Wondering how you can accommodate obese clients in your massage practice? Here are a few suggestions for modifying your massage techniques and adjusting your massage table for obese clients.

Save your hands! Use a massage tool for deeper strokes.

1. Set the massage table height lower.
   You probably have your massage table set at a “standard” height that works well for most of your clients. With thicker clients, however, you may need to adjust the massage table a few notches lower.
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   Don’t sacrifice your body mechanics or risk injury with a table height that forces you to stretch beyond your comfort zone or stand on your tiptoes. Stand on a folding massage stool if you need to (not a rolling one!).

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2. Use side arm extenders.
   Massage table side extensions are a lifesaver for therapists. They increase the comfort of wider clients without sacrificing the width of the table required for safe ergonomics. Side extenders can easily be added when you need them and removed when you don’t need them.
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3. Use massage tools for deeper access.
   The extra effort needed to massage thicker clients can easily fatigue your thumbs and fingers. Use your elbows and forearms as much as possible to take the strain off of your hands. Massage tools, such as a thumb helper, hand helper, or T-bar, also help you massage deeper without straining your hands. Don’t be afraid to use them as needed. Most clients can’t tell the difference between the touch of your fingers and the touch of a massage tool.
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4. Consider floor work.
   Don’t exceed the static weight capacity or working weight capacity of your massage table. If a client exceeds the weight capacity of your table, suggest Thai massage or other form of floor massage. Both you and your client can fully relax without any nagging fears that the massage table will collapse, and working on the floor will give you better leverage and more options for positioning.

Reflexology views the feet as the map of the body.

Reflexology is an increasingly popular spa and therapeutic treatment that focuses on healing the body through applying specific pressure to the feet, hands, and ears. The goal of reflexology is to achieve a state of internal and external balance in the body through stimulation of the nervous and energy systems.

Reflexology is based on the idea that there is an invisible map on the feet, hands, or ears that corresponds to the health of a certain area of the body, such as the lungs, the lower back, or the liver. By stimulating a certain point on the feet, a specific organ in the body is also affected. Stimulating the reflexes balances the various systems and organs in the body and allows the body’s energy to flow freely.

During a reflexology session, the practitioner will ask you to remove your shoes and socks and lie down on a massage table to encourage deep relaxation during the treatment session. The practitioner will sit on a rolling stool at the foot of the massage table and wash and dry your feet before beginning treatment. Using the thumbs and fingers, the reflexologist will apply gentle pressure to certain areas on the feet that correspond to your health concerns. Depending on the length of the session and your specific concerns, the practitioner may also focus on the hands and ears.

A full reflexology session generally lasts for one hour, although some sessions may be shorter. Reflexology is beneficial for a large number of health concerns. It can be used as a stand-alone treatment or as a complementary therapy.

Although primarily designed for athletes and those involved in regular physical activity, sports massage also benefits weekend warriors and individuals with chronic injuries.

The goal of sports massage therapy is the prevention or treatment of injury in order to enhance athletic performance by focusing on strength, endurance, and flexibility. Sports massage uses techniques that are similar to Swedish massage but more vigorous and energizing in nature. Some sports therapists also use trigger point massage in treating their clients.

Sports massage is broken down into four categories:

1. Pre-event

Sports massage therapists use portable massage tables in order to treat athletes on-site at sporting events. Massage before an athletic event stimulates the muscles, helping the athlete to warm up before an event. On an emotional level, pre-event massage relieves anxiety over athletic performance. An athlete generally receives this type of massage 15 to 45 minutes before an event. Depending on the athlete’s sport, the massage therapist will focus on the areas of the body that will experience the most stress during the event.

2. Post-event

Sports massage after an event helps to speed recovery. This type of massage occurs within an hour or two after an event, usually on-site with a portable massage table, and focuses again on the areas of the body that experience the most stress in the athlete’s particular sport, including any area that feels particularly sore or painful after the event. In most cases, no massage oil or lubricant is used before or after an event, and the athlete remains fully clothed.

3. Restorative

Sports massage during training is restorative, helping the tissues to recover from intense training and preventing injury, including chronic injuries that set in over time. Restorative massage focuses on areas of the body that are vulnerable to overuse injuries in a particular sport and areas of the body that have been injured in the past and may be susceptible to reinjury.

4. Rehabilitative

Rehabilitative massage focuses on recovery from injury. The location of injury and any other areas of the body directly affected by the injury or directly contributing to the injury receive the greatest attention during this type of sports massage. The muscles around the injury often tense up and other parts of the body work harder to make up for the injured area. Sports massage allows these muscles to relax and prevents further injury caused in areas of the body that bear more stress than normal in order to favor the injured area.

A sports injury can cause an athlete to feel frustrated or anxious because of their inability to perform to their full athletic potential, if at all. Sports massage helps to ease the emotional and mental stress of an injury as well as the physical stress.

Through the use of energy stimulation and flow, Reiki practitioners promote physical, mental, emotional, and spiritual wholeness in their clients.

Reiki is a popular form of energy healing based on the assumption of a universal life force energy known as chi. This form of energy work is taught by Reiki masters, who grant their students access to Reiki through attunements that allow chi to flow freely through their students.

Most energy practitioners use a special massage table designed with Reiki end plates. These end plates allow the practitioner to sit on a massage stool with knees under the table while administering Reiki. The end plates on standard massage tables are too low for the practitioner to sit comfortably close to the table.

During a Reiki session, the practitioner performs mind-body therapy to control and redirect the flow of chi throughout the client’s body. As the client relaxes on the Reiki table, the healer often takes a brief moment to enter a meditative, neutral state of mind (otherwise known as grounding or centering) in order to attune to the client’s energy and state of being.

Guided by a refined sense of intuition and the basic techniques established for Reiki treatment, the practitioner lays hands on certain areas of the client’s body, holding each position for several minutes. The practitioner may also choose to hold each hand position several centimeters above the client’s body, rather than directly touching the client.

As a holistic therapy, Reiki generally focuses on the whole body, but as treatment for injuries, it may focus on a localized area of the body to promote healing. Most recipients of Reiki benefit from the deep state of relaxation experienced during therapy. They also report a feeling of general wholeness and well-being.

Massage therapy reaches out to seniors with a gentle, caring touch.

Massage for the elderly takes into account the special needs of the body as it ages. Massage therapists who work with seniors are acutely aware of the need to use a gentle touch. They know the importance of communicating with elderly clients to assess painful or sensitive areas of the body so that the client is as comfortable as possible throughout the massage.

The massage table height may be lowered for safe and easy access for individuals with limited mobility. Once the client is comfortably resting on the massage table, the massage therapist rarely asks an elderly client to move during the massage session.

For clients who are less agile or wheelchair-bound, the therapist may use a desktop massage support, which allows the client to remain in bed or in a wheelchair during the massage. The soft and ergonomic desktop massage portal helps the client to relax and allows the therapist to easily reach aches and pains in the back and neck areas.

The hands and feet of seniors may require greater attention than for younger clients. Hand and foot massage can reduce swelling and ease the pain of arthritis.

Seniors who receive massage benefit from the alleviation of general aches and pains and improved overall health. Senior massage also can improve the quality of life for clients who suffer from Parkinson’s, Alzheimer’s, and other degenerative diseases.

In addition to relief from joint pain, body aches, and stiffness, the benefits of senior massage also extend to emotional and mental wholeness. The intimate interaction of physical touch and gentle caring helps to ease the loneliness and depression many seniors experience.

Pregnancy massage is a specialized form of massage therapy designed to complement prenatal and postnatal care for pregnant women.

• The Benefits of Pregnancy Massage

Pregnancy massage, which includes prenatal and postnatal massage, is designed to relieve stress and soothe the aches and pains of expectant and new mothers.

Massage therapists who are certified in prenatal or postnatal massage therapy modify their massage techniques to improve the mother’s comfort during and after pregnancy. Prenatal and postnatal massage helps reduce stress, diminish swelling, soothe physical discomfort, and alleviate depression and anxiety.

• What to Expect During Pregnancy Massage

Your prenatal massage therapist may ask you to lie on your side on the massage table, with one or two wedge or bolster pillows for support and comfort. Some massage tables include breast and belly cutouts for pregnant clients, but the safety of these pregnancy massage tables is hotly debated in the medical world.

As a result, your massage therapist may choose to position you on your side or in a reclining position rather than face down. A massage table with an adjustable backrest can increase the comfort and safety of pregnancy massage in the reclining position.

• Communicating with Your Healthcare Provider and Massage Therapist

If you are considering pregnancy massage, discuss this with your prenatal care provider. If your obstetrician or midwife approves you for pregnancy massage, look for a professionally certified massage therapist with training in pregnancy massage.

Before your first pregnancy massage, let your massage therapist know of any discomfort you may be feeling or any areas that you prefer not to be massaged.

Many pregnancy massage therapists require a signed approval form from your healthcare provider before they will provide pregnancy massage. Some complications during pregnancy may rule out the safety of massage. Certain massage facilities may also refuse pregnancy massage during the first trimester.

Understanding the various types of massage will help you choose the best style of massage therapy for your needs.

     1.   Swedish massage is the most common type of therapeutic massage. This method involves long, rhythmic strokes, kneading, and a circular flow of movement using massage lotion or oil. The Swedish massage technique focuses on relaxing the superficial layers of muscle. This form of therapeutic massage is gentle and soothing and is an excellent style for those who are receiving a massage for the first time or who prefer a softer touch. Some massage therapists use aromatherapy to complement the physical touch of massage with the pleasing fragrance of essential oils or a reed diffuser. Swedish massage is ideal for use in the home, as it is uses simple techniques that may be practiced without formal training.

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           2.   In Deep Tissue massage, the therapist targets the deeper layers of muscle and connective tissue, using a slower, deeper stroke technique across the grain of the muscle. The benefits of deep tissue massage are particularly valuable for chronic pain, muscle strain from repetitive use, and treatment or prevention of injury. Deep tissue massage therapy may cause sore muscles for a day or two following treatment.

           3.   Shiatsu massage is a Japanese form of bodywork that focuses pressure on specific points of the body, following the twelve meridians, or channels of energy, defined by Traditional Chinese Medicine. The massage therapist applies steady, gentle pressure on specific areas of the body in order to promote the free flow of energy throughout the body. Shiatsu massage techniques are administered through loose, comfortable clothing without the use of massage oils or lotion.

     4.   Thai massage focuses on the free and balanced flow of energy throughout the body by applying light pressure, following the traditional meridians of Chinese medicine. Thai massage is a passive form of yoga, where the therapist guides the client in focused stretching and movement. Unlike most types of therapeutic massage, Thai massage is performed on a mat on the floor rather than on a massage table.

Some massage techniques are used only for certain populations. Sports massage is tailored to athletes’ needs, and infant massage is for babies. Each of these techniques has specific qualities that make it unique. Prenatal massage and postpartum massage are no different.

Prenatal massage, which is also referred to as pregnancy massage, is a very effective way to relieve pain for pregnant woman when availability to medications is often limited. Pregnancy massage can also be helpful for stress reduction and to assist in the reduction of swelling by increasing blood and lymph circulation. Others say it can give relief from muscle cramps, spasms, and myofascial pain, improve the outcome of labor, ease labor pain, enhance pliability of skin and underlying tissues, and provide support for the new mother with the physical and emotional strains of mothering. While there can be many benefits from prenatal massage, there are a few precautions that a certified pregnancy massage therapist should know about.

One thing that is very important for the client to tell the therapist is what, if any, aversions they have to scents or sounds. Many pregnant women have extra sensitivity to these types of environmental factors. They can easily be changed by the massage therapist, so don’t let that stop you from enjoying your massage experience. Another precaution is to make sure your doctor or midwife says you are healthy enough to get a massage. Some preexisting medical conditions can preclude a person from getting a massage, and these conditions need extra special attention when pregnancy is involved.

There are also some precautions that do not necessarily need to be taken. The biggest one of these is refraining from massage during the first trimester. Most massage clinics will refuse to give massages during the first trimester because it is deemed unsafe, for fear of miscarriage. This may just be an old wives tale, because most causes of miscarriages have nothing to do with what the mother did or did not do. On this subject it is always best to take your doctor’s advice on what is the right decision for you, but getting a massage should not, statistically, cause a miscarriage in the first trimester.

Once you are in your second or third trimester you should not be turned away from receiving massage. While massage tables exist that have cutouts for the belly and breasts, some people say that having a pregnant woman lie on her back causes too much pressure on the lower back. One thing that can be agreed on is that having the woman lie on the table in an upright position is best. OneTouch massage tables are designed with this in mind. The adjustable backrest can place the woman in a comfortable position.

Many pregnant women swear by the positive effects of prenatal massage. After pregnancy, postpartum massage can be equally as effective. Postpartum massage is designed to help restore the body to its pre-pregnancy condition. It also addresses the stress of carrying and caring for a newborn. It can speed recovery by bringing relief to sore muscles and by helping the mother to relax more easily. Abdominal massage helps to shrink the uterus and relieve subcutaneous scar tissue. It may be given as early as 24 hours after a vaginal delivery but only with written permission from your doctor or midwife.

It is always best to consult your doctor on what is right for you. If you are looking to get a prenatal or postpartum massage, make sure the therapist you choose is licensed in these specific areas. A therapist’s knowledge of the anatomy of a pregnant woman will serve to increase the safety of the massage and the health of your baby.