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I'm just starting my career as a massage therapist and I seem to be getting a lot of clients who want deeper pressure than I feel I can give. I often feel like I'm giving as much pressure as my body can take and even that starts hurting my hands and arms. I was wondering if anybody else had these issues when first starting out? I know I can use my elbow and forearm, etc but it is often on their neck that they want more pressure so I'm not able to use my elbow.

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Amanda, yeah, we all catch clients who have been conditioned to believe if it ain't painful, it ain't therapeutically beneficial-- and the more painful the treatment the more beneficial the effect.  As you learned in school and in your experience, that is not true.  But, okay, the client is boss: if they demand killer pressure, you have to give it, or someone else will.

Have you studied Deep Tissue Massage or, better, NMT (Neuromuscular Therapy)?  Both techniques employ forearm sweeps... letting your bodyweight apply the pressure.  You can sweep caudal or cephalic with forearm.  Oh, you'll still have to apply some muscle strength as well as your bodyweight to the stroking-- but when treating a client that expects deep tissue work, using forearm and weight is surely easier on your own body.

Work slowly when you're going deep into the tissue-- for if you work too quickly you can cause unnecessary soreness in the client that will last for days.  Work slowly and check in often with the client.  A pointer: if you ask, "How's the pressure?", the answer you'll most often get will be a muttered, OK.  Instead, ask, "Would you like more pressure, or do you prefer less pressure?"

Too bad that so many have been conditioned to the hard pressure, even when they come in just to relax.  Light stroking and gentle kneading of any tight areas feels great to a client-- it soothes the nerves and relaxes the mind.  But... the client has the right to choose.

Amanda, this is a challenging profession on several levels. The average career span for a massage therapist is something like five to seven years. Wear and tear on the body being one of the main reasons. You will get stronger, and learn to work wiser in time. But what ever you do, don't hurt yourself just to please a client. I've done that..and it cost me way more money then loosing one client. Do a lot of stretching. Try to strengthen your hands and body without causing further damage or stress. Increase your protein intake. Also, you can't please everyone. Eventually in time the clients that like your work will come to you. The ones that don't won't. I'm an expert. Been doing this for thirty years. I still get clients that won't come back to see me because I can't give enough preasure, or it's not the kind of massage they like. Trust me. Don't hurt yourself to please a client.

I certainly did!  Less than 2 years in (I'm at 8 years now) I thought I would have to quit because of the pain in my hands.  I still have some of that occasionally but I have a much heavier client load and sometimes have to get specific with my hands and fingers.

Get the DVD "The Forearm Dance" by Val Guin - it saved my career!  As did starting to use bamboo sticks from Bamboo Fusion.

I don't understand why people would want deeper pressure on their necks!  It does damage to very sensitive tissue that is highly innervated.

There are a few ways to achieve optimal pressure for the client; one way is to slowly sink into the tissue until you feel the resistance in the tissue.  Add just a few grams of pressure at that point and it will be optimal for working with that area of the body.  This could be right at the surface, or very deep, it depends on what is happening in the tissues.

Well said, Therese.

Therese Schwartz said:

I certainly did!  Less than 2 years in (I'm at 8 years now) I thought I would have to quit because of the pain in my hands.  I still have some of that occasionally but I have a much heavier client load and sometimes have to get specific with my hands and fingers.

Get the DVD "The Forearm Dance" by Val Guin - it saved my career!  As did starting to use bamboo sticks from Bamboo Fusion.

I don't understand why people would want deeper pressure on their necks!  It does damage to very sensitive tissue that is highly innervated.

There are a few ways to achieve optimal pressure for the client; one way is to slowly sink into the tissue until you feel the resistance in the tissue.  Add just a few grams of pressure at that point and it will be optimal for working with that area of the body.  This could be right at the surface, or very deep, it depends on what is happening in the tissues.

Thank you, Gary!!

Gary W Addis, LMT said:

Well said, Therese.

Therese Schwartz said:

I certainly did!  Less than 2 years in (I'm at 8 years now) I thought I would have to quit because of the pain in my hands.  I still have some of that occasionally but I have a much heavier client load and sometimes have to get specific with my hands and fingers.

Get the DVD "The Forearm Dance" by Val Guin - it saved my career!  As did starting to use bamboo sticks from Bamboo Fusion.

I don't understand why people would want deeper pressure on their necks!  It does damage to very sensitive tissue that is highly innervated.

There are a few ways to achieve optimal pressure for the client; one way is to slowly sink into the tissue until you feel the resistance in the tissue.  Add just a few grams of pressure at that point and it will be optimal for working with that area of the body.  This could be right at the surface, or very deep, it depends on what is happening in the tissues.

At the spa where I work there is an additional fee for deep tissue. A lot of the clients, nearly all of them, that request deep tissue massage simply want a good massage as opposed to one that is too soft. And a lot of massage therapists think they need to press harder. And indeed, I hear some therapists on occation complain that they have an 80 minute deep tissue massage as opposed to an 80 minute none deep tissue massage. Implying that it's a lot more work.. To me deep tissue massage means working more specifically as opposed to using more pressure. I rarely charge for deep tissue because if they don't ask for a deep tissue massage I'm not going to press less firmly on purpose.

Try lowering the table slightly if needed, and I incorporate hot stones to help aid getting rid of toxins in the muscles. Also check your body mechanics. It's all in leverage. If you're having pain in your hands or sweating, your probably working too hard and may need to adjust your body mechanics so you make more effective use of the tools you have.

Brian, hey.  Yep, lowering the table one hole will enable you to lay your bodyweight rather than muscle power into the tissue.  Now, I'm certainly not disagreeing with Gordon.  Deep tissue isn't bone massaging, as so many DT specialists do...causes bruising deep, which can remain sore for a week or more-- and BTW, cause the development of trigger points.  The vast majority of our clients will have at least one trigger point at the start of the session.  Even the AMA admits that an estimated 85% of all pain originates in myofascial tissue.  And what causes pain in myofascial?  Well, there's nerve entrapment by a muscle or severe muscle strain and, seldom, tendon or ligament tears.  Overwhelmingly, however, if a client is experiencing pain on movement, one or more trigger points exist in agonist and / or antagonist muscles that move that limb.

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