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Expert Advice
by Charlotte Michael Versagi, L.M.T.

Q: "I'd like to know more about bolsters. Are they just for certain types of clients, like pregnant women, or can they be used for anyone?"

Thomas Myers, an advanced Rolfing practitioner who has a structural integration practice in Maine, and who writes the Body Language column for MASSAGE Magazine, has been using bolsters and pillows for 25 years.

Myers evaluates each client individually and support bolsters depending upon each condition, the level of comfort and intended therapy. "There's no set pattern, it's all very individual," Myers says.

"I do not use what most massage therapists use; I don't bolster under the ankles when a client is [prone]. I prefer to have them slide down so their feet dangle over the edge of the table and they are more able to move. It's more natural," Myers says.

If someone has a strong lordosis and is lying prone, I'll put a pillow or towel or even a bolster under the belly to get rid of the exaggeration of the lordotic curve," Myers says.

Myers suggests you supply yourself with a variety of bolsters, pillows and towels so you're ready for anything.

Christopher Alvarado is the education director for the Chicago School of Massage Therapy in Illinois. His students are taught that bolsters are used for three purposes: comfort, safety and to improve the therapist's accessibility.

"Certain situations call for comfort," Alvarado says. "If the client is supine, bolster under the knees to help alleviate pressure on the lower back or de-accentuate the curvature of the lower back. If the client is prone, bolster under the ankles to avoid cramps in their calves."

Alvarado says bolstering is a safety issue with certain conditions. "If someone is pregnant, she needs to be cushioned under her back if she is supine to keep her in a semi-reclining position," he says, adding, "Some asthmatic patients are not able to lie completely flat, either supine or prone, and need substantial pillowing or bolstering to allow for a comfortable massage."

Some muscles are more easily approached when bolsters are used, Alvarado says. "If you want to work the posterior deltoids with the client in the prone position, a bolster under the upper arm will put the deltoid into a relaxed position and allow for easier lifting and compression techniques."

Alvarado suggests using various-sized small pillows, but proper hygiene and protective covering changes are essential. And pillows can be used under the bottom sheet to reduce the frequency of laundering. He says rolled towels are easy to use and to launder.

Mary Ann Kurth is owner of the King County Lymphedema and Massage Clinic in Kent, Washington. Her clinic specializes in prenatal, post-surgical and trauma work. Kurth relies heavily on the bodyCushion for all of her work.

"For my prenatal clients, during their first trimester or post-delivery when the women are nursing, you can use the bolsters with the breast depressions to keep your patients comfortable in a prone position," Kurth says. When a pregnant client is farther along and side-lying is the only comfortable position, Kurth will give her a "pillow to hold in front, giving her a sense of security while someone is working behind. She feels less like she'll be pushed off the table." Large-breasted women who are normally unable to lie prone also appreciate these specialized bolsters.

For her clients with cancer and emphysema, often laying in a flat supine position makes breathing difficult, so Kurth uses a body cushion under the mid-thoracic region to elevate them and allow them to relax and breathe easily during the massage.

Kurth said sometimes a pillow and a bolster could be used simultaneously. "If I need to use the bolster under the knees in supine position, but the veins in their legs are very tender and they may lose circulation with just the hard bolster, I'll use a soft, small pillow on top of the bolster. This maintains circulation in the legs while still elevating the knees," she says.

Here's a summary from the experts on how to use bolsters: Look at each body, determine its natural alignment, determine what type of session you'll be doing and then bolster accordingly to get at the body part as gracefully as possible while supporting the patient comfortably; assess your clients individually, don't use the same bolsters in the same positions for all clients; know what's available on the market and purchase a wide variety of pillows and bolsters; bolster for your patient's safety and for your accessibility.

- Charlotte Michael Versagi, L.M.T., N.C.T.M.B., is a journalist and a massage therapist who specializes in manual lymph drainage and work with clients with cancer.

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