Many massage therapists will spend the vast majority of session working on the back of the client. They will give great bodywork to the back, shoulders, neck and the back of the legs but then only give cursory attention to the front of the body. Now it is true that most of us have significant issues with the back of our bodies but to neglect the muscles and soft tissues at the front of the body is to provide an incomplete session. Only a few therapists would routinely incorporate an abdominal massage within a full body massage, yet there is little doubt that bodywork through the stomach area can offer many health benefits.
Most people who do request an abdominal massage would likely do so because of digestive issues although there is also significant musculature in the area that may require release to assist with physical problems. For example, a tight and contracted rectus abdominis muscle will impact on the stability and movement of the lower part of the body or lead to us slouching forward setting up postural imperfection through the lower back.
In total there are at least four layers of muscles in the abdomen and these can impact on your core strength (both your physical and emotional core). Trigger points are not uncommon in the abdominal muscles and the pain referral patterns can include the lower back. Simons and Travell (1) observed that
An active trigger point high in the rectus abdominis muscle on either side can refer to the mid-back bilaterally, which is described by the patient as running horizontally across the back on both sides at the thoracolumbar level … In the lowest part of the rectus abdominis, trigger points may refer pain bilaterally to the sacroiliac and low back regions.
Regardless of the requirement for remedial massage and trigger point techniques for hypertonic muscles in the abdomen, the vast majority of abdominal massage will be for digestive issues. Most therapists consider that massage to the stomach areas will improve the capability of the digestive system and will potentially benefit some of the organs that are contained within the abdominal cavity (such as liver, pancreas, gall bladder, small intestine and colon). A recent review of research has confirmed that there are likely to be benefits for performing abdominal massage to treat chronic constipation. Sinclair (2) concluded “studies have demonstrated that abdominal massage can stimulate peristalsis, decrease colonic transit time, increase the frequency of bowel movements in constipated patients, and decrease the feelings of discomfort and pain that accompany it. There is also good evidence that massage can stimulate peristalsis in patients with post-surgical ileus.”
Routine for Abdominal Massage
In order to give an abdominal massage then the stomach needs to be exposed and it is usually recommended that there be some bolstering under the knees to slightly relax the abdominal region. Normal massage lubricatants are fine to use.
– Place your hands gently on the stomach and palpate. The stomach should feel soft and relaxed
– Always be aware of the breathing of the client and work with the breathe, not against it.
– Sink in through the diaphragm region with the breathe of the client
– Lightly work along the lower border of the rib-cage with fingers and thumbs.
– Gently effleurage the area with light circular strokes. Always work in the direction of the digestive system which means working clockwise around the stomach.
– Place your hands over the rectus abdominis and gently palpate for areas of tenderness and restriction. Work the edges of the muscles with static compression (asking the client to tense the muscle by have them start to sit up) with sufficient pressure to be therapeutic but not too much that it causes pain. Release attachments at the xyphoid process (obviously without ever putting direct pressure on the vulnerable process itself). Release the attachments at the upper border of the pubic bone (mindful of the sensitive nature of this area – if client has any concerns then you can get them to use their own hand to achieve this release or alternatively work through a drape).
– Work deeper under the ribcage on both sides of the body (be aware of working too deeply directly into the liver which is on the right side of the body). Cross friction at any tender points.
– Pull through the sides of the body with relaxed hands, reaching around the body as far as possible, working and stretching the fascia.
– Work the ascending colon (right side) and descending colon (left). Make sure you connect with sufficient pressure through colon although not too much so that it causes pain. Some therapists recommended clearing the descending colon first too “make room”.
– Finish with a calming connective touch to the abdomen.
Normal massage contraindications would apply for abdominal bodywork and if the massage is to be performed for a specific health objective then it is recommended that it be discussed with suitable doctor prior to treatment. Also be aware that many people may have emotional sensitivity and instinctively be highly protective of this so any bodywork needs to be mindful and respectful
1. Simons DG, Travell JG. Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1, Upper Half of Body, 2nd Edition. Lippincott, Williams and Wilkins, 1999:943.
2. Sinclair M. The use of abdominal massage to treat chronic constipation. J Bodyw Mov Ther 2011; 15:436-445.
Update – a 2011 review of the effect of abdominal massage in chronic constipation found that abdominal massage can stimulate peristalsis, decrease colonic transit time, increase the frequency of bowel movements in constipated patients, and decrease the feelings of discomfort and pain that accompany it.
“The use of abdominal massage to treat chronic constipation.” Sinclair M.
J Bodyw Mov Ther. 2011 Oct;15(4):436-45. doi: 10.1016/j.jbmt.2010.07.007. Epub 2010 Aug 25.
By Richard Lane