QUICK NOTE: This post is intended for those performing deep tissue and injury/pain recovery work, not for stress relief massage.
PURPOSE: As a massage therapist, we want to always have our client’s best interests at heart, and this post may propose some very uncomfortable (and admittedly not fully fleshed out) ideas, but ones that need to be shared to the community for examination and feedback.
What is the problem?
SCENARIO: While every client is unique in the reasons they see massage therapists, one of the most common is pain in the upper back and shoulder pain (thanks to the decrease in movement variability, our jobs being more desk-centric, and the posture keyboarding and phone-fiddling puts us in, etc.)
Client’s expectations are often “I hurt here, therefore if you press where it hurts, it will loosen up, and I can get on with my life.” As often occurs, it isn’t quite that simple. When our upper backs are hurting, very often the problem is posture related. What I notice in approximately 90% (if not more) of clients I see with upper back pain is a shoulder that is posturally anterior and/or inferior from “neutral” by either muscles on the chest, or below the shoulder blade, respectively.
To make that more clear to my big-picture bodyworker allies, in most cases Pectoralis Minor is pulling the shoulder forward, and the rhomboids are being pulled tight and hanging on for dear life. They spasm because they are playing tug-of-war, not because there is a problem in the rhomboids. The problem is almost never in the upper back. The problem is with Pectoralis Minor being short. When a massage therapist digs into the rhomboids that are stretched tight and in pain, they may create some slack, which the client feels as relief. DANGER: Stretched tissue was just lengthened, and although the client feels temporary relief, the underlying postural pattern has been exacerbated. SOLUTION: release Pectoralis minor, and the spasm releases from the rhomboids almost immediately. It ends the tug-of-war, and the client’s shoulder moves closer to neutral.
Why does this happen?
Many clients have experienced the temporary relief that comes from massaging where it hurts, and with our culture of instant gratification, have come to expect this from massage therapists. I can’t blame them, we as massage therapists have largely failed them. Massaging where it hurts is a quick temporary measure that provides symptom relief. Its often easier on a massage therapist’s body to stick an elbow in the rhomboids than to do a pin and stretch on Pec Minor. When I queried one of my peers about this, they mentioned discomfort working on their client’s chest. To that I say: GET OVER YOUR DISCOMFORT WORKING ON THEIR CHEST. We are medical professionals. If you need to, review your anatomy. Be precise, practice, and get comfortable. I promise the client will be perfectly fine if you are confident and you explain what is happening, and why you’re working there. Besides, Pec Minor isn’t all that invasive.
That doesn’t take into account the therapists that have had GREAT education, but still do it. I’m curious if perhaps we partially do it because we believe the client wants us to, and we fear we’ll get a bad review if we don’t do what they want. Let me tell you, likely more than anything, they want RELIEF, and don’t care how, so long as it is effective. It is up to us to educate them WHY they’re hurting, and HOW to relieve it. We have had training in Agonists and Antagonist muscle groups, and yet SO many massage therapists are not addressing underlying issues.
I hate to bring this one up (no I dont), but addressing underlying issues and teaching the client self care means we may lose them as a client and if they stop seeing us, it means less money coming in. I don’t know how you sleep at night if you think like this. This is the wrong career for you. Take up politics, it would suit you better.
How do we fix this?
Doing QUALITY bodywork that addresses the underlying postural issues CAUSING the pain, and educating clients on the cause, and self-care exercises will nurture a much greater respect between client and therapist than just about anything else.
I don’t care WHAT modality you choose, there are EFFECTIVE tools in most modalities.
I’ve had INCREDIBLE results with my own clients utilizing Structural Bodywork, and they’ve referred friends and family because they trust me to take care of them and facilitate their healing faster than they had ever imagined.
I invite those who are massaging where it hurts to look deeper and see if someone’s pain might be coming from somewhere else.
I’d genuinely appreciate feedback either privately, or on here about this issue. Have you witnessed this in your place of emplyment? What are other reasons you’ve heard that this happens? How can we move the field of massage therapy into greater acceptance into working cooperatively with other medical professionals?