Take a moment to consider why you chose to get a massage. If you don’t, take a moment to consider why not.
Many people receive massage therapy to feel better and/or for improvement in performance. Whatever the reason they choose to get a massage, chances are some have received a massage that just didn’t quite cut it. Maybe the massage was so deep and firm that there was an aggravation of an existing problem. Or maybe they just came away feeling like the massage did nothing for them. Often clients express past experiences of massage, some good and some not so good. One common issue is the subject of pressure – either not enough or too much. Generally speaking, there is an assumption that more pressure (more pain) leads to more gain. Whilst not to encourage this viewpoint, applying more pressure can be OK. However, there are other factors to consider before doing so. Let us explore this a bit more.
When providing manual therapy or massage, therapists follow a system of neurological and biomechanical laws. These laws help to explain how the central nervous system maintains and achieves homeostasis. Homeostasis refers to the maintenance of vital bodily processes that are necessary for survival (read more on this on Livvy’s blog here). One law that pertains to the subject of pressure is Hooke’s law, which states that “stress used to stretch or compress a body is proportional to the strain experienced, as long as the elastic limits of the body have not been exceeded”. What this means clinically is to meet and match the resistance of the tissues, but not exceed it. In other words, the pressure must match that tension to elicit tissue change.
But that is just one half of it – what good is pressure without any feedback? The other half is to get feedback from the client as the pressure meets that tissue resistance. This lets the therapist know the level of pressure that is tolerable and importantly, not to cause further pain. Furthermore, the client’s response to pressure either during palpation and/or treatment assists with the working diagnosis and potential problem lists or red flags. So the client feedback is crucial in getting that pressure just right as well as improving treatment outcomes.
With all this in mind, consider some presentations that require adjustments to pressure or take a different approach altogether.
1. Tissue sensitivity
– Clients can present with an abnormal response to pain as a result of tissue injury or local inflammation. Sometimes an injury that is left untreated may progress into a chronic condition. Persistent pain can do weird things to the nervous system affecting how pain is perceived. For example, light touch to the skin before an injury was not considered painful but afterwards is perceived as pain. In this situation, light massage may be possible to desensitize the area and often combined with pain education to manage symptoms.
2. Referred pain
– Clients can complain of pain in a region and upon physical assessment show no abnormalities. However, it is suspected that it may be referred pain coming from another structure further away. For example, gluteal and hamstring pain to one side may be coming from irritation at the lower back. In this instance, a further assessment would be required at the lower back to confirm the hypothesis. If results are positive, massage directed at the lower back would be more effective at relieving the gluteal and hamstring pain.
3. Myofascial tension
Myofascia is the connective tissue sheath that surrounds muscles. Imagine the inside of an orange, the white skin that holds each compartment is like the myofascia within muscles. When muscles contract, the myofascia needs to slide and glide. After an injury or repeated micro-trauma, the myofascia can get matted and stuck. Often clients report of muscle tightness and upon physical assessment show fascial tightness. In this situation, traditional massage techniques are less effective as it uses compression of the soft tissue. Instead, myofascial release is a manual therapy technique that uses a shearing force capable of restoring the sliding motion of the myofascia. And as a result relieve muscle tightness.
So the key to getting the right pressure is to match the resistance of the tissues while getting feedback from the client. Other clinical presentations require adjustment of pressure or employ a different tact altogether.
So next time you’re getting a massage and you’re wondering why it’s not as firm as you were expecting, it may be just what your body needs.
Ray Gesta is a Sports Lab Massage Therapist. He’s a pocket rocket with a tonne of energy and passion for what he does. He enjoys running, snowboarding and boxing, and knows all the best places to eat.