Prone vs. Supine Massage (You’re the Boss!)

The typical massage on a massage table combines both up (supine) and and face down (prone) time. Sometimes it’s a 50:50 mix, and other times more of one vs. the other. As therapists we develop guidelines for how to help you achieve your objective, and budget your time accordingly.

For example, a popular request is to have most of the time devoted to back, neck and shoulders. Within that, there are two variations. One request could be referring to the goal of maximum stress reduction or pain relief of the focus areas, or perhaps the more direct interpretation of working on the target areas as a way the primary way to address them. That is the purpose of that conversation at the beginning of your session. To achieve mutual clarity about your intentions. Sometimes there is an expectation that we will be spending the bulk of the session doing techniques directly on the pain place. In that case, probably what’s most important is for us to start your session at your target area and after a few minutes you will be ready for us to branch out, and find related areas which also need attention. Too much time on one area, and you eventually find diminishing returns or those muscles could put up more defense.

Suppose you have neck pain, and the assumption is that most of the time will be working directly on neck muscles and fascia. The first thing to realize is this will be a mostly supine massage. The alternative would be side-lying. Lying prone gives minimal access to the neck, and it is also the least comfortable way to have someone work on your neck as you would be feeling your face against the face cradle. It’s simply an unpleasant experience. Conversely, when you are supine, your neck can be put into a variety of positions, by turning the head one way and the other. Most people enjoy getting some traction at the neck, and this can be done most effectively facing up.

Shoulders get an equal opportunity, up and down. When shoulders are the priority, it makes sense to work them in both positions. Your six rotator cuff muscles can get more techniques
supine since there are more ways to position and stretch the arm in relation to the scapula. Moving the arm also will move the scapula several inches and expose muscles that would otherwise be hidden and inaccessible. If you have shoulder issues, it’s wonderful to receive work on the pectoral muscles which connect the sternum with the front of the scapula and the top of the arm. That’s supine. If you have back issues, in addition to working directly on the back muscles, including time for the front torso has the potential to help the back also.

For arms and hands, we have equal access up or down. The difference is your comfort, and reducing the face down time will reduce the time that your face is in the cradle. Also for some
people, facing up is a bit easier on the neck. Clearing the stress out of your arms will do more than just make your arms feel better. All of the nerves in the arm come out of the neck, and go through the shoulders. Some of the stress in your neck will exit your body through the arms when those channels open up.

Clearing the upper extremities will pay off at the top of the spine. Doing a good job on the lower extremities is going to support the bottom of the spine. With deep tissue sessions, we are also usually thinking about getting some green lights in the extremities prior to addressing the core.

The summary point with all of this is looking at the budgeting of your time on the massage table. With relaxation massage it is common to spend 60-80% of the session prone. Once you have had that type of massage several times a year for several years, and you’re interested in more of a result-oriented stronger therapy, you might enjoy starting at least half of your sessions up, and allowing at least half the time for supine work.

The prone work is analogous to coasting downhill… less challenge, more enjoyment. The supine work can have more challenge, and more noticeable benefits. Based on that, an excellent compromise is to request a session that starts supine and finish prone. By starting supine, there’s more likely that half the time will be supine, and you will have more time on some of the muscles that have been neglected in massages that started prone and only left 10-15 minutes at the end to cover all of the great work that can happen facing up.

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