Issue link: https://www.massageandbodyworkdigital.com/i/588318
Women who have calf cramps will especially appreciate learning daily preventive resisted stretching techniques to reduce the torturous frequency of nighttime cramps. A simple pelvic flexion and leg swing repeated daily have been shown to reduce round ligament pain common in the medial thigh, mostly in the second trimester. These are just two examples of educational activities to possibly share, if they are within your scope of practice. Observing, guiding, and informing your client about how she can maintain a more vertical, organized structure is essential to reducing almost all prenatal achiness. POSITIONING CONSIDERATIONS The side-lying position's primary advantage when working with pregnant clients is the ideal access it offers to the most needy structures. Some women's left shoulders and hips are achy from lying primarily on their left sides. This restriction is necessary only if a midwife or doctor recommends it (another example of fear-based and limited pregnancy understanding, so common in our culture). Encourage all others to switch sleeping sides, and be sure to work both during your sessions. BABY WATCH F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 71 If either side is more problematic, spend more time with that side up. There's more stability and joint protection when your client extends the table-side leg, and you place bolsters and/or pillows beneath the flexed ceiling-side leg. Align her hip, knee, and foot horizontally with supports of sufficient size and density. This level alignment of the torso and lower extremity will also reduce her tendency to roll forward with deep gluteal work and otherwise prevent rotational strain and pull to the hip, pelvic, and lumbar joints (Image 6). If she has sharp anterior pelvic pain from symphysis pubis instability, she will likely want supports between her legs, forgoing stability for comfort. As softer supports compress over time, add additional pillows to maintain optimal leg alignment as your session progresses. Add cushioning if either the hip or shoulder joint compresses the table's foam down to its plywood base. Certain products, such as Oakworks' Side Lying Positioning System and the bodyCushion, usually provide more shoulder joint space and prevent these discomforts. Sometimes a flat pillow placed across the table gives a bit more shoulder room, but much less ideally than either system's comfort. Having sufficient and firm head height protects the shoulder and the cervical spine, too, but avoid extensive side- bending. If the client's hip joint is off the torso cushion, insert a small wedge under her hip. Place a higher pillow under the arm to help fluid drainage; elevating it to face level often helps ease carpal tunnel symptoms by allowing further mechanical drainage. Semi-reclining or supported supine positions usually give the best access to the inguinal area and thigh. Remember to avoid inguinal and medial deep pressure, but the anterio-lateral rectus femoris, vastus lateralis, and iliotibial tract may safely benefit if there are no vascular issues evident. The more dangerous veins are medial, with the femur between them and your pressure—that is, as long as your vector is not directed to those veins. FINDING THE WAY With so many hormonal, structural, and emotional changes to adapt to, women live with many common discomforts throughout their pregnancy. Your job as a massage therapist is to understand these changes, discern what you can do to help your client, and educate yourself on the protocols that can safely assist her along her journey. Carole Osborne is an author and instructor of pre- and perinatal massage therapy and other somatic arts and sciences. See her workshop and mentor group schedules at www.bodytherapyeducation.com. Contact her at carole@bodytherapyeducation.com or via Facebook at Carole Osborne's Prenatal and Deep Tissue Massage Training. Find an expanded discussion of this topic, including specific techniques in her book, Pre- and Perinatal Massage Therapy, 2nd ed. Free videos are available at www.bodytherapyeducation.com. Safe, comfortable side-lying positioning requires horizontal alignment of hip, knee, and foot, including support under the belly, and sufficient space for shoulder, arm, and head. Photo courtesy of Oakworks. 6