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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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Replies to This Discussion
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Permalink Reply by kristi marco on
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If I might add my two cents. I have a therory to go along with the lmp that stated the toxitity level being different from person to person,along with pain threshhold levels.Most importantly, in my opinion, is the cli hydration levels at the time of the massage and after really have made a difference in whether or not the person had any complaints a day or so after the treatment. Dt or otherwiz, i always tell them,very loudly, to drink the h2o ,or live to regret it.
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Permalink Reply by Therese Schwartz on
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Gordon, I completely agree with you. I have the same experience with my clients. I don't do "deep tissue" or "swedish" or a "spa massage" or whatever label you want to put on it, I work at doing a "good massage". My clients always feel like they get what they need each session. It's a lot of work to do it that way - it takes a lot of focus and attention. I've only been doing this for 3 years (although I started my business before I graduated from school which was 3 years ago this month), so I'm sure it will get easier as I get more experience.
I give people the option of the number system but we very rarely ever use it because it really doesn't matter, like you say. If it doesn't feel good or it's not OK, I do something different immediately.
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Permalink Reply by Alyson C Schlobohm on
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I completely agree with both of you guys (Therese and Gordon). So now my issue is how do I get my clients to understand that it doesn't have to hurt? I think there is a misconception among the majority (including some MTs, haha) that a good DT Massage is going to be painful. One of my clients was so sore the day after his first massage with me that he had his wife check for bruises (and believe me, I'm not bragging about this, I felt horrible). When he came in for his second massage, I told him I was going to back off because I didn't want him to be that sore again. When he came in for his THIRD massage, he asked me to go back to what I did on the first one! Have either of you noticed that, even with the soreness, the affects are longer-lasting afterwards?
Also, with all of this being said, how do I know when I'm using an amount of pressure that's going to CAUSE soreness? I always check in with my clients and ask how the pressure is, and even the ones that become sore tell me it's fine. (Again, most clients don't mind the soreness b/c they say that, even though they're sore, they feel better than they have in months or years, but I would still like to be able to offer a Therapeutic/DT Massage where I can avoid soreness if the client is NOT okay with being sore the next day).
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Hmmmm...Alyson, this is SUCH a big issue! I worked on a client 2 weeks ago - been working on her for a year and a half - and at her request did an hour on her neck. She had a headache for 2-3 days afterward which I felt terrible about but she knew it was from working on her neck and that it would be better in the long run. Although she had a good attitude about it, I'm not going to work on necks for more than 30 minutes any more! I had another client have headaches after 45 minutes on her neck...
I had a long conversation with my husband about this last night. We've been talking about it for 4 years, ever since I started MT school. He is OK with pain as long as it's beneficial but he's really taught me a lot about pressure vs. force because he will not tolerate force. Any amount of pressure is OK though - it's the intention on my part that matters. Remember that your intention is the most important part of the massage you give! :)
Here's what we came up with last night: Change causes soreness. The point of massage and/or bodywork is to create change. (And by change we mean any change - change in exercise, change in diet, change in homes, job, etc, etc, you get the idea!!) So you necessarily want to create change because that's why we are here doing this work. If the client accepts the changes we make (at a conscious or non-conscious level, hopefully both!) they won't be sore, or if they are it won't be for long. If they don't accept the change we make they will be sore for longer. So a lot of how sore a person gets depends on where they are emotionally at the time of the massage.
I've had massages that were painful but I did OK with them because I knew it was OK for it to hurt. Like Gordon says, it's about it being a good hurt. But the last massage I got where I got injured was different - what she was doing wasn't OK. She was angry and taking it out on me. It took a long time for my arm to heal because I was so upset about the situation.
Causing soreness - hmmm, my experience tells me that the tissue will tell you. When it's gunked up and congested it's a lot more likely to be sore later. Also remember that the idea isn't about how much pressure you use, it's how much tissue you are moving. If you focus on a small spot with a lot of pressure you are more likely to create soreness than if you use a broader surface (like your forearm) over a wider area and just plain get stuff moving. I do a combination of both focused and broad pressure and then also use heated bamboo after really focused work (and as a warm up for the tissue) and generally people do really well with that. About it not having to hurt - at some level most people believe that they deserve to hurt for one reason or other. As MT's we deal a lot with people's beliefs just to get them in the door (ever had a client it took several sessions to get them undressed enough you could do a full body massage? That's a fun time!) So just understand that you are dealing with core beliefs, treat people gently and over time push just enough that you get them where you need them to be. And yes, even with the soreness the effects are longer lasting because you can produce bigger changes. Just don't push hard enough to meet or exceed what people can manage! They will abandon the change and go back to the old habits.
It's just my opinion and I don't want to get in trouble with anyone but in my experience MT's who think DT should hurt really don't want to pay attention to what is going on with the client, either their tissues or their being. They just want to get in there and "I have to get this to release!" - it becomes about the tissue or the issue and not about the person as a complete entity.
And yes when I work on people I am as completely paranoid about pressure as you would expect from my posts!! I have less anxiety about it now than I used to...
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Permalink Reply by Gary W Addis, LMT on
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Admittedly, I am no expert. In fact, I am still a student. But an eager one. Not attempting to lecture you pros, just adding my observations.
During a decade of competitive bodybuilding and 20 years as a personal trainer, I learned that there are two distinctly different kinds of pain. There is the achy kind of pain called soreness (either localized or widespread over an entire area); then there is the sharp "right here!" pain of an injury site. Massaging soreness (TP, DT) feels good to a client...it's the kind of massage that elicits the moan "It hurts soooo good." BTW, have others noticed that this soreness feels very much like exercise-induced soreness? What does that suggest to you? To me, it suggests that the soreness is a good thing, for soreness results because more nutrient-rich blood has settled into the tissue, aiding recovery. But digging hard into a genuinely painful point creates muscle guarding in the primary and several antagonist muscles.
Initially upon finding a painful TP (as opposed to sore) I dig in, but only for a couple of seconds, gradually decreasing the pressure and spreading the pressure to surrounding tissue.. Spreading the pressure...keeping blood from pooling in a small area which might create prolonged painful-as opposed-to-mild post- massage soreness.
One final thought. I'm sure y'all have all had a client who insists that you apply jackhammer pressure directly over a bone. Some of these people are perhaps ... masochistic. Sorry, I don't do torture. I apply what I feel is appropriate pressure to such people. As a personal trainer, I don't allow a beginner to attempt a one-rep max bench press. As a massage therapist, I am very careful working around endangerment sites and local contraindications.
After all, isn't the rule, First, do no harm?
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Gary, I love it when people have different backgrounds that add to their wisdom in doing this work. You may still be a massage student but you have a wealth of knowledge and understanding that will be very useful to you and your clients.
I agree that sometimes people are masochistic. That is what I was dancing around a little earlier, trying not to come out and say it. So thanks! I don't know what my issue was with holding back on that...oh well!
I just got back from one of the best massages I've ever had. I tried a different MT here in my town and it was exactly what I hoped for. She used a lot of pressure but no force, never took me over my pain threshold...just what we've been talking about! I will definitely be going back! So I'm loopy, out of it, happy, feel more like myself...and I have a client in 30 minutes! So I'm going to pull myself together... :)
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Permalink Reply by Jeanne Riley on
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more 2 cents ....
I don't think you are ever going to find a definitive answer to this one because really we are all human and complicated and in a different place each and every day. There are so many factors that contribute to our pain level. Are we overtired one day and not the next? Have we been eating nutriciously or binging on junk food? Are we dehydrated or well hydrated? Has our imune system been overworking fighting off something that we are perhaps not even aware of? Have we been actively moving our bodies or sitting long days at a desk. What is going on with our stress level? Have we been breathing fully or holding our breath and stress level with it. Do we take care of ourself and get bodywork on a regular basis or just stop in when we are at a breaking point and a few tylenol are no longer taking care of what is bothing us.
Pain is our bodies way of telling us that there is an issue we need to work on or correct. It's not necessarily a bad thing and it is a different thing for each an every person we work with. So, while it is possible your work with some people went too far for them and created pain (doesn't sound like it), it is also possible that some of these people had perhaps long term areas of tension that needed work and you helped to increase their awareness of an issue that they have been ignoring for too long.
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Hey Gang. just reading some of your replies. Has anyone thought that if it is painful in that area or spot that there is a problem there. Not necessarily a muscle problem but a lack of general mobility or maybe this area is compenating for a problem elsewhere in the body ( especially if you are always having to work on the same trigger point ). Massage is not suppose to hurt. You should be able to massage someone either deep or superficial and there should be no pain, that is if there are no problems with general mobility of the structure, pain means lack of mobility. Your structure governs how your muscles function. Creating a headache in someone means you have stirred up some problems and that persons body had to compensate for what you have done therefore creating more strain at the C0- C1 area voila headache. Mobility, Mobility, Mobility. So deep tissue doesn`t mean more pressure it means the tissue will allow you in to get deeper so go slow, sometimes it`s a waiting game. Also when you find a trigger point, you need to ask yourself what has created this trigger point, there`s a reason why it has appeared.
Cheers
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Permalink Reply by Tom Martin on
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Good question and good answers. I'm learing a lot. These forums are the most productive form of procrastination I've ever discovered.
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Tom, LOL. I must say, I am soooooooo happy I found this forum! I went through a major withdrawal when I went out on my own. I have reconnected with one other student from my class, but I needed more. I have been looking for something like this for over 6 months now and the other forums I discovered were totally sketchy!
Thank you ALL for all of your insight - I truly, truly appreciate it and so many of you brought up SO many good points.
The timing is funny - I have a client who has been coming to me every 3-4 weeks for over 6 months now, and yesterday when he came in he said he was sore for FOUR days after his previous massage. Obviously, I felt horrible that he was sore for that long, even though he often "guides" me as to what he needs during the massage. (This is an absolute extreme situation in its entirety, too, because he was in a horrible accident years ago and, without bodywork, can barely move).
However, I had a new client today and, even though she told me she really likes DT, she also informed me that she is getting married this weekend so I definitely took it easier on her than I would have in the past. I am totally utilizing so much of your feedback and will let you all know if I come up with some new "theory"!
PS - the difference between pressure and force - HUGE. My MT will sometimes just use so much FORCE that it drives me crazy!
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Oh that is so true!!
Tom Martin said:
Good question and good answers. I'm learing a lot. These forums are the most productive form of procrastination I've ever discovered.
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Permalink Reply by Gordon J. Wallis on
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Gary, that's my rule.. You stole it from me I think? I will have to call the massage police now.
Gary W Addis said:
Admittedly, I am no expert. In fact, I am still a student. But an eager one. Not attempting to lecture you pros, just adding my observations.
During a decade of competitive bodybuilding and 20 years as a personal trainer, I learned that there are two distinctly different kinds of pain. There is the achy kind of pain called soreness (either localized or widespread over an entire area); then there is the sharp "right here!" pain of an injury site. Massaging soreness (TP, DT) feels good to a client...it's the kind of massage that elicits the moan "It hurts soooo good." BTW, have others noticed that this soreness feels very much like exercise-induced soreness? What does that suggest to you? To me, it suggests that the soreness is a good thing, for soreness results because more nutrient-rich blood has settled into the tissue, aiding recovery. But digging hard into a genuinely painful point creates muscle guarding in the primary and several antagonist muscles.
Initially upon finding a painful TP (as opposed to sore) I dig in, but only for a couple of seconds, gradually decreasing the pressure and spreading the pressure to surrounding tissue.. Spreading the pressure...keeping blood from pooling in a small area which might create prolonged painful-as opposed-to-mild post- massage soreness.
One final thought. I'm sure y'all have all had a client who insists that you apply jackhammer pressure directly over a bone. Some of these people are perhaps ... masochistic. Sorry, I don't do torture. I apply what I feel is appropriate pressure to such people. As a personal trainer, I don't allow a beginner to attempt a one-rep max bench press. As a massage therapist, I am very careful working around endangerment sites and local contraindications.
After all, isn't the rule, First, do no harm?
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