by Charlotte Michael Versagi, L.M.T.
like to know more about bolsters. Are they just for certain types
of clients, like pregnant women, or can they be used for anyone?"
Many of us begin and end our
use of education about bolsters when we unpack our first massage table
and unwrap that one long, tubular-shaped bolster that we think is
the answer to all of our bolstering needs. Some of us consider ourselves
advanced if we purchase a couple various-sized pillows. But the use
of bolsters ranges from the absolutely pragmatic to a fine art, as
these three experts explain.
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.
Myers doesn't always use a pillow under
the head when a client is supine. He determines their normal alignment
and supports the neck and shoulders accordingly. If a client is side-lying,
he'll use a pillow under the head so the shoulder is not compressed
and put a bolster between their knees. "If, in the side-lying
position, I need to access the inner part of the leg that is on the
table, I'll [have the client] flex the upper leg and that leg which
is flexed needs to be supported," he adds.
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 suggests you supply yourself
with a variety of bolsters, pillows and towels so you're ready for
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
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
- 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.