Category Archives: Massage Tips

Deep Tissue: 10 Tips to Give a Deeper Massage

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New students, especially smaller women, say that they can’t give good pressure.  They’re not able to go deep.  If you think this, you’re wrong.  First pressure is not equal to depth.  I will speak about the difference.  Then I will present some strategies to help you work deeper.  Please understand that depth is not about working harder, putting more muscle into it, or needing to be bigger.  Often I feel deep tissue work is easier than a light Swedish.

Pressure is the force that a therapist uses, hopefully through body weight, not muscle.  The amount of force you use, even if equal, will be perceived differently by different clients.  This perception is depth.  Even the same client may perceive depth differently from session to session.  That’s why agreeing to give the same massage as last time can be a trap.  Students quickly make the link that depth can be achieved through pressure.  Client wants more depth = I need to use more pressure.  It’s not the only way to achieve depth.  How to achieve depth:

  1. Use Pressure: Yes, you already know this method.  Still it is a common way to increase depth, and I must remind you to use body weight, not muscle to increase pressure.  Clients sometimes want deep tissue to be affected deeply for a specific complaint, but mistakenly ask for a full body Swedish with deep pressure thinking they are the same.  Deep tissue relies on anatomical and technique knowledge, not necessarily more pressure.
  2. Master Body Mechanics: If you are going to use body weight properly you must master body mechanics.  This deserves its own post.  If you don’t change your stances, bend your knees, and lean in then your muscles are doing the work.  Goodbye full work day.
  3. Lower Table Height: Don’t limit body mechanics by having your table height too high.  If it is you must muscle it again, and this time you’ll be muscling with weaker muscles.  This is important with larger clients and side lying.  Drop the table down.
  4. Stand a Proper Distance:  If you’re too close to your work then your arms will be bent and cramped.  They’ll fatigue too quickly.  You don’t want to lock out your arms, but you want them to be straight.  If you’re too far from the table then your body weight won’t transfer through your arms, even if they’re straight.
  5. Watch your Tempo:  You must slow down and sink into the tissue to achieve depth.  Remember my rules of giving a better massage.  Don’t bulldoze through tissue.
  6. Use Less Lotion:  If you use too much lotion or oil, then you won’t be able to control tempo.  Your stroke will be too fast to sink into tissue.  Taste the tissue first.  By that I mean palpate to see how much oil the skin already has.  Remember if you use too little salt you can always add more, but once too much is added you can’t take it away.
  7. Use a Sharper Tool:  If your tool is sharper, the client will perceive greater depth.  This is similar to lying on a bed of nails.  If you lie back on a board with ten thousand nails it won’t pierce the skin.  Lie back on one nail and greater depth is achieved.  If you use your whole ulna on the erector spinae, and your client wants more pressure, you lift your arm to use just the olecranon of the ulna.  Without changing the pressure you have changed depth.  Sometimes a client likes the depth, but not the pressure.  This happens when the client feels they can’t breathe because of the pressure on their back.  Change to a sharper tool so you may work with less pressure while maintaining the client’s perception of depth.                                   
  8. Work Muscle Attachments:  Massaging only the muscle belly is doing only a third of the job.  The muscle has an origin and insertion.  These attachments are full of proprioceptors that impact the tension in a muscle.  Work attachments and you may find yourself having to spend less time on the muscle belly.  You may also get better results.
  9. Change Techniques:  Sometimes the techniques you’re using won’t work.  You should switch techniques allowing use of better body mechanics and a sharper tool.  Sometimes the technique you’re using isn’t the most direct way to the tissue you’d like to affect.  For example if you work splenius capitis by the vertebrae then you’ll find trapezius in the way.  You could pressure through it, but don’t forget part of splenius capitis is superficial by the occiput.  Psoas is another example.  Most therapists try to slowly pressure their way through the intestines.  Instead why don’t you sneak in through the side and slide under the intestines?
  10. Stretch Tissue:  I’m not speaking about stretching itself, even though stretching is wonderful.  I’m speaking about elongating the tissue through your massage stroke.  When you’re going through your stroke are you solely pushing on the muscle causing a compression, or are you working the fiber direction trying to stretch the tissue with your stroke?  This is especially good on long muscles.  You have to know your muscles to do this, and you must not use too much lotion, or you won’t have the friction necessary.

Remember sometimes clients lie about how much pressure they can take.  Listen to what they say, but also watch how they respond to your pressure.  Also, just because a client is thin and petite doesn’t mean they will break if you give them a lot of pressure.  Client sets pressure.  Don’t assume for them.


How to Check Pressure

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Most schools teach a number scale usually around an optimum therapeutic zone (OTZ) that “hurts so good”.  This is the pressure you give to maximize the benefits of the stroke.  Usually this is a ten scale.  One is feather touch, two to three is palpation, four to six starts to feel good, seven to eight hurts but still feels good, nine to ten just plain hurts. OTZ is when somebody says “oooh, right there!”

A lot of students don’t like to explain the number scale and stop using it.  They resort to “how’s the pressure?”  In response you almost always get a short monotone “it’s good.”  It’s like you fed them a horrible dish and they know you’ll be offended if they didn’t like it.  Staring at them with wide eyes you ask “how’s the hog rectum?”  Sweat dripping slowly down their forehead they answer “it’s good.”  You nod in agreement.  That’s not how it should be.  If you don’t use the number scale at least ask them “do you want me to use more pressure, less pressure, or the same?  This stops them from copping out with “it’s good” response to “how’s the pressure” or “yes” response to “is the pressure good.”

Sometimes clients aren’t honest.  Society taught them not to be honest to avoid confrontations.  You may need to follow up with “could the pressure be better?”  Remember it’s your responsibility to get an accurate pressure level from the client.  And NO you can’t magically feel if you’re at the right level with experience.  Don’t ask too often, but check two to four times during a relaxation massage.  Check more often during a clinical massage.

What are Muscle Knots

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“I’ve got knots in my back,” is a common complaint.  When students get to massage school they learn what knots are.  Well, they think they learned what knots are.  The truth is the explanation you heard was one of several theories.  Don’t believe a theory just because you’ve heard it so often, “it must be true.”  This post is going to explore the theories of metabolic accumulate, trigger points, myofascial adhesion, muscles sliding, and fibrous tissue.

One of the oldest explanations was that some minerals and metabolic waste got left behind and began accumulating.  So you’ve developed a local deposit of minerals and stuff that needs to be broken down manually.  Well the problem is the body is actually very efficient at removing metabolic waste.  Even in sedentary individuals it doesn’t take that long.  This explanation has fallen out of favor.

The explanation that most students probably still hear is that muscle knots are trigger points.  The basic definition of a trigger point is an area that is tender when pressed on and it refers pain towards another part of the body.  Trigger points are actually well mapped out and were considered scientifically accurate, but lately some therapists began looking back and discovered that this was more pseudoscience.  The problem lies with when you ask why does a trigger point develop into a “knot?”  The explanation is that it is a local twitch response.  Not a spasm, because that would involve the whole muscle.  The problem is that even if you’re looking at just a muscle fiber, the fiber does not contract in just one spot, a fiber contracts all or nothing.  I’m not completely throwing away trigger points.  I, as well as many therapists, got good mileage out of using their theories, but it doesn’t completely hold up to scrutiny.

As trigger points fall slowly from use the next most common explanation currently doled out is that knots are actually adhesions between two fascial layers.  These fascial layers are connective tissues that run through and about all parts of the body creating order and support.  If two parts that were supposed to slide past each other get stuck together then you’re going to experience limited range of motion, pain, and a knot.  Fascia has been made popular by structural styles like rolfing and kinesis, and also gentler styles like myofascial release.  I love how slow fascial work feels, but many therapists are questioning if fascia really has the properties it is attributed to have by the above styles.  Turns out fascia probably can’t stretch out to the extent we thought and when you find out one thing is untrue the rest is questioned.  The possibility that cross fibers can reach across adjacent layers seems plausible, especially in sedentary individuals or people immobilized by an accident/trauma.  I imagine this will stay popular for a bit more.

A theory that is getting attention, and may be the next popular one is that a knot is just muscles that overlap.  As you put pressure or manipulate the knot the superficial muscle will slide over the the deeper muscle and you’ll feel a bump slide back and forth under your pressure.  This is probably true for some of the knots you feel.  This explains the knot commonly found by the inferior trapezius as it slides above erector spinae muscles.

Another explanation that makes sense is that a knot is just fibrotic tissue.  It could be especially fibrous muscle or tendon that has extra connective tissue.  This may be due to some sort of stress like poor posture or a repetitively stressful activity.  An example is how common it is to find a fibrotic levator scapula attachment at the superior angle of the scapula.  This could be due to the common head-forward-posture and sedentary lifestyle.

So what’s a knot?  I’m going to guess one of the bottom theories, but only because I want to be ahead of popular and accepted theory.  If you want the most company you’ll want to stick with trigger points.

10 Tips for Giving a Better Massage

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After getting some basics down students start learning about different modalities.  They start wondering which modality they would enjoy receiving and giving.  Inevitably they ask their instructors “what type of massage do you do?”  They want an easy answer of one to two modalities, but that’s not how I think about massage anymore.

What’s involved in my style of massage:

1. Throw away modalities.  When you learn a modality you get a style to emulate and a reasoning why it works.  The truth is we don’t know the real reasons.  Using only one modality is cutting off techniques you could learn or be “allowed” to use.  Don’t restrict yourself.  I didn’t care for my time in the spa when I worried if they asked for Swedish massage for example, I shouldn’t use such and such technique because it is a myofascial technique.  Why can’t I use the stroke that is best at that time for the client?

2. Make sure clients are always comfortable.  If they’re not comfortable then I’m not nurturing trust, and they’ll be tense and unable to receive the benefits of a massage.  Comfortable means I let them know upfront that I’ll accept feedback at anytime about anything that is making them uncomfortable.  It’s my responsibility to empower them to be in control of what happens to their body in my session.  Sometimes clients won’t offer up feedback willingly, so you still have to check in occasionally and prompt them for a response.

3. Leave your ego at home.  To make sure they’re comfortable you can’t bring your ego into it.  I see students and teachers who want to improve, but upon receiving feedback they get frustrated, disappointed, or worse angry.  The moment that happens you just nonverbally said that you don’t really want feedback.  Yeah, you went to school for this and you may “know better”, but it’s their session and body.

4. Don’t plow, allow.  Give yourself time to sink into the tissue.  Don’t just bulldoze through it.  I’m not a fan of “no pain, no gain.”  If they tell you it’s too much, you don’t know better.  You don’t have to go deeper to “work it out.”  They decide what is deep for them and that can change each session.  If they say no, and you don’t listen, I think you just committed massage rape to their tissues. Learn how to check pressure.

5. Understand your anatomy.  This can never make your massage worse.  Understanding anatomy helps you understand pathology.  Understanding musculoskeletal anatomy helps you plan your massage.  It gives you the ability to muscle test, stretch, and work the muscle competently.  You could forget them when you work at the spa and just work the area.  However, if you want the pleasure of seeing your client struggle to walk like a new born fawn, because of an awesome massage, then you need to learn to work muscles from attachment to attachment.

6. Cultivate mindfulness.  Everything is multitasking, no more doing one thing as well as you can…except for us.  Your client paid for your attention.  Most students are hungry to learn as many new techniques as possible.  New strokes are nice, but they only get you to average.  Mindfulness is bringing your attention and awareness to what you’re doing.  Have you ever driven down the highway while thinking about groceries, rent, errands, arguments, and then notice you passed your exit five miles ago.  That is the absence of mindfulness.  While massaging you shouldn’t pay attention to mental chatter or be distracted by your phone.  It’s blasphemous.  Your touch feels horrible and you told the client that some text message is more important than the price they paid. What deserves your attention?  Body mechanics, nonverbal cues from the client, objective data you notice, and time management.  Don’t think you’re doing them a favor by going over time.  You may be making them late while decreasing the amount you earn per hour for massage.  Massage is not a volume business.  Protect what you make per hour.

7. Master flow and transition.  To take your massage up a level you must connect with the client at the beginning, then flow and transition through the massage.  Really it’s the quality of touch that makes the massage, and not the number of techniques you use.  Quality of touch includes relaxed hands.  Don’t jump around the body, and do try to build your strokes on top of each other.  I imagine orchestrating a symphony with each stroke having the purpose of building on the stroke before and also preparing the tissue for what follows.  Since it is so hard to teach, it often comes with experience.  The best experience for mastering connection, flow, and transition is to pay attention while receiving.

8. Slow down.  To continue increasing the quality of your massage you must slow the pace down.  Beginning students don’t know enough techniques.  You worry that your techniques won’t get you through an hour massage.  Eventually you know more techniques than you could hope to use in an hour.  Instead of cutting some out you decide to speed up so that you can fit them all into the session.  That massage sucks.  Use less strokes and slow down.  Even if you’re behind and feeling time pressure- slow down.  Nothing communicates I messed up and you’re getting short changed like a therapist hustling through a body part.

9. Immerse yourself in your new craft.  I was watching Jiro Dreams of Sushi and this chef is at the pinnacle of the sushi world.  He charges $300 a plate, has no appetizers, and you must make a reservation a month in advance.  His advice is to immerse yourself.  Now when I say to immerse yourself I’m not suggesting you go broke taking every continuing education class available.  Yet, you need to continue doing things to improve.  I read about research in the field.  I also read books, blogs, watch videos, and take CEUs that I deem worth it.  Keep increasing the number of techniques you know.  Continue brushing up on your anatomy.  Join an association that will keep you current.

10. Be professional and personable.  I never want a client uncomfortable on my table.  When I’m with friends I may act inappropriately, but not when I’m working.  You don’t know who you might offend.  That doesn’t mean that your client wants a robot.  You want to give clients a reason to come to you over another therapist.  You think that other therapist isn’t going to smile, give a decent massage, and offer water at the end.  What sets you apart?  Preferably both your massage skills and personality.  You need to learn the balance that gets people returning to you.

What’s that?  You still want to know what kind of massage I give.  Let’s just call it that slow cooked, melt off the bone, style of massage.