Monthly Archives: March 2012

Massage and Pain Vol. 2

Volume 2  of Massage and Pain

The second part of this series features a client I’ll call Joe.  Joe is an avid athlete- runner, cyclist, and swimmer. Recently he signed up and trained for his first triathalon. He completed this event the day before I saw him. This particular event was not Ironman in parameter. I think it featured a quarter mile swim, 10 miles of biking and a 5K (3.1 miles) run. Still, not Ironman by any means, but still a good test of endurance and perseverance.

People ask me all the time when is it better to get a massage after a hard work out or race: before, after or both. My personal feeling is that it depends on the person. A good massage before an event can help prepare the body by loosening up muscles and may help prevent injury because muscles may be functioning more efficiently. After an event, a massage can help ease the soreness. You don’t know what will work best for you until try both before and after a hard gym day or a race.

Joe’s Session After the Race: What I Can Do 

Joe came for his late morning session the day after his event. He said the race went well, that he reached his personal goals for the first time out. He was happy overall with the whole experience. We discussed what he wanted from the massage. He was sore in all the usual places one might expect from his activities (legs and back). He was looking to ease the soreness,  and speed his recovery by just feeling better.

As he talked I formulated an overall approach for the session which would include mostly lighter pressure than his usual sessions.  My intention was not try to “fix” anything that may seem really out of whack with deeper, specific work. There would be no unnecessary probing into unaffected areas.  Jostling and other Swedish massage techniques (see post entitled “Swedish Massage in a nutshell” for more info) sounded good to him, and to me.  So we proceeded.

Post – Race Care

During the session I asked him about what his post-race recovery and activities were. They included some light stretching, a hot shower, a good solid meal. He mentioned that he was lax in his hydration prior to, during and after the race. The session targeted the desired areas (especially the lower back and hips) with a lighter and quicker touch.

Also during the session I asked what he planned to do proactively to maybe head off the soreness commonly felt about 2 days after any arduous exercise. He mentioned easy walking, Ibuprofen if/when it was needed. More water.  I stressed to him the importance of the proactive part, especially the water. I also mentioned that sometimes a client can be sore after any massage, even if the pressure used was not that firm.

At the end of the session he said felt better overall, more relaxed. We parted ways until the next session.

Uh oh: Post Massage Feedback

Later that same afternoon I received a phone call from Joe. He sounded bad. He said that he hurt all over, his joints ached and he felt like he had the flu. Achey, feverish and just plain bad.  Well, CRAP! I said to myself.  I’m sorry I said to him. Throughout a peppering of questions to him about what he had done when he got home after the massage he mentioned that he had no water since that morning. He expected the aches and soreness but never anticipated this full-on “feel like I’ve been hit by a truck” feeling. ICK. His word.

Feeling horrible for him I explained that the additional aches may have  come from the massage.  Plus,  the lack of water may have concentrated the Ick such that its effects were magnified. I also mentioned that in rare cases that these symptoms can occur after a massage, regardless of the activity level of the client; that they were short-lived (24-48 hours) and can respond well to painkillers and increased hydration. He was understandably unimpressed and unappeased with the ‘might have’s  and ‘can have’s at that particular moment. I asked him what he usually did in situations of soreness. His particular remedy was Ibuprofen and a hot shower. I asked him to please drink more water and follow through on his usual routine.

The Next Session: Clarity

His next session came around, about 2 weeks later. I was wondering if he would show up for this session considering what he felt like after the last massage. He did show up for his next session (whew!) and after giving me (an affectionate) hard time about our last session’s consequences, he said that he did as I requested and he began to feel better later that night and into the next day. He was pretty much back to normal 24 hours later. Sigh of relief for all.

Lessons learned from this experience…while massage is great, it does sometimes have unpleasant repercussions. I try, with every client, to educate about these realities, situation by situation.

Lastly, I’m grateful that my clients have enough faith in me and my skills to keep coming back even after an unwelcome consequence of my services.

Massage and Pain Vol. 1

Volume 1 of Massage and Pain

This post and its contents are based mostly upon my own experiences giving and receiving massage.  I will use two different client experiences to illustrate some of these points. Client 2’s experiences can be found here.

Jane and Her Lower Back Pain

Client 1, I’ll call her Jane, came in one day complaining of lower back pain mostly triggered from bending over.  Putting shoes or socks on was a painful process.  Watching Jane walk into my office I was struck by how awkwardly she moved, and how she held herself. She couldn’t seem to stand up straight. During the intake process we formulated a plan of action for the session.  This included working the lower back into the hips and also included working the quads (quadriceps: muscles running down the front of the thigh) as there are connections to tightness here and lower back tension/pain.

The session progressed nicely.  She was able to withstand a fair amount of pressure and I was able to feel that some of the tighter muscles had relaxed and no longer caused her as much pain when touched. On a scale of 1 to 10 with 10 being the most painful, her pain went from a 7-8 to 2-3.

Post-Massage Discussions

After the massage I recommended that she be vigilant about the changes she felt in her body from the session.  I said there might be some soreness as the work was very specific.  In the event of soreness I explained that applying heat  and cold to the worked areas would be ideal to alleviate some of the aches.  Adding heat to an already inflamed area is not a good idea, which is why I recommend both hot and cold.

I also discussed with her what she normally did when she  had stiff or achey muscles. Did she take ibuprofen or Tylenol?  Ride out the pain? I advocated whatever worked for her but stressed the importance of  being proactive regarding her discomfort. Don’t wait so long so that when you do decide to do something about it your relief will take longer to achieve.

The Next Appointment and a Rude Awakening

Jane’s next session was 3 days later. She said she almost cancelled the appointment.  She said that hours after the massage she was in a lot of pain in the hip area especially, to the point that her knees almost buckled.  This pain went into the next day but by the 2nd day after the massage she felt much better. Her range of motion was back to normal. She was feeling slight twinges but no pain. She felt that her daughter’s friend’s 3 doses of 800mg of Ibuprofen was very helpful to her to get through the pain.

Hearing about a client in pain from something a massage therapist did during the session is something not he or she ever wishes to hear.  However, even if all precautions were considered and appropriate action was taken from the client’s feedback during the session, this situation still occurs.

DOMS: Post massage pain

I’ve read that the pain from a massage can be likened to what is called delayed onset muscle soreness (DOMS). Pain, aches,  and stiffness from doing a fair amount of infrequent exercise where the muscles are used in a way that is unusual.  The pain and stiffness from DOMS usually dissipates within 24-72 hours with good hydration and wet heat application. The same can be said for post-massage soreness.

The bigger issue, for me anyway, is whether the massage therapist is exposing the muscular issues/pain or inflicting muscular pain.  Exposing the pain is working through a series of techniques on an area that was already in distress, with the intention of easing the pain/stiffness with appropriate pressure and technique.  Inflicting the pain is exactly what it sounds like- using too much pressure or an inappropriate technique on an area that may or may not have been distressed.

Massage Limitations and Communication

When dealing with a specific issue like Jane’s I am very careful in explaining what I’m going to be working on and why.  I always say that if I’m using too much pressure or an area is just too sore to the touch to please tell me so I can adjust it or move on.  Communication is absolutely vital here. I cannot stress enough to people that the massage session is yours, you paid for it,  so you definitely have a say as to what goes on during it.  Some aches and pains are normal.  This may explain the soreness, or feeling sick.  Yes, sick.  With flu-like symptoms.  See more about this in this post.

After a Bad Massage Experience…

An option for those who may have had bad massage experiences before: tell your massage therapist about your past experiences.  Good massage therapists are more interested in making the massage work for you rather than going about the massage with their own results in mind.

Or, if you’re trying someone new ask specifically for a Swedish massage which is a more superficial, flowing and relaxing type of massage.

As for Jane, her next massage was a reworking of the affected areas and a new awareness of how a massage can affect the client.