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Why are some clients sore after a Deep Tissue Massage and others are not?

I've been practicing Massage for about a year now. During the Massage Program I completed, we learned Deep Tissue and even practiced it on each other. I always tried to work with one person in particular because she was so strong and did amazing DT work. There were times when I felt as though the pressure was too much, but I never told her to let up and I never developed any soreness - of course, at this point, we were practicing on each other 3-4 times a week, meaning I was getting several Massages each week for several months.

 

In the past year, since finishing the program and working on my own, I've come across a lot of different levels of soreness after DT work. I have some clients who come in, haven't had a Massage in a couple of years, receive a DT Massage (and I know I'm strong based on client feedback) and have NO soreness. I have other clients who come in and are extremely sore after their first DT Massage, and then I have OTHER clients who are not sore after their first couple of DT Massages, but become sore after their third, fourth or fifth DT Massage.  I've even put together a spreadsheet looking for any sort of consistency in what causes the soreness, but I have yet to come across any patterns.

 

Two other factors - I ALWAYS do Trigger Point work when I do DT, and I try to ensure that I work slowly - starting superficially and working deeper.

 

Does anyone know or have a theory on why some clients develop soreness, why some never do, and why some develop it later after several treatments? 

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I've wondered about this too. Could it have something to do with the clients blood toxicity?

In other words, maybe someone who smokes and eats a bad diet will feel more soreness than an athlete. 

Anyone know enough to confirm or deny this theory??
Tom, based on the spreadsheet that I've put together, that doesn't seem to be a factor. Diet and exercise were one of the first things I thought about, but I have some clients that exercise religiously, some not at all, some that eat well and some that don't, and paths crossing and not crossing on all of the above. Here are the categories of my "study" - Gender, Duration of Massage, Frequency (of Massage), Previous Massage Experience, Injury/Disease, Areas Affected, Areas Targeted, Level of Tension, Exercise Regimen, Stretch Regimen, Hydration, Diet, Overall Health, Body Type, Level of Soreness, Duration of Soreness. 

Tom Martin said:
I've wondered about this too. Could it have something to do with the clients blood toxicity?

In other words, maybe someone who smokes and eats a bad diet will feel more soreness than an athlete. 

Anyone know enough to confirm or deny this theory??
That is the ONE thing clients complain about and is the reason why they wont get a massage anymore or for awhile. I`ve several clients that have told me they got DT and they didnt like it,  but i think some people have general adaption sydrome
If you press too hard.. You damage tissue.. Damaged tissue causes pain..  As an experienced therapist...It doesnt happen anymore...And besides that...you can release trigger points in only a few seconds using only light pressure,if you know what you are doing.

Nyema, I completely understand where those clients are coming from. I ALWAYS ask a client what type of pressure they want for that session, no matter how many times they've been in. Even if they say something along the lines of, "Oh, I like a TON of pressure", I ask them if they mean Deep Tissue specifically. If and when they say they want Deep Tissue, I tell them there is a possibility of becoming sore, taking all precautions before I actually perform Deep Tissue work. What is "general adaption syndrome"?

 

Gordon, I don't mean any disrespect because I realize you've been practicing much longer than I have, but I'm not sure that's the answer. When I'm performing DT work, I ALWAYS tell my clients to keep their pain threshold around a 7 or 8 on a scale of 1-10, then I watch for signs of pain and check in with them verbally concerning the pressure throughout the massage. I have a dozen clients that I've used the same amount of pressure on and some develop soreness, others don't and this is what's baffling me.

Alyson, it's just my opinion but I think that 7-8 on the pain scale is too high.  I was taught that anything above a 6 is at a minimum creating guarding and at worst doing actual tissue damage.

 

I admire your tracking system!  That is a lot of work.  Have you kept track of how long in each session you work a particular area?  Duration of work can also create soreness; it's possible to overdo an area.

 

Also, this is one of my personal things after an MT left my arm bruised for 2 1/2 weeks.  There is a difference between pressure and force. Are you clients maybe getting sore on days you are tired and don't have as much energy to moderate the amount of pressure you are using?  I am not trying to be mean or pick on you - there are days I work on people that I don't have the energy to pay attention my body mechanics or what my clients are saying (not related to the work but just the general chatting).

 

General adaptation syndrome reflects a state where a person's body is already at the limit of what it can tolerate.  Massage creates changes in the body but the body can't deal with those changes.  A good example of this is one of my clients who can take 90-120 minutes of CranioSacral work (including some really in-depth dialoging and working on big issues) and Myofascial Release but massage wipes her out for 4 days.  She is finally getting real help with her Lyme disease, and she has low thyroid and some other stuff going on.  

Therese, I don't disagree with your opinion on the pain threshold. In our program, during Trigger Point work, the recommended pain threshold was a 9 or 10, which I thought was absurd. I lowered mine to a 7 or 8, but still watch for reactions that it's too much. 

 

You might be on to something with the duration of work in the particular area - that's not something I've tracked, although, off the top of my head, I can think of two clients that were in so much pain we spent an entire hour (several times) on their necks and backs, one was extremely sore, the other was not. As far as pressure v. force, I'm a little less inclined to look further in to that one because there have been far too many cases over the past year for that to have been a significant factor. 

 

I appreciate the insight - I know it sounds as though I'm being argumentative, I just really have tried to think of everything! Will keep better track of durations, though...

No, it doesn't sound like you are being argumentative!  I can't imagine working on someone at a pain threshold of 9 or 10 - basically they are asking people to tolerate body work that feels like their ankle being torn up or bones breaking or a car accident.  Wow!  Glad you backed off of that.

 

I also encourage people to just simply not allow me to work at a pain threshold that is more than they want to deal with.  Some days people can barely take any pressure and the same person might be able to handle much deeper work the next session.

 

I have clients with whom I only work necks and backs.  Through trial and error I've found that people can tolerate 30 minutes on the neck but not more.  That's just my group though and other people may have different experience, but that may help.

 

As I said, you are doing a fantastic job of tracking!  I'm impressed with all you've thought of.

A healing massage hurts good... Those are just words open to interpretation..But. The right amount of pressure...If one was to vocalize would be something like this... Oh gawd thats sore but it feels good dont stop!!.  Often accompanied by a low moan... Ok...    So , the part that hurts , is your body telling you that something is wrong( like duh ! ), but the part that feels good, is your body telling you that what you are doing, or what your therapist is doing, is healing...Dont think numbers.  Sore but good...Anything more then that is causing tissue damage.. Thats the reality of it. The biggest complaint about maissage is pressure...A good portion of my income is from clients that left their massage therapist because the massage hurt too much, or it was too soft...Pressure is very important...You want it to feel freakin good to the client... Sore is good. Hurt is bad.
Its hard to explain things online, in print.. But I can tell you..Its not even a remote issue for me any more...It was for the first ten years...But not at all for the last 16.  A zero issue now..  Not arguing...because we are just typing.. and words are open to interpatation.. so,,just at least consider what Im saying is all..Thats why I commented...Cause Im making money because of this issue... Every time I gain a new client thats been seeing another therapist.. Had one today...Its because the massage hurt too much, or it was too soft.. Otherwise they wont leave you.  And when they say I want deep tissue..you know its because other massages have been to soft...And when they say, I dont want deep tissue, its because other massages they've had were too hard...Good healing massages feel so freakin good you dont want em to stop.. Thats it.   Trust me...for the last 16 years, its been a none issue for me....but we all have our own path,, and Im not saying I know it all.. Cause I dont... lol   But I know that issue is a pretty good source  of income for me.. lol  Worth thinking  about.  I made $60.00 off it today.

Alyson Schlobohm said:

Nyema, I completely understand where those clients are coming from. I ALWAYS ask a client what type of pressure they want for that session, no matter how many times they've been in. Even if they say something along the lines of, "Oh, I like a TON of pressure", I ask them if they mean Deep Tissue specifically. If and when they say they want Deep Tissue, I tell them there is a possibility of becoming sore, taking all precautions before I actually perform Deep Tissue work. What is "general adaption syndrome"?

 

Gordon, I don't mean any disrespect because I realize you've been practicing much longer than I have, but I'm not sure that's the answer. When I'm performing DT work, I ALWAYS tell my clients to keep their pain threshold around a 7 or 8 on a scale of 1-10, then I watch for signs of pain and check in with them verbally concerning the pressure throughout the massage. I have a dozen clients that I've used the same amount of pressure on and some develop soreness, others don't and this is what's baffling me.

Just another comment.   To me at this point.. Deep tissue or not deep tissue, means nothing to me..There is only one kind of massage.. And thats a GOOD ONE.  Thats it...Only one kind.. One thats so good, they dont wanna leave...And they cant wait to get another one.. Thats it.  Deep tissue means working specifically as opposed to working generally. . Everybody has a certain pressure that feels so perfect to them regardless if you are using your palm, thumb or elbow. Holding steady on one point or moving in broad  strokes. ..But we as therapists,give them two choices.. Deep tissue or not deep tissue..   But what they (clients) really want is a  Good Massage..  A massage with perfect pressure...its not taking pain or breathing through it or anything..Thats b*******..lol   What most people want is firm substantial massage that feels really freakin good...Call it what you want.. Again, just telling you MY truth. Not arguing or challenging...Just telling you My Truth...But we all have our perspectives.. Jesus means something   completely different to a Hindu then to a Christian...So...just telling you My Truth.  Uhm, also, not trying to dominate this issue...or tell anyone Im right and you are wrong...I think we all believe what we want anyway..

Gordon J. Wallis said:
Its hard to explain things online, in print.. But I can tell you..Its not even a remote issue for me any more...It was for the first ten years...But not at all for the last 16.  A zero issue now..  Not arguing...because we are just typing.. and words are open to interpatation.. so,,just at least consider what Im saying is all..Thats why I commented...Cause Im making money because of this issue... Every time I gain a new client thats been seeing another therapist.. Had one today...Its because the massage hurt too much, or it was too soft.. Otherwise they wont leave you.  And when they say I want deep tissue..you know its because other massages have been to soft...And when they say, I dont want deep tissue, its because other massages they've had were too hard...Good healing massages feel so freakin good you dont want em to stop.. Thats it.   Trust me...for the last 16 years, its been a none issue for me....but we all have our own path,, and Im not saying I know it all.. Cause I dont... lol   But I know that issue is a pretty good source  of income for me.. lol  Worth thinking  about.  I made $60.00 off it today.

Alyson Schlobohm said:

Nyema, I completely understand where those clients are coming from. I ALWAYS ask a client what type of pressure they want for that session, no matter how many times they've been in. Even if they say something along the lines of, "Oh, I like a TON of pressure", I ask them if they mean Deep Tissue specifically. If and when they say they want Deep Tissue, I tell them there is a possibility of becoming sore, taking all precautions before I actually perform Deep Tissue work. What is "general adaption syndrome"?

 

Gordon, I don't mean any disrespect because I realize you've been practicing much longer than I have, but I'm not sure that's the answer. When I'm performing DT work, I ALWAYS tell my clients to keep their pain threshold around a 7 or 8 on a scale of 1-10, then I watch for signs of pain and check in with them verbally concerning the pressure throughout the massage. I have a dozen clients that I've used the same amount of pressure on and some develop soreness, others don't and this is what's baffling me.



Gordon J. Wallis said:
Just another comment.   To me at this point.. Deep tissue or not deep tissue, means nothing to me..There is only one kind of massage.. And thats a GOOD ONE.  Thats it...Only one kind.. One thats so good, they dont wanna leave...And they cant wait to get another one.. Thats it.  Deep tissue means working specifically as opposed to working generally. . Everybody has a certain pressure that feels so perfect to them regardless if you are using your palm, thumb or elbow. Holding steady on one point or moving in broad  strokes. ..But we as therapists,give them two choices.. Deep tissue or not deep tissue..   But what they (clients) really want is a  Good Massage..  A massage with perfect pressure...its not taking pain or breathing through it or anything..Thats b*******..lol   What most people want is firm substantial massage that feels really freakin good...Call it what you want.. Again, just telling you MY truth. Not arguing or challenging...Just telling you My Truth...But we all have our perspectives.. Jesus means something   completely different to a Hindu then to a Christian...So...just telling you My Truth.  Uhm, also, not trying to dominate this issue...or tell anyone Im right and you are wrong...I think we all believe what we want anyway..

Gordon J. Wallis said:
Its hard to explain things online, in print.. But I can tell you..Its not even a remote issue for me any more...It was for the first ten years...But not at all for the last 16.  A zero issue now..  Not arguing...because we are just typing.. and words are open to interpatation.. so,,just at least consider what Im saying is all..Thats why I commented...Cause Im making money because of this issue... Every time I gain a new client thats been seeing another therapist.. Had one today...Its because the massage hurt too much, or it was too soft.. Otherwise they wont leave you.  And when they say I want deep tissue..you know its because other massages have been to soft...And when they say, I dont want deep tissue, its because other massages they've had were too hard...Good healing massages feel so freakin good you dont want em to stop.. Thats it.   Trust me...for the last 16 years, its been a none issue for me....but we all have our own path,, and Im not saying I know it all.. Cause I dont... lol   But I know that issue is a pretty good source  of income for me.. lol  Worth thinking  about.  I made $60.00 off it today.

Alyson Schlobohm said:

Nyema, I completely understand where those clients are coming from. I ALWAYS ask a client what type of pressure they want for that session, no matter how many times they've been in. Even if they say something along the lines of, "Oh, I like a TON of pressure", I ask them if they mean Deep Tissue specifically. If and when they say they want Deep Tissue, I tell them there is a possibility of becoming sore, taking all precautions before I actually perform Deep Tissue work. What is "general adaption syndrome"?

 

Gordon, I don't mean any disrespect because I realize you've been practicing much longer than I have, but I'm not sure that's the answer. When I'm performing DT work, I ALWAYS tell my clients to keep their pain threshold around a 7 or 8 on a scale of 1-10, then I watch for signs of pain and check in with them verbally concerning the pressure throughout the massage. I have a dozen clients that I've used the same amount of pressure on and some develop soreness, others don't and this is what's baffling me.

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