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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?
Views: 44188
Replies to This Discussion
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Permalink Reply by Joan Cole on
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Think too much? I disagree... with great power comes great responsibility. It is possible to create change in a client's body doing this type of work. To increase the possibility that the change is for GOOD and not ILL, it is best not to go just releasing everything willy nilly but to have a plan that considers the structure and function and is based on your best understanding of what the problem is that led to the pain that brought them in your door. Order of operations is important.
If you don't want to put the work into learning at this level, it is best to stay with massage modalities that have different aims than changing the structure or fascial balance of a body. Aims such as circulation enhancement or stress management are quite unlikely to do harm and require less anatomical knowledge and precision.
Gordon J. Wallis said:OMG you guys think to much???
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Permalink Reply by Massage Gnome on
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I am confused, how do we think too much? I don't know about Joan but I don't think overly about it when it's happening. It's just what you know and your mind does when you are working. Sometimes tho you do need to think things through. If you have worked on a problem a couple of times and the customer is not responding to the therapy, would you think about it or just do what you have been doing? Massage Therapy in my opinion is not a mindless passing of an hour. I help a lot of people get rid of pain and get long term results from their massage. If you are doing DT work then thought should be in the process without fail. If you do only relaxation massage then by all means...
Gordon J. Wallis said:
OMG you guys think to much???
Massage Gnome said:
That is how I do my massage as well. I want to come have one from you just from reading your statement. LOL
Joan Cole said:
1) It's not just about whether the pressure was too much. Sometimes it's that your strategy isn't right. Very often, the actual problem isn't where the pain is. The pain is an arrow, but the problem is somewhere else, and THAT'S what needs to be released. Don't go trying to lengthen tissue that is in crisis because it is already overstretched. Lengthen the tissue on the other side of the chain that is CAUSING the painful tissue to be overstretched. It's like chess - you need to be reasoning several moves ahead.
2) Compression isn't the only game. Often the tissue needs decompression, torsion, shear or needs to be approached from a more oblique angle than what you are attempting.
3) Don't spend too much time in one place, as that DOES tend to traumatize. If it isn't releasing, hammering on isn't going to make it release. There may be something wrong with how you have the client positioned. For instance, they may need to be sidelying for you to successfully position an extremity to release that spot, and trying to do it with them prone isn't going to get you anywhere. Your angle may be wrong. Your depth may be wrong. Try searching in a shallower layer. You may be working on the wrong spot. You may not be relaxed in your own body. Stop and reconsider. Release something elsewhere in the chain and come back after taking a break.
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Permalink Reply by Jacqui Evans on
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In my experience you are also releasing old traumas and emotional blockages that are stored on a cellular level, whether you or the client realises it or not. I get my clients to breathe into there pain and give there body permission to release these emotional blockages, this sometimes helps in the minimization of pain and discomfort felt in the proceeding 72 hours. How ever some people are less willing to release these blockages and i feel suffer more pain as a result after there treatments.
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Permalink Reply by Gary W Addis, LMT on
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During tonight's (school) clinic I discovered what felt like an adhesion in a client's anterior scalene, down by the clavicle. Since it wasn't painful, and wasn't referring pain anywhere, I left it alone, rather than wake up an inactive TP . I did release other TPs, however. The client was more than satisfied with the massage. Another client had what my instructor called a locus in vicinity of posterior iliac--it was maybe dime sized, round and mobile when pressure applied, but not painful at all. It too was left alone. Don't create problem where none exists, I was told, and that makes sense to me. Opinion?
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Permalink Reply by Therese Schwartz on
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Jacqui, I really agree with you! Massage is fantastic for releasing traumas and emotion. I also do SomatoEmotional Release with people (CranioSacral therapy on steroids!) where we very deliberately release emotions through dialoging with the tissue and the emotions themselves. Not everyone is up for that, which is fine. I agree with you that when people are less willing to allow the release they feel more pain; at the very least they don't get the full benefit of the massage. I also feel that it is up to them to release when they are ready and not up to me to "force" the release.
Gordon, I think a LOT while I'm working on people. I've only been doing this for 3 years though, so it's not all down to an intuitive level yet. I think about clients in between sessions, and have come up with some really good ways to get better results for people. It's really interesting for me to think about things and gain understanding. I am fascinated by how people work, and how to get them "back to good".
Gary, someone somewhere on this monster thread said "First, do no harm". I think you followed that perfectly tonight! With the anterior scalene, I might just focus some energy on it and offer it the intention of doing what it needs to with that energy without necessarily "working" the area. That is also maybe a good candidate for Myofascial Release rather than massage.
Not sure what a "locus" is.
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Me neither. I looked up locus, and found a bunch of stuff, nothing related to tissues. Instructor wasn't sure of the terminology either, but he seemed to know what he was talkign about. When I called him to the client, my instructor first lightly palpated the whatever, then worked deeply in all areas around it, questioning about the presence of any tenderness. With negative reply from the client, the NMT/MFR specialist moved the questionable tissue some more, he instructed me to leave it be. It is quite mobile, and does not extrude higher than the skin, it is smaller than a dime, and feels round, top to bottom, like a cyst beneath the dermis. I wouldn't say that it was actually within the QL, more likely sitting above it or between its fibers' strands.
I've just started the NMT/MFT class, but we learned to thumb/elbow compress TPs last quarter in DT--which didn't always work with even a ton of pressure applied. Relatively light pressure combined with deep friction of area in direction of the tissue is much faster, and easier on both client and therapist. Gawd! I love learning this stuff!
Thanks to all for the input.
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Permalink Reply by Stephen Jeffrey on
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Hi Gary
yes isn't fantastic learning about the human body whilst learning theraputic affect.:)
The cyst may have been a lipoma (benign fatty tissue).
Great that you now understand a ton of pressure only makes for a tightening reaction in the tissue's. Now you can go on to engage the center (bull's eye) of the trigger point, increase the pressure in miniscule amounts, and then follow the melt.
This skill is one of the most effective techniques you can learn (and it takes time to learn) because when you start out the inclination is to rush and possibly bruise the client.
Re latent/inactive triggerpoints, further on in your career you may find these points of invaluable use in "turning off" the most noxoius of active triggerpoints. I treat these points First as often they are feeding the noxoius potential of the active point and consiquently make turnng off the "main/most active" point easy, and much much less likely to re form at later date.Because this all takes time in preparation and delivery we as massage therapists can deliver the client's the best outcome.:)
Gary W Addis said:Me neither. I looked up locus, and found a bunch of stuff, nothing related to tissues. Instructor wasn't sure of the terminology either, but he seemed to know what he was talkign about. When I called him to the client, my instructor first lightly palpated the whatever, then worked deeply in all areas around it, questioning about the presence of any tenderness. With negative reply from the client, the NMT/MFR specialist moved the questionable tissue some more, he instructed me to leave it be. It is quite mobile, and does not extrude higher than the skin, it is smaller than a dime, and feels round, top to bottom, like a cyst beneath the dermis. I wouldn't say that it was actually within the QL, more likely sitting above it or between its fibers' strands.
I've just started the NMT/MFT class, but we learned to thumb/elbow compress TPs last quarter in DT--which didn't always work with even a ton of pressure applied. Relatively light pressure combined with deep friction of area in direction of the tissue is much faster, and easier on both client and therapist. Gawd! I love learning this stuff!
Thanks to all for the input.
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My instructor said he didn't think it was lipoma, but that makes as much sense as a locus--whatever that is. I had one of those on my glutes, years aback. Dr cut it out...looked like feta cheese.
Surprising to me that the trigger points on one client melt as soon as you glance at it; on another, they require long minutes of work Perhaps you can help me straighten something out in my mind. Fernandez says in Deep Tissue Massage Treatment that knots are not TPs (although they are often bordered by trigger points); in Trigger Point Therapy Workbook, Davies repeatedly refers to TPs as knots. Then there's the...knot, for lack of better word, that rolls away from pressure. My understanding, that those are adhesions. If not, I'm not sure that I understand yet how to identify adhesion. Sometimes those "knots" are small, sometimes they are long and sinuous like a snake. Classroom is always so busy, the instructor on a schedule or distracted by seemingly hundreds of questions. Help?
Stephen Jeffrey said:
Hi Gary
yes isn't fantastic learning about the human body whilst learning theraputic affect.:)
The cyst may have been a lipoma (benign fatty tissue).
Great that you now understand a ton of pressure only makes for a tightening reaction in the tissue's. Now you can go on to engage the center (bull's eye) of the trigger point, increase the pressure in miniscule amounts, and then follow the melt.
This skill is one of the most effective techniques you can learn (and it takes time to learn) because when you start out the inclination is to rush and possibly bruise the client.
Re latent/inactive triggerpoints, further on in your career you may find these points of invaluable use in "turning off" the most noxoius of active triggerpoints. I treat these points First as often they are feeding the noxoius potential of the active point and consiquently make turnng off the "main/most active" point easy, and much much less likely to re form at later date.Because this all takes time in preparation and delivery we as massage therapists can deliver the client's the best outcome.:)
Gary W Addis said:Me neither. I looked up locus, and found a bunch of stuff, nothing related to tissues. Instructor wasn't sure of the terminology either, but he seemed to know what he was talkign about. When I called him to the client, my instructor first lightly palpated the whatever, then worked deeply in all areas around it, questioning about the presence of any tenderness. With negative reply from the client, the NMT/MFR specialist moved the questionable tissue some more, he instructed me to leave it be. It is quite mobile, and does not extrude higher than the skin, it is smaller than a dime, and feels round, top to bottom, like a cyst beneath the dermis. I wouldn't say that it was actually within the QL, more likely sitting above it or between its fibers' strands.
I've just started the NMT/MFT class, but we learned to thumb/elbow compress TPs last quarter in DT--which didn't always work with even a ton of pressure applied. Relatively light pressure combined with deep friction of area in direction of the tissue is much faster, and easier on both client and therapist. Gawd! I love learning this stuff!
Thanks to all for the input.
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Gary, here's more info on lipomas:
http://www.healthy-massage.com/the-back-mouse/
http://www.massagetherapy.com/articles/index.php/article_id/602/The...
I know your instructor said he didn't think it was one, but this may help clarify things for you.
I've been confused about the TP, knot, adhesion thing you are asking about too. So I'm hoping someone with more experience than I have will post an answer about all that!!
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Permalink Reply by Gordon J. Wallis on
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read the thread Knot in Muscle
Therese Schwartz said:
Gary, here's more info on lipomas:
http://www.healthy-massage.com/the-back-mouse/
http://www.massagetherapy.com/articles/index.php/article_id/602/The...
I know your instructor said he didn't think it was one, but this may help clarify things for you.
I've been confused about the TP, knot, adhesion thing you are asking about too. So I'm hoping someone with more experience than I have will post an answer about all that!!
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Gordon's explaination from knot in muscle thread. =
Hmm.....How do I say this???? Well first off...I'm not trying to start any aguments in here...Or challenge anyone as to what they think.or whats real...Like my way or the highway... Im right your wrong kinda thing... But Ive been doing this kind work for 26 years now..So I think what I say should at least be considered. That's all... Not saying that I might not change my mind later?...And Jody Hutchenson gave a really interesting answer, that made sense...But I came up with something comletely different?? I think they are both true.. And I will try to integrate Jody's definition, in with mine.. Does that make sense? Anyway .. Hardly any massage school teaches what a knot in a muscle is, from what I can tell?? And I find that very very interesting.. Because when you consider that 85% of all pain is caused directly from trigger points( knots ) in muscles, and that trigger points are involved in 95% of all pain syndromes...Seems important to know? If you ask me?? Anyway..........
Your muscles are made up of bundles of cells.. They are long and skinny like the hairs on your head. Wrapped around each muscle cell is an organelle called a Sarcoplasmic Recticulum. One of the things the sarcoplasmic recticulum does is to control calcium flow within the cell...So when there is an electrical signal from the brain for the muscle cell to contract. The sarcoplasmic recticulum exudes calcium from its membrane, and that calcium mixes with a protein in the cell called myosin. That starts a chain reaction, and then the muscle cell( fiber ) contracts...Then when there is an electrical signal from the brain for the muscle cell to relax or lengthen ... The sarcoplasmic recticulum reobsorbs the calcium , seperating it from the myosin, and the muscle fiber relaxes.
Now do to stress. And stress is a big word( Emotional Tension,Repetitive movements, a blow from an accident, sudden movement ,or whatever) the sarcoplasmic recticulum can rupture or beak...And when it breaks, the calcium just leaks out,and mixes with the myosin thats present in the area.. So whatever muscle fibers run through that mxsture, they Contract. And thats your Knot.. An area of contracted muscle fibers within a relaxed muscle..
Anyway, when you find a Knot, Trigger Point, Sore Spot or whatever you wanna call it...When you press on it, you are pushing that calcium myosin mixture out of the area.. Back into the venous system. Then the muscle fibers can open up and lengthen..Now the cellular damage is still there. But now the fresh blood can get in and repair the damage(broken sarcoplasmic recticulum ) .. That's why trigger points tend to linger ,until they get stretched out or pressed out . The capillary flow is cut off... So that's what I figured out about massage as it pertains to do with knots in muscles..... But I don't hear that being taught in schools schools? Not sure what that means? .Considering that 85% of all pain is directly caused from knots in muscles.. And that's why I thought your answer was not correct. But not saying I know everything.. Cause I know I don't - Gordon.
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Hi Gary,
good area's to palpate as example's of differences of densifications .............or call them what you like.
Fibrosis with embedded myogelosis. Upper thoracic ES between shoulder blades.
Palpates as rock hard groups of individual fibers that grate/crunch against one another (calcification). Reversal of fibrosis is possible, but myogelosis will remain (rock hard dead "nucleous" in the center of worst sections of fibrosis )
Fibrosis in almost, the full length of lateral fibers of QL = responds well to cross fiber then "ishemic compresson"
Palpates as guitar string "twang" .
Adhesions Medial knee ligament and tendon attachments, where they cross the joint to become the pes anserinus area,
Palpate as gum like thickening that interfere with the propioception potential and golgi organs hindering biomechanical function of the whole knee joint. Responds well to crossfiber and inline friction technique's. Yes a little painfull but very effective:)
These are just a few examples of where the different densifications = TP's fibrosis, myogelosis, adhesions ect are most likely to be found.
Gary W Addis said:My instructor said he didn't think it was lipoma, but that makes as much sense as a locus--whatever that is. I had one of those on my glutes, years aback. Dr cut it out...looked like feta cheese.
Surprising to me that the trigger points on one client melt as soon as you glance at it; on another, they require long minutes of work Perhaps you can help me straighten something out in my mind. Fernandez says in Deep Tissue Massage Treatment that knots are not TPs (although they are often bordered by trigger points); in Trigger Point Therapy Workbook, Davies repeatedly refers to TPs as knots. Then there's the...knot, for lack of better word, that rolls away from pressure. My understanding, that those are adhesions. If not, I'm not sure that I understand yet how to identify adhesion. Sometimes those "knots" are small, sometimes they are long and sinuous like a snake. Classroom is always so busy, the instructor on a schedule or distracted by seemingly hundreds of questions. Help?
Stephen Jeffrey said:
Hi Gary
yes isn't fantastic learning about the human body whilst learning theraputic affect.:)
The cyst may have been a lipoma (benign fatty tissue).
Great that you now understand a ton of pressure only makes for a tightening reaction in the tissue's. Now you can go on to engage the center (bull's eye) of the trigger point, increase the pressure in miniscule amounts, and then follow the melt.
This skill is one of the most effective techniques you can learn (and it takes time to learn) because when you start out the inclination is to rush and possibly bruise the client.
Re latent/inactive triggerpoints, further on in your career you may find these points of invaluable use in "turning off" the most noxoius of active triggerpoints. I treat these points First as often they are feeding the noxoius potential of the active point and consiquently make turnng off the "main/most active" point easy, and much much less likely to re form at later date.Because this all takes time in preparation and delivery we as massage therapists can deliver the client's the best outcome.:)
Gary W Addis said:Me neither. I looked up locus, and found a bunch of stuff, nothing related to tissues. Instructor wasn't sure of the terminology either, but he seemed to know what he was talkign about. When I called him to the client, my instructor first lightly palpated the whatever, then worked deeply in all areas around it, questioning about the presence of any tenderness. With negative reply from the client, the NMT/MFR specialist moved the questionable tissue some more, he instructed me to leave it be. It is quite mobile, and does not extrude higher than the skin, it is smaller than a dime, and feels round, top to bottom, like a cyst beneath the dermis. I wouldn't say that it was actually within the QL, more likely sitting above it or between its fibers' strands.
I've just started the NMT/MFT class, but we learned to thumb/elbow compress TPs last quarter in DT--which didn't always work with even a ton of pressure applied. Relatively light pressure combined with deep friction of area in direction of the tissue is much faster, and easier on both client and therapist. Gawd! I love learning this stuff!
Thanks to all for the input.
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