Body Positivity & Informed Consent Regions
Are there any specific areas we should avoid today? When I ask this question, I am sometimes met with "well what all do you do in a massage?" The answer should be, whatever YOU are comfortable with.
So, to get the obvious out of the way, there are a few body regions that are illegal to massage. The genitals, anus/rectum, intraoral, and (except with specific circumstances) breast tissue are not going to be worked on during a legitimate, professional massage. A decent massage therapist should have at least a few good techniques to address any other body region. I cannot tell you how many times I've had a client voice shock and delight that I was working on their hands (or their glutes) (or their feet)! Some of those body regions are considered regions of informed consent.
Most (if not, all) massage therapists are trained in the tradition of a client-centric approach. That means the client makes the choices for the treatment they will receive. That doesn't mean that the therapist won't make recommendations for care, or that they can't refuse to provide specific treatments if there is a reasonable health concern for the client or a risk to their safety or license should they provide a service. In order for the client to exercise the most autonomy in their session, the therapist should rely on some system to secure informed consent.
Informed Consent is a protection process that requires the client know and understand what will occur during the session and that their participation is voluntary. Informed consent has three requirements; the consent must be made voluntarily, be reasonably informed, and the client must be capable of giving consent. There are at least six major body regions that should require informed consent.
Before we get into the 6 Informed Consent Regions, I would be remiss if I didn't talk about Body Positivity. While massage therapists are healthcare professionals, we should all make an effort to be accepting of all body sizes, shapes, skin tone, & physical abilities. Massage therapists should only make comments about a client's body in a neutral and respectful way that is directly related to the massage & health of the client. I once had a client who, out of nowhere and totally unprompted, said in the middle of their massage "I bet you've never worked on someone as fat as me..." It wasn't true, but even if it had been it wouldn't have had any effect on the massage session. The disdain this client had for their body was shocking, violent, and heartbreaking. Other than a concern about table weight limits (which most have 500lbs +) and bolstering/positioning modifications- a client's size and weight just isn't that big of a deal. A massage table is a place for compassion and healing- not self loathing and judgment. And while we're on the subject of body positivity and self love, a word about body hair- No one cares! Seriously, I've had so many clients apologize about their body hair (especially leg hair). I've had client's interrupt their their peace and relaxation to apologize for the completely natural and irrelevant non-issue of leg hair. I've even had clients go as far as to insist I didn't need to work with their legs because "I didn't shave today". I always try to make the client's understand that they don't owe shaved legs to anyone but themselves (least of all their massage therapist) and that it needn't keep them from receiving bodywork. I am begging you- please do not ever allow a negative self-image keep you from getting the massage you need and want for yourself.
Informed Consent Body Regions
The six major body regions that should require some degree of informed consent are:
These are all regions that for largely cultural regions are considered inappropriate to have a stranger (even a professional) touch. But all six of these body regions are well within a massage therapist's scope of practice and have their therapeutic benefits when massage is administered properly. Gaining informed consent can be as simple as having a checkbox on intake forms or pointing to each region on yourself or an anatomical poster. Keep in mind that because informed consent is given voluntarily, the client can changer their mind and withdraw their consent at anytime.
Peace and Healing,
Kirby Clark, MMT, BCTMB