April 5, 2011

Fat and Massage

“What do you do with a client who's really fat? I mean, like 300 pounds? How can you do them any good?”

It was a fellow student in massage school asking the question, a few years ago. I looked at him in surprise. He was a big guy, heavier than me, probably only 60 pounds shy of the 300 mark himself. The question struck me as bizarre. He went on, “How do you even get to the muscle?”

I don't remember what the teacher answered. She seemed as perplexed as I was. How do you get to it? You go around the adipose tissue or through it, just like with anyone else. If there's a lot, going through it can be poky, so you use a blunter “point” – the heel of the hand instead of fingertips or thumbs, say. But we all already did that. Even a skinny person, anyone who's not downright emaciated, has patches of adipose tissue. We'd been working with it for a year. What was the big deal?

But this student was plainly distressed, and I could see that we had left the realm of the rational. He was a good guy, not a jerk. But some people are a little nuts about obesity. We had left the realm of facts and were floating in the anxiety zone.

I find it slightly easier to work on fat people than to work on skinny people. Skinny people are easy to hurt: the muscle tissue lies smack against the bone without any padding and working it without pinching it takes some delicacy. Fat people often have a few places where I change techniques so as not to poke – upper arms and inner thighs, for example. Trigger point can be a little trickier. But actually the way the body lays in fat leaves almost all of the sweet spots completely accessible. It's just not a problem. And if you work glutes and abdominals at all, you already know how to work through fat.

Every body – every body, no exceptions – presents challenges and requires some improvisations and adaptations. There's no such thing as a normal body. They all have injuries and unexpectedly tender places; joints with limited range or hyperextensible ones. If you can't modify your routine to fit the body at hand, you simply can't do massage. The clients I find most challenging are heavily muscled men, weight lifters, for instance, who are simply damned heavy to move around, and present a lot of dense muscle acreage to get through. But I don't mind that. It's my job, working with different bodies. That's what I do. I got into this profession partly because I like bodies. I'm curious about all the shapes they can take. I don't want them all to be the same.

Over and over people – especially women – apologize to me for their fat, as if they were offending me. I'll be working on what seem to me like perfectly lovely calves, and suddenly my client will be explaining to me how she has always had thick ankles and the weight just seems to settle in there, and she's been trying to diet and . . .

There's always a moment of disorientation, while I try to figure out what on earth they're talking about. But when I do, it makes me unhappy. I want to say, “Look, there's nothing wrong with your ankles, or anything else about you! Your body's lovely! I'm enjoying it! If I wanted to do massage only on bony fourteen year old models, I would have mentioned it in my ads!” But that would not quite be professional either. I don't really know what I do. Murmur something reassuring and neutral, I suppose. It's all the odder because the people who do this are often leaner than I am. If apologies are in order, shouldn't I be apologizing to them?

I have worked on some very obese people, and their obesity has never been the main thing I have been coping with, during the massage. It's the regular challenges – what's the root of this tension? How do I work with this injured shoulder? What's the best positioning for this leg? – that occupy my attention. It simply doesn't make that much difference.

A couple years ago I had an email inquiry about massage, in which the writer said something to the effect of, “I'm very big, so please tell me up front if you have issues about fat.” I was glad she felt she could ask, but I was mortified, on behalf of my profession, that she felt she had to. No one should have to ask that. We're therapists, for God's sake. We have no business “having issues about fat,” any more than we should be having issues about shin splints or headaches.

I understand that many people – erroneously, I believe, but that's a different subject – think that obesity is a self-inflicted condition. But so what? We're surrounded by injuries and conditions that are more or less self-inflicted. I see lots of people who have run on concrete until their knees or ankles are a mess. I see long-time smokers who have an eerie, system-wide dessication of tissue. I see desk workers who have so abused their neck muscles, by staring motionless at a screen for twenty hours a day, that they can no longer turn their heads. Do I suddenly get on my moral high horse and refuse to treat them? Turn them away in disgust? I do not.

Nor do I tell people they should lose weight. If they haven't been living in a particularly remote section of the Carlsbad Caverns for the last fifty years, they already know that, and they've already tried to do it – repeatedly, and at a grievous expense of spirit. The last thing they need is for their massage therapist, the person they go to for comfort, to start harping on the same theme.

38 comments:

  1. Gosh, this was refreshing to read! Thank you, sir--and best luck to you!

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  2. <3 backatcha, Rachel :-)

    Tangoiste, welcome, & thanks!

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  3. Love you for this. I was so worried when I first called.

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  4. "I was glad she felt she could ask, but I was mortified, on behalf of my profession, that she felt she had to."

    Sadly, this is not uncommon in our profession. I once has a colleague on my table, who spent the better part of the hour lecturing me on my weight, telling me everything I was "probably" doing wrong, and how I presented a "poor image" of "us as professionals." At one point during this diatribe, she informed me that the only reason I was "so fat," was because I "obviously make a lot of bad choices," and that it was really "quite simple not to look the way you do."

    I'm sorry, WHAT?

    She spent the balance of the hour telling me how long she exercised daily, how far she walked, and how her sister had "really let herself go." (From what I could gather, her sister was about 20 lbs heavier than she was.)

    Maybe she felt free to talk like that (and to be so rude to me regarding my extra pounds,) because she was the client, but I suspect that she projects that attitude towards "disgusting and unhealthy fat" on her clients also.

    This was not the first time I've been lectured about my weight by another massage therapist, either while giving or receiving a massage. This is not a subject I bring up either.

    They're out there. And until reading your post just now, I didn't realize how very angry I was (and still am) at this massage therapist for abusing me in my own space. (Hey, maybe now I can let it go.)

    I suspect that more than a few of our clients, who feel compelled to apologize or preface their scheduling requests with inquiries regarding our view of "large" people, have encountered these attitudes from those who are supposed to be providing care.

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  5. Stacey, it gets downright bizarre sometimes. It was commendable of you not to accidentally roll this person off the table, and give them some gentle advice about their bad choice of falling to the floor.

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  6. Dale, thank you so much for this post. Now I can relax during my massages.
    Elsie

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  7. Random person from the interwebs, here. Props to you for being cool to your clients. And to Stacey, you shouldn't ever let another person treat you like that. Just throw some of that spa cucumber water in her face.

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    1. OMG....that made me laugh so much, love it!

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  8. As a fat person who realy fees like I need a massage but am tired and fearful of being judged with righteous indignation by those who seem to think they are morally superior to me because they are thin, I did a google search to see how massage therapists feel about working on fat people. I must say your post has made me weep in gratitude. Thank you for validating me and my right to feel good about myself and my body. Just wish there were more people like you out there.

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  9. Oh, hugs. & do, go get a massage! There are plenty of people like me out there.

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  10. Hi Dale! I was looking for Mole and got here somehow, but I'm glad I did. I've read a lot about the "Body Beautiful" movement and found my empowerment, but one sentence in your essay helped me find my compassion:

    We had left the realm of facts and were floating in the anxiety zone.

    I think this is the only time I've ever thought about the mess people work themselves into about other people's weight. It's kind of nice to take a short break from frustrated anger and feel a little sympathy. Thanks!

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  11. Oh dale. Please relocate to the UK! I'm a larger lady and having terrible anxiety, refuse to get a massage out of fear of being laughed at. I'm 260lb and so very aware of my shortcomings!!!

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  12. Missionbean, get on the phone, or email, and interview some massage therapists in your area and ask them straight up. If they're weird about dealing with someone fat they'll be weird about other things, and you don't want to hire them anyway. There is nothing wrong -- these days there's nothing even unusual -- about being 260 lbs, and there are kind caring people who would love to work on you. Give them a chance!

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  13. Thank you - maybe I'll give some a call :) amy xx

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  14. I am going for my first massage in 15 years today, and I was anxious about what the massage therapist would think of my body (pretty normal, actually, but larger than I'd like). Thanks for this post - I now will be much more relaxed during the massage.

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  15. Thank you so much for this article...once the money situation settles down, I will be calling you for a massage!!! I have been way too scared for many years because of my weight.

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    1. Do call, Norma! Sooner rather than later! :-)

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  16. As A massage therapist, I agree with this in so many ways. Because I am a high responder to exercise, my body stays fairly thin. That and I do Thai Massage for a living. I think partly because I'm a tall thin man, I hear a lot of the body size issue, based comments that you mention. I say unabashedly that they have beautiful bodies, and nothing to be ashamed of. Also a lot of what people think of as fat, is often muscle. I hear how people hate their fat caves, or thighs all the time. I have to show them that it's muscle, or they don't believe me. Thank you for writing this!

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    1. Yes, all that lovely muscle. In the case of the calves, often a tremendous help to circulatory health. I have to be a bit circumspect, being male, about telling my clients their bodies are beautiful. But I always want to :-)

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  17. I love that you are accepting of all bodies, no matter what size but not everyone is like that. I am very big(and I have lost weight) and several years ago a Doctor let me know that he would NOT do a breast exam for a lump because I was big. So thanks for being accepting of people, and I also loved your poetry that I found. You are quite an interesting person and a very good writer.

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    1. Wouldn't do an exam? That's unconscionable! I'm so sorry, Bonnie.

      Thank you for reading!

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  18. Dale,

    I wish you were on the east coast. I have been weeding through your blog and essays and really appreciate that you have put 'pen to page'. Thanks for that.

    One request...Please add a widget to your site so I can get your blog posts to my email :)

    Thank you for doing what you do...

    Sarah

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  19. Dude, you are awsome, was sent to your other essay by someones tyrant and not only did I think the other essay was great, I think this one is even better. Thank you for doing healing and good in the world.

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  20. I haven't had a massage in years but know that I need one - the issue for me in putting on weight and getting to around the 300 mark is that I'm worried about the strength of those fold out massage tables and whether or not one could hold my weight.

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  21. Excellent article! I've often wondered about this topic but never discussed it with any therapist.

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  22. Thank you so much for writing this. I haven't had a massage for years because I've gained 20 pounds and there are gross lumps on my thighs (heaven forbid). I've been considering cancelling my appointment and rescheduling it in a few months after getting back in shape. I really don't want to though! Maybe now I'll stop obsessing and be able to relax and enjoy it for the beautiful experience it is. Thanks again!
    April

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    1. No, don't reschedule! Get the massage.

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    2. Oh my gosh - You were so right! It wasn't even an issue (or if it was, he was polite enough not to mention it). Getting a massage was even better than I remembered. I really wouldn't have kept my appointment if it weren't for this though. You're the best :)

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  23. Was looking to allay my fears that the massage therapist I saw today was grossed out by my fat. She didn't do anything to make me feel that way but I was still concerned. The massage was a gift and so I went even though I was fearful. The first post that came up was yours and now I am crying with relief, I didn't realize until just now how upset I was that she might have been judging me. Thank you for such a lovely post. You've mad this heavy girl feel much relieved.

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    1. Thanks so much. You know, mostly you just don't get into this business if you think bodies of any sort are gross. That's an at-a-distance attitude: it doesn't survive actually laying hands on someone.

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  24. Thank you. I've lost 100 pounds through walking but have felt embarrassed to go for a massage despite lower limb issues. This article has convinced me to book an appointment and seek treatment, without fear of being sent away for being to fat(still) or laughed at. Thanks once again. ��

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  25. From someone who was thin and active to 110 pounds heavier due to Thyroid disease....I go for my first massage in 5 years since the weight gain...I am terrified she might be thinking silently to herself...she is so fat. I am going to a different place from which I use to go every month only because she no longer works there. Praying she is just like you. Thanks for this article, Dale.
    Terri

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  26. What a wonderfully reassuring blog post :-)
    Lovely to read.

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