While massage therapists learn in school to use a bolster to support below the knees in supine position, under the ankles in prone position, and between the knees and ankles in side-lying position, there are other simple and effective ways to take your bolstering skills and your client’s comfort to the next level.
Clearly, there is sometimes a need for extra cushion or extra space. This is evident in the development of some products and optional upgrades to massage tables, such as breast recesses. If you are just starting out or need to stick to a budget, though, these upgrades to your practice can feel out of reach.
Here are six ways to bolster your client without breaking your budget.

Prone Position

1. Shoulder Bolsters

One of the most common causes of pain and suffering in clients is conducting most of life’s details in front of them. The amount of time spent on cell phones alone is enough to cause forward-rounded shoulders (protracted scapula), resulting in imbalance of all the muscles that attach to the scapula. Sometimes it is difficult to get overstretched, overloaded muscles to soften because they are locked in a patterned position. In prone position, it can be difficult to encourage the shoulders into retraction.
Using two rolled hand towels, place each one under the anterior shoulder slightly medial to the head of the humerus and inferior to the clavicle. This slight lift of the shoulder girdle in prone position will encourage the scapula to retract while gravity pulls the rib cage toward the table. Pectoral muscles will lengthen. Rhomboid muscles will shorten and soften, allowing you to more easily sink into them and relieve stress and strain. The domino effect into connected neck and shoulder muscles creates an overall release of tension. Simple and effective.

2. Breast Bolsters

Clients with large breasts often suffer from the same challenges mentioned above, but with exacerbation from the weight of breast tissue. In addition, it can be difficult to get comfortable lying on one’s stomach when a significant amount of breast tissue is in the way. Breast recesses are designed to create space in the table that the breasts can fit into. However, you can lift the client off the table with proper bolstering and create the same effect.
Use two large, rolled towels and one rolled hand towel. Position the two large towels horizontally across the table so that one towel runs across from shoulder to shoulder just below the clavicles, and the other towel runs across the lower rib cage just beneath the breasts. The hand towel will span vertically between each large towel, running the approximate length of the sternum. If you like, you can also add the shoulder bolsters described earlier as well as the pelvic bolster described below for full lift of the client’s torso.

3. Pelvic Bolster

Have you ever experienced low-back pain and tried to lie on your stomach? If so, you can attest to the fact that it isn’t comfortable. If the issue is anterior pelvic tilt, lying prone can enhance the misalignment and subsequent compression of vital nerve roots of the lumbar spine.
A simple way to decompress this region; soften the taut muscles of the erector spinae, multifidi, and quadratus lumborum; and make the deeper muscles more accessible is simply to place a regular-size bed pillow underneath the pelvis. This bolstering supports lengthening of the lumbar spine and tilting of the pelvis posteriorly.

Supine Position

4. Wrist Bolsters

Wrist bolsters might seem like they wouldn’t make as big a difference as they do. But how often have you observed clients awkwardly trying to find a comfortable position for their arms when they are lying supine? Especially when they are deeply relaxed, their arms splay out to the sides and off the table. With wrist bolsters, your client’s arms, wrists, and hands are supported alongside their body while slightly elevated off the table. It is not only more comfortable, but it also softens the pectorals and even the upper trapezius as a result of the arm being directed and held in place.
All you have to do is roll up two hand towels and place one under each wrist. Voila! Instant comfort and support.

5. Neck Bolster

Returning to the point of how much time we spend with our heads down looking at cell phones, there’s commonly a loss of healthy cervical curve, or hyperflexion of the cervical spine, which can cause nerve compression that radiates down into the arms and hands. Adding a neck bolster before and/or after applying neck work is an excellent way to encourage healthy curvature; soften the muscles of the anterior, posterior, and lateral neck; and unload compression on the vital nerve roots that exit the cervical spine. Even though the bolster only makes contact with the posterior neck, all neck muscles are affected by the supported positioning.
Use one rolled towel, and place it between the posterior neck and table. Some therapists use the face cradle pillow turned upside down; however, the cushion of the pillow is typically too lofty, causing the back of the head to not make contact with the table. This doesn’t support the cervical curvature as well as a rolled towel.

6. Vertical Spine Bolster

This final bolstering technique is a bit trickier than the others, but it is so effective, it’s worth it. I even recommend it to my clients as an easy but powerful at-home self-care practice. Because the towel will span the entire length of the spine, the gentle contact with all the nerve roots, especially the parasympathetic nerve roots, creates a natural relaxation response to the entire body. It also softens overtaxed back muscles that work hard to keep the body upright against gravity and poor postural habits, and supports opening and lengthening of shortened muscles of the front body.
Roll up a large towel lengthwise. Assist your client in sitting upright momentarily by asking them to hold the sheet against their chest while you place your upper hand behind their head/neck and your lower hand gently grasps their forearm. On a count of three, assist the client upright. Place the towel lengthwise so that one end sits against the sacrum and the upper end at the top of the table. Assist the client as they roll down onto their back with the bolster along the spine. You can also lift the towel slightly in the region below the neck to support the cervical curvature. Direct the client to allow the scapula to wrap around the towel, softening the upper and mid-back muscles and opening the anterior chest and abdominals. Be sure you include a bolster under the knees as you would commonly do in a massage session to take any pressure off the low back. Use only a soft towel, never a standard bolster.

All Bodies Are Different

While this probably goes without saying, bodies come in all shapes, sizes, lengths, and proportions. It is wise to keep extra towels and pillows on hand, because if you are using the above suggestions and clients still report discomfort or you can visually observe misalignment, adding a little cushion here or there is easy. Don’t be afraid to take the time to get it right. Some therapists report not wanting to “fidget” with their clients, but I assure you, a client will get far more therapeutic benefit from your work when you confidently put forth this effort. Plus, they will feel your care and concern, and keep coming back!