Working with obese or overweight clients involves understanding how to work differently, both logistically and emotionally. Join Allison as she revisits a blog post she wrote back in 2016 to talk about this ever-evolving conversation. With tips on how to rethink your office to thoughts about how to understand the weight of pain, this episode explores the many layers of working with clients who struggle with weight.
Rebel Massage Therapist:
My name is Allison. And I am not your typical massage therapist. After 20 years of experience and thousands of clients, I have learned that massage therapy is SO MUCH more than a relaxing experience at a spa. I see soft tissue as more than merely a physical element but as a deeply complex, neurologically driven part of who you are. I use this knowledge to work WITH you — not ON you — to create change that works. This is the basis of my approach.
As a massage therapist, I have worked in almost every capacity. Massage clinics, physical therapy clinics, chiropractor offices, spas, private practice, as well as teaching . I have learned incredible techniques and strategies from each of my experiences. In my 20 years as a massage therapist, I have never stopped growing. I currently have a private practice based out of Long Beach, CA., where I also teach continuing education classes and occasionally work on my kids. If they're good.
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0:00:48.4 Allison Denney: Hi, my name is Allison Denney, and this is the The Rebel MT Podcast, where you'll hear me forcibly colliding the worlds of anatomical jargon and humor. I believe that when you know your anatomy, the what, and you know your physiology, the how, the techniques will follow. But the loads of Latin and the gobs of Greek can make a cranium convulse. It is a little overwhelming to dip your toe into the sea of anatomical knowledge, only to find that it is a bottomless ocean. You are smart, but this is intimidating. You will get there eventually. In the meantime, let's look at things differently so that you will actually want to take a swim or at least hop on a boat and take a peak at what's under the surface.
0:01:36.6 AD: I get a lot of requests from massage therapists who want to see a YouTube video tutorial on how to work with obese clients. This is tricky for a couple of reasons. The first reason is that I have not had any luck finding anyone who is comfortable being a model for this, which I definitely understand, but the second reason is a little more complicated. I have made a lot of videos that offer techniques about how to handle a myriad of soft tissue dysfunctions. Most of them we learned about in school, like what happens when we sprain an ankle or hold an inefficient posture for too long or sustain a traumatic break.
0:02:12.6 AD: But the complicated pain of being overweight is not so well-defined. To demonstrate how to work with obese clients in a video would not be a simple process because it is far from a simple dysfunction. And let me pause here and offer a bit of a disclaimer, I do not think that obesity is a dysfunction, nor do I think of it as a disease, and I definitely don't see it as an injury, I see being overweight as the combination of the physical, emotional and psychological processes of life that have wandered down a path that is more difficult to navigate. I also see obesity as a break that happens under the social construct and cultural pressures that weigh on each of us differently.
0:02:57.9 AD: There have been societies who celebrate a larger girth, but for the purposes of this episode, I'm speaking from the perspective of a modern day American, the culture in which I live, there is a weight to it and a pain that comes with that. To put it more simply, being heavy in today's world might just be the best insight into the complexity of pain than any torn rotator cuff or carpal tunnel syndrome can offer.
0:03:25.1 AD: I should add that this podcast is taken from a blog post that I wrote back in October of 2018. I originally wrote it because I had read a blog post online about a massage therapist's thoughts on working with obese clients. I did not know this person, I still don't, but I read it and it was disheartening. I dove in expecting to read some reflections on how to hold a judgment free zone, or maybe some insightful ideas on how to bolster or drape an overweight client or even a story about the effects of obesity on joints and soft tissue, but instead, I read a shockingly cold statement from a practitioner who consciously made the choice to turn obese clients away. He never worked on them. His decision, he recounted, was because he simply couldn't reach the muscle tissue and found it pointless.
0:04:14.4 AD: Needless to say, I had so many reactions to this post, but my first and strongest was anger. I mean, I was sad for this massage therapist that he was clearly missing a majority of what the practice of massage and body work is all about, but I was downright irate with him for being so ignorant and unkind to a demographic that receives an extraordinary amount of judgment and accusation. Dismissing clients who might need a safe healing touch more than most, goes against the very grain of what we do. So I dove in and wrote my own blog post on the topic. I will, of course, include a link to it in the show notes, and now I am expanding on it here in this episode.
0:04:57.3 AD: There are a couple of good logistical tips on how to work with a client who is obese. Okay, there might be six of them. Let's start here because this is the easy part. Having an obese client is going to mean a couple of things for you as a therapist right off the bat. Number one, lower your table, your client will rest higher on the table, which means that your mechanics will have to shift to accommodate, in order to be able to lean in with your body weight, lower the height of your table. As an empathetic group, we tend to bend more to accommodate those who need us most, but do not forget your own body mechanics. Remember to take care of you as you are taking care of others.
0:05:37.8 AD: Number two, offer to raise the face cradle up. With the extra girth, it can be difficult for a client to allow his or her head to drop into the face cradle while lying prone, if it is the same height as the table. Lift it to meet their face and offer their cervical spine some relief. Fun fact, this also works really well for female clients who are large breasted. In some cases, you may even want to offer a small pillow and suggest that the client turn their head to the side. Ensuring that your client is comfortable is something you will need to carve out a couple of more minutes for at the beginning of the session. Do not skip this important step.
0:06:16.4 AD: Number three, invest in table extensions that increase the width of your table. This helps your clients arms to stay on the table with no effort. With no table extensions the client may feel like they are working to keep their arms in place, and we all know that the goal is to help our clients let go of unnecessary muscle tension. If you don't have the extensions or you don't want to invest, use your draping skills to their advantage. As soon as they get on the table or flip during the session, tuck the blanket around their arms and under their body, so the blanket does the holding. Not their muscles. This can also feel really nurturing, which if we're being honest, we all want to feel.
0:06:56.5 AD: Number four, have extra pillows and towels on hand. Extra body weight can make it uncomfortable to lay on a flat surface. Placing a small rolled up towel under their forearms and hands while they're laying supine can ease the tension from their upper arms and shoulders. Adding a towel or a bolster to increase the height of the knee or the ankle can feel relieving as well. Even better, ask your client where they may want to feel extra support. As Big Bird from Sesame Street likes to say, and one of my favorite pieces of advice, "Asking questions is a good way to find things out."
0:07:30.7 AD: Number five, while working with your client, stay in communication. It is a misperception that you have to sink deeper through the fat to get to the muscle. On the contrary, adipose tissue is actually layered in with muscle. Think about what a marbled fatty piece of meat looks like, and it can often be more sensitive than muscle tissue. Sinking deeper can actually backfire and create more pain, which is not quite the goal here. There are conflicting articles of research that discuss whether adipose tissue is more or less sensitive than other tissues in the body. Talk to your client about what pressure feels good and what is too deep. Pain and the perception of pain as is true for all clients, varies greatly and needs to be honored as such.
0:08:16.1 AD: Number six, using a flat palm, flat finger pads or the soft part of your forearm, the side where your hand and wrist flexors live is going to feel less painful than a pointy thumb or elbow. You can work deeply with your techniques, if that's what your client is looking for, it just doesn't have to be sharp.
0:08:35.0 AD: And now on to the not so easy part. Being overweight comes with a cultural and social stigma that even when we don't hold judgment can cast a huge shadow on the human living on this planet. Our ability to be sensitive to that shadow is the most effective technique we can offer our clients. I read once that being fat is like being simultaneously way too visible and invisible at the same time. Having struggled with weight issues myself, I have felt this harsh reality. No one wants to be noticed for their flaws and not given a chance to prove their strengths at the same time. And I think that is what it comes down to.
0:09:15.8 AD: Being overweight more often than not, is seen as a flaw, and we all know the saying about judgment and books and covers, there are so many other parts to this human who is standing with you in your office, what we look like is a mere fraction of the whole picture of who we are, what is important and what we all really want is to be seen for the kindness we carry, the loving relationships we have, and the talents that lay deep and are often hidden from others. Here is how I believe that being overweight can be the most genuine insight into what pain really is.
0:09:52.3 AD: The experience of having a dysfunction, any dysfunction is quite often seen as a weakness. A sprained ankle means you can't run. Carpal tunnel syndrome means you can't type. Migraines are another excuse to miss an event. Chronic back pain means you can't do a lot of things. Pain becomes an obstacle, and the collective attitude towards overcoming obstacles is often riddled with the pressure of no pain, no gain, or suck it up and deal. Take a moment and Google artistic images for pain. It produces some very thought-provoking pictures. Having to sit out of doing the things you love can offer a little perspective on how much you are missing. The notion that you don't know what you've got till it's gone comes to mind here. Any injury often means an inability to take part in life being lived. Being overweight kind of covers all of those bases. It is not just one activity that becomes problematic, and most of the time, it is not temporary.
0:10:53.0 AD: Not being able to do the things you love, being limited in what you can do can be one of the most painful experiences for any human. It begins to teeter into the vast darkness of loneliness and isolation, which tips into the grey matter of despair, which can stumble down the dark chaos of depression. I'm not saying this is always the case, there are incredible stories of humans overcoming towering impossibilities, but maybe, just maybe, working with obese clients is more about helping that human being to become without sounding too cliche, the person they want to be, whether that means decreasing pain, managing daily activities, or simply finding acceptance.
0:11:40.3 AD: We do this all the time with soft tissue. We listen to the details around the dysfunction and apply the best techniques for each scenario. We work with our clients until they are back to doing what they love or what gives them purpose. And I know we are not psychologists, but we do offer a safe space. We listen, we hold no judgment and we do no harm, and maybe that is the best technique for this situation.
0:12:08.2 AD: As an addendum to my original blog post, I wanna add that there has been a trend towards body aware acceptance in the last handful of years. We are seeing larger models on the runways and more quote unquote "normal looking people" in commercials. I don't know if this trend will stay or pass us by. But I do hope that it coincides with an equally as daring switch to move away from exhaustion as a status symbol, and towards rest and self-care as something we covet. The scope of how we can help a person find a path towards healing is limitless. It is not bound by the technical constructs of a modality. Holding the pain of weight, and the weight of pain is something we are all capable of doing.
0:12:53.3 AD: And here we are, the end of the episode. Thank you to the extraordinary crew over at ABMP for helping me get my words into your ears. And if you wanna get any of your words into my ears or more accurately into my brain via my eyeballs from a computer screen, drop me a line at email@example.com. That's R-E-B-E-L-M-T at ABMP dot com.
0:13:16.2 AD: I always wanna hear your questions, comments, suggestions or salutations. Also, if you're interested in checking out anything else I'm doing, head over to rebelmassage.com where you will find all sorts of fun things to click on, like homemade organic products for your practice, cool links to continuing education classes, thoughts I have typed up and posted here and there, and other Rebel Massage dabblings.
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