Massage Manual For DoH Licensure 1

CENTRAL LUZON ALTERNATIVE HEALTH AND DEVELOPMENT INC.
DOH Accredited Training Institution
WORKBOOK GUIDELINES
For
LICENSURE EXAMINATION
FOR MASSAGE THERAPY
January 2014
1ST Edition
jhh/cdmd/hhrdb/11-101
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TABLE OF CONTENTS
FOREWORD
MODULE 1: ANATOMY AND PHYSIOLOGY
A. Basic Terminologies
B. Body Regions
a. Head and Neck
b. Trunk
c. Upper Extremities
d. Lower Extremities
C. Body Positions
a. Supine
b. Prone
c. Side-Lying
D. Major Organ Systems

a. Skeletal
b. Muscular
c. Integumentary
d. Circulatory
e. Lymphatic
f. Nervous
g. Respiratory
h. Digestive
i. Urinary
j. Endocrine
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MODULE 2: MICROBIOLOGY AND PATHOLOGY
B. Microbiology
a. Common Microorganisms
b. Infection Process
c. Signs of Inflammation
C. Pathology Relevant to Practice of Massage Therapy

a. Musculoskeletal System
b. Integumentary System
c. Circulatory System
d. Nervous System
e. Endocrine System
f. Excretory System
D. Component of Massage Therapy Infection Control Program

a. Education and Training
b. Exposure Prevention
c. Disposable Client Care Items
d. Records Management
MODULE 3: MASSAGE THERAPY I : FUNDAMENTAL CONCEPTS OF

MASSAGE THERAPY
B. History of Massage
a. Ancient Era
b. Modern Era
c. Latest Developments
C. Effects of Massage
a. Physiological Effects
b. Psychological Effects
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D. Indications and Contraindications of Massage
a. Indications
b. Local and Absolute Contraindications
E. Wellness Massage vs. Therapeutic Massage
MODULE 4: MASSAGE THERAPY II - MASSAGE THERAPY APPLICATION
B. Massage Therapy Process
a. Pre-Massage
b. Massage Proper
i. Effleurage
ii. Petrissage
iii. Friction
iv. Tapotement
v. Vibration
c. Post-Massage
C. Assessment & Documentation

a. Vital Signs
b. Visual Assessment
c. Palpation
d. Sensory Assessment
e. Range of Motion Assessment
MODULE 5: MASSAGE THERAPY III - PRACTICE OF MASSAGE THERAPY
A.Code of Ethics for Massage Therapists

B.Legal Mandate of Massage Therapy Practice
a. PD 856
b. Administrative Order No. 2010-0034
APPENDICES
A. Acknowledgment
B. Summary of Nominal Hours of the DOH Licensure Reference
Manual (Revision 1)
C. Bibliography
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Module 1
ANATOMY AND PHYSIOLOGY
General and Organ System Anatomy and Physiology
Learning Objectives:
1. Discuss the common terminologies essential in the understanding of

applied human anatomy and physiology related to the practice of massage
therapy.
2. Explain the important organs found in the body regions.
3. Describe the use of body positions applied in massage.
4. Discuss the structures and functions of the different organ systems of the
human body that affects massage practice.
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ANATOMY AND PHYSIOLOGY
To be an effective (mabisa) and skillful (mahusay) massage therapist, one must

have knowledge (kaalaman) on anatomy and physiology. A clear picture of the
many arrangements of cells and tissues will assist you to feel what is beneath
(ilalim) your hands during a massage session.
As a massage therapist, you will be compressing and working on much different

kind of tissues – gliding the epidermis, stretching the muscle fibers (hibla),
kneading pectoralis majors or rubbing metacarpals (buto sa palad) and
metatarsals (buto sa talampakan).
Anatomy and physiology is inseparable (hindi mapaghihiwalay) because as one

studies the structures (kabuuan o bumubuo), s/he must know how that particular
structure/s will function. As the massage therapist slowly begins to explore the
wonders of anatomy and physiology, s/he simply becomes more aware and
more conscious in implementing (mapatupad) a massage plan that will truly
benefit (nagdudulot ng mabuti) the client, hence, giving the best of client-care.
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Anatomy – The study of the structure of living things, from the whole
organism down to the cell level. (Pagaaral sa mga bahagi
ng katawan ng tao hanggang sa mga maliit na organismo.)
Physiology – The study of the mechanical, physical and biochemical
functions of living things. “Physio means function”, “logy
or logos” means study. (Pagaaral sa mga gawain o
tungkulin ng isang bahagi ng katawan ng tao)
Structure of the Human Body
Cell – the basic structural and functional unit of most living

organisms. It is the smallest unit of a multi-cellular organism and is often
called the building block of life.
Tissue – refers to the cells of similar origin which are organized into
groups (tissues) to carry out specific functions.
Organ – the tissues of different kinds are organized into organs to
perform specific functions.
Organ System – These are groups of organs that work together to

perform a larger, more complex (masalimuot) function.
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B. Human Body
The human body is bilaterally (magkabilaan) symmetrical (magkatulad). It has

right and left halves that are mirror images. Many of the body parts are found in
pairs, one in each half of the body, eg. brain hemispheres, eyes, ears, lungs, etc. The
following terms describe the orientation and direction assuming that the body is in
anatomical position:
Body Directions/ Orientations
Notes:
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ORIENTATION/
MEANING
DIRECTION
Superior (Taas) – above or towards the head
Example: The brain is superior to the heart.
Inferior (Baba) – below or toward the lower part of the body
Example: The nose is inferior to the forehead.
Anterior/Ventral – towards the front of the body
(Harapan) Example: Breasts are on the anterior surface.
Posterior/ Dorsal – towards the back of the body
(Likod) Example: Buttocks are on the posterior surface
Medial/ (Gitna) – at or nearer to the center plane; or in the inner
side of the body
Example: The mouth is medial to the ears.
Lateral (Tagiliran) – away from the center plane of the body
Example: The lungs lie lateral to the heart.
Proximal (Malapit) – nearer to the center of the body
Example: The hip is proximal to the knee.
Distal (Malayo) – farther the center of the body
Example: The foot is distal to the hip.
Notes:
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Fig.5. Orientation/Direction
When viewed externally, the whole body is divided into four (4) regions:
BODY REGIONS DESCRIPTION

1. Head and Neck Region The head houses the brain and major sense organs. It
also forms the framework of the face. The head is held
upright by the muscles and bones of the neck, which
connects the head to the trunk.
2. Trunk The trunk (or torso) forms the central part of the body
and has two sections: the thorax forms the upper trunk;
from the neck to the diaphragm and the abdomen
which is the lower part of the trunk.
3. Upper Extremities Each is divided into three regions: the arm, forearm and
hand; the hallow part just below the connection
between the upper extremity and the trunk is the axilla
or armpit.
4. Lower Extremities Each is divided into thigh, leg and foot.
C. Body Positions
No matter what the position of the client, the therapist will describe the location
of the anatomical parts as if the client is always in anatomical position.
T T
Fig. 2 – Anatomic
Locations of Body
Regions
Anterior View Posterior View

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Anatomical position is described as:
 body erect and facing forward
 arms at the side
 palms are facing forward with thumbs on the side
 feet about a hip distance apart with toes pointing forward
The next illustrations are the various positions used in massage therapy, it is
important for massage therapists to recognize the different positions and understand
its rationale (kadahilanan) during the massage in order to minimize (mabawasan), if
not totally prevent or control (mapigilan o kontolin), the possible injury to the client.
Fig. 3. Supine (nakahilata)– a

position of the body lying down
with face up
Fig. 4. Prone (nakadapa) – a

position of the body lying down
with face down
Fig. 5. Side-lying (nakagilid) – a

position of the body lying on one
Side Lying side
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D. Body Planes - Planes are imaginary lines - vertical or horizontal - drawn through
an upright body. The terms are used to describe a specific body part.
Coronal Plane (Frontal Plane) --

divides the body or any of its parts
into anterior and posterior portions.
Sagittal Plane -- divides the body or

any of its parts into right and left
sides.
Transverse Plane -- divides the

body or any of its parts into upper
and lower parts.
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E. Major Organ Systems
The human body has organ systems that work together in close coordination
with one another. Its functions include support and movement, transport system,
integration and coordination, absorption, excretion and reproduction.
TABLE 1. DIFFERENT BODY SYSTEMS, ORGANS and FUNCTIONS

SYSTEM ORGANS MAJOR SYSTEM
FUNCTION
1. Skeletal Bones, joints, cartilage Shape and support body
system and ligaments framework; protect vital
organs
2. Muscular Skeletal, smooth and Movement; produce
system cardiac muscle heat
3. Integumentary Skin, hair, nails, oil Protection
system glands and sweat
glands
4. Circulatory Heart, blood and blood Distributes nutrients to
system vessels the body
5. Lymphatic Spleen, thymus, lymph Protects the body from
system nodes and tonsils disease
6. Nervous Brain and spinal cord Regulatory and
system communicating system
7. Respiratory Upper and lower Exchange of gases
system respiratory tract, lungs
and accessories
8. Digestive Alimentary canal and Digestion and absorption
system accessory digestive of food
organ
9. Urinary system Kidneys, ureters, Eliminates metabolic
bladder and urethra waste
10. Endocrine Glands and hormones Release hormones
system
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Name : Date :
Topic : Score :
CHECK YOUR UNDERSTANDING
I. Choose and encircle the best answer.

1. Cluster of tissue.
a. Organ
b. Tissue
c. Cell
d. Body system
2. Each is divided into thigh, leg and foot.
a. Upper Extremities
b. Lower Limb
c. Upper Limb
d. Trunk
3. The nose is _______ to the mouth.
a. Anterior
b. Posterior
c. Inferior
d. Superior
4. The hallow part just below the connection between the upper extremity and
the trunk.
a. Groin
b. Axilla
c. Popliteal
d. Torso
5. A position where the belly touches the bed.
a. Supine
b. Prone
c. Side Lying
d. Trendelenberg
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II. Enumeration
Give the major function of Skeletal System

1. _support body frame
work
_2. _protect vital organ
Body ____________________
Regions
1.Head and neck
2. Trunks
3. Upper extremities
4. L o w e r
extremities
Body Positions
1.Supine
2.Prone
3.Side lying
Orientation/Direction of the body
1. Anterior
2. Superior
3.Inferior
4. posterior
5. Medial
6. _____________7. ______
_____
Body System
1. ____________________ 9. ____________________
2. ____________________ 10. ___________________
3. ____________________
4. ____________________
5. ____________________
6. ____________________
7. ____________________
8. ____________________
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1. SKELETAL SYSTEM
The skeleton provides a strong, internal framework (panloob na balangkas) that

supports the body and protects some vital (mahalaga) organs. These bones meet at
joints, the majority (karamihan) of which are freely moveable (malayang
naigagalaw), making the skeleton flexible and mobile.
The skeleton also contains cartilage and ligaments. Cartilage is a tough

(matigas), flexible (naibabaluktot) connective tissue that forms the framework of the
ear and nose, links the ribs to the sternum, and covers the ends of bones inside the
joints. Ligaments (litid) are strong strips of fibrous connective tissue (malakas na
piraso ng hibla) that hold bones together at joints, thereby stabilizing (magiging
matibay) the skeleton during movement.
The nervous system coordinates with muscle movements. Without our skeleton,
we would not be able to stand and walk and move around. Many blood cells are
formed in marrow found in the central opening of certain bones.
Division of Skeletal System
Appendicular Bone (126 bones) - The appendicular skeleton is composed of bones

that connect the appendages to the axial skeleton. The upper and lower extremities,
the shoulder girdle, the pelvic girdle.
Axial Bone (80 bones) - The axial skeleton consists of bones that form the axis of the
body and support and protect the organs of the head, neck, and trunk the skull, the
sternum, the ribs, the vertebral column.
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Fig. 6. Skeletal System
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TABLE 2. MAJOR BONES AND BONE GROUPS OF THE BODY
FUNCTIONS
BONES OF THE HEAD
This is the cranium, the bony framework of the head composed of
the cranial and facial bones plus the maxilla and mandible (upper
and lower jaws). The skull houses and protects the brain.
a. Skull(29)
VERTEBRAL COLUMN
b. Vertebrae (26) The vertebrae are any of the 33 bones of the vertebral column,
comprising 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and coccygeal
vertebrae. The sacral and coccygeal vertebrae are fused into single
units. The spinal cord passes through and is protected by the
vertebrae.
THORACIC CAGE
c. Ribs (2x12) Twelve pairs of narrow curved bones that extend from the
vertebrae to the sternum. The upper seven enclose the thoracic or
chest cavity and protect the heart and lungs. The lower five enclose
part of the abdominal cavity.
d. Sternum (1) The sternum is found on the midline of the anterior chest wall. It
extends from the throat down to the upper abdominal area. The
anterior end of each rib is attached to the sternum.
PECTORAL GIRDLE
e. Clavicle (2) This is the elongated, slender curved bones of the anterior shoulder
known as collarbone. It extends laterally from the top of the
sternum to the scapula. The connection of the sternum and the
clavicle is an important landmark in locating the internal carotid
artery.
f. Scapula (2) The shoulder blade provides for attachment of the clavicle (collar
bone) and the humerus (upper arm bone). The blade portion
extends downward over the dorsal surface of the rib cage.
g. Humerus (2) This is the long bone of the upper arm.
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UPPER EXTREMITIES
h. Radius (2) The shorter and the lateral two bones of the forearm. It attaches on
the thumb side of the wrist.
i. Ulna (2) The medial and longer bone of the forearm. It attaches on the little
finger side of the wrist.
j. Carpals (16) The wrist bones.
k. Metacarpals (5x2) The five long bones of the hand. They are slightly concave on the
palmar surface.
PELVIC
l. Pelvic girdle (2) Three pairs of bones: the ilium, ischium and pubis, fused to form
the pelvic girdle. It attaches to the lower spine, provides support to
the internal organs and has sockets where the upper leg bones
(femur) are attached.
LOWER EXTREMITIES
m. Femur (2) The longest, strongest, and heaviest bone of the body located in
the thigh area.
n. Fibula (2) The lateral and smaller two bones of the lower leg.
o. Patella (2) The kneecap
p. Tibia (2) The medial and larger two bones of the lower leg.
q. Tarsals (14) The bones in the ankle.
r. Metatarsals The five long bones of the foot that are concave on the plantar or
(5x2) lower surface.
s. Phalanges The bones of the toes and fingers.
(14x2x2)
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Name : ___________________________ Date : __________ Score : ___________
I. Identify the following parts
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2. MUSCULAR SYSTEM
Muscles produce movement of, and inside the body. Muscle tissue is made up of
cells called fibers that have the ability to contract ( kakayahang umikli) or shorten, in
order to produce a pulling force. Muscles are also extensible, and are elastic
(maaring naibabanat) so that they can be stretched and then recoil and resume their
normal resting length. Muscles are also electrically excitable, so that they can be
stimulated to contract by a nerve impulse. There are three types of muscles in the
body – skeletal, smooth and cardiac.
CHARACTERISTICS OF MUSCLE
Excitability - the ability to receive and respond to a stimulus

Contractility - the ability to shorten
Extensibility - the ability to be stretched
Elasticity - the ability to resume normal length after contraction or having been
stretched.
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Fig. 7. Muscular System
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TABLE 3. MUSCULAR SYSTEM
TYPE OF MUSCLE DESCRIPTION WHERE FOUND
1. Skeletal muscle Voluntary muscles attached to the bones of the
skeletons
2. Smooth muscle Involuntary muscles hollow organs like small
intestine, blood vessels
3. Cardiac muscle Involuntary muscle heart
TABLE 4. SKELETAL MUSCLE DISTRIBUTION WITH CORRESPONDING CONTENTS

BODY REGION MUSCLE AREA CONTENTS
Deltoid
Arm Biceps
Triceps
Brachioradialis
1. Upper extremities
Forearm Pronator
Supinator
Thenar muscles
Fingers
Hypothenar
Rectus femoris
Quadriceps ( Rectus Femoris, Vastus
Lateralis, Vastus Medialis, Vastus
Upper leg Intermedius ) – located in the anterior
( Thigh ) of thigh
Hamstrings ( Biceps Femoris,
2. Lower extremities Semitendinosus, Semimembranosus )
– located in the posterior of thigh
Gastrocnemius muscle
Lower leg
Tibialis anterior
Trapezius
Upper back
Erectors Spinae
Lower back Gluteals (buttocks)
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Name : Date :
Topic : Score :
CHECK YOUR UNDERSTANDINGS
I. ENUMERATION
Characteristics of Muscle
1. __________________
2. __________________
3. __________________
4. __________________
Quadriceps Muscle
1. __________________
2. __________________
3. __________________
4. __________________
Types of Muscle
1. __________________
2. __________________
3. __________________
Muscles in the Forearm
1. __________________
2. __________________
3. __________________
Muscles in the Arm
1. __________________
2. __________________
3. __________________
Muscles of the Upper Thigh
1. __________________
2. __________________
3. __________________
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3. INTEGUMENTARY SYSTEM
The skin is the largest organ of the body. As a physical barrier (pisikal na
harang), skin stops water from leaking (tagas) out of or into the tissues; prevents the
entry of bacteria (pinipigil ang pagpasok ng bakterya) and other disease-causing
microorganisms; filters out the harmful (mapaminsala) and potentially carcinogenic
ultraviolet (UV) radiation in sunlight; and repairs itself if cut or torn. Skin also helps
maintain the body’s temperature (panatilihin ang temperature ng katawan) at a
constant 37°C (98.6°F); and contains a range of sensory receptors.
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TABLE 5. SKIN LAYERS AND COMPONENTS
SKIN LAYERS DESCRIPTION COMPONENTS
Keratin
1. Epidermis Upper layer of the skin
Melanin
blood vessels
sensory nerve endings and
receptors
Lower, thicker part of
2. Dermis sebaceous glands
the skin
sweat glands
adipose cells
tiny veins and arteries
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Name : Date :
Topic : Score :
1. A component of epidermis that is responsible for skin pigmentation.

a. Sebaceous gland
b. Keratin
c. Adipose cells
d. Melanin
2. It is the largest organ in the body.
a. Liver
b. Skin
c. Gall bladder
d. Pancreas
3. It means lower than the normal body temperature.
a. Hyperthermia
b. Hypothermia
c. Hypertension
d. Hypotension
4. All but one is components of dermis.
a. Keratin
b. Sebaceous gland
c. Arrector pili muscle
d. Adipose cells
5. A component of dermis that is responsible for production of sebum or oil in
the body.
a. Keratin
b. Sebaceous gland
c. Arrector pili muscle
d. Adipose cell
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II. Enumeration
Sensory Skin Receptors

1. _____________________
2. _____________________
3. _____________________
4. _____________________
5. _____________________
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4. CIRCULATORY SYSTEM
The circulatory or cardiovascular system consists of the blood vessels and the
blood that is pumped along them by the heart. The circulatory system plays a vital
role (gumaganap ng isang mahalagang papel) in maintaining homeostasis by
controlling the concentration and composition of tissue fluid, by supplying cells with
essential materials and removing their wastes, by helping to keep the body warm,
and by protecting the body against attack by pathogens. A vast (malawak) network
of blood vessels carries blood from the heart to the tissues and back to the heart
once again in an unending circulation of this life-giving fluid.
How does this system work?
pulmonary vein lungs pulmonary artery
head & arms
aorta
main vein
Right Left
liver
digestive system
kidneys
legs
Circulatory System
Fig.8. Circulatory System Pathway
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Fig. 9. Major Arteries of the Body
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Fig. 10. Major Veins of the Body
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TABLE 6. BLOOD PRESSURE RANGE FOR ADULTS
RANGE STATUS
70/40 ~ 90/60 Low blood pressure
Over 90/60 ~ 120/80 Normal blood pressure
Over 120/80 ~ 140/90 Pre-high blood pressure
Over 140/90 ~ 190/100 High blood pressure
Fig. 11. Anatomy of a Heart
TABLE 7. HEART RATE CHART:

BABIES TO ADULT
AGE BEATS PER MINUTE (BPM)
0–1 100 – 160
1+ – 10 60 – 140
10+ - adults 60 - 100
Athletes 40 – 60
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TABLE 8. CIRCULATORY SYSTEM ORGANS, STRUCTURE AND FUNCTIONS
ORGANS STRUCTURE FUNCTIONS
Red blood cells transport oxygen through
(Erythrocytes) hemoglobin
White blood cells antibodies that deals with foreign
(Leukocytes) materials like disease organisms
1. Blood
Platelets blood clotting (pamumuo ng dugo)
(Thrombocytes)
Plasma and plasma carries foods and wastes from
proteins tissues
Arteries carries blood away from the heart
2. Blood Capillaries exchange of materials between
vessels blood and tissue cells
Veins carries blood towards the heart
Arch of the aorta carries oxygenated blood to the
rest of the body
Abdominal aorta and supplies blood to the abdominal
3. Heart
thoracic aorta and thoracic area
Inferior and superior carries deoxygenated blood from
vena cava the rest of the body to the heart
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Name : Date :
Topic : Score :
I. IDENTIFICATION
1. It transports oxygen through hemoglobin.
2. Other term for White blood cells.
3. Range for High blood pressure.
4. Medical terminology for high blood pressure.
5. Largest artery in the body.
6. Antibodies that deals with foreign materials like disease organisms.
7. It carries blood towards the heart.
8. It carries foods and wastes from tissues.
9. Other term for Red blood cells.
10.Heart rate range for an infant.
II. ENUMERATION
Structure of Blood
1. __________________
2. __________________
3. __________________
Structure of blood vessels
1. __________________
2. __________________
3. __________________
Heart rate ranges from babies to adult
1. __________________
2. __________________
3. __________________
4. __________________
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5. LYMPHATIC SYSTEM
As blood passes through capillary beds (maliliit na ugat), some of the fluid
portions leak through the capillary walls into the spaces between cells. While much of
the fluid diffuses back (lumalaganap pabalik) into the capillaries, a portion remains in
the interstitial spaces between the cells. The lymphatic system collects this fluid
(called lymph) and returns it to the circulatory system. Lymphatic vessels are thin-
walled vessels in close contact with most tissues. Lymph vessels join together to
eventually form the thoracic duct which empties the lymph from the lower part of
the body into the subclavian vein. This is an essential function (mahalagang
tungkulin) because without it, the lymphatic system will die from the resulting edema
(fluid accumulation) within 24 hours.
Fig. 12. Lymphatic System
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TABLE 9. LYMPHATIC SYSTEM ORGANS, DESCRIPTION AND FUNCTIONS
ORGANS DESCRIPTION FUNCTIONS
1. Lymph Swellings in the lymphatic lymphocytes or white blood cells
nodes system are stored here
2. Spleen Largest organ in the lymphatic removes worn out red cells,
system bacteria and cell fragments from
the blood
3. Thymus Lies top of the thorax and partly generates t-cells lymphocytes
over the heart and lungs
4. Tonsils Small masses of lymphoid tissue provides protection against
on side of the pharynx pathogens that enters body
through mouth or nose
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Name : Date :
Topic : Score :
I. ENUMERATION
Enumerate the organs involved in Lymphatic System.

1. ________________
2. ________________
3. ________________
4. ________________
Major function of the Lymphatic System
1. ________________
II. IDENTIFICATION
_______ 1. Largest organ in the lymphatic system.

_______ 2. It provides protection against pathogens that enters body through mouth
or nose.
_______ 3. It removes worn out red cells, bacteria and cell fragments from the blood.
_______ 4. It generates T-cells lymphocytes.
_______ 5. Small masses of lymphoid tissue on side of the pharynx.
_______ 6. Lymphocytes or white blood cells are stored here.
_______ 7. Swellings in the lymphatic system.
_______ 8. Lies at the top of the thorax and partly over the heart and lungs.
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6. NERVOUS SYSTEM
The nervous system is the major controlling, regulatory, and communicating

system in the body. It receives information from both outside and inside the body,
gathered by sensors such as the eyes and proprioceptors then sends out instruction
to effectors such as muscles and glands to make the body react. It enables
(nagbibigay daan) a person to think, create, remember, and feel. It is also responsible
for regulation of internal events such as heart rate or body temperature. The nervous
system has two (2) main parts:
Fig. 13. Nervous System Pathway of Impulses
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TABLE 10. THE NERVOUS SYSTEM
1. Central Nervous System (CNS)- Brain
represents the largest part of the Spinal Cord
nervous system, including the brain
and the spinal cord
2. Peripheral Nervous System (PNS)- Somatic System
refers to parts of the nervous Autonomic System
system outside the brain and spinal
cord. It includes the cranial nerves,
spinal nerves and their roots and
branches, and peripheral nerves.
Central Nervous System Peripheral Nervous System
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Name : Date :
Topic : Score :
I. MATCHING TYPE
Match Column A to Column B
Column A
_______ 1. Somatic System Column B
_______ 2. Brain A. Central Nervous System (
_______ 3. Sympathetic Nervous CNS )
System B. Peripheral Nervous System
_______ 4. Spinal Cord ( PNS )
_______ 5. Parasympathetic
Nervous System
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7. RESPIRATORY SYSTEM
The respiratory system takes air into the body, and facilitates the
entry of oxygen into the bloodstream which carries it to all body cells. At
the same time, the respiratory system removes carbon dioxide which
would poison the body (nakalalason sa katawan) if allowed to
accumulate and expels it from the body into the atmosphere.
The respiratory system consists of the lungs through which oxygen

enters, and carbon dioxide leaves the bloodstream; and the airways are
the nose, pharynx (throat), larynx (voice box), trachea (wind pipe), and
bronchi that carry the air between the lungs and the atmosphere. Air is
sucked into and pushed out of the lungs by the action of breathing.
Fig. 15. The

Respiratory System
Page 41 of 209
TABLE 11. RESPIRATORY SYSTEM STRUCTURE, ORGAN AND
FUNCTIONS
STRUCTURE ORGAN FUNCTIONS
Nose where air passes and organ of
1. Upper
smell
Respiratory
Pharynx serves both digestive and
Tract
respiratory system
Trachea wind pipe; transport air to and
from lungs
2. Lower
Bronchi, where the air entering the lungs
Respiratory
Bronchioles are sent to each lung
Tract
Lung transport air to alveoli for gas
exchange
3. Accessory Diaphragm muscular partition that separates
abdominal and thoracic cavities
PHYSIOLOGY OF RESPIRATION
 Inspiration (inhalation) – the process of taking air into the

lungs.
 Expiration (exhalation) – the process of letting air out of the

lungs.
Page 42 of 209
Fig. 16. The Breathing Cycle
TABLE 12. RESPIRATORY RATE CHART: BABIES TO ADULT
AGE BREATHS PER MINUTE (RR)
0–1 30 – 40
1+ – 3 23 – 35
3+ – 6 20 - 30
6+ – 12 18 – 26
12+ – Adults 18 – 20
Page 43 of 209
Name : Date :
Topic : Score :
I. Choose and encircle the correct answer.

1. All are parts of the Lower Respiratory Tract EXCEPT.
a. Pharynx
b. Lungs
c. Bronchi
d. Trachea
2. It is a muscular partition that separates abdominal and thoracic cavities.
a. Nose
b. Pharynx
c. Diaphragm
d. Trachea
3. Also known as the “voice box”
a. Larynx
b. Trachea
c. Pharynx
d. Bronchi
4. The process of taking the air into the lungs.
a. Inspiration
b. Expiration
c. Inhalation
d. Both A and C
5. Also known as the “wind pipe”
a. Larynx
b. Trachea
c. Pharynx
d. Bronchi
Page 44 of 209
II. Fill out the table with the correct respiratory ranges.
RESPIRATORY RATE : BABIES TO ADULT

AGE BREATHS PER MINUTE (RR)
0–1
1+ – 3
3+ – 6
6+ – 12
12+ – Adults
Page 45 of 209
8. DIGESTIVE SYSTEM
The digestive system is responsible for the digestion (pantunaw)

and absorption (pagsipsip) of food and water and for the elimination
(pag-alis) of solid wastes. Food contains nutrients essential for normal
cell function, growth and repair, therefore to keep the body alive.
Digestion is the breaking (pinaghiwahiwalay) down of complex nutrients
into simple substances that can be absorbed by the body.
Fig. 17.
The Digestive System
Page 46 of 209
TABLE 13. DIGESTIVE SYSTEM DIVISION, ORGAN AND FUNCTIONS
DIVISION ORGAN FUNCTIONS
Mouth chewing and breaking down of
food
Pharynx swallowing mechanism of food
(lalamunan) (paglunok ng pagkain)
Esophagus serves as passage (daanan) of
1. Alimentary
food
Canal
Stomach digestion takes place
Small Intestine absorption takes place
Large Intestine food further processed and ends
up as feces
Anus exit of waste products
Liver (atay) detoxifies drugs and alcohol
2. Accessory Gall bladder serves as reservoir (imbakan)of
Digestive (apdo) bile
Organs Pancreas produces the digestive enzyme
(lapay)
Page 47 of 209
RUQ LUQ
 Small bowel  Small bowel
 Liver and Gall bladder  Left lobe of liver
 Pylorus  Spleen
 Duodenum  Stomach
 Head of Pancreas  Body of pancreas
 Portion of ascending and  Portion of transverse
transverse colon and descending colon
 Right adrenal gland  Left adrenal gland
 Portion of right kidney  Portion of left kidney
RLQ LLQ
 Small bowel  Small bowel
 Cecum and appendix  Sigmoid colon
 Portion of ascending  Portion of descending
colon colon
 Lower pole of right  Left pole of left kidney
kidney  Left ureter
 Right ureter
Page 48 of 209
Fig. 18. The Digestive Process
Page 49 of 209
Name : Date :
Topic : Score :
I. MATCHING TYPE
COLUMN A _______ 9. Detoxifies drugs and

alcohol
_______ 1. Digestion takes _______ 10. Absorption takes
place place
_______ 2. Exit of waste
products COLUMN B
_______ 3. Swallowing
mechanism of food A. Mouth
_______ 4. Produces the B. Pharynx
digestive enzyme C. Esophagus
_______ 5. Food further D. Stomach
processed and ends up as feces E. Small Intestine
_______ 6. Chewing and F. Large Intestine
breaking down of food G. Anus
_______ 7. Serves as a reservoir H. Liver
of bile I. Gall Bladder
_______ 8. Serves as a passage J. Pancreas
of food
Page 50 of 209
9. URINARY SYSTEM
The two kidneys play a vital role in homeostasis by processing the

blood to produce a waste fluid of about 1 ml per minute called urine
which is expelled (nilalabas) from the body. The kidneys are carrying out
two major functions: first, excretion of unwanted and potentially
poisonous (nakalalason) metabolic wastes produced by cells and
second, regulation or removal of excess water and salts (such as sodium
and potassium salts) in order to maintain constant levels of water and
salts in the blood and other body fluids.
Fig. 19. The Urinary System
Page 51 of 209
Fig. 20. The Urinary Cycle
TABLE 14. URINARY SYSTEM ORGANS AND FUNCTIONS

ORGAN FUNCTIONS
Kidney site of urine production
Urether connects kidney to urinary bladder
Urinary bladder serves as storage for urine
Urethra passage through which urine is discharged outside
the body
TRIVIA : Did you know that Female has a shorter Ureter than the Male?
That is why they are more prone on acquiring Urinary Tract Infection
(UTI).
Page 52 of 209
Name : Date :
Topic : Score :
CHECK YOUR UNDESTANDINGS
I. Enumerate the organs involved in the Urinary System and

give their functions.
URINARY SYSTEM ORGANS AND FUNCTIONS

ORGAN FUNCTIONS
1.
2.
3.
4.
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10. ENDOCRINE SYSTEM
The endocrine system releases chemicals known as hormones

that are carried by the blood and regulate the metabolic activities of
cells thereby controlling processes such as growth, metabolism, and
reproduction; and the nervous system. The two systems interact to
control body activities. Endocrine glands or ductless glands, release their
secretion (hormones) into the bloodstream. The major endocrine glands
are the pituitary, thyroid, parathyroid, thymus, and adrenal gland. Other
organs, including the testes, ovaries, and pancreas have significant areas
of endocrine tissue and are also considered as endocrine organs.
Fig. 21. The Endocrine Glands
Page 54 of 209
TABLE 15. EXOCRINE VS. ENDOCRINE GLANDS
EXOCRINE ENDOCRINE
Have ducts to carry hormones Do not have ducts to carry
hormones
Hormones released outside of the Hormones released inside of the
body body
Have sub-classifications Do not have sub-classifications
Response is slower due travels Response is faster as it travels
through the blood then released directly into the bloodstream
outside
Transmission duration prolonged Transmission duration is shorter as
as hormones passes through the hormones no longer passes
kidney to filter blood through the kidney
TABLE 16. ENDOCRINE SYSTEM ORGANS AND FUNCTIONS

ORGAN FUNCTIONS
1. Pituitary gland master gland; regulates metabolism, growth, sexual
development and immune response
2. Thyroid gland influences the rate of body metabolism
3. Parathyroid important in the control of calcium metabolism
gland
4. Thymus stimulate the immune system
5. Pancreas secretes insulin when carbohydrates are being digested
6. Adrenal gland produces hormones that balance electrolytes and water
in the body
7. Ovary female organ which produce sex female hormones and
ova
8. Testes male organ which produce male sex hormones and
spermatozoa
Page 55 of 209
Name : Date :
Topic : Score :
I. MATCHING TYPE
COLUMN A ____ 7. Transmission

duration is shorter as
____ 1. Do not have sub- hormones no longer passes
classifications through the kidney
____ 2. Transmission ____ 8. Response is slower
duration prolonged as due travels through the
hormones passes through blood then released outside
the kidney to filter blood ____ 9. Hormones released
____ 3. Hormones released inside of the body
outside of the body ____ 10. Have sub-
____ 4. Do not have ducts to classifications
carry hormones
____ 5. Response is faster as COLUMN B
it travels directly into the
bloodstream A. Exocrine Gland
____ 6. Have ducts to carry B. Endocrine Gland
hormones
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II. IDENTIFICATION
________ 1. It influences the rate of body metabolism
________ 2. Female organ which produce sex female hormones and ova
________ 3. Secretes insulin when carbohydrates are being digested
________ 4. Produces hormones that balance electrolytes and water in
the body
________ 5. It is the master gland
________ 6. Important in the control of calcium metabolism
________ 7. Stimulate the immune system
________ 8. Male organ which produce male sex hormones and
spermatozoa
Page 57 of 209
Name : Date :
Topic : Score :
Guideline Questions

1. The study of the structure of living things from the whole
organism down to the cell level.
b. Physiology
c. Anatomy
d. Botany
e. Microbiology
2. The building block of life.
e. Cell
f. Tissue
g. Organ
h. System
3. The sternum is _______to the clavicle.

a. Medial
b. Anterior
c. Inferior
d. Superior
4. Cluster of Tissues
a. Cell
b. Tissue
c. Organ
d. System
5. A position wherein the belly touches the bed.
a. Supine
b. Prone
c. Side-Lying
d. T-berg
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6. It distributes the nutrients to the body.
a. Digestive System
b. Circulatory System
c. Integumentary System
d. Urinary System
7. All are included in the pectoral girdle EXCEPT
a. Clavicle
b. Scapula
c. Humerus
d. Sternum
8. Number of bones found in the skull.
a. 26
b. 27
c. 28
d. 29
9. It extends laterally from the top of the sternum to the
scapula.
a. Ribs
b. Humerus
c. Clavicle
d. Scapula
10. It divides the body into anterior and posterior portion.
a. Coronal Plane
b. Sagittal Plane
c. Plantar Plane
d. Transverse Plane
11. Component of the skin that is responsible for sebum
production.
a. Melanin
b. Keratin
c. Sebaceous gland
d. Eccrine gland
Page 59 of 209
12. All are normal heart rate of an infant EXCEPT
a. 120 bpm
b. 130 bpm
c. 100 bpm
d. 90 bpm
13. It carries oxygenated blood EXCEPT
a. Radial Artery
b. Ulnar Artery
c. Pulmonary Artery
d. Brachial Artery
14. Respiratory Range of a 5 year old child
a. 30-40
b. 23-35
c. 20-30
d. 18-26
15. It produces the digestive enzyme
a. Liver
b. Gall bladder
c. Pancreas
d. Adrenal
16. The largest organ in the lymphatic system.
a. Tonsil
b. Spleen
c. Thymus
d. Lymph node
17. It serves as a reservoir for urine.
a. Kidney
b. Ureter
c. Urinary bladder
d. Urethra
18. Have ducts to carry hormones.
a. Endocrine
b. Exocrine
c. Urinary
d. Digestive
Page 60 of 209
19. It influences the rate of body metabolism.
a. Pituitary gland
b. Adrenal gland
c. Thyroid gland
d. Parathyroid gland
20. It is the process of breaking down of complex nutrients into
simple substances that can be absorbed by the body.
a. Absorption
b. Ingestion
c. Digestion
d. Infestation
II. Identification
1. The basic structural and functional unit of the most living

organisms.
2. Towards the front of the body.
3. A position of the body lying down with face up.
4. The longest, strongest and heaviest bone of the body located in
the thigh area.
5. Carries blood towards the heart.
6. It generates t-cells lymphocytes.
7. It serves both digestive and respiratory system.
8. Serves as a passage of food.
9. It produces hormones that balance electrolytes and water in
the body.
10. Site of urine production.
Page 61 of 209
Module 2
MICROBIOLOGY AND PATHOLOGY
General Pathology and Microbiology
Student Objectives:
1. Explain the basic terminologies essential in the understanding of

microbiology and pathology.
2. Differentiate the common microorganisms.
3. Discuss the infection process.
4. Recognize signs and symptoms of inflammation.
5. Discuss the pathology of body systems relevant to the practice of

massage therapy.
6. Discuss the components of massage therapy infection control

program.
Page 62 of 209
MICROBIOLOGY AND PATHOLOGY
As health care professionals, massage therapists seek to improve

(upang mapabuti) the health and well-being of their clients through
massage therapy. Regardless of work setting or treatment style, the
massage therapist encounters clients who have disorders, who are
under medical supervision, and/or who are taking medications. The
therapist needs information regarding these conditions and
medications, as well as how massage can be safely administered in these
situations.
Like in pathology, various microorganisms are always present in the

massage environment and are easily transmitted (madaling maipasa)
causing diseases. Therefore, it is important that as massage therapists,
we need to study Microbiology and Pathology to prevent the
transmission of disease from client to massage therapist and vice versa,
and from client to client during massage sessions, thus protecting public
safety and further complications of existing health conditions.
1. Carrier (tagapagdala)– a person who is infected with a pathogen

and can transmit it to others but shows no symptoms of the
disease.
2. Communicable Disease – any disease that is transmissible by

infection directly or through the agency of a vector. Childhood
diseases such as chickenpox, measles and mumps are considered
communicable.
3. Contagious Disease (nakakahawang sakit) – a disease that

someone can catch from another person. Often times, just being
close to the person, having contact with the person, or touching
something the person touched is enough for you to contract the
disease.
Page 63 of 209
4. Disease (sakit) – this refers to a condition of illness that impairs
bodily functions, associated with specific signs and symptoms. It
may be caused by external factors such as invading organisms or
internal factors such as cancer.
5. Endemic - a disease that exists permanently in a particular region

or population. Malaria is a constant worry in parts of Africa
6. Epidemic (epidemya) - An outbreak of disease that attacks many

people at about the same time and may spread through one or
several communities
7. Microbiology – this refers to the branch of biology that deals

with microorganisms, such as bacteria, viruses and protozoa, and
their effects on other living organisms
8. Microbe (mikrobyo) – a microorganism that is able to carry on

living process and may or may not cause disease. (e.g. virus,
bacteria, fungus and protozoan)
9. Pandemic - When an epidemic spreads throughout the world
10. Pathology – this refers to the study of diseases
11. Pathogen – a microorganism or parasite that can cause disease
Page 64 of 209
B. Common Microorganisms
BACTERIA VIRUS FUNGI PROTOZOAN PARASITES

S
 Small one-  A tiny  A simple  Single-  An organism
celled organism parasitic celled, tiny living in or
microorgani that can plant living on and
sms of the only grow in that lacks things that obtaining
class the cells of chloroph are the nourishment
Schizomycet another yll. lowest from
es. animal.  It is form of another
 Some are unable to animal life. organism.
round  More than make its
(cocci), rod- 200 viruses own food  More  A facultative
shaped have been and complex parasite may
(bacilli), found to depends than live on
spiral cause on other bacteria, another
(spirochetes disease in life which are organism but
), or humans. forms. forms of is capable of
comma- plant life. living
shaped  Some kinds  A simple independent
(vibrios). of viruses fungus  About 30 ly.
are reproduc kinds of
adenovirus, es by protozoa  An obligate
arenavirus, budding; cause parasite is
enterovirus, many- diseases in one that
herpesvirus, celled humans- depends
and fungi protozoal, entirely on
rhinovirus reproduc protozoan. another
e by organism for
 Self-limiting, making its survival.
hence spores.
developmen
t of
resistance is
Page 65 of 209
the only
treatment
without
further
medications
REMEMBER : Very Bad For PeoPle (Virus, Bacteria, Fungi,

Protozoans, Parasites )
C. Infection Process
Infection is an invasion to the body tissue by pathogenic

microorganisms, resulting in signs and symptoms as well as an
immunologic response. The patient’s own immune response may
compound the tissue damage; such damage may be localized or
systemic.
Page 66 of 209
D. Signs and Symptoms of Inflammation
The body reacts to microbial invasion by producing an inflammatory

response. The inflammatory response is controlled by chemical, cellular
and vascular functions that have the remarkable ability to adjust that
response to the severity of the threat. Other manifestations include
fever, malaise, nausea, vomiting and purulent discharge from wound.
CHAIN OF
INFECTION
Infectious Agent
Susceptible Host Reservoir
Portal of Entry Portal of Exit
Mode of
Transmission
Causative Agent
 Agents that cause disease ( Eg. Mycobacterium Tuberculae,
Helicobacter Pylori )
Reservoir
 Where the causative agent stay ( Eg. Sick or infected person )
Portal of Exit
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 A port where the agent exit or escape ( Eg. Respiratory Tract,
mucous membrane, Gastrointestinal Tract or urinary tract )
Mode of Transmission
 A way on how the causative agent transferred to another either
direct contact or indirect contact.
 Direct contact – skin to skin contact
 Indirect contact – things used by the infected person like
handkerchief, spoon and fork
Portal of Entry
 Where the causative agent enter and get inside the body ( Eg.
Respiratory tract, mucous membrane, Gastrointestinal Tract or
urinary tract )
Susceptible host
 If the organism has escaped and entered another organism, the
persons must be susceptible to have an infection.
The signs and symptoms of inflammation are the following:
a. Redness (pamumula) - rubor

b. Swelling (pamamaga) - tumor
c. Heat (init) - calor
d. Pain (pananakit) - dolor
e. Loss of function (pagkawala ng tungkulin) - function laesa
Page 68 of 209
Name : Date :
Topic : Score :
I. Encircle the correct answer.
1. This refers to a condition of illness that impairs bodily

functions, associated with specific signs and symptoms.
a. Communicable disease
b. Disease
c. Carrier
2. This refers to the branch of biology that deals with
microorganisms, such as bacteria.
a. Microbiology
b. Pathogen
c. Pandemic
3. An outbreak of disease that attacks many people at about
the same time.
a. Epidemic
b. Contagious disease
c. Communicable disease
4. A microorganism or parasite that can cause disease.
a. Microbe
b. Pathogen
c. Pathology
5. This refers to the study of diseases.
a. Microbiology
b. Pandemic
c. Pathology
Page 69 of 209
6. A simple fungus reproduces by budding.
a. Fungi
b. Parasites
c. Bacteria
7. An organism living in or on and obtaining nourishment
from another organism.
a. Bacteria
b. Virus
c. Parasites
8. A tiny organism that can only grow in the cells of another
animal.
a. Virus
b. Fungi
c. Protozoans
9. Small one-celled microorganisms of the class
Schizomycetes.
a. Fungi
b. Virus
c. Bacteria
10. Single- celled, tiny living things that are lowest form of
animal life.
a. Protozoans
b. Bacteria
c. Virus
ENUMERATION
The Chain of Infection (in PROPER ORDER)
1. ____________________
2. ____________________
3. ____________________
4. ____________________
5. ____________________
6. ____________________
Page 70 of 209
E. Pathology of Systems Relevant to the Practice of Massage Therapy
1. Musculoskeletal System
IS MASSAGE
WHAT IS / HOW IS IT
CONDITION NAME INDICATED OR
ARE THEY? RECOGNIZED?
CONTRAINDICATED?
Dislocations Dislocations Acute (New) Massage is indicated in
are traumatic dislocations are the sub-acute stage for
injuries to extremely dislocations, as long as
joints in which painful. The work is conducted
the bones may be within pain tolerance.
articulating visibly separated As the area heals,
bones are and a total loss massage may be useful
forcefully of function for managing scar
separated. occurs at the tissue accumulation
joint. and muscle spasm
around the affected
joint.
Fatigue (pagod) Fatigue is a A person In the absence of other
state of less suffering from contraindicated
than optimal mental or conditions, massage is
performance physical fatigue systemically indicated
because the feels tired, move for fatigue.
body has had inefficiently and
inadequate may be more
rest and prone to injury.
recovery time.
Page 71 of 209
IS MASSAGE
WHAT IS / ARE HOW IS IT
CONDITION NAME INDICATED OR
THEY? RECOGNIZED?
CONTRAINDICATED?
Fibromyalgia Fibromyalgia is Fibromyalgia is Massage is indicated
a condition diagnosed when for fibromyalgia. Care
that involves other diseases must be taken not to
chronic muscle have been ruled over treat, however
pain, trigger out and seven to because patients are
points tender ten active extremely sensitive to
points and trigger points pain and may have
nonrestora-tive are identified. accumulations of waste
sleep. products in the tissues
that are difficult to
flush out adequately.
Fractures (bali) A fracture is Most fractures Massage is locally

any kind of are painful and contraindicated for
broken or involve loss of acute fractures, but
cracked bone. function at the work done on the rest
nearest joints, of the body can yield
but some may reflexive benefits.
be difficult to Massage is indicated
Nabaling buto. diagnose for people in later
without an stages of recovery from
X– ray. fractures.
Gout Gout is an Acute gout Massage is

inflammatory causes joints to systematically
arthritis caused become red hot, contraindicated for
by deposits of swollen, shiny gout in the acute stage
sodium urate and extremely and locally
(uric acid) in painful. It contraindicated for
and around usually has a gouty joints at all
Page 72 of 209
joints sudden onset. times.
especially in
the feet.
Herniated disc A herniated The symptoms Massage is indicated in

disc is a of nerve root the subacute of
situation in pressure include herniated discs.
which the referred pain
nucleus along the
pulposis or the dermatome,
surrounding specific muscle
annulus fibrosis weakness,
of an paresthesia and
intervertebral numbness.
disc protrudes
on nerve roots
or on the spinal
cord itself.
Osteoarthritis This joint Affected joints Massage is locally

inflammation are stiff, painful contraindicated in the
brought about and occasionally acute stage and
by wear and palpably indicated in the
tear causing inflamed. subacute stage, when it
cumulative osteoarthritis can contribute to
damage to most often muscular relaxation
articular affects knees, and mobility of the
cartilage. hips and distal affected joint.
joints of the
fingers.
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Spasms (pasma), Spasms and Cramps are Massage is locally
cramps (pulikat) cramps are extremely contraindicated for
involuntary painful with acutely cramping
contractions of visible muscle bellies through
skeletal shortening of origin/insertion work
muscle. muscle fibers. can trick the
Spasms are Long term proprioceptors into
considered to spasms are achy letting go. Subacute
be low grade, and cause cramps respond well to
long lasting inefficient massage, which can
contractions, movement, but reduce residual pain
while cramps may not have and clean up chemical
are short-lived, acute waste. It is indicated
very acute symptoms. for long term spasm
contractions. because it can break
through the spasm
pain cycle
Sprains Sprains are In the acute Massage is indicated

injured stage, for sub-acute sprains. It
ligaments symptoms can influence the
include pain, healthy development
redness, heat, of scar tissue and
swelling and reduce swelling and
loss of joint damage due to
function. In the edematous ischemia.
sub-acute stage Care must be taken to
these symptoms rule out bone fractures.
will be abated,
although
perhaps not
entirely absent.
At all stages
Page 74 of 209
pain will be
present on
passive
stretching of the
affected
ligament.
Strains Strains are Pain, stiffness Massage is indicated

injured and occasionally for muscle strains, to
muscles. palpable heat influence the
and swelling will production of useful
be present. Pain scar tissue, reduce
is exacerbated adhesions and edema
by stretching or and reestablish range
resisted exercise of motion.
of the injured
muscle.
Tendinitis Tendinitis is Pain and Massage is locally
inflammation stiffness will be contraindicated for
of a tendon, present as well acute tendinitis.
usually due to as, in acute Massage is indicated
injury at the stages, palpable for tendinitis in the
tenoperiosteal heat and sub-acute stage, to
or swelling. Pain is influence the
musculotendin exacerbated by production of useful
ous junction. resisted exercise scar tissue, reduce
of the injured adhesions and edema
muscle tendon and reestablish range
unit. of motion.
Page 75 of 209
Tenosynovitis Tenosynovitis Pain, heat and Massage is locally
is the stiffness will be contraindicated for
inflammation present in the tenosynovitis in the
of a tendon acute stage. In acute stage and very
and or the sub-acute much indicated in the
surrounding stage, only subacute stage.
synovial stiffness and
sheath. it can pain may be
happen present. The
wherever tendon may feel
tendon pass or sound creaky
through these (crepitis) as it
sheaths, but is moves through
especially the sheath. It is
common in the difficult to bend
forearm, fingers with
particularly in tenosynovitis,
the extensor but even harder
muscle. to straighten
them.
Myofascial Pain Myofascial pain Myofascial pain Massage is currently

syndrome syndrome is a syndrome has the best treatment for
chronic form of muscle pain that this condition.
muscle pain. persists or Massage must be
The pain of worsens. tailored fit to the
myofascial pain Myofascial pain clients’ needs as it
syndrome caused by varies from one client
centers around trigger points to the other.
sensitive points has been linked
in your muscles to many types
called trigger of pain,
points. The including
Page 76 of 209
trigger points headaches, jaw
can be painful pain, neck pain,
when touched. low back pain,
And the pain pelvic pain, and
can spread arm and leg
throughout the pain.
affected
muscle
Osteoporosis Osteoporosis is Osteoporosis- Gentle massage, while

a disease affected bones avoiding undue
characterized have more pressure over bones is
by low bone pronounced indicated. Massage
mass and loss hollow spaces therapist and client
of bone tissue within them, communication is
that may lead which causes necessary especially on
to weak and them to break pressure tolerance.
fragile bones. If more frequently Joint mobilizations
you have and more easily. should be limited or
osteoporosis, Such fractures avoided.
you have an happen in
increased risk situations where
for fractured healthy people
bones (broken would not
bones), normally get a
particularly in fracture.
the hip, spine Osteoporosis
and wrist. mostly affects
the long bone
femur, or the
spine or the
wrist bones.
However, the
Page 77 of 209
porosity of the
bones happens
throughout the
body.
2. Integumentary System
HOW IS IT IS MASSAGE INDICATED

CONDITION NAME WHAT IS IT?
RECOGNIZED? OR CONTRAINDICATED?
Acne (taghiyawat) Acne is a It looks like Massage is locally
bacterial raised inflamed contraindicated for acne
infection of pustules on the because of the risk of
sebaceous skin, sometimes spreading infection,
glands usually with white or causing pain and
found on the black tips. exacerbating the
face, neck and symptoms with the
upper back, it application of an only
is closely lubricant.
associated with
adolescence or
liver
dysfunction
that results in
excess
testosterone in
the system.
Boils (pigsa) Boils are local Boils look like Boils at least locally
staphylococcus acne, too, contraindicate massage
infections except that the and care should be taken
similar to acne, lesions are to make sure the
but they are bigger and they infection is not systemic
not related to usually occur (screen the client for
adolescence or singly rather other symptoms such as
liver than being welling, fever or
dysfunction. spread over a discomfort other than at
large area. the site of the lesion).
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Burns (paso) Burns are First degree Massage is locally
caused by burns involve contraindicated for all
damage to the mild burns (except perhaps
inflammation.
skin that mild sunburns) in the
Second degree
causes the cells burns include acute stage. In the sub-
FIRST DEGREE to die. They blistering and acute and post-acute
can be caused damage at the stages, massage may
by fire, deeper levels of be performed around
overexposure the epidermis. the damaged area
to the sun, dry Third degree within pain tolerance
burns penetrate
heat, wet heat, of the client.
the dermis itself
SECOND DEGREE electricity, and will often
radiation, show white or
extreme cold black charred
and toxic edges. In the
chemicals. post acute stage,
serious burns will
THIRD DEGREE often develop
shrunken
contracted scar
tissue over the
area of affected
skin.
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Dermatitis/ Eczema Dermatitis is an Dermatitis The appropriateness of
umbrella term presents itself in massage depends
for various ways completely on the
source of the problem
inflammation depending on
and the condition of
of the skin. what type of skin the skin. If the skin is
Eczema is a reactions are very inflamed or has
type of atopic elicited. Exposure blisters or other
dermatitis a to poisons oak or lesions, massage is at
Sakit sa balat na non-contagious poison ivy results least locally
may pangangati at skin rash in large inflamed contraindicated until
pamumula. the acute stage has
usually brought wheals, metal
Pamamaga ng balat. passed. If signs indicate
about by an allergies tend to a rash could spread
allergic be less inflamed (e.g. with poison oak)
reaction. and more massage is systemically
Contact isolated in area. contraindicated while
dermatitis is a the irritation is present.
Eczema usually Dry, flaky eczema
related but
appears as one of indicates massage. If
slightly
two varieties; the skin is not itchy and
different type the affected area is
of very dry and
highly isolated as with
hypersensitivit flaky skin a metal allergy to a
(seborrheic watch band or earrings,
y reaction.
eczema) or massage is only locally
. blister weepy contraindicated.
skin (dyshidrotic
eczema)
Hives Hives are an They can be Massage is

inflammatory small red spots systematically
skin reaction to or large wheals contraindicated in the
an allergen or that are warm to acute stage and locally
emotional the touch and contraindicated in the
stressor. itchy. They subacute stage of
generally subside hives. By bringing even
within a few more circulation to the
Page 80 of 209
hours. skin, massage would
only make a bad
situation worse.
A crust or scab Massage is locally

Open wounds and appears at the contraindicated for any
sores These include site of the injury unhealed skin injury
any injury to with which bleeding
the skin that has occurred. When
has not healed the underlying
and that is epidermis has been
vulnerable to completely replaced,
infection if the scab will no longer
exposed to be at risk for infection.
bacteria or
other It may be systemically
microorganism. contraindicated if skin
Skin injuries injury is connected to a
are vulnerable contraindicated
as long as there underlying condition
is a visible crust such as diabetes.
or scab.
Lice & Mites Lice and mites Mites that cause Massage is
are tiny scabies are too contraindicated for all
arthropods small to see, but three infestations, until
that drink leaves itchy trails infestation has been
blood. They are where they completely eradicated.
highly burrow under If a massage therapists
contagious and the skin. Prefers is exposed to any of
spread through warm, moist these parasites, every
close contact places such as client subsequently
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with skin or the axillae or works on will also be
infested sheets between fingers. exposed even before
or clothing. the therapist shows
Head lice are any symptoms.
easy to see, but
they can hide. A Parasitic infestations
more reliable are something every
sign is their eggs. massage therapist fears
Nits are small, as they are very
white, rice – vulnerable to whatever
shaped flecks is crawling around on
that cling client’s skin.
strongly to hair
shafts.
Pubic lice look

like itchy white
crabs
Scar tissue Scar tissue is Scar tissue on the Massage is locally

the growth of skin often lacks contraindicated during
new tissue, pigmentation the acute stage of any
skin or fascia and hair follicles. injury in which the skin
after injury. has been damaged. in
the subacute stage,
massage may improve
the quality of the
healing process.
Warts (kulugo) Warts are Typical warts Massage is locally

neoplasm that (verruca vulgaris) contraindicated for
arise from the look like hard, warts. the virus is
keratinocytes cauliflower- contrained in the blood
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in the shaped growths. and shedding skin cells
epidermis, they they usually and it is possible to get
are caused by occur on the warts from another
extremely slow hands. They can person.
acting viruses. affect anyone,
but teenagers
are especially
prone to them.
Psoariasis Psoriasis is a Psoriasis is Massage can be

chronic, non- reddish, performed on clients
contagious scaly rash often though therapist must
disease located over the ask how sensitive the
characterized surfaces of the areas are and how
by inflamed elbows, knees, much pressure can be
lesions covered scalp, and used.
with silvery- around or in the
white scabs of ears, navel,
dead skin. genitals or
buttocks.
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3. Circulatory System
IS MASSAGE
CONDITION HOW IS IT
WHAT IS IT? INDICATED OR
NAME RECOGNIZED?
CONTRAINDICATED?
Edema Edema is the Edematous is Massage is
retention of puffy or boggy. If contraindicated for
the interstitial associated with most edemas,
fluid either local infection or particularly pitting
because of quite cool, if it is edema, where tissue
electrolyte or cut off from local won’t immediately
protein circulation. spring back from a
imbalances or touch.
because of
mechanical Indicated edemas
obstruction in include those due to
Di- the circulatory subacute soft tissue
pangkaraniwang or lymphatic injury or temporary
dami ng tubig sa systems. immobilization
mga himaymay ng
katawan, gaya ng
sa mga binti
Embolism or Thrombi are Venous emboli Massage is
Thrombus stationary land in the lungs, systematically
clots; emboli causing contraindicated in the
are clots that pulmonary presence of diagnosed
travel through embolism. thrombi or emboli, as it
the circulatory symptoms of PE is for any disorder
system. include shortness involving potential
of breath, chest blood clots.
Emboli are pain and
usually coughing up
composed of sputum that is
blood but may streaked with
also be blood. Arteries
fragments of (heart attack),
plague, fat the brain
globules air (transient
bubbles, ischemic attack
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tumors or bone or stroke),
chips. kidneys, legs or
some other
organ.
Heart Attack A heart attack Symptoms of Massage is
(atake sa puso) or myocardial heart attacks contraindicated for
infarction (MI), include angina, patients recovering
is damage to shortness of from heart attacks.
the breath, feeling of After complete
myocardium great pressure on recovery, heart attack
caused by a the chest, pain patients may be good
clot or plague around the left candidates for massage
fragment shoulder, pain but not without
getting lodge around the left medical clearance.
somewhere in shoulder and
a coronary arm, jaw and
artery, back.
depriving the
cardiac muscle
of oxygen.
Hematoma A Superficial Massage is locally

hematoma hematomas are contraindicated for
is a deep simple bruises. acute hematomas
bruise Deep bleeds may because of the
(leakage of not be visible, possibility of blood
blood) but they will be clots and pain. in the
between painful and if sub acute stage (at
muscle extensive least two days later),
sheaths. bleeding is when the surrounding
present, the blood vessels have
Pamumuo ng dugo sa affected tissue been sealed shut and
mga himaymay. will have a the body is in the
characteristic gel process of breaking
– like feel. down and reabsorbing
the debris, gentle
massage within pain
tolerance around the
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perimeter of the area
and hydrotherapy can
be helpful. Watch for
signs of
thrombophlebitis or
deep vein thrombosis
and if there is any
doubt, consult a
doctor.
Hypertension Hypertensio High blood For borderline or mild

n is the pressure has no high blood pressure,
technical dependable massage may be useful
term for symptoms. The to control stress and
high blood only way to increase general health,
pressure. identify it is by however pathologies
taking several related to kidney or
blood pressure cardiovascular disease
measurements must be ruled out. High
over time. blood pressure that
Pagtaas ng presyon requires medication
ng dugo. usually contraindicates
circulatory massage, but
under some
circumstances, massage
may be appropriate with
a doctor’s approval.
Thrombophelibitis Thrombo- Thrombophlebiti Massage is strictly
or deep vein phlebitis s may or may not systemically
thrombosis and deep include pain, contraindicated for
vein heat, redness, thrombophlebitis or
thrombosis swelling and local deep vein thrombosis.
(DVT) are itchiness and a
inflammatio hard cord-like
ns of veins feeling at the
due to blood affected vein.
Pagbabara ng isang clots. Symptoms for
daluyan ng dugo DVT: possibly
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dahil sa pagkakaroon pitting edema
ng pamumuo. distal to the site,
often with
discoloration
Varicose veins Varicose Varicose veins are Massage is locally
veins are ropey,slightly contraindicated for
distended bluish, elevated extreme varicose veins
veins, veins that twists and anywhere distal to
usually in and turn out of them. Mild varicose
the legs, their usual course. veins contraindicate
caused by they happen most deep, specific work,
valvular in frequently on the but are otherwise safe
competence medial side of the for massage.
and a calf, although they
backup of are also found on
blood the posterior
returning to aspects of the calf
the heart. and thigh.
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4. Nervous System
IS MASSAGE
HOW IS IT
CONDITION NAME WHAT IS IT? INDICATED OR
RECOGNIZED?
CONTRAINDICATED?
Carpal Tunnel Carpal CTS will cause Massage is indicated
Syndrome Tunnel pain, tingling, with extreme caution
Syndrome numbness and for CTS. Work on
(CTS) is weakness in the around the wrists
irritation of part of the hand must stop immediately
the median supplied by the if any symptoms are
nerve as it median nerve. elicited. Some types of
passes under CTS will respond well
transverse to massage. It is
carpal necessary to get a
ligament into medical doctor’s
the wrists. diagnosis in order to
know which type of
CTS’s is present.
Headaches (sakit sa Headaches Tension Massage is
ulo) are pain headaches may systematically
caused by be bilateral and contraindicated for
any number headache due to
generally painful.
of sources. infection or CNS
muscular Vascular disturbance. Massage
tension is the headaches are is indicated for
most often unilateral vascular headaches in
common and have a the subacute stage.
source of distinctive Massage is indicated
pain; “throbbing” pain for tension headaches.
congestive
from blood flow
headaches
are less into the head.
common and Headaches
headaches brought about by
due to central nervous
serious system disease
underlying
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pathology are extreme,
are the rarest severe and
of all. prolonged. they
can have a
sudden or gradual
onset.
Insomnia Insomnia is Signs of insomnia Massage is

the inability include general systematically
to attain fatigue, reduced indicated for insomnia.
adequate
mental capacity
amounts of
sleep and slow healing
processes.
Hindi makatulog.
Seizure Disorders Seizure Seizure disorders Massage is

Epilepsy Disorders are are diagnosed contraindicated during
usually through CT scans seizures, but is
caused by
and MRI’s, seizure indicated at all times.
neurological
damage, may take very
although it different forms
may be for different
impossible to people, they
delineate range from barely
exactly what noticeable to life
the damage
threatening
is. Epilepsy is
one type of
seizures
disorder.
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5. Endocrine System
IS MASSAGE
HOW IS IT
RECOGNIZED?
CONTRAINDICATED?
Diabetes Mellitus Is a group of Early symptoms Massage is indicated
metabolic of diabetes for people with
disorders include diabetes as long as
characterized frequent
their tissue is healthy
by glucose urination,
intolerance or thirstiness, and and they receive
deficiency and increased medical clearance.
disturbances appetite along
in with weight
carbohydrate, loss, nausea
fat and protein and vomiting.
metabolism.
6. Excretory System
IS MASSAGE
HOW IS IT
RECOGNIZED?
CONTRAINDICATED?
Kidney stones A kidney Small stones Massage is
(bato sa bato) stone is a may show no contraindicated for
deposit of symptoms at all, someone experiencing
crystalline renal colic (a kidney
but larger
substances stone attack) although
inside the stones can it is appropriate for
kidney or the cause extreme people with a history of
ureters. pain that may stones, but no current
be accompanied symptoms.
by nausea and
vomiting. Pain
may refer from
the back into
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the groin and
hips
Renal failure Renal failure is Symptoms of Massage is
a situation in acute and systematically
which the chronic renal contraindicated for
kidneys are failure differ in both acute and chronic
incapable of severity and renal failure.
functioning at type of onset,
normal levels. but they have in
it may be an common
acute or a reduced urine
chronic output,
problem, but systemic edema
it can be life and changes in
threatening. mental state
brought about
by the
accumulation of
toxins in the
blood.
Urinary tract A urinary tract Symptoms of Circulatory massage is
infection infection (UTI) the UTI’s include systematically
(impeksyon sa ihi) is an infection pain and contraindicated during
of the urinary burning acute UTI’s as it is for
tract, usually sensations all acute infections.
by bacteria during Massage may be
that live urination, appropriate in the sub-
normally and frequency, acute stage. Although
harmlessly in urgency and deep work on the
the digestive cloudy or blood abdomen is still locally
tract. – tinged urine. contraindicated until
In the acute signs of infection are
stage fever and gone.
general malaise
may also
present.
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THINGS TO REMEMBER :
“-itis “means inflammation

“myo- “means muscle
“osteo- “means bone
“arthro- “means joints
“derma- “means skin
“cardio- “means heart
“pulmo- “ means lung
“nephro- “ means kidney
Locally Contraindicated – means a particular area of the body which is

affected is not indicated for massage
 Fracture (acute stage)
 Osteoarthritis (acute stage)
 Cramps (acute stage)
 Tendinitis (acute stage)
 Tenosynovitis (acute stage)
 Acne
 Boils
 Burns (acute stage)
 Dermatitis (acute stage)
 Hives (sub-acute stage)
 Open wounds and sores (acute stage)
 Scar tissue (acute stage)
 Warts
 Hematoma (acute stage)
 Varicose veins (extreme varicose veins)
Systematically Contraindicated – means massage is not indicated for
any parts of the body
 Gouty arthritis
 Dermatitis ( if the irritation is present )
 Hives (acute stage)
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 Open wounds and sores ( if skin injury is connected to a
contraindicated underlying condition such as diabetes )
 Embolism or Thrombus
 Thrombophlebitis or Deep Vein Thrombosis (DVT)
 Headaches (due to infection or CNS disturbance)
 Renal failure
 Urinary tract infection (acute stage)
Absolutely Contraindicated – means massage is TOTALLY not given to
the body
Locally Indicated – means massage is indicated on the affected area
 Dislocations (sub-acute stage)
 Fibromyalgia
 Fractures (in later stage of recovery from fracture)
Systematically Indicated – means massage is indicated in any parts of
the body
 Fatigue (in the absence of other contraindicated conditions)
 Insomnia
Page 93 of 209
Name : Date :
Topic : Score :

1. It is a condition that involves chronic muscle pain.
a. Fatigue
b. Fractures
c. Fibromyalgia
d. None of the above
2. Traumatic injuries to joints in which the articulating bones are
forcefully separated.
a. Fatigue
b. Dislocations
c. Fatigue
3. It is situation in which the nucleus pulposis of an intervertebral
disc protrudes on nerve roots.
a. Spasm
b. Herniated disc
c. Gout
4. It is an inflammatory arthritis caused by deposits of sodium urate
around joints.
a. Osteoarthritis
b. Cramps
c. Gout
5. This are injured muscles

Page 94 of 209
a. Tenosynovitis
b. Strains
c. Tendinitis
6. It is an inflammation of a tendon, due to injury at the
musculotendinous junction.
a. Tendinitis
b. Strains
c. Osteoarthritis
7. Bacterial infection usually found on the face, neck and upper
back.
a. Burns
b. Boils
c. Acne
8. An inflammatory skin reaction to an allergen.
a. Hives
b. Eczema
c. Burns
9. It is a chronic characterized by inflamed lesions covered with
silvery-white scabs of dead skin.
a. Psoariasis
b. Scar tissue
c. Warts
10. It is a deep bruise between muscle sheaths.
a. Varicose veins
b. Hematoma
c. Hypertension
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11. The inability to attain adequate amounts of sleep.
a. Insomnia
b. Headaches
c. Hypertension
12. It is a deposit of crystalline substances inside the kidney.
a. Diabetes Mellitus
b. Kidney stones
c. Headaches
13. This are distended veins, usually in the legs caused by valvular in
competence.
a. Varicose veins
b. Renal failure
c. Urinary tract infection
14. An infection of the urinary tract, usually by bacteria that live
normally in the digestive tract.
a. Renal failure
b. Urinary tract infection
c. Carpal Tunnel Syndrome
15. The growth of new tissue, skin or fascia after injury.
a. Psoarisis
b. Warts
c. Scar Tissue
Page 96 of 209
F. INFECTION CONTROL PROGRAM COMPONENTS
In general, massage therapists are exposed to more viruses and

bacteria than the average person because of the nature of their work –
touching an unclothed person.
A breach (paglabag) in infection control practices facilitates

transmission of infection from clients to massage therapists and vice
versa, massage therapist to other clients and to other people that they
may be in contact with either in the workplace or outside the workplace.
Thus, to prevent any untoward infection incidents in the workplace,

the following components are considered:
1. EDUCATION AND TRAINING
Massage therapists should be oriented toward the importance of an

infection control program. They should be equipped with basic
knowledge, skills and attitudes for good infection control practices.
In order to implement a good infection control program, an

infection control team should be created with the following tasks:
a. Assess training needs of the staff and provide the required

training through awareness programs, in-service education and
on-the-job training;
Example of Trainings: Work Restrictions – employees with

certain contagious illnesses are not allowed to report until they
are deemed neither contagious nor communicable.
b. Provide periodic re-training or orientation of staff and review

the impact of the training;
Page 97 of 209
c. Organize regular training program for the staff for essential
infection control practices.
2. EXPOSURE PREVENTION
As massage therapy professionals, there are precautions that can be

taken to reduce (mabawasan) the risks of infection. First, treat every
client as if they have an infectious disease. Many persons with
infectious diseases do not exhibit symptoms and may appear to be
healthy. Precautions should be taken with clients who deny having an
infectious disease as they may not realize they have an infectious
disease or they may be concealing their disease for fear of
discrimination or being denied treatment.
Treating all clients in a massage facility with the same basic level of
“standard” precautions involves work practices that are essential to
provide a high level of protection to clients, other massage therapists
and other people they get in contact with. Sanitation guidelines for
massage therapist professionals include the following
a. Hand Washing And Antisepsis
Two methods of improving massage therapists’ hand hygiene are as

follows:
 Traditional Hand Washing – uses running water and apply soap

or detergent.
 Hand Asepsis – uses running water and apply antimicrobial soap

or detergent that contains an antiseptic
– uses an alcohol-based antiseptic hand rub when hands are not

soiled with dirt
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Factors to consider when choosing antiseptic agent:
 effectiveness of the product against the pathogens likely to

be encountered in the workplace
 persistence of antiseptic activity
 speed at which the product takes effect
 acceptance and compliance by employees
Massage therapy professionals should be expected to wash their

hands:
 upon arrival to the massage facility

 when gloves are noted to have a tear or defect
 when hands come in contact with saliva or blood
 before a patient is seen and gloves are put on
 after a patient is seen and gloves are taken off
 anytime gloves are removed
Page 99 of 209
 when hands are visibly soiled
 before leaving the facility for the day
b. Use of Lotions
Frequent hand washing and use of antiseptic products can lead

to dry, chapped hands which can provide easy entry for pathogens.
Moisturizing lotion to the hands can ease dryness associated with
frequent hand washing. However, it is important to avoid
petroleum or oil-based lotion since it can break down latex gloves
and increase permeability.
c. Jewelry
It is advised to avoid wearing jewelry like rings, bracelets, or

wristwatches while performing massage therapy because removing
microorganisms from small cracks and fractures found in jewelry is
difficult. Furthermore, jewelry and any sharp objects can also
potentially injure the client or break the protective barrier of gloves.
d. Fingernails
Fingernails should be kept clean, short and without nail polish.

Long fingernails or cracked nail polish provide hiding places for
microorganisms thus, violating sanitary standards. Long fingernails
can also injure the client or break the protective barrier of gloves.
Any practitioner with artificial nails presents high risk for fungal
infections, which can be transmitted to the client.
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e. Vaccination and Immunization
Massage therapists are considered high risk for acquiring

vaccine-preventable diseases. Thus, it is essential that a vaccination
and immunization program be put in place to protect them.
Some of the vaccine-preventable diseases that therapists may

be exposed during their work are:
- Hepatitis B
- Influenza
- Measles (tigdas)
- Mumps (baiki)
- Rubella (German Measles)
f. Use of Protective Barriers
Using personal protective equipment or gears provides a

physical barrier between microorganisms and the massage
therapist. It offers protection by helping to prevent microorganisms
from contaminating hands, eyes, clothing, hair and shoes and for
being transmitted to other clients and staff. Personal protective
gears are used when handling blood, body substances, excretions
and secretions.
As for any unidentified substance, treat it as unsafe at all

times. Proper method of handling unsafe substances should be
imposed to avoid contamination and any protective gear is
advisable.
Personal protective equipment includes:

- gloves
- masks
- cap
- gown / scrub suits / uniforms
- boots / shoe covers
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g. Appropriate handling of
client massage equipment and
soiled linen
In the event of body fluid discharge, linens must be removed

with gloved hands. Contaminated linens or equipment must be
washed separately from the rest in hot water and put disinfectants.
h. Environmental cleaning
Surfaces or equipment in the massage therapy office that do

not touch clients directly are known as environmental surfaces. The
surfaces of items such as knobs, switches, and handles can become
contaminated with microorganisms. For the purposes of
disinfection, there are two categories of environmental surfaces:
 clinical contact – (ex. countertops, switches, door knobs).

 housekeeping – (ex. walls, floors).
Clinical contact surfaces should be disinfected with more

rigorous methods than housekeeping surfaces because they are
touched more frequently. Following treatment of each patient and
at the end of the work day, environmental surfaces that may have
been contaminated by client debris should first be cleaned with
paper towels and a cleaning agent then disinfected appropriately.
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i. Post exposure Prophylaxis
Even with the most advanced infection plan, certain accidents

and exposure may still occur. When this happens, a written policy
for management of exposures will help. Procedures should be in
place to promptly report, medically evaluate, and record all cases of
accidental occupational exposures.
A qualified health care professional should be assigned to

perform a medical evaluation and provide first aid and counseling if
necessary. The medical evaluator should include in the chart the
following:
i. date and time of the exposure

ii. details of where and how the exposure occurred
iii. type, brand, and size of the massage device involved in the
exposure
iv. amount of contaminant involved and what type of injury
v. details regarding the depth of the wound and whether any
potentially-infectious fluid was injected into the body
vi. estimate of the amount of potentially-infectious fluid
involved
vii. how long the potentially-infectious material remained on
the skin or mucous membranes before washing or flushing
of the area
viii. infectious medical history of the patient from which the
exposure occurred
ix. vaccination history of the exposed massage therapist
x. details of any counseling, treatment, or prophylaxis
performed
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3. DISPOSABLE CLIENT CARE ITEMS
Disposable (single-use) client care items should not be cleaned,

disinfected, or sterilized for reuse at a later time. Such items should be
used only once then discarded. Some examples include:
a. Disposable wear implements

b. Face rest covers
c. Gloves
d. Masks
e. Table paper
4. RECORDS MANAGEMENT
The health status of every massage therapist should be recorded in

a medical chart and properly maintained according to what is required
by laws regarding confidentiality and duration of maintenance.
This medical chart should contain information relating to:
a. initial screening tests

b. work-related medical examinations
c. immunizations
d. work restrictions
e. exposure incident reports
f. postexposure management
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Name : Date :
Topic : Score :
I. ENUMERATION
Give atleast 5 examples of a situation when a Massage Therapist

will be expected to wash their hands.
7. ______________________________________
8. ______________________________________
9. ______________________________________
10. ______________________________________
11. ______________________________________
Common vaccine-preventable diseases that the therapist may be
exposed during their work.
1. _________________
2. _________________
3. _________________
4. _________________
5. _________________
Give atleast 6 examples of personal protective equipment.
1. _________________
2. _________________
3. _________________
4. _________________
5. _________________
6. _________________
Two categories of environmental surface.
1. _________________
2. _________________
Page 105 of 209

Name : Date :
Topic : Score :
GUIDELINE QUESTION
1. This may be caused by external factors such is invading

organisms or internal factors such as cancer.
a. Endemic
b. Disease
c. Carrier
d. Microbe
2. This refers to the study of diseases.
a.Physiology
b. Pathology
c. Microbiology
d. Biology
3. Severe Acute Respiratory Syndrome (SARS) is an example of
what disease?
a. Endemic
b. Epidemic
c. Pandemic
d. Sporadic
4. A simple parasitic plant that lacks chlorophyll.
a. Bacteria
b. Virus
c. Fungi
d. Parasites
5. It is the invasion to the body tissue by pathogenic
microorganisms.
a. Infection
b. Infestation
c. Pathogen
d. Microbe
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6. Also known as swelling.
a. Rubor
b. Tumor
c. Calor
d. Dolor
7. This is traumatic injuries to joints in which the articulating
bones are forcefully separated.
a. Fracture
b. Dislocations
c. Fibromyalgia
d. Osteoporosis
8. This are injured muscles.
a. Sprain
b. Strain
c. Spasm
d. Cramps
9. This is inflammatory skin reaction to an allergen or emotional
stressor.
a. Dermatitis
b. Hives
c. Eczema
d. Burns
10. It is the retention of interstitial fluid either because of
electrolyte or protein imbalances.
a. Edema
b. Enema
c. Embolism
d. Emphysema
11. It is the inflammation of the veins due to blood clots.
a. Phlebitis
b. Thrombophlebitis
c. Tendinitis
d. Tenosynovitis
Page 107 of 209

12. This is stationary clots.
a. Emboli
b. Thrombi
c. Edema
d. Enema
13. This is injured ligaments.
a. Sprain
b. Strain
c. Spasm
d. Cramps
14. This are examples of causative agent EXCEPT.
a. Streptococcus
b. Staphylococcus
c. Helicobacter pylori
d. Port of entry
15. Single-celled tiny living things that are the lowest form of
animal life.
a. Bacteria
b. Virus
c. Fungi
d. Protozoans
16. Small one-celled microorganisms of the class Schizomycetes.
a. Bacteria
b. Virus
c. Fungi
d. Parasites
17. A person who is infected with a pathogen and can transmit it
to others but shows no symptoms of the disease.
a. Carrier
b. Susceptible host
c. Causative agent
d. Disease
18. It is an umbrella term for inflammation of the skin.
a. Hives
b. Dermatitis
c. Phlebitis
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d. Eczema
19. A type of headache that may be bilateral and generally
painful.
a. Vascular headaches
b. Migraine
c. Tension headache
20. Early symptoms of this disease include frequent urination,
thirstiness, and increased appetite.
a. Epilepsy
b. Diabetes Mellitus
c. Renal Failure
d. Urinary tract infection
II. Matching Type.

Match Column A to Column B.
Column A. 7. Self-limiting hence

1. A tiny organism that can development of resistance is
only grow in the cells of the only treatment without
another. further medications.
2. It is unable to make its own 8. Some are round, rod-
food and depends on other shaped, spiral, or comma-
life forms. shaped.
3. An organism living in or on 9. Streptoccocus
and obtaining nourishment 10. Hook-worm
from another organism.
4. More complex than bacteria Column B
which are a form of plant A. Bacteria
life. B. Virus
5. Small one-celled C. Fungi
microorganisms of the class D. Protozoans
Schizomycetes. E. Parasites
6. A simple parasitic plant that
lacks chlorophyll.
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Module 3
MASSAGE THERAPY I
Fundamental Concepts of Massage Therapy
Student Objectives:
1. Explain the basic terminologies essential in the understanding of

massage therapy.
2. Discuss the developmental milestone of massage therapy.
3. Explain the different effects of massage.
4. Discuss the indications and contraindications of massage.
5. Differentiate wellness from therapeutic massage.
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MASSAGE THERAPY I
FUNDAMENTAL CONCEPTS OF MASSAGE THERAPY
Massage is a method of healing that applies various techniques

like fixed or movable pressure, holding, vibration, rocking, friction,
kneading and compression using primarily the hands and other areas of
the body such as the forearms (braso), elbows (siko) or feet (paa) to the
muscular structure and soft tissues of the body. Traditional medicine
throughout the world recognizes the significance of therapeutic
massage in managing stress, illnesses or chronic ailments.
It is crucial for a massage therapist to determine if a person is

indicated or contraindicated for massage as well as recognizing its
physiological and psychological effects to a client.
1. Contraindications – This refers to the presence of a disease or

physical condition making therapy in the usual manner
impossible or undesirable; requires further evaluation by a
physician before a therapist can recommend a massage therapy
plan.
2. Indications – This is a fitting therapeutic treatment for a given

condition; has beneficial effects and promote healing.
3. Physiological Effects – Refers to results from activities which

affect organs and systemic functions without regard to
a particular disease after undergoing a massage
4. Psychological Effects – refers to influencing or intended to

influence the mind or emotions after undergoing a massage
5. Therapeutic Massage – it is a remedial, rehabilitative and

medical type of massage in which use for recovery after physical
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injury, adjunct to medical treatment for illness and for relieve of
muscle soreness and minor injury pain using application of
water, heat and cold, stretching, passive and active joint
movement within the normal range of motion.
6. Wellness Massage – it is a preventive, aesthetic, hygienic and

relaxation type of massage in which use for general health,
provide a sensuous, pleasurable indulgence or as adjunct to
remove the results of stresses of daily life. Using a variety of
strokes such as effleurage, petrissage, friction, tapotement and
vibration and can use or apply oil, essences, mineral and water.
B. History of Massage
The origin of the word massage is unclear, but it can be traced to

numerous sources: Hebrew word mashes, the Greek roots masso
and massin, the Latin root massa, the Arabic root mass’h, the
Sanskrit word makeh, and the French word masser.
Ancient World
In the ancient East a concern with illness has been documented

in China for several millennia, and records have revealed that the
practice of massage goes back as early as 3000B.C. However, it was
in the period between the second century B.C. (200-202 B.C.) and
the first century AD (AD 1-100), that Chinese medicine began to take
on its basic shape. Manuscripts found in China dating from the
second century BC discussed massage as one of the various methods
of treatment for illnesses. The Chinese had developed the art of
massage so well that they were the first to train and employ
massage therapists who were blind.
As early as the first century AD, various medical schools had

been founded and had already begun to produce diverging ideas.
These various ideas and beliefs were compiled under the name of
mythical Yellow Emperor and become the classic scripture of
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traditional Chinese medicine, the Huang – ti Nei – ching. Although
the exact date of the original writing of the work is unknown, it was
already in its present form by approximately the first century BC. The
work commonly known as Nei Ching, contained descriptions of
healing touch procedures and their uses.
By the sixth century AD, the techniques and use of massage

were well established in China and had found their way into Japan.
In general, the Japanese methods of massage were basically the
same as the Chinese. In Japan, we see shiatsu, literally meaning
finger pressure; it is considered a component of amma. Shiatsu is a
Japanese modality based on the Asian concept that the body has a
series of energy points, or tsubo. When pressure is properly applied
to these points, circulation is improved and nerves are stimulated.
Numerous tsubo points bring balance between mind and body. Like
the Chinese, the medieval Japanese employed blind massage
therapists.
In addition to the Chinese and Japanese, other Asian cultures

like Indian subcontinent practiced massage known to have existed
for more than 3000 years. It was believed that knowledge of
massage was probably brought to India from China which eventually
became an integral part of Hindu tradition. This was shown by the
inclusion of massage in the sacred practice of Ayur-Veda (c. 1800
B.C.) which literally means code of life. As for medicine, the most
important Ayurvedic texts are the Samhitas and later another work,
Manav Dharma Shastra (c. 300 B.C.), also mentions massage.
Around 500 B.C., the various ideas of healing and treatments in

Greece emerged into healing science and Hippocrates of Cos, a
follower of Herodicus in this new science became known for his
belief that the healer should take care to avoid causing any
additional harm to the patient. On his essay On Joints he wrote “the
physician must be skilled in many things particularly friction”,
making him a proponent of massage.
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Modern Era
The era of modern massage began in the early nineteenth

century when a wide variety of authors were advocating massage
and developing their own systems. The most important of these
writers was Per Henrik Ling (1776 – 1839), a Swedish physiologist
and gymnastics instructor. Through his experiences at the University
of Lund and the Swedish Royal Central Institute of Gymnastics, Ling
developed his own system of medical (Swedish) ) gymnastic and
exercise, known as the Ling System, Swedish Movements, or
Swedish Movement Cure.
The primary focus of Ling’s work was on gymnastics applied to

the treatment of disease and or injury. In this regard, Ling was
proponent of gymnastics, a subject that was promoted more than
2000 years earlier by Herodicus, the teacher of Hippocrates.
According to Ling, gymnastics were a therapeutic system by which
we try – by means of influencing movement – to overcome
discomfort through abnormal conditions.
Massage is viewed as a component of Ling’s overall system and

is known commonly as Swedish massage. Ling, the father of Swedish
massage, and his followers used a system of strokes that created a
very relaxing experience. In general, these followers used massage
strokes in tamed with the movements described above. Its
movements of the joints promoted general relaxation, improved
circulation, relieved muscle tension, all improved range of motion.
Another key individual in the history of massage was the Dutch

physician Johann Mezger (1817 – 1893) who is responsible for
making massage a fundamental component of physical
rehabilitation. He has also been credited for introducing the still-
used French terminology effleurage, petrissage and tapotement to
the massage profession. Mezger was quite successful in getting the
medical profession to accept massage as a bona fide medical
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treatment for disease and illness more readily. What occurred was
the inclusion of the art of massage in the science of medicine.
Latest Developments
As the health care system in the Philippines started to evolve,

the Department of Health (DOH) started to reposition the practice of
massage to be part of the health care family. With the mandate
given through Presidential Decree No. 856 in December 23, 1975,
the Department of Health came up with a series of consultative
meetings in 2008 and issued Administrative Order No. 2008 – 0031,
this sets the policies and guidelines for accreditation of training
institutions, training programs and training providers for massage
therapy in the Philippines.
The administrative order gave way to a series of writeshop that

developed the curriculum, manual, code of ethics and the licensure
performance protocol. In December 10, 2010, a new Administrative
Order No. 2010-0034 was signed by Secretary Enrique Ona which
revised the existing implementing rules and regulations of PD 856
specifically Chapter XIII.
The popularity of massage therapy today stemmed from the

highly stressful conditions of modern living and various harmful
effects of unhealthy foods. Presently, more people are increasingly
looking for holistic and natural healthcare methods to remedy their
health problems. The Department of Health (DOH), in partnership
with the accredited training institutions, training providers and the
Philippine Association of Philippine Licensed Massage Therapists
(PALMT) are in one goal of ensuring the highest standard of massage
therapy practice in the country and strictly enforces the revised
implementing rules and regulations in order to keep up the
credibility of its profession, hence, no person shall be authorized to
practice massage as a profession in the country without holding a
valid Certificate of Registration (COR) issued by the Committee of
Examiners for Massage Therapy (CEMT) and approved by the
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Secretary of Health. Massage therapy in the Philippines is being
promulgated by the Department of Health (DOH) as a profession and
a viable career.
C. Effects of Massage
Effects of massage will vary according to the intent with which it

is provided, the selection of techniques used, and the condition of
the client. Depending on the type and manner of manipulation, a
sense of mild relaxation, stimulation, or refreshment may follow
massage. Under no circumstances should massage be applied so
vigorously that is causes the client to feel exhausted or results in
bruised or injured tissues.
TABLE 1. PHYSIOLOGICAL EFFECTS OF MASSAGE ON SYSTEMS
SYSTEM EFFECT OF
DESCRIPTION
AFFECTED MASSAGE
Circulatory Dilates blood Aids in the widening or stretching
System vessels of superficial blood vessels
(napapaluwang
ang mga ugat)
Improves blood Deep stroking improves blood
circulation circulation by mechanically
assisting venous blood flow back to
the heart (nakakatulong sa
pagdaloy ng dugo sa ugat papunta
sa puso)
Decreases blood When blood vessel dilates the
pressure blood pressure decreases
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SYSTEM EFFECT OF
DESCRIPTION
AFFECTED MASSAGE
Circulatory Replenishes Increased circulation helps in the
System nutritive materials delivery of nutrients (e.g.
carbohydrates, water, fat, etc.) and
oxygen to cells and tissues
Helps in removal Increase circulation also aids in the
of waste products removal of metabolic wastes
(nakakatulong sa
pagtanggal ng
mga dumi sa
dugo)
Reduces heart and Massage decreases heart rate
pulse rates through activation of the relaxation
(napapababa ang response
bilang ng pulso)
Increases red The number of RBC’s and their
blood cell (RBC) oxygen-carrying capacity are
count (tumataas increased due to stimulating
ang bilang ng stagnant capillary beds and
pulang dugo) returning this blood into general
circulation
Increases white As the body sees massage as a mild
blood cell (WBC) stressor, it recruits additional WBCs
count leading to an increase in number of
WBC which enables the body to
protect itself more effectively
against disease ( tumataas ang
bilang ng puting dugo na mas
nakakatulong at pumuprotekta sa
katawan laban sa mga sakit )
Lymphatic Promotes lymph Lymph circulation depends on
System circulation pressure from muscle contraction,
pressure changes in the thorax and
abdomen during breathing or
applied pressure from massage
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Reduces edema Massage reduces edema (swelling)
(accumulation of by improving lymph circulation
excessive amount (nakakabawas ng pamamaga sa
of watery fluid in pamamagitan ng maayos na
cells, tissues, or sirkulasyon)
body cavities)
Decreases the When an area swells, the diameter
circumference of increases and when it subsides,
an area affected circumference decreases
with edema
(nababawasan
ang sukat ng
apektadong parte
ng katawan)
Decreases weight Fluid retention adds weight to a
in patients with person so when edema is
edema addressed with massage, weight is
reduced
SYSTEM EFFECT OF
DESCRIPTION
AFFECTED MASSAGE
Integumentary Increases skin Warming of the skin indicates a
System temperature reduction of stress
(napapataas
ang
temperature ng
balat)
Improves skin As circulation increases, added
condition nutrients are made available to the
skin thus improving its condition,
texture and tone
Stimulates oil Stimulation of the sebaceous oil
glands glands causes an increase in oil
(sebum) production
Reduce skin Due to the increase in oil (sebum)
dryness production
(nakakabawas
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sa panunuyo ng
balat)
Nervous Reduces stress Activating the relaxation response
System reduces stress
Reduces anxiety Since relaxation response is
activated, anxiety or nervousness is
reduced and interestingly, a study
showed that it affects both the
receiver and giver of massage
Promotes General relaxation is promoted
relaxation through activation of the relaxation
response. Relaxation has a
diminishing effect on pain
Decreases beta Beta brain waves are seen during
wave activity wakefulness and associated with
relaxation. A decrease in beta
brainwave activity was confirmed
by electroencephalogram (EEG)
during and after a massage
Increased delta Delta wave activities which is
wave activity typically noted during deep sleep
increase as confirmed by EEG
during a massage
Activates Depending on factors such as
sensory stroke choice, direction, speed and
receptors pressure, massage can stimulate
different sensory receptors e.g.
cross-fiber tapotement stimulates
muscle spindles which activates
muscular contraction
SYSTEM EFFECT OF
DESCRIPTION
AFFECTED MASSAGE
Endocrine Increases Massage stimulates the increase
system dopamine levels production of dopamine
responsible to decreased stress and
reduced depression
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Increases Massage stimulates signals that
serotonin levels increases the production of
serotonin which is believed inhibits
pain signals and thus reducing pain
Reduces Since pain is reduced with massage,
analgesic use the need for excessive use of pain
medication is also reduced
Muscular Relieves There is a relationship between
system muscular muscle tension and blood flow, so
tension as massage enhances blood
circulation, it relieves muscular
restrictions, tightness,
stiffness(paninigas) and spasms
Relaxes muscles Muscles relax as massage reduces
excitability in the sympathetic
nervous system
Reduces muscle Massage enhances blood
soreness and circulation increasing the amount
fatigue of oxygen and nutrients available to
muscles which reduces muscle
fatigue and post exercise soreness
Manually Compressive strokes and cross-fiber
separates friction strokes separate muscle
muscle fibers fibers thereby reducing muscle
spasms
Increases range When muscular tension is reduced,
of motion range of motion is improved. The
freedom of the joints is dictated by
the freedom of the muscles.
Improves When trigger points and muscle
performance tensions are reduced, many
(balance and postural distortions are removed.
posture) Range of motions increases,
posture is more aligned and
balanced, and performance is
improved.
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SYSTEM EFFECT OF
DESCRIPTION
AFFECTED MASSAGE
Muscular Lengthens Massage mechanically stretches
system muscles and broadens tissue especially
(napapahaba when combined with joint
ang mga mobilization and stretches.
muscle)
Increases By lengthening muscles and
flexibility promoting relaxation
Tones weak Muscle spindle activity is increased
muscles during massage stroke (e.g.
tapotement, vibration) which
further stimulates tiny muscle
contractions hence helping tone
weak muscles
Respiratory Reduces Massage slows down breathing
system respiratory rate because of activation of the
(nakakabawas relaxation response
sa bilang ng
paghinga)
Strengthens The muscles of respiration have a
respiratory greater capacity to contract, thus
muscles helping improve pulmonary
(napapalakas functions
ang mga muscle
sa paghinga)
Decreases Through increased relaxation and
asthma attack improved pulmonary functions, a
person with asthma experiences
fewer attacks after massage
Increases fluid The mechanical loosening and
discharge from discharge of phlegm increase with
the lungs rhythmic pressures like tapotement
(cupping) and vibration on the rib
cage
Digestive Promotes By increasing peristaltic activity in
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system evacuation of the colon through massage,
the colon movements of bowel content
toward the anus for elimination is
aided
Relieves Because evacuation of the colon is
constipation promoted, constipation is relieved
Relieves colic Increased peristaltic activity also
and intestinal helps relieves colic and the
gas expulsion of intestinal gases
Stimulates Massage also promotes activation
digestion of the relaxation response, which
stimulates digestion
SYSTEM EFFECT OF
DESCRIPTION
AFFECTED MASSAGE
Urinary Increase urine Massage activates dormant capillary
system output beds and recovers lymphatic fluids
for filtration by the kidney, which, in
turn increases the frequency of
urination and amount of urine
produced.
Promotes the Levels of metabolic wastes like
excretion of nitrogen, inorganic phosphorus and
metabolic wastes sodium chloride in urine are
increased after massage
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TABLE 2. PSYCHOLOGICAL EFFECTS OF MASSAGE
EFFECT OF MASSAGE DESCRIPTION

Improves sleep When clients who have had massage therapy
patterns went to sleep, they reported a deeper sleep and
felt more rested after waking
Reduces job related Massage reduces many types of stress, including
and post traumatic job related and post traumatic stress
stress
Improves mood The mental health status and mood improved
after massage
Decreases feeling of Clients reported a decrease in aggression
anger feelings of anger after massage. This is due to
lesser stress and a feel good state of mind.
Improves self-esteem Because clients feel good physically, their self-
esteem is improved.
Promotes Massage can assist the ease of emotional
communication and expression with relaxation
expression
Improves lifestyle Lifestyle habits includes increased activities of
habits daily living, fewer physical symptoms, fewer
visits to physician, and increased level of
exercising
Increases physical Massage enhances well-being through stress
well being reduction and subsequent relaxation
EFFECT OF MASSAGE DESCRIPTION
Reduces touch Victims of rape and spousal abuse when
aversion and touch massage is done with much care and empathy
sensitivity reported a reduction in touch aversion.
Hypersensitivity to touch was reduced in other
individuals
Increases academic A decrease in math computation time and an
performance increase in accuracy were noted in massage
studies
Increases mental Massage increases mental alertness by relaxing
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alertness the body and mind and by removing stress
Satisfies emotional Using the therapeutic relationship to satisfy
needs clients emotional needs for attention,
acceptance, caring and nurturing touch
D. Indication and Contraindications for Massage
TABLE 3. INDICATIONS FOR MASSAGE

CONDITION DESCRIPTION
Anxiety a feeling of apprehension, uncertainty, and fear

without apparent stimulus, associated with
physiological changes
Depression In psychiatry, a mental state of altered mood

characterized by feelings of sadness, despair, and
discouragement; distinguished from grief, which
is realistic and proportionate to a personal loss.
Insomnia inability to get quality sleep either by falling

asleep or keeping asleep
Lumbago lower back pain
Myalgia muscle pain
Myofascial Pain pain in a localized area rather than the entire

Syndrome (MPS) body
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Neuralgia nerve pain
Paralysis complete loss of strength in an affected limb or

muscle group
Pre and Post Stress a set of symptoms occurring together either

Syndrome before or after being stressed
Sciatica sciatic nerve inflammation
TABLE 4. CONTRAINDICATIONS FOR MASSAGE
Local Contraindications
AREA/S TO BE
AVOIDED
Abdominal An abnormally large separation avoid
diastasis between associated bones, as abdomen
between the ribs.
Abnormal lumps Unusual swelling as in skin lumps avoid area
Acne vulgaris A skin disease characterized by avoid infected
(chronic acne) pimples on the face, chest, and area
back. It occurs when the pores of
the skin become clogged with oil,
dead skin cells, and bacteria.
Athlete’s foot A common fungus infection avoid infected
(Tinea Pedis or between the toes in which the skin area
Foot Ringworm) becomes itchy and sore, cracking
and peeling away
Blister A local swelling of the skin that avoid area
contains watery fluid and is caused
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by burning, infection, or irritation.
Bruise An injury to underlying tissues or avoid bruised
bone in which the skin is unbroken, area if less
often characterized by ruptured than 72 hrs
blood vessels and discolorations; a old
contusion.
Local Contraindications
AREA/S TO
BE AVOIDED
Decubitus ulcers An ulcer due to local interference avoid
with the circulation; called also ulcerated
pressure sore area
Folliculitis Inflammation or infection of one or avoid
more hair follicles (openings in the infected area
skin that enclose hair).
Furuncle/carbuncle It is almost always caused by avoid
(boil) infection by bacteria resulting in a infected area
painful swollen area on the skin
caused by an accumulation
of pus and dead tissue
Herpes simplex A contagious viral disease caused avoid
by herpes simplex virus infected area
Local inflammation Usually a result of an injury or avoid
infected area
infection characterized by pain,
heat, redness, swelling
Phlebitis Inflammation of a vein. lightly over

affected area
Shingles An acute viral disease affecting the avoid
ganglia of certain nerves, infected area
characterized by inflammation,
pain, and skin eruptions along the
course of the affected nerve
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Absolute Contraindications
Cardiac arrest Sudden cessation of the pumping function of the
heart with disappearance of arterial blood pressure
Chickenpox Itchy rash of spots that look like blisters appear all
over the body and be accompanied by flu-like
symptoms caused by the varicella-zoster virus (VZV)
Contact Any skin inflammation that occurs when the skin's
dermatitis (if surface comes in contact with a substance
widespread area originating outside the body
is involved)
German measles Highly contagious viral disease, spread through

(rubella) contact with discharges from the nose and throat of
an infected person
Hepatitis (during Inflammation of the liver.
acute phase)
Hypertension High blood pressure (if not controlled by diet,
exercise, and or medication)
Infectious Caused by pathogenic microorganisms, such as
disease bacteria, viruses, parasites or fungi; the diseases can
be spread, directly or indirectly, from one person to
another e.g Cholera, Malaria
Influenza A highly infectious disease that attacks cells in the
upper respiratory tract, causing typical flu symptoms
such as fatigue, fever and chills, a hacking cough,
and body aches
Liver Cirrhosis (if A condition in which the liver fails to fulfill its
due to viral function or is unable to meet the demand made on
agent) it. It may occur as a result of trauma, neoplastic
invasion, prolonged biliary obstruction, viral
infections (hepatitis c), or chronic alcoholism.
Migraine A severe recurring headache, usually affecting only
headache (during one side of the head, that is characterized by sharp
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the migraine pain and is often accompanied by nausea, vomiting,
headache and visual disturbances
episode)
Multiple sclerosis Chronic autoimmune disorder affecting movement,
(during flare-up) sensation, and bodily functions. It is caused by
destruction of the myelin insulation covering nerve
fibers (neurons) in the central nervous system (brain
and spinal cord).
Mumps Relatively contagious mild short-term viral infection
of the salivary glands
Pneumonia Is an inflammation of the lung tissue affecting one
(during acute or both sides of the chest that often occurs as a
phase) result of an infection.
E. Wellness Massage vs. Therapeutic Massage
Massage is a beneficial way to relax the body and enhance the

functions of the body’s tissues that lead to wellness, at the same time,
has a therapeutic effect.
Massages normally begin with five types of long, flowing strokes.

Massage therapists apply massage oil on the back and other parts of the
client’s body to facilitate the smoothness of the rub and then use gliding
strokes on the parts of the body being worked.
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TABLE 5. WELLNESS vs THERAPEUTIC MASSAGE
Factor Wellness Massage Therapeutic Massage
Customer client patient

relationship
Dominant paradigm intuitive, nurturing scientific, problem-solving
Reason for treatment client request medical necessity
Focus client satisfaction functional outcomes
Termination of care when client’s needs maximum medical improvement

are met or change (usually)
Primary massage relaxation massage clinical massage techniques like

treatment techniques techniques like myofascial treatments, deep
Swedish, deep tissue massage, cross-fiber
tissue, circulatory friction, neuromuscular “trigger
massage, and point” technique, and muscle
craniosacral energy technique
Therapist clients  patients

accountable to  referring providers
 other HCPs involved with
case
Time spent on 1-5 minutes or less 5-20 minutes or more per

documentation, per session session
coordination, and
communication
Training basic massage basic massage certification

certification course course plus advanced training in
 orthopedic assessment &
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treatment protocols
 pathologies and
contraindications
 medical terminology
 pharmacology
 documentation
 communication skills
Experience can start practicing need clinical and professional
right after passing experience and/or an internship
DOH licensure exam
for massage
therapist
Receiver’s emotional proactively seeking didn’t ask to be injured, may be

state/level of care, typically depressed, anxious, or
proactiveness healthy and active otherwise distressed by both the
injury/accident and/or ensuing
work, life, and health
complications
Physical demands on may be lighter – can be heavy – orthopaedic

practitioner Swedish and some assessments, muscle energy
other techniques techniques, myofascial
are less demanding, treatments, cross-fiber
but deep tissue frictioning, and other injury-
massage can be treatment techniques can be
hard on your body hard on your body
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Factor Wellness Massage Therapeutic Massage
Emotional demands on typically light and/or can be heavy – patients

practitioner manageable can be disengaged,
distraught, or otherwise
unengaged or difficult to
engage
Client education OK within scope of may be OK (therapist

practice (“drink plenty of should ask the
water,” “do that stretch I prescribing referrer
showed you,” “put an ice about this), but
pack on it,” etc.) shouldn’t contradict
what the rest of the
medical team is saying
Marketing model consumer marketing business-to-business

(much like a tax networking with
preparer, hair dresser, referring providers,
real estate agent, etc.); health care networks,
gift certificates, referral etc.; many legal and
discounts, and other ethical considerations
consumer marketing regarding referral
practices are OK relationships, etc.
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Name : Date :
Topic : Score :
Guideline Questions
Multiple Choices
1. It is a method of healing that applies various techniques like fixed
or movable pressure, holding, vibration, rocking, friction, and
kneading.
a. Massage
b. Swedish Massage
c. Shiatsu Massage
d. Reflex
2. This refers to the presence of a disease or physical condition
making therapy in the usual manner impossible or undesirable.
a. Indications
b. Physiological Effects
c. Psychological Effects
d. Contraindications
3. This is a fitting therapeutic treatment for a given condition, has
beneficial effects and promotes healing.
a. Indications
b. Wellness Massage
c. Psychological Effects
4. Refers to results from activities which affect organs and systemic
functions without regard to a particular disease after undergoing
a massage.
a. Wellness Massage
b. Physiological Effects
c. Therapeutic Massage
d. Psychological Effects
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5. Refers to influencing or intended to influence the mind or
emotions after undergoing a massage.
a. Contraindications
b. Indications
c. Physiological Effects
d. Psychological Effects
6. It is a preventive, aesthetic, hygienic and relaxation type of
massage in which use for general health.
a. Therapeutic massage
b. Wellness Massage
c. Contraindications
d. Indications
7. It is a remedial, rehabilitative and medical type of massage in
which use for recovery after physical injury.
a. Therapeutic Massage
b. Wellness Massage
c. Indications
8. What is the Hebrew word of Massage?
a. Massin
b. Mashes
c. Masso
d. Massa
9. What is the French word of Massage?
a. Makeh
b. Masso
c. Massa
d. Masser
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10. Aids in the widening or stretching of superficial blood vessels.
a. Lymphatic System
b. Circulatory System
d. Nervous System
11. Affects of massage in this system is reduces stress.
a. Nervous System
b. Lymphatic System
d. Circulatory System
12. The description of this system is warming of the skin indicates a
reduction of stress.
a. Lymphatic System
b. Respiratory System
d. Muscular System
13. The effect of massage in this system is increases dopamine
levels.
a. Nervous System
b. Digestive System
c. Endocrine System
d. Muscular System
14. The description in this muscular system relieves muscular
tension.
a. Endocrine System
b. Muscular System
c. Respiratory System
d. Urinary System
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15. The effect of massage in this system is to increase urine output.
a. Urinary System
b. Digestive System
c. Nervous System
d. Endocrine System
16. He is the responsible for making massage a fundamental
component of physical rehabilitation.
a. Enrique Ona
b. Johann Mezger
c. Isaac Newton
d. Per Henrik Ling
17. The most important Ayurvedic texts is
a. Code of Life
b. Ethics
c. Shiatsu
d. Samhitas
18. The primary focus of Ling’s work was on __________.
a. Gymnastics applied to the treatment of disease
b. Overall system
c. General relaxation
d. Healing treatments
19. In __________ a new Administrative Order No. 2010-0034 was
signed by Secretary Enrique Ona.
a. December 23, 1975
b. December 5, 1978
c. December 23, 1975
d. December 26, 1979
20. The issued Administrative Order that sets the policies and
guidelines for accreditation of training institutions, training
programs and training providers for massage therapy in the
Philippines.
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a. Administrative Order No. 2008-0031
c. Administrative Order No. 2006-0031
d. Administrative Order No. 2010-0033
21. What is the effect of massage in this description, the mental
health status and mood improved after massage?
a. Decreases feeling of anger
b. Improves sleep pattern
c. Improves mood
d. Improves self-esteem
22. What is the condition if the description is lower back pain?
a. Myalgia
b. Anxiety
c. Lumbago
d. Insomnia
23. What is the condition if the description is muscle pain?
a. Myalgia
b. Lumbago
c. Anxiety
d. Insomnia
24. What is the condition if the description is nerve pain?
a. Sciatica
b. Paralysis
c. Neuralgia
d. Lumbago
25. What is the condition if the description is complete loss of
strength in an affected limb or muscle group?
a. Paralysis
b. Pre and Post Stress Syndrome
c. Sciatica
d. Neuralgia
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26. What is the area to be avoided in abdominal diastasis?
a. Avoid infected area
b. Avoid area
c. Avoid abdomen
d. Avoid ulcerated area
27. What is the area to be avoided in bruise?
a. Avoid bruised area if less than 72 hrs
b. Avoid ulcerated area
c. Avoid infected area
d. Avoid area
28. An inflammation of a vein.
a. Shingles
b. Herpes simplex
c. Phlebitis
d. Local inflammation
29. What is a condition when sudden cessation of the pumping
functions of the heart with disappearance of arterial blood
pressure?
a. Chickenpox
b. Infectious Disease
c. German Measles
d. Cardiac Arrest
30. What is the condition where high blood pressure (if not
controlled by diet, exercise, and or medication).
a. Hepatitis
b. Hypertension
c. Chickenpox
d. Influenza
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31. A highly infectious disease that attacks cells in the upper
respiratory tract, causing typical flu.
a. Infectious disease
b. German measles
c. Chickenpox
d. Influenza
32. Highly contagious viral disease, spread through contact with
discharges from the nose and throat of an infected person.
a. Cardiac arrest
b. German measles
c. Hepatitis
d. Influenza
33. What is the area to be avoided in shingles?
a. Lightly over affected area
b. Avoid ulcerated area
c. Avoid abdomen
d. Avoid infected area
34. The description of this condition is inflammation of the liver.
a. Hypertension
b. Influenza
c. Hepatitis (during acute phase)
d. Cardiac arrest
35. An inflammation of the lung tissue affecting one or both sides of
the chest that often occurs as a result of an infection.
a. Pneumonia
b. Mumps
c. Liver Cirrhosis
d. Multiple sclerosis
36. What is the factor if the therapeutic massage is maximum
medical improvement
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a. Primary massage treatment techniques
b. Termination of care
c. Experience
d. Training
37. What is the factor if the wellness massage is basic massage
certification course?
a. Training
b. Focus
c. Termination of care
d. Experience
38. What is the system affected if the effect of massage is increases
delta wave?
a. Endocrine System
b. Muscular System
c. Nervous System
d. Respiratory System
39. Who is the Father of Swedish massage?
a. Per Henrik Ling
b. Johann Mezger
c. Nei Ching
d. Chinese
40. In psychiatry, a mental state of altered mood characterized by
feelings of sadness, despair, and discouragement; distinguished
from grief, which is realistic and proportionate to a personal loss.
a. Anxiety
b. Depression
c. Lumbago
d. Insomnia
41. Using the therapeutic relationship to satisfy client’s emotional
needs for attention, acceptance, caring and nurturing touch.
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a. Improves lifestyle habits
b. Improves self-esteem
c. Satisfies emotional needs
d. Increases physical well being
42. A feeling of apprehension, uncertainty, and fear without
apparent stimulus, associated with physiological changes.
a. Depression
b. Myalgia
c. Anxiety
d. Lumbago
43. Unusual swelling as in skin lumps.
a. Abnormal lumps
b. Blister
c. Bruise
d. Folliculitis
44. An ulcer due to local interference with the circulation; called also
pressure sore.
a. Abdominal diastasis
b. Decubitis ulcers
c. Blister
d. Athlete’s foot
45. Chronic autoimmune disorders affecting movement, sensation,
and bodily functions, It is caused by destruction of the myelin
insulation covering nerve fibers in the central nervous system.
a. Migraine Headache
b. Liver Cirrhosis
c. Mumps
d. Multiple Sclerosis
46. A severe recurring headache, usually affecting only one side of
the head, that is characterized by sharp pain and is often
accompanied by nausea, vomiting, and visual disturbances.
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a. Migraine Headache
b. Multiple Sclerosis
c. Mumps
d. Pneumonia
47. What is the area to be avoided in abnormal lumps condition?
a. Avoid infected area
b. Avoid abdomen
c. Avoid Ulcerated area
d. Avoid area
48. A decrease in math computation time and an increase in
accuracy were noted in massage studies.
a. Increases academic performance
b. Satisfies emotional needs
c. Increases mental alertness
d. Improves lifestyle habits
49. What is the affect of massage in digestive system?
a. Increase urine output
b. Stimulates digestion
c. Reduce respiratory rate
d. Increase range of motion
50. What is the effect of massage in respiratory system?
a. Increase flexibility
b. Increases range of motion
c. Stimulates digestion
d. Decreases asthma attack
Page 141 of 209

Module 4
MASSAGE THERAPY II
Massage Therapy Application
Student Objectives:
1. Explain the basic terminologies essential in the application of

massage.
2. Identify the three massage therapy processes.
3. Explain the five basic strokes, its rationale and benefits.
4. Explain the significance of assessment and documentation in the

practice of the profession.
5. Practice communication and interviewing skills.
6. Describe the process of good documentation.
Page 142 of 209

MASSAGE THERAPY II
MASSAGE THERAPY APPLICATION
The general principles of massage application are the principles that

the massage therapists must know before applying or practicing
massage. By means of understanding and abiding by these principles,
the client, the public, the profession, the co-therapists and the
therapists themselves will be protected, guided & be safe for any
untoward or unethical circumstances.
Bodywork may be helpful in flushing out debris and improving

sluggish and congested circulation in the post-acute stages of infection
and inflammation.
1. Application/ Paglalagay – It is a process of putting something

such as healing agent or lotion into the body especially the skin
for soothing action.
2. Assessment – It is an evaluation of the health status of an

individual by performing a physical appraisal after obtaining a
health history.
3. Documentation/ Dokumentasyon – This refers to a

chronological written account of a client's assessment and
management that includes the client's medical history and
complaints, the therapist's physical findings, the results of
assessment and procedures, and therapeutic procedures.
4. Massage Therapy - refers to a system of assessment, evaluation

and manual application techniques used in a scientific manner
taking into account the muscle locations, stress points and other
anatomical considerations of the human body. It includes
adjunctive external application of water, heat and cold,
Page 143 of 209

stretching, passive and active joint movement within the normal
physiologic range of motion as a means of promoting pain relief,
injury rehabilitation or health improvement in a safe, non-sexual
environment that respects the client’s self-determined outcome
for the session.
5. Palpation – This is an assessment of the body by touching or

pressing with the fingers or the palm of the hand.
6. Range of Motion / Saklaw ng Paggalaw – It is the extent of
movement of a joint from full extension to full flexion (bending)
measured in degrees like a circle.
7. Sensory Assessment – It is a process of appraisal using the

senses in a scientific and documented manner.
8. Stroke / Paghagod – it refers to a single uninterrupted and

complete movement or process, especially when repeated or in
a back-and-forth motion with the use of a hand or a tool to the
surface or deeper structures of the body.
9. Visual Assessment – It is a simple appraisal tool consisting of a

10 cm line with 0 on one end, representing no pain, and 10 on
the other, representing the worst pain ever experienced, which
a patient indicates so the massage therapist knows the severity
of his or her pain.
10. Vital Signs – This refers to the basic indicators of body function,
usually meaning heartbeats per minute, breaths per minute,
blood pressure, body temperature, and weight.
B. Massage Therapy (MT) Process1
The Massage Therapy Process includes three phases:
1
See details of MT Process in the Licensure Performance Protocols (LPP)
Page 144 of 209

1. Pre-massage – This consists of two main activities conducted
prior to massage application:
a. Client Assessment. The therapist shall interview the client in

order to understand his/her therapeutic needs and requests.
This includes the identification of contraindications, taking
the client’s vital signs, and formulating a massage plan. This
assessment shall be recorded in written S.O.A.P. format. This
will be discussed elaborately in the assessment and
documentation topic later.
b. Preparation. The therapist prepares the venue and
paraphernalia for massage while the client prepares
him/herself for the massage proper.
2. Massage Proper – This is the application of massage

techniques, in accordance with the previously formulated
massage plan either in a wellness massage or therapeutic
massage.
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The Five (5) Basic Massage Strokes, Its Variations and Sub-variations
STROKE RATIONALE BENEFITS
1. EFFLEURAGE
 Used to introduce touch  Warm bodily tissues,
Other term: and for applying lubricant making them more
- Gliding extensible
 Used for assessing and
- unbroken exploring surface and  Relaxes the client
gliding underlying tissues and prepares the
movements area for deeper
repeated  Used to begin and end a strokes
following the massage to move blood
contour of the and lymph  Soothes an area
body using: after deep work
a. palm  Used to prepare tissue for
b. knuckles deeper massage and flush  Addresses places
c. fingertips out tissues after using too painful for deep,
d. forearms other stokes specific work
 Used on almost every  Calm the nervous

type of body surface, system when done
hence a preferred slowly
transition stroke to use
between other strokes  Stimulate the
nervous system
 Delivered using a lean- when done quickly
and-drag technique
 Relieve insomnia
 When working on
extremities, first work
area most proximal, then
to distal, stroking in the
heart direction
Page 146 of 209

2. PETRISSAGE
Other term:  Stroke of choice to  Working out

- Kneading milk the tissue of metabolic waste
metabolic waste and
- Cycle of rhythmic draw new blood and  Reducing local
lifting, squeezing, and oxygen into the swelling
releasing of tissue tissues
 Improving cellular
 The hand is in a C nutrition
formation.
 Mechanically
 It lifts up the skin and lengthen the muscle
Page 147 of 209

the underlying
muscle tissue and  Addressing the
firmly knead, wring, tension under the
or squeeze. surface
 Lifting, compressing  Reducing muscle

and releasing of soreness and
muscle tissue can stiffness
done in one or both
hands intermittently  Softening superficial
fascia
 The focus is on lifting
the tissue and
moving it vertically or
horizontally rather
than just pinching it.
 The pressure should

be applied in a
rhythmic circular
pattern to achieve
alternate
compression and
relaxation of the
muscle.

3. FRICTION
 Often used for areas  Generating heat

Other term:
that have little or no
- Rubbing
blood supply, such as  Loosening stiffness
Page 148 of 209

- compressing tissues ligaments and in joints
in several directions; tendons
 Improving the
- sliding hands, palm,  Deep friction is well glandular action of
finger, knuckles back suited for areas that the skin
and forth over skin or lack muscle bulk such
deeper tissue layers. as the ankle, the  Promoting proper
sides of the head, or scar formation
- usually dry, with the sub-occipital
little or without oil. regions  Breaking down and
freeing adhesions
 Applied either by
pressing down or  Softening
around an area or hyperplasia
with circular or linear
reciprocating  Reducing trigger and
movements tender point
formation

4. TAPOTEMENT
 Has a pleasant stimulating effect  Stimulate
nerve endings
Other term:  Used by respiratory therapist initially,
-Percussion and nurses to loosen phlegm becoming
congestion in the lungs more sedative
-Repetitive if continued
staccato striking  The style of percussion depends
Page 149 of 209

movements of on the location where it is  Aid in
hands, employed and the desired effect decongesting
simultaneously the lungs
 Muscular areas such as the leg
or alternately
and hips may absorb more force  Tone
using:
in the delivery and thin tissue or atrophied
a. ulnar surface delicate areas such as the face muscles
of hand require a smaller lighter tap increase local
b. fingertips blood flows
c. open palm  Avoid application immediately
d. cupped palm after exercise because this  Access deeper
e.loosely closed stroke can activate muscle structure such
fist spindles and stimulate cramping as hip
rotators
 Heavy strokes over the kidneys
in the low back area is not  Create an
advised ultrasound
effect
 May be applied directly to the manually
skin or through the drape
 Desensitize a
 Begin with light pressure and hypersensitiv
moderate strike speed gradually e area
increase speed and finally
diminish speed and depth
 Delivered rhythmically allowing

hands to spring back after
contact
 Percussion delivered with too

much force can bruise a client
Page 150 of 209

5. VIBRATION
Other Term:  Done properly you will be  Stimulates

able to observe the tissue muscle spindles
- Shaking
moving near the area on
contact  Relieves upper
- Rapid shaking,
respiratory tract
quivering,
 The client should feel the congestion
trembling, or
onset and removal of
rocking movements
pressure  Stimulate
applied with
peristalsis of
fingertips or full
 Performing vibration the large
hand.
correctly requires intestine
coordination and practice
 Moves gas in
 Is the most physically the lower GIT
demanding massage stroke
 Stimulate
 Avoid imposing unnatural synovial fluid
rhythm production in
joints
 Accesses
deeper
structures as
hip rotators
 Reduces trigger
and tender
point activity
Page 151 of 209

3. Post-massage – This consists of two main activities conducted
after the massage application:
a. Aftercare. Means providing assistance to the client after the

massage proper.
b. Documentation. Final completion of the S.O.A.P. form, to

include the evaluation of the massage, client response, and
the therapist’s recommendations for future sessions.
C. ASSESSMENT and DOCUMENTATION
1. Assessment.
In the world of medicine, there is a saying that states

“treatment should never be administered without a diagnosis”.
Similarly, clinical or therapeutic massage should never be done
unless an accurate assessment has first been made. An
assessment informs the therapist about the physical integrity of
the tissues of the client’s body that are to be treated, and points
the therapist toward the appropriate treatment tools to facilitate
the healing of the condition.
Assessment for massage therapy encompasses all the

evaluation skills that a massage therapist should learn and
enhance. The massage therapist, being a member of the health
team, must be familiar with the language used by other
professionals in their assessment of the client.
The following are basic assessments that every massage

therapist must know and understand. They must have the skills
to use these evaluation tools to be able to give the right massage
plan for every massage session.
Page 152 of 209

a. VITAL SIGNS
Purpose:
1. To observe the general condition of the client.
2. To serve as a guide in meeting the needs of the client.
3. To aid the massage therapist in planning the client’s therapy
program.
4. To prevent possible injury and complication to the client.
Types:
1. Blood Pressure
2. Pulse Rate
3. Respiratory Rate
4. Temperature
General Considerations:
a. Before vital signs are taken, be sure that the client has
rested and is placed on a comfortable position.
b. Explain the procedure to the client so that he/she will feel at

ease.
c. The frequency of taking the vital signs depends upon the

condition of the client and the massage management policy.
d. Stop the activity/program promptly for any significant

change in the vital signs.
Page 153 of 209

SUMMARIZED TABULATION
BLOOD PRESSURE, PULSE RATE, RESPIRATORY RATE AND
TEMPERATURE
Blood Respiratory
Dimension Pulse Rate Temperature
Pressure Rate
Normal 120/80 60 – 100
15 – 20 cpm 37.5 ° C
Value mmhg bpm
Definition pressure of number of number of level of heat

blood pulsations movements natural to a
against the noted in a of the chest living human
walls of peripheral wall per unit being
any blood artery per of time,
vessel unit of time indicative of
inhalation
and
exhalation
Dimensio Blood Respiratory

Pulse Rate Temperature
n Pressure Rate
Purpose 1. measure 1. count the 1. To obtain 1. To obtain

systolic, number of respirator body
diastolic times that y rate per temperatur
and pulse the heart minute. e
pressure. beats per
minute. 2. To obtain
2. obtain an an
2. evaluate informatio informatio
general 2. obtain n of the n of the
condition informatio patient’s client’s
of the n respirator temperatur
patient. regarding y status e and
Page 154 of 209

the and general
hearts’ general condition.
action and condition.
client’s
general
condition .
Special 1. Keep the 1. Remembe 1. Note the 1. When

concerns client r that one rate, using the
physically pulse depth and axillary
and movemen character method,
emotional t, or one of see to it
ly rested complete respiratio that the
before rise and n. axilla is dry
taking the fall of the and the
blood arterial bulb of the
pressure. wall is thermo-
considere meter is
d as one within the
beat or hollow of
count. the axilla.

n Pressure Rate
Special 2. See to it 2. Be sure 2. While

concerns that the that both counting,
client is client and observe
comfortab therapist the client
ly are in a closely
positione comfort- for any
d, sitting able sign of
Page 155 of 209

or position. abnormal
recumben -lity (like
t, with the color,
3. When
arm chest
taking the
abducted movemen
pulse, note
a little t, etc.)
the rate,
and rhythm,
supported volume 3. Ensure
in such a and that the
way that quality. client is
the artery not
is at heart aware
level. 4. Do not
that his /
take pulse
her
when the
3. For respiratio
client is
required n is being
restless or
repeated counted.
when a
readings, child is
take the crying.
blood
pressure
in the 5. If
same arm, peripheral
in the pulse is
same difficult to
position obtain,
and at the take the
same time apical or
of the cardiac
day. rate.
Page 156 of 209

n Pressure Rate
Special 4. Take the

concerns blood
pressure
reading as
quickly as
possible
to prevent
congestio
n and
discomfor
t.
5. See to it
that the
size of the
cuff is
appropria
te to the
diameter
of the
limb on
which it is
used.
6. Allow 20 –
30
seconds
for
circulation
to
stabilize if
Page 157 of 209

repeated
reading is
necessary.

n Pressure Rate
Special 7. Stop the

concerns activity /
program if
there is
significant
change in
the blood
pressure
reading.
b. VISUAL ASSSESSMENT
Purpose:
1. To provide information regarding the conditions of the soft
tissues for any variations of skin coloration.
2. To observe the differences in bilateral symmetry of tissues.
3. To check for any kind of marks or wounds on the skin.
Page 158 of 209

c. PALPATION (Pagkapa)
Purpose:
1. To locate the target muscle that is being palpated.
2. To assess its health by feeling for its tone and texture.
e.g.
 Is it tight or loose?
 Is it inflamed or tender to touch?
 Are there trigger points located within it?
 Are fascial adhesions present?
d. SENSORY ASSESSMENT
Purpose:
1. To provide information regarding the conditions of client on
pain tolerance.
2. To assess the clients’ pain through a pain scale.
e.g.
 When does the pain occur?
 What type of pain is experienced (local or referring)?
 What is the level of intensity?
 What aggravates / relieves the pain?
ACUTE vs CHRONIC PAIN

DESCRIPTION ACUTE CHRONIC
Cause Normal response to Often unknown or
injury or medical unrelated to medical
condition findings
Signal of tissue Pain is often not a

damage or underlying signal of harm
medical condition
Duration Short term Last longer than three
Page 159 of 209

months
Pain Reduces as body heals Often continues even
after healing
Treatment Often responds to Minimal or no
traditional medical response to traditional
treatment medical treatment
Quality of Life Does not affect long Often interferes with
term quality of life quality of life including
sleep, work,
recreational activities
May or may not affect Often accompanied by

mood depression, anger and
depression
e. RANGE OF MOTION (ROM)
Purpose:
1. To help maintain clients’ awareness of movement
2. To decrease or inhibit pain.
3. To determine the joints affected.
Types:
1. Active Range of Motion (AROM) – Limb is actively moved ;
WITH MUSCLE CONTRACTION
2. Passive Range of Motion (PROM) – limb is passively moved;
NO MUSCLE CONTRACTION
Page 160 of 209

MOVEMENTS
Spinal Column
The vertebral column has the following normal ranges of movement:

Flexion, Extension, Lateral Flexion and Rotation.
Flexion Extension
Lateral Flexion
Rotation
Shoulder Girdle
The shoulder girdle has the following normal ranges of movement:

Elevation, Depression, Adduction and Abduction.
Page 161 of 209

Shoulder Joint
The shoulder joint has the following normal ranges of movement:

Flexion, Extension, Adduction, Abduction and Medial Rotation.
Page 162 of 209

Elbow Joint
The elbow joint has the following normal ranges of movement: Flexion,
Extension, Pronation and Supination.
Page 163 of 209

Wrist Joint
The wrist joint has the following normal ranges of movement: Flexion,
Extension, Adduction, Abduction and Circumduction.
Page 164 of 209

Hip Joint
The hip joint has the following normal ranges of movement: Flexion,
Extension, Adduction, Abduction Medial Rotation and Lateral Rotation.
Knee Joint
The knee joint has the following normal ranges of movement: Flexion
and Extension.
Page 165 of 209

Ankle Joint
The ankle joint has the following normal ranges of movement: Plantar
Flexion, Dorsi Flexion, Inversion and Eversion.
 Flexion – Movement that bends a joint so that the angle between

two body parts is decreased and parts come close together.
 Extension – Is the opposite of flexion. Extension causes the parts

at the joint to straighten out or open so that the angle between
the body parts is increased and the parts move farther apart.
 Hyperextension – It is the movement beyond the movement of

extension.
 Abduction – It is the opposite of adduction and moves a body part

away from the midline of the body or midline of the hand or foot
along the coronal plane.
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 Adduction – A joint brings a body part closer to the midline of the
body or the midline of the hand or foot in the case of fingers or
toes.
 Rotation – The turning movement of a bone around its own long

axis and involves movement in the transverse plane. Turning your
head is an example of simple rotation.
 Pronation – Turning the hand so that the palm faces down
 Supination – Involves turning the hand so that the palms faces

upward and is in a supine (face up) position
 Circumduction – The movement of a body part so that its end

follows a circular path. It is a combination of extension, adduction,
flexion and abduction and occurs in the shoulder and hip joints
and in the thumb, knuckles and wrist.
 Plantar flexion – It is the movement at the ankle joint that occurs

when the toe is pointed.
 Dorsiflexion – It involves upward flexing of the foot at the ankle.
 Inversion – This occurs when the foot moves medially so the sole
faces inward or if the foot is positioned so toes turn in.
 Eversion – It involves turning foot laterally so the sole faces away

from the body or if the foot is positioned with toes splayed out.
 Elevation It is a movement superiorly or upward along the coronal

plane
 Depression – It refers to the movement inferiorly or downward.
Page 167 of 209

2. Documentation.
Within the healthcare community, documentation is used to

create and maintain a patient’s record and develop initial and
session-to-session treatment plans as well as for communication
between healthcare professionals. Documentation is a guideline
for safe and effective treatment and proof of the client’s progress.
Currently in massage field, documentation is becoming more

common. As massage continues to develop as a healthcare
profession and governmental licensure becomes prevalent, the
need to learn documentation becomes more critical because
licensed healthcare practitioners are legally required to document
client progress. There are therapists who do not keep accurate
records of client progress because they consider it unnecessary at
the time, think it takes too much time, or do not want to bother
clients with paper work and interviews. Realistically, most clients
are not interested in filling out forms or sitting through an
interview. Most of them just want to get on the massage table,
receive treatment and go home.
Purpose:
– Preserves basic patient information
– Records changes in patient condition
– Justifies treatment
– Allows continuity of care
– Satisfies regulatory requirements
– Provides data for quality control
Characteristics of Good Medical Record

a. Accurate
b. Complete
c. Legible
Page 168 of 209

Types of Documentation Forms Used in the Practice of Massage
a. Client Intake Form – used in initial massage session which

includes clients’ name, gender, date of birth, session date
to name a few.
b. SOAP form – an acronym for Subjective, Objective,

Assessment and Plan. It is a method of documentation
used by massage therapists to write out notes in a clients’
chart.
c. Pain Assessment Form – a pain scales and checklist useful

for clinical assessment on clients’ feeling on pain and for
monitoring on the effectiveness of treatments at different
points in time.
d. Range of Motion Assessment Form - a form used with the

purpose of evaluating if joint movements are within its
normal range
e. Massage Wellness / Therapeutic Summary Form – a

summary form of the massage session per session details
since the initial appointment until the purpose has been
achieved. The details on every session will guide the
massage therapist on the effectiveness of the treatment
done as requested by the client.
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Name : Date :
Topic : Score :
Guideline Questions
Identification
1. Identify the 10 Basic Terminologies

a. ________________
b. ________________
c. ________________
d. ________________
e. ________________
f. ________________
g. ________________
h. ________________
i. ________________
j. ________________
2. Identify the 3 Phases of Massage Therapy

1. ___________________
2. ___________________
3. ___________________
3. Identify the 5 Basic massage Strokes

1. ___________________
2. ___________________
3. ___________________
4. ___________________
5. ___________________
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4. Identify the 4 Purpose of Vital Signs
1. ______________________________________
2. ______________________________________
3. ______________________________________
4. ______________________________________
5. Identify the 4 Types of Vital Signs

1. ___________________
2. ___________________
3. ___________________
4. ___________________
6. Identify the 4 General Considerations in Taking Vital Signs

1. ______________________________________
2. ______________________________________
3. ______________________________________
4. ______________________________________
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Module 5
MASSAGE THERAPY III
Practice of Massage Therapy
Student Objectives:
1. Explain the Code of Ethics for Massage Therapists.
2. Discuss the legal mandate of massage therapy practice.
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MASSAGE THERAPY III
PRACTICE OF MASSAGE THERAPY
Ethics and professionalism are the cornerstones for a successful

massage practice. The massage therapy profession follows a set of
guiding principles based on right and wrong, commonly referred to as
ethics. They provide guidelines for appropriate and safe decisions and
behaviors. The fundamental ethical principle for massage therapy is
client – centered care, which focuses on the attitudes, decisions and
activities on whatever is best for the client’s health and well being.
Client – centered care is the key component that determines a massage
therapists professionalism, which is the combined qualities of integrity,
competency, effective communication and interpersonal skills,
respectful behavior, and good business practices. Ethics and
professionalism are closely intertwined and often times inseparable as
they reinforce and support each other.
The relationships you develop as a professional can be complicated

and rewarding, but ethics and professionalism can provide guidance.
Combining ethics and integrity with professionalism establishes a
foundation for developing yourself as an effective, successful,
professional massage therapist.
A. CODE OF ETHICS FOR MASSAGE THERAPISTS
PREAMBLE/Pambungad
Massage Therapists are duly licensed professionals who possess,

maintain and uphold at all times the dignity, integrity and reputation of
the profession, with high moral values as well as technical skills and
professional competence. They strictly adhere to scientific principles,
professional standards and moral values. The principles embodied in
this Code of Ethics aim to help massage practitioners, individually and
collectively, to pursue and maintain the high level of ethical conduct
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demanded by the practice of Massage Therapy. The provisions of this
Code shall govern the Massage Therapist’s relationship with clients, co-
practitioners, employers, members of allied professions and the public
in general.
GENERAL RESPONSIBILITIES
The services rendered by Massage Therapists are universal and

unrestricted by considerations of nationality, race, creed, color, politics,
or social status. The professional relationship of Massage Therapists
towards various industry stakeholders shall be characterized as follows:
DUTIES TOWARD THE CLIENT – The client's health and wellbeing are the
paramount concern of the Massage Therapist.
DUTIES TOWARD THE PROFESSION – The Massage Therapist shall strive

for excellence and advance the moral reputation of the profession
by conducting himself/herself with honor and integrity.
DUTIES TOWARD CO-PRACTITIONERS – The Massage Therapist shall

foster fellowship, mutual assistance, and professional respect
among co-practitioners.
DUTIES TOWARD EMPLOYERS – The Massage Therapist shall be fair,

honest, and loyal in dealings with employers.
DUTIES TOWARD ALLIED PROFESSIONALS – The Massage Therapist shall

respect the dignity, competence, and the scope of services of allied
professionals, working harmoniously with them for the good of the
community.
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DUTIES TOWARD THE GENERAL PUBLIC – The Massage Therapist shall
obey the laws of the land and all laws governing the practice of the
profession, as enforced by the duly constituted authority.
DUTIES TOWARD THE CLIENT
1. A Massage Therapist shall attend to clients faithfully and

conscientiously, securing for each one the benefits obtained from
professional skill and care, without imposing terms and conditions
which would diminish the quality of client care.
2. A Massage Therapist shall practice in a scientific manner.
3. A Massage Therapist shall desist from the performance of any

procedure which is of doubtful scientific basis or of questionable
moral propriety.
4. A Massage Therapist shall observe professional secrecy and

delicadeza in all private and confidential matters personal to the
client, including ideals, beliefs, values, customs and the like, except in
the interest of justice, public health or public safety;
5. A Massage Therapist shall document, monitor, and regularly evaluate

the client’s condition. Any unusual occurrences pertinent to
therapeutic massage must be addressed scientifically and promptly.
6. A Massage Therapist shall motivate clients to pursue holistic

wellness.
DUTIES TO THE PROFESSION
1. A Massage Therapist shall uphold the dignity and integrity of the

profession.
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2. A Massage Therapist should be known for excellence and compassion
in the delivery of scientific, compassionate and respectful touch.
3. A Massage Therapist shall not directly or indirectly participate in any

immoral or illegal practices, and shall report to the proper authorities
any colleague or stakeholder who engages in such practices.
4. A Massage Therapist shall foster a broader cultural outlook and an

ever increasing interest in research and innovations that would
contribute to the growth and advancement of the profession.
DUTIES TO OTHER MASSAGE THERAPISTS
1. A Massage Therapist shall strive to acquire greater knowledge and

skills and, with fairness, share these with fellow Massage Therapists
for the growth and recognition of the profession.
2. A Massage Therapist shall observe utmost caution, tact and prudence

in appraising the professional conduct of fellow Massage Therapists,
taking care to make no public remarks, except in the interest of
justice, public health or public safety that may ruin the professional
standing of their colleagues.
3. A Massage Therapist shall not take charge of a client already under

the service of another Massage Therapist, nor advise the same
exchange to client’s acquaintances, except in cases of emergency, or
unless the attending Massage Therapist has yielded and endorsed the
client.
4. A Massage Therapist shall actively participate in the process of self-

regulation and be open to internal assessment and external scrutiny
of all aspects of their professional performance, as well as
remediation and discipline for failing to meet professional standards.
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5. Charges of malpractice, professional conflicts, or significant
differences of professional opinion among Massage Therapists shall
be referred to the Center for Health Development (CHD) Human
Resource Development Unit (HRDU) concerned or the Committee of
Examiners for Massage Therapy (CEMT).
6. A Massage Therapist shall actively collaborate with Massage Therapy

associations for the promotion of Licensure and the professional
development of massage practitioners.
DUTIES TO EMPLOYERS
1. A Massage Therapist shall not enter into any agreement with any
institution or enterprise of suspicious or ill repute, or which is in any
manner involved in illegal activities, or whose terms of agreement
violate any provision in this Code.
2. A Massage Therapist employed under a duly registered training
institution or wellness enterprise shall faithfully and wholeheartedly
abide by all legal agreements entered into therewith.
3. A Massage Therapist who is employed as a Training Provider shall

engage in continuing research on the art and science of massage, and
apply methods of effective teaching, in accordance with the
standards set by the Department of Health and the accredited
Training Institution.
4. A Massage Therapist shall avoid any conflicts of interest, and shall not
engage in any activity that competes with or in any way jeopardizes
the legitimate goals of the wellness enterprise or Training Institution
which the Therapist is bound by mutual agreement to serve.
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DUTIES TOWARD OTHER ALLIED PROFESSIONS
1. A Massage Therapist shall acknowledge and respect all other ethical

health care providers and work towards working harmoniously and
professionally with them in promoting health and wellness.
2. A Massage Therapist shall in no way encroach upon the

competencies and titles specific to allied health care professions and
shall not perform procedures beyond the scope of Massage Therapy
as regulated by the Department of Health.
3. A Massage Therapist shall refer clients to appropriate allied health

care professionals, in matters beyond the expertise of Massage
Therapy.
DUTIES TO THE PUBLIC
1. A Massage Therapist shall cooperate with the proper authorities in

the promotion of health in the community.
2. A Massage Therapist shall render community services, in

collaboration with the local authorities.
3. A Massage Therapist shall inform the public that Licensed Massage
Therapy is a noble profession, with its own dignity and role in the
delivery of Public Health, together with allied health professions.
4. A Massage Therapist shall promote Massage Therapy in mass media

and public affairs.
EFFECTIVITY
This Code of Ethics for Massage Therapists shall be disseminated

through the accredited Training Institutions and associations of massage
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therapists after approval hereof by the Department of Health,
Committee of Examiners for Massage Therapy (DOH-CEMT) and shall
take effect immediately.
Done in the City of Manila, this July 2010
Approved as per
CEMT Resolution No. 2010-001.
B. LEGAL MANDATE OF MASSAGE THERAPY PRACTICE
To uphold and safeguard the massage therapy profession, it is very

important to have guidelines. Presidential Decree No. 856 (P.D. 856)
“Code on Sanitation of the Philippines”, specifically Chapter XIII entitled
“Implementing Rules and Regulations governing Massage clinics & sauna
bath establishments” has been amended to upgrade the profession, as
well as respond to the illegal & unethical issues in the practice of
massage.
Presidential Decree No. 856
1. CHAPTER XIII - MASSAGE CLINICS AND SAUNA BATH

ESTABLISHMENTS
Section 59. Definition of Terms As used in this Chapter the following

shall mean:
(a) Massage. A method wherein the superficial soft parts of the

body are rubbed or stroked or kneaded for remedial or aesthetic
or hygienic purposes.
(b) Massage Clinic. An establishment where massage is

administered to customers.
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(c) Masseur. A trained person duly licensed by the Secretary or
his authorized representative to perform massage and to
supervise massage clinic attendants.
(d) Massage Clinic Attendant. A trained person duly permitted

by the Secretary or his authorized representative to massage
customers under the guidance and supervision of a masseur.
(e) Sauna Bath Establishment. An establishment where

customers are exposed to steam which is generated by sprinkling
water on hot stones or by some other means.
(f) Sauna Bath Attendant. A person who applies the proper

technique of giving steam bath to customers.
Section 60. Sanitary Permit No person or entity shall operate a massage

clinic and/or a sauna bath establishment without first securing a sanitary
permit from the local health authority.
Section 61. Sanitary Requirements The following requirements shall be

enforced:
(a) Massage Clinic
1. The reception and office rooms shall be properly

lighted and ventilated.
2. Every massage room shall be adequately ventilated,

provided with a sliding curtain at the entrance and
equipped with a suitable and clean massage table.
3. Sanitary and adequate handwashing, bath and toilet

facilities shall be available.
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4. Customers shall be provided with soap, clean towels,
sanitized rubber or plastic slippers. They shall be required
to take a thorough bath before massage.
5. Masseur and masseur attendant shall wash their hands

with soap and water before and after massaging a
customer.
6. The establishment and its premises shall be maintained

clean and sanitary at all times.
(b) Sauna Bath Establishment
1. The reception and office rooms shall be properly

lighted and adequately ventilated.
2. The sauna bath room shall be properly lighted,

provided with thermometers, and maintained clean and
sanitary at all times.
3. Sanitary and adequate handwashing, bath and toilet

facilities shall be available.
4. Customers shall be provided with soap, clean towels

and sanitized rubber or plastic slippers.
Section 62. Personnel The following requirements shall be enforced:
(a) Masseur
1. The person must have a certificate as a registered

masseur, issued by the Committee on Examiners for
Masseur of the Department.
2. He must possess an up-to-date health certificate issued

by the local health authority.
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3. The person shall wear a clean working garment when
attending to customers or when supervising massage
clinic attendants.
(b) Massage Clinic Attendant
1. The person shall be properly registered and authorized

by the local health authority to work as massage clinic
attendant after compliance with the following
requirements:
a) The Satisfactory completion of a training course

or study given by a government office, school or
hospital, which is duly authorized and recognized
by the Department; and
b) Up-to-date health certificate issued by the local

health authority to include VD clearance secured
from any government clinic or hospital.
2. Person must clean working garments when attending

to customers.
(c) Sauna Bath Attendant
1. Attendant must possess an up-to-date health

certificate issued by the local health authority.
2. The person must wear clean working garments when

attending to customers.
2. ADMINISTRATIVE ORDER NO. 2010 – 0034 : REVISED

IMPLEMENTING RULES AND REGULATIONS GOVERNING MASSAGE
CLINICS AND SAUNA ESTABLISHMENTS
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RATIONALE
Traditional medicine throughout the world recognizes the

significance of therapeutic massage in managing stress, illnesses or
chronic ailments. Massage therapy is considered the oldest method
of healing that applies various techniques like fixed or movable
pressure, holding, vibration, rocking, friction, kneading and
compression using primarily the hands and other areas of the body
such as the forearms, elbows or feet to the muscular structure and
soft tissues of the body.
Massage therapy can lead to significant biochemical, physical,

behavioral and clinical changes in massage as well as the person
giving the massage. It contributes to a higher sense of general well-
being. Recognizing this, many healthcare professionals have begun
to incorporate massage therapy as a complement to their routine
clinical care. Efficacy of massage therapy in patient ranges from
preterm neonates to senior citizens.
To effectively carry out the provisions of Section XIII of PD 856 –

“Massage Clinics and Sauna Bath Establishments”, the Department of
Health created the Committee of Examiners for Massage Therapy
(CEMT) to regulate the practice of massage therapy, hence, ensure
that only qualified individuals enter the regulated profession and that
the care and services which the massage therapists provide are
within the standards of practice.
The revision of the implementing rules and regulations will

further adopt current trends and modern practices of massage; it will
prepare massage therapists of becoming more competent and
globally competitive. At the same time, it will help improve the
quality of health service, as well as in the performance of massage
therapists.
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OBJECTIVES
General: To set sanitation standards to governing facilities providing

massage services
Specific:
1. Upgrade the quality of health services being accorded to the
public;
2. Delineate the scope of functions of massage therapists and
offices responsible in the management of the practice;
3. Recognize the specific offices responsible relative to the
management of facilities providing massage services; and
4. Instill the essence of compassionate service to the
public/clients.
SCOPE
These implementing rules and regulations shall apply to all
facilities providing massage services, and the practitioners.
DEFINITION OF TERMS
To provide the implementers / stakeholders a common frame of

reference in the interpretation of the guidelines, the following terms
are herein defined as used in this Order:
1. Accreditation – This refers to the act of recognition or a method

of determining that an eligible organization, institution,
individual or program complies with the approved standards.
2. Assessor – This refers to a person expert to the industry of

massage, appointed by the chairman of the Committee of
Examiners for Massage Therapy (CEMT) to conduct practical
assessment to the candidates undergoing DOH massage therapy
oral and practical licensure examination.
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3. Certificate of Registration – This refers to a written
commendation issued by the DOH-CEMT authorizing a person to
practice massage therapy as a profession.
4. Committee – This refers to the Department of Health Committee

of Examiners for Massage Therapy (CEMT).
5. Continuing Massage Therapy Education (CMTE) - This refers to

the acquisition of knowledge, skills, ethical and moral values
after the initial registration of a massage therapist, which
improves and enhances his / her technical competence in
massage therapy
6. Health Certificate – This refers to a written commendation

issued by the city or municipal health officer to persons providing
massage services after passing the required physical and medical
examinations to include and having been administered the
required immunizations:
6.1 X-Ray/Fluoroscopic examination
6.2 Stool and other examination required
7. Licensed Massage Therapist – This refers to a trained person

who passed the licensure examination for massage therapists.
He / She is a holder of a valid Certificate of Registration (COR)
and license for massage therapists issued by the Department of
Health (DOH) Committee of Examiners for Massage Therapy
(CEMT).
8. Massage Therapy - This refers to a system of assessment,

evaluation and manual application techniques used in a scientific
manner taking into account the muscle locations, stress points
and other anatomical considerations of the human body. It
includes adjunctive external application of water, heat and cold,
stretching, passive and active joint movement within the normal
physiologic range of motion as a means of promoting pain relief,
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injury rehabilitation or health improvement in a safe, non-sexual
environment that respects the client’s self-determined outcome
for the session.
I. GENERAL GUIDELINES
Article 1
Organization, Structure and Functions
SECTION 1 COMMITTEE OF EXAMINERS FOR MASSAGE THERAPY

(CEMT)
1.1. Membership
1.1.1 There shall be a Committee of Examiners for Massage

Therapy, hereinafter referred to as the “Committee”, created
by the Department of Health, through a Department Personnel
Order which shall be directly under the Secretary of Health.
The “Committee” shall be composed of a chairperson, vice-
chairperson and members coming from the following offices /
organizations and shall hold office for three (3) years or until
their successors shall have been appointed and duly qualified
without prejudice to reappointment for another term.
 Health Human Resource Development Bureau –

Chairperson
 Environmental Health Office – Vice-Chairperson
 Sanitary engineer – Member
 Medical Practitioner – Member
 Physical Therapist – Member
 Legal officer – Member
 Massage Therapists – Members / Assessors / Facilitators
(active members of an organization of massage
therapists)
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1.1.2 The Health Human Resource Development Bureau (HHRDB)
shall serve as the Committee Secretariat.
1.2 Powers, Duties and Functions of the Committee
1.2.1 To announce, schedule and hold examinations for massage

therapists; to approve or disapprove applications for
examination and to perform all other duties pertinent and
related thereto;
1.2.2 To issue licenses to massage therapists who have satisfactorily

passed the licensure examination and have complied with the
requirements prescribed by law; to deny the issuance of
license to any candidate and / or to cancel the license issued to
any holder of certificate upon conviction of any criminal
offence involving moral turpitude, or has been declared to be
of unsound mind or physically unfit, or who has been found
violating existing laws, rules and regulations as the case maybe;
1.2.3 To issue certified true copies of lost or damaged licenses for

massage therapists;
1.2.4 To conduct investigations all sworn complaints against

licensed massage therapists and to submit its findings and
recommendations to the Secretary of Health for appropriate
action;
1.2.5 To accredit institutions, associations or trainers conducting

training programs and review courses for massage therapists;
1.2.6 To establish criteria for the accreditation of institutions,

associations or trainers who shall train the massage
therapists;
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1.2.7 It shall be the duty of the Department of Health (DOH)
Committee of Examiners for Massage Therapy (CEMT) to
cause the monitoring of massage therapists of massage
establishment at least twice a year or as may be deemed
necessary for the enforcement of the rules and regulations as
applied to massage therapists.
1.2.9 To perform other functions necessary to regulate, standardize,

professionalize and uplift the practice of massage.
1.2.10 To perform such other related duties assigned by the

Secretary of Health to implement pertinent provisions of the
Code on Sanitation of the Philippines and these implementing
rules and regulations.
1.3 Allowance
The Chairperson, Vice-Chairperson and Members of the

Committee shall receive a monthly allowance during their term of
office. Likewise, they are allowed to receive honorarium as resource
speakers/persons under Administrative Order No. 93 s.2003 dated
September 23, 2003.
SECTION 2 CONTINUING MASSAGE THERAPY EDUCATION COUNCIL

(CMTEC)
2.1 Composition
2.1.1 In accordance to the provisions of Administrative Order No.

2008-0031, the DOH Committee of Examiners for Massage
Therapy (CEMT) hereby creates the three-member
composition of the Continuing Massage Therapy Education
Council (CMTEC)
2.1.2 The CMTE Council shall be composed of a chairperson and

two (2) members and will be assisted by the CEMT
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Secretariat. The chairperson shall be designated amongst
the members of the CEMT. The first member shall be
chosen from amongst the members of the DOH accredited
training institutions for massage therapists by the members
themselves. The second member shall be chosen from
among the licensed massage therapists (active organization
with the most number of massage therapist members) who
are in active practice with valid certificate of registration and
updated license and chosen among the members
themselves.
2.2 Powers, Duties and Functions
2.2.1 Accept, evaluate and approve applications for accreditation

of CMTE programs, activities or sources as to their relevance
to the profession; and determine the number of CMTE
credit units to be earned on the basis of the contents of the
program, activity or source submitted by the CMTE
providers;
2.2.2 Determine the appropriateness of the training fee vis-à-vis

the training course / programs, activities and sources to be
offered;
2.2.3 Monitor the implementation of CMTE programs, activities or

sources;
2.2.4 Assess periodically and upgrade criteria for CMTE programs,

activities or sources; and
2.2.5 Perform such other related functions that may be incidental

to the implementation of the CMTE programs, activities or
sources.
2.3 Honoraria
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The Chairperson and two Members of the Council shall
receive the same compensation / honorarium as resource
speakers/persons under Administrative Order No. 93 s.2003 dated
September 23, 2003.
Article 2
Examination, Registration and Practice
SECTION 3 Examination
3.1 Date of Examination
Examination for massage therapists shall be conducted any

day of the first week of June and December of every year. In
exceptional cases, the committee may give examination on other
dates outside the prescribed ones as may deemed necessary.
3.2 Place of Examination
3.2.1 The examination for massage therapists shall be conducted at

the Department of Health, Manila, or
3.2.2 At any Department of Health regional health offices as

determined by the committee upon the recommendation of
the regional director.
3.3 Qualifications of Applicants
3.3.1 Applicants for the licensure examination must posses the

following qualifications:
a. He/she must be a Filipino citizen, at least eighteen (18)

years old at the time of the examination;
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b. He/she must be of good moral character certified by the
Barangay Captain of the community where the applicant
resides.
c. He/she must submit a certification or clearance from the

National Bureau of Investigation (NBI) or provincial fiscal
that he/she is not convicted by the court of any case
involving moral turpitude;
d. He/she must submit medical certificate from a government

physician that he/she is physically and mentally fit to take
the licensure examination;
e. He/she must be at least a high school graduate;
f. He/she must submit a certificate of training from any

Department of Health accredited training provider that
he/she has taken practical massage for at least sixty (60)
hours;
g. He/she must submit certificate of training from any

Department of Health accredited training institution that
he/she had received basic instructions on the following:
COURSE CODECOURSE TITLE COURSE DESCRIPTION

ANA-PHY Anatomy & Physiology General and Organ System Anatomy
PTH Pathology/Microbiology General Pathology and Microbiology
MT I Massage Therapy I Introduction to Massage Therapy
MT II Massage Therapy II Massage Therapy Application
MT III Massage Therapy III Practice of Massage Therapy
3.4 Application and Examination Fees
3.4.1 Applicants must submit to the committee secretariat the

prescribed application form duly accomplished and notarized
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and accompanied by three (3) copies of passport size
photograph taken within the last six (6) months;
3.4.2 Applicants shall pay an examination fee in the amount

prescribed by the Department of Health Committee of
Examiners for Massage Therapy; and
3.4.3 The application form and examination fee, including the

necessary documents stated, must be filed two (2) weeks
before the examination date in order for the applicant to be
included in the list of examinees.
3.5 Scope of Examination
The examination shall be conducted in two (2) parts; theoretical and

oral/practical. The theoretical examination shall be conducted in
writing and shall comprise basic questions based on the prescribed
curriculum (Article 2, Section 3.3). The oral/practical examination
shall consist of three (3) phases: (1) pre-massage phase, (2) massage
proper and (3) post-massage phase.
3.6 Passing Average
3.6.1 Only those who have passed the theoretical examination shall
qualify to take the oral/practical examination.
3.6.2 All examinees who passed the theoretical examination shall

take the oral/practical examination within one (1) month after
official advice, otherwise, the results of the theoretical
examination shall be deemed cancelled. He/she shall pay the
fee prescribed by DOH;
3.6.3 In order that an examinee maybe deemed to have passed the

examination successfully, he/she must obtain a general
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average of 75% in the theoretical examination and a general
average of 75% in the oral/practical examination.
SECTION 4 Certificate of Registration
4.1 Issuance
4.1.1 All examinees who have passed the required examination shall
be issued a certificate of registration duly signed by the
chairperson of the committee and approved by the Secretary
of Health.
4.1.2 The certificate of registration shall bear the recent picture and
signature of the successful examinee and will be valid for three
(3) years from the date of issuance. Payment of registration
and miscellaneous fees shall be paid to the Department of
Health.
4.1.3 The certificate of registration shall be posted conspicuously in

the establishment concerned.
4.2 Renewal of the Certificate of Registration
4.2.1 A massage therapist shall apply for the renewal of the

certificate of registration and miscellaneous fees for three(3)
years on his / her birth month to any regional health office;
4.2.2 The following requirements shall be presented when applying

for renewal of the certificate of registration:
a. Health certificate;
b. Current professional tax receipt;
c. Current community tax certificate;
d. Receipt as payment of registration and miscellaneous fees
for three (3) years in the amount prescribed by the
Department of Health
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e. Certificate of attendance to continuing education/training
on massage conducted by accredited
institutions/associations/trainers;
f. When all the requirements are found in order, the said
certificate shall be stamped with the notation ”VALIDITY
UNTIL _________” and the receipt number of registration
fee and the signature of the regional health director
concerned shall be affixed below.
4.2.3 The regional health director concerned shall submit the list of
renewed licenses of massage therapists to the Committee
every last quarter of the year.
4.3 Suspension or Revocation of Certificate of Registration
4.3.1 The Committee and / or the regional health office concerned

shall recommend to the Secretary of Health to reprimand
erring massage therapists by suspension or revocation of the
certificate of all those found guilty after due investigation on
any of the following grounds:
a. Conviction by a court of competent jurisdiction of any

criminal offence involving moral turpitude;
b. Insanity;
c. Fraud in the acquisition or renewal of the certificate of
registration;
d. Gross negligence, ignorance or incompetence in the
practice of his/her occupation;
e. Addiction to alcoholic drinks and prohibited drugs;
f. False or unethical advertisement and practice;
g. Physical incapacity which will impair the performance of
duty as a massage therapist;
h. Failure to revalidate the certificate of registration for at
least five (5) years; and
i. Other analogous grounds affecting the occupation.
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SECTION 5 PRACTICE OF MASSAGE
5.1 Licensed massage therapists shall practice massage in

accordance
with the following:
5.1.1 No person is authorized to practice massage as a profession in

the Philippines without holding a valid certificate of
registration issued by the Committee and approved by the
Secretary of Health;
5.1.2 It is absolutely prohibited for any qualified or practicing

massage therapist to use the “Dr. sign before , or the letters
“M.D.” after his/her name in advertising his/her profession in
the newspapers, cards, signboards or any other means of
advertisement.
5.1.3 No massage therapist shall engage in any other occupation

which may infect his/her hands and transfer the disease to
other person. In case of disease/infection, the massage
therapist shall inhibit him/herself in the practice of massage
until such time that the infection has been cured.
5.1.4 No massage therapist is allowed to prescribe any form of drugs

or medical therapy.
5.1.5 No massage therapist shall perform massage to any person by

using or applying substance or preparation of any kind
containing chemicals or materials that are detrimental to
human health and hygiene.
5.1.6 Massage therapists shall comply with the standard and

scientifically accepted procedures and techniques in
performing massage to any person.
Page 195 of 209

5.1.7 Massage therapists shall possess an annual up-to-date health
certificate secured from the Department of Health accredited
government clinic or hospital;
5.1.8 The health certificate shall be clipped visibly in the upper left
portion of the uniform worn while working;
5.1.9 The massage therapist shall wear a clean working garment

when attending to clients;
5.1.10 The massage therapist shall wash his/her hands thoroughly

with soap, water and 70% isopropyl alcohol before and after
attending to clients;
5.1.11 The massage therapist shall not be allowed to render other

services, other standard massage;
5.1.12 A licensed massage therapist shall render no more than eight

(8) hours of supervision a day.
5.2 Career Path
5.2.1 Human Resource Production, Utilization, Placement and

Development
The Committee, in coordination with the accredited training

institutions and accredited training providers, as well as the
professional organizations, is hereby mandated to formulate and
develop a comprehensive Massage Therapy Program through a
continuing massage therapy education that includes a valid
assessment of career performance and potential, thus, upgrade the
level of skills of massage therapists in the country, such as but not
limited to the areas of performing massage procedures as may be
determined by the Committee.
5.2.2 Salary and Compensation

Page 196 of 209

In order to enhance the general welfare and commitment to
service and professionalism of massage therapists, the minimum
base pay of licensed massage therapists working in massage clinics,
sauna establishments, training institutions and areas relevant to the
practice of the profession, shall not be lower than the prescribed
minimum wage by the Department of Labor and Employment
(DOLE). Provided, that for licensed massage therapist working in
small establishments, adjustments to their salaries shall be in
accordance with their number of clients per month as per
agreement between the employer and the massage therapist.
SECTION 6 FUNCTIONS / RESPONSIBILITIES OF THE REGIONAL

DIRECTOR.
6.1 The Regional Director shall;
6.1.1 Act on the renewal of the certificates of registration of

massage therapists through the Human Resource Development
Units (HRDUs);
6.1.2 Submit the list of renewed licenses of massage therapist to the

Committee every last quarter of the year;
6.1.3 Recommend to the Secretary of Health through the

Committee, the suspension or revocation of the certificate of
the erring massage therapist.
Article 3
Penal Provisions
SECTION 7. PENAL PROVISION
7.1 Any person who shall violate, disobey, refuse, omit or neglect to
comply with any of the provisions of these rules and regulations,
interfere with or hinder, or oppose any officer, agent or member of
Page 197 of 209

the Department or of the bureaus and officers under it, in the
performance of his/her duty as such under these rules and
regulations, or shall tear down, mutilate, deface or alter any placard,
or notice, affixed to the promises in the enforcement of these rules
and regulations, shall be prosecuted before the Court of Justice as
provided in Section 103 (a) and (b) of the Code of Sanitation of the
Philippines (P.D. 856).
7.2 All massage therapist and other personnel who shall violate the
provision of P.D. 856 and the IRR shall be punished by revocation or
suspension of license to practice the profession or shall be
prosecuted under Section 103 (a) and (b) of P.D. 856.
SECTION 8. SEPARABILITY CLAUSE
In the event that any rule, section, paragraph, sentence, clause

or words of these implementing rules and regulations is declared invalid
for any reason, the other provisions thereof shall not be affected
thereby.
SECTION 9. REPEALING CLAUSE
All rules and regulations which are inconsistent with the

provisions of these implementing rules and regulations are hereby
repealed or amended accordingly. As thus amended, all other provisions
in this AO still stands in effect.
SECTION 10. EFFECTIVITY
These rules and regulations shall take effect after fifteen (15)
days from date of publication in the official gazette or newspaper of
general circulation.
ENRIQUE T. ONA, MD, FPCS, FACS

Secretary of Health
Page 198 of 209

Name : Date:
Topic : Score :
Guideline Questions
Multiple Choices
1. The client’s health and wellbeing are the paramount concern of the
Massage therapist.
a. Duties Toward The Profession
b. Duties Toward The Client
c. Duties Toward The Co-Practitioners
d. Duties Toward Employers
2. The Massage Therapist shall strive for excellence and advance the
moral reputation of the profession by conducting himself/ herself
with honor and integrity.
a. Duties Toward The Client
b. Duties Toward Employers
c. Duties Toward Co-Practitioners
d. Duties Toward The Profession
3. The Massage Therapist shall obey the laws of the land and all
governing the practice of the profession, as enforced by the duly
constituted authority.
a. Duties Toward The General Public
b. Duties Toward Allied Professionals
c. Duties Toward Employers
d. Duties Toward The Client
4. The Massage Therapist shall strive for excellence and advance the
moral reputation of the profession by conducting himself/ herself
with honor and integrity.
a. Duties Toward The Profession
b. Duties toward The Client
c. Duties Toward Employers
d. Duties Toward Co- Practitioners
Page 199 of 209

5. The Massage Therapist shall foster fellowship, mutual assistance,
and professional respect among co- practitioners.
a. Duties Toward Allied Professionals
b. Duties Toward Employers
c. Duties Toward Co- Practitioners
d. Duties Toward The General Public
6. The Massage Therapist shall be fair, honest, and loyal in dealings
with employers.
a. Duties Toward Employers
b. Duties Toward The Client
c. Duties Toward The Profession
d. Duties Toward The Co- Practitioners
7. A method wherein the superficial soft parts of the body are rubbed
or stroked or kneaded for remedial or aesthetic or hygienic
purposes.
a. Massage Clinic
b. Masseur
c. Massage
d. Sauna Bath Attendant
8. An establishment where massage is administered to customers.
a. Masseur
b. Massage Clinic
c. Sauna Bath Attendant
d. Sauna Bath establishment
9. A trained person duly licensed by the Secretary or his authorized
representative to perform massage and to supervise massage clinic
attendants.
a. Masseur
b. Massage
c. Sauna Bath Establishment
d. Massage Clinic
10. Sanitary Permit No person or entity shall operate a massage clinic
and/ or a sauna bath establishment without first securing a sanitary
a. Section 61
b. Section 60
Page 200 of 209

c. Section 62
d. Section 63
11. This refers to the act of recognition or a method of determining that
an eligible organization, institution, individual or program complies
with the approved standards.
a. Assessor
b. Committee
c. Accreditation
d. Health Certificate
12. This refers to a person expert to the industry of massage, appointed
by the chairman of the Committee of Examiners for Massage
Therapy to conduct practical assessment to the candidates
undergoing DOH massage therapy oral and practical licensure
examination.
a. Assessor
b. Accreditation
c. Committee
d. Health Certificate
13. This refers to a written commendation issued by the DOH-CEMT
authorizing a person to practice massage therapy as a profession.
a. Accreditation
b. Assessor
c. Committee
d. Certificate of Registration
14. This refers to the Department of Health Committee of Examiners for
Massage Therapy.
a. Committee
b. Continuing Massage Therapy Education
c. Assessor
d. Licensed Massage Therapist
15. This refers to the acquisition of knowledge, skills, ethical and moral
values after the initial registration of a massage therapist, which
improves and enhances his/ her technical competence in massage
therapy.
a. Health Certificate
b. Committee
Page 201 of 209

c. Accreditation
d. Continuing Massage Therapy Education
16. This refers to a written commendation issued by the city or
municipal health officer to persons providing massage services after
passing the required physical examinations.
a. Health Certificate
b. Committee
c. Assessor
d. Massage Therapy
17. This refers to a trained person who passed the licensure examination
for massage therapists. He / She is a holder of a valid Certificate of
Registration and license for massage therapists issued by the
Department of Health.
a. Massage Therapy
b. Licensed Massage Therapist
c. Massage Therapy
d. Committee
18. This refers to a system of assessment, evaluation and manual
application techniques used in a scientific manner.
a. Licensed Massage Therapist
b. Assessor
c. Massage Therapy
d. Committee
19. Where is the place of examination?
a. DOH Regional Office
b. DTI
c. DSWD
d. GSIS
20. The certificate of registration is valid for how many years?
a. 2
b. 3
c. 4
d. 6
21. The Fundamental ethical principle for massage therapy is ________.
a. Professionalism
b. Client-centered care
Page 202 of 209

c. Ethics
d. Behavior
22. Client-centered care is the key component that determines a
massage therapist’s _________.
a. Professionalism
b. Client-centered care
c. Behavior
d. Ethics
23. A method wherein the superficial soft parts of the body are rubbed
or stroked or kneaded for remedial or aesthetic or hygienic
purposes.
a. Massage
b. Masseur
c. Shiatsu
d. Wellness
24. An establishment where massage is administered to customers.
a. Sauna Bath establishment
b. Spa
c. Massage Clinic
d. Clinic
25. Sanitary Permit No person or entity shall operate a massage clinic
and/or a sauna bath establishment without first securing a sanitary
a. Section 60
b. Section 61
c. Section 59
d. Section 62
26. To conduct investigations all sworn complaints against licensed
massage therapists and to submit its findings and recommendations
to the Secretary of Health for appropriate action.
a. 1.2.3
Page 203 of 209

b. 1.2.4
c. 1.2.5
d. 1.2.6
27. Examination for massage therapists shall be conducted any day of
the first week of ________of every year.
a. July and November
b. January and December
c. June and December
d. February and October
28. Who shall serve as the Committee Secretariat?
a. HHRDB
b. DOH
c. PRC
d. DTI
29. The DOH Committee of Examiners for Massage Therapy hereby
creates the three-member composition of the Continuing Massage
Education Council.
30. It composed of a chairperson and two members and will be assisted
by the CEMT Secretariat.
a. CMTE Council
b. DOH
c. CEMT
d. COA
31. The Chairperson and two Members of the Council shall receive the
same compensation / honorarium as resource speakers/ persons
under Administrative No.93s. 2003 dated ________.
a. September 16, 2010
Page 204 of 209

b. September 6, 2007
c. September 23, 2003
d. September 25, 2005
32. CLAHD stands for?
a. Central Luzon Alternative Health and Development Inc.
b. Central Luzon Association for Health and Development
c. Central Luzon Alternative for Health and Disease Inc.
d. Central Luzon Association Health and Development
33. Who is the President of CLAHD?
a. Joan P. Castro
b. Gino A. Martin
c. Jevren A. Sibug
d. Jane Nunag
34. In order that an examinee maybe deemed to have passed the
examination successfully, he/she must obtain a general average of
______.
a. 85%
b. 75%
c. 90%
d. 70%
35. A massage therapist shall apply for the renewal of the certificate of
registration and miscellaneous fees for _____ years on his/ her birth
month to any regional office.
a. 4
b. 1
c. 2
d. 3
36. All massage therapist and other personnel who shall violate the
provision of P.D. 856 and the IRR shall be punished by revocation or
suspension of license to practice the profession or shall be
prosecuted under Section ______.
Page 205 of 209

a. 103 of P.D 856
b. 102 of P.D 876
c. 101 of P.D 898
d. 104 of P.D 855
37. Who is the secretary of health?
a. Per Henrik Ling
b. Enrique T. Ona
c. Kenneth B. Ronquillo
d. Josephine H. Hipolito
38. Revised Implementing Rules and Regulations Governing Massage
Clinics and Sauna Establishments.
39. In the event that any rule, section, paragraph, sentence, clause or
words of these implementing rules and regulations is declared
invalid for any reason, the other provisions thereof shall not be
affected thereby.
a. Section 7. Penal Provision
b. Section 8. Separability Clause
c. Section 9. Repealing Clause
d. Section 10. Effectivity
40. All rules and regulations which are inconsistent with the provisions
of these implementing rules and regulations are hereby repealed or
amended accordingly. As thus amended, all other provisions in this
AO still stands in effect.
a. Section 10. Effectivity
b. Section 9. Repealing Clause
c. Section 8. Separability Clause
d. Section 7. Penal Provision
Page 206 of 209

41. CMTE stands for?
a. Committee of Massage Training Experts
b. Continuing Massage Training Experts
c. Continuing Massage Therapy Education
d. Committee of Massage Therapy Education
42. CEMT stands for?
a. Committee of Examiners for Massage Therapy
b. Commission of Examiners for Massage Therapy
c. Committee of Education in Massage Therapy
d. Commission of Education in Massage Therapy
43. CHD stands for?
a. Cultural Health Development
b. Committee of Health and Disease
c. Center for Health Development
d. Center for Human Development
44. HRDU stands for?
a. Human Resource Development Unit
b. Health Resource Development Unit
c. Human Resource Disaster Unit
d. Health Resource and Disease Unit
45. CMTEC stands for?
a. Continuing Massage Therapy Course
b. Continuing Massage Therapy Education Council
c. Continuing Massage Therapy Education Course
d. Continuing Massage Therapy Education Course
46. Submit the list of renewed licenses of massage therapist to the
Committee every _____ quarter of the year.
a. Last
b. First
c. Third
d. Second
Page 207 of 209

47. The Code of Ethics for Massage Therapists shall be disseminated
through the accredited Training Institutions and associations of
massage therapist after approval hereof by the Department of
Health, Committee of Examiners for Massage Therapy and shall take
effect immediately. Done in the City of ______.
a. Quezon
b. Paranaque
c. Manila
d. Caloocan
48. To uphold and safeguard the massage therapy profession, it is very
important to have guidelines.Presedential Degree No. ______.
a. 865
b. 856
c. 987
d. 587
49. No person is authorized to practice massage as a profession in the
Philippines without holding a valid certificate of registration issued
by the Committee and approved by the Secretary of Health.
a. Section 5 Practice of Massage
b. Section 6 Functions/ Responsibilities of the Regional Director
c. Section 7 Penal Provision
d. Section 8 Separability Clause
50. Any person who shall violate, disobey, refuse, omit or neglect to
comply with any of the provisions of these rules and regulations,
interfere with or hinder, or oppose any officer, agent or member of
the Department or of the bureaus and officers under it.
a. Section 8 Separability Clause
b. Section 9 Repealing Clause
c. Section 7 Penal provision
d. Section 10 Affectivity
Page 208 of 209

ENRIQUE T. ONA, MD, FPCS, FACS
Secretary of Health
Page 209 of 209

Massage Manual For DoH Licensure 1

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Massage Manual For DoH Licensure 1

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CENTRAL LUZON ALTERNATIVE HEALTH AND DEVELOPMENT INC.

DOH Accredited Training Institution

MODULE 1: ANATOMY AND PHYSIOLOGY

D. Major Organ Systems

C. Pathology Relevant to Practice of Massage Therapy

D. Component of Massage Therapy Infection Control Program

MODULE 3: MASSAGE THERAPY I : FUNDAMENTAL CONCEPTS OF

E. Wellness Massage vs. Therapeutic Massage

MODULE 4: MASSAGE THERAPY II - MASSAGE THERAPY APPLICATION

C. Assessment & Documentation

MODULE 5: MASSAGE THERAPY III - PRACTICE OF MASSAGE THERAPY

A.Code of Ethics for Massage Therapists

General and Organ System Anatomy and Physiology

1. Discuss the common terminologies essential in the understanding of

2. Explain the important organs found in the body regions.

3. Describe the use of body positions applied in massage.

To be an effective (mabisa) and skillful (mahusay) massage therapist, one must

As a massage therapist, you will be compressing and working on much different

Anatomy and physiology is inseparable (hindi mapaghihiwalay) because as one

Structure of the Human Body

Cell – the basic structural and functional unit of most living

Organ System – These are groups of organs that work together to

The human body is bilaterally (magkabilaan) symmetrical (magkatulad). It has

Body Directions/ Orientations

BODY REGIONS DESCRIPTION

Anterior View Posterior View

Fig. 3. Supine (nakahilata)– a

Fig. 4. Prone (nakadapa) – a

Fig. 5. Side-lying (nakagilid) – a

Coronal Plane (Frontal Plane) --

Sagittal Plane -- divides the body or

Transverse Plane -- divides the

TABLE 1. DIFFERENT BODY SYSTEMS, ORGANS and FUNCTIONS

CHECK YOUR UNDERSTANDING

I. Choose and encircle the best answer.

Give the major function of Skeletal System

The skeleton provides a strong, internal framework (panloob na balangkas) that

The skeleton also contains cartilage and ligaments. Cartilage is a tough

Division of Skeletal System

Appendicular Bone (126 bones) - The appendicular skeleton is composed of bones

CHECK YOUR UNDERSTANDING

I. Identify the following parts

Excitability - the ability to receive and respond to a stimulus

TABLE 4. SKELETAL MUSCLE DISTRIBUTION WITH CORRESPONDING CONTENTS

CHECK YOUR UNDERSTANDINGS

CHECK YOUR UNDERSTANDING

I. Choose and encircle the best answer.

1. A component of epidermis that is responsible for skin pigmentation.

Sensory Skin Receptors

How does this system work?

pulmonary vein lungs pulmonary artery

head & arms

Fig. 11. Anatomy of a Heart

TABLE 7. HEART RATE CHART:

CHECK YOUR UNDERSTANDINGS

Structure of blood vessels

Heart rate ranges from babies to adult

Fig. 12. Lymphatic System

CHECK YOUR UNDERSTANDINGS

Enumerate the organs involved in Lymphatic System.

_______ 1. Largest organ in the lymphatic system.

The nervous system is the major controlling, regulatory, and communicating

Fig. 13. Nervous System Pathway of Impulses