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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 Lolita Knight on
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I have yet to figure out how to follow a thread. Do I click on the name of the sender--the reply never seems to be in the same box and where I want to reply. Anyway --to follow my suggestion of offering clients choices with the idea you can't do it all in 60-90 minutes I will use an analogy. You call a plumber and tell him your kitchen sink is leaking and he gives you a quote and suggests 1 hour to fix it. When the plumber arrives you tell him the bathroom shower is not working and in trying to fix the kitchen sink the plumber discovers a problem with the sewer. As a customer you would realize the plumber can't fix it all in the quoted hour. The same with a massage session. Lolita
Gordon J. Wallis said:
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.
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Permalink Reply by Gordon J. Wallis on
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Yea the thread thing can get confusing in here I havent really figured it out myself....Its all good though...Just thread the best you can... lol
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Permalink Reply by Stephen Jeffrey on
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Hi Lolita, you are right, we can't do it all, but even before we decide how we will focus the session. specific or globall, the most important thing is to listen,.........and listen good.......most clients can tell their story in sub 15 mins, or sub 30 mins, and some take longer, specific or globall, don't be tempted to rush your client to the treatment couch, only when they have finnished telling their story are they ready for the restoration of mind and body.
Do you agree, ?
Lolita Knight said:I have yet to figure out how to follow a thread. Do I click on the name of the sender--the reply never seems to be in the same box and where I want to reply. Anyway --to follow my suggestion of offering clients choices with the idea you can't do it all in 60-90 minutes I will use an analogy. You call a plumber and tell him your kitchen sink is leaking and he gives you a quote and suggests 1 hour to fix it. When the plumber arrives you tell him the bathroom shower is not working and in trying to fix the kitchen sink the plumber discovers a problem with the sewer. As a customer you would realize the plumber can't fix it all in the quoted hour. The same with a massage session. Lolita
Gordon J. Wallis said: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.
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Permalink Reply by Therese Schwartz on
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Stephen, you are so right! I have the luxury of scheduling my clients 30 minutes apart - I work out of my house and can set my own schedule. That gives people time to tell their stories. I've had people need to pace and vent before we could even consider getting them on the table! I know not everyone has that luxury and I consider myself very fortunate.
Lolita, to make a reply to the comment you wish to, look for the little brown right-facing arrow and the word "Reply" at the bottom of each post. That will bring up a box you can type into for a specific post that someone has made. If you just want to reply to the general discussion, look for the downward facing brown arrow with "Reply to Discussion" by it. That will bring up a box and you can type in it and post without specifically replying to an existing post. Hope that helps!!
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Permalink Reply by Massage Gnome on
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Gary,
I understand the rolling muscles you are referring to and was very short on typing time earlier sorry about that. Wanted to give you the info I know about the adhesions tho. It can be a number of things. The small bubbles you are referring to, if they are not a muscle but above the muscle could be a fatty tumor or a cyst. If they are in the muscle and they pop as you say they are most likely a gas bubble, if they are hard bubbles they may be scar tissue and small adhesions. Sometimes you will experience the gas bubbles along the erector spinae muscles if you strip them it will sound like a crackling sound. The ones that are the length of the muscle I am not 100% on either but I experience them. They seem to respond to the pacman technique well and I have also done it like you state in your message. If you can stabilize the muscle using a couple of fingers one on each side (with one hand) and then using your free hand to do some friction followed by DT technique they will typically release. Sometimes it will take a couple of sessions focusing on it for a full release and sometimes they won't release at all. I sometimes think that they may just be a very well defined muscle or could be the fascia is very tight on the muscle as well.
As for the Graston, it is a good technique I have had it done on me before. Very painful, causes bruising that will last for a few weeks or months but when the tissue heals it is rejuvenated. I have found that cupping technique is equally effective, less painful and perhaps easier to get your client to love you for. LOL Thanks for sharing your post and allowing me to share with you as well.
MG
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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Well said Lolita!!
MG
Lolita Knight said:I have yet to figure out how to follow a thread. Do I click on the name of the sender--the reply never seems to be in the same box and where I want to reply. Anyway --to follow my suggestion of offering clients choices with the idea you can't do it all in 60-90 minutes I will use an analogy. You call a plumber and tell him your kitchen sink is leaking and he gives you a quote and suggests 1 hour to fix it. When the plumber arrives you tell him the bathroom shower is not working and in trying to fix the kitchen sink the plumber discovers a problem with the sewer. As a customer you would realize the plumber can't fix it all in the quoted hour. The same with a massage session. Lolita
Gordon J. Wallis said:
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.
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not sure I understand your comment. My clients usually rush themselves to the massage table and often talk during the session so we can create a preventative program to not re-create the problem. By allowing the conversation, the real cause of the problem becomes apparent. Others of course just want to be quiet and enjoy their time out.
Gordon J. Wallis said:
Yea the thread thing can get confusing in here I havent really figured it out myself....Its all good though...Just thread the best you can... lol
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love your sense of humor.
Gordon J. Wallis said:
Yea the thread thing can get confusing in here I havent really figured it out myself....Its all good though...Just thread the best you can... lol
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Permalink Reply by Alyson C Schlobohm on
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Okay, I really need to interject here and say that, while I think there are some great theories out there, there is NO scientific proof as to what a knot, trigger point or "tense" muscle consists of or where it even comes from. There are TONS of articles out there by doctors and scientists who have even surgically removed and studied the above stated, and, again, there is no scientific proof or even conjecture as to where these "problem areas" come from or even what they are.
If a client asks what a knot or trigger point is, I have no qualms with saying, "You know, there is no scientific proof... However, I agree most with the theory that...". I think we discredit our industry when we speak in definites and scientific fact when, in fact, we have nothing to base it on. There is a lot that we ALL have to learn about our musculoskeletal system and its many functions and dysfunctions...
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Wow !!!! Ok well lets micro damage your sarcoplasmic recticulum and see? Its scientific enough for me.. Dr.Janet Travell and Dr. Dan Simmons devoted their medical life spans to study muscle pain. They wrote the bible of muscle pain. Myofacial Pain and Dysfunction The Trigger Point Manual. ..And thats what they came up with .Freakin good enough scientific for me!!..and it makes sense. .And its working for me and my clients... I just had an osteopathic physicians wife come into see me . She said she had both rotator cuff injuries. And has always had to deal with hip pain. She had never seen me before. Anyway, a total of six trigger points, and her hip pain, and rotator cuff pain was gone... Ive studied this stuff along time....If its not true..Might as well be... I can't tell the difference. But people a lot smarter then me came up with that definition...So dont come down on me...I dont tell Freak mythical stuff in here.. Believe what you want.. I believe Travell over you.. lol
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Alyson,
I absolutely agree with you. We can have our best guess and that is it. I don't think it is a good idea for any massage therapist to go into all that detail with a client anyway because you risk malpractice and could be sued for diagnosing a condition. You need to use good judgement. Keep it simple if you do need to say something.
MG
Alyson Schlobohm said:Okay, I really need to interject here and say that, while I think there are some great theories out there, there is NO scientific proof as to what a knot, trigger point or "tense" muscle consists of or where it even comes from. There are TONS of articles out there by doctors and scientists who have even surgically removed and studied the above stated, and, again, there is no scientific proof or even conjecture as to where these "problem areas" come from or even what they are.
If a client asks what a knot or trigger point is, I have no qualms with saying, "You know, there is no scientific proof... However, I agree most with the theory that...". I think we discredit our industry when we speak in definites and scientific fact when, in fact, we have nothing to base it on. There is a lot that we ALL have to learn about our musculoskeletal system and its many functions and dysfunctions...
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Oh come on????? All I do is massage people..and if I find a sore spot. I make it go away... Im a massage therapist...You accuse me of malpractice...I massage doctors.. lol Im a massage therapist that sees nothing wrong with educating clients... Those books are medical books...any good massage therapist that wants to know about trigger points has read them...I come in here to tell people what I do...What do you want me to do? Just repeat the same ole stuff everybody else says? Ive dont this 26 years... I know my job...That explanation about trigger points came from a medical book...That book started a lot of modalities used today by many good massage therapists. Im not doing anything thats out of the scope of my profession. I dont think I will bother saying anything in here anymore...
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