Body Consultation

The Mesomorph

The shape here is determined by the muscular shape of the individual, with well developed shoulders and slim, boyish hips being the classic mesomorph type. The inverted triangle shape and well-toned musculature often points towards athletic interests, and this type usually has no weight problem whilst they remain active.

The Ectomorph

The long bones and slim pencil shape of the ectomorph are easy to recognise in both men and women. The long, thin trunk is often associated with a bent-over posture and the person may appear lacking in vitality and energy. The Ectomorph seems often to lack strength and stamina and does not have a lot of energy reserves. An underweight problem, with a lack of curves, may also be present.

The Endomorph

This type is rounded, often plump and with a heavy body. The contours are padded, the neck is short and fatty deposits are in evidence around the hips, abdomen, neck and shoulders, and upper arms. The hands and feet may be small and delicate in appearance, whilst limbs are short. Body movements may be slow and deliberate. Anyone tending to this body shape, either through hereditary factors or eating habits, has a much greater problem achieving a slim figure and may always be prone to weight accumulation.

Figure Diagnosis

Figure diagnosis is carried out so that all following treatment will produce effective results, without harm or discomfort to the client. A client may need medical referral prior to treatment and the diagnosis will be able to tell if this is the case. People requiring medical guidance would be, for example, someone who is obese, of someone who has recently given birth.

There are various things that need to be looked at in s figure diagnosis, and these are:-

Body type (Somatotype)
Fat, flabby muscle or fluid
Posture
Figure faults
Muscle weakness and muscle flexibility
Medical history
Diet
Lifestyle and fitness level

Posture

First of all we need to see how the client moves in normal daily life. This is a part of the visual assessment, which is then backed up with the manual and verbal aspects of the diagnosis. Visually it has been ascertained that poot posture is not causing figure faults, so the correct standing position should be checked before anything else. Getting the client to observe her figure and its faults in a full length mirror is of importance at the start of the diagnosis. Attempts to disguise any faults by holding the muscles in should be discouraged.

Correct Standing Posture

The client should have on a minimal amount of clothing, or be naked under a gown, so the figure can be properly assessed. The correct standing posture is considered to be when the person stands easily, with no strain and can maintain a relaxed body posture without physically holding in any part of the body.

The head should be level and the chest slightly to the fore of the abdomen. The shoulders should be level and slightly squared.

The abdomen should be slightly retracted and the buttocks tucked in, not protruding and causing a sway backed effect.

The knees should be slightly, but not over, extended, with the feet at a slight angle to each other and not rolled inwards.

From the front, the client should look like they are able to hold the posture with ease, and have an upright, but not stiff, bearing. Viewed from the side, you will be able to confirm good or bad posture. A plumb-line dropped down a wall alongside a height measure will have the same effect. The figure would appear to have the line passing through the ear lobe, then the point of the shoulder, through, or directly behind, the hip joint, slightly in front of the knee joint axis, to end just in front of the ankle joint, through the arch of the foot, to the ground.

Line of gravity

Correct posture

Trunk

Anterior
Sternomastoid
Longus Colli
Rectus Abdominus
Obliques

Posterior
Splenius Capitis
Long erector spinae muscles

Back
Anti-gravity muscles

Lower Limbs

Anterior
Psoas major illiacus
Gluteus medius and minimus
Tensor fascia latae
Tibialis anterior
Long extensors of toes

Posterior
Hamstrings
Long flexors of toes
Tibialis posterior

Front
Anti-gravity muscles

The Back

Any deviations from the normal position of the spine should be noted, as these will limit or prohibit exercise and certain treatments, These deviations take several forms:-

Kyphosis

An increase in the normal thoracic curve, often accompanied with tightness in the pectorals. Often associated with exaggerated lumbar curve - Lordosis - which is itself associated with anterior pelvic tilt and shortened hip flexor muscles. Known as Kypholordosis if the conditions are combined.

Scoliosis

A lateral curvature of the spine which alters total body alignment. An established degree of scoliosis may cause scapula deviation, slight horizontal rotation of the pelvic and shoulder girdles, uneven shoulder position and occasional differences in leg lengths. The client is best observed in stoop standing to see the degree of the curve.

Flat Back

A flat back condition is a decrease or absence of the normal anteroposterior spinal curves. The back presents a rigid appearance. If there is mobility in the lumbar area then fine, as it can just be hereditary. If degree immobility then forward, backward and sideways tilting of the pelvis is recommmended to mobilise the lumbar region.

Rib Cage and Breasts

The shape and position of the sternum and rib cage are involved with the way the breasts look and how they are positioned on the chest wall. Improving the general posture can have an immediate effect on the bust line and general breast problems. Well supported breasts, positioned high on the rib cage appear to have fewer faults and less tendency to sag. The rib cage may be normal or expanded, boxy in shape, or may give the appearance of being long waisted.

Deposits of adipose tissue, such as midriff bulge, alter the body shape in relation to the breasts with the rest of the trunk. Any chest deformities such as pigeon or hollow chest should be noted, as these cannot be altered by exercise routines.

The breasts should be noted for size, position and any degree of sag.

Boxy Rib Cage

High Positioned Breasts

Hollow Chest

Deflated Breasts

Breast Sag

Somatotype is graded out of 7. So, for example, if someone was muscular but with a tendency to put on weight they may be a 5 meso/2 endo. The upper and lower portions of the body are measured separately.

In most clients there are elements of many body types, few people fitting in to a specific category. Active people may be nearer to the mesomorph, whilst the obese person may appear like an endomorph, due to fatty deposits. Obesity changes the total appearance and is an added factor in deciding body type.

Recognising the approximate type is helpful in deciding the correct size they should be and judging how far from it they are. It also points out the genetic shape inherited , about which little can be done. Like the bone structure and height of a person, the body type is set for life. Surface deposits of fat, which alter body shape, and postural defects can, however, be altered.

Having considered the client posture and general body type, to determine any limitations in the planned improvement, the next step in the diagnosis is to assess specific faults present.

Special Figure Faults

First, in an upright position, following on from posture checking, the figure is observed and factors concerning various parts of the body are recorded on the client's card. The general body proportions are considered first: whether the upper and lower body are balanced in size and in relation to each other.

A check list of specific body areas is useful for figure diagnosis, providing a thorough means of recording body faults.

Shoulder Girdle

Points to be observed include: the position of the head in relation to the shoulders, with regard to forward tilt. It is a postural defect if a small degree of angle is present and this will point to postural re--education. The condition known as 'Dowager's Hump', where fatty deposits accumulate at the back of the neck at the base, over the spine, is often associated with a forward positioning of the head. The shoulders, whether held high, normal or rounded will indicate tightening or shortening of the muscles.

The shoulder blades, scapulae, may project like wings or be abducted away from the mid-line. This may be a combination of poor posture and lack of fatty tissue to pad and round out the contours. If normal postural correction is difficult or painful to attain and maintain, then further help should be sought.

Arms

The arms are a problem area for many women, with conditions ranging from solid muscular appearance, with fatty deposits, to the thin, scrawny arm, with loose crepy skin. The arms may be involved in a general overweight condition, or be out of proportion to the rest of the body. Like the thighs, the upper arms are slow to reduce in size, due to underlying muscular bulk and need concentrated attention for good results.

The Waist, Abdomen and Buttocks

Muscle tone and amount of adipose tissue deposits should be noted in these areas. Weak or elongated muscles in the abdominal area may result in a protruding abdomen, which will require salon muscle contractions and home exercises. Superficial fatty deposits over the buttocks, pelvic girdle, waist and abdomen may indicate a need for general reduction. Postural faults may also be indicated here. Pelvic tilt may be present as a result of weight carried during pregnancy where the centre of gravity will be altered due to the weight being carried in front.

The link between pregnancy and abdominal weakness has to be recognised when assessing this area. Any operations in this area should also be noted, as they may affect muscle strength and, therefore, fatty deposit levels.

Pelvic Tilt

Thick Trunk Shape

General Overweight

The muscular bulk and fatty deposits of the buttocks are a common problem in figure diagnosis and may indicate that general weight loss is required. If no weight loss is needed then inch loss may be desirable, suggesting a salon treatment plan and home exercises. The general shape of the buttocks should be noted, whether rounded, hollow, low slung, or over large. An out of proportion figure with the weight around the thigh area is a common figure problem often seen in women.

Legs

The general shape of the legs should be noted. Heavy, muscular legs, due to sport or inherited will be difficult to reduce as the fatty tissue is present between muscle fibres as well as laid superficially over large muscle groups. When on a reduction diet it is subcutaneous fat that is lost first and established fat in muscular areas tends to be lost last.

The shape and any established faults should be noted, i.e. knock-knees, bow legs, hyper-extended knees or flat feet.

Fatty deposits, areas of soft, dimpled fat and areas of oedema should be noted. Circulation, varicose veins and thread veins should also be noted.

Exceptionally thin legs may also be noted and will need shaping and building up.

To complete the upright figure diagnosis, the client should be viewed from the side to obtain a total picture. Bust sag, protruding midriff and abdomen, and the position and size of the buttocks and thighs can be confirmed from the side view to give an overall picture.

Knock-Knees

Heavy Thighs

Bow Legs

Very Thin Legs

Hyper-extended Knees

Muscular Legs

Obliques

Crook lying, left elbow on bed, right hand on outside of left knee. Slowly lift torso over to left side. Repeat on other side.

Legs - Abductors

Side lying. Upper leg straight, toes pointing down to floor, foot flexed. Lift leg and holf for 10 seconds (feel degree of tone).

Adductors

Side lying, upper leg taken over to place foot flat on floor. Lift underneath leg and hold for 10 seconds.
Alternatively, in supine on elbow, support one leg bent with foot on floor. Rotate other leg out so inside thigh faces ceiling. Raise leg and hold for 10 seconds.

Quadriceps

Sit client on bed, legs hanging down. Feel degree of tone as she straightens one leg ata time. Hold each for 10 seconds.

Dorsi Flexors

Supine lying. Place your hands over dorsum of foot to provide resistance. Get client to dorsi flex foot against resistance from you and feel degree of and ease of performance.

Plantar Flexors

Supine lying. Place hand over plantar surface of foot and get client to plantar flex against resistance - not ease of movement and degree of tone.

Testing Against Resistance for strength in dorsi flexors of foot

Hamstrings

Prone lying. Whilst feeling for degree of tone, get client to bend leg to 90 degrees.
Then get client to raise the bent leg off the bed and hold for 10 seconds.

A test for excessive subcutaneous adipose (fatty) tissue in any area of the body can be made using a skin fold test. If loose surface tissues can be held away from the underlying muscles, and be sufficient to fill a finger and thumb without discomfort, the client is generally or locally overweight.

Further information is obtained about the figure during a manual treatment, where muscle tone, adipose tissue distribution and circulatory factors are noted.

Manual Body Assessment

It may be a good idea to carry out a manual massage and in this way assess the state of the client's muscular and circulatory conditions.

Skin Condition

The age of the client and her general health will have affected hew skin texture and its elasticity. A crepy or loose skin may be the result of weight loss, poor health, incorrect care, or age. Stretch marks may be from pregnancy or weight loss. Poorly textured skin, easily stimulated skin and poor circulation will all need to be recognised, as their presence will affect the plan of treatment. Varicose veins, thread veins and bruises will contra-indicate many forms of electrical therapy.

Weight Deposits

The distribution of fatty deposits in the body will determine the treatment to be given. Subcutaneous fat may make certain treatments less effective, so diet would be advised. Superficial soft fat is quickly gained and lost through diet, but hard fat deposits are more long established and feel solid to the touch. This is more difficult to remove with diet and tends to be the last area to reduce, along with trapped fat, which is easy to detect as the client is usually fairly muscular in that area. Cellulite can be seen on fairly slim clients as well as the overweight. Recognised from its dimpled 'orange peel' appearance. If long-standing it can be painful to massage over. Advice on diet and exercise is needed for all types of fatty deposits.

Test for Muscle Strength

Simple tests can be performed on the massage couch to give an initial guide to the client's strength and general mobility. A need for postural exercises, relaxation routines, or specific exercises are undertaken. The need for electrical muscle contraction is also decided at this stage. If an exercise programme needs to be given, always get the client to fill in a fitness questionnaire and carry out fitness testing.

Abdominal Area

Rectus Abdominus

Crook lying, hands on thighs, get client to slowly curl up, sliding hands up thighs as she does so (feel for the degree of tone).
If client can't achieve this, then from sitting, assist her in rolling back down to crook lying.
From standing get client to hold in stomach for 10-12 seconds and observe - best result is concave abdomen.

Gluteus Maximus

Prone lying. Feeling for degree of tone get client to raise first one leg, then the other off the bed. hold each for 10 seconds.
From standing, get client to clench gluteals together and hold for 10 seconds

Lower Back Extensors

Same exercise as gluteals (1) only feeling degree of tone either side of lower spine.

Upper Back Extensors

Prone lying, hands on bottom. Client raises head and shoulder off the bed (keeping chin pointing down) while you feel degree of tone either side of upper spine. (A well developed erector spinae groups shows itself as a channel down the spine).

Pectorals

Sitting or standing with arm in 'How' position, i.e. upper arm abducted 90 degrees, lower arm elevated at 90 degree angle to that. Feel for degree of tone while client brings arm across front of body.
From supine lying, arm in yard, feel for tone while client elevates arm, keeping it level with her shoulder.

Biceps

Client seated, arm extended in front, palm facing up. Place your hand over mid forearm (palmer side) to provide resistance and tell client to flex arm while you feel for degree of tone and ease of movement.

Triceps

Client seated, arm flexed to 95 degrees, palm facing towards client. Place your hand over mi forearm (opposite side) to provide resistance and feel for degree of tone and ease of movement as client tries to extend her arm.

Results of muscle tone are put on record card graded from excellent to very poor. Faradic treatment and home exercise can then be decided for weaker areas.

Fat, Flabby Muscle or Fluid

Fat

Check weight of client against height.
Soft fat can be easily held away from the body between finger and thumb without client discomfort.
Hard fat is less easy to manipulate and tends to be deposited on front and outer thigh and back, It us usually longer established than soft fat.
trapped fat can be seen as fairly hard fat between toned muscle, more common areas being upper arms and hamstrings.
Cellulite is seen as dimple 'orange peel' effect. Can be painful if pressed. Usually on bottom and thighs, can be on anterior side of lower leg

Flabby Muscle

Loss of normal body contours in that area.
Difficulty or inability to hold a contraction of that muscle. Will show poor muscle tone.

Fluid

Quick weight loss or gain.
Fluctuation of swelling.
Client may take water tablets.
Usually doesn't drink much water.
Weight gain and swelling just before menstruation.
Cellulite.

Medical oedema must not be confused with fluid retention as this is a medically treated condition. Skin will be distended and look tight and shiny. If on the stomach, the navel will be flat or protruding. Ifon the legs, when pressed with thumb, you will be able to see your thumb impression on removal.

If you have a client with this condition, advise her to see her doctor. The causes are various, including congested cardiac failure, cirrhosis of the liver and malignant diseases.

Conditions and Advice

Kyphosis

Condition

Kyphosis may be recognised by rounded shoulders. This causes the pectoral muscles to tighten and over stretching of the muscles over the thoracic region of the spine.

In women it can lead to sagging breasts as the suspensory ligaments which hold the breast upright become stretched.

This condition is common with females who are embarrassed about a large bust, office workers, drivers, frequent carriers of heavy shopping and people who are embarrassed about their height.

Advice

To strengthen the scapula adductors - recommend the client lies on the floor in a prone position with the forehead resting on the floor, arms can be extended upwards with palms facing the floor. Maintaining this position lift the arms as high as possible, away from the floor without raising the head or trunk. Hold the position for 2 seconds, relax and repeat.

To stretch the pectoral muscles - sit upright on a chair and lift arms so that hands are level with ears, palms are facing forwards and elbows form aright angle. Gently push the shoulders and arms backwards, hold for 2 seconds, release and repeat.

Lordosis

Condition

Lordosis may be recognised by increased curvature of the lumbar area of the lower back. This causes the muscles of the lower back to tighten and overstretching of the abdominal muscles. This condition is common with women who have been pregnant, clients who wear high heeled shoes, gymnasts, ballet dancers and clients who are trying to appear taller.

Advice

To strengthen the abdominal muscles - recommend the client lies on the floor on their back, with their knees bent and pointing upwards, feet on the floor. The client should place their hands level with their ears, and gently sit upwards only lifting the body 30 degrees upwards. At the same time ensure that the client does not tuck their neck in towards the chest. The stomach muscles should be pulled tight. Lift and hold for 2 seconds, release and repeat.

To stretch the muscles of the lower back - the client should lie on their back and pull on one knee at a time into their chest and hold with their hands for a few seconds, release and repeat.

Continue for both legs.

Scoliosis

Condition

Scoliosis may be recognised by a lateral alteration of the spinal column which could be either in a C or S shape. This causes the muscles on one side of the body to shorten which can drop the shoulder on one side, give an uneven waist line, uneven scapulae and possibly a tilting pelvis. This condition is common with mothers who carry their children on one sire of the hip, carrying heavy bags on one side, or standing with the body weight unevenly.

Advice

To strengthen the stretched muscles - recommend - (this would be the side of the body which is higher up) you would ask the client to stand with feet shoulder distance apart and push down the shoulder blade which is higher, hold, release and repeat.

To strengthen the tightened muscles -

you should stand with feet at shoulder distance apart. Place one hand on hip and extend one arm up into the air on the side of the body which is lower.

Stretch up and across over the head, hold for a few seconds, return to the original position and repeat at least 10 times.

Relationship Between Height, Weight and Body Type

During the consultation procedure you should check on the following client characteristics to ascertain how you will proceed with the treatment and what advice to give.

Weight

Weight should be checked as this will give you a guideline when deciding on the client's fitness levels and ability. If a client is overweight they may suffer from joint problems, immobility, breathing problems, backache, varicose veins, etc. A person's weight is also linked strongly with blood pressure problems and diabetes, which will restrict treatment. Being underweight is also undesirable, as it often means that the body is not getting all the nutrients it requires for efficient functioning.

Size

The client's body size and height should also be taken into account when deciding on your treatment application For example, a larger person will require more stokes to cover the area and the opposite applies for a smaller person, therefore your procedure will need to be adapted. The body size will also affect how much product you will require for an effective massage treatment. You may also have a choice of massage couches to use which my be suitable for a client with a larger frame.

A simple way of working out the client's ideal weight is to use a body mass index. To use this you simply trace a line from the height, and trace a line from the weight and this will indicate what category a person falls into. This will therefore allow you to work out what that person's ideal weight should be.

Body Norms Chart