In massage school, I learned that a side-lying position was only to be used if someone, such as a pregnant woman, was unable to lie prone. The side-lying position was like the alternate cheerleader who only performed when the varsity girl was out sick. In practice, I’ve learned just the opposite—a side-lying position is the secret weapon for clients with hip and shoulder pain.
In a side-lying position, the shoulders and hips have freedom to move. This potential freedom of movement is an invaluable tool in determining where clients are tight, and it offers more possibilities to stretch, lengthen, and massage their tight joints and muscles.
Furthermore, since many practitioners don’t use a side-lying position to treat pain, incorporating it into your practice will give you an advantage. I have helped many people who came to me after seeing a number of other therapists. Because I use side-lying positions, I can better access and relieve the tightness that is causing pain. They leave thinking I’m a miracle worker, but really, I’m just using the advantages that a side-lying position offers.
Advantages to A
Side-Lying Position
1. Client Evaluation
A side-lying position is a great way to evaluate muscle tightness in your client, because the therapist can move a client’s shoulders or pelvis forward, back, up, and down to feel for where the joint is impinged. The therapist can also look at the client’s hips and shoulder joints in a side-lying position to see if the joint is tilted anteriorly, posteriorly, or superiorly. This visual and tactile information can help the therapist to evaluate, treat, and structure the session.
2. Troubleshooting
Because the whole shoulder girdle and pelvic girdle are available to be massaged in a side-lying position, troubleshooting pain is easier. Doing massage is like peeling an onion: as one layer or muscle releases, the practitioner moves on to massage the next layer or other muscles that are tight. A side-lying position allows you to move easily from the front of the body to the back of the body and/or side of the body—there is no need for your client to flip over.
3. Balance and Realign
With the front, back, and sides of the shoulder and pelvic joints available to be massaged, it’s possible to balance the front of the joint respective to the back of the joint, and vice versa.
For example, shoulders have a tendency to round forward; in a side-lying position, it’s possible to massage the front of the shoulder (with a stretch if necessary), releasing the tension in the chest that may be pulling the shoulder forward. From this position, you can also work the tension that builds in the back of the shoulders from this kind of misalignment.
4. Stretch and Lengthen
Freedom of movement in a joint means more opportunities to stretch. Take the shoulders, for example. In a side-lying position, it’s possible to stretch while massaging both the chest muscles and the rhomboids without changing position.
Tight hips and shoulders tend to move up the body. Oftentimes, mothers favor one hip when carrying their baby, causing a misalignment in their pelvis (the hip that carries the baby ends up being higher than the other one). It’s difficult to stretch and lengthen the quadratus lumborum (QL) in a prone position; in a side-lying position, the therapist can traction a downward stretch while massaging the QL, creating length in the QL and encouraging the hip to move back down.
5. Massage Lateral Sides of the Body
Many massage therapists treat the body as though it has two sides—a front and a back. The body actually has four sides: a front, back, right side, and left side. A side-lying position is the best way to massage the muscles that run along the sides of the body. By making these muscles easy to access, the practitioner can use downward leverage to massage these muscles (downward leverage is much easier on the practitioner’s body), instead of lateral leverage.
6. Body Mechanics
Body mechanics experts are in favor of a side-lying position because it allows the practitioner to maintain a neutral spine while massaging. Because the client’s body is higher up on the table, the practitioner is able to sit up straighter. In addition, when massaging in a side-lying position, there are many opportunities to sit on the table. Because the client takes up much less space on the table, there is plenty of room for you. Massage is a laborious profession; it’s important for career longevity to take advantage of opportunities to sit down.
7. Client Comfort
Some massage practitioners are in the habit of only massaging their clients in prone and supine positions, and think they are being bothersome to ask clients to turn on their sides. Nothing could be further from the truth. A side-lying position is reminiscent of the fetal position and is the position many people commonly sleep in. In fact, many clients prefer it to being facedown in the face cradle. Once you’ve massaged your clients in a side-lying position, don’t be surprised if they request it the next time.
8. Clinical Advantage
Because many massage practitioners are in the habit of only massaging their clients in prone and supine positions, they are limited to the benefits these positions provide and are not always able to help their clients. Learning to massage clients in a side-lying position will give you an edge over the competition because you will be able to treat a wider variety of issues more effectively.
9. Forearm Massage
It’s possible to massage the whole body in a side-lying position using your forearms. Because the forearms are more durable than the hands, fingers, or thumbs, you’ll be able to work longer and deeper on your clients with less wear and tear on the more fragile joints of the hands (see page 69).
10. Better Access
One of the more obvious advantages to positioning your clients on their sides is having access to the muscles that run along the sides of the body, such as the tensor fasciae latae (TFL). In a side-lying position, it is possible to use downward pressure to massage the TFL. The TFL is a small muscle that, when tight, can cause enormous pain. I have often had clients come in complaining of stubborn hip pain and tell me about the bodywork they’ve had on it with no relief. Once I release the TFL, the pain is gone. It’s difficult to access the TFL from supine or prone positions, but from a side-lying position, it’s easy.
A Fresh Perspective
A side-lying position opens up possibilities by offering another angle from which to massage your clients. If you’re a seasoned practitioner, a side-lying position can give you a fresh perspective on the body. If you’re a new practitioner, a side-lying position can increase your repertoire in a competitive market.
Shari Auth is a licensed massage therapist and acupuncturist, and is certified in the Rolf method of structural integration and Chinese herbology. She is the founder of the Auth Method and has a DVD, book, and home-study course on forearm massage, as well as a new DVD titled Forearm Massage: A Guide To Side-Lying Position. She teaches CE workshops and is an NCBTMB-approved provider. For more information, visit www.authmethod.com.