Massage & Bodywork

JULY | AUGUST 2018

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A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 43 PATHOLOGY PERSPECTIVES avoidant, but they can derive great benefit from carefully and skillfully applied massage therapy, with appropriate accommodations. Massage Table Weight Capacity Most standard portable massage tables can handle up to 500 "working pounds" of pressure—that is, the weight of the client, plus the downward and moving force exerted by the therapist. Sturdier tables are available, and they are an important investment for plus-size clients. (That said, it is important to point out that lots of tables break under the weight of clients who are not obese. Sometimes table breakage is an issue of maintenance and structural integrity, not of a client's weight.) Furniture Another often-neglected adaptation for larger clients is the furniture in waiting rooms. Do all your chairs have arms? If they do, are they wide enough to comfortably accommodate a person who is obese? If not, consider adding a couple of armless chairs to your office. Client Positioning People who are overweight may have breathing difficulties and low-back pain while supine. And being prone can be uncomfortable for women of any size if they have large breasts. Extensive bolstering can help, and a table with breast recesses is useful too. Arm extensions are a popular add-on that are much appreciated by large clients. Some therapists find that doing a lot of work with the client in a side-lying position is a good option too. Linens Typical massage table sheets may not provide adequate coverage, especially when a client turns over. Some therapists recommend using a full- size or queen-size top sheet for clients who are bigger than average. Technique Clients who live with obesity also require accommodations in technique. Bony landmarks are less obvious, so we need to be more sensitive to subtler signals about anatomy. While many massage therapists assume that clients who are overweight require more pressure for massage to be effective, the opposite is often true: many people with this body type are extremely sensitive to touch and easy to overtreat. And as we've discussed, these clients are at risk for cardiovascular problems, diabetes, and many other challenges, so we need to know what medications they use, if they've had surgery, and what side effects and other repercussions of treatment they experience. This is a topic we will discuss in part 2 of this series. Communication In my opinion, the most important accommodation a massage therapist can make for a client who struggles with obesity is to take care in the way we communicate— verbally and nonverbally—about our client's body. It is easy to fall into the "I always give wellness advice to my clients" kind of attitude, but I promise you our overweight clients know they're overweight—they don't need anyone to point it out. What they need from us is an opportunity to have a positive physical experience that celebrates their wonderfulness and that helps them meet their goals (not ours). They don't need a lesson in nutrition or exercise unless (a) they ask for it, and (b) we are qualified and credentialed to give such counseling. So instead of, "Have you tried the supplement or exercise?" maybe we can switch to a message like, "I'm glad you're here. Let's have a really great session." My entire life I've had to deal with people intentionally or unintentionally rolling their eyes at me. They think I'm not healthy, I'm unhygienic, I'm lazy." —Marcy Basile, LMT, massage therapy instructor, personal trainer Massage therapy—by definition safe, welcomed, nonsexual touch—can help fill the need for human connection. We can have a powerful, positive influence on a person's physical experience, just by creating an hour when our client can feel cherished, precious, and beloved. Many obesity treatment protocols call for nonfood rewards—it's hard to imagine a better reward than massage. I urge readers of this article to consider how they can be of service to this population of touch-starved people. What will you do to meet the needs of your clients who are obese? Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology (available at BooksofDiscovery.com), now in its sixth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com or wernerworkshops@ruthwerner.com. Obesity becomes a self-sustaining condition. In other words, once a person's physiology and internal chemistry has changed, it becomes increasingly difficult to reverse that change.

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