There are many variations of massage therapy principles and practice. One intriguing development I have witnessed is the growing trend of schools to avoid presenting massage techniques upon “sensitive” body regions.
These areas include the abdomen, pectoral region, gluteal region and medial thigh.
I’m a CE provider, and massage graduates from entry-level programs nationwide attend my classes. Many of them have told me their entry-level instructors discouraged performing massage technique upon any of these areas.
When these graduates encounter the opportunity to address these areas in my continuing education classes, I find many shy away from this opportunity. They either express a fear of liability, reiterating their teachers’ words against addressing these regions, or a profound sense of discomfort related to touching these regions.
Clients have the right to dictate, change, end and provide consent for any bodywork provided. Certainly, the important mantra of informed consent must always be honored with clients.
The intention of this article is to help dispel fears of working sensitive areas of the body, and my aim is to provide a healthy means of expressing work in the abdomen, pectoral, gluteal and medial thigh regions.
What is Client Guarding?
How a client perceives touch is greatly influenced by the level of confidence displayed by the therapist. Clients can sense confidence in a therapist’s approach and skill set. If I, as the massage therapist, approach a client with shaky hands, the average client will not feel safe and secure upon the table.
The phrase “energy follows intention” applies here. This statement highlights how a confident approach while working with the body will help a client feel more at ease with the therapists’ work. With client trust, a therapist has more options with tools, applications and approaches available within bodywork sessions
The term guarding is relevant at this point. Client guarding represents either a conscious or subconscious attempt to protect an area by a client. Myofascial tissue and neurological tissue may both respond to facilitate a guarding response. A therapist often ponders, “Why will this tissue not soften here?” over areas of guarding.
Clients may begin guarding an area due to many reasons. A prior treatment session may have created further injury. Improper technique created unforgettable discomfort to their body. A therapist may have made unappreciated comments about the client’s body. Someone may feel inferior if a therapist compared a client’s body to a more fit or functional body. A therapist’s touch may inadvertently remind a client of an unpleasant memory.
Recognizing this phenomenon is key to ensuring a client feels safe and secure upon the table. Guarding is a sympathetic response. Your efforts to facilitate a parasympathetic response will help ease guarding.
Work more slowly than usual with a heightened sense of awareness of perception of touch wherever guarding is present. Encourage deeper breathing to slow their breathing and heart rate. Guide the client through a relaxation technique or visualization. Play a meditation in lieu of music. Any music played ideally is softer in tone, lower in volume and harmonic.
Be ready for the potential of somato-emotional responses (SER) occurring when working at a guarded region. These responses are often an expression of emotion displayed by the client upon the table. Sometimes sense-based changes such as hearing sounds, seeing colors and changes in smell and touch perceptions may be experienced. In my continuing education classes, I present three essential steps when interacting with clients experiencing an SER:
• Acknowledge the shift energetically within the client;
• Validate the experienced response is OK;
• Continue with session as directed.
Communication is Key
How I speak massage matters just as much as how I perform massage. I ensure healthy, open communication with clients when working sensitive body regions. I will awaken a client if they happen to fall asleep to ensure they are aware of my presence in a certain area. As I work upon a sensitive region, I will inform my client of three key ideas:
• Where my hands are positioned;
• Where my hands are going;
• The reason I am performing a particular stroke or technique.
Communicating these three ideas will ensure my client and I understand equally what is occurring during the session. Clients will respect a therapist who actively involves them when working sensitive areas.
The comfort level of the therapist must also be examined. Remember if you, as a therapist, are approaching a body region with professional touch, technique and decorum you will be safe in your approach.
The energy a therapist brings to the session will translate into its effectiveness. A confident approach will ultimately dispel fears of working with sensitive areas. I highly encourage any therapist trepidatious about work in these areas to obtain more massage training and practice on friends and family. There is a great deal of healing potential offered when working within these sensitive areas.
Another idea to consider is communicating through masks. As of late 2020, when this article was written, many U.S. states and cities required masks to be worn during massage practice. Even without mandates, many massage therapists have utilized mask-wearing as one of many safety measures to maintain their professional practice.
Wearing masks during massage sessions creates communication challenges. When prone, many clients may have a difficult time hearing a therapist, regardless of wearing a mask.
Because voice quality may be easily muffled by the mask, do not assume your client fully hears and understands when you are moving to a sensitive area. Speak clearly and with good volume to your voice. Articulate words well. Ensure your client understands your intention before your hands make contact in a sensitive area.
Benefits of Working Each Area
Abdomen/Core: Many clients do not realize the many muscles found here within the core region. Addressing tension from the rectus abdominus, external and internal oblique help improve breathing, especially deep breathing efforts.
Easing quadratus lumborum within the low back aids in lumbar pain relief and supporting low-back stability. The transversus abdominus muscle spans deep within the core, helping support the internal organs.
Flanking the core upon the rib cage are the serratus anterior and intercostal muscles. Freeing tension of these muscles will ease pressure off internal organs and aid in rib misalignment that may translate to scoliosis development later in life.
Pectorals: We may work within the décolleté region to address muscles of the pectoral region. Communicate that the décolleté is the safe zone between the clavicle bones and breast tissue.
Ensure your client provides you a boundary either with the drape or their hand on where they consider their breast tissue to begin. Remember there may be men who will appreciate this approach just as much as the average female client.
Easing tension from the pectoralis major and minor will aid in correcting medial rotation of the shoulders so commonly witnessed with clients on computers or cell phones.
Freeing the subclavius muscle will free the subclavian artery and vein as well as the brachial nerve plexus, which contribute to thoracic outlet syndrome symptoms. The upper intercostal muscles and inferior attachments of sternocleidomastoid and scalene muscles can be freed to aid in pain relief of the chest and neck.
Gluteals: There are 10 muscles to address directly within the gluteal region. Gluteus maximus, medius and minimus, and tensor fascia latae lie superficial. Easing tension of these muscles will aid in relief from sciatic conditions, neuropathy symptoms of the legs, SI joint dysfunction, pregnancy or injury-related hip challenges and knee-related pain.
Lying deep within this region are the deep hip rotators, commonly called “the deep six”, which lie deep to gluteus maximus. The sciatic nerve may be commonly impinged within this region. Working this deep group of musculature can further alleviate sciatic conditions. Pelvic floor disorders related to pregnancy or trauma can be addressed by working with the deep six muscles.
Medial thigh: The adductor muscles primarily lie within the medial thigh region. They share a fascial plane with the iliopsoas, therefore tension patterns of excessive hip flexion can also affect the thigh and lower back. Gait is improved when addressing hip flexor muscles in addition to the adductor group.
Addressing the adductor magnus helps alleviate thigh and knee pain. The other muscles of this region — pectineus, gracilis and adductors minimus, brevis and longus — affect the hip joint directly.
Unlock Healing Potential
Communicating how the work is to be done and why the work is being performed are key elements to dispelling fears of working sensitive areas. This article focused on the four areas most associated with aversion by clients and therapists; however, these lessons can work on any region a client is guarding.
As the massage therapist communicates effectively and ensures client comfort, potential is unlocked to help facilitate a client through their healing process.
About the Author:
Jimmy Gialelis, LMT, BCTMB, is owner of Advanced Massage Arts & Education in Tempe, Arizona. He is a National Certification Board for Therapeutic Massage & Bodywork-approved provider of continuing education, and teaches “Professional Ethics for LMTs” and many other CE classes. He is a regular contributor to MASSAGE Magazine, and his articles include “Diabetes and Massage: What Therapists Need to Know” and “Massage for Trauma: 3 Ways of Responding to an Emotional Release.”