Working With Obese Clients. The pain of weight and the weight of pain.

I read a blog post once about a massage therapist's thoughts on working with obese clients. I was expecting some reflections on how to hold a judgment-free zone. Or maybe some insightful ideas on how to bolster and drape that would be helpful. Or even a story about the effects of obesity on joints and soft tissue. But instead I read a disheartening and shockingly cold statement from a person who consciously made the choice to turn obese clients away. He never worked on them. His decision, he recounted, was because he simply couldn't reach the muscle tissue and found it pointless.

Needless to say I immediately wanted to write my own blog. And so here I am. Why a blog, you ask? Why not a video? Good question!

I have made a lot of videos that offer techniques about how to handle a myriad of soft tissue dysfunctions. Most of them we learned about in school - what happens when we sprain an ankle, hold an inefficient posture for too long, sustain a traumatic break - but the complicated pain of being overweight is not so well defined. To demonstrate how to work with obese clients in a video wouldn’t be a simple process, because it is far from a simple dysfunction. And let me pause here and offer a bit of a disclaimer. I do not think that obesity is a dysfunction. Nor do I think of it as a disease. And I definitely don’t see it as an injury. I see being overweight as the combination of the physical, emotional and chemical processes of life that have wandered down a path that is a bit harder to walk. I also see obesity as a break that happens under the social construct and cultural pressures that weigh on each of us differently. There have been societies who celebrate a larger girth, but for the purposes of this blog, I am writing from the perspective of a modern day American, the culture in which I live. There is a weight to it. And a pain that comes with that. To put it more simply, being fat in today's world might just be the best insight into the complexity of pain than any torn rotator cuff or carpal tunnel syndrome can offer. There are a couple of good logistical tips (ok... 6) on how to work with a client who is obese. Let’s start here because this is the easy part. Having an obese client is going to mean a couple of things for you as a therapist right off that bat.

1) Lower your table. Your client will be higher which means that your mechanics will have to shift to accommodate. In order to be able to lean in with your body weight, lower the height of your table.

2) Offer to raise the face cradle up. With the extra weight, it can be difficult for a client to allow his or her head to drop into the face cradle if it is at the same height as the table. Lift it to meet their face and offer their cervical spine some relief. (Fun fact this also works really well with female clients who are large breasted)

3) Invest in table extensions that increase the width of your table. This helps your clients' arms to stay on the table as opposed to them feeling like they are working to keep them there. If you don’t have the extensions (or don’t want to invest), use your draping to their advantage. As soon as they get on the table or flip during the session, tuck the blanket around their arms and under their body so the blanket does the holding - not their muscles. This can also feel very nurturing - which, if we’re being honest, we all want to feel!

4) Have extra pillows and towels on hand. Extra body weight can make it uncomfortable to lay on a flat surface. Placing a small rolled up towel under their forearms and hands while they are laying supine can ease the tension from their upper arms and shoulders. Adding a towel to Increase the height of the knee/ankle