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Why do so many therapists avoid "belly work"?

I've found many workshop participants are uncomfortable performing hands-on abdominal work, i.e., pelvic and respiratory diaphragm releases and sometimes even superficial belly techniques. This seems particularly true when working with pregnant clients/patients. Do you feel belly-work is under-emphasized in bodywork trainings? Does the area hold too much emotion or possibly too intimate for some? I've written a short e-newsletter & posted a video showing some basic, but useful structural integration techniques @ http://erikdalton.com/NewslettersOnline/Sept_09_Newsletter.htm

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Comment by Shanna Schultz on November 5, 2009 at 11:53am
I agree wtih previous posts...this was not an area that I learned a whole lot about in massage school. If the opportunity ever came up for more in depth training in this area, I would jump on it!
Comment by Erik Dalton, Ph.D. on November 4, 2009 at 8:05am
Does anybody have abdominal techniques that help with acid reflux? I demonstrate a couple of extended finger and hand techniques on one of my DVSs. I learned these maneuvers from an old osteopath many years ago and my clients love them. Of course, there are dozens of ways to manually help people with this widespread condition commonly referred to as GERD.
Comment by Michelle Doyle, D.C., CNMT on November 3, 2009 at 5:52pm
You will miss a lot of low back pain issues if you do not address the psoas muscle. Just need to educate your clients before treating any vulnerable area...explain that trigger points in the iliopsoas may refer pain to the low back or groin area...and the ONLY way to reach and release this muscle is through the abdominal region. Always perform a psoas stretch immediately following trigger point release. Also explain to them that emotional issues may surface during or after the session. I find that educating the client before and while I am working this area is essential in disolving any apprehension and fears that they may have.
Comment by Katie Wolff on November 3, 2009 at 11:23am
I work in a clinic with around 15 therapists, none of them do any belly work. I only learned a little superficial work in school but I always try to include it. I wish I could find good CE's in my area so I could do more beneficial belly work for my clients.
Comment by Jenni Malm on November 2, 2009 at 9:08pm
I think a lot of therapists avoid the abdominal area because it takes a lot of time to address the area slowly and properly. Personally, I deeply enjoy both giving and receiving abdominal massage, and given the existence of the enteric nervous system, or "belly brain", I also think abdominal massage is woefully neglected. Let's not lose such a powerful application as abdominal massage techniques!!!
Comment by Erik Dalton, Ph.D. on November 2, 2009 at 5:42pm
Yep , you're right Laura...gotta respect their wishes. However, I've found that often clients change their minds as they begin to trust your nonjudgemental touch.

I like to carry on a running dialog when working in areas that may be emotionally loaded. It helps them open up... if needed. I always try to keep the conversation light and easy as I explain the purpose, intent and benefit of belly-work.
Comment by Erik Dalton, Ph.D. on November 2, 2009 at 5:32pm
I believe clients who refuse to experience belly-work are missing out too. Some of the comments on this blog, i.e., working through the drape until you gain the client's trust, are very useful....thx ~ ERIK
Comment by Christina Evette Marquez on November 2, 2009 at 4:50pm
In school we learned a 2 minute abdominal massage. I was actually the demo because none of the other girls wanted to step up. To be honest, I have no problem with working that area. I believe that the stomach is one of the main areas that we tend to hold a lot of stress. I feel for those who have never experienced it due to their own personal reasons because they're missing out. My mother loves it and she can't get enough of it.

Out of respect for my clients I always offer and if they don't want their abdomen touched, I always leave the 2 minutes to work longer in areas needed.
Comment by Laura Allen on November 2, 2009 at 4:35pm
I appreciate a therapist working my belly and especially appreciate one who really knows how to do it. I've taken some visceral somatic classes but I would never claim to be an expert...and you don't often see CE classes on the subject.

When I give massage, I always ask if the client wants their belly worked on; I don't just do it automatically.
Comment by Erica Olson on November 2, 2009 at 1:25pm
I love doing psoas and iliacus work! It's one of my main go-to tools for lower back pain. When a client mentions lower back pain, I ask if they've ever received psoas work. Most haven't, so I describe where it attaches, what it does, the consequences of a tight psoas and the benefits of opening it. . . . then I let them know what I have to do to get to it (I also go in with the client's torso draped; I find that helps them feel less vulnerable and exposed). If they're a little uncertain, I let clients think about it while they're on the table, allowing them to get to know my touch and figure out whether or not they want to try it.

For actual psoas work, I've found that often less is more. For many clients, they've never been touched there before, so going in gently and using a lot of focused intention seems to be the best way to introduce them to the work. I've done this even with clients who carry a lot of extra weight around the middle, although I occasionally have overweight or sensitive-guts folks roll on one side to displace the viscera. For pregnant women, IBS/IBD sufferers, or people who just don't want their tummies touched, I utilize PNF/PIR stretches to release the hip flexors.

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