It means being able to: 1) treat a client who is in significant pain, remedially 2) use a variety of master techniques to get a reduction of pain 3) achieve an increase of ROM (range of motion) and 4) allow time and energy to make the client feel safe, taken care of and experience a nurturing, fluid treatment.
Sounds like a tall order. But one of the best things you can do is work with your client from every angle – figuratively and literally. Treating clients prone, supine and on the side allows you to treat hard-to-access muscles and anatomical structures. In addition, it gives you, the therapist, a positive position to work from that decreases risk of injury to your precious fingers, thumbs, wrists and back.
Perhaps even more importantly, it gives you an option to treat those clients, who might not find it so easy to be prone or supine for 30 minutes or even at all. This means being able to treat individuals in different settings like a hospice or hospital. Also, it is the recommended positioning for pregnant women in all trimesters. Below are some different techniques that we have developed at the JING Institute to treat chronic pain in the side-lying position. Each one has been designed to achieve a specific outcome as part of JING’s advanced clinical massage protocol series for treating chronic pain. However, if you are a qualified therapist, you can get started right away and incorporate these into any treatment and see what happens.
THE BASICS – Recovery position
First, let’s get the positioning right. Ask your client to lie on their side as if they are sleeping. This helps to generally get in the position. Bolster under the neck and between the knees or under the top leg, with knee and hip in flexion. Then support her to straighten her spine including the cervical spine. Some clients tend to roll forward – consider a bolster for her to hold onto. Most clients will be so happy and comfortable in this position – you might have an even harder time getting them to leave your clinic.
Draping – My students know, I am a real stickler for draping and towel techniques: especially, in the side-lying position. This is because to be 100% professional and for your clients to feel comfortable and safe, you must keep your draping tight; in the side lying position we use something called T-draping. One towel/sheet along the length of the body and the other placed on top and horizontally. This allows for maximum access to different areas as well as maximum coverage of areas not being worked on at certain times.
Table height – Your table height needs to be very low as working with someone on their side means the body itself has more height. If you stand next to your table it should be at least as low as your mid-thigh. This way you can use proper body mechanics to sink into your work and apply appropriate pressure without over using your shoulders and arms. To see a video of this please Click Here.
JING’s advanced clinical side-lying techniques. Treating: Neck and shoulder pain as well as migraine suffers Deep fist/forearm effleurage with trapezius stretch:
Success in the art of a balanced clinical massage is a beautiful thing to achieve.
1. Stand behind client. Interlace your caudad arm under their exposed arm.
Wrap your fingers around genohumeral joint.
Place cephalad hand at base of occiput – apply gentle pressure and lean back to achieve a
2. Use soft fist or forearm to carry out deep effleurage from inferior to superior. From acromion – clavicular joint to occiput. Circumduction of Gleno-humeral joint
In the same position as above, place cephalad hand on flat of posterior scapula.
Lightly compress scapular thorasic joint and engage GH joint into circumduction – 3 x in one direction then the other. Each time with a slightly larger ROM.
Note: This is a great technique for assessing the client’s passive ROM at the beginning and end of treatment. Especially for anyone experiencing pain on active movement but not passive movement.
STR (Soft Tissue Release) for Trapezius
STR in the UK has been categorized mostly as a sports technique, but in the US and many clinical and remedial massage schools; STR is used to treat all kinds of patients in treatment and rehabilitation.
Using very little or no lubricant – so as to be able to be as specific as possible
Use cephalad thumb to compress upper fibres of trapezius and then lean back for a 2-sec
Repeat 4–6 times with different points of compression (or locks) in the muscle
Stretches must be quick to achieve best results
For low back pain: Quadratus lumborium trigger point release
1. Trigger points in the Q.L
Trigger points in the Q.L are responsible for the low back pain symptoms of approximately 75% of my clients. Even those who have been diagnosed with disc problems or have had surgery in their history, usually have a need for the Q.L to be worked.
In the side-lying position, it is easy to access the lateral aspect of this muscle with hands supporting each other, work between the 12th rib and the iliac crest. Any trigger point should be found and treated accordingly. At JING, we apply static pressure for 8–10 seconds and repeat 2–3 per session for primary trigger points.
2. Q. L and Abductor stretch
This is a great position to stretch these structures.
Allow the top leg to drop down off the table, making sure the knee clears the table.
Place your forearm just inferior to great trochanter.
Ask the client to take a deep breath and on the exhale use your weight to apply appropriate pressure through forearm until client feels a stretch. Hold for at least 15–30 seconds. The longer, the better with passive stretches. You can easily hold for a minute to get great results.
For everyone – Arm stretches
This is a great position to really stretch the arm in all directions. Clients love it and its great for your body mechanics as it is little or no strain to you.
Take the client’s arm into abduction, so that it is at 90 degrees from the torso. Support proximal to elbow and wrist and lift.
If needed, get on the table behind the client for extra stretch.
Take the client’s arm over their head and lean back, stretching latisimous dorsi and entire lateral side.
Arm can be placed in all variation of planes of movement to stretch different structures and fibres of different muscles.
Side-lying is the preferred and recommended position for treating pregnant woman at any stage of pregnancy. This is a safer position for the body and allows for maximum access to all structures that might be causing pain, like the Q.L. and Piriformis causing ‘sciatica’. It also good for great work under the occiput and around the temple
where woman might have trigger points that lead to headaches. In addition, many women suffer from Carpal tunnel and oedema in the lower leg. Side-lying is the perfect position to treat these common conditions. Please be aware that most professional insurance will not cover you to work with pregnant women, if you have not undergone specific training. Also, if you want to work with women in the 1st trimester, make sure it is covered by the course you take.
From an Eastern perspective
Gall bladder meridian – I always tell my students it takes at least one lifetime to begin to grasp the enlightening complexity of Eastern Medicine. As Shiatsu was my first training, it has always informed my practice and therefore informs the way we teach at JING. Although, I am not a proponent of the modern teachings of specific points for specific outcomes, i.e. press LI 4 to get rid of headaches. That is too simplified. Having some understanding of the foundation of Eastern practice can inform and enrich your Western table-based work.
Undergoing further training in any Eastern practice can give you additional skills to ground yourself and protect yourself for the long term. It can also give you tools to work with clients living with systemic conditions such as fibromyalgia, chronic fatigue and anxiety-related conditions. Traditional Chinese medicine often works with 12 major meridians. Each meridian is a pathway for chi to flow through the body. If at any one point, the flow of chi is disturbed, by either becoming stagnant or abundant, that is when disease occurs in the body.
The gall bladder meridian runs along the side of the body, through the temples down to the toes. So obviously this is a great position to treat it. The gall bladder energy or chi flow is meant to facilitate decisions making and judgment, as well as courage and initiative. Known as the ‘Honorable Minister’, the gall bladder works to clear the body. It is the meridian that many tension headaches build in. The gall bladder energy affects quality of sleep. If it is deficient, then an individual may wake up suddenly with anxiety in the early hours of the morning. Or have fits of short sleep unable to sleep through the night. By working this meridian you can encourage balance in the body and create a more harmonious mind–body system.
If you have tried these, and enjoyed them, there are many more structures you can work from a side-lying position. For instance:
Subscapularus for frozen shoulder
Illiotibial tract for runners and anyone who suffers from knee injury
Gastrocnemius and soleus for lower leg cramps. You can also stretch these structures in this position in a quick manner to achieve a lymph pump for suffers of ankle oedema
Psoas for lower back pain.
The possibilities are endless. If you haven’t played with this position then give it a go. We have incorporated them into our protocols for neck and shoulder pain, all of our stretching work and have developed a very unique three-day pregnancy side-lying course – where one can learn techniques that are applicable for anyone who you want to treat on the side.
If for no other reason, try it because it’s different. Doing interesting and memorable things is good for you and your clients. Variation reduces the incidence of therapist RSI – repetitive stress injury. Working from different angles allows you to be more specific and gives an indicator to clients that you are different than the therapist down the road. This is really important especially in this moment in time when clients are letting go of luxury treatments, yet will happily pay for clinical treatments that reduce their chronic pain. Clients – like us, want to know that we are in expert hands that are educated and confident in treating pain and discomfort in creative ways. Enjoy!
© Written by Meghan S. Mari Co- Director of the JING Institute.
The JING Institute offers over 50 CPD courses in the treatment of chronic pain.
Covering frozen shoulder, TMJ, carpal tunnel, and many more, plus a
revolutionary Btec Level 6 in Advanced Clinical and Sports Massage. JING also
offers course in Hot Stone Fusion and Pregnancy Massage.
For more info call 01273 628 942 or email [email protected]