When clients get demanding, it can be so disheartening that we question whether or not we are fit to carry the mantle of deep tissue therapist.

There exists a mindset on the part of some massage therapists today that supports a flawed idea: Pain equals progress.

While some massage therapists have embraced this idea, others are eager to condemn it. Regardless of your school of thought, we can agree that the concept has produced a culture of clients with goals that are not oriented toward wellness.

Despite our approaches as professionals, which can be as diverse as our clientele themselves, are we really helping anyone by supporting this culture?

Sometimes it can seem like our clients are posing as ascetics, intent on illustrating their tolerance for pain: “You can go as deep as you want.” “Just press through this spot until your elbow hits the table.” “I want you to pretend that I am a 500-pound sumo wrestler with knots the size of bowling balls.”

And when a client tells a massage therapist, “Don’t worry, you can’t hurt me,” it can feel like the proverbial gauntlet of deep tissue expectancy has been thrown.

Clients with these demands can be intimidating. Every massage therapist eventually encounters a request for pressure beyond their capability, or finds their own knowledge of bodywork insufficient to develop an effective session plan. Either of these scenarios can be awkward.

When both instances are happening with regularity, it can be so disheartening that we question whether or not we are fit to carry the mantle of deep tissue therapist. This article suggests that we set a goal of shifting the attitudes of clients who believe that high levels of pain during massage are an inevitable part of finding relief.

Relief Should Outweigh Pain

Let us consider what our goals are as massage therapists. Most of us just want the confidence to understand a client’s complaint and have a clear plan for providing them the relief they are expecting.

The truth is, most of us are perfectly capable of this—but we often find ourselves hindered by requests for more and more pressure by clients who have been trained to expect invasive, impatient techniques that force their way through soft tissue instead of finding a cooperative balance with the body. Sessions then seem to go awry regardless of whether our methods were ever effective or not.

Throughout my 12 years as a massage therapist, I have experienced and witnessed a multitude of encounters with this population of the pain persuasion. Many times the result has been one of frustration on the part of both the client and the massage therapist. This frustration has done worse than ruin someone’s session; it can deter a person from receiving future massages.

For the therapist, it can sour one’s attitude toward the work. In extreme cases, repeated and prolonged frustration of this type detective in the who-done-it of myofascial pain, so why not reveal the trail of clues that lead us to our culprit? Of course, in order for clients to be receptive to our information and recommendations, we have to know what we are talking about.

Professional Development

How many times have you reopened your textbooks since you graduated massage school? It’s OK—you don’t have to answer— but the question highlights an issue. As health care professionals we have a duty to remain vigilant about our professional development.

Now, I will admit, a client has never asked me to explain the role of the sarcoplasmic reticulum or the intricacies of action potential. But synergists and antagonists to major muscle groups, gait patterns, the inflammatory process and fiber direction are merely four examples of the wealth of knowledge it takes to develop an effective session plan. We should know these things— but if you don’t, or if you don’t remember them, you do have the resources to re-learn them.

I know some people will say, “Massage is an art, not a science.” I’ve even heard someone say, “All of that left-brain focus is stifling my chi.”

While massage is undeniably an art, it is also a craft with real science at its core. Whenever you consider how hard it is to review your notes or study a muscle chart, consider first the anxiety and embarrassment of leaving every one of your client’s anatomy questions hanging in the air before you reluctantly admit, “I don’t know.”

A well-rounded massage therapist does not occur without ongoing professional development. If you are unable to construct an elegant blueprint for your session with the supportive scaffolding of kinesiology know-how, then of course the client is likely to take control and contribute nothing but brick after brick of “Just go deeper!”

Advanced Continuing Education

Below is a short list of modalities that offer virtually painless therapeutic approaches with minimal physical effort from the therapist. Anyone who feels that they are not strong enough to perform classic deep tissue techniques should consider these for their next continuing education course:

    • Myofascial Release. This involves the slow application of pressure over fascial restrictions to reduce pain and restore motion. This can be the perfect warm-up to your deep tissue techniques to ensure the dense web of fascia surrounding each muscle does not put up a bitter fight. Outwitting fascial tension this way allows for direct access to deeper muscles with lessThrough palpation and visual assessments, specific muscles are identified for focused work.
    • Active Release Technique. will first have us manually shorten the muscle, apply pressure at the point of restriction, and then lengthen that muscle passively or actively while sustaining pressure over it. This gets the client involved and produces an unmistakable sensation of release. You’ll rejoice to remind your client that the sensation they feel is progress.
    • Proprioceptive Neuromuscular Facilitation. This is an exciting take on muscle release that does not involve direct pressure at all. Originally designed as a form of rehabilitative flexibility training, Proprioceptive Neuromuscular Facilitation involves stretching and contracting a targeted muscle group to restore a normal resting length through resistance.For example, a supine client could lengthen their hamstrings through full hip flexion and knee extension and attempt to extend their hip while a therapist offers resistance. This isometric contraction will lead the hamstrings to expend elastic energy and restore a normal tension and resting length to the muscle. There’s no need for elbows here—or even lotion, for that matter.

There are many ways we can reinvent our approach to deep tissue massage. If you are interested in doing so but you don’t know where to begin, consider which of the previous topics made you the most uncomfortable to confront. That is probably the area where you need the most work—just as when exercising, the workout you dread the most is the last one you should skip.

Today I have set a bit of a challenge: Convince clients there is another way. Let’s get our industry, our own minds—and especially our clients—to understand that pain is not a goal for massage, but relief is.

About the Author

Kyle Spain, L.M.T., M.T.I., is an instructor at American Massage & Bodywork Institute (ambimassageschool.com), in Vienna, Virginia. He has been trained in medical massage and teaches continuing education to massage therapists. Spain was awarded 2015 Massage Therapist of the Year by Massage Envy for the North Virginia/Washington, D.C. region.

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