How deep is too deep

[John Gordon]

Hi all

Yesterday we had an very interesting discussion as part of a course i was taking. I was being worked on by a practitioner of sports massage and trigger/fascia release techniques. She correctly identified several areas of my body, back, buttocks, knees and ankles which had been very sore. Needless to say, she got in there; I was yelping and even crying...but the pain was worth it in that i felt immediately better if not a little embarrassed for letting rip in front of a room of quiet strangers.

however, we all got to talking about pain during massage. one therapist said it could promote the body to go into spasm. but the course leader said that if someone came for a massage with pain or muscle trauma - to NOT tackle that area firmly to the point of the pain would almost tantamount to 'cheating' in that they'd go away with the original problem...muscles must be shocked into healing etc.

Now, because i work with people whose health is compromised, i cannot do these massage techniques at all...i have to be quite gentle and soothing: but these comments have made me feel a little 'lightweight' - as though i am not quite a REAL practitioner as i don't set about people and i haven't got a pneumatic drill for a thumb.

Where do we all stand on this;
a x

 

[Jippee]

I think it is all about client communication and watching their body too. For clients who come to me with pain conditions I use trigger point therapy and some mysofascial realease techniques. I warm muscles first and don't just go straight in doing trigger point work. I also work within the clients pain tolerance - if what I am doing is too painful for them then I ease off. You don't have to use a lot of force to work on trigger points. If the trigger points are there they'll be found. It is working slowly with focus that helps find them. I ask clients on a scale of 1 to 10 how the pain feels - my aim is for it not to be above 7 plus I am not trying to get to a 7. Clients find the pain pleasurable. I do say that if at any time the pain feels like it is not helping then they must let me know. I also say if they are finding it too much also to let them know.

I go back to the trigger points a few times during a session and treat for about 10-12 seconds and I don't increase the pressure. Some therapists may be taught to hold them for longer but that can be hard work on the thumbs and not nice for the client either.

I've not yet had a client's muscle go into spasm when I've done trigger point work. Also some mysofascial realease techniques can be gentle in their application.

Also sometimes gentle and soothing is what a client needs. I've had a few clients who can only tolerate the gentle pressure (I find it hard to hold back but raise the leve of the couch to help me).

Not sure if I've answered your question but I'm sure others will chime in.

 

[aspicco]

Hi happygoddess
I am very surprized your instructor and the fellow therapist thought it ok to have you yelping and crying ???? the person recieving treatment should be empowered to controll the pressure/discomfort by using a 1 to 10 scale thereby keeping the therapist informed who should respond accordingly....this is teamwork! not a lie there while I hurt you technique.

Fortunately you were able to experience the benifits of identifying and treating the triggerpoints. Triggerpoint work can be used on clients whose health is compromised eg fibromyalgia, it is how you apply/work with your client that counts.!
I have worked on many chronically compromised clients who have benifited enough to sleep at night and return to work.
By working gently in short sessions. You can eventually build up to much longer deeper sessions = longer lasting more effective benifits.

There will always be a market for deep treatments with the more pain more gain athlete brigade who in a medical/chronic pain environment could/would hurt someone if techniques were applied in the way you describe above.

I really hope you are not put off from using triggerpoint work on your clients (if suited)
you dont need pnumatic drill for a thumb just care and patience in application and you will go a long way .

Regards steve

 

[Mack singh]

This is a great thread and I hope you get lots of answers.

I have many clients that on their first visit they expect pain, either because of past massage experiences or because of what they've read.

IMO it doesn't have to be that way to achieve pain relief and deal with soft tissues problems. Although there are times when I think a particular technique will cause pain, I will warn the client and advise them to use a breathing technique under guidence.

However, we have many techniques available to us where there is no need to go in with a shot gun technique. When I finshished my Swedish/Holistic massage course I actually felt ill-prepared to deal many of the conditions presented to me. But with further training, I have some excellent mentors who have enabled me to learn how to deal with specific problems.

I would strongly recommend massage therapists to go on and learn sports and/or remedial massage, or other advanced techniques. When you have indirect techniques in your massage portfolio as well as direct techniques, then it's possible to deal with each condition while minimizing the pain.

Every client is different, and everyone has a different pain threashold, some clients are very fit and others are elderly, infirm or are in a great deal of pain. Therefore it's essential that the technique used is right for the condition and the client. Far too many clients have had bad massage experiences because of over zelous application.

My tutor says, "massage is not an act of violence", and I agree with him completely.

Know your A&P, conditions, techniques and client, then massage is less about depth and more about being effective and appropriate.

Myarka.

 

[rnqvzoid]

At last! someone speaks the words of true bodywork

In order to effectively treat painful obstructions, you must work as close to the 'wall' as possible to get good results. Relieving pain and restoring the body needs this kind of work.
I always say that the treatment is no more painful than the condition, and will minimise the duration of suffering.

Trigger points will always be tender which guides the practitioner to the site of treatment.

That is not to say that 'lighter' techniques do not work. The main aim in all bodywork should be to instill relaxation throughout the body. You can't work a joint or muscle if it is not relaxed. If i treat someone with fibromyagia or osteoparosis or cancer, i will tailor the treatment to suit....which in most cases will be 'lighter'

IMO all physical bodywork should be taught a the deeper level so that each practitioner has the confidence and ability to apply successful treatment. Making it 'lighter' is just a matter of intent.

INDO

 

[notHonEndancy]

This has been a bit of an issue for me in my initial training - not sure it's reassuring to see the issue never goes away!

I guess in my role as a student of Holistic Massage, which is largely for treating stress and improving general wellbeing, it's not in my remit to 'treat' a knot / adhesion / trigger point - one of my case studies is seeing a physio for tendinitis, so it's her job to treat the injury, using massage that leaves my client pretty sore, and mine to do general loosening, soothing, etc.
But another one has several knots / TPs that are simply a result of a stressful job, they have been there for years and do not qualify for physiotherapy treatment. So she needs someone to help her with them. I am reading all I can, but I intend to take a course eventually. From what I've seen so far, the comments regarding communication with the client and giving them control over the pain are important - my friend's physio tells her the massage will hurt, she deals with it, she goes home and heals and continues to get better. It's got to be about the client choosing what they want to get out of a treatment (help with pain or relaxing and soothing massage), knowing what to expect, how the treatment will affect them, and being able to say 'stop!' if it gets too much.

 

[who da man?]

Personally I advise my clients that as an aromatherapist, my primary concern is the assimilation of the oils rather than the condition of the muscles. I did study Swedish massage but refuse to do it because the rheumatoid arthritis has affected my hands to the extent that they are deformed and I'm not putting my own health in jeopardy.

Most of my clients have compromised health and really appreciate the gentleness but firmness of the massage. The key for these clients is to be gentle, yet firm. Done properly, it should be soothing and relaxing.

 

[LionLove]

Do any of the massage therapists on this thread use METs?

Myarka.

 

[Pompal 09.]

A personal view as a Sports Massage practitioner. I can apply a lot of pressure if necessary (I'm 6ft and over 14 stone), and spent the first 2 years of my career treating professional rugby players, but deep massage must be used selectively. You need to factor in various elements such as the amount of tension in the muscle, is the condition acute or chronic, the pain tolerance of the client and the potential effectiveness of deep tissue work for the particular problem. There may be a more appropriate technique.

If using deep work do it progressively and intelligently, warm the muscle(s) and build the intensity slowly. Check with the client continuously and ensure they are OK. It is not a competition between the client and yourself to see who can administer/take the most pain. Bruised, unhappy clients are not acceptable.

Deep tissue work can also be tremendously damaging to the practitioner so learn to master 'no hands' techniques.

Hope this helps.

Oh yes, and I do practice MET (post before this one-MYARKA)

 

[Tarun]

Great thread!
I find so interesting how elusive the concept of pain is and how much it greatly depends on the trust the client has on the practitioner. Once the client can trust and relax, the pain becomes more like an "intense sensation" rather than "pain".

Art Riggs says that pain is not caused by deep work but by going too deeply too soon and I totally agree.
Sloooooooow work is the trick for me. And i try to always remember never force the tissues. Just "knock at the door and ask if i may come in". Then make a suggestion, invite the tissue to follow a direction, a stretch, a move, a release...but without imposing.

Ida Rolf said that pain is resistance to change. And I find that to be very true not only in massage world but in every aspect of life!

My feeling is that if the client trusts me, knows what I am doing and why and is ready to get on with some "changes" in their bodies, pain is not pain anymore. It is more like an intense sensation that feels actually pleasurable. That's the "good pain" and "good pain" works!

 

[Stephbiatchxxx]

I had a new client this morning that asked for a light aromatherapy massage because she was fed up with being bruised and hurt by other therapists but her neck and shoulders were ridiculously tight. I used cranio-sacral techniques on her for half the first half of the treatment and she could not believe how much looser her neck and shoulders were without even doing any normal massage. By the time she got off the table (2nd half was massage) she said she couldn't remember when she ever felt that loose and rebooked straight away. CranioSacral is ridiculously light, if I hadn't had such good results receiving it myself after an accident, I would probably have felt like it was a complete joke giving someone a treatment using the ultra light techniques and expecting anything beyond them feeling relaxed. Luckily I knew how effective it is even if it fells like nothing is being done, and I have continued to use it and the results with clients are great.

I can, and still do, deep work, but I'm using ultra-light work more than deep these days. It's also much easier on my hands/thumbs/wrists.

 

[Sideillurce]

Guys, this is all really useful to know! With just basic Holistic Massage I feel like I hardly know anything, and am anxious to learn more.
I guess I'd better get some good old experience first!

 

[viva]

Hi Thell
v good idea, too many therapists bounce from one course to another without mastering the one they have just done.
When you feel the time is right, ( after a while you will intuatively want to work deeply) fork out for the best sports and remedial course you can afford. Then when your clients come and mention old scar tissue, muscle strains migriane etc you can confidentaly offer to help them.

 

[mlefdulbiyaihsece]

As a receiver, rather than a giver, of massage, I found this discussion very interesting.

From my point of view, I find deep trigger point work very helpful. I completely agree with the comments of “massage space” that “pain” is an elusive concept, and that a great deal depends on establishing a relationship of trust between client and practitioner.

Some practical points from my own experience:

1. Slow deep work is much more bearable than quick deep work! I had some sessions of trigger point work from a physio, but found it very uncomfortable as I never had time to relax as she attacked point after point! I have since found other therapists who work much more slowly, and paradoxically much more intensely. Because there is time to breathe into the tight spots and let the tissues relax, I am much less aware of “pain” and more aware of a delicious feeling that tight spots are letting go.

2. I have never liked being worked on through a sheet or a towel – some deep tissue practitioners do this. But it can actually make the treatment more uncomfortable, as the sensation is less precise – I would much prefer feeling a thumb or elbow going directly to the tight spots and exploring them.

3. I have never come away from sessions with bruises, but I have felt some tenderness on the trigger points for a few days afterwards – particularly if the work has been on sensitive spots such as the ribcage. This tenderness can be a good thing – I find it reminds me to breathe into these spots, so the treatment carries on working after I have left the treatment room.

4. Finally, communication is vital. I and my therapist don’t talk much about “pain” during the sessions – this can encourage the therapist to back off, for fear of hurting the client. We both know that we can stop at any time if the work becomes too intense. So rather than say “this is painful” I prefer to say “slow down here” or “give me time to breathe” or my therapist will feel a knot and ask “can I stay longer / can I go deeper?” In this way, the treatment becomes an exploration which we undertake together.

I hope these comments are helpful, and that they might encourage those who are new to this sort of massage to explore it further.

 

[Pompal 09.]

MVT - thank you, these comments are certainly useful to me. As a relative beginner I feel this is something definitely need to learn more about.