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Should Massage Hurt?

Ask 10 therapists this question and you are likely to get 10 very different answers. Some therapists do not believe that massage should be painful, ever, and if you are in any sort of discomfort then you are being massaged too hard. Other are at the opposite end of the spectrum and if you are not squirming, squealing and wriggling as they beat the knots out of you then they are not going hard enough.

My answer….it depends.

If you are purely after relaxation massage at a day spa or for stress relief then you would be looking for a massage that is be blissful and pain free. If you have never had a massage before then this is probably the end of the pain spectrum that you can reasonably expect to receive.

You should not feel sore or uncomfortable that day (or the next morning) and any pain is an indication that the therapist wasn’t listening to you or your body.

However, I’m sure I gave one of those massage in 2004.

Deep Tissue massage of a woman's thighPeople who book in to see me are generally after remedial, deep tissue or sports massage and for this group of massage recipients then some degree of discomfort both during and after the massage should be anticipated. Sometimes you have to take one step back to move two forwards.

If you are suffering from a sore back or a stiff neck then myofascial restrictions and adhesive scar tissues need to be worked. Polishing the skin just isn’t going to cut the mustard even if it does calm the nervous system and relax the sympathetic nervous system. You need to get into the muscles (and other soft tissues such as ligaments and fascia) and disrupt their current condition in order to obtain the response that you are looking for.

Now although a deep tissue massage sounds as though it should be excessively painful, this is not necessarily the case. Deep tissue merely means working the deeper levels of tissue, working through superficial layers of fascia and muscle to achieve a change in the structure of the deeper tissues.

But while it needn’t be excessively painful, in reality it is almost always the case that it can be uncomfortable. Personally I do take issue with therapists who say that deep tissue massage should never hurt and feel that either they have never experienced genuine deep tissue massage or they are doing it wrong.

By the same token, though there are therapists who work at such a pressure and intensity that a client is literally bruised and in more discomfort than when they started the massage. “No pain – no gain” may the mantra of the therapist. This doesn’t sit comfortably with me but if it works for them and their clients then so be it. So long as they are genuine with their intentions, explain how they will work and warn their clients how they will feel after the massage then that’s ok with me.

It’s just not the way I work.

  
I like to work within the clients pain threshold so that whilst it may be uncomfortable and bordering on painful (when I consider it to be appropriate), it should never be so heavy that they are wincing and flinching on the table. By the way, the level of pain threshold does tend to increase the more massage you receive and arguments have been made that this isn’t necessarily a good thing (eg needing more and more pressure to achieve the same response is almost an addiction).

Ultimately it is up to you to find a massage style and therapist that suits you. If you have never had a massage before and you are in pain during the massage, then speak up. Similarly if you know what you want and the therapist is one of those who insists on not hurting you at all then maybe you need to find someone else who can give you the type of bodywork you are after.

By Richard Lane

Massage Swaps

There are very few people who do not benefit from massages and massage therapists are no exception. In fact, given the physical nature of the work often with suboptimal postural position, massage therapists probably need more massage than some other professions.

There are often debates on social networks about the merits of fellow massage therapists trading massages.

Massage exchangeIt can be a great way for students to practise their strokes and receive constructive criticisms about their bodyworking style in a non-threatening environment. They can learn and discuss new techniques. They can ‘talk shop’ about the massage industry, their ideas and their business plans.

However, professional therapists who trade massages in Sydney tend to be the exception rather than the rule.

In theory it should seem logical that therapists work on each other. However, in practice, even though most therapists try it at some stage in their career, most end up deciding that paying for massages works better for them.

There are a number of reasons for why professional do not tend to swap massages.

– They struggle to find someone that they want to receive regular bodywork from who also wishes to trade.
– They struggle to find suitable times that work for both parties.
– Very few therapists like to do a mutual swap within the same session. It is always very hard to get up from a massage table and then have to give your trade partner a massage straightaway.
– If they do find a massage swap partner who they do like, it is very rare that the bartering relationship is completely reciprocal. As often occurs in any relationship, one party tends to feel that they are investing more than the other. Eg one therapist may cancel or put paying clients ahead of their trade partner.

  
Most therapists tend to find swap partners when they are studying and it may well be that they only swap whilst they are learning new modalities or techniques. There are massage exchange websites where therapists can check out other massage practitioners who they may wish to consider swapping with. However, as a word of caution, many those with register with these sites may be after a sensual massage swap.

Even therapists who find that they are compatible with respect to swapping massages often drift away over time and what might start out as a weekly or fortnightly swap, ends up being just an occasional massage. In the end most experienced therapists end up preferring to become just another paying customer with therapists they enjoy receiving bodywork from.

By Richard Lane

The Benefits of Abdominal Massage

Many massage therapists will spend the vast majority of session working on the back of the client. They will give great bodywork to the back, shoulders, neck and the back of the legs but then only give cursory attention to the front of the body. Now it is true that most of us have significant issues with the back of our bodies but to neglect the muscles and soft tissues at the front of the body is to provide an incomplete session. Only a few therapists would routinely incorporate an abdominal massage within a full body massage, yet there is little doubt that bodywork through the stomach area can offer many health benefits.

Abdominal massageMost people who do request an abdominal massage would likely do so because of digestive issues although there is also significant musculature in the area that may require release to assist with physical problems. For example, a tight and contracted rectus abdominis muscle will impact on the stability and movement of the lower part of the body or lead to us slouching forward setting up postural imperfection through the lower back.

In total there are at least four layers of muscles in the abdomen and these can impact on your core strength (both your physical and emotional core). Trigger points are not uncommon in the abdominal muscles and the pain referral patterns can include the lower back. Simons and Travell (1) observed that

An active trigger point high in the rectus abdominis muscle on either side can refer to the mid-back bilaterally, which is described by the patient as running horizontally across the back on both sides at the thoracolumbar level … In the lowest part of the rectus abdominis, trigger points may refer pain bilaterally to the sacroiliac and low back regions.

Regardless of the requirement for remedial massage and trigger point techniques for hypertonic muscles in the abdomen, the vast majority of abdominal massage will be for digestive issues. Most therapists consider that massage to the stomach areas will improve the capability of the digestive system and will potentially benefit some of the organs that are contained within the abdominal cavity (such as liver, pancreas, gall bladder, small intestine and colon). A recent review of research has confirmed that there are likely to be benefits for performing abdominal massage to treat chronic constipation. Sinclair (2) concluded “studies have demonstrated that abdominal massage can stimulate peristalsis, decrease colonic transit time, increase the frequency of bowel movements in constipated patients, and decrease the feelings of discomfort and pain that accompany it. There is also good evidence that massage can stimulate peristalsis in patients with post-surgical ileus.”

Routine for Abdominal Massage
In order to give an abdominal massage then the stomach needs to be exposed and it is usually recommended that there be some bolstering under the knees to slightly relax the abdominal region. Normal massage lubricatants are fine to use.

– Place your hands gently on the stomach and palpate. The stomach should feel soft and relaxed

– Always be aware of the breathing of the client and work with the breathe, not against it.

– Sink in through the diaphragm region with the breathe of the client

– Lightly work along the lower border of the rib-cage with fingers and thumbs.

– Gently effleurage the area with light circular strokes. Always work in the direction of the digestive system which means working clockwise around the stomach.

– Place your hands over the rectus abdominis and gently palpate for areas of tenderness and restriction. Work the edges of the muscles with static compression (asking the client to tense the muscle by have them start to sit up) with sufficient pressure to be therapeutic but not too much that it causes pain. Release attachments at the xyphoid process (obviously without ever putting direct pressure on the vulnerable process itself). Release the attachments at the upper border of the pubic bone (mindful of the sensitive nature of this area – if client has any concerns then you can get them to use their own hand to achieve this release or alternatively work through a drape).

– Work deeper under the ribcage on both sides of the body (be aware of working too deeply directly into the liver which is on the right side of the body). Cross friction at any tender points.

– Pull through the sides of the body with relaxed hands, reaching around the body as far as possible, working and stretching the fascia.

– Work the ascending colon (right side) and descending colon (left). Make sure you connect with sufficient pressure through colon although not too much so that it causes pain. Some therapists recommended clearing the descending colon first too “make room”.

– Finish with a calming connective touch to the abdomen.

  
Normal massage contraindications would apply for abdominal bodywork and if the massage is to be performed for a specific health objective then it is recommended that it be discussed with suitable doctor prior to treatment. Also be aware that many people may have emotional sensitivity and instinctively be highly protective of this so any bodywork needs to be mindful and respectful

1. Simons DG, Travell JG. Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1, Upper Half of Body, 2nd Edition. Lippincott, Williams and Wilkins, 1999:943.
2. Sinclair M. The use of abdominal massage to treat chronic constipation. J Bodyw Mov Ther 2011; 15:436-445.

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Update – a 2011 review of the effect of abdominal massage in chronic constipation found that abdominal massage can stimulate peristalsis, decrease colonic transit time, increase the frequency of bowel movements in constipated patients, and decrease the feelings of discomfort and pain that accompany it.

“The use of abdominal massage to treat chronic constipation.” Sinclair M.
J Bodyw Mov Ther. 2011 Oct;15(4):436-45. doi: 10.1016/j.jbmt.2010.07.007. Epub 2010 Aug 25.
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By Richard Lane

Breathing and Neck Pain

Have been seeing a few clients lately with neck pain with trigger points present in their scalenes muscles. These muscles are side of the neck (more towards the front than the back) and they are used to tilt the neck and also stabilise the ribs when breathing.

Typically this arises when the person is what is known as paradoxically breathing or thoracic breathing when we should be diaphramatically breathing.

Some people can diaphragmatically breathe in one position but not in another. For example, many of us fail when we are sitting typing on a computer. Yet, We should be able to breathe correctly whether standing, sitting or lying.

One technique that is often used to train our breathing patterns is to put your right hand on your chest and left hand on your stomach. With your eyes closed then breathe in through the nose to a count of around 4 and then exhale via the mouth. This exhalation is also performed to the count of four. Whilst this exhalation is taking place then the abdomen should be returning to the original position.

This exercise should be practiced for around 60 seconds at any one time and should be repeat during the day whilst standing, sitting and lying down.

A demonstration of breathing exercises is shown in the video below.

  

Free Massages – How Not to Give Them

When you are a student massage therapist then providing a free massage for Sydney family members and friends is considered part of the training. In return for you giving them a massage then you get the chance to practice strokes and techniques that you may have learnt in class. In addition, you can solicit feedback from the recipient of the free massage.

It is a win-win situation.

However, once you have qualified and start working as a massage therapist then this synergistic situation changes. You are confident of your skills and how your bodywork is received by clients and client feedback is less important for you.

If you have been working hard at a clinic, doing mobile massage or at a spa then the last thing you want to be doing when you get home is to give away a freebie.

free massage in SydneyUnfortunately from the therapists point of view though friends and family don’t necessarily see it this way and many therapists are frequently asked to give them a few minutes of time to massage their stiff neck or sore shoulder.

A question that is often posed is how can I, as a therapist, politely decline to work on them?

On a recent Facebook posting, therapists gave suggestions on how to deal with this issue. The most common response was along the lines of handing the person your business card and asking them to call to make a booking.

Here of some of the other answers.

I say in a funny sarcastic yet friendly way, “I have all my free massages when I was in school for two years. I have to pay off my student loans before giving anymore free massages.”

I’m just honest. I tell them that I don’t have the stamina on my days off and they always understand. If I can tell someone is just trying to get a freebie, I tell them they can have a business card. They laugh and say, “Smart answer”.

Tell them you’ll trade if they work on you first

When family and friends come crying to me about what is hurting on them (hinting about wanting me to work on them) I always reply by telling them what is hurting on me. They usually get the hint

It seems that people think that because we are MT’s, that we never hurt. Typically don’t like it when I say… Yeah, my neck and back are killing me too!

Sometimes if my friends say “Oh, my back hurts so badly!” I answer with, “I’m sorry, I wish I knew someone who could help”

Make an appointment, today’s my day off.

“Sure! I’ll trade you. I can always use a massage! 5 minutes for 5 minutes?” “Uhh.. uhh… uhh… “

  
But probably my favourite is

If you know someone who is a mechanic, and says “My back hurts, can you help me?” answer: My car needs brakes, can you help me later tonight?
If you know someone who does daycare and they ask for free massage, ask them in turn to babysit your kids for free when they get off work.
You get the point. If they wouldn’t work for free, why should you?

By Richard Lane

Subscapularis Massage

I recently posed an online question to other therapists about what muscles they believe do not receive sufficient attention from bodyworkers. My suggestions was the SCM (sternocleidomastoid) muscle at the front of the neck. Other suggestions included the gluteal muscles, the pecs and abs which didn’t surprise me too much. However, a few therapists included the subscapularis muscle in their lists which I have to admit, is not a muscle I would normally spend a great deal of time on.

Their comments inspired me to have a look at subscapularis, what it does and why it may be important for some shoulder conditions.

Now the subscapularis muscle is part of the rotator cuff group, along with the teres minor, infraspinatus and supraspinatus muscles. These muscles work together to stabilise the humerus in the glenoid fossa of the shoulder. From a massage therapists terminology it attaches to the anterior surface of the scapula at the subscapular fossa and the lesser tubercle of the humerus. It’s action is to internally rotating and adducting the humerus (along with it’s stabilisation role).

Pain and dysfunction in the subscapularis muscle often manifests as an inability to lift the arm above the shoulder (although it should be mentioned that not being able to lift the arm above the shoulder does not necessarily indicate that there is an injury to the muscle as there are other conditions which have the same impact on lack of shoulder mobility). It is often the case that someone who spends a lot of time in front of a computer may very well have some dysfunction of the subscapularis, such as trigger points (this applies to anyone who works with their arms out in front of them including massage therapists!).

Pain that is due to dysfunction of the subscapularis can manifest in a number of different ways, it can be sharp and located in the shoulder, deeper or at the top of the shoulder. It can refer down the arm. There can be impingement of the brachial nerve which can lead to numblike sensations or tingling down the arm. The pain can gradually appear over time or, in the case of an acute incident, it can happen at an instant (throwing or pitching a ball is commonly cited as a major contributer to subscapularis injuries). Subscapularis therapy is often indicated when a client is recovering from frozen shoulder.

Massage for the Subscapularis
Access to the subscapularis is limited particularly when a client is lying prone and most therapists prefer to do their subscapularis bodywork with the client either supine or in a side-lying position. Examples of supine and sidelying subscapularis massages are shown in the videos below.

Supine Massage

Sidelying Massage

Dr Ben Benjamin advocates using friction treatments to address subscapularis tendon injuries and claims that it can be a remarkably effective treatment for most muscle, tendon and ligament injuries. Friction massage for the subscapularis can be mildly unpleasant and should be performed from 5 to 15 minutes and is demonstrated on the video below.

  

Learn Massage Online

If you think that you would like to learn about massage then there are a number of options available for you. This is particularly true if you are looking for more of an introduction to massage rather than formal training (eg being able to give your partner a relaxing yet effective massage).

You could buy a book (or loan one from your local library. You could buy DVDs on the types of massage that you think you might be interested in be it for sports, sensual massage for your partner or relaxation massage. There are formal courses available either at massage schools or there are local colleges that offer one day or weekend introductory courses to massage.

However, the internet has introduced a further options, namely that of learning massage online. Now whilst this can be a convenient option, studying Youtube massage videos should not be considered as a substitute for hands-on tuition. It is not possible to really understand the finer aspects of massage from a random video (that is not to say that there are not good Youtube massage videos by any stretch of the imagination – just that some are good and some are not so good and a novice may struggle to differentiate between the two).

There are a number of online massage courses and DVDs which are intended to assist people obtain an introduction into the world of massage. One of the more established online massage courses which could assist you improving your (and your partner’s) massage skills is:

If you choose to buy the massage course online and video workshop you’ll get

  • 15 Online massage lessons (video). This include the basic strokes and routines for parts of the body including back, neck, legs, arms, feet, head etc.
  • Basic anatomy relevant for massage.
  • Step-by-step massage instruction to attack critical hot spots of the body – key areas of tightness on most people that ‘demand’ to be released.
  • Tips on how to perform massage safely.
  • Hard copies of the full body massage sequence to make it easier for you to remember.
  • Member support and other helpful resources.

One of the beauties of massage is that the power of touch can be so strong that it is difficult to go too far wrong giving a massage even with minimal training. Rubbing your partner’s shoulders isn’t that challenging particularly as they will be instructing you on what feels good and what doesn’t.

Probably for most important people can learn from an online massage course is what doesn’t feel good and what are the most important massage contraindications. If you are interested in understanding more about massage then you would do worse than check out this course.

By Richard Lane

Massage Videos – Fun

There are many massage videos on Youtube, some provide good instruction, tips and advice. Others try to offer good instruction, tips and advice but fall short. Many are tacky and there are a few that are just good fun.

The videos below embedded below are a couple of my favourite humorous massage videos. If you have any suggestions for other ones to add to the list then please let us know.

How Not to Massage – “Massage from Hell”

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Tough Jobs: Massage Therapist to Models


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“Day in the life of a massage therapist”


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David Beckham massage prank

Disadvantages of being a mobile massage therapist

We recently wrote about the advantages of being a mobile massage therapist compared to working in a clinic or day spa. To balance that article, we are now discussing the corresponding disadvantages.

Traffic facing mobile massage therapist in SydneyNow many of the advantages could also be considered as disadvantages depending on your point of view. For example, I enjoy the flexibility and variety that comes from being a mobile therapist whereas others may perceive that the more irregular nature and the variable hours of the work are a disadvantage. The reality of mobile massage Sydney is that the majority of clients want their appointments in the evenings (often relatively late at night when kids have been put to bed) or at weekends when they have the time. Being out and about at night in locales that you might not be familiar with is not for everyone (and particularly female therapists need to mindful of their security).

Similarly it can be argued that calls for mobile massage need to be screened more effectively than clinics. If you are working at a clinic then it is likely that there will be people you can call on at short notice should ever the situation arise. When you are out and about on the road then, although you can always take security measures of making sure that someone knows where you are, ultimately you are on your own. This is particularly relevant if you take appointments at relatively short notice.

As a male massage therapist, though, this has never really been an issue for me and only occasionally have I arrived at a clients house with a sense of unease about the fear of the unknown. In virtually all cases when this has happened, my concerns have been unfounded and the clients have often gone on to book regular appointments.

The previous comments are relevant with respect to the disadvantages of doing mobile massage and should not be underestimated. However, for most therapists the number one disadvantage when compared with being in a Sydney massage clinic or day spa comes down to the logistics.
Traffic hold ups and delays can be stressful and add significantly to your total time for a given appointment.
Parking can be a challenge in some locations (such as when someone books in for a hotel massage in Sydney CBD). You may have to park a significant distance from the house/unit/hotel and have to lug your massage table, towels and equipment to the venue. Some clients don’t realise as well that if you have to park in a car park it can take a considerable time and effort to get to the room
Stairs. If you working in a block of units then if there is a lift you will be on the bottom floor, no lift top floor. Without fail.
Room layout and environment. You are working in someone else’s house. The space may well not be ideal for massage in that it is too small, too noisy or the wrong temperature. Unfortunately, whilst there may be steps you can take to improve your working space a little, ultimately you are governed by whatever the client provides. In a clinic, you can (normally) control the environment to ensure that it is conducive to the bodywork session you like to provide.
Limit to what you can carry. In a clinic you can make sure that there is all the equipment that you require eg bolster, pillows, blankets, heat pack etc. When you are working in someones home then there may be occasions when you simply do not have something that you could really do with. Whilst it may be possible to improvise, often once client is on the table you just have to accept that you may have to work in a sub-optimal way.

  
Ultimately if you consider yourself to be a mobile massage therapist, then it is just a case of accepting the disadvantages and working around them as best you can. If you only do outcall massages to occasional clients (and you would prefer not to do them) then many therapists will charge a premium to compensate themselves for the perceived hassles. However, effectively the clients make the ultimate decision, if the convenience of having a massage at home gives them a positive experience compared with the clinic then they will continue to rebook.

By Richard Lane

You should always Massage Distal to Proximal. Is this yet another Massage Myth?

Recently there has been significant discussion about the massage myths that are frequently perpetuated by therapists (and sometimes even taught in massage schools). For example, pregnancy massage being contraindicated during the first trimester and massage releasing toxins are myths that are in the process of being eliminated.

distal to proximal massage
Massage therapists are always taught that they must massage distal to proximal, from the extremities towards heart. The argument is that the bodywork can increase the back pressure in the veins and potentially damage the vein’s valves through undue pressure.

Although it may appear to be logical rationale, is there any evidence that massaging proximal to distal does cause damage?

If you can imagine a fluid filled balloon inside a second fluid balloon and apply a local pressure to the external balloon, then (without claiming to be a scientist), it is hard to imagine that there will be a significant increase in the local pressure of the internal balloon. Isn’t this the situation in say the hamstrings, the calves or the quads? Would applying a distal force in one of these muscle groups really cause an increase in pressure significant enough to cause damage to a valve in a vein, even if the therapist was performing a strong deep tissue massage?

Please note, I am not advocating that therapists throw out the mantra that you must always work towards the heart. It is always understandable that there should be caution with working distally with anyone who has varicose veins, risk factors for deep vein thrombosis, potentially weaker veins (ie the elderly), during pregnancy, etc. However, let’s say for reasonable fit and healthy clients, is it true that we can really damage their veins?

I’m struggling to find any evidence that it can and has happened.

There are those who argue that working in a distal direction can be effective in achieving your massage goals, particularly if you are performing structural bodywork or the like. If you are massaging with correct intentions and are in tune with the requirements of the client’s, then you should work in the directions that will get the best results for the client.

According to Art Riggs(1) there are significant advantages of working distally:

• Since most muscles attach proximally in order to exert force proximally, working distally lengthens short muscle fibers and fascia for lasting relief from contraction which limits joint function and causes discomfort.
• It frees and lengthens nerves that have shortened along with the muscles.
• It decompresses joints and releases tight ligaments for better osseous function.
• Possibly the most important benefit is that working distally helps train our clients to override protective holding and reprograms movement patterns as they release in the direction of lengthening and relaxation.

  
If you have never tried releasing soft tissues by working proximal to distal then maybe it’s time to consider introducing it to your range of massage strokes and techniques. Just be mindful of normal massage contraindications, what you are doing, why you are doing it and who you are doing it on.

(1) “Distal vs Proximal Work”. Art Riggs. http://www.abmp.com/textonlymags/article.php?article=91

By Richard Lane


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