Routines & Positions
Alright, let's start out face down, face in the cradle today. Have you ever wondered why your therapist has you start off in a specific position? Have you ever wondered if you are getting the same massage your therapist provides everyone?
When I started massage therapy school, at Blue Cliff College in 2013, routines were talked down about and discouraged. There was such an air of superiority for not having a routine and providing every client with a "cookie cutter" massage.
When I received my license and began my first job, I soon found that having a routine was supremely helpful. Granted, I've always worked in a spa setting- but my first massage job with Massage Envy in Fayetteville provided me experience working with all kinds of clients! Students, Athletes, Geriatrics, Bridal Parties, Office Workers, Manual Laborers, Doctors, Nurses- any type of person you can think of almost, I worked with in my five years with Massage Envy Fayetteville. I discovered that for me, developing a routine helped me have a standard plan of treatment that could easily be modified based on each client's needs. I was shocked (and a little ashamed) to learn that having a routine afforded me a plan of action while also allowing flexibility for customization. I spent a long time feeling bad about myself as a therapist and trying to reconcile why my instructors discouraged routines so much. I've since gained self confidence and stand by my routine.
There are four major positions in Massage Therapy:
1) Prone Position (Face Down)
2)Supine Position (Face Up, "Supine, on your Spine)
3)Side Lying Position (Bolstered with pillowing on Left or Right side- typically used for Prenatal Massage or Hip/Gluteal work)
4) Seated Position (In a Massage Chair or less commonly, on a Massage Table, clothed with Legs dangling off the edge)
So, I have a standard plan for a 60-minute massage (which can be altered and modified for any client). Body regions and techniques can be added or removed depending on client needs and length of session. I typically begin each session in Prone (face down) position and start working on the client's Right side. Then proceed as thus;
- Shoulder (forearm strokes & thumb compresses)
- Arm (top of Arm into Neck and bottom of Arm under Shoulder)
- Forearm (striping before positioning overhead to stretch out low Back)
- Back (right side alternating Tensile Force)
- Quadratus Lumborum (outlined with soft fists and open palms)
- Gluteals (clothing/client permitting, with elbow/forearm first, then soft fists & thumbs to address Piriformis)
- Lamina Groove/Erector Spinae Group (gentle rocking with fingertips to pull tissue off spine, followed by elbow/forearm)
- Arm & Hand/Fingers (after returned to client's side, soft fists & thumbs)
Then the same is repeated for the Left side (modifying for any asymmetrical presentations that might exist. Re-draping the upper body, I also like to place a heating pack on the back. And proceed to the lower body on the Left side;
- Calves (soft fists, forearm, thumbs, torsion force & petrissage)
- Hamstrings & IT Band (forearm & soft fists/knuckles)
And then the same is repeated for the Right Leg. And I finish out Prone work with;
- Feet (Right foot first, basic reflexology points, Plantar Fasciitis stripping, soft fists, & Acupressure holds)
Then I remove the Ankle bolster and heat pack & apply some quick Tapotament to both sides of the Back, before transitioning the client into Supine (face up) position.
- Scalp (fingertips & thumbs, acupressure points, palms)
- Face (forehead stripping, sinus release, TMJD stripping on jaws, temporal strokes)
- Pectorals (starting at sternum & working outward unilaterally)
- Neck (unilaterally, stripping Scalenes/Sternocleidomastoid-bilaterally, stroke along spineX3, tapotament upwardX2, occipital tractionX1)
If time allows (longer sessions or if certain regions weren't accessible for any reason), Feet, Legs, Abdominals, Arms, & Hands can also be added into the Supine portion.
So there we have it, my personal (and now unabashed) massage routine. What I love so much about it is it provides a variety of strokes, forces, touch modifiers- which we'll get deeper into at a later date.
Peace and Healing,
Kirby Clark, MMT, BCTMB