Many of my clients report having less pain and feeling “better” after a session. While this is very comforting, a question is often posed about why manual therapy yields different results compared to other examples of self care. Surely the pressure applied through massage therapy is not so different from a foam roller. While I always encourage self care through stretching, foam rolling, and hydrotherapy, the fact is our hands are much more pliable than any hard surface. Not to mention a foam roller cannot give feedback on what it is pressing against.
If I were to be truly honest, massage therapy is not as complicated as it appears to be. It boils down to just two basic techniques: broadening and lengthening. I literally cannot execute anything except for these two things. The purpose of broadening is to loosen fascia and allow for more glide between muscle fibers and different layers. Lengthening is reserved for shortened muscles, or those muscles which are in spasm. The trick to executing this requires anatomical knowledge, and knowing which direction the fibers run. Where does the muscle start, and where does it begin? If you put it all together, you have the basic theory behind massage therapy!
The only other question I have to ask myself throughout a session is, “Which tool do I need to whip out from my tool box, and how do I know when to use it?” My goal is to use palpation to figure out exactly what needs assistance. That is, using my sense of touch to determine what’s the “tissue issue” as well as what form of massage would best help me accomplish what needs to be done. A spasm, for instance, is not only a game of pressure but also time. It is pertinent that I monitor how the muscle responds to different pressure applications. While it is important to only work at a client’s specific level of comfort, a basic rule I follow is to add pressure until the muscle starts resisting. The golgi tendon organs recognize that more tension exists in the muscle, and will hopefully adjust accordingly. Essentially, I “trick” the system into releasing tension by adding a slightly greater amount of tension. However, GTO’s are responsible for monitoring muscle length as well as tension. If pressure alone does not relax the muscle, it is at this point we can experiment with stretching (lengthening).
If you’re well-versed in receiving massage therapy, you’ll notice that therapists employ many different ways of shaping their hands. So, how do I know whether to use my thumb, fingers, palm, fists, forearm, or elbow? Again, we have to go back to our original goal. Firstly, we consider the area we are working on. A forearm isn’t terribly pleasant when working on the sub-occipital region at the base of the skull; these muscles are quite tiny. Second, we must take into account the principle of surface area. If we want a greater amount of pressure applied, using a tool with smaller surface area will successfully accomplish this.
Upon completion of a session, client education is always a big priority. Rehabilitation requires knowledge of what the issue is so that we can not only fix the problem, but also prevent the same issue from returning. The treatment for myofacial adhesions will be significantly different from that of spasm or scar tissue. A muscle which has been overstretched will not receive the same treatment as a muscle which is chronically shortened. Knowing which of these conditions are present and in which specific areas will determine the course of rehabilitation and prevention.
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- Brittany B, Brittany.Forge.email@example.com