“Refine your touch!” These three words of admonishment from a partner on my first day of Rolfing training were probably the best single lesson I’ve received in my bodywork career. I realized that my touch was, indeed, harsh; if I attempted to make things happen against the will of my clients and their tissue, my work was less effective and could be a cause of alienation rather than a rewarding and close connection.
Recently, I was working very deeply with a client in a particularly recalcitrant area when she suddenly volunteered, “You have such a comforting touch!” I was a bit surprised at such a nice compliment because I’m often concerned that I sacrifice a soft touch when I become over-focused on the outcome of my work, and I was concerned that I was approaching her pain threshold. So I asked her if she could explain what she meant. She responded: “Well, first, I always feel safe, so I can relax knowing that you know your anatomy and precautions and that you are always tuned into how I’m accepting the work. Mostly, your hands, elbows, and all your tools seem ‘soft,’ even when you’re working hard or very deeply, and you always let me determine how fast I can let go. Sometimes there might even be something that could feel like pain, but it seems necessary. I feel that it is more like the pain when my mother would remove a splinter—kind of intense, but really giving a feeling of relief and actually comfort.”
In a nutshell, she said what I’ve tried to teach for the past 20 years: the sensations your clients receive are a function of your relationship with them and their trust of your competence, the specifics of your mechanical skill, your sensitivity to their reactions, and the focus of your attention to removing tension in areas of holding.
Your Relationship With Your Client
Pain does not exist in a vacuum. Much of our perception of this sensation is influenced by context, as in my client’s analogy of removing a splinter. Of course, the mechanics of your techniques—including speed, pressure, direction, and depth of work —are major factors, but the context of your relationship with your clients and your intention can provide the confidence and feeling of being cared for that can make the difference between a tense struggle or a relaxed and easy session as your clients realize the benefits from a mutually focused commitment to solve problems.
Since our bodies and minds are conditioned to interpret pain as the messenger that says “Something is wrong here,” fear is often a primary emotion we deal with when working deeply with our clients. The first few minutes of your session can be your major ally in allaying the fear and bodily tension caused by this emotion. Following are some suggestions for consideration.
Establish Rapport
It’s crucial to build a relationship with your clients based on mutual trust and connection. Taking time to chat with them, especially if it is the first time you have seen them, can set the tone of everything you do in the session. Just a few minutes of relaxed conversation can let your client feel like a person you actually care about on a personal level, rather than a set of symptoms.
Cultivate Confidence
Incrementally introducing your skills and working style can help ease the process. Rather than immediately beginning work on sensitive or troublesome areas, address areas that will feel good to lower the fight-or-flight charge in the nervous system. Let your clients become familiar and relaxed with your touch in areas where they feel safe before venturing into more thorny territory.
Explain the rationale behind your strategies, especially in sensitive areas, and communicate that you realize the area may sometimes be uncomfortable and that you appreciate how they are working with you. Intense therapy with a clear intention will be perceived very differently from work that appears to be insensitive and without a purpose.
The most important gift of trust you can give to your clients is the knowledge you will stop immediately if they ask you to. However, there is a delicate balance between being receptive to feedback and relinquishing your control of the session and appearing to be less than confident. Constantly asking your client if the work is too intense can call attention to the issues of pain. The client should be able to relax with confidence in your sensitivity rather than having to be overly vigilant in giving feedback.
Err on the side of caution rather than overworking and having to interrupt the flow of the session by frequently stopping work and having to regain the trust and relaxation of your clients after overstimulation. Very often, if you sense that your client is tightening against your intention, it best to not suddenly interrupt the stroke. The speed at which you are working is usually the culprit—just slow down, slightly ease up on pressure, wait for both of your energies to mesh and then continue.
The Intangibles
It is important to realize that your mind-set can determine the quality of touch as much as your specific biomechanical techniques. Probably the single most important cause of work being perceived as painful or too intense is working too quickly. Often, therapists feel a generous sense of urgency to get too much work done or cling to routines that emphasize covering the whole body with equal attention to all parts. They may end up spending unneeded time on relaxed areas and rushing on areas of holding. Many therapists report fear of clients feeling shortchanged if they don’t perform a full-body massage. Although educating clients about the benefits of detailed spot work is helpful, it is also possible to have the best of both worlds by simply educating clients on the advantages of longer massages that leave enough time for a thorough unraveling of the client’s holding patterns while still covering the entire body with varying degrees of focus depending on the need.
Wasted or ineffective strokes take precious time from the areas that need additional and slow care and can spell the difference between work that feels good at the time but doesn’t leave lasting benefits or a session that brings significant change. Consider increasing your effectiveness by overcoming some of the following common habits that waste time.
Superficial Strokes
Do you take up too much time at the beginning of the session with superficial strokes in order to relax clients when their tension and holding patterns are deep? Related to this is an overemphasis on warming up tissue. Of course, we don’t want to just dive in, but I often see therapists warming up tissue that is superficial and unrelated to actual tightness: spending inordinate time working on the gluteal muscles when the actual tightness is in the deeper rotators; working on the gastrocnemius when the soleus is the problem; or warming up the pectoralis major when the tightness is in the pectoralis minor. I frequently see practitioners spending excessive time on the external abdominals and then diving in too quickly to address the psoas, which is a totally different muscle and layer of the body.
The key is to slowly sink vertically to the layer of the body that begins to push back against you and then work horizontally at that layer to lengthen short tissue. You will benefit the more superficial areas at the same time you focus your attention on deeper areas. By the same token, don’t be too attached to long, mechanical strokes performed with the same speed and pressure. Individual muscles have great variation in where their restrictions lie. Move quickly along relaxed sections of long muscles like the hamstrings, quadriceps, calves, the erectors, the I.T. band, and arms so that you can slow down and do focused, repetitive strokes in isolated areas of tightness along these areas.
Equal Time
People hold tension in very different spots of their bodies, often with vast differences from one side to the other. Each session should be a bit of a treasure hunt looking for the gold of hidden tension. Relaxed tissue can receive great benefit from quick work that enables you to concentrate on other areas. So that clients understand why I may be spending less time on an area, when I encounter an area that needs minimal work, I often explain, “This leg feels relaxed and fluid … I won’t need to spend as much time here, allowing more time for the shoulder that bothers you.”
Forced Results
We massage therapists are a generous lot when it comes to wanting to give our clients the best and most helpful work possible, sometimes emphasizing our objectives at the expense of comfort. Attempting to give too much benefit or offer miracles can make us work too hard and actually overstimulate our clients. Even with the best mechanics, we also can try too hard, which will give our touch an abrasive nature as well as create unnecessary strain in our own bodies. If you find yourself shaking or feel stress or pain in the joints of your hands, shoulders, back, or legs, then you are working too hard. It is important to choose realistic goals and work within yourself, even with those clients who crave intense work.
Cultivate Sensitivity
The threshold where your work becomes too intense for your client to relax is variable between individuals and also between different areas on a single client. The key to providing effective but pleasant work is to hone your awareness of the subtle preliminary signs of resistance to your pressure that precede crossing the threshold into pain. Even if you feel less effective in your strategies, it is much better to hover at a level safely below the pain threshold rather than risking overstimulation and the disruption that stopping a stroke causes in the smooth flow of your session. Of course, it is an option to have clients inform you when you are working too hard, but then it is usually too late and they aren’t able to relax with confidence if they need to be vigilant.
It helps to have some tools to gauge client reactions to your work. A one-to-10 scale is a safe way to begin until you hone your nonverbal sensitivities, but has the drawback of some clients becoming too involved in controlling the session rather than relaxing. Trust that you will know their limits. Some people are afraid of being wimps and it is important they feel perfectly relaxed about communicating their limits. When I occasionally use this technique, I explain that I never want to cause pain, which I arbitrarily define as “around an eight.” Of course, one person’s five might be another’s eight, but the number is high enough for people to feel like they aren’t being overly sensitive. Most important is to have them tell you when they are at a seven, so that they are comfortable, but don’t have to worry about your applying more pressure.
Basics of Pain-Free Work
The following guidelines can help you modify your work in ways that may be more appealing for your clients—and you.
Use Minimal Lubrication
The goal of most deep structural work is to stretch short tissue rather than just applying pressure and squeezing. I prefer the term grabbing rather than the increasingly popular term hooking, which can imply a harsh or overly aggressive intention, thus contributing to the misperception that deep work needs to be painful. Using too much lubrication requires significantly more unpleasant pressure in order to grab and stretch short tissue rather than sliding over adhesions and other holding patterns.
Move Slowly
Most often when people complain of painful bodywork, it is due to strokes moving faster than the tissue can adapt to and relax. Imagine you are pushing a heavy boat away from a dock. It takes a while to conquer inertia with slow steady pressure. When you feel the tissue melt, that is the time to lighten your pressure and let the tissue dictate depth and direction of release.
Pace Your Sessions
Although my early career motives were well-intentioned, as a goal-oriented person, my greatest sin in my early practice was trying to accomplish too much. I wish I could give recall notices to my early clients as I watched them levitate off the table as a result of my overgenerous attempts at being a miracle worker. Make your sessions a journey rather than a destination and don’t become too attached to the outcome of your work. It also helps to clarify your goals with reasonable expectations. Some therapists appear to be trying to win an argument with stubborn holding patterns, rather than having a give and take dialogue and allowing for the great educational benefit of voluntary release on the part of the client rather than coercion.
I have learned a great deal from going to yoga classes. In some poses, when I’m sweating bullets and considering crying out, the teacher will sometimes say, “We only have 30 seconds left.” Suddenly, my perception of overwhelming pain dissipates as I realize that an end is in sight. I relax and move to a new level of release.
When you feel that your clients are working with you for important release but are on the edge, let them know you are aware of and grateful for their cooperation and that relief is around the corner. The very tension of conscious withholding is often the last obstacle in the way of dramatic and lasting change, so lightening up in force and speed may be all that is needed to achieve that last release.
Sink vertically, then work
One of the biggest errors I see is when therapists “sink and work” vertically at the same time before encountering the layer where they want to work and before the body can adjust. Slowly sink through superficial tissue at a fairly vertical angle until you encounter resistance and then alter your direction obliquely. Once you decide to work obliquely, only apply as much force as is necessary to grab the tissue and stretch it. A common error is to apply too much pressure so that the muscles actually contract out of discomfort, thus negating your efforts to teach them to relax and lengthen. Imagine pulling on a rope in a tug of war—you only need enough pressure in your grip to hold the rope; any additional pressure will only cause tension and waste energy.
Allow for Rest
A friend once gave me some excellent advice: “In life, as in music, the rests are as important as the notes.” I apply this wisdom to my sessions. Intense work has a cumulative drain on the nervous system and the energy of the client to cooperate. When performing intense work, I give frequent short breaks where I actually just break contact, or I lighten my touch or do feel-good work to nearby areas. This allows for a rest and the chance to evaluate, appreciate, and solidify the good work you have performed. It is difficult for the gelatin to set if it is constantly stirred.
Work Toward the Core
The areas that need the most work are often the most defensive and have a lower pain threshold. You can gain the trust of your client by beginning work in less sensitive areas on the periphery and extending the relaxed area into the core of holding rather than starting at the epicenter.
Contact Large Areas
Use your non-dominant hand to broaden your contact; this gives the brain some other input to consider and can actually direct attention away from sensitive areas.
direct your strokes
Students who often cling to earlier Swedish or Esalen massage training—where the emphasis is on working distally to proximally—may conflict with therapeutic goals of distracting joints and lengthening muscles away from their origins. I have my students apply the same pressure to sensitive areas and they are surprised how much more comfortable the stroke feels when moving in the direction of muscle lengthening (usually distally). Applying significant force to muscles such as the quadriceps, hamstrings, iliotibial band, rotators, and gluteals in the direction of lengthening allows them to stretch and relax, rather than buckling them into a shortened position.
The issue of pain is emotionally charged, both for our clients and ourselves. It is important to realize that pain, albeit with lots of real, variable, and emotional considerations, also has a great deal of cultural judgment. I see absolutely no purpose or benefit from imposing unnecessary discomfort in a session. However, fibrosed tissue or long-held contraction may need considerable patient force near the threshold of discomfort. Don’t berate yourself if you occasionally overstep the limits of your clients’ sensitivity. As my Catholic friends remind me, “It isn’t a sin unless you enjoy it.” For intense work, a careful dialogue—both with your touch and your unique relationship with each person—of communication and negotiation (rather than coercion) in intense work can spell the difference between an overcautious lost opportunity and profound release.
Art Riggs is the author of the textbook Deep Tissue Massage: a Visual Guide to Techniques, which has been translated into seven languages, and the acclaimed seven volume DVD series Deep Tissue Massage and Myofascial Release: A Video Guide to Techniques. This article is part of an expanded chapter in an upcoming textbook edited by Erik Dalton. You may visit Riggs’ website at www.deeptissuemassagemanual.com.