These days, a full-body massage treatment is not always “full body.” Certain body segments have become part of the “untouchables” that are intentionally left out of massage and bodywork sessions altogether. That unfortunate, growing list includes the abdominals, the pectorals, and, most notably, the glutes. The problem is increasingly exemplified in some franchise spas that are trying to protect themselves from the lawsuits of a sometimes-litigious clientele, and in schools that aren’t always prepared to teach their students the importance of gluteal work. The trend seems to be growing, and experts are concerned about its impact on the profession.
Muted Glutes
The three gluteal muscles—gluteus maximus, gluteus medius, and gluteus minimus—are part of the structure that literally holds the legs to the pelvis. These muscles are critical to most movements we make throughout the day, yet sexual undercurrents, ill-prepared therapists, and litigiousness sometimes keeps them from being addressed in a massage therapy session. And that, experts say, is a mistake.
“The gluteal muscles are extremely important and are critical players in posture, gait, and special movements,” says massage educator and therapist Clint Chandler. “This muscle group stabilizes the pelvis and spine, and creates powerful movements at the hip joint.” He says the inability to work these gluteal muscles, especially as we face an aging baby boomer clientele, limits one’s effectiveness to practice.
Some spas refuse to allow work on a client’s glutes, while others will do so once a release is signed by the client. “These restrictions of no-touch zones are not just for modesty or sexual gray areas, but more and more are also being applied to important clinical areas because of a lack of training in techniques and safety on such areas as the anterior neck, adductors, tissue next to the spine, the abdomen, and others,” says Art Riggs, author, bodywork educator, and advanced Rolfer. “The combination of inflexible restrictions and lack of training is not only depriving the public of good work, but is now defining what the public and therapists consider appropriate techniques and is exacerbating this problem. I feel that neglecting to work on such an important area as the gluteals is a great disservice to our clients.”
Schools Reacting Out of Fear?
In addition to somatic omissions happening in spas, more and more massage graduates are reporting that their school’s gluteal massage curriculum lacked in content and practice. Some new graduates admit they come out of school with sparse knowledge of how to address this critical muscle group and little to no communication skills on how to talk to clients about it. The combination makes for awkward interactions with clients and a further distancing from best practices.
The fear has grown to the point that some schools don’t allow gluteal work in their school clinics, while others cite student privacy as a reason for not covering gluteal work in their classrooms, all of which exacerbates trepidation about client boundaries.
“I have no idea why a school or a clinic would avoid teaching students how to work this important muscle group,” Chandler says. “I can’t imagine the rationale for such nonsense. They are doing a disservice to the profession, to students, and to potential clients.”
While she hopes it’s a very limited experience, ABMP’s Director of Education Anne Williams says she has heard rumors of schools that don’t teach gluteal massage and she finds it concerning. “The Entry-Level Analysis Project (ELAP) determined that gluteal massage should be part of core curriculum. I would encourage all entry-level programs to teach it. This way they can ensure that their graduating students know how to discuss it with clients in a professional manner and how to drape and apply strokes in a way that preserves the client’s modesty,” she says.
Longtime educator Erik Dalton says while he feels massage therapists should indeed err on the side of caution when performing gluteal work because of possible misconstrued intentions and interactions, these somatic omissions are affecting the profession on an even deeper level: “What concerns me most is the absence of classes that teach adequate biomechanical and neurological assessment skills. Gluteal function is complex, multifaceted, and often not well understood. Therapists need to consider the dynamic function of the gluteals as they relate to the entire body during normal, everyday movements, not from an isolated, compartmentalized viewpoint,” he says. “Hip musculature requires restoration of proper length-strength balance. Random deep-tissue or assisted stretching techniques may be detrimental to the therapeutic outcome if the gluteals are already neurologically inhibited. I believe there is a need to focus on teaching better functional biomechanics and improving our hip-assessment skills.”
Do No Harm
“It is pretty clear this (trend) is coming out of a fear-based model of trying to avoid issues of inappropriate touch,” says author and clinical massage educator Whitney Lowe. “However, it sure seems that if appropriate ethics and responsible practices are adhered to, this is much less of an issue. We are in a time now where massage has gone mainstream and many people are coming to get massage who have never had this type of touch therapy before. Many of them may be uncomfortable with work on the gluteal region because of perceived associations with the former ‘shadow side’ of massage. It seems like the only way to really address this issue is to talk about it a great deal more and also have more open discussion with clients.”
Ultimately, the conversation should come back to what we’re denying the client as a result of these choices. Are we following best practices when we ignore this entire area of the client’s body? And, from a more global professional perspective, are we doing a disservice to the future of the massage profession by diminishing the potential of the work today?
“Let’s face it, massage is no longer counterculture—it’s big business,” Riggs says. “I suppose restrictions on gluteal work could be ignored as just being a somewhat silly practice, but it is growing, and I fear it’s symbolic of other possible trends to sacrifice high quality bodywork in deference to corporate interests. We aren’t just depriving clients of good work when we skip important areas; we may be upsetting an integrated balance in the body and causing harm instead.”
Confidence in the Work
An important factor in this equation of best practices is a therapist’s confidence, Lowe says. “If the therapist comes across as not being confident and being uncomfortable with the idea of working the gluteal region, that discomfort will be translated to the client and could lead to them also not feeling confident with the therapist’s work.”
New therapists are encouraged to practice their conversations, techniques, and draping protocols with family, friends, and colleagues. The more comfortable you are in delivering gluteal work, the better the outcome.
And the payoff is worth it. “As soon as you do good work in that area, even the clients who may have been skeptical have an immediate awareness of how beneficial glute work is,” says ABMP’s Manager of Professional Development Kristin Coverly, LMT. “They feel the hypertonicity and imbalance as you’re working the area and new clients are often surprised by that because these are not always muscles that scream at you when they’re tight. New clients may not know what’s happening with their glutes until you work them and create that awareness. But once they know, and understand, they want the work.” She says it’s also important to build and strengthen this awareness by talking about it with clients after the session as well. She asks clients, “Did you feel the tight muscles in your glutes as I worked them?”
What’s the Answer?
“I do empathize with the difficult position of spas and individual therapists to protect themselves from a litigious public,” Riggs says. “But the answer is not to tie therapists’ hands behind their backs with no-fly zones. I’ll grant that for some, the gluteals are a ‘private’ area, and we all have to be careful and sensitive to our clients’ feelings and concerns. But the answer is not universal prohibition. It seems to me that it makes much more sense to simply ask clients if there are any areas they would like you to keep away from during a session, rather than automatically depriving them of quality work. Don’t build roadblocks out of assumptions.”
Coverly concurs. “Always work the glutes. Draped or undraped. Every session. They’re so important! I honestly feel like I wouldn’t be giving a complete session and would actually be doing clients an injustice by giving a session without that work.”
What’s Your Favorite Gluteal Technique?
Erik Dalton, M&B columnist, educator: I use a “Spindle-Stim” routine to turn on weak, inhibited gluteus muscles. Optimally, the hip should extend at least 30 degrees past the pelvis with the client prone. The hamstrings typically begin the motion, and the gluteus maximus primarily comes into play at the end range of a prone hip extension. The inability to extend 30 degrees, or compensatory lumbar spine “dipping,” indicates poor motor control or weak glutes.
• With the client prone, ask her to lift her left leg as high as comfortably possible, keeping the knee extended. Get a sense of how high the extended leg elevates off the table.
• Place the client’s left foot against the right knee, forming a Figure-4 position.
• With elbows extended, use both soft fists and begin slowly bouncing on the left hip.
• Drop your body weight so all the energy is coming from your legs and ask the client to slowly lift and relax her left knee to help activate the glutes.
• Work the gluteal fibers in all directions and gradually begin to pick up speed until you see the entire body rocking and rolling. This is not tapotement—the moderate force must come from your legs through your extended elbows and soft fists. The goal is to kick in a mild stretch reflex via the muscle spindle’s dynamic gamma motoneuron system.
• After two minutes of rapid spindle-stim, stop and retest the client’s degree of hip extension.
• Repeat on the opposite side. Take notes on the degree of improvement so the client can be retested at the beginning of the next session to see which hip still needs more work.
Karrie Osborn is senior editor at Associated Bodywork & Massage Professionals. Contact her at karrie@abmp.com.