Sunday, January 17, 2010

Should Deep Tissue or Structural Massage Hurt?

This is a question I hear countless times from clients and non-clients alike, over and over again. Although each practitioner is different, and each client's pressure preferences vary, this, in my opinion and training, is my take on it.

First, define "hurt." This is what I tell my clients when they first come to see me. If it feels like a "productive" hurt, and you are able to enjoy the feeling that your painful or stuck problem is easing up, then it's great. I'd call that a therapeutic hurt. The kind of hurt you get when you get a good stretch say, to your hamstrings. It may not be pleasant, but it feels "good." I tell my clients to let me know immediately if this kind of "good hurt" turns into a bracing, wincing, pull-away kind of "ouch"-- or a "bad" hurt. If that happens, it's time to back off to a more tolerable level, it's too much hurt. Let me tell you why.

The whole point of my practice is to help people out of pain, or injury, or stress, or insert whatever issue here. If you are on the table and are able to allow in the work, then therapist and client are in sync with the process and relaxation is achieved. That restful, relaxing, safe state then augments the work I can accomplish. Here's how. The client's brain is now involved, and amicable to the work. Tissues soften, I can work deeper. This is a synergistic process, so the next time they are on the table, the brain knows it's a good and safe place, and I can go even further into the tissues as a result. The "friend or foe" gates of the central nervous system open up to let me in and help clean the place up a bit. More relaxation, looser muscles and connective tissues, more work at deeper levels can be accomplished.

To the contrary, if the client on the table is bracing, wincing, or pulling away because the work is too painful or uncomfortable, just the opposite will happen. The brain will associate this experience with stress, pain, further injury and discomfort and all gates go up. Now, not only am I trying to work through whatever tight or scarred tissues are there to begin with, but also am having to fight through guarded, braced and tense muscles that are trying to protect themselves from further assault. Now therapist and client's nervous system are engaged in a non-verbal battle of the wills, and as you can imagine, it's not very productive. Client's not getting relief, therapist is working double hard to get the work done. Not an optimal nor healing scenario.

Now, of course, there are certain types of injuries that are inherently painful to rehabilitate. Rotator cuffs, hip flexors, and post-surgical scar tissue to name some of the most common culprits. In those instances, I am up front with my clients and tell them that the work they need can be uncomfortable, but that we'll go in short bursts, and to *still* let me know if it gets too intense, and remind them that they are in the driver's seat. This reassurance is usually all it takes to prepare someone for an uncomfortable release technique.

Will I be sore afterwards?

This is another question I hear often. Here is what I say. "You may feel sore to the touch, like a bruised sensation, but even with that, you should have better mobility, range of motion, and less overall pain to the complaint area. Bruising is not acceptable, so if you experience any discoloration, please let me know immediately. The post-session tenderness should resolve in 36-48 hours. Longer than that, also, please let me know."

The reason I bring this up, is I want people to understand that a bruise is an injury. You are bleeding on the inside. Defined like that, how can an MT giving you a bruise be considered beneficial or therapeutic? Of course there are the occasional cases where someone easily bruises and it wasn't due to excess pressure, but for a client to be told that "they needed that, and it's part of a theraputic regimen" is, in my experience, training, and opinion, utterly wrong. If discoloration occurs, in my book, it means that the therapist worked either too deeply, and/or too fast, meaning they didn't wait for the layers of tissue to melt before proceeding to the next deeper layer. Innocent mistakes from time to time, but "hard and fast" does not a successful deep tissue therapist make, in my professional opinion.

To put things into place and show a real-life example, I'm going to share a horror story. A woman who was not my client was training for a marathon, and was receiving weekly sessions from a prominent sports therapy clinic. Her husband was a client of mine. We ran into each other out after work one evening, and he told his wife to go to the ladies' room and show me what happened to her. It was a little awkward, and was clearly not on his wife's nor my list of things to do in a public bathroom, but he insisted and so off she and I went. Whereupon she showed me softball sized bruises on both glutes, both quads, both hamstrings, and multiple smaller bruising along her IT bands, and this was within just a few short weeks before her race. I was shocked. This woman is training for a marathon, has limited recovery time before the event, and has now been contused and injured on all of her major running muscle groups. I told her she needed to show that to her MT, and if the reaction is anything less than shock, she needs to run to a different therapist-- it didn't have to be me, but it shouldn't be whoever that was. This poor woman had no idea, as she said she knew it hurt pretty bad during that session, but had been told that it was acceptable and within therapeutic ranges. When I broke it down that bruises are internal bleeding, which set up swelling, and pull resources to heal rather than restore and strengthen the surrounding tissues, the light bulb turned on. She made an appointment with me to see if she could tell a difference in how I worked from what she was used to, and was astounded. She had no idea that effective didn't have to be brutal. We worked to gently flush out her legs to speed the healing of her injuries, and she completed the marathon without issue.

So, in summation, more is not always more. Our society is really attached to the "no pain, no gain" philosophy, and I present to you that in the world of structural bodywork and deep massage, this is not only untrue, but following it can cause further pain and injury.

Until next time....

Note: As a licensed massage therapist, I can not diagnose nor treat any illness or condition, and am not a substitution for medical care.