Category Archives: Massage Techniques

Knowing Your Client – What Works For One Person Doesn’t Work For All

In the early days of a massage therapist’s career, discovering which techniques work well in a treatment session can be baffling.

Is it deep tissue? Soothing strokes? Is it short sessions? Long sessions? Is it movement? Breath? Is it the clients’ mindset? Perceived value? Desire?

Somehow fumbling about in our dim-lit treatment rooms we establish our patterns of understanding, and hopefully we can match those up to our clients’ expectations.

But ask a room full of massage therapists what works can be maddening. Folks who otherwise feel compassion for others can get rigid about their thinking. After all, if something works for them, should it not work for everyone?

It’s a hard fact of life that what works for one person doesn’t work for all. Yet we as a profession are constantly trying to define and establish “scientific” protocols for what works. An effort of little reward, it seems, for therapists and their clients. It does seem to fill up chat rooms and discussion groups.

I saw a lot of this discussion in other professions, as I spent much of my first career reporting on medicine and health sciences. People in these professions don’t want to do any harm, but they want to alleviate suffering and improve lives. Complicating that is the fact that outcomes vary widely. Protocols often work far better for one doctor over another, and for one facility versus another.

The human factor, a long-time friend explained, is what drives people a bit crazy in clinical practice. Was it the protocol or the nurse/doctor/therapist/team/facility or the family prayer group in the waiting room? Is the new drug a wonder pill or is it the selection of patients and monitoring of its use?

I suspect the answers in massage therapy may be about as difficult to vet as it is in medicine. Meanwhile, we practice in the dim-lit rooms of our vocation. If lucky, our clients will tell us what we need to know.

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Providing Quadriceps Massage

My massage therapy client has been working very hard to lose weight. She is going to the gym four times a week, training under the watch of two very good kiniesiology trainers, and eating a diabetic diet. She has lost more than 70 pounds in the past year.

That is a little fast to lose weight, but she has been a trooper. This past holiday season she stayed on track, upping her workouts to make up for time spent traveling and enjoying a few extra carbs. I had not seen her for nearly more than 6 weeks when she limped into my office.

“It’s my knee,” she said. “My good knee!”

Sharp pain was curling around her kneecap. I recognized that look of dread. Try losing weight when you have knee surgery and you are going to spend a month on the couch. A few years ago she experienced that with her bad knee.

Knee pain can be anything, a testy sciatic nerve, nerve root impingement, a poorly tracking kneecap, and osteo-arthritis in the joint. But I do massage, so I follow my muse. Chances are, a sore knee is a sore, entrapped quadriceps – or more likely a sore, entrapped group of quadriceps.

It’s not the easiest massage, but opening the quads can bring a lot of relief. I have learned to start slow, with a lot of warming Swedish massage, to reduce the pain and agony of myofascial release and trigger point work on the most adhesed muscles of all.

Quadriceps that have become trapped in their fascia feel like stone. They lack the softness and rubbery bounce of muscle, feeling sharp and bumpy, almost lifeless.

Warming Swedish can get at the overlay of skin and adipose tissue but that will leave the quadriceps unchanged. Trigger point maps of the quads show so many “x” spots it is hard to see the anatomy. I have learned to start at the top of the muscle, near the trochanter and ISIS, using forearm rather than fingers. Both of these moves reduce the pain.

As trigger points fade, the muscles start to soften. Then add a layer of myofascial release, again using forearm to reduce the strain on the therapist and the client. I slowly move down each quadriceps in strips, starting with the medialis. As I work, I using overall Swedish strokes in between to structurally integrate and encourage circulation.

I am used to feeling the major changes in the quads as they soften. What is remarkable is that my client noticed this, too.

“They feel like they are getting softer and warmer,” she said.

The monster trigger points hide in the area of the vastus lateralis nearest to the knee. I work those last as they are the worst. On these points the knee pain finally subsided.

“Those ball squats you have been doing at the gym have been very effective,” I told my client. “We need to do the bad knee, too.”

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The Push

Massage therapists know that when a client has been pulling something – wire or cable, storage boxes, dogs, etc. that they will find a host of sore and overstretched muscles.

Ergonomically, it is not good to pull, but to push. Push we can do much more easily and with much less fatigue. Somehow the design of things and the human body makes push much better than pull.

This concept gets forgotten, here and there, by otherwise wise, experienced and intuitive massage therapists, in this case me. push

Oh my, something was up. I went for my weekly massage, which I hadn’t had for three weeks because my schedule got crazy, and felt what seemed like a loop of fatigued tissue running from my traps to posterior rotators to lats to triceps to forearms to my thumbs.

Funny I didn’t know that bad patch was there until the massage therapist starting rubbing there. How many times has a client told me that they had no idea something hurt until it was touched? It was especially bad on my left side. Lo, I am left-handed.

As my friend and massage therapist trade-partner tried to get the angst out of this area, I suddenly became aware that I had been doing something wrong. Oh so very wrong. Me? In the biz now for 20 years and I have found a new way to feel yucky?

Hey, it happens.

After three massages that week, I began to feel a lot better. The drilled-in fatigue dropped, I felt less looped in the shoulders and back.

But I needed to find out for myself what I had been doing that had run me off the boards.

I was working with a client who had a habit of clutching items – files, purses, children, and etc. when the dawn finally broke over Marblehead.

I had been working on rotator cuffs from the opposite side of the client, pulling up and back on trigger points in the lats / tereses / infraspinatus muscles. One can massage from the opposite side, on occasion, of course without ending up sore. But one must use the weight of the body, mainly one’s assets, to create the pull. Somehow in the frenzy of the past month I had forgotten this and started using my pulling muscles instead of leverage. What are the pulling muscles? Traps, lats, triceps, etc. Somehow I had forgotten to bend my knees and use weight instead of muscle.

Oh, I have been very good this week. Now I work trapped shoulder blades from the same side. I take care to move the arm into flexion to expose the shoulder. And I vow to never, ever, to pull again. Time for another Epsom soak.

Muscles or Tendons?

Massage therapists have their favorite spots to approach changing patterns of movement and improving function.

Over the years, I have asked the question often: Muscles or tendons?

My early experience dictated muscles. There we find bunched-up, dysfunctional fibers and endplates. Trigger point theory called for a full cleansing of these scatterbrains, along with their associates and satellites. Follow with a stretch, and the trigger points are gone from the muscles.

Unless they come back.

More recent experience leans toward the tendons. If the tension returns to the muscle, it must be from a higher direction. First up, the tendons. Treat tendons and the muscles will unfurl like the Stars & Stripes on the Fourth of July.

Illustrious massage leader Ida Rolf squares off against tendons more often than muscle bellies. Her first run tends to be the big guys: TFLs, ITBs, ligamentum nuchaes, thoracolumbar aponeuroses and raffe. Stretch and function returns.

Sometimes after a full run at tendons I have pulled back and checked muscles. Are they clear? Have they found their function again? Will it last?

I try not to doubt my work, but there are those folks who have chronic patterns. Sometimes they seem to have more than enough fuel from stress at work and home for muscle/tendon function to recur. Yet I wonder, is it the structure touched or the touch itself? And is it perhaps different based on the massage therapist’s own personal tuner?

Perhaps the site of intervention is like a menu. You pick what you like. Hmmm. That might explain why I often begin a session with a bright: “Happy to see you today!”

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Zombies vs. Massage Therapists

One of my most fun massage therapy clients likes to update me on his activities and the connection between what he has been doing and what is going on in his neck, back, hands, etc.

I don’t get a laundry list of precarious Christmas lights installations or kneecaps wondering off by themselves on Audubon bird-sighting missions. He gets all of his angst from the mouse.

The past three years have been spent trying to write a non-fiction book. Ahhh, three years of the highs, the lows, the numbing tundras of white screens and spell-checks that cannot tell the difference between wet and whet.

Sometimes it has been the mouse-side shoulder. Deltoids, pecs, infraspinatus and the dreaded Bermuda Triangle of the human body: posterior scalene/trapezius/levator scapula. Oh the pain.

The bulk of writing the book merely took a toll in terms of pain and stiffness. The editing process involved sweaty panic anticipation that flowed up the neck into the sub occipitals, parietals and jaw. Pop goes the tempo-mandibular joint.

Rewrite heck followed. If it is possible for a man to ever experience the pains of childbirth, this author did. I spent several sessions reminding him to breathe through the pain. At one point we even held hands while he practiced.

All told, he has now emerged from the haze and is undergoing the butterflies of seminars and speaking engagements. I am, too, a bit off to the sideline. Dare I say I feel his pain?

He often talked about ideas on solving structural problems in his book while I rubbed a forearm. Sometimes he found the solutions on the middle of the session, when he would slow-breathe like a sleeper, though awake enough to feel my touch and hear the I-Pod.

All told, he has now emerged from the haze and is undergoing the butterflies of seminars and speaking engagements. I am, too, a bit off to the sideline. Dare I say I feel his pain?

The subject of his book, by the way, is the result of a lot of experience and research in the field of education. I asked him to sum it up.

Don’t be a zombie, he said. Be human, care, do the best you can do to touch people’s lives. Stick your finger in the water. You do not know where the ripples will go but they will go far beyond where you will see.

I had to pause. That just might apply to massage, eh?

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They are Called Trigger Points for a Reason…

The nice man who likes to run every day came into my massage therapy office looking for some relief.

I thought I was going to do a massage – but it turned out to be an intervention.

This man had gotten a hold of a trigger point therapy workbook. He had been doing his own trigger points at home – now his aches and pains were so bad he couldn’t sleep.

The points had been overworked to the point that his body was now so tight and armored this was going to be a tough massage.

With his knee bent, I tried to distract the femur from the hip capsule. Nothing doing. The psoas was so tight it wouldn’t move.

I took a teaching moment. “You go through this at massage school,” I said. “You discover trigger points, see them as the answer to all ills, and you come into class one day having set them all afire with your own merciless fingers. You learn the hard way.”

I took another moment to demonstrate a trigger point release on his common extensor. “Really?” he said. “Is that all the pressure you use?”

Uh-huh.

It took a while, but I was able to get some of the psoas unlocked. I see a lot of Swedish in his future.

With some massage therapy clients, assigning a little homework on their own trigger points may be a good thing. But (oh no please!) don’t try this at home without some instruction.

If home trigger point therapy seems like a good idea, I like to tell clients: “You will be very tempted to be much meaner to your trigger points than I am.”

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Massage Relief for Reflux and Indigestion

So many people work on computers and in hunched positions that massage therapists are seeing more clients for acid reflux and heartburn problems.

Recently I doctors have referred clients for massage to relieve reflux, and the results seem good. I wanted to offer some treatment tips.

First, reflux symptoms – burning in the throat, burping or stomach discomfort, especially at night, need to be evaluated by a doctor for other conditions. Clients I have seen for this problem have been to the doctor and had various tests to rule out other troubles. Most are taking medicine and avoiding certain foods to relieve their discomfort.

Second, I assess the client’s posture and ask questions about their body mechanics at work. Hunched shoulders and thoracic kyphosis are common. Some have had car accidents where their chest was compressed by seat belts. Many work on computers for long hours or have jobs where bending and lifting are frequent, for example, nurses or bartenders. I have also observed some cyclists who use racing-style bikes requiring bent posture.

These observations tell me that when I do the massage, chances are their backs and shoulders will be very sore from overstretching and the abdominals will be flaccid and shortened. Often the shoulder girdle is quite high and forward, the thoracic flexed, creating shallow, upper-chest breathing.

Lying flat on a table is often very difficult, so I like to start with the client prone. A back and neck massage comes first to relieve back and neck soreness and also to assess the stiffness in ribs and spine and specifically the scalenes and serrati. After massage I like to gently mobilize the shoulders toward their anatomical positions.

Many clients have had doubts about getting any massage on their abdomen, fearing tickling or invasive techniques. I assure them that as a ticklish person myself; I use slow, firm touch to avoid triggering tickle reactions. I also assure them that the techniques are not invasive and I can lighten them at any time without tickling.

If a client is still averse to tummy massage, I will suggest that they allow it over the sheet as a demonstration. If the answer is still no, I move on to breath work and ask them to let me know if they feel comfortable getting tummy massage later.

As you may infer, permission to treat is important. If the client is defensive, the massage will not work.

The actual massage for reflux is fairly simple. Slow Swedish-circles in the direction of the colon (counter-clock-wise) followed by slow half-circles over the solar plexus just under the rib cage. The stomach is on the client’s left side of the abdomen, immediately under and to the left of the xyphoid process. Gentle effluerage away from the rib cage; this encourages the stomach to drop down into its anatomical position.

Then I suggest they fill the area under their navel with air as they breathe in. This encourages diaphragm breath and releases the thoracic area from paradoxical chest breathing.

Let me emphasize that a doctor’s exam and diagnosis are important before starting this work. Some very serious illnesses such as cancers and heart disease can masquerade as heartburn.

With the occasional client who refuses to get medical exams, I ask them to write in their own hand a release for massage, in which they specifically state that they understand they could have serious medical conditions. Not seeing a doctor could cause death or disability. They should specifically state they do not hold the massage therapist liable. (I have never seen a client finish such a note.)

The joy of massage for reflux is that as the clients unwind and practice diaphragm breath, their reflux lessens and often disappears. If it does not, I refer to an osteopathic who practices visceral manipulation.

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Stalking the Numb Thumb

Sometimes massage therapists are faced with a whodunit – and it takes a good bit of detective work to unveil the unusual suspect.

The fun of massage therapy, I find, is solving these puzzles and giving a client not only relief but also the confidence that they will get better.

Recently a client came in looking frazzled and tired. A friend had referred her and she didn’t expect much. While she sat in the waiting room, she clutched her purse in front of her midsection with both arms.

A recent trip to the doctor and some bad X-rays had revealed some pretty bulgy discs in her neck. Her MRI was scheduled. She had known about the discs for a while, but these pictures looked worse and her left arm had experienced shooting pains. Now her thumb was numb, and the numbness seemed to be creeping up her thumb toward the wrist.

When a massage therapist listens to a client’s history and observes the posture, it tells a story. I was not sure what was going on yet, but I had a pretty good working theory. But puzzles can be tricky.

Cautiously, I warmed up her anterior shoulder and neck with Swedish massage. The skin was sore to the touch, and the muscles underneath were rock-hard. Working within her tolerance, I drew a flat forearm across her left anterior shoulder to gently press the suspects: subclavius, anterior trapezius, pectoralis major and pectoralis minor.

The thumb and forearm tingled a bit but the numbness remained. I took the shadow referrals to the arm as a hopeful sign. Erik Dalton teaches the forearm sweep as a great way to bust up sludge, adhesions and gummy bears stuck to the muscles and fascia just below the coracoid process. I used his inspiration and started down the shoulder girdle toward the arm.

Technically, my trigger point charts tell me subclavius should be the bad boy in this hunt for thumb-numb. But the constant pressure of rounded shoulders, stress, poor circulation, etc. had brought all these muscles to the table. Just picking one out would not do. Too many other players were jammed into the small space beneath the acromium to pick them apart.

All of these players were so stuck they were acting in a clump. Her numbness and pain gradually subsided. I then spent a long time doing Swedish warming massage up and down the arm, shoulder and neck.

My reward?

“It feels like my arm again,” the client said.

I feel like Nancy Drew.

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Stalking those Darn SCMs

The massage client who can’t turn the head, the headache that arcs over the ear to the ridge of the eyebrow, the sensation of steel cables squeezing the anterior neck: These are all signs of those darn sternal-cleido-mastoids.

We massage therapists see these symptoms frequently, and I have made a hobby of asking other therapists how they try to free the dreaded SCMs. There must be dozens of techniques, dozens of approaches, and yet I still seek one method that won’t make a client levitate.

Lucky for us, clients with taut SCMs are so miserable they will tolerate our fingers making an attempt to unwind these two-headed sticklers. They will try anything to get the eyebrow to stop pounding.

My first experience with unlocking SCMs was with a fairly invasive technique I learned in school: Lifting the sternal and clavicular heads of the SCMs together, on one side, and sifting the TrPs between thumb and forefinger, careful to exclude the pulsating nearby artery.

Well, that does work, but my experience with clients leaving skid marks led me to believe it might be better to learn a softer approach.

It does help to lift the head and shorten the side being palpated by turning the head to the opposite side. An MFR technique I tried to lengthen the SCM from short to long with pincing fingers also left me cold. If the client has any fear of neck constriction, this technique will make it a full-blown phobia.

One time I encountered a client who had survived an attempted strangulation. These SCMs had gone over the moon to protect her. There was no way in heck I was going to lift, sift or pince while twisting.

A class with Erik Dalton saved my hands on that one. He showed, with his usual complete relaxation, a non-threatening way to cross one hand over the front of the neck, palpating the anterior edges of the SCMs with soft finger-pads. The other hand, from behind the head, brought soft finger-pads to the posterior side. A few moments of light touch and patience, the SCMs unwound. No twisting necessary, and no skid marks.

Believe me, that client was able to enjoy a good night’s sleep for the first time in a long time.

What about the chronic phone holder? With today’s tiny phones, and with the old-timey, clodhopper phone handsets, many people have ground in one tight SCM. This pattern creates one-sided headaches and can persist for years. Enough stress and people come in looking like they are holding an invisible violin in their neck.

Well, when challenged, I look to topical magnesium lotions to help. Magnesium oil from seawater stings cut skin so it can be used only if the area has not been shaved. Otherwise, Epsom lotion. A light coating and then leave the client with that side in a light stretch while doing arms and legs.

By the time I return to the neck (20 or 30 minutes) the SCM at least knows it can stretch. If it lets me, I will do whisper-light TrP release on the surface followed by lymphatic circles toward the thoracic duct at the clavicular notch. You don’t have to get fancy, however, light Swedish in direction of the duct works also.

I send clients home with instruction not to turn quickly or whip their heads to either side. Use a little heat if sore. And hold the phone to an ear only looking straightforward and holding the phone in the opposite hand.

There are probably a many more good SCM secrets out there. Anyone?

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Touching the Masses

Chair massage is a great way to deliver massage services – and it offers independence for many therapists who don’t want to be limited to table services.

This new era of chair massage is a big step forward. When it started more than 25 years ago, chair was seen by some traditional massage therapists as a Cinderella stepchild.

Chair was viewed solely as a marketing introduction for table service. Interesting, some massage therapists felt the need to label chair massage as fluff, non-therapeutic, even gulp, recreational – and let me say this fuddy-duddy crowd gave the chair pioneers some grief.

All is forgiven now as chair massage has garnered respect as both therapeutic and a regular form of massage. Chair is found in airports, conventions, employee health fairs, malls and at my local car wash.

For the massage therapist, chair offers some freedoms. Most chair massage at workplaces has the advantage of being held during working hours. A chair therapist can get home in time to pick up the kids from school. They can take nights and weekends off!

Some of the barriers to male therapists melt on the chair squad. Male therapists often have to endure bruised egos in spas when men and women clients refuse them. But male therapists are very accepted in chair massage. They even have an advantage with a bit more upper-body strength, which helps in chair techniques.

Chair also lets therapists do more invigorating techniques such as tapotement. By the way, how many kinds of tapotement are there?

I’ve seen at least five, and there are probably more. I can do two of them without looking like an industrial accident.

Check out some of the leaders in this field: David Palmer, founder of TouchPro, offers many online and in person courses in chair massage, as does Boris Prilutsky. Another chair pioneer, Ralph Stephens, offers a medical chair massage class.

Sure, you can watch these folks and their video how-to chair massage, but you will not know how to do chair massage from a video any more than it will teach you to play the violin.

Take some classes.

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