Massaging the right places – not always where the pain is

Why is it that when you come in for a massage, your therapist will work on a different area first before attending to where you told her you are hurting or tight? Sometimes the therapist even starts working more on the wrong side of the body! Or when the therapist gets to where it is painful, she is not spending enough time there and go even deeper and harder. Does this massage therapist know what she is doing?  What is going on here?

Marisha Garcia, RMT

Marisha Garcia, RMT

Well, a massage therapist has to understand the reasons and principles behind why pain or tension has come to a particular area, and then treat the problem accordingly for the best outcome.  If your massage therapist can address the root of the problem, then the treatment is more effective.  Our modern lifestyle of too much chronic sitting and not enough movement causes wasting of certain muscles together with a lack of proper coordination that we took for granted when we were young and played naturally all day.  These daily imbalances accumulate over time and cause the body to not function in the best way — it can cause long term problems in the neck, and shoulders, and back especially.  Since posture is about how all the muscles are coordinated to allow proper stability and movement, a problem in one area can affect another.

An good example would when a client comes in with issues on his low back from no particular origin. I would ask if he sits for long periods of time; if so, I would investigate releasing the hip flexors that tend to become shortened in people who sit a lot.  Specifically, there is a muscle called the Psoas major muscle, and it originates from the 1st to 5th lumbar vertebrae, and goes through from the low back into the front hip bone of the femur. When I release this hip flexors before working on the low back, the pelvis automatically shifts for me — half my job is done! Now my job is easier in working to relax the back muscles. In this case I also work on the gluteal muscles of the hip to enable them to activate and work properly to stabilize the posture of the lower back when walking, picking something up, or holding good posture while sitting.  The ultimate solution is for my client to take advantage of the massage treatment and move his body more, taking frequent breaks from sitting, doing exercises that activate his core muscles, and quick walking a few times a day.

Another example is if a client has upper back issues with muscle tension. The therapist often observes a slight curvature in the upper shoulders and back, usually caused by poor posture (again, usually from too much sitting!) which elongates the back muscles between the shoulder blades (Rhomboids) and shortens the front pectoral muscles of the chest. To give the best release on those upper back muscles  which are loosing to the front muscles in a tug of war, is to massage to relax and lengthen the pectorals and front neck muscles.   By releasing the chest muscles it gives room for the rhomboids between the shoulder blades to bring the shoulders back into proper posture.  Homework for the client would be to stretch the front pectoral muscles and to activate gentle many times a day the rhomboids.  This will help him or her have better posture to sit correctly.

So if a massage therapist is mostly focusing on deep tissue massage just on the sore and painful areas, this may not be effective or therapeutic as working on releasing and/or activating areas that will normalize posture and efficiency of movement for the client.  So do not be concerned if a massage therapist works away from your pain before touching this main problem area; she is strategically achieving the best results by improving function.  Again, the ultimate solution is what you do with the treatment; how you move in the right way to maintain coordination and stability of your back and neck.

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