tips for side lying position

[cherise]

well, a couple of times the question was posed in some other threads about the best way to work deep with the client in the side lying position.

sleep apnea:
http://www.massageplanet.com/forum/viewtopic.php?t=12369&highlight=

post-natal massage:
http://www.massageplanet.com/forum/viewtopic.php?t=11987&highlight=

rather than tack on a response to the end of the thread, i will start a new topic. the following is suggestions, and i will try to describe some ways to work low back, hips and shoulders in side lying. please add what you know, all other tips welcome, of course.

set up
most important seems to be getting the bolstering right.
client is lying on the right side. the right leg should be extended straight, left leg is bent (flexed 90 degrees at the hip and the knee). you must use enough pillows to bolster the leg so the hip is not dropping forward. you may have to use about four or five standard pillows, or a body pillow doubled up and one standard pillow, or one fluffy bolster and two standard pillows... whatever you use, it takes a lot.
you also need a pillow (or two) for the client to hug with left arm. and a small pillow for the head or use the face cradle cushion. the client is lying with the right arm bent at the elbow cradling the head pillow with the arm and hand. client should not lie with the shoulder abducted, lying on serratus anterior and arm scooping pillow over the top of the head, but shoulder in neutral, lying on deltoid.
also, play with your table height, and see what you like. probably better too low than too high (can always bend the knees more), but i personally just leave my table at regular working height. when i need more pressure, i just move my back leg further away, then lean in.

working deep is about working specific, so the understanding of anatomy is as important as palpation skills. and if you can remember back to learning deep tissue in prone and supine positions, what really makes anyone any good is practice. if you want to be good at doing massage in side lying, you have to step out of the prone/supine comfort zone and practice, practice, practice side lying.


low back

*bolstering changes for quadratus laborum*
for the side to be worked... arm on side to be worked overhead, resting on ear, hand holding edge of table (top). client straightens uppermost leg and extend behind bottom leg (bolster top leg in this position). this position opens the space where you find QL. (area between ribcage and ilium)
after warm up of superficial tissues:
face the client from the front. cross fiber attachment of QL, last rib, iliac crest. gently apply circular cross fiber to the transverse processes of L-1 to L-5 through the lateral edge of the erectors group. repeat the cross fiber a few times before treating trigger points or tender points.

stretch QL. gentle pull on the arm overhead, ask client to place leg over front of table and gently lean back, slowly. the shoulder drops backward, gently manipulate the arm overhead, until the client feels a stretch in the QL.

hips, gluteal group

*obviously use extreme caution with pre-natal, change or do not use some of these routines*

after warm up of superficial tissues
iliacus - face the client from the back. cup ASIS with fingertips, trace border of ilium several times before pressing fingers underneath the superior ilium as far as they will go/comfortable for client (caution: extreme tenderness) keep the hand static without pressure, place the other hand on the sacrum and gently rock the pelvis forward and back. as you continue rocking, and the tissues soften, your fingers will sink deeper into ilacus. now you can cross fiber iliacus fibers against the ilium. spend time with moving or direct pressure on trigger points or tender points.

gluteals and piriformis - face the client from front or back, whatever you prefer. cross fiber attachments for gluteus maximus, medius, and minimus. inferior border iliac crest, sacrum border, the greater trochanter. after releasing attachments, work the muscle belly fibers to relieve trigger points and tender points. for deeper pressure, lean in with ulnar side of arm or olecranon process. can also apply circular cross fiber.

stretch hips/gluteals - uppermost hip and knee flexed 90 degrees, support uppermost leg while allowing gravity to pull downward, then pull knee to chest. then, uppermost leg extended straight, pull leg gently back.

shoulders

a lot can be said here, but i'll try to keep it on the brief side. the side lying position is great for accessing and treating rotator cuff muscles. when treating the uppermost shoulder, place your own arm (preferably your superior arm) under the clients arm at the elbow. the clients upper arm is abducted slightly, and hanging loosely over your arm. in this "weave" position, you can manipulate the shoulder for ROM and best palpate tuberosity tendons.

in this arm weave position (or ask the client to hold up the uppermost elbow with the bottom arm), kneel or sit on a chair facing client. you can treat supraspinatus and infraspinatus, as well as teres minor (and teres major) with the free hand. if you need both hands, the client holds the arm. warm up latissimus dorsi and serratus anterior, then treat subscapularis (mild pressure should be used). the clients uppermost arm is pulled forward slightly, thumbs can be placed on the anterior surface of the scapula and onto subscapularis. gentle static pressure or cross fiber.

 

[Vincent]

Thanks Marie!
Now it's just figuring out proper draping procedures. Like you said, Practice Practice, Practice!

 

[H B]

Same here. It's the draping I have trouble with. I don't like them to feel exposed around the glut area, but have trouble massaging the hips and gluts.

 

[Martha S.]

I was taught a sidelying drape that ends up looking a bit like a french-cut bikini. Works great for the whole hip and glute area. Hard to explain though. One of these days I'll take a video of the whole thing and post it on youtube. :

You need quite a bit of slack in the sheet, and a towel to cover the extended leg on the table. Gather the sheet up until the bottom hem is above the knee. Now you will have both bottom corners hanging down on either side of the table at about knee level. These are your tails.

Standing behind the person: Take tail #1 on the anterior side, and tuck it under the top leg. Pull it up like a diaper drape and pull the tail from the posterior side until it makes the front side of the diaper. Let that hang down the posterior side of the table/client. Take the tail #2 (original posterior tail,) and tuck it under the leg just above the knee, until you can reach the tail on the anterior side of the leg. Pull this tail just a little, but leave it loose for now.

Roll and gather the hem side until you can get it up over the hip, until the sheet roll is lying just above the iliac crest. As you roll and gather, you can adjust the tail #2 to keep things snug. Standing behind the person, you are unlikely to get a glimpse of anything private, while adjusting the drape, if you do it in this order.

Use the towel on the extended leg (and another for the lower part of the bent leg) to provide warmth and coverage.

The great thing about this drape is the whole of the adductors can be worked on the lower leg, and with the upper leg bent, it feels less invasive than working the adductors supine.

It's a difficult drape to get at first, but once you have it figured out, it's like any other, and you can do it quickly and with ease.

 

[Flip]

what a great draping description! thanks. i am going to try it, i like a precise, neat drape.
if the client is wearing underwear, then i just move the blanket and apply techniques through the sheet.
my drape for side lying is a little sloppy, but just using one corner of the sheet. at the side of the uppermost leg, i fold back the sheet to expose the knee, give a tuck under the medial thigh, then kind of move the sheet around the glute (keeping the sheet close against the thigh and hip) and another tuck of the sheet under the posterior thigh.

i don't like tucking when i drape in supine or prone, but a complete drape around the leg for security, so i can't wait to try the french bikini drape.

 

[Aaron D]

I am so not good at understanding physical directions through writing. Your technique "sounds" great, Breathe, but I can't picture it! I'll describe what I do, and it may very well be what you just described (though I don't think so).

Start the client lying on their back. Undrape the leg you intend to be the top leg after they roll to their side. Undrape it entirely, all the way up to superior portion of the quads. Then pull the drape under that leg (they are still on their back). Some people call this the diaper drape (but it's not as diapery as other drapes). You lift the leg up a bit and pull the sheet through. Pull it through farther than you normally would, so that you can grab it on the other side. Pull it up high near their glute.

Now instruct them to roll over so that the uncovered leg is on top. This is where you need to be paying attention. As they roll over, you are standing behind them and holding that sheet that is near their glute. As they roll over, pull it up to cover the gluteal cleft. Once they are completely rolled over, I put that end of the sheet abover their ASIS, just loosely sitting there. Their entire buttocks on that side, the hip and leg are exposed, great for working the gluts and IT band.

As Breathe said you can use a towel or something to cover the areas of the leg you are not working on for warmth.

Now that I am reading your description for about the 5th time I think I am getting it. (Nothing to do with your writing, you are very clear. I'm also sick today, muddled head.) I will definitely try that method. It sounds great for having easy access to both legs, the adductors of the lower legs, as you said.

 

[legionfalls]

Well yesterday I had my "sleep apnea" client, and marie, your directions came at just the right time. I studied them, and used them in our first side lying experience.
He has a lot of QL/ low back/ glut issues, so the QL/ Ilacus techniques were well apreciated.
As far as the draping went, although I was a lil uneasy I did ok. The main text we used in school had some pretty good pics that I refered to as well as your instruction prior to the session.

Throughout the session, I made sure to keep an ear on his breathing because when he falls asleep, he has trouble breathing properly. I don't feel that this position helped all that much more with his alignment, and breathing issues.

He is a regular client, so after the session I made time to discuss how he felt throughout. He felt that it was as comfortable, or more so than supine/prone.

I will continue to work with him in side lying if he chooses, and hopefully over time my techniques will improve.

In the meantime, I will use my fiance and mother as "dummys" to get better with the techniques.

Thanks again Marie!

And Breathe~ I am sooo a visual person. I look forward to you putting that up on You Tube! Thanks for the instructions, I will attempt to use them until then!

 

[Cliff Jumper]

Breathe, you defo have to post a video, I'm dyslexic and I was lost by the second sentence. :