Effleurage:

• Prepares tissue for deeper work
• Soothes and relaxes client
• Moves blood and lymph
• Good transition stroke
• Should be used following petrissage or friction stroke

Petrissage:

• Lifts tissue away from the bone “milking”
• Milks the tissue of metabolic wastes
• Draws new blood and oxygen into the tissue
• This stroke does not need to be done towards the heart

Friction:

• Heat producing compressive stroke
• Breaks down adhered scar tissue
• Rearranges muscles and collagen fibers
• Increases circulation to areas that have little to no blood supply (ligaments/tendons)

Percussion:

• Successive strikes
• Loosens mucus and phlegm in thoracic region
• Can be used to stimulate or relax

Materials Needed:
1. Device to warm stones. Temperature should be set between 175 to 200 degress for roasting ovens. Typically takes stones 1 hour to heat up.
2. Bleach. Stones should be cleaned in � cup of bleach to 1 gallon of hot water before first use and following each treatment.
3. Massage oil. Massage oil rather than lotion or cream should be used when performing hot stone therapy.
4. 1-2 bath towels.
5. Massage sheets and table.
6. Tongs or slotted spoon.
7. Selection of stones. Stones should vary in size as well as shape.
15-20 small stones to fit between the toes
10-20 hand size stones
5-10 large round stones
3-5 irregular shaped stones
Most stones should be flat, round, and have a nice edge. Irregular shaped stones should have a point for reflexology work and trigger point palpitation purposes. Weight of rocks and shape of rocks are important qualities to consider when selecting your stones. Expect your collection to change and grow over time.

When performing Japanese hot stones, it is important to gage temperature of stone based on individual client. Some people can tolerate a warmer temperature than other, but regardless of individual heat preferences, it is important not to burn the skin! If necessary, place a towel between client’s skin and stone while the stone cools. General rule of thumb is if the stone is cool enough to hold in the palm of your hand, it is cool enough to use on the body.

Contraindications for Japanese hot stones:
1. High blood pressure
2. Diabetes
3. Elderly clients
4. Skin rashes
5. Open sores or cuts

General Procedure:
1. Start prone.
2. Apply oil to client’s back.
3. Medium sized stones used to glide (effleurage) on erector spinae 5-10 passes.
4. Medium stones effleurage from C7 to pelvis back and forth.
5. Place a large stone in the center of SI joint and 1 on each glute.
6. Use medium stones to work Rhomboids and trace under the scapulas.
7. Use small/medium stone to work supraspinatus and infraspinatus.
8. Small/medium stone to work the arm. Can use 2 stones at once.
9. Remove stones on the low back - with new stones cross-fiber friction on low back and glutes.
10. Use 2 stones to compress the neck - a small stone can be used for detailed work on the neck.
11. Place a stone in the hands of the client.
12. Cover back and place stones directly on the spine from the pelvis to C7.
13. Work legs with large or medium stones.
14. Bend leg at knee joint, flex foot, and use stone on heel, arch, and pads.
15. Remove stones from back - starting at pelvis and working your way up.
16. Switch to supine.
17. Start with quads, move to flexors, and end with feet (large stones for legs, small stones for feet).
18. Move to arms (you can remove the stones from hands now or before they turn over). Use small or medium stones on arms.
19. Incorporate pectoralis with medium or small stones.
20. Breast drape and incorporate stomach. Use Swedish movements.
21. Drape client with sheet and place stones large to medium up center of stomach to just below the clavicle.
22. Work face like taught in Swedish.
23. Remove stones as final step, starting with the largest to the smallest.

Japanese hot stones treatment are designed to:
1. Cause extreme relaxation.
2. Remove deep tension in the muscles.

The therapist should always allow 1.5 hours to complete a treatment.

Preparing the environment for massage

• Temperature: warm 88-90 degrees
• Surface: soft, warm and cozy place
• Oil: cold pressed oil (typically something you can eat) Ex. Olive oil, etc.
• Lighting: low setting; not bright
• Music: soothing
• Supplies: diapers, baby wipes, cloth diaper, towels

Infant massage is a simple, gentle, yet firm application of stroking, pressing, squeezing, and movement of the limbs. Examples of the techniques used are soft circular motions with fingertips all over the baby’s head; gentle but firm squeezing and twisting of soft tissues of the legs; broad strokes on the chest; milking the arms; and small circles all around the back with the fingertips. Talking to the child and maintaining eye contact are important throughout the massage. It is a time of connecting and playful interaction that helps the infant’s emotional and social development, as well as the physical.

Contraindications:

Acute infections
Fever
Staph infections
Tuberculosis
Hemophilia
High blood pressure
Contagious skin disorders
Inflammations
Fractures
Dislocation
Osteoporosis
Nausea, vomiting or diarrhea
Swollen joints
Cysts
Jaundice
Recent surgery (not for at least one to two weeks after surgery)
Diabetes- advanced stage
Gastrointestinal or jejunostomy feeding tubes
Varicose veins
Edema
Tumors
Dislocated fracture or broken bones
Sunburn

Head and Face:
Supine Position.
1. Gently place hands on client’s shoulders or thumbs in the center of the forehead to establish touch.
2. Starting from just above the eyebrows, use the pads of your thumbs to stroke from the middle of the forehead moving laterally to hairline. Repeat 3X.
3. Return to center just above the eyebrows again, drag thumbs up to center of forehead, and move laterally to hairline. Repeat 3X.
4. Return to center just above eyebrows again, drag thumbs to top of forehead just below hairline, and move from center laterally to hairline. Repeat 3X.
5. Drag thumbs in slow, short motions up center of forehead, from eyebrows to top hairline.
6. With R hand, use circular friction on R side forehead. Move from eyebrows up to hairline. Repeat 3X.
7. With L hand, use circular friction on L side forehead. Move from eyebrows up to hairline. Repeat 3X.
8. Continue circular friction with both thumbs at the same time into hairline and across the parietal bone of the skull. Repeat 2X.
9. With R hand, use pads of fingers to perform circular friction just above the temples, around the ear, affecting the temperalis muscle. Repeat 3X.
10. With L hand, repeat step 9.
11. With pads of thumbs, move from the nasal bone across the zygomatic arches. Use both thumbs at the same time, and pull up slightly at the finish (ending just below the temples). Repeat 2X.
12. With pointer fingers above the lip and thumbs below the lips, moving from center, pull slightly upward like a smile. Repeat 2X.
13. Trace mandible with fingers, end stroke by slightly pulling and rubbing the ears.

Neck, Arms, and Hands:
Supine Position.
1. Apply lotion. Use circular friction with both hands on S.C.M. Repeat 3X.
2. Apply lotion. Slide hands under the back. Hands should be between the scapulas, but not touching the spine! Bend fingertips and drag hands up the back of the neck - on both sides of the spine - and stop at the occipital ridge. Allow head to rest on fingertips for 10-15 seconds. Repeat 2X.
3. Turn head to L side. Place your forearm on client’s temporal bone and use slight pressure to give a stretch. Ask client to tell you when they feel a stretch. Lift hand and repeat circular friction on the S.C.M. Repeat 3X.
4. Turn head to R side. Repeat stretch. (Remember to ask client if they feel a stretch). Repeat circular friction on the S.C.M. Repeat 3X.
5. Return head to straight position. Using slight traction, take L ear almost to the L shoulder.
6. Use palms and then fists (light to medium pressure) along with the trapezius. Repeat 3-5X.
7. Return head to straight position. Using slight traction, take R ear almost to the R shoulder.
8. Repeat step 6.
9. Return head to straight postion. Petrissage the trapezius muscle with alternating hands. (Milk the traps).
10. Stand up and move to the L arm. Pull arm around until it is superior to the head. Give a slight pull to offer a stretch. Hold for 10-20 seconds.
11. Apply lotion to full arm with light effleurage strokes. Using gliding motion up entire arm 2-3X, then return to the forearm.
12. Use V strokes and fist to work the forearm. Use circular and cross fiber friction at attachment sights.
13. Move superiorly to the arm. Kneel down and glide down the forearm using more pressure on the back of the arm (flexors) than on the front. This stroke is performed by using the thumbs on the extensors and fingertips on the flexors.
14. Move to the biceps and deltoids. V hand up and around arm and use circular friction on the deltoid. Finish arm by light effleurage.
15. Move to hand. Use gliding stroke for between the metacarpals (bones in the hand) and light circular kneading on the carpel bones (wrist). Rotate wrist. Flip hand over and perform cross fiber friction and circular friction to the palm.
16. End hand by pulling and fractioning each individual finger.
17. Apply lotion. Effleurage the entire arm and up the neck to the head and glide back down to the trapezius insertion on the shoulder. Repeat the trapezius move 2-3X. Lift arm and cross it over to the R side of the body. While holding the arm, reach under the scapula. Apply effleurage and knead the Rhomboid muscles. Be careful not to touch the spine. Work this area 3-5X.
18. Return arm to table and under the sheet (if client isn’t hot). Repeat steps 10 to 17 on the R arm and hand.

Abdominals, Legs and Feet:
Supine Position.
1. Provide breast drape for women and firmly tuck sheet under client’s pelvis. This is your barrier - Do not work under the sheet ever!
2. Apply lotion. Working clockwise so as to follow the pattern of the large intestine. Use light effleurage starting below the sternum, just below the ribcage, above the pelvic bones, under the ribcage on the lateral side and back up to the sternum. This should be a large, smoothly flowing circle. Repeat 3X.
3. Repeat clockwise circle with light circular friction. Petrissage abdomen, starting at the pelvic bone and pulling all the way up the torso to the scapula. Repeat step by moving to the R side of the table.
4. Apply lotion. Slide hands under the clients back. One hand on each side of the spine. (Like you are giving the client a hug around their lower back). Pull up and slide hands back around to the sides of the client. Repeat 2X.
5. Undrape R leg. Using effleurage, apply lotion to entire leg. Increase pressure to medium. Facing the calf and using the horse stance, roll thumbs down the calf moving from the ankle up to the kneecap. Repeat 2X.
6. Use fingers to apply pressure to the digitorum longus and brevis muscles in the calf. (Move up the sides from the ankle to the knee and glide back down to the ankle).
7. Move to the thigh. Use effleurage, cross fiber friction, forearm, fist, and petrissage to thoroughly work the entire thigh. Pressure should progress from light to deep. Redrape leg. Repeat steps 5-7 on the L leg.
8. Uncover R foot. Use effleurage, cross fiber friction, fists, and circular friction on the bottom of the foot. Run thumbs up the spine of the foot and spread fingers across the pads and balls of the foot. Run thumbs between each metatarsal bone on the top of the foot. Rotate ankles. Pull and use light friction on each toe. Repeat on L foot.

Back:
Prone Position.
1. Cover client’s back with the sheet. Stretch hips by applying pressure just below the pelvis, first on the R then on the L, or visa versa. Use circular friction on the glutes by first working medially and then rotate your circles out laterally until you reach the hip flexors. Work with circular friction back to the midline and increase pressure with each pass. Work this area for a minute or two.
2. Walk palms of hands up the client’s torso by applying pressure to either side of the spine. This loosens the erector spinea. Apply pressure with palms or fists to the trapezius muscles by first pushing on the R side, then the L, or visa versa.
3. Undrape the client’s torso. Tuck the sheet. This is your barrier. Do not work under the sheet!
4. Apply lotion to entire torso by using first light effleurage and then gradually work deeper. Repeat strokes 3-4X.
5. Apply lotion to your R forearm and run it up the L side of the client - below the 12th rib but above the pelvic bone. Use no pressure until you are on the erector spinea above the 12th rib. Repeat 2X.
6. Use both thumbs side by side starting at the trapezius and move down the erector. When you reach the pelvis, separate your hands so you L thumb moves just above the other pelvic bone. Glide back up to the trapezius. Repeat 2X.
7. Face the clients head in the archer position. Use effleurage strokes to loosen trapezius. Repeat 3-5X.
8. Cross fiber friction and circular friction on the rhomboids. Work area for 1-2 minutes.
9. Bend arm and tell client to relax their shoulder blade. Using both thumbs or palms, trace the rhomboids insertions on the scapula. Repeat 2X.
10. Unbend arm. Apply lotion to entire arm, including the scapula with effleurage.
11. Use fist on the flexors, then move to effleurage on the biceps and triceps. Circular friction on the deltoid. Repeat effleurage.
12. Compress and friction the teres major and minor as well as the infraspinatus (on the scapula). Effleurage. Redrape the arm.
13. Repeat steps 4-12 focusing on the client’s R side.
14. Fingers and then fists up trapezius all the way up to the occipital ridge. Repeat 2X then switch to the thumbs and run them down the erectors to the pelvis and drag hands slowly back. Repeat 2X.
15. Return to neck and petrissage or milk the neck.
16. Shampoo circles on the back of the neck, temperalis, and the occipitals.
17. Effleurage the entire torso.
18. Circular friction across the lower back. Circular friction on the glutes (working above the sheet) and any other nice polishing moves that are feather gliding. Redrape the back.

Hamstrings, Glutes and Calves:
Prone Position.
1. Undrape entire L leg, tuck sheet under R leg and apply lotion using effleurage.
2. Use effleurage 3X on entire leg.
3. Face client’s calf using the horse stance and use petrissage, friction and long gliding strokes with the forearm.
4. Transition to the hamstrings. Do not apply pressure to the back of the kneecap!
5. Use effleurage, transition into the forearm, cross fiber friction, petrissage, and fists up the illiotibial band (lateral side of the tigh).
6. Effleurage and feather stroke the entire leg and redrape.
7. Bend leg to stretch the quadriceps. Make sure to ask the client to tell you when they feel a stretch. (If they feel any uncomfortable pressure in the knee do not do this stretch).
8. Frog stretch. Once again, ask if the client feels a stretch. Work hip flexors with palm and fingertips. Straighten leg.
9. Repeat steps 1-8 on the R leg.
10. After you redrape the client’s R leg, perform light percussion to the entire body, starting at the top of the back and moving over the glutes, down the calf and back up, then switch sides (avoid the kidneys).

****** Do not perform any stretches on the elderly or anyone who has osteoporosis, or any other condition that is contraindicated. Remember to also keep your pressure light on anyone who fits into these categories as well.

The advent of drug therapy in the 1950s pushed hydrotherapy to the side. Today, practitioners realize the importance of hydrotherapy and use it in their everyday practices.

Effects of Cold Water:

• Improved circulation, simulating the nerves and awakening the functional activity of body cells.
• Prolonged use has a depressive effect.

Immediate effects of cold water:

• The skin is chilled.
• Surface blood vessels contract and blood is driven to the interior of the body.
• Nerve sensitivity is reduced. The functional activity of body cells slows.

The Three Stages of Sensation:

• Stage 1: Feels cold
• Stage 2: Pain, aching, and burning
• Stage 3: The cassation of pain or onset of numbness

Advantages of Cold Treatments:

• Decreased swelling
• Decreased pain

Disadvantages of Cold Treatments:

• Increased stiffness
• Many people have an aversion to cold

Effects of Hot Water:

• Immediate effect is to temporarily draw blood to the surface of the skin
• Local blood vessels dilate and increase circulation
• Moderately warm applications have a relaxing effect on the blood vessels, muscles, nerves, and promote the functional activity of body cells.

Advantages of Heat Treatments:

• Decreased pain
• Increased tissue extensibility (ability to stretch)
• Decreased stress response (use after stressful days)

Disadvantages of Heat Treatments:

• May cause increased swelling
• May cause secondary tissue damage if left on too long
• May cause fatigue
• May increase infection

When using Heat and Cold consider the following:

• Stage of injury or disease
• Area of body
• Medical status
• Client preference

Negative Reactions to Hydrotherapy:

• Cyanosis: blue lips or beds of nails
• Red marbling of skin: a small area is okay, but the entire limb is not
• Pain longer than 3 minutes
• Uncontrollable shivering or shivering that lasts longer than 1-2 minutes
• Cold extremities
• Fullness or congestion in the head - have client sit up; warm foot bath and cool compresses on the head
• Dizziness or lightheadedness
• Faintness, fatigue or nausea - have client lay down and give them sips of water

IF YOU SEE ANY OF THESE REACTIONS, IMMEDIATELY STOP OR MODIFY THE TREATMENT!!!!!

Contraindication for Hydrotherapy:

• Cardiac impairment
• Diabetes
• Lung Disease
• Kidney Infection
• Extremely high or low blood pressure
• Infectious skin condition

Injury Classification

Acute Injuries (7-10 days post-injury)

• Inflammation
• Pain at rest
• Pain with motion

Use cold only - cold packs, ice massage, cold whirlpool, cold/ice immersion. Mild heating may be used at the end of the acute stage if the majority of swelling and bruising is gone.

Sub-acute Injuries (7-21 days post-injury)

• Stiffness
• Mild inflammation
• Pain
• Development of scar tissue

Use cold and mild heat - same as acute + paraffin bath; moist, mild heat. Vigorous heating can be used only at the end of the sub-acute phase or if all of the swelling is gone. End all treatments with cold application.

Chronic Injuries (21+ days post-injury)

• Stiffness
• Pain with motion but improving
• Motion restrictions
• Scar tissue

All forms of cold and heat are okay, but base your decision on each case. If swelling is still present, vigorous heating is contraindicated. End all treatments with cold applications.

The purpose of electro therapy is to assist the body in its attempt to heal itself.

How Electro Therapy Works:

• “Short Circuit’s” the pain signals from the injury to the brain
• Reduces swelling
• Increases mobility
• Increases blood flow
• Expedites healing
• Increases scar tissue debris

General uses for electro therapy:

• Muscle spasms
• Pain control
• Edema or swelling
• Injuries
• Rehabilitation of muscular injuries or surgeries
• Rehabilitation of joint injuries*

* Excluding plastic or metal replacement joints.

Contraindications for electro therapy:

• Pregnancy
• Pacemakers or defibrillators
• Cancer of tumors
• Open wounds or sores
• Directly over the spine
• Over carotid arteries

*When in doubt do not use electrical modalities*

Man’s first cure for what helped heal him was water. It is instinctive to seek water when sick or injured. Ancient hunters learned this by watching injured animals treat their wounds in natural springs.

Many of the hydrotherapy techniques we are using today were first prescribed in ancient Greece and Rome. The Romans built elaborate and expensive baths for all citizens to enjoy. The baths were holistic health centers as well as social entertainment; Learning and exercise facilities.

The modern history of hydrotherapy saw the development of hydrotherapy as an important medical tool for both fighting disease and promoting health. This time period started in Europe in the early 1800s with Vincent Preissnitz (1799-1852). He was a Salesian peasant who used cold water to successfully treat problems in both animals and people. His success warranted the local government to build new roads to his clinic so he was able to take care of his patients.

Father Kniepp, who had an influence on hydrotherapy, was originally rejected from the priesthood due to his tuberculosis. He was able to cure himself through his diet and also the use of hydrotherapy. He was also able to cure others of this disease through the same method. He wrote My Water Cure and taught his methods to countless others including Benedict Lust and Henry Lindlar who brought Kniepp’s teachings to America. Benedict Lust was known as “the greatest menace to official medicine”. He founded the American Naturopathic Association and integrated hydrotherapy into chiropractors, massage therapy and physical therapy.

As late as the 1930s, hydrotherapy was still being taught and used in medical schools and hospitals in America and Europe. Today, practitioners of hydrotherapy include physical therapists, chiropractors, homeopaths, naturopaths, midwives, massage therapists, aqua-aerobic instructors, athletic trainers and colon hydrotherapists, to name a few.