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L i s te n to T h e A B M P Po d c a s t a t a b m m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 73 abdomen on the psoas muscle attachments to the spine, treating rectus abdominis muscle strains, and working on menstrual pain or alleviating constipation issues. Also, visceral manipulation techniques can be effective if the therapist has the appropriate training. Above all, abdominal work should only be performed with an explicit request or consent of the client. PECTORAL MUSCLES In the Unites States, working the pectoral muscles of a female client can also be problematic. As an expert witness, I have seen many cases of sexual assault in a massage setting that start with the therapist working the upper pectorals and drifting onto the breast and beyond. In the oversexualized cultural context of the United States, massage of breast tissue is not recommended. In most states, in fact, breast massage is illegal. In certain provinces of Canada, breast massage is an accepted technique. In massage school programs of 2,400- plus hours of training, breast massage is often taught and is performed regularly on clients where there is a good reason. These provinces' regulations are clear and strict; for instance, the client must consent in writing each time a breast massage is performed. Women with certain conditions can definitely benefit from pectoral work and (in some cases) work on, near, or under breast tissue. Cases of clogged milk ducts in nursing mothers, painful surgical scarring on the breast, and intercostal and lower pectoral muscle strains are instances where manual therapy treatment is effective. In the United States, I suggest two ways of working on the pectoral muscles of a female client. One: Carefully drape one side of the chest with just the very upper pectoral muscle undraped on one side. Work the upper segment of the muscle, then redrape the client and undrape the other side to continue the work. Two: Work through the sheet or towel in There are exceptions, such as an injury to the adductor muscle tendon units in the upper thigh, where the client has explicitly requested treatment. However, only a therapist trained and confident in injury assessment and treatment work should honor that request. In this type of session, assessment is crucial because a pain in the groin area might be coming from the low back. For example, an inflamed iliolumbar ligament or hip joint will often refer pain to the groin area. The therapist must be skilled in assessment and able to differentiate an adductor injury from other injuries that refer pain to that area. There are also a number of gynecological and urological issues that would refer pain to the upper inner thigh as well, but these are beyond the scope of the massage therapist. Unless there is a specific injury or pain to address, it is recommended to avoid the inner upper thigh area. Working on the area is not necessary in a relaxation massage and often causes the majority of clients to tighten up. ABDOMEN The abdomen is also a very sensitive area for the majority of people. Many emotions and feelings are held in that part of the body. Working on the abdomen is often used as a gateway, along with the inner upper thigh and the pectoral muscles, therapists with sexual predatory tendencies who are testing how far they can go without meeting resistance. Therefore, some of the larger spa companies prohibit any work on the abdominal muscles. Additionally, launching into work on the abdomen without a specific request can create a scary, unsafe environment for the client. There are certain instances where abdominal work can be very useful. Examples include working through the small circular motions. Work the upper pectoral muscle with moderate pressure. In my opinion, if we lived in a different, more evolved time, it would be acceptable and beneficial to work on parts of the breast tissue, but not in the current social climate in the United States. CONCLUSION Always treat the client and their body with sensitivity and respect—the very same way you would wish and expect to be treated. Always ask permission, and be especially aware and careful when you work on more sensitive and personal areas of the body. Provide a space that upholds client safety to cultivate trust and maintain boundaries. Remember, trust takes time to build, yet can be damaged in seconds. If you follow these guidelines, you will protect not only yourself and your clients, but also your employer and the massage industry as a whole. NOTE 1. National Council for Behavioral Health, "How to Manage Trauma," May 2013, www. uploads/2013/05/Trauma-infographic.pdf. Ben E. Benjamin holds a PhD in sports medicine and owned and ran a massage school for over 30 years. He has studied under James Cyriax, MD, widely known for his pioneering work in orthopedic medicine. Dr. Benjamin has been teaching therapists how to work with injuries for over 35 years and has been in private practice for over 50 years. He works as an expert witness in cases involving both musculoskeletal injury and sexual abuse in a massage therapy setting. He is the author of dozens of articles on working with injuries, as well as these widely used books in the field: Listen to Your Pain and The Ethics of Touch.

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