Lower Body Refresh

 By Steve Hendershot, November 1, 2021

If your clients’ shoulders and backs tend to receive more attention during massages than their lower bodies, you’re not alone. There are lots of reasons to emphasize those areas, starting with the fact that many clients are seeking relief from neck and back pain.

Yet there are downsides to denying the lower body its due.

“Nobody ever says, ‘I want to focus on my quads during this massage,’” says David Lobenstine, LMT, owner of Full Breath Massage in New York City, as well as Body Brain Breath, a continuing-education provider. “So we focus on the things that they want us to focus on. But then we risk getting into this cycle where the client believes that the only stuff that’s worthy of therapeutic treatment is in the upper body—so then they ask for it even more, and we focus on it even more.”

But the result of that benign neglect can be a body out of balance. The remedy, of course, is to devote more attention to the lower half, and to do so in a way that helps the client understand the benefit of a true, full-body massage.

It’s not only clients who sometimes need a nudge to give the lower body the attention it deserves, however. Massage therapists can also fall into a rut that prioritizes the upper body while addressing the lower body in rushed, repetitive fashion.

If that’s you, fear not. Here are six ideas intended to shake up your approach to lower-body massage—and to reinvigorate both you and your clients.

Assess and Educate

One of your best opportunities to educate clients about the importance of caring for their lower-body muscles, tendons and fascia is when they first arrive for their massage session. Watch them walk. Look for signs of strain, some of which may confirm the symptoms they’ve mentioned, as well as others that may open the door to a broader focus. Clients bothered by lower-back pain, for example, often have deeper issues.

“I’ll say, ‘I know you wanted lower-back work, so we’re going to focus on that. But these other areas may also be aiding in that pain that you’re feeling, so do you mind if we work that, too?’ And they never say no,” says Jill Felland, LMT, who practices in San Diego, Calif. “I’ll work the low back first so they can see how tight it is, but then I’ll move to the glutes—to the hamstring attachment, specifically, before I go back to the lower back. Then they realize that indirect contact and therapy works.”

Bilateral Lengthening

Another way to expand the focus of a massage beyond the upper body is to engage the upper and lower body at the same time. Bilateral lengthening—working simultaneously across the body on, say, the left shoulder and the right hip—is one strategy for doing so.

You’re placing your hands on the front of one shoulder and also on the front of the opposite hip, and then leaning your body weight in—and creating that awareness of the client’s ability to sink or melt in that ‘X’ fashion, first in one plane and then in the other,” says Lobenstine. “Some of the most powerful techniques are the ones that show the client how [the upper and lower body] are connected. When you lengthen, and it feels amazing because the client is in the opposite position for so many hours a day, you’re expanding the client’s sense of how they can feel comfortable in their own body and how they can move in the world.”

Jump In Feet First

If you want to ensure that your next full-body massage doesn’t give short-shrift to the lower body, then start at the feet and work your way up. Laura Jenkins, LMT, owner of the Massage Studio of Philadelphia, often begins by spending two minutes on each foot, softening the fascia in the lower body while explaining how lower-body issues can often be the root cause of upper-body pain.

“Giving your client information typically sways them to give the lower body a go,” Jenkins says.

She starts with soft fists over the blanket to avoid initial ticklishness or sensitivity, rhythmically pressing into the soles, then grabs and squeezes the heels, using the heel of her hand or thumb to press into the lateral edge of the sole. Later, when the client is supine, she takes hold of both sides of the foot and gently manipulates the metatarsal areas by alternating movements between hands.

Next come the calves, where Jenkins starts with light-but-firm effleurage strokes and checks to gauge the client’s reaction. For clients who can handle it, she wraps both hands around the calf muscles with her thumbs meeting in the middle, then works first down the center of the gastrocnemius, before also running her fingers down the gastrocnemius’ lateral aspects, sometimes working the soleus as well.

While you’re here, don’t neglect the tibialis anterior (TA), urges Felland. She’s seen a new category emerge in recent months: people who grew sedentary during the pandemic and are now trying to get in shape quickly by training for a big race or a new sport.

“They’re going from zero to 100, and often they start experiencing pain due to the lack of arch in their foot,” Felland says. “Working the TA gives immediate relief for the arch.”

Gravity is your friend. Working large lower-body muscle groups such as the hamstrings can put massage therapists at risk of strain and injury. Lobenstine proposes a simple solution: Don’t work so hard. He suggests lowering the table, slowing down dramatically (he often encourages students to work at half speed), and delegating the hard work to gravity.

“You give your body weight into the stroke—you contact the client and then you sink in, rather than muscling. Then you just wait and see what happens,” Lobenstine says.

One example is double forearm leg lengthening, where Lobenstine leans in, lets his arms widen, and without trying to force anything, he lets the client’s tissue dictate the speed and duration of the stroke. That’s when they have those revelatory moments like, ‘I didn’t know I was carrying so much tension in my calf.’ Those moments only happen when we give the client the space to feel those muscles, and then feel the changes that are possible.”

Felland sometimes takes the body weight idea even further, climbing onto the table for extra leverage when working with athletic clients with especially large hamstrings, such as bodybuilders. In those cases, she first tells them she’ll be getting on the table, then—slowly, and after anchoring her body to ensure stability—positions the area of her knee just distal to the patella on the client’s hamstring. She then rocks slowly back and forth until she’s at the desired depth, asking the client to tell her when she reaches what she calls the “hurts so good” point, where the muscle is tightening just enough. Once the client gives that signal (or earlier, if she senses tension), she holds the position for about 30 seconds, then slowly moves her knee all the way to where the hamstring attaches near the glutes. The process can take up to 10 minutes per side.

That type of massage can pay especially big dividends for clients engaged in athletic training. Hamstring massage acutely increased flexibility among female athletes, according to a 2020 study in the Journal of Bodywork and Movement Therapies.

Sensitive Subjects

Working the glutes, hip flexors and inner-thigh muscles can be awkward. But with proper draping, good client communication and setting clinical expectations, working these areas can be very effective.

“We have such a hesitation about working on the glutes because we’re concerned that our clients will think that we’re doing something that’s sexual or inappropriate, even though it’s obviously not. But the glutes can become this ‘no fly zone’ where we just stay away,” says Lobenstine. “Well, we do that at our peril, because the glutes are essentially the hinge between the upper body and the lower body, so we have to find effective ways to work on them that feel comfortable for us and for our clients.”

Jenkins addresses that by working over the blanket while the client is prone, and using gentle-yet-firm petrissage or kneading techniques with a soft fist. She then gauges the client’s comfort level before moving on, and uses her elbow to address the area around the head of the femur, as well as the sacroiliac joint.

Lobenstine’s favored approach is gluteal melting: contacting the glutes with a big (and less threatening) part of your body, such as your forearm, soft fist or the heel of your hand, then using thumbs to go underneath the glutes and surrounding muscles before lifting and holding—then letting them go and allowing the muscles to loosen and sink.

“We’re creating a passive release of these muscles, not digging in and forcing them to do anything, but just holding them in this position slightly away from the skeleton, then letting them kind of ooze back into a more relaxed position,” he says.

Beyond the Foam Roller

A new generation of athletes and people who have worked with physical therapists have elevated the previously anonymous iliotibial band to star status. Many people try to work the IT band themselves using a foam roller, but it “really benefits from someone else’s trained hands,” says Jenkins. Indeed, a 2019 review in Sports Med found that rollers aren’t highly reliable in identifying trigger points.

Jenkins’ approaches involve working over the blanket while the client is supine, beginning with rhythmic petrissage to start relaxing the muscles, then using her forearm to add pressure.

The idea is to separate the IT band from nearby muscles such as the lateral quadriceps and hamstrings.

“There can be a lot of congestion, or adhering of the muscle to the IT band,” says Lobenstine. “You’re working to create a little bit more pliability between the IT band and those other structures, so you’re not loosening anything in the IT band itself, but you’ve made the whole area work a little bit more in sync.”

Whole Body Care

Change can be uncomfortable, and adjusting your practice to incorporate new techniques or a greater emphasis on the lower body can definitely push you beyond your comfort zone. That’s not always fun at first, but Lobenstine promises it will be worthwhile.

“Yes, there’s a learning curve, but the way that you have a long satisfying career in this work is to continue to grow, and to continue to find new ways to contact the body,” he says. Besides, it’s the client who ultimately benefits when thoughtful, thorough lower-body work is included as a core element of a whole-body massage.

Says Lobenstine: “When we only focus on certain parts of the body, or when our massages are so disproportionate to certain portions of the body, it means that we deny the client that systemic sense of self-awareness and wholeness.”