Welcome back to another post in my series on informed consent body regions. This Massage Monday, we’re talking about Pectoral Massage!
The pectorals are considered a body region that requires informed consent because they are in a location on the body that could be misinterpreted by the client as inappropriate or suggestive.
Clients may not be aware that the Pectoral muscles are separate from breast tissue and that pectoral massage is not only within a massage therapist’s scope of practice, but also beneficial for upper body discomfort.
The pectorals are heavily involved in shoulder/arm movement as well as breathing.
The Pecs are often shortened due to rounded shoulders, so stretching techniques on the Pectorals are beneficial.
In terms of anatomy, there are three muscles in this body region, and technically two bones (but I count the humerus – so it’s 3 bones by my count).
When working the Pectorals, massage therapists are always working well above the breast tissue. The breasts are NOT to be undraped at all - regardless of the client’s sex/gender. It goes without saying, but special care should also be taken to avoid the client’s nipples and be aware how easily nipple tissue can be irritated.
Notice how I start working close to the sternum and move my stokes outward toward the client’s arms. I follow the strokes out all the way to the client’s arms on each side, eventually working the top of the humerus bone & most anterior portion of the deltoid. It can feel less invasive and less inappropriate to the client if the therapist begins by working unilaterally (one side at a time), then finishing up with bilateral strokes.
In my experience, clients are always shocked at how tense their pectorals feel and never leave without being pleased with the massage applied directly to the tissue of their pecs.
Notice how my massage strokes never go into the domain of the breast tissue- I’m never out of bounds beyond where the pectoral muscle lies.
In Arkansas Massage Therapy Law, “Massage of the breasts (except under specific circumstances) is included as Sexual Misconduct. The Massage Therapy Technical Advisory Committee (MTTAC) shall revoke the license of a person who engages in the practice of massage of the breasts unless the massage therapist engages in the practice of massage of the breasts for therapeutic and medical purposes including without limitation to the reduction of scar tissue following a surgery of the breasts, release of myofascial binding, or improving lymphatic flow AND has received at least forty-eight (48) hours of continuing education credits in lymphatic drainage, myofascial massage, or oncology massage.”
From the Rules that further promulgate the Law, “there must also be a valid request from the client, a valid prescription presented, or a referral from a qualified medical professional. The client’s breasts may not be exposed without first having obtained prior written and signed consent, and a written description and explanation must be given to the client before the massage begins and permission granted again before uncovering the breasts. Treatments must be noted on the client’s assessment form. MTTAC shall revoke a license for a period of three (3) years if a person engages in the practice of massage of the breasts without following these processes.”
Accompanying Vlog: https://www.tiktok.com/@kirbyclark.mmt/video/7306140496685042986
Peace and Healing,
Kirby Clark Ellis, MMT, BCTMB