Client had no feedback on pressure

[Marc S]

Hi I was doing deep tissue on a client yesterday and she wanted deep tissue so I did but I noticed that she could take alot of pressure! I went so deep with elbows and fingers and in the end of the massage she told me I was gentle with her when I was giving her all the pressure anybody could handle.
I even purposely tried to go just a little extra deep to see how her pain tolerance was and no she was tough, her back was very stiff and I just want to know if anybody had a client like this before because I give really good deep work and I just couldnt believe she took all that pressure. from a 1-10 pressure she said it was a five the whole time even, I just think something is wrong with her.

 

[toto]

Full gas

Hi.

That sounds like a very difficult case. I've never struck that problem. Aside from belting her with the blunt end of an axe, I don't see what else you could have done.

We were discussing the pros and cons of rolling the back over two tennis balls in a sock. Perhaps if you were to turn her face up on two new, hard tennis balls or baseballs and massage her pecs, forcing downwards as she tortured herself. That may work???? She sounds like she could do with some spinal flex's anyway. Failing that you could refer her to an s&m therapist.

Good luck.

 

[AessaMenevrah]

I have a client like that also. She used to be a semi-pro tennis player, and now teaches tennis. So she is active. But her shoulders have alot of "crunchies" (her term).

I learned to go really slow and push as hard as I can, but she seems not to notice my pressure. In the meantime, I'm sweating and usually need a nap after treating her!

 

[postal p]

Had a client like that in MT school clinic. I couldn't believe she wanted that much pressure. I remember even the pressure she wanted while I massaged her scalp and head caused my fingers to tremble with fatigue.
I, too, am known for my deep tissue work, and I know this one client left feeling a bit disappointed. A few weeks later she was scheduled with one of my male classmates and he was able apparently to give her the depth of massage she wanted. :roll: Though even he admitted it was hard on him.

I did have one client who I had difficultly going deep enough on her legs...it was like she experienced no sensation there. I think perhaps it was partly a psychological issue in her case. (Disassociation from abuse.)

If I am not getting the sort of response I think I should be getting from my deep tissue work, I tend to slip into trying to warm the fascia with either application of heat or using MFR techniques. Sometimes the answer isn't always more pressure or force from me... but a total change of direction or way of thinking on how both the client and I are addressing the problem.
(And then there's that whole other issue of not being attached to the outcome...)

Can you suggest that the client have a hot shower, bath or time in the sauna or steam room before her session? Do you have access to a hot towel cabinet, or other way of applying moist heat? Let the client know it's really important to your results that she be properly hydrated both Before And After a massage. Hopefully with a little more self-care on her part you'll be able to get better results. All else fails, do like I had to do with the client mentioned above... refer out!

 

[BuStErBaBy]

Check her meds. Some pain meds will actually deaden the nerves. I had one client like that, she insisted on deep work and I wouldn't because I didn't want to harm her.

The biggest thing I find about those types, they seem to be emotionally hard, they got that tough outer shell.

One client I have like that, she actually fell asleep during her last session and I was AMAZED at how relaxed her muscles became. To me that indicates that its all in her head and if she would let go of what she percieves as stress, she would be 100% better!

At this point, I work where I feel its safe, not where the client wants me too. If I am applying major pressure and they say its not enough, to bad. I am not going to break a rib or bruise someone.

 

[RosieB-x]

The biggest thing I find about those types, they seem to be emotionally hard, they got that tough outer shell.

Yep, that's my experience too. Either they have such a protective exterior they can't let the touch in, or they are so out of touch with what they are feeling inside, they literally can't feel the pressure until you force your way in.

This type of person "needs" a therapist who pays no attention to tissue cues and just digs, regardless of resistance. If you are the type of therapist (and I hope we all are,) that listens to the body, works WITH the tissue and waits to be let in for deeper work, you will likely never be able to deliver the requested pressure.

 

[Combat Commo hooah]

I have had one or two of those kinds of clients. They seem to have a lack of sensation. The first time it really bothered me. You start to doubt yourself even though you may have had 10 other people that week who loved your work. Now, I trust myself enough to know thats just the way it goes sometimes. I will echo Breath, that yes its best to listen to the body. We are the "expert". Just because they think they need more does not mean we have to try and give it if its not going to help. I had a fantastic instructor in school who always told us in clinics not to kill ourselves trying to muscle our way in. I actually feel confidant enough now that I will explain to someone why I am not or can't go any deeper. If they can't understand or don't like my massage there a zillion others they can try out there. And it won't hurt my feelings a bit!

 

[Vietnam War Veteran]

not exactly the same situation, but it might be worth having a read of this old thread http://massageplanet.com/forum/viewtopic.php?t=5217 lots of replies and going deep discussion.

 

[darl]

um.... maybe she has fibromyalgia. Many of my clients that have that can't really "feel" even the deepest work. Maybe she doesn't even know she has it.

That would be my guess.

 

[Jefisia]

Many fibro people as also highly sensitive too. Fibro is a pretty complicated thing from my experience of working with clients with it.

 

[A Man]

wow alot of responses

thanks for your feedback. I dont know when i will see her again but if i do i have alot of things to ask her next time.
she wasnt on any meds because i asked their that.
she is a surgery doctor and she is alway bending forward.
I told her after the massage that i put all my pressure into her and i was just amazed on much pressure you can take.
she says that she has had elbows knees fingers everything she just love deep work and that she works out alot!
I dont think she has firbro only because she just complained of trapezius muscles.
Hopefully i get her again and i will try different methods and use a hot towel to warm her up.

 

[~?~Freebird~?~]

wow alot of responses

thanks for your feedback. I dont know when i will see her again but if i do i have alot of things to ask her next time.
she wasnt on any meds because i asked their that.
she is a surgery doctor and she is alway bending forward.
I told her after the massage that i put all my pressure into her and i was just amazed on much pressure you can take.
she says that she has had elbows knees fingers everything she just love deep work and that she works out alot!
I dont think she has firbro only because she just complained of trapezius muscles.
Hopefully i get her again and i will try different methods and use a hot towel to warm her up.

I've had two clients like this and I think I tend towards this as well - I can definately be a challenging body to work on becuase I'm skinny but have a lot of restrictions that need (and are getting) work. But I know I'm a challenge. A basic massage is NOT what my body needs so I can't go to a massage therapist who isn't used to a deeper type of work.

Sometimes with a client like this they are so out of touch with their own body they truly don't feel it. It's like a disconnect - big time. You have to, as a therapist, protect them from their own lack of connection in that you can't work "to please them" while bruising and irritating muscle tissue. It might "feel good" to them but if you are tearing muscle fibers you aren't helping obviously.

With my two clients I had to just say something like "I'm working at the level your body seems to need right now and it might not feel like this is accomplishing much but as we work through these layers you'll notice a big difference." And we worked a lot on body awareness and connection. I did some integrative work - we did passive AND ACTIVE movements together - ROM work - resisted stretches, etc. I would point things out like, "Do you feel how your hamstrings are so tight? They are also stretched though from your pelvic tilt issues so I'm working to strengthen them with you."

I found that in my experience, as these clients became more aware of themselves in general they would go from flopping on the table saying, "Push as hard as you can" to saying "I noticed my shoulders have been tense ever since I ______." Really making the connection to their body balance once they learned what to pay attention to.

If that makes sense. *laughing*

Angela <

P.S. I want to say - if you find yourself trembling or shaking I would definately check your body mechanics. As I've implemented better physical stances and ways of using my body while giving a massage I've been able to give better, deeper massages WITHOUT the physical exhertion - and I'm 115 pounds and 5'4 with shoes. Art Riggs has an entire DVD out of his set devoted to this topic that is well worth watching.

 

[Jessi]

thanks AngEngland

I do have that dvd of art riggs and I also own the myers anatomy trains dvd which is rolfing.
thanks for all your advice, I will use it.

 

[sh0rtea d0o wh0p]

Really well put, AngEngland.

 

[Rawrs[: Munchkin]

The biggest thing I find about those types, they seem to be emotionally hard, they got that tough outer shell.

Yep, that's my experience too. Either they have such a protective exterior they can't let the touch in, or they are so out of touch with what they are feeling inside, they literally can't feel the pressure until you force your way in.

This type of person "needs" a therapist who pays no attention to tissue cues and just digs, regardless of resistance. If you are the type of therapist (and I hope we all are,) that listens to the body, works WITH the tissue and waits to be let in for deeper work, you will likely never be able to deliver the requested pressure.

SO true, to both your posts.
I can go very deep, but prefer to not push beyond my limit and let them go to someone who can go deeper than I can. (and I'm a strong woman!) I've injured myself trying to satisfy a client like that who came on a regular basis.

 

[I Like Turtles]

I do a lot of John Barnes MFR and I have been known to say to someone " Do you want me to go deep, or would you like to get rid of the problem?"

Very often, if you can re-train them into feeling the results from the gentle sustained pressure of JFB MFR, they will get much better results.

If you go deep, you risk their body going into "defense" mode and tightening up again, either immediately or later, to say nothing of bruising.

 

[ki-ki]

Client had no feedback on pressure

Hi I was doing deep tissue on a client yesterday and she wanted deep tissue so I did but I noticed that she could take alot of pressure! I went so deep with elbows and fingers and in the end of the massage she told me I was gentle with her when I was giving her all the pressure anybody could handle.
I even purposely tried to go just a little extra deep to see how her pain tolerance was and no she was tough, her back was very stiff and I just want to know if anybody had a client like this before because I give really good deep work and I just couldnt believe she took all that pressure. from a 1-10 pressure she said it was a five the whole time even, I just think something is wrong with her.

I haven't read everyone elses thoughts on this, and please don't take this as a dig or soemthing, but, I have found many times a therapist thinks they are giving deep pressure (and they are working hard at it) when in fact their deep work is not very deep at all.

I think since you are new in massage (about a year)*, this could be part of the situation, but not experiencing your technique, I certainly couldn't say for sure.

It is very possible your client needs a deeper pressure than you are currently able to give, even though you feel it was more "than anyone could handle" or what you consider deep is not really what some clients perceive as deep.

Don't let it discourage you though, it may be something you want to study more if this is the case and you are interested in deep tissue techniques.


Another possibility is that this client is used to a therapist that doesn't necessarily go very deep --- but does it in a way that compresses the edges of the bones and causes pain, thereby causing the client to think that is what deep work is supossed to be like. If that is the case, that's probably not what you want to focus on.



*From a 2006 post of yours: "i'm a student, right now were learning about asian bodywork therapies."

PS: I finally got a chance to read over the other posts and those are some great responses. Of course(!) those could be possibilities too - along with some great ideas to apply our work.

 

[geegee]

My thoughts, in no particular order ...

Keep in mind that chronic tight muscles can become desensitized. Her perception of pain could be "off". I have a client who I have seen weekly for just over 3 years. When he first came to me, it felt like a major workout for me each session. After some client education he 'let me' start mixing in CST, MFR, BMT, PNF; in other words techniques other than just plowing through the tissues (my words). It took some time, but now in sessions he sometimes asks me to back off a bit on certain spots to see if lighter pressure will do the trick.
My point? Two points here. #1 - Client education can be key to our work. Some people just assume deeper, harder is better. No pain, no gain, right? #2 - As his muscles began to let go and repattern, he began to feel the work more and more.


You mention that this client talks about her traps. What are you finding in your sessions? How are the aneforum.xxxonists? How do her shoulders look? Does she have forward head posture?

Is the client willing to do some self care? Is she willing (or able) to stretch and relax for 10-15 minutes after surgery? Would she be willing to sit for 5 minutes with a heat pack on her neck and shoulders?

To clarify: You also mention she works out a lot. Did you mean during a deep tissue session or actually works out in a gym? (That part confused me)

Lastly, I agree with maestra: A fomentation can work wonders to help draw fluid to the area, soften connective tissue and relax the client. It can help give you access to deeper tissues and make your 'job' much easier. Try hot towels, a seed/rice pack, sauna, steam, hot tub, hot shower or even products like Prossage.


These are just some thoughts. I know you may not see her again, but I hope this helps you out then next time a similar client shows up on your table.

Brian

 

[Hobo Joe]

Thanks guys for all your feedback.

To pueppi I have about 9 months experience so maybe that could be the problem. I've had alot of clients since school and I practice alot on my friends so i can get better and i have dvds of deep tissue and rolfing. So maybe my deep tissue wasnt deep enough,but I honestly didnt think so since purposely tried to hurt her so by giving her exremely hard pressure just to get a response, you know i still didnt get a response.

To cstbrian her posture and everything looked okay. shoulders good, everything looked in balance from what i remember. I cant ask her now about the self care because i haven't seen her since but i learned alot from that experience.
i had another client liked that two days ago who works in bootcamp and is a personal trainer and she pretty much works out alot hours a day, running hitting weights. she usually goes to another massage therapist where i work and he was booked so i had to work on her. i guess he does a good job since she always keeps coming in requesting him.
she wanted deep tissue, i mean deep so thats what i did.
i was giving exremely deep pressue and she couldnt feel a thing,I finally change tools and did some thumb work on her it band since thats one of the problem areas.
she was exremely bony there wasnt any muscle on her.
I'm trying to figure out on a way to help these people that could that amount of pressure and not feel a thing. I've written all your helpful advice down on my notepad to study on and thank you so much.
I will talk to the massage therapist that works on this women and try to get some advice.he is a tall muscular guy so i'm thinking it might my pressure. I 've felt happy that i got a response from her and that i hit the spot but it took all of my power and energy to help this woman.
I didnt like that she wasnt willing to do self care, she wasnt willing to do anything relaxing like yoga or to take it easy at work.
she has chronic pain and had it for years. I did have a heat pad on her back and legs before i worked on them, so maybe that helped a little.
I didnt do that in my first session with that other woman and this one and i got some feedback.

please give me more advice and if you guys had people like this how many sessions will it help to get them back to normal?
or what questions should i ask?
or what modalites should i learn?
thanks everyone.

 

[latissimus dorsi]

Thanks guys for all your feedback.

To pueppi I have about 9 months experience so maybe that could be the problem. I've had alot of clients since school and I practice alot on my friends so i can get better and i have dvds of deep tissue and rolfing. So maybe my deep tissue wasnt deep enough,but I honestly didnt think so since purposely tried to hurt her so by giving her exremely hard pressure just to get a response, you know i still didnt get a response.

To cstbrian her posture and everything looked okay. shoulders good, everything looked in balance from what i remember. I cant ask her now about the self care because i haven't seen her since but i learned alot from that experience.
i had another client liked that two days ago who works in bootcamp and is a personal trainer and she pretty much works out alot hours a day, running hitting weights. she usually goes to another massage therapist where i work and he was booked so i had to work on her. i guess he does a good job since she always keeps coming in requesting him.
she wanted deep tissue, i mean deep so thats what i did.
i was giving exremely deep pressue and she couldnt feel a thing,I finally change tools and did some thumb work on her it band since thats one of the problem areas.
she was exremely bony there wasnt any muscle on her.
I'm trying to figure out on a way to help these people that could that amount of pressure and not feel a thing. I've written all your helpful advice down on my notepad to study on and thank you so much.
I will talk to the massage therapist that works on this women and try to get some advice.he is a tall muscular guy so i'm thinking it might my pressure. I 've felt happy that i got a response from her and that i hit the spot but it took all of my power and energy to help this woman.
I didnt like that she wasnt willing to do self care, she wasnt willing to do anything relaxing like yoga or to take it easy at work.
she has chronic pain and had it for years. I did have a heat pad on her back and legs before i worked on them, so maybe that helped a little.
I didnt do that in my first session with that other woman and this one and i got some feedback.

please give me more advice and if you guys had people like this how many sessions will it help to get them back to normal?
or what questions should i ask?
or what modalites should i learn?
thanks everyone.

If I were you I would go get a massage from the therapist she usually goes to - it will help you get a feel for the differences out there and you might be able to pick up more information from being a lcient than is possible to convey through typed words.

Angela