Making Masks and Gloves Work

PPE Tips and Advice for the Massage Therapist and Bodyworker

By Karrie Osborn

Outside of a hospital, oncology, or hospice setting, most massage therapists and bodyworkers have never had to wear face masks in their practice. And it’s on the rare occasion that an MT needs to give a massage with gloves on. But what once was a rarity will be the norm going forward until we find solutions to combat COVID-19. As ABMP first recommended in our Back to Practice guidelines released on April 24, clients and practitioners need to wear face coverings in their therapeutic interactions going forward. This will not be easy, but neither should it be overwhelming. To help make the transition a little smoother, we’ve compiled some of the best tips and advice we’ve found for wearing masks (and gloves) in your practice.

Wearing it Right

The most important aspect of wearing a face mask is wearing it right. Make sure your mouth and nose are both covered, with masks extending below the chin. Anything less means the mask is ineffective.

• For an explanation and overview of the kinds of personal protective equipment (PPE) and their uses, read ABMP’s “Use of Personal Protective Equipment (PPE) for Massage Therapists.”
• For an explanation on how to properly don (put on) and doff (take off) all the various kinds of PPE you might use in your massage or bodywork practice, watch this ABMP video.

• Click here to see what PPE is available from our ABMP Discount Partners.

In getting comfortable with wearing a mask, it’s important to figure out how it works best for you. You want masks that fit tight enough to do their job, but not so tight you feel like your breath is being restricted. Masks need to be big enough to properly cover your nose and mouth, but not so big that they gap and hang loose at the edges. With experimentation, you will decide what styles and sizes fit you best.

As recommended by the Centers for Disease Control and Prevention, much of the public will wear cloth face coverings in their daily comings and goings while we deal with COVID-19. Until the supply chain is fully resupplied with PPE (including disposable surgical/procedure masks and N95 respirators), and until hospitals and health-care workers have the PPE they need to work safely, cloth face covers might initially be what you will use in your practice too. When you begin practicing, have enough masks so you can use a clean one for every client you see throughout the day. These can be laundered with your other massage linens. While you can get a variety of cloth masks from clothing companies that have pivoted to producing them for consumers, it’s nice to support local mask-makers if you can. Look for face coverings made with the CDC’s homemade mask guidelines. Some cloth masks even come with a pouch to put a disposable filter.

“Homemade cloth masks are great … if they fit properly,” says Kerry Jordan, operations director at Healwell, an organization that provides massage therapy and education in hospitals in Washington, DC, and around the world. “If they are too big, too loose, too small, etc., they aren’t effective. Make sure your mask is snug on your face without openings or gaps at the sides and around the nose.” Jordan says a recent a study out of the University of Illinois suggests that a double layer of T-shirt material is the most effective of fabrics available at home to make a mask from, and also the most breathable—even more so than medical masks.¹ Experts say this is important because if a mask has low breathability, then air will be brought in from the sides of the mask on inhalation, making its protection much less effective and giving its wearer a false sense of security.²

Here are some of Jordan’s other best practices for wearing masks in general:

• Don’t touch it. It’s important you don’t touch the exterior of any mask you wear. “This is another good reason to make sure your mask fits,” Jordan says. The better the fit, the less adjustments you’ll need to make.
• Limit talking. “The more you talk, the more your mask will move, the wetter it will get, and the more you will be tempted to touch it.”
• Change your mask between every client. “Don’t try to get through the day with a single mask,” Jordan says. “Besides being unsanitary (a new mask for each new client interaction is absolutely required), it will be uncomfortable. Masks get wet even if you’re not talking. You produce a LOT of ‘mouth rain’ even just breathing.”

Additional Mask Advice

• Don’t push your mask below your chin; instead, remove it properly by the ear loops when you need to answer the phone, drink water, etc., being careful not to touch the exterior.
• Remember, face covers are intended to keep the person wearing them from spreading droplets when talking, sneezing, or coughing. Simply put, when you wear a cloth mask, you are protecting others. When others wear them, they are protecting you.
• Don’t let your mask give you a false sense of security. Proper and frequent handwashing, limited outside contact, and social distancing remain critically important.
• Even when wearing a mask, it’s important that everyone still practice proper respiratory hygiene by sneezing or coughing into their arm, confirms Shanina Knighton, a clinical nurse scientist and infection preventionist.³ This seems especially important in the treatment room.
• Have a supply of disposable surgical face masks for outfitting anyone who comes to their appointment without a mask. Again, until the PPE supply chain regains its health, prices for these masks may be considerably more than they were pre-COVID, shipping times may be extended, and you may be limited in the numbers you can buy.
• While N95 respirators are still in short supply for frontline workers dealing with COVID-19 patients, these may be the type of PPE you will want to use in your practice once they become more readily available, as they provide the wearer much greater protection.
• According to the Food and Drug Administration (FDA), people with chronic respiratory, cardiac, or other medical conditions that make breathing difficult should check with their health-care provider before using an N95 respirator specifically, because it can make it more difficult for the wearer to breathe.

Comfort is Important

One of the most common complaints about wearing masks is how uncomfortable they are. From an ill-fitting mask to one that rubs your ears raw, most masks are not built for the greatest comfort. But that doesn’t mean you have to settle for them being painful either.

Ear loops are the biggest instigators for discomfort. Crafty innovators and ear-lesioned nurses have been working on that problem for the health-care community for years. Nifty S-hooks, crocheted mask extenders, or even just a simple paperclip can be used to hook the loops behind your head and give your ears some relief when you need to wear your mask for an extended period of time. Another DIY option is sewing buttons onto headbands to loop your mask to. (Search the internet for any of these items using the words ear savers or ear guards, and you’ll get hundreds of options to consider.) These hacks work with cloth face coverings and surgical or procedure masks.

Here are some additional comfort tips:

• Nose and skin savers—Put a piece of medical tape on the inside of the nose bridge of the mask to help avoid slippage and chaffing issues. Moisturize consistently and frequently as your skin gets used to this new irritant and builds up a mask “callous” of sorts.
• Feeling claustrophobic? Longtime mask wearers suggest popping a mint in your mouth before masking up as it will lessen that sensation.
• Foggy glasses—A 2011 study found that washing eye glasses with soap and water could fix the foggy glasses problem. “Immediately before wearing a face mask, wash the spectacles with soapy water and shake off the excess. Then, let the spectacles air dry or gently dry off the lenses with a soft tissue before putting them back on.”⁴ Others swear by an eyeglasses defogger spray you can buy from a variety of retailers.

A Reminder About N95 Respirators

The N95 face mask, called a respirator, is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including dust particles and infectious agents), as well as gases or vapors. It also protects those around you from being exposed to any of your droplets. This is the type of PPE mostly used by medical staff as they deal with coronavirus patients, and which has been in dangerously short supply. Once N95s come back plentifully into the supply chain, you might consider using these for yourself in your practice.

Remember, in a massage or bodywork setting, if a client is asymptomatic but unknowingly has COVID-19, or if a client feels they can’t wear a mask in prone position, then wearing an N95 face mask could provide the best protection for massage therapists.

Also, please note that recent expert guidance says N95 masks with a front vent are not recommended, as they protect the wearer, but not necessarily others. These front-vent masks are typically used in construction and are meant for one-way protection from dust and particles. This type mask can emit droplets and would not keep your clients safe. A cloth face covering or surgical face mask would be preferred in this instance.

While N95 respirators are meant for one-time use, the medical community has been conserving their inventory and reusing these items. To reuse an N95 mask, make sure to put it into a paper bag and only remove it again using the straps. Consider purchasing several N95 masks you can cycle through, giving each used respirator a three-day window to air out in its paper bag before reusing it again. Discard a respirator once it is wet or visibly soiled.

Gloves For When You Need Them

While the use of gloves might be prudent when taking payments, and certainly when undergoing sanitation processes, there has been no universal mandate that they be worn by therapists in a massage or bodywork setting. However, you may find some clients are more comfortable having you wear gloves during their session, so it’s a good idea to get comfortable with them.

While many of the gloves you might purchase for your practice come in one-size-fits-all, other glove brands come in a variety of sizes. This customization can make a huge difference in the qualitative value of your touch. “As someone who often gives massages in the hospital while wearing gloves, I can tell you that having gloves that fit is key,” says Jordan. “If your nitrile gloves fit, neither you nor your client will be aware of them during the massage. If they are too big, you will feel them sloshing around and bunching up and it will not feel good. Honestly, it will probably be more distracting for you than for your client. When I haven’t had access to small gloves in the hospital, patients generally report not noticing at all, but it’s felt very different to me.”

During sanitation procedures, Jordan says one way to reduce waste and costs is to “use dishwashing gloves and reuse them, being careful to sanitize them between uses. So, there’s a tradeoff there—disposable nitrile gloves are ‘easier,’ but probably more expensive in the long run (especially environmentally speaking).”

Where Can I Buy It

Start sourcing and researching the various kinds of PPE you’ll want to use in your practice. The supply chain is still severely hampered, and products like N95 respirators are still very hard to come by (especially at a reasonable price). While some manufacturers say they have product to ship today, it’s important to do your homework, vet the company you want to work with, and determine if their products are right for you.

It’s also important to be careful about purchasing inferior or counterfeit products.

According to the CDC, there are several signs that a respirator may be counterfeit:5

• No markings at all on the filtering facepiece respirator
• No approval (TC) number on filtering facepiece respirator or headband
• No NIOSH markings
• NIOSH spelled incorrectly
• Presence of decorative fabric or other decorative add-ons (e.g., sequins)
• Claims for the approval for children (NIOSH does not approve any type of respiratory protection for children)
• Filtering facepiece respirator has ear loops instead of headbands

Practice Makes Perfect

It will be good to practice using your various PPE before you start seeing clients. What are the challenges, and what gets better with practice? Use your partner or your children as guinea pigs so you can experiment and feel firsthand what working in a mask or gloves feels like. Those colleagues who work with PPE on a regular basis tell us the process gets easier with time and practice.

How do you make it work? Write your best tips in the comments below to share with your massage and bodywork community.

Notes

1. O. Aydin, M. Emon, and M. Saif, “Performance of Fabrics for Home-Made Masks Against Spread of Respiratory Infection Through Droplets: A Quantitative Mechanistic Study,” MedRxiv, (April 2020), accessed June 2020, https://doi.org/10.1101/2020.04.19.20071779.

2. Ibid.

3. T. Haelle, “Everything You Need To Know About Wearing Masks—Until The CDC Tells Us More,” Forbes, April 7, 2020; accessed June 2020, www.forbes.com/sites/tarahaelle/2020/04/07/everything-you-need-to-know-a....

4. S. Malik and S. Malik, “A Simple Method to Prevent Spectacle Lenses Misting Up on Wearing a Face Mask,” Annals of The Royal College of Surgeons of England, 93, no. 2 (March 2011); accessed June 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC3293317.

5. Centers for Disease Control and Prevention, “Counterfeit Respirators/Misrepresentation of NIOSH-Approval,” last updated June 1, 2020; accessed June 2020, www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html.