Larger Clients

[lizi]

Any medium to small build therapists have any great techniques for working with much larger people? I am a male massage therapist, but at 5'6" and 140 lbs., I'm a little bit limited. Its a little frustrating when working with much larger or obese (and I hate that word) clients. My frustration only stems from my inability to figure out what to do when practicing on people without sacrificing my body mechanics, or when its practically impossible to find bony markings....these people need work damnit! how do I give it? Where are the key locations that need work? We only discussed attitudes around larger clients in my school, not how to actually work on them.Help!

 

[Pipes]

Larger Clients

Don't hate the word, it's the valid description.Any of the adjectives which describe a larger person have a lot more to do with the tone and inflection and intention than the word itself.Treat this population with the same caring massage you would any other client.  They do need touch.  They do sometimes shy away from situations involving touch.Be sure to show no judgement while working on a fat/obese client.As far as technique....aside from leverage being a problem let's say in some leg support work( I run into this with not only obese clients but BIG/tall atheletes)...Lower your table height.  That should help with your body mechanics.  Bony landmarks...they are there....really.You may not feel a release the same you would on a leaner body but you will in time.Now I have gotten flack for this but....sometimes working on fat HURTS....or rather has more "owie" spots than a leaner body.  I don't know why, but it does...to friends, clients and myself.Work that I always need is LB and legs.  I could use an hour on gastroc and hams alone.....I am intrigued by what the "attitude" of an obese client is.  Can you expand on that...no pun intended.Kudos for you to help out this population.They will greatly appreciate your work.Go to the local Contours or Curves and offer GC's for goals reached.(If they dont have an MT onsite)Robyn

 

[Pompal 09.]

i'm female, 5'6", 130lbs, and have recently worked on a man that was 500lbs.i work with a lower table height as it is, but i lowered it even more with this man. he had a lot of adipose tissue that 'settled' off to the sides of his body as he reclined onto the table. i found i needed to concentrate on the muscles as i saw them in their 'normal' position and somewhat 'ignore' the excess tissue except through superficial strokes.otherwise i do nothing different than any other massage... focus on the areas he indicated were troubled, made sure the pressure was to his liking, and offered assistance to get on and off the table. he needed to rise completely off the table to turn from supine to prone. i held the sheet and told him i would close my eyes, for his privacy while he did so.yes, these folks need work.  

 

[Mar C]

Larger Clients

By "attitude" I was referring to the therapists attitude toward the client, to be caring and thoughtful, but avoid the whole subject of weight, and not be judgemental, or think that you know what would be best for the client as far as diet, etc. Stay within your scope and do your best to customize the work for the person.thats what I learned in school.How much lower does the table need to go typically? I have yet to master the technique of guessing the need for table height adjustment.Thanks for your tips

 

[-xoxo-]

How much lower does the table need to go typically? I have yet to master the technique of guessing the need for table height adjustment.

I lower my table enough so I can lean in well with both my arms and elbows while still remaining comfortable in my upper body.  I agree with what everyone has said.  I use my elbows and fists a lot with larger clients.  They may also need the face cradle adjusted more.  Bringing the cradle above the normal table height can help with the discomfort of having the cradle lower.    

 

[Precy]

Larger Clients

Being "larger" myself I love body work. Sometimes I get a little self-concious about my body, but once I'm on the table I'm just fine. My own experience is that many like the deeper pressure, but you need to go a little slower to get there, making sure the tissues under the fat are warmed up and ready to accept the work. As for table height... I usually forget to adjust! (What I wouldn't do for an electric table sometimes... LOL) But when I rememeber, it usually depends on the client I'll be working on, but generally a notch or two lower than normal.

 

[pomparents?]

Larger Clients

I'd like to second my thanks to you for extending yourself to this special population. They are in need of compassionate touch in a loving, accepting, non-medical environment....and yes, they may need a lot of deep work (especially in those areas of the body that are accepting a lot of the strain and doing a lot of work - LB, the quads/hamstrings/gastrocs (and let's not forget those ankles and feet!)....but, as for getting the tissue to warm up sufficiently so that you are wrecking your own body and you're able to maintain proper body mechanics, you might try a heating pack (hydroculator, etc.) as long as the person does not have diabetes or uncontrolled blood pressure issues....as for table height, I think I heard somewhere that the top of the glutes should reach your navel (mid abdomen). But this, of course, will vary from client to client.Good luck and let us know what you've developed.

 

[GlenjaminO @ YouTube.com]

Larger Clients

Also, be careful with the strokes (or types of) you're using. For example, some overweight/obese clients have vericose veins if they tend to be on their feet alot (due to job responsibilities) or for a length of time longer than they should for their height/weight ratio. As a result, vericose veins can creep on and certain techniques (e.g., tapotement) should be avoided in those areas. Be well,Jen

 

[Jade S]

Larger Clients

Just got my part of a trade I do with my co leasee every so often...ahhhh....(Don't 'cha love trades!!)Wanted to add that sidelying is a great alternative for anyone with lower back problems...and it has been my experience that larger people almost always have LB problems.Robyn

 

[Richard Li]

I like to work barefoot most of the time.  I, too, am on the small side.. 5'0".. I haven't worked on many obese people.  Only 2.  I can't lower my table any more than it already is.  No notches left to go down!  So, I put some tennis shoes.  I dont think it made a big difference.  Hmm.. this comment was useless.   :-/

 

[Vaughn.student]

Larger Clients

DoLLz, You could get a step aerobics rectangle which is a light weight firm plastic thing used in excerise classes. I know a therapist who keeps one under her table and if she needs to be instantly higher, she just slides it out and steps up on it!

 

[Miss Anne Thrope]

Larger Clients

Another issue that came up for me was maintaining a comfortable position long enough to do the work. My client must have been in the 400 lb range and could only lay in one position for so long before various parts began to ache and go knumb from circulatory issues. Both prone and supine put alot of weight and extra strain to different areas of the body, even though we used several pillows for proper support. We eventually settled on the side lyeing position. Though this position was the most comfortable for my client...it def made the work more difficult. You can only imagine the effort it took for both my client and myself going from prone, to supine, to side lyeing...while attempting to maintain balance on the table!I am now thinking for future reference, when dealing w/ people who are that large, to use a floor mat (like what we use for Tai massage) and then use pillows for extra support. That particular experience left me feeling very uneasy putting such a large person on what seemed to be a very small table, and then having to move him around like that without falling off. It certainly took away from a relaxing massage experience.I am curious to know how others have managed to turn obese clients on the table, and what positions you found to be more effective. I am not talking about "large" folks here...but truly obese clients (300 + lbs). I am also interested in any other creative ways anyone has used to offer obese clients a truly rewarding massage experience.

 

[Diana!!!]

I have found with myself and with a the few heavy clients I've worked on that it's all about experimenting.  For me and my husband (both obese by medical standards-I'm 5'4 and 220lbs), using pillows is best.  He needs 2 (one under his chest and one under his pelvis).  And definitely having the face cradle above table height is key since the head will be leaning too far forward to allow for alignment of the spine.  As a client, it's taken (and in some instances I'm still learning) me a while to figure out how to be more comfortable.  So play around with positions, pillow props, etc.  Most people are not that aware of their bodies much less their comfort potential...so make suggestions and encourage them to try something different.  Hope that helps.

 

[Hmmmm]

Unfortunately using the floor is usually pretty uncomfortable for most of us v large folks (it's *hard* to get up!) and despite the good intentions of the therapist, it's v easy to really hurt somebody's feelings right off the bat by making them use the floor.  My biggest target market is people like me (I call myself "fat" but not everybody chooses that word, that's for sure!) and have not at all found that you have to "wreck your body" warming up the tissue, as suggested above.  To address the original question -- I've found that the massage needs of fat folk (myself included) are as varied as the massage needs of all the rest of my clientele.  There are sedentary people, stressed-out people, busy people, MTs (!), people with other physical challenges or with pathologies, even fat professional athletes (take a look at any NFL offensive line).  It sounds like you had no plump classmates, so there wasn't an opportunity to gain confidence while in school, but I think you can do it using the hints here and bringing your good attitude to the table with you.  Bony landmarks aren't nearly the issue I was taught they would be - when in doubt, you can often do some PROM or ask a client to do a movement in the context of the tx (I find I don't have to say "because I can't see your shoulderblades").  Good luck and have fun!PS  I'm only 5'3", so I sympathize w/the small-build thing too - plus I'm further away from the table!  

 

[Pompal 09.]

Larger Clients

DoLLz, You could get a step aerobics rectangle which is a light weight firm plastic thing used in excerise classes. I know a therapist who keeps one under her table and if she needs to be instantly higher, she just slides it out and steps up on it!

*slapping myself repeatedly*  why didn't I think to do that?

 

[NewsReader]

Larger Clients

I am curious to know how others have managed to turn obese clients on the table, and what positions you found to be more effective. I am not talking about "large" folks here...but truly obese clients (300 + lbs). I am also interested in any other creative ways anyone has used to offer obese clients a truly rewarding massage experience.

I would use more or less strictly sidelying.  I would have them turn as I do a pregnant woman.  From one side, legs swing down, client moves to sitting position then lays/lies on the other side, up go legs.

I would also finish with supine with pillows(semi reclined) for legs/feet.

Robyn

 

[chrissyaquarius1979]

I n63e9

Very good idea... I have a little step stool but I need something a little longer because I lunge, I think I will keep this in mind!!!

 

[ARBOB]

Larger Clients

I love the step stool idea! So simple, I can't believe I've never thought of it. Thanks!

 

[Caliban]

It'd be pretty easy to build a ?what? riser??? Depending upon how short you are, and how much height you wish to gain, you could simply buy a 2x12 6' long....now you are instantly 1 1/2" taller.  I've noticed that fat folk are a lot thicker than thin folk, seems obvious, doesn't it?  You might need 4" or even 6".  You could nail on some feet to make it taller, put it on bricks, stack several identical boards together.  Please find out from the client how he/she is most comfortable.  You may not need to put them sidelying, maybe just some pillows or maybe nothing special will be needed.  I don't require any pillows or any special treatment at all.  My wife can't take any deep/firm pressure, even now, at a normal body weight.  Everyone is unique, that is the message here.

 

[Pompal 09.]

Larger Clients

iv never really had a problem with the larger clients. i guess being 6'5 can be a blessing