© Eleshia Venners-Howell 2011
The information contained herein shall not be used without
the express permission of the Author.
While massage therapy may be considered a
universal treatment approach, across the broad
community (and cultural) spectrum, there are a
few considerations that must be undertaken in
order to provide best practice and remain
within statutory guidelines.
Good interview skills
 Understand the client’s condition or special
 Determine client’s needs
 Establish your scope of practice in providing the
service being sought
 Maintain clear and informative communication
with all parties involved
 Undertake comprehensive and appropriate
 Adhere to relevant Code of Conduct.
While providing massage therapy for children and
adolescents is not much different from
providing massage to adults, it should not be
automatically assumed that they are ‘just little
Indeed there are numerous considerations to
respect and incorporate into your treatment
Baby massage (0-2 yo) is a separate modality
requiring specific training.
Growth & Development:
 Be aware of child’s stage of growth and
development. Prepubescent growth spurts begin
between 10-12 yrs of age and will dramatically
affect their body on a physiological level.
 Growth plates occur in all of the long bones of the
body and care should be taken not to apply
excessive pressure or dynamic stretching
techniques to the attachment sites of muscles in
these areas.
Children tend to be hypermobile in their joints
 Muscle tissue is much less dense, so be
mindful of pressure and apply superficial to
medium techniques.
 If providing corrective exercises, try to make
them fun – use household items, play
equipment, etc and keep the time frame short.
 During adolescence, take the signs / symptoms
of puberty into consideration, eg breast
development, hormones, body image.
Physical Contact:
 Thoroughly explain your intentions and ask
permission to engage in physical contact.
 Perform techniques over clothing if necessary.
 Respect if the child says ‘no’.
 Demonstrate on the parent/guardian present if
it will help the child to understand what you
would like to do.
 Instruct the parent to perform techniques if the
child is unwilling to co-operate.
Legal Requirements:
 In NSW a minor is legally defined as a person
less than 16 yrs of age. However, it is the policy
with most massage therapy associations that
no unsupervised treatment of a person under
the age of 18 be provided.
 The NSW Police Safety Check is now mandatory
for any person having direct, unsupervised
contact with a person under 18.
A minor must give consent for treatment, and
the parent or guardian in attendance must sign
their consent and be informed of all treatment
to be provided.
 The parent or guardian must remain in the
room for the entire duration of the treatment.
 Massage therapists are included under the
definition of Mandatory Reporters in NSW –
therefore obliged to report abuse or neglect.
Generally considered to range from 60 years of
age, but should be looked at on an individual
basis, depending on the health status of the
Massage can be extremely beneficial during the
aging process, as the integrity of body tissue
diminishes, some bodily functions begin to slow
and the onset of illness or age-related disease
takes effect.
Some special considerations when treating
elderly clients include:
 Postural distortions – as we age, the
intervertebral discs become narrower, and less
able to provide structural support to the spine.
Bone degeneration, arthritis, and ligament /
tendon laxity also combine to cause problems
with posture and mobility.
 Poor skin integrity – thinner skin, less fatty
tissue mean greater risk of skin tears, bruising.
Poor circulation – especially to extremities.
 Medications – always ask what they are taking
and for what condition(s). Have a good
understanding of side-effects and any
pharmacological contraindications.
 Nutrition & activity levels – can both be poor as
age progresses.
 Financial constraints
 Decreased cognitive function – client must be able
to understand your communication. If not, request
a third party to be present.
Chronic illness is defined as a disease, injury, or
syndrome that shows either little change or
slow progression. (Fritz, 4th Ed.)
“Healing” may not be an option – or may be a
long, slow process.
Providing management of pain / symptoms,
stress relief, nurturing touch & support is often
the role of a massage therapist.
Work in co-ordination with other allied health
Gain an understanding of the progression of
client’s condition, to better prepare future
treatment plan.
 Medications – side-effects, contraindications.
 Be aware of energy needs of the client, and
their reaction to massage techniques. Minimise
undue duress / harm, including infection
control (compromised immune system??)
In general terms, a disability can be defined as a
conditions that, in some way, hampers or
hinders a person in terms of their ability to
carry out activities of daily living (ADL’s). The
extent to which a condition hinders a person’s
ability varies between individuals.
Disability is a multi-dimensional experience* for
the person involved: body structure & function;
activity; participation.
(*including the impairment / restrictions thereof)
Self care, mobility and communication are listed
as being critical elements in assessing
The World Health Assembly (2001) adopted the
International Classification of Functioning,
Disability and Health (ICF):
• mild - where a person has no difficulty with self
care, mobility or communication,
but uses aids or equipment;
moderate — where a person does not need
assistance, but has difficulty with self
care, mobility or communication;
severe — where a person sometimes needs
assistance with self care, mobility or
communication; and
profound — where a person is unable to
perform self care, mobility and/or
communication tasks, or always needs
People with a disability can benefit from massage in
many of the same ways as any other individual.
Openly discuss with the client (wherever possible) to
determine their needs:
- Positioning
- Mobility / vision / hearing aids
- Desired outcomes
- Appropriate time-frame for treatment, and suitable
*Refer to Ch12 Fritz for further information
Encompasses developmental disorders, psychiatric
conditions, learning disorders and emotional
*assess the risk of personal harm when dealing with
unstable psychiatric conditions – request a 3rd
party be present during treatment.
Ensure the boundaries of the client-therapist
relationship are clear and the client fully
understands the process being undertaken for
physical assessment and application of massage
therapy techniques.
Be aware of client’s emotions and comfort during
treatment session – touch may need to be
introduced gradually. The mind-body connection is
powerful and massage may trigger an emotional /
physical reaction.
Massage can be calming, grounding, sedating,
stimulating, supportive, respectful and
pp586 -590 Fritz, 4th edition has some helpful information
on this topic.
Therapeutic touch has a way of reaching a
terminally ill client on an emotional and
spiritual level, as well as a physical one.
Massage can help to relieve anxiety & stress,
provide pain relief and encourage emotional
Massage combined with aromatherapy has been
shown (in numerous studies and clinical
experience) to provide the most beneficial form
of treatment.
Apart from providing pain relief, there is often not
much on a ‘physical’ level that massage can
However, on the emotional level, the gain is
• Makes them feel special
• Nurturing touch
• Empowering – they can choose what they want,
as opposed to being told (by doctors, family etc)
what they must have / do.
Always maintain good communication between
client, family, medical / allied health professionals.
 Assess the client’s individual needs and set of
circumstances before determining the most
appropriated course of action.
 Work within your scope of practice, professional
conduct principles and legal guidelines.
 Document thoroughly!
 Remember the first rule of being a health care
provider....first do no harm!

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