next time’

Next time are the two most powerful words to keep your business going, and it’s something no-one ever tells you (it took me decades to find this out!) These words help you get repeat business. When you are speaking with your client, get the idea of their next appointment out in the open, by mentioning it during the consultation, treatment and afterwards. For example, today we worked on …….., next time I will focus on ……. Then ask when they would like to book in their next appointment for.

Extra business guidance

I created this online guide for you called Grow Your Massage Business.

It was designed so you can set up working as a massage therapist safely and sensibly, and that you can learn how to earn with ease.

Find out tons about marketing and everything else you need to rock it as a self employed massage therapist!

Plus get a video consultation call to help you reach your goals.

How to access it?

Contact Devon to request access.

Contact