[PDF] Day-Break Geriatric Massage Institute - Bon Vital

120566_7dr_sharon_puszko_tips.pdf

7434A King George Drive

Indianapolis, IN 46260

317-722-9896

spuszko@juno.com www.daybreak-massage.com

Day-Break Geriatric Massage Institute

Day-Break Geriatric Massage Institute is a continuing education provider dedicated to enhancing the quality of life for the senior population. Geriatric Massa ge is not just "Swedish lighter". It is the use of judicious and skilled touch fo r specific conditions with intention to improve quality of life.

DAY-BREAK GERIATRIC MASSAGE TECHNIQUE

SUPPLIES

: Bon Vital Deep Tissue Creme Bon Deep Tissue Lotion Bon Vital Foot Balm Bon Vital Facial Therapy Massage Creme Bon Vital products work very well with the geriatric population. Foot Balm Helps relieve inflammation and tenderness of swollen, tired feet. Both Bon Vital Deep Tissue Lotion and Creme are enriched with vitamins, leaving no stains or greasy feel. Either can be used depending on your preference. Bon Vital Facial Therapy Massage Creme is vitamin enriched and formulated for sensitive skin.

EFFECTS OF GERIATRIC MASSAGE

Day-Break Geriatric

Massage Institute

AGE GROUPS:

For this work, we look at seniors as three basic types:

1. Robust

2. Age-Appropriate

3. Frail

WHY A HALF HOUR IS ENOUGH FOR GERIATRIC CLIENTS

Massage has a profound effect on the heart and on the sensory nervous system in many of the elderly. A 60-minute massage can have a negative effect by overloading the nervous system, the heart, and possibly the kidneys. A second reason is that if you want to do a good job with your client, you must be very attentive. Every move should be purposeful, and your mind should not wander. A shorter massage will be more focused than a one-hour massage. Reason number three is of a practical nature: It is easier to find people that can afford a weekly half -hour massage than a two-hour massage. You will find half hour massages easier to schedule at senior centers and nursing homes.

The first thing to consider is positioning. The most comfortable position for the elderly client is

side lying position. Begin with a 5-minute introduction, an unhurried application of calming strokes, some deep breathes, gentle rocking, etc. to set the scene. Then proceed to the bulk of the work, which should take a total of about 20 minutes. Again do not be hurried or carry on a conversation as it takes away from the quality of your work. Leave about 5 minutes for a closing. A grad ual disengagement

will allow the client to rejoin the world, feeling great and refreshed, with the pain and discomfort

gone.

SUPINE POSTION

FOOT Apply Bon Vital Foot Balm to entire foot and ankle

1. FOOT PUMPING

Do this for at least for 1 minute or 50 strokes. This move results in "EDRF.

2. WIDENING OF THE METATARSAL SURFACE

Widen pad of the foot by laterally arching the sole over the two thumbs which are forming a fulcrum at the metatarsal joint. Manipulate the metatarsal joints. Follow to the insertion of the plantar ligament.

3. PLANTAR LIGAMENT

Stroke and lengthen.

4. FINGERTIP MASSAGE TO ANKLE

Soothing fingertip circles around the lateral and medial aspect the ankle bones.

5. SNAKING OF ACHILLES TENDON

A gentle alternating massage of the tendon with the thumb on one side and the fingers on the

6. ANKLE ARTICULATION

Articulate ankle and work joints, gentle ROM

7. GENTLE KNUCKLE STROKE

Useful when the foot and/or ankles are swollen. Middle knuckles of the hand are used in a feather LEG Apply Bon Vital Deep Tissue Crème or Lotion to entire leg

8. STROKING OF TIBIALIS ANTERIOR

Stroke up to shin with full hand contact focusing the pressure along the lateral side of the lower leg.

9. FLUFFING CALF

hand. Stroke up calf to the popliteal area a few times. Then, FLUFF up the calf to popliteal area. KNEE

10. WORKING AREA AROUND PATELLA

Put the leg flat on the table so the kneecap is disengaged. With fingertips, gently massage around the patella.

11. PALM MASSAGE KNEE

Massage sides of the knee with the palms of hands

THIGH

12.BILATERAL CROSS FIBER STROKE UP RECTUS FEMORIS

Place fingers on both sides of the thigh and place thumbs on rectus femoris. With thumbs, do alternating cross fiber strokes up to rectus femoris to attachment on hip.

13. LATERAL/MEDIAL FLUFFING OF QUADRICEPS

Fluff sides of leg with full hand contact.

14. HAMSTRINGS DIGGING A DITCH

middle of the back of the knee. You will feel a groove between the muscles. Gently "dig a ditch" with your fingertips up to this groove to the ischial tuberosity.

15. HAMSTRINGS-MEDIAL & LATERAL FLUFFING OF THE THIGH

With hands in the same position, fluff sides of the hamstrings but this time using full hand contact, not just the fingertips.

16. GENTLE HIP ROTATION -"COME HERE, COME HERE"

Slip hand under popliteal area for gentle rocking

17. RANGE OF MOTION OF LEG AND THIGH

Stand close to the client's hip with one knee (yours) on the massag e table. With one hand under the knee, support the foot by the heel. Your hand that holds the heel will control the motion. Rotate the leg gently and watch the ROM in the hip using irregular moves. (Not a suitable move for hip replacement unless cautious that there is no lateral/medial movement.) REPEAT 1 - 17 OF THE LEG PROTOCOL ON THE OPPOSITE LIMB

18. ROM WITH BOTH LEGS FOR BENEFIT OF LUMBAR AREA

Cross the farther leg over the nearer leg at the ankle. Support under the knees and the heel. Gently lift the legs so that the thighs are above the hip area. Do gentle circle and irregular move - ments to relieve lumbar and sacrum strain. (For hip replacements, do not cross the ankles.)

19. ROCKING WITH HAND AT HIP BONE

Gentle rocking at the hip bone to continue loosening up of the hip area.

UPPER BODY- SUPINE POSTION

ARMS & HANDS Apply Bon Vital Deep Tissue Crème or Lotion to the hand and entire arm

1. HAND AND FINGER MASSAGE

Work on the palmer surface of the hand and fingers in the position that is comfortable for the client.

2. FLUFFING OF FOREARM

Fluff the lower arm from wrist to elbow.

3. FLUFFING OF UPPER ARM

Support the elbow with one hand while the other hand fluffs the upper arm from elbow to shoulder.

4. PETRISSAGE UPPER TRAPS

To shorten the upper trap, gently push the shoulder closer to the neck. Use Tapotement, friction and petrissage to loosen the upper trapezes muscle.

5. LIFT ARM STRAIGHT UP AND SHAKE IT

Lift the arm while gently shaking it to help loosen. Then support the arm in an upraised position to

soften the pectoralis muscle. Work along the insertion of pectoralis using three-finger friction/petrissage massage. Friction/petrissage massage along clavicle and sternum. Insert gentle Tapotement wherever necessary.

REPEAT 1 - 5 ON THE OPPOSITE ARM

NECK

6. THUMB FRICTION TO THE NECK MUSCULATURE

Place both hands on top of each other under the occipital area to support the head. Using your thumbs, massage both sides of the sternocleidomastoid muscle from the occiput to the shoulder at the same time.

7. CHECKING FOR AVAILABLE R.O.M. OF NECK

Ask the client to look right to left and left to right comfortably to check for the safe margin of avail

- able range of motion. FACE Apply a small amount of Bon Vital Facial Therapy Creme to entire face

8. SIMULTANUEOIS BILATERAL GENTLE THREE FINGER FRICTION ON TEMPORALIS

Using your fingertips, massage the muscles around the eyes, temple and forehead.

9. SIMULTANEOUS BITLATERAL GENTLE THREE FINER FRICTION IN CHEEK AREA

Using your fingertips, massage the triangle of the cheekbone and jaw.

10. GENTLE CLOSING STROKE

Start with your elbows at the jaw and withdraw the forearms ever so lightly along the cheeks until your hands reach the face. This is a gentle closing stroke.

END OF THE SUPINE POSITION

AGE GROUPS:

For this work, we look at seniors as three basic types:

1. Robust

2. Age-Appropriate

3. Frail

WHY A HALF HOUR IS ENOUGH FOR GERIATRIC CLIENTS

Massage has a profound effect on the heart and on the sensory nervous system in many of the elderly. A 60-minute massage can have a negative effect by overloading the nervous system, the heart, and possibly the kidneys. A second reason is that if you want to do a good job with your client, you must be very attentive. Every move should be purposeful, and your mind should not wander. A shorter massage will be more focused than a one-hour massage. Reason number three is of a practical nature: It is easier to find people that can afford a weekly half -hour massage than a two-hour massage. You will find half hour massages easier to schedule at senior centers and nursing homes.

The first thing to consider is positioning. The most comfortable position for the elderly client is

side lying position. Begin with a 5-minute introduction, an unhurried application of calming strokes, some deep breathes, gentle rocking, etc. to set the scene. Then proceed to the bulk of the work, which should take a total of about 20 minutes. Again do not be hurried or carry on a conversation as it takes away from the quality of your work. Leave about 5 minutes for a closing. A grad ual disengagement

will allow the client to rejoin the world, feeling great and refreshed, with the pain and discomfort

gone.

SUPINE POSTION

FOOT Apply Bon Vital Foot Balm to entire foot and ankle

1. FOOT PUMPING

Do this for at least for 1 minute or 50 strokes. This move results in "EDRF.

PRONE POSITION

LOWER LIMB

(NOTE: This section repeats the lower-limb protocol from the supine position with a few additions. It is not necessary to do this again with your client unless the new additions were beneficial. In this position, gravity is an added benefit as is the greater trocanter movement.) FOOT Apply Bon Vital Foot Balm to entire foot and ankle

1. FOOT PUMPING - For 1 minute and 50 strokes

2. WIDENNG OF THE METATARSAL SURFACE

3. PLANTAR LIGAMENT

4. SNAKING OF THE ACHILLES TENDON

5. ANKLE ARTICULATION

6. GENTLE KNUCKLE STROKES

LEG Apply Bon Vital Deep Tissue Crème or Lotion to entire leg

7. HAND OVER HAND STROKE WITH OPEN PALM UP CALF

foot rest against your chest or shoulder. Hand over hand stroke with the full palm from the ankle to the popliteal area.

8. FLUFFING OF CALF

Fluff from the ankle to the popliteal area.

9. BUTTERFLY TAPOTEMENT

Gentle fingertip tapotement (piano style not accordion style) from the ankle to the popliteal area.

2. WIDENING OF THE METATARSAL SURFACE

Widen pad of the foot by laterally arching the sole over the two thumbs which are forming a fulcrum at the metatarsal joint. Manipulate the metatarsal joints. Follow to the insertion of the plantar ligament.

3. PLANTAR LIGAMENT

Stroke and lengthen.

4. FINGERTIP MASSAGE TO ANKLE

Soothing fingertip circles around the lateral and medial aspect the ankle bones.

5. SNAKING OF ACHILLES TENDON

A gentle alternating massage of the tendon with the thumb on one side and the fingers on the

6. ANKLE ARTICULATION

Articulate ankle and work joints, gentle ROM

7. GENTLE KNUCKLE STROKE

Useful when the foot and/or ankles are swollen. Middle knuckles of the hand are used in a feather LEG Apply Bon Vital Deep Tissue Crème or Lotion to entire leg

8. STROKING OF TIBIALIS ANTERIOR

Stroke up to shin with full hand contact focusing the pressure along the lateral side of the lower leg.

9. FLUFFING CALF

hand. Stroke up calf to the popliteal area a few times. Then, FLUFF up the calf to popliteal area. KNEE

10. WORKING AREA AROUND PATELLA

Put the leg flat on the table so the kneecap is disengaged. With fingertips, gently massage around the patella.

11. PALM MASSAGE KNEE

Massage sides of the knee with the palms of hands

THIGH

12.BILATERAL CROSS FIBER STROKE UP RECTUS FEMORIS

Place fingers on both sides of the thigh and place thumbs on rectus femoris. With thumbs, do alternating cross fiber strokes up to rectus femoris to attachment on hip. THIGH

10. DIGGING A DITCH

With the foot still resting on the shoulder or chest and using your thumbs, massage up the mi ddle of the hamstrings from the popliteal area to the ischial tuberosity.

11. LATERA/MEDIAL FLUFFING OF THE THIGH

With the foot still resting on the shoulder or chest, fluff the lateral and medial muscles of the hamstrings with full-hand contact, moving from the popliteal to the hip area. HIP

12. PUMPHANDLE - LOOSENING THE GREATER TROCHANTER AND HIP FLEXORS

Find the greater trocanter and while pumping the leg lateral to medial, do fingertip petrissage around the trocanter.

13. GLUTEI

Fingertip petrissage and gentle fist tapotement around glutes, sacrum, iliac crest and sciatic notch.

REPEAT 1 - 14 ON THE OPPOSITE LIMB

BACK PROTOCOL

LOW BACK Apply Bon Vital Deep Tissue Crème or Lotion to entire back

1. ROCKING

Trager shake the hips. Hands are on the hips performing gentle, alternating pushing of the hips to produce rocking in the lumbar/sacral area.

2. SHAKING THE TREE

Move hands to the lower portion of the ribs and perform a more aggressive form of Trager rocking. Both of these movements help to relieve tension and pain in the lumbar/sacral area.

3. OVAL LUMBAR STROKE

Stroke down from C-7 to the sacral area. Then using the heels of your hands, start with small ovals in the sacral/lumbar area progressing to ever widening ovals. The idea is to separate the lumbar from the sacrum.

2. FLUFFING OF FOREARM

Fluff the lower arm from wrist to elbow.

3. FLUFFING OF UPPER ARM

Support the elbow with one hand while the other hand fluffs the upper arm from elbow to shoulder.

4. PETRISSAGE UPPER TRAPS

To shorten the upper trap, gently push the shoulder closer to the neck. Use Tapotement, friction and petrissage to loosen the upper trapezes muscle.

5. LIFT ARM STRAIGHT UP AND SHAKE IT

Lift the arm while gently shaking it to help loosen. Then support the arm in an upraised position to

soften the pectoralis muscle. Work along the insertion of pectoralis using three-finger friction/petrissage massage. Friction/petrissage massage along clavicle and sternum. Insert gentle Tapotement wherever necessary.

REPEAT 1 - 5 ON THE OPPOSITE ARM

NECK

6. THUMB FRICTION TO THE NECK MUSCULATURE

Place both hands on top of each other under the occipital area to support the head. Using your thumbs, massage both sides of the sternocleidomastoid muscle from the occiput to the shoulder at the same time.

7. CHECKING FOR AVAILABLE R.O.M. OF NECK

Ask the client to look right to left and left to right comfortably to check for the safe margin of avail

- able range of motion. FACE Apply a small amount of Bon Vital Facial Therapy Creme to entire face

8. SIMULTANUEOIS BILATERAL GENTLE THREE FINGER FRICTION ON TEMPORALIS

Using your fingertips, massage the muscles around the eyes, temple and forehead.

9. SIMULTANEOUS BITLATERAL GENTLE THREE FINER FRICTION IN CHEEK AREA

Using your fingertips, massage the triangle of the cheekbone and jaw.

10. GENTLE CLOSING STROKE

Start with your elbows at the jaw and withdraw the forearms ever so lightly along the cheeks until your hands reach the face. This is a gentle closing stroke.

END OF THE SUPINE POSITION

BACK

4. RINGING THE DOORBELLS

Massage the erector spinae muscles from the sacrum to neck by gently pressing your fingers on each side of the spine.

5. FLYING ACES

Standing at the client's waist place your hands on either side of the spine and stroke toward the head. The left hand peels off to the shoulder, and the right hand goes to the occiput for stretch. The left hand then strokes to the occiput and the right hand strokes to the shoulder to stretch the upper trapezius. client put his/her arms over the sides of the massage table for greater accessible movement in shaking of the shoulder area.

6. FIRST LONG BACKSTROKE

Working from the opposite side, place your hand just above the sacrum at a right angle to the neck. Shake the shoulder.

7. SECOND LONG STROKE

Using the heel of your hands, massage the erector spinae muscles, from the sacrum to the neck with short, alternating circular motions. Shake the shoulder.

8. THIRD LONG STROKE

on the side of the body. One hand pushes away from the spine while the other hand pulls up from the side of the body in a wringing-like movement. Move from the sacrum to the neck and then shake the shoulder.

9. JACKHAMMER

This is a transitional move to get to the other side of the body. It also stimulates the spinal spine (in the vertebral groove). Support this hand at the wrist by the other hand which makes small jackhammer-type movements pushing the fingers down the spine to th e sacrum. The fingers do not lose contact with the skin. Move to the other side of the body.

10. UPPER TRAP TAPOTEMENT

On the same side of the body do opposing fingertip Tapotement on the upper traps and around the medial border of the scapula. Walk to the other side of the table.

11. SHOULDER BLADE LIFT

Lift the shoulder up to shorten and soften the rhomboid muscle area. Stroke along the edge of the scapula with your thumbs in the rhomboid area.

11a. ALTERNATIVE SHOULDER BLADE LIFT

Use a small rolled-up towel placed under the shoulder and elbow to support the arm and to soften and shorten the rhomboid muscle area. Use your fingertips or thumbs to Petrissage the rhomboid area.

12. THUMB OR FINGER STROKES ON THE SURFACE OF THE SCAPULA

Massage the medial to the lateral surface of the scapula through the deltoid on to the rotator cuff,

teres major and teres minor. Add tapotement where necessary.

13. SEE SAW

With the arm hanging off the side of the table, cup the front of the shoulder in one hand and sup - port the elbow, in the other hand. Alternate up and down motion (like a see-saw) to get more move - ments in the scapula area.

14. SWING ARM

Swing the arm to loosen. Catch it in mid air and lay it on the table.

15. HAND AND FINGER MASSAGE - Arm is outstretched on the table, palm up.

16. FLUFFING OF THE FOREARM

17. FLUFFING OF THE UPPER ARM

REPEAT 10 -17 OF THE SHOULDER PROTOCOL

ON THE OPPOSITE ARM

18. NECK STROKE

Standing beside the client's head and using both hands, massage the n eck from the occiput to C-7 with downward motion or a gentle kneading motion.

19. FINISHING STROKES along the outline of the upper body, shoulder and neck to the occiput.

20. DISENGAGEMENT through scalp massage if this is the end of the massage.

With our somewhat limited knowledge of health impairments, we MUST seek the advice and permis - sion of the client's physicians, chiropractors, PTs, etc. when we work with people who have a major health problem. In a person with multiple concerns, work on the simplest one first. To measure progress, find a yardstick that is understandable to the client. Nothing encourages more than visible progress. If the person is, or recently was, under a medical care, you MUST discuss your plan with the client's doctor and obtain his/her permission.

DISCLAIMER:

The practice of Geriatric Massage without proper or certified training from a practitioner qualified

to teach this modality may cause discomfort or injury to the client. Therefore, Bon Vital & Day - Break Geriatric Massage Institute and Sharon Puszko jointly, severally, cannot and shall not be held liable for any injury or other consequence resulting from the practice of Senior or Geriatric

Massage in any format.

Sharon Puszko, PhD, CMT

Owner, Director, Educator/Author

Sharon is a graduate of the University of California with a major in education. After teaching Biol - ogy internationally, in Europe, Asia, Central America and the Eastern United States, Sharon made a career change into the wellness field in 1986. She attended massage school in northern Califor - nia and then graduated from the Pittsburgh School of Massage Therapy and Healthbuilders School of Massage Therapy in St. Augustine, FL. Along with overseeing the funct ion of DAYBREAK Geriatric Massage Institute; she has a private practice, in four retirement communities and does volunteer hospice work. Day-Break was founded in 1982 by Dietrich Miesler of Germany. Sharon worked and studied with Dietrich for a number of years after she graduated from massage school. Dietrich passed the

Institute to Sharon in 2000 upon his retirement.

teaching the DAY-BREAK Geriatric Massage Level 1-Beginning and Level 2-Advanced worksho ps in massage schools and community colleges. The classes are approved by the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) as well as Florida State Massage Therapy Association ( FSMTA) for continuing education for massage therapists, nurses and other he alth providers. Day-Break conducts over 40 workshops per year. BACK

4. RINGING THE DOORBELLS

Massage the erector spinae muscles from the sacrum to neck by gently pressing your fingers on each side of the spine.

5. FLYING ACES

Standing at the client's waist place your hands on either side of the spine and stroke toward the head. The left hand peels off to the shoulder, and the right hand goes to the occiput for stretch. The left hand then strokes to the occiput and the right hand strokes to the shoulder to stretch the upper trapezius. client put his/her arms over the sides of the massage table for greater accessible movement in shaking of the shoulder area.

6. FIRST LONG BACKSTROKE

Working from the opposite side, place your hand just above the sacrum at a right angle to the neck. Shake the shoulder.

7. SECOND LONG STROKE

Using the heel of your hands, massage the erector spinae muscles, from the sacrum to the neck with short, alternating circular motions. Shake the shoulder.

8. THIRD LONG STROKE

on the side of the body. One hand pushes away from the spine while the other hand pulls up from the side of the body in a wringing-like movement. Move from the sacrum to the neck and then shake the shoulder.

9. JACKHAMMER

This is a transitional move to get to the other side of the body. It also stimulates the spinal spine (in the vertebral groove). Support this hand at the wrist by the other hand which makes small jackhammer-type movements pushing the fingers down the spine to th e sacrum. The fingers do not lose contact with the skin. Move to the other side of the body.

10. UPPER TRAP TAPOTEMENT

On the same side of the body do opposing fingertip Tapotement on the upper traps and around the medial border of the scapula. Walk to the other side of the table. Sharon has published numerous articles in Massage & Bodywork (Associated Massage & Body - work Association trade publication) as well as Advanced for Rehab Directors magazine. She has - sage, 3-D Anatomy for Primal Pictures of London England and has appeared on public television shows such as Age Wise in Pittsburgh, PA and radio talk shows. She is on the Bon Vital Education Team and a spokesperson for Biofreeze. Sharon has been interviewed by numerous magazines for her insights on seniors from robust to frail. She is a member of ABMP (Associated Bodywork & Massage Professionals) and a founding member of the AMTE (Alliance for Massage Education).