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It has surprised me a few times when I've seen successful massage therapists state that they do not feel anything while massaging clients. Obviously, the job gets done either way, but I am curious, who here can find the pain by touch alone? Or do you need the client to tell you where it hurts?

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Hi Gordon! What time is it in Alaska?

I would like to read your attachment, but I don't see a link to it here...

Uhm.... well this happened today... I had a new client... she told me that she sees a chiropractor and gets myotherapy there for her low back pain once a month and that she is here just to relax..she doesn't want any deep tissue work...I said well your low back hurts...  she said it hurts all the time...So I went to her hip and low back area and found a really sore left SI joint and two really sore spots at L5 left and right on her spinal erector muscles.I mean she filnched and let me know it was sore where I was touching.... She was very surprised to find her hips and back free of pain after her massage...lol   I got a BIG tip..... So for what I do now I seem to have no need to asses tissues and textures?   

its 3am now... haha.... I  do have to work at 2pm tomorrow... so I better hit the sack.. I work from 2pm to 6pm tomorrow....

Linda LePelley, RN, NMT said:

Hi Gordon! What time is it in Alaska?

I would like to read your attachment, but I don't see a link to it here...

No, you don't have any need to assess tissues and textures, your clients are happy and you get paid. There's nothing at all wrong with that, it's part of the beauty of this profession, we can run our business as we see fit. If we just want to do the work and be left alone, we can. But for me, I've got something to prove. I want to draw a picture of, "before", that any other skilled therapist would draw independently, based on the TD. Then, provide treatment, and draw the, "after". Again, independently assessable and documentable. When we can do that, no one can deny that we have objective proof of condition, before and after. It doesn't matter how we achieve the improvement (whether by Swedish, MFR, CST, or TDR, etc.), only that an actual, positive change of condition has occurred. Once we have that documentation, we have a leg to stand on when communicating with other members of the health care team or insurance providers.

 
Gordon J. Wallis said:

Uhm.... well this happened today... I had a new client... she told me that she sees a chiropractor and gets myotherapy there for her low back pain once a month and that she is here just to relax..she doesn't want any deep tissue work...I said well your low back hurts...  she said it hurts all the time...So I went to her hip and low back area and found a really sore left SI joint and two really sore spots at L5 left and right on her spinal erector muscles.I mean she filnched and let me know it was sore where I was touching.... She was very surprised to find her hips and back free of pain after her massage...lol   I got a BIG tip..... So for what I do now I seem to have no need to asses tissues and textures?   

I am not sure that what is felt in meridian work to free stagnated energy in the acupressure point (tsubo) can be directly compared with the feeling from soft tissue. To me that is another level. This is more like feeling a disruption in a stream or a magnetic pull. In Korean Martial Therapy (Hwal Bup Do) the joints are major blockage points where energy must be freed. Acupoints are also used. While this can take care of some pains, physical illness, and emotional problems the feeling from muscle, fascia, and tendons is different. In Korean Martial Therapy, as well as Lomi Lomi and Thai Massage the physical and energetic therapies are traditionally never separated. However, they are like two over lapping circles. There is the area of purely physical, purely energetic, and the area of overlap. Therapy for pain works all three with techniques to remove physical obstruction to energy flow and correct energetic flow.

Gary W Addis said:

What y'all are calling difference in tissue density is a good descrption of what I feel pretty well--what Shiatsu calls tsubo's jitsu and kyo.  The "hollow" spot are harder for me to find by touch alone, it often surprises me that the client reports tenderness there, sometimes intense pain.  The other kind, I can find with touch.  

        The hypertonicity I referred to is like plates of armor, especially in the upper traps.  I look to antagonists first for the cause; if no TPs (or if you prefer "tissue density issues" there) I work inward toward the iron tissue.  Once it is relaxed I can scan for the tender spots, which if I find one or more will be deeper than the traps.  

 

But this one guy, he is like a knight in hairy armor. in his 50s, tall, looks flabby but he tenses when the limbs, pecs, back are touched.  Trying to stretch his hams, you want to reach for a hammer!  Tell him 20 times to relax, he will, but only for a second.  His SOAP charts are criss-crossed with  hypertonicity (HT) marks, hardly ever is a TP noted by anyone who has worked on him. 

A successful competitive bodybuilder  in a former life, two years ago at the start of massage school I became a weight trainer again after 24 years away from the gyms--my first few times on the table, I too was a knight in hairy armor.  The "big guns" (big biceps) guys are always aware of their bodies...when they get out of bed in morning, they stand before a mirror and put on their armor...the lats tighten and spread, the glutes tighten, the abdominals and obliques and serratus combine to shrink waist size by ten inches.  So, sometimes one must learn to relax.   

Daniel Cohen said:

Some clients like to go into detail about their pain. I let them and encourage it because it is part of their therapy for letting go. I depend on what I feel almost entirely. As I go I will ask for input as to what they feel as I move along. This is more for their ease of mind then benefit in locating the problem. I am usually ahead of them anyway. Experience and feel is what searches out the problem and addresses it. What do I feel? Very tiny changes in tension that give the signals as to what goes on under the skin. A common comment clients make is; "how did you know that was there? I didn't even realize  it. I don't use Trigger Points (seems the definition has changed over the years to include several things) and I can't name the location often without consulting an anatomy book, but I do find it quickly with no questions asked.

I think you hit on part of the issue.  For a 63 yr old I am well built--I'm well built for a 30 yr old!.  So when I'm working on them they may think I might be judgmental and tighten up so I won't think less of them.  Possible? yeah. Likely?

Linda LePelley, RN, NMT said:

I have not had the opportunity to work on a (currently active) bodybuilder other than feet, but there are a lot of oil rig workers and pipe fitters around here, I've had a few cases of peripheral neuropathy on guys whose biceps are huge. It takes longer to get through to the right spot. And it is harder to get them relaxed, I have to shake the muscle and tell them I need it to be like a jello jiggler!

"Knight in hairy armor", LOL!!

You mentioned the "hollow spot" as being more tender and painful, and I find that to be true as well. I'm convinced that it is because the localized tissues have impaired circulation and are hypo-hydrated, which results in a loss of mass and elasticity. It has dried up and shrunken to a degree, however, the nerves are still sandwiched in there. And they are not at all comfortable. The nerves, “slidey glidey” abilities are gone, movement now involves tugging and shredding. Good news is, you can restore it to normal density = normal circulation =no pain =normal function.

I have a client whose son is a bodybuilder, and he is supposed to be coming to see me soon for shoulder pains. It will be interesting to note how well he can relax. Of course, my being a non-body-builder-competitor older female may make it a lot easier.

 

 
 
Gary W Addis said:

What y'all are calling difference in tissue density is a good descrption of what I feel pretty well--what Shiatsu calls tsubo's jitsu and kyo.  The "hollow" spot are harder for me to find by touch alone, it often surprises me that the client reports tenderness there, sometimes intense pain.  The other kind, I can find with touch.  

        The hypertonicity I referred to is like plates of armor, especially in the upper traps.  I look to antagonists first for the cause; if no TPs (or if you prefer "tissue density issues" there) I work inward toward the iron tissue.  Once it is relaxed I can scan for the tender spots, which if I find one or more will be deeper than the traps.  

 

But this one guy, he is like a knight in hairy armor. in his 50s, tall, looks flabby but he tenses when the limbs, pecs, back are touched.  Trying to stretch his hams, you want to reach for a hammer!  Tell him 20 times to relax, he will, but only for a second.  His SOAP charts are criss-crossed with  hypertonicity (HT) marks, hardly ever is a TP noted by anyone who has worked on him. 

A successful competitive bodybuilder  in a former life, two years ago at the start of massage school I became a weight trainer again after 24 years away from the gyms--my first few times on the table, I too was a knight in hairy armor.  The "big guns" (big biceps) guys are always aware of their bodies...when they get out of bed in morning, they stand before a mirror and put on their armor...the lats tighten and spread, the glutes tighten, the abdominals and obliques and serratus combine to shrink waist size by ten inches.  So, sometimes one must learn to relax.    
 

Gary I think you have something there regarding the big bodybuilder types. My more petite female MT friends seem to get many of that type. I think they like watching them struggle to get into the muscles. With my techniques I zero in immediately to the point of pain or find pains they had buried. I easily lift leverage and probe. A few like this and the quick results it gets. But most go back to the petite MT who makes them feel big and nearly impervious.


Gary W Addis said:

I think you hit on part of the issue.  For a 63 yr old I am well built--I'm well built for a 30 yr old!.  So when I'm working on them they may think I might be judgmental and tighten up so I won't think less of them.  Possible? yeah. Likely?

Linda LePelley, RN, NMT said:

I have not had the opportunity to work on a (currently active) bodybuilder other than feet, but there are a lot of oil rig workers and pipe fitters around here, I've had a few cases of peripheral neuropathy on guys whose biceps are huge. It takes longer to get through to the right spot. And it is harder to get them relaxed, I have to shake the muscle and tell them I need it to be like a jello jiggler!

"Knight in hairy armor", LOL!!

You mentioned the "hollow spot" as being more tender and painful, and I find that to be true as well. I'm convinced that it is because the localized tissues have impaired circulation and are hypo-hydrated, which results in a loss of mass and elasticity. It has dried up and shrunken to a degree, however, the nerves are still sandwiched in there. And they are not at all comfortable. The nerves, “slidey glidey” abilities are gone, movement now involves tugging and shredding. Good news is, you can restore it to normal density = normal circulation =no pain =normal function.

I have a client whose son is a bodybuilder, and he is supposed to be coming to see me soon for shoulder pains. It will be interesting to note how well he can relax. Of course, my being a non-body-builder-competitor older female may make it a lot easier.

 

 
 

Gary & Daniel, I think you are both correct! LOL!!

I act and behave somewhat differently with each client in order for them to feel more comfortable...I wanna be more like them in a sense...Sometimes thats more important then other times....gosh I want everyone to feel comfortable with me.. For me, also having a testimonial letter from an important person like a medical doctor helps...Not kidding.. After i show them that letter they relax and open up to me...Ive only discovered this last year....You can visually see them relax because they feel safe and in good hands...It has had an amazing effect...I know it initiates the placebo effect.  

Gary W Addis said:

I think you hit on part of the issue.  For a 63 yr old I am well built--I'm well built for a 30 yr old!.  So when I'm working on them they may think I might be judgmental and tighten up so I won't think less of them.  Possible? yeah. Likely?

Linda LePelley, RN, NMT said:

I have not had the opportunity to work on a (currently active) bodybuilder other than feet, but there are a lot of oil rig workers and pipe fitters around here, I've had a few cases of peripheral neuropathy on guys whose biceps are huge. It takes longer to get through to the right spot. And it is harder to get them relaxed, I have to shake the muscle and tell them I need it to be like a jello jiggler!

"Knight in hairy armor", LOL!!

You mentioned the "hollow spot" as being more tender and painful, and I find that to be true as well. I'm convinced that it is because the localized tissues have impaired circulation and are hypo-hydrated, which results in a loss of mass and elasticity. It has dried up and shrunken to a degree, however, the nerves are still sandwiched in there. And they are not at all comfortable. The nerves, “slidey glidey” abilities are gone, movement now involves tugging and shredding. Good news is, you can restore it to normal density = normal circulation =no pain =normal function.

I have a client whose son is a bodybuilder, and he is supposed to be coming to see me soon for shoulder pains. It will be interesting to note how well he can relax. Of course, my being a non-body-builder-competitor older female may make it a lot easier.

 

 
 
Gary W Addis said:

What y'all are calling difference in tissue density is a good descrption of what I feel pretty well--what Shiatsu calls tsubo's jitsu and kyo.  The "hollow" spot are harder for me to find by touch alone, it often surprises me that the client reports tenderness there, sometimes intense pain.  The other kind, I can find with touch.  

        The hypertonicity I referred to is like plates of armor, especially in the upper traps.  I look to antagonists first for the cause; if no TPs (or if you prefer "tissue density issues" there) I work inward toward the iron tissue.  Once it is relaxed I can scan for the tender spots, which if I find one or more will be deeper than the traps.  

 

But this one guy, he is like a knight in hairy armor. in his 50s, tall, looks flabby but he tenses when the limbs, pecs, back are touched.  Trying to stretch his hams, you want to reach for a hammer!  Tell him 20 times to relax, he will, but only for a second.  His SOAP charts are criss-crossed with  hypertonicity (HT) marks, hardly ever is a TP noted by anyone who has worked on him. 

A successful competitive bodybuilder  in a former life, two years ago at the start of massage school I became a weight trainer again after 24 years away from the gyms--my first few times on the table, I too was a knight in hairy armor.  The "big guns" (big biceps) guys are always aware of their bodies...when they get out of bed in morning, they stand before a mirror and put on their armor...the lats tighten and spread, the glutes tighten, the abdominals and obliques and serratus combine to shrink waist size by ten inches.  So, sometimes one must learn to relax.    
 

Its interesting as to how we are all so different in out approach.  Yet all massage therapists.. For the most part, all our clients leave happy...Its an interesting profession.

Linda LePelley, RN, NMT said:

No, you don't have any need to assess tissues and textures, your clients are happy and you get paid. There's nothing at all wrong with that, it's part of the beauty of this profession, we can run our business as we see fit. If we just want to do the work and be left alone, we can. But for me, I've got something to prove. I want to draw a picture of, "before", that any other skilled therapist would draw independently, based on the TD. Then, provide treatment, and draw the, "after". Again, independently assessable and documentable. When we can do that, no one can deny that we have objective proof of condition, before and after. It doesn't matter how we achieve the improvement (whether by Swedish, MFR, CST, or TDR, etc.), only that an actual, positive change of condition has occurred. Once we have that documentation, we have a leg to stand on when communicating with other members of the health care team or insurance providers.

 
Gordon J. Wallis said:

Uhm.... well this happened today... I had a new client... she told me that she sees a chiropractor and gets myotherapy there for her low back pain once a month and that she is here just to relax..she doesn't want any deep tissue work...I said well your low back hurts...  she said it hurts all the time...So I went to her hip and low back area and found a really sore left SI joint and two really sore spots at L5 left and right on her spinal erector muscles.I mean she filnched and let me know it was sore where I was touching.... She was very surprised to find her hips and back free of pain after her massage...lol   I got a BIG tip..... So for what I do now I seem to have no need to asses tissues and textures?   

In the first sentence you said that you doubt whether soft tissue work can be compared to the feel of stagnated energy. 
But here, "Therapy for pain works all three with techniques to remove physical obstruction to energy flow and correct energetic flow,"  you seem to contradict yourself.  

  I agree with both statements.  Energy work is not NMT--although both recognize the existence of painful points than can be relieved with ischemic pressure.  Actually, the Chinese, not Travell and Simon, discovered TP work--they were applying ischemic compression to painful points along with "Swedish" massage strokes 6,000 years ago in their Tuina modality.  They didn't know diddly about the inside of a muscle cell, so they described the points' existence in the only way they could grasp the idea: as energy blockages.  Different name, same thing basically.  In Tuina (as I understand it) you don't follow meridians,you find a painful spot and press into it till the pain disappears? Isn't that what we do with our TP work?  Admittedly, I might be all wet.  Although I employ Shiatsu and Reflexology when circumstances in a session call for it in a session, I don't claim to understand the mechanism.  Placebo, reflexive, mechanical or magic effect?  Don't know, don't care-- if it works I'll use it. 

TP work

Daniel Cohen said:

I am not sure that what is felt in meridian work to free stagnated energy in the acupressure point (tsubo) can be directly compared with the feeling from soft tissue. To me that is another level. This is more like feeling a disruption in a stream or a magnetic pull. In Korean Martial Therapy (Hwal Bup Do) the joints are major blockage points where energy must be freed. Acupoints are also used. While this can take care of some pains, physical illness, and emotional problems the feeling from muscle, fascia, and tendons is different. In Korean Martial Therapy, as well as Lomi Lomi and Thai Massage the physical and energetic therapies are traditionally never separated. However, they are like two over lapping circles. There is the area of purely physical, purely energetic, and the area of overlap. Therapy for pain works all three with techniques to remove physical obstruction to energy flow and correct energetic flow.

Gary W Addis said:

What y'all are calling difference in tissue density is a good descrption of what I feel pretty well--what Shiatsu calls tsubo's jitsu and kyo.  The "hollow" spot are harder for me to find by touch alone, it often surprises me that the client reports tenderness there, sometimes intense pain.  The other kind, I can find with touch.  

        The hypertonicity I referred to is like plates of armor, especially in the upper traps.  I look to antagonists first for the cause; if no TPs (or if you prefer "tissue density issues" there) I work inward toward the iron tissue.  Once it is relaxed I can scan for the tender spots, which if I find one or more will be deeper than the traps.  

 

But this one guy, he is like a knight in hairy armor. in his 50s, tall, looks flabby but he tenses when the limbs, pecs, back are touched.  Trying to stretch his hams, you want to reach for a hammer!  Tell him 20 times to relax, he will, but only for a second.  His SOAP charts are criss-crossed with  hypertonicity (HT) marks, hardly ever is a TP noted by anyone who has worked on him. 

A successful competitive bodybuilder  in a former life, two years ago at the start of massage school I became a weight trainer again after 24 years away from the gyms--my first few times on the table, I too was a knight in hairy armor.  The "big guns" (big biceps) guys are always aware of their bodies...when they get out of bed in morning, they stand before a mirror and put on their armor...the lats tighten and spread, the glutes tighten, the abdominals and obliques and serratus combine to shrink waist size by ten inches.  So, sometimes one must learn to relax.   

Daniel Cohen said:

Some clients like to go into detail about their pain. I let them and encourage it because it is part of their therapy for letting go. I depend on what I feel almost entirely. As I go I will ask for input as to what they feel as I move along. This is more for their ease of mind then benefit in locating the problem. I am usually ahead of them anyway. Experience and feel is what searches out the problem and addresses it. What do I feel? Very tiny changes in tension that give the signals as to what goes on under the skin. A common comment clients make is; "how did you know that was there? I didn't even realize  it. I don't use Trigger Points (seems the definition has changed over the years to include several things) and I can't name the location often without consulting an anatomy book, but I do find it quickly with no questions asked.

It's that with some, certainly.  Others of the "ilk" are fearful of being thought of as soft.  Guy I worked on the other day--big, flabby, not a bodybuilder type-- stiffened every muscle I touched.  Trying to stretch the guy's hams, I wound up lifting his entire hip and lower back into the air.  His fear would not allow him to relax.  Instructors say he is always like that, has been for several years of twice-monthly sessions...that I am unlikely to change him.  His loss. 

Daniel Cohen said:

Gary I think you have something there regarding the big bodybuilder types. My more petite female MT friends seem to get many of that type. I think they like watching them struggle to get into the muscles. With my techniques I zero in immediately to the point of pain or find pains they had buried. I easily lift leverage and probe. A few like this and the quick results it gets. But most go back to the petite MT who makes them feel big and nearly impervious.


Gary W Addis said:

I think you hit on part of the issue.  For a 63 yr old I am well built--I'm well built for a 30 yr old!.  So when I'm working on them they may think I might be judgmental and tighten up so I won't think less of them.  Possible? yeah. Likely?

Linda LePelley, RN, NMT said:

I have not had the opportunity to work on a (currently active) bodybuilder other than feet, but there are a lot of oil rig workers and pipe fitters around here, I've had a few cases of peripheral neuropathy on guys whose biceps are huge. It takes longer to get through to the right spot. And it is harder to get them relaxed, I have to shake the muscle and tell them I need it to be like a jello jiggler!

"Knight in hairy armor", LOL!!

You mentioned the "hollow spot" as being more tender and painful, and I find that to be true as well. I'm convinced that it is because the localized tissues have impaired circulation and are hypo-hydrated, which results in a loss of mass and elasticity. It has dried up and shrunken to a degree, however, the nerves are still sandwiched in there. And they are not at all comfortable. The nerves, “slidey glidey” abilities are gone, movement now involves tugging and shredding. Good news is, you can restore it to normal density = normal circulation =no pain =normal function.

I have a client whose son is a bodybuilder, and he is supposed to be coming to see me soon for shoulder pains. It will be interesting to note how well he can relax. Of course, my being a non-body-builder-competitor older female may make it a lot easier.

 

 
 

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