learner guide · 2018. 11. 27. · 2. prepare for treatment • check readiness of treatment area...

Shop 2, 161 New South Head Road, Edgecliff, NSW 2027 Australia

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SHBBBOS006

Provide Superficial Lymph

Massage Treatments Learner Guide

http://www.sbdi.com.au/

mailto:[email protected]

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Learner Guide SHBBBOS006

This work is Copyright© of:

Fuss Education Pty Ltd

Shop 2/161 New South Head Road

Edgecliff NSW 2027

Created for the delivery of Vocational Education within Sydney Beauty & Dermal

Institute, RTO 91192, CRICOS 02725B

Resources have been created by Fuss Education Pty Ltd to support the SHB Hair

and Beauty Training package and are from a collection of professional, industry

representatives and resources, and reasonable effort has been made to ensure

that the material is accurate and current. Author/s takes no responsibility for act or

omission as a result of learning. Copying, reproducing, transmission or alterations

are not permitted and a license will not be granted.

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TABLE OF CONTENTS

INTRODUCTION ...................................................................................... 4

APPLICATION ......................................................................................... 4

This learner guide covers ..................................................................... 4

FOUNDATION SKILLS .............................................................................. 5

ELEMENTS AND PERFORMANCE CRITERIA ............................................ 6

PART 1 - KNOWLEDGE EVIDENCE ......................................................... 8

SECTION 1 – ESTABLISH CLIENT PRIORITIES ......................................... 13

SECTION 2 – PREPARE FOR TREATMENT .............................................. 37

SECTION 3 – PROVIDE LYMPH MASSAGE ........................................... 38

APPLY SUPERFICIAL LYMPH MASSAGE TO THE FACE ......................... 38

APPLY SUPERFICIAL LYMPH MASSAGE TO THE BODY ........................ 41

SECTION 4 – REVIEW TREATMENT AND PROVIDE POST TREATMENT

ADVICE ................................................................................................ 45

SECTION 5 – CLEAN TREATMENT AREA ............................................... 47

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INTRODUCTION

This book is designed to provide a theory and assessment framework to support the

gathering of suitable evidence to prove competency in the unit.

The resource is designed for self-paced learning, as well as, distance education

settings, in a classroom or workshop setting. It is more than capable of supporting

new learners entering the industry, as well as experienced workers seeking to up-skill;

transfer to a new industry or to obtain formal qualifications.

At the completion of the learning, the Learners shall be able to demonstrate or

provide evidence of competency and understanding of the following:

• Problem solving

• Counselling processes and methods

• Respect for client strengths or particular needs

• Capacity to maintain and critique realistic limits for agency service and client

expectations

SHBBBOS006 – PROVIDE SUPERFICIAL LYMPH MASSAGE TREATMENTS

APPLICATION

This unit describes the performance outcomes, skills and knowledge to provide

superficial lymph massage for the treatment of specific skin and body conditions. It

requires the ability to interpret a treatment plan, and to select and apply a range of

superficial lymph massage techniques.

This unit applies to beauty therapists with knowledge of the anatomy and physiology

of the lymphatic system, the role of the lymphatic system in wound healing,

inflammation and oedema and the biology of acne conditions. They provide

treatments in beauty therapy or medical cosmetic clinics. Treatment may be

performed post-operatively under medical supervision. They exercise judgement in

planning and implementing an appropriate treatment program.

No occupational licensing, certification or specific legislative requirements apply to

this unit at the time of publication

This learner guide covers • Establish client priorities

• Prepare treatment area

• Provide lymph massage

• Review treatment and provide post treatment advice

• Clean treatment area

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FOUNDATION SKILLS

Foundation skills essential to performance in this unit, but not explicit in the

performance criteria are listed here, along with a brief context statement.

Oral communication skills to: • select and use appropriate terminology in

consultations with clients

• protect confidentiality of client information by

ensuring that other clients and colleagues do

not overhear discussions

Reading skills to: • interpret and follow manufacturer instructions

and safety data sheets for dilution, handling and

disposal of cleaning products

• source and interpret credible information from

anatomy and physiology publications and

anatomical charts and models

Numeracy skills to:

• calculate treatment price and timing

Writing skills to:

• record treatment using anatomy and physiology

terminology to describe body areas and

anatomical positions

Technology skills to:

• access credible online publications and

resources that build knowledge for providing

advice to clients

• use client software to update client notes, and

record stock data and product purchases

Self-management skills to: • manage treatment length

• recognise scope of practice issues and refer

clients to colleagues or health care professionals

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ELEMENTS AND PERFORMANCE CRITERIA

ELEMENTS PERFORMANCE CRITERIA

Elements describe

the essential

outcomes.

Performance criteria describe the performance needed to

demonstrate achievement of the element.

1. Establish client

priorities

• Access and review client treatment plan if available.

• Discuss massage requirements and lifestyle factors with

client and identify treatment priorities.

• Review indications for treatment, contraindications and

client feedback and modify treatment plan as required.

• Identify contraindications which prevent treatment and

recommend suitable alternative treatments or refer client

to appropriate professional as required.

• Confirm treatment objectives and revised treatment plan

with client.

• Obtain written medical approval as required.

2. Prepare for

treatment

• Check readiness of treatment area and availability of

equipment.

• Prepare client, equipment and products based on

agreed treatment plan.

• Use energy, water and other resources efficiently during

preparation and subsequent treatment process

3. Provide lymph

massage

• Position self to minimise fatigue and risk of injury.

• Apply superficial lymph massage routine according to

treatment plan.

• Ensure client modesty and comfort throughout treatment.

• Maintain infection control procedures throughout

treatment.

• Monitor effects and modify massage appropriately.

• Apply post treatment products according to

manufacturer instructions.

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ELEMENTS PERFORMANCE CRITERIA

4. Review treatment

and provide post

treatment advice

• Evaluate lymph massage treatment with client.

• Record outcomes of treatment on client treatment plan.

• Advise client on expected reactions and provide home

care and lifestyle advice.

• Discuss next treatment and rebook client as required.

• Complete and store treatment documentation

5. Clean treatment

area

• Remove used linen and clean surfaces and equipment

according to organisational policies and procedures.

• Restock equipment and products in preparation for next

treatment.

• Dispose of general waste to minimise negative

environmental impacts according to organisational

policies and procedures.

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PART 1 - KNOWLEDGE EVIDENCE

State or territory and local health, hygiene and skin penetration regulations

and requirements relevant to superficial lymph massage treatment

Within Australia and each State and Territory there is legislation that applies to

practitioners working in the beauty industry and directs the infection control

procedures for all services. The aim of this legislation is to protect you and your client

by preventing cross infection and controlling the spread of disease. Each state has

developed a set of health guidelines based on the legislation to guide infection

control in a salon setting.

The skin penetration guidelines are additional and apply to any service where there

is a risk of breaking the skin or drawing blood. Skin penetration guidelines apply to

beauty services as there is a risk that blood can be drawn in some treatments.

So why do we have such detailed regulations and guidelines covering this industry?

Infections can be spread between the client and operator, and from client to client,

from you to other employees of the salon and even from you to your family and

friends. Most people that visit your salon will be free of diseases, some will

unknowingly have come into contact with a contagious condition and in rare cases

they may know that they have a contagious condition but hope that you will

proceed with the service anyway. If you follow the recommended procedures

Organisational policies and procedures relevant to superficial lymph

massage treatment

Equipment use and maintenance

As with all beauty services, it is important that the area for service is well prepared

and organised before the client arrives and the service begins. Beauty treatments

may be performed in a variety of places and are often provided as an additional

service in hair and laser clinics or can be a business that is dedicated solely to body

treatments.

You may work in a salon where you simply need to ensure all the equipment and

materials are available and the service area is clean. Alternatively, you may be

expected to set up a service area in a new salon. The following is a list of what you

would need to take into account if you were setting up a new salon service area.

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Some suggested equipment includes

TOOLS LINEN EQUIPMENT

Massage medium Larges towels Treatment bed

Pump bottle Hand towels Stool (with wheels)

Dappen dish Disposable sheeting Trolley

Alcohol wipes Client gown

Hair net

Blanket

Disposable G-string

Bolster

Eye pillow/ tissues

Hot towels

All necessary equipment and materials must be prepared and maintained

according to health requirements, manufacturers’ instructions and workplace

policies and procedures. The work area must be cleaned and waste disposed of

after each client service. It is important to become familiar with the tools of the trade

including furniture, tools, skincare products, machinery and cosmetics.

A clean, tidy workplace is essential for good health and safety. A dirty workplace

can result in slips and falls which may cause injury. More importantly, it can also

contribute to infection by providing an unhygienic environment where micro-

organisms can thrive.

Incident reporting

If you are an employee, you should report immediately to your supervisor the nature

of the incident and complete an Incident Report form which should include:

• the date and time of exposure,

• how the incident occurred and

• the name of the source individual, if you know it

If you are the owner, manager or an employee, you should report the incident to

your doctor or the Accident and Emergency Casualty Department at the nearest

hospital.

Linen use and laundry procedures

Linen used in premises where skin penetration procedures are undertaken shall be

• Stored to prevent contamination

• Only fresh, clean linen shall be used on each client

• Used, dirty or soiled linen shall be stored in a suitable receptacle

• Household laundering procedures are adequate for processing all soiled linen

• Hands shall be dried thoroughly using disposable paper towels

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• Clean the surface that has been contaminated with detergent and water

using disposable wipes or paper towels

• Disposable items must be used where possible

Personal hygiene and presentation

Another important part of preparation is your personal presentation which should

create a professional image. A clean and neat appearance and high standards of

personal hygiene are critical. Clients may be put off by a general lack of cleanliness

or signs of body odour which they can detect because of close contact with you.

As you are performing a body treatment clients will expect that your skin, hands and

nails are representative of the sort of care that you take and the services that you

are selling. The condition and presentation of you as a therapist are excellent

advertisements for the services of the salon.

Presentation of treatment area

When in a workplace, it is common to be asked to perform a variety of procedures,

your station should be stocked with a wide assortment of necessary tools and

supplies arranged to conform to your work habits. Since you spend so much time in

one small area, each element of your compact module should be efficient, clean

and comfortable, both for you and your clients.

Adequate lighting is essential to any job requiring visual precision. Your lighting

source should illuminate your work directly, without either getting in your way or

causing an uncomfortable glare. An adjustable lamp can be used as a moveable

heat source to help accelerate oil or cream absorption, as well.

Your chair should have ample low back support to comfortably encourage good

posture. Your station should be neatly arranged,

with tools and supplies easily accessible. Provide

each client with a clean gown and headband,

and make sure that you have a wastebasket

handy for immediate disposal of used supplies.

Waste and hazardous substance disposal

Waste should be disposed of in an enclosed

waste bin fitted with a plastic line, durable

enough to resist tearing. The bin should be

regularly disinfected in a well ventilated area.

Clinical waste (contaminated waste) are items

such as cotton wool, sponges, tissues plus other

materials, that have come into contact with

blood and bodily fluids. These items should be

disposed of immediately to prevent

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contamination of other clean items and protection for both the therapist and client.

Categorised waste:

• Biohazardous bin – for clinical and contaminated waste

• Sharps container – for single-use sharp instruments that are used to penetrate

the skin, such as needles & razors

• Recycle bin – for anything that may be recycled, such as paper, plastic

bottles and aluminium

• General waste – for all other waste

Work health and safety

The Work Health and Safety Act 2011 is the main piece of legislation affecting WHS

issues. It clearly communicates the minimum standards of health, safety and welfare

required in each area of the workplace. It is the employers legal responsibility to

implement the Act and to ensure, so far as is reasonably practicable, the health and

safety at work of the people whom they are responsible and those who may be

affected by the work they do.

There is a WHS regulatory authority for every state and territory of Australia. The local

authority appoints workplace inspectors to enforce health and safety law by visiting

the workplace to check compliance is being met with all health and safety

legislation. Every business is required to have a health and safety representative

(HSR) available to provide advice and guidance and gather relevant data in

relation to health and safety and your business.

An employer is obliged to make to workplace safe. A written Health and Safety

Policy for the business is important to ensure staffs follow safe working procedures.

The health and safety policy identifies how health and safety is managed for that

business: who does what, when and why. The policy must be issued and discussed

with each employee and should outline their safety responsibilities. It should include

idea such as:

• Details of storage of chemical substances

• Details of stock cupboard and dispensary

• Details and records of the checks made by a qualified electrician on

specialist electrical equipment

• Names and addresses of the holders of the keys

• Escape routes and emergency evacuation procedures

All health and safety policies should be reviewed regularly to ensure they meet all

relevant legislation guidelines including updates.

Management of WHS:

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Legal and insurance liabilities and responsibilities regarding treatments

New businesses are required to register their ABN (Australian Business number). The

owner of that business is then responsible for the health and safety of that workplace

under the WHS Act. As the business develops it may be necessary to notify the local

authority of further services that are available.

A therapist must never perform a procedure without a signed consent Form as a

verbal agreement is not valid. Informed consent consists of the client’s acceptance

of the recommended procedure, and confirmation that they fully understand that

the treatment is completed at their own risk.

A consent form must briefly, but thoroughly outline the treatment procedure and

preparation and include details on the benefits, how the treatment will work,

limitations and potential changes to the outcome, any risks and the number of visits

that may be needed. Should the client require more time to think about the

treatment this time must be granted to them. It is also important to present the full

financial commitment that will be required for their service.

Scope of practice

The Scope of Practice describes the procedures, actions, and processes that a

healthcare practitioner is permitted to undertake in keeping with the terms of their

professional qualification.

When consulting with clientele, it is the therapist’s duty of care to recognise certain

conditions or disorders that may stop or alter the treatment they are about to

perform. These conditions and disorders are categorised as contraindications.

As therapists we are not qualified to state diagnosis or treat certain

contraindications, although we can refer them to appropriate practitioners to seek

further medical assistance. Specialists that a client may be referred to include:

• Medical practitioner

• Complimentary therapist

• Physiotherapist

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SECTION 1 – ESTABLISH CLIENT PRIORITIES

Client record management

When performing lymph massage a thorough client consultation is required to

ensure that the treatments offered are both safe and appropriate for each

individual client.

In addition to this you will need to find out and record specific information related to

clients’ body characteristics and contra-indications to treatment. This section covers

the specific requirements for developing and implementing treatment plans for

body massage. You may be dealing with new or existing clients. If the client has not

attended your workplace before you will need to develop a new treatment plan.

Sample consultation card

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The consultation should put the client at ease and be used to answer any questions

and explain aspects of the treatment. Post consultation a therapist must design,

record and maintain treatment plans and records for each of the treated clients,

specifying the details of:

• client feedback

• contraindications and conditions

• products used

• outcomes of previous and current treatment

• post treatment lifestyle and product advice

• correct pressure, direction and stroke pattern

• appropriate rhythm, speed and treatment duration

• stationary, circle, pump, scoop and rotary movements

• treatment objectives

• recommended future treatments

A treatment plan is a plan that states how you are going to perform the treatment

on the client. The therapist will need to evaluate the information the client has

specified in order to recommend the most appropriate treatment to meet the

client’s needs.

Asking your client to describe exactly what they would like shows them that their

needs are important and that they will receive the best possible service from you. To

collect information about your client’s needs, you will need to ask open questions

and actively listen to the client’s needs. Clients are also encouraged to ask questions

regarding any concerns or comments they may have.

An essential part of providing a professional service to your clients is to identify why

they want the treatment so that you can then provide accurate advice and

recommendations for the client.

Indications for manual superficial lymph massage

Lymph massage can help to achieve any of the following:

• Relaxation of the body

• retention of fluid in limbs

• facial oedema

• pre and post-operatively

• relaxation

• scar tissue

• acne

• rosacea or telangiectasia

The use of massage to increase the movement of lymph fluid through the soft tissues

is an old practice found in many parts of the world. However in Western culture the

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process of lymphatic drainage is relatively new. The technique was developed

between 1932 and 1936 by Dr Emil Vodder and his wife Estrid Vodder, who treated

the swollen lymph nodes of their patients successfully. At that stage little medical

research had been conducted on the lymphatic system but since then much more

interest has been taken in researching the lymphatic system and its effect on the

functioning of the human body.

Superficial lymph drainage massage is a rhythmic, gentle massage that imitates the

movement of the lymphatic system. Precise pressure is applied to stimulate

contraction and reduce oedema (a condition in which excess fluid saturates tissues

and causes them to swell indicating that the lymphatic flow in the area is

overloaded).

This unusual accumulation of fluid in the soft tissues can be temporary or serious as in

chronic lymphedema. In addition to improving lymph flow, superficial lymphatic

drainage massage is relaxing because the slow, gentle repetitive movements help

reduce stress.

Superficial lymph drainage massage is a useful technique for beauty therapist to

apply to clients for cosmetic reasons, general wellness and relaxation. The technique

can be used to enhance the outcomes of other treatments and service for example

body massage and aesthetic aromatic massage or a facial massage. There is a

range of potential benefits of applying superficial lymph drainage massage for

clients in the beauty industry.

1. Physical structure of the skin

In some cases unhealthy skin is caused by poor circulation and superficial lymph

drainage massage can improve the condition. The application of superficial lymph

drainage massage techniques, particularly on the face may:

• enhance the texture and appearance of skin through the removal of waste

materials and toxins and provide nourishment to the skin cells and restoring

the fluid balance

• relieve acne

• reduce mild skin puffiness in some areas, for example under the eyes

• promote cellular regeneration and aid desquamation

• release wrinkles from their underlying adhesions, so that they become

shallower

• also reduce the appearance of red, thickened and coarse skin in the lower

limbs of obese people

2. Improving cellulite

Cellulite is the dimpled rippling deposits of fat, body fluids and waste material that

form on the bodies of some men and women – usually on the hips, abdomen and

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thighs. It is different from fat because the connective tissue is damaged causing the

rippled appearance. The fatty cells in these areas, are held in place by a network of

fibres, and nourished and cleansed by fluids. When this process is slowed down, the

tissue is flooded with waste materials; the fibres thicken, become coarse and less

flexible and often adhere to underlying structures that it normally slides over. Areas

harden to form immovable pockets. Because cellulite is a condition of stagnation

the remedy is to improve the body’s circulation. Appropriate exercise, improved diet

and superficial lymphatic drainage massage can help.

3. Lessen scaring

As scar tissue forms, lymph flow is often blocked. Superficial lymph drainage

massage applied to a wound as soon as it is appropriate to do so after the injury,

can assist in forming scars that are smaller, smoother and stronger than they might

otherwise be.

4. Relieving tension and stress

Chemical and physical changes occur in people who are tense because the body’s

defence system is stimulated. Adrenaline is secreted into the bloodstream, the

respiratory and heart rate increases, organ function decreases and the immune

system is suppressed. Massage, and especially superficial lymph drainage massage

stimulates the parasympathetic nervous system which has the opposite effect on the

body - muscles relax and respiratory and heart rate decrease. The gentle, slow

repetitive strokes performed in a specific direction have a soothing effect on the

body which may enter a state of relaxation that promotes healing and balance.

Effects, benefits and application of each type of massage movement and

techniques

Massage techniques are used to mechanically circulate lymph through the

superficial lymph vessels like squeezing liquid through a tube. This action stimulates

the lymphangion’s (smooth muscle) to contract thus starting up the lymphatic pump

that continues to function on its own.

The basic techniques or movements used for superficial lymph drainage include:

• stationary circles

• scoop

• pump

• rotary

These techniques and variations should be repeated rhythmically about 6 to 8 times

either at the same location or in expanding spirals using two hands to save time. The

inert mass of the tissue needs time and repetition before it responds. As you work,

you need to pay close attention to the subtle changes which occur in tissue

temperature, texture and elasticity. As the superficial lymph drainage massage

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progresses, the skin should become warmer, softer, looser and more liquid.

Reddening of the skin or pain should not occur with the application of these

techniques.

The stationary circle

This technique is the basis of all lymph drainage massage which involves

compression at the beginning of the movement and a stretch of tissues at the end

of the movement. The fingertips are placed flat on the skin applying enough gentle

pressure to create traction and move superficial skin layers. Fingertips move in

stationary circles (clockwise or anti clockwise) which involve the fingertips returning

to the starting position once a circle has been completed. It is important to remain

stationary and repeat the movement 6 to 8 times before moving to adjacent areas.

The pressure phase of a circle lasts longer than the relaxation phase. Stationary

circles are commonly applied to the neck, face and lymph nodes.

The scoop

This technique is described as a ‘giving motion’ and is applied to the legs and arms

with the palm facing upwards. It involves the corkscrew movement of the wrist and

hand .The thumb is on the upper part of the limb and the fingers below are

outstretched and swing inwards towards the body during the pressure phase with no

pressure on the outward stroke.

The pump

The palms face downwards and the thumb and fingers move together in the same

direction moving the skin in an oval or diamond pattern. The exaggerated

movements of the wrist, which acts like a hinge, control the movement of the thumb

and fingers. The forward motion of the finger is carried out under pressure, the hinge

motion of the wrist without pressure. The pump technique is applied to arms and

legs.

Rotary

This technique is used on relatively broad areas of the body such as the back. Palms

and fingers lie flat on the surface of the skin and wrists move up and down in range

of extensions during the application. As they press downwards, the fingers swing

from the outside towards the insides applying light pressure to the skin. The thumb

also rotates in the direction of the lymph drainage. In the passive phase, the wrist is

raised and the four outstretched fingers move back into position to repeat the

movement.

Other superficial lymph drainage massage techniques include J stokes, Thumb

walks, Flat hand push and Figure 8 as well as effleurage which is one of the most

versatile massage techniques.

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Lymphatic massage components

The principles of superficial lymph drainage massage involve the application of the

right pressure, rhythm, sequence and direction of massage movements to ensure

that fluid is effectively moved through the lymphatic system.

COMPONENT EFFECT

Pressure

Should be very light and only cause enough traction so that

the superficial surface of the skin moves over the underlying

tissues.

With each movement the skin should be stretched with

enough intensity that it snaps back when released. Correct

pressure is deep enough so that you do not slide over the skin,

but light enough so that you don’t feel anything below the

skin.

Stretching the skin gently lengthwise, horizontally and

diagonally through massage movements stimulates the

complex bed of lymph capillaries in the superficial tissues.

Rhythm

A smooth rhythm involving 6 – 8 repetitions alternating active

pressure and then inactive pressure should be applied.

With the correct rhythm and speed, the lymphatics are

opened, and then allowed to shut and then there is a little

time given for the lymph to get sucked down along the vessel.

This way the massage strokes can stimulate and co-ordinate a

wave in lymphatic fluid.

An appropriate rhythm will also stimulate the parasympathetic

nervous system, causing the client to relax

Sequence

The correct sequence of massages strokes is very important.

Lymph nodes must be drained first, then the related quadrant

of the trunk, and gradually you work outward to the

extremities.

The purpose of massaging lymph nodes first, where circulation

slows, is to make room for more lymph which will be drained

from adjacent areas.

Direction

Lymph must always be pushed towards the targeted node as

you work, and as you move further and further away from the

node, the fluid should be pushed back in the direction of the

node.

By using this sequence, a path is cleared for the lymph to

move, as well as a suctioning effect being created that draws

the lymph to the node.

The direction of the active part of the stroke should always be

towards the targeted lymph node ensuring that lymph is

pushed along the vessel. If you push the lymph the wrong

way, your work will not be effective.

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Direction of superficial lymph massage

Treatment timing

Lymphatic massage can be completed only on a localised area or full body. This will

be specified by the client main concern and reason for treatment. The massage

timeframe will usually be specified by the salon in which you work, may include

consultation, aftercare and homecare and may not.

When treating one specific area of the body it will be necessary to adapt your

techniques and timing to suit the specific treatment needs. The timing for the body

areas can be broken down as follows.

CONSULTATION

Décolletage & Face 5 minutes

Each leg and feet 10 minutes

Each arm and hands 5 minutes

Abdomen 2- 3 minutes

Back 20 minutes

Scalp 2 – 3 minutes

AFTERCARE & HOMECARE

Detailed anatomy and physiology of lymphatic system

The lymphatic system is the body’s secondary system of circulation. Throughout the

body, plasma- like fluid called lymph fills the spaces between the cells. The

lymphatic system collects this lymph and carries it to the bloodstream. The system

functions as one of the body’s major defences against infection. Also, lymphatic

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capillaries pick up nutrients and filter wastes that cannot be absorbed by blood

capillaries.

Functions of the lymphatic system:

• Maintenance of fluid balance in the body

• Immunity

• Shares some of the functions of the cardiovascular system

• Collection of materials from the tissue fluid and returns it to the blood

• Filtration of lymph by the lymph nodes which help prevent the spread of

infection

• Absorption of fats from the digestive system through the lymph capillaries of

the intestinal villi

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The spleen

The spleen is located on the left side behind the lower ribs. It produces white blood

cells and destroys organisms that cause disease. The spleen also filters blood,

destroying worn-out red blood cells and platelets and recapturing the haemoglobin

for new red blood cells. It also stores blood, releasing it when the body suddenly

needs an increased supply such as during intense physical activity or during heavy

bleeding.

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The thymus

The thymus is located in the upper chest behind the sternum. It produces specialised

white blood cells called T cells that provide immunity against different diseases. The

thymus is active during childhood and adolescence when the body’s immunity is

being developed.

Lymph tissue, vessels, nodes, nodules

Lymph tissue includes the lymph fluid, vessels nodes, nodules, spleen and the

thymus. These represent a collection of organs and/or cells that make up a system.

Each of these components is rich in lymphocytes and macrophage that help

protect the human body from bacteria and other foreign organisms.

Lymphatic vessels resemble small veins and capillaries and are distributed

throughout the body. They have thinner walls and more valves than the veins. The

walls are also more permeable allowing very large molecules and even particulate

matter to be removed from the interstitial spaces. Lymph is pushed through the

vessels by contraction of the skeletal muscles, by inspiration (intake of breath) and

the valves which prevent a backflow. Lymph from all parts of the body drains into

the large veins in the neck and enters the bloodstream. The system moves about 3

litres of fluid a day. Massage is one of the most effective ways of moving lymph

through the system.

Lymph nodes are small lumps of tissue that filter out disease-causing organisms and

dead body cells. Lymph nodes are located throughout the body and lymph passes

through the nodes as it travels through the lymphatic vessels. The nodes also

produce some types of white blood cells. When your body is fighting an infection,

your lymph nodes may swell and feel tender to touch, due to their increased

activity. Lymph nodes (afferent) have several vessels entering them but only one

leaving (efferent). The direction of lymphatic flow is controlled by valves.

A person has between 500 and 1,500 lymph nodes that range in size from very tiny to

about 2.5 centimetres in diameter. Nodes are generally found in clusters in the head

and neck regions, armpits, chest, abdomen, pelvis, and groin and are also scattered

all along the lymph vessels. The lymph system has the ability to regenerate itself after

injury. New lymph capillaries sprout in areas where lymph flow has been disrupted.

When normal lymph nodes are damaged, new lymph nodes have been observed

growing along deep lymph vessels.

Lymphocytes are a form of white blood cells. The importance of this type of cell is

that they determine the specificity of the immune response to infectious

microorganisms and other foreign substances that enter the body. There are two

prominent types of lymphocytes produced in the human body,

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• B cells

• T cells

Both cells originate and are formed in bone marrow. Many stay within bone marrow

(B cells) and the remaining cells migrate to the thymus and mature into T cells.

T cells multiply and differentiate into:

• Helper - Once stimulated by the appropriate antigen (substance that is

capable of stimulating an immune response), helper T cells secrete

chemical messengers called cytokines, which stimulate the differentiation

of B cells into plasma cells (antibody-producing cells).

• Regulatory - Regulatory T cells act to control immune reactions, hence their

name

• Cytotoxic T cells - Cytotoxic T cells, which are activated by various cytokines,

bind to and kill infected cells and cancer cells.

• Memory T cells - T-cells that have learned how to overcome an invader by

'remembering' the strategy used to defeat previous infections

They are then sent to neighbouring tissue or circulate in the blood or lymphatic

system. Because the body contains millions of T and B cells, many of which carry

unique receptors, it can respond to virtually any antigen

Lymph composition and formation

Lymph is pale, straw coloured fluid that surrounds the tissues of an organism,

maintaining fluid balance, and removes bacteria from tissues; it enters the blood

system by way of lymphatic channels and ducts. As mentioned earlier, it is rich in

white blood cells and has a similar consistency than that of blood.

Lymph is formed when the interstitial fluid (the fluid which lies in the interstices of all

body tissues) is collected through lymph capillaries. It is then transported through

lymph vessels to lymph nodes before emptying ultimately into the right or the left

subclavian vein, where it mixes back with the blood.

Interstitial fluid is also known as ‘intercellular’ or ‘tissue fluid’. It provides the cells with

the medium in which they have to live and represents the individual’s internal

environment or the immediate surroundings of the cells. This environment must be

kept constant in order for the cells to function properly. Even small fluctuations in

pressure, temperature or the amounts of certain chemical substances can disrupt

biochemical activities and in extreme cases may kill cells altogether. Interstitial fluid is

the medium in which the cells are bathed. Through it, respiratory gases diffuse, from

it the cells extract all their metabolites, and into it shed all their unwanted substances

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Lymphatic circulation

The drainage of all regions of the body begins in the spaces between the cells

called interstitial space. Fluid consisting of molecules and particles too large to enter

the blood capillaries drain into the initial lymphatics that begin in the tissues. The

initial lymphatic walls are only one cell thick and overlap at the cell junctions so that

they form one-way valves that allow liquid to enter the tiny vessels from the interstitial

spaces and prevent backflow.

Anchoring microfilament connects the initial lymphatics cell walls to the tissues which

surround them and they stretch and relax with the skin movements. This is why any

body movement that moves the skin, triggers the stretch reflex of the initial

lymphatics because pulling them open allows the interstitial fluid to flow in.

Movements in the body at a deeper level such as in the intestines, pulse in the

arteries and the act of breathing all contribute to lymph circulation.

Even gentle body moments such as stretching, blinking and yawning assist in lymph

circulation because they draw fluid from the tissues into the initial lymphatics and

stimulate movement of lymph along the capillaries towards the ducts. People who

are inactive for long periods (especially on long flights) often experience swelling in

their legs where tissue fluids have pooled because of insufficient body movement as

well as the effect of gravity.

The vigorous movement which occurs with exercise, greatly increases lymph

circulation in the muscles and has the effect of cleaning them by ridding them of

waste materials. The lymph fluid, which is drained from the muscles, is replaced with

fluid from the nearby blood vessels which contains nutrients for muscles.

Inhalation causes the thoracic duct to be squeezed, which pushes the fluid forward

and creates a partial vacuum in the duct. The exhalation that follows causes the

fluid to be drawn into the thoracic duct to fill the vacuum created by inhalation.

Lymph circulation can also be stimulated by appropriate limb elevation as gravity is

used to promote the flow away from the limb and towards the ducts.

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The thoracic duct and the right lymphatic duct

There are two lymphatic ducts

1. The right lymphatic duct

2. The thoracic duct

Lymphatic pathways

Lymph vessels from the right arm and the right half of the head, neck and chest

converge in the right lymphatic duct that drains into the right subclavian vein.

However this structure does not exist in this form in every one. In some people, the

large lymph vessels of the right upper quadrant merge and join blood vessels in the

venous angle without forming a specific right lymphatic duct.

Lymph vessels from the left arm and the left side of the head, neck and chest empty

into the thoracic duct located in the thoracic cavity. This duct arises from the

cisterna chyli which collects and receives a fluid called chyle from the small

intestines. The thoracic duct empties into the left subclavian vein. Lymph vessels from

both legs and the abdominal cavity also empty into the thoracic duct after passing

through the lymph nodes.

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Anatomy and physiology of the skin and skin structures as they relate to

superficial lymph massage treatments

Skin is the part of the body which is most visible and therefore contributes to the

development of a person’s self-esteem and wellbeing. The care, maintenance and

enhancement of the skin are the central functions of the beauty industry.

Knowledge of the structure and function of the skin will give you an understanding of

how a range of beauty treatments affects the skin and its functions. The skin itself is

an organ – a combination of tissues that performs a specific function in the body.

A group of organs that operate together in the body is called a system. The skin is

commonly recognised as the Integumentary System. The integumentary system or

skin covers the whole body and made up of two layers of skin and includes the hair

and nails.

The skin is a cell-making factory containing approximately 4.5 meters of blood

vessels, 1300 nerve endings, 650 sweat glands, 100 sebaceous glands; it can cover

20 square feet and accounts for 15% of our body weight.

The Epidermis is the outer layer of skin that is composed of five (5) layers of different

cells, the most important of which continue to develop throughout our life. The

epidermis plays an important role for the rest of our skin, providing a barrier against

light, heat, water, bacteria and a range of chemicals.

The epidermis is composed of four or five layers. The skin of the palms and the soles

of the feet have five layers due to their greater exposure to friction.

The epidermis is composed of four or five layers. The skin of the palms and the soles

of the feet have five layers due to their greater exposure to friction.

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Phases of skin growth, cell renewal, healing of skin and factors affecting

epidermal mitosis

Epidermal cells

The cells in the epidermis layer are flat, dead

and completely filled with keratin. They are

continually shed at the rate of 20,000 per hour

and are replaced from below. These

keratinized cells or keratinocytes are

arranged like the bricks in a wall. The narrow

spaces between these ‘bricks’ are filled by a

protein and lipid substances that acts like

cement holding the cells together. The

surface of the stratum corneum is flat and

continuous and is pierced by the opening of

the hair follicles and sweat glands. It fulfils its

remarkable role despite being only 15-150

microns thick – about the thickness of two

sheets of paper.

The cells which make up the epidermis are known as stratified squamous epithelium.

The most numerous is the Keratinocyte

This cell undergoes the process of keratinisation. The keratinocyte’s function is to

produce the protein, keratin. This protects the skin, makes it less permeable to water

and other substances. It also plays a role in immunity.

Keratinisation

An organised rotational production line that converts living cells at the base of the

epidermis, basale layer, into dead, hardened, compacted layers of protein (keratin)

on the outer surface, corneum layer, this process taking approximately 200 days for

a cell to mature in the epidermis. The life time of a mature cell is between 7-20 days

and the replacement time for the stratum corneum (top layer) between 32-36 days.

Every day millions of dead skin cells are sloughed off or worn away from the surface

of the skin. As the dead cells are worn away, the skin will naturally trigger itself to

produce more. The name for this process is called desquamation.

The Langerhans cell and Melanocyte cell are additional cells to the epidermis where

they play roles in immunity, UV filtering and reproduction.

Cell division and differentiation

Mitosis is used when a cell needs to be replicated into exact copies of itself.

Everything in the cell is duplicated. The two new cells have the same DNA, functions,

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and genetic code. The original cell is called the mother cell and the two new cells

are called daughter cells.

Cells go through different phases called the cell cycle. The "normal" state of a cell is

called the "interphase" where genetic material is duplicated. When a cell gets the

signal that it is to duplicate, it will enter the first state

of mitosis called the "prophase".

1. Prophase - During this phase the chromatin

condenses into chromosomes and the

nuclear membrane and nucleolus break

down.

2. Metaphase - During metaphase the

chromosomes line up along the middle of

the cell.

3. Anaphase - During anaphase the

chromosomes separate and move to

opposite sides of the cell.

4. Telophase - During telophase the cell forms

two nuclear membranes around each set of

chromosomes and the chromosomes uncoil.

The cell walls then pinch off and split down

the middle. The two new cells, or daughter

cells, are formed. The splitting of the cells is

called cytokinesis or cell cleavage

The Dermis is the second layer. The skin gets its thickness and toughness from this

layer; making it roughly 25 times thicker than the epidermis, these features come

from its collagen and elastin fibres. The dermis consists of two (2) layers; the papillary

layer and the reticular layer. This layer also contains blood and lymph vessels, which

supply nourishment and detoxification to the skin, sebaceous (oil) and sudoriferous

(sweat) glands, nerves, hair follicles, arrector pili muscle and large protein molecules

such as glycosaminoglycan’s and hyaluronic acid forming connective tissue.

The lymphatic fluid rests just below the skin in the Dermis. If it is toxic or sluggish (from

processed foods, smoking, chemical body products, lack of exercise), the skin will

take on a lack-lustre, dull and blemished complexion. If the lymphatic system

becomes stagnant and slow, it will try to ‘off-gas’ through the layers, glands and

pores of the skin releasing toxic components that the body has rejected or used.

Often enough, these toxins get re-absorbed when the skin has been sealed (make-

up or nylon clothing) or improperly cleansed. This creates the build-up and

congested conditions on the epidermis, appearing over the face, chest, back and

other pore-dense areas.

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The Hypodermis is at the bottom of the dermis and composed of adipose (fat) tissue.

This creates a protective cushion that gives contour and smoothness to the body, as

well as providing a source of energy.

Function of the skin

Protection

The skin provides protection from abrasion and slows the loss of water from the body.

It stops most chemicals entering the skin and is an effective barrier preventing

microorganisms from entering the body. It shields us from the most harmful rays of

the sun. The stratum corneum is laminated and is infused with an oil and protein

substance that repels water and many chemicals and micro-organisms. It also

prevents water loss from the deeper layers of the skin. The stratum corneum is an

important layer in understanding the effects of skin care products such as

moisturisers which are applied as part of facial and body treatments to reinforce the

skin’s protective functions.

Hair provides a feedback mechanism to the body. When the hairs of the skin are

touched, even very lightly, the sensation is detected by the touch receptors in the

skin and you react to the stimulus. Protection from UV rays is performed by the

melanocytes located in the skin.

Role in skin of tissues

‘Tissue’ is a collection of similar cells that perform a particular function. Each tissue

has a specific function and can be recognised by its characteristic appearance.

Body tissues are composed of approximately 60-90% water, along with other

substances. There are five (5) main types within the body:

1. Connective – Supports, protects and binds other tissue together. For example

collagen. Collagen is the most abundant type of connective tissue within the

body. Not only found in the skin, but also in ligaments and cartilage and

tendons.

2. Nervous – carries messages to and from the brain and controls and

coordinates the bodily functions. Nerve tissue is composed of special cells

known as neurons, which make up the nerves (touch receptors), brain and

spinal cord.

3. Vascular/Liquid – includes lymph and blood. Carries food, waste products

and hormones through the body.

4. Epithelial – is the protective covering of the body, primary example is skin, but

also mucous membranes, lining of the heart, digestive and respiratory organs

and glands (sebaceous and sudoriferous).

5. Muscular – sit below the skin and attach to bone. Muscular tissue creates

movement, contraction and expansion to various parts of the body.

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Sensation

Abundant nerve endings and specialised receptors detect changes on the outside

of the skin and give information about pain, temperature, touch and pressure. This

allows us to interact with the environment safely.

Thermoregulation

During temperature homeostasis, or thermoregulation, the skin and homeostasis

cause the body to sweat. When the skin senses that the body is heating up because

of the environment's temperature, the hypothalamus sends a signal via nerves to

sweat glands and blood vessels in the skin. The blood vessels dilate to allow more

blood flow through the skin, which — in tandem with sweating — lowers body heat.

Body temperature regulation done by skin and homeostasis also informs the

hypothalamus of when the body is cold. This causes the hypothalamus to send

signals to the body to tell it to raise its temperature. The body then begins shivering,

constricting blood vessels and forming goose bumps in a process called

piloerection. Piloerection is when hair follicles make the hair stand up in an effort to

warm the body.

The body creates its own heat through involuntary actions such as cellular activity

and reproduction, contraction of muscles and the heat produced by organs such as

the liver, brain and heart. In other circumstances, outside influences such as hot

food and drink, digestion and absorption of heat from UV, warm water, saunas and

steam trigger thermoregulation throughout the body.

To stay cool, the body has four pathways – convection, conduction, radiation and

evaporation.

• Convection is getting rid of the heat by physically transferring it to another

liquid or gas. For example to cool air circulating over the body.

• Conduction is almost the same process but in this case the heat is transferred

to an object by direct contact, for example, through the urine and faeces. Or

it may mean that the heat is moved around the body.

• Radiation, the loss of heat through electromagnetic radiation. This is when the

surface blood vessels dilate and heat radiates into the surrounding air. This

only works if the surrounding air is cooler than the body.

• Evaporation, through the production and evaporation of sweat from the skin

surface. This is particularly important when the temperature of the surrounding

air is higher than the temperature of the body and radiation doesn’t work.

That is sweating only works if it has the opportunity to evaporate. Evaporation

works efficiently in dryer air. It is harder to achieve in high humidity. The last

two methods of heat reduction are the most predominant ways to keep your

body at the right temperature in hot weather.

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Vitamin D production

Ultra-violet light from the sun activates the production of vitamin D. The skin contains

a substance call pro-vitamin D3 that reacts with UVB (ultraviolet-B) rays in sunlight.

This produces vitamin D3. From here, vitamin is travels to and through the liver and

kidneys, converting it into the form that the body needs. It is recommended that 10

minutes of protected sun exposure each day is an appropriate amount to increase

and sustain vitamin D3 within the body.

Normal skin response to irritation and trauma

A common reaction to trauma can include a range of mental, emotional, physical

and behavioural changes. These reactions are normal and, in most cases, they

subside as a part of the body’s natural healing and recovery process. When it

comes to the skin and as beauty therapists, the ability to distinguish the difference

between a normal and adverse response is highly important.

Wound healing, origin and evolution of scars

Wound healing is a complex subject although we give it little thought and take it for

granted. Skin damage or injury stimulates a process that aims at returning the injured

tissue to its normal structure and function. Two kinds of wound healing can occur,

depending on the depth of the wound.

• Epidermal Wound Healing - Common types of epidermal wounds include

abrasions (skin has been scraped away) and minor burns (superficial blisters).

Epidermal wound healing also occurs in deep wound healing and is seen in

the migratory and proliferation stages.

• Deep Wound Healing - This occurs when an injury extends to the dermis and

subcutaneous layer. This healing process is more complex because different

tissue layers need to be repaired. The wound healing process can take

months, even years and in some case may never actually end.

These processes are based on the scientific fact that cells communicate by

electrical signals. When the skin is wounded cells react by changing their usual

electrical signaling. These changes stimulate skin cells to release chemical

compositions, proteins, growth factors and the proliferation of fibroblasts (collagen

cells), which in turn create new stronger, healthier collagen.

The factors of wound healing can be altered when dealing with clients who:

• Are in poor health

• Smoke

• Consume excessive amounts of alcohol and caffeine

• Circulatory disorders

• Diabetes

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Scars, including hypertrophic, keloid and abnormal scar tissue

Hypertrophic scars

A hypertrophic scar is a cutaneous condition characterized by deposits of excessive

amounts of collagen which gives rise to a raised scar, but not to the degree

observed with keloids. Like keloids, they form most often at the sites of pimples, body

piercings, cuts and burns.

Keloid scaring

This type of scarring is caused by an increase of collagen fibres, resulting in an

overgrowth of scar tissue. The raised scar is initially red, fading from pink to white,

and may be ridged, smooth or shiny. This condition can affect all skin types. The scar

occurs over the site of a previous lesion or along a surgical incision. These convex

areas will need to be smoothed and diminished using darker colours.

Wound healing in different skin types and locations

Along with the above lifestyle factors influencing how a wound heals, the location or

site of the wound and skin type plays a major role.

The clients Fitzpatrick skin type (amount of melanin within the skin) can determine:

• Likelihood of scaring

• Risk of hypopigmentation

• Risk of hyperpigmentation

The location has many factors including:

• Thickness

• Level of hydration

• Interference of hair follicles

• Amount of elastin & collagen

• Friction over the area

• Exposure to UV

Role of lymphatic system in immunity and wound healing

At a cellular level the lymphatic system is the body’s first line of defence against

diseases because it transports immune cells or antibodies throughout the body. The

lymphatic system depends on the ability of these immune cells to differentiate

between cells that belong to the body and invaders that do not and to create

antibodies to counter the disease organisms they encounter. The lymph nodes

contain lymphocytes that filter lymph by recognising and destroying harmful

invading micro-organisms.

When there is an injury to tissue, chemicals from the damaged cells cause

inflammation. Blood circulation in the area increases and capillaries become more

permeable. More fluid is released to the damaged area, bringing with it immune

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cells and organisms that start to wall off the area and destroy any harmful micro-

organisms. The pressure difference between the fluid filled tissue and the lymphatic

vessels creates a slight vacuum that pulls the debris from the injury and into the

lymphatic system where it is destroyed and thus aids the healing process.

Contraindications to manual superficial lymph massage

“A condition or disease that can either stop or alter the treatment you are about to

perform…”

It is very important that all contra‑indications for treatments be taken into account

when recommending and providing treatments to clients. It is also important that

you are able to communicate these to the client without causing unnecessary

alarm. The client may not be aware that certain treatments can affect their

particular medical condition and you may need to explain why you are unable to

provide a particular treatment or why a treatment needs to be varied.

By explaining all relevant issues to the client and offering solutions you will further

strengthen your relationship with your client. If the client has a medical condition

and you are unsure whether treatment should start you can refer to a more senior or

experienced beauty therapist for advice. Before doing this however, make sure that

you get the client’s permission. You may also refer the client to their doctor for

permission before starting treatment. If this is the case you should make sure that the

client has all the necessary information to explain the treatment and its effects to

their doctor.

1. TOTAL contraindication: A contraindication that would completely stop the

client from receiving a beauty treatment.

2. Condition requiring MEDICAL PERMISSION: A contraindication that requires

documented approval from the client’s doctor or specialist to proceed with

beauty treatments.

3. LOCAL contraindication: A contraindication that may change the application

of treatment, for example products used, areas covered.

Some contraindications may include:

Bacterial infections occur when the infection on the skin is caused by bacteria, such

as:

• Pustules and boils, bacteria form in the follicle.

• Acne can also be described as a bacterial infection.

• Conjunctivitis, an infection of the eye, it becomes red, swollen & a pus

discharge.

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• Stye found in the follicle of the eyelash, the eye becomes hot, red and sore

and a pimple forms. It may also become itchy and can spread very quickly to

the other eye or from person to person.

• Impetigo where the infection is in the epidermis

Fungal infections are caused by fungi and can occur anywhere on the body.

• Tinea corporis which affects the body

• Tinea capitis which affects the scalp and hair

• Tinea pedis is found on the foot

Parasitic infections is an infectious disease caused or transmitted by a parasite

• Scabies, a contagious skin disease marked by itching and small raised red

spots, caused by the itch mite.

• Pediculosis is an infestation with lice. Generally over areas covered with hair

• Fleas a small wingless, jumping insect which feeds on the blood of mammals

and birds

Viral infections occur because of a viral infection.

• Herpes simplex type 1 (known as cold sores) found on the face mainly around

the mouth and nose as red, sore blisters.

• Warts are another common viral infection.

Clients with symptoms of infectious disease, Treatments should not be performed in

cases where infectious skin infections or diseases (that is, those that can be

transmitted to others) are present in and around the treatment area. The client

should be advised to seek medical treatment, where appropriate, and obtain

clearance from their doctor before treatment can resume or start.

Cancer presents in various forms of dysfunctional cells which multiply rapidly in the

body. It can be topical (e.g. melanoma) or internal (e.g. lung cancer). A medical

certificate is required as some treatments may accelerate the condition due to

stimulation of blood and lymphatics, which could transport cancerous cells to other

parts of the body.

Raised temperature, should the bodies measured temperature be heighted prior to

treatment, it is recommended to ask the client the cause and take caution or

rebooking the client. Causes of high temperature can be due to sun exposure, the

immune system taking defence from foreign disease, increased circulation and/or

central nervous system reaction.

Systemic diseases

• Heart, also known as cardiovascular disease, generally refers to conditions

that involve narrowed or blocked blood vessels that can lead to a heart

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attack, chest pain (angina) or stroke. Other heart conditions, such as those

that affect your heart's muscle, valves or rhythm.

• Kidney, also known as renal failure or renal insufficiency, is a medical

condition of impaired kidney function in which the kidneys fail to adequately

filter metabolic wastes from the blood.

• Liver, any damage that reduces digestion and removal of waste products

from the blood to the liver.

Lymphatic massage can place excess demands on already failing organs and

systems within the body. Medical permission will be required.

Organ transplant, the lymphatic system is naturally compromised from the trauma of

surgery and anaesthetic used. And while it can be recommended to commence

lymphatic drainage post-op, medical clearance must be given prior to

commencement of any treatment.

In cases of organ transplants a thorough medical history and medications must also

be checked and confirmed.

Acute asthma, a respiratory condition often caused by allergens, exercise and

anxiety, characterised by sudden attacks of laboured breathing, chest constriction

and coughing. Some products and treatments may bring on an asthma attack, for

example, strong smelling acetone products.

Acute allergies, both contact and systemic, the rule of thumb is if the client cannot

ingest the ingredient, it is not to be used on the client. For example, if the client is

allergic to nuts, do not use any product containing ingredients or traces of anything

from the nut family.

Hyperthyreosis, medically known as Athyreosis, it is characterized by complete

absence of the thyroid gland that results in primary congenital hypothyroidism, a

permanent thyroid deficiency that is present from birth.

Clients presenting with this condition are often prone to lymphedema and may

require medical permission in severe cases or those under care of a medical

practitioner.

Formation of oedema

Oedema, also known as lymphedema, is swelling of tissues, which occurs when fluids

accumulate rather than return to the bloodstream. This causes enlargement and

‘puffiness’ in the interstitial space (around the cells). Oedema can present as a

localised condition, for example after surgery in a specific area, or general a

condition, which is more widespread and effects limbs and extremities.

This failure of the lymphatic system may be due to:

• Pressure from thickened plasma

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• Obstruction

• Destruction of lymph vessels

• Infection

• Failure of the pumping action of muscles and immobility

• Failure of the circulatory system

• Imbalance in the composition of the blood

• Recent operations and surgery

If you are concerned about a condition and the client does not know what it is, you

should recommend the client seek medical advice. You must not frighten a client

unnecessarily by attempting to diagnose a condition. A beauty therapist is not a

doctor and therefore should only recommend that the condition be checked. This

should be done in a tactful manner, ensuring that no offence is caused.

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SECTION 2 – PREPARE FOR TREATMENT

When preparing the massage treatment

area, ensure the environment is hygienic,

professional and presented as a sanctuary

for the client to relax and unwind.

• make sure the work area is clean and

tidy,

• ensure you have all the required items

within your reach, and remove those

items that you are not going to use in

this treatment,

• clean all work surfaces with warm

water and detergent, rinse and then dry

• Cover the massage table appropriately with a bed wrap if possible. Large

towels and a disposable sheet can then be placed on top of this.

The following items should be available during the treatment:

• A disposable headband to protect the clients hair and prevent it from falling

on to the face and neck area during treatment.

• Extra towels to drape the area that you are working on

• A covered and lined waste bin

• A bowl or snap lock plastic bag for the client’s jewellery if it is not put in their

bag

• A clean towel or disposable paper for your hands

Work safely

In order to reinforce your professional image you should always be well groomed

and wear clean clothing. You will need to protect your clothing, particularly when

using oils during treatments. Different workplaces will have different requirements

and you should always make sure that you follow your workplace policies and

procedures or accepted or expected practices.

You should always ensure that both you and your service areas are prepared

according to all workplace policies and procedures and hygiene and work health

and safety requirements. Work health and safety (WHS) is an integral component of

the beauty industry. Employers have a responsibility to provide both their staff and

clients with a safe environment. Staffs are also responsible for contributing to their

own health and safety and that of clients and fellow staff.

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SECTION 3 – PROVIDE LYMPH MASSAGE

Beauty salons can offer superficial lymphatic drainage massage treatment of the

body in a variety of ways. Most places offer superficial lymph drainage of the upper

extremities and trunk as a separate service from superficial lymph drainage of the

lower extremities. Often superficial lymph drainage massage is offered in

combination with detoxifying treatments, relaxation therapies or as part of deep

tissue massage and cellulite therapies.

APPLY SUPERFICIAL LYMPH MASSAGE TO THE FACE

1. Perform thorough consultation with your client

Identify the objective and client characteristics, gain consent and design and

record these details in a treatment plan.

2. Prepare the treatment area, therapist, then the client

Allow the client to change in private; they are to remove all clothing above

the waist.

3. Instruct the client to lay face up

4. Ensure they are comfortable. This may include a neck pillow and bolster

under their knees. A blanket can be used for warmth.

5. Wash your hands

6. Apply a hairnet and or headband to the client

7. Perform a facial cleanse

Using a milk, lotion or cream cleanser, warm the product in your hands,

starting at the chin, spread the cleanser over the chin, cheeks, nose and

forehead, perform small circles over the face then finish by sliding down the

neck onto the décolletage and perform larger circles

8. Remove the cleansing product

Using two warm, damp fibrella pads, remove cleanser from décolletage to

forehead, in long sweeping movements. Blot the skin dry.

9. If the client is wearing heavy make-up, this process may need to be

repeated.

10. Apply massage medium to décolletage, neck and face

11. Beginning on the neck, place the pads of four fingers over the super

clavicular nodes and perform 20 stationary circles

12. Move to the sub-auricular nodes and perform 20 stationary circles

13. Move to the anterior chain of nodes and perform 20 stationary circles

14. Move to the posterior chain of nodes and perform 20 stationary circles

15. Slide hands behind the neck, between the vertebrae and hairline, perform 7

stationary circles

16. Slide hands to the sides of the neck, perform 7 stationary circles

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17. Using the pads of two fingers at the base of the sternocleidomastoid muscle,

perform 1 minute of rotary movements

18. Move fingers just below the mandible, directly under the corners of the

mouth, perform 1 minute of rotary movements

19. Move fingers directly below the ears, perform 1 minute of rotary movements

20. Using the pads of four fingers, either side of the sternocleidomastoid muscles,

perform rotary movements for 1 minute.

21. Move one hand over the clavicular space; perform rotary movements for 1

minute.

22. Effleurage the décolletage, neck and back of the neck 6 times.

Directing the pressure along the path of drainage

23. Effleurage the face 6 times

Movements sweep from the centre to the outside of the face, directing the

pressure along the path of drainage

24. Using the pads of four fingers, perform 20 stationary circles over the masseter

muscle

25. Using the pads of two fingers, perform 7 stationary circles over the following

areas:

• Under the bottom lip

• Directly under the corners of the mouth

• Corner of the mandible

• Above the upper lip, underneath the nose

• Over the corners of the mouth

• Wings of the nose

• Sides of the bridge of the nose

• Bone of the nose between the eyes

26. Using the pads of four fingers, place them from the corner of the inner eye,

down the nasolabial folds. Perform rotary movements for 1 minute

27. Move to in front of the ears and perform 20 stationary circles

28. Move to over the masseter muscle and perform 7 stationary circles

29. Using the pads of two fingers, place them below the inner eye. Perform rotary

movements for 1 minute

30. Using the thumb and index finger, gently pinch the eyebrow from the inner

corner to outer corner, 5 times

31. Using the pads of four fingers, place them over the forehead. Cup the scalp

and perform 20 large stationary circles

32. Move to the temples and cupping the scalp, perform rotary movements for 1

minute

33. With two fingers in front of the ear and two fingers behind the ear, cup the

scalp and perform rotary movements for 1 minute

34. Using the pads of four fingers, place them over the scalp and perform 20

large stationary circles

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35. Using the pads of four fingers, perform 7 stationary circles over the following

area:

• Pre-auricular nodes

• Over the masseter muscle

• Posterior to and below the ear

• Posterior cervical chain of nodes

• Anterior cervical chain of nodes

• Along the border of the clavicle

36. Effleurage the décolletage, neck and behind the neck

37. Effleurage the face

38. Hot towel the face

Remove from forehead to décolletage, in long sweeping movements.

39. Complete the treatment by applying an appropriate moisturiser and SPF

40. Assist the client sitting up

41. Allow the client to dress in private & provide them with a glass of water

42. Provide the client with appropriate aftercare and homecare

43. Rebook according to treatment plan

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APPLY SUPERFICIAL LYMPH MASSAGE TO THE BODY

You need to be able to identify the main groups of lymph nodes in the body and be

able to visualise them and the movement of the lymph as you are performing a

superficial lymph drainage massage. The lymph vessels of the body resemble four

branching trees made up of lymph vessels that drain lymph from the outermost

reaches of the trees towards the axillary and inguinal nodes. In some places the

branches of the tree overlap.

In the upper body, between the waist and the clavicle, the lymph vessels drain into

the axillary lymph nodes – the left arm and side of the trunk to the left axillary nodes

and the right vessels to the right axillary nodes. (The superficial lymphatics on the

sternum drain upward to the nodes in the neck).

In the lower body, the lymph vessels drain to the inguinal nodes. The buttocks drain

laterally around the hips to the inguinal nodes in the front and lymph from the

abdominal area drains down towards the inguinal nodes. At the back of the thigh,

the lymphatics divide with each side draining in a different direction back around

the leg to the inguinal nodes at the front. Lymph from the right leg and the right

lower quadrant of the trunk drains into the right inguinal nodes. Lymph from the left

leg and left lower quadrant of the trunk drains into the left inguinal nodes. Lymph

from the lower section of each leg drains upward through the popliteal nodes

before continuing to the inguinal nodes.

Lymphatic massage is not about speed, it is about precision. Movement are

performed slowly and with little pressure to target the lymphatic system.

• Perform thorough consultation with your client’s

• Identify the objective and client characteristics, gain consent and design and

record these details in a treatment plan.

• Prepare the treatment area, therapist, then the client

• Allow the client to change in private, they are to remove all clothing except

underwear, disposable underwear may be offered.

• Instruct the client to lay face down, with their face comfortable placed

downward and arms by their hips.

• Ensure client modesty is kept throughout the entire massage treatment.

Clients are to be covered and kept warm.

Décolletage & Face

1. Effleurage décolleté to spread oil

2. With two hands, squeeze ear lobes

3. Cup hands over ears and hold for 10 seconds

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4. Perform pressure points on scalp (middle, medial, lateral) REPEAT THREE TIMES

5. Using the middle and ring fingers gently press from sternum out to shoulder

under and on top of clavicle, draining to axillary nodes REPEAT THREE TIMES

EACH

6. Perform pressure points on face and scalp. Ensure to work from the middle

outwards. REPEAT EACH POINT THREE TIMES

• clavicle

• superior cervical

• sub mandibular

• masseter

• zygomatic

• around the orbital

• nasal flares (one at a time)

• corrugator

• frontalis

• temporalis

7. Pressure points into hairline and “walk” into hair using firm circular movements

REPEAT THREE TIMES

8. Cup hands over eyes, hold for 10 seconds.

9. Cup hands over ears, hold for 10 seconds. Squeeze ear lobes and lift off.

Front of Legs / Feet

1. Light effleurage the whole leg to spread oil

2. Place one hand on each foot gently lean onto client and stretch

3. Effleurage whole leg REPEAT THREE TIMES

4. Effleurage knee to thigh REPEAT THREE TIMES

5. Perform stationary circles to gently open iliac nodes

6. “Tick” shaped pumping movement knee to thigh (middle, medial, lateral)

REPEAT THREE TIMES

7. With hands in a diamond shape, pump knee to thigh (middle, medial and

lateral)

8. With hands on top of each other, fingers entwined, pump and slide to drain

to inguinal nodes REPEAT TWO TIMES

9. Repeat over medial and Lateral REAPEAT THREE TIMES

10. Effleurage ankle to knee REPEAT THREE TIMES

11. “Tick” shaped pumping movement ankle to knee (medial, lateral) REPEAT

THREE TIMES

12. Softly tissue the patella with light circular movements

13. Drain to popliteal REPEAT THREE TIMES

14. Effleurage whole leg very lightly REPEAT THREE TIMES

15. Effleurage whole foot

16. Slow rotations clock ways and then anti clock ways REPEAT THREE TIME EACH

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17. Flexion stretch, and lymph drainage points between metatarsals, drain ankle

18. Effleurage full leg to finish

Abdomen

1. Effleurage to spread oil

2. Circle effleurage clockwise / anticlockwise / clockwise REPEAT THREE TIMES

EACH

3. With fingers, firmly stroke in diamond shape around large intestine REPEAT

THREE TIMES

4. Hands placed on either side of abdomen, gently drain up into centre

Abdominal nodes

5. Right hand on solar plexus, left hand on client’s shoulder gently rock REPEAT

NINE TIMES

6. Pressure on solar plexus – ask client to breathe in and out slowly, applying

pressure on exhale REPEAT SIX TIMES

7. Circle effleurage clockwise to finish REPEAT THREE TIMES

Arms

1. Effleurage whole arm X 3 then effleurage elbow to wrist X 3

2. Support client and raise their arm, “pump” upper arm, to axillae nodes, and

then lower arm to supratrochlear nodes. Middle, medial and lateral sides of

arm X 3

3. Holding the client’s arm straight out, slightly extend the arm, and shake very

gently, then on a 45’ angle upwards repeat. Stretch gently. Place arm down

again

4. Entwine fingers and slowly drain whole arm from wrist to axillae nodes

5. Effleurage whole arm very lightly x 3

Back of legs

1. Effleurage to spread oil

2. Effleurage ankle to thigh REPEAT THREE TIMES

3. Effleurage knee to buttocks REPEAT THREE TIMES

4. “Tick” shaped pumping movement knee to buttocks (middle, medial, lateral)

REPEAT THREE TIMES

5. With hands in a diamond shape, pump the upper thigh (middle, medial and

lateral)


to inguinal nodes REPEAT TWO TIMES

7. Repeat over medial and Lateral REAPEAT THREE TIMES

8. SCOOP movement front of thighs knee to hip REPEAT THREE TIMES

9. Effleurage ankle to knee REPEAT THREE TIMES

10. “Tick” shaped pumping movement ankle to knee (middle, medial, lateral)

REPEAT THREE TIMES

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11. Circles around popliteal

12. Drain into popliteal REPEAT THREE TIMES

13. Effleurage ankle to knee very lightly REPEAT THREE TIMES

14. Run thumb up the outer side of the leg once, ankle to buttocks (gall bladder

meridian)

15. Effleurage whole leg very lightly REPEAT THREE TIMES

Back

1. Place one hand on cervical vertebrae and one hand on sacrum and stretch

gently

2. Effleurage to spread massage medium very slowly REPEAT SIX TIMES

3. Hands side by side perform large figure 8 circles over entire back REPEAT

THREE TIMES

4. Small thumb circles sacrum to Occipital either side of spine REPEAT THREE

TIMES EACH SIDE

5. Come to the head of the treatment bed

6. Slide tall and index fingers down either side of spine to sacrum, apply pressure

then effleurage lightly back to occipital

7. Perform criss cross/pressure to Sacrum using thumbs (criss then cross then

pressure) SLOWLY

8. Using thumbs, clean through the ribs, starting closest to head


to axillae nodes first on top of, then underneath the scapula REPEAT THREE

TIMES EACH SIDE

10. Circling the hip: small thumb frictions from sacrum up spine about 8cm, then

slide thumbs over iliac down to the table firmly REPEAT THREE TIMES

11. Brush kidneys: Keeping hands flat, perform short firm friction raking strokes

REPEAT TEN TIMES EACH SIDE

12. With hands in a diamond shape, pump the lower back and buttocks


to inguinal nodes REPEAT THREE TIMES EACH SIDE

14. Effleurage lightly REPEAT THREE TIMES

15. Move to side of couch

16. Very lightly petrissage knead the entire back

17. Using alternating hands perform rotary movement over entire back. REPEAT

THREE TIMES

18. Using the middle and ring fingers on top of each other, perform small

stationary circles in clockwise direction over back

19. Effleurage very lightly REPEAT THREE TIMES

20. Lightly tap “Tingle” back with fingers

21. Cover client with towel

22. Place one hand on cervical vertebrae and one hand on sacrum and stretch

gently

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SECTION 4 – REVIEW TREATMENT AND PROVIDE POST TREATMENT

ADVICE

If salon scheduling allows, the ideal environment post-treatment is a separate,

relaxing and quiet area to discuss aftercare, homecare and further treatment

recommendations. A glass of water can be waiting for them and ensure they know

where the restrooms are if needed. This allows for the client to wake properly and

return to normal. During this time it is important to gain necessary feedback on the

delivered service to ensure the client is satisfied, schedule the client as per their

treatment plan and take payment.

Causes of skin reactions and allergies in regard to treatments

During or post-treatment, the skin and/or body may react to the products or

techniques used. This is referred to as an adverse reaction. These reactions may

include the following:

• Pain or discomfort over lymph nodes

• Swelling/inflammation

• Bruising

• Increase urination

• Raised blood pressure

• Skin blemishes

Where appropriate and when the client is worried or cannot manage the adverse

response, always refer them to see a medical practitioner for professional advice.

Do not manage the reaction by yourself or with other staff members.

Aftercare advice, products and treatments relevant to lymphatic massage

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This advice supports the treatment they receive in salon and aid achieving their

results. This means that you will need to provide them with information about suitable

products to use at home and how to apply them.

When providing aftercare advice at the conclusion of a body massage, you should

take each client’s individual characteristics and circumstances into consideration. It

may be appropriate to advise clients about services and products they can use to

enhance the effects of their particular treatment. For example, body massage can

be combines with deep tissue massage, detoxifying body treatments, facial

treatments and cellulite therapies.

General advice on dietary or lifestyle changes which promote wellness is vital for

clients to achieve their objective whilst at home. However, it must be realistic,

achievable and enticing. Advice should always be delivered sensitively.

Remind the client of how to use the products and confirm the application

techniques to be used at home. Encourage the client to ask questions and provide

visual demonstrations to clarify any information. You can put this information on a

card so that the client can take the instructions home. Advice could include, but is

not limited to:

• enjoy a light walk to encourage continual lymph movement

• relaxation

• avoid heavy exercise

• avoid heated swimming pools, saunas and extreme heat

• eat a light, balanced meal

• avoid caffeinated beverage such as coffee, black tea, energy drinks

• increase water intake

• provide advice on dietary or lifestyle changes that would complement their

treatment

• advice on stress management techniques and breathing

• importance of fresh air

• encourage regular exercise and movement

• sun protection

• advise clients about products they can use to enhance the effects of their

particular treatment

• retail products to assist their homecare regime

• how to use the recommended products and when

• recommended treatment schedule

• additional services to recommend

• next scheduled appointment

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SECTION 5 – CLEAN TREATMENT

AREA

Difference between cleaning, disinfection and

sterilisation

Cleaning is the process of removing dirt and

other types of soil from a surface, such as a

dish, glass, or hard surface. Cleaning is

accomplished using a cleaning agent that

removes these deposits and utilizes a cleaning

agent such as ‘spray and wipe’.

Disinfection and Sanitisation is the process of reducing the number of

microorganisms that are on a properly cleaned surface to a safe level. A safe level is

defined as a 99.999% reduction of the number of disease microorganisms that are of

public health importance. Sanitizing is accomplished by using heat, radiation, or

chemicals. Some disinfectants may be harmful to human health. Always check the

manufacture’s (MSDS) prior to using a chemical disinfectant.

• Contact time (how long the equipment is in contact with the chemical) may

become ineffective if left for long time periods. Always read manufacturer’s

instructions.

• Chemical concentration (manufacture will recommend an optimal strength).

Always read manufacturer’s instructions.

Sterilisation defines the complete destruction of all microorganisms including spores.

This can require the use of a ‘hot-air oven’ or ‘glass-bead steriliser’, but more

commonly used is an Autoclave. This unit sterilises using boiling water; because of

the increased pressure the temperature reaches approximately 121-134◦c

Benefits of chemical and physical disinfection

Chemical disinfectants should be used only for items for which thermal disinfection

and sterilisation are not suitable – for example items unable to be immersed in water

(thermal) or unable to withstand high pressure (sterilisation). It is appropriate to use

chemical disinfectant when equipment or the environment is contaminated with

blood or other body substances and cannot be thermally disinfected. (Detergent is

sufficient for cleaning off perspiration, for example.)

Due to the over use and misuse of chemical disinfectant, many micro-organisms

have become or are becoming resistant to them. For this reason, the routine use of

disinfectants is not recommended. Disinfectants can easily become contaminated

and are a potential source of infection. Detergent or disinfectant solutions should

not be mixed because they may react with each other and in doing so reduce their

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effectiveness or cause harm. Some disinfectants such as those producing chlorine

must be freshly prepared. Operators should only use disinfectants specified by the

Australian Register of Therapeutic Goods (ARTG) and for the approved purpose and

for the time specified by the manufacturer.

Methods of cleaning, disinfection and sterilisation

Any instrument or part of an instrument used on a client should be cleaned with

detergent and warm water, dried and either thermally or chemically disinfected

before being used on another client. Below is a step-by-step procedure:

1. Wash implement with anti-bacterial soap in warm water.

2. Rinse under fresh water

3. Dry

4. Treat with chemical disinfecting / sanitising agent (cover and leave for

appropriate amount of time)

5. Rinse under fresh water

6. Dry

7. Store in a clean, air-tight container

Thermal disinfection uses heat and water (moist heat) at temperatures that destroy

most organisms. It is the most cost-effective and efficient method of disinfection. It is

only suitable for items that can be fully immersed in water at high temperatures. All

items must be fully immersed for the time indicated in the table below once the

water boils. Additional items must not be added during this boiling stage

Micro-organisms

Micro-organisms are everywhere! On all the surfaces you can see, on you and your

clothes, on the tools and equipment you use. Most of these micro-organisms are

harmless; some are even needed to maintain our health. However, there are some

micro-organisms that are harmful to us and cause illness and disease. The goal of

infection control procedures is to kill these harmful micro-organisms and to stop the

movement of them between people (cross-infection). The micro-organisms of

interest in infection control are bacteria, fungi and viruses.

Bacteria

There is a whole classification system that puts

bacteria into categories. For example, you

may have heard of ‘golden staph’. This is a

bacterium that has caused problems in

hospitals. Its real name is Staphylococcus

aureus. It is conical in shape, grows in grape

like clusters and it has a gold colour. About

20% of the population carries golden staph; they often do not know it and it may

cause them no problems. The shape of ‘golden staph’, the way it grows and its

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colour help scientists to classify it and give it a

name. However, some bacteria are useful. An

example would be some of the bacteria in your

digestive system that help to keep the system

healthy.

Fungi

Are next on our list and are also useful micro-

organisms to humans. For example they are used as yeast in bread-baking and in

making soy sauce. A few are harmful to humans. Fungi that are harmful in a beauty

treatment context are usually rare, and predominantly found on fingernails, toenails

and feet. They like the warm, moist and dark environment provided by feet which

are in socks and shoes. Fungi like the keratin (a protein) in the nail plate and also the

skin. An example of the type of fungi that can cause problems for you is those that

cause tinea pedis or ‘athletes foot’.

Viruses

The third micro-organisms that we are interested in are viruses. They are sub-

microscopic infectious agents that are unable to exist outside a cell. These are

spread by blood-to-blood contact. Examples of viruses that you should be

concerned in a beauty treatment are HIV

and Hepatitis. Clients are not obliged to tell

you that they have blood borne diseases

like HIV and Hepatitis; you are safe to do

treatments on them provided you follow the

guidelines. If the client tells you they have a

blood borne disease you must not reveal

that information to other people. As a result

of the privacy considerations the industry works as if everyone has a blood borne

disease and everyone strictly follows the correct procedures to prevent cross

infection/contamination, that way you are automatically protected whether your

client has a blood borne disease or not. Immunisation against Hepatitis B is

recommended. You need to consult your personal doctor about this option.

Infection control procedures and application

Infection control procedures

Infections can be spread between the client and operator, and from client to client,

from you to other employees of the salon and even from you to your family and

friends. This gives you some idea of the importance of following the health

guidelines. Most people that visit your salon will be free of diseases, some will

unknowingly have come into contact with a contagious condition and in rare cases

they may know that they have a contagious condition but hope that you will

proceed with the service anyway. If you follow the recommended procedures in

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your States or Territories guidelines you and your clients will be protected from cross

infection.

Prevention

The above information should not make you uncertain and unconfident in providing

beauty services, you should not be concerned because there are guidelines,

procedures, tools, chemicals and equipment all designed to make it safe for you to

work in the beauty industry.

The first thing you should know is how cross infections can occur. There are many

routes of infection. Intact skin is the body’s first defense against infection. You should

make sure that you have no cuts or abrasions on your skin, if you have cuts and

abrasions you should cover them with a waterproof dressing and gloves, and you

should keep the skin of your hands moisturized and supple.

The first route of infection to consider is through the penetration of the skin. In beauty

services and treatments, it might be through hair removal services. Sometimes the

treated area can bleed. Any instrument that comes into contact with the blood is

then infected and you must follow the right sterilisation process before using the

instrument again.

• Wash your hands before and after working on a client, before working on the

next client and if you are interrupted during a service, when you resume the

service.

• Follow the workplace procedure for the cleaning and disinfection of tools

and equipment and never mix clean and unclean instruments.

• Use clean single use gloves for hair removal procedures

The second route of infection is through open wounds or cuts. If you accidentally cut

the skin on the client and if you also have an uncovered cut on your finger, the

client’s blood can enter your body through the wound.

• Ensure any wounds on you or the client with a waterproof dressing that

completely covers the affected area. You can also use clean disposable

gloves if you have a cut on your hand.

Third, contamination of instruments is another way that infection travels from one

person to another. You need to follow a particular procedure to make sure that all

instruments you use are cleaned and disinfected properly and then stored correctly

until they are used on the next client. For example if you use tweezers on a client

and there is an infection that is not visible you will transfer this to the next client if you

reuse the tweezers without following the correct disinfection processes.

• Use disposable or single use equipment where possible.

• Use equipment that has been properly cleaned and disinfected or if

necessary, sterilised.

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Next you should consider what the client comes into contact with and what needs

to be changed after a service. For example, if a client has an eyebrow wax and you

use a hand band to protect and draw back their hair then that headband must not

be used on another client until it has been laundered correctly.

• Linen that has come into contact with the client’s skin should be changed

after each client and laundered according to the State or Territory guidelines.

Finally, contaminated waste is another source of infection. This can happen when,

for example, you put a cotton round you have used on the client, onto the trolley.

The table top then becomes a potential source of cross contamination during the

service. All waste should go directly into a rubbish bin with a lid.

Waste should be disposed of in accordance with your State or Territory guidelines.

Make sure you dispose of waste directly into the proper bin; never leave used

disposables, soiled linen or other waste lying around.

learner guide · 2018. 11. 27. · 2. prepare for treatment • check readiness of treatment area...

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