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I had a contest for a free massage. (I needed new clients.) The woman who won was so excited in her email. She made an appointment and I saw her that same week.
When she came in I was taken aback (not visibly, that would have been rude). She is my first obese client.

I have been practicing massage for two years and have never experienced anything like what I experienced. I could barely feel her muscles under all the weight. Her bones weren't where they should have been. Her hips, especially were "off". There was too much to work on in just one hour. Too much to address.

She scheduled another appointment, because she loved my work, but I need help.

I got a sense of where her bones are (they are spread out to accommodate her weight), but the muscle that is giving her problems is her illiopsoas. I know where it IS, but was unable to palpate it. If I press harder, will the pressure on her fat and organs hurt her, will they yield (I know it may take several minutes to get to it with her)? All I was able to do was give her a Swedish massage and show her a stretch to help with the illiopsoas. I have worked the same muscle on previous clients, but I need to know if I have to do anything different with her. I have already received some very good advice regarding this.

My second concern is draping. I think I will need to get bigger sheets just for her. And I really hope she finds this unoffensive.

Third concern was my table. I knew it wouldn't support her, so I dropped it down to the floor (thank goodness for shiatsu cables). Is there something out there that would accommodate her and my pocketbook?

Any suggestions, advice or stories from your own clients would be MOST appreciated.

Her review:
"I won Crystal's contest for the free massage, so that was our first time meeting. Crystal made me feel comfortable right away, was so kind and respectful, and the massage was WONDERFUL!!

Thank you so much! I'll be back, and I'll bring friends :-D"

Tags: client, massage, obese, obesity

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Crystal, any good massage table should accommodate at least 600 lbs static weight. My Oakworks table is 10 years old and it's good for more than twice that. I bought side extensions and a foot extension to go on it years ago when I was working on a really big guy...after the first visit he was hooked and I decided it was worth the extra money to make a regular client more comfortable and he was pleased that I did it. There's no point in even mentioning the sheet, just use a full size, queen size or whatever it takes to cover her and she'll probably be grateful that she's comfortable.

I haven't ever had a big person say it hurt to have the psoas released, and sure, it will take a little longer. She obviously appreciated your work so just keep doing what you're doing. If you think she can afford it you might suggest longer sessions, or discuss just focusing on problem areas instead of giving her a full-body Swedish every time since there's so much terrain to cover :)
Thank you Laura. She almost didn't come to her appointment because of how conscience she is of her weight. I just don't want to draw attention to it more than is necessary. I'll see her this week, I will definitely take your advice.

Laura Allen said:
Crystal, any good massage table should accommodate at least 600 lbs static weight. My Oakworks table is 10 years old and it's good for more than twice that. I bought side extensions and a foot extension to go on it years ago when I was working on a really big guy...after the first visit he was hooked and I decided it was worth the extra money to make a regular client more comfortable and he was pleased that I did it. There's no point in even mentioning the sheet, just use a full size, queen size or whatever it takes to cover her and she'll probably be grateful that she's comfortable.

I haven't ever had a big person say it hurt to have the psoas released, and sure, it will take a little longer. She obviously appreciated your work so just keep doing what you're doing. If you think she can afford it you might suggest longer sessions, or discuss just focusing on problem areas instead of giving her a full-body Swedish every time since there's so much terrain to cover :)
Crystal
It is wonderful that she did come . Often obese individuals are too self conscious and the fact she re-booked means you made her feel safe and comfortable. That is great!

Like Laura said, no need to bring attention to the size of sheet.

You can get those side extenders on your table which aren't very expensive if you feel you really need it and she plans on being a steady client. I also use small pillows to help with prone positioning and breast space

The stretches are the best way to go as you won't possibly be able to get in that deep. Thai massage/leg work stretches could aid as well. Often I have found obese clients are sensitive to touch, so guiding them in self care methods / walking/ stretching/ yoga etc., has been helpful

Remember too, that relaxing our system, allows for everything to let go. Often we think "technique" /deeper, more specific. If we are are effective with calming the nervous system and providing a safe space for them to "let go", they will see some improvement too.

Keep up the caring work!
Thank you, Gloria, great advice. I'm glad I can offer her some comfort and tips for self care.

Gloria Coppola said:
Crystal
It is wonderful that she did come . Often obese individuals are too self conscious and the fact she re-booked means you made her feel safe and comfortable. That is great!

Like Laura said, no need to bring attention to the size of sheet.

You can get those side extenders on your table which aren't very expensive if you feel you really need it and she plans on being a steady client. I also use small pillows to help with prone positioning and breast space

The stretches are the best way to go as you won't possibly be able to get in that deep. Thai massage/leg work stretches could aid as well. Often I have found obese clients are sensitive to touch, so guiding them in self care methods / walking/ stretching/ yoga etc., has been helpful

Remember too, that relaxing our system, allows for everything to let go. Often we think "technique" /deeper, more specific. If we are are effective with calming the nervous system and providing a safe space for them to "let go", they will see some improvement too.

Keep up the caring work!
also...to add what Gloria said...

one thing i have found in overweight people with regards to massage is the importance that body awareness plays into a long term treatment. just working on her regularly, will help her become more in touch with her own body. and that alone could be the spark that could help her begin to lose weight. do you know the why's behind her weight? i ask because if it's medical, then you may want to know that and be working in conjunction with her doctor. if it's not medical, then you may want to eventually start guiding her to other healthy choices.

either way, just working on her, no matter what techniques you use, will be beneficial for her. don't worry so much about what you're working on or what you're able to release. sounds like right now just the power of touch will be enough to get her feeling better. and as she starts to feel better, the health benefits will just organically evolve.

Gloria Coppola said:
Crystal
Remember too, that relaxing our system, allows for everything to let go. Often we think "technique" /deeper, more specific. If we are are effective with calming the nervous system and providing a safe space for them to "let go", they will see some improvement too.

Keep up the caring work!
What a fantastic review! How awesome that you were able to hold space for this client and provide a nurturing, non-judgmental experience. :D

Re: the psoas--I've done plenty of work on big-bellied clients, and I find that following my intuition is really the way to go. Even if I can't feel the muscle directly, I know it's there, and I don't need to dig deep in order for the client to feel it. Just check in with her--she'll know when you're on it, after all. Sidelying might be an option for you to experiment with, too.

As others have mentioned, getting a full or queen top sheet and making no mention of it is a good idea. If you have to get a larger sheet "just for her," that's not something she needs to know. Same with any extenders you may decide to get.

Check with the manufacturer of your table. As Laura mentioned, most are built to take 600 lbs static weight. If you're still unsure, but found that working with your table dropped was okay for your body mechanics, that's always an option. Doesn't sound like being that low to the ground bothered your client.

I've worked on a few obese clients, and really, intuition was the way to go for me. With some, I had to use more pressure to work through the adipose layers; with others, they were sore enough that a light touch was all they wanted. They range in what they want/need like all clients, but I think the best thing we can do is provide love, a safe space, and non-judgmental touch.
I'm going to raise a note of caution here. I would ask about any other medical conditions (heart, blood pressure, etc.) in an intake, but if she's relatively healthy other than the weight, it's really none of our business why she's heavy. Asking why would be a horrible personal intrusion, especially when the client has already indicated how self-conscious she is about her weight.

As for "guiding her to other healthy choices"--well, first off, that's outside our scope of practice. Secondly, if she's obese, she's heard "healthy suggestions" from any number of people, including family, friends, doctors, and total strangers. All those suggestions do is reinforce a negative sense of self and guilt: if you really wanted to lose weight, you'd do x, y, and z . . . it's not healthy for someone to be so big . . . Trust me, the client knows that she's not in ideal health or living up to our culture's standards of beauty; the last place she needs to hear it is from the person she is putting her trust and vulnerability into.

Lisa said:
one thing i have found in overweight people with regards to massage is the importance that body awareness plays into a long term treatment. just working on her regularly, will help her become more in touch with her own body. and that alone could be the spark that could help her begin to lose weight. do you know the why's behind her weight? i ask because if it's medical, then you may want to know that and be working in conjunction with her doctor. if it's not medical, then you may want to eventually start guiding her to other healthy choices.

. . . as she starts to feel better, the health benefits will just organically evolve.

I agree Erica, she has probably heard all the "healthy" advice and perhaps she is among those that are quite ok with themselves, not our judgement call for sure. At any rate, when I work with obese clients and there is an unreachable area that you feel needs work I rely on positional release more than anything. That way I am not trying to press through adipose to the target area particularly in the psoas region as that can cause some pretty intense pressure on the organs if you aren't very slow and precise. As far as the table goes, if it is any of the major brands check with the manufacture's weight limit on it. Most are quite sturdy. The extentions are also a good idea and well worth the cost. If someone I am working on is too wide for the table I also do a sheet tuck around the arm or side I am not working on so that they don't have to put as much effort into holding their body part on the table. I do lower my table when working on large clients, but that is for my body mechanics, if it was lowered to the floor I imagine many would have a tough time getting up.
Good job!
She did confide in me the source of her weight gain. That she wasn't always overweight. But she does walk and try to keep up with her children. After speaking with her more I think a nurturing touch is all she really wants. And maybe an ear as well.

Lisa said:
also...to add what Gloria said...

one thing i have found in overweight people with regards to massage is the importance that body awareness plays into a long term treatment. just working on her regularly, will help her become more in touch with her own body. and that alone could be the spark that could help her begin to lose weight. do you know the why's behind her weight? i ask because if it's medical, then you may want to know that and be working in conjunction with her doctor. if it's not medical, then you may want to eventually start guiding her to other healthy choices.

either way, just working on her, no matter what techniques you use, will be beneficial for her. don't worry so much about what you're working on or what you're able to release. sounds like right now just the power of touch will be enough to get her feeling better. and as she starts to feel better, the health benefits will just organically evolve.

Gloria Coppola said:
Crystal
Remember too, that relaxing our system, allows for everything to let go. Often we think "technique" /deeper, more specific. If we are are effective with calming the nervous system and providing a safe space for them to "let go", they will see some improvement too.

Keep up the caring work!
Everyone's suggestions have been really helpful. I'd love to hear more stories about your overweight clients, whether they be good, not so good, or funny.
Erica, how can she be relatively healthy if she's obese?

i certainly wasn't suggesting to be rude and forward about asking her directly. and i certainly wasn't suggesting to point the finger as to what aren't you doing. there ARE ways to incorporate healthy information in the realm of what we do. we offer up water after a massage because we know the benefits it offers in relation to a massage. in the same token we know that many chronic issues are directly related to weight.

i have a friend who's wife is obese and she comes to see me fairly regularly. most of her chronic pain is a direct result of her weight. so over the course of time i have encouraged her to work at it. sometimes when one is obese they can only look at the big picture and become overwhelmed at the process of losing weight. and many times coming from a doctor it is in one ear and out the other. but during the scope of a massage, a nuturing massage, one can say the same thing differently and it is more openly received.

having been 220 lbs i speak to her having been there and known the struggle. i simply encourage her to make small steps.

the fact IS that weight is a huge reason why many feel awful. and because of the weight they stop moving. and movement is key to keeping our joints healthy. Carrying extra weight our bodies were NOT intended to carry is a major factor in chronic pain. and as someone who lost weight i know that all it takes is the right voice to say the right message and suddenly it's heard. and i can tell you it didn't come from the countless doctors, ex husband (notice i said ex) or countless friends that told me.

all i'm saying is that over the course of their relationship as MT and client, it can be introduced in small doses to help her client. it can begin with print outs of small stretches she can take home and do in the morning. it can be as simple as suggesting to drink more water. i think there are many health benefits/suggestions we can share with our clients that stay in our realm of what we were taught. and as responsible MTs we should, always with the suggestion of speaking with a medical professional.

the fact that she DID confide in her that she was not always that way says a lot. and to me that would tell me as her MT that she was wanting to share and reaching out. you'd be surprised at how the same message she's heard time and time again, done in a non judgmental way can be all it takes. and it CAN be done in a non judgmental way. it's what motivated me to lose 70lbs.

Erica Olson said:
I'm going to raise a note of caution here. I would ask about any other medical conditions (heart, blood pressure, etc.) in an intake, but if she's relatively healthy other than the weight, it's really none of our business why she's heavy. Asking why would be a horrible personal intrusion, especially when the client has already indicated how self-conscious she is about her weight.

As for "guiding her to other healthy choices"--well, first off, that's outside our scope of practice. Secondly, if she's obese, she's heard "healthy suggestions" from any number of people, including family, friends, doctors, and total strangers. All those suggestions do is reinforce a negative sense of self and guilt: if you really wanted to lose weight, you'd do x, y, and z . . . it's not healthy for someone to be so big . . . Trust me, the client knows that she's not in ideal health or living up to our culture's standards of beauty; the last place she needs to hear it is from the person she is putting her trust and vulnerability into.

Lisa said:
one thing i have found in overweight people with regards to massage is the importance that body awareness plays into a long term treatment. just working on her regularly, will help her become more in touch with her own body. and that alone could be the spark that could help her begin to lose weight. do you know the why's behind her weight? i ask because if it's medical, then you may want to know that and be working in conjunction with her doctor. if it's not medical, then you may want to eventually start guiding her to other healthy choices.

. . . as she starts to feel better, the health benefits will just organically evolve.

Relatively healthy as in "other than carrying too much weight, heart/cholesterol/blood pressure etc. are in good shape/within normal limits." I still maintain that it's really none of our business why someone is the weight they are, whether it is too much or not enough.

My note of caution about "incorporating healthy info" still stands. I'm not saying not to do anything of the sort, just to be extremely careful about how it's done, both due to scope of practice and the possibility/likelihood as coming across as judgmental. One doesn't have to directly point a finger at another's behavior in order to cause feelings of shame and guilt; helpful, well-meaning suggestions can do that alone: I know I should . . . why don't I . . .I'm so weak . . . look at all these other people who have been able to do it . . . what's wrong with me? . . . I'm such a failure . . .

Obese/overweight clients will already know that they would feel better if they lost weight. Yes, there are specific musculoskeletal examples we may be able to demonstrate (postural distortions due to weight, etc.), but I still wouldn't bring up weight loss as a solution. The client will be able to make that conclusion. Again, just a note of caution.

Lisa said:
Erica, how can she be relatively healthy if she's obese?

i certainly wasn't suggesting to be rude and forward about asking her directly. and i certainly wasn't suggesting to point the finger as to what aren't you doing. there ARE ways to incorporate healthy information in the realm of what we do. we offer up water after a massage because we know the benefits it offers in relation to a massage. in the same token we know that many chronic issues are directly related to weight.

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