Congestion Conundrum

By Art Riggs

Q: Dear Art,

Some of my clients complain of congested sinuses when I work on them in the prone position with a headrest. Do you have any suggestions?

—sniff sniff

A: Dear sniff sniff,

Have you ever had a gourmet meal at a fancy restaurant, only to be distracted by a wobbly table to the point that you don’t notice the excellent food? That’s the way I (and quite a few others I’ve polled) often feel about stuffed-up sinuses or an uncomfortable headrest when getting otherwise great bodywork. The reality is that a significant number of people find headrests problematic (especially with the sinus issue), irrespective of how comfy the headrest may be for others.

It speaks well of your communication skills that your clients feel free to discuss such issues with you. Of course, many people love a headrest, but I suspect that a fair number of potential clients assume it is an uncomfortable necessity that must be endured for the convenience of the therapist, and worse, for some it may even deter them from getting bodywork.

The first step is to determine if your client also has this problem with other practitioners. If not, check out the most common possible causes in your workspace.

• Allergens—Make sure that your space is free of dust, cleaning solvents in carpets, or other common allergy culprits. Use unscented and hypoallergenic lubrication, and have a conspicuous sign asking clients to not wear any scents that may linger after a session.

• Relative humidity—Dry air may sensitize sinuses; a humidifier may help.

• Gravity—Consider adjusting the legs of your table to have the head 2–3 inches higher than the foot.

• Headrest—These are all factors: the comfort, firmness, shape, and particularly the flexibility of the headrest to move into flexion or extension a bit to accommodate individual differences. The investment in a state-of-the art headrest is money well spent, but may not solve the problems of sinus congestion, claustrophobia, or lack of mobility to work with the neck in different positions.

A Paradigm Shift?

Most importantly, simply ask clients if they prefer to use a headrest. Too many therapists automatically begin massages in the prone position with a headrest in place, so clients just assume this convention is not open to discussion and that there are no other options. As is often the case, good communication is the key. If sinus congestion is an issue, explain that it is a common problem and simply suggest trying an alternative.

The fabulous side-lying position that I often tout is a simple and effective solution. Not only will it take care of sinus problems, it also affords many positioning options to actually accomplish more effective work. Be sure to provide a thick enough pillow to keep the neck in a neutral position. If you often utilize side lying, you may want to add a 2-inch pad of firm foam under your sheet to ease pressure on the shoulder girdle—your clients will be more comfortable in all other positions, too.

My favorite suggestion, however, is to lose the headrest and place a pillow under the chest and abdomen so that the neck can comfortably rest in forward flexion to one side in a combination of side bending and rotation.

I hope this helps in solving the problem. These positional options are also really great in general, irrespective of any nasal congestion or headrest issues. My clients love prone work with the neck in side bending and rotation for its advantages of stretching short muscles and improving mobility.

Art Riggs teaches at the San Francisco School of Massage and is the author of the textbook Deep Tissue Massage: A Visual Guide to Techniques (North Atlantic Books, 2007), which has been translated into seven languages, and the seven-volume DVD series Deep Tissue Massage and Myofascial Release: A Video Guide to Techniques. Visit his website at