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Anatomy of a Massage Session

Updated on February 8, 2013
A Massage Spa
A Massage Spa | Source

I have been a massage therapist for a little over two years and absolutely love what I do for a living. For me, it is deeply satisfying work. There is no greater pleasure than to have the skill to help someone feel better physically and mentally. In this country, massage is quickly becoming an essential part of a person's health regimen. The benefits are well documented and if they could be compiled into one long list, this list probably wrap the globe. I view it as a privilege to be part of something that is rapidly growing in popularity, and that is so good for people.

That being said, there are still some out there who have never had a massage and would like to try it, but feel shy. Or you may be one of those who are coming to have a massage for the first time because your significant other has persuaded or dragged you into this "new experience." This is the poor soul who sits in a chair in the massage center looking awkward and somewhat scared. Let's face it, the thought of lying on a table wearing only underwear or nothing at all, and letting a stranger touch you, even though you have a blanket covering you, is extremely intimidating. Some people don't even like to be touched by those they know and love, let alone someone they have never met.

Well, help has arrived. This article is for you, that awkward scared person who was persuaded to "try something new," and the one who has never had a massage, but would like to try. This is some helpful advice as to what to expect. I will take you through a massage session from beginning to end: the greeting, consultation, health form, the actual massage and post massage. Let's begin with the greeting.


The greeting sets the tone for the massage, especially for the first timer. When I come to the lobby to get the person for the massage I introduce myself and make sure to warmly shake hands. The spa where I work encourages the therapists to know the client's name and prior massage history if any, before retrieving the person they will massage. We have a computer in the back room so we can do this when we review our clientele for the day. When I come to the lobby and ask for the person by name, this has a way of putting my client at ease.

My connection with the client begins in the lobby of the massage center. I always give my regular clients a quick hug. First time clients get a hand shake, unless they are open to a hug. The greeting is when I start to get a sense of the person. I take note of body language; voice and appearance, all of these are indicators as to how he/she might be feeling. As I lead the person from the lobby to the room where the massage will take place, I make sure to touch the person's arm. This small gesture seems to break the ice so to speak and puts the person at ease. Sometimes, on the way to the room the client nervously tells me that they have never had a massage and asks me: "You are not going to hurt me are you?" They say this half jokingly. I joke right back to them, "No, not today I won't, I'm in a pretty good mood," then I wink. This gets some laughter. I then assure them that when I am done with the massage, they will be what we call a massage junkie.

Consultation and Health History

The next step after the greeting is the consultation and review of the health history form. Even though this process takes only takes a few minutes it is a very important step in the anatomy of the whole massage. The consultation phase of the massage is the opportunity for the client to discuss areas that he/she would like emphasis on, and also to inform the therapist about health issues or other concerns. One of the most common questions I get is: "Why do I have to fill all this out? This is only a massage, why do you need to know so much about my health? My health is a private matter." Yes, a person's health is a private matter, and because of this all the information disclosed on the health history intake form comes under HIPPA (Health Insurance Portability and Accountability Act of 1996). This is an act that prohibits medical professionals, or those involved in the health care field, of which massage therapists are a part of, from discussing a patient's medical information with anybody else but the patient, or in this case the client.

The other very important reason the health intake form is part of the massage process is because massage, not only affects circulation and lymph movement, but also affects many of the body systems. When the massage therapist knows what is going on health wise with the client, the therapist is better able to determine how to manage the client's health issue(s). A known issue can determine the amount of pressure that will be used, which techniques will or will not be employed, and even whether massage is appropriate for this person. Here are a couple of examples:

Massage and blood clots:

This is a serious health concern. Blood clots occur when blood thickens and lumps together or clots. Massage does have the potential to move a blood clot, although deep tissue massage is not recommended for someone suffering from this complaint. However, this does not mean that this person cannot receive massage at all. The therapist may decide to avoid massaging the legs. There are other modalities available to a person who has a problem with clots. Cranio-sacral and energy work are two very effective kinds of therapy. Another interesting modality I found out about was sound therapy which employs the use of music tones to promote healing in the body.

Massage and varicose veins:

This is a condition where the blood pools in the superficial veins of the legs because the blood in deeper veins has been pushed into them due to the valves that are not working properly in the deeper veins of the leg. This causes the superficial veins, meaning the veins closer to the skin, to become swollen and longer. People who stand, sit, or wear tighter clothing only exacerbate this condition. Not only does the condition tend to be unsightly, but it is painful, especially when walking. For a massage therapist, it means to proceed with caution. The therapist will have to make decisions on what techniques will be used depending on the condition of the veins. This does not mean someone with varicose veins cannot receive a massage. It just means the therapist may have to employ a different technique on this part of the body like myo-fascial release or lymphatic drainage.

The health history form not only contains questions about health, but it also may have questions about hobbies and occupation. Knowing these things helps a therapist know what muscle or muscle groups are being used or over used. Does the person sit at a computer all day? Does the person stand a lot? Is the person on the phone all the time? This information gives the therapist a good idea about why a person is sore or stiff in certain areas. From this point, the therapist can formulate a plan of action to help the client.

The consultation part of the massage also gives the therapist and client the opportunity to discuss expectations. What is the client looking to get out of the massage? Is this a relaxation massage? For the client who is receiving a massage for the first time I recommend this form. Is this a therapeutic massage? Meaning is the client looking to "fix" something, so to speak. A deep tissue massage is not a good idea for the first massage; it could scare the client off for good in most cases. Another aspect of the consultation is to talk about the kind of services the massage center may offer. Is aroma therapy available? Is heat or ice therapy available? Is hot stone massage offered?

Once the health history, expectations, and services are discussed I move on to the next step, which is to explain the massage room to the client. I point to the hooks and hangers on the wall. I explain to disrobe to the client's level of comfort. Usually, the first time client will ask for more clarification as to exactly what 'level of comfort' is. Does this mean to take off all clothes? Can underwear be left on? I explain that it means that if he/she wants to leave on all the clothes this is acceptable (I have done a few massages this way), it's whatever the person is comfortable with. The policy in the spa I work at is that a client can undress down to underwear only, nothing beyond. At this point, I show the client the massage table. If we have decided to start the massage face down or prone, I show the face cradle and explain where to put the face. If we have decided to start the massage face up or supine, I tell my client that I want the head and shoulders on the table. Usually, I just put the face cradle down so there is no confusion. One last thing I do before leaving the room is pull back the blanket on the massage table. I tell the client that after disrobing to get under the blanket just like climbing into bed at home.

I know all of this seems so fundamental! I used to think so myself. When I was in massage school my instructor drilled this massage room instruction into the students' heads. We were even graded on it! We would lose points if we left a client in the room without explaining the room to him or her. At the time, I thought my teacher was being overzealous about it, and then I started I know why my teacher was such a stickler about it. Every time I have neglected to explain the massage room to a new client I have walked in on a surprise! I have entered the room only to find my client sitting on the table in their underwear, or sitting on the table wrapped up in the blanket that was on the massage table, or laying on top of the blanket on the massage table. Some fellow therapists have returned to the room only to find the person sniffing the aroma therapy bottles while waiting for the therapist to come back. I have to admit one thing though, I do find it cute when I look down, and the client has left the socks on! (So far, I have had the good fortune to not walk in and find some one walking around in their birthday suit! I am only two years into my career though; I suppose it's bound to happen sooner or later).

The Massage

We have at arrived at our destination, the actual massage. Since this article is dealing with first time massage recipients, I will explain the strokes for a Swedish massage. This kind of massage consists of five strokes: Effleurage, this stroke is a long gliding stroke. It can be done with the hand or forearm. The next stroke is petrissage, this is kneading the skin, like kneading dough, this done with the fingers. The next stroke is compression. This is a consistent pressure to a certain area of the body, done with a fist, hand, or forearm. Tapotement, or tapping done with fingers, or with the hand in a karate chop fashion. The fifth technique used in Swedish massage is friction. This is used to warm muscle tissue or to “rub” a knot down.

Every massage therapist is different, and has his or her own way of beginning a massage session. I prefer to start my sessions with a simple breathing exercise I do with the client. I ask the person to breathe in through the nose and slowly exhale out of the mouth. This helps me to center myself, and focus on my client's needs. It allows me to "listen" to the body. For my client, it slows them down. They clear out any negative energy or emotion they have been carrying around. I like to begin over the blanket with long gliding strokes. It gets the circulation and lymph moving, but it also gives me a feel for the kind of energy the person is giving off. As I do compression I tend to gently rock the person, because it helps put them into a deeper relaxation mode. The breathing slows; the person breathes more with the diaphragm instead of the chest. At this juncture, the heart beat has also begun to slow down. This process is called the parasympathetic response, opposite of sympathetic response or fight or flight mode. I now have my person where I want him/her--entering la-la land! The muscle tissue is even beginning to soften under my hands. I pull back the blanket (during the massage, only the body part being worked on is exposed). Now I can begin the actual work.

As I have mentioned previously, every massage therapist is different, some like to start a person face up or supine, and some like to start face down or prone. Some massage therapists like to start at the person's head, and others like to start at the feet; there is no hard and fast rule on this. A massage routine should be comfortable and relaxing to the client. It should have a flow and rhythm to it and a logical sequence. The pressure a therapist uses should be to the client's liking. I always tell the person I am massaging to let me know if the pressure is too hard or light. Please don't scream silently into the face cradle as I blissfully give what I think is an enjoyable massage. The average cost of an hour massage is $50-$90 dollars, for that amount of money (especially these days) the massage should be a pleasurable experience. I always use the example of a meal in a nice restaurant; nobody would go to an eating establishment, pay that amount of money and suffer through a bad meal or bad service. Massage is no different; let the therapist know if something is not comfortable.

Other questions I get asked by clients are: Where do I put my arms? Is it okay if I sleep? What if I start snoring, or worse yet drool! Do I have to stay quiet the whole time? The answer to the first question is, typically the arms go down by the sides, but many people like to drape their arms over the sides of the table while face down. Massage tables usually have a device to accommodate this. There is an arm rest that can be attached to the front of the massage table so the arms can be placed there to rest. While a person is face up, some people like to keep the hands on the stomach or to the sides. As for sleeping and drooling, I say have at it! This the only profession I know of, that if someone falls asleep while in the presence of another person, it is a compliment! If they start drooling, even better! Don't worry, the sheets are stripped off the table after each massage and washed. I try to keep talking during the massage to a minimum. Some people talk because of nerves at first, but once they feel relaxed the talking stops. The reason I avoid getting involved in full fledged conversations during a massage is because it's most likely the only time during the day where the person can quiet the mind. Another reason I don't want the person talking too much, is because it's probably the only real quality rest this person gets. This is one hour where the person can leave whatever they have going on in life just be still physically and mentally for at least an hour.

When the massage session has come to an end, I repeat the breathing exercise that was done in the beginning. This is a slow way to disconnect with the client, this is important because during our hour session we have formed a bond, although unspoken. It is important that we each leave with what belongs to us energy-wise. When I end the session I silently give the person whatever energy belongs to them and I take back my own, then I slowly bring the session to an end.

As I did at the beginning of the session, I leave the client with some instructions before I leave the room. Sit up slowly; massage can lower blood pressure so it is quite possible to be a little dizzy. I tell my client that ounce they are finished dressing to crack the door open so I know, and I can back in with water.

Post Massage

When I have first time massage recipients I almost can't wait to get back to the room when the massage is done! I am always anxious to find out what they thought about the whole experience. So far in my two short years doing this, most of the time the reaction is positive. Many are converts immediately and can't believe they have been missing out on something like this for so long. Before they leave my room, I always explain to them the importance of making sure to drink water to flush out the metabolic waste that was stirred up, and to keep the muscle hydrated, so that any soreness that is typical a day or two after can be minimized or avoided. It is also normal to have a loopy relaxed or “out of it” feeling for awhile after the massage. This is what we call “massage drunk” it is a normal feeling, and my recommendation to clients is to lay low after a massage, and enjoy the feeling!

I hope this breakdown of the massage therapy experience addresses any questions or anxiety you may have had, and that you feel enticed to try this wonderful holistic modality for yourself. There has been the conception in Western health that something that "feels good" cannot be good for you, and that massages are only for the rich and spoiled. In truth, more and more Americans are discovering for themselves that the physical and mental benefits are immeasurable, and ounce begun, they continue to incorporate massage into their health regimen.


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