Bolster Your Practice

By Rebecca Jones
[Ten for Today]

The massage therapist was kind and thoughtful, and had done everything she could think of to make Tom Owens comfortable as he lay prone on her massage table. So when she asked if he was comfy, he did the polite thing—he lied.

“I said I was fine,” Owens says. “And all the while I was thinking, ‘No, I’m not comfortable! I feel like I’m scrunched against a horizontal wall!’” 

Owens left the experience determined to find a way to make massage tables more cushiony. In the process, he developed the bodyCushion, a support system now used by thousands of bodywork professionals to not only make clients more comfortable, but also help put them in more optimal positions for therapeutic massage.

Cushions, bolsters, pillows, rolled-up towels, face and arm rests—all of these are ingredients in a massage therapist’s positioning pantry. Here are some things to think about when deciding when and how to use these positioning tools to your best advantage, and which ones might be worthwhile investments for your practice.


1. Ask About Size and Placement

When clients are lying prone, consider placing a bolster or some other support under the ankles, pelvis, and sternum. When on their backs, support under the knees and neck usually feels good. You’ll want different sizes for different positions and for different clients.

The best way to find out what size and placement to use is simply to ask. “Don’t forget to check in with your clients for feedback,” says Kelly Metz-Matthews, spokeswoman for EarthLite Massage Tables, which offers a full range of positioning accessories.

2. Experiment with Positioning

Don’t be afraid to experiment with positioning. “A common mistake is believing there is only one right way to use a bolster,” Metz-Matthews says. “Every client is unique and their experience with a bolster will be unique as well.”

3. Give Special Support to Side-Lying Clients

Side lying is the preferred and safest method for bodywork for pregnant clients, but it’s also helpful for clients with back or breathing problems. Remember that when clients are lying on their side, they’ll need support for their torso, neck, and head, as well as hip and legs.

“Side-lying positioning is more effective in some ways because it allows you more freedom of motion for the extremities,” says Jeffrey Riach, founder and president of Oakworks, a company that makes a whole line of massage tables and accessories, including its Side Lying Positioning System. “The core issue is, you need to create a stable and comfortable position that relieves the pressure off the lower shoulder and allows the hip to relax.”

4. Get a Comfy Face Rest

Paying attention to the padding in the face rest will result in substantially greater comfort for most clients—especially if your client has sinus problems or will be lying prone for an extended time. Experts advise getting the comfiest face rest you can find.

Riach promotes the Boiance Face Cradle pillow as a good alternative to memory foam or polyurethane face pads. The pillow is stuffed with water spheres that remove virtually all pressure from the face.

5. Face the Music

OK, this has nothing to do with comfort, but it’s just cool. The Zenvi Sound cushion, marketed by EarthLite, incorporates the soothing effects of crystal-clear, high-fidelity sound into a massage. It’s a super-comfy face cradle that connects to a client’s MP3 player. Clients get to listen to whatever music they prefer. Enough said.

6. Integrate Wedges for Better Breathing

Some clients have difficulty breathing when lying supine. Propping up their back and shoulders can make them more comfortable. Three or four pillows can do the job, but stacks of pillows aren’t as stable as a good, solid wedge. “Pillows can move or shift,” says Rachael Cook, spokeswoman for Pisces Productions, a California company that specializes in unique massage tables, chairs, and accessories. “It’s just one piece, so it’s not reacting and shifting the way a stack of pillows would.” Wedge cushions are also useful for pregnant clients, or to provide an incline for the knees.

7. Address Women’s Needs

Large-breasted women, or women experiencing breast tenderness, may find lying prone extremely uncomfortable. Some cushions are designed specifically to provide support to the breasts, which in turn will allow female clients to relax more.

Some new high-end massage tables go a step further and provide a built-in recess for the breasts. Oakworks, for example, offers what it calls its ABC (Adjustable Breast Comfort) system that uses a foot pump and release valve to allow therapists to reduce the pressure on a woman’s breasts without stopping the massage to get more pillows. Conversely, pumping more air into the system raises the area around the shoulders of a prone client, creating a stretching position. “This is part of a trend you’ll see in the future,” Riach says. “Eventually, we’re looking to put this in multiple areas across the tabletop, so massage therapists can lift different parts of the body and realign them.”

8. Get Better Access to the Neck and Shoulders

This is an area of concern to many clients. The Soothe-A-Ciser is a specially designed pillow that elevates the shoulders and lets the neck and head drape over the top, thereby hyperextending them and providing easier access for the therapist. “It was invented by a chiropractor for use as a traction device, but it’s an excellent item for massage therapists to use,” says Philip Mattison, president and owner of Core Products, a Wisconsin-based company that carries a line of therapeutic pillows.

9. Reposition Without Redraping

Most massage therapists try to avoid moving pillows and bolsters around too much once clients are positioned and draped. One option for easily repositioning a client without having to touch the drape is a butterfly cushion. Designed like a butterfly, with upper and lower wings on each side, the cushion is ideal for supporting the chest, shoulders, or spine, and is particularly good for clients recovering from recent surgery. “It’s attached to two little hand pumps and you can pump it up under the sheet, so there are no modesty issues,” Riach says. “When the client is comfortable, you just close the valve.”

10. Use Washable/Waterproof covers

Pillows make great positioning devices, but standard cotton pillowcases don’t provide much of a barrier for germs. Massage oils and body fluids can soak through cotton covers and remain inside the stuffing of a pillow. So if you use pillows in the course of a massage, be sure to use a washable, waterproof cover that you can disinfect afterward.


Rebecca Jones is a tenured Massage & Bodywork freelance writer. She lives and writes in Denver, Colorado.
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