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Massaging large clients

Massaging large clients

Posted: 8/1/18

Olivia is getting longer and skinnier by the minute. She's all legs. Jona is twice her size and weight and eats the same amount. The story of my life.

Years ago, a massage magazine published an article saying fat people shouldn't be massage therapists. Their fat could get in the way and inappropriately touch clients.

I was both devastated and angry. I've been large much of my life and called many things, but this was the first time I'd been told I shouldn't have the career of my dreams because I was fat.

Throughout my time as a massage instructor, I heard students complain about massaging large classmates, saying "I can't feel anything but fat." I struggled with how to separate fat phobia from a fair question that merited education.

Fat people are people too and deserve access to quality massage therapy. Treating large bodies can require accommodations. Here are some tips for making sure your large clients have a good experience:

  • Comfort is key. Make sure the client feels safe, respected, heard, and comfortable. If your table has arm rests, use them. If not, roll up a towel for under their shoulders. If your bolsters are not wide enough, use two pillows, one under each knee (supine) or each ankle (prone). Elevate their upper body if they have difficulty breathing deeply when lying flat.
  • Bolster for better access. Place a pillow, small bolster, or wedge under their spine when supine. This will help excess tissue drop towards the table or their waist, allowing you more access to their neck and chest. Ask them to roll up slightly to give you access to their scapula area or hips. It's better to ask than struggle getting your hand underneath them, which could make them feel embarrassed.
  • Go slow. Awareness is key. Adipose tissue is not all on the surface. You will find much of what you're looking for along the way as you explore deeper.
  • Be gentle. You don't have to push hard through the adipose tissue to get to the muscles. The fat pushes on the tissue beneath it which pushes all the way through. Everything is affected.
  • If you're not sure, ask. Get feedback as you work. If you're unsure about what you feel, ask them.

Everyone has fat phobia. We're trained by health care providers, the media, and bullies at school to hate fat. Women internalize it and are filled with fear and self-hatred. And remember, it's women who make up the majority of our profession and our clientele.

It's important we sensitize and educate ourselves. This research summary and blog post may change the way you think about your large clients.

There is such a thing as "metabolically healthy obesity"

51 ways to make the world less hostile to fat people

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In health,

Introducing Olivia, me, and a stunning statistic

Introducing Olivia, me, and a stunning statistic

Posted: 6/8/18

New beginnings are always full of promise and excitement.

We just got a new puppy, Olivia, who is bringing joy and a bit of chaos into our lives.

This, my first blog post, is another exciting beginning. One that shouldn't require a call to the carpet cleaner!

Going forward, I'll be sharing about my life's obsession: How to advance massage therapy in integrative health care.

But first, an introduction.

I'm a massage therapist, with 35 years in this amazing profession. My practice is focused on post-surgical work, but I see patients with everything from chronic illnesses to spinal cord injuries to strokes.

In 1988, I opened a large medical massage clinic. In the 1990s, I wrote books on SOAP charting and consulted on research. I also chaired the Massage Therapy Foundation, funding research internationally in the new millennium.

Most recently, I co-edited a book on pain management and created Hands Heal EHR, an electronic health record system for massage therapists.

I've got a head full of statistics and ideas I can't wait to share with you.

Here's one that's truly stunning:

Only 54% of opioid overdoses are unintentional

That tells me that people really struggle with the dependence on prescription pain medication. For some, there's enough physical and psychic pain that they'd rather remove the struggle altogether.

We know pain. Massage therapy is now included in the list of federal and state recommendations to alternatives for prescribing pain medication.

Make yourself available to pain clinics, cancer centers, and other biomedical providers that aren't familiar with prescribing massage therapy.

We can be part of the solution.

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In health,

Informational Videos


Instructional prompts help you chart better

Contributing to research

Why Massage Therapists Should Chart

Hands Heal EHR Client Participation

Diana L. Thompson on Hands Heal EHR (full interview)

August Teaching Tip - Charting with Diana Thompson

Global Massage Makes Me Happy Day