ramping up to deliver deep pressure

[bhai_saddam]

Hello there. I just graduated from school and received my license and I had my first interview today. Given the fact I was (of course) nervous, I think it went very well. I got a job offer as an on call therapist for a very nice wellness center, with the possibility of being hired as a regular therapist when an opening occurs. Given the fact this won't be full time work for the foreseeable future, I will continue to interview, and have my next interview set up for Monday.

One comment I received from a clinic client when I was in my last semester of school was that I did not deliver the amount of pressure she preferred. I spoke with some of my instructors about this, and they encouraged me by giving me ideas on imagery to use (that you are swimming through the tissue) and telling me, as other therapists who are friends have told me, that sustained deep pressure is largely a matter of just building the stamina and strength. In any event, I know I still struggle with consistently delivering deep pressure when asked to by a client/practice partner/interviewer. I seem to only be able to sustain it for a couple of minutes. I also don't want to feel like I am "muscling it", b/c I don't feel that's truly the right way to deliver deep pressure. (It's more about leveraging your body weight, isn't it?) It may in part be strength and stamina, but I think a part of it is also just letting my mind wander in terms of not keeping it focused on the amount of pressure and reverting to my "medium depth" pressure mode, which is second nature to me. FWIW, I do also know that some clients seem to want unreasonable amounts of pressure, and this it isn't worth hurting yourself to meet this person's need, whatever it stems from. I don't think I have really encountered that yet.

So, I do have practice scheduled with a former classmate of mine day after tomorrow, which I want to use to prepare for my next interview on Monday. I don't expect to be able to completely solve my "pressure quandary" in just a few days, but I thought I'd turn here for advice from you all before Monday's interview. It is an important interview for me, because an acquaintance who is a MT there passed my resume on to her boss to hook me up with the interview, and it is a spa that is at the top of my list in terms of places I'd like to work. Having been out of school for 6+ weeks, I have not had as much hands on time as I would like during that period, but I am practicing as often as I can find a willing partner at home, either a classmate (makes for more meaningful feedback), or my husband. So, I know I have lost a bit of strength/muscle memory in giving massages during these past few weeks.

Any helpful tips on how I can improve the amount of pressure I am able to deliver for sustained periods of time? I typically do a good amount of work with my forearms, if that is useful to know. I used to work with the table low, but have actually started using a higher setting, which is more comfortable for me (I am 5" 9') and I don't feel has been detrimental to how I use my body weight. Is it just a matter of time? Any advice is much appreciated!

 

[MHMcHH #2]

ramping up to deliver deep pressure

With your height it's really a matter of learning to simply lean forward - keeping good body posture mechanics in mind of course - and working from your core -
leveraging your body weight through your arms & hands. And deep pressure is not something you need to keep up throughout an entire session - but rather apply as needed through the areas that require it, shifting between Swedish to start working your way into the depth of tissue appropriate to the region you're paying attention to. Be sure you exchange with other therapists as you can learn a great deal more about the subtle shifts in touch that occur just by a change in how the therapist moves. Sessions can be much like a dance & flow from one move to the next - but it takes time to get into a basic routine from which you can add in whatever is needed by the client.

99.9% of clients I work with generally have neck, shoulder & upper back areas which need considerable work - then there's the lower back region of course as well as the hips. Arms & legs typically not as much, though this will vary considerably depending upon the lifestyle of your client - if they're more sports oriented, runners & skiers, dancers etc. then they may need a good deal of work on the hips & legs. Musicians & hairstylists, for example, are often standing a great deal & would often appreciate more attention not only to the upper body, (especially points listed at the top of the paragraph) with special attention to their arms & hands, but also their lower back/hips & their poor tired feet. Someone who sits at a desk all day - using a computer, or who texts a great deal, may not appear to need much attention to the legs - but if their hips & quads are worked it really helps their lower backs, and working the entire upper back, neck, shoulders, arms & hands is very important.

When doing the case history, always ask the person you're about to work on what they feel they needs special attention, & what they've enjoyed or disliked from other sessions they may have received. If they're open about it, this will give you the information you need along with what your hands will pickup along the way. Let them know that when you are providing deep tissue/detailed work to give you feedback about your pressure & their comfort level. Many people think that deep pressure should hurt - but rarely does it need to, & shouldn't, unless it's of the "hurts so good" variety. That is unless your training is in some of the more intense Structural Integration work geared toward relieving scar tissue or other restrictions that require very specific work - some of that can be as intense as childbirth when you're on the receiving end! But thankfully the duration is much shorter

Give yourself a little time to gain experience & you'll find everything will come easier to you. Best of luck in your new career path!

 

[Bond 003 1/2]

ramping up to deliver deep pressure

Just a little more food for thought. If you're finding that you're expending a lot of energy to "go deep" or that you're getting tired or wearing out, ask yourself these questions -

Did you warm the area thoroughly?

Is the tissue ready/accepting the work?

Are you overusing a tool?

If you feel like you're fighting to get into the tissue, it might not be ready yet. You may need more time preparing the area, or maybe just calming the nervous system/getting the client to relax to make them more receptive. If I'm in a position where I don't have as much time to work the area as I'd prefer, sometimes I find that just compressing into an area steady and slowly, waiting for the tissue to give, can get me deeper quicker. I'll often do this with a forearm or elbow. Just sink a little and wait, then as the tissue gives, sink a little more.

That brings me to choice of tool. I was taught to prevent injury and burn out, whenever whatever tool I'm using tells me it's *thinking of starting to get tired* to change what I'm doing. If you're using fingers to sink into a trigger point and your fingers don't like it STOP and listen to them. Ask yourself why it doesn't feel good - are you pushing yourself too much? Should you switch to an elbow? A knuckle? Was the tissue responding, or does it need more preparation?

Yes, you will build up more strength and stamina as you go, but that doesn't mean that you should be pushing all your limits to get there. The last thing you want to do is burn yourself out just as you're getting started.

Good luck!

 

[Miss Behavin]

ramping up to deliver deep pressure

Just a little more food for thought. If you're finding that you're expending a lot of energy to "go deep" or that you're getting tired or wearing out, ask yourself these questions -

Did you warm the area thoroughly?

Is the tissue ready/accepting the work?

Are you overusing a tool?

If you feel like you're fighting to get into the tissue, it might not be ready yet. You may need more time preparing the area, or maybe just calming the nervous system/getting the client to relax to make them more receptive. If I'm in a position where I don't have as much time to work the area as I'd prefer, sometimes I find that just compressing into an area steady and slowly, waiting for the tissue to give, can get me deeper quicker. I'll often do this with a forearm or elbow. Just sink a little and wait, then as the tissue gives, sink a little more.

That brings me to choice of tool. I was taught to prevent injury and burn out, whenever whatever tool I'm using tells me it's *thinking of starting to get tired* to change what I'm doing. If you're using fingers to sink into a trigger point and your fingers don't like it STOP and listen to them. Ask yourself why it doesn't feel good - are you pushing yourself too much? Should you switch to an elbow? A knuckle? Was the tissue responding, or does it need more preparation?

Yes, you will build up more strength and stamina as you go, but that doesn't mean that you should be pushing all your limits to get there. The last thing you want to do is burn yourself out just as you're getting started.

Good luck!

Can I clap and jump up and down? What a wonderful post!

 

[Just-Me]

ramping up to deliver deep pressure

There are several good threads about self-care and physical/mental preparation in the Self-Care and Body Mechanics forum. Check it out!

 

[Brodo]

ramping up to deliver deep pressure

Thanks to all for the wonderful words of wisdom, which I am taking to heart! I have been able to accept a couple of on call assignments, and just getting my hands on people more frequently practicing at home as well has helped me feel more comfortable, now that I've been out of school for a couple of months and was beginning to feel "out of practice." I have been getting good responses to my resume and have an interview today and one tomorrow morning as well. The woman I am interviewing with tomorrow morning specifically referred to needing her therapists to truly be proficient in deep tissue work, so I really need to bring it tomorrow.

Thanks!

 

[Jesus]

ramping up to deliver deep pressure

Any helpful tips on how I can improve the amount of pressure I am able to deliver for sustained periods of time?

I wanted to mention, that when doing neck and trap work, you can also perform this sitting. If you position your stool in a way that the work is more effortless on your part, you will definitely be able to improve your pressure.

Below is an example of how I work the neck:

"Neck work is basically my specialty, so I can give you some ideas.

First, of course, one has to know the contraindications for your client and have background of the vessel anatomy.

I work the neck without any lubrication when I start.

Now, of course, all of this depends on the size of the neck, which muscles are "rolling", tight, tender taut, spastic, etc.

First, I decide by general touch where the problem areas are and consider the plan of action.

A good place to begin is at the sub-occiput. I use a very slow, firm and concentrated movements, usually with the fingertips or thumbs. Many times the occiput is very tight when you have these rolling muscles. I have seen that it can take a lot of treatment to release a neck, and if the client is continuing to do the same sorts of work habits that may be aggravating the original problem, one may be looking at six months of treatment at once per week minimum. Of course this is also dependent on how the body reacts. Sometimes I get good results in a few weeks.

When I work a neck, I always cup the head with my opposite hand for the majority of the work, and sometimes use this hand for better traction, movement, etc. - not just the "gentle hand of massage well being", like many people do.

I usually plan to spend an hour on the neck and traps. and working from the occiput to the area of concern. I look at the origin and insertion of the muscle. I work the posterior cervical musculature and then consider working the anterior musculature. I also look at the sternum and the clavicular area. All movements slow and methodic, and very very very (I cannot express how very) small, but intense in depth as tolerated. Mid-way through I consider some stretching with gentle and slow but persistent movements, usually blocking with the thumbs on the problem musculature origins or insertions with movement of the head as I do this (for a deeper stretch and compression to the affected areas).

You should definitely know your anatomy and if you don't, get a book and look at it while you work.

Most of the work I do is face up.

I like to finish off with lotion and smoothing movements with some stretching too.

I usually turn the client over and perform about ten mins. work on the traps, rhomboids and back up into the occiput again, unless they need more.

And, there are always the muscles of the head. Look at them close, see what is tight and tender.

All of my work is based on knowledge I have gained from having neck injuries and a lot of anatomy background."