Potential Problems of Using Too Much Pressure

[maurice]

I have a regular client who always requests a tremendous amount of pressure when I'm working on her back, especially in the rhomboid area. I have worked with this client for over 3 1/2 years now and she has never once complained about having had any problems after any of our sessions.

She is obviously very satisfied with the massages she has received and has been such a consistent client that she hasn't gone longer than three weeks between sessions the entire time that I have worked with her. My concern is that she wants as much or even more pressure than what I give to my largest male clients even though she is only an average sized woman with very little body fat.

In one of my massage classes from many years ago, I recall an instructor saying that clients received the most therapeutic benefit when you are working at about level "8" on a scale of “1” to “10.”. This level was considered to be the most pressure your client could take before starting to experience any discomfort.

Since we work so deep during her sessions, I always ask for feedback about the level of pressure I am using on her back and she typically says that I am at about a level "7" or "7.5." I've been concerned for awhile now about potentially hurting her if I work any deeper than I have been even though she says that she can take more pressure.

In my 10+ years of doing massage full time, this is the only client that I have ever had this particular challenge with. I'm wondering if anyone else who posts here has had the unfortunate experience of injuring a client by using too much pressure even though the client requested the additional pressure and their pleasure/pain threshold was apparently not exceeded?

 

[G_Zidane]

I've never had the unfortunate experience of injuring a client with my deep pressure work. That said, I do believe
there are clients who are rather disassociated from their bodies, and it seems they either literally find it difficult to
"feel anything" on multiple levels, or that they simply have a
very high pain tolerance. The disassociation may come from a variety of causes, from either mental, emotional, physical or sexual abuse.

I'm also very careful to watch my pressure when working with anyone who is ill, or in anyway frail, and of course when working on those with little to no "extra padding/body fat". It's always good to ask the client for some feedback as to your pressure. Plus you don't want to strain yourself in the process of a session either, so varying your techniques and how you apply them is a good idea as well.

You may want to express to your client that it might be an interesting experience for her to recieve a gentler session and see how she responds. I always tell people I don't subscribe in the "no pain, no gain" theory, and that it is as important for me to take my cues from their body, as much it is from them speaking out as to how deep the pressure may feel.

 

[~C.b.~]

Twice in the same week, several months ago, a couple regulars reported bruises after some deep work. They both had requested more and more pressure, one of whom actual said she hesitated to tell me about the bruising for fear I'd hold back on pressure the next time. Yeah, I most certainly did from then on! I had been checking in with pressure, and they both had said it was fine at the time. I'd imagine someone would feel pain before they bruise...these girls were healthy 20-somethings, too, not elderly or with bleeding disorders. (Shrug.)

 

[Abdel]

FYI:

Some people bruise more easily than others, for a variety of reasons. Sometimes there are certain nutritional issues that are part of it, or there can be medical conditions which are factors as well.

 

[Baby Ruth]

I tell people that "No Pain, No Gain" is an archaic notion contradicted by the last 30 years of medical science and many more years of anecdotal evidence prior to that. Even as a personal trainer, I find no use for it in practice. Discomfort is normal, but significant pain experienced by a client should be incidental and unintentional, even when there is a reasonable expectation of it.

 

[*w0wZ* [mALiSSa]

Here's a pretty good older thread to utilize as a cross-link for other thoughts about deep tissue:

Should a massage hurt?

 

[Master Buz Lawson]

I would also say if your client "needs" regular, hard work on the rhomboids you may actually be making her overall structural condition worse. Check her pecs to see if they are chronically tight and pulling her shoulders forward. If so you'll need to work on loosening the PECS - not the rhomboids. "loosening" an already stretched muscle that is under such pressure could actually be making the chronic imbalance worse, instead of better. Search for information on "upper crossed syndrome" for more details.

It will never feel like enough becuase you'll be working the wrong muscle group.

Angela

 

[rabcnesbit]

I agree fully with Angela. Find the pain, look elsewhere for the cause. Repeatly treatming the same area with no lasting results, whether deep or light, tells one to open their focus and look elsewhere for the cause. Step back and check out the posture. Along the lines of Angela's response, are the shoulders pulled forward, placing the rhomboid region in a state of chronic overstretch? The anterior structure could quite possibly be the/a cause.

As for the depth of work, invite your client to try a different pressure. Remind her that the deep pressure has not taken care of the proble. If she refuses, you either bite the bullet and comply with her wishes...or tell her she might be better served by moving on to another therapist.

 

[mugwaffin]

I have been recommending a foam roller for clients' self care (I sell them at my shop). They can use them at their house to stretch the stubborn muslces so I don't have to work as deep next time.

http://www.power-systems.com/p-2469-foam-rollers.aspx

2 tennis balls in a sock may do the same trick.

Also yoga exrecises like the eagle pose would stretch the rhomboids.

I have a few clients who respond better to hot stones with less pressure than to extra deep pressure.

I agree with Angela about taking a look at other muscles.