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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 Therese Schwartz on
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Gary, never apologize for sharing information!!
To be honest, I'm embarrassed to admit that I did read the "Knot in a Muscle" thread, and was fascinated at the time with Gordon's explanation. All I can say is, I forgot about it! Trying to cram too much new info into my head all at once I guess! Gordon, thanks for the reminder. Stephen, thanks for the copy/paste.
Gary, I've been seeing the same thing you are about lactic acid.
Wisdom and knowledge are not synonymous! Knowledge is great, understanding is better but wisdom is knowing what to do with the knowledge and the understanding! :)
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Permalink Reply by Gary W Addis, LMT on
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What I'm referring to are sometimes small, kinda like a bubble; other times there's a long strand (or an entire muscle, such as vastus medialis), that acts as if it wants to roll out of the way. The latter I'm assuming was due to my speed of DT and possibly trying to force the muscle out of its normal groove. Understand what I'm trying to say? Haven't had that happen since the early days of my DT class last quarter, when we were all tending to move too fast. The bubble thing? they are like bubbles, in that they sometimes pop when compressed. But, sometimes, they slink away from the pressure. Now, I'm not talking killer pressure. When that happens I've learned to spread my work the length of the muscle, and return to the spot several times if necessary; sometimes, they won't dissolve.
Back to my original question. Davies' textbook refers to knots as TP, but these knots are not usually painful. Fernandez's textbook for the same NMT class says that TPs and knots are dissimilar, that TPs may exist adjacent to a knot, but the knot itself is not a TP. In my limited experience, the latter seems to be true.
MG, I will research gaston technique. Thanks.
Massage Gnome said:Gary,
Adhesions will not roll when you apply pressure. An adhesion is formed when the skin and the fascia of the muscle bond together much like scar tissue and feels like ripples under the skin, as if there is a honeycomb embedded under it forming immobile tissue. It takes a completely different technique to release and can often be painful. Trigger point technique will not release an adhesion. Myofascial release, Cupping therapy is very helpful tho or a technique called graston which is often done by a chiropractor but can be learned by an MT as well. If there is a cyst you should not engage it with TP or DT work as it will only irritate the area. These must be surgically removed by an MD. If the rolling area is a thin and long like a rubber band most likely you are seeing either a tendon or if it is thicker then it is a muscle that the fascia has constricted compressing the muscle itself.
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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Grin. Thank you.
Therese Schwartz said:
Gary, never apologize for sharing information!!
To be honest, I'm embarrassed to admit that I did read the "Knot in a Muscle" thread, and was fascinated at the time with Gordon's explanation. All I can say is, I forgot about it! Trying to cram too much new info into my head all at once I guess! Gordon, thanks for the reminder. Stephen, thanks for the copy/paste.
Gary, I've been seeing the same thing you are about lactic acid.
Wisdom and knowledge are not synonymous! Knowledge is great, understanding is better but wisdom is knowing what to do with the knowledge and the understanding! :)
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Massage Gnome, Gosh, my face is red! I just reread your post (below) and finally note that you did not call calcium a toxin! I sincerely apologize for my error and big mouth. However...
I read somewhere the other day that calcium can deposit inside muscle, in effect building a bone that is unconnected to bone or other muscle. Sometimes it must be surgically removed, sometimes MT is used to break it up, and if it is small and doesn't grow larger, it is left alone. So, in that case I guess calcium would be a toxin? Heck, thinking about it, even water can be a toxin, can't it.
Again, I apologize to you, Massage Gnome.
Massage Gnome said:
These are the two textbooks that we had at school. We had a 6 month course total to learn massage and spa modalities. I still have my books and I think that you will find that it has the info you are looking for. The only difference is that it refers to the buildup causing the TP as waste products or toxins instead of calcium. Tho, I fail to see why it makes a difference what you refer to being inside the muscle since the treatment would remain the same. I have not read any of the titles you have mentioned and have not heard of them, tho I have read many others. Hope this helps. If not you can also look in Wikipedia for the same information.
Mosby's Essential Sciences for Therapeutic Massage : Anatomy, Physi...
Mosby's Fundamentals of Therapeutic Massage, by Fritz, Enhanced 3rd Edition 3
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Permalink Reply by Gordon J. Wallis on
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The treatment may be the same.. But you want to explain the information to your client. Well I do anyway. And in 26 years I have not met one client that could tell me what a knot in a muscle is... And tons of em have had trigger point therapy of some sorts....It really helps the healing process when you explain reality to your clients. Ive done thousands of massages...And the information might be there.. But its not used. Man Im healing and helping at a much higher frequency then even a year ago.. Learning never stops... But Ive learned more about massage by reading non massage or bodywork books... Then you can figure stuff out. Well that helps me. Again Im not telling anyone what to do... Im just telling you what I do.. Truth has changed for me several times in my bodywork career ...Hope it changes again..Then I will be even more able to help people. hmmmm
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Gary just so you know..I don't pay attention to any of that stuff ? And whatever it is...I'm starting to call them sore spots now. Find them and then eliminate them... If, you are doing that kind of work. If it hurts good to the client...You are healing them...Or it wouldn't feel good to them.. Nothing else matters to me.
Gary W Addis said:
What I'm referring to are sometimes small, kinda like a bubble; other times there's a long strand (or an entire muscle, such as vastus medialis), that acts as if it wants to roll out of the way. The latter I'm assuming was due to my speed of DT and possibly trying to force the muscle out of its normal groove. Understand what I'm trying to say? Haven't had that happen since the early days of my DT class last quarter, when we were all tending to move too fast. The bubble thing? they are like bubbles, in that they sometimes pop when compressed. But, sometimes, they slink away from the pressure. Now, I'm not talking killer pressure. When that happens I've learned to spread my work the length of the muscle, and return to the spot several times if necessary; sometimes, they won't dissolve.
Back to my original question. Davies' textbook refers to knots as TP, but these knots are not usually painful. Fernandez's textbook for the same NMT class says that TPs and knots are dissimilar, that TPs may exist adjacent to a knot, but the knot itself is not a TP. In my limited experience, the latter seems to be true.
MG, I will research gaston technique. Thanks.
Massage Gnome said:Gary,
Adhesions will not roll when you apply pressure. An adhesion is formed when the skin and the fascia of the muscle bond together much like scar tissue and feels like ripples under the skin, as if there is a honeycomb embedded under it forming immobile tissue. It takes a completely different technique to release and can often be painful. Trigger point technique will not release an adhesion. Myofascial release, Cupping therapy is very helpful tho or a technique called graston which is often done by a chiropractor but can be learned by an MT as well. If there is a cyst you should not engage it with TP or DT work as it will only irritate the area. These must be surgically removed by an MD. If the rolling area is a thin and long like a rubber band most likely you are seeing either a tendon or if it is thicker then it is a muscle that the fascia has constricted compressing the muscle itself.
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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I comprehend what you're saying. The labels ain't important. But how to work the different things is everything, right? I know, I'm trying to absorb the decades of knowledge that are by now in your DNA--in your muscle memory, something you don't have to think about while you do it. Like you said, all that's important is that it works. But I don't want to be trying to release something that shouldn't be messed with. In one of the ABMP webinars someone remarked that if it is released over and over and keeps returning, maybe it's supposed to be there. So much to learn. Luckily, I don't consider learning a chore. Your help and encouragement are appreciated, my friend Gordon.
Gordon J. Wallis said:
The treatment may be the same.. But you want to explain the information to your client. Well I do anyway. And in 26 years I have not met one client that could tell me what a knot in a muscle is... And tons of em have had trigger point therapy of some sorts....It really helps the healing process when you explain reality to your clients. Ive done thousands of massages...And the information might be there.. But its not used. Man Im healing and helping at a much higher frequency then even a year ago.. Learning never stops... But Ive learned more about massage by reading non massage or bodywork books... Then you can figure stuff out. Well that helps me. Again Im not telling anyone what to do... Im just telling you what I do.. Truth has changed for me several times in my bodywork career ...Hope it changes again..Then I will be even more able to help people. hmmmm
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If you find a sore spot. And you can work it in a way that hurts good to your client.. You are healing them. If it feels horrible and painful...You are not healing them. You are worried about releasing something that shouldn't be released?..If its a sore spot in a muscle, it needs released... And as long as it hurts good to your client..You are not hurting them. With the possible exception of working the area too long. Then you will have that post massage soreness issue.
Gary W Addis said:
I comprehend what you're saying. The labels ain't important. But how to work the different things is everything, right? I know, I'm trying to absorb the decades of knowledge that are by now in your DNA--in your muscle memory, something you don't have to think about while you do it. Like you said, all that's important is that it works. But I don't want to be trying to release something that shouldn't be messed with. In one of the ABMP webinars someone remarked that if it is released over and over and keeps returning, maybe it's supposed to be there. So much to learn. Luckily, I don't consider learning a chore. Your help and encouragement are appreciated, my friend Gordon.
Gordon J. Wallis said:
The treatment may be the same.. But you want to explain the information to your client. Well I do anyway. And in 26 years I have not met one client that could tell me what a knot in a muscle is... And tons of em have had trigger point therapy of some sorts....It really helps the healing process when you explain reality to your clients. Ive done thousands of massages...And the information might be there.. But its not used. Man Im healing and helping at a much higher frequency then even a year ago.. Learning never stops... But Ive learned more about massage by reading non massage or bodywork books... Then you can figure stuff out. Well that helps me. Again Im not telling anyone what to do... Im just telling you what I do.. Truth has changed for me several times in my bodywork career ...Hope it changes again..Then I will be even more able to help people. hmmmm
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Permalink Reply by Boris Prilutsky on
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Hi Gordon.
Couldn't find term" muscle knots" at Travell's texts.will appreciate if you will refer to page.thanks.
Boris
Gordon J. Wallis said:I hope it is in a text book...Ive never seen it in a text book. Well not a massage book.. Travells Myofacial Pain and Dysfunction is where I got that or figured it out from back in the eighties. I have asked many many therapists if they can tell me what a knot in a muscle is....Im talking hundreds of therapists.. Probably weakly sense 1986.. lol They dont know this.. So , I hope it is in a text book...Trigger Points are crucial to understand, if you want to be a massage therapist..Crucial.
Massage Gnome said:
Hi Gordon,
You mention that this is not taught in schools but it is in all the textbooks I have seen. Was this not in yours?
Gary W Addis said:Gordon, that is an absolutely eloquent explanation, an actual explanation of what causes the damage--thank you.
Stephen Jeffrey said: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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I believe that this discussion, including article on the subject will offer additional support to this discussion but not limited to vigorous pressure.
http://www.massageprofessionals.com/forum/topics/response-to-knot-i...
thanks.
Massage Gnome said:These are the two textbooks that we had at school. We had a 6 month course total to learn massage and spa modalities. I still have my books and I think that you will find that it has the info you are looking for. The only difference is that it refers to the buildup causing the TP as waste products or toxins instead of calcium. Tho, I fail to see why it makes a difference what you refer to being inside the muscle since the treatment would remain the same. I have not read any of the titles you have mentioned and have not heard of them, tho I have read many others. Hope this helps. If not you can also look in Wikipedia for the same information.
Mosby's Essential Sciences for Therapeutic Massage : Anatomy, Physi...
Mosby's Fundamentals of Therapeutic Massage, by Fritz, Enhanced 3rd Edition 3
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Permalink Reply by Massage Gnome on
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That may be true but I have found that when I explain things to a customer that explaining the concept helps them more than using tech terms. That just makes them feel frustrated like talking to a doctor. Even doctors have changed the way they explain things to their patients so it is easier to understand.
Gordon J. Wallis said:
The treatment may be the same.. But you want to explain the information to your client. Well I do anyway. And in 26 years I have not met one client that could tell me what a knot in a muscle is... And tons of em have had trigger point therapy of some sorts....It really helps the healing process when you explain reality to your clients. Ive done thousands of massages...And the information might be there.. But its not used. Man Im healing and helping at a much higher frequency then even a year ago.. Learning never stops... But Ive learned more about massage by reading non massage or bodywork books... Then you can figure stuff out. Well that helps me. Again Im not telling anyone what to do... Im just telling you what I do.. Truth has changed for me several times in my bodywork career ...Hope it changes again..Then I will be even more able to help people. hmmmm
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Boris, I dont have that book anymore...I read it when it first came out like five times...I formed my entire massage around the information in that book. The information is in there somewhere. The entire book is about muscle knots (trigger points).
Boris Prilutsky said:
Hi Gordon.
Couldn't find term" muscle knots" at Travell's texts.will appreciate if you will refer to page.thanks.
Boris
Gordon J. Wallis said:I hope it is in a text book...Ive never seen it in a text book. Well not a massage book.. Travells Myofacial Pain and Dysfunction is where I got that or figured it out from back in the eighties. I have asked many many therapists if they can tell me what a knot in a muscle is....Im talking hundreds of therapists.. Probably weakly sense 1986.. lol They dont know this.. So , I hope it is in a text book...Trigger Points are crucial to understand, if you want to be a massage therapist..Crucial.
Massage Gnome said:Hi Gordon,
You mention that this is not taught in schools but it is in all the textbooks I have seen. Was this not in yours?
Gary W Addis said:Gordon, that is an absolutely eloquent explanation, an actual explanation of what causes the damage--thank you.
Stephen Jeffrey said: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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