Spa Bodyworks

E D I T I O N
SPA BODYWORK
A Guide for Massage Therapists
A n n e W i l l i a m s, LMT, CHT, BFA
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Acquisitions Editor: Jonathan Joyce

Product Manager: Linda G. Francis
Marketing Manager: Leah Thomson
Design Coordinator: Joan Wendt
Compositor: Absolute Service, Inc.
2nd edition
Copyright 2015 Anne E. Williams
Copyright 2007 Anne E. Williams
351 West Camden Street
Baltimore, MD 21201-2436 USA
Printed in China.
All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any
means, including photocopying, or utilized by any information storage and retrieval system without written permission
from the copyright owner.
The publisher is not responsible (as a matter of product liability, negligence, or otherwise) for any injury resulting from
any material contained herein. This publication contains information relating to general principles of medical care which
should not be construed as specific instructions for individual patients. Manufacturers product information and package
inserts should be reviewed for current information, including contraindications, dosages, and precautions.
Library of Congress Cataloging-in-Publication Data
ISBN: 9781451176780
Cataloging-in-Publication Data available on request from the publisher.
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will be pleased to make the necessary arrangements at the first opportunity.
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Acknowledgments
Writing and producing Spa Bodywork: A Guide for Massage

Therapists has involved the contributions of many people,
some of whom are unknown. I am thankful to all of them
and would like to acknowledge those who stand out here.
I am grateful to have had the opportunity to work with the
team at Lippincott Williams & Wilkins, and I am thankful
for their tireless enthusiasm and hard work. I would particularly like to thank Linda Francis for her great organization,
understanding, and support. I also want to acknowledge
Pete Darcy who approved the proposal for the first edition
of Spa Bodywork and suggested me for the Massage Mastery
project. Pete, Ill always appreciate your creativity, vision,
and insight. Many thanks also to Spa Bodyworks first project
manager, David Payne, who was always sensible and practical (while remaining flexible) and to Susan Schlosstein who
inspired me with her support and interest.
During its development, Spa Bodywork has been reviewed by
a number of professionals in the massage industry, each of
whom have given thoughtful and helpful input, so I would
like to thank them for their time and contribution.
Thanks to the photographer Mel Curtis and his team,
Connie and Doug, for their visual contribution to the first
edition of the book and to Rick Giase for the additional
photos needed for the second edition of the book. Thank
you also to June Pendleton of Universal Companies and
Professor Jim Simon of Rutgers University for help with
some of the images. Thank you to the team at Savi Day Spa
for allowing us to use their facility for the location shots,
especially Kelly Wilson and Mary Wilson. Thank you to
the models that gave up their weekends and did their best
with body mechanics on the slippery floor! The models
were Debbie Bates, Destiny Harrison, Catharine Jakeman,
Sunny Kim, Melody Lickert, Faithann McVeigh, Natalie
Mayer-Yeager, Erin Murphy, Earl Nabritt, Jason Priest, Keith
Shawe, Jenni Shires, Jill Wells, and Tiffany Williams. In the
second edition, thank you to Ronie Werner, Aleya Littleton,
and Brian Halterman.
The material for this book was originally developed for four
different spa programs, and so I am deeply grateful to the
individuals who believed in spa/aromatherapy training for
massage therapists and were willing to invest in the equipment and training necessary to launch these programs.
These individuals include Feliz Rodriguez for the original
program at Ashmead College and Meredyth Given, Kim
Lothian, Lorine Hill, Siri McElliott, and Eric Rasmussen for
the second program at Ashmead College (Washington and
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Oregon). Chris Froelich and the team at Somerset School of

Massage Therapy (New Jersey), Ray Siderius and Jill Stanard
and the team at Oregon School of Massage Therapy
(Oregon), and Lisa Hensel at Seattle School of Reflexology
for the Reflexology Foot Spa Workshops.
I want to say a grateful Thank you to Keith Shawe whose
considerate feedback on the first edition and unwavering
support helped me develop my confidence and skill as a
writer.
I extend my sincere appreciation to my family and friends
for understanding when I couldnt be at events because of
the book and for their unwavering support and encouragement during the time that I was writing. Thank you to
Mom and Dad; Jill Shawe; Cindy, Larry, Jason, and Sarah
Rantanen; Pam, Kurt, Joe, Gloria, and Natalie Mayer; Rick,
Sharon, Jeff, and Gayle Selden; Anthony Knoll; Derek
Peace; Deanna Scalf; Edana Biddle; Gretchen Pelsma; and
Kim Virant. Thank you to my amazing and inspiring fitness
trainer, Burt Henry.
I am especially grateful to my rock climbing and adventure family who keep life in Colorado so fun. Thank
you Abram Herman, Jon Barr, Jessica Barr, Ronie Warner,
Arthur Nisnevich, Michael Pastko, Tyler Knowles, Adele
Schopf, Chris Devenney, Ryan Jaret, David Weinstein,
Christy Sims, Tiffany and Zack Shocklee, Aleya Littleton,
and Brian Halterman.
I would also like to thank the amazing massage and spa professionals, spa instructors, aromatherapists, administrative
staff, workshop participants, and individuals who I have had
the privilege of working with and learning from, especially
Alicia Chapman, Alla Kammers, Amanda Flynn, Amy Klein,
Amy Stark, Andrea McClelland, Andrea Niemeyar, Andrew
Biel, Angie Parris-Raney, Angie Patrick, Angie Schneider,
Anita Harper, Ben Benjamin, Bill Fee, Bill Langford, Carey
Rosen, Carrie Ebling, CG Funk, Cherie Sohnen-Moe, Cheryl Young, Chris Damalas, Christy Cael, Cindy Babb, Cliff
Korn, Clint Chandler, Cynthia Ribeiro, Darren Buford,
David Christian, Debra Persinger, Deby Giske, Dennis
and Gina Simpson, Diana Thompson, Elan Schacter, Erin
Murphy, Faithann McVeigh, Felicia Brown, Gemini Sanford,
Geraldine Thompson, Gini Ohlson, Ingrid Martin, Jack Elias,
Jacki Borde, Jade Shutes, James Sutherlin, Jan Schwartz, Jeff
Mahadeen, Jenni Shires, Jenny Good, Jesse Cormier, Jill Stanard, Jim OHara, Jolie Griffin, Judy Scheller, Julie Carico,
Kate Bromley, Kate Zulaski, Katharine Appleyard, Kathy
Thielen, Katie Armitage, Kim Precord, Kitty Lawrence, Lara
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iv
Acknowledgments
Bracciante, Laura Allen, Leslie Young, Lincoln Heartsong,

Margie Miller, Marla Gold, Marsha Elston, Marti Mornings,
Mary Ann Foster, Mary Bryan, Meghan Lawrence, Melanie
Hayden, Melody Lickert, Pat Archer, Patty Glen, Rick Garbowski, Rick Rosen, Roger Patrizio, Roz Burnet, Ruth Werner, Scott Dartnall, Shannon Alyea, Shelly Johnson, Su Bibik,
Susan Salvo, Terri Zelepuza, Til Luchau, Tom Lochhaas, Veronica McHugh, Vickie Branch, Vicky Karr, Victoria Roberson, and Whitney Lowe.
Thank you to everyone at Associated Bodywork & Massage

Professionals, with a special thank you to our leaders, Les
Sweeney and Bob Benson, and to our education team Cindy
Williams, Kathy Laskye, Taffie Lewis, Katie Mills, Kristen
Coverly, and Brian Halterman.
Last but not least, thank you to my amazing partner, Eric
Brown, for being an inventive thinker and collaborator and
an endless source of wisdom, support, and inspiration.
I would like to dedicate the second edition of Spa Bodywork:

A Guide for Massage Therapists with love to my dear friend, Erin Murphy, who
is an inspiration to massage and spa students, fellow teachers,
administrators, and professional therapists who have the
privilege of working with her and knowing her.
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Preface
Spa Bodywork: A Guide for Massage Therapists is primarily a

textbook for the massage student enrolled in a spa program. It is also a guide for the practicing massage therapist
who wishes to add spa treatments to a private practice or
work in the spa profession. To some extent, the text can be
used by estheticians to improve their product knowledge
and develop new skills for full-body skin care.
As the title implies, Spa Bodywork aims to illuminate
the powerful links between massage and spa treatments.
Many of the spa products often used just for beauty have
the same physiological effects as massage or act in synergy
with massage techniques. Seaweed, for example, stimulates
local circulation and metabolism and supports the natural
detoxification process of the body. Many useful minerals in
seaweed can be absorbed through the skin. Seaweed treatments can have a pronounced effect on the thyroid, so they
must be used carefully. This requires a good knowledge of
the products and application methods being used. Similarly, therapeutic mud such as Dead Sea mud and Moor
mud have proven anti-inflammatory properties, so they are
used in Europe to treat arthritis and other musculoskeletal
disorders. Such products can be used to support relaxation
and stress reduction or as part of a treatment plan for injury
rehabilitation.
Spa Bodywork breaks each spa treatment down into an
easy-to-understand sequence of steps that have been carefully
designed to provide an efficient routine for the practitioner
and a satisfying experience for the client. It gives instructions
for standard methods of delivery as well as for some creative
options that make sense when the service is provided by a
massage therapist. In these cases, the service is designed to
incorporate a natural healing substance such as mud, seaweed,
shea butter, or essential oils into the massage. Clients do not
have to give up their massages to enjoy spa treatments.
The basic concepts and application methods covered
earlier in the book lay the foundation for more advanced
techniques that are described in later chapters. All aspects
of a treatment are addressed including indications and contraindications for the treatment, equipment needs, product
choices, promotion, combining one service with another,
and client management during the treatment.
Although wet room treatments (i.e., treatments that depend on expensive hydrotherapy equipment such as Vichy
showers) are discussed in Chapter 5 and 6, the emphasis
is on the delivery of spa treatments in a dry room setting
(no shower). This makes the book usable in a wide range of
surroundings because it shows how spa services that are usually thought to be too difficult to deliver in a dry room (e.g.,
seaweed and mud) can be used in both the day spa and small
private practice without the need for expensive equipment.
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Organization and Structure

Spa Bodywork is practical and comprehensive in its approach.
For example, spa instructors will find that the materials
are presented in a format that can be easily referenced and
that is flexible enough to allow them to use as little or as
much of the information as they choose. Students can be
directed to the treatment considerations and procedure
section, whereas advanced therapists will find the detailed
background on spa products useful. The topics have been
divided into three main areas.
Part 1: Spa Foundations
Part 1: Spa Foundations provides a framework for massage
therapists venturing into the world of spa. The first chapter gives a history of the spa industry and defines the types
of spas that are common in the United States. Chapter 2
describes the equipment needed to deliver spa treatments
and the different types of spa products therapists encounter
in spa body treatments. In Chapter 3, client and therapist
safety issues such as ethics, scope of practice, sanitation and
hygiene, cautions, contraindications, and safety protocols
are discussed. Although skin care is out of the scope of practice for massage therapists in most states, every therapist
working in a spa should have a basic understanding of the
skin. This information is provided in Chapter 3 along with
a clear discussion of scope of practice restrictions related to
spa work for massage therapists.
Chapter 4 (Your Spa Massage) is a new topic added to the
second edition to support new therapists as they venture
into spa work. It looks at the subtle elements of massage
application that help create a vivid and lasting positive
impression for clients. It also explores the creative use of enhancers to elevate the massage experience toward an artistic
expression of touch that exceeds client expectations.
Chapter 5 teaches core techniques that are essential to
the effective application and removal of spa products. These
techniques include modest spa draping, positioning the client for product application, and removal techniques for the
dry room and wet room. In Chapter 6 (Water Therapies),
the basic principles of hydrotherapy are discussed together
with the proper use of wet room equipment such as Vichy
showers, Swiss showers, and hydrotherapy tubs.
It is important to have a solid understanding of aromatherapy when working in a spa environment. Chapter 7
introduces aromatherapy, provides an overview of the
physiological and psychological effects of essential oils,
describes basic methods of application, and presents
some simple ways to add essential oils to any treatment.
Smell-scapes refer to the aroma landscape that a therapist
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vi
Preface
creates to enhance a spa treatment. This concept is defined,

and readers are given practical advice about creating a variety of unique smell-scapes. New to the second edition is an
extended discussion on methods for blending essential oils
creatively and safely.
Part 2: Spa Treatments
In Part 2: Spa Treatments, the lessons learned in Part 1
become a stepping-stone for more advanced techniques.
Common treatments delivered routinely at most spas are
described in step-by-step detail in Chapter 8 (Exfoliation
Treatments) and Chapter 9 (Body Wraps). In Chapter 10
(Spa Foot Treatments), reflexology, satisfying massage techniques, and various products such as clay and seaweed are
combined for pain-relieving and revitalizing foot services.
The sample treatments described at the back of the book
for each chapter demonstrate how basic treatments can be
combined with different treatment concepts and promotional descriptions to create many ready to use treatments
or inspire therapists to create their own services.
Fangotherapy, the use of clay, mud, and peat for healing
purposes, is discussed in Chapter 11. This chapter looks at
the traditional use of fango in Europe as well as its evolution in the United States. Popular relaxation treatments are
described, as are the use of fango for acute, subacute, and
chronic muscular conditions.
In Chapter 12 (Thalassotherapy), the therapeutic benefits of seaweed are explored in relationship to a number
of popular services. In each of these chapters, traditional
approaches are described along with variations in techniques and creative departures that suit the special skills
of a massage therapist and allow application in a dry room
environment.
Stone massage (Chapter 13) is a popular massage system at spas and clinics across the country. It requires focus
and commitment to the treatment, attention to detail, and
excellent massage skills. The routine taught in this chapter walks the reader through the basic elements of a stone
massage before teaching more advanced techniques that
require practice. The goal is to move beyond effleurage with
stones to a more satisfying form of bodywork that includes
a variety of techniques, including deep tissue and range of
motion work. New in the second edition is an increased
focus on working with stones safely. Associated Bodywork &
Massage Professionals (ABMP), the largest massage therapy
association in the United States, reports that burns from
hot stone massage are the highest liability claim area experienced by massage therapists. The revised Stone Massage
chapter in Spa Bodywork is based on best practices for safe
stone massage as required by ABMP for stone massage
liability insurance coverage.
Ayurvedic-inspired spa treatments and Indonesianinspired spa treatments are based in countries that have
rich histories and complex cultures and described in
Chapter 14. The environment, the people, the traditional
medical systems, and the myths from India and Indonesia
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come alive through these massage methods, natural spa

products, and unique treatments. The first section of this
chapter explores ayurvedic bodywork and spa applications
including Indian head massage, abhyanga, udvartana, and
shirodhara. The second section of this chapter looks closely
at the natural plant products from Indonesia, which infuse
their medical and spa practices with luxury and opulence.
For students who are rapidly advancing in their spa skills,
ayurvedic and Indonesian treatments will offer some new
challenges that keep learning fun and interesting.
Part 3: Your Spa Career
Part 3: Your Spa Career helps massage therapists bring all of
their new skills together into well-designed spa treatments,
a spa program, a signature spa service, and a satisfying
spa career. In Chapter 15 (Your Spa Program and Menu of
Services), therapists explore their personal life missions and
visions and weave these into a spa philosophy to inform
their ideas about meaningful spa programs. Individual
treatment design and in-depth session planning help readers turn standard spa applications into multidimensional
and dynamic pieces of performance art in Chapter 16 (Treatment Design and Your Signature Spa Treatment). Chapter
17 (You in the Spa Profession) looks at career opportunities
and choices to help students plan their first career steps after graduation. An expanded section on starting a private
practice or spa that includes spa bodywork treatments is
new in this second edition.
Chapter Organization
Each chapter in the book begins with an outline and a
list of key terms with definitions. The treatment chapters
have the same internal structure so that information can
be found quickly. Each of these chapters has the following
components:
Introduction: At the beginning of each chapter, the
topic is introduced and the framework for the treatment is set up. If the treatment has a unique history, as
is the case with thalassotherapy, this is briefly described.
Product details are also described in this section when
appropriate. For example, a number of different types of
fango are used in spa treatments, and each has a different set of therapeutic benefits. When developing a spa
service, the therapist needs to have enough information
to be able to choose the fango most likely to achieve the
desired therapeutic goal.
General Treatment Considerations: This section discusses the indications, contraindications, and any other
special considerations for the delivery of each service.
For example, in a body wrap, claustrophobia is always
a concern. Even clients who have no previous history
of claustrophobia may become panic-stricken when
wrapped. This section gives practical advice about how
to avoid or deal with such situations.
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Preface vii
Treatment Overviews: Treatment overviews allow therapists to get a speedy snapshot of the indications, contraindications, supplies, and treatment steps involved in
each service. These overviews benefit the therapist who
likes a concise list and wants to find information quickly
and also provide a framework for understanding treatment details in the procedure sections.
Treatment Procedures: Each treatment procedure describes how to prepare for the treatment and position
the client at the beginning of the service. The treatment
is broken down into easy-to-follow steps accompanied by
photos that illustrate how to position the client and how
to apply the products. When appropriate, variations in
treatment delivery methods are discussed, taking into account the available equipment, positioning of the client,
timing limitations, and the implications of combining a
treatment with enhancers or other treatments. Although
wet room options are described when appropriate, all of
the treatment steps are based on dry room delivery.
Sanitation Boxes: Sanitation boxes appear in the procedure section to remind the therapist about cleanliness
and hygiene. Methods for cleaning specific equipment
used in the treatments are described.
Broaden Your Understanding Boxes: Some chapters
contain a box that helps to give the therapist an understanding of the broader application of spa therapies.
Some of these boxes focus on the use of a unique product in other countries (i.e., the use of fango in Europe),
whereas others focus on treatments or techniques used
by estheticians (e.g., What is a facial?).
Spa Fusion Sections: At the end of each chapter, a Spa
Fusion section provides useful information, a study tip,
review questions to test knowledge and comprehension,
and a chapter summary.
Appendices
Appendix A provides sample treatments that can be used,
as they are, to guide treatment design in the therapists
private practice, clinic, or spa. The sample treatments also
show how a basic treatment procedure is delivered within
the context of an overall treatment concept. Promotional
descriptions and ready-to-use recipes provide a valuable
resource for planning how to add spa services to an existing
massage practice. By using the main treatment as a starting
point and adding other therapeutic elements to it, the therapist can learn to develop highly original spa services.
A master list of essential oils with botanical names is provided
in Appendix B, and Appendix C provides a list of sources for spa
products and equipment to help therapists find the necessary
materials for the delivery of treatments. Appendix D provides
ready-to-copy forms for the spa business, and Appendix E gives
answers to the chapter review questions.
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Online Resources
On the inside front cover of this book, you will find information and a scratch-off code for accessing the many online
resources developed to enhance your learning and practice
experience.
Students and all readers may access a series of engaging
video clips created especially for Spa Bodywork, as well as an
online quiz to test their knowledge and understanding.
Instructors will find an array of resources designed to
help them present the materials in this text effectively.
Instructor resources include a test generator, PowerPoint
slides, and a Teaching Resource document developed for
each chapter. This resource contains learning objectives,
lecture outlines, instructor demonstration checklist, and
student activities.
Summary
In the last 10 years, complementary therapies such as massage, traditional Chinese medicine, acupuncture, aromatherapy, meditation, yoga, and hydrotherapy have gained a
wider acceptance with the general public. At the same time,
stress in the workplace has increased, resulting in a higher incidence of diseases such as repetitive musculoskeletal injury,
heart disease, high blood pressure, and panic attacks. There
has never been a better time for therapists to promote the
use of spa therapies, and the continuing expansion of the spa
industry is evidence for the strong demand that exists. From
spas origins in ancient cultures and from its established
use in Europe, it is plain that spa assimilates many forms of
therapy into a comprehensive system that leads to wellness.
The spa experience can be life changing. Far from being just
a luxury, spa therapy represents the bold first step toward a
better form of health care. Its future is in the hands of those
dedicated therapists and visionary spa owners who have the
ability to provide a space where clients can experience balance and celebrate life while receiving exceptional care.
I hope that this book inspires massage therapists to include spa therapies in their practices or to find a job in the
spa industry that is challenging and rewarding. I believe
that the use of the products and treatments described in
these chapters will support better health and wellness. I am
grateful for the opportunity to share spa with all of the talented therapists and students who populate this wonderful
profession, and I invite therapists to share their spa experiences, best practices, and suggestions. These can be sent by
email to anne.williams20@yahoo.com.
Anne Williams
Boulder, Colorado
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Table of Contents
Acknowledgements
Preface v
iii
3 Client and Therapist Safety
Commitment to Personal and Professional

Boundaries 33
Scope of Practice 35
PART ONE Spa Foundations 1
Spa Sanitation and Hygiene
1 Spa from Past to Present 2

A Brief History of Spas
European Spas in the 18th and 19th Centuries

The Modern European Spa 4
Spa in the United States 5
Basic Spa Categories 6
50
Spa-Specific Considerations 56
Common Conditions That Require Caution 56
Critical Thinking and Contraindications 61
Documentation of Sessions in a Spa
62
4 Your Spa Massage 68

Overview of a Wellness Massage Session
Spa into the Future 10
2 Spa Equipment and Products 13
Massage Enhancers
23
25
What the Client SeesDcor 25

What the Client Hears 28
What the Client Smells 28
What the Client Tastes 29
What the Client Feels 29
Accessibility and Functionality 29
Planning Spa Treatment Rooms 29
78
Warm Packs 79
Steamy Aromatic Towels 79
A Simple Hand or Foot Treatment 80
Paraffin Dip 81
Easy Aromatherapy Enhancements 81
Wet Room Equipment 19
Cleansers 23
Toners and Astringents 23
Exfoliation Products 23
Treatment Products 24
Moisturizers 24
Important Product Terms 24
Product Exploration 25
73
Resting and Holding Strokes 74

Breathwork 74
Aromatherapy Inhalations 78
Use of an Auditory Cue 78
Massage Tables 15
Basic Linens 17
Hot Towel Heating Units 17
Product Warmers 18
Paraffin Warmers 18
Body Wrap Materials 18
Body-Warming Equipment 18
Spa Clothing 19
Other Dry Room Supplies 19
Tubs 19
Showers 20
Specialized Environments 22
Purchasing and Maintaining Equipment
69
Before the Massage 69

The Massage 72
After the Massage 73
Opening and Closing the Massage
Dry Room Equipment 14
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48
Cautions and Contraindications
Your Spa Environment
43
Safety of the Facility 48

Safety of the Client 48
Safety of the Therapist 49
Spas for Women 9

Spas for Men 9
Spas for Families 10
Programs for Teens 10
Spa Products
37
Diseases 37
How Diseases Are Transmitted 39
Preventing the Transmission of Disease 40
Sanitation of the Facility, Equipment, and Supplies
Universal Precautions 46
Creating a Safe Environment
Destination Spas 6
Resort Spas 6
Amenity Spas 7
Medical Spas 7
Day Spas 8
Hot Spring Spas 8
Mobile Spas 8
The Spa Client
32
Spa Ethics 33
Putting Your Spa Massage Together
23
82
Sequencing 82
Routines 84
Subtle Factors That Influence the Massage
85
5 Foundation Skills for Spa Treatment

Delivery 96
Spa Draping
97
Posterior Leg 97
Anterior Leg 97
Breast Drape 97
Anterior Pelvic Drape 97
Turban Drape 97
Gluteal Drape 97
Simple Hair Drape 97
Side-Lying Drape 97
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Table of Contents
Aromatherapy Massage 149

Aromatherapy Baths 150
Aromatherapy Wraps 150
Aroma Mists and Aura Mists 151
Support Lotions 151
Positioning the Client When Applying

Spa Products 100
The Side-Lying Position 101
The Sit-Up Method 101
The Flip-Over Method 101
Basic Application Techniques
101
Application by Hand 101

Application with One Hand Gloved 101
Application by Brush 101
Application with Gauze or Fabric 101
Application by Mist 101
Application of Product with a Sugar Shaker
Dry Room Removal Techniques
PART TWO Spa Treatments 154

8 Exfoliation Treatments 155
101
103
Steamy Rosemary Towels 104

Herbal-Infused Towels 104
Hot Towel RemovalLegs 104
Hot Towel RemovalFeet 104
Hot Towel RemovalBack 104
Hot Towel RemovalArms 105
Hot Towel RemovalAbdominal Area and
Upper Chest 105
Other Dry Room Removal Techniques 105
Moving a Client from Plastic to a Preset
Massage Sheet 105
Wet Room Removal Techniques
105
The Handheld Shower 105

The Standard Shower 105
The Swiss Shower 106
The Vichy Shower 107
Hydrotherapy Benefits and Effects
112
113
Benefits of Using Hydrotherapy in a Massage and

Spa Practice 113
Effects of Hydrotherapy Applications 113
The Salt or Sugar Glow
160
The Salt or Sugar Glow Procedure 162
The Full-Body Polish
165
The Full-Body Polish Procedure 165
The Body or Loofah Scrub

The Buff and Bronze 167
167
117
7 Introduction to Aromatherapy for Spa 129

Safety Considerations 134
Pathways In and Out of the Body
The Hot Sheet Wrap
The Cocoon
AromatherapyAn Art and Science

Essential Oils 131
130
176
181
Cocoon Types 182

The Cocoon Procedure 186
Tension Wraps
189
Techniques for Tension Wrapping
10 Spa Foot Treatments
137
The Physiological and Psychological Effects of

Essential Oils 137
Physiological Effects 137
Psychological Effects 142
143
Carrier Products 143

Essential Oil Concentrations 145
Synergy 145
Top, Middle, and Base Note Blending
Approach to Blending 146
174
Contraindications 175
Healing Crisis 175
Allergies or Sensitive Skin 175
Modesty 175
When the Wrap Goes Wrong 175
Claustrophobia 175
Wrapping Materials 176
Hot Sheet Wrap Types 176
The Hot Sheet Wrap Procedure 177
117
General Treatment Considerations

Hydrotherapy Applications 120
189
194
146
148
195
Reflexology Certification 195
Possible Reactions to Reflexology 195
Therapist and Client Comfort during Reflexology
Elements of a Spa Foot Treatment
Inhalations 149
Aromatic Exfoliations and Body Shampoos 149
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156
Dry Skin Brushing Techniques 157

The Enhanced Dry Skin Brushing Procedure 158
Therapeutic Characteristics of Water
Application Methods
Dry Skin Brushing
9 Body Wraps 173
General Uses for Hydrotherapy 111

Introduction to Hydrotherapy 111
Blending Essential Oils
Scope of Practice 156

Skin Conditions 156
Overexfoliation 156
The Buff and Bronze Procedure 168

Home Care and Retail 171
6 Water Therapies 110
Hydrotherapy Applications
Types of Exfoliation Treatments 156

General Treatment Considerations 156
A Quick Foot Assessment 196

Soaking and Cleansing the Feet
Exfoliation 197
Foot Massage 199
Reflexology 203
Treatment Products 208
Finishing Products 211
195
196
197
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Table of Contents
A Sample Foot Treatment Procedure
211
Session Start 211

Step 1: Soak and Cleanse 211
Step 2: Exfoliation 211
Step 3: Move the Client to the Treatment Table 211
Step 4: Foot Massage 212
Step 5: Reflexology 212
Step 6: Application of a Treatment Product 212
Step 7: Process 212
Step 8: Removal of the Treatment Product 212
Session End 213
11 Fangotherapy
215
Fangotherapy in Europe 216

Fangotherapy in the United States 217
Types of Products Used in Fangotherapy
217
Clay 217
Mud 219
Peat 220
220
Session Start 238

Step 1: Exfoliation of the Posterior Body 238
Step 2: Application of a Cellulite Cream to Target Areas
of the Posterior Body 239
Step 3: Exfoliation and Cellulite Cream Application on
the Anterior Body 239
Step 4: Application of Seaweed 239
Step 5: Cocoon 239
Step 6: ProcessMassage the Face and/or Feet 240
Step 7: Unwrap 240
Step 8: Application of Firming Products 241
Session End 241
The Seaweed Breast Treatment 241

Other Seaweed Treatments 242
The Full-Body Fango Cocoon 221

The Fango Back Treatment Procedure
249
Stone Temperatures 249
Therapist Safety 249
Draping and Insulation for Placement Stones
Essential Oils 249
Contraindicated Individuals 220

Broken or Inflamed Skin 220
Fango Temperature 221
Mixing and Storing Fango Products 221
Preventing Dry Out 221
Equipment and Setup

222
Session Start 222

Step 1: Steam the Back with Hot, Moist Towels 223
Step 2: Cleanse the Back 223
Step 3: Exfoliate the Back 224
Step 4: Massage the Back 224
Step 5: Application of Warm Fango 224
Step 6: ProcessMassage the Legs and Feet 224
Step 7: Remove the Fango 224
Step 8: Application of a Finishing Product 224
Session End 224
The Fango Scalp and Neck Treatment

Procedure 225
Session Start 227
Step 1: Steam the Head and Face 227
Step 2: Massage the Neck 227
Step 3: Massage the Scalp 227
Step 4: Application of Warm Fango to the Head 227
Step 5: ProcessMassage the Feet and Hands 227
Step 6: Remove the Fango from the Hair 227
Step 7: Face Massage 227
Session End 228
Fango Applications for Musculoskeletal Injury and

Disorder 228
Acute Conditions 228
Subacute Conditions 230
Chronic Conditions 230
232
A Brief History of Thalassotherapy 233

The Therapeutic Benefits of Seaweed for the
Body 233
General Treatment Considerations 235
Sensitive Skin 236
Product Form and Application Considerations 236
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238
The Slimming Seaweed Cocoon Procedure 238
13 Stone Massage 247
12 Thalassotherapy
Seaweed Odor 237

Cellulite and Cellulite Products
xi
Stones 250
Heating Units 250
Equipment Organization
249
250
251
Core Techniques 251

Introduction of the Stones to the Clients Body
Stone Flipping 251
Stone Transitions 252
Bad Stone Body Mechanics 252
Heating Unit Speed versus Body Speed 252
Remove Enough Stones 252
Draping 252
Stones on the Face 252
Basic Strokes
251
253
Long Strokes with the Stone Flat 254

Stone Ptrissage 254
Wringing with Stones 255
Stone Stripping 255
Rotation of a Stone with Compression 255
Stone Vibration 255
Deep Tissue with the Edge of a Stone 255
Deep Tissue with the Flat of the Stone 255
Friction with Stones 255
Stone Tapotement 255
Vascular Flush with Stones 255
Stone Strokes for Specific Areas 255

Posterior Leg: Gastrocnemius and Soleus Pin and
Stretch 255
Posterior Leg: Hamstring Pin and Stretch 255
Posterior Leg: Double-Arm Deep Tissue Stroke 259
The Back: Stoning the Lamina Groove 259
The Back: Latissimus Pin and Stretch 259
Anterior Leg 259
Anterior Leg: Quadriceps Pin and Stretch 259
Anterior Leg: Tensor Fasciae Latae and Iliotibial Tract
Stretch with Stones 259
Arm: The Triceps 259
Arm: Flexor or Extensor Pin and Stretch 259
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xii
Table of Contents
Hands 259
The Neck: Prone 259
The Neck: Supine 259
16 Your Spa Program and Menu of Services 334
A Basic Full-Body Stone Massage Procedure 260

Session Start 260
Step 1: Posterior Placement 260
Step 2: Massage the Posterior Legs 261
Step 3: Massage the Back 261
Step 4: Transition to the Supine Position 262
Step 5: Anterior Placement 262
Step 6: Massage the Anterior Legs 262
Step 7: Foot Massage 262
Step 8: Abdominal Massage (Optional) 262
Step 9: Arm and Hand Massage 262
Step 10: Neck Massage 263
Step 11: Face Massage 263
Session End 263
14 Culturally Based Spa Treatments 265

Ayurvedic-Inspired Spa Treatments
Core Concepts in Ayurveda 266
Indian Head Massage 281
Abhyanga 286
Udvartana 293
Shirodhara 295
266
273
Indonesian-Inspired Spa Treatments
297
Indonesian Spa Products 297

Treatment Considerations 298
Indonesian-Inspired Massage 299
Indonesian-Inspired Exfoliation and Body Wrap
Treatments 308
Balinese BorehInspired Treatment 310
Javanese Lulur Ritual 310
Benefits and Drawbacks of Spa Body Treatments 335

Your Spa Philosophy 336
Your Life Mission
336
Creating Your Spa Program
340
Choosing Spa Treatments for Your Program 340

Balance Your Spa Program 343
Review Other Spa Programs 343
Design Individual Treatments 346
Write Detailed Treatment Guides 348
Refine Your Treatments 348
Your Spa Menu

Design 348
Writing Style 348
Essential Contents
348
351
17 You in the Spa Profession 353

Your Career Plan 354
Self-assessment for Career Planning 354
Explore Your Options 354
Have a PlanIt Can Change 360
Activities for Further Exploration 360
Plan to Thrive 360
Write Your Career Plan 361
Work as an Employee
363
Identify and Research Potential Spa Employers

Write a Resume 363
Write a Cover Letter 364
Interviewing 364
Negotiating the Employment Package 367
Meeting and Exceeding the Employers
Expectations 368
Starting a Private Practice

Your Business Plan
363
369
369
PART THREE Your Spa Career 316

15 Treatment Design and Your Signature
Spa Treatment 317
Individual Treatment Design
318
The Therapeutic Goal 319

Finding Inspiration through a Treatment
Concept 319
Treatment Texture 320
Enhancing Treatments 324
Transitions 324
Product Planning 325
Client Management 325
Retail Sales as Part of the Treatment 326
Treatment Planning Forms 326
Considerations When Pricing Services 330
The Signature Spa Treatment
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330
APPENDICES
Appendix A. Sample Spa Treatments 386
Appendix B. Essential Oils and Their Botanical
Names 407
Appendix C. Resources 409
Appendix D. Ready-to-Copy Forms 411
Appendix E. Answers to Chapter Review
Questions 420
Glossary 421
References 426
Index 431
10/24/13 3:43 AM
P A R T
ONE
Spa
Foundations
Williams_2E_CH01_printer_file.indd 1
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1
Spa from Past to
Present
Chapter Outline
K e y Te r m s
Ayurveda: The 5,000-year-old medical system of India. Ayurveda influences are often used in spa treatments.
Esthetician: This word is a variant of the word aesthetician, which is
derived from aesthetic, a branch of philosophy dealing with the nature
of beauty. Estheticians are beauty specialists with around 300 to 750
hours of training. Their scope of practice includes skin care, hair removal, and makeup application.
Exfoliation: A procedure that removes dead skin cells from the surface of
the skin, stimulates lymph circulation, and increases muscle tone when
used with manual friction.
Hamam: An Islamic bath characterized by a vaulted ceiling and a raised,
heated marble platform called a hararat, which is used for massage or
exfoliation.
Hydrotherapy: The use of water in one of its three forms (liquid, solid, or
vapor) at specific temperatures for therapeutic purposes.
The Kur system: A German medical system that includes spa treatments
as part of a wider system for health and wellness. Kur treatments are
medically prescribed and paid for by the national health care system.
Luxury spa: A spa with exceptional accommodation, a full range of treatments, the latest advances in spa technology, a full array of wet room
equipment, and well-trained staff.
Radon: A naturally occurring atmospheric gas that is radioactive and is
released as uranium in rock and soil as it breaks down. It is used in
trace amounts in Europe for the treatment of arthritis and asthma.
Spa: A commercial establishment that provides health and wellness treatments.
Spa therapy: A general term for a wide range of spa treatment methods
or techniques used by various professionals in different settings to support health and wellness.
Spa treatment: A general term for a treatment that uses water, specialized
products, and various techniques to bring about relaxation, address a
specific pathology, and/or support overall health and wellness.
Terme: From the Greek therme meaning heat, and thermai meaning of or
related to hot springs.
Thermal mud: Thermal mud comes from the areas around hot springs. It
can be applied at the site while still hot from the spring water, or it can
be extracted and heated for later application elsewhere.

The Modern European Spa
Spa in the United States
Basic Spa Categories

Destination Spas
Resort Spas
Amenity Spas
Medical Spas
Day Spas
Hot Spring Spas
Mobile Spas
The Spa Client

Spas for Women
Spas for Men
Spas for Families
Programs for Teens
Spa into the Future

SPA FUSION
INTEGRATION OF SKILLS
STUDY TIP: Group Discussion
SPA INSPIRATION: My Spa Experience
CHAPTER WRAP-UP
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Chapter 1
The spa profession is dynamic, changeable, and difficult

to define or categorize. It employs a variety of professionals
that may include physicians, chiropractors, ayurvedic
doctors, massage therapists, estheticians, life coaches,
counselors, dietitians, yoga instructors, spiritual leaders,
cosmetologists,
dermatologists,
cosmetic
surgeons,
naturopathic doctors, hypnotherapists, fitness trainers,

and others. A wide range of therapies may be offered in an
array of different settings under the heading of spa. This
chapter aims to briefly describe the historical roots of the
spa profession and its evolution in the United States and to
define broad categories of spas and the types of individuals
that frequent them. It also looks at the future of spas and
the potential role that spa plays in a broader system of
health care.

It is hard to pin down the origin of spa therapy. Mineral
springs and thermal muds were probably used long before
the first civilizations developed. In Finland, for example,
nomadic people heated holes in the ground with hot rocks
and covered them with a tarpaulin to have a warm place
for bathing.1 These saunas were also holy places where
births and deaths took place. In much the same way, North
American Indian tribes used a separate hut or a covered
sweat lodge built partly into the ground. Large stones were
heated in a fire and taken inside the hut, where they were
sprinkled with water. Many early civilizations had a version
of the spa bath, which combined some form of social interaction with cleanliness. Russian steam baths, which can
still be found in Europe, combine hot air and steam piped
from a boiler. The atmosphere is humid, and the aim is to
get the body to perspire continuously for a period after the
bath has finished.
Traditionally, Arabs would bathe only in cold water
and would never use a tub because this would subject the
bather to his or her own filth.2 Cleanliness is intertwined
with Islamic spirituality. The hamam (bath) became popular around 600 AD after Muhammad recommended sweat
baths. They gained religious significance after this and began to be built close to mosques. When the Arabs conquered
Syria, they quickly adopted Roman and Greek forms of
bathing with hot water and steam, and cold water bathing
fell out of fashion. The hamam became central to the community, serving as both a place of spiritual retreat and for
socializing with friends. The beautiful vaulted ceilings cut
Spa from Past to Present
through to allow disks of natural light to shine down on the

bathers were more modest than their Roman counterparts.
Bathers would stop first at the camekan, a small court of
changing cubicles surrounding a fountain, before entering
the hararat (hot marble baths). Bathers would receive a vigorous massage or kese (exfoliation with a rough cloth) on
a raised marble platform above the wood or coal furnaces
that are used to heat the hararat.
Although the use of the public hamam is on the decline,
travelers to Istanbul can still experience a Turkish bath
complete with an exfoliating scrub and a brief invigorating massage. Historical hamams such as the Galatasaray
Hamam in Beyoglu give visitors a glimpse of the lasting
splendor of the Ottoman Empire.
Perhaps the most famous ancient spas were those of
the Roman Empire, where public baths were a part of the
culture that served an important social function as well as
providing a means of hygiene. The central role of spas in
Roman culture led to a well-developed use of hydrotherapy
(healing with water), and garrisons were often built around
hot springs so that the soldiers could heal their battle
wounds. By 43 AD, the Roman public viewed the baths as
a way to relax and maintain health, and by the early fifth
century AD, there were 900 baths in Rome alone. Although
not everyone could afford a massage, all classes used the
baths. Apart from the bath itself, there would usually be an
area that served as a community center, a restaurant, fitness
center, bar, and a performance center where a juggler, a
musician, or even a philosopher might entertain.

In the 18th and 19th centuries, Europeans would take
the waters for common ailments such as rheumatism and
respiratory disorders. Often, spas were built in secluded
mountain towns, providing visitors with spectacular views;
fresh, clean air; and exercise on nature walks. A trend in
spas at the time was to employ medical professionals who
carefully monitored each visitors treatment. Eventually,
spas expanded to include restaurants, casinos, theaters,
racetracks, and other forms of entertainment. One such
mineral spring town is Spa in Belgium (Fig. 11). The rich,
royal, and famous have been visiting the mineral springs
of Spa since the 16th century. The writer Victor Hugo was
an advocate of Spas curative waters and visited it often.
The town, situated in a wooded valley surrounded by undulating hills and mineral-rich springs and rivers, is still a
favored destination for those seeking rest and relaxation.
Some speculate that the word spa can be traced to the
name of the town, but it is more likely that it comes from
the Latin words espa (fountain) and sparsa (from spargere
or to bubble up). Health through or by water is sanus
per aquam (SPA) and solus per aqua (SPA) is Latin for by
water alone.
The use of water has long been central to spa therapy
because bathing in mineral-rich waters has some positive
10/24/13 1:04 AM
Spa Bodywork: A Guide for Massage Therapists
administering last rites to the gravely ill, he used water

and herbs to cure them. Kneipps healing system, which
combined physical exercise, simple food, hydrotherapy
and herbs, forms the basis of modern naturopathy. He is
well known for the wet nightshirt treatment in which the
remedy was to wear a shirt that had been dipped into water with salt or hay flower.
The Modern European Spa

The modern spas of Europe are still based on the hydrotherapy principles developed by Priessnitz and Kneipp. Visitors
to the Bad Hofgastein Spa in Austria stay at a comfortable
hotel with an indoor thermal pool fed by the mountains
waters, a whirlpool, sauna, Turkish bath, fango (mud) treatments, massage, radon baths, and a bar with a fireplace.
Arthritic patients at the Spa are given the Gastein cure.
This treatment consists of visits to the radon caves of the
Radhausberg Mountain and seems to be effective for arthritis, sinusitis, and chronic asthma sufferers (Fig. 12). Radon
is a naturally occurring radioactive gas released by rock, soil,
and water from the breakdown of uranium. It is absorbed
by the body in very small doses through inhalation and
through the skin in the 70% to 80% humidity that is found
deep in the mountain caves. The use of environments with
trace amounts of radon is not unique in Europe. In fact,
FIGURE 11 Spa, Belgium. The copper tubs used at Termes de Spa in

Belgium date back to the 1800s.
effects on the body. The medical benefits of taking the

waters were advanced in Europe by two natural healers
who developed their ideas in the early 1800s. The first was
the Austrian Vincent Priessnitz (17991852) who promoted
the cold water cure. The cure consisted of drinking large
amounts of cold water, bathing in cold water, following
a simple diet, and participating in physical activity in the
open air. Priessnitz was able to use the cold water cure to
care for a personal injury that doctors of the time thought
untreatable. In 1826, Priessnitz opened a water cure establishment at Grfenberg in the mountains of Silesia, where
his ideas were adopted by many prominent physicians.3
The second natural healer was Father Sebastian Kneipp
(18241897), a German priest who cured himself of pulmonary tuberculosis by bathing in the icy Danube and
shocking his body into health. In one of his many books,
My Water-Cure (1894), Kneipp writes, Being a priest, the
salvation of immortal souls is the first object for which
I wish to live and die. During the last 30 or 40 years,
however, the care for mortal bodies has absorbed a considerable portion of my time and strength.4 Instead of
FIGURE 12 Bad Hofgastein Radon Cave at Bad Hofgastein Spa

in Austria.
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Chapter 1
some research appears to support the use of radon inhalation and radon baths for asthma, hypertension, osteoarthritis, and diabetes.58
Visitors to the little spa town of Le Mont-Dore in Auvergne,
France, can take the radon-rich air in the form of a nasal irrigation with a tube inserted up one nostril. They breathe in a gas
drawn from a nearby natural hot spring. Although this gas is
mostly carbon dioxide, it also contains a radon concentration
that is well above average. The radon is supposed to activate
the blood, combat allergies, improve digestion, and stimulate
the immune system.9
The Italian towns of Abano, Montegrotto, Galzignano,
and Battaglia, which lie in a broad, green plain northeast
of the Euganean Hills in the Veneto of Italy, are famous for
their ancient thermal baths. The spa at Montegrotto dates
from the 76th century BC, and the remains of Roman spas
in the area can still be seen. Abano Terme (terme means
thermal bath) is considered to be one of the oldest spa
centers in the world. According to legend, the Abano waters
were warmed when Phaeton, the offspring of the sun,
fell and landed in the mineral springs. It is likely that the
inactive volcano there feeds the 130 hot springs in the area
that still flow at a constant temperature of 188F (86C).
Guests enjoy thermal treatments under the supervision of
medical staff, and the Euganean Hills mud found in the
area is used for arthritis and fibrosis neuritis as well as for
gout and metabolic problems.
It is common in Italy, as in many European spas, for the
guest to stay up to 3 weeks and receive daily treatments. In
Germany, for example, spa therapies are regarded as medical treatments and as a general preventive against poor
health. Over 9 million Germans enjoy the benefits of the
Kur system each year. In the Kur (cure) system, a person
spends 2 to 4 weeks in a climate chosen for his or her condition. Patients receive a wide range of treatments, including
massage; mud, herbal, and seaweed applications; inhalation
therapy; and the use of mineral and thermal water. Part
of the treatment is enjoying leisure time in a beautiful,
efficiently run natural setting. Long-term studies show that
the number of sick days taken by German workers who received a Kur treatment drop by an average of 60%.10 Medical drug consumption and other health care costs also decrease. The long-term effects of the Kur system include a
drop in the number of early retirements and an increase in
productivity throughout the patients working life.
Spa in the United States

After the Industrial Revolution, spa treatments were seen as
less scientifically viable than fast-acting, medically measurable drugs. As a result, the European concept of spa did not
cross the Atlantic intact. Even though hydrotherapy cures
quickly gained popularity in mid-1800s America, spa and
complementary therapies developed in different directions.
In the early 1900s, water-cure centers became rallying
points for new medical ideas including meat-free diets
and drugless healing that were among the forerunners of

alternative medicine as we know it today. Dr. John Harvey
Kellogg pioneered many of the practices that have been
proven in modern medicine at the Battle Creek Sanitarium
(the San) in Michigan. Kellogg recommended a good vegetarian diet, regular exercise, correct posture, fresh air, and
proper rest. He persuaded women to discard their corsets
and ignore fashion to improve their breathing. Kellogg
also practiced some questionable medicine, including electropathy and radium cures. Many regarded him as a quack,
even though he was one of the nations leading surgeons.
Kelloggs program was offered in a luxurious, restful, and
elegant setting that was often attended by the rich and
famous.11
In 1934, Elizabeth Arden turned her Maine summer
home into a beauty and health spa called the Maine Chance.
She targeted two groups of women; those that were middle
aged trying to recapture youth and plain women looking
for a means to achieve beauty in a jar.12 With cosmetics
as her primary product, Arden pioneered the integration of
diet, exercise, sports, yoga, facials, massage, beauty training, and pampering into a focused spa program. She used
science and technology to develop her concept of beauty
and to turn that concept into a $20-million industry.
Today, Ardens signature, Red Door Salons are recognized
worldwide.
Spas in the early 1960s developed the stigma of fat
farms for wealthy women who wanted to lose weight and
detoxify (sometimes from drug and alcohol addictions).13
The fat farm stigma may have slowed the growth of the spa
industry for some time, but the concept of an integrated
program of fitness, diet, and healthy lifestyle training balanced with pampering treatments and beauty became established. This comprehensive approach differentiates the
American spa from its European counterpart, where the
focus is usually on treating a recognized medical condition.
In the 1970s, hair salons seeking to expand their businesses started to offer la carte spa treatments as well as
regular salon services. This transformation of the salon into
the day spa was the idea of Noelle De Caprio.14 She regularly attended spas in Europe and wanted to offer her clients a mini-spa experience in the convenience of her salon.
She also recognized that Americans rarely had the time or
the money to travel for 3 or 4 weeks to experience spa treatments in Europe. Making these services available locally,
in easy-to-manage, half-day or full-day packages, added to
their popularity. Other salon owners quickly followed De
Caprios lead. By 2010, there were an estimated 19,900 spas
in the United States, and 7 out of every 10 of these establishments is a day spa.15
Over the last 10 years, complementary therapies such
as massage, traditional Chinese medicine, acupuncture,
aromatherapy, meditation, yoga, and hydrotherapy have
gained acceptance with the public, especially for illnesses
and injuries that are not so effectively treated using conventional medical approaches.16 At the same time, Americans
10/24/13 1:04 AM
now have greater access to information about health care

options. This has led to the birth of integrative approaches
in which alternative and conventional medicine are practiced side by side in many spas to improve health and fight
disease.17 Another factor in the growth of the spa industry is
the general increase in the level of stress being experienced
by the American public and a decrease in the amount of leisure time.18 Spas offer guests a way to decrease stress while
improving their health at the same time.
According to a survey conducted by the International
Spa Association (ISPA), 150 million visits were made to U.S.
spas in 2010, producing $12.8 billion in revenue. Over a
decade, the amount of spa revenue has grown from $5 billion in 1999 to $12.8 billion in 2010. Shopping malls, cruise
ships, and fitness clubs are adding spas, and they have even
become a feature or focus of large hotels and resorts. Once,
spa was only for the wealthy and privileged, but today, there
is a spa experience available for every budget. American spa
owners are a vibrant and creative bunch and draw inspiration from a range of healing modalities, spiritual systems,
and cultural influences to create a unique experience for
their guests.
Basic Spa Categories

Because of the diversity that currently exists within the
industry, spas are difficult to place into clear categories.
For example, spas might be grouped on the length of
the clients stay or on the focus of the spa program. A
destination spa might be a weight loss spa, or it might be
a spiritual retreat. A resort spa might be an adventure spa
focusing on healthy athletes or a family spa with programs
for both adults and children. Spas might be luxury spas
with expensive treatments and high-tech equipment or
budget spas with moderately priced services and a relaxed
dcor. The following list of spa types will help you begin
to understand the general differences between basic spa
categories.
FIGURE 13 New Age Health Spa, New York.
wish to detoxify, a juice fast replaces regular meals. Body

treatments include a full range of services such as a shirodhara spiritual treatment, aromatherapy body wrap, and a
maple sugar body scrub. As the name suggests, this type of
spa targets a client who is looking for a spiritual as well as
physical experience.19
Resort Spas
A resort spa offers different recreational opportunities
such as hiking, rock climbing, water sports, shopping,
tennis, golf, and horseback riding as well as spa services.
Often, it is the beautiful natural landscape around a resort that is the primary reason for the visit, and the spa
itself is just one of many activities offered to the resort or
hotel guest. Some resort spas are a cross between the destination and hotel spa where health programs are on offer,
and guests can choose from low-fat spa cuisine or more
traditional fare. The Watermark Hotel and Spa in San Antonio, Texas, is a resort spa that sits right on San Antonios famous River Walk (Fig. 14). Guests can explore the
2.5 miles of trails that follow the San Antonio River, shop
in boutiques, or make an excursion to the Alamo. The spa,
Destination Spas
Guests visit a destination spa for a weekend, a 4-day program or longer to make significant lifestyle changes or to relax completely. Spa programs focus on fitness, healthy diet,
detoxification, and lifestyle education. Some destination
spas offer classes and services geared toward spiritual as
well as physical renewal. Many destination spas offer a full
menu of beauty services in addition to the spa program. A
good example is the New Age Health Spa (Fig. 13). This is a
destination spa with a philosophy of mindful living, a calm
mind, and a strong body. They offer guests a program that
is spiritual while promoting fitness, good nutrition, and enjoyment of the outdoors. A typical day includes a morning
meditation, a 3-mile hike, and yoga classes. For those who
FIGURE 14 The Watermark Hotel and Spa in San Antonio, Texas.
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Chapter 1
which occupies the entire second floor of the hotel, offers various beauty services, massage, and hydrotherapy
la carte.20
Amenity Spas
At one time, amenity spas, which are usually found in hotels, offered basic services only and were really an afterthought even in large hotels. A massage room, a simple
fitness center containing little more than a treadmill, and
a basic salon were usually all that was offered to guests.
Many hotels now view spa services as an important contributor to the bottom line, so they have started to offer
full-service facilities.21 Keeping pace with this trend, smaller hotels, bed-and-breakfasts establishments, and even
some time-shares have moved toward offering in-room
massage or mobile spa services if they do not have room
for a full-service spa.
Medical Spas
In many ways, the medical spa is a direct counterpart of a
European spa at which guests receive health care services
in a relaxing and beautiful natural setting. Some hospitals
are adding spas to ease the discomfort of the terminally ill
and to help with pain management. Three different types of
medical spas (sometimes called medi-spas or medspas) are
listed by SpaFinder. 22
The first type is the esthetics-oriented medical spa, which
includes services such as Botox or collagen injections, chemical skin peels, laser hair removal, laser skin treatments,
liposuction, plastic surgery, and sclerotherapy (spider vein
elimination). In this type of spa, medical cosmetic and clinical esthetics procedures are offered together with revitalizing treatments (such as massage) to support the recovery process. A good example is the Juva MediSpa, which is
linked to the Juva Health and Wellness Center.23 Skin health
and beauty are addressed with anti-aging and skin damage
treatments, Botox injections, liposuction, and breast augmentation. The bodymind connection and its effect on
health are treated using hypnotherapy, psychotherapy, fitness training, and nutritional consultations (Fig. 15).
The second type of medical spa is the complementary
or alternative medicine spa, where the program designed
for each guest is based on one of the alternative medicine
systems such as ayurveda or Chinese traditional medicine.
Naturopathic medicine, nutrition therapy, Western herbal
medicine, and acupuncture all fall into this category. The
Maharishi Vedic Health Center in Lancaster, Massachusetts,
uses authentic ayurveda treatments for disease prevention
and chronic disorders.24 Traditional diagnostic procedures
such as Vedic pulse diagnosis are used in designing the
treatment and spa regime. Guests can also take part in yoga
classes, healthy cooking instruction, and evening lectures
on Maharishi Vedic medicine.
FIGURE 15 Juva MediSpa, New York.
The third type of medical spa is the preventive health

care spa in which medical staff carry out a number of tests
(blood tests, bone density screening, etc.) before designing the treatment program. Sometimes, the spa specializes
in general areas such as weight loss, pain management,
or prenatal or postnatal care. They may also offer specific
programs for particular conditions such as diabetes, high
blood pressure, or chronic insomnia. The Canyon Ranch
Health Resort in Tucson, Arizona, combines the wellknown luxury and pampering of the famous Canyon Ranch
Spas with a health and healing center (Fig. 16).
10/24/13 1:04 AM
FIGURE 16 Canyon Ranch Spa Executive Health Program.
The Executive Wellness Program is a 4-day health program

that includes a complete physical examination as well as lifestyle assessment. The general approach of Canyon Ranch is
to encourage guests to make a long-term commitment to
healthy living so as to decrease the occurrence of disease.25
Day Spas
Day spas are mini-retreats with services delivered la carte
or in half-day to full-day packages. The Day Spa Association defines a day spa as a spa that offers a full range of
treatments including massage, body treatments, hydrotherapy treatments, esthetic services, weight management,
yoga, or meditation, with hair care, manicures, and pedicures. Many business owners are using the term day spa
loosely to indicate an establishment that focuses on beauty
and/or wellness. An example of a creative day spa concept
is Embodywork, a day spa in Decatur, Georgia, that offers
daily retreats based on the principle that a good life begins
with being good to ourselves (Fig. 17).
Clients can choose a half-day or full-day retreat that
begins with a conversation about health, diet, relationships,
and exercise goals. Conscious breathing exercises progress
to a full-body massage and full-body polish. After lunch,
the client can choose between a facial, reflexology, hand and
foot treatment, or body wrap for their final service.26
FIGURE 17 Embodywork, a creative day spa concept in Decatur,

Georgia.
Hot Spring Spas

Hot springs spas use the natural thermal waters from hot
springs in their spa regime or treatments. The Ojo Caliente
Spa surrounds the Ojo Caliente hot springs in New Mexico
(Fig. 18). This spring was sacred to the ancestors of the
Tewa tribes that still live in the region.27 The mineral pools
are open to the public for an entry fee, or spa guests can
opt for a private pool and spa treatments that include
facials, massage, and body wraps.
Mobile Spas
Mobile spas bring day services directly to clients at their
home, office, hotel room, or at a party. The treatments
are designed to be set up and delivered on-site and are
popular as a feature at bachelorette parties, prom parties,
and corporate retreats. Treatments include seated massage, manicures, pedicures, reflexology, facials, and diet
consultations.
10/24/13 1:04 AM
Chapter 1
Although massage remains the most accepted treatment at spas, facials, manicures, and pedicures are popular. Clients report that they want to focus on health,
fitness, anti-aging, increased energy, and stress reduction.31
Many clients visit spas simply to revitalize themselves and
give themselves a break from work stresses. Cultural elements that include ayurvedic medicine, Native American
wisdom, and Asian influences are used to inspire treatments and create links to the environment and the global
community.
In general terms, spas attract clients by adopting a philosophy and creating a menu of services that appeal to a
specific group of clients. The facility, its visual appearance,
the equipment available, and the price of its services will
also play a role in attracting these target clients to the spa.
Clients are as diverse and difficult to define as the spas they
attend, so it is helpful to look at the different ways that spas
design their programs to attract a particular type of client.
Spas for Women

FIGURE 18 Ojo Caliente Hot Spring.
The Spa Client

In Roman times, the local spa was a focal point of the community and enjoyed by all social classes. This is still the
case in some parts of Europe where spas are a part of the
mainstream health care system. Although the American spa
industry encourages the idea that spa is for everyone and
should be a regular part of a healthy lifestyle, there is still a
bias in the social status of individuals that attend spas.
In the 1960s and the 1970s, the average American spa
client was most likely to be wealthy, female, and overweight. Her goals for visiting the spa probably included
weight loss, exercise, and pampering in the form of beauty
treatments. She expected the best possible service and was
a discriminating customer.28 The ISPA Spa-Goer Survey for
2003 showed that the primary spa client was still female
but has a middle to upper middle class income ($72,200 annual household income).29 This client is most likely to be
Caucasian (87%), with African Americans, and those of
Asian descent making up only 9% of the spa-going population. In 2010, the ISPA reports that spas are branching out,
and spa owners are targeting various income backgrounds
and age groups. The industry study reveals that 80% of spas
have introduced special packages targeted at diverse client
groups, including men, couples, teens, families, athletes,
and seniors. Over 6 in 10 spas introduced discounts and
incentives to attract first-time clients, although franchises
with membership rates took off in 2010.30 The number of
men attending spas is growing rapidly, and men currently
comprise 29% of the market. Products and services for
teenagers are also on the rise.
Spas for women can take many forms. A spa for women
might offer expensive high-tech skin care or detoxification,
vegetarian cuisine, and yoga. Anything and everything is possible. A spa might cater to brides, to mothers and babies, to
athletes, or to grandmothers. For example, the target client
of the Body Shop Spa in Utah, close to Zion National Park,
is a female on a budget (services are moderately priced), between the ages of 18 and 65 years, who wants to lose weight
and enjoy the outdoors. The program at the spa is based
on a seven-point philosophy that addresses nutrition, endurance, strength, flexibility, self-awareness, education, and
relaxation. Manicures, pedicures, and massage are available,
but rock climbing lessons and hiking replace other normal
spa services.32
The Olympus Health Spa in Washington is a womenonly spa because clothing throughout the spa is optional.
Body scrubs and massage are offered in a Roman bath setting while other guests lounge nearby in the hot pools or
converse in the sauna. It is a communal experience that
caters to groups of women enjoying each others company
while they relax and renew. This spa has built its business by
selling the just for women experience.33
Spas for Men

Research carried out using SpaFinder shows that nearly
29% of men book their own appointments, and the number
of men attending spas has tripled since 1987. The International Spa and Fitness Association suggests that spas can
target men by linking spa treatments to health and fitness,
by offering discount treatments for men, and by using spa
treatments as interesting giveaways at business meetings
and conventions. The Nickel Spa in New York City, which
has cobalt and silver dcor, was designed specifically for
men. It has a menu of massage and facials that meet the
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10
special needs of men including a Love Handle Wrap, a fullbody wax called the Bodybuilders Special, and 15 different
skin care lines.34
Spas for Families

Spas that target families offer services that fit every members needs. There may be a full spa offering services for men
and women as well as programs geared toward teens. Child
care facilities for the younger members of the family might
be offered with programs designed to get everyone together
such as horseback riding or hiking. The Pointe Hilton in
Phoenix, Arizona, is a good example of this because they
offer a full-service spa, coyote camp for the kids, a family
pool, and a golf course.35
Programs for Teens

Some day spas focus on the needs of teenagers with treatments that address oily skin, acne, and sports injury. Spa
prom parties are a clever way to introduce young women and
men to the benefits of spa treatments. Teens enjoy the chance
of preparing for the big event surrounded by a group of
friends getting manicures, pedicures, facials, and body wraps.
Spa into the Future

By its very nature, spa is indefinable, ever changing,
diverse, and evolving. Therapists and clients alike are
embracing spa treatments as a means of promoting health
and wellness. This seems likely to continue as the public understanding of spa treatments develops. The rate
of growth in the industry is expected to become steadier
as the dramatic boom of recent years slows down. It is
likely that spa will continue to drive a movement toward
a more integrated form of medicine. Currently, one-third
of all Americans are in favor of complementary medicine
becoming more widely available within the conventional
medical system. This is the trend in Europe, where 60%
of the public in Belgium and 74% of the public in the
United Kingdom use alternative forms of medicine for
wellness. Spas provide a place where conventional medicine and exceptional client care have become integrated.
Taking care of oneself by being willing to receive care
and pampering is an important aspect of healing in a spa
environment. Although spa is still often considered as
just a luxury, it is likely that spa services will come to be
viewed as necessary for thriving in a fast-paced contemporary lifestyle.
SPA FUSION
STUDY TIP: Group Discussion
We all learn most effectively when we are actively
involved with information. One way to get involved is to
form a study group and hold group discussions about
reading assignments and class lectures. Get together
two to four other students and explore the elements
shown in the image developed by the ISPA Education
Committee (Fig. 19) through the questions provided
below. Have one person keep notes on ideas that came
up during your discussion. Photocopy these notes so
that everyone in the group has a copy. Instructors can
also use these questions for in-class discussions.
1. Four words are used on the outside of the image
(revitalize, rejoice, relax, reflect). Describe what each
of these words means to you and how these words
are mirrored in different activities you undertake in
your life.
2. The words body, mind, and spirit are shown in the
next level of the image. Describe one way you
support the health of your body each day. How do
you support the health of your mind? What about

your spirit?
3. Explore each of the following words as part of a
meaningful spa experience. What does each word
mean to you? How might it be expressed in the
activities a client participates in at a spa?
a.
b.
c.
d.
e.
f.
g.
h.
Nourishment
Movement
Touch
Aesthetics
Environment
Cultural expression
Social contribution
Waters
SPA INSPIRATION: My Spa Experience

Create your own collage of words and images that
express the type of spa experience you would like to
offer clients or receive yourself. Share your collage
with your classmates and explain why the visual elements and words you use express your ideas of spa.
10/24/13 1:04 AM
Chapter 1
11
SPA FUSION
INTEGRATION OF SKILLS (continued)
S P I R I T
REVITALIZE
REJOICE
S P A C E
R
NOURISHMENT
MOVEMENT
WATERS
TOUCH
INTEGRATION
SOCIAL
CONTRIBUTION
I N
CULTURAL
EXPRESSION
ENVIRONMENT
S
I M
REFLECT
R H
S P A C E
B O
AESTHETICS
RELAX
FIGURE 19 ISPA 10 Elements Image.
CHAPTER WRAP-UP
The ISPA Education Committee developed the
10 Elements of the Spa Experience image shown in
Figure 19 that we discussed previously.36 Their goal
was to help define the elusive and ever changing
nature of the spa experience and to create a foundation, a common language, and career path for the
emerging spa professional. Many concepts, important
to the practice of spa, emerge from the ISPAs dialog
around the 10 Elements image. The most important perhaps is the idea of integration. Everything is
connected. Feeling beautiful, feeling joyous, feeling
healthy, and feeling energetic are signs of a balanced
life. A balanced life requires both reflection and action.
Spas provide a space where clients can experience each

element represented in the image and reflect on its
presence or absence in their lives. Movement, touch, an
appreciation of beauty, our connection to the environment, cultural expression, social contribution, the healing quality of water, and nourishment both of the body
and the soul are the essential concepts on which spa
is founded. The spa experience can be life changing.
Far from being just a luxury, spa therapy represents
the bold first step toward a better form of health care.
Its future is in the hands of those dedicated therapists
and visionary spa owners who have the ability to provide a space where clients can experience balance and
celebrate life while receiving exceptional care.
(continued on page 12)
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12
SPA FUSION
REVIEW QUESTIONS
Multiple Choice
1. Many early civilizations had a version of a:
a.
b.
c.
d.
Spa shower
Exfoliation treatment
Meditation center
Spa bath
2. Roman baths may have originally been built to

treat soldiers battle injuries. By 43 AD, they were
used by:
a.
b.
c.
d.
Field soldiers only

Emperors only
All classes of the Roman Empire
Men only
3. The Turkish bath is called a:

a.
b.
c.
d.
Sweat lodge
Garrison
Hamam
Camekan
4. In the 18th and 19th centuries, Europeans would

go to spa towns to heal common ailments such as
rheumatism and respiratory disorders. This practice
was known as:
a.
b.
c.
d.
Take the mud

Take the waters
Take the cure
Take the air
5. The word spa originated from:

a.
b.
c.
d.
A mineral spring town in Belgium named Spa

The Latin words for fountain (espa)
The Latin words for by water alone (solus per aqua)
No one is really sure although more than likely
it is from a Latin source.
Fill in the Blank

6. In Germany, there is widespread acceptance
of spa therapies as a viable form of treatment
for individuals who have not responded to
conventional medicine. This system is called the
___________ system.
7. An Austrian healer named Vincent Priessnitz was
an advocate of the ________ cure.
8. Naturopathic medicine is rooted in the
healing methods of a German priest named
______________.
9. At Bad Hofgastein, patients with arthritis,
sinusitis, and chronic asthma take part in the
Gastein cure. This cure consists of visits to
caves where __________ is absorbed and inhaled
in small amounts.
10. The ISPA Spa-Goer Survey for 2003 indicates that
the primary spa client will be of middle to upper
middle class income and _______________.
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2
Spa Equipment and
Products
Chapter Outline
K e y Te r m s
Dry Room Equipment
Antioxidants: Antioxidants are substances that prevent damage to cells

and DNA by free radicals.
Astringents: Astringents are skin toner for oily skin. They contain alcohol
to dissolve excess oil during facial treatments to ensure the skin is clean
before a treatment product is applied to the face.
Botanicals: Botanicals are plant extracts used in spa products to achieve a
specific therapeutic goal.
Cleansers: Cleansers are skin care products used to remove impurities
from both the skins surface and the pores during routine face cleaning
or during a facial or spa body treatment.
Dry room: A treatment room in which there is no shower or hydrotherapy
equipment.
Exfoliation products: Skin care products used to remove trapped debris
while sloughing off dead skin cells, smoothing the skins surface,
stimulating circulation in the local region of the skin, and relaxing or
invigorating the body.
Fragrance: An ingredient in spa products used to enhance the smell of
a product. Fragrances added to spa produces will be either natural or
synthetic (human-made).
Hot towel cabinet (cabbi): A piece of spa equipment used to heat up
towels for spa treatments.
Hydrotherapy tub: A specialized tub with multiple air and water jets used
to deliver professional therapeutic hydrotherapy immersion treatments.
Moisturizers: Skin care products formulated to soften the epidermis and
increase the skins hydration (water content) by reducing evaporation.
Paraffin warmer: Paraffin warmers (sometimes called dips) hold paraffin wax that is used to cover the hands and feet of the client.
Sauna: Saunas are rooms constructed of cedarwood used to promote
perspiration through dry heat.
Steam room: A steam room is an enclosure that can be filled with steam
from a steam generator so that people can bath in the vapor to induce
sweating or to aid respiratory conditions.
Swiss shower: A specialized shower stall with multiple shower heads that
surround the client with jets of water directed at specific areas of the body.
Toners: Skin care products used to complete the cleansing process and
help to restore the skins acid mantle.
Treatment products: Products such as seaweed or mud that are used
during a spa treatment to elicit a particular therapeutic benefit.
Vichy shower: A specialized shower with a horizontal rod with holes or
water heads that rain water down onto the client from above a wet table.
Wet room: A special treatment room that is tiled, has drains in the floor,
and houses equipment such as Vichy showers or hydrotherapy tubs.
Massage Tables
Basic Linens
Hot Towel Heating Units
Product Warmers
Paraffin Warmers
Body Wrap Materials
Body-Warming Equipment
Spa Clothing
Other Dry Room Supplies
Wet Room Equipment

Tubs
Showers
Specialized Environments
Spa Products
Cleansers
Toners and Astringents
Exfoliation Products
Treatment Products
Moisturizers
Important Product Terms
Product Exploration

What the Client SeesDcor
What the Client Hears
What the Client Smells
What the Client Tastes
What the Client Feels
Accessibility and Functionality
Planning Spa Treatment Rooms
SPA FUSION
STUDY TIP: Up to the Test!
SPA INSPIRATION: There Is No Substitute for
Direct Experience!
CHAPTER WRAP-UP
13
10/24/13 1:05 AM
14
There is no doubt that the luxurious surroundings of

an upscale spa enhance the mood and character of the
spa experience. But with attention to detail and with an
eye toward functional ambiance, spa treatments can be
delivered satisfactorily in a small spa, massage clinic, or
private practice without inordinate expense.
equipment, wet room equipment, spa product categories,

and methods for creating a relaxing spa environment. The
detailed procedures for using each piece of equipment
and additional equipment and supplies, which are needed
for specific spa bodywork treatments, are discussed in
greater detail in other appropriate chapters. Sanitation of
equipment is discussed in Chapter 4.
The term spa equipment refers to all items and tools a

therapist might use in his or her spa bodywork practice.
The equipment must be well made, safe, attractive, and
comfortable for the client and not cause undue stress to
the therapists body. Each piece of equipment represents
an investment in your business and in your clients. When
you purchase your own equipment, do so carefully after
researching brands, understanding available options, and
comparing products. This chapter describes dry room
Dry Room Equipment

The term dry room refers to a treatment room in which
there is no shower or hydrotherapy equipment. Instead, hot
towels are used to remove spa products from the clients
body, or clients take showers in a different area. Essential
dry room equipment includes massage tables, linens, hot
towel heating units, product warmers, paraffin warmers,
body wrap materials, body-warming equipment, and other
treatment room supplies (Fig. 21).
FIGURE 21 Examples of dry room equipment. (A) Hot towel cabinet (cabbi). (B) Product warmer. (C) Treatment bar. (D) Paraffin warmer. (E) Body
wrap materials including a wool blanket, thermal space blanket, wet wrap sheet, and plastic body wrap sheet. (F) Free-standing heat lamp. (G) Fomentek
water bottle. (H) Electric (thermal) booties and mitts.
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Chapter 2
Massage Tables
Portable massage tables are a popular choice for massage
therapists who do outcall work or work from their homes
because these tables are designed to fold up for easy transport to different locations. If you intend to offer spa treatments as part of your private massage practice, you may
want to consider investing in a stationary, hydraulic lift,
or electric lift table with additional features such as sit-up
options, side extenders, arm shelves, and plush padding.
Stationary tables are constructed with solid frames that
often include built-in storage space for items such as towels, lotions, oils, and cleaning products. Some newer models include features such as hot towel cabinets, foot soaking
tubs, and sit-up options. Most tables have some type of lift
to raise or lower the table. With a manual lift, the therapist
simply turns a handle to raise and lower the table height.
Hydraulic lifts use a system of pumps and motors to power
the mechanical motion. Electric lift tables use motors to
change the table height. The height of both hydraulic and
electric tables can be adjusted during the treatment, using
a foot pedal, to facilitate different massage or spa techniques or make it easy for the client to get on or off the
table. Because they have heavier bases and height-adjusting
equipment, stationary tables are usually much more expensive than portable tables (Fig. 22).
Table Padding
The padding on massage tables varies from a single-layer to
multiple-layer systems. Multiple-layer systems are typically
more comfortable because the deeper foam layers are firm,
giving support, whereas the upper foam layer is softer and
conforms to the clients body. Padding comes in 1-inch to
4-inch thicknesses. Firm table paddings (1.5 to 2.5 inches)
are sometimes preferred by therapists who offer deeper
techniques because the client doesnt sink away from the
stroke. Therapists who offer spa bodywork or relaxation
FIGURE 22 Stationary table. A stationary table is a good choice for

spa environments because the frame often includes built-in storage space
for items such as towels, lotions, oils, and cleaning products.
Spa Equipment and Products
15
massage sometimes prefer plush padding because the table

feels more comfortable and nurturing.
Covers
Most massage table manufacturers today use different
types of vinyl, with different degrees of softness, to cover
the table surface. Because a sheet covers the table surface,
the softness of the table cover usually does not make a difference to the client. Most important, the cover should be
durable and easy to clean. Oil, creams, and spa treatment
products can break down the top layer of the vinyl, so the
table must be cleaned to ensure that it lasts. Wipe the table
down with a suitable cleaning product between clients and
use diluted bleach solutions only if the table comes into
contact with body fluids. Some therapists use antibacterial
wipes to give the table a quick cleaning and prevent drying
out of the vinyl top.
Accessories
A variety of massage table accessories are available from
table manufacturers to increase the clients comfort and
help you work efficiently without undue stress on your
body (Fig. 23):
Arm shelf: An arm shelf can be attached to the front of
the table to provide a place for clients in the prone position
to rest their arms. This is useful because it gives you easy
access to the sides of the clients body. In the supine position, side extenders can be placed on each side of the table
to widen the table and provide more space for the arms.
Side extenders: Side extenders provide a resting place
for the arms in both the prone and supine positions.
Sit-up feature: Some massage tables allow the therapist to place the client in a sitting position. This is a nice
feature if you plan to work with pregnant clients, if you
offer reflexology, or if you are also an esthetician and
offer facials. A cushion is often needed to support the
clients lower back because the steep angle of the upper
portion of the table tends to create a gap.
Bolsters: Bolsters are used to support the clients body
for complete relaxation while on the table. These pillows
and cushions come in a variety of shapes and sizes and
are usually placed under the knees and neck when the
client is supine and under the ankles when the client is
prone.
Massage stool: Massage stools usually have wheels
so that they can be rolled around the massage table.
Sitting down at appropriate points during the massage
or spa treatment helps rest your feet. Most stools can
be adjusted to different heights, and some are available
with back supports. Some therapists instead sit on a
Swiss exercise ball during sessions, which can encourage
good body mechanics.
Step stool: A stepping stool is useful for clients for getting on and off the table. A long, flat exercise step also
works well because it is wide enough to prevent missteps.
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16
E
FIGURE 23 Massage table accessories. (A) Arm shelf. (B) Side extenders. (C) Bolsters. (D) Massage stool.
(E) Step stool.
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Chapter 2
17
Basic Linens
Blankets
The centerpiece of a well-designed and comfortable spa

room is the massage table well made up with linens. For
therapists on a budget, plain sheets and a large bath towel
can be used. Multi-tonal colors in slightly varying shades
give an impression of texture and depth. Take care to match
the linens to the dcor of the room. An upscale spa might
opt for Egyptian cotton and a matching coverlet with a multitude of different throw pillows. Massage and spa suppliers
provide everything from the basics to very expensive linens.
Have washable cotton blankets on hand to keep the client

warm. Clients often experience a drop in peripheral body
temperature as their blood pressure lowers during the massage or beginning of a spa treatment. This is normal, but a
chilled client cannot relax completely. Heavy blankets feel
nurturing and comforting for many clients and give the
client the sensation of being snug and secure. Some clients
find that heavy blankets feel suffocating and restrictive.
Have a few options on hand to accommodate each clients
needs. The blanket is always placed over the top massage
sheet. If a blanket comes into contact with the clients body
(which is likely), it should be laundered before it is used
with another client.
Massage Sheets
Purchase massage sheets from a massage or spa supplier or
department store (twin size). Cotton, flannel, and cotton
blends all work well and feel soft and comfortable. Make
sure that the material is thick enough to provide sufficient
coverage, avoiding thin see-through sheets that are inappropriate for draping. Make sure that sheets are small enough
not to touch the ground during the session, an unsanitary
condition. White, cream, earth-toned, and pastel colors are
easy to bleach, but darker colors tend to show oil stains.
Massage and spa suppliers sell laundry products that help
to get oil out of massage sheets, but over time, oil usually
build up in the fabric and can smell or look dirty. Plan to
replace massage sheets regularly to prevent this situation.
Disposable sheets are available from spa suppliers, but
these are not as cost-effective as washable linen and impact
the environment with unnecessary waste.
Face Cradle and Bolster Covers
A pillowcase can be used to cover the face cradle, provide
draping material (breast drape, anterior pelvic drape, etc.), or
cover bolsters. Fitted face cradle covers available from massage suppliers are better than a pillowcase because they fit
the face rest snugly and do not fall off. Fitted bolster covers
that enclose the entire bolster prevent cross-contamination
between clients; often, a bolster is not covered but placed
under the bottom massage sheet. Face cradle and bolster
covers that come in contact with the clients skin must be
laundered and changed for each client.
Towels
Bath towels and larger bath sheets are often used over
the top massage sheet to provide warmth and additional
draping material. Choose lightweight ones that will not
be bulky during draping. They are also easy to launder.
Bath towels are often used to wrap hydrocollator packs or
other hot packs to prevent burning the client. Hand towels
are sometimes used as draping material to protect the clients hair from oil or to make a roll to support the neck.
Hot, moist hand towels are used to remove spa products
from the clients skin or to provide a warming body steam
(placed over the face, wrapped around the feet, etc.) during
the session. Any towel that comes into direct contact with
the clients skin or hair must be laundered between clients.
Linen Storage
Linen is washed in hot water with detergent, dried with
heat, and stored in a closed container. You want to have
enough linen on hand to get through 2 days of business
without doing laundry if possible. The amount of linen you
need varies based on the type of massage and spa work you
do. For example, if you provide dry room spa treatments,
you are likely to go through 16 hand towels and 2 bath
towels per client. A good start for a new spa bodywork practice might be 10 sets of sheets, 10 face cradle covers, 15 bath
sheets, 15 bath towels, 100 hand towels, and 2 cotton blankets. Dirty linen is stored in a closed, ventilated container,
preferably outside the treatment room, until it is laundered.
Hot Towel Heating Units

Hot towels are required throughout spa body treatments,
even when a shower is available. You have a number of
options in the way you heat and maintain your towels.
These options include the following:
Hot towel cabinet (cabbi): Hot towel cabinets (often
called a cabbi) range in size from small 6-towel units to
much larger 72-towel units. They look like small refrigerators and are placed somewhere convenient close to
the treatment table.
Hydrocollator: Hydrocollators are most often used to
heat hydrocollator packs but also heat towels and hot
sheets for body wraps. They keep water at a constant
165F and, in busy spas, are useful as a source of hot
water for filling foot soaking containers.
Hot stone heaters: For massage practices and spas that
are on a budget, a hot stone heating unit filled with water
is a cheap and efficient alternative to the more expensive
cabbi. A hot stone heater can hold up to 20 towels and is
also a useful heater for hot sheet wraps, spa products, and
the stones used in a hot stone massage. Remove the towels from the heating unit and wring out the excess water
before putting them into an insulated soda cooler to keep
them hot until use. If only a few towels are needed for the
treatment, a crock pot serves the same purpose.
10/24/13 1:05 AM
18
Soda cooler: When you remove product with hot towels,

the towels must be close at hand to keep the process
quick and efficient. Walking back and forth to a hot
towel cabbi disrupts the flow of the treatment and is
time-consuming. Instead, transfer the towels from any
of the previously mentioned heating units to a small
soda cooler (9 to 12 quarts) and place this near to the
treatment table for convenience. Make sure to close the
lid of the soda cooler to maintain the heat inside each
time you open it to remove a towel.
Product Warmers
There are some situations where a spa product is meant to
be applied cold, but in most cases, spa product is warmed
before it is applied to the body. There are many different
types of spa product warmers. Some are effectively double
boilers with two pots so that the spa product can warm
inside a small pot placed inside a second larger water-filled
heating pot or an electrically heated outer pot. Lotion
warmers heat spa products to around 122F with a thermostat to control the temperature. A hot stone heating unit
can hold towels on one side and a metal or Pyrex container
full of spa product on the other. To avoid contamination,
cover the container with a lid while it is in the heating unit.
Metal warmers will contaminate seaweed and mud, so usually, these products are heated in a Pyrex glass container in a
water bath and then placed in a plastic container before the
treatment (glass may break, so it is dangerous). Never use a
microwave oven to heat spa products because microwaves
are likely to affect many of the products therapeutic properties. Lastly, many products will break down, change consistency, or lose their therapeutic benefits if left in a warmer
for too long.
Treatment bars are an expensive but handy way to heat
several products at the same time. These bars are usually built
into the treatment room and have a number of inlaid pans
on a large heater, rather like the food heaters used in buffets
at restaurants. The heater pans can hold such varied items
as towels, hot stones, products, hot soapy water for hand
washing, hot wrap sheets, and product application brushes.
Paraffin Warmers
Paraffin warmers (sometimes called dips) hold paraffin
wax that is used to cover the hands and feet of the client.
Paraffin has been used to treat arthritis or sore joints but is
most often applied to enhance other spa services. It is best to
use a high-quality professional unit on a rolling stand rather
than an ordinary home care unit, which usually heats up
more slowly and does not have good temperature control.
Body Wrap Materials

In many spa body treatments, the client is wrapped to
allow the treatment product to absorb or to encourage
perspiration. The type of material used for the wrap will

depend on the amount of trapped body heat needed for
the wrap to be effective and the type of treatment product
being used during the session. These body wrap materials
are commonly used:
Heavy wool blanket: A heavy wool blanket is ideal for
trapping enough heat to make the client perspire in
detoxification wraps. The blanket must be large enough
to wrap up and around a large person (80 to 90 inches
works well). Washable wool is essential because the blanket will need to be washed between clients.
Thermal space blanket: The thermal blanket is a
heavy emergency blanket. It is plastic on the outside and
has foil on the inside to prevent loss of body heat.
Wrap sheets: Hot (or cold) wet wrap sheets (for wet
wraps such as herbal, coffee or milk, and honey) are
made of 100% cotton, heavy muslin, or a combination
of linen and either cotton or fleece. Flannel is never used
with hot wet sheet wraps because it is difficult to wring
out completely, so it may burn the client.
Body wrap plastic and Mylar: Plastic and Mylar sheeting (Mylar is like a light tinfoil) are used with messy products such as seaweed or mud. If the body was wrapped in
a fabric, the fabric rather than the skin would absorb the
product. Plastic and Mylar come on large rolls that are
cut to about 6 feet per client. Mylar tends to keep the
body warmer but is a bit more expensive.
Body-Warming Equipment
In a spa body treatment, the client might be draped with
only a hand towel across the breasts and a hand towel
across the genitals. If external heating is not provided, the
client might get cold during the treatment. Here are some
of the ways you might ensure the clients warmth and comfort during a session:
Heat lamps: Heat lamps can be hung above the treatment table and placed on a dimmer switch to allow for
more or less heat. Free-standing units with flexible necks
are available, but these have large heavy bases that take
up a good deal of space in the treatment room.
Electric table warmers: Electric table warmers can be
used to heat up the sheets before the client gets onto the
treatment table. For body wrap treatments, the client
will often be lying on a piece of plastic sheeting that
sits on top of a thermal blanket and wool wrap blanket. Electric table warmers cannot warm the client sufficiently through all of these layers and are not used in
this situation.
Table pads: Wool and fleece table pads provide extra
softness and warmth on the massage table. Many contain electrical heating devices with adjustable heat controls to keep the client warm during the session. Some
therapists believe that electrical devices disrupt the
clients electromagnetic energy field, however, and use
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Chapter 2
such pads only to warm the table; they turn off the pad
once the client arrives. Wool is a desirable material because it breathes and allows the body to regulate its own
temperature a little better. The drawback of wool pads is
that they require dry cleaning and may cause some clients to experience allergic reactions. Synthetic fiber and
cotton pads are also available.
Fomentek: A Fomentek is a large water bottle designed
to sit flat on the treatment table. Put the bottle under a
pillowcase and place it directly beneath the plastic layer
or the wet sheet. This provides warmth and comfort during a body wrap.
Microwavable packs: Corn, rice, or flax packs heated in
a microwave are a good way to apply external heat to a
client during a spa treatment. Do not use a hydrocollator pack because the client may get burned if he or she
lies down on top of the pack. Instead, hydrocollator
packs can be placed under the feet to increase core body
temperature.
Booties and mitts: Electric or microwavable booties
and mitts are good for keeping spa products warm on
the feet or hands. They can be used at any time to keep
the client warm, but if used for too long, the clients
limbs may start to feel heavy and swollen. Because thermal booties and mitts cause increased vasodilatation in
the distal limb, it is important to use flushing strokes
toward the heart after removing them.
Spa Clothing
Clients receiving a spa body treatment may feel uncomfortable with the degree of skin exposed during the session. Although the breasts and genitals are never exposed,
the client might only be draped over these areas. Disposable undergarments preserve client modesty and make spa
product application easier because they are made of a thin,
permeable fabric that allow spa product to reach the skin.
Small-, medium-, and large-sized womens briefs, thongs,
and bras and mens briefs or boxers should be made available to clients. For wet room treatments, dark blue or black
disposable undergarments are much better than white ones,
which become transparent when wet. A fluffy terry robe,
washable spa slippers, terry hair protectors, and terry body
wraps allow clients to move about in the spa or to move
from one treatment room to another in comfort.
Other Dry Room Supplies

Dry rooms used for massage and spa treatments need certain basic items to be functional and efficient. These items
might include the following:
Reference library: During the course of your professional practice, you will need to look up a condition,
medication, or other information. Key reference books
that should be available include an up-to-date medical
dictionary, drug reference, and a pathology reference
19
book. Access to the Internet is also a plus because it

allows you to quickly look up information on emerging
drugs, pathologies, and recommendations for session
protocols.
Clock: A visible clock helps you stay on schedule and
adjust your treatment plan as the session progresses.
Spa treatments and treatment elements requiring specific application times (body wraps, mud or seaweed
applications, etc.) are easily tracked using a digital timer.
Storage area: A cabinet with hinged or sliding doors is
best to keep extra supplies such as table cleaners, extra
hand gel sanitizer, boxes of tissue, and clean linens out
of sight. Soiled linens should be stored in a closed, ventilated container, preferably outside the treatment room
in a separate laundry area.
Wastebasket: Wastebaskets in massage treatment rooms
should have a lid opened and closed with a foot pedal to
prevent hand contamination. Dispose of paper towels
used for cleaning the massage table and hard surfaces,
used vinyl gloves, used tissues, and other items in the
wastebasket. The wastebasket should be cleaned and sanitized at the end of each day.
Music system: Music often significantly impacts the
clients ability to relax and enjoy the session. The music
system might be as simple as a CD player or MP3/
iPod system. Ensure the sound has a clean quality and
that the system is in good working order (no skipping
CDs, etc.).
Supplies for cleanliness and safety: Approved cleaning products (discussed in Chapter 3), paper towels,
extra tissue boxes, gel hand sanitizer, alcohol, finger cots
(vinyl finger covers to protect against the transmission of
pathogens if your cuticles are rough or if your skin is broken), vinyl gloves, and a first aid kit should be stored in
the treatment room for ease of access. Also, have a large,
battery-operated flashlight in case of a power failure.
Wet Room Equipment

The term wet room refers to a treatment room that contains specialized hydrotherapy equipment such as professional grade tubs, showers, and wet tables. Often, wet rooms
will be tiled and have drains in the floor for easy cleaning.
The unique pieces of equipment that might be found in wet
room environments can be broken into three categories:
tubs, showers, and specialized environments.
Tubs
Therapeutic baths (sometimes called balneotherapy) use a
variety of tubs in different sizes with different features to
provide clients with a relaxing and beneficial experience
(Fig. 24). Essential oils (aromatherapy bath), herbs (herbal
bath), seaweed, seawater or algae (thalassotherapy or algotherapy), and mud or clay (fangotherapy) are common
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20
FIGURE 24 Tubs. (A) A full-body immersion could be offered in a whirlpool, professional hydrotherapy tub,
or soaking tub. It may contain additives such as seaweed, fango, or herbs. (B) Professional hydrotherapy tub with
underwater massage.
additives that increase the therapeutic benefit of the water

treatment. Tub features will vary based on the manufacture.
Read the instruction manual that comes with each piece
of equipment carefully for proper operation and sanitation. The types of tubs commonly used at spas include the
following:
Foot soaking tubs: Foot soaking tubs range from inexpensive basins filled with warm water and additives to
deluxe pedicure stations with whirlpool features. Pedicure stations consist of a comfortable reclining chair
with an attached foot soaking basin plumbed for water
and drainage. They often have a whirlpool feature with
jets that agitate the water, which feels pleasant to the
feet, and a handheld spray used to remove spa product
or rinse the feet. Although they are most often used during the delivery of pedicures, which is out of the massage
scope of practice and provided by nail technicians, they
work well for therapists offering reflexology-based foot
spa treatments as discussed in Chapter 10.
Soaking tub: Soaking tubs at spas are like standard
bathtubs but much more luxurious. They tend to be high
sided, roomy, and design savvy. Soaking tubs might be
used to warm the body before a treatment or soothe the
body and remove product at the conclusion of a session.
Whirlpool tub: Whirlpool tubs have jets that agitate
the water and bounce it against the clients body. This
manipulates the soft tissue and causes effects similar to
some massage strokes. Whirlpool tubs might be used
as a standalone treatment or as the beginning or ending to a combined session where multiple treatments are
strung together.
Hydrotherapy tub: The main type of tub used in a spa
setting is a hydrotherapy tub. These tubs are designed for
professional use with multiple air and water jets. Professional hydrotherapy tubs have an underwater massage
hose that uses air pressure aimed at specific body areas to
improve circulation and lymph flow. Modern hydrotherapy tubs come with a self-cleaning function that makes
sanitizing the jets of the tub easier. The therapist puts a
concentrated disinfectant (formulated by the manufacture of the tub) in a special holder and then pushes a
button.
Showers
Therapeutic showers are used to remove a product from the
client, to facilitate a desired physiological effect, to warm
the body in preparation for another treatment, or to cool the
body at the end of a treatment (Fig. 25). Shower features
will vary based on the manufacture. Read the instruction
manual that comes with each piece of equipment carefully
for proper operation and sanitation. In a spa wet room, five
main types of showers are used:
Handheld shower and wet table: A handheld shower is
used in combination with a wet table for the easy removal
of product. Some handheld showers can deliver a pulsating water massage and may also have an attachable body
brush for exfoliation. A wet table has a special surface to
channel water into a receptacle under the table or a drain
in the wet room floor. The table is often constructed of
heavy plastic or acrylic for easy clean up and sanitation.
A soft waterproof insert makes the table comfortable for
the client.
Standard shower: A standard home shower is less expensive than a Swiss or a Vichy shower but does not allow
the same range of control. The pressure of the water, the
degree of pulsation, and the temperature of the water cannot be controlled by the therapist as they can with more
specialized equipment. The client is moved between the
massage table and the shower as needed during the treatment to remove product, or the client uses the shower to
freshen up at the end of a session.
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Chapter 2
21
E
C
FIGURE 25 Showers. (A) This image shows a handheld shower used in combination with a wet table. (B) A standard shower is less expensive than specialized showers but does not allow the same range of therapeutic control. It is
used primarily for removing spa treatment products or cleaning up at the end of a session. (C) A Swiss shower surrounds the client with jets of water directed at specific areas of the body. (D) A Vichy shower is a horizontal rod with
holes or water heads that rain water down onto the client from above the wet table. (E) A Scotch hose directs a strong
stream of water at the client to increase vital energy and for other therapeutic purposes.
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22
Swiss shower: A Swiss shower surrounds the client with

jets of water directed at specific areas of the body. Usually, the shower stall has pipes in all four corners with 8
to 16 water heads coming off each pipe. The water heads
are adjusted according to the clients height and the
treatment goals of the session. A control panel outside
the shower stall allows a therapist to control contrasting
warm and cool jets of water.
Vichy shower: A Vichy shower is a horizontal rod with
holes or water heads that rain water down onto the client
from above the wet table. Vichy showers are used to rinse
spa products off the client, but they can also be used as
a treatment in themselves. A control panel allows the
therapist to alternate between hot and cool water, which
increases the therapeutic benefits of some products and
uses the mechanical effects of water on soft tissue. Vichy
showers have an adjustable face guard that is meant to
keep water off the clients face.
Scotch hose: A Scotch hose is an apparatus that directs
a strong stream of water at the client for therapeutic purposes. Clients stand at the end of the wet room holding
on to handles that are attached to the wall while a therapist directs the pressurized stream in a specific sequence
over the clients body.
Specialized Environments
Specialized environments are used at spas to produce a
specific therapeutic effect by forcing the body to maintain
homeostasis in response to calculated environmental influences (Fig. 26). The types of therapeutic rooms or adaptations often found at spas include the following:
Steam room: A steam room is a room or enclosure that
can be filled with steam from a steam generator so that
people can bath in the vapor to induce sweating or to
aid respiratory conditions. There are many special considerations when building a steam room because it is a
moist environment where all building materials must
be waterproof or resistant to corrosion and decay. Seats
inside the steam room are built with a slop to allow condensation to run off of their surfaces. A floor drain and
nonskid floor ensures a clean and safe environment.
Steam showers: Steam enclosures are specialized showers that produce the same effects as a steam room but in
a shower-like environment. They often have steam heads
that fill the enclosure with steam vapor and a shower fixture that can be used alternately with steam.
Steam cabinet: Steam cabinets are like small steam
pods. The client sits down on a plastic bench, and the
FIGURE 26 Specialized environments.

(A) Steam shower. (B) Steam canopy. (C) Sauna.
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Chapter 2
cabinet is closed around him or her, leaving the head

exposed. Steam cabinets are often used to warm and
moisten product while it is absorbing into the skin.
Steam canopy: A steam canopy fits over the top of a wet
table or massage table and can be used in place of a blanket for body wraps. Like a steam cabinet, the head of the
client resides outside the warm and steamy interior environment, which may be used to promote detoxification
or to encourage product absorption.
Sauna: A sauna is a room that is constructed of either
cedarwood or hemlock because these woods can withstand moisture and resist fungi. Saunas are used to promote perspiration through dry heat and to help the body
to naturally detoxify. Saunas contain a kiuas. This is an apparatus that heats rocks that are used to heat the air inside
the sauna. Water is poured on the rocks to briefly elevate
the humidity in the air and the temperature in the sauna.

The right equipment is an absolute necessity to the spa
therapist. Keep these items in mind when you source, assess,
compare, and decide on equipment purchases:
Durability: Many therapists purchase economical home
care equipment such as paraffin warmers or hot stone
warmers with an eye to cutting costs. This type of equipment is meant for infrequent home use and cant hold
up to continuous use in a busy spa or massage clinic.
Purchase professional equipment that will last your
business for at least 5 years.
Manufacturers time in business: Assess any equipment manufacturers for the amount of time they have
been in business. Some equipment comes with warranties that can protect your investment should the item
malfunction or break down. You want to know that the
manufacturer is going to be in business should you need
replacement parts or equipment.
Consumer reports: Before purchasing equipment, read the
consumer reports on the item to find out about the experiences of people who have worked specifically with the piece
of equipment you are contemplating for your business.
Return on investment: Spa equipment is often luxurious and opulent. Its easy to get enticed to purchase
something that is beautiful but wont provide an appropriate return on investment. Think about how many
specific treatments you will have to deliver in order to
pay off the equipment when you contemplate what you
really need for your business.
Spa Products
If you add spa treatments to your menu of services in your
private practice or if you work as an employee at a spa, you
will be surrounded by a multitude of different spa products.
23
Its important to know some basics as you start to explore

the differences in spa products and methods for working
with them effectively. You will also want to review the safety
recommendations related to the skin and spa products discussed in Chapter 3 (Client and Therapist Safety).
Spa products fall into basic categories including cleansers, toners or astringents, exfoliation products, treatment
products (sometimes called masks), and moisturizers.
Cleansers
Cleansers rid the skin of dead cells, excess sebum, dirt, and
other impurities. An effective cleanser removes impurities
from both the skins surface and the pores. Soaps are alkaline and will strip the skin of its acid mantle upsetting the
proper pH of the skin and leaving it dry. Soaps also leave
a dulling film on the surface of the skin. It is important
to find a gentle body cleanser that rinses off completely.
A cleanser will often be used at the beginning of a treatment
to purify the skin before a second product, such as a treatment mask, is applied. A cleanser applied with warm water
provides enough lubrication for Swedish massage strokes
to be used. This relaxes muscles, stimulates circulation, and
adds a textural experience for the client. The use of water
with the massage strokes stimulates and energizes the body.
Toners and Astringents

Toners complete the cleansing process and help to restore
the skins acid mantle. They are usually glycerine based and
do not contain alcohol, so they are suitable for dry skin
types. Astringents are a stronger form of toner designed
for oily skin. Astringents usually contain alcohol to dissolve excess oil. Toners leave the skin feeling fresh and cool.
Alcohol is very drying for the skin, but a gentle toner applied
with massage strokes feels invigorating and refreshing. As
we progress through chapters, you may notice that a skin
toner is often used as a treatment step in the procedures
section. This is a good skin care practice but also acts as a
safety measure. Toners return the skin to a balanced pH,
which decreases the chances of the client developing skin
sensitivity to strong treatment products such as seaweed.
Exfoliation Products
Exfoliation products are used to remove trapped debris
while sloughing off dead skin cells, smoothing the skins
surface, stimulating circulation in the local region, and relaxing or invigorating the body. The salt glow is a classic
exfoliation treatment that first developed as a friction
technique in traditional hydrotherapy. At the time, its primary focus was to increase the vital energy of the body and
not to smooth the skin. These treatments were applied to
patients in weakened conditions who had various, often undiagnosed, chronic medical conditions. Now, it is a popular
and refreshing body treatment offered at most spas.
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24
New therapists and clients practicing skin care at home

often overexfoliate the skin by working too vigorously or by
using exfoliation products too often. Overexfoliation on a
regular basis can lead to an increase in epidermal thickness
resulting in a leathery skin appearance. The skin should
not be exfoliated more than once a week except by estheticians for a specific treatment goal.
Treatment Products
Treatment products, sometimes referred to as masks are
usually applied with a specific purpose or treatment goal in
mind. One treatment product might be applied to the body,
or a series of treatment products might be applied in a particular order. There are many different treatment products
options you might try depending on the session goals and
the type of consistency you want in the product (the feel of
the product on the skin).
Treatment products tend to have benefits for the skin
and may also have benefits for muscle, stress reduction, or
enhanced body energy. An example is Parafango, which is a
mixture of mud and paraffin. Massage therapists might apply
Parafango to relax hypertonic muscles, soothe arthritis pain,
and promote greater range of motion. An esthetician would
find it useful in improving the appearance of cellulite. A fullbody seaweed mask is an effective treatment for fibromyalgia,
stress reduction, and low energy. The mineral elements in
many seaweed products are absorbed through the skin and
support the general health of the entire body by stimulating
metabolism and the natural detoxification processes of the
body (see the safety information on seaweed before using it
on yourself or with clients). An esthetician will apply a mask
to the facial or body skin to tighten sagging skin, absorb
excess oil, hydrate and moisturize the skin, soothe irritated
skin, and beautify the skin.
Moisturizers
Moisturizers are usually applied at the end of a session to
replace any natural skin oils and moisture lost during the
other steps of the treatment. Moisturizers are most often
formulated to soften the epidermis and increase the skin
hydration (water content) by reducing evaporation. They
might also be formulated to tighten the skin so that it
appears firmer or to deliver therapeutic components such
as retinol (vitamin A), which reduce the appearance of fine
lines, wrinkles, and skin discoloration. Moisturizing components can be broken into three areas:
Occlusives: These are components in moisturizers that
work by forming a thin film on the surface of the skin to
reduce moisture loss from evaporation.
Humectants: This type of component attracts water
from the air in order to hydrate skin.
Emollients: These components restore oils to skin that
is deficient in factors such as amino-lipids to make the
skin softer, pliable, and more resilient.
Moisturizers can be classified depending on their oil, water,

and wax content. In general, from heavier to lighter, you
will find:
Balms or butters: These types of products are often
water free and contain mixtures of oil and beeswax that
are very heavy and protective. They might be used in
cold weather seasons to lock moisture into the skin and
guard against lower temperatures and the elements such
as wind, which can chap the skin.
Creams: Creams are combinations of oil and water but
tend to have more oil than lotions.
Lotions: A lotion tends to have a lower emollient content
than a cream and may be water based or aloe vera based.
It feels lighter on the skin because it is less occlusive.
Important Product Terms

Learning to read a product label is an important skill for
anyone applying spa products to clients. A product label
will indicate the type of seaweed or botanical product which
has been added, if dyes or fragrances have been added, if the
product has ingredients that might be potential allergens
for a particular client, or that the product has undesirable
fillers or chemicals. Miladys Skin Care and Cosmetic Ingredient
Dictionary by Natalia Michalun is an excellent guide to
product ingredients.1 The following terms are used widely,
so they require a basic explanation.
pH
The pH of a product refers to its level of acidity or alkalinity;
pH is measured on a scale of 1 to 14, from acid to alkaline.
A pH of 7, which is in the middle of the scale, is considered
to be neutral. If the products pH is lower than 7, it is acidic.
If its pH is higher than 7, it is alkaline. The skin is naturally
slightly acidic with a pH between 4 and 6 depending on the
skin type. In general, the less acidic the skin (the higher the
pH number) is naturally, the more prone it is to irritation
and sensitivity. The more acidic the skin (the lower the pH
number) is naturally, the less prone it is to sensitivity.
Antioxidants
Antioxidants are substances that prevent damage to cells
and DNA by free radicals. Free radicals are compounds produced by chemical reactions in the cell that involve oxidation. Normal metabolic reactions and external factors such
as UV radiation, exposure to chemicals such as pesticides,
air pollution, drugs, and cigarette smoking can produce
free radicals. Free radicals interfere with a cells biochemistry and play a role in some diseases associated with age
including heart disease and cancer. They attack fats, carbohydrates, proteins, and enzymes including the collagen
in the dermis. This results in decreased skin elasticity and
pliability. Common antioxidants include vitamins E and
C, carotenoids (lycopene, lutein, beta-carotene), selenium,
green tea, and honey. These ingredients are often found in
anti-aging cosmetics or after-sun products.
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Chapter 2
Botanicals
Botanicals are plant extracts used in spa products to
achieve a specific therapeutic goal. The botanical extracts
added to a preparation are often chosen because they are
anti-inflammatory, soothing, or antiseptic, although they
may have a wide range of other actions depending on the
extract. The concentration of the botanical extract and
other components in the preparation will determine the
overall therapeutic value of the preparation. Sometimes, an
extract is added to a preparation for marketing purposes in
very low concentrations, so it will add very little if anything
to the therapeutic properties of the product. Sometimes,
the preparation only contains an isolated chemical component of the original botanical extract.
25
to remove from the clients body and may require a foaming cleanser to lift it off the clients skin. Some products
may dry out quickly and need a plastic cover to keep them
moist. It is not a good idea to find these things out during
a session. Ordering and trying out new spa products is the
best way to discover new treatments and new ways of using
products. Only by practicing regularly with products will
the treatment steps and transitions between the steps become easier. For example, there is an exfoliation product on
the market that goes on wet and dries as it is rubbed in. It is
brushed away with a dry towel. It requires only one towel for
removal on the entire body (eight towels would normally be
required). This is faster and easier than a wet exfoliation
requiring hot towel removal, and it feels just as satisfying as
dry skin brushing (discussed in Chapter 8).
Fragrance
Fragrances enhance the smell of a product, and even products such as seaweed and mud are often fragranced. The
fragrance used will be either natural or synthetic. Natural
fragrances are usually based on natural essential oils or botanical extracts. Synthetic fragrances are usually composed
of a small number of artificially synthesized compounds,
which on their own may cause skin irritation or unwanted
side effects such as headaches or a slightly sore throat. The
popularity of aromatherapy has led to the increased use of
essential oils in expensive skin care lines. Although this is
a positive move, it is difficult to determine the quality and
purity of the essential oils that are being used.
Natural Ingredients
The term natural is not regulated in the cosmetic industry.2
A company can legally put just about anything in their
product and call it natural if they want to. A product line
claiming to be all natural will usually still contain some synthetic ingredients, dyes, or preservatives. In aromatherapy,
it is well known that an essential oil may smell differently
from batch to batch. The smell of the oil is naturally variable due to the climatic conditions during the year in which
it was grown, the time of day at which it was harvested, the
skill of the distiller, and the means by which it was stored
and shipped. All of these circumstances will affect the final
chemical composition of the oil and therefore its therapeutic properties and its smell. If the oil smells the same from
batch to batch, the consumer would be right to wonder if
the oil has been adulterated with isolated components or
synthetic additives to achieve a reliable fragrance. Many
products claiming to be all natural have a consistent fragrance, which is not possible without the addition of other
chemicals to standardize the scent.
Product Exploration
It is important to know the products that you are using
and to play with the products before you apply them to
a client. Individual seaweeds will have different mixing and
spreading properties. Some types of mud will be difficult

The clients perception of the massage business is created
or altered through his or her five senses because this is how
we interpret our environment. We create a special spa environment by paying attention to what the client sees, hears,
smells, tastes, and feels during the session. If you own your
spa business, you have control of many of the issues we are
about to discuss. If you work as an employee, you will have
less opportunity to determine how the environment of the
business is set up. Still, by considering client perception and
comfort issues, you can make good choices in the development of your own business space or make good recommendations to your employer if it is necessary.
What the Client SeesDcor

Every business has its own unique focus and personality.
A therapist who practices relaxation massage, soothing spa
body treatments, and stress reduction is likely to operate in
a different environment from the therapist who practices
clinical massage and spa body treatments with a rehabilitative or health care focus. The first may choose soothing
color combinations and images of natural beauty for the
walls, whereas the second might choose a neutral color
palate, medical charts, and anatomical models. To choose
your own appropriate dcor, consider the techniques you
will use and the types of clients you desire. Color, window
treatments, flooring, lighting, wall decorations, and extra
touches are all elements of decoration.
Color
There are many ways to think about color, and choose the
colors that are right for your business. Therapists can learn
from color psychology and color symbolism in making
their decisions.
Color psychology is a field of study that evaluates the
effect of color on human behavior and emotion. Color symbolism explores the cultural significance of color and what
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26
Yellow:
Blue:
Stimulating
Increased mental attention
Increased anxiety ratings
People argue more in
yellow rooms
Babies cry more in
yellow rooms
Decreased irritation levels

in stressful conditions
Decreased anxiety ratings
Decreased blood pressure
Slowed breathing patterns
Increase of physical
performance
Orange:
Creative stimulant
Increases enthusiasm
Used in color therapy for
respiratory conditions
Increased metabolism
Color
Psychology
Purple:
Red:
Appetite suppressant
Decreased anxiety
Mentally balancing
Creative stimulant
Green:
Increased blood
pressure
Adrenal stimulant
Increased anxiety
Increased performance
on tasks
Decreased tension and

stress
Decreased anxiety ratings
Decreased blood pressure
Decreased performance
on tasks
Balancing
FIGURE 27 Color psychology is a field of study that evaluates the effect of color on human behavior and
emotion. This diagram shows some of the effects of color based on research.
colors mean to different groups of people. Color psychology is appropriate for situations in which the business has
no cultural overtones. For example, a therapist who delivers
relaxation treatments might use a green palate because studies have demonstrated that green colors decrease tension and
stress, slow breathing patterns, and, in some cases, decrease
blood pressure.3,4 A clinical massage therapist or a spa focused
on physical fitness might note the results of a study showing
weight lifters can lift more weight in rooms with a blue palate;
blues seem to promote strength and physical gains.5 A therapist working with pregnant mothers, parents, and infants
would not choose a yellow palate because research shows that
babies cry more frequently in yellow rooms (Fig. 27).6
Color symbolism works well when a business has cultural
overtones or a specific client group (Fig. 28). For example,
a business focused on Eastern bodywork might choose colors with cultural significance in Asian countries. The color
red might play a decisive role because in Asia, red is the color of good luck and a wedding color. It has positive, joyful
overtones. A business set in a busy urban area and wanting
to attract businessmen might choose a blue palate because,
in Western society, blue is associated with excelling (blue

ribbon), loyalty (true blue), and noble descent (blue blood).
It is also associated with intelligence (bluestocking) and
morality (blue laws).
Window Treatments
Window treatments are an important design feature in
any room and provide privacy, light control, and style. In a
spa environment, privacy is very important. Window treatments should not be so sheer that people outside can look
in and see the body treatment session. Window treatments
also control light entering the room. Natural light streaming through sparkling windows might be desirable during
the client consultation or assessment. When the spa treatment starts, softer, dimmer light is more relaxing. You can
choose between semi-sheer fabrics that diffuse the light and
rich opaque fabrics that shut it out completely.
Windows are often the main focal point in the treatment
room. Interesting and well-planned window treatments
add style and eye-catching appeal. They also absorb sounds
from outside and from the room itself, helping create a
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Chapter 2
27
Yellow:
Green:
Nature and the beauty
of nature
Movement forward
Youth
Naivet
Jealousy
Envy
Victory (in Greece)
Blue:
Travel
Loyalty
Feelings of sadness
Unexpected opportunities
Social prominence
Achievement
A noble character
Intelligence
Protection from harm
Morality
Warmth
Stimulating conversation
A warning
Cowardliness
(in Western cultures)
Courage (in Japan)
The season of spring
Support to soldiers who
are in battle
Sourness (the flavor)
Black:
Sophistication
Elegance
Expertise
Darkness
Loss of consciousness
Things that are
underground or illegal
Punishment
Purple:
White:
Heaven
Gods
Angels
Truce and peace
Things that are rare
Purity
Cleanliness
Red:
Energy
Aggression
Passionate love
Beauty (in Russia)
Luck and happiness
(in Asian cultures)
Battle (in Roman times)
Royalty
Authority
High-ranking official
Exaggeration
Ornamentation
Meditative states
FIGURE 28 Color symbolism explores the cultural significance of color and what colors mean to different
groups of people. This diagram shows some of the cultural associations of color.
quieter overall environment while conserving energy by

insulating the glass.
In the treatment room, dimmer switches work well. Lights can

be made bright for cleaning or sanitizing equipment, put at a
medium setting for the health intake consultation, and turned
down for the spa treatment. Several pools of soft, diffused
light or diffuse natural light are more relaxing than one bright
light in a corner or the room being too dark. Avoid the use of
candles because open flames are a safety hazard, and they can
pollute the air, especially when they are used in small rooms.
used to help clients feel connected to the earth and nature.

Clinical or rehabilitative businesses benefit from medical
charts and images that allow clients to see and understand
the structures involved in their soft tissue condition. Businesses specializing in Eastern bodywork or Eastern-inspired
spa treatments are likely to hang Asian images or objects on
the walls to evoke a sense of that culture and create continuity in the clients experience. Wall decorations can be functional as well as beautiful. For example, fabric wall hangings
dampen noise, whereas a stylish mirror gives the client a place
to freshen up at the end of the session and allows the therapist
to check his or her body mechanics during the session.
Wall Decorations
Extra Touches
Wall decorations can promote the image of the business,

make a soothing impression on the client, and dampen sound.
In relaxation-oriented spas, images of natural beauty are often
Decorative items on shelves, side tables, and windowsills help

create interest and define the rooms style. A relaxation business
using an all-natural theme might display shells, nonblooming
Lighting
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28
plants (to avoid allergies), or interesting stones. A clinical or

rehabilitative business might feature anatomical models of
the body. Rattan baskets, bamboo, and Japanese river stones
might adorn an Eastern bodywork business. Items can be functional as well as decorative. For example, in a business focusing
on ayurvedic bodywork, one therapist has different types of
Indian, Nepalese, and Bhutanese bells and chimes on display.
They are beautiful to look at but also sound lovely when she
rings one to signal the beginning and end of the session.
What the Client Hears

The auditory environment is also important because it sets
the tone for the session and may mask outside noise. Consider the treatment room flooring. A tile or wood floor may
cause echoes that are annoying or distracting. The wrong
sort of music may also be disturbing and irritating to the
client. Most therapists have probably heard spa or massage
CDs that are downright alarming. One CD on the market
features wolves howling incessantly in every songit is difficult for a client who feels like prey to relax!
The right music can evoke strong feelings and beneficial
physiological changes in the client. Research shows that
music decreases anxiety, decreases systolic blood pressure,
and decreases heart rate even when the person is actively
stressed.7 Music also exerts complex influences on the
central nervous system and can, in a short period of time,
change brain waves associated with an alert state to brain
waves associated with a relaxed state.8 In a single session of
music therapy delivered to hospice patients with chronic
pain conditions, music decreased the participants overall levels of pain and increased their physical comfort.9
Research also shows that the positive physiological benefits
of music are increased when patients can choose their own
music.10 It is a good idea to have a variety of musical styles
available and to ask clients about their musical preferences
during the client consultation. Clients can also be encouraged to bring their own appropriate music for the session.
morning until after the last session of the day. The use of a
sea salt scrub on your hands can help to exfoliate skin that
holds the aroma of cigarette smoke. Although this might
seem harsh, clients who do not smoke often find the lingering smell of cigarette smoke intolerable.
In a therapeutic setting, the good smells from natural essential oils used in aromatherapy can promote relaxation
and a pleasant mood. This is important because stress is at
the core of many modern diseases, and studies suggest that
decreasing stress improves ones health and immunity.11,12
Smells can evoke intense emotional reactions and can even
be used to change behavioral patterns. Credible evidence
shows agreeable aromas can improve our mood and sense
of well-being.13 This is not surprising because olfactory receptors are directly connected to the limbic system, the oldest and most emotional part of the human brain.
In a study of how scent impacts social relationships,
people in photographs were given a higher attractiveness
rating when the test subjects were exposed to a pleasant
fragrance. In a test of shampoos, a product initially ranked
last in performance was ranked first in a second test after its
aroma was adjusted.14
Therapists can use gentle, soft aromas to enhance the
clients perception of the business and to provide an emotionally satisfying experience. For example, diffusing citrus
essential oils throughout an area can purify the air, repel
insects, enhance mood, and make the area smell clean and
fresh. A commercial nebulizing diffuser works well to eliminate microbes and promote a clean, healthy living or working space (Fig. 29). Avoid the use of strong scents and even
What the Client Smells

Good ventilation and fresh air are important in the spa
treatment space. In the warm, closed environment of the
treatment room, aromas from a previous client (e.g., heavy
perfume, cigarette smoke) can persist into the next session
if the room is not well ventilated. Open the windows between clients if possible or point a fan at the ceiling to circulate the air. Leafy, nonblooming foliage plants make good
natural air purifiers. Because many clients have allergies to
blossoms, flowers, despite their beauty, should not be used
in the treatment room.
Therapists must also consider their own smells and how
they may impact a client. Avoid strong-smelling deodorants, perfumes, and aftershave products. Brush your teeth
after meals and rinse your mouth with mouthwash between
clients. Smokers should not smoke after showering in the
FIGURE 29 Nebulizing diffuser. A commercial nebulizing diffuser

works well to promote a clean, healthy living, or working space without
overscenting the air.
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Chapter 2
too much of a soft scent. Dont use scented carpet sprays,

laundry detergent, or fabric softeners because these have
synthetic ingredients and may irritate clients.
When using aromas, use products with natural rather
than synthetic fragrances. Synthetic fragrances are artificial
and do not come from aromatic plants, fruits, or flowers.
Clients often develop adverse reactions to synthetic fragrances (headaches, sore throat, sneezing, coughing, and
emotional irritation) and may come to dislike all aromas as
a result. Aromatherapy and the use of pure, natural essential oils are discussed in detail in Chapter 7, Introduction to
Aromatherapy for Spa.
What the Client Tastes

In most cultures, food and drink have celebratory associations. Children commemorate their birthday with ice
cream parties, cake is eaten at weddings, and special friends
are invited over for a meal. Incorporating small food items
in the session is a pleasant and smart practice. Clients can
sometimes get up from a session and feel shaky and dizzy
from low blood sugar. A small snack provides an opportunity for the client to wake up and come back to the real
world before venturing back out into the busy world. It
doesnt have to be elaborate and can be as simple as a cup
of green tea served from a Chinese tea set after an Asian-inspired service or a complementary chocolate on Valentines
Day. Similarly, a treatment developed for athletes might
serve a sports drink as part of the session. In the summer,
clients might enjoy leaving their treatment with a colorful
Popsicle to remind them that spa is fun. Granola bars and a
bowl of fresh fruit might be offered to clients. Fresh, filtered
water should be provided before, during, and after the session. Food and drink should be simple and manageable but
focus on the intention of the offering: to welcome; to nourish on a spiritual level; and to show care, thoughtfulness,
and appreciation.
What the Client Feels

Once on the treatment table, the client should be enveloped in warm, soft textures whenever possible. Bolsters
support the joints in a relaxed position. Blankets, warm
packs, Fomentek water bottles, and heat lamps help keep
clients warm throughout the session. Lotion warmers heat
massage oil or spa products so that it does not feel cold
when applied. Never use a microwave oven to heat products
because microwaves may affect the products therapeutic
properties. Because many products break down when heated, it is recommended to use 1-oz bottles with flip or pump
lids. These small bottles are filled with fresh product at the
beginning of each day so that the larger container is not
exposed to heat and can remain in the refrigerator.
Some therapists have chronically cold hands, which can
feel shocking to the client at the beginning of the session.
Warm your hands as much as possible by holding them
29
under warm water, holding a warm pack, or rubbing them

briskly before the session.
Accessibility and Functionality

When designing your spa space, think about each area of
the business and analyze its accessibility and functionality.
Consider the entrance and reception area, dressing area,
and the bathroom.
Entrance and Reception
When choosing a business location, consider its accessibility. Are doorways, hallways, and bathroom entrances wide
enough to accommodate a wheelchair? Is there enough space
around furniture to accommodate someone in a cast and on
crutches? Does a long flight of stairs make the business prohibitive for elderly clients? Is parking convenient and userfriendly or will clients be spending the first 10 minutes of
their sessions looking for a space and feeling stressed?
The reception area must be friendly, neat, and functional. Clients generally fill out paperwork in this area while
waiting for their session. They might also pay for the session and book additional sessions in this area. Magazines, a
retail area, tea or water, and comfortable chairs and attractive furnishing help ensure the clients comfort.
The Undressing and Dressing Space
Carefully plan the space where clients remove their clothing
before the session and get dressed afterward. A screened-off
area provides a sense of privacy and decreases the clients
anxiety that the therapist might walk into the room unexpectedly. Place a chair and hooks behind the screen where
clients can hang their clothing. A small container for personal items such as keys and jewelry helps ensure clients do
not misplace or forget them. A box of tissue, disposable wet
wipes, and mirror are useful as well.
The Bathroom
In the bathroom, provide only liquid soap. Have on hand
amenities that make it easy for clients to tidy up after
the session. Gentle face cleanser, makeup remover, and
moisturizer allow women to remove their makeup before
a session or fix it up afterward. Disposable combs, bobby
pins, spray gel, and hair bands come in handy, especially
after a neck massage using oil. Contact lenses solution,
spray antiperspirant (solids or gels used by more than
one person are unsanitary), and mouthwash are also
appreciated.
Planning Spa Treatment Rooms

If you are planning your own spa business, you need to
think about how each treatment room can be organized
and equipped to allow for the delivery of multiple treatments. In Chapter 15 (Treatment Design and Your Signature Spa Treatment), you will learn about how to organize
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30
and develop a meaningful menu of services to entice clients

to your business and build their loyalty. If you develop a
highly specialized treatment, you may need a highly specialized treatment room to enable its delivery. The problem
is that a treatment room designed solely for a specialized
treatment it is unlikely to generate revenue on a daily basis

and becomes a wasted space. Plan your menu and your
treatment rooms with enough flexibility so that each room
is generating income for your business every hour you
are open.
SPA FUSION
STUDY TIP: Up to the Test!
To do well on any written test, you must not only
know the information but also have a good test-taking
plan. A good plan helps prevent test anxiety and leads
to better test scores. Try the PASS method to do your
best on the next test:
P Prepare: Prepare for the test by breaking the test
topics into different study sessions. Dont try to learn
a whole chapter the night before the test. For example,
for a test on a chapter with three key subject headings,
you might plan four study sessions. Study one subject
in each of the first three study sessions and then study
all the topics together in the final study session. Write
yourself a test from the chapter. By combing the chapter
for test questions, you predict what the instructor might
ask and have a good chapter review in the process.
A Arrive early: Before leaving for school, eat a light
meal but avoid sugar, which can adversely affect your
thinking. Drink lots of water because people think
better when they are hydrated. Get plenty of sleep the
night before the test so you are well rested. Arrive early
and read through your notes one last time. Then put
the notes aside and focus on your breathing while you
clear your mind.
S See success: Dont fall into negative thinking (e.g.,
I dont know this chapter well enough and Im sure
to fail!). Give yourself positive energy (e.g., I studied.
Im ready. Ill do great!). See yourself succeeding and
answering every question with ease. Visualizing success
helps your mind relax and focus on the test content.
S Strategize: Proven test-taking strategies can help
you score high. First, read the directions carefully.
Many students assume they understand the directions and then make wrong choices based on false
assumptions. Next, answer everything you know first.
This warms up your brain and gives you confidence.
If youre stuck, underline key words and define them
in the margins of the test or on scrap paper. Thinking
about key terms often unlocks the answer to a test
question. Look for absolutes such as always and never.
Absolutes in an answer choice often signal that its the

wrong choice. Finally, when your tests are returned
to you corrected, look it over carefully and determine
the sources of the tests information, which helps you
know what to study next time. For example, if you
missed two lectures but know the textbook material
well, you still might have difficulty on a test if the
instructor asks questions primarily from lecture content. You now know that attending every lecture is a
must if you want a good grade in this particular class.
SPA INSPIRATION: There Is No Substitute for

Direct Experience!
Isadora Duncan, the famous American dancer,
remarked, What one has not experienced, one will
never understand in print. Spa equipment is best
understood through direct experience. Have some fun
by contacting local spas in your area. Let them know
that you are a student in a spa program and would
like to visit the spa as part of your learning process.
Ask a therapist to show you around and describe the
different types of products and equipment he or she
uses in their facility. This way, you will have an excellent point of reference when you start to think about
purchasing your own equipment and create your own
spa environment.
CHAPTER WRAP-UP
The quality of the equipment that you use, the quality
of lubricants and spa products that you use for massage and spa treatments, and the time and care you
put into planning your spa space convey your level of
professionalism to your clients. Although it may seem
early to start thinking about equipment needs and
dcor for your business, its not too early to explore
options. Try out different massage tables and different
lubricants. Purchase sample sizes of spa products such
as mud, salts, and seaweed. Start to explore interior
design and think about color choices and window
treatments and visit a spa show in your area for demonstrations of specialized equipment. Starting now
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Chapter 2
31
SPA FUSION
helps ensure you to be prepared to enter the massage
and spa profession with a clear and informed plan.
This also helps you keep your spa career vision alive,
an important motivator when the massage and/or spa
program gets challenging!
REVIEW QUESTIONS
Multiple Choice
5. A shower with a horizontal rod with holes or water

heads that rain water down onto the client from
above the wet table is called:
a.
b.
c.
d.
A Swiss shower
A Kneipp shower
A Vichy shower
A Dutch shower
True or False
1. Dry room equipment is:

a. Equipment that has a self-drying feature
b. Equipment used in a room where water
treatments are delivered
c. Equipment used in a room where water
treatments are not delivered
d. Equipment that is meant to get wet
6.
There are some situations where

a spa product is meant to be applied warm, but,
in most cases, spa product is cooled before it is
applied to the body.
7.
The main type of tub used in a

spa setting is a common bathtub designed for
professional use with color therapy to cause the
water to change colors during the session.
8.
Steam cabinets are like small steam

pods. The client sits down on a plastic bench,
and the cabinet is closed around him or her,
leaving the head exposed.
9.
A sauna is a room that can be filled

with steam from a steam generator so that people
can bath in the vapor to induce sweating or to aid
respiratory conditions.
2. A Fomentek is:
a. A shower with seven water heads
b. A large water bottle designed to sit flat on the
treatment table
c. A type of wrap blanket that is highly insolated
d. A heat lamp hung over the top of the massage table
3. A wet table:
a. Has a plush, comfortable velvet-like cover that
resists water
b. Has a cold hard surface to channel water
c. Has a special surface to channel water covered
by a plastic mat for comfort
d. Has a special surface that has a self-drying finish
for use between clients
4. A shower that surrounds the client with jets of water
directed at specific areas of the body from shower
heads in the four corners of the stall is called:
a.
b.
c.
d.
10.
Exfoliation products are used to

remove trapped debris while sloughing off dead
skin cells, smoothing the skins surface, and
invigorating the body.
A Swiss shower
A Kneipp shower
A Vichy shower
A Dutch shower
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3
Client and
Therapist Safety
Chapter Outline
K e y Te r m s
Spa Ethics
Antiseptics: A type of cleaning agent that is generally appropriate for use

in a spa setting so long as no blood or body fluid is present.
Code of ethics: A document or creed that states a professional groups
ethical principles and the values by which the group abides.
Direct contact: The transfer of a pathogen from an infected person to
an uninfected person through touch, sexual contact such as kissing or
intercourse, or expelling body fluid droplets onto a person by sneezing,
coughing, or touching mucous membranes and then touching an
uninfected person without having washed the hands.
Disinfectants: A type of cleaning product that should not be used on the
skin and that is stronger than an antiseptic. Disinfectants kill or are
effective against most bacteria and viruses.
Estheticians: People licensed to practice professional skin care.
Indirect contact: The transfer of a pathogen from an infected person to
an uninfected person via an inanimate object (known as a fomite) such
as a countertop, doorknob, toy, or magazine.
Lice: Parasitic animals that can be spread via direct and indirect contact
that suck the blood of their hosts and cause itching.
Mites: Parasitic animals, similar to lice, that can be spread via direct and
indirect contact that suck the blood of their hosts and cause itching.
Pathogen: A producer of disease.
Power differential (power advantage): The authority a massage
therapist is granted by a client based on the clients perception of the
massage therapist as a knowledgeable and skilled health care provider.
Scope of practice: A term used by regulating boards of health care professions to describe the techniques, activities, and methods that are
permitted to a therapist under the law.
Sterilization: The elimination of all microorganisms on and in an object
through heat, chemical substances, or irradiation.
Universal precautions: A protocol used in health care settings that
reduces the risk that health care workers will be exposed to bloodborne
diseases transmitted through broken skin, mucous membranes, or
contact with blood and body fluid.
Vector transmission: The transmission of a pathogen via vectors (insects
or animals capable of transmitting diseases, including mosquitoes,
flies, fleas, ticks, mites, rats, dogs, and cats).
Vehicle transmission: The transmission of a pathogen by a vehicle
such as air, food, and liquid.

Boundaries
Scope of Practice

Diseases
How Diseases Are Transmitted
Preventing the Transmission of Disease
Sanitation of the Facility, Equipment, and Supplies
Universal Precautions

Safety of the Facility
Safety of the Client
Safety of the Therapist

Spa-Specific Considerations
Common Conditions That Require Caution
Critical Thinking and Contraindications

SPA FUSION
STUDY TIP: Graphic Organizers
SPA INSPIRATION: Your Spa Journal
CHAPTER WRAP-UP
32
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Chapter 3
Client and Therapist Safety
33
to spa equipment and spa environments. Reviewing the
relationship involves learning how to assert and maintain

your own boundaries while respecting the boundaries of
clients. One area where this is particularly important is in
issues related to sex (see number 8 of the ABMP Code of
Ethics in Table 31).
There are various levels of sexual misconduct, ranging
from lack of attention to sexual innuendo, to sexual impropriety, to sexual abuse of clients. You must always control
the atmosphere of the spa business. Allowing clients to
act inappropriately is as serious as acting inappropriately
yourself.
details of contraindications and understanding how spa
Lack of Attention to Sexual Innuendo
treatments might adversely affect a clients condition is
It is not uncommon for people to compliment each other

and express their affection by positively commenting on
another persons appearance. In a spa setting, this can
lead to mistrust. If you tell a client, you look really good
in those jeans, it plants a seed of doubt and mistrust in
a clients mind about your intentions, regardless of how
long you have known each other or how innocent the comment. Because of the intimate nature of spa work, refrain
from making any body comments that indicate approval
or disapproval of a clients body and physical features such
as the eyes, mouth, or hair. Do not carry magazines, pictures, or written material of a sexual nature to the work
environment. Do not allow the client to make sexual jokes
and discourage clients from commenting on your personal
appearance by downplaying those types of compliments
with a brief thank you and then a return to the business
at hand.
This chapter aims to introduce new spa therapists to

areas that will need attention and careful planning before
spa treatments are offered as an employee or in a private
practice. The first area we will explore is ethics and how
massage ethics are applied to spa-related situations. Next,
is a closer look at sanitation, hygiene, and safety as it relates
also important. We will discuss common conditions and

spa-specific contraindications that will help you know
when to postpone a treatment or suggest a different service
to ensure the clients health.
Spa Ethics
Ethics is a major branch of philosophy exploring values,
morals, right and wrong, good and evil, and responsibility.
Also called moral philosophy, ethics is a system of principles governing the appropriate conduct for an individual
or group. It is concerned with values and the standards by
which human actions can be judged right or wrong. Ethics
are different from laws, which are rules of conduct that are
recognized by a community as binding or enforceable by
authority. Some behaviors may be legal but nonetheless are
not ethical. For example, it is not illegal for a therapist to
date a client, but the massage community actively discourages this as unethical because dating a client may cause the
client harm.
A code of ethics states a professional groups ethical
principles. It suggests values by which the group abides.
Table 31 shows the code of ethics for members of Associated Bodywork and Massage Professionals (ABMP), the
largest massage therapist membership organization in the
United States. Review this code of ethics as a reminder of
ethical principles that guide your work as a massage therapist. In a spa setting, certain ethical standards are placed in
greater focus than in other work environments. Lets review
those areas now.

Boundaries
Boundaries are conscious and subconscious imaginary lines
that mark the limits of an individuals personal space or territory. Boundaries create a separation or a border between
a person and other people and between a person and the
environment. Part of establishing a healthy therapeutic
Sexual Impropriety
Sexual impropriety is more serious than a general lack
of attention to sexual innuendo and could lead to sexual
harassment charges. Behaviors that could be labeled as
sexual impropriety include the following:
Any behavior that is immodest or encourages immodesty in clients; for example, a therapist who stands in the
treatment room while the client undresses in front of
him or her or allows a client to place himself or herself
on top of the drape exposing the genitals or breasts
Draping loosely or deliberately looking at a clients body
while adjusting a drape; not using draping practices or
pressuring a client to take off his or her underclothing
when he or she leaves it on; and not providing disposable
spa underclothing, which allows a client to receive a fullbody spa treatment without a loss of modesty
Using nicknames for clients, especially those that have a
sexual connotation, or allowing the client to use sexual
nicknames for you such as Romeo, Handsome,
Baby, Honey, or Sexy
Telling a client jokes or listening while a client tells jokes
of a sexual nature
Discussing ones own sexuality within hearing of a client
(its a bad idea with coworkers as well because it could
lead to a sexual harassment claim)
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34
TABLE 31 Associated Bodywork & Massage Professionals Code of Ethics

1. Commitment to High-Quality Care
I will serve the best interests of my clients at all times and provide the highest quality of bodywork and service possible. I recognize that the obligation for building and maintaining an effective, healthy, and safe therapeutic relationship with my clients is my responsibility.
2. Commitment to Do No Harm
I will conduct a thorough health history intake process for each client and evaluate the health history to rule out contraindications or determine
appropriate session adaptations. If I see signs of, or suspect, an undiagnosed condition that massage may be inappropriate for, I will refer that
client to a physician or other qualified health-care professional and delay the massage session until approval from the physician has been granted.
I understand the importance of ethical touch and therapeutic intent and will conduct sessions with the sole objective of benefitting the client.
3. Commitment to Honest Representation of Qualifications
I will not work outside the commonly accepted scope of practice for massage therapists and bodywork professionals. I will adhere to my states
scope of practice guidelines (when applicable). I will only provide treatments and techniques for which I am fully trained and hold credible
credentials. I will carefully evaluate the needs of each client and refer the client to another provider if the client requires work beyond my capabilities, or beyond the capacity of massage and bodywork. I will not use the trademarks and symbols associated with a particular system or
group without authentic affiliation. I will acknowledge the limitations of massage and bodywork by refraining from exaggerating the benefits of
massage therapy and related services throughout my marketing.
4. Commitment to Uphold the Inherent Worth of All Individuals
I will demonstrate compassion, respect, and tolerance for others. I will seek to decrease discrimination, misunderstandings, and prejudice. I
understand there are situations when it is appropriate to decline service to a client because it is in the best interests of a clients health, or for my
personal safety, but I will not refuse service to any client based on disability, ethnicity, gender, marital status, physical build, or sexual orientation; religious, national, or political affiliation; social or economic status.
5. Commitment to Respect Client Dignity and Basic Rights
I will demonstrate my respect for the dignity and rights of all individuals by providing a clean, comfortable, and safe environment for sessions,
using appropriate and skilled draping procedures, giving clients recourse in the event of dissatisfaction with treatment, and upholding the integrity of the therapeutic relationship.
6. Commitment to Informed Consent
I will recognize a clients right to determine what happens to his or her body. I understand that a client may suffer emotional and physical harm if
a therapist fails to listen to the client and imposes his or her own beliefs on a situation. I will fully inform my clients of choices relating to their
care, and disclose policies and limitations that may affect their care. I will not provide massage without obtaining a clients informed consent
(or that of the guardian or advocate for the client) to the session plan.
7. Commitment to Confidentiality
I will keep client communication and information confidential and will not share client information without the clients written consent, within the
limits of the law. I will ensure every effort is made to respect a clients right to privacy and provide an environment where personal health-related
details cannot be overheard or seen by others.
8. Commitment to Personal and Professional Boundaries
I will refrain from and prevent behaviors that may be considered sexual in my massage practice and uphold the highest professional standards
in order to desexualize massage. I will not date a client, engage in sexual intercourse with a client, or allow any level of sexual impropriety
(behavior or language) from clients or myself. I understand that sexual impropriety may lead to sexual harassment charges, the loss of my
massage credentials, lawsuits for personal damages, criminal charges, fines, attorneys fees, court costs, and jail time.
9. Commitment to Honesty in Business
I will know and follow good business practices with regard to record keeping, regulation compliance, and tax law. I will set fair fees and practice honesty
throughout my marketing materials. I will not accept gifts, compensation, or other benefits intended to influence a decision related to a client. If I use the
Associated Bodywork & Massage Professionals logo, I promise to do so appropriately to establish my credibility and market my practice.
10. Commitment to Professionalism
I will maintain clear and honest communication with clients and colleagues. I will not use recreational drugs or alcohol before or during massage
sessions. I will project a professional image with respect to my behavior and personal appearance in keeping with the highest standards of the
massage profession. I will not actively seek to take someone elses clients, disrespect a client or colleague, or willingly malign another therapist
or other allied professional. I will actively strive to positively promote the massage and bodywork profession by committing to self-development
and continually building my professional skills.
Used with permission from Associated Body & Massage Professionals.
Members commit to follow ABMP Code of Ethics to protect clients, themselves, and the massage profession.
Gender-based comments or harassment, which includes

verbal, nonverbal, or physical intimidation or hostility
based on sex or sex-stereotyping such as comments
about another therapists sexual orientation or criticism
of a sexual orientation
Displaying or distributing sexually explicit drawings,
pictures, and written materials (i.e., showing pictures of
undraped bodies, no matter how artistic they are, in

the reception area)
Requests to date or acceptance of an offer to date
E-mailing or phoning clients or sending them notes or
cards that are not specifically and exclusively related to
the spa session; for example, it is acceptable to call a
client the day after a session and ask how the muscles
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Chapter 3
are feeling. It is not acceptable to call a client for a conversation about personal details of events the client mentioned in the session.
Sexual Abuse
In a therapeutic relationship, the therapist develops a
power advantage over the client because the therapist is
the caregiver (For Your Information 31). For this reason,
any sexual misconduct, whether or not the client consents,
is considered sexual abuse. The therapist is responsible
and liable for sexual abuse, even if the client initiates it.
Never engage in any sexual activity with a client, whether
in or out of the treatment room. This includes behavior
that could reasonably be interpreted as sexual, including
touching with the hands, body, mouth, or genitals the
clients genitals, breasts, mouth, or anus; allowing the client to touch you; or allowing or encouraging the client to
touch himself or herself or masturbate during the session
in your presence, or directly after the session, in the treatment room. If the therapist masturbates or touches himself
or herself in a sexual manner in the presence of the client,
it is sexual abuse.
Sexual impropriety may lead to sexual harassment
charges and the loss of massage credentials. Sexual abuse
could lead to loss of massage credentials, lawsuits for personal damages, criminal charges, fines, attorneys fees, court
costs, and jail time.
Scope of Practice
In number 3 of ABMPs Code of Ethics, therapists make a
commitment to honest representation of qualifications by
agreeing to work within a defined scope of practice. The
term scope of practice is used by regulating boards of health
care professions to describe the techniques, activities, and
methods that are permitted to a therapist under the law.
Although most states define the scope of practice for massage in similar terms, small variations require the therapist
to carefully inspect and understand the scope of practice in
the state where he or she practices massage. Ohios scope of
practice for massage therapy provides a good example and
states, Massage therapy is the treatment of disorders of the
human body by the manipulation of soft tissue through
the systematic external application of massage techniques
including touch, stroking, friction, vibration, percussion, kneading, stretching, compression, and joint movements within the normal physiologic range of motion; and
adjunctive thereto, the external application of water, heat,
cold, topical preparations, and mechanical devices.
Floridas definitions show an example of a variation
that is uncommon. It states that massage means the manipulation of the soft tissues of the human body with the
hand, foot, arm, or elbow, whether or not such manipulation is aided by hydrotherapy, including colonic irrigation,
or thermal therapy; any electrical or mechanical device;
or the application to the human body of a chemical or
35
FOR YOUR INFORMATION 31

The Power Differential
In a spa setting, a power differential is defined as the authority
a massage therapist is granted by a client, based on the clients perception of the massage therapist as a knowledgeable
and skilled health care provider. Take a moment to contemplate your relationship with these people: parent, boss, best
friend, physician, teacher, counselor, spiritual leader, or spouse.
Each of these relationships involves differing levels of trust,
closeness, loyalty, respect, and responsibility. It is likely that you
perceive some of these people as having more authority than
you in some situations. For example, if you go to your spiritual
leader to discuss a personal concern, you grant him or her the
power of an advanced understanding of spiritual concepts. It
is easy to assume that history teachers are more knowledgeable about history than other people or that dentists know
more about teeth than other people. When clients make an
appointment with a massage therapist, a power differential is
at play in the relationship because the client assumes and respects the therapists understanding of soft tissue structures and
manual techniques that reduce tension and pain. Furthermore,
during the session, the client shares details of his or her personal
health history and is situated at a level below the therapist, in a
vulnerable reclining position, while unclothed under a drape.
The therapist by virtue of his or her knowledge and skill in the
area of massage is granted control of the situation, so he or
she has a power advantage over the client.
Ethical massage therapists remain aware of the power differential and seek to minimize it as much as possible to ensure
the mental, emotional, and physical safety of clients. When
the power differential is minimized, clients are better able to
Take an active role in the decision-making process to
determine reasonable treatment goals.
Alert a therapist to an uncomfortable technique or voice
concerns.
Give honest feedback on the quality of treatment or the
effectiveness of sessions.
Maintain their boundaries, personal power, and responsibility for health.
Actively practice self-care activities and other types of
therapy to augment the results achieved from massage or
spa sessions.
You can actively minimize the power differential by listening
carefully to clients and responding compassionately to their
needs while representing the benefits of massage, spa treatments, and your personal skill level realistically. You can give
clients choices about the types of techniques that might be
used in the session and product options. If you remain attentive, you will notice when a client tenses because of discomfort
and urge the client to speak up if a technique causes pain.
Finally, you can encourage clients to seek out other therapists
that might help them meet treatment goals and discuss selfcare options that speed or enhance treatment outcomes.
In all cases, whether the client actively gives all of the
power to the therapist or not, the therapist is always responsible for what happens in a session and must constantly
strive to understand and minimize the power differential.
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36
herbal preparation. Colonic irrigation, also called colon

hydrotherapy, or colonics, involves the low-pressure injection of water into the colon for cleansing purposes using a
mechanical device. It is believed to flush toxic buildup out
of the colon, leading to better overall health. This type of
treatment is usually not included in the massage scope of
practice.
that he or she must apply the aromatherapy balm four

times a day for 2 weeks is prescribing.
Clients sometimes ignore messages from their bodies
that indicate something is wrong. When a massage therapist
listens, is empathetic, and suggests that a medical opinion
be sought, it provides a space for the client to acknowledge
his or her concerns and seek help.
Restrictions to Scope of Practice
Adjusting Bones Is Out of Scope

A chiropractor is a medical professional who adjusts bones
to improve structural alignment and free nerve tissue, leading to better overall function. Sometimes, a clients bones
will shift naturally during the application of a massage
stroke. This is normal and should not cause alarm. A therapist is working outside his or her scope of practice if he or
she tries to get a bone to move. It is not uncommon for massage therapists to developed highly refined palpation skills.
Sometimes, therapists can feel that a bone is not aligned
normally. If a therapist attempts to shift the bone by using
a thrusting movement or even holds in his or her mind the
intent to move the bone with a massage stroke, he or she
is working out of his or her scope of practice. Instead, the
therapist should refer the client to a chiropractor.
Usually, the definitions will list some of the restrictions

to the practice of massage. Arizona definitions state that
practice of massage therapy means the application of massage therapy to any person for a fee or other consideration.
Practice of massage therapy does not include the diagnosis of illness or disease, medical procedures, naturopathic
manipulative medicine, osteopathic manipulative medicine, chiropractic adjustive procedures, homeopathic neuromuscular integration, electrical stimulation, ultrasound,
prescription of medicines or the use of modalities for which
a license to practice medicine, chiropractic, nursing, occupational therapy, athletic training, physical therapy, acupuncture or podiatry is required by law.
You may notice that three primary restrictions to scope
of practice come up repeatedly in massage law. Massage
therapists cannot diagnose a patients condition, prescribe
a medication or treatment, or adjust a clients bones. Lets
look at each of these areas in more depth.
Diagnosing Is Out of Scope
Some therapists fall into diagnoses accidentally and do not
realize the serious ramifications of their actions. The term
diagnose means to identify an illness or disorder through
an interview, physical examination, and medical tests. For
example, a client may describe to the therapist a set of symptoms that the therapist recognizes as a particular soft tissue condition such as carpal tunnel syndrome. A therapist
who says, Oh, your condition is carpal tunnel syndrome
and you need to take 1,200 mg of ibuprofen a day, wear a
wrist splint, and receive treatment massage has crossed the
line and is diagnosing. Anytime the therapist labels a set
of symptoms as a defined medical condition, he or she is
diagnosing. Instead, the therapist should acknowledge the
seriousness of the clients symptoms and suggest the client
visit a physician for a diagnosis.
Prescribing Is Out of Scope
The term prescribe means to direct a patient to follow a particular course of treatment, specifically to use a particular
drug at set times, and in specified dosages. When the therapist in the example stated earlier advised the client to take
1,200 mg of ibuprofen a day and wear a wrist splint, he was
prescribing. Therapists sometimes accidentally prescribe
things such as herbal remedies or aromatherapy cures.
To say to a client, You should drink six glasses of peppermint tea a day for your stomach condition, is prescribing.
To suggest a client take supplements offered in the spa gift
shop to improve health is prescribing. To explain to a client
Counseling Is Out of Scope

Another area where massage therapists may venture out of
their scope of practice is counseling. People seek out counseling from a mental health care provider to gain insight
into personal or psychological problems. It is not uncommon for clients to share personal issues with their massage
therapists during sessions. This is not a scope of practice
violation so long as the therapist listens compassionately
but does not give advice or professional input. At other
times, listening is not enough, and the client expresses a
need for guidance or becomes emotional. The massage
therapist must be very careful not to counsel the client or
try to talk the client through the situation. If listening is
not enough, the massage therapist should refer the client to
a professional mental health care provider. In all cases, the
massage therapist must know and understand the scope of
practice and its restrictions in the state where he or she provides massage services.
Skin Care Is Out of Scope
The spa industry has grown so rapidly that this has created
some confusion about the scope of practice for therapists
delivering spa services. Much of this has centered on massage therapists and estheticians (people licensed to practice skin care). In many states, the board of cosmetology has
raised concerns that massage therapists are encroaching on
the scope of practice of estheticians when they provide such
services as a seaweed wrap or body polish. On the other
hand, in some states, massage therapists are concerned that
estheticians are using massage techniques that manipulate
soft tissue while applying products, so they are encroaching
on the scope of practice for massage therapists.
The basis of such concerns is that many of the products
used in the spa industry affect the physiological health
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Chapter 3
of the muscle tissue and body as well as the health and

appearance of the skin. A seaweed wrap could be used for
relaxation or as an active treatment to support a client with
fibromyalgia, sore muscles, or low energy (general massage scope of practice). A seaweed wrap can also be used
to soften, hydrate, and beautify the skin (general esthetics
scope of practice). Body polishes stimulate local circulation
to superficial soft tissue structures, tone muscle tissue, and
increase the vital energy of the body as in a classic friction
rub (general massage scope of practice). They are also an
exfoliation treatment that deep cleans, softens, smooths,
and beautifies the skin (general esthetics scope of practice).
This issue is further complicated because laws and regulations vary widely from state to state. A treatment that is
within the scope of practice for massage therapists in some
states may be banned for massage therapists in another
state. For example, massage therapists cannot cleanse, exfoliate, mask, or tone the facial tissue in most states. They
can apply creams or lotions (including essential oils) to the
face to perform a massage. In many states, massage therapists cannot use the word facial even when describing a facial massage (they must say face massage). In a few states,
however, massage therapists can provide facials using certain types of product only. Usually (but not always), massage therapists can use an exfoliation product such as salt
on the body (except the face) to increase local circulation
and relax muscle. Products such as seaweed and mud can
be used to promote changes in soft tissue or for relaxation
or revitalization.
In many states, estheticians cannot apply products
with any stroke other than effleurage. They can use various strokes on the face, arms to the elbows, feet to the
knees, and on the dcollet (upper chest) for beautification purposes only. They cannot manipulate soft tissue, so
they should avoid strokes that lift, knead, or broaden the
muscles. Again, in certain states, the previous statement is
not true, and estheticians even receive training in full-body
massage.
This textbook is written on the premise that spa body
treatments are a shared practice. It assumes that massage
therapists will focus on the benefits of a treatment for the
body, and estheticians will focus on the benefits of the
treatment for the skin. The treatment steps for the massage
therapist may be the same steps that an esthetician uses,
but the goals of the treatment (therapists intention) will
be different. This may also be expressed in the promotional
descriptions used to sell the treatments to the public. The
massage therapist markets the benefits of the treatment for
the body, whereas the esthetician markets the benefits of
the treatment for the skin.
Throughout the treatment chapters, esthetically oriented
information is included in Broaden Your Understanding
boxes. This information has been separated from the main
body of the text to avoid confusing new spa therapists who
are still unclear about their scope of practice. Estheticians
who are using the book as a reference will want to be aware
37
of the properties of products such as mud and seaweed for

the skin. Massage therapists who want the broadest possible understanding of a treatment will also want to understand its implications for the skin, even though they will
probably not market these effects to their clients.
Therapists should check to see if there are any treatments or practices that are not allowed by the regulatory
body in the state where they are practicing. Both ABMP and
the American Massage Therapy Association (AMTA) cover
spa treatments delivered by massage therapists with some
various restrictions. Call your professional association to
check that your liability insurance policy covers the treatments you are offering.
Therapists who are trained both as massage therapists
and as estheticians are growing in numbers. These therapists can market and deliver spa treatments for both the
body and skin at the same time.

Spa therapists are required by health standards and professional ethics to provide a clean environment for clients
that ensures they dont pick up any diseases while they are
at a spa or massage clinic. Therapists must understand
how infectious diseases are spread and then adopt standard sanitation procedures to prevent the spread of these
diseases. Sanitation protocols include therapist hygiene; the
sanitation of the treatment room, equipment, and product
containers; and general cleanness of the facility. The state
board of massage, the state board of cosmetology, the state
department of health, and the Centers for Disease Control and Prevention (CDC) are useful sources of additional
information for people working in spas or massage clinics.
Diseases
A disease is defined as an infectious or noninfectious
abnormal condition that results in medically significant
symptoms and often has a known cause. Diseases may
cause changes in the appearance, structure, or function of
cells, tissues, organs, or systems in the human body. The
signs and symptoms of diseases may result from the disease
process itself or the immune systems attempt to defeat an
infectious agent. Such signs and symptoms include but are
not limited to fever, nausea, elevated white blood cell count,
fatigue, and cardiovascular and metabolic changes.
The terms acute, subacute, and chronic are often used to
note a diseases severity or stage. When a disease is in an
acute stage, the symptoms are severe, and in some cases, the
situation is more dangerous. The acute stage usually lasts a
short time before the symptoms decrease, and the body enters a subacute stage. A chronic disease, persists for a long
time or regularly recurs.
Types of diseases include autoimmune, cancerous, deficiency, genetic, metabolic, and infectious diseases. You
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38
probably learned something about each of these disease

types in your massage training so our focus here is a review
to prevent the spread of infectious diseases in a spa environment.
Infectious Diseases
Infectious diseases, also known as communicable diseases,
are caused by an infectious agent referred to as a pathogen.
The term pathogen comes from the Greek pathos meaning
suffering or disease and gen meaning producer. Therefore, a pathogen is a producer of disease. The term refers
to infectious organisms such as bacteria, viruses, fungi,
and protozoa. Parasitic animals can also be passed from
person to person or from animals to people and cause
disease.
Bacteria
Bacteria are one-celled living organisms found in every
environment on earth, including inside and outside the
human body. They divide and multiply independently of a
host and can thrive in almost any environment including
on nonliving surfaces such as plastic. Most bacteria are not
harmful, and many bacteria are necessary for good health.
The immune system relies on probiotic bacteria (sometimes
referred to as the intestinal flora), which live in the intestinal track. Probiotic bacteria aid normal food digestion and
provide immune support against certain viruses, yeasts,
parasites, and pathogenic bacteria.
Pathogenic bacteria such as Escherichia coli (E. coli) and
Salmonella enteritidis (Salmonella) may enter the body through
improperly handled food or unwashed hands (especially
after toilet use) and cause food poisoning or acute diarrhea.
Staphylococcus aureus is the species of bacteria that causes
staph infections. It commonly lives harmlessly on the
skin and hair and around the nose. It can potentially be
passed to massage clients by therapists who touched their
own hair or nose and then touched a client without first
decontaminating their hands. If staph gets into a cut and
rapidly reproduces, it may cause serious infection and blood
poisoning. Streptococcus pneumoniae, known informally as
pneumococcus, causes pneumonia when it is inhaled into
the lungs and cannot be cleared. Its relative, Streptococcus
pyogenes, causes strep throat among many other diseases.
Pathogenic bacteria normally live on the skin and hair, in
the nose, throat, and lungs or in the intestines without
causing a problem. They infect the body only when its defenses are low or when the pathogenic bacterium suddenly
comes into contact with vulnerable tissue.1
Rickettsiae and chlamydiae are smaller than bacteria but
still classified as bacteria. These pathogens are parasites
that must live inside a cell at the expense of their hosts. In
most instances, these organisms are transmitted through
the bites of insects such as lice, ticks, and fleas. Rickettsiae are responsible for a number of serious diseases such
as typhus and Rocky Mountain spotted fever. Chlamydiae
cause trachoma, an eye infection that causes blindness; the
sexually transmitted diseases chlamydia and lymphogranuloma venereum; and some respiratory diseases.
Viruses
Viruses are smaller than bacteria and cannot self-replicate
or self-reproduce outside a living host cell (plant, animal,
or human). To grow and spread, they effectively take over
the host cell, causing the cell nucleus to replicate both its
own genetic material and that of the virus. The cell is usually eventually destroyed when it ruptures, and the new viral
particles formed are released into the extracellular fluid to
infect more cells. Viruses mutate quickly, making them difficult to treat effectively. Some viruses lie dormant in cells
until a stimulus or a decline in the hosts defenses activates
them. Some persistent viruses, such as HIV which causes
AIDS, can enter or exit a cell without killing it.
Viruses are present in infected body fluids such as
blood, saliva, or droplets from the nose, mouth, or genitalia. They are transmitted person to person or animal to
person. Although most viruses cannot live long without a
host, some, such as the herpes simplex virus, can linger on
surfaces for several hours and infect a person via indirect
contact. This is one reason why the proper sanitation of linens and equipment in a spa environment is so important
(discussed below).
Fungi
Fungi, which include molds and yeasts, comprise a large
group of simple plantlike organisms that are larger and
more complex than bacteria. Warm, moist environments
promote the reproduction of fungi through simple cell
division and the production of large numbers of spores.
A common fungus, Candida albicans, is present in the
mouth, mucous membranes, vagina, and rectum. It can also
travel through the bloodstream and affect the throat, intestines, and heart valves. Candida becomes dangerous when
some change in the body environment allows it to grow out
of control. When it grows out of control in the mouth, it is
called thrush. When it grows out of control in the vagina,
its often called a yeast infection or vaginitis. In individuals
with low resistance due to other diseases such as leukemia
or AIDS, Candida can enter the bloodstream and cause a serious infection in vital organs.
A group of related fungi cause skin infections characterized by red, scaly patches known commonly as ringworm,
but despite the name, it is not caused by a worm (Fig. 31).
Ringworm might be found on the skin (tinea corporis),
scalp (tinea capitis), around the groin (tinea cruris, sometimes called jock itch), or feet (tinea pedis, most often
called athletes foot). Ringworm is highly contagious and
is transmitted via skin-to-skin contact or contact with contaminated items such as unwashed sheets, flooring, and
combs. Therapists who practice spa treatments or massage
barefoot can pass an undetected fungal infection to clients
or pick up a fungal infection when clients walk barefoot in
the same area.
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Chapter 3
FIGURE 31 A group of related fungi cause skin infections characterized by red, scaly patches known commonly as ringworm, but despite
the name, it is not caused by a worm. Ringworm might be found on
the skin (tinea corporis), scalp (tinea capitis), around the groin (tinea
cruris, sometimes called jock itch), or feet (tinea pedis, most often called
athletes foot).
Protozoa
Protozoa (from the Greek protos meaning first and zoon
meaning animal) is a single-celled organism regarded as
the simplest form of animal life. They grow in moist environments such as fresh water, marine environments, decaying organic matter, wet grass, and mud. Protozoa cause
diseases such as amoebic dysentery, which is usually contracted through contaminated water or food; African sleeping sickness, which is spread by the tsetse fly; and malaria,
which is transmitted by the anopheles mosquito.
Parasitic Animals
The parasitic animals of most concern to massage therapists are mites and lice because they are spread very easily
through direct contact or contact with infected sheets and
clothing. Lice and mites do not carry infectious bacteria,
viruses, or fungi to the host. Instead, their wastes cause intense itching that leads the host to scratch the skin, leaving
it open to more serious infection.
Lice
Head lice (Pediculus humanus capitis), body lice (Pediculus
humanus), and pubic lice (Pthirus pubisoften called crabs)
suck the blood of the host and cause itching (Fig. 32).
Head lice often spread among grade school children and
must be treated with repeated applications of special
shampoos. A fine-tooth comb is passed through the hair to
remove eggs. Body lice live in the seams of clothing rather
than directly on the host. This type of lice is usually seen in
homeless people who do not have regular access to laundering facilities. Body lice are transmitted through unwashed
39
FIGURE 32 Head lice (Pediculus humanus capitis), body lice (Pediculus

humanus), and pubic lice (Pthirus pubisoften called crabs) suck the blood
of the host and cause itching.
clothing but could be passed from clothing to massage

sheets. Pubic lice are nicknamed crabs because of their
crab-like appearance. They are usually spread through sexual contact but might also be spread to clothing or linens.
Although they tend to inhabit the groin area, they can live
in any course body hair (armpits, eyebrows).
Mites
Mites (Sarcoptes scabiei) like warm, moist areas of the body,
especially skinfolds. They burrow under the skin and live off
the blood of the host (Fig. 33). Mite infestations are often
referred to as scabies. The excrement of the mite is highly
irritating and leads to itchy, red allergic reactions. Like lice,
mite infestations are highly contagious and spread through
person-to-person contact or from clothing and linens.
If a lice or mite infestation occurs at your massage clinic
(e.g., a client calls to say she just found out that she has
lice), cancel all appointments until the facility can be deep
cleaned. Wash in hot water and detergent any linens or
cloth materials that may have come into contact with the
infected person and then dry them with heat. Vacuum carpeted floors carefully and change bath mats and towels in
the bathroom. Mop hard floors and wipe down all hard surfaces. Lice and mites live only about 38 hours off the host,
but care should be taken that they are not spread to an unsuspecting client.
How Diseases Are Transmitted

An infectious pathogen must breach the bodys defenses
to cause a disease. Some pathogens, called opportunistic
pathogens, cause disease only if the hosts immune system is depressed. Others, called virulent pathogens, readily
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40
fomite where an uninfected person touches it obtaining the

pathogen via indirect contact.
Vehicle Transmission
FIGURE 33 Mites (Sarcoptes scabiei) like warm, moist areas of the body,
especially skinfolds. They burrow under the skin and live off the blood of
the host.
cause disease when they gain entrance to the body. Pathogens are transmitted by direct contact, indirect contact,
vehicle transmission, or vector transmission.
Air, food, and liquid that are routinely taken into the body
provide a mode of transport for pathogens. This type of
pathogen transmission is called vehicle transmission.
Pathogens can travel in the air in droplets (usually mucous
droplets such as are released by a sneeze), aerosols (very
small droplets that may have evaporated from droplets on a
surface), or dust particles. This is why people often get sick
after flying on a plane; because cabin air is recycled, pathogens have repeated opportunities to infect passengers.
A number of pathogens are found in food. If these pathogens are not killed during food processing, they are transmitted directly to the gastrointestinal tract. Bacteria in the
intestinal flora of animals may be safe for those animals but
unsafe for humans. For example, Salmonella is part of normal chicken intestinal flora but can cause serious illness in
humans if it is not destroyed during food preparation. The
food preparer may also be infected and transfer pathogens
to otherwise uncontaminated food.
In the United States, drinking water is generally safe,
but if the water supply is contaminated with human or animal fecal matter (e.g., sewage), it may cause serious illness.
Homes and businesses with a private well should have the
water tested annually to ensure its safety. Pathogenic organisms as well as harmful chemicals such as lead and radioactive isotopes such as radon can enter well water and cause
health problems.
Direct Contact
The sweat and sebum in skin provide some natural protection against the transfer of pathogens via direct contact of
the skin. But if the skin is damaged by cuts, scrapes, wounds,
burns, or even dryness that leaves the skin with microscopic
breaks, the chances of infection increase.
Pathogens often reside around areas with mucous membranes such as the nose, lips, eyes, gastrointestinal tract,
genitourinary tract, genital area, and anus. Lymph tissue
such as the tonsils, mucus, and cilia provides some protection for the mouth and respiratory system. Other mucous
membranes provide less protection.
An infected person can transfer a pathogen to an uninfected person through touch, sexual contact such as kissing or intercourse, or expelling body fluid droplets onto a
person by sneezing, coughing, or touching mucous membranes and then touching an uninfected person without
having washed the hands.
Indirect Contact
An infected individual can transfer a pathogen to an inanimate object (known as a fomite) such as a countertop, doorknob, toy, or magazine. A person might touch his or her
nose or mouth and then touch the fomite, sneeze or cough
on a fomite, or fail to wash his or her hands after using the
toilet and then touch a fomite. The pathogen lingers on the
Vector Transmission
Vectors are insects or animals capable of transmitting diseases, including mosquitoes, flies, fleas, ticks, mites, rats,
dogs, and cats. Vectors are mobile and can easily spread a
disease to previously uninfected areas. The vector usually
breaks the skin through a bite or sting but may also cause
disease through its feces. A pathogen might be located on
the outside surface of a vector and spread through physical
contact with food or a surface when it lands (e.g., flies).
Preventing the Transmission of Disease

It is impossible to know if a client who walks in through the
door of your business is infected with a pathogen. Similarly,
you may be infected and not know it. Because pathogens
that cause serious illness are all around us, sanitation and
hygiene practices are required at all times to prevent the
spread of disease. These practices include therapist hygiene;
sanitation of equipment, supplies, and the building; and
the use of universal precautions.
Therapist Hygiene
As health care providers, spa therapists must adhere to
the highest standards of personal hygiene. This includes
cleanliness of the body and hair; wearing clean, appropriate
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Chapter 3
clothing; removing jewelry; proper hand washing; and

attending to issues such as smoking and illness.
Cleanliness of Body and Hair
Shower daily and wash your hair on work days. Avoid the
use of scented antiperspirants, perfumes, colognes, aftershaves, and body care products because these may cause
sensitivity or allergies in some clients. As described earlier, the hair can act as a reservoir for pathogens such as
Staphylococcus aureus and must be tied back so that it does
not touch the client during the delivery of a spa treatment
or massage. Men should shave before each work shift or
keep facial hair neatly trimmed. If you touch your own hair
during a session, including facial hair, you must sanitize
your hands before touching the client.
For better hygiene and client comfort, keep your nails
short, natural, and filed to a smooth edge. Long nails, nail
polish, and artificial nails are breeding grounds for pathogens and may scratch a client; they are best avoided. Brush
and floss your teeth before the shift and directly after eating food during breaks in the day. Because therapists and
clients come into close contact during spa treatments, it is
a good idea to rinse your mouth with mouthwash before
each new client.
Therapists who perspire heavily while giving spa treatments can wear sweatbands on the forehead and wrist to
prevent droplets of perspiration from falling onto the
client. A clean towel can be used to absorb perspiration
throughout the session if necessary.
Clean and Appropriate Clothing
Launder your work uniform or clothing at the end of each
working day. Short sleeves are better for spa work because
long sleeves, which may touch the clients skin and become contaminated, may then contaminate the next client.
Although many therapists like to work barefoot, this is not
advised. Your feet may harbor an undetected fungal infection, which can be spread to an unknowing client getting
on and off massage table or wet table. For clients with suppressed immunity, this may cause serious complications.
Remove jewelry including rings, wristwatches, bracelets,
and necklaces. These items contain small crevices and sharp
edges that can harbor bacteria or potentially scratch a client. Small earrings that will not touch the client are fine.
Proper Hand Washing
Proper sanitation of the hands is probably the single most
important part of the sanitation protocol for therapists (For
Your Exploration 32). You need to clean your nails carefully and use foaming liquid soap to thoroughly wash your
hands up to your elbows. An alcohol-based hand rub is recommended for decontaminating the hands before the session, before or after certain treatment steps, and at the end
of a session. Nonalcohol-based hand rubs have not been
adequately evaluated by the CDC and are therefore not recommended. In those instances where you use gloves (see the
upcoming section for details), wash your hands and decontaminate them before putting gloves on and immediately
41
after removing gloves. Decontaminate your hands with an

alcohol rub before moving from a potentially contaminated
body area (such as the feet) to a clean body area (such as the
face) during a spa treatment or massage. Do the same when
moving from contact with an unsanitized inanimate object
(e.g., a product container) to the client. As well, wash and
decontaminate your hands before and after eating or using
the restroom.2 The CDC provides specific recommendations for hand washing and the use of alcohol-based hand
sanitizers for health care workers, as described in For Your
Information 32 and Figure 34.
Therapists Who Are Smokers
The smell of cigarette smoke lingers in hair, on clothing, on
skin, on the breath, on carpets, and on fabrics such as window treatments and linens. Smokers often become oblivious to the smoke odor and do not realize its impact on
nonsmoking individuals. Many nonsmokers intensely dislike the smell of cigarette smoke. Some are so sensitive that
they cannot tolerate the lingering smell of smoke anywhere
around them. Even clients who can tolerate the smoke odor
often associate it with an environment that is unclean, so
they may subconsciously feel uncomfortable.
Smoking should never be allowed in the treatment room,
reception area, bathrooms, hallways, office area, or laundry
area of a spa business. Therapists who smoke must strive
to balance their personal needs with the clients needs. In
the best case, a therapist would smoke before showering,
washing the hair, dressing, and brushing the teeth. After
showering and dressing, the therapist would not smoke
again until after all of that days spa sessions. A therapist
who is unable to finish the days spa sessions before having
a cigarette must make every effort to minimize the impact
on clients. Use a mechanics jumpsuit to cover and protect
clothing. Cover your hair with a plastic shower cap and
put hand lotion on your hands before handling cigarettes
(which rinses away when the hands are washed and keeps
smoke odor from seeping into skin). Smoke outside at a
good distance away from the spa business. After smoking,
wash any areas of skin that might come into contact with
smoke. You might include the use of a salt scrub on your
hands to help eliminate the smell of smoke. Your face, neck,
arms, and hands should all be washed. Brush your teeth
and rinse with mouthwash.
Therapists Who Are Sick or Have Allergies
A therapist who is sick or may have a contagious infection
must protect clients by canceling all spa appointments. The
common cold is caused by a large number of different viruses and is easily transmitted through the air or by direct
contact. In general, the viruses that cause colds incubate in
the body for 12 hours to 5 days and then become contagious
23 hours before the onset of symptoms. The person remains
contagious for about 5 days after the onset of symptoms.3
Therapists with allergies with symptoms similar to those
of a cold are not likely to be contagious but may need to
take extra precautions to prevent spreading pathogens.
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42

Proper Hand Washing and Hand Decontamination
1. Clean your nails before your hands using an orange stick or
a personal nailbrush that has not been used by anybody
else. Wash your hands with a nonantimicrobial soap or an
antimicrobial soap (liquid soap with a pump dispenser is the
most sanitaryavoid bar soap) for 30 seconds using fiction and
lather to lift contaminants off the skins surface.
2. Clean the area between your fingers and from your forearms
up to your elbows. Rinse your arms and hands thoroughly with
running water and dry them with a disposable towel.
3. Use the same towel to turn off the water tap and to open any
doors on the way to the treatment room.
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Chapter 3
43

Proper Hand Washing and Hand Decontamination (continued)
4. Use an alcohol-based hand sanitizer at these times: (A) Directly
after washing your hands and directly before touching the client. (B) Directly after washing your hands and directly before
donning gloves and directly after removing gloves. (C) Directly
after moving from a potentially contaminated body area (e.g.,
feet) and directly before working on a clean body area (e.g.,
face). (D) Directly after touching an unsanitized inanimate
object (e.g., product container) and directly before touching
the client. (E) If you accidentally touch your hair or a mucous
membrane (eyes, nose) or cough or sneeze during the session.
Do not retouch the client until your hands have been decontaminated with the hand sanitizer. (F) Directly after removing
soiled linens from the table and directly before handling fresh
linens.
For example, if your eyes are itchy and watering, you must
decontaminate your hands if you rub your eyes in the middle of a session. If sneezing is a problem, wear a face mask
as an extra precaution. Inform clients that you suffer from
allergies to prevent the impression that you are sick. If you
are uncertain whether your symptoms are those of a cold or
allergy, take your temperature. Allergies usually do not elevate body temperature, whereas even a low-grade cold will.
Sanitation of the Facility, Equipment,

and Supplies
A clean facility has a lower risk of pathogen transmission.
To provide a clean environment, pay attention to the proper
use of cleaning products, sanitation of the treatment room
and equipment, care of linens, proper product handling,
and general housekeeping activities.
Cleaning Products
A variety of cleaning products can be used in the spa business. Use dusting aids and wood polishes on wood surfaces
and glass cleaners on windows and mirrors. Antiseptics
and disinfectants are the most important types of cleaners
used in a health care setting because they reduce the transmission of disease. These types of cleaners are described in
detail below.
Note that cleaning products often contain ingredients
that cause irritation to eyes, the skin, and the respiratory
system. Wear heavy cleaning gloves, a face mask, and eye

protection when handling cleaning products and increase
the ventilation in rooms where you are cleaning by opening windows or running ceiling fans. Many cleaning products also cause damage to the environment. In recent years,
interest has increased in using natural, environmentally
friendly products for cleaning. Finding suitable products
is often difficult because of the unique challenges of sanitation in health care environments. Some U.S. and Canadian health care workers have formed an association called
Health Care Without Harm: The Campaign for Environmentally Responsible Healthcare. This group offers a kit
to help health care providers go green. The kit can be
ordered through their website at http://www.noharm.org
/goingGreen. At the very least, avoid heavily scented cleaning products and look up cleaning product dangers at the
Occupational Safety and Health Administration (OSHA)
website at http://www.osha.gov.
Antiseptics
Antiseptics are safe for use on the skin and create an unfavorable environment for pathogen reproduction. Antiseptics are weaker than disinfectants and do not kill some
types of pathogens but are generally appropriate for use in
a spa setting so long as no blood or body fluid is present.
Hand soap, iodine, hydrogen peroxide, and rubbing alcohol
are commonly used antiseptics. Rubbing alcohol is often
used to spray clean countertops, doorknobs, and spa equipment in between clients.
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44
FIGURE 34 Proper use of gloves. (A) Directly before putting on gloves, wash your hands as described in the
section on Therapist Hygiene, and decontaminate your hands with an alcohol-based hand sanitizer. The gloves
should fit snugly and not roll down your hands while giving massage. When it is time to remove the gloves, peel
the first glove from the wrist to the fingers so that it is turned inside out. Any contaminants are now on the inside
of the glove away from you. (B) Place the fingers of your ungloved hand inside the second glove and peel it back
so that it is inside out. Make an effort not to touch the outside of the gloves with your ungloved hand. Dispose
of the gloves in a closed trash container and immediately wash and decontaminate your hands with alcohol after
removing the gloves.
Disinfectants
Disinfectants are stronger than antiseptics and should
not be used on the skin. They kill or are effective against
most bacteria and viruses. Disinfectants are also called germicides and bactericides. Commonly used disinfectants
include bleach solutions, phenols, and quaternary ammonium compounds (quats). Disinfectants are used for deep
cleaning at the end of the day, if an infectious agent may be
present (e.g., if a client denied having a cold but sneezed and
coughed throughout the session) or if blood or body fluids
are present.
including Staphylococcus, Streptococcus, hepatitis, HIV,

herpes, and tinea (the fungus that causes ringworm).
Phenols (also called cresols): Phenols are used on hard
surfaces and are effective against tuberculosis, bacteria,
fungus, herpes, and the flu virus. Phenols are irritating
for skin and the respiratory system.
Quaternary ammonium compounds (quats): Quats
are formulated to kill pathogens on a variety of hard surfaces and are effective against pseudomonas, Staphylococcus and Salmonella, certain bacteria, HIV, and the hepatitis B and C viruses.
Bleach solutions: Bleach mixed with water in a 10% concentration is used to clean hard surfaces such as countertops, equipment, and floors and to clean linens exposed
to body fluids. It is noted to be effective on pathogens
Sterilization is the elimination of all microorganisms

on and in an object through heat, chemical substances,
or irradiation. Sterilization is rarely used in massage environments but might be used in a spa environment. It is
10/24/13 1:08 AM
Chapter 3
commonly used in hospitals where moist heat (hot water or

steam) or dry heat is used to sterilize medical instruments.
Sterilization with an autoclave (a device in which high temperature and pressure is used to sterilize instruments) may
be used in some spa environments where estheticians use
sharp implements to pierce the superficial layers of the skin
when performing deep cleaning facials that include extractions of whiteheads and blackheads.
Sanitation of the Treatment Room and Equipment
Sanitizing the treatment room and equipment involves a
cleaning step that removes visible dirt and a sanitation step
that removes most pathogenic organisms from inanimate
objects with an antiseptic. Follow these guidelines:
Wipe down countertops, equipment, treatment chairs
and tables, the floor, and any other hard surface such
as doorknobs, handles, and cabinets with an antiseptic
such as alcohol between clients.
If possible, open windows and doors to ventilate the
room and circulate air.
At the end of the day, deep clean the treatment room,
equipment, and hard surfaces with a disinfectant.
Usually, a sick client is sent home without receiving a spa
treatment. If you suspect that a client was on the verge
of a cold or the flu, deep clean the treatment room with
a disinfectant before proceeding with the next session.
Regularly dust window blinds, shelves, decorative items,
picture frames, and lamp fixtures. Keep electronic equipment and CDs neatly organized and free from dust.
Wash all reusable equipment such as metal or plastic bowls,
spatulas, application brushes used in spa treatments, and
soda coolers (used to hold hot towels) in hot, soapy water
and sanitize them with alcohol between clients.
Specialized equipment such as foot soaking basins,
hydrotherapy tubs, showers, and massage tools such as hot
stones used in stone massage must be cleaned and sanitized
with a disinfectant between clients. Foot soaking basins
are of special concern especially if they have jets that might
harbor bacteria:
Wash them with hot, soapy water and spray them with a
disinfectant.
Allow the disinfectant to remain for 10 minutes and
then wipe the basin dry.
If the basin has jets, flush a bleach solution through the
jets to eliminate pathogens.
Follow these guidelines for cleaning a shower:
Clean, disinfect, and dry the shower after use by each client.
Disinfect the shower curtain or door and the floor outside the shower.
Change all towels and the mat outside the shower for
each client.
Use only liquid soaps or shower gels. Bars of soap that
have been used by more than one person are unsanitary
and should not be left in the shower or sink.
45
Modern hydrotherapy tubs usually have a self-cleaning

function that makes sanitizing the jets of the tub easier:
Put a concentrated disinfectant (formulated by the manufacturer of the tub) into the special holder and then
push the button.
At the end of the cleaning cycle, dry the tub and put out
fresh bath mats and towels for the next client.
Between clients, wipe down the area around the tub, including the floor and any handrails, with an antiseptic, and deep
clean the area with a disinfectant at the end of the day.
Small, one-person steam cabinets should be completely
wiped with an antiseptic between clients. For larger steam
rooms or steam showers, sanitize the floor and seat between
clients, although the walls can be left until the end of the
day. Disinfect this equipment at the end of each workday.
Proper Care of Linens
Clean linens are stored in a closed cabinet until they are
brought out for use. Decontaminate your hands after
touching soiled linens and before placing fresh linens on the
table. Linens may include massage sheets, face cradle covers,
bolster and pillow covers, uniforms, smocks, hair wraps, robes,
washable slippers, blankets, draping material, and washable
floor mats. Any item that comes into contact with the clients
skin or hair during the session must be stored in a closed, ventilated container and washed before use with another client.
Soiled linens should not be stored in the treatment room but
should be moved to the laundry or work area. At the end of
the day, wash linens in hot water with regular detergent, dry
them with heat, and return them to the closed cabinet. Handle
linens soiled with body fluids with special caution as discussed
in the upcoming section on Universal Precautions.
Proper Product Handling
Keep lubricants and special treatment products refrigerated
between uses to prevent the breakdown of their natural oils or
therapeutic properties. Transfer lubricants used for massage
from larger, bulk containers to smaller bottles so that they
can be heated without damaging the unused product, which
would break down if heated, cooled, and reheated. Some
products are dispensed directly into your hand using a pump
top or flip lid. Take care to decontaminate the pump container with an antiseptic both before and after each session.
Remove spa products from their original closed containers with a sanitized spoon or spatula and placed them in presanitized holders for later use during the treatment. Cover
the spa product with plastic wrap to avoid contamination
before use. All products would become contaminated if you
used your hands to remove the product or dip into the original container during the treatment. Discard any unused spa
product rather than return it to the original container. During a body treatment, proper waste disposal procedures are
important. Some items used in the treatment are used only
once (e.g., gauze, sponges, and plastic body wrap). Dispose
of these items in a closed trash can immediately after use.
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46
Housekeeping Activities
The general cleanliness of the facility must be assessed and
maintained on a daily basis. The reception area, retail area,
office area, hallways, and bathrooms all need attention.
Vacuum or sweep and mop floors daily.
Wipe items such as coffee tables, beverage dispensers,
toys in the reception area, doorknobs, handrails, and the
reception countertops daily with an antiseptic.
Deep clean bathrooms and empty trash bins at the end
of each work day.
Clean window ledges, retail shelving, picture frames, and
light fixtures weekly.
Fish tanks and water fountains are not advised because
they may harbor pathogens and are difficult to keep
clean.
Think also about the safe use of food items in the business. Home-baked products are not advised, but individually wrapped items such as chocolates, granola bars, sports
bars, and popsicles can be used. Its a good idea to provide
filtered water from commercial dispensers. These water
containers come presealed to prevent contamination. Use
disposable cups for all beverages including tea, juice, or
water. Table 32 provides a checklist of tasks to ensure you
maintain a clean, sanitary, and safe facility.
Universal Precautions
The purpose of universal precautions is to ensure that
health care workers protect themselves from bloodborne diseases transmitted through broken skin, mucous
membranes, or contact with blood and body fluid. To understand universal precautions, it is helpful to understand
HIV/AIDS and hepatitis, to know when to use gloves, and
to know the proper methods for cleaning up body fluids
and items exposed to body fluids.
HIV/AIDS
HIV causes AIDS. HIV is transmitted through body fluids
including semen, vaginal secretions, and blood and can be
transmitted during pregnancy from a mother to her fetus
or after birth through breast milk. HIV can also be spread
by drug users sharing a needle, by accidental needle pricks,
and from infected blood used in a blood transfusion (rare
in developed countries). There is no evidence that HIV is
transmitted through saliva, sweat, tears, urine, or feces
unless the fluid contains blood. There is no evidence that
HIV is spread through casual contact such as sharing towels, food utensils, telephones, or swimming pools. HIV is
not believed to spread by biting insects such as mosquitoes
or fleas.3
HIV is a retrovirus that can live in the infected individual for a long time before causing symptoms. The National Institute for Allergies and Infectious Diseases reports
that people infected with HIV develop a flulike illness 1 to
2 months after their initial exposure to HIV. The symptoms
are often mistaken for another viral infection and clear up
within a week or two. Severe symptoms may not appear
for 10 years or longer. (Children born with HIV develop
symptoms around the age of 2 years.) During this period,
HIV is slowly multiplying and killing immune system cells.
Gradually, infected people experience periodic symptoms
TABLE 32 Tasks to Ensure a Clean, Sanitary, and Safe Facility

AFTER EACH SESSION
Open doors and windows to ventilate
room.
Remove soiled linen from table, face
cradle, bolsters, etc.
Wipe massage table, face cradle, and
bolster with disinfectant.
Cover table, face cradle, and bolsters
with fresh linens.
Disinfect countertops, door handles,
and any objects clients regularly touch.
Disinfect the lubricant container or
bottles used to hold spa product.
If tools (hot stones, massage tools,
etc.) were used during the session,
wipe them with a disinfectant.
If a shower or wet room has been
used, it must be disinfected and dried.
If a hydrotherapy tub or foot basin with
jets has been used, the jets must be
flushed with bleach or the manufacturer's recommended cleaner and dried.
Change bath mats and towels if
shower or tub has been used.
END OF BUSINESS DAY

Wash all bowls, implements, application brushes, trays, and other equipment with hot, soapy water and wipe
with a disinfectant before storing them
in closed containers.
Wash cloth products such as massage
sheets, blankets, robes, slippers, hand
towels, bath towels, and shower mats
in hot water with detergent and dry
using heat before storing in a closed
container.
Deep clean and disinfect bathrooms.
Clean floors, clean and disinfect
items in the reception area, clean any
beverage service items, clean common
areas, and disinfect items such as
handrails and doorknobs.
Empty and disinfect trash bins.
WEEKLY
Clean windows, window frames, and window
ledges.
Deep clean the reception area and wipe down
chairs, the beverage service, magazines, and
decorative side tables.
Wipe down shelving used to hold retail items
and dust retail items.
Dust light fixtures, picture frames, the music
system, shelving, and decorative items in the
treatment room.
Organize CDs, storage cabinets, and
supplies.
Check smoke detectors to ensure they are in
good working order.
Check and replace light bulbs both inside
and outside the facility.
Water and dust plants.
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Chapter 3
such as swollen glands, decreased energy, weight loss, fevers

and night sweats, persistent yeast infections, short-term
memory loss, persistent pelvic inflammatory disease, frequent and severe herpes outbreaks, and shingles.
An HIV infection is called AIDS when the HIV-infected
person has fewer than 200 CD3T cells (the immune systems primary infection fighting blood cells). Uninfected
adults usually have 1,000 or more CD3T cells. The immune system, gradually destroyed by HIV, loses its ability
to fight off common pathogens that usually do not cause
illness in healthy individuals. In people with AIDS, these
opportunistic infections can be severe and often are fatal.
People with AIDS are also prone to developing various cancers, especially those caused by viruses and cancers of the
immune system (lymphomas).
Massage and many spa treatments are safe for HIVpositive clients who do not have symptoms. In the advanced
stages of AIDS, many forms of bodywork or spa treatments
may still be safe, but the most effective techniques depend
on the individual clients level of health. It is unlikely that
a therapist would contract HIV from a client during the
delivery of a spa treatment or massage, but the use of universal precautions is required. This is especially important
because an HIV-positive client must be protected from an
undetected infection the therapist may have.
Hepatitis
Several different viruses cause different forms of hepatitis,
termed hepatitis A through G. These are diseases characterized by inflammation of the liver. Hepatitis A, B, and C are
the most common forms.
Hepatitis A virus (HAV): HAV is transmitted through
contaminated food and water or by contact with feces. It usually resolves in a few weeks without medical
intervention.
Hepatitis B virus (HBV): HBV is spread through many
of the same routes as HIV but is a hundred times more
contagious than HIV. Many people who contract hepatitis B recover fully and have no long-term complications.
Some individuals develop chronic hepatitis B and become carriers of the disease. These people may develop
varicose veins on the stomach and esophagus, cirrhosis
of the liver, and liver cancer.4
Hepatitis C: Hepatitis C is transmitted primarily
through contact with infected blood (often by drug users sharing needles). Hepatitis C spreads less commonly
through sexual contact and childbirth, but these are possible routes. Of people who contract hepatitis C, 75% to
95% develop chronic long-term infections and have an
increased risk for cirrhosis and liver cancer.5
Spa treatments and massage are contraindicated for individuals with acute hepatitis. Clients with chronic hepatitis can benefit from many spa treatments, but techniques
should be chosen based on the individuals level of health.
Universal precautions are required.
47
When to Use Universal Precautions

Spa therapists rarely make contact with clients body fluids in
practice, but in some situations, a therapist may be exposed
to a body fluid and therefore be at risk for infection. A scab
may rub off during the application of a product, a blemish
may erupt under the pressure of a massage stroke, menstrual
blood may leak onto the treatment table, or a client may
experience nausea during treatment and vomit in the treatment room. Universal precautions are an approach to infection control in which all blood and body fluids are treated
as if infected with HIV, hepatitis, or another bloodborne
pathogen. Universal precautions are guidelines for dealing
with broken skin and mucous membranes, blood and other
body fluids, and the cleanup of body fluids. Important components of universal precautions include the following:
Correctly using gloves
Properly cleaning linen soiled with blood or body fluids
Properly cleaning surfaces contaminated with blood or
body fluids
Use of Gloves
Vinyl gloves are worn to protect both the client and therapist from the transmission of disease. Wear gloves at these
times:
Any time the potential exists to come into direct contact
with blood or body fluid
If the client has broken skin such as a scratch, open cut,
or blemish
If you have broken skin on your hands or forearms, such
as a scratch, hangnail, or blemish
If you are likely to come into contact with mucous membranes; this is rare in a spa environment, but in some
states, intraoral massage is sometime used with conditions such as temporomandibular joint disorder
When you are cleaning linens or hard surfaces soiled
with blood or body fluids
If the client is HIV-positive or has a condition that causes
weakened immunity
If you are HIV-positive or a hepatitis carrier
Wear gloves also any time you are concerned about the
potential for infection or the client requests it.
Latex gloves break down when exposed to oil-based
lubricants such as those used in massage. Latex may also
cause a mild to very serious allergic reaction or skin sensitivity. For this reason, vinyl gloves are recommended. Vinyl
gloves do not break down when exposed to oil-based lubricants or spa products and seldom cause allergic reactions
or skin sensitivity.
Proper Cleanup of Soiled Linen
Linens soiled with blood or body fluids should be handled
with gloves and stored in a leakproof bag until they can be
laundered. Wash these linens separately with laundry detergent and chlorine bleach. Dry them with heat and store
them as normal in a closed cabinet.
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48
Proper Cleanup of Blood or Body Fluids on

Hard Surfaces
Add one part bleach to nine parts water (10% bleach solution) to clean hard surfaces contaminated with blood or
body fluid. Wear gloves and use disposable cleaning materials such as paper towels to wipe up the spill. Dispose of the
cleaning materials in a closed trash container.
Because new information about communicable diseases is
issued often, keep up-to-date about the most recent standards
and guidelines issued by the CDC (http://www.cdc.gov).

Injury or harm is unlikely to happen in a safe environment.
In such an environment, conditions that may cause injury
have been eliminated. Procedures are adopted to increase
security and plans made to efficiently handle any accidents
that may occur. The safety plan should include guidelines
for ensuring the safety of both clients and therapists. If you
decide to open your own practice, you have greater control
over safety issues than if you work as an employee. As an employee, maintain your awareness of safety issues and alert
your supervisor should you feel that the environment is not
conducive to your safety and/or the safety of your clients.
Safety of the Facility

The facility must be accessible to a wide array of clients,
including those who are unsteady on their feet and those
using wheelchairs. Assess the parking area, common areas,
equipment, and fire plan:
Parking area: Begin an assessment of the facility in the
parking area. Is the pavement smooth and even, or are
cracks or an uneven surface present that may cause a client to fall? Is lighting adequate and the pathway to the
front door unobstructed? If clients must climb stairs or
use a wheelchair ramp, are these areas well lit and handrails provided?
Common areas: All common areas such as the reception
area, hallways, and bathrooms should have good lighting and nonslip flooring and be free of area rugs (which
may cause a client to trip) and barriers. Bathrooms
should include a lavatory at wheelchair height and handrails. Doorways should be wide enough to accommodate
people with physical disabilities, and lever-style door
handles used.
Equipment: Regularly check equipment to ensure that
it is in good working condition. Check bolts, hinges, and
knobs for tightness before each spa session. Any exposed
electrical cords should be heavy-duty and taped down
around the edges of the room, behind furnishings and
equipment when possible. Do not run extension cords
across a doorway or in any area where therapists or
clients must walk.
Fire plan: Check with state authorities to ensure that

proper fire and safety codes are followed. At least one
fire extinguisher and smoke detector should be in clear
view; more are likely needed. Check the fire extinguisher
and all smoke and heat detectors monthly to ensure they
are in good working order. A fire escape route should be
clearly indicated in every room. The use of candles, incense, and open flames is not advised.
Emergency numbers: Keep a list of emergency phone
numbers by the business phone. This includes the local
fire station, poison control center, police department,
ambulance, and local hospital or emergency medical
facility. Keep your liability insurance coverage up-to-date
and display a copy on the premises.
Safety of the Client

To ensure the safety of the client, stay up-to-date with your
training in CPR and first aid. A first aid kit should be kept
in each treatment room along with hydrocortisone cream,
which can be used to decrease any skin reactions to spa
products. Never give a spa treatment without first taking
a thorough health history. If you have any concern that a
spa treatment is contraindicated for a particular client, err
on the side of caution and contact the clients physician or
postpone treatment. Because all therapists will need to look
up a health condition, medication, or other information at
some point during their professional career, have available
key reference books including an up-to-date medical dictionary, drug reference, and pathology reference book.
Some clients need help getting on and off the treatment table. Provide a wide step stool and offer assistance
to elderly clients, pregnant clients, and clients with physical
challenges. Do not leave alone a client who is unstable and
may fall. Instead, assist the client to the treatment room
and help with undressing if appropriate. After the session,
wipe the clients feet with a paper towel to remove excess
lubricant from the foot massage, which could cause a client
to slip while getting off the treatment table, especially in
wet rooms with tiled floors.
Alcohol, Drugs, and Prescription Medications
It is a serious breach of professional ethics for the therapist
to work while under the influence of an illegal drug or alcohol. This would place clients at risk of emotional harm or
physical injury. These substances also interfere with logical
reasoning and decision making, which might lead to making a poor treatment choice for a client. Alcohol and drugs
also influence the therapists behavior and feelings and
may result in inappropriate communication or emotional
outbursts. Therapists who are suffering from a hangover
should cancel any spa appointments or refer their clients to
another therapist.
Sometimes, a therapist must take prescription medications for a condition or disorder. Each situation is unique,
as is the therapists response to the medication. Be aware
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49
that medications may alter your perception, change your

behavior, or affect your physical abilities. Talk with the prescribing physician about possible side effects in relation to
your spa duties and responsibilities. Always act in the best
interests of the client. If the medication interferes with your
physical or mental ability to provide a safe and beneficial
spa treatment, you may need to explore different medication options or take a break from your career until the situation improves.
Spa treatments may also be contraindicated for clients
taking a prescription or over-the-counter medication that
distorts their perceptions of hot, cold, pain, or pressure, or
you may have to adapt the treatment to each clients needs.
Do not provide a spa treatment to a client under the influence of an illegal drug or alcohol because it would place
both of you in an unsafe situation. Spas that serve alcohol
as part of a treatment should rethink this policy because it
places them at liability risk in the event the client has a slip
and fall accident at the spa facility or an accident while driving home from the spa.
to discuss the situation, document this conversation and

keep it with the accident file. If a client is involved, a signed
release is required before sending client information to an
outside entity (e.g., insurance company, equipment manufacturer). This protects the clients privacy.
Accident Report
Client Screening
Any time that anyone at a businessincluding employees,

the owner, clients, and visitorsis injured in an accident,
causes injury to another, or causes property damage, an
accident report should be written and filed. This report
should provide detailed and accurate information about
the accident, the people involved, injuries or property damage, and how the situation was resolved. This information
must be accurate and detailed because it may be used by an
insurance company to process a claim or may be evidence in
a lawsuit. The accident report should include the following:
In some areas, illegitimate massage at illegitimate spas is

still used as a cover for prostitution. Although most clients
understand that professional massage is for wellness and
good health, some people seek massage for sexual gratification. Regardless of whether your practice is based in
your home or office or as a call-out service, careful client
screening helps ensure your safety.
The screening process begins when the client calls to
book an appointment or inquire about fees and services.
Ask clients for their name, address, home phone number,
work phone number, occupation, and how they heard
about the spa business. Record all of this information in
a clients new file. Ask what type of spa treatment or massage they are looking for (e.g., relaxation, sports, hot stone
massage, an herbal body wrap). Ask if this is the first spa
treatment or massage and/or if they have received spa treatments or massage regularly. With clients who have had spa
treatments or massage before, ask them to describe the results they experienced and their current expectations for a
spa treatment or massage. If the answers do not seem legitimate, be courteous but continue to question and educate the client. For example, you might say, I would like
to inform you about our spa policy. This information can
include the policies for a no-show client, the draping policy,
and the policy on drugs and alcohol. A client who confuses
massage with sexual favors may say something such as, Do
you provide erotic massage or spa treatments? What will
you wear during the spa treatment? What do you look
like? Can I massage myself during the session? or Will
you help me if I get excited? Remain courteous but end the
conversation and refuse the appointment.
All therapists should be careful about booking new clients during times when they are alone in the office. Avoid
this situation whenever possible. If you cannot avoid such
The address and location in the premises where the

accident occurred
The date and time
The name of the person filing the report and his or her
job title
The name, address, e-mail, and phone number of all
individuals involved and those of any witnesses
A detailed account of what happened
Written witness accounts of what happened when
appropriate
A description of injuries or property damage
How the matter was resolved (e.g., the individual was
sent to the emergency room, the individual refused medical treatment and went home)
If more information later becomes available, it should
be documented and kept in the same file as the accident
report. For example, if a client was injured by falling off
a wet table and a physician diagnosed an ankle sprain the
next day, record this in the file. If the accident was caused by
equipment failure (e.g., the wet table suddenly buckled due
to a faulty brace), file a report with the manufacturer immediately. File a copy of this letter along with any response
from the manufacturer. If the manufacturer telephones
Safety of the Therapist

While at work, you may be required to lift heavy objects
such as laundry, bulk spa products, or housekeeping supplies. Always use good body mechanics to prevent back injury. You will also come into contact with strong cleaning
products and should wear heavy gloves, a face mask, and
protective eyewear to prevent contact with your eyes, respiratory system, or skin.
When you take good care of yourself, you are less likely
to suffer an injury or illness while working as a spa therapist. Proper nutrition, adequate sleep, exercise, stress reduction activities, and good body mechanics all support your
health and longevity in the profession.
10/24/13 1:08 AM
50
a situation, make arrangements with someone available to

assist by telephone. Tell this person the time of the appointment and that you will call again after the intake interview.
If anything feels strange during the intake interview, cancel
the session and politely ask the client to leave. When the client leaves, call your backup person to say that you are safe.
The backup person should be instructed to call you if you
have not called by the time specified, and if you do not pick
up the phone, they should call emergency services.
Incident Report
An incident report is written whenever an unusual event
occurs that creates an unsafe environment or distress for
a client, therapist, or business owner. For example, a therapist might file an incident report if a client makes sexual
advances during a spa session and the therapist had to end
the session. The report should go directly to the business
owner, who should then inform the client that he or she
is no longer welcome at the spa. Another example is a client who is unhappy with the spa session and demands a
refund. The therapist should document why the client was
unhappy and actions taken to solve the problem. An incident report should include the following:
The date, time, and place the incident occurred
The name of the person filing the report and his or her
title
The name, address, e-mail, and phone number of all
involved individuals and any witnesses
A detailed account of what happened
Written witness accounts of what happened when
appropriate
How the matter was resolved (e.g., the client was told
that he or she is no longer welcome at the clinic, the client was given a refund and referral to another therapist)

A contraindication is any condition that makes the application of spa treatments unadvised or potentially dangerous to the health of the client. Table 33 provides an
overview of conditions that may contraindicate spa treatments or require greater caution from the therapist. Following are the different types of contraindications and other
considerations:
Absolute contraindication: If the client has a condition
that is an absolute contraindication, the client should
not receive a spa treatment or a massage. Examples include a significant fever (100F or higher), vomiting, a
cold (unless the symptoms have been present for 5 days
or longer; usually, people are contagious from 24 hours
before they notice symptoms to 5 days after the first
symptom), an acute systemic condition (when the condition affects the entire body and not just one local region),
an injury that requires medical attention, or symptoms

that are intense and unexplained (e.g., intense headache
pain). For example, a client with chickenpox or pink eye
should not receive a spa treatment because the client
is extremely contagious, and these conditions could be
passed to the therapist or to other clients. Similarly, massage should not be provided to relieve headache pain in
a client with a recent concussion. Not only would massage overstimulate this client, but the client also needs to
see a physician to rule out serious complications. Note in
Table 33 that many conditions are contraindicated in
an acute stage, when the body is inflamed and the condition flares up, but are not contraindicated in a subacute
or chronic stage. Usually, if massage is contraindicated,
spa treatments will also be contraindicated; sometimes,
the opposite is true. Sunburn is a good example. Massage is contraindicated, but a soothing aloe vera and
German chamomile essential oil wrap are not.
Local contraindication: A condition may affect only
one area of the body. Spa treatments can be applied to
the rest of the body, but the local area is avoided. If a client recently had a mole removed, you would not massage
or apply seaweed over the area of reforming skin. If a client has a swollen knee, you would not apply warm mud
to the area distal to the swelling and the swollen area,
but the area proximal to the swelling and the rest of the
body can be treated.
Advanced understanding: Some therapists receive extra training and specialize in working with clients with
specific conditions. Because of their experience, often
through participation on a health care team, they develop
an advanced understanding of the condition and know
the limits of spa treatments and massage. These therapists can often work safely with a condition that would
be contraindicated for a less experienced therapist. Novice therapists may avoid certain conditions early in their
practices and then work with the same condition later as
their knowledge increases with professional experience.
Regardless of your level of experience, it is important to
obtain a physicians release with complex conditions or
clients who are taking multiple medications.
Physicians release: Before providing spa treatments to
clients with certain conditions, it is prudent to obtain a
physicians release. The release indicates that the physician believes that the spa treatment will not harm the client and may prove beneficial to the clients health. Some
physicians do not understand spa treatments, their physiological effects, or the increased burden they might place
on a clients system. If possible, explain to the physician
or the physicians staff the types of methods you plan to
use in the clients session and the ways these methods
might affect the clients body systems. This may help the
physician make the best possible recommendations.
Use caution: In many cases, spa treatments are not contraindicated, but the session must be adapted to fit the
(text continues on page 56)
10/24/13 1:08 AM
Chapter 3
51
MASSAGE
STONE MASSAGE
PARAFANGO
SHIRODHARA
UBVARTANA
FOOT TREATMENTS
UC
UC
UC
UC
UC
UC
SC
SC
SC
SC
SC
UC
UC
UC
SC
SC
UC
UC
UC
UC
UC
Acromegaly
UC
UC
UC
UC
UC
UC
UC
UC
Addisons disease
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
AIDS (client condition

good)
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Allergies: shellfish,
iodine, seafood
Alzheimers disease
Amenorrhea
Angina pectoris
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Anorexia nervosa
appendicitis
UC
UC
UC
UC
UC
Anxiety disorder
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
SC
SC
SC
SC
SC
SC
SC
SC
SC
Bed sore or pressure

sore
SC
AU
SC
SC
SC
SC
SC
SC
SC
UC
UC
SC
SC
Bipolar disorder
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
SC
UC
SC
SC
SC
SC
SC
SC
SC
UC
UC
UC
SC
SC
SC
Bronchitis
UC
UC
UC
Bruise
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Arteriosclerosis
Asthma
Atherosclerosis
Athletes foot
Boil
Burns, recent
Cardiac arrest,
history of
Cellulitis
X
Chickenpox
Cholecystitis
Xb
Chronic fatigue
syndrome
Colitis
Cerebral palsy
Cirrhosis of the liver
REFER TO SKIN CARE SPECIALIST
PEAT
UC
SC
COOL WRAPS
CLAY
UC
SC
WARM WRAPS
MUD
UC
UC
HOT WRAPS
SEAWEED
AU
EXFOLIATION
UC
DR. RELEASE
Abortion, recent
Acne vulgaris
CONDITIONa
HYDROTHERAPY
CONTRAINDICATED
TABLE 33 Contraindications Chart
For a description of the conditions, please refer to a pathology textbook.

Except under medical supervision or with advanced training or specialized understanding.
, indicated/safe; AU, advanced understanding required; C, contraindicated; SC, site contraindicated; UC, use caution.
b
10/24/13 1:08 AM
52
HOT WRAPS
WARM WRAPS
COOL WRAPS
SHIRODHARA
UBVARTANA
FOOT TREATMENTS
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
SC
UC
SC
SC
SC
SC
SC
SC
SC
UC
SC
SC
SC
UC
UC
Coronary artery
disease
UC
Cb
UC
UC
UC
UC
UC
UC
Crohns disease
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Cushings disease
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Cystic fibrosis
UC
AU
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Cystitis (chronic;
acute C)
Depression
UC
UC
UC
UC
UC
Diabetes insipidus
UC
Cb
Cb
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Diabetes mellitus
Diarrhea
UC
UC
UC
UC
Xb
Diverticulitis
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Diverticulosis
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Dysmenorrhea
UC
Eczema
SC
UC
UC
SC
UC
SC
UC
UC
UC
UC
UC
SC
UC
UC
Cb
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Embolism
Emphysema
Endocarditis
UC
UC
Cb
UC
UC
UC
UC
UC
UC
UC
UC
UC
Fibrocystic breast
disease
Fibroids
Fibromyalgia
AU
UC
UC
UC
UC
Endometriosis
Epilepsy
Fever
PARAFANGO
Contusion or
concussion, recent
STONE MASSAGE
Contact dermatitis
MASSAGE
Constipation
PEAT
CLAY
Conjunctivitis
(pinkeye)
MUD
Xb
SEAWEED
Congestive heart
failure
HYDROTHERAPY
Common cold (2 to
3 days after acute)
EXFOLIATION
DR. RELEASE
CONTRAINDICATED
CONDITIONa
TABLE 33 Contraindications Chart (continued)
X
X
Flaccid muscles
AU
UC
UC
UC
Folliculitis
SC
UC
UC
SC
UC
SC
SC
SC
SC
UC
UC
UC
SC
SC
Gastritis (chronic;
acute C)
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC

b
10/24/13 1:08 AM
Chapter 3
53
AU
AU
SC
UC
UC
SC
SC
UC
UC
UC
UC
UC
SC
Graves disease
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Heart murmur
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Hemangioma
SC
UC
SC
SC
SC
SC
SC
SC
SC
UC
UC
UC
SC
SC
Hematoma
SC
Cb
SC
SC
SC
SC
SC
SC
SC
UC
UC
SC
SC
UC
UC
UC
UC
UC
UC
UC
UC
Hepatitis (chronic;
acute C)
UC
Cb
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Hernia
SC
UC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
Herniated disk
Hemophilia
Hemorrhage
Herpes simplex
SC
AU
SC
SC
SC
SC
SC
SC
SC
UC
UC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
SC
UC
SC
UC
Hypercholesterolemia
UC
Cb
UC
UC
UC
UC
UC
UC
UC
UC
UC
Hypertension
UC
Cb
UC
UC
UC
UC
UC
UC
UC
UC
UC
Hyperthyroidism
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Hypotension
UC
Cb
UC
UC
UC
UC
UC
UC
UC
UC
UC
Hypothyroidism
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Inflammation, acute
AU
AU
AU
AU
AU
SC
SC
SC
AU
UC
SC
Inflammation,
chronic
Inflammation, subacute
AU
AU
AU
AU
AU
UC
SC
AU
UC
UC
UC
SC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Ichthyosis vulgaris
Impetigo
Influenza
X
X
Irritable bowel
syndrome
Jaundice
Kidney stones
(acute C)
Lice
Insomnia
Intestinal obstruction
AU
UC
FOOT TREATMENTS
AU
UBVARTANA
AU
UC
SHIRODHARA
UC
UC
COOL WRAPS
UC
UC
WARM WRAPS
Goiter
Gout
UC
HOT WRAPS
UC
PARAFANGO
CLAY
UC
STONE MASSAGE
MUD
UC
MASSAGE
SEAWEED
UC
PEAT
HYDROTHERAPY
UC
Gastroenteritis
DR. RELEASE
Gastroesophageal
reflux disease
CONDITIONa
EXFOLIATION
CONTRAINDICATED
X
X

b
10/24/13 1:08 AM
54
Lou Gehrigs disease

(ALS)
Lupus (in remission)
Lymphedema
Xb
Meningitis
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
SC
SC
SC
SC
SC
SC
UC
UC
SC
SC
AU
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
SC
SC
SC
SC
SC
SC
UC
SC
SC
SC
SC
SC
SC
SC
SC
UC
SC
SC
Mononucleosis
Multiple sclerosis
Xb
Muscular dystrophy
Myocardial infarction
(history of)
X
Neuropathy
Obesity
Osteoarthritis
Ovarian cysts
Pancreatitis (chronic;
acute C)
Xb
Parkinsons disease
Pelvic inflammatory
disease
Pericarditis
Peripheral vascular
disease, mild
Xb
Phlebitis
Pleurisy, nonbacterial
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Polycystic kidney
disease
UC
UC
UC
AU
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Preeclampsia
Pregnancy
Pregnancy, high risk
FOOT TREATMENTS
UBVARTANA
SHIRODHARA
COOL WRAPS
WARM WRAPS
HOT WRAPS
PARAFANGO
STONE MASSAGE
MASSAGE
PEAT
CLAY
MUD
C
UC
Menopause
Peritonitis
SEAWEED
UC
UC
Lymphangitis
Paralysis
HYDROTHERAPY
Xb
Lyme disease
Myocarditis
EXFOLIATION
DR. RELEASE
CONTRAINDICATED
CONDITIONa

b
10/24/13 1:08 AM
Chapter 3
55
MASSAGE
STONE MASSAGE
PARAFANGO
HOT WRAPS
WARM WRAPS
Prostatitis
UC
UC
UC
Pseudo sciatica
Psoriasis
UC
UC
UC
UC
SC
AU
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Cb
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
AU
UC
UC
UC
UC
UC
SC
UC
UC
UC
UC
UC
Pyelonephritis
Raynauds syndrome
Rheumatoid arthritis
Ringworm
Scabies
Scars, old
Scars, recent
SC
AU
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Scleroderma
UC
AU
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
SC
SC
UC
UC
UC
Sebaceous cyst
UC
UC
UC
UC
UC
UC
UC
UC
UC
Sinusitis (no fever

present)
Site infection or
fungus
SC
SC
UC
SC
SC
SC
SC
SC
SC
SC
SC
Sickle cell disease
UC
UC
UC
UC
Stroke
UC
Cb
UC
UC
UC
UC
UC
UC
UC
UC
UC
UC
Substance abuse,
recovery from
UC
UC
UC
UC
AU
SC
SC
Skin tabs
Sunburn
Thromboangiitis
obliterans
SC
SC
SC
SC
SC
SC
UC
SC
SC
Thrombophlebitis
SC
SC
SC
SC
SC
SC
UC
SC
SC
UC
UC
UC
SC
UC
UC
UC
UC
UC
UC
SC
UC
UC
UC
UC
UC
UC
Ulcers
Varicose veins
Tuberculosis (no
longer infective)
Urethritis
Pulmonary edema
Tonsillitis
PEAT
FOOT TREATMENTS
CLAY
UBVARTANA
MUD
SHIRODHARA
SEAWEED
COOL WRAPS
HYDROTHERAPY
DR. RELEASE
Premenstrual
syndrome
CONDITIONa
EXFOLIATION
CONTRAINDICATED

b
10/24/13 1:08 AM
56
clients overall vitality and stamina. Obviously, a client

who is young and in good physical condition can receive
a more vigorous spa treatment than an elderly client who
is thin and frail. Sometimes, the spa treatment is shortened or certain methods are avoided. Sometimes, the way
in which the client is positioned on the table is changed
to accommodate a particular condition. You may be able
to work with the client as you normally would but with
increased vigilance. Watch for any change in the clients
condition or for side effects or adverse effects that may
develop. A sudden increase in pain, moderate to intense
discomfort, agitation, nausea, headache, or excessive dizziness is a sign that the client is not responding to spa
treatments normally. If any of these symptoms occurs
during a treatment, stop the session, offer the client water, and allow the client to relax. Monitor the client at
all times and do not allow the client to leave until the
symptoms have disappeared. If symptoms persist after
the session has ended, you should consult a physician.
If the symptoms increase rapidly after the session has
ended, the client could be in danger, and you should call
emergency services.
Spa-Specific Considerations
The spa product chosen for a particular treatment, the
surface area of the body that it is to cover, and the overall condition of the client all need careful consideration.
A spot treatment may be safe when a full-body application is contraindicated. If the product, or some of its ingredients, can penetrate the skin and enter the circulation
(e.g., essential oils), it must be used with more caution.
In such a situation, a full-body application would allow
substantially more of the product to penetrate than a spot
application.
Seaweed applications can affect thyroid medications, so
they should be avoided in cases of hypothyroidism or hyperthyroidism (except when used under the direction of a physician). Peppermint, eucalyptus, and rosemary essential oils
will counteract the effects of many homeopathic remedies,
so they should not be applied to a client who is using such
remedies to treat a condition. If the client is taking a prescription or over-the-counter medication that distorts his
or her perception of hot, cold, pain, or pressure, postpone
the treatment. For the same reason, clients under the influence of drugs or alcohol should not receive a treatment.
Also, offering wine, champagne, or other alcoholic drinks
as part of the treatment or spa package endangers the client
and may affect the legal liability of the clinic or spa.
Clients who are pregnant, in a weakened condition, have
neurological conditions, have heart conditions, or have uncontrolled high or low blood pressure should not receive
hydrotherapy treatments except when under the care of a
physician. Similarly, such clients need a doctors release for
full-body spa treatments including mud, herbal hot sheet
wraps, and seaweed wraps.
Common Conditions That Require Caution

Although the range of conditions you might see as a professional spa therapist is vast, hypertension, integumentary
issues, diabetes, and allergic reactions to spa products are
more common, so they require special attention.
Hypertension
Blood pressure refers to the force of blood pushing against
blood vessel walls as it circulates throughout the body.
A sphygmomanometer is an instrument that measures this
pressure at two different moments. The systolic pressure is
the peak pressure in the arteries, which occurs near the beginning of the cardiac cycle during ventricular contraction.
The diastolic pressure is the lowest pressure of the resting
phase of the cardiac cycle during ventricular relaxation.
A blood pressure cuff measures the pressure in the arteries in millimeters of mercury, which is why the abbreviation
mm Hg is used in blood pressure descriptions.
High blood pressure, called hypertension, is a blood
pressure consistently elevated above 140 mm Hg systolic
and 90 mm Hg diastolic. Usually in chart notes, physicians
or nurses would write this blood pressure as 140/90 mm
Hg. The top number refers to the systolic pressure and the
bottom number the diastolic number.
Essential hypertension is hypertension that is not due
to some other pathology. Secondary hypertension is high
blood pressure that is a symptom of a separate pathology
such as a hormonal disorder. Malignant hypertension is
a dangerous condition in which the diastolic pressure increases rapidly over the course of weeks or months and
requires immediate medical attention. Most hypertension
cases are essential hypertension and are caused by smoking, being overweight, a sedentary lifestyle, a salty diet, high
alcohol consumption, stress, age, and genetic factors as
evidenced in a family history of hypertension. Pregnancy,
kidney disease, and adrenal and thyroid gland disorders are
some of the causes of secondary hypertension.
Hypertension is a serious condition that causes damage
to the heart and blood vessels. Left untreated, it can lead
to atherosclerosis, aneurysms, stroke, heart failure, heart
attack, kidney failure, and vision problems. Blood pressure
parameters are the following:
Normal: less than 120/80 mm Hg

Prehypertension: 120/80 to 139/89 mm Hg
Stage 1 hypertension: 140/90 to 159/99 mm Hg
Stage 2 hypertension: 160/100 mm Hg and above
Some clients with hypertension take prescription medications to control their blood pressure and reduce their risks
of adverse effects related to the interplay of spa treatments
and hypertension. Still, some spa treatments should not
be delivered without first consulting the clients physician.
For example, any deep abdominal massage is contraindicated for clients with elevated blood pressure or who are
taking blood pressure medications, but gentle, superficial
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Chapter 3
abdominal massage for relaxation is usually fine. Also avoid

very vigorous or very stimulating massage or spa techniques
that trigger the sympathetic nervous system. This includes
intense hydrotherapy treatments such as contrast showers
or baths (discussed in Chapter 6, Water Therapies), cold
treatments, or exposure to heat in a sauna or steam room.
Saunas raise the temperature of the clients skin to above
103F. This change in skin temperature stimulates sweating, the elimination of wastes through the skin, a faster
heart rate, and lower blood pressure.
For healthy adults, the reduction of blood pressure is a
temporary reaction to the bodys rise in skin temperature.
When a healthy person exits the sauna, blood pressure returns to normal. People with high blood pressure also experience this temporary lowering of blood pressure, but after
leaving the sauna, their blood pressure can behave abnormally, sometimes rising dramatically.
Integumentary Conditions
A basic understanding of the skin is vital to every therapist working in a spa to ensure client safety. Massage lubricants and body treatment products affect the skin, so they
must be chosen with care. For example, although a product
might be indicated for a clients muscular condition, it may
be contraindicated for the clients skin condition. Massage
therapists therefore need a good knowledge of skin types
and skin problems so that they know when to direct the
client to an esthetician or dermatologist for professional
skin care.
The essential oils used in aromatherapy are often misused in skin care because the word oil is misleading. Essential oils do not directly address dry skin conditions by adding oil or moisture to the skin. In fact, most essential oils
are quite drying for the skin and can cause irritation if used
inappropriately on a particular skin type. Essential oils are
useful as antiseptics and for helping the body to relax.
Stress plays a role in many skin disorders, so massage
therapists and estheticians can work together for the benefit of the client. A full-body massage using spa products
that are appropriate for the clients skin condition can significantly reduce stress and have a significant impact on
skin health. Improvements in the condition of the skin take
a while and require patience. At least a month is required
before a significant improvement can be seen in most conditions. Often, skin conditions require many months to resolve. When estheticians and massage therapists recognize
the potential synergy of the work that they do, they can provide integrative and supportive treatment plans for clients.
Table 34 provides an overview of skin types and conditions which the massage therapist should be aware of. Some
essential oils appropriate for each condition are included
in the table. This information will be useful for massage
therapists making blends for a safe full-body massage and
for estheticians using essential oils in skin care treatments.
In addition, recommendations are given on products that
should be avoided. Go to the chapters on aromatherapy,
57
body wraps, fangotherapy, and thalassotherapy for more

detailed information.
The Skin
The skin is the largest organ of the body and has many important functions (Fig. 35). Color and texture changes,
such as paleness, redness, bumpiness, or yellowing, reflect
the overall health of the body and may indicate internal disease. Rashes and skin eruptions illustrate poor nutritional
habits, stress, allergies, and sensitivities.
The outer layer of the skin is called the epidermis. It
contains no blood vessels but has many nerve endings. The
epidermis has multiple sublayers called strata. The bottom
layer of the epidermis is the stratum basale layer, which produces a constant supply of new cells. Keratinocytes make
up 80% to 90% of the epidermis and produce keratin. As the
Keratinocytes mature, they lose water and flatten out. They
are shed when they reach the outermost layer of the epidermis called the stratum corneum.
The stratum corneum provides the barrier function of
the skin, protecting the body from microbial invasion and
injury. It also protects the body from water loss. In fact, this
layer is 1,000 times more impermeable to water than most
other membranes of living organisms.
A healthy stratum corneum is compact with an orderly
arrangement of cells in what is often referred to as the
brick and mortar of the skin. The bricks are dead cells
filled with keratin. The mortar is the lipids between the
cells that cement them together. When the corneum
layer is damaged, the cells are thin and arranged in an uneven pattern. Damage allows preparations applied to the
skin to penetrate more readily. This is way dry or scaly
skin may give a burning sensation when products are
applied to it.
On the stratum corneum, sebum, perspiration, and
other water-soluble acids produce a pH of 4.4 to 5.6. This
is the skins acid mantel that acts as a defense mechanism
against invading microbes (Fig. 36). Research indicates
that the low pH in the stratum corneum also plays a role in
corneocyte maturation (the maturation of the keratin-filled
cells that make up the stratum corneum).
The inner layer of the skin, the dermis, is thicker than the
epidermis and is composed of connective tissue that contains collagen and elastin. Collagen makes up a large part of
the dermis (70%) and gives the skin structural support for
cells and blood vessels. It forms a network of microscopic
interwoven fibers that allows for stretching and contraction
of the skin. It also aids in the healing of wounds. Moisture
is important for keeping the collagen network supple.
The follicles, sweat glands, sebaceous glands, most of the
sensory receptors, and nerve endings are all found in the
reticular layer of the dermis. The sebaceous glands secrete
sebum, an oily, waxy substance composed of various kinds
of lipids that lubricate the skin. Normally, it flows through
the oil ducts, leading to hair follicles. When sebum becomes
hardened, the follicle becomes blocked. This is what causes
blackheads (comedones). Excessive flow of oil from the oil
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TABLE 34 Important Skin Types and Conditions

BASIC SKIN TYPE OR
SKIN CONDITION
DESCRIPTION
GENERAL RECOMMENDATIONS
Normal
The skin is clear, with an even tone

and texture, and good color and is
blemish free.
Full-body massage blends with essential oils of lavender, neroli, Roman or German
chamomile, geranium, jasmine, frankincense, or rose. Citrus oils can also be
used in moderation. Seaweed, clay, mud, and peat can be used at full strength.
Oily
Characterized by the overproduction of sebum. Enlarged pores

(follicles) may be filled with visible
grease and debris. Blemishes may
be present on the face or back.
Full-body massage blends with essential oils of bergamot, tea tree, lemon,
grapefruit, lavender, geranium, German chamomile, or cedarwood in a jojoba
base. If inflammatory acne is present, products should be diluted or the client
should be referred to an esthetician before the treatment progresses. Seaweed
mixed with aloe vera and clay is appropriate. Mud and peat should be avoided.
Oil dry
Sebaceous output has slowed and

the skin is not receiving enough
natural oil. The skin appears dry
and dehydrated.
Full-body massage blends with essential oils of lavender, German chamomile,

geranium, rose, carrot seed oil, frankincense, myrrh, and Roman chamomile in
shea butter or a heavy carrier oil such as sweet almond. Keep products covered
and moist while on the skin and do not allow clay, peat, or seaweed to dry out.
Refer the client to an esthetician for a professional skin care evaluation.
Water dry
Skin that is water dry has sufficient

oil but lacks moisture. The skin is
thin in texture, with small capillaries
showing in certain areas. This type
of skin is prone to fine lines, early
wrinkles, and a flaky appearance.
Full-body massage blends with essential oils of carrot seed, seaweed essential
oil, frankincense, myrrh, German chamomile, Roman chamomile, yarrow,
helichrysum, rose, or geranium. Avoid citrus oils in high concentrations. Avoid
the use of clay and direct the client to mud, peat, seaweed, shea butter, or
honey applications instead. Refer the client to an esthetician for a professional
skin care evaluation.
Sensitive
The texture of the skin tends to be

fine with redness, heat, broken
capillaries, and itching patches.
Sensitive skin reacts to strong
chemicals, cleaning products,
dyes, and fragrances.
Full-body massage blends with essential oils of helichrysum, carrot seed,

lavender, rose, frankincense, geranium in sweet almond oil, or expellerpressed sunflower oil (12 drops maximum of essential oil in 2 oz of oil). Avoid
products with dyes and synthetic fragrances. Avoid hot treatments such as
sheet wraps or Parafango. Dilute seaweeds to half strength with aloe vera gel
or wheat germ oil. It is a good idea to keep hydrocortisone cream on hand in
case of skin irritation.
Acne on the back
Blackheads, whiteheads, pimples,

redness, and irritation may be
present. If the condition is inflamed
and hot, do not apply product to
the area.
If the condition is mild, then the massage therapist can proceed with massage
or a body treatment. Full-body massage blends that benefit oily skin and acne
include tea tree, lavender, German chamomile, Roman chamomile, yarrow,
grapefruit, bergamot, and lemon mixed in jojoba or hemp oil. Avoid the use
of peat, paraffin, Parafango, and mud and direct the client toward clay or
seaweed instead.
Psoriasis
Skin cells divide much faster than

normal, resulting in round, reddish patches with silvery scales.
Psoriasis usually affects the
elbows, knees, lower back, ears,
and scalp.
A wide range of essential oils is indicated because psoriasis is considered by

many to be a stress-related disorder. Nurturing oils that are unlikely to cause
irritation include neroli, ylang ylang, rose, lavender, cypress, helichrysum,
yarrow, and frankincense. A combination of these oils can be mixed in hemp
seed oil, apricot kernel oil, or expeller-pressed sunflower oil. Although mild
cases of psoriasis do not seem to be irritated by spa products, mud and peat
should be avoided. Direct the client to clay, Parafango, paraffin, honey, shea
butter, or diluted seaweed instead. Refer the client to a dermatologist.
Eczema and dermatitis
These terms are used to describe

many chronic and inflammatory
disorders of the skin. Scaling and
papule formation as well as red
oozing vesicles may accompany
burning and itching sensations.
If the condition is mild, the massage therapist can proceed with full-body
massage or the application of a product to the body. Essential oils of German
chamomile, Roman chamomile, yarrow, frankincense, helichrysum, lavender,
and myrrh can be used in shea butter, sweet almond oil, hemp oil, or borage
oil. Seaweed may cause irritation, so it should be diluted. Mud and peat
should be avoided, but clay or Parafango can be used. Avoid products with
synthetic fragrances or dyes. Refer the client to a dermatologist.
glands may produce seborrhea and problem skin. Emotional stress increases the flow of sebum.
The skin was thought to be impervious to most chemicals
until, in the 1960s, dimethyl sulfoxide (DMSO) was shown
to transport other substances through the skin barrier and
into the bloodstream. It is important to understand that
some of the ingredients of spa products do pass through the
skin into the bloodstream where they may affect the body
on a physiological level. There are many factors that contribute to the passage of these ingredients through the skin.
Lipophilic (literally lipid-loving or fat-loving) ingredients penetrate better than hydrophilic (water-loving) ingredients. Essential oils pass rapidly through the skin due to
their lipophilic nature. The polysaccharides (mucilaginous,
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59
Stratum corneum
Stratum lucidum
Stratum granulosum
Epidermis
Stratum spinosum
Stratum germinativum
Epidermal ridge
Capillary loop
Dermis
Hair
Nerve ending
Epidermis lifted to reveal

papillae of the dermis
Dermal papillae
Epidermis
Dermis
Sweat pore
Papillary layer of dermis
Nerve endings
Sebaceous gland
Reticular layer of dermis
Arrector pili
muscle of hair
Hypodermis (subcutaneous tissue)
Blood vessels
Hair root
Sweat glands
Nerve to hair follicle
Adipose tissue
FIGURE 35 The skin is the largest organ of the body and has many important functions. Color and texture
changes, such as paleness, redness, bumpiness, or yellowing, reflect the overall health of the body and may
indicate internal disease. Rashes and skin eruptions illustrate poor nutritional habits, stress, allergies, and
sensitivities.
slimy substances) in seaweed also pass readily through the

skin. It is not surprising that small-sized molecules penetrate faster than larger molecules or that a viscous formulation will pass through more slowly than more fluid preparations. Dead cells and lipid accumulation in the stratum
corneum as well as sebum pH and skin thickness affect the
rate at which a substance passes through the skin.6 Some
natural components increase skin penetration. These include linoleic acid (found in evening primrose oil and some
Acidic
Less
sensitive
Skin
other seed oils),7 oleic acid (found in almond, cod liver oil,
and others),8 menthol (found in some essential oils such as
peppermint),9,10 and squalene (found in olives, wheat germ
oil, and shark liver oil).11
Any areas of broken skin such as open wounds, scratches,
blemishes, or scabs are local contraindications. Contagious
skin conditions such as cellulitis, impetigo, mites (scabies),
and lice are absolute contraindications, and spa treatments
or massage should not be provided. Hives is a reaction to
10
11
12
More
Neutral
sensitive
13
14
Alkaline
FIGURE 36 pH Graph. On the stratum corneum, sebum, perspiration, and other water-soluble acids produce
a pH of 4.4 to 5.6. This is the skins acid mantel that acts as a defense mechanism against invading microbes.
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60
stress or an allergy that makes the skin hot, swollen, and

itchy. It is a local contraindication if it is confined to one
small region but an absolute contraindication if widespread.
With a skin condition that is contagious but confined
to one small area such as boils, fungal infections including
ringworm, herpes simplex, and warts, the area is locally contraindicated, but spa treatments or massage can be applied
to other areas of the body. Separate used linens that were exposed to contagious skin conditions, especially herpes, and
use bleach and hot water in the wash cycle. Sanitize your
hands, wear vinyl gloves, and clean all massage equipment
and the treatment room with extra care after the session.
Avoid massaging directly over areas of acne (a bacterial
infection of the sebaceous glands), using heavy creams in
these areas, or applying natural products such as mud that
may contain bacteria that could enter the body through
broken skin. Any of these activities might spread the infection to other areas of the clients skin or cause increased
blemishing by blocking pores.
Dermatitis is a nonspecific term describing many types
of skin inflammation. Often, dermatitis is caused by contact with an irritating substance or allergen. Eczema is
caused by hypersensitivity reactions of the skin. Psoriasis
is a noncontagious skin disorder in which epithelial skin
cells replicate rapidly in patches and turn itchy and scaly.
If the skin of a client with any of these conditions is very
inflamed, is open due to scratching, or is weepy or crusty
with delicate scabs, treat the areas as a local contraindication and avoid the application of spa products.
If the skin is in relatively good condition, not overly
inflamed, intact, and not crusty, it may respond well to
massage with a natural anti-inflammatory lubricant such
as hemp seed oil and skin-soothing essential oils such as
German chamomile and helichrysum oil (see Chapter 7 on
aromatherapy). Do not use mud, seaweed, or products with
synthetic fragrances, dyes, mineral oil, lanolin, coconut oil,
grapeseed oil, or cocoa butter on clients with dermatitis, eczema, or psoriasis.
Precancerous skin conditions such as actinic lesions and
skin cancers such as basal cell carcinoma and squamous
cell carcinoma are local contraindications. Malignant melanoma spreads rapidly and is treated aggressively, often with
chemotherapy and radiation. Any spa treatments for clients
with malignant melanoma should take place only under
the guidance of the clients physician.
Skin injuries such as burns (including moderate to severe sunburn), ulcers, or open wounds are local contraindications. Widespread burns and ulcerations may be an absolute contraindication, depending on their severity. The scar
tissue that forms over burns, ulcers, or wounds responds
well to massage, seaweed treatments, and mud treatments
in the subacute and chronic stages. These natural products
and massage can improve the appearance and mobility of
this type of scar tissue. Keloid scar tissue and raised moles
are local contraindications.
Allergies
It is possible for clients to have allergies to spa products,
so therapists must understand something about allergies
and how they occur. A primary function of the immune
system is to differentiate self from nonself substances.
The immune system destroys or subdues anything identified as nonself as fast as possible. Allergies are an immune
system response and are not caused by an infectious agent.
Even substances that pose no threat to the body such as
pollen, pet dander, a component in a lubricant, or other
allergens (substances that causes an allergic reaction) are
perceived by the immune system as a threat. Common allergies such as hay fever induce mast cells (cells that play a
role in wound healing and protection against pathogens) to
release histamine and other chemicals that change vascular
permeability. This inflammatory response leads to symptoms such as watery eyes, itching skin, swelling, a runny
nose, or vomiting and diarrhea (with food allergies). In
severe allergic reactions, known as anaphylaxis, mast cells
release large amounts of histamine that lead to edema and
sudden low blood pressure. Symptoms can include hives,
redness, shortness of breath, coughing, sneezing, decreased
heart rate, fainting, and shock. The rapid onset of localized
swelling is called angioedema. Swelling that occurs in the
tongue, larynx, or pharynx might block airflow, creating a
life-threatening condition. Peanuts (and other nuts), fish
and shellfish, latex, bee stings, and some foods such as milk
and eggs can cause severe reactions of this sort. Clients with
known allergies to nuts should not receive massage with a
lubricant containing ingredients from that nut (e.g., peanut
oil, almond oil). Clients with a known allergy to shellfish
or seafood should not receive seaweed treatments or contact products with seaweed in them. People who know they
are at risk for anaphylactic reactions usually keep medication with them, such as Benadryl or injectable epinephrine
(EpiPen).
Diabetes
Diabetes is a group of related conditions that result in elevated levels of blood sugar (hyperglycemia). About 98% of
all diabetes cases are either type 1 (rare and more serious)
or type 2 diabetes (approximately 20.8 million cases in the
United States). Gestational diabetes affects about 4% of all
pregnant women and accounts for around 135,000 cases
each year.12
In type 1 diabetes, the body does not produce insulin,
the hormone needed to convert sugar (glucose) into energy. It may have genetic roots, as it runs in families, or be
caused by exposure to certain drugs, chemicals, or infections. It is caused by an autoimmune response in which
killer T cells damage parts of the beta cells in the pancreas
where insulin is created, causing a lifelong deficiency.
People with type 1 diabetes must take injections of insulin and monitor their blood sugar levels carefully to avoid
very high levels, which can cause ketoacidosis, or very low
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Chapter 3
blood sugar, which can cause insulin shock. Ketoacidosis is

a condition in which the body metabolizes fats for fuel because the lack of insulin does not allow glucose to be used
for energy in cells. The acidic waste of rapid fat metabolism
changes the pH balance of the blood and can led to shock,
coma, and death.
In type 2 diabetes, the body does not produce enough
insulin, or target cells have fewer receptor sites for insulin than needed. Although the exact cause of type 2 diabetes is unknown, it is linked to high-carbohydrate diets
and is often treated with diet, exercise, and medications.
Some people with type 2 diabetes have to supplement this
regime with self-administered insulin. Although people
with type 2 diabetes do not experience ketoacidosis, they
may develop a blood pH imbalance related to high blood
sugar, called hyperosmolality, that can lead to shock,
coma, and death.
Insulin shock, very low blood sugar, can occur in both
type 1 and 2 diabetes but can be treated effectively simply by
ingesting juice, milk, candy, or sugar-containing soft drinks
right away to increase blood sugar levels. Over time, diabetes can lead to serious complications, including cardiovascular disease, stroke, hypertension, aneurysm, edema,
ulcers, gangrene, amputations, kidney disease, impaired vision, blindness, and neuropathy.
The types of spa techniques that can be used with clients
who have diabetes depend on the state of the individuals
health. Clients with poorly treated diabetes may have serious edema, ulcerations on their extremities, impaired circulation, and/or severe neuropathy. Very light massage or
energetic techniques might be the only treatments that
are appropriate for such clients. Hydrotherapy treatments
using extremes of hot and cold temperatures, hot stone
massage, or the application of aggressive treatment products such as seaweed are contraindicated. On the other
hand, a client who monitors blood sugar carefully, eats a
healthy diet, gets exercise, and experiences few complications may benefit from a variety of spa treatments.
Keep in mind the fact that spa treatments often stimulate the body, which uses up available glucose and insulin
faster, which can lead to an imbalance, usually low blood
sugar.13 Its important to talk this over with the client who
may need to plan mealtimes and insulin injections to better accommodate the spa session. Clients can also monitor
their blood sugar immediately before the spa treatment and
make necessary adjustments by eating a small snack or injecting insulin if needed. Keep some form of sugar in your
office (juice, candy, regular soft drinks) in case a client becomes hypoglycemic. If a diabetic client becomes confused,
irritable, weak, or shaky or has clammy skin, stop the session and give the client some sugar. If the client does not
respond quickly to the sugar, call emergency services immediately. It is not in the massage therapy scope of practice to
test a clients blood glucose level or inject insulin.
Spa therapists should obtain a physicians release when
working with a client with advanced or poorly treated
61
diabetes. If possible, discuss with the physician the types

of methods you would like to use in the session and their
effects on the body to obtain the best possible recommendations to ensure the clients safety.
Critical Thinking and Contraindications

Therapists discover contraindications or situations that
require caution from the clients completed health intake
form and the intake interview, from observations of the client, and from palpation findings or reactions the client has
to the spa treatment.
Often, the client has a condition diagnosed by a physician and understands how that condition affects the body.
As long as the condition is not completely contraindicated,
the client and therapist can discuss session goals and plan
adaptive measures to ensure comfort during the session. In
some cases, a clients condition may be serious or complex
enough to cause concern, in which case the therapist should
contact the clients physician and obtain a release. Clients
who do not have a diagnosed condition but who complain of symptoms such as fatigue, muscle weakness, unexplained pain or stiffness, persistent headache, or feelings
of lethargy should see their physician and obtain a release
before receiving a spa treatment. Undiagnosed symptoms
may indicate a serious condition that might be exacerbated
by spa treatments. Following is the basic process by which
therapists rule out contraindications:
1. Administer a health intake form and review the form
carefully.
2. Conduct a health intake interview and ask the client to
describe symptoms, general health, goals for the spa session, and side effects from medications. Ensure that the
client has listed all medications and conditions on the
health intake form.
3. Look up unfamiliar diagnosed conditions in a pathology reference. A Massage Therapists Guide to Pathology by
Ruth Werner is highly recommended.
4. Determine if the clients condition has flared up (moved
suddenly from a chronic stage to an acute stage with
intense symptoms). A condition that has flared up is
more likely to be contraindicated. If the symptom level
is normal for the client and the condition has not flared
up, spa treatment is more likely to be safe for the client.
5. Look up medications in a drug reference. Note the side
effects of the medication and check these against the
clients experience. If the client describes symptoms
that are listed as adverse effects of a medication, the
situation needs further discussion. A call to the clients
physician is advised.
6. Conditions vary from client to client, depending on
other variables in the clients life. After researching the
condition and medication and questioning the client
about any side effects experienced from medications,
assess the client visually. Get an overall impression of
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the clients physical health, level of vitality, and stamina. Dont underestimate your intuition. Even if the
reference books say massage or spa treatment is okay,
but if your gut tells you no, listen to your gut.
7. Determine if the client is contraindicated, needs a
physicians release, has any area that should not receive
treatment, should be referred to a more experienced
therapist, or should be referred to another health care
provider. If you decide that a spa treatment is not
contraindicated and that you do not need a physicians
release but adaptive measures are required, discuss your
thoughts with the client. What does the client hope to
achieve from the session? What type of spa treatment
does the client want? How does the client feel right
now? How does the client hope to feel at the conclusion
of the spa session? Depending on the clients condition,
you may eliminate the use of some techniques or adjust
the temperature of some aspects of the treatment to
reduce the load on the clients body. You may decide
to avoid the use of hydrotherapy (e.g., a hot pack) and
shorten the sessions length (e.g., offer a 30-minute session instead of 60 or 90 minutes).
8. A client may list a few symptoms but not have a diagnosed condition or be taking medications. Question
the client carefully. Perhaps a client tells you about
weekly headaches believed to be from neck and shoulder tension. The client may have periods of nausea and
refer to them as nervous stomach. The nausea may
occur when the client must give a presentation at work.
The client also reports being unable to sleep for the
last week and feeling moody and irritable. The client
believes these symptoms are related to work stress and
not related to any serious condition. You palpate the
shoulders through the clients clothing and confirm the
neck and shoulders are very tense, and the headaches
could be the result of this tension. You have to decide if
it is safe to provide a spa treatment or massage. Probably it is. Although these symptoms could be related
to a more serious condition, the client has given you
a logical explanation, and your shoulder and neck
palpation supports the clients perception about the
headaches. Your visual assessment tells you the client is
in moderate physical health and has good skin coloring,
and your impression of the clients overall vitality and
stamina is good. You decide to proceed with the session
but remain vigilant and check in regularly to determine
that the client has not had an increase of symptoms or
pain related to the session.
A different client might tell you about waking up with
pain in all the joints, with a pounding headache, and feeling incredible fatigue. The client can give no explanation
for these symptoms. Because these symptoms came on very
suddenly with no logical explanation, you refer such clients
to their physician for a release and postpone the session.
Remember, when in doubt, refer out.
As mentioned previously, Table 33 provides an overview of conditions for quick reference, but do not rely
completely on such a list. Each client and each situation is
different, and therapists need to learn to reason clinically
so that they can make appropriate decisions for each client. Novice therapists may shy away from conditions that
an experienced therapist can work with safely. If you have
any doubt about the suitability of a spa treatment for a
client, be cautious and postpone the treatment until you
have obtained a physicians release or can discuss the situation with your supervisor. Contraindications for specific
spa treatments are described in greater detail in upcoming
chapters.

The client intake process is just as important for a spa treatment as it is for massage, and before being treated, all clients need an evaluation of their physical condition. Refer
to your massage therapy textbook to provide details of the
health intake process in the event you need a reminder. To
set a relaxing tone, you might provide a cup of herbal tea
and soak the clients feet in a decorative tub while he or she
fills out the health intake form (Fig. 37). The type of information included on the health form will depend on the
scope of the spa, the services offered at the spa, or the needs
of the therapist for that particular session. A nutritionist
may ask some questions about the clients diet, whereas an
esthetician will focus on the condition of the skin and a
massage therapist will ask about muscular conditions. Spas
can plan to have one intake form or several different forms
that suit individual therapists or services.
When the client has completed the form, introduce
yourself, describe the benefits of the treatment the client
is about to receive, and review the form verbally with the
client. Ask the client follow-up questions about health
conditions and medications to rule out contraindications.
Also ask clients about their expectations of the session
so that you can tailor methods and experiences to their
particular needs.
After the session, take a few moments to process the results with the client. Ask the client about methods he or
she found particularly enjoyable or effective. This is a good
time to recommend other beneficial services or home care
products for the client. Document what occurred during
the session, the clients results, and next steps if appropriate
on a form such as the spa treatment record (Fig. 38). In the
event of a liability claim, you will need this basic information to protect yourself and your business.
All therapists should plan some time at the beginning
and end of every treatment, even for retuning clients, to
discuss the clients current condition, determine the results
obtained from treatment, and document what happened
during the session.
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63
SPA HEALTH INFORMATION

Patient's Name
Date
Address
State
Phone
Zip
Occupation
Emergency Contact
Phone
Primary Health Care Provider

Name
Phone
Address
State
Zip
Current Health Information

Please list all conditions currently monitored by a health care provider.
Please list all the medications you took today (include pain relievers and herbal remedies).
Please list the medications you took in the past 3 months.
Please list and briefly explain (including dates and the treatment received) the following:
Surgeries
Accidents
Major
Illnesses
Tobacco Use:
Current
Past
Never
Comments
Alcohol Use:
Current
Past
Never
Comments
Drug use:
Current
Past
Never
Comments
Are you currently menstruating?
Yes
No
Have you received a spa treatment before?
Yes
No
If yes, what types of spa treatment have you received?
FIGURE 37 Spa health form. The type of information included on the health form will depend on the scope
of the spa, the services offered at the spa, or the needs of the therapist for that particular session. A nutritionist
may ask some questions about the clients diet, whereas an esthetician will focus on the condition of the skin and
a massage therapist will ask about muscular conditions. Spas can plan to have one intake form or several different
forms that suit individual therapists or services. (continued)
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64
Current and Previous Conditions

Please check all current and previous conditions and give a brief explanation, if appropriate, in the comments section
at the end of this form.
Current
Past
Current
Past
Headache
Lymphedema
Pain
High blood pressure
Sleep disorders
Low blood pressure
Fatigue
Poor circulation
Infections
Swollen ankles
Fever
Varicose veins
Sinus condition
Asthma
Skin conditions
Bowel dysfunction
Athlete's foot
Bladder dysfunction
Warts
Abdominal pain
Skin sensitivities
Thyroid dysfunction
Sunburn
Diabetes
Burns
Pregnancy
Bruises
Fibrotic cysts
Aversions to scent
Pacemaker
Aversion to oils
Phlebitis
Allergies
Raynaud's syndrome
Sensitivity to detergents
Aversion to cold
Other Conditions:
Claustrophobia
Osteoarthritis
Spinal problems
Disc problems
Lupus
Tendonitis, bursitis
Comments:
Fibromyalgia
Dizziness, ringing in the ears
Mental confusion
Numbness, tingling
Neuritis
Neuralgia
Sciatica, shooting pain
Depression
Anxiety, panic attacks
Therapist's Name:
Heart disease
Signature:
Blood clots
Date:
Stroke
FIGURE 37 (continued)
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Chapter 3
65
SPA TREATMENT RECORD

Patient's Name
Date:
Date
Therapist:
Comments:
Retail items purchased:
Therapist:
Comments:
Therapist:
Comments:
Therapist:
Comments:
Therapist:
Comments:
Therapist:
Comments:
Treatment received:
Date:
Treatment received:
Date:
Treatment received:
Date:
Treatment received:
Date:
Treatment received:
Date:
Treatment received:
FIGURE 38 Spa treatment record. Document what occurred during the session, the clients results, and next
steps if appropriate on a form such as the spa treatment record.
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66
SPA FUSION
Direct Contact
The transfer of a
pathogen via direct
contact with the skin
Vector
Transmission
The transfer of a
pathogen via an
insect or animal
Indirect Contact
The transfer of a
pathogen to an
inanimate object
and then to
another person
Vehicle
Transmission
The transfer of a
pathogen via air,
dust, food, or
water
Example of a graphic organizer.
STUDY TIP: Graphic Organizers

Graphic organizers are visual representations of
concepts, ideas, and other information. They can help
you organize and clarify information to improve your
comprehension and recall. They are especially useful
for visual and kinesthetic learners. Visual learners benefit from the structure of graphic organizers, whereas
the process of creating a graphic organizer motivates
kinesthetic learners.
SPA INSPIRATION: Your Spa Journal

Journaling can be a powerful practice during your
spa training program. It allows you to keep track of
the changes you are making on a mental, emotional,
physical, and spiritual level. You will face challenges
during your schoolingeveryone doesand when
you capture these in a journal you begin to see the
pattern of your strength. This is exciting! Ask yourself simple questions to begin the process of journaling such as, What did I learn in my class today that
was particularly interesting? How will this change
the way I approach my spa work? or What are
some of my challenges right now? How can I better
organize my life to get the most out of my training
program?
CHAPTER WRAP-UP
As a professional spa therapist, you want to practice
exceptional ethics at all times to maintain your personal integrity and the integrity of the massage and
spa professions. This means learning and following a
code of ethics as established by the organizations you
join as a professional. Requiring a health intake form

and checking it carefully to ensure spa treatments are
not contraindicated for your client is just as important to your integrity and professionalism. Make sure
to keep the proper reference books on hand and to
research any unknown medications or client conditions before providing spa services. Document your
sessions to ensure you have good records to follow on
treatments and to protect yourself in the event of a liability claim. You are also required by health standards
to provide a clean, hygienic, and safe environment for
your clients. Good sanitation skills require practice.
Its easy to forget small things in the course of a busy
day, but such forgetfulness may cause a client to get
sick. For example, a new therapist might forget to sanitize her hands before moving from foot massage to
another area of the body. This client is now potentially
exposed to a fungus that can take hold and grow on
another area of the skin. A new therapist might forget
to disinfect the oil bottle between clients. The second
client is then exposed to pathogens from the first
because the therapist touches the skin, touches the
bottle, and then touches the new clients skin. Good
sanitation practices also require you to pay attention
to your every gesture. Did you touch your hair or
scratch your nose as you transitioned from one body
area to another? If you did, you should decontaminate your hands before you touch the client again. Be
vigilant and practice thinking about sanitation as part
of your spa treatment application. If you accidentally
skip a sanitation step, stop and practice incorporating the step. In this way, you will be ready when you
are a professional to provide your clients with the best
possible care.
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Chapter 3
67
SPA FUSION
REVIEW QUESTIONS
Multiple Choice
1. A creed that states a professional groups
principles and the values by which the group abides
is called:
a.
b.
c.
d.
A code of values
A code of principles
A code of professionalism
A code of ethics
2. The transfer of a pathogen from an infected

person to an uninfected person through touch
is called:
a.
b.
c.
d.
Direct contact
Indirect contact
Vector transmission
Vehicle transmission
3. A type of cleaning product that should not be used

on the skin is:
a.
b.
c.
d.
An antiseptic
Alcohol
A disinfectant
Hydrogen peroxide
4. The authority a massage therapist is granted by a

client because the massage therapist is a health care
provider is called:
a.
b.
c.
d.
The health care authority

The power differential
The authority difference
The health care differential
5. A term used by regulating boards of health care

professions to describe the techniques, activities,
and methods that are permitted to a therapist
under the law.
a.
b.
c.
d.
Health care authority

Power differential
Code of ethics
Scope of practice
6. A protocol used in health care settings that

reduces the risk that health care workers will be
exposed to bloodborne diseases is called:
a.
b.
c.
d.
Universal precautions
General precautions
Code of precautions
Health workers precautions code
7. Showing artistic pictures of undraped bodies in

the massage or spa reception area is a form of:
a.
b.
c.
d.
Sexual assault
Sexual impropriety
Ethical conduct
Professional conduct
8. When regulations state that massage therapists

cannot diagnose a patients condition, prescribe a
medication or treatment, or adjust a clients bones
they are referring to:
a.
b.
c.
d.
Code of ethics restrictions

Sanitation and hygiene restrictions
Sexual impropriety restrictions
Scope of practice restrictions
9. Offering wine, champagne, or other alcoholic

drinks as part of a spa treatment:
a. Is fine if the client is of legal drinking age
b. Is fine so long as the client does not consume
more than two drinks
c. May lead to criminal charges against the
therapist
d. Endangers the client and may lead to liability
claims
10. A skin condition that is contagious but confined
to one small area such as boils, fungal infections
including ringworm, herpes simplex, and warts is:
a.
b.
c.
d.
A local contraindication
An absolute contraindication
Not a concern
Can receive treatment so long as the therapist
wears gloves
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4
Your Spa Massage
Chapter Outline
K e y Te r m s
Overview of a Wellness Massage Session
Aroma mist: A combination of distilled water and essential oils placed in

a misting bottle. It is misted over the client at the end of a session to fill
the treatment room with a refreshing scent.
Aromatherapy inhalation: One drop of an essential oil or 1 drop of a
blend of different oils is briefly rubbed together in the hands before the
hands are passed over the clients nose in an arc so that the oil can be
enjoyed on a deep inward breath.
Auditory cue: A cue, such as the ringing of a chime, used to signal the
beginning and ending of the massage session.
Diaphragmatic breathing: A breathing exercise that promotes deep,
relaxed breathing patterns.
Massage enhancers: Additional session elements or small complementary treatments that increase the clients enjoyment of the session.
Paraffin: Paraffin is a waxy substance obtained from the distillates of
wood, coal, petroleum, or shale oil. It is used to coat the skin and trap
heat and moisture at the skins surface.
Pursed-lip breathing: A breathing technique that promotes deep, relaxed
breathing patterns.
Routines: Routines are a series of strokes that are planned in advance,
delivered to body areas in a preset order, and practiced until they flow
smoothly together.
Sequencing: Sequencing refers both to the sequence of strokes (the order
in which strokes are applied to a given body area) and to the overall
sequence of the massage (the order in which body areas are massaged).
Before the Massage

The Massage
After the Massage

Resting and Holding Strokes
Breathwork
Aromatherapy Inhalations
Use of an Auditory Cue
Massage Enhancers
Warm Packs
Steamy Aromatic Towels
A Simple Hand or Foot Treatment
Paraffin Dip
Easy Aromatherapy Enhancements

Sequencing
Routines
SPA FUSION
STUDY TIP: Party! Thats Right. Party!
SPA INSPIRATION: Spa Massage Olympics
ITS TRUE! Diaphragmatic Breathing Exercises
Support Different Client Groups
CHAPTER WRAP-UP
68
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Chapter 4
Massage in a spa setting is just like massage in any

other setting; it is usually customized to fit the needs
of the individual client and can take many forms. All
types of massage, including Swedish, lomilomi, Thai,
sports, craniosacral, orthopedic, Shiatsu, myofascial
work, ayurvedic marma point therapy, stone massage,
Your Spa Massage
69
generally viewed as a healthy activity to promote a balanced,

functional life and is regularly promoted at spas, wellness
centers, private practices, and massage clinics. We are about
to examine the sequence of events that occur in a wellness
massage. Note that the sequence of events in a health care
massage (also called treatment or rehabilitative massage) is
likely to be different. Usually, a health care massage requires
more in-depth assessment of the client such as a posture
and range of motion assessment and more detailed treatment planning.
neuromuscular therapy, and many others, are offered in spas

around the country. Sometimes, the whole massage routine
Before the Massage
will be based on one style (e.g., lomilomi), and sometimes,
When a client arrives for his or her first massage appointment at the spa, make every effort to make the person
feel welcome. Orient the client to the new environment
and recognize that a new client is making numerous
boundary adjustments to participate in the massage session and is likely to feel some nervousness or discomfort
as a result.
a combination of techniques from many styles (e.g., Thai,

marma point massage) will be integrated with Swedish
massage strokes. The spa may train everyone to deliver the
same massage, or they may allow each therapist to do his
or her own massage routine. The goal is to develop your
massage skills so that you can fluidly adapt to the style of
massage requested by employers or meet the needs of your
clientele in a private massage or spa business. This chapter
provides an overview of a wellness massage session before
looking closely at the subtle factors that can influence a
clients enjoyment of a session. Finally, we put everything
together into a beautiful, flowing, and luxurious session.
Overview of a Wellness Massage

Session
Massage theory and techniques are sometimes taught in
isolation, especially in the early portions of a massage training program. Students focus on one skill at a time and then
put them all together into an organized whole. Alternately,
you may have completed your massage training program
so that you can focus on specialization in spa therapies.
In either case, it is helpful to preview the big picture to better understand where and how different skills are used during a wellness massage sessionthe type of massage session
often offered at spas.
Lets review the difference between wellness massage and
health care massage. The public seeks wellness massage
to decrease stress, promote relaxation, support the bodys
natural restorative mechanisms, and have an enjoyable experience that leaves the body feeling refreshed and revitalized. Wellness massage is also used to reduce temporary
pain from overexertion caused by activities such as weekend
athletics or by unusual work stress. This type of massage is
The Greeting
As the client walks through the door, you or the receptionist should be on hand with a warm greeting. Step out from
behind the reception desk to shake the clients hand and
smile while making eye contact. Hand the client a clipboard with the required paperwork (usually, a health history form and documents relating to informed consent)
and explain each document. Show the client to a seat in the
reception area and perhaps offer a cup of herbal tea. The client fills out the paperwork and hands it in to you. In many
spas, this process might take place in a quiet room, apart
from the reception area, and be accompanied by a relaxing
foot soak.
The Tour
With paperwork in hand, you escort the client into the
treatment area. Point out where the bathroom is located
and any amenities such as the steam room or sauna the
client might use on his or her next visit. Let the client
know if a shower is available before or after the massage.
Show the client into the treatment room and explain
where to undress and hang clothing. Its a good idea to
remind clients to remove jewelry before the session because
lubricants can cause jewelry to look tarnished and delicate
pieces may be damaged during massage strokes. Use a small
dish to hold personal items so that jewelry is not lost or
forgotten.
The Interview
The client interview does not need to be a complex process,
but each of the items we preview here should be discussed
to ensure the safety of both client and therapist. The overview here is to describe where and how an interview occurs
in the progression of a wellness massage, so in-depth details
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70
are not included. Refer to your massage program training

materials or instructor for more information about any
processes you feel uncertain about. Offer the client a seat
and sit down facing the client. The initial intake interview
should accomplish a number of tasks but take no longer
than 10 minutes:
1. Policies and procedures: Briefly review the spas
policies and procedures and information relating to
informed consent, including the scope of practice
for massage and the limitations of massage. Ensure
that the client has signed an informed consent form.

An example is provided in Figure 41.
2. Rule out contraindications: Review the clients
completed health history form. In some cases, you may
need more information from the client about a particular condition to rule out contraindications. When
you feel you understand the clients medical picture
and that massage is not contraindicated, treatment
planning begins. A sample of a health history form
and a discussion of contraindications is provided in
Chapter 3.
FIGURE 41 Example of an informed consent statement and form. An informed consent statement and form
is a document that fully informs clients about choices related to their care. It discloses policies and limitations
of services that might affect their care. All of the national massage organizations require massage therapists to
provide informed consent documentation to their clients as part of their codes of ethics. (continued)
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Chapter 4
Your Spa Massage
71
3. Client expectations: Ask the client to share about

expectations for the session. Its sometimes helpful to ask, What results do you want to achieve? or
When you leave here today after your session, what
do you want your body to feel like? In a relaxation
session, it is common for clients to want to feel more
relaxed or to have less tension in a particular area.
First-time clients may not know what to expect and may
be anxious. They may have seen a picture of massage
or read about the benefits of massage in a magazine.
Perhaps, a friend described a positive massage experience. A client who has received only one previous
massage is likely to expect this massage to be exactly

the same as the first. In this case, the client may wonder
whats going on when you use a different style or techniques. In each of these circumstances, you can set the
client up for a good experience by explaining that there
are many different types of massage and then describing some of the techniques you plan to use and their
effects.
Although concerns about the therapists gender
have diminished because people become more educated
about massage, some clients want to choose the gender
of their therapist and may be surprised if this was not
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72
discussed during the booking phone call. In our culture,

many men and women tend to feel more comfortable
with a female therapist. Many women may feel less selfconscious about how their bodies look to other women.
Some women have concerns about the potential sexual
misconduct of a man based on some past experience,
whereas others may worry that their male partners will
feel uneasy that they have received massage from a man.
Some men feel anxious about receiving an enjoyable
experience from a mans touch. Cultural and religious
beliefs can also influence clients. Although these stigmas can frustrate male therapists, this situation continues to improve because people embrace massage as a
regular health care practice. All clients have the right to
determine what happens to their body. If the client asks
for a therapist of a specific gender, this request must be
honored. Sometimes, a clients expectations of massage
are not reasonable, however. In this case, outline for the
client what is realistic and what is beyond the scope of
massage.
4. Determine treatment goals: With the clients input,
determine specific treatment goals for the session.
This can be fairly simple, as in the following example,
or fairly complex. In a wellness massage, treatment
goals are based on the clients expectations and often
help you focus on areas that need the most attention
during the session. For example, the goals for a session
might be to decrease bilateral neck tension, decrease
upper back tension, and decrease foot soreness. You
then know that you will be massaging this clients
back, neck, and feet. Will the client want other areas
massaged?
5. Plan the massage: Sometimes, clients only want
selected areas to be massaged, or they may want a
full-body massage with extra focus in certain areas.
Clarify the plan before the session starts. You might
say something like, Im going to start on your back to
focus on your upper back tension and your shoulders.
These tense areas are probably contributing to your
neck pain. Would you like me to work on the back
of your legs? Yes? Okay, then I will massage your legs
before I turn you over and focus on your neck. Would
you like me to massage your arms and the front of
your legs? Great. How about your abdominal muscles?
No? Okay, I will finish with a good 20 minutes on your
sore feet. This is a good time also to ask clients about
their music preferences and preferences for lubricants.
When all these things have been decided, the session
can begin.
Transition to Massage
Before you leave the treatment room, show the client the
massage table and explain the position you would like the
client to take on the table after undressing. Because clients
may feel very nervous about how much clothing they need
to remove, its important to reassure them. You might say
something like this: Undress to your level of comfort.

Some clients choose to remove all of their clothing and
this is fine, and others prefer to leave on some of their
underclothing, which is also fine. You will always be draped
during the session, and I will only undrape the area where
I am working. This is to keep you warm but also to preserve modesty. This is also a good time to check if the client needs to use the restroom before undressing. Unless the
client needs assistance getting on the massage table, leave
the room while the client undresses. Because some clients
feel nervous that the therapist may walk back in while they
are partially undressed, it helps to say that you will knock
and wait to hear they are ready before you enter.
Prepare Yourself for the Massage
Usually, clients need no more than 5 minutes to undress
and situate themselves on the massage table. Use this time
to warm up your hands and to ground and center your
energy for the session. Use the restroom if you need to and
wash your hands carefully directly before returning to the
treatment room.
The Massage
Knock and wait for the clients response. Enter the treatment room and greet the client again. If the client is in the
prone position and cannot see what you are doing, explain
your actions or movements (e.g., Im just going to start the
music and turn on this space heater so you dont get cold.).
A client who doesnt know what you are doing may become
nervous when hearing you moving about the room.
1. Bolster: Decontaminate your hands and use bolsters to
support the clients position on the table.
2. Check in: Ask the client about the room temperature
and turn on a heater or add a blanket over the drape if
the client is cold. Warm packs might be placed on the
client at this time (discussed later in this chapter).
3. Open the massage: There are a number of ways to
open a massage. You might choose to use a breathing
exercise such as those described later in this chapter. You might apply a resting and holding stroke or
perhaps add a creative flourish such as ringing a small
chime to mark the start of the session.
4. Follow the treatment plan: Once the massage starts,
follow the plan you discussed with the client. If you
discover an area of particular tension that needs massage but was not part of the original treatment plan,
talk with the client about this. Its as easy as saying
something like, Carole, Ive found an area on your low
back where the tissue is very bound up. I would like to
spend some extra time working on this area. We didnt
discuss this earlier, but would you mind if I cut some
time off the massage of your legs to work longer on
your low back? Carole will answer yes or no or may ask
a question. This negotiation helps minimize the power
10/24/13 1:13 AM
Chapter 4
differential and encourages clients to make decisions

about their own body, as discussed in Chapter 3 in the
section on ethics. Make sure to address each area where
the client wants work.
Sometimes, new massage therapists frustrate clients
by not getting to important areas in a timely manner.
In one case, the client reported to the spa manager that
she specifically requested 30 minutes of work on her
back and 30 minutes on her neck. She told the therapist she didnt want any other areas massaged. The
therapist massaged the clients legs, feet, and arms, and
spent only 15 minutes on her back and 5 minutes on
her neck. The manager questioned the new therapist
and found that she felt uncomfortable with neck massage and was avoiding it. In school, she had learned a
full-body massage routine, and that was what she was
most comfortable doing. Ethically, this therapist should
have explained her limitations up front and referred
the client to another therapist until she had the skills
needed to meet the clients needs.
5. Close the massage: The massage can be closed in a
number of ways, as discussed later in this chapter. Many
therapists match their massage opening to their massage closing. For example, if they opened with a breathing exercise, they close with a breathing exercise.
4.
5.
6.
7.
8.
After the Massage

Your actions following the massage help ensure the client
has had a good experience:
1. Transition out of the massage: After closing the
massage, remove the bolsters and ask the client to get
dressed. Provide disposable wet wipes and a dry hand
towel for the client to clean up or explain that amenities
such as saunas, whirlpool baths, or showers are available. Sometimes, therapists give clients suggestions for
activities they can use at home to improve the condition
of their muscle tissue, such as stretches or self-massage.
If you intend to give home care, ask the client to dress
and remain in the treatment room. This way, you
can demonstrate the stretches or massage techniques
privately. If not giving home care, ask the client to meet
you at the reception desk after dressing.
2. Sale of retail product: In many spas, the sale of retail
product is required of all of the staff working at the spa.
If you intend to sell retail products, know each product
line well and think carefully about products that would
truly benefit your client. Ask clients if they would like to
hear about some of the products in the retail area that
might be of benefit. If the client says, yes, then outline
one of two key products and show the client these products before processing the clients fee for the session.
3. Collect the fee: Back in the reception area, collect the
fee for the massage and offer the client water. Clients
appreciate bottled water they can take with them.
Your Spa Massage
73
Ask if the client would like to book another session.

Some therapists choose to collect the fee and schedule
additional sessions before the massage. This way, the
client can be on the way as soon as the session ends.
Both methods are fine.
Book a session: Book the session and give the client an
appointment card with the date and time.
Say goodbye: You might remind clients to pay attention to how their body feels as a result of the massage.
Phrase this in goodbye language to avoid opening a
new conversation that would be better in the privacy of
the treatment room. Say something like, Remember
to keep track of how your body feels so we can discuss
it when I see you at your next session. Shake the clients hand warmly as you walk toward the door. This
behavior helps the client transition out of the massage
session and back into the real world. It also helps to
maintain the boundaries of the therapeutic relationship, end the session on a friendly note, and keep you
on schedule with future clients.
Chart notes: Complete the chart notes and documentation for the session and file the clients record neatly.
Change the room: Cleaned, disinfect, and sanitize the
treatment room as needed to prepare it and the massage
table for the next session, as discussed in Chapter 3.
Self-care: You might now perform any regular self-care
activities such as stretching or eating a snack before the
next client arrives for a session.
Massage sessions involve interpersonal skills such as professional communication, ethics, and boundary setting and
practical skills such as draping, bolstering, along with the
actual massage techniques. The theory that underlies all of
these skills is of primary importance. Without an understanding of the physiological effects of massage techniques,
you wouldnt know which methods to use to address a
clients neck tension. Without an understanding of the
structures of the neck, you wouldnt know where to apply
techniques. Each skill is important, and together these different types of skills create an accomplished massage professional. As you review this outline of a wellness session,
think about areas where you would like to improve your
efficiency and smoothness. For example, if you find that
you always feel uncomfortable greeting clients and explaining the paperwork included in the health intake, practice
these skills with a friend or supervisor. Practice what you
will say and do out loud, as if it is really happening, until
you gain the desired fluidity.

Consider the following examples of how two different massage therapists open and close their sessions.
Steve pays attention to how he opens and closes his
massages. He likes to use resting and holding strokes
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74
and breathwork (described below). To open the massage,

he places his hands on the client with clear intent and
allows the client to accept and become use to his touch.
He asks the client to take three deep breaths and release
all body tension with each exhalation. Steves touch is
assured and firm. The client feels a therapist who is energetically balanced and focused and who has a plan. The
client relaxes before Steve even undrapes a body area,
confident that Steve knows what he is doing. The opening is a simple moment, and yet it can affect clients trust
level and willingness to allow their body to let go and
relax. At the end of the session, Steve finishes the massage, redrapes the client, and places his hands in the same
position as when he opened the massage; although this
time, the client is supine. Steve asks the client to breathe
deeply for three breaths and to slowly wake up with each
exhalation. The exhalation of each breath brings the
client gently back to the real world and leaves the client
feeling peaceful.
Jay doesnt worry much about how he starts and finishes
his massages. When he enters the treatment room, he fusses with the drape, leaves the client to look around for the
massage lubricant, and then struggles to place the bolster
under the clients knees. The clients body tenses to ward
off the irritating sensations of all this disjointed activity.
Jay undrapes the clients leg and starts massaging but soon
leaves to adjust the volume of the music. When he returns
to the client, he reminds the client to relax, but the client
remains watchful for the first 20 minutes of the session.
Once Jay settles into the massage, he has good massage
techniques, and the client eventually relaxes deeply when
Jay works on the posterior legs and back. The client is calmly drifting when Jay abruptly replaces the drape and says,
Okay, times up, and Ill meet you up front in the reception
area when youre dressed. He pulls out the bolster and
leaves the room. The client gets up quickly from the massage table and gets dressed. The client has less muscle tension but feels oddly irritated.
The opening and closing of the massage are important
moments because they frame the entire massage experience. The opening of a massage is a formal moment that
recognizes the importance of what is coming. Massage is
an opportunity for the body to change in a positive way,
to release long-held tension, to rest, to recover, and to have
a healthy experience of touch. In many ways, a massage
starts the minute a therapist enters the treatment room
and approaches the client. Even if the client is in a prone
position and cannot see the therapist, root hair receptors in
the skin will recognize changes in air movement and heat.
This may trigger instinctive survival responses that cause
the client naturally to be tense during the initial contact.
It is better to look at the client, offer a verbal greeting,
and approach slowly with therapeutic intent. Dont look
around for bolsters or massage lubricant. Have everything
ready before the client enters the treatment room so that
your entrance into the room can be calm and relaxed.
The closing of the massage should leave a client feeling

complete, peaceful, and balanced. You want the client to
know the massage is ending before it actually ends and to
start to return to normal waking consciousness smoothly
without being jarred awake. Avoid abrupt closings that
leave a client feeling rushed or disturbed.
Therapists use a variety of techniques to formally open
and close the massage, including resting and holding strokes,
breathwork, aromatherapy inhalations, and auditory cues.
Resting and Holding Strokes

In a resting or holding stroke, the hands are placed, without lubricant, on the client with the intent to greet the client and allow the client time to become accustomed to the
unfamiliar touch. You might match your inhalations and
exhalations to those of the client during a resting stroke to
feel in sync with the clients rhythms. Tension in the clients
body, the clients temperature and breathing patterns, and
the quality of the tissue under your hands all convey an impression, which may affect how you proceed with the session (Fig. 42).
Breathwork
Breathwork in massage is an important skill. A breathing
exercise such as the diaphragmatic breathing technique
described in For Your Information 41, the pursed-lip
FIGURE 42 In a resting or holding stroke, the hands are placed,

without lubricant, on the client with the intent to greet the client and
allow the client time to become accustomed to the unfamiliar touch.
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Diaphragmatic Breathing
Diaphragmatic breathing is used with the client in a supine position both to assess the clients breathing pattern and to educate
the client about proper breathing. It works well to use this technique at the beginning of a session. Communication skills are key
because you will coach the client into a functional breathing pattern. Focus on ensuring that the clients breaths are slow,
rhythmic, and relaxed. Keep the exercise short enough that the client does not become concerned about losing time from the
massage.
1. Place your hand on the clients abdominal area and ask the client
to lift your hand with each inhalation up to three times.
2. Place one hand on each side of the ribs and ask the client to move
your hands outward with the breath up to three times.
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Diaphragmatic Breathing (continued)
3. Place the fingers of one hand on the lower section of the sternum and ask the client to lift your hand with each breath up to
three times.
4. Have the client put the breaths together by cueing your hands. Ask
the client to inhale first, filling up the abdominal area, then laterally
expanding the ribs, and then allowing the chest to rise. Touch each
area in order as the client inhales and pace the client on a full, even
breath. As the client exhales, it can be effective to gently massage
any areas of the upper neck that look tense, such as the shoulders,
which may tend to pull forward or up during breathing. Repeat the
cueing and coordinated breathing up to three times.
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Pursed-Lip Breathing
Pursed-lip breathing tones and strengthens the diaphragm and
helps to reeducate the clients kinesthetic sense of breath. When
the client exhales with lips pursed (imagine the lips closing around
a straw), this creates resistance for the diaphragm. The diaphragm
contracts on the inhalation and relaxes on the exhalation. Pursedlip breathing keeps the diaphragm working at the same time that
it is relaxing. Use this technique at the opening or closing of the
massage session with the client in a supine position or sitting up in
a chair. As with diaphragmatic breathing, communication skills
are important as you coach the client through pursed-lip breathing. Place your hand on your clients abdominal area and instruct
the client to raise your hand with each inhalation by breathing in
through the nose on a slow 2- to 4-second count. Demonstrate
the pursed-lip position of the mouth for the client and instruct the
client to exhale through the lips on a slow 4- to 8-second count. The
client should exhale through the lips as slowly as possible. Practice
the technique a few times. Clients who are interested in improving
their breathing and toning the diaphragm can practice pursed-lip
breathing 20 to 40 times, twice a day at home.
breathing technique described in For Your Information 42,

or simply asking the clients to take three deep breaths
can help clients drop into their body, center themselves
energetically, and consciously release unnecessary muscle
tension. Breathwork helps you tune into the clients breathing rhythms and thereby pace the massage to the client.
Many people breathe with a disturbed pattern that can
disrupt the delicate balance of carbon dioxide and oxygen
in the blood. Proper breathing during a session revitalizes
the body by ensuring the correct levels of oxygen and carbon dioxide in the body. The use of breathwork in a session
helps clients become more aware of their breathing patterns
and can lead to better breathing on a regular basis. Still, spa
therapists must walk a careful line here. Too much focus
on a breathing pattern can disrupt the clients relaxation
experience and may cause resentment. Some clients resist
breathwork because they just want to get on with the massage. Breathing exercises used in wellness massage should
be brief and to the point.
The diaphragmatic breathing technique and the pursedlip breathing technique are brief enough to be used in every
session, as desired by the client, and can help clients develop

greater breath awareness and help change poor breathing
patterns. These exercises set the client up to breathe more
evenly and deeply throughout the session, enhancing relaxation and ensuring proper amounts of carbon dioxide and
oxygen in the blood.
Breathwork throughout the Massage
Breathwork is important throughout the massage and can
be used in a variety of circumstances. Sometimes, you may
notice that a client is taking a breath, holding it without
conscious awareness, and then letting it out suddenly.
Some clients regularly hold their breath without realizing
it. You might say, As I massage, try to focus on the even
inward and outward movement of your breath. Try to make
each breath full and complete. This will help regulate your
breathing pattern and help relax your muscles. Clients
then become aware of their breathing. Clients typically
focus on breathing for a short time and then forget about
it, but they are likely to breathe more regularly throughout
the remainder of the session.
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You can also match your own breathing to the clients to

help pace the massage to the clients natural body rhythms.
Alternatively, focus on your own breathing to add intention
to a stroke or to ensure that your movements flow in harmony with breathing. In this case, you are likely to exhale
as strokes move away from your body and inhale as strokes
come back. Your breathing pattern can also cue a client to
breathe more regularly. For example, if you take an audible
inward breath at the start of the stroke, you may find that
the client joins in. As you exhale during the application of
the stroke, the client might again follow along.
Clients can be encouraged to release bound muscle
tissue with their breathing. As a muscle is lengthened,
as you move from the origin of a muscle to its insertion
during a stroke, or as you move from distal body areas to
proximal body areas, encourage the client to take a full
breath and then exhale as the stroke is performed. Your
directions to the client should be simple: Please take a
full breath, and now, release it. If an area is particularly
painful or tense, the client can use breathing to release the
area or decrease the pain. For example, if you are applying
a stroke on the back and, as you approach the rhomboid
muscles, the client tenses and you feel increased muscle
tension, you can say to the client, Im going to drop into
this bound tissue. Take a full breath and feel as if you
are using your breath to lift up my forearm. Good. Take
another deep breath and feel the tension dissipate as you
release the breath. Good!
In certain stretching techniques, such as active isolated
stretching and post-isometric relaxation, the use of breath
is fundamental to the technique. Potentially painful methods such as trigger point therapy require a client to breathe
through the technique to better tolerate the discomfort.
Aromatherapy Inhalations
Aromatherapy inhalations are used either at the begin-
ning or end of the massage (Fig. 43). One drop of an
oil or 1 drop of a blend of different oils is briefly rubbed

together in the hands before being passed over the clients nose in an arc so that the oil can be enjoyed on a
deep inward breath. The therapist then proceeds with the
massage. Choose soothing oils such as a drop of lavender, mandarin, or cardamom at the onset of the massage
to support the relaxation process. Stimulating oils such
as peppermint, rosemary, or eucalyptus help the client
wake up at the end of the session as part of closing the
massage.
Use of an Auditory Cue

An auditory cue, such as the ringing of a chime, can be
used to signal the beginning and ending of the massage
session. This opening might be paired with resting and
holding strokes, an aromatherapy inhalation (described
earlier in this chapter), or a breathing exercise. This form
of massage opening and closing creates a sense of ritual
and lends the session a more spiritual formality. Over
time, an auditory cue may become linked in the clients
mind with relaxation, causing an instantaneous relaxation response.
Massage Enhancers
Therapists who would like to work in an established
spa should make sure that their Swedish massage is
flowing and elegant. Work to engage the tissue so
that the strokes have depth and intent. Practice draping efficiently and incorporating a variety of strokes so
that the massage feels complete. When developing a spa
massage, try to make the service as luxurious as possible by adding several small but exceptional massage
enhancers. These enhancers might include the use of
steamy aromatic towels, aroma mists, a simple hand and
FIGURE 43 Aromatherapy inhalations. Aroma inhalations are used either at the beginning or end
of the massage. One drop of an oil or 1 drop of a blend of different oils is briefly rubbed together in the
hands before being passed over the clients nose in an arc so that the oil can be enjoyed on a deep inward
breath.
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TABLE 41 Spa Massage and EnhancersSample Outline

SIMPLE AND SUMPTUOUS
AN EFFORTLESS INDULGENCE
1. Client supine, semireclined, and bolstered
1. Client prone and bolstered
2. Place a warm pack on the belly.
2. Place a warm pack on the back and on the bottom of the feet.
3. Place a drop of lemon oil in the hands and pass the hands in an arc over
the clients nose for one or two breaths.
3. Place 1 drop of lavender oil on a tissue and tuck it into the

bottom of the face cradle so that the client can smell a light
fragrance.
4. Place an aromatic hot towel over each foot and steam the feet. Remove
the towel and proceed with the foot massage.
4. Massage the posterior legs and gluteals. Undrape the back and
place a steamy rosemary towel on the back.
5. Massage the anterior legs.
5. Massage the back. At the end of the back massage, apply a body
wash gel with warm water and work it into lather. Remove the
lather with a hot towel. Redrape the back.
6. Massage the arms and hands. Apply an exfoliation product to the hands
and then remove it with a hot towel. Paraffin dip the hands and wrap
them in cellophane and a warm towel.
6. Remove the warm pack that is sitting on the feet. Turn the client
into a supine position. Place a warm pack under the neck and an
eye pillow over the eyes. Rebolster the client.
7. Remove the pillows from under the clients head and proceed with a neck
and face massage. Place a steamy aromatic towel on the face at the end
of the massage.
7. Massage the feet. At the end of the foot massage, apply exfoliation cream to the feet and scrub the feet. Remove the exfoliation
product with hot towels.
8. Remove the paraffin from the hands, remove the warm packs, and turn
the client into the prone position.
8. Massage the anterior legs and abdominals.
9. Rebolster the client and massage the posterior legs and gluteals.
9. Massage the arms and hands.
10. Massage the back. Apply a foaming exfoliation product to the back and
work it into lather. Remove with steamy aromatic towels.
10. Massage the neck and face. Place a steamy, aromatic towel
over the face to end the massage. Remove the towel and use an
aroma mist spritzed high over the client.
11. Spritz an aroma mist over the client and throughout the treatment room to
complete the massage. When the client gets off the table, they will smell
the fresh scent.
11. Allow the client to relax on the treatment table for an extra ten
minutes before they get up.
foot treatment, paraffin dips, the use of warm packs, an

eye pillow, and a firming face massage. The spa massage
outline presented in Table 41 is meant to provide some
structure for those developing a relaxation spa massage.
The outline helps the therapist to see how the massage is enhanced with little extras to make it special.
Step-by-step directions for some useful enhancers are
described below.
Warm Packs
Chapter 6 (Water Therapies) describes the use of hot
and cold packs to facilitate a change in muscle tissue
and to achieve a physiological effect on the body. In a
relaxation massage, the goal is to support client relaxation and help clients rest, breath, and reflect on their
inner thoughts and to feel revitalized at the end of the
session. Warm packs of rice, corn, or flax seed keep the
client warm but do not generate enough heat to produce
perspiration (Fig. 44). They are used to make the client
feel pampered and cozy and are placed on the back and
on the feet. In the supine position, a warm pack can be
placed on the belly, around the feet, and, if the shape is
appropriate, under the neck. Eye pillows filled with fragrant herbs can be warmed or cooled and placed over the
eyes to block out excess light. A Fomentek water bottle
might be placed under the bottom massage sheet to provide warmth, or the table can be heated with an electric
table warmer.
Steamy Aromatic Towels

FIGURE 44 Warm packs. Warm packs of rice, corn, or flax seed keep
the client warm and feel soothing and nurturing. Use them to enhance
your relaxation massages.
Steamy aromatic towels make a pleasing enhancer when

used during a full-body relaxation massage (Fig. 45).
For example, a steamy aromatic towel can be applied to
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skin irritation because essential oils are volatile substances and begin to evaporate rapidly the minute that
they are placed on the hot towels in the cooler. They will
mostly burn off before the first towel is used, leaving
only some of the scent behind. Skin irritation is therefore minimized.
Herbal-Infused Towels
FIGURE 45 Steamy aromatic towels. Steamy aromatic towels make

a pleasing enhancer when used during a full-body relaxation massage.
They might be applied to the back, face, or feet as part of your massage
routine.
Muslin bags filled with fragrant herbs can also be used to

scent towels. A muslin bag of herbs is added to the water
that the towels are heated in. A nice combination is eucalyptus leaf, rosemary, clove buds, and juniper berry. A half
a cup of herbs to around 16 quarts of water provides a nice
concentration, although more or less herbs can be used
according to taste. Towels heated in herbal solutions will
be lightly stained.
A Simple Hand or Foot Treatment

the back directly before the back massage. This warms
the tissue and feels especially satisfying. Another way of
using a hot towel on the back is to apply a bit of body
wash gel or foaming exfoliation cream with warm water
at the end of the back massage. Lather it with the hands
and then remove the lather with a hot towel. This takes
only 1 minute out of the massage but becomes a memorable moment for the client. Another benefit is that
they dont feel oily at the end of the session. A steamy,
aromatic towel can be used in the same way on the feet
before the foot massage, on the face before the face massage, or on the face at the end of the service as a closing
gesture.
During a relaxation massage, a simple hand or foot

treatment can be added to make the massage special
(Fig. 46). These enhancers take up very little massage
time and are a memorable part of the experience for
the client. For a simple foot treatment, prepare the
massage table by placing a bath towel at the end of the
table where the clients feet will sit. Place two hot, moist
hand towels in a soda cooler. Just before or just after
the foot massage, simply apply a little exfoliation cream
(a cream that has rough textured ingredients that polish
Preparing Steamy Towels

To prepare the towels, pull off all the tags, then fold the
towels in half (the long way), and roll them up like a sausage. It is important that all the tags are removed because
they could scratch the client. Place the towels in a hydrocollator, hot towel cabinet, or stone massage heating unit for
20 minutes at 165F. With thermal gloves, remove a towel
from the water, wring it out, and place it in a soda cooler.
Close the lid of the cooler and remove the next towel. Keep
the lid of the cooler shut as much as possible so that the
towels stay hot throughout the treatment. Towels can be
enhanced by soaking them in herbal infusions or adding
essential oils just before use.
Steamy Rosemary Towels
Add 3 to 5 drops of rosemary essential oil to the soda
cooler full of hot towels. As each towel is removed, it
will fill the treatment room with a refreshing scent.
Most single oils such as eucalyptus, common sage
(Salvia officinalis), Spanish sage (Salvia lavandulifolia),
thyme and lemon oil smell good, but floral scents such
as ylang ylang and jasmine are not as pleasant in steam.
The essential oil on the towel is not likely to cause any
FIGURE 46 A simple hand or foot treatment. During a relaxation

massage, a simple hand or foot treatment can be added to the session to
enhance the massage experience. Apply an exfoliation cream to the hand
or foot directly before or after the massage and then remove the cream
with hot, steamy hand towels.
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the skin) to each foot. Scrub the feet with the exfoliation cream and then place a hot towel over each foot.
After the feet have steamed in the towels (about 30 seconds), use the towels to remove the exfoliation product. A simple hand treatment is conducted in the same
way. An exfoliation cream is massaged into the hand
and up to the elbow. A hot, moist towel is placed over
each hand, and the product is removed directly before
or after the hand massage.
Paraffin Dip
Paraffin is a waxy substance obtained from the distillates
of wood, coal, petroleum, or shale oil. It is used to coat

the skin and trap heat and moisture at the skins surface
(Fig. 47). This increases local circulation, which improves
joint mobility and increases absorption of spa products
whenever they have been applied before using the paraffin.
It is an effective treatment for chronic arthritis, tight muscles, and painful joints. It also leaves the skin soft, and it
feels warm and sumptuous.
To apply paraffin to the hands or feet, wipe or mist the
area with alcohol so that it is properly sanitized. Dip the
hand or foot into the paraffin and allow the paraffin to
harden slightly before dipping the area again. Dipping the
area up to five times should be sufficient. Wrap the paraffincovered hand or foot in cellophane wrap or a plastic bag,
before placing it into a heated mitt or a warm towel. To remove the paraffin, simply peel off the cellophane wrap
together with the wax in one piece. The hands can be dipped
while the client is on the table in the prone or semi-reclined
position. The feet can be dipped while the client is on the
table in the supine position. Paraffin can also be applied
with a brush or on gauze strips, which wrapped around the
body area.
FIGURE 47 Paraffin application. Paraffin is used to coat the skin and

trap heat and moisture at the skins surface. Wipe or mist the hands or
feet with alcohol so that it is properly sanitized. Dip the hand or foot into
the paraffin and allow the paraffin to harden slightly before dipping the
area again.
FIGURE 48 Aroma mist. An aroma mist is usually made from

distilled water with some added essential oils, but a hydrosol (flower
water) can also be used. The mist is spritzed high over the client while
he or she is in a supine position to fill the treatment room with a
refreshing scent.
Easy Aromatherapy Enhancements

Aromatherapy is the use of essential oils for healing and
wellness. It is discussed in depth in Chapter 7. Small aromatherapy enhancements stand out as moments of particular
radiance in a good relaxation massage. Essential oil massage blends create an olfactory reaction that may facilitate
deeper relaxation in the client. It is a good idea to provide a
selection of from three to five blends so that the clients can
choose which one they like best. Aroma mists are another
way to bring the pleasure of good smells into the massage.
An aroma mist is usually made from distilled water with
some added essential oils, but a hydrosol (flower water) can
also be used. The mist is spritzed high over the client while
he or she is in a supine position to fill the treatment room
with a refreshing scent (Fig. 48). The scents used in the
treatment can be varied to keep the clients olfactory palate stimulated.
Earlier, we discussed aroma inhalations, which might be
used either at the beginning or end of the massage. As was
mentioned previously, 1 drop of an oil or 1 drop of a blend
of different oils is briefly rubbed together in the hands
before being passed over the clients nose in an arc so that
the oil can be enjoyed on a deep inward breath. Relaxing
or calming oils are used at the beginning of the massage,
whereas refreshing, stimulating oils are used at the end of
the session.
Table 42 provides some nice aromatherapy blends
that are generally popular with clients. These blends
can be mixed into a plain massage cream or in expellerpressed vegetable oil for the massage, or they can be mixed
with water for an aroma mist. The table also includes a
list of single oils that work well for aroma inhalations.
Aromatherapy and blending techniques are discussed in
Chapter 7.
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TABLE 42 Easy Aromatherapy

MASSAGE BLENDS
AROMA MISTS
INHALATIONS
The following blends can be added to 1 fl oz of

an expeller-pressed oil (i.e., hazelnut, sweet
almond, sunflower) or plain massage cream.
The numbers refer to drops.
The following blends can be added to 1 oz of

distilled water.
The following blends can be mixed up and used

undiluted (1 drop) in the hands for an aroma
inhalation.
Relax Factor
Radiance
Inspiration
Frankincense 4
Mandarin 8
Ylang ylang 2
Cypress 2
Atlas cedarwood 5
Neroli 2
Lavender 4
Grapefruit 6
Rose 1
Mandarin 10
Clove 1
Refreshing
Revitalize
Verve
Rosemary 3
Clary sage 2
Lemon 7
Geranium 1
Grapefruit 8
Eucalyptus 1
Cypress 2
Sweet orange 6
Rosemary 2
Geranium 1
Citrus Star
Summer
Sparkle
Grapefruit 11
Jasmine 1
Mandarin 6
Lemon 7
Geranium 1
Peppermint 1
Grapefruit 8
Muscle Ease
Rain
Siesta
Sweet birch 3
Juniper berry 2
Lavender 6
Lemon 6
Juniper berry 4
Thyme 2
Lavender 6
Cypress 3
Lime 7
Jasmine 1
Detox
Mental Boost
Quietude
Sweet fennel 5
Juniper berry 4
Grapefruit 10
Rosemary 2
Basil 4
Lemon 7
Neroli 2
Clary sage 5
Sandalwood 10
Body Boost
Sweet Dreams
Wake Up
Peppermint 1
Tea tree 2
Lavender 6
Lemon 6
Neroli 2
Lavender 7
Mandarin 10
Peppermint 2
Rosemary 2
Basil 1

The techniques used in Swedish massage form the foundation of most therapists massage routine, even those
practicing specific different forms or systems of massage.
Swedish massage is sometimes called relaxation massage,
but Swedish techniques have many benefits in addition
to relaxation. In fact, Swedish massage techniques can
be delivered with light, moderate, or deep pressure for a
variety of treatment outcomes. Swedish massage still uses
the six traditional stroke techniques given French names
by Dr. Johann Mezger in the 1800s. These techniques are
effleurage, ptrissage, friction, tapotement, vibration,
and joint movements (also called Swedish gymnastics or
range of motion techniques). Each of these techniques is
performed with the depth and vigor most appropriate for
the individual client. Therapists often integrate Swedish
strokes with other strokes, such as myofascial work, neuromuscular therapies, compression strokes, Asian bodywork
methods, or with resting/holding strokes used to open and
close massage sessions. An overview of Swedish techniques
and considerations is provided in Tables 43 and 44 for
review. Think about the individual strokes, how they tie
together, their effects on the body, and how you palpate
and adapt the techniques during a massage. The next step
is then to understand how to sequence the massage and use
the subtleties of massage skills.
Sequencing
Sequencing refers both to the sequence of strokes (the order
in which strokes are applied to a given body area) and to the
overall sequence of the massage (the order in which body
areas are massaged). In Swedish massage, the strokes often
follow a defined progression from effleurage to ptrissage,
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TABLE 43 Overview of Swedish Massage Techniques

STROKE
DEFINED
GENERAL EFFECTS
CONTRAINDICATION
VARIATIONS
Effleurage
A long, gliding stroke Desquamation of dead skin cells,

usually applied
increases circulation and lymph
toward the heart
flow, triggers parasympathetic
nervous system response, supports venous return, causes
relaxation
Should not be used distal to an area of in- Superficial; moderate;

flammation or injury; avoid application
or deep, shingling
over open skin lesions, skin diseases,
technique
or bruises. Avoid prolonged application
on the limbs of clients with cardiovascular disorders, high blood pressure, or
circulatory conditions.
Ptrissage
A rhythmic stroke
Stimulates sebaceous secretion,
that lifts the muscle
increases circulation and lymph
off the bone and
flow, activates Golgi tendon
compresses it
organs (GTOs) to relax muscles,
between the fingers
decreases adhesions
Avoid use with atrophied muscles that

lack moderate tone. Do not use over
open skin lesions, skin diseases,
bruises, acute injuries, inflammation, or
moderate to severe varicose veins.
Skin rolling, fulling ptrissage, and wringing

ptrissage
Friction
A heat-producing
chafing or rubbing
stroke
Superficial friction is stimulating

and warming and increases
blood and lymph flow. Deep
friction separates muscle fibers
and breaks up adhesions and
scar tissue.
Do not apply friction over open skin

lesions, skin diseases, bruises, acute
injuries, inflammation, or moderate to
severe varicose veins.
Superficial friction,
circular friction, linear
friction, and cross-fiber
friction
Vibration
A pulsating tremorlike or oscillating

stroke
Primarily stimulating and then

relaxing; sustained vibration is
numbing and analgesic and
decreases muscle guarding; fast
vibrations can cause muscle
contractions and stimulate
nerves.
Do not apply vibration over open skin

lesions, skin diseases, bruises, acute
injuries, inflammation, or moderate to
severe varicose veins.
Fine vibration; coarse

vibration including
jostling, shaking, and
rocking
Tapotement
A rapid and rhythmic

percussion stroke
with which the
hands are used in
various formations
to drum on the
client
Short applications are stimulating;

longer applications are relaxing.
Very light tapotement causes vasoconstriction of capillaries in the
local area. Moderate tapotement
causes increased circulation,
useful for loosening of mucus.
Do not apply tapotement over the kidneys, Light, moderate, hackover bony areas, especially directly over
ing, cupping, beating,
the spine, or over bruises or varicose
slapping, pincement,
veins.
and tapping
Stimulate the production of synovial fluid to nourish and protect

the joint structure; increase range
of motion
General contraindications include acute

injuries to bones, joints, muscles, or
nerves. Techniques that traction the
joint are contraindicated for sprains,
rheumatoid arthritis, and hypermobile
joints. See specific contraindications in
Table 131.
Joint movements Movements such as

flexion, extension,
abduction, and
adduction performed as part of
the massage
to friction, to vibration, to tapotement, with joint movement added as appropriate. Each stroke addresses the tissue in a different way, and the sequence of strokes takes
into account the physiological changes that have occurred
in soft tissue during the preceding stroke. In a traditional
Swedish massage, the therapist might simply deliver
each type of stroke to the body area in a predefined order
before moving on to the next body area. Alternatively, the
order of the strokes might be changed to meet the clients
particular needs.
Often, a therapist will combine different massage systems
in a session, which may change the sequencing of the strokes.
For example, if myofascial release techniques are being combined with Swedish massage and deep tissue work, myofascial techniques would probably be applied first because
they are used on dry skin without lubrication. Deeper work
Active, passive, and

restricted
might be used directly after effleurage, ptrissage, and moderate friction with vibration and tapotement coming after.
Another factor determining the sequencing of techniques is
the quality of the clients tissue and how quickly it changes.
Some clients need a prolonged warmup, whereas others are
ready for deep work early in the session. Sometimes, areas of
taut muscle tissue require work with very specific techniques
to reset muscle length and promote better muscular balance.
As you contemplate how you want to sequence your
massage, remember that there are advantages to starting
the massage with the client supine and other advantages to
starting prone. When the massage starts in a supine position, clients can open their eyes and look at the therapist.
This is important if the client is new to massage and does
not know the therapist. Being able to visually check with the
client during the first half of the massage helps the client
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TABLE 44 Overview of Swedish Massage Considerations

GENERAL BENEFITS
APPLICATION CHOICES
PALPATION
SUBTLE FACTORS
Desquamation of dead
skin cells
Increased sebaceous
secretion to condition skin
Increased blood and
lymph circulation
(increased tissue warmth)
Improved nutrient and
waste exchange in local
tissue
Improved venous return
Decreased muscle
spasm, tension, and
soreness
Decreased adhesions in
myofascia
Decreased pain
Increased range of
motion and joint health
Increased relaxation
Decreased symptoms
relating to stress
Improved muscle tone
The effects of the massage

technique on the body
vary, depending on how
the stroke is applied. Pay
attention to the following:
Technique: gliding versus
lifting
Depth: light versus deep
Speed: fast versus slow
Direction: toward the
heart versus away from
the heart
Duration: brief application versus prolonged
application
Palpations skills increase with

more experience. Develop
palpation skills by being
aware of what you see and
feel during the massage
session.
Visual: How does the client
look (skin color, expression,
posture, etc.)?
Move: How does the client
move (stiffly, lightly, forcefully, smoothly, etc.)?
Touch: How does the tissue
feel (crackly, taut, fluid, hot,
cool, clammy, etc.)?
Sound: How does the client
sound when he or she communicates (relaxed, sleepy,
anxious, fretful, etc.)?
Intention: client centered

Contact: quality of touch
Use of lubricant: Use lubricant in
moderation. Remove excess lubricant if not absorbed into the skin.
Pacing and leading: Match the
clients pace and then lead a client
to more relaxing rhythms.
Depth: Engage the tissue unless a
superficial massage is requested.
Rhythm: Use regular patterns or
strokes and a regular tempo.
Flow and continuity: Techniques
should flow in an uninterrupted
action so the client experiences the
constant and steady pressure of
your hands.
Stroke length: Work the length
of the muscle or the length of the
body area.
gain confidence and relax. Clients often experience congestion when they are placed face down in a face cradle. One of
the advantages to starting the massage in the prone position
is that the clients sinuses have time to decongest during the
second half of the massage when they are turned into the
supine position. This sequencing allows the client to leave
the session feeling more alert and with less facial puffiness.
Specific treatment goals may also determine the sequencing of a session. For example, if the client has lower back
pain, the therapist might choose to release the hamstrings
and adductors of the legs before working the back and then
turn the client supine to finish with psoas work and low
back stretches. In health careoriented massages, some
regions of the body might not be massaged, allowing more
time for problem areas and their associated structures.
Most important to sequencing the massage is the information the client provides during the intake interview. This
process involves designing the session to meet the clients
needs. It is a little like a negotiation. The client might say,
I want a lot of work on my back and legs. The therapist
might say, Do you only want me to work on these areas,
or would you like a full-body massage with extra focus on
these areas? The client might then say, I want you to work
on my back, legs, feet, and neck with most of the work on
my back. The therapist can also suggest areas the client
needs to have massaged based on assessment findings. The
therapist and client now have an agreed plan for the session.
The term full-body massage often means something different to the client than to the therapist. Clients sometimes say
they want a full-body massage and then express dismay when
their abdominals or gluteals are undraped and massaged.
Always be clear about what will happen during the massage

by saying things like, In a full-body massage, I massage the
legs, feet, arms, back, neck, gluteal muscles (the muscles of
the buttocks), abdominal muscles (the muscles of the belly),
and the face. Would you prefer I avoid any of these areas?
Although the clients wishes always prevail (unless they are
asking for techniques that are contraindicated, illegal, or out
of the massage scope of practice), the therapist can educate
clients about the benefits of massage for certain areas. For
example, clients often feel uncomfortable with the idea of
having their gluteals or abdominal muscles massaged. When
a therapist takes the time to explain the importance of releasing tension in these muscles, the client may feel safe enough
to give it a try. The three examples of massage sequences in
Table 45 demonstrate how diverse sequencing can be.
Routines
Routines are a series of strokes that are planned in advance,
delivered to body areas in a preset order, and practiced until

they flow smoothly together. Some spas and massage clinics
develop set routines that are delivered by all of the businesss therapists. These standardized wellness sessions often
include enhancing extras such as the use of warm packs,
aromatherapy, and foot soaks to increase the sense of luxury and relaxation experienced by the client as we discussed
previously. The drawback to standardized wellness sessions
is that clients may not get the specific work they need for
their particular areas of muscular tension. The advantage
is that clients know beforehand what the massage will be
like and can count on receiving the same massage when they
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TABLE 45 Examples of Different Massage Sequencing

EXAMPLE SEQUENCE 1
1. Begin with client prone.
2. Place warm pack on the lower back.
3. Open massage with holding strokes.
4. Massage posterior legs.
5. Remove warm pack and place on feet.
6. Massage back.
7. Remove warm pack.
8. Turn client supine.
9. Transition to anterior massage with
diaphragmatic breathing exercise.
10. Massage anterior legs.
11. Massage feet.
12. Massage abdominals.
13. Place fresh warm pack on abdominals.
14. Massage arms and hands.
15. Massage shoulders and neck.
16. Massage face.
17. Close massage with holding strokes.
EXAMPLE SEQUENCE 2
1. Begin with client supine.
2. Place warm pack on abdominals.
3. Open massage with diaphragmatic
breathing exercise.
4. Massage neck and face.
5. Massage arms.
6. Massage anterior legs and feet.
7. Remove warm pack from abdominals.
8. Turn client prone.
9. Transition to posterior massage with
holding strokes.
10. Massage back.
12. Close massage with three deep breaths.
return for another session. When massage is used purely for

relaxation, the predictable quality of a set routine can actually add to the clients sense of safety and ability to unwind.
The danger for the therapist is that a set routine makes it
easy to stop paying close attention to the individual client.
Routines for specific body areas are very useful in relaxation settings. For example, some therapists develop a very
effective foot routine that helps them to build a loyal clientele who especially like foot massage. In many spas, the
face is massaged while the body is cocooned in a body wrap.
If a therapist has taken the time to develop a face massage
routine that incorporates a variety of strokes, it is likely to
enhance the clients experience. For Your Information 43
demonstrates a nice face routine. A foot routine is provided
in Chapter 10 (Spa Foot Treatments).
The use of routines is not advised for health careoriented
massage or massage sessions in which the client and therapist have agreed on specific treatment goals. In these cases,
the therapist must adapt the massage to the clients specific
needs and to moment-by-moment changes that occur in the
clients soft tissue structures. The term routine should not
be confused with a treatment protocol in which a series
of techniques are used in a particular order. For example,
in trigger point work, the protocol is to warm the area with
friction strokes or skin rolling before the trigger point is
located and treated. Joint movement and flushing strokes
are applied after the trigger point has been treated to help
reset the muscles normal resting length.

If you are a novice massage therapist who is still a student
or entering your first massage-related job, you will want to
master each individual technique before trying to combine
EXAMPLE SEQUENCE 3
1. Begin with client prone.
2. Place warm packs on hamstrings.
3.Open the massage with holding strokes.
4. Myofascial release to back.
5. Swedish massage back.
6. Deep tissue massage back.
7. Remove warm packs from hamstrings and
place on back.
8. Myofascial release to posterior legs.
9. Swedish massage posterior legs.
10. Remove warm packs.
11. Turn client supine.
12. Myofascial release anterior legs.
13. Swedish massage anterior legs.
14. Massage abdominals.
15. Psoas release work.
16. Passive hamstring stretches.
17. Passive lower back stretches.
18. Massage neck and upper arms.
19. Close massage with holding strokes.
techniques in a flowing, integrated professional massage.

After mastering these core skills, you can consider how subtle
factors such as intention, depth, stroke length, and rhythm
profoundly influence the clients massage experience.
Therapists Intention
It is always important to ground and center yourself before
a session. This helps to calm your energy and focus your
mind so that you are fully present during the session. Some
therapists forget this principle and talk loudly; bang into
things; fuss with supplies, the drape, or the music; and
cause such static in a room that the client cannot completely relax. Before entering the treatment room, take a
moment to center and ground your energy. Pay attention
to your tone of voice and volume. Talk softly but not so
softly that the client has difficulty understanding your verbal directions. Everything should be ready for the session
before the client undresses and moves into position beneath
the drape. If the music level is set and music is playing; if the
lubricant is warm and within reach; and if extra blankets,
bolsters, and draping material are readily available; you are
likely to feel more centered and grounded.
When working with a therapeutic intention, maintain
appropriate professional boundaries and work in such a
way that the client will not experience emotional, physical,
mental, or spiritual damage from the session. Therapeutic
intention also includes the idea that you are focused only
on the session. You are present, in the moment, and
paying attention to the clients facial expressions, sounds,
soft tissue, and communication. When you walk through
the door of the treatment room, everything but the client
should go away. Set aside all thoughts about bills, relationship problems, to-do lists, and plans with friends so that
you focus only on the client.
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Face Massage Routine
Ask clients if they would like their face massaged as part of their relaxation session, especially if the client is wearing makeup.
If the client is wearing makeup, she may want to remove it before the massage to enhance her enjoyment of the session and
protect her skin. Rich emollient face cream or whipped shea butter is recommended for this treatment. Massage oil, massage
cream, or massage gel are not recommended because these products may leave facial skin feeling clogged and bogged
down. Before touching the clients face, the therapists hands should be sanitized with an alcohol-based sanitizer. This will prevent any microbes that were picked up on the body or in the treatment room from being transferred to the delicate facial skin
and will ensure that the therapists hands smell clean to the client. The therapist may want to drape the clients hair to protect
it from face cream using the simple hair draping method described in the next chapter. To view a video demonstration of face
massage, visit thePoint.
Apply an aromatic towel to the face. Remove a steamy
rosemary or herbal-infused towel from a cooler and
drape it on the face by spreading it from under the chin
to the forehead. Allow the towel to sit on the face for
up to 1 minute and then gently press it into the face to
increase the sensation of heat. Remove the towel from
the face and repeat with a second towel if desired.
Apply a rich emollient facial cream starting under the

chin, coming up around the mouth, around the nose,
up the nose to the forehead, and down the sides of the
face to the chin. Repeat this technique six to eight times
to spread the cream evenly over the surface of the skin.
Perform gentle cross strokes between the eyebrows.
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Face Massage Routine (continued)
Transition into s-bows and cover the whole forehead with
s-bow strokes.
Transition to glide down either side of the nose and

activate the pressure points at the top of the nose and
bottom of the nose as the fingers circle. Repeat this
technique three to six times.
Transition into small figure of eights using light finger pressure and glide over the entire face, chin, and forehead
with this technique.
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Slide a relaxed hand over one eye in a circular motion
and finish the stroke with pats at the side of the eye.
Repeat this four times and transition to the other eye.
Make small circles around both eyes at the same time

and then transition to the chin using small finger circles.
Lightly ptrissage the jaw line and s-bow the chin, then use
a crossed thumb technique at the chin.
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Use the index finger and the thumb on both hands to apply a lifting technique around the upper and lower lips.
Bring the thumb and index finger of one hand around

the mouth in five to seven strokes to smooth the tissue at
the sides of the mouth.
Using soft hands and relaxed wrists, apply a gentle slapping tapotement to the underside of the jaw.
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Bring the gentle slapping tapotement up the jaw line
and cheek area and then transition back to underneath
the jaw.
Transition from the slapping tapotement into a snapping tapotement and apply the stroke to the jaw line
and cheek area on both sides of the face.
To learn this stroke, make a pinching movement with

the thumb and index finger but instead of meeting the
fingers, lift them up off the face.
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Soothe the sides of the face with gentle upward strokes
toward the top of the forehead.
Gently massage the outer edge of the ear and push

the ear forward to stretch it. Massage the area directly
behind the ear and finish the area by laterally flexing the
neck to one side during a long stroke down the neck,
over the shoulder and down the arm. Repeat this stroke
on the opposite side.
The facial sequence can be repeated up to three times

for a longer face massage. To end the face massage,
place 1 drop of peppermint or lemon oil in the hands
and rub them together and cover the nose lightly for
30 seconds. A second steamy, aromatic towel can be
placed over the face, or place a cool towel over the
face to finish the service.
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In a Swedish massage, most strokes require the use of lubrication to prevent undue friction between your hands and
the clients skin. Use the lubricant in moderation. When the
client is too slippery, your hands cannot sink into the tissue
and manipulate it effectively. After undraping a body area,
turn one hand over and set it on the clients skin with the
palm side up. Pour a small amount of lubricant into your
palm and warm it by rubbing your other hand across it,
staying in contact with the clients skin. Turn both hands
over and apply long strokes over the entire undraped body
area to spread the lubricant. As the lubricant is absorbed
into the skin, work the strokes deeper into the tissue. If the
skin becomes dry and the strokes start to drag, apply more
lubricant (some drag on the tissue is desirable with certain
strokes). Again, do not break contact with the client. Keep
one hand in contact with the clients skin while warming
the lubricant in your hands. If you accidentally apply too
much lubricant and it is not absorbed into the skin during
effleurage strokes, remove some of the lubricant with a hand
towel. Its better to take a moment and remove the lubricant
than give a slippery superficial massage of the body area.
Most clients do not want to feel oily at the end of the massage. It is a good idea to provide disposable wet wipe towels and a dry hand towel for the client to use at the end of
the massage if you use oil for the lubricant. Creams and
lotions cause less slip but also feel cooler on the clients skin.
the client halfway and tune in to the clients rhythm and

state of being. For example, it may be disconcerting for a
mildly depressed client to walk through the clinic doors and
encounter the therapist Chirpy Mary Sunshine. Similarly, it
may be off-putting for an upbeat client who is enjoying a
great day off to encounter the therapist Low Energy Larry.
Therapists can learn to pace the massage by matching
the first part of the massage to the client. As the massage
progresses, the therapist can lead the client into more
relaxing rhythms. To understand pacing and leading
better, consider one aspect of a counseling and life-coaching
technique from neuro-linguistic programming (NLP). NLP
uses the word pacing to describe techniques that build rapport between the counselor and the client. The idea is that
people tend to like people that they are liked, so the counselor
makes himself or herself more like the client. The counselor
tunes in to the clients breathing patterns, speech patterns,
body language, and personal rhythm. During the session,
the counselor uses speech and body language patterns similar to those of the client. When the client is relaxed and when
the counselor feels that a rapport has been established, he or
she starts to lead the client. The counselor breathes with a
new pattern, and the client follows (so long as good rapport
has been established). The counselor slows down (or speeds
up) his or her speech and changes his or her body language,
and the client follows. All of this is done while the client and
counselor are talking about other things. The benefit of this
for the client is that these new breathing patterns, body gestures, and/or speech patterns create a shift in the client.
It is almost as if these new patterns put a person in touch
with new internal resources that allow looking at a situation
from a new vantage point.1 NLP is much more complex than
this simple description, but this example can help massage
therapists think about how they pace and lead clients.
The goal is to match the clients basic energy levels but
not mimic the client or go to extremes of behavior. For a
client and therapist both to be bouncing off the walls with
hyperactive energy does not do the client any good. Instead,
be upbeat but remain grounded until the client can be led
to more relaxing patterns. If a client is downhearted, you
might still remain positive but subdue your personal energy
levels and speak in a quiet voice to respect the clients state
of being.
Pacing and Leading
Depth
All people have an internal pace or personal rhythm that

influences how fast they move, how quickly they react, the
speed and cadence of their speech, their physical mannerisms, the speed of their thought processes, and even their
breathing patterns. At the same time, a client is likely to
arrive in a particular state of mind and body (state of being).
Perhaps he or she encountered bad traffic and is running
late. Perhaps the client just came from a yoga class and
is feeling balanced. Maybe the client is feeling depressed
because of personal issues. Regardless of the cause of the
clients mental, emotional, and physical state, try to meet
Massage therapists sometimes call a superficial massage a

fluff and buff. Although some clients like gentle massage
that only skims the surface of the tissue, most clients want
the therapist to sink into the tissue, take hold of the tissue,
move the body with confidence, and address tension and
any adhered muscle and fascia. This should not mean that
you are working so deeply and with so much pressure that
the client feels pain. It means that you can feel the quality
of the tissue and understand how to engage it properly.
Working with appropriate depth is a product of good palpation skills and self-confidence.
Contact
The quality of your touch is important, and you must think
about what your hands are communicating to the client.
Warm, soft, dry, open, and confident hands tell the client that
you are relaxed and self-assured and know what to do. Cool,
damp, uncertain hands tell the client that you are anxious
or doubtful about the session. Cultivate confidence in your
touch. Do not just touch the client but feel the tissue, open
your hands, and sink into the muscle. Once you establish
contact, avoid disrupting it. Sometimes, novice therapists
take their hands off the client repeatedly while transitioning
between strokes or lift their hands off the body to get more
lubricant. Instead, try to keep at least one hand in contact
with the client at all times. This helps the client to keep track
of your presence and the progression of the massage.
Use of Lubricant
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Chapter 4
To build these skills, pay attention to the way a clients

tissue feels and how it changes in different areas of the body.
In a Swedish massage, effleurage starts out light and quickly
gains depth as the body area softens. Circulation increases
in the local area, and the tissue begins to melt, signaling
that you can drop deeper into the muscle and fascia. Feel for
the bottom of the muscle. Think of sinking into a pillow
or other soft structure. Drop down and maintain an even
pressure as the stroke travels the length of the body area.
One way to learn about depth is to practice on clients or fellow students and ask for honest feedback. Ask direct questions like, Is my pressure deep enough or would you prefer
more pressure? If the client answers more pressure, sink
in and feel what it feels like to sink in. Ask again, Is this deep
enough or should I be deeper? Keep asking until the client
communicates that the pressure is just right. Feel what just
right feels like and remember that feeling. Remind clients
to speak up if something hurts or feels too forceful.
Remember to practice massaging a variety of body types
when learning to work with depth. Each body responds to pressure differently, and you must adapt to the tension levels and
density of the individual tissue. The more massages you give as
a student, the faster you develop these skills. If it happens that
you start out working with too much depth and a client complains about the pressure, try to avoid becoming fearful but
simply promise yourself to pay more attention to the quality
of the tissue. It is okay to work too lightly or too deeply at first.
No therapist walks out the training room door and has perfect
depth the first time he or she gives a massage. These skills are
developed over time through practice and mindfulness.
Rhythm
Rhythm in massage is a lot like rhythm in dancing. Therapists with good rhythm apply strokes in a regular pattern at a regular pace or tempo. The client relaxes to the
rhythm, much as a child relaxes when rocked by a parent.
Imagine how ptrissage strokes would feel if delivered in
an uneven pattern. That sensation may well be distracting
and disturbing for the client. Sometimes, the rhythm of the
massage changes naturally because you change strokes or
techniques. Deep work is most often applied very slowly,
whereas tapotement is applied more quickly. You might
deliver the first few passes of effleurage at a quicker tempo
and then slow down to lead a client into relaxation.
To build good rhythm, think about the regularity of
strokes and strive to keep them even in both depth and
speed. Use music to set the pace for the massage and
dance the strokes as a training exercise. Check in with
your practice clients and get feedback on their perception
of the rhythm of the massage. As with all massage skills,
rhythm is developed over time and with practice.
Flow and Continuity
Flow and continuity refer to the progression of massage strokes
from one technique to another and from one body area to
another. Think of a river streaming over rocks in one unbroken
Your Spa Massage
93
movement. Strokes are like the river water. They should flow
in one uninterrupted action so that the client experiences the
constant and steady pressure of your hands. A therapist who
has not yet developed flow and continuity might pause during
strokes, lift the hands off the client, change techniques at the
wrong times, and feel disjointed and sporadic.
Changing techniques at the wrong times is a common
mistake of novice therapists. For example, it is a bad idea
to start with effleurage on the calf muscles, shift to tapotement at the hamstring, then to ptrissage as the stroke
approaches the gluteal muscles, and then back to effleurage
as the stroke moves into the gluteals. The nervous system
cannot process these rapid technique changes and may
become hyperalert and irritated. Instead, start effleurage at
the ankle, sweep all the way up the leg, and come all the way
back down the leg before shifting techniques.
The great ballet choreographer, Balanchine, often choreographed dance sequences in groups of three. He felt that the
first time an audience saw a dance sequence, it captured their
attention but they did not have time to really see the moves.
When the sequence was repeated a second time, Balanchine
believed that the audience studied the movement and analyzed the technique. The third time a sequence was danced,
the audience could simply enjoy the beauty of the movement. Although massage strokes would not be delivered in
strict groups of threes, the same philosophy applies. A client
needs time to be surprised by a sensation, analyze what is
happening, and then settle into enjoyment of the technique.
Stroke Length
A therapist with strong massage skills tends to use long
strokes that tie body areas together. He or she will travel the
length of a muscles fibers, or the length of a body area, before
changing techniques or lifting the hands away from the clients body. When a stroke is cut short, it leaves the client feeling oddly frustrated. One area where this happens is on the
posterior and anterior leg. Inexperienced therapists often
stop short in the stroke because they are taught to be careful
of draping and worry that the stroke will become invasive.
The stroke should travel all the way up to the gluteals and
around the greater trochanter, or all the way up to the anterior superior iliac spine (ASIS) and back again. On the arm,
the stroke should travel up to the shoulder or even up to the
neck. Understand the muscles and seek to work their entire
length whenever possible. Many therapists undrape one or
the other side of the client and travel from the foot, up the
leg to the back, and then return to the foot again. These
strokes build clients kinesthetic awareness of their bodies
and how different body areas relate to each other.
By learning and integrating the techniques and subtle
skills discussed in this chapter, you are preparing to give an
excellent relaxation massage that will help to reduce stress
in the clients, rejuvenate their energy levels, relieve muscular tension, and help the body to find balance. This level of
integrated work is what keeps clients coming to your business for repeat massages.
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SPA FUSION
1 to 2 p.m.Aromatherapy reviewled by Steve

2 to 2:30 p.m.Essential oil properties flash cardsled
by Ellen
2:30 to 3:00 p.m.Food! Everyone brings one dish for
a potluck
3:00 to 4:00 p.m.Spa Massage Olympics (See explanation below.)
4:00 to 10:00 p.m.Watch a movie and more food!
medication levels and sedentary habits.2 Another study

showed that diaphragmatic breathing lowered blood
pressure as long as it was practiced regularly.3 Patients
with anxiety disorders and panic attacks found that
the diaphragmatic breathing exercise helped them
experience less fear, fewer cognitive symptoms, and
fewer catastrophic thoughts during an attack, and the
technique sometimes served as an intervention to prevent an attack.4 Finally, patients suffering from chronic low back pain improved significantly with breath
therapy (a variety of techniques were taught including
pursed-lip breathing and diaphragmatic breathing).
This study reports that changes in standard low back
pain, measures of pain and disability were comparable to those resulting from high-quality, extended
physical therapy. Again, the regular practice of these
methods was important for continued benefit.5
SPA INSPIRATION: Spa Massage Olympics
CHAPTER WRAP-UP
A beautiful, flowing spa massage requires careful

thought and lots of practice. One way to make this
process fun is to hold a Spa Massage Olympics. Ask
your instructor to set a date and arrange for three
judges. Make a set of large cards with the numbers 1
to 10 for each judge. It works well to have judges score
participants on areas such as correctness of stroke
application, draping skills, routines, sequencing,
use of enhancers, flow and continuity, rhythm, etc.
Arrange for prizes and generate some enthusiasm!
You can learn a lot by practicing for your event and by
watching your competition perform. If your instructor
does not have time for this in the class schedule, this is
a fun activity for a study party.
The topics in this chapter illustrate the diverse skills

needed by a professional massage therapist to manage
a client before, during, and after a relaxation massage
session. These skills involve four primary areas: communication skills, organization skills, client management skills, and exceptional hands-on skills. Getting
clients in and out the door involves many steps along
with giving them an exceptional bodywork experience in between. An organized therapist, skilled at
client management, can better plan and implement a
meaningful opening and closing of the massage that
add to the clients experience and help build client
loyalty. Therapists often emphasize learning advanced
soft tissue skills and fail to fully appreciate skills that
seem less technical, such as positioning and draping
and sequencing a relaxation massage appropriately.
Although it is desirable to master a range of therapeutic techniques, the foundation skills of draping and
fluid relaxation massage lead to an uninterrupted client experience and allow the client to relax completely
and enjoy the session. Underlying all of these skills is
the ability to communicate effectively when explaining
paperwork to clients, directing them to the treatment
room, describing the benefits of a technique, giving
direction during the session, and coaching the client
through an activity such as diaphragmatic breathing.
Lack of skills in any of these areas can directly impact
the therapists ability to attract and retain clients and
make a good living from massage.
STUDY TIP: Party! Thats Right. Party!

Students in massage and spa training programs sometimes feel like their social lives are curtailed by the
need to study. One way to study and also have some
social time is to hold a study party. To be productive,
the party should have clear learning objectives and
planned activities. For example, the schedule might be
planned like this:
ITS TRUE! Diaphragmatic Breathing Exercises

Support Different Client Groups
Several research studies on diaphragmatic breathing
exercises demonstrate that this technique can help
a diverse group of clients meet health care goals as
long as the technique is practiced regularly. In one
study, asthmatic adults who practiced diaphragmatic
breathing exercises experienced a significant reduction in the medication they used to treat asthma and
a lower intensity of their symptoms. This reduction
in symptoms led to increased physical activity, which
improved their overall health. Unfortunately, most
participants decreased their practice of diaphragmatic
breathing after the study and relapsed into previous
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SPA FUSION
REVIEW QUESTIONS
Multiple Choice
1. A waxy substance obtained from the distillates of
wood, coal, petroleum, or shale oil that is used to
coat the skin and trap heat and moisture at the
skins surface is called:
a.
b.
c.
d.
Seaweed
Fango
Paraffin
Steam
2. A series of strokes that are planned in advance,

delivered to body areas in a preset order, and practiced until they flow smoothly together is called:
a.
b.
c.
d.
A sequence
Pacing
Leading
A routine
3. Additional session elements or small complementary treatments that increase the clients enjoyment
of the session are called:
a.
b.
c.
d.
Add-ons
Up sells
Enhancers
Additions
4. This type of massage is used to decrease stress,

support the bodys natural restorative mechanisms,
and reduce temporary pain from overexertion
caused by activities such as weekend athletics or by
unusual work stress:
a.
b.
c.
d.
5. When 1 drop of an essential oil is briefly rubbed

together in the therapists hands before being
passed over the clients nose in an arc so that the
oil can be enjoyed on a deep inward breath it is
called:
a.
b.
c.
d.
Opening the massage

Closing the massage
An auditory cue
An aromatherapy inhalation
True or False
6. ______ Warm packs of rice, corn, or flax seed keep
the client warm and increase the clients enjoyment of the session.
7. ______ The tags on hand towels used to remove
product from the clients body should be left
intact so that you always know how to launder the
towels properly.
8. ______ The use of a paraffin dip on a clients
hands for stiff joints is outside the massage
therapy scope of practice.
9. ______ Essential oil massage blends create an
olfactory reaction that may facilitate deeper relaxation in the client.
10. ______ Flow and continuity refer to the progression of massage strokes from one technique to
another and from one body area to another.
Wellness massage
Health care massage
Orthopedic massage
Hospital massage
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5
Foundation Skills
for Spa Treatment
Delivery
Chapter Outline
K e y Te r m s
Spa Draping
Dry room: A treatment room in which there is no shower or hydrotherapy

equipment. Instead, hot towels are used to remove the product from
the clients body, or the client takes a shower in a different area.
Exfoliation: A process by which dead skin cells are removed to improve
the skin texture and appearance. Other benefits include increased
circulation and lymph flow, increased immunity, and relaxation.
Flip-over method: A method of positioning the client for product application in which the client flips over after a treatment product has been
applied to the posterior of the body.
Side-lying position: A client positioning method where the client is
positioned on a treatment table on his or her side so that product can
be applied to both the anterior and posterior areas of the body without
changing positions.
Sit-up method: A client positioning method where the client sits up on
the treatment table so that product can be applied to his or her back.
Wet room: A treatment room in which there is specialized hydrotherapy
equipment such as showers that remove spa products from the clients
body, hydrotherapy tubs, and Scotch hoses.
Posterior Leg
Anterior Leg
Breast Drape
Anterior Pelvic Drape
Turban Drape
Gluteal Drape
Simple Hair Drape
Side-Lying Drape
Positioning the Client When Applying Spa Products

The Side-Lying Position
The Sit-Up Method
The Flip-Over Method

Application by Hand
Application with One Hand Gloved
Application by Brush
Application with Gauze or Fabric
Application by Mist

Hot Towel RemovalLegs
Hot Towel RemovalFeet
Hot Towel RemovalBack
Hot Towel RemovalArms
Hot Towel RemovalAbdominal Area and Upper Chest
Other Dry Room Removal Techniques
Moving a Client from Plastic to a Preset Massage Sheet

The Handheld Shower
The Standard Shower
The Swiss Shower
The Vichy Shower
S
SPA
FUSION
IINTEGRATION OF SKILLS
STUDY TIP: Internet Work!
CHAPTER WRAP-UP
96
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Chapter 5
This chapter focuses on the basic skills needed to deliver

spa body treatments. It begins with a discussion on how to
drape a client elegantly and efficiently, preserving the clients
Foundation Skills for Spa Treatment Delivery
97
Breast Drape
Align the top edge of the main drape with the bottom edge
of a hand towel or pillowcase. As the main drape is pulled
down, the hand towel or pillowcase becomes a breast drape
and takes its place.
modesty, while being able to apply spa products without

inconvenience. You may want to explore the many different
Anterior Pelvic Drape
ways therapists position the client on the treatment table
After the breast drape is in place, continue to pull the main

drape down until the abdominal muscles are uncovered.
Align the fold of the main drape with the bottom edge of a
hand towel or pillow case. As the main drape is pulled down,
the hand towel or pillow case will become a pelvic drape. Tuck
the bottom section of the pelvic drape between the legs leaving a safe distance between the tucking hand and the genitals.
to apply a variety of spa products effectively. Dry room

and wet room removal techniques are also discussed. After
mastering these foundation skills, different treatment steps
can be chosen and matched to develop more creative spa
services.
Spa Draping
In a massage session, range of motion techniques require
a tight drape that is tucked in, wrapped around the limb,
and, sometimes, held taut by the client. Clients receiving
spa treatments are draped slightly differently than they
would be in a normal massage. Although the client is always
draped, the aim is to preserve modesty and warmth without being too fussy. Spa draping should be quick, elegant,
and efficient. Disposable undergarments are useful for
treatments in which the client is more exposed because of
extensive spa product application. The draping methods
shown in Figure 51 work well. For a demonstration of spa
draping, visit thePoint.
Turban Drape
This type of drape protects the clients hair from spa products
and prevents heat loss during a treatment. Put a bath towel on
the table before the treatment. Bring the bath towel up over the
clients head to cover the forehead or the eyes. Using the hand
as a wedge on each side of the drape, bring the side portions
around the neck and tuck them into the top of the body drape.
Gluteal Drape
Uncover the back and fold the drape down to the gluteal
cleft. Grasp the folded edge of the main drape and the bottom edge of the hand towel or pillow case. As the main
drape is pulled down to expose the gluteals, the hand towel
or pillow case replaces it. Tuck the bottom of the gluteal
drape between the legs, leaving a safe distance between the
tucking hand and the genitals. Fold the edges of the gluteal
drape to create clean lines for product application.
Posterior Leg
To undrape the posterior leg, gather the drape at the greater
trochanter and at the ankle. Fold the bottom end of the
drape at an angle across the opposite leg while holding
the drape at the greater trochanter as a pivot point. With
the lower hand, grab the fold of the drape and tuck it under
the opposite thigh. Fold the top section of the drape across
the back, leaving the gluteals exposed. With practice, this
draping can be accomplished in three moves and provides a
clean line for the application of spa products from the toes
to the top of the posterior superior iliac spine (PSIS).
Anterior Leg
To undrape the anterior leg, gather the drape at the anterior superior iliac spine (ASIS) and at the ankle. Fold the
bottom section of the drape at an angle across the opposite
leg using the upper hand to hold the drape at the ASIS as a
pivot point. With the lower hand, grab the fold of the drape
and tuck it under the opposite thigh. Fold the top section
of the drape across the belly, leaving the ASIS exposed.
Simple Hair Drape

Hold diagonally opposite ends of a hand towel at the corner
and allow the rest of the towel to drop into a triangle. Place
this on the treatment table before the client gets on it and then
bring the edges around the hair and secure the towel with a
bobby pin or by tucking the end into the fold of the towel.
Side-Lying Drape
Because spa products are applied to the clients while they are
in a side-lying position, this drape is different than it would
be for a massage. It is important to ask clients to wear disposable undergarments to preserve their modesty. The sheet is
kept over the client until he or she is moved into the side-lying
position. Undrape the clients upper body (females should
either wear a disposable bra or hold a towel over their breasts)
and place a bath towel across the clients hip. Grasp the folded
edge of the main drape and the bottom edge of the bath towel.
As the main drape is pulled down to expose the gluteals, the
bath towel will replace it, and the sheet is removed completely.
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98
A1
A2
B1
B2
B3
C1
C2
FIGURE 51 Draping techniques. (A1 and A2) Posterior leg drape.

(B1B3) Anterior leg drape. (C1 and C2) Breast drape. (continued)
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Chapter 5
D1
D2
D3
E1
E2
F1
FIGURE 51 (continued) (D1D3) Anterior pelvic drape. (E1 and E2)

Turban drape. (F1 and F2) Gluteals drape.
99
F2
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100
The client needs to be in disposable briefs because the bath

towel is used as a cover but is not pulled between the legs.
Positioning the Client When Applying

Spa Products
Rumi (12071273 CE), the well-known Sufi poet, said, There
are a thousand ways to kneel and kiss the earth. The same
could be said for spa treatments. There are a thousand ways
to deliver the same treatment. A good therapist will explore
a treatment thoroughly and arrange the treatment steps in
different ways until they can be delivered perfectly with maximum fluidity. Each therapist brings something different to a
treatment, and in a private practice, therapist can adapt the
basic steps and enhance the treatment in unique and creative
ways. By contrast, most spas want their therapists to deliver
the same treatment in the same way each time. It is important
to maintain this sort of consistency for returning clientele. The
techniques described below work well, but each can be done
in many different ways. Again, exploration is the best way for
therapists to find out what works for them. For a demonstration of product application, visit thePoint site for this text.
The choices made when delivering a treatment in a dry
room setting may well be different to those made for a wet
room setting. In a wet room, spa products are removed with

a specialized or handheld shower. Shower removal is quicker
and easier for the therapist than removal using hot towels.
Still, hot towel removal feels wonderful if the towels are hot
(rather than lukewarm), and the therapist works with purpose, flow, and attention to detail.
Many body treatments, regardless of their therapeutic
objectives, have the same basic steps:
Exfoliation step to cleanse, remove dead skin cells, and
invigorate the body
Application of the treatment product
Time for the treatment product to absorb and work
Removal of the treatment product
Application of a finishing product (usually a moisture
lotion, gel, or cream)
Sometimes, it is better to treat the body in segments because
this helps the treatment to flow more smoothly through the
product transitions. More often, you have to plan how to
apply several different products without turning the client
over too many times. The treatment procedures section in
each chapter discusses positioning for each treatment. It is
helpful if you are familiar with three different application
positions before continuing. These are the side-lying position, the sit-up method, and the flip-over method (Fig. 52).
B1
B2
FIGURE 52 Positioning the client for product application. (A) The side-lying position. (B1 and B2) The
sit-up method. (C) The flip-over method.
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Chapter 5
The Side-Lying Position

The client begins the treatment in the supine position for
the exfoliation step. After exfoliation on the anterior body,
turn the client into a side-lying position for the posterior
exfoliation. The client remains in the side-lying position
while the treatment product is applied. Once the product
is applied, roll the client onto his or her back again before
wrapping them in warm blankets. The client needs to stay
alert throughout the treatment and roll from side to side.
As the spa product is being removed, the client again rolls
from side to side to be toweled off (in a dry room).
101
need to be considered. The following methods work well

and are shown in Figure 53.
Application by Hand
Smooth the product onto the skin using effleurage strokes.
Some products are oily enough to massage into the skin
with a full range of strokes. The use of massage enhances
the treatment and is more enjoyable for the client. If applying the spa product by hand, you need to decide if you will
use gloves or wash it off your hands after the application.
Gloves are quickest.
The Sit-Up Method
Application with One Hand Gloved
The client begins the treatment in a prone position, and the

posterior body is exfoliated. He or she turns into a supine position for exfoliation of the anterior side of the body. The knees
are bent, and the treatment product is applied to both the anterior and posterior sides of the legs. Flatten the legs against
the plastic body wrap and then wrap the legs in the body wrap.
Ask the client to sit up (remove the bolster first). Apply the
treatment product to the back and gluteals and ask the client to lie back down again. Finally, the belly, upper chest, and
arms are treated, and then the clients upper body is wrapped.
The product is removed using the same method, and the client is only turned over once during the entire treatment. For
some clients, sitting up is impossible because of lower back
problems or weak abdominal muscles. In this case, choose the
safest and easiest application method for the individual client.
You may want to apply product with one gloved hand. The
ungloved hand is used to undrape body areas as needed or
hold the container of product. This technique works well
with the flip-over position described previously.
Application by Brush
If the client is sunburned or has delicate skin, using a
brush works well so long as the product is thin enough to
be applied with a brush. A large brush (purchase natural
bristle paint brushes) is quicker and more efficient than the
smaller brushes used for facials. If massage is included as
part of a different treatment step, applying the product with
a brush will provide a different sort of texture and give the
overall treatment greater tactile variety. Using a brush also
keeps your hands clean if you need to drape and undrape
body areas during the application process.
The Flip-Over Method

In the flip-over method, the client starts the treatment in
the prone position for the exfoliation step. Apply the treatment product before turning the client. Ask the client to
flip over (the goal is to make sure that the client makes a
clean flip and does not get spa product all over the place).
You hold up a drape and look away to protect the clients
modesty. Exfoliate the anterior body and apply the treatment product before you wrap the client.
This application method can be messy if the client
doesnt make a clean flip. Sheets or bath towel drapes are
difficult to use because they will become covered in product. For this reason, the client will probably want to use disposable undergarments. The treatment product will be on
the clients back and posterior legs for an extra 10 minutes
while the anterior body is being treated. This may be problematic with some products (e.g., very strong seaweed).

When choosing an application technique, the thickness of
the product, the speed at which it needs to be applied, and
the way the product should feel as it goes onto the body
Application with Gauze or Fabric

For some spa products, a piece of gauze or light fabric is
dipped into the product and then applied to the body area.
This method is used with paraffin, Parafango, herbal infusions, and mud, although it can be used with many different products. It allows you to cover body areas rapidly and
precisely. Paraffin and Parafango drip easily. The use of the
gauze prevents the product from getting onto the floor or
dripping onto the client. If the product is too warm, it may
burn the client or be very uncomfortable because the heat
feels intense because a large area is being covered at once.
This is the main drawback of this method of application.
Application by Mist
Very thin or watery products can be sprayed onto the body
with an atomizer or mister. Products that are misted onto
the body feel cool even when the product has been heated.

Dry products such as ground herbs, salt, sugar, medicated
powder, or flour can be applied to the body through a
sugar shaker. This is a unique sensory experience for the
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102
D1
D2
F
FIGURE 53 Application methods. (A) By hand. (B) Using a brush. (C) With one hand gloved.
(D1 and D2) Using gauze or fabric. (E) Using a mist. (F) Using a shaker.
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Chapter 5
client because the product, even when it is dry, feels like

raindrops.

Use hot, moist towels to remove treatment product from the
clients body in a dry room setting (Fig. 54). This is a warm
and satisfying experience when the towels are steamy hot
and you use long, elegant strokes. To prepare the towels, pull
103
off all the tags, then fold the towels in half (the long way),
and roll them up like a sausage. It is important that all the
tags are removed because they could scratch the client. Place
the towels in a hydrocollator, hot towel cabinet, or hot stone
heating unit for 20 minutes at 165F. With thermal gloves,
remove a towel from the water, wring it out, and place it in
the soda cooler. Close the lid of the cooler and remove the
next towel. Keep the lid of the cooler shut as much as possible so that the towels stay hot throughout the treatment.
You can enhance your towels by soaking them in herbal infusions or adding essential oils just before use. Some therapists
A1
A2
C1
C2
C3
FIGURE 54 Hot towel removal. (A1 and A2) Legs. (B) Feet. (C1C3) Back. (continued)
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104
FIGURE 54 (continued) (D) Arm. (E) Abdominal area. (F) Upper chest. (G) Product removal with sponges and
hot water.
color coordinate their towels for the treatment (e.g., green

towels for seaweed treatments, brown towels for mud treatments, beige towels for herbal infusions) to camouflage any
product stains. For a demonstration of hot towel removal of
treatment product, visit thePoint site for this text.
towels are heated in. A nice combination is eucalyptus leaf,

rosemary, clove buds, and juniper berry. A half a cup of herbs
to around 16 quarts of water provides a nice concentration,
although more or less herbs can be used according to taste.
Towels heated in herbal solutions will be lightly stained.
Hot Towel RemovalLegs
Add 3 to 5 drops of rosemary essential oil to the soda cooler

full of towels. As each towel is removed, it will fill the treatment room with a refreshing scent. Most single essential oils
such as eucalyptus, common sage (Salvia officinalis), Spanish
sage (Salvia lavandulifolia), thyme, and lemon oil smell good,
but floral scents such as ylang ylang and jasmine are not as
pleasant in steam. The essential oil on the towel is not likely to
cause any skin irritation because essential oils are volatile substances and begin to evaporate rapidly the minute that they
are placed on the hot towels in the cooler. They will mostly
burn off before the first towel is used, leaving only some of
the scent behind. Skin irritation is therefore minimized.
Remove a towel from the soda cooler and hold it by the edges
(because it is hot). Let it cool slightly and place it on the
proximal portion of the leg (anterior or posterior). Allow it
to sit on the leg and do not touch it again until it cools down
(about 30 seconds). Place both hands on the towel and pull
it toward the distal portion of the leg and off the foot. Turn
the towel over and use the clean side to make another sweep.
Hot Towel RemovalBack
Muslin bags filled with fragrant herbs can also be used to

scent towels. Add a muslin bag of herbs to the water that the
Place the hot towel horizontally on the lower back and allow
it to cool slightly without touching it. Place both hands on
Hot Towel RemovalFeet

Place a hot towel around each foot to steam the feet and
provide a nice sensation and then remove the product from
one foot at a time.
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Chapter 5
the towel and pull it toward the clients head. As the towel
gets to the neck, pull it off to one side, removing the product
from the shoulder without getting it into the clients hair.
Turn the towel over and use the clean side to make a second
sweep removing the product from the second shoulder.
Hot Towel RemovalArms

Place the hot towel vertically on the proximal portion of the
arm and pull the towel toward the hand in one sweep. Lift
the arm by holding onto the clients hand and use the clean
side of the towel to wipe down the other side of the arm.
Hot Towel RemovalAbdominal Area and

Upper Chest
Place the hot towel horizontally on the belly and pull it from
the left side to the right side. Turn the towel over and use
the clean side to remove product from right to left. Place a
hot towel across the upper chest and remove the product by
pulling the towel from one side to the other.
Other Dry Room Removal Techniques

Sponges and warm water can be used to remove the product
in a dry room setting. In this case, place a bucket of warm
water close to the treatment table on a rolling cart. Dip a
sea sponge, large cosmetic sponge, or a washcloth into the
water and use it to wipe the product off. Dry the client with
a hand towel after the product has been removed. The only
problem with sponge removal is that it is difficult to keep
the linens under the client dry. Some therapists put a thick
bath towel on top of the linens before the treatment and get
the client to lift his or her body so that this can be removed
after the sponge bath. At one spa, the floor was tiled with
a drain in the middle of the room. The massage table was
covered by a plastic wrap and large bath towel. A bucket of
warm water was doused over the client to remove product.
This was a quick and efficient method of product removal
that was also invigorating, surprising, and fun. The client
was handed a thick terry robe and moved to a fresh treatment room for massage after the removal of spa product.
Moving a Client from Plastic to a Preset

Massage Sheet
In many different types of body wraps, the client is covered
in a spa treatment product and then wrapped in plastic.
After the treatment product is removed, a finishing product
is applied to the client often in a full-body massage. In a
dry room setting, you have to get the dirty plastic out from
underneath the client without asking the client to get off
the treatment table (a clean massage sheet has been preset
under the plastic). To do this, review Figure 55 and unwrap
the plastic leaving the client covered by the breast drape
and anterior pelvic drape (or disposable undergarments).
105
Remove the product from the clients arms, upper chest,

and abdominal area and ask him or her to hold onto the
breast drape and sit up. Remove the product from the back
and the posterior arms. Roll up the plastic sheet so that the
dirty side is rolled in until it sits as close to the gluteals as
possible and ask the client to lie back down (onto the clean
massage sheet). Move down to the lower legs and wipe the
feet with a hot towel. Ask the client to bend the knees and
hold the feet up. Roll up the dirty side of the plastic (that
is underneath the clients feet). Place the clients clean feet
on the massage sheet, which is underneath the plastic (the
knees are still bent). Remove the spa product from both legs
with hot towels and roll the plastic up as high as possible
under the gluteals. Place the clean legs flat on the massage
sheet and cover the client with a sheet or towel for warmth.
The client then lies back down on the massage sheet and
slightly lifts his or her hips so that the plastic can be
removed. You need to work quickly and efficiently during
product removal because the client must stay alert during
this entire process.

In a wet room, a specialized shower is used to remove
spa products from the clients body. Specialized showers
include a handheld shower, a standard shower, the Swiss
shower, and the Vichy shower. Always read the manufacturers instructions for the particular piece of equipment
beforehand. It is important to practice a treatment at least
two to three times when using a specialized shower so that
the temperature and pressure of the shower are safe and
comfortable for the client. Wet room removal techniques
are shown in Figure 56. Wet room equipment and considerations are also described in Chapter 6 (Water Therapies).
The Handheld Shower

A handheld shower is used in combination with a wet table
for the easy removal of product. Some handheld showers
can deliver a pulsating water massage and may also have
an attachable body brush for exfoliation. A wet table has a
special surface to channel water into a receptacle under the
table or a drain in the wet room floor. The table is often
constructed of heavy plastic or acrylic for easy cleanup and
sanitation. A soft, waterproof insert makes the table comfortable for the client. Sometimes, a bucket of warm water is
poured over the client to remove the spa product. This type
of removal provides an invigorating experience for the client,
but dry the client quickly so that he or she does not get cold.
The Standard Shower

A standard shower is less expensive than a Swiss or a Vichy
shower but does not allow the same range of control. The
pressure of the water, the degree of pulsation, and the
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106
temperature of the water cannot be controlled by the therapist. The client is moved between the massage table and the
shower as needed during the treatment. For example, if seaweed is applied after exfoliating the client with a dry brush,
the client is moved off the massage table after the seaweed
has been allowed to process and taken to the shower so
that it can be washed off. While being moved, the client
stays loosely covered in the plastic wrap until he or she gets
into the shower and passes it back to the therapist to throw
away. The therapist then places clean linen sheets on the
massage table while the client finishes his or her shower.
FIGURE 55 Moving a client from plastic to a preset massage sheet.

(A) Unwrap the client. (B) Remove product from the arms, upper chest,
and abdominal area. (C) Remove product from the back and roll up
the plastic. (D) Remove product from the legs and roll up the plastic.
(E) Remove the plastic from under the client.
The client returns to the massage table for a massage or to

have a finishing lotion or cream applied.
The Swiss Shower

A Swiss shower surrounds the client with jets of water
directed at specific areas of the body. Usually, the shower
stall has pipes in all four corners with 8 to 16 water heads
coming off each pipe. Adjust the position of the water heads
for the clients height. A control panel outside the shower
stall allows you to control contrasting warm and cool jets
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Chapter 5
107
FIGURE 56 Wet room removal. (A) The handheld shower. (B) The Swiss shower.
(C) The Vichy shower.
of water. A shower can be used for product removal, as an

active treatment in itself, or to provide the heating phase of
the treatment for products such as a cellulite cream.
The Vichy Shower

A Vichy shower is a horizontal rod with holes or water
heads that rain water down onto the client from above the
wet table. Vichy showers are used to rinse spa products off
the client, but they can also be used as a treatment in themselves. A control panel allows you to alternate between hot
and cool water, which increases the therapeutic benefits of
some products and uses the mechanical effects of water on
soft tissue. Vichy showers have an adjustable face guard that
is meant to keep water off the clients face, although some
water invariably gets through. A soft, lightweight washcloth
can be used to cover the clients face and protect it from
water droplets. Care must be used when moving the client

off the wet table because the area around the table may be
slippery with water. Although a finishing lotion or cream
can be applied while the client is on the wet table, it is nicer
to move the client to a dry room massage table for this final
step. Wet rooms may feel a little cold and can echo because
of the tiled floor.
SANITATION
The shower stall or wet table, the floor outside
the shower, the shower curtain (if there is one),
and any other surface that touches the client or water
must be cleaned, disinfected, and dried between clients.
Towels and floor mats will also need to be changed
between clients.
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SPA FUSION
STUDY TIP: Internet Work!
REVIEW QUESTIONS
The Internet provides people with fast access to information, which can be very helpful when you want to
learn more about anything that is unfamiliar. Some
of the information on the Internet is from questionable sources, so we spend a lot of time sorting through
advertising, false claims, and other spam. One way
to avoid this sorting process is to use a teachingand research-oriented search engine such as Google
Scholar available at http://scholar.google.com when
youre looking for information. It can also be helpful
to look for massage and spa technique videos supplied by massage and spa teachers on TeacherTube
(http://www.teachertube.com) if you want to see
visual examples of techniques being applied to clients.
Finally, ask other massage professionals for information on http://www.massageprofessionals.com.
This social networking site created for the massage
profession by Associated Bodywork and Massage
Professionals lets you connect with massage people
across the country.
Multiple Choice
CHAPTER WRAP-UP
As an aspiring spa professional, you should practice
basic spa skills in preparation for the delivery of core
spa treatments rigorously. These skills include elegant
spa draping, appropriate positioning of the client for
product application, the use of a variety of application methods, and the smooth and efficient removal
of product with hot, moist towels. Enhancers such
as steamy aromatic towels, firming face massage, and
simple foot treatments provide moments of particular
radiance in a spa massage as described in Chapter 4
(Your Spa Massage). New spa therapists should perfect
their Swedish relaxation massage and offer several
enhancers while maintaining the flow of the massage.
If a wet room is used to remove product, practice with
the specialized equipment to ensure that the water
temperature and pressure are safe and comfortable for
the client. Once these skills are mastered, you will be
able to work more creatively with treatment steps to
develop unique services. Remember, you are responsible for checking the laws and regulations in your particular state to ensure that you are delivering services
within your scope of practice.
1. A method of positioning the client for product

application in which the client turns over after a
treatment product has been applied to the posterior of the body is called:
a.
b.
c.
d.
The sit-up method

The flip-over method
The side-lying method
The pronator method
2. This type of drape protects the clients hair from

spa products and prevents heat loss during a
treatment.
a.
b.
c.
d.
Facial drape
Gluteal drape
Breast drape
Turban drape
3. When choosing an application technique, you want

to consider:
a.
b.
c.
d.
The thickness of the product

The color of the product
How the product will be removed
Face massage techniques
4. Oily products lubricate the skin enough so that:

a. They can be applied with steamy hot towels
b. They can be applied with a full range of massage
strokes
c. They can be sprayed directly onto the body with
a mist bottle
d. They can be applied with powders
5. Paraffin, Parafango, herbal infusions, and mud can
be applied with:
a. Gauze or fabric that has been coated with the
product
b. A full range of massage strokes
c. Gloved hands and a full range of massage
strokes
d. A mist bottle
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Chapter 5
109
SPA FUSION
True or False
6.
9.
Clients receiving spa treatments are

draped slightly differently than they would be in a
normal massage.
10.
7.
Shower removal is slower and harder

for the therapist than removal of products using
hot towels.
8.
If the client is sunburned or has delicate skin, or if the product is thin, the use of a large
paint brush for product application works well.
Products that are misted onto the

body feel cool even when the product has been
heated.
A Vichy or Swiss shower are used in
a dry room setting to remove products from the
clients body.
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6
Water Therapies
Chapter Outline
K e y Te r m s
General Uses for Hydrotherapy

Introduction to Hydrotherapy
Buoyancy: Buoyancy refers to floating in water because of the water is

displaced by bodyweight.
Compress: A wet cloth soaked in warm, hot, cool, or cold water (sometimes
with additives dissolved in the water) that is wrung out and applied to
the skin.
Cryotherapy: The therapeutic application of cold temperatures.
Father Sebastian Kneipp: A Bavarian priest who combined herbal treatments with water cures.
Friction treatments: Friction treatments include salt, sugar, dry brushing,
wet brushing or mitt treatments where the mechanical action of the
rough-textured product, brush, or mitts against the skin causes local
circulation to increase as the friction generates heat in the tissue.
Full immersion bath: A hydrotherapy treatment where the clients body
is fully immersed in cold, cool, warm, or hot water for a period of time
to stimulate or sedate the body.
Homeostasis: The bodys ability to maintain a relatively constant internal
environment despite changing external conditions.
Hunting reaction: Alternating cycles of vasoconstriction and vasodilatation
in response to cold.
Hydrostatic pressure: The amount of pressure exerted by a liquid, in this
case water, when the liquid is at rest. In other words, water has weight.
Hydrotherapy: The use of water for health and wellness.
Mechanical effects: The effects on the body caused by water that is pressurized in sprays, whirlpools or through jets to manipulate soft tissue.
Paraffin: A waxy substance obtained from the distillates of wood, coal,
petroleum, or shale oil. It is used to coat the skin and trap heat and
moisture at the skins surface.
Sauna: A room where hot air (60 to 210F) is combined with low humidity
to stimulate metabolism, increase core body temperature, and facilitate
detoxification.
Scotch hose: A hydrotherapy application in which a strong stream of water
is directed at the client to increase circulation, stimulate function, tone
muscles, decrease pain, and decrease congestion in a particular body area.
Steam bath: A hot air bath used to facilitate perspiration that helps the
body naturally detoxify.
Thermotherapy: The therapeutic application of heat.
Vasoconstriction: When the lumen of a blood vessel is contracted, reducing
the diameter of vessel and decreasing blood flow to a region of the body.
Vasodilatation: When the lumen of a blood vessel is relaxed, increasing the
diameter of the vessel and increasing the blood flow to a region of the body.
Vincent Priessnitz: An Austrian farmer who became famous for the cold
water cure, which consisted of drinking large amounts of cold water
and applications of cold water by packing, immersions, and douches.

Benefits of Using Hydrotherapy in a Massage and
Spa Practice
Effects of Hydrotherapy Applications
S
SPA
FUSION
STUDY TIP: Fact Sheets
SPA INSPIRATION: Self-care with Hydrotherapy
ITS TRUE! Hydrotherapy Improves Physical
Performance for People with Osteoarthritis
CHAPTER WRAP-UP
110
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Chapter 6 Water Therapies
Hydrotherapy is the use of water for health and wellness
111
use hydrotherapy regularly to promote healthy changes in

soft tissue structures.
and is a historical cornerstone of the spa experience. As we

discussed in Chapter 1 (Spa from Past to Present), the
Introduction to Hydrotherapy
revitalizing effects of water were well known in ancient

cultures around the world. Vincent Priessnitz and Father
Sebastian Kneipp developed methods and procedures that
advanced the understanding of hydrotherapy. Although
spa treatments can be offered without wet room equipment
such as Vichy showers and hydrotherapy tubs, it is helpful to
be well versed in hydrotherapy principles. For the therapist
working in a spa offering hydrotherapy treatments, this
understanding is essential to providing safe and effective
client care.
General Uses for Hydrotherapy

The effects of hydrotherapy applications are the same even
when the focus of sessions is different. In a wellness setting
such as a spa or massage practice focused on reducing stress
and promoting enjoyment of sessions, hydrotherapy is
most often used to relax the body with hydrotherapy baths,
showers, steams, and saunas.
In spas, hydrotherapy is also used as part of the beautification process by estheticians. A particular product might
be applied to the legs to improve the appearance of cellulite. Specialized water applications such as a Swiss shower
or Scotch hose might then be used to activate the product
or stimulate the skin and circulation as part of the session.
In health care settings, such as those at some integrated
or resort spas, hydrotherapy is applied to support changes
needed in the body for the management of a particular
pathology or condition and to rehabilitate musculoskeletal
tissue after injury. In a health care setting, a sauna or steam
room might be used as part of the clients treatment plan.
If a client suffers a sports injury, ice packs are likely to be
applied to the area to reduce inflammation. As the clients
injury heals, heat applications might be used to soften scar
tissue and improve range of motion as the client returns to
full function.
In the first section of this chapter, we discuss the therapeutic characteristics of water that make it useful and beneficial for clients. The physiological, psychological, and
reflexive effects of hydrotherapy are explained in the next
section of the chapter, before hydrotherapy applications are
demonstrated at the end of the chapter. Whether you choose
to work on providing wellness massage and relaxation spa
work or work in a health careoriented spa providing condition management or injury rehabilitation, you are likely to
The term hydrotherapy originates in two Greek words: hydro,

meaning water, and therapeia, meaning therapy. Stedmans
Medical Dictionary for Health Professions and Nursing defines
hydrotherapy as the external application of water as a
liquid, solid, or vapor for therapeutic purposes.1
The use of water for healing dates back before recorded
history, and many cultures around the globe have traditions that include hydrotherapy. North American Indian
tribes, for example, used a special hut or a covered sweat
lodge built partly into the ground. Large stones were heated
in a fire and taken inside the hut where they were sprinkled
with water to warm the air, causing the body to perspire as
a means of purification. There is evidence that every major
U.S. hot spring was used at some point by an Indian tribe.2
Native Americans considered hot springs to be sacred,
neutral ground. Warriors could rest by hot springs to heal
battle wounds without worry of attack from another tribe.
Early civilizations often had a version of the spa bath,
which combined some form of social interaction with
cleanliness. The hamam (bath) became popular in Islamic
countries around 600 AD after Muhammad recommended
sweat baths for spiritual cleanliness. Later, hamams became
central to the community both as a place of spiritual retreat
and for socializing with friends. Bathers would stop first at
the camekan, a small court of changing cubicles surrounding a fountain, before entering the hararat (hot marble
baths). Bathers would receive a vigorous massage or kese
(exfoliation with a rough cloth) on a raised marble platform
above the wood or coal furnaces used to heat the hararat.3
As mentioned in Chapter 1 (Spa from Past to Present), the
baths of the Roman Empire are probably the most famous
in history. The central role of public baths in Roman culture led to a well-developed understanding of hydrotherapy,
and garrisons were often built around hot springs so that
the soldiers could heal their battle wounds. By 43 AD, the
Roman public viewed the baths as a way to relax and maintain health, and by the early fifth century AD, Rome alone
had 900 baths.
The medical benefits of hydrotherapy were advanced in Europe by two natural healers who developed their methods in
the early 1800s. Many of these methods are still used today
as part of hydrotherapy. The first was the Austrian Vincent
Priessnitz (17991852), who promoted the cold water cure.
This cure consisted of drinking large amounts of cold water, bathing in cold water, following a simple diet, and participating in physical activity in the open air. Priessnitz used the
cold water cure to care for a personal injury that doctors of the
time thought untreatable. In 1826, Priessnitz opened a water
cure establishment at Grfenberg in the mountains of Silesia,
where his ideas were adopted by many prominent physicians.4
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112
The second natural healer was Father Sebastian Kneipp

(18241897), a Bavarian priest who cured himself of pulmonary tuberculosis by bathing in the icy Danube and
shocking his body into health. In one of his many books,
My Water-Cure (1894), Kneipp writes, Being a priest, the salvation of immortal souls is the first object for which I wish
to live and die. During the last 30 or 40 years, however, the
care for mortal bodies has absorbed a considerable portion of my time and strength. Instead of administering
last rites to the gravely ill, he used water and herbs to cure
them. Kneipps healing system, which combined physical
exercise, simple food, hydrotherapy, and herbs, forms the
basis of modern naturopathy. He is well known for the wet
nightshirt treatment that involved wearing a shirt that
had been dipped into water with salt or hay flower. He also
introduced classic methods of friction such as salt glows
and body wraps, which are widely used today in spas.5
Today, hydrotherapy applications are used successfully
to treat a broad range of conditions and are particularly useful for musculoskeletal problems. Modern research proves
what people throughout the ages have always known: Water
has healing characteristics that change the way we feel mentally, emotionally, and spiritually.

Water is a unique substance that covers more than 70% of
the earths surface and provides the natural beauty of oceans,
rivers, rain, waterfalls, and snow. The human body is 55%
to 60% water, and tissues such as lean muscle (75%), blood
(95%), and bone (22%) contain significant amounts of water.
Water also has a number of characteristics that make it useful
as a therapeutic application. Water is versatile and changes
forms, dissolves other therapeutic substances, exerts hydrostatic pressure, causes buoyancy, and absorbs and transfers
hot and cold temperatures (For Your Information 61).
Water Is Versatile and Changes Forms
Water is a liquid that can easily be changed into ice or vapor.
It is therapeutically useful in all of these forms. As a liquid,
water is applied in baths and showers or used to heat special packs, called hydrocollator packs, that bring moist heat
directly to a specific body area. Ice packs and ice massage
Water is versatile and changes forms (water, ice, vapor).
Water dissolves other therapeutic substances (minerals,
plant materials).
Water exerts hydrostatic pressure (weight of water).
Water causes buoyancy (lift of displaced water).
Water absorbs hot and cold temperatures.
Water transfers hot and cold temperatures
(conduction direct contact, convection via air).
cool heated tissue and reduce inflammation, whereas saunas and steam rooms use water in a vaporized form to promote perspiration and detoxification.
Water Dissolves Other Therapeutic Substances
Water is known as the universal solvent because it dissolves
so many other substances. Many of the known elements
found on earth are dissolved in seas and lakes. For example,
people all over the world have noticed that they feel revitalized from a day at the beach and swimming in the ocean,
where seaweeds and minerals dissolve in the water, making
it a rich, therapeutic soup. Many different substances can
be dissolved from a solid to a liquid form for absorption
through the skin. Substances such as clay, minerals, powdered seaweed, ground oatmeal, and a variety of herbs are
routinely dissolved in water and applied to the body in baths
and body wraps as part of hydrotherapy at spas.
Water Exerts Hydrostatic Pressure
Hydrostatic pressure is a term that refers to the amount
of pressure exerted by a liquid, in this case water, when the
liquid is at rest. In other words, water has weight. If you
have swum underwater, you have probably noticed that the
deeper you go, the more pressure you feel in your ears from
the accumulated weight of the water above you. If you stand
neck deep in water, there is greater hydrostatic pressure on
the lower part of your body (deeper) than on your upper
body. Hydrostatic pressure pushes blood and fluid from the
lower body into the thorax. This characteristic of water has
been used effectively to treat edema in the extremities caused
by many different conditions. Pregnant women who exercise in water find that hydrostatic pressure reduces lower leg
edema, decreases the occurrence of varicose veins, improves
general blood circulation, and stabilizes blood pressure.6
Water Causes Buoyancy
Buoyancy refers to floating in water. When you enter a
swimming pool, you displace water and there is an upward
thrust of water that lifts you. This is why you feel weightless when you swim. The water you displaced supports the
weight of your body. Exercising in water reduces the stress
on joints, tendons, and bone that would occur with the
impact of the body moving on a hard surface. People who
have arthritis, are elderly, or have recently undergone surgery for a musculoskeletal condition benefit from movement in a buoyant environment.
Water Absorbs Hot and Cold Temperatures
Water can be heated or cooled to specific temperatures for
therapeutic application to the body as described later in the
chapter when we talk about the effects of hot and cold temperatures on the structures and function of the body. As you
can probably imagine, hot applications increase local blood
circulation, warm soft tissue structures, relax tense muscles,
and soften muscle tissue. Cold applications decrease local
blood flow to an area and increase muscle tone.
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Water Transfers Hot and Cold Temperatures

Water effectively transfers hot and cold temperatures to the
body in two different ways. When heated or cooled water
makes contact with your body, it transfers the warmth or
coolness to your body through conduction (the transfer of
hot or cold temperatures through direct contact). Water is
more effective at transferring hot or cold temperatures than
is air, which is why moist heat feels hotter than dry heat.
Convection is the process by which hot or cold temperatures are transferred via air or gas. For example, it feels
colder when the wind is blowing (wind chill) than if the air
is still. Saunas are an example of the transfer of temperatures via air; water poured over hot rocks turns quickly into
a vapor, which evaporates into the air and warms it.
These general characteristics of water help lay the foundation for better understanding the mechanisms by which
hydrotherapy is effective in the upcoming sections of this
chapter.
113
and prolongs the pleasure the client experienced during the

session. At the same time, dead skin cells desquamated during the massage or body wrap and impurities released from
the skin are removed, leaving the client feeling clean and
revitalized.
In both wellness and health care spas, therapists often
suggest that clients use hydrotherapy applications at home
for self-care. Use of hot packs on tight shoulder muscles
at the end of a workday can help the client maintain the
lengthening effects achieved through a massage session.
Regular Epsom salt baths help reduce stress, decrease muscle soreness, and improve sleep. Cold packs are applied during the early stages of inflammation to reduce swelling and
heat in the tissue and speed the healing process. The simple
act of taking a warm bath at night can serve as part of a
stress reduction regimen. These general benefits complement the significant physiological and psychological effects
of hydrotherapy applications.
Effects of Hydrotherapy Applications

Hydrotherapy applications support many of the benefits
and effects of massage and can improve the results clients
experience from the massage or spa session. The benefits
of hydrotherapy include the pleasure and comfort clients
receive through hydrotherapy applications.
The effects of hydrotherapy usually depend on the temperature of the application and the delivery method (bath,
pack, shower, etc.). Lets consider the benefits of hydrotherapy
applications in a massage and spa practice and their physiological, psychological, reflexive, and mechanical effects.
Benefits of Using Hydrotherapy in a Massage

and Spa Practice
The use of hydrotherapy applications in both wellness and
health care spas increases clients enjoyment of sessions,
offers soothing comfort, ensures that clients stay warm, and
provides a useful means of empowering clients to manage
many conditions through self-care practices.
A recent study suggests that feelings of warmth are associated with a sense of relaxation and well-being. Researchers
have found that sensations of warmth alter neural circuits
controlling cognitive function and mood, influencing
serotonin levels. So, whether you are lying on a warm beach
in the Caribbean, sitting in a sauna or hot bath, or even
working up a sweat through exercise, your brain chemistry
changes and your mood is enhanced.7
Many clients begin to feel cold as a spa session progresses. A warm hydrocollator pack on the feet or low back
can warm the client and increase the clients enjoyment
of the session. A hydrotherapy tub immersion (bath) with
soothing additives such as essential oils or herbs after a
massage or body wrap boosts the benefits of the treatment
Understanding hydrotherapys effects on the body begins

with the concept of homeostasis. Homeostasis is the relative
constancy of the bodys internal environment. The bodys
internal environment includes the extracellular fluid that
bathes cells. From this fluid, cells receive oxygen and nutrients, and into this fluid, cells excrete wastes from their metabolic activities. The health of each cell and an organisms
survival depends on the ability of the organism to sustain
a relatively constant internal environment. If the internal
environment is disturbed to the extent that it cant adjust,
such as by prolonged exposure to cold and hypothermia,
death of cells and potential death of the organism result.
Humans are able to maintain internal environmental
stability because intricate regulatory mechanisms continually monitor and correct the bodys internal environment
by adjusting physiological functions.8 The bodys core temperature is relatively constant, even in the face of widely
varying external environmental temperatures, because of
this ability. For example, the body produces heat when the
core becomes too cool and increases heat loss when the core
starts to overheat. Hydrotherapy applications are designed
to change the internal environment of the body by applying temperatures above, close to, or below that of the bodys
normal temperature (97F). The physiological effects of
hydrotherapy occur as a result of the bodys attempt to
return to a constant internal state. For example, a common
physiological effect of the application of heat is vasodilatation of blood vessels and increased blood flow to the local
area, which moves warm blood out toward the periphery,
cooling the core of the body. A common physiological effect of cold is decreased local edema and decreased pain.
The edema is reduced through vasoconstriction of blood
vessels, which drives warm blood back to the core, ensuring the core maintains the proper temperature. As a result,
pain is reduced by a decrease in nerve conduction velocity.
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114
Three key factors influence the degree to which the body is

affected by hydrotherapy applications:
The greater the temperature difference between the
body and the hydrotherapy application, the greater
the physiological effect on the body: If a client is placed
in a bath at 97F (close to normal body temperature),
neither the therapist nor the client will notice much of
a physiological difference (although a mild tonic effects
occurs with neutral applications). If the same client is
placed in a bath at 110F, the physiological changes
in the body will be readily apparent to both. The pulse
rate increases, the skin flushes, body temperature rises,
metabolism picks up, the blood becomes more alkaline,
and white blood cells increase in number. The client may
feel nervous or even agitated by the application and will
probably want to get out of the hot water.
The length of the hydrotherapy application influences
the physiological effect on the body: A client placed in
very cold water (32 to 55F) will have two very different reactions based on the length of the treatment. If the
application is brief (less than 1 minute), blood vessels will
constrict to prevent heat loss. A short time later, blood vessels will dilate as the body attempts to warm itself and prevent tissue loss at the periphery. Muscle tone is increased,
and there is an initial spike in blood pressure and respiratory rate. The client is likely to report feeling refreshed and
invigorated. If the application is longer than 1 minute,
the clients blood vessels constrict as the body attempts
to move blood to the core to keep the core temperature
consistent. After about 20 to 30 minutes of continuous
cold, vasodilatation occurs, which increases circulation
(For Your Information 62), although not above the baseline when the cold was first applied. The physiological
processes of the body are depressed, and if the client is not
removed from the cold water, death could result.

The H
Th
Hunting
ti R
Reaction
ti
The hunting reaction involves alternating cycles of vasoconstriction and vasodilatation. When an ice pack is
applied to an area, the body undergoes a series of distinct
physiological responses. In the first phase, the blood vessels constrict, and blood flow to the area is reduced. This
decreases local edema and causes the skin to appear pale.
In the second phase, the body attempts to warm the area
through vasodilatation that increases circulation. If the cold
persists, vasoconstriction resumes, and the cycle repeats
itself with irregular sequences in an apparent hunting for
equilibrium of skin temperature. The benefits of the hunting
reaction are that vasodilatation phases flush the area with
fresh blood, bringing nutrients and oxygen to the tissue.
Vasoconstriction phases squeeze the blood out of the tissue,
removing many metabolic wastes, before another vasodilatation phase again flushes the area with fresh blood.
The larger the body area treated, the greater the

physiological effect on the body: Hydrotherapy applications can be used over the entire body or locally. If the
body is immersed in a bath, as in the previous examples,
the effect is more profound than if a cold pack is applied
to one local area, say the hamstring. If the cold application is a full-body immersion, the hunting reaction
described in For Your Information 62 is potentially
deadly because heat from the bodys core is used to delay
tissue loss at the periphery. If the cold is applied just to
the hamstrings, the hunting reaction acts as a pump
to flush out metabolic wastes in tissues and bring fresh
oxygen- and nutrient-rich blood to the area.
The effects of hydrotherapy applications can be understood
in terms of six primary categories, which overlap and interrelate (For Your Information 63):
Physiological effects
Psychological effects
Reflexive effects
Mechanical effects
Effects from dissolved substances
Effects from specific temperatures
A combination of different types of effects usually occurs

simultaneously during a hydrotherapy application. For
example, different temperatures cause physiological effects,
and dissolved substances, such as herbs, can influence the
psychological impact of an application.
Physiological Effects
As mentioned earlier, many of the effects of hydrotherapy
occur because the body responds to temperatures above or
below normal body temperature in an effort to maintain
homeostasis. Hydrotherapy applications have a strong
effect on blood circulation, causing vasodilatation of blood
vessels in some instances and vasoconstriction of blood vessels in others. Certain applications can shift blood from
one area of the body to another or cause cycles of vasoconstriction and vasodilatation that flush the local tissue of
metabolic wastes by bringing fresh nutrient- and oxygenrich blood into an area, pushing blood back out, and repeating the process. In this way, metabolic wastes are removed

Physiological Effects of Hydrotherapy
Homeostasis is the relative constancy of the bodys internal
environment.
Hydrotherapy seeks to change the internal environment of
the body.
Physiological effects occur as a result of the bodys attempt
to maintain homeostasis.
When the body is hot, it attempts to cool itself.
When the body is cold, it attempts to warm itself.
10/24/13 1:17 AM
from the area, leaving the tissue healthier. Certain types of

applications cause an increase in blood pressure and heart
rate, whereas others cause it to decrease.
The skin is also directly impacted by hydrotherapy
applications because sensory receptors are responding to all
the textures and nuances of feeling created by the application and sending rapid signals to the brain. Overheating the
body, as in a sauna treatment or hot immersion bath, stimulates sweat glands, which helps the skin excrete metabolic
wastes from the body. Metabolic wastes that have accumulated in the adipose layers under the skin can be metabolized and released during this process, helping the body to
naturally detoxify.
Psychological Effects
Although the psychological effects of water and hydrotherapy applications are not always as clearly defined as physiological effects, you have only to contemplate your feelings
as you visualize a warm tub full of water, the delights of a
swimming hole on a hot summer day, or the feel of warm
sea mist on your face to understand waters psychological impact. People love water. In fact, maps of the worlds
population show that most of humanity lives near water.
People gather along coastlines, along the course of rivers,
and on islands. Popular vacation spots are often located on
bodies of water.9 Water holds an important place in myth
and legend and is often viewed as a transformative power.
Artemis in Greek mythology ruled the tides as the goddess
of the moon. She also personified the unconscious depths
of the human mind, which are associated with water. Rituals of purification often involve water because it is a substance that washes away dirt from the body and, in some
religions, cleanses the soul. Many cultures believe that life
sprang from water and that special waters impart youth
and renewed beauty. Water can represent an important passage through difficulties to renewal of the spirit. All of these
conscious and subconscious factors can be at play during
hydrotherapy sessions and benefit clients through the pleasure they receive through interaction with water.
Reflexive Effects
Hydrotherapy applications can produce reflexive effects
(sometimes called a consensual response) that occur because
of a nervous system reaction to the treatment. Reflexive
effects happen in an area removed from the point of local application, usually between the skin and the viscera,
although heat applied to one limb will increase circulation
in the other limb. The reflex relationship between the skin
and the internal organs is due to a segmental connection.
Both receive sensory innervation from the same segment
of the spinal cord. For example, heat applied to the abdomen causes the activity of the intestines to decrease. A hot or
cold application to the sternum affects the function of the
esophagus. A cold application to the head stimulates mental
activity, whereas the application of a cold pack to the sacrum
or feet causes dilation of the uterine blood vessels.10
115
Mechanical Effects
When water is pressurized in a spray, shower, hydrotherapy
jet, or whirlpool, the force of the water on the skins surface
and on the muscle tissue below manipulates the tissue for
a mechanical effect. The body may respond to the sensation of water striking the tissue defensively at first, causing
muscle tone to increase. Gradually, the body relaxes into
the sensation of the pressurized water, and muscular tension is reduced, circulation is improved, and overall body
function and vital energy are increased.
The hydrostatic pressure of water can be considered to exert
a mechanical effect on body tissue. Recall that water exerts
more pressure on body areas that are deeper in the water. This
effect can be used to squeeze fluid from the lower extremities
to the thorax; for example, exercising in water reduces edema
in the lower legs. In some types of hydrotherapy applications,
fluids are pulled from the upper body to the lower body.
A classic example is the use of a hot foot bath to decrease congestion in the sinuses due to a cold. The hot water pulls fluid
down toward the feet and out of the head. In folk medicine,
migraines are treated with a warm foot bath and an ice pack
on the back of the neck. The dilation of blood vessels in one
body area reduces the fluid congestion in another area.
Another type of mechanical effect of hydrotherapy applications occurs with classic friction rubs such as salt glows,
wet skin brushing (like dry skin brushing as described in
Chapter 8 except the skin is dampened with water or vinegar), or cold mitt friction. The mechanical action of the
rough-textured product, brush, or mitts against the skin
causes local circulation to increase as the friction generates
heat in the tissue.
Effects from Dissolved Substances
Earlier, you learned that water is called the universal solvent
because it dissolves many other substances such as minerals
and plants, creating a therapeutic soup. For example, the
Dead Sea is an ancient landlocked sea whose water has been
slowly evaporating over the centuries, producing a highly
concentrated natural salt solution. After bathing in the Dead
Sea, people often report a feeling of increased energy and wellbeing as well as soft skin. The main mineral elements in Dead
Sea water are chlorine, magnesium, sodium, calcium, potassium, and bromine.11 Research on the usefulness of bathing
in the Dead Sea confirms that it benefits a variety of skin conditions because it improves the barrier function of the skin.12
It is also used to reduce inflammation from musculoskeletal
injuries including back injuries,13 improves the function of
joints effected by both rheumatoid and osteoarthritis,14,15 and
decreases the severity of symptoms associated with fibromyalgia.16 Additives dissolved in water may have physiological or
psychological effects that enhance and support the benefits
of the hydrotherapy application. For example,
Herbs: When herbs are soaked in water, many of their
chemical components are transferred to the water along
with their therapeutic properties. Red clover, lavender
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116
flowers, chamomile flowers, powdered oatmeal, comfrey,

elderflower, and calendula petals soothe skin irritation and
are used to improve many skin conditions. Juniper berries,
ginger root, clove bud, allspice, rosemary, and sage warm
the body and support perspiration for detoxification treatments. A wide range of herbs and herbal products are used
in combination with hydrotherapy applications. Visit spa
and massage supplier websites to research your options.
Milk: Milk, powdered milk, buttermilk, and cream can
be dissolved in water to soften and condition the skin.
Minerals: Minerals in salts such as those from the Dead
Sea, regular sea salt, or Bearn salt from the mineral
springs of the Pyrenees Mountains of Southern France
dissolve in water, allowing the minerals to be absorbed
by the skin to improve both the texture of the skin and
overall body function. Epsom salts are inorganic mineral
salts that help the body detoxify and increase general
circulation. They are well known for use with sprains,
strains, and sore, fatigued muscles. They also relax the
body and are useful for insomnia.
Seaweed: Seaweed contains many bioactive compounds
that can be absorbed through the skin and used by the
body to support overall body function. Seaweeds have
high concentrations of vitamins A, B1, B2, B5, B12, C, D, E,
and K. They also contain polyphenols and carotenoids,
which play a role in protecting the body from oxidative
stress. Brown seaweeds such as Laminaria, Sargassum, Fucus,
and Ascophyllum species stimulate metabolism, raise body
temperature, and affect cell membrane transport, facilitating detoxification. All seaweeds contain some amount of
iodine, which influences thyroid activity. For this reason,
do not use seaweed with clients who have iodine, shellfish,
or seaweed allergies or who take thyroid medications.
Essential oils: Essential oils do not dissolve in water, as we
will discuss in the next chapter (Introduction to Aromatherapy for Spa), but they are commonly added to baths,
saunas, and steam rooms to increase the therapeutic benefits of these applications. Review Chapter 7 for specific
information on essential oils to use in such treatments.
TABLE 61 Degrees of Hot and Cold in

Hydrotherapy
DEGREES OF HOT AND COLD
Neutral to Very Cold
Neutral
9098F
Warm
98100F
Cool
7090F
Hot
100104F
Cold
5670F
Very Hot
104110F
Very Cold
3256F
Too Hot (dont use)
110F and abovea
Some products such as paraffin (122 to 126F), Parafango (120 to

126F), therapeutic mud, and peat (115F) are applied at temperatures
above 110F. These products transfer the heat slowly to the body area
and do not burn the client.
foot bath, the peripheral blood vessels dilate, and the client
begins to perspire. The blood flow to the area where hydrotherapy is applied increases significantly and flushes the tissue. The heart rate, pulse rate, respiratory rate, and overall
rate of metabolism rise, which increases the consumption
of oxygen in the tissues. The rise in core body temperature creates an artificial fever, which, in turn, stimulates
the immune system and causes the bodys white blood cell
count to increase, inhibiting the growth of some bacteria
and viruses. The higher blood flow to the area relaxes muscles, reduces muscular spasm, increases the extensibility of
collagen, melts the superficial fascia, increases the range
of motion in joints, reduces pain, and is generally relaxing.
Effects of Cold
The physiological responses of the body in reaction to cold
result from the bodys attempt to prevent a decrease in body
temperature. Like heat, brief applications stimulate the
body, whereas applications of longer duration sedate the
body. The use of external applications of cold for therapeutic purposes is sometimes referred to as cryotherapy.
TABLE 62 Effects of Heat and Cold

OVERVIEW OF THE EFFECTS OF HEAT AND COLD
Effects from Specific Temperatures

Different reflexive and physiological effects depend on the
temperature of the water applied to the body. Table 61 provides an overview of common water temperatures used in
hydrotherapy, whereas Table 62 summarizes the effects of
hot and cold temperatures. Hot, cold, neutral, and contrasting temperatures are used in hydrotherapy applications.
Effects of Heat
The physiological responses of the body to heat result from
the bodys attempt to prevent a rise in body temperature.
Brief applications stimulate the body, whereas applications
of longer duration sedate the body. The use of external
applications of heat for therapeutic purposes is sometimes
referred to as thermotherapy.
When heat is applied to a client with a full immersion
bath, steam bath, sauna, hot pack, or partial bath such as a
Warm to Very Hot
Hot
Cold
Perspiration
Increased local blood flow
Tissue will flush
Increased heart rate
Increased pulse rate
Increased metabolism
Increased oxygen consumption
in body tissues
Increased white blood cell count
Stimulates immune system
Relaxes muscles
Decreased muscle spasm
Increased range of motion
Decreased pain
Short applications stimulate
Long applications sedate
Decreased local blood flow

Decreased tissue metabolism
Decreased edema
Increased numbing
Decreased pain
Initial increase in respiratory
rate
Initial increase in heart rate
Initial increase in blood
pressure
Respiratory rate, heart
rate, and blood pressure
gradually drop
Increased muscle tone
Short applications stimulate
Long applications sedate
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117
Cold penetrates more deeply into the tissues than heat

because vasoconstriction causes a decrease in local circulation and tissue metabolism. There is also a decrease in leukocytic migration through the capillary walls, which aids in the
reduction of edema and pain. Initially, there is an increase in
respiratory rate, heart rate, blood pressure, and muscle tone.
These gradually drop if the application of cold is prolonged.
The reduction of nerve conduction velocity leads to a numbing effect that significantly reduces pain. If the cold persists,
vasodilatation and circulation are briefly stimulated.
Clients often have difficulty with cold applications and
pass through distinct stages that might feel uncomfortable.
The first stage is a sensation of cold that progresses to a feeling of itchiness or tingling. As the cold continues, the tissue
feels as if it is aching and burning. Eventually, numbness
replaces the uncomfortable feelings, and the client relaxes
toward the later stages of the treatment.
hydrotherapy treatments were explained. This section of this

chapter discusses how to clean and sanitize hydrotherapy
equipment, how to recognize contraindications and adapt
sessions to ensure client safety, and how to apply common
hydrotherapy treatments.
Effects of Neutral Temperatures

Neutral applications are administered at or close to normal
body temperature and produce a tonic and balancing effect
in most clients. These types of applications are used to soothe
the nervous system and can be an effective treatment for
insomnia, nervous irritability, anxiety, or depression. Neutral
applications are sometimes used at the beginning or end of
a hot or cold application to help the body ease into or out of
more extreme temperatures. The use of external applications
for therapeutic purposes at temperatures close to the bodys
normal temperature is sometimes called neutrotherapy.
In Chapter 3 (Client and Therapist Safety), you learned how to

prevent the transmission of disease by properly cleaning and
sanitizing the treatment room and paying attention to your
own hygiene and hand washing habits. Hydrotherapy equipment often requires rigorous cleaning and sanitation between
treatments. Showers, tubs, steam rooms, wet tables, and
soaking basins must be cleaned, sanitized, and dried between
clients. Soaking basins without jets are simply washed with
hot, soapy water; dried; sprayed with alcohol; and left to air
dry. If the soaking basin has jets, it must be flushed with an
approved disinfectant. Modern hydrotherapy tubs usually
come with a self-cleaning function that makes sanitizing the
tub jets easier. You put a concentrated disinfectant (formulated by the manufacturer of the tub) into a special holder
and then push a button. At the end of the cleaning cycle, you
simply dry the tub. Small, one-person steam cabinets should
be completely wiped out with an antiseptic between clients.
For larger steam rooms or steam showers, the floor and seats
should be sanitized between clients, but the walls can be left
until the end of the day. The floor and walls around hydrotherapy equipment must also be cleaned with an approved
disinfectant and dried after each use. Pay particular attention
to handrails and door handles (e.g., the handle of the steam
cabinet). Bath mats, bath towels, robes, washable slippers,
and hand towels are changed between clients.
Clients should shower before entering hydrotherapy
treatment pools to decrease the spread of waterborne infections. The clients hair should be secured or covered with a
cap before using hydrotherapy equipment including tubs,
steam rooms, wet tables, or showers. In the event of body
fluid spills (e.g., the client suddenly gets sick and vomits on the wet table), follow the procedures for Universal
Precautions outlined in Chapter 3.
Effects of Contrasting Temperatures

Contrasting applications involve applying a heat application and then a cold application to the same body area in an
alternating sequence. This creates a vascular flush in which
the tissues are pumped free of metabolic waste buildup
due to the alternating vasoconstriction and vasodilatation
of the peripheral blood vessels. Often, the treatment uses a
pattern of 3 minutes of heat to 1 minute of cold for three
rounds. The treatment always ends with a cold application to prevent congestion in the local tissue. Sometimes,
a longer rotation is used with a ratio of 10 to 15 minutes
for the hot application followed by 10 to 15 minutes of
a cold application. Again, the treatment ends with a cold
application. When using packs to apply heat and cold, it
works well to place a cold pack on the area of injury and a
hot pack proximal to the injury site close to the cold pack.
This relaxes the client and makes it easier to tolerate the
cold pack. Contrasting applications are used with immersion baths, partial baths, showers, and packs.
Earlier in the chapter, you learned about the history of
hydrotherapy and the characteristics of water that make it
therapeutically beneficial. Next, the changes that occur on
both a physiological and psychological level as a result of

Before you can offer hydrotherapy treatments, you will
want to understand these general considerations that
ensure your clients health and safety. Areas that require
particular attention include the sanitation of hydrotherapy
equipment and protocols that reduce the transmission of
germs and disease, safety issues, and cautions and contraindications to hydrotherapy services.
Cleanliness and Sanitation Guidelines for
Hydrotherapy Equipment
Safety Guidelines
Specific safety issues must be considered before you offer
hydrotherapy treatments:
Equipment: Check hydrotherapy equipment regularly
to ensure it is working properly. Maintain the equipment
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118
according to the manufacturers recommendations.

Dont allow bare electrical cords in wet rooms or any
areas where they might be exposed to water. Identify hot
equipment with a sign so that clients dont inadvertently
touch it. For example, the outside of a hydrocollator can
get very hot, and the heating units for saunas should be
surrounded with a grate.
Health history intake: Hydrotherapy applications
cause profound physiological changes in clients bodies.
Do not provide any hydrotherapy applications until you
have conducted a thorough health history intake process,
identified cautions, and ruled out contraindications.
Preparation: Install handrails around showers, wet
tables, and hydrotherapy tubs to ensure clients have
something solid to hold on to when they get into, out of,
or onto and off hydrotherapy equipment. Invest in robes
and disposable or washable slippers so that clients can
move about in warmth and comfort. Dont allow clients
to walk around the facility barefoot. Foot funguses can
be spread in this manner, and the client is more likely to
slip on a tile floor and sustain an injury.
Water spills: Water is often sloshed about during a
hydrotherapy treatment. For example, the area around
a wet table usually gets wet and slippery. Before allowing
clients to exit hydrotherapy equipment, take a moment
and dry the floor with a hand towel.
Oils and lotions: Clients who have had a massage or
who arrive at the clinic or spa covered in body lotion,
cream, or body oil should shower before using hydrotherapy tubs, saunas, pools, or steam rooms. The oil or
heavy cream can block perspiration and make it more
difficult for the body to detoxify. Clients are more likely
to slip when getting into and out of hydrotherapy equipment when covered in lubricants. Lotions and oils might
interact with a treatment product (such as mud, seaweed, essential oils) and decrease the effectiveness of the
session, or the client might leave a sticky residue on seats
and equipment making cleanup more difficult.
Prevent chills: Clients who are wet and exit either cold or
hot treatments may suddenly become chilled. As clients exit
hydrotherapy tubs, wet tables, steam rooms, and saunas,
wrap them in towels or a robe and get them entirely dried
off as soon as possible. Pay attention to the temperature of
treatment rooms and the facility so that clients stay warm.
Cold clients never respond well to cold treatments:
If a client is cold, dont put him or her into a cold treatment (e.g., cold plunge) or apply a cold application.
Warm the client before applying cold.
Dizziness and low blood sugar: Clients sometimes feel
a slight dizziness at the conclusion of the session, or low
blood sugar may cause shakiness. Make sure clients stay
hydrated during sessions by offering them water at regular intervals. Have packaged food items such as fitness
bars on hand in cases of shakiness. Educate clients not
to eat a heavy meal before a hydrotherapy session.
Temperatures: Use a thermometer to check the water
temperature in hydrotherapy tubs and permanently
mounted temperature gauges to monitor the temperature

in saunas and steam rooms. Never rely on how hot or
cold an application feels to you. Use a thermometer to
ensure you are working at the correct temperatures.
Timers: In some situations, the client should receive a
particular type of treatment only for a fixed amount of
time. Use timers with alarms to monitor the clients session time. If you rely on a clock, you may forget to check
the start time and leave a client in an application for too
long, endangering his or her health.
When used properly, hydrotherapy is safe for most clients.
Like massage, hydrotherapy treatments can be contraindicated completely, contraindicated without a physicians
release, contraindicated at a particular location on the
clients body, or require adaptive measures and increased
therapist vigilance. For example, in many full-body hydrotherapy treatments such as immersion in a hot bath, you
can decrease the cardiovascular load on the client by using
warm and cool applications rather than hot and cold ones.
The closer the temperature of the application to the clients
body temperature, the less intense the response will be.
In general, hydrotherapy is contraindicated for individuals who have serious heart, circulatory, nervous system, or
systemic conditions. Open wounds and skin rashes are also
contraindicated when using extremes of hot or cold. The
length of time that the client is exposed to the treatment
depends on the clients overall state of health and vitality.
Children, those in a weakened condition, the elderly, and
those with mental challenges may be contraindicated for
full-body treatments such as saunas, steam rooms, and
immersion baths. Children have thinner skin and become
overheated or chilled more easily than adults. Elderly clients have less subcutaneous adipose tissue and may be
burned by topical hot applications or chilled more easily
as a result. Blood vessels may not function efficiently, such
that repeated cycles of vasodilatation and vasoconstriction
may place a heavy burden on the circulatory system.
If the client seems healthy enough to benefit from such
treatments, or if treatments are conducted under the supervision or direction of a physician, start slowly. Begin with
10-minute sessions and progress up to 15-minute sessions.
Healthy individuals can remain in saunas, steam rooms,
and baths for 20 to 30 minutes. Very cold applications
longer than 20 minutes are not recommended for any client because of the risk for tissue damage, frostbite, or even
hypothermia. A client who is already cold will not benefit
from a cold treatment.
If a client feels light-headed, nauseous, headachy, or dizzy,
stop the treatment and monitor him or her while he or she
is relaxing in a quiet environment at a normal temperature
with a glass of water. If the clients symptoms increase or persist, consult a physician. If symptoms increase rapidly, contact emergency services because the client might be in danger.
Specific cautions and contraindications for hydrotherapy
applications are outlined in Table 63.
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TABLE 63 Cautions and Contraindications for Hydrotherapy

Acute inflammation
Warm and hot applications can increase swelling in injured tissue and thus are contraindicated. Cold applications are indicated.
Allergies
Check for allergies to any substances you dissolve into the water for the session. Allergies to iodine and shellfish indicate an allergy
to seaweed or products containing seaweed. Clients might also be allergic to herbs or essential oils, although this is rare.
Artificial devices
Hot or cold applications should not be applied over pacemakers, defibrillators, medication pumps, implants, or artificial devices.
Hot and cold applications may be indicated for use with hip and knee replacements.
Asthma
Avoid the use of cold applications on clients who have asthma. Ensure that clients with asthma do not get chilled or walk from a
hot environment such as a sauna to a very cool or cold environment such as an air-conditioned hallway. Movement from very
warm to cool environments can trigger asthma attacks.
Athletes
Athletes tend to have very low body fat and may be easily burned by topical hot applications or chilled by cold applications.
Use caution and monitor athletes carefully during sessions.
Autoimmune
conditions
Autoimmune conditions can flare up, causing contraindications for hydrotherapy applications, or a hydrotherapy application
might trigger a flare-up. Ask for a physicians release before providing hydrotherapy.
Cancer
Some types of cancer and cancer treatments cause the client to experience a condition that would not indicate hydrotherapy.
In other cases, hydrotherapy may prove beneficial. Discuss the particular treatment with the clients physician and obtain a
physicians release before providing hydrotherapy treatments.
Children
Children have thinner skin and become overheated or chilled more easily than adults. Avoid the use of extreme temperatures with
children, shorten applications, and monitor children closely. Dont apply hydrotherapy applications to infants or very young
children except under the guidance of a physician.
Decreased ability
to sense hot
and cold
Some pathologies and conditions including arteriosclerosis, nerve injuries, diabetes, spinal cord injuries, neuropathy, and multiple sclerosis decrease the clients ability to determine if something is too hot or too cold. In many situations, the extremities
are site-contraindicated, or you can choose warm and cool as opposed to hot and cold temperatures.
Diabetes
Diabetes can lead to cardiovascular diseases and affect the blood vessels in the legs and feet, depending on the way in which
the condition has been managed and its severity. Consult with the clients physician to determine if hydrotherapy applications
are contraindicated, site-contraindicated, or require adaptations. Obtain a physicians release before providing hydrotherapy.
Heart disease
Clients with heart disease such as coronary artery disease or congestive heart failure are likely to be contraindicated for hot
full-body treatments such as sauna and steam room use or baths. Medications may alter the way the heart functions, contraindicating cold applications. Consult with the clients physician and obtain a physicians release.
History of stroke
Clients with a history of stroke are contraindicated for full-body hydrotherapy such as saunas, baths, and steam rooms. Local, moderate applications such as a warm pack are likely to be safe. Consult with the clients physician and obtain a physicians release.
HIV/AIDS
The suitability of hydrotherapy applications for clients with HIV/AIDS depends on the condition of the individual. Consult with the
clients physician and obtain a physicians release.
Hypersensitivity to
hot or cold
Usually, treatments can be modified to temperatures that are warm and cool if the client has a hypersensitivity to hot or cold.
Hydrotherapy treatments should not be unpleasant, and you can adjust temperatures to suit the clients preferences.
Hypertension
At the beginning of both hot and cold full-body hydrotherapy applications, there is an initial spike in blood pressure that may
be dangerous for some clients. Additionally, clients are likely to be on medications that affect the way in which they respond
to hydrotherapy. Modify temperatures to warm and cool, consult with the clients physician, and obtain a physicians release
before providing hydrotherapy.
Hypotension
Hot or cold full-body hydrotherapy applications may cause fainting in clients with hypotension. Modify temperatures to warm and
cool, consult with the clients physician, and obtain a physicians release before providing hydrotherapy.
Lymphedema
Hot applications are contraindicated. Neutral and cold applications may be indicated, depending on the condition of the individual
client. For example, exercise in pools close to normal body temperature can be helpful. Consult with the clients physician and
obtain a physicians release before providing hydrotherapy.
Medications
Clients on various prescription medications may respond adversely to hydrotherapy applications. Consult with the clients physician and
obtain a physicians release before providing hot or cold full-body hydrotherapy (local applications are usually not contraindicated).
Mental conditions
Hot or cold full-body hydrotherapy applications should be provided to clients with mental conditions only under the direction of a
physician.
Multiple sclerosis
Hot applications can increase symptoms in people living with multiple sclerosis and are therefore contraindicated. Neutral and
cool applications are indicated.
Obesity
Because of the load on the cardiovascular system and because of the way in which adipose tissue holds heat and cold, extreme
hot or cold applications are contraindicated. Warm and cool applications are more appropriate. If the clients condition is weakened, consult with a physician and obtain a physicians release before providing hydrotherapy.
Osteoarthritis
In some cases, cold applications have caused an increase in symptoms in clients with osteoarthritis. Use cool applications or use
short applications of cold and monitor the clients responses carefully. Warm to hot applications are generally indicated.
Phlebitis
Hydrotherapy is contraindicated except under the direction and supervision of a physician.

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TABLE 63 Cautions and Contraindications for Hydrotherapy (continued)

Poor kidney
function
Cold applications are contraindicated.
Pregnancy
Hot full-body applications including baths, showers, saunas, and steams are contraindicated. Hot local applications to the
abdominal region are contraindicated. Cool or warm applications are usually not contraindicated, but it is best to consult with
the clients physician and obtain a physicians release.
Raynauds
syndrome
Cold applications are contraindicated.
Rheumatoid
arthritis
Hot and cold full-body applications are contraindicated. Warm local applications are contraindicated. Neutral and cool local
applications are safe.
Seizure disorders
Hot or cold full-body applications are contraindicated.
Skin conditions
Burns including sunburn, open wounds, rashes, and skin infections are contraindications for both full-body and local hydrotherapy applications. Because some skin conditions benefit from hydrotherapy, you should consult with the clients physician and
obtain a physicians release if the condition is pronounced or covers a large body area.
The elderly
Elderly clients are more likely to have less adipose tissue and prone to burns or chills from hydrotherapy applications. The heart and
circulatory system may not be strong enough to cope with the cardiovascular load caused by full-body applications. If the client
seems healthy enough to benefit from hydrotherapy, consult with the physician and obtain a physicians release.
Thyroid disorders
Regular hot or cold full-body applications are contraindicated for clients with thyroid disorders. Local applications are generally safe.
Varicose veins
Varicose veins are site contraindications for hot and cold packs. If the client has severe varicose veins, full-body applications such as
hot or cold baths may be contraindicated. Consult with a physician if you are unsure about the correct way to proceed with the client.
Common methods of application include hot, warm, or cold
packs, local applications such as ice massage and mustard
plasters, therapeutic showers and immersion baths, hot air
baths, friction treatments, and specialized body wraps. In
a wellness setting, hydrotherapy is most often used to relax
the client, revitalize the body, or remove a treatment product such as mud or seaweed. In medical spas, certain types
of wellness centers, many European spas, massage clinics,
and private massage practices, hydrotherapy applications
might not only be used for relaxation but also for condition
management or injury rehabilitation.
Hydrotherapy Packs and Compresses
Pack is a general term for any local hydrotherapy treatment
(hot, warm, cool, or cold) that uses a gel pack, hydrocollator
pack, fomentation pack (moist heat), or commercially made
chemical pack. Some packs are electric, some are heated
in the microwave, some are chilled in a freezer, and some
require specialized equipment. Probably the most effective
hot pack is the hydrocollator pack shown in Figure 61.
This type of pack has a canvas casing filled with either silicon granules or clay particles that can hold moist heat for
up to 30 minutes. These packs are submerged in water kept
at 65F in a specialized heating unit called a hydrocollator. Hot and warm packs are most often used to relax tense
muscles, keep the client warm and comfortable, or soften
tissue before massage is performed.
To apply a hot pack, remove the pack from the hydrocollator using tongs or thermal gloves and wrap it in a minimum of four to six layers of thick towels. Place the bundle
on the area to be treated for up to 20 minutes. Monitor the
FIGURE 61 Hot pack. To apply a hot pack, remove the pack from the
hydrocollator using tongs or thermal gloves and wrap it in a minimum of
four to six layers of thick towels.
10/24/13 1:17 AM
FIGURE 62 Cold packs. Gel-filled commercial packs or homemade ice

packs can be used effectively as cold packs
pack constantly by lifting it every 5 minutes to check the

skin for extreme redness so that it does not burn the client.
Clients should never lie on top of hydrocollator packs.
Gel-filled commercial packs or homemade ice packs can
be used effectively as cold packs (Fig. 62). In fact, large
bags of frozen peas make an effective cold pack because the
small size of the peas feels lighter on an injury site than ice
in a plastic ziplock bag or large ice cubes. Gel-filled packs
are also useful because they dont freeze in a solid block and
can be shaped to fit a body area. Cold packs are an effective
treatment for acute inflammation or after a massage treatment using friction techniques. Apply cold packs on top of
a thin layer of insulation (rather than the thick layer used
with a hot pack) for up to 20 minutes.
Compresses are wet cloths soaked in warm, hot, cool,
or cold water (sometimes with additives dissolved in the
water) and wrung out before they are applied to the skin.
Compresses are used to provide comfort or enhance the
enjoyment of a session. A cool compress might be placed
over a clients forehead while he or she is wrapped in a detoxification wrap. Alternately, a warm compress might
be applied to the back of the neck, whereas a cold pack is
placed on a shoulder injury. The compress helps the client
deal more easily with the cold of the cold pack.
Local Applications
You might use a variety of local hydrotherapy applications
for condition management or injury treatments. Ice massage, mustard plasters, castor oil packs, and paraffin dips
are popular.
Ice massage is massage provided with ice. A paper cup is
filled with water and frozen. The edges of the cup are then
121
peeled away while the base of the cup is left intact. Hold on
to the base of the cup while applying the ice to the affected
area in a circular motion. Ice massage of an area can last
up to 20 minutes and is used to reduce inflammation during the acute inflammatory stage or to cool tissue after using intensive heat-producing techniques such as friction.
The term plaster refers to herbal pastes (herbs mixed with
either water or oil) that are spread on a particular body area
or onto a piece of cloth that is then applied to a particular
body region. Mustard plasters are warming and useful for
the treatment of osteoarthritis, poor circulation, back stiffness, joint stiffness, and general muscular aches and pains.
To make a mustard plaster, mix 1 tbsp of mustard seed
powder and 4 tbsp of wheat flour with warm water until
you have a paste of medium consistency. Spread the paste
onto a muslin or cotton cloth and place it over the region
being treated. Because a mustard plaster gets hot and can
even blister the skin, monitor it constantly. Cover the plaster with a warm pack to increase the therapeutic benefits of
the application. Mustard plasters can irritate sensitive skin.
Castor oil packs and castor oil applications have been
used in both European folk medicine and ayurvedic medicine (the traditional medical system of India) for centuries
to increase blood and lymph circulation, relax tight muscles,
reduce pain, ease joint stiffness, and break down scar tissue.
Castor oil is extracted from castor beans and is high in the
fatty acid ricinoleic acid. It is believed to support natural detoxification in the body. Apply castor oil to the affected area
in a thick layer and cover it with plastic wrap. Place a hand
towel and an electric heating pack over the top of the plastic.
The castor oil pack can be left in place for 30 to 45 minutes.
As you learned earlier, paraffin is a waxy substance
obtained from the distillates of wood, coal, petroleum, or
shale oil. It is used to coat the skin and trap heat and moisture at the skins surface. This increases circulation and
softens the local tissue, which improves joint mobility and
decreases pain. A paraffin dip is an effective treatment for
chronic arthritis, tight muscles, and painful joints. It also
leaves the skin soft, and it feels warm and sumptuous. To
apply paraffin to the hands or feet, first wash the area to be
dipped or mist the area with alcohol so that it is properly
sanitized. Dip the hand or foot into the paraffin and allow
the paraffin to harden slightly before dipping the area again.
Dipping up to five times should be sufficient. Wrap the paraffin-covered hand or foot in cellophane wrap or a plastic
bag before placing it into a heated mitt or a warm towel.
To remove the paraffin, simply peel off the cellophane wrap
together with the wax all in one piece. The hands can be
dipped while the client is on the table in the prone or semireclined position. The feet can be dipped while the client is
on the table in the supine position.
Therapeutic Baths
Therapeutic baths (sometimes called balneotherapy) encompass a range of different hydrotherapy methods including foot baths, whirlpool baths, steam baths, saunas, full
immersion baths, partial baths, and sitz baths (Table 64).
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TABLE 64 Therapeutic Baths

BATH TYPE
LOCATION
TEMPERATURE
TIME
Partial
Feet
Warm to hot
(98110F)
1020 minutes
Cold feet, menstrual cramps, arthritis, gout, migraine headache,

insomnia, sinus congestion, relaxation, to warm a chilled client, to warm a client in preparation for a detoxification treatment
Cool to cold
(9855F)
115 minutes
To revitalize and stimulate the body, to cool the body, to reduce

inflammation from an injury to the feet or lower legs
Contrasting hot
(110115F)
with cold (50F)
2 minutes hot/
1 minute cold/
3 rounds and
end with cold
Poor circulation, repair stage in the inflammatory process for

a lower leg injury such as an ankle sprain, to revitalize and
stimulate the body
Warm to hot
(98110F)
1020 minutes
Cold hands, arthritis, hand fatigue, hand or arm injury in the

maturation stage of inflammation
Cool to cold
(9855F)
115 minutes
Inflammation from acute injury, hand fatigue
Contrasting hot
(110115F)
with cold (50F)
2 minutes hot/
1 minute cold/
3 rounds and
end with cold
Hand or wrist injury in the repair stage of the inflammatory

process, hand fatigue, arthritis
Hand
INDICATIONS
Paraffin dip
Feet or hands Hot (122126F)
1520 minutes
Hand, wrist, foot, or ankle soreness or stiffness; poor circulation;

to warm tissue and aid scar tissue reduction in the repair or
maturation stage of the inflammatory process for injury; hand or
foot fatigue; cold hands or feet
Full-body
immersions
Whole body
Warm to hot
(98110F)
520 minutes
To relax muscle tissue, soften fascia, and increase circulation; for

relaxation (warm); to decrease pain
Cool to cold
(9855F)
12 minutes
To stimulate and revitalize the body, to cool the body after a hot
treatment
Neutral (9498F)
1020 minutes
To reduce anxiety, insomnia, and depression; to provide gentle

revitalization
Epsom salt bath
Whole body
Warm (98104F)
1520 minutes
Sore and stiff muscles or joints, general fatigue, insomnia,

anxiety, general detoxification
Oatmeal bath
Whole body
Warm (98104F)
1520 minutes
Skin irritation, skin conditions, rashes, itchy skin, to soften

the skin
Baking soda bath
Whole body
Warm (98104F)
1520 minutes
Skin irritation, skin conditions, rashes, itchy skin, to soften

the skin
Sea salt bath
Whole body
Warm (98104F)
1520 minutes
General revitalization and detoxification, as part of the rehabilitation process for a soft tissue or bone injury
Mustard bath
Whole body
Warm (98104F)
1520 minutes
Sore and stiff muscles or joints, back pain, general detoxification
Herbal bath
Whole body
Warm (98104F)
1520 minutes
Effects depend on the herbs are used in the bath; skin soothing,
muscle soothing, revitalizing, and sedative herbs might be
chosen
Aromatherapy
bath
Whole body
Warm (98104F)
1520 minutes
Effects depend on the oils used in the bath; skin soothing, muscle
soothing, revitalizing, and sedative oils might be chosen
Thalassotherapy
bath (seaweed)
Whole body
Warm (98104F)
1520 minutes
To promote weight loss and detoxification, for general fatigue or

mental burnout, to stimulate circulation and firm skin, and to
revitalize the body
Fangotherapy
bath
Whole body
Warm (98104F)
1520 minutes
Sore and stiff muscles, joint pain, back pain, to soften and
condition skin
Steam bath
Whole body
104F with
100% humidity
520 minutes
To warm the body, for detoxification, to increase circulation, for

sore or stiff muscles, for joint stiffness or pain, for general relaxation, to unblock congested skin, for certain skin conditions
Sauna
Whole body
145200F with 6%
to 8% humidity
520 minutes
To warm the body, for detoxification, to increase circulation,

for sore or stiff muscles, for joint stiffness or pain, for general
relaxation, for certain skin conditions
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123
Hydrotherapy tubs with multiple air and water jets are

designed for professional use and are used to apply full
immersion baths. Additives are often used with baths to
increase their therapeutic benefits.
Foot Baths
Foot baths ease foot fatigue or pain, cleanse the feet,
warm the body, and relax the client in preparation for
a massage or spa service (Fig. 63). Sometimes, they are
used therapeutically to draw fluids down toward the feet
as in a foot bath delivered to reduce sinus congestion.
Massage therapists often use foot baths as a complementary treat for the client while the client fills out paperwork before the session. Some clinics encourage clients
to arrive early and relax with a foot bath in a quiet room
where soothing music, a cup of warm herbal tea, and
dim lights to facilitate the process of releasing tension. A
therapist might start every massage with a 5-minute foot
bath while the clients neck and shoulders are massaged
in a seated position.
Prepare the foot bath by placing warm (not hot) water
in a soaking basin. One or two additives such as cup of
Epsom salt (for foot pain), cup of sea salt (energizing),
bubble bath (cleansing), herbal infusions (detoxifying),
3 drops of essential oil (properties based on the oil), or powered milk (relaxing) add to the experience. Place the basin in
front of a comfortable chair on top of a bath towel. A cup
of warm herbal tea on a side table is a nice touch. The client relaxes with the feet in the soak while you massage the
shoulders, neck, and scalp. It works well to have the client
FIGURE 63 Foot baths ease foot fatigue or pain, cleanse the feet,
warm the body, and relax the client in preparation for a massage or spa
treatment.
FIGURE 64 Some therapists deliver the foot bath with the client
seated on the massage table. This way the client can simply lean back,
and the session can start.
change into a robe before the soak; otherwise, having to roll

up pant legs can be inconvenient and defeat the purpose of
the soak, which is to relax the client. At the conclusion of
the soak, ask the client to lift his or her feet from the basin.
Remove the basin and have the client place his or her wet
feet on the preset bath towel. Dry the clients feet by bringing the bath towel up and around the feet. Then move the
client to the massage table.
Some therapists deliver the soak with the client seated on
the massage table (Fig. 64). This way the client can simply
lean back, and the session can start. Notice that the client
wears a robe and that the drape is placed over the clients
lap. The client then removes the robe under the drape and
hands it to you.
Full-Body Baths
Full-body baths include whirlpool, steam, sauna, and full
immersion baths. Whirlpool baths contain turbines that
mix air with water. The agitated water is directed at specific
body areas so that soft tissues are manipulated by the force
of the water hitting the body.
Steam baths, steam showers, steam cabinets, and saunas
are considered hot air baths because the client is bathing
in water vapor. Steam baths use steam to facilitate perspiration and help the body to detoxify. Steam baths are often
applied before another treatment to warm and relax the
muscles or before the application of a particular product.
They are also used to clear the sinuses and respiratory congestion or to clear clogged and congested skin.
To prepare for a steam bath, the client should change
into a swimsuit or disposable undergarments for the session and take a shower to remove any oils or lotions from
the skin. Place a towel on the seat and floor of the steam
cabinet and close the door when the client sits down. Place
a towel around the clients neck to keep steam from escaping out the top of the cabinet. Set the timer for the session
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124
based on the clients health and treatment goals. At the end

of the session, offer the client water and wrap him or her
quickly in a robe or towel to prevent chilling.
A steam canopy fits over the top of a wet table or massage table and can be used in place of a blanket or thermal
space blanket for body wraps. Cover the massage table with
a plastic table protector and a large bath towel. With the client relaxing on the towel, lower the canopy into place. Wrap
a towel around the clients neck to prevent steam from
escaping out the top of the canopy and set the timer for the
session based on the clients health and treatment goals. At
the end of the session, cover the client in a robe or towels to
prevent chilling and offer a glass of water.
Saunas combine hot air (60 to 210F) with low humidity to stimulate metabolism, increase core body temperature, and facilitate detoxification (Fig. 65). They are
useful as a support treatment for a number of different
conditions. For example, people living with chronic fatigue
syndrome often experience debilitating feelings of fatigue,
musculoskeletal pain, and low-grade fever. One study
found that regular use of a sauna improved these symptoms significantly.17 The humidity in a sauna must not be
allowed to drop below 10%, or else, the hot air will start to
dry out the mucous membranes of the respiratory system.
Like a steam bath, a sauna can be used to preheat the body
in preparation for another treatment.
To prepare for a sauna, ask the client to change into a
swimsuit or disposable undergarments for the session and
to take a warm shower to remove any lotions or oils. Place
a bath towel on the sauna seat and have the client sit or recline on the towel. Set the timer for the session based on the
clients health and treatment goals. At the end of the session, the client can take a cool, warm, or graduated shower
to cool down. Wrap the client in a robe or towels to prevent
chilling and offer a glass of water.
FIGURE 65 Sauna. Saunas combine hot air (60 to 210F) with low
humidity to stimulate metabolism, increase core body temperature, and
facilitate detoxification.
FIGURE 66 Full immersion baths use hot, warm, neutral, or cool

temperatures and pressure from water jets for therapeutic purposes.
Full immersion baths use hot, warm, neutral, or cool

temperatures and pressure from water jets for therapeutic purposes. Many treatments also use additives such as
seaweed, essential oils, or herbs to increase the therapeutic
value of the service or to achieve specific treatment goals
(Fig. 66).
To prepare for a session using a hydrotherapy tub, ask
the client to change into a swimming suit or disposable
undergarments for the bath. As you fill the tub, monitor
the temperature with a thermometer so that the bath is
hot, warm, neutral, cool, or cold, depending on your treatment goals. Help the client into the tub. If the application is hot, it is useful to have the client get into the tub
when it is half full of warm water and then fill the tub the
rest of the way with hot water to the desired temperature.
Place a towel behind the clients neck for support and set
the timer.
Professional hydrotherapy tubs have an underwater
massage hose that uses air pressure aimed at specific body
areas to improve circulation and lymph flow. Begin the
underwater massage by pointing the hose at the plantar
surface of the foot and work your way up and over the top
of the foot in small circles. Continue up the medial leg
and then return to the foot and repeat the process, this
time working up the lateral leg. Then direct the air flow
from the hose from the distal area of the body toward the
proximal area of the body. Work up the lateral leg and ask
the client to shift slightly to the side so that the gluteals
and back are treated. Treat both sides of the lower body
before moving to the upper body. Ask the client to lie low
enough in the water for the shoulders and neck to be treated; the hose will splash if it is not kept under the surface
of the water.
Partial Baths
Partial baths involve the submersion of body areas such as
the feet, legs, arms, or hands into baths of water heated to
specific temperatures. A sitz bath is a type of partial bath in
10/24/13 1:17 AM
which the patient sits in water that comes up to the navel

but no higher. Naturopathic doctors use it to treat reproductive or urinary disorders.
Therapeutic Showers
Chapter 5 (Foundation Skills for Spa Treatment Delivery) introduces the use of therapeutic showers for product
removal and demonstrates the use of a Swiss shower, Vichy
shower, handheld shower, and standard shower (Fig. 67).
Therapeutic showers use hot, warm, cool, or cold temperatures to facilitate desired physiological and reflex effects.
Often, they are used to warm the body in preparation for
another treatment or to cool the body at the end of a treatment. Swiss and Vichy showers have control panels with
which you can manage the temperature of the water. In
a standard home shower in which the client controls the
water temperature, the temperature will not be exact or provide the same benefits.
Hot showers (100 to 104F) are stimulating and pain
relieving. They might also be used to raise the core body
temperature of the client in preparation for another service
such as an herbal detoxification wrap. A hot shower begins
at 100F. As the client acclimates to the temperature, it is
gradually increased. A healthy client may tolerate very hot
temperatures up to 110F, but the temperature should not
exceed 110F. The hottest temperature that is safe and tolerable for the individual client is held for 2 minutes and
then decreased rapidly to a neutral temperature to end the
shower.
FIGURE 67 A Vichy shower is a therapeutic shower that rains water

onto the client from above a wet table.
125
A graduated shower is used to cool the body after a prolonged heating treatment such as a steam bath or sauna.
The water temperature begins at 102F and is increased
quickly to the tolerance of the client. The elevated temperature is held for 2 minutes and then lowered at intervals.
Each interval is held for 1 to 3 minutes. The final ending
temperature is in the range of 80 to 85F. This temperature is held for 4 minutes to finish the shower.
Cold showers (56 to 70F) are stimulating and toning
for muscles and skin. They are often used to refresh the
body after the application of a treatment that heats the
body. They are short and used only on healthy individuals
with no contraindications.
Hot and cold contrast showers stimulate metabolism,
increase circulation, and revitalize the body. They are effective for fatigue, mental burnout, and low energy. Hot and
cold temperatures are reversed for three sets of one interval
each; the timing per interval ranges from 1 to 3 minutes.
The treatment ends on the cold water setting.
A Scotch hose directs a strong stream of water at the
client to increase circulation, stimulate function, tone muscles, decrease pain, and decrease congestion in a particular
body area. It is an effective treatment to use on areas that
are prone to poor circulation (Fig. 68).
Ask the client to change into a swimsuit and then stand
at the end of the wet room holding onto the handles attached to the wall. Direct the pressurized stream of water
over the clients body in the sequence as shown on this
diagram (Fig. 69). Start with a warm water temperature,
and graduate to hot for 1 minute. Then shift between
contrasting hot and cold temperatures. The pressure of
the hose can also be controlled based on the clients level
of comfort with the pressure. Avoiding the breasts and
FIGURE 68 Scotch hose. This is an image of the type of Scotch hose

used in a spa.
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126
FIGURE 610 Cold mitt friction. Cold mitt friction is still widely used
to prevent colds, boost immunity, increase circulation, increase endurance, and invigorate the body.
face, use long, smooth movements from the feet to the

shoulders.
table under a drape beginning in either the prone or supine

position. Place the terry mitts on your hands and dip them
into ice water. Rub him or her vigorously over the selected
body area with a back-and-forth motion. Then rub the area
dry with hand towels and drape the area just treated. Move
onto the next body area. Depending on the clients health
and the treatment goals, you may treat one body area or
many areas in a session. If the client is shivering and cold,
end the treatment.
Friction Treatments
Body Wraps and Wet Sheets
We will discuss salt glows, dry skin brushing, and loofah

scrubs in depth in Chapter 8 (Exfoliation Treatments). Each
of these treatments traces its origin back to the traditional
methods of Sebastian Kneipp. Kneipps classic frictions
were carefully chosen for each patient. Frictions could be
delivered soft and dry with the palms flat; covered in powder; buffed across the skin to warm and invigorate, or wet
and brisk, with water, vinegar, or rubbing alcohol mixed
with salt.
Cold mitt friction is still widely used to prevent colds,
boost immunity, increase circulation, increase endurance,
and invigorate the body (Fig. 610). To perform a cold mitt
friction treatment, ask the client to recline on a massage
Like frictions, body wraps, which we will discuss in depth in

Chapter 9 (Body Wraps), originated in Kneipp hydrotherapy. One of his most famous body wraps was the cold wet
sheet wrap. Kneipp believed that this treatment strengthened the patients body so that it could overcome a disease
or resist diseases. Kneipps patients lay on a cold wet sheet
or were covered with a cold wet sheet and then wrapped
in blankets for up to an hour.5 The patient would experience a vascular flush effect in which body temperature was
elevated so that the patient perspired. Kneipp used cold
wet sheet wraps successfully for menstrual cramps, digestive complaints, fever, weakness, lower back pain, and for
general revitalization.
Start
Start
FIGURE 69 Scotch hose application. Direct the pressurized stream

of water over the clients body in the sequence as shown on this diagram
when delivering a Scotch hose application.
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127
SPA FUSION
STUDY TIP: Fact Sheets
When you start to provide treatments with fixed
protocols, like many of the treatments that make up
hydrotherapy and spa work, it is helpful to develop
one-page fact sheets that outline pertinent information about the treatment (see the samples at the
back of this book). For example, write these headings equally spaced down one side of a blank page:
Indications, Cautions, Contraindications, Temperature Range, Time Frame, and Procedural Steps. Now
title the page with the name of the treatment, such
as Full Immersion Hot Bath, and write the key
information under each heading. Keep these fact
sheets in a binder. They are useful when preparing for an exam and may prove even more valuable
when you finish school and deliver the treatment at
a clinic or spa.
SPA INSPIRATION: Self-care with Hydrotherapy

Many of the hydrotherapy treatments you provide
clients at a spa or massage clinic you can try at home.
For example, get in the shower and gradually increase
the water temperature until it is as hot as you can
tolerate it safely for 2 minutes; then rapidly turn the
shower to cold for 1 minute. Repeat this cycle three
times and end with 1 minute of cold. Get out of the
shower and dry off briskly. How do you feel? You can
learn a lot by playing with different temperatures at
home and keeping track of your physiological and
psychological reactions in a journal. Remember to
check your own health history for contraindications
and check with your physician before experimenting
if you think any of the treatments might cause you to
experience adverse reactions.
ITS TRUE! Hydrotherapy Improves Physical

Performance for People with Osteoarthritis
Researchers studied 152 older persons with chronic
symptomatic hip or knee osteoarthritis to determine
if hydrotherapy or Tai Chi classes were more helpful
in managing their symptoms. Pain, physical function,
general health, psychological well-being, and physical
performance were assessed at 12 and 24 weeks in both
the hydrotherapy group and Tai Chi group. Although
both groups had improved scores, the hydrotherapy
group showed significantly greater improvement
at 12 weeks. Furthermore, the hydrotherapy group
continued to demonstrate improvements at 24 weeks,

whereas the Tai Chi group remained relatively the
same. Researchers noted that this difference probably
occurred because the hydrotherapy group had regular
session attendance, whereas 40% of the Tai Chi group
missed multiple classes.18
CHAPTER WRAP-UP
One predominant theme has ran throughout this
chapter: Most people like water. They like to swim
in it; they like to soak in it; they like to stand in it;
they like to have it sprayed on them; and they like
the moist, comforting warmth of a hot pack on their
shoulders, lower back, feet, and just about everywhere
else. Water generally conveys a sense of wellness and
health. It simply makes most people feel better. Think
about this as you enter your massage and spa career.
Whether you work in a clinic, a fancy spa, a chiropractors office, or a private practice and whether you
practice wellness massage and spa or health care massage and spa, many clients like waterand this gives
you a powerful way to boost the benefits your clients
receive from your sessions. Offer to apply a warm or
hot pack to a clients low back, even if they dont have
low back pain. Offer a foot soak to a client as he or she
fills out health intake forms, even if he or she doesnt
have sinus pressure or tired feet. Offer to place a cool
compress on a clients forehead on warm days. Offer
free paraffin dips to a client, even if he or she doesnt
have arthritis. Most people like water, and water is
good for people, and now you know how to use water
therapeutically.
REVIEW QUESTIONS
Multiple Choice
1. Hydrotherapy is best defined as:
a.
b.
c.
d.
The use of wet sheet wraps for healing

The use of hot temperatures for healing
The use of hydrocollator packs for healing
The use of water for healing
2. Hydrotherapy is traditionally used in three forms.

These are:
a.
b.
c.
d.
Solid, liquid, vapor

Vapor, syrup, herbal concoction
Ice, herbal rub, liquid
Steam bath, friction rub, ice
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128
SPA FUSION
3. The polar bear plunge is a form of hydrotherapy. It
is best described by the word:
a.
b.
c.
d.
Thermotherapy
Cryotherapy
Neurotherapy
Aromatherapy
4. The hunting reaction could best be described as:

a. Never-ending vasoconstriction
b. Never-ending vasodilatation
c. Vasoconstriction of the heart with prolonged
applications of cold
d. Alternating cycles of vasoconstriction and vasodilatation with prolonged applications of cold
5. There are two types of effects that occur with
hydrotherapy applications. These are:
a.
b.
c.
d.
Cold and hot effects

Tonic and nontonic effects
Physiological and reflexive effects
Reflexive and psychosomatic effects
Fill in the Blank

6. The greater the
differences between
the body and the water, the greater the physiological effect on the body.
7. The
of the application will influence the physiological effect on the body.
8. The
the body area treated, the
greater the physiological effect on the body.
9. A
effect occurs because of a nervous system response to the treatment.
10. Physiological effects occur with hydrotherapy
applications because the body is trying to
.
maintain
10/24/13 1:17 AM
7
Introduction to
Aromatherapy for Spa
Chapter Outline
K e y Te r m s

Essential Oils
Aromatherapy: The use of essential oils for healing.

Essential oils: Volatile plant oils extracted from certain aromatic
plants that have both physiological and psychological effects on the
human body.
Fixed oils: Vegetable oils that are nonvolatile such as sweet almond or
sunflower. Essential oils readily dissolve into fixed oils, so fixed oils are
often used as a carrier for essential oils.
Functional group: A reactive oxygen or nitrogen-containing unit of a
chemical compound (in an essential oil).
Learned-odor response: A response that occurs when an odor is paired
with a person, place, or thing, and a memory link is formed.
Limbic system: The oldest part of the brain where olfactory signals
activate smell-related responses.
Olfactory response: Olfaction is the sense of smell. An olfactory response
refers to the mental, emotional, or spiritual changes that may be
elicited by an aroma.
Oxidation: A reaction that occurs when the chemicals in essential oils
interact with the oxygen that is present in the air. This results in degradation of the oil.
Quenching: Process that occurs when the action of one compound in an
essential oil is suppressed by another compound, thereby making the
oil safer for use.
Synergy: When the whole is greater than the sum of its parts and those
parts are mutually enhancing.
Volatility: The rate at which a compound turns from a liquid to a gas at
room temperature (i.e., when it evaporates).
Safety Considerations
The Physiological and Psychological Effects of

Essential Oils

Carrier Products
Essential Oil Concentrations
Synergy
Approach to Blending
Application Methods
Inhalations
Aromatic Exfoliations and Body Shampoos
Aromatherapy Massage
Aromatherapy Baths
Aromatherapy Wraps
Aroma Mists and Aura Mists
Support Lotions
S
SPA
FUSION
STUDY TIP: Botanical Flash Cards
CHAPTER WRAP-UP
129
10/24/13 1:18 AM
130
Aromatherapy is both a complex area of study and a
simple enhancing technique that can be added to any spa
Looking at the many definitions of aromatherapy offered

by different authors, one that comes very close to describing
the reality of practice is that of Jade Shutes, president of
NAHA (20002004). She defines aromatherapy as follows:
Aromatherapy is the art and science of healing body, mind,
and spirit through essential oils.
Each client is unique, so an aromatherapist must reflect
on and synthesize numerous pieces of information when
determining the best form of essential oil support for a
client. This requires intuition, creativity, and the ability to
process information abstractly and then form it into a support plan. In other words, the practice of aromatherapy is
an art.
Aromatherapy is also a science. Essential oils are composed
of a complex mixture of chemical compounds, and the
skilled aromatherapist will select oils for a treatment based
on their known biological effects (Fig. 71). Understanding
the effects of different oils on the human body requires
rigorous study and careful observation over time. The
experienced practitioner will know that some compounds
can have negative effects on the human body under particular conditions, so understanding how to select and blend
different oils is both an art and a science.
Lastly, aromatherapy not only affects the body but also
the mind and the spirit. The psychological effect of essential
oils on the mind and spirit are based on the often powerful
emotions and memories elicited by an aroma.
Essential oils are regularly used for their relaxing effects and to ensure that the treatment area is clean and
healthy. It is important to point out that different types of
health care providers may use essential oils in quite different ways. Medical doctors in France can legally prescribe
essential oils to be taken internally for a specific pharmacological effect.2 This type of use is not often seen in a spa
service. The goal of this chapter is to provide an overview of

the topic and some guidance on safe and effective ways to use
essential oils in a spa for those without extensive training.
The National Association of Holistic Aromatherapy (NAHA)
suggests a formal course of study of no less than 230 hours
for professional therapists.1 A number of comprehensive
programs are described in the resources section at the
back of the book. Also at the back of the book is a chart
listing common names of essential oils with their botanical
names to help therapists order the correct oil indicated in
the text. In certain instances, the Latin names will be given
in the text to provide clarity. This is to prevent confusion
because sometimes the common name refers to more than
one botanical species, or very similar common names are
used for different species. For example, the common name
sage can cause problems. Common sage (Salvia officinalis) is
used differently than clary sage (Salvia sclarea) and Spanish
sage (Salvia lavandulifolia). Common sage contains up
to 42% thujone, a potentially dangerous ketone that is
contraindicated for the elderly, pregnant women, those
who are in a weakened condition, and children. Although
common sage is not dangerous when applied topically in
low concentration to healthy individuals, it does contain
methyl chavicol, which can cause skin irritation. Clary sage
Linalyl acetate (ester)

sedative
contains 75% esters, which support relaxation and stress

reduction and are safe for liberal use. Spanish sage contains
camphor and cineol, making it the best of the three oils for
respiratory support.
Limonene
(monoterpene)
antiviral
Clary sage
It is important to note that essential oils are not meant

to take the place of professional medical treatments and
should be used by massage therapists to provide general
1,8, cineole
(oxide)
expectorant
Caryophyllenal
(aldehyde)
anti-inflammatory
Linalool
(alcohol)
stimulant
support for their clients. Although blends can be created

that directly address the symptoms of many conditions,
therapists must always be careful not to make false claims
or go beyond their scope of practice.
Camphor (ketone)
mucolytic
FIGURE 71 Essential oils are chemically complex. This diagram represents some of the chemical components that are found in clary sage and
their general properties.
10/24/13 1:18 AM
Chapter 7
setting. More often, the oils will be used by massage therapists, counselors or life coaches, and estheticians. Massage
therapists focus on topical applications of essential oils for
stress reduction, injury rehabilitation, detoxification, and
to help reduce chronic symptoms associated with an underlying soft tissue pathology. Psychologists, counselors,
and life coaches focus on inhalations of essential oils to reduce anxiety, facilitate emotional clearing, dissipate defensive relating, improve moods, or to associate a scent with a
positive experience for use as a resource in latter sessions.
Finally, estheticians will often use professional skin care
lines that incorporate essential oils as active ingredients to
increase the therapeutic benefits of skin care applications.
(e.g., Aveda, Decelor).
Aromatherapy can be viewed as the primary treatment
(e.g., aromatherapy massage, aromatherapy wrap) or as accent notes in treatments with a different focus (e.g., aroma
mists, cellulite cream, aromatic foot soak). All of these
uses enhance the spa experience. Figure 72 lists six easy
ways that aromatherapy can be added to any treatment,
whereas Figure 73 provides an overview of aromatherapy
treatments that are common in spas. As Susan Irvine writes
in The Mystery of Perfume, Scent passes under doors, seeps
through walls, crosses boundaries. It is the un-containable,
the symbol of being between one State and another.3
Essential Oils
Essential oils are complex mixtures of chemical compounds
that are found in aromatic plants. The compounds
contained in essential oils are mostly terpenes, a class of
chemical compound that is quite toxic to living plant
tissues, so they must be stored in specialized structures
such as glands, ducts, scales, and hairs (Fig. 74).
Most essential oil compounds are volatile to some degree,
depending on how many carbon atoms they have or, in other
words, their molecular size. Small molecules tend to be more
volatile than larger molecules. The term volatility refers to
the rate at which compounds turn from a liquid to a gas at
room temperature and evaporate.
The specialized structures storing essential oils can be
found in the leaves or needles, twig, bark, flowers, flower
buds, fruits, stems, roots, or, sometimes, as in the conifers,
all organs of the plant (Fig. 75). They are usually extracted
from fresh plant material using steam distillation, carbon
dioxide (CO2) hyperbolic production, solvent extraction, or
physical expression (Table 71). On average, most essential
oil species contain about 1% to 2% of their fresh weight in
essential oils. In some species of Eucalyptus, up to 10% of
the fresh weight of the leaves consists of essential oil (100 lb
of Eucalyptus leaves may yield up to 1 lb of oil). In rose and
jasmine, the essential oil is nearly all found in the petals,
so the yields are very low. For example, 60,000 whole rose
flowers produce about 1 fl oz (30 ml) of oil, a yield of about
Introduction to Aromatherapy for Spa
131
0.05% of the fresh weight on average. It is no surprise then

that rose and jasmine are quite expensive, whereas Eucalyptus is inexpensive and readily available.
Many factors affect the chemical composition and therefore the therapeutic value of an essential oil. The chemical
composition can vary greatly, depending on climate, soil
conditions, air quality, and the variety or cultivar of the
plant being grown; the cultivation, harvesting, and extraction methods being used; the storage and transportation
conditions; and the age of the oil. No chemical compound
is likely to be present in any essential oil in exactly the same
proportion from 1 year to the next. The acceptable range
in the percentage of the main chemical constituents present in most commercial essential oils has been defined by
the International Organization for Standardization (ISO).
The purpose of the ISO standards is to describe the normal range of variability in the oil so that users can compare
samples with an agreed standard. Essential oils are costly to
produce, so they are often adulterated to increase the profit
margin of the grower or supplier.
Professional aromatherapists notice that the human
body responds differently to natural oils than to synthetic
oils. This is probably due to the relative chemical simplicity of synthetic oils compared to natural oils. A pure,
natural oil is so chemically complex that it is not economically viable to synthesize all of the compounds present in a
laboratory. Instead, only the most important aroma compounds are synthesized. Even the best synthetic oils used
in perfumery will seldom have more than about 30 chemical compounds compared to 100 to 400 or more present
in a natural oil. Although little is known about how the
chemical constituents interact with each other and thereby
affect the body, it is likely that both the trace compounds
as well as major constituents play a role in the overall
therapeutic action of the oil. Also, any quenching effects
due to the presence of particular compounds in an oil
could be compromised in oils that have been synthesized
or reconstructed from isolated components. Quenching
effects occur when the action of one compound (usually
negative) in an essential oil is suppressed by the presence
of another compound, making the oil safer to use in such
cases. For example, citral in a pure and isolated form is a
strong skin irritant, but when it is combined with the other
compounds in lemon oil, it is rarely irritating. (Lemon oil
contains approximately 5% citral and 95% other terpenes.)
The other terpenes present (particularly d-limonene and
-pinene) have a quenching effect on citral, so any side effects due to the presence of citral are minimized. Synthetic
oils often cause nausea, headache, skin sensitivities, and
emotional irritation. These symptoms are rarely, if ever,
seen when pure oils are used.
Lastly, there are companies that specialize in supplying therapeutic-grade essential oils for the aromatherapy
market and small suppliers who import oils based on
close relationships developed with producers. The oils
sold through such companies will be more expensive but
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D2
D1
FIGURE 72 Six easy ways to add aromatherapy to any treatment. (A) Diffuse oils in the treatment room.
When a client enters a clean and fragrant treatment room, the perception of the business and the treatment is
enhanced. Use light scents such as lemon, mandarin, or lavender and avoid heavy fragrances such as ylang ylang
or jasmine that some clients might dislike. (B) Steamy aromatic towels. Scent hot, moist towels with essential oils.
These towels can be used for product removal or as an accent before a step in the treatment (e.g., steamy rosemary
towel before the face massage). (C) Fragrant foot soaks. While the client fills in the health history form, its nice to
offer an aromatherapy foot bath. Foot soaks are warming and relaxing. (D1 and D2) Aromatherapy inhalations.
At the beginning of the treatment, place a drop of essential oils between your hands. Rub the hands together and
then hold them in an arc over the clients nose while he or she takes a deep breath. (E) Smell-scapes. Smell-scapes
are aroma landscapes that are created to fit the theme of the treatment. Essential oils are carefully chosen and
added to base product to treat the client to a unique olfactory experience. (F) Aroma mists. At any time during
a treatment, an aroma mist can be spritzed over the client to refresh the body and fill the treatment room with a
revitalizing fragrance.
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A1
A2
A2
E1
133
E2
FIGURE 73 Overview of some common aromatherapy treatments. (A1 and A2) Aromatherapy consultation. In
a consultation, a blend of oils is created especially for a client. The blend can then be applied in numerous ways such
as in a bath or through massage. (B) Aromatherapy body shampoo. Essential oils are added to a foaming cleanser for
a revitalizing body shampoo. (C) Aromatherapy body polish. Essential oils might be added to a variety of granulated
exfoliation products for a fragrant body polish. (D) Aromatherapy massage. Essential oils are well known to balance
the central nervous system (CNS) and relax the body. A popular way to use essential oils is in a massage. (E1 and E2)
Aromatherapy body wrap. Essential oils can be used in numerous types of body wraps. For example, essential oils
might be added to melted shea butter and brushed on the body before it is wrapped. (continued)
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FIGURE 73 (continued) (F) Aromatherapy baths. Essential oils can be added to hydrotherapy tubs or standard soaking tubs for therapeutic baths. Usually, the oils are mixed first into an emulsifier or carrier product to
prevent skin irritation or pooling of the oils. (G) Aromatic saunas. Essential oils are added to the water that
is used on the saunas heat source. Usually, respiratory support oils such as pine and eucalyptus are preferred.
(H) Aromatic steams. Essential oils can be used in steam rooms, steam cabinets, or under a steam canopy.
(I) Sunburn relief. Anti-inflammatory and skin soothing essential oils are added to aloe and brushed on the
skin to heal the tissue after it has been burned by the sun. (J) Spot application. Certain essential oils such as
German chamomile can be used at full strength for specific conditions such as carpal tunnel syndrome. Oils
from grapefruit, juniper berry, or thyme might be used as an application for cellulite. (K) Guided meditation
with aromas. Essential oils can be used during a guided meditation session or hypnotherapy session for their
psychological effects.
are much more attractive to professional aromatherapists.

Even with the best of intentions, it should be noted that
adulterated oils can sometimes be sold unknowingly by the
most knowledgeable and reputable suppliers. A number of
reputable suppliers who carry high-quality, therapeuticgrade essential oils can be found in the resources section at
the back of the book.
When oils are exposed to light, heat, and oxygen, their
chemical composition is altered (oxidation), and their therapeutic properties may change. To slow the rate of oxidation, keep the oils in dark bottles with as little air at the top
of the bottle as possible. Store them in a refrigerator and
replace them if they have not been used within a year. Citrus
oils oxidize more rapidly than other oils, so they should be
replaced every 6 months.
Safety Considerations
When therapeutic-grade essential oils are used at low concentration (1% to 3% or 6 to18 drops to every fluid ounce
of carrier) and applied externally, negative reactions are
minimal. It is important for a therapist to understand the
potential undesirable effects that may occur if the oils are
used inappropriately or without understanding. It should
be emphasized that before using any oil, you should identify
any possible contraindications for use of the oil by checking
safety data sheets or reliable textbooks.
It is out of a massage therapists scope of practice to recommend the internal use of essential oils because all essential oils
are potentially toxic when taken internally, especially when
taken in doses that are larger than those used therapeutically
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FIGURE 75 Essential oil storage sites. Essential oils might be stored

in leaves, needles, twigs, resin tears, flowers, fruits, roots, bark, wood,
heartwood, zests, or the whole plant.
FIGURE 74 Essential oil storage structures. Magnification shows

essential oils storage in a trichome (hair) of basil (Ocimum basilicum).
by doctors. For this reason, oils must be kept out of the reach
of children and not used internally. Some oils contain chemical components that may cause liver or kidney irritation
when used for prolonged periods of time (even when they are
applied topically). The general rule of thumb is that an oil
should not be used continuously for longer than 2 weeks to
prevent sensitization of the kidneys, liver, or skin.
It is believed that most essential oil compounds are able
to pass through the placenta to the developing fetus. It is
also possible that certain essential oils may disrupt the
delicate hormonal balance of the body and cause unwanted
effects during pregnancy. With the exception of mandarin
TABLE 71 Methods of Extraction of Aromatic Materials

METHOD
DESCRIPTION
COMMENTS
Expression (essence or
essential oil)
Citrus fruit peels are subjected to lateral compression

(squeezing) or machine abrasion (puncturing or
grating) to extract the essence or essential oil from
the rind.
This method of extraction is used to obtain essential

oils from citrus fruits. Because no heat is used in the
process, the composition of the expressed oil is very
similar to that of the oil in the plant, and the smell is not
affected by high temperatures.
Steam distillation (essential

oil and hydrosol)
Steam is used to rupture the storage sites of volatile

essential oils. The oils vaporize in the steam and are
passed through a condenser, which cools the vapor so
that it becomes a liquid. The water (from the steam) and
the essential oils that have been condensed are separated. Some oils, such as rose oil, are slightly soluble in
water, so the infused water, known as a flower water or
hydrosol, is also sold as a valuable product.
Different plant species may require slightly different

distillation conditions. Sometimes the plant is placed in
the still directly after harvesting, sometimes it is left to
dry, sometimes it is placed on a grate above the water,
or sometimes it is mixed with the water. A variety of
methods are used.
Solvent extraction (concrete, Aromatic plant material is extracted by means of a

resinoid, and absolute)
hydrocarbon solvent. Solvent extraction yields either a
concrete or a resinoid, which is further processed with
pure alcohol to produce an absolute.
Solvent extraction is used with aromatic plants whose

delicate fragrance would be damaged by the heat used
in steam distillation. This includes jasmine, narcissus,
and violet. Some plants are offered as either an absolute
or an essential oil. Absolutes smell closer to the original
plant than essential oils.
Under high pressure, hypercritical (in a state between a

liquid, vapor, and gas) carbon dioxide is used as a
solvent to extract essential oils.
This is considered by many as an ideal form of extraction

because it happens at low temperature with no chemical
reactions between the solvent and aromatic substances.8
CO2 hyperbolic production

(CO2 oil)
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Avoid tanning for

24 hours after the use
of phototoxic oils.
Use only therapeuticgrade essential oils.
Use oils at mild

concentrations to
avoid skin irritation.
Don't use known skin
irritants with heat.
Avoid the internal

use of essential oils
without advanced
training.
Best Practices
for Safe Essential Oil Use
Do not use essential
oils with pregnancy
without formal training
in aromatherapy.
Avoid the longterm use of any oil

or blend of oils.
Do not encourage
clients to use essential
oils internally.
Keep oils out of

the reach of children.
and lavender (used at 1% concentrations 6 drops/fl oz

of carrier), those without formal training in aromatherapy
should avoid the use of essential oils with pregnant clients.
The most likely undesirable effect that a spa therapist
will see when using essential oils is skin irritation or phototoxicity. Skin irritation is rare if the therapist is using
standard concentrations of 1% to 3% of therapeutic-grade
oils (irritation is more likely with synthetic oils). When large
amounts of certain oils are used topically, or when oils are
FIGURE 76 Best practices for safe

aromatherapy.
used with heat (e.g., stone massage, hot pack, hot sheet
wrap), irritation is more likely to occur.
The term phototoxicity refers to an increased sensitivity to
the sun. Oils containing compounds called coumarins and
furocoumarins increase the skins tendency to burn. Clients
should avoid suntanning and tanning booths for 24 hours after the application of these oils. Figure 76 lists some general
best practices for the safe use of essential oils. Table 72 lists
oils that should be avoided or used with caution.
TABLE 72 Essential Oils to Avoid or Use with Caution

ESSENTIAL OILS TO COMPLETELY AVOID
Bitter almond, boldo leaf, buchu, yellow camphor, brown camphor, sassafras, calamus, horseradish, mugwort, mustard, pennyroyal, rue, savin,
savory, tansy, thuja, wormseed, wormwood
ESSENTIAL OILS TO AVOID WITH PREGNANCY
Aniseed, basil, birch, wintergreen, cedarwood, clary sage, cypress, geranium, sweet fennel, jasmine, juniper berry, sweet marjoram, myrrh,
peppermint, rosemary, common sage, thyme, hyssop
ESSENTIAL OILS THAT ARE SKIN IRRITANTS
Ajowan, cinnamon bark, cinnamon leaf, sweet fennel, cassia, clove leaf, clove bud, costus, oregano, basil, fir needle, lemongrass, lemon verbena,
Melissa, peppermint, thyme
ESSENTIAL OILS TO AVOID WITH CLIENTS WHO HAVE HIGH BLOOD PRESSURE
Pine, hyssop, rosemary, common sage, thyme
ESSENTIAL OILS TO AVOID WITH CLIENTS WHO ARE TAKING HOMEOPATHIC REMEDIES
Rosemary, eucalyptus, peppermint
ESSENTIAL OILS TO AVOID WITH CLIENTS WHO HAVE EPILEPSY OR A HISTORY OF SEIZURE
Sweet fennel, bitter fennel, common sage, hyssop, basil
ESSENTIAL OILS TO AVOID WITH A HISTORY OF ESTROGEN-DEPENDENT CANCER
Aniseed, basil, birch, wintergreen, cedarwood, clary sage, cypress, geranium, sweet fennel, jasmine, juniper berry, sweet marjoram, myrrh, peppermint, rosemary, common sage, thyme, hyssop
ESSENTIAL OILS THAT ARE PHOTOTOXIC
Bergamot, lime, bitter orange, lemon, grapefruit, sweet orange, mandarin, ginger, angelica root
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Ingestion
Essential oils enter the body by absorption through the skin,

inhalation, and ingestion. They are eliminated through the
kidneys, through perspiration, and through exhalation.
Ingestion of essential oils is a form of treatment that is

mainly used by medical doctors in Europe. When an oil is
ingested, it is taken internally by placing 1 to 3 drops in
water, on a sugar cube, or in honey. Ingestion is not commonly used by anyone other than doctors because all of the
essential oil is rapidly absorbed by the body, making this a
potentially toxic and dangerous practice.
Absorption through the Skin

Compounds in essential oils that are absorbed through
the skin enter the capillary network of the bloodstream.
Although many aromatherapists take skin absorption for
granted, the research supporting this is not clear. A number of studies indicate that essential oils promote penetration of other substances through the skin.4 Some show that
certain compounds in essential oils pass through the skin,
whereas others do not.5
Absorption of essential oil compounds will be affected
by both the viscosity of the carrier product (thicker products slow the rate of absorption) and by the thickness of the
adipose layer in the skin, which varies from individual to
individual (the thicker the adipose layer, the slower the rate
of absorption is likely to be). The most permeable areas of
the body are the armpits, forehead, scalp, hands, feet, and
inguinal areas.
Inhalation
When an essential oil is inhaled, the scent triggers an
olfactory response, which will be discussed in the section
on the psychology of oils.
Inhaled essential oil molecules travel down the respiratory tract to the lungs, where they are either absorbed by
the mucous membrane lining of the respiratory tract or
are transferred to the blood circulating in the lungs at the
point of gaseous exchange between air and blood in the
alveoli and respiratory bronchioles. In the nose, where the
endothelium is thin, it is assumed that essential oil molecules reach local circulation in the brain fairly quickly and
easily.6
The Physiological and Psychological

Effects of Essential Oils
Aromatherapy has significant therapeutic potential because each essential oil has a unique combination of chemical compounds that interact with the bodys chemistry
and thereby affect specific organs, systems, or the body as
a whole (physiological effects). The inhalation of essential
oils also triggers an olfactory response that can lead to powerful mental and emotional behavioral changes (psychological effects).7 Holistic aromatherapy is concerned with both
the symptoms of a condition and its underlying causes.
Its aim is to address the body, mind, and spirit for mental,
emotional, and physical wellness.
Each essential oil has a set of potential therapeutic properties based on its chemical composition (Fig. 77). Sometimes, the properties of the individual compounds present
may seem to oppose each other. This is the case with lavender, which contains esters (generally sedative), and alcohols (generally stimulating). In fact, this check and balance
system of chemicals with opposing physiological effects allows essential oils to act in a balanced manner without side
effects.6
Aldehydes
Sedative
Anti-inflammatory
Antiviral
Alcohols
Stimulating
Oxides
Expectorants
Essential Oil
Chemistry
Esters
Antispasmodic
Balancing
Antifungal
FIGURE 77 Essential oil chemistry. Chemical

components in essential oils have therapeutic
effects on the body.
Ketones
Cell regenerative
Mucolytic
Neurotoxic
Phenols
Strong antibacterial
Immune stimulating
Warming
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138
Therapists use oils with specific properties (actions) to

improve the functioning of a particular body system and
support health. For example, if the treatment aims to
decrease muscular tension and increase relaxation, oils that
are antispasmodic, pain relieving, warming, and sedative
will probably be chosen. Essential oils are often used in a
spa setting to treat the symptoms of mild lymphatic stasis.
These treatments can be focused on a cosmetic goal such as
the reduction of cellulite, or they can aim to boost immunity, facilitate natural detoxification processes, and support
general wellness. Lymph flow is hindered by a sedentary lifestyle or whenever a person sits or stands in one place for a
long period of time. When lymph flow is slow, excess fluid
may accumulate in the tissues and gradually overwhelm the
lymph nodes and liver. This metabolic buildup may lead to
infection and disease.
Citrus oils, such as lemon, grapefruit, and sweet orange,
and warming oils, such as clove, black pepper, and ginger,
are a good choice for lymph stimulation. Diuretics applied
topically, including sweet fennel, grapefruit, and juniper
berry, support elimination through the kidneys and increase the flow of urine. This accelerated elimination helps
to detoxify the body and reduce water retention. All of the
oils mentioned previously could be used in various ways to
support detoxification treatments such as slimming wraps
or herbal wraps. The oils may be applied to the body before
a warming soak, or they might be applied in a massage at
the end of the wrap. A blend of three to four of these oils
might be massaged into target areas to further stimulate
local circulation to the area.
A key benefit of using essential oils regularly is that they
kill many strains of pathogenic microorganisms. They either
destroy the pathogen or disrupt its life cycle so that it cannot
reproduce. Oils that kill pathogenic organisms are known as
antiseptics, antibacterials, antifungals, and antivirals. Certain essential oils also stimulate the production and activity
of white blood cells, which boosts immunity. This cytophylactic activity was noted by Gattefoss and Valnet and has
been observed by many other researchers.8,9 Phagocytosis,
the ability of white blood cells to ingest foreign bodies and
wastes, is increased by essential oils known as depuratives or
by the popular name of blood cleansers. Although a massage
clinic or therapists would not sell or market essential oils to
boost immunity because this would be out of their scope of
practice, they will likely notice that clients feel energized, rested, and revitalized by treatments that include essential oils.
Aromatherapy massage is a popular treatment at many
spas, and a wide variety of essential oils can be used in massage to achieve a broad spectrum of treatment goals. Often, essential oils are used for their pleasant aromas and to decrease
stress. Oils high in a functional group known as the esters
are usually effective antispasmodics. These oils, including Roman chamomile, clary sage, and petitgrain, are especially helpful in balancing the nervous system.10 Phenylpropane ethers
especially estragole, which is found in basilare thought to
stabilize an overactive sympathetic nervous system, whereas
cypress, basil, and sweet marjoram are noted for skeletal

muscle spasm.6 Caution should be used with basil due to its
methyl chavicol content, which may cause skin irritation.
White birch (Betula alba), German and Roman chamomile, frankincense, wintergreen, clove, lavender, and mint
oils are all effective analgesics.11 White birch, yellow birch
(Betula alleghaniensis), sweet birch (Betula lenta), and wintergreen (Gaultheria procumbens) all contain a high percentage
(up to 98%) of methyl salicylate (an ester). Methyl salicylate is
the active ingredient used in pain rubs such as Bengay. These
oils would be effective in blends used in sports treatments
or to decrease general muscular soreness. They could also be
used in medical spas to decrease pain from a musculoskeletal
condition such as osteoarthritis or Osgood-Schlatter disease.
Mint oils contain menthol, which has been used traditionally for headache pain. It should be noted that peppermint oil should not be applied undiluted to the temples to
decrease headache pain. Used in this manner, it may cause
a burning sensation and skin irritation. However, it is very
effective for headaches when massaged, diluted in lotion or
oil, into the posterior neck and shoulders. Mint oils are often used in treatments that aim to refresh the body because
menthol increases peripheral circulation and affects cold
receptors in the skin, resulting in a cooling sensation.
Essential oils that support the respiratory system are effective when used in the steam room or sauna. In a study
by Eremenko et al.,12 96 patients suffering from chronic
bronchitis showed significant clearing of the airways as well
as reduced infection levels when inhaling vapors of camphor and menthol and particularly oils of eucalyptus and
peppermint. The oils improved the function of the lungs
and bronchi by reducing mucous congestion and dealing
with chest infections, colds, and influenza.12 When inhaling essential oils in steam, smaller doses are more effective
than large amounts of oils.13 Pine, rosemary, eucalyptus,
and thyme oil work well in both a sauna or steam room. Although a massage therapist at a spa will not focus on respiratory pathologies, a basic understanding of core respiratory oils will allow the therapist to support a clients overall
health and wellness. For example, floral oils would not be
used in a sauna or steam room because they may cause a
headache in a close, hot environment.
Oils with a high sesquiterpene content are likely to have
good anti-inflammatory properties. The most important
anti-inflammatory compounds in essential oils are chamazulene and -bisabolol (a sesquiterpene alcohol), both of
which are found in German chamomile and in Helichrysum.
The more effective compound of the two is -bisabolol,
which works mainly by inhibiting some of the enzymes involved in the inflammation response.2 Anti-inflammatory
oils will most often be used in a spa for skin irritations such
as sunburn. They can be used in a medical spa for soft tissue
pathologies such as carpal tunnel syndrome, plantar fasciitis, and tendonitis. Table 73 gives an overview of some of
the properties of essential oils and some of the treatments
they support.
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DEFINITION
SELECTED INDICATION
Alterative
An agent that corrects

disordered body
function and supports
balance in the body
Stress, for recent trauma

such as a car accident, as part of a
detoxification regime,
burnout, anxiety
Lavender, Melissa, geranium, fir, juniper

berry, petitgrain, lemongrass, valerian
Bath, body lotion, massage, as part

of any relaxation treatment, mist
inhalation, room scent, foot bath,
aromatherapy wrap, etc.
An agent that reduces

the sensation of pain
Soft tissue pain (use

analgesics that are
also anti-inflammatory
during acute injury)
Bay laurel, bay rum, bergamot,

birch, cajeput, German chamomile,
Roman chamomile, clove, coriander,
eucalyptus, fir, ginger, jasmine (mild),
lavender, lemongrass, sweet marjoram,
peppermint, nutmeg, black pepper,
rosemary, rosewood (mild), turmeric,
wintergreen
Local application for an area of pain,

massage, compress, muscle blends,
sports massage blends
Anti-depressant
An agent that helps to

alleviate depression
Depression, stress,
anxiety
Basil, bergamot, geranium, jasmine,

lavender, lemongrass, neroli, sweet
orange, patchouli, rose, rosewood,
clary sage, Spanish sage, sandalwood,
vanilla, ylang ylang
Massage, bath, mist, inhalation, room

scent, foot bath, with hypnosis or
guided meditation
Anti-inflammatory
An agent that decreases

inflammation
Recent soft tissue injury,

skin irritation or sensitivity, neuritis
Benzoin, birch, camphor (white), German

chamomile, frankincense, geranium,
helichrysum, jasmine, peppermint,
myrrh, bitter orange, sweet orange,
patchouli, common sage, Spanish sage,
spikenard, tea tree, turmeric, wintergreen, yarrow
Local application for area of

inflammation, skin lotion, cool bath,
sunburn wrap
Antimicrobial
An agent that destroys

or inhibits the life
cycle of pathogenic
microorganisms
Onset of a cold or the

flu, for skin infections,
in natural cleaning
products
Most essential oils to some degree
Massage, body lotion, lymph rub, bath,

foot bath, body wrap
Antineuralgic
An agent that relieves or

decreases pain from
irritated nerves
Neuralgia
Bay rum, cajeput, Roman chamomile,

clove, eucalyptus, helichrysum,
Scotch pine
Application to the nerve path, massage

to associated areas
Antipruritic
An agent that relieves or

prevents itching
Itchy skin, insect bite,

skin irritation, itchy
scalp, sunburn
Birch, peppermint, wintergreen
Cool bath, skin lotion, hair rinse, body

wrap
Antirheumatic
An agent that decreases Rheumatic conditions,

or relieves rheumatism
stiff, sore muscular
conditions
Bay laurel, bay rum, birch, clove,

coriander, cypress, eucalyptus, juniper
berry, lavender, lemon, lime, nutmeg,
Scotch pine, rosemary, thyme, turmeric,
yarrow
Massage, body wrap, dry skin brush,

body lotion, bath
Antisclerotic
An agent that helps to

prevent the hardening
of tissue
Scar tissue, mature

skin, wrinkles
Lemon, carrot seed
Spot treatment, application to scars,

massage with cross-fiber friction
An agent that controls

the production of
sebum
Oily skin, dandruff
Atlas cedarwood, clary sage (sebum

regulator), Spanish sage (sebum
regulator), valerian (antidandruff),
ylang ylang
Skin lotion, bath, hair rinse, in skin care

products for oily skin
Analgesic
ACTION
Antiseborrhoeic
TABLE 73 Therapeutic Actions and Properties of Selected Essential Oils

SELECTED ESSENTIAL OILS
SELECTED METHOD OF APPLICATION
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TABLE 73 Therapeutic Actions and Properties of Selected Essential Oils (continued)

An agent that firms or

tightens tissue
Saggy skin, skin lacking

in tone, oily skin, as a
support for inflammatory conditions
Balsam fir, bay rum, benzoin, birch,

atlas cedarwood, cypress, frankincense,
geranium, grapefruit, helichrysum, hyssop, juniper berry, lemon, lemongrass,
linden, peppermint, myrrh, bitter orange,
patchouli, rose, rosemary, clary sage,
common sage, Spanish sage, sandalwood, spruce (tsuga), tea tree, thyme,
wintergreen, yarrow
Skin care products, massage, cellulite

and firming treatments, body wraps,
body lotion
An agent that promotes

healing through the
formation of scar
tissue
Wounds, skin conditions, skin revitalization treatments
Balsam fir, German chamomile, Roman

chamomile, elemi, eucalyptus, geranium,
helichrysum, hyssop, jasmine, juniper
berry, lavender, lemon, myrrh, neroli, palmarosa, patchouli, rose, rosemary, clary
sage, sandalwood, thyme, yarrow
Skin care products, skin care

treatments, massage, baths
An agent that increases

the activity of leukocytes in the body,
therefore boosting
immunity
To boost general
immunity
German chamomile, frankincense,

lavender, oregano (caution), rosemary,
tea tree
Massage, reflexology, baths, foot baths,

lymph rubs, dry skin brushing, detoxification treatment
An agent that combats

impurities in the blood
and organs and aids
detoxification
Detoxification treatments, revitalization

treatments, to support
a diet
Angelica, birch, carrot seed, coriander,

eucalyptus, grapefruit, juniper berry,
lemon, rose, Spanish sage, vetiver
Massage, reflexology, baths, foot baths,

lymph rubs, dry skin brushing, detoxification treatment

the production of
urine and aids water
retention
Detoxification
treatments, water
retention, revitalization
treatments
Angelica, balsam fir, bay laurel, benzoin, ber- Massage, bath, body lotion, dry skin
gamot, birch, camphor (white), cardamom,
brush, body wrap, detoxification
atlas cedarwood, cypress, eucalyptus,
treatment
frankincense, geranium, grapefruit, helichrysum, hyssop, juniper berry, lavender,
lemon, linden, mandarin, sweet marjoram,
patchouli, black pepper, Scotch pine, rosemary, common sage, sandalwood, spruce
(tsuga), thyme, turmeric, valerian
An agent that softens

the skin
Dry skin, mature skin,

dehydrated skin,
rough skin
Linden (other oils are not specific emollients but support dry skin: frankincense,
myrrh, elemi, rose, lavender)
Skin lotion, massage, bath, skin care

products, body wraps

the removal of mucus
from the respiratory
system
These oils can be used

for general respiratory support to prevent
congestion and aid
breathing
Angelica, balsam fir, bay rum, benzoin,

cajeput, camphor (white), atlas cedarwood, eucalyptus, fir, frankincense,
ginger, hyssop, sweet marjoram, peppermint, myrrh, Scotch pine, Spanish sage,
spruce (tsuga), tea tree, thyme, yarrow
Inhalation, chest rub, steam bath,

shower, sauna
An agent that combats

fungal infection
Fungal foot infections
Angelica, bay laurel, atlas cedarwood,

coriander, geranium, helichrysum,
lemongrass, sweet marjoram, myrrh,
bitter orange, rosemary, sandalwood,
spikenard, tea tree, thyme
Direct application to the local area of

fungus, in cleaning products used at
the spa
An agent that tones and

stimulates the function
of the liver
As a support for liver

cleansing or detoxification treatments
Carrot seed, German chamomile, Roman

chamomile, cypress, helichrysum,
peppermint, rose, rosemary
Body wrap, dry skin brush, body lotion,

bath, massage
An agent that lowers

blood pressure
Stress, anxiety
Bay laurel, lavender, lemon, sweet

marjoram, neroli, sweet orange, clary
sage, Spanish sage, turmeric, valerian,
yarrow, ylang ylang
Massage, body lotion, room scent,

with guided meditation, hypnosis,
inhalation, mist
Fungicidal
Expectorant
Emollient
Diuretic
Cicatrisant
Astringent
Antiviral
Inhalation, massage, lymph rub, body

lotion, body wrap, bath
Cytophylactic
Depurative
SELECTED INDICATION
Onset of a cold or the flu Camphor (white), clove, eucalyptus, hysor to generally boost
sop, lime, sweet marjoram, peppermint,
immunity
oregano (caution), patchouli, Scotch
pine, tea tree, thyme
Hepatic
DEFINITION
An agent that destroys
or disrupts the life
cycle of a viral
pathogen
Hypotensive
ACTION
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Stress, nervous tension,

burnout, neuritis,
neuralgia
Angelica, basil, helichrysum, hyssop, juniper berry, lavender, lemon, lemongrass,

linden, sweet marjoram, peppermint,
patchouli, petitgrain, rosemary, clary
sage, Spanish sage, spruce (tsuga),
thyme, ylang ylang
Body wrap, massage, body lotion,

bath, direct application to an area of
nerve pain
Relaxant
An agent that soothes

and relieves tension
Stress, anxiety,
insomnia
German chamomile, Roman chamomile,

lavender, neroli, nutmeg, sandalwood,
vanilla, ylang ylang
Body wrap, massage, bath reflexology,

body lotion, room scent, mist,
inhalation
Restorative
ACTION
An agent that revitalizes

and strengthens the
body
Low immunity, burnout,

mental exhaustion,
stress
Basil, coriander, lavender, lemon, lime,

myrrh, Scotch pine, rosemary, tea tree

body lotion, room scent, mist,
inhalation

local circulation to the
skin and is warming; may lead to skin
irritation
Tight muscles, detoxification, cellulite treatments, muscle pain

and soreness
Birch, camphor (white), eucalyptus, fir,

ginger, juniper berry, oregano (caution),
black pepper, Scotch pine, rosemary,
spruce (tsuga), thyme, turmeric, vetiver,
wintergreen
Cellulite application, massage, spot

treatment, muscle blends, sports
massage blends
An agent that sedates

or calms the CNS, a
body system, or the
body in general
Relaxation treatments,
stress, anxiety,
insomnia
Balsam fir, bay laurel, benzoin, atlas

cedarwood, German chamomile, Robody lotion, room scent, mist,
man chamomile, frankincense, hyssop,
inhalation, with hypnosis or
jasmine, juniper berry, lavender (balancmeditation
ing), lemongrass, linden, mandarin,
sweet marjoram, myrrh, bitter orange,
sweet orange, rose, clary sage, sandalwood, spikenard, tuberose, valerian
(depresses CNS), vanilla, vetiver, yarrow, ylang ylang

the function of a body
system or the body in
general
Mental and physical

burnout, stress, to
revitalize and energize
Angelica, bay rum, bergamot, camphor

Body wrap, massage, bath, reflexology,
(white), cove, cardamom, carrot seed,
body lotion, room scent, mist, inhalaatlas cedarwood (circulatory), coriander,
tion, dry skin brushing
elemi, eucalyptus, fir, geranium,
ginger, grapefruit (lymphatic), lavender (balancing), lemon (lymphatic),
mandarin (lymphatic), peppermint,
nutmeg, neroli (nerve), sweet orange
(lymphatic), palmarosa (circulatory),
patchouli, black pepper, petitgrain,
Scotch pine, rosemary, rosewood
(immune), common sage, Spanish
sage, spruce (tsuga), thyme, turmeric,
vetiver (circulation)
An agent that promotes or increases

perspiration
To warm an area,
detoxification
treatments, cellulite
treatments, sore
muscles
Bay laurel, cajeput, German chamomile,

Roman chamomile, cypress, ginger,
hyssop, juniper berry, sweet marjoram,
rosemary, tea tree, thyme, yarrow
Body wrap, massage, body lotion, spot

treatment
An agent that causes

narrowing of the blood
vessels
Varicose veins, broken

capillaries
Cypress, lemon, peppermint (rose,

lavender, German chamomile can be
used as support oils)
Direct application to the local area
An agent that is healing

for the skin
Skin conditions, wounds Balsam fir, benzoin, bergamot, German

chamomile, Roman chamomile, eucalyptus, geranium, hyssop, juniper berry,
sweet marjoram, rosemary, rosewood
(tissue regenerator)
DEFINITION
Vulnerary
Vasoconstrictor
Sudorific or
Diaphoretic
Stimulant
Sedative
Nervine
SELECTED INDICATION
An agent that strengthens and tones the

nerves and nervous
system
Rubefacient
TABLE 73 Therapeutic Actions and Properties of Selected Essential Oils (continued)
Massage, body lotion, skin care

products
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In a therapeutic setting, good smells can be used together
with massage, hydrotherapy soaks, meditation, hypnotherapy, or any other treatments to promote relaxation. This
is important because stress is at the core of many modern
diseases, and studies suggest that by simply decreasing
stress, health and immunity can be improved. Smells can
evoke intense emotional reactions and can even be used
to change behavioral patterns. This psychological use of
aromas has ancient roots. Incense has been burned for
thousands of years to connect the human spirit with the
gods and to shift consciousness from the everyday to the
divine. There is credible evidence that agreeable fragrances
can improve our mood and sense of well-being. This is
not surprising because our olfactory receptors are directly
connected to the limbic system, the oldest and most
emotional part of our brain (Fig. 78).
One way that smells can be used for healing is through a
learned-odor response. In learned-odor responses, a smell
is used to form memory links to a person, place, or thing
(e.g., a positive experience or relaxed state). Hiramoto et al.14
paired camphor with fever induction and found that a fever response could be elicited by camphor afterward. Whole
memories, complete with all their associated emotions,
can be prompted by smell.15 This is entirely unconscious
and cannot necessarily be prompted voluntarily, although
countless studies have shown that recall can be enhanced if
the learning was done in the presence of an odor and that
same odor is presented at the time of recall. This information can be used by the therapist to help the client recall
resource states from a body treatment or meditation
session. For example, if the therapist uses an exfoliation
or body wash product scented with an uplifting mint fragrance in the treatment room, the client will remember the
session every time he or she uses a home care product with
the same fragrance. Not only will the client remember the
session mentally but also his or her body will remember
and, through that memory, feel more relaxed.
Therapists interested in designing a treatment that
would encourage their clients to relax completely would
turn to oils known as sedatives, calmatives, and relaxants.
These oils help the body to let go of mental, emotional, and
physical tension. For example, when the sedative essential
oils of lavender, rose, and valerian were dispersed in the air,
rats took longer to perform tasks.16 This shows that these
oils have the ability to sedate the CNS. Oils such as lavender, Roman or German chamomile, and sweet marjoram
sedate the body and decrease stress because they stimulate
the raphe nucleus, which releases serotonin. Ambient lavender was also shown to increase sleep and lead to better
waking moods in psychogeriatric patients under long-term
treatment for insomnia.17 During stressful magnetic resonance imaging medical testing, a vanilla-like scent was used
successfully to help patients relax and to reduce anxiety at
Memorial Sloan-Kettering Cancer Center in New York.18
Olfactory signal
Smell center
Olfactory bulb
Olfactory nerve
Olfactory
epithelium
Cilia
Smell receptor
Odor
FIGURE 78 The limbic system. Olfactory receptors are directly
connected to the limbic system, the oldest and most emotional part of
the brain.
Stimulating scents are being used by many companies to

promote alertness and increase the efficiency and precision
of their workers.19 In one study, there was an increase of
cerebral blood flow in humans following inhalation of 1,8,
cineol (rosemary, eucalyptus oil).20 Rosemary, lemon, basil,
and peppermint offer a quick energy pickup because they
stimulate the locus ceruleus, which releases noradrenalin.
People do much better in a task that requires sustained attention if they receive regular puffs of an uplifting aroma.21
Peppermint, which is often the oil chosen to promote
alert states, enhanced the sensory pathway for visual detection, which allowed subjects more control over their
allocation of attention. Ambient peppermint aroma increased word learning and recall.19 A spa therapist would
use stimulating oils in treatments aimed at energizing the
body or at the end of a relaxation treatment to help wake
the client up.
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Spas spend large amounts of money to influence a

clients perception of their business. Perception can only
be created or altered through one of the five senses because
these are the means by which we interpret our environment.
The positive emotional effects of agreeable fragrances can
be used to affect our perception of other people, of a business, or of a product. In a study to show that scent impacts
social relationships, people in photographs were given a
higher attractiveness rating when the test subjects were
exposed to a pleasant fragrance. In a test on shampoos, the
product originally ranked last in performance was ranked
first in a second test after its fragrance was adjusted.22
with essential oils that have deep, pungent, heavy, and spicy
aromas, the body polish product might be scented with oils
that smell light, green, and of citrus. Table 74 breaks essential oils into smell categories for easy scent contrasts.
When therapists use smell-scapes in a treatment, they are
using oils psychologically. Blending oils for a physiological
effect requires a different set of considerations. Eventually,
therapists will find that they can achieve both a physiological and psychological balance in their blends. This type of
blending is called holistic blending because the formulation
aims to address the needs of the body, mind, and spirit.
Smell-Scapes
Olfaction provides the spa therapist with another form

of communication. It creates connections to the spiritual
aspect of self; to the cultural background of a treatment;
and to the natural world of field and forest, sea, and desert.
It adds dimension and texture to the treatment and provides an emotionally satisfying experience for the client.
When a designer plans a service, one of the aspects that
should be considered is the smell-scape. A smell-scape is
the aroma landscape that is planned for the treatment.
The therapist will want to keep all the scents in a particular
category but vary them in such a way that they maintain
the clients interest. For example, a citrus salt glow would
obviously include citrus oils. If the therapist used the same
scent for all of the products (massage oil, body mist, finishing lotion, etc.), the client will register the scent for the first
10 minutes of the treatment but then forget it. A therapist
that wants aroma to be an integral part of the treatment
will vary the smell-scape. He or she might use grapefruit in
the massage oil, mandarin with a floral accent in the body
mist, and lemon in the finishing lotion. Each time the product is changed, the room is filled with a new scent, and the
clients olfactory enjoyment is enhanced.
For culturally inspired treatments, the smell-scape creates a powerful emotional link to the region where the service originated. In ayurveda, the traditional medical system
of India, medicated oils called taila are used.23 Traditional
taila smell very strange to the Western nose, and some clients take time to adjust to the new aromas. As this adjustment takes place, it often brings a deeper curiosity about
ayurveda, which, in turn, enriches the clients experience of
the treatment. Culturally influenced treatments must be
designed carefully. It makes sense that a treatment named
the Nile body wrap would use plant products that were
known and used in ancient Egypt. North American pine oil
would be out of place in such a treatment, but frankincense,
myrrh, and rose are appropriate. In Chapter 15, Your Spa
Program and Menu of Services, a table of different themes,
smell-scapes, accents, and associations can be found that
provide more ideas on scents that might be used in a particular smell-scape.
One easy way to create interest is to contrast distinct smell
categories against their opposites. If the massage oil is scented
The techniques outlined in this chapter are keys to blending only. They are meant to provide structure for those who
are learning how to blend by providing a way to think
about the blend and the many considerations that a therapist must have in mind when blending. Like smell itself,
the blending process is personal, biased, and inspired by
private memories and relationships with past events. There
is no such thing as a bad blend, and there are many different ways, beyond those outlined here, for the therapist to
approach blending. Before the blending begins, the therapist will need to choose the type of carrier product that is
to be used.
Carrier Products
A carrier product (some therapists refer to them as a vehicle)
is a general term for the product that is used to carry the
essential oil to the client. Essential oils are rarely applied
at full strength. More often, they are diluted into a carrier product before they are used in a treatment. Massage
therapists will most often use an expeller-pressed fixed oil
as a carrier for essential oils delivered in massage. Expellerpressed fixed oils are different from essential oils in that
they do not evaporate (they are composed of nonvolatile
compounds) and are classified as lipids. Fixed oils are sometimes used to adulterate essential oils because essential
oils dissolve completely and easily in fixed oils. Fixed oils
are lubricating for the skin and often therapeutically useful in their own right. Commonly used fixed oils include
expeller-pressed sunflower, sweet almond, apricot kernel,
hemp (anti-inflammatory and pain relieving), avocado,
borage, jojoba (sebum balancing), or hazelnut, although
many different types of fixed oils can be used. Some fixed
oils such as evening primrose, hemp, jojoba, wheat germ,
and pure vitamin E may be added in small amounts to other fixed oils to enhance the therapeutic properties of these
oils or act as a natural preservative (1 tbsp of preservative
oils to 1 oz of the main fixed oil).
Plain, unscented lotion or massage cream, bath gel,
exfoliation product, aloe vera, clay, and body gels can be
purchased as carrier products for essential oils. This is
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TABLE 74 Basic Scents of Essential Oils and Other Aromatic Materials

SPICY
REFRESHING
HERBACEOUS
SWEET
EXOTIC
Ajowan
Basil
Ajowan
Copaiba balsam
Bay rum
Allspice
Bay laurel
Angelica root
Peru balsam
Copaiba balsam
Angelica seed
Melissa
French basil
Tolu balsam
Peru balsam
Aniseed seed
Fir needle
Calamintha
Benzoin
Tolu balsam
Peru balsam
Bergamot
German chamomile
Sweet birch
Ginger CO2
Tolu balsam
Cajeput
Roman chamomile
Jasmine
Jasmine
Bay rum
Cypress
Helichrysum
Lavender
Myrrh
Caraway
Elemi
Hyssop
Lime
Narcissus
Cardamom
Eucalyptus
Marigold
Mandarin
Nutmeg
Cascarilla bark
Geranium
Marjoram
Mimosa
Oakmoss
Cassia
Juniper berry
Myrtle
Neroli
Neroli
Cinnamon
Lemongrass
Oregano
Carnation
Patchouli
Clove
Tilia absolute
Patchouli
Rose
Sandalwood
Coriander
Myrtle
Rosemary
Rosewood
Spikenard
Cubeb
Palmarosa
Common sage
Liquidamber
Liquidamber
Cumin
Pine
Santolina
Tonka
Tonka
Ginger CO2
Rosemary
Tarragon
Tuberose
Tuberose
Nutmeg
Spanish sage
Thyme
Vanilla
Turmeric
Black pepper
Clary sage
Valerian
Wintergreen
Valerian
Turmeric
Common sage
Yarrow
Ylang ylang
Vetiver
LIGHT AND FRESH
POWDERY
EARTHY
FLORAL
WARM/HOMEY
Rosewood
Copaiba balsam
Angelica root
Gardenia
Almond
Sweet orange
Peru balsam
Carrot seed
Geranium
Honey
Bay laurel
Tolu balsam
German chamomile
Hyacinth
Beeswax
Bergamot
Benzoin
Fennel seed
Jasmine
German chamomile
Grapefruit
Cedarwood
Ginger
Lavender
Cinnamon
Lavender
Frankincense
Myrrh
Tilia absolute
Clove
Lemon
Orris
Oakmoss
Mimosa
Inula
Lemongrass
Sandalwood
Patchouli
Narcissus
Lavender
Lime
Liquidamber
Spikenard
Neroli
Nutmeg
Litsea
Tonka
Vetiver
Rose
Vanilla
Mandarin
Vanilla
Yarrow
Carnation
Mandarin
Clary sage
Violet flower
Tuberose
Rose
Lemon verbena
Violet flower
Ylang ylang
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TABLE 74 Basic Scents of Essential Oils and Other Aromatic Materials (continued)
LEMONY
CAMPHORACEOUS
MEDICINAL
LEATHER
ALPINE
Melissa
Exotic basil
Bay laurel
Cade
Fir needle
Elemi
Borneol
Sweet birch
Cypress
Bay laurel
Eucalyptus citriodora
Cajeput
Cajeput
Guaiacwood
Sweet birch
Lemon
White camphor
White camphor
Labdanum
Cedarwood
Lemongrass
Eucalyptus
Eucalyptus
Oakmoss
Cypress
Litsea
Niaouli
Niaouli
Opopanax
Juniper
Lemon verbena
Oregano
Spanish sage
Patchouli
Spruce
Tea tree
Valerian
Thyme
Vetiver
Yarrow
WOODY
GREEN
MINTY
CITRUS
Amyris
Galbanum
Cornmint
Bergamot
Ambrette seed
Cade
Tilia absolute
Peppermint
Grapefruit
Costus
Cascarilla bark
Myrtle
Spearmint
Lime
Cumin
Labdanum
Cedarwood
Narcissus (dark)
Lemon
Cubeb
Tagetes
Mandarin
Inula
Tarragon
Bitter orange
Rosewood
Valerian (dark)
Sweet orange
Sandalwood
Violet Leaf
especially helpful if the therapist is designing an original

service and wants to create a smell-scape for the client, although it is important to avoid products that contain components that block the absorption of essential oils through
the skin. Such products include mineral oil, petroleum,
lanolin, coconut oil, and coco butter. Sometimes, a spa
product will be fragranced when it arrives at the spa. If the
scent is light, it can easily be modified by adding essential
oils. This is not ideal, however, because the fragrance may
be synthetic and not appropriate for use in aromatherapy.
MUSKY
to a base or carrier for a particular concentration. Figure 79

illustrates which concentration to use on a particular type of
client or condition. Concentrations of between 1% and 4%
are standard in the field of aromatherapy and are low enough
to insure safety and minimize negative reactions. Concentrations of above 4% are used in acute situations or by experienced therapists; 100% (neat) applications are used for spot
treatments with specific oils such as tea tree for toe fungus;
helichrysum for trigger point therapy; lavender for small
burns; German chamomile for inflammation of soft tissue;
and lemon, tea tree, or lavender to dot on a skin blemish.
Essential Oil Concentrations

The term concentration refers to the amount of essential
oil in the final volume of massage oil or carrier product.
Table 75 outlines how many drops of essential oil are added
Synergy
A synergy is when the whole is greater than the sum of its
parts, and those parts are mutually enhancing. Derived
TABLE 75 Carrier Volume to Essential Oil Concentration

CARRIER (OZ)
EO 1% (DROPS)
EO 2% (DROPS)
EO 2.5% (DROPS)
EO 3% (DROPS)
EO 4% (DROPS)
12
12
15
18
24
12
24
30
36
48 ( tsp)
24
48
60
72
96
48
96
120
144
192
EO, essential oil.
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146

1%
Children, the elderly,
pregnant women
2.5%
Standard full-body
applications
3.5%
Strong full-body applications
4%
Local applications for a specific purpose
(i.e. cellulite cream)
5% to 10%
5% to 10% concentrations are strong. They are used in acute
situations by practitioners with advanced training.
FIGURE 79 Standard concentrations in aromatherapy.
from synergios, which is a Greek word that means associate

or partner or, literally in this context, working together.
Synergistic interactions between chemical compounds create a greater spectrum of action than would be possible
using a single oil alone.
When creating synergistic blends, it is important to
remember that essential oils are chemically complex,
so blending too many oils at once tends to muddy the
result. Often, only three to four oils are needed to make a
good synergistic blend. When you put two, three, or four
oils together with similar or complementary therapeutic
actions, you create a blend that is much more effective than
a single oil working along.
To create a synergy for relaxation, fir could be chosen
for its alterative action, which helps the body to regain
balanced function. Sweet marjoram could be added for its
nervine qualities, which help to strengthen and support the
overall nervous system. Finally, lavender might be added as
a restorative that helps with burnout and exhaustion. These
three oils will have a broader action on stress than fir on
its own.
You can also use the action or property words in aromatherapy literature to create a synergy. For example, if
you wanted a blend that was antiviral, you would simply pick two to three oils that listed antiviral in the
action/property area associated with the essential oil.
The chemistry of oils can also be used. For example, if
you want a blend that is a powerful muscular antispasmodic, you would turn to essential oils high in esters,
such as Roman chamomile (77%), clary sage (70%), and
petitgrain (65%).
Many perfumers and aromatherapists use the top, middle,

and base note classifications of essential oils and perfume materials to achieve a symphony of balance in the
fragrance. Top, middle, and base notes are determined by
their different rates of evaporation. Top notes are generally
composed of small molecules (i.e., they are lightweight and
evaporate quickly). They are the first aromas to hit your nose
and give you the initial impression of the fragrance. Middle
notes are slower to evaporate and create the substance or
main theme of the fragrance. Base notes appear last due to
their larger molecular size and slower rate of evaporation.
They also bind all the other ingredients in a scent, holding
the scent together. When using notes to create blends, the
idea is to include an oil that resonates on each note so that
the fragrance smells integrated and whole. If the blend does
not harmonize, try to use bridging oils such as jasmine
and ylang ylang that resonate on more than one note. If the
blend smells rough, you can soften it by adding a blend
smoother such as rosemary, marjoram, or a citrus oil. Blend
enhancers such as sandalwood, bergamot, clary sage, and
lavender will bring out the scent of the other oils, bridge
gaps, and generally enhance the aroma. Rose and chamomile species will often jump out of a blend and can be
modified with black pepper, geranium, lemon, or clove.
Table 76 provides an overview of the note classification of
some essential oils.
Approach to Blending
In a spa setting, therapists often approach blending by asking questions such as, What smells good? What combination of aromas will delight and inspire my clients? or
Can I create an aroma that will affirm and encourage the
spirit or cause deep restful relaxation? Each blending situation is different, and therapists must constantly evolve their
skills to integrate both practical and intuitive approaches
to blending. It is helpful to look at every specific classifications of blends.
Physiological blend: This type of blend aims to meet
the needs of the body. If the client has sore muscles, the
essential oils are chosen to decrease pain and spasm in
muscle tissue. If the client is stressed out, the oils are
chosen to balance the CNS and decrease stress.
Psychological blend: A psychological blend is focused
on changing a mood, overcoming an internal obstacle,
opening the mind to new ideas or new ways of being,
forming a connection to a resource state, refreshing the
mind, and alleviating mental fatigue and burnout.
Spirit blend: A spirit blend affirms characteristics of
the individual spirit. It reminds wearers to focus on the
aspects that they like most about themselves and want
to strengthen. For example, an individual who is having
difficulty in expressing or in experiencing joy might
build a blend around grapefruit, which affirms joy.
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TABLE 76 Top, Middle, and Base Notes of Essential Oils

TOP NOTES
Anise
Fennel
Mandarin
Petitgrain
Bay
Fir
Marjoram
Pine
Bergamot
Galbanum
Mimosa
Rosemary
Birch
Ginger
Nutmeg
Spearmint
Carrot seed
Grapefruit
Orange
Tangerine
Cedarwood
Juniper berry
Oregano
Taragon
Coriander
Lavender
Palmarosa
Thyme
Cypress
Lemon
Pepper
Wintergreen
Davana
Lime
Peppermint
Wormwood
Allspice
Clary sage
Melissa
Ylang ylang
Basil
Clove
Neroli
Beeswax
Geranium
Orris
Benzoin
Jasmine
Osmanthus
Boronia
Lavender
Pepper
Carnation
Lemon verbena
Rose
Roman chamomile
Lemongrass
Tagetes
MIDDLE NOTES
Champa
Linden
Tuberose
Cinnamon
Litsea cubeba
Violet leaf
Ambrette
Fir
Opopanax
Vanilla
Angelica
Frankincense
Patchouli
Vetiver
Benzoin
Galbanum
Peru balsam
Cassia
Hay
Sandalwood
BASE NOTES
German chamomile
Helichrysum
Seaweed
Clary sage
Myrrh
Tarragon
Copaiba balsam
Nutmeg absolute
Tolu balsam
Costus
Oakmoss
Tonka
An individual who is suffering from feelings of jealousy

and wants to amplify the more trusting aspects of his or
her spirit might build the blend around clary sage.
Holistic blend: A holistic blend includes an essential
oil(s) for the body, mind, and spirit to address the needs
of the entire individual.
Perfume blend: A perfume blend can include aspects
of the blends described previously but is intended to
be worn as a personal scent or to scent a product. In all
blends, the oils will amalgamate to form a new scent (as
opposed to smelling like a single oil). The scent created
by the merging of many aromas has its own personality
something entirely new and complete in itself. The perfume blend is a creative expression of themes.
Smell-scape blend: A smell-scape blend is one blend in

a series of blends based on a unifying theme. The idea
is to keep the blend within the parameters of the theme
but to smell differently than every other blend in the
smell-scape to create the most olfactory interest for the
client.
Holistic Blending Type 1
Clients will often experience their physiological conditions
in a variety of psychological ways. A client who has moderate to severe back pain will also feel a certain way about
dealing with that pain on a daily basis. The ongoing pain
may cause irritation, firing of the sympathetic nervous
system (fight or flight response), agitation, and increased
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stress levels. A therapist who creates a blend that addresses

both the physiological situation and the psychological reaction to the situation is blending holistically.
Holistic blending type 1 is a blending method for novice
blenders that encourages them to identify their reasons for
using an essential oil and considering both the physiological and psychological state of the client. In this method, the
physiological oils will be chosen first. The psychological oil,
the most difficult of the oils to select, will be chosen last.
Holistic blends should be composed of a total of three to six
oils. A therapist who wants to weight the blend for its physiological action will choose more oils to address the physiological needs of the client. For a psychologically weighted
blend, the therapist would choose more oils to address the
psychological needs of the client.
Choose First: Core Physiological Oil
The core physiological oil should directly address the physiological condition of the client. For example, if the client requests a blend for neuralgia, the core physiological oil would
need to have an antineuralgic, or nervine, action. If the client
has recently been in a car accident and is experiencing mild
inflammation in the cervical vertebrae, the physiological oil
would likely be anti-inflammatory and analgesic.
Choose Second: Physiological Support Oil
The physiological support oil complements the actions
of the core physiological oil. It should address the condition but from a different direction. For example, suppose
that helichrysum is chosen as the core physiological oil for
its nervine action and usefulness in treating the neuralgia
mentioned previously in the first example. You might then
choose Roman chamomile as the physiological support oil
because it is a reliable antispasmodic and analgesic. Alternatively, for acute inflammation, you might choose German
chamomile oil for its anti-inflammatory abilities. For additional support, you might include frankincense, which is
mildly analgesic and also anti-inflammatory.
Choose Third: Psychological Balance Oil
The psychological balance oil is chosen to address the emotional aspect of the clients condition. It is often sedative for
the CNS but not always because some conditions require
stimulation of the CNS. If a client is feeling agitated about
a reduction in his or her work output because of neuralgia,
the psychological balance oil would be chosen to deal with
that agitation. An oil such as lavender might be used to balance out the CNS and bring mental/emotional relief. In the
second example, in which the client had recently been in a
car accident, the psychological oil might be chosen to combat the emotional imbalance often felt after such an event.
Neroli, which is used to combat shock and anxiety, might be
chosen. Geranium, lavender, or cypress would also be good
choices because they stabilize the endocrine system.
The psychological support oil is the most difficult to
choose because it requires the most thought. You must
choose an oil that will address the emotional/mental/
spiritual needs of the client but not contradict the
physiological actions of the other two oils. For example, if a

warming oil such as clove was chosen as the psychological
balance oil for the neuralgia blend, it would counteract the
anti-inflammatory cooling actions of the helichrysum and
Roman chamomile. The warming, cooling, sedative, and
stimulating properties of the oils should be considered in
holistic blending.
Holistic Blending Type 2
The second type of holistic blend is very similar to the previous blend but equally balances the body, mind, and spirit.
It is composed of only three oils.
Choose First: Body Oil
The oil for the body will directly address the physiological state of the client. This is different from the first blend,
which provided support for a symptom of a specific condition or a body system. This time, the oil has a larger
focusthe entire physiological state of the client. Massage
therapists are not doctors, and we cannot diagnose a clients physical condition. Instead, we are trying to get an
impression of the clients body state. Perhaps you notice
that the client fidgets in the chair and gets up to walk nervously around the room. The body oil for this client would
be different from that for a client who looked at you listlessly during the health intake and slumped in the chair.
Choose Second: Mental Oil
The second oil addresses the mental state of the client and
seeks to bring balance and clarity to mental processes. The
first client in the previous example might be supported by
a mental oil that is expanding and positive to disrupt any
unchecked negative self-talk. Frankincense is an excellent
choice because frankincense is transformational, meditative, and expanding. The second client might best be supported by an oil that facilitates mental clarity and sharpness,
such as peppermint.
Choose Third: Spirit Oil
This oil is chosen to support the part of the self that the
client wants to affirm. It is helpful to ask clients what they
would like to radiate into the world or, in less esoteric
language, what they love and value most about themselves.
The oils should resonate with those qualities. For example,
if the client in the first example loved his or her openheartedness, rose might be chosen as the spirit oil. Rose directly
affirms the heart and openheartedness. If the second client
claims to really like the fact that he or she is good with
money, the therapist might choose basil as the spirit oil.
Basil is associated with wealth and abundance in many
cultures worldwide.
Application Methods
Well-trained, professional aromatherapists are assets to
spas. They can provide custom blending specifically tailored
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Chapter 7
to the needs of the individual client. They can also develop

signature blends for the business and provide smell-scape
recommendations for specific treatments. Even the simplest
aromatherapy treatment can benefit a client immensely by
decreasing stress and increasing the pleasure he or she derives from the service. The methods of application described
below focus on some of the common ways that essential oils
can be used in a spa. Figure 73 shown earlier in the chapter
provides an overview of common aromatherapy treatments.
149
they should be generally avoided. If the candle is in a base of

beeswax or soy, it is more likely to contain a pure oil because
essential oils dissolve into beeswax and soy but not into regular candle wax.
SANITATION
Nebulizing diffusers have a glass chamber that
should be cleaned out with alcohol once a
day to keep the apparatus functioning well. Follow the
manufacturers directions.
Inhalations
Unless the spa has a medical focus, you will probably use
inhalations to facilitate clear breathing in saunas, steams,
and showers or to provide mental stimulation or mood
enhancement. Some steam baths have a special holder in
which essential oils are placed. If this is not available, the
oils can be placed directly onto the floor at the edges of the
cabinet or room; 4 to 6 drops provide a light but detectible
scent because the essential oils evaporate into the steam. In
the sauna, add the oils to the water that will be ladled on the
heat source; 2 to 6 drops of essential oil are used, depending
on the size of the water container. Oils added to the heat
source in a sauna must always be mixed in water because
essential oils are potentially combustible and could pop or
flame up if added plain. A drop of oil can be placed on a
tissue tucked in the face cradle to prevent congestion from
lying in the prone position during any treatment.
Diffusing essential oils throughout an area can purify
the air, repel insects, enhance mood, or simply make the
place smell good. A commercial nebulizing diffuser is the
best choice if the aim is to eliminate microbes and promote
a clean, healthy living or working space (Fig. 710). Earthenware burners, electronic fan diffusers, or items such as
lamp rings can be used to scent a room. Spa suppliers will
have a variety of different types of scenting diffusers. Aromatherapy candles are often scented with synthetics, so
FIGURE 710 Aromatherapy diffusers. A nebulizing diffuser is the

best choice if the goal is to decrease airborne pathogens and create a clean
and healthy environment.
Aromatic Exfoliations and Body Shampoos

Essential oils can be added to a granulated exfoliation
product or applied in a foaming bath gel for a fragrant and
satisfying body polish or body shampoo. Add 24 drops of
an essential oil blend to 2 oz of either exfoliation product
or foaming body wash. Aromatic exfoliation can be the
first step in a larger treatment as discussed in Chapter 8,
Exfoliation Treatments.
Aromatherapy Massage
An aromatherapy massage provides both physiological and
psychological benefits for the client. Use a 2% (12 drops/oz
of carrier) to 3% (18 drops/oz of carrier) concentration of
essential oils in carrier oil or cream for a full-body massage.
Use a 1% (6 drops/oz of carrier) concentration when massaging the elderly, children, or pregnant women; 4% blends
(24 drops in 1 oz) can be used for spot treatments (trigger
point therapy, cross fiber friction, etc.) or for specific conditions (carpal tunnel, lateral epicondylitis, etc.). Certain oils
such as German chamomile can be used at 100% to decrease
pain and inflammation in a specific area.
In a classic aromatherapy treatment, the therapist meets
with the client during a formal aromatherapy consultation
in which the client fills out a health history form and the
client and therapist discuss the clients expectations of aromatherapy and health care goals. A custom blend is created
and then applied in a full-body massage. Some therapists
use methods such as applied kinesiology or body talking
to choose oils for the client. In such a method, the client
holds a bottle of oil and the therapist uses muscle testing to
determine which oil increases strength in the muscle. Some
therapists let the client pick all of the oils for the blend, believing that clients will only be drawn to oils that support
them in their particular healing process. Other therapists
take the opposite approach and choose oils that the client
has a mild dislike of. The assumption in this case is that clients are out of balance with what they need for healing and
that healing will happen slowly as the client develops an affinity to the oil or blend. Most often, choosing oils for the
blend is a joint process between the client and the therapist.
The therapist suggests oils that have physiological or psychological effects that would support the clients healing
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150
needs, and the client shares likes and dislikes until both are
satisfied with the oils chosen. The therapist will then check
for contraindications before creating the final blend of oils.
Some spas choose not to offer custom blending but create a series of premade blends from which the clients choose
a scent they like. This allows the clients to have more massage time for the same amount of money. It also enhances
retail opportunities because clients often become attached
to a scent and will purchase the body wash, body lotion,
and room mist that match their massage oil. A selection of
starter oils and ready to blend recipes is offered in Table 77
for easy adoption by a massage clinic or spa.
Aromatherapy Baths
A hydrotherapy tub is a specialized soaking unit that has
multiple air and water jets. Essential oils can be added to the
hydrotherapy tub or to a standard soaking tub for therapeutic
baths. Sometimes, the oils are added simply for the pleasure
of their fragrance, or they can be used to treat sore muscles,
stress, insomnia, low immunity, skin problems, depression,
irritability, or a variety of other conditions. The drawback to
using essential oils in a bath is that the oils will pool on the
top of the water. When the client gets into the bath, the oils
will stick to the area that hits the water first, or they will pool
around exposed area and may cause skin irritation. For this
reason, it is best to dilute the oils in carrier oil and massage
the blend into the clients skin. After the massage, the client
soaks in a warm tub where he or she can enjoy the fragrance
of the oils and allow for greater skin absorption. Sometimes,
essential oils are added to an emulsifier, which disperses
them in the body of the water to prevent pooling. In this case,
6 to 9 drops of essential oil are used for a bath.
Aromatic foot and hand baths can be used to treat disorders of the feet and hands, such as arthritis and athletes
foot, or used for relaxation, low immunity, or stress-related
disorders. The oils are diluted into a carrier product and
massage into the skin before the area is soaked, or the oils
are blended into an emulsifier and added directly to the
bath. In the case of a foot or hand bath, 2 to 4 drops of oil
might be used.
Aromatherapy Wraps
Aromatherapy wraps can take many forms. In the simplest
wrap, the client is cocooned in blankets at the end of an
TABLE 77 Starter Oils and Easy Blend Recipes
21 VERSATILE OILS
THESE BLENDS ARE FORMULATED AT A 2% CONCENTRATION FOR USE IN

1 OZ OF CARRIER PRODUCT (12 TOTAL DROPS TO 1 OZ OF CARRIER).
THEY ARE COMPOSED OF THE 21 STARTER OILS AT THE LEFT.
Bay laurel
Muscle ease: Bay laurel (3), rosemary (1), lemon (6), juniper berry (2)
Bergamot
Breathe easy: Eucalyptus (3), lemon (7), thyme (2)
Clary sage
Mother-to-be: Lavender (7), mandarin (7)
Cypress
Clarity: Thyme (1), grapefruit (9), cypress (2)
Eucalyptus
Rain: Cypress (7), thyme (2), geranium (2)
Frankincense
Equilibrium: Clary sage (3), neroli (2), bergamot (7)
Geranium
Girl power: Clary sage (2), lavender (6), geranium (1), frankincense (3)
German chamomile
Body boost: Lemon (4), thyme (1), bergamot (4), lavender (3)
Ginger CO2
Purity: Juniper berry (3), grapefruit (8), thyme (1)
Grapefruit
Revitalize: Bergamot (6), rosemary (2), lavender (4)
Jasmine
Ocean: Rosemary (3), frankincense (7), ylang ylang (2)
Juniper berry
Zen: Ylang ylang (2), ginger CO2 (2), mandarin (8)
Lavender
Renew: German chamomile (1), rosemary (2), clary sage (4), lavender (7)
Lemon
Shimmer: Bay laurel (3), ylang ylang (1), bergamot (7), frankincense (3)
Mandarin
Meditation: Frankincense (4), jasmine (1), ginger CO2 (2)
Neroli
Energy: Peppermint (1), thyme (4), bay laurel (4)
Peppermint
Summer: Neroli (2), lavender (4), bergamot (6)
Rose
Refresh: Peppermint (1), eucalyptus (2), lemon (8), geranium (1)
Rosemary
Moon mist: Jasmine (2), grapefruit (10)
Thyme
Relax factor: Rose (1), clary sage (2), mandarin (6), frankincense (3)
Ylang ylang
Circulate: Ginger CO2 (2), grapefruit (9), juniper berry (1)
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Chapter 7
aromatherapy massage to relax while the essential oils continue to absorb into the bloodstream. Sometimes, essential
oils are blended into a very heavy carrier product such as
wheat germ oil or shea butter; massaged into the skin; left
to absorb during a wrap; and then removed with hot towels,
a Vichy shower, or a body shampoo. If a body shampoo is
used to remove the excess carrier, a light moisture lotion
may be applied at the end of the treatment to rehydrate
the skin. These treatments are sometimes called emollient
wraps because the heavy carrier product is nourishing for
the skin and softens very dry or dehydrated skin. Other carrier products might also be used. For example, aloe vera and
anti-inflammatory oils can be brushed on the skin for an
effective sunburn relief wrap. Essential oils can be added to
body milk (very light and watery lotion) and misted on the
body with an atomizer before the body is wrapped. Some
therapists soak cotton sheets in hot water and essential oils
and apply them in a hot sheet wrap. This is the least effective method of using essential oils in a wrap because the
oils tend to evaporate very quickly and do not really penetrate the skin. However, this type of sheet wrap does smell
nice. Alternatively, essential oilscented hand towels can be
layered on the body after it has been massaged with aromatic oils, and the body can be wrapped. Oils might also
be mixed up with clay (kaolin, French green, Sedona, etc.)
and applied to the body with a brush before the client is
wrapped. As you can see, there is no end to the ways that
different steps can be mixed and matched to form satisfying
treatments. Body wrap procedures are covered in Chapter 9,
Body Wraps.
Aroma Mists and Aura Mists

Aroma mists have a number of different uses in a spa
setting. They can be used as air purifiers and fresheners, as
linen fresheners, as mood enhancers, skin toners, or body
coolers. In many of the services described in upcoming
chapters, aroma mists are used as a treatment step. Aroma
151
mists make nice take home gifts for clients because they
can use them to refresh the car or to mist at any time as an
olfactory link to the relaxation they experienced in their spa
treatment.
An aura mist is an aromatherapy body mist that is used
only at the very end of the treatment. It is misted in a high
arch over the client from the head to the toes. It should be
scented with an aroma that contrasts with the treatment
products and fills the treatment room with a refreshing
scent. This helps to wake the client up and stimulate them
at the end of the session.
A number of different base fluids can be used when creating aroma or aura mists including purified water, herbal
teas, floral waters (hydrosols), lemon juice, witch hazel, and
vinegar. Add 30 drops of an essential oil blend to 2 oz of base
liquid in a bottle with a spray top. It is best to refrigerate
mists between uses to prevent the product from expiring. If
tea is used as a base, the product will have a short shelf life
(2 to 3 days) and should be made up in small batches only.
Support Lotions
A support lotion is a blend of essential oils mixed into a
lotion base that is given to the client to use as a form of selfcare. The oils might be chosen to give the client an energy
boost, to calm the client if he or she is feeling anxious, as a
link to a positive affirmation or new life choice (quit smoking, take a break, eat healthy, etc.), or as a pleasant reminder
of his or her stay at the spa. The lotion can be used at any
time by the clients in a variety of ways and gives clients a
simple way to bring aromatherapy into their lives. They can
rub it on their hands and then hold their hands over their
nose for a simple inhalation. They can spread the lotion
over the anterior neck, down the sternum, under the breast
tissue, and behind the neck, where lymph nodes come up
close to the surface of the body for a gentle immunity boost.
Finally, they can rub the lotion all over their body and take
a bath.
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SPA FUSION
STUDY TIP: Botanical Flash Cards
Aromatherapists use the botanical names of plants
to ensure they are using the correct species in their
treatments. If aromatherapy is important to you,
learn the botanical names of essential oil, baring
plants with botanical flash cards. To create flash cards,
review Appendix B (Essential Oils and Their Botanical
Names) at the back of this book. List the common
name of an essential oil on one side of the card (e.g.,
Bergamot) and the botanical name on the other side
(Citrus x bergamia). When you pronounce Latin, you
usually simply sound out the word as it is spelled
there is nothing tricky about it. Work through five
cards a day until you have them memorized, and soon
you will have an excellent foundation of knowledge of
botanical names.
CHAPTER WRAP-UP
Aromatherapy is the use of essential oils for healing
the mind, body, and spirit. Different health care providers will use essential oils in diverse ways based on
their scope of practice. These modern-day uses mirror
ancient times, when aromatic substances were used for
both medical and spiritual practice.
Essential oils are volatile plant oils extracted from
certain aromatic plants that have both physiological
and psychological effects on the human body. These
oils are chemically complex and may contain as many
as 400 different components. The oils are stored in the
leaves, needles, twig, bark, flowers, flower buds, fruits,
stems, and roots; they are extracted through steam
distillation, expression, solvent extraction, or CO2
hyperbolic production. Essential oils are often adulterated on the international market to increase the profit
margin of the grower or supplier. Aromatherapists
believe that the human body responds differently to
natural oils than to those that are synthetic or adulterated. For this reason, it is important to purchase
high-quality, therapeutic-grade essential oils from a
reputable supplier.
The oils enter the body via the skin, inhalation
through the lungs, and ingestion (which is not used
without advanced training). Once in the body, the
chemical compounds in essential oils interact with the
bodys chemistry to affect specific organs, systems, or
the body as a whole (physiological effects). The inhalation of essential oils also triggers an olfactory response
that can lead to powerful mental and emotional
behavioral changes (psychological effects).
Basic blending methods such as synergistic

blending and note blending allow the therapist to create interesting smell-scapes to enhance the clients spa
experience. Aromatherapy massage, exfoliation, wraps,
and hydrotherapy introduce clients to the benefits of
essential oils. The pleasing fragrances of the oils also
support their use as accent notes in other services.
REVIEW QUESTIONS
Multiple Choice
1. These compounds, present in essential oils, can
be toxic to the living plant and must be stored in
specialized structures such as glands, ducts, scales,
and hairs. These compounds are:
a.
b.
c.
d.
Mostly terpenes
Not chemical in nature
Only found in flowers
Mostly aldehydes
2. Aromatherapy is said to affect the mind, body, and

spirit. Essential oils have a physiological effect on
the body. How do they affect the mind and spirit?
a. Through their effect on the limbic system after
inhalation
b. Through absorption of the oil into the bloodstream
c. Through olfactory effects but only when paired
with hypnosis
d. Through the ability of black pepper oil to break
addictive behaviors
3. Volatility is best described as:
a. The ability to scent an area for a given period
of time
b. The ability to turn from a liquid to a gas at
room temperature
c. The ability to attract useful and needed insects
to the plant
d. The ability to defend the plant against microbial
infection
4. Essential oils are described as:
a. Chemically complex with 100 to 400 or more
chemicals present in the oil
b. Chemically simple with 3 to 7 chemicals found
in the oil
c. Not chemical when they are in a natural form
d. Chemically dangerous unless they are adjusted
in the lab before sale to the public
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SPA FUSION
5. Distilled essential oils will smell:
a. Just like the plant from which it has been extracted
b. Burntdistillation should not be used to produce essential oils
c. Slightly different than the natural plant as some
chemical compounds are lost during the distillation process
d. Sweeter than the plant in its natural form
Fill in the Blank
6. In the process of extraction known as
, essential oils are placed in a still,
and steam is used to burst the essential oil storage
sites.
7. The therapeutic value of essential oils will
decrease with age even under ideal storage
conditions, mostly due to oxidation and the
resulting chemical changes this causes. Replace

essential oils if they have not been used within
. Citrus oils should be replaced
every
.
8. When the potential unwanted side effects of one
compound are decreased or eliminated by one or
more other compounds present in an essential oil,
this is referred to as
.
9. Many factors affect the chemical composition
and therefore the therapeutic value of an essential oil. Three of these factors are
,
, and
.
10. The human body seems to respond differently to
natural oils compared to synthetic oils. Synthetic
,
,
oils often cause
and
.
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P A R T
TWO
Spa
Treatments
10/24/13 1:24 AM
1
8
Exfoliation
Treatments
Chapter Outline
K e y Te r m s
Types of Exfoliation Treatments

Aura mist: An aromatherapy body mist that is used only at the very end
of the treatment. It is misted in a high arch over the client from the
head to the toes. It should be scented with an aroma that contrasts
with the treatment products and fills the treatment room with a refreshing scent.
Dihydroxyacetone (DHA): The component in autotanning products
that causes the skin cells to change color and appear tanned.
Dissolving exfoliants: Dissolving exfoliants are composed of alpha
hydroxy acids (AHAs) and beta hydroxy acids (BHAs). AHAs include
glycolic, citric, lactic, and malic acids. The most widely used BHA in
cosmetics is salicylic acid or its related substances, sodium salicylate
and willow extract.
Enzymatic exfoliation: Exfoliation that relies on biological action rather
than physical abrasion. They are applied to the skin and then rinsed
off. The enzymes used dissolve keratin in the skin, thereby removing
dead cells and supporting the natural process of exfoliation. Papain
from papaya is a good example of one of these enzymes.
Exfoliation: A process by which dead skin cells are removed to improve
the skin texture and appearance. Other benefits include increased
circulation and lymph flow, increased immunity, and relaxation.
Mechanical exfoliation: A physical process in which the body is rubbed
with an abrasive product or with a coarse handheld item such as a
loofah.
Ultraviolet A (UVA) rays: Sometimes referred to as aging rays, these
rays from the sun penetrate deeper into the skin than UVB rays and
cause photosensitivity reactions.
Ultraviolet B (UVB) rays: Also known as burning rays, these rays from
the sun are the primary rays associated with skin damage and cancer
from the sun.
Scope of Practice
Skin Conditions
Overexfoliation
Dry Skin Brushing

Dry Skin Brushing Techniques
The Enhanced Dry Skin Brushing Procedure

The Salt or Sugar Glow Procedure

The Full-Body Polish Procedure

The Buff and Bronze
The Buff and Bronze Procedure
Home Care and Retail
SPA FUSION
STUDY TIP: Good Listening Skills
SPA INSPIRATION: Roll Tape!
CHAPTER WRAP-UP
155
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156
In a manual exfoliation treatment, the skin is polished or

scrubbed with a coarse-textured product that gently sands
Broaden Your Understanding 81 provides an overview of

exfoliation treatments offered exclusively by estheticians or
physicians in a spa.
the skins surface. This brightens the skin by removing the

dull top layer of dead cells, deep cleanses the pores, and
improves the skins texture. These actions are important for
skin health and have other therapeutic benefits that work in
synergy with massage. During an exfoliation treatment, the
vital energy of the body is improved and the body is relaxed.
This chapter aims to describe the types of exfoliation
treatments commonly used by massage therapists. It also
provides a brief overview of other exfoliation treatments
provided by estheticians or physicians in the spa profession.
Before delivering the treatments described in this chapter,
you may wish to review the information in Chapter 4
(Your Spa Massage), Chapter 5 (Foundation Skills for
Spa Treatment Delivery), and Chapter 7 (Introduction to
Aromatherapy for Spa). You may also want to look at the
sample exfoliation treatments provided at the back of the

Before you provide exfoliation treatments at the spa or in
your massage practice, check with the state board of massage
to ensure that the types of treatments you want to provide
are in your scope of practice as defined by the state where
you work. You should also pay attention to the clients overall skin condition and the dangers of overexfoliation.
Scope of Practice
Massage therapists in most states (but not all) must be
careful not to encroach on the scope of practice for estheticians when they promote or deliver an exfoliation treatment. Massage therapists usually aim to decrease muscle
tension, increase the vital energy of the body, and relax the
body with exfoliation treatments. A fair amount of soft tissue manipulation is usually included in the service to meet
these treatment goals. To avoid problems, it is a good idea
to highlight these body-oriented goals in the promotional
description of the treatment rather than focus on the benefits of the treatment for the skin.
book for inspiration when developing your spa program.
Skin Conditions
Types of Exfoliation Treatments

There are two basic types of exfoliation: mechanical exfoliation, which is used by both massage therapists and estheticians, and enzymatic or dissolving exfoliation, which is
used by estheticians or delivered only by a physician.
Mechanical exfoliants rely on the skin being physically
rubbed with a mildly abrasive exfoliation product or a coarse
handheld item such as a loofah or cactus fiber cloth. Types
of mechanical exfoliation include dry skin brushing, salt or
sugar glows, body scrubs, friction, or body polish treatments.
Although the words brush, scrub, glow, friction, and polish
are often used interchangeably, each of these words implies
a type of product, type of implement, or the degree of abrasiveness in the treatment. The overview of manual exfoliation treatments provided in Table 81 will help you differentiate between these treatments.
The enzyme and dissolving exfoliants used by estheticians and physicians rely on their biological action rather
than simple physical abrasion. They are applied to the skin
and then rinsed off. The enzymes used in these treatments
dissolve keratin in the skin, removing dead cells and supporting the natural process of exfoliation. These types of
treatments are not described in this text because they are
usually out of the scope of practice of massage therapists.
Exfoliation products should not be used on open wounds or

broken skin, on clients with chronic skin conditions (unless
recommended by a physician), on sunburned or inflamed
skin, over varicose veins, or immediately after waxing or
shaving. Using exfoliation products in these circumstances
may cause irritation or complicate the condition.
Overexfoliation
The overuse of manual exfoliation products during a treatment can leave the skin sensitive and inflamed. If such products are used too frequently, the skin will start to thicken
and grow leathery. Exfoliation treatments should not be
given more than once a week for the best results.
Dry Skin Brushing

Dry skin brushing is a technique in which the skin and lymphatic system are stimulated with a natural bristle brush,
rough hand mitts, or textured cloths. Dry skin brushing increases local blood flow to the skin, bringing fresh oxygen
and nutrients to the skin. The sebaceous glands are stimulated and dead skin cells are removed to reveal the healthy
new skin below.
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Chapter 8
Exfoliation Treatments
157
TABLE 81 Overview of Manual Exfoliation Treatments

Dry skin
brushing
Dry skin brushing is a treatment in which the body is brushed to stimulate local blood circulation to the skin, boost general immunity,
increase the vital energy of the body, and desquamate dead skin cells. It is usually performed with natural bristle brushes, but
rough hand mitts or terry cloths can also be used. This is a mild to moderate exfoliation treatment because only light pressure is
used with the body brushes.
Wet skin
brushing
Wet skin brushing is applied in the same manner as dry skin brushing except that the body is dampened with water, apple cider
vinegar, or a foaming body shampoo before it is brushed.
Salt glow
In a salt glow treatment, a specialized salt is mixed with oil, body wash, water, apple cider vinegar, or other wet or oily product and
applied to the body to stimulate local circulation to the skin, smooth the skin, increase the vital energy of the body, or relax the
body. The degree of vigor with which the therapist applies the strokes determines the abrasiveness of the treatment.
Sugar glow
A sugar glow treatment is less abrasive than a salt glow. Table sugar, brown sugar, or raw sugar is mixed with water, oil, milk, wine,
or a body wash product and then applied to the body to increase local circulation to the skin, relax the body, and smooth the skin.
Body polish
A body polish is different than a salt glow in that the exfoliation product is usually blended into an emollient base to protect the
skin. A body polish often has a skin care focus, so the steps of the treatment follow those of a facial. This is the most relaxing and
elegant of the manual exfoliation treatments, so stress reduction is often a primary treatment goal.
Body scrub or
loofah scrub
As the name suggests, a body scrub is a vigorous and revitalizing treatment. A loofah mitt, rough hand mitts, or cactus fiber cloths
are used with a foaming body wash to cleanse the skin, stimulate local circulation to the skin, and rejuvenate the body.
Friction
In Rational Hydrotherapy, Kellogg10 gives very specific recommendations for the way that friction should be applied to a particular
client for a specific physiological effect. For general purposes, a friction could best be described as a treatment in which the skin
is rubbed in a back-and-forth motion with dry hands or with a wet lubricant such as apple cider vinegar or a body shampoo. Terry
mitts or rough hand mitts may also be used with water at specific temperatures (i.e., cold mitt friction). The abrasiveness of a friction are based on the treatment goals of the individual service and the types of implements that are used.
Buff and
bronze
A treatment that includes a full-body exfoliation, moisture massage, and the application of an autotanning product that leaves the
client looking as if they are naturally tanned.
Dry brushing is a nice enhancer treatment before a fullbody massage. When the dry brushing is part of a spa treatment, each area can be brushed separately before applying
the treatment product, or the entire body can be brushed
first before applying the spa product. When planning such
a treatment, consider how many times the client will have
to turn over. The fewer times the client has to turn over, the
more relaxing the treatment will be.
Dry Skin Brushing Techniques

Use a natural fiber brush with very light pressure on dry
skin, working from distal to proximal with rhythmic
strokes. Although some claim that circular motions and
figure of eights are calming, dry brushing works best when
it is done in brisk, straight lines with very light pressure,
directed toward the heart. Brushing techniques for each
body area are described below and shown in Figure 81. For
a video demonstrating dry skin brushing techniques, visit
thePoint.
Posterior Legs
Undrape the first posterior leg and brush it with light, rhythmic strokes from the ankle to the knee. Overlap the strokes
so that the entire area is covered by brush strokes. Brush
from the knee to the hip across the top of the thigh with
overlapping strokes. To brush the inner thigh, stand at the
clients hip facing toward the foot of the table. Place both
brushes on the medial aspect of the thigh and pull them
toward the lateral side of the leg in light, rhythmic strokes.

To brush the lateral thigh, stand by the knee and run the
brushes briskly up the iliotibial band to the hip. To finish
dry brushing the posterior leg, brush from the ankle all the
way up the leg with long, flushing strokes. Many therapists
brush from the knee to the hip before they brush from the
ankle to the knee. The reason for this is that they believe
that brushing the proximal area first clears and opens up
lymph flow, so that stagnation does not occur when the distal area is brushed.
The Back
Stand on one side of the client, facing across the clients
body. Place the brushes on the far side of the client and pull
them in light strokes toward the spine. Move around the
table to the other side of the client in order to repeat the
side brush. To dry brush the main area of the back, stand
at the head of the table and begin the stroke at the sacrum,
pulling the brush toward the head of the client. To ensure
that the strokes are rhythmic, only brush as far as the midback. Use a separate set of strokes from the mid-back to the
shoulders.
Anterior Legs
When dry brushing the anterior legs, it is easiest to start
with the medial leg by standing at the clients hip and facing toward the foot of the table. Start the strokes by the ankle and work up the leg. Each stroke runs from the medial
side of the leg to the midline of the leg. To dry brush the
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Broaden Your Understanding 81
EXFOLIATION TREATMENTS OFFERED BY

ESTHETICIANS AND PHYSICIANS IN THE
SPA INDUSTRY
Ideally, all the therapists at a spa would have a working understanding of the different types of exfoliation
treatments that are available. Massage therapists
who understand the types of exfoliation treatments
used by estheticians and physicians are better
placed to advise clients on possible treatment options
and can suggest appropriate providers for the client.
The following exfoliation treatments are often seen in
a spa but are not regularly performed by a massage
therapist.
Facial Exfoliation: A specially formulated product
is used to exfoliate skin cells from delicate facial tissue.
This treatment is usually part of a facial service.
Enzyme Exfoliation: An enzyme such as papain
is applied to the skin to dissolve keratin and remove
dead and dulling skin cells. The product should not
be rubbed in. Enzyme exfoliation treatments are most
often used by estheticians in facial treatments but can
also be used in full-body treatments.
Skin Peels: High concentrations of alpha hydroxy
acids (AHAs) and beta hydroxy acids (BHAs) can
be used to resurface the skin. Only estheticians
with advanced training should use these products.
Treatments should only be carried out under the
supervision of a physician.
Chemical Peels: Chemical peel products may
include trichloroacetic acid or tretinoin (a vitamin
A derivative) to decrease fine lines and wrinkles
and resurface the skin. Chemical peels (known
as chemosurgery) should be applied only by a
physician.
Dermabrasion: Dermabrasion and dermaplaning
help to refinish the skins top layers. These treatments
both involve a controlled surgical scraping and should
be performed only by a physician.
Microdermabrasion: Microdermabrasion is a
nonsurgical procedure used by qualified estheticians.
The skin is literally sandblasted with microcrystals
of aluminum oxide to treat sun damage, wrinkles,
hyperpigmentation, acne scarring, and stretch marks.
Laser Skin Treatments: Laser skin treatments use
a carbon dioxide laser beam to remove layers of
damaged skin. It is commonly used for wrinkles, fine
lines, scars, or uneven pigmentation. This treatment
should only be performed by a qualified, experienced
physician.
top of the anterior leg, stand by the foot and brush upward
toward the knee with light, overlapping strokes. The thigh
is brushed from the knee to the hip in straight, overlapping
strokes. The lateral section of the leg is brushed from the
ankle to the knee along the peroneal muscles and from the
knee to the hip along the iliotibial band. As with the posterior leg, some therapists prefer to brush from the knee to
the hip before they brush from the ankle to the knee. To
complete the anterior leg, brush from the ankle all the way
to the hip with long, continuous strokes.
Abdominal Area
To brush the abdominal area, stand to one side of the client and brush from the far side of the body toward the centerline. Brush the sides of the client from the hip into the
armpit by standing at the head of the table and pulling the
brushes upward in a straight line.
Chest
Stand at the head of the table and brush from below the
navel, pulling in a straight line between the breasts with
overlapping strokes. To avoid the breast drape, simply lift
the brush and jump over it. Brush from the armpit up
and around the breast, ending at the upper portion of the
sternum. Again, jump the breast drape to keep the flow of
the stroke. To finish the chest area, stand to one side of the
massage table and brush across the upper chest from one
shoulder to the other in a straight line.
Arms
Brush from the fingers to the elbow and from the elbow to
the shoulder. Some therapists prefer to brush from the elbow to the shoulder before they brush from the fingers to
the elbow. To complete the arms, use long strokes all the
way from the fingers to the shoulder.
Feet
Brush the feet from the toes down to the heel. Brush firmly
to avoid tickling the client, but if they are too ticklish to
tolerate this, skip the feet and move on.
SANITATION
Before brushing the feet, check them carefully
for fungal infections. If athletes foot or any
other contagious condition exists, skip the feet to avoid
spreading the condition. When brushing the feet, wipe
them first with a disposable antibacterial cloth such as a
diaper wipe.
The Enhanced Dry Skin Brushing Procedure

In the enhanced dry brushing treatment described below,
an invigorating toning massage step, a herbal steam, and
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159
Chest area:
1. Navel to upper chest
2. Armpit to sternum
3. Upper chest
Anterior arms:
Back:
1. Fingers to elbow
2. Elbow to shoulder
3. Fingers to shoulder
1. Side to center
2. Sacrum to mid-back
3. Mid-back to shoulders
Abdominal area:
1. Side to center
2. Hip to armpit
Posterior leg:
Anterior legs:
1. Ankle to knee
2. Knee to hip
3. Medial thigh
4. Lateral thigh
5. Ankle to hip
1. Medial leg
2. Ankle to knee
3. Knee to hip
4. Lateral leg
5. Ankle to hip
Feet:
1. Toes to heel
FIGURE 81 Dry skin brushing techniques. (A) The posterior body. (B) The anterior body.
the application of a revitalizing support lotion are added

to the treatment. The addition of these simple enhancers creates a well-rounded and satisfying skin brushing
service. For an overview of the treatment, review the dry
skin brushing outline in Treatment Overview 81 and
Figure 82.
Session Start
The client can begin the treatment in either a supine or a
prone position because the order in which each area of the
body is brushed is not fixed. In this particular procedure,
the posterior legs, gluteals, back, and posterior arms are
treated first. The client is then turned into the supine position so that his or her anterior legs, abdominal area, upper
chest, anterior arms, and feet are treated.
To start the service, place one hand on the clients
sacrum and one hand on C7 and ask the client to take three
slow, deep breaths. Next, undrape the first posterior leg and
proceed with the treatment.
Step 1: Dry Brush the Area
Dry brush the particular area as described previously under
Dry Skin Brushing Techniques. It is important to note
that people learning dry skin brushing often make the mistake of brushing too hard. The lighter the brush stroke, the
more effective the treatment.
Step 2: Toning Massage
Carefully pour skin toner into one hand from a bottle
with a flip-top lid. Apply the toner to the client with massage strokes. Add more toner as needed until there is sufficient lubrication for massage. Most alcohol-free toners
(avoid the use of products with alcohol because these dry
the skin) contain glycerin, which makes them feel slippery
and refreshing. Keep the toning massage brief because skin
toners tend to be cooling, and the client may get cold if this
step is carried on for too long.
Step 3: Application of a Steamy Herbal-Infused Towel
Remove a hot, moist, herbal-infused towel from the soda
cooler and lay it over the body area youre working on.
Allow the towel to sit without touching it for 30 seconds.
To activate the towel and increase the clients perception
of warmth, use compression strokes over the top of the
towel. Remove the towel and blot the client dry with a soft
hand towel.
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Treatment Overview 81:

Dry Skin Brushing Overview
Indications
Dull skin; low energy; stress; sore muscles; to supportt a llarger treatment aimed at detoxification; dull, congested skin;
as preparation for application of a treatment product (the
removal of dead skin cells supports product absorption)
Contraindications
Skin conditions, broken or inflamed skin, sunburn,
high blood pressure, heart or circulatory conditions,
illness or fever, lymphatic condition, cancer (except
under the supervision of a physician), any condition
contraindicated for massage
simple aura mist. Make sure to use an aroma that contrasts

with the scent of the herbal towels and revitalizing lotion
for the greatest olfactory impact as discussed in Chapter 7
(Introduction to Aromatherapy for Spa).
SANITATION
At the end of the treatment, the dry skin
brushes are washed in warm, soapy water
and placed in alcohol for 20 minutes. They are allowed
to air dry and then placed back into a closed container.
Because alcohol is very drying for the brushes, they will
need to be replaced regularly.
Supplies for the Treatment Table Setup

Massage sheet, blanket or bath sheet for warmth, bolster,
warm packs as needed
Supplies for the Work Table Setup

(for the Enhanced Procedure)
1) Skin toner in a bottle with a flip-top lid
2) Soda cooler with nine herbal-infused towels
3) Revitalizing support lotion in a bottle with a flip-top lid or
other finishing product
4) Aura mist
Basic Procedure
Dry brush the particular body area working from the distal
area toward the heart. Begin on the posterior legs; proceed to the gluteals and back; turn the client and brush
the anterior legs, belly, arms, and upper chest before
brushing the feet.
Enhanced Procedure
1) Dry brush the particular body area working from the
distal area toward the heart.
2) Apply a skin toner with a variety of massage strokes.
3) Steam the area with a herbal-infused towel.
4) Apply a revitalizing support lotion or seaweed gel to the
area.
5) End the session with an aura mist of a contrasting scent.
Revitalizing Lotion Recipe

2 fl oz of plain unscented lotion, lavender essential oil
(9 drops), grapefruit essential oil (15 drops), thyme
essential oil (4 drops), juniper berry essential oil (2 drops)
Step 4: Application of a Finishing Product

In this treatment, a revitalizing support lotion is used as the
finishing product, but seaweed gel, plain moisture lotion, or
aloe vera gel may also be used. A revitalizing support lotion
consists of a regular moisture lotion or gel product mixed
with essential oils that support the lymphatic system (see
Treatment Overview 81 for a recipe). Apply the lotion from
the distal area to the proximal area with long, flushing strokes.
Session End
Once each area of the body has been treated, end the service with a neck and face massage, a face steam, or with a

Salt and sugar glows are therapeutically useful because
they stimulate local circulation to the skin, increase the
vital energy of the body, remove dead cells and impurities from the skin, and improve skin health. The role of
minerals in healthy skin metabolism and body function
is not fully understood. Minerals from Dead Sea salt and
other salt deposits (e.g., Bearn salt from the Pyrenees
Mountains in the South of France) are believed to help
regulate some skin and certain body functions. In a study
published in the International Journal of Cosmetic Science,1
potassium from sea salt increased carbon dioxide (CO2)
transport, whereas calcium helped to regulate cell membrane permeability in the skin. Some minerals are hygroscopic (meaning they attract water molecules) and can be
used to restore skin moisture perhaps by increasing intercellular water capacity. Of the many different types of salt
that can be used for a salt glow, the cheapest and most
readily available is ordinary sea salt, which is available at
many local grocery stores. The most popular type of sea
salt for spa treatments is Dead Sea salt.
The Dead Sea is an ancient landlocked sea whose water
has been slowly evaporating over the centuries, producing a concentrated natural salt solution. After bathing in
the Dead Sea, people often report a feeling of increased
energy, well-being, and special baby-soft skin. The main
elements in Dead Sea water are chlorine, magnesium,
sodium, calcium, potassium, and bromine.1 These minerals
are absorbed through the skin by bathing in the dissolved
salts or by using a Dead Sea salt cosmetic preparation.
In the study noted previously, the skin-smoothing effects
of Dead Sea minerals in a cosmetic product were compared
with the same cosmetic product containing no Dead Sea
minerals. The control in the study, a plain gel with no active
ingredients, showed an average decrease in skin roughness
of only 10.4%. The cosmetic product containing no Dead
Sea minerals reduced roughness by 27.8%. The cosmetic
product containing Dead Sea minerals reduced roughness
by 40.7%.1
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Chapter 8
B1
B2
161
FIGURE 82 Enhanced dry brushing procedure. (A) Dry brush the

area. (B1 and B2) Toning massage. (C) Herbal steam. (D) Application of
a finishing product.
Bearn salt, from springs in the Pyrenees Mountains of

Southern France, has well-known restorative and antistress
properties, making it especially useful for hydrotherapy tub
soaks. It is mined close to a small spa town called Saliesde-Barn, where the thermal waters are seven times more
salty than seawater. The thermal pool in the middle of
town is a favorite place to soak tired feet after hiking in the
Pyrenees. As early as the 16th century, the ladies of the court
of Navarre would leave their chateaus to bathe in Salies,
believing it would prevent premature aging. Today, the
salt springs are still used to heal urinary infections, to treat
arthritis, and for children with developmental problems.
Epsom salts are inorganic mineral salts that support

the body in its efforts to detoxify itself. Epsom salts are
often used for sore, tired muscles and as a soaking agent
for bruises, sprains, and strains. Because Epsom salts are
drying, they are best used on oily skin types.
Chemically, salt consists of 60.663% elemental chlorine
(C1) and 39.337% sodium (Na). Table salt is processed, so
it contains higher levels of chlorine than other types of salt.
The relatively high chlorine content of table salt can burn
a clients skin, and this is the reason that it is not suitable
for use in spa treatments. Sea salt and mineral salts are safer
for spa use because they contain a wider range of minerals
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162
and proportionately less total chlorine. They are therefore

gentler, less irritating to the skin, and can be safely used in
spa treatments.
Sugar is gentler than salt and has emollient and humectant (moisturizing) properties that leave the skin feeling
soft and smooth. When dissolved, it can be applied to the
skin as a glaze to soften, increase water content, and aid in
healing. Brown sugar and table sugar are granular, so they
can be used for exfoliation, whereas honey, molasses, and
dissolved sugar are used as body glazes.
The Salt or Sugar Glow Procedure

As with all spa treatments, there are a number of different
delivery options for this service. Often, a salt or sugar glow
will be a quick 30-minute treatment that is used to prepare
the body for another service. Sometimes, the salt or sugar
glow is given together with a Vichy shower to take advantage
of the contrasting water temperatures, an equally important
part of the treatment. The treatment described here is not traditional in its approach but will quickly gain popularity with
clients. It is meant to be used in a dry room and delivered with
a full-body massage. The massage step is intertwined with the
salt or sugar step so that each part of the body is addressed
separately. Because so much massage is used in this treatment, it takes from 75 to 90 minutes to deliver the session.
For an overview of the treatment, review the salt or sugar glow
outline in Treatment Overview 82 and Figure 83. Table 82
describes different salt and sugar mixtures and various ways
to apply the salt or sugar to the body. Also, you can see a video
demonstrating this technique by visiting thePoint.
Session Start
Bolster the client as you would for a massage. The order in
which each body area is addressed is not fixed, but it works
well if the client starts in a prone position, beginning the
treatment with the posterior legs and gluteals and progressing to the back. The client can then be turned into a supine
position for the last half of the treatment while the anterior legs, feet, abdominal area, upper chest, and arms are
treated. The treatment ends with a neck and face massage.
Step 1: Massage
Undrape the desired body area and apply massage oil with
Swedish strokes. You can determine the length of the massage step, the depth you use, and the types of strokes you
use based on how you design the session or on the treatment goals you have agreed with the client. Many therapists
choose to offer a longer version of this treatment and include a full range of strokes during the massage step.
Step 2: Exfoliation
Be careful not to apply salt or sugar to a body area that is
not well oiled because this may cause irritation to the skin
and will feel abrasive to the client. After lubricating the area
with massage oil, lightly sprinkle the salt or sugar onto the
area with a cheese shaker or scoop it up from a bowl after it

The Salt or Sugar Glow Overview
Indications
Low energy; sore muscles; stress; dull, rough skin; or as a
preparation step before the application of a treatment
product in a larger service
Contraindications
Skin condition, inflamed skin, broken skin, poorly managed
diabetes, illness, fever, any condition contraindicated for
massage

(from the bottom layer to top layer)
1) Plastic table protector
2) Bottom massage sheet
3) Bath towelthe weave of the bath towel will catch
excess salt or sugar that falls off the client during the
first half of the treatment. When the client turns over,
the towel will prevent him or her from feeling the salt or
sugar granules.
4) Top massage sheet
5) Blanket or bath sheet for warmth

1) Salt or sugar in a bowl or a cheese shaker
2) Massage oil or body wash gel for mixing up salt or
sugar
3) Aroma mist or skin toner
4) Mist bottle or cosmetic sponges for applying aroma mist
or toner
5) Finishing product (lotion, gel, etc.)
6) Soda cooler and hot, moist towels
7) Bowl of warm water
8) Other items as needed for variations or enhancers (i.e.,
slippers, robe, foot soak, essential oils, etc.)
Dry Room Procedure

1) Massage the body area.
2) Apply salt or sugar and exfoliate the area.
3) Remove salt or sugar with a hot towel.
4) Apply aroma mist or skin toner.
5) Pat the area dry with a hand towel.
6) Apply a finishing lotion or gel.
7) Redrape the body area and move on to the next area.
8) At the end of the treatment, provide a massage of the
neck and face then finish with an aura mist of a contrasting scent.
Wet Room Procedure

1) Begin on the posterior of the body.
2) Wet the body with warm water.
3) Apply salt or sugar in a bath gel.
4) Add warm water and exfoliate the posterior body.
5) Rinse the salt or sugar from the body.
6) Turn the client and repeat on the anterior body.
7) Dry the client and move him or her to a massage table.
8) Apply a finishing lotion or gel.
Note
If a Vichy shower is used (instead of a handheld shower),
the rinsing step can take up to 10 minutes.
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Chapter 8
FIGURE 83 The salt or sugar glow. (A) Massage. Undrape the desired
body area and apply massage oil with Swedish strokes. (B) Apply salt or
sugar to the body with a shaker (the salt or sugar can be premixed with
oil or bath gel and applied by hand if preferred). (C) Exfoliation. Using
gentle, superficial strokes, rub the salt or sugar across the surface of the
body. (D) Product removal. Remove the salt or sugar with a moist, hot
towel and apply a skin toner to firm the skin and remove excess salt.
(E) Redrape. Dry the area with a soft hand towel, redrape, and move to
the next body area where the same steps will be repeated.
has been mixed with oil and apply it by hand. Avoid using
too much salt or sugar because a very small amount gives
good results. Also, be careful not to get the salt or sugar all
over the massage table when sprinkling.
Work the salt or sugar across the top of the skin with
gentle circular strokes to stimulate the soft tissue and to
remove dead skin cells. Massage therapists often overexfoliate because they tend to work into the muscle rather
than keeping the strokes superficial. With coarse crystalline products such as salt, this can cause some discomfort
to the client. It is advisable to check regularly if the client is
happy with the depth of the application and the sensation
of the exfoliation.
163
E
The salt or sugar will often trickle off the client onto the
bath towel you placed on top of the massage sheet. Although
you may want to avoid getting product all over the massage
table, there is no way to prevent some of the salt or sugar
from falling off the client. If large amounts of salt or sugar
fall off the client, it may feel uncomfortable when he or she
is turned over and has to lie on it. In this case, you are probably using too much salt or sugar and not enough oil.
Step 3: Product Removal
Remove the salt or sugar mix with a hot towel. It should
be possible to remove all of the salt or sugar using just one
hand towel per body part. Review Chapter 5 (Foundation
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164
TABLE 82 Salt and Sugar Mix Ups

SALT OR SUGAR SILK
Most often, salt or sugar is mixed with a fixed oil such as sunflower or sweet almond oil (a variety of fixed oils can be used) and then applied directly
to the skin by hand. You can choose from premixed products purchased through a spa supply outlet or you can mix your own.
Cream Silk
Sweet and Silky
Sea Silk
cup Dead Sea salt, cup table sugar,

2 tbsp milk powder, 1 tbsp sweet almond
or sunflower oil, and cup of body cream
will make a nice emollient salt or sugar glow
mixture. Depending on the granule size of the
salt, more or less lotion may be required.
cup table sugar, cup brown sugar, 1 tbsp

cup Dead Sea salt, cup plain sea salt,
ground lavender powder, and 1 tbsp aloe vera
1 tsp seaweed powder, and 1 tbsp aloe vera
gel. Add sweet almond or sunflower oil to
gel. Add sweet almond or sunflower oil to
create a slightly runny paste or to achieve the
create a slightly runny paste or to achieve the
consistency desired by the individual therapist.
consistency desired by the individual therapist.
SALT OR SUGAR FOAM
If the salt or sugar glow is delivered in a wet room with a Vichy, Swiss, standard, or handheld shower, a body wash gel makes a desirable
base. The gel will turn to bubbles that are easily rinsed away, leaving the skin clean and smooth. The dry room option is to apply the salt
or sugar with oil as noted above and then add foaming body wash over the top. You place your hands in warm water and then use the
water to work the body wash into lather. Remove the body wash, salt or sugar, and oil with one hot, moist towel and proceed to the next
body area.
Foamy Flowers
Foamy Fruits
Foamy and Flirtatious
cup plain body wash, cup brown sugar, 2

cup plain body wash, cup sea salt,
drops ylang ylang essential oil, 7 drops manda- 8 drops grapefruit, 8 drops lemon, and 1 drop
rin essential oils, and 5 drops lavender essential peppermint essential oil. You may choose
oil. You may choose to add more or less sugar
to add more or less sugar depending on the
depending on the consistency you desire.
consistency you desire.
cup plain body wash, cup table sugar,

11 drops lime oil, 2 drops jasmine oil, and
2 drops rosemary oil. You may choose to
add more or less sugar depending on the
SALT OR SUGAR SHAKE-UP

Dry salt or sugar is stored in a cheese shaker and sprinkled on the body after the body has been massaged generously with oil. This feels like cool
raindrops falling onto the body. Extra oil is added as needed to provide adequate lubrication for the salt or sugar exfoliation.
Sea Shake
Earth Shake
Milk Shake
Dead Sea salts mixed with 1 tbsp seaweed

powder stored in a cheese shaker
Table sugar with 1 tbsp Sedona clay stored in a

cheese shaker
Table sugar with cup powdered milk stored in

a cheese shaker
SALT OR SUGAR HAPPY HOUR

These mixtures are blended and applied directly to the skin as in the mixtures made with oil. Massage the client first with a generous layer of oil so
that there is sufficient lubrication for the exfoliation. The happy hour products are applied over the top of the oil, and then the entire mixture is
removed with a hot, moist towel.
Sangria
Japanese Plumb
Champagne Sparkler
cup of table sugar, cup of red table wine,

cup of table sugar, cup of Japanese plumb cup of table sugar, cup of champagne,
cup of orange juice, and 2 tbsp of grapeseed
wine, and 2 tbsp of sesame seed oil. You may
and 2 tbsp of sunflower oil. You may choose
oil. You may choose to add more or less sugar
choose to add more or less sugar depending
to add more or less sugar depending on the
depending on the consistency you desire.
on the consistency you desire.
Margarita
Cream de Coco
Sea Breeze
cup of finely granulated sea salt, 8 drops

of lime essential oil, and sunflower oil to the
consistency desired by the therapist
cup of table sugar, cup of powdered

cocoa, and sunflower oil to the consistency
desired by the therapist
cup of finely granulated sea salt, cup of

cranberry juice, and 2 tbsp of sunflower oil
Skills for Spa Treatment Delivery) for step-by-step direction

for using hot towels to remove product.
Step 4: Aroma Mist or Skin Toner
Apply an aroma mist or skin toner to the area and then
blot the skin dry with a soft, dry hand towel. Large facial
sponges can also be used to apply skin toner directly
to the skin. The mist or toner allows you to pick up
any stray salt or sugar while returning the skin to the
proper pH.

Lotion, body cream, or a light gel product can be applied to
the skin to lock in moisture and add to the overall textural
enjoyment of the treatment. Redrape the finished body area
and move on to the next body area.
Session End
Once each area has been treated, massage the clients neck
and face with a massage cream. This rounds out and completes the treatment. The session can end with an aura mist
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Chapter 8
spritzed in a high arch above the client to fill the treatment

room with a refreshing scent.
165

The Full-Body Polish Overview
Indications
Dull, congested skin; stress; to facilitate relaxation; or as

preparation for the application of a treatment product
A full-body polish is usually delivered as a standalone

service and involves an elegant four-step exfoliation
process that focuses on skin care and deep relaxation.
This treatment also increases local circulation to the
skin, stimulates the vital energy of the body, removes
dead skin cells, and cleanses and smooths the skins
surface.
In a body polish, an exfoliation product, a cleanser, a
toner, and a moisturizer are used separately in each step
of the treatment to mimic the steps in a facial. Usually,
the exfoliation product has a fine-textured ingredient
such as mesh pumice that is suspended in a heavy emollient to protect the skin. This creates a softer sensation
than a salt, sugar, or dry brush exfoliation. For this
reason, a full-body polish is considered the more elegant
and gentle of the exfoliation treatments.
The development of a well-considered treatment concept and smell-scape will enhance the clients perception
of this service and give it a unique flair. For example, the
Four Seasons Hotel and Spa2 offers a crushed pearl and
lavender polish, whereas the Ritz-Carlton Hotel and Spa3
highlights the alpine berry body polish on their treatment menu. The sugar sand polish featured at the Beau
Rivage Spa on the Mississippi Gulf Coast uses the fine
white sand found only on the Gulf s barrier islands.4
Samasati Spa on the Caribbean Coast uses the refined
sand from their beaches in an avocado and black sand
body polish.5 Each of these treatment names suggests a
certain type of smell-scape that adds interest to the treatment. Matched products can be purchased from spa suppliers or you can create your own using essential oils as
discussed in Chapter 7 (Introduction to Aromatherapy
for Spa).
Contraindications
poorly managed diabetes, illness, fever, any condition

3) Bath towelthe bath towel will catch any excess moisture from the treatment, keeping the client dryer.

2) Exfoliation gloves (optional)
3) Exfoliation product
4) Body wash product
5) Body mist or skin toner product
6) Rich moisture cream
7) Soda cooler
8) Hot, moist towels
9) Dry hand towel
Dry Room Procedure

For each body area:
1) Dampen the body area with warm water.
2) Apply the body polish product with bare hands or
exfoliation gloves.
3) Apply the body wash product and work into a lather.
4) Remove the polish and body wash product with a hot,
moist towel.
5) Apply aroma mist or skin toner.
6) Blot the area dry with a soft hand towel.
7) Apply rich body cream with massage strokes.
8) Redrape the area and move onto the next area.
9) Finish the service with a neck and face massage and
an aura mist of a contrasting scent.
Wet Room Procedure
The Full-Body Polish Procedure

As with the salt or sugar glow, the treatment described below was developed for massage therapists to use in a dry
room. In a traditional body polish, massage would not
normally be included as part of the treatment. This takes
longer, but clients respond well to treatments that include
an exceptional massage, so aim to deliver this service in 75
to 90 minutes, depending on the length of the massage.
It should be noted that in a traditional body polish, the
cleanser step is always first (just as in a facial). In a dry room,
it is helpful to exfoliate before using the cleanser because
the cleanser helps to lift the fine-mesh exfoliant off of the
skin, leaving the skin smoother. The full-body polish outline in Treatment Overview 83 and Figure 84 provide a
useful snapshot of the service.
1) Wet the posterior body with the handheld shower and

apply the body wash product.
2) Rinse the cleanser off with the handheld shower.
3) Apply body polish with the hands to the posterior body.
4) Rinse with the handheld shower (if a Vichy is used, the
rinse step can be a 10-minute contrast shower).
5) Turn the client into the supine position and repeat steps
1 to 4 on the anterior body.
6) Move the client to a massage table covered with massage sheets.
7) Apply the toner to the posterior body and blot with a
soft hand towel.
8) Apply moisture lotion, cream, or gel with massage
strokes to the posterior body.
9) Turn the client into the supine position.
10) Repeat steps 7 and 8 on the anterior body.
11) Provide a neck and face massage if desired.
12) Finish with an aura mist of a contrasting scent.
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FIGURE 84 The full-body polish. (A) Exfoliate and cleanse. Dampen the body area with warm water and
apply an emollient exfoliation cream. Textured exfoliation gloves can be worn if desired by the therapist. After the
exfoliation is applied, cleanser helps to lift the exfoliation product off the skin, leaving the body feeling clean and
smooth. Remove the cleanser and exfoliation product together in one step. (B) Tone. Apply a skin toner or aroma
mist with cosmetic sponges or a mist bottle. Dry the skin with a soft, dry hand towel. (C) Moisturize. Use a heavy
moisture cream if this will also be the massage step. If massage is not included, a light lotion or gel can be used.
(D) End the session with an aura mist.
Session Start
In this procedure, each body area is treated in exactly the
same way, so the sequence of body areas is not important. It
works well to begin in the prone position with the posterior
legs, gluteals, and back and then turn the client into the
supine position for the anterior legs, feet, abdominal area,
upper chest, and arms. End the treatment with a neck and
face massage and an aura mist to revitalize the client before
he or she leaves the spa.
the exfoliation product is not removed before the cleansing step. Instead, the cleansing product is applied on top
of the exfoliation product and both products are removed
with one towel.
Step 2: Cleansing
Apply a liquid or lotion-based cleanser to the body with the
hands and work it into a gentle lather. Remove the product
with a hot, moist towel. The body wash is used to lift exfoliant off the skin, leaving the skin smoother.
Step 1: Exfoliation
Wearing exfoliation gloves, the therapist places his or her
hands in a bowl of warm water and lightly wets the body
area in focus. Use the water sparingly. Do not allow droplets of water to roll down the sides of the client. Add a
small amount of body polish to the gloves and use circular
motions to manually exfoliate the area.
In a wet room setting, a Vichy or handheld shower is
used to rinse the product off. In a dry room, hot, moist
towels are used to remove the product. To save on laundry,
Step 3: Aroma Mist or Skin Toner

Apply an aroma mist with a spritz top or apply skin toner
with large cotton pads or facial sponges. Blot the skin dry
with a soft hand towel.
Step 4: Moisturize
If the moisturizing step is also the massage step, a heavy moisturizing cream works best. If massage is not part of the treatment, a light body milk, lotion, or gel product may be used.
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Chapter 8
Session End
If the treatment ends in the supine position, a neck and face
massage can be given as a closing step. End the session with
an aura mist spritzed over the client in a high arch to fill the
treatment room with a refreshing scent.
167

The Loofah Scrub Overview
Indications
Low energy, to revitalize the body, to decrease stress, or as
preparation for the application of a treatment product
Contraindications

The body or loofah scrub is the most invigorating and least
formal of the exfoliation treatments. It is often paired with
uplifting and refreshing smell-scapes such as eucalyptus
or citrus and mint. Like the salt glow or body polish, the
amount of massage you provide with this service will determine the amount of time required for delivery. Although
this treatment is not described in step-by-step detail, the
loofah scrub overview in Treatment Overview 84 and
Figure 85 provide a useful snapshot of the service.
SANITATION
The handheld loofahs (approximately $2.00
each) should be thrown away or given to the
client after each treatment because they deteriorate
when sanitized with alcohol.
The Buff and Bronze

As people became more aware of the dangers of natural tanning in the sun over the last few decades, tanning booths
became popular because they were marketed as a healthier
alternative. Tanning booths use mainly ultraviolet A (UVA)
rays to cause pigment changes without burning. Because
tanning booths are more or less ultraviolet B (UVB) free, it
was thought that they were safe. As more research has been
conducted, both UVA and UVB rays have been found to be
implicated in skin damage, immune suppression,6 premature
aging,7 and skin cancer.8
Artificial sunless tanning products provide an alternative to tanning booths. The professional products available through spa suppliers produce natural-looking results
that are safe for the skin and easy to maintain. Avoid overthe-counter products that are of lower quality and sometimes have an orange tint. Artificial tanning products can
be applied in many different ways, including air brushing,
buff and bronze spa treatments, and even in sunless tanning booths.
Although booths and air-brushing techniques are quick
and effective, full-body buff and bronze treatments are effective and also relaxing and enjoyable to receive. All three
types of application have linked home care products that
help to generate more income for the spa or clinic. Buff and
bronze treatments can also be used to attract male clientele,

poorly managed diabetes, illness, fever, any condition

3) Bath towelthe bath towel will catch any excess moisture from the treatment, keeping the client drier.

2) Two loofah mitts 3) Bowl of warm water
3) Body mist or skin toner
4) Dry hand towel
5) Moisturizer
Dry Room Procedure

1) Use a gluteal drape so that the entire posterior body
can be treated at one time.
2) Apply a foaming body wash with two handheld loofahs
to the posterior body.
3) Apply a body mist or skin toner to each body area.
4) Redrape the body and massage each posterior area
with a massage cream or moisturizing lotion.
5) Turn the client and repeat the steps on the anterior
body.
Wet Room Procedure

1) Wet the posterior body with the handheld shower
and apply the body wash product with two handheld
loofahs.
2) Rinse the cleanser with the handheld shower (if a Vichy
is used, the rinse step can be a 10-minute contrast
shower).
3) Turn the client into the supine position and repeat steps 1
and 2 on the anterior body.
4) Move the client to a massage table set with massage
sheets.
5) Apply the toner to the posterior body and blot with a soft
hand towel.
6) Apply moisture lotion, cream, or gel with massage strokes
to the posterior body.
7) Turn the client into the supine position.
8) Repeat steps 5 and 6 on the anterior body.
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168
especially bodybuilders who must look tan under the bright

lights of the competition stage. Bodybuilders often shave
their bodies, making application simple. With hairy men,
the therapist should plan extra treatment time so that they
can work the product into the skin well.
Most of the sunless tanning products use the chemical
interaction of dihydroxyacetone (DHA), a sugar, with the
amino acids in the dead skin cells in the upper layers of the
skin. The chemical interaction causes the cells to change
color, leaving the skin golden brown until the skin cells
naturally slough off.9 Although the rate at which skin cells
slough off varies from person to person, sunless tans usually start to fade in about 3 days, and the product needs to
be reapplied.
The Buff and Bronze Procedure

Clients should shave or remove unwanted hair from the
body the evening before the treatment. Exfoliation is usually not performed on freshly shaved or waxed skin. For
this reason, only a gentle, fine-mesh product should be
used in this treatment. If shaving or waxing takes place after the treatment, it will streak the autotanner even if the
tan has already developed. Usually, an exfoliation product is sold with the autotanning product and a specific
FIGURE 85 The loofah scrub. (A) Loofah scrub. Apply a foaming

body wash with two handheld loofah mitts to the posterior body. Use a
gluteal drape so that the entire area can be treated at once. (B) Remove.
Use hot, moist towels to remove the foaming body wash from the posterior body and then dry the client with a hand towel. (C) Moisture massage.
Redrape the posterior body with a sheet and massage moisture cream
into each body area separately. Repeat the scrub on the anterior body
using a breast drape and anterior pelvic drape.
type of moisturizer to make product planning easy for the

therapist.
Autotanning product will stain clothing and the palms
of the therapists hands, so it is best to wear vinyl gloves.
An apron and beige or dark-colored treatment sheets
can be purchased to protect both bedding and clothing
from stains. The buff and bronze overview in Treatment
Overview 85 and Figure 86 provides a snapshot of this
service.
Session Start
Ask the client to get on the massage table in the supine
position. Exfoliate the anterior body and then turn the client to exfoliate the posterior body. Next, the moisturizing
and bronzing steps are carried out straight after the exfoliation on the posterior body. The client is turned over again
so that the moisturizing and bronzing steps can be completed on the anterior side of the body. This prevents the
wet exfoliation from streaking the bronzing product and
allows the client to finish the session face up.
If the client has extremely dry or patchy skin where
some areas are very dry, apply a cold pressed oil such as sunflower or sweet almond oil to the body before the rest of the
treatment. This conditions and softens the skin. When the
exfoliation product and cleanser are used in their normal
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Chapter 8
169
Indications
apply the exfoliation product to the entire body; remove it

with a standard shower, Vichy shower, or handheld shower;
dry the client; and then move him or her to a massage table
for the rest of the service.
For cosmetic purposes to hide skin discolorations, to

t appear
tan while protecting the skin from the sun, relaxation
Step 1: Exfoliate Anterior

The Buff and Bronze Overview
Contraindications
Broken skin, inflamed skin, sunburned skin, allergies to DHA,
illness, fever, any condition contraindicated for massage

(from the bottom layer to the top layer)
1) Beige or dark massage sheet
2) Bath towel
4) A warming device such as a heat lamp because the
client will air dry and may become cold if warming is
not planned

2) Exfoliation product
4) Moisturizing product
5) Autotanning product
6) Vinyl gloves
7) Buffing mitts
8) Soda cooler
9) Hot, moist towels
Dry Room Procedure

Supinetreat each area with the same series of steps
before moving on to the next body area.
1) Exfoliate area.
2) Cleanse area.
3) Remove both products with a hot towel.
4) Apply moisturizer (do not apply autotanning product
to the anterior body yet).
5) Turn the client prone and repeat steps 1 to 4 on the
posterior body.
6) Apply autotanning product to posterior body areas.
7) Allow the product to air dry.
8) Buff the posterior body.
9) Turn the client back to the supine position.
10) Apply more moisture lotion if the skin feels dry.
11) Apply autotanning product to the anterior body areas.
12) Allow the client to air dry.
13) Buff the anterior body.
sequence, they will remove the excess oil and not affect the
processing of the autotanner product.
In some clinics, the therapist has the client perform the
exfoliation step himself or herself. In this case, the therapist
takes the client to the shower and shows him or her how the
product should be applied. After the shower, the client is
moved to a treatment table, and the therapist performs the
moisturizing and autotanning steps. When the client does
the exfoliation himself or herself, it cuts the treatment time
by about 20 minutes. Another option is for the therapist to
Bolster the client in the supine position and exfoliate the

legs, abdominal area, and arms by wetting the hands and
applying a generous amount of exfoliant to the area. Pay
special attention to the area around the ankles, knees,
elbows, and wrists. The arm can be lifted to expose the armpit and the side of the body. This area is often overlooked
and should be carefully addressed with all of the products.
Step 2: Cleanse Anterior
Apply a foaming cleanser over the top of the exfoliation
product and work it into lather with warm water. Remove
both the cleanser and exfoliation product with hot towels.
Step 3: Moisturize Anterior
Apply the moisturizer to anterior areas, paying particular
attention to the elbows, knees, ankles, and wrists. If the
moisturizer soaks in quickly, apply the moisturizer a second time so that the skin is soft and evenly moisturized.
Do not apply the autotanning product at this stage because
water or moisture from the posterior exfoliation would
streak it. Turn the client and bolster him or her in the prone
position.
Step 4: Exfoliate Posterior
Apply warm water and a generous amount of exfoliant to
the posterior legs, gluteals, back, and posterior arms. Pay
special attention to the wrists, elbows, ankles, and the back
of the neck.
Step 5: Cleanse Posterior
Apply a foaming cleanser over the top of the exfoliation
product and work it into lather with warm water. Remove
both with hot towels.
Step 6: Moisturize Posterior
Apply the moisturizer to any dry areas first such as the
elbows, knees, ankles, and wrists. Use enough moisturizer
to hydrate the area completely. If it absorbs into the skin
quickly and dries out, apply a second coat so that the skin
feels soft, silky, and evenly moisturized. Apply moisturizer
in this way to the entire posterior body.
Step 7: Autotanning Application Posterior
Apply the autotanning product evenly over the posterior of the body. Rub it in a little but not completely.
Excessive rubbing when the product is first applied may
rub some of the tan away. Leave the autotanning product in a slightly moist state and allow it to absorb into
the skin.
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170
FIGURE 86 The buff and bronze. (A) Exfoliate, cleanse, and moisturize all anterior body areas and then turn
the client to the prone position to repeat these steps on the posterior body. Apply moisturizer liberally to each area
until the client is evenly moisturized. (B) Apply autotanning product to the posterior body areas, allow the client
to air dry, and buff the posterior body. Turn the client and repeat these steps on the anterior body. (C) Lightly buff
fleshy body areas such as the abdominal area. Knees, ankles, elbows, and wrists can be buffed more vigorously.
It is a good idea to turn up the lights while the autotanning product is being applied. Most autotanning products have a brown tint added to make it easier to see where
the product has been applied, but it is still difficult to see
the product clearly in a dark treatment room.
Step 8: Buff Posterior
The autotanning product should only be buffed once it has
absorbed into the skin and had time to air dry. To buff an
area, simply place a buffing mitt on each hand and use circular motions to gently smooth the product. The buffing
should be light and even. It is important not to overbuff
the client by rubbing too hard with the mitts. The mitts are
meant to smooth out any areas where product may have absorbed unevenly. Pay particular attention to areas such as
the ankles, wrists, elbows, and knees. When the posterior
body has been buffed, turn the client supine and proceed
with the moisturizing, autotanning, and buffing steps on
the anterior body.
Step 9: Remoisturize Anterior
If the body still feels moisturized, proceed with the autotanning step. If it has dried out, apply a second layer of
moisturizer to the anterior body.
Step 10: Autotanning Application Anterior
Apply the autotanning product evenly over the anterior of
the body and allow the product to air dry to prevent streaking during buffing.
Step 11: Buff Anterior

Lightly buff the anterior body, making sure to buff across
any lines where product application was overlapping. Buff
into the elbows, knees, ankles, and wrists carefully to prevent streaking in these tricky areas.
Tricky Places
Some areas are tricky to work with because they absorb
autotanning product easily and can become discolored.
Work carefully on the feet and hands, ankles, wrists and
knees, underarms, and face.
Feet and Hands
Do not apply autotanning product to the bottoms of the feet
or the palms of the hands because it will look strange and
out of place. Apply a small amount of product across the top
of the feet (dont work it in between the toes) and the top of
the hands (dont work it in between the fingers). Use a damp
tissue to remove product from the nail and edge of the cuticle
immediately after the feet and hands have been treated.
Ankles, Wrists, and Knees
If these areas have been adequately moisturized, they should
tan evenly. Light applications of autotanning product are
better than heavy applications. Heavy applications tend to
discolor the area because dry patches turn darker. Buff the
ankles, wrists, and knees into the surrounding tissues for the
best results. Although the fleshier areas of the body such as
the abdominal area or arms should not be overbuffed, areas
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Chapter 8
such as the ankles or knees, where the skin tends to be dry or

wrinkled, need to be buffed well. This will create a smooth
look and prevent these areas from absorbing excess product
and appearing darker than the main areas of the body.
Underarms
Lift the arm and sweep the product across the underarm
and smoothly down the sides of the body to avoid a white
streak. Use the buffing mitts to smooth the transition zone
between the anterior and posterior sides of the body. The
underarms should have been shaved if necessary the evening before the treatment takes place. Autotanning product does not develop when it is applied over the top of antiperspirants or deodorants, so the underarms should be
cleansed before application.
Face
Apply a small amount of autotanning product to the face
after the skin has been well moisturized. Work in upward
strokes from under the chin to the forehead. Make sure
to work the product into the earlobe and side of the face
down the neck to avoid uneven coverage. Make sure to
apply product to the back of the neck and behind the ears
to avoid uneven coverage should the client choose to wear
his or her hair up. Some products look streaky as they dry.
171
This is normal, and they will look fine within 3 hours when
the tan starts to emerge.
Home Care and Retail

To keep the tan looking natural or to darken the tan to a
deeper shade, clients can purchase home care tanning products from the clinic or spa. Instruct the client to moisturize
daily to keep the tan looking smooth. Every 3 days, reapply
autotanning product to maintain the desired color. Instruct
clients to gently exfoliate before each application of moisturizer and autotanning product. If the product tends to
streak when the client applies it at home, tell him or her to
exfoliate in the morning and apply the autotanning product
in the evening before bed. Often, clients exfoliate too aggressively, which causes the skin to absorb the product unevenly.
For a darker tan, the client should apply the autotanning
product three nights in a row or until the tan is the desired
shade. The client can apply the product as often as every
3 hours. The client should not exfoliate before each of these
applications if they take place on the days following the initial treatment. If the client waits 2 to 3 days before using the
home care products, he or she should exfoliate on the first
day but not on the second and third days.
SPA FUSION
STUDY TIP: Good Listening Skills
Good listening skills are important in all aspects of
your studies and in interactions with clients when you
become a professional therapist. Review this checklist
of good listening and use it to assess your own listening skills. If you find that you are weak in a particular
area, pay attention and strive to build these skills.
I am present and willing to listen.
I have eliminated or minimized distractions

(e.g., turned off the TV, put away my
phone, etc.).
I am attuned to the speakers body language

(e.g., I am paying attention to nonverbal
communication cues such as eye contact or
crossed arms).
My body position is open and receptive (e.g.,

I am making good eye contact, and my arms
are uncrossed).
My eye contact is consistent.
I use short verbal interjections to encourage

the speaker (e.g., Im listening, Really?
What then?).
I reflect the meaning of the communication

back to the speaker when appropriate
(What I heard you say was . . . ).
I reflect the speakers feelings back when
appropriate (It sounds like you are feeling
upset. Are you upset?).
I am aware of communication blockers
and avoid them (e.g., interrupting the
speaker, etc.).
SPA INSPIRATION: Roll Tape!

It can be difficult to pay attention to your body
mechanics while also learning new techniques and
applying a variety of products to the body. When your
body falls into poor postural habits, those habits start
to feel normal and may become difficult to change.
One way to develop more self-awareness is to ask a
friend or classmate to videotape you while you deliver
a spa session. This way, you can see how you hold your
body during each technique and even as you reach for
different products or pull hot towels from the soda
cooler. Identify two areas that need improvement and
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172
SPA FUSION
focus on those areas. Repeat the video process later
to see where you have made progress and where you
still need further improvement. If you pay careful
attention to body mechanics while in massage and spa
school, you are likely to carry good habits with you
into professional practice.
CHAPTER WRAP-UP
In this chapter, you learned about exfoliation
treatments. Exfoliation is both a step in other treatments and also an important service as a standalone
application. Massage therapists often deliver exfoliation treatments, including dry skin brushing, salt or
sugar glows, body polishes, body scrubs, and buff and
bronze treatments. The most appropriate choice of
exfoliation treatment depends on the particular set of
treatment goals. Salt glows and body scrubs are more
vigorous than a body polish or dry skin brushing
treatment. Some treatments aim to revitalize and
energize the body, whereas others aim to help the body
relax. Practice different types of exfoliation treatments
until you have achieved mastery. These skills will serve
you well when you seek employment at a spa or add
spa treatments to your own practice.
REVIEW QUESTIONS
Multiple Choice
1. There are two basic types of exfoliation. These are:
a.
b.
c.
d.
Assisted and releasing

Cleansing and scraping
Mechanical and enzymatic or dissolving
Biological and assisted
2. Because of scope of practice restrictions in most

states, massage therapists cannot generally:
a.
b.
c.
d.
Cleanse the face or feet.

Cleanse, exfoliate, or mask the face.
Use salt or sugar.
Apply any exfoliation treatment.
4. When using salt or sugar as the exfoliation

product, the massage therapist should:
a. Use light pressure and not work into the muscle
tissue.
b. Use deep pressure and work into the muscle tissue.
c. Use only circular compressions.
d. Use only those strokes that are directed
proximal to distal.
5. Inorganic mineral salts that support natural
detoxification and are often used for sore, tired
muscles and as a soaking agent for sprains are
called:
a.
b.
c.
d.
Pyrenees salts
Burn salts
Table salts
Epsom salts
Fill in the Blank

6. Name three conditions that are contraindicated
for an exfoliation treatment.
,
7.
salt should not be used in spa

treatments because it will burn the client, cause
skin irritation, and lead to extreme dryness.
Sea salt and Epsom salt are much safer.
8. The overuse of exfoliation products can leave the

skin sensitive and inflamed. Over time, they can
make the skin look
.
9. Chemical peels can only be applied by a
.
10. Microdermabrasion is a nonsurgical procedure
used by qualified
. The skin
in literally sandblasted with microcrystals to treat
skin conditions.
3. Exfoliation treatments are indicated for the following situations:

a.
b.
c.
d.
Skin disorders
Freshly shaved skin
Increased vitality and body energy
Sunburn
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9
Body Wraps
Chapter Outline
K e y Te r m s
Claustrophobia: The fear of being enclosed in narrow spaces.

Cryogenic product: A product that cools the body area to which it is
applied.
Emollient: A substance that softens the skin by slowing the evaporation
of water.
Fomentek: A type of water bottle that is designed to lie flat on the massage table.
Interferons: A protein secreted by some cells that protects them (and
other cells) from viral infection.
Poultice: Usually a cloth filled with heated herbs, clay, or a medicated
product spread on a cloth and applied to wounds or an injury.
Contraindications
Healing Crisis
Allergies or Sensitive Skin
Modesty
When the Wrap Goes Wrong
Claustrophobia
Wrapping Materials
The Hot Sheet Wrap

Hot Sheet Wrap Types
The Hot Sheet Wrap Procedure
The Cocoon
Cocoon Types
The Cocoon Procedure
Tension Wraps
S
SPA
FUSION
STUDY TIP: Catchwords
SPA INSPIRATION: Mix and Match
GOOD TO KNOW: Sample Sizes
CHAPTER WRAP-UP
173
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174
Body wraps could be considered as the earliest known spa

treatment. The ancient Egyptians were using a body wrap when
they embalmed bodies using herbs, resins, and spices. This
practice preserved body tissues and prevented degradation
and decay. Emollient wraps in modern-day spas have the
same aim: to fortify the skin and prevent premature aging.
Many soft tissue conditions can benefit from wraps aimed at
decreasing muscular tension, stimulating local circulation to
the muscles, or by simply relaxing the body and providing time
for reflection. Today, a wide variety of body wraps are used for
cosmetic purposes or to treat conditions such as low energy,
stress, low immunity, fatigue, and muscular aches and pains.
There are numerous ways to perform a body wrap, and
as with any spa treatment, you can mix and match methods
to best meet the treatment goals you have determined
with the client. It is helpful to understand three different
wrapping procedures: the hot sheet wrap, the cocoon,
product is applied directly to the body. You can use a variety

of words to describe your body wrap services in an enticing
manner for clients.
The types of products that might be used in a hot sheet
wrap or cocoon are limited only by your imagination.
Table 91 gives a brief description of some different
treatments that are currently offered at spas. Table 92
provides an overview of some of the products that might be
used with each type of wrap. As you can see, the products
are often the same. The difference is in the way the product
is prepared and the method used to wrap the client.
Before delivering the treatments described in this
chapter, you may wish to review basic earlier chapters
to ensure your draping, product application, and dry
room product removal skills are solid. See Appendix A
(Sample Treatments) at the end of the book for body wrap
samples including promotional descriptions and product
suggestions.
and the tension wrap. It is important to point out that the

words hot sheet wrap and cocoon are used to differentiate two
distinct procedures. This is a device to provide clarity and
not meant to suggest that the word wrap always means a hot
sheet wrap, whereas the word cocoon always means that the

Before delivering any type of body wrap, perform a careful pretreatment health intake process to rule out any
TABLE 91 Sample Body Wrap Treatments

SPA
TREATMENT NAME
TREATMENT DESCRIPTION
Double Eagle Resort and

Spa, June Lake, CA5
DeVine Grapeseed Mud Therm
In this treatment, the body is dry brushed before grape seedenriched mud is layered
on the skin. This spa uses a piece of equipment called a Hydro Therm to enhance
their service. The Hydro Therm is a combined steam cabinet and Vichy shower. The
mud is steamed to facilitate product absorption, and then the Vichy shower rinses the
mud away. The treatment concludes with the application of a grapeseed lotion.
Sonnenalp Resort, Vail, CO6
Swiss Paraffin Dip
This service begins with a dry brush treatment and is followed by the application of
body milk (light lotion). The paraffin is layered over the body milk, and then the client
is wrapped in thermal blankets.
Chateau Elan at St. Andrews

Bay, Scotland7
Papaya A Peel
The Papaya A Peel begins with an exfoliation that uses Caribbean Sea sand and freshly
mashed papaya. The body is then wrapped in a combination of coconut and yogurt.
Grand Geneva Resort and

Spa, Lake Geneva, WI8
Ocean Essence Body Wrap
This wrap uses a seawater gel that is warmed and mixed with essential oils of lavender, ylang ylang, sandalwood, basil, and sage. The service ends with a 30-minute
massage.
Lake Austin Spa Resort,

Austin, TX9
Babassu Butter Wrap
In this 40-minute treatment, the client receives an aromatherapy steam, followed by a

sugar exfoliation. Babassu butter (Orbignya phalerata) from the Amazon is applied to
the skin before the body is wrapped. A face and scalp massage complete the service.
Lake Tahoe Resort and

Spa, Incline Village, NV10
Mountain Rain Herbal Wrap
This treatment consists of a classic herbal hot sheet wrap and aromatherapy massage.
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TABLE 92 Hot Sheet Wraps and Cocoons

HOT SHEET WRAPS
COCOONS
Herbal
Coffee
Seaweed
Emollient
Aloe
Essential oil
Mud
Clay
Peat
Paraffin
Vitamin
Seaweed
Milk
Honey
Cider
Juice
Other
Mud
Clay
Peat
Mint
Cryogenic
Other
INDICATIONS FOR HOT SHEET WRAPS
INDICATIONS FOR COCOONS
Detoxifying
Slimming
Firming
Detoxifying
Slimming
Firming
Cellulite
Skin focus
Sore muscle
Cellulite
Skin focus
Sore muscle
Revitalizing
Immune boosting
Weight loss
Relaxing
Revitalizing
Immune boosting
conditions that contraindicate the use of a body wrap. You

also want to be prepared for some of the problems that
might arise during this particular type of spa treatment.
Contraindications
Very hot wraps, very cold wraps, or wraps that might cause
intense detoxification systems should not be used on children; the elderly; pregnant women; or those with a heart
condition, high blood pressure, diabetes, fibromyalgia,
rheumatoid arthritis, on people taking multiple medications, or are contraindicated for massage. Hot wraps are
contraindicated for people that have recently been in a car
accident or suffered a soft tissue injury. With wraps that
use hot or cold temperature extremes, check that the client does not have any nerve damage that may interfere with
his or her ability to sense hot or cold. These types of wraps
increase the load on the cardiovascular system and kidneys
and may aggravate an existing condition. For example,
clients with impaired circulation or those with advanced
or poorly treated diabetes should not receive hot or cold
wraps. Tension wraps are contraindicated for individuals
with spider veins, varicose veins or weakened veins or arteries, or poor circulation.
Healing Crisis
Wraps may trigger detoxification symptoms such as headache and nausea. It is normal for a client to experience mild
detoxification symptoms. However, if the symptoms are intense or if they occur during the wrap itself, remove the client from the wrap, encourage him or her to drink water, and
to rest at a comfortable temperature. If the clients symptoms persist after he or she is unwrapped or if symptoms
get worse rapidly, the client could be in danger, and you
should consult a physician or call the emergency services.
Allergies or Sensitive Skin

Check that clients do not have allergies to herbs, essential
oils, iodine in seaweed, or other ingredients in products, es-
pecially with hot sheet wraps. Heat increases the irritation

potential of any product being applied to the skin. Individuals with sensitive or thin skin will often experience skin
irritation with hot sheet wraps and are more likely to enjoy
cocoons (which are not so hot and aggressive).
Modesty
During a hot sheet wrap, the client should be wearing disposable undergarments or an old swimsuit so that he or
she is always covered. During the wrap procedure, clients
lie down on top of the hot sheet quickly after it has been
unfolded by the therapist. To maintain their modesty, they
will wear the robe over the undergarments up until the moment they get onto the treatment table.
When the Wrap Goes Wrong

Like any spa treatment, hot sheet wraps, cocoons, and tension wraps require practice, but even experienced therapists
have days when the wrap goes wrong. For example, if you
cut the plastic sheeting too short, you may try to wrap it
around the client and find that you have a gap. The best
practice in this case is to cover the gap with two bath towels
and keep going with the treatment. If the hot sheet wrap
turns cold before the client is wrapped, continue to wrap
the client and then place a hot pack under the clients feet
and turn the heat up in the treatment room as high as
possible. If the hot sheet wrap is so cold that the client is
uncomfortable, you have two options. The first is to start
again by reheating the wrap sheet and the client. The second is to offer an alternative treatment and give the client
a gift certificate.
Claustrophobia
Even clients who have no previous experience with claustrophobia can become anxious or panic-stricken when
wrapped up as tightly as they are in a hot wrap or cocoon.
It is recommended that the therapist remains with the client at all times so that he or she can remove the wrapping if
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176
the client becomes anxious. Watch for signs of distress such

as rapid breathing or a concerned expression on the clients
face. As a compromise, the client can be wrapped with his
or her arms outside the sheets and blankets, but this will
result in heat loss, which may reduce the effectiveness of the
wrap. Place a loose blanket over the clients arms to minimize heat loss.
Wrapping Materials
For the hot sheet wrap procedure, you can choose to use
two wrap sheets (both cotton, cotton and linen, cotton and
muslin, or cotton and fleece) or a wrap sheet and a bath
towel. A bath towel is handy because it can be unfolded very
quickly, so it does not get cold before the client is wrapped
in the outer layer of blankets. The only concern with the
bath towel is that it is difficult to wring out completely, so
it may have very hot pockets that could potentially burn the
client. If a towel is used for the hot wrap, you may want to
purchase cheap, very thin towels rather than thick plush
towels. Thinner towels wring out more easily, so they are
safer. Flannel sheets are also difficult to wring out completely, so their use is not advised.
The Hot Sheet Wrap

In a hot sheet wrap, the treatment product (herbs, coffee,
milk, honey, seaweed, mud, etc.) is dissolved in hot water.
Two sheets (or a sheet and a bath towel) are steeped in the
dissolved product and then wrapped around the client. This
method is often used for detoxification treatments or where
the goal is to stimulate metabolism as part of a weight loss
program, to decrease water retention, to decrease muscle
soreness, or to boost immunity.
Hot sheet wraps elevate body temperature, creating an
artificial fever that accelerates detoxification and decreases water retention through perspiration. Fevers commonly occur during infection and inflammation. They
are part of a natural healing response that intensifies the
production of interferons, inhibits the growth of some
microbes, and speeds up chemical reactions involved in cell
and tissue repair. Fever also increases the heart rate, which
speeds up the delivery of white blood cells and oxygen to
body tissues. At the same time, antibody production and Tcell proliferation increase, further boosting immunity. Despite the name, cold sheet wraps are hot wraps and create
the same response in the body as a hot wrap. The cold sheet
shocks the body, which tries to quickly warm itself. This
burst of warming body heat gets trapped inside the heavy
wrap materials, causing increased perspiration and detoxification. In a cold sheet wrap, the client should already be
perspiring when he or she is wrapped in the ice-cold sheet.
The client must be preheated in a sauna, hot shower, hot
bath, hydrotherapy tub, steam cabinet, steam room, or by
carrying out some sort of aerobic activity. If the client is not
hot enough when he or she is wrapped in the cold sheet, the

body cannot usually get warm enough to perspire, so the
purpose of the wrap is not achieved.
Hot Sheet Wrap Types

There are many different types of products that can be
used in a hot sheet wrap procedure. Common hot sheet
wraps include the herbal body wrap; coffee wrap; seaweed,
mud, clay, or peat wrap; milk and honey wrap; and cider or
juice wrap.
The Herbal Body Wrap
The herbal body wrap dates back to early medical practices
in which herbs were applied to the body in a poultice to
heal disease. Many ancient healing traditions, including
those of the Romans, Chinese, Native Americans, and Indians, used herbs as medicine to decrease toxins or evil
humors in the body. Today, these treatments are marketed
to jump-start a diet, support an internal cleansing regime,
decrease pain and stiffness in muscles, decrease water retention, aid in a weight loss program, slim the contours of the
body, or rid the body of specific chemicals while breaking
an addiction (e.g., nicotine).
In preparation for this service, the appropriate herbs are
placed in a muslin bag and soaked in hot water (165F) to
make a strong tea. Usually, about 1 cup of dried herbs is
used per treatment (steeped in approximately 16 quarts
of water). Table 93 provides some combinations of herbs
for different treatment goals. Premixed herbs are available
from spa suppliers.
The Coffee Wrap
Coffee wraps have been used for some time in spa treatments
to firm tissue and decrease water retention. Coffee has the
same pH as the skin and is useful for evening out the skins
texture and tone. A study conducted at Rutgers University by Conney1 found that caffeine lowers the risk of skin
cancer in mice when it is applied topically. A second compound (epigallocatechin gallate [EGCG]) found in green tea
was also tested. This study has prompted the use of coffee
and green tea as ingredients in after-sun products.
In preparation for a coffee hot wrap, cup of finely
ground coffee is placed in a muslin bag and soaked in approximately 17 quarts of hot water for 20 minutes. For a
coffee and green tea wrap, cup finely ground coffee and
cup of green tea leaves give good results.
The Seaweed, Mud, Clay, or Peat Hot Sheet Wrap
Seaweed powder, mud, clay, or peat can be dissolved in hot
water and then used in a hot wrap procedure. Add 1 tbsp of
powdered seaweed to approximately 17 quarts of hot water
during the setup for a hot wrap. If mud, clay, or peat is used
as the hot wrap product, 1 cup is dissolved in approximately
17 quarts of hot water (stronger concentrations can be used
if desired). Before delivering a seaweed or mud treatment,
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177
TABLE 93 Herbal Combinations for Hot Sheet Wraps

DETOXIFICATION
SORE MUSCLES AND JOINTS
SKIN SOOTHING
SLIMMING
Rosemary
Eucalyptus
Red clover
Juniper
Juniper
Juniper
Lavender
Lemon peel
Clove
Peppermint
Chamomile
Thyme
Allspice
Ginger root
Calendula petal
Fennel seeds
Ginger root
Clove
Oatmeal (powdered)
Ginger root
Echinacea
Agrimony
Borage
Dulse
Goldenrod
Bay laurel leaves
Chickweed
Horsetail
Lemon peel
Nettle
Comfrey
Kelp powder
Nettle
Pine needles
Elder flower
Parsley
Parsley
Thyme
Rose petal
Raspberry leaf
Sage
Wintergreen
Feverfew
Yarrow
Yarrow
it will be helpful to review the contraindications for these

products in Chapter 11 (Fangotherapy) and Chapter 12
(Thalassotherapy).
SANITATION
Used herbs, coffee, clay, or mud should not
be put down on a standard drain after the
treatment. Over time, these items can block the drain or
damage the pipes. Filter the water out using a strainer and
throw the solid matter away separately.
The Milk and Honey Hot Sheet Wrap

Milk, buttermilk, full-fat milk, and honey can also be used
as a hot wrap product. This fragrant mix is deeply relaxing and will soften and smooth the skin. One to 2 cups of
honey and 2 to 4 cups of powdered milk or regular milk
are dissolved in approximately 10 to 12 quarts of water for
this hot wrap (the concentration of the mix is up to the
therapist).
The Cider or Juice Hot Wrap
Hot cider or juices such as orange, cranberry, or pineapple
can be used in a hot wrap to brighten the skins appearance,
firm tissue, stimulate local circulation to the skin, and relax
the body. At Christmas, cider and honey mixed with wine
mulling spices make a deliciously aromatic seasonal hot
wrap. One gallon of either juice or cider is mixed with 1 gallon of water and heated to 165F.
The Hot Sheet Wrap Procedure

Dissolve the products chosen for the hot wrap in hot water
(165F) in either an 18-quart hot stone massage heating
unit or a hydrocollator. Fold the wrap sheets into tight

squares as shown in Figure 91 and place them in the product solution (while it is heating in the stone heater or hydrocollator) for 20 minutes. A stone or weight placed on
top of the sheets will keep them submerged completely. The
water must be hot enough for the sheets to be pulled out
of the heating unit, wrung out, stored in a soda cooler, and
then unfolded on the treatment table without becoming
cold. If a cold sheet wrap is being used, place the sheet and
towel in a bucket of ice water for 10 minutes.
It is helpful to set up the massage table at a lower height
so that it is easy for the client to climb onto the table and
lie down on top of the hot sheet. If you are going to deliver
a full-body massage after the wrap, the table may need to
be higher to minimize physical stress on your body. In this
case, the client can get onto the table using a step stool.
A basic hot sheet wrap takes approximately 20 to
30 minutes to deliver. This does not include the preheating phase, which takes up to 20 minutes beforehand. For
this reason, a hot wrap is often given together with other
treatments or enhancers to create a more rounded and fulfilling service. To enhance the treatment, depending on the
equipment available, you might dry brush the client on a
wet table or use a Vichy shower as the heating phase of the
service. Another idea is to give the client a refreshing body
scrub at the end of the wrap to help him or her cool down
and to remove the impurities released from the skin during the wrap. A toning massage (delivered with skin toner
and not oil) might be given before the wrap or a moisture
massage could be given after the wrap. As you can see, you
can adapt the hot sheet wrap procedure based on your goals
for the session. For a look at the table setup for a hot sheet
wrap, view Figure 92. For a quick snapshot of the basic
procedure, see the hot sheet wrap overview in Treatment
Overview 91 and Figure 93.
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178
FIGURE 91 Folding a wrap sheet. (A) Open the sheet lengthwise

across the width of the massage table and fold the long sides into the
center. (B and C) Fold the two new sides into the center until the sheet is
long and narrow. (D and E) Fold the ends of the long, narrow strip into
the middle until the sheet is square.
Contraindications
The Hot Sheet Wrap Procedure Overview
Heart conditions, high blood pressure, pregnancy, vascular

conditions, neurological conditions, illness or fever, acute
conditions, inflammatory conditions, people who are in a
weakened condition, children, the elderly
Indications
To support the natural detoxification processes off th
the
body; to support internal cleansing regimes, slimming,
low immunity, low energy, and water retention; to help
with the treatment of an addiction (e.g., nicotine, sugar,
soda); sore, tight muscles; and certain skin conditions; to
promote weight loss

1. Wool blanket placed horizontally so that the long
edges fall off either side of the treatment table
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179
FIGURE 92 Massage table setup for a hot wrap. (A) The massage table is set from outermost layer to innermost layer as follows: wool blanket, thermal space blanket (shiny side up), and Fomentek (covered by a pillowcase). The hot sheet will be unfolded on top of the thermal space blanket (and Fomentek) directly before the client
gets on the table and is wrapped up. (B) A bath towel is placed lengthwise, over the edges of the blankets on each
end of the table. One of these bath towels will be used to wrap up the head and the other to wrap up the feet.
Thermal space blanket placed horizontally

Fomentek hot water bottle
Pillow case to cover the Fomentek
One bath towel placed horizontally at the top of the
treatment table
6. One bath towel placed horizontally at the bottom of
the treatment table
2.
3.
4.
5.
The table setup is shown in Figure 92.
Session Start
Ask the client to change into a robe, slippers, and disposable undergarments. The robe and slippers allow the client
to move about the spa in comfort. Escort the client to a
sauna, steam room, or wet room for step 1 of the service if
such facilities are available. If there are no warming facilities
available, use a warm foot soak, a heating unit, and blankets
to warm the client before the wrap.
Supplies Needed for a Dry Room Treatment

1. Insulated gloves
2. Soda cooler
3. Wrap sheets soaking in dissolved product in a
heating unit
4. Foot soak container filled with warm water
5. Comfortable chair
6. Warm neck pillow (optional)
7. Warm pack for the feet
8. Robe and washable slippers
9. Warm herbal tea
10. Glass of water with a flexible straw
11. Disposable undergarments
12. Aroma mist
Dry Room Procedure

1.
2.
3.
4.
5.
Foot soak and warm herbal tea

Hot sheet wrap
Process in the wrap
Unwrap
Session end (massage, body scrub, cool shower, etc.)
Facility with Sauna or Soaking Tub Procedure

1.
2.
3.
4.
5.
Sauna or hot immersion for 15 minutes

Hot sheet wrap
Process in the wrap
Unwrap
Session end (massage, body scrub, cool shower, etc.)
SANITATION
It is important for clients to wear disposable
or washable slippers when they move about
the spa or clinic to avoid cross-contamination with fungal
infections. Robes and washable slippers must be freshly
washed and dried (with heat) for each client.
Step 1: Increase Core Body Temperature

As mentioned previously, you can elevate the clients core
body temperature in a number of ways. For example, the
client can sit in a sauna or steam cabinet; soak in a warm
hydrotherapy or standard soaking tub; receive a Vichy,
Swiss, or Scotch hose treatment; take a hot shower; or rest
sipping warm tea while soaking his or her feet in warm
water. If a foot soak is used as the preheating method, it is
helpful to ask the client to drink a cup of warm (not hot)
herbal tea while relaxing in the soak. The reason that warm
instead of hot tea is used is that hot tea must cool down,
so the client will often leave it instead of drinking it. Warm
flax seed packs or corn packs can be placed around the clients shoulders, and a heat lamp can be used to further
heat the body. The goal is to get the client to perspire before being wrapped, especially if the goal of the treatment
is detoxification.
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180
It is important to note that some clients will not perspire.

They will feel warm throughout the treatment but never
hot. This can happen even if you perform every step of the
wrap correctly and efficiently. The hot sheet wrap is still
relaxing, even if perspiration and, therefore, detoxification
are minimal.
Step 2: Final Preparation for the Wrap
The table is set up with the wrap blankets and a Fomentek
hot water bottle before the treatment. While the client is
soaking his or her feet, remove the sheets from the hot
FIGURE 93 The hot sheet wrap. (A) Increase core body temperature.
In a dry room setting, a warm foot bath and cup of herbal tea are used to
increase the clients core body temperature. A sauna, steam room, warm
bath, or hot shower can also be used. (B) The wrap. The sheet is wrapped
around the client, and the infused bath towel is placed on top of the
sheet before the thermal blanket and wool blanket are brought up and
around the client. The therapist must work quickly to trap the maximum
amount of heat. (C) The wrap 2. The towel at the top of the table is
brought up around the clients head. The second bath towel is wrapped
around the feet, and a hot water bottle or hydrotherapy pack is placed under the feet for additional warmth. (D) Process. Water is offered through
a straw during the processing phase of the wrap. (E) Aroma mist. The
client is regularly misted with a soft, refreshing scent during the wrap
phase of the treatment.
water solution. Using heavy, insulated gloves, wring the

sheets (or sheet and bath towel) out as quickly as possible
and place them in the cooler. If possible, the client should
not see the therapist wring out the sheets with thermal
gloves. The use of thermal gloves makes the clients feel
that the sheet will be too hot, so they hesitate when they
get on the treatment table. This hesitation results in a loss
of valuable heat.
Take the clients feet out of the foot bath and dry them
with a towel. Ask the client to stand on one side of the
treatment table while you stand on the other side. It is a
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Chapter 9
good idea to describe the procedure to the client so that

he or she knows what to do at each stage of the treatment.
When both you and the client are ready, remove the hot
sheet from the cooler and unfold it as quickly as possible
on the massage table. Place it horizontally so that the long
edges can be brought up around the client.
Step 3: The Wrap
The client removes the robe (he or she should be wearing disposable undergarments or an old swimsuit) and
places him- or herself in the supine position on the massage table while you hold the sheet on one side and look
away to preserve the clients modesty. Clients often find
that the sheet feels too hot on their gluteals, so it is a good
idea to put a hand towel on the sheet where the gluteals
will rest before the client gets on the treatment table. Men
often find that the sheet is too hot on their genitals (disposable undergarments are very thin). To solve this problem, the male clients can hold a hand towel in front of
their genitals so that this area is insulated when the sheet
is wrapped over them.
Quickly wrap the first hot sheet around the client. Pull
the second hot sheet (or towel) from the cooler and lay
this on top of the first hot sheet. The second sheet is only
unfolded as much as needed to completely cover the top
of the client. Next, the space blanket and then the wool
blanket are tucked around the client. This wrap works
best if it is fairly tight and snug. The towel at the top of
the table is brought up around the clients head in a turban drape (described in Chapter 5) to lock body heat inside the wrap. The second bath towel is wrapped around
the feet, and a hot pack (flax seed, hydrocollator, rice, hot
water bottle, etc.) is placed under the clients feet for additional warmth. Once the client has been wrapped, you can
place a bolster under the knees (outside the wrap blanket). Throughout the wrapping process, you want to move
quickly and efficiently to trap the maximum amount of
body heat.
Step 4: Process
The client usually starts to perspire within 5 minutes of
being wrapped up. He or she may continue to perspire freely
throughout the treatment. An aroma mist can be spritzed
high over the clients face at various points during the wrap.
This cools and calms the client. You may also dab the clients forehead with a cool cloth and offer water through
a flexible straw every 3 to 5 minutes during the wrap. The
flexible straw allows the client to sip water without lifting
his or her head. It is important to stay with the client at
all times during a wrap to provide support or to remove
the client quickly from the wrap should he or she become
claustrophobic.
Step 5: Unwrap
At the end of the wrap (the standard wrap time is between 20
to 30 minutes), the outer blankets and towels are removed,
Body Wraps
181
leaving one sheet loosely draped around the client. When

the client is ready, he or she can sit up and slip back into the
robe. Help the client from the table and offer him or her a
seat. Once seated, the client should sip cool water and dry
off with a hand towel. With most infused or dissolved wrap
products, the client will not feel sticky or unclean after the
treatment.
Session End
The treatment can end in a number of different ways.
In the dry room option described previously, the client
is moved to a chair to sip water and cool down. While
the client is cooling down, put clean massage sheets on
the treatment table. Once the client is back on the table,
provide a massage with a light lotion or gel product. A
gel-based product works well because it feels velvety and
cooling to the client who may still be hot and perspiring
slightly. Alternatively, a refreshing body scrub or body
shampoo might be used to remove the impurities released
from the skin during the wrap. If a wet room is available,
a graduated shower or cold plunge can be used to end the
service.
SANITATION
The thermal space blanket is often overlooked
in the cleanup process. Perspiration can soak
through the wrap sheet and contaminate the space blanket. Spritz the inside of the space blanket with alcohol and
let it air dry before it is folded and returned to a closed
cabinet.
The Cocoon
In a cocoon, the treatment product is not dissolved in
water but is applied directly to the client before the client is
wrapped in a plastic sheet and a blanket. Although this type
of wrap might still be used for detoxification and slimming
treatments (i.e., seaweed, paraffin, etc.), the client does not
need to perspire for the wrap to work well. Sometimes, this
wrap procedure is used with a product that aims to cool
body tissues (e.g., a sunburn wrap). In this case, the body is
wrapped lightly in plastic to allow air to circulate around
the client.
In a cocoon procedure, you will almost always want to
use an exfoliation product before the treatment product is
applied to the skin. The removal of dead skin cells increases
the absorption of the product into the skin. An exception
would be a sunburn wrap where the treatment is aimed at
soothing sunburned or irritated skin, in which case, exfoliation is contraindicated.
For essential instructions common to most cocoons, see
Treatment Overview 92.
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182

The Cocoon Overview
Indications
Indications are dependent on the product
that is chosen for the treatment.
Contraindications
Contraindications are dependent on the product that is
chosen for the treatment. For example, seaweed is contraindicated for pregnancy or thyroid disorders. A shea
butter cocoon would be suitable for such individuals.
Supplies for the Treatment Table Setup (from the

bottom layer to top layer)
1. Blanket (wool or cotton) set horizontally so that the long
edges fall on either side of the table
2. Thermal space blanket turned horizontally (optional)
3. A plain flat sheet turned in its normal orientation on the
table (if the product needs to be removed in a dry room)
4. A plastic sheet turned horizontally
5. One bath towel placed horizontally at the top of the table
6. One bath towel placed horizontally at
the bottom of the table
7. Drape
A Fomentek bottle might be used under the massage
sheet if additional warmth is needed. The table setup for
a cocoon is shown in Figure 94.

1.
2.
3.
4.
5.
6.
7.
8.
9.
Exfoliation product
Treatment product
Application brush or vinyl gloves
Finishing product
Aroma and/or aura mist
Soda cooler
Hot moist towels
Dry hand towels
Disposable undergarments
Procedure
Exfoliation
Treatment product application
Cocoon
Processing time where the feet or face could be
massaged
5. Unwrap
6. Application of finishing product
1.
2
3.
4.
Cocoon Types
Many different types of product are used in cocoons. Cocoons
can be based on emollient products, aromatherapy products,
paraffin or Parafango, cellulite or firming products, vitamins,
aloe vera, cryogenic products, seaweed, mud, clay, peat, or
other natural elements. Some cocoon products are shown in
Figure 94. Treatment outlines for cocoons based on each of
these products are provided below. Unlike the hot sheet wrap,
there is a wide degree of variability in the way a cocoon might

be delivered or enhanced. These outlines are just samples
and are not meant to suggest that this is the only way to do a
particular treatment. You need to experiment with products
and treatment steps until you discover what you believe your
clients would enjoy and what you will enjoy delivering. For
a video demonstrating cocoon technique, visit thePoint.
Emollient Cocoon
Emollient cocoons make use of the healing qualities of
medium to heavy lipids such as shea butter, almond butter, evening primrose, wheat germ, jojoba, hemp seed, and
borage oil to revitalize the skin, increase the skins moisture
content, and to provide a moisture barrier. Often, emollient
cocoons are enhanced by adding essential oils that give the
treatment a wider range of benefits. Hemp seed oil (Cannabis
sativa L.) is of special interest to massage therapists because
of its anti-inflammatory and pain-relieving qualities. When
used in a cocoon, it is good for sore muscles and soft tissue
conditions such as fibromyalgia and chronic pain. It degrades easily, so it must be stored in a refrigerator at all times.
Shea butter comes from the nut of Vitellaria paradoxa
(also widely known under the botanical name of Butyrospermum parkii), a tree found only in the semi-arid Sahel region
of West Africa and Cameroon. Shea nuts have traditionally been processed and used by women in West Africa to
protect their skin from drying out in the hot African sun.
As the demand for shea butter increases, international and
local organizations promoting jobs for women of Africa are
starting to provide funding for modern processing equipment, which has led to the availability of high-quality shea
butter in the United States.
Pure shea butter has a firm texture and must be slowly
warmed in a double boiler until it is liquid before it is applied to the body with a brush and left to absorb. Excess shea
can be massaged into the skin at the end of the service. Alternatively, the shea is warmed until it is a liquid and then
essential oils and a small amount of a fixed oil such as wheat
germ are added. The warm shea mixture is then whipped in a
blender as it cools so that it has a frothy texture when applied
to the body. Shea butter is composed mainly of triglycerides
and linoleic acid. It is high in vitamins A, E, and F. It has
antioxidant, anti-inflammatory, antiarthritic, skin soothing, skin healing, and skin moisturizing properties and is
believed to bring relief from chronic skin diseases, scarring,
and stretch marks. It is finding its way into many hair care
products as a small amount revitalizes dry, damaged hair.
An emollient cocoon using shea butter might be delivered as follows: (1) exfoliation, (2) warm melted shea
brushed onto the body, (3) cocoon, (4) unwrap, and (5) fullbody massage using excess shea as the lubricant. If the spa
or clinic has a steam canopy, the shea emollient cocoon can
be delivered as follows: (1) exfoliation, (2) full-body massage with whipped shea butter and essential oils, (3) place
a steam canopy over the client and steam the shea for
15 minutes, and (4) blot the client dry with a hand towel.
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A1
A2
B1
B2
D1
FIGURE 94 Types of cocoons. (A1 and A2) Parafango. In a Parafango

wrap, a tension wrap is often used on target areas for slimming before the
entire body is cocooned. (B1) Cryogenic. Cryogenic products can make the
client cold, so they are often used for spot treatments. (B2) Some cocoon
products (such as this cryogenic product) are made with a component that
causes them to rubberize after a short time. They are pulled off the client
in one piece, making cleanup easy. (C) Emollient (shea). Shea; honey; and
other heavy butters, creams, or oils are used in a cocoon to relax the body
and rejuvenate the skin. In this particular wrap, essential oils have been
added to the shea butter so it could also be considered an aromatherapy
wrap. (D1 and D2) Natural elements (papaya and yogurt). (E) Seaweed or
fango.
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D2
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Aromatherapy Cocoon
An aromatherapy cocoon can be offered as a standalone service using premade blends or as a more comprehensive service including a professional aromatherapy consultation,
custom blending session, massage, and wrap. The oils may
be chosen for their physiological effects (i.e., support the
natural detoxification mechanisms of the body, stimulate
immunity, reduce muscle soreness, etc.) or for their effects
on the mind and spirit. The goal is to provide a space where
body and mind can rest, be still, and reflect while surrounded
by inspiring and uplifting fragrances. Essential oils can be
mixed into a number of different carrier products including
seaweed, clay, shea butter, and aloe vera gel. Aromatherapy
and blending are covered in detail in Chapter 7. A sample
aromatherapy cocoon outline might be delivered as follows:
(1) aromatherapy consultation, (2) custom blend, (3) dry
brush exfoliation, (4) massage with essential oils in a massage cream, (5) application of steamy aroma-infused towels
to the anterior body, (6) cocoon, (7) firming face massage
while the client is cocooned, (8) unwrap, and (9) aura mist
to end the session.
Paraffin or Parafango Cocoon
Paraffin provides deeply penetrating warmth to the area
where it is applied. It traps heat and moisture at the
skins surface, which increases local circulation and helps
with product absorption (sometimes, a product such as a
cellulite cream will be applied under the paraffin). It is an
effective treatment for chronic arthritis and painful joints.
It also leaves skin feeling soft and supple.
Parafango is a combination of fango (mud) and paraffin
with different melting points. It is heated and applied with
a brush, or it is poured into forms to make large body packs.
Parafango has been used successfully as a means of thermotherapy for such conditions as osteoarthritis, chronic conditions, muscular spasm, and scleroderma. The superior
heat retention properties of Parafango have led to its use
in the United States for the reduction of cellulite and inch
loss in target areas. The flow of heat from Parafango is continuous and long lasting. Traditional hydrotherapy packs
cool within 30 minutes, but Parafango packs remain warm
for up to 60 minutes. Parafango is different than peat or
mud in that it is designed for heat delivery, and there is little
or no absorption of minerals through the skin. The heat it
delivers increases local circulation, facilitates perspiration
to aid the natural detoxification mechanisms of the body,
helps with product absorption, decreases hypertonicities of
muscular tissue, decreases pain, and increases relaxation.
In a full-body paraffin or Parafango cocoon, the product
is applied with a large application brush (large paintbrush
size) and then covered in plastic using the sit-up method described in Chapter 5 (Foundation Skills for Spa Treatment
Delivery). Sometimes, gauze strips are dipped in the paraffin or Parafango and then layered on the body. As these two
products are often used in cellulite treatments, a cellulite
cocoon outline is described here: (1) full-body exfoliation,
(2) apply cellulite cream to target areas, (3) apply paraffin

or Parafango over the cellulite cream in target areas, (4) cocoon, (5) massage the face or feet, (6) remove the paraffin or
Parafango, and (7) massage firming cream into target areas.
A treatment designed for sore back pain and using Parafango might consist of the following steps: (1) With the
client prone, apply Parafango to the back, (2) massage the
legs, (3) remove Parafango from the back and massage the
back, (4) application of a cooling, pain-relieving aroma support lotion to the back, (5) turn the client supine, and (6)
massage the neck and shoulders to complete the session.
Aloe Vera Cocoon
At tropical and resort spas, it is not uncommon to see an
aloe sunburn relief wrap included in the menu of services.
Guests often overexpose themselves to the sun during the
first few days of their vacations. Research supports the use of
aloe for dry skin, ulceration, acne, and chapped skin and to
soothe the inflammation and itching in conditions such as
eczema, poison ivy, and allergic reactions.2 A combination of
aloe and essential oils that works well for sunburn is 1 cup
of aloe vera gel, 5 drops of German chamomile essential oil,
10 drops of lavender essential oil, and 1 drop of peppermint
essential oil. Mix well and apply this blend to the skin in a
heavy layer (do not exfoliate sunburned skin). A treatment
outline might look like this: (1) Apply the aloe vera blend
or aloe-based treatment product with a brush, (2) cocoon in
plastic and a light blanket for 20 minutes, (3) massage the
feet while the aloe absorbs (so long as the tops of the feet are
not sunburned), (4) unwrap the client and apply cool coffeeand/or green teainfused towels to the body and allow them
to sit for 5 minutes, and (5) apply an after-sun lotion with
gentle hands or with a brush without removing the aloe vera.
Cryogenic Cocoon
Cryogenic products are often composed of a kaolin clay
base with menthol as the active ingredient. Menthol increases peripheral circulation and affects cold receptors in
the skin, resulting in a cooling sensation. Besides the cooling effect, menthol has a numbing, pain-relieving action
that is indicated for use on stiff or sore muscles. It alleviates
itching from skin conditions and stimulates local circulation to the skin and muscles.
The problem with cryogenic products is that they may
make the client coldreally cold. For this reason, cryogenic
applications work best as spot treatments. For a sports application, you might apply the cryogenic product to areas of
particular stiffness such as the lower back, hamstrings, and
gluteal muscles. Use blankets, heat lamps, and warm packs
to keep the rest of the body warm. A cryogenic sports outline
might progress as follows: (1) Massage the back; (2) apply a
cryogenic product to sore areas of the back; avoid covering
the entire back as this will be too cold; focus on one area of
particular stiffness such as the upper back and shoulders, or
directly down the spine, or on the low back; (3) massage the
legs; (4) apply the cryogenic product to the hamstrings or
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lower legs; (5) remove the cryogenic product from the back
and apply a pain-relieving finishing lotion; (6) remove the
cryogenic product from the legs and apply a pain-relieving
finishing lotion; and (7) turn the client to the supine position
and massage the neck and shoulders to finish the treatment.
You might notice that the cryogenic product shown in
Figure 95 can be removed without water and hot towels. A
component of this mask rubberizes shortly after it is mixed
up. When it dries and at the end of the treatment period,
the entire mask is simply peeled off the skin. A number of
different products are currently being formulated to rubberize, so they can be removed easily without a shower or
even hot, moist towels.
Seaweed Cocoon
Seaweed has a number of positive benefits for the body
when it is applied topically. It has been used successfully
to promote endocrine balance, to reduce the symptoms
of fibromyalgia, for detoxification, to decrease pain from
sore muscles, and to stimulate circulation to the skin and
muscles. It is a popular choice for slimming and firming
treatments because it increases skin tone and makes the
body appear smoother and more contoured. Seaweed is discussed in detail in Chapter 12 (Thalassotherapy). A general
seaweed cocoon might progress in this manner: (1) exfoliation, (2) application of seaweed, (3) cocoon for 20 minutes
(massage the face and feet), (4) removal of seaweed, and
(5) full-body massage.
Fango Cocoon (Mud, Clay, or Peat)
Mud, clay, and peat are therapeutically different, so
they are used for different reasons in a treatment. Each
of these substances is discussed in depth in Chapter 11
(Fangotherapy). In general, these substances can be used for
musculoskeletal injury and health or to refine the texture of
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THE VITAMIN COCOON

Vitamin cocoons use products that are high in
vitamins A, C, B, and E to nourish the skin. Vitamin A
helps to balance and normalize (in terms of pH and
sebaceous output) dry skin or skin that has been
overexposed to the sun. High levels of vitamin A
(retinol) are used to decrease fine lines and wrinkles.
Vitamin B5 (panthenol) functions as a moisturizer and
skin conditioner, whereas vitamin B3 (niacinamide)
speeds the turnover of surface skin cells to clarify the
skin and improve its texture.3 Vitamin E is a well-known
antioxidant that acts as a natural preservative, helping to decrease the development of wrinkles and
discolorations. With age, the number of papillae
in the epidermaldermal junction in human skin is
reduced; this restricts the supply of nutrients to the
epidermis and contributes to skin aging. Vitamin C
(ascorbic acid) decreases the oxidative stress on
the skin and increases the number of papillae in the
dermis.4
Vitamin facials are currently a popular treatment
performed by estheticians, which has led in recent
times to the availability of full-body vitamin products.
Because the main goal of vitamin treatments is to
improve the health of the skin, they are not usually
within the scope of practice for massage therapists in
most states. Vitamin products also tend to be a little
expensive but usually have linked home care products that generate a greater income for the spa or
clinic.
FIGURE 95 Massage table setup for a cocoon. (A) The massage table is set from the outermost layer to innermost layer as follows: blanket (wool or cotton), thermal space blanket (optional), and a plain flat sheet in its
normal orientation on the massage table (for dry room removal only). On top of this, place a plastic sheet turned
sideways on the table so that it covers the blanket. (B) A bath towel is placed across the top and bottom of the
plastic sheet at either end of the table to anchor the plastic wrap sheet.
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the skin. A general fango cocoon outline might progress as

follows: (1) exfoliation, (2) application of fango, (3) cocoon
for 20 to 30 minutes (massage the face and feet), (4) removal
of fango, and (5) full-body massage.
Natural Elements Cocoon
Some spas specialize in using natural food items such as
papaya, pumpkin, avocado, honey, yogurt, oatmeal, or
cucumber in cocoons. Often, the food item is mashed up
and spread on the body in the same manner as seaweed or
mud. Many natural food items are beneficial for the skin
and have pleasing fragrances. However, they do tend to be
more messy and time-consuming than premixed, prepackaged items. Like the seaweed and fango cocoon, a natural
elements cocoon will follow the standard cocoon progression: (1) exfoliation, (2) application of the natural product,
(3) cocoon, (4) removal of the product, and (5) massage.
The Cocoon Procedure

The procedure described here is a basic cocoon that can be
used with a variety of products. As mentioned before, there
are many ways to deliver this type of body wrap, so you
are encouraged to explore your options or to modify techniques as you deem appropriate. For example, if a steam
canopy is available, you might steam the product instead
of using wrap blankets to warm the client. The procedure
here ends with a massage but could just as easily end with a
Vichy shower or a hydrotherapy tub soak.
You can ask the client to wear disposable undergarments, use standard draping practices, or use a combination of both. With a very messy product such as seaweed or
mud, standard draping can be challenging. The product invariably gets all over the drape and from the drape onto the
floor, on the walls, and onto you. In a wet room, this is not
so much of a problem as it is in a dry room. The simplest
method is to start with the client wearing disposable undergarments, drape him or her as much as possible with a
bath towel, and have a heat lamp available for extra warmth.
The table setup for a cocoon is shown in Figure 95. The
cocoon overview in Treatment Overview 92 and Figure 96
provides a snapshot of this procedure.
Session Start
Because the client needs to be in a supine position for the
wrapping up phase of the treatment, he or she should begin
the service in the prone position.
Step 1: Exfoliation of the Posterior and Anterior Body
A number of different types of exfoliation might be used at
the beginning of a cocoon treatment. Choose the technique
that best supports the overall treatment goals for the session
youre providing. For example, you might choose a dry skin
brush exfoliation with a cocoon that aims to stimulate the
natural detoxification processes of the body. A body polish
might be given when the cocoon aims to relax the client.
A salt glow would be appropriate for cocoons that energize
the body. Directions for exfoliation treatments are provided

in Chapter 8 (Exfoliation Treatments).
The manner in which you apply an exfoliation service will
be determined by the type of product application method
you choose for the cocoon as discussed in Chapter 5 (Foundation Skills for Spa Treatment Delivery). For example,
The sit-up method of application: (1) client prone,
(2) exfoliate the posterior body, (3) turn the client supine, (4) exfoliate the anterior body, and (5) apply product using the sit-up method.
The flip-over method of application: (1) client prone,
(2) exfoliate the posterior body, (3) apply product to the
posterior body, (3) the client flips over, (4) exfoliate the
anterior body, and (5) apply product to the anterior body.
The side-lying method: (1) client supine, (2) exfoliate the
anterior body, (3) position the client in a side-lying position and exfoliate the posterior body, (4) apply product,
(5) roll client to the other side, and (6) apply product.
Step 2: Product Application
The product application method shown in Figure 96 is the
sit-up method. It is therefore assumed that both the posterior body and anterior body have been exfoliated, and the
client is now in the supine position. The knees are bent, and
the treatment product is applied to both the anterior and
posterior sides of the legs. The legs are flattened against the
plastic body wrap, and the client is asked to sit up (remove
the bolster first). The treatment product is applied to the
back and gluteals, and the client is asked to lie back down.
Finally, the abdominal area, upper chest, and arms are
treated and the client is wrapped in the plastic.
Massage Application: If the treatment product is applied using massage, you will want to exfoliate the posterior body and then apply the treatment product as in the
flip-over method described in Chapter 5. It is a good idea
to wear gloves so that your hands dont need to be cleaned.
The treatment product is massaged in from the posterior
legs to the gluteals and then on the back. Depending on the
product, a full range of strokes might be used. The client is
flipped, and the anterior body is exfoliated and then massaged with the treatment product. The client is now in the
supine position and ready for the cocoon.
Step 3: Cocoon
The plastic wrap is pulled up around the client and tucked
in loosely. Next, the outer wrapping materials are pulled up
and around the client. The bath towel at the top of the massage table is used around the clients head in a turban drape
or tucked into the top of the cocoon. The feet are wrapped
with the towel at the bottom of the massage table. Hot
water bottles, heat lamps, or warm packs can be used for
additional warmth if they are needed.
Step 4: Process
While the client is processing in the wrap, provide a relaxing face massage. Offer the client a sip of water or herbal
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B1
B2
C1
C2
C3
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187
FIGURE 96 The cocoon. (A) Exfoliation. Exfoliate prone and then turn the client to the supine position. This
way, the client are face up for the cocoon. (B1 and B2) Product application. Apply the treatment product to the
newly exfoliated body areas with massage strokes or with a large application brush. In these pictures, the legs have
already been treated and wrapped up in the plastic. (C1C3) Cocoon. The plastic wrap and blankets are pulled up
and around the client. The towel at the top of the table is wrapped around the head in a turban drape, and the
towel at the bottom of the table is wrapped around the feet. Notice that a light cotton blanket is used instead of a
heavy wool blanket. A client does not need to perspire in a cocoon, so lighter wrap materials are used.
iced tea through a flexible straw and mist him or her with
an aroma mist or spring water. Massage the clients feet at
the conclusion of the face massage. In a hot sheet wrap,
the client is perspiring freely and will not appreciate either
a face or foot massage. In a cocoon, enhancers such as
face massage, hot stone foot massage, reflexology, a scalp
treatment, or other special extras will help to make the

treatment exceptional for the client.
Step 5: Unwrap
To remove the wrap, the blankets are pulled off the client.
At this point, the client is still wrapped in plastic. You now
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have two options based on the equipment you have available in your facility.
Option 1: If a shower is available, you can leave the client
wrapped loosely in the plastic and move him or her to the
shower. If the client has to go outside the treatment room
to get to the shower, he or she will need to be draped over
the top of the plastic with a bathrobe or sheet. As the client
steps into the shower, the plastic is handed back to the therapist who throws it away. While the client showers, change
the treatment table to massage sheets. The treatment can
end with a full-body massage or with a quick application of
a finishing lotion, cream, or gel.
Option 2: In many different types of body wraps, the

client is covered in a spa treatment product and then
wrapped in plastic. After the treatment product is removed,
a finishing product is applied to the client, often in a
full-body massage. In a dry room setting where a shower
is not available, you have to get the dirty plastic out from
underneath the client without asking the client to get off
the treatment table (a clean massage sheet has been preset under the plastic). We discussed this process in depth
in Chapter 5, but it is repeated here for your convenience.
First, review Figure 97 and unwrap the plastic, leaving the
client covered by the breast drape and anterior pelvic drape
D
D
FIGURE 97 Removal from the cocoon. (AE) If the cocoon product

does not need to be removed from the client (e.g., shea butter), the client is
left on the plastic for the remainder of the treatment (massage or application of a finishing product). If the product is messy (such as this marine
clay), it will need to be removed from the client, and the plastic will need
to be removed from the treatment table before the massage or application
of a finishing product. These images were also used in Chapter 5 with stepby-step instructions for moving a client from plastic to a massage sheet.
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(or disposable undergarments). Remove the product from

the clients arms, upper chest, and abdominal area and
ask him or her to hold onto the breast drape and sit up.
Remove the product from the clients back and the posterior arms. Roll up the plastic sheet so that the dirty side is
rolled in until it sits as close to the gluteals as possible and
ask the client to lie back down (onto the clean preset massage sheet). Move down to the lower legs and wipe the feet
with a hot towel and ask the client to bend his or her knees
and hold his or her feet up. Roll up the dirty side of the
plastic that is underneath the clients feet. Place the clients
clean feet on the massage sheet, which is underneath the
plastic (the knees are still bent). Remove the spa product
from both legs with hot towels and roll the plastic up as
high as possible under the gluteals. Place the clean legs flat
on the massage sheet and cover the client with a sheet or
towel for warmth. The client then lies back down on the
massage sheet and slightly lifts his or her hips so that the
plastic can be removed. You want to work quickly and efficiently during product removal because the client must stay
alert during this entire process, and if you take too long, the
session will feel dull and uninspired.
Session End
The treatment might end in different ways as mentioned previously. Some treatment products will absorb
completely, so the finishing product is simply applied over
the top of the first product. You may choose to provide a
full-body massage at the end of the cocoon. Alternatively, a
full-body massage may have been given before the wrapping
up phase. With some treatment products, the skin does not
need a finishing lotion or cream (e.g., emollient products).
With others, it does. An aura mist might be spritzed high
over the client to signal the end of the session and fill the
treatment room with a refreshing scent.
SANITATION
After every treatment, product bottles and
equipment should be sanitized with alcohol.
This is important to prevent cross-contamination. For example, if you massage the clients feet, do not sanitize your
hands, and then pick up the bottle of finishing lotion, the
bottle is now contaminated. If it is used on another client
without being sanitized, the second client has potentially
been exposed to an infectious pathogen.
Tension Wraps
A tension wrap is used in combination with a treatment
product (e.g., cellulite cream) with the aim of pushing excess fluid out of a limb (e.g., thigh) or to compress tissue so
that it appears slimmer when unwrapped. Tension wraps
also increase heat in a body area so that the area perspires.
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189
Tension wraps are either made of terry cloth strips that

are soaked in a treatment product (e.g., herbal infusion,
dissolved seaweed) or of heavy cellophane on a small roll.
The wrap strip or roll is circled up the limb or torso either
with the treatment product on it or over the top of a treatment product that has already been applied to the area.
Tension wraps are controversial. Some therapists feel that
treatments featuring tension wraps mislead clients into
believing that these wraps can make them lose inches and
weight. In fact, the results experienced with tension wraps
are usually temporary. Other therapists swear by tension
wraps and point to their popularity with clients. Tension
wraps are offered in many spas, so you should know the
methods that are used in this type of body wrap so that you
can make your own decision about this treatments viability.
It is important to note that tension wraps are potentially
dangerous and can cause damage to blood vessels if a limb is
wrapped too tightly. Overtight wrapping most often occurs
with the heavy cellophane wraps that are easy to pull tightly
and twist to flatness against the skin. In one case of overtight tension wrapping, the client developed a varicose vein
as a result of the treatment. The need for caution cannot
be stressed enough. Do not apply a tension wrap to a client
with poor circulation, diabetes, circulatory conditions, high
blood pressure, spider veins, or varicose veins.
You may choose to measure the size of target areas before
and after the application. Usually, the midcalf, midthigh,
hips, waist, and, sometimes, the upper arm are measured
and treated. A session including the use of a tension wrap
might progress as follows: (1) The client is measured,
(2) full-body exfoliation, (3) application of a specialized cellulite cream or firming product to target areas, (4) tension
wrap, (5) the body is cocooned in warm blankets to process,
(6) removal of the blankets and tension wrap, and (7) application of a finishing product to target areas.

If terry strip tension wraps are used, they are rolled up
and then placed in a crock pot or hot stone heating unit
full of dissolved treatment product rather like the hot
sheet wrap. The terry strips are then removed and wrung
out before being placed in a soda cooler to keep them
hot. The strips are wrapped around the area that is being
treated. Sometimes, a treatment product such as a cellulite cream is applied underneath the wet tension wrap but
not always.
If a cellophane wrap is used, the treatment product is
applied directly to the client, and then the area is wrapped.
Sometimes, more than one product is applied, as in the case
of a Parafango cellulite treatment. In this treatment, a specialized cream is massaged into target areas and then covered
by hot Parafango, which activates the specialized cream. The
tension wrap is applied over the top of the Parafango.
The wrapping techniques are described using the cellophane wrap, but wrapping with terry strips is carried out
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A1
A2
A3
A4
FIGURE 98 Techniques for tension wraps. (A1A4) Tension wrap of the legson table. Start on the foot
and wrap up the leg. Move forward as you work higher. Twist the wrap to keep it flat against the clients leg.
(B) Tension wrap of the legsstanding. (C) Tension wrap of the hips and belly. (continued)
in the same way. Cellophane is a bit easier to work with because it sticks to itself, so you dont have to worry about it
slipping. Terry strips loosen and slip easily; they require a
lot of practice. You may notice that for some of the techniques described here, the client is standing up. This is not
ideal because the client cannot fully relax during the session. In many cases, a good wrap and noticeable results will
be more important to the client than relaxation, so he or
she wont mind this positioning. Tension wrapping techniques are shown in Figure 98.
Tension Wrap the LegsClient on the Table
With the client supine, unwrap a small bit of plastic from
the cellophane roll and hold it in place on the clients foot
as you lift his or her leg at a straight angle onto your shoulder. While one hand holds the plastic wrap onto the foot,
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E1
E2
E3
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191
FIGURE 98 (continued) (D) Tension wrap of the arms. (E1E3) Removal of tension wrap.
the other brings the wrap roll around the ankle to begin
wrapping the clients leg. Work distal to proximal twisting
the wrap with each turn to keep it flat against the clients
skin. The aim of the wrap is to encourage tissue fluid to
move from the distal area of the leg towards the heart.
As you reach the knee, lift the leg up from your shoulder and move your body weight forward as you continue to
wrap the plastic. When you reach the hip, anchor the plastic
under the client and repeat the process on the opposite leg.
Tension Wrap the LegsClient Standing
This is the easiest way to get a good wrap. The client stands
with his or her legs apart. The therapist anchors the strip of
plastic under the clients heel and wraps from the ankle up
the leg, twisting the plastic to keep it flat against the clients
leg. Once both legs have been wrapped, move onto the waist
and hips.
Tension Wrap the Hips and Abdominal Area
It is very difficult to get a good wrap on the hips and abdominal area with the client supine on the table. If the client is
sitting up, this does not work well either because the belly
will pouch, so the wrap becomes loose when the client lies
down. It is easiest to get a good wrap with the client standing up. This way, you can move directly from the last leg you
wrapped to the hips and then over the abdominal area. Circle
the wrap around the clients torso and pull it snug. If the client is standing next to the table, he or she simply leans back
and swings onto the table to relax while the wrap takes effect.
Tension Wrap the Arms
Usually, the lower body is treated and allowed to process
while the upper body is treated. The arm is wrapped from
the wrist up to the deltoid even though the lower arm is not
usually covered in treatment product.
Unwrap
To remove terry strip wraps, simply unwind them from the
clients body. Cellophane wraps are cut in a straight line up
the front of the wrap using a specially designed safe cutter.
SANITATION
The terry wraps should be stored in a closed,
ventilated container after they are removed
from the client. Straight after the session, they should be
laundered in hot water with a commercial-grade laundry
detergent and dried with heat. They are then rerolled and
stored in a closed cabinet.
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SPA FUSION
STUDY TIP: Catchwords
Catchwords, catchphrases, and acronyms, such as
SHARP, used to remember the signs and symptoms
of acute inflammation, are useful memory devices.
SHARP stands for
S Swelling
H Heat
A A loss of function
R Redness
P Pain
When you are trying to remember something such
as the steps in a spa treatment process, write out its
aspects in brief notes and see if they dont suggest a
catchword or catchphrase. Come test time, you will be
glad you made the extra effort.
SPA INSPIRATION: Mix and Match

You may have noticed that you can apply body wrap
treatments in a variety of different ways. Heres a challenge. Pick one body wrap type (e.g., shea butter cocoon) and deliver it with three different session starts
and three different session ends. This way, you see
how easy it is to mix and match treatment elements to
make unique spa body treatments with your personal
stamp of style and excellence.
GOOD TO KNOW: Sample Sizes

Most spa suppliers are willing to send therapists
sample sizes of product to try out before they purchase large back bar product containers (that can
be very expensive). Contact two or three spa suppliers
and order sample sizes of anything you might imagine
using in a body wrap service. Meet up with a classmate
and experiment with different products. Soon you will
discover what you really like and want to use in your
own spa practice.
CHAPTER WRAP-UP
In a body wrap, the body is enclosed in sheets or
plastic and insulating blankets to trap heat. This
stimulates detoxification through perspiration and/
or helps the skin to absorb any products that you
applied. Today, a wide variety of body wraps are used
for cosmetic purposes or to treat conditions such as
low immunity, fatigue, muscular aches, and pain or
simply for relaxation. In this chapter, you learned that

there are numerous ways to give a body wrap, but two
procedures that work well are the hot sheet wrap and
the cocoon. If you practice these two techniques until
you can perform them fluidly, you will be prepared to
deliver a variety of different services in a spa or to add
body wraps to your own massage and spa practice.
REVIEW QUESTIONS
Multiple Choice
1. A cold sheet wrap is a form of this type of wrap.
a.
b.
c.
d.
Detoxification and immune boosting wrap

Cryogenic wrap
French hydrotherapy wrap
Skin care wrap
2. Hot wraps elevate body temperature and create an

artificial fever. This:
a. Dehydrates the body and causes brain damage
b. Accelerates the elimination of toxins through
perspiration
c. Causes a temporary reduction in immunity
d. Causes antibody production and T-cell
proliferation to decrease
3. In a cold sheet wrap:
a.
b.
c.
d.
The body experiences a vascular flush effect.

The body shivers, which tones muscles.
The skin is cooled, which softens its texture.
The muscles contract, which forces excess water
from the tissues.
4. The client does not need to perspire in this type of

wrap.
a.
b.
c.
d.
Coffee slimming wrap

Emollient cocoon
Herbal hot sheet wrap
Seaweed detoxification wrap
5. Many ancient healing traditions used

as
a medicine to decrease toxic buildup in the body.
a.
b.
c.
d.
Aloe vera
Shea butter
Massage oil
Herbs
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Chapter 9
Body Wraps
193
SPA FUSION
Matching
7.
Match the client to the most appropriate treatment

option.
A. Herbal detox wrap
D. Aloe vera wrap
B. Cryogenic wrap
E. Shea butter wrap
C. Lavender and rose petal wrap
Healthy client who is about to start a

diet
8.
Client with chronically dry skin
9.
Athlete who has sore and stiff muscles
6.
Elderly client who is in good health but

has minor circulatory insufficiency
10.
Sunburned client
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10
Spa Foot Treatments
Chapter Outline
K e y Te r m s
Arch: The bones in the foot are actually arranged to form three strong
arches (the medial longitudinal arch, the lateral longitudinal arch, and
the transverse arch) that are commonly referred to as the arch of the
foot. The arch provides the foot with the strength to support the body
while remaining flexible and mobile.
Callus: A small area of thickened skin that is caused by continued friction
or pressure. The epidermis becomes more active in response to mild,
repetitive irritation. This causes a localized increase in the thickened
tissue at the surface of the skin.
Cuticle: The border of the nail is partly covered by a fold of skin commonly
called the cuticle. In a pedicure (or manicure of the hands), the cuticle is
pushed back so that the surface of the nail appears cleaner and smoother.
Dorsiflexion: Bending the top of the foot (the dorsal surface) toward
the shin.
Nail technician: A practitioner who is certified or licensed to provide care
of the nails or to apply, repair, or decorate gel nails or acrylic nails.
Pedicure: A treatment in which the foot is soaked, calluses are reduced,
the nail is trimmed and filed, the cuticle is pushed back and trimmed,
and the nail is buffed or polish is applied to the nail. Nail care is provided only by a certified nail technician or a cosmetologist (depending
on the laws of the particular state).
Plantar flexion: Bending the bottom of the foot (plantar surface)
downward (as in pointing the toes).
Reflexology: A holistic therapy that is based on the belief that specific
points on the hands, ears, and feet correspond to specific areas of the
body including the organs and glands.
Contraindications
Reflexology Certification
Possible Reactions to Reflexology
Therapist and Client Comfort during Reflexology

A Quick Foot Assessment
Exfoliation
Foot Massage
Reflexology
Treatment Products
Finishing Products
A Sample Spa Foot Treatment Procedure

Session Start
Step 1: Soak and Cleanse
Step 2: Exfoliation
Step 3: Move the Client to the Treatment Table
Step 4: Foot Massage
Step 5: Reflexology
Step 6: Application of Treatment Product
Step 7: Process
Step 8: Removal of the Treatment Product
Session End
S
SPA
FUSION
STUDY TIP: Pay Attention to Your Internal Clock
GOOD TO KNOW: Reflexology Certification
CHAPTER WRAP-UP
194
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Chapter 10
Treatments that focus on the feet are well liked by clients,

so these are regularly offered on spa menus. Pedicure
treatments, which are intended to beautify the skin and
nails, are delivered by cosmetologists, estheticians, and nail
technicians, depending on the laws in the individual state.
Massage therapists provide foot treatments that decrease
foot pain, revitalize tired feet, enhance or promote relaxation,
and support the balance of the body. Although massage
therapists cannot provide nail care or services aimed at
improving the appearance of the feet (in most states), they
can mix and match different treatment elements to create
enjoyable services that quickly gain popularity with clients.
A foot treatment consists of basic steps that can
be modified to fit the goal and concept of the service
being provided. Most foot treatments include a general
foot assessment, soaking and cleaning, exfoliation, the
application of a treatment product (mud, paraffin, etc.), and
basic massage. These fundamental steps are enhanced with
massage, reflexology techniques, aromatherapy smell-scapes,
Spa Foot Treatments
195
thrombosis, infections, ingrown toenails, painful corns,

gout, warts, or athletes foot in the area of the lower leg and
foot, he or she should not receive a foot treatment. Caution
should be used when working with the elderly, clients on
multiple medications, and clients who have a compromised
circulatory system. Reflexology techniques should only
be used on such individuals with light pressure to avoid
overstimulation or accelerated elimination symptoms such
as nausea, diarrhea, or headache.
Reflexology Certification
The foot spa treatments described in this chapter include
reflexology techniques. To become a certified reflexologist
requires specialized training. In some states, a specific
license is required to practice as a reflexologist, but in
other states, reflexologists must also be qualified as massage therapists before they can practice. Massage therapists who are not reflexologists can use reflexology
techniques during a treatment but should not claim to
be reflexologists. The American Reflexology Certification
Board (ARCB) is an independent testing agency (http://
www.arcb.net). They require students to take a hands-on
reflexology course of no less than 110 hours and complete
90 postgraduate treatment sessions that have been properly documented using ARCB forms. To obtain the certification, students then have to take a 300-question test and
a practical exam.
and enhancers that address other areas of the body such as
Possible Reactions to Reflexology
the hands and face. The goal of this chapter is to describe each
Although negative responses are rare, clients may experience

a variety of reactions to reflexology techniques. During the
session, the clients may have muscle cramping in the legs
and feet, their feet and hands may perspire, and they may
feel mildly nauseous or headachy. Some clients respond
to reflexology by falling into a deep sleep during the session. Others will experience involuntary jerks of the arms
and legs as the nervous system unwinds. In all cases, you
should monitor the clients comfort level and make necessary adjustments to the degree of pressure that you apply
during the treatment.
element of a foot treatment and suggest some options for

each step. Some specific massage and reflexology techniques
will also be discussed so that you have the necessary building
blocks in place to create unique foot treatments. Review
the sample treatments section at the back of the book for
inspiration when you design your own foot spa menu.

Before giving spa foot treatments to clients, it is important to be aware of possible contraindications, the types of
reactions that clients may have to the treatment, and the
regulations on reflexology certification. It is also useful to
be aware of the positioning techniques that make reflexology less stressful on your body.
Contraindications
If a client has pitted edema, broken bones or fractures,
advanced or poorly treated diabetes, neuropathy, deep vein
Therapist and Client Comfort during

Reflexology
Set your massage table high enough so that you do not
have to hunch over the table while delivering the treatment.
The client uses a step stool at the side of the massage table
to get on and off the table safely. This is not the only way to
position a client for the delivery of reflexology techniques.
Some therapists place the clients feet on a stool in front
of them. Others place the feet on a pillow to lift them up
off the massage table. In this case, the client should be bolstered so that elevating the feet does not place unnecessary
stress on the knees.
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TABLE 101 Elements of a Spa Foot Treatment

TREATMENT ELEMENT
DESCRIPTION
Foot assessment
The foot is evaluated to rule out contraindications and identify areas of particular stress. The shoes of the client might also
be appraised so that the therapist can describe to the client how their shoes might be contributing to foot pain or to hip,
knee, and lower back conditions.
Soaking and/or
cleansing
The feet are soaked in water, usually with a product to soften and clean the skin and to relax the muscles. Sometimes,
the feet are not soaked but are washed while the client relaxes on the treatment table.
Exfoliation
A granulated product (estheticians can also use an enzyme or dissolving exfoliant) is rubbed on the feet to remove dead
skin cells, smooth the skins surface, stimulate lymph flow, and increase local circulation.
Callus care
A heavy, specially formulated cream may be massaged into the callus to help reduce it, or a callus file or pumice stone
may be rubbed across the callus to remove dead skin (in some states, this is prohibited for the massage therapist).
Massage
The lower legs and feet may be massaged to relax muscles, stimulate lymph and blood flow, decrease pain, and revitalize
the feet. A variety of techniques can be used, including hot stone massage, trigger point therapy, and lengthening/
strengthening techniques such as active isolated stretching (AIS) and post-isometric relaxation (PIR).
Reflexology
Reflexology techniques may be used to decrease foot pain, increase the flexibility and pliability of the feet, relax the body,
revitalize the feet, and balance the body.
Hydrotherapy
Foot soaks at specific temperatures, whirlpool baths, or affusions may be used to treat a specific condition, decrease
inflammation, increase blood and lymph flow, and revitalize the feet. See Chapter 6 (Water Therapies).
Treatment product
A treatment product such as mud, seaweed, cocoa butter, or essential oils is applied to the feet and sometimes the lower leg to
achieve a specific result (decrease foot pain, decrease of inflammation, stimulation of circulation, revitalization, etc.).
Foot cocoon
The feet and lower leg may be wrapped in a cloth soaked in herbs, heated towels, or thermal booties to warm the tissues or
to activate a specific treatment product that has previously been applied to the area.
Finishing product
To end the treatment, a light gel or lotion may be applied to the feet, the feet might be misted with a toner, or a powder
might be applied. Often, peppermint lotions are used because they leave the feet feeling tingly and refreshed.
A CLASSIC PEDICURE
In the following section, different elements of a spa foot
treatment are described along with techniques, variations in
products, and alternative delivery steps. When you understand
how to deliver each of these elements, you can mix and match
options to create unique services. The sample treatment at the
end of the book gives examples of how the different elements,
products, and delivery steps can be combined. Table 101
provides an overview of the basic elements of a foot treatment,
whereas the Broaden Your Understanding 101 describes the
steps in a classic pedicure. Also, for a demonstration of a spa
foot treatment, visit thePoint.
A Quick Foot Assessment

When assessing the feet before a session, look for any obvious
contraindications such as a fungal infection or pronounced
edema. Corns, calluses, and areas of discoloration or
dryness are not contraindicated but help you determine
where extra stress is being placed on the foot or the body.
In reflexology, for example, a callus on the medial side of the
big toe might correspond to a clients chronic neck pain and
stiffness. Eliminating the cause of the callus (often ill-fitting
shoes) and specifically stimulating the area during the treatment may help to decrease the severity of the neck stiffness
while relaxing and revitalizing the feet at the same time.
In a pedicure, the toenails are groomed, the skin is

beautified, and the appearance of the foot is enhanced.
This treatment can only be delivered by a professional
licensed or certified to provide nail care (a cosmetologist, nail technician, or esthetician, depending on the
laws in the particular state). In a classic pedicure, the
therapist first removes old polish with acetone (nail polish
remover) and then soaks, cleanses, and exfoliates the
feet. A heavy, specially formulated cream may be massaged into calluses to help remove them. Alternatively,
a callus file or pumice stone may be rubbed across the
callus to remove the dead skin. Nail technicians can
use a callus shaver to shave off layers of dead skin. This
is a potentially dangerous piece of equipment and
should only be used by a trained professional. The cuticles are treated with a cuticle cream, which softens the
cuticle so that it can be pushed back off the nail. The
nail is trimmed and then shaped with an emery board.
A foot mask may be applied to soften and purify the
skin, and then a light massage is provided. Finally, the
nails are polished with a base coat, two coats of color,
and a top coat to protect against chipping.
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Chapter 10
The most common cause of foot pain and dysfunction

is ill-fitting shoes.1 Clients often wear shoes that are one
or two sizes too small for their feet. This miss-sizing usually occurs because clients try new shoes on while they are
sitting down (nonweight bearing), lace the shoes tightly
around their feet, and then stand up and walk around. The
shoes hold the foot in a cramped position so that the bones
cannot lengthen out into a strong arch. Over time, this may
lead to foot pain and may contribute to knee, hip, and lower
back conditions. Its a good idea to try on shoes in the afternoon when feet are at their largest due to normal swelling.
Peoples feet get wider as they age, so they should expect
their foot size to increase over the years.2
The quick foot size test described below is an effective
way to determine if a client is wearing a shoe that is too
small for his or her feet. This method is adapted from that
taught by Bill Runquist, a noted reflexology instructor. To
perform the test, the client sits on a chair with his or her
bare feet placed a shoulders width apart. Pieces of cardboard are then placed under each of the clients feet, and the
client is asked to stand up. You then trace around each foot
onto the pieces of cardboard. Because the clients weight is
on the feet and he or she is barefoot, the imprints will indicate the true foot size for which shoes are required.
Cut out the impressions of the feet and attempt to slip them
into the clients shoes. If the cardboard impressions do not fit
into the clients shoes, the shoes are too small. Ideally, the client would throw away any shoes that do not fit the cardboard
impressions. When clients first wear shoes that fit the cardboard impressions, they will often make the comment that the
shoe feels too large. This is because it takes some time for the
feet to relax back into their natural lengthened positions.
Although this is an oversimplified assessment of what
can be a very complex situation, this easy test illustrates
for clients the importance of purchasing shoes that are
big enough. Clients with persistent foot pain, knee, hip, or
lower back pain should be referred to a physician for professional medical assessment and treatment.

Cleansing is required before any foot treatment for hygienic
reasons. Different cleansing and soaking methods and equipment are shown in Figure 101. In the simplest cleansing
method, you wipe off the clients feet before massage with a
disposable cleansing wipe such as a diaper wipe. Another simple method is to wet your hands in a bowl of warm water and
apply a foaming cleanser to the feet while the client relaxes on
the treatment table. The cleanser is removed with hot towels.
A more elegant cleansing might take place in a soaking
container with warm water and a soaking additive. The clients feet are soaked for 5 to 10 minutes to soften the muscle
tissue, increase local circulation, and relax the body. The feet
are pulled out of the water one after the other and washed
with a cleanser. Dry the feet with a hand towel before the client is moved to a treatment table for the rest of the service.
Spa Foot Treatments
197
Some spas have expensive pedicure equipment with a reclining chair attached to a multijet hydrotherapy foot tub.
The clients feet remain immersed in the tub for much of
the treatment and are pulled out and placed on a foot rest
when necessary during the service. This type of equipment
is ideal for a pedicure, but it is not strictly necessary for a
foot treatment delivered by a massage therapist. A cheaper
option is to use a foot soak basin and purchase a pedicure
chair with an attached foot rest. You can now work on the
clients feet from a seated position rather than being down
on your knees when cleansing and drying the feet during
the soaking and cleansing step.
The presentation and style of the foot soak is important.
Large decorative basins with whole flower petals or leaves
floating on the surface of the water create an attractive
display and add a sensation of luxury and indulgence. A cup
of herbal tea on a side table, relaxing lighting, and soothing
music add to the experience. The clients might also be offered
a shoulder and neck massage while their feet are soaking.
In a third method, the foot soak is delivered while the client
relaxes on the massage table. The clients legs are propped up
with a large wedge or bolster. The foot soaking basin is placed
at the end of the table on top of a bath towel and a hand towel.
The client places his or her feet into the bowl for the treatment
and then lifts them out at the end of the soak. You remove the
container of water and place the clients feet on top of a preset
hand towel to be dried. In this case, a plastic dish bowl is ideal
for the soaking container. Large decorative containers are difficult to lift and maneuver in this type of a soak.
Additives such as Epsom salt, seaweed powder, and
essential oils can increase the therapeutic benefit of a
foot soak while helping to cleanse the feet of impurities.
Table 102 provides an overview of some of the additives
that might be used in the foot soak or cleansing step.
SANITATION
Any soaking basin that contains jets must
be flushed with a small amount of bleach or
an approved sanitation product between clients. This
is also true for decorative items such as marbles or polished stones added to the soaking basin. Basins without
jets should be washed with hot, soapy water; dried and
sprayed with alcohol; and then left to air dry. Careful sanitation of foot soaking containers is very important because
this is often an area where bacteria can grow and spread
between clients.3
Exfoliation
Buff the feet during the soaking process by lifting one foot
out of the tub at a time and applying an exfoliant cream
or loofah mitt to the sole of the foot and the heel. A callus
file or pumice stone can be rubbed across calluses while the
feet are wet in some states. If the client is positioned on the
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198
B1
B2
E
C
F
FIGURE 101 Cleansing and soaking the feet. (A) Cleansing with a disposable diaper wipe. (B1 and B2)
Cleaning with a cleanser and hot, moist towels. (C) Soaking in a decorative tub while seated. (D) Soaking while
positioned on the treatment table. (E) Professional multijet foot soak. (F) Foot soak basin and pedicure chair.
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Chapter 10
Spa Foot Treatments
199
TABLE 102 Additives for a Foot Soak

ADDITIVE
GENERAL PROPERTIES
HOW MUCH TO USE
Epsom salt
Traditionally used as a soaking agent for sprained or bruised

muscles and to decrease muscular pain and stiffness.
cup to 1 cup, depending on the size of the soaking

unit
Sea salt
Sea salts are skin softening and relaxing. Dead Sea salts aid
psoriasis, eczema, and arthritis and are pain relieving.
cup to 1 cup, depending on the size of the soaking

unit
Seaweed
Seaweed powder is stimulating for blood and lymph flow,

detoxifying, and revitalizing.
1 tsp is dissolved in hot water, and the mixture is

poured into the tub.
Clay
Clay is soothing, softening, and relaxing. Certain clays such

as those derived from sea sediments or volcanic areas may
remineralize through absorption.
The amount used is at the discretion of the therapist.

One tablespoon (softens and colors the water),
whereas larger amounts can create a runny but
enjoyable soup.
Mud or peat
Mud or peat can be added in moderate amounts to cool water

temperatures to support the decrease of inflammatory conditions and refresh the feet.
1 cup or more; some treatments may call for the feet

to be soaked in undiluted mud or peat (although this
is expensive).
Foamy soaking product
Spa suppliers carry a variety of scented foaming soaking products for the feet. Sometimes, these products contain dyes
that color the water. Clients who are sensitive to synthetic
fragrances may prefer a more natural additive such as clay
or sea salt.
Usually, 1 tbsp is added and then frothed up with

the hands. Follow the product directions if they are
provided.
Fizzy soaking product
Fizzy soaking products are placed in the water and fizz when
they dissolve like an Alka-Seltzer. They are often scented and
contain dyes to color the water.
Read the product directions to determine how much

product to add to a soaking tub.
Herbal infusions
Herbal infusions can be added to the foot bath to refresh the

feet and senses. The same herbal mixture that is used for the
herbal body wrap can be used in the foot bath. Eucalyptus
leaf, juniper berry, clove buds, calendula, and rosemary leaf
make a nice combination.
To make an herbal infusion, place cup of dried

herbs in a muslin bag or metal tea ball and cover
with a quart of boiling water. Allow the mixture to
steep for 15 minutes before it is added to the foot
bath.
Essential oils
Essential oils have numerous properties that can be used in a

foot soak. The therapist adds the oils after the clients feet are
immersed in the water to prevent premature evaporation of
the oils.
Cover the clients feet with essential oils diluted in a

fixed oil and then place them into a foot soak basin
of warm water.
Powdered milk and

honey
Powdered milk, buttermilk, full-fat milk, and honey make a

soothing, softening, and relaxing foot soak.
Add cup of powdered milk or 1 cup of regular or

buttermilk and cup of honey to the foot soak basin
of warm water.
Other
A variety of other professional soaking products with different

properties are available through spa suppliers.
Follow product directions.
massage table, you can wet your hands in warm water and
apply the exfoliation product directly to the feet and then
remove it with a hot towel.
SANITATION
Callus-reducing files or other implements used
on the feet should be washed in hot, soapy
water at the end of the treatment; soaked for 20 minutes
in alcohol; and left to air dry before being returned to a
closed cabinet.
Foot Massage
One of the things that sets massage therapist apart from
other therapists delivering services at a spa is the depth and
variety of the massage strokes that they use in a treatment.

Few treatments are more relaxing and satisfying than
an exceptional foot massage. You may already have an
exceptional foot routine, but if you are still developing your
skills, you may find the techniques offered below helpful
(Fig. 102). Many of the strokes outlined here are taught by
Geraldine Thompson and Lisa Hensel at the Seattle School
of Reflexology. To view a video demonstration of a foot
massage routine, visit thePoint.
The Sandwich Slide
Lace your fingers and stand on the lateral side of the foot
facing toward the table. Slide your interlaced fingers down
the medial edge of the foot to the heel and then back up
to the starting position. The emphasis is on the downward
stroke. Repeat this technique up to 15 times.
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200
FIGURE 102 Foot massage techniques. (A) Sandwich slide. (B) Folded hands glide. (C) Circular thumbs on the
top of the foot. (D) Circular palms around the ankle. (E) Achilles stroke. (F) Circular thumbs on the bottom of the
foot. (G) Metatarsal pull. (H) Stone scrape. (I) Metatarsal stone roll. (continued)
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Chapter 10
Q1
Q2
Spa Foot Treatments
201
FIGURE 102 (continued) (J) Transverse thumb slide. (K) Rotation of all toes. (L) Circular finger friction.
(M) Spinal twist. (N) Lung press. (O) Solar plexus hold. (P) Laced fingers hold. (Q1 and Q2) Bouncebounce
traction. Lift the legs and bounce them on the massage table three times. Lean back while holding the ankles and
swing the legs right and left.
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202
Folded Hands Glide

Place one hand on top of the other with your thumbs to the
outside and hold your elbows close to your body so that you
can use your body weight to facilitate the stroke. With the
edge of your hands contacting the ball of the foot (directly
over the metatarsal heads), push the foot into dorsiflexion.
Once the foot is dorsiflexed, run the edge of your hands
down the plantar surface of the foot and around the heel,
pulling the foot into plantar flexion at the end of the
stroke. Repeat this stroke 10 times. You may notice that this
stroke is difficult to perform with good body mechanics
because it causes a pronounced wrist deviation. Holding
your elbows close to your body and using your body weight
to facilitate this stroke is important. Although this stroke is
really popular with clients, you must determine if you can
provide it without injury or undue stress on your body.
Circular Thumbs on Top of the Foot
Starting at the distal part of the foot, use circular motions
with your thumbs down the dorsal surface of the foot.
Repeat this stroke three to six times.
Circular Palms around the Ankle
Apply moderate pressure in circular motions around the
ankle with the palms of your hands.
Achilles Stroke
Run one hand up the anterior surface of the lower leg
and the other down the posterior surface of the lower leg,
traction the ankle at the end of the posterior leg stroke.
Circular Thumbs on the Bottom of the Foot
Apply circular friction with your thumbs from the heel to
the toes. Repeat this stroke three to six times combined
with the metatarsal pull described next.
Metatarsal Pull
As you approach the top of the foot with circular thumbs,
gently grab around the first metatarsal head with one
hand and around the fifth metatarsal head with the other.
The fingers fall into the groves created by the metatarsals.
Loosen the foot in a seasaw motion to complete this stroke.
Stone Scrape
Using the flat edge of a warm stone, scrape from the solar
plexus point (the point directly beneath the ball of the
foot) to the heel in a straight, even motion and repeat this
technique 6 to 10 times.
Metatarsal Stone Roll
Place the edge of the warm stone in between the fifth and
fourth metatarsal and roll upward three or four times.
Repeat this stroke between each of the metatarsals.
Transverse Thumb Slide
Apply thumb friction in a crossing pattern from the bottom
of the toes to the heel. When you reach the heel, begin again
at the top of the foot or use circular thumb friction to create

a smooth transition. Repeat this stroke three to six times.
Rotation of All Toes
Stabilize the foot with one hand while the other rotates
all of the toes in a circle. Repeat, rotating the toes in the
opposite direction. This stroke is followed by a toe twist in
which each toe is lightly twisted back and forth while gentle
traction is applied. You want to be careful not to pull too
hard on the toes, which may cause the client discomfort.
Circular Finger Friction
With the thumbs on the plantar surface of the foot, circle
the fingers down the sides of the foot using firm pressure.
Repeat this stroke three to six times.
Spinal Twist
Stand at the end of the table in the center, facing out over
the foot. Place your hand that is closest to the table on the
base of the ankle and stabilize the foot. The outer hand
twists the distal tarsals, metatarsals, and phalanges outward, moving the outer hand up the foot but leaving the
lower hand firmly in place.
Lung Press
Make a fist with your inside hand and place it against the
ball of the foot. The outside hand stabilizes the foot on
the dorsal surface. Using a rhythmic motion, plantar flex
and dorsiflex the foot to loosen it and stimulate the lung
reflexes.
To end a massage session, one or all of the following
techniques might be used.
Solar Plexus Hold
Sit holding one foot in each hand. Your thumbs are positioned so that they rest on the point directly below the ball
of the foot known as the solar plexus point. This is associated with deep breathing and calm. Ask the client to take
three deep breaths while you apply firm pressure to this
point on both feet at the same time.
Laced Fingers Hold
Place the fingertips of each hand on the plantar surface of
the foot, lacing them almost but not actually in between
each toe. Hang onto the foot as if you are hanging onto a
ledge with just your fingertips. Hold this position and ask
the client to take three deep breaths.
BounceBounceTraction
Standing at the end of the table in the center, hold each
leg just above the foot. Lift the legs and bounce them on
the massage table three times. Bring your hands around
the leg so that you can lean backward and traction at the
ankles while swinging the legs right and left. This releases
the sacroiliac joint and relaxes the lower back. Repeat this
sequence three to four times. Avoid this technique if the
client has lower back, hip, pelvic, knee, or ankle problems.
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Chapter 10
Follow the foot massage routine with reflexology techniques to help bring the whole body into a relaxed and balanced body and mind state.
Reflexology
Reflexology is a therapy that is based on belief that there
are points in the feet, hands, and ears that stimulate the
function of different parts of the body, including the glands
and organs. It is most often used as a preventive therapy that
aims to soothe the nervous system, reduce stress, improve
circulation, and create the optimum internal environment
for balanced energy, rest, and recovery. The goal is that the
body can draw on its natural healing ability because it is in
a relaxed and balanced state.
Although hands, ears, and feet can all be manipulated
to improve health and well-being, it is the feet that receive
the most attention. The feet are very important because
of their rich supply of superficial nerve endings (7,000 in
each foot). The feet connect us to the earth and support our
bodies with an intricate structure that consists of 26 bones,
33 joints, 19 muscles, and 107 ligaments. In addition, circulation tends to stagnate in the feet because they are farthest
from the heart. Inorganic waste materials such as uric acid
and calcium turn to crystalline deposits that can build up
in the bottom of the feet. Reflexologists focus on working
every surface of the foot to decrease muscle tension and
pain, increase local circulation, loosen the foot so that it is
more flexible and mobile, and stimulate the flow of energy
through the body.
Modern reflexology owes its development to an American
doctor named William Fitzgerald, who developed a comprehensive method for working the feet in the early 20th century. Dr. Fitzgerald discovered that when he applied gentle
pressure to the feet, other areas of the body were affected.
He called his work zone therapy and mapped out 10 zones
in the body that could be accessed by massaging the feet or
hands. When a zone on the feet or hands is manipulated,
any gland or organ falling in the path of that zone is positively affected. Although reflex zones can be compared to
meridians, it should be understood that although the two
systems are based on similar ideas, the underlying philosophy is different.
Eunice Ingham, an American physical therapist, became
interested in Fitzgeralds methods while working with
Dr. Riley. She worked on a variety of patients over a number of years and kept detailed notes on her findings. She
charted each body area on the foot and, through trial and
error, created an intricate map that shows the placement
of reflex points for each gland and organ in the body. She
is credited by many as being the first person to create an
anatomical model of foot reflexes in which the feet are a
mirror image of the body.
Ingham published her work in 1938 in a book entitled
Stories the Feet Can Tell Thru Reflexology and toured the country teaching her methods until the age of 80 years.4 Her
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203
nephew, Dwight C. Byers, currently runs the International

Institute of Reflexology, which counts its membership in
the thousands.5 The Ingham Method of Reflexology is a
registered trademark of Dwight Byers and the International
Institute of Reflexology.
Reflexology Techniques
The most common technique used in reflexology is thumb
walking (Fig. 103). To thumb walk, use the edge of your
thumb in an inchworm motion to take small bites out of
the area you are working. Your pressure is steady and firm.
To practice the technique, walk your thumb up your forearm. Finger walking is similar to the thumb walk except
that the edge of the index finger is used, and the pressure
is usually gentler. The hook and back up technique is used
to stimulate a specific point. The thumb is used to apply
direct pressure to the point and is then pulled back slightly
to hook the point (think of taking slack out of fascia). The
point will then be reactivated with direct pressure again.
Sometimes, a therapist will rotate his or her thumb on a
point as a way of stimulating the point.
In general, when you identify a tender area, you give
it focused attention. Although the pressure is firm, it
should not feel unbearable. Areas of tenderness may relate
to what is considered congestion in the corresponding
glands and organs of the body. It is important to remember that the foot is a complex structure, prone to adhesions, hypertonicities, and inflammations, just as the rest
of the body is. Congestion in an area does not necessarily
indicate pathology, and you should be careful not to
FIGURE 103 Thumb walking technique.
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204
alarm the client by relating tenderness specifically to an

organ or gland.
A Stress Reduction Reflexology Routine
clearing the zones and working on specific reflex points

that can be activated to decrease stress and balance the
body. A snapshot of the routine is provided in Treatment
Overview 101 and shown in Figure 104.
The amount of reflexology you use in a spa foot treatment

is left to your discretion or that of a treatment designer at
the spa where you work. The routine described below takes
approximately 25 minutes and works nicely when preceded
by a 10-minute foot massage. This treatment focuses on
Session Start
The client is supine on the treatment table with his or
her feet at the very end of the table. He or she is covered
by a bath sheet or blanket for warmth. Place a pillow under the clients head and bolster his or her knees. You
D1
D2
FIGURE 104 A core reflexology routine. (A) Massage the feet. (B) Solar plexus hold. (C) Clear the zones. (D1
and D2) Spinal walk. Walk the spinal reflexes from the bottom up and then from the top down. (E) Thumb walk
the toes. (continued)
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205
FIGURE 104 (continued) (F) Pituitary press. (G) Thumb walk the horizontal lines. Thumb walk each horizontal line from zone 5 to zone 1. For longer sessions, walk the spaces in between the lines working horizontally
across the plantar surface of the foot. (H) Thyroid press. (I) Adrenal gland press. (J) Thumb walk the lung
reflexes. (K) Solar plexus holdtransition to the other foot.
may choose to place a pillow under the clients feet to elevate them in order to make technique application easier
on your body. Clean the feet with a disposable wipe such
as a diaper wipe or with foaming cleanser and hot, moist
towels.
Step 1: Massage the Feet
Warm the feet with massage techniques before the reflexology session. When you have finished the foot massage,
remove the lubricant from the feet with a hot, moist towel
or diaper wipe. The feet need to be dry or else your thumb
will slip over the reflex points instead of grab them.
Step 2: Solar Plexus Hold
Sit down, place your hands in the correct position for the
solar plexus hold as described previously, and ask the client to take three long, slow deep breaths. Release and cover
one foot.
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4
5
A Reflexology Routine
32
11 2
3
4
5
Indications
Stress, general relaxation, low energy, sore or tired
d ffeett
Contraindications
Pitted edema, broken bones or fractures, advanced or
poorly treated diabetes, infections, ingrown toenails, painful corns, gout, warts, or athletes foot
2
3

bottom layer to the top layer)
1. Massage sheet
2. Bath towel situated horizontally at the bottom of the
treatment table where the clients feet will sit
3. Top massage sheet
4. Blanket or bath sheet for warmth
5. Pillow for the clients head
6. Bolster
4
5
54 3 2 11 2 3 4 5
1
5
4 3
34

1.
2.
3.
4.
5.
6.
7.
Antiseptic wipe such as a diaper wipe

Two hot, moist towels
Soda cooler
Massage cream
Dry hand towel
Aroma mist
Essential oils (optional)
Procedure
1. Cleanse the feet with a diaper wipe or cleanser and
hot towels.
2. Massage.
3. Remove the massage cream from the feet.
4. Clear the zones.
5. Reflex specific points associated with relaxation.
Step 3: Clear the Zones

Cover the entire plantar surface of the foot when you clear
the zones. Figure 105 shows 10 zones on the bottom of the
feet and the areas of the body to which they correspond. To
clear the zones, thumb walk each zone from the heel to the
top of the toe in that zone. It may take two to three passes
over a zone before you feel the tissue soften. When you feel
an area of particular tension, thumb walk it repeatedly until
it feels noticeably softer.
Step 4: Spinal Walk
Using Figure 106C, identify the spinal reflexes. They are
on the inside of both feet at the medial edge of zone 1.
Thumb walk from the heel to the base of the big toe. Turn
the hand over and support the plantar surface of the foot.
Thumb walk from the base of the big toe to the heel. Repeat the stimulation of the spinal reflexes until the tissue
softens.
5
43
2 1
1 23
5
4
FIGURE 105 The 10 zones.
Step 5: Thumb Walk the Toes

Support the foot with one hand and thumb walk the toes
with the other hand in a technique sometimes referred to as
biting the toes. Bite the big toe first making five passes down
the toe with 15 bites per pass. Repeat this process on each toe
until the little toe and make three passes down the little toe
with 10 bites per pass. To finish the toes, roll the knuckle of
a finger over each of the brain reflexes at the top of each toe.
Step 6: Pituitary Press
Hook and back up on the pituitary reflex point (Fig. 106A).
You might also hold this point for up to 2 minutes using direct
pressure on the point. If you wish to add aromatherapy to the
treatment place a drop of lemon, pine, or myrrh essential oils
(all reputed to balance the pituitary gland) on this point.
Step 7: Thumb Walk the Horizontal Lines
Using Figure 107, identify the horizontal lines on the
plantar surface of the foot. These lines include the shoulder line, diaphragm line, waist line, and pelvic line. Thumb
walk each line horizontally from zone 5 to zone 1 and then
again from zone 1 to zone 5. In a longer reflexology session,
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Chapter 10
the areas in between each line are also thumb walked in a

cross pattern so that the entire plantar surface of the foot
has again been stimulated and softened.
Step 8: Thyroid Press
Thumb walk the area associated with the thyroid point.
Hook and back up on the area at the base of the big toe
(Fig. 104H). You can also hold this point with direct pressure for up to 2 minutes. A dot of pine oil or seaweed essential
oil can be placed on this point after it has been stimulated.
Step 9: Adrenal Gland
Apply direct pressure for up to 2 minutes to the adrenal gland
reflex, which is located below the solar plexus, above the
kidney, and toward the medial side of the foot (Fig. 104I).
A drop of rose, pine, or rosemary essential oil can be placed on
this point after it has been stimulated.
Step 10: Thumb Walk the Lungs
Beginning at the diaphragm line in zone 5, thumb walk diagonally across the lung reflexes to the base of the big toe.
Next, thumb walk from the diaphragm line in zone 1 to the
base of the little toe. Thumb walk from the diaphragm line in
zone 4, diagonally across the lung reflexes to the base of the
Spa Foot Treatments
207
second toe. Thumb walk from the diaphragm line in zone 2

diagonally, across the lung reflexes to the base of the fourth
toe (Fig. 104J). The hand that is not thumb walking is always supporting the foot and holding it upright and open.
Step 11: Solar Plexus Hold and Transition to the
Other Foot
Take hold of the solar plexus point on both feet and take
three deep breaths together with the client. Cover the foot
you just finished and repeat the routine on the other foot.
At the end of the reflexology session, take hold of the solar
plexus point and ground the energy between both feet
before moving on to the next section of the treatment or
ending the session.
Designing a Reflexology Routine
By starting with steps 1 to 7 and then focusing on specific
points in a systematic manner, a reflexology routine can be
designed to suit most clients. For example, if a detoxification routine is indicated, steps 1 to 7 are completed and
then you thumb walk or use direct pressure on the kidney,
spleen, stomach, and colon points on the left foot and the
kidney, liver, gallbladder, and colon points on the right foot
Left bottom
Right bottom
Brain
Sinus, head,
and brain area
Brain
Sinus, head,
and brain area
Pituitary
Pineal
7th cervical
Throat/neck/thyroid
Eyes and ears
Lung
Breast
Liver
Influence on
the thyroid
and bronchials
Solar plexus
Eyes and ears
Lung
Breast
Heart
Diaphragm
Stomach
Adrenal glands
Spleen
Gallbladder
Pancreas
Waistline
Waistline
Bladder
Ileocecal
valve
and
appendix
Small intestines
Sacrum/coccyx
Sciatic
Transverse colon
Kidneys
Ascending
colon
Descending
colon
Sigmoid
colon
Sciatic
FIGURE 106 Overview of reflex points on the feet. (A) Reflexes on the bottom of the feet. (continued)
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208
Top right
Right inside
Influence on the
prostate and uterus
Influence on the
lymphatic system,
groin, and fallopian
tubes
Influence on the
lymphatic system,
groin, and fallopian
tubes
Influence on
the hip, knee,
and lower back
Uterus and
prostate reflex
Lymph drainage
lines and
influence on the
breast, chest,
and lung
Cervical
vertebrae
(C1C7)
Thoracic
vertebrae
(T1T12)
Lumbar
vertebrae
(L1L5)
Sacrum/
coccyx
Spinal reflexes
Right outside
Influence on
the sciatic
nerve
Influence on
the lymphatic system,
groin, and fallopian tubes
Ovary and
testicle reflex
Influence on
the hip, knee,
and lower back
Arm and shoulder
(Fig. 106A). Figure 108 shows some of the essential oils

that are believed to have an affinity for each point.
Treatment Products
Treatment products are sometimes applied as a mask to
the feet and lower legs to stimulate local circulation to
the skin of the leg and foot, to warm the feet, or to soften
FIGURE 106 (continued) (B) Reflexes on the top of the feet.

(C) Reflexes on the medial side of the feet.
(D) Reflexes on the lateral side of the feet.
the tissue. The physiological effect of the mask is different based on the type of product that you use. Table 103
provides an overview of different masking products you
might choose for a foot treatment. Before the treatment,
unless the treatment product is designed to be applied
cold, a sufficient amount is removed from its original
container and placed into a covered holding container,
which is kept warm in a suitable heater (a lotion warmer,
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4
Head
Chest
Abdominal
organs
Shoulder line
Diaphragm line
Waistline
Pelvic
area
Pelvic line
FIGURE 107 The horizontal lines on the

bottom of the feet.
a hot stone heating unit filled with warm water, a double

boiler, etc.).
A small amount of petroleum jelly or thick, waxy cream
is applied to the cuticle and nail, covering the gap between
the nail and the flesh on the tips of the toes completely. This
prevents the treatment product from entering that gap and
making the nail appear dirty or stained.
A piece of cellophane wrap or an open plastic bag is
placed under each foot before the treatment product is
applied (Fig. 109). This prevents messy treatment product
from getting on the treatment table. After the product has
been applied, the cellophane wrap or plastic bag is used
to cover the foot, keep the product moist, and prevent the
product from getting all over the place.
You can apply the treatment product with a gloved hand,
a brush, fabric, or gauze strip coated with product, or you
can dip the clients foot into the product. To apply the
product by hand, wear vinyl gloves, dip the fingers into the
warm product, and smooth it evenly over the entire foot.
If you choose to use a brush to apply the product, clean
each foot by lifting it by the metatarsal heads and covering
the heel with product first. Place the heel down on top of a
piece of cellophane into the opening of a plastic bag. Now,
cover the top of the foot with product and bring the cellophane or plastic bag up and around the foot to wrap it.
You might choose to dip gauze strips into the product
and wrap the coated strips around each foot. In this case,
the product must be thick enough to cling to the gauze and

not drip all over the floor and treatment table.
Sometimes, therapists dip a clients foot directly into
a container of product as might occur with paraffin. This
works best if the client is in a seated position so that the
product container can be held directly under the clients
foot. Dipping can also be used if the client is in a supine position but this can be a bit tricky. Bring the clients knee up
toward his or her chest and then place the leg down along
the side of the table, controlling the leg as you lower it so
that it doesnt bump into the table. Bring the product container up underneath the clients foot. If the client is not
very flexible, he or she may need to be moved to the edge of
the table so that the leg is not overstretched as it is dropped
over the side. All the shuffling from side to side feels a bit
ungraceful and does not allow the client to relax completely.
SANITATION
If the foot is dipped (e.g., for a paraffin dip),
it should be misted with alcohol before it is
dipped to prevent cross-contamination between clients.
Once the feet are covered in product, wrap them up

in cellophane or a plastic bag and slip them into thermal
booties (electric booties or microwavable booties) or warm
towels.
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Rosemary
Pine
Eucalyptus
Rose
Helichrysum
Lemon
Sweet fennel
Juniper berry
Thyme
Sandalwood
Sweet birch
FIGURE 108 Sample essential oils for the reflex points.
TABLE 103 Foot Treatment Products

PRODUCT
BASIC THERAPEUTIC PROPERTIES
Lightening serum
Lightening serums are used to decrease skin discoloration, decrease age spots, and smooth the skins surface. In
most states, they can only be used by an esthetician or cosmetologist. Lightening serums make an excellent retail
item for the gift shop.
Seaweed
Powdered seaweed can be mixed with a number of ingredients to make stimulating, detoxifying, and toning foot
masks. Massage oil, water, kaolin clay, aloe gel, lotion, and essential oils can all be mixed up with seaweed
powders.
Fitness gels
Fitness gels are usually sold for use on the body. They often contain menthol or Eucalyptus, which is pain relieving and refreshing. These products make revitalizing foot masks. The gels can be mixed up with kaolin clay to
give them additional weight and heaviness for use as a treatment product.
Clay
Clay powder can be mixed with a number of different ingredients to make foot masks. Gel seaweed, aloe gel, massage oil, water, lotion and ground herbs, yogurt, fruit juices, and essential oils can all be mixed with clay powders.
Moor mud
Moor mud is a thick, rich peat that is well known for its anti-inflammatory properties. It is a good choice for sore feet or
arthritis.
Dead Sea mud
Dead Sea mud is high in sulfur and is used for foot pain, inflammation, and arthritis.
Cryogenic products
Cryogenic or ice masks are cooling and pain reliving. They are revitalizing for sore, tired feet.
Paraffin and Parafango
Paraffin and Parafango masks are warming and soothing. They are often used for arthritis or to soften and smooth
the skin.
Essential oils
Essential oils can be mixed into a clay base to provide a wide range of different therapeutic effects in the feet. For
example, 6 drops of juniper berry essential oil can be mixed up with clay for a detoxifying mask. Two to 4 drops of
peppermint makes a revitalizing mask. Eight to 10 drops of German chamomile mixed with kaolin clay and hemp
seed massage oil make a good mask for foot puffiness.
Other
A variety of other professional masking products with different properties are available through spa suppliers.
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211
products based on your treatment concept (described in detail

in Chapter 15). For example, a treatment for athletes with
foot pain might finish with a medicated foot powder, whereas
a soothing treatment aimed at relaxation may use a lavender
lotion instead. Wipe the feet with a dry hand towel after they
have been moisturized to remove any excess product, especially if the spa has tiled floors. Excess product can cause a client
to slip and fall when he or she gets off the massage table.
A Sample Foot Treatment Procedure
FIGURE 109 Placing a piece of cellophane under the foot before

application of the treatment product.
The treatment described below shows just one way that

the different elements of a foot treatment might be organized into an enjoyable session. Change the order of steps
or the treatment elements to suit your treatment goals and
concept. For example, the massage step could come before
the application of the treatment product, as it does in this
sample, or after the application of the treatment product.
For a snapshot of this foot treatment, review Treatment
Overview 102 and Figure 1010.
Session Start
While the product is processing on the feet, cleanse, exfoliate, and massage the hands and then dip them in paraffin.
Massage the neck, shoulders, and face or treat the scalp to a
massage with conditioning product.
SANITATION
After working with the feet, wash and sanitize
your hands before touching any other part of
the body to minimize the spread of an undetected fungal
or bacterial infection.
There are two main ways to remove treatment product

in a dry room setting. You might resoak the feet by placing them into a fresh foot soaking container, or you can
remove the product with hot towels. With heavy mud and
thick seaweed, a second foot bath works well. With easy-toremove masks such as shea butter or light clay, hot towels
are quicker and easier. Take special care to wipe off the toenails (if you covered them in petroleum jelly before you applied the treatment product, cleaning the toenails is easier).
If you used heated booties to warm the treatment product,
make sure to remove them within 20 minutes, elevate the
feet on a pillow, and apply light flushing strokes to encourage fluid to move toward the heart. Otherwise, the limb may
feel swollen and heavy at the conclusion of the session.
With the client in a robe and seated in a comfortable chair,

soak the feet in a decorative container that is filled with
warm water and a soaking additive. A side table holds a
cup of warm herbal tea. Place a hand towel, a nailbrush,
cleansing product, disposable or washable slippers, and
an exfoliation product to the side of the chair within easy
reach. A pedicure seat and a foot rest are placed in front of
the foot soaking basin.
Step 1: Soak and Cleanse

Provide a neck and shoulder massage while the client soaks
his or her feet. After this, take one foot out of the soak and
place it on the foot rest. Apply a cleanser and gently scrub
the nails with a nailbrush. Put the first foot back in the foot
soak container and repeat this process with the second foot.
Step 2: Exfoliation
Take the first foot out of the soak and place it on the foot
rest. Apply an exfoliation product and scrub the foot. Rub a
callus file across rough areas of the heel to the tolerance of the
client if the laws of your state allow it. Callus files can feel too
ticklish for some clients. If the client is ticklish, simply skip
this step. Put the first foot back in the foot soak container and
repeat this process with the second foot. Alternatively, the foot
soak and exfoliation can take place on the treatment table.
Finishing Products
Step 3: Move the Client to the Treatment Table
Finish the foot service by applying a gel, light lotion, cooling

aroma foot mist, or foot powder to the feet. Choose finishing
Remove the clients feet from the soaking basin, place them
on a hand towel, and dry them. Slip the clients feet into
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A Sample Spa Foot Treatment
Indications
Relaxation; foot pain; sore, tired feet; low energy; stress
t
disposable or washable slippers and escort him or her to the

massage table. Cover the client (who is still in a robe) with
blankets for warmth. You need to ask the client to position
him- or herself with the feet at the very end of the massage
table because this makes reflexology easier to apply.
Contraindications
Pitted edema, broken bones or fractures, infections,
ingrown toenails, painful corns, gout, warts, athletes foot,
neuropathy, circulatory conditions

bottom to the top layer)
1. Massage sheet
2. Bath towel set horizontally at the bottom of the
massage table
5. Pillow for the clients head
6. Bolster
Supplies for the Foot Soak Setup

1. Comfortable chair for the client
2. Side table with a beverage such as hot herbal tea or
lemonade
3. Pedicure chair with foot rest for the therapist (optional)
4. Foot soak container placed on top of a hand towel
and filled with warm water and a soaking additive
5. Cleanser
6. Robe and slippers
7. Dry hand towel

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Exfoliation product
Massage cream
Diaper wipes
Petroleum jelly
Treatment product
Soda cooler
Hot, moist towels
Cellophane wrap or plastic bags
Thermal booties plugged in
Finishing product
Aroma mist
Paraffin dip plugged in
Essential oils (optional)
Procedure
Soak and cleanse the feet.
Exfoliate the feet.
Move the client to the treatment table.
Provide a foot massage.
Provide reflexology techniques.
Apply treatment product.
Massage hands and arms and dip in paraffin.
Remove the treatment product from the feet.
Apply a finishing product to the feet using flushing
strokes.
10. Remove the paraffin from the hands and apply
flushing strokes up the arms.
11. Provide an aura mist.
1.
2.
3.
4.
5.
6.
7.
8.
9.

Place a warm pack over the drape on the clients abdominal
area for warmth and an eye pillow over the eyes to eliminate excess light. Massage the feet and legs using a variety
of strokes or the routine described previously.
Step 5: Reflexology
Remove the lubricant from the clients feet with a diaper
wipe or hot, moist towels and apply reflexology techniques
to both feet. Stimulate specific reflexology points based on
the treatment goals for the session. Essential oils can be
dotted on specific reflex points to incorporate aromatherapy into the session.
Step 6: Application of a Treatment Product

Choose a treatment product based on a treatment concept
and/or to support the achievement of specific treatment
goals. For example, seaweed is a perfect choice if you want
to support increased vital body energy. Moor mud is a great
choice if the goal is to decrease foot pain or inflammation in
the feet. A treatment that aims to revitalize tired feet might
apply a tingly peppermint mask.
Apply petroleum jelly to the cuticle and nail and to the
space between the nail and the flesh of each toe. This prevents treatment product from lodging in this space and
making the toenails appear dirty at the end of the service.
Place a piece of cellophane under each foot before the treatment product is applied. Lift the first foot by holding onto the
ball of the foot with one hand. Apply treatment product to
the underside of the heel with a brush using the other hand.
After the heel is covered, place the foot back onto the cellophane. Cover the top of the foot with treatment product and
then bring the cellophane up and around the foot to wrap it.
Repeat this process on the second foot and slip the feet into
thermal booties to process for up to 15 minutes.
Step 7: Process
Decontaminate your hands and then massage the clients
arms and hands. Spritz the clients hands with alcohol, dip
them in paraffin, and wrap them in cellophane. Massage
the clients shoulders, neck, and face.
Step 8: Removal of the Treatment Product

Remove the clients feet from the thermal booties and
use the cellophane wrap to pull as much product off the
clients feet as possible. Remove the remaining product
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FIGURE 1010 A reflexology foot spa treatment. (A) Soaking, cleansing, and exfoliation in a foot basinseated.
(B) Foot massage and reflexology routine. (C) Application of treatment product. Cover the nail and the gap between
the nail and the flesh with petroleum jelly and then apply the treatment product to the foot. (D) Wrap the foot in cellophane wrap (or a plastic bag) and insert the feet into heated booties or warm towels. (E) Process. Massage the face or
treat the hands with an exfoliation, massage, and paraffin dip. (F) Removal of treatment product. Treatment product
can be removed with hot towels or in a second foot bath as shown here. Finish with a peppermint lotion, foot powder,
or foot gel.
with hot, moist towels or return the clients feet to a fresh

foot soaking basin. Pay special attention to the nails and
cuticle (which are covered in petroleum jelly). Wipe them
clean with a tissue or rinse them with water until they are
spotless. Apply flushing strokes to the legs, working from
the ankles to the thighs to encourage fluid movement and
prevent heaviness in the limb.
Session End
Use a lotion, gel, or powder as the finishing step of the foot
treatment, depending on your treatment concept and goals.
Remove the clients hands from the paraffin wrap and lightly massage the clients arms. Spritz an aromatherapy mist in
a high arch over the client to signal the end of the service.
10/24/13 1:32 AM
214
SPA FUSION
STUDY TIP: Pay Attention to Your Internal Clock
Each person has a time of day when he or she is at his
or her best. Some people jump out of bed refreshed,
whereas others struggle until they have consumed two
shots of espresso. Some people feel sleepy in the afternoon, and others cant sleep until well after midnight.
You can optimize your school performance by paying
attention to your internal clock. Whenever possible,
plan study sessions during periods when you are usually the most alert and awake. If you know you are a
night owl, then dont plan 9 a.m. study sessions. Instead, study at nighteven late at night. Early birds
do best when they study in the morning.
GOOD TO KNOW: Reflexology Certification

The ARCB is an independent testing agency. They
require students to take a hands-on reflexology course
of no less than 110 hours and complete 90 postgraduate
treatment sessions that have been properly documented
using ARCB forms. To obtain the certification, students
then have to take a 300-question test and a practical
exam. Find out more at http://www.arcb.net.
CHAPTER WRAP-UP
Foot treatments are a popular offering on spa menus
across the country. Although massage therapists cannot
perform nail care as would be expected in a pedicure,
they can mix and match treatment elements to design
enjoyable foot care services. When you design a foot
treatment, include a foot assessment step, soaking and
cleansing step, exfoliation step, treatment mask, massage,
and reflexology techniques. Other steps and techniques
can be added based on your training and interests. Have
fun with spa foot treatments by trying out a variety of
treatment products and mixing and matching elements
and enhancers. These are easy services to offer to family
members and friends for enjoyable spa practice sessions.
REVIEW QUESTIONS
2. The border of the nail is partly covered by a fold of

skin commonly called the
.
a. Cuticle
b. Callus
c. Plantar surface
d. Dorsal surface
3. A small area of thickened skin that is caused
by continued friction or pressure is called a
.
a. Cuticle
b. Callus
c. Plantar surface
d. Dorsal surface
4. An individual who is certified or licensed to provide
care of the nails, or to apply, repair or decorate gel
nails or acrylic nails is called a
.
a. Massage therapist
b. Esthetician
c. Hand and foot specialist
d. Nail technician
5. The arch of the foot refers to
.
a. Actually three strong arches (the medial longitudinal arch, the lateral longitudinal arch, and the
transverse arch) that give the foot the strength
to support the weight of the body.
b. Actually two strong arches (the longitudinal
arch and the transverse arch) that give the foot
the strength to support the weight of the body.
c. There is no true arch in the foot. Instead, the
foot is flat.
d. The ankle is sometimes referred to as the arch of
the foot.
Matching
Please place an X by those techniques that are out
of the scope of practice of a massage therapist. Place
an A by techniques that the massage therapist can
perform in a foot treatment.
6.
Multiple Choice
1. A
is a foot treatment in which the
cuticle is pushed back and trimmed, the nail is
trimmed, and the nail is filed.
a.
b.
c.
d.
Reflexology treatment
Foot massage
Pedicure
Manicure
7.
Polish is removed and the nail is trimmed

and shaped with an emery board.
Reflexology techniques
8.
The cuticle is pushed back and the excess is

trimmed.
9.
A treatment product such as seaweed, mud,

or paraffin is applied to the feet.
10.
The feet are soaked in a basin of warm water.
10/24/13 1:33 AM
11
Fangotherapy
Chapter Outline
K e y Te r m s
Fangotherapy in Europe
Fangotherapy in the United States
Types of Products Used in Fangotherapy
Clay: A variable group of fine-grained natural materials that is usually

plastic when moist and is mainly mineral in composition.
Emulsion: A mixture of two or more liquids in which one is present as
microscopic droplets distributed throughout the other.
Fango: The Italian word for mud; the term is used loosely to describe
products including mud, peat, and clay.
Moor mud: A low-moor peat from the Neydharting Moor in Austria that
is well known for its anti-inflammatory effects. It is regularly mined
and shipped to the United States for spa treatments.
Mud: Soft, wet earth that is mainly mineral in composition (derived from
rock) with some percentage of organic matter (matter derived from
plant breakdown).
Peat: Partially carbonized organic tissue formed by decomposition in
water of various plants but mainly mosses of the genus Sphagnum.
Sphagnum: A type of moss that grows only in wet acid areas where the
remains of the moss are compacted over time (sometimes with other
plants) to form peat.
Sulfur: A chemical element that is an important constituent of many
proteins and is often found in thermal pools and in some therapeutic
muds. Sulfur is believed to reduce oxidative stress on the body and is
used to treat arthritis, sore muscles, skin diseases, and other conditions.
Clay
Mud
Peat

Contraindicated Individuals
Broken or Inflamed Skin
Fango Temperature
Mixing and Storing Fango Products
Preventing Dry Out
The Full-Body Fango Cocoon

The Fango Back Treatment Procedure
Session Start
Step 1: Steam the Back with Hot, Moist Towels
Step 2: Cleanse the Back
Step 3: Exfoliate the Back
Step 4: Massage the Back
Step 5: Application of Warm Fango
Step 6: ProcessMassage the Legs and Feet
Step 7: Remove the Fango
Session End
The Fango Scalp and Neck Treatment Procedure

Session Start
Step 1: Steam the Head and Face
Step 2: Massage the Neck
Step 3: Massage the Scalp
Step 4: Application of Warm Fango to the Head
Step 5: ProcessMassage the Feet and the Hands
Step 6: Remove the Fango from the Hair
Step 7: Face Massage
Session End
Fango Applications for Musculoskeletal Injury and

Disorder
Acute Conditions
Subacute Conditions
Chronic Conditions
S
SPA
FUSION
STUDY TIP: Read and Learn
GOOD TO KNOW: The American Pain Society
CHAPTER WRAP-UP
215
10/24/13 1:36 AM
216
Fangotherapy is the use of mud, peat, and clay for healing

purposes (Fig. 111). The word fango is the Italian word
for mud, so, strictly speaking, peat and clay should not be
labeled as fango treatments. However, most spas use the
term fango loosely, so to avoid confusion, the more general
meaning of the word is adopted here.
regular and popular item on spa menus. This chapter aims to

briefly describe the classic use of fango, identify different type
of fango products, and build on the skills learned in previous
chapters. New treatments are described in step-by-step detail,
but services such as the full-body fango cocoon assume that the
reader has achieved proficiency with the treatments outlined in
earlier chapters. This chapter also introduces the use of fango
Each of these materials (mud, clay, and peat) has its own
special properties, but in general, they hold heat and are useful
as a thermal application for chronic conditions. They also
for the different stages of inflammation in the healing process.

Review the sample fangotherapy treatments at the back of this
book for inspiration when you design your spa menu.
stimulate local circulation to the skin, support the natural

detoxification mechanisms of the body, and help the body to
relax. Some types of fango have anti-inflammatory and painrelieving properties that make them useful for soft tissue
injury. The sensation of being covered in thick, warm mud is a
unique experience for clients, so services featuring fango are a
Fangotherapy
Fa
angotherapy in E
Europe
urope
Many early European spas originated around thermal
areas with mineral hot springs. The mud around these
hot springs was used for its therapeutic mineral content.
It was not uncommon for mineral springs to hold religious
FIGURE 111 Clay, mud, and peat. (A) Kaolin clay. (B) Sedona clay. (C) Dead Sea mud. (D) Marine mud. (E) Peat.
10/24/13 1:36 AM
Chapter 11
significance for the local people, so bathing in the springs

or using the mud from the area was believed to give healing
on both a spiritual and physical level.1 Over time, research
has shown that hot spring mud, and the microorganisms
that it contains, has healing properties that are valuable for
the treatment of a wide range of conditions.
As mentioned in Chapter 1, the Italian towns of Abano,
Montegrotto, Galzignano, and Battaglia are famous for
their thermal baths, which have a long history of use. Over
the centuries, people have come to the area for the healing
properties of the thermal fango called Euganean Hills mud
that is found at the spas. Today, more than 170 hotels with
spa facilities circle the 130 mineral springs. Traditionally, the
mud was used in its natural state, but now, it is matured
in special tanks to improve its therapeutic properties. The
maturation process developed by the Pietro dAbano Spa
Research Centre involves incubating the mud in Euganaean
mineral water for 50 to 60 days, allowing the nonpathogenic microorganisms present to multiply. The mud is used to
treat osteoarthritis, fibromyalgia, soft tissue injury, inflammation, and some skin conditions.
In Europe, fangotherapy usually takes place once or twice
a year at health spas under a doctors guidance. Although
the regime may vary from spa to spa, in many cases, the
patient fasts for 4 to 6 hours before a treatment. The treatment begins with mud applied to the body at a temperature
of around 104 to 115F (40 to 46C). Full-body applications are left on the body for 20 minutes, whereas spot
treatments are left in place for up to 30 minutes. After the
mud treatment, the client soaks in the mineral springs or
in the thermal waters of the region or takes a hot and cold
contrast shower. Sometimes, the client is wrapped in blankets to increase perspiration after the hydrotherapy soak.
The treatment ends with a massage and a long nap.
Fangotherapy
Fa
angotherapy in tthe
he Unit
United
ted St
SStates
tatte
es
There is evidence that every major U.S. hot spring (and
probably its associated mud) was used at some point by
an Indian tribe.1 The Native Americans considered a hot
spring as sacred, neutral ground. Warriors could rest by a
hot spring to heal a battle wound without worry that they
would be attacked by another tribe. The early European settlers recognized the healing benefits of these hot springs
and later developed them into commercial spas in the tradition of their homelands. Saratoga Springs in New York is an
example of this type of early American spa.
In the face of modern medicine, spa therapy declined in
the 1940s, and many of the European-inspired spa centers
closed. With their closure, some of the specific knowledge
about thermal waters and therapeutic mud at these locations was lost.1
The increasing focus on fitness and wellness has fueled
the reemergence of the spa industry and, with it, the use of
fango for healing. At the time of writing, fango treatments
Fangotherapy
217
are mainly used for skin care in the United States. This may
be because their therapeutic benefits have yet to be fully
understood or appreciated. Another factor may be that most
spa clients are familiar with the idea that fango improves the
texture of the skin but may be less clear about its benefits
for the musculoskeletal system and body. This is likely to
change as information spreads about the use of fango treatments for decreasing pain from chronic conditions such as
osteoarthritis or soft tissue injury, supporting detoxification, reducing stress, and relaxing the body.
Ty
Types
ypes of Products Used in
n
Fangotherapy
Fa
angotherapy
All types of fango have heat retention properties and can
be warmed up and applied to relax the body or decrease
muscular tension. Clay, mud, and peat have different therapeutic properties and uses. Clay is mainly mineral (derived
from rock) and is the most drawing and stimulating of
the fango substances. Mud is also predominantly mineral
but has small amounts of organic components that give
anti-inflammatory or analgesic properties. Peat is therapeutically the most active substance of the three because it is
mainly organic and derived from the breakdown of plant
material over thousands of years. A number of European
studies have concluded that peat is anti-inflammatory,
analgesic, a local circulatory stimulant, antiviral, immune
boosting, and endocrine balancing. Table 111 gives an
overview of fangotherapy substances.
Clay
Clay is a general term for a variable group of fine-grained
natural materials that are usually plastic when moist.
When viewed under an electron microscope, clay particles
are about 100 times longer than they are wide. If water is
added to dry clay, the moisture is held between the flat
plates by surface tension so that the particles do not pull
apart but, instead, slide easily over one another. This gives
moist clay its smooth and creamy consistency.
Many different types of clay are commercially available
from different soils and environments around the world.
Clays from marine sediments or from areas around hot
springs or geysers usually have a higher mineral content
than other clays, but all commercially available clay has the
same basic properties. First, clay holds heat, so it can be
warmed and used to decrease muscle tension and relax the
body. Second, clay is highly absorbent and is used to draw
impurities and moisture from the surface of the skin. This
drawing action simulates local circulation and purifies
the skin. Finally, clays readily suspend to form an emulsion
in water or other liquid substances. This property is useful in cosmetics because clay helps to hold other substances
together and prevent separation. Clay is regularly used as
an emollient and colorant in powders, liquid foundations,
10/24/13 1:36 AM
218
TABLE 111 Fangotherapy at a Glance

COMPOSITION CATEGORIES
MAIN TYPES
COMMERCIAL NAME
PROPERTIES
USES
Mainly mineral
Clay
Kaolinite
Illite
Smectite
Kaolin, China white

French green
Bentonite
Fullers earth
MAS
Thermal, relaxing, circulatory stimulant, absorbs excess oil and draws

out impurities, suspends to form
an emulsion to hold cosmetic substances together, acts as a carrier
for other therapeutic products
As a thermal agent to warm

and relax the body, as a
base for treatment products,
for esthetics
Cosmetic emulsions
Mud
Sulfur containing Dead Sea

and matured Euganaean
Piestany
Many others
Anti-inflammatory, circulatory stimulant, analgesic, antiseptic, immune

boosting, thermal, detoxifying,
relaxing, others
Arthritis, muscle pain or

soreness, joint pain,
inflammation, relaxation,
revitalization, esthetics, others
Low-moor peat
High-moor peat
Mosses and
other plants
Mainly mosses
Anti-inflammatory, circulatory stimuArthritis, muscle pain or

lant, antiviral, antiseptic, immune
soreness, joint pain,
boosting, endocrine balancing,
inflammation, relaxation,
thermal, detoxifying, relaxing, others
revitalization, esthetics, others
Mainly organic
Moor mud, many

others
Many European types
lotions, and skin masks. This characteristic also makes it

useful as a carrier product for other therapeutic substances.
Items such as seaweed, herbal infusions, essential oils, and
natural food products (yogurt, honey, milk, fruit juices, and
mashed fruits) can be mixed into clay to make interesting
treatment products.
The use of clay is often associated with the areas in which

it was mined. For example, Sedona clay is no more healing
than other clays, but its link to the majestic red rocks of
Arizona and to Native American healing traditions makes
it a popular choice with clients. Table 112 gives an overview of some popular and commercially available clay.
TABLE 112 Overview of Popular Clays

CLAY TYPE
COMMERCIAL NAME
ORIGINS
APPEARANCE OR TEXTURE
COMMENTS
Kaolinite: From the Chinese

word kauling meaning high
ridge, referring to the hill in
the Jiangxi Province of southeastern China from which the
clay was first obtained
Kaolin
China white
China clay
Southeastern China;
Malaysia; Cornwall;
England; and Georgia,
United States
Fine-grained consistency,
pure white color, smooth
and creamy when wet
A good choice for in-house

treatment products or as a
carrier for essential oils
Illite: These clays are mica-like

in structure and often originate
from recently deposited deepsea sediments; the most common clay found in nature.
French green
(French green clay
classically refers to
an illite clay that has
been mined in France
and sun dried.)
Illite clays are found all

over the world. The
title French green
clay does not always
mean the product
originated in France.
Extremely fine-grained,
pale in color, smooth and
creamy when wet
A good choice for in-house

treatment products but often
more expensive than kaolin
Smectite: Expanding lattice clays

that usually swell in water
Sedona clay
Sedona, Arizona:
Formed from ancient
ocean sediment and
volcanic activity
Fine to medium textured,

red in color, smooth to
slightly abrasive
A good choice for treatments

aimed at detoxification
or that contain a Native
American spiritual element
Wyoming bentonite
Often from Mississippi

and Alabama; associated with freshwater
sediments
Consistency can be lumpy,

gray or brownish in color
Because the consistency can

be lumpy, this is a good clay
to avoid unless it has been
processed commercially.
Sodium bentonite
Associated with marine

sediments and mined
in many areas of the
world
Gel-like in consistency and

gray or brownish in color
(may also be yellowish,
pinkish, or greenish)
Used to regulate the viscosity

in homemade skin care
products; kaolin and French
green clay are easier to use
as treatment products.
Fullers earth
England and other areas;

the clay gets its name
from fulling, the process of removing grease
from woolen cloth
When mixed with water, it

crumbles into mud and
has little natural plasticity, so it has a lumpy,
crumbly consistency.
Kaolin and French green

clay are a better alternative for in-house treatment
products.
10/24/13 1:36 AM
Chapter 11
Fangotherapy
219
TABLE 113 Creative Clay Mix-Upsa

NAME
RECIPE
PROPERTIES
USES
Juniper clay
Spot treatment: 4 drops of juniper berry essential oil and water to

the desired consistency
Full-body treatment: 8 drops of juniper berry, 10 drops of
grapefruit, and 2 drops of lemon oil with water to the desired
consistency
Stimulating, warming,
detoxifying, circulatory,
and lymphatic stimulant,
revitalizing
Foot mask for sore feet, fullbody fango cocoon for

detoxification, spot treatment for sore muscles
Coffee clay
Spot treatment: 1 shot of espresso and warm water or strong coffee

to the desired consistency
Full-body treatment: 3 shots of espresso and warm water or strong
coffee to the desired consistency.
Stimulating, firming, circulatory stimulant
Spot treatment for body

contouring or cellulite
Peppermint clay
Spot treatment: 36 drops of peppermint essential oil and warm

water to the desired consistency
Stimulating, cooling, revitalizing, analgesic, circulatory

and lymphatic stimulant
Foot mask for tired feet, spot

treatment for sore muscles,
spot treatment for cellulite
Rose petal clay

Lavender clay
Spot treatment: 1 tsp of dried and powdered rose petals or lavender, 1 drop of rose, or 4 drops of lavender essential oil, and
warm water to the desired consistency
Full-body treatment: 2 tbsp of dried and powdered rose petals or
lavender, 2 drops of rose or 8 drops of lavender essential oil, and
warm water to the desired consistency
Relaxing, soothing, calming,

softening
Foot or hand mask for a

gentle treatment, full-body
mask for a relaxation
treatment
Pain-away clay
Spot treatment: 2 drops sweet birch oil, 2 drops eucalyptus oil, 1

drop German chamomile, and hemp seed oil to desired consistency
(do not use water)
Full-body treatment: 6 drops sweet birch oil, 4 drops eucalyptus
oil, 2 drops German chamomile oil, and hemp seed oil to desired
consistency (do not use water)
Analgesic, circulatory
stimulant, antispasmodic,
anti-inflammatory
Application to a specific
joint, application to an
area of pain (back,
hamstring, etc.), spot
treatment for sore feet
Egyptian clay
Spot treatment: 2 drops frankincense, 2 drops myrrh, 1 drop rose,

and water to the desired consistency
Full-body treatment: 8 drops frankincense, 4 drops myrrh, 1 drop
of rose, 1 drop of geranium, and water to the desired consistency
Relaxing, softening, soothing,

calming
For a treatment inspired

by Egypt, for a full-body
fango cocoon aimed at
relaxation
Botanical clay
A variety of powdered herbs can be used and mixed with clay

powder. Add 2 tbsp of powdered herbs to every cup of clay.
Use an herbal infusion or tea to mix up the clay powder. For
example, a green tea and lemongrass make a nice botanical
combination.
The properties will be based

on the botanicals that are
used in the mix.
Foot or hand mask,

full-body detoxification
treatment, slimming
treatment
Sunny clay
One-half cup of powdered oatmeal is added to every cup of clay

powder and mixed with warm juice (apple, cranberry, pineapple,
or orange work well) to the desired consistency.
Refreshing, softening,
revitalizing
Foot or hand masks, fullbody cocoons aimed at

relaxation and revitalization
Natural food
items clay
Natural food items can be blended with clay and water to form
treatment products. For example, fresh pumpkin, fresh avocado,
fresh mango, or fresh papaya might be mixed with clay and
water in a blender to the desired consistency. Note: Blend the clay
as little as possible because it can lose some of its permeability
with overmixing.
Refreshing, relaxing,
softening, stimulating
Foot or hand treatment,

back treatment, hair
treatment, full-body
cocoon
a
Each of these products can be mixed into any type of clay base. The reader will notice that the exact amount of clay or liquid is not indicated. This is
because different clays hold water and mix up differently. The reader is advised to start with cup of clay for a spot treatment and 2 cups of clay for
a full-body treatment. More clay may be needed depending on the size of the client. The different liquids will be added until the desired consistency is
reached. Aim for a creamy texture that is not too runny. To powder a botanical ingredient, it is dried and placed in a coffee grinder.
Table 113 offers some easy clay recipes for in-house treatment products.
Mud
Although mud is mainly mineral in origin such as clay, it
contains 2% to 4% organic substances, which play an important role in its therapeutic use. Therapeutic mud is matured
or ripened in natural mineral water. The maturing process for each mud may be slightly different, but generally,
it involves the oxidation and reduction of the mud over a
period of up to 12 months. The process of maturing the
mud is characterized by changes in the chemical composition of the mud and changes in its appearance.2
A good example is the maturing process used at the
Piestany spa in Slovakia. The brown Piestany mud is matured
10/24/13 1:36 AM
220
to increase its sulfur content by curing the mud in outdoor storage units and exposing it to bacteria, which reduce
the sulfates present in the mud to sulfides. This changes the
muds color from brown to black.2 Up to 40,000 patients
come to the spa each year to receive its famous fango treatment for arthritis.3
Sulfur is perhaps the most important component in the
different kinds of therapeutic mud and occurs naturally in
the vicinity of volcanoes and hot springs. Sulfur baths have
been researched as a viable means of reducing oxidative
stress on the body and decreasing inflammation in muscles
and joints.4 Sulfur-rich mineral and mud baths are useful
in the treatment of osteoarthritis, rheumatoid arthritis,
and other inflammatory conditions. Individuals report
that they experience increased strength, decreased morning
stiffness, better walking ability, and decreased pain after a
course of sulfur mud treatment. Therapeutic mud is also
used successfully for bursitis, tendonitis, sprains, strains,
and other musculoskeletal injuries and disorders.
One of the most popular types of sulfur-containing
therapeutic mud is that obtained from the Dead Sea region
in Israel. The extremely saline water (27% salt) is 10 times
saltier than the Mediterranean Sea and has a high concentration of calcium, magnesium, sodium, potassium, and
bromine. Research on Dead Sea mud supports it use in the
treatment of arthritis,5 rheumatoid arthritis,6 skin problems, and respiratory diseases.7
FANGO BENEFITS FOR THE SKIN

Estheticians value fango applications for the reason
that clay, mud, and peat benefit the skin and improve
the skins texture. Because of its absorbent nature,
clay is the most popular choice for oily skin types. Clay
draws impurities out of the skin, stimulate local circulation, which aids in nutrient exchange, and retextures
the skin by supporting natural exfoliation. Clay can
also be softening, even for dry skin, so long as it is kept
moist while it is on the skin and not allowed to dry out.
Mud and peat soften the skins texture, and some
minerals may be absorbed from the mud into the
skin, although the evidence for this is unclear. Some
studies suggest that fango treatments help to normalize the pH of the skin, strengthen the barrier function
of the stratum corneum, decrease transdermal water
loss, and normalize sebum flow, making fango useful
for both dry and oily skin.10,11 After a full-body fango
application, clients will often notice the improved texture of their skin and its softness.
General
G
eneral Treatmen
Treatment
nt Considerations
Consid
derat
erratiio
on
o
ns
Peat
Sphagnum is the main genus of mosses that form a bog.
As the Sphagnum moss decays, the bog becomes filled with a
deeper and deeper layer of dead Sphagnum, which is known
as peat. The lack of oxygen in the bog and the acidic conditions created by Sphagnum slow the growth of microbes.
This is why human bodies unearthed from peat bogs thousands of years after burial are perfectly preserved. Because
the rate of decomposition is very slow, the minerals usually
recycled by living things remains in the peat.8 This is why
peat is therapeutically active and why gardeners use peat to
build up the fertility of soil.
Peat is usually broken down into two main commercial
categories: high-moor peat and low-moor peat. The basis for
this is unclear, and the two types are often so similar that
they are difficult to separate without information on their
geographical origin.9 Spas generally prefer to use low-moor
peat (a well-known lowland peat is Moor mud from the
Neydharting Moor in Austria) because it is thought to have a
broader range of therapeutic properties than high-moor peat.
This idea reflects the belief that compared to high-moor peat,
low-moor peat is composed of a wider range of plant species,
so it is likely to have a wider range of therapeutic properties.
However, research gives no clear evidence of a significant difference in the therapeutic benefits of the two types of peat.
For more on the benefits of fango, see Broaden Your
Understanding 111.
Before providing fango treatments, assess the contraindications for the treatment and pay attention to the special
storing, mixing, warming, and processing requirements for
fango.
Contraindicated Individuals
Clients with heart or circulatory conditions; who are pregnant; or have a fever, diabetic neuropathy, or neurological
disorders should not receive full-body hot fango treatments.
Spot applications on such individuals may be appropriate
for use, depending on the medical condition, the temperature of the fango (98 to 102F is recommended), the
length of the treatment, and the use of other products in
the service.
Broken or Inflamed Skin

The use of peat and mud is not advised on broken or
inflamed skin. Although peat and mud are regularly used
in Europe and by estheticians for skin care, broken skin is
prone to infection. Peat and mud is not necessarily checked
for harmful pathogens or held to any standardized quality requirements. Clay can be used with oily skin that has
minor blemishing, but severe acne, which might be located
on a clients back, should not be treated except by an esthetician or dermatologist.
10/24/13 1:36 AM
Chapter 11
Fango Temperature
Fango can be applied from room temperature up to 115F. It
is interesting to note that in Europe, the fango is applied at a
temperature of 104 to 115F even in situations where there is
acute inflammation. Despite the excellent results they achieve
in Europe, it is better to err on the side of caution and not use
hot temperatures for inflammation. Apply fango at room temperature or chilled to the area of injury and apply heated fango
to the rest of the body. Areas distal to the injury site should not
be treated with fango to prevent stagnation in the distal tissue. An overview of the use of fango for soft tissue injury and
inflammation with specific temperature recommendations is
given below. A metal probe-type thermometer or a latte thermometer can be used to check the temperature of the fango.
Mixing and Storing Fango Products

When using mud, clay, or peat, they should not be mixed or
stored in metal containers because they may react chemically with the metal. Clays can lose some of their permeability
if they are overprocessed or overmixed. It is recommended
that fango products are heated once only in a double boiler,
used shortly afterward, and the leftovers discarded.
Preventing Dry Out

Mud and peat are not commonly allowed to dry out on the
body. They are covered in plastic or with a hot, damp towel
during the treatment to keep them moist. This is because the
therapeutic properties of the mud are affected if the fango
dries out, and the microorganisms living in the fango are
killed. For certain purposes (e.g., to draw blood to the local
area of skin or oily skin on the back) clay can be allowed to dry
out slightly but not completely. Clay that is too dry is not good
for the skin because it can become irritated and dehydrated
as the clay pulls out its moisture and oils. Use a moisturizing
lotion after using clay products on any area of the body.
The
Th
he Full-Body Fang
Fango
go Coc
Cocoon
co
oon
on
n
A full-body fango cocoon is indicated for a wide range of
conditions, including low energy, low immunity, stress,
muscle tension and soreness, chronic soft tissue conditions
such as fibromyalgia, cellulite, and contouring treatments,
and to support the natural detoxification mechanisms of
the body. Full-body applications of mud, clay, or peat are
difficult to carry out in a dry room setting because product
removal is time-consuming, and the client may get cold and
impatient. Gel-based fango products are now available and
are easy to remove in a dry room, but the fango in these
products is significantly diluted. If a shower is not available,
a gel-based product or spot treatment is recommended.
In the full-body fango cocoon overview shown in
Treatment Overview 111, a foaming body wash product
Fangotherapy
221

The Full-Body Fango Cocoon Overview
Indications
Stress, muscle tension and soreness, chronic soft titissue
condition, relaxation, detoxification support, body contouring, revitalization
Contraindications
Heart or circulatory conditions, pregnancy, fever, diabetic
neuropathy or neurological disorders, recent soft tissue
injury, any condition contraindicated for massage

1. Blanket (wool or cotton) placed across the table
(horizontally) so that the long edges are at 90 degrees
to the table edges
2. Thermal space blanket placed horizontally (optional)
3. A plain flat sheet placed in a standard orientation with
its long edges parallel to the edge of the table (if the
fango needs to be removed in a dry room)
4. A plastic sheet placed horizontally
5. One bath towel placed horizontally at the top of the
table
the table
7. Drape
8. Bolster
A Fomentek might be used under the massage sheet if
additional warmth is needed.

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Dry brushes
Fango warming in a double boiler
Bowl of warm water
Foaming body wash product
Massage cream
Aroma mist
Soda cooler
Hot, moist towels
Dry hand towels
Disposable undergarments
Dry Room Procedure

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Dry brush the posterior body areas.

Apply fango to the posterior body areas.
Turn the client supine using the flip-over method.
Dry brush the anterior body areas.
Apply fango to the anterior body areas.
Cocoon for 2030 minutes. Massage the feet and/or
face while the fango is processing.
Unwrap.
Remove the fango from the clients body and remove
the plastic sheeting under the client.
Cleanse and then massage each anterior body
area.
Aroma mist.
10/24/13 1:36 AM
222
The Full-Body Fango Cocoon Overview

(continued)
The Fango Back Treatment Overview
11. Turn the client prone.

12. Cleanse and then massage each posterior body area.
Late subacute to chronic back pain, stiff muscles ffrom a

workout or overexertion, stress, chronic muscular holding
patterns, or for general relaxation
Procedure if a Shower Is Available

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Exfoliate or dry brush the posterior body areas.

Turn the client supine.
Exfoliate or dry brush the anterior body areas.
Apply fango using the sit-up method.
Cocoon for 2030 minutes. Massage the feet and/or
face while the fango is processing.
Unwrap the client and remove some of the fango by
hand (wear vinyl gloves for quick cleanup).
Move the client to the shower wrapped in the body
plastic.
Change the table to massage sheets while the client
showers.
Client returns to a clean massage table
Full-body massage.
Aroma mist.
is applied after the fango has been removed. The body

wash helps clean off any remaining traces of fango if a gelbased product was not used and no shower is available.
Step-by-step directions for a cocoon wrap are described in
Chapter 9 (Body Wraps). Notice that the outline in Treatment Overview 111 does not follow the directions in
Chapter 9 exactly. As with any service, treatment steps can
be mixed and matched, depending on the facility, products,
and the preferences of the individual therapist.
Th
The
he Fango Back Treatme
Treatment
en
nt
Procedure
Pr
rocedure
Fango back treatments are delivered by massage therapists
to decrease lower back or upper back pain, to release tense
muscles, for general relaxation, or for revitalization. You are
encouraged to include lots of massage in this treatment. Any
other treatment product could be used in place of the fango in
this outline, depending on your treatment goals. A snapshot
of this service is given in the fango back treatment overview
described in Treatment Overview 112 and in Figure 112.
Session Start
In option 1, the client begins the treatment in the prone
position. This requires the client to lie face down for
approximately 40 minutes, which can be too long for some,
especially those clients that are prone to respiratory congestion when in a face cradle. If this is a concern, use option 2
described in the overview.
Indications
Contraindications
This particular outline is contraindicated for acute inflammation. Fango is also contraindicated for broken skin,
severe back pain, or posterior leg pain from an undiagnosed cause or any condition contraindicated for
massage.

1.
2.
3.
4.
5.
Bottom massage sheet

Bath towel
Top massage sheet
Blanket or bath sheet for warmth
Bolster

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Cleanser
Exfoliation product
Bowl of warm water
Massage oil or cream
Fango warming in a double boiler
Plastic body wrap cut so that it will cover the back
Warm pack
Thermometer
Hot, moist towels
Soda cooler
Finishing product
Skin toner and cosmetic sponges
Aroma mist
Procedure Option 1
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Apply steamy towels to the back.

Cleanse the back.
Exfoliate the back.
Apply a skin toner to the back.
Massage the back.
Remove excess massage cream or oil.
Apply fango to the back and cover with plastic.
Drape the back and place a warm pack on top of
the drape so that it keeps the fango warm.
Massage the posterior legs (while the fango is in
process).
Remove the fango.
Apply a finishing product.
Massage the neck and shoulders.
Aroma mist.
Procedure Option 2
1. Massage the posterior legs.
2. Massage the back.
3. Cleanse the back.
10/24/13 1:36 AM
Chapter 11
4.
5.
6.
7.
8.
9.
10.
11.
12.
Exfoliate the back and skin tone.

Turn the client to the supine position.
Sit the client up and apply fango to the back.
Lay the piece of plastic body wrap across the top of
the massage table.
The client lies back onto the body wrap plastic.
Massage the neck, face, and feet while the fango is in
process.
Sit the client up and remove the fango with hot, moist
towels.
Apply a finishing product to the back.
Lie the client down and aroma mist to close the
session.
Fangotherapy
223
Step 1: Steam the Back with Hot, Moist Towels

Place two hot, moist towels on the back to steam the area
and warm the tissue. A professional steaming unit (the type
that is frequently used by estheticians in facials) can be used
if it is available. If a professional unit is used, steaming can
continue during the cleansing and exfoliation step because
it warms the tissue and feels good.
Step 2: Cleanse the Back

Apply warm water to the back with the hands and then
work a foaming cleanser into the skin with relaxing massage strokes.
FIGURE 112 The fango back treatment. (A) Steam the back. (B) Exfoliate and cleanse. (C) Massage the back.
(D) Apply the fango to the back. The product used in this picture is Moor mud (a peat). (E) Cover the fango with
plastic. (F) Process. Massage the posterior legs. (continued)
10/24/13 1:36 AM
224
FIGURE 112 (continued) (G) Remove the fango. Remove as much fango as possible with the plastic body cover.
Remove the remaining fango with hot towels. (H) Apply a finishing product to the back.
Step 3: Exfoliate the Back

Complete the cleansing step by using a small amount
of exfoliation product on the skin. Work it in circular motions over the top of the back with two handheld
loofahs or your bare hands. This feels stimulating and
invigorating, and it improves local circulation to the skin.
Remove both the exfoliation and cleansing products with
one hot, moist towel and apply a skin toner with cosmetic
sponges.
the needs of the client by offering a sports-oriented massage

with essential oils for sore muscles such as bay laurel or
sweet birch or a skin-firming massage with essential oils of
grapefruit and thyme.
Step 7: Remove the Fango

After 15 to 20 minutes, remove the fango with hot towels
and apply a skin toner with soothing massage strokes.
Most alcohol-free toners contain glycerine, which provides
enough lubrication for the application of massage strokes.

Massage the back with Swedish, deep tissue, or other massage techniques for 10 to 20 minutes, depending on the
time you have allotted for the session. Remove the massage
oil or cream with a hot towel and apply a toner to the skin
with cosmetic sponges.

Check the temperature of the fango with a metal probe
thermometer or a latte thermometer. It should be warmed
to between 100 to 110F. Apply a thick layer of warm
fango to the back with a brush or use massage strokes to
apply it with your hands while wearing vinyl gloves. Cover
the fango with a precut piece of plastic wrap sheet and
place an insulating blanket and warm pack (hydrocollator pack, rice, or flax seed microwavable pack, etc.) on top.
To view a video demonstration of product application, visit
thePoint.
Step 6: ProcessMassage the Legs and Feet

Massage the posterior legs and feet while the back processes
in the fango. The treatment can be further customized to

Choose a finishing product that matches your treatment
goals and apply it to the client. For example, a sore muscle
treatment might end with a tingly fitness gel that contains
pain-relieving camphor or peppermint. A general revitalization treatment might finish with a cream rich in citrus oils,
which boost immunity and firm the skin.
Session End
Turn the client into the supine position for a neck, shoulders, and face massage. Finish the service with an aroma
mist to fill the treatment room with a refreshing scent.
SANITATION
Some exfoliation mitts, textured cloths, and
gloves are meant to be washed in a washing
machine with hot water and dried in the dryer. If they cannot stand up to being washed, they should be disposed of
after use on the client or wrapped up in plastic and sent
home with the client.
10/24/13 1:36 AM
Chapter 11

The Fango Scalp and Neck Treatment Overview
Indications
Neck tension, face tension, stress reduction, relaxation,
ti
revitalization
Contraindications
Broken skin on the scalp, scalp condition, recent soft tissue
injury such as whiplash, severe headache pain or migraine,
illness, fever, or any condition contraindicated for massage

1. Bottom massage sheet
2. Plastic body wrap placed horizontally at the top end of
the massage table
5. Bolster
6. Hand towel rolled into a sausage to be placed under
the clients neck
7. Warm pack for the belly
8. Eye pillow for the eyes
9. Warm pack or microwave booties for the feet

1. Soda cooler
2. Hot, moist towels
3. Scalp oil in a bottle with a flip-top lid warming in a hot
water bath
4. Massage cream
5. Fango warming in a double boiler
6. Comb
7. Hair clip
8. Plastic hair cover or shower cap
9. Aroma mist
10. Essential oils (optional)
Fangotherapy
225
galea aponeurotica are firmly attached to each other. The

thin, sheetlike muscles of the scalp move the scalp, ears,
and eyebrows. The thin, small muscles of the face create
the movements that lead to facial expression. Every day,
these muscles get a workout, and tension in facial and
scalp muscles can play a significant role in tension headache pain or pathologies such as temporomandibular joint
syndrome (TMJ). The fango scalp and neck treatment is
indicated for neck tension, tension headache, face tension,
relaxation, stress reduction, and revitalization. This service
allows massage therapists to focus on an area that is often
touched on only briefly in a full-body massage. Although
fango is used in this treatment outline, seaweed or melted
shea butter can also be used with good results.
In this service, oil and fango are massaged through the hair
to the scalp. Obviously, this will mess up the clients hair, and
shampooing the hair is out of the scope of practice for massage
therapists in most states. To avoid scope of practice conflicts,
you have three main options: (1) The client can be passed on to
a cosmetologist who will finish the service by washing, cutting,
and/or styling the clients hair; (2) the client can wash and condition his or her own hair (provide high-quality professional
products) in a shower or tub; or (3) most of the fango can be
removed with hot, moist towels so that the client can go home
and wash his or her hair. In this case, the type of treatment
product you use is important. Most fango (or shea butter) will
not damage the hair or irritate the scalp if it is left on for an
extended period of time. Seaweed, on the other hand, may irritate the scalp, so it should be avoided in this instance. The scalp
and neck treatment overview in Treatment Overview 113 and
Figures 113 and 114 provide a snapshot of this service.
Procedure
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Comb out the hair if needed.

Steam the head and face.
Massage the neck.
Massage the scalp.
Apply fango to the scalp.
Massage the feet and/or the hands while the fango is
processing.
Remove the fango from the hair.
Massage the face.
Clip the hair up and cover it with a plastic shower cap
(optional).
Aroma mist.
Th
The
he Fango Scalp a
and
nd Ne
Neck
ec
ck
k
Treatment
Tr
reatment Procedure
Proced
dure
The scalp consists of five layers that include the skin, subcutaneous tissue, epicranius (including its aponeurosis,
the galea aponeurotica), loose connective tissue, and the
pericranium. The skin, the subcutaneous tissue, and the
FIGURE 113 Orientation of the plastic for the scalp, hair, and neck
treatment.
10/24/13 1:36 AM
226
FIGURE 114 The scalp, hair, and neck treatment. (A) Place a hot, moist towel over the hair.
(B) Steam the face. (C) Massage the neck. (D) Oil the hair. (E) Massage the scalp. (F) Application
of fango. The product used in this picture is a marine fango. (G) Face massage. The face massage
can take place while the fango is in process on the scalp, or it can be used as the final step in the
treatment.
10/24/13 1:36 AM
Chapter 11
Session Start
The client will need to remove his or her top and socks (for
foot massage) for this service. Clients often feel more comfortable if they leave on their underclothing but remove
their clothes. This prevents their clothing from getting
wrinkled or from bunching and restricting the clients
movement. The client is bolstered as he or she would be
for massage and covered with a top sheet and blanket for
warmth. A hand towel is rolled up and placed under the
neck to give support. Warm packs placed on the belly and
under the feet are soothing and comforting. If the clients
hair is tangled, it is helpful to comb it out gently before the
treatment starts.
To begin the service, place 1 drop of an essential oil in the
palm of your hands, rub them together briefly, and place
them in an arch over the clients nose with your hands about
1 inch above the highest point of the nose. Ask the client to
take a slow, relaxing breath. Essential oils that work well for
this type of inhalation include lemon, Spanish sage, peppermint, rosemary, common sage, or eucalyptus, although
any oil could be used.
Step 1: Steam the Head and Face

Remove a steamy towel from the soda cooler and place it
around the top of the clients head. Place a second towel
over the clients face. Allow the towels to steam the head
and face for approximately 1 minute. Remove the towels
and repeat this procedure with a second set of towels if
desired. It is nice to scent these towels with essential oils
or with herbs. If you scent the towels, use a different aroma
in the hand inhalation. You want the aromas to contrast
to increase the clients olfactory enjoyment as discussed in
Chapter 7 (Introduction to Aromatherapy for Spa).
Step 2: Massage the Neck

Remove the rolled hand towel supporting the clients neck
and provide a 10- to 15-minute neck massage using a full
range of strokes and techniques. Include the upper chest
area and arms if desired. Use a massage oil or cream but
think about the aroma. Again, you want it to work well with
the other aromas in the service.
Step 3: Massage the Scalp

Test the temperature of the scalp oil in a bottle with the
flip-top lid to ensure that it is not too hot. Part the clients
hair down the middle and pour warm oil down the parting from the hairline to the whorl of hair at the crown of
the head. The whorl is the place where the hair changes the
direction of its growth at the back of the head. Using soft
pressure, zigzag the oil into the scalp, working out from the
parting toward the sides of the head. Direct pressure and
gentle circular friction applied down the path of the parted
hair stimulates the scalp and helps to relax tight muscles.
Fangotherapy
227
From the centerline created by the parting, jump down 1

inch on one side of the head and create a new parting, flipping the excess hair over the other side of the head. Repeat
the oil and massage sequence. Jump down another inch and
create a new parting and then repeat the oil and massage sequence. Jump down another inch and create a third parting
and repeat the oil and massage sequence. The final parting
of the side of the head should start just above the ear. When
one side has been oiled and massaged, the entire process is
repeated on the other side of the head. This ensures that the
entire scalp has been covered in oil. You can now massage
the scalp with a variety of techniques for an additional 5 to
10 minutes. Be sure to include the ears in the massage because this is an area that can hold a great deal of tension. A
number of head massage techniques are shown in Chapter
14 under the Indian Head Massage section. At the end of
the massage, the hair is combed straight back from the forehead in preparation for the application of fango.

to the Head
Wearing vinyl gloves, apply warm fango from the hairline to
the back of the head. The hair is then twisted up and a hot,
moist towel is used to cover the fango and wrap around the
head. A second dry towel is placed over the top of the hot,
moist towel to insulate it.
Step 5: ProcessMassage the Feet

and Hands
The feet and hands can be massaged while the fango is processing on the scalp. You may also exfoliate the feet and
hands and dip them in paraffin. For shorter treatments,
massage the clients face while the fango is processing on
the scalp and then end the service by removing the fango
from the hair.
Step 6: Remove the Fango from the Hair

Remove the insulating towel and pull the hot, moist towel
from the hair, taking as much fango as possible with it.
A second and then a third hot, moist towel is placed over
the hair and used to gently remove fango from the head.
It is not possible to remove all of the fango or scalp oil
from the hair in this manner, so the hair is now twisted and
clipped up out of the way in anticipation of the final step of
the service, the face massage.

Massage the face using either a heavy face cream or a light
massage cream and then move on to the neck because both
the head and neck will have been immobile for some time
while the fango was processing. The face massage typically takes from 5 to 15 minutes, depending on the time
10/24/13 1:36 AM
228
available. Face massage techniques are described in Chapter 5 (Foundation Skills for Spa Treatment Delivery).
mation on these topics, therapists are referred to A Massage

Therapists Guide to Pathology by Ruth Werner,17 and Massage
for Orthopedic Conditions by Thomas Hendrickson.18
Session End
Spritz an aroma mist in a high arch over the client to end
the service and fill the treatment room with a refreshing
scent. The session can end in three different ways: (1) Pass
the client on to a cosmetologist for a shampoo, cut, and
style; (2) escort the client to a shower or soaking tub where
he or she can relax and shampoo hair; or (3) the client goes
home to wash his or her hair.
Fa
Fango
ango Applications for
Musculoskeletal
M
usculoskeletal Injury
In
njury and
nd Disorder
Diso
sord
order
er
Massage and fango treatments are a powerful combination
for the treatment of musculoskeletal injuries or conditions.
Although some believe that mud therapy is a purely thermal process and therefore similar to any topical application of hot or cold, research in Europe suggests otherwise.
In a study conducted in Italy, the level of hormone peptides from proopiomelanocortin, plasma beta-endorphin,
and some hormones of the pituitary-adrenal glands were
all decreased when mud pack treatments were used. The
decrease in the levels of these peptides and hormones led to
a reduction in the stress experienced by the patient, which,
in turn, supported the healing process. These effects began
after the first of 12 mud sessions and lasted for 30 days after
the treatments had finished.11
In osteoarthritis, proinflammatory cytokines and nitric
oxide play a role in progressive cartilage degradation and in
the secondary inflammation of the synovial membrane of the
affected joint. Mud pack treatment can positively affect the
chemical mediators of inflammation and decrease damage to
cartilage and the synovial membrane.1214 In Germany, a study
conducted at the Department of Natural Cure, Blankenstein
Hospital in Hattingen showed that peat components had
positive effects on both the endocrine and immune system.15
A study in France showed that vascular changes induced by
mud pack therapy are not fully explained by vasodilatation
in response to local temperature elevation. Although the
other mechanisms involved could not be determined, it was
concluded that mud packs could be successfully used to address vascular insufficiency in the lower limbs.16
The goal of this section is to encourage therapists to
explore the use of fango in treatments to reduce inflammation, decrease stress, increase range of motion, increase
circulation to the local tissue, and decrease adhesion formation and for conditions including soft tissue injury,
fibromyalgia, osteoarthritis, and rheumatoid arthritis. It is
assumed that a therapist using fango for such conditions
understands the principles of hydrotherapy, has a solid understanding of pathology, and has prior knowledge and experience working with these conditions. For further infor-
Acute Conditions
In Massage for Orthopedic Conditions, Hendrickson18 summarizes the causes of pain as mechanical, chemical, and
thermal. When abnormal tension is placed on soft tissue,
especially over a period of time, it leads to tissue damage and
inflammation, resulting in mechanical injury. Chemicals
that are released as mediators of inflammation irritate nerve
endings, leading to increased pain and muscle guarding.
This, in turn, causes hypertonic muscles and ischemia (low
oxygen), which increases the chemical toxicity of the tissue.
In an acute situation, where pain, loss of function, redness, heat, and swelling are present, you may be unable to
manipulate the soft tissue structures involved in the injury.
The general treatment goal is to reduce inflammation,
reduce pain, reduce sympathetic nervous system firing,
and maintain any available range of motion unless passive
movement is contraindicated as with bursitis. Often, you
will apply an ice pack and gently massage the other areas
of the body if the client can tolerate it. In some situations,
the client is only able to tolerate the lightest touch, so only
energy-work techniques are appropriate.
Mud or peat applications are ideal in this situation
because they are more relaxing for the client than ice
and because the mud may affect the chemical mediators
involved in the inflammatory process.13,14 The application
method is the same in most cases of inflammation including rheumatoid arthritis, bursitis, osteoarthritis flareups,
sprains, strains, tendonitis, tenosynovitis, and whiplash.
Fango is applied to the area at the beginning of the treatment at a temperature of 50 to 75F (10 to 24C).
A thermometer is used to monitor the temperature of the
product. Anti-inflammatory essential oils such as German
chamomile and helichrysum can be applied to the skin at a
10% concentration (60 drops of essential oil to every ounce
of carrier product) before applying the mud. Although this
may seem too high to American aromatherapists, this is
the concentration used in Europe for topical applications
and is very effective so long as the oils are not skin irritants.
Aromatherapy blends for inflammation are provided in
Table 114, whereas single essential oils for acute, subacute,
and chronic inflammation are described in Table 115.
The soft tissue structures in an acute injury are already
under extreme pressure due to the buildup of fluid in the
tissue. The fango cannot be slathered on the body area as it
would be in a normal treatment because the area will be sensitive. Instead, the fango is moistened with mineral water
until it has the consistency of a smooth paste. This paste
is spread on a cotton cloth or pillowcase in a half-inch to
1-inch layer (Fig. 115). The cloth is placed gently over the
affected body area with the mud facing toward the skin. It is
left in place for up to 30 minutes while associated areas are
10/24/13 1:36 AM
Chapter 11
TABLE 114 Sample Essential Oils for Stages of
229
TABLE 115 Sample Essential Oil Blends for
Inflammation
Stages of Inflammation
ACUTE TO EARLY
SUBACUTE
LATE SUBACUTE
CHRONIC
Sweet birch
Bay laurel
Bay laurel
Fangotherapy
White camphor
Sweet birch
Sweet birch
German chamomile
White camphora
White camphor
Cypress
Carrot seed
Clove
Fennel seed
Roman chamomile
Eucalyptus
Geranium
Eucalyptus
Fir needle
Grapefruit
Fir needle
Ginger
Helichrysum
Juniper berry
Juniper berry
Lavender
Lavender
Lavender
Lemon
Lemon
Sweet marjoram
Peppermint
Sweet marjoram
Peppermint
Myrrh
Peppermint
Scotch pine
Tea tree
Scotch pine
Rosemary
Wintergreen
Rosemary
Turmeric
Yarrow
Wintergreen
Wintergreen
ACUTE TO EARLY
SUBACUTE
LATE SUBACUTE
CHRONIC
Blends are at a 10%

concentration
Blends are at a 3%
concentration
Blends are at a 2.5%

concentration
Blend 1
2 oz of hemp seed oil
German chamomile
10 drops
Helichrysum 10 drops
Note: This blend will
smell strong and
be very expensive
to create but it is
highly effective.
Blend 1
Bay laurel 10 drops
White camphor 6 drops
Sweet birch 6 drops
Rosemary 5 drops
Lavender 11 drops
Blend 1
Atlas cedarwood
10 drops
Ginger 5 drops
Lemongrass 2 drops
Lavender 10 drops
Thyme 3 drops
Blend 2
Lavender 32 drops
German chamomile
9 drops
Helichrysum 9 drops
Grapefruit 30 drops
Sweet birch 9 drops
Blend 2
Sweet marjoram
11 drops
Turmeric 7 drops
Eucalyptus 6 drops
Roman chamomile
3 drops
Spike lavender
11 drops
Blend 2
Bay laurel 10 drops
Clove 2 drops
Lemon 12 drops
Fir needle 6 drops
a
Brown and yellow camphor contain high concentrations (up to 80%)
of safrol, which is toxic and carcinogenic. White camphor contains no
safrol and is considered nontoxic and non-irritant.
massaged (so long as the client can tolerate touch). Warm

fango (98F or 36C) can be applied to areas proximal to
the injury site for its relaxing and soothing effect and to dissipate muscle spasms. Note that warm mud should not be
applied to areas distal to the injury site due to the restricted blood flow in these tissues caused by the injury. Gently
remove the mud with warm water and sponges at the end
of the treatment.
FIGURE 115 Application of fango for an

acute or early subacute condition.
SANITATION
To clean the cotton cloth or pillowcase used for
the fango compress, rinse it in a bucket of hot,
soapy water until most of the fango is removed. They can
then be washed in the washing machine and dried with
heat. Fango must be cleaned up in such a way to prevent
damage to plumbing and equipment.
10/24/13 1:36 AM
230
Subacute Conditions
As the body progresses into the late phase of subacute
inflammation, fango can be applied directly to the body area
at warmer temperatures (98 to 104F) for 20 to 30 minutes
either before or after the massage (Fig. 116). Once applied, it is
covered with a moistened cloth and an insulating blanket. It is
important to use rhythmic joint mobilizations at the end of the
session to encourage collagen to reorient itself along the lines of
muscular stress. When an area is immobilized due to an injury,
there can be a significant increase in adhesion formation. Carrot seed essential oil is particularly useful with cross-fiber friction techniques for decreasing adhesions and scar tissue.
Chronic Conditions
In the chronic stages of inflammation, the treatment goal
is to lengthen and strengthen the tissue to prevent further
microtearing and irritation. Hot fango can also be used for
osteoarthritis that is not in a flareup, chronic plantar fasciitis,
thoracic outlet syndrome caused by middle scalene or pectoralis minor tension and torticollis. A variety of massage techniques including deep tissue, myofascial release, muscle energy
technique, post-isometric relaxation (PIR), active isolated
stretching (AIS), and many others can be used in combination
with fango applications, depending on the type of condition.
For chronic conditions, the ability of fango to hold heat is particularly effective. It can be applied directly to the area in a to 1-inch thick layer and left on for up to 30 minutes.
A full-body fango application is indicated for fibromyalgia and chronic fatigue syndrome but should only be given
with a doctors release or an advanced understanding of these
conditions. It is important to remember that a full-body
FIGURE 116 Application of fango for a subacute or chronic condition.
application may be contraindicated for weakened individuals. Follow the steps outlined in the cocoon procedure in
Chapter 9 (Body Wraps). If caution is required, the fango
should be applied at a temperature closer to body temperature (98 to 104F rather than 104 to 115F) and should
not be left so long (15 minutes rather than 20 minutes).
SPA FUSION
STUDY TIP: Read and Learn
A number of excellent resources for myofascial
and deep tissue work can help you to explore these
techniques in depth and then incorporate fango with
advanced treatment work into sessions to benefit soft
tissue conditions. Check out these books:
Travell and Simons: Myofascial Pain and

Dysfunction: The Trigger Point Manual. Media,
PA: Williams & Wilkins; 1901.
Barns: Myofascial Release: The Search for Excellence. Available at http://www.myofascialrelease.

com/store/books.asp. Accessed June 2008.
Schultz and Feitis: The Endless Web: Fascial

Anatomy and Physical Reality. Berkeley, CA:
North Atlantic Books; 1996.
Myers: Anatomy Trains: Myofascial Meridians

for Manual and Movement Therapists. New York,
NY: Churchill Livingstone; 2002.
Juhan: Jobs Body: A Handbook for Bodywork.
New York, NY: Station Hill/Barrytown; 1989.
Riggs: Deep Tissue Massage: A Visual Guide to Techniques. Berkeley, CA: North Atlantic Books; 2002.
GOOD TO KNOW: The American Pain Society

The American Pain Society (http://www.american
painsociety.org) and the American Pain Foundation
(http://www.painfoundation.org) are two national
organizations that conduct research on pain and
seek to improve the quality of life for people living
with pain. Their websites contain research, the latest
10/24/13 1:36 AM
Chapter 11
Fangotherapy
231
SPA FUSION
interventions for pain management, and other
resources that you or your future clients may find
useful. As you work with fango, you are encouraged
to move beyond the applications for relaxation and
beauty into sessions that support pain management
treatment goals.
CHAPTER WRAP-UP
Fangotherapy is the use of mud, peat, and clay for
healing purposes. Although fango treatments are
mainly used for skin care in the United States, massage therapists will find fango useful for spa treatments aimed at the reduction of soft tissue pain and
dysfunction and to relax and revitalize the body.
The therapeutic substances used in fango spa
treatments have different characteristics that affect
their therapeutic properties and uses. Clay, which is
mainly mineral (derived from rock), is the most absorbent of the fango substances. It is used to pull impurities from the skin and to stimulate circulation. Mud
is also predominantly mineral but has small amounts
of organic components that give it a wider range of
properties. A mud may be anti-inflammatory, antiviral, and immune boosting. Peat is therapeutically the
most active substance of the three because it is mainly
organic and derived from the breakdown of plant
material over thousands of years.
REVIEW QUESTIONS
Multiple Choice
1.
3. When a mud is matured, it is:

a. Processed to develop nonpathogenic microorganisms that make the mud more therapeutic
b. Aged to make the mud smell more pleasing
c. Dried or dehydrated to kill any pathogenic
microorganisms
d. Mixed with fresh plants to increase the range of
chemicals
4. In Europe, fangotherapy is regularly used in the
treatment of:
a.
b.
c.
d.
Cancer
AIDS
Arthritis
Meningitis
5. Therapeutic peat falls into two main commercial

categories. These are:
a.
b.
c.
d.
Mainly black and mainly brown

Mainly mineral and mainly organic
High moor or Dead Sea
High moor or low moor
6. In Europe, fango is applied to the body at this

temperature, even in cases of acute inflammation.
a.
b.
c.
d.
56 to 66F
24 to 32F
78 to 89F
104 to 115F
Fill in the Blank
is a component of therapeutic mud,

especially those that are obtained in the vicinity of
volcanoes and hot springs.
7. Full-body fango applications can last between

and
minutes.
a.
b.
c.
d.
8. When viewed under electron microscope, clay

particles are about
times longer than
they are
.
Mucilage
Fango
Sea salt
Sulfur
2. Fango is the Italian word for

a.
b.
c.
d.
Seaweed
A body wrap
Relaxation by a mineral spring
Mud
9. Kaolinite clay is generally

was first mined in China.
in color and
10. At the Piestany spa in Slovakia, the mud turns

from brown to black when it is
.
10/24/13 1:37 AM
12
Thalassotherapy
Chapter Outline
K e y Te r m s
A Brief History of Thalassotherapy

The Therapeutic Benefits of Seaweed for the Body
Algae: Algae occur in all marine and terrestrial ecosystems of the world
wherever there is water. The words algae and seaweed are often used
interchangeably, which causes some confusion. Seaweeds are algae
that have a particular growth form, but the term algae also includes a
wide range of other terrestrial and aquatic organisms with different
evolutionary histories.
Alginate: A substance found in seaweed that has therapeutic properties
for skin and body and is often used as a thickening agent in cosmetic
preparations.
Galvanic current machine: A machine that is used by estheticians in a
facial treatment. It has two different uses depending on the polarity
of the current that is used. When the working electrode is the negative pole, it is used with a disincrustation solution to soften blocked
sebum in pores. When it is set on the opposite polarity (positive pole is
the working electrode), it is used to soothe the skin and encourage the
absorption of a water-soluble treatment product.
High-frequency machine: Machine that generates a rapidly oscillating
electrical current that is transmitted through glass electrodes. The
current produces heat in the skin, which stimulates circulation. It also
produces ozone, which acts as a germicide to kill bacteria.
Minerals: Naturally occurring substances that play a crucial role in the
bodys metabolic processes. They are required by the body to function
properly.
Mucilage: A gelatinous substance found in plants and animals that is
extracted for cosmetic purposes from plants such as seaweeds. It is
composed of protein and polysaccharides and is used to give cosmetics
a creamy substance and to moisturize and protect the skin.
Polysaccharides: A class of long-chain sugars composed of monosaccharides that are often used in skin care as antioxidants and water-binding
agents.
Seaweed: Multicellular, marine-based algae that fall into one of three
main groups: the green algae (Chlorophycota), brown algae (Phaeophycota), and red algae (Rhodophyta).
Silicone: One of the elements present in seaweed that binds water to the
skin and gives a silky feel when added to cosmetics.
Thalassotherapy: The use of marine environments and sea products,
including seawater, sea mud, seaweed, and seafood, for healing and
wellness.
Contraindications
Sensitive Skin
Product Form and Application Considerations
Seaweed Odor
The Slimming Seaweed Cocoon Procedure

Session Start
Step 1: Exfoliation of the Posterior Body
Step 2: Application of a Cellulite Cream to Target
Areas of the Posterior Body
Step 3: Exfoliation and Cellulite Cream Application on
the Anterior Body
Step 4: Application of Seaweed
Step 5: Cocoon
Step 6: ProcessMassage the Face and/or the Feet
Step 7: Unwrap
Step 8: Application of Firming Products
Session End
The Seaweed Breast Treatment

Other Seaweed Treatments
SSPA FUSION
STUDY TIP: Quiz It!
SPA INSPIRATION: Dance Massage
CHAPTER WRAP-UP
232
10/24/13 2:18 AM
Chapter 12 Thalassotherapy
Thalassotherapy is the use of marine environments and

sea products, particularly seaweed, for healing and wellness.
Joseph Conrad wrote, The true peace of God begins a
thousand miles from the nearest land. In that single line,
Conrad captured the magical, indescribable quality of
the sea. The mystique of the sea may be one reason that
treatments featuring seaweed are held in such high regard
by spa clients. It is probable that the reliable results achieved
by the use of seaweed in slimming treatments, revitalization
treatments, esthetics, and relaxation treatments are the
other reason for its popularity.
Seaweeds are multicellular, marine-based algae that may
fall into one of three groups: green seaweed (Chlorophycota),
brown seaweed (Phaeophycota), and red seaweed (Rhodophyta).
Brown and red seaweeds are the most common types of
seaweed used in cosmetic products or for spa treatments,
although all seaweeds have some therapeutic value due to their
high mineral content. Many seaweeds also have interesting
forms of antimicrobial and other biological activity.
This chapter aims to give a brief history of thalas-
233
was coined by Dr. de la Bonnardire. In 1960, the French

Medical Academy officially defined thalassotherapy: Thalassotherapie uses seawater, seaweed, sea mud or other sea
resources and/or the marine climate for the purpose of
medical treatment or treatment with a medicinal effect. In
France, thalassotherapy is covered by medical insurance as
a standard treatment for sore throats, digestive problems,
arthritis, musculoskeletal injury, respiratory ailments, developmental disorders in children, endocrine imbalances,
and skin conditions.
Therapeutic techniques in French thalassotherapy include the following:
Hydrotherapy using seawater

Argotherapy, which uses seaweed packs on the body
Fangotherapy, which uses sea mud packs on the body
Eliotherapy, the inhalation of aerosol-sized particles of
seawater
Kinesitherapy, which consists of floating in a relaxation
pool filled with seawater
Aquagym therapy, which is exercise in seawater
Sea diets, which are diets rich in seaweeds and seafood
In the United States, thalassotherapy is most often used
to firm, moisturize, and condition the skin. The American
spa-going public may be familiar with the general benefits
of seaweed for the skin but may not as yet be exposed to the
benefits of seaweed for full-body wellness, revitalization,
detoxification, and as an energy booster. As with fango, this
is likely to change as spa menus continue to expand and
substances once valued primarily in esthetics are accepted
for their full range of therapeutic properties.
sotherapy, to review the relevant research on the benefits of

seaweed for the body, and to describe the use of seaweed in
combination with other products such as cellulite creams.
The Therapeutic Benefitss o

off
Seaweed for the Body
A slimming seaweed cocoon is described in step-by-step

detail, whereas a seaweed breast treatment is demonstrated
with a treatment outline. You are encouraged to use seaweed
as the treatment product in many of the other services
described in this book. Review the sample treatments at
the back of the book for inspiration. For an overview of the
types of seaweed that are used in thalassotherapy, see Table
121. To learn about a form of algae that is not a seaweed
(Spirulina), see Broaden Your Understanding 121.
A Brief History of Thalassotherapy

The French recognized the therapeutic benefits of sea
bathing in the early 1800s, and by 1824, they had set up
facilities to warm seawater for treatments. In 1869, the
term thalassotherapy (thalassa is the Greek word for sea)
The different forms of thalassotherapy may be effective

because seaweed and seawater contain significant concentrations of minerals, and seaweeds contain many useful
bioactive compounds that are absorbed by the skin. It is
helpful for the therapists to have a general understanding
of the physiological actions of the main species of seaweed
before they design thalassotherapy treatments. Empirical
evidence, clinical studies, and research suggest that seaweed treatments can be used to support endocrine balance,
support detoxification, support the elimination of excess
fluid in body tissue, decrease the symptoms of fibromyalgia, decrease muscular pain, stimulate local circulation to
the skin, boost general immunity, give an energy boost, and
facilitate relaxation and the decrease of stress.
The studies on seaweed show that it contains large
amounts of polysaccharides, which have a wide range of
biological activities, including antithrombotic, anticoagulant, anticancer, and antiviral effects.1 The minerals that
seaweeds accumulate from seawater account for up to 36%
of their dry weight. Seaweeds have high concentrations of
10/24/13 2:18 AM
234
TABLE 121 Algae at a Glance

TYPES
Green (Chlorophycota)
7,000 species
800 of these are seaweeds
BOTANICAL
COMMON
PROPERTIES
INDICATIONS
CAUTIONS
Ulva lactuca
Sea lettuce
Antiviral, high
vitamin C content,
anti-inflammatory,
demulcent
Inflammation, muscle
soreness or pain,
fibromyalgia, stress,
low energy, low
immunity, others
Skin irritation possible

but unlikely
Iodine or shellfish
allergies
Evernia prunastri
(lichen)
Oakmoss
Antiseptic, demulcent
Most often used as an

absolute for base note
in fragrances
612 drops maximum

for a full-body
treatment
Blue-green (Cyanophycota or
Cyanobacteria)
Not seaweeds
Spirulina maxima
Spirulina platensis
Spirulina
Anti-inflammatory,
stimulating, skin
firming, moisturizing
Detoxification treatments,
slimming treatments,
low energy, stress,
others
None
Brown (Phaeophycota)
3,000 species
Most are seaweeds
Laminaria spp.
Sargassum spp.
Fucus spp.
Ascophyllum spp.
Kelps
Wracks
Wound healing, hair

growth, stimulates
metabolism detoxifying, aids cellular
exchanges, revitalizing, stimulates
circulation and
lymphatic flow, heats
the body
Detoxification treatments;
slimming treatments;
muscle pain or tension;
low energy; stress;
burnout; dry, rough,
dull, saggy, dehydrated
or congested skin
There is some concern

that full-body
treatments using
brown algae will
overstimulate the
thyroid or affect thyroid
medications
Iodine allergies
Red (Rhodophyta)
8,000 species
Most are seaweeds
Chondrus crispus
Gelidium amansii
Carrageen
Agar-agar
(also known
as Japanese
isinglass)
Anti-inflammatory,
circulatory stimulant,
demulcent, stabilizer
used in cosmetic
emulsions
Detoxification treatments;
low energy; stress;
slimming treatments; for
dry, rough, dehydrated,
or irritated skin
Skin irritation possible

but unlikely
Iodine or shellfish
allergies
vitamins A, B1, B2, B3, B5, B12, C, D, E, and K. They also contain polyphenols and carotenoids, which play a role in protecting the body from oxidative stress.
A polysaccharide compound, isolated in 1994 from Ulva,
a green marine algae, has significant antiviral activity, reducing replication rates of some strains of human and
avian influenza viruses.2 In Scottish folk medicine, the thin
mucilaginous nature of Ulva fronds made it useful as a cold
compress for nosebleeds, migraines, burns, sores, and cuts.
SPIRULINA
Spirulina is a blue-green alga (Cyanophycota or
Cyanobacteria) that is not a seaweed but is notable
for its use as an agent to firm and moisturize the skin.
It also has a wide range of biological activity with actions including anti-cancer,5,9,14 immunostimulating,6,9,14
antidiabetic,7,9,15 anti-inflammatory,8,9,11 antioxidant,8
membrane-stabilizing,8 antiatherogenic,13 anti-allergy,9,11
blood vesselrelaxing,16 antiviral,14 antiarthritic,12 blood
lipidlowering,17 and antianemic9 effects. It has been
used to treat chronic hepatitis8 and herpes simplex
virus type 2.12
Research showing that Ulva produces a biologically active

steroid (3-O-beta-D glucopyranosyl-stigmasta-5, 25-diene)
that reduces edema when applied topically supports this
traditional use.3
Brown seaweed, such as Laminaria, Sargassum, Fucus, and
Ascophyllum species, stimulates metabolism, raises body
temperature, and affects cell membrane transport, facilitating detoxification and contains iodine, which influences
thyroid activity.18 Brown seaweeds also contain alginate, a
jelly-like carbohydrate used for its water-holding, gelling,
emulsifying, and stabilizing properties. Alginate dressings
are used on epidermal and dermal wounds to give a moist
environment that leads to rapid granulation and healing.19
Alginate has also been used as a medium for transdermal
drug delivery systems20 and to regulate abnormal collagen
metabolism.21
Species of another seaweed genus, Sargassum spp. (known
as hai zao in Chinese), have been used in traditional Chinese
medicine since the eighth century AD. In Chinese medicine,
it is mainly used for the treatment of goiter due to its action
on the thyroid, which helps to regulate metabolism. Other
uses include the treatment of edema, other thyroid disorders, and pain from inflammation. Herbalists use Sargassum
to promote weight loss, but long-term use is avoided due to
its action on the thyroid. The literature suggests that Sargassum has a mild diuretic effect, is effective against herpes simplex type 1 and 2,22 can be used as a topical antifungal,23 has
10/24/13 2:18 AM
liver-protecting capabilities,24 and contains antioxidants

that protect the body from damage caused by free radicals,
so it can slow the aging process.25 To learn about the beneficial effects seaweed can have on the skin, see Broaden Your
Understanding 122.
235
products for clients with sensitive skin, and how the odor
of seaweed may affect your business. Because a slimming
treatment is described in this chapter, some notes on
cellulite and cellulite products are also included here.
Contraindications

Before offering thalassotherapy treatments, it is important
to understand the contraindications to seaweed, the different forms of seaweed products, how to dilute seaweed
People with vascular problems such as high or low blood

pressure, who are pregnant, or who have a fever should
only be given this treatment if first approved by their physician. Seaweed tends to have an aggressive effect that accelerate detoxification, which increases the load on the
THE BENEFITS OF SEAWEED FOR THE SKIN

France is the largest market for seaweed used in cosmetics with an estimated 5,000 tons of wet seaweed being
harvested and processed annually to meet the demand.26 The vitamins, minerals, amino acids, sugars, lipids,
and other components of seaweeds, such as alginic
acid, silicone, alginates, agar-agar proteins, cellulose,
mucilage, and fucosterol, make them useful for a variety
of cosmetic products. For example, seaweed extracts react
with skin proteins to form a protective gel on the skins surface that reduces moisture loss.27 Seaweed also appears
to promote local vasodilatation and increased circulation
of blood and lymph flow. This may be the basis for the
widespread use of seaweeds to treat cellulite. Seaweed
cleanses, purifies, tones, firms, softens, and hydrates the
skin. It is recommended for most types of skin due to its balancing and soothing effects. It is used in acne treatments
for its antibiotic and anti-inflammatory properties. It can
also be used on clients with dry skin to retain moisture,
stimulate circulation, and promote nutrient exchange.
When used on mature skin, its firming and toning action
has a positive effect on the appearance of fine lines and
wrinkles. Zinc, a mineral found in most seaweed, acts as a
biocatalyst. It is useful for stabilizing the skin by balancing
glandular secretions. Commercially, zinc creams are used
to treat acne, to give protection against exposure to the
sun, and to regulate the sebaceous glands.
There is a large amount of research on the uses of seaweed for skin treatment. For example, crinitol, an acyclic
diterpene alcohol found in Sargassum tortile, a brown marine alga, is effective against gram-positive bacteria including Propionibacterium acnes, the bacterium associated
with inflammatory acne.28 Interestingly, the activity of crinitol
was shown to increase in the presence of antioxidants.
In a study conducted in Japan and published in the
Journal of Cosmetic Science, 29 Fucus vesiculosus extract
(1% in a gel) applied topically to one cheek twice daily for

5 weeks decreased skin thickness and increased skin elasticity. With age, cheek skin usually increases in thickness and
its elasticity decreases, leading to wrinkles and sagging skin.
Extracts of Fucus vesiculosus also aid the wound contraction and the granulation process30 and show in vitro antibiotic activity against Staphylococcus aureus, Pseudomonas
aeruginosa, and Escherichia coli.31 An absolute (alcoholic
extract) of Fucus vesiculosus, a brown marine alga, can be
obtained commercially from some aromatherapy suppliers
and mixed into creams and lotions by the therapist.
Ascophyllum nodosum, another species of brown
seaweed, contains large amounts of fucoidan, a sugar
(alpha-L-fucose) based polysaccharide that retains
moisture and has immunostimulating, anticoagulating,
and anti-aging activity.3235 Two separate French studies
published in Biomedical Pharmacotherapy show that
fucose and fucose-rich polysaccharides penetrate the
skin, decrease free radical scavenging, and increase the
cell proliferation to slow down the aging of skin cells.34,35
French women traditionally used Ascophyllum nodosum
extracts to increase hair growth and soften rough and
damaged skin.36
Red seaweed such as carrageen extracted from
Irish moss (Chondrus crispus) and agar-agar (Gelidium
amansii; note: agar-agar is derived from the Malaysian
word for seaweed) are good emulsifiers, balancers, and
lubricants.37 A study conducted by the Este Lauder
company showed that sulfated polysaccharides from
red micro-algae have anti-inflammatory properties when
applied topically to the skin.38 The anti-inflammatory
effects of red seaweed are recorded folk remedies from
Ireland to Malaysia. For example, the Celts used Irish moss
for sore throats and to soothe chapped skin, whereas
Malaysians used agar-agar for burns and skin irritation.
10/24/13 2:18 AM
236
cardiovascular system and may cause complications in

weakened individuals.
Brown seaweeds have high concentrations of iodine
and may overstimulate the thyroid gland. In a healthy
person, this usually results in a feeling of increased energy and well-being at the end of the treatment. For those
with thyroid disorders or who are taking thyroid medications, a full-body treatment may throw the body out of
balance. Until more research is available, it is best to err
on the side of caution and avoid giving full-body brown
seaweed treatments to clients with thyroid disorders.
Choose green or red seaweed treatments instead or only
apply the seaweed to one area of the body as in a seaweed
back treatment.
When taking the clients health history, it is important
to check for shellfish or iodine allergies. If a client is allergic
to either shellfish or iodine, he or she should not receive
a seaweed treatment as a dangerous allergic reaction could
result.
Sensitive Skin
In a seaweed cocoon, the trapped heat from the body
causes perspiration and may make sensitive skin more susceptible to irritation. If the skin type of the client is fair or
prone to sensitivity, choose a green or red seaweed product
and avoid using brown seaweed. Alternatively, use a gentler aloe gel-based product because it is milder in action
than powdered seaweed. Seaweed products can also be diluted by adding kaolin clay or a fixed oil such as sunflower
or sweet almond to the mix. Many premixed products
cause irritation because poor quality essential oils have
been added to improve the smell of the seaweed product.
To avoid this problem, buy unscented products that are as
pure as possible and add therapeutic-grade essential oils
to scent them if desired. If skin irritation occurs during a

seaweed treatment, remove the seaweed product with cool
towels and apply a fixed oil such as sunflower to the body
in a heavy layer. Do not massage the oil in but, instead,
remove the excess oil with more cool towels. If a shower
is available, the client should rinse in cool water until the
irritation subsides.
You may want to protect your hands from strong
seaweeds, cellulite creams, and firming creams by wearing
vinyl gloves while applying these products. Your hands may
become overexposed to such products during the course of
a day at the spa so they are prone to sensitivity and even
contact dermatitis.
Product Form and Application Considerations

Cosmetic products containing seaweed take many forms.
The seaweed may have been dried and powdered, blended as
an extract into a lotion or gel base, dried and mixed with sea
salts for hydro soaks, extracted for use in body mists and
facial toners, or mixed with paraffin for easy removal. Absolutes (solvent extracts) of Sargassum, Fucus, and Laminaria
species can be purchased from some aromatherapy suppliers
and added to creams, oils, gels, cleansers, and other products for easy use. These are highly concentrated products
and should be used cautiously.
The type of product chosen for a spa service usually depends on the equipment available at the spa and the removal method you plan to use (Fig. 121). For example, a clinic
without a shower may choose a gel-based seaweed for easy
cleanup and quick hot towel removal. A spa with a Vichy or
Swiss shower may choose powdered seaweed for the treatment. Powdered products are thicker when they are mixed
up for use and stick to the body during hot towel removal.
They are time-consuming and difficult to remove without
FIGURE 121 Comparison of seaweeds on the body. This figure shows the different consistencies of seaweed
products that have been applied to the body. It is easy to see that a gel-based product would be easier to remove
than a powdered product mixed with water. (A) Gel seaweed. (B) Powdered seaweed mixed with kaolin clay.
(C) Powdered seaweed mixed with oil.
10/24/13 2:18 AM
237
TABLE 122 Seaweed Mix Upsa

NAME
RECIPE
PROPERTIES
USES
Sea milk
Add cup of milk powder to every

cup of seaweed powder. Use a small
amount of hot water to dissolve the
mixed powders. Add cup of plain
body lotion to the mix. Now add warm
milk, cream, or buttermilk to the mixture
until the desired consistency is reached.
Relaxing, soothing, calming, softening
Full-body application for sensitive

skin, breast treatment, scalp and
neck treatment
Ocean oil
Sixteen ounces of a cold pressed vegetable or nut oil is warmed on the stove.
Two tablespoons of seaweed powder is
dissolved into this oil and heated on a
low temperature for 20 minutes while
stirring constantly. The mix is placed in
a glass bottle and shaken each day for
a week. The oil is strained through a
coffee filter. Essential oils can be added
to scent this product.
Stimulating, firming, circulatory

stimulant, energizing, revitalizing,
immune boosting
Full-body massage or as the massage

oil in a larger seaweed treatment;
as a product that can be applied to
the skin before a therapeutic shower
(Vichy, Swiss) or soaking treatment
Peppermint sea twist
Six drops of peppermint essential oil

is added to gel seaweed for a spot
treatment or full-body application.
Stimulating, refreshing, cooling,

revitalizing, analgesic, circulatory
and lymphatic stimulant
Foot mask for tired feet, spot treatment

for sore muscles, spot treatment
for cellulite, full-body cocoon for
refreshment
Sea shea
Melt shea butter in a double boiler until it

is liquid. Mix powdered seaweed with
warm oil until it dissolves and then add
it to the shea. Allow the shea to cool
while it is whipped with a wire whisk
or in a blender. Use 1 tbsp of powdered
seaweed to every cup of shea butter.
Relaxing, revitalizing, softening,

calming, gentle lymph and circulatory
stimulant
Useful as a thick, after-treatment body

butter, as a massage product, or as
the treatment product in a full-body
cocoon, neck and scalp treatment,
or hand and foot treatment
Marine minerals
Gel seaweed is mixed with kaolin clay

until a creamy, rich treatment product is
produced. Essential oils can be added
to the mix if desired.
Stimulating, slimming, detoxifying,

softening, revitalizing, relaxing
Full-body cocoon, back treatment,

foot treatment, breast treatment
Usually, seaweed powder is mixed up with warm water, but a number of useful treatment products can
be made by mixing seaweed powders with different liquids or oils. Each of these recipes can be used with
any type of seaweed powder. The reader will notice that the exact amount of seaweed or liquid is not
indicated. This is because different seaweed powders have been processed differently and mix up differently. The reader is advised to start with 3 tbsp of seaweed powder for a spot treatment and 1 cups of
seaweed for a full-body treatment. More seaweed may be needed depending on the size of the client.
The different liquids will be added until the desired consistency is reached.
a shower. That said, there are ways to mix up powdered

seaweed to make it easier to remove. Table 122 gives some
ideas for mixing up powdered and gel seaweed for hybrid
treatment products.
There are several seaweed gels on the market that are designed to be applied with a brush in a generous layer and
then left to absorb during a cocoon. At the end of the wrap
phase, the gel is simply massaged into the skin with a finishing product rather than being removed. These products are
simple to use and give satisfying results. Try out a number
of different products to determine their ease of delivery and
results before finalizing your treatment outline.
If a soaking tub or hydrotherapy tub is available, bathing
in seaweed solutions is a relaxing way to experience thalassotherapy. Seaweed soaks remineralize the body, stimulate
both circulation and metabolism, soften and cleanse the
skin, and leave the body feeling energetic and revitalized.
Seaweed is usually heated before being applied. As with

fango products, seaweed products should not be mixed,
heated, or stored in metal containers because they may
react chemically with the metal.
Seaweed Odor
Seaweed has a strong smell that some people like (Oh, it
smells like the ocean in here!) and some people dislike
(That smell is giving me a headache and making my
stomach upset!). The smell is potent and may spread
beyond the treatment room. This can be a problem in a
small, busy clinic and should be considered by the owner
before investing in the equipment and products needed
to deliver seaweed treatments. Some therapists add
essential oils to seaweed products to improve the smell
and to add to the therapeutic properties of the treatment.
10/24/13 2:18 AM
238
Adding essential oils just to mask the smell is not usually

very practical because a high concentration of essential
oil is needed.

Before offering a slimming body service, it is useful to
understand something about cellulite and why it occurs.
Cellulite is a cosmetic term that refers to uneven, dimply areas of skin found on the thighs, hips, and buttocks of women. Although the formation of cellulite is usually found in
mature women, it can begin as early as puberty. This condition is not restricted to overweight women but can occur in
very slim women too.
Three fat layers lie directly below the epidermis and dermis of the skin. The most superficial of these layers, known
as the subcutaneous fat layer, has specialized fat storage
chambers. These chambers are created by connective tissue
that anchors the skin to muscle tissue. The characteristic
dimpling of cellulite is caused by weakened connective tissue, which may be linked to increased levels of estrogen.
When the fat cells swell against the weakened connective
tissue, a bulge occurs, creating the dimpled appearance of
cellulite. Men rarely develop cellulite because they store fat
differently than women. In women, the fat storage chambers are organized into broad vertical chambers. Men store
fat in smaller chambers that are diagonally oriented and
less likely to bulge.
It is also likely that poor lymph and blood flow contributes to the problem. As the fat cells swell, they place surrounding structures under pressure. This causes increased
permeability of capillary walls, leading to localized fluid accumulation. If lymphatic flow is sluggish, this excess fluid
is never removed and causes connective tissue strands to
stiffen, pulling down on their anchor points and further
increasing the bulging appearance of the skin.
There has been a great deal of research carried out on
methods to reduce cellulite by nonsurgical means. Treatments include intensive massage techniques, often with
electrical suction devices; topical creams; compression
wraps; and intramuscular injections. However, there is little
evidence for the effectiveness of these treatments, making it
ethically difficult to sell them to clients.
Although it is difficult to reduce cellulite, its appearance
can at least be improved. Cellulite creams are a popular
and accepted means of improving the appearance of cellulite. These products are often used with tension wraps
(described in Chapter 9), which compress the tissue so that
it appears slimmer for a period of time after the wrap is removed. Sometimes, cellulite or firming products are activated with heat and applied underneath very warm treatment products such as Parafango or paraffin.
Cellulite and firming creams contain ingredients that
stimulate local circulation and heat the tissue. The most
widespread ingredient in cellulite and firming creams is
aminophylline (its chemical cousin, theophylline, is also
used). In vitro, aminophylline causes fat cells to shrink,

which has led to its popularity.8
Another trendy ingredient is yohimbine from the bark
of Pausinystalia johimbe, a tree that is grown in West Africa
along the coast of Nigeria and Gabon. Yohimbine is well
known as a male sex stimulant and is often added to bodybuilding formulas because compounds in its bark are precursors of testosterone. The compounds in yohimbine
increase local circulation to the skin, which may help to
break down fatty deposits. Products containing yohimbine
often alarm therapists because some cause the skin to turn
fire-engine red. This is not skin irritation, but the skin will
feel very warm for about 20 minutes after the application.
Cellulite and firming creams that increase local circulation
make very effective sore muscle creams, so they can be used
as treatment products in services for athletes.
The Slimming Seaweed Cocoon

Cocoon
n
Procedure
A full-body seaweed treatment is indicated for a wide range
of conditions, including low energy, low immunity, stress,
muscle soreness, fibromyalgia, detoxification, relaxation,
body slimming, and cellulite reduction. Both the hot sheet
wrap procedure and the cocoon procedure described in
Chapter 9 (Body Wraps) can be used with seaweed as the
treatment product to meet the general treatment goals
described previously. The procedure explained in this chapter aims to help define the contours of the body, so includes
a cellulite product and skin-firming product.
Slimming treatments are popular with clients who are
preparing for a big event and want to look their best in tightfitting clothing or a special outfit such as a prom dress. This
treatment can also be marketed to men who want to sculpt
their physique, especially bodybuilders in the last stages of
preparation before a competition. In any case, this service
will also support full-body relaxation and revitalization. The
slimming seaweed cocoon overview in Treatment Overview
121 and Figure 122 provide a snapshot of this service.
Session Start
The client begins the treatment in the prone position and
bolstered as he or she would be for massage. A warm pack
(hydrocollator, flax seed pack, etc.) is placed on the lower
back to warm the area and enhance the clients experience.
Step 1: Exfoliation of the Posterior Body

Any type of exfoliation treatment can be used, but because
the treatment goals include detoxification, dry skin brushing is appropriate. An exfoliation with sea salts is also
stimulating and maintains an ocean theme. Chapter 8
(Exfoliation Treatments) describes exfoliation techniques
10/24/13 2:18 AM

The Slimming Seaweed Cocoon Overview
Indications
To slim the contours of the body, to support natural
detoxification, to decrease stress, to promote revitalization
and boost energy
Contraindications
High or low blood pressure, varicose veins, poor circulation, thyroid disorders or thyroid medications, shellfish or
iodine allergies, sensitive skin, pregnancy, heart conditions, thrombosis or deep vein thrombosis

1. Blanket (wool or cotton) placed horizontally across the
table so that the long edges are at 90 degrees to the
sides of the table
2. Thermal space blanket placed horizontally across the
table (optional)
3. A plain flat sheet placed with the long edges parallel to
the long edges of the table (if the product needs to be
removed in a dry room)
4. A plastic sheet placed at horizontally across the table
5. One bath towel placed horizontally at the top of the table
the table
7. Disposable undergarments or dry hand towels to act
as a drape
8. Bolster
A Fomentek might be used under the massage sheet if
additional warmth is needed.

1.
2.
3.
4.
5.
6.
7.
8.
9.
Exfoliation product or dry brushes

Cellulite cream
Seaweed warming in a double boiler
Firming product
Skin toner
Soda cooler
Hot, moist towels
Aroma mist
Procedure
1. Exfoliate posterior body areas.
2. Apply a skin toner to the posterior body.
3. Massage cellulite cream into target areas of the
posterior body.
4. Turn the client supine.
5. Exfoliate anterior body areas.
6. Apply a skin toner to anterior body areas.
7. Massage cellulite cream into target areas of the
anterior body.
8. Apply seaweed to the body using the sit-up method.
9. Cocoon and massage the face, feet, or hands while
the seaweed is processing.
10. Remove the seaweed with hot, moist towels.
11. Apply firming cream to the body.
12. Aroma mist.
239
in step-by-step detail. As each body area is exfoliated, a skin

toner is applied to balance the pH of the skin. This is especially important with seaweed treatments because it helps
to prevent skin irritation.
Step 2: Application of a Cellulite Cream to

Target Areas of the Posterior Body
After exfoliating the posterior body, a cellulite cream is
massaged into target areas such as the posterior thighs,
gluteals, and low back. Some therapists advocate the use
of intensive massage in these areas based on the idea that
they break down fat deposits and move them out of the
tissue. How exactly the fat deposits are moved out of their
connective tissue chambers is not clear unless the connective tissue is damaged. Some spas or therapists buy expensive machines that use a suction massage to lift and manipulate the tissue. Local circulation is visibly increased
but whether this results in a decrease of cellulite is unproven. Intensive or painful massage techniques are not
recommended because they could bruise the client, lead
to varicose veins, or cause undue discomfort. Good results
are achieved with standard massage strokes and the application of seaweed over the top of the cellulite cream. To
view a video demonstration of product application, visit
thePoint.
Step 3: Exfoliation and Cellulite Cream

Application on the Anterior Body
Turn the client into the supine position and treat the
anterior areas of the body. Exfoliate each area; apply a skin
toner; apply a cellulite cream; and then massage the areas of
the anterior thighs, abdominal area, and upper arms.
Step 4: Application of Seaweed

Use the sit-up method to apply seaweed to both the anterior and posterior body. First, ask the client to bend his or
her knees so that you can apply seaweed to both the anterior and posterior sides of the legs. The legs are flattened
against the plastic body wrap, and the client is asked to sit
up (remove the bolster first). Apply seaweed to the back and
gluteals and ask the client to lie back down. Apply seaweed
to the abdominal area, upper chest, and upper arms and
then wrap the client in plastic.
Step 5: Cocoon
Pull the plastic wrap up and around the client and tuck it in
and then wrap the client in the blankets. The bath towel at
the top of the massage table is wrapped around the clients
head in a turban drape or tucked into the top of the cocoon.
Wrap the feet with the preset towel at the bottom of the
massage table. Heat lamps or flax seed warm packs can be
used for additional warmth if they are needed.
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240
A1
A2
FIGURE 122 The seaweed slimming treatment. (A1 and A2)

Application of a treatment ampoule. Massage techniques will be various
and firm but not painful for the client. (B) Application of seaweed. This
product is a powdered seaweed that has been mixed first with water and
then with an emollient cream to make it easier to remove in a dry room.
(C) Process during the slimming cocoon. Massage the face and/or mist
the client with light aromatherapy scents. (D) After removing the seaweed
and transitioning the client from plastic body wrap to the massage sheet,
apply a firming cream to the body with massage strokes.
Step 6: ProcessMassage the Face and/or Feet
Step 7: Unwrap
While the client is processing in the cocoon, provide a

relaxing face massage using a high-quality face cream. Offer
the client a sip of water or herbal iced tea through a flexible
straw and mist him or her with an aroma mist or spring
water. Massage the feet at the conclusion of the face massage. During any type of cocoon, enhancers such as face
massage, hot stone foot massage, reflexology, a scalp treatment, or other special extra can be used to fill out the treatment and make it exceptional for the client.
To remove the wrap, first take off the blankets. You now
have two options for removing the plastic based on the
equipment available at the practice.
Option 1: Leave the client loosely wrapped in the plastic
and take him or her to a shower. If the shower is outside
the treatment room, drape the client with a bathrobe or
sheet. Take the plastic from the client as he or she steps into
the shower and throw it away. Put massage sheets on the
massage table while the client is showering.
10/24/13 2:18 AM
Option 2: If there is no shower, the plastic sheeting will

need to be removed completely from underneath the client
as the client is cleaned off with hot towels. To remove a plastic sheet, a clean sheet will need to have been placed under
the plastic when the table was made up.
Remove the product from the clients arms, upper chest,
and abdominal area and ask him or her to hold onto the
breast drape and sit up. Remove the product from the clients back and the posterior arms. Roll up the plastic sheet
so that the dirty side is rolled in until it sits as close to the
gluteals as possible and ask the client to lie back down
(onto the clean preset massage sheet). Move down to the
lower legs and wipe the feet with a hot towel and ask the
client to bend the knees and hold the feet up. Roll up the
dirty side of the plastic (that is underneath the clients feet).
Place the clients clean feet on the massage sheet, which is
underneath the plastic (the knees are still bent). Remove
the spa product from both legs with hot towels and roll the
plastic up as high as possible under the gluteals. Place the
clean legs flat on the massage sheet and cover the client with
a sheet or towel for warmth. The client then lies back down
on the massage sheet and slightly lifts his or her hips so that
the plastic can be removed. You want to work quickly and
efficiently during product removal because the client must
stay alert during this entire process and if you take too long,
the session will feel dull and uninspired. The client is now
draped with a massage sheet for the rest of the treatment.
Step 8: Application of Firming Products

Some firming products are so strong that they are only applied to target areas of the body, whereas others are meant to
be applied to the entire body. Sometimes, the products are
combined in a treatment. The strong product is applied to target areas, and then the rest of the body is treated with a gentler product. Read the directions and cautions on any firming
products carefully to ensure that they are used correctly.
Session End
After the application of a firming product, use an aroma
mist to signal the end of the treatment and to fill the room
with a refreshing scent.
SANITATION
During the cleanup for a cocoon, it is important
to spray the thermal space blanket with
alcohol and allow it to air dry before putting it in a closed
cabinet. Reusable mixing bowls, application brushes,
and the soda cooler should be washed with hot, soapy
water and sprayed with alcohol. Product bottles that were
handled during the treatment should also be wiped down
with alcohol before they are put away.
241
The Seaweed Breast Treatment

The breast, which has no muscle tissue, is composed
of glandular tissue surrounded by fat. It is sensitive to
estrogen, progesterone, and prolactin levels during the
menstrual cycle or pregnancy. As elsewhere in the body,
an intricate system of blood and lymphatic vessels bring
nutrient-rich blood to breast tissues and carry metabolic
wastes away for elimination. When breast tissue is compressed or restricted, usually by bras, metabolic wastes
may build up in the tissue.40 There is some evidence that
this may cause a woman to experience greater tenderness
during menstruation or increase a womans chances of
developing breast cancer.39
In the United States, breast massage and spa treatments for improving breast health generate a somewhat
weary reception from therapists and clients alike. This may
be because massage was once linked to prostitution, and
therapists worry that their professionalism will be called
into question if they give a treatment for breast health.
Breast massage is often avoided in massage schools due
to state laws or discouragement from school accreditation
bodies. Some states allow therapeutic breast massage with
informed client consent, whereas others have legislation
that requires therapists to take an advanced training and
certification. Many men are rightly concerned about providing breast massage in cross-gender spa treatments. Even
with informed client consent, male therapists are at risk in
such a setting.
The American public is uncertain of the benefits of breast
massage and breast treatments for disease prevention. Services aimed at improving the appearance of breast tissue
are often more readily accepted. Therapists are rarely given
training in breast massage at massage schools, so they have
to seek out specialized instruction if they want to learn.
Specialized training is important because it covers a wide
range of topics from the psychology of touch and good ethical practice to proper lymphatic drainage and the anatomy
of the structures involved. Breast Massage, written by Debra
Curties, is a particularly helpful guide for the massage therapist interested in learning more.41
Although many spas do not offer treatments that involve
working with breast tissue, some spas do, so it is important
that you know how to approach this type of service professionally. When working with breast tissue in a spa setting,
avoid the nipples and areola and use firm, steady pressure
at all times. Make sure that you check the laws in your state
and obtain the clients written consent before offering a
breast treatment.
The seaweed breast treatment overview given here
(Treatment Overview 122) presents an outline for novice
therapists to help them understand the treatment steps that
might be used in such a service. This service is advanced, so
specialized training in breast massage is recommended for
novice therapists to build a solid foundation of knowledge.
10/24/13 2:18 AM
242

The Seaweed Breast Treatment Overview
Indications
To encourage breast health, to decrease stress, to firm
and tone the breast tissue
Contraindications
Iodine allergies, broken or inflamed skin, high blood
pressure, pregnancy or nursing, fever or illness, current
breast cancer (unless the therapist has an advanced
understanding), lymphatic insufficiency (unless the
therapist has an advanced understanding)

1.
2.
3.
4.
5.
Massage sheet
Top massage sheet
Blanket or bath sheet for warmth
Bolster
Pillow for the clients head

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Plastic body wrap cut to fit over the upper chest

Cream cleanser
Gentle exfoliation product
Skin toner
Cosmetic sponges
Essential oil support lotion
Seaweed warming in a double boiler
Soda cooler
Hot, moist towels
Vinyl gloves
Aroma mist
Procedure
1. Steam the breasts and upper chest with a
professional steamer or with hot, moist towels.
2. Cleanse the area with a cream cleanser; remove the
cleanser with hot, moist towels.
3. Exfoliate the area; remove the exfoliation product with
hot, moist towels.
4. Apply a skin toner to the area.
5. Apply seaweed to the area.
6. Cover the area with plastic and a blanket.
7. Massage the hands, feet, or face.
8. Remove the seaweed with hot, moist towels.
9. Provide breast massage (optionalwith written
consent only)
10. Apply a skin toner to the area.
11. Apply an essential oil support lotion to the area.
12. Aroma mist.
Experienced therapists might use this overview as a starting

point when designing an original breast service. The goals
of this treatment are to tone breast tissue and to improve
breast health by increasing local circulation and lymph
movement. An esthetician would add treatment steps for
smoothing and moisturizing the skin to improve the appearance of the breasts. This outline is meant to be used as
a wellness treatment rather than an active therapy for a diagnosed disease. Therapists with an advanced understanding of breast cancer or other serious breast conditions may
include seaweed or therapeutic mud in their treatments to
stimulate lymphatic drainage and the elimination of metabolic wastes from breast tissue. It is important to recognize
that a breast treatment may be against the law. It is the
therapists responsibility to be aware of the relevant laws,
regulations, and restrictions that apply in the state where
he or she practices.
Other Seaweed Treatments

You are encouraged to try out seaweed products in a number of the other treatment outlines offered in this book. For
seaweed back treatments or neck and scalp treatments, follow the appropriate outlines in Chapter 11 and substitute
seaweed for fango. For a seaweed foot service, follow the
outline for a basic foot treatment in Chapter 10 and use seaweed as the treatment product. Consider using a seaweed
gel with hot stone massage to bring clients the rejuvenating qualities of both of these treatments. In this case, the
gel is used instead of massage oil. Seaweed powders can be
blended with sea salts to offer in the gift store as an energizing soaking product for home use. Seaweed is also used
in facials, which are described and shown in Broaden Your
Understanding 123.
Essential oil support lotion: 1 oz plain lotion, lavender

(3 drops), grapefruit (5 drops), juniper berry (2 drops),
frankincense (4 drops), lemon (4 drops)
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243
WHAT IS A FACIAL?
Currently, the most popular treatment offered at spas
is massage. The second most popular treatment is a
facial. In most states, facials are outside the scope of
practice of a massage therapist and can only be given
by a licensed or certified esthetician. Although massage
therapists will not usually give a facial, they may help to
inform clients of the benefits of facials, which will help to
sell additional services for the spa.
Each facial is tailored to meet the skin type and
specific needs of the client. The overall goal of a facial
is to deep clean the pores, remove impurities from the
skin, nourish and condition the skin, and improve or
normalize skin function for better skin health. The session begins with a consultation and an analysis of the
clients skin. This may be done with a Woods lamp, a
fluorescent light that is used to identify the skin type.
Next, the skin will be cleansed, steamed, and exfoliated before ripe pimples or other blemishes such as
comedones (blackheads) and milia (whiteheads) are
Skin analysis.
extracted manually. This step may include the use of a

disincrustation solution and a galvanic machine. The
disincrustation solution is an alkaline product that helps
to soften hardened sebum in the pores. A galvanic
current machine may be used to help the solution
penetrate the skin. The facial mask is applied to further
draw impurities from the skin or to nourish and recondition the skin after it has been deep cleaned. Seaweed
is perhaps the most beneficial natural product that
might be used in a facial mask because of its ability
to improve the moisture content of the skin, tone and
firm tissue, and stimulate nutrient exchange in the skin.
Sometimes, a galvanic current machine will be used
to encourage the absorption of a nutrient-rich, watersoluble treatment product. A high-frequency machine
may also be used. The ozone generated by this type
of current has germicidal properties and helps to kill
bacteria on the skin. The facial usually ends with the
application of a moisture-rich finishing cream.
Cleanse, exfoliate, and massage.
Steam.
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244
WHAT IS A FACIAL? (CONTINUED)
Galvanic current.
Extractions.
Treatment mask.
High frequency.
10/24/13 2:18 AM
245
SPA FUSION
STUDY TIP: Quiz It!
CHAPTER WRAP-UP
Visual learner: For this chapter, pretend that you are

the instructor writing a quiz on thalassotherapy.
For each main heading in the chapter, write one
quiz question on a main point. Highlight the answer to your question in the body of the text.
Auditory learner: Make a testing tape for this chapter. As you read through each section, create a test
question from the material and read it into a recorder. After each question, leave 6 seconds of blank
space and then record the answer. When you finish
reading the chapter, listen to your tape and try to
answer your questions during the 6-second delays.
Kinesthetic learner: For each chapter section, write a
quiz question, but do not write the answers to your
questions. When you have finished, take the quiz.
Look up the answers to any questions you cannot
easily answer.
Thalassotherapy is a broad term for many different

types of treatments that are based on sea products
or seawater. It includes seawater hydrotherapy, the
application of seaweed or sea mud packs, exercise
in seawater, relaxation by floating in seawater, diets
rich in seaweed or seafood, and even the inhalation
of aerosol-sized particles of seawater. You will find
that seaweed has many benefits for both body and
skin, providing a number of treatment options that
are possible to deliver in a dry room setting. You will
also find that adding seaweed treatments to your
menu of services allows you to tap into your creative
side and the fresh, uplifting, and magical qualities of
the sea.
SPA INSPIRATION: Dance Massage
1. The different forms of thalassotherapy may

be effective because seawater contains a
concentration of:
One of the things that make a great spa treatment

is the quality of the massage that is delivered during
the session. You want your massage to flow! Flow
refers to the fluid quality of your strokes. The speed
of the strokes, the amount of body area covered by
strokes, the depth of strokes, and the overall rhythm
all contribute to flow. A fun way to develop your flow
is to practice with dance massage. Pick out 10 favorite
songs in any style of music (hip hop, alternative, jazz,
pop, classical, new age, rock, country, etc.)any style is
fine as long as you like the songs (your practice client
does not have to like the musicthis exercise is for
you as the therapist). Then play all 10 songs in a row
while giving a massage to a friend, family member, or
classmate. The goal is to infuse the massage with the
quality of the music. What happens to the massage
during a song that is sad and haunting? How does
the quality of strokes change? What happens to the
massage during a song that is fast or aggressive? Each
song communicates something different and affects
the massage in a new way. Do not judge whether a
song is right for a massagethats not the point. The
point is to feel the music and let it guide your massage
as you explore the flow. Therapists often find that
listening to music while providing massage improves
the flow of the massage and the quality of the strokes.
Go with it! Have fun!
REVIEW QUESTIONS
Multiple Choice
a.
b.
c.
d.
Mica crystals
Essential oils
Analgesic components
Minerals
2. This nation embraced sea bathing in the early

1800s and developed facilities to warm seawater by
1824.
a.
b.
c.
d.
English
French
Germans
Italians
3. Thalassa is the Greek word for:

a.
b.
c.
d.
Water
Rain
Sea
Seaweed
4. Thalassotherapy does not include:

a.
b.
c.
d.
Inhalation of fine particles of seawater

Seafood diets
Desert clay
Floatation in seawater
10/24/13 2:18 AM
246
SPA FUSION
5. Seaweed is defined as a:
a. Plant that needs large amounts of sunlight to
thrive
b. A marine-based algae
c. A blue-green algae
d. A green algae from the genus of Spirulina
Matching
6. Red algae
A.
Chlorophycota
7. Green algae
B.
Rhodophyta
8. Brown algae
C. Phaeophycota
9. Blue-green algae
D. Spirulina
10. Not seaweed
_______
E.
Cyanophycota
10/24/13 2:18 AM
13
Stone Massage
Chapter Outline
K e y Te r m s
Basalt: A type of igneous rock formed from the solidification of molten

magma. Because magma cools quickly on the earths surface, it
generally has microscopic crystals and a smooth texture. Basalt holds
heat better than many other rock types, and ocean or river basalt has a
smooth surface, so it is one of the best types of stone for stone massage.
Lamina groove: Located between the spinous and transverse processes
of the thoracic and lumbar vertebrae, the lamina groove is a vertical
depression filled with the fibers of the transversospinalis (multifidi,
rotators, semispinalis) and erector spinae (spinalis, longissimus,
iliocostalis) muscles.
Pin and stretch techniques: Techniques in which the muscle is first
shortened and then pinned at its origin, insertion, or muscle belly
before being lengthened. The effect of this technique is to reset proprioception and lengthen chronically shortened muscles.
Proprioception: Proprioception is the kinesthetic sense in which sensory
receptors receive information about rate of movement, contraction,
tension, position, and stretch of tissue. This information is processed
in the central nervous system, which sends motor impulses back to
muscle, causing it to contract, relax, restore, or change position.
Contraindications
Stone Temperatures
Therapist Safety
Essential Oils
Equipment and Setup

Stones
Heating Units
Core Techniques
Stone Flipping
Stone Transitions
Bad Stone Body Mechanics
Heating Unit Speed versus Body Speed
Remove Enough Stones
Draping
Stones on the Face
Basic Strokes
Long Strokes with the Stone Flat
Stone Ptrissage
Wringing with Stones
Stone Stripping
Rotation of a Stone with Compression
Stone Vibration
Deep Tissue with the Edge of a Stone
Deep Tissue with the Flat of the Stone
Friction with Stones
Stone Tapotement
Vascular Flush with Stones
Stone Strokes for Specific Areas

Posterior Leg: Gastrocnemius and Soleus Pin and
Stretch
Posterior Leg: Hamstring Pin and Stretch
Posterior Leg: Double-Arm Deep Tissue Stroke
The Back: Stoning the Lamina Groove
The Back: Latissimus Pin and Stretch
Anterior Leg
Anterior Leg: Quadriceps Pin and Stretch
Anterior Leg: Tensor Fasciae Latae and Iliotibial Tract
Stretch with Stones
Arm: The Triceps
Arm: Flexor or Extensor Pin and Stretch
Hands
The Neck: Prone
The Neck: Supine

247
10/24/13 1:49 AM
248
Chapter Outline
(c ontt inu
(con
i nuee d)
A Basic Full-Body Stone Massage Procedure

Session Start
Step 1: Posterior Placement
Step 2: Massage the Posterior Legs
Step 4: Transition to the Supine Position
Step 5: Anterior Placement
Step 6: Massage the Anterior Legs
Step 8: Abdominal Massage (Optional)
Step 9: Arm and Hand Massage
Step 10: Neck Massage
Session End
SPA FUSION
STUDY TIP: Practice Clients Are Not Clients
GOOD TO KNOW: Avoid the Burn!
CHAPTER WRAP-UP
be used where they are needed for the different stages of

inflammation in the healing process. In the early stages of
injury, cold stones can be used in the same way as an ice cup
is used for ice massage. Heated stones can be placed proximal
to the injury site to decrease muscle spasm and guarding. The
uninjured areas of the body can be worked with hot stones,
helping the body balance and relax. The use of alternating
hot and cold stones might also be used in cases of subacute
inflammation to achieve a vascular flush effect.
Later, in the late subacute and chronic stages of
inflammation, heated stones can be used for specific
techniques such as trigger point and cross-fiber friction,
saving the therapists hands from repetitive stress. The
stones bring a comforting sense of weight and depth to
In stone massage, both hot and cold stones are combined

with various massage techniques to produce a unique
the work, especially with deep tissue techniques. Essential

oils used during the stone treatment help to stabilize and
soothe the nervous system.
treatment that can be adapted to meet the needs of each client.
Hot stones can also be used for reflexology to activate
Stone massage is used for relaxation, injury rehabilitation,
the reflex points on the feet and hands more deeply, which
energy balance, deep tissue work, reflexology application, and
affects the entire body in a positive way. Pointed stones can
many other types of massage. It can also be incorporated into
be used for specific techniques, whereas larger stones placed
spa treatments as an accent or to provide textural variety.
around the feet and lower legs provide soothing warmth.
In a relaxation treatment, the stones are heated and
Today, energetic bodywork systems are a synthesis of
usually applied with long, flowing Swedish strokes. Large,
ancient practices and insights gained from contemporary
flat stones placed on points of tension over an insulating
sciences such as quantum physics, psychology, and
drape increase local circulation and help to warm muscle
medicine. Exploring these concepts gives practitioners
tissue. These placement stones also help to draw the
new insights into the healing process. Many practitioners
clients attention to an area, which supports deeper muscle
have an instinctive and deeply held belief that stones and
release and greater body awareness. Sedative and calming
essential oils have their own peculiar energetic stamp.
essential oils might be incorporated into the treatment to
They use these stamps to balance the electromagnetic field
decrease stress and balance the central nervous system.
to support the bodys natural healing mechanisms. Hot or
For an invigorating treatment, a hot stone can be used
cold stones are often used with this approach in a number
in one hand and a cold stone in the other, or the area is
of energetic bodywork practices such as polarity therapy,
heated first with hot stones and then massaged briskly
chakra balancing, guided meditation, and other techniques.
with cold stones. This contrast therapy feels refreshing and
Stones included in spa treatments introduce the earth
stimulating without being too cold or uncomfortable.
element to the treatment or help to cover a transition
Stones are not just used for relaxation or stimulation.
between one phase of a session and another. They can
Like any thermal medium, hot or cold temperatures can
be incorporated when applying products or included
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Chapter 13
as a separate step to warm the tissue before a product is

applied. Increasingly, stones are used as a defining feature
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249
pressure, neuropathy, high-risk pregnancy, renal diseases,

rheumatoid arthritis, varicose veins (site contraindication),
and intolerance to heat are all contraindicated.
in facials, body applications, manicures, and pedicures.

Their smooth surface can be used to apply the rougher
Stone Temperatures
textured products such as exfoliants, creating a unique
Before they are used, stones are warmed up in water heated

to between 130 and 140F. The best water temperature for
most clients and therapists is between 130 and 135F. At
130F, the stones are warm and comfortable, but they cool
so quickly that it is difficult to maintain any flow in the massage. At 140F, the stones will be too hot for many clients
and too hot for many therapists to hold in their hands. It is
not advisable to work with stones above 140F at any point
during the treatment because both the client and therapist
may get burned. The therapists hands will quickly grow
accustomed to the heat, and soon, very hot temperatures
will feel only warm. For this reason, the temperature of the
stones must be constantly monitored using a thermometer. Novice stone massage therapists are advised to work at
lower temperatures until they have mastered stone massage
techniques. As with any treatment, it is better to err on the
side of caution and give a warm stone massage rather than
endanger a client in any way.
sensation for the client.

Specialized approaches to stone massage begin to evolve
when therapists experiment with stone techniques. In one
example, a therapist wanted to use hot stone massage to
bring balance and calm to emotionally disturbed children.
She developed her own unique approach to stone massage
that incorporated a number of different ideas including
polarity therapy with stones, aromatherapy, placement
stones, vibration with the stones, and gentle clicking of
the stones. Her routine calmed and captivated her young
clientele, and she was able to develop a series of practical
techniques that she taught parents to use at home. This
is just one of the innovative ways that therapists are using
Therapist Safety
stones for relaxation and healing. Therapists should not
You should always wear shoes during stone massage because the client can move accidentally, sending one of the
placement stones flying onto the floor (or the therapists
feet), or you might drop a stone on yourself.
feel bound by the routine described in this chapter, but

instead, they should view these techniques as a starting
point, a resource for exploring their creativity.

Consideratio
ons
Contraindications, therapist safety, stone temperatures,
and insulation of placement stones should be conserved
before offering stone massage services.
Contraindications
A hot stone massage increases local circulation and influences soft tissue structures in the same way that a standard
massage does, but because of the heat involved, the body
tends to react more strongly to a stone massage. This can
produce a positive result, such as deep muscular release,
or a negative result, such as accelerated detoxification and
nausea. Any condition contraindicated for regular massage
is also contraindicated for stone massage. Acute illness,
fever, circulatory conditions, sunburned skin, broken or
inflamed skin, recent soft tissue injury, advanced or poorly treated diabetes where tissue is unhealthy and circulation is decreased, edema, thrombus, deep vein thrombosis,
gout, heart disease or a serious heart condition, high blood

In promotional brochures for hot stone massage, you often
see photos of clients with the stones placed directly on
their bodies. If the stones are hot enough for the treatment,
they will burn the client if placed on the skin in this way.
Either some form of protection from the heat is needed or
the stones will need to be moved rapidly until the client
gets used to the temperature. Placement stones are usually placed on top of the clients drape. A large, thick bath
towel provides enough protection so that the stones do not
burn the client, but at the same time, the client can feel the
warmth of the stones penetrating through the drape.
Essential Oils
Essential oils can be added to the massage blend used in
a stone massage, but there are a few cautionary notes that
should be mentioned. It is important to remember that
any essential oils that are skin irritants will probably be
more irritating when they are applied with heat. A blend
with lemongrass and clove that works fine in a regular massage may cause serious irritation with a stone massage. It is
therefore best to keep the concentration of the essential oils
at 2% or lower (12 drops in 1 fl oz of carrier).
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Equipment and Setup

Before you deliver a stone massage, you must invest in
some additional equipment, purchase or find a set of massage stones, and organize the treatment room so that all
the items needed are within easy reach during the service
(Fig. 131).
Stones
Basalt stones are the main type of stones used in hot stone
massage because they hold heat so well. Basalt is formed
from the solidification of molten magma after erupting
from a volcano, or else, it solidifies near the surface of the
earth and is exposed later by erosion or upheaval during
movements of the earths plates. It is tumbled to smoothness in river beds and on ocean shores over thousands
of years.
Marble is often used for cold techniques in stone massage. In its natural state, marble feels cool to the touch
because it absorbs heat rapidly. Marble must be specially cut into man-made disks for use in stone massage.
Although marble stones are visually pleasing and have a
unique texture, they are not strictly necessary for cold
stone therapy. Cooled basalt works just as well, is easier to
find, doesnt fracture when dropped as marble does, and is
less expensive.
There are many different companies offering training in
stone massage. Most of these companies sell sets of stones
that work well with their particular techniques. Most therapists use a set of approximately 55 stones of which some are
placement stones, and some are working stones.
Placement Stones
Placement stones are larger and rougher than working
stones. They are placed on the body to heat an area and to
relax the client with their weight. Placement stones consist
of a sacral stone, four large oblong stones, six to eight back
stones, two palm stones, two foot stones, eight toe stones,
and an optional neck stone.
One sacral stone: The sacral stone is the largest stone in
the set. It is placed on the sacrum in the posterior layout
or on the belly in the anterior layout.
Four large oblong stones: The four large oblong stones
are slightly smaller than the sacral stone and are used in
the posterior layout to heat up the erector muscles on
either side of the spine. In the anterior layout, they are
placed up the centerline of the body and at the origins of
the pectoral muscles.
Six to eight back stones: The back stones can be used
during the posterior layout if the client has a long back,
and the four large oblong placement stones dont cover
a large enough area. They also work well for long fluid
strokes where their larger size provides optimal warmth
for the client. However, they are usually too large to hold
easily and dont work well for more intricate techniques.
Two palm stones: The palm stones are placed in the
clients hands after he or she has been smoothed with
massage oil (or else, they feel dry).
Two foot stones: The foot stones are about the same size
as a back stone with a flat side that fits easily into the arch
of the foot. They are held in place on the foot by being
wrapped and tied on with terry strips or with hand towels.
Eight toe stones: Eight small stones are placed between
the clients toes. It is a good idea to have a large set for big
feet and a small set for small feet. The toe stones must be
cooled before they are placed between the toes because this
is a tender, bony area that is sensitive to heat. The toe stones
cool off very quickly because they are small, but remember
to ask the client if they are too hot as you put them in.
One neck stone: The neck stone is placed under the
neck when the client is in the supine position and then
pulled gently up against the occiput to provide a slight
traction.
Working Stones
Working stones are usually smoother than placement
stones and fit comfortably in the hands of the therapist.
It is useful to have a variety of sizes that can be used for
different techniques. It is also helpful to have at least two
stones that have a sharper point, so they can be used for
trigger point or reflexology techniques.
Heating Units
FIGURE 131 Stone equipment.
As stone massage has become widely popular, spa and massage suppliers have developed a number of different ways to
heat stones in the treatment room. Some of these heating
units are designed to look more like pieces of art than
a practical piece of equipment. Research the equipment
options available to identify the type of heating unit that
matches both the budget and the type of stone massage you
plan to provide. A practical and common type of heating
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Chapter 13
unit for stone massage is an 18-quart heating unit as shown

in Figure 131. A smaller crock pot can be used if you only
plan to use a few stones in a treatment.
The heating unit is placed on top of a bath towel to absorb
any water splashes as the stones are removed. A white plastic dish mat (cut to size) is then placed in the bottom of
the heating unit, and the stones are arranged on top of it.
The white dish mat helps the stones to stand out against
the otherwise black interior of the heating unit. This makes
them easier to see in the low light of the treatment room
and prevents the stones from making a scratching noise on
the bottom of the heating unit as they are removed.
The most efficient way to arrange the stones is to place
them in the order that they will be pulled out of the heating unit. The sacral stone is placed in the upper right-hand
corner of the unit with the four large oblong stones in front
of it. In the next row are the back stones, palm stones, foot
stones, and toe stones. The toe stones are placed in a small
mesh bag so that they do not get lost under other stones during the treatment session. On the left-hand side of the heating unit are the working stones in a pile. Some therapists
split their working stones into four or five mesh bags that
contain prearranged sizes and shapes of stones. This makes
it easy to quickly pull the right stones from the heating unit.
A bowl of iced water containing four to six working
stones (or marble discs) is placed on the work table. These
stones will be used for the vascular flush application or to
provide a contrast to hot stones.
A pitcher of cold water is placed close to the heating unit
in case the stones get too hot and need to be cooled quickly.
A thermometer is used at all times to monitor the temperature of the water in the heating unit. A digital thermometer
is the easiest type to use because the unit can be fixed to the
outside of the heating unit and read from a distance while
the attached probe is placed in the water. A set of thermal
gloves and a strong slotted spoon is placed to the side of
the heating unit. The gloves will be used to pull the placement stones from the heating unit during the posterior
and anterior layouts. The slotted spoon (slotted so that the
water can drain out) makes it easier to remove the stones
from the hot water in the heating unit.
A bottle of expeller-pressed massage oil (sunflower or
hazelnut work well, although many different types of coldpressed or expeller-pressed oil can be used) and an aroma
mist are placed on a rolling cart along with six to eight
dry hand towels. Stone massage does not work well with
a massage gel or cream product. These products leave a
sticky residue on the stones and turn the water in the heating unit cloudy.
The massage table is laid with sheets and a large bath
towel over the top sheet. The bath towel is necessary
because it provides an insulating layer to prevent burning
from stones placed in a static position.
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251
SANITATION
To quickly clean the stones between clients,
they are removed from the heating unit and
sprayed with alcohol. The water in the heating unit is
dumped out, and the interior of the heating unit is sprayed
with alcohol. At the end of the day, the stones are washed
with hot, soapy water and allowed to dry completely.
The heating unit should be rinsed out and sprayed with
alcohol. If the stones become sticky or gummy, they can
be soaked overnight in a covered container filled with
rubbing alcohol. The stones can also be cleaned in a
dishwasher (make sure that the stones are secured in the
dishwasher because they may cause damage to the
unit if they become dislodged and fall). Alternatively, for
those concerned about the effect on the energy of
the stones, they can be soaked overnight in baking soda,
water, and lemon juice.
Core Techniques
Before working through the basic stone massage procedure, it is helpful to practice some core techniques
and basic strokes. Once these have been mastered, you
are ready to move on to a full-body stone massage. For
a video demonstrating stone massage techniques, visit
thePoint.

Oil the clients body area and then pick up a stone in each
hand and move them briskly over the skin to begin the
massage. You should not place the stones directly on the
skin and hold them still while asking, Is this too hot? They
will be too hot, and the client will be tense for the rest of the
massage. The important thing to remember is to keep the
stones moving briskly over the skin and keep flipping them
(described below) until they begin to cool. After only three
or four passes, the client will have adapted to the temperature, and the stones will be cool enough so that deeper,
slower strokes can be used for the treatment work and to
add variety to the massage.
Stone Flipping
You will notice that the side of the stone that is next to
the client will cool more quickly than the side of the stone
that is touching your hand. To keep the stone temperature
even for the client, flip the stone over at the end of a long
stroke. When the stones are very hot, you will need to flip
the stones repeatedly to protect your hands (the stone is
static for the therapist while it is moving for the client). To
flip the stones, pick up one end of the stone with the thumb
and turn the stone over while it is in motion. With practice,
flipping the stones becomes easy and natural.
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252
Stone Transitions
Heating Unit Speed versus Body Speed
The smooth transition from one stone (that has cooled

down) to another (which is nice and hot) is an important
part of stone massage technique. This transition can be
made in a number of different ways. The first method is
to keep one stone moving and take the other hand off the
body. Change the stone in the first hand and then repeat
the process with the second hand (Fig. 132). The second
method is to take the stones off a body area in a long,
slow sweep; quickly grab fresh stones; and return the new
stones to the same place on the body. A third method is to
leave a cooled stone on the body area while new stones are
picked up. The cooled stone gives the client the sensation
of the therapists presence until the new stones are introduced. Finally, a fourth method would be to try taking the
stone off the body while an elbow or forearm continues
the stroke. Use the free hand to change the stones for both
hands. Whichever method is used, the aim is to minimize
any disruption to the flow of the treatment when changing stones.
In stone massage, there are two different speeds at which you

work: heating unit speed and body speed. A therapist with
good heating unit speed is fast and focused when he or she
is removing stones from the heating unit. The minute their
hands leave the client, they move into high gear, remove the
next set of stones from the heating unit, and then return to
the client. As soon as they get to the client, they shift to a slower body speed. Their pace becomes slow and relaxing again.
They instantly ground and center themselves as their hands
make contact with the clients body and they start to massage.
Bad Stone Body Mechanics

It is not uncommon for novice stone therapists to deathgrip a stone during a stroke, to position their wrists
at extreme angles, or to watch the stone as it moves over
the body and therefore begin to hunch over the client.
Although stones can feel slippery, it is best to trap the stone
against the clients body with the palm and reach the fingers around the stone so that they contact and palpate the
clients tissue. Some techniques do require the therapist to
grip the stone. In this case, you must think about gripping
without overstraining your hands. You must also watch
the position of your wrists when using stones so that they
remain as straight as possible during techniques. Any technique that causes strain to your body should be reevaluated
and either changed to avoid unnecessary stress or eliminated from the routine.
Remove Enough Stones

A common mistake of novice stone therapists is that they
do not remove enough stones from the heating unit for the
body area they are working on. They pull two or three stones,
walk to the client, undrape the area, and massage, and soon,
the stones are cold. They must now walk back to the heating
unit and swap the cold stones for hot stones. Instead, you
want to remove a minimum of six to eight stones for each
body area. Stones start to cool off the moment that they are
used on the clients body, but when they are sitting off to
one side of the client wrapped up in a towel, they remain
relatively hot. This way, you do not need to walk away from
a client to get more hot stones more often than necessary.
Draping
Before placing any stones, first check the clients drape.
In both the supine and prone positions, pull the drape up
toward the top of the clients body so that there is excess over
the shoulders. Many clients have shoulders that slope downward. This is especially true of women with larger breasts.
Placement stones tend to roll or slide off these clients with
the slightest movement. To avoid this and other problems,
the drape is brought around the stone, creating a pocket to
hold the stone in place. The drape is then anchored with
another stone, and both the client and therapist can relax.
Stones on the Face
FIGURE 132 Stone transitions.
In promotional brochures, it is not uncommon to see photos of clients with stones on their faces. A warm stone on
the forehead or over the eyes feels very nice, but if it is too
hot, it might burn the client so be very careful using this
technique. If the stone is oiled with a massage blend that
contains essential oils, do not place it over the eye because
the eyelid is sensitive, and the oils may also penetrate
through the gap between the eyelids and irritate the eyes.
The other problem is that when stones are left in place on
the face for too long, the client tends to tense his or her neck
muscles to keep the stones from sliding off. Stones used
for massage on the face should only be kept on for a short
time and should be warm rather than hot (around 125F or
lower) to protect delicate facial tissues from irritation.
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Chapter 13
Basic Strokes
Like Swedish massage, stone massage strokes often follow a progression from effleurage at the start to ptrissage, friction, deep tissue techniques, proprioceptor
techniques, vibration, and, finally, tapotement. You can
explore your own massage techniques for inspiration.
If you have a massage stroke that you particularly like, it
Stone Massage
253
will usually be possible to find a way to do the same technique with a stone. On the other hand, some really great
moves are impossible to perform with a stone. In this
case, transition out of using the stone for long enough to
perform the move. Try to keep what is unique and special
about your massage and just add stones to enhance the
performance. This is what makes a stone massage a personal and creative experience. Basic strokes are illustrated
in Figure 133.
FIGURE 133 Basic stone strokes. (A) Long strokes with the stone flat. (B) Stone ptrissage. (C) Wringing with
stones. (D) Stone stripping. (E) Rotation of a stone with compression. (F) Stone vibration. (continued)
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254
Long Strokes with the Stone Flat

Long strokes (effleurage with stones) are the basic type of
stroke used in a stone massage (see Fig. 133A). They are
used when a stone is first introduced to a body area and to
transition between different types of strokes. The stones are
placed flat against the body and passed up the length of the
body area and down again without losing contact. If an
area is particularly bony, lighten the stroke over the area.
Stones will glide over bony areas so long as there is enough
oil on the skin. You will want to pay attention in certain
FIGURE 133 (continued) (G) Deep tissue with the edge of the stone.
(H) Deep tissue with the flat of the stone. The stone is used to heat the
area while the pressure is exerted with the forearm or elbow. The stone
must be cool enough to be moved slowly. (I) Friction with the stones.
This friction stroke is performed by running the stones down the lamina
groove. It could also be performed in the same manner on any area of the
body where the therapist normally uses their thumbs. (J) Stone tapotement. (K) Vascular flush with stones. In this picture, a marble stone is
used for to show that the stone is a cold stone. Cooled basalt could also
be used.
areas so that you do not knock the stone accidentally into a

bony prominence. It also helps to palpate the tissue around
the edges of the stone by keeping the fingertips on the surface of the skin. This helps you judge the appropriate depth
for the stroke.
Stone Ptrissage
A small stone is placed in each hand so that the therapist
is able to use his or her fingers to lift the tissue as he or she
would in normal ptrissage (see Fig. 133B).
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255
Wringing with Stones
Vascular Flush with Stones
A medium-sized stone is placed in each hand and used in

a cross-motion, lifting the tissue at the top of the stroke
where the hands meet (see Fig. 133C).
A hot medium-sized stone is held in one hand, and a cold

medium-sized stone is held in the other hand. With the hot
stone leading, both stones are applied over the body area
in long, brisk strokes. This feels stimulating and invigorating and is a nice way to finish a body area before redraping and moving on (see Fig. 133K). In a variation on this
technique, the body area is heated with hot stones, and then
two cold stones are introduced with brisk strokes over the
area. This technique can also be used as contrast therapy on
an area of subacute injury. In a general massage, hot stones
are then used again to finish the area off.
Stone Stripping
The stone is turned on its side and used to strip the muscle
tissue in a given area. This stroke can feel intense to the client and should only be used when deeper, more detailed
work is desired (see Fig. 133D).
Rotation of a Stone with Compression

Hold a medium-sized working stone flat against the body
area and rotate it in a half circle toward the outside of the
body while compressing the stroke into the tissue. You
can apply this stroke with one hand or in alternating twohanded strokes. This stroke is particularly useful on fleshy
areas such as the hamstrings (see Fig. 133E).
Stone Vibration
Place a large stone against the body area and use a smaller
stone to tap it (see Fig. 133F). This creates a pleasant sound
and a gentle vibration. Some therapists open their massage
routine by tapping on the sacral stone before they massage
the legs. Another nice idea is to gently tap both edges of
the neck stone while it is positioned up against the clients
occiput. This creates a vibration throughout the head and
face, which feels relaxing for some clients.
Deep Tissue with the Edge of a Stone

The edge of a stone is placed on the area to be worked, and as
the client exhales, the stone is pressed into the area. This technique is particularly useful around the scapulae (see Fig. 133G).
Deep Tissue with the Flat of the Stone

A medium-sized stone is held flat against the body ahead of
the therapists elbow or forearm. The stone is not used to exert pressure but is used to warm the area ahead of the elbow
or forearm, facilitating a deeper release. The stone must be
cool enough to be moved very slowly (see Fig. 133H).
Friction with Stones

Stones can be held in the hands and used in place of the
thumb for friction. For example, a stone is really useful
for producing friction as it is run slowly down the lamina
groove (see Fig. 133I).
Stone Tapotement
A stone is placed in each hand and used to apply gentle
tapotement to the body (see Fig. 133J).
Stone Strokes for Specific Areas

A number of the hot stone techniques used on specific areas
of the body can be described as pin and stretch techniques.
Pin and stretch refers to a technique in which the muscle is
first shortened and then pinned at its origin, insertion,
or muscle belly before being lengthened. Some therapists
describe this technique as muscle stripping with range of
motion. Others express it as deep tissue with Swedish gymnastic. Some say it is Golgi tendon organ release with range
of motion. Regardless of how the technique is described, its
effect is to reset proprioception and lengthen chronically
shortened muscle.
The heat from the stones seems to support proprioceptor resetting and the release of chronically held tissue.
The techniques described here are meant to offer some
ideas for moving beyond a typical stone routine (effleurage
with a stone) into a deeper, more satisfying level of stone
bodywork. Stone strokes for specific areas of the body are
illustrated in Figure 134.
Posterior Leg: Gastrocnemius and

Soleus Pin and Stretch
Lift the lower leg to a 90-degree angle and place the hand
closest to the end of the massage table across the plantar surface of the foot, grasping the heel. Place a stone in the other
hand and wrap the fingers around the Achilles tendon (see
Fig. 134A). Plantar flex the foot to shorten the gastrocnemius and soleus and then dorsiflex the foot while the hand
with the stone travels down the posterior leg. At the end of the
gastrocnemius and soleus pin and stretch, place the foot on
your shoulder while facing toward the head of the table and
then use two stones to wring the lower leg (see Fig. 133C).
Posterior Leg: Hamstring Pin and Stretch

Stand at the side of the table by the hamstring and, facing
toward the head of the table, lift the lower leg so that the
knee is flexed (see Fig. 134B). Place a medium-sized stone
on the hamstrings close to the posterior knee and then
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A1
A2
B1
B2
C1
C2
C3
C4
FIGURE 134 Stone strokes for specific areas. (A1 and A2) Gastrocnemius and soleus pin and stretch.
(B1 and B2) Hamstring pin and stretch. (C1C5) Double-arm deep tissue stroke with stones. (continued)
256
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C5
E1
E2
G1
G1
G2
H1
FIGURE 134 (continued) (D) Lamina groove flare. (E1 and E2) Latissimus pin and stretch. (F) Stone
massage on the peroneus muscles. (G1 and G2) Quadriceps pin and stretch. (H1 and H2) Tensor fasciae latae
and iliotibial tract stretch with stones. (continued)
257
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258
H2
FIGURE 134 (continued) (I) Stone massage on the triceps. (J) Flexor
pin and stretch. (K) Extensor pin and stretch. (L) Stone massage on the
hand. (M) Stone massage on the neck: prone. (N) Stone massage on the
neck: supine.
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lower the leg into a neutral position before bringing it up

into a flexed position as the stone runs toward the ischial
tuberosity with moderate pressure. As the stone reaches the
gluteals, it can be circled around the greater trochanter to
create a long, flowing stroke.
Posterior Leg: Double-Arm Deep Tissue Stroke

Holding a medium-sized stone in each hand, stand at the
posterior knee. Push the forearms forward on either side
of the posterior knee (see Fig. 134C) and then bring them
back again. As the stones come back, they are placed onto
the skin and separated. One stone goes toward the foot
while the other goes toward the hip. They are then brought
back together again, and the stroke is repeated.
The Back: Stoning the Lamina Groove

There are a number of strokes that can be performed using
the lamina groove as a guide. The two stones can be pressed
into the lamina groove on either side of the spine and run
slowly with moderate pressure toward the sacrum (see
Fig. 133I). You can also stand on one side of the client and
place the edge of a stone in the groove on the opposite side
of the spine. Press downward and then flare the stone outward (see Fig. 134D). This is a small movement that nevertheless feels intense. Novice therapists should work slowly
and carefully while they build their palpation skills. Running stones quickly or roughly over the spinous processes
feels uncomfortable for the client and may cause an injury.
The Back: Latissimus Pin and Stretch

Shorten the latissimus by bringing the arm behind the back
into extension and internal rotation. Pin anywhere along
the lateral body from just above the waist to the axilla with
a warm stone (see Fig. 134E). Ask the client to inhale. On
the exhalation breath, bring the clients arm out, around,
and forward into flexion. A running pin can begin close to
the axilla and run down toward the posterior superior iliac
spine as the arm is brought into flexion.
Stone Massage
259
the rectus femoris just above the patella. As you extend the
lower leg and then returns it to a flexed position, the stone
is pushed toward the anterior inferior iliac spine.
Anterior Leg: Tensor Fasciae Latae and

Iliotibial Tract Stretch with Stones
With the knee flexed, place the foot on the lateral side of the
opposite leg (see Fig. 134H). Press the stone into the iliotibial tract superior to the lateral knee and run up the lateral
leg while the bent knee is gently pressed across the opposite
leg. This stretches the fasciae latae and iliotibial fascia. The
stone can be lowered posterior to the greater trochanter and
taken into the lower back to finish the stroke.
Arm: The Triceps

Range of motion is important in the arm massage because it
facilitates a better release in the muscles and feels flowing and
interesting to the client. The triceps can be accessed by lifting
the arm over the head and locking the hand gently against the
treatment table with your thigh (see Fig. 134I). The stone is
passed from the medial to the lateral side of the triceps across
the biceps. To finish the stroke, stretch the arm behind the client and pass the stone down the lateral side of the lower back.
Arm: Flexor or Extensor Pin and Stretch

A passive pin and stretch is achieved when you hold the
clients hand and flex and extend the wrist while you use a
smaller sized stone to provide a running pin up either the
flexors or extensors (see Figs. 134J and 134K).
Hands
Stones do not feel particularly good on the posterior surface
of the hand, so it is better to incorporate a warm stone to hold
the hand while the fingers are massaged. The palm can be massaged with a stone using reflexology point work (see Fig. 134L).
The Neck: Prone

Anterior Leg
The bony anterior lower leg can be a tricky place for stone
massage. The stones are kept on either side of the tibia,
where they access the many attachment sites for the extensors of the ankle and toes. In a nice technique for the peroneus muscles, the lower leg is held in medial rotation, and
a hot stone is worked up the lateral side of the leg (see Fig.
134F). A stone can also be held on one side of the tibia
while the foot is passively dorsiflexed and plantar flexed.
Anterior Leg: Quadriceps Pin and Stretch

The clients leg is dropped off the side of the table (see
Fig. 134G). The ankle is held in one hand and a stone in
the other. The stone is pushed with moderate pressure into
The upper fibers of the splenius capitis, the trapezius, and

the suboccipitals can be accessed when you sit at the head of
the table and bring the stones up the lamina groove and out
toward the mastoid process (see Fig. 134M). To reach the
suboccipitals, a deeper, more specific pressure must be used.
The Neck: Supine

Stone massage on the neck works best when the head is kept
in gentle and constant movement. This opens up the neck
so that the stone can flow without becoming stuck in flesh.
On the anterior neck, the stone should be kept in a flat position for the clients safety. On the posterior neck, the edge
of the stone can be used to access the suboccipitals, splenius
capitis, and trapezius at the occiput (see Fig. 134N).
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260
A Basic Full-Body Stone M

Massage
assage
e
Procedure
The treatment overview in Treatment Overview 131 offers
a quick snapshot of a complete full-body 90-minute stone
routine. Figure 135 shows the stone positions for the posterior and anterior layout of the stones. Therapists can adapt
this routine and cut it down to 60 minutes by removing

Full-Body Stone Massage
Indications
Muscle soreness, stress, chronic musculoskeletal
condition, low energy, to promote relaxation
Contraindications
Heart condition, high-risk pregnancy, vascular conditions,
illness or fever, acute condition, inflammatory condition,
poorly managed diabetes

1.
2.
3.
4.

Top massage sheet
Bath sheet (drape)
Bolster

1. Heating unit placed on top of a bath towel and with
white plastic dish mat inside
2. Stones arranged in the unit and covered in water
3. Insulated gloves and/or a slotted spoon
4. Bowl of ice with four to six medium basalt stones or
marble disks inside
5. Thermometer
6. Pitcher of cool water
7. Massage oil
8. Aroma mist
9. Glass of drinking water
10. Six to eight hand towels
11. Rolling cart (optional)
12. Bowl of soapy water in which to soak toe and foot
massage stones after they are used (optional)
Procedure
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Place the posterior stones.

Massage the legs.
Remove the back stones.
Massage the back.
Place the anterior layout.
Massage the anterior legs and feet.
Remove the upper chest stones and neck stone.
Massage the arms.
Massage the abdominals (optional).
Massage the neck and face.
Remove all stones and end with an aroma mist.
FIGURE 135 Stone placement for full-body stone massage. (A) Posterior placement. (B) Anterior placement. Note: Stones should never be
placed on bare skin. This image is shown without the use of an insulating
drape for clarity. Fully drape the client and place the stones over a sheet
and thick bath towel.
certain body areas (e.g., the abdominals) and simplifying

stone placement (e.g., eliminate tying stones on the feet,
etc.). Some therapists choose not to use placement stones
and simply use a set of stones to open the body area with
effleurage strokes before progressing on to their regular
massage routine. Timing options are shown in Table 131.
Session Start
Upon entering the treatment area, bolster the client while
he or she is lying in the prone position. Pull the drape up
high over the clients shoulders so that there is enough to
wrap a stone in a pocket to avoid it slipping. Check the
temperature of the stones and adjust the heat as needed by
either turning up the heating unit or pouring in cold water.
Step 1: Posterior Placement

Remove the placement stones from the heating unit using
insulated gloves, tongs, or a slotted spoon. Place each stone
in order up the sides of the spine as follows (see Fig. 135A):
1. Sacral stonePlace the sacral stone over the coccyx of
the client rather than directly over the sacrum. This will
provide a slight fascia traction that stretches the tissue.
2. Stones are placed on either side of the spine directly
above the sacral stone all the way up the length of the
back. The four large placement stones are placed on
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Chapter 13
Stone Massage
261
TABLE 131 Suggested Timing Options for a

Stone Massage Session
DESCRIPTION
TIME ALLOTMENT
(MINUTES)
90-Minute Session
1. Posterior layout
2. Posterior legs
14 (7 each)
3. Back
15
4. Turn the client supine
5. Anterior layout
6. Anterior legs
12 (6 each)
7. Feet
10 (5 each)
8. Abdominal area
9. Arms
10. Neck and face
11. Session end
Total
12 (6 each)
10
2
90
60-Minute Session
1. Posterior layout
2. Posterior legs
10 (5 each)
3. Back
13
4. Turn client (omit spinal layout)
5. Modified anterior layout (place a belly

stone and neck stone only and omit
stones on the feet or hands)
6. Anterior legs and feet (combine the feet

with the anterior legs)
12 (6 each)
7. Arms (omit abdominal massage)
8 (4 each)
8. Neck and face
9. Session end
Total
1
60
the lower back, and the back stones are used on the
upper back.
3. The foot stones are wrapped in a towel and tied around
the arch of the foot. To do this, fold a towel in half
across its length and slip the stone into the pocket that
is created by the folded towel. The towel is then tied
around the clients foot with the stone placed directly
over the arch (Fig. 136).
4. The two palm stones are oiled and slipped into the
clients hands by lifting the drape and placing the stone
in the palm. If the stone is too hot, the client may not
be able to hold it, so a washcloth can be placed across
the clients hand for protection.
5. Ground and centerOnce the stones have been placed
on the client, you are ready to open the massage section
of the treatment. Take a moment to ground and center
FIGURE 136 Detail of wrapping the feet with a stone.
by activating the sacral stone and the stone at the midback. To activate the stones, press down on each stone
to increase the clients perception of weight and depth.
As you press down, take three deep breaths with the
client. This creates a nice transition between the placement of the stones and the massage. Some therapists
tap four to six times ceremonially on the sacral stone to
open the session.

The stones for the first leg are removed from the heating
unit before the clients leg is undraped (six to eight stones
of various sizes or one mesh bag of working stones). The
stones are placed in a towel on a moveable cart so that they
are easy to reach.
The leg is undraped, and oil is massaged into the skin.
More oil is used than with a normal massage so that the
stones glide over the skin more easily. Hot stones are then
introduced using a variety of strokes. If the stones become
cool during the massage, they should be changed for a fresh
set of hot stones. All the stones that are not on the body
should be placed back in the heating unit to reheat.
At the end of the posterior leg massage, a cold stone
vascular flush can be performed by taking a hot stone in
one hand and a cold stone in the other and running both
stones over the area with effleurage strokes. The area is
spritzed with an aroma mist, and the stones are placed back
in the heating unit to reheat. The first leg is redraped, and
you move to the second leg.

Once both posterior legs have been massaged, remove the
placement stones from the back and put them in the heating unit to reheat (these stones will be placed on the anterior body when the client is turned into the supine position).
The working stones for the back are removed from the
heating unit and placed close by for easy access. The back
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262
is undraped, and oil is massaged into the skin before the

stones are introduced. Range of motion techniques, such
as the latissimus pin and stretch described previously, and
deep tissue techniques bring variety to the back massage.
At the end of the back routine, finish with a stone vascular flush. An aroma mist is spritzed over the client, and the
stones are put back into the heating unit.
Step 4: Transition to the Supine Position

Before the therapist turns the client, it is a good idea to
quickly reorganize the work area. Any stones left on the
work surface are placed back into the heating unit to reheat. If any stones remain on the clients body, they should
be removed and reheated at this point. Turn the client
into the supine position and pull the drape up around the
shoulders.
Step 5: Anterior Placement

Bolster the clients knees and lay out the anterior placement
stones as shown in Figure 135B.
1. The sacral stone is placed over the navel to act as a belly
stone.
2. Two large placement stones are positioned up the
centerline of the body.
3. The two remaining large placement stones are placed
above the origin of the pectoralis minor muscle on
either side of the body.
4. The feet are wrapped with fresh foot stones, and a toe
stone is placed between each of the toes. It is important to cool the toe stones sufficiently as they can
feel uncomfortably hot in the bony, unprotected area
between the toes.
5. Two fresh palm stones are oiled and placed in the
clients hands. Some clients like to bring their hands
around the edges of the blanket and rest their hands
over the belly stone (sacral stone) instead.
6. The neck stone is placed in the crook of the neck and
then pulled toward the occiput to traction the neck
slightly. This stone can be used either hot (wrap it in a
towel before placing it under the neck) or cold.
Before beginning the anterior massage, take a moment
to activate the two pectoralis minor stones and take a few
breaths with the client. This helps to create a smooth transition into the second half of the massage. Some therapists
gently tap ceremonially four to six times on both ends (at the
same time) of the neck stone to begin the anterior routine.

The stones (six to eight stones of various sizes) for the first
leg are removed from the heating unit and placed in a towel on a moveable cart so that they are easy to reach before
the clients leg is undraped. The leg is undraped, and oil is
massaged into the skin with the hands. Hot stones are introduced to the area with a variety of strokes. At the end of
the posterior leg massage, a cold stone vascular flush can be
performed before the area is spritzed with an aroma mist
and redraped.

Remove six to eight stones from the heating unit to massage the feet. For ideas on foot massage techniques and
reflexology, review Chapter 10 (Spa Foot Treatments). Some
therapists prefer to massage the foot while they are massaging the anterior leg. If so, it helps to remove the toe stones
first. Other therapists choose to delay the placement of the
toe stones until after the foot has been massaged. In this
case, you will remove the toe stones as the end of the neck
and face massage. Note that the toe stones will cool quickly,
and once cool, they often feel uncomfortable to the client,
so they should not be left in place for too long.
SANITATION
The used toe stones and foot stones are
not put back in the heating unit. Instead,
they are put to one side of the heating unit or directly
into warm, soapy water to soak until the equipment is
cleaned and reorganized for the next client. Otherwise,
they might contaminate the water in the heating unit.
Step 8: Abdominal Massage (Optional)

Abdominal massage with hot stones feels soothing and
deeply relaxing and is a nice addition to the stone massage
routine. The abdominal area is undraped and oiled with
the hands. Hot stones are applied in a clockwise, circular
motion. For a massage that aims to relieve chronic lower
back pain, hot stones are very useful for supporting abdominal release during psoas work. However, therapists who are
not experienced in palpation of the psoas should not try to
use a stone for this purpose.
Step 9: Arm and Hand Massage

The upper chest stones, neck stone, and palm stones are
removed to facilitate mobilization of the arm during massage. If the stones are left in place, they may roll or shift
uncomfortably as the arm is moved.
The arm is undraped, and oil is massaged into the
skin before hot stones are introduced. Range of motion
techniques and gentle stretching add variety to the stone
massage. The hand is massaged together with the arm. This
is perhaps one of the more difficult areas in which to use
stones. Reflexology-like pressure point techniques work
well, but stone massage does not feel particularly good on
the posterior side of the hand. It is best to massage the posterior side of the hands without a stone. To finish the area
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Chapter 13
off, cold stones are used in brisk effleurage strokes, and the
area is spritzed with an aroma mist. New stones are removed
from the heating unit for the second arm.
Step 10: Neck Massage

Stone massage for the neck feels best when the neck is mobilized during the work. This opens up the area and allows
the stones to move freely in a flowing arc. The stones are
used only in flat positions on the anterior neck to protect
the client. In the posterior areas, an edge may be used to
work deep into the suboccipitals and upper trapezius.

The face is massaged with warm (120F) or cooled stones.
Light upward strokes with the edge of the stone will allow
Stone Massage
263
you to avoid the use of oil on the face. Ideas for face massage techniques are described in Chapter 5 (Foundation
Techniques for Spa Treatment Delivery). As the facial massage comes to an end, a warm stone can be placed on the
forehead. This stone remains in place while all of the other
stones are removed.
Session End
You may choose to end the massage with a full-body aroma
mist that fills the treatment room with a refreshing scent.
The belly stone and forehead stone are removed at the very
end of the session.
Some spas and clinics give the client a small stone to take
home after their stone massage. This is a nice way to say
thank you to the client and to remind them to come back
and get another treatment.
SPA FUSION
STUDY TIP: Practice Clients Are Not Clients
CHAPTER WRAP-UP
In massage and spa classrooms, it is easy to check

out when you act as the client and feel that the student acting as a therapist and practicing his or her
skills is like a real therapist and therefore completely
responsible for the session. In fact, as a client, you
have an important role to play in your peers learning
process. Stay alert and comment on everythingthats
rightgive lots and lots of feedback. When you feel a
technique really works, say so. If you feel something
less than great, give feedback for what would make it
feel better. If something makes you uncomfortable,
say so. This consistent feedback will help your classmate adjust his or her techniques and polish skills.
You learn because you stay alert during the session
and figure out what works and what doesnt through
your experience as a client.
In stone massage, both hot and cooled stones can be

combined with various massage techniques to produce a unique treatment that can be adapted to meet
each clients needs. Stone massage can be given for
relaxation, injury rehabilitation, energy balance, deep
tissue, and reflexology work. It can also be incorporated into other spa treatments as an accent or to provide
textural variety. Because of the heat involved in stone
massage, the body tends to react more strongly to this
service. This usually results in a deep muscular release,
deep relaxation, and a decrease of stress. Specialized
approaches to stone massage often evolve as therapists
begin to experiment with the stones, using them to
replicate and extend their existing massage techniques.
Stone massage techniques can be used in a variety of
situations and will introduce the earth element into
any treatment.
GOOD TO KNOW: Avoid the Burn!

Burns from hot stone massage are the highest claim
area at Associated Bodywork and Massage Professionals (ABMP), the largest professional membership
organization in the United States. ABMP reports that
clients get burned when stones are left in one position on bare skin. Always place a thick towel between
clients and stones left in one place and keep your
stones within safe temperature ranges. Dont practice
stone massage on clients until you have obtained
massage liability insurance.
REVIEW QUESTIONS
Multiple Choice
1. Placement stones are used to:
a. Warm a body area by being placed on the client
b. Facilitate deeper breathing when placed on the
belly
c. Draw the clients awareness to an area of tension
to facilitate relaxation
d. All of the above
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264
SPA FUSION
2. Working stones refer to:
a. Stones that will be used for deep tissue
techniques only
b. Stones that are placed on areas of tension
c. Stones used in the late subacute stage of
inflammation for cross-fiber friction techniques
d. Stones that are held in the therapists hands
during a massage technique
Fill in the Blank

6. List three contraindications to hot stone massage
7. List three indications for hot stone massage
3. A stone vascular flush refers to:

a. A hot pack held down with stones
b. A cold pack held down with stones
c. One hot stone and one cold stone ran over a
body area at the same time
d. All of the above
4. Stones included in a spa treatment introduce the:
a.
b.
c.
d.
Sea element
Sky element
Water element
Earth element
5. Hot stones should never be heated hotter than:

a.
b.
c.
d.
120F
130F
135F
140F
8. The therapist should always wear

during the treatment in case the client moves
suddenly, sneezes or coughs, and sends his or her
placement stones flying.
9. Hot stones should never be placed directly onto
the clients
. Instead, a drape should
be used to provide some insulation.
10. Essential oils can be used with hot stone massage
at low concentrations. This ensures that the oils
will not cause
with heat.
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14
Culturally Based
Spa Treatments
Chapter Outline
K e y Te r m s
Ayurvedic-Inspired Spa Treatments
Abhyanga: Massage with oil provided by one, two, or more therapists.

Ayurveda: The traditional natural medicine system of India dating back
over 5,000 years.
Balinese Boreh: The Balinese Boreh is an Indonesian traditional
medicine treatment that is used to ward off or to treat a chest cold,
cough, influenza, or fever.
Doshas: One of three subtle energies (vata, pitta, kapha) that hold
together two of the five elements.
Javanese Lulur Ritual: The Javanese Lulur Ritual is a traditional beauty
treatment used by Javanese princesses as they prepare for their
weddings.
Kapha: A dosha that is a combination of earth and water.
Pitta: A dosha that is a combination of fire and water.
Prakriti: The constitution or inherent characteristics of a person
including the physical type, mental type, and emotional type.
Shirodhara: The application of a thin stream of oil to the forehead to
reduce vata disorders and bring calm to the mind and body.
Taila: Medicated massage oil that is made by cooking herbs into a fatty
base such as sesame or coconut oil.
Ubtan: An herbal paste used to support detoxification and smooth the
skin. It is applied externally to the body.
Vata: A dosha that is a combination of space and air.
Vikrti: An individuals diet, environment, work stress, mental or
emotional trauma, relationships, or physical injury may cause the
prakriti (dosha constitution) to become unbalanced. The unbalanced
state is referred to as a vikrti state.
Core Concepts in Ayurveda

Indian Head Massage
Abhyanga
Udvartana
Shirodhara
Indonesian-Inspired Spa Treatments

Indonesian Spa Products
Treatment Considerations
Indonesian-Inspired Massage
Indonesian-Inspired Exfoliation and Body Wrap
Treatments
Balinese BorehInspired Treatment
Javanese Lulur Ritual
S
SPA
FUSION
STUDY TIP: Make It Personal
MASSAGE INSPIRATION: Get Some New Culture!
CHAPTER WRAP-UP
265
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266
Ayurvedic-inspired
spa treatments and Indonesian-
inspired spa treatments are based in countries that have

rich histories and complex cultures. The environment, the
people, the traditional medical systems, and the myths from
India and Indonesia come alive through these massage
methods, natural spa products, and unique treatments. The
first section of this chapter explores ayurvedic bodywork and
spa applications including Indian head massage, abhyanga,
udvartana, and shirodhara. The second section of this chapter
looks closely at the natural plant products from Indonesia,
which infuse their medical and spa practices with luxury
and opulence. For students who are rapidly advancing in
their spa skills, ayurvedic and Indonesian treatments will
offer some new challenges that keep learning fun and
interesting.
These include surgery; medicine; gynecology; pediatrics;

toxicology; ear, nose, and throat; rejuvenation; and virilification therapy (treatments that improve fertility). In each
of these branches, detoxification, diet, yoga, herbal medications, external treatments (e.g., massage), and meditation
will play a role in the healing or strengthening process.
Although there are some spas in the United States and
the United Kingdom that are designed as ayurvedic medical centers where ayurvedic physicians work together with
a highly trained support staff, most American spas do
not focus on the treatment of disease. Instead, they adopt
elements of ayurveda that focus on positive life choices,
general detoxification, relaxation, enhanced spiritual awareness, and gentle exercise. This is a positive practical use of a
complex traditional healing method that might otherwise
be inaccessible and readily dismissed by Westerners.
This chapter aims to introduce some of the core concepts of ayurveda that support the practice of ayurvedic
body treatments that are commonly offered at spas, such
as Indian head massage, abhyanga, shirodhara, and udvartana, which are well suited to dry room delivery. Other
external treatments are described in Table 141, and a few
are shown in Figure 141.
Core Concepts in Ayurveda
Ayurvedic-Inspired Spa Tr
TTreatments
reatments
Ayurveda is both a traditional medical system and a philosophy that offers keys for creating harmony and balance in
life. In Sanskrit, ayur means life, and veda means knowledge.1
Traditional ayurveda, which developed in Southern India
and Sri Lanka, includes many elements of practice that
require years of careful and dedicated study. The ayurvedic
physician will have had at least 5 years of specific training
and a year of supervision in a hospital. He or she will follow
a rigorous patient examination process before arriving at
a diagnosis and treatment plan. The eight branches of traditional ayurveda are integrated into a holistic practice.
The foundation of traditional ayurveda is based on the

belief that everything in the universe is composed of five
elements (panchamahabhutas). These elements (eternal substances) provide a means for understanding the nature
of the universe and ourselves. They are space (sometimes
referred to as ether), air, fire, water, and earth. Each of these
elements has specific qualities that intermix in the body and
when combined with the soul, form a unique individual.
The five elements can be related to different parts of the
body, to the senses that help us interpret the world, and to
particular actions that produce change (Table 142).2 Specific combinations of the five elements make up the three
doshas (tridoshas).
FIGURE 141 Other ayurvedic-inspired body treatments.
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Chapter 14
Culturally Based Spa Treatments
267
TABLE 141 Traditional and Ayurveda-Inspired Body Treatments

NAME
BRIEF DESCRIPTION
MAIN INDICATIONS
Shirodhara
A thin, thread-like drizzle of refined sesame oil is poured across the

forehead to bring calmness of mind, body, and spirit.
Aggravated vata, insomnia, and anxiety
Udvartana
This is an invigorating massage delivered with the application of an

herbal paste.
Increased circulation; cleanses, exfoliates, and tones the

skin; stimulates weight loss; supports detoxification;
good for kaphas
Garshan5
One or two therapists briskly massage the client wearing raw silk
gloves.
Increased circulation, toxin removal, weight loss, used to

increase energy; good for kaphas
Swedana
This is an herbal steam bath usually given after a massage.
Detoxification, balancing for vata and kapha types.
Vishesh5
This is a firm massage that uses deep strokes and squeezing

movements.
Detoxification, muscle soreness; particularly indicated for

kapha types
Pizzichilli
Large amounts of warm oil are poured over the body while two or
more therapists perform massage.
Indicated to decrease muscle pain and to bring flexibility

to joints; indicated for vatas but contraindicated for pitta
types
Pinda
The client is massaged by one or two therapists who hold muslin

bags full of rice, milk, and herbs. This leaves the client very
relaxed and the skin smooth.
Indicated for dry, rough skin; this is very relaxing and has
a particular and unmistakable fragrance; cooling for
pittas
Kati basti5
A massage using heat and specific medicated oils to address lower

back pain.
Lower back pain, rigidity of the lower spine
Abhyanga
A massage performed by one, two, or more therapists working in

synchronicity. The strokes are varied depending on the dominant
dosha of the client.
To bring balance to the doshas, to increase circulation,

and aid detoxification
Bindi
Bindi means point or origin. Spas combine different elements

to make their own unique bindi treatment. These elements
might include a hydro soak, botanical mask, exfoliation, and
herbal wrap.
To bring balance to the doshas, to increase circulation

and detoxification, and to smooth the skin
Dosha wrap
Like the Bindi treatment, spas mix and match elements for this wrap.
It usually includes a custom blend of oils for the clients dosha, an
exfoliation, massage, and wrap in warm towels or sheets.
To bring balance to the doshas, to increase circulation

and detoxification, and to smooth the skin
TABLE 142 The Five Elements (Panchamahabhutas)

ELEMENT
BODY PART
SENSES
QUALITY
TASTE
ACTION
Space (also
called ether)
Relates to spaces in the body:

mouth, nostrils, abdomen,
respiratory tract, cells
The ears:
Sound
Smooth, soft, subtle,

porous, non-slimy
No taste
Creates softness,
lightness, and
porosity
Air
Relates to movement: muscle,

pulse, respiration, peristalsis, movement in cells
The skin:
Touch
Rough, light, dry, cold,

soluble
Astringent
and slightly
bitter
Creates lightness,
dryness, and
emaciation
Fire
Relates to metabolism,
digestive processes, and
intelligence
The eyes:
Sight
Rough, bright, heating
Pungent
Creates an increase
in temperature,
burning sensations,
improved eyesight,
improved digestion
Water
Relates to plasma, blood,

saliva, digestive liquids,
mucous membranes, and
cytoplasm
The tongue:
Taste
Cold, fluid, moist,

heavy, slimy, emollient,
purgative
Sweet with
astringent,
sour, saline
Creates moisture,
glossiness; increases
fluid content
Earth
Relates to bones, teeth, nails,

muscles, tendons, skin,
hair, cartilage
The nose:
Smell
Heavy, dull, thick, firm,

immobile, compact,
strong, rough, emollient,
purgative
Sweet
Creates firmness,
strength, hardness
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268
The Three Doshas (Tridoshas)
state (vikrti) allows disease to take root. When an individual

practices ayurveda, he or she is mindful of the activities and
life choices that aggravate and pacify his or her particular
prakriti. This allows the person to make choices that promote
balance and harmony and thereby decrease stress and disease.
Although a person may have a dominant dosha, this
does not mean that the doshas are static. Like everything in
life, the doshas are in a constant state of transition. A certain situation may aggravate one dosha but pacify another
dosha. Sometimes, a client will exhibit physical, mental, and
emotional traits that indicate that he or she is decidedly a
kapha (prakriti), but the current condition suggests that he
or she has a pitta imbalance (vikrti). During the treatment
session, you will aim to pacify the pitta imbalance, and the
long-term treatment goal might be to bring overall balance
to the clients kapha-dominant prakriti.
The doshas, known individually as vata, pitta, and kapha,

can be viewed as vital body energies and as the energies
that underlie all things in the world. In nature, the doshas
govern different times of the day or night and different seasons or climates (Fig. 142). In the body, each dosha governs
specific physiological functions. The way that the doshas
combine in an individual governs the body type, mental
and emotional characteristics, and personality. Although
every individual has elements of all three doshas, one or
more of the doshas will be dominant. This unique dosha
combination is referred to as a persons doshic prakriti
(constitution) and is believed to be determined by karma
from the persons previous lives.3
In the simplest terms, an individual is healthy when the
three doshas are in a state of balance. An unbalanced dosha
Pitta
10
Kapha
Late winter, early spring
and summer, or anytime
it is cold, wet, dull
and still
Organized,
ambitious,
logical, focused,
confident
Stable,
grounded,
strong,
faithful,
slow
Mid to late summer or

any time it is hot or
humid
2
Quickness
of mind,
enthusiasm,
energy,
movement
Vata
Fall, early winter, or
anytime it is cold,
windy, and dry
6
Attention and attunement to the natural world and its rhythms is one way to keep the doshas in balance. In
ayurveda, time, the seasons and the phases of life are governed by the doshas. Through mindfulness to the
dosha clock and dosha season, greater harmony, balance, and health are achieved.1
Wake up: It is best to wake up during vata time (by 6:00 AM) to start the day with vata qualities (quick and
energetic). Sleeping into kapha time (past 6:00 AM) gives the day kapha qualities (slow and heavy).
Exercise: Exercise is best during the early phases of kapha time (6 to 10 AM and 6 to 10 PM) because the body
will be at its strongest and have the most stamina. Exercise during the middle of the day tends to aggravate
pitta and can lead to feelings of irritability.
Work: Focus, organization, planning, and clear communication are at their best during pitta time from 10:00 AM
to 2:00 PM. In the evening pitta cycle from 10:00 PM to 2:00 AM, pitta qualities enhance the dream state.
Main meal: Pitta governs metabolism and the absorption of nutrients from food. For this reason, it is
important to eat the main meal during the middle of the day during pitta time, around 12:00 noon. Digestive
processes slow during kapha time, so avoid eating anything heavy after 6:00 PM.
Sleep: To fall asleep quickly and to have a sound sleep throughout the night, ayurveda recommends bed before
10:00 PM (before kapha time ends). This allows a complete nights rest before the next kapha cycle begins.
FIGURE 142 A dosha-mindful day.
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269
TABLE 143 Vata Dosha Profile

FACTORS THAT AGGRAVATE
Rainy, cold or windy weather
The seasons of fall and early winter
Vata-increasing foods (foods that are cold,
dry, light, bitter, and astringent, including raw vegetables, dried fruits, red meat,
stimulants such as coffee or soda, dried
beans)
Physical overexertion
Irregular eating
Snacking between meals
Lack of sleep
Mental overstimulation
Emotional upset
VATA MASSAGE AND FOOT BATH

Vata Massage Long, smooth strokes and
efficient draping; quiet music or silence;
darkened room; extra oil; warm packs;
grounding elements such as guided breathing exercises, guided meditation, or warm
stones placed on areas of tension. Massage
oils include sesame, olive, almond, and
ghee (clarified butter).
Vata Foot Bath (using herbs recognizable to
the Western therapist)
Fill a muslin bag with cup of mixed herbs
that include ground ginger, sandalwood,
eucalyptus leaf, calamus, and basil. Cover
this bag with boiling water and allow it to
steep for 20 minutes while it cools. Add
cool or hot water as needed to adjust the
temperature for the foot soak.
AGGRAVATED VATA DISEASE

Arthritis
Musculoskeletal disorders
Paralysis
Cardiovascular disorders
Digestive disorders
Constipation
Diarrhea
Foot diseases and disorders
Mental instability
Quiet time
Chanting or calming music
Massage with warm sesame oil
Warm, natural colors
Sweet, gentle, and calming scents
Vata-decreasing foods (food that is rich,
oily, and moderately spicy, including dairy
products; grains; natural sweeteners such
as honey; cooked vegetables; sweet, sour,
and heavy fruits; chicken; seafood and
turkey; herbs and spices)
Regular sleep
Structured routine
Grounded and creative exercise such as
gardening and dance
VATA HERBS
VATA ESSENTIAL OILS
Traditional herbs that are used to pacify vata

or to make vata taila are listed below.
Ayurveda suppliers are listed in the back of
the book. Suppliers will have a variety of
premade taila that are easy to use.
Agnimantha (Premna integrefolia),
ashwagandha (Withania somnifera), bala
(Sida cordifolia), bhringaraj (Eclipta alba),
bilva (Aegle marmelos), brihati (Solanum
indicum), chandana or sandalwood
(Santalum album), gokshura (Tribulus terrestris), jatamansi or spiknard (Nardostachys
spp.), kantakari (Solanum xanthocarpum),
neem (Azadirechta indica), patola (Trichosanthes cucumeria), prasarini (Paederia foetida),
punarnava (Boerrhavia diffusa), tulsi or sacred
basil (Ocimum sanctum), vacha or calamus
(Acorus calamus)
Angelica, anise, basil, bay laurel, birch

(sweet), black pepper, cajeput, camphor
(white), caraway, cardamom, cedarwood (atlas), cinnamon (caution), clove
bud (caution), eucalyptus, sweet fennel,
frankincense, geranium, ginger, jasmine,
lavender, lemon, lemongrass, myrrh,
nutmeg, orange (sweet), rose, spikenard,
sage (clary), turmeric, valerian, wintergreen
Sample Vata Massage Blend 2 oz of sesame
or almond oil, cardamom (12 drops),
clary sage (8 drops), ginger (6 drops;
buy the ginger CO2), spikenard (3 drops),
lemongrass (1 drop)
Sample Vata Aura Mist Blend 2 oz of
purified water in a mist bottle, bay laurel
(8 drops), eucalyptus (3 drops), jasmine
(2 drops), sweet orange (10 drops),
lavender (4 drops).
The Dominant Vata Profile

Vata is the strongest of the three doshas and combines the
elements of space and air. The word vata means to move
or to enthuse. These words describe the vata tendency to
move so quickly or to move so much that balance is lost.
It is not surprising then that vata is the dosha most likely to
become unbalanced. Table 143 provides an overview of the
vata profile for quick reference.
General Vata Qualities
Vata governs both the physical and mental movements of
the body, including thought processes; circulation of blood;
conduction of impulses in the nervous system; elimination
of wastes; and muscular movements such as walking, lifting, and speaking. The vata season is autumn and early winter and any day that is cold, dry, and windy. Each dosha will
have its own qualities. Vata qualities are described as dry,
light, cold, subtle, unstable, rough, clear, and transparent.
Vata Body Type
People with vata as their dominant dosha will tend to be
thin or angular. They may be short or very tall. The skin
FACTORS THAT PACIFY
and hair is typically dry and rough, the teeth are large, the
mouth is small and thin, and the eyes are dull and dark.
Vatas are highly active and have difficultly gaining weight
despite the fact that they are fond of sweet foods.
Vata Mental and Emotional Characteristics
The vata mind is restless, sensitive, and flexible. Although
recent or minor events may be recalled with exacting precision, long-term memory is weak. A balanced vata is creative,
filled with enthusiasm, artistic, and open-minded. This sensitivity of mind, however, often leads the unbalanced vata
to emotional insecurity, anxiety, and even to deep-seated or
irrational fear. Vatas sleep little, and the sleep they do get is
easily interrupted.
Factors That Aggravate or Pacify Vata
Vatas are easily aggravated by situations that are overstimulating, such as noisy parties, an overindulgence in TV
or Internet surfing, confrontational situations, or conditions where others are stressed or intense. Vatas need quiet
sounds or calming music, gentle talk, soft touch, and a
structured routine. Foods should be warming; uncooked
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270
or raw foods are kept to a minimum. When a vata is out of

balance, he or she may experience joint pain, arthritis, constipation, high blood pressure, heart disease, and mental
instability.
Spa Techniques That Pacify Vata or a Vata Imbalance
Vata qualities are as dry, light, cold, subtle, unstable,
rough, clear, and transparent. A person who is a dominant vata or who has a vata imbalance will need to pacify these qualities with treatments that are oily, heavy,
warm, obvious, stable, smooth, dark, and opaque. For the
Western therapist, using these words to match a treatment to a client can feel a bit challenging. Instead of getting attached to these words, you are encouraged to view
them as metaphors and to use them to explore ayurvedic
influences, promote creativity, and have fun. For example,
a classic treatment for vata or a vata imbalance is the shirodhara treatment, where a thin stream of oil is played
across the forehead. The oil is oily (balances dry), heavy
(balances light), warm (balances cold), obvious (balances
subtle: oil is being poured on the head, and this is observable and palpable), stable (balances unstable: the sensation of the oil running down the head pulls the minds
eye to one point, which helps to focus the mind creating
stability), smooth (balances rough; the oil feels smooth),

and dark and opaque (balances clear and transparent: the
treatment happens with the clients eyes covered or closed
in a darkened and quiet room). During this treatment, it
is not uncommon for the client to explore internal mental
and emotional spaces that are not as clear and transparent
as everyday experience.
In another example, the vata client or client with a vata
imbalance is not contraindicated for the udvartana treatment (a treatment where an herbal paste is smoothed onto
the body and then buffed off with towels), but the treatment will need to be modified. The ubtan (herbal paste)
should be mixed up with extra oil (oily balances dry), and
it should not be buffed off (buffing is rough, and vata is
already rough). Instead, the paste can be removed with
hot, moist towels, making long, smooth sweeps (warm and
smooth balances cold and rough) or in a soaking tub (warm
and wet balances cold and dry).
The Dominant Pitta Profile
In Sanskrit, pitta means to heat or to burn. Pitta is considered the dosha of transformation and is composed of the
elements of fire and water. Table 144 provides an overview
of the pitta profile for quick reference.
TABLE 144 Pitta Dosha Profile

Hot or humid weather
Mid to late summer
Hot rooms or being overdressed in a warm
environment
Irregular meals
Pitta-increasing foods (foods that are salty,
sour, light, pungent, too oily, and acidic
foods, including cheese, yogurt, hot
peppers, tomatoes, garlic, onion, citrus
fruits, tofu, peanuts, fish, red meat)
Excessive mental activity
Long periods indoors
Alcohol consumption
Uncommitted relationships
PITTA MASSAGE AND FOOT BATH
Pitta Massage Slow, calming strokes and
efficient draping; darkened room; rhythmic
and melodic music; and moderate oil and a
grounded massage therapist. Massage oils
include coconut, sunflower, safflower, and
ghee (clarified butter).
Pitta Foot Bath (using herbs recognizable to
the Western therapist)
that include chamomile flowers, lavender
flowers, peppermint, and lemongrass. Cover
this bag with boiling water and allow it to
steep for 20 minutes while it cools. Add
cool or hot water as needed to adjust the
temperature for the foot soak.
AGGRAVATED PITTA DISEASE

Burning sensations in the body
Impaired vision
Skin disorders and itching skin
Indigestion and diarrhea
Ulcers
Blood disorders
Jaundice
Excessive perspiration and foul body odor
FACTORS THAT PACIFY

Soft music
The sound of water
Massage with coconut oil
Cool colors with blue, green, or cream hues
Pitta-decreasing foods (basmati rice, oats,
wheat, unprocessed sugars such as
maple syrup, vegetables that are not spicy,
grapes, raisins, apples, nuts in moderation,
chicken, turkey)
Increased water intake
Walks by water or in cool forests
Stable relationships
PITTA HERBS
PITTA ESSENTIAL OILS
Some traditional herbs that are used to pacify

pitta or to make pitta taila are listed below.
Ayurveda suppliers are listed in the back of
the book. Suppliers will have a variety of
premade taila that are easy to use.
Agaru (Aquilaria agalocha), bala (Sida
cordifolia), brahmi or gotu kola (Centella
asiatica), ela or cardamom (Eletteria cardamomum), guduchi (Tinospora cordifolia),
laksha (Lacifera lacca), manjishtha (Rubia
cordifolia), musta (Cyperus rotundus),
sariva (Cryptolepis buchanani), shatavari
(Asperagus racemosus), sveta chandan or
white sandalwood (Santalum alba), ushira
or vetiver (Vetivera zizanoides), yastimadhu
or licorice
Camphor (white), cardamom, chamomile

(German or Roman), champaca, coriander,
fennel (sweet), gardenia, geranium, jasmine, lemongrass, lime, myrrh, peppermint,
rose, sandalwood, spikenard, turmeric,
valerian, wintergreen, yarrow
Sample Pitta Massage Blend 2 oz of olive or
coconut oil, coriander (9 drops), geranium
(2 drops), lavender (8 drops), vetiver
(1 drop), peppermint (1 drop), sandalwood
(9 drops)
Sample Pitta Aura Mist Blend 2 oz of
purified water in a mist bottle, jasmine
(4 drops), lime (20 drops), lemongrass
(1 drop)
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271
General Pitta Qualities

Pittas functions include digestion, heat production, appetite, intellectual tasks, vision, the softness and suppleness
of the body, and the imparting of color to the body. The
pitta season is middle and late summer or any day that
is hot and/or humid. Pitta qualities are described as hot,
sharp, bright, liquid, slightly oily, sour, and pungent.
gentle treatment that is not too stimulating). Some ayurveda treatments are contraindicated for pittas. The pizzichilli
treatment where large amounts of warm oil are poured over
the client while he or she is massaged is too hot and too oily
for pittas. Similarly, swedana, an herbal steam bath, may also
be too hot for pittas. They may enter the steam but need to
come out sooner than a vata or kapha.
Pitta Body Type

People with pitta as their dominant dosha will tend to be
of medium build and gain or lose weight easily. They often
have light or red hair that is fine and soft in texture. Pittas hair may gray or fall out prematurely. They have hot,
sweaty bodies and experience intense hunger pains. Pittas
eyes are light blue or gray in color and may easily turn red
in the summer, after bathing, or after intense mental work.
Pittas tend to have fair skin with prominent freckles, birthmarks, or moles; the nose and chin are pointed. Pittas sleep
soundly but lightly and may sleep for short periods of time.
They like strong foods with sweet, bitter, or intense flavors.
The Dominant Kapha Profile

Kapha means to keep together, to embrace, and also
phlegm. A combination of earth and water, kapha expresses
itself in nature as the solid structures of rock and mountain.
Table 145 provides an overview of the kapha profile for
quick reference.
Pitta Mental and Emotional Characteristics

The pitta mind is aggressively sharp with a clear memory
and the ability to precisely articulate thoughts and ideas.
Pittas are ambitious, organized, and focused. They have a
tendency to become emotionally intense and are prone to
irritability and jealous behavior. They may become perfectionists and show little latitude to individuals around them
that are vague or indecisive. When pittas are in balance, they
are confident, bold, and brilliant. When they are out of balance, they are irritable, aggressive, impatient, and critical.
Factors That Aggravate or Pacify Pitta
Pittas are aggravated by overheated rooms, overexposure to
the sun, or too much clothing in overwarm environments.
Although pittas are strong and determined in an argument, too much confrontation leads to imbalance. Pittas
should have regular meals and drink adequate amounts of
cool water. Excessive alcohol or spicy foods as well as eating
while emotionally upset aggravate pitta. Pittas must balance mental activity with outdoor time. Walking in green
forests or next to water is particularly calming.
Spa Treatments That Pacify Pitta or a Pitta Imbalance
Pitta qualities are described as hot, sharp, bright, liquid,
slightly oily, sour, and pungent. A person who is a dominant pitta or has a pitta imbalance will need to pacify these
qualities with treatments that are cool, soft, dark, solid,
slightly dry, sweet, and mild. A classic treatment for the
dominant pitta or a client with a pitta imbalance is pinda.
Pinda is a treatment in which the body is massaged with
muslin bags full of rice and herbs that have been cooked in
milk. Pinda is cooling (balances hot), soft (balances sharp:
the muslin bags create the sensation of being massaged
with rice pudding), slightly dry (balances slightly oily: no
oil is used, so the treatment is not as oily as a massage or
shirodhara), sweet (balances sour: the milk, herbs, and rice
smell sweet and yet exotic), mild (balances pungent: this is a
General Kapha Qualities

Kapha is the most stable of the doshas, and this stability
functions as both physiological and psychological strength
in the human body through anabolic or building processes,
mucous membranes, phlegm, fat, and the lymphatic system.
The kapha season is late winter and spring or any day that is
cold, wet, dull, and still. Kapha is the dosha that is the least
likely to go out of balance. Kapha qualities are described as
heavy, cold, soft, viscous, sweet, stable, and slimy.
Kapha Body Type
A person with kapha as his or her dominant dosha is likely
to be tall and solidly built or short and stocky with a large
frame and a tendency to gain weight. Kapha hair is thick,
soft, dark, and oily. Kaphas have round faces; large, expressive eyes; full mouths with small, white teeth; and pale,
often oily skin. Kaphas have a steady appetite and slow
metabolism. They like bitter, pungent, and sharp tastes.
They need the most sleep of all the doshas and will sleep
soundly when other dosha types would be disturbed.
Kapha Mental and Emotional Characteristics
The kapha mind absorbs information slowly but has a
strong, long-term memory. Kaphas speak slowly and precisely after carefully considering their position on a topic.
They are the most loyal, patient, and compassionate of the
dosha types, with a loving and emotionally secured nature.
The stability and grounded nature that gives kaphas their
reserves of strength and their steadiness of personality also
makes them reluctant to change or release possessions.
When in a balanced state, kaphas are content, supportive of
others, loving, and affectionate. When they are out of balance, they sleep too much; overindulge in food; have a predisposition to laziness; and may exhibit greedy, possessive
behavior.
Factors That Aggravate or Pacify Kapha
Kaphas require plenty of vigorous exercise, bright colors,
and upbeat music. Overeating, oversleeping, and eating
very salty or very sugary foods aggravates kapha and leads
to an imbalanced state where the kapha feels bored, listless,
and too dependent on loved ones. An out-of-balance kapha
may be prone to obesity or its opposite, emaciation; to conditions of excess mucus; to loss of joint function (kapha
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272
TABLE 145 Kapha Dosha Profile

Wet, cold, dull, or still weather
The seasons of late winter and early spring
Kapha-increasing foods (foods that are
heavy, oily, cold, sweet, salty, or sour,
including dairy products; sweets; sweet
fruits such as avocados, bananas, coconut,
and citrus fruits; nuts; red meat; dark meat;
oily fish; salt; cold, carbonated drinks)
Lack of exercise
Overeating
Too much sleep and taking naps
Overdependence on loved ones
Not allowing change
KAPHA MASSAGE AND FOOT BATH

Kapha Massage Stimulating, fast paced,
firm, and non-oily. Powders (dry ubtan)
may be used instead of oil. If oil is used, it
should be lightweight and warming such as
safflower, apricot kernel, sunflower, sesame,
and mustard oil.
Kapha Foot Bath (using herbs recognizable
to the Western therapist)
that include basil, ground ginger, eucalyptus leaf, and common sage leaf. Cover this
bag with boiling water and allow it to steep
for 20 minutes while it cools. Add cool or
hot water as needed to adjust the temperature for the foot soak.
AGGRAVATED PITTA DISEASE
FACTORS THAT PACIFY
Weight gain or obesity

Skin irritations
Anorexia
Disorders caused by excess mucus
Goiter
Indigestion
Allergy and asthma (in traditional ayurveda,
these two disorders as well as chronic
eczema are believed to be inherited from life
in the womb)
Diabetes (starts as kapha and exacerbates
pitta and vata in latter stages)
Sinus problems
Regular exercise
Regular mental stimulation
Change of routine
Kapha-decreasing foods (foods that are light,
dry, warm, spicy, bitter, and astringent,
including most grains; vegetables; light
fruits such as apples, pears, and berries;
beans; and spices)
Bright colors
Upbeat music
Stimulating and mucus-reducing scents
such as eucalyptus, rosemary, and white
camphor
Relationships that encourage appropriate
autonomy
KAPHA HERBS
KAPHA ESSENTIAL OILS
Some traditional herbs that are used to pacify

kapha or to make kapha taila are listed
below. Ayurveda suppliers are listed in
the back of the book. Suppliers will have
a variety of premade taila that are easy
to use.
Chitraka (Plumbago zeylonica), deodar or
Himalayan cedar (Cedrus deodar), kavavira
(Nerium indicum), manjishtha (Rubia
cordifolia), neem (Azadirechta indica),
nirgundi (Vitex negundo), punarnava
(Boerrhavia diffusa), tulsi or sacred basil
(Ocimum sanctum), vacha or calamus
(Acorus calamus)
Anise, angelica, basil (sweet), bay laurel,

birch (sweet), black pepper, cajeput,
camphor (white), caraway, cardamom,
cedar (atlas), clove bud (caution),
cinnamon (caution), eucalyptus, frankincense, fir, ginger (buy the CO2), myrrh,
nutmeg, parsley, peppermint, pine needle,
rosemary, sage (common), tea tree, thyme,
turmeric, valerian, wintergreen
Sample Kapha Massage Blend 2 oz of
sunflower oil, myrrh (12 drops), cinnamon
(2 drops), sweet birch (4 drops),
eucalyptus (4 drops), common sage
(4 drops), rosemary (4 drops)
Sample Kapha Aura Mist Blend 2 oz of
purified water in a mist bottle, bay laurel
(4 drops), thyme (4 drops), fir (2 drops),
anise (2 drops)
governs body lubrication); to depression; and to mental

confusion.
Spa Treatments That Pacify Kapha or a Kapha Imbalance
Kapha qualities are described as heavy, cold, soft, viscous,
sweet, stable, and slimy. An individual who is a dominant
kapha or has a kapha imbalance will need to pacify these
qualities with treatments that are light, warm, sharp, liquid,
pungent, variable, and dry. For example, a classic treatment
for kapha or a kapha imbalance is udvartana, where the body
is massaged with an herbal paste (ubtan). In this case, the
herbs are used dry (similar to an herbal powder), or they are
blended with water or milk, and no oil is used (dry balances
slimy). Udvartana is stimulating (balances heavy), warming
(balances cold), textured and rough (balances soft: dry hand
towels are used to buff off the herbal paste), spicy (balances
sweet: ubtan contains mustard powder and various spices),
and vigorous (balances stable). It invigorates and energizes
the body, balancing the kapha tendency to remain at rest.
In another example, the kapha client or client with a
kapha imbalance is not contraindicated for the shirodhara
treatment, but the treatment will need to be modified.

Instead of oil (the kapha is already slimy and viscous),
warm milk or salt water is used (liquid, light, variable).
Marma Points
Marma points are energy centers in the body that are traditionally used with Indian massage and ayurvedic healing.4
The name marma means secret, hidden, and vital. They connect the physical body with subtle energy bodies and often
relate to specific organs or body areas. Marma points are
massaged in order to restore the body to normal function,
balance the bodys energies, and either energize or relax the
body as is necessary for improved health. Although specific
marma points and gentle balancing methods are described
in this text, it should be understood that this is a brief
introduction to a complex system of healing. In fact, many
traditional ayurveda physicians warn against the practice of
marma therapy by anyone without specific training. This
draws attention to the need for sensitivity and respect by
the therapist when working with these dynamic points.
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Chapter 14
Marma points are located on the body by taking finger measurements from identifiable starting points.
An individuals marma points will be specific to his or her
body. For this reason, the clients fingers are traditionally
used to do the measuring. Marma points can be quite large
(as much as 6 inches across), so in a modified treatment, it
is best if you approximate and palpate for the point while
allowing the client to relax.
These points are primarily massaged with the thumb
(sometimes, the fingertips, knuckles, fist, palm of the hand,
or heel of the foot are used), after a drop of warm oil or a specific taila (medicated oil described below) has been applied
to the point. Most often, the point is massaged in clockwise
circles to strengthen and tone the tissue, but sometimes,
counterclockwise motions are used. Direct pressure for
1 to 3 minutes can be used to stimulate a point. Often, the
therapist will begin at the center of the point and make ever
larger circles until the entire point has been massaged for
3 to 5 minutes. The pressure should be firm but not hard.
If the client experiences any discomfort, the pressure on
the point is too deep.1 Table 146 provides an overview of
some marma points, whereas Figure 143 shows the general position of the points. In Table 146, specific essential
oils are given for each point, but you need to choose the
essential oil for each point based on the dosha and condition of the client and on the treatment goals. It should also
be noted that many of the oils indicated by ayurvedic therapists are quite strong (e.g., cinnamon and basil) and should
only be used in a diluted form (6 drops to 1 fl oz of carrier
oil is recommended).
Prana
Prana is spiritual, physical, and mental energy. This vital energy is the fundamental life force of the body and the source
of all knowledge. From the Sanskrit for breath, Prana
flows through a network of subtle energy channels that can
be likened to the Chinese concept of meridians, called nadis.
The breath is the main medium that Prana uses to enter the
body. It enters the body on the inhalation and leaves the
body on the exhalation of breath. When the body is healthy,
Prana flows continuously creating vigor, life, spirit, passion,
and self-determination. Too little Prana in the body is often
experienced as a feeling of being stuck, a lack of motivation,
or fatigue. This type of depressed state can lead to illness.
Stress can affect the amount of Prana and the way it flows
through the body, leading to a condition where disease can
take root.
Ayurvedic therapies are a form of communication with
Prana. For example, your attitude as a therapist is as important as the way that you apply strokes. Sincerity, a sense of
wonder, honor for the client and for yourself, and respect
for the beauty of ayurveda are believed to lead to positive
outcomes in the session. As you apply pressure or begin a
stroke, exhale through the mouth (not the nose, as is done
in meditation) and become the Prana quality you want to
give the client. A client who has aggravated pitta may need
273
cooling. An image of a quiet pool of water generated

in your mind brings a cooling quality to your strokes.
Imagine the water as self while exhaling and beginning a
stroke. The image of the water will affect the quality of the
stroke, and this, in turn, affects your communication with
Prana. It sounds mysterious, but the important point is that
you have a clear positive intent for each stroke or technique.
Use of Taila
Indian massage (abhyanga described in the next section) often uses medicated oils called tail or taila (tila means sesame
oil). To make taila, a base oil such as sesame or coconut
oil is cooked with herbs to infuse the oil with the properties of the plant. The herbs used in taila tend to be tonic or
nervine, and the oil will often (but not always) be named
after the main herb in its recipe. For example, masha taila
is composed of masha (Phaseolus spp.a type of bean) and
sesame oil, whereas jyotishmati taila is composed of jyotishmati (Celastrus paniculatacommon name Celastrus or oriental bittersweet) and apamarga (Achyranthes asperacommon
name prickly chaff flower).
Sometimes, a full-body massage is performed with taila,
whereas at other times, only specific marma points are massaged with a particular taila to treat a symptom or condition.
In one example, the respiratory system might be supported
by massaging the two amsaphalaka marma points (one on
each of the upper medial boarders of the scapula) with strong
clockwise circles using mahanarayan taila (mahanarayan taila
is a combination of 14 herbs and sesame oil that is used for
muscle pain and joint pain and to support the respiratory
system). Taila ingredients for the different doshas are outlined in each dosha profile overview, but it is easiest to purchase taila from specialist ayurveda stores, some of which are
listed in the resources section at the back of the book.

Skin sensitivity, contraindications, accurate treatment representation, use of essential oils, assessment methods, and
hair issues are important considerations before adding
these treatments to your spa menu.
Accurate Representation of Ayurveda in a Spa
There are many authentic ayurvedic physicians who feel
disturbed and even angry that spas are using variations of
their ancient healing art in their spas.1 First, there is a concern that spas are offering an oversimplified piece of a metaphorical and complicated system. Ayurveda is closely linked
to Hinduism, which is not strictly a religion but rather the
practice of dharma, the code of life. The concept of a person
having a dominant dosha, which is central to the practice
of ayurveda, is interwoven with a belief in karma and previous lives. Many Westerners do not believe in karma and,
in fact, hold quite opposite views. All clients can benefit
from ayurveda no matter what their personal beliefs may
be. However, the cultural context of ayurveda should not
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274
TABLE 146 Selected Marma Points

POINT
NUMBER
NAME
MEANING
LOCATION
FUNCTION OR ASSOCIATION
ESSENTIAL OILS
Adhipati
Overlord
Top of the head
Seventh chakra, pineal gland,

Prana (life-force),
self-realization
Frankincense, myrrh
Simanta
Summit
Fissures of the
skull (five)
Seventh chakra, nervous

system, Prana
Frankincense, myrrh,
camphor, mint oils
Sthapani
What gives
support or
fixes
Point between the

eyes
Sixth chakra, Prana, the pituitary

gland, inner vision
Sandalwood, camphor,
basil, mint oils,
lavender
Avarta
Calamity
Midpoint above the

eyes (two)
Vata, Prana, sight, body posture
Camphor, mint oils,

eucalyptus
Utkshepa
What is
upward
Above the ear

(two)
Vata, the mind, large intestine,

sense of smell, increasing
awareness
Sandalwood, basil,
spikenard, valerian
Shankha
A conch shell
Temple (two)
Vata, large intestine, sense of

touch, clear hearing
Lavender, peppermint,
eucalyptus, ginger
Apanga
Looking
away
Outer corner of the

eye (two)
Sense of sight, clarity of thought
Sandalwood, vetiver,
rose
Shringataka
Where four
roads meet
Soft palate of the

mouth (four)
Vitality, taste, sight, hearing,

smell, nourishment to Prana
and the mind
Myrrh, frankincense,
mint
Phana
A serpents
hood
Side of the nostrils

(two)
Prana, sense of smell, balance

of energy between the left and
right side of the body
Camphor, eucalyptus,
peppermint
10
Krikatika
Joint of the
neck
Inferior to the
external occipital
protuberance on
either side of the
neck (two)
Body posture, subconscious

mind, lubrication and contentment of the brain
Atlas cedarwood, mint,

ginger, eucalyptus
11
Vidhura
Distress
Behind and below

the ears (two)
Controls hearing, increases

awareness of inner sounds
Sandalwood
12
Sira Matrika
Mother of
the blood
vessels
Base of the neck

(eight): four
on each side
of the neck on
either side of the
trachea
Blood flow to the head, nervous

system
Angelica, spikenard,
valerian, cypress,
sandalwood, cajeput,
rosemary, myrrh
13
Manya
Honor
Anterior neck
inferior to the ear
(two)
Speaking honorably, plasma,

blood, circulatory system,
throat, sense of taste, tongue
Cardamom, rosemary,
tea tree, juniper,
geranium, lavender
14
Nila
Dark blue
The main points

are lateral to the
trachea on both
sides (two)
Upward-moving Prana, speech,

thyroid, heat absorption, improvement of voice and power
of speech
Sandalwood, chamomile, coriander, rose,

peppermint
15
Amsa
Shoulder
Shoulder on the
trapezius (two)
Fifth chakra, heat absorption,

upward movement of Prana,
brain, dream state
Jasmine, sandalwood,
chamomile, mint,
sage
16
Amsaphalaka
Shoulder
Blade
Shoulder blade
(two)
Respiratory system, joint lubrication, energy circulation, fourth

chakra
Eucalyptus, mint,
camphor
17
Brihati
Wide
Area of the upper

back (two)
Courage, valor, heat absorption,

third chakra, lymphatic system
Cardamom, camphor,
eucalyptus
18
Parshvasandhi
The side of
the waist
The lateral aspect

of the lumbosacral joint (two)
Second chakra, adrenal glands,

ovaries, reproductive system,
immune system
Nutmeg
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Chapter 14
POINT
NUMBER
NAME
MEANING
LOCATION
275
ESSENTIAL OILS
19
Nitamba
Buttocks
The upper gluteal

region (two)
Plasma, lymphatic system,

skeletal system, urinary
system, kidneys, kapha
Cardamom, camphor,
lemongrass, juniper,
cypress, orange
20
Kukundara
What marks
the loins
Top of the sacrum

(two)
Blood formation, circulation,

menstruation, second chakra,
water element
Rosemary, turmeric,
myrrh, angelica,
cypress, juniper, birch
21
Katikataruna
What rises
from the hip
Hip (two)
Bones, lubrication of the joints,

skeletal system
Myrrh, camphor,
wintergreen,
eucalyptus, sage
22
Apalapa
Unguarded
Axilla (two)
Nervous system, nerve flow to

the arms
Valerian, spikenard,
basil
23
Stanarohita
Upper region
of the
breast
Above and to the

center of the
nipples (two)
Muscular system, nervous system, lungs, Prana
Sage, valerian, myrrh,

juniper, sandalwood,
eucalyptus, camphor
24
Hridaya
Heart
Heart
Circulatory system, blood,

plasma, power of the mind,
vitality, strength, immunity,
fourth chakra, higher self,
consciousness
Sandalwood, jasmine,
rose, eucalyptus,
ginger
25
Apastambha
What stands
to the side
Upper area of the

abdomen, lateral
to the sternum
(two)
Kapha digestion, bone, fat
Myrrh, ginger,
cinnamon,
eucalyptus
26
Nabhi
Navel
The navel
Third chakra, digestion,

balancing energy, pitta dosha,
element of fire in the body,
power of action
Digestive oils, jasmine,

rose, sandalwood
27
Basti
Bladder
Lower abdominal
area
Muscular system, body fat,

urinary system, reproductive
system, second chakra
Nutmeg, valerian,
sandalwood, clove,
camphor
28
Guda
Anus
Anus
First chakra, reproductive system, excretion, earth element
29
Kakshadhara
What
upholds the
flank
Top of the shoulder

(two)
Muscular system, body posture
Eucalyptus, turmeric,
myrrh
30
Lohitaksha
(arm)
Red-jointed
Center of the
deltopectoral
triangle (two)
Lymphatic system, peripheral

circulation to the legs
Eucalyptus, mint,
cardamom, rose,
myrrh
31
Bahvi
Relates to
arm
Inside of upper
arm (two)
Plasma, healthy tissue growth,

lymphatic system, circulation
Camphor, cardamom,
mint, thyme, ginger
32
Ani (arm)
Point of a
needle
Lower area of
upper arm (two)
Pancreas, kidneys
Ginger, cardamom,
parsley, juniper
33
Kurpara
Elbow joint
Medial and lateral

side of the elbow
(two)
Blood, circulation, balancing

Prana, right elbow controls
liver, associated with liver
diseases, left elbow controls
spleen, pancreas
Coriander, myrrh,
turmeric (right
elbow), ginger,
cardamom, myrrh or
turmeric (left elbow)
34
Indrabasti
(arm)
Indras arrow
Center of the
forearm (two)
Digestive system, balancing

Prana, small intestine
Anise, fennel, ginger,

cardamom
35
Manibandha
Bracelet
Wrist (two)
Skeletal system, movement of

the hands, lubrication of the
joints, peripheral circulation,
expression of the self in the
world
Angelica, birch, myrrh,

wintergreen, vetiver,
spikenard, valerian
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TABLE 146 Selected Marma Points (continued)

POINT
NUMBER
NAME
MEANING
LOCATION
ESSENTIAL OILS
36
Kurchashira
(hand)
The head of
kurcha
Base of the thumb

joint (two)
Digestive system, stomach,

head, mind, nervous system,
fire
Digestive oils,
myrrh, camphor,
sandalwood,
valerian, spikenard
37
Kshipra
(hand)
Quick to give
results
Between the thumb

and index finger
(two)
Plasma, respiratory system,

heart, lungs, Prana, passion,
connection to will
Eucalyptus, sage,
fennel, sandalwood,
cardamom
38
Kurcha (hand)
A knot or
bundle
Bottom of the
thumb (two)
Seeing, sensory keenness,

Prana, vata, nerve energy
Sandalwood, rose,
chamomile,
camphor, mint, clove
39
Talahridaya
(hand)
Center of the
surface
Center of the palm

of the hand
(two)
Energy flow, health, balance,

respiratory system, heart,
lungs, circulation, calling
healing energy, releasing
negative energy
Cardamom, rose,
orange, ginger,
eucalyptus, camphor
40
Lohitaksha
(leg)
Red-jointed
In alignment with
the inguinal
ligament (two)
Lymphatic system, downward

movement of energy
Camphor, eucalyptus,
rose, myrrh, sage
41
Urvi
What is wide
The midregion of
the upper thigh
(two)
Plasma, water element, kapha
Atlas cedarwood,
juniper, parsley,
cardamom
42
Ani (leg)
Point of a
needle
Lower area of
upper leg (two)
Circulation of body fluids downward, balance
Yarrow, rose,
sandalwood, atlas
cedarwood, ginger
43
Janu
Knee joint
Knee (two)
Lubrication of the joints,

circulation to the legs, liver
(right knee), spleen and
pancreas (left knee)
Lime, myrrh, coriander

(right knee), ginger,
lemon, cardamom,
turmeric (left knee)
44
Indrabasti
(leg)
Indras arrow
Center of the lower

leg (two)
Digestive system, digestive fire,

small intestine
Lavender, fennel,
ginger, black pepper
45
Gulpha
Ankle joint
Ankle joint (two)
Bone, fat, reproductive system,

circulation of Prana, lubrication of the joints
Clary sage, vetiver,

jasmine, rose
46
Kurchashira
(foot)
The head of
kurcha
Base of the big toe

(two)
Muscular system, posture,

digestion
Myrrh, camphor, ginger
47
Kurcha (foot)
A knot or
bundle
Bottom of the big

toe (two)
Seeing, sensory keenness, mental clearness
Sandalwood, rose,
chamomile
48
Talahridaya
(foot)
Center of the
surface
Center of the sole

of the foot (two)
Respiratory system, power of circulation, earth element, heart
Sandalwood, rose,
cardamom,
rosemary, ginger
49
Kshipra (foot)
Quick to give
results
Between the big

toe and the
second toe (two)
Lymphatic system, respiratory

system, heart, lungs, flow of
Prana
Camphor, cardamom,
eucalyptus
be ignored and is something that should be considered and

accurately represented during the treatment.
As responsible therapists, it is important that we educate clients about the holistic practice of ayurveda and
provide references to books or referrals to authentic ayurvedic physicians for those clients wishing to learn more.
It is also important to clearly define the treatment goals for
any ayurveda services offered and to represent those services appropriately. For example, many spas use ayurvedic
principles as a starting point for developing an otherwise

original service. There is nothing wrong with this so long
as it is reflected in the promotional literature. To say that a
service is inspired by ayurveda is different than saying it is
ayurveda.
Treatment Naming
To avoid confusion, traditional treatment names should
only be used for authentic and traditional treatments.
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1
277
1
3
9
8
6
4
5
7
11
12
2
10
15
15
14
29
22
30
16
17
25
31
32
33
24
26
33
18
34
19
35
36
38
39
37
27
40
20
28
21
41
41
42
42
43
43
47
48
44
46
45
49
A
FIGURE 143 Marma points.
For example, in one case, a spa brochure included a

panchakarma herbal wrap, and, not knowing any better,
the client would probably assume that this is an authentic
ayurvedic treatment. Panchakarma (also spelled pancha
karma and pancakarman) is a detoxification treatment consisting of five different cleansing methods. These
methods include emesis (therapeutic vomiting), purgation
(use of a specific laxative), enema, nasya (administration
of massage to the nasal cavity with a finger dipped into
ghee), and detoxification of the blood (through a specific
type of bloodletting). Clearly, this is not a treatment that
would ever be offered by a massage therapist because it
would violate scope of practice restrictions in all states that
regulate massage.
Ayurvedic Assessment in the Spa
Ayurvedic physicians use an in-depth 8- or 10-fold examination process to determine which dosha needs to be pacified in order to bring balance and healing to the body.1 In
a standard spa setting, a questionnaire is used to gather

general data about a clients dosha state before his or her
ayurvedic-inspired body treatment. The answers on the
questionnaire help the therapist to make choices about the
delivery of the treatment and the products that might be
useful for the client. The questionnaire offered here is easy
to use and not too complicated (Fig. 144). The first set of
questions (section 1) helps to determine the clients dominant dosha (or doshas) and prakriti, whereas the second
set of questions (section 2) helps to determine any current
dosha imbalance (vikrti). For example, if the client marks a
high number of P boxes and some V or K boxes in the first
section, he or she is likely to have a dominant pitta prakriti
(remember that all three doshas will always be present in
each persons constitution even though one or two will be
dominant). If he or she marks a high number of V boxes
in the second section, he or she is likely have a vata imbalance. You will need to pacify vata even though the client is
a dominant pitta.
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278
DOSHA QUESTIONNAIRE
Client's Name:
Date:
Section One: Prakriti
Directions: Choose the answer that describes you most accurately. No answer may fit perfectly, so
simply make the best possible choice with the answers provided.
Place a V, P, or K in the box to the left.
My size at birth was small (V)
My size at birth was average (P)
My size at birth was large (K)
I am thin and either short or very tall (V)
I am medium in height and body (P)
I am tall and sturdy or short and stocky (K)
I have difficulty gaining weight (V)
I gain or lose weight easily (P)
I tend to gain weight easily (K)
I have long, tapered fingers/toes (V)
I have fingers/toes of medium length (P)
I have square hands and shorter toes/fingers (K)
I have knobbly, prominent joints (V)
I have well-proportioned joints (P)
I have large, well-formed joints (K)
I have a delicate chin and a small forehead (V)
I have a moderate chin and a medium forehead that have a tendency toward lines and folds (P)
I have a large jaw and large forehead (K)
I have uneven or buck teeth that are sensitive to either hot or cold (V)
I have even teeth of medium or small size that tend to yellow (P)
I have large, white, even teeth (K)
My lips are thin and narrow (V)
My mouth is of medium size (P)
My lips are full (K)
My skin is dry, rough, cold to touch (V)
My skin is fair, soft, warm to touch (P)
My skin is pale, cold, clammy, and tends to be oily (K)
My hair is fine, coarse, brittle, and fine to medium in texture (V)
My hair is fine, fair, or reddish (P)
My hair is thick, oily, lustrous, and wavy (K)
My neck is thin, very long, or very short (V)
My neck is of regular proportion (P)
My neck is solid and strong (K)
My eyes are small, narrow, or shrunken, and my eye color is dull (V)
My eyes are of average size and light colored (P)
My eyes are large and lustrous (K)
The shape of my face is long and angular (V)
The shape of my face is heart-shaped, and I have a pointed chin (P)
The shape of my face is rounded and full (K)
My tongue tends to be dry with a thin, gray coating (V)
My tongue tends to have a yellowish or orange coating (P)
My tongue tends to be swollen with a thick, white coating (K)
FIGURE 144 Dosha questionnaire.
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279
I have a high tolerance to heat and enjoy hot weather (V)

I have a low tolerance to heat and enjoy moderate to cool weather (P)
I have a high tolerance to heat and prefer hot, dry, and windy weather (K)
My normal body temperature is cool, and I tend to have cold hands and feet (V)
My normal body temperature is warm, and I often feel too warm or hot (P)
My normal body temperature is cold (K)
My sleep is light and fitful (V)
My sleep is sound but sometimes disturbed (P)
I enjoy deep, prolonged sleep (K)
I have short bursts of energy, but my endurance is low, and I run out of steam easily (V)
I have moderate energy, moderate endurance, and good reserves (P)
I have good endurance and large reserves of energy (K)
In heat, I perspire minimally (V)
In heat, I perspire profusely (P)
In heat, I get clammy but I don't perspire freely (K)
I am always doing different things: I have a tendency to fidget (V)
My activity level is focused and moderate (P)
I can be sluggish and even lazy (K)
I have a lot of ideas that I have difficulty putting into action: I have a restless imagination (V)
I am organized, efficient, intelligent, and tend toward perfectionism (P)
I am steady, calm, and not easily disturbed but do not like to be rushed (K)
I am good at remembering recent events but have poor long-term memory (V)
I have a good memory (P)
Information absorbs slowly, but once it does, I have excellent long-term memory (K)
I am creative and expressive: I often change my beliefs (V)
I am goal-oriented, ambitious, and have strong convictions that govern my behavior (P)
I am contented and calm. I have steady, deeply held beliefs that I will not change easily (K)
I have difficulty making decisions and change my mind often (V)
I make rapid decisions and feel that they are good (P)
I take a long time to make a decision but stick to the choices I make (K)
I dislike routine and need a lot of change (V)
I enjoy planning and organizing my life (P)
I like routine and don't like it when things change (K)
When stressed, I become fearful, anxious, and insecure (V)
When stressed, I become confrontational, aggressive, judgmental, and hot tempered (P)
When stressed, I have a tendency to withdraw. Sometimes I am greedy and possessive (K)
I am a free spirit: I don't carefully plan my life but go with the flow (V)
I am an achiever and I am ambitious. I carefully plan each step of my life (P)
I feel safe, steady, and calm in my life. I would prefer it if things remain as they are (K)
On a good day, I am secure, grounded, and settled (V)
On a good day, I am confident, warm, brilliant, and witty (P)
On a good day, I am warm-hearted, loving, and active (K)
On a bad day, I am cold, distant, and insecure (V)
On a bad day, I am jealous and controlling (P)
On a bad day, I am possessive, lackadaisical, and clinging (K)
I know a lot of people, but I have few close friends (V)
I have a few good friendships. I seem to make enemies without meaning to (P)
I have many loyal and close friendships (K)
I spend the money I have impulsively and easily (V)
I plan how I will spend money (P)
I spend money reluctantly and I like to save (K)
Totals: Place the total number of V's under vata, the total number of P's under pitta, and the total number of K's
under kapha in the spaces provided.
Vata
Pitta
Kapha
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DOSHA QUESTIONNAIRE
Section Two: Indications of Imbalance
Directions: Choose the answer that describes you most accurately and place a V, P, or K in the box at
the left. If none of these descriptions fit, place an NA in the box to the left.
Recently, my skin has been dry or I have dry patches (V)
Recently, I have had heat rashes and spots (P)
Recently, my skin has been oilier than usual (K)
Recently, my hair has been dry, and brittle, and I have split ends (V)
My hair seems to be thinning or graying more rapidly than usual (P)
My hair has been excessively oily lately (K)
I feel underweight and can't seem to gain weight even though I am trying (V)
I keep gaining and losing the same 10 pounds (P)
I'm overweight, and I am having difficultly losing weight (K)
Lately, I feel cold a lot (V)
These days, I often feel hot and irritated (P)
Lately, I've been feeling cold and dull (K)
I keep waking up and have difficulty getting back to sleep (V)
I have difficulty getting to sleep but once asleep, I sleep soundly (P)
I am sleeping excessively (9 to 10 hours), and I don't want to get up (K)
I feel exhausted, restless, and nervous (V)
I feel tense and tired but determined to get the job done (P)
I feel lethargic and have low energy and I have difficulty taking on new tasks (K)
Lately, I feel indecisive, chaotic, and forgetful, and I have difficulty focusing and concentrating (V)
Lately, I feel judgmental of others, overly ambitious, and often negative (P)
Lately, I feel uninspired and resistant to change, and I'm having difficulty retaining information (K)
When stressed, I feel tearful and anxious (V)
When stressed, I feel angry, aggressive, and confrontational (P)
When stressed, I feel like I want to hide away from the world (K)
Totals: Place the total number of V's under vata, the total number of P's under pitta, and the total number of K's
under kapha in the spaces provided.
Vata
Pitta
Kapha
Therapist's comments:
When the therapist and client have reviewed the questionnaire, they are ready to choose which type of treatment
will suit the clients particular dosha or address the clients
dosha imbalance. The dosha profiles below will help the
therapist and client to understand the characteristics of
each of the doshas and the types of treatments that support dosha balance. A ready-to-copy questionnaire appears
in the Appendix section at the back of the book.
Using Essential Oils in Ayurvedic Treatments

Essential oils can be used to make dosha-pacifying blends
or to anoint a specific marma point. Heating oils are indicated for pacifying vata and kapha. These will commonly
be spicy oils such as ginger, nutmeg, pepper, thyme, and
cinnamon. Sweet oils, such as the floral oils of rose, ylang
ylang, jasmine, and neroli, or cooling oils, such as German
chamomile and yarrow, pacify pitta but aggravate kapha.
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Chapter 14
Root oils, which are energetically grounding, are good for

vatas. These oils include ginger and angelica. Many oils are
neutral and balancing for all of the doshas. This group includes lavender, clary sage, and frankincense. Each dosha
profile overview provides a starter list of essential oils and
blends for that particular dosha.
Remember, if the season or conditions of the day are decidedly of one dosha, any individual regardless of the dominant
dosha or dosha imbalance might be given a massage with an oil
blend that pacifies the qualities of the day. For example, if the
day is cold, dry, and windy, a vata-pacifying blend and warm
packs might be used on all individuals. This is because even the
pitta will be cold on such a day and need vata qualities pacified
to feel in balance.
Skin Sensitivity
In India, where ayurveda originated, the climate is generally
hot, and the local people have thick, strong hair and skin
that is less prone to sensitivity. Some of the ingredients used
in ayurveda can cause sensitivity in fair-skinned people. Err
on the side of caution and dilute products with aloe gel,
milk, or a plain fixed oil (as opposed to the medicated taila
that will be described later) before their application to
fair-skinned clients.
Hair Issues
Many ayurvedic services begin with an Indian head massage
and foot soak. In an Indian head massage, oil will be massaged
through the hair to the scalp. The shirodhara treatment will
also coat the clients hair and scalp in oil. Obviously, this
will mess up the clients hair, and shampooing the hair is
out of the massage scope of practice in most states. The
therapist has three main options: (1) The client is passed
to a cosmetologist who will finish the service by washing,
cutting, and/or styling the clients hair; (2) the client is
escorted to a shower or soaking tub where he or she can
wash and condition the hair; or (3) the therapist removes
most of the oil with hot, moist towels so that clients can
go home and wash the hair. In all cases, hair issues must be
discussed with clients when they book their appointments
so that clients are prepared for the service.
Indian Head Massage

Indian head massage is a traditional ayurvedic art form that
is deeply relaxing and rejuvenating for clients. In a typical
session, you massage the head, neck, and shoulders; stimulate
marma points on the head and face; and oil and invigorate
the scalp and hair (Fig. 145). Often, Indian head massage
is paired with a traditional foot soak, which provides the
spiritual element of welcoming and purifying the client.
These two therapies might be used as the opening step in any
ayurvedic treatment (see Treatment Overview 141 for an
overview). Herbal blends for appropriate dosha foot soaks are
listed in the dosha profile overviews. A dosha-specific taila or
plain sesame oil are used for the head massage.
281

Overview of Indian Head Massage
Indications
To decrease stress, decrease facial tension, and decrease
mental exhaustion; to balance the doshas; and to promote
health and wellness
Contraindications
Broken or inflamed skin on the scalp or face, any condition contraindicated for massage
Supplies and Setup

1. Foot soak container (copper is traditional; jasmine or
other flowers floating on the surface are a nice touch)
3. Bath towel placed under the foot soak container
4. Robe or spa wrap
5. Dry hand towel
6. Slippers
7. Bottle of sesame oil or dosha-specific taila for the massage
Procedure
Clients feet in soaking container.
Holding strokes.
Oiling marmas on the skull.
Zigzag fingers to spread oil across the scalp.
Pounding.
Circle finger friction.
Skull squeeze.
Massage marma points on the face.
Ear massage.
Remove feet from soaking container and wrap the
feet in a towel.
11. Shoulder, neck, and arm massage.
12. End the session with holding strokes.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Session Start
Place a bath towel in front of a comfortable chair. Fill a foot
soaking basin with warm, herbal-infused water and place it
on top of the bath towel. The client, in a bathrobe, sits in the
chair and places his or her feet in the water. Check that the
temperature of the water is not too cold or too warm. Adjust
the temperature by adding cool or warm water as needed.
Step 1: Holding Strokes
This series of holding strokes provides a nice, soothing
opening sequence for Indian head massage and for other
seated therapies (Fig. 146). Review the previous section on
Prana and consider what qualities of Prana the client needs.
As you breathe with the client, visualize the quality of Prana
you are bringing to the client.
Stand behind the client and place both hands on the clients
shoulders. Ask the client to take a breath and exhale.
Leave one hand on one shoulder and place the other,
very lightly, over the clients head. Ask the client to take
a breath and exhale.
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E1
E2
FIGURE 145 Indian head massage. (continue)
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F1
F2
283
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284
FIGURE 146 Holding strokes for the head and shoulders.
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285
Change hands, placing the other hand on the clients shoulder and head. Ask the client to take a breath and exhale.
Move to one side of the client. Place a hand on the forehead and on the back of the head. Ask the client to take
Move to the other side of the client and repeat the hold
with the other hand on the forehead and on the back of
the head. Ask the client to take a breath and exhale.
Move behind the client and place a hand over each ear.
Ask the client to take a breath and exhale.
Place both hands on the shoulders. Ask the client to take
Step 5: Skull Squeeze
Step 2: Oiling and Stimulating Marma Points on

the Skull
There are two marma points called Phana (a serpents

hood) on the side of each nostril. Massage these points
with strong circular strokes to decrease headache pain,
decrease sinus pressure, and decrease congestion. Treat
the entire side of the nasal bone.
The Apanga marma points are located on the outer corner
of the eye and are massaged to relieve headaches due to eye
strain. These points also help to clear the upper sinuses.
Shankha (conch) is the name of the point located on each
temple. These points aid sleep and are associated with
directing energy to the brain.
The points named Utkshepa (what is cast upward) reside
above the ear and are gently massaged to calm vata and
the mind.
Just above the center of each eyebrow is a point called
Avarta, which is massaged to decrease vata and improve
energy and adaptability.
The Sthapani marma resides between the eyebrows and is
often called the third eye. This point is discussed further
in the shirodhara section below.
The Simanta (summit) marma falls along the lines of the

sutures of the skull, so it covers a large area.4 The Adhipati
marma (overlord), which is located at the top point of the
skull, has a ruling action over the Simanta marma and controls the seventh chakra, pineal gland, and nervous system.
Measure 8 finger widths up the head using the point
between the brows as a starting point as shown in
Figure 145. Pour a generous amount of oil on this spot
(part of the Simanta marma) and lift and twist the hair
here to stimulate the point.
Next, oil the point where the clients hair forms a whorl
(another part of the Simanta marma). Lift and twist the
hairs over this point to stimulate the marma.
Oil the Adhipati marma, which is located in between these
two Simanta points, at the highest point of the skull.
Stimulate this point by pulling and twisting the hairs here.
Ask the client to drop his or her chin to the chest. This
allows access to the Krikatika (joint of the neck) marmas.
The points are directly beneath the occipital protuberance on each side of the neck. Oil and stimulate these
points with hair twisting.
Using zigzag finger movements, work the oil evenly through
the hair and into the scalp. Go back to each of the marma
points and use gentle circular finger friction in clockwise
circles to release the energy and tension in these areas.
Step 3: Pounding
Place both hands together in a prayer position, keeping the
wrists loose and flexible. Pound the entire head by using the
edge of the joined hands in a tapotement-like action.
Interlace the fingers over the top of the skull and press the
hands together gently. Repeat this four to six times, working
over the anterior and posterior sections of the skull. Place
one hand on the forehead and the other at the back of the
head and repeat the skull squeeze.
Step 6: Massage Specific Marma Points
on the Face
There are numerous marma points on the face that respond
to massage. Try working with these points during your
Indian head massage routine.
Step 7: Ear Massage

Rub oil into the external regions of the ear, pulling the ear
backward as the oil is applied. Pull the lobe in a downward
and backward direction and then pull the lobe across the
opening of the ear to stretch it.
Step 8: Remove the Feet from the Soaking Basin
Remove the clients feet from the soaking basin before the
water in the basin gets cold. Ask the client to lift his or her
feet, remove the basin while the feet are lifted, and ask the
client to place the feet onto the preset bath towel. Wrap the
clients feet in the bath towel.
Step 9: Shoulder and Neck Massage
Step 4: Circular Finger Friction

Use gentle circular finger friction to massage the scalp by
reaching up underneath the clients hair. Massage the
forehead, above and behind the ears, and the base of the skull.
Now, apply circular finger friction from the point between
the brows, down the sides of the nose, under the eyes, under
the cheekbones, and then down around the edges of the
mouth and across the lower part of the cheek in repeating
patterns. Make sure to use this technique to massage every
inch of the head and face in a comfortable manner.
Complete the massage by massaging the clients shoulders,

upper arms, and neck. You can perform the strokes through
the clients robe or ask the client to drop the robe off of the
shoulders while still remaining covered.
Session End
End the session by performing the same series of holding
strokes and breathing you used to open the session shown in
Figure 146. You can now move the client to a massage table
for the abhyanga session or to another ayurvedic session.
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SANITATION
The comb used to detangle the clients hair
before the Indian head massage should be
soaked in Barbicide solution in a jar with a lid after use.
Barbicide solutions are available from spa suppliers.
Abhyanga
In India, massage is part of daily life, and it is common
to see mothers, with a blanket spread across the ground,
massaging their children in the open marketplace or to see
woman chatting and massaging each others shoulders.
Self-oiling and self-massage are also common practices.
Abhyanga is the Sanskrit word for oil massage and can be
performed by the client themselves or by one, two, or more
therapists working together in a coordinated manner on a
client. The strokes and massage oils vary depending on the
dosha of the client (review the dosha profiles for details).
Traditional Indian Massage Strokes
India is a large country, so the techniques used will vary in
different regions. There are, however, five general strokes
that are used in traditional massage (Fig. 147) and in a fixed
order. These are the sweep, tapping, kneading, rubbing, and
squeezing.5
Sweep: Apply sweeping strokes (similar to effleurage)

from the navel out toward the distal areas of the body
in brisk, straight strokes. On the legs, the sweep would
start at the greater trochanter and end at the feet. On the
upper body, the sweep would start at the navel, sweep
up to the shoulder (jump the breast drape), and then
sweep down to the hands. Sweeps are used to open and
close a body area and are repeated up to 25 times on
one area.
Tapping: Tapping (similar to tapotement) is believed
to awaken the body, alert nerve endings, increase local
circulation, and revitalize energy. Apply tapping strokes
with open palms and relaxed fingers.
Kneading: Kneading (similar to ptrissage) is applied at
a depth that is tolerable to the client. Knead areas thoroughly and completely before moving on to the rubbing
technique.
Rubbing: Rubbing (similar to friction) can be done on
dry skin (except for vatas), or it can be performed with
oil. It can be deep (applied with the knuckles or thumbs),
or it can be light and superficial (applied with the fingertips). It can be performed quickly or slowly. Although
some specific techniques will rub in a counterclockwise
direction, most often, the rubbing is in clockwise circles.
Squeezing: To perform squeezing strokes, use both
hands to lift an area of muscle with a squeezing and
FIGURE 147 Traditional Indian massage strokes. (A) Sweeping strokes.

(B) Tapping strokes. (C) Kneading strokes. (D) Squeezing strokes.
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Chapter 14
crossing torque-like motion. In bony areas such as the

fingers and toes, a combination of squeezing and twisting are used to mobilize the area. To finish the fingers
and toes, place a drop of oil on the finger so that it fills
the gap between the nail and the flesh.
Sweep: The massage sequence ends for each body area
just as it began with straight sweeps working out from
the navel to the distal areas of the body.
The Vata Massage
From our previous discussion, you probably remember that
vata qualities are dry, light, cold, subtle, unstable, rough, clear,
and transparent. The massage for a vata or client with a vata
imbalance should be oily (balances dry), firm (balances light),
warm (balances cold), smooth (balances rough), and precise
(balances subtle). Strokes are long and flowing with firm
pressure and an even rhythm. Irregular movements, abrupt
transitions, fussy and inefficient draping, tapotement, and
pressure that is either too deep or too light aggravate vata.
The appropriate massage oils for vata include sesame, olive,
almond, and ghee (clarified butter). Extra oil might even be
applied to the body and allowed to soak in after the massage
of a particular body area has concluded. Warm packs, such as
flaxseed packs heated in a microwave, provide extra warmth
during the massage. Applying warm oil to the abdominal area
and covering it with a heated towel and then a warm pack is
particularly comforting for vatas. Grounding elements such
as the placement of warm stones on the feet or on areas of
muscular tension (heavy balances light; warm balances cold)
pacify vata.
The Pitta Massage
Pitta qualities are hot, sharp, bright, liquid, slightly oily,
sour, and pungent. The pitta massage must be moderate
in temperature or cooling (balances hot), smooth (balances
sharp), dark (balances bright), precise (balances liquid), and
varied. If you are ungrounded and start to daydream during
the massage, a pitta client is likely to notice and become
287
critical and aggravated. The massage rhythm must be slow

and calming because too many fast movements are irksome. Use light or cooling oils in moderation such as coconut, sunflower, safflower, and ghee (clarified butter). Only
use warm packs and heavy blankets if the day or treatment
room is particularly cold.
The Kapha Massage
Kapha qualities are heavy, cold, soft, viscous, sweet, stable,
and slimy. The massage for a kapha is the most stimulating
and the least oily of the dosha massages. This massage must
be vigorous (e.g., a sports massage), fast paced, warming,
firm, and non-oily. In a traditional ayurveda setting, massage
for kaphas might be done with powders, alcohol, or silk
gloves (a massage with silk gloves is called gershan) to avoid
adding more oil to the kapha constitution. Lightweight oils
or warming oils include safflower, apricot kernel, sunflower,
sesame, and mustard oil used in moderation. Provide warmth
with heating packs during a kapha massage.
As mentioned previously, one, two, or more therapists can
work together to provide a coordinated abhyanga session
(an overview of session elements is provided in Fig. 148).
In the routine described here, two therapists work together
in synchronicity with a specific series of strokes (shown in
Fig. 149). Therapists are encouraged to use this routine
as a starting point and add or delete strokes as they deem
appropriate. The process of developing a synchronized
routine will often lead both therapists to innovative ways to
stretch or move the body.
The therapists must decide who will be the leader and
who will be the follower. The leader sets the pace of the
massage strokes and never leaves the clients body; he or she
always maintain contact with the client in some way. The
follower gets everything needed for the treatment (extra oil,
hot herbal towels, eye pillow, etc.) and follows the leaders
pace. An abhyanga overview is provided in Treatment
Overview 142.
FIGURE 148 Abhyanga routine. (A) Client interview. (B) Foot soak and Indian head massage. (C) Abhyanga massage.
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288
C1
C2
D1
D2
D3
E1
FIGURE 149 Abhyanga procedure. (continue)
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E2
G1
G2
289
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290
L1
L2

Abhyanga Overview
Indications
To balance or pacify a particular dosha, to decrease muscle pain or soreness, to decrease stress and mental exhaustion, to bring balance to the body and promote health
Contraindications
Any condition contraindicated for massage

1.
2.
3.
4.
5.
6.

Top massage sheet
Blanket, if needed for warmth
Two hand towels for draping
Bolster
Warm packs (optional for vata and kapha clients)
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Chapter 14

1. Dosha questionnaire
2. Two bottles (one for each therapist) of a massage oil or
taila appropriate for the dosha
3. Oil-warming unit or hot water bath to warm the oil
4. Spoon (used for oiling the ears)
5. Dry hand towel

4. Robe or spa wrap
5. Dry hand towel
6. Slippers
Procedure
Client fills out dosha questionnaire.
Foot soak and Indian head massage are done.
The client is moved to the treatment table.
Posterior massage based on dosha.
Client turned to supine position.
Vata only: Application of heavy oil to the abdominal
region; cover this with a warm towel and a warm pack.
7. Anterior massage based on dosha.
8. Oil the ears.
1.
2.
3.
4.
5.
6.
291
their breathing to the clients breathing; they cross their

hands and place one hand on a hip and one hand on a
shoulder. Take three grounding breaths.
Step 3: Application of Oil to the Posterior Body
The leader applies oil from the lower back, up the back,
down the arm to the hand, back up the arm, and down the
back to the hip on one side. At the same time, the follower
applies oil from the hip, down the leg to the foot, and back
up the leg to the hip on the same side. Repeat this process
on the second side.
Step 4: Spreading the Oil in Tandem
The leader works the oil across the upper body while the
follower works oil across the legs until it is even. The leader
spreads the oil from the lower back, up the back, and down
to the hands. At the same time and with the same rhythm,
the follower spreads the oil from the hips to the feet. The
leaders hand should be on the lower back (at the beginning
of the stroke) at the same time that the followers hands are
at the hips (the beginning of the stroke). The speed of the
strokes, the depth of the strokes, and the use of additional
features such as a warm pack are all determined by the dosha
or dosha imbalance of the client. Review the dominant dosha
profiles for details. Regardless of the series of strokes that are
used, the two therapists must practice together to become
proficient and achieve harmony.
Step 5: Posterior Leg Massage
Session Start
Take the client to a treatment room and ask him or her to
change into a robe (or spa wrap) and slippers and fill out a dosha
questionnaire. Serve juice, traditional fruits or food, or Indian
tea while the client fills out the questionnaire. This introduces
the nourishing element of ayurveda. Return to the treatment
room after a suitable length of time (15 minutes) and review
the questionnaire with the client to determine the clients
dominant dosha and any dosha imbalances. The follower
prepares a dosha-specific foot bath while the leader describes
basic principles of ayurveda and some of the factors that might
aggravate the clients dosha. Some spas or therapists hand out
informative brochures that give directions for following homebased routines to support balance in the doshas.
Step 1: Foot Soak and Indian Head Massage
Begin the session with a traditional foot soak and the Indian
head massage routine as described previously. The leader performs the Indian head massage while the follower prepares the
appropriate taila and other items for the session based on the
clients dosha. At the conclusion of the Indian head massage,
the client is moved to the massage table in the prone position.
Step 2: Undrape the Client and Open the Session
The leader adjust the drape (use a gluteal drape) to allow
access to the back and the posterior legs at the same time.
The leader moves to one side of the table while the follower
moves to the other side of the table. The therapists match
The leader joins the follower at the hips for the posterior leg
massage. Perform each of the five traditional strokes (sweeps,
tapping, kneading, rubbing, squeezing, and ending with a
second set of sweeps) on each leg simultaneously covering the
entire area. You need to watch each other carefully so that the
strokes are occurring in the same area at the same time. Each
stroke begins at the greater trochanter and moves toward the
feet. (The energy is pushed out from the core of the body,
the navel, and toward the extremities; in this case, the feet.)
Begin the sequence with 20 to 25 straight sweeps and hold
the foot at the end of the last stroke. Progress from straight
sweeps to the tapping technique, then followed by kneading, rubbing, and, finally, the squeezing technique. Marma
points are incorporated into the routine at the discretion
of the leader or treatment designer. End the posterior leg
sequence in the same way it began, with 20 to 25 straight
sweeps and hold at the foot on the last stroke.
Step 6: Gluteal Massage
While the follower holds both feet to ground the clients
energy, the leader massages the clients gluteal muscles.
Eventually, the follower joins in on one side of the gluteal
massage to make a smooth transition into the back.
Step 7: Back Massage
Stand on either side of the table at the hips facing toward
the head of the client. Apply the five traditional strokes simultaneously starting at the lower back, running up the
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292
back to the shoulder and down the arm to the hand. Begin
with 20 to 25 straight sweeps and hold at the hand on the
last stroke. Progress from the straight sweeps to the tapping
technique, then followed by kneading, rubbing, and, finally,
the squeezing technique. Marma points can be incorporated
into the routine at the discretion of the leader or treatment
designer. End with another 20 straight sweeps and hold at
the hand on the last stroke to end the back sequence.
As part of the back routine, the therapists can develop
a number of creative tandem strokes. One idea is for each
therapist to do a deep tissue stroke starting at the top of the
spine and running down to the sacrum on either side of the
spine. Another enjoyable stroke is to do effleurage strokes in
a rhythmic and crossing sequence as shown in Figure 149.
Step 8: Transition to the Anterior Body
The leader turns the client into the supine position, bolsters
him or her for comfort, and drapes him or her with a breast
drape and an anterior pelvic drape while the follower moves
to the clients feet.
Step 9: Application of Oil to the Anterior Body
leader while the follower continues to press the feet and

stabilize the clients energy.
Step 14: Upper Body Massage
The follower moves with the leader to the upper body
when the abdominal massage is complete. The two
therapists stand on either side of the client and apply oil
from the chest and down each arm simultaneously. The
oil is spread in an even layer, working from the abdominal areas up to the upper chest and down the arms to the
hands with straight sweeping strokes (20 to 25 times).
Jump the breast drape when it gets in the way of the
stroke.
Step 15: Massage the Arms
Each of the traditional strokes (sweeps, tapping, kneading,
rubbing, squeezing) is carried out on each arm simultaneously starting at the glenohumeral joint and working down
to the hand. End with straight sweeps (20 to 25 times) and a
hold at the hand on the last stroke.
Step 16: Neck and Face Massage
Apply oil to the anterior body in tandem. The leader turns the
clients head to one side and applies oil down the neck, across
the shoulder, and down the arm to the hand. At the same
time, the follower applies oil to the foot (on the same side)
and up the leg. Repeat this procedure on the opposite side.
The leader moves to the head of the table and massages the
neck and face while the follower moves to the bottom of the
table to ground the clients energy through the Talahridaya
marma on the bottoms of the feet.
Step 10: Spreading the Oil in Tandem
Session End
The leader spreads the oil in an even layer on the upper chest,
neck, and down the arms. At the same time, the follower
spreads the oil in an even layer on the lower legs.
You can end an abhyanga session in a number of different

ways. For example, hot, moist hand towels can be steeped in
an herbal infusion and laid across the anterior body. Now,
wrap the body in thermal blankets and allow the client to
relax or nap after the session. You might cover the client
with a drape and blanket and perform the shirodhara session discussed in an upcoming session, or cover the client
with a steam canopy, moved the client to a steam cabinet or
steam room for the swedana treatment.
A nice tradition is to pour oil from a spoon into the ears
(Fig. 1410). This practice is called karna purana, and it is
used to relieve itching or dryness in the ears, to settle the
vata dosha through the sense of hearing, and to relax the
mind and body. In karna purana, a towel is placed under
the clients head, and the head is then rotated to one side
so that the ear can be filled with a spoonful of warm sesame oil. Massage the area around the ear and ask the client
to open and close his or her mouth two to three times. In
most states, it is out of the scope of practice for massage
therapists to massage inside the ears of a client, so only
the outer area of the ear is massaged. Rotate the head to
the other side and repeat the procedure on the second ear.
The oil in the first ear will run out onto the towel under
the clients head. Massage around the second ear and ask
the client to repeat the process of opening and closing the
mouth. Turn the head and allow the oil to run out of the
second ear. The client can then dry his or her ears out with
a tissue.
Step 11: Anterior Leg Massage

The leader moves to stand at one hip facing toward the
feet, and the follower stands at the other hip facing the feet.
Again, the energy is pushed out from the navel toward the
feet with the five strokes performed simultaneously (sweeps,
tapping, kneading, rubbing, squeezing). End with 20 to 25
straight sweeps and a hold at the feet.
The leader takes one foot, and the follower takes the other
foot, and together, the therapists massage the feet with the
same series of strokes. Foot massage strokes are described
in Chapter 10 (Spa Foot Treatments). The other option is to
have the leader move to the top of the table and place his or
her hands on the clients shoulders while the follower massages the feet. At the end of the foot massage, the follower grasps
both feet and holds them with his or her thumbs on the
Talahridaya (heart or center of the foot) marma. Interestingly,
this is called the solar plexus point in reflexology. This point is
believed to pacify vata and ground and center the body.
Step 13: Abdominal Massage
The leader moves to the abdominal area and fills the navel
with oil. The oil is worked into the abdominal area by the
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293
FIGURE 1410 Karna purana.
Udvartana
Udvartana (sometimes spelled ubvartan or urdvatana) is a
treatment in which herbal powders or pastes are rubbed into
the body, allowed to dry, and then buffed off. In ayurveda,
this procedure is believed to stimulate circulation to the skin
and aid cell renewal, smooth the skin, tone the bodys tissues,
support natural detoxification processes, and relax the body.
Originally, udvartana was a beauty treatment that was (and
still is in some treatment centers) used with a specific diet,
herbal teas, incense, showers, baths, and relaxing music in a
40-day course to return the body to a state of radiant health.6
Ubtan is a paste made from nuts, seeds, and unprocessed flour to which oils, spices, and milk are added. An
easy spa-friendly ubtan recipe is offered in the udvartana
overview, although a variety of combinations and ingredients exists. The paste is massaged into the skin and allowed
to dry slightly. As the paste starts to dry, it is rubbed off
with mitts, rolled towels, or bare hands. Sometimes, ubtan
powder (without liquids) is used during abhyanga for the
kapha massage. An overview is provided in Treatment Overview 143 and shown in Figure 1411.
4.
5.
6.
7.
Bolster
Two hand towels to use for draping
Warm packs, if needed for vata and kapha clients
Fabric drop cloth or flat massage sheet placed under
the massage table

1. Ubtan mixed up and warming in a heating device or
hot water bath
2. Massage oil or taila appropriate for the clients dosha
3. Six dry and rolled up hand towels for buffing (you need
multiple pairs because they get dirty from ubtan)
4. Soda cooler
5. Nine hot, moist, herbal-infused towels

4. Robe
5. Dry hand towel
6. Slippers
Procedure

Udvartana Overview
Indications
To invigorate the body, to increase vital energy to the
h b
body,
d
to decrease stress and mental exhaustion, to smooth the
skin and add a healthy glow, for relaxation or sore muscles
Contraindications
Broken, inflamed, or sensitive skin, any condition contraindicated for massage

3. Blanket if needed for warmth
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Foot soak and Indian head massage.

Move client to the treatment table.
Oil massage of the posterior legs.
Application of ubtan to the posterior legs.
Oil massage to the back.
Application of ubtan to the back.
Buff off the ubtan on the posterior legs.
Buff off the ubtan on the back.
Apply hot, moist herbal towels to the legs and back.
Oil massage of the anterior legs.
Apply ubtan to the anterior legs.
Oil massage of the abdominal area and arms.
Apply ubtan to the abdominal area and arms.
Buff off the ubtan.
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294

Udvartana Overview (continued)
16. Apply hot, moist herbal towels to the anterior b
body.
bo
ody
ody
17. Move the client to a shower or soaking tub, if available.
il bl
Spa-Friendly Ubtan Recipes

Base cup of chickpea powder, 1 tbsp of mustard seed
powder (additional mustard seed powder can be added
for a warmer treatment), cup of milk, cup of sesame
oil, 1 tbsp of turmeric and one of the following: addition
1: 13 drops of sandalwood, 1 drop of patchouli, 1 drop of
rose; addition 2: 10 drops of sandalwood, 1 drop of vetiver,
2 drops of jasmine; addition 3: 4 drops of ginger, 1 drop of
rose, 5 drops of myrrh, 8 drops of mandarin
Step 2: Oil Massage and Ubtan Application

to the Back
Perform an oil massage using the traditional strokes
described in the abhyanga section on the back. Apply warm
ubtan to the back in a thin layer and massage it into the
skin until it starts to feel sticky and dry.
Step 3: Buff Off the UbtanPosterior Legs
Buff the ubtan off the posterior legs while it is drying on
the back. Terry mitts or hand towels rolled into sausages
work well. Buffing should feel brisk and rough, but it can
be too stimulating for some clients (especially vatas). If
buffing feels too forceful for the client, remove it with hot,
moist towels instead.
Step 4: Buff Off the UbtanBack
SANITATION
Ubtan can get messy when it is buffed off the
body. It is helpful to place a clean, flat massage sheet or a fabric drop cloth (similar to those used
for interior house painting) under the massage table. This
collects any ubtan that falls off the table but does not
make a plastic sound while you move around the table.
Session Start
The treatment begins with a dosha questionnaire, foot soak,
and Indian head massage as described previously. Move the
client to the treatment table in the prone position after this
opening segment.
Step 1: Oil Massage and Ubtan Application to the
Posterior Legs
Use a gluteal drape so that both posterior legs and the back
are exposed. Perform an oil massage using the traditional
strokes described in the abhyanga section on both posterior
legs. Apply warm ubtan to the legs by holding the bowl of
ubtan in one hand and using the other to scoop ubtan and
smear it in a thin layer onto the legs. Massage the ubtan
into the legs until it starts to feel sticky and dry. Leave the
ubtan to continue drying while you treat the back.
Buff the ubtan off the back as soon as you complete the
buffing step on the posterior legs.
Step 5: Application of Herbal TowelsPosterior
Apply steamy, herbal-infused towels to the posterior legs and
back. Allow the towels to steam the area by leaving them static for 30 seconds and then use them to remove any remaining
ubtan. Alternatively, a steam canopy can be used to steam the
body, or this step can be eliminated at your discretion.
Step 6: Oil Massage and Application of Ubtan
Anterior Legs
Turn the client into the supine position and bolster him or
her for comfort. Drape the client with a breast drape and
anterior pelvic drape. Apply an oil massage using the traditional strokes described in the abhyanga section to the
anterior legs and then apply a thin layer of ubtan. Massage
the ubtan into the skin until it starts to feel sticky and dry.
Step 7: Oil Massage and Application of Ubtan
Anterior Upper Body
While the ubtan dries on the anterior legs, perform an
oil massage using the traditional strokes described in the
abhyanga section to the abdominal area and the arms.
Apply ubtan in a thin layer to the abdominal area and
FIGURE 1411 Udvartana procedure. (A) Application of ubtan. (B) Removing dried ubtan using rolled up hand towels.
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Chapter 14
arms. Massage the ubtan into the skin until it starts to

feel sticky and dry.
Massage the clients feet while the ubtan continues to dry
on the anterior legs and anterior upper body.
Step 9: Buff Off the UbtanAnterior Body
Buff the ubtan off the anterior legs and then off the abdominal area. Buff the ubtan off of the arms.
Step 10: Application of Herbal TowelsAnterior
Apply steamy, herbal-infused towels to both anterior legs,
to both arms, and to the belly. Once the towels have begun
to cool, use them to remove any ubtan still on the skin after
buffing, or wrap the client while the towels are still hot, so that
the client can relax in a cocoon while you massage the neck.
Session End

2. Plastic body wrap placed so that it covers the top
quarter of the treatment table, falls over the top of the
table, and has its ends tucked into a bowl; place a
number of Kleenex tissues in the bowl to dampen the
sound of the oil hitting the plastic.
3. Bath towel set over the top of the plastic
5. Blanket for warmth
6. Warm packs as needed
7. Bolster
8. Rolled hand towel for positioning the head
9. Shirodhara stand and vessel
The set up for the shirodhara table is shown in Figure 1411.
Ubtan is messy but fun. If possible, plan your session so

that you can rinse the client with water on a wet table, move
them to a shower to wash off, or move them to a soaking
tub to conclude the treatment.
1. One quart (or more) of refined sesame oil (or other

product as deemed appropriate for the individual
dosha). The oil should be warmed to 100 to 104F.
2. Thermometer
3. Small cup to capture the first part of the flow of oil out
of the shirodhara vessel
Shirodhara
Procedure
Shirodhara (shiro means head and dhara means threadlike

stream) is the application of a thin stream of sesame oil on
the forehead or in a pendulum-like motion that pauses for
a moment each time it reaches the point between the brows
sometimes called the third eye. The marma point between
the brows is known as Sthapani, or what gives support or
holds firm. This point is associated with the sixth chakra,
Prana (primary life force), the mind, senses, and pituitary
gland. The purpose of the treatment is to center the mind
and body, to increase relaxation and inner peace, and to settle vata disorders such as anxiety and insomnia. It is always
the last treatment a client receives in an ayurvedic series.
In the shirodhara treatment, refined sesame seed oil is
traditionally used in the shirodhara vessel, but herbal milk,
seawater, buttermilk, coconut milk, medicated oils, and
other products can also be used. The treatment lasts between
20 and 30 minutes and is often combined with abhyanga.
Review the shirodhara overview (Treatment Overview 144)
and Figure 1412 as you practice this service.

Shirodhara Overview
Indications
Aggravated vata; insomnia; to decrease stress and
d mental
t l
exhaustion; to balance the body, mind, and spirit
Contraindications
Broken or inflamed skin on the forehead, low blood
pressure, pregnancy
295
Massage the neck and shoulders gently.

Position the clients head for shirodhara.
Place a warm pack on the abdominal area (optional).
Prepare the forehead by rubbing it gently with oil.
Open the tap of the shirodhara vessel first into a small
cup and then allow it to run onto the forehead.
6. Check the streams position and/or move the stream in
a pendulum motion across the forehead.
7. Stop the stream of oil and gently massage the neck,
shoulders, and scalp.
8. Allow the client to rest without being disturbed for
15 minutes or longer after the session.
1.
2.
3.
4.
5.
Session Start
Position the client in the supine position with his or her
head at the very top of the treatment table. Bolster the client, cover him or her with a warm blanket, and place a warm
pack on the belly or under the feet if it is appropriate. Massage the neck and face with slow, soothing strokes in preparation for the session. The clients head will remain in a
static position for up to 20 minutes, so this initial massage
is important. Place a rolled hand towel under the clients
neck to tip the head slightly backward. It is not necessary
for the head to be tipped at an extreme angle. Move the shirodhara equipment into position and place warm oil in the
shirodhara vessel with the opening in the closed position.
Adjust the vessel to the proper height directly over the clients forehead as shown in Figure 1412. You may choose to
use a small cup and recycle the oil in the bowl at the bottom
of the table. Quietly scoop it up and place it back into the
vessel to prolong the treatment.
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296
FIGURE 1412 Shirodhara procedure.
D
D
Step 1: Prepare the Forehead

Place a drop of warm oil on your index finger and circle
this finger around the clients forehead in a clockwise direction on the area where the oil will spill from the shirodhara
vessel. This ensures that the client is not startled as the oil
starts to hit his or her forehead.
Step 2: Adjust the Flow of Oil
Hold a small cup under the vessel and open the tap so that
oil begins to flow into the cup. Adjust the stream of oil
while it runs into the cup. You need a thin but even flow
of oil. You dont need a heavy flow or a sputtering drizzle.
Check the position of the clients head (you need it tipped
slightly backward). Oil will flow into the clients eyes if the
head is tipped forward. Remove the cup when the flow of
the oil is thin and even. Sometimes, clients are startled as
the oil starts to flow onto their forehead so it is helpful to

remind them to remain quiet and still.
Step 3: Adjust the Bowl If Needed
Once you are certain that the vessel position is correct
and that a thin, even flow of oil is hitting the target point
between the eyebrows, check the bowl under the massage
table. Sometimes, the oil flowing off the clients head
runs onto the floor and not into the bowl. Sometimes,
the oil hits the sides of the bowl and makes an annoying
sound. You can muffle this sound by placing tissues under
the drips.
Step 4: During the Application of Oil
Usually, the stream of oil is left in the same position for the
entire session. Sometimes, therapists like to lift the vessel,
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Chapter 14
hold it in their hands, and move the oil stream in a pendulum motion across the forehead. Any movement must be
steady and even, so this requires quite a lot of practice. As
the oil starts to run out at the end of the treatment, place
a cup under the stream of oil and turn off the tap on the
vessel. It is important that the oil is not allowed to sputter
out and drip unevenly on the clients head as it starts to run
out at the end of the treatment.
During a shirodhara session, the less movement or noise
in the treatment room, the better. Shirodhara treatments
heighten clients senses. Any excess movement you make,
any chatter in the hallway, and any crinkling of plastic are
distracting. Silence and low lighting work best.
Session End
Quietly pull the shirodhara equipment out of the way and
massage the clients neck and shoulders with slow, gentle
strokes. Allow the client to relax for 15 minutes undisturbed.
Shirodhara is the last service clients receive during a day at
the spa. People emerge from shirodhara sessions in a calm,
open, sensitive, and awakened state of mind. If they receive
additional treatments, they are likely to be overstimulated
and leave feeling irritated or restless. If a soaking tub is available, the client can relax quietly in warm water and remove
the oil from the hair while the client snack on a small food
item. A snack helps clients return to the present time and
prevents low blood sugar or shakiness. Some therapists give
clients their shirodhara oil to use at home for self-oiling. This
is a nice way to salvage the oil and encourages clients to bring
ayurveda more fully into their life. Otherwise, the oil must be
discarded. It cannot be repurposed for use with other clients.
SANITATION
The traditional shirodhara vessel and bowl are
copper and require careful cleaning to keep
them looking attractive. Clean the inside of the vessel
out with hot, soapy water; dry the vessel; and then wipe
it with alcohol. Use a copper cleaner and a soft cloth on
the outside of the vessel and bowl to remove fingerprints
and oil.
Indonesian-Inspired Spa Treatm

Treatments
ents
The Republic of Indonesia is a country in Southeast Asia and
Oceania composed of approximately 17,508 islands. Lying
along the equator, Indonesia has a tropical climate and
boasts the worlds second highest level of biodiversity (after
Brazil). An array of flowering plants, especially orchids and
jasmine abound in the rain forest environments, along with
spices such as nutmeg, cardamom, cinnamon, and coriander.
Across its many islands, Indonesia consists of hundreds
of distinct native ethnic and linguistic groups influenced
by Indian, Arabic, Chinese, and European sources because
of the long history of the spice trade. Traditional Javanese
297
and Balinese dances, for example, have roots in aspects of

Hindu culture and mythology. The largest ethnic group in
Indonesia is the Javanese, who follow a form of gentle Islam
influenced by Hinduism and Buddhism. The Javanese hold
beliefs embodying a search for the inner self, peace of mind,
connection with the universe, and with an Almighty God.
Women of the region use natural products to improve the
texture of their skin, promote wellness, and relax in luxury.
From this place of rich vegetation and interweaving cultures,
it is easy to create Indonesian-inspired spa treatments.
Indonesian Spa Products

Indonesian women have used the fragrant flowers, spices,
woods, and oils from their lush environment to promote
beauty, health, and wellness for centuries. There are 28,000
species of flowering plants in Indonesia, with an astounding
2,500 kinds of orchids and 6,000 identified medicinal
plants used as Jamu (traditional medicine). Spa products
are composed of natural ingredients that you can purchase
from import stores, incense shops, and health food stores
and blend by hand. You can also obtain products from
suppliers out of Indonesia or from general spa suppliers.
Ingredients in Indonesian-inspired spa treatments might
include the following:
Cempaka or champaca (Magnolia champaca): Cempaka
(not to be confused with Himalayan champaca from the
botanical, Michelia champaca), is a species of Magnolia tree
with fragrant yellow or white flowers. The flowers are
used for worship at temples, worn in the hair as a beauty
accessory and natural perfume, or floated in bowls of
water for their beauty and to scent a room. The tree is
grown ornamentally in California, and blooms can be
obtained in some flower shops, but cempaka essential
oil as sold by some aromatherapy suppliers is most often
synthetic and overly sweet. Ylang ylang essential oil has a
similar fragrance and is a good substitute.
Cloves (Syzygium aromaticum): Historically, cloves were
only grown on the famous Spice Islands (Maluku Islands)
in Indonesia. A Frenchman named Poivre transferred
clove seedlings from the Spice Islands to France and
then to Zanzibar (which is the largest producer of cloves
today) in 1770. Cloves have strong analgesic properties,
which were highly prized in England in the 17th and 18th
centuries where cloves were literally worth their weight in
gold. Indonesians use cloves for their warming properties
to ward off illness and to decrease muscular soreness and
headache. This use shows up in the traditional Balinese
Boreh treatment described later in the chapter.
Coconut (Cocos nucifera): The coconut tree is the most
familiar palm in the tropics where it spread through
human use from its origins in the Western Pacific. Indian
mythology influences the Indonesian mythology about
the coconut. It symbolizes complete usefulness, selfless service, prosperity, and generosity. The palms are
believed to be the embodiment of the ancient Indian
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298
concept of kalpavriksha, or the tree that grants all wishes.

Many parts of the coconut including its meat, water, and
palms are used in traditional medical systems to promote health and wellness. Coconut oil has also been used
for centuries in hair care and cosmetics for its moisturizing and softening qualities. In many parts of Asia, coconut oil is boiled with lemon, mixed with jasmine-infused
water, and used as a hair shampoo. Coconut oil is often
the base oil used in Indonesian massage treatments.
Coriander (Coriandrum sativum): Coriander is native to
regions in Europe, Northern Africa, and Asia. It probably
found its way into Indonesian use from Hindu or Buddhist
influences and is widely used in ayurvedic medicine where
it is added to preparations to reduce pitta (to cool heat).
Frangipani (Plumeria spp.): The widely used common
name, frangipani, comes from an Italian noble family
who used plumeria flowers to make a popular perfume. The rich, sweet plumeria flowers grow on small
trees and are most fragrant at night in order to lure the
sphinx moth to pollinate them. Because of their strong
night fragrance, they are often associated with the
moon. Indonesians believe that the trees give shelter to
ghosts and wayward spirits, and they are often planted
in graveyards. The flowers symbolize color, beauty, and
sweetness.
Ginger (Zingiber officinale): Ginger most likely originated in India and spread to Africa, Asia, and the Caribbean when it was carried in pots on local sailing vessels
traveling ancient trade routes. Indonesians call ginger
jahe and use it as a topical herbal preparation to reduce
fatigue and control poor dietary habits. Wedang jahe is
an invigorating tea made from ginger, palm sugar, and
pandan (a type of palm) leaves.
Indonesian cinnamon (Cinnamomum burmannii): Cinnamon is a spice that comes from the inner bark of several
species of trees in the genus Cinnamomum. Indonesian
cinnamon is cultivated in Java and Sumatra and called
kayu manis meaning sweet wood by the locals. It is
used for its warming properties, for muscle soreness and
fatigue, and to stimulate circulation to the skin to improve the complexion.
Jasmine (Jasminum sambac): The species of jasmine
grown in Indonesia is Jasminum sambac, commonly known
as Arabian jasmine, although it is not native to Arabia and
likes moist, humid, tropical climates. It should not be
confused with Jasminum grandiflorum, which has a lighter,
more delicate aroma and is usually chosen for French
perfume work. Ruled by the moon and the element of water, jasmine represents elegance and womanly sweetness.
Hindus call it moonlight of the grove, which conjures
images of the delicate flowers opening to the night and
releasing their opulent perfume.
Nutmeg (Myristica fragrans): Nutmeg is native to the
Banda Islands of Indonesia and has a long history of
medicinal use dating to the first century and the Roman
writings of Pliny, early Indian Vedic writings, and early
Arabian medical texts. Brought to Europe during the

middle ages, the spice was highly prized for the exotic
flavor it brought to cuisine and as a cure for the plague.
It became so popular that the Dutch, Portuguese, and
British fought wars to control the island of Run where it
was grown. Eventually, the British transported plants to
Grenada and Zanzibar to maintain control of the nutmeg
trade. The flavor and fragrance of nutmeg comes from
a chemical component called myristica, which is a mild
narcotic. Nutmeg is often used to expand consciousness
and explore inner space.
Sandalwood (Santalum album): Sandalwood is called
cendana in Indonesia. It is a precious tree yielding fragrant
wood used all over the world as a spice, incense, and
aromatherapy oil. In Java, the timber is used traditionally
for the sheath of a precious kris, a Javanese traditional
dagger. It is believed to make people purer and therefore
closer to god.
Seaweed (Eucheuma cottonii): Seaweed is an important
trade crop in Indonesia. The species Eucheuma cottonii (similar
to Iris moss discussed in the chapter on thalassotherapy) is
harvested on many islands, placed on tarps to dry in the
sun, and then shipped around the world to be used as a
thickening ingredient (carrageenan) in food and cosmetics.
Some Indonesian spas pride themselves on their locally
grown, harvested, and dried seaweed treatments.
Turmeric (Curcuma longa): Turmeric rhizomes are harvested, boiled for several hours, and then dried in hot
ovens, before they are ground into a deep orange-yellow
powder commonly used as spice in cooking. Turmeric has
been used for over 2,500 years in India as part of ayurvedic
medicine. Indonesians believe it firms the skin, improves
the skins radiance, and brightens the completion.
Ylang ylang (Canangium odoratum): Ylang ylang is a tall,
tropical tree that grows to about 60 feet and yields pink,
yellow, or mauve flowers. On the Maluku Islands, the
flowers of the ylang ylang tree are added to coconut oil
and made into a pomade. This is rubbed into the whole
body to protect against fevers. It smells so good that the
young women chose to use it all year long to perfume
their hair. In the 1800s, ylang ylang was the main ingredient in a hair preparation called Macassar oil, which was
widely used by Victorian ladies. In Indonesia, ylang ylang
flowers are spread on the bed of newlywed couples and
strung into a necklace worn for beauty and as a natural
perfume.
Treatment Considerations
Before offering Indonesian-inspired spa treatments, it is
important to understand cautions and contraindications,
and other issues related to these services.
Mixing Your Own Products
Finding sources for traditional products can be difficult.
Although there are suppliers that provide Indonesian products
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Chapter 14
for traditional services, they are often adulterated or synthetic.

Frangipani is produced as an absolute and costs about $30
for a milliliter (a milliliter is 20 drops). Jasmine sambac is
around $30 for 3 ml. Although only small amounts of these
oils are needed for a session, it is unlikely they are provided in
an unadulterated form when they are blended into a premade
spa product. You can control the quality of the product by
blending your own and using therapeutic-grade essential oils.
This practice however can be time-consuming.
Sensitive Skin
The spices used in Indonesian services tend to be very
stimulating for the skin and body. Many are rich in phenol
components, which have positive antiviral, antibacterial,
and immune-boosting properties but may also cause skin
irritation for fair-skinned people. Use pastes made of spices
and essential oils with caution. If skin irritation occurs, apply a vegetable oil to the skin to soak up and dilute oils and
spices and remove the oil with paper towels before rinsing
the skin with cool water. Keep cortisone cream on hand to
apply to irritated skin to reduce redness and itching.
Sensitive Noses
Frangipani, jasmine, and ylang ylang are powerful, intense
aromas. They can be overwhelming for clients with sensitive
noses, and they can be overwhelming for you, the therapist.
Err on the side of caution and use 1 or maybe 2 drops of any
combination of these aromas until you have experience in
how you and clients respond to their fragrances.
The Fragrant Soaking Tub
Soaking in a big tub filled with flower petals is part of the
luxurious enjoyment of Indonesian services. It is common
at Indonesian spas for a client to rinse off in a shower before
soaking in a tub. Obviously, this means another piece of
equipment must be sanitized and dried in between clients.
You must also factor the time necessary to prepare the tub
into the overall flow and plan for a service. For example, you
cant fill the tub too early because the water will cool down
and the essential oils will evaporate. You cant ask a client
to stand around while the tub fills with water. Instead, you
must plan an appropriate moment to leave the client and
start the water running into the tub. You must plan another
appropriate moment to leave the client and stop the water
running into the tub. Add flower petals and essential oils
directly before the client enters the tub so that they are fresh
and fragrant for the soaking experience.
The Cost of Fresh Flowers
Indonesia is full of flowers, and Indonesian spas take
advantage of easy access to a unique national resource. To
replicate the overabundance of fresh blooms in an American spa or massage clinic is difficult and costly. Instead,
think of using flowers strategically. Place one large colorful
bloom in the foot soaking basin, scatter a small handful of
rose petals over the massage table, and float a variety of less
299
expensive flowers such as carnations along with other flowers in the soaking tub. Factor the cost of fresh flowers into
the product cost for the service when you price the service.
Clients Who Are Pregnant
Indonesian treatments tend to be warm, spicy, stimulating,
and very fragrant. They are not an ideal choice for pregnant
women. Although the treatments are not specifically contraindicated, pregnant women may become overheated by
the spices and overstimulated by the aromas. Alert them
to these possibilities during the booking phone call and
encourage them to opt for a treatment with gentle aromas
and less stimulating products.
Indonesian-Inspired Massage
Balinese massage and Indonesian massage are commonly
listed items on spa menus throughout Asia, Europe, and
the United States. It is hard to know if these massage styles
are practiced in a traditional form or if influences from a
variety of places and if massage techniques have diluted
traditional methods. For example, some spas in Indonesia
insist that Balinese massage is not traditionally applied
with oils. Instead, pureed cucumber, carrot, and yogurt
are used as lubricants. At other Indonesian spas, Balinese
massage is described as the original oil massage influenced
by ayurvedic treatments in India. It is also common to see
Balinese and Indonesian massage described as a combination of gliding, aromatherapy, reflexology, and acupressure.
Indonesia is a large group of islands, so it makes sense that
massage techniques would vary. What stands out about
this form of massage is the use of compression strokes and
the beautiful fluidity of forearm techniques. The procedure
described here does not claim to be traditional but instead
incorporates common and enjoyable Indonesian elements
into a relaxing and pleasurable massage experience. Review
the overview provided in Treatment Overview 145 and
Figures 1413, 1414, and 1415.

Overview of an Indonesian-Inspired Massage
Indications
To relax the body, decrease muscle soreness or stiffness,
tiff
and promote health and wellness
Contraindications
Supplies for the Foot Soak

1. Foot soak container with warm water, 1 cup of warm
milk, 2 drops of ginger CO2, 2 drops of nutmeg, 1 drop
of ylang ylang, and fresh flowers
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300
slip them into washable slippers, and move the client to the
massage table in the prone position.
Overview of an Indonesian-Inspired
Massage (continued)
Step 1: Compression Strokes to the Posterior Body
4. Robe
5. Dry hand towel
6. Slippers

(from bottom to top layer)
2. Bath towel for a top drape

1. Massage oil made with 2 oz of coconut oil with 1 drop
of frangipani absolute and 1 drop of jasmine absolute
2. Crme hair mask (optional)
3. Alcohol-based hand sanitizer
Procedure
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Foot soak and crme hair treatment (optional).

Compression strokes to posterior body.
Massage the back.
Massage the posterior legs.
Turn the client and massage the anterior legs.
Massage the feet and sanitize the hands.
Massage the abdominal muscles.
Massage the arms and hands.
Massage the neck and face.
Transition the client to a shower, soaking tub, or hair
care professional.
Session Start
Prepare a foot soaking basin with warm water, 1 cup of
warm milk, 2 drops of ginger essential oil (use the oil produced through carbon dioxide [CO2] extraction if possible
because it smells more like fresh ginger), 2 drops of nutmeg
essential oil, and 1 drop of ylang ylang essential oil. Float
blossoms or rose petals on the surface of the water. Place
the basin on top of a bath towel and provide the client with
a robe, comfortable chair, and slippers while he or she soaks
the feet. Indonesians enjoy a crme hair mask applied to the
scalp and hair with gentle strokes to stimulate the scalp and
moisturize the hair. Traditional Indonesian crme products
are available through suppliers in Indonesia (use the search
term Indonesian crme hair products for a variety of sources).
If you choose to provide the crme service, massage the
scalp for 10 minutes while the feet are soaking, wrap the
hair in a plastic shower cap, and allow the product to absorb during the massage. The client must be able to wash
his or her hair at the end of the massage in a soaking tub or
in a shower, or a hair care professional can shampoo, cut,
and style the clients hair.
Ask the client to lift his or her feet. Slide the soaking basin out from under the feet. Instruct the client to place his
or her feet onto the preset bath towel. Dry the clients feet,
With the client bolstered in the prone position and draped

with a massage sheet and bath towel, apply firm, slow compression strokes starting at the shoulders and working all
the way down the body to the feet. Apply the strokes to both
sides of the body at the same time as shown in Figure 1413A.
Make three passes down the body using compression strokes.
Undrape the clients back and apply warm massage oil
that you have prepared for the session by adding 1 drop
of frangipani and 1 drop of jasmine absolute (2 drops
of oil will still smell very strong and sweet) to 2 oz of a
coconut oil base. Spread the oil evenly with long, slow
gliding strokes starting at the low back and running
up to the shoulders and down to the arms as shown in
Figure 1413B.
Deepen the gliding strokes by dropping the heel of your
hands into the tissue on either side of the spine and
using firm slow pressure up to the shoulders as shown
in Figure 1413C. When you reach the shoulders, apply firm kneading strokes as shown in Figure 1413D.
Repeat this sequence up to six times.
Move to the left side of the table and reach across the clients back to the right side of his or her body. Place one
palm over the other and use circular strokes that pull the
tissue toward the spine to work up the right side of the
body. Make three or four passes on the right side then
change sides while keeping your hands on the clients
body and repeat the strokes on the left side as shown in
Figure 1413E.
Standing by the clients hips on either side of the massage
table, apply skin rolling techniques starting at the low
back and running up to the shoulders in multiple passes
on each side of the spine as shown in Figure 1413F.
Use long forearm strokes applied continuously at a
moderate pace and depth (dont lift your forearms off
the clients body) starting at the low back, working up the
opposite side of the spine, working around the shoulder,
working down toward the low back, applied on the sides
of the client, and repeated until the tissue is soft and
relaxed. Techniques using the forearms are shown in
Figures 1413G, 1413H, and 1413I. Explore the use of
these strokes until you have combinations of strokes that
cover the entire area in a fluid and flowing sequence.
Standing at the head of the table, apply linear friction
with the fingers down either side of the spine. When you
reach the sacrum, lean back and pull the fingers back
toward the head along the lamina groove while swaying
back and forth with your body and fingers as shown in
Figures 1413J and 1413K. Pull gently at the occiput
when your fingers reach the top of the spine and repeat
the two strokes four or five times. Use circular thumb
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FIGURE 1413 Indonesian-inspired massage strokes for the back. (continued)
friction down the sides of the spine to transition back to

the low back as shown in Figure 1413L.
Apply wrist spinning strokes into the gluteal muscles
working both sides of the body simultaneously as shown
in Figure 1413M.
Use pincement strokes where the fingertips pluck
pieces of tissue lightly (think of a bird picking up tissue
with its beak) in a percussive motion up the back and
down the back on one side of the spine and then up the
back and down the back on the other side of the spine as
shown in Figure 1413N. You can repeat this technique
up to three passes. End the last pass by one arm. Pull

the arm off the side of the table and apply compression
strokes to the upper arm and then complete the series
by squeezing all the way down to the hand as shown in
Figures 1413O and 1413P. Repeat this series on the
arm three or four times and then complete the same
series on the other arm.
Finish the back massage with soft, soothing gliding
strokes. Cover the back with the drape and repeat the
compression stroke down the entire posterior body to
transition in the massage of the posterior legs.
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304
FIGURE 1414 Indonesian-inspired massage strokes for the legs. (continue)

Apply oils to the first leg using gentle gliding strokes from
the ankle to the gluteals and back to the ankle as would be
applied in a Swedish massage. Deepen the pressure by using
the heel of the hand pressed toward the gluteals as shown in
Figure 1414A. Repeat this stroke four or five times.
Apply a wringing kneading stroke from the ankle to the
thigh and back again as shown in Figure 1414B. Repeat
this stroke three times.
Use skin rolling techniques from the ankle to the gluteal
muscles making up to six or seven passes to cover the
entire posterior leg as shown in Figure 1414C.
Apply forearm technique to the leg as shown in Figure

1414D and then to the thigh as shown in Figure 14
14E. Repeat these techniques, first massaging the leg and
then the thigh three times.
Apply circular thumb friction up the leg as shown in
Figure 1414F and then wring the leg from the thigh
to the ankle as shown in Figure 1414G. Repeat this
sequence three or four times.
Use wrist spinning up the posterior leg, making two or
three passes as shown in Figure 1414H.
Apply the pincement technique beginning at the
ankle and working up to the gluteal muscles and
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305
back down again for three or four passes as shown in

Figure 1414I.
Compress the tissue working from the gluteals down the
leg to the ankle, making three passes.
Finish the posterior leg massage with effleurage strokes and
redrape the leg. Repeat the sequence on the opposite leg.
Turn the client into the supine position and bolster the
knees. Place a pillow or rolled towel under the neck. Apply
compression strokes from the thighs down to the ankles
using one hand on each leg. Repeat the strokes three times.
Apply oil to the first leg using gentle gliding strokes from
the ankle to the hips and back to the ankle as would be
applied in a Swedish massage. Deepen the pressure by
using the heel of the hand pressed toward the hip as
shown in Figure 1414J. As you work on the leg, apply
the stroke so that it covers the tibialis anterior and not
the bone. Repeat this stroke four or five times.
Apply a kneading stroke from the ankle to the thigh and
back again as shown in Figure 1414K. When you reach
the thigh, the kneading stroke turns into a wringing
stroke as shown in Figure 1414L. Repeat this series of
strokes three times.
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Use skin rolling techniques from the knee to the hips

making up to six or seven passes to cover the entire thigh
area as shown in Figure 1414M.
Apply forearm technique to the leg as shown in Figure
1414N and then to the thigh as shown in Figure 14
14O. It feels best to press the foot into medial rotation
while applying the stroke to the leg. Repeat these techniques, first massaging the leg and then the thigh three
times.
Apply circular thumb friction up the leg as shown in

Figure 1414P. Repeat this sequence three or four times.
Apply the pincement technique beginning at the ankle
and working up to the hip and back down again for three
or four passes as shown in Figure 1414Q.
Compress the tissue working from the thigh down the
leg to the ankle making three passes.
Finish the anterior leg massage with effleurage strokes and
redrape the leg. Repeat the sequence on the opposite leg.
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FIGURE 1415 Indonesian-inspired massage strokes for the arms and hands. (continue)
Step 7: Massage the Arms and Hands
Massage the feet using any of the techniques for foot massage
or reflexology demonstrated in Chapter 10 (Spa Foot
Treatments).
Apply compression strokes from the shoulder down to

the hands, squeezing the hands, and then back up toward
the shoulder as shown in Figure 1415A. Repeat this
sequence for three passes.
Apply oil to the arm using gentle gliding strokes from
the wrist to the shoulder and back to the wrist as would
be applied in a Swedish massage. Deepen the pressure by
using the heel of the hand pressed toward the shoulder
Step 6: Abdominal Massage

Massage the abdominal muscles by applying firm gliding
strokes in a clockwise direction as would be used in Swedish
massage.
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308
as shown in Figure 1415B. Repeat this stroke four or

five times.
Apply a kneading stroke from the wrist to the shoulder
and back again as shown in Figure 1415C. Repeat this
series of strokes three times.
Use skin rolling techniques from the wrist to the shoulder
making up to six or seven passes to cover the entire area
as shown in Figure 1415D.
Apply the forearm technique to the arm as shown in
Figure 1415E. Repeat this technique three or four times.
Massage the hands with circular thumb friction as
shown in Figure 1415F.
Apply circular thumb friction up the arm as shown in
Figure 1415G. Use squeezing techniques to work back
down to the wrist as shown in Figure 1415H. Repeat
this sequence three or four times.
Apply the pincement technique, beginning at the wrist
and working up to the shoulder and back down again for
three or four passes as shown in Figure 1415I.
Compress the tissue working from the wrist to the shoulder
and back to the wrist making three passes.
Finish the arm massage with effleurage strokes and repeat
the sequence on the opposite arm.
Step 8: Massage the Neck and Face

Massage the neck and face using any techniques you like or
the face massage routine demonstrated in Chapter 4 (Your
Spa Massage).
Session End
The session can end after the massage, or the client can soak
in a tub or take a shower and wash his or her hair if a crme
hair product was applied with a scalp massage during the

foot soak. Alternately, the client can be moved to a hair care
professional for a shampoo, cut, and style.
Indonesian-Inspired Exfoliation and Body

Wrap Treatments
Indonesian exfoliation and body wrap treatments can take
many forms and might be delivered with a variety of natural
products using methods you have learned in previous chapters. These sessions might use volcanic mud, purees of carrots, yogurt, and cucumber, or the traditional Lulur mixture.
Indonesian Mud Exfoliation and Wrap
In some Indonesian spas, local volcanic mud, which has a
gritty texture, is applied to the body with massage strokes
to exfoliate the skin, and then the body is left to absorb the
properties of the mud in a cocoon (review Chapter 9, Body
Wraps, for directions on how to apply a cocoon wrap). You
can purchase Indonesian volcanic mud, which is believed to
have a high mineral content, through spa suppliers, or you
can use a clay base and add natural Indonesian ingredients
described previously to create your own product. Pair the
mud wrap with a crme scalp massage, a shower to rinse the
mud, and a soak in a fragrant bath with flowers.
Indonesian Cucumber Exfoliation and
Carrot Wrap
Purees of cucumber, yogurt, and carrot are applied to
the skin with massage strokes to exfoliate, brighten, and
moisturize the skin (Fig. 1416). To perform this type of
session, prepare the natural ingredients by blending two cu-
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Chapter 14
cumbers in a food processer. Clean the food processer and

repeat the process with four carrots. Keep these products
in separate bowls and place them on the work table with
a cup of sea salt and a bottle of coconut oil. Place 1 cup
of plain, organic, Greek yogurt in a third bowl. Using the
massage strokes described in the previous section, apply cucumber to the back and posterior legs and then add sea salt.
Work the sea salt and cucumber across the skin with gentle
strokes. Remove the cucumber with hot, moist towels and
apply yogurt to the skin of the back and the posterior legs.
Massage the posterior body with yogurt, adding more as
309
FIGURE 1416 Natural treatment using

cucumber, carrot, and yogurt.
needed to facilitate your massage strokes and then remove

the yogurt with hot, moist towels. Turn the client into a supine position and repeat the exfoliation steps on the anterior body. Use the sit-up method described in Chapter 5
(Foundation Skills for Spa Treatment Delivery) to apply the
puree of carrot to the clients skin and wrap him or her in a
cocoon. Massage the clients face and scalp (you can use the
crme hair treatment if desired) while the client remains in
the cocoon for 20 minutes. Move the client to a shower to
rinse off and then to a fragrant soaking bath if it is available
to conclude the session.
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Balinese BorehInspired Treatment

The Balinese Boreh is an Indonesian traditional medicine
treatment that is used to ward off or to treat a chest cold,
cough, influenza, or fever. People with muscle aches and
pains, headaches, arthritis, or sensations of cold also find it
warming, soothing, and pain relieving. Purchase the Boreh
spice mixture from Indonesian spa suppliers or make your
own by combining three parts rice powder, with one part
sandalwood powder, powdered ginger, powdered coriander,
turmeric, nutmeg, cinnamon, and ground cloves with warm
water into a paste. Add 2 drops of nutmeg, 1 drop of CO2produced ginger essential oil, and 4 drops of coriander to
the paste.
Massage the client with 1 oz of coconut or palm oil
to which you have added 2 drops of turmeric, 1 drop of
clove, and 4 drops of coriander essential oil using some
of the strokes described previously. Cover the back and
thighs with the Boreh paste and allow the paste to sit for
5 or 10 minutes on the skin. During the waiting period,
cover the client with a sheet and blanket and massage
the arms, hands, and scalp. Remove the paste by rubbing
it off with your hands or by buffing it with rolled hand
towels. Leftover paste is removed with hot, moist towels.
Turn the client into the supine position and massage
the anterior legs and abdominals. Apply the Boreh paste
to the abdominal area and upper chest. While the paste
dries, massage the clients feet, neck, and face. Remove
the paste by rubbing it off with your hands and with hot,
moist hand towels. End the session by moving the client
to a fragrant soaking tub.
Javanese Lulur Ritual

The Javanese Lulur Ritual is a traditional beauty treatment
used by Javanese princesses as they prepare for their weddings. Applied for 40 days before the wedding, the Lulur
ritual beautifies the skin and provides an opportunity for
the women of the household to pass on wisdom to the brideto-be. Today, the Javanese Lulur is a popular spa treatment
enjoyed by both men and women as a way to celebrate love
and romance. The Lulur ritual might consist of a number of
different spa treatments organized in a relaxing sequence.
This outline includes a foot soak, crme hair treatment,
massage, and Lulur scrub. Review the overview in Treatment
Overview 146 and Figure 1417 and follow directions for
the massage table setup, work table setup, and preparation
of products. It is important to provide clients with disposable undergarments to protect their modesty due to the level
of body exposure during the treatment.
Session Start
Prepare a foot soaking basin with warm water and 2 drops
of ylang ylang essential oil. Float blossoms or rose petals
on the surface of the water. Place the basin on top of a bath
towel and provide the client with a robe to wear over dis-

Overview of the Javanese Lulur Ritual
Indications
To relax the body and beautify the body, mind, and
d spirit
i it
in honor of love and romance
Contraindications
Broken or inflamed skin, any condition contraindicated for
massage
Supplies for the Foot Soak

1. Foot soak container with warm water, 2 drops of
ylang ylang, and fresh flowers
2. Bath gel and sea salt
5. Robe
6. Dry hand towel
7. Slippers
8. Client should be wearing disposable undergarments
under the robe

1.
2.
3.
4.
Bottom layerblanket turned horizontally

Plastic wrap sheet turned horizontally
Bath towel placed horizontally at the top of the table
Bath towel placed horizontally at the bottom of the
table

1. Massage oil made with 1 oz of coconut oil with 2 drops
of ylang ylang and 8 drops of lime essential oil
2. Lulur scrub (The Lulur scrub can be purchased from
Indonesian spa suppliers, or you can make your own
by combining rice powder, turmeric, and sandalwood
with warm water and 2 drops of frangipani oil and
2 drops of jasmine oil into a paste.)
3. Plain, full-fat yogurt
4. Hand sanitizer
5. Crme hair treatment (optional)
6. Two dry hand towels for buffing
7. Two dry hand towels for draping
8. Soda cooler filled with hot, moist hand towels
9. Finishing lotion or body butter (optional)
Procedure
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Foot soak and crme hair treatment (optional).

Massage the back and posterior legs.
Apply Lulur scrub to the posterior body.
Remove the Lulur scrub with hot, moist towels.
Apply yogurt to the posterior body.
Turn the client to the supine position.
Massage the anterior legs, abdominals, and arms.
Apply Lulur scrub to anterior body.
Remove the Lulur scrub with hot, moist towels.
Apply yogurt to the anterior body.
Wrap the client in a cocoon.
Massage the feet; sanitize the hands.
Massage the face.
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Chapter 14
14. Move the client to a shower and soaking tub.

15. Reset the massage table with fresh sheets.
16. Apply finishing lotion or body cream to the posterior
body.
17. Apply finishing lotion or body cream to the anterior body.
posable undergarments, a comfortable chair, and slippers

while he or she soaks the feet. Incorporate the crme hair
311
mask and scalp massage if the client desires it as described

previously. Use sea salt in bath gel or a scrub to exfoliate
the clients feet. Pull one foot from the soaking basin, scrub
the foot vigorously, and then return the foot to the soaking
basin. Repeat the process on the second foot.
Ask the client to lift his or her feet. Slide the soaking
basin out from under the feet. Instruct the client to place
his or her feet onto the preset bath towel. Dry the clients
feet, slip them into washable slippers, and move the client
to the massage table in the prone position.
FIGURE 1417 Javanese Lulur Ritual procedure. (continue)
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312
Step 1: Massage the Back and Posterior Legs
Step 2: Apply Lulur Scrub to the Posterior Body
Open the massage with compression strokes as described in the previous section and a back massage (Fig.
1417A). Use a gluteal drape over the top of disposable
undergarments to leave the clients back expose and to
expose both posterior legs at the same time. Complete
the massage on the posterior legs as shown in Figure
1417B.
Apply the Lulur scrub with one hand (the goal is to get the
scrub on the body), beginning by the ankle on the left side
and slathering it up the thigh, over the gluteals, and up the
back on the left side, down the back on the right side, over
the gluteals, and from the thigh on the right side to the
ankle as shown in Figures 1417C and 1417D. Now return
to the left side of the body and work the scrub into the skin
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Chapter 14
using long, full-body strokes. Transition to the right side

and repeat the long, full-length body strokes.
Step 3: Apply Yogurt to the Posterior Body
Remove the gluteal drape so that the client is wearing only
disposable undergarments. Remove the Lulur scrub with
hot, moist hand towels from the posterior legs and back as
shown in Figure 1417E. Take fresh, organic, full-fat yogurt
and apply it to the posterior body using the same sequence
you used to apply the Lulur scrub. Begin at the left ankle,
slather the yogurt up the leg and thigh, across the gluteals,
up the back on the left side, down the back on the right side,
over the gluteals, and from the thigh on the right side to the
right ankle as shown in Figure 1417F.
Step 4: Massage the Anterior Body
Turn the client into the supine position (the yogurt is left
on the posterior body), bolster the knees, and drape the client with a towel over the disposable undergarments. Repeat
the compression stroke sequence down the anterior body
and massage the anterior legs as described in the previous
section.
Use a breast drape for female clients to expose the abdominal area and an anterior pelvic drape to get the large
bath towel drape out of your way. Massage the abdominal
area and the arms as shown in Figure 1417G.
Step 5: Apply Lulur Scrub to the Anterior Body
Slather the Lulur scrub onto the anterior body by starting at the left ankle, slathering up the thigh to the hip,
over the abdominals, up the arm on the left side, across
the upper chest, down the arm on the right side, and
down the leg from the thigh to the ankle as shown in
Figure 1417H. Now return to the left side of the body
and work the scrub into the skin following the same progression of leg, thigh, abdominals, arm on the left, upper
chest, arm on the right, abdominals, thigh on the right,
and leg on the right.
313
Step 6: Apply Yogurt to the Anterior Body

Remove the Lulur scrub from the anterior body using hot,
moist towels. Apply yogurt to the skin using the same sequence, beginning at the left ankle, slathering up the leg
to the thigh, over the abdominals from the left, up the left
arm, across the upper chest, down the right arm, over the
abdominals from the right side, down the right thigh, and
ending at the right ankle as shown in Figure 1417I. Wrap
the preset plastic and blankets up and around the body as
you would for a cocoon as shown in Figure 1417J.
Massage the clients feet (Fig. 1417K) using a variety of
strokes or any of the techniques you learned in Chapter 10
(Spa Foot Treatments). Sanitize your hands.
Step 8: Massage the Face
Massage the clients face (Figure 1417L) using a variety of
strokes or the routine you learned in Chapter 4 (Your Spa
Massage). Conclude the massage, scrub, and wrap phase of
the session with compression strokes applied over the top
of the wrap and down the anterior body.
Session End
Unwrap the client and move him or her to a shower or soaking tub to remove the yogurt from the skin and crme from
the hair. After the client has completed this step, he or she
can return to a clean massage table set with sheets for the
application of a finishing lotion or body cream.
SANITATION
Avoid throwing Lulur scrub, purees of natural
food material, mud, seaweed, or wet flower
blossom down the spa drain. Instead, use a strainer to
remove these items from water or paper towels to wipe
them from surfaces. If you attempt to wash them down
the drain the drain will become clogged.
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SPA FUSION
STUDY TIP: Make It Personal
In order to learn anything, you must feel interested in
it, have a basic understanding of concepts, and spend
time processing subject matter. With ayurveda concepts, this process can be particularly important. In order to apply ayurveda concepts, you have to make the
analogies about energy, the makeup of the universe,
and the flow of Prana personal. So, as you contemplate this material, pay careful attention to yourself.
Can you recognize your dosha from the descriptions?
Can you identify events in nature that might aggravate
or pacify your dosha? Can you palpate a tender area
on your arm, leg, or back and associate it to a marma
point? The more you can engage these concepts at a
personal level, the easier they will be to understand
and apply.
MASSAGE INSPIRATION: Get Some New Culture!

Its fun to learn about other cultures, and the more
you know about other cultures, the easier it will be to
develop original spa bodywork treatments for your
practice. In this chapter, you learned about ayurveda
from India and Indonesian bodywork. You can deepen
your understanding by planning activities that expose
you to the Eastern worldview. You might go and see
a subtitled film from India or Bali. You might attend
a yoga class, meditation class, or practice Balinese
dance. Maybe you visit the local art museum to view
their Eastern or Indonesian collection of artifacts.
Participation in any of these activities will help you
create connections between pieces of information in
your classes. As you make connections, write them
down in a massage or spa journal so that they continue to inspire your spa bodywork practice, even after
you graduate. When you run into new cultures, seek to
find out more. What types of products do they use and
export? Are any of these products natural? Would they
make suitable spa treatments? Have fun and explore
your world while you explore all the creative possibilities in spa work.
CHAPTER WRAP-UP
If you have been raised in a Western culture, Eastern
concepts of bodywork can seem very strange at first,
and you might want to simply reject them because
they dont match your worldview. This is a normal reaction but may cut you off from ideas and techniques
that could inspire and inform your developing
practice. You have probably noticed already that many

of these new ayurvedic and Indonesian techniques
are surprisingly like the old Western techniques
you already know. Its interesting to contemplate
that people in many different areas of the world were
developing similar ways to use touch therapeutically.
Isnt it amazing that comparable methods developed
despite the very different cultural viewpoints people
held as they approached bodywork? As you continue
to progress through your studies think about your
prospective and how it is changing. In the early days
of massage school, you probably couldnt apply the
idea of prana or marma points to your massage.
Today, these are concepts that you understand and
can explore as you deliver massage. Think about all
the other cultures that are out there waiting to be
explored. Each concept you learn changes you in some
way; changes your thinking, changes your hand placement, changes the questions you ask clients to plan
session goals, and changes the way you understand the
world and spa treatments.
REVIEW QUESTIONS
Multiple Choice
1. Ayurveda is best defined as:
a. The practice of Hinduism in a spa
b. The practice of Indian massage and spa treatments
c. A medical system that is mainly focused on
massage
d. A medical system and a philosophy about how
to live life in balance
2. In traditional ayurveda, everything in the universe
is composed of five elements (panchamahabhutas).
These include:
a.
b.
c.
d.
Space, air, fire, water, and earth

Metal, wood, space, air, and breath
Space, breath, water, fire, and spirit
Earth, planets, sun, fire, and forest
3. Although every individual has elements of all three

doshas, one or more will be dominant. This unique
dosha combination is referred to as a persons:
a.
b.
c.
d.
Prakriti
Vata
Pitta
Kapha
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Chapter 14
315
SPA FUSION
4. Balinese massage is characterized by:
a.
b.
c.
d.
Amazing tapotement
Neuromuscular integration with reflexology
The use of compression and forearm techniques
The use of Victorian herbs such as lavender and
rosemary
5. The Javanese Lulur Ritual is:

a. A beauty treatment used by Javanese princesses
before their weddings
b. A treatment to inspire courage used by Javanese
kings before battle
c. A moon ritual used by Javanese villagers
d. A moon ritual used to inspire creativity
Fill in the Blank

7. Kaphas need a massage that is
8. Each dosha has its own qualities. Vata qualities

are dry, light, cold, subtle, and unstable. Three
kapha qualities are
,
,
and
.
9. Pittas are aggravated when the temperature becomes too
.
10. The most unstable of the doshas and the dosha
most likely to go out of balance is
.
6. The Balinese Boreh treatment is:

a. A beauty ritual used by Javanese villagers
b. A beauty ritual used by Balinese princesses
c. A medical treatment traditionally used to ward
off colds and flu
d. A treatment to inspire courage used by Balinese
kings before battle
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P A R T
THREE
Your Spa
Career
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15
Treatment Design and
Your Signature Spa
Treatment
Chapter Outline
K e y Te r m s
Signature spa treatment: A special treatment that is only offered by one

spa. It is designed to highlight the spas unique features and particular
strengths.
Spa program: All of the different services that are offered at a spa are
collectively called the spa program.
Treatment concept: An abstract idea that helps both to organize the different parts of a treatment and to send a specific message to the client.
Textural elements: The word texture describes the varied sensations the
therapist creates during the treatment by paying attention to what the
client sees, hears, smells, tastes, and feels.
The Therapeutic Goal

Finding Inspiration through a Treatment Concept
Treatment Texture
Enhancing Treatments
Transitions
Product Planning
Client Management
Retail Sales as Part of the Treatment
Treatment Planning Forms
Considerations When Pricing Services

S
SPA
FUSION
STUDY TIP: Learn from Your Treatments
CHAPTER WRAP-UP
317
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318
Immagine for a moment that body treatments are pieces of

performance art. With careful planning, a spa experience
can be very like classical theater. Each moment of a play
(treatment) is broken down, examined, staged, practiced,
smoothed, and memorized by the artist (therapist). On
to reflect on the artistic elements of spa treatments and

to provide a framework for the creative design of original
spa services. The information in this chapter helps inform
the spas program as described in Chapter 16. Review the
sample treatments at the back of the book for ideas and
inspiration.
opening night, the audience (client) is unaware of the

intense planning that went into the piece (treatment).
Instead, they are dazzled by what they see, moved by
different sensations, revitalized by what they smell, and
intrigued by what they hear. The play (treatment) feels
alive, spontaneous, free-flowing, and effortless, when, in
fact, it has a carefully designed structure. If the director
(spa designer) has successfully achieved his or her vision,
the audience (client) leaves revived and satisfied.
All spa businesses, regardless of size or financial status,
can achieve art with their services. A big spa with a large
budget might hire a spa consultant to do the planning and
train the staff for them. A smaller massage clinic or day spa
is more likely to do it all themselves. Each designer will have
his or her own method for achieving the spas goals. The
process is dynamic, layered, and exciting. At times, it can
feel overwhelming because most plans need revision and
flexibility. The goal of this chapter is to encourage therapists

Dessign
The process of designing an individual spa service frequently begins with a reflection on the spas philosophy.
As discussed in greater detail in Chapter 16 (Your Spa
Program and Menu of Services), a spa philosophy is defined as the fundamental beliefs that the individual or
business holds about health, wellness, and beauty. A
treatment designer will want to uphold the spas philosophy with each treatment he or she creates for the
spa. Often, a complete spa program is adopted before
the individual treatments are planned (Table 151). This
allows the designer to balance the services on the menu
so that one area does not dominate another (e.g., the spa
ends up with three body polish treatments and only one
body wrap treatment).
The development of each treatment goes through the
same design process. First, you determine the therapeutic
goal of the treatment and match it to the spas philosophy.
A concept may be adopted to inspire the textural elements
that add richness and depth to the service. Core treatments are matched with smaller enhancing services before
appropriate spa products and retail opportunities are identified. Finally, the treatment is practiced many times so that
TABLE 151 Overview of the Treatment Design Process

1. THE FIRST DRAFT MENU
2. DESIGN THE INDIVIDUAL TREATMENTS
Identify the spas philosophy.
Define the therapeutic goals of the treatment.
Identify the target client.
Find inspiration.
Determine the spa program.
Plan textural elements.
Identify specific services.
Plan enhancing treatments.

Plan transitions.
Plan product and retail tie-ins.
Create a signature treatment.
3. PLAN CLIENT MANAGEMENT
4. THE MENU REVISION
Greeting and pretreatment
Check for balance and continuity.
Client management during the treatment
Write strong promotional descriptions.
Presentation of retail items
Determine what you will charge for each treatment.
Payment and rescheduling
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Chapter 15 Treatment Design and Your Signature Spa Treatment
the designer can smooth transitions, recognize and eliminate problems, and determine how clients will be managed
from the time of their arrivals at the spa until their departures. All of these processes and procedures are captured
in detailed treatment guides that ensure treatments are
delivered consistently as discussed in Chapter 16 (Your Spa
Program and Menu of Services).
The Therapeutic Goal

It is helpful if the goal of the treatment is clearly defined
before beginning the design process. Treatment goals can
be physiological (e.g., decreased muscle pain), psychological
(e.g., increased contentment), spiritual (e.g., an increased
sense of connection to nature), mental (e.g., decreased mental exhaustion and confusion), or a combination of these
effects in a more holistic treatment. Holistic treatments are
designed to consider all aspects of a clients mental, physical, and spiritual health.
A treatment will usually try to achieve three to six therapeutic goals with some goals being more important than
others. For example, in an herbal detoxification wrap, the
primary goal of the service is detoxification, so the body
should perspire profusely. The client may feel so hot that
he or she is uncomfortable to the point of being mildly agitated. Some degree of relaxation is sacrificed to achieve an
effective level of detoxification. If relaxation as well as detoxification is the goal, you would be more likely to base
the treatment design on a lymphatic dry brush and deep
tissue massage with juniper berry and grapefruit essential
oils. These treatments encourage the natural detoxification
processes of the body but are more relaxing to receive than
a detoxification wrap.
Finding Inspiration through a Treatment

Concept
A treatment concept is an abstract idea that helps to organize all of the different aspects of a treatment so that
together they convey a specific message to the client. The
treatment concept and the spas philosophy must be carefully coordinated so that they dont conflict. A concept can
be developed from any aspect of our experience of life, but
in this chapter, inspiration through art, world culture, spirituality, mysticism, simplicity, food, and drink are explored.
Art as Inspiration
Look up Claude Monets painting Les Tuileries, Esquisse (The
Tuileries Study, 1876) on the Internet and consider this
question: What would a spa treatment based on this paining be like? The Tuileries is a French garden that is the most
central park in Paris. Designed by Le Notre (the gardener
of Louis XIV) in 1664, it is a place filled with shady walks,
fountains, and elegant statues. The painting by Monet was
composed using soft greens and a gentle orange haze, as if
the sun were ready to set. A designer would want the spa
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treatment to capture the early evening feel of the painting. This is a time when people are finished with work and
lounge in a caf sipping iced coffee before heading home.
Paris is famous for being one of the most refined and fashionable cities in the world. The treatment would want to
borrow that feeling of sophistication and the edgy, freespirited grace of young Parisian women. Stacking stones on
a client or burning incense during the session would feel
completely wrong. Instead, the treatment should encourage
a client to enjoy traditional elegance in the form of a rose
petal foot bath, a paraffin dip for the hands, a European
firming face massage, an emollient body polish, and a firming breast mask.
Compare this treatment to a service inspired by a painting by Jackson Pollock called White Light. This one is more
difficult, but it seems reasonable that a treatment based on
White Light would have spiritual aspects and require a variety of contrasting textures. This treatment might include
a vigorous eucalyptus loofah scrub, a thick application of
alabaster kaolin clay with tingling oils such as rosemary
and bay laurel, hot stone massage, and lomilomi stretches.
Paintings give a different feeling and help the designer to
generate ideas to develop a treatment. Ideas for treatments
might also be sparked by a favorite song, a poem, a novel,
or a movie.
World Culture as Inspiration
Many spas draw on different world cultures to formulate
their philosophy and inspire their treatments. The Mii amo
Spa at Enchantment Resort in Sedona, Arizona, uses the
red rock landscape and Native American traditions of the
Sedona area as an inspiration.1 Treatments that link to these
concepts include the Blue Corn Polish and Sedona Clay
Wrap. The Connect with Spirit section of the menu offers the Mii amo Meditation in which clients are smudged
with a sage stick at the beginning of the service. Smudging
is a traditional Native American practice in which smoke
from a branch of sage bush or juniper is wafted over a person to purify and protect them.
Eastern and particularly ayurvedic influences are currently very popular in the spa industry. This is probably
because Eastern cultures have well-designed and timehonored healing systems that are already valued by Westerners. Eastern culture also has a particular environmental
style that consists of clean lines and simple, elegant beauty.
This style is appealing to the senses and allows the treatment creator to use a room design that supports the concept of the treatment.
Although Eastern culture is popular, any culture can be
used as a starting point to stimulate fresh ideas and offer
new insights for treatment design. The designer must simply find out something about the country and let the information guide the treatment choices. The example below
was inspired by Gabon, a country that is probably not well
known to most Americans. This unfamiliarity gives it an intriguing appeal.
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Located on the west coast of Africa, most of Gabon is

covered in dense equatorial rain forests, although the coastal plain is characterized by narrow lagoons and estuaries.
The Gabonese consists of 40 Bantu tribes, which are divided into four different tribal groups. The Eshira are a Bantu
group who holds Night Ceremonies, which are meant
to bring the tribe together into only one heart, through
singing, dancing, and the use of hallucinogenic plants. The
Eshira people trade in many natural products that may be
useful in a spa treatment. These include bananas, cassava,
cocoa, coffee, palm oil, rice, and sugar cane.2
Treatment Name: EshiraThe Night Ceremonies
The Night Ceremonies are about celebration, feeling connected to the earth and reinforcing relationships. The treatment is carried out in a darkened room, lit only by electric
candles, which are safe but cast flickering shadows on the
walls. It begins with rain forest night sounds and then
evolves into a 30-minute massage choreographed specifically to an uplifting and rhythmic piece of African music. The
massage should fit the music perfectly and evoke the spirit
of African dance (tribal unity). The music then transitions
back into the sounds of a rain forest. During the rain forest
segment, the body is polished with palm oil, sugar, and cocoa powder. This is then either removed with steamy towels
or in a Vichy rain shower. While the feet are being massaged (relationships), heated stones are placed over specific
areas of the body to invoke earth energies. The music then
transitions back into the African music and dance massage for the final 30 minutes of the treatment. The service
ends with an aromatic mist of rain forest scents.
Spirituality and Mysticism as Inspiration
Some spas embrace a mystical philosophy and tie their services into a broad-based spiritualism. This is sometimes
handled in a serious way, and, sometimes, in a funky, offbeat way. Serious treatments may include services such as
Reiki, guided mediation, yoga, shirodhara, and psychologically oriented aromatherapy. Spas may consider using
mythology, ancient goddesses, or sacred places to inspire
unique treatments.
For a more offbeat mystical concept, the spa might base
the design of all of the services on the zodiac or on forms
of divination such as tarot cards, rune stones, or ogham
symbols. It is a fun idea. Consider designing all of the
spas services on the zodiac; each of the treatments could
be tailored to one of the sun signs. If you are a Pisces, you
would probably receive a seaweed treatment because Pisces is a water sign. Capricorns are ruled by the earth element, so they would probably opt for a mud treatment or
hot stone massage, whereas Geminis would get an aromatherapy treatment to balance their split personalities! It is
important to remember that this type of spa fits a niche
market. This can hurt or help a spa, depending on the location and the type of clientele. Having a clearly defined
niche can set a spa apart from other spas in the area but
may also restrict the population that the spa can market
its services to.
Simplicity as Inspiration
Many spas design their treatments to be as straightforward
as possible. The treatment names and descriptions are
not particularly evocative, but clients are left in no doubt
about what they will receive. In the most generic examples,
the treatments are called by their common names such as
herbal body wrap, mud wrap, seaweed soak, full-body paraffin mask, body polish, etc. On the more creative side, a
straightforward designer may use the body treatments
listed earlier but add names that suggest their use in specific conditions: Travel Fatigue Fighter (seaweed soak), Dry
Skin Boost (paraffin mask), Stress Tonic (mud wrap), Body
Soft (body polish), etc. In the United States, these straightforward themes are often made to sound more sophisticated by using European place names. For example, an herbal
body wrap becomes the Swiss Herbs Wrap. A seaweed soak
may become the Brittany Sea Soak, and a mud mask might
become the Italian Fango Wrap.
Food or Drink as Inspiration
Occasionally, spas will develop a treatment based on a type
of food or drink in a way that is surprisingly interesting.
Consider these treatment names: Orange Sorbet, the Champagne Sparkler, the Manhattan, Crme Brul, Hot Cider
Twist, Strawberries and Cream, Chocolate Mousse, and
Lime Margarita. A treatment called the Champagne Sparkler conjures up images of cocktail dresses, smooth radiant
skin, and bubbly vivacity. A treatment called the Manhattan
inspires the same metropolitan appeal, whereas a treatment
named after a chocolate mousse is likely to be decadent,
smooth, and contains chocolate, which smells wonderful
and softens the skin. The Lime Margarita sounds upbeat
and sassy and could be expected to include a salt glow.
It is clear that, as a treatment designer, you can draw inspiration from a variety of sources and that brainstorming
a new treatment is a lot of fun.
Treatment Texture
The treatment concept will often influence the different
treatment textures that are chosen for the service. A good
spa treatment will include an assortment of textures, or
layers of varied sensation that enrich the overall experience.
To add texture, you will need to consider what the client
smells, what they feel, what they hear, what they see, and
even what they taste. This does not mean that you should
go to extremes of either hot or cold. It means that you
should pay attention to the different textures in products
and use those textures to increase the clients awareness of
tactile sensations during the treatment so that they enjoy
the treatment more. For example, research indicates that
there are four main types of skin receptors that respond
to hot, cold, pain, and pressure, but our experience of the
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world goes beyond these simple sensations because combinations of receptors allow us to feel in vivid and varied
detail. Consider all the nuances of sensation. Pain can feel
dull, or it can shoot down a nerve path. It can burn or feel
like a twinge or pinch. When a kitten licks human skin, it
has a wet, scratchy feel. The velvety softness of a horse taking a sugar cube off a hand feels completely different. In A
Natural History of the Senses, Ackerman3 explains that
Any first time touch, or change in touch (from gentle to
stinging, say), sends the brain into a flurry of activity.
Any continuous low-level touch becomes background.
When we touch something on purposeour lover, the
fender of a new carwe set in motion our complex web
of touch receptors making them fire by exposing them
to a sensation, changing it, exposing them to another.
The brain reads both the firings and the stop-firings
like Morse code and registers smooth, raspy, cold.
In a spa treatment, the application of each unique product or technique, along with its special texture, awakens
the mind and body to the novelty of sensation. The rough
scratch of the dry brush; the smooth, all-encompassing
warmth of heated mud; the tingly shiver of mint lotion; the
delicate flicker of cool mist over a hot forehead; the rapturous scent of orange blossoms; each of these becomes a word
in the complex language of enjoyment.
What Will the Client Smell?
Nichols4 writes that to be overcome by the fragrance of
flowers is a delectable form of defeat. Good smells have
been used by ancient and modern cultures all over the
world for spiritual, emotional, and therapeutic purposes. In
a spa treatment, they provide a powerful point of interface
between the mind and body by affecting the psyche, nervous system, and immune system.5 They link a client to the
cultural context of treatments that are developed around a
foreign theme or ethnicity. They transport the client to the
landscape of the treatment whether it is the desert or ocean,
a field, a flower garden, an alpine forest, or an orange grove.
In Chapter 7 (Introduction to Aromatherapy for Spa), the
sense of smell and the possible effect of aroma on mood and
emotion were discussed, as were the ways in which the clients
enjoyment of a service is enhanced through a smell-scape. The
concept of a smell-scape encourages you to think carefully
about what you want a client to smell during a spa service.
You will also need to change the smells during the treatment
to create greater olfactory interest. The smells may be tied to
a particular place as in an Eastern-inspired treatment. In this
case, you would use aromas that are characteristic of the East
such as mandarin, ginger, vetiver, and spikenard. The smells
might be familiar and comforting such as grapefruit, pine
needle, and nutmeg, or they could be unexpected and exotic
such as Peru balsam (it has a velvety, powdery, vanilla-like, but
darker smell). The important thing is that the smells communicate something about the treatment to the client and facilitate their immersion in the world of the service (Table 152).
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When providing a smell-scape, you should make every

effort to use products with natural as opposed to synthetic
fragrances or to scent plain products in house with highquality, therapeutic-grade essential oils. Synthetic fragrances are man-made and do not come from aromatic plants,
fruits, or flowers. Clients will often develop adverse reactions to synthetic fragrances (e.g., headaches, sore throat,
sneezing, coughing, and emotional irritation) and may
avoid all strong aromas as a result.
What Will the Client Feel?
Therapists who pay attention to the texture of a spa treatment will usually plan every tactile sensation that the client
experiences. Once on the treatment table, you want the client to be enveloped by warm, soft textures. This is not easy
if the client is lying on plastic during the treatment. One
idea is to put a Fomentek (large hot water bottle) under a
pillowcase (to insolate it) under the plastic sheeting. A soft
bath towel can also be placed horizontally across the top
and bottom of the table to anchor the plastic sheeting and
provide a soft place for the upper body and feet to rest. Regardless of the type of treatment bedding used, it can and
should be warm before the client gets onto the table.
With the exception of those products that are meant to
be applied cool, every product should be warmed just before
it is applied. Cold mud, cold lotion, or cold anything is jolting and distracting. Cool temperatures alternating with very
warm temperatures can feel refreshing and invigorating under the right circumstances. Think about the tactile sensations experienced in a dry room salt glow. First, the client
is massaged with warm oil using soothing Swedish strokes.
Salt is applied in rhythmic circular strokes. This feels scratchy
and rough but very pleasurable and invigorating. A hot towel
(it should be nice and hot, not lukewarm) is placed on the
body area and left for a few seconds to steam the skin. It is
then pressed into the skin by the therapist (which increases
the sensation of heat) and pulled in a straight line from the
proximal to distal areas of the body to remove the salt.
To add a new sensation, the therapist can mist the area
with a toner. This feels bracing and stimulating, and if the
right product is used, it will balance the pH of the skin.
Another texture can be added by applying an aloe gel after the
body mist. Aloe gel goes on in a satiny smooth layer. It will not
make the client sticky, and it gives a final textural sensation
before the therapist moves on to the next body area.
Although this may all seem like common sense, it is
easy to use an inappropriate product in a treatment. For
example, in an herbal detoxification wrap, the client feels
very hot and continues to perspire after he or she has been
removed from the thermal blankets. A massage with oil at
this point would feel unpleasant, but a body mist with cool
water followed by the application of a light cucumber, aloe,
or seaweed gel will decrease body temperature and replace
moisture without making the skin feel clogged. Usually, an
exfoliation comes first in a treatment, but there is no reason that a therapist couldnt end an herbal wrap with an
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TABLE 152 Themes, Smell-Scapes, Accents, and Associationsa

THEME
SMELL-SCAPE
ACCENTS OR ASSOCIATIONS
Summer
Citrus oils, floral oils, tropical aromas, spicy

oils
Joy, brightness, warmth, openness, strength, the sun, light, tan skin, the
beach, ice cream, lemonade, water sports, seaweed treatments, buff and
bronze treatments, sunburn treatments
Winter
Peppermint, clove, nutmeg, cinnamon, apple

cider, fir needle, pine needle, frankincense
Hibernation, going within, recuperation, the end of a cycle, flannel, hot

chocolate, winter sports such as skiing, warm cocoons and body wrap
treatments
Spring
Light floral scents, herbaceous scents
New beginnings, opportunities, childlike enthusiasm, renewal of energy,

gentle rain, gentle breezes, hydrotherapy treatments such as a Vichy
shower
Autumn
Woody scented oils, earthy oils, warm or

homey aromas
Slowing down, preparation for quiet and reflection, midnight, the moon,
hot cider, apples, dried leaves, wind, warm cocoons and detoxification
treatments
Ocean or sea
Camphor, chamomile, eucalyptus, gardenia,

helichrysum, jasmine, lemon, geranium,
sandalwood, vanilla, ylang ylang
Wisdom, inner peace, harmony, emotional balance, intuition, the subconscious, the moon, guided meditation, seaweed treatments, marine fango
treatments, hydrotherapy with seawater, buff and bronze treatment
Desert
Sage, juniper berry, spicy oils
Simplicity, purification, transformation, change, openness, aloe gel, cactus

syrup (which can be used in cocoons or as a masking product), sisal
fiber cloth for exfoliation, Sedona clay, other desert clays
Forest or alpine
Fir needle, bay laurel, sweet birch, cedarwood, cypress, juniper, pine, spruce,
Canadian balsam, cade, oak moss
Growth, strength, wisdom, shelter, protection, exploration, adventure, flannel, hot cider, foot treatments aimed at hikers, any treatment offered at a
ski resort or winter resort
Garden
Floral oils, herbaceous oils
Tranquility, peacefulness, cultivation of manners, refinement, inner beauty,

fertility, abundance, botanical products, iced tea, herbal tea, shortbread,
tea cake, gentle treatments aimed at relaxation
Jungle or tropical
Ambrette seed, amyris, copaiba balsam, Peru

balsam, tolu balsam, West Indian bay,
cascarilla bark, cassie, clove, elemi, ginger,
lime, nutmeg, oak moss, opopanax, black
pepper, rosewood, schinus molle, tagetes,
tonka bean, turmeric, vanilla
Instinct, exhilaration, adventure, courage, wildness, impulse, travel, exotic

fruits (e.g., mango, papaya, coconut, pineapple), body polish treatments, natural product cocoons
Eastern
Star anise, benzoin, bergamot, calamintha

(Himalayas), calamus, camphor, ylang
ylang, cardamom, cassia, cinnamon,
clove, costus, sweet fennel, galangal,
gardenia, ginger, grapefruit, jasmine,
lemon, lemongrass, litsea, mandarin, mastic, orange, neroli, palmarosa, patchouli,
rose, sandalwood, spikenard, liquidambar,
turmeric, vetiver
Peace, harmony, spiritual practice, mindfulness, elegance in simplicity,

balance of body, mind and spirit, cycles of creation, purification, detoxification, meditation, jasmine tea (India), green tea (China), ayurvedic
treatments, Chinese herbal treatments
Mediterranean
Lemon balm, basil, bay laurel, bergamot,

cumin, cypress, inula, sweet fennel,
helichrysum, hyssop, labdanum, lavender,
lemon, sweet marjoram, mastic, myrtle,
neroli, orris, rose, rosemary, clary sage,
sage, santolina, thyme, lemon verbena
Connection, relationships, exchange of ideas, travel, exploration, culture;

the Mediterranean sea is a part of the Atlantic Ocean almost completely
enclosed by land. On the north side is Europe, on the south is Africa,
and on the East is Asia. In ancient times, it was a byway for trade between the people of the region including the Egyptians, Romans, Greeks,
Phoenicians, and Middle Eastern people. Herbal treatments (many herbs
are indigenous to the region), seaweed, and clay treatments
South or Central
American
Cabreuva, Peru balsam, tolu balsam, cardamom (El Salvador, Guatemala), cascarilla
bark, guaiacwood, jaborandi, lime, orange,
palmarosa, black pepper, rosewood, schinus molle, tagetes, tonka bean, tuberose,
vanilla, lemon verbena
Central and South America are a region of environmental and cultural

diversity. The environment ranges from the lush tropical rain forests of
the Amazon to the high altitude desert of the Andes. This area is the
home of the Incas and Mayans, innovative and advanced cultures. It is
also a place where the influences of the indigenous peoples are mixed
with Spanish, Portuguese, and African people. Any type of treatment
could be developed with a Central or South American concept.
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TABLE 152 Themes, Smell-Scapes, Accents, and Associationsa (continued)

THEME
SMELL-SCAPE
ACCENTS OR ASSOCIATIONS
Egyptian
Chamomile, cumin, frankincense, calendula,

sweet marjoram, myrrh, rose, spikenard,
Culture, beauty, innovation, preservation, timelessness, abundance; the

Egyptians had an advanced understanding of aromatic plants and how
to use them for beauty, spiritual connection, and preservation of tissue.
Other associations include gods and goddesses, lotus flowers, art, and
any treatments aimed at renewal.
Earth element
Earthy aromas, musky aromas, woody

aromas, green aromas
Home, survival, the mother, solid and steadfast, heavy, weighty, core,
true self, stone massage, clay, mud, peat treatments, natural elements
cocoons
Air element
Citrus oils, oils with a light or fresh aroma,

oils with a powdery aroma
Breath, mental processes, communication, wisdom, understanding, wit,

light treatments, dry treatments, treatments that include movement
Fire element
Spicy oils, carnation absolute, atlas

cedarwood, cinnamon, clove, frankincense,
myrrh, neroli, rosemary
Passion, creativity, transformation, purification, death and rebirth, truth,

spicy foods, lemon and ginger tea, detoxification treatments, hot stone
massage
Water element
Camphor, chamomile, eucalyptus, gardenia,

helichrysum, jasmine, lemon, geranium,
sandalwood, vanilla, ylang ylang
Emotion, intuition, the female, the flow of life, rebirth, subconscious, inner
clarity, receptivity to new ideas, hydrotherapy treatments, seaweed
Associations with different themes, words, ideas, or places are subjective and should not be taken as fact. This table is meant to provide one
example of ways to investigate themes during treatment design. It is meant to remind therapists to have fun and explore ideas before settling on
one way of working. The treatments indicated under some of the associations are just suggestions and should not limit the therapist in any way. For
example, there is no reason that a treatment inspired by winter could not be paired with a buff and bronze treatment. Perhaps, the whole idea
of the treatment is to invoke summer in the midst of cold and snow (i.e., Missing the Sun? Our Buff and Bronze treatment will leave you relaxed
and feeling sunny. . . .). Table 74 in Chapter 7 (Introduction to Aromatherapy for Spa) provides lists of oils in basic scent categories and should be
used in combination with the smell-scapes provided here.
invigorating and cooling grapefruit scrub. This will cool the

client, contribute to the treatment goals, and give a pleasing
textural variation.
One of the problems with the delivery of spa services in a
wet room is that the area is often completely covered in tiles
and feels cold. Vichy showers can splash on a clients face if
the Plexiglas face guard is not adjusted properly, and sometimes, the first blast of the water from the showerheads will
be jolting. All of these things affect the pleasure of the experience, so therapists must plan the treatment carefully to
minimize these disruptions.
What Will the Client Hear?
When planning a treatment, the auditory environment
is also important to consider. The wrong sort of music is
likely to be disturbing and irritating to the client. Most
therapists have probably encountered spa or massage music that is downright alarming. One on the market features
wolves howling incessantly in every song. It would be difficult for a client to relax if he or she felt like prey!
The right music can evoke strong feelings and enhance
the service. In the treatment inspired by the Eshira tribe
from Gabon (the Night Ceremonies treatment), the music
is a central and pivotal element. The treatment begins with
a massage choreographed to African music. As the music
changes into rain forest sounds, the treatment also moves
on to the body polish section, a new tactile experience.
When the music changes back to an African rhythm, the
treatment moves with it, and the body is massaged again.
Pairing music with specific massage strokes and product
applications creates a powerful and evocative service. This

is spa theater!
There is no need to feel restricted about the types of
music that you play. The music does not have to be of the
minimalist and often chime-ridden background spa variety.
Instead, it should always be chosen to fit the mood of the
treatment. An example is a buff and bronze treatment that
is delivered at a beachfront spa in New Jersey. The spa has
a funky style of dcor, treatment names, and staff attire.
Instead of regular spa music, the therapists play the Beach
Boys during the service. This is a perfect and creative complement to an autotanning service and encourages clients
to take pleasure in the fun of the moment.
What Will the Client See?
The visual texture of the treatment is probably the most difficult aspect to achieve because it requires that the dcor of
the treatment room is changed to match the services being
offered. Sometimes, all of the treatments can be carried out
in rooms with a common dcor style as in an ayurvedic spa,
which would use cultural flourishes from India, or a desert
spa that uses Native American designs. The form of visual
texture used will usually depend on the therapists skill and
attention to details, such as flowers floating in the foot soak
basin or tucked into the fold of the linens on the treatment
table, decorative Japanese lanterns lit for an Eastern-inspired
treatment, or the splash of a brightly colored throw for a
treatment inspired by summer. At the very least, the treatment room should be clean and organized with the spa products attractively displayed on the work table.
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What Will the Client Taste?

The Bantu tribe (the tribe of people who inspired the Eshira
Night Ceremonies treatment) believes that handing food
between two people creates a clanship of porridge. Food is
celebratory. Children commemorate their birthday with ice
cream parties, cake is eaten at weddings, special friends are
invited over for a meal, and the first threads of true love are
often experienced over a romantic dinner. When carefully
chosen food items are used in a spa treatment, an ancient
subconscious message is sent to the client. As Ackerman3
writes in A Natural History of the Senses,
Our friends offer us food, drink. It is a symbolic act, a
gesture that says: This food will nourish your body as
I will nourish your soul. In hard times, or in the wild,
it also says I will endanger my own life by parting with
some of what I must consume to survive. Those desperate times may be ancient history, but the part of us
forged in such trials accepts the token drink and piece
of cheese, and is grateful.
With culturally inspired treatments, the use of a traditional
food item helps to envelop the client in the world of the service. This might be as simple as a cup of green tea served from
a Chinese tea set before an Eastern-inspired treatment or a
complementary chocolate on Valentines Day or at the end
of a couples massage. Similarly, the therapist could plan a
sports drink to be served at the end of a sore muscle sports
wrap. In the summer, the client can leave the seaweed treatment with a colorful Popsicle to remind them of the at the
beach feel of the service. Still, it is important to keep it simple enough to be manageable but to hold in your mind the
intention of the offering: to welcome; to nourish on a spiritual level; and to show care, thoughtfulness, and appreciation.
Enhancing Treatments
Enhancing treatments are accent pieces that add value
to the service and make it feel special. They are not large
enough to constitute a service on their own, but when added to the main treatment, they act as moments of particular
radiance. In a basic massage, a therapist who pays attention
to detail might add one or two enhancers. He or she might
perhaps place a hot, steamy rosemary towel on the clients
back before beginning the back massage. The therapist may
repeat this process with a hot, steamy rosemary towel on
each foot before the foot massage and on the face before
the face massage. This feels wonderful, smells wonderful,
and is an unexpected treat. The steamy towel enhancer is
simple enough not to cut into the clients massage time
but special enough to stand out in the clients mind as a
valuable part of the treatment. The simple addition of hot
towel steams and aromatherapy mists to a treatment often
increases client loyalty and may become so popular at a clinic that they are adopted as standard practice in every massage. Enhances were described in detail in Chapter 4 (Your
Spa Massage).
Small food items can be used to provide an accent to a

treatment as was mentioned previously or to help smooth
transitions from one section of a service to the next. It is
sometimes necessary for the client to receive a service from
one therapist and then move to a second therapist for the
rest of the treatment. In such cases, the client can be moved
to a chair in the treatment room and served with a small
plate of simple appetizers while the first therapist makes
sure that the second therapist is on schedule and ready to
take over the clients treatment. For long treatments, or for
treatments that accelerate detoxification, a drink is as much
a necessity as a nicety. The same is true for spa packages in
which the client is undergoing a series of treatments. Some
time must be planned for the client to stop, rest, and have
a snack.
Nonspa-oriented activities can also be planned to accompany a service and enhance the treatment. In the discussion of the spa treatment concept, the idea of using a
zodiac sign to inspire a treatment was described. A creative
designer might arrange for the client to receive the horoscope printed on nice paper, rolled up, and tied with nice
ribbon at the end of the service. In an upscale spa, the designer might pair sterling silver charms with treatments.
Each treatment could have its own charm, which the client
receives at the end of the service. These little extras are not
strictly necessary but add to the overall experience of the
client and the perception of the spa.
Transitions
Transitions are the moments between the steps of a treatment. There are small transitions such as the transition between the application of a product and its removal with hot
towels and larger transitions such as the movement of the
client from the treatment table to the Swiss shower. Transitions are the parts of the treatment that are the most likely
to feel disjointed if they are not carefully planned. For example, if the removal of a product with hot towels has not
been carefully planned, you may find that you have to walk
over to the hot towel cabbi to get a towel out for the removal. A better option is to have some hot towels in a soda
cooler that can be carried around the table with you during the service. This way, you simply reach down and grab a
towel and then progress to the next step of the service.
One of the most difficult transitions in a dry room is the
removal of plastic from underneath the client after a cocoon. First, the treatment product has to be removed quickly so that the client does not get cold. At the same time, the
plastic sheeting that is under the client must be rolled up
and removed. The messy product cannot be allowed to get
onto the clean sheet that is under the plastic. This is not
something that can be done smoothly without practice.
Another aspect of the transition to consider is the communication that needs to occur between the client and
therapist. You should practice the language that you will
use to move the client between the different steps of the
10/24/13 2:03 AM
treatment. Clients are often in a deeply relaxed state and

will become confused if you do not explain things clearly
and concisely. This is important because poor communication can result in the need to have the client adjust his or
her position on the treatment table. If clients are told exactly how to position themselves on the treatment table, it
will save them from feeling that they have to move in one
direction or another to accommodate the treatment.
Product Planning
Every product used in a spa treatment will need to be carefully chosen and evaluated for its suitability. To find spa
products, you will probably do a search on the Internet and
review spa supply websites. You might also visit other spas
as part of your market research and find out what products
they use. A number of spa suppliers can be found in the
resources section at the back of the book.
Before ordering any product, it is a good idea to call the
supplier and ask for an ingredient list if one is not readily available. Assess the ingredients and check the information on each provided in an ingredient dictionary such as
the Skin Care and Cosmetic Ingredients Dictionary by Natalia
Michalun.6 If the product is acceptable, it should be ordered
in its smallest size (sometimes, a sample size can be ordered)
and tested to ensure that it works well before large quantities are ordered.
A designer is often faced with the dilemma of not being
able to find suitable spa product for the original treatments.
In this case, he or she has to modify an existing product
or make a new product in house. Both options can work
but are not ideal because they require extra time and planning by the spa staff. More and more suppliers are offering
base products that spas can modify to fit their needs. Some
offer premade essential oil blends for quick smell-scapes.
Although this is a positive move that allows for greater
creativity in treatment design, spa suppliers often use a substandard aromatherapy product. You are advised to check
your essential oil sources carefully or preferably buy your
essential oils from an aromatherapy supplier selling therapeutic-grade oils instead.
Client Management
Good client management leads to good client retention, so
client management activities should be built right into the
plan for the individual service. The clients path through the
clinic or spa must be premeditated, and every effort must be
made to pamper the client from the moment he or she first
contacts the spa. The receptionist must be friendly, upbeat,
and knowledgeable. He or she needs to know all about each
of the services that the spa offers, so he or she should have
received each service on the treatment menu at least once.
This way, he or she will be ready for any questions that
the client may have about the treatment. The receptionist
should also practice describing a treatment in a way that is
325
captivating yet clear and concise. If he or she describes a salt

glow simply as a treatment in which salt is rubbed on the
body, coaching is needed so that he or she can express the
intention and feeling of the treatment more clearly.
The spa will need to plan what happens when a client
walks through the door. How will the client be greeted?
Some spas have a changing room with lockers for the clients belongings, where the clients can change into robes
and slippers before beginning their treatments. Clients
might be taken to a quiet room where they are served with
herbal tea while their feet rest in foot soaks, and they fill
out their health history forms. In a smaller clinic or spa,
they might simply be given the necessary paperwork on a
clipboard and asked to wait in the reception area. The main
thing is that all clients should be treated warmly, professionally, and efficiently.
Pampering activities include offering a beverage while
the client fills in paperwork, providing a snack during longer sessions, and allowing the client to relax at the end of a
session instead of feeling pressured to get up and move on.
Pampering might begin with a complementary foot soak or
paraffin dip with every service. The treatment table should
be warm and inviting with good-quality linens and special
treats such as thick fleece padding and a heated gel face
cradle lining. Warm packs, eye pillows, inviting scents, and
relaxing lighting add to the sensation of luxury.
Once the treatment has started, the client should never
be left alone. If the client is wrapped, receiving hydrotherapy, or sitting in a sauna or shower, the therapist should
always be within earshot. To leave a client is not only unprofessionalit is dangerous. For this reason, you must be
completely prepared for the session before it begins. The
use of checklists for equipment and products will ensure
that you are not hunting for the finishing lotion halfway
through the treatment.
How the session ends is as important as the session itself and must be planned just as carefully. In one example, a
client had a facial at a well-known and highly regarded spa
that handled sales of the retail line and the process of paying
for the service flawlessly. After the treatment, the client was
taken to the spa shop where caf tables were set up in a softly
lit room. Spa products on glass shelves lined the cafs exterior. Other clients sat enjoying herbal tea or lemonade and
glancing through the spas product brochures and fashion
magazines. The client was offered a glass of lemonade with a
small plate of bread, cheese, and fresh fruit and then handed
a product brochure. After a few moments, an elegant young
woman walked up and asked if the client had any questions.
She addressed the client by name and informed her that her
esthetician had mentioned that she had very sensitive skin
and would respond well to a particular product. A sample
was offered, and the line was so well described that instead
of buying just the night cream, the client bought the whole
sensitive skin care line. The purchase was placed in an attractive bag and a bill was brought to the table and presented
in a leather folder (just as the bill would be presented at a
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326
fine restaurant). The client put her credit card in the folder
and enjoyed her magazine and lemonade while the elegant
young woman took the credit card to the front desk for processing. The client left the spa having spent far more than
she intended but very happy with the service.
Although most massage clinics and even many day spas
will not have the space or staff available to handle the payment as described previously, there is much that can be
learned from such an experience. How the spa presents the
retail items available and how the staff handles the payment for the service in a way that is relaxing and elegant
are very important. Having to stand in line to ask the receptionist a question about a particular product or waiting
to pay for your service is not ideal. The spa must develop a
clear plan for handling clients and communicate this plan
to its staff. The staff should practice moving clients from
the reception area, to the treatment room, and then to the
retail area. Work out how to smooth the payment process.
Some clinics stagger treatment room schedules so that they
are 15 minutes apart. This way, the receptionist only has
one client at a time to deal with. This seems an easy and
workable option for most clinics or spas.
Retail Sales as Part of the Treatment

In Chapter 17 (You in the Spa Profession), retail sales are
discussed as an important contribution to the financial stability of the spa business. Retail sales must be handled in
such a way that they do not mar the relaxation experienced
during the treatment. If a client feels pressured to buy
something that he or she doesnt want or need, the whole
spa experience will be ruined. Instead, sales of spa products
should be built into the treatment itself so that it feels like a
natural extension of the treatment and is not jarring.
To take advantage of retail opportunities during the
course of a treatment, you must have a solid knowledge of the
services and product lines offered by the spa, their benefits,
and, most importantly, a commitment to hearing the needs
of your clients. The products that you attempt to sell clients
should be matched carefully to the treatment that the client
is receiving and to the clients perceived needs. For example,
a client visiting the spa for a slimming and contouring treatment will probably be interested in home care cellulite products that continue the results achieved by the spa treatment.
A pregnant woman would probably not be interested in the
home care cellulite cream, and you should not attempt to sell
it to her. Clients will often express their needs while receiving
a treatment. The attentive therapist can support the clients
healing process by guiding him or her toward products or
services that will meet these needs. For example,
While providing a massage to a client, the therapist
learns that the client loves essential oils and would like
some custom blending. The therapist suggests that the
client visits the resident aromatherapist who will create
the blends that he or she needs. The therapist also shows
the client the line of essential oils and home care blends
that the clinic provides and helps the client to make an
informed purchase.
At the end of a buff and bronze treatment, the treatment
designer has built in time for the therapist to show the
client bronzing home care products and to offer tips on
getting a good result at home.
During a massage, a client expresses doubt that seaweed
has any benefits for the body or skin. The knowledgeable
therapist outlines some of the research that has been
done on the benefits of seaweed and introduces the client to a sea soak product offered for home care in the
clinic gift shop. The therapist also shares his or her experience in receiving the seaweed wrap offered at the clinic
and encourages the client to give it a try.
A massage therapist learns that a client is often sore
from working out. The soreness passes after 2 or 3 days
but interferes with the clients other activities. The therapist recommends a home care soaking product offered
in the spa gift shop that is specifically designed for sore
muscles.
During a foot treatment, the client mentions to the therapist that it is her husbands birthday and that she has
run out of gift ideas. The therapist mentions that the hot
stone massage offered at the spa is a big favorite with men
and that gift certificates are available at the front desk.
In each of these examples, clients were given the time and

attention necessary to help them make informed decisions
about the purchases of products or services. The therapist
also increased his or her income by receiving a commission
on the sales of products or services.
The most important point is that advice should be offered that is directly linked to the clients needs. This advice
should be offered in a professional manner without any
pressure so that the mood of the treatment session is not
disturbed. The retail process should feel like a natural extension to the treatment itself.
Treatment Planning Forms

Once you have considered all of these areas, you are ready
to formalize your ideas and begin the planning process. The
treatment planning form and the example treatment that
follows will help you to get started. A blank form is provided in the appendix section at the back of the book. It is best
to start with too many ideas and narrow them down in the
later stages of development. The first planning form should
be used in a brainstorming session, and then the second
form is worked through to streamline your ideas. The next
step is to try to deliver the treatment itself. Complications
during delivery will lead to changes in the treatment and a
third copy of the planning form. The final planning form
can be added to your spas operations manual as a guide for
staff (Figs. 151 and 152).
10/24/13 2:03 AM
TREATMENT PLANNING FORM
327
(with directions)
TREATMENT NAME: Sometimes the treatment will start with a catchy name and sometimes the name will come later
in the planning process
THE SPA'S OVERALL CONCEPT
THE SPA'S PRIMARY STRENGTH
THE TREATMENT INSPIRATION
What is the spa's main focus? Is

it relaxation? Is it spiritual? Is it
health and fitness? Is it skin care
and beauty?
Describe the spa's primary strength.

For example, the spa may focus on
reflexology and its primary strength
may be foot treatments.
Describe the source you used to

inspire the treatment and determine
the treatment concept.
THE TREATMENT CONCEPT
PROMOTIONAL DESCRIPTION
Very briefly describe the overall

concept of the treatment.
Describe this treatment as you would in the menu. New ideas for a treatment
often come when the promotional language is developed.
TREATMENT GOALS
INDICATIONS
CONTRAINDICATIONS
List three to six goals for the

List three to six situations for which
treatment. Are the goals
this treatment would be indicated.
physiological, psychological, or both?
List three to six situations for which this

treatment would be contraindicated.
CORE TREATMENTS
ENHANCERS/EXTRAS
RETAIL OPPORTUNITIES
List the core treatments (focus

points) that will take place during
this service. There may be one
focus point or many depending
on the size and scope of the
service.
List the enhancers and extras that will

be used to round out or accent
elements of the treatment.
List retail items or opportunities that

could be paired with this service.
TEXTURAL ELEMENTS
SMELL-SCAPE
MUSIC/SOUND
VISUAL ELEMENTS
List the scent combinations that

will be used to create olfactory
texture for the treatment.
List the music or sounds that will be

used to add auditory texture to this
treatment.
List any special visual elements that

will be used to enhance this treatment.
SUPPLIES AND EQUIPMENT

PRODUCT CHOICES
SPECIAL EQUIPMENT
List the products that will be used for the treatment and any
modifications that must be made.
List the special equipment that

will be required to deliver this
treatment.
TREATMENT/TRANSITION/CLIENT MANAGEMENT STEPS
NOTES
List the treatment steps, transition steps, and client management steps
required in the delivery of this treatment.
Make notes as new ideas occur to

you.
COMMENTS:
The therapist uses the comments section to briefly describe how the first or second run-through went.
These comments will be read directly before the second or third run-through so that improvements
can be made to the treatment.
FIGURE 151 Treatment planning form with directions.
10/24/13 2:03 AM
328
TREATMENT PLANNING FORM
(example)
TREATMENT NAME: IKEBANA FLOWERS RITUAL

THE SPA'S OVERALL CONCEPT
THE SPA'S PRIMARY STRENGTH
THE TREATMENT INSPIRATION
Eastern bodywork and spiritual

practices. To date, the spa has not
focused on indulgence, slimming,
or a relaxation treatment.
Japanese stone massage and a

reputation for exceptional bodywork.
Even though this is the spa's strength,
the focus with this treatment is to find
greater balance in the service menu
by adding a relaxation and slimming
treatment.
Ikebana is the art of Japanese flower

arranging (history dates back 7
centuries). In Ikebana, the main aim
is to use as few stems and leaves as
possible in composing elegant
contours that highlight the flower's
beauty.
A flower ritual to achieve relaxation,

contour, elegance, and harmony.
Inspired by the centuries-old art of Japanese flower arranging, this treatment

strives to realize beauty, gracefulness of body, and inner harmony. These ideas
are achieved through a massage with fragrant oil, an elegant body polish, and
alabaster clay and rose petal mask. Warm Japanese river stones applied to
areas of tension complete this flowers ritual, leaving tranquility, perfection of
form, and radiance as its result.
TREATMENT GOALS
INDICATIONS
CONTRAINDICATIONS
Increase relaxation and inner peace,

firm and contour the body's shape,
gentle detoxification
Stress and feelings of disharmony, to

feel beautiful and refreshed
Broken or inflamed skin, conditions

CORE TREATMENTS
ENHANCERS/EXTRAS
Massage and full-body polish,

kaolin and rose petal mask of the
back and breasts, hot stone face
massage
Flower-filled foot soak, hot stones

placed on the body during the mask
phase of the treatment
Sell the Ikebana body polish products

(unmodified) as a skin-smoothing trio
TEXTURAL ELEMENTS
SMELL-SCAPE
MUSIC/SOUND
VISUAL ELEMENTS
Single floral scents such as jasmine,

rose narcissus, and neroli balanced
by Eastern spices such as ginger and
turmeric with lemongrass accents.
Simple Japanese flute music will be

played very softly throughout the
treatment. Chimes will sound once at
the beginning of the treatment and
once at the end of the treatment.
The treatment room will be lit with

Japanese lamps and small candles.
The client will enter and see the foot
soak prepared with flowers floating
on the top of the water. A single flower
will be placed on the treatment table.
SUPPLIES AND EQUIPMENT

PRODUCT CHOICES
SPECIAL EQUIPMENT
Body polish: Bamboo and lemongrass body polish modified with a hint of
jasmine absolute to introduce the flower theme. Green tea body wash
modified with ginger, rose, and mandarin essential oils. Seaweed-based
finishing gel modified with a few drops of narcissus and mandarin.
Hot stones and heating unit
Massage: Warm sesame oil with a few drops of neroli and sweet orange
essential oil for the face massage. The massage oil for the body will also
include turmeric to add a spicy base note.
A large Japanese bowl would be

ideal for the foot soak.
Kaolin clay, green tea infused water, and ground rose petal mask; this will
need to be created in house because it could not be adapted from an existing
product.
Bamboo and rattan table to hold

products
It would be nice if the client could

wear a kimono instead of a robe
during the foot soak.
FIGURE 152 Treatment planning form sample. (continued)
10/24/13 2:03 AM
TREATMENT/TRANSITION/CLIENT MANAGEMENT STEPS

1. Greet the client and take him or her to the treatment room. Instruct the client to change into the
kimono and slip his or her feet into the flower foot soak. Pour the client a cup of green tea from a
Japanese tea set sitting on a small rattan table next to the client's chair. While the client relaxes,
conduct the intake interview and describe the treatment to the client. Highlight the Ikebana body
polish trio, describe the product benefits, and mention that they are carried for home use in the spa
gift store.
2. Exfoliate the client's feet while they are in the foot soak. Remove the feet from the soak and dry
the feet. Explain to the client how he or she should position on the treatment table.
Leave the room and collect the hot towels needed for the treatment.
3. Return and bolster the client. Place a warm pack on the client's feet and place one hand on
the sacrum and one hand at the top of the spine. Ask the client to take three deep breaths. Remove
the hands from the client's back and ring the chimes once to signify the start of the treatment.
4. Treat each body area with the following series of steps: 1) Massage the area with the warm
sesame or essential oil combination using long, flowing strokes. 2) Apply a small amount of cleanser
to the hands and work into lather with hot water. Apply this to the client's body area with long
strokes. 3) Apply the body polish directly over the body wash without removing the wash (to save
laundry and time). 4) Remove both with a hot towel. When each of these steps has been completed
on the posterior body, turn the client into the supine position. Rebolster the client and repeat the
massage and exfoliation steps on the anterior body.
5. Mix the clay and rose petal mask. Remove eight hot back stones from the heating unit. Remove
the bolster and ask the client to sit up (give the client a glass of spring water to drink to cover this
transition). Place hot stones under the client and cover him or her with a bath towel. Place a piece
of body wrap plastic over the bath towel. These two steps must happen very quickly or else the
transition takes too long. Place plastic gloves on both hands and apply the clay mask to the client's
back in a thick layer using one hand. Remove the dirty glove and ask the client to lie back down.
Check that the position of the stones is comfortable. Remove and place them in the client's hands.
6. Apply a thick layer of clay to the upper chest, breasts (optional), and belly of the client with the
other hand, which is still gloved. Remove the glove and cover the mask with a piece of plastic
sheeting followed by a bath towel. Remove five large placement stones and two palm stones from the
heating unit and place them on the belly, anterior chakra points, and the bilateral origins of the
pec minor muscles. Oil the palm stones and place them in the client's hands.
7. Remove eight small stones from the heating unit and sit at the top of the table. Use the stones in
a face and neck massage (20 minutes) with the warm aromatic sesame oil. At the end of the face
massage, remove the excess oil with facial toner and cover the face with a cool towel. Mist high over
the client's face with a rose and mandarin spritz blend.
8. Remove the stones from the anterior body and use the plastic body wrap to pull some of the clay
off the client. Remove the rest of the clay with hot towels. Apply the seaweed finishing gel to the
belly, around the breasts, and upper chest. Cover the client and apply finishing gel to the arms and
hands. Undrape each anterior leg and apply the gel to the legs. Standing on one side of the client,
gently (but quickly) remove the stones from under the client by reaching the hands under the towel
and pulling the stones out the sides. Repeat on the other side of the client. Unbolster the client and
ask him or her to turn over. Rebolster the client.
9. Apply finishing gel to the posterior legs and back with soothing massage strokes. Redrape the
back and place a hand on the sacrum and a hand at the top of the spine. Ask the client to take three
deep breaths. Ring the chimes once to signify the end of the treatment. Unbolster the client and
tell him or her to take as much time as needed to get up from the treatment table. Wait for the client
outside the treatment room.
329
NOTES
*Get a Japanese tea set for the
foot soak.
*The mask dried out before it

could be applied. It cannot be
mixed up and kept warm before
the treatment. Hot water will
need to be mixed into the mask
directly before it is applied.
*Add lemongrass to the hot

towels to add more olfactory
texture.
*Mixing the mask took too

long, and the practice client
opened her eyes and looked at
me to see what I was doing. I
need to find a way to smooth
that transition. I will try a hot,
steamy towel placed on the face
during the second practice run.
*Problem: The towels have

lemongrass on them, and the
lemongrass might irritate
the client's facial skin. Try using
only 1 drop of lemongrass
placed in the bottom of the
soda cooler to decrease a
chance of irritation.
*The spinal layout stones were

placed too high on the first runthrough. They interfered with
the neck massage. Use six
stones instead of eight and end
the layout at the bottom of the
rhomboid muscles.
*Problem: If the client is very

large, the therapist will not be
able to get the stones out from
underneath him or her.
10. Escort the client to the reception area and offer a glass of water. Check to see how the client
feels after the treatment. Inform the client of any areas of tension you found during the massage, or
of skin care or body products that might specifically suit the client's needs. Show the client to the
spa gift shop if appropriate. Process the client's payment and invite him or her to return.
COMMENTS: After the first run-through of the treatment, I have identified the areas that need improvement. The main concern is the transition from the
massage (the climax of the treatment) to the removal of both the stones and the clay. The practice client commented that the removal of
the anterior stones and clay was fine but that it felt strange to her that I reached under her to remove the spinal layout stones. We agreed
that it would have been odd to sit her up for a second time to remove the stones. She felt that the initial warmth of the spinal layout was
very enjoyable and that she wouldn't remove that part of the treatment even though the transition is a bit awkward. The practice client also
commented that she enjoyed all the scents used in the treatment but was disappointed when she found out that the retail products were
not scented in the same way as the treatment products. This is a bit of a problem because I could not find products that fit my flower
rituals theme and feel that I need to modify the product to make it work. Perhaps some other retail tie-in could be created.
10/24/13 2:03 AM
330
Considerations When Pricing Services

Part of the development process is deciding what to charge
for a treatment. This can be a fairly complex process. In
general, you will want to consider your surroundings
first. A full-service day spa with elegant dcor and extra
support staff can simply charge more than a small massage clinic for the same service. You should also check
what competitors with similar facilities are charging and
charge similar amounts for your services. When a massage clinic adds spa treatments to its massage menu, it is
recommended that spa treatments are priced at about $25
to $40 more than the rate charged for the same amount
of massage time. If a 1-hour massage is $50, a 1-hour spa
treatment will cost between $75 and $90. The exact difference should be determined by the cost of the products
used to deliver the treatment and by the prices offered
by the competition for similar treatments. Salt glows can
cost as little as $2 to deliver, whereas a Parafango treatment can cost as much as $12 to $15. The product cost
will have to be factored into the final cost of the treatment. Figure 153 shows an example of how to determine
the cost of delivering a treatment. This information will
help you to price the treatments and make accurate budget projections.

Treatm
ment
A signature spa treatment is a special service that is
exclusive to the spa where it is being offered. It is developed to highlight the spas unique features and particular
strengths. For example, some spas will have access to a local product that has healing associations (e.g., a special botanical ingredient, local mud). The use of this product in
a treatment will become the spas signature. A spa in a
desert setting may offer a cactus syrup wrap using syrup
that is produced from the cacti that grow in the region.
If the spa uses a local healing mud, it will probably base
its signature treatment on the use of this special mud. It
may also remind its clients that this type of mud application is not available anywhere else. In Seattle, a center of
coffee culture and the home of Starbucks, there is a coffee
shop on almost every street corner. A number of spas in
Seattle developed signature treatments based on coffee to
reflect this local interest. These coffee treatments appealed
to Seattleites sense of humor and also just happened to be
firming for the skin.
The Golden Door Spa in California has a unique and
beautiful custom-made labyrinth designed to create a
calming and spiritual environment (Fig. 154).7 A labyrinth is a purposeful but meandering path that leads the
walker from the edge of the circle to the center of the circle
and then back to the edge again. The Golden Door labyrinth consists of a smooth stone path inlaid against the
textured surface of a circle. Set in a natural environment

of trees and grass, the labyrinth is lit at night by candles
arranged around its edge. This labyrinth was inspired by
historical labyrinths that were used to focus the mind and
create inner peace. Even though the labyrinth is not an actual body treatment, it could still be considered a special
signature service.
A good signature treatment will capture the overall
philosophy of the spas or clinics approach to health and
well-being. Spas sometimes call their special treatments
rituals because the treatment consists of a series of carefully considered actions performed in a specific order.
Signature rituals tend to combine core treatments (wrap,
polish, massage, etc.) with enhancing add-ons such as paraffin dips, hydrotherapy soaks, foot baths, saunas, and
steam baths or mini facials. In a standard emollient wrap,
the client receives just the wrap and perhaps some small
enhancers such as an herbal eye pillow or face massage to
round the session off. In a signature ritual, the body wrap
is just one part of a more complex service. The client might
start in the sauna, receive a body polish, enjoy the emollient
wrap, finish with a massage or facial, and end in the meditation room. In many ways, a signature treatment is like a
spa package in that it combines a number of different treatments in a single session.
In addition to the unique treatments offered by individual spas, some spas offer signature treatments that are
based on a particular product line. Cosmetic companies often create body and facial treatments based on their own
skin care products (e.g., Aveda, Decleor). They then provide
training to spas on the benefits of their product line and
how to use the products in specially designed treatments.
Spas offering signature treatments using these products effectively act as marketing agents for the company by introducing the public to the skin care line and increasing retail
sales of the product.
A signature treatment is a marketing tool to identify
what the spa does best for clients. All establishments from
the small local spa to the larger deluxe day spas, resorts,
and international spas can benefit from introducing a
signature treatment. This is why the spas main concept
should be carefully considered when developing a signature service. For example, a spa whose motto is the ultimate desert retreat will not want its signature treatment
to be named the alpine forest escape. It seems simple, but
a search on the Internet will show that a lot of spas have
missed this point. This may be because these spas want
to do something really different, but they should instead
be focusing on their strengths and doing what they are
especially good at. A massage clinic that specializes in automobile injury treatment may offer a number of rehabilitation-oriented spa services. Perhaps, they normally offer
a detoxifying herbal body wrap, a balancing aromatherapy
wrap, eucalyptus steams, cryogenic sore muscle wraps, and
reflexology foot spa treatments. Such a clinic wouldnt
10/24/13 2:03 AM
331
STEP 1: Determine a General cost of Overheads

A general cost of overheads can be approximated by adding up all of the costs of running the business each month and then
dividing it by the average number of treatments offered or, even better, the number of treatment hours delivered in a month. This
will tell you what it costs (in terms of overheads) to deliver a treatment. This amount will vary based on how many actual
treatments were delivered in a particular month because some of the running costs will be fixed.
Laundry
Office costs (Internet, office supplies, phone, etc.)
Receptionist(s)
Rent and utilities (the monthly cost to rent space, electricity, water, etc.)
Marketing and promotion
$6480/1440 treatments = $4.50 per
treatment
Bulk
Price
Bulk
Quantity
Unit
Price
Product
Quantity
Exfoliation product
16 oz
1 oz
Gel seaweed
1 gal (128 fl oz)
5 oz
Cosmetic sponges
100 per pack
2 sponges
Plastic body wrap
600 feet
6 feet
Skin toner
16 oz
0.5 oz
Moisture lotion
1 gal (128 fl oz)
2 oz
Cellulite cream
8 oz
0.25 oz
Lavender essential oil
6 mL
7 drops
(added to moisture lotion)
(1 mL = approx 20 drops)
Rosemary essential oil
6 mL
2 drops
(added to moisture lotion)
Overhead
Product cost
Compensation to therapist (arbitrary amount that does not reflect an industry standard)
FIGURE 153 The cost to deliver a spa treatment.
10/24/13 2:03 AM
332
want to offer a cellulite treatment for its signature service.

This wouldnt appeal to this spas existing clients, and it
would take the focus off what it does bestrehabilitation.
Instead, this spas signature treatment could be a European fango treatment for arthritis or a Parafango treatment
for chronic pain conditions and fibromyalgia. Similarly,
a salon that is well known for its skin care and esthetics
treatments will not want to highlight a treatment for the
muscular system.
As you contemplate your overall spa program, think
about your personal strengths and the way they are reflected in your treatments and start brainstorming a list of
possible signature treatments ideas. Alternately, review the
treatments you already have planned. Maybe one stands out
as a particular favorite. You may already have your signature designed!
FIGURE 154 The labyrinth at the Golden Door Spa in California.
SPA FUSION
STUDY TIP: LEARN FROM YOUR TREATMENTS
As a spa student, you may believe that you are a long
way away from developing a signature spa service for
your clinic or spa. You still have to graduate, pass
the national exam, and submit paperwork for your
license. Still, the amount of information you learn
from developing your signature spa service now, working through it, and refining it, trying out multiple
products and sessions steps is invaluable. Everything
you have learned in your training thus far comes together and integrates in your signature spa treatment.
Dont wait. Plan this service now, have fun, and learn
from it!
CHAPTER WRAP-UP
Treatment planning is required for every service that is
delivered at a spa or a massage clinic. Even basic services such as salt glows require careful consideration. The
therapeutic goals of the treatment must be matched
to appropriate spa products. The best application
method, enhancers, and product removal techniques
you use will be chosen based on the facilitys restrictions or its particular strengths. The environment
created in the treatment room, the sights, sounds, and
smells that the client experiences and the way a client
is managed during the treatment all require thought.

If the treatment is the spas signature service, it must
be clearly developed to express the spas overall philosophy and approach to health and well-being.
REVIEW QUESTIONS
Multiple Choice
1. A good signature treatment will:
a. Be exclusive to the spa at which it is offered
b. Highlight a spas unique features and particular
strengths
c. Promote a line of products or draw attention to
a particular amenity
d. All of the above
2. A spa ritual is best defined as a:
a. Series of carefully considered actions that are
performed in a precise order to lead to a specific
state of being
b. Treatment designed from accepted Eastern
practices
c. Treatment that must have a specific spiritual
focus
d. Spa package that always includes hydrotherapy
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333
SPA FUSION
3. When designing a signature treatment, the spa or
massage clinic will want to:
a. Focus on doing something really different to
shake up its current clientele
b. Focus on using a widely known skin care product because skin care signature treatments sell
better than any other type
c. Focus on a treatment that highlights the spa or
clinics particular strengths, using a treatment
that expresses the facilitys philosophy of health
and wellness
d. Focus on opulence and price the treatment very
high to generate a higher income clientele
5. An enhancer is best defined as:

a. The finishing point in a treatment where the
body is misted with an aromatherapy blend
b. Accent pieces that are not large enough to
constitute a service on their own but make the
overall service special
c. The middle section of a treatment where a paraffin dip, foot bath, or light snack is used to cover
the transition to the next section of the treatment
d. Any type of hydrotherapy treatment that is
added onto a service
Matching
Match the smell-scape to the treatment concept.
4. The treatment concept is:

a. Either skin care or body care oriented; it is rarely
both
b. Used only in the promotional descriptions of
the treatment to the client and has no bearing
on the product choices that will be made
c. Must consider the therapeutic goals of the treatment and is used to promote retail sales
d. An abstract idea that helps to coordinate all aspects of a treatment so that it conveys a particular feeling, philosophy, or mental picture to the
client
Smell-Scape
6. Grapefruit, rose
A.
Eastern
7. Juniper, fir needle
B.
Summer
8. Lavender,
rosemary
C.
Alpine
9. Frankincense,
sandalwood
D.
Botanical
E.
Mystical
10. Ginger,
lemongrass
Treatment Concept
10/24/13 2:03 AM
16
Your Spa Program and
Stoneof
Massage
Menu
Services
Chapter Outline
K e y Te r m s
Benefits and Drawbacks of Spa Body Treatments

Your Spa Philosophy
Back bar: Spa products that are usually sold in large-sized bottles versus
the same product sold in smaller sizes to the client in the spa gift shop.
Characteristic: A distinguishing trait or quality that forms part of an
individuals personality.
Mission statement: A statement of the purpose that guides the activity of
a company, organization, or individual.
Skills: A learned ability to do something competently; a developed aptitude.
Spa menu: A document that lists the spas contact details, hours of operation, location, and services.
Spa philosophy: The beliefs, ideals, and attitudes held by the spa in
relationship to health, wellness, and beauty.
Spa program: A collection of bodywork services that reflect a spas
philosophy and are offered to the spas clientele.
Talents: The natural endowments of a person such as a special (athletic,
creative, mental, or artistic) aptitude.
Values: The relative worth or importance we place on something.
Your Life Mission

Choosing Spa Treatments for Your Program
Balance Your Spa Program
Review Other Spa Programs
Design Individual Treatments
Write Detailed Treatment Guides
Refine Your Treatments
Your Spa Menu

Design
Writing Style
Essential Contents
S
SPA
FUSION
STUDY TIP: Spa Party
SPA INSPIRATION: Idea Folder
CHAPTER WRAP-UP
334
10/24/13 2:06 AM
Chapter 16 Your Spa Program and Menu of Services
Although beautiful luxury surroundings and a fullservice wet room can only enhance the spa experience, they
are not strictly necessary when introducing spa treatments
to an existing massage practice. You can add several spa
body treatments with a minimum of equipment and startup expense. Some clients actually avoid spas because they
perceive them as too expensive or fussy. The spa-oriented
massage clinic bridges the gap between the traditional
massage clinic and a full-service spa and directly appeals to
the spa-shy client. This chapter supports massage therapists
as they develop a spa program and menu of services based
on their life missions and personal spa philosophies.
Benefits and Drawbacks of Spa

Body Treatments
There are not only many benefits to adding spa treatments
to your business model but also some potential drawbacks.
It is important to consider all aspects of your business
before you invest in additional spa equipment. Lets explore
the many ways that therapists and clients benefit when a
massage practice adds spa treatments.
Clients have options: As you build a clientele at your
massage practice, your clients will come to know you,
respect you, and trust you. They may be very interested
in spa treatments but not want to venture to the big,
intimidating, expensive spa down the road. They know
and like you. When you offer clients options such as a
salt glow, body wrap, foot treatment, or hot stone massage, they have the opportunity to venture into new
bodywork realms in the safety and comfort of a familiar
space with a familiar therapist.
Complementary benefits: Many products support the
benefits and effects of massage and combine with massage to treat sports injury, repetitive stress injuries, and
chronic conditions. Products such as seaweed and mud
have a long history of therapeutic use in Europe due to
their anti-inflammatory, antiarthritic, and pain-relieving
qualities. Fibromyalgia responds well to seaweed application, whereas essential oils have strong immuneboosting properties, and muds high in sulfur are pain
relieving. A wide variety of products and spa applications
support the benefits and effects of massage to reduce
stress, relax, and revitalize the body.
Save your hands: Adding spa treatments to a massage
practice also helps you protect your hands and body
from repetitive stress because many spa treatments are
less taxing to deliver than a full-body massage. You can
335
offer more sessions in a day and increase your income

with less effort.
Higher price point: Clients tend to be willing to pay
more for spa body treatments or sessions that include
the use of products than for a massage during the same
amount of treatment time. You can offer the same number of treatment hours and make more per hour offering
spa body treatments.
Retail opportunities: Clients often like the aromas and
textures of products used during their spa services. It is
easy to find unique product upsells for spa treatments.
For example, if your client enjoys the smell of your citrus salt glow, remind her that she can purchase the same
product to use at home from your gift shop. If you learn
to sell retail products effectively, it can become a significant income stream for your massage practice.
Creative outlet: Spa treatments are fun to develop and
deliver. They provide you with a creative outlet that helps
to alleviate burnout and boredom from delivering massage sessions over and over again during a busy work week.
Although the benefits of adding spa body treatments are
numerous, there are some downsides you should consider
before you purchase additional equipment.
Setup and cleanup: Spa treatments require more setup
and cleanup time than massage sessions. You should
plan additional time in between clients to prepare or
change over the treatment room either before or after a
spa session. If you employ other therapists, you will need
to consider how your employees are compensated for
setup and cleanup time.
Laundry: If you are using hot towels to remove product from clients during spa treatments, you can plan on
having lots of laundry to do at the end of a busy day.
Most spa treatments require around 10 hand towels and
2 bath towels at a minimum. In a normal washer and
dryer, this equals one load of laundry per client.
Product inventory: Spa products are usually sold in
large-sized bottles (often referred to as the back bar to
differentiate them from the same product sold in smaller
sizes to the client). Although the cost of delivering a particular treatment may be relatively low ($2 to $14), the
initial outlay for product can be high. Although many
products can be stored for a long time without damage
to their therapeutic value, other products must be used
up before they become old or dry out. Think about the
number of products you need for a particular spa treatment and consider treatments that require less product
steps and fewer products first until you establish your
business. You can always add more services later.
Products with strong aromas: Some spa products such
as seaweed or taila (the medicated oils used in ayurveda)
can have a strong aroma, which may be disturbing to the
other clientele at your massage clinic. Often, clients will
be intrigued by these unique scents and will ask questions that help to sell them the treatment at a later date.
10/24/13 2:06 AM
336
Sometimes, they are put off by unfamiliar scents, and if

they are very sensitive, they may take their business elsewhere. If this is a problem, consider offering spa treatments on a particular day of the week (spa Saturdays) or
at specific times (spa lunches).
More therapist training: Sometimes, spa treatments sell
best to pairs of clients, either family members or friends.
In this case, two treatments will need to be delivered at
the same time, and sometimes, two sets of equipment
will be required (i.e., two sets of massage stones and stone
heating units). Obviously, two therapists who know how
to perform the treatment will need to be scheduled at the
same time, and they will have to deliver the treatment in
a similar fashion. The last thing you want is for the clients to compare their treatments and find that one therapist was more accomplished than the other.
If you are uncertain about adding spa services to an existing
massage practice, consider working 1 day a week at a day
spa for a period of time to gain spa experience. As you work
with different products and treatments during a busy day
at the spa, you will develop a better understanding of what
might work for you in your own practice.
Your Spa Philosophy

What fundamental beliefs do you hold about health, beauty,
fitness, disease, and wellness? Do you believe in the therapeutic value of relaxation for everyone, do you want to focus on
health care massage and condition management, or are you
interested in beauty, style, and art? Do you want to work with
everyone, with clients seeking to manage conditions such as
fibromyalgia or osteoarthritis, or with fit people concerned
with physical performance? Your beliefs will help you to
develop your spa program and your spa menu and to work
authentically with clients who want and need your particular
spa services.
Your Life Mission

You need your spa bodywork practice to integrate closely
with your personal life mission and the vision you hold for
your business. Complete this activity to define your life mission, write a spa philosophy statement that resonates with
your life mission, and use them to determine your goals for
your spa program and menu.
As you contemplate your life mission, think about the
activities that give your life purpose. Purpose could be
described as the qualities we want to bring to our life and
the way we orient ourselves to aspects of our life to create
meaning. Our purpose finds expression through our dedication to personal goals; relationships to family, friends,
colleagues, and clients; the satisfaction and fulfillment we
find in our work; and the sense of connectedness we feel
with nature and our communities.
A mission statement is usually understood as a statement of the purpose of a company or organization. The
mission statement guides the actions of the organization,
spells out its overall goal, provides a path, and guides decision making for the organizations leaders. It provides the
framework or context within which the companys strategies are formulated. For example,
Googles mission is to organize the worlds information
and make it universally accessible and useful.
The American Red Cross prevents and alleviates human
suffering in the face of emergencies by mobilizing the
power of volunteers and the generosity of donors.
Nikes mission is to bring inspiration and innovation to
every athlete in the world. If you have a body, you are an
athlete.
Your goal is to write a personal mission statement that
helps you clarify what has meaning and gives you a sense
of purpose.
Writing a Personal Mission Statement
A good mission statement stands the test of time and the
many changes that occur throughout life. It resonates even
when you change your job, your family status, your living
situation, or your life path. You want it to be broad enough
to encompass all of the elements of your lifenot just
your career or your relationship. For example, if you write,
I want to be a teacher, you are writing a goal. Goals are
important, but they are usually too specific to serve as good
mission statements. Instead, you might write, My mission
is to help other people learn. This is broad enough to reflect all areas of your life from your career to your relationships with family and friends. To create a personal mission
statement, complete each of these steps using the worksheets in For Your Exploration 161.
Step 1: Value List
Review the Value List and cross off values that dont
resonate with your life. Put a check mark by values that you
do hold and circle the values you hold most dear. If there
are values you hold that do not occur on the list, add them
in the spaces provided. Analyze the values you have circled
and pick your top five values. Write them into the space
provided on the Mission Statement Worksheet.
Step 2: Characteristics List
Review the Characteristics List and cross off characteristics that dont resonate with who you are now or
who you want to be in the future. Place a check mark
by characteristics that describe ways you want to grow
and circle the characteristics that describe attributes of
your personality that you value. If there are characteristics that you possess that are not on the list, add them
in the spaces provided. Analyze the characteristics you
have checked or circled and pick your top five characteristics. Write them into the space provided on the Mission
Statement Worksheet.
10/24/13 2:06 AM
337
FOR YOUR EXPLORATION 161

Write a Personal Mission Statement
Values List
Achievement
Action
Adventure
Affection
Appearance
Autonomy
Balance
Beauty
Career
Challenge
Change
Children
Civil rights
Civility
Cleanliness
Common sense
Community
Community service
Competition
Conformity
Congruency
Conservation
Contribution
Cooperation
Courage
Creativity
Culture
Development
Discipline
Diversity
Earth
Education
Effectiveness
Efficiency
Effort
Emotional expression
Emotional health
Environmental sustainability
Equality
Established norms
Excellence
Excitement
Expertise
Expression
Extroversion
Fairness
Fame
Family
Financial security
Free choice
Free thinking
Free time
Freedom
Friendship
Frugality
Generosity
Goals
Happiness
Health
Hobbies
Home
Honesty
Human dignity
Human potential
Humility
Independence
Inner harmony
Integrity
Intellectual challenge
Intelligence
Intimacy
Introspection
Introversion
Intuition
Involvement
Joy
Justice
Knowledge
Law
Learning
Leisure
Love
Loyalty
Manners
Marriage
Materialism
Meaningful work
Money
Music
Nature
Nonviolence
Order
Passion
Patriotism
Peace
Peace of mind
People
Perfection
Personal growth
Philanthropy
Philosophy
Physical activity
Physical beauty
Physical challenge
Physical fitness
Pleasure
Political activism
Popularity
Possessions
Potential
Power
Privacy
Productivity
Progress
Purpose
Quality
Recreation
Relationship
Relaxation
Religion
Responsibility
Romance
Routine
Safety
Security
Self-actualization
Self-respect
Serenity
Sexual fulfillment
Simplicity
Sincerity
Single life
Skill
Social change
Social justice
Social status
Socializing
Solitude
Sophistication
Spirituality
Spontaneity
Stability
Status
Success
Tradition
Travel
Truth
Variety
Wealth
Work
Other values:
Bold
Bright
Calm
Carefree
Careful
Caring
Charitable
Charming
Charismatic
Cheerful
Clever
Committed
Compassionate
Competent
Competitive
Confident
Congruent
Conscientious
Considerate
Consistent
Cooperative
Courageous
Creative
Curious
Daring
Decisive
Deep
Dependable
Dignified
Diplomatic
Direct
Discreet
Discriminating
Characteristics List
Accepting
Active
Adaptable
Adventurous
Affectionate
Altruistic
Ambitious
Assertive
Athletic
Attractive
Beautiful
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338

Write a Personal Mission Statement (continued)
Dominant
Down-to-earth
Eager
Easygoing
Educated
Elegant
Emotional
Empathic
Energetic
Enterprising
Entertaining
Enthusiastic
Expressive
Fair
Faithful
Firm
Flexible
Focused
Forceful
Forgiving
Forthright
Friendly
Frugal
Fun-loving
Generous
Gentle
Genuine
Goal-oriented
Graceful
Grateful
Hardworking
Healthy
Helpful
Honest
Humble
Idealistic
Imaginative
Independent
Industrious
Inner-directed
Innovative
Insightful
Intelligent
Intuitive
Judging
Kind
Logical
Loving
Loyal
Mature
Mellow
Methodical
Mild
Modest
Moral
Motivated
Mysterious
Natural
Neat
Nice
Nonjudgmental
Open-minded
Optimistic
Organized
Original
Outgoing
Patient
Peaceable
Perceptive
Perseverant
Philosophical
Pleasant
Popular
Powerful
Practical
Predictable
Principled
Proactive
Productive
Purposeful
Quiet
Rational
Realistic
Reasonable
Reflective
Relaxed
Reliable
Reserved
Resourceful
Respectful
Responsible
Secure
Self-controlled
Selfless
Self-reliant
Sensible
Sensitive
Serious
Sincere
Skillful
Sociable
Spiritual
Spontaneous
Stable
Strong
Supportive
Sweet
Sympathetic
Tactful
Thoughtful
Thrifty
Tidy
Tolerant
Tough
Trusting
Trustworthy
Understanding
Uninhibited
Unique
Versatile
Visionary
Warm
Wild
Wise
Witty
Other characteristics:
Coaching
Cooking
Comforting others
Communication
Computer literacy
Concentration/focus
Coordinating projects/tasks
Counseling
Craft work
Creating clarity
Creating metaphors
Creating systems
Creative
Critiquing
Customer service
Dancing
Decision making
Designing
Detail orientation
Developing instructional
materials
Developing models
Developing theories
Dexterity
Efficiency
Empathizing with others
Empowering others
Entertaining people
Establishing order
Establishing rules
Esthetic sensitivity
Explaining things
Expressing feelings
appropriately
Facilitating communication
Facilitating processes
Facilitating understanding
Finding new uses for things
Fixing things
Following directions
Gardening
Generating new ideas
Giving positive feedback
Helping people
Homemaking
Hunting/fishing
Identifying problems
Implementing systems
Inspiring others
Interpersonal skills
Interventions
Intuitive knowledge
Knowing and following
protocol
Skills and Talents List

Accuracy
Acting
Adapting to change
Advising
Analyzing problems
Art
Assessing resources
Assessing situations/things
Baking
Bargain shopping
Brainstorming
Budgeting
Building things
Caring for animals
Caring for others
Carpentry
Changing things
Cleaning
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339

Write a Personal Mission Statement (continued)
Leadership
Learning new skills
Listening
Maintaining systems
Making bridges between
theory and practice
Making connections
Making decisions
Managing crises
Managing multiple tasks
Managing people
Manual labor
Mechanically inclined
Meeting deadlines
Meeting people easily
Mentoring
Methodical analysis
Motivating others
Musical
Needle crafts
Negotiating
Observing accurately
Organizational development
Organizing
Parenting
Persisting
Persuading
Physical agility
Physical stamina
Physical strength
Planning
Poetry
Precision
Problem solving
Promoting a positive
environment
Psychic
Putting people at ease
Public speaking
Quality control
Raising children
Repairing things
Research
Resolving conflicts
Resourceful
Running meetings
Science
Seeing all sides of an issue
Seeing connections
Seeing possibilities
Seeing the big picture
Selling
Sensitive awareness of the
feelings of others
Serving others
Setting up systems
Sewing
Singing
Spatial relations
Speaking
Sports
Story telling
Straightening things up
Strategizing
Supervising
Synthesizing information
Teaching
Team development
Team work
Technology
Thinking quickly
Thoroughness
Training
Understanding complicated
ideas
Versatility
Vision
Woodworking
Working independently
Working on a team
Working with your hands
Working with machinery
Working with numbers and
formulas
Working with tools
Working with children
Working with the elderly
Working with people
Writing
Other skills and talents:
Mission Statement Worksheet

1. Top 5 Values:
2. Top 5 Characteristics:
3. Top 5 Skills and Talents:
Mission Statement Templates
To (what you want to achieve, do, or become) so that (reasons why it is important). I will do this by (specific behaviors or
actions you can use to get there).
I value (choose one to three values) because (reasons why these values are important to you). Accordingly, I will (what you
can do to live by these values).
To live each day with (choose one to three values or principles) so that (what living by these values will give you). I will do this
by (specific behaviors you will use to live by these values).
To appreciate and enjoy (things you want to appreciate and enjoy more) by (what you can do to appreciate/enjoy these
things).
To treasure above all else (most important things to you) by (what you can do to live your priorities).
Your First Draft Mission Statement:
Step 3: Skills and Talents List

Review the Skills and Talents List and cross off skills and
talents that you dont possess or that are not important to
you. Place check marks by skills and talents that you would
like to develop and circle the skills and talents you possess
that you particularly value. If there are skills and talents
that you possess that are not on the list, add them in the
spaces provided. Analyze the skills and talents that you have
checked or circled and pick your top five. Write these skills
and talents into the space provided on the Mission Statement Worksheet.
Step 4: Reflect
Review the Mission Statement Worksheet and reflect on
the aspect of yourself that it illuminates. Set the worksheet
aside for a moment and then pick it up again and pretend
10/24/13 2:06 AM
340

Sample Spa Philosophy Statements
Pampering, Pleasure, and Perfect Skin
Supporting SuccessMaintaining Balance
Ancient WisdomModern Approaches
A Haven from a Hectic Workplace
Ultimate BeautyUltimate Luxury
A Pure Body Is a Strong Body
Jump-starting a Healthy Lifestyle
Specialists in Helping the Athlete Achieve a Competitive
Edge
Rest, Reflection, Renewal
Life Outdoors Leads to Inner Peace
that you are seeing a strangers worksheet. What impression do you get of the person from the worksheet? Do you
see any themes emerging? Does a purpose or mission begin
to emerge as you consider your values, characteristics, and
skills and talents together at the same time?
Step 5: Start Writing
Review the Mission Statement Templates (For Your
Exploration 161) and use a template to craft a first draft
mission statement. Your mission statement can be as long
or as short as you like. Play with different versions until you
have a statement that feels meaningful and inspiring when
you say it out loud.
Step 6: Post It
Once you have written a personal mission statement, post
it where you can see it every day. Its fun to create a collage
with pictures and words that represent your mission. Frame
your collage and hang as a work of art somewhere in your
living space or workspace.
Step 7: Use Your Mission Statement to Write a Spa
Philosophy Statement
Review the sample spa philosophy statements in For Your
Exploration 162 and think about your life mission. Now,
spend some time brainstorming spa philosophy statements
that resonate with your life mission. Choose the one you
like best and use it to guide your thinking as you determine
your spa program and menu.
Choosing Spa Treatments for Your Program

As you choose spa treatments for your program, you need
to consider your facility, your own interests and skills, if
you have additional staff that can learn treatments, product and delivery costs, laundry, and the way in which all
of your treatments hold together and reflect your spa
philosophy.
Massage and Bodywork Treatments
As a massage or bodywork therapist, you probably already
specialize in specific forms or styles of massage. Your menu
might include Swedish or relaxation massage; deep tissue
massage; neuromuscular therapy; pregnancy massage; and
a culturally based system such as lomilomi, abhyanga, or
Balinese massage, along with many others. The sample spa
menu in Figure 166 shows how this type of massage program might be described in a basic menu of services. This
type of massage and bodywork program is very common
and offers clients a nice variety of choices.
You can also take a different approach as shown in this
example. In this example, two different spa programs are
compared and contrasted with menu entries that are written in a particular style that integrates a defined spa philosophy with a menu of bodywork offerings. For example,
if your philosophy is Ultimate BeautyUltimate Luxury,
you might not offer deep tissue massage or neuromuscular
therapy (Fig. 161). Instead, your focus might be a number
of enhanced and specialized Swedish massages described
such as this in your spa menu:
At Two Towers Day Spa, we believe that ultimate beauty lies in our ability to relax deeply, embrace our daydreams, and believe in our right to experience luxury.
These deeply satisfying massage sessions have been
designed to include exceptional massage, a sole softening foot scrub, the application of paraffin to the hands,
and a firming face massage amidst the splendor of natu-

You have weighed the pros and cons of adding spa treatments to your massage practice and you have thought
about your life mission and how it integrates with your beliefs about beauty, health, wellness, and fitness. You have
written a spa philosophy statement and determined that
adding spa is right for your life and business. You are ready
to design a spa program.
FIGURE 161 Choosing bodywork systems for your spa program. If

your spa philosophy is Ultimate BeautyUltimate Luxury, you might
not offer deep tissue massage or neuromuscular therapy. Instead, your
focus might be a number of enhanced and specialized Swedish massages.
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341
ral essential oils and botanical skin care products. You

have three choices. Choose Sumptuous if you want to be
surrounded in the opulence of Turkish roses and deep
powdery resins from the East. Beautiful explores the harmonies in combinations of citrus and floral aromas,
whereas Brilliance is spicy and refreshing.
Contrast the Two Towers massage menu with a menu
from a spa with the philosophy, A Pure Body Is a Strong
Body. This menu highlights various forms of treatmentoriented massage and includes enhancers that support the
natural detoxification processes of the body.
Pure Body offers a number of massage services aimed at
supporting your physical strength and balance. Choose
Deep if you want massage directed at the deeper muscular structures of your body to release tension and
decrease areas of pain. Reflect is a full-body therapeutic
session that aims to eliminate stress with long, firm,
soothing strokes that allow you to relax completely
into your body. Clean incorporates dry skin brushing to
stimulate the natural detoxification mechanisms of the
body and leave your energy invigorated, whereas Breathe
combines massage with techniques that passively stretch
your muscles to increase flexibility.
Take a moment to think about your spa philosophy
and the types of clients you want to draw to your business.
Brainstorm your massage and bodywork treatments by defining styles, names, and enhancing extras that appeal to
you and will likely appeal to your clients.
Exfoliation treatments are popular on spa menus especially
when they are integrated with massage as in the treatments
described in this book. Lets look at some considerations
for each of these exfoliation treatments that will help you
choose what might be right for your business.
Skin brushing: Skin brushing pairs easily with massage
and makes a nice enhancing extra for massage sessions
(Fig. 162). It stimulates natural detoxification processes
of the body, so it works well in spas where the philosophy
is jump-starting a diet, healthy life choices, or detoxification. Product costs are next to nothing as a pair of natural bristle dry skin brushes costs under $20 a pair and
can be reused after sanitation or given to the client and
included in the treatment pricing.
Salt or sugar glows: These exfoliation treatments use
natural sea salt, cane sugar, or raw sugar and are easily
paired with massage. They can be mixed up in a variety
of natural or man-made products for application. They
work well in spas that have an ecological or all-natural
philosophy where clients seek out treatments that wont
expose them to man-made chemicals. Product costs are
minimal, and the same treatment steps are easy to vary
simply by changing the smell-scape as shown in the sample spa menu in Figure 166.
FIGURE 162 Skin brushing pairs easily with massage and makes a
nice enhancing extra for massage sessions.
Body scrub treatments: These treatments are vigorous

and stimulating for the body and pair nicely with massage where the scrub step is applied after the massage
step and removes lubricants left from the massage to
leave the body feeling clean. They can be applied with
any body wash product, making them easy to customize for a variety of treatment themes as explained in
Chapter 15 (Treatment Design and Your Signature Spa
Treatment).
Body polish treatments: These exfoliation treatments
work well for spas where beauty and skin care are the
focus. The products for body polish treatments tend to
be more expensive but usually come with matching retail
options you can sell in your gift store. Before you opt for
this option, examine the cost of treatments in a number of online spa catalogues and calculate the price you
need to charge clients to make the investment in product
worthwhile.
Take a moment to think about your spa philosophy
and the types of clients you want to draw to your business.
Brainstorm the types of exfoliation treatments you want
to add to your business and capture styles, possible names,
and interesting smell-scapes you want to explore.
Body Wrap Treatments
The body wrap treatments you choose should be based
first on your facility. If you dont have at least a standard
shower, it wont be practical to offer mud wraps or seaweed wraps (Fig. 163). These types of wraps are simply too
messy and take too long to remove with hot towels. Gelbased seaweed is the exception because it is designed to
be removed with hot towels. If your philosophy is focused
on beauty, then seaweed is an important consideration because it cleanses, refines, and firms the skin; is useful in
treatments that decrease the appearance of cellulite; and
stimulates metabolism for slimming and detoxification
sessions. If fitness is the focus, then spot treatments using
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FIGURE 163 The body wrap treatments you choose for your business
should be based first on your facility. If you dont have at least a standard
shower, it wont be practical to offer mud wraps or seaweed wraps.
mud for sore muscles or overexertion from participation

in a fitness event are a good choice. Sulfur muds leave muscles feeling relaxed and revitalized, whereas Moor mud is
an excellent topical anti-inflammatory. If your program
is focused on wellness using botanical products, then an
herbal body wrap fits the picture. Review the hot sheet
wrap and cocoon treatment outlines in Chapter 9 (Body
Wraps) and review product considerations in Chapter 11
(Fangotherapy) and Chapter 12 (Thalassotherapy) as you
think about your spa philosophy and brainstorm you spa
program.
Foot Treatments
If you practice reflexology, then you will probably want to
include a number of foot treatments on your spa menu
(Fig. 164). In fact, one reflexologist created a full menu of
25 different foot services, all incorporating reflexology and
different products. She became known in her community
as the happy feet lady. Because her business was different from the spas and massage clinics in her area, she received a lot of media attention that kept a steady stream of
new clients coming to her business curious about all the
ways they might pamper their feet. Because of her special
focus on feet, the clinic gift shop became the place to go for
people looking for foot-oriented gifts or specialty foot care
products.
Another foot massage business was located in a busy
mall and owned by a team of two massage therapists and
two nail technicians. A nail technician would start each foot
service by cleansing the feet, trimming the nails, removing
the cuticles, and filing the nails. A massage therapist would
take over the service and provide a 35-minute massage and
reflexology session and then apply a foot mask. The nail
technician, who had started a second treatment with another client, would switch with the massage therapist and finish the service by removing the mask and applying polish to
the toenails. The business only accepted walk-ins, and one
FIGURE 164 If you practice reflexology, then you will probably want
to include a number of foot treatments on your spa menu.
team could manage three treatments at a time keeping all

four therapists busy all day.
Although these unique business models offer some
interesting opportunities for exploration, most spas offer some types of foot service because clients enjoy them.
If you decided not to offer a mud wrap or heavy seaweed
wrap as part of your menu, consider using these products
in foot treatments. Because they are confined to one specific body region, it is practical to remove them with hot
towels or in an end-of-the-session foot bath. Your spa philosophy may determine if you offer foot services and what
form they take. For example, if your spa philosophy is A
Haven from a Hectic Workplace, then spa treatments focused on reducing foot pain or revitalizing tired feet make
sense.
In Chapter 14 (Culturally Based Spa Treatments), you
learned about ayurvedic-inspired spa treatments and
Indonesian-inspired spa treatments. These unique forms
of bodywork are based in countries that have rich histories
and complex cultures. The environment, the people, the
traditional medical systems, and the myths from faraway
places entice both therapists and clients who love travel,
novelty, and adventure (Fig. 165).
In one example, a massage therapist found herself drawn
into the world of ayurveda. She adopted an ayurvedic diet,
took up yoga, and explored the therapeutic properties of
ayurvedic botanicals and services. When her massage practice grew to a size where she felt she could take a financial risk, she decided to dedicate Saturdays to offering an
10/24/13 2:06 AM
FIGURE 165 Culturally inspired spa treatments are based in countries

that have rich histories and complex cultures. The environment, the people,
the traditional medical systems, and the myths from faraway places entice
both therapists and clients who love travel, novelty, and adventure.
exclusive ayurvedic package. She offers the same program

and price to each client. She sees one client in the morning
and one client in the afternoon. The session begins with an
ayurveda consultation to determine the clients dosha and
any dosha imbalances. The client is served a cup of hot jasmine tea and Indian biscuits during the consultation. After
the consultation, the client soaks in a foot bath during an
Indian head massage, which is followed by a full-body dosha massage. Ubtan (an herbal paste) is applied to the skin
and buffed off with dried towels before an Indian firming
face massage and classic shirodhara treatment are delivered.
The client is left to nap for 20 minutes while a fragrant
bath is prepared. To end the service, the client soaks in a
tub filled with flowers and herbs before his or her hair is
shampooed to remove the oil from the shirodhara treatment. At the end of the service, the client is escorted back
to the reception/retail/consultation area where the therapist makes specific recommendations about ayurvedic
products that would be good for the client. After the client
has purchased products and departed, the therapist has
lunch and then cleans the treatment room and bathroom
in preparation for her second client. Because her program
is the same for every client, she is able to maintain a small
product inventory and refine the delivery of the service so
that every detail is considered.
It is easy to see that a series of Indonesian-inspired treatments or a session based on lomilomi could also be offered
in a half-day package such as the ayurveda package described
here and become the basis for a spa concept or for a special
day dedicated to exotic treatments from other lands.
Creating Spa Packages
In the previous section, we explored the use of culturally
inspired services used together in a half-day spa experience.
Culturally inspired services are not the only types of treatments that work well in this type of program. Therapists
with a small workspace could offer many different spa
343
programs using the one described previously as a model.

For example, a program could be based exclusively on specific types of treatments such as aromatherapy (Sensual
Escape), fangotherapy (Mud Madness!), or botanicals
(Herbal Remedies). Another option would be to combine
a small number of different treatments working toward
achieving a specific spa philosophy. If the spa philosophy
is Cleanse the Body, Expand the Soul, the program might
include a detoxification treatment and a guided meditation
session. A spa program based on the philosophy Reflect,
Relax, Renew could include any treatment that was relaxing. A couples romance package, especially if the clients
can be in the same room together while they enjoy their
services, works well as does a prom party package for teens
and a pregnancy package for pregnant women. Consider
your spa philosophy and brainstorm a series of treatments
that last between 2 and 4 hours. Plan to include opportunities for the client to have a bite to eat between services in
longer packages to avoid situations of low blood sugar and
shakiness.
Balance Your Spa Program

You want your spa program to be balanced in such a way
that each individual treatment supports, rather than competes, with other treatments. You wouldnt want to offer
three body wraps that all have the same therapeutic goal
of decreasing muscle soreness, for example. Three competing treatments would only confuse clients who wont know
which is the best treatment to schedule if they all do the
same thing. As we have already discussed, you may choose
to offer a number of different versions of the same treatment, and this is fine, so long as they aim to achieve different treatment goals to make it simple for clients to choose
what they want. In this case, one body wrap might focus on
detoxification, the second on relaxation, and the third on
decreasing muscle soreness. Review your draft spa program
and look for competing treatments. Adapt your choices of
products and treatment goals to find balance and harmony
in session objectives and treatment choices.
Review Other Spa Programs

Sit down at your computer and take a few hours to conduct
a search on the Internet. Look at a variety of spas, massage
clinics, wellness centers, and retreats. Carefully review their
spa programs and menus. What do you like? What doesnt
work? What are some fresh ideas? Maybe you never thought
about adding an esthetician, nail technician, or cosmetologist to your business model. Maybe youre clear that
you want to be a one-person operation, but maybe a team
of people working together is suddenly a consideration.
Table 161 provides an overview of popular services, their
therapeutic benefits, and the most likely spa professional
to deliver the services. You might choose a program model
that is small and specific by adding two or three spa choices
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TABLE 161 Overview of Spa Servicesa

SPA SERVICE
BENEFITS
LIKELY INDUSTRY PROFESSIONAL
Hydrotherapy
Specialized showers, steams, baths, saunas,
and other applications using water
The benefits of the treatment will be based on

Physician, physical therapist, massage therapist
the temperature of the treatment, length of
Estheticians use specialized baths and showers
the treatment, and the effects of the specialized
in the removal of products or to improve the
apparatus that is used in combination with
health and condition of the skin.
water.
Full-body exfoliation
Loofah scrubs, full-body polish, salt glows,
sugar glows, dry skin brushing, almond
scrub, others
Stimulates circulation and lymph flow,

stimulates vital energy of the body, relaxation,
revitalization, deep cleans, removes dead skin
cells, softens and refines the skins texture,
beautifies the skin
Massage therapist, esthetician

Exfoliation has benefits for both skin and body.
Massage therapists focus on the benefits for
the body, whereas estheticians focus on the
benefits for the skin. Estheticians can also
deliver enzyme peels.
Autotanning
Buff and bronze, spray-on tans, spray tan
booths
Depending on the treatment steps, the treatment

may stimulate circulation and lymph flow and
relax muscles. Autotanning treatments are
most often delivered to darken the skins color
so that the client appears tan.

Spray tans and booths can be facilitated by
unlicensed or uncertified individuals in some
states.
Body wraps
A wide variety including herbal, seaweed,
fango, cryogenic, slimming, detoxifying,
aromatherapy, others
The benefits of the treatment depend on the

type of products and techniques that are used
during the service.

Depending on the desired effects of the
application and on the promotional
description of the service
Thalassotherapy
Treatments using seawater, marine algae, sea
air, and diets high in sea products
Thalassotherapy has been used for a wide

range of conditions. In general, it revitalizes
and detoxifies the body and beautifies the
skin.
Massage therapist, esthetician, physical

therapist, physician
Depending on the desired effects of the application
and on the promotional description of the service
Fangotherapy
Treatments using therapeutic mud, clay, and
peat
Fangotherapy has been used for a wide

range of conditions but especially arthritis,
musculoskeletal conditions, and to beautify
the skin.
Massage therapist, esthetician, physical

therapist, physician
Depending on the desired effects of the
application and on the promotional description
of the service
Spot treatments
Cellulite, back, bust, others
The benefits of the treatment will depend on the

type of products and techniques that are used
during the service.
Esthetician, massage therapist
Foot and hand treatments (not pedicures

or manicures)
Treatments that do not include trimming the nail
or cuticle
Pain relieving, relaxing, revitalizing, stimulate

circulation, increase range of motion, can be
used to treat soft tissue pathology such as
plantar fasciitis, relaxing, deep cleans, softens
and reconditions the skin on the hands or feet,
beautifies the hands or feet
Massage therapist, certified reflexologist

(some states), esthetician
Massage therapists and reflexologists focus
on treatments that relax the body and
decrease foot pain. Estheticians focus on the
beautification of the skin of the hands and feet.
Pedicures
Treatments that include trimming the nail and
cuticle
Relaxing, improves the overall health and

qappearance of the feet, beautifies the feet
Nail technician, cosmetologist, estheticians

(some states)
Manicures
Treatments that include trimming the nail and
cuticle
Relaxing, improves the overall health and

appearance of the hands, beautifies the hands
Nail technician, cosmetologist, estheticians

(some states)
Massage
Swedish, Shiatsu, manual lymphatic drainage,
craniosacral, lomilomi, Thai, sports, deep
tissue, others
The effects of the massage will be based on the

types of techniques that are used. In general,
massage stimulates circulation and lymphatic
flow, relaxes the body, and decreases soft
tissue imbalance.
Massage therapist, physical therapist

Sometimes specialized training and certification
are required to deliver certain types of massage.
Stone massage
Warms tissue, stimulates circulation, decreases

tension in hypertonic muscles, decreases
adhesions, relaxes the body
Massage therapist
Ayurveda-inspired body treatments

Abhyanga, dosha wrap, dosha massage,
ubvartana, Indian head massage, shirodhara,
pinda abhyanga, pizzichilli, garshan, others
To relax the body, stimulate circulation, revitalize Ayurvedic physician, massage therapist
the body, facilitate detoxification of body
tissues, bring balance to the body, promote
spiritual awareness, create a space for
reflection and renewal
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TABLE 161 Overview of Spa Servicesa (continued)

SPA SERVICE
Ayurveda-inspired beauty treatments
Facials, shirodhara, ubvartana, dosha skin
wraps, scalp treatments, pedicures and
manicures, others
BENEFITS
To beautify the intended area using ayurveda
principles and products
To bring health, wellness, and beauty to the

Indonesian-inspired body treatments
client using Indonesian beauty and health
Balinese massage, Javanese Lulur, body wraps,
principles and products
others
LIKELY INDUSTRY PROFESSIONAL

Ayurvedic physician, esthetician, cosmetologist,
nail technician
Massage therapists, estheticians
Natural and traditional forms of medicine

Ayurveda, Chinese traditional medicine,
acupuncture, naturopathic medicine, herbal
medicine, others
To bring the body into balance, to treat a

specific condition, or as a preventive to
disease
Ayurvedic physician, traditional Chinese medicine

practitioner, acupuncturist, naturopathic doctor,
herbal medicine practitioner
Facials
To deep clean, smooth, refine, soften, and

condition the facial skin and treat certain
skin conditions on the face; to improve the
appearance and beautify the skin; to slow
the signs of aging
Esthetician, cosmetologists (some states)
Face and scalp massage
To relax the muscles of face and scalp,

decrease overall tension, firm and tone the
muscles of the face, stimulate the skin and
increase local circulation, aid in product
penetration, loosen trapped debris in the
follicles, facilitate product application to the
face or scalp
Massage therapist, esthetician, cosmetologist
Hair removal services

Physical depilatories (wax), chemical
depilatories (powder, cream, others),
electrolysis, electric current tweezers
To remove unwanted hair from the body;

electrolysis is a form of permanent hair
removal, whereas depilatories remove the
hair temporarily.
Esthetician, cosmetologist
Electrolysis is performed by a licensed
electrologist.
Nails
Includes nail art, gel nails, acrylic nails
To beautify the hands and the feet, improve

nail health, embellish the nails for esthetic
purposes
Nail technician, cosmetologist (some states)
Hair services
Cutting, styling, highlighting, coloring, perming,
straightening, conditioning, and so on
To improve the health or appearance of the hair,

stimulate the scalp and promote healthy hair
growth.
Cosmetologist
Makeup application
To improve the appearance of the face or

camouflage a skin condition or injury such as
scarring from burns
Esthetician, cosmetologist
Nutrition
Nutrition assessment or programming, healthy
cooking
To assess the nutritional viability of a clients

diet and to make recommendations that lead
to better nutritional health; to support healing
from a specific condition using diet
Nutritionist, fitness trainer
Fitness
Fitness assessment or programming, personal
training
To assess the fitness level of the client and

make recommendations that lead to better
physical health; to motivate clients to reach
their physical goals
Fitness trainer, strength and conditioning

specialist
Mind and spirit therapies

Hypnotherapy, group counseling, counseling,
psychotherapy, guided meditation, life
coaching, yoga, others
To support the individual in finding inner peace

and contentment; to guide personal transformation, create relationships and connections,
generate resource states for better living
Psychotherapists, psychologists, counselors,

hypnotherapists, yoga instructors, spiritual
instructors, life coaches, others
As discussed in Chapter 1 (Spa from Past to Present), the laws, regulations, and scope of practice for professionals working at
a spa vary widely from state to state. It is important that you review the laws in your state before providing any treatment. You will
also need to check that a given treatment is covered by your liability insurance. Because products and treatment techniques often
provide benefits for both the revitalization of the body and the beautification of the skin, the promotional description of the treatment
may become the determining factor in who delivers the service. In general (although not in every state), massage therapists
will want to focus on the effects of a treatment for soft tissue and the body, whereas estheticians will focus on the effects of the
treatment for the health and beautification of the skin. This table is meant to provide a general overview. It is not comprehensive in
terms of treatments or the industry professionals who might deliver them.
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TABLE 162 Small Spa Program Model
TABLE 164 Large Spa Program Model
MASSAGE
MASSAGE
Swedish massage
Swedish massage
Deep tissue massage
Aromatherapy massage
Hot stone massage
Deep tissue massage
Pregnancy massage
Hot stone massage
SPA BODY TREATMENTS
Custom massage
Salt glow
Indian head and face massage and shirodhara
Spa foot treatment
BODY TREATMENTS
Herbal body wrap
Full-body seaweed wrap

Parafango treatment for back pain
Herbal detoxification wrap
to your massage menu as shown in Table 162. A mediumsized program designed to be offered by a single practitioner in a private practice is shown in Table 163 (a sample
spa menu for this program is provided in Fig. 166). A larger clinic with multiple massage therapists on staff may offer
a program such as the one described in Table 164. Finally,
you might choose to hire an esthetician or become an esthetician yourself and offer some body treatments and some
facials in your business. Perhaps, you want to branch out
and hire additional spa staff to offer a full range of services
including manicures and pedicures, facials, hair services,
depilatory services, makeup application, hydrotherapy
treatments, body treatments, life coaching, mediation, nutritional programs, fitness programs, and more as shown in
Table 165. Think over all your options and write an outline of your spa program.
TABLE 163 Medium Spa Program Model
Ubvartana treatment
Salt glowthree choices (citrus, alpine, floral)
Loofah scrubthree choices (eucalyptus, sage and lavender,
peppermint and sweet orange)
Buff and bronze
REFLEXOLOGY FOOT SPA TREATMENTS
Treatment aimed at decreasing foot pain
Treatment aimed at revitalizing tired feet
Treatment aimed at stress reduction
COUPLES ROMANCE PACKAGE
(MEDITERRANEAN THEME)
Foot soak and foot massage (goat cheese, bruschetta, and sliced
tomato snack)
Mediterranean herbs wrap
Aromatic hot stone massage with essential oils of rosemary, lavender,
sage, and lemon
WORKDAY ESCAPE PACKAGE
MASSAGE
Citrus salt glow
Swedish massage
Aromatherapy massage
Deep tissue massage
Foot spa treatment for tired feet
Hot stone massage

Pregnancy massage
BODY TREATMENTS
Design Individual Treatments
Salt glowthree choices (Zen, citrus, floral)
When you have finalized your spa program outline, you are
ready to design each individual treatment. This process is
described in detail in Chapter 15 (Treatment Design and
Your Signature Spa Treatment). As you work on designing
each individual treatment, you may find yourself adapting
the spa program as you get into the details of your vision.
This is normal and helpful. Write everything out and let it
sit. Review it and revise it. Give copies of treatment designs
and your spa program outline to friends and ask for their
thoughts. Continue to research and refine. Finally, you will
feel that you have arrived at a program that matches your
facility, your budget, your particular talents as a therapist,
and your spa philosophy.

Herbal detoxification wrap
Parafango treatment for back pain
Buff and bronze
Aromatherapy consultation and massage
REFLEXOLOGY FOOT SPA TREATMENTS
Treatment aimed at decreasing foot pain
Treatment aimed at tired feet
Treatment aimed at stress reduction
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TABLE 165 Extra Large Spa Program Model

MASSAGE
Swedish massage
Deep tissue massage
Thai massage
Lomilomi massage
Hot stone massage
BODY TREATMENTS
Full-body fango wrap
Parafango cellulite treatment
Slimming herbal body wrap
Athlete treatment with sports massage and application of cryogenic product
Salt glow
Flowers ritual foot soak, body polish, and scalp conditioning massage
Buff and bronze
Skin softening emollient wrap
FACIALS
Signature facial (matched to skin type)
Deep-cleansing facial with extractions
Anti-aging facial for mature skin
Gentlemans facial
Teens facial (aimed at problem skin)
DEPILATORY SERVICES
Face (lip, chin, eyebrow)
Legs and bikini
Arms (underarm, forearm)
Bodybuilders wax (back, legs, chest, arms)
MANICURES
Spa manicure
French manicure
Gentlemans manicure
Nail repair and nail art
Hand hennas
PEDICURES
Spa pedicure
French pedicure
Foot hennas
Ultimate foot treatment (pedicure, reflexology session, foot mask, paraffin dip, nail art, or henna)
PREGNANCY PACKAGE FOR MOMS-TO-BE
Flowers ritual
Pregnancy massage
Signature facial
PROM PARTY PACKAGE
Teen facial
Mini manicure and pedicure
30-minute aromatherapy massage
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Write Detailed Treatment Guides

When you design each of your spa treatments (described in
Chapter 15), you will find that it is easy to create detailed
treatment guides for each of the services you plan to offer
in your spa program. The guide provides step-by-step directions for how to manage every aspect of the clients experience from the moment he or she walks through the doors of
your business until the moment he or she walk out the doors
of your business. For each treatment, describe the following:
Promotional description: A promotional description
helps you or another therapist quickly get a feel for the
treatment and an overview of treatment elements.
Benefits: List the benefits you expect clients will experience when they receive the treatment.
Contraindications and cautions: Identify contraindications and cautions for the treatment. For example, you
know you want to check for iodine or shellfish allergies
for any treatments that incorporate seaweed or products
containing seaweed. Indonesian-inspired treatments
might include spices that are too stimulating for fairskinned people. Make sure to capture all of these concerns in your treatment guide for the service.
Treatment room setup: Give precise directions for how
the room should be set up for the treatment. Include the
setup for the massage table, for the work table, and for
any hydrotherapy or showering facilities (e.g., place a
fresh bath mat outside the shower).
Supplies and products: List all of the supplies and
products necessary for delivery of the treatment. If specific amounts of spa product must be removed from
their containers and heated before application, provide
precise measurements and give directions for heating
and maintaining the product until it is needed. If you
are creating your own product formulations such as aromatherapy massage oils, give precise recipes and indicate
the amount of product a therapist might be expected to
use during the session.
The procedure: Describe each step in the treatment
in vivid detail. Explain when and how the benefits of
the service are described to the client; how the client is
positioned and bolstered; and which body area is treated
first, second, third, and fourth, along with the order of
products and the amount of time they are left on body
regions. You want to be able to visualize the treatment by
reading the procedure.
Cleanup notes: Outline the cleanup steps that need to
be conducted at the end of the service.
Retail opportunities: Identify any possible retail
opportunities and describe how these opportunities are
presented to the client.
Writing treatment guides can be a time-consuming process, but it saves you money and time in the end. Sometimes,
you wont deliver a treatment for a few weeks and need the
guide to remind you of important treatment processes and
steps. The guides also come in handy when you train new
therapists to deliver the spas services. They are useful for

the reception staff who must artfully describe treatments to
clients over the phone.
Refine Your Treatments

As you write your treatment guides, its a good idea to work
through all of the aspects of each treatment, play with different product options, and analyze your choices. Plan to
practice a treatment four times in rapid succession, rewriting the treatment guide as you go, until you have a fluid,
refined, and functional service. When you have a final program, you are ready to write a spa menu.
Your Spa Menu

Your spa menu is an important promotional item that
outlines your spa program and describes each of the services that are offered at the facility (see Fig. 166). As a key
promotional tool, it is taken away with clients, mailed to
clients, posted in a frame for walk-up business, handed out
at community events, and, sometimes, sent out in a mass
mailing to attract new business.
Design
Design and write your spa menu so that it upholds the
overall philosophy of your business. For example, if your
goal is an elegant environment full of old world charm and
perfect etiquette, you might design your menu on delicate
cream colored paper using a flowing Victorian script font to
describe your classic services in perfect English. Alternately,
you might opt for hot pick card stock; a bold modern font;
and quirky, funky treatment descriptions.
Writing Style
Whether you describe your treatments in perfect English or
play with fun, funky, or whimsical descriptions, you want
clients to know what they are getting so your description
must clearly define treatment steps. Strong sensory language
captures the clients imagination and elicits an emotional
response. You want the client to smell, taste, and feel the
treatment just by reading the description. Uplifting grapefruit body polish sounds much more exciting than body
polish. Swiss herbs cocoon sounds more appealing than
wrap. As mentioned previously, you want your spa philosophy to shine through in the style in which the promotional
descriptions are written. Some spas will be very traditional
or sophisticated; others will be spiritual or even funky and
lighthearted. Writing that matches the overall philosophy
and style of the spa works best. For example, in a lighthearted description of a seaweed wrap, the treatment might
be named the Mermaid Shimmer and start with the line,
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349
Kocc[jho
EWiiW][ $ <Wo KfW
Massage Selections
Classic Swedish Massage: 1 hour $60
This relaxing full-body massage will
decrease muscular tension and soothe the
entire body. Add aromatherapy touches
such as a sweet sage stream, aromatic
massage oil, and aroma mist for an
additional $10.
Deep Tissue Massage: 1 hour $60
A combination of Swedish and deep tissue
techniques release those tight, painful
places and leave the body deeply relaxed.
The therapist will target the areas that you
want addressed.
Hot Stone Massage: 90 Minutes $130
Hot stones are placed on points of tension
and used in the therapist's hands to relax
the body as the heat penetrates deeply
into muscle tissue. This is a one-of-a-kind,
must-try treatment for the massage
enthusiast. Makes a great gift!
Pregnancy Massage: 1 hour $60
Our Swedish classic tailored to the
specific needs of the mom-to-be. Our
special pregnancy pillows make this a
comfortable and relaxing experience.
At Symmetry Massage and Day Spa, our

goal is to help our clients make good
choices for healthier lives. At Symmetry,
each service is designed to incorporate
natural healing substances such as
essential oils (from aromatic plants) or
therapeutic mud into a massage.
This creates a highly satisfying experience
for our clients. You don't have to give up
your massage! Instead, you add spa
products such as seaweed that enhance
the effects of the massage and support the
body. Our treatments promote
detoxification, relaxation, and stress
reduction.
Uncertain of the benefits of spa
treatments?
Join us on the first Monday of every
month for an open house event.
Presentations, tasty snacks,
demonstrations, door prizes, and free
treatments make this a fun way to spend
the evening and learn about the benefits of
spa. 6:00 PM to 10:00 PM.
Tuesdays to Sundays 9 AM to 8:30 PM

Symmetry Massage & Day Spa
5000 Anywhere Street, Suite 400
Any Town, Any State 90000
For appointments: 222-333-4444
www.symmetrymassagespa.com
FIGURE 166 Spa menu. (continued)
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350
Spa Selections
Aromatherapy Salt Glows: 1 hour $80
A salt glow is a revitalizing treatment that
stimulates circulation and relaxes and tones
muscle tissue while smoothing the skin.
Clients have three choices:
Aroma Relief: 90 Minutes $110
The Buff and Bronze: 75 minutes- $90
This classic aromatherapy massage begins

with a consultation and a blend of essential
oils created especially for you. The oils are
applied in a full-body relaxation massage with
enhancers such as rosemary face steam and
paraffin dip. You keep your special blend for
use at home in a soothing aromatherapy bath
or shower. Think MUCH-NEEDED REPRIEVE!
The buff and bronze is a relaxing treatment

that leaves you looking like you just returned
from a tropical vacation. Tanned skin has
never been so good for you! Your body is
buffed, smoothed with moisture creams, and
treated to an expert application of
auto-bronzant (automatic tanning product). In
3 hours, the product produces a rich, golden
tan. The products used at Symmetry are
professional quality and look natural. Home
care products are available in our gift shop to
keep the tan looking fresh. Think BETTER
THAN A DAY AT THE BEACH!
Reflexology Foot Spa Treatments: 1 hr - $80

1. The Zen Glow infuses spicy ginger with
the soothing scents of mandarin and
lemongrass. Think CALMING!
2. The Citrus Glow is fresh and uplifting with
the scents of grapefruit, lime, lemon, and
sweet orange intertwined in a constantly
changing aroma melody. Think REFRESHING!
3. The Victorian Garden Glow surrounds the
client with the soothing fragrance of an herb
garden. Lavender, rosemary, thyme, rose, and
just a hint of nutmeg invoke a warm
afternoon in the sun. Think RELAXING!
Mud Sport!: 1 hour $85

If you have a sore back or if your workouts
have been slowed down by muscle tension,
this treatment is for you. Your back is
massaged with deep tissue techniques before
a warm layer of Parafango* is applied to
stimulate circulation and relax sore muscles.
While the Parafango works its magic, the
backs of your legs are massaged. To end the
service, your neck and shoulders are
massaged.
Think GOODBYE BACK PAIN!
*Parafango is a combination of a special mud
from Italy and paraffin with different melting
points. It holds heat for up to 60 minutes and
locks moisture at the skin's surface. Because
of its superior heat retention abilities, it has
been used since the 1950s in Germany for
arthritis pain and chronic muscle conditions.
At the client's request, the Parafango
application can be focused for special needs
such as sore hamstrings or calves.
Reflexology is based on the belief that there

are points on the feet, hands, and ears that
correspond to all the areas of the body. By
activating these points, full-body relaxation is
achieved. In each of the treatments described
below, the feet are soaked, smoothed with an
exfoliation cream, massaged, treated to a
series of reflexology techniques, masked to
facilitate detoxification, and finished with
lotion or powder. Clients have three choices:
1. The Tired Feet Tingle refreshes your feet
with a sea salt soak, peppermint
exfoliation, kelp mask, and reflexology
point work targeting the reflex points
associated with mental burnout and
exhaustion. Think REVITALIZATION!
2. The Pain-Away Treatment focuses on
eliminating foot pain. Your feet are soaked
in Epsom salt and eucalyptus oil before a
bracing rosemary loofah scrub. The
massage and reflexology session uses the
healing properties of bay laurel and sweet
birch oils before thick, warm Moor* mud
is slathered on your feet to decrease
inflammation and pain. Think LET'S GO
DANCING!
3. The Sole Soother is soft and gentle.
Lavender, ylang ylang, basil, mandarin, and
rose oils caress your feet and allow your
body to deeply relax. A paraffin treatment
for your hands completes this delightful
indulgence. Think TRANQUILITY!
*Moor mud is a high moor peat from Austria
that is used in Europe for foot pain, arthritis,
and skin and respiratory disorders. It is thick
and black with superior heat retention
qualities and proven anti-inflammatory action.
Sea Boost: 1 hour $90

Seaweed is a unique product that stimulates
circulation and lymphatic flow, boosts
immunity, stimulates metabolism, and
promotes detoxification. In this treatment, the
body receives a dry brush exfoliaton aimed at
increasing lymph flow before a warm layer of
seaweed is applied and the body is wrapped.
While wrapped in this relaxing cocoon, your
feet are massaged. A Swedish massage with
rich sea creams ends this service. Clients can
request the application of a cellulite cream to
target areas for body slimming. Think
ELEGANCE!
Swiss Herbs Slimming Wrap: 90 mins $100
Relax in our sauna before being wrapped in
fragrant linens that have soaked in an herbal
infusion. As your body detoxifies, a cooling
mist of citrus oils revitalizes your senses and
relaxes your mind. Your body is removed
from the wrap and treated to an invigorating
grapefruit and juniper berry loofah scrub.
This cools your body but continues to
stimulate circulation and lymphatic flow. To
complete this service, a firming cream with
seaweed and aloe is massaged into your
skin.
Think RADIANCE!
Symmetry
Massage & Day Spa
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Feeling scaly, waterlogged, and listless? A more sophisticated interpretation might be, Enjoy the skin smoothing and
body-slimming benefits of pure marine algae. In the example below, a seaweed wrap is described in two different ways.
In the first description, most of the sensory language has
been left out, and the writer speaks about a general client.
In the second description, strong sensory language has been
included, and the writer speaks directly to the client.
Seaweed Wrap: After a relaxing foot bath, our specially
trained therapist will apply seaweed to the body. The
body will then be wrapped, and the feet are massaged.
The seaweed is then rinsed from the body, and a moisturizer is applied to rehydrate the skin.
Sea Dream: Begin your journey to the sea with a relaxing
foot bath of warm salt water and ocean stones. Next,
feel revitalized as fresh, nourishing seaweeds harvested
in the pure waters off the coast of Brittany are slathered
over your skin. Rest, cocooned in warmth, while ocean
sounds release everyday worries and your feet receive a
351
pain-relieving reflexology foot massage. Your session

ends in a warm aqua shower with skin-softening ocean
tonic body wash and fragrant moisture balm. Your body,
mind, and spirit are restored to balance by this inviting
day at the beach.
Although both of these descriptions clearly define the
treatment steps the client will experience, the second description sounds inviting, personal, fun, and special. Review
the sample treatments at the back of the book for ideas.
Essential Contents
Your spa menu should include the full, correct name of the
business; your business address, phone number, e-mail, and
website; and the hours you are open for business each week.
It should include a description of each service you offer at
your facility, the length of the service, and the cost of the
service. Some spas include a welcome note that shares the
spas philosophy and mission.
SPA FUSION
STUDY TIP: Spa Party
A fun way to practice your spa skills is to host a
spa party. Get a group of massage friends together
and develop a menu of simple spa services such as a
salt glow, seaweed gel cocoon (seaweed gel is easier
to remove with hot towels than seaweed powder
mixed with water), reflexology foot treatment, and
hot stone massage. Organize aromatherapy accent
treatments and appetizers. With a plan in place,
invite family and friends to come and find out what
you are learning in school by being a guest at your
spa party. Many therapists offer spa parties on their
menu of services when they graduate and become
professionals.
what you like. When its time for you to write your
spa program, youll be ready to choose what appeals
to you.
CHAPTER WRAP-UP
You have completed a lengthy process to identify your
spa philosophy and develop a spa program that resonates with you as a therapist, your values, your unique
talents and skills, and the types of clients you want to
work with. You have practiced your treatments, written
treatment guides, and created a spa menu. Its exciting
to know that you will be ready to launch your spa program and enjoy the positive responses of your clients
after you graduate from your spa training program.
SPA INSPIRATION: Idea Folder
REVIEW QUESTIONS
While you are enrolled in your spa training program,

it is helpful to start an idea folder. Every time you
walk by a spa business, step inside and pick up their
menu of services. Have friends and family members
pick up spa menus from the places where they live and
visit. If you come across a particularly interesting spa
treatment on the Internet, print it out and add it to
your idea folder. Any treatments that you receive at a
spa can be written off on your taxes as research. Use
the time you are in school to gather ideas and explore
Multiple Choice
1. An important benefit of adding spa treatments to a
massage clinic is:
a. Clients always like spa treatments more than
massage.
b. Clients have options and choices.
c. Clients purchase nail services more than other
treatments.
d. Clients avoid spas but like massage clinics.
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352
SPA FUSION
2. One drawback of adding spa treatments to a
massage clinic is:
a. Spa treatments require less laundry than
massage.
b. Spa treatments cost less to deliver than massage.
c. Spa treatments require more cleanup and setup
time between sessions.
d. Spa treatments give therapists a creative outlet.
True or False
Mark each of the following questions as True or False.
6.
When developing a spa program,

you have to think about your facility and what
types of treatments you can reasonably provide.
7.
Seaweed and mud body wraps

should probably be offered by every spa and
massage clinic because they are a cornerstone of a
spa experience.
8.
A couples package or a prom party

package are common treatment packages offered
by spas.
9.
Its important not to look at the

menus of other spas or massage clinics because it
is considered plagiarism if you copy any of their
good ideas.
10.
Spas should avoid the use of

detailed treatment guides that give step-by-step
instructions to therapists. Instead, therapists
should bring their personal creative flair to each
treatment.
3. The term back bar refers to products:

a. That are purchased in bulk and measured out
for each individual treatment
b. That are sold in the gift shop to clients
c. That are prepackaged into small sizes for clients
to take home
d. That are preheated and delivered to the clients
home
4. Your spa philosophy includes your:
a. Ideals and beliefs about health, wellness, and
beauty
b. Ideals and beliefs about a personal diet plan
c. Ideals and beliefs about religion and marriage
d. Ideals and beliefs about the supernatural
5. Your life mission is a statement about:
a.
b.
c.
d.
Your campaign to improve health and wellness

Ideas about personal financing and investing
Actions and activities that give your life purpose
Thoughts for how to improve your primary
relationship
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17
You in the Spa
Profession
Chapter Outline
K e y Te r m s
Your Career Plan
Advertising: Direct payment made to another business or organization in

order to gain public notice.
Business plan: A written guide to starting and running your business.
Cover letter: A letter that introduces you to employers and arouses their
interest so that they read your resume and ask to interview you for
the job.
Employee: A person who is hired by another person to perform particular
duties for a determined fee.
Marketing: All of the activities you undertake to obtain new clients and
keep current clients.
Promotion: Activities that increase your visibility in the marketplace and
attract the attention of potential clients.
Publicity: Media exposure that usually arises from a special event held at
your business.
Resume: A written summary of your background, experience, education,
training, and skills used by employers to determine if you have the
experience necessary to fill an open position.
Target market: The specific group of customers that a business aims to
attract.
Self-Assessment for Career Planning

Explore Your Options
Have a PlanIt Can Change
Activities for Further Exploration
Plan to Thrive
Write Your Career Plan
Work as an Employee
Write a Resume
Write a Cover Letter
Interviewing
Negotiating the Employment Package
Meeting and Exceeding the Employers Expectations
Starting a Private Practice

Your Business Plan
S
SPA
FUSION
STUDY TIP: Space Out for the Big Test
GOOD TO KNOW: Helpful Business Resources
CHAPTER WRAP-UP
353
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354
Each person enters the spa profession for a different

reason. Some are seeking meaningful work where they
can help other people feel better. Others want a flexible
schedule, to meet new people, skills that can travel with
them wherever they go, or interesting part-time work they
can balance with family life or another parallel career. All
of these reasons are valid and should be kept in mind as
you plan your spa career. In this chapter, we look at some of
your career options so that you can develop a written plan
to follow when you complete your spa program. We also
discuss the process for getting your first spa job including
how to write a resume and cover letter, how to build your
interviewing skills, and thoughts about negotiating the
employment package. Starting a private massage and spa
practice is the subject of the final section of this chapter,
which explores the basics of starting a business and writing
a business plan.
Your
Yo
our Career Plan
Career planning is a lifelong process that takes place as people grow and change through new experiences. A career in
spa allows for constant growth because you can work in a
variety of different environments, specialize in knowledge
related to particular populations of clients, and learn a multitude of massage and spa bodywork systems that approach
the body and healing from new perspectives. Many therapists also gain knowledge and credentials in related fields
such as fitness trainer, esthetics, yoga instructor, and nail
technician to practice alongside massage in a spa setting.
The career planning process can be broken into a three-step
procedure that involves a self-assessment step, an exploration of the options, and a written plan.
Self-assessment for Career Planning

Self-assessment is the process of gathering information
about yourself in order to make good career decisions.
There are numerous ways to conduct a self-assessment for
career planning and many free tools available on the Internet to help in the self-assessment process. It is helpful to
evaluate these key areas:
A value assessment helps you determine what things are
most important to you. For example, is security more
important than autonomy? Is helping others more
important than a high salary?
A personality and skill assessment helps you explore

your personal qualities, motivation level, needs, attitudes, and skills. Different careers in spa fit better with
different personality types. In some cases, particular skill
sets are required to work with special populations, specific conditions, or using advanced techniques in a medically oriented spa versus a wellness spa environment.
Visualization helps you identify your hopes, dreams, and
possibilities regarding your career in massage and spa
bodywork and how your career fits into your life.
The information you discover from completing a selfassessment provides you with valuable insight when you
write a career plan. For example, if you find that you have
many of the characteristics of an entrepreneur, you may
be well suited to developing a spa concept for a private
massage practice. If your value assessment reveals that
you like working on a team, you may want to seek work
in a busy spa where you are surrounded by other therapists and have a good deal of contact with the public.
Remember that you can develop interests, values, and skills
you dont have now. If a particular career path requires
some personal development and is important to you, then
make the changes you need to reach your goals. The selfassessment exercises in For Your Exploration 171 can help
you gather key data about yourself for use as you write your
career plan.
Explore Your Options

As you have progressed through massage school and your
spa training and learned more about the massage and spa
profession, it is likely that some of your ideas about where
you want to work have changed. As you plan your career,
evaluate all of your options with an exploration of spa
environments, specialization opportunities, and employee
versus self-employment preferences.
Massage Environments
In Chapter 1 (Spa from Past to Present), you were introduced to a variety of spa environments where massage
and spa body treatments are practiced. If you completed
Activity 3 in For Your Exploration 171, you should have
a strong idea about whether spa and massage work with
more health careoriented tasks or wellness-oriented tasks
are more appealing. For Your Information 172 outlines
spa environments, but it will take some investigation into
the nature of each individual business to determine if they
ask therapists to provide health care or wellness massages,
or both. For example, its easy to assume that spas want a
therapist to offer wellness massage when, in fact, some have
a very strong treatment focus and require the documentation, treatment planning, and health care skills you might
normally see in a medical setting. Review For Your Information 172 and pick the top three massage/spa environments that interest you.
10/24/13 2:10 AM
Chapter 17 You in the Spa Profession
355

Self-assessment Activities for Career Planning
Activity 1: Value Assessment
Review the list of values associated with career planning and place 1, 2, or 3 in the space provided. 1 Things I Value Highly,
2 Things I Value, 3 Things I Dont Value Very Much
Score
Personal Values
Description
Help my community
I want to participate in career activities that contribute to improving the community

I live in.
Help people
I want to participate in career activities that contribute to improving the quality of

peoples lives.
Contact
I want to participate in career activities where I have high levels of contact with
other therapists and with the public on a day-to-day basis.
Work alone
I want to participate in career activities where I have limited day-to-day contact

with other therapists and members of the public.
Team
I want to participate in career activities where I work with a team of people to

achieve common goals.
Autonomy
I want to participate in career activities where I plan my own schedule, make my

own business decisions, decide my own policies, and personally determine the
success or failure of my business based on my own actions.
Influence
I want to participate in career activities where I can influence the attitudes or opinions of others.
Knowledge and mastery
I want to participate in career activities where I can master knowledge of the body
and work in situations where attention to detail and accuracy are very important.
I want to be an expert in the field.
Creativity
I want to participate in career activities where I can create new programs, organizational structures, and materials or express myself artistically.
Management
I want to participate in career activities where I am directly responsible for the work
of others and for the financial viability and operations of a business.
Supervision
I want to participate in career activities where I am responsible for my own work

and am not directly responsible for the financial viability and operations of a business. I want to work in a situation where I have regular guidance from a mentor or
supervisor.
Change and variety
I want to work in a career environment where work activities frequently change.
Stability
I want to work in a career environment where my duties and routine are predictable.
Security
I want to work in a career environment where I can be assured of receiving satisfactory compensation.
Risk
I want to work in a career environment where I determine my own salary based on

my willingness to commit to activities that bring in income. I can tolerate risk and
uncertainty.
Recognition
I want to participate in career activities where I can be publicly recognized for the
high quality of my work.
Money
I want to participate in career activities that will lead to the achievement of high
monetary gain for my work.
Physical challenge
I want to participate in career activities that use my physical capabilities to the

fullest measure.
Physical comfort
I want to participate in career activities that are not physically challenging.
Time
I want to be able to work according to my own schedule.
Identify your top five values and consider them when you write your career plan.
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356

Self-assessment Activities for Career Planning (continued)
Activity 2: Personality and Skill Characteristics of an Entrepreneur
One of the key choices that graduating therapists must make is whether to be an entrepreneur or to work as an employee. An entrepreneur is a person who owns his or her own company, enterprise, or venture and assumes significant accountability for the risks and
outcomes. Numerous studies have been conducted to determine the personality characteristics of people who are successfully selfemployed or own their own businesses. In his book, The Young Entrepreneurs Guide to Starting and Running a Business, Steve Mariotti lists
many of the following characteristics of an entrepreneur. Additional characteristics that are particularly important for a spa entrepreneur have also been included. Place a check by the traits you think you have already and an X by the traits you think you can develop.
In a journal or on a separate piece of paper, answer the questions that are asked under each trait. Dont be discouraged if you find
you possess few of the traits listed here. Entrepreneurship is not a good fit for many therapists, but these therapists often find success and
happiness working as employees. The point is to discover where you can best find personal success right now. Remember, you will continue to grow as you gain life experience and may be ready for entrepreneurship later in your career, even if you arent ready for it now.
Characteristic 1: AdaptabilityAre you able to cope with new situations and find creative solutions to problems? Are you
flexible and look at opportunities and challenges from a number of different perspectives? Describe one situation where you
demonstrated adaptability to overcome an obstacle.
Characteristic 2: CompetitivenessAre you willing to compete with and test yourself against others? Describe one event in
your life where you drew on your competitive instincts to achieve your goals.
Characteristic 3: ConfidenceDo you believe that you can do what you set out to do? Explain the ways you demonstrate confidence in your life now and describe how you developed your current level of confidence. How might you gain more confidence?
Characteristic 4: DisciplineAre you able to stay focused and stick to a schedule and deadlines? Describe a time in your life
when you had to be disciplined to reach an important goal.
Characteristic 5: DriveAre you willing and able to work hard to achieve your goals? People with drive demonstrate high
levels of motivation, energy, and initiative and have good physical health. Describe an event where you needed to sustain
your drive over a period of time in order to achieve an important goal. How did you maintain your energy and motivation?
Characteristic 6: HonestyAre you committed to telling people the truth even when it causes discomfort? When you make
a promise, do you stand by your word? Do you deal with all people fairly? Describe a time when you had to be honest with
someone even though it was difficult.
Characteristic 7: OrganizationAre you able to plan and structure your life in a logical manner? Are you able to place tasks
in an order to structure the completion of a project? Are you able to differentiate between priorities so that you finish important
tasks first? Describe a situation where you had to organize and follow through on tasks to complete a project.
Characteristic 8: PerseveranceAre you able to keep your goals in sight even when obstacles present challenges? Do you
refuse to quit and keep working at a goal or project even if you have encountered difficulties or failures? Describe an event
where you had to persevere even when you were faced with obstacles.
Characteristic 9: PersuasivenessDo you have a knack for convincing people to see your point of view? Are you able to
get people interested in your ideas? Describe an event where you had to win people to your side to achieve your goals.
Characteristic 10: Risk takingAre you willing to expose yourself to possible losses to try a new venture? Explain a time in your
life when you took a risk and succeeded. Explain a time in your life when you took a risk and failed. What did you learn from
these experiences that might help you in your spa career?
Characteristic 11: Thinking abilityAre you able to analyze problems and come up with possible solutions? Can you look
at projects from multiple perspectives to generate creative ideas? Do you readily see ways to overcome obstacles or rework
processes to be more efficient? Explain a time when you had to think creatively, analytically, or critically to solve a problem or
complete a project.
Characteristic 12: Human relationshipsAre you able to listen to other people and understand their points of view? Can
you empathize with people to comprehend what they are feeling and why they are behaving in a certain way? Do you strive
to reach a fair resolution when you have a conflict with another person? Describe a time in your life when you had to let go of
your own point of view to reach a resolution in a conflict with another. What did you learn from the experience?
Characteristic 13: CommunicationAre you able to verbally express your ideas and point of view? Do you share your
thoughts, ideas, and opinions openly with others? Do you possess a strong health care vocabulary and do you feel comfortable conversing about massage, spa products, and the body? Do you possess basic writing skills? Describe your level of communication skills and give one example of a time you have to communicate in a written format.
Characteristic 14: VisionAre you able to see the end result of your goals while you are working to achieve them? Describe
a time when you had to hold a vision of a goal in your mind while you worked toward that goal. Did fears and doubts cloud
your vision? What was the outcome?
Characteristic 15: Technical skillsAre your draping skills, hands-on massage skills, spa product application and removal
skills, and body mechanics solid? Are you able to observe new techniques and integrate them with your existing hands-on
skills? Do you constantly strive to improve your hands-on skills? Describe your current technical skill level and list three areas
where you are actively striving for improvement.
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357

Self-assessment Activities for Career Planning (continued)
Activity 3: Which Do You Like Better?
In each column, pick the activity you would most like to do for every line of the table by placing an X by that activity. At the end,
total the number of X marks in each column.
I would rather have 15 regular clients that I see one
time a week than lots of one-visit clients.
I would rather see lots of one-visit clients than see the same
clients over and over again.
I would like to develop detailed treatment plans for each

client and set long-term and short-term goals for progress.
I dont feel that detailed treatment plans are necessary. I like to

get on with the massage and release muscle tension.
I like SOAP charting and use SOAP documents to track

the progress of my clients over time.
I like simple charting systems that dont require me to track the

progress of clients over time.
I like to analyze a clients posture, range of motion,

and movement patterns to plan my treatments.
I like to add creative flourishes like the use of aromatherapy

and special music to help my clients relax.
I like to research pathologies to find out more about

them. I am not afraid to work with clients who have
diagnosed pathologies and conditions.
I dont particularly like to work with clients who have diagnosed

pathologies. I would rather focus on stress reduction because
stress causes or exacerbates many diseases.
Musculoskeletal injuries fascinate me. I like to use massage to facilitate healing and to support rehabilitation.
I want to explore my creativity by planning treatments that

please the senses and promote mental, spiritual, emotional,
and physical wellness.
I want to work with a team that includes athletic coaches,

physicians, nurses, physical therapists, and chiropractors.
I want to work with a team that includes skin care specialists, cosmetologists, dermatologists, yoga instructors, and spiritual coaches.
Total
Total
SOAP, subjective, objective, assessment, plan.
If you have more X marks in the first column, you are well suited to design the main portion of your career as a massage therapist
who works in environments such as a hospital, sports medicine clinic, chiropractor office, hospice, or with athletes. If you have
more X marks in the second column, you may particularly like to work at a spa, salon, wellness center, resort, or retreat.
Activity 4: Visualize Your Ideal Life
Visualizing the life you want can help you choose activities and behaviors that lead to the attainment of your goals and dreams. Life
visualization includes living environment, relationships, finances, spirituality, health and wellness, social life, personal development, as well
as career. Find a quiet place and collect your thoughts about your future in a journal or on sheets of paper. Dont question whether your
desires about your life are realistic; just get them down on paper and grant yourself permission to dream big. During visualization exercises, it is not uncommon for people to have doubts and fears surface. Dedicate one area of your journal to list your fears and doubts
about the future. When you acknowledge fears and doubts, they instantaneously lose some of their power, and you will be better able
to plan strategies for overcoming obstacles if they are clearly identified. Use these questions to structure your visualization process:
1. In your perfect life, where do you live (e.g., I live in Boulder, Colorado) and what is your living environment like (e.g., I live in a
beautiful three-bedroom, modern home with hardwood floors and large windows that look out at the mountains)?
2. In your perfect life, what are your relationships like? How do you want to interact with your parents, siblings, spouse, partner, children, coworkers, and friends? How do your relationships support your personal goals and give pleasure and meaning to your life?
3. In your perfect life, how much money do you make and how do you use your money to achieve the lifestyle you want, contribute to the wellness of the world, and feel secure about your financial future?
4. In your perfect life, how do you connect to your spiritual beliefs and practice those beliefs in the world? How do your beliefs
influence the choices you make and the ways you interact with other people? How do you nurture and care for the mental,
emotional, and spiritual aspects of yourself?
5. In your perfect life, what do you look like? What is your fitness level and eating habits? What do you do to maintain your
health and wellness and how do you feel about participating in these activities?
6. In your perfect life, what do you do for fun? What sort of friends do you have and what sort of interests and activities do you
pursue for recreation?
7. In your perfect life, what activities do you undertake to develop as a person? What makes you curious, excited, and motivated?
How do you foster your mental, emotional, spiritual, and physical growth?
8. In your perfect life, what is your career like? What is the environment like? What kind of people do you work with? What are
your daily tasks and responsibilities? How do you feel about your job? What is your financial status? How does your job feed
your other goals and desires?
9. In your perfect life, what do you care about and what do you focus on?
10. Describe how you feel when you think about this life. What feels good? What feels scary? What feels possible? What feels
impossible? Now, describe three things you can do every day, right now, to achieve the life you want.
Use the information you uncovered in your visualization when writing your career plan.
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Common Environments Where Spa Is Practiced
Cruise ship
Day spa
Fitness center
Massage clinic
On-site massage (corporations, dance studios, health food
stores, etc.)
Private practice
Resort spa
Salon
Wellness center
Specialization
Massage therapists often specialize by learning and offering a specific massage or bodywork system or by studying
additional knowledge and treatment protocols for a particular client condition or special population. You have already
been introduced to spa bodywork systems as part of your
massage training and may aspire to work at a big resort spa
and offer body treatments such as salt glows and body wraps
in addition to massage. Maybe pain reduction is your objective, and you want to work in a medical setting with clients
who are living with chronic pain conditions. If specialization
is part of your career plan, you need to carefully evaluate your
skill level. You may need additional training above the entry
level to achieve your goals. It is important to point out that
specialization can make you more marketable to an employer
or to a client population. Alternately, in some cases, employers or clients wont know enough about a particular system
of bodywork to seek it out. If you plan to specialize, include
these areas on your career plan. For Your Information 173
Client Types
Animals
Athletes
Children
Clients recovering from musculoskeletal injury
General public
Infants
Men
Older adults
People living with cancer
People living with chronic pain conditions
People living with HIV/AIDS
Physically challenged
Pregnant women
Psychologically challenged
Survivors of abuse
The terminally ill
Women
can help you identify specific client groups that you may
want to target. There are over 450 different systems of massage and bodywork identified at the time of this writing by
Associated Bodywork and Massage Professionals (ABMP)
(http://www.abmp.com). Many spas value massage therapists who can effectively offer unique forms of bodywork.
If you plan to learn a specialized massage system, review spa
menus on the Internet to find out some options, decide what
appeals to you, determine if you will need continuing education, and include this information on your career plan.
Continuing Education
Continuing education is education you pursue after you
have completed your entry-level training and received your
massage credentials. It is often called CE in massage publications or on the Internet. Although it might seem strange
to think about getting more education when you havent
even graduated yet, you want to factor continuing education into your career planning process. In fact, if you want
to offer an advanced form of bodywork such as ayurveda or
broaden your career options by becoming an esthetician, you
may need continuing education shortly after graduation in
order to meet your career planning goals. Most states where
massage is regulated require massage therapists to complete a specified number of continuing education hours to
maintain their massage credentials. Continuing education
is viewed as beneficial because it brings the therapist up to
date with new advances in massage knowledge or skills and
encourages therapists to diversify their practices. As part
of your career plan, it can be helpful to include continuing
education activities that will help you grow and develop as
a person and as a professional.
Employment Options
Probably the biggest decision you have to make about your
early spa career is if you are going to be an employee, selfemployed, an independent contractor, or a combination
of these.
Work as an Employee
An employee is a person who is hired by another person
to perform particular duties for a determined fee. The
employer is required by law to withhold income taxes,
withhold and pay social security and Medicare taxes, and
pay unemployment tax on wages paid to an employee. As an
employee, you agree to abide by the rules and processes outlined by your employer. You may have to follow a specific
dress code, work a fixed schedule, and perform other duties in addition to massage such as laundry and answering
phones. In many instances, employers pay an hourly rate for
the hours you are on a shift and an additional fee for every
massage or spa treatment you perform during your shift.
The responsibility for marketing and promotion, abiding by state and local business ordinances, organizing and
tracking inventory of retail items, and all other activities for
running and managing the business will fall largely on the
shoulders of the employer.
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As an employee, you may gain the experience and contacts you need to work your way into other careers in the
spa profession. Other careers in the spa profession include
positions such as the spa educator/product representative,
a spa consultant, a massage (and/or esthetics) manager, or
a spa director.
Spa Educator
There are many different types of spa educator. For example, spa product representatives are people hired by a product line manufacturer to educate the spa staff at spas where
their products are used and distributed. Some spa product
companies develop treatment outlines so that particular
products are used in each of the steps of a predesigned
treatment. The product representative travels to spas, provides training on the benefits of the companys product
line, and instructs the spa staff in the application of treatments using the specialized products.
Another type of spa educator is a spa representative who
is also an expert in a particular area such as aromatherapy, ayurveda body treatments, reflexology, or hot stone
massage. He or she might offer his or her services to a spa
and provide training in the area of his or her expertise to
meet the spas needs. Some spa educators focus on the development of spa curriculum for massage schools, beauty
schools, or continuing education workshops.
Spa Consultant
A spa consultant usually combines the skills of a therapist
with those of a businessperson. Often, a talented therapist will work his or her way up in the spa profession and
learn the business through personal experience. Sometimes,
the consultant is a businessperson who has specialized in
the spa profession. Many spa owners start their own spas
because they have a strong vision of the type of environment and services that they want to offer. These people
might hire a spa consultant to review their service menu,
make suggestions for additional treatments, or plan a specific marketing campaign. At the other end of the spectrum
is a large corporation who hires a highly trained individual
to handle all aspects of the spa start-up. In this case, a spa
consultant would conduct a market assessment and financial feasibility assessment and help the spa to identify its
philosophy and target client group. In addition, the consultant might give some input on the floor plan and select the
equipment and product lines that will be used at the spa.
Spa consultants may also develop an operations manual
and job descriptions, hire the initial spa staff, create the spa
menu, and oversee the training of the therapists and staff.
Lastly, they will probably identify or give some input on
how the spa should position itself in the market place and
build its special identity with the public.
Spa Department Manager
At larger spas, there is often a massage manager who oversees the massage therapists, an esthetics manager who oversees the estheticians, and a salon manager who oversees
the cosmetologists and nail technicians. Organized and
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ambitious massage therapists might work their way into

the massage manager position and then later into a spa
director position based on their ability to learn management and business skills.
Spa Director
A spa director is responsible for ensuring that the spa runs
smoothly and efficiently and is profitable. He or she is in
charge of pay systems and the payroll and oversee the spas
accounting practices to ensure that proper records are kept.
Spa directors handle the marketing and promotion of the
spa and put practices into place that ensure good customer retention. They usually hire and oversee staff training,
stay abreast of spa trends and regulatory requirements, and
make changes to the service program if necessary.
Self-employment
A self-employed person works for himself or herself and is
not employed by someone else. In this case, you set your
own schedule and dress code but must also secure your own
clients through marketing and promotional activities. You
are responsible for keeping your own tax records and for
reporting and paying taxes to the Internal Revenue Service
(IRS) and for abiding by any rules that regulate businesses
in your local area. If you are self-employed, you need to work
hard to learn good business practices and feel comfortable
acting as a businessperson as well as a therapist.
Independent Contractor
An independent contractor is a self-employed person who
contracts with another business to provide specific services.
This is a common arrangement in the massage profession
where a massage business owner contracts with massage
therapists instead of hiring them as employees. This
arrangement is sometimes available at day spas. The difference between employees and independent contractors is
subtle. An employer has the right to direct the means and
methods an employee uses to accomplish a job. A person
hiring an independent contractor has the right to control
only the result of the work and not the means and methods of accomplishing the job. Still, in many instances, the
contract is written in such a way that the independent contractor must follow a dress code, keep to a specific schedule, and perform other duties in addition to massage or
spa body treatments, just as an employee would. Independent contractors may be responsible for securing a specific
number of client sessions per week, or they might share
the responsibilities for marketing and promotion with the
business owner. Independent contractors must keep their
own tax records and report and pay taxes to the IRS.
Blended Career
Many massage therapists interested in spa work choose to
work part-time for an established spa and part-time developing their private massage practice and spa concept. This
plan allows you to learn the ropes for your business, make
a good income, and build your clientele with less financial
pressure. You may work at one spa on Monday, Wednesday,
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360
and Friday; at a second on Saturday; and run your own

practice on Tuesday and Thursday. Read your employee
contract carefully in case the spa has restrictions about you
working at a competitor or starting your own practice on
the side. Talented therapists can sometimes negotiate an
agreement that works for everyone.
Have a PlanIt Can Change

Each situation has pros and cons that require careful
examination. In addition, your personality may predispose
you toward one particular employment model as was demonstrated in Activity 2 in For Your Exploration 171. If you
found in Activity 2 that you dont have many of the characteristics of people who are successful when self-employed,
you should not be discouraged. If self-employment is an important goal, you can develop the skills and attributes you
need to be successful, but obviously, developing personality
traits that are not natural to you may take some work.
Many therapists dont make a choice about whether to
be an employee, self-employed, or independent contractor; they do it all, as we discussed in the blended career
option. This is an excellent career strategy, especially when
you are trying to build a clientele. For example, Elena
has diversified her practice to ensure that she always has
clients. On Mondays, Elena has set up two corporate office
accounts where she offers seated massage to a companys
employees. She sees the first in the morning from 9:30 a.m.
to 12:00 p.m. and the second after lunch from 1:30 p.m. to
4:00 p.m. On Tuesdays, Wednesdays, and Fridays, she works
shifts at a nearby spa as an employee. On Thursdays, she is
working to build her private practice and massages friends,
family, and clients she has met through her seated practice.
She acts as an independent contractor at a massage clinic
that offers spa treatments every other Saturdays and takes
Sundays off.
Activities for Further Exploration

As you can see, you have a lot of choices to make when planning your spa career. If you feel confusion or if you want to
make certain that your plan is a good one, you can pursue
some specific activities that may provide you with invaluable information.
Job shadowing is where you learn about a job by walking through the workday as an unpaid shadow to a
competent worker. You witness firsthand the spa work
environment, client interactions, and skill sets required
for the particular job. Some schools set up job shadowing opportunities for students. If your school doesnt
do this, you can call local spa businesses and ask if they
would allow you to job shadow. You might also provide
massage or spa body treatments to the working massage
therapists on staff for feedback.
Internships are school-sanctioned and school-supervised
programs where students get hands-on training,
career-related experience that supplements classroom

academic experiences to enhance a students education.
For example, at one school, students could apply for a spa,
sports, or hospital internship. Students chosen for the spa
internship worked at a local spa to gain classroom credit 1
day a week. Students in the sports internship worked with
a professional football team, and students in the hospital
internship worked in the oncology ward of a hospital providing massage to patients, family of patients, and nurses.
Volunteer opportunities are often organized by schools
to help students understand the value of community
outreach and to give students insight into potential
career paths. A school might take students to a nursing home as part of the learning activities planned for
a module on geriatric massage. Alternately, students
might provide massage to pregnant women at a birthing center or experience seated massage in a corporate
work environment. Oftentimes, volunteer opportunities
are not required, and students have an option whether
or not they participate. These activities can provide you
with invaluable insight into work environments and also
help you round out your massage resume when looking
for a spa job.
Online forums provide opportunities to ask questions
of seasoned massage and spa professionals over the
Internet. ABMP powers a website for massage professionals and students (Massage and Bodywork Professionals
at http://www.massageprofessionals.com) that allows
you to take part in online forums and discussion groups.
Associated Skin Care Professionals (ASCP) also has an
online forum (http://www.skincareprofessionals.com)
where you can ask questions about spa work. Log on,
join the groups that interest you, and ask professional
therapists to give you input on profitable career paths in
massage and spa.
Plan to Thrive
If you ask a professional therapist what was the one thing
that most surprised her when she began her career in
massage, she may very well tell you that massage and spa
work can be a bit lonely. Although you are working with
other people, it is not appropriate to chat about personal
interests or the latest movie release to clients. Sessions
are often very quiet, and the focus is on the client and
the clients changing experience. Time between sessions
is usually spent changing table linens, sanitizing the
space for the next client, cleaning the hydrotherapy tub,
doing laundry, and completing chart notes, leaving little time for friendly conversation with other therapists.
Many therapists build a thriving practice by cultivating
relationships with mentors and with other professionals. These activities develop knowledge, provide useful
feedback and guidance, and help prevent burnout by
creating a social outlet that balances the solitude of a
spa practice.
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Mentors
Preventing Burnout
A mentor is a more experienced person that provides guidance as you establish your career and grow as a therapist.
Mentoring can be a formal relationship established by your
school or by the business that employs you. Informal mentoring often occurs spontaneously between two people who
share common interests but have different levels of experience. The older or more experienced person naturally falls
into the role of directing and encouraging the younger or
less experienced person. For example, the manager that
employs you might take an interest in developing your
skills, or an established massage therapist might steer you
toward treatment choices when you provide a specific type
of massage form or spa treatment. Massage therapists in
private practice might seek out a mentor who is an established spa business owner in a noncompeting area. Finding
a mentor is a good idea because it gives you a designated
person to contact in the event you encounter challenges in
your career. This trusted person might also help you celebrate new learning and the development of new skills.
Possible mentors are all around you. Is there a person
you work with or have met who you admire and respect
because of his or her insight and knowledge? Does this person have experience he or she would be willing to share?
Approach the person and ask if he or she would consider
being your mentor. Let him or her know why you selected
him or her and what you hope to learn from the association. Ask that the relationship has some structure such as a
weekly phone call to discuss issues and challenges you faced
during the week or a monthly lunch meeting to talk over
your career development. You can also find online mentors
through your professional membership organization.
Massage and spa work are physically and mentally demanding professions where you give your energy and focus to
helping other people feel better in their bodies. If you dont
plan ways to nurture and care for yourself while you are
nurturing and caring for others, you may experience burnout. Burnout is a state of emotional, mental, and physical
fatigue caused by prolonged job-related stress. The signs
and symptoms of burnout include mental, emotional,
and physical exhaustion; loss of interest in your job; the
inability to care about your job performance; and feelings of hopelessness, irritation, resentment, cynicism, and
unhappiness. If you start to show up late for sessions or
dread working on your next client, you may be headed
toward burnout.
Burnout happens in every profession but is most prevalent in employees who feel underpaid, underappreciated, or
criticized for events that are beyond their control. If managers set unrealistic goals for you in terms of the number
of sessions you must provide in a workday, or if you must
work under rules that are particularly restrictive, you may
be at higher risk for burnout. Boredom can also be a factor
if you are asked to provide the same massage routine over
and over again or the same spa session over and over again
despite the needs of the individual client. If your work never
changes and you never feel challenged to learn and grow,
it is not unlikely that you will feel bored and dissatisfied.
Health care professionals, including massage therapists
who work in medically oriented spas, may find themselves in contact with some of the more tragic aspects of
human experience, such as people living with chronic pain
or serious injury, or work with the terminally ill. This type
of work can expose you to prolonged emotional stress that
may lead to burnout.
If you notice that you start to experience the symptoms
of burnout, take some time to identify the reasons. It can be
useful to take a few days off to rest and evaluate the situation. Once you identify the problem, brainstorm solutions
with mentors or people from your networks.
Professional Networks
Professional networking is the development and cultivation of
friendships and acquaintances that can help you build your
business. Professional networks give you access to the insights
and knowledge of other people, put you in contact with people
who might offer career advancement or business opportunities, and provide an outlet for pleasant social interaction. As
part of your professional networks, you might belong to a local
massage or spa group who meets every other month to discuss
spa trends and happenings in the region. This group can provide knowledge, advice, and information on spa-related topics. If you start your own business (as discussed later in the
chapter), you might also join a small-business group where
you meet other owners and managers of small businesses who
provide information, experience, and recommendations that
can help you better manage the business aspects of your practice. General networking groups in your area can put you into
contact with people from diverse backgrounds who may well
become clients when they get to know you and find out more
about massage and spa services. Online social tools such as
Facebook, Twitter, and Massage and Bodywork Professionals
(http://www.massageprofessionals.com), among others, provide a virtual networking option.
Write Your Career Plan

A written career plan helps you focus your activities to
achieve specific goals related to your career. Plans can be
written for 1 year, 3 years, 5 years, or longer. Although there
are many different models for career planning, this one is
specifically related to massage and spa work. A sample plan
is provided in Figure 171.
Goal: Describe your primary career goal for the year
ahead.
Employment status: Describe the employment status
you prefer. Do you want to be self-employed, work as an
employee, work as an independent contractor, or a combination of these. List activities that will help you prepare for your chosen employment status.
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362
FIGURE 171 Sample career plan. A written career plan helps you focus your activities to achieve specific goals
related to your career.
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Work environments: Describe your top three preferred

work environments and list activities that will help you
prepare to obtain a job in such an environment or create
such an environment for a private practice.
Target clients: List the top three client types you would
like to work with in this section and describe ways you
plan to reach out to these client groups and educate
them about the benefits of massage and spa treatments.
A description of target clients is provided later in the
chapter under the section on Marketing.
Specialized skills and knowledge: Describe any areas
where you would like to specialize and list any additional
training you will need in order to offer a specialized massage
or spa system or work with a particular group of clients.
Mentors and professional networks: List people or
groups you would like to meet or develop relationships
with to grow yourself and your business.
Plan for self-care and personal growth: Describe
activities you will undertake to care for yourself and
grow as a person over the course of a year.
Once you have written a career plan, post it where you can
see it regularly and keep track of your progress. It is a useful
exercise to reevaluate and rewrite a career plan annually.
Work
W
ork as an Emplo
Employee
oyee
There are plenty of opportunities if you want to work as
an employee in a variety of environments such as day spas,
massage clinics that offer spa treatments, resort spas, cruise
ships, and fitness clubs. The benefits include a dependable
income, a regular schedule, freedom from the responsibilities of running a business, and taxes will automatically be
withheld from your paycheck. The drawbacks are that you
make less per hour for the massages or spa treatments you
provide than you would in private practice (although this
must be balanced against the fact that you have no overhead costs); you must meet employer expectations; and
you are likely to be required to perform duties in addition
to massage or spa treatments, such as laundry, cleanup
of hydrotherapy equipment, and answering the phone.
To attain your first spa job, you will need to identify and
research potential spa employers, write a resume, write
a cover letter, be interviewed, get a job offer, and negotiate your employment package. Once you are working, you
will want to meet or exceed your employers expectations to
potentially move to a higher position as you gain experience.

A search on the Internet is probably the easiest way to develop a list of potential spa employers in your area and abroad.
SpaFinder is a company that helps consumers plan spa
vacations. Through its website (http://www.spafinder.com),
you can find out about an assortment of spas by category,
363
services, and price range. The site provides links to spa

websites so that you can examine their treatment menus
and mission statements. Often, spa sites will have a job
opportunity link that lists openings and application procedures. Both ABMP and the American Massage Therapy
Association (AMTA), professional massage therapy associations who provide your liability insurance, offer job search
boards for their members. Local employers often send job
announcements to schools to be posted on the school job
board. Develop a list of at least 10 potential employers and
then use the Internet or make a phone call to the business
to gather some basic information. Ask the following:
Are they currently hiring massage therapists?
What is the pay rate for entry-level massage therapists?
Do massage therapists have the opportunity to offer spa
body treatments?
Do they offer an employee benefit package (i.e., Will they
pay your liability insurance? Will they pay for continuing education for therapists? Do they provide paid vacations, sick days? etc.)?
What are the hours of operation and how long are
massage/spa shifts?
What type of clientele does the business attract and what
types of massage do they provide?
What is the name and spelling of the person in charge of
hiring massage therapists?
What is the job application procedure?
Before applying for a job at a spa, research and become
knowledgeable about the spas product lines, services, body
treatments, facility, and philosophy. Its also a good idea to
travel the route from your house to the business and back
to determine flow of traffic and distance. You might also
want to visit the business as a client to get a feel for the
environment and the general working conditions. Narrow
the list down to your top five best options and prepare a
resume and cover letter. Follow the job application procedure for each business, or if there isnt a specified procedure, send a resume and cover letter to the person in charge
of hiring massage therapists.
Write a Resume
A resume is a summary of your background, experience,
education, training, and skills. Employers use it to determine if you have the experience necessary to fill an open
position. A well-written resume is a first step to securing a
job interview. Effective resumes are as follows:
Brief and concise: Keep your resume to one page, if possible, or two pages at the most. If your resume is long
or difficult to read, the employer may skip parts of the
resume or put it aside entirely.
Positive: A resume should emphasize positive elements
in your record and use action verbs such as planned,
organized, collected, initiated, assessed, etc. to show employers what you have accomplished.
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364
Relevant: The information on the resume should be

written in such a way as to make it meaningful to the
employer and pertinent to the specific position.
Readable: Care should be taken to present the information neatly, so that it is easy to gather information at a
glance. Pay attention to the type of font and the font size
you use, to the balance of information on the page, and
especially to spelling and correct punctuation. Avoid
abbreviations of words or incomplete sentences.
Honest: Dont fabricate any of the information on your
resume and make sure that the dates and time frames for
previous experience are correct. If an employer finds out
that part of your resume was fabricated, you are likely to
be dismissed.
The chronological resume provided as an example in
Figure 172 is easy to write and appropriate for entry-level
positions because it illustrates both your education and
experience. There are, however, many different types of
resume formats you might use. A search on the Internet
with the search term resume formats or resume services provides a variety of examples and resources. A chronological
resume includes the following:
Contact information: List your name, address, phone
numbers, and e-mail address. Avoid the use of nicknames and surnames such as Senior, Junior, or II
and spell out all the words in the address (e.g., Street,
Avenue).
Career or job objective: An objective tells potential
employers what sort of work you are hoping to do. Be
specific about the type of job you want and be sure to
tailor your objective to the specific position or employer.
Education: Include the name and location of the institution and the date of the degree, diploma, or certificate
you attained. List your most recent education experience
first and include your grade point average if it is higher
than 3.0. Describe your main area of study (i.e., massage
and spa, or massage, reflexology and aromatherapy, etc.),
list the hours of training you underwent, and mention
any academic honors or awards you received. If you have
taken continuing education in addition to your entrylevel training, list the courses after your main educational
experience.
Work experience: Include any relevant work experience
in reverse chronological order with the most recent job
first. List the title of the position, name of the organization, location of the work (town, state), dates of employment, and a description of your work responsibilities.
If the experience is not an actual job, list it under the heading Experience as in the sample resume (see Fig. 172).
Other information: Depending on the specific job for
which you are applying, you may choose to include leadership experience in volunteer organizations, special certifications or accreditations, membership in professional
organizations, special accomplishments, computer skills,
or foreign languages.
References: Do not include your references on the bottom

of your resume. Instead note, References are available on
request. Ask people if they are willing to serve as references before you give their names to potential employers.
Once you have completed a draft of your resume, share
it with your instructor or with your mentor for feedback.
Many people contact professional resume writers to help
them create a professional looking resume. Again, the
Internet is the best source for locating resume writers.
Write a Cover Letter

A cover letter introduces you to employers and arouses their
interest so that they read your resume and ask to interview
you for the job (Fig. 173). Write each letter to address the
specific employer and the specific job using paragraphs
(avoid bulleted lists) and a conversational yet formal tone.
Cover letters have three sections:
Section 1Opening: In the opening section of your
cover letter, briefly state the job you are applying for and
how you learned about it. If you have any personal contacts with the company, mention them in this section.
State your general qualifications for the job.
Section 2Body: In the body of the letter, expand on
your qualifications and describe why you are a good fit
for the specific position. For example, if you are applying
for a spa job and the spa is well known for aromatherapy
treatments, highlight your aromatherapy training and
experience. If you are applying for a job in a medical spa,
highlight the fact that you took part in a hospital internship and worked with clients recovering from surgery.
Pick out the most relevant qualifications listed in your
resume and discuss them in detail to demonstrate your
particular suitability for the job.
Section 3Conclusion: To conclude the letter, request
an interview (or some other response, as appropriate)
and include the times when you can be reached. Thank
the reader for his or her time and consideration.
Follow up with a phone call a few days later to ensure that the
package has been received and to speak to the person who
hires massage therapists, if possible. This initial discussion
is important. It provides you with the opportunity to outline
your credentials, special skills, and knowledge, which will
hopefully lead to a request by the employer for an interview.
Interviewing
In an interview, the employer will appraise your suitability
for a specific position and for the company as a whole. Your
self-confidence, the way in which you express yourself, your
level of professional dress, and the validity and content of
your answers to questions will influence the employers
evaluation. The interview is also a time for you to gather
information about the companys policies and determine if
this is a job that matches your personal career goals.
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Jane Anybody
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214 Any Street #202

(303) 222-3232
janeanybody@internet.com
OBJECTIVE: To obtain a position as a massage therapist at a leading spa where I can use my skills
in massage, body treatments, aromatherapy, and reflexology.
EDUCATION: Massage Diploma, June 2005
Any Massage College, Any Town, Any State
800 Hours, Combined GPA 3.66
Spa Certificate, June 2005
200 Hours, Combined GPA 3.66
Reflexology Certification, October 2005
Any School of Reflexology, Any Town, Any State
300 Hours
Aromatherapy Certification, January 2006
Any School of Aromatherapy, Any Town, Any State
300 Hours
EXPERIENCE: Student Massage Clinic Coordinator, January 2005June 2005
As part of the work-study program, I answered phones, assisted clients, and
managed client files. I implemented a new policy for tracking client files that is now
being used at the school's three campuses.
Walk for Breast Cancer Massage Coordinator, May 5, 2005
Initiated and coordinated an on-site massage event at the Walk for Breast Cancer
Event in Any Town, Any State. As the event coordinator for Any Massage College, I
met with event planners, organized the site where massage would be provided,
coordinated volunteer massage therapists, and managed the flow of clients at the
event.
ASSOCIATIONS: American Massage Therapy Association (AMTA)
Associated Bodywork and Massage Professionals (ABMP)
National Association of Holistic Aromatherapy (NAHA)
REFERENCES: References are available on request.
FIGURE 172 Sample resume. The chronological resume shown here is easy to write and appropriate for entrylevel positions because it illustrates both your education and experience.
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366
200 Any Street, Suite 300

janeanybody@internet.com
February 5, 2006
Mr. Eric Sanders

Recruiting Coordinator
Express Spa
Dear Mr. Sanders:

Your advertisement for massage therapists in the January issue of Spa Spectrum Newsletter
caught my attention. I was drawn to the advertisement by my strong interest in aromatherapy
and reflexology, areas where Express Spa has a well-known focus.
Although I have only recently finished my education in massage, spa body treatments,
aromatherapy, and reflexology, I have had the opportunity to work in a high-pressure,
customer service oriented team environment as the student massage clinic coordinator for Any
Massage College. I am seeking a career with a recognized and respected spa that will allow me
to integrate my understanding of wellness and relaxation while building my practical skills in
aromatherapy and reflexology.
I would very much like to meet with you to discuss your open positions for massage
therapists. If you wish to arrange an interview, please contact me at the above e-mail or by
telephone at (303) 222-3232.
Thank you for your time and consideration.
Sincerely,
Jane Anybody
FIGURE 173 Sample cover letter. A cover letter introduces you to employers and arouses their interest so that
they read your resume and ask to interview you for the job.
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When you set up the interview with the employer, be

sure to inquire if you will be asked to provide a sample of
your work. If the answer is no, dress as professionally as
possible and even consider wearing a business suit. If the
answer is yes, wear professional massage attire such as black
pants and shoes and a short-sleeved polo shirt so that you
can deliver a massage. The hands-on massage segment of
the interview should last no longer than 30 minutes unless
the employer is paying you for the massage. An experienced
employer can determine your skill level very quickly based
on your quality of touch, professional communication, and
draping skills.
One way to prepare for an interview is to role-play with a
friend or classmate so that you can practice answering standard interview questions (For Your Information 174). Ask
your friend to honestly evaluate your strengths and weaknesses and practice until you can answer questions fluidly,
concisely, and without hesitation. During the role-playing
session, assess the manner of your speech and your body
language. For example, if you speak too quickly, you may
seem high strung and chatty. If you speak with too little
volume, you may seem to lack confidence. Eye contact is
extremely important during an interview because averting
the eyes might be interpreted as a lack of self-confidence
or as dishonesty. Smiling too much looks unnatural, but a
tight mouth could be read as disapproval or as a judgmental personality. Crossed arms convey defensiveness, whereas a slouched position sends a message that you might be
lazy or disinterested. Avoid gesturing too much with your
hands, which can be distracting and do not touch your hair
or face during the interview.

Examples of Standard Interview Questions
1. Describe the experience and skills you possess that
directly relate to this particular position.
2. What is it about working at this company that particularly
interests you?
3. What is your primary weakness? Note: Some feel that it is
best to identify a weak area honestly but then focus on
a plan for self-improvement (e.g., I have a tendency
to be overly sensitive when criticized. Im working on
listening closely to constructive criticism, not becoming
defensive, and then working to make positive changes.).
Others feel that it is best to mention something that will
be perceived as a strength (e.g., Im something of a
perfectionist or Im a bit of a workaholic.). There is not
a correct answer to this question, so the best advice is
probably to answer truthfully.
4. What is your primary strength?
5. What do you hope to be doing 5 years from now?
6. What is your greatest accomplishment?
7. Why should we hire you?
8. Describe a problem or conflict you have had in a previous job or at school and explain how you solved it.
367

Examples of Good Questions to Ask during the Interview
1. What are the companys challenges and current goals?
2. Is a detailed written job description available for this
position?
3. Are there opportunities for advancement?
4. To whom would I report?
5. Why is this position open?
An interview provides you with an opportunity to find

out more about the employer and to decide if the business
is a good fit for you. Decide on questions you would like to
ask during your interview and practice politely interjecting
them during different points in your interview. Some sample questions are provided in For Your Information 175.
Show up 10 to 15 minutes early to your interview and
treat everyone cordially, including the receptionist or assistant. When introductions are made, offer to shake hands
and make it a firm handshake while looking the employer
in the eye and smiling. Remember the employers name and
used it when speaking to him or her during the interview.
Do not smoke directly before the interview or do not chew
gum or drink a beverage during the interview. Bring an extra
copy of your resume, a copy of your school credentials or
transcripts, and a reference sheet. At the conclusion of the
interview, express your appreciation for the interviewers
time and show enthusiasm for the job.
Negotiating the Employment Package

When a job offer is made, discuss the employment package,
schedule, dress code, training procedure, and additional duties
in a warm, friendly, and respectful manner. Some employers
require therapists to participate in training on businesses
policies, procedures, and/or special treatments (e.g., a spa may
want to train you to provide salt glows in a particular series
of steps). Some employers pay for therapists to train, whereas
others dont. Your employer might require you to perform a
number of additional housekeeping activities such as cleaning the restroom, sanitizing wet room equipment, or doing
the laundry, whereas others provide support staff to handle
such duties. It is important to understand the expectations
of the employer before accepting the job. Table 171 outlines
some questions you may want to ask to clarify the employment package. Although you should always behave in a calm,
professional, and flexible manner, you should also ask for what
you need in terms of scheduling and the employment package.
It never hurts to ask about opportunities for advancement
especially if you have skills or credentials in addition to your
spa training and massage certificate or license. Once these
items have been discussed, consider the job in relationship to
your specific needs and career goals. Sometimes, a job is an
ideal fit, and sometimes, it is not an ideal fit but provides a
stepping-stone toward your ultimate career goal.
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TABLE 171 Evaluation of the Employment Package

Compensation
How will you be compensated for your work? Will you receive an hourly fee and commission on sessions that you perform
or will you receive a flat rate per session or a flat hourly fee regardless of the number of sessions you provide on a shift?
Scheduling
Who will determine your work schedule and how are schedule changes made when necessary? How will your shifts be
covered if you become sick or have a personal emergency?
Extra duties
Will you be expected to perform housekeeping duties between appointments? Who does the laundry? Who cleans the bathrooms, retail area, reception area, and showers?
Staff meetings
Will you be compensated for staff meetings? Are staff meetings mandatory? When and how often are they scheduled?
Dress code
What is the dress code? Are uniforms provided or are you expected to purchase your uniform?
Inappropriate client
behavior
How does the business define inappropriate client behavior? If you are uncomfortable working with a particular client, will
the employer require you to work with him or her? When is a client refused service and who informs the client that he or
she is being refused service?
Performance reviews
and wage increases
Are there annual staff performance evaluations and are wage increases tied to the outcome of the evaluations? Are bonuses
given on overall performance or on meeting certain company goals (i.e., highest retail sales for the month, etc.)?
Training
How will you learn how the business operates? When will you be expected to train? Will you be compensated for training? Does the
company contribute to outside training such as continuing education workshops to help you maintain your massage credentials?
Professional
exchanges
Are you allowed to trade services with other professionals at the business? Are you required to pay for the linens, use of the
room, and supplies when participating in trades?
Discounts
Do you receive discounts on services or products provided by the business? Can you get discounts for family members on
spa treatments?
Retail sales
Will you be expected to sell retail products? How will you be compensated for retail sales? Are there quotas for sales of retail
product? What happens if you do not reach your quota for a particular month?
Health plan
Does the company provide a medical insurance plan or life insurance?
Liability insurance
Does the company provide liability insurance to cover clients who may be injured in a treatment or are you required to provide your own liability insurance? Review the company policy carefully if you are told it covers you. Often, clients sue both
the business and the individual therapist. In this case, you will not be covered if you dont hold your own policy.
Termination of
employment
What is the procedure for termination of employment? Where can you work after you terminate employment? Some companies have noncompete clauses in their contracts that may prevent you from working in a certain radius of the business or
working for a direct competitor.
Meeting and Exceeding the Employers

Expectations
Employers will expect you to meet certain expectations
to maintain your position. If you exceed employers
expectations, you may be able to earn better wages, take on
additional responsibilities, or work your way up to a higher
position. Employer expectations could be broken into two
areas. First, you will be expected to have the knowledge
and perform the skills of an entry-level massage and spa
therapist.
Knowledge of anatomy and physiology, especially the
muscular system and individual muscles
Knowledge of the benefits and effects of massage techniques and of cautions, contraindications, and standard
adaptations made for special populations
A basic understanding of common pathologies and
chronic pain conditions that might cause massage or
spa treatments to be contraindicated for a particular
client
Contraindications and cautions for hydrotherapy equipment and treatments
Knowledge of assessment, treatment planning, documentation, and record-keeping procedures
Exceptional draping skills

Exceptional Swedish massage skills, deep tissue, and
other massage and bodywork techniques based on the
services provided by the business
Good knowledge of basic spa products, such as salts, seaweeds, muds, clays, and peats, and an understanding of
the skin and skin sensitivities
The ability to follow a series of predetermined spa treatment steps and to understand the basics of working with
hydrotherapy equipment
Exceptional client communication skills and customer
service
Second, employers will expect you to demonstrate the characteristics of a good employee and health care professional
at all times.
Professionalism: You dress appropriately, refrain from
using slang and swear words, behave in a calm and collected manner even when dealing with difficult clients,
and perform your duties without complaint. If you have
a grievance with a client, coworker, or your supervisor,
you follow the companys grievance procedure or speak
privately and assertively with the other person avoiding
gossip and unnecessary conflict.
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Ethics: You demonstrate high ethics at all times and set

good boundaries for clients while maintaining client
confidentiality. Your intent is to do no harm and to do
good and to never place the client in mental, emotional,
or physical danger.
Dependability: You show up on time and can be counted
on to perform the duties assigned to you.
Responsibility: In the event you are sick or unable to
work a shift, you notify your employer promptly and try
to find someone to cover your shift. If it is appropriate,
you contact your clients to cancel appointments.
Initiative: You look around and see what needs to be
done and do it. You dont wait for someone to ask or
assign you duties. You demonstrate a willingness to take
on new tasks and responsibilities.
Curiosity: You demonstrate a desire to learn new information and skills. You ask questions and show interest
in your job, clients, and the skill sets of other therapists.
Positive attitude: You show up ready and willing to work
while demonstrating a high regard for your job, clients,
coworkers, and employer. You encourage others to be
positive or to deal with conflicts in a productive manner.
Motivated: You strive to do your job to the best of your
ability at all times.
If you develop these skills while in massage and spa
training and actively seek to improve yourself, your communication, and your skills and to try hard, you will prove
an excellent employee and are likely to be promoted to positions or higher pay and responsibility.
Starting
St
tarting a Private Practice
e
Earlier in the chapter, you assessed your values and skills
and wrote a career plan to carry you through your first year
as a massage and spa therapist. This section provides an
overview of issues that concern therapists who start a private practice or work as independent contractors. Because
the process of running a business is complex, this chapter
should be viewed as an introduction and used to structure
further research. This topic does not cover aspects of running a business that includes hiring and managing other
massage or spa therapists. Instead, it is set up to discuss
each of the sections of a business plan so that you can write
a basic business plan and use it as a map for running your
business.
Your Business Plan

The U.S. Small Business Administration (SBA) describes
a business plan as a written guide to starting and running a business. A business plan helps you identify areas
that need your attention as a business owner and helps
you plan useful business activities to ensure your success. Although few massage or spa therapists need to
369
seek a loan from a bank to start their businesses, a loan

officer would expect to see a business plan, as will shareholders should you set up your business as a corporation
(described below). Each massage and spa business will be
different, so a business plan helps you answers these key
questions:
What services does my business provide and what needs
do my services fill?
What are the potential clients for my services and why
will they purchase them from me?
How will I reach potential clients?
Where will I get the financial resources to start my business and keep it running?
Business plans can take many forms, but the SBA suggests
that you break your plan into four areas.
A description of the business: In this section, you
determine your business name, location, and the way
in which your business will be structured. You describe
your business mission, vision, services, and fees.
Marketing: The marketing section describes your business identity and helps you recognize your potential
clients, their special needs, and how you intend to meet
those needs. It also examines the competition and your
strengths and weaknesses in regards to the competition. In the marketing section, you will explain how you
intend to alert clients to your presence, services, and
value and convince them to visit your business.
Finances: In the finances section of your business
plan, you describe how you intend to start the business
financially and keep it running while you build a client
base. You analyze the costs associated with starting and
running the business and set goals for client sessions in
order to make a profit.
Management: The management section explains how
the business runs including licenses, regulations, and
insurance needs; hours of operation; policies and procedures; staff roles and job descriptions (if applicable); and
how services are provided.
Each of these areas is described in greater detail in the
upcoming section of this chapter. For Your Information 176 provides an overview of the components of a
basic business plan.
Description of the Business
Describing your business requires you to make important
choices that influence your ability to attract and retain
clients and meet your business goals. You must choose
a business name, a business location, and a structure.
Furthermore, you write a mission and vision statement to
guide your business activities and outline your services and
fees. The work you did in Chapter 16 (Your Spa Program
and Menu of Services) will help you now as you integrate
your life mission with your spa philosophy, your spa program, and your business identity.
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370

Your Business Plan
As you work through the pages of this topic, start to think
about and fill in the sections of your basic business plan as
outlined below. If you use your business plan to approach a
bank for a loan or to entice stockholders for a corporation,
you may want to enlist the help of an accountant in order
to prepare the correct financial statements.
Section 1: Description of the Business
a. Business name
b. Business location
c. Business structure
d. Business mission and vision
e. Services and fees (describe the services you provide and
the benefits of these services for clients as well as the fee
you charge for each service)
Section 2: Marketing
a. Business identity
b. Target market
c. Competition
d. Advertising, promotion, and publicity plan
Section 3: Finances
a. Balance sheet
b. Cash flow statement
c. Profit and loss statement
Section 4: Management
a. Licenses, permits, and insurance
b. Operating procedures
c. Policies
d. Personnel
Your Business Name

Choosing the right business name is an important part of
your public image. You want to find a name that is distinctive and memorable, easy to pronounce and spell, suggests
the services you offer, and separates you from the competition. A search on the Internet will tell you if names you like
are currently being used by other massage or spa businesses
in your area or nationally by massage or spa chains. You
might also check for availability of the web domain name
before making a choice so that the name you choose can
also be the name of your website, making it easier for clients
to find your business.
Sometimes, therapists make the mistake of naming
their businesses using words from a foreign language.
Although these names are often distinctive, clients may not
know what they mean or how to pronounce them, so avoid
the business as a result. Another mistake is naming your
business after a type of technique that clients may not be
familiar with. The name Center for Integrative Spa and
Neuromuscular Therapy may aptly describe your services
but might mystify the person who just wants a regular massage or a simple salt glow. In fact, most clients wont know
what integrative spa means or that neuromuscular therapy is a

form of massage therapy.
Sometimes, clients perceive a business as too new-agey
because of its name. Will the general public be attracted to
a business called New Spirit Place of Touch? Alternately,
you might name your business to attract a particular
clientele such as Spa for Pregnancy and Children, but
remember, you are now limiting your potential for sessions
because your client pool just got a lot smaller. To choose
a name, brainstorm ideas and share them with the types
of people you want to attract to your business and with
friends, family, and colleagues.
Location
The location of your business influences whether or not
potential clients feel comfortable visiting you in the first
place, if they return, and if they recommend you to friends
and family. Think carefully about these issues when choosing a location:
Proximity to clients: Is drive-by and pedestrian traffic
heavy enough that your sign alone generates new clients?
Are you located in an area where clients feel safe walking to and from their cars? If you are choosing to focus
on a special population, are other services for that population located nearby? For example, if you specialize in
pregnancy massage, you are likely to get more business if
you are located next to a midwifery business or birthing
center than if you are located next to an auto mechanics
shop or sporting goods store.
Ease of access: How easy is it to find parking and are
parking areas safe and well lit? How far will clients have
to walk to reach your front door? Will a steep stairway
and no elevator prohibit some client groups from accessing your business (e.g., older adults, injured clients)?
Practicality: Sometimes, a space is located in a busy
high-traffic area with great parking and easy access but
is simply too expensive to be practical. You have to balance the need to attract clients against the possibility to
make a profit. For example, you might rent space in a
busy shopping mall boutique for $3,000 a month (rent
in such spaces could be much higher). You need to provide a minimum of 60 massages or spa treatments a
month at $50 each just to cover rent. Its unlikely you
could be profitable in such an expensive space unless you
were sharing costs with other therapists.
Functionality of the space: The space has to be functional so you can greet clients, process their payment,
provide an assessment, and deliver a massage or spa
treatment without undue noise or loss of client privacy.
For example, will clients need to walk down an outside
hallway to use the restroom? How will they manage if
they should have to use the facilities in the middle of a
session?
Zoning and signage restrictions: In some situations,
a business space may not be zoned for massage or spa
services (see information on zoning in the section on
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Management). In others, signage restrictions (where

you can and cant place signs advertising your business)
are so extreme that it will be impossible for you to alert
drive-by or pedestrian traffic to your location. Before you
rent or lease a space, understand the zoning and signage
restrictions and consider how these restrictions might
impact your business.
Public image: The businesses around you can reflect
favorably or unfavorably on your business. If you are
located next to an upscale coffee shop, bookstore, or fitness center, it is likely to reflect more favorably on your
business than if you are located next to a video store,
pawnshop, and nightclub. Consider the surrounding
businesses and the types of clients they attract when
choosing your location.
Home-based businesses: Many therapists choose
to offer massage and spa services from a home-based
business because it is convenient, cost-effective, allows
household tasks to be accomplished between sessions,
and provides more time for family. If you offer massage
or spa services from your home, you must consider noise
levels (Are children playing noisily in another room or
outside?), pet issues (Are clients allergic to your cat or
dog? Will your pet make noise or sniff around the client,
making her uncomfortable?), cleanliness (any area of
the house the client might see or use must be spotlessly clean), and family boundary issues (Is your spouse
lounging on the sofa watching TV in a bathrobe when
the client enters or exits?). Many clients feel unsafe going
to a therapists home unless they already know the therapists work. This may decrease the number of sessions
you are able to fill in a workweek. In addition, zoning
regulations might prohibit the use of a home for a business, or else, special permits might be required.
Shared space: Many therapists share space with other
therapists or with chiropractors, naturopathic doctors,
or other health care providers. This can be a cost-effective
option with other benefits such as on-site referrals from
other health care providers and wellness or health care
goal planning for clients as a team (with the clients
informed consent).
371
Business Structure
As a massage and spa therapist, you might structure your
business in a number of different ways based on your goals
and if you intend to partner with other people.
personal assets, such as your home, in the claim (see the

section on Insurance).
Independent contractor: As a sole proprietor, you may
form a contract with another business to provide your
skills as a therapist without becoming an employee.
In this type of arrangement, you act as an independent
contractor. You receive a fee based on the completion of
a task, in this case, a massage or spa treatment. Independent contractors are often required to provide their own
equipment and supplies. The business owner will not
withhold your taxes, and you are expected to keep track
of your profit and loss and report it on your individual tax
forms.
Partnership: If you go into business with another therapist, you might want to structure your business as a partnership. Its a good idea to have an attorney write up a
partnership agreement that defines the parameters of
the relationship to avoid confusion and conflict as the
business grows. Like a sole proprietorship, you will need
a business license from the city or county where the business operates, and each partner reports his or her own
income on a standard income tax form. Although you
must share decision-making with your partner, you are
also able to share expenses and rely on each others skills
and strengths. The drawback to a partnership is that
you are liable for all of the business debts if your partner
dies, and if your business is sued, you can be held liable
in suits brought against your partner.
Limited liability company (LLC): Two or more therapists might decide to form an LLC. An LLC protects
your personal assets in the event of a suit brought
against the business. Each member of the LLC claims
profits and loss on their personal tax forms. The drawback to an LLC is that it requires you to file articles of
organization with the secretary of state and to establish an operating agreement to help define profit sharing and ownership responsibilities. In the event that a
member dies or files bankruptcy, the LLC is automatically dissolved. Check with your local state office about
the rules regarding an LLC in your area because these
can vary state to state.
Corporations: You might also structure your business
as a corporation where shareholders hold stock in the
company and a board of directors oversees operations.
This is the most complicated type of business structure
and usually requires the involvement of an attorney.
Sole proprietorship: Most therapists who are starting

private practices structure their businesses as sole proprietorships. The business can be operated under your own
name or under a business name, and your business profit
or loss is reported on Schedule C of your individual tax
return. All you need to set up a sole proprietorship is a
business license issued by the city or county where your
business operates. The drawback to sole proprietorships
is that you are personally liable in the event that someone sues your business, and he or she can involve your
Business Mission and Vision

A mission statement describes what your business aims to
accomplish, the people it helps, and the problems it solves.
Your mission statement should align with your values (see
Activity 1 in For Your Exploration 171), should be short
enough that you can memorize it easily, and should be powerful enough to make you feel inspired. If you completed
the activities in Chapter 16 (Your Spa Program and Menu
of Services) to write a personal mission statement and spa
philosophy statement, you might simply insert your spa
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372
philosophy statement here, or you might lengthen it to better describe your mission like this:
To provide massage and spa treatments customized to
the individual client so that the quality of peoples lives
is improved
To provide massage and spa treatments so that clients
feel pampered, indulged, and supported in their commitment to beauty and wellness
To create a warm and inviting haven where people can
relax and escape their hectic work environment
To provide therapeutic services promoting physical,
mental, emotional, and spiritual health and wellness
A vision statement is a vivid idealized description of a
desired outcome. It might describe how the world will be
better when your business achieves its mission, or it might
describe what success looks like to you. Sample vision statements include the following:
[Name of business] is the recognized leader in helping
people improve the quality of their lives through massage therapy.
[Name of business] is regarded as the center of excellence
in the provision of spa therapies to anyone seeking wellness and beauty.
Alternative wellness therapies are valued and used by
people everywhere to maintain healthy and happy lives.
Services
Many massage therapists think of themselves as providing
one service: massage. It can be useful to think of all of the
different types of massage you offer as separate services to
help clients better identify what they need and want from a
session. This is also true of spa treatments, as we discussed
in Chapter 16 (Your Spa Program and Menu of Services).
In your descriptions of services, you want to identify the
benefit of the service for the user, and, when appropriate,
the specific client for whom the service is intended. Massage therapy and spa treatments are not the only service you
might offer. You might branch out and learn esthetics to
offer skin care services. You might be a fitness trainer and
offer other health enhancing opportunities. The sale of
retail products could be considered a service, as could classes you teach or presentations you provide to community
groups. Your services should be included in your business
plan, should be posted on your website and in your office,
and developed into a menu, as discussed previously.
Retail Sales
The sale of retail products is a service that some therapists
choose to provide clients. Many massage therapists feel that
the power differential between a therapist and client makes
the sale of retail items to clients unethical in some circumstances. In a blended massage and spa practice, the sale of
retail makes sense, but each therapist will want to consider
this issue carefully before offering retail items to clients.
Discuss this issue with teachers, colleagues, on online
forums such as Massage and Bodywork Professionals at
http://www.massageprofessionals.com, and with mentors

to make the choice thats right for you and your business.
If you choose to sell retail items, the retail area should be
visually exciting and positioned in such a way that clients
see it when they walk through the door. To keep returning
clients interested, you may want to change the color, dcor,
and some of the products seasonally for fall, winter, spring,
and summer promotions. Important retail selling times are
Valentines Day, Mothers Day, Fathers Day, Christmas,
and New Year. The retail area must be spotlessly clean and
well organized. Wholesale product lines for retail can be
purchased from both massage and spa suppliers (a search
on the Internet with the term massage retail items or spa retail
supplies will provide numerous resources). Usually, you will
need to pay for all of the items in your retail area in advance,
so this cost must be factored into your startup budget.
You will want to set up some sort of system for tracking
retail inventory. Those retail items that sell best should be
highlighted. Retail items that sit and collect dust should
be cleared in a special promotion and discontinued to
make space for other more viable products. Computerized
inventory tracking systems can be purchased for larger
businesses. A smaller business may want to set up a simple system such as a running list of items that are sold,
the employee that initiated the sale, and the client who
purchased the product. A physical inventory will need to
be conducted on a regular basis to check written records
against stock. Items commonly sold for retail in massage
businesses are outlined in For Your Information 177.
If your business also provides skin care services because
you or an employee is an esthetician, then sales of your
product line are important and should be featured
prominently in your display.
Fees
Market-based pricing is the most common means of setting
fees in the massage and spa profession. If everyone in your
area charges $60 per hour of massage and $80 per hour of spa
treatment, then so do you. The most common pricing error
is setting fees too low. The idea behind this mistake is that
Retail Items Commonly Sold in Spa Businesses
Aromatherapy
diffusers
Bath cushions
Bath oils
Bath salts
Bath soaks
Body lotion
Body scrubs
Books
Candles
Essential oil blends
Essential oils
Exfoliation gloves
Flower remedies
Foot masks
Foot soaking aids
Gift baskets
Hand lotion
Herb-filled dream
pillows
Herb sachets for
bath
Lip balms
Loofah mitts
Natural baby care

Natural hair care
products
Peppermint foot
lotion
Sea sponges
Shower gels
Soap
Sore muscle
balm
Spa bath robes
T-shirts
10/24/13 2:10 AM
the lower price will entice clients away from other therapists.
Instead, the opposite occurs. Clients wonder if there is
something wrong with your massage or spa treatments or
if you cant attract business, so they avoid you. Once clients
pay a low fee for massages and spa treatments, they are
unlikely to pay a higher fee. Its a better strategy to charge the
average market fee for your sessions and set yourself apart
from the competition in other ways. An exception to this
rule is prepaid package plans and special promotions that
last a limited amount of time and are geared to bring in new
business (discussed in the section on Marketing).
Value-based pricing is determined by what a service is
worth to a buyer. You may offer associated services that
make the value of your massage or spa sessions higher
than the value in the marketplace. For example, you might
have an upscale spa facility with complementary sauna and
mineral salts soaking pool. If every client has free access to
these facilities when they come for a massage, your massage
is probably worth more than the going rate in the market.
Similarly, if you offer a type of spa service that clients cant
get anywhere else, you can charge more per hour than you
would for your regular spa services.
Cost-based pricing is used to set fees for items such as
retail products. You buy the products for your retail area
wholesale and then mark them up between 50% and 90% for
resale. For example, if you pay $3 per unit of a bath soaking
product, you would charge between $4.50 and $6.00 for the
same product when you sell it to clients.
Payment Processing
You want to think about the ways you process payments from
clients and accept as many forms of payment as possible.
Although there is a setup and processing fee attached to
credit card sales, most people expect to be able to use a credit
and debit card system when buying something as expensive
as massage and spa services. If you dont offer this service to
clients, it will likely impact your business and decrease the
number of sessions you can fill in a week. Talk to your bank
about setting up a merchant account to provide credit card
processing. ABMP offers credit card processing discounts as
part of its member benefits package to massage therapists.
Tips
Tips are payments that clients make of their own volition.
Although many therapists expect clients to tip, tipping is
optional, and clients have the right to choose how much
they tip. If tips from clients exceed $20 per month, they are
considered taxable wages, and you must track the amount
you make in tips and include it in your income records. IRS
Publication 1244 (Employees Daily Record of Tips and
Report to Employer) provides useful guidelines and information about tips.
Marketing
The term marketing refers to all of the things you do to attract
new clients and retain existing clients. You want to consider
your business identity, target markets, competition, advertising
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choices, promotional programs, ways to generate publicity,

and a plan for building client loyalty when developing a marketing plan.
Business Identity
Your business identity is based on the message you want to
communicate to clients and how clients perceive you as a
result. Starbucks, Apple Computers, and Target are examples of companies that have powerful business identities.
One important way to establish your business identity is
through the design and use of a logo. You want your logo
to reflect your values and be easy to associate with your services. It should stand out and have a style that can persist
through years of change, new spa trends, and the growth of
your business (e.g., you add a new service such as skin care
to your service menu). Hire a graphic artist to help you create a professional and meaningful logo and then use your
logo on all of your printed materials, on the uniform you
wear to provide treatments, on your website, and on your
business sign. It becomes a unifying element for all things
that relate to your business and helps clients remember
who you are and what you stand for (Fig. 174).
You need to make sure to have a highly visible sign with
your business name and logo placed in at least one location
on your premises where drive-by and pedestrian traffic can
see it. Some massage therapists use printed words on windows or doors to provide additional detail about services.
For example, you might have a large sign with your name
and logo over your doorway, and the words Relaxation Massage, Spa Therapies, Reflexology, Hot Stone Massage, and Aromatherapy printed on your doorway.
Your business cards, website, brochures, promotional
materials, signs, newsletters, and everything else you print
or publish provide a means to reinforce your mission and
vision for clients. All of these items should feature your
logo and use a consistent color scheme and font style. Plan
to have these items professionally designed and ready when
you start your business.
Business cards: Your business information (business logo,
business name, your name and position, phone number,
address, e-mail, website, and a summary of services) is
Your Spa
Name
For Your Life in
Balance
FIGURE 174 Sample logo. You want your logo to reflect your values
and be easy to associate with your services.
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Gift certificates: Make gift certificates available for purchase so that clients can buy friends and family spa treatments when they visit for their own sessions.
Your Spa
Name
Sarah Spa Spa Therapist
222 Any Steet, Suite 300
Any Town, AS 00044
222-333-444
www.YourSpaName.com
FIGURE 175 Sample business card. A business card provides a summary of your contact details so people can reach you to set up a massage
appointment.
printed on heavy card stock about the size of a credit card.

Pass out business cards to all of your friends, family, and
acquaintances so that they can contact you for spa services
(Fig. 175). Business cards can also be used for appointment reminders (write the clients next appointment date
and time on the back of your business card) or for easy promotions (write $10 off your next salt glow and give it to the
client to use as a coupon on his or her next visit).
Website: It is important to have a web presence so that
potential clients can find you easily; most people have
abandoned their Yellow Pages and head straight for the Internet when they want information. Websites are useful
tools to communicate a wide array of information to clients and potential clients. Pages might include general
information about your business (location, hours of
operation, phone number), your services and fees, policies
(no-show policy, termination of session policy, informed
consent, etc.), a description of what to expect during a
massage or spa session, and even research articles that
discuss the proven benefits of massage or of therapeutic applications such as mud and seaweed. Professional
membership organizations such as ABMP offer website
hosting for members. You can often use simple programs
to create your own website that looks professional and is
attractive and functional.
Menu of services: As we discussed in Chapter 16, you
need to have a menu of services that fits your spa philosophy and your business mission and vision. It should
include your logo, business name, address, phone
number, e-mail address, and website. Use it to explain
to clients each of the services you provide and your fees.
You may want to include a biographical sketch that
outlines your credentials, training, and experience. You
might also provide clients with a number of different
informational brochures to give them in-depth information about a special service. For example, brochures on
sports massage, reflexology, pregnancy massage, your
ayurvedic services, and aromatherapy explain to clients
the benefits and techniques associated with each type of
massage or spa system.
Target Market
Target market is a term that refers to the specific group of
customers that a business aims to attract. Target markets are
identified as people with needs and/or wants that can be met
with the products or services of the business. Massage therapists usually seek to capture the general public (anyone who
wants a massage and is not contraindicated), plus particular
target markets that interest the individual therapist. Possible target groups can be broken down into broad categories,
such as men, women, teens, and children, and into special
populations, such as athletes, pregnant women, older adults,
people seeking skin care solutions, people interested in wellness and relaxation, or others. Sometimes, spa therapists
target groups that have specific goals such as individuals
starting a self-improvement program, dieters, or people
looking for a spiritual experience.
Much can be learned about how to attract and retain target
markets by paying attention to the demographic indicators
and to lifestyle indicators of each market. Demographic indicators include age, income level, occupation, gender, geographic
location, and education level. Lifestyle indicators include
philosophical beliefs, social customs, health care needs, specialty activities, and personal priorities. For example, client A is
a female (gender) with a bachelors degree (educational level),
who earns an income of $40,000 a year as a schoolteacher
(occupation). She is also a yoga enthusiast (specialty activity)
who practices Buddhism and organic gardening (philosophical beliefs). She has fibromyalgia (health care need) and is a
single parent of a small child (personal priority). This client
would most probably be attracted to your business if you had
a spa featuring a well-known yoga instructor with meditation classes and on-site child care. She will want linens made
from organic fibers; natural, unprocessed spa products; and
music that has a spiritual bent. Client B is a 60-year-old male
(age, gender) who works as an executive in a financial firm
(educational level, income, occupation). He recognizes that
stress is affecting his health (health care need) and is focusing
on staying fit and healthy as he ages (personal priority). He
considers himself an atheist (philosophical belief) and doesnt
like advertising that makes unsupported or unscientific claims.
Client B is more likely to attend your business if you own an
upscale massage clinic offering treatments targeting men. He
is likely to be put off by any mention of treatments that are of
a spiritual nature or by new age dcor in the treatment room.
As you plan your business, think about the target markets that interest you and try to understand these markets
by investigating the relevant health care needs, specialty
focus, concerns, and goals of each group. Next, assess the
skills and services you provide, your business identity, the
dcor of your facility, and all the other aspects of your business in relationship to these groups. Make sure that your
business will appeal to the clients you want to attract and
that your services will meet their particular needs.
10/24/13 2:10 AM
Competition
The primary goal of marketing is to clearly communicate
your advantages over the competition to the general public
and your target markets. In order to do this, you must analyze your competitors strengths and weaknesses. Use the
sample competitor analysis form shown in Figure 176 or
make up your own form to record your findings.
First, use the Internet to locate every spa business within
a 25-mile radius of your business and gather general data
including their name, address, phone number, and website. Use their website to find out about their services, fees,
the client markets they target, and their areas of expertise
(e.g., spa therapies, sports massage, hot stone massage,
Indonesian bodywork, pregnancy massage, energetic bodywork, Eastern bodywork). Pick out the five businesses you
375
consider to be your primary competitors and call them to set

up a spa appointment (sessions used for competitive analysis
can be deducted on your tax return). Pay attention to phone
etiquette. How fast was your call answered or returned? Did
you immediately get a live person or did you have to leave
a message? Was the receptionist friendly and helpful? Visit
their establishment as if you are a client and pay attention
to their signage, location, ease of access, attention to
cleanliness, and dcor. Pretend to be a curious client and
ask a lot of questions. How many clients does your therapist
see each week? Is it easy to get appointments or is the clinic
always busy? What type of clients does the clinic attract?
Finally, pay attention to the quality of intake procedures and
paperwork, to the quality of the massage or spa treatment
itself, and to the ease with which payment is processed.
FIGURE 176 Sample competitor analysis form. A competitor analysis form helps you analyze your competitors
strengths and weaknesses.
10/24/13 2:10 AM
376
Identify your competitors strengths and weaknesses in

relationship to your own strengths and weaknesses. If you
find a competitor has a clear advantage over you, you need
to undertake activities to correct this imbalance, if possible.
If you find you have a clear advantage over a competitor,
highlight this strength in marketing materials.
Promotion
Promotional activities increase your visibility in the marketplace and attract the attention of potential clients. These
activities might include holding an open house, providing
a free workshop, sponsoring an event to benefit the community, renting a booth at a community event or health
expo, sending out informational newsletters, offering free
foot treatments at a local walkathon, and mailing flyers to
current and potential clients that include a special offer or
personalized gift item. Important methods of promotion
include client education, client referral programs, health
care provider referral programs, and special offers.
Client Education
Educating people about the benefits of massage and spa
services supports the growth of your client base. Your client
education plan may include activities such as speaking at
meetings of particular groups such as a womens group,
runners group, business networking group, or others.
Presentations at fitness clubs, health food stores, sporting
events, community events, and coffee shops raise the
awareness of the general public to the benefits of your
services. You want to focus your efforts on your target
market because these are the groups that interest you, and
it is likely that you have developed special services just for
them. For example, lets imagine that pregnant women
are your target market. To alert pregnant women to your
practice, you might create a flyer offering discounted
pregnancy massages or spa foot services on Monday evenings (your slow day). The flyer also boasts the proven benefits of massage to decrease pregnancy aches and pains, support the labor and delivery process, and promote healthy
birth size in infants. Post the flyer where pregnant women
are most likely to see it (Lamaze classes, fitness center,
health food store, obstetricians office, midwifery centers,
maternity clothes shops, etc.) and partner with the Lamaze
teacher to provide free informational presentations about
the benefits of massage and spa foot treatments for pregnancy to her classes.
Newsletters are another effective way to maintain
contact with clients between sessions and educate them
about different styles and systems of massage and spa services. Newsletters might also alert clients to an open house
event, introduce a promotion, and provide a coupon for
$10 off the clients next herbal body wrap. E-newsletters
have become popular in the last few years because no printing or mailing of published materials is necessary so costs
are low and there is less impact on the environment. Make
sure to gather your clients e-mail address on your intake
forms and then use any of a number of web-based e-news-
letter generators (do a search on the Internet with the term

e-newsletter generator) to send clients information. Be sure to
provide a link so that clients can choose not to receive your
newsletters if they prefer.
Open house events educate clients about your business
and entice them into your business so that they are
comfortable with their surroundings. This makes it more
likely that they will visit you for a spa session. An open
house event usually includes refreshments; sample services (free foot soak, seated massage, paraffin dip, etc.);
a presentation on the different types of spa services the
business offers; and even displays that allow attendees to
feel, smell, and try out spa or retail products. Its important to have a receptionist ready to book appointments
on the spot instead of waiting for the client to call in after
the event.
Client Referral Programs
A client referral program enlists your regular clients as sales
agents for you as a way to get a reduced rate on massage.
Provide clients with referral cards (Fig. 177) and have them
write their names onto the cards. Clients hand out the cards
to friends and family members and encourage them to visit
you for a treatment. The friend or family member gives you
the card when they show up for their session in order to
get a reduced introductory rate. You keep the card on file
and give the discount to the referring client when he or she
comes in for a session.
Health Care Referral Programs
As part of your massage practice, you will develop a
referral list of other health care professionals. This group
of physicians, naturopathic doctors, traditional Chinese
medicine practitioners, acupuncturists, movement teachers,
chiropractors, physical therapists, mental health specialists,
nutritional advisors, fitness trainers, yoga instructors, and
others will be ready to support your clients with services
other than massage when they are needed. You can ask the
health professionals on your referral list to direct clients/
patients to you when they need massage. Building solid
Your SSpa
Spppaa
Name
am
aame
me
I was refered to you by

I understand that when I retr
this card to Your Spa Name I will
receive a $10 discount on
my massage
222 Any Steet, Suite 300

Any Town,
own, AS 00044
222-333-444
www.YourSpaName.com
FIGURE 177 Sample client referral card. A client referral program

enlists your regular clients as sales agents for you as a way to get a
reduced rate on massage. Give your clients referral cards that are returned
to you and kept on file.
10/24/13 2:10 AM
health care alliances takes time but builds important relationships in your community that will feed your business
for years to come. It is helpful to write a letter to the health
care provider introducing yourself, set up a brief meeting,
and offer the other health care provider a free 30-minute
massage. This way, the health care provider can feel the
quality of your work and better understand the benefits of
massage for clients/patients.
Special Offers
Special offers are promotions that provide discounts on
services when users meet specific criteria or for a particular amount of time. Ideas for special offers to bring in
new spa clients or to increase repeat business include the
following:
Spa or massage club: Clients join a spa club or
massage club where the price for one spa session or
massage is automatically charged to their credit cards
one time a month. After they have enjoyed the one-timea-month treatment, any additional treatments they
book during that month are provided at a discounted
rate (e.g., $10 off or $20 off).
Prepaid cards: Clients pay up front for a certain number
of sessions and receive a reduced rate on each session as a
result.
Punch cards: Clients receive a punch card on their first
visit to your business. Every time they get a session, you
punch the card. When they have the necessary number of
punches (e.g., 5, 10, 15), they turn in the card for a heavily discounted session or for a free session.
Coupons: Include coupons in the newsletters you send
to clients to generate repeat visits or pass them out in
your immediate area to generate new client visits.
Employee appreciation: Approach local corporations
or businesses with an idea for employee appreciation.
They purchase 12 sessions from you (1 per month for
a year) at a discounted rate, and they give the sessions
to a different employee each month as a way to demonstrate appreciation and promote employee health.
Seasonal promotions: Pick a holiday usually associated with gift giving such as Christmas, Mothers Day,
Fathers Day, or Valentines Day. When clients purchase
a gift certificate for their friends or family members, they
get a discount on their sessions, too.
Others: As you can see, special offers take many forms,
and you can come up with many unique ideas for creating
special offers that entice clients to your business or reward
regular clients for their loyalty.
Advertising
Advertising is different from promotion because it requires
direct payment in order to gain public notice. The most
common types of advertising used by massage and spa
professionals are classified ads, display ads, phone book ads,
and website ads. Identify where to place the advertisements
and then contact the publication for a media kit. The kit
377
will contain the rates for different ads, deadlines for placing
ads, and art development information. Statistics show that
an advertisement will need to be seen at least three times before it is noticed. It may need to be seen at least seven times
before the reader decides to take action. Ads seem to work
best when they contain a strong visual image and clearly define the benefits and incentives of a service. Advertising can
be expensive, so other methods of marketing a spa business
may be preferred.
Publicity
Publicity is media exposure that usually arises from an
event held at the business. Publicity might arise from an
interview, news coverage of participation in a community
event, or a feature story about the business or a particular
service. For example, a local magazine might have a Tips
for Better Living section. Try sending in a press release
outlining the benefits of one of your services for stress reduction. If the magazine is interested in this new approach to
stress reduction, they will contact you about the service and
even write a story about it including your comments and
contact details in the story. Research the media outlets in
your area. Identify those that target the same client markets
as your business or that focus on health-related topics and
regularly send them press releases.
Writing a Press Release
A press release draws the attention of a media representative
to a newsworthy event (Fig. 178). It is generally one page in
length and lists the business name, address, phone number,
and contact person in the top left-hand corner of the
page. The release date (usually For Immediate Release)
is placed in the top right-hand corner of the page. A headline summarizes the content of the release and is placed in
the middle of the page in bold capital letters. The body of
the release will contain short, concise paragraphs with the
most important information described at the top. The final paragraph will indicate the action the reader is meant
to take as a result of the story (book an appointment, attend the event, conduct an interview, etc.). A press release
is sent out each time the business participates in a community event, offers a free information workshop, donates
their services in support of a charitable cause, introduces a
new treatment, or provides an important service to a particular client group (e.g., free fitness checkup on Mondays
for seniors).
Building Client Loyalty
Most spa therapists truly care about their clients and enjoy
building a strong relationship as a partner in good health.
This natural tendency of therapists to relate positively to
their clients is the foundation of good customer relations
and helps build client loyalty. You must also keep good
client records; use high-quality products; make realistic
claims for your services; provide a safe, comfortable, and
sanitary environment; be prompt and reliable; refer to other health professionals when appropriate; and treat clients
10/24/13 2:10 AM
378
For Immediate Release
REDUCE WORK-RELATED STRESS WITH REFLEXOLOGY
Contact:
Melissa Massage
400 Any Street #1
Any Town, Any State
10000
Ph: 255-555-5252
Fax: 252-222-5555
info@bodyinbalance.com
www.bodyinbalance.com
Massage
Aromatherapy
Body Treatments
Reflexology
A balanced
body is achieved
when time is made
for self-care
Take off your shoes and relax! That's how easy it is to reduce work
week stress at the Body in Balance massage clinic and spa. The clinic
has designed a selection of unique foot spa treatments that target
foot pain and stress through reflexology.
Reflexology is a holistic treatment that works on the theory that points
on the feet, hands, and ears correspond to all areas of the body.
Through stimulation of these points, the body is able to rest, relax, and
recover from the pressures of everyday life.
Body in Balance offers a full menu of massage, body treatments,
aromatherapy services, and reflexology. Melissa Massage, the owner,
is an American Board Certified Reflexologist. She personally designed
each of the seven reflexology foot spa treatments offered at the spa.
Athletes will enjoy the Pain-Away Treatment, which uses therapeutic
Moor mud from Austria. This special healing mud has been used in
Europe to treat joint pain and inflammation. Also popular is the
Sedona Clay Ritual, which utilizes the powerful red clays of Sedona,
Arizona, together with juniper and sage essential oils.
Melissa notes that "anyone bashful about getting undressed for a spa
treatment should try reflexology. Reflexology is a great way to unwind
from a stressful work week, and it's literally as easy as taking off your
shoes."
To contact a Body in Balance and find out more about reflexology
and foot spa treatments, call 255-555-5252.
FIGURE 178 Sample press release. A press release draws the attention of a media representative to a newsworthy
event.
warmly and respectfully, even when clients are perceived as

difficult.
It is a good idea to set up procedures to maintain contact
with clients between scheduled sessions and to acknowledge
special dates. These activities might include checkup calls
the day after the session, a birthday card with a discounted
or free session on the clients birthday, newsletters with
coupons, anniversary cards on the anniversary of the clients
first spa appointment at your business with a coupon for
a discounted session, and thank you notes for referrals.
An annual open house event for clients and their guests is a
nice way to thank clients for their loyalty. The event might
include hors doeuvre, seated massage, paraffin dips, a gift
of bath salts, and a free spa session as a door prize.
Your Marketing Plan
It is helpful to write a marketing plan that gives details
on daily, weekly, and monthly marketing activities. Time
moves fast, and opportunities to promote the business will
come and go if a clear schedule is not maintained. Even a
small business with a correspondingly small marketing
budget should plan to spend 6 to 8 hours a week on short-
10/24/13 2:10 AM
term or long-term marketing activities. First, think about

seasonal promotions and then do a search on the Internet
to discover community events coming up in your area. Plan
an open house event or set up at a street fair. Make sure that
clients know who you are, what you do, and where they can
find you.
Finances
Your business finances include financial statements needed
for a business plan; record keeping to track startup and
operating costs; and bookkeeping systems that help you
predict income, expenses, and taxes as well as considerations for personal financial management.
Financial Statements for Business Plans
When you write up your business plan, especially if you
intend to submit it to a bank as part of a loan application, you will need to prepare a balance sheet, cash flow
statement, and profit and loss statement. If the business
is new, you will not have the financial history necessary to
organize these documents. In this case, you must be prepared to demonstrate your earning power and the ability to
support your new business with your personal income from
wages at a job.
Balance sheet: This document demonstrates the
current status of your business or personal financial
situation at a given point in time (usually at the end
of a quarter or year). It shows what you own (assets),
what you owe (liabilities), and what your worth (owners
equity). Assets include cash on hand, money in checking and savings accounts, money that is owed you or
your business, prepaid expenses such as the deposit on
your rental space or prepaid utility bills, equipment you
own such as your massage table and computer, and the
building if you own it. Liabilities include outstanding
bills yet to be paid to suppliers, wages you owe but have
not paid to contractors or employees, payments you
owe on a loan, or taxes you owe but have not paid. Your
equity is the difference between your assets and your liabilities.
Cash flow statement: This type of statement is prepared
weekly as part of your normal bookkeeping procedures.
You list revenue from sessions; sales of retail product,
sales of gift certificates; and sales of other services against
expenses such as rent, utilities, office supplies, and laundry expenses. A cash flow statement helps you make good
choices about purchases and upgrades to your business
and helps you track your net income or net loss week to
week.
Profit and loss statement (also called income statement): This statement shows how your business performed during a certain period of time (usually reported monthly, quarterly, and/or annually). It documents
the total amount of money that came into your business (revenue), the money spent to operate the business (expenses), and what was left over (net income). If
379
your expenses exceeded your revenue, you show a net

loss.
Although these documents may seem daunting, they are not
difficult to compile. Do a search on the Internet with the
terms balance sheet sample, cash flow statement sample, and profit
and loss statement sample to view examples of these documents
and then compile these documents for your business.
Financial Record Keeping
Good financial record keeping provides you with financial
data that helps you operate your business more efficiently
to increase your profitability. Accurate records are essential
for the preparation of financial statements such as those
described in the previous section and ensure that you dont
pay more than you really owe in taxes. The first step in
setting up an ongoing system is to get baseline information
for your business. This involves estimating your startup
costs and operating costs.
Startup Costs
All of the expenses related to setting up businesses are
called startup costs. Estimate your startup costs by listing
all the equipment, furnishings, supplies, and dcor you
need to outfit your business. Factor in the cost to develop
marketing materials and your website as well as all licensing,
permit, and insurance fees. Include security deposits on
rental property and utility setup fees. If you plan to have a
gift shop, you will also want to include the cost to purchase
wholesale items that you sell to clients when you open your
doors. Be as accurate as possible in your estimates or err on
the side of estimating too high.
Operating Costs
Some expenses such as the purchase of a massage table and
music system are only made one time and are listed as part
of your startup costs. Other items are consumables, so they
will run out at some point (i.e., liquid soap for bathrooms,
massage lubricant, mud for your fango treatment, etc.) or
need to be replaced as they wear out (i.e., linens, terry robes,
table pads, etc.). In addition, you will have regular costs related to laundry, utilities, phone, and rent. These expenses
are your operating costs. Get a monthly calendar and think
about the year ahead. On each month, list expenses you
know you must pay such as rent and utilities. If you have annual fees related to licenses, insurance renewal, or mandatory continuing education, pencil these into the months they
are due. Try to predict when supplies and marketing materials will need to be ordered or reprinted and write them
in to the appropriate months. Look at your marketing plan
and factor in the costs to advertise, promote, or publicize
your business. For example, if you plan to set up a booth
at a street fair, how much will the booth cost to rent? You
want to know, with as much detail and precision as possible, what it will cost you to run your business each month.
The first year you write your operations projection, you are
likely to miss some costs. If you keep good records, you will
be able to refine the operations projection overtime.
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380
Estimating Income
ABMP notes that therapist salaries range from $10,000 a
year to $60,000 a year. This vast difference in salaries demonstrates the diverse nature of massage and spa businesses.
Many therapists practice massage or spa part-time and may
provide as few as three sessions a week. For others, massage and spa is a full-time job and they provide 20 to 25
sessions per week. It is very rare for therapists to provide 40
hours of sessions per week because massage and spa is such
a physically demanding profession. Your income is likely to
be influenced by a number of other factors including the
market rate for sessions in the area where you practice, your
ability to attract and keep clients, the number of sessions
you are willing to provide each week, and your ability to
manage expenses. Once you set your fees, you can do a simple calculation to estimate your gross (income before taxes
and expenses are deducted) and net (income after taxes and
expenses are deducted) income as shown in Figure 179.
This basic example does not account for sessions offered at
special rates, for weeks when the therapist does not provide
20 sessions, or for variations in expenses.
Record-Keeping Systems
There are many types of established record-keeping systems described in financial management books or used in
small-business computer software packages. Small-business computer software packages are recommended because they are easy to learn and have a reporting function
that compiles all of the data you have entered in different
worksheets into useful reports that help you track the financial health of your business. Some massage therapists
choose to hire a bookkeeper or accountant to manage their
finances. This is a useful practice especially if you have little
interest in learning a software package or learning to keep
1. Business checking account: Open a separate business

checking account for your spa practice. If you need to
make cash purchases, write a check for petty cash from
this account. Deposit all of the income you make for
any of the services you provide as part of your business
into this account. Have credit card income automatically transferred to this business account. Pay all of
your expenses, including the salary you pay yourself
from this account. If you pay some bills with a personal
credit card, pay the amount back to the credit card with
a business check. Dont pay for business expenses with
cash or a personal check if it can be avoided. This way,
there is accurate documentation of all of the financial
transactions your business makes that you can reconcile
with your other business records.
2. Record transactions: Set up a ledger (financial record
book) to record all of your financial transactions
(money coming in and money going out). You can
keep a handwritten ledger in a simple columnar book
from office supply stores, set up a simple spreadsheet
on your computer, or use a ledger as part of a financial
software package. People often separate income from
expenses and write these two different categories of
transactions on separate pages of the columnar book
(Fig. 1710). You need as much information about
each transaction as possible. For example, if a client
pays for a session and also purchases a gift certificate
you want to note this in the ledger. Record the clients
name, method of payment (cash, check, credit card,
etc.), the check number if the client paid with a check,
amount of payment, description of the service (i.e.,
WEEKLY
20 massages per
week at $60 per
massage
$1200
MONTHLY
Expenses
4 x $1200 a
week for
massage
$4800
YEARLY
Gross Income
records yourself. Record keeping for sole proprietorships

can be very simple.
12 months of 20
massages per
week
Income after
Tax Deductable
Expenses
Net Income
$337.50
$862.50
$215.62
(25%)
$646.88
$1350
$3450.00
$862.50
$2587.50
$16,200
$41,400
$10,350
$31,050.00
Rent
($700)
Utilities
($250)
Taxes
Supplies
($150)
$57,600
Marketing
($250)
FIGURE 179 Estimate of gross and net income. Once you set your fees, you can do a simple calculation to
estimate your gross (income before taxes and expenses are deducted) and net (income after taxes and expenses are
deducted) income.
10/24/13 2:10 AM
Date
Description
Income
1/6/10
1-hr Sw. Massage with

Sue Smith check #1123
$60
$60
1/6/10
90-min Sw. Massage with

Dave Johnson cash + $10
tip
$90
$150
1/6/10
1-hr sports massage with

Jenny Good Visa + $5 tip
$75
$225
1/6/10
30-min infant massage

with Amy Morgan Visa
$35
$260
1/6/10
90-min stone massage

with Jane Murphy cash
+ $10 tip
$120
$380
1/6/10
Utility bill paid check

#2345
$60
$320
1/6/10
Liability insurance
renewal
$199
$121
Expenses
381
Balance
FIGURE 1710 Sample ledger of income and expenses. Set up a ledger (financial record book) to record all of
your financial transactions (money coming in and money going out).
1-hour Swedish massage, 30-minute foot treatment,

etc.), and date.
3. Keep receipts: Keep every receipt associated with purchases and expenses for your business and store them
in the same order as they are recorded in your ledger.
If you have lost a receipt or didnt get a receipt associated with an expense, record the transaction in your
ledger and make a note that you are missing the receipt.
Reconcile your receipts with your checkbook and credit
card statement at the end of every month.
4. Keep records: Most of your business-related records
must be kept for 6 years. Some records, such as those related to property purchases, should be kept forever. If you
are in doubt, keep the record. Store your records in a safe
place such as a safety deposit box at your bank or in a fireproof filing cabinet. Items that should be kept for 6 years
include receipts; bank statements; copies of tax returns;
ledger sheets; check, cash, and credit card payments; balance sheets; cash flow statements; profit and loss statements; lists of inventory; equipment and furnishings; and
automobile mileage logs if you do outcall services.
Taxes
The taxes you pay will depend somewhat on the way your
business is structured (i.e., Do you have employees?) and
the types of services you offer (Do you sell retail products?
Are clients charged sales tax on massage in your state?).
Tax laws change regularly, so it is a good idea to review
IRS Publication 334 (Tax Guide for Small Businesses) each
year to stay informed about current tax regulations. As a
small business, you may be required to pay income tax, selfemployment tax, employment tax, and sales tax.
Income tax: Income tax is the federal and state taxes
you pay on your business profits. The amount of your
business profit is determined by subtracting deductible

expenses from your revenue as discussed in the RecordKeeping Systems section (For Your Information 178).
The percentage of tax you pay depends on how much
you made during the year. State taxes vary from state to
state, so you should check with your local department of
revenue for information. Usually, small businesses pay
estimated taxes to the IRS on a quarterly basis. To find
out more about paying quarterly taxes, download IRS
Publication 505 (Tax Withholding and Estimated Tax)
from the IRS website.
Self-employment tax: If you worked as an employee,
your employer would withhold social security and Medicare taxes from your wages. Self-employment tax is social
security and Medicare taxes you withhold for yourself.
The current self-employment tax rate is 15.3%.
Employment tax: If you hire employees, you are required to withhold federal income taxes, social security
tax, and Medicare taxes from their wages and pay these
taxes to the IRS for employees. In addition, you must
pay a matching amount of social security and Medicare tax on behalf of each employee to the IRS. If your
business hires employees, download IRS Publication 15
(Employers Tax Guide) and 15A (Employers Supplemental Tax Guide) for more information from the IRS
website.
Sales tax: Sales tax is a state or local tax based on a
percentage of the selling price of products or services
that the buyer must pay. The seller simply collects this
tax from the buyer and passes it on to the state or local
government. In most states and in many cities, you
must collect sales tax if you sell retail products to clients. In some areas, sales tax is collected on the massage
or spa service itself. You must obtain a sales tax permit
10/24/13 2:10 AM
382

Examples of Business Expenses that Can Be Deducted from Taxes
Accounting fees
Advertising costs
Business personal property insurance
Cleaning services
Continuing education (including travel and expenses at the
workshop/seminar)
Costs to purchase a uniform
Depreciation on equipment purchases
Health insurance
Interest on loans
Laundry services
Legal services (attorney, business consultant, etc.)
License fees
Mileage for outcall services or business related travel
Office supplies
Postage and shipping
Postage and shipping costs
Practice supplies (i.e., massage lubricant, spa products,
supplies for the bathroom, etc.)
Printed business materials costs
Profession-related magazines
Professional conferences, conventions, and national meetings
Professional liability insurance (including general liability and
product liability)
Promotion costs
Reference books
Rent or lease
Repairs on office equipment
Service charges (bank fees, credit card processing fees)
Telephone and Internet fees
(see the Management section) and contact your local

department of revenue and taxation for information
about sales tax rates and submission in your area.
Personal Finance Management
Personal finance management is an important area to
research as a small-business owner, and there are many
books available at your local bookstore that can help you
sort through some of these issues. It can also be useful to
contact a financial advisor to help you set up systems to
manage your personal finances effectively. This section
aims to provide an overview of areas to consider as part of
business planning.
Contingency planning: Contingency planning is planning for an unforeseen emergency. As a small-business
owner, you must plan ahead for events such as an injury that prevents you from providing massage to the
usual number of clients each week or a downturn in the
economy that causes people to cut back on the number
of spa sessions they receive. As discussed in the RecordKeeping Systems section, you will pay yourself a salary each month from your business account. Try to pay
yourself less than your business income and put at least
10% of your income into a savings account each month.

Contingency planners suggest that you save 6 months of
salary and business expenses to ensure that you can maintain your life and business in the event of an emergency.
Your will: A will should be written if you have money or
possessions that you want distributed according to some
plan. Wills provide clear, legal instructions regarding
your intentions and ensure that your family members are
protected. Although you can download will-generation
programs to your computer, most small-business resources suggest that you contact a lawyer to create your
will.
Retirement accounts: Retirement accounts ensure you
have money to live on when you retire and provide a tax
advantage for small-business owners. There are four selfemployed retirement plan options commonly used by
small-business owners. These are the individual 401(k),
Simplified Employee Pension Individual Retirement
Arrangement (SEP IRA), Defined Benefit Plan, or Individual Retirement Account (IRA). The plan you choose
depends on your income and the type of tax protection
you need. Visit your local bookstore or your bank to
find out more about these types of accounts and start a
retirement fund early in your business.
Management
To manage your business successfully, you will need to
be aware of regulations in your area including necessary
licenses and permits. It is important to understand and
procure insurance to protect your business as well as write
policies and procedures that help you and your clients
understand each others expectations.
Licenses and Permits
During your massage training program, you likely learned
about the process to attain and maintain your massage
credentials including education requirements, state testing
and licensure, registration or certification, and scope of
practice. As part of the setup of your business, you may
also need to obtain other licenses and permits at the local,
county, state, or federal level to operate legally.
Business license: In most cities or counties, you are
required to get a business license that grants you the
privilege of legally operating a business within a certain
city and/or county jurisdiction. Contact the city hall and/
or county government offices to obtain the application
paperwork. Complete the application and file it in person
with the appropriate government office (the application
will provide the location). Fees range from $30 to $150.
Business licenses are usually renewed annually.
Sales tax permit (also called sellers permit or sales
tax license): In most states, a sales tax license or permit
is required if you sell retail products to clients. In a few
states, sales tax is collected on the massage or spa service itself. You collect sales tax from clients when you
sell them products (or provide services) and then report
10/24/13 2:10 AM
and pay the sales tax to the state or county monthly,

quarterly, or twice yearly. Contact your state franchise
tax board to obtain this permit.
Zoning permit: Dont sign a lease or rental contract on
a property until you first check that the space is properly
zoned for a massage and spa business. Some cities require
all new businesses to get a zoning compliance permit
before they open. Contact the local planning department
or the zoning board in your area for information.
Home occupation permit: In some areas, the local
government will require you to obtain a home occupation permit if you practice massage or spa out of your
home. You may also need approval to run a home-based
business from your local homeowners association.
Contact the city hall or zoning board in your area for
information.
Registration of a business name: If you are a sole
proprietor, the legal name of your business is your full
name. If your business is a partnership, the legal name
is the name given in your partnership agreement or the
last names of the partners. For LLCs and corporations,
the legal name of the business is one that is registered
with the state government. If you want to conduct
business under a different name (e.g., Mary Smith wants
to conduct business as Soothing Massage Company),
then you may have to file a fictitious name (also called
assumed name; trade name; or DBA name, which is
short for doing business as) registration form with the
country clerks office or with the state government.
Employer Identification Number (EIN): If you are a
business that hires employees or if you are a corporation,
you are required to obtain an EIN (also known as a
Federal Tax Identification Number), which is used to
identify your business at a federal level. To obtain an
EIN, fill out Form SS-4, which is available through the
IRS. You can apply online at http://www.irs.gov in the
section for businesses.
If you are uncertain which agency in your city or state to

contact for specific questions about business licenses and
permits, SBA (http://www.sba.gov) and your local chamber
of commerce can help.
Insurance
People obtain different types of insurance to protect themselves in the event of a liability suit; personal loss because
of fire, flood, or theft; or loss of income due to health care
bills, injury, or illness. Assess the type of insurance you need
to protect yourself and your business.
Professional liability insurance: This type of insurance
protects you in the event that a client is injured by your
treatment or if your treatment causes complications
in conjunction with another pathology. Many states
require proof of professional liability insurance in order
to obtain your massage license. It is very important to
hold this type of insurance if you are practicing massage
or spa treatments on the public.
383
General liability insurance: This type of insurance is

often nicknamed slip and fall protection because it
covers you in the event that a client is injured (i.e., slips
and falls walking up your stairs) or that the clients
property is damaged (e.g., a lamp post on your property
falls on the clients car) on your premises.
Product liability insurance: If you sell products to
clients or use products such as lotions, oils, and creams
in your practice, this insurance protects you if the client has an allergic reaction or injury caused by the
product.
Business personal property insurance: In the event
of flood, fire, or theft, this insurance covers your losses
(depending on how the policy is written). Sometimes,
therapists think that their homeowners policy will
cover the loss of their business property if the business is
home-based. Usually, this is not the case.
Health insurance: Illnesses and injuries resulting in
visits to physicians or hospitalization are covered to
some degree by health insurance. Self-employed people
can obtain health insurance through the National Association for the Self-Employed (NASE). Find information
on the NASE website at http://www.nase.org.
Disability insurance: If you are unable to work because
of an injury or illness, disability insurance ensures that
you still have income from which to pay your bills and
live. Insurance companies that provide life insurance
usually offer disability insurance, or you can use the
search terms disability insurance and self-employed to compare rates on the Internet.
Professional massage membership organizations such as
ABMP and AMTA provide professional liability, general
liability, and product liability insurance as part of membership. Both organizations provide business personal
property insurance for a small additional fee. Compare
and contrast the policies carefully to make sure you get the
right coverage for your business.
Business Policies and Procedures
Your business policies and procedures are the ways you deal
with specific situations. They explain to clients what clients can expect from you and your business and what you
expect from clients receiving massage and spa treatments.
Policies and procedures are shared with clients as part of
the informed consent process:
Hours of operation: Some businesses are by appointment only. The advantage is that you dont have to be on
the premises during standard business hours. You are
only at the business if you have an appointment. The
disadvantage is that you miss the chance to increase client sessions with walk-in business. By appointment only
works well for home-based businesses or businesses that
dont have pedestrian or drive-by traffic.
Phone etiquette: One important aspect of good customer relations is phone etiquette. There is nothing more
frustrating for a client than not being able to reach a
10/24/13 2:10 AM
384
therapist promptly. Think hard about how you will manage your phone and be available to clients. Sometimes, a
group of therapists will share the expense of a receptionist to ensure that clients always have access to a live voice
when they book appointments. At the very least, you need
to inform clients that you will be checking voicemail and
returning calls every 90 minutes (usually, sessions last no
longer than 90 minutes).
Fees and payment options: You need to clearly describe
your fees for different services and payment options
if you offer standard discounts (e.g., $5 off your first
massage); publish them and offer them to every client

without exception.
Scheduling: You need to establish clear no-show, late
arrival, or late cancelation policies for clients. Once these
policies are set, it is important to maintain these business boundaries even with friends or family members.
Therapist/business rights: As a therapist or business
owner, you have rights and can refuse service to clients
who dont demonstrate good hygiene, use illegal drugs
or alcohol before the session, may be contraindicated, or
behave in a sexual or immodest way.
SPA FUSION
STUDY TIP: Space Out for the Big Test
As you near graduation, it is likely that you will start preparing to sit for one of the three primary licensing exams
if you practice in a regulated state. Information for the
Massage and Bodywork Licensing Exam (MBLEx) can
be found at http://www.fsmtb.org. Information for the
two exams offered by the National Certification Board
of Therapeutic Massage and Bodywork (NCBTMB)
can be found at http://www.ncbtmb.org. Oftentimes,
students cram for these exams shortly before their exam
dates. Research studies have shown that people retain
more information when they study 7 hours over 4 days
(spaced practice) instead of 7 hours in 1 day (massed
practice). Studying for short periods of time prevents
boredom, improves concentration, and helps reduce
fatigue. Spaced practice works well for students who
have jobs and family obligations. For example, Anisa
goes to massage school during the day and works as a
food server at night. In class, she writes her lecture notes
directly onto flash cards. She carries the flash cards with
her each night on her shift. When her tables are slow or
while she waits for the kitchen to put up her food, she
pulls a flash card out of her apron and reads and repeats
the information it contains. Anisa is able to memorize
six to seven flashcards each shift. Plan ahead at least
4 weeks before your licensing exam so that you can space
your study sessions and refresh the information from
your education slowly over a period of time.
GOOD TO KNOW: Helpful Business Resources

Resume writing: http://www.resumeedge.com,
http://www.careerperfect.com, http://www.
professional-resumes.com, http://www.
resumeservice.com, http://www.resumelines.com
Small-business resources: SBA at http://www.

sba.gov, Inc. A Daily Resource for Entrepreneurs
at http://www.inc.com, Small Business Service
Bureau, Inc. at http://www.sbsb.com
Books:
Veruki P. The 250 Job Interview Questions Youll Most
Likely Be Asked. 4th ed. Avon, MA: Adams Media;
1999.
Allen L. One Year to a Successful Massage Therapy
Practice. Baltimore, MD: Lippincott Williams &
Wilkins; 2009.
Sohnen C. Business Mastery: A Guide for Creating a
Fulfilling, Thriving Business and Keeping it Successful. 3rd ed. Tucson, AZ: Sohnen-Moe Associates,
Inc; 1997.
CHAPTER WRAP-UP
In this chapter, you started to put together a concrete plan for your spa career after you graduate. You
read about all of the practical things you will need
to think about and do, such as writing a resume or
constructing a startup budget. Career planning can
bring up some uncomfortable feelings in massage
and spa students, especially when they try to balance
their excitement with their fears about starting a new
career. Some students share that they feel guilty charging money for massage or spa sessions. They feel that
they entered the profession of massage to help people,
not to make truckloads of money! How can I reconcile
my desire to be helpful with a desire to be paid fairly
for the service I provide? Others are concerned about
all the regulations for self-employed people. What
happens if I do my taxes incorrectly or dont put aside
enough sales tax when the bill comes due? There is
no doubt that these are real and reasonable concerns,
10/24/13 2:10 AM
385
SPA FUSION
and everyone feels some uncertainty when starting
any type of new venture. The best advice is to talk
through your concerns while you dedicate yourself to
careful planning. Discuss your worries with teachers,
classmates, established professional therapists, family members, and friends. At the same time, cultivate
your excitement for all the possibilities that are before
you. This passion will help you face the challenges
that arise with spirit and determination so that you
can meet your goals and build the spa career of your
dreams.
REVIEW QUESTIONS
employers to determine if you have the experience

necessary to fill an open position is called:
a.
b.
c.
d.
A resume
A transcript
A reference list
A cover letter
6. The specific group of customers that a business

aims to attract is called:
a.
b.
c.
d.
A special population
A conditional group
A target market
A health market
Multiple Choice
1. Direct payment made to another business or
organization in order to gain public notice is:
a.
b.
c.
d.
Publicity
Marketing
Advertising
Promotion
2. A written guide to starting and running your

business is:
a.
b.
c.
d.
A marketing plan
A business plan
A personal plan
A health plan
3. A document that introduces you to employers and

arouses their interest for a job is:
a.
b.
c.
d.
A resume
A transcript
A reference list
A cover letter
4. All of the activities you undertake to obtain new

clients and keep current clients are part of your:
a.
b.
c.
d.
Marketing plan
Business plan
Personal plan
Health plan
5. A written summary of your background,

experience, education, training, and skills used by
7. The primary person who is responsible for ensuring that a spa runs smoothly and efficiently and is
profitable on an ongoing basis is:
a.
b.
c.
d.
The employee
The spa consultant
The product consultant
The spa director
8. A self-employed person who contracts with another

business to provide specific services is called:
a.
b.
c.
d.
An employee
An independent contractor
A spa consultant
A spa director
9. This promotional document is used to explain

your services and fees to clients. It should include
your logo, business name, address, phone number,
e-mail address, and website. It is:
a.
b.
c.
d.
A spa menu
A spa program
An informed consent
A health history
10. All of the expenses related to setting up businesses

are called:
a.
b.
c.
d.
Running costs
Product costs
Finishing costs
Startup costs
10/24/13 2:10 AM
APPENDIX A
Sample Spa Treatments
Introduction
These sample treatments demonstrate the many ways you
can mix and match treatment elements to develop your
own services for your spa or massage clinic. Copy these pages from the book and place them in plastic sheet protectors
in a spiral notebook for easy access when you practice. You
can use these treatments in your spa or clinic as they are or
as inspiration when you create your own services. Detailed
Ocean Pearl Polish
information and step-by-step directions for different treatment types (e.g., full-body polish, hot sheet wrap) are provided in corresponding chapters. Recipes are provided in
the Notes section for specialized products that fit particular smell-scapes. In some instances, you should be able
to source preblended products; in others, you may need to
make your own. If no recipes are provided, it is likely that
suitable products are readily available from spa suppliers.
(Full-Body Polish)
Promotional Description
Release yourself to the sirens song with this refreshing
treatment that smooths and purifies the body by using
healing benefits from the sea. Your body is buffed to the
translucency of a fine pearl with a combination of seaweed gel and sea salts. Next, bubbles fragrant as Atlantic
air deeply cleanse and remove impurities before hydrating sea milk is applied with relaxing massage strokes.
Your body shimmers and is renewed and balanced by this
relaxing journey to the deep.
Benefits
Decreased muscle
tension
Improved skin health
Relaxation
Stress relief
Contraindications
Broken or inflamed skin
Iodine or shellfish
allergies
Skin conditions
Sunburn
Thyroid conditions
Massage Table
Plastic table protector
Bath towel
Top massage sheet
Blanket or bath sheet for
warmth
Work Table Supplies

Warm water
Exfoliation gloves
Exfoliation product
(seaweed based)
Body wash product
(seaweed based)
Body mist or skin toner
product (seaweed based)
Rich moisture cream
(seaweed based)
Soda cooler
Hot, moist towels
Dry hand towel
Dry Room Procedure

For each body area:
1. Dampen the body area with warm water.
2. Apply the body polish product with bare hands or
exfoliation gloves.
3. Apply the body wash product and work into a lather.
4. Remove the polish and body wash product with a hot,
moist towel.
5. Apply aroma mist or skin toner.
6. Blot the area dry with a soft hand towel.
7. Apply rich body cream with massage strokes.
8. Redrape the area and move onto the next area.
9. Finish the service with a neck and face massage and an
aura mist of a contrasting scent.
Wet Room Procedure
1. Wet the posterior body with the handheld shower and
apply the body wash product.
2. Rinse off the cleanser with the handheld shower.
3. Apply body polish with the hands to the posterior
body.
4. Rinse with the handheld shower (if a Vichy shower
is used, the rinse step can be a 10-minute contrast
shower).
5. Turn the client into the supine position and repeat
steps 1 to 4 on the anterior body.
6. Move the client to a massage table covered with massage sheets.
7. Apply the toner to the posterior body and blot with a
soft hand towel.
8. Apply moisture lotion, cream, or gel with massage
strokes to the posterior body.
9. Turn the client into the supine position.
10. Repeat steps 7 and 8 on the anterior body.
11. Provide a neck and face massage if desired.
12. Finish with an aura mist of a contrasting scent.
386
Williams_2E_Appendix A_printer_file.indd 386
10/24/13 12:57 AM
Appendix A
Zen Glow
387
(Salt Glow)
This lava luscious treatment combines massage with
heated volcanic stones; Chinese herbs; mineral salts; and
the fragrant oils of mandarin, sweet ginger, ylang ylang,
and lemon. Each body area is massage with warm stones
to release muscle tension before the skin is polished to a
radiant glow. Like yin and yang, the soft smoothness of
the oiled stones and pleasurably rough textures of salt and
herbs flow into and out of one another. Think tranquility!
Benefits
Decreased muscle
tension
Relaxation
Stress relief
Contraindications
Iodine or shellfish allergies (if seaweed is used as
a Chinese herb)
Skin conditions
Sunburn
Thyroid conditions
(if seaweed is used as a
Chinese herb)
Massage Table
Bath towel
Top massage sheet
warmth
Bolster
Work Table Supplies

Hot stone heating unit
Ten medium-sized basalt
stones
Massage oil (see recipe)
Sea salt and Chinese
herbs in a bowl or a
cheese shaker (see recipe)
Aroma mist (see recipe)
Finishing gel (see recipe)
Soda cooler
Hot, moist towels
Dry hand towel
Dry Room Procedure

For each body area beginning with the client prone:
1. Apply oil to the body area and massage the area with
heated stones.
2. Apply sea salt and Chinese herbs mixture and exfoliate
the area.
3. Remove the sea salt and herbs with a hot, moist towel.
4. Pat the area dry with a hand towel.
5. Apply the finishing gel in a thin layer.
6. Redrape the body area and move on to the next area.
7. At the end of the treatment, massage the neck and face
with the finishing gel.
8. Finish with an aroma mist in a high arch over the client
to fill the treatment room with a refreshing scent.
Notes
(2 drops), lemongrass oil (1 drop), turmeric oil
Zen Massage Oil: 1 fl oz sunflower oil, mandarin
(4 drops)
essential oil (7 drops), lemon oil (5 drops), ylang ylang oil Zen Finishing Gel: 2 fl oz aloe vera gel, mandarin
(2 drops), ginger CO2 oil (1 drop); CO2-produced ginger
(8 drops), patchouli (1 drop), tagetes (1 drop), sandalsmells sweeter than steam distilled ginger and provides a
wood (5 drops)
better base note for this particular smell-scape.
Zen Chinese Herbs Scrub: cup sea salt, 1 tbsp ground
Zen Body Mist: 1 oz purified water in a spritz bottle,
licorice root, 1 tbsp dried ginseng, 1 tbsp dried green tea
sandalwood oil (8 drops), gardenia (or ylang ylang) oil
leaves, 1 tbsp ground ginger
10/24/13 12:57 AM
388
Wine and Roses
(Sugar Glow)
Spoil yourself with an afternoon of wine and roses that
leave the body deeply relaxed and the skin replete with
moisture. Cane sugar mixed with red wine and olive oil is
slathered over the body to revitalize the skin and to prepare
the way for steamy rosemary towels and a dewy application
of damask flower water. A delightful Swedish massage with
Victorian rose cream completes the indulgence.
Benefits
Decreased muscle
tension
Relaxation
Stress relief
Contraindications
Skin conditions
Sunburn
Massage Table
Bath towel
Top massage sheet
warmth
Bolster
Work Table Supplies

Wine and roses polish
(see recipe)
Damask flower water in a
spritz bottle (see recipe)
Victorian rose cream
(see recipe)
Soda cooler
Hot, moist towels
(add 2 drops rosemary
essential oils)
Dry hand towel
Notes
Wine and Roses Polish: 1 cup cane sugar, cup red
wine, 1 tbsp extra virgin olive oil
Damask Flower Water: Purchase a damask rose
(species Rosa x damascena) hydrosol (flower water) from
an essential oil distributor and store it in the refrigerator between uses or add 1 drop of high-quality rose
essential oil to 1 fl oz of water in a spritz bottle.
Dry Room Procedure

For each body area beginning with the client prone:
1. Apply the wine and roses polish to the body area.
2. Remove the polish with a steamy rosemary towel.
3. Mist the area with damask flower water.
4. Blot dry with a hand towel.
5. Massage the area with Victorian rose cream.
6. Redrape the body area and move on to the next area.
7. At the end of the treatment, massage the neck and face
with the Victorian rose cream.
Victorian Rose Cream: 2 fl oz unscented body cream or

a professional vitamin C cream, rose oil (1 drop); alternative blend: rose oil (1 drop), violet leaf oil (2 drops),
lavender oil (6 drops), clary sage oil (2 drops), black
pepper oil (1 drop)
10/24/13 12:57 AM
Appendix A
Solar Glow
389
(Buff and Bronze Treatment)
You want a glowing tan, and you want to protect your skin
from the sun. The solar glow body treatment is the answer.
Your skin is polished to satiny smoothness and drenched
in moisture-rich creams before an expert application of a
professional autobronzing product. No orange finish here.
This treatment will leave you shimmering in radiant gold.
Benefits
Cosmetic purposes to
hide skin discolorations
Relaxation
Stress relief
To appear tan while
protecting the skin
from the sun
Massage Table
Bath towel
Top massage sheet
warmth
Bolster
Contraindications
Allergies to dihydroxyacetone (DHA) in bronzing
products
Skin conditions
Sunburn
Table Supplies
Bowl of warm water
Exfoliation product
Body wash product
Moisturizing product
Autobronzing product
Vinyl gloves
Buffing mitts
Soda coolers
Hot, moist towels
Dry Room Procedure

For each body area beginning with the client supine:
1. Exfoliate the body area.
2. Cleanse the body area.
3. Remove both products with a hot, moist towel.
4. Apply moisturizer to the body area.
Turn the client to the prone position:
1. Exfoliate the body area.
2. Cleanse the body area.
3. Remove both products with a hot, moist towel.
4. Apply moisturizer to the body area.
With the client still in the prone position:
1. Apply autobronzing product to each body area.
2. Allow the product to air dry.
3. Buff areas of the posterior body prone to streaking.
Turn the client back into the supine position:
1. Apply autobronzing product to each body area.
2. Allow the product to air dry.
3. Buff areas of the anterior body prone to streaking.
10/24/13 12:57 AM
390
Herbal Diet Right Wrap
(Hot Sheet Wrap)
This detoxification wrap is the perfect way to jump-start a
diet or fuel a diet that has hit a plateau. The session begins
with a Roman dry brush that stimulates circulation and
supports the natural detoxification mechanisms of the
body. Next, the body is warmed with a soothing foot bath
and hot herbal tea. Linen sheets steeped in rosemary,
juniper, ginger, clove, and sage are wrapped snugly around
the body to facilitate natural detoxification of excess body
fluid. The session ends with a relaxing application of seaweed firming lotion. Looking great never felt so good!
Work Table Supplies

1. Two dry brushes
2. Insulated gloves
3. Soda cooler
4. Wrap sheets
5. Herbal mixinfused hot water
6. Warm neck pillow
7. Warm pack for feet
10. Aroma mist
Benefits
Boosts energy
Boosts immunity
Can cause temporary
slimming effect
Revitalizing
Support natural
detoxification
mechanisms
Contraindications
Children
Elderly
Heart conditions
High blood pressure
If the client is in a weakened condition
Neurological conditions
Pregnancy
Systemic conditions
Vascular conditions
Dry Room Procedure

1. Dry brush posterior body areas.
2. Turn client and dry brush anterior body areas.
3. Move client to foot soak in robe and slippers.
4. Soak the feet and offer a cup of warm herbal tea.
5. Set up the table for the hot sheet wrap.
6. Wrap the client with the hot sheet wrap (process for
20 minutes).
7. Unwrap.
8. Apply cooling finishing gel anterior.
9. Turn client and apply cooling finishing gel posterior.
Massage Table
Wool blanket
Thermal space blanket
Fomentek hot water
bottle
Pillowcase to cover
Fomentek
Two bath towels
Bolster
Foot Soak
Comfortable chair
Side table
Warm herbal tea
Foot soak container with
soaking mixture
Robe and slippers
Dry hand towels
Notes
The Roman dry brush is simply a dry brush treatment
with the word Roman added for marketing purposes.
Spas also use the words Celtic dry brush for the same
reason.
10/24/13 12:57 AM
Appendix A
Caf Cocoon
391
(Hot Sheet Wrap)
Dont drink coffeebe wrapped in it! Coffee stimulates
circulation; decreases water retention; and tones, firms,
and conditions the skin. Coffee culture begins with a
revitalizing body buff and foot soak. Linen sheets, steeped
in a steaming French roast, envelop the body to slim and
soften. As a finishing touch, moisturizing lotion with
green tea and caffeine are smoothed on to protect the skin
from damaging sunlight.
Benefits
Boosts energy
Boosts immunity
Can cause temporary
slimming effect
Revitalizing
Skin firming
Support natural
detoxification
mechanisms
Contraindications
Children
Elderly
Heart conditions
High blood pressure
Pregnancy
Systemic conditions
Vascular conditions
Massage Table
Wool blanket
Fomentek hot water
bottle
Pillowcase to cover
Fomentek
Two bath towels
Massage sheets
Bolster
Foot Soak
Comfortable chair
Side table
Warm herbal tea
Foot soak container
Robe and slippers
Dry hand towels
Work Table Supplies

1. Exfoliation product
2. Warm water
3. Insulated gloves
4. Soda cooler
5. Hot, moist towels
6. Wrap sheets
7. Hot coffee mixture
8. Warm neck pillow
9. Warm pack for feet
10. Robe and washable slippers
13. Green tea and coffee finishing lotion
14. Aroma mist
Dry Room Procedure
1. Exfoliate posterior body areas and remove the product
with hot towels.
2. Turn client and exfoliate anterior body areas and
remove the product with hot towels.
3. Move client to foot soak in robe and slippers.
4. Soak the feet and offer a cup of warm herbal tea.
5. Set up the table for the hot sheet wrap.
6. Wrap the client with the hot sheet wrap (process for
20 minutes).
7. Unwrap.
8. Apply finishing lotion to the anterior body.
9. Turn client and apply finishing lotion to the posterior
body.
10/24/13 12:57 AM
392
Desert Nectar Honey Glaze
(Cocoon)
A relaxing body polish prepares the skin for the luxury of
pure Arizona honey and rich buttermilk spun to a golden
glaze. While enveloped in this nectar of the desert, enjoy a
firming face massage and soothing foot rub. Steamy rosemary towels and a cooling mist of chamomile water leave
the body drenched in moisture and radiant.
Benefits
Relaxation
Revitalization
Stress reduction
Contraindications
Massage Table
Cotton blanket
Massage sheet
Plastic wrap sheet
Two bath towels
Drape
Bolster
Work Table Supplies

Exfoliation product
Arizona honey glaze
Large application brush
Soda cooler
Hot, moist towels
Dry hand towels
Finishing lotion
Aroma mist
Notes
Arizona Honey Glaze: Mix cup honey with cup hot
water until it is dissolved. Add cup buttermilk.
Dry Room Procedure

1. Exfoliate posterior body.
2. Turn client and exfoliate anterior body.
3. Apply the honey glaze using the sit-up, flip-over, or
side-lying method.
4. Cocoon.
5. Massage the face.
6. Massage the feet.
7. Unwrap.
8. Remove product with hot towels.
9. Apply finishing product.
Chamomile hydrolate (flower water) can be bought

from an aromatherapy supplier, or you can add 1 drop
of German chamomile essential oil to 1 oz of purified
water in a bottle with a spritz top.
10/24/13 12:57 AM
Appendix A
Athlete Muscle Aid
393
(Cocoon)
If muscle pain and stiffness are slowing down your workouts, this treatment is right for you. A deep tissue massage
with sweet birch and bay laurel (essential oils that are well
known to decrease muscle pain) is enhanced with the latest
in spa technologya cryogenic sports mask. This tingly
mask helps to increase circulation in the regions where it is
applied, leaving your muscles refreshed and ready for action.
Benefits
Improved energy
Reduces muscle tension
Reduces muscle fatigue
Reduces muscle soreness
Relaxation
Stress reduction
Contraindications
in areas where cryogenic
mask is applied
Unexplained and sudden
muscle soreness/
weakness
Massage Table
Massage sheets
Blanket for warmth
Bolster
Work Table Supplies

Warm water
Cryogenic product
Massage oil
Notes
Cryogenic peel-away products rubberize when they are
mixed up with water. Break the cryogenic mix into four
parts in four different containers. Mix it up directly
before it is applied to each area to prevent it becoming
too rubbery to apply.
Dry Room Procedure

2. Mix up and apply cryogenic mask to back.
4. Mix up and apply cryogenic mask to legs.
5. Massage arms while client is in prone position.
6. Remove peel-away mask from back and legs.
7. Turn client into supine position.
8. Massage anterior legs and arms.
9. Mix up and apply cryogenic mask to thighs and arms.
11. Massage the neck and face.
12. Remove peel-away masks from arms and thighs.
Muscle Massage Oil: Add 4 drops of sweet marjoram,

6 drops of bay laurel, and 4 drops of sweet birch
essential oil to 1 fl oz of hemp seed oil or sunflower oil
(hemp seed oil is pain relieving and anti-inflammatory
but must be refrigerated between uses to prevent rapid
break down of the oil).
10/24/13 12:57 AM
394
Foot Loose Athlete Reprieve (Foot Treatment)

Whether youre a professional competitor, a weekend warrior, or you simply want a reprieve for your feet, the Foot
Loose Treatment will bring relief. The session begins with
a quick foot assessment aimed at identifying the stressors that make feet ache. Next, the feet are soaked in a
fizzy blend of menthol crystals and essential oils before
being scrubbed with an antiseptic tea tree buff. Soothing
foot massage with reflexology point work loosens tense
areas in the feet. Next, Moor mud, which is long used in
Europe for rheumatism, is applied in a generous layer before the feet are inserted into cozy heated booties. While
the feet absorb the healing properties of the mud, the
neck and shoulders are massaged.
Benefits
Reduces foot fatigue
Reduces foot pain
Relaxation
Revitalizes the body
Stress reduction
Contraindications
Athletes foot
Broken bones or recent
fractures
Circulatory conditions
Foot infections
Gout
Ingrown toenails
Neuropathy
Painful corns
Pitted edema
Warts
Massage Table
Massage sheets
Bath towel
Blanket for warmth
Pillow
Bolster
Foot Soak
Comfortable chair
Side table with beverage
Foot soak container
Foot scrub
Robe and slippers
Dry hand towels
Work Table Supplies

1. Cardboard (for foot assessment)
2. Pen
3. Scissors
4. Massage cream
5. Hand sanitizer
6. Petroleum jelly
7. Moor mud
8. Application brush
9. Soda cooler
10. Hot, moist hand towels
11. Cellophane wrap or plastic bags
12. Thermal booties plugged in
13. Finishing product
14. Aroma mist
Dry Room Procedure
1. Asses the feet with a quick foot assessment.
2. Soak and cleanse the feet.
3. Exfoliate the feet.
4. Move the client to the massage table.
6. Massage the feet with reflexology point work.
7. Apply Moor mud.
8. Wrap feet in plastic and place in thermal booties.
10. Remove Moor mud with hot, moist towels.
11. Apply a finishing product to the feet.
12. Aroma mist to end service.
Notes
Massage Lotion: 2 fl oz massage cream with bay laurel
Fizzy Menthol Soak: Purchase menthol crystals and cit(9 drops), sweet birch (4 drops), peppermint (2 drops),
ric acid from a soap-making outlet. Use a pinch of each
basil (2 drops), lemon (11 drops)
in a full basin of water.
Tea Tree Buff: Add 3 drops of tea tree essential oil to 1 tbsp
of exfoliation product just before applying it to the feet.
10/24/13 12:57 AM
Appendix A
395
Peppermint Beach Feet Tingle (Foot Treatment)

Tired? Run down? Do you need a day at the beach and just
cant find the time? This treatment aimed at refreshing the
feet and is lighthearted and upbeat! The feet commune
with the sea in an ocean soak with soothing seaweed. Next,
sea salt is applied in a vigorous buff that removes hardened
skin and stimulates circulation. A massage with aromatic
lotions and reflexology techniques prepares the feet for
the peppermint kelp mask that leaves feet refreshed and
tingly. While the mask works its magic, your therapist will
smooth hands with a gentle buff and a massage. This treatment is almost as fun as a day at the beach!
Work Table Supplies

1. Massage cream
2. Exfoliation product
3. Hand sanitizer
4. Petroleum jelly
5. Treatment product
7. Soda cooler
10. Finishing product
11. Aroma mist
Benefits
Reduces foot pain
Refreshing for feet
Relaxation
Stress reduction
Contraindications
Athletes foot
fractures
Foot infections
Gout
Ingrown toenails
Neuropathy
Painful corns
Pitted edema
Warts
Massage Table
Massage sheets
Bath towel
Blanket for warmth
Pillow
Bolster
Foot Soak
Comfortable chair
Foot soak container
Soaking product
Foot scrub
Robe and slippers
Dry hand towels
Dry Room Procedure

6. Apply peppermint kelp mask.
7. Wrap feet in plastic and a bath towel.
8. Exfoliate the hands and arms.
9. Remove with hot, moist towels.
10. Massage the hands and arms.
11. Remove the peppermint kelp mask with hot, moist
towels.
12. Apply a finishing product to the feet.
Notes
Peppermint products purchased from a spa supplier
work well, or you can make your own products with
these recipes.
Ocean Soak: cup of sea salt, 1 tsp of seaweed powder,
warm water; its nice to include polished ocean stones
and a clean, smooth-textured shell in the foot soaking
container.
Sea Salt Scrub: Mix 2 tbsp of foaming body wash with
sea salt just before applying it to the feet.
Peppermint Kelp Mask: Mix cup of powdered kelp
with cup of kaolin clay and add water until it reaches
the consistency of a thick paste. Add cup of aloe

vera gel or a light lotion and mix the formula until it
is smooth and creamy. Cover the mixture with plastic
wrap and heat it until it is warm. Add 1 drop of peppermint essential oil directly to the mixture before it is
applied to the feet.
Ocean Body Mist: Add 10 drops of mandarin, 3 drops
of basil, and 2 drops of sweet fennel to 2 oz of distilled
water in a mist bottle.
10/24/13 12:57 AM
396
The Garden Walk (Foot Treatment)

When feet need gentle relief, the Garden Walk foot treatment is the answer. A rose petal soak is followed by a
sweet sage foot buff and sunshine masque. Light and
calming reflexology point work is applied after the feet are
massaged with lavender lotion. Your hands are massaged,
dipped in softening paraffin, and wrapped in warm mitts.
This treatment is soft and soothing like a walk along a
shady garden path.
Benefits
Reduces foot pain
Refreshing for feet
Relaxation
Softening for hands
Stress reduction
Contraindications
Athletes foot
fractures
Foot infections
Gout
Ingrown toenails
Neuropathy
Painful corns
Pitted edema
Warts
Massage Table
Massage sheets
Bath towel
Blanket for warmth
Pillow
Bolster
Foot Soak
Comfortable chair
Foot soak container
Soaking product
Rose petals
Foot scrub product
Robe and slippers
Dry hand towels
Notes
Rose Petal Soak: Add foaming body wash and 1 drop
of rose essential oil to warm water and froth it into
bubbles. Sprinkle rose petals on top of the bubbles.
Sweet Sage Buff: 2 tbsp exfoliation cream, 1 drop clary
sage, 1 drop Spanish sage, 2 drops lavender, 3 drops
mandarin essential oil
Work Table Supplies

1. Massage cream
2. Paraffin warmer and wax
3. Microwave hand mitts
4. Hand sanitizer
5. Petroleum jelly
6. Treatment product
8. Soda cooler
11. Lavender powder (see recipe)
12. Aroma mist
Dry Room Procedure
6. Apply sunshine masque.
7. Wrap feet in plastic and a bath towel.
8. Exfoliate the hands and arms.
9. Remove with hot, moist towels.
10. Massage the hands and arms.
11. Paraffin dip the hands and place in warm mitts.
12. Remove the sunshine masque with hot, moist towels.
13. Apply a lavender powder to the feet.
14. Remove paraffin from the hands.
Sunshine Masque: cup milk powder, cup finely

ground oatmeal, 1 tbsp honey, 2 tbsp aloe vera gel,
4 drops of sweet orange essential oil; add warm water
until the mask achieves the consistency of a paste.
Lavender Foot Powder: 1 tbsp plain foot powder to 1 tsp
powdered lavender (powder the lavender in a coffee
grinder)
10/24/13 12:57 AM
Appendix A
397
Mindful Mud Cranium Care (Scalp and Face Treatment)

When was the last time you took care of your head? Thats
rightyour head! Every day, the muscles of the scalp and
face get a workout while we mull over the challenges in
our day-to-day life. Over time, tension builds up, and the
face and head feel tired and weary. Let your mind unwind
while the neck, face, and scalp are massaged with soothing aromatic oils. Let tension melt while warm mud is
slathered over the head to release everyday worries and
relax the entire body. Leave with a smile, revitalized, and
invigorated by your well-cared-for cranium!
Benefits
Reduces face tension
Reduces neck tension
Relaxation
Stress reduction
Contraindications
Broken skin on the scalp
Scalp condition
Unexplained severe
headache
Massage Table
Massage sheets
Plastic body wrap
Blanket for warmth
Rolled hand towel
Warm pack
Bolster
Work Table Supplies

Soda cooler
Hot, moist hand towels
Scalp oil in a warmer
Massage cream
Fango in a warmer
Comb
Hair clip
Plastic hair cover or
shower cap
Aroma mist
Dry Room Procedure

1. Comb out the hair if needed.
2. Steam the head and face with hot towels.
3. Massage the neck.
4. Massage the scalp.
5. Apply fango to the scalp.
8. Remove the fango from the hair.
10. Clip the hair up and cover with a plastic cap.
11. Aroma mist.
12. Move the client to a hair care professional for shampoo, cut, or style (optional).
Notes
Psyche Connection: 1 oz sunflower oil, neroli (2 drops),
Scalp Oil Options
mandarin (6 drops), patchouli (1 drop), clary sage
Brain Bliss: 1 oz sunflower oil, rosemary oil (1 drop),
(3 drops)
lavender oil (4 drops), grapefruit oil (6 drops), nutmeg
Clarity: 1 oz sunflower oil, rosemary (3 drops), geraoil (1 drop)
nium (1 drop), lemon (5 drops), lavender (3 drops)
Mindful Spirit: 1 oz sunflower oil, frankincense (3 drops),
sandalwood (4 drops), jasmine (1 drop), sweet orange
(4 drops)
10/24/13 12:57 AM
398
Adobe Purification Ritual (Fango Treatment)

This specialized treatment inspired by Native American
healing uses the rich red clay of Sedona. A stimulating
exfoliation with blue corn and a cactus cloth is followed
by an application of the clay to the entire body. The clay
draws impurities from the skin, soothes muscle tension,
and relaxes the spirit. Warm juniper oil is massaged into
muscles to complete this healing experience.
Benefits
Relaxation
Revitalization
Stress reduction
Supports natural
detoxification
mechanisms
Contraindications
Children
Elderly
Heart conditions
High blood pressure
Pregnancy
Systemic conditions
Vascular conditions
Massage Table
Cotton blanket
Massage sheet
Plastic wrap sheet
Two bath towels
Drape
Bolster
Work Table Supplies

Exfoliation product
Sedona clay mixed up
and in a warmer
Soda cooler
Hot, moist towels
Dry hand towels
Finishing lotion
Juniper massage oil
Plain massage cream
Aroma mist
Dry Room Procedure

3. Apply the Sedona clay using the sit-up, flip-over, or
side-lying method.
4. Cocoon.
5. Massage the face with plain massage cream.
7. Unwrap.
9. Massage body with juniper massage oil.
Notes
Blue Corn Polish: cup ground blue corn, cup plain
Sage Sauna or Steam: You might begin this session with
moisture cream, 1 tbsp plain body wash
the client relaxing in a sage sauna or sage steam.
Juniper Massage Oil: 1 oz massage oil, juniper berry oil
For a sage sauna, add 2 drops of common sage (Salvia
(6 drops), lavender oil (3 drops)
officinalis) and 1 drop of rosemary to 2 cups of water.
Use this water on the heat source in the sauna or use the
blend without water in a steam room.
10/24/13 12:57 AM
Appendix A
399
Dead Sea Delight (Fango Treatment)

The Dead Sea region is a unique environment that yields
a therapeutic mud famous throughout the world for its
mineral-laden healing properties. The body is buffed with
Dead Sea salts and enveloped in warm mud to absorb
nutrients essential to the body. Muscle tension melts as
the skin is rinsed clean of impurities and rich creams are
applied to seal in moisture.
Benefits
Relaxation
Revitalization
Stress reduction
Supports natural
detoxification
mechanisms
Contraindications
Children
Elderly
Heart conditions
High blood pressure
Pregnancy
Systemic conditions
Vascular conditions
Massage Table
Cotton blanket
Massage sheet
Plastic wrap sheet
Two bath towels
Drape
Bolster
Work Table Supplies

Dead Sea salt in a cheese
shaker
Dead Sea mud in a
warmer
Soda cooler
Hot, moist towels
Dry hand towels
Finishing lotion
Rich cream or body
butter
Plain massage cream
Aroma mist
Notes
A variety of different support products made with salts
from the Dead Sea region are available through spa
Dry Room Procedure

3. Apply the Dead Sea mud using the sit-up, flip-over, or
side-lying method.
4. Cocoon.
5. Massage face with plain massage cream.
7. Unwrap.
9. Massage with rich cream or body butter.
suppliers. If you want to create a smell-scape or use

plants indigenous to Israel, you might include products
with olive, fig, citrus fruits, and avocado.
10/24/13 12:57 AM
400
Moor Back Treatment (Fango Treatment)

Back pain can slow down your day and leave you feeling
drained and irritable. This treatment using the healing
peat from the Austrian Moors will bring relief from pain
and revitalize your spirit. A 30-minute deep tissue massage and application of essential oils aimed at the muscular system completes this service.
Benefits
Reduces muscle pain
Relaxation
Stress reduction
Contraindications
Acute musculoskeletal
injury
on the back
Posterior leg pain from
an undiagnosed cause
Severe undiagnosed back
pain
Massage Table
Massage sheets
Bath towel
Blanket for warmth
Bolster
Work Table Supplies

Body cleanser
Exfoliation product
Bowl of warm water
Moor mud in a warmer
Application brush or
vinyl gloves
Plastic body wrap cut to
cover the back
Warm pack
Soda cooler
Finish product
Skin toner
Cosmetic sponges
Aroma mist
Notes
Essential Oil Blends Ideas for the Moor Back Treatment
Body Balance Blend: 2 fl oz massage oil, essential oils of
rosemary (4 drops), lavender (7 drops), lemongrass
(2 drops), clary sage (5 drops), mandarin (12 drops)
Overworked Muscles: 2 oz massage oil (hemp seed oil is
ideal), essential oils of bay laurel (8 drops), eucalyptus
Dry Room Procedure

1. Apply steamy towels to the back.
2. Cleanse the back.
3. Exfoliate the back.
4. Remove the products with hot towels.
6. Remove massage lubricant with skin toner and cosmetic sponges.
7. Apply Moor mud to the back and cover with plastic.
8. Drape the back over the plastic.
9. Apply a warm pack to the back over the drape.
10. Massage the posterior legs and feet.
11. Remove the Moor mud with hot towels.
12. Apply a finishing product.
14. Massage the neck, shoulders, and face.
15. Aroma mist.
(2 drops), CO2 ginger (1 drop), lemon (10 drops), white

camphor (4 drops; it must be white camphor, not yellow
or brown), myrrh (5 drops)
Burnout Relief: 2 fl oz massage oil, essential oils of
geranium (2 drops), grapefruit (15 drops), lavender
(7 drops), cypress (5 drops), clove (1 drop)
10/24/13 12:57 AM
Appendix A
401
Sulfur Mud Pack (Fango Treatment)

Do you experience achy joints and chronic muscular pain?
If the answer is yes, then this healing treatment using the
sulfur muds from Europe may bring some relief. In Europe,
mud is used to treat arthritis and muscle pain with remarkable results. The warm mud will be packed on areas of
tension to warm the tissue and to bring its special healing
properties to the body. Swedish and deep tissue massage
techniques release tense muscles and calm the spirit.
Benefits
Reduces muscle pain
Relaxation
Stress reduction
Contraindications
Acute musculoskeletal
injury
Posterior leg pain from
an undiagnosed cause
Severe undiagnosed back
or leg pain
Massage Table
Massage sheets
Bath towel
Blanket for warmth
Bolster
Work Table Supplies

Bowl of warm water
Sulfur mud in a warmer
vinyl gloves
cover the back
Plastic body wrap cut
to cover the posterior
thighs
cover the anterior thighs
Warm pack
Soda cooler
Finishing product
Skin toner
Cosmetic sponges
Aroma mist
Dry Room Procedure

1. Apply steamy towels to the back.
4. Apply sulfur mud to the back and cover with plastic.
5. Drape the back over the plastic.
6. Apply a warm pack to the back over the drape.
7. Massage the posterior legs.
9. Apply sulfur mud to the posterior thighs.
10. Cover the thighs with plastic.
11. Drape the legs.
12. Place warm packs over the thighs.
13. Remove the sulfur mud from the back with hot
towels.
15. Remove the sulfur mud from the posterior thighs
with hot towels.
20. Apply sulfur mud to the anterior thighs.
21. Cover the thighs with plastic.
22. Drape the legs.
23. Place warm packs over the thighs.
26. Remove the sulfur mud from the anterior thighs with
hot towels.
29. Aroma mist.
10/24/13 12:57 AM
402
French Thalassotherapy (Seaweed Treatment)

The finest seaweeds from the coast of Brittany are used
in traditional methods to relax and revitalize the body. A
sea salt exfoliation is followed by a purifying kelp mask
that supports natural detoxification and firms the skin.
Vitamin-rich creams are massaged into the skin to finish
this elegant and graceful treatment.
Benefits
Relaxation
Revitalization
Stress reduction
Contraindications
Iodine or shellfish
allergies
Thyroid disorders
Massage Table
Cotton blanket
Massage sheet
Plastic wrap sheet
Two bath towels
Drape
Bolster
Work Table Supplies

Sea salt in a cheese
shaker
Massage oil
Seaweed treatment
product
Soda cooler
Hot, moist towels
Dry hand towels
Finishing product
Aroma mist
Dry Room Procedure

3. Apply the seaweed treatment product using the sit-up,
flip-over, or side-lying method.
4. Cocoon.
7. Unwrap.
9. Apply finishing product.
10/24/13 12:57 AM
Appendix A
403
Sea Sculpt (Seaweed Treatment)

Slim the silhouette with revitalizing elements from the sea.
This service targets problem areas such as the hips, thighs,
belly, and upper arms with powerful seaweeds and essential
oils. First, a vigorous dry brush stimulates stagnation prone
areas. A cellulite cream rich in essential oils and natural
botanicals and the application of stimulating seaweeds
support the natural detoxification processes of the body to
support the movement of fluid in areas of the hips, thighs,
belly, and upper arms. An application of firming gel finishes
this service and leaves the body feeling radiant and toned.
Benefits
Reduces bloating or
puffiness in target areas
Relaxation
Revitalization
Stimulates the natural
detoxification
mechanisms of the body
Temporarily diminishes
the appearance of cellulite
Temporarily slims the
contours of the body
Contraindications
High or low blood
pressure
Iodine or shellfish
allergies
Pregnancy
Thrombosis or deep vein
thrombosis
Thyroid disorders
Varicose veins
Massage Table
Cotton blanket
Massage sheet
Plastic body wrap
Two bath towels
Drape
Bolster
Work Table Supplies

Two dry brushes
Cellulite cream
Seaweed in a warmer
vinyl gloves
Firming product
Skin toner
Cosmetic sponges
Soda cooler
Aroma mist
Dry Room Procedure

2. Remove exfoliation product with hot towels.
3. Apply a skin toner to posterior body areas.
4. Apply cellulite cream to target areas of the posterior
body.
9. Apply cellulite cream to target areas of the anterior
body.
11. Cocoon the client to process in the seaweed.
14. Remove the seaweed and move the client to a clean
massage sheet.
15. Apply firming cream to anterior and posterior body
areas.
16. Aroma mist.
yellow camphor contain high concentrations (up to 80%)

Notes
of safrole, which is toxic and carcinogenic. White cam A variety of seaweed-based slimming and firming prodphor contains no safrole and is considered nontoxic and
ucts are available from spa suppliers, or you can make
nonirritant. All three camphors are fractions obtained
your own with these recipes.
during the distillation of Cinnamomum camphora. White
Slimming Massage Oil: Warm 16 fl oz of sunflower oil
camphor is the lightest fraction (lowest boiling point)
slowly on the stovetop and add 2 tbsp of seaweed powand should be colorless to very pale yellow.
der. Mix the powder into the oil over the heat for about
20 minutes. Store the mixture in a glass bottle for 1 week Cellulite Activating Cream: Mix 2 oz of plain massage
cream with grapefruit (20 drops), clove (2 drops), sweet
and shake the bottle daily. Filter the excess seaweed
fennel (4 drops), and Spike lavender (12 drops).
through a coffee filter and place the filtered oil in 2fl
oz bottles. Add the following essential oils to each of the Seaweed Firming Gel: 2 oz plain seaweed gel (search
spa suppliers and find one that is meant to be used as
2-oz bottles: grapefruit (25 drops), thyme (2 drops), junia body gel and not removed after a processing period),
per berry (5 drops), and white camphor (3 drops). Essenjuniper berry (5 drops), sweet fennel (5 drops), grapetial oil safety note: It is important to use white camphor
fruit oil (26 drops).
rather than brown or yellow camphor. The brown and
10/24/13 12:57 AM
404
Mermaid Shimmer (Salt Glow and Seaweed Treatment)

Feeling scaly and water logged? This combination of
treatments filled with the benefits of sea products is more
relaxing than a day at the beach! The body is descaled
with an invigorating Dead Sea mineral scrub. Next, target
areas are massaged with a firming cream to increase
local circulation and reduce water retention. The body is
cocooned in a thick kelp mask while the feet are massaged
with essential oils and reflexology techniques. To finish
the service, rich creams are massaged into the body to
relieve muscle tension and deeply hydrate the skin.
Benefits
Skin firming
Reduces bloating or
puffiness in target areas
Relaxation
Revitalization
Stimulates the natural
detoxification
mechanisms of the body
Temporarily diminishes
the appearance of cellulite
Temporarily slims the
contours of the body
Contraindications
High or low blood
pressure
Iodine or shellfish
allergies
Pregnancy
Thrombosis or deep vein
thrombosis
Thyroid disorders
Varicose veins
Massage Table
Cotton blanket
Massage sheet
Plastic body wrap
Two bath towels
Drape
Bolster
Work Table Supplies

Sea salt in a cheese
shaker
Massage oil
Firming cream
Seaweed in a warmer
vinyl gloves
Skin toner
Cosmetic sponges
Soda cooler
Aroma mist
Dry Room Procedure

3. Apply a skin toner to posterior body areas.
9. Cocoon the client to process in the seaweed.
12. Remove the seaweed and move the client to a clean
massage sheet.
13. Perform a full-body massage using firming cream as
the lubricant.
14. Aroma mist.
10/24/13 12:57 AM
Appendix A
405
Body Stone Balance (Hot Stone Massage)

Experience the elegance of a hot stone massage and restful botanicals combined together in a treatment that
delights the senses and soothes the soul. The warmth of
the stones relaxes tight muscles and eases pain, whereas
the scents of fruits and flowers calm the nervous system
and return the whole body to balance.
Benefits
Reduces muscle pain
Relaxation
Stress reduction
Contraindications
Children
Elderly
Fibromyalgia
Heart condition
High-risk or first-term
pregnancy
Poorly managed or advanced diabetes
Massage Table
Massage sheets
Large bath towel
Bolster
Work Table Supplies

Stone set
Slotted spoon
Bowl of ice with four
medium stones for
vascular flush technique
(optional)
Thermometer
Pitcher of cool water
Massage oil
Aroma mist
Hand towels
Small bowl of hot, soapy
water for toe stones
Notes
You can describe this hot stone relaxation massage a
number of different ways and give it different titles.
For example, Body Stone Balance, River Rock Massage,
Desert Stone Massage, Serenity Stone Massage, Lava
Stone Therapy, and Hot Stone Therapy are just a few of
the names that can be used for this service.
Essential Oil Blends: You can choose to use one of the
blends described here for the massage oil and one blend
for the aroma mist to provide an interesting smell-scape
for the client.
Dry Room Procedure

1. Place posterior stones.
2. Massage the legs.
3. Remove back stones.
6. Place anterior stones.
8. Remove the toe stones and foot stones.
10. Remove the stones from the upper chest.
11. Remove the neck stone (if applicable).
13. Massage the abdominal muscles (optional).
15. Remove all stones from the client.
16. Aroma mist.
Symmetry: 2 fl oz carrier product, frankincense

(5 drops), mandarin (10 drops), rose (1 drop), sweet
birch (3 drops), clove (1 drop)
Body Boost: 2 fl oz carrier product, grapefruit (10 drops),
neroli (2 drops), myrrh (6 drops), thyme (1 drop)
Botanical Balance: 2 fl oz carrier product, lavender
(10 drops), patchouli (4 drops), rosemary (3 drops),
sweet orange (14 drops)
Fatigue Fighter: 2 fl oz carrier product, rosemary
(4 drops), geranium (2 drops), lemon (15 drops),
cardamom (8 drops)
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406
Solar Stone Glow (Stone Massage and Salt Glow)

The warmth of the sun is felt in the luxurious weight of
hot stones placed strategically on the body. The stones,
like liquid heat, glide over the skin and relax tight muscles. After each area of your body is soothed with stone
massage, your therapist will apply a rich emollient polish
to the skin and then steam it with hot towels. This treatment will leave you with a radiant glow and a soul alight.
Benefits
Reduces muscle pain
Relaxation
Stress reduction
Contraindications
Children
Elderly
Fibromyalgia
Heart condition
High-risk or first-term
pregnancy
Poorly managed or advanced diabetes
Massage Table
Massage sheets
Large bath towel
Bolster
Work Table Supplies

Stone set
Slotted spoon
Bowl of ice with four
medium stones for
vascular flush technique
(optional)
Thermometer
Pitcher of cool water
Massage oil
Emollient body polish
product
Hot, moist towels
Soda cooler
Aroma mist
Hand towels
Small bowl of hot soapy
water for toe stones
Bowl of hot soapy water
for exfoliation stones
Dry Room Procedure

1. Place posterior stones.
2. Massage the legs.
3. Apply emollient exfoliation product and exfoliate
with two medium stones.
4. Remove the product with hot, moist towels.
5. Remove back stones.
10. Place anterior stones.
14. Remove the toe stones and foot stones.
18. Remove the stones from the upper chest.
19. Remove the neck stone (if applicable).
23. Massage the abdominal muscles (optional).
25. Remove all stones from the client.
26. Aroma mist.
Notes
Place exfoliation stones into hot, soapy water after use
Use an emollient product in a creamy base. Avoid rough
and not into the heating unit. They will gum up the
products such as sea salt because they are too scratchy
edges of the heating unit and the other stones if they
when applied with stones.
are placed directly back into the heating unit.
10/24/13 12:57 AM
APPENDIX B
Essential Oils and Their Botanical Names*
*Oils colored light blue are the preferred species for use in aromatherapy or are the oils referred to in
this text under that particular common name.
Common Name
Botanical Name and Authority
Common Name
Allspice
Pimenta dioica (L.) Merr.
Eucalyptus dives
Eucalyptus dives Schauer
Amyris
Amyris balsamifera L.
Eucalyptus lemon
Eucalyptus citriodora Hook
Angelica
Angelica archangelica L.
Eucalyptus smithii
Eucalyptus smithii R.T. Baker
Balsam fir
Abies balsamea (L.) Miller
Eucalyptus radiata
Eucalyptus radiata Labill.
Basil eugenol
Ocimum gratissimum L.
Fennel sweet
Basil reunion (exotic)
Ocimum basilicum L.
Foeniculum vulgare Miller var. dulce

Battand & Trabut
Basil sweet
Ocimum basilicum L.
Fir needle silver
Abies alba Miller
Basil tyymol
Ocimum gratissimum L.
Frankincense
Boswellia carteri Birdw.
Bay laurel
Laurus nobilis L.
Galbanum
Ferula gummosa Boiss.
Benzoin
Styrax benzoin Dryander
Geranium
Pelargonium graveolens LHrit.
Bergamot
Citrus x bergamia Risso Poit
Ginger
Zingiber ofcinale Roscoe
Black pepper
Piper nigrum L.
Grapefruit
Citrus x paradisi Macfady
Cabbage rose
Rosa x centifolia L.
Helichrysum
Helichrysum italicum (Roth) G.Don.f.
Cade
Juniperus oxycedrus L.
Hyssop
Hyssopus ofcinalis L.
Cajeput (or cajuput)
Melaleuca cajuputi Powell
Jasmine
Caraway
Carum carvi L.
Jasminum ofcinale L. form

grandiorum (L.) Kobuski
Elettaria cardamomum (L.) Maton
Jasmine
Cardamom (or cardomon)
Jasminum sambac (L.) Aiton
Carrot seed
Daucus carota L.
Cassia
Cinnamomum aromaticum Nees
Cassie
Acacia farnesiana (L.) Willd.
Catnip
Nepeta cataria L.
Cedar texas
Juniperus ashei Buchholz
Cedar virginian
Juniperus virginiana L.
Cedarwood atlas
Chamomile German
Juniper
Juniperus communis L.
Lavandin
Lavandula x intermedia Emeric ex Lois.
Lavender spike
Lavandula latifolia Medik
Lavender English or true
Lavandula angustifolia Miller
Lemon
Citrus x limon (L.) Osb.
Lemongrass East Indian
Cymbopogon exuosus (Steudel)

W. Watson
Cedrus atlantica (Endl.) Carr.
Lemongrass West Indian
Cymbopogon citratus (DC) Stapf
Matricaria recutita (L.) Rauschert
Lime
Citrus x aurantiifolia (Christm.) Swingle
Chamomile maroc
Chamaemelum multicaulis
Linden
Chamomile Roman
Chamaemelum nobile (L.) All.
Tilia x europaea L. (old name or

T. x vulgaris)
Cinnamon
Cinnamomum verum J. Presl.
Litsea
Litsea cubeba (Lour.) Pers.
Clary sage
Salvia sclarea L.
Mandarin
Citrus reticulata Blanco
Clove bud
Syzygium aromaticum (L.) Merr. & Perry
Marjoram Spanish
Thymus mastichina L.
Copaiba balsam
Copaifera ofcinalis (Jacq.) L.
Marjoram sweet
Origanum majorana L.
Coriander
Coriandrum sativum L.
Melissa lemon balm
Melissa ofcinalis L.
Cypress
Cupressus sempervirens L.
Mimosa
Acacia dealbata Link
Dill
Anethum graveolens L.
Mint cornmint
Mentha arvensis L.
Elemi
Canarium luzonicum (Blume) A. Gray
Mint peppermint
Mentha x piperita L.
Eucalyptus bluegum
Eucalyptus globulus Labill.
Mint spearmint
Mentha spicata L.
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408
Common Name
Common Name
Myrrh
Commiphora myrrha (Nees) Engl.
Sage Spanish
Salvia lavandulifolia Vahl
Myrtle
Myrtus communis L.
Sandalwood
Santalum album L.
Niaouli
Melaleuca quinquenervia (Cav.)

S.T. Blake
Savory summer
Satureja hortensis L.
Savory winter
Satureja montana L.
Spikenard
Nardostachys grandiora DC
Spruce Canadian
Picea mariana (Miller) Britton
Spruce hemlock
Tsuga canadensis (L.) Carrire
Sweet birch
Betula lenta L.
Nutmeg
Myristica fragrans Houtt.
Orange bitter
Citrus x aurantium L. amara
Orange blossom (niroli)
Orange pettigrain
Orange sweet
Citrus sinensis (L.) Osbeck
Origanum
Origanum heracleoticum Benth.
Palmarosa
Cymbopogon martinii (Roxb.) W. Watson
Patchouli
Pogostemon cablin (Blanco) Benth.
Pennyroyal
Mentha pulegium L.
Peru balsam
Myroxylon balsamum var. pereirae

(Royle) Harms
Pine dwarf
Pinus mugo Turra.
Pine longleaf
Pinus palustris Miller
Pine Scots
Pinus sylvestris L.
Ravensara
Cryptocarya aromatica (Becc.) Costerm

(or Ravensara aromatica Sonn.)
Tagetes
Tagetes minuta L.
Tarragon
Artemisia dracunculus L.
Tea tree
Melaleuca alternifolia Cheel.
Thuja white cedar
Thuja occidentalis L.
Thyme sweet (linalol type)
Thymus vulgaris L.
Thyme Moroccan
Thymus saturejoides Coss. & Balansa
Tolu balsam
Myroxylon balsamum (L.) Harms
Turmeric
Curcuma longa L.
Vanilla
Vanilla planifolia Andr.
Vetiver
Vetiveria zizanioides (L.) Nash
Violet
Viola odorata L.
West Indian Bay
Pimenta racemosa (Miller) J. Moore
Rock rose
Cistus ladanifer L.
Rose
Rosa x damascena Miller
Wintergreen
Gaultheria procumbens L.
Rosemary
Rosmarinus ofcinalis L.
Yarrow
Achillea millefolium L.
Rosewood
Aniba rosaeodora Duke
Ylang ylang
Sage common
Salvia ofcinalis L.
Cananga odorata (Lam.) Hook.f. &

Thomson
Williams_2E_Appendix B_printer_file.indd 408
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APPENDIX C
Resources
This list represents a small selection of suppliers, associations, and courses. Spa Bodywork does not endorse
any particular product or company.
General Equipment and Supplies

American Salon and Spa
1-888-230-2040
http://www.americansalonandspa.com
Bio Jouvance
http://www.biojouvance.com
Heat Inc. Spa Kur Therapy Development
1-800-473-4328
http://www.h-e-a-t.com
International Beauty and Barber Equipment
1-800-824-7007
http://www.ibbe.net
Dr. Hauschka Skin Care, Inc.

1-800-247-9907
http://www.drhauschka.com
MD Formulations
http://www.mdformulations.com
PHYTOMER
http://www.phytomer.com
SkinCeuticals
1-800-811-1660
http://www.skinceuticals.com
SpaSkin
http://www.spaskin.com
Massage Warehouse
1-855-425-0985
http://www.massagewarehouse.com
Many Others: Try the search terms spa skin care, skin spa, or
professional skin care.
New Life Systems

1-800-852-3082
http://www.newlifesystems.com
Specialized Products
Skin for Life Salon and Spa Products

1-866-312-7546
http://www.skinforlife.com
TouchAmerica
1-800-678-6824
http://www.touchamerica.com
Universal Companies, Inc.
1-800-558-5571
http://www.universalcompanies.com
Many Others: Try the search terms salon and spa equipment, spa
equipment and supplies, or hydrotherapy equipment.
Skin Care Lines

Aveda
1-800-644-4831
http://www.aveda.com
Bidwell Botanicals
1-888-360-3398
http://www.bidwellbotanicals.com
Bioelements
http://www.bioelements.com
Cellex-C
http://www.cellex-c.com
Decleor
http://www.decleor.com
ABANOterme Bath and Beauty

http://www.abanousa.com
African Shea Butter Company
http://www.africansheabuttercompany.com
Amana Essentials (aromatherapy and products for spas)
http://www.amanaessentials.com
Argiletz Clays
http://www.argiletz.com
Australias Earth Beauty Clays and Minerals
http://www.australiasearth.com.au
Banyan Botanicals (ayurveda products)
http://www.banyanbotanicals.com
Dead Sea Cosmetics Company
http://www.deadsea-cosmetics.com
Diamond Way Ayurveda
(ayurveda trainings and equipment)
http://www.diamondwayayurveda.com
Elizabeth Van Buren Aromatherapy (aromatherapy,
natural products, bases, carriers, and trainings)
1-800-710-7759
http://www.evb-aromatherapy.com
Essential Aura (aromatherapy, natural products, bases, and
carriers)
250-758-9464
http://www.essentialaura.com
409
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410
Essential Wholesale (oils, butters, clay, seaweed)

http://www.essentialwholesale.com
Reflexology
Fragrant Earth Aromatherapy

http://www.fragrant-earth.co.uk
American Reflexology Certification Board (ARCB)

303-933-6921
http://www.arcb.net
Golden Moor
613-764-6667
http://www.goldenmoor.com
Spa Business Sites
Kerala Ayurvedic Pharmacy (products directly

from India)
http://www.keralayurveda.biz
Moor Spa Moor Mud Products
http://www.moorspa.co.uk
Natures Body Beautiful Clay
http://www.naturesbodybeautiful.com
Original Swiss Aromatics (aromatherapy and trainings)
415-479-9120
http://www.originalswissaromatics.com
Pascalite Clay
http://www.pascaliteclay.com
Premier Dead Sea Company (Dead Sea products,
salts, and mud)
http://www.premierdeadsea.com
Purely Shea (shea butter)
http://www.purelyshea.com
Repechage Beauty from the Sea (seaweed products)
http://www.repechage.com
SaltWorks (Dead Sea and other spa and bath salts)
http://www.saltworks.us
Samara Botane (aromatherapy, natural products, and
trainings)
1-800-782-4532
http://www.wingedseed.com
San Francisco Bath Salt Company
http://www.sfbsc.com
Shea Butter Hut
http://www.sheabutterhut.com
Skin Mind Body (SMB) Essentials (seaweed powders and
more)
http://www.smbessentials.com
Thalgo Marine Beauty (seaweed products)
http://www.thalgo.co.uk
The Ayurveda Company (products)
http://www.bytheplanet.com
Torf Spa Organic Moor Mud
1-877-811-1008
http://www.torfspa.com
WellNaturally Products (seaweed powder, clay powder,
bulk lotions)
http://www.wellnaturally.com
Many Others: Try the search term ayurveda products and supplies.
Williams_2E_Appendix C_printer_file.indd 410
MedSpa Solutions (spa consulting, products)

http://www.medspaadvisors.com
Plus One (spa design and management)
http://www.plusonehealthmanagement.com
Preston, Inc. (spa consulting)
http://www.prestoninc.net
SpaElegance (a resource site for the spa business or therapist)
http://www.spaelegance.com
SpaEquip (equipment, consulting, products)
http://www.spaequip.com
SpaTrade (a resource site for the spa business or therapist)
http://www.spatrade.com
Many Others: Try the search terms spa consulting, spa management,
or spa business.
Spa Associations
Day Spa Association
http://www.dayspaassociation.com
International Spa Association
http://www.experienceispa.com
Search for Spas

About Spas
http://www.spa.about.com
SpaFinder Wellness
http://www.spafinder.com
The Spas Directory
http://www.thespasdirectory.com
Massage and Spa Membership

Associations
American Massage Therapy Association
(membership and liability insurance)
1-877-905-0597
http://www.amtamassage.org
Associated Bodywork and Massage Professionals
(membership and liability insurance)
1-800-458-2267
http://www.abmp.com
Associated Skin Care Professionals (membership and
liability insurancesister company of Associated
Bodywork and Massage Professionals)
1-800-458-2267
http://www.ascpskincare.com
10/24/13 12:58 AM
APPENDIX D
Ready-to-Copy Forms
Spa Health Information

Patient Name
Date
Address
State
Phone
Zip
Occupation
Emergency Contact
Phone
Primary
Pr
rimary Health Care Provider
Name
Phone
Address
State
Zip
Current
C
urrent Health Information
Please list all conditions currently monitored by a health care provider.
Please list the medications you took today (include pain relievers and herbal remedies).
Please list the medications you took in the last 3 months.
Please list and briefly explain (including dates and the treatment received) the following:
Surgeries
Accidents
Major Illnesses
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412
Tobacco Use: Current Past
Comments
Alcohol Use:
Current Past
Comments
Drug Use:
Current Past
Comments
Are you currently menstruating?
Yes
No
Have you received a spa treatment before?
Yes
No
If yes, what types of spa treatments have you received?
Current
C
urrent and Previous Conditions
Please check all current and previous conditions and give a brief explanation, if appropriate, in the comments section at
the end of this form.
Current
Past
Headache
Pain
Sleep disorders
Fatigue
Infections
Fever
Sinus condition
Skin conditions
Athletes foot
Warts
Skin sensitivities
Sunburn
Burns
Bruises
Aversion to scents
Aversion to oils
Allergies
Sensitivity to detergents
Aversion to heat
Other Conditions:
Current
Past
Current
Aversion to cold
Claustrophobia
Osteoarthritis
Spinal problems
Disc problems
Lupus
Tendonitis, bursitis
Fibromyalgia
Dizziness, ringing in ears
Mental confusion
Numbness, tingling
Neuritis
Neuralgia
Sciatica, shooting pain
Depression
Anxiety, panic attacks
Heart disease
Blood clots
Past
Stroke
Lymphedema
High blood pressure
Low blood pressure
Poor circulation
Swollen ankles
Varicose veins
Asthma
Bowel dysfunction
Bladder dysfunction
Abdominal pain
Thyroid dysfunction
Diabetes
Pregnancy
Cancer
Fibrotic cysts
Pacemaker
Phlebitis
Raynauds syndrome
Therapists Name:
Signature:
Date:
Comments:
10/24/13 12:59 AM
Appendix D
Ready-to-Copy Forms
413
Spa Treatment Record

CLIENT NAME:
Date:
PHONE:
Therapist:
Comments:
Retail Items Purchased:
Therapist:
Comments:
Therapist:
Comments:
Therapist:
Comments:
Therapist:
Comments:
Therapist:
Comments:
Treatment Received:
Date:
Treatment Received:
Date:
Treatment Received:
Date:
Treatment Received:
Date:
Treatment Received:
Date:
Treatment Received:
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414
Treatment Design Form

Treatment Name:
THE SPAS OVERALL CONCEPT
THE SPAS PRIMARY STRENGTH
THE TREATMENT
INSPIRATION
TREATMENT GOALS
INDICATIONS
CONTRAINDICATIONS
CORE TREATMENTS
ENHANCERS/EXTRAS
MUSIC/SOUND
VISUAL ELEMENTS
Textural Elements
SMELL-SCAPE
Supplies and Equipment
PRODUCT CHOICES
SPECIAL EQUIPMENT
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Appendix D
Treatment / Transition / Client Management Steps
Ready-to-Copy Forms
415
Notes
Comments
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416
Dosha Questionnaire
CLIENT NAME:
DATE:
Section 1: Prakriti
Directions: Choose the answer that describes you the most accurately. No answer may fit perfectly so simply make the
best possible choice with the answers provided.
Place a V, P, or K in the box to the left.
My size at birth was small. (V)
My size at birth was average. (P)
My size at birth was large. (K)
I am thin and either short or very tall. (V)
I am of medium height and body. (P)
I am tall and sturdy or short and stocky. (K)
I have difficulty gaining weight. (V)
I gain or lose weight easily. (P)
I tend to gain weight easily. (K)
I have long, tapering fingers and toes. (V)
I have fingers and toes of medium length. (P)
I have square hands and shorter fingers and toes. (K)
I have knobby, prominent joints. (V)
I have well-proportioned joints. (P)
I have large, well-formed joints. (K)
I have a delicate chin and small forehead. (V)
I have a moderate chin and a medium forehead that has a tendency toward lines and folds. (P)
I have a large jaw and large forehead. (K)
I have uneven or buck teeth that are sensitive to either hot or cold. (V)
I have even teeth of medium or small size that tend to yellow. (P)
I have large, white, even teeth. (K)
My lips are thin and narrow. (V)
My mouth is of medium size. (P)
My lips are full. (K)
My skin is dry, rough, and cold to touch. (V)
My skin is fair, soft, and warm to touch. (P)
My skin is pale, cold, clammy, and tends to be oily. (K)
My hair is fine, coarse, brittle, and fine to medium in texture. (V)
My hair is fine, fair, or reddish. (P)
My hair is thick, oily, lustrous, and wavy. (K)
My neck is thin, very long, or very short. (V)
My neck is of regular proportion. (P)
My neck is solid and strong. (K)
My eyes are small, narrow, or shrunken, and my eye color is dull. (V)
My eyes are of average size and light colored. (P)
My eyes are large and lustrous. (K)
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Appendix D
Ready-to-Copy Forms
417
The shape of my face is long and angular. (V)

The shape of my face is heart shaped, and I have a pointed chin. (P)
The shape of my face is rounded and full. (K)
My tongue tends to be dry with a thin, gray coating. (V)
My tongue tends to have a yellowish or orange coating. (P)
My tongue tends to be swollen with a thick, white coating. (K)
I have a high tolerance to heat and enjoy hot weather. (V)
I have a low tolerance to heat and enjoy moderate to cool weather. (P)
I have a high tolerance to heat and prefer hot, dry, and windy weather. (K)
My normal body temperature is cool, and I tend to have cold hands and feet. (V)
My normal body temperature is warm and I often feel too warm or hot. (P)
My normal body temperature is cold. (K)
My sleep is light and fitful. (V)
My sleep is sound but sometimes disturbed. (P)
I enjoy deep, prolonged sleep. (K)
I have short bursts of energy, but my endurance is low, and I run out of steam easily. (V)
I have moderate energy, moderate endurance, and good reserves. (P)
I have good endurance and large reserves of energy. (K)
In heat, I perspire minimally. (V)
In heat, I perspire profusely. (P)
In heat, I get clammy, but I dont perspire freely. (K)
I am always doing different things. I have a tendency to fidget. (V)
My activity level is focused and moderate. (P)
I can be sluggish and even lazy. (K)
I have a lot of ideas that I have difficulty putting into action. I have a restless imagination. (V)
I am organized, efficient, intelligent, and tend toward perfectionism. (P)
I am steady, calm, and not easily disturbed but do not liked to be rushed. (K)
I am good at remembering recent events but have a poor long-term memory. (V)
I have a good memory. (P)
I absorb information slowly, but once I do absorb it, I have an excellent long-term memory. (K)
I am a creative and expressive. I often change my beliefs. (V)
I am goal-oriented, ambitious, and have strong convictions that govern my behavior. (P)
I am contented and calm. I have steady, deeply held beliefs that I will not change easily. (K)
I have difficulty making decisions and change my mind often. (V)
I make rapid decisions and believe that they are good. (P)
I take a long time to make a decision but stick to the choices I make. (K)
I dislike routine and need a lot of change. (V)
I enjoy planning and organizing my life. (P)
I like routine and dont like it when things change. (K)
When stressed, I become fearful, anxious, and insecure. (V)
When stressed, I become confrontational, aggressive, judgmental, and hot tempered. (P)
When stressed, I have a tendency to withdraw. Sometimes, I am greedy and possessive. (K)
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418
I am a free spirit. I dont carefully plan my life but go with the flow. (V)
I am an achiever, and I am ambitious. I carefully plan each step of my life. (P)
I feel safe, steady, and calm in my life. I would prefer it if things remain as they are. (K)
On a good day, I am secure, grounded, and settled. (V)
On a good day, I am confident, warm, brilliant, and witty. (P)
On a good day, I am warm-hearted, loving, and active. (K)
On a bad day, I am cold, distant, and insecure. (V)
On a bad day, I am jealous and controlling. (P)
On a bad day, I am possessive, lackadaisical, and clinging. (K)
I know a lot of people, but I have few close friends. (V)
I have a few good friendships. I seem to make enemies without meaning to. (P)
I have many loyal and close friendships. (K)
I spend the money I have impulsively and easily. (V)
I plan how I will spend my money. (P)
I spend money reluctantly, and I like to save. (K)
Totals: Place the total number of Vs under vata, the total number of Ps under pitta, and the total number of Ks under
kapha in the space provided.
Vata
Pitta
Kapha
Section 2: Vikrti Indications of Imbalance

Directions: Choose the answer that describes you the most accurately and place a V, P, or K in the box at the left.
If none of these descriptions fit, place an NA in the box to the left
Recently, my skin has been very dry, or I have dry patches. (V)
Recently, I have had heat rashes and spots. (P)
Recently, my skin has been oilier than usual. (K)
Recently, my hair has been dry and brittle, and I have split ends. (V)
My hair seems to be thinning and/or graying more rapidly than usual. (P)
My hair has been excessively oily lately. (K)
I feel underweight and cant seem to gain weight even though I am trying. (V)
I keep gaining and losing the same 10 lb. (P)
Im overweight, and I am having difficulty losing weight. (K)
Lately, I feel cold a lot. (V)
These days, I often feel hot and irritated. (P)
Lately, Ive been feeling cold and dull. (K)
I keep waking up and have difficulty getting back to sleep. (V)
I have difficulty getting to sleep, but once asleep, I sleep soundly. (P)
I am sleeping excessively (9 to 10 hours a night), and I dont want to get up. (K)
I feel exhausted, restless, and nervous. (V)
I feel tense and tired but determined to get the job done. (P)
I feel lethargic and low energy, and I have difficulty taking on new tasks. (K)
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Appendix D
Ready-to-Copy Forms
419
Lately, I feel indecisive, chaotic, and forgetful, and I have difficulty focusing and concentrating. (V)
Lately, I feel like I feel judgmental of others, overly ambitious, and often negative. (P)
Lately, I feel uninspired and resistant to change, and Im having difficulty retaining information. (K)
When stressed, I feel tearful and anxious. (V)
When stressed, I feel angry, aggressive, and confrontational. (P)
When stressed, I feel like I want to hide away from the world. (K)
Totals: Place the total number of Vs under vata, the total number of Ps under pitta, and the total number of Ks under
kapha in the space provided.
Vata
Pitta
Kapha
Therapists Comments:
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APPENDIX E
Answers to Chapter Review Questions
Chapter 1
1. D
2. C
3. C
4. B
5. D
6. Kur
7. Cold water
8. Kneipp
9. Radon
10. Female
Chapter 5
1. B
2. D
3. A
4. B
5. A
6. True
7. False
8. True
9. True
10. False
Chapter 2
1. C
2. B
3. C
4. A
5. C
6. False
7. False
8. True
9. False
10. True
Chapter 6
1. D
2. A
3. B
4. D
5. C
6. Temperature
7. Length
8. Larger
9. Reflexive
10. Homeostasis
Chapter 3
1. D
2. A
3. C
4. B
5. D
6. A
7. B
8. D
9. D
10. A
Chapter 7
1. A
2. A
3. B
4. A
5. C
6. Distillation
7. 1 to 2 years, 6 months
8. Quenching
9. Climate conditions,
soil conditions,
extraction method,
harvesting methods,
storage methods,
shipping method
10. Headache, nausea,
slight sore throat
Chapter 4
1. C
2. D
3. C
4. A
5. D
6. True
7. False
8. False
9. True
10. True
Chapter 8
1. C
2. B
3. C
4. A
5. D
6. Sunburn, shaved
skin, condition where
the skin is broken
7. Table
8. Leathery
9. Physician
10. Esthetician
Chapter 9
1. A
2. B
3. A
4. B
5. D
6. C
7. A
8. E
9. B
10. D
Chapter 10
1. C
2. A
3. B
4. D
5. A
6. X
7. A
8. X
9. A
10. A
Chapter 11
1. D
2. D
3. A
4. C
5. D
6. D
7. 20, 30
8. 100, wide
9. White
10. Matured
Chapter 12
1. D
2. B
3. C
4. C
5. B
6. B
7. A
8. C
9. E
10. D
Chapter 16
1. D
2. A
3. C
4. D
5. B
6. B
7. C
8. D
9. E
10. A
Chapter 13
1. D
2. D
3. C
4. D
5. D
6. High-risk pregnancy,
rheumatoid arthritis,
high blood pressure
7. Muscle soreness,
muscle tension, stress
8. Shoes
9. Skin
10. Skin irritation
Chapter 17
1. C
2. B
3. D
4. A
5. A
6. C
7. D
8. B
9. A
10. D
Chapter 14
1. D
2. A
3. A
4. C
5. A
6. C
7. Vigorous
8. Heavy, cold, slimy
9. Hot
10. Vata
Chapter 15
1. B
2. C
3. A
4. A
5. C
6. True
7. False
8. True
9. False
10. False
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Glossary
Abhyanga: Massage with oil provided by one, two, or more
therapists.
Advertising: Direct payment made to another business or
organization in order to gain public notice.
Algae: Algae occur in all marine and terrestrial ecosystems of
the world wherever there is water. The terms algae and seaweed
are often used interchangeably, which causes some confusion.
Seaweeds are algae that have a particular growth form, but
the term algae also includes a wide range of other terrestrial
and aquatic organisms with different evolutionary histories.
Alginate: A substance found in seaweed that has therapeutic properties for skin and body and is often used as a thickening agent in cosmetic preparations.
Antioxidants: Antioxidants are substances that prevent
damage to cells and DNA by free radicals.
Antiseptics: A type of cleaning agent that is generally
appropriate for use in a spa setting so long as no blood or
body fluid is present.
Arch: The bones in the foot are actually arranged to form three
strong arches (medial longitudinal arch, lateral longitudinal
arch, and transverse arch) that are commonly referred to as the
arch of the foot. The arch provides the foot with the strength
to support the body while remaining flexible and mobile.
Aroma mist: A combination of distilled water and essential
oils placed in a misting bottle. It is misted over the client
at the end of a session to fill the treatment room with a
refreshing scent.
Aromatherapy: The use of essential oils for healing.
Aromatherapy inhalation: One drop of an essential oil or
1 drop of a blend of different oils is briefly rubbed together
in the hands before the hands are passed over the clients
nose in an arc so that the oil can be enjoyed on a deep
inward breath.
Astringents: Astringents are skin toner for oily skin. They
contain alcohol to dissolve excess oil during facial treatments to ensure the skin is clean before a treatment product
is applied to the face.
Atomizer: A device that breaks down a watery product into
a fine mist for spraying onto the body.
Auditory cue: A cue, such as the ringing of a chime, used
to signal the beginning and ending of the massage session.
Aura mist: An aromatherapy body mist that is used only at
the very end of the treatment. It is misted in a high arch over
the client from the head to the toes. It should be scented with
an aroma that contrasts with the treatment products and
fills the treatment room with a refreshing scent.
Ayurveda: The traditional natural medicine system of
India dating back more than 5,000 years.
Back bar: Spa products that are usually sold in large-sized

bottles versus the same product sold in smaller sizes to the
client in the spa gift shop.
Balinese Boreh: The Balinese Boreh is an Indonesian
traditional medicine treatment that is used to ward off or
to treat a chest cold, cough, influenza, or fever.
Barrier function: The ability of the skin to prevent penetration by microorganisms and chemicals that might
otherwise damage tissues or enter the circulation. The skin
also reduces water loss.
Basalt: A type of igneous rock formed from the solidification of molten magma. Because magma cools quickly on
the earths surface, it generally has microscopic crystals and
a smooth texture. Basalt holds heat better than many other
rock types, and ocean or river basalt has a smooth surface,
so it is one of the best types of stone for stone massage.
Botanicals: Botanicals are plant extracts used in spa
products to achieve a specific therapeutic goal.
Buoyancy: Buoyancy refers to floating in water because of
the water is displaced by bodyweight.
Business plan: A written guide to starting and running
your business.
Callus: A small area of thickened skin that is caused by continued friction or pressure. The epidermis becomes more active in
response to mild, repetitive irritation. This causes a localized
increase in the thickened tissue at the surface of the skin.
Characteristic: A distinguishing trait or quality that forms
part of an individuals personality.
Claustrophobia: The fear of being enclosed in narrow spaces.
Clay: A variable group of fine-grained natural materials
that is usually plastic when moist and are mainly mineral
in composition.
Cleansers: Cleansers are skin care products used to remove
impurities from both the skins surface and the pores during
routine face cleaning or during a facial or spa body treatment.
Code of ethics: A document or creed that states a professional groups ethical principles and the values by which the
group abides.
Compress: A wet cloth soaked in warm, hot, cool, or cold
water (sometimes with additives dissolved in the water) that
is wrung out and applied to the skin.
Cover letter: A letter that introduces you to employers and
arouses their interest so that they read your resume and ask
to interview you for the job.
Cryogenic product: A product that cools the body area to
which it is applied.
Cryotherapy: The therapeutic application of cold
temperatures.
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422
Cuticle: A fold of skin that partly covers the border of the nail.
In a pedicure (or manicure of the hands), the cuticle is pushed
back so the surface of the nail appears cleaner and smoother.
Diaphragmatic breathing: A breathing exercise that
promotes deep, relaxed breathing patterns.
Dihydroxyacetone (DHA): The component in autotanning products that causes the skin cells to change color
and appear tanned.
Direct contact: The transfer of a pathogen from an infected
person to an uninfected person through touch, sexual contact such as kissing or intercourse, or expelling body fluid
droplets onto a person by sneezing, coughing, or touching
mucous membranes and then touching an uninfected person without having washed the hands.
Disinfectants: A type of cleaning product that should not
be used on the skin and that is stronger than an antiseptic.
Dissolving exfoliants: Dissolving exfoliants are composed
of alpha hydroxy acids (AHAs) and beta hydroxy acids
(BHAs). AHAs include glycolic, citric, lactic, and malic acids.
The most widely used BHA in cosmetics is salicylic acid or
its related substances, sodium salicylate, and willow extract.
Dorsiflexion: Bending the top of the foot (the dorsal surface) toward the shin.
Doshas: One of three subtle energies (vata, pitta, kapha)
that hold together two of the five elements.
Dry room: A treatment room in which there is no shower
or hydrotherapy equipment. Instead, hot towels are used
to remove products from the clients body, or clients take
showers in a different area.
Emollient: A substance that softens the skin by slowing the
evaporation of water.
Employee: A person who is hired by another person to perform particular duties for a determined fee.
Emulsion: A mixture of two or more liquids in which one
is present as microscopic droplets distributed throughout
the other.
Enzymatic exfoliation: Exfoliation that relies on biological action rather than physical abrasion. They are applied
to the skin and then rinsed off. The enzymes used dissolve
keratin in the skin, thereby removing dead cells and supporting the natural process of exfoliation. Papain from papaya is an example of one of these enzymes.
Essential oils: Volatile plant oils extracted from certain
aromatic plants that have both physiological and psychological effects on the human body.
Esthetician: This word is a variant of the word aesthetician,
which is derived from aesthetic, a branch of philosophy dealing
with the nature of beauty. Estheticians are beauty specialists
with around 300 to 750 hours of training. Their scope of practice includes skin care, hair removal, and makeup application.
Exfoliation: A process by which dead skin cells are removed
to improve the skin texture and appearance. Other benefits
include increased circulation and lymph flow, increased

immunity, and relaxation.
Exfoliation products: Skin care products used to remove
trapped debris while sloughing off dead skin cells, smoothing the skins surface, stimulating circulation in the local
region of the skin, and relaxing or invigorating the body.
Fango: The Italian word for mud; the term is used loosely
to describe products that include mud, peat, and clay.
Father Sebastian Kneipp: A Bavarian priest who combined herbal treatments with water cures.
Fixed oils: Vegetable oils that are nonvolatile such as sweet
almond or sunflower. Essential oils readily dissolve into
fixed oils, so fixed oils are often used as a carrier for essential
oils.
Flip-over method: A method of positioning the client
for product application in which the client flips over after
a treatment product has been applied to the posterior of
the body.
Fomentek: A type of water bottle that is designed to lie flat
on the massage table.
Fragrance: An ingredient in spa products used to enhance
the smell of a product. Fragrances added to spa produces
will be either natural or synthetic (human-made).
Friction treatments: Friction treatments include salt, sugar,
dry brushing, wet brushing, or mitt treatments where the
mechanical action of the rough-textured product, brush, or
mitts against the skin causes local circulation to increase as
the friction generates heat in the tissue.
Full immersion bath: A hydrotherapy treatment where the
clients body is fully immersed in cold, cool, warm, or hot
water for a period of time to stimulate or sedate the body.
Functional group: A reactive oxygen or nitrogen-containing
unit of a chemical compound (in an essential oil).
Galvanic current machine: A machine that is used by
estheticians in facial treatments. It has two different uses
depending on the polarity of the current that is used. When
the working electrode is the negative pole, it is used with a
disincrustation solution to soften blocked sebum in pores.
When it is set on the opposite polarity (positive pole is the
working electrode), it is used to soothe the skin and encourage the absorption of a water-soluble treatment product.
Hamam: An Islamic bath characterized by a vaulted ceiling
and a raised, heated marble platform called a hararat, which
is used for massage or exfoliation.
Herbal infusions: Herbs steeped in water to produce an
infusion. Sheets, bath towels, or hand towels are soaked in
herbal infusions and applied to the body for therapeutic
purposes.
High-frequency machine: Machine that generates a rapidly oscillating electrical current that is transmitted through
glass electrodes. The current produces heat in the skin,
which stimulates circulation. It also produces ozone, which
acts as a germicide to kill bacteria.
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Glossary
Homeostasis: The bodys ability to maintain a relatively

constant internal environment despite changing external
conditions.
Hot towel cabinet (cabbi): A piece of spa equipment used
to heat up towels for spa treatments.
Hunting reaction: Alternating cycles of vasoconstriction
and vasodilatation in response to cold.
Hydrostatic pressure: The amount of pressure exerted by
a liquid, in this case, water, when the liquid is at rest. In
other words, water has weight.
Hydrotherapy: The use of water in one of its three forms
(liquid, solid, or vapor) at specific temperatures for therapeutic purposes.
Hydrotherapy tub: A specialized tub with multiple air and
water jets used to deliver professional therapeutic hydrotherapy immersion treatments.
Indirect contact: The transfer of a pathogen from an
infected person to an uninfected person via an inanimate
object (known as a fomite) such as a countertop, doorknob,
toy, or magazine.
Interferons: A protein secreted by some cells that protect
them (and other cells) from viral infection.
Javanese Lulur Ritual: A traditional beauty treatment used
by Javanese princesses as they prepare for their weddings.
Kapha: A dosha that is a combination of earth and water.
The Kur system: A German medical system that includes
spa treatments as part of a wider system for health and wellness. Kur treatments are medically prescribed and paid for
by the national health care system.
Lamina groove: Located between the spinous and transverse processes of the thoracic and lumbar vertebrae, the
lamina groove is a vertical depression filled with the fibers
of the transversospinalis (multifidi, rotators, semispinalis)
and erector spinae (spinalis, longissimus, iliocostalis)
muscles.
Learned-odor response: A response that occurs when an
odor is paired with a person, place, or thing, and a memory
link is formed.
Lice: Parasitic animals that can be spread via direct and indirect
contact that suck the blood of their hosts and cause itching.
Limbic system: The oldest part of the brain where olfactory
signals activate smell-related responses.
Luxury spa: A spa with exceptional accommodations, a full
range of treatments, the latest advances in spa technology,
a full array of wet room equipment, and well-trained staff.
Marketing: All of the activities you undertake to obtain
new clients and keep current clients.
Massage enhancers: Additional session elements or small
complementary treatments that increase the clients enjoyment of the session.
Mechanical effects: The effects on the body of water that is
pressurized in sprays, whirlpools, or through jets.
423
Mechanical exfoliation: A physical process in which the

body is rubbed with an abrasive product or with a coarse
handheld item such as a loofah.
Minerals: Naturally occurring substances that play a crucial role in the bodys metabolic processes. They are required
by the body to function properly.
Mission statement: A statement of the purpose that guides
the activity of a company, organization, or individual.
Mites: Parasitic animals, similar to lice, that can be spread
via direct and indirect contact that suck the blood of their
hosts and cause itching.
Moisturizers: Skin care products formulated to soften the
epidermis and increase the skins hydration (water content)
by reducing evaporation.
Moor mud: A low-moor peat from the Neydharting Moor
in Austria that is well known for its anti-inflammatory
effects. It is regularly mined and shipped to the United
States for spa treatments.
Mucilage: A gelatinous substance found in plants and animals that is extracted for cosmetic purposes from plants
such as seaweeds. It is composed of protein and polysaccharides and is used to give cosmetics a creamy substance and
to moisturize and protect the skin.
Mud: Soft, wet earth that is mainly mineral in composition
(derived from rock) with some percentage of organic matter
(matter derived from plant breakdown).
Nail technician: A practitioner who is certified or licensed
to provide care of the nails or to apply, repair, or decorate
gel nails or acrylic nails.
Olfactory response: Olfaction is the sense of smell. An
olfactory response includes the mental, emotional, or spiritual changes that may be elicited by an aroma.
Operations manual: A policy and procedure guide for the
spa staff. It lists important information such as contact phone
numbers, dress code, and opening and closing procedures.
Oxidation: A reaction that occurs when the chemicals in
essential oils interact with the oxygen that is present in the
air. This results in degradation of the oil.
Parafango: A product composed of paraffin and mud. It is
mainly used to apply heat to body parts.
Paraffin: Paraffin is a waxy substance obtained from the distillates of wood, coal, petroleum, or shale oil. It is used to coat
the skin and trap heat and moisture at the skins surface.
Paraffin warmer: Paraffin warmers (sometimes called
dips) hold paraffin wax that is used to cover the hands
and feet of the client.
Pathogen: A producer of disease.
Peat: Partially carbonized organic tissue formed by decomposition in water of various plants but mainly mosses of the
genus Sphagnum.
Pedicure: A treatment in which the foot is soaked, calluses
are reduced, the nails are trimmed and filed, the cuticles are
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424
pushed back and trimmed, and the nails are buffed or polish
is applied to the nails. Nail care is provided only by certified
nail technicians or cosmetologists (depending on the laws of
the particular state).
Pin and stretch techniques: Techniques in which the
muscle is first shortened and then pinned at its origin,
insertion, or muscle belly before being lengthened. The
effect of this technique is to reset proprioception and
lengthen chronically shortened muscles.
determine if you have the experience necessary to fill an

open position.
Retail sales: The spa or clinic may choose to buy sparelated items or skin care products at wholesale prices from
distributors. It then marks up these items (average is 40% to
50%) and sells them to the public. This provides the spa or
clinic with an additional income stream.
Pitta: A dosha that is a combination of fire and water.
Routines: Routines are a series of strokes that are planned

in advance, delivered to body areas in a preset order, and
practiced until they flow smoothly together.
Plantar flexion: Bending the bottom of the foot (plantar

surface) downward (as in pointing the toes).
Sanitation protocol: The spa or clinics procedure for

keeping the facility clean and disinfected during operation.
Polysaccharides: A class of long-chain sugars composed of

monosaccharides that are often used in skin care as antioxidants and water-binding agents.
Sauna: A room, constructed of cedarwood, where hot air

(60 to 210F) is combined with low humidity to stimulate
metabolism, increase core body temperature, and facilitate
detoxification.
Poultice: Usually a cloth filled with heated herbs, clay,

or a medicated product spread on a cloth and applied to
wounds or an injury.
Power differential (power advantage): The authority a
massage therapist is granted by a client based on the clients
perception of the massage therapist as a knowledgeable and
skilled health care provider.
Prakriti: The constitution or inherent characteristics of a
person, including his or her physical type, mental type, and
emotional type.
Price point: The price the public will pay for a retail item.
The business must choose how much of a markup it will
add to retail items. This markup becomes the price point.
Promotion: Activities that increase your visibility in the
marketplace and attract the attention of potential clients.
Proprioception: Proprioception is the kinesthetic sense in
which sensory receptors receive information about rate of
movement, contraction, tension, position, and stretch of
tissue. This information is processed in the central nervous
system, which sends motor impulses back to muscle, causing it to contract, relax, restore, or change position.
Publicity: Media exposure that usually arises from a special
event held at your business.
Scope of practice: A term used by regulating boards of

health care professions to describe the techniques, activities,
and methods that are permitted to a therapist under the law.
Scotch hose: A hydrotherapy application in which a strong
stream of water is directed at the client to increase circulation, stimulate function, tone muscles, decrease pain, and
decrease congestion in a particular body area.
Seaweed: Multicellular, marine-based algae that fall into one
of three main groups: green algae (Chlorophycota spp.), brown
algae (Phaeophycota spp.), and red algae (Rhodophyta spp.).
Sequencing: Sequencing refers both to the sequence of
strokes (the order in which strokes are applied to a given
body area) and to the overall sequence of the massage (the
order in which body areas are massaged).
Shirodhara: The application of a thin stream of oil to the
forehead to reduce vata disorders and bring calm to the
mind and body.
Side-lying position: A client positioning method where
the client is positioned on a treatment table on his or her
side so that product can be applied to both the anterior and
posterior areas of the body without changing positions.
Pursed-lip breathing: A breathing technique that promotes deep, relaxed breathing patterns.
Signature spa treatment: A special treatment that is only

offered by one spa. It is designed to highlight the spas
unique features and particular strengths.
Quenching: Process that occurs when the action of one

compound in an essential oil is suppressed by another compound, thereby making the oil safer for use.
Silicone: One of the elements present in seaweed that

binds water to the skin and gives a silky feel when added to
cosmetics.
Radon: A naturally occurring atmospheric gas that is

radioactive and is released as uranium in rock and soil
breaks down. It is used in trace amounts in Europe for the
treatment of arthritis and asthma.
Sit-up method: A client positioning method where the

client sits up on the treatment table so that product can be
applied to his or her back.
Reflexology: A holistic therapy that is based on the belief

that specific points on the hands, ears, and feet correspond
to specific areas of the body, including the organs and glands.
Resume: A written summary of your background, experience, education, training, and skills used by employers to
Skills: A learned ability to do something competently; a

developed aptitude.
Spa: A commercial establishment that provides health and
wellness treatments.
Spa menu: A document that lists the spas contact details,
hours of operation, location, and services.
10/24/13 3:43 AM
Glossary
Spa philosophy: The beliefs, ideals, and attitudes held by

the spa in relationship to health, wellness, and beauty.
Spa program: A collection of bodywork services that reflect
a spas philosophy and are offered to the spas clientele.
Spa therapy: A general term for a wide range of spa treatment methods or techniques used by various professionals
in different settings to support health and wellness.
425
Thermotherapy: The therapeutic application of heat

Toners: Skin care product used to complete the cleansing
process and help to restore the skins acid mantle.
Treatment concept: An abstract idea that helps both to
organize the different parts of a treatment and to send a
specific message to the client.
Treatment products: Products such as seaweed or mud
that are used during a spa treatment to elicit a particular
therapeutic benefit.
Spa treatment: A general term for a treatment that uses

water, specialized products, and various techniques to
bring about relaxation, address a specific pathology, or support overall health and wellness.
Ubtan: An herbal paste used to support detoxification and

smooth the skin. It is applied externally to the body.
Sphagnum: A type of mosses that grows only in wet acid areas

where their remains are compacted over time (sometimes
with other plants) to form peat.
Ultraviolet A (UVA) rays: Sometimes referred to as aging

rays, these rays from the sun penetrate deeper into the skin
than ultraviolet B rays and cause photosensitivity reactions.
Steam bath: A hot air bath used to facilitate perspiration

that helps the body naturally detoxify.
Ultraviolet B (UVB) rays: Also known as burning rays,

these rays from the sun are the primary rays associated with
skin damage and cancer from the sun.
Steam room: A steam room is an enclosure that can be

filled with steam from a steam generator so that people can
bath in the vapor to induce sweating or to aid respiratory
conditions.
Sterilization: The elimination of all microorganisms on and
in an object through heat, chemical substances, or irradiation.
Stratum corneum: The outermost layer of the epidermis
of the skin that provides the skin with its barrier function.
Sulfur: A chemical element that is an important constituent of many proteins and is often found in thermal pools
and in some therapeutic muds. Sulfur is believed to reduce
oxidative stress on the body and is used to treat arthritis,
sore muscles, skin diseases, and other conditions.
Swiss shower: A specialized shower stall that has pipes in all
four corners with 8 to 16 water heads coming off each pipe.
Universal precautions: A protocol used in health care settings

that reduces the risk that health care workers will be exposed
to bloodborne diseases transmitted through broken skin,
mucous membranes, or contact with blood and body fluid.
Values: The relative worth or importance we place on
something.
Vasoconstriction: When the lumen of a blood vessel is
contracted, reducing the diameter of vessel and decreasing
blood flow to a region of the body.
Vasodilatation: When the lumen of a blood vessel is
relaxed, increasing the diameter of the vessel and increasing
the blood flow to a region of the body.
Vata: A dosha that is a combination of space and air.
Synergy: When the whole is greater than the sum of its

parts, and those parts are mutually enhancing.
Vector transmission: The transmission of a pathogen via vectors (insects or animals capable of transmitting diseases, including mosquitoes, flies, fleas, ticks, mites, rats, dogs, and cats).
Taila: Medicated massage oil that is made by cooking herbs

into a fatty base such as sesame or coconut oil.
Vehicle transmission: The transmission of a pathogen by

a vehicle such as air, food, and liquid.
Talents: The natural endowments of a person such as a special (athletic, creative, mental, or artistic) aptitude.
Vichy shower: A specialized shower with a horizontal rod

with holes or water heads that rain water from above a wet
table down onto clients.
Target market: The specific group of customers that a

business aims to attract.
Terme: Thermal bath. From the Greek therme meaning heat
and thermai meaning of or related to hot springs.
Textural elements: The word texture describes the varied sensations the therapist creates during the treatment by paying
attention to what the client sees, hears, smells, tastes, and feels.
Thalassotherapy: The use of marine environments and
sea products, including seawater, sea mud, seaweed, and
seafood, for healing and wellness.
Thermal mud: Mud that comes from the areas around
hot springs. It can be applied at the site while still hot from
the spring water, or it can be extracted and heated for later
application elsewhere.
Vikrti: An individuals diet, environment, work stress, mental or

emotional trauma, relationships, or physical injury may cause
their prakriti (dosha constitution) to become unbalanced. The
unbalanced state is referred to as a vikrti state.
Vincent Priessnitz: An Austrian farmer who became
famous for the cold water cure, which consisted of drinking
large amounts of cold water, and applications of cold water
by packing, immersions, and douches.
Volatility: The rate at which a compound turns from a
liquid to a gas at room temperature (i.e., when it evaporates).
Wet room: A treatment room that contains specialized hydrotherapy equipment such as showers that remove spa products
from clients bodies, hydrotherapy tubs, and Scotch hoses.
10/24/13 3:43 AM
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Chapter 2

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4. Color Psychology. http://library.thinkquest.org/27066/psychology
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7. Knight WE, Rickard NS. Relaxing music prevents stress-induced
increases in subjective anxiety, systolic blood pressure, and heart rate
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on the observed and self-reported levels of pain control, physical
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10. Thorgaard B, et al. Specially selected music in the cardiac laboratory
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Chapter 3

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3. Journal of the American Medical Association. HIV Infection:
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Sauna, Russian Bania, Islamic Hammam, Japanese Musi-Buro, Mexican
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CA: CAPRA Press; 1978.
4. Buchman DD. The Complete Book of Water Healing. New York, NY:
McGraw-Hill; 2002.
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Chapter 4
Your Spa Massage

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5. Mehling WE, et al. Randomized, controlled trial of breath therapy
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Chapter 6
Water Therapies
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Baltimore, MD: Lippincott Williams & Wilkins; 2005.
Chapter 7
Introduction to Aromatherapy
for Spa
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.org. Accessed August 8, 2004.
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Therapy. Rochester, VT: Healing Arts Press; 1997.
3. Irvine SA. Perfume: The Creation and Allure and Classic Fragrances.
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4. Okabe H, et al. Effect of limonene and related compounds on
the percutaneous absorption of indomethacin. Drug Des Deliv.
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5. Ceschel GC, et al. In vitro permeation through porcine buccal
mucosa of Salvia desoleana Atzei and Picci essential oil from topical
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6. Price S, Price L. Aromatherapy for Health Professionals. 2nd ed. London,
United Kingdom: Churchill Livingstone; 1999.
7. Battaglia S. The Complete Guide to Aromatherapy. Virginia, Australia:
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Chapter 8
1. Maor Z, Yehuda S, Voss W. Skin smoothing effects of Dead Sea
minerals: comparative profilometric evaluation of skin surface. Int J
Cosmet Sci. 1997;19:105110.
2. The Crushed Pearl and Lavender Polish. Four Seasons Hotel and Spa.
http://www.fourseasons.com. Accessed May 25, 2005.
3. The Alpine Berry Body Polish. Ritz-Carlton Hotel and Spa. http://
www.ritzcarlton.com. Accessed May 25, 2005.
4. The Sugar Sand Polish and Magnolia Massage. Beau Rivage Spa.
http://www.beaurivage.com. Accessed May 25, 2005.
5. The Avocado and Black Sand Body Polish. Samasati Spa. http://www
.samasati.com. Accessed May 25, 2005.
6. Ullrich SE, Kripke ML, Ananthaswamy HN. Mechanisms underlying
UV-induced immune suppression: implications for sunscreen design.
Exp Dermatol. 2002;11(suppl 1):1316.
7. Wang SQ, et al. Ultraviolet A and melanoma: a review. J Am Acad
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8. Krutmann J. Ultraviolet A radiation-induced biological effects
in human skin: relevance for photoaging and photodermatosis.
J Dermatol Sci. 2000;23(suppl 1):S22S26.
9. Kunin A. Sunless tanners. Derma Doctor. http://www.dermadoctor.
com/pages/newsletter239.asp?WID=57BA13B88D0-C4E8-4E24.
Accessed April 10, 2004.
10. Kellogg JH. Rational Hydrotherapy. 2nd ed. Philadelphia, PA: F.A.
Davis; 1903.
Chapter 9
Body Wraps
1. Conney AH, et al. Inhibitory effects of tea and caffeine on UV-induced
carcinogenesis: relationship to enhanced apoptosis and decreased
tissue fat. Eur J Cancer Prev. 2002;11(suppl 2):S28S36.
2. Syed TA, et al. Management of psoriasis with aloe vera extract in a
hydrophilic cream: A placebo-controlled, double-blind study. Trop
Med Int Health. 1996;1(4):505509.
3. Draclos ZD. Topical vitamins for the skin. http://www.olay.com
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4. Raschke T, et al. Topical activity of ascorbic acid: from in vitro
optimization to in vivo efficiency. Skin Pharmacol Physiol. 2004;17(4):
200206.
5. Double Eagle Resort and Spa. http://www.doubleeagleresort.com.
Accessed August 29, 2004.
6. Sonnenalp Resort of Vail. http://www.sonnenalp.com/activities/spa
/treatments.html. Accessed August 29, 2004.
7. St. Andrews Bay Chateau Elan Spa. http://www.standrewsbay.com
/Spa/treatments.htm. Accessed August 29, 2004.
8. Grand Geneva Resort and Spa. http://www.grandgeneva.com/recreation
/spa/spa_treatments.asp. Accessed August 29, 2004.
9. Lake House Spa. Lake Austin Resort. http://www.lakeaustin.com
/lakehousespa.php. Accessed August 29, 2004.
10. Lake Tahoe Resort, Spa and Casino. http://www.laketahoe.hyatt
.com/property/sportsrelax/spa/body_treatment.jhtml. Accessed
August 29, 2004.
Chapter 10
Spa Foot Treatments

1. The general causes of foot pain. University of Maryland Medical
Center. http://www.umm.edu. Accessed October 10, 2005.
2. Heart JA. Foot pain and shoe size. http://www.nlm.nih.gov. Accessed
May 30, 2005.
3. Getting nailed, An ABC News 20/20 Presentation. http://www.spatrade
.com. Accessed September 29, 2004.
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Chapter 14

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Chapter 16
Treatment Design and

Your Signature Spa Treatment
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February 10, 2004.
10/24/13 3:44 AM
Index
NOTE: Page numbers followed by f indicate figures, t indicates tables.
A
Abano, Italy, 5
Abhyanga, 265, 286292
overview, 290291
traditional Indian massage strokes, 286287,
286f, 288290f
Absolute contraindication, 50
Accident report, 49
Achilles stroke, 202
Adobe purification ritual (Fango), 398
Adrenal gland, 205f, 207
Advanced understanding, 50
Advertising, 353, 377
Alcohol, use by therapist, 4849
Algae, 232234, 234t
Alginates, 232, 235
Allergies, 60
wraps, 175
Aloe vera cocoon, 184
Amenity spas, 7
Anterior leg draping, 97
Anterior pelvic drape, 97
Antioxidants, 13, 24
Antiseptics, 32, 4344
Arch, 194, 197
Arden, Elizabeth, 5
Arm shelf, 15, 16f
Aroma mist, 68, 81, 81f, 82t, 132f, 151
Aromatherapy, 129153
baths, 134f, 150
body shampoo and polish, 133f
body wrap, 133f
consultation, 133f
inhalation, 68, 78, 78f, 82t, 132f
massage, 133f, 149150
methods, 148149
nebulizing diffusers, 28f, 149, 149f
standard concentrations in, 146f
wraps, 150151
Aromatherapy cocoon, 184
Aromatic exfoliations, 149
Aromatic sauna, 134f
Aromatic steam, 134f
Astringents, 13, 23
Athlete muscle aid (cocoon), 393
Auditory care, 68
Auditory cue, 78
Aura mists, 151, 155
Autotanning, 344t
Ayurveda, 2, 7, 265, 344344t
assessment in the spa, 277, 278280f
core concepts, 266273
essential oils in, 280281
five elements (panchamahabhutas), 267t
spa treatments inspired by, 266312, 266f, 267t
treatment considerations, 273, 276
B
Back bar, 334
Bacteria, 38
Bad Hofgastein Spa, Austria, 4, 4f

Balance sheet, 379
Balinese Boreh, 265, 310
treatment overview, 310
Balms or butters, 24
Basalt, 247, 250
Bathroom, 29
Battaglia, Italy, 5
Blankets, 17. See also specific type
Bleach solutions, 44
Blended career, 359360
Body (loofah) scrub, 167, 168f
overview, 167
Body polish treatments, 341, 386
Body scrub treatments, 341
Body stone balance (hot stone massage), 405
Body-warming equipment, 1819
Body wrap, 173193, 344t
aromatherapy, 133f
hot sheet wraps and cocoons, 175t, 390391
materials, 14f, 18, 176
plastic and Mylar, 18
problems, 175
sample treatments, 174t
treatments, 341342, 342f
wet sheets and, 126
Bolsters, 15, 16f
cover, 17
Bone adjustment, 36
Botanicals, 13, 25
Bouncebouncetraction, 202203
Breast drape, 97
Breathwork, 7478
Brush application, 101
Buff and bronze, 167171, 170f, 389
contraindications, 169, 389
overview, 169
Buoyancy, 110, 112
Burnout, 361
Business location, 370371
home-based, 371
shared space, 371
Business management, 382384
Business name, 370
Business plan, 353
private practice, 369385
Business policies and procedures, 383384
Business sites, 410
Business structure, 371
C
Caf cocoon (hot sheet wrap), 391
Callus, 194, 196
Camekan, 3, 111
Career plan, 354363
client types, 358t
employment options, 358360
self-assessment, 354, 355357
specialization, 358
written, 361363, 362f
Carrier product, 143

volume to essential oil concentration, 145t
Cash flow statement, 379
Caution, conditions requiring, 5661
Cellulite, 238
Cempaka or champaca (Magnolia champaca),
297
Chapter review answers, 420
Characteristic, 334, 336
Chart notes, 73
Chemical peels, 158
Cider or juice hot wrap, 176
Circular finger friction, 202
Circular palms, around ankle, 202
Circular thumbs
bottom of foot, 202
top of foot, 202
Claustrophobia, 173, 175
Clay, 215, 216218, 216f
creative mix-ups, 219t
overview, 218t
Cleaning products, 43
Cleansers, 13, 23
Clear the zones, 204f, 206
Client education, 376
Client expectations, during interview, 7172
Client interview
determine treatment goals, 72
informed consent, 7071f
plan the massage, 72
policies and procedures, 71
Client loyalty, 377378
Client management, 325326
Client positioning, when applying products,
100101, 100f
Client referral programs, 376, 376f
Client safety, 4849
Client screening, 4950
Clock, 19
Closing the massage, 7374
Cloves (Syzygium aromaticum), 297
Coconut (Cocos nucifera), 297298
Cocoon, 175t, 181190
athlete muscle aid, 393
contraindications, 182
desert nectar honey glaze, 392
massage table setup for, 185f
overview, 182
procedure, 186189, 187188f
types, 182186, 183f
Code of ethics, 32, 33, 34t
Coffee wrap, 176
Color, in spa environment, 2526, 2627f
Common areas, 48
Complementary benefits, 335
Compress, 110, 120121, 120f, 121f
Conduction, 113
Considerations, spa-specific, 56
Contact, quality of touch, 92
Continuing education, 358
431
Williams_2E_Index_printer_file.indd 431
10/24/13 3:44 AM
432
Index
Contraindications, 5055, 5155t

body or loofah scrub, 167
buff and bronze, 169, 389
client interview, 70
cocoon, 182
critical thinking and, 6162
dry skin brushing, 160
fango treatments, 220, 398
foot treatments, 195
full-body polish, 165, 386
hot sheet wraps, 178, 390391
hydrotherapy, 118, 119120t
reflexology, 195
salt or sugar glow, 162, 387, 388
stone massage, 249, 405
thalassotherapy, 235236, 402
Convection, 113
Core body temperature, in hot sheet wrap,
179180
Coriander (Coriandrum sativum), 298
Corporations, 371
Counseling, 36
Cover letter, 353, 364, 366f
Creams, 24
Cryogenic cocoon, 184
Cryogenic products, 173, 184
Cryotherapy, 110
Culturally based spa treatments, 265315,
342343, 343f
Cuticle, 194
D
Day Spa Association, 8
Day spas, 8, 8f
De Caprio, Noelle, 5
Dead sea delight (Fango), 399
Dead sea mud, 216f
Dcor, 2526
Depth, 9293
Dermabrasion, 158
Desert nectar honey glaze (cocoon), 392
Destination spas, 6, 6f
Diabetes, 6061
Diagnosis, 36
Diaphragmatic breathing, 68, 7475, 7576f,
94
Diffuse oils, 132f
Dihydroxyacetone (DHA), 155, 168
Direct contact, 32, 40
Diseases, 3738
prevention of transmission, 4042
transmission of, 3940
Disinfectants, 32, 4445
Dissolving exfoliants, 155156
Documentation, 6265, 6365f
Dorsiflexion, 194, 202
Dosha questionnaire, 278280, 416419
Doshas, 265
Draping, 97100, 9899f
Drugs, use by therapist, 4849
Dry room, 13, 96
equipment, 14, 14f
moving from plastic to preset massage sheet,
105, 106f
removal techniques, 103104f, 103105
Dry skin brushing, 156160
enhanced procedure, 158159
overview, 160
techniques, 157158, 158f, 161f
E
Electric table warmers, 18
Electric (thermal) booties and mitts, 14f, 19
Emergency numbers, 48
Emollient, 24, 173
Emollient cocoon, 181
Employee, 353, 358, 363
Employment packages, 367368, 368t
Emulsion, 215
Enhancing treatments, 324
Enzymatic exfoliation, 155156
Enzyme exfoliation, 158
Espa (fountain), 3
Essential oils, 129137, 130f, 132134f
approach to blending, 146147
in ayurvedic treatments, 280281
basic scents, 144145t
to be avoided or used with caution, 136t
blending, 143148
botanical names and, 407408
chemistry, 137f
concentrations, 145, 145t
in hydrotherapy, 116
methods of extraction, 135t
pathways in and out of body, 137
physiological effects, 137138, 137f, 142143
for reflex points, 210f
safety considerations, 134136, 136f
spot application, 134f
for stages of inflammation, 229230t
starter oils and easy blend recipes, 150t
for stone massage, 249
storage, 135f
sunburn relief, 134f
synergy, 145146
therapeutic actions and properties, 139141t
top, middle, and base note blending, 146,
147t
Esthetician, 2, 32, 3637
Ethics, 3337
European spas
modern, 45, 4f
18th and 19 centuries, 34, 4f
Exfoliation, 23, 96, 155156
feet, 197198
full-body, 344t
overexfoliation, 156157
scope of practice, 156
skin conditions, 156
types of treatments, 156, 157t
Exfoliation products, 13, 2324
F
Face cradle, cover, 17
Face massage, 345t
Face massage routine, 8691f
Face treatment, mindful mud cranium care, 397
Facial, 243244f, 345t
Facial exfoliation, 158
Families, spas for, 10
Fango, 215, 216
adobe purification ritual, 398
back treatment procedure, 222225, 223224f
benefits for the skin, 220
broken or inflamed skin, 220221

dead sea delight, 399
full-body cocoon, 221222
mixing and storing products, 221
Moor back treatment, 400
musculoskeletal injury and disorder,
228230, 229f
preventing dry out, 221
scalp and neck treatment, 225228, 226f
sulfur mud pack, 401
temperature, 221
treatment overview, 221222, 225
Fango cocoon (mud, clay, or peat), 185186
Fangotherapy, 215231, 218t, 344t
types of products, 217218
in the U. S., 217
Fee collection, after massage, 72
Finances, 379382
personal, 382
record keeping, 379381, 380381f
statements, 379
Fire plan, 48
Fitness, 345t
Fitzgerald, William, 203
Fixed oils, 129, 143
Flip-over method, 96, 101
Flow and continuity, 93
Folded hands glide, 202
Fomentek water bottle, 14f, 19, 173, 180
Foot assessment, 196197
Foot baths, 123, 123f
Foot loose athlete reprieve, 394
Foot massage, 199203, 200201f
Foot soak
additives to, 199t
essential oils, 132f
Foot soaking tubs, 20
Foot treatments, 194214, 342, 342f, 344t
elements of, 196t
exfoliation, 197198
foot loose athlete reprieve, 394
garden walk, 396
overview, 212
peppermint beach feet tingle, 395
sample procedure, 211213, 213f
soaking and cleansing, 197, 198f
Forms, ready-to-copy, 411415f
Foundation skills, 96109
Fragrance, 13, 25
Frangipani (Plumeria spp.), 298
French thalassotherapy, 402
Friction treatments, 110, 120, 126, 126f
Full-body baths, 123124
Full-body polish, 165167, 166f, 386
ocean pearl, 386
overview, 165
Full immersion bath, 110, 124, 124f
Functional group, 129
Fungi, 38, 39f
G
Galvanic current machine, 232, 243
Galzignano, Italy, 5
Garden walk, 396
Gauze or fabric application, 101
10/24/13 3:44 AM
Index
Ginger (Zingiber officinale), 298
Gloved hand application, 101
Gloves, 44f, 47
Gluteal drape, 97
Guided meditation, aromas, 134f
H
Hair removal, 345t
Hair services, 345t
Hamam (bath), 2, 3, 111
Hand and foot treatment, during relaxation
massage, 8081, 80f
Hand application, 101
Hand treatments, 344t
Hand washing, 4244f
Handheld shower and wet table, 20, 21f, 105
Hararat, 3, 111
Healing crisis, wraps, 175
Health care massage, versus wellness massage, 69
Health care referral programs, 376
Health information form, 411412f
Heat lamp, 18
free-standing, 14f
Heavy wool blanket, 18
Hepatitis A virus (HAV), 47
Hepatitis B virus (HBV), 47
Hepatitis C, 47
Herbal body wrap, combinations, 177t
Herbal diet right wrap (hot sheet wrap), 390
Herbs
steamy towels, 80, 80f
High-frequency machine, 232, 243
HIV/AIDS, 4647
Holistic blend, essential oils, 147148
Home-based business, 371
Homeostasis, 110, 113
Hot sheet wraps, 175t, 176181, 390391
overview, 178179
procedure, 177179, 178179f
types, 176177
Hot Springs spas, 8, 9f
Hot stone heaters, 17
Hot towel cabinet (cabbi), 13, 14f, 17
Housekeeping activities, 46
Humectants, 24
Hunting reaction, 110, 114
Hydrocollator, 17
Hydrostatic pressure, 110
water exertion of, 112
Hydrotherapy, 23, 110, 344t
applications, 117126
benefits and effects, 113117
cautions and contraindications, 118, 119120t
cleanliness and sanitation guidelines, 117
contrasting temperatures, 117
degrees of hot and cold, 116t
effect of applications, 113114
effects from dissolved substances, 115
general uses, 110
introduction, 111113
local applications, 121
in a massage and spa practice, 113
mechanical effects, 115
natural temperatures, 117
packs and compresses, 120121, 120f, 121f
physiological effects, 114115
psychological effects, 115

reflexive effects, 115
safety, 117118
specific temperatures, 116
therapeutic baths, 121123, 122t
Hydrotherapy tub, 13, 20
Hygiene, 3748
Hypertension, 5657
I
Incident report, 50
Independent contractor, 359, 371
Indian head massage, 281286, 282284
overview, 281
Indirect contact, 32, 40
Indonesian cinnamon (Cinnamomum burmannii),
298
Indonesian-inspired exfoliation and body wrap
Indonesian-inspired massage, 299308, 301308f
treatment overview, 299300
Indonesian-inspired spa treatments, 297314, 345t
Indonesian spa products, 297298
Infectious diseases, 38
Informed consent form, 7071f
Ingham, Eunice, 203
Inhalation
aromatherapy, 68, 149
essential oils, 137
Insurance, 383
Integumentary conditions, 57
Interferons, 173
International Spa Association (ISPA), 6
10 elements image, 1011, 11f
Interviewing, 364, 367
questions, 367
J
Jasmine (Jasminum sambac), 298
Javanese Lulur Ritual, 265, 310313, 312313f
overview, 310
K
Karna purana, 293f
Kaolin clay, 216f
Kapha, 265, 268, 268f, 287, 291
profile, 271272, 272t
Kellogg, John Harvey, 5
Kese, 111
Kneipp, Father Sebastian, 4, 110112
Kur system, 2, 5
L
Laced fingers hold, 202
Lamina groove, 247
Laser skin treatments, 158
Learned-odor response, 129, 142
Le Mont-Dore, Auvergne, France, 5
Lice, 32, 39, 39f
Licenses and permits, 382383
Life mission, 336337
Lighting, in spa environment, 27
Limbic system, 129, 142, 142f
Limited liability company (LLC), 371
Linens, 17
proper care, 45
soiled, 4748
storage, 17
433
Local contraindication, 50
Loofah. See Body (loofah) scrub
Lotions, 24
Lubricant, 92
Lung press, 202
Luxury spa, 2, 6
M
Makeup application, 345t
Manicures, 344t
Marine mud, 216f
Marketing, 353, 358, 373378f, 373379
competition, 375376, 375f
promotion, 376
special offers, 377
your plan, 378379
Marma points, 272273, 274276t, 277f
Massage, 344t. See also specific type of massage
aromatherapy, 133f, 149150
Massage blends, for aromatherapy, 82t
Massage enhancers, 68, 7882, 79t
Massage for Orthopedic Conditions
(Hendrickson), 228
Massage stool, 15, 16f
Massage tables, 1517, 15f
accessories, 15, 16f
covers, 15
padding, 15
setup for cocoon, 185f
Mechanical effects, 110, 115
Mechanical exfoliation, 155156
Medical spas, 78, 7f, 8f
Men, spas for, 9
Mentors, 361
Menu of services, 334352
Mermaid shimmer (salt glow and seaweed
treatment), 404
Metatarsal pull, 202
Metatarsal stone roll, 202
Microdermabrasion, 158
Microwavable packs, 19
Milk, in hydrotherapy, 116
Milk and honey hot sheet wrap, 176
Mind and spirit therapies, 345t
Mindful mud cranium care (scalp and face
treatment), 397
Minerals, 232
Mission statement, 334, 336339
Mist application, 101
Mites, 32, 39, 40f
Mobile spas, 8
Modesty, wraps, 175
Moisturizers, 13, 24
Montegrotto, Italy, 5
Moor back treatment (Fango), 400
Moor mud, 215
Mucilage, 232, 235
Mud, 215, 216, 216f, 219220
Music system, 19
what the client hears, 28
My Water-Cure (Kneipp), 4, 112
N
Nail services, 345t
Nail technician, 194195
National Association of Holistic Aromatherapy
(NAHA), 130
10/24/13 3:44 AM
434
Index
Natural and traditional medicine, 345t

Natural elements cocoon, 186
Natural ingredients, 25
Nebulizing diffuser, 28f, 149, 149f
Nutmeg (Myristica fragrans), 298
Nutrition, 345t
O
Occlusives, 24
Ocean pearl polish, 386
Olfactory response, 129, 137
Opening the massage, 7374
Overexfoliation, 156157
Oxidation, 129, 134
P
Pacing and leading, 92
Parafango cocoon, 184
Paraffin, 68, 110, 121
Paraffin cocoon, 184
Paraffin dip, 81, 81f
Paraffin warmer, 13, 14f, 18
Parasitic animals, 39
Parking area, 48
Partial bath, 124125
Partnership, 371
Pathogen, 32, 38
Peat, 215, 216, 216f, 220
Pedicure, 194195, 344t
classic, 196
Peppermint beach feet tingle, 395
Perfume blend, essential oils, 147
pH, 24
graph, 59f
Phenols (cresols), 44
Physicians release, 50
Physiological blend, essential oils, 146
Pin and stretch techniques, 247
Pitta, 265, 268, 268f, 287
profile, 270271, 270t
Pituitary press, 205f, 206
Plantar flexion, 194, 202
Plaster, 121
Policies and procedures, in client interview, 70
Polysaccharides, 232, 235
Posterior leg draping, 97
Poultice, 173
Power differential (power advantage), 32, 35
Prakriti, 265
Prana, 273
Prescribing, 36
Prescription medications, use by therapist,
4849
Press release, 377, 378f
Pricing services
market-based, 372373
payment processing, 373
tips, 373
Priessnitz, Vincent, 4, 110111
Private practice, business plan, 369385
Product inventory, 335
Product planning, 325
Product warmer, 14f, 18
Professional networks, 361
Profit and loss (income) statement, 379
Promotion, 353, 358
Proprioception, 247
Protozoa, 39
Psychological blend, essential oils, 146
Publicity, 353
Pursed-lip breathing, 68, 74, 77f
Q
Quaternary ammonium compounds (quats), 44
Quenching, 129, 131
R
Radon, 2, 4
Reflexology, 194196, 203211
certification, 195, 214
designing a routine, 207211
horizontal lines on bottom of feet, 209f
overview of reflex points, 207208f
possible reactions, 195
resources, 410
stress reduction routine, 204205f, 204207
techniques, 203207
treatment products, 208211, 210t, 211f
Resort spas, 67, 6f
Resources, 409410
Resting and holding strokes, 74, 74f
Resume, 353, 363364, 365f
Retail opportunities, 335
Retail product sales, 72, 326, 372
Rhythm, 93
Room changing (cleaning), 73
Rosemary oil, steamy towels, 80, 80f
Routines, 68, 8485
face massage, 8692f
S
Safety
client, 4849
essential oils, 134136, 136f
hydrotherapy, 117118
spa equipment, 48
supplies for, 19
therapist, 4950
Salt or sugar glow, 160165, 163f, 387, 388
mermaid shimmer, 404
mix-ups, 164t
overview, 161
solar stone glow, 406
Sandalwood (Santalum album), 298
Sandwich slide, 199
Sanitation, 3748
cocoons, 189
dry skin brushing, 158, 160
fango treatments, 224, 229
foot treatments, 197, 199, 209, 211
guidelines for hydrotherapy equipment, 117
herbs, coffee, clay, or mud wraps, 176
hot sheet wraps, 179
Indian head massage, 286
Javanese Lulur Ritual, 313
loofahs, 167
reflexology, 209
seaweed cocoon, 241
shirodhara, 297
stone massage, 251, 262
tension wraps, 191
thermal space blanket, 181
ubtan, 294
Sanus per aquam (SPA), 3

Sauna, 13, 23, 23f, 110, 124, 124f
aromatic, 134f
Scalp massage, 345t
Scalp treatment, mindful mud cranium care,
397
Scope of practice, 32, 35
restrictions to, 36
Scotch hose, 21f, 110, 125126f
Sea sculpt (seaweed), 403
Seaweed, 232233
benefits for skin, 235
breast treatment, 241242
comparison, 236f
French thalassotherapy, 402
mermaid shimmer, 404
mix-ups, 237t
mud, clay, or peat hot wraps, 176177
odor, 237
sea sculpt, 403
sensitive skin and, 236
slimming cocoon procedure, 238239
therapeutic benefits of, 233234
Seaweed cocoon, 185
Seaweed (Eucheuma cottonii), 298
Sedona clay, 216f
Self-care, prepare yourself before massage, 72
Self-employment, 359
Sensitive skin, wraps, 175
Sequencing, 68, 8284, 85t
Session booking, after massage, 73
Setup and cleanup, spa treatments, 335
Sexual abuse, 35
Sexual impropriety, 3335
Sexual innuendo, 33
Sheets, 17
Shirodhara, 265, 295297, 296f
overview, 295
treatment considerations, 298299
Showers, 2021, 21f, 105106, 107f
sanitation, 107
therapeutic, 105107, 125
Side extenders, 15, 16f
Side-lying drape, 97100
Side-lying position, 96, 101
Signature spa treatment, 317332
Silicone, 232, 235
Simple hair drape, 97
Sit-up feature, 15
Sit-up method, 96, 101
Skills, 334, 337
Skin brushing, 341, 341f
Skin care, 3637, 409
Skin conditions, 5760, 58t, 59f
Skin peels, 158
Slimming seaweed cocoon procedure, 238241,
240f
Smell-scapes, 132f, 143, 147
Soaking tub, 20
Soda cooler, 17
Solar glow (buff and bronze treatment), 389
Solar plexus hold, 202, 204, 205f, 207
Solar stone glow (stone massage and salt glow),
406
Sole proprietorship, 371
Solus per aqua (SPA), 3
10/24/13 3:44 AM
Index
Spa, 2
into the future, 10
Spa associations, 410
Spa categories, 69
Spa client, 910
what he/she feels, 29
what he/she hears, 28
what he/she smells, 2829, 28f
what he/she tastes, 29
Spa clothing, 19
Spa consultant, 359
Spa department manager, 359
Spa director, 359
Spa educator, 359
Spa employers, 363
meeting expectations, 368369
Spa environment, 2530, 358t
accessibility and functionality, 2930
career planning and, 354, 358
safe, 4850
sanitation and hygiene, 3748
sanitation of facility, equipment and supplies,
4346, 46t
Spa equipment, 14
exploration, 25
hydrotherapy, 117118
important terms, 2425
purchasing and maintaining, 23
safety of, 48
supplies and, 409
Spa massage, 7273
after, 7374
book next session, 73
change room, 73
chart notes, 73
collect fee, 73
goodbye language, 73
sale of retail products, 73
self-care, 73
transition out of massage, 73
bolster, 72
check in with client, 72
follow treatment plan, 7273
olympics, 94
open, 72
subtle factors, 8593
Swedish techniques, 8285, 8384t
Spa massage appointment, 69
greeting, 69
interview, 6970
tour, 69
transition to massage, 72
Spa menu, 334, 348351, 349350f
Spa packages, 343
Spa philosophy, 334, 336340
Spa products, 2325, 409
proper handling, 45
Spa profession, 353385
Spa program, 317, 319, 334, 340348, 340f
balance, 343
extra large model, 347t
individual treatments, 346347
large model, 346t
medium model, 346t
overview of services, 344345t
review of others, 343344
small model, 346t
Spa therapy, 2
Spa treatments, 2, 5
benefits and drawbacks, 335336
culturally based, 265315
Indonesian-inspired, 297314
signature, 317332
writing detailed guides, 348
Sparsa (to bubble up), 3
Specialized products, 409
Sphagnum, 215, 220
Spinal twist, 202
Spinal walk, 204f, 206
Spirit blend, essential oils, 146
Spirulina, 234
Spot application, essential oils, 134f
Spot treatments, 344t
Steam bath, 110, 123124
Steam cabinet, 2223, 22f
Steam canopy, 23, 23f
Steam room, 13, 22
Steam shower, 2223, 22f
Steamy aromatic towels, 7980, 80f
Step stool, 1516, 16f
Sterilization, 32
Stone massage, 247264, 344t
basic full-body procedure, 260263f, 260263
basic strokes, 253256f, 253255
body stone balance, 405
core techniques, 251252, 252f
draping and insulation, 249
equipment and setup, 250, 250f
equipment organization, 251
essential oils, 249
heating units, 250251
solar stone glow, 406
strokes for specific areas, 255259, 256258f
suggested timing options, 261t
therapist safety, 249
Stone scrape, 202
Storage area, 19
Stories the Feet Can Tell Thru Reflexology (Ingham), 203
Stroke length, 93
Strong aromas, 335336
Study party, 94
Sugar shaker application, 101102
Sulfur, 215
Sulfur mud pack (Fango), 401
Sunburn relief, essential oils, 134f
Supplies for cleanliness and safety, 19
Support lotion, 151
Swedish techniques, 8294, 8384t
Swiss shower, 13, 20, 21f, 106107, 107f
Synergy, 129, 145146
T
Table pads, 1819
Taila, 265, 273
Talents, 334, 337
Target market, 353, 374
Taxes, 381382
Teens, spa programs for, 10
Tension wraps, 189191
techniques, 189191, 190191f
Terme, 2, 5
Termes de Spa, Belgium, 3, 4f
Textural elements, 317, 320324, 322323t
435
Thalassotherapy, 232246, 344t

general treatment considerations, 235238
history, 233
seaweed treatment, 402
Therapeutic baths, 121123, 122t
Therapeutic goal, 319
Therapeutic shower, 105107, 125
Therapist hygiene, 4041
Therapist safety, 4950
Therapist training, 336
Therapists intention, 8586
Thermal mud, 23
Thermal space blanket, 18
Thermotherapy, 110, 116
Three doshas (tridoshas), 268, 268f
Thumb walking technique, 203, 203f, 204205f,
206207
Thyroid press, 205f, 207
Tips, 373
Toe rotation, 202
Toners, 13, 23
Towels, 17
herbal-infused, 104
hot towel heating units, 1718
removal, 104105
steamy aromatic, essential oils, 132f
steamy rosemary, 104
Transitions, 324325
Transverse thumb slide, 202
Treatment concept, 317, 319
art as inspiration, 319
food and drink as inspiration, 320
simplicity, 320
spirituality and mysticism as inspiration, 320
world culture as inspiration, 319320
Treatment design form, 414f
Treatment design process, 318t
Treatment goals, determine during interview, 72
Treatment planning forms, 326327, 327329f
Treatment products, 13, 14f, 24
basic application techniques, 101103, 102f
client positioning, 100101, 100f
Treatment record, 413f
Treatment rooms, planning of, 2930
Tubs, 1920, 20f
Turban drape, 97
Turmeric (Curcuma longa), 298
U
Ubtan, 265, 293295
Udvartana, 293295, 294f
overview, 293294
Ultraviolet A (UVA) rays, 155, 167
Ultraviolet B (UVB) rays, 155, 161
Undressing and dressing space, 29
United States spas, 56
Universal precautions, 32, 4648
when to use, 47
V
Values, 334, 336
Vascular flush, 117
Vasoconstriction, 110
Vasodilatation, 110
Vata, 265, 268, 268f, 287
profile, 269270, 269t
10/24/13 3:44 AM
436
Index
Vector transmission, 32, 40

Vehicle transmission, 32
Vichy shower, 13, 20, 21f, 107, 107f, 125f
Vikrti, 265
Viruses, 38
Vitamin cocoon, 185
Volatility, 129
W
Wall decorations, in spa environment, 27
Warm packs, 79, 79f
Wastebasket, 19
Water therapies, 110128

buoyancy, 112
dissolving other therapeutic substances,
112
hot and cold temperatures, 112113
hydrostatic pressure and, 112
therapeutic characteristics, 112
Wellness massage, versus health care massage, 69
Wet room, 13, 96
equipment, 1920
removal techniques, 105107, 107f
Whirlpool tub, 20
Window treatments, 2627

Wine and roses (sugar glow), 388
Women, spas for, 9
Wrap sheets, 18
Y
Ylang ylang (Canagium odoratum), 298
Z
Zen glow (salt glow), 387
10/24/13 3:44 AM

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E D I T I O N

Acquisitions Editor: Jonathan Joyce

Writing and producing Spa Bodywork: A Guide for Massage

Oregon). Chris Froelich and the team at Somerset School of

Bracciante, Laura Allen, Leslie Young, Lincoln Heartsong,

Thank you to everyone at Associated Bodywork & Massage

I would like to dedicate the second edition of Spa Bodywork:

Spa Bodywork: A Guide for Massage Therapists is primarily a

Organization and Structure

creates to enhance a spa treatment. This concept is defined,

come alive through these massage methods, natural spa

3 Client and Therapist Safety

Commitment to Personal and Professional

PART ONE Spa Foundations 1

Spa Sanitation and Hygiene

1 Spa from Past to Present 2

European Spas in the 18th and 19th Centuries

Basic Spa Categories 6

Documentation of Sessions in a Spa

4 Your Spa Massage 68

Spa into the Future 10

2 Spa Equipment and Products 13

What the Client SeesDcor 25

Wet Room Equipment 19

Resting and Holding Strokes 74

Before the Massage 69

Opening and Closing the Massage

Dry Room Equipment 14

Cautions and Contraindications

Your Spa Environment

Safety of the Facility 48

Spas for Women 9

Creating a Safe Environment

The Spa Client

Putting Your Spa Massage Together

5 Foundation Skills for Spa Treatment

Aromatherapy Massage 149

Positioning the Client When Applying

Basic Application Techniques

Application by Hand 101

Dry Room Removal Techniques

PART TWO Spa Treatments 154

Steamy Rosemary Towels 104

Wet Room Removal Techniques

The Handheld Shower 105

Hydrotherapy Benefits and Effects

Benefits of Using Hydrotherapy in a Massage and

The Salt or Sugar Glow

The Salt or Sugar Glow Procedure 162

The Full-Body Polish

The Full-Body Polish Procedure 165

The Body or Loofah Scrub

7 Introduction to Aromatherapy for Spa 129

The Hot Sheet Wrap

AromatherapyAn Art and Science

Cocoon Types 182

Techniques for Tension Wrapping

10 Spa Foot Treatments

The Physiological and Psychological Effects of

Carrier Products 143