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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

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

Therapeutic Breast Massage

Breast massage can be a contentious issue amongst therapists. Some promote that there potential health benefits through lymphatic drainage; others are less enthusiastic about any advantages of performing breast massage. Some are concerned about the personal nature of any Sydney massage that involves touching of breast tissue; others are more relaxed.

However, it must be mentioned that professional associations have policies regarding breast massage. For example, the Australian Association of Massage Therapists offers a policy development document on this issue at http://membership.aamt.com.au/lib/Journals/Summer06/AAMTbreast.pdf.
Within this document they state:

Massage therapists must recognise, accept and respect the right of every individual client to choose whether they wish to decline breast massage …..
Even when agreement with the client for the breasts to be included in a treatment is granted, it is entirely inappropriate and completely unnecessary to provide disproportionately prolonged massage to the area and that that the client is free to revoke that consent during the massage.

AAMT suggest that massage of the breast tissue is currently practiced in modalities of Manual Lymph Drainage, Lymphodema, Lomi Lomi and post surgical breast augmentation and when specifically prescribed by a Medical Practitioner. During a standard remedial or relaxation massage then there is no reason for the breasts to be massaged and the ATMS policy is that mammary glands should not be massaged and only professional techniques should be applied to surrounding tissues.

This last point can cause a little confusion from massage recipients though. For example, the pectoral muscle groups are often indicated when people have tension in their neck and shoulders. Tightness in the upper back muscles is often the result of excessively hypertonic pectoral muscles bringing the shoulders forward. Therapists may often feel that lengthening these muscles of the upper chest is important for improved posture yet to access these muscles then the therapist needs to work close to breast tissue.

Massage for the pectoral musclesThe picture to the right on this page of this page demonstrates a therapist performing a remedial massage technique on the pectoral region. It is easy to image that, on women with a larger bust, performing such a stroke for the pectoralis major and pectoralis minor muscles would be extremely difficult without touching breast tissue.

But this stroke would not be applying massage to the breast itself.

  
Therapists do need to be mindful of such strokes, explaining why they need to work in this area and soliciting permission from the client before commencing. The client also has the right to request the therapist stop should they ever become uncomfortable about the nature of the touch. Some therapists may ask the client to hold their breast to provide a physical barrier between the therapist’s hand and the breast.

As mentioned above breast massage in Sydney is not permitted within a remedial or relaxation massage. I have included the technique (with client permission) during Lomi Lomi massage. Within a traditional Lomi Lomi massage then including massage to the breasts is considered to be a normal part of the routine and whilst there is obviously no muscles within breast tissue, there are claims that it can reduce pain and stress in the chest.

Want Great Massage
– Then Speak Up!

If you regularly experience massage then you know the type of touch you like. Some people like point pressure, some people like flowing strokes. Some people like strong pressure (which they may refer to as deep tissue massage), others like a more gentle nurturing approach. Some people like different techniques and pressures for different muscle groups. Some people like different massages at different times depending on their mood and how their body is feeling on a particular day. Some people like a full body massage including massage to the glutes, abdomen and pecs, others prefer the session to concentrate on specific problem areas such as the neck, shoulders or back for example.

massageNow whilst many massage therapists may consider that they have a degree of intuition and may modify a particular session based on what they are feeling both physically and intuitively, unfortunately none of us are mind readers. We are only guessing how the massage feels for you.

To optimise the benefit you receive from your massage then there is an onus on you to communicate your requirements and preferences.

If there are techniques, strokes and styles that you particularly enjoy (or particularly dislike) then let your therapist know before the session. If there are parts of your body that you want included in the massage then please communicate that to your therapist (similarly if you don’t want particular areas included).

   
For me personally, I dislike being jabbed or prodded with point pressure with a sudden motion. It does nothing for me (and to be honest I cannot understand how it is supposed to improve the function of the soft tissue). But it is up to me to tell is to the therapist.

Once the session begins again if there is anything that is bugging you with the way the therapist is working, don’t just lie there but speak up. Tell your therapist that you want more or less pressure. Let them know that you would prefer more gliding/stretching strokes rather than acupressure style or whatever the case may be.

Although you may not wish to talk too much during your treatment, just a couple of comments to direct the therapist will go a long way to providing you with the bodywork you are after.

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

Sports Massage Does Work!

In recent years there seems to be have a move towards more evidence based practise for a range of practitioners. This is not a bad thing for the massage industry as many of the more spurious claims that are made can be challenged and dismissed. However, one of the problems that massage faces is that there is a dearth of quality research available.

There are a number of reasons why this is the case which include a lack of money when compared with the amount of funds available for pharmaceutical trials and also a fundamental problem with much of the research in the natural therapies domain in that designing standard treatment protocols is extremely difficult when most therapists’ practice is based on tailoring a treatment to an individual client’s needs at the time.

A 2012 study into the benefits of sports massage has attempted to redress the issue of quality massage research with findings that are encouraging for the industry.

Sports massage SydneyAfter a water skiing injury a researcher at McMaster University, Canada, Mark Tarnopolsky, found that massage therapy provided a significant amount of pain relief and he decided that he wanted to understand the underlying mechanism whereby massage aided his recovery.

Along with some colleagues, Tarnolpolsky decided to investigate why massage can reduce pain and the results (for massage therapists and for sports people) were encouraging (1).

For the study, 11 males were exercised to such an extent that they were affected by exercise-induced muscle damage after working out on an upright bicycle. One of their legs was then massaged for 10 minutes. The researchers took muscle biopsy samples from the participants’ vastus lateralis muscles at various times:
– at baseline
– immediately after the massage
– after 2.5 hours of recovery.

The results were extremely encouraging. There is strong support for the hypothesis that exercise can activate the genes which are associated with repair and inflammation and it was no surprise that the researchers observed there was significantly more indicators of cell repair and also inflammation in the biopsy samples post-exercise when compared with the pre-exercise measurements.

However, there was a clear distinction between the study participants’ legs that had been massaged and had not been.

They found that the legs which had received the 10 minutes of sports massage had:
– reduced the amount of exercise induced muscle inflammation by diminishing the activity of a protein, NF-kB
– increased by about 30% a gene that helps muscle cells build mitochondria, PGC-1
– modified levels of other proteins with similar roles in the body.

  
Although this is only one study and the massage protocol may not be relevant for all sports people, it does provide evidence supporting the use of massage therapy to reduce pain and encourage muscle repair. Further work would need to be carried out to assess the optimum pressure, length of massage and the commencement time after exercise.

But there are few who would argue that getting a massage to reduce pain from sport is a preferable alternative to anti-inflammatory medications.

(1) J. D. Crane, D. I Ogborn et al “Massage Therapy Attenuates Inflammatory Signalling After Exercise-Induced Muscle Damage”. Science Translational Medicine 4, 119ra13 (2012).

By Richard Lane

Carpal tunnel, pregnancy and massage

Carpal tunnel can be an extremely painful and uncomfortable condition that can affect anyone. However, during pregnancy the chances of suffering from carpal tunnel syndrome are greatly increased, particularly in the latter stages of pregnancy. The reason for the greater incidence of carpal tunnel syndrome during pregnancy is that there is greater retention of fluid (due to varying hormones during pregnancy) and that relaxin can soften the ligaments that form part of the carpal tunnel.

Carpal tunnel and pregnancy massageCarpal tunnel syndrome will normally manifest in the form of pain, numbness and/or tingling in the outside three fingers of either hand. In more extreme cases, the compression on the nerve through the carpal tunnel can lead to the forearm feeling numb. The fingers and the hands will feel weak and have poor grip strength and pain may radiate up the arm as far as the shoulder.

For pregnancy induced carpal tunnel syndrome the symptoms will be worse either during the night or first thing in the morning due to greater fluid retention as the arm is relatively inactive.

There are a number of steps to you can take to reduce the impact of the condition. These include:

  • Avoiding any task or action that causes pain
  • Elevate the affected arm to attempt to reduce the amount of oedema and swelling
  • Be aware of your posture. There is a tendency amongst pregnant women (+ office workers + people who drive a lot etc) to have their neck protracted ie their chin juts out. Even a little can add compression to the lower cervical vertertae so try to keep your chin back in a more neutral position.
  • Try to keep your wrist in as neutral a position as possible (some physiotherapists recommend the use of splints to maintain a neutral wrist while you sleep. If you are suffering from carpal tunnel from breast feeding then remember to bring the baby to the breast rather than move the breast to the baby and again be aware of your wrist position.
  • Some professionals may suggest modifying your diet (and/or lifestyle) to reduce your body’s general propensity for swelling

Massage for Carpal Tunnel Syndrome During Pregnancy
An effective massage for carpal tunnel syndrome is primarily aimed at reducing the amount of swelling in the arm through lymphatic drainage techniques and, when performed by a therapist who has a good understanding of the condition, it can be a highly effective treatment.

Routine for Carpal Tunnel Pregnancy Massage
This routine can be considered as being relevant for during pregnancy and also post-partum when the new mum can have wrist problems when breast feeding.

Start at neck with little or no lubrication and work very and gently. The movement of lymph at the level of the skin is the objective for the routine. Always proximal to distal with the order of the strokes but work each individual stroke in a distal to proximal direction. Stretch the skin and work down the arm all the way down to the hand. Again need to reiterate that the pressure should be very light as working deeply can be ineffective.
Repeat this series of strokes a few times.

  
Perform a lymphatic compression on the arm – scooping up and then hold each compression for a count of about 10. Pressure is still very light.

Compressive tissue release – keep wrists neutral and stroke down the forearm (both top and botton of the forearm) using thumb and fingers whilst applying traction to the wrist. This stroke can free up the nerve sheaves through the carpal tunnel.

If you feel that you need to stretch the fascia of the palm make sure that you keep the wrist in neutral. Work the joints of adjacent fingers in opposite directions.

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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Massage Strokes Using Active and Passive Movement

We have previously written about static massage strokes where there is no movement of the body part being massaged, http://www.innerwestmassage.com.au/blog/static-massage-strokes. For this post we will be introducing some techniques which incorporate either passive or active movement of a joint using similar compression and stripping strokes. Whilst these strokes are effective within a remedial, sports or deep tissue massage, it must be mentioned that not every technique will be useful for each massage recipient. Typically these strokes will require more pressure and can lead to some discomfort, although therapists should only ever work within the pain tolerance of the client.

Massage with active and passive joint movement
For many of the following techniques, whether the movement is active or passive makes little difference to the actual physical action of the therapist. The difference is more that a passive movement will bring about mostly physiological changes to the soft tissue whereas an active movement can introduce some neurological impact as excessive muscle spindle activity is reduced when a muscle is contracted. Another difference may be that an active movement may cause the client pain so from a comfort level a passive stroke may be more appropriate.

Shortening Strokes
Shortening strokes can be effective in dealing with trigger points, myofascial tension and some joint restrictions. They are performed by applying some static compression to the part of the muscle that requires bodywork and then the tissues are shortened/contracted either by moving the joint actively or passively. Generally for the start of the stroke the muscle will be in an elongated and lengthened state.
The philosophy behind shortening strokes is that by deliberately reducing the tension in the muscle through shortening then it may decrease trigger point activity and neuromuscular dysfuncationality within the muscle. If there is less tension on the muscle fibres while compression is applied then it may lessen the amount of neurological activity.
Often the end position of the joint and muscle after a shortening stroke will be held for an extended period of time as a form of positional release.

Lengthening Strokes
Often the primary intention of a massage therapist is to lengthen muscles that have been hypertonic through overuse or through a constant state of contraction due to poor posture. Active or passage lengthening strokes are a great way to achieve this objective as the mobilise connective tissue, reduce tension in the muscle and encourage elongation and lengthening of the muscle.
There a number of different ways to perform these strokes. A popular approach is referred to as “pin and stretch”. Static compression is applied to a particular point using a massage tool that is strong enough and specific enough to be able to hold the muscle in place as the muscle extends either actively or passively. The sharper the massage tool then the more intense the sensation for the client.

As an example of a pin and stretch technique for pectoralis minor then have a look at the video below.

The second common use of lengthening strokes is to perform a stripping stroke along the length of the muscle as the muscle is lengthened via active or passive joint movement. The muscle is put into a shortened state and then slowly stretched as the therapist strips the muscle. This can be referred to as facilitated lengthening. Often for larger muscle groups this stroke is repeated a number of times in parallel so that the entire muscle is treated.
The overall effect of lengthening during a stripping stroke is to magnify the intensity and the effect on the soft tissue. The trick to performing it effectively is to work slowly. The slower you work then the deeper you can penetrate without causing undue discomfort to the recipient.

By Richard Lane


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