Issue link: https://www.massageandbodyworkdigital.com/i/81195
Q & ART • Gravity—Consider adjusting the legs of your table to have the head 2–3 inches higher than the foot. • Headrest—These are all factors: the comfort, fi rmness, shape, and particularly the fl exibility of the headrest to move into fl exion or extension a bit to accommodate individual differences. The investment in a state-of-the art headrest is money well spent, but may not solve the problems of sinus congestion, claustrophobia, or lack of mobility to work with the neck in different positions. Pillow Positioning Place the pillow(s) so that there is no pressure applied to the anterior neck, allowing the head and cervicals to comfortably rest to one side in forward fl exion. This is a great position to gently mobilize vertebrae with side bending and rotation, which is impossible with the head immobilized in a headrest. It is beyond the scope of this article to go into the complex explanations of spinal mechanics, but observe how with a left side bend of the spine and head, the thoracic vertebrae rotate to the right, while the cervicals rotate to the left. So working in the non-neutral position offers an excellent opportunity to free up the motion of the spine for rotation as well as side bending. Apply downward rotational pressure on the transverse processes of the thoracic area on the concave side of the bend and on the convex side of the cervicals to improve spinal mobility. A PARADIGM SHIFT? Most importantly, simply ask clients if they prefer to use a headrest. Too many therapists automatically begin massages in the prone position with a headrest in place, so clients just assume this convention is not open to discussion and that there are no other options. As is often the case, good communication is the key. If sinus congestion is an issue, explain that it is a common problem and simply suggest trying an alternative. The fabulous side-lying position that I often tout is a simple and effective solution. Not only will it take care of sinus problems, it also affords many positioning options to actually accomplish more effective work. Be sure to provide a thick enough pillow to keep the neck in a neutral position. If you often utilize side lying, you may want to add a 2-inch pad of fi rm foam under your sheet to ease pressure on the shoulder girdle—your clients will be more comfortable in all other positions, too. My favorite suggestion, however, is to lose the headrest and place a pillow under the chest and abdomen so that the neck can comfortably rest in forward fl exion to one side in a combination of side bending and rotation (see Pillow Positioning, left). I hope this helps in solving the problem. These positional options are also really great in general, irrespective of any nasal congestion or headrest issues. My clients love prone work with the neck in side bending and rotation for its advantages of stretching short muscles and improving mobility. Art Riggs teaches at the San Francisco School of Massage and is the author of the textbook Deep Tissue Massage: A Visual Guide to Techniques (North Atlantic Books, 2007), which has been translated into seven languages, and the seven-volume DVD series Deep Tissue Massage and Myofascial Release: A Video Guide to Techniques. Visit his website at www.deeptissuemassagemanual.com. 30 massage & bodywork march/april 2012