Pillow talk: Paul Lewis explains how carefully placed pillows and bolsters can significantly improve comfort and support for clients

Originally printed in IT e-Xtra June 2010 Issue

Another therapist – who I was treating for stiff shoulders and low back pain – recently asked me, ‘why do you use pillows in your treatment?’ Although not a new concept, I believe pillows can prove invaluable tools if used in conjunction with the client’s needs and the treatment objectives. 

Pillowing and bolstering can provide comfort and support to both the therapist and the client throughout a number of treatments, with the client in a variety of positions such as prone, supine, side lying, and 3/4 prone. They can provide extra support to a pregnant client, aid the treatment of tight hip flexors, or help provide relief for clients with low back discomfort during a therapy session.

The benefits of using pillows and bolsters

The majority of people use pillows when they sleep for a number of reasons: to support their heads; for comfort; as a barrier between the head and lower surface; or perhaps even to maintain distance from a pet, child, or snoring spouse.  

These same fundamental concepts – comfort, support, or even distance – can apply, regardless of whether I am giving a therapeutic massage to a client on a table, chair, or mat; before a reflexology treatment; or during a physical therapy assessment prior to treatment. The use of pillows and bolsters can also be advised as part of a home-care programme, providing simple exercises or promoting effortless lifestyle adjustments to clients suffering from conditions such as planter fasciitis, sleeplessness/insomnia due to low back pain, or cramping in he calf muscles.

How I use pillows during treatments

In my clinic, I have bolsters and at least four pillows that are almost wide enough to cover the width of my table. One of the pillows is a little flatter than the others, which I specifically use under the patient’s abdominal area and anywhere else that may only require half the height of a regular pillow.  

They are not too puffy, therefore I don’t have to wait long for the specific structure to settle down onto the pillow. The pillows have a protective vinyl covering, which facilitates ease of cleaning, and in addition, all pillows are covered with freshly cleaned pillowcase linens.

Here are some examples of pillowing in various treatment positions, which can be used both as additional tools by the therapist during the therapy session, or advised as self care for the client:

Supine Position: One pillow

If the client is on the table in a supine position, I suggest using at least one pillow or bolster under the thighs to help prevent hyper-extension of the knees. If the knees are bent and supported, this should result in reduced anterior rotation of the hips, which translates into a more relaxed lumbar region and reduces extension on the lower back.

Supine Position: More than one pillow

Although using more than one pillow may not increase the benefits beyond those achieved through the use of one pillow, multiple pillows may help if your intention is to work into the abdominal area or your objective is to reduce the tension on the hip flexors and pelvis area, allowing you to work into the psoas muscles. 

In the prone position, I usually only use two pillows, placing one under the abdominal area and one distal to the knee, under the shins. Three pillows may
be beneficial if the client’s hamstrings are short and the shins do not rest on the pillow, or if the feet cannot stay in anatomical position.  

Ideally, it would be best not to have the toes touching the table, as this will allow the feet to flex naturally rather than being extended through the tibia.   
The pillow under the abdominal area can help to reduce the lordotic curve in the back, which helps to bring the spine into a neutral position and prevents jamming of the facet joints.  

This action will also put the client’s hip flexors into slight flexion. In addition, make sure the pillow is balanced and not gathered on one side, causing an imbalance to the hips.

Prone Position: Two or more pillows

It is advisable to always check the position of the head, neck and shoulders, bearing in mind that you may have to place a towel roll under the shoulders in the direction of the anterior deltoids to keep the shoulders in alignment.

Side lying Position: Three pillows

When I ask a client to lie on their side, I usually use three pillows – and on occasion a fourth pillow along the back – to help the client feel secure or prevent them from rolling back.   

While one pillow supports the head; one between the knees can help to keep the hips in line; and another can be used for the client to hug in front of the
abdominal and chest area, which not only supports the arm, but also aids reduction in forward rotation of the shoulders and upper body. This type of
pillowing may be used more primarily with pregnant clients.

Reflexology

When I am giving a reflexology treatment, I prefer to use three pillows: one pillow behind the head; the second behind the knees for the reasons stated previously to relax the lumbar area; and the third to support the calves and heels.

Chair massage

In my clinic, I incorporate both chair and table modalities into some of my treatments.

On occasion, it will be necessary for you to have a barrier between you and the client during assisted stretching or some treatment positions.  

The position of the therapist and client determines whether a towel, bolster, pillow case, or pillow is sufficient to create enough of a barrier and privacy.

Bear in mind that although pillows and bolsters are wonderful tools, which can be both supportive and comforting, they should not interfere with the client’s ability to safely maneuver themselves and should be removed prior to the client getting on or off the table.   

About the author:
Paul Lewis, MFHT, RMT (Toronto), CMTO (Canada), NCBTMB (USA), and FHT accredited CPD course provider is a Toronto-based massage therapist. He is also a reflexologist, international presenter and fitness instructor. To find out more about Paul Lewis’ training courses, please visit www.paullewis.ca  

Pictures: Paul Lewis