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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 Gary W Addis, LMT on
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Thank you. an understandable explanation. That popping, that's essentially what you hear when your back or knuckles are "cracked"?
Massage Gnome said:
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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Permalink Reply by Massage Gnome on
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Yes, that is the same thing you hear when you pop your back and knuckles only you are sending the pressure a different direction so you get a softer pop. When I worked at the chiro office my boss always hated letting me work on a client that was also going to see him because after the massage all the bubbles were gone and so the customers didn't feel he was doing anything for them. LOL He relied on the cracking sounds of the bubbles to convince his clients that they needed his treatments. In reality they probably did need them but people need to hear, see, feel etc something tangible to believe it is helping. :) I don't think I actually addressed your question about Fernandez and don't feel I can but I hope that I gave you some useful info.
Merry Meet-MG
Gary W Addis said:Thank you. an understandable explanation. That popping, that's essentially what you hear when your back or knuckles are "cracked"?
Massage Gnome said:
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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Permalink Reply by Therese Schwartz on
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MG - that reminds me about the fact that people need suds to think their soap is working! :)
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Ha ha ha! That is so true too Therese. Take out all the sulfates and parabens and they don't know what to do.
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Permalink Reply by Lucianna Johnston on
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Um...actually they do need suds. The scrubbing and "sudzing" pulls the germs off the hands or other part of the body and moves them into the suds. That's why when you use regular soap vs. antibacterial soap it doesn't contribute to antiobiotic resistant strains of bacteria in our environment...sorry...I had to comment I am a hand washing advocate. LOL....
Therese Schwartz said:MG - that reminds me about the fact that people need suds to think their soap is working! :)
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Gordon,
You misunderstand what I am saying. I am not accusing you of anything, least of all malpractice. What I am saying is by telling your clients the way you say the client could easily accuse you of it. I also work on doctors and nurses from the Mayo Health system here. My comment was to say that it is best to be careful how you say things. At the Ethics convention from the AMTA a few years ago, we were told about a lot of actual cases where things like that happened for a whole lot less. To the point of them trying to restrict us from selling essential oils, supplements and the like in our profession just to keep the court cases down. I have no doubt in my mind that you are a very talented and dedicated massage therapist. I just wanted to point out that things we as professionals say and the way we say them can be used against us in this way so it is best to be cautious, choose your words wisely (not on the forum we are here to voice our views, right?) But in our practice we deal with people from all over, in different backgrounds and values and you don't know what they are capable of. That is all that I meant. So please forgive me if I offended you in any way, it was not my intention.
MG
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Permalink Reply by Boris Prilutsky on
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Hi Gordon.
Practically I am possessing all works of Dr.Travell including books that she wrote with Dr.Simons.I believe you are mistaking them mentioning " muscle knots" as a term. most likely you saw it at some other books. More than this I don't believe that any pathology and histology texts referring as well as describing muscle knots as a pathological changes within muscles or mentioning it at all. I believe that"muscle knots" is a sensation description by people who is suffering from pinpoint pain localization .as a practitioners we shouldn't keep in mind "muscle knots"pathology in our minds because it can lead to some techniques that can harm. I mean if pathology is not existing and you trying to apply some techniques to "open up muscle knots"it can be not only not productive but also traumatizing.On the other hand morphology of trigger points is very much known fact, as well proposed treatment designed to address this blood supply insufficiency to this particular inflamed cells. Have a proposal let's stop in our discussion to use this term, and let's stop simplifies massage therapy in general including simplifies adequate trigger point therapy that's a little bit more demanding then you have described in your posts.
With respect.
Boris PrilutskyGordon J. Wallis said:
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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Haha...I'm reading back now.....you are talking about bubbles ;).....semantics always get me in trouble on here....
Lucianna Johnston said:Um...actually they do need suds. The scrubbing and "sudzing" pulls the germs off the hands or other part of the body and moves them into the suds. That's why when you use regular soap vs. antibacterial soap it doesn't contribute to antiobiotic resistant strains of bacteria in our environment...sorry...I had to comment I am a hand washing advocate. LOL....
Therese Schwartz said:MG - that reminds me about the fact that people need suds to think their soap is working! :)
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Yup.
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Gordon, you have already contributed so much. When you have something to say, we ALL want to hear it. I don't think MG was saying that you are committing malpractice, are you, MG?
Gordon J. Wallis said:
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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MG, I checked out the Graston technique. They don't have a demo video onsite, so I have to guess. Appears to me to be MFR with a variety of probably expensive stainless steel tools rather than forearm. Going deep to the point of light tenderness, then slowly stripping the muscle lengthwise at that level. Not saying Graston ain't affective; today we learned to sweep along lamina groove, down from occipital and across, stripping a big area of TPs and adhesions. But maybe my guess is wrong.
From the Graston website:
Why is scar tissue a problem? A. Scar tissue limits range of motion, and in many instances causes pain, which prevents the patient from functioning as he or she did before the injury.
How is scar tissue different from other tissue? A. When viewed under a microscope, normal tissue can take a couple of different fashions: dense, regular elongated fibers running in the same direction, such as tendons and ligaments; or dense, irregular and loose with fibers running in multiple directions. In either instance, when tissue is damaged it will heal in a haphazard pattern--or scarring--that results in a restricted range of motion and, very often, pain.
How are the instruments used? A. The Graston Technique® instruments are used to enhance the clinician's ability to detect adhesions, scar tissue or restrictions in the affected areas. Skilled clinicians use the stainless steel instruments to comb over and "catch" on fibrotic tissue, which immediately identifies the areas of restriction. Once the tissue has been identified, the instruments are used to break up the scar tissue so it can be absorbed by the body.
Is the treatment painful? A. It is common to experience minor discomfort during the procedure and some bruising afterwards. This is a normal response and part of the healing process.
Sounds like NMT/MFR to me.
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Permalink Reply by Gordon J. Wallis on
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lol yea....I find this site interesting.
Lolita Knight said:
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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