Massage and Obesity

Replies to This Discussion

Permalink Reply by Laura Allen on December 27, 2009 at 7:00am

I agree with Erica. In spite of the fact that I am overweight, my stats are all within normal range and better than those of a lot of skinny people. High cholesterol, high blood sugar, and HBP do not just apply to overweight people.

I was anorexic as a teenager...I have pictures of myself weighing 75 pounds and it is a miracle I didn't fall over dead. I have obviously gone too far in the other direction, and I obviously have emotional issues with food, but if I had to choose one or the other, I would choose myself now as opposed to the anorexic.

We have a married couple who are clients at my office, and the woman is perhaps 20 lbs overweight, nothing serious. A few months ago when her husband came in for his appt, he actually told the therapist that he "wanted her to say something to his wife about how overweight she is." The therapist told him that was not her job to do and that she would say nothing of the sort. I don't think he's concerned about her health at all, I think he just doesn't like her little bit of padding. He always acts like he thinks he's god's gift to women.

Nutritional counseling is not in our scope of practice unless you happen to be a registered nutritionist or a registered dietitian. Counseling on the whole is not in our scope. I completed a 2000 hour internship in counseling as part of my master's in psych studies, could counsel if I wanted to, and I still do not counsel people. That is not why they are coming there. They are coming for massage, and that's what they're going to get. Our board regularly gets complaints about unqualified therapists setting themselves up as counselors.

Erica Olson said:

Relatively healthy as in "other than carrying too much weight, heart/cholesterol/blood pressure etc. are in good shape/within normal limits." I still maintain that it's really none of our business why someone is the weight they are, whether it is too much or not enough.

My note of caution about "incorporating healthy info" still stands. I'm not saying not to do anything of the sort, just to be extremely careful about how it's done, both due to scope of practice and the possibility/likelihood as coming across as judgmental. One doesn't have to directly point a finger at another's behavior in order to cause feelings of shame and guilt; helpful, well-meaning suggestions can do that alone: I know I should . . . why don't I . . .I'm so weak . . . look at all these other people who have been able to do it . . . what's wrong with me? . . . I'm such a failure . . .

Obese/overweight clients will already know that they would feel better if they lost weight. Yes, there are specific musculoskeletal examples we may be able to demonstrate (postural distortions due to weight, etc.), but I still wouldn't bring up weight loss as a solution. The client will be able to make that conclusion. Again, just a note of caution.

Lisa said:

Erica, how can she be relatively healthy if she's obese?

i certainly wasn't suggesting to be rude and forward about asking her directly. and i certainly wasn't suggesting to point the finger as to what aren't you doing. there ARE ways to incorporate healthy information in the realm of what we do. we offer up water after a massage because we know the benefits it offers in relation to a massage. in the same token we know that many chronic issues are directly related to weight.

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Permalink Reply by Gloria Coppola on December 27, 2009 at 9:41am

Yes Crystal there is some truth to what Laura speaks about. Often obesity has nothing to do with the "typical" types of conditions we might think apply. And Yes often it is some food issue as Laura mentions and NOT within our scope to counsel.

Just nurture your client. That's what they came for anyway. You can have articles around your office in site and if they are interested they will pick them up. They probably just want someone most of all to feel comfortable touching them, just as much as they want to feel comfortable being touched. That is my experience in working with obesity.

I have had obese woman actually come away feeling like a "goddess" for the first time in their life. Now that says a lot.

Laura Allen said:

I agree with Erica. In spite of the fact that I am overweight, my stats are all within normal range and better than those of a lot of skinny people. High cholesterol, high blood sugar, and HBP do not just apply to overweight people.

I was anorexic as a teenager...I have pictures of myself weighing 75 pounds and it is a miracle I didn't fall over dead. I have obviously gone too far in the other direction, and I obviously have emotional issues with food, but if I had to choose one or the other, I would choose myself now as opposed to the anorexic.

We have a married couple who are clients at my office, and the woman is perhaps 20 lbs overweight, nothing serious. A few months ago when her husband came in for his appt, he actually told the therapist that he "wanted her to say something to his wife about how overweight she is." The therapist told him that was not her job to do and that she would say nothing of the sort. I don't think he's concerned about her health at all, I think he just doesn't like her little bit of padding. He always acts like he thinks he's god's gift to women.

Nutritional counseling is not in our scope of practice unless you happen to be a registered nutritionist or a registered dietitian. Counseling on the whole is not in our scope. I completed a 2000 hour internship in counseling as part of my master's in psych studies, could counsel if I wanted to, and I still do not counsel people. That is not why they are coming there. They are coming for massage, and that's what they're going to get. Our board regularly gets complaints about unqualified therapists setting themselves up as counselors.

Erica Olson said:

Relatively healthy as in "other than carrying too much weight, heart/cholesterol/blood pressure etc. are in good shape/within normal limits." I still maintain that it's really none of our business why someone is the weight they are, whether it is too much or not enough.

My note of caution about "incorporating healthy info" still stands. I'm not saying not to do anything of the sort, just to be extremely careful about how it's done, both due to scope of practice and the possibility/likelihood as coming across as judgmental. One doesn't have to directly point a finger at another's behavior in order to cause feelings of shame and guilt; helpful, well-meaning suggestions can do that alone: I know I should . . . why don't I . . .I'm so weak . . . look at all these other people who have been able to do it . . . what's wrong with me? . . . I'm such a failure . . .

Obese/overweight clients will already know that they would feel better if they lost weight. Yes, there are specific musculoskeletal examples we may be able to demonstrate (postural distortions due to weight, etc.), but I still wouldn't bring up weight loss as a solution. The client will be able to make that conclusion. Again, just a note of caution.

Lisa said:

Erica, how can she be relatively healthy if she's obese?

i certainly wasn't suggesting to be rude and forward about asking her directly. and i certainly wasn't suggesting to point the finger as to what aren't you doing. there ARE ways to incorporate healthy information in the realm of what we do. we offer up water after a massage because we know the benefits it offers in relation to a massage. in the same token we know that many chronic issues are directly related to weight.

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Permalink Reply by Lisa on December 28, 2009 at 1:53pm

Erica Olson said:

Trust me, the client knows that she's not in ideal health or living up to our culture's standards of beauty; the last place she needs to hear it is from the person she is putting her trust and vulnerability into.

I feel like i need to clarify myself, so i will state this and then leave it at that.

never once did i say anything about "living up to our culture's standards of beauty". that almost implies that i was being judgmental of the client's weight on a superficial level, which i was not nor would i ever be. having come from a severely overweight place myself, i could never do that to someone else.

nor was i suggesting that we dole out nutritional advice or an exercise regiment.

i spoke to a fellow colleague about this thread and she shared that occasionally she will educate her clients (obese or otherwise) the benefits of yoga or plates. she wasn't showing her clients how to do yoga or even telling her clients to start an exercise regiment. she was merely educating the client that yoga and plates are known to be good for the joints and our core muscles (i'm paraphrasing our conversation). it was in that suggestion that i said...well see...that's guiding them to healthier choices.

i feel like it's being suggested that i am being judgmental to a client's weight and possibly going beyond my scope of practice. we were very educated in school as to not crossing the lines in scope of practice. so i go on record that my suggestions were not to do that at all. and again, i was certainly not encouraging an MT to talk "weight" during the first few visits. but over the course of a client/MT relationship, i think there are many opportunities we have to educate our clients on how their bodies work, and how things such as weight and our posture throughout the day can all play into affect on our client's chronic aches and pains. and educating our clients to things like drinking more water, the benefits of yoga or even meditation, stretches that can be done to alleviate tightness, and things of that nature all are health suggestions...this is all i was suggesting.

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Permalink Reply by Crystal Dawn Suovanen on December 28, 2009 at 2:46pm

Thank you all. And thank you Jenny, I'll read that article. My new client has seen me twice now and scheduled for a third. I wish there was a class in my area for working with obese clients, but I'll have to settle for learning as I go. :)

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Permalink Reply by Stephen Jeffrey on January 2, 2010 at 12:03pm

Hi Crystal, MT school doesn't prepare us for everything does it? but maybe life has prepared you better ?

The way I see it is like this, Your treatments will already be supplying a chemical balance via the feel good factor, then as you two get to know one another ,the more friendly and open the chit chat will become. Do not initiate the conversation wait for her to take the lead in conversation re diet, weight loss or what ever is on her mind at the time. All you have to do is listen and encourage her towards more a positive outlook/action. She will be expecting you to do this, her higher self may just need to " hear it spoken " and so could mark the start of important changes in her life.

You can't take a class to match every client/intake/awkward/medicle/ situation, trust your heart and mind and spirit to guide you as you gain experience. You are good MT, you can only get better.






Crystal Dawn Suovanen said:

Thank you all. And thank you Jenny, I'll read that article. My new client has seen me twice now and scheduled for a third. I wish there was a class in my area for working with obese clients, but I'll have to settle for learning as I go. :)

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Permalink Reply by Crystal Dawn Suovanen on January 3, 2010 at 3:25am

Good advice. Right now I think she is contented to just to receive the massage and the rest will come later. She has said that she is pain free for three or more days after a massage. I said great! It's one of the best things she can do to get those stress levels down.

Stephen Jeffrey said:

Hi Crystal, MT school doesn't prepare us for everything does it? but maybe life has prepared you better ?

The way I see it is like this, Your treatments will already be supplying a chemical balance via the feel good factor, then as you two get to know one another ,the more friendly and open the chit chat will become. Do not initiate the conversation wait for her to take the lead in conversation re diet, weight loss or what ever is on her mind at the time. All you have to do is listen and encourage her towards more a positive outlook/action. She will be expecting you to do this, her higher self may just need to " hear it spoken " and so could mark the start of important changes in her life.

You can't take a class to match every client/intake/awkward/medicle/ situation, trust your heart and mind and spirit to guide you as you gain experience. You are good MT, you can only get better.






Crystal Dawn Suovanen said:

Thank you all. And thank you Jenny, I'll read that article. My new client has seen me twice now and scheduled for a third. I wish there was a class in my area for working with obese clients, but I'll have to settle for learning as I go. :)

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Permalink Reply by Gary Brownlee on January 6, 2010 at 4:41pm

Crystal,
Regarding the table, yes they will support a lot of static and distributed weight, such as when a person is lying on one. However the danger is when a person is getting on or off the table and all the weight is in one area. Someone usually will be in the middle of the table, and that can be where it is the weakest. I think you made a wise choice of putting the table on the floor. You certainly don't want the table to collapse when they are either getting on or off. Unless your table is exceptionally strong, you would be much safer on the floor with a very heavy person.

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Permalink Reply by Choice Kinchen on January 6, 2010 at 6:25pm

I like your answer Stephen...that could apply to all of our clients that have issues....not just with weight.

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Permalink Reply by Lisa on January 6, 2010 at 7:36pm

and for many that WANT to start a weight regiment, many times they can't (again I am speaking from personal experience here) because it just hurts. the more "pain free" days she gets, the more she'll be ABLE to move and more movement equates to a healthier life.

Crystal Dawn Suovanen said:

Good advice. Right now I think she is contented to just to receive the massage and the rest will come later. She has said that she is pain free for three or more days after a massage. I said great! It's one of the best things she can do to get those stress levels down.

Stephen Jeffrey said:

Hi Crystal, MT school doesn't prepare us for everything does it? but maybe life has prepared you better ?

The way I see it is like this, Your treatments will already be supplying a chemical balance via the feel good factor, then as you two get to know one another ,the more friendly and open the chit chat will become. Do not initiate the conversation wait for her to take the lead in conversation re diet, weight loss or what ever is on her mind at the time. All you have to do is listen and encourage her towards more a positive outlook/action. She will be expecting you to do this, her higher self may just need to " hear it spoken " and so could mark the start of important changes in her life.

You can't take a class to match every client/intake/awkward/medicle/ situation, trust your heart and mind and spirit to guide you as you gain experience. You are good MT, you can only get better.






Crystal Dawn Suovanen said:

Thank you all. And thank you Jenny, I'll read that article. My new client has seen me twice now and scheduled for a third. I wish there was a class in my area for working with obese clients, but I'll have to settle for learning as I go. :)

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Permalink Reply by jill beaulieu on January 6, 2010 at 8:20pm

i have had good results with myofascial release and trigger point release
using positioning to let the adipose tissue fall to the side is helpful, ie. sidelying or placement of a pillow under the abdomen
definitely try sidelying for psoas release or simply work at the point of attachment at the lesser trochanter
i have always included treatment to the muscles of the lower leg to bring some pressure off the feet
for sidelying try using 2 larger sheets one for vertical draping and one between the thighs (ask pt to pull it up towards her chest)

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Permalink Reply by Jason Day on January 7, 2010 at 5:25pm

What massage table are you using that you knew it wouldnt accomodate her weight? I would think any professional table would handle easily 600 lbs.

Jason

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Permalink Reply by Crystal Dawn Suovanen on January 8, 2010 at 5:23pm

All I can remember is that it wasn't a name brand table. It was a three year old table that had been used in massage school classrooms, but was still under warranty. Some sort of signature table by a man who's 1st name starts with R. The owner of the clinic has been in contact with the guy, but the person want to charge $60 to fix a structural problem for his under warranty product. Lame...

Jason Day said:

What massage table are you using that you knew it wouldnt accomodate her weight? I would think any professional table would handle easily 600 lbs.

Jason

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