Unresponsive clients

[curiouswoman]

Let me start off by saying that I'm a newer grad to massage therapy, so that may be part of my problem. I have been working on a client the last few weeks and she has shown no signs of improvement what so ever. Her main complaint is neck and shoulder pain. I have attempted stretching techniques, trigger point therapy, however today I was pretty astounded by her body's response to the last massage she received a week ago. I was attempting to stretch the neck and shoulder area through passive stretching and was met with quite a bit of resistance on the client's part. When asked if she was in pain, she said she couldn't tell I was even touching her. at this point I'm at a loss as to what the next step should be in treatment. Has anyone else been frustrated like this before? I'm not frustrated with her, i'm more frustrated that I can't come up with a plan that is going to help. any input is greatly appreciated!!!

 

[Pompal 09.]

Unresponsive clients

Is she working with a doctor? Has her condition been diagnosed? Has she undergone any diagnostic testing - MRI, nerve conduction testing, etc.?

 

[chance]

Unresponsive clients

I am sure that you have done an intake/history with your client.
While I have no treatment suggestions for you - there are just too many variables -
I CAN say in my experience that when a person's body is very protective and/or armoured (assuming there is no medical reason for the rigidity) that they always have a history of an accident or trauma.

I would even hazard a guess in your clients case of a past motor vehicle accident(s) with whiplash injury.
'course that's just a guess...

anyway - as Pete suggested - you need to know a bit more to help you treat this client and the first place to start is with a medical diagnosis - if there is one. Medical, surgery, and accident history is also needed.

 

[Keegan W]

Unresponsive clients

Oh - and if there are no contraindications for stretching,
I have found that post-isometric-relaxation (PIR) stretches to be more effective than passive or static stretches.
But there are several muscle energy techniques that you will be learning as you go besides that.

 

[Casey R]

Unresponsive clients

Since you are new, my 1st question would be are you working the deeper layers of the muscles? My experience with new therapists has been that usually do not make it past the 1st layer. i.e. they work the traps but don't get down to either levator or the splenius or capitus muscles.

It is also important to work slow and work specific.

Angie

 

[IWonder]

Unresponsive clients

Let me start off by saying that I'm a newer grad to massage therapy, so that may be part of my problem. I have been working on a client the last few weeks and she has shown no signs of improvement what so ever. Her main complaint is neck and shoulder pain. I have attempted stretching techniques, trigger point therapy, however today I was pretty astounded by her body's response to the last massage she received a week ago. I was attempting to stretch the neck and shoulder area through passive stretching and was met with quite a bit of resistance on the client's part. When asked if she was in pain, she said she couldn't tell I was even touching her. at this point I'm at a loss as to what the next step should be in treatment. Has anyone else been frustrated like this before? I'm not frustrated with her, i'm more frustrated that I can't come up with a plan that is going to help. any input is greatly appreciated!!!

Since I don't know anything much about this client, I'm just going to present some thoughts about the work you are doing and your experiences thus far.

Yes, pretty much every professional MT has experienced this. For whatever reason, you will have some clients that simply do not respond positively to your work, no matter what you try. This happened to me yesterday. It was frustrating for both of us, and I am doing some research into possible reasons for the problem and how I might otherwise address it in the future. I have already determined a few things I might do differently if there is a "next time."

A common beginner mistake is to go right to the areas that a client is feeling discomfort, in this case the shoulders and neck. If you just pound away at those areas and don't make progress, you might be wasting your time. I have much more success with those areas when I release the pec major and minor, SITS, serratus anterior, lats, and so forth BEFORE I attempt to address the neck and traps. I also often work with the client's hip flexors, anterior neck, glutes, and abdominals when treating chronic cases (not necessarily in that order).

Passive stretching is pretty close to useless, so you might want to look into Active Isolated Stretching, Muscle Energy Technique, and other forms of active stretching. The sooner you get the client actively involved in the tissue lengthening process, the sooner you will be successful.

More subtle methods such as Dermoneuromodulation, positional release, myofascial release, and joint mobilization techniques can be extremely effective even if the client is subconsciously "bracing" the area.

Trigger point therapy may also work, but you need to adapt your method of application to the tissues. Very hard, stubborn tissues may respond better to a softer touch. Trigger point techniques do NOT have to be hard, aggressive, or painful in order to be helpful. Instead of a static hold on the point, try slow, small strokes over and around the point. It's a subtle but more effective modification of the basic method.

STUDY!!! Massage school is elementary school. Don't believe that you learned much more than the very minimum needed to practice. If you want to be truly good, keep hitting the books and attending CE classes whenever possible to expand your knowledge. Constantly apply what you learn in your practice and see how your clients respond. Get hands-on training whenever you can, so that you better understand the feel and rhythm of a method. Especially study anatomy, physiology, and the nervous system -these are the things that every massage method is absolutely dependent upon.

 

[Tayler F]

Unresponsive clients

I traded with another therapist recently and I have neck issues as well. The benefits of massage typically does not last more than a day or two on my neck. This therapist worked my masseter with the intent to affect my neck. She worked very deep, sometimes to the point of painful. (I'm not a fan of painful work) However I immediately noticed I could open my mouth wider and my neck muscles were much more pliable. It has been 4 days and my neck still feels better!

 

[Zubayr]

Unresponsive clients

WOW, thank you to everyone for all the responses back. Update on the client in question:

after MUCH research and through speaking with this particular client, I found that she is a bundle of stress (obviously) and her body holds stress in many, many different areas. I am currently working with a chiropractor to help her with the issue at hand. new grad mentality is that everyone that I see is going to feel some sort of, for lack of a better term, relief after just one session of massage. This particular client did not experience that, and as a result, is the first time I had questioned myself and my abilities as a massage therapist. I may have forgotten that massage incorporates, MIND, body and spirit, not just body.

The good news: she is still seeing me ( ) and we have developed a professional relationship with open communication. At least that barrier is gone, and she in fact, has referred a few people to me because she enjoys the massage so much. The question I have now is, do some clients use massage at their outlet? they may not WANT, consciously or subconsciously, to get better for fear of losing their outlet for "therapy". I'm obviously not opposed to having a client see me regularly, but how do we, as massage therapists, continuously try new techniques to help these clients when they could be their own worst enemy on their path to wellness. I have since been able to assist this client in learning new relaxation techniques which have been helpful before the massage has even started. (we all, i'm sure, have met the client that has forgotten how to relax)
thank you again to everyone for the suggestions. Will keep studying and researching. take the national exam august 9th realize i have much work todo!

 

[Stevie mac]

Unresponsive clients

In my personal experience, it's an energetic issue more than purely just a physical issue. In many circumstances, the client will have issues that ARE solely caused by 'overworking' or misuse, but many others have lifestyle complications and energetic blockages throughout the body that THEY must heal and 'fix' themselves. you can absolutely help their bodies, but if they're unwilling to change the true source of their pain, there will be serious limitations on the work you are able to accomplish. how you explain this to your client is up to you....
bless!

 

[MilitaryPolicemen]

Unresponsive clients

My best and worst clients have been my friends. I've had a few who've come to me for weekly massages, but see little to no improvement in their day-to-day well-being.

In one case, I nearly had to browbeat a friend into communicating during a massage. I always tell my clients that I'll check in with them a few times during the treatment, but if they ever feel they need more or less pressure, just tell me. Any more than a couple of times per session, unless they wince, can become pesky. This one friend kept assuming that I just inherently knew how much pressure to use, even though I was consistently too light, and they'd tell me so afterwards. They're also incredibly ticklish, so I'd have to watch for signs of stifled giggles. This being a close friend, I had to fight the temptation to flip them off my table. They've since gotten better.

In another case, my friend wasn't making any changes to their daily life. They still slouched in one position for hours on end, despite suggestions to alleviate the strain it was causing. One simple option: keep a glass of water by your computer at all times. Even if you're not much of a water drinker, you're very likely to just automatically sip at it. This will force you to remove yourself from your computer every so often. When you do this, top off the glass of water. As long as you're sipping and not chugging every glass, there's no need to fear water intoxication. This method is also safer than keeping a bag of potato chips at your desk, but I suppose water isn't as tantalizing. You satisfy your munchies and don't need to move from your desk for several hours on end. :irked:

I've had other clients who fit your description, but it's something else when I can see the client saboeforum.xxxing all our work. I say "our" because it's their treatment and I'm the facilitator.

 

[Know It All]

Unresponsive clients

Very well said healingfaerie. I see quite a few clients and I can say that 97 percent of them react great to our sessions. The other 3 percent are a mix of those that have underlying physical conditions that they do not want to have attended to, those how will not change the consistent factors that are causing their issues and sadly some clients I feel don't want to admit that they feel better as a way to cope with other issues in their lives. Its this last bit that is the most frustrating. Just do what you can, work your best for the client and know your intent is always to help them to feel better.

Eric