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PNF Stretching

PNF stretching is considered to be the most effective way to increase static flexibility and is a combination of static passive stretching and isometric stretching. PNF stands for Proprioceptive Neuromuscular Facilitation and was first developed as a treatment for paralysis patients.

PNF stretching is usually carried out with a partner who provides the resistance for the isometric contraction although it can be done without a partner (but generally will be less effective). If using a partner, then it is important that the partner be attentive and focused.

Pnf StretchingThe most commonly used PNF technique is the “Hold-Relax” which is sometimes referred to as the “Contract-Relax”. The muscle is stretched passively towards the limit of its range of motion and then the muscle being stretched is isometrically contracted for 5-15 seconds after which the muscle is relaxed for a couple of seconds before being subjected to a passive stretch which should be greater than the initial passive stretch. This stretch is held for around 10-15 seconds before repeating the PNF stretch one or two more times.

PNF Stretching Examples: Hamstring Stretch
For an example of a PNF stretch, then the person being stretched lies flat on their back with one leg bent at 45 degrees and the other leg extended straight. The partner lifts the straight leg until a comfortable stretch is felt through the hamstring (nb partner just supports the stretched leg and does not push). This stretch is held for 15 seconds.

The stretchee should then isometrically contract the hamstring against partner’s resistance for 5-15 seconds, relaxes and the partner gently guides the hamstring to a deeper stretch. This is repeated a few more times until there is no further increase in range of motion.

Brief PNF Physiology of Stretching
Muscles spindles cells located within the muscles, protect the muscle from injury. They sense how far and fast a muscle is being stretched and when activated produce a stretch reflex. This reflex causes the muscles to contract to prevent overstretching the muscle.

Located within the muscle tendon is another sensor called the golgi tendon which senses how much tension is being put upon the tendon. When the golgi tendon is activated then it relaxes the muscles (unlike the muscle spindle).

A voluntary contraction during a stretch increases the tension on the muscle, activating the golgi tendon organs more than the stretch alone. So when the voluntary contraction is stopped the muscle is inhibited from contracting against a subsequent stretch. PNF stretches uses this to take advantage of the sudden vulnerability of the muscle and its increased range of motion by using the period immediately following the isometric contraction to train the stretch receptors to get used to this new, increased, muscle length. This is accomplished by the final passive stretch.

Some General Recommendations for PNF Stretching

•Leave 48 hours between PNF stretching routines
•For each muscle group complete 2-5 sets of the chosen exercise
•Each set should consist of one stretch held for 10-15 seconds after the contracting and relaxing phases
•PNF is not recommended for anyone under 18 years old
•A 5-10 minute thorough warm up is recommended before performing PNF stretching as a separate exercise session.

While most of us could obtain benefit from the improvement in flexbility that PNF stretching can bring, there is some conjecture amongst sports professionals about the effective of stretching in general to reduce the risk of injuries and to improve performance. Although there is some conflicting evidence reported, on balance research literature reviews such as reported by Thacker et al (1) support the hypothesis that routine stretching has little impact on reducing total injuries amongst competitive or recreational athletes.

  
However, research has also found that pnf stretching may lead to improvements in running mechanics. Caplan et al (2) concluded from studying rubgy league players that stretch training at the end of regular training is effective in improving running mechanics during high velocity running.

As with all stretches, only take a PNF to the limit of what feels comfortable. Pain is an indication that you are overstretching.

In addition, there are advantages and disadvantages of PNF stretching and it may be worthwhile discussing these with a suitably qualified sports therapist.

(1) Thacker SB, Gilchrist J, Stroup DF, Kimsey CD., Jr. “The impact of stretching on sports injury risk: a systematic review of the literature”. Med Sci Sports Exerc. 2004;36:371-378
(2) Caplan N, Roggers R, Parr MK, Hayes PR. “The effect of proprioceptive neuromuscular facilitation and static stretch training on running mechanics.” J Strength Cond Res, 2009, 23: 1175-1180

By Richard Lane

Deep Tissue Massage Sydney

If you check out any website of a massage clinic or service that offers therapeutic massage then the chances are that they have listed “Deep Tissue Massage” as one of the services that they offer. It may be listed separately or in conjunction with other massage modalities such as sport or remedial massage.

It is not unusual that the price for a Sydney deep tissue massage is quoted higher than for a relaxation or Swedish massage (or even remedial massage).

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deep tissue massageThe use of the term deep tissue massage causes much discussion in the massage fraternity and there are therapists who believe that deep tissue massage = deep pressure massage and this is simply not the case. Whilst most therapists would concur that it refers to the massaging of the deep layers of the muscles, the massage strokes and techniques used in a deep tissue massage will vary depending on the training and preferences of the therapist.

This is purely my opinion but those who have received specific recognised training in deep tissue massage will work slowly and with intent. They will use a wide range of massage tools to work through the superficial layers of the body to reach the deeper muscles and soft tissues. Although the massage can be a little intense at time they are not necessarily using a great deal pressure as by working slowly then it is

Those who have not received specific training may not have the same level of understanding and believe that deep tissue massage means using a lot of pressure. Indeed many clients believe that a deep tissue massage is by definition a strong massage. As such these therapists often use more body force and energy to achieve their goals and this may be the reason why they charge a greater price for their services if they believe that they cannot do as many deep tissue massages in a day compared with relaxation.

Recently this issue was discussed on Facebook and below are some of the quotes from therapists regarding the a discussion about charging differential prices for deep tissue massage. There are certainly some differences of opinion!

We don’t, but I have considered it. When you are massaging a Lions football player, it’s hard work no matter how good your mechanics are!
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I certainly come out sweating a lot more doing deep tissue than just a traditional relaxation swedish massage… especially if I am working on an athlete!
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I’m going to go ahead an entertain this subject. Each individual has a RIGHT/PREFERENCE to charge however & whatever rate they choose. It baffles me that MTs want a justification for what others do in their own private practice or Spa. But to tickle your fancy…..rather seeing as charging a client a higher rate for Deep Tissue, I see it as offering a discount to a modality that is less cumbersome. Some may see it as charging a higher rate as being ‘unfair’. Well, my deep tissue is $80 per hour. Sure I can charge one flat rate. But I would much rather charge $60 for Swedish given the fact that is IS less taxing for me and my team. So you see, where others may see it as charging a higher rate for Deep Tissue, I consider it as offering a discount for Swedish. In summary, ‘I don’t charge MORE for Deep Tissue, I charge LESS for Swedish & other modalities.’ 😉
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I charge $5.00 extra for deep tissue. It’s more straining on my hands and requires more effort which intern I take fewer appointments. I’ve never had a client complain about the increased price either. So for my practice it works.
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I work on a body builder with layers and layers of muscle….that’s justifiable for the rate increase on deep tissue. He’s a regular client, if my body mechanics were off, I would be a mess and I wouldn’t be able to get through those layers of muscle that are “deep” requiring me to work deeper.
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Exactly. I have great body mechanics (although could always use improvement in some areas), but saying a deep tissue is as easy as a swedish is minimizing the work of the therapist, IMO. I actually find it a bit offensive. I find Swedish massage quite easy on the body, but deep tissue takes more work. Especially sports massage on a huge, solid, muscular man. We must all be doing it wrong, then?
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For clients to continue valuing massage at a healthy level, I agree with charging more for deep tissue styles of bodywork. There is greater usage of the therapists’ body and more detailed knowledge of anatomy is needed as well. Swedish massage is primarily meant for relaxation, any therapeutic massage beyond this demands more effort whether for realigning the body or clinically oriented bodywork.
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good body mechanics can not alone compensate for the overall wear and tear on your body, I’m not sure how your neuro clients are but I have very large men, ex NFL and some MMA, plus I customize product usage for the massage style, swedish gets just biotone bought in bulk and some essential oils, neuro gets joint and muscle cream and usually sombra at minimum plus for deep tissue I almost always use aids like hot rocks, bamboo or other to help my get get started, that adds cleaning cost and product wear, my neuros are more in depth plus I utilize additional education and incorporate some gentle tai yoga stretches to further the effect. So I have listed 3 of my main reasons for charging for and 2 of them are not wear and tear on my body, although for me that is #1.
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i don’t charge more for DT, but I do offer a seniors’ discount. I do, however, charge more for Hot Stone massage because it takes 15-30min of my time to clean them afterwards, and I charge more for spa treatments that use product, so that I don’t lose money on the deal.
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In my practice I charge more for deep tissue/clinical work. Swedish massage doesn’t require the brain power that assessment and clinical approach requires, as well as the physical effort if you are moving limbs, checking ROM, doing PNF stretches, and the like. Swedish is generally the first thing taught in massage school as far as hands on work. Myofascial, Trigger Point work and more advanced modalities do cost a lot to learn. If you took classes for prenatal and wanted to charge more for those sessions, that is your right as a practitioner. People will pay you what you are worth! If you have expertise in other modalities, price them how you feel is worth that expertise. Don’t under sell yourself. You know the benefits which you provide!
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I charge for my time and don’t have different charges for different treatments, but that’s just how I like to run my business. If another therapist wants to charge more or less for different treatments that’s their call.
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One of the toughest clients I’ve worked on recently is a challenge. Though I’m well trained in deep tissue body mechanics this client has the toughest fascia I’ve come accross. After doing 2 hours of deep tissue, the nxt day I’m sore but I still don’t break a sweat unlike some of my coworkers lol. If someone wants to charge more for deep tissue that’s their choice so we shouldn’t judge or think of ourselves more highly. We are all different.
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I really like therapeutic body work so feel free to send all those tuff ones to me. its all in the mechanics folks. I will send all my Swedish clients
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I do charge more for both deep tissue and for pregnancy massage as I had to acquire additional specialized training for my prenatal certification as it involved more extensive/ different studying and training of anatomy, trigger points, contraindications, etc. Taking into account the different positioning, consort considerations for the client in the later stages, much like deep tissue there is a different use and exertion of my skills level of work and body mechanics used. Unfortunately many people treat prenatal as just Swedish in a side-lying position and many who perform prenatal in spas are NOT properly trained or certified to do so IMO watching a 30 min home video does not a certification make, And I also agree w/ Jennica, how are we ever going to be expected to be taken seriously if we’re always discounting all over the place – I feel this is one of the primary reasons a lot of people have difficulty seeing our service as a necessity or compliment to their health and wellness and continue to view it as a ‘treat’ or ‘luxury’. It may be hard to admit but there is a certain expectation of quality and competence that comes along with competitive pricing. When your pricing is always cheap or discounted – that’s how your work is viewed as cheap.
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I sometimes wonder if the LMT’s are doing deep tissue or deep pressure when they talk about being worn out after doing it. i find that the deeper tissue that i work on the lighter pressure i’m actually doing (sometimes confusing to my clients which is the perfect chance for me to educate them on the difference). i have had many / most of my clients tell me they’ve never had a massage like i do – i combine many “techniques” — swedish / rom / pnf / trigger point / deep tissue – basically what ever they’re body is telling me it needs. i’ll work on all the “tough” clients that you want to charge extra for and i’ll send you all my “swedish” clients – i almost want to charge extra for that since it stresses me out to do only swedish – if i find a knot or something – i want to work it out to benefit my client!
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In my area I have seen them charge more for prenatal than deep tissue!
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deep tissue is more specialised and carries with it more “risk”, more on costs and more effort (both mental and physical). I charge less for Swedish because it’s simple and easy to do – to me, it’s like meditation. Remedial is a worthy challenge. And those of you who swear “it’s all body mechanics”, get over yourselves and get some experience with professional athletes (esp footballers) before you make your judgements.
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Here’s another thing I wonder about as well….in spa’s well, in most spas – they almost always upcharge for evvvvery little ‘extra’ thing, most of which we use anyway – paraffin, aromatherapy, bio-freeze, wrapping/ taping, etc. Why are those charges NEVER questioned in fact most people are happy to pay the difference w/o giving it a second thought, but as individual practitioners, we are nickeled and dimed to death about why we charge this and why we charge that – I promsie you I believe its a direct effect of the group-on syndrome – why pay full price and actually COMPENSATE the therapist for his/her time/effort/energy/skill, when you can just wait for the next dirt cheap discount!
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I’ve been doing “deep tissue” for 20 years. I charge more because if you need deeper work, my education and experience is worth paying for. Deep work can be anything from deep muscle therapy, fascial work or craniosacral work. When the person’s body is ready for Swedish maintenance work the fee is adjusted to the lower price. I have also worked on my body mechanics constantly over he years so I can continue to give people massage therapy, no matter what type of bodywork they need. I do have to say, when I have somebody on the table who needs pure physical strength to get what they need, I am very happy that I am making more money.
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Seems difficult to charge more for a service if it’s based on the reasoning of extra effort…that would mean we have to charge more for an OBESE client and bulky athletes, and LESS for skinny minny and the cyclists/runners who are thin (but still athletes).

As for training, all clients benefit from training, not just what ever style chosen for the session.

Products? Absolutely charge extra. They cost extra. Aromatherapy oils are expensive!
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The salon I work at charges more for deep tissue than Swedish (the former receptionist set the prices. She was not an MT, but shes had massages in the past making her an expert {I hate people like that}). Most people I see there want relaxing with deep pressure. If they really want deep tissue, I will do it at the regular price of the Swedish (it doesn’t matter to me). In my out call business, I charge different for relaxation and therapeutic. Relaxation is easy to me, and some people just want to relax, which is fine. I charge more for therapeutic because it does take greater knowledge and training. I have never had anyone complain.
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I myself do an integrated style of massage, using many different techniques in a single session. As others have stated , deep tissue is harder- but using leverage, and for Pete’s sake, slowing down makes a world of difference in how much pressure you have to use, how uncomfortable it is for you and the client, and how sore they might be later. There are a lot of good arguments here, and I think all of them are valid. I charge for my time. Deep tissue takes longer, or else it will only be a targeted session, not a full body. So for me, it all equals out. Each therapist has to decide what is ethical and appropriate for them. There just isn’t one right answer to this question. For instance, I do quite a bit of deep tissue, and some of it isn’t about pressure. But, I don’t have any football players or body builders. Everyone’s clientele is different, and you have to look at that….

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I charge exactly the same for all my work. I charge by the time, with different rates for half hour, hour or 90 minute massage. I don’t feel that the patient can know in advance what kind of treatment they will need – we make that decision after I have done the intake and assessment. I treat based on what I find and what their needs and goals are. I do whatever techniques are most suited to helping the patient — I don’t do more or less based on what they are able to pay.
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I charge by time & modality and I have never had a client be upset or argue with me about my rates once I explain that the more specific the massage, the more detail is involved. I charge a higher rate for PreNatal than Deep Tissue or Sports. Everyone’s rates are their own choice. I have chosen to value my services & professional liability accordingly.
Any therapist who is practicing should have liability insurance at the least even if they are in unregulated territory. Having said insurance and/or credentials is an automatic need for CE to maintain these. Some therapists will spend more on CE while others will spend less. If you are one to spend more, then charge more for your sessions across the board. Deep tissue techniques are not hard on the body if you are truly applying proper technique and body mechanics. Please send me the “toughies”….deep tissue rocks!
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i work deep tissue in preventive injury and injury treatment, i work with professional mma fighters, pro lacrosse players and at boeing on the factory workers who build the planes, many of these people dwarf me in size and their strength as athletes which demands a intense amount of work in a short amount of time. i work with people who out weigh me by 150 and up. and the most time i have is a half hour to be effective and 15 at the shortest. it is very different than Swedish even with proper mech. this has been my experience.
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It is just a business and marketing tactic. You can do whatever you want really. You could charge more for pregnancy massage or different rates for any type of massage really. why not?
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Personally I can’t be bothered trying to charge for different services when it comes to massage. I charge for my time and skill. If you want spa services they are charged accordingly.
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I think it is a personal choice on what therapists want to charge. I myself mix my techniques…if I do massage at my house for friends that come over I just charge one price. Also at the Chiropractors we charge one price..I just find that its easier to just stick with one price.. and tell them I do my consult and then from there create my massage based on what I think is best for them..esp. depending on what they do for work. I don’t think you can compare Swedish to deep tissue.Swedish is long flowy strokes and I feel lazy doing them lol and just feel like I’m rubbing in lotion. I do deeper lunges and I feel like cross fiber work does make me sweat. Especially when I do a lot of my forearm and elbow work.. I am def using more of my body and more effort. But sometimes I believe it all falls on the therapist.. I’ve gotten many massages.. and sometime’s I find myself thinking.. that felt lazy.. or wow.. now that he/she has moved on to my right side of my back I can feel the difference on the other side already! Some people just put more effort into their work.. and I believe they deserve to charge a higher rate! 🙂
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I charge a bit more for specialties, such as prenatal, hotstone, lymph drainage, ashiatsu etc – modalities that require special training and/or extra equipment. I charge the same price for THERAPEUTIC massage, be it swedish, deep tissue, trigger point work, or a combination of all. Massage Nerd is correct. We should all know how to give proper pressure to each body using proper mechanics and not feel we need to charge more for clients who may or may not feel what you felt.

  
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imho, if a therapist has invested time and money to learn advanced modalities then it is justified to adjust the fee accordingly.
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Deep tissue requires more work for the MT, physically and thought process as well as training. And yes, it can be taxing despite proper body mechanics. I don’t book as many DT clients in the same day as I would swedish. I think blaming the ability or lack of on just body mechanics is very inaccurate. For the record I charge a flat fee regardless of the tyoe of massage.
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