Do you know how many pounds of pressure you are applying with your elbow during your deep tissue massage? It is easy to learn this number if you do not know.

Do you know how many pounds of pressure you are applying with your elbow during your deep tissue massage? It is easy to learn this number if you do not know it.

Simply place a bathroom scale on a massage table or desk. Now, stand over the scale similar to how you would stand over a client. Place your elbow on top of the scale, similar to how you would apply your elbow on a client’s tissue. Next, push inferiorly downward onto the scale with the same amount of pressure you would apply to a client with your elbow. Then, look at the number on the scale.

That is how you can determine how many pounds of pressure you are applying with your elbow during your deep tissue massage. (We advise placing a towel or small pillow between your elbow and the scale during this measurement to protect your elbow.)

Using a scale to measure pressure.

While this bathroom-scale method could be used to measure pressure applied with your fist, forearm and more, it assumes you are using your elbow to apply deeper pressure. Using elbows with proper training is an efficient method to achieve significant amounts of pressure in deep tissue massage.

Deep tissue massage can easily be applied with elbow pressure, which is how and why these same elbow pressure measurements can be determined on a bathroom scale.

In the U.S., we would measure our deep tissue massage pressure in pounds. If you are practicing in Canada, Europe or any other place where the metric system is used, you would measure your pressure in kilograms.

Why Would I Need to Know Pounds of Pressure Application?

There are several helpful reasons to learn the pounds of pressure applied in bodywork:

• Sharing these numbers with other trained practitioners who work on the same client could provide a more consistent client experience.

• Clients and insurance companies like to see treatment progress that can be documented with tangible numbers.

• Documenting pounds of pressure tolerated with each application provides a valuable assessment tool for the practitioner.

Train Yourself to Know How Many Pounds of Pressure You Are Applying

Practitioners can train themselves to know how many pounds of pressure they are applying with their elbows. You can do this with a blindfold and a bathroom scale.

Guess how many pounds of pressure you are applying while blindfolded, then remove your blindfold and look at the number while maintaining the same amount of pressure on the scale.

View how close your guess was to the number showing on the scale.

Eventually, with practice, most therapists can reliably determine how many pounds of pressure they are applying, once they are able to accurately determine their number blindfolded with each effort. And while these measurements can be fallible because it uses human application, it does not involve significant financial expense or additional licensure for a massage therapist to practice. 

Using a scale to measure pressure.
Using a digital device to measure pressure.

Use an Intensity Scale to Do No Harm and Take Reliable Measurements

It is critical to use an effective communication system with any deep tissue recipient. An example of this would be a verbal intensity scale of 1 to 10. The client solely determines their own number on the intensity scale

A 1 on the intensity scale would feel similar to little or no pressure to the client. A 10 on the intensity scale would be an intolerable amount of pressure to the client.

Most clients and practitioners like to work around a number 7 on a 1-to-10 intensity scale in a deep tissue massage, but the client can choose to work at a number lower than 7 if they wish.

Never work higher than a 7, because of the bruising and tearing that could occur with greater pressure; after all, tissue damage could be one of the reasons why a number greater than 7 could be felt.

More is not always better with deep tissue massage, because you could damage the underlying tissues, including the capillaries, with too much pressure.

Track Progress with Pressure Measurements and Verbal Intensity Scale

Therapists can track progress once they can reliably determine how many pounds of pressure is applied with each session. Most client’s pressure tolerance will increase with successive treatments.

Keep in mind that the same pressure is not used for the entire body. For example, most clients can tolerate more pressure in their back versus their biceps or calves. Multiple pressure measurements should be taken over different areas of the body.  Or, a practitioner can focus on measuring a singular area if they are working on a focused chief complaint.

To track progress, make an agreement with the client about the number on a 1-to-10 intensity scale that they would like to work with. The agreed intensity scale number should be the same number that is used every time a pounds of pressure measurement is observed.

For example, a client may tolerate 10 pounds of pressure on their lower trapezius during their first appointment before reaching a number 7 on the 1-to-10 intensity scale. But, after a few sessions, that same client may be able to tolerate 40 pounds of pressure on the lower trapezius before reaching the number 7 on a 1-to-10 intensity scale. This is how a massage therapist would use a pounds of pressure measurement plus an intensity scale to track a client’s progress.

Special note: use the same pressure application method for comparative measurements, such as repeatedly using a dull elbow or whatever can be reliably executed for consecutive pressure measurements.

Measure Pain Tolerance

One objective used to achieve pain relief is to increase an individual’s pain tolerance. However, increasing a client’s pain tolerance is not guaranteed to relieve pain, but it often helps.

The health care profession uses various methods for pain tolerance measurements. A mechanical device such as a dolorimeter or algometer is often used to apply pressure, and an increase of toleration time to this pressure is considered to be an improvement of the client’s pain tolerance.

Our method shared here can also gauge a client’s pain tolerance. When a practitioner is able to successfully apply a greater number of pounds of pressure while remaining at the same number on a client’s intensity scale, they have achieved an improvement in the client’s pain tolerance in the world of massage.

Share Your Progress and Outcomes with Clients

Using pounds of pressure provides a valuable comparison for deep tissue treatments from start to finish, as soft tissues are compressed, stretched and manipulated with each successive treatment.

Unfortunately, a client could also regress during treatment, and it is important to be honest if this happens. Sometimes there could be underlying disease or dysfunction that could cause a regression, so it is important to address all outcomes so that the client can seek a different treatment or physician’s evaluation as needed.

Most clients are impressed when they hear that they are able to tolerate greater pressure numbers with each successive treatment, when this happens. While an increasing amount of pressure should not be used as a sole benchmark for success, it’s usually a good indicator that the treatments are headed in the right direction.

While the only massage gauge that usually matters is what your client thinks or feels after their appointment, being able to provide tangible numbers could help validate the effectiveness of your bodywork.

Selena Belisle

About the Author

Selena Belisle is the founder of CE Institute LLC in Miami, Florida, where they teach massage, nursing and cosmetology industry CE courses. She has been practicing massage therapy and bodywork for over 30 years. She is approved as a continuing education provider by many industry state boards and the National Certification Board for Therapeutic Massage & Bodywork.