Don't Leave it on the Sidelines

By Cindy Williams
[Classroom to Client]

When is the last time you gave or received a massage that incorporated side-lying position? Can’t remember? You aren’t alone. This often-underutilized position has so many uses and benefits, it’s curious why many massage therapists tend to leave it on the sidelines instead of highlighting it as a star player in their massage practice.
Let’s up our game by first exploring the obstacles that might be hindering the choice to use side-lying position. Then, we’ll recall a few of the abundant reasons side-lying can be an integral player in the success of our work.

The Obstacles

A few conversations with fellow massage therapists shows there are three primary reasons why side-lying gets benched. While they are valid reasons, a little coaching and training can remove these obstacles.

Obstacle #1: Side-Lying Draping is Scary

Well, it can be. But it doesn’t have to be! There is a very simple side-lying leg drape approach that only recently came to my attention, and now it’s the only approach I take.
The key to side-lying draping is maintaining a client’s sense of comfort, safety, and modesty while undraping their lower extremity. This can be tricky when they are lying on their side, because the massage therapist has to effectively guide a sheet between the client’s legs without causing exposure or even a sense of exposure (sometimes there is no exposure, but it feels like it to the client). Try the side-lying leg drape technique to keep your client feeling comfortable and safe.

Side-Lying Leg Drape

1. From supine position, undrape the anterior leg using a diaper drape method.
2. As you pull the drape underneath the client’s leg, guide it all the way up to the low back and ask the client to anchor it against their body along with the anterior portion of the drape.
3. Hold the long edges of the drape and guide it alongside and up the table as you instruct the client to roll away from you onto their side.
4. Tuck the drape beneath the low back and hip.
5. Voila! The client is draped in side-lying position.
6. To re-drape, simply untuck the drape from beneath the low back and hip and hold the long edges of the drape as the client rolls back to supine.
Undraping the back is even easier.

Side-Lying Back Drape

1. From a fully draped side-lying position, pull some excess drape up to the waist to ensure you have plenty to work with.
2. Tuck the drape beneath the hip and pelvis to the height of the iliac crest.
3. Begin to undrape at the low back, arranging the drape in an L-shape along the waistline and lateral side of the torso.

Obstacle #2: I Don’t Want to Make My Client Change Positions Multiple Times

I get it. In general, clients like to check out and go into a quiet, inward zone during massage. Asking them to flip from supine to prone, or vice versa, is a disturbance to the zone. Adding side-lying could keep them from remaining in their deep state of relaxation. However, consider these alternatives:
• This is simply a belief. Have you asked your client if they mind repositioning additional times so you can offer more effective approaches to their body? I bet if you put it that way, they’ll be all for it! After all, they come to you to benefit from the relief your work provides.
• Try side-lying only. This position can be used in place of prone and supine while still delivering quality work. It doesn’t mean you have to replace these standard positions for every session, but variety is rarely a bad thing; it helps you stay engaged with your work and your client’s ongoing enjoyment and benefit.
• Approach repositioning like a moving meditation. Similar to incorporating breath to movement in a yin or restorative yoga class (which always chills people out in maximum fashion!), instruct your client to inhale before the movement, and then exhale as they roll over as slowly as possible, using the entire breath to complete the action. If they are a regular client who feels especially safe and comfortable with you, encourage them to keep their eyes closed as they move.

Obstacle #3: It’s Difficult to Maintain Good Body Mechanics

While it may seem difficult, the same principles of body mechanics apply to     side-lying as they do in prone and supine. The basics are to always face the direction of your stroke and initiate force from your feet, legs, and core. Stay close to your work, stack your joints, and keep your body in motion.
Applying these principles only becomes difficult when side-lying clients roll to their side and remain in the middle of the table. This causes the therapist to overreach and lose their center. Simply instructing the client to roll and slide toward you as you stand at the side of the table will fix this problem. Their back and hips will be close to the edge of the table, which places you closer to your work. Just remember to instruct them to slide forward again before returning to their back to avoid them rolling off the table.

Uses and Benefits

As mentioned, there are abundant reasons why side-lying can earn Most Valuable Player in your massage practice. To name a few, side-lying offers:
• A wider variety of angles from which to approach the neck, shoulders, hips, IT band, abductors, and adductors
• Increased range when performing coxal, glenohumeral, and scapulothoracic joint movements
• A safer and more comfortable option for clients with respiratory issues, large or tender breasts, low-back pain, medical devices or ports (depending on the location), or dislike of the face cradle
• A safer and more comfortable option for work with special populations, such as pregnant women, fragile seniors, clients who are postsurgical from procedures that prohibit lying on the belly or back, or posttraumatic clients who may have anxiety or trust issues
• A deeper sense of rest and nurturing, such as the fetal position while cradled in pillows, which can be delightfully therapeutic and exceptionally beneficial to inviting a parasympathetic response in your client

Equipping the Playing Field

Perhaps the most essential component to successfully bringing side-lying position into the game is equipping your practice with plenty of pillows and/or bolsters. Side-lying is most effective when enough props are placed to stack and align the client’s joints. Every side-lying client should enjoy a pillow under the head so the cervical spine is in line with the rest of the spine. (Frankly, I’m not a fan of using the face cradle pillow, even though it might be most convenient; a regular pillow is more comfortable and supportive.) Use a pillow in front of the chest and abdomen to avoid rolling forward and rounding the spine and one or more pillows beneath the upper knee and ankle to align them with the hip. Clients can either stack knees and ankles or extend the lower leg. Either way, alignment needs to be intact.
It’s easy to incorporate side-lying position. Remove the obstacles, remember the benefits, and before you know it, you’ll be scoring repeat clients because of your expanding offerings.

Since 2000, Cindy Williams, LMT, has been actively involved in the massage profession as a practitioner, school administrator, instructor, curriculum developer, and mentor. She maintains a private practice as a massage and yoga instructor. Contact her at