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massage therapy musings &
persistent pain ponderings

I Want a Massage BUT I'm Worried About ... My Hips

photograph of man holding a pelvic bone model in front of his hips

Massage therapy can bring up all kinds of anxiety and self-conscious thought gremlins. And often they get in the way of receiving the pain and stress relief that massage can provide.

This series is a literal head to toe candid exploration of the many common body concerns that make us hesitant to schedule, or uneasy once on the table. If you've had some of these same worries, know you're not alone. And perhaps this info will give you new resolve to give it a go.

This fifth article is on the hips: the rump and genitals.

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First and foremost, you can always request that your massage therapist skips whatever area of your body you don't want them to massage.

It's your time, your session, your body.

muscular anatomy diagram highlighting the posterior hips


The posterior (backside) of the hips includes sophisticated joints, some of the strongest muscles in the body, and major nerve bundles.

Due to the complexity of the hips, and the many layers of criss-crossing soft tissue, you may have experienced this area as literal pain in the ass - I'm looking at you, sciatic nerve.

Massage therapy can provide so much value to clients by working on this area with skillfully applied pressure, range of motion and mobility movements, and general self-care education.

But... it's our butt. And we may understandably feel apprehensive to have someone place their hands on ours, let alone request therapy for that area.

So here's some common questions we may not want to ask aloud:

Should I shower before my massage? Maybe. Everyone's body chemistry is different - and highly influenced by the amount and type of activity you do before your appointment. A full on shower or bath before massage may be warranted, or it may not be. Either way, if you know hips are an area you need addressed, some intentional hygiene is a courtesy your massage therapist will appreciate.

Do I need to be naked? Nope. You should only remove clothing that is comfortable for you. If you'd benefit from hip massage, consider contacting your massage therapist before your appointment - ask what they prefer you wear for your session. Underwear, swim trunks, bicycling shorts, yoga pants - are all good options.

Some therapists may prefer you keep on your underwear, so they can tuck a sheet into the elastic band to create a clear, firm barrier. Other therapists may not mind if you have clothing on or off, but choose to still work on the hips through a cloth barrier - like a towel, or sheet avoiding the need to drape or tuck anything.

Even if you are comfortable going bare, the massage therapist should still practice proper sheet draping around your hips so your body is not unnecessarily exposed. Often this is called "surgical draping" - only the area being actively worked on is uncovered, and the rest of the body remains covered. Like this:

massage therapist applying pressure to draped client's glute muscles

Ricki gets a bit too enthusiastic about new yoga routines. Once she over did it, and was all but limping into my massage office with screaming hips. As we've worked on this area many times before, she knows my policy: keep on or take off whatever is comfortable for you. A few times Ricki has opted to keep on a pair of yoga pants. Today she just kept on her underwear. As I provided massage therapy to her hips, I checked in on pressure, and also tucked the sheet into the elastic band of her underwear so I could press firmly into the upper gluteus maximus muscle and not unintentionally expose her posterior. Communication is key to a successful session. As the therapist, I discuss where and why I'm going to apply pressure, respecting Ricki's boundaries. And as the client, Ricki determines what clothing to keep on or take off, as well as letting me know if pressure is too much, or just right.

What if I have to pass gas? We're all human, it happens. More than you'd probably think. Some clients make a joke. Some ignore it. Some giggle. Some blame it on their lunch. Hey, whatever works.

Especially when I'm applying pressure on your hips, and thus your guts, it happens. No judgement. If you find yourself in discomfort or pain trying to hold it in, but don't want to just let one rip, consider asking: "Hey, can you work on my shoulders for a bit and then go back to the hips? I think they need a break." You can also ask to pause your session so you can visit the restroom for a moment.

muscular anatomy diagram highlighting anterior hips


Now to the anterior (front side) of the hips. As with the posterior, this area also includes sophisticated joints, important muscles, and major nerves.

But, there are genitals and sensitive areas that the massage therapist must work around. Plus the social stigma, possible misunderstandings, misplaced assumptions, and general anxiety associated with our interior pelvis.

Massage therapy has a complex history and entanglement with sexual services. The term “massage” is still often used as a facade for commercial enterprises that offer sexual services - both sex work (consensual) and sex trafficking (not consensual).

Geographic location, cultural norms, and inaccurate media portrayals all add further layers of confusion to the public’s perception of massage therapy as it relates to sexual services.

More education, better depictions in popular media, and the establishment of state-endorsed professional licenses have all sought to change this perception. But, change doesn't happen over night. And, the anxiety of "breaking" ingrained social norms certainly doesn't change over night either.

So let's start with defining some terms:

Sensuality is the condition of being pleasing or fulfilling to the senses.

Sexuality is the capacity for feeling states of arousal or desire to initiate sexual activity.

Massage therapy can certainly be a sensual experience. It is most often designed to be a sensual experience. Aspects like mood lighting, peaceful music, soothing techniques, deep breathing, and relaxing aromas - are all things that are designed to be pleasant to the senses.

But those sensual aspects of massage therapy are not inherently sexual. Their purpose is to relax and reduce stress or pain, not to arouse or initiate sexual activity.

All that being said, sometimes our bodies can respond in ways that differ than our conscious intentions or thoughts. If you're receiving massage therapy and find you're feeling emotions of arousal, here's some considerations:

Let it pass. If something during the massage therapy session triggered or stimulated your mind/body in a way that led to sexual arousal, consider if you can simply allow the emotion to pass on by. Although it may not be as easy as flipping on and off a light-switch, ultimately, feelings are just feelings, until we act upon them.

To be clear, feeling arousal in and of itself is not bad, shameful, or negative. It's a natural part of being human. But, we are responsible for how we react to our feelings. Especially when that feeling arises in context were it's not appropriate to indulge or act upon it.

Change position. This doesn't have to be over-explained, or even explained at all. Simply inform your massage therapist that you are feeling discomfort and would like to change position on the table and/or have them work on a different part of your body.

Request a solution to a problem. If something during the massage therapy session consistently leads to feelings of arousal, you may need to request a change. Again, you shouldn't need to go into specific details, just let the massage therapist know it is causing you discomfort. That should prompt them to offer options about alternatives, adaptations, or a simple agreement to avoid an area or motion.

When all else fails: humility. Some situations may require a bit of potentially uncomfortable discussion. In those cases, honest humility is the best bet to smooth things over as quickly as possible - without miscommunication or misunderstanding.

Jason was a college football player. From training, he was usually sore from head to toe. One time his quad muscles (front of the thigh) were particularly sore. As I massaged the upper section of the quads (which reach into the hip joint area), Jason fell silent and tensed up. I asked if something hurt. He paused, then hesitantly said, "I uh... don't think you should massage there. I'm having a ... uh ... reaction... nearby ..." He had developed a penile erection. I replied, "Okay. I'm going to stop massage to your quads. Would you like to turn over and we can work on something else? Then you can tell me if at any point we can return to the quads, or skip it for today." Sigh of relief, then, "Yes. I would like to do that." "Let's focus on relaxing the hamstrings and then I'll do some joint movements - that should still provide indirect benefit to your quads." "I'm sorry. I'm so embarrassed." "It's okay. It can happen. I'm sure you feel awkward, maybe still do, but I'm glad you spoke up. We can now change course and still continue the therapy you need today."

If/when you do have a legitimate musculoskeletal issue involving your hip region (like hip flexor tension, a groin pull, or upper thigh pain), try these approaches:

Speak specifically. Describe the area you're feeling tension or pain in a detailed, specific way - instead of using broad terms. Using vague language doesn't help your massage therapist determine what you need. It may also unintentionally give the impression you're seeking sexual services, not massage therapy.

You may feel a bit awkward at first, but remember, your massage therapist is a health care provider, not a mind reader. They want to help with your health concerns, and can do their best when they have all the information.

You don't need to be an anatomy expert, but a simple google search for "muscles of the hip" can give you some more accurate vocab to work with. Or at least give you some perspective on what tissues lie underneath the skin that may be involved in the problem you're having.

Show rather than tell. If you can demonstrate a certain movement or activity that causes you the discomfort or pain, and then point to it during your session's intake - that works! It might be more difficult or awkward describing the issue with words alone. So, consider a visual aide. Find an anatomy diagram of the area that you can print off or point to on a mobile device.

Ask about clothing before you arrive. Just like with working on the backside of the hips, your massage therapist may prefer you keep on undergarments, or wear something like bike shorts or yoga pants to your session. Ask up front and then both parties can feel more prepared for the session.

Ted is an avid soccer player and had a misstep that resulted in a painful groin pull. In combination with physical therapy, massage therapy helped decrease the pain and sensitivity during his recovery. At my request, he wore bike shorts during the massage session so I could apply pressure to muscle attachment points in the far upper thigh without concern over sheet adjustments.

Ask about or suggest side lying position. Many people find massage therapy to the front side of their hips more comfortable when they are laying on their side, instead of laying on their back. More comfortable in terms of modesty and privacy (external genitals fall toward gravity and away from the area that is being actively massaged) and more comfortable in terms of pressure (some muscles may be more relaxed when laying on your side and thus not as tender to pressure). Based on their professional preference, your massage therapist may already plan on providing your massage in this position if there's deep hip work requested, but it's worth asking ahead of time.

* * * Do you have any additional questions or concerns about the hips? Feel free to contact me. Also, check out the other articles in this series below!

I Want a Massage BUT I'm Worried About Series


Raechel Haller Massage Therapist Holland MI Michigan

Whoa, you made it all the way down to the footer!
And might be wondering... who wrote all these words?
Well hello! My name's Raechel and I'm a massage therapist.

I enjoy researching and writing about pain and wellness; nerding out about sci-fi or Dungeons & Dragons; gardening; sailing; thoughtful conversations; loving my German Sheppard dog; and getting lost in a book. Or two. Or three.

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