Ok folks, as promised here are my case studies i did last year for the Itec Holistic massage course. There are five in total and the names have been removed. There are no consoltation sheets or follow up sheets cos they would have to be scanned in and would take up far too much space on the board.
Ok,so here are the rules. Do not present these as your own work, as this spoils it for everyone and besides you really should do the case studies as it is the only way that you will learn. These are to be posted here only, don't put them on your site or anyone else site without my permission. You can keep them on your hard drive and ditribute them to fellow students once the same conditions are applied to them.
Sorry for the conditions, but i think they are fair enough. I hope other people follow my example and give up whatever information/case studies/sample papers they have.
Hope they are of value. These all passed by ITEC but are by no meansd presented as definitive case studies, many forms i assume are acceptable. This is the format i choose.
**** is a thirty-four year old man who lives with his fiancée in the town centre of ******. He is the bar manager of a local venue and is a singer in a rock band. He is a very busy man and seldom has time for himself. He decided to come to massage to get some time to relax and get away from the worries of the world. His job is very stressful as his boss puts him under a lot of pressure. He also finds dealing with drunken customers very stressful and often ends the night with a headache. He doesn’t get much sleep ( about six hours a night at the most) because he finds it hard to switch his brain off when he is trying to sleep and doesn’t have a day off. He is a non-smoker but feels that the smokey working atmosphere is having a toll on his lungs.
On average he does at least one gig a week with his own band. They play all over the country so he spends a lot of time travelling at the weekend. Although he puts a lot of time into the band, organising bookings etc he finds this very enjoyable. He does find however that things can get on top of him and he gets a bit overwhelmed.
Because of the amount of time he spends at work he gets little time to exercise. He was once very fit, he use to work on a building site, but would see himself as been very unfit now. He has put on a bit of weight over the last couple of years and is finding it hard to lose it as he lose his sweet stuff and eats a lot of microwave meals.
TREATMENT PLAN
Because **** has no serious health problems, and I found no areas of tension or stiffness, I intend to make ****’s sessions as relaxing as possible. I will put more emphasis on effleurage and petrissage movements and stray away from frictions and percussion. This will also help him with his sleeping problems. I will try to make the session as relaxing as possible to help him get some time away from his stresses.
I will encourage him to try to eat more healthily and try to take some exercise. I will suggest that he cuts down on his caffeine intake and try to relax a bit more.
SESSION ONE
**** seemed to be a bit nervous at the beginning of the session so I asked him what his concerns where. He told me that he had never gone for a massage session before and wasn’t really sure what was going to happen. I explained that he would be covered with towels at all times apart from the area that I was working on. I explained that I would start on his legs, go to his abdomen, followed by his head shoulders and arms. I would then ask him to turn over and I would work on the back of his body. I told him that if at any time he was feeling uncomfortable, tender or in pain to let me know. He seemed a bit calmer and relaxed after this and so we proceeded with the session.
Judging by the amount of stress that **** is under form work I was expected to find areas of tension in his body. However over the entire message I found no area of significant stiffness or tension. All his muscles seemed quite relaxed.
For homecare advice I suggested that he cut down on his caffeine intake as this may be a factor in his sleeping patterns. I also encouraged him to drink plenty of water as he drinks very little to none at the moment. I also suggested that he cut down on his sweet and biscuit intake and try to eat a more b****ced diet.
SESSION TWO
I asked **** how he had gotten on after his last session and he told me that he had a great and long sleep that night after the session but was back into his normal sleep pattern after that. He was still feeling very stressed about work as a lot was going on. There was work been done in the venue and it was behind schedule and his boss was putting a lot of pressure on him.
During the massage when **** turned over onto his abdomen he feel asleep nearly straight away. Again during the session I didn’t notice any areas of significant tension.
After the session **** told me that he felt really tired and a bit worn out. For home care advice I suggested that he should cut down on his caffeine especially before he goes to bed or late in the evening. I also suggested that he try not to think about work related stuff before he goes to sleep. He should try to put all thoughts of work out of his head until he is in work. Perhaps he should take a walk in the evenings to clear his head.
SESSION THREE
**** told me that he once again had a great nights sleep on the night of the previous session, but was still finding it hard to get a long night’s sleep after that. He also told me that he had headaches all week, they where mild and dull but nearly constant.
The whole way during the session **** was restless, and was constantly twitching, scratching and re-arranging himself on the couch. I asked him if he was uncomfortable or if the room was too hot or too cold but he told me he was fine. When I pointed out that he was moving about so much he told me that he couldn’t really relax as he had stuff on his mind. He had had an argument with his girlfriend earlier in the day and was finding it hard to put it out of his mind
I performed a lot of effleurage and petrissage movements on him and spent a lot of time on his back as he had told me that he enjoyed this area been worked on.
For homecare advice I suggested that he spend an hour or even half hour each day relaxing with no television, stereo or other distractions. During this time he should not think about work or his worries but just let his mind relax. He was still drinking a lot of coffee and told me he was finding it hard to cut down. He blamed the lack of coffee during the week for his headaches. He knew that it was withdrawal symptoms but felt that he just didn’t have the energy to go through them at the moment.
SESSION FOUR
**** told me that he had felt more relaxed this week. He had been taking time out each day to relax and not thinking about all his stresses. The pressure was calming at work and he was now walking to work each day to get exercise. He also told me that he had started listening to his favourite radio programme (The Goon Show) just before he went to sleep and this was putting him in good form and keeping his mind of things. He was sleeping better now.
He also informed me that he had bumped his left leg at work and now had a bruise that covered his left rectus femoris and Vastus Lateralis. I didn’t work on or around this area as he sore and tender.
I noticed that when I got to his left gastrocnemus muscle that there was a good deal of tension in it. I put this down to the fact that his upper leg was sore and that he was probably walking slightly irregularly because of this.
For homecare advise I suggested the same things as before. Cut down on his caffeine intake, cut down on his sweet/biscuit intake and try to drink more water.
CONCLUSION.
I was very surprised that **** didn’t have more areas of muscle tension in his body due to the amount of stress that he is under. He finds it very hard to get to sleep at night because he starts thinking about stuff when he gets into bed. His new idea of listening to a comedy show before he goes to sleep seems to be taken his mind off things and helping him to get to sleep. He is also spending some time each day to relax and take his mind of things.
He has also started to walk into work to get more exercise. He tried to cut down On his caffeine intake but started getting headaches from the withdrawal. This made his a bit agitated and in bad form so he went back to his normal daily amount.
I believe that if **** continues with his massage sessions and spend some time each day relaxing that his stress levels will be greatly reduced and his sleeping patterns will improve.
**** **** is a twenty-seven year old women who lives with her boyfriend and her dog. Her parents are separated but she sees both of them regularly and has a good relationship with them both. She has one brother who she sees less regularly but she enjoys his company when she does. She has an up and down relationship with her boyfriend as he has suffered from a drinking problem for a number of years and has a tendency to go on drinking binges. This, obviously cause a lot of stress for her at home. In the last couple of months he has however gone for professional help and has been sober.
**** is also doing her final year at college. She is studying to be a teacher and say that the work load is just “unbelievable”. This is causing her a lot of stress also.
**** would not be too fit and would be overweight. She has started the Atkins Diet recently and has gotten some success. She tries to go for a walk everyday but has found that since she has started this exercise programme that she has had one problem after another. First of all she broke her one of the phalanges in her right foot big toe and then she developed planter fibrositis in the same foot. fibrositis is a build-up of lactic acid inside muscles, it’s causes inflammation of soft tissues and stiffness and pain. Her doctor believes that she developed this condition because of her new exercise programme.
She is currently not taking any medication
TREATMENT PLAN
For her right foot I intend to perform a lot of effleurage to help feel out the areas of tension. I will then perform some petrissage on her heel to break down tension and stiffness and to manipulate the muscles. This will help to release the build up of the toxins present there. It will also help with increasing the circulation. I will perform some friction movements on her heal to also help with the tension and to loosen tightness. **** suffers from cold hands and feet and this would suggest that her circulatory system is could do with some encouragement. However in all these movements I will be very careful of her recent bone injury.
For her over all circulation I intend to do a good deal of petrissage, percussion and effleurage all over her body. I will encourage her to perhaps take up some exercise that will cause less impact on her feet such as swimming.
**** would also like some help with her cellulite which she has around her buttocks and upper legs. I will perform some pounding movements to help breakdown the fatty deposits. This will also help with her circulation and improve her muscle tone.
SUMMARY
SESSION 1
I spent a lot of time on ****’s legs and feet as this was where she was having the most problems. Starting with some gentle effleurage to help her relax into the message I worked my way into some petrissage movements such as wringing and lifting of her rectus femoris and outer vastus muscles. I did some kneading and lifting on her lower leg which worked on the sides of her gastrocnemius and soleus muscles. When I got to her feet I did a leg stretch and ankle rocking. I noticed that her left foot was slightly longer than her right foot. I performed a lot of effleurage on her foot before going into lateral stretches, thumb rotations and frictions around her heel. All the time I was performing these movements I was checking in constantly with her about tension, pressure and pain. She found that these movements were not uncomfortable.
Over the rest of her body I performed a lot of effleurage and petrissage to help with circulation. I did some hacking and cupping on her thighs, gluteal muscles, trapezius, lattissimus dorsi and hamstrings to also help with circulation and to improve muscle tone. I did some pounding movements on her gluteal muscles and hamstrings.
After the massage I suggested that she took up an exercise like swimming that would have less impact on her feet. She felt that this would be a good idea. For her stress levels to do with college I suggested that she took ample breaks and not to over strain herself too much. She should perhaps spend half an hour each day meditating and taking her mind off all her worries.
SESSION 2
Before the message I asked **** how she had gotten on since the last session. She told me that she had been in great form all week, the best she had felt in years. She was putting this down to a combination of the message session and a Reiki session that she had had. She said that it felt great to be looking after herself and treating herself well. She told me that she had started swimming the night before and was intending to go at least once a week.
I asked her how her foot was doing and she said that although it did feel better it was still giving her a bit of trouble every now and again.
I began to talk to her about her diet and suggested that the Atkins diet was really a healthy diet to be following. She told me that she finds it very hard to eat healthy and would rather eat unhealthy and lose weight than try to stick to a diet that she won’t follow. Either way she says she is going to eat unhealthy, the only difference is that with the Atkins you will loose weight.
As with the first session I spent a lot of time on her legs trying to improve circulation, and improve muscle tone. I paid particular attention to her feet yet again by doing some kneading, frictions and effleurage. Along the posterior of her upper legs I performed some lymphatic drainage towards the inguinal nodes to help to encourage the lymphatic system to remove the toxins that the body was now letting go off. I also did some drainage to the submandibluar nodes, the axillary nodes and the cervical nodes.
After the session I encouraged her to drink plenty of water to help flush out of the toxins in her body. I asked her to think again about her diet and to continue her swimming.
SESSION 3
Before the massage I asked **** how she had gotten on since her last session. Again she told me that she had been in great form. She was continuing with her swimming and had now added an underwater aerobic class to it. She told me she was also at another Reiki session and believed that this was helping her a lot. She had also lost nearly a stone since she had started on her Atkins diet and was very pleased with this. I asked her had she thought about my suggestion about her diet and she said that she had but was still going to stay on it as it was working for her. She told me however that she had been slightly constipated over the last couple of days.
Her foot was feeling much better and she believed that this was a lot to do with the message and also to do with her new exercise programme.
Again I worked on her legs breaking down the tensions and stiffness. I tried to improve her circulation with some petrissage and effleurage and then did some lymphatic drainage towards her inguinal nodes to help release these toxins that were being released.
I performed some pounding movements on her gluteal muscles and her hamstrings to help with her cellulite.
I also spend some time doing some large intestine creeping to encourage peristalsis and help with her constipation. She found this slightly uncomfortable along her transverse colon.
I encouraged her once again to drink plenty of water after the session. I asked her about her stress levels and home and she told me that it was considerable less these days that her boyfriend was coping well with being sober and was doing fine. She has put her college work in perspective and although still stressful it no longer causing as much. She told me that she was taking half an hour each day sitting in her spare room with a oil burner and some relaxing music and meditating. She was finding this to be a great help and described it as getting away from the world for awhile.
SESSION 4
Since the last session **** had been to the doctor to get a check up on her foot. The doctor was very pleased with her recovery, he too believed that the swimming was a good idea.
**** had also been to another Reiki session and was feeling a lot calmer and happier. I asked her how she felt that the messages where affecting her and she told me that she definitely felt a lot more relaxed and was sleeping easier at night. She also told me that she now found it easier for her to relax her body almost as if her body had gotten use to it. She told me that she doesn’t really have cold hands or feet anymore and believed that her circulation was a lot better. Her overriding feeling was that it felt great to be looking after herself physically after years of letting herself go. It was improving her confidence level and her self esteem.
I asked her about her constipation since her last session and she said that she was back to normal and having no more difficulties.
During the message I didn’t pay as much attention as I had done in previous sessions to her legs and feet as the problem had depleted more or less. However I did spend some time doing some basic effleurage and petrissage movements along with some percussion and lymphatic drainage. The rest of the massage I performed as more of a relaxing massage than an invigorating one to help with her relaxation and stress relief. I spent a good bit of time on her back doing plenty of effleurage, circle of eight over her trapezius and fanning all over her back.
For homecare advice I suggested she drink plenty of water, continue with her swimming and under water aerobics and to continue with her half hour daily of “getting away from the world”.
CONCLUSION
Since our first session together **** has come along way. At the beginning she was a bit down on herself and felt that maybe it was too late for her to start doing stuff to improve physically. By the end of her fourth session she was almost a different person. It was at this point that I noticed just how down she had been. She is enjoying her new lifestyle and I believe that she will continue as she now has the momentum behind her.
The problem with her foot seems to be under control. I believe that the swimming rather than walking is a better form of exercise for **** at the moment. Because she is overweight her feet would be under considerable impact when she walks which would is not the case when she is swimming or doing her under water aerobics.
I would still be concerned about her diet. The Atkins plan does not seem like a healthy diet to me. I have researched it and the jury seems to be out on it at the moment. There are as many people for it as there is against it. However I believe that a more balanced diet would be more satisfactory and healthy. But for **** it seems to be getting her where she wants to be weight-wise. I would suggest that when she gets down to her target weight that she visits a dietician and discuss a more balanced diet to keep the weight off and to make sure that she is getting the right vitamins and minerals.
**** **** is a twenty-two year old single man who lives at home with his parents and two sisters. He would put his stress levels at home between 5 and 8 out of ten. Recently his grandmother died and this obviously has had an effect on his stress levels.
**** works as a mechanic and he would put his stress levels at work at 6. He enjoys his work even though he works long hours.
When **** was a child he was very sick and often spent time in hospital. He has however had no serious health problems for the last number of years.
His diet is fairly well balanced, although he has a high in-take of sweets and biscuits. He is a non-smoker and doesn’t drink alcohol. He drinks about 4 to 5 pints of water a day.
All in all, **** would see himself as fit, healthy and happy.
TREATMENT PLAN
I intend to use a lot of effleurage on **** as his skin comes under a lot of stress from his work. He is often covered in oil and grease. This will help in desquamation and will help improve his circulation.
I also intend to use a lot of Petrissage all over his body but particularly on his legs, as I felt that he had a lot of tension in his hamstrings and gastrocnemus muscles. This will help to break down any tension or stiffness that he has from his job. He is fairly active and drinks plenty of water each day so this will also help in the release of any lactic acid that has built up on his muscles.
I will also perform some percussion to stimulate the cardiovascular system and help improve his circulation.
Session One
I spent a lot of time of doing effleurage all over ****’s body as he comes into contact with a lot of grease and dirt because of his job as a mechanic. This will help with desquamation. I followed this with some petrissage to encourage circulation and to help break down any tension in his muscles. I noticed that he had a good deal of tension in the back of his legs along his ham-strings, more so in his left leg than his right. However this did not continue up through his body as I found that most areas of ****’s body were more or less tension free.
I noticed that in places, such as his hands and face, that ****’s skin is very dry and a bit flaky in patches, I put this down to his work.
As home care advice, I suggested that even though he comes home from work very tired he should really try to have a shower ever night to wash the grease off his skin. He said that he tries to most nights but sometimes he is just too tired and just goes to sleep and has his shower in the morning. I also suggested that perhaps he should use some sort of moisturiser on his skin to help with it’s dryness.
SESSION 2
I asked **** how he had gotten on after the last session. He told me that he felt very tired for the rest of the night after the massage and that it was very hard for him to get out of bed the next morning. He also told me that his stomach felt like he had been doing crunches and that he had urinated frequently the night and day after the massage.
He also told me that he had tried to use moisturiser but was feeling a bit stupid putting it on thinking about what the boys at work would think of him if they found out. He said that he used the moisture mostly on his hands and had started to use moisturising soap.
I went easy and gently over his transverse abdominis, going easy on the large intestine creeping. I did this because he found that his stomach was sore after the last session.
I noticed that the tension in his hamstrings was not as pronounced and was moving more freely when I performed some wringing movements.
I asked him how he was getting on with his showering at night. He told me that he was able to shower most nights but that one or two nights he was just too tired.
I also advised him to cut down on his sweet and biscuit intake as this might be a reason for his tiredness. Sugar and caffeine giving him a quick fix but leaving him more tired in the long term. He said that he would give it ago.
SESSION 3
Since the last session ****’s grandmother died and he had been off work. Her funeral was the following day but he decided that he would still attend the session as he needed a break from all the mourning and ritual that surrounds a funeral. He was close to his grandmother and was taking the death very badly. He was also worried about his Mum as it was the second relation of hers that had died recently and she was really taking it bad. He was very worried for her.
I decided that for this session that I would do more of a relaxing session than an invigorating one to help **** reduce his stress levels. I did plenty of effleurage and some gentle petrissage . I spent a lot of time on his back, predominately on his trapezius as I found a lot of tension and stiffness there. It was not surprising considering the amount of stress he was under. I performed some wringing, circle of eight and some hacking and cupping on his trapezius to help breakdown the stiffness.
For homecare advice, I suggested that he look after himself and make sure that he got to talk about his feelings with someone. I suggested that maybe he should go talk to a counsellor if he felt really bad. I suggested that he spend some time to relax and get away form the whole stress of the funeral, perhaps going for a walk on his own or listening to some relaxing music.
SESSION 4
It was two weeks since the last session I asked **** how he was getting on. He told me that he was getting back into the swing of things and that life had more or less returned to normal. He was back at work and back into his routine. He said that his stress levels where getting back to normal and that he was feeling a bit better about his grandmothers death.
I asked him if he had continued using the moistureiser on his skin and he told me that he was using it everyday and was noticing that his skin wasn’t as dry.
He also said that his stomach had not been as sore as it was after the first session. He had also cut down slightly on his sweet intake but was still eating a lot of junk.
I performed a good deal of effleurage over his entire body to try and find the places of tension and stiffness. A lot of his body was tense and I had to perform a lot of petrissage and percussion to try and sort this out. I noticed a lot of tension again around his trapezius. When I was performing some wringing movements I checked in with **** and asked about pressure and he said that it was a bit tender. This was the same around his deltoids.
Summary
**** has been under a lot of stress recently with the death of his grandmother and his worries about his mum. He is also in a job that is very tireing and he feels exhausted a lot of the time. The oil and grease from his job was having a negative impoact on his skin but with the help of the massage (which helped with desquamation) and the use of skin moistueresers he should be able to get this under control.
Although he has a well balanced diet and drinks plenty of water I suggested that he cut down on his sweet and biscuit intake. This could be having an impact on him with regard to his tiredness and also such a high intake of sugar isn’t good for his digestion.
**** told me that he enjoyed the sessions and that he would continuing having massages done as he felt that they were very beneficial.
**** **** is a twenty-one year old woman who lives with her Fiancée and two cats. She has a sister and a brother who are both older than her. Her parents have recently separated and this has been causing her a lot of anxiety and stress. She works as a body Piercer in a tattoo shop in ****.
She had her tonsils removed when she was sixteen and had her appendix removed when she was eleven. She suffered from anorexia when she was seventeen/eighteen and was so ill she nearly died twice. Once when her stomach suffered serious injury and again when she had kidney trouble. She has recovered and is in good health now. However she still takes medication for depression. She does on occasion suffer from panic attacks but not near as often as previous.
Since recovering from anorexia she has been working with a Dietician and now has a very well balanced diet. She is now normal weight, but told me that she has a tendency to eat unhealthy every now and again, indulging in sweets and fast food.
She doesn’t take much exercise and would not be fit.
TREATMENT PLAN
I intend to use a lot of effleurage on ****’s hamstrings, quads, gastrocnemus and Tibialis anterior as she has poor circulation in this area. I will perform some kneading and Hacking and cupping movements on her quadriceps and hamstrings to also promote circulation.
I believe that **** will benefit from the feelings of well-being that come from a holistic massage so I will to make her sessions as relaxing as possible. I will do this by using very vigorous movements sparingly and concentrate more on petrissage and effleurage than the more rigours percussion and friction movements.
I intend to do some large Intestine creeping to encourage Peristalsis as **** would only have a bowel movement about twice a week.
I will encourage **** to take more exercise and to try to keep her diet more consistent. I believe she will benefit from drinking more water as she suffers from frequent urinary tracts infections and the water will help to flush out the toxins from her body. I will also perform some lymphatic drainage along with the petrissage to encourage this toxin release.
Session One
I notice from the outset of this session that the circulation in ****’s legs was poor as she had areas of white blotches on her legs. I performed a lot of effleurage and followed this by some petrissage on her upper and lower legs. She told me that she doesn’t like anyone touching her feet as she finds this very uncomfortable. I tried some basic effleurage but even this was too much for her so I discontinued.
I moved onto her abdomen area and spent some time doing some large Intestine creeping. I did this to encourage peristalsis as **** would not have frequent bowel movements. After a few movements she started to find this slightly uncomfortable so I moved on to some wringing on her Internal and external obliques.
I next moved to her head, where I performed some basic effleurage followed by some scalp kneading. This was followed by some effleurage on her face and some lymph drainage to her submandibluar nodes. I use some tapotment on her cheeks and again some drainage.
I moved to her upper torso doing some effleurage. I followed this with a series of sliding neck movements starting on the left side and continuing on the right. After this I did some deltoid frictions, a movement she found a bit tender and sore but I didn’t notice any tension in them.
I continued to her arms with some effleurage, tricep and bicep kneading and some gentle hacking and cupping on her triceps. I did some work on her lower arm and moved to the hand doing some lateral stretches and metacarpal frictions and palmar kneading.
I got her to move on to her front so that I could begin to work on the back of her body. I noticed that her legs seemed to bend inwards in this position with her feet angled medially. I asked if she was comfortable and would she like a cushion or pillow under her feet to support her. She declined saying that she was comfortable as she was.
I performed some effleurage, wringing and hacking and cupping on her left and right hamstrings followed by some Lymphatic drainage towards her inguinal nodes. I tried to encourage circulation.
On her lower legs I kneaded and divided her gastrocnemus
I moved on to her back starting with some effleurage, back stretches and kneading from her buttocks to shoulders. When I started performing wringing and circling on her trapezius she told me that her nipple ring was sore because of the pressure. She informed me that she had been at a music concert recently and in the course of dancing had torn part of her nipple with her nipple ring. I eased on the pressure and moved down towards her lower back. I suggest that she use Savlon spray on her nipple to clean it.
I did some lymphatic drainage first to her cervical nodes, then her axillary nodes and finished with some thenar effleurage across her lower lumbar area.
I finished the session with some fanning over her kidneys and full back, followed by some more effleurage and some hacking and cupping over her entire back area.
I suggested that she take some time each day for exercise, to help with her circulation and for her sense of well-being, perhaps going for a walk in the evenings after work. This would also help to increase her level of fitness.
SESSION TWO
I asked her how she felt after her last massage. She told me that she had felt very relaxed and tired after it. She also had gone to the toilet nearly straight away after the session. Her nipple piercing had healed more or less completely and was not causing any problems.
I began the session with some effleurage on her legs and followed with some wringing, rolling and some percussion movements. This was to increase circulation and to release any lactic acid that had accumulated from ****’s new exercise regime. I stayed away from her feet as I knew she found this uncomfortable.
I moved onto her abdomen area and spent some time doing some large Intestine creeping. I did this to encourage peristalsis. I moved on to some wringing on her Internal and external obliques.
I next moved to her head and face, where I performed some basic effleurage followed by some scalp kneading, some effleurage on her face, lymph drainage to her submandibluar nodes and tapotment on her cheeks.
Moving to her upper torso I did a series of sliding neck movements starting on the left side and continuing on the right. After this I did some deltoid frictions. **** had found this area a bit tender in the last session so I was careful to ask her how my pressure was and how the movement felt. She told me that it was fine.
I moved unto her arms performing effleurage, tricep and bicep kneading and some gentle hacking and cupping on her triceps. After doing some work on her lower arm I moved to the hand doing some lateral stretches and metacarpal frictions and palmar kneading.
After performing some effleurage, wringing and hacking and cupping on her left and right hamstrings I followed with some Lymphatic drainage towards her inguinal nodes.
On her lower legs I kneaded and divided her gastrocnemus
I moved on to her back starting with some effleurage, back stretches and kneading from her buttocks to shoulders. I did some wringing of the trapezius and lymphatic drainage to both her cervical nodes and her axillary nodes. I did some fanning over her kidneys and full back before I moved onto wringing of her gluteal muscles. I finished the session with some gentle effleurage and some spinal vibrations.
I noticed that ****’s circulation had not really improved much even though she was now taking more exercise. I asked her what type of shoes did she wear on a regular basis and she told me that she usually wore boots that went up as far as her knee and had thick soles. She also told me that she had been wearing these boots for a number of years (as they where her favourite) and at this stage where starting to fall apart. I suggested that she stop wearing these boots for a couple of weeks and see if there is any improvement in her circulation. I also suggested that she keep up her daily exercise.
SESSION THREE
Since the last session **** had hurt her neck. She told me that she woke up one morning with a stiffness in her right side sternocleidomastoid muscle area that was limiting her movement somewhat. She put it down to the way she had slept as she could think of no incident where she could have suffered the injury. I asked her if she had been wearing her boots, she told me that she hadn’t worn them since I suggested that she didn’t. I put forward the idea that maybe there was some kind of re-alignment was happening in her back because of her change of foot wear. This hypothesis was backed up when I noticed that the muscles in her right leg (particularly her gastrocnemus muscle) also seemed to be more tense than usual.
I asked her about her bowel habits and had there been any change. She told me that she finds it easier to go to the toilet now especially after she has a massage. I did some work on her large intestine to further encourage bowel movement and suggested that she talks to her dietician about her bowel habits.
I performed some effleurage on her legs and followed with some wringing, rolling and some percussion movements. I concentrated on her right leg as there was more tension in it than her left. I did a lot of kneading on her right gastrocnemus and some lymphatic drainage on both legs.
On head and face I performed some basic effleurage followed by some scalp kneading, some effleurage on her face, lymph drainage to her submandibluar nodes and tapotment on her cheeks.
I moved unto her arms performing effleurage, tricep and bicep kneading and some gentle hacking and cupping on her triceps. I some lateral stretches and metacarpal frictions and palmar kneading.
I moved on to her back starting with some effleurage, back stretches and kneading from her buttocks to shoulders. I did some wringing of the trapezius and worked on her sternocliedomastoids and deltoids to try to work out some of the tension. I did lymphatic drainage to both her cervical nodes and her axillary nodes. I did some fanning over her kidneys and full back before I moved onto wringing of her gluteal muscles. I finished the session with some gentle effleurage.
SESSION FOUR
I noticed straight away that ****’s circulation had improved greatly. She hadn’t worn her boots for a few weeks at this stage and had been taking more exercise and this has seemed to make all the difference. She still had the tension in her sternocleidomastoid muscle but she told me that it was no-where near as severe. I performed some wringing movements followed by some frictions to try to work out the stiffness and tension. The tension that I had notice in her right leg was now more or less gone and seemed to be back to normal. But I still did some wringing on the area to break down any residual stiffness.
**** had gotten her belly-button pierced since the last session so I avoided doing too much effleurage on the area. I simply did some large intestine creeping and some lifting and wringing of her obliques. I took into account her piercing when she turned over onto her stomach by offering a pillow to lie on so that her piercing wouldn’t get damaged.
On her head and face I performed some basic effleurage followed by some scalp kneading, some effleurage on her face, lymph drainage to her submandibluar nodes and tapotment on her cheeks. I also did some eyes and nose stroking.
I moved unto her arms performing effleurage, tricep and bicep kneading. I some lateral stretches and metacarpal frictions, palmar kneading and some wrist and elbow frictions..
When working on her back I kept in mind her new piercing and so was very careful with my pressure and check in with **** frequently to ask her how the movements felt. I performed some kneading on her gluteal muscles and did lymphatic drainage to both her cervical nodes and her axillary nodes. I did some fanning over her kidneys and full back before I moved onto wringing of her gluteal muscles. I finished the session with some gentle effleurage.
Summary
Since the first session ****’s circulation has greatly improved. I believe this id due not only to the massages but also due to her change of footwear. I also have encouraged her to take more exercise. Her diet is very balanced and healthy although I believe she would benefit from taking more water each day.
Because of her piercing I was unable to work over certain areas at times, but I believe that the massages would have helped in the healing process.
The pain in her sternocleidomastoid had more or less disappeared by the last session and I believe that this pain was do to with a realignment that was happening from her change of footwear.
**** enjoyed her sessions and she believes that she would benefit from more sessions. She intends to have massages regularly.
**** **** is a forty-nine year old woman. She lives alone in her house in #####. She has two grown up children called ############. She has been separated from her husband for nearly eight years. She is currently unemployed.
**** would say that she has currently no health problems but goes on to state that she has an ulcer which flares up every now and again. She has had no major operations in her life but has always suffered from painful periods and has had very bad headaches. She also suffers from constipation.
She smokes about twenty cigarettes but claims that she doesn’t really think that they are doing her too much harm (if any). She bases this on the fact that when she was off them for nearly a year she didn’t feel any different from when she was smoking other than she was having panic attacks. She says that smoking is good for her.
She would put her stress levels at 4 out of ten and is finding the time away from working very relaxing. She does however wish that she was a bit more financially better of.
**** exercises regular. She goes for a walk every day and often goes hill walking at the weekend.
TREATMENT PLAN
Because of her problem with constipation I intend to do some work along her intestine to encourage peristalsis. I will do some large intestine creeping and some circling movements over her abdomen.
Her left side Trapezius is very tense so I will do some wringing and friction movements on this area to try to break down the tension and stiffness. I will follow this with some lymphatic drainage to clear any lactic acid or toxins. This seems to be a localised tension area as the rest of the left side of her body is not overly tense.
I will encourage **** to cut down on her smoking habits and to increase her intake of protein.
SESSION 1
**** felt very relaxed during and after the session and told me that she felt great. I noticed that she had some tension in her left side of her trapezius muscle so I performed some wringing and friction movements on the area trying to work out the tension. **** told me that the area was a bit tender as I was working on it.
I followed this with some lymphatic drainage all along her back top help with the absorption of the toxins into the lymphatic nodes.
I performed some large intestine creeping to encourage peristalsis as **** has a problem with constipation. There was a number of areas along the intestine that where hard, so I performed the movement a number of times. **** did not find this movement uncomfortable or painful.
For home care advice I suggested that **** drink some extra water to help flush out the toxins that were removed during the session. I also suggested that she continue with her walking and exercise programme.
SESSION 2
**** told me that she had really enjoyed the last session and was looking forward to the massage. I asked her about her constipation and she told me that she was still having trouble going to the toilet.
I spent some time doing large intestine creeping and notice a lot of hardness in a couple of areas. **** found these movements to be slightly painful so I lessened the pressure.
The left side of her trapezius was less tense than the previous session and seemed to be going back to it’s normal relaxed tension.
For homecare I suggested that she continue with her exercise programme, drink plenty of water, try to cut down on cigarettes and try to include some more protein in her diet.
SESSION THREE
**** told me that her bowel movements where a lot better and that she no longer was feeling constipated. She told me that she was really enjoying having the massage done and felt that that it was really helping her to relax. She also told me that she was having her menstrual period and asked me not to work on her abdomen as she was tender and sore in this area. She told me that she always had painful periods and that they took a lot out of her physically and emotionally. **** looked a bit pale and a bit tired looking.
Overall **** seemed to relax into the massage and had no areas of significant tension or stiffness. Because I was leaving out her abdomen I spent more time on her upper back , doing some petrissage movements (wringing, circle of eight) on her trapezius which she found very enjoyable.
For homecare advise I suggested that she take it easy during her period and not worry too much about going for her walks if she didn’t feel up to it.
SESSION FOUR
**** has had a very bad tooth ache all week and had been using clove oil on it to ease the pain. I asked her why she hadn’t gone to the dentist and she told me that she was very nervous about going to the dentists and was putting it off hoping that the pain would go away.
I stayed away from doing any movements on her face as the whole left side of her face was in pain.
The rest of her body was more tense than usual, particularly her upper arms and shoulders. I performed some petrissage movements on her trapezius, some frictions on her deltoids and some wringing/hacking and cupping on her triceps.
For home care advise I suggested that she should try to over come her nervousness of going to the dentists and make an appointment to have her tooth looked at. It was quite obvious that her tooth was causing her a lot of pain.
SUMMARY
**** **** told me that she was really enjoying having the massage done and that she would continue to have sessions. She believed that the massage was helping her relax more and was giving her a greater sense of well-being.
She had no areas of significant tension in her body until the last session when she had some tension in her shoulders and upper arms. I believe that this was due to her toothache as she hunched her shoulders every time the toothache became severe. I suggested that she go see a dentist to have it looked at but she said that she is nervous of dentist.
**** believes that the massage has helped her with her constipation. I performed a lot of intestine creeping to encourage peristalsis and I believe that this had a positive impact on her.
So there they are, if i have missed a name or some other personal detail let me know and i will edit them out. If you recognise anyone from the case studies keep the privacy.
And good luck all of you with your holistic massage!!!
When i am finished my Aromatherapy and Reflexology i will put up my case studies for that as well.
If anyone is interested i have some assignments for fetac Anatomy and phis, work health and safety, human growth and development, care provision and practice etc. Let me know if these would help!!
Frater you are absolutely amazing, and really generous of you to spend all that time making these case studies available for others. The case studies are really well written, you've obviously put a lot of thought into them.
I hope that this will encourage others to share their knowledge so they can repay the favour to you someday in your next set of training.
__________________
Justine Justicia Health & Complementary Therapies
The largest fences we need to climb are those we've built within our minds
Practitioner of EFT, Advanced Freeway CER, NO HANDS Massage
Hi, I'm doing my ITEC Holistic Massage case studies now. I've sent one in to my tutor and she was very pleased so I will try to copy and paste here.
She did say that there was perhaps too much detail. My belief is better too much than too little. Hope this is of help.
Actually just noticed you can add attachments so I'll do that instead. OOOPS it was too big.
So copy and paste into word and hopefully you will be able to get the pages to line up.
Page setup Portrait, Top 1.8cm, bottom 2cm, left 2cm, right 1cm
JB is a man aged 55 and has been happily married for 25 years. He has 2 children living at home, age 20 and 22. One child has caused him concern in the past with major health problems for several years but these appear to be resolved now.
He is a self-employed contract computer project management consultant and is currently between contracts. His work involves a lot of computer work and therefore it is mostly sedentary. His work environment changes with each new contract which usually involves working and living away from home during the week returning at the weekends. Although staying in hotels is not ideal he enjoys the freedom of working for himself.
JB’s health is generally very good but he does admit to being overweight. He does not smoke and drinks alcohol only at the occasional party. He enjoys his food, particularly fresh vegetables and drinks 2 glasses of water a day and 3 cups of black coffee. He takes a general mineral and vitamin supplement daily.
JB has no contra-indicators to holistic massage so GP permission is not required. JB has signed an informed consent form.
He has decided to have a massage session as he is currently feeling a little stressed due to his unemployed situation. He says this is unusual for him as he is normally very laid back.
He has also been experiencing some left hip and right shoulder joint discomfort which he attributes to working on his lap top at home.
TREATMENT PLAN
The benefits and the different aspects of holistic massage were explained and discussed and the plan is to receive treatment over four sessions, spaced at weekly intervals.
The initial treatment will be a full body massage to help relax and de-stress but also paying particular attention to the left hip, gluteus maximus, and the right shoulder, across and up over the scapula and up over the trapezius, into the neck area.
Further massage treatments will be adapted to JB’s needs and will mostly be tailored to relieve his current stress related feelings.
Client Ref No: M001
TREATMENT RESULTSTreatment 1 – Date: 9/12/2008
TREATMENT
As this is JB's first massage I began the session with him lying on this back so that he would feel more at ease and would be able to see me moving around him. I had discussed allergies with JB during the consultation so almond oil was used as the massage medium.
I proceeded through the classical movements of effleurage, petrissage and kneading to left arm and including wringing, hacking and cupping to left leg. Movements were mirrored on right leg and arm. Then moving onto the abdomen to perform circling to aid peristalsis the client asked if it was actually necessary so I finished with some smoothing effleurage.
Turning the client over to face down was awkward for him due to the shoulder and hip pain. Once I had ensured he was settled and comfortable I proceeded with the routine for posterior legs and glutes, checking throughout that the pressure used during kneading and hacking were at a comfortable level, more kneading and stronger effleurage was performed to the left hip area and gluteus maximus.
Moving onto the back area I decided to use extra kneading to the scapula and trapezius, with deeper petrissage around the scapula up to the shoulder, checking throughout with the client. I finished the back area with firmer effleurage strokes in circling motions, decreasing to gentler circling and strokes down the back from the scapula to the sacrum.
CLIENT FEEDBACK DURING TREATMENT
When asked JB expressed his dislike for the abdomen circling, he said it was an unpleasant sensation so I finished the area with gentle effleurage. He liked the kneading to his shoulders and up into the neck even though aware of some pain while it was happening.
CLIENT FEEDBACK AFTER TREATMENT
JB said that he felt much more relaxed and his leg and hip were more comfortable. He said that although the work on his upper back, shoulder and neck had been painful he did feel it was a lot looser and also felt warm.
POST TREATMENT ADVICE
General advice was given in a fact sheet and I advised him to drink more water which would help flush out the released accumulated toxins in his body and relieve the discomfort in his abdomen. But the most important advice was for JB to try to find a better position when using the laptop to improve his posture, ie correct table height, better chair which would help with his shoulder problem.
REFLECTIVE PRACTICE
JB was the first male that I’ve massaged. His longer body meant that I had to alter my stance more often, changing to the striding position for the longer limbs. I also found some difficulty in reaching over his body to massage his glutes so that I had to stand on tiptoes. I will have to ask colleagues how they cope with the broader or larger figure. I didn’t seem to be constantly checking with the client on pressure of the movements, just enough to adapt to his comments. The problem with the abdomen was overcome quickly and I will have to make a mental note to ask clients their preference before starting the deeper movements.
Client Ref No: M001
__________________________________________________ ___________________________________ TREATMENT RESULTSTreatment 2 – Date 16/12/2008
CLIENT FEEDBACK FROM PREVIOUS TREATMENT
JB said that the hip joint pain had gone, not straight after the last session but he had not noticed over the last two days. He has bought a rolling chair and a computer desk to change his posture when using the laptop. He is still experiencing discomfort in his right shoulder but not as much as before.
He needed to use the toilet frequently the day of his last session.
He also felt extremely tired and had slept better.
He has increased his water intake and has also been taking a daily walk.
Before starting massage JB asked that the abdomen be left alone.
JB is still looking for employment and is beginning to feel the strain.
TREATMENT
Using almond oil as the massage medium I gave a full body massage to JB, concentrating on his right shoulder area. I kneaded the scapula and trapezius, and then petrissaged up around the medial side of the scapula making sure the pressure was not too hard for him. Further kneading was carried out over the shoulder area and into both sides of the neck which felt very tense. I asked the client if he would like to try a heat lamp on the area while I worked on the posterior legs and glutes. I then returned to the back and after removing the heat lamp, effleuraged and kneaded the whole scapula area up into the lower neck. This was followed with long downward strokes from the cervical vertebral area down to the sacrum.
CLIENT FEEDBACK DURING TREATMENT
JB said the kneading to the shoulder and neck was feeling slightly uncomfortable. He was happy to have some heat treatment to his shoulder. He did not respond when I returned to his back after working on his legs, he appeared to be asleep.
CLIENT FEEDBACK AFTER TREATMENT
JB was asleep by the end of the treatment. I spoke more forcefully to rouse him. He said he felt very relaxed and that his shoulder felt much more comfortable. He asked to use the toilet.
POST TREATMENT ADVICE
I advised JB to continue with his increased water intake and exercise. We talked about how much time he spends on his laptop and he agreed that he should take more frequent breaks, to rest his eyes and move his shoulders and upper torso.
REFLECTIVE PRACTICE
JB fell asleep towards the end of the session. Although I spoke to him he seemed reluctant to wake, but he did begin to rouse after I made more noise ‘tidying up’ around him. I must ask the tutor how to manage client’s who remain asleep.
The treatment itself appeared to go well and the heat lamp (that was my daughters) came in handy for his shoulder.
JB did not want his abdomen massaged today so I agreed to leave it out of the routine, adapting to the client’s needs.
Client Ref No: M001
__________________________________________________ ___________________________________ TREATMENT RESULTSTreatment 3 – Date 30/12/2008
CLIENT FEEDBACK FROM PREVIOUS TREATMENT
JB said that his shoulder was much looser and more comfortable. He had once again felt tired after the last session and had slept well that night. He was feeling the stress of not having work but was aware that the Christmas holidays were a major factor. He had increased his alcohol intake over the Christmas period and also knew he had eaten more than usual. JB said that his upper legs were causing him some problems, as he’d been partying and dancing a lot. He asked if the session could finish by working on his back and shoulders.
TREATMENT
When cleaning JB’s feet prior to massage I noticed that his heels were very cracked and that the edges of the soles of the feet were very dry. He appears to have very flat feet. As JB is not a hairy male I asked if he would like to try a massage cream for this session and he agreed.
The planned full body massage was carried out but with more attention concentrated on his feet, using effleurage and petrissage to the dorsal areas of the tarsals and metatarsals and paying particular attention to moulding of the soles using the palm of my hand. This method of treatment for the feet was used both during the posterior and anterior positions. When working on the posterior legs I was also able to massage the heels more thoroughly. I continued the massage to the front of the body, checking for client comfort and depth and firmness of pressure and performed kneading, wringing, hacking and cupping followed by deep effleurage to the upper legs both anteriorly over the quadriceps; biceps femoris, semimembranosus and semitendinosus and posteriorly over the hamstrings; rector femoris, vastus lateralis, vastus intermedius and vastus medialis, were used for longer periods at the client’s request.
I finished by massaging JB’s back and both shoulders with deep effleurage, petrissage of the erector spinae muscles either side of the spine, kneading of the scapula and trapezius, with petrissage on the upper vertebra up to the occipital, to relax the neck and shoulders which felt very tense.
CLIENT FEEDBACK DURING TREATMENT
JB said that he really enjoyed the feel of the massage cream when massaging his feet. When checking the pressure of the strokes he did ask for more work, especially hacking and cupping to his upper legs, particularly the posterior aspect as his legs were a little stiff after partying and dancing over Christmas. After completing his back it was obvious that he was deeply relaxed and actually sleeping.
CLIENT FEEDBACK AFTER TREATMENT
JB said he felt extremely relaxed and was enjoying the sessions more than at the start. His upper legs were feeling very warm and his feet were nice and soft but not oily as on previous sessions. He said he often gets dry and cracked heels and uses a specific Scholl cream for that purpose but not regularly. He said that he preferred the almond oil for body work but did like the feel of the cream on his feet.
POST TREATMENT ADVICE
I discussed with JB the benefits of using the Scholl cream on a regular basis if it helps the cracked areas. We also discussed a cutback in his alcohol and food intake. He will return to a having a daily walk now that Christmas is over. Cont…
Client Ref No: M001
__________________________________________________ ___________________________________ TREATMENT RESULTScont…Treatment 3 – Date 30/12/2008
REFLECTIVE PRACTICE
This was the first time I had used massage cream and I do prefer the feel of it, for using on the client and the feel of it on my hands. JB asked for extra work to his upper legs which I was happy to do. The falling asleep and trying to wake the client is still an issue, although I’m glad that the treatment does relax JB so well and is actually a compliment, I’m still unsure on how to go about waking the client without making them feel uncomfortable or embarrassed. Turning the lights up and changing the music to something more up tempo helps, but bustling around and making more noise at the end of the hour does appear to work better.
Client Ref No: M001
_________ TREATMENT RESULTSTreatment 4 – Date 6/01/2009
CLIENT FEEDBACK FROM PREVIOUS TREATMENT
During the past week JB said that he bought and used a new tube of Scholl Cracked Heel and Foot cream on his heels and that they feel much better. He said that the stiffness in his upper legs was still evident after the massage but was really improved after a good nights sleep. He is looking forward to this session.
JB is still unemployed but says the contract market is picking up now and he feels more optimistic. Since the last session he has been walking every day and feels he has lost any weight gained during the holiday. He hasn’t been drinking alcohol since the New Year but found he enjoyed drinking more water which also means he is drinking less coffee.
TREATMENT
As planned this session was a full body massage treatment, using all the classical movements. This time I used grape-seed oil for the body and massage cream on the feet. I noticed that JB seemed to have tense muscles in most areas and tried to increase the firmness and depth of pressure checking with the client throughout although he said this was now unnecessary, as he was getting used to it all. JB prefers to finish with the back massage as he finds this more relaxing.
I had planned to add in a chest, face, neck and head routine but although JB had shaved that morning, his session was in the evening and the re-growth was quite sharp. I did do some hand circles and knuckling to his pectorals and the anterior aspect of the trapezius over his shoulders and the sides of the lower neck. He declined the rest of this routine.
After completing the posterior aspect of the legs and the gluteus maximus muscles, I moved on to the back area and JB was once again asleep.
CLIENT FEEDBACK DURING TREATMENT
JB said that all the checking was unnecessary as he was finding it all very good.
JB said he was not bothered about having the massage to his face or head but was happy to have the chest and neck area done.
CLIENT FEEDBACK AFTER TREATMENT
Turning over from back to front lying down was a little difficult for him this time, he didn’t know why. He said that the grape-seed oil was okay but he preferred the feel of the almond oil. The massage cream on his feet was great. He needed to use the toilet when he had finished dressing.
POST TREATMENT ADVICE
Spoke to JB about continuing with a regular routine of using the cracked heel cream, maintaining his daily walk, returning to his normal low intake of alcohol but perhaps not eating quite so much. He would feel better if he continued to drink more water.
The advice regarding computer use, such as having short frequent breaks and ensuring his working posture was comfortable was reiterated. I also advised him that he can continue to have massage treatments, if he wishes to, as they do provide some personal time away from his problems and they do appear to have helped reduce his stress levels and body tension with the related discomfort and pain. I suggested that he try some deep relaxation classes or meditation as a means of distressing when unable to have massage. Cont…
Client Ref No: M001
TREATMENT RESULTScont…Treatment 4 – Date 6/01/2009
REFLECTIVE PRACTICE
JB appeared to be slow to relax today and a little grumpy too. There was a lot of tension in all his major muscle groups. He became more relaxed as the treatment progressed to the point where he fell asleep during the back massage. I was a little surprised to find his beard re-growth so noticeable but relieved that he didn’t want the facial part of the massage. Some of that routine would have been rather painful on my inner fore arms.
I was a little annoyed with myself to find that I had almost run out of almond oil. I must ensure that I have enough in stock in future. Fortunately I had a sample bottle of grape-seed oil to try out. I am glad that I decided to install a toilet and small basin within the therapy chalet as it does get used by clients and allows me to wash my hands after cleansing clients feet but before starting the massage.
SUMMARY OF TREATMENT
JB has now completed four holistic massage sessions but he has expressed a wish to continue as he finds them very relaxing and a means of escape from his current situation.
The first session dealt primarily with the hip and shoulder pain which appear to have been caused by his posture when using a laptop computer at home. He did relax more as the session continued, but turning over was a problem this time.
The second session focused on his shoulder discomfort, since the hip was no longer troubling him. We used some heat treatment to the shoulder area which loosened the area before I massaged it. He relaxed so much that he fell asleep. He has made alterations to his lifestyle, walking regularly and drinking more water.
By the third session JB was more relaxed throughout the massage as his shoulder was feeling much more comfortable. I did notice that his heels were cracked and used massage cream to soften the area. This session also concentrated on his upper legs, where the muscles were very tense. JB was aware that he’d put on weight over Christmas and he was feeling less stressed because his job prospects were on hold until the new year. He plans to return to his daily walking routine.
The last session was a relaxing massage to de-stress and remove tension throughout the body. JB said he is less worried as the consultancy work market is picking up but the tension found throughout his body didn’t show this. Initially JB seemed a little grumpy, especially when I was asking about firmness and pressure of the movements but he soon relaxed and he said he had really enjoyed the session.
Chatting about the different massage mediums revealed that he liked the massage cream used on his feet but preferred the overall feeling of almond oil. JB didn’t like the more oily feel of grapeseed oil. He is still interested in receiving massage treatments and will return on a less frequent basis.
Overall I think the sessions with JB went well, he didn’t seem aware of any shortcomings on my part, except for the last session when he was grumpy and got a little short-tempered about the checks I was making about pressure of movements. Working on a man for the first time was interesting, different body shape and length, so that I had to use more body pressure. I certainly felt that I need to improve my overall stamina and fitness which will be necessary when treating more clients throughout the day.
I need more help please , I have the exam next February , i need the past exam papers in Anatomy and Physiology , and one more thing do you have any papers about the business plane UNIT 385
ITEC Holistic Massage Case Studies!
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