To complement the MASSAGE Magazine article, “Soft Landing: Sessions Accessories to Increase Client Comfort,” , in the October 2010 issue. Article summary: Certainly, the hands of the massage therapist are the main catalyst for stress relief and relaxation. With the right combination of fabric accessories—linens, bolsters and pillows—the effects of a massage session, and the sense of oasis, can be enhanced to luxurious levels.

by Paul Lewis, R.M.T.

“Why do you use pillows in your treatment?” was the question I was asked by another therapist. As I was treating this same person for stiff shoulders and low-back pain, I began to explain the reasons behind my use of pillows. I went on to explain and demonstrate where to place the pillows, the expected results and when I use them. In the end, I concluded our conversation with details about the use of towel rolls when treating and the benefits.

I truly believe in comfort for both the therapist and client, which results in mutual benefits for both. A majority of us use pillows when we sleep to support our heads, for comfort and unintentionally as a barrier between our head and the lower surface (perhaps to maintain distance from a pet, child or snoring spouse). These same fundamental concepts apply whether I am giving a therapeutic massage to a client on the table, on the chair, before a reflexology treatment or during my assessment prior to treating the client.

In my clinic, I have four pillows that are wide enough to cover the width of my table. One of the pillows is a little flatter than the others, which I specifically use under the client’s abdominal area and anywhere else that may only require half the height of the regular pillows. They are not too puffy, therefore I don’t have to wait long for the specific structure to settle down onto the pillow. The pillows themselves have a protective vinyl covering in case of client bodily fluid contamination, which facilitates ease of cleaning. In addition, all pillows are covered with freshly cleaned pillow case linens.

I have compiled examples of pillowing in various treatment positions. You will find these can be useful self-care suggestions for clients suffering from insomnia due to uncomfortable sleeping positions, low-back pain or cramping in the calves.

Supine position

If the client is on the table in a supine (face up) position, I suggest using at least one pillow under the thighs, which helps to prevent hyper-extension of the knees. If the knees are bent and supported, this should result in less pull (anterior rotation) on the hips, which translates into a more relaxed lumber area reducing extension on the lower back.

Using more than one pillow may not increase the benefits beyond what was achieved through the use of one pillow, but if your intention is to work into the abdominal area or your objective is to reduce the tension on the hip flexors and pelvis area to allow you to work into the psoas muscles, then this would be advisable.

Prone position

In the prone (face down) position, I usually only use two pillows. I place one under the abdominal area and one distal to the knee, under the shins. Three pillows are beneficial if the person’s hamstrings are short resulting in the shins not resting on the pillow, or if the feet cannot stay in anatomical position. Ideally, it would be best to have the toes not touching the table.

The pillow under the abdominal area helps to reduce the lordotic curve in the back. This helps to bring the spine into a neutral position and prevent jamming of the facet joints. This action will also put the client’s hip flexors into slight flexion. In addition, I try to make sure the pillow is balanced and not gathered on one side causing an imbalance to the hips. You should always check the position of the head, neck and shoulders keeping in mind you may have to place a towel roll under the shoulders in the direction of the anterior deltoids to keep the shoulders in alignment.

If you find you are void of a third pillow, you could fold the existing leg pillow to help create additional height.

Side-lying position

When I ask someone to go on their side, I usually use three pillows. On occasion, a fourth pillow along the back is employed to help the client feel secure and may prevent the client from rolling back.

Place one pillow to support the head and one between the knees to help keep the hips in line. Another pillow for the client to hug for the abdominal and chest area not only helps support the arm, but it also helps with reducing forward rotation of the shoulders and upper body. You may find you will use this type of pillowing primarily with pregnant clients.


When I am giving a reflexology treatment, I prefer to use three pillows. One pillow behind the head, one behind the knees for the reasons mentioned above to relax the lumbar area and the third pillow to support the calves and heels. I find most of my clients fall asleep, so I like to go one step further and cover the client with a blanket for warmth.

Chair massage

In my clinic, I incorporate both chair and table modalities into some of my treatments. On occasion, it will be necessary for you to have a barrier between you and the client during assisted stretching or treatment positions. The position of client and therapist determines whether a towel, pillow case or pillow is sufficient.

Keep in mind that although pillows and bolsters are wonderful tools that are both supportive and comforting, they should not interfere with the client’s ability to safely maneuver themselves and should be removed prior to the client getting on or off the table.

Paul Lewis is a Toronto-based massage therapist and a National Certification Board for Therapeutic Massage & Bodywork-approved provider. He is also a reflexologist, international presenter and fitness instructor, changing the world one treatment at a time. For more information, visit