ITEC HOLISTIC MASSAGE CASE STUDY 1

Mr M.T. is a male in his mid-twenties, and he works full time in a busy hotel. He is a doorman, and his job consists in welcoming the people and unloading luggage from their cars before parking vehicles in a nearby garage (0.5 miles) for the hotel's customers; he has to go to this garage several times a day, and he finds his job very stressful and physically and mentally challenging, as he is often rushing back from the garage or hurrying there to collect a customer's car. He must always stay alert and remember many things at the same time. He works standing or walking: the only occasion to sit is the brief car journey from the garage to the hotel or vice-versa. He works mainly outdoor, but his very smart uniform is not adequate for all the weather conditions, and he is often cold, especially in his fingers, which are a little bit swollen.
He lives with his girlfriend in South London, and he enjoys playing tennis and football during his free time.
He describes himself as fairly healthy, and he had two major operations, a surgery after a car accident about 6 years ago and a menisco hectomy on his right knee four years ago He is very proud and happy of his job, and he likes travelling to faraway destinations to clear his mind.

He sought massage hoping to experience a reduction in the pain and muscular tension he feels in his back and the feeling of floppiness and tiredness in his legs.

CLIENT'S PERSONAL DETAILS:

Name Mr M T

Address CONFIDENTIAL

Telephone (Home/Work) CONFIDENTIAL

Emergency Contact CONFIDENTIAL

Where did you find out about my practice? Word of mouth




MEDICAL DETAILS:

Doctor's name and address: CONFIDENTIAL

Have you visited your GP or the hospital within' the last 5 years? YES (Blood Test)

List any ongoing health complaints and any medication you are taking: sometimes client experiences localised backaches.

Do you suffer from any allergy? N

Do you wear contact lenses? N

Permission to contact doctor yes




CONTRAINDICATIONS TO MASSAGE

There are some contraindications to massage requiring medical referral or the client to indemnify their condition in writing prior to the treatment and some contraindications that restrict treatment

PLEASE UNDERLINE THOSE CONDITIONS WHICH APPLY TO YOU IF ANY. ¨ With medical, GP or specialist permission - In circumstances where written medical permission cannot be obtained clients must indemnify their condition in writing prior to treatment

¨*pregnancy *cardio vascular conditions such as thrombosis, phlebitis, hypertension, hypotension or any heart conditions *haemophilia *any condition already being treated by a GP or another complementary practitioner *medical oedema *osteoporosis *arthritis *nervous or psychotic conditions *epilepsy *recent operations *diabetes *asthma *any dysfunction of the nervous system as muscular sclerosis, Parkinson's disease, motor neuron disease, Bell's Palsy *trapped or pinched nerve like sciatica *inflamed nerve *cancer *postural deformities *spastic conditions *kidney infections *whiplash *slipped disc*undiagnosed pain *when taking prescribed medications *acute rheumatism.

Contraindications that restrict treatment
*Fever *contagious or infectious diseases *under the influence of recreational drugs or alcohol *diarrhoea and vomiting *skin diseases *undiagnosed lumps and bumps *localised swelling *inflammation *varicose veins *pregnancy-abdomen *cuts *bruises *abrasions *scar tissues- 2years for major operations,6 months for a small scar *sunburn *hormonal implants *abdomen-first few days of menstruation, depending how the client feels *haematoma *hernia *recent fractures-minimum 3 months *cervical spondylitis *gastric ulcers *after a heavy meal *conditions affecting the neck.

PLEASE NOTE THAT IT IS IN YOUR INTEREST ANSWERING HONESTLY TO ALL THE QUESTIONS IN ORDER TO TAILOR MAKE THE BEST TREATMENT SUITABLE FOR YOUR SPECIFIC NEEDS. ALL THE PERSONAL DETAILS PROVIDED ARE STRICTLY CONFIDENTIAL
ABOUT YOU AND YOUR LIFESTYLE

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stress level at home 1 2 3 4 5 6 7 8 9 10
List the factors that make you feel stressed at home : no stressors at home, sometimes thinking about work on uncertainty about his future shifts can make the client feel stressed.
Typical breakfast: a bowl of cereals with whole milk, or a sandwich and a coffee.
Food eaten more often? Favourite foods? : pizza, pasta, sushi, sashimi.
Do you pay attention to your calorie intake? (Y) (N) If yes, state your average calories intake UNKNOWN
Would you say you have a well balanced and varied diet?
The diet is varied but the client feels his diet is not well-balanced, as some days he eats regularly (breakfast,luch and dinner), but this often does not happen when the client is at work, as if he only has a few minutes break he feels in a rush to eat and does not enjoy his lunch properly.
Are you vegan, vegetarian, or do you follow any particular diet? Please provide brief details N/A
What do you drink on a typical day? Water, coke, tea and coffee.
List any vitamin or mineral supplements or herbs you take NONE
Average hours of sleep 8
Smoker? If yes, state how many a day 5 to 10
Do you drink tea/coffee? If yes, how many a day? 3a day

Do you drink alcohol? Occasionally

If yes, how many drinks/glasses a week? 2 to 4

Hobbies/leisure PC, travels

Do you do any sport? Tennis, football How many hours a week? 2
stress level at work 1 2 3 4 5 6 7 8 9 10
Work pattern: day/night, shifts. Different day shifts. (6.30-16.00; 10.00-18.30; 15.00-22.30; 17.00-01.30 )
List the factors that make you feel stressed at work:
people, taxi drivers, noise, congestion, pollution.

To provide four full body massage sessions lasting approximately 1 hour each 1 week apart, to promote relaxation and relief from muscular stiffness, paying particular attention to the neck, the shoulders and the lumbar area, and to reduce the feeling of fatigue and floppiness in the legs, therefore concentrating on hamstrings and the gastrocnemius. I will avoid putting pressure on the right patella and knee, because of the client's previous surgical intervention to the meniscus.
The massage will be smooth and slow, the movements deep and rhythmical, and the transition between strokes will be barely perceptible. The strokes used will be mainly effleurage, petrissage and kneading, performed at a constant and unhurried tempo avoiding percussive movements, to help reduce stress and tension, and to promote a feeling of physical and mental well-being.

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TREATMENT ONE
DATE: 01/ 03/ 2008
Feelings before treatment: The client feels stressed and very tired after 6 consecutive days of work. He is happy to receive a massage and in a good mood because he will now have two days off work.
Treatment given: Full body massage avoiding percussive movements, in order to stimulate total relaxation.
Therapist's observations: the client's muscles feel very tense, especially in the cervical area and his shoulders are stiff. His legs muscles are contracted, especially in the calf area.
FEEDBACK FROM CLIENT:
Feelings during massage: the client felt good throughout the treatment.
Feelings after massage: feeling of well being and relaxation. Increased micturition. The client feels purified as if the massage had cleansed his body and freed it from toxins.
The client felt good after the first treatment, and declared that his stress level dramatically dropped. He felt relaxed and self-contented, and he believes that the massage session also improved his level of mental well-being.

HOME CARE ADVICE/REFERRALS:
I recommended avoiding tight clothes, that may apply pressure and restrict the blood and lymphatic circulation especially on the legs, giving that feeling of fatigue and heaviness. Also, I told the client that a strong and greasy hand cream may be required under his gloves, and perhaps another pair of cotton protective gloves underneath those of the uniform, in order to improve hand and fingers protection and isolation against cold, wind and rain.
REFLECTIVE PRACTICE:
I performed a slow and rhythmical massage routine, starting from the back, then going to back of legs (to which I dedicated a longer amount of time as I felt this to be necessary in order to relieve the tension in the lower side of the gastrocnemius), and a shorter amount of time to the front of the body.
Mr. M's hands and fingers looked swollen. As he warned me, he had worked for 6 consecutive days in a row in the wind and cold weather. Despite wearing gloves, his fingers and hands were swollen, therefore I preferred not to massage the hands and fingers, as this could have worsened the situation.

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TREATMENT TWO
DATE: 08/03/08

Feedback from last treatment: the client felt relaxed and enjoyed his week-end off. However, once back to work, his stress level and muscular stiffness increased.
Feelings before treatment: the client feels tired and powerless, however, he will have to work early in the morning tomorrow.
Treatment given: full body massage. This time I decided to try a different type of massage, stimulating and invigorating, including percussive movements, effleurage du poign and heavier pressure on acupressure points on the back and back of legs. This is because the client has to work soon and I do not want him to feel more tired, too relaxed or lazy after the session.
Therapist's observations: I noticed less stiffness in the cervical area, and the client said that he did not experience any neck or back pain since the last massage session. I also noticed that his skin was moisturized and not as dry as I had found it the previous week. This time I massaged also hands and fingers, as they were not swollen.

FEEDBACK FROM CLIENT:
Feelings during massage: the client was awake during the course of the whole session. He relaxed but he felt that this time the massage was deeper and more invigorating.
Feelings after massage: Client was happy as said that he felt like brand new at the end of the session.

HOME CARE ADVICE/REFERRALS:I told the client to continue using a good skin moisturizer for his body and face. The condition of his hands also slightly improved as he started applying thick hand cream and an extra pair of protective gloves.

REFLECTIVE PRACTICE: I noticed that the client was sometimes moving and readjusting his position on the couch. This was not because he did not enjoy the session, but he could not reach the same level of deep relaxation he achieved during the previous session. This was caused by the fact that I had decided to perform a tonifying and invigorating massage, by applying more pressure and using more my body weight. Perhaps I should have been a little softer.

TREATMENT THREE
DATE: 16/03/2008
Feedback from last treatment: the morning after having received the treatment, the client felt less tired than on the previous days. It was not hard at all to get out of bed and he felt full of vitality and energy.
Feelings before treatment: the client has felt anxious and stressed, as he had to change his plans for Saturday and reschedule his day: he was supposed to be off work, but he has been called-in last minute to cover a 10.00 to 18.00 shift. He told me his job makes him feel pressurized and angry at times. He had to call me to rearrange the massage session for the following day, and this added up to his tension and worries. He was still angry for the previous day and nervous. He asked me if I could try and make him relax as much as I could, and I tried my best by paying particular attention to the atmosphere in the therapy room, making sure that the temperature and the volume of the music were suitable, and proceed to the massage with soft and soothing strokes.

Treatment given: full body massage to improve relaxation of the muscular tissues and elimination of toxins and waste from the skin.
Therapist's observations: the continued use of hand cream dramatically improved the condition of the client's hands and fingers. The finger joints were not painful as they used to be. I also noticed that the client fell in what seemed to be a light sleep during the massage. I invited him to free his mind from the thoughts of work and imagine that the massage table was placed in the middle of a green field with lush vegetation and tropical flowers. All of his muscles were relaxed and I did not notice any particular area of stiffness.
FEEDBACK FROM CLIENT:
Feelings during massage: the client was still and relaxed. He felt that the massage had been very beneficial and allowed him to completely forget about work- a successful escape from reality, as he enjoyed the picture of being surrounded by plants and beautiful flowers, and the warm temperature in the massage room made him feel like if it was summer.
Feelings after massage: the client took a few minutes to get off the couch. He felt so relaxed he wished the session had not ended so early. He experienced increased micturition and he was thirsty.

HOME CARE ADVICE/REFERRALS: now that hand cream and body moisturizer entered the client's routine, I recommended to pay more attention to his diet. Increase fluid intake, especially water or fruit juices, trying to avoid fizzy drinks or too many coffees or energy drinks at work, which could add on the caffeine intake and help the building up of toxins.

REFLECTIVE PRACTICE: It looked as if the client did not want to turn around for I could massage the front of his body: perhaps I should have asked if he wished me to continue and concentrate for longer on his back.

TREATMENT FOUR
DATE: 22/03/2008
Feedback from last treatment: the client told me he had greatly enjoyed the previous session and that he was looking forward to receive another massage. He said he had drunk a lot of water during the previous week, and he started to notice that his skin condition had improved, as it was no longer dry and flaky.
Feelings before treatment: the client is happy because he will soon be going on holidays with his girlfriend, however he feels nervous as they just had an argument about the destination. He does not want the holiday to represent an extra stressor and just needs to relax.
Treatment given: I opted again for a relaxing full body massage, to help the client free his mind from any unpleasant thoughts. I performed some light percussive movements; however, most of the massage routine I have chosen for this session consists of effleurage and petrissage.
Therapist's observations: I could see the client moving and readjusting his position on the couch several times during the session.

FEEDBACK FROM CLIENT:
Feelings during massage: the client enjoyed the massage and said it was beneficial, however, he admitted he could not relax completely as his mind was full of thoughts.

Feelings after massage: the client felt better, his muscles were more relaxed and he felt he was now ready to face again the holiday destination topic with his girlfriend. He said he will try in any possible way not to argue, and this was made easy by the fact that he felt really good and positive after the massage session.

HOME CARE ADVICE/REFERRALS: I told the client to buy plenty of sunscreens for his holiday, as he told me that it would certainly be in a seaside resort. I recommended high sun protection such as 30 for the first three to four days, which could then be reduced to 25 to 20 for the rest of his stay. The client's skin tans quite easily and scarcely ever gets burnt, however, I recommended a higher protection in order to prevent skin ageing and dehydration, loss of elasticity and wrinkles.

REFLECTIVE PRACTICE:
The fact that the client was re-adjusting his position on the couch made me increase the speed of the massage. I should have not allowed the feelings of the client to interfere with the massage speed. I am the therapist, therefore I set the rhythm of the massage and its speed and the amount of pressure applied. I realized I had increased the speed after a while, therefore I slowed down and went back to a more relaxing and soothing rhythm.

Mr M T greatly enjoyed his sessions, and from now on he intends to have regular massage treatments, at least twice a month. He felt that the massage had been beneficial both for his body and his mind, also thanks to the holistic approach of considering a person as a whole, as a particular individual, similar to others but different from anybody else. Also, he greatly appreciated the advices regarding the use of cream: he told me he never thought that simple operations such as wearing protective cotton gloves could improve so much the condition of his fingers. He believes that massage helped him to live a healthier life and improved also the quality of his diet and his hands.

Disclaimer (to be signed by both therapist and client)

I................................................................... confirm that I have understood the treatment that I am to receive and confirm that I am willing to proceed without confirmation from my own GP or consultant.
I hereby indemnify the therapist against any adverse reaction sustained as a result of the treatment.